HomeMy WebLinkAbout2574 OXFORD LN - Building Permits(714) 754-5273 • Faz (714) 754-4856 • wv+w.ci.costa-mesa.ca.us 77 FAIR DFIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Job Address: 2574 OXFORD LN
Suite:
Vicinity:
Parcel Number: 14137335
nppiicant: SINGH, SURAT
Address: 2574 OXFORD LN
COSTA MESA, CA
Owner: SINGH, SURAT
Address 2574 OXFORD LN
COSTA MESA, CA
Contractoc .
Address: � "
Zoning:
Phone: 949-650-1009
Zip: 92626
Phone:
Zip: 92626
Phone:
Status: ISSUED
Applied: 08/O6I2007
Issued: 08/06/2001
ISSUED BY: �/�/` �
�
Zip: License:
Arch : - Eng:
Address: Address:
� Phone: - Phone:
Zip: License: License:
SCOPE OF PERMIT
INTERIOR ALTERATIONS TO THE AREA BETWEEN THE KITCHEN AND GARAGE ( INSTALL ANEW BATHROOM , NEW
WINDOW , NEW DOOR - - -
Plan Check: $72.31
Permit: $111.25
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $184.06
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0-0
PARKING ExiStinq: o
NOTES:
FEE SUMMARY
PLANNING 8 ZONING
Rear 0- 0 Lek 0- 0
Rear 0- 0 Left 0- 0
Reouired: 0 Proposed: 0
Calc Valuation:
Claim Valuation:
Right 0-0
Right 0-0
NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under California
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 susF
tor a period ot 180 days.
INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must comply with all�appl
requlred inspectiona and final approval must be obtained. Failure to obtain inspections and final approval will result in the.expirat
FOR INSPECTIONS CALL: (714) 7545626 � � /
2C66-08 (BI00)
�
$4,500.00
sa,soo.00
related
orabandoned
�le codes, and all
of this permit.
WORKERS'COMPENSATON DECLABAnON: ' ' �
I hereby attirm under penalry of perjury one of the tollowing declarations:
❑ I heve end will maintein a certiticate oi consent to selbinsure for workers' compensetion, as providetl for by seclion 3700 of the Labor Cotle, for the peAormance ot the
work lor which t�is pertnit is issued.
� I have antl will maintain workers' compensation insurance, as requiretl by section 3700 oi the Labor Gode, for the peAortnance of Ihe work for which Ihis pe� issu�
My wolkers' compensation Insurenca carrler antl policy number ere:
Carrier: Policy Number:
(This sectian neetl not be comp/eted il the permit Is valued et one hundred dollars ($100J or /ess.)
❑ I certity Ihat in the pedormance of the work for which this permit is Issuetl, I shall not employ any pereon in eny manner so as to become subject to t�e workers'
compensation laws ot Calitomia, en0 agree that If I should become sublect to Ihe workers' compensation provisions of Sectlon 3700 oi tha LeDor Code, I shall torthwith
comply with Ihese provision5.
Applicent Signeture: Date:
WAqNINO: FAILURE TO SECURE WORKERS' CAMPENSATION COVERAGE IS UNLAWFUL AND SHALL SU&IEGT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TO ONE HUNDFED
THd15AND OdlARE ($100,OW�, IN ADDITION TOTHE COST OF COMPENSATION, DAMAGES AS PROVIDEO FOR IN SECTIIXJ 3]O60F THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby eHirm Ihat I am licensed untler provisions of Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Cotle, end my Ilcense Is in full
brce antl eBect. Lic. N Class A
Contractofs Signature: Date:
CONSTRUC710N LENDING AGENCV:
❑ I hereby aHirm that ihere is a construction lending egency for ihe Dertormance of the work for which this permit is issued. (Sec. 3097, Civil Code).
Lenders Neme: Lender's Address:
Signawre: Date:
OWNER-BUILDER DECLARA710NS:
I herehy ettirm that under penalry of perjury that I am E%EMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business entl Professions
Cotle: Any ciry or counry which requires e parmit to consiruct, alter, improve, demolish, or repair eny structure, prior to its issuance, also requires �he epplicant for such permit
to file a signed statement ihat he or she is Ilcensed pursuent to the provisions ot ihe Conlractors Llcense Law (Chapter 9(commencing with Section 7000) oi Dlvision 3 of the
Business end Pmtessions Coda) or that he or she is axempt therefrom and the basis for tha allaged e:emption. Any violation oi Sectlon 7031.5 by any applicent tor e pern+.
su6jecis the epplicant to e civil penalry ot not more ihan five hundred dollers ($500).):
i�l, as owner of the properry, or my employees with wages as Ihelr sole compensation, WILL DO THE WORK, and ihe sWCWre is not intanaetl or oHered tor sele (Sec.
� 7044, Business and Professions Code: The Coniractors License Law does not apply to an owner of property who builds or improves thereon, end who tloes such work
himseN or herselt or through his or her own employees, provided ihat such improvemenis are not intended or oNeretl foi sale. I(, however, the 6uiltlinq or improvement is
soltl wit�in one year oi completion, ihe owner-builder will have the burden ot proving ihat he or she did not build or improve for purpose of sale.).
❑ I, as owner ot the property, am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the projact (Sec. 704d, Business and Prolessions
Code: The contr) c ors License Lew tloes not epply to an owner ol property w�o bulltls or improves Ihereon, end who comracts lor such pmlect with a comractor(s)
license pureyefi�ihe Comrecbrs License Laws.).
❑ I em exem{ nder a.
S�ign`aWre: i
Owner I eri ied by tl ver's license.
Venfication of Ownership by (rype of
Business and Professions Code for this reason:
s ❑ No ,� Driver's�Ucense
i.e. - property tarz bill or tleetl):�^
DIVISION OF INDUSTRIAL SAFETY VERMIT CER7IFICA710N:
❑ I here6y certify ihat no excavetion five (5) or more feet in tlepth in�o which a person is required to descend, will be made in connec�ion with work authorizad by this
pertnit, and ihat no builtling strucWre, scafloltling, falsework, or demolition or dismamling thereof, will be more than ihirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Title 8, Califomia Adminisirative Code).
❑ As owner-builtlar, I wili not employ anyone to do work which would require e permit from Ihe Division of Industrial Safety, as notetl above, unless such person has e
permit to do such work from the tlivislon.
Signature: Date:
Division of InduStrial Safety Permit Number:
CERTIFlCATE OF COMPl1ANCE AND A� ORVATION OF EMAV: I certify under penalry ot perjury that I have reatl �his application and state �hat the infortnation given is
correct. I agree to comply with all at�IpKspnd cit atlinances relating to building consWciion, and authorize representatives ot ihe Giry of Casta Mesa to enter upon the
above-described property for i� c�iar(pu �6ses., �ee ��i to occupy or allow ocapancy of any buiiding authorized by ihis permit until final i spedion.
/l rt>% S-
�3 ne ure` . gSl:Ow er(s) �
. AnNOr Authonzed Ap0licant Date
CODE t, INSPELTIONP/PE
1fi16 Fixetl System Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Root
201 Fina181ocWRetaining Wail
202
203
Final Factory Fire Place
Final Sign
204 Final Demolition
QBj� RIRL
LOOEN INSPECTIONTYPE
206 Final Mechanicel
20B Finel Plumbing
210 Final Elecirical
212 Finel Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
�ATE INTRIALS
�
: • � t
��i � G'� 7;�a ����y D��
OWNER-BUILDER
VERIFtCAT10N
A city or county, which is reyuired ro give notice pursuant to Section 19830, shall at[ach [o such notice, and,
as a condition precedent to issuing a building permi[, require the completion and require the remm of, an
owner-builder verification.
Attention Property Owner:
An 'owner-builder' building permit has been applied for in your name and bearing your signamre.
Please complete and re[um this information in the envelope provided at your earliest opportunity to avoid
unnecessary delay in processing and issuing your building permit. No building permi[ will be issued until this
verification is received.
1. I personally plan [o provide [he major labor and materials for construction of the proposed
property improvemen[. 'Yes _No
�2! I�e� noy ti signed an applica[ion for a building permit for
[he propo�d wor .
3. I have contracted with the following person (�rm) to provide the proposed construction:
Name
Address
Phone ( )
City _
Contractor's Lic. No.
4. I plan to provide portions of the work, but 1 have hired the following person to coordinate,
supervise and provide the major work:
IVame
Address
Phone (
City _
Contractor's Lic. No.
� 1 will provide some of the work but 1 have contracted (hired) tha following persons to
provide the work indicated:
Name
1042-46 (REV, gryB)
Phone Type of Work
. g � s- 9� q� ('� ,,,z
(714) 754-5273 • Faz (714) 754-4856 • www.ci.coste-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
!ob Address: 2574 OXFORD LN
Suite No
Vicinity:
Parcel Nunmber: 14137335
Applicant: SINGH, SURAT
Address: 2574 OXFORD LN
COSTA MESA, CA
Owner. SINGH, SURAT
Address 2574 OXFORD LN
Coniractor:
Address:
Arch / Eng :
Address:
COSTA MESA, CA
PLUMBING PERMIT
Phone: 949-650-1009
Zip: 92626
Phone:
2ip: 92626
Phone:
Zip:
License:
Phone:
Zip:
License:
SCOPE OF PERMIT
REF 801-01227.
1 SHOWER, i TOILETAND 1WASH BASIN.
ISSUE FEE
Backflow irrigation
Backflow Preventer
BathWb
Clarifier System
Connect (Ice,Soda,ety
Dental Units
Dishwasher
Drain, Floor
Drain, Rainwater
Drain, Roof
Drinking Foun[ain
Expansion Tank
Gas Earthquake Valve
Gas (1-4 outlets)
Gas (Over 4 outlets)
Gas Repipe
Gas Service
Interceprors (Grease, Oil)
Interceptors (Sand Auto )
AMT
523.50
$0.00
$0.00
50.00
50.00
50.00
50.00
50.00
50.00
50.00
$0.00
50.00
$0.00
$0.00
50.00
50.00
50.00
50.00
50.00
$0.00
QTY
FEE SUMMARY
AMT
Laundry Tub / Washer $0.00
Landscape Irrigation $0.00
P-Trep $0.00
Pressure Regulator $0.00
Process Piping (per 70 ft) $0.00
Recepiors $0.00
SepticTank $0.00
SewerCapforDemo $0.00
Sewer Connect $0.00
Sewer Private Line $0.00
Shower $s.80
Sink, bar $0.00
Sink, commercial $0.00
Sink, Floor $0.00
Sink, kitchen $0.00
Sink, service/mop $0.00
Spa (private) $0.00
Spa (public) $0.00
QTY
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
Status: ISSUED
Applied: 08/O6/2001
I ssued: 08/06/2001
ISSUED BY: ✓ ,' \ '
Sump Pump
Swimming Pool
Trap Primer
Urinal
Vacuum BrkrBkflow(7�)
Vacuum Brkr BkFlow(5+)
Wash Basin
Wash Basin Set
Waste and Vent System
Water Closet (Toilet)
Wa[er Heater/ Vent
Water Piping (Inst or Rep.)
WaterRe-pipe
Water Service
water Softener
OTHER
VIOLATION
PLAN CHECK
REINSPECTION
AMT
$0.00
$0.00
$0.00
$0.00
$0.00
50.00
$9.80
50.00
50.00
$9.80
50.00
50.00
$0.00
$0.00
50.00
$0.00
$0.00
$0.00
$0.00
TOTAL CALCULATED FEES: 552.90
an
0
0
0
0
0
0
1
0
0
7
0
0
0
0
0
L
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statufes and related
regulations. (Ord. No. 92-28, § 1, 72-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced wflhin 1B0 days, or it work is suspentl�d 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 Inspectlone and final epproval must be obtained. Failure to obtain Inspections and final approval will result in ihe expiretlon of this permit.
�
FOR INSPECTIONS CALL: (714) 7545626 �
264&68 (8�W)
WORKERS'COMPENSAnON DECLARATON:
I hereby attirm untler penalry of perjury one ol the tollavinq declarations:
❑ 1 have end will maiNain e certiticate of consent to self-Insure lor workers' crompensation, as pmvidetl for by sectlon 3700 0l ihe Labor Code, for ihe peRormance oi the
work tor which this permit is issued.
❑ I have entl wiil maintain workers' compensation insurance, as requiretl by seIXion 3700 of the Labor Gode, for the peAortnance of the work for which this parmit is i5sue0.
My workers' compensatlon Insurence cartiar and policy number are:
Carrier: policy Number:
(7liis section need nof be cromp/eretl i/ the pemiit /s velued af one hundred dallers ($100) or Iess.J
❑ I ceRity thet in Ue DeAormance oi the work tor which this pertnit is issued, I shell not employ eny person in eny manner so as ro bewme sublect to t�e workers'
compansatlon laws of Celllomla, and apree that II I should become subject to t�e workers' compansetion provisions at Sectlon 3700 oi tha LaEor Code, I shall fotlhwith
comply wit� ihe5e pravisions.
AppliCent SlpneNre: Oe�e:
WARNING: FAILURE TO SECURE WOHKERS' COMPENSAiION ODVERAGE IS UNUWFUL rWD SHALL SUBJECT Ml EMPLOYER TO CRIMINAL PENALTIES ANO CMl FlNES UP TOONE HUNDRED
TMOUSAND DOLLARE (5100,000). IN ADDITION TO THE COST OF COMPENSAPqJ, DAMAGES AS PROVIDED FOR IN SECTION 3]O60F THE LABOF CODE, INTEREST, qND ATiORNEV'S FEES.
LICENSED CONTRAC70RS DECLARATION:
I hereby eHirm that I am Ilcensed under proNslons of Chapter 9(commencing with Section 7000) of Division 3 0l the Business end Prolessions Code, end my license is In tull ,
lofCe entl eHaCL LiC. q CIe55 M
GontrectoYs Signawre: Date:
CONSTRUCTION LENDING AGENCV:
❑ I hereby aHirm Ihat Ihere is e construction lending egency tor the paAormance of ihe work for which this permit is issued. (Sec. 3097, Civil Code).
Lentler'9 Neme: lender5 Adtlr855: '
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby ettirm ihat under penelry of perjury thet I em EXEMPT FROM T1E CONTRACTORS LICENSE LAW tor Ihe following reason (Sec. 7031.5, Buslneu end Professlons
Cotle: Any ciry or counry which requires a permit to consiruct, elter, improve, demolish, or repair any sWcture, prior to its issuance, also requires ihe appllcaN for such permlt
to fila e signed statement thet he or she is licensed pursuent to ihe proNsions ol the Caniractore License Law (Chepter 9(commencing with Sec�on 7000) oi Division 3 oi the
Business end Professions Cotle) or that he or sha is exempt therefrom antl the basis for Ihe alleged exemption. Any vlolation of Section 7031.5 Ey any epplicant for e pertr+i
subjects the epplicant to a civil penalry ot not more ihan five hundred dollars ($500).):
Qr I, as owner of the properry, or my employees with wages es �heir sola compensation, WILL DO 7HE WORK, end the structure Is noi intended or otteretl for sale (Sec.
7044, Business and Protessions Code: Tha Coniractors License Law dces not apply to an owner of properry who builds or improves ihareon, and who tloes such work
himself or herself or through his or her own employees, provided that such improvements are not intanded or otterad lor sale. If, however, Iha builtling or improvement is
sold within ona year oi completion, the owner-builtler will have the hurden of proving that he or she did not build or improve tor purpose oi sale.).
❑ I, as owner of the property, am EXCLUSIVELV CONTRACTNG WIT}i LICENSED CONTRACTORS to consiruct the project (Sec. 7044, Business anC Professions
Code: The contracmrs License w does mi appty to an owner ot properry who builds or improves thereon, entl who contracts for such project with e wnimcbr(5)
license pur,Gent to the Contr rs Licpnse Lews.).
❑ lem
Verification oi Ownership by (type oi
Business antl Professions Code for this reason:
�, ❑ No Dnvefs
i.e. - property tax bill or deed): _
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hareby certity Ihat no ezwvation five (5) or more fee� in depth in�o which e person Is required to descend, will ba made in connectlon wlih work euthonzetl by �his
permit, and that no building sWdure, scaHOlGing, falsework, or demolition or dismantling thereot, will be more than ihirty-six (36) feet hig�. (Ghap. 32, Grp 2, Art 2, Sec.
341, Title B, Californla Atlminis�retive Cotle).
❑ As ownerbuilder, I will not employ enyone to do work w�ich would require a permit fmm the Divislon of Industriel Sefety, es noretl a6ove, unless such person hes e
permit to do such work Irom the division.
Signature: Dete:
Division of Industnal Satery Permit Number:
CERTIFICATE OF COMPLIANCE AND AUTHORVJITION OF ENiRY: I certify under penalry ot perjury thet I heve reatl this application and state ihat the infortnation given is
correct. I agree to comply wlih all state laws and ci ' nces releting to building construction, and authodze rapresentatives of ihe Clry of Coste Mesa to enter upon the
ebove-described property for insp i' u es. I re ot to ocyupy or ellow occupancy ot any building euthorized by ihis pe� It until tinel 9i spection.
M �, ,/1.r-/�-G
S � e��� -0 �� -�'7 0� ��
� ,I
Antl/Or Authorized Applicant Date
cooe .. INSPEC
1616 Fized System Final Fire Prevention
1266 Pool Spa Finel
200 Final Re-Roof
201
202
203
Finel BIocWReteining Well
Final Fectory Fire Place
Final Sign
204 Finel Demolition
P� 1[�9L5
COUE I INSPECTION TYPE
206 Final Mechanical
208 Finel Plumhing
270 Final ElecMcal
212 Final Fire Prevention
220 Final Plenning Approval
222 Final Site
250 Final Building/Occupency
2Ag 1NSIDal6
(714) 754-5273 • Faz (774) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address:
Suite No
Vicinity:
Parcel Nunmber:
Applicant:
Address:
owner:
Address
Conirector.
Address:
ISSUE FEE
Temp service test
Res. a/c package
New Res (7-2 units)
New Res (3+units)
Pool / Spa
Lighting Fixts
Recept Outlets
Switches
Non Res Appl
Res Appl
Service to 200a �
Service to t000a
Service over 7000a
Motors to 1 hp
MotOrs to 10hp
Motors to SOhp
Motors to t00hp
Motors over 100hp
Communication drop5
Sub panel to 200a
Pole Light Pkg
Sign Circuits
Temp Pwr Pole
Intermed Pole
2574 OXFORD LN
14137335
SINGH, SURAT
2574 OXFORD LN
COSTA MESA, CA
SINGH, SURAT
2574 OXFORD LN
COSTA MESA, CA
ELECTRICAL PERMIT
Phone: 949-650-1009
Zip: 92626
Phone:
Zip: 92626
Phone:
Zip:
License:
SCOPE OF PERMIT
REF 801-01221. -
1 LIGHT, 1 OUTLETAND 1 SWITCH. � �
1 SHOWER, 1 TOILET AND 1 WASH BASIN.
$23.50
$0.00
$0.00
50.00
£0.00
50.00
$1.10
$1.70
$1.70
$0.00
50.00
50.00
50.00
S0.00
$0.00
50.00
$0.00
$0.00
$0.00
50.00
$0.00
$0.00
$0.00
$0.00
$0.00
Quantity
0
0
0
1
1
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
FEE SUMMARY
Temp Dist System�/ Lighting
Busway/t00N
Standing Section
Misc Electrical Equipment
Transformers up to 1 kva/kw
................up to 10 kvaBw .
.................up to 50 kva/kw
.................up to 700 kva/kw
..................over 100 kva/kw
Low Voltage Equipment
Low Volt Wiring System / Cki
Misc Conduit
Misa Conductor
Circus ( gen or ride)
Circus (mech ride or lights)
Christmas Tree Stand
Fireworks Stantl
Other Electrical Fee
Investigation Fee
Plan Check Fee
Reinspection Fee
TOTALCALCULATEDFEES
COMMENTS / SPECIAL CONDITIONS
Status: ISSUED
Applied: OB/06/2001
Issued: OB/O6/2001
ISSUED BY: `� '
Quantity
$0.00 0
so.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
50.00 0
$0.00 0
S0.00 0
$0.00 0
50.00 0
50.00 0
50.00 0
50.00 0
50.00 0
50.00 0
50.00 0
50.00
$0.00
$0.00
$0.00
$26.80
NOTICE: The work authorized by this permit shall comply with all applicable handirap access requiremenis under California
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become voltl if work is not commenced within 180 days, or if work is susF
for a period of,180 days. . �
INSPECTIONS: In order for the work authorizetl under this permit to be considered legal, such work must comply with all appl
required Inspecttons and tinal approval must be obtained. Failure to obtain insDections and final approval will result in the ezpirat
FOR INSPECTIONS CALL: (714) 7545626
zmase �aroo�
�
tut/e"s and related
led or abandoned
7
tle codes, and all
O� IhIS permil.
WORKERS'COMPENSAnON DECLARAnON:
I heraby aHirtn under penalty oi per�ury one ol Ihe lollowing tleclarations:
❑ I heve end wlll maintein e certificata ot consent to selbinsure for workers' compensetion, es pmddetl tor by sectlon 3700 of ihe Lebor Code, for the pedortnance of the
work for which Ihis pertnit is IssueO.
❑ I have entl wlll malntain workers' campensation Inwrance, as require0 by sectlon 3700 oi Ihe Lebor Cotle, for Ne perfortnance ot Ihe wwk tor which Ihis pertnit is issued.
My workars' compensatlon Insurence carner end policy number are:
Cartier: Polity Number:
(This secfion need not be completed i! fhe permit 15 velued af one hundred dWlars ($100) or /ess.)
❑ I certity Ihat in the peAormance ol Ue work for which ihis pertnit is issuaQ I shell not employ eny person in any manner so es to become subject to the workers'
compenution laws ol Celitomia, entl apree Ihet If I s�oultl Decome suDject to the wOrkers' compensatlon provi5ion9 0l Seciion 3700 Of Ihe Labor CoAe, I shall forthwith
comply with these provisions.
Applicent Signeture: Date:
WAPNINO: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNIAWFUL ANO SHALL SUBIEC� AN EMPLOYEP TO CRIMINAL PENALTIES AND CIVIL FlNES UP TO IXJE HUNDRED
TFIOUSAND DOLLARE (5100,000). IN ADDRION TO TME CQST OF COMPENSATIIXJ, �AMAGES AS PROVIDED FOH IN SECfIIXJ 3]OB OF THE IABOR CODE, INTEHEST, AND ATTORNE`fS FEES.
LICENSED CONTFACTORS DECLARATION:
I hareDy eHirm that I am licensed under provislons ot Chapter 9(commencing with Section 7000) of Divislon 3 of Ihe Business antl Pmfessions Cotle, and my license is In tull
force end eflect. Llc. p Class M
ConlrectoYs Signawre: Daie:
CONSTRUCTION LENDING AGENCV:
❑ I here6y affirtn that there is a consiruction lentling agency for Ihe perfortnance of the work for which ihis pertnit is issuetl. (Sec. 3097, Civil Code).
Lenders Name: Lender5 Address:
Signalure: Date:
OWNER•BUILDER DECLARATIONS:
I �ereby eflirtn that under penelry of perjury thet I em EXEMPT FROM TME CONTRACTORS LICENSE LAW lor ihe tollowing reeson (Sec. 7031.5, Business antl Protesslons
Code: Any dry or counry which requires e permit to construct, alter, impmve, demolish, or repeir eny structure, pnor to its issuance, elso requires the applicant for such pertnit
m file e signetl statement that he ar she Is Ilcensetl pursuem ro the pmvlsions of Ihe Contrac�ors LJcense Lew (Chepter 8(commencing with Sectlon 7000) ot Divislon 3 of Ihe
Busineu end Prafessions Code) or that he or she is exempt Iherelrom end the basis for Ihe elleged ezemption. Any violation at Sectlon 7031.5 by eny applicant tor e pem:.
subjects the epplicant to a civll penalry ot not more than five huntlreA tlollars ($500)J:
�� I, es owner oi Iha property, or my employees with wages as their sole compensalion, WILL 00 THE WORK, and the structure is not Intentled or oflered lor sale (Sec.
7044, Business and Professions Code: Tha Conirectors License Lew does not apply ta an owner of property who builds ar improves ihereon, and who tloes such work
himsetl ar hersetl ar thraugh his ar her own employees, provided thet such imprwements ara not intentletl ar ottered for sale. If, however, the Duilding or improvemen� is
sold within one year ol completion, the owner-builtler will have the burtlen ot proWng that he or sha did not build or improve for purpose of sale.).
❑ I, as owner ot the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the prqect (Sec. 7044, Business antl Professions
Code: The coniractors License Lew does not apply to an owner oi pmperty who builds or Improves ihereon, antl who contracis lor such project with a conlrector(s)
license pursuant t�e Contrectore Licensa Lews.).
❑ I am exemD� � r sec. Business antl Professions Code for ihis reason:
SignaWre: ' ��2IB1 ['
s
Ownar ID v fie y dri s' n.� )Yes ❑ No Drivers Lir�pse Na/' � _Eapres: Ql — o�
Vedticatlon ol Ownership by pype oido ument, i.e. - propeny taz 6ill or tleetl):��—� � �— —��
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify ihat no excevetlon five (5) or more teet in depih inro which e person is required to descend, will be mede in connection with work authonzed by this
pertni�, end that no building sWcture, scallolding, talsework, or demolition or tlismantiing I�ereol, will be more than thirty-six (36) teet high. (Chap. 32, Grp 2, A� 2, Sec.
341, Titla 8, Celitomia Atlminisiretive Cotle).
❑ As ownerbulltler, I wlll not employ anyone to do work which would require e permit Irom ihe Divlslon of Indusinel Sefary, es noted above, unless such person hes a
pertnit to do such work Irom the division.
SignaWre: Date:
Division ot Industrlel Safety Permit Number:
CERTIFICATE OF COMPLIANCE AND AUiHORIZA710N OF ENTRV: I certity under penelry of perjury Ihet I have reatl �his epplica�ion end siate Ihet �he infortnation given is
correct. I agree to comply wilh all sta end ary nances relating to building construclion, end authorize representatives of the City at Coste MeSa to enter upon Ihe
ebove-tlescnbed property tor insp w u ses ^ ee rryt to occupy or allow occupency of any building euthorized by this permit un/til �fin�al'�n. !
/l� (y� CI
, Si a J�� rI �" DAta"'"
AnNOr Authorized Applicant Date
cooe �, wsaeenoNTrve
1616 Fixed System Final Fire Prevention
1266 Pool Spe Final
200 Final Re-Root
201 Final Block/Retaining Well
202 Final Faciory Fire Place
D�TE ��y COpE1 INSPECTIONTYGE
206 Final Mechanical
208
210
212
220
Finel Plumbing
Final Electrical
Flnal Flre Preventian
Final Planning Approval
203 Final Sign 222 Final Site
204 Finel Demolition 250 Final Bui6
7� E I[�,4
i i i
I
PBOJECi qD�BE$S: .� 5`] Q OX FORU LN
OWNEfl'SNpME: SURAT SINGHCHAEL D
PDOHESS: zSi4 OXFORll LN
COSTA MESA,CA 92626
650-3131
NflCH/ENGINEER:
ROOflE55:
HEG.NO.:
uxit:
UNIT:
PEPMITTEE: SURAT SINGA ( 714 ) 650-3131
auoeess: �579 OXFORD LN
' C.M. CA 92626
I LILENSEU CONTHRCTOH DECLABATION: I �erety allirm that I am licensetl un0er pmvisions ol ChaO�er 9(commencing wilh $e[tion
7000� ol Division 3 oI IAe Business an0 Pw�euions Code, anA my license is in Iuil force anG eflect.
CITY IIC.: STATE LIC.: C1A55:
Daie: Sfgnamre:
WOflNENS' COMPENSRiION OECLABATION: I here�y aliirm fhai I �ave a ceM1ilitate oI ton5eni �o sell-insure or a tehifitate Of Work¢rs'
Compensa�ion Insurance. or a cenilietl cooY ��ereai (Seciion 3800. Lab. C1.
POLICY NO.: E%P. DRTE:
COMPANY:
❑ Ce�ilietl copY is hereby fumishetl. ❑ Cenified copy is filed vrith ��e ciry Builtling Division.
Dale: Appliwni:
E%EMPTION FROM WOFKEBS' COMPENSATION OECUMTION: (Ihk seclian neeA mi be<omp�eleA if tAe permt is Ior ane Aun4red �5100) or les5�.
1 certily that in t�e pedormance of t�e work �or which ihis Oermit is issuetl. I shall not employ any Derson in any manner so as �o become
sub�ect to the Workers Compensa�ian Laws oi Cafitomia.
Daie: Signaiure:
NOTICE: II, al�¢r making ��is 4etlaraiion, yoU shoulE Eecome 5u01eCi lo Ihe Workers' Compensation D�ovisions oi the Labor
CoOe. you musl fotlhwith comply with such pmvisions or IN5 Dermi� shall be aeemetl revokea.
CONSTflUCTION LENOING AGENLY: I �ereDy ailirm that ��ere is a conslmciion lentling agency br the peAormance of �he work lor
wnich I�is permi� is issued �Seclion 3097. Ci¢ C�.
LENOFfl:
A�OXESS:
OWNEH BUItoEB OELIANAiION: I hereby affirm inat i am exemo� ��om Ihe Coniraclors' State License Law for Ihe followinq reason
(Section 703t.5 Business and Professional COAe: Pny cily ol county wMch reQuires a permii to consimct, alter, imDmve. Oemolish. or
repair any simqure, D�ior to ils is5uante, also 2puires Ue aOPN�am �or 5uch Oe��� �a �ile a sipne0 s�a�ement Nai he/s�e is licensed
pursuant lo �Ae prOvisions al I�e Con�ractors' Staie LicenSe Law (Chapler 9(commenung vnth Section 7000) o� Oivision 3 0l ihe Business
antl Pmlessions Code) or that he/s�e is eKemD� I�e�elmm antl Ne basis �or lne allegea exemD�ion. Any violation o� Seclion 7031.5 hy
any dp0licanl lor a permil su�lec6 ttle aDD�ican� lo a civil penalty ol not more tAan live �unOreO �ollars �5500).
I, as owner ol ��e O�oDeny or my emDloyees wi�� wages as i�eir mle wmpensa�ion, will tlo ��e work, and ihe
� stmmure is noi in�entled or olieretl for sale (Section 70C4, Business anC Prolessional Code: T�e Contractors' S�ate Licensa Law
Uoes no� apply Io an owner ol a pw0eny w�a �uilJs or impmves I�ereon, antl who Eoes SucA work himself/hersell or �hmuAh
�is ar �er own emDloyees. Dmvitle0 ihat suc� impmvements aie not inlenOeE or aitereA lor sale. If, Aowever the builtling or
improvement is 5014 within one year of tompletion. Ine owner will have Ihe Durden ol pmvinA he/she ditl no� builtl or improve
for Ihe purpose ol sale).
i, as owner ol lne D�aperry, am exclusively conlracting with lirensed comractars lo consvutl i�e pmlaci (Section 7044, Business
❑ antl Pmlessions COUe: T�e Comrac�ors' Sia�e License Law Does not aDPly to an owner ol O�openqwho buAas or improves thereon
anG who tOnlratis �or SUth pmjeCis wiN a tOnira[lOr�s�lic¢nSe OurSuani lo IAe fAntrattars' Slaie Litense Law). I am aware
Ihal Dmoi ol I�eir Worker'S CompensaUon insurance shoulU b pmvided lo me. /J
� I am exem0� untler Seclion: B. 8 P. � �% � �
lor I�is reason: � �
I tlo here�y cenify tha� I a(i%ware ol anE untlerstan0 ��e reQuirements o� Calilomia Heal�h an0 Salery Cotle Sec�ions 25505, 25533, and
2559A and lhat I ar any luture buil0ing occupanl wilVwiO nat (circle one� neetl to comDly wit� said state codes and ihe reQuirements for a
peimil lor cons�mclion or mo0ilication Imm Ih¢ Air Ovahry Manag¢meni Oistrict. ReSidenliai con5imclion applicaiions are exempi �mm
ihese pmvisions.
Oa�e: AO icanl:
I here0y retlify �hal I have read this applicati an0 51aie itwi ihe above iniormaiian is [orrect I agr comply wit� all city antl counry
ortlmancesandsiatelaws�ela�ing�obmltlin ons�Nciianantlher twr¢ere0�esenldlivuofi' ' toenleruDon�heabove-mentioned
pmperry Ior inSDecuon purposes. �
Oa�e: � — SlgnaWre' � �t � /
ori�er's license o� Socia� Seaniy a: _
1641 n6 Whiee—Butlding: Green—CoOe EnlorcemenL Canary—Applitant; Pmk—Revenue: Goltlenrotl—Assessor
CITY OF COSTA MESA — BUI D7NG PERMIT PERM NO; H 05222`
PERMIT NO: B 052225 PLAN CHECK NO: N GOVT: N SUPP; N
CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: DEM
JOB DESCRiPTION : DEMO ILLEGAL BEAZEWAY ADDITION SQ FT:
CLAIM VALUE: 1,000.00 CALC—VALUE: 1,000.00 GROUP OCC: R-3 /
COMMENTS: X
�7F iE 3f� j'r If x- i� if af 1f if lE IE it rt�x- te *�F �F 3f aF 1E �F IE it aE i!� aE 3F x iF IF iF �7E �lF i(� rt IE �lE 3P �F aF aE it� af aF iE if dF if lf ji �f �t af �E if � 1E iE iE x� jF af +EjE i!� 7F x� IF a if iF r. x�+E +E 3F
7. 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 HUILDING ----------
FRNT': FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN
--------- ACCESSORY BUILDING ---------
FRNT: FT TN REAR: eT IN
LEFT: FT IN RGHT: FT IN
PARKING REp • PROV: PARCEL: 14137335 ZNE: REF NO:
PLANNING Nt51'ES>
i
*****�r**v**��r*���*�*�********��**+r�*****�r**��c�r*�*�K*�t�*x�xw�**�x��r**�*�v*x*��**+�+t�
D E V E L O P M E N T S E R V I C E S R E Q U T. R E M E N T S
ZONING APPROVED HY DATE;
BUILDING APPROVED BY : DATE:
APPLICATION ISSUED BY: DATE: ��� Ll
ifi6Kll�iElEaF1E1FifK1E1F1Eif#IEiEiEiEiFiE . aF#iflelfiEiE�YiFif �f
3E IE �F )E iP 1E 1f if IE 1E tf if iE iE if iF iF iblE iE If 1F if iF lE IE aE if iE iE �E if #�F if # iE fF iE # iE aE iE iE iF 3f 3F iE iE if IE iE 3f af� if iE if �74 if if if if Y.� )f iE aE if if iF if iF * iF iE �f iF lF 1f iF
LEGALIZATION:N F E E S U M M A R Y STR[ICTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMT'P 2�.00 '
SMIP/NON—R�S
PLAN .50 .
ZSSUE FEE '
BiJILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAI, PAID � DUE
TOTALS----> 25.50 0.00 0,00 25.50 25,50, .00
REVENUE DIVISION TOTALS--> (:OLLECTED: 25.50 OVER/SHORT: 00
BLDz5P00 PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOO GRADING P,LAN—CHECK
iF iE j! # it if aE IE iE if iF 3t jf� 3F jF if if 1E if 3F 3f ih iF iE if 1f if iE if �f 3E 3E iF aE iE 3f iE �f jF IF jf �E if iF �F �lE iF if # fE iE iF IE 3E if jf iE jE 3F 3E 1f 1E * ie iF �E iE # iE iE if 1f 3e iF if iE �f IE iE
I N D I V I D U A L F E E H R E A K D O W N .'
/1'YPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
NO FEES WERE SELECTED FOR THIS PERMIT .
.._�_ D � 9C��."+"49 :' L�;,L'i ri d� . � • : -
r.i�r:.. c�.a��3i Tt��a !, 1�
L�
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit # Date Inspeeior APpROVALS Permit # Oate Inspector
i. Temporary Electrical Service or Pole 52. Pooi & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms '
4. Electrical Condui[-Undrgrnd. 55. Electrical Bonding
, 5. �Steel Reinforcement 56. Rough Plumbing & Pressure Test
.6. ElectricalUFERGrnd. 57. APPROVALTOCOVER�GUNITE
7. Footings 58. Electrical Conduit�Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P�Trap, O Undrgrnd.
70. Structural Floor System 61. APPROVAL TO DECK .
11. Property Sewer Line & House Connection 62. Backwash & Recep[or-Final
12. Sewer Cap 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 67. Fencing & Access Approval
77. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
79. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace '� - '- APPROVALS Permit # �
21. Ducts, in Structure, 70. Underground Hydro
22. Ducts, Ventilating ' 77. Product'Piping OGas ❑Oil
23: Gas Pipe-Rough & Test � i : 72. Underground Flush
24. Roof Framing ' ' �73. Undergrnd. Storage Tank O 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 F�INAL
29. Insulation � � 78. FIRE PREV. FINAL - .
30. Drywall Nailing i HEALTH�DEPT. REQUIREMENT
31. Plaster Brown Coat , , � 79. FINAL INSPECTION
32. Electrical Power Meter�Final � j••80. FOOD CERTIFICATE ISSUED
i
33. �Final Electric , I i `Notes:
34. Final Heating & Air Conditioning� . I '
35. Final Gas Pipe-Test i � � '� '
36. Hood or Canopy , - ' �
37. Final Factory Fireplace � ' '
�
38. Final Plumbing .
39. Water Service-Final " ' •
40. Gas Service-Final � -
47. Solar pomestioFinal � `
42. Backflow Preventer , , _
43. Backflow Irrigation �
44. Landscape Irriqation SYstem, , � • _ . � .
45. Sound Attenuation -
46. Handicap Regulations � " _
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING �
49. Electric Release to Edison I
� � ,
50. Gas Release to Southem California Gas Co ' � �
51. CERTIFICATE OF OCCUPANCY . , � � .
No. Date
. �
CITY OF COSTA MESA � `
BUILDING DIVISION
OWNER-BUILDER VERIFICATION
A ciry or county, which is required to give notice pursuant to Section 79830, 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 ajor la r and materials for construction of the pro-
posed property improver�en�Yes C��No
2. I have/have not //
( ) � a�� signed an application for a building permit for the
proposed work.
3. I have contractgd with the�following person (firm) to provide the proposed construction:
Name _
Address
Phone (
City
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
Phone (
Ci[y
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 ot Work
I hereby affirm that I have received a copy of the information set forth in Section 19830 of the State
ot California Health and Safety Code and have completed the above information to the best of my per-
sonal knowledge, in compliance with this State law.
Signed:
Name: �/ �
(Printed or Typed)
C.D.L. H or S.S. # -�� /��
754-5273
Date: � � � � I \\
�1
n
�
PB0.IECT RDOflESS: 2 S% 4 OX FORD LN
OWHEfl'SN�ME: SURA1 SINGH
RDONESS: 2S I4 OHFURll LN
COSTA ME$A,CR
� 650-3131
RflCH/ENGINEEfl:
92f+76
HEO.NO.:
uxrt:
AO�flE53: UNR:
YENMITTEE: SURAT SINGH ( 7i4 ) 65U-3131
noosess: 2574 OXFORD LN
C.M. CA 92626
UCENSEo CaNiMCTOfl DECUM7loN: I hereby aflirm tlut I am OcenSeE uMer plml5ions al Cnapter 9(commenpnp xitn Section
7000) oi OiNsion 3 ai tAe Busineu anA Pmlessions CoOe, antl my licensa is in lull lorca anE ellect.
Cltt LIC.: 8Tl1TE L1C.: CUSS:
�ate: Sipretum:
WOXNERS' COMPEN311TION OECUMTION: 1 trereEy aHirm Itwt I Aave a unifiraie al consent to ull�irtcure or a urtifiwte al Workers'
Compenutian Insuance, or a certifieG caOY Ihereal (Section 3800, LaD. C).
PoLICY NO.: E1(P. O�TF:
9MP�NY:
CeNfieG copy is here�y IumisheA. ❑ CeN1iM copy is IileE xit� Ne tlry Bulldin0 �on.
Date: ApDlicant:
E)IFMPTION FBOM WOPKEflB' COMPENS/�TION OECIAIWTION: (�his sectlon nre0 not Oe complete0 if Ne pemit is tar one �uMred �f100) or lar�.
I ceNy that in t�e pedormanca ol ehe work for which lhis Dermit Is issue0, I slull not employ any person in any manner so as to Uewme
su�ie�� �o t�e Workers' Campensation Laws at Califomu.
Oate: Sipruture:
NOTICE: It, atter maldnA �Ns UeUaatbn, you slioNE become wOjecl to tAe Workers' Campe�ation pmNsions ol Ihe LaCar
CoOe, you must forihwilh wmDN ��h suc� provisions or tNs permit shall De EeemeU 2vokeU.
fANSTRUCTION LENOING 10ENCY: I �ereEy atlirm thatthere is a constmction IenEinp apenry for tAa peAormance of t�e work lor
which Nis permit is iuue0 (Section 3097, Civ. C�.
LENOEfl:
FODflE33:
OWNEB BUILOEH UECIAMTION: I herehy atlirm that I am e�ampt from t�a Contraclors' Stah License Law far t�e follavnn0 reuon
(Sectlan 7031.5 Busineu antl Pmfessianal COGe: My dry of counry wOic� requires a permit to consimcl, alter, imDrwe, Eemolis�, ar
repair airy structure, Drior ro its Issuance, also requires I�e appliunt lor SucA Dermit ta lile a siqneA statement that he/s�e k licensed
pursuant to ��e provisions al Ne Contracrors' S[aro Lkense Law (Ctwpter 9(cammenpnp vnih Salion 7000) of Divisron 3 of tAe Businea
anE Profusions Cade) ar that hNshe is eKemD< <heretrom an0 t�e Easis lor ihe alle0e� exemDtion. My Wolatian oi Sectlon 7031.5 Ey
any applicant lor a permit suble�ts t�e apDlicant to a ciNl Denatty ol not more [�an /ive hunAr¢d OWlars (f50�.
^y I, as owner of I�e pmperry or my employees with wapes as I�eir sola compensatlon. vnil Ao the work, and [he
u simqure is not intenae0 or oflered tor sale (Section 70dd. 9usmess anA Proleuional CoOe: Tna Cantractors' State License Law
Aces not apDN �o �n ovmer ol a pmpeM � builOs or imD�oves Iherean, anA w�o tlow such work himsetl/Aersetl or thmuph
his or �er own emplayees, Oravitled t�at such ImprovemenLs am not inten0ea ar atleretl lar ule. II, howev¢r tAe DuilEinp ar
improvement is so10 vnihin one year ol completion, tAe owner will tuve tAe CurAen of proWnp hUs�e Eitl not Gui10 or improve
' for tne purpase of ule).
1, as owner ol the D�oDehy, am exclusively cantractin0 with IicenseC coniractors to canstmct Ne prolect (Section 7074, Business
❑ antl Professions COAe: Tl�e Contractors' Staro License Law Ooes wt apDy to an owner of DmDerry who EmIQs onmD�oves Ihereon
an0 who contracts for SucA pmlects ��tA a contractor(s) license pursuant Io I�e Controctors' State License Law). I am aware
itwt proof of iheir Worker's ComDens:lAn insurance s�ou10 be D�ovitle0 to me.
� I am exempt under Section: B. d P. .
for this reason:
� � � ,
Oaie: Owner.� 1'✓'d
I Uo �ereby certity that I am awam oi anE un0erstan0 t�e requirements of Califomia HealtA anG Safery CaOa Sections 25505, 25533, an0
25534 anE that I ar any luture Ouiltlinp accupant wllVwill nat (circle one) neetl to comply with said state co0es anU t�e requirements tor a
permA for canstmctian or moUilicatian Imm Ihe Air ualiry Mana9ement Distnct. HesiAential constmction aOPlications am exampt Irom
these provisions.
Date: �l_L.J �^_^" � I-1_ FpP' anc _
I hereEy ceNty tlut 1 have aaU this appliwtio n0 state t�at tAe at
ordinances anE state lavrs relaGnp to 6uildinp sirucGan an0 here0
propeRy far inspectian Ourpaus.
Date: ^"L Siqnatum: �
oriver's �iunm or soria� Security x:
matlon Is carrmt. I apme to camply wnh all
reDreuntatives ol Ih¢ ciry to enter upon Na:
1641<6 W�Ita—BuiWing; Graen—COEa Enlorcemem; Canary—Applicant; Plnk—Ravenue; Goldenro0—Aaieasor
CITY Oc COSTA/�c'SA – B�ILDIN � ERMIT PERM NO: B 052411
PERMI'P NO; B 052911 PLAN CHECK NO: U2091-91 S GOVT: N SUPP; N
CONSTRUCTION TYPE: PERMIT TYFE: STR PliRPOSE: ADD
JOB DESCRIPTION ; LEGALIZE 137SF BREE2EWAY SQ FT: 137
CLAIM VALUE: 8,OU0.00 CALC–VALUE: 9,453.00 GROUP OCC: R-3 /
COMMENTS: X
a:- x+4 fE 3F �7F �l: iF 3F-0(� iF iF iR �(� i'r i� 3E if } ie 1E iF iE #� 3F 1PY� iF iF iE�iF %� �k iE aF aF iF 3E jE +E 1F �lf iF iF�F # ai � 3: %� iF �lf 3!-ae �i�Y� #��f aE s; 3F 7(� x. x aE iF 3f'r aF aE?E Y jf ic {c v- }•. �7{.
Z O N I N G R E Q i] I R E N. E N T S
s E r s A c x s �
------------ MA3N HUIi,DI1�?G ---------- --------- ACCESSORY Ht7IL1)iNG ---------'•
FRNT: FT IN REAR: FT IN FRNT: FT It3 REAR: FT Ii�i
LE:T; 5 FT IN RGHT; 90 FT IN LEFT; FT IA' RGHT: FT IN
PARKING REO• 2 PROV: 2 PARCEL• 1413"/335 ZNE• R1 REF NO•
PLANNING NOTES> LcGALIZATTON OF BREE2EWAY CONVBRSION 3ETWr,EN EXISTING GA.'�AGE
> AND RESIDENCE (TO HE JSED AS STORAGE)
iF if If iF 1k i(� if 3E?E ii� 1E * aF iF 3f k if �% IF if N� iF iE iE N� K� af if 3F iF iF i4�7F jE if ib Ih aF 3F # 3Ejf 3E if ih% IE iE % T'�iE 1E iF iE # iF if �I(� R K iF * 34 �K iF iE fE iF 3� 3F iE'* iF 3F iE �. i�. } i(.
D�. 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 APPBOVED 3Y C-,(i DATE:��"%
BUILDZNG APPROVED BY : DATc:
APPLICATION ISSUEll BY: /�— DATE;, �?���� ���' – _\\
�if ie iF ��]F �]F it #F 1F if iE K 14 d! iF jE if iE 3F }?i� iE3F3r�TalFiF iF it ii iTiF7F3F�itiF�F�iFiFRiFiF3�iFTv3F irTFi?'iF%i€T�i� IE ie ±6?i� tc * if ii� iP ie r #
iE if� iF K i6 af if iF ih it ii R li� iP ic )E ?M1 iE Ik af M� iF iE iF if� i6 k ir IE if if iF k*Y� iF �k 1E iE 3i� 9E iE iE i� iF iF 1E �7F,f i%IF # Ih 1E �li if k 1( !F k� A� %� lf iE i6 f6 3ej'r4E iE 3e )E !G M� iE k� 1F iF ih
LEGALIZAYION:Y F E E S U M M A R Y STRUCTUR�AL�S�GNENT:Y
BLDG PMT FLUMHING ELECTRIC MECHANIC FIRE SMIN/RES' GRADII3G
PERMIT 234.U0 .55
SMIP/NON–RtS
PLAN 152.10
iSSliE FEE
BUILDING–DIV–> PERMTT ISSUE PLAN–CHcCK
TOTALS----> 234,95 0,00 76.05
REVENUE DIVISION TOTALS--> COLLECTED;
BLDG PMT FLUMBSNG ELECTRSC MECHANTC
234.OQ
TOTAL FAID Di7E;
311,00 311.00 ,OU
311,U0 UVER/SriORT: ,OU
FIAE SMIP/TOT GRADING PLA73–CiiECK
.95 76.05
k iE-%iF 16 �1'r if iF 3i� jE if 3E �% # if * iE if 3'r �k i+ �f #'� i(� lf iF K!E �E 1E iE # i(� if 3E ih %� iE 3f iF i(� 3(� If 1E k� 3F jE af 3F k�Y%K K� 3F i6 k K� �f K� N�+E iE d'r 3e 3e 7'r #k 3? ii-iE �f #� 3E it i(� N� iE iF
� Z N D I V I D U A L r E E B R E A K D O W N
TYPS QiY D E S C R't P T I O N UNIT COST TOTAL COST
SFR 137 DWE–TYPE V–WOOD FRAND OF FEES –GOOD 69.00 9,453.U0 �
' i�i, " ' ;r_ ; n
` l�
�I..T' � .. ' . . .. . ..
/' _ _ . . _"`
L�
CON .fRUCT10N AND PLANNING � P� f SPA
APPROVALS Permit # Date Inspector AppROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcemeni
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�Undrgmd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Test "
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P•Trap, O Undrgrnd.
10. Structural Floor System 67. APPROVAL TO DECK "'
11. Property Sewer Line & House Connection 62. Backwash & Receptor�Final
12. Sewer Cap 63. Heater & Vent�Final
13. Roof Drains 64. Plumbing SVstem - Final
14. Rough Plumbing 65. Electrical-Final
75. Rough Electrical-Conduit 66. Solar SYstem-Final
16. Rough EleGtric Wiring 67. Fencing & Access ApProval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING �
18. Rough Electrical�T Bar Ceiling � 69. POOUSPA SYSTEMS FINAL
79. 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 �Gas ❑Oil
23. Gas Pipe�Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.StorageTank OGas ❑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. Drywall Nailing ��� � HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electfic 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
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irriqation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING � Z(, Q`
48. FINAL PLANNING �
49. Electric Release to Edison '
50. Gas Release to Southern California Gas Co �
51. CERTIFICATE OF OCCUPANCY
No. Date
CITY OF COSTA MESA
BUILDING DIVISION
OWNER-BUILDER VERIFICATION
A ciry 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.
7. I personally plan to provide the ajor labor and materials for construc[ion of the pro-
posed property improvement. �Yes ❑ No
2. I (have/have not)
proposed work.
3. I have contracted with
Name �e / -�
signed an application for a building permit for the
following person (firm) to provide the proposed construction:
Address � City
Phone ('] �u) �C/� `3 /,�_ Contractor's lic. No. � � 2 `L ^ �� �
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
Phone (
City
Contractor's Lic. No..
5. I will provitle some of the work but I have contracted (hired) the following persons to pro-
vide the work indicated:
Name Address
Phone Type of Work
S'r��f �...�li 9.S'7y 9�Fo,-� �,�( CoS� �N�iE•r
�!�—�2�2 �
I hereby affirm that I have received a copy of the in(ormation set forth in Section 19830 of the State
of California Health and Safety Code and have completed the above information to the best of my per-
sonal knowledge, in c pliance with thi State layv.
// �Signed: � n�� �'k �'/ H Date: �76 N M 2 4 f
Name: �'u J���"" �/ /--(�/�
(Printed or Typed)
C.D.L. N or S.S. # ���
754-5273
,wz.e
1
.
�
7POJECT AODXESS: z S% 9 OX FORD LN
OWNEfl'SNPME: SLIITSKE MICHAEL D
AOOflESS: z S% Q OX �'ORD LN
COSTA MESA,CA 92626
650-3131
PPCHIENGINEEX:
ADUflESS:
sec.No.:
UNIT:
PEPMITTEE: CUSTOM ROME IMPROVEMENT ( 714 ) 898-3116
aooeess: 15472 DUKE CI
H,H, CA 92647
LICENSEO CONTPPCTOB OECLAMTION: I �ertEy afii�m Itul I am Iken5e0 unEer D�ovisqns oi ChaO�er 9(commencinp wilh $ecli0n
7000� ol Oitision 3 ot Ine Business antl Pmfession .Cotle. an0 my IicenSO is In tull lorce an0 ellect.
arruc{.:0532/37 sTnTcuc.�2987 / /cLL�99ss: _A /�/7
oate: l /� � L�� Siqnamre: _/�! / _ — ' �
WOflNEPS' COMPENSRTION OECIABAT10N: I �ere0y allirm t�at I tuve a cenilitdt¢ of consenl ta sell-insure or a cenilicate al Workets'
Comoensalion Insurance. o� a tRrtdied copy tner¢ol �Section 3900. La�. C1.
'OLILY NO.: EIIP. ORTE:
'OMPANY:
i �] Cendietl coOY is �ereUy Wmis�eE. ❑ C¢rtiliea wpy is �ileE mN I�e ciry BuilOinp Division.
Date: Appliwni:
EXEMPTION FflOM WUNKENS' CUMPENSATION OECIANpPON: (itrs SE[Ipn nred roi Oe compkte0 il Ilk p¢rml is lor one �unErN (5700� a Ie55�.
I ceNty thal in I�e perlwmaMe o� Ihe wah Iarw�h tks oermit a issuetl. I snau noi empby am oerson io airy manner w as io eecome
subletl to I�e Workers Com en5aiion Laws /o/' Caiilomia. / �' �/ ���//
oate: �'7 / 4 � ' SlgnaWre: �/ � " "�
�
NOTIC : II, a�ter making Illis tletlaration, y0u S�oNA �¢tome SuDI�� �o I�e Wofkers' Comoensation provisions ol �Ae Laboi
Code. you musl fontmil� compty wit� Suc� provisions or ttis permii 51u11 Oe aeeme0 mwkeE.
CONSTflUtTION LENOING �GENLY: 1 �ereCy affirm tiut I�ere ¢ a[onStNctqn IenEing aqene/ lor the pehormance of iM work lor
w�it� this Oe�mi� is issuea �Seclion 3097. Gv. C�.
LENOEP:
aooeess: �
OWNEB BUILOEfl OEQAfiAT10N: 1 �ereGy allirm tlial I am exempt Imm rtie Conlraciw5' Stale LKense �aw lot l�e I011ovrinp reason
(S¢[tion 7031.5 Business an0 Pmlessqnal CuCe: Any uty ol fAunty wNcn r¢puiRS a pefmil Io con5irutt. alter. imD�ove, tlemolish, ar
fCDdif d0Y S�NC�YfP. D�iOf IOIIS ISSIIdOCC. d150 flQNfQS (�E dppl1Cd11I IOf SYL� OEflfll� Ip�110 d Slqfl24 SIdICI11C0I I�dl ilE/ShQ IS IIC205C4
pursuam to �ne orovisiort ol me Canlractws' Sta�e Lkenu Law (Cnaph� 9(camme�np wiN Secuon 7W0) ol 0ivision 3 of i�e Business
antl Pw�esvons COUeI or Ilul �e/She is ehempt t�e�elrom anG I�e EaLs for I�e all¢peC eKemplion. My vioWlian UI Seclion 7Q71.5 by
any applicani lor a permii suElecls I�e appliWn� lo a d'ril p¢nalty ol noi more ItWn live �uMreG OotlaR �SSOfI).
I, as ownet ol ihe pmp¢ny or rtry em Iayees wilh wdpes as ineir Sole compen5ation, will Aa IAo wark, ana Ihe
rJ simcWre is not imenCM o� ofleie0lor sale I�tion 76+4. Busmeu ana Roleuimal CaUe: Tne Lomracmrs' Stam Liunse Law
Eoes no� apply to an owner ol a D��7etly wtw OuiWs or impmves t�ereon, anC who Oou 5uU wark �imselV�ersell or thmu0h
�is ar �¢r own ¢mployee5. OmviQeO Ihai 5ut� imp�Ov¢mMls afe noi intrn0e0 Or O�lered lOr sale. II, how¢ver I�e EuilAinp Or
impmvement is sdG v.it�in one yedr ol tUmplelion, ��e Owner xill luve I�e buMen ol provinA ��she Eitl not builE or improve
! Ior ine ourpose al salel.
I. as owner ol Ihe D�opehY. am eaUusNety rontrapinp vnl� IicenseG coniracmrs Ia wnsUutl Ihe pmleci (Seclion 7004, Business
❑ ana Pml¢Ssions CoGe: TA¢ fqnlraclOrs Slate Lk¢Me Law Uo¢5 not appty to an owne� ol prop¢riy wlio EuAds or imD�oves t�ereon
ane wno conVacis Ior su[11 O�qecls witA a Contractorls) license purswnl to the fAninctors' Slate Licensa Law�. I am aware
I�a� pr00i ol IM1eil Workei 5 COmD¢n5d�i0n ill5uf3nt¢ SIIOu10 0¢ pfOnd¢G 10 m0.
� I am enempl unaer Seciion: B. 8 P. C.
br t�is reason:
�ale: �M'ner:
I Oo hereby cenity rtidt I am aware al an0 un0erstand the reQuiremenls ol Calilomia Heallh an0 Safely COAe Sections 255�5, 25533, ana
25534 antl ihat I or any fuWre �uilOmg acu0ant wiNvnll nol (circle one) neea to tampty wilh saiG stale co0es an0lhe ieQuiremenls for a
permil fai consim[Iion or moCil¢aiion Imm Ihe Air uably Managemenl @5Irk1. He5i0entul COnSlructi0n applicaiions are exempi Imm
I�ese pmvisions.
Daie: AOP�icanl:
I her¢Ey cerUly iha� I �ave reae Ihis apphWiion an0 Iaie Ihai I�¢ aUwe in�ormaiion is torrttl. I agree to tOmpty wi�h all Ciiy anC [ounly
ortlinancesanaslalelavrsielatinglobuilNngtonsl ctionanaherebyamhor¢erepresenlativesol�luscirytoenterupont�eaEove�mentionetl
pmperry lor inspeclio/n purposes.
Oa�e: �/Z(�/ 5 � ignaW�e: / /
�
o���er's ucense or sociai secudty s_
t6nt�a6 WM1ne—Bmltling; Green—Cotle Enlorcemenl: CanarY—!PPlicanl: Pink—Revenue' Goltlanrotl—Pssessor
CITY OF COSTA MESA — BUZLDING PERMIT PERM NO: BP 05219
PERMIT NO: BP 052198 PLAN CHECK NO: N GOVT: N SUPP; N
CONSTRUCTION TYPE; PERMIT TYPE: PLU STR PtJRPOSE: OTH
JOB DESCRIPTION : DEMO ILLEGAL ADDITION, RESTUCCO FRONT SQ FT: 2,000
CI,AIM VALUE: 2,000.00 CALC—VALUE: 2,OU0,00 GROUP OCC: R-3 /
��***********�D***�****�x**x$*�*����#��***`+��*��***D��r�*�****+�******�r�r�t***x�*x�*�
Z O N I N G R E Q U I R E M E N T S
5 E T B A C K S
------------ MAIN BUILDING ----------
FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN
--------- ACCESSORY BUILDING --------
FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN
PARRING REQ• PROV: PARCEL: 14137335 ZNE; REF NO:
PLANNING Nt5'I'ES>
�
3f iF lF iF �F # fE 3F 7Eif iE �f if iE if if if �E if 3F iE iE 3f aE 3F �1F iE iE �lE if if �lE iE if� if 3F iF 3f lf iF �7(� iE 3f if iE #jF IE 3f )f 3E if if� IE iE 3E If� �)f �lf if iE iE iE iE IF 3f 1F 3!� iF * If iF �F 3E iF iE 3E if ii
D E V E L O P M E N'P S E R V I C E S R E Q U I R E M E N T S
ZONING APPROVED HY DATE: '
BUILDING APPROVED BY : DATE:
**�*��***�***��**D��*� � ��**D*�*�* Z �, �**
iF iF if if jF iE iF iF iF iF 3E If IE iF 1E iE if ih if 9E 1E iF iF IE 1i iF if 1f 1F fE iF if if iF iF ir If if 1FiF if iFif if iF �E if if 3f if IF iF iF iF iF 1f iF if �f� if� IF iF i6 iE IE if 3f �)f If if iE if 1F iE 1F IE if 1E if
LEGALIZATION:N F E E S U M'M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADItJG
PERMIT 95.00 8,25$ ,50
PLAN
ISSOE FEE 3.00
BUILDING—DIV—> PERMIT ISSUE
TOTALS----> 53.50 3.00
PLAN—CHECK
0.00
REVENUE DIVISION TOTALS--> COLLECTED:
BLDG PMT PLUMBING ELECTRIC MECHANIC
45,�� 11.��
SMIP/NON—RES
TOTAL PAID DUE
56.50 56.50 .00
56,50 OVER/SHORT; .00
FIRE SMIP/TOO GRADING PLAN—CHECK
1E ik �1F iE fP If lf if if iF IF iF If i61F 1E fE # M-If iE If iE M iF iF iE M� aE if ff %1E M IE k IF 3E if if iE iF k dF 1E 3E )f� iE iE if iF if if IE 3f if� iF if K ih * 1E 1f iE i!� af if iE if If iE ii IE ff if� )f if iF iE
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
SFR 2000 ALTER BY VALUE RESIDENTIAL NOZONE 1.00 2,000,00
PLU 1 BATHTUB 2.00 2,00
PLU 1 SINR BAR 2,00 2,00
PL[J 1 WATE{t CLOSET ( TOZLET ) 2. 00 2, 00
PLU 1 GAS SERVICE 2.00 2,00
END OF FEES ��/ /
/ �' , }/
u Y
l�'1 ��IiC`�ib1'��]i)$i;bi .. ` '
3ATE: 05/:'�?I7: Tii.': _ ..
�-
CONSTRUCTION AND PLANNING F .& SPA
APPROVALS Permit # Date Inspector APpROVALS Permit # Date Inspector
1. Terraorary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. $[eel Reinforcement
3. Electricel Conduit Utility-Undrgrnd. 54. Forms
� 4. Electrical Conduit-Undrgrnd. 55. Elect�ical Bonding
5..Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
. 8. Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Water PiPe-Undrgrnd. 60. Backwash Lines, P�Trap, O Undrgrnd.
10. Structural Floor System ' 61. APPROVAL TO 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 �a�Q( (�(� 65. Electrical�Final
15. Rough Electrical•Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
77. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electricat-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rou9h Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit # '
21. Dutts, 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 O Gas � Oil �
25. Roof Sheathing 74. Overhead Hydro
26. T�Bar CB�ling (Structural) & Monocoat •• 75. Dry Chemical �.
27. Frame and Flashing 76. Dry Standpipe ' � �
28. Lathing & Siding � � 77. F�XED $YSTEM FINAL-
29. Insulatipn � . � � 78, FIRE PREV. FINAL
30. Drywall Nailing �HEALTH DEPT. REQUIREMENT
� 31. Plaster 6rown Coat 79, FINAL INSPECTION
32. Electricel Power Meter�Final � � 80.�FOOD CERTIFICATE ISSUED
33. Final Electric ' Notes: . � ,
34. Final Heating & Air Conditioning � , �
35. Final Gas Pipe-Test . ' � '
, 36. Hood oi Canopy � � . � •
37. �Final Faccory Fireplace ' ' •
' 38. Final Plumbing . - � - ,E�. ��
39. Water Service�Final � -
40. Gas Service-Final - . '
41. Solar pomestic-Final !
42. Backflow Preventer � . ; , �
43. Backflow Irrigation �
44. LandscaPe Irripation System . ' � ' ,
45. Sound Actenuation ' .
46. Handicap Regulations ' � .
47. F1NAL STRUCTURE & BUILDING �l ��
48. FINALPLANNING .
49. Electric Release to Edison �
50. Gas Release to Sou{hem Califomia Gas Co ; ;
51. CERTIFICATE QF OCCUPANCY
No. Date
PFOJECTPOOflE$S:�`579 OXFORD LN
OWNEfl'S NAME: ��UTSY.E MICHAET.. D
p��S' 2574 OX�'ORD LN
t -
'COSTA MESA,CA 92626
pqLHIENCINEEN: 6 5� — 3 1 3 1
' nooeess:
XEG.NO.:
UNIT:
uNiT:
PEflMITTEE: CUSTOi'I HOME IMPP,OVEMF,NT ( 714 ) 898-3116
RODNESS: SS4%2 DUKE CI
H.B. CA 92697
LICENSEo CONTflAC70fl DECUMiION: I hereGy athrm ihal I am littnsea uMer DroWsians af CIiaO�er 9lcommencing witn Seclion
7000� ol �iv.sion 3 0l ��e Busineu anU Pmless///i���ppp555 Coae. an0 my license is in tull lo¢e anG eHect.
cirv uc.: 3�3 � STATE UC.: �( q Z y 8 �/ cuss: /
Date:? ��� � �Sigreture: �� �
WOBKEHS' COMPENSATION UECLAflATION: I �ereGy allum t�at I IWve a ceniliWte of cort5enl to ull�insure or a unifitate af Workers'
Comoensa�ion insurance. or a cemliea copy inereoi (�ction 7800. LaO. t1.
POLICY NO.: E%P. OFTE:
COMPANY:
� CetlifieC copy is her¢�y �um6lle0. ❑ CenilieG coOY n �ile0 wit� t�e dry BuJainO �sion.
Jaie: ApDticant:
EIEMPTIONFROMWOBNEflS'COMPENSRPONO NATIQN: (iNssectbnneearro�oecompleteOilthece��ploroirchuMreC�Et001orless�.
I cerlify Ihai in Ihe pedormance oi I�e work � whic� I�is permit is issued, I stwll nol employ any perian in any manner w as lo become
sublect lo ihe Workers' ComDensation Law ol Cahfomia. � /
Da1e: � 3 � — r � Signa�ur¢:
NOTICE: II. afl¢r making Ihis tleClar IiOn. you S�oV10 beCOmC Su61�� �o ��e Warkers' CamDenutian pmvisions ol ihe Labor
Coee. you must fonhwilh comply witn such provisions or tnis oermit shall be aeemeC revoked.
CONSTflUCTION LENOING PGENCV: I herety affirm I�a� I�ere is a ConSimction Iending agenty for I�e OeAormance oi t�e wark tor
whicA I�is permit i5 i55ueU (Seciion 3097, Civ. C�.
LENDEfl:
AOOPESS:
OWNEfl BUILUEfl UECLAPRTION: I �ete0y allirm Itlal I am exempi IrOm III¢ fAnlraClors' State License Law lor tne Iollowinp reason
�5¢tiion 7031.5 BuSineiS an� Pm�e55i0na1 COEt: Any rily 01 cauniy wNt� re0uire5 d pErmil IO mnSVut�, ali¢r, impmv¢, demalish. or
repair any situcture. prior to i6 issuance, also r¢puires ine apWicant lor sucn permil lo Iiie a sipnea statemenl inat nelshe is licensetl
pur5uanl io I�e Omvisions al tha CONraciors' Sia�e License Law (CIUD�er 9(cammencinq wit� Seclion 7000) al �ivision 7 0� I�e Business
an0 Pmfessions CoEe) Or Ilwi he/5�e is e�¢mpi U¢�¢��am an0 t�e Ga95 IOr l�e allepe0 eaempii0n. My vidalion ot SeciiOn 7031.5 by
any aoWicant tor a permit subjttts the aOWirant io a cidl penalty ol nol rtqre Uwn live nunOmO aolWrs (5500).
I, as owner ol iAe D�openy or my em byeu wllh wapes as t�ei� sole compen5aiqn, wiil Aa Ihe work, anG tha
❑ simcmre ¢ noi intendeE oi offeretl for sale (�twn 70ad. Buvneu an0 Prof¢ssianal CoCe: Tne Contractors' State License Law
eoes no� apD�Y to an owner oi a D�ooeny wM ouilas orim0�oves tnereon, ana who aoes sucn woh nimself/nerseli or t�mupn
�is or Oet own empbyles, prM'iae0 I�ai suc� imprOvemenls am nol intenEM o� oflereG tor Sale. 11. �owever tN! OuilOinq or
improvemem is saltl witNn one year ol comdetion. ��c ovmer eiil Nve Ihe GurGen of O��np �Ns�e Oi0 not OuiIG or im0�ove
lor Ihe purpose af Salel.
I,dS OWIICfOi Iht O�OQGM1y, drt12MU115NC1y COtllfdCI100 WIIIIIIfRM1tEA COItlIdC�OfSIO COf15INLi IOE D�01lL�4SCC�10117UAE, BI15111P55
❑ and Prolessions CaE¢: IDe ConVaclws' Stare License �aw Eo¢5 irot apPly io an ovm¢r ot Dmpenp wlio UwWs or im0�wes chereon
aM w�o wnlratl5 Ior Sut� Drojetis wii� a cOntra[Iar�s) IKMS! Wrsuani lo I�e COnlraCiorS' State Lxense law). I am aware
Ihat prooi al I�eit WorkeYS Lompen5alion inwranca sMUIG �e p�unGeOlo m¢.
� I am exempl under Section: 8. 8 P. C.
lor I�is reason:
Oa�e: Gmer.
I Oo �ere�y ceney �nai I am aware ol ana un0erslanG 1he repuiremems ol Calitomia Health an0 Salely Coae Sec�ions 25505, 25533, and
2553< ana i�at I or any luwre �utlamg occupant vulUvnll no� (cirtle one) neeG ta tromON •+�� ��� state coGes and Ne iequiremenis lor a
permii lo� consimc�ion or m00ilicatian Imm Ilie Air Oua41y Mandgertren� Dairkl. fleSaenGal tonsVuction appliwtions are erempi Imm
inese pmn5ions.
�ate: A licanl:
I here�y ceridy IAaI ��averea0��i5 aD�licalioi ana s�ale I�a�i�e a0oveinlormalioni5 corr¢CI.Iagaeio comply vnlh allcily antl counry
ortlinancesannstalelamreWlingto0mldmgc simaronanOhereOyautlprrzerepmsentativesaliksdrytoenterupon�hea6ove-memioned
properry �orinSDecliLan OurOases.
Date: / _�I'4 R gnaWie: /
Orivefs License ar Saul SecurilV 4�
Applicent: Pink—Revenue; GoldanraC—Assessor
CITY OF COSTA MESA — HUILllING PERMIT' PERM NO; P U5315'i
FERMIT NO: P 053157 PLAN CHECR NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: PERMIT TYFE: PLU PURPOSE; OTH
JOB DESCRIPTION : LEGALIZE WASHER IN GARAGE, RE:#BP52198 SQ FT;
CLAZM VALUE: CALC—VALUE; GROUP OCC: R-3 /
COMMENTS: 20FT BY 20FT TO MAINTAINED CLEAR IN GARA
it-if �E *!e �1F iE �E �F ie �E if 3E i(� ah iF if aF af-i4 x� �f 3f i� iE ?f if �E K iF N� Y� 1E iE it- ak iE �14 iE ae jh 16 x- �E R K iF iF if x� x- # iF iE+i 3E aF IE jE ae 3F+F 3E k iF tF if # If iF k# i(� i� +F x� iF M� ie
7. O N I N G R E Q U I R E M E N T S
S E T H A C K S
------------ MAZN BGILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN
PA.^�KING REp • PROV; PARCEL; 14137335 ZNc: REF NO:
PLANNZNG N6'fES>
>
�j43e aE IE if ik iE IE iF 3E 3F �F iE 3F �1F 3E If 1F * IF IF i6 iE IF jF 3f if aE � If �1f� �f i6 if ji if �]E iE dE 3E IF iE if aF aF9E 3F iE )E IF iF k iF �e iF if �E if iF aF iE±F 1E i41E iF af If IF �F 3E if )F X� K- R iF �f�
D E V E L O P,M E N T S E R V I C E 5.; R E Q U I R E M E N T S
ZONING APPROVED BY DATE:
Bi7ILDING APPROVED HY ; � DATE;
APPLICATION ISSUED BY; � DATE•
if•�lEiEiFiElFififiEi(�ifiFiFlf�afllEibiElEiE# . . �EIFY�ifib#F�]Ykif* •� �i47e
iE iF 1f #� iE Ik if 1f iE if 3f #F IE iE iE 1E fF if It i£ iE if iF ie k if k IE �f iF Ik �F if if if if If 1F 1E 1f it fE iP iF ie iF ie ir N� iE IE aE i� 16 R iE ic if 1f if i6 #' 1f iE iE iE aFlf iP If Ir 3f ii IF i ie If if af
LEGAL27ATION:Y F E E S II M M A'R Y STRUCTURAL SEGMtNT:N
�:
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 4.00 '
258 � SMTP/NON—RES
PLAN
ISSUE FEE 3.00
BUILDING—DIV—> PERMZT ISSUE FLAN—CHECK TOTAL PAID DUE
TOTALS----> 4.00 3.00 0.00 7,00 7.a0 ,00
REVEiJUE DIVZSZON TOTALS--> COLLECTED; '1.00 OVER/SHORT;' 00
BLDG FMT PLUMBING ELECTRIC MECHANIC FIRE SNIP/TOT GRADINCy.,PLAN—CHECK
%.Q� �j
if #?F ii� 1F iF iE ie # 1F if If k iF if if i!� iF i(� iE iE # iF 1F iF 7!�!f 1F lf iF i'r iF iE R if ic iE lE iF iE ie i!� 16 #f IE df if M� �6if if iE if� if If if �f iF a('!f if iE fE �F i'r ff if �lE iE i� #'� fF fi * ii�� IE I(� ih
I N D Z V I ll U A L F E E B R E A K D O W N
TYPE QTY D E S C R Z P T I O N
PLU i LAUI�DRY TUB OR WASHER
END OF rEES
UNZT COST
IC�y1i�1�Ki7�.Yi11
�i �0�7S.7.a`-1�Gaz:S', -�"��'r
D'iT�: Oi'3I.';1 Tii � ._ --
i�
CO�TRU�TION AND PLANNING POO� PA
APPROVAL3 Permit # Date Inspector ,4PpROVALS Permit # Date I�spector
7 Temporary Electrical Service or Pole 52. Pool & Equipment Location
�. �il Pipe-Undrgrnd. 53. Steel Reinforcement
3.` Electrical Conduit Utiliry-Undrgrnd. 54. Forms
4. Electrical COndui[-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure 7est
6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE
7. Footings 56. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P�Trap, O Undrgrnd.
10. Struaural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backw3sh & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Orains 64. Plumbing System � Final
14. Rough Plumbing 65. Electrical�Final �
15. Rough Electriwl�Conduit 66. Solar SYstem-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
77. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Elecuical�T Bar Cei�ing 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
22. Ducts, Ventifating � 71. Product Piping O Gas OOiI
23. Gas Pipe�Rough & Test 72. Underground Flush
24. Roof Framing . 73. Undergrntl. Storaye Tank � Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro
26. T•Bar Ceiling (Structurall & Monocoat 75. Ory 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 �SSUED
33. Final Electric . Notes:
34. Final Heati�g & F,ir Conditioning
35. Final Gas PiPe-Test I
36. Hood or CanopY
37. Final Facto�Y Fireplace
38. FinalPlumbing F/�,/�j� ��0 �pr�
(/ ( •' -- �
39. Water ServiCe�Final
40. Gas Service�Final
41. Solar pomesticFinal
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irriqation System �
45. Sound Attenuation .
46. Handicap Re9ulations ,
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING •
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co � .
51. CERTIFICATE OF OCCUPANCY -
No. Da[e
I
PflOJECT N�OPESS: 2 j 7 q OXFORD L�
OWNEF'SNpME: SLUTJKL� MICYIAEL D
FDOflESS: .�y-74 OXFORD LN
" COSTA MESA,CA 92626
AFCHIENGINEEfl: 6 5 �— 3 1 3 1
AOUHESS:
flEG.NO.:
UNIT:
UNIT:
PEPMITTEE: CUSTOM HOME IMPR()VEMENT (714)898-3116
RDDflESS: 1J4%Z DUKE CI
H.B. CA 9264'1
LICENSED CONTHPCTOP �EQAPATION: I hereby aifirm that I am licensea under pmvisions o� C�apter 9(commencing wiM Section
7000) ol Dfvision 3 01 the 6usiness antl Pmles5ion5 CoOe. and my license is in lull lorce antl eflect.
c�uc.:r5. 3'1�STpTELIC.:522987 cuss:B
Signamre: . �
WOBRERS' COMPENSpTION OECUIPATION: I hereby affirm Ihat �ave a cenificale ol consent to self-insure or a cenificate of Worker5'
Compensa�ion Insurance. or a certitietl copy �hereoi (Sec�ion 3800. Lab. C).
POLICV NO.: EXP. DATE:
COMPpNY:
Z � Cenifie0 copy is �ereby Wmished. ❑ Cenified copy is filetl with ihe cily BuilAing Division.
e: Applicant:
E%EMPTION fBOM WORKEflS' COMPENSATION UECLAPRTIOR (iAis seciian need noI 0e cample�e0 if the permil is for one hundretl (5100) or less�.
I cetlify Iha� in Ihe Oertormante of Ihe work lor which t�is permii is issued, I shall n � emplay any person in anner so as �o �ecome
su0iec� �o �he WorkpJe-Lom�enytion Laws of Calilornia
.�ti
�: � —3 � Signa[ure: �
NOTICE: Ii, afier making �his Ueclaration, you shoultl become subject to the Workers' Compensa�ion pmvisions ot �he Labar
Code. you mu5i lo��wi�h comply vn�h such pmvisions or Ihis Oe�mil shall be aeemed revoked.
CONSTHIICTIDN LENOING PGENCY: I hereby a�firm I�a� Ihere is a constmciion lentling agency for �he pedormance o� Ihe woB �or
whic� I�is permii is issue0 (Seciion 3097. Civ. C�.
LENOEH:
ADOflESS:
OWNEfl BUILDEB OECLl�BBTION: I here�y a�firm �hal I am exempl imm ��e Contracmrs' Staie License Law br �he f�llowing reason
(Section 703L5 Business and Pmlessional Cotle: Any cily oi county which �equires a Dermil to constmct, aller, impmve, aemolish, or
repair any s�mc�ure, pnor lo ils issuance, also requires lhe applicanl tor such permi� Io �ile a signe0 5ta�emeni ihal he/she is licensetl
pursuan� Io �he pmvisions ot 1he Contratlors' State License Law �ChaD�er 9(commencing w��h Semion 7000� oi Oivision 3 of ihe Business
antl Pmlessons Cotle) or I�aI helshe is exempt there�mm antl Ihe �asis �or [he allege0 exemption. Any violation o� $ection 703L5 by
any aOPlicant lor a permi� sublec�s the applican� to a civil penal�y o� noi more �han five huntlred tlollars �$500).
I. as owner al ihe properiy or my employees with wages as their sole compensa�ion, will tlo �he work, and the
❑ siNCNreis notlnlen0ed or offere0lorsale�Section 7044, Business and ProtessionalCode: 7he Coniractors' State license Law
tloes no� appty to an owner ot a pmperty who builds or improves ihereon, antl who does such wad himselflherself or �hrough
his or her own emDloyees. O�ovidea ihat such impmvemenls are not imenaea or ottereA for sale. If. Aowever t�e building or
� improvemen� is sold withm one year ot completian, I�e owner wtll have t�e burtlen o� pmving �e/she di0 no� builtl or impwve
for the Ouroose of sale�.
I, as owner o� ��e pmperty, am exclusively contracting with licensed conVacbrs lo constmc� lhe pmjecl (Seclian 7044, Business
I� antl Pm�essians Coae' T�e Contractors' Siate License law Coes noi apPN �o an owner of pmperty who builds or impmves Ihereon
ana w�o coniracts �or such pmjecis wiih a coniractor(5) license pursuan��o I�e Contractors' Sta�e License Law�. I am aware
', �ha� pmot of their Worker'S Compen5aiion insurance shoultl be pmvideJ Io me.
I� I am exemp� under SeClion: B. 8 P. C.
lor �his reason:
Dale: bwnec
1 do hereby ceniry that I am aware of anA unOerslan0 �he repuiremenis of Calilomia Health and Sa1ery COAe Sections 25505. 25533, antl
25534 and Ihat I or any fuiure builtling occupant will/will nai (circle one) need to comply wrth saia s�ate cotles antl the requirements tor a
permit lor canslmclion or motlification Imm ��e Air Ouali�y Managemem Districl. ResiAential cons�mction applica�ions are exemp� from
Ihese p�Ovisions.
Oate: ApPlicanC
I hereDy cerlily Ihal I have rea0ihi5 apPlica�ion and siate�hal Ihe aboveinforma�ion is correci. lagree�o comply with alicily antl coun�y
orainances anA staielawsrelating�a builtling cons�mc�ion an0 hereby aut rizerepresenta�ives olthis ci�yio en�eruponih ve-mentionetl
o�ooerly brinspeclion purposes.
� i
"Uate- � S $ignaiure:
Drivei's License or Social Sewmy x: � �
164v46 White—Building; Green—Cotle EnlorcemenL Canary—ApplsanL Pink—Revenue', Goltlenmtl—Assessor
,` -- -- --��
CITY OF COSTA MESA - BUZLDING PERMZT PERM NO: B 05228
PERMIT NO: E 05�2$8 PLAIv CHECK NO; N GO�'1: N SUPP: N
CONSTRUCTION TYPE: V-2� PERMIT TYPE: ELE - PURPOSE: OTH
JOB DES(:R.lPTION : DEMU ILLEGAL AllDITIC)N, RESTUCCO FRONT SQ FT;
CI.AIM VALUE; CALC-VALUE: GROUP OCC: k-3 '/
CONiMENTS; REFERENCE BUILDING PERNIT #BP052198
***�*�r��e*xx�*���*���*��**x�**�**����+�x*�+�**�**����������c��*x���**x�cx�**�*��*��*x
Z O N Z N G R E Q TI I R E i4 E N T S
S E T B A C K S
------------ MA1N BUILDING ------ --- --------- ACCESSORY BUTI:DING --------
FRNT: FT IN REAR; FT IN FRNT: FT IN REAR: FT IN
LEFT; F'T IN RGHT: FT TN LEF1': FT IN RGHT; F1 IN
PARKING REQ• PROV; PARCEL; 19137335 ZNE: REF NU:
PLANI3ING N01'ES>
> "
aE iE 1F if R 3E-lE 1E iF �F if �1't IE 3f 3f 1E iE iE iE iF X� K� �f IF if jF 1E �E� 3F if dE )E 3F.iE }f 3F i(� if iE iE IE #� 3f i'r )f 1E IF jE 1F iF W if #'� !t iE #'� 3E 1f i(� i't K� �F iP � Y.� 3f �P 3F df 3f IE jE 3f 3E }:� iF if iE id
D E V E L O P M E N T S E R V T C E S R E Q U I R E M E N T S
ZONING APPROVED BY DATE;
BUILUING APPROVED BY : DATE:
APPLICATION ISSUED BY:�� t LATE: 6'-� C/
1FjfiF�lE3flE1fif34jF3E3EihaFiEifiE�7FiEIF�1Fif f �� FiF�i�iF�)(�1fiElEk�ififlfiFlEiF£"i�'�'4FC�'�)t
�ikiflE%3EiE1EfFiEiElEiEi¢�1FiE3EiFiEiF3ficiF%iElelFRifiFK�3i�i(�ii�iFifYifiFit3F3fi� .iFif�ici43FIFiEiEjFi63EiFlEifiFiEaf3Ei41E76M�3hiEjfifiEiE3E3Eihif3f3fiE�%
LEGALIZATION:N F E E, S U M M A R Y STRiJCTURAL SEGMENT:N
HLllG PMT FLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRAPING
PERMIT 9,75
50� 5MIP/NON-RES
YLAN
ISStJE FEE �15.00
BUILDING-DIC'-> PERMIT ISSUE P-LAN-CHECK TOTAL PAID DUE
TOTALS----> 9.75 15.00 0,00 24,75 29,75 ,00
REVENUE DIVISION TOTALS--> COLLECTED: 24.75 OVER/SHOR't: ,(?0
BLDG PMT PLUMBING aLECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
�4,75
1F 1E 9P 3t 3E if� iE af �E iE �f 1E 1EiF ib iE IF 3F iF �E if iE af ##� 1k iE 1f iF �f iF i4 1@ iF?E it iP f6 �E ii iF 3F 3F iE iF if if M� if 1F ii�jF k aE iE 3E iE iElf �K if i(� i(� #f iE 1E iE 3F iF 3f iF �E iE 3e iE iE-1k if *
I N D I V I D 0 A L F n E B R E A Ft D O W N
TYFE QTY D E S C R Z P T Z O N iJNST COST TOTAL COS7'
ELE 1 FIXTURfiS LIGHTING 1 5T 20 EA. .75 75
ELE 10 RECEPT/O�JTLET 1 ST 20 EA, ,75 7.50
ELE 2 RECEPT/ST+IITCH 1 ST 20 EA. ,15 1.SU
END OF FEES
�,
O1 OOOE�h29-G��(�''s"a'�2:. '�.M ; . .
DfiTE: C',•„urJ+"7. T;?'� :G'-
C'°' ��'C
. � �
CONSTRUCTION ANDPLANNING POOL. . �
APPROVALS Permit# Date Inspector AppROVALS Permit# Date Inspector
F:; ,
1: Temporary Electrical Serviceor,Pole 52. Pool & Equipment Location .
2. � oil Pipe-Undrgrnd. � y 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.
8. Foundation i 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe�Undrgrnd. _ 60. Backwash Lines, P�Trap, O Undrgrnd. �
10. Structural Floor System � 61. APPROVAL TO DECK �
11. Property Sewer Line & House•Connection ' 62. Backwash & Receptor-Final �
��
12. Sewer Cap �• �
� 63. Heater & Vent�Final
13. Roof Drains � � 64. Plumbinq System � Final
14. Rough Plumbing . �� 65. Electrical-Final
15. Rough Electrical�Conduit ` 66. Solar SYstem-Final ,
16. Rough Electric 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 DEPT. REQUIREMENT
20. Rough Factory Fireplace � APPROVALS Permit #
21. Ducts, in Structure _ 70. Under9round Hydro
22. Duas, Ventilating � 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test ' 72. Underground Flush
24. Roof Framing � 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. fioof Sheathing 74, Overhead Hydro
26. T-Bar Ceiling (Structurall & Monocoat - 75. -Dry Chemical
27. Frameand Flashing 76. Dry Standpipe
28. Lathing & Siding ' 77. FIXED SYSTEM FINAL .
29. Insulation ' � 78. FIRE PREV. FINAL
30. Drywall Nailing ; HEALTH DEPT. REQUIREMENT
37. Plaster Brown Coat � .�� 79. FINAL INSPECTION '
32. Electrical Power Meter�Final � ' S0. FOOD CERTIFICATE ISSUED
33. Final Electric � r No
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test � , '
36. Hood or Canopy � � �' .
i
37. Final Factory Fireplace , � ' � " ' '
38. Final Plumbing �
39. Water Service�Final
40. Gas Service-final , �
41. Solar pomesticFinal �
�
42. Backflow Preventer � I � '
t
43. Backflow Irrigation
44. Landscape Irripation System � '
45. Sound Attenuation
46. Handicap Regulations � � � �
47. FINAL STRUCTURE & BUILDING �'
48. FINALPLANNING� " �
49. Electric Release to Edison
� 50. Gas Release to Southern California Gas Co ! �
51. CERTIFICATE OF OCCUPANCY . ,
No. Date
,
OWNER COLI.ECE PA.RK ' DATE 12—lj—rj(j
JOBADDRESS 2571� Ox£ord Lane BUILDINGPERMITNO. /I(lO%O
GENERALCONTRACTORH3I't70T COASt• CO• VALUE� u�POO.00
L 21 BLOCK TRACT 272�7 Res. 1T�Ci8t, �az'.
INSPECTIONS DATE
Footing Trench /—� � �
Foundation Forms and Grade to Garage
Rough Framing /y.f
Plumbing, Rough to Slab
Plumbing, Rough Camplete • vyj, ^�s 3' •S-
Temporary Pole
wiring, ttougn h1AR 4 9�7 1
Heatino. Rouoh / � :
l ig, In Out
Plastering
Plumbing, Final, Fixtures Co
Plumbing, Final Gas Test �
Wiring, Final
Occupancy
FOflM 110 9M �O�•v5
—!(
SUBCONTRACTOR
PERMITS ISSUED
DATE � NUMBER
Costa Mesa Building Department � APP�ICATION FOR PERMIT
' �� 171 EA3T 20th STREET a� 1�, � U B L D i N G �
� -'��.vaiia mtah, cNurvttrvin - �
FOR OFFICE USE ONLY
FOR APPLICANT TO FILL IN Reeeipt No. Permit No.
6u��a�og I �o • 0
Address 2 � QX ORD �AN
Costa Mesa, Ci8��017118� Received by Date Rec'd. Date Issued
Nearest � — �—J �2—�� s�
CrossSt. HA R �i Building
Address
Owner � Costa Mesa, California
Mail
Address 2 � � 6 $O. MA I N $T . Nearest
Tel. Cross St.
City SANTA ANA CALIF. No.KI Zo I No.oT I Type �rou
A rch itect or Lic. P�a^$ �
Engfneer No. Appro W
b Date
ddress COILRECTIONS
� ' CitY LIc.
-.�;;f�tracMr�-iAR80R CpNST: O No. 3 6�
Address $AME
Legal Lot I
Description No.21 siock I Tract2 26
(Attach Metesand Bounds)
No. of Bldgs.
SizeofLot (�� � NowonLot
O
Useoi I No.of I No.of 77
Existing Bldg. Familles Rooms �
Setback Line from Rear Vard Z
Center of Street � Side Vard y
DESCRIPTION OF WORH �
New I X I Alteration I I Addition I
0
Repair I Moving I Demolish
Building No. of
Size 1379 Rooms Stories .
'erior Wall I Roof —
er�ny covering APPROVALS I
use of New Foundation Location Ins eCtor Date
Building R 5 DENCE & DETACHEO Forms,Materials, P
Under-Pinning
Frame: Fire Stops, N
Bracing, Bolts
I hereby acknowledge that I have read this Application --�
and state that the above is correct and agree to comply Lath. Int. �
with all City Ordinances and State Laws regulating �r
building construction. Lath. Ext.
Signatureof
Permittee HARBOR CONSTRUCTION C0. P�aster,�nt.
Aulhorized Agt. Plaster, EUL p
Valuation Permit Fee $ v�C Fi � Masonry Reinforced M
� �� 200 , Plan Check $� 7� gond Beam �
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� �� Fee $ e� — FINAL o
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' PLOT PLAN
Show Ioeation and distaneeg from
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OWNER JO"IES, H�riT'V L. DATE q_��,_['7
JOB ADDRESS 257�1 0.'tford L2,'le BUILDING PERMIT NO. 5731
GEN�FRA� CONTRACTOR O�vner plllldet VAL[IE $ 180 00
11'A "No. LOT 'I'RACT FIRE ZONE DESCRIPTION OF WORK Wooden Fence
� UP TYPE ZONE PLAN NO. �821
INSPECTIONS � DATE � gUBCONTRAGTOR
cont
Gas Test
ITS ISSUED
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COSTA MESA BUILDING DEPARTMEPIT
P. O. BOX 317
COS7A MESA CAUFORNIA
C•L. OF STREET
' __�iPROP.
� 10 FT. FOR 60 FT. S
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60 FTI ST.
�_ C.L. OF STREET� � _�
MAX4IMUM 4 FT. FENCE MAY BE PLACED ON DOTTED LINES------
MAXIMUM 6 FT. FENCE MAY BE PIACED ON SOLID �INES
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FOR APPLICANT TO FIId. IN
BUILDING
Mail /Ad'dres .+�5 ��(- �JK /=o �h I_a. PI C
City ( osTl� _ ��'� t��r4 — — —Ph. No.� _ � _Z i 9L
Contractor �.�/�� � Ph. No.
City Lic._No. _ _ _ _ _ _ _ State Lic =No. ^ _ _ _ _
Size of Lot t,a j��� AP No. ��-3 - 3 S J "r��
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Setbacks: C/L Street Sa � Rear Z9
Side Yard - Right .� ' � Left 5
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Type of Fence �400! EP� " ��V �C �
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I hereby acknowledge that I have read this application and state
that the above is correct and agree to comply with all City Ord-
inances and State �is regulating byi�Clina_sonstruction.
VALU
by
FOR OF`F'ICE USE ONLY
7
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Permit Fee $ � '"'
{J O � Plaii Check $ � T
TOTAL FEE $ � �'
USE REVERSE SIDE FOR DETAILS