HomeMy WebLinkAbout3210 NEW YORK AVE - Building PermitsL �
(714) 754-5273 • Fex (714) 754-4856 • www.ci.costa-mesa.c�ILDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
Job nddress: 3210 NEW YORK AV
!
Suile:
Vicinity: RESIDENCE AND ATTACHED GARAGE
Primary Occ. R-3 Dwellings/ Cong Res <'10 Type of Construction: V-N
Parcel Number: 13910228 Zoning:
Applicant: WOLSKY, BRIAN *
Address: P O BOX 771 �
HUNTINGTON BEACH, CA
Owner. COHEN, PAULINE'M' �
Phone: 714-847-9332 ISSUED BY:
. Zip: 92647
Status: ISSUED
Applied: 11/14/2006
Issued: 11/14l2006
Address 3210 NEW Y,ORK-AVE ,: � .
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/,�� j� � A . � , Phone: . . - �
COSTA�MESA, CA � '� � � Zip: 92626 �
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Coniractoc., � ,T.OM'BYER�ROOFING_ �. " � � �
Addressi '%P O BOX 771 � � � � - - - ` ' � � ' �
� �' � �� / � /i� ; ' Phone: 714-847-9332 �
i
�, �f `-.HUNTINGTON:BEACH, CA ` �
` Zip: 92647,i "% License: 575002 . -
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Address: " � /,�%� �' � Address: � �
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' - '� �'��" ' 7 �" � � - SCOPE OF PERMIT �
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-. REROOF RESIDENCE AND ATTACHED GARAGE: T/O EXISTING COMP ROOF, REPAIR/REPLACE SHTG AS NEEDED, 2 LAYERS 15# FELT,
APPLY "40-YEAR COMP�SHWGLES.'%PITCH 3:12 25 SQUARES �
, , " . ,. � � � �� j _ ' -
�� Plan Check� - $0.00
Permit: $15325
SMIP.Res: ' � $0.79
SMIPCom: ,'� $0.00
^ ' �, ', Other:. .`. $0.00
1' Inspection:,",}�; $0.00
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, - ,: -, -, FEE SUMMARY
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�,� Total: $154.04 ;
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MAINSTRUCTURE Front\ 0 0 Rear 0 0���
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ACCESSORY, Front�,,0=0� ���� Rear� 0-0 „
� V� � C, 1 �/? �` V A ` �.� 0
PARKING ��\Ezistina:r/-0, \�Reawred . i-0 -
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Left 0- 0
Lefl 0- 0
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Calc Valuation: S�,soo.00
Claim Valuation: S�,soo.00
Right 0-0
Right 0-0
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NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28. § 7, 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
tor 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 applicabla codes, antl all
requlred Inspectlons and final �epproval must be obtained. Failute to obtain inspections and final approval will result in the, expiration of this permit.
FOR INSPECTIONS CALL: (714) 754-5626
2646d8I8�00)
WORKERS'COMPENSATIONDECLARATON:
I hereby aHirm under penalry oi perjury one of Iha tollowing declarations:
❑ I h e and will maimain a canilicate of wnsent to selbinsure tor workers' compensailon, as pmvided for by section 3700 of ihe Lebor Code, for Ihe peAortnence of tha
� rk tor which Ihis pertnit is issuetl.
V� 1 have entl wiil meintain workBrs' compensalion insurance, es required by section 3700 of the Lebor Code, for the performance oi the work for which this pertnit I5 Issued.
My workera' wmpensatlon Insuranca cerrier and policy numCer ere: / ^�
Cam~er: � �� Policy� bar. JI-���Z,S� -F
(ThissecNon need nof be comp/etetl il the permi( is veluetl et ane hundretl dollers ($100) w less.)
❑ I cetlify Ihet in ihe pedormance of the work for wNch this permit is issued, I shell not employ any person in eny manner so as to become su�ject to ihe workers'
compensatlon laws of Califomia, end agree Ihet if I shoula becoma s bject to the workers' compensatlon pmvisions of Section 3700 ot Ihe Lebor Cotle, I shell forthwith
comply wlth these provisions.
AppGwnt�fpneture: � �� �Dale:� � � �� �/C �
WARMNQ: FAILURE TO SECURE WORKERS' ENS E IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER40 CRIMINA� PENALTIES PND CML FlNES UP TOONE HUNDRED
hpUSANODOLURE(5100,000),INAODITIONT WSTOFCOMPENSATIIXJ,OAMAGESASPROVIDE�FOHINSEGTION3�O60FTHELABORCAOE,IMEREST,ANDATTORNEYSFEES.
LICENSED CON7RACTORS DECIARATION:
I hereby eHirtn ihat I am licensed untler provisions of Chapter 9(wmmencing wlth Section 7000) of Division 3
force end eHect. L1c..p S�� �� Z— __
Code, end my license is in lull
CONSTRUCTION LENDING AGENCY:
❑ 1 hereby aHirm that there is a construction lending agency for the peAormance of the work for which this pertnit is issued. (Sec. 3097, Civil Cotle).
Lender's Name: Lendefs Adtlress:
SigneNre: Dete:
OWNER-BUILDER DEGLARATIONS:
I hereby effirm Ihet untler penalry of perjury thai I am EXEMP7 FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business antl Professions
Code: Any ciry or counry which requires e permit to consWct, elter, improve, tlemolis�, or rapair any strucWre, prior to its issuance, also requires the applicant for such permit
b tile e signetl statemenl that he or she ISllcensed pursuant to the provisions ol the Contractors License Law (Chapter 9(commencing wit� Section 7000) of DiWsion 3 of the
Business and Pmtessions Code) or Net he or sha is exempt Iherefmm antl the besis for the elleged exemption. Any violation of Sectlon 7031.5 �y eny epplicant tor e pertnit
subjects ihe epplicant to a civil penalry cf not more than five hundred dollars ($500)J: '
❑ I, es owner of Ihe pmperry, or my employees wl�h weges es iheir sole compensation, WILL DO THE WORK, antl the structure is not inten0etl or ottered for sele (Sec.
7044, Businass flnd Professions Code: The Contractors License Law does not apply to an owner of property who builtls or improves thereon, end who does such work
himself or herselt or through his or her own employees, provided Ihet such improvements are not intended or oHered for sale. If, however, ihe building or improvement is
sold within one year oF completion, the owner-builder will heve ihe burden of proving that he or she did noi build or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSNELY CONTRACTING WITH UCENSED CONTRACTORS to construct t�e pmject (Sec. 7044, Business and Protessions
Code: The coniractors License Law tloes not epply to an owner oi propeny who bullds or Impmves thereon, and who comracts for such project with e contrector(s)
license pursuant to iha Contractors License Laws.).
❑ I am e:empt under sec. Business and Professions Code for this raason:
Signature: Date:
Owner ID veritietl by driver5licen5e. ❑ V85 ❑ No Dnver's Licensa No. Expires:
Vedficatlon of Ownership by (rype oi document, i.e. - proDerty tax bill or deetl): ..
DIVISION OF INDUSTRIAL SAFETY PERMR CERTFICATION:
❑ I hereby ceriify thet no excavetion five (5) or more feet in tlepth into which e person is required Io tlescentl, will be made in connection wilh work euthorized by Ihis
permit, and Ihat no building structure, scaMolding, falsework, or demolition or dismantling ihereoi, will be more ihan thirty-six (38) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Ttle B, Calitomla Administrative Code).
❑ As owner-�uilder, I will noi employ anyone to do work which would require e permit from the Division of Indusirial Safety, es noted ebove, unless such person hes e
permit ta do such work from Ihe division.
Signawre: Date:
Division ot Indusirial Safery Pertnit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTiFICATION:
1 WIII the apPlicant or prasent or future builtling occupant need to File antl certity a Business Plan tor emergency response to release or threatenetl releese of e hazartlous
meterial? ❑ Yes ❑ No �
(Section 25505 oi Ihe Celitomia Health end Satery Code requires, with some eviceptions, ihat e Business Plan be filetl with Ihe Costa Mesa Fire Department by every
business which has at any one time dunng a reported year e quantity of hazardous materials aqual to or greater ihan a weight of 500 pountls, or e volume ot 55 gellons,
or 200 cubic feet of compressetl gas at stendard temperature and pressure).
......................................................_.........._......................................................_.........................................................................................................................................._................_....... ............._........ ...................................................
2 Does or will Ihe applicent or present or tuture building occupant need to file e regislration tortn for acutely hazardous materials? ❑ Yes ❑ No
(Sectlon 25533 ot ihe Calilomia Health antl Safery Code, with some exceptlons, requires registratlon wIN the Costa Mesa Fire Department by each business which et any
one �ime has on hend e quantiry of ecutely ha�rdous materlals equal to or greater then e weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at stentlartl tempereture and pressure).
..............................................................................................................................._...._............................................................................................................................................................................................_..........._.....................................
3 Does or will the applicant or presant or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely harardous matenels)7
❑ Yes ❑ No
(Section 25534 oi the Calilomia Health and Safery Code provides that the Costa Mesa Fire Depariment may require the preparation, cetlitication end tiling wflh the Fire
Department of an RMPP by businesses which ere required to register ecutely herardous matedels with Ihe Fire Department.
.. _ . . .. .. ........................ _........ _......... _.................................................................................................................................... _. . _........................... _.. _............... .......................
4 Ii an RMPP Is oresentiv reauired. has Section 25534 of the Celifomie Healih end SafeN Cotle Deen fullv comolied with? O vas O�No �������������������������������������������������������������
5 Does or will �he epplicent ar present or �uture bulltling acwpant raqutra ror me wark wmcn is me suD�ea ot Inls a puG
irom tna South Coast Air Oualiry Menagement Distdd or from any other air pollution control distria or agencyt � Ye:
(Section 658502 ot ihe Californie Govemment CoOe reQuires ihet Ihe requested infortnation be fumishetl on applicatior
...._............_.........._.........._ ........................_...........................................................................................................................................................__......_............................
6 Will any Datl of the taclliry to be constructed untler this permit Da within 1000 feet from Ihe outer 6ountlanas of a school'
Qt yes", Ihe tacility must meet the requirement of Sedions 25534 and 42303 of the Californla Health end Satety Cotle).
............................................................................................._........_.................................................................................................................................................................
7 II a permil irom Ihe South Coast Air �ualiry Menegement Distnct or other elr polWtion control disMct ot egency is
aoolicatlon. have ell ot the dlsclosures orescnbed bv Celitomia Health and SateN Cotle Sectlon 42303 been made7 C
e
conswction or
for non-resitlentiel Dullding permits).
subjact of
CERTIFICA7E OF COMPUANCE: I certity �hat under penalry of perjury ihe information given ebove is correci. I agree to compty with all stete laws end ciry ortlinances
regarding Haiardous Materials and Emissions.
Signatura: �ate:
CEHi1FlCATE OF COMPIJANCE AND AUiHORVATON OF ENfAV: I certity under penalry ot perjury that I have read this epplication and stete thet the infortnation given is
corcecf. I egree to comply with ell state laws end ciry ordinences relating to tuiltling construction, antl authodze represeniatives of Iha Ciry of Costa Mesa fo enter upon the
ebove-descnbed property for inspection purposes. I e9ree not to occupy or allow occupency ot any building authonzed by this permit until tinal inspection.
CQOE1, INSGECTIONTYPE
1616 Fi:ed System Final Fire Prevention
1268 Pool Spe Final
200 Finel Re-Root
201 Finel BIocWRetaining Well
202 Final Factory Fire Place
203 Finel Sign
204 Final Demolition �
uw
/
�Qi1 %
r _—
COpE 1 INSPEGfION TYPE
206 Final Mechanical
208 � Finel Plumbing
210 Final Electncal
212
220
222
250
Final Fire Preventlon
Final Planning Approval
Final Site
Final Bulltling/Occupancy
Pe�. li�e�
PHOJEC7 ADOflESS: UNIT:
' OWNEN'S NPME: 3 � 1 � hr'w Y�Rx A�'�
nooeess: COt?EN, PAUi�INE M
3210 NEW YORR AVE
/ COST7� MESA,CA 92626
AXCH/ENGINEEN: �� S 4�'� 4 6'7 6`� 7 pEG.NO.:
RO�flE55: UNIT:
PEBMITTEE: NAt,L TILE COMFANY ( IZ%t��TCll-5�3�%
aoosess: �552 LINCOLN AV 455
CYPRESS CA 90630
LICENSEU CONTBRCTOfl DECIAflATION: I hereby afiirm Ihal I am licensetl under pmvisions ol C�ap�er 9(cammencing with Section
7000) ol �ivision 3 0� I�e Busmess antl Protessions Code, an0 my license is in tull �orce antl effect.
cirvuc.:�55631 s'"TEuc'188082 S � � /�Q
Oate: �3�5� 7'L Signa�ure: _ . _ �"
WOBI(EPS' COMPENSATION �ECIANpiION: I hereby a rtm �hat I �ave a certificale ol con5eni � sell-insure or a certilica�e of Workers'
Compensation Insurance. or a cenibed copy �hereof (Section 3800. Lab. C).
PoLICY NO.: E%P. DATE:
COMPpNY:
1� Cetlifie0 copy is hereby furnished. � Cetlifie0 copY is file� with ihe ciry Builtling Uivision.
Dale'. Applicant:
E%EMPTION FflOM WOPNFBS' fAMPENSATION UECIAPATION: (This seciion nee0 nol be completeG i� I�e permii is �or one huNreA (5f00) or leu).
I tetlity thal in Ihe pedOrmante 01 �he work for whiCh �hi5 Dermi� i5 i55Ued I Sh I not employ any per ny man So as �o �ecOme
sublem m ihe Workers' Compensation Laws ol Califomia.
oate: 3' S� q2' Signa�ure'
NOTICE: II, after making this declaraiion. you shoul0 become suble�� �o Ihe Workers' Compensation pmvisions Of Ihe Labor
Code. you musl forthwiih comply wiih such provisions or �his permit shall be Oeemetl revoketl.
CONSTflUCTION LENUING RGENCY: I hereby a��irm Nal Ihere is a mnS�mClion Ien4inA agenCy fOr �he pedormante Oi Ihe wotk for
which Ihis permii Is issued (Seclion 3097. Civ. C�.
LENOEN:
ROOflESS:
,��
CIiY OF C051'A NESA — i3JILliING PERMIT PERM NO: 7 U5645f
PERMIT N(�: B 056458 FLAi�' CHECK �10; N GOVT: N S'UPF. N
CO2vSTkilCTTi7N TYPE: 5—t+l PERt�777' TYPE; STR PFJRFOSE; ��p
JOB DESCRIPTION : SHO'vJEA PAN RF.MOVAL S REPLACEMENT/RETILE S� FT: 1,93z
CLAIN VALUE: 1,932,00 CALC—VALUE: 1,432,00 GRUi7P OCC: R-3 /
COMMENTS; SMOKE DETECTOR(S) RE�UIRED� IN �oNE. SNIOKE DE�`ECTOR
3F�kk3Edi�dER�1E3rIh�F�EiFi!��If�1'r163ElE�ifiE3E1k'l�ItielEiEiE# .�1E3iieiEif#FitieiEliifiFiFfE�3F3ciE?6iF'k�M��kii�l(-3elt%�1e%�3'tiEic3EjE3FaF�-k�: s.Y�.• it.ie
ZON iNG REQU SREMENTS �E(���`RE
sE, Br.cxs
----------- MAIN BJILDING ---------- — ------ ACCcSSORY BIIILD"SNG ---------
FRNT;. FT IN REAR: FT IN FRNT; FT IN RGAR: FT IN
LEFT; FT IN ftGHT: FT IN LEFT; FT ID] RGHT: FT IN
PARKING kE9• FROC�; PAkCEL; 1393.022II ZNE: REF NO;
PLANNING NZSTES; �J ��
*���*�u�*�����*��r���*�***�x:�tst********�*+r*��c��*��ta;*��**k�*�*� *������a.��c�ti��,�**x�
D E V E L O P M E N�,rP 5 E R V I C E S R�-E �� U I k E M � N T S
7,Ot�lInG APPROVEU HY vs � ~"?�' DATc:
�J'
3UTLDIt�G APPkOVEll BY ; �� n'� ' DATE;
APPLICATION ISSUED BY: ��J£�� ,� , DATE: ,i,�//�Z
iF'li'iEiF'1FiEif'ii'ilil'if'lFiE'IFi�%iElEii'iflEiei('3F'AeFiF�'�"x�F �C�`'� �� � '* iEjE'1ki("kifiEie-IE'k"k�K�+I�R'-it�felF
*�l'e #f it� 3i� !F 3f �F lt� 3f� 3t iF iE #- lE 3f �lE if # ii� iF �f # 3F � 1f ih ie i(� ir iF iE lE i(� R iF X� 3F ict.l {(�-k {(� �(. * j(-�(� {( {(� �(..�.�..x� jf ?c x� if �E ie3f lr i(� if� iF i'r if ie 1Fi• iE',F �f iF k iF ii� lf �x�
LEGALIZATION;N F E E S U M M A R Y-`i" STRUCTURAL SECiNe�N?';Y
OWNEBBUILOENUECLANRTION: IhereDya��irm(hallamexemp�irom�heConirac�or5'$tateLic¢nseLawlorlhe�ollowingrea5on B1�DG PN{T PTJMBING ELECTRIC MCCHANIC �'1RE SMIP/.TZr.S Gii�.r,.l.IING
�Sec�ion 7031.5 Business and Pm�essional Coae: Hny ciry o� roun�y which requires a permit �o cons�mci, ai�er, improve, Oemolis0. or IjERN I•t• j r� , � 0 � �
repau any s�mc�ure. prior �o its issuance. also requires Ihe apDlicant for such permit to lile a sipnetl statemen� Ihat he/she is licensed
pursuant m the provisions al ihe Coniracmrs' State License Law (ChaD�er 9(commencing with Section 7000) ot Division 3 of t�e Business SNt � p� N�l�—�ES '
an0 Professions Cotle) or Iha� he/she is exempl Ihereimm an0 Ihe �asis �or the alleged e�emption. My violaiion o� Section 7031.5 Uy pLAN ^
any apD�icant for a permit sublects t�e aDPlicanl to a civil penalty oi not more ihan five hundretl dollars (5500). zSSIIE F�E ���
i, as owner oi ihe pmDeny or my empioyees with wages as their sole comDensation, win ao ine woB, antl lhe BJILDING—DIV—> FERMIT ISSUE PLAN—CHECF TOIAL PAID � DJE
❑ stmcWre is no� intentled or o��ered �or sale (Seciion 7044, Business and Pm�essional Code: The Conlrac�ors' State License Law TOTAL S----> 3 S,.`-i 0 n, � � �, 0 0 3 5. 5 0 3 �. 5 � . 0 0
;tloes nat apPly b an owner al a Ompeny who builOs ar improves �hereon, an0 w�o tloes suc� woB himsel�/herself or Nrough
his ar her own emDloyees, provitled Iha� SUch imD�Ovemen�5 are not intentle0 or o��eretl lOr Sale. I�, �owever �he Auilding or �9
improvement is so�U wimin one year at camv�e�ion, �he owner will have �he 6urden o� Oroving he/she Uitl no� bui�U or improve .T2 cVENU$ D I V I S ION TOTALS-- > COLLEC TED • 3 5. 5 0 OVEP. /SAORT : f � �
iortneo�rooseoisaiel, BLDG PMT PLUMB'iNG ELECTRIt: MECHANIC F'ZRE SNiIP/TOT Gk7iD1NG PLAN—:CHc<:K
I, as owner o� [he D�openy, am exclusively con�raciing wi�h licensetl contractors 10 cons[mci �he prole�� (Section 7044, Business 7�. � 0 , rJ 0 {.
'❑ and Professions Cone' The Conlradors' S�a�e License Law does not apDly �o an owneroi Omperry who builtls or improves �here0n -
andwhocon�rac�sforsuchpro�ectswi��econvactor(s�licensepursuantlo�heCon��acto�s'S�afeLicenSeLaw�.lamaware �..x.{f3Pii..x.#.x.�(.*�Ey.ff..y6.k3f.if..x..?f.�f.3f.ii.{�.�.�(.ri..h.y.�(.{fll..x.p..x.x.{c�(..}(.�(.*{(.�.�-�;(.y.�..k.jp.k..%1f..IFi�..K;c.k.{(.j(.�y..µjp�[.�jt.j(.{cr.7(.ii.lE�.3E.{yqEi(.3�.��(.
'Iha� pmol ol �heir Worker'S Compensa�ion insurance s�oultl be pmvitle0 to me. 1' /,
� I am exemp� under Section: B. 8 P. C. Z N D:I V I 17 U A L F E E B R E A R D O W N ,i-�
�orthisreason: 7 UNIT OST TOTA"
Oa�e�, Ownec
I Oo hereby ceniry Ihat I am aware oi antl untlersland the repuiremenis of Calilornia Heal�h an0 Safe�y CoOe Sec�ions 25505, 25533, antl
25534 anA Ihat I or any fulure builtling occupant wilVwill not (circle one) nee0 to comply vnih saitl stale cotles antl ��e requiremen�s for a
permil for cons�mc�ion or modi�icalion trom ihe Air Ouahry Management OisMci. Residential conslmc�ian apDlicalions are exempt imm
�hese pmvisions.
�aie'. Applicanl:
I hereby cerlity�Aa1 I have reatl Ihis aDPlica�ion antl sta�e Iha�i�e a�ave inlormalion is carrecL IaAree to wmply ' all ciry antl coun�y
or4inance5an05ta�elaw5relating�obWltlingCons�mClionantlhere�yauthorizere semalivesafiti ' enter heabove-men�ioned
properry �or mspetlion purposes.
oate: �� �' 9� siqnalure:
Oriver's license ar Social Security
164L46 WM1ile—Building; Green—Code EntorcemenC Canary—Appli<ant; Pink—Revenue; Goldenrotl—Assessor
TYPE QTY D E S C R_ F T I O N C L CGST
0
SFR 193?. AL'tER $Y VALUE RESSDE�TIAi h07.ONE 1.00 1;'�l�32.00
� � END OF FEES "
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incomp)ete Inspectwns �!�:�' f-'�' "'�� •^
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n
� C j STRUCTION AND PL'-ANNING �� - -_ � PO(�SPA ,
APPROVALS . Fermit #� '" Date Inspector AppROVALS Permit # - Date Inspector
1. Temporary Electrical Service or.Pole - � 52. -Pool & Equipment Locaiion "
2. Soil Pipe-Und�gmd. � � � 53. Steel Reinforcement ' •
3. Electrical Conduit Util+ty-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. E�ectrical Cqnduit-Undrgrnd. •
8. Foundation , . � 59. Gas Qipe, a Undrgrnd., Test '
9. Water Pipe-Undrgrnd. 60. �Backwash Lines, P-Trap, O Undrgrnd. �
70. Structural Floor System 61. APPROVAL TO DECK �.
71. Property Sewer Line & House Connection 62. Backwash & Receptor-Final ��
12. Sewer Cap ' 63. Heater & Vent-Final
73. Roof Drains � " 64. Plumbing SYstem - Finai
14. Rough Plumbing 65. Electrical�Fina� � � .
15. Rough Electrica6Conduit . 66. Solar System�Final
16. Rough Electr�c Wiring " 67. Fencing & Access Approval
77. Rough Wiring Sign 68 ° APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE OEPT, REQUIREMENT
20. Rough Factory Fireplace APPROVAIS Permit #
21. Ducts, in Structure 70. Underground Hydro _
22. Ducts, Ventilating 71. Product Piping O Gas � Oil
23. Gas Pipe�Rough & Tesc 72. Underground Flush :_.._
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil . -�
25. Roof Sheathing 74. Overhead Nydro --
26. T-Bar Ceiling (Svucturall & Monocoat 75. Dry Chemical � � "
27. Frame and Flashing 76. Dry Standpipe �
28. Lathing & Siding 77. FIXED SYSTEM FINA� .
29. Insulation - 78. F�RE PREV. FINAL . -`-
30. Drywall Nailing �f `�_ll ��� 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 Conditioni�g
35. Final Gas Pipe-Test
36. Hood or Canopy 'T
A
37. Final Factory Fireplace �' �;
38. Final Plumbing E.X P��� � �
39. Water Service�Final . � � � e ��
40. Gas Service-Final Qa�@ � �e _ ,
41. Solar pomest�cFinal
42. Backflow Preventer , ' .
43. Backflow Irrigation � ,
44. Landscape Irriqation SYstem
45. Sound Attenuation �,,.
46. Handicap Regulations ;
47. FINALSTRUCTURE&BUILDING �
48. fINALPLANNING:=. �
49. Elec[ric Release to Edison ` '� / y �,- .� �`_
/-__C� - ( 2- S 6-
50. Gas Release to Soutliern California Gas Co � ��
51. CERTIFICATE OF OCCUPANCY
No. Date
L
�
►J
Pfl0.1ECT A�OflE55:� "� 1 S U NEW YURK AV
OWNEfl'SNAFIE: COHEN, PAULINE M
nooeess: j210 NEW YORK AVE
COSTA N�SA,CA
ABCNIENGINEEB: � 71 �� 546-7�? �
RDONESS:
UNIT:
52625
XEG.NO.:
UNIT:
PEflMITTEE: NA1�L TII�E CUMPANY ( 719 ) 761-8237
ROOPESS: SSJ2 i,INCOT.�N AV 455
CYPRESS CA 90630
❑CENSEO CONTFACTOB OECIAflRTION: I hereby aifirm ihat I am bcenxed under pmvisions oi Chapler 9(commencing with $ec[ion
7000) ol Division 3 of Ihe Business antl Pmlessions COUe, ana my license is in �ull torce an0 ellect.
ciTruc.:055639 sT"TEuc.:188082 �
�ale: ?��^�� Signalur._ ��
WOBREflS' COMPENSRTION DECIABATION: I here�y afhrm iha� I have a certi�ica�e o� conSeM �o selbinsure ar a certitica�e o1 Workers'
Compensalion Insurance. or a cerlili¢tl copy thereo� (Section 3800. Lah. C�.
PoLICY NO.: E%P. OFTE:
':OMPANY:
Certilietl coOY is hereby Wmished. ❑ Cetlifie0 coDY �s fileA wi�h �he ci�y Builtling Division.
oate: ApplicanP. "
EIIEMPTIONFqOMWOflNEHS'COMPEN511TIONDECLAB,ITION: (i�issectionneetlnotbecomple�eGilthepermilrsforoneh pOre0�5100�arless�.
I cetlity �hal in the pedormance of �he work /or w�ich Ihrs permii is issued empl y an i Rer so as �o become
sublect �o �he Workeri' Comcpefnsa�ion Laws of Calitomia.
Daie: 3� s' / Z Signature'.
NOTICE: If, alier making Ihis declara�ion, you 5hou10 U ome sublec� lo the WOBers' Compensa� on D�ovisions of ihe La6ar
Cotle, you mus� �onhwith camoty wiih such pmvisions or Ihis permit s�all be tleemed revoked. '
CONSTPUCTION LENOING PGENCY: I hereby a��irm [hai �here is a conSVuc�ion lending agenq �or �he peAormance oi Ihe work lor
which Ihis permil is issued �Semion 3097. Civ. q.
LENDEfl:
ROONESS:
OWNEP BUILDEN UECLi1NR710N: I hereby affirm that I am eaempt tmm the Contractors' Stale License Law for ihe following reason
�Seclian 70.31.5 Business and Pwfessional Code: Any ci�y ol counry w�ic� requires a permit to constme�, alier, impmve, Oemolish, or
repair any S�mcNre, prior lo ils issuance. alm requires �he applicant �ar such permit Io �ile a signed s�atemenl Ihat helshe is Iicen5e0
pursuanl Io Ihe provisions of Ihe Comracmrs' Slaie License Law �Chapier 9(cammencing wi�h Seciion 7000� o� Oivision 3 of Ihe Business
antl Pmlessions CoOe) or Ihat hehhe is exem0� �herefmm antl Ihe basis for Ihe allege0 eeemp�ion. Any viola�ion af Seclion 7031.5 �y
any applicant for a Oermit su�jecis �he applicant to a civil penalty o1 not more than five huntlretl tlollars (55001.
I, as owner of �he D�oDeM1y or my employees wi�� wages as their sole cOmpensa[ion, will tlo Ne woM, antl the
❑ s�mcWre is no� intenAed or oilereA lor sale (Seclion 70ad, Business antl Professional Cotle: The Coniractors' State License Law
tloes not apPly m an owner o� a Ompetly w�o builds or impmves �hereon, antl w�o tloes such work himseltlhersel� or �h�ouAh
his or her own employees, pmvitle0 (hai such impmvemen�s are no� in�enaetl or otieretl for sale. II, however �he �uil0ing or
im0�ovemem is soltl wi�hin one year o� comple�ioq the owner will have �he burtlen oi Droving he/she ditl not 6uild or impmve
br Ihe purpose ol sale�.
I, as ownerof �he pmp¢hY. am exclusively con�racling wilh Iicen5e0 coniractors �o conSlNct Ihe pmleci (Sec�ion 7M4. Business
❑ ano Pmfessions Cotle: TAe Contractors' State License Law Ooes not apply to an owner o/ Oropeny who Guilds or impmves ihereon
and wha contracis far such pmjects wilh a contractor(s) license pursuant to ihe CaniractoK State License Law). I am aware
�ha� prooi oi Iheir Worker'S Compensa�ion insurance should he pmviAed ro me.
I� I am ezem0� un0er Sedion�, 8. & P. C.
for mis reason:
oale'. Owner
I Uo here0y cehily that I am aware ol an0 untlersland the repuiremen�s ot Calibmia Heal�h an0 Sa�ery Cotle Sec�ions 25505, 25533, antl
25534 antl ihal I or any fulure huiltling occupant willlwill not (circle one) neee to comply with said stale codes anA ihe requiremenis tor a
permil lor conslmciion or motlilication irom �he Air Ouality Management DiSinci. flesitleniial conslmction apDlicaiions are exempt irom
Ihese provisions.
Date: AOPbcam:
I hereby certAy Na�l hav¢ r¢atl Ihis aDVlicalion and s�ale Ihal�Ae above inlorma�ion is correcL I agre mply wi Ilci�y ana coun�y
ortlinancesanAsla�elawsrela�ing�obwlaingconstmclionan4herebyaWhari taf ' ciry nter eabove-men�ionetl
pmDe�W �or inspeclion purposes.
Dale: � �� ` 2 Signat e:
�iiver's L¢ense or Social Secun�y k:
Apolicant: Pink—Revanue: GolEenroC—Actxssor
CITY OF COSTA MESA - 3UILDING PERMIT PERM NO: P 05645`.
PERMIT NO: P 056459 FLAN CHECK h0: N GOVT: N SJPP: N
CONSTRUCTION 'I'YPE: 5-N FERMIT TYPE: PLU PURPOSE; OTH
JOB DESCRIP'tION : SHOWEk PAN REMOVAL & REPLACEMEI�T/RETILE SQ FT;
CiAIM VALUE: CALC-VAI,liE; GRUUF OCC: R-3 /
COMMEN'tS• RE: H56458 PRIMARY Bi;DG. PERNIT.
+�-�*�***��t****��*�x�*�**�:�r*r�****��r���**���c+��v*�***�-**�**x�*��*�e� x*�*�**��**���.��
Z O N I N G R E Q U I ft E M E N: 5
S E T B A C K S
------------ MAIN BUILnING ----------- --------� ACCfiSs'ORY HUILDING ------"--
FRNT; FT' IN REAR• FT IN FRNT: FT ZN REAR; rT It�'
LEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ� PkOV; PARCnL; 2.391�0228 ZNE: REF i.tp;
PLANNING NZSTcS> ''
> _�:
�*�3i�*���*kk**� x#aEx-*�*r.�i!.iE#�*�*�*x��kx��c��i�+rk���:�+�*#aE#****xr���-x*�r*+;x*ir���*):�i�:�.r�-�;*
D E C� E I� O P M E N'C S E R V 3'� C, -n�: S R � Q iJ I R n M E N T S
ZONING APPROVED BY -i" DATE:
BT.JILDING APPROVED BY ; DATE•
APPL'ICATION ISSUED BY•
if� iE iFif if iF iE }'} iElF 1E iE iF 3i� i(� �1e ii if �lE iE !f'lF %"�7f1�
�e #-iE �lE iE iF fE 3f �1(� iF �If iE jf if ii iE 1E df 3E iE i� if� lE iE k iF�3F iE
LEGALIZA'CZON:N
--- -: F �.,
nAT�: ,�/
nxn x.x ..�-x��---�-�'t�x-�-r-���u.��xt.x.�*`t3��-.!��.�xK.
�7F iE IE if iF x x iF if iE iE �.: *iE.' k IF ib iFlc K� iF'iF 3FiE iE N� iE 1f ii 3f i!- lE 3e iF�k if #E 3f if iE if ic > iF 3%� i'r iE i: iF
i E E S U M M�A R Y STRUCTLTRAL SEGMENT;N
BLDG PMT PiiJMBING ELECTRIC MECHI�NIC F.TRE S�:IP/RES GRADING
PERMIT 2.00
25� � SkIP/t�ION-RES
PLAN ,
ISS[JE FEE 3,Q0 -
BUILDING-DIV--> PERMiT ISSIiE PLAN-CHECK TOTAi, PAIJ DiJE
TOTALS----> 2,00 3,00 �i. 0,00 S,UU S.UO .00
REVENUE C�IVZSTON TOTALS--> COLLECTE:D: S,UO OVER/SAORT: .00
RZ.DG PMT PLUMBING ELECTRIC MECHANZC FiRE SMIP/iOT GRADING PLAN-C:IECY,
J,Q� )_.
:i
1E iE 3F if ##�14 �7't # 9(� �7t iE aF # N' i(-!F �%� 1F N��7i 3'r iE �x�?E iE lE 3E if ii- iE �)E 16 �E 1!� # iF # if �k iF dF if # IE iF 3E k##F aE if %iP if�if ii� ie#� iE 1E #F iE w� i't )t ii� ic ie i(� �? 3F 3'r }:� i'r r; } je 3E
I N D I V I D U A L F E E 9 R E A K D O W N
TYFE QTY D c S C R I P T I O N UNIT COST TOTAL COST
PLU 3 I SHO?AER 2.00 2,00
�
EXPIRED
�"��P1ote Irspe�ti�
� �a \ a �`��']� �
� —�1...
� � 8
!
.� _...ND Or FEES
i
r
� , 4.�,--��� .,
` k?i.in r, lnp) � W
3,,..
''l.•,.. .., u._,:�1..._�,�
�
CONSTRUCTION %�ND PLANNING .
APPROVALS Vermit #
1. Temporary Electrical Service or Pole
i ,
2. Soil Pipe�Undrgmd. -
3. Electrical Conduit Utility-Undrgrnd.
4. Electrical Conduit-Undrgrnd.
5. Steel Reinforcement
6. Electrital UFER Grnd.
7. Footings
6. Foundation �
9. Water Pipe�Undrgrnd.
70. Structural Floor Svstem �.
1 t. Property Sewer L�ne & House Connection
12. Sewer Cap
13. Root Dreins -
14. Rough Plumbing
15. Rough Eleariwl•Conduit
16. Rough Elearic Wiring
1�. Rough Wiring Sign
18. Rough Electrical-T Bar Ceiting
19. Rough Heating & Air Conditioning
20. Rough Factory �ireplace
21. Ducts, in St�uctu�e
22. Ducts, Ventilating
23. Gas Pipe-Rough & Test
24. Roof Freming
25. Foof Sheathing
26. T-Bar Ceiling (Structural) & Monocoat
27. Frame and Flashing
28. Lathing & Siding
29. Insulation
30. Drywall Nailing
31. Plaster Brown Coat
32. Electrical Power Meter�Final
33. final Electric
34. Final Heating & Air Conditi hing
a%
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. $olar pomestic•Final �
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irripation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUC7URE & BUILDING
46. FINAL PLANNING '
49. Electric Release to Edison
50. Gas Release to Southern California Gas Cc
No. Date
�
PO SPA -
Date Inspector qppROVALS Permit # Date
- 52. Pool & Equipment Location
� 53. Steel Reinforcement -
54. Forms
- 55. E�ectricai Bonding
_ 56. Rough Plumbing & Pressure Test
57. APPROVALTOCOVER-GUNITE
58. Electrical Conduit-Undrgrnd.
f- 59. Gas Pipe, O Undrgmd., Test
," � � 60. Backwash Lines, P-Trap, � Undrgrnd.
' 61. APPROVALTODECK
' 62. Backwash & Receptor-Finat
� 63. Heater & VenrPinal
- 64. Plumbing System - Final
�((��(Z LF�/7 65. Electrical-Final '
- 66. So�ar System-Final
� 67. Fencing & Access Approval �
. . 68. APPROVED FOR PL9STERING
69. POOUSPASYSTEMSFIIVAL
FIRE DEPT. REQUIREMENT -
APPROVALS Permit #
70. Underground Hydro
77. Product Piping O Gas ❑ Oil
72. Underground Flush '
73. Undergmd. Srorage Tank � Gas ❑ Oil �
74. Overhead Hydro - _
75. Dry Chemical t � •
76. Dry Standpipe
77. FIXED SYSTEM FINAL
78. FIRE PREV. FINAL
HEALTH DEPT. REQUIREMENT
79. FINAL INSPECTION
80. FOOD CERTIFICATE ISSUED
Notes: 3 - �f `l'2- �f2. �7R+'l otL-C,�/�
i '
,ApPlieant to till in all soaces except tnose witM1in heavy Eortler Iines an0 sign all apPropriata tleclarations.
CiTY oF COSTA MESA CONSTRUCTION PERMIT
Project Address 3� �� �<'W �o �1[ Q V� _
Applicant's Mailing Address 1
Owner's Name Q� ���^' e�0�12�J phone
Address ���� �%ew �( /t(� A ✓e
Arch/Eng. License No.
Address ' �
Contracror'sName 2aS5 c 8 p,�/low9 �4phone SS]�%�/[�C
Address (mailingl �=�O C. d \?ou �ve .
City License No. %��� 2—j�
LICENSED CONTRACTOR DECLARATION
I hereby affirm Ihat I am licensetl untler p�ovislon5 0( Cha�te� 9(commencing
witn section 7000) ot DiviSion 3 0/ the BuSinesS antl Professions Cotle, antl
my license is in f I for e antl effect.
�,icense clAss �' � 1 ense No.��'�'���
�—�-5-$% Signature
u:.s'iKERS'COMPENSATION DECLARATION
'��;reby aHirm tbat I have a cer[ificate of consent to self-insure or a certificate
��df Workers' Compensation Insurance, or a certifietl wpy thereot (Section
3800, Lab. C.) '
Porov'No. DGo6S3�i_�Company S�✓1�¢. Fi��•�-
bfietl mpy is hereby fumizhe0.
Cer fieg wpy i5j�Jed with ihe city @,W�tling i sion.
Oate � "2S _ �7 Applicant [V / �
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(Thissection neetl not be campleted i� the permit is for one huntlretl ($300) or
less).
I certify tha[ in the perto�mance of the work to� which thi5 pe�m�t is issuetl, I
� shall not employ any person in any manner so as to become subject to the
Workers' Compensation Laws of California.
Date Signature
' NOTICE: If, after making this tleclaration, you shoultl become subject to the
Wo�kers' Compensation provision5 Of Ihe Labor Cotle, you must /orthwith
comply with such provisions or thi5 permit shall be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV
I hereby aiilrm that lhere is a consiruction lentling a9ency for the performance
of the wOrk for which this permit i5 is5uetl (Section 3097 Civ. C.)
Lentle�'S Name �
l.entler's Atltliess �
OWNER BUILDEN DECLARATION
I hereby affirm ihat I am ezemOt from the Contractor's License Law for the
following reason (Sec[ion 7031.5 Business antl Protesslonal Cotle: Any city or
county whith requires a pe�mit to wnstruct, alteq improve, tlemolish o� repair
�y structure, prior to its issuance, also requires the applicant for such permit
file a siqnetl statement that he/she I5 licensetl pur5uant to the p�ovi5ions of
; Contracror's License Law (Chapter 9(wmmencinq with Section ]000) o(
.vision 3 of the Business antl Professions Cotle) or that he/she is exempt
[herefrom antl the bazis tor the allegetl exemption. Any violation of Secfion
7031.5 by any applicant for a permit subjects tne applicant to a civil
eenalty of not more than five huntlretl tlollars ($500). .,
LJ I, as owner of the property or my employees with wages as their sole
mmpensation, will tlo the work, antl the structure is not intentletl or ofteretl
for sale (Section 704a, Business antl Professional Cotle: The Contractor's
License Law tloes not apply to an owne� of a p�operty who builtls o� imp�oves
thereon, antl who tloes sucM1 wo�k himselt/heiself or tn�ougn his or her own .
employees, provitletl that such improvements are not intentletl or otferetl for
sale. If, howev¢q the builtling or improvement is soltl within one year ot rom-
pletion, the owner will have the burtlen of Droving he/she tlitl not builtl or im-
nrove tor the purpose of sale).
❑ I, as owner ot the Oroperty, am exclusivety mntracting with Ilcensetl con-
tractors [o construct the project (Section ]044, BuSiness antl PrOfessions Cotle:
The Coniractor's License Law tloes not apply to an owner of property who
builtls or imowves tbereon. antl who contra<tsfor such oroiects witn a com
tractor(s) license pursuani to me ConVactor•s License Law). I am aware thax
proof of their Wo�ker'S Compensation insurance 5houitl be provitletl to me.
❑ I am exempt untler Section B. & P. C. tor this reason
Date Owner
I nereby certify that I have reatl this application and state tnat the above
Information is correcL I agree to comply with all city antl county ortlinances
antl State laws relating to builtling construction, antl hereby au[hO�ize �ep�e-
SentaHves of-IhiS city to enter pon [h¢ bove-mentioned Propertyo pfOr
InspeCtion purpOse . • ��ss-p /
Signature Date
Orivers' License or SS � � �
� ,�.�.� ...,. . ....._. .._. _'. ..'. .,�..
A.P. #
S Main Buildi
TYPE OF CONS RUCTION � NEW ADD ALTERATION EPAIR E
❑ CONVERSION ❑ DEMOLISH ❑ OT ER T Front
DESCRIPTION OF WORK/USE OF BLDG. �PA2" o�C { C Xi S'/ � w..a I A Rear '
TYPE OF PERMIT GRADING FOUNDATION STRVCTURAL � C Rlght
❑ TENANT �� ELECTRICAL ❑ PLVMBING ❑ MECHANICAL � � g � l.Bft '
❑ OTHER Ping. Ref. #
PROJECT DESCRIPTION 5c�. FT.�.�S O J � oCCUPnN v P
�— � a i Planning Notes:
CONSTRUCTIONTVPE VALUATION$ �
ZOfVE GRADINGCU.VDS.' ACRES ._. —
Remarks:
Sink
Preventer
Irrigation
Drinking Fountains
Floor Dreins
Floor Sinks . -
Gas Service Outlets
Interceptors
Kitchen Sink
Lavatories
P—Trap •
Roof Drains
Reinspection.Fee _ ! $15
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. Bit. iCBO #
Heating System & Ducting
❑ 0-100,000 BTU O 100,000 BT
Reinspec[ion Fee � $15
0865-46, rev. 5/88 White - guiltling; Canary - Applicant; Pink - Accounting; Goltlenrotl - Assessor
� ... . .
$%IOWEfS
Service Sink �
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Po01 w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto�Wash
Issue Fee
Hood or Typel ❑
Canopy Type I I ❑
❑aioo,000.eru ❑ioo,000
System Repair/Alteration
Fire Dampers
fiegisters
Issua Fee
FEES
zooe
Accessory Building:
ELECTRICAL ,
Automatic Washer Trensfoimer �� 15-50 KW
Construction Pole Su6. � 50 + KW
CoOking Unit
Dishwasher '
Dryers ❑Gas ❑Electric
Fan
F.A.U.
Fiztures
Device Boxes
Outlets
Switches
Garbage Disposal
Generator �0.5 KW �5-15 KW
FEES
Meter Llup to 100 amps
Meter �over100amps �
Sub Panel
Motors �0-1 HP � 1 X� 8
Inc.Solar �9-15 HP �16-15+
Microwave
Pole Light
Sign
Standing Sections
Trash Compactor
Fee �$15 � � Issue Fee
$ 3 DEVELOPMENTSERVICESREQUIREMENTS:
2onin8 APProved By
FEES Building Approved By �
� Application Issued BY
$ 3
S M V OF FEES
BUILDING PERMIT $ SMIP
PLAN�CHECK $ - PERMIT
PLUMBING $ ISSUANCE
PLAN CHECK 25% $ ENERGV P.C.
ELECTRICAL $ GRADING
PLAN CHECK 50°.6 $ MICROFILM
MECHANICAL $ TOTALFEE
PLAN CHECK 25% $
$ 3
$
N
1
N
G
R
E
Q
M
T
$.
oi oac�sias9-oau4iasv a�a-r �_,,+a
OATi:: 08l:j/S4 TIhE: t�:t�4
�
� ,..
CONSTRUCTION AND PLANNIN� ] - & SPA
Date Inspector Date Inspector
APPR9UALS Permit# �f APPROVALS Permit#
1. Temporary Electrical Service or Po�e .y 52. Pool & Equipment Location
2. Soil Piq�-Undrgrnd. ,� � ^ � 53. Steel Reinforcement ' .
•��, Ele i�l Conduit Utility-Undrg�nd�. ^ •� • 54. Forms
,�
4� Electrical Conduit-Undrgrnd. � W 55. �Electrical Bonding ,.
5, Stee� ReinfarcerRent. � ;. 56. Rough Plumbing & Pressure Test .'�
�
^ �� 57. APPROVALTO COVER-GUNITE � `�.•
6: Electrical UFER Grnd. .',, �
7:Footings - - „ �- 58. Electrical Conduit-Undrgrnd. � ±
8e� Fou Jdation '� ? '.r 59. Gas Pipe, O Undrgrnd., Test !'�+
_ '!
9aWa[er Pwpe-Undv-rnd. ' �% 'f 60. Backwash Lines, P-Trap, O Undrgrnd. �
14 Structural Floor�Ystem .t �� 61. APPROVAL TO DECK' �
�
11. Property Sewer Line & House ection ��'�, 62. Backwash & Receptor-Final
12. Sewer Cap a1 �' �� ' 63. Heater & Vent-Final '
f' ,
13. Roof Drains . "5 �
y � , 64. Plumbing System - Final
14. Rough Plumbing; 65. Electrical-Final '
15. Rough Electrical'Conduit 66. Solar System-Final
[k6 Rough Electric Wiring � 67. Fencing & Access Approval
1y:� Rough Wiring Sign 68. APPROVED FOR PLASTERING
�18. Rough Electrical-T Bar Ceiling � � 69. POOUSPA SYSTEMS FINAL
..�
19.^'Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace • APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing � � 73. Undergrnd. Storage Tank � Gas ❑ Oil
25. Roof Sheathing ; 74: Overhead Hydro
26. T�Bar'Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe � �
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywail Nailing �•� HEALTH DEPT. REQUIREMENT
31. Plastec Brown Coai��: 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 pomestic-Final r'•
iY
42. Backflow Preventer � �� �i
43. Backflow Irrigation �
1h
44. Landscape Irrigation System �
45. Sound Attenuation �
46. Handicap Regulations .
47. FINAL STRUCTURE & BUILDING 9' --
48. Special Requirements Completed
49. Electric Release to Edison �� .�.,�
r ,
.} . ��
50. Gas Release to Southern California Gas Co ,,
51. CERTIFICATE OF OCCUPANCY i .C7
No. Date ' jr �
.• 123"/'7
COSTA MESA BUILDING-SAFETY DEPARTMENT
� P. O. BOX 9f7 C08TA MF$A, CALIFORNIA
For Applieanf fo Fill ln Complefely
� TYPE OR PRINT
wooRe�ss 3210 New York Ave.
COSTA ME9A. CALIFORNIA
OWNER �ermont Avenue Land Co. Inc.
AOORESS L•�L9 E• �.%�itl `�fi•
TEL.
■ 8T'ATE _ . _ _ TEL.
NO. OP
� 88TBACK LINH FROM
� I �EFT S� I RIGHT S�
DESCRIPTIOtd OF WORK
�. �� � ��
,SZEDING 1�65 SQ.f•.�RooMS
EXTERIOR WALL IROOF
��2K To BE
E EE RECEIV ED
FiNoNC� �APMESA
APPLICATfON FOR PERMIT
BUILDING
For Offiee Use Only
REGEIPT NO. �9i{tp��
M1i/J
RECEIVED BY I DATE FECEIVED I DATE IB6UEO
COSTA MESA. CALIFORNIA
FIRE
ZONE TYPE �G
APPROVED
BY DATE
ZONING
ZO __ // NO. OF U8E OP I.
� �� I PWNB�� BUILDING
I
LEOAL � _ _ _ _ T ,
, � [CeNTER
APPROVED
.C/_�L
O/
�--� �.
K-
1 HEPBBY ACKNOWLEO3H THAT 1 HAVE RBAO THIB APPlAGT10N }HE AMOIINT 6HOWN UNOER VALUATION 18 FOR THE
AND BiASB THAT TXE ABOVE �8 CORRELT AND AGREE TO COM-
PURPOBE OF EBTABLIBXING A PERMIT FEE ONLY.
PLY WITM ALL GITY OPDINANGEe ANO STATE LAWB RHOULATING
euLLo1NG GONeixurno ., ,,,_ VALUATION
SIGNATURE OF �� PERMI7 FEE $ 3G�•
PERMITTE
' S 14,179 • PLAN CHECK � 17 .
AUTHORIZED AGENT ��'e & CO B�TOVB� TIIC•
TOTAL FEE S�-•
z
LL
oWNER Vermont Ave. Land Co., Inc. DATE 6/21�60
GENERAL CONTRACTOR
AP. No. LOT
INSPECTIONS �_,o.�.o
Power
OCCUPANCY
Form 210—SM-71-59 5-B P
& Cole�rc
TRACT
I DATE
Inc. VALU�
FIRE ZONE DESCRIPTION
,OUP I & J TYPE
SUBCONTRACTOR I
L�!
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