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1861 NEW JERSEY ST - Building Permits
r (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 1861 NEW JERSEY ST Suite: Vicinity: Parcel Number: 13910303 Zoning: HURST GEOFF ISSUED BY: Status: ISSUED Applied: 07/13/2004 Issued: 07/13/2004 Applicant - PLANNING.& ZONING REMOVE NON -LOAD BEARING WALL BETWEEN LIVING: ROOM AND HALLWAY,: CONSTRUCT INTERIOR NON-BEARING,WALL Address: 1861 NEW JERSEY ST INSTALL NEW 36" DOOR WAX4 HEADER. ALL WORK TO COMPLY WITH 2001 CBC. ' Rear 0-0 Left'0=.0 "+ Right 0-o !/ �++' Phone: 714-751-2595 0-,; ,_Required: FEE SUMMARY ; COSTA MESA;.CA- Zip: 92626-2219 — - - Calc Valuation: Owner: HURST; GEOFF AND KIRA -' �' Claim Valuation: ," - Address NEW JERSEY ST SMIP Com:. / �X1861i �." Phone: 714-751-259S �'�-$0.00 -. COSTA MESA, CA Zip: 92626-2219 Contractor 'OWNER -BUILDER 71 ;Address: i i Phone:-` Zip: License: 000000 - ,1 'Arch' :' - 1 Eng: i - , ," : Address: ff " ,Address: 2�1p: - License: Phone. License: SCOPE•OFPERMIT PLANNING.& ZONING REMOVE NON -LOAD BEARING WALL BETWEEN LIVING: ROOM AND HALLWAY,: CONSTRUCT INTERIOR NON-BEARING,WALL TO MATCH . CONSTRUCTION, INSTALL NEW 36" DOOR WAX4 HEADER. ALL WORK TO COMPLY WITH 2001 CBC. ' Rear 0-0 Left'0=.0 "+ Right 0-o !/ �++' 1 'Arch' :' - 1 Eng: i - , ," : Address: ff " ,Address: 2�1p: - License: Phone. License: SETBACKS\ y`,, ' MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0-0 PARKING Existing SCOPE•OFPERMIT PLANNING.& ZONING REMOVE NON -LOAD BEARING WALL BETWEEN LIVING: ROOM AND HALLWAY,: CONSTRUCT INTERIOR NON-BEARING,WALL TO MATCH . CONSTRUCTION, INSTALL NEW 36" DOOR WAX4 HEADER. ALL WORK TO COMPLY WITH 2001 CBC. ' Rear 0-0 Left'0=.0 "+ Right 0-o !/ �++' 0-,; ,_Required: FEE SUMMARY ; Plan Check: " $25.19 — - - Calc Valuation: gl,000.go PerTlit:"' �;.SMIPRes: '' $38.75 �' Claim Valuation: ," $1,000.00 •+.• $0.50 SMIP Com:. $0.00 Other: �'�-$0.00 Inspection:. $0:00 Total: .: $64:44.-,�7_ 71 i SETBACKS\ y`,, ' MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0-0 PARKING Existing NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. 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 2"a 6 (moo) PLANNING.& ZONING .Rear 0-0 -Left 0.0 -- - Right 0-0 Rear 0-0 Left'0=.0 "+ Right 0-o !/ �++' 0-,; ,_Required: '0--_, •, Proposed: •'-0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. 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 2"a 6 (moo) WORKERS' COMPENSATION DECFARATION: I hereby affirm under penalty of perjury one of the following declarations: \ ❑ 1 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. ❑ 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 carder and policy number are: Carder: Policy Number: (This 0) or less.) section need not be completed if the permit is valued at one hundred dollars ($10 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' _f- compensation laws of California, and agree t t if I sh GI become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith corn 1y with mese provision wppli— canI SignaNra % t 3 O 1} FAILURE TO SECURE WORKERS' COMPENSAT N GUV \GE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL NALTIES D CML RNES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 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. Lia 1i Class a Contractors Signature: Date: 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 Cade). Lenders Name: Lenders Address: Signature: Data: 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!' _ t;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'Ncensed 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 sub the applicant to a civil penalty ofinotimore than five hundred dollars ($500).): folli 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 Cade: 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.). I am exempt under sec. Business and Professions Code for this reason: signature: Date: c 1 O (-Ir c k1wrier ID verified by drivers license. es ❑ No overs License No. — —'' Expires: o JT U Werification of Ownership by (type of document, Le. - property tax bill or dea: L�� DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 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 pernit 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 ❑ 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 toren 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 theappplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ElNo (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 ..................................................................................._....................._........................................................................................-..........................................................................................................._...................................-.................................... 5 Does or wlll the applicant or present or future building occupant require for the work which is the subject of this a plication a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control distract or agency? U Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ._........................... ............... .........-........................................................................................................... .................................................................................................................................................................................... ................. .................... 8 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? [I Yes [:1 No ....... ..........._............................................................................................................-..................................... ........... ..._........ ............................................................................................................................................................................................ 8 (II'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 EN jRV: I certify under penalty of perjury that I have read this application and state that the information given is cored. agree to comply wit I state cos d city ordinancgd relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described propeA r inspec io rpo s. I roe n o occupy or allow occupancy of any building authorized by this permit until final inspection. 7 I Si �natu .Of.y wner(s)_` Date And/Or Authorized Applicant Date CODE 1. INSPECTION TYPE QL1¢, 1NT3L3 CODE -E INSPECTIONTYPE RM 1NTMAL5S 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 206 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 © e W14 -LOAD BEdRrNE W&L CotlsreucT �rtceatut �otJ.-. Qseauacl wAu_ -rb .w►TC.,,-f (am) GattS[StucT�otl lNSrau.. New 3�b8bo wrrA 4x4- 4w.aaee, 4 LL Woar- lb CCnt�L.y ��M4 2001 G$C__ PoACN I — O BE OAOOM XIiCHEN OMINp 1.11 I R� nAA I O ,Al. . ( •I \ BE�ACOM ll, TM CFMpE xn.v„ _ -----L7 HiAV vio..e II OF I0 GILDING SAFETY I Y OF COSTA MESA --- —1)PROVED —� By specific an i be kept on this job at al 'L,les end it Is unlawlul to This set of pa,, make anv ch _ nd permissler. iron mensiOncfBuW ngf or zr,eranc :ossa MesThestampin SHALL NOT be held Ic pe mi; or to to an approval ispanandions Jonawtotawritten any City cl Cos,a Mesa Ordinance andlDrStatelaw. Oftheviolaanyprovi become nulland void it the r lithin Thesepla n ennit shall y a`�Ne 00rand UBC §303 (d) 180 days o� sswnc work s not m anted and (Z,(O k nem IQs OWNER -BUILDER , ,' , VERIFICATION A city or county, which is required to give notice pursuant to Section 19830, shall attach to such notice, and, as a condition precedent to issuing a building permit, require the completion and require the return of, an owner -builder verification. Attention Property Owner: An 'owner -builder' building permit has been applied for in your name and bearing your signature. Please complete and return this information in the envelope provided at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received. �. I personally plan to provide the major labor and materials for construction of the proposed property improvement. byes ❑ No I (have/kwee-oot) ho. ale signed an application for a building permit for the proposed work. 3. 1 have contracted with the following person (firm) to provide the proposed construction: Name Address City Phone ( ) Contractor's Lie. No. 4. 1 plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work: Name Address City Phone ( ) Contractor's Lie. No. 5. I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: Name Address Phone Type of Work I i IN2-a6 (REV. 9198) (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 1861 NEW JERSEY ST Suite No Vicinity: Parcel Nunmber: 13910303 Applicant: HURST, GEOFF Address: 1861 NEW JERSEY ST Owner: Address Contractor: Address: r( COSTA MESA, CA ' HURST, GEOFF AND KIRA 1861,NEW JERSEY ST - .COSTA MESA, CA. OWNER -BUILDER ELECTRICAL PERMIT Phone: 714-751-2595 - Zip: 92626-2219 status: ISSUED Applied: 10/12/2004 Issued: 10/12/2004 ISSUED BY: Phone: 714-751-2595 Zip: 92626-2219 Q Phone: ` Zip: License: 000000 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. 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) 7545626 2446-46 (6/00) SCOPE OF PERMIT i NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. 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) 7545626 2446-46 (6/00) SCOPE OF PERMIT REMOVE NON-LOAD,BEARING WALL BETWEEN LIVING ROOM AND HALLWAY, CONSTRUCT INTERIOR NON-BEARING WALL TO MATCH CONSTRUCTION, INSTALL•NEW 36" DOOR _ W/4X4 HEADER. ALL WORK, ' TO COMPLY WITH 2001 CBC: REF.:'B04-01251' ELECTRICAL TO INCLUDE: 20 LIGHT FIXTURES, 2 OUTLETS, AND 4 SWITCHES. ll ` l FEE SUMMARY ;Quantity, . _ ,' _ Quantity/ 5' ISSUE FEE $23.50 Temp.DistSyste_m % Lighting $0.00 Oi Temp service testft , - $0.00 �� Busway /100 1$0.00 '0' .'� • Res�a/c package) -. 50.00 Standing Section $0.00 0, 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 New Res (3+units) "$0.00 .,why 0 -. - Transformers up to 1 kva/kw $0.00 �'�� 0 Pool / Spa ",$0,00 0 ,. ` ` * .........up to 10 kva/kw ;.= '. , _ $0:00 i 0 Lighting Fixts 9 9 $22.010 `� - 20 '" w '-- ." ...............up to 50 kva/k $0.00- 0 i ,- Recept Quit - i� $220'- 2 - :.....:. .....„.0 to 100 kva/kw _ p _ ''$0.00 i 0"- Switches V�..� ,- - $4.40 ' `;,4 =..................over 100 kva/kw-,,. `, x'$0.00' /0 " Non Res Appl � � $0;00 �• . ��0 � - � .Low VOltage,EquipmenC -- � �, $0.00- ,0 / Res Appl $0.00 -ti. 0 -. ' "� _ ' Low Volt Wiring System / Ckt ; , .$0.00: Oi Service to 200a $0.00 - ,0_ _ Misc. Conduit , - ' .$0.00' j 6, ' Service to 1000a $0.00- - 0 ” - - Misc. Conductor ,. $0.00 Service over 1000a $0.00 0 - Circus.( gen or ride) $0.00 ' 0 Motors to 1 hp "$0.00 - 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 - 0 - , Christmas Tree Se i $0.00 0 Motors to 50hp $0.00 -0- - - FirevkrksStand '$0.00 0 Motors to 100hp $0.00 0 "_ - Other Electrical" Fee $0.00 Motors over 100hp $0.00 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. 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) 7545626 2446-46 (6/00) DECLARATIONS WORKERS' COMPENSATION DECLARATION:' r. - I hereby affirm under penalty of perjury one Of the following declarations: - ❑ 1 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. _ ❑ 1 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: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars ($100) or less.) I certify that in the performance of the wort 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 California, and ogrep that if I sh uld become subject to the workers' compensation provisions of Section 3700 of the Labor Coda, I shall forthwith comply with these provisi a-� ti A tuna .. - ini��.D, ate: 10 I IA I O L -t' W rZR . RE TO SECURE WORKERS' COMPENSATION RAGE IS UNLAWFUL AND SHALL SUBJECT AN EMP tHr-lO'CRIMINAL PENALTIESANDCIVIL FINES UP TO ONE HUNDRED THOUSAND DOUARE ($1 W,(DO), IN ADDITION TO THE COSTOF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3705OF THE LABOR CODE, INTEREST, ANDATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cade, and my license is in full force and effect. Lic. # Class # Contractors 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 Coda). 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 that hWor 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 penaftys&� oi'more than five hundred dollars ($500).): ❑ I, as owner o1 the property, or my eit mployees with wages as their sofa compensation, WILL DO THE WORK, and the structure Is not intended or offered tot 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. It, 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.). `ham exemptujc. Business and Professions Code for this reason: Si i81Ure:E (� Date l l O -Owner'ID'veiified by driver's license. s ❑ No sticense No. xpiree:, r Verification of Ownership by (type of document. i.e. -property tax hill or de 1 Z O 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, All 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 certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be tiled 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). ............................................................................................... ............................................ .................................................... ................................................................................................ .............................................................. I ......................... ... 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 Cade 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 ............................... ......................... ................... ...............................-........................................................................-...... ............................ ....................... ......................................................... ................ ..................................................... ............... 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication a ermit 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 pert 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 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 cly ordinances rijilating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for in Ion OSOS. gree not to o upy or allow occupancy of any building authorized by this permit until final inspection. S4ghatuhto O B:OI.LA9aLUw (s) Date'" And/Or Authorized Applicant''�u Date CODE t. INSPECTION TYPE - . PAN III LS CODEC INSPECTION TYPE 2AH INTITALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Root 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 ' FinalDemolition" "' 250 -' Final Building/Occupancy - M- (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 1861 NEW JERSEY ST Suite: Vicinity: Status: ISSUED Applied: 07/13/2004 Issued: 07/13/2004 Parcel Number: 13910303 Zoning: Applicant: HURST, GEOFF AND KIRA ISSUED Address: 1861 NEW JERSEY ST Phone: 714-751-2595 COSTA MESA;.CA Zip: 92626-2219 Owner: HURST, GEOFF AND KIRA Address ,1861 NEW JERSEY ST. Phone:' -714-751-2595. ' COSTA MESA, CA, "� - - Zip: 92626-2219 " Contractor: OWNER -BUILDER .'Address: Phone: - Zip: , License: • 000000 - Arch !'. Eng: 1, ., 'Address: - - - _ Address:- , Phone: .- - Phone: Zip: License: License: - SCOPE OF PERMIT . , WIDEN EXISTING 6'-0"X6'-8" IN THE DINNING ROOM TO 8'0"X6'-8" SLIDING DOOR AND ENCLOSE EXISTING 6-0"X3'-0" WINDOW IN THE FAMILY ROOM AND INSTALL A 8'-0"X6'-8"TEMPERED SLIDING DOOR'' " FEESUMMARY ' Plan Check: $72.31 Calc Valuation: $4,500.00 Permit: $111.25 - - Claim Valuation: - $4,500.00 SM IP Res: $0.50 SMIPCom: $0.00;,x;' Other: -',$0.00 Inspection: ;$0.00 - �! -Total: $184.06 - PLANNING & ZONING SETBACKS.`_A.i V� MAIN STRUCTURE,Front ' 0- 0 - " Rear 0- 0'�-, Left -0 0%% Right �0 '0, i ACCESSORY Font 0-0 Rear 0-0 Left 0-00- �' Right-0"/'`� PARKING Existing: 0 Required: 0- Proposed:' 0 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. 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 !44646 IWO) DECLARATIONS U WORKERS' COMPENSATION DECLARATION: ' I hereby alltrm 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 work 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 workers' compensatlon Insurance carder and policy number are: Carder: Policy Number: (This section need not be completed i/ the permit is valued at one hundred dollars ($100) or less.) ❑ 1 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 California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 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. x Class k Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby atfirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sac. 3097, Civil Code). Lender's 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 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 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 (Sac. 7044, Business and Professions Code: The contractors License Law dcAs not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) �i ense pursuant to the directors Li se Laws.). "I am axe n e e Business and Professions Code for this reason: sSlgiWtDre: /Oates _ Owner ID verified by driverslicense. s ❑ No Ddvers,U ;No. 'Expirs'%1 6 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 Cade). ❑ 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 certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ 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 o1 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). r building occupant need to file a registration form for acutely materials?........... V ................................................................................................. ......................... ..... 2 Does or will the applicant or present or future building p g y ❑ es ❑ 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 ❑ No ............................................................................................................................................................................................................................................................................................................................................................................................ 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this m e a plication a it for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Ll Yes 8 No (Section 65850.2 of the California Government Cade requires that the requested information be furnished on applications for non-residential building permits). .............................................................................................................................................................................-........................................................................................................................................................... 6 Will any pert 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 It 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 ........._.................................. _........................... ......................................................................................................................................................................... ............. _............................................ ............................. -............... I.............................. B (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 Materalsaytnd Emissions. `� Signature: 4 Date: CERTIFICATE OF COMPLIANCE AND AUTNORIA ON 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 stat laws and 1 ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described pro MyT6TTflspepti u o Cee not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature -O. egal, nods) (r --Dates - And/Or Authorized Applicant Date CODE #. INSPECTION TYPE p/�¢ MINI ITEM^ CODE INSPECTIONTYPE ggg• INTITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Root 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 I M #�' I I I / � I / • / ' 1. I �i 7 VERIFICATION A city or county, which is required to give notice pursuant to Section 19930, shall attach to such notice, and, as a condition precedent to issuing a building permit, require the completion and require the return of, an owner -builder verification. Attention Property Owner: An 'owner -builder' building permit has been applied for in your name and hearing your signature. Please complete and return this information in the envelope provided at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building, permit will be issued until this verification is received. /ppersonally plan to prov)dc t c major labor and materials for construction of the proposed roperty improvement. [Yes ❑ No �I (have/have not) kc—, J e- signed an application for a building permit for the proposed work. 3. 1 have contracted with the following person (firm) to provide the proposed construction: Name Address City Phone ( ) Contractor's Lic. No. 4. 1 plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work: Name Address City Phone ( ) Contractor's Lic. No. 5. 1 will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: Name Address Phone Type of Work 1M2248 (FEV 9/98) (UOTE.ct5T'pN 4- SI N.G LE L=XT 6030 3'y'+— c '. VX_ . 6O3o u<<o S 9/ S r) c.c0 6068 St_rOU2. t ad D 6,030 w r.roaw 45068 Sc-IQZCC 5 tJ/ ONS 0 , Qc`lw'cr✓ t2$S t o T vTi & L- i\1 E %%o of the 011," 0DCOspA MESA �gTY p1V 1SI ;j -TY 0 O 1 V 1z. 1) I A P � � Date to L pataUiv�sandho�&uwda9 MUST be kept oe� p. 'wnlroeDm Pi "Salons on sameM .,n t�ldto Pe 1..re and Sl la ^^ SPe�n"'"..- Y 01 w„- - vo..... 1an_�I t anY Gh vt ou11 da � of Rs 0 a Y P ebq, %on BC V91d1whtinlBO Y' LrXT Idpettoh�' aodadaeQet ` n g06$ +-f030 I . 3H 6 �7 66 7 — �6=1, Fac I STiNL, 3,S/„ 4- 1 X 1 1Py'1'1' OF COSTA Egk PANNING DIVI 606$ S PJECT TO BLDG. IEPIT. REG. � NOTE: ADDITIONS, DELETIONS, R CORRECTIONS SHALL BE APP) OVED BY THE PLANNING DIV. 3y— // (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.caa..us UILDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 1861 NEW JERSEY ST Suite: Vicinity: RESIDENCE AND ATTACHED GARAGE Parcel Number: 13910303 Zoning: Applicant: BURKE, MIKE Address: 1653 SUPERIOR AVE Phone: (949) 642-7222 COSTA MESA, CA Zip: 92627 Owner: CAMERON, ODIS T - Address 1861 NEW JERSEY ST Phone: ,COSTA MESA, CA Zip: 92626-2219 Contractor: LEE ROOFING OF COSTA MESA Address. 1653 SUPERIOR AVE - COSTA MESA, CA Zip: 92627 Arch : Address: Phone: (949)642-7222 License: 349686 Eng: Address: Status: ISSUED Applied: 01/07/2004 Issued: 01/07/2004 ISSUED BY: WA Phone: Phone: Zip: License: License: SCOPE OF PERMIT REROOF RESIDENCE AND ATTACHED GARAGE: T/O EXISTING ROCK ROOF, REPAIR/REPLACE SHTG AS NEEDED, 2 LAYERS 15# FELT, APPLY "30 -YEAR COMP SHINGLES." 34 SQUARES FEE SUMMARY Plan Check: $0.00 Calc Valuation: $6,995.00' Permit: $139.25 Claim Valuation: $6,995.00 SMIP Res: $0.70 SMIP Com: $0.00 Other: $0.00 Inspection: = $0.00 , Total: $139.95 PLANNING R ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 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 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. 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) 750.5626 i406i6 (6/00) 0070 WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of pedury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to sell -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. 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�`o%�pensetio Insurance artier d policy number are: Carrier: - �Tp Polity Number: �N Z Qeo z% (This section need not be complete Ar a permit s valued at one hundred dollars ($100) or less.) r ❑ 1 certify that in the performance of the wo r which this permit is Issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of C 'fora nd at if should become subject to the workers' compensation provisions of Section 3700 of the bor Code, I shall forthwith comply with these Applicant Signature: / Date: 7 �� WARNING: FAILURE TO SECURE W KER IMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBIECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TOONE HUNDRED THOUSAND DOLLARE($iOo000) ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37060E THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisio f Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Uc. » Class Al Contractors Signature: Date: CONSTRUCTION LENDINGAGENCY: ❑ 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). 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 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 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.). ❑ 1 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: ❑ 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 6, 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 certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ Nd (Section 25505 of the California Health and Safety Cade requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any chit time during a reported year a quantity of hazardous materials equal to or greater than a weight o1 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). _ ....r w'..... represent or future building Occupant need to file a registration form f_.r.ac ..............................................I....................................................................... ..................... .......... ..... 2 Does or III the applicant or pr g p g o acutely hazardous matenals7 ❑Ves ❑ 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 Cade been fully complied with? ❑ Yes ❑No ............................................................................_......................___............................................................................................................................................................................................................................................................................ 5 Does or WIII the applicant or present or future building occupant require for the work which is the subject of this a plication 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 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). _................................................................................................................................................................................................_..__..._.............................................................................................................................-..........I............................ 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required lot 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 .........................................................................................................int........._._.................................................................................................................................................._.........................._............................................................................. 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 ins Gtion purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. atur f Legal Owners) Date nd/or Authorized Applicant Date r CODE I NglienORTYPE Ij{$ITIALS CQ0E4 INSPECTION TYPE gpTE INTITIALS 1616Ixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 7 /y-�f - 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 PROJECT ADDRESS: 1861 NEW JERSEY ST (q13 UNIT: OWNER'S NAME: CAMERON ODIS T FLOOD; AE -37 ADDRESS: 1861 NEVI JERSEY COSTA MESA,CA 92626 ARCHIENGINEER: 546-1450 REG.NO.: ADDRESS: UNIT: PERMITTEE: PACIFIC COAST APPLIANCE (310)324-8476 ADDRESS: 139 W VICTORIA ST GARDENA CA 90248 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 70001 of Division 3 of the Business and Professions Code. and my license is in full force and effect. yl�Truc.: 06 ?11 STATE LIC ':36264".CleASl. I :XP ,09/95 /rvaR: ZC Signature: _•+�_— RKERS' COMPE SATIDN DECLARATION: I hereby affirof cons oself-insure or a certificate of Workers' Compensation Insurance. or a certified copy thereof (Sectio... '-OLICY NO.: NWC26825303 EXP. DATE: 08/01/95 COMPANY: GOLDEN EAGT E Cenified copy is hereby furnished. `, Candied copy is is fi d wi�the gity Building Divisio�wi�the gity Building Division ate: —`� Applicant: �^� I EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This section need not b complet, the permit is for one hundred($100)or less). I cenity that in the performance of the work for which this permit is issued. I shall not er any person in any manner s0 as to became subject to the WorkersCompensation Laws of California. Date: Signature: NOTICE: It. after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. 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 (Section 3097. Civ. C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt Iron the Contractors' State License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of 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/she is licensetl pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7D00) of Division 3 of the Business and Professions Code) or that he/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 (S500). I. as owner 01 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 (Section 7044, Business and Professional Code: The Contractors' State License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees. provided that such improvements are not intended at offered for sale. If, however the building or improvement is sold within one year of completion, the owner will have the burden of proving he/she did not build or improve for the purpose 01 sale). L 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 not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractil license pursuant to the Contractors' State License Law). I am aware that pmol of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: B. 8 P. C. for this reason: Date Owner: I do hereby eerily that I am aware of and understand the requirements of California Health and Safety Code Sections 25505, 25533, and 25534 and that I or any future building occupant will/will not (circle ane) need to comply with said state codes and the requirements for a permit for construction or modification from the Air Quality Management District. Residential construction applications are exempt from these provisions Date: Applicant', I hereby certify that I have read this application and state that the above information is correct. l agree to comply with all city and county ordinances and state laws relating to budding construction and hereto authorize representatives of this city to enter upon the above-mentioned or ly ti Li inspection purposes, - T —7— C� Signature: Driver's License or Social Security Revenue; Goldenrod—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERM NO: P 069036 PERMIT NO: P 069036 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: PERMIT TYPE: PLU PURPOSE; OTH JOB DESCRIPTION DISHWASHER C/O SQ FT; CLAIM VALUE: CALC—VALUE: GROUP OCC: R-1 / COMMENTS: ONLY FOR THE DISHWASHER C/O ' ##i6###*#####>Foe#+eiE#*#####ar#########-�t###x-N-##->E-x##>t-x•#�t#-x####�t ir-rE#x--it##�i##N#r x-#pr-a#*+e x*' Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR; FT IN FRNT: FT IN REAR; FT IN LEFT: FT IN RIGHT; FT IN LEFT: FT IN RGHT: FT IN PARKING REQ: PROV: PARCEL; 13910303 ZNE: REF NO: PLANNING NOTES> D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY BUILDING APPROVED BY ; DATE: DATE: APPLICATION ISSUED BY: DATE: )IT ## LEGALIZATION:N F E E -S U M M A R Y STRUCTURAL S-CMENT:N BLDG PMT PLUMBING ELECTRIC'.MECHANIC FIRE SMIP/RES GRADING PERMIT 7.00 25% SMIP/NON—RES PLAN ISSUE FEE 20.00 BUILDING—DIV—> PERMIT ISSUE PLAN -CHECK TOTAL PAID DUE TOTALS ---- > 7.00 20.00 0,00 27.00 27.00 ,00 REVENUE DIVISION TOTALS—> COLLECTED.; 27.00 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 27.00 I N D I V I D U A L .-F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST PLU 1 DISHWASHER 7,00 7,00 END OF FEES r 01 00168612-00168612 TILT GATE: 09/49/9,4 TIME: 10:32 27.00 CONSTRUCTION AND PLANNING APPROVALS Permit # - Date Inspector PG & SPA APPROVALS Permit # Date Inspector i t. 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 UFER Grnd. 57. APPROVAL TO COVER-GUNITE ') 7. Footings 58. Electrical Conduit-Undrgrnd. B. Foundation r 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 _11. Property Sewer Line & House Connection -- 62. Backwash & Receptor -Final . 12. Sewer Cap-' - -y 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 I - 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18, Rough Electrical -T Bar Ceiling 69. POOLISPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70, Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas 000 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank OGas OOil 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 PREY. 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. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy % 37. Final Factory Fireplace 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 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING n 48. FINAL PLANNING -J- 49'. Electric Release to Edison 50. Gas Release to Southern California Gas Co _!� - 51. CERTIFICATE OF OCCUPANCY No. Date '5710 12/1'2/85 Zone ,g, Accessory Building: r Par. king, Req./Provided I3800, Applicant to fill in all spaces except th6se within heavy border lines and sign all appropriate declarations. Dishwasher CITY OF'COSTA MESA CONSTRUCTION PERMIT 1 ?ERM T NO. TRACT NO. LOT NO. UNIT NO. I ; I certify'that ,in the pe[formance,of the work for which this permit is issued, I Backflow IrrigationSewer 'Jersey of the work for which this permit is issued (Section 3097 Civ. C.) (Section 3097 Lender's Name I , �- Construction Pole Sub. I Bathtubs Sewer Connection Project Address 1861 New St..- I Lavatories -i Auto -Wash I Cooking Unit ' shallnotemploy any person in any manner so as to become subject to the Clarifiers •. , Solar Collectors i , IP -Trap, Laundr Trays Y Y Applicant's Mailing Address' 5413 E. -La Palma—Anaheim .TYPEOFCONSTRUCTION NEW ADO ALTERATION, REPAIR -Itllt>_ Workers' Compensation, Laws of California. -❑ CONVERSION ❑ DEMOLISH ❑ OTHER. •, Date Owner's Name'Od ¢ & Edna Cirnerclh Phone 546-145 - � "DESCf�IPTIQN (h'aat A.P. Floor Drains, _ Mesa - cvcam in OF WORK/U$ OBLDG. Tngtall t S Main Buildi Address'1861 New J&Ley St.�OSta Sl.ri l.e. Yarin.]. residF ence ' SMIP, I $ ; Arch/Eng.'. JLicense No.: TYPE OF PERMIT. ' GRADING FOUNDATION STRUCTURAL r T Front UF 1 - ❑TENANT ❑ ELECTRICAL ❑PLUMBING MECHANICAL 13 - (ISSUANCE $ ENERGY P.C. I $ GRADING $ MICROFILM $ Address Name PRO HEATING & AIR • 779-686& ❑'OTHER i - A Rear ' MECHANICAL l $ I .L1� PLAN CHECK l25%, $ ' Contractor's Phone $ C Right 5413' E: La Pa1Rka—Anaheiin"92807 PROJECT DESCRIPTION SQ. FT. OCCUPArvCY' _ K Address (mai ling) "' - , CONSTRUCT( ON TYPE " VALUATION$ $ Left Cit License No. 35251 Y: ZONE GRADINGCU.YDS ACRES Ping. Ref. # LICENSED CONTRACTOR DECLARATION , _ hhereby affirm that I am licensed under provisions of,Charter 9 (commencing ' Remarks: P anning,N Otes: '%mLt section -.7000) of Division 3 of the Business and Professions Code, and my Il Cense -isin full fore effect. ' I a 469637 c �t °C Gicen Class `"—� License Date1.2 3 85' Signature .YsyK.lLi ` (il�lcfa/ i'PLUMBING -':. ' FEES 'ORKERS' COMPENSATION DECLARATION' ' ! Bar Sink-$hOWers O hereby affirm that I have a certificate of consent to siilf-insure or a certificate , ' t of Workers' Compensation Insurance or a certified copy thereof (Section '5710 12/1'2/85 Zone ,g, Accessory Building: r Par. king, Req./Provided I3800, Lab. C. - I --' - - - - --- --- -- Policy No. 54-06392 company Homeland r�'Iy Certified copy is hereby furnished. Id'Certif i��tl-��cff��..QP��,ts iletl with the'cityr� Id Date�LL.1/t3 Applicant'���it & AIR EXEMPTION'FROM WORKERS' COMPENSATION DECLARATION Dishwasher - Backflow Preventer __. _ Service Sink.- .. . - ' 'Dryers OGas ❑Electric .Automatic Washer ' I ; I certify'that ,in the pe[formance,of the work for which this permit is issued, I Backflow IrrigationSewer Cap of the work for which this permit is issued (Section 3097 Civ. C.) (Section 3097 Lender's Name I , �- Construction Pole Sub. I Bathtubs Sewer Connection - I Lavatories -i Auto -Wash I Cooking Unit ' shallnotemploy any person in any manner so as to become subject to the Clarifiers •. , Solar Collectors i , IP -Trap, Laundr Trays Y Y ' Dishwasher 7,QIJ TL ELECTRICAL FEE Transformer- El15-50KIN - '. 50+KW ;Meter 0up to 100'amps t Meter ❑over 100 amps' :Sub Panel I j Motors 00-1 HP 01'/1 -•8 1 !Inc. Solar 09-15 HP 016-15+ I I ' r (Thissection-need not be completed if the permit is for, one hundred ($100) or less). Dishwasher Solar Piping _> Jxtures _ .-.._, ._. __, -... Microwave... F ' Gas Service Outlets ' Yy Water Closet . i ' 'Dryers OGas ❑Electric - - Device Boxes Pole'Li ht ' g I ; I certify'that ,in the pe[formance,of the work for which this permit is issued, I i .l of the work for which this permit is issued (Section 3097 Civ. C.) (Section 3097 Lender's Name I , �- . I , - I Lavatories -i Auto -Wash I shallnotemploy any person in any manner so as to become subject to the Drinking Fountains Solar Tank I , IP -Trap, Laundr Trays Y Y ' 7') Fan' Workers' Compensation, Laws of California. Zoning Approved By Date Date '' Signature ure Floor Drains, Swimming Pool w/Spa I , Date ' F.A.U. 'NOTICE: If, after making this declaration, you should become subject to the • 'SUMMARY OF FEES BUILDING PERMIT $ i ' SMIP, I $ ; Workers' Compensation provisions of ,the Labor Code you must forthwith Floor SinksI UF 7,QIJ TL ELECTRICAL FEE Transformer- El15-50KIN - '. 50+KW ;Meter 0up to 100'amps t Meter ❑over 100 amps' :Sub Panel I j Motors 00-1 HP 01'/1 -•8 1 !Inc. Solar 09-15 HP 016-15+ I I ' r comply-wlth{'such' provisions or this' permit, shall -Ibe deemed revoked. '" CONSTRUCTION LENDING AGENCY ' 4 f_ .y ' _ I M1ereby affirm that there is a' is permit lending the performance '' -�- I. -rihe -.- �..� _ _ _> Jxtures _ .-.._, ._. __, -... Microwave... F ' Gas Service Outlets ' Yy Water Closet . i - - - - - Device Boxes Pole'Li ht ' g _ Interceptors, ` ' Water Heater p Outlets ; Range of the work for which this permit is issued (Section 3097 Civ. C.) (Section 3097 Lender's Name I , �- _ Lender's Address ' ' - ' OWNER BUILDER DECLARATION_ I hereby affirm that I am exempt from the ContractorN L¢ense Law for the Kitchen Sink - Water Service' y Switches t Sign - I Lavatories -i Auto -Wash I Garbage Disposal ; Standing Sections DEVELOPMENT SERVICES REQUIREMENTS: following reason (Section 7031.5 Business and Professional Code: Anycity or , IP -Trap, Laundr Trays Y Y ' Generator 00.5 KW ❑5-15 KW ,Trash Compactor " ) county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, a Is licensed the applicant for Such Permit - (o file a, signed statement. thab he/she is licensed pursuant to the provisions of Zoning Approved By > 'Dy any. y of not m as' owner 'eon; and who, do )loyees, provided I . If, however, the ion,ithe owner wi ve for the purpose I,!as. owner of the torstb construct t Contractor's Lic, ❑''1'am'exempt Date Signature .Drivers' License or,SS-r CMF -0865-46, rev. 10/84 s for the alleged exemption_ Any violation of Section ant for'lai permit subjects. the, applicant to a ci vi . n five hundred dollars ($500).; propertyior my�employees with wages as their sole he work, and the.structure is not intended or offered Business and Professional Code: The Contractor's' iply to an.owner of a property who builds or improves such work-himself/herself or through his or her own A such"improvements are not intended or offered for iilding or improvement is sold within one year of com- have'the burden of proving,he/she did not build orim- sale). i . roperty, am exclusively contracting with licensed con. project(Section 7044, Business and Professions Code: Se Law does not apply to an owner of property who . 'eon,and who contracts.for-such-projects-with a.con- ,nt to the•Contractor's License Law). I am aware that s Compensation insurance should be provided tome. action ; B. & P. C. for this reason Owner( have -read this application and state that theabove. agree to comply with all city and county ordinances to b., ding construction, and hereby authorize repre- to enterupo the above-mentioned (property for I White - Buildi n9; Canary - Applitanp Pink - Accounting; Reinspection Fee ' Duct - Structural Duct - Ventilating Exhaust System. ❑ - Multi Firepl/Fact. Bit. ICBO # Heating System & Ducting $15 Fee Hood or Type ❑ Canopy , Type I I, ❑ i Refrigeration System ' 00-100,000 BTU ❑ 100,000 BTU ale El System Repair/Alteration Fire Dampers ' Registers Reinspection Fee, •$15 nrotl - Assessor - ' Issue Fee Z O N G R. E M S i i Reinspection Fee $15 Issue Fee $ 3 FEES DEVELOPMENT SERVICES REQUIREMENTS: , Zoning Approved By Date Building Approved By Application Issued By AL—L- _'D1lte_JWJ11fj Date ' • 'SUMMARY OF FEES BUILDING PERMIT $ i ' SMIP, I $ ; PLAN CHECK $ 1 PERMIT PLUMBING $ ' PLAN CHECK 25%� $ ELECTRICAL $ PLAN CHECK 50%1 $ (ISSUANCE $ ENERGY P.C. I $ GRADING $ MICROFILM $ , ' ' ' MECHANICAL l $ I .L1� PLAN CHECK l25%, $ ' TOTAL FEE ; $ ' 7.00 ? - $ 3 _ •C.,ONSTRUCTION AND PLANNING • APPROVALS , Permit # -Date Inspector- ,• K & SPA - ^ APPROVALS ' Permit +-. -Date - Inspector '"!.'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 UFER Grnd. - - ' 57., APPROVAL TO COVER-GUNITE .1 7. Footings. 58. Electrical_Conduit-Undrgrnd. 8. Foundation - - 59. fias Pipe, 0 Undrgrnd., Test - 9. Water Pipe-Undrgrnd. - 60. Backwash Lines, P -Trap, 0 Undrgrnd. 10. Structural Floor System 61: APPROVALTO'DECK - 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater &Vent -Final ' 13. Roof Drains ' 64. Plumbing System - Final - 14. Rough Plumbing 65. Electrical-Final- lectrical-Final15. 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 000 23. Gas Pipe -Rough & Test 72. Underground Flush 24., Roof Framing - 73. Undergrnd. Storage Tank El Gas 0Oil 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. Final Heating & Air.Conditioning ✓? f�f 35. Final Gas Pipe -Test - - 36. Hood or Canopy 37. Final Factory Fireplace _- 38. Final Plumbing 39. Water Service -Final - 40. Gas Service -Final 41. Solar Domestic -Final L_' - -. _ - •-, -, , 42. Backflow Preventer tt': 43. Backflow Irrigation - 44. ,Landscape Irrigation System s 45. Sound Attenuation s` - 46. Handicap Regulations , 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to,Edison •- -- - -- - 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date 1 _ I` ' ose within heavy border Tines and sign all appropriate tleclaratlons. _ _ _ ADPlica nt to fill In all sDaus exwpt th _ FCOS PE IT NO. 'TRACTN LO NO. B D J 2)111 .IY13/n,' �.'.`., �L ;iRUC 0 HERMIT' '.. I , . i .. _.', �.5 .. a3 ApplScant'a Mailing Addreu I 1'�. .TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR Project Address? S ' = '❑ CONVERSION ❑ DEMOLISH OTHER CIS' Owner's Neme f�l5 V` M� � Phone � - 1 0 DESCRIPTION OF WORK - - - Address \' GW Sr- - _ r - ZONING REGULATIONS - -- Q PERMIT - — ` L r No .TYPE OF GRADING' FOUNDATION STRUCTURAL A. P. gp'�' ONE Arch/Eng: - I ense .l s ❑ TENANT ❑ ELECTRICA IL G ET a41�CHVAy�NN PLNG. REF. sk - 'B ILOING - ddress - - i - ' 1 O �s =.-,a ❑, OTHER A�n ♦P /c7A�wL��� •-\-. \1�.\:--SSUy"� TO BUILDING PROPERTY INE 2 REAR YARD (TO P/U Contr .- a Nam �- one �. - PROJECT DESCRIPTION SO: FT-' -�� OCCUPANCY �•^ -' I. Address(fnailing) IJ lr-� ' ICON CONSTRUCTION TYPE ) VALUATION$ "320 •LEFTSIDEYARD RIGHT SIDE YARD .Q �Q y ' i. , No.. r ZONA GRADING CU. YDS. 'ACRES/ PKG. SPACE REO. PROVIDED - - - LICENSED CONTRACTOR DECLARATION F,License "' .' Remarks: 3 STREET WIDTH PARK FEE $ (,hereby affirm that -I am Iicensetl under.provislons of Charter 9�(comn ancing `I {•- AL with 7000) of Division ,3�af the'Buslness and.Professions Code, and llcense'Is In full f0"�pp effect ' ` ;' "' _ ' � '^• _ 'SPECIAL CONDITIONS: my and y' - • ('"- t Ucense - U - �% i �4ba-- ]s0 g� - Cf��aazz _ y r ..,.�niA PLUMBING `�T� -Cap t„'YORK 5• GOMPENSATION'DECLA RATION i , gar Sink Sewer I - ELECTRICAL -'�"I hereby affirm that Lhave a. certificato of, consent to salt s re,or a cartNlcatey +,. �. of Workers' Compensation `Insurance,, oreA carti0ed1c py th§reof (Section!'• -::..-. Backflow Preventer--• ' r - Sawer'ConneMion'"'. -' - - .. x .' __�Z ,Automatic Washer, _ _ _ -Meter over_100,amps'. - 3800, Lab. C.): ;w 1 �'� T ! �� Backflow Irrigation SolarCollectors -' •', -' 1 7 -: ,y ' Construction Pole,r Sub Panell Policy No. Company rtifietl DY'I hereby furnished. iY�' Bathtubs '% ri-, _.... '`: ra r r SOIar Piping �, Z ": Cooking Unit I� 'Sub Pole '- r - r r 1 Certif 0 s if d with the city. Buildin D1' Date \•• Applicant• i Clarifiers `r Solar Tank - '* v t✓ Dishwasher :yMotors❑0-t HP C]1X$ - _ EXEMPT N,F OM WORKERS' COMPE NSATI CLARATION ,r' -not be if the for - _ _ ,, Oryers'❑Gas;❑Electric -• ;Ina Solar❑9-15 HP❑16-15+- ' Dishwasher ,, Swimming Pool.w/Spa' i (This sect on need completetl per s one huntl retl ($100) or, / •• less). = '.1 - _3 .. - _ , I certify that lathe performance of work for which this perm It is issued 9w Drinking Fountains - L Unna l �; 1 is, Fan 'Microwave . Sha not employ any person I - y manner so az,to become subject. to the, Workers' Compensatlon•La 'California. • ” f ,.,�•' .:i. _u . -- r I F.A.U. Pule Light J " ' 1 I '�• - �''. Floor Drams a -"s Water Cl Oset' 'y 6.0 Date Signature - • NOTICE: If; after irig this declaration, you sfiouldrbeeome subject to.the- ^ Floor Sinks - - - Water Heater _ _ Fixtures Range Workers' Com mtlon provisions of the Labor, Code, you must forthwith comply wl such provisions!, or this permit! shall be deemed revoked. " Gas Service- Outlets; Water Service- +� Device Boxes r '-;,,_ `-Sign. CONST CTION LENDING AGENCY - I 1 I her affirm that there Is a,construc lom lending agency for thelperformance Interceptors ' } '• q : �, `1 Outlets Standing Sections of the (work for which this; per I is'iss (Sectlon -3087 Civ. C) Lender's Name' - - r �' - .•, -' - Switches ' Lender's. Address' OWNER BUILDER OEC LA RAT( N - - - '- Kitchen Sink - ,49: Trash Compactor 'Garbo a DI 9 , Sposal ._ ''� Lavatories - OfJ I hereby;affirm that 1 am exempt. from the Contractor's. License Law for the • Generator, ❑0-5 KW ❑5-15'KW following reason:,(Section`7031.5 Business and Professional Code: Any city or P -Trap, '� .. ' i w.' ,z ','county -which req?as a permit to construct, alter, Improve, demolish -or re air any structure, prior to its Issuance, 'also requires the applicant for su mit Roof; Drains - 4 Transformer'❑15-50 KW o Tile a signed statement that he/she is licensed pursuant to the vi z,ons oT .s Contractor's License Law,(Cha ter 9 (commencingwith on J000 of i _ - - - r - - 1 ❑5Q+ KWv+- '' 1 Reinspection Fee ' , - - , > , d`�,vision'3'- of, the Business and Cotle) or.t a/she is exempt i ,:^eerefrom and the' basis for the alleged axe m ptlon.- Section , Showers ', L '" ,• Reinspection:Fee ,$15v - . Meter ❑up,to 100 amps ' - Issue Fso' $ 3, 1 ,violation'of 7031.5 by_iany applicant for'.a:permiL'subjec a applicant to' a. civil penalty of not more than five hundred dollars 0). .; ,=• _ Serwce Slnk ' - j' " r 1 Issue Fee $ 3' ! ✓ Zoning Appraved'By01 Date -f ' LJ I,'as ,owner of thelproperty or'my ployees with wages -as their sole the MECHANICAL •+• ? + 1 vs' ! 3 ' compensation; will:do work; and .structure is not Intended or offered for sale'(Sectaon 7044, Business, 'Professional-Cotle: ThaConfractor's i _: /_ Ut -7 f APp�igtion Approved By"' stat License Law does not apply to wner of a property'.who builds or Improves i. thereon,lan0 tloeslsuc Boiler ' '� c I j Refrigeration System l i c . -- Application Issued ey,. l who ork himself/herself or through his or her own , employees, provided tha ch improvements are not intended or offered for : sale. If however, the Iding Improvement Is i - -i Duct' Under'Ground i ) ❑0.100,000 BTU ❑100,00 BTU f' / 7 _ _Date , -y }; { or Sold Within one.yearof com- pletion, the owner' I have the burden of proving he/she did not build or Im- I (grove for the ose ofsale)'. t ' 1 f' ( r' q�' ;SUMMARY FEES- `arl,' , Duct -Structural } System Repair/Alteration j F v'•• __ � ' I U I, aT o rot the I ' f q.;.BUILDING PERMIT .$ , SMTP, property, am exclusively contracting :with'licensetl CO n- t tractor conscrucLthelproject (Section,7,044, Business and.profes5ions.COde: !, utt ;.Ventilating _ _ _ _ ., - n_.�� _ I - r / 1' - f pLAN CHECK; �,'s '$ t " s"= PERMIT_.. . The ntractor's License Law does not apply to an owner of property who , dz or improves thereon, and who contracts for such projects with acon- Exhaust System ❑ Multiple ❑; I� } " 1""` - ISSUANCE' n'r�PLUMBING � t frac (a) license pursuanttothe Contractor's License Law). j I ❑ liam exempt unifier Section ' B, & P. C. for this reason - j !r ,�I,r y$, 1440 ,.>PL:AN CHECK r �$ - 'T1•�%O - GRADING' i 7$ , ' - Firepl/Fact. BIt..IC80 # i . ; :„ , ; _ 1 4 $. tr3.. Q- - Date ,• owner• t I - !.Iheraby certify t ova res .his -application and state. that [ e above--- Information Is co act. ogre to omply with all city, antl din Heating System & Ducting ' ` ❑0.100,000BTU'❑100,000 BT - -- -i : - - - - - •- - - i ' j .ELECTRICAL• $ ,,} r K '" MICROFILM '1 $- i LAN CHECK' t P r $ �.3o "' ^ ! C "'"' and'state laws re n to b i di county o aces nstruction, 'antl hereby epre- , I y p -p TOTAL FEE: MECHANICAL $ } sentatives of s ,to a autho ze on the above-mentioned r p per for Hood or T e I ❑ I Type 1 1 Reinspection Fee: ' - $15,' _^ . LESS -•{ ` 'PLAN CHECK: $'— �^ Inspection P Pq ! ! ( ,� �Slgna'tur< 1 Data Carso Type I ❑ e. 1 , �tv - ADVANCED PC $ ii" 'Kars• Licenu or 55 1 ( 3 Registers i r Issue Fee 3" '" "FINAL FEE' 1 1$ ,y' i• -'S5-46 rev. 12/82- Pink - Accounting; Goldenrod - Assessor i" �, ., :. w, 0 ;•;.:. ,-Y _ i ..•��� 1 _ vi T V� ION AND.PLANNIIIW: 2 PO - ..SPA Ir, , .: 1 � � PPFIOVALS Permif. L Permit. #' 4 . Date1, Inspector �'ctor Iti TemporarylEtectncal Service or.P, '52- Pool WE ui .1t N -21 Soil Pipe-Undi 2., F5 Steel Reinfoi8erAent IA- I - �W-4d -31 Electrical Conduit drtilil' ' ' - 1 - !v-Uiiqrgrnd., -, -54.1. r Forms "'-' r _-0 _- ��ectriiaal Coricluit-Uncirgrn & 2,1 :!55-' Eiectria�136ncl�ng': 11e' 5St Rough Olunbing & Pressure -Test St 6 LIFER Gr d., i i 3, '- 6ovgR -GUN]Tt� il�lectrical 7. 'Fdot�Ong! 'Z 5e. Electrics 1. ectrical,Coriduit 4 Pq 849,uh6aiio' n1, 59. Gas P'peEl Wilrgrincl'Test �* 9. -Orfdrg :Water Pipe rnd. F1 kwash L 66. Bac Lines, PJrap 'D Undrgrnd /YOM.. n�)� 10. �t'uct: " � I h6cr'�yst�rr, St VIA .1 , 3 , 'V� 1:7 ::61. APPR6VAL TO -DECK qra 3! 11. Property Sewer LinIrle House Connection - 62 Backv�ash'-& Re' r-Final'J i 12. Sewer Cap 63. Heater, & Vent -Final I En ' in's 13. 'Roof'bratem 'q4. Pfumbing.Sys Final' . l.�. 14. Rough Pluriibdng-1 Ae=" 0 '-65. 6ectriral-Final-� 15'.4Rough-r:lectrical-Conduit-1--F--�o-r 6 6-SoIai,,SY5�tem-Final I .1 fii 6j gh.Ele(�6ic Wir'irig.',, i K il I! 67't'Fencin�T&,Ac_c I Approv _�,s '17. RougM1 Wiring!Signf • Ff 7 _6RTLASTERINd APPROVED F 8. P "OV'D 6 :A 7 qctr call;VB C�iiingj j' I 1 �'JRo I-rEI i' ar, ug r POOL/SPA SYSTEMS.FINAL tl riditioning 19:;!R;�gt^i.ng &:AirCo' FIRE DEPT. REQUIREMENT; ,HE�ati r� lace, 20. ?rgu�hAFa,',F�rF la APPROVALS! i Permit, iucts,�n S_ruciu_ 70.1 1 4 Underground Hydro' r 22,,bu ', Venfllzilin6 cts ji 1 '71.: Product Piping . ng P Gas 0 Oil I t rrh, `Gas10ipp-6'ugh,� �est h 72.1 Uncl& round Flus rt'. .1 ", 1 9 V'24JR�' liz�fl I of Framing, I l'i I I I Undergrn,d. Storage Tank b�das,.E]'&I, Ila hl�, je�j �7�.t 25:`IRoc�f Sheathing -'A 74. Over6ead Hydr' 0 i ir i _!�?6. T -Bar Ceiling (Structural Mono 't` Dr' y Chemical :Foa , j75., �,2T '1� me an� Wtfs' $r_T_"j Fr -Y W'i"YG 16. Dry Standpipe y : 28. ?Cathin§ 8i Sidling -1-.1 44,649 J,A -Jy 1 1 77.. FIXED SYSTEM FINA . L 9. ?1n,suation P ;78.', FIRE PR,EV. FINAL Na 11 iling,:. 'Notes: r W .�O _y a 531.Pla;t6rBrown Coat 'iE'Lecfrical 'Power Meter Final ji I 33,' inal Electric f 34: Final Heating &fAir Concliiion'in 35. Final Gasjpipe est! 36. Hood or Fanol3y-� 37. Final Factory 38. Final Plumbing 0! Aeei EP -Z 643 r 7 Q' ealck, o,, 39. Water t; rffi_1 lqI na A 10. TA -a- I #?Pj e V, rsil 0-T-2 L70 lipl� 40. Gas Service -Final J f -1 1 t 0: - Ae I, 41. Solar bo"m"bstic-Final 1 04- 4 -fen - 4- 4- -3 -`Flo Qr'Eirli J;1A 42. Backf I'-` Pr'e ver�terr UP'S1 11 1-00ior V, C� 41 Backf I'0'W! lrrigaticin} 't. +A y I)s• PF h io SPI n W" rA al/ 44. LandscapeIR • I "rJ 'r -C q,q Pas akiis fer nc re] P�11H 45. Sound Attenuation t" 1 1 i 00 &a 46. Handicap Regula'tion's) r 517, 14 OC k .1 1 -1 47. FINAL STRUCTURE BUILDING III! 1 111;" of 0 0; P 48. Special Require 49. Electric Rielease'to tdison! ckj m npv e eto South�rpC�Iifo�,ia Ga's Co50. Gas Rehas r) I I I , 51. CERTIFICATE CIF;OCCUPANCY 014-0- 0. :2#1 No Date L 1 -74 -S -i jen6r., XP INSULATION CERTIFICATION This is to certify that, in conformance with the current energy regulations (California Adminis- trative Code, rife 25, State of California*) and approved plans, insulation has been installed in the building located at: .. CityI owner Street No. (If Ann") Sftd tel NWAW Trot No. DESCRIPTION OF INSTALLATION ROOFS Type of AlateriaL Manufacturer_ Thickness -__ gin Value'* -- EXTERIOR WALLS Type of Materiel iberslass Manufacturer J•1'4.Thickness-1-1.Z$t"Walue*' 11 _ (Of Teale Nave) - CEILINGS . , j/ Ie' BAITS: 7L Type of Material Fin. a v 1AS s Manufacturer s Vr Thicknesses R Value**._s,M (Of Trade Naw) Sq. Ft Covered BLOWN: Type of Material Manufacturer Thickness No. Bags _ (Of TmA Naw) Wt/Bag Sq. Ft Covered R Value**_ FLOORS Type of Material Manufacturer Thickness R Value** (or Trade Naw) SLA! ON GRADE . Type of Material Manufacturer Thickness R Value**_ roe Teach Naw) Width of Insulation Inches FOUNDATION WALLS (N required) Type of Material Manufacturer Thickness --R Value**— .! ,. (of Trade New) REMARKS (if .desirod) General Contractor (Builder) I)A V WEL S A Brae -d,- S n K) License Numbered L.;? 9 2 By V is_ Title G Date i�3 Sub -Contractor (insulation Applicator)__ (Imtaem, M ee ry. Eft.) (state "UNE" If raw ee Seasonal CwtbatW By Title owner Date (•Callfernla Adwlnhtratira Cd., Ers"Y Insulation Standard., deelann "Caw►Ilona. upon completion of the installation of Inrvlatie t, a mrd cwtifYlna Not the Insulation has been Installed in mrdoresanm with Iha reaulnwents of these rwoulations shall be completed and eeecuted by the N.Oation appumts, and by the bolder. This Insulation mmpuonce card .hell be peeled at a mnsplcueus Ixation wlMln the dwolins.-I ("A V.I. b The sono.. of w ml.hnm of a wtadal a bolldin s mmoamt to the pa.ege of has. The roldanm Val" (E) of mass-ty" halation. shall net Indude MY Vales for reNedlyl fadM•) EXCERPT frees Sac. I9375 of Iba H"Ilh and folly Cado of she State of California. "Ha catiemte of armpanry ar similar sertiNmnan tbt a rawly sen. struned hotel, wast, aparbnonf hauu, hal a other residential dwolllna 1, habitable rhalt be bested by Inch a MnUlm dam cant untau the .frud.. of least setlseee Iha wldmum arrey Inmlaflon standards established pumanf h4b11 shapbI 13652 03fX MESA BUILDING -SAFETY DEPARTMENT P. O. BOX 917 COSTA MESA. CALIFORNIA For Applicant to Fill In Completely TYPE OR PRINT I,?6/ /Vow )eRse)� COSTA MESA. CALIFORNIA ' F : RECEIVED SAN 17 1961 FINANCE DEPT. rlTy nF COS1A MESA APPLICATION FOR PERMIT BUILDING For Office Use Only ? RECEIPT NO. /PERMIT NO. OWNER e I Z. /✓.I / [i I 3 L/ MAIL I fi� / ^/^� \n Q e ADDRESS I o II I ♦ J QG J RUC BY I DATE RECEIV!D/I DATE ISSUED 1//J- 7 CITY If OJiA /1'l eJ �' NOTEL. BUILDING ADDRESS (/ ARCHITECT TEL. COSTA MESA. CA FORNIA OR ENGINEER NO. ADDRESS FIRE ZONE TYPE GROUP CONTRACTOR 0 WIVSA - V 1 tip x APPROVED BY DATE ZONING ADDRESS ZO NO. OF OF NEW CITY PLANBy� I BUI BUILDING STATE TEL. LEGAL LIG NO. NO. DESCRIPTION SIZE NO. OF 5LOO6. OF LOT Now ON LOT A. P. NO. USE OF YARDS EVES ' EXISTING BLDG. APPROVED ALLOWED SETBACK LINE FROM (CENTER LINE 5T.) CENTER OF STREET REAR YARD FRONT --T---= IN. 'SIDE YARD I LEFT I RIGHT R. SIDE FT. IN. DESCRIPTION OF WORK L. SIDE - IN. NEW I L_IALTERATION I ADDITION I REAR —FT'— IN. REPAIR I I MOVING I DEMOLISH I APPROVED DATE BUILDING NO. OF SIZE ROOMS STORIES EXTERIOR WALL ROOF COVERING COVERING USE OF I BUILDING AND WORK TO BE PERFORMED 6 - e/V I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IE FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONE CION. VALUATION SIGNATURE OF PERMIT FEE S,_ PERMITTE ' $ / PLAN CHECK $ AUTHORIZED AGENT TOTAL FEE JOB ADDRESS lb(31 New Jersev Ave. BUILDING PERMIT NO. 13652 GENERAL CONTRACTOR Owner-Bldr. VALUE $126.00 A.P. No. LOT 103 TRACT 36h8 FIRE ZONE DESCRIPTION OF WORK Eilock Eall INSPECTIONS DATE I GROUP TYPE ZONE RI Underground Soil U.G. Water SUBCONTRACTOR _ PERMITS ISSUED Underground Gas --- DATE NUMBER Overhead Water and Gas Rough Heating Rough Plumbing Miscellaneous Prop. Swr. ine House Con. St. Swr. Sprinkling System Heating, Final Plumbing Fixtures Final Gas Test Construction Pole Underground Power Rough Wiring Trenches Forms Steel Floor System Steel Reinforce Chimney Re -Rod Bond Beam Sheathing Frame and Flashing _ Lathing, In Out Plaster, brown coat Plumbing Fixtures, Final Electric Fixtures, Final Building, Final OCCUPANCY Form 210-5M-11.59 S -B P PJ C'---2 Z 13652 38267 P''" 1 A.50 =DR 0-74-..00 376i' **** COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 APPLICATION FOR BUILDING PERMIT For Applicant to Fill in Compl telt' BUILDING ✓ RE I V BY D{1=E ROE=FIVE DpT` ISSUE !TL / I/T/' `/ P` ADDRESS `` PERS J� OWNER A.P. NO. MAIL - l BUILDING ADDRESS (/O_ / ADDRESS ,Z W f�f spy Q 3(O r , U CITYNOL ? ^ACT lOT BLOCK Z Z Q CONSTRUCTION NEW A AREPAIR O N LENDER V /� 1 I d m J BRANCH / J N OWNER m J ADDRESS VALUE J Q ARCHITECT r EL �-/y $ �� U OR ENGINEER Q FIRE W CL ADDRESS ZONE VPE GROU d W APPROVE J O CONTRACTOR BY DATE MZ JCC ADDRESS W �= TEL. ZON NO. OF USE OF NEWjt' CE4J FLANSZ BUILDING Z_H CITY NO. O �U w0 STATE{/ CITY LIC. NO. �/ LIC. NO ----3C)6 YARDS APPROVED YARDS APPROVED BUILDING ACCESSORY BUILDING j O (FROM C/L STREET) SIZE (% NO. OF SLOGS. ` OF LOT `.ice NOW ON LOT FRONT FT. /+-7TFT. FT. USE OF J. EXISTING BLDG. R. SIDE FT. IST. I— SIZE OF NO. OF 1 j Z NEW BLDG. ROOMS STORIES L. SIDE FT. FT. EXTERIOR WALL ROOF - _ COVERING COVERING REAR FT. LO FT. J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & 1 a MAIN SLOGS. ACCESS. SLOGS. Q VAR. # DATE O X1 C.U.P.* APPROVED F APPROVED t�J lb _7 LO J Z 0 I hereby acknowledge that I have read this application and state STATE that the above information is correct and agree to comply with it all laws regulating building construction, and I shall not employ F- any person in violation of the workman's compensation laws of (Al the State of California. ra ZSO. I hereby certify that I am properly licensed as a contractor under FT. TAX o �IS THE AMOUNT SHOWN UNDER VALUATION IS FOR the State of California Business and Professions Code, Divisicn 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 and Professions Cn/r/e1, Division Chapter 9. m ��11 O� PERMIT FEE $ /� Signature of ,r Permittee L�(1b /1 /t- / $ �7 PLAN CHECK $ I/�V m E ' i Authorized Agent LL TOTAL FEE $ .j OWNER CAMERON, O.T. DATE 4-10-74 `.JOB ADDRESS New Jersey St. BUILDING PERMIT N0. 3 2 7 \�`G EN ERAL CONTRACTOR c erran DESCRIPTION of WORK A Patio Cover to Res. AP No. 139-103-03 LOT TRACT FIRE ZONE VALUE $ 1,200.00 INSPECTIONS Si nature Date TYPE IV GROUP J ZONE RI SOIL SUBCONTRACTOR PERMITS ISSUED GAS Date I Number I Signature WATER Plumbin ROUGH PLUMBING PROP. SWR. LINE D HOUSE CON. E] SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND POWER ROUGH WIRING Heating and Vent. TRENCHES 0 FORMS [:] STEEL REINF. FLOOR SYSTEM BOND BEAM STEEL REINFORCE SHEATHING FRAME AND FLASHING LATHING — IN E OUT PLASTER, BROWN COAT STRUCTURAL, FINAL Electric HEATING, VENT., REFRIG. AND A.C., FINAL PLUMBING, FINAL AND GAS TEST ELECTRIC, FINAL BUILDING. FINAL ,tCC&STA MESA BUILDING -SAFETY DEPARTMENT I#, P. O. BOX 917 COSTA MESA. CALIFORNIA For Applicant to Fill In Completely .TYPE OR PRINT ADDRESS 1861 New Jersey St. COSTA MESA. CALIFORNIA �RECEINQ FtNA�1c� C�+FO� �fi� APPLICP T�OtJ PERMIT�A BUILDING For Office Use Only York Avenue Pro Inc REDEIFT NO. erties E. 17th St. RECEIV BY -%6° DATE REC ED DATE I86UED „11 1 196Q Mesa No.Li81159 FRCHITECT BUILDING ADDRESS Carlson & TEL. COSTA MESA. CALIFORNIA NO.arden GroveFIRE ZONE TYPE Y GROUP CONTRACTOR R_ C P^ Inc* APPROVED BY DATE 'Dike I ADDRESS 419 E. 17th St. ZONING ,I,c CITY Costa R4esa ZONE I NO. OF PLANE �/I 1fII SEE OF N BUILDINGSTA P E LIC. NO. 1672 No: Li. 8-1159 LEGAL DE6CRIPTION Lot, 103, Tr, 3648 SIZE NO. OP B"'rione OF LOT 70 X NDw ON LOT A. P. NO. USE OF EXISTING BLDG none YARDS APPROVED EVES ALLOWED SETBACK LINE FROM O 1 2 1 (=NTER LINE ST.) CENTER OP STREET REAR YARD FRONT FT. IN. 81 I I 151 / SIDE YARD LEFT RIGHT R. SIDE T. IN. DESCRIPTION OF WORK L. SIDE FT. IN. NEW X ALTERATION I II ADDITION REAR FT. IN.//, REPAIR I I MOVING I DEMOLISH APPROVED GATE ING NO. OF - BOOMS STORIES EXTERROOF FXT IING OR WALL (COVERING Rock C m & BUILDING AND WORK TO BE PERFORMED Single family residence with ached gara;e. Plan 20C LAUTHORIZEDAGE'NT EBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPUA TION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE TATE THAT 7X8 ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. ITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION ING CONSTRUCTION.. URE OF �-/J/ ,s PERMIT FEE S 36. PLAN CHECK 8 18. TTE 16,101. RIZED AGENT ake & Col grove, Inc. 54• TOTAL FEE s 0 11/26/83 STATEMENT SELL ROOFING CO. 17072 Rosebud Dr. Yorba Linda, CA 92686 (213)860-1757 Cameron 1861 New Jersey Costa Mesa UNLESBS OTHERWISE AGREED, THE PRICE SMALL BECOME DUB AND PAYABLE UPON COMPLETION Of WORK. 3 layers --15 lb. (1 nailed, 2 mopped with hot asphalt with 25 pounds per layer) Flood coat of 50 lbs. asphalt and all new white rock Ron Sell