HomeMy WebLinkAbout3291 IOWA ST - Building Permits:�
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(714) 754-5273 • Fex (714) 754•4856 • wv�w.ci.costa-mesa.ca.us 77 FAIF DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Job Address: 3291 IOWA ST
Suite:
Vicinity: ROOF
Parcel Number: 13904342
Applicanr. HAN, AUSTIN
Address: 1022 W ORANGETHORPE
FULLERTON,CA"
Owner: INTHAPANTI, TAR,4JAR
Address 3291 IOWA ST ,
COSTA MESA, CA ,
Contractor: ACE ROOFING SYSTEMS CO
Address: 1022 4V ORANGETHORPE
FULLERTON,CA
2ip: 92838
Arch :
Address:
Zoning: ,
ISSUED BY:
Phone: (714) 871-9923
Zip: 92838
Phone:
Zip: 92626
Phone: (774) 871-9923
License: 679543
Eng:
Address:
Status: ISSUED
Applie� 11I20I2002
Issued: 11I20I2002
Phone: Phone:
Zip: License: . License:
SCOPE OF PERMIT
TEAR OFF EXISTING ROOF. INSTALL 30# FELT, 30 YEAR, COMPOSITION SHINGLES. 2,000 S.F. INCLUDES ATTACHED GARAGE.
Plan Check: $0.00
Permit: $97.25
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $97.75
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0- 0
PARKING Existin : 0
NOTES:
Rear 0- 0
Rear 0- 0
Required: 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Left 0- 0
ProDosed: 0
Calc Valuation:
Claim Valuation:
Right 0-0
Right 0- 0
$3,280.00
$3,280.00
NOTICE: The work aulhorized by this permit shall comply with all applicable handicap access requiremants under Califomia statutes and related
regulations. (Ortl. No. 92-28, § 7, 12-27-92)
EXPIRATION: This permit shall automatically eupire and become vold it work is not commenced wlthin 180 days, or if work Is suspended or abandonetl
lor a perfod of 180 days.
INSPECTIONS: In order for the work authorizetl under this permit to be consideretl legal, such work must comply with all applicable cotles, end all
requlred Inspeetlona end final approval must be obtained. Failure to obtain Inspections and final approval will result In the expiretion of lhis permit.
FOR INSPECTIONS CALL: (714) 7545626 _
�as�ae�ww�
WORKE9IS' CpM:�ENSATION DECLARA710N:
I hereby eNirm Under penalry oi perjury one ol the tollowing tleclarations: i
a
❑ I heve and wlll maintain a certificate of consent ta selbinsure tor workers' compensetlon, es providetl for by sec0on 3700 of Ihe Lebor Code, for Ihe peAormance of Ihe
work for which this pertnit is Issuetl.
�I have and wi�� majp �ers' compensatlo "nsurance, es requlred by sectlon 3700 of Ne Lehor Cotle, for Ihe perlormance ot the work for which Nls peimit Is issued.
My warkers' comp s tl nsura arcie nd palicy numher are: � /��
Carner: r '- Pollcy Number. _ '��
(This section n6ed not be comp/ered F4�e Oerm Is luetl ef one hundred dWlars ($100) or less.) �
❑ I certify tha� �� the perfortnance ol the work f hich tpl�ermit Is issueQ I shell nol employ eny person in eny mnnner so as to bocome su��oci to Ihe workerg'
compensation lews ol Celifomia, entl egree I I If
comply wilh Ihese proWsions.
Applicant SigneWre:
WARNINO: FAIWPE TO SECURE WORKERS' fAMPE TIOP
T/qUSAND DOLLARE (5100,000), IN / DDRION TO THE
LICENSED CONTAACTORS DECLARATION:
I heroby aMirm Nat I em Ilcensed untler pravlslons ol
lorce entl eflect. �c. q
Cantrectors SlgneWre:
CONSTRUCTION LENDING AGENCV:
❑ 1 hereby aN�� that thare is e cons
Lendels Neme:
Signalure:
9
:ome sub�ect to the workers' compensetlon provlslons of Sectlo� 70 of the LqDor CoCe, I shell forthwith
�'-1 Dem: l � �o Z
IS UNIAWFUL AND SHALL SUBJECT AN EMPLOVEP TO CRIMINAL PENALTIES AND VIL FWES UP TOONE HUNURED
�PON, DAMAGES AS PROVIDED FOR IN SECTIqJ 3108 OF THE IABOR CODE, IMEREST, FND AiTORNEY'S FEES.
7000) of Dlvislon 3 0l Iho Business end Pro lons e, entl my Ilcense Is In tull
CI049 M �"Q� �� / �%
Deie: _ _ ' /� 1.�
tor the Dedormance ot the work tor which this Dotmit Is issuetl. (Sec. 9097, CWfI Gotle).
Lontlors Adtlress:
pate:
OWNER•BUILDER DECLARATIONS:
I hereby eMlrtn inet untler penelry of per�ury thet I em EXEMPT FROM TME CONTRAC70R5 LICENSE LAW fOr �he following reeson (Sec. 7031.5, Business entl Profeulons
Cotle: Any ciry nr counry which requires a permit lo construct, elter, Improve, demolish, or repelr eny atructura, pnar to Its luuance, also repWres Ihe eppllcanl lor 5uch pertnit
to file n signeC s�etemem thet ha or she is Ilcensetl pursuant to the proWslons of the Camrectora License Lew (Chapter 9(commencing with Section 7000) of Dlvislon 3 ot t�e
Business and Prolessions Cotle) or thet he or she is eaempt Iherefmm and I�e besls for the alleged azemptlon. Any vloletlon ol Section 7031.5 by any epplicant for e pertnit
subjects the apD�icant ta e civil penelry ol not more Ihen five hunAred dollers ($500).): '
❑ I, es owne� ol the property, or my employees wlih weges as Ihelr sole compansetlon, WILL DO THE WORK, and the structure Is not Intendetl or oHered tor sele (Sec.
7044, Business antl Professions Cade: The Contractore License Lew does not apply to en owner of properly who 6uilds or Improves therean, and who does such work
himself or hersalf o� ihrough hls or her own employees, provided that such improvemants ere not Intended or oHered lor sele. If, however, �he bUiltling or impmvament is
sold within one year of completion, ihe owner6uilder will have t0e burden of prodng ihat he or she did not build ar improve br purpose of sala.). �
❑ I, es awnel of �he pmparty, am EXCLUSIVELY CONTRACTNG N�RF1 LICENSED CONTRACTORS to conSWct fhe pmjec� (Sec. 7044, Business and Profeuions
Cotle: The �ontrectors License Lew does not appy to an owner ol pmpeny who builds or Improves thereon, and wno comrects for such prolect wlih a contractor(s)
license pufsuaN to the Contrectors License Laws.).
❑ I em exemp� under sec. Business end Professions Code for this reason:
Signature: Da7e:
Owner ID veniietl by drivers license. ❑ Yes � No OriveYs IJcense No. Expires:
Vedfcation at Ow�ership by (rype of tlocument, i.e. - properry tae Dill o� deetl):
DIVISION OF INDUSTRIAL SAFETV PERMR CERTiFICATION:
❑ I hereby ce�ity ihat no excavetlon five (5) or more leet in Aepth into which e person Is requlred to tlescentl, will be matle In connecilon with work euthorized �y this
pertnit, end �hat no building structure, sceHoltling, falsework, or tlemolillon or dismantlinp thereot, wlll be more ihen thlrty-slx (38) feet high. (Chep. 3.2, Grp 2, An 2, Sec.
. 3E7, Tltle B, Calilomia Administretive Code).
❑ As owner-builtler, I will not employ anyone ta tlo work which woultl repuire e pertnil Irom ihe DlNslon ol Indus�rial Selery, es noted ebove, unless such person hes e
permit to do such work trom l�e division.
Signatura: Date:
Dlvision ol Intlus��al Selery Permlt Number.
HAZARDOUS MATEAIALS AND EMISSIONS CER7IFICATON:
1 Will the appl��am or present or tuture building occupant neeC to lile enA certily e Business Plan lor emerpency response to reloase or threetened releese of e hazertlous
materlel7 Q Yes ❑ No
(Section 255�5 of the Calilomia Heelth end Safety Cotle requlres, with somo exce0��ans, Ihet e Businoss Plen be filed with t�e Coste Mesa Fire Department by every
business whlc� �as at eny one time tluring e reponed year a quanliry ol harertlous matadals equel to or gmeter ihan e welghl of 500 pounds, or e volume of 55 gallons,
or 200 cubic leet ot compressed ges et stantlartl tempereture end preuure).
..........................................._.._..................................._._..__..........._........._........__....._....__'............._......................................_.................................................__ _.._._.... ...—�—_
2 Does or will the applicanl or present or future building accupant need to file e replstratlon torm lor ecutaly hezertlous meterials7 ❑ Ves ❑ No
(Sectlon 255� ol t�e Cellfomia Health anA Safery Code, with same ezceptlons, requlres repistre0on wlth t�a Cosla Mese Fire DeDartmenl by eech Dusiness whlch et eny
one Ilme has on hand e quentiry ot ecutety harardous meteria�s equal to ar qreeter Ihen e welght of 500 pounds, or e volume al 55 gellons, or 200 cublc fee� of
compressetl gas at stantlard temperamre an0 pressure).
5
6
Does or will the applicant or Dresem or tuture Duilding occupam neatl to prepare en RMPP (Risk Management end Prevemion Progrem lor acuiely �azerdous matedals)?
❑ Ves ❑ No
(Section 255� ot the Calitomia Heallh end Satery Cotle provides that Ihe Costa Mesa Fire DepatlmeM may raqoire ihe preparstion, ceM1ilicatfon end tilinp with ihe Flre
Department of en RMPP Dy busineues whic� ere reduired to ragister ecutety �azerdous metedals wlih the Fire Depanment.
".._........... __..___.........._._........._......_ .................. __..�
H en RMPP is presenity requireQ has Section 25534 ot lhe Calilomie Heelth enA Safery Code beon lully complietl wit�7 ❑ Ves ❑ No
............__........_"".... .__._ ..................._.........__.._......................................................_.._........._""—"
Does or will t�e applicent or present ar future bullding accupeni reQulre lor Ihe work whic� Is the sub�ect ol thia e plicetlan a gertnit 1or sucn conswctlon or modllicatlan
Irom Ihe SOU�h Coast Alr Oueli�y ManaBement Olstdct or trom any other eir pollutlon wNrol tlisidct or agency7 � Yes LJ No
(Section 65B5oz of the Calitomia Govemment CaAe requires thet Ihe reduested Inlwmation De lumishetl on epplicatlons lor non-residentlel building pertnl6j.
"_' ..............�................_.............................................__...._....................................__....................._......................................................................................._..... ....................... ......_....._..._.................._..._....._._..
W ill any pan of the feciliry to be constructetl untler this permlt De wlthin 1000 teet trom t�e outer bountlenes ot a school4 ❑ Ves ❑ No
Uf Yes', ihe fadliry must meet c�e repuiremem ot Sactions 25534 end 42303 oi t�e Califomia Heelih and Safery Cotle).
7 II e pertnit Ilom the SOuU CoeS� Air QualitY Managemem District or other eir polluiion wniml dis�nct or egency i5 requiretl for Ihe work whiCh �s I�e subject of Ihis
applicatlon, nave all ot t�e disclosu�es p�escnbetl by CalitorMa Healih snd Sataty Cotla Saclion 42307 bean made7 ❑ Yes ❑ No
'__"""'"_'....' _ __""'...__._.._._..__..........."""__""'
B Qf yes', ana� �ertlTiw�e of compliance trom the apD�aD�ate air polWtion wNrol oHicer).
CERTIFICA7E OF COMPLIANGE: I cenity t�at under penelry ot perjury Ihe informetion given aDove is correct. I apree to comply with all state 18ws and ciry ortlinances
regarding HB�rdous Metenals antl Emissions.
Signeture: Date:
CERTiFlCATE OF COMPLIANCE AND 0 ON OF ENTAV: I certity under penalty ot perjury thal I heve read this application end sta�e Ihet the information piven is
wrrect. I egrea to comply with ell slete aws e c ortlinances relatln building consWction, end eu�hodze representalives of the iry ot GsJ e Mesa to enter upon the
ebove-descnbod p�apetlY lar inspection urpos s. egjee not ta occupy r�l penty ol eny building euthonzed by Ihis permit un�inal insy4ction_
COOE 1. �ucocrnnNTYPE
1818 Fixed System Flnal Fire Preventlon
1266 PoM Spd Flnal
200 Finel Re•Roo�
201 Final BIak�Fetalning Well
202 Final Foctory Fire Plece
203 Final Sign
204 Final Demolition
�g
CQOE� INSVECTIONTYPE
208 Finel Moc�anicel
208 Flnel Ptumhlnp
270 Finel Eloctrical
212 Finel Flre Preventlon
220 Finel Plenning Approvel
222 Finel Site
250 Final Bulltling/Occupancy
.nu. :
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Job AddrB55: 3291 IOWA ST
Suite:
Vicinity:
Parcel Number: 13904342
Applicant: UNK
Address:
Owner: INTHAPANTI, TARAJAR
Address 3291 IOWA ST
COSTA MESA, CA
Contractor: MOLITONI TAKAPU
Address: 450 S SPRUCE ST
SANTA ANA, CA
Zip: 92703
Arch :
Address:
Zoning:
Phone:
Zip:
Phone:
Zip: 92626
Phone: 714-972-8566
License: 811095
Eng:
Address:
ISSUED BY:
Stalus: ISSUED
Applied: 08/21/2002
Issued: OB/21/2002
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
57' LONG BLOCK WALL (MAX 6' HIGH) ALONG LEFT SIDE PROPERTY LINE, SETBACK 40' FEET FROM FRONT PL
Plan Check: $29.15
Permit: $44.85
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $74.50
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0-0
PARKING Existinq: o
NOTES:
Rear 0- 0
Rear 0. 0
Re uired: 0
FEESUMMARY
PLANNING & ZONING
Left 0- 0
Left 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation:
Right 0- 0
Righl 0. 0
s�,iao.00
sa.00
NOTICE: The work authorized by ihis permit shall compty with all applicable handicap access requirements under Calilomia �statutes and related
regulations. (Ord. No. 9248, § 1, 12•21•92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or il work is suspended or abandaned
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 epplicable cotles, end all
requlred inepeations and finel epproval must be obtatned. Failure to obtain inspections and final approval will resufl in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754-5626
2saere �a�vo)
WORKERS' COMPENSATION DECLAfiATION: ��
I hereby affirm under penalry of perjury one of the fallowing CeUarations: �
❑ 1 heve enA wlll �meintain e cenilicate ot consent to setl-Insure br workere' compensetlon, es provided for by sectlon 3700 ot t�e Lebor Code, for Ue pertormenca ot the
work for whiCh tliis pertnil is IsSueC.
❑ I heve antl wlll mainiain workers' compensatlon Inwrafroa. as requiretl by seclbn 3700 of fhe Lebor Cotle, tor Ne peAortnence oi Ne woAc for whkh Ws pertnit is issued.
My woBers' compansatlon Insuranca cartler end polity numbar ere:
Cerder. Policy Number:
(Thls sectlon need not be complefed I! the perm/t!s veluetl e( one huntlred dd/ers (S I00) or less.)
❑ I certiy thet in Ihe peAormance of the wark for which ihis pertnit Is issued, I shell not employ eny person In eny mennar so es to �ecome sub�ect to t�e workers'
compensatlon laws oi Celifomia, end agree thet II I should Decome sub�ect to t�e workers' compensatlon provlslons of Sactlan 3700 ot Ihe Labor CoOe, I ahell forthwith
comply with Ihese provisions.
Appllrant Signeture: Dete:
WARNINO: FAILURE TO SECURE WORNERS' CON�PENSATION COVEMGE IS UMAWFUL AND SHALL SUBJECT AN EMPLOVER TO CFIMINPL PENA�TIES AND GVIL FINES UP TOONE HUNDRED
TTIOUSAND OOLLAFE (5100,000�, IN ADDf710N TO THE COST OF OOAIPENSATIIXJ, DMMGES AS PRWIDED FOR IN SELTION J]OB OF TME UBOF CODE, IMEREST, AND ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby nflirtn Ihat I em licensed under provislons ot Chepter 9(commendng wit� Sectbn 7000) ol Division 3 oi Ihe Business antl Professlons Code, anA my Ilcense is in tull I
lorce nnd eHect. lJc. M Class q
Controclofs Signeture: Date: I
CONSTRUCTION LENDING AGENCY: ',
❑ I horeby eHirm ihat thare Is e consiructlon lentlinp eqency br ihe peAormance of the work br which this permit Is issuetl. (Sec. 3097, Civil Cotle). I
Lenaer9 Name: Lentler'S AGGr855:
Signeturo: Dete:
OWNER•BUILDER DECLARATONS:
I hereby elfirm ihat untler penalry ot perjury thet I em EXEMPT FROM 7HE CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5, Business entl Professions
Cotle: Any Gry or counry which reQuires a permit to conswct, alter, lmprove, tlemdlsh, or repair any swcture, prior to its issuance, elso requlres the epDliwnt for such permit
lo lile e slgnetl statemant that he or she Is Ilcensed Dursuent to the pravisions of the Contrectors License Lew (Chepter 9(commencing with Sealon 7000) ot Division 3 o11he
Business end Pwlessions Code) or thet he or she is e:empt therelrom end the basis tor the alleqetl e:emptlon. Any Wolatlon af Section 7031.5 Dy flny epplicent for a pertnit
subjecis iha applicant to e civil penelry ol not more than live �untlretl tlollars (5500)J:
❑ I, es owner ot lhe property, ar my employees wit� wages es t�eir sole compensatlon, WILL DO THE WORK, end the slrucWre Is not intentletl or ottere0 Por sala (Sec.
7044, Business antl Professlons Code: Tha Conirectors License Lew does noi apply to an owner of property who builtls or Improves thereon, and who tloes such work
hlmself or hersetl or through his or her own employees, provided ihet such improvemenis ere not Intendetl or oNeretl for sale. If, however, the bullding or Improvement is
/5010 wit�in one year of completion, �he ownerbuilder will have the burtlen of proving that he or she did not builA or improve for purpose ot sale.).
I, es owner of the pmperry, em E%CWSIVELV CONTRACTING WITH UGENSED CONTRACTORS to consWct the project (Sec. 7044, Business antl Professions
Code: The concractors Llcense Lew tloes nm epply to an owner ol pmpeny who builds or improves thereon, entl who contracis for such pmject with a conirector(s)
liten5e pur5uanl lo Ule COntrador5 LitBnSe LBws.). _
� under sec. � Business entl Pmt� for ihis reason:
O� verified by vefs license. Ves ❑ No Drl ts Lice Mo. �
Venllcation of Ownership by (rype ol tlocument, i.e. - praperry tat bill or tleetl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATON:
❑ I �ereby certify t�et no excavetion tive (5) or more feet in Cepth into which e person Is required to descentl, wltl be matle in connectlan with work euthorizetl Dy thls
permit, entl Ihat no 6uilding structure, scafloltling, falsework, or tlemoliUon or dismantling Ihereof, will be more then thirry-six (36) teet hiph. (Chap. 32, Grp 2, Art 2, Sec.
341, Tltle 8, Callfomia AdminlslretNe Catle).
❑ As owner-�uilder, I will not employ enyane to tlo work which would requlre a permit Irom the Divislon ol Indusirial Selery, es noted ebove, unless such person has e
pefmlt to tlo suth work irom Ihe AIvi5lon.
Signeture: Date:
Divislon of InAustrial Safery Pertnit Number:
CERTIFICATE OF COMPLIANCE AND AllTHORIZATON OF EMRV: I cenity untler penelty of Derjury that I heve read Ihis application end state thet the infortnetion given is
wrrect. I egree to wmply with ell stete lews end dry ordinences relaUnp to DUIltling consiruction, and euthodze representa�ives of t�e Ciry ot Costa Mesa to enter upon the
ebo scribed property lar 1 specti Wrycaes_ ree noI to acupy or ellow occupanry ol eny building euthorized bytpi; pg ��ntil finel ins0edion.
YI� � �-�
—� Slg [ure Of L al �t@_�
And/Or Authodzetl Applicant Date
COUE A. INSPECTIONTYPE
1818 Fixotl System Finel Fira Preventlon
1268 Pool Spe Final
200 Finel Re-Root
201 Final Block/Reteining Well
202 Flnal Factory Fire Place
203 Final Sign
204 Flnel Demolilion
QAg It{�LS
� �
COOE 1 INSPECTIONTYVE
206 Flnel Mochanlcal
208 Flnel PIum6ing
210 Finel ElecMcal
212 Flnel Fire Prevenllan
220 Flnel Planning Approvel
222 Flnal Site
250 FinalBulldinplOccupency
PAIF Q�L4
ONLY.
AN AC
IN CAS
Wlft! 1
0
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i .' ` E-
s Foe wFow�noru��rimaos'Es •
�►rrr�sxfsaonsia�roRrRovmnvcTkO"{5 S„Ae
�
�
CITY OF COSTA MESA
pLANNING DIV.
irc7 TO BLDG. DE?7.
DA
weus/r�a�s eenvm,r s��• k e w r�cxr stta.t
IAIX A7IELSf ]0' FROM FROM PROPERTY llNE_
WAILS/FFNQ�S AiALL NOT WC�U 76' IN FfflCtf!
Id OF 7}{E tRON[ PROPFR7Y I�NEE Qd07' C17R91Wt)•
! DSTAN� FROM LVRH lU PROPD[fY I�NE
OW ON PIAN. VER[F7G2ION FROM 17� QIYS
PRING DIVHON 6 REQU6tPD. GIL (114) 751-S.il7
�o2.lG[3��
3� p � ,u a,� � ��n�+'°�
_ .L_,a W �_{STREET _ _
BLOCK WALL LAYOUT FOR BUILDING PERMIT
PLANNING DIVISION
e
�
Cemenl Coping Opt�on�l —
Channel8bck With 1�]/8�
Horitontal Top ol all
Fcncn
For Fentes 5' or Leu
Ven. Bars 3/8"yS al 4' �0" O.C.
For Fenns Higher TAan $'
Vert. Ban 3I8"� at 32" O.C. �
FJI Cells Solid WitA Grout
Where Steel Occurs
Rnninrcing Sleel $hal)
Conlorm to Sec.A-15��9
A.S.T.M.
All Sleel to he Lapped
24�� Or l0 C.Ode
NATURALGRADE
TWp 7/B"094R5
CONTINUOUSTOP
6 BOTTOM
HORILSTEEI MUST BE TIEO IN
YLqCE AT TIME OF TqENCM
INiPECT10N.
TYPICAL 6�� CONCRETE BLOCK FENCE
a x
V F
�
� W
a =
> i
r –
a
i�
W O
u �-
z
w n
V
��
+A '� ry
e�
� N IDTM
� SEE CNe
� BELOw
� I .
WIDT►1 . . �q•'
THICKNESS . . IO"
DEPrH Of EARTHTOOTM 24�
SPA�ING OF EARTHTOOTH IQ'
FOOTING RE�UIREMENTS CHART
t4�
10"
20"
14�
BUILDING DiViSIOiV
12-
9�
16"
16'
G
GENERAL- NOTES
MORTAR; p�e part Ploslic Cement, and
TArtt Partt Sand
GROUT: One Port Cement TMee ana
Ooe Hulf Ports S�and
COPiNG: One Port Cement, T�ree
POffS $O�4
CONCRETE: Wen M�aed 1:2-I/2:3-I/2
Ma� of 7-1/2 Gollcns of
Woter Per Sock of Cement
GROUT MAY BE POUPED FROM TNE TOV
Oi THE FENCE IN CELlS WHERE STEEL
OCCURS.
CELLS AND .\REAS OF MON120NTAL REIN
FORCEMENT SNALI BE CLEAR, CLEAN 6
FREE OF All MORTAR OEBFIS, ETC.
M (.�' C4RTHTCOTM
�/_ Tr�E HE�GTM O� �ENCE
�LOW BOTtOM O� �OGT�NG
SCALE: I/2'� = I'
12'
8�
12"
i6'
�
�� `.�' �� %� �'u�u�C�cs� �u<idte�t
OWNER-BUILDER
VERIFICAT(ON
A city or county, which is reyuired to give notice pursuan[ ro Section 19830, shalLattach to such notice, and,
as a condition precedent to issuing a building perntit, require the completion and require the return of, an
owner-builder verification.
Attention Property Owner.
An `ownerbuilder' building permit has been applicd for in your name and bearing your signature.
Please complete and retum this infortnation in the envelope provided at your earliest opportuniry [o avoid
unnecessary delay in processing and issuing your building permit. No buildine cemti[ will be issued until this
verification is received.
I. 1 personally plan to provide [he major labor and materials for construction of the proposed
property improvement. ❑ Yes ❑ No
<L. 1(have/have not) � signed an application for a building permit for
the proposed work.
� 1 have contracted with the following person (�rm) to provide the proposed conswction:
Name
_ _ __ _ _
Address City
Phone ( ) Contractur's Lic. No.
4. 1 plan to provide portions of the work, but 1 have hired [he following person to coordinate,
supervise and provide the major work:
Namc �FJC. f'l�b W � -�rTT /L�YF�'U
Address �_� 4y�9 Q���'� City � , �
Phone �� q�� _ �' �(�n Contractor's Lic. No. R/ / c�i�j �
5. 1 will provide some of the work but 1 fiave convacted (hired) the following persons to
provide the work indicated:
Name Address Phone Type of Work
t0a2a6 (REV.998)
I hereby affirtn that 1 have received a copy of the information set forth in Section 19830 of the State
of California Health and Safety Code and have completed the above informa[ion to [he best of my personal
knowledge, in compliance with [his State law.
Signed: a�"'`�i'�^p_����
Name:�/ji«� ZN��I�Y � 1 fi
(Prinmd or Typed)
C.D.L. # OR S.S. #
/
Date: � �1 ���
For more information call City of Costa Mesa Building Division at (714) 754-5273.
1O12J6 (REV.&98)
/ � �
�nntK nneu�rvnu� i.�a UAIt (-1�-(4
JOB ADDRESS °Wg • BUILDING PERMIT N
SOIL
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WATER
ROUGH PLUMBING
PROP. $WR. LINE � NOUSE CON. �
SPRINKLING SVSTEM
MISCELLPNEOUS
ROUGN HEATING ANO RIR CONDITIONING
TEMPOR4RY SEHVICE OR POLE
UNOERGROUN� � POWER �
ROUGH wIRING
TRENCNES FORMS � STEE� RE
FLOOR SYSTEM
BOND 6EAM [� STEEL REINFORCE [
$HEATHING
FRAME ANO FLFSHING
LATNING - IN n OUT n
P�ASTER.BROWN COAT
STRUCTURAL, FINAL
HEATING, VENT., REFRIG. AND A.C., FI
PLUMBING, FINRL AN� GAS TEST n
ELECTAIC, FINAL
BUILOING. FINAL
SUBCONTRACTOR
l �. 3867��
COSTA MESA BUILDING•SAFETV DEPAflTMENT
P.O. BOX 1200 COS7A MESA, CALIFORNIA 92626
For App/icant to Fill in Completely
BUILDING �J
ADDRESS
OWNER
MAIL !'.� _ _
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ARCHITECT
OR ENGINEER
ADDRESS
CONTFACTOR
AO�RE55
��T�,��T,
STATE
LIC. NO. ? �
SI2E
OF LOT
SI2E OF
WALL
TEL.
NO.
��T� y
LIC. NO.
NO.OF BLDGS.
NOW ON LOT
ROOF // /
COVERING (�( ({(/�
C TO BE PERFORMED
R
A.P. NO.I�
BUILDING
ADDRESS p
OWN£R
FIRE
an;_ .;i,; �
���� �5-����..::Ooi�r;> •�. 1,,.5G
V FOR BUILDING PERMIT
]�pECE1VE DQT �� ED
7 �
���u� PER I
L
LOT� BLOCK
VALUE
% s /OQ�'
YPE GROUV ^
� l� DATE���I�` /
N� NO.OF � I USE OF NEW`1J�.�p �
PLANS BUILDING �0`� y�
VARDSAPPROVED VARDSAPPROVED
MAIN BUILDING ACCESSORV BUILDING
L SIOE �� FT.1
REAR "�'� FT.
DISTANCE BET.
MAIN BLDGS.
VAR. r@
C.V.P.aR
APPROVED�� nl
I hereby ecknowleGBa [hat I have reatl this application antl state
that the ebova intormetion is cortect and aBree to compfy w{th
all laws re0ulatin8 builtling construction, antl 1 shall no2 employ
any peKon In violatlon of the wOrkman'S compensatiOn laws ot
the State of Celifornia.
I hereby certlfy that I em proparly licensetl as a conxacior untler 5�
t�e State ot Celitornia B�siness antl Professions Cotle, Divisicn 3, THE MOU
Cnapxe. 9, and [het sve� licenses ore tn full force and effect, or I THE PURPOE
am azempt from the provisions of the Stete of Californta Businesz
untl Protessions Code, Dlvision 3, /Chaptar 9. VALUATION
Signatura oq �/ ii/�%w _/ a/A, `%�i�1_ I
Permittae � XYdL£JC��;S-i •q� ( I uru g O O �
AuthoriZetl AOent /
BET. MAIN &
V b
T. O
SHOWN UNDER VALUATION IS FOF±
iF ESTABLISHING A PERMIT FEE ONLV: m
a
m
�. PERMIT FEE $ O �
J
m
PLAN CHECK $ E
J1 � u
TOTAL FEE $ ��
�-I � ~ . JLF+���..Fe
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 977 COBTA MHBA. CALIFORNIA
For Applicanf fo Fill In Completely
TYPE OR PRINT
� STATE
COS7A MESA. CALIFORNIA
� x 100 � � "� oo °`°°71one
NOW N
BUILDWG
ZON!
R-1
LEGAL
J,
��L ��T �- l G` ' E t1
I�,
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
COSTA MESA.
ZONING
PLA 8F 2 IBUILDINGEW/•$yy
USE OF � YARDS
EXISTING BLDG N APPROVE�
S6TBACK LIN[ PROM fCEM¢R LINE BT.1
�NTEN OP 6RtBHT � FiEAR YARD 2 � FRONT
61OE YARO LEFT �� IRIGHT � R.SIDE
DESCRIPTION OF WORK
APPROVED
EXTERIOR WAL ROOF
COVERING R� t .CO COVERII
USE OF BUILDING AND WORK TO BE
none
i HEPeeY ACKNOWLE00¢ THAT 1 HAVB RHAD THIB �PPLJGTION }HE AMOUNT BHOWN UNDER VALIIATION IB FOp TH¢
AND 9TATE TXAT THe ABOVH 18 COHNHCT AND A6REH TO CON-
PUI806E OF E6TABLI6HING .� PERMIT F66 ONLY.
PLY WITH AlL QTY ORDINANGE9 AND BTATH LAWB fi80ULATNO
BUILoiNa coNeTRU� n VAWA710N
SIGNATURE OF L% PERMIT FEE $
PERMITfH �I��� /�c"�L
$ �JJ 7`� PLAN CHECK S ]_rJ�SO
AU7HORIZED AGENT �ke & CO (�i'048� IT1C•
TOTAL FEE 52�5�
e