HomeMy WebLinkAbout2000 MONROVIA AVE - Building Permits\
ytp M
4 CITY OF COSTA MESA
� _ � BUILDING DIV/SION
� � DEVELOPMENT SERVICES DEPARTMENT
J
yq,�� �p PERMIT
�4pQ�Q R'
(714) 754-5273 • Fau (714) 754-4856
Job Address:
Suite No
Vicinity:
Parcel Nunmber:
Applicant:
Address:
2000 MONROVIA AV
42250518
LARSON, DAVID
23722 VIA SAN GIL
MISSION VIEJO, CA
Owner: LARSON, EDITH A TR
Address 2000 MONROVIA AVE
COSTA MESA, CA
Contracror. .
Address:
ISSUE FEE
Temp service test
Res. a/c package
New Res (1-2 units)
New Res (3+units)
Pool / Spa
Lighting Fizts
Recept Outlets
Switches
Non Res Appl
Res Appl
Service to 200a
Service to 1000a
Service over 1000a
Motors to 1 hp
Motors to 10hp
Motors to 50hp
Motors to 100hp
Motors over 100hp
Communication drops
Sub panel to 200a
Pole Light Pkg
Sign Circuits
Temp Pwr Pole
Intermed Pole
200 AMP SERVICE CHANGEOUT.
1 SERVICE TO 200a.
$23.50
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$30.50
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Quantity
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
ELECTRICAL PERMIT
Phone: (949)458-9372
Zip: 92691
Phone:
Zip: 92627
Phone:
Zip:
License:
SCOPE OF PERMIT
FEE SUMMARY
Temp Dist System / Lighting
Busway /100 ft
Standing Section -
Misc Electrical Equipment
Transformers up to 1 kva/kw
................up l0 10 kva/kw
.................up to 50 kva/kw
.................up to 100 kva/kw
..................over 100 kva/kw ,
Low Voltage Equipment
Low VOIt Wiring System / Ckt
Misc. Conduit
Misc. Conductor
Circus ( gen or ride)
Circus (mech ride or lights)
Christmas Tree Stand
Fireworks Stand
Other Electrical Fee
Investigation Fee
Plan Check Fee
Reinspection Fee
PE IT NUMBER
oo'oOV�v
77 FAIR DRIVE, COSTA MESA, CA 92626
status: ISSUED
Applied: 07/13I2000
Issued: 07/13/2000
ISSUED BY:
Quantity
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
so.00 0
$o.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00
$0.00
$0.00
$0.00
TOTAL CALCULATED FEES $54.00
COMMENTS / SPECIAL CONDITIONS
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void it work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days. �
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspectiona and flnal approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of Ihis permit.
FOR INSPECTIONS CALL: (774) 7545626
/
WORKERS' COMPENSATION DECLARATION: � ��
I hereby ettirm under penalry oi perjury one of ihe tollowing tleclarations:
❑ I have antl will maintain a certificate of consent to self-Insure for workers' compensation, as providetl for by section 3700 of the Labor Coae, for ihe pertormance of ihe
work for whiCh thi5 permit IS i5suad.
❑ I have entl will mainiain workers' compensatlon insurance, as required by section 3700 of the Labor Cotle, tor Ihe pedormance of Ihe woM For which this pertnit is issued.
My workers' compensation Insurance carrier and polity number are:
Carrier Policy Number:
(This section need no( be completed i! (he permlt is velued at one huntlretl dollars ($f 00J or Iess.J
❑ I certity that in the pertormance of the work for which this permit is issued, I shall not employ any person in eny menner so as to become subject to the workers'
compensation laws of Califomia, and agree thet if I should become subjact to the workers' compensation provisions oi Section 3700 of the Lebor Code, I shall forthwith
comply with ihese pravisions.
Applicant Signature: Date:
WARNING FAILURE TO SECURE WORKERS' C01dPENSATION COVERAGE IS UNLAWfUL AND SHALL SU6IECT AN EMPLOYER TO CFIMINAL PENALTIES AND CIVIL FINES UP TOONE MUNDRED
THOUSAND OOILARE (5100,000), IN AODITION TO THE COST OF CAMPENSATIIXJ, DPA4IGES AS PROVIOED FOF IN SEGTIIXJ 3]O60F THE LABOR CODE, IMEREST, AND ATTORNEV'S FEES.
LICENSED CONTRAC70R5 DECLARATION: '
I hereby aHirm Ihat I am licensed under pmvisions of Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Cotle, antl my license is in full �
force and ettect. Lic. x Glass x
Contraqors SlgnaNre: ' Da�e:
CONSTRUCTION LENDING AGENCV:
❑ I hereby aHirm that there is a consimction lending agency tor the pertormance of the work tor which ihis permit is issued. (Sec. 3097, Civil Code).
Lender's Name: Lendels Adtlress:
Signawre: Date:
OWNER•BUILDER DECLARATIONS:
I hereby aflirm that untler penalry of perjury ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business end Professions
Code: Any ciry or counry which requires a permit to constmct, alter, improve, demolish, or repair eny siructure, prior to its issuance, also requires the applicant tor such permit
to file e signed statement ihat he or she is licensed pursuant to the provisions ot the Contractors License Lew (Chapter 9(commencing with Section 7000) of Division 3 of ihe
Business and Protessions Code) or that he or she is exempt therefrom and the basis for the alleged exemplion. Any violation of Section 7031.5 hy any applicant tor a permit
sub�ects the applicant to a civil penalty of not mora than five huntlred tlollars ($500).):
,$L I, es owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, entl the strucNre is not intentled or ofleretl for sale (Sec.
7044, Business antl Professions Cotle: The Contractors License Law does not apply to an owner of properry who builds or improves thereon, and who tloes such work
himself or herself or ihrough his or her own employees, provided that such improvemenis are not intended or oHered tor sale. If, however, ihe building or improvement is
sold within one year of completion, the owner�builder will have the burden of proving ihat he or sha did not build or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSNELY WNTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business antl Profassions
Code: The coniractors License Law does not eppry to an owner ot propeny who builds or improves thereon, and who contracts for such project with a contrecror(5)
license pursuam to the�onifactors License Laws.).
❑ I am ezemptynder se .� Business and Professions Code for this reason:
by dnver's license. ❑ Yes ❑ No Dnvefs Licensa No. �� .�{] �� Expires:
Venfication ot Ownership by (type of document, i.e. - property �ax bill or tleed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no escavation five (5) or more feet in depih into which a person is requiretl to descend, will be matle In connection wiih work authonzetl by this
permit, and that no building siructure, scaflolding, falsework, or demolition or tlismantling ihereof, will be more than �hirty-sia (36) feet high. (Chap. 32, Gry 2, An 2, Sec.
341, Ttle e, California Administretive Code).
❑ As owner-builtler, I will not employ anyone to do work which would require a permit from the Division of Industrial Satety, as notetl above, unless such person has a
permit to do such woric irom the division.
Signawre: Date: __ _
Division ot Industrial Safety Permi� Number:
CERTIFICATE OF COMPLI CE D AUTHORIZATON OF ENTAV: I certify under penalty of perjury ihat I have read Ihis application and state that the information given is
correct. I agre o comply i h I tate laws antl ciry ortlinances relating to building construction, and authorize representatives of tha Ciry of Costa Mesa to enter upon the
ebove-d scribe property i n�ect'ion —purposes. I agree not to occupy or allow occupancy of any builtling authorize�d7by ihis pertnit until final inspection.
� bAb� W ✓ ` ! � �'�� �
`igneture Ot Legal Owner(s), Datb
And/Or Authorized Applicani
CODE 1. INSPECTIONTYVE
1616 Fixed System Final Fire Prevention
i266 Pool Spa Final
200 Final Re-Roof
201 Finel BIwWRetaining Wall
202 Finfll Fectory Fire Place
203 Final Sign
204 Final Demolition
2446 46
��L�I�IJlL/1�j
�
CODE� INSVECTIONTYPE
206 Final Mechanical
208 Final Plumbing
270 Pinal Electncal
212 Final Fire Prevention
220 Finel Planning Approval
222 Final Site
250 Final BuildindOccuoan�
DASE
ai
IJIIILI�
, _
� � �� �� ��� ���
OWNER-BU[LDER
VER[FICATION
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 permi[, require the completion and require the retum of, an
owner-builder verification.
Atten[ion Propetty Owner.
An `owner-builder' building perntit has been applied for in your name and bearing your signamre.
Please complete and retum this information in the envelope provided at your earliest opportunity to avoid
unnecessary delay in processing and issuing your building permit. No buildine permit will be issued un[il this
verification is received.
L I personally plan to provide the major labor and materials for construction of the proposed
property improvement. �C Yes ❑ No
2. 1(have/have not) NJ� �J� signed an application for a building pertnit for
the proposed work.
3. 1 have contracted with the following persoo (firm) to provide the proposed construction:
Name
Address
Phone (
City _
Contrac[or's Lic. No.
4. I plan to provide portions of [he work, but 1 have hired the following person to coordinate;
supervise and provide the major work:
Name
Address
Phbne(
City _
Contrac[or's Lia No.
5. 1 will provide some of the work but 1 I�ave contracted (hired) [he following persons to
provide the work indicated:
Name
1042-46 (REV.9/98)
Address
Phone Type of Work
I hereby affirm that ( have received a copy of the infortnation set foRh in Section 19830 of the State
of California Health and Safety Code and have completed the above infortnation to the best of my personal
knowledge, in compliance with this State law.
Signed: � '�
Name: I/1�VlI� �-ni �j`-�v
(Printed or Typed)
C.D.L. # OR S.S. # �%��� �
Date: � �.��-'0�
For more information call City of Costa Mesa Building Division at (714) 754-5273.
iaz-�e (aev.asel
RECORDING REQUESTED BV
AND WHEN RECORDED MAIL TO:
NFME
SiqEFf
A�OPE55
CIiV.SiRTE 8
Ziv CooE
�
�i=�"'.ii����J !i ��G,`i���j_
��.i :��;ui.�i`Si ��L i l.iV`i �
/ %� / .�:;�/ /Jl
� ✓� � i � � .' /
_ ' i% i�,���ii%
,�";7—`---� ,�r •–
� SPACE ABOVE THIS LME FOq RECORDER'S USE
�m���iinivi���o�o�uiae�����uiaiaii. a000�aiaia����������viaiaa�o�������iii�������iaaai, a�o��uiaoii�.�������� �io�
SPOWER OF ATTORNEY - �ENERA� I�ncludesoptional DURABLE POWER OF ATTORNEY]/
KNOW Att PERSONS BY THESE PRESENTS: That t, F��� � %.�E?"b/jf
the undersigned (jointly or severally, i5 more than onel hereby make, constitute and appoint l_T')� �f [�f�.�f / (j1
J��r�LA,�Sa�t/
my irue and lawful Attorney for me and in my name, place and stead and for my use and benefi[:
(a) To ask, demand, sue for, recover, collect and ieceive each and every sum of money, debt, account, legacy, bequest,
interest, dividend, annuity and demand (which now is or hereafter shall become due, owing or payablel belonging -to or claimed by
me, and to use and take any lawiul means for the recovery thereof by legal process or otherwise, and to execute and deliver a
satisfaction or release therefor, together with the right and power to compromise or compound any claim or demand;
(b) To exercise any or all of the following powers as to real property, any interest therein and/or any building thereon: To
contrecc for, purchase, receive and take possession thereof a�d of evidence of title thereto; to 4ease the same for any term or
purpose, including leases for business, residence, and oil and/or mineral development; to sell, exchange, grant or convey the same
with or without warranty; and to mortgage, transfer in trust, or otherwise encumber or hypothecate the same to secure payment
of a negotiabie or non-negotiable note or performance of any obligation or agreement;
(cl To exercise any or all of the followina powers as to all kinds of personal property and goods, wares and merchandise,
choses in action and other property in possession or in-action: To contract for, buy, sell, exchange, transfer and in any legal manner
deal in and with the same, and to mortgage, transfei in trust, or otherwise encumber or hypothecate the same to secure payment
of a negotiable or non-negotiable note or performance of any obligation or agreement.
(d) To horrow money and to execute and deliver negotiable or non-negotiable notes therefor with or without security; and
to loan money and receive negotiable or non-negotiable notes therefor with such security as he/she shall deem proper;
(e� 7o create, amend, supplemeni and terminate any trust and to instruct and advise the trustee of any trust wfierein I am
or may be trustor or beneficiary; to represen[ and vote stock, exercise stock rights, accept and deal with any dividend, distribution
or bonus, join in any corporate finaricing, reorganiza[ion, merger, liquidation, consolidation or other action and the extension,
compromise, conversion, adjustment, enforcement or foreclosure, singly or in conjunction with o[hers of any corporate stock, bond,
note, de6enture or other security; to compound, compromise, adjust, settle and satisfy any obiigation, secured or unsecured, owing
by or to me and to give or accept any proper[y and/or money whether or not equal to or less in value than the amount owing in
payment, settlement or satisfaction Ihereof;
(f) To transact business o5 any kind or class and as my act and deed to sign, execute, acknowledge and dellver any deed,
lease, assignmr,nt of lease, covenant, indenture, indemnity, agreement, mortgage, deed of trust, assignment of mortgage o� of the
benefi�ial interest under deed of trust, extension or renewal of any obligation, subordination or waiver of priority, hypothecation,
bottomry, charter-party, bill of lading, biil of sale, bill, bond, note, whether negofiable or non-negotia6le, receipt, evidence of debt,
full or partial release or satisfactionof-mortgage, judgment and other debt, request for partial or full reconveyance of deed of trust
end such other instruments in writing or any kind or class as may be necessary or proper in the premises. ,
(gl [Strike if not applicableJ This Power of Attorney shall not be affected by subsequent incapacity of the principal (and
shall rerhain effective for a period of years after the disabfllry or incapacity occurs�.
Ih) (Sr �k 'f r r M I _ e effectiv (and shall
terrmirr e �ncspactiiyAcee�sl.
(i} ff �g) and/or Ih} are not stricken, the Notice at the top of page 2 applies.
Page i of 2
Belore you use this form, lill in all blanks, and make whatever Chan9 es
are appropria�e and necessary to your pariicular vansacUon. Consult a
lawyer If you doubt Ihe form's h;r.ess for your purpose and use. WOIcoVs
makes no reprnsenlation or �varran[V, express ar implied, with respect [o
THlS FORM 45 NOT VALID FOR HEALTH CARE DECISIOMS. themerr,hantabiliryoriimessofthisformtoranintendeduseorourpose.
(Us? `Nolcotts Form 1401 (or Ihat parpose.) I� �IIIIIII II I�I I�I
•,`/OLCO i TS :ORta ta00 � POtvEq Of AiiORUEY � GENERnL
�mcNnasootlo�+a��URAR�EPp4VEROFATTORtlEY1.Rrcv.M1-95 (Pd¢da«JIl) �L905WOLCOLTSFO�MS.�RC
, 67775 39400 � v
�� i,a�,�axc,-•xri�,c��t,��rM�vriir��nv.w�. . �h��������
NOTICE 70 PERSON EXECUTING DURAB�E POWER OF ATTORNEY:
A durable power of attorney is an important legal document. By signing the durable power of attorney, you
are authorizing anotiier person to ar,t for you, the principal. Be(ore you sign this durablo power of a[torney,
you should know these important facts:
Your agent (attorney in tact) has no duty to act unless you and your agent agree otherwise in wri[ing.
This document gives your agent the powers to manage, dispose of, seil, and convey your reaf and personal
property, and to use your property as securiry if your agent borrows money on your behalf.
Your agent will have ihe right to receive reasonable payment for services provided under Ihis durable power
of attorney unless you provide otherwise in this po�ver of attorney. �
The powers you give your agent will continue to exist for your entire lifetime, uniess you sta[e that the
durable power of attorney' wi11 last for a sfiorteT period of time or unless you otherwise terminate the durable
power of a[[orney. The powers you give your agent in this durable power of attorne�� will continue [o exist
even if you can no longer make your own decisions respecting the management of your prOperty.
You can amend or change this durable power of attorney only by executing a new durable power of
attorney or by executing an amendment through the same formalities as an original. You have the right to
revoke or termirtate this durable power of attorney ai any time, so long as you are compeient.
This durable power of attorney must be dated and must be acknowledged before a notary public or signed
by two witnesses. lf it is signed by two witnesses, they must witness either �1) the signing of the power ot
attorney or (2� the principal's signing or acknowledgment of his or her signature. A durable power of attorney
that may affect real property should be acknowledged before a notary public so thai it may easily be recorded.
You should read this durable power of attorney caretully. When effective, this durable power of attorney
will give your agent the right to deal with property that you now have or might acquire in the future. The
durable power of attorney is important to you. If you do not understand the durable power of attorney, or any
provision of it, then you should obtain the assistance of an attorney or other qualified person.
GI VING ANO GRANTING unto my said At:omey fuli power and auchority co do and perfcrm all anc =�rery act aad (hing •r�hatsoever
requisit=, necessary or appropriate to be done in and about the pr=mises as f�lly to all inten.s and ��.:rpcs?s as I might or could do
if oerscnallY Present, hereby ratffying aN ihac my said Attomey shall lawfully do or ca�se to oe ccnz by virtue of ihese presents.
The po•:+ers and authority hereby conferred upon my said Attorney shall 6e apolicable to all real and o=rsoral property or intsrests
therein now owned or hereafter acquired bY me and where�rer sltua:=. -
My said Attorney is emoowered hereby to determine in hisiher soie discretion the time r+-.=n, ?urpose for and manrer in
which any power herein conferred uoon him/her shall be exercised, and the conditions, provisions aco covenants of any instrument
or document which may be executed bY himlher pursuant hereto; and in the acquisitio� or.disoosi;icn �f real or personal property,
my szid Atromey shall have exclusive power ,o fix the terms Ihereof `cr cash, credit and/or proper;y, and if on c;edit �,vith or wi:hout
security.
bVhen the context so requires, the masc�line gender includes the feminine and/or neuter. =_r�' ;h= singular numb=r includes
the plural. .
WITNESS my hand Ihis ��-..day of %k�y ,�0��_.
.T—
= L� r ry� '-" � u : � •-e/
STA � _ oF �.�� �c
cour�Tv oF /%i-��,, �
On � � �-Q- before me, ��.�_� ���
�o rE� ' �nnvE. rir�e ec o.��<ea.,.e. �e ocx. >:,,-> �„�=ur�
perscr,aliy appeared ��l�.-��j f-_ � ZVSiJ h
�.�a.... �- S�G'�iat5�
perscrally kno•.vn to me (or proved to me on the basis of satisfar,:ery =videnc=) to be [he person(sl •.�hose nam=15) is/are ;ubsoiSed
to L�•= •::i,hin instrument and ackno��l=dged [o me tha! helshelthey =reru:=d th= same in hislheritheir authorized caoacity(i=s1, and
that c�i ��s/herltheir sic�nature�s) on thz ins,rument the person(s), or the =n;ity upcn behalf of v:hic^. :`= personis) acted, =xecu;Ho
[he ins7ru,��ert.
':'lIT�dESS :ny hand and offic:a� seal. � - LINDA J, CAFrEY
� � COMM;..1224074 �
���t .
" �. ��.�vtxrr�n �
/�����i�� -- ---- - __,: � :, ,.".. _�z�murrr [�
�'""-"-'y,i;:.",� C�c:.��. � crJJVIY9,<"C93 �
�,•�� r,oriar� t:r.�;=r p=nalrt/u� Perlerv nnder the 1aw; ;.` [!�q c' � c�� tl�at [he persun •.:, _'^cnzd or ackno�.vf=,^=� this
cnr,�.:— �c7 is �e*s^naliv knn•::n ,o i;s ;or pro�•ed to us on ,h= ��r.is �^.. -nnvinr.�ng evldence! ;c _3 :h,=, princip�l �.vho sign=d or
ae'e.nr.::'�jg=d ;i�i5 d�:irab{e po:ver o( arior�wV in o��r {xesenc�. c, _,�,_.. 7his day n(
_.._. __ __ _.__._..—___ ____.__
� .,, .; .�..;.::
....r�.;ss�
TH!: - :;i i:: ;!C'�i �,,:L�D FOR i.ir. �,. �� ,_: __ ..�r.:^iOi!.';. ._. .. - .: . � ,. . .
- �..:,� v;-. . _ ��,., �-. .... -.... �.:r• ",:,crr�n:=..:
,�_ - _, _
AOiPE550FBUILOMG: zOOO MONRdVIA AV uxr:
t i:MlER9N19EIFq10WN: LARSON, EDITH A TR �
�,00nEu: 2000 MONROVIA AVE .
COSTA MESA CA 92627
714) 548-7�i23
�vv�. wuuxo wox�ss:
MCXIfECT OR ENtlNEEP: L1G NO.:
AXCN.OqF1x.3AWpE55: , UNT:
1 ,
CONIIi1CTOR'SNAYE ,q�qRE ( 714 ) 241-7902
CONIqACTOP'SMNIJNG 3042 S. ORANGE .
■ wuxess: SANTA ANA CA _ uc.ra.: 473042
92707 uxr
LICRlSED CONTRRCTOflS DECLAPRTION: I MreLy Mim uMx pe�1y d pmjury ihet I em Icenaed uMer porivwu ot Chepw 9
'(mmmenarq Mi�h Sec�im ]000) d Diriaion 3 d Ne Buri�u eM PMneions Cod�, ub mY u�enea b in tull brca vM eflecl.
crrvuc.No.:049126 uc.cuss: g u� 973042 EXP: 10/95
� ,. - 9f ��,��: 1�,1"��ri/��,�.��-
IEH BUILDEX OECLAFRTION: 1 hereby e(firm umier perely d perjury Ihet I em eRemp Imm tM Cmtredae Licenae Lew la iM
idlow'vig roamn (`�ion 103t.5 &niwsa vM Proleuiom Cale: R�ry cry a couny �^'Aidi niuiree e partnX to epuwn. ellx. impwe.
�� demoleh, or repei eny n�ruciure, prior w as'sauance, elao repuiree iM epplirent la auch pmmn ta file e agrieE sleiemenl Mel M a aM
i u licensad Wn�e�l lo �M provibions d tho Canlreclps Lironaa law �Chaqer 9(ewnmemnp xil� SeGion )OW) d Div'vian 3 d the
Businass eM Prdeseions Code� or ihe� he or Me e ecemq iherelrom aM Ihe buia lor Ne eAaped ezamqion. My volelion ol Setlon
]U�t.5 by enY aPW� lor e permil wbjMe �M epplicenl lo a fivil parelry d rwl more Ihen /Ha huMred dd4n �SSWp.
� I. es owmr d tM W WaM a my emObY�s wYh'�'e8m m thei ade can0a�bn. wJI do Na woM. erW Ns etruclure b rwt in�e1Metl
wdteraCbraeb(Section]OaJ.B�vr�aardPmleaeimaCotla:ThaContreawalicenseLewEoesrwlepplytoenoxmerotqapeny .
who Wide «'vnprovas ihereon, eM xfa Eoea euch wik Nmsetl or henall a Mrwph lin or hm own empbyaea, pioviEeE ihel wc�
'mqwnname ara mt inteMed a WereE Im eeb. M, Iwwever, �M puikirp w impovameM u eoN wilhin ar yav ol mmpblion, the
owmr-Duitler will heva Ihe DUNen d peovinp M a she dk rwt buik rn imprmn far tM WR�e ��1.
� I, n oxner d tM popa�y, em eKduaively con�reqinp wM IicensaE wnbeciwa �o wwruq Ms D�qed (�� �. Buaimee and
Prafeviom Cade: The Camreaon Lieenm Lew doea iwl npply lo en owewr d popany who Wilde a'unpovm iherean ud who �
wniteclf Iw ax3� Wol�s Mn e coMrada�sl licenaed puauenl lo Ihe Conl'acla5 licensa lew). '
� I an ezemq uMer Sx�im: B. 8 P C., la Ihb reamn:
oa1e: Oxnx:
i ao na,aM ronM �nd i em ewme a ane wweniene me �ew��.�u a cmaomb Heenn.ne sereir coe. smia,. zsws, zssa3, ene
zssas. �e mm i«vrv nno�. w+w��o om,wm mii i wai �a �d2b o�) ��e �o �dr wan .�e mme �dr �e ms reaw�«�ro i«
apeimnlormnVuciionamoJifrationtram�MAv i�e yl.ranepmientDimna.ReaidenlWcaWrutlionWpimtioreareavemptiromthma
prwisione.
Dma: ApplcaM:
WORKEX'S CONPENSATION DECLIH�TION: I Mrepy elfirm unCx per�My d perjwy one d Me fdbxiip Cetivetiwn:
� I here vd wil meimen e cerlNiute d canem to saMrnwre 1« wwken' compensetion, n prwked la by Sauian ]]t10 d �M lebor
JCada, fa �M pe�oimence d iM wak fa wluc� ihie permi� b iauad.
� I hew e�d wil meinlen woMen' oompenaalion ins�rarKw, av �puiraC by SeGbn 3)00 d Ne lebor Catla. lor tM peAormenm W IM
wwk lor which Nie paim� ie ieeued. MY warFari canpermiion u�wirence ramer vd pa4ry ber ere:
c�,: TRANSPQRT�TIO� EXPIRES
� va� rwme�: �r � n 2 5�3 11 / O 1/ 9 5
Jrmh secrion need �wr be canvbree � tne w�t u �o. wn nuriered eor�ers R�wl a hn.l . .
❑ I nnly thm in Ne parlormerr,e d iM work tor xfich Iho permG is i»usd, 1 ehall rw� empby eiry pereon in eny menmr ao m to
necome sueiea �o me v.oAen' compense�ion bwe d Cdil«nia, end epiee ihet p I slwuk wqea io ma �wnse•
f�Q�nsetbn povuona o/ Sed'pn 3]00 d tha Lebor CoJe. I ahell mmp�y wN M
`/ f �+ i %
Y.B�J ��'�lo—ZS ACdicenl: /� /J� .��.`�
IWaminp: FaNun ro��cun wohen' eomperuetlon rov�r�q li unlewAu( md slvll aW/ecf en employsr ro ulMnsl peneMp end
c/Hl Ilm� up ro ons h�mCretl fMuunJ 0ollan (S10qGd0A M aWltlon ro Ms rost ol rompxuetbn, Esnupr e� provkNC br In
SxHon 9](I6 0l tl�� {wpor Cods, /nfruf, entl ettomsyi /su.
' CONSTHUCTION LOlOINO RGENCY: I hemW effirm uMer paneM� d perjury ihm tMn ia e oonmiwfion WMiip epency 1« Ne
paAwmerKa d �he wwk br wAirh ihe M�Y ia eaued (Seaon 309]. Civ. CI.
1 LENDEN'S NRYE:
LENOEN'S RODPE55:
I ce�ily thm I heva reeE t�u epplcmian ard mate ihet IM ehova in/ormetion c cortee. I epiea to compy Milh ell Wy enA counry atlinenroa
- �aa��abws�wmomb�aaero�x��.�dn«enremn«aerev,�m�.dinaav�oam«�c«�m..ro...memo�,eaaorom
�IX1118�IBtlq11 plllpJ8B9.
DAVID SMZTH
� _ v[�9La�o r
A � Dete: 7'�ZG— ( 4�
s�e��.a�o..,� genVAPGtiran vmo.
� �� � � ' � � � � •
(5151de.WP� WhXe-BuiMmp65dery:Orser�Fla;Cenery-AppFranl;Hnk-Revenw;Goldenmd-Meemw
�
CITY OF COSTA MESA — BUIliurrvv—.-__�
„I�r �.. _.-�_
PERMIT NO: B 073412 PLAN CHECK NO: N GOVT: N SUPP:�N�-----._
CONSTRUCTION TYPE: 5—N PERMIT TYPE; STR PURPOSE: ALT
JOH DESCRIPTION : INSTALL 'VINYL SIDING' PER ICBO# 2517 SQ FT: 2,351
CLAIM VALUE: 2,351.00 CALC—VALUE: 2,351.00 GROUP OCC: R-3 /
COMMENTS: SMOKE DETECTORS REQUIRED PER THE 1991 EDITION OF THE UHC.
*it**ieat�t***x **�*�****itit*itx��t*�+r*at�t��rir*it+�+�+r+r+ritieitit*x�**iratx�+�*it*�t*�riex *****+r�*aEx�**iritx�r�
_ Z O N I N G R E Q U I R E M E N T S .
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING -------�—
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARRING REQ: PROV: PARCEL: 42250518 ZNE: REF NO:
PLANNING NOTES>.
i
iE if 1E 1E ff iE 1E 1E It iE 1F 1f 1E 181E 1E if 1f� 1E 1F iE 1E 1F iE iE 7f 1f'IE 1E iE if 1E 1f if iE iE 1E 1E IE 1E iE If if 7E 1f 1E IE 1E ik ik 1E iE iE 1E iE 1E �F 1E IEiF IE1E iE1E iF iE iE 1E 1E 1E 1E 1f iE 1E iE if �M'ik 1E
D E_V,E L O P M E N T S E R V I C E S R E Q U I R E M E N.T S
ZONING AppROVED BY DATE; '•
BUILDING APPROVED BY : DATE: �
�
APPLICATION ISSUED BY: `— DATE: �� Z �'�
1f1@1F1fiEfEiFiF1E1F1E1f1F1E1fiE1F1I'1E1fiflf 1fiEfFlFIEiEiElEifi(� 1F
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL EGME T:Y
BLDG PMT PLUMBING. ELECTRIC MECHANIC FIRE SMIP/RES GRP.I>ING
PERMIT 54.00 .. .SO
SMIP/NON—RES
PLAN
ISSUE FEE
HUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 54.50 0.00 0.00 54.50 54.50 .00
REVENUE DIVISION TOTALS-->. COLLECTED: 54.50 OVER/SHORT: 00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
� , 54.00 .50
1E 1f� iE iE iE iE if 1E IE 1E iE if 1k 161f iE iF 1E iE 1E iE iE iE'lE 1E� iE 1f if ik if iE 1E if 1E iE 1E 1E if' 1E Ih 1E iE'If 1E 1E iE1Eif 1E fE IE iF 1E 1E 181E iF iE iF 1E 1E1E 1F IE iF if 1(� iE if iE 7f� 1F iE iE * IE �p IE 1E
I N D I.V I D U A L F E E H 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 2351 ALTER HY VALUE RESIDENTIAL NOZONE 1.00 2,351.00
END OF FEES ��O
R� �ETECT�R
���R
ai ao�avsos-u��!�a� T�]T S;.aU
UATE: L�7/?o/7` T:M'�5'::;;_^'�'S
. "�.()
• CONSTRUCTION AND PLANNING : � POOL��4,�6PA ^
, APPROVALS Permit # ' - Date Inspector APPROVALS Permit # Date% inspector
1. TemDorary Electrical Service or Pole 52. Pool & Equipment Location '
2. Soil Pipe•Undrgmd. J � 53. Steel Reinforcement • f
C �
,,;��;Eerctrical CondQr�litY-Un�lf9rnd. 54. Forms ,
C.4%�iettricai Condc7it=Urrcirq_md. 55. Electrical Bonding '
'� . r: a�
�'.�.Sfgel Reinforcem�� 56. Rou9h Plumbing & Pressure Test �y „
���"�Elpctrical UFER r!�8. . 57. APPROVAL TO COVER-GUNITE �-
rti^.r�. ,
� 7��Fobtings � ' 58. Electrical Cond"ui3Undrgrnd. ^ .
y�8~ Foundation ij a 59. Gas Pipe, O UndcBrnd., Test
��
;_��Water Pipe-Undrgmd.:_; � �; 60. Backwash Lines�P�Trap, � Undrgmd. �
10. Structural Floor System � j 61. APPROVALTp�DECK � �
11 .�Roperty Sewer �ine & Hous'�Connection 62. Backwash & R�e`ptor-Final �
12.,$ewer Cap ' - 63. Heater & Vent�inai ,
13. Roof Drains 64. Plumbing Syscem - Final
74. Rough Plumbirig, .. 65. Electricai�Finai � �
15. Rough Electrical-Carxluit - � 66. Solar System-Finai
�
16. Rough Electric�Viri�f� .� 67. Fencing & Acc'e_Ys;.ApProval �
77. Rough Wir�ng 5ign � � 68. APPROVED FffR-PLASTERING .
r�
18. Rough Electric3l;T Bar Ceilirt� 69. POOUSPA SYS�MS FINAL
79. Rough Heating & Air Conditionin5 FIRE DEPT. REQUIREMENT
- - - T �-. w i- �^ � C.1
20.� ou Factoi P�E.lace '"'� �` * `.�.{ � �'�r APP$�05YAp-YJ P mit# * '" �
�? `�' ..0 a� Z � � s r � < x � t+ , r. - .:t� _: �, � --s--- :ti
. � {... � ..
21. �ucts, in-SiraCtu�e,:� i •• r- = �t �:� •^x " 70.-Unde�tJr7d t�dro �"
c � �, . t
22.,1pucis,Veynti inj';� � ^S �� �, j�*" 71. ProduT_c;'Pi�ing`�.�Gas �Oil
'- _- : . . � `, _,. ;..� : .1•,� ti„
23. Gas�Pipe;Eiough &�'�€st � �,; � - �.� r_*+ ¢ �,��: ' 72. UndergtOLnd Fk151�n_� .s - �:
24,'Roo�Framing' =�` � �"•`' " �` = Q '�' * 7� Undergmil.St6� ye an° �Gas rS�Oil
px '�^+ �r ��r S�`.�'T �1
25. Rod.ShE'a,thing ;:j. =• :.�r� ;j ^ c;- 74i�.OverheadHydFD^� +
26.=�-85i%Ceiling IStrrclLrall & li��i coat �� �, ;Y =� � � 7�,_pry Che.qiical �� * " C' "�
27.`_F.rafneaQd FIa�Shi�; �M A ' "� ;. - „ �' ''' "
�� - >, m:r� 76. Dry Stanclpipe�c ,r,
28.yLatF.ing'& Siding;,* �� 7�,` � i r ..� .. ..� 7� FIXED��ST�A1'.FINA�y �� x
� '�� � �: �. .. .. r ; , i t ' ' � * �
29. Insulatioq . nj r`� .. * � � �� 7$, FIRE PREV. FdNA� +> �.
30. Drywall Nailirig �'X ` � �� � i ' ��'' " ��EALTfl DEPR�"REQUIF,�EMENT
ix S .ti" i 1 x
37. Plaster B"r.ow;�Co�it� � � j � �t.. 7. FINALlijl$PEC7rf,ON �: ' r M
32."ElectricaYPower Nfeter=Final • } f� i I k�. T 8Q; FOOD CEflTIF,��ATE �SS�IED
r^ i C� .,. i S .Y:*7 j ' I+'�. '- - �r r ^[,
33.�inSl,Elegtric) -� � y � I f.. i�}otes: _ -;;n r� �; p,.;�
34.CFinaCHe32in�-&/3�vCoridition�'g_ ^ ��� � � i* w ... �iS, x S O�
. m -, � � r* c ;.r� . �•
35.�FinefGas;Pipe�Tes,�}.�' �' ;�t.. � i r " xo 7r; -- �V
r- r�'
36.�HoddorCanoPYTxDV� .Lr _: n r,�- ' ' �* � iio � �'" �'.;T
w �, �-r:, ,� x i I?: ,> �- ,�:
r; :ri H I S.T ✓ ',r, r; ; �_ �? �� r
37.`F.inal.Pactoryfirep�acex �E,.._- z; * j � e, � * :�
�38. Finat)Plumbing --* ~ n: i r� a. ' i � �;_ _ : ra � e O
�. i � r�: F-. r i;
i _ .� r-. m F �r Ci L.?; ,r �Z;
39. Wat� Se`vice�Fina`I "� �
:.� .. Y `1 .: : � I I if �� ±� . i
�40. Gas Service-F nal;-.* � �;m;-- <' x?7 � i FR C� vn; s��
I .-.c_.� � a o" *
f1. Solar OomesucFiflat =_ � " � �-�' � i �,�' `ZJ * r � �°_`
f_
��2.�Backflow Preven�r:- �+ � . GK >F . »� ;.1 r! •:?- �- `
i i� s� ri :n(1.:. . �
3. 8ackflow Irrtqation f n y,�= � .��. � * « ``' � t � � � ; I' (�5_
�
Landscape ImgaYrOn Systema�l ^ - f.'1 7 C � x� ti D: ^C. "• N c -
S' f: Y (_ '
�'.�Sound P,�ttenuatip��.: ���'T • L L' t^� "� ti V' Q:�. t� _.
11 v -1 . �1- .^•, t'! �1. C'i ;- 7 E
!'Handicap.Regulafioi�s �-; _ .,. � . •S �o S �x '•.:
_ t' r�� � r� i i
��INAL STRIlCTURE & BUtLD�NG -� ( � �' ' ���5 * •-
IN,AL PLANNING:� �� �-�^ � <<� ' � �
� �:.��i� - _•� ¢ :�
�
F�ec�'rtc Re�ease to Edison � x � ' '* T �: � 7 -
i �-. •,.
i �.; x I �.. S • i. t .
.. ^J a _.
�ias.Fielease to Southem CaliforniaGatCo z � i ��� !� r, n. �! ; .i� �, .
l _"K l7 r^ (ii
ER-71FtC�TE OFOCCUPANCY r. �>> o r.?o .� f - o
� Date
'�" ORANGE COUNTYtSUILQ,�NG DEPARTMENT APPLICATION FOR PERMI �%����%� . �
636 North Broadway ---" — ��� e� � �r--\\j� '
"�!- f� SANTA ANA, CALIFORNIA � ``y
' FOR APPLICANT TO FILL IN � V' FOR' OFFICE USE ONLY ''
RECEIPT NO. PERMIT NO.
BUILDING
nooRess 2000 /HOivipOviA S-% '_ 733 6 s66-�o
SCHOOL DIST. GOSTA INESA RECEIVED BV DATE REC'D. OATE ISSIaED
OR TOWN
NEAREST ���.I�S � �� �
GRO55 5T. �Q TN, ST,
OWNER
�.✓ E� GR/IPNS AD�RE sG.vCi O
MAIL y SCHOOL OIST.
ADDRESS 2b�O ///ONIPOJ,�. Sz ORTOWN:
GOs%A /Y/ESA rE� NaNE _
CITY NO NEAREST 1 '7q - .
CRO55 SL� iC��
ARCHITECT OR. /,/ LIC. ZONE\\\� � NO.OF TY�E/ G�jOUP�
ENGINEER /I O NE N�' M I a✓ I PLA�IS I V /✓��t
( (r
ADDRE55 pppROV D ����!ii%� � _�_ S1 /
LIC. BY. DAT
NTRAGTOR NO. i
� CORRECTIONS
DRE55
DESCRIPTION I NO.�2OI BIOCK ITRACTI��� ""
tATTACH METES 8 BOUNDSI
NOW ON LOTS J
sae oF �or//0� %%0.86� � i '
USE OF I F Miuee I ROO �5 '
E%ISTING 6LOG. � ._
�a
SETBACK LINE FROM� r I REAR YARD� /�
CENTER OF STREET J S SIDE YARO � / , ' '- - � --'-'- " - "' -
DESCRIPTION OP WORK � • p
ks ! . ���.� �
NEW I I ALTERATION I I� ADDITION I � �� � '� s� - � ' � '" � D
. ..
..�...... I I .....,..... I .._...., ,�.. I , _ ' V ! ', : . �
COVERHGWpLL'`�/�/iS I COVERING��C�� N �
USE OF NEW � gi
'IDING G G �''
�
QC—D � /,rj � 7 � APPROVALS .
1 FOUNDATION: LOCATION INSPECTOR DATE
1 HEREBV ACKNOWLEDGE THAT 1 HAVE READ THIS FORMS, MATERIALS,
UNOER�PINNING
APPLICATION AND STATE THAT THE ABOVE IS CORRECT fRAME: FIRE STOPS.
AND AGREE TO COMPLV WITH ALL COUNTV ORDINANCES BRACING. BOLTS
AND STATE LAWS REGULATING BUIL�ING CONSTRUCTION:- /� N
/� LATH. INT. J�/O �I /�IIV 6 Q I�
SIGNATURE OF ��• / e._ � � LATH. EXT. � � A1 /N L� LLE D
PERMITfE �r • L���NKf- �
PLASTER. INT.
AUTMORIZED AGT. PLASTER, EXT/.'�
/'� a PEflMIT FeE S � Q M �i10l�I�EO �
VALUATION S 7 G. �� pLAN CHCCK S f
� � BOND BEAM
� FEEAL NAL 6 � � ���
_\ ].20.59 ' �
' � ,-6:4;�i:'..,. � '.':.'ra�_`3::... . ...�krV. ._. :..y —.-'' -. . . ...
r _ . .
ci r : p/ � � . � � - • ' �.
_ p � , rD 4j-.�, _ �. . - ,, . - . -.. .
w' _.r •-59— ---• e -
�'y -���3'-fj„— -J,�:' .a _..d -
J' ' ` �._..J � �'• Z �1' . .f�.�t . , a . .
• i�� J �.`
.. a ; . '_` '- _ 1 _ _
rt
°z " ' � • o ' . . . . �' . .
a. .. . � _ . . . . .
��t\.��'� _ . . "' a . . ..., .
_ . . i � - . . . .
� ._ . . : . . � - � .
. �� 'i� as/ -, -�, • Y:-. . ♦ . . . _.' _
� �� � - � .
.07 _� _ ,_- __� ;_; _ . - - . - _ ;,
--. .. ..
.— - = - - --
n ,
--- �Z ._ - - - -- - -
- _ �y9��,�J- _ _. --- : . _ - ~ , .. . _ . .
-. : = �', - -.- .
,.. ... .-._. _
� aS � . _ . . . . _ �--- � .-
, _ - ..
, -
., . .
' � STREET� - �� � -- •
, '�'''F+ q'i � .. . _ - ; - _ , -
PLOT PLAN - - � �'' ' '
Show location and distances from ,, . . �
,'' . , � - - - �
' � � property line and between buildings.-"�� . ; � _ : , , , _ a :
. . . . . �_ .� Z . ' .� - .. .- - -� ' . __, _ .� _ _ .
.. . . ._ . . . . . _ ' ��\'�_`__ _ ' vi':�. _ _ r'�?:' ,
' � , .- _� _. ' . �. .. . . . . ' . . � .
� ' " _'"' _" _ _ � " � � . . � .' .
. . \'
" ___'_.�'_" _ '___ " _ "_'� _'" _'"_ I.' '._ _ ' _ ' '
�' . r ,
._ ---'- _ -,-_,-'..—'. -' . -, ,� , . . . . . . . _. .
. - ' �.t-. . .. . . ,
��,,.,.' _ � � . . �� . .
- -- -- . ... - . c - , .
.. . . .. . .:n : � i - .
; - " . _ � .?_.__�,i � . �� .. i :. .. . _ .- _ . . .- .
. . . , ' _ "_. .__'I • _ _ . _. _'" _" . - -.. ` . _ ' .r.
- ".. " I
. " _ ' __'_ _ . " , . .i� r �. � -_ - ' t."i. . •
.., . . � . . . _ .�-._..,.._=.�..f.:iT i' 1' ' �
'
� ' - i^ r.. _ _ ._ . _ .
1 . _ ....�',v.���..�._.-�..�...��....�+.� .. . _ .' ' . . _. . '