HomeMy WebLinkAbout1761 NEWPORT BLVD - Building Permits Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
•
PERMIT NO. TRACT NO. LOT NO. UNIT NO.
CNV OrCOSTA MESA CONSTRUCTION •PERMIT 1 2419 I ! /16/84 8.00 IL.
Troject Address . _ . 'o a' / ai f j � -
Applicant'sMailingAddress ca..—VA/4/41/2/' 4*2 d0, C",40 • TYPE OF CONSTRUCTION NEW UADD Li ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# I Zone
Owner's Name/e,e 14///2f'f"live Phone DESCRIPTION OF WORK/USE OF BLDG. _
Address Q. S Main Building: Accessory Building:
I Arch/Eng. License No. TYPE OF PERMITS ,'/❑ GRADING ❑ FOUNDATION ❑ STRUCTURAL E Front O
LI) Address CI TENANT 1;(J ELECTRICAL CI PLUMBING CI MECHANICAL B Rear N
G Contractor's Name /✓ow. p / T Phone / ❑ OTHER ` I
` F �I f 31 �D 777 PROJECT DESCRIPTION SG. FT- OCCUPANCY C Right G
Address(mailing) ./+�/gs / ♦ R
g /fig/I 4 / l/-r�`A ' CONSTRUCTION TYPE VALUATION $ S Left
i• City License No. _ ZONE GRADING CU.YDS. ACRES Ping. Ref.# Parking Req./Provided E
�' LICENSED CONTRACTOR DECLARATION !c� • •
I I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks. NBV,tX�n L-JP u r • Planning Notes: (y1
ci
with section 7000) of Division 3 of the Business nd Professions Code, and S— '1 r4. 7/ .�-•t�T`1Jf-r T
my license is in full force and effect. Y S
License Class L— lo— ens- • 4027 7 1/
Date //.--1/4 f Signature PLUMBING I FEES
WORKERC ENSATION DELL
I �se . Bar Sink Showers ELECTRICAL FEES
hereby affirm that have a certificate o o .el(-insure or a certificate
,f Workers' compensation Insurance • a c-rtlfied copy hereof (Section •
Backflow Preventer Service Sink
3800, Lab. C) Automatic Washer Transformer 0 15-50 KW
Policy No. t{0 2-9 Company . ' Backflow Irrigation Sewer CapConstruction Pole Sub. - ❑ 50+ KW
8 Certified copy is hereby furnished.
Certifi/e/tl cozy is •
e with the city Buil•ing Di . on. Bathtubs Sewer Connection a Cooking Unit Meter Aup to 100 amps G.90
Date ,f —/1- Applicant /
EXEMPTION FR ((ll��WORKERS'COM" N5' • rf CLARATION Clarifiers Solar Collectors Dishwasher Meter Clover 100 amps
(This section need not be completed if the p• it i or one hundred ($100) or
less). Dishwasher Solar Piping - Dryers ❑Gas ❑Electric Sub Panel
I certify that in the performance of the Werk for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank - Fan Motors 00-1 HP 01 t4-8
Workers' Compensation Laws of California. •
.,Date Signature Floor Drains Swimming Pool w/Spa F.A.U.
-NOTICE: If,after making this declaration, you should become subject to the _ Inc Solar 09-15 HP 016-15+
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures
comply with such provisions or this permit shall be deemed revoked. Microwave
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes Pole Light
I hereby affirm that there is a construction lending agency for the performance 9
of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets Name Range
Lender's Address Kitchen Sink Water Service Switches Sign
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash
following reason (Section 7031.5 Business and Professional Code: Any city or Garbage Disposal ;Standing Sections
county which requires a permit to construct,alter,improve,demolish or repair P—Trap Laundry Trays Generator ❑0-5 KW❑5-15 KW Trash Compactor
any structure, prior to its issuance, also requires the applicant for such permit
to file a signed statement that he/she is licensed.pursuant to the provisions of Roof Drains
the Contractor's License Law(Chapter 9 (commencing with Section 7000)of
Division 3 of the Business and Professions Code) or that he/she is exempt
herefrom and the basis for the alleged exemption. Any violation of Section
'031.5 by any applicant for a permit subjects the applicant to a civil
penalty of not more than five hundred dollars($500). $ 3
0 I, as owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee
compensation, will do the work, and the structure is not intended or offered - Fee Reinspection
for sale- (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES p $15 Issue Fee $ 3
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 Boiler Hood or Type I 0 DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not intended or offered for yP
sale. It, however,the building or improvement is sold within one year of com- Canopy Type II 0 Zoning Approved By Date
pletion, h owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By Date
prove t
for the purpose of sale). e—LI ILIt1 ) 1L1 •
—
0 I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Dat
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 0100,000 BTU SU ARV OF FEES
builds or improves thereon, and who contracts for such projects with a con-
tractors) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ SMIP $
proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT
0 I am exempt under Section B.& P.C.for this reason Firepl/Fact.Bit. ICBO# Fire Dampers PLUMBING $ ISSUANCE $
Date Own- Heating System& Ducting Registers PLAN CHECK 25% $ /� ENERGY P.C. $
I hereby certify that I have /ea./th' application and state that the above ❑0-100,000 BTU ❑100,00067 $ U CO GRADING $
information is correct. I agr- • t./cooly with all dy and county irepre-
sentatives
ELECTRICAL
and state laws relating to ii. g ',instruction,aand- herebyion authorize yfor MICROFILM $
PLAN CHECK 50% $ .�j
inspection ofpu th' city -r on the above-mentioned property for MECHANICAL $ TOTAL FEE $ `'J
inspection purples. l / -/A
Signature / i Date/�.-/�.i
Drivers' Lice se o S# - oo
CMF 0865-46,rev. 10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod -Assessor
,' :• CONSTR IJCt ION AND PLANNING - PO` „& SPA
Date Inspector Date Inspector
' APPROVALS - Permit APPROVALS Permit 4/
i
L.Temporary Electrical Service or Pole 152. Pool & Equipment Location•
2. -Soil.Pipe-Undrgrnd. , , - 53. Steel Reinforcement
3: Electrical Conduit Utility-Undrgrnd. - 54. Forms
4: Electrical Condujt-Undrgrnd. • 155. Electrical Bonding '
• 5; Steel Reinforcernen't 56. Rough Plumbing & Pressure Test -
6. Eleckrical UFER Gind. 57. APPROVAL TO COVER-GUNITE
•
- 7, Fpotings , - _ , - 58. Electrical Conduit-Undrgrnd.
8] Foundation - 59. Gas Pipe. 0 Undrgrnd.,Test
9. Water Pipe-Undrgrn'd. . • - 60. Backwash Lines, P-Trap, 0 Undrgrnd.
-i
• 10: Structural Floor System - • 61. APPROVAL TO-DECK
11.; Property Sewer Line & House Connectign 62. Backwash & Receptor-Final
12.; Sewer Cap • I 63. Heater & Vent-Final •
13; Roof Drains 64. Plumbing System - Final
I
•
14.1 Rough Plumbing' 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval -
17. Rough Wiring Sign • - 68. APPROVED FOR PLASTERING ..
• 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL .
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
• 20. Rough Factory Fireplace APPROVALS. Permit#
21. Ducts, in Structure 70. Underground Hydro I
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing73. Undergrnd.Storage Tank 0 Gas 0 Oil
r
25. Roof Sheathing 74. Overhead Hydro •
26. IT-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
' - 31c Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final il�ApC 80. FOOD CERTIFICATE ISSUED
33. Final Electric ��ff 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
•
48. Special Requirements Completed • ,
49. Electric Release to Edison - .
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY _ -- - '
No. - Date -
—`" Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA MESA C NSTRUCTION A -RMIT PERMIT NO. —_ TR zNO. t LOT NO. UNIT NO.
Project Address !� 61•♦dgbt�� V.D. 3 5 (ALJ 1�.1 .
Applicant's Mailing Address �?/� G TYPE OF CONSTRUCTION ❑ NEW p.ADD Li ALTERATION ❑ REPAIR
Y ❑ CONVERSION ❑ DtmoosH' ❑ OTHER A,P.# t..(2.4—2—t I—QS Zone C2
Owner's Name \YL 1` c-lalt! z 't1L.,'1 Phone LA? DESCRIPTION OF WORK/USE OF BLDG.aa ACAKYA'Y� `
Address i" es&(I��t-� ♦ t . �.�� .,_ L --... t• S Main Building: Accessory Building:
Z
,n•Ah/Eng.'?OPLQ(yQ2 �N1fs�License No. �'.t-I IG 35�r[���� "TYPE OF PERMIT ❑ GRADING . FOUNDATION ^STRUCTURAL T Front I f O
Address � o t s 0o-sie <� )�+.a�-Yl V�•oy El❑ TENANT ❑ ELECTRICAL El PLUMBING ❑ MECHANICAL B Rear q• .t N
�ntractor's Name ( J L...-Q) co 'Phone OTHER - C Right \Q I •
N
Address(mailing) PROJECT DESCRIPTION Sq. FT. 17-0 OCCUPANCY
CONSTRUCTION TYPE -SL' N VALUATION$_7 '� - s Left 'l tot R
City License No. ZONE GRADING CU.YDS. (] ACRES
LICENSED CONTRACTOR DECLARATION Ping. Ref. 4 Ph�"II/ g(rpj Parking Req./Provided E
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: ' C cp n PlanningNotes: /' / Q
with section 7000) of Division Business and Professions Code,and /2 C. ESC �r �� �"•� �o�2�/r�T `Q���� ( h0 —Qq,,,„l d2s� M
\J T
my license is in full force and e ect n C. 770 17 7 S• s
License Class Lic No. /_ PLUMBING FEES
Date_��f��j{� � SignatuO �•� I I I r r_-
WORKERS' COMPENSATION DECLARATION Bar Sink ShowersELECTRICAL FEES
I hereby affirm that I have a certificate of consent to self-Insure or a certificate _
'if Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink
800, Lab. C.) I I Automatic Washer Transformer 0 75-50 KW .
671 ,'olicy No. Company Backflow Irrigation Sewer CapU ❑ 50+KW
Construction Pole Sub.
8 Certified copy is hereby furnished.
Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps
Date Applicant
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps
(This section need not be Completed if the permit is for one hundred ($100) or -
less). Dishwasher • Solar Piping Dryers ❑Gas DElectric Sub Panel
I certify that In the performance a won r which this permit is issued, I
shall not emp oy any person in ny manner s as to me subject to the Drinking Fountains • Solar Tank Fan Motors 00-1 HP 01%-8
Workers' ko is n7,•ipn,Laws of-California. �.r
Date (O L/Fe-�Signature _ —'/ r-�Gl_ Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar 09-15 HP 016.15+
NOTICE:1 after making.this declaratio , you should become subject to the — - -
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures Microwave
comply with such provisions or this permit shall be deemed revoked- _
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes
I hereby affirm that there is a construction lending agency for the performance 7 Pole Light
of the work for 'which this permit is issued (Section 3097 Civ. C.) -
Lender's Name
Interceptors Water Heater Outlets Range
Lender's Address Kitchen Sink Water Service • Switches Sign
— OWNER BUILDER DECLARATION
I hereby affirm that Faris exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposal
following reason (Section 7031.5 Business and Professional Code: Any city or 9 P Standing Sections
county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays Generator ❑0-5 KW ❑5-15 KW Trash Compactor
any structure, prior to its issuance, also requires the applicant for such permit P
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains
the Contractor's License Law(Chapter 9(commencing with Section 7000)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
'31.5 by any applicant for a permit subjects the applicant to a civil • ,—_ -.
natty of not more than five hundred dollars($500).
J I, as owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee $ 3
compensation, will do the work, and the structure Is not intended or offered i - Reinspection Fee I $15 Issue Fee $ 3
I
• for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES .
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 Hood or Type I ❑ l DEVELOPMENT SERVICES REQUIREMENTS: G I 1
employees, provided that such improvements are not intended or offered for Boiler ZoningApproved By1'\�-�-�
sale- If, however, the building or improvement is sold within one year of corn- Canopy Type II ❑ pp 0 ! Date yl
pletion, the owner will have the burden of provinghe/she did not build or im- Duct-Under Ground Building Approved By x Date ��'-17-2 7
/ i �I
Lova for the purpose of Sale). Ii .%�'
Li I, as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By . . :■ /....--....._ Data d--?a
tractors to construct the project (Section 7044,Business and Professions Code: r/
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 0100,000 BTU SU"ARV p F S Dt r
builds or improves thereon, and who contracts for such projects with a con- p \l
• proofr(s) license pursuant t• - •' tor's License Law). I am aware thatBUI LDING PERMIT $ IJ•OQ SMTP $ Cl
ofExhaust System 0 Multiple 0 ystem Repair/Alteration
their Worker's •.mpensatlon in rance should be provided to me. PLAN CHECK $ PERMIT
0 I am exem•t under Se•tion - -.C.for this reason Firepl/Fact.BIt. ICBG 4 Fire Dampers
-- — PLUMBING $ ISSUANCE $
�
Date 7 �� ���-�J�1�>L�� Heating System& Ducting Registers ENERGY P.C. $
PLAN CHECK 25% $
I hereb• certify that I have read this application and state that the above 0o-100,000 BTU 0100,000 BTL .
GRADING $
information i ELECTRICAL I agree to comply with all city and county ordinances $
and state laws relating o buildings truction, and hereby authorize repre- PLAN CHECK 50% $ MICROFILM $
sentatives((of this c to enter upo the above-mentioned/propppeeerty or ��1
inspection`purp.:.a 27 „ �7� er- •
TOTAL FEE $ /3 • ✓ t/
Signature � <� / /
Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $
•
. . _ .. . „»..5
CMF 0865-46,rev.10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor V V�V V V VV Vv�vVY ���
:CONSTRUCTION AND PLANNING POOL &SPA
Date Inspector Date Inspector
APPROVALS Permit# APPROVALS Permit#
I
1'. Temporary ElectricalrSet-vice 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 Gi id. /•`', 57. APPROVAL TO COVER-GUNITE
7. Footings .,/,'":4 / 58. Electrical Conduit-Undrgrnd`1
8. Foundation ' 59. Gas Pipe, 0 Undrgrnd.,Test, '
9. Water Pipe-Undrgrnd'. '•,, 60. Backwash Lines,P-Trap, 0 Undrgrnd. " t
10. Structural Floor System', 61. APPROVAL TO DECK ,
11. Property Sewer Line $c:House Connection 62. Backwash & Receptor-Final ` ._ •
12. Sewer Cap 63. Heater & Vent-Final I .-
13. Roof Drains 64. Plumbing System - Final ..
14. Rough Plumbing 65. Electrical-Final '
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing &Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL ••
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT " ..
20. Rough Factory Fireplace APPROVALS Permit# t'/ _
21. Ducts, in Structure 70. Underground Hydro �'
•
22. Ducts, Ventilating 71. Product Piping 0 Gas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush , •
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro I • ,
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical �` •
27. Frame and Flashing 4' 76. Dry Standpipe - . ,
28. Lathing & Siding 77. FIXED SYSTEM FINAL ,l,
29. Insulation 78. FIRE PREV. FINAL
•
30. Drywall Nailing HEALTH DEPT. REQUIREMENT ' J
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
3,7;. Final Factory Fireplace • ,
38. Final Plumbing • : n
39."Water Service-Final
40. Gas Service-Final . r •
41.. Solar Domestic-Final '
/41
• ,
42. Backflow'Preventer ,. '
'43. Backflow,lrrigation 7j I •• 4
'44: Landscape Irrigation System ., !• ,
:45: Sound Attenuationr'•
r
46. Handicap Regulations - - -
.r
47. FINAL STRUCTURE & BUILDING , ..
�- ' ff
/D0
48. Special Requirements Completed t
1
49. Electric Release to Edison _
50. Gas Release to Southern California Gas Co i
51. CERTIFICATE OF OCCUPANCY �w .
No. Date _
1 : 7 '
CITY OF COSTA MESA _,., %.
BUILDING DIVISION
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. /
1. I personally plan to provide the or labor and materials for construction of the pro-
posed property improvement. Yes 0 No
2. I (have/have not) A _ signed an application for a building permit for the
proposed work.
3. I have contracted with the following person (firm)to provide the proposed construction:
Name
Address / ill City
Phone ( ) Contractor's Lic. No.
4. I plan to provide portions of the work,but I have hired the following person to coordinate,
supervise and provide the major work:
Name /�/
Address Jt / City
Phone ( ) Contractor's Lic. No.
5. I will provide some of the work but I have contracted(hired)the following persons to pro-
vide the work indicated:
Name Address Phone Type of Work
I hereb •at I have received a copy of the information set forth in Section 19830 of the State
of alifor is afety Code and have completed the above information to the best of my per-
so = k owler�—=pliance wit ate law. ����L
Sign-•: ____ _ APAP a_ ' Date: 0
Name: ' CZA Maki ad)
(Printed or Typed) •
C.D.L. # or S.S. #
754-5273
1042-48
/ S0334'5 B6 - 1e790 Tyse f Sign N/4LL City of Costa Mesa
Project Address 17 4 ( u EwFOtT Ruth • P ,Electric ❑Non-electric SIGN PERMIT 2321
5/p3/85 Ig4PB7 TL
Applicant's Mailing Address SAME• Description Programs
Owner's Name ✓}`-r '-51740 vat VLof'•//�jPhonto» � u ❑ Canopy El Shopping Center/Integrated dev.
Address /`�/ �r✓'�'� Cw^� ' ❑ Attraction Board ❑ By Owner/or Eby City
Arch/Eng. - _ License No. ❑ Advertising Statuary Date letter sent: Office Use Only
Address 0 Other -
•
(/J/hbrf/�= ❑ Tract Sign (Security& Right of
Contractor's Name �N • Phon€ ••^�6 �� g ❑ Variance Pro arty
Entry E Agreement �/g2$027/_DO /� •1
Address(mailing) / • _ 0 MT JA 5 1 ❑ Planned Signing JJ / l.� O`
9 ❑ Special Event(Request form submitted) .P.No. Zoning
City License No. ❑ Change of Copy(amortization) C,U.P.No _
LICENSED CONTRACTOR DECLARATION Ground Illumination ign Dist. I .�•�-y',1� Date Received Ste•
I hereby affirm that I am licensed under provisions of Charter 9(commencing Wall f •�I - „�'
with section 7000) of Division 3 of the Business and Professions Code, and - ,,❑•( Non-Illuminated eceived by
my license is in fu •r , a • - - t. Roof y(I Interior Illumination
I _ --�� J-'-` Street frontage:
Licen • ass v Licens. ��1L ❑ Projecting Exterior •
Illumination �.� �
Da - ' ,� aka S' re ,•� `. - •r ❑ fi I Front: 510 Ft. Street:
❑ Constructionta _ /
IDR E affi OMP Ae I ONDECte of
❑ Convenience E(�/ Right: Ft. Street:
ta ICIR affirm that 1 have a certificate R cons= t to self-Insure or a certificate
occ
of Workers' Compe sation Insurance, or a c:rtified copy hereo (Sectio ❑ Super Graphic reft: Ft. Street:
\ 3800, Lab. C.) \ — Z /) III Rear Ft. Street:
Policy No. ��� COmpa •--• IL C• 3 3 �� •/`1
t� titled copy is hereby furnished.
V
�}I^ `-ert p with the city Building Divisio (� . g set back from ultimate right-of-way ft.
' pat •
Applicant 1 1 l o ELECTRICAL FEES INSPECTION APPROVALS
N. EXEMPT! N F OM WORKERS'COMPENSATION DECLARATION Fixtures Sign DateSign Location
(Thissecti ne not be completed if the permit is for one hundred ($100) or /
less).
I certify that in the performance of the work for which this permit is Issued, I Device Boxes Underground Conduit Front1.0"...- ------Right Left
shall not employ any person in any manner so as to become subject to the •
Workers' Compensation Laws of California. Outlets
Date Signature Sign Description
NOTICE:If,after making this declaration, you should become subject to the Switches Sign Dimensions Area Letter Height
Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked. FaundationS / �'
CONSTRUCTION LENDING AGENCY 2 Sign /re° 7 a
= 2�
I hereby affirm that there is a construction lending agency for the performance (1) x sq.ft.
of the work for which this permit is issued (Section 3097 Civ. C.) Standing Sections /I / /V[Jr'rC
Lender's Name ( x.# � _I
Lender's Address 0./CJNL= �1•ry�re6P VA' ZidS f -Q4 (2) /O• x .E '-`aa sq.ft.
OWNER BUILDER DECLARATION - 1 Rough Wiring
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason (Section 7031.5 Business and Professional Code: Any city or I (3) x Sq,ft.
county which requires a permit to construct,alter,improve,demolish or repair Ill
any structure, prior to its issuance, also requires the applicant for such permit
to file a signed statement that he/she is licensed pursuant to the provisions of - Items of Information: (1) (2) (3)
the Contractor's License Law(Chapter 9(commencing with Section 7000) of Framing
Division 3 of the Business and Professions Code) or that he/she is exempt
therefrom and the basis for the alleged perm exemption. Any violation of a civil Total for Activity
.
7031.5 by any applicant for a permit subjects the applicant to a civil Issue Fee $3iv
En ally of not more than five hundretl dollars employees with wages as their sole Copy Verbage
compensation, will do the work,and the structure is not Intended Or of fere' Valuation $
for le (Section 7044, Business and Professional Code: The Contractor's Final Electric
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 or offered for Planning Fee $ SO. co
sale. If, however, the building or improvement Is sold within one yearearofof com-
pletion,
.•�
pletion, the owner will have the burden of proving he/she did not build or im- Building Permit $ /7.So
prove for the purpose of sale). /• �7 Ground Sign: Overall Height Planter Area
❑ I, as owner of the property, am exclusively contracting with licensed con- Plan Check $ e Fin Planning
tractorsto construct the project (Section 7044,Business and Professions Code: Electrical $ /Q GQ Ground Clearance
The Contractor's License Law does not apply to an owner of property who ��f�
builds or improves thereon, and who contracts for such projects with a con- Plan Check 50% $ So ///
tractor(s) license pursuant to the Contractor's License Law). I am aware that
proof of their Worker's Compensation insurance should be provided to me. SMIP $ So Total Sq.Ft.of All Signage
ID I am exempt under Section B.& P.C.for this reason 104€ f17 Final Sign
TOTAL FEE $ T Q This activity T tal Site
Date Owner _ ` / '...„,,_4„,,f -
f e
I hereby certify that have read this application ytl state that the above Notes:
information is correct. I agree to comply with all city and county ordinances DEVELOPMENT SERVICES REQUIR MENTS: '
and state laws re tat in• to building construction,ab, and- hereby ion authorize repro- 3 G • i =.' ! , / / J
sen Is city -o'enter pen`t M1e above-mentioned proper for T J iAx -'SO
L. _ I /�C/�
pectin •urposes. Planning Approved By: 1 T• Date
Signature __e
Enforcement; Canary-Applicant; Pink-Revenue; Goldenrod-Assessor
v ab2-
CITY OF COSTA MESA
(1111°
,
SERVICE REQUEST & PUBLIC ASSISTANCE FORM VS-( ?)-C Date
Time 2^ U 0
/Q
Caller's Name \n(7�`(b:iL /�
Address /-.7 .-7"- I/ b I £ J?2'T ) v'%7 Phone Sz -iti-
Nature of Request: (location, type, severity) I _
Z ,'I� ro- � 42).LifosvK.3 U r- C3,,Siu t_, l owl- fief 0;,-1-5 al rev
1,A - -10-,c_lo} ,,:-c 3 oinc v a v iv-c Cl , 6 J- /up p-ia r'" +3.
�gea?IT - 49 7/0 , X97'//
Re erred to
�J/ Call back
„ez,....„_____ap
09 - "f"ety
a am" Service Only l
Information Only ri
Person Receiving Call
CMF 0378-18
‘frinj" f-e-4;-n-J6-"qt>w°
/ 7 ,I)
y/Y �
3
idl<ery •4
..Lulu ..fl ...
JOB ADDRESS 1761 Newport Blvd. BUILDING PERMIT NO. 49613
GENERAL CONTRACTOR Winston Verdult DESCRIPTION of WORK Shiplap fron of biding
0� No. LOT TRACT FIRE ZONE VALUES 300.00
I, ECTIONS Signature Dote TYPE GROUP ZONE
SOIL
SUBCONTRACTOR PE$MITS ISSUED
GAs
Dote Number Signature
WATER Plumbing
ROUGH PLUMBING
PROP. SWR. LINE r] HOUSE CON. C
SPRINKLING SYSTEM ,
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND POWER LI A`
ROUGH WIRING Heating and Vent.
TRENCHES II FORMS u STEEL REINF. C
FLOOR SYSTEMr�u
BONO BEAM STEEL REINFORCE n
SHEATHING
FRAME AND FLASHING
LATHING - IN OUT •
PLASTER. BROWN COAT
'TURAL, FINAL Electric
H. ,NG, VENT„ REFRIG. AND A.C., FINAL L X P I R �
PLUMBING, FINAL AND GAS TEST n
ELECTRIC, FINAL nota I�IRCOfrVIetG InsucctiQOS
BUILDING. FINAL ..(�Canc`big
SPECIAL REQUIREMENTS I v big
-sem - -
�- - - --- �'��- --�-
- - COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATIO19F%1 STREthli AL PERMIT I0e 50 TL
' P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 yy�tt -
RECFJA7EPERMIT N2 - 4 9 613
For Applicant to Fill in Completely— Use Ink O!n�ly / VV
BUILDING f 7 , /t4 n/ A.P. NO.
ADDRESS QQ77 aLJ 000((( /74/ a /,
OWNER OR �r �r ADDRESS /
TENANT /�'�!v✓�✓^�C--L UNIT OR IL //// ^� /
ADILIEG (/] -_ � SPACE NO. `U /+/�( LS -
MAILIN S OC/Kf+�G/
//}} ���/"y�.�,,Q �`- TR.NO. LOT BLK.
CITY NO.
NEW A g1DD ALTER REPAIR MOVINGI DEMOLISH
CONSTRUCTION ('f
LENDER
BRANCH
- OWNER �� j,
ADDRESS S "►'�rVALUE r`�M
ARCHITECT TEL. USE . $�/CClr r'
OR ENGINEER NO. V .'
ADDRESS ZONE TV PE GROUP
CONTRACTOR� .12 V�le-lr L�--- BYPROV ED DATE zl��w
ADDRESS 5, C. c
TEL.
CITY NO.
F. STATE CITY APPROVED SETBACKS
LIC.NO. LIC.NO.
SIZE INO.OF BLDGS. (FROM C/L STREET)
C. OF LOT NOW ON LOT FRONT FT.
VUSE OF
EXISTING BLDG. R.SIDE FT.
Vf
2 Separate permits are required for L.SIDE FT.
electric,plumbing and heating work. REAR ET.
IW. USE OF BUILDING AND WORK TO BE PERFORMED
PLANNING ACTION
'C
A r ,
/ DATE
'C APPROVED
..1
�!���7! / '�z/-, APPROVED
> _BY DATE
14 t/
oI hereby ackno ledge that I have read this application and state a'
that the above Information is correct and agree to comply with
L all laws regulating building construction, and I shall not employ ..
i
Z any parson In violation of iha workman's compensation laws of
IQ the State of California. m
3 I hereby certify that I am properly licensed as a contractor under SO. FT. N
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: n
am exempt from the pr isions of t•. ate of C. fornia Business
VALUATION PERMIT FEE S V
and Professions e, ivision 3 r 9 / j0,o-o
n
Sipnaturo o PLAN CHECK S !� `n
$ 3�, (�
Permltte t D TAX $ r V v . LL
Authorized Agent Da -/ ao Q e) U
U
-- TOTAL PAID E ro.S�
lb( 384r:9. _ II ,I FALoo zzs : ****4 3 PS
F`" COSTA MESA BUILDING-SAFETY DEPARTMENT •
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For A plicant to Fill in Completely
RECEIVED BY DATE
RECEIVED �FSU D
BUILDING/7BUDRENS Agoci` er vv.. ISSUED
G7
c n �1�� / • 1Q
PERMIT NO.
OWNER r —u t2/G(/(a 'C eIQ cia4'sc i A.P.NO. Libr• ✓/ 3 !J
�/y l �'+� BUILDING ri tmc'tftrADDRESS .J ( / pLc/M1ma.. J•r ADDRESS / }�.I� Gj/
a.0 CITY SSS f`2. j27psg . NOLit L -Ze/3 TRACT ((J LOT'Li- BLOCKP
H Z
CONSTRUCTION p 29 /j Q� d / 1 NEW ADD ALTER REPAIR MOVING DEMOI KH
O N LENDER D L )69-7 /37 C, '� ,n�-z ' Y�j /'/�yJ
_.1 VI BRANCH ��Sv /1 419, 5'
�/r'�7� OWNER goie&- og r\/F-c,iiNt/`
Q w ADDRESS �J,� n // , 5, sre /' /� VALUE /t-CO ARCHITECT 6O
CO N OR ENGINEER C���/2rZ ,$,4 NOt.(�7 Z-470 7 USE �UN(7"C.Ah7/11�-7QC(RL $iG.�--LS
FIRE
W W ADDRESS WelNOW/'Qzrt,7 ZONE TYPE �� GROUP / 7�
W 2 /J61 APPROVED r
J O CONTRACTOR ( �(�ti,�� BV _ / DATE /2^
CO
J cc ADDRESS
w w TEL. ZONE� NO.OF USE OF NEW
Z 1_ CITY NO. /Nr: oPLAKS 4BVILDIN 01I �
�m \
LU-O STATE CITY IkY'ARDS APPROVED YARDS APPROVED t�
N m LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING
70 SIZE ��JJ11�t NO.OF BLOCS. /..,..., (FROM C/L STR Eq.,
OF LOT �JL/ N 1?7 INOW ON LOT 1/4/ FRONT /O Fn.. r/ i3 - FT.
USE OF
EXISTING BLDG. R..$IDE 0 FT FT.
Z NEW BLDG.' ROOMS STORIES / L.SIDE OOF �d FT. FT.
a EXTERIORIN WALL L.t �(J,J, COOVERING REAR �T tLA A.
FT.
V COVERING LO(�s({,j.Y' JL
-i USE . BUILDING AND WORK O BE PERFORMED DISTANCE BET. BET.MAIN&
d ( U.Q,en< 5l t � (/.,' MAIN SLOGS. ACCESS. SLOGS.
Q VARC.U.P. ,\rti- ! AATE
PPR
O C.U.P.# -� APPROVED
I- APPROVEP�) /� PC'
fa —gY +V Ln DAT -75/
Z
Ojinn) FOR SPECIAL
UI hereby acknowledge that I have read this application and state f
✓ that the above information is correct and agree to comply with
CC all laws regulating building construction, and I shall not employ \ ••.Y/
i- any person In violation of the workman's compensation laws of ` 1M
i
N the State of California. ob
ZI hereby certify that I am properly licensed as a contractor under SO. FT. .-
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR i
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: a
CC
am exempt from the provisions of the State of California Business
VALUATION
and Professions Cone, Division 3,Chapter 9. coPERMIT FEE $ r
D
Signature of �t�t co
Permittee . / $ '/ / 5� PLAN CHECK $ 4/ - E
/ / I"4. VVV .
Authorized Agent ,� a
\ TOTAL FEE $