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Home My WebLink About3125 JEFFERSON AVE - Building Permits.,y� r'.. . . . y ��ia� �sa-sz�s • Fax (714) 7543856 • www.ci.costa-mesa�DING PERMIT JobAddress: 3125 JEFFERSONAV Suite: Vicinity: RESIDENCE AND ATTACHED GARAGE � Primary Occ: R3 Dwellings/ Cong Res <10 Type of Construction: V-N Parcel Number: 14165228 Zoning: R1 Applicant NGUYEN, JOHNNY D ,�,---------�,r.,--.�_ Address: 3125JEFFERSON AV �� (�1one: 71a=5: COSTA MESA;.�CA� -� � �J Zip: 92623 oW�er Address �`�!�%� Z P -f i:r l'�. r��`� �Arch;� �:"'� . ; ,Address~� {iy ! �� ' �r}� `Zip: r �i',•°, 1�`�A� I-� ;Rl �/- fi� � t�REROOF RESIO � �FELT; APPLY �E � 41 I 'fdi , t ACCESSORY PARKING � � � =SA,T � �� --� � -„ -- -_--___�—� �_��/ �� v �� ,;.� --^!"" — Phone: ----� Zip: 92623 AND � . , � ; % � �� . .A. � G'= .'� $0.00 . � !�$181.25' " � �$i t 1 = License: 000000 �;�>_�'�.' �{ . �� jf�� `Eng: ��"" ,.-----_Address �",�' 3�0' o,��''°� �� ' � �° � o0 0 �0 0 � �npo o,,o 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 05/11/2005 � - Issued: OS/1�1/2005 � ISSUED BY: 5 � �\�� 0 � � �\� �� \ � � ��\ �( ,/`�. \�` �� '` ; �� l '�� i�`r D� �.,�%�� ,'� :,� :, � � ��i�\ � 1 � � ��, ✓ �� S ^ ��i�� _ `v�i Phone:� ( ��` � � �� ' �h1� 1 ��---�� ', �'"' � �1 t ��`, 6icense: � n \ . . - ... . ,. . _ 11)i,t�1 � J 1111 �n . EtSHTG AS �NEE 7 ^ i ", ",�y. Ic Valuation: 3im Valuation: � � �. ��/ " \ `\�� `��D� °� �,o� o� Front 0-0 Rear 0-0��'—fiLeft=�0'"0 ��V /'� --d�.__-*-�__ —._— —:�% ,� .... � /0�"7.1 f"-.... Front 0-_0 �Rear �0' 0- Left 0-�0 `<.``��,� u(t`�l` i� tr�S�n��.C'��2-, �. Existing: 0�` `Required: 0� Proposed: 0 , i �. NOTICE: The work authorized by this permit shall' comply with all applicable handicap access requirements under Califomia statutes and related -regula�ions. (Ord. No. 92-28, § 1�, 12-21-92) � . EXPIRATION:. This pertnit shall automatically expire and.become void if work is not commenced within 180 days, or it work is�suspanded or abandoned �for a period ot /80 days. . ' INSPECTIONS: In order for the work authorizad.under this permii to be considered�legal,,such wark must comply�with all applicable�codes, and all �I required inapeetlons and finat epproval must be obtained. Failure to obtain inspections arW tinal�approval will resul� in the expiration of this�permit. I FOR INSPECTIONS CALL: (714) 7545626 .wa �rvw7 WORKEflS' COMPENSATION DECLARATION: � � � ' � - � - , _e. I hereby eflirtn unAar penalry of perjury one ot t�e following tledarations: �� '� ' . - - . .- ❑ I have entl will maintain �e cenllicate of consent to self-Insure br workers' compensatlon, as provitled for by section 3700 of �he Labor Cotle, for the pertortnence of the work for which this pertnit is Issued. -- • � � . ❑ I �ave and wlll maintain workers' compensation insurance, as requiretl by section 3700 of Ihe laDor Code, for ihe pertortnance of the work for which this,pertnit is issuetl. My workers' compensation Insurance cerner antl pollcy number ere: ,�, ' Carrier: Policy Num6er: (This secflon need not be comp/eted i! (�e permi( is valued et one hundred dollers ($100) or IessJ ' � �y I certity Ihat in the peAortnance of ihe work for which this pertnit Is issued, I shall not employ any person in eny manner so as to become subiect to the workers' � compenseilon laws oi Celilornle, end agree that it I should Eecome sub�ect to the workers' compensation provisions ot Section 3700 of the Labor Catle, I shall forthwilh compty wit� these prov�ons. �—� �MPII� �� rsi9neture: � � � ate� C: � I� 1 0 l� WARNINO:FAIWRETOSEWREWORK COMPENSATIONCOVE UNL4WPULANDSHALLSUBIECTANEMPOYFATOCRIMINALPENALiIESANDdVILFlNESUPTOONEHUNDRED THWSAND DdlARE (5100.000), IN AOOfTION TO THE C0.ST OF COMPENSAPON, DAAKGES AS PROVIDED FOR IN SECiION 3]O60F THE UBOR CODE, IMEREST, rW D ATTORNEI^S FEES. LICENSED CONTRACTORS DECLAflATION: I hereby eNirm IOa� I am licensed untler provisions of Chapter 9(commencing with Section 7000) of Oivision 3 oi ihe Business end Professions Code, end my license Is in full force entl eMeci. Lla k Cless k Gontractors Signature: Date: CONSTRUCTION LENDING AGENCV: . ❑ I �ereby aMirtn ihat there is e consiruction lending agency for the peAormance of ihe work for which t�is pertnit is issuetl. (Sec. 3097, Civil Cotle). Lenders Neme: Lender's Adtlress: � Signeture: Date: OWNER-BUILDEH DECLARATIONS: I hereby afllrtn Ihe� under penfllry of perJury Ihat I am EXEMPT FROM THE CON7RACTORS LICENSE LAW for ihe tollowing reason (Sec. 7031.5, Busineu entl Professions Code: Any ciry or counry which requires e permil to consiruct, alter, improve, Aemolish, or repair any siructure, prior lo its issuance, elso requires Ihe epplicant for such permil to file e signed slatement that he or she Is licensed pursuem ta the provisions of tha CONrectors License Lew (Chapter 9(commendnq wiih Section 7000) ot Division 3 of the Business end Prolessions Code) or thet he or she is exempt therefrom end the basis tor the ellagetl e:emption. My violation of Sedion 7031.5 6y eny applicant far e permit �u �Qcis �he epplicant to a civll penelry ol not more then five hundred dollers ($500).): ' 71, es awner of Ihe properry, or my employees with weges as Iheir sola compensation, WILL DO 7HE WORK, antl Ihe siructura Is not imendetl or oHeretl for sale (Sec. 7044, Business antl Professlons Cotle: The Contractors License Law tices no� apply to an owner ot propeny who builtls or improves thereon, end who does such work �imself or herself or ihrough his or her own employees, providetl ihat such improvemenis ere not intended or oHered tor sale. If, however, the building or improvement is sold within one yeer of completion, the owner-builder will heve the burden of pioving �hat he o� she did not build or improve for puryose of sale.). � ❑ I, as owner oi ihe property, em EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTOBS to construct the project (Sec. 7044, Business antl Proteuions Code: The contractors License Lew tloes not apply to en owner of propetly who bulltls or Impmves Ihereon, end who conirects for such project wl�h e conirector(s) license pursuant to ihe Comrectors License Laws.). ❑ I em exempl u er sec. BuSiness and Protessions Code for this reason: Signature;`_., -. j�u�nu , s�vn.n f�(n ��} bn �Date: - i f I 0 r "' �v.i Ow�D verified by drivef ' ense. �Ves D�dvets� �'�cerise�Nb?• K-Explres: Venficetion ot Ownership by (type al documem, i.e. - pmperty Ias Cill or tleetl): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby certify ihat no excavetion tive (5) or more feet in depih into which a person is required to descentl, will be made in connec�lon with work euthonzed by Ihis permi�, anC that no builtling sWcture, sceHolding, talsework, or tlemolition or tlisman�ling Ihereof, will De more �hen �hirty-six (36) taet high. (C�ap. 32, Gry 2, Art 2, Sec. 341, Ttle 8, Calilomia Administrative Coda). ❑ As owner-builder, I will nol employ enyone to do work which would require e permit irom ihe Division ol Industnel Sefety, es notetl above, unless such person hes a permit to tlo such work trom ihe division. Signature: Division of Indusirial Salety Permit Number: Date: CER71FlCA7E OF COMPLIANCE ANO AUiHORIZA710N OF ENTRY: I cenity under penelry of perjury that I have read �his apDlication antl state thet the infortnation given is wrrect. I egree �o comply with all sta�e lews entl ciry ordinances �elafing to builtling construction, end authorize represantatives of the City ol Coste Mese to eMer upon the ebovo-tlescnbed property for inspection purposes. I agree not to occupy or ellow occupancy ol eny building authorized by this permil until final inspectioh. ..n. . . . .. , e �E "'x.. .� � ial Fire Prevention � " -d � �� ' � 1266 Paol' 200 ine 201 Final � �c. 202 , Final ctory Fire Place , ' ' " 203 Final Sign , � 204 Final emolition 220 222 50 Date i � ( I �.Q,-r')-. LDa�e� INSPECTIONTYPE � ' ' ^'�Q�¢, ` ' �$ Final Mec�aniwl Final Plumbing � ' ' ' � - ' � "Pinal Fire Prevention Final Planninq Approval � ' ' � Final Site Final BuildincyOccupancy' � ,, DECLARATION OF AUTHORITY FOR AGENTS OF PROPERTY OWNER TO APPLY FOR PERMITS referenced real property, and that I(we) hereby authorize: Bldg. Permit # This Permit # Number: declare that I am the Owner of Title of the above Name: .� nln�n ��,� Telephone Number. T� h S 7- 9 70 h Street Address: Ciry: �A��A. �2ha State: to obtain pertnits in my behalt, as owner/builder, for at the above referenced property. 2. Should any person become an employee engaged in the improvement of the property, I(we) shall immediately provide Workers Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa Mesa, as required by State of California laws. 3. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other person, company or corporation. 4. I agree to indemnify and hold the Ciry of Costa Mesa and its employees or o�cers harmless from any claim resulting in damage or personal injury to myself or any other parties as a result of work authorized by the permits from the Ciry of Costa Mesa. 5. I declare under the.penalty of perjury that the foregoing is true and correct. Exewted this day of �' � f I(� � 20 _, at PrinGName:�_ �� i'9�' T}'�l l�(t1�� " $ignature�E=" Note: This authorization does not grant authorization to perfortn the work as owner, it solely provides for limited power of attomey to secure this permit in any behaK. 0779-46(�ev.11100) California. � ' � � � ' ' t3U1LU1NC9 YtKMI l ,lob Address: 3125 JEFFERSON AV � Suite: Vicinity: ROOF Primary Occ: R-3 Dwellings/ Cong Res <10 Parcel Number: 14165228 Applicant: NGUYEN, JOHNNY Address: 3125 JEFFERSON AV.,e SETBACKS '�' MAIN�STRUCTURE ACCESSORY PARKING Type of Construction: V-N Zoning: R1 ISSUED BY: Status: ISSUED Applied:. OS/11/2005 Issued: OS/11/2005 NOTICE: The work aulhorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 7, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced wiNin 180 days, or if work is suspended or abandoned for a period of 180 days. . INSPEC710NS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspectlona and final approval must be obtained. Failure to obtain inspeclions and tinal approval will result in the expiration of this permit. FOR INSPECTIONS CAIL: �(714) 754-5626 ' �ma-ae ta�ov) WORKERS' COMPENSATION DECLARpTION: � ' -' ' ' ' � � I hereby aMirtn untler penalry oF perjury one of ihe following declarationsi:' "' - ' �� - ❑ 1 have and will maintain a certificate of consent to self-Insure for workers' compensation, es provided for by section 3700 of the Labor Code, forJhe perfortnance of the work for whiCh �hi5 permit is issued. -�"�' - � — , ❑ I have and will maintain workere' compensation insurance, as required by section3700 of tha Labor Code, Por the perfortnance of Ihe work for which this permit iSissued. My workers' compensation Insurance carrier and policy number are: ' Carrier: PolicyNumber: ' - - (This section need not be completed i! the permit is valued ef one huntlretl tlollars ($100) or /ess.) .� � 1_cetlify that in the pedormence of the work foi which tfiis perinit Is issued, I�shall not employ any person in any manner so as to tiecome sutiject to the workers' '- ' compensation laws ot Celibmia, anry'agree ihat it I shoultl become subject lo ihe workers' compensation provisions of Sedion 3700 ot Ihe Labor Code, I s�all forthwith comply with ihese p_ovi ' ns. • BpplicenfSlgnatuie."'"' - . pate:r�.: - � : �C" f � 1 Q � WARNING�FAILURETOSECUFEWOFKESCpMPENSATIONCOVEPA IS IAWFULANOSMALLSU&IECTANEMPLOYERTOCR�MINALPENALTIESANDCIVILFINESUPTOONEHUNORED T/i0U5AN� OOLLFRE (5100,000), IN ADDITI TO THE WST OF CAMPENSATION, DAN,AGES AS PROVIDEO FOR IN SECTION 3106 OF THE LABOR COOE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirtn that I am licensed under provislons of Chapter 9(commencing with Section 7000) of Division 3 ot the 8usiness and Pmfessions Code, and my license Is in full force end ettect Lic. M Class k Coniractofs Signamre: � Data: CONSTRUCTIONLENDINGAGENCY:'r). - ❑ I hereby affirtn that ihere is a consirp�ion lentling agency for the performance oi Ue work tor which this permit is issued. (Sec. 3097, Civil Cotle). Lender's Name: Lender'S Addres5: Signeture: Date: OWNEH-BUILDER DECLARATIONS: I hereby a%Irtn thet under penairy of perjury thel I am EXEMPT FROM THE CONTRACTORS LICENSE LAW tor ihe following reason (Sec. 7031.5, Business end Protessions Codei Any ciry or county which requires e permit to construct, alter, improve, demolish, or repair any stmc�ure, prior to its issuance, also requires Ihe applicant tor such permit b file a signed slatement ihat he or she b" licensed pursuent to Ihe provisions of Ihe Contractors Licensa Law (Chapter 9(commencing with SecGoo 7000) ot Dlvisioo 3 ot the Busineu end Professions Code) or thet he or she is exempt therefrom antl ihe besis lor Ihe allegad exemption. Any violation ot Section 703L5 by any eppliceM for a Dermit sublects Ihe applicant lo e civil penalty of not more then five hundred dollars ($500).): � I, as owner of the property, or my employees with wages es �helt sole compensation, WILL DO THE WORK, and iha siructure is not intended or otteretl for sale (Sec. 7044, Business end Professions Code: The Contractors License Law does not apply to an owner ot properry who builds or improves ihereon, antl who tloes such work himseli or herself or ihrough his or her own employees, provided that such improvemenis ere not intended or oHered tor sale. If, however, tha buiiding or improvement is sold within one year of completion, ihe owner-builtler will heve the burden of proving ihat he or she did noi buiid or improve for purpose ot sala.). � ❑ I, as ownet of the property, em E%CLUSIVELV CONTRACTING WITM LICENSED CONTRACTORS to consiruct [he projecl (Sec. 7044, Business and Professions Code: The contrectors Licanse Lew does not epply to an owner of property who builds or impmves theraon, and who coniracts tor such project with e contractor(s) license pursuant to ihe Coniractors License Laws.). ❑ I am ezempt undar sec. Business and Professions Cotle for Ihis reason: Signature: Date: Owner ID veriFied by dnver's licensa. ❑ Ves ❑ No Drivefs License No. E:pires: Venfiwtion of Ownership by (rypa oi daument, i.e. � property taz bill or deed): DIVISION OF INDUSTRIAL SAFETY PEpM1T CERTIFICATION: ❑ I hereby cenify thet no excavation fiye (5) or more teet in depth into which a person is required to descend, will be matle in connection with work euthonzed by Ihis permit, and ihat no 6uiltling stmcture, scaffoitling, talsework, or demolition or dismantlinq thereot, will be more than thirry-six (36) feet high. (Chap. 32, Grp 2, Ar12, Sec. 341, Ttle e, Califomia Adminisirative Code). ❑ As owner-builtler, I wiil not employ anyone to do work which would require e permit from lhe Division of Industrial Sefery, es noted above, unless such person hes e pertnit lo do such work trom the division. Signature: _ _ _ _ Date: Division oi Industrial Sefety Permit Numbgr: DECLARATION OF AUTHORITY FOR AGENTS OF PROPERTY OWNER TO APPLY FOR PERMITS Street Address: Bidg. Permit # This Permit 3t Number: 1. I(we), !� 111�C� j�� L`� l:��,� +��t1 , declare that I am the Owner of Title of the above C) �) referenced real property, and that I(we) hereby authorize: � Name: i��a�+�, �-�.�.��n ��• ��TelephoneNumbec �'��+i `�=i�'-'17U�'-� (1 _ \ Street Address: City: �. -.� *. N�'v•. State: to obtain permits �n my behalf, as owner/builder, for_ at the above referenced property. - Zip: c? :; ( '� (. 2. Should any person become an employee engaged in lhe improvement of the property, I(we) shall immediately provide Worker's Compensation Insurance coverage and cause a certificate of ihat coverage to be filed with the Building Division of the City of Costa Mesa, as required by State of California laws. 3. As ownedbuilder in facl, I understand and accept that my responsibililies do not transfer to any o�her person, company or corporation. 4. I agree to indemnify and hold the City of Costa Mesa and its employees or ofTicers harmless from any claim resulting in damage or personal injury to myself or any other parties as a result of work authorized by the permits from the City of Costa Mesa. 5. I declare under the penally ot perjury that the foregoing is true and correct. Executed this day of >� f�O � 20 _, at PrintName: i}'I v�1,r:'\ T�-Ii TV�-lii(. (�r' Signature: � ll�-. _ 4 : .� �. Date: Note: This authorization does not grant authonzation lo perfortn the wnAc as owner, ii solely provides for limited power oE attomey to secure this pemiit in any beha8. Ol�9�a6 (rev.n�00) Califomia. (714) 754-5273 • Faz (714) 754-4056 • wvnv.ci costa-mesa.caBUILDING PERMIT 77 FAIR DfiIVE, COSTA MESA. CA 92616 �obnddress: 3125 JEFFERSONAV Suite: �1 Vicinity: Primary Occ: R-3 Dwellings! Cong Res <10 Parce� Number: 14165228 npp�icant NGUYEN, LONG N - Address: 3125 JEFFERSON AV COSTA MESA, CA Owner: NGUYEN, LONG N � Address 3725 JEFFERSON AV COSTA MESA, CA Contraclor. Address: Zip: Arch : Adtlress: Phone: Zip: � License; � ,��°� RENEWAL OF EXPIRED PEftMITS FOtR!A�$2�SQ� d��.,+�� . tlr.� t6�.:. REF; B 081923, P 082576, P 081925yE 081924,'E ection:�' $0.00:"` Total: $0.00 � �CKS : g, ; fRUCTURE �F,r`ont 0- 0�� "�'t'! iORY ��ont 0- 0 — (��,�a'��:�?��, NG ,,d�;��Ezlstinq: 0 � Status: ISSUED �r9. IR�jy/lssuled: 09 282006 Type of Construction: V-N +�� ' Zoning: R1 pA�� ftear" 0- 0 ui Reauired: 0 Phone: Zip: 92623 Phone: Zip: 92623 Phone: License: Lek 0- 0 LeR 0- 0 Pr000sed: 0 ISSUED BV: • BA7H, Calc Valuation: Claim Valuatio�: Right 0-0 Right 0- 0 so.00 so.00 I � NOTICE: The work aulhorized by Ihis permit ;hall comply wilh all applicable handicap access reQuirements under Calilornia statules antl related regulaiions. (Ord. No. 92-28, § 1, 12-27-92) EXPIRATION: This permit shall aulomaticalty e> pire antl become void il work is not commenced wilhin 180 days, or if work is suspendetl or abantloned for a period of 180 days. . ' � INSPECTIONS: In order tor the work authorized under Ihis permit to be consitlered legal, such work musl comply with all applicable codes, and all requlred InBpecllona and tlnal epprovel must t�e obtainetl. Failure to oblain inspeclions and linal approval will result in the expiration ol Ihis permit. FOR INSPECTIONS CAIL: (714) 7545626 � � »o o �ao.�i WORKEFS' COMPENSATION DECIARATION: � ' I pereoy attirm unUer ponalty ot per�vry one ol'ha lollowing tleclaralions' - ❑ I �eve en0 will maintain a candicaie ol c<mseN �o salbinsure br workors' compansation, as providetl lor Dy setlior 3700 0l i�e La�or Cotle, lor Ihe perlormance al t�e work lo! w�ic� I�is pelmil �5 issUetl. ❑ I nave an0 will mainlain wOrkerY tomponsalion insurance. as reqmretl by se[lion 3700 0l rtie L&bor Cotle, lor inu perl�rtnance of Ine woB lor w�ich ihis ponnii is issue0. My worhers' compansation Insurancn cauier ana policy number are: Carrie[ PWicy Nu nbnr: (T�is :ecfinn nen� nofOe camp�oletl rt ��e pxnnrt is valuetl at onn huntlrxtl Uolleis ($100f or Inss ) ❑ 1 cBnity IOBI m Ibe purtorrdanCe ot Ihe wcrk lor whiCh Ihis permii is i55u0Q 1 Shall nol employ eny person in any ma lner 5o as lo tleCome SubjeC� lo Ihtl workers' compnnsaiion luws ul Calibrnia, antl ag�ee mat il I snoul4 becoma suU�nct to me workers" compensa�ion provisions ot Section 3�U0 0l Ihe Labor CoJe, I'shnll lorl�wi�h COmyly wi�M1 IptlSn provisi0��5, . Applicenl Signatmo: Dale: WAHNING� FAIWRE TO SECURE W�KERS' COMPENSATION CqVERAGE IS UNIAW FUL �ND SHALL SUBIECi �N EMPLOYER TO C�UMWAL PEN/�LTIES AND CIVIL FINES VP 10 ONE MUNDRED TIq�SAND DOI..URE IS100,C001. IN ADDIiIUN TO THE IX)ST OF CqMPENSATION, OAM4GE5 n5 PROVI�[D FOR W SECTION 9106 OF fHE LABOq LOOE, IMEREST, A11D�FTTOHNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hero�y aflirm Iha(I am licensetl untler pwvisions ol C�apier 9(commencing wiln Seclian 7000) ol Division 3 of Ine Bu!ines5 lorce anG efleci. LiL'. �_ � Class � Comraaor's Signawra� CONSTRUCTION LENDING AGENCV: ❑ I hereby nflinn Inet the�e ib a consvuction lentling agoncy lor ��e performance ol Ihe woik br LenUer's Name: Lenaer's AtlUress: Signamru: wL6 OwNER-BUILDER DELLARAi�ONS: 1 nereoy atlirm IOaI untler Denally ot perjury thul I am E%EMPT FROM TTIE Cotle: Any nry or cumvy which �equrtes a pormit to consbuct, alier, impmn to tilo B s�gnetl sletnmunt Ihal pa or she is I¢ensetl pursuani lo Ine prOV191( Bu5ine55 antl Prolesaions Cotle) or Ihai �a or she is erempt iherefmin'�80� >ub�ecls tne ap01¢anl to a civil penalty ol not more t�an five �untlretl tldhif /i:eR�a��rm, ❑ I, as owner o� �be pmpeny. or my empbyees wilh wages aa�tlle6 eols ' 7044, Businnss antl ProleSsions Cotle: T�e Conln � bimsell or ber5xll or I�mugh his or �er own emplo sold wilhin ono year ol canipletion, ihe owner-buil� ❑ I, as ownor nl Ihe propeny. am E%CWSNELV CI Cotle'. T�e mnvac�ors Licanse Law,tloe: nol appl license Fwsuant m tne ConUaqoFn tker,se laws. ❑ I am e.amp� untlar sec. Signawre: OwnOr ID v0riti00 Oy tlriv¢i'9l VerJicalion ol Ownershio DY 1 m bill or DIVISION OF INDUSTRIAL'SAFETY PEqMIT CERTIFICATON: K 3sh1i:1 .s:. ,p:,;;.ax ❑ I �ereby ceniry Iliet �ro azeavaUon live (Si or mora teet N deptn into peimit, ano Ihal iq biil�ding simcwre, scatlolding?,fel6ewofk, or tlen 341, Tille B, Caldoiriip,Administra�ive CoAe). ��,'�"�?� � Daie: or rBpetriBnyslmcWre; p�iM,to i 5 issuance inlrecYore;Ucanse Law:(Chepler 9 (commei >r tlie'ellepe0 axemptiori.".`A�n�j� vi�lation ol ; w�w'Py ;, r��. � ' r�.:!: ln' .. m, WILLDO�TME WORK:end ne slrucWr lly tu ariytiwner,W,properry�who Luiltls or im amentf'eraltio4lntendeC pt oHerotl for sala. �g I�BI li6`o/ ili9'Aid'noLb�iltl or improve k w:u..�Mu.,l.w.%..a.qit�V ) CONTi1AC70R9�t0'conslmci he prolnct iiltls'OilmpFo49e',Iheieon, antl w io coNrac t�F, `��" ns Codo'lor I�is reason: �.'d t� — J Dala: my license is in lull 37.5, Businosa ana Prolessions as Ine ap0licanl tor sucn permil iction 7000) ol Uivision 3 ot I�a .5 by any applicanl tor a permil �ded or oHered lor sale (Sec. �on, antl wno tlnes suc� work , IOe builtlin[J or impravumenl is sal6.). Business antl Prolassions , rolec� wilh a COnlracloi(s� Espires: tlescenQ will bo natle in connection wil� work eWhorizeE by this will be more than miey-siz (36) leei higR (C�ap. 3.2. Grp 2, An 2, Soc. ❑ As owner�OuiltlM; I�iwiO'no� employ enyone to tla wmk'whikh:woWEl%pqNfe e permit hom Ihe Division ol Intlusir al Safety, as notetl above, unless such per5on �as B permil lo tlo su�Cyh wCoifi {from tne tlivisicn. l[1'�� t �t° y�I. q� S'� �.,��'� Si9nawre: {ai�7Sc41 %•GY� aY�:t„ncs� '.'*as.eir...* Date: . . ysr '. y.r.- •3 . Divisian of Induslrial�5a�feryParmi� NumMr.� �Sy�� Mo&#.i::Nf M.i.�e:.:.v. Vru..u.0 - MAZAqDOUS MATERW:S'ANO EMISSION9 CER7IFICATION: . �.wvr,.:�� n.e.u�.n,_,. . i Will ihe eppGcanl'oqpres¢_n{ oRlufurB:buBding occupanl neaE Io file end conily a dusiness Plan lor emergenCy resPonse Io release or Ihreatanetl reloesn ol a hezertlous �Section 25505 pl.�fle'CelHufrua�HeMh�antl Safely Cotle requires, with somo oKceplions, Inel e Business Plan D�� filntl wit� lhe Cosla Mesa Fire Depanmenl by ewry . Uusiness which Yieaj9P4iy,0�9,thne tlYnn� a reponetl year a quanliry ol nazerUous malanals oquul lo or grea�ar Nan a weighl ol S00 pouna>, or a volwno ol 55 galbns, .or 200 cu�ic teel 0� OOIIIpf05594 Qfi6 et slJntlartl lemperature and pressure). .......... . =r- . ............... ........... ..., ... . .. ...... . ........ ... ..... ... .. .. 'L DOBs or will Ihe dpD�� Dre56i11 or W W re bwltlin occu ant neetl lo lile a re i51r01i0n lorm lor uculel ha¢artlou! malenals� �r.F`.m.w*.nro�r 9 P 9 Y ❑VeS.�....�No ISecuon 25533 0l ina Cairttl!M0 Healih antl Satety Cotle, wnn some excep�ions, reqwres reqislrauon wilh ihe Costa Mesa Fve Depanmant �y each Ousinuss which at xny unn brr�e hus on han'Aia?q�onlily of aculaly hazaraous metenals.aqual Io o� granler ihnn e weighl ol 500 pouitls, or a volumn ol 55 gallons, o� 200 cuDic fuel ol compressea gus a� stan0ar0 iempeialure antl pressure�. � 3 Does or will Ilie ap0��an1 or present or tuWre Ouiitling occupanl nae0 �o pmparo en RMPP (Risk ManageineN anE Pievemion Program br acWely haza�tlous materials�7 ❑ Yes � ❑ Nu � _ � ISnction 2553a of �he CahtO�nia Healtn antl Safery Cotle provides �hat the Cosla Mesa Fire Deparlment may requ re the preparalion, cenitica�ion and lihng with I�e Fire Oepanmani ol an RMPP uy businesses wnic� are reqwretl ro reqister acwely �azardous matorials wilh i�e Fue �a{ aninenl. ........... . ......... . ......... ........__ ..,.,.,....... . .._..... . ......... . .... ...._.... . .......... ... .. ........ ..... 4 li an HMPP is prosontly required, has Section 25534 of ihe Cahtomia Hoalt� antl Sately Cotle baen lully wmplie0 with7 ❑ Ves ❑ No .._ ............ .............. ............... .....___.. ...._................. ........... . ........ ..,.. ........ ............ __... ............ . ... ... .... ........ ......... 5 Uoes oi will Ino uppliCani Of prBSnN ot lu:ure buildmg occupaN �equi�e lor Iho work wpic� is Ibe subjeci 01 Ifiis d JliWiion a $e�mii b� SUGh Conslmc�ion O/ mOtllfiCalion ' trom ibe Saulti Coasl Au Oqaltly Mdnagemenl Disinct or imm any oihar &ir pollulion conirol tlislricl or agency9 � Vea �J No ISection 65850.2 ot me Cablornia Govemmenl Coae requlres mat Ina requasietl inlormalion be lumishetl on aPpliG.tions tor non-resitlenliel Ouiltling permnsJ. ,...... ..... ._..._..._...... ..............................................................._...................._................___.. ._._............... ........_..........................._.............................. ti Will uny p&rt ol Ihn lanliry �0 �a consimcletl untler Nis permi� Oe wi�hin 10001ea1 bom ��a au�ut bountlaries OI a scl ool'? ❑ Yns ❑ NO (11 yes", tne iar.ili�y musi mde� ihe requiremem of Sections 25534 antl d2303 ot t�e California Nealtn antl Safely Cal�). ...... ......................... ..........................._... _...................._............._...._.................................._......,............................_.............................. ,.y_.....__..................................................................................................... 7 II a pemiii vom Ine South� Coasl Air Ouahry Management District or oiher air pollul�on conlml tlislricl or agenc�' is reQuired lor ihn woik whit� is I�e 5ublect ol Ihis bpUliCalwn, navu all ol Ine d�5closure5 prescribeu by Galilomie Heal�h antl Sainly CWb SnCtion 42303 �aem m�tle? ❑ Vas ❑ No ............ ...... . .......... . . ........... .. ,............_..... ........... . . . ......... ....._._ _......... . ,. .............. _ .......... .............. . . . ............ ...,..... B pl'yes", altacn conihcatn ot �omV�iance Imm tna appropnate eir polluiion conirol oHicer�. CEHIIFICA7[ OF COMPLIANCE: I cemty tnat unaer penalty of perjury Ine inbrmation given abova is rorrecl. I a3rae �o comply wiih all staie laws and ciry ominances � regartling Mazartlous Metorials nnJ Emissions. Signelurn: Dalo: CERTIFICATE Of COMPLIANCE AND AUTHORIZA710N OF ENTAV: I cenity untler penalty ol porjury I�al I have read INs epplication antl siate Ihal iho intormation given is correci. I agrxe �o comply wii� .II slate laws entl ciry ortlinances relaunq to builtling conslmc�ion, antl auihoriie reU�es3matrve5 of Ihe Cily ol Cosla Mnsa m enter upon ibe above�descrioetl propony lor inspec�ion purposes. I aqree not io «cupy or allow occupancy ol any builtling awhorized b�- this permit un�il linal inspociion. COpE � INSPECTIONT]pf, 1616 FjXeG 518t8111.1 Fire 203 204 Signalure O� Lugd Owneqs) nWOr Amnonzetl Apphcant D�iE INTIilALS NPfBVB�l10� ��--��-t'�S'� �. '� �.�/��r � � �r�`uf�.+�Y��^':w`e��''r� �kil��,'Y I 47 Wall %��+Tr A+ COpE � INSPECiION TYPE � 21 D�IE VITRI�LS WEIDENKELLER, MARY JANE From: Sent: To: Cc: Subject KENNERSON, SILVIA Tuesday, August 24, 2004 8:41 AM PETROS,EDWARD W EIDENKELLER, MARY JANE B04-01004/3125 JEFFEFRSON AV THIS ACTIVITY WAS ISSUED TO RENEW EXPIRED PERMITS AND APPLICANT NEVER CAME IN TO PAY FEES. THANKS! Silvia O. Kennerson City of Costa Mesa Bldg. Dept. (7l4) 754-5652 �l�o��9a3 P �8a5 �� f' �819�5 �a8��a� Loga� � � u e (714) 75a-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.�LDING PERMIT // rHln UnIVC, l.vJin mwr, a.n nmm JobAddress: 3125 JEFFERSONAV Status: ISSUED Suite: Applied: 05/11Y2005 Vicinity: ROOF Issued: OS/11I2005 Primary Occ: R-3 Dwellings/ Cong Res <10 Type of Construction: V-N EXPIRED ParcelNumber: 14165228 Zoning: R1 Appliwnt: NGUYEN, JOHNNY D:l'PE_y(;y.�J:L� C//�'��,D� Address: 3125 JEFFERSON AV (� �!i�'�� _ - ��--Phone: ,�.714-557-9705 ISSUED BY: COSTA MESA, CA �� -� 'Zip 92623;,,a; �,y, g ""j/ Owner: NGUYEN,THERESAT'� ' '`� � -� . ,. .�.. ... Address 3125 JEFFERSON AV -� .. � � �-�;M1_� ' � � „ �,. �,' - . � - ..� - �?�Phone � ,. COSTAMESA,CA �� ,� _ - Zip �92623<��' � �� . � ;'a ,.� � � � - . �� . :�., � Contractor `'OWNER BUILDER � �� < ,q�, . > `� -� Address ��, '� : � �' I��.' . fv s✓.- <:�. � '� '.�, t K.", � Phone: a'e . � , 3 \ � F - '� � �� 5 r` r�yv � �� Zip:� License: 000000 r:y' �-, �� y::1'7 r�: i,Arch 4 . . �, �y E�9: -��;��' ,� . Address: � Address: : _ � ? � � � �- <. , i�., . Phone: ° �r . , � Phone: a , ,.._ : , ., . ., , , . • _ � Zip: - � �' . � 9Cicense - � . `� • .., ,� License .� ,; , � . - � ..,.. . .. _ , . . : , � . ._. , a ,. , .. r,�.i ' �A�' Y.� � ,- _ � _. . . _ . :f r. ,�•: ` SCOPE OF PERMIT ,� " '; �' � . . '.`1;�yyORK DONE WITHOUT BERMIT, INSTALLED 3 SKYLIGHTS, CABO #216 AND 6 TUBE LIGHTS, ICBO LISTED OR EQUAL�ON ROOFTOP. NO ' '�3CUTTING OF ROOF RAFTERS OR�JOISTS. ' � " ` ' '��-WORKISSUBJECTTOFIELDINSFECTION _.� , � '_�. ,�V �,�'�` 'z?$9/1%05:REVISEDPERMIT 6. � .� .� �� ^`- - �. �.^, .. .. ._� '�:. �. . . . � , � ', ; ; . . . i,�� 3 ELEC OPENABLE SKYLIGHT IN A ROW ;(EACH 2 FT X 6 FT OPEN WG)SAND A PULL'=DOWN LADDER IN GARAGE _- � .: . �st t' , _ ' _ _ _"__ _ _ :�Y .�t. �, a t ' - i�I_v �� , as ; t �_ ;� � FEE SUMMARY mr. � � � �'. � - t , �Plan Check !' $54 11 � � " _ " �' ' �� Calc' Valuation ` ` ' `S3;000.00` , . � Permit '.` �'$8325 _ - ? e '= T Claim Valuation ,: . 53,000.00 -_ . : ,-�SMIP Res: :�., ,� $0.50>.. .,. , � • �� , - � �$MIPCom: �'�,$0.00 � � .. � �� -�a��`. ,Other, '�$8325' �> �. ' _ - _.. 0.00 '' � : inspection:, � � $ • , , t;Total: $221.11, _� �, �;�1" r�;�I <<a, ,t. ., . ; �, . , . . ..;, e .�• . PLANNWG 8 ZONING „ . w .,: n , ,�.. � ,, � � ._ � � " §� SETBACKS. -� � . ,"� �,, MAIN STRUCTURE Front` 0--0 ,�~ �'� 3 Rear 0 0-, Leffy 0 0 � Right 0- 0'- ��- �� - � . _ -Y . _ . � ; , :`5� "�s, _�.�-� �. s x � -. �.__ �--` � ..,'� z ACCESSORY '-�Front 0 0 , � Rear 0 0 ��xi �LeR; 0 0�� Right �,0 0' �, � : � i '� •�.,.� -�'��:� . .... 9, z ��,ab ' •, '}�.: ,•� ', PARKING Exisiin � 0�� Reauired 0.�-, Pr000sed ° 0 r„�. ? ..�. . 1 " �--- ..x'a i' ',� .'� ' � ,�tiz , . a„� �'�r": - ,.. � , ^�„ ,.. _ �. ...Fr:, u . _ . ��, NOTICE: 7he work authorized by this permit shall comply with all applicable handicap access requirements untler California statutes and related 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 it work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for ihe work authorized under Ihis permit to be considered legal, such work must comply with all appliCable codes, end all requlred Inepactiona end flnal approvel must be obtained. Failure to obtain inspections and tinal approval will result in the expiration of this permit. I FOR INSPECTIONS CALL: (714) 7545626 � " 244&46(8N0) WORKEAS' COMVENSATION OECLARATION: ' • � . _ I hereby aHirtn under penalry ol perjury ona ol tha following tleclaretions: ' - ❑ 1 have end wlll maintain e caNlicete at consent lo sell-InSure for workers' compensetlon, es pro. ,�, . e700 of tha Labor Code, tor the pertormance oi the work lar wNCh Ihis pertnit IS issueA. . `� � ❑ I have entl will maintain woAcers' compensatlon Insurance, es requirad by sectlon 3700 oi the Lebor Code, for the pertortnance ol tha work for which Nis pertnit is iswed. My woMerS' �mpensatlon Insurenca carrler entl poliq number are: Certier: POlicy Number: (Thls 5ection ne�d not be cwnpletetl i/ Ihe pertnit ts va/uetl at onB hundretl tlollars ($100) or less.) .. I:certity t�at in the pertormence af the wOrk lor which thl5 pertnit Is issued, I shell not employ eny pereon in eny manner so as to hemrrie subject to Ihe workers' compensel�w� iaws ot Calllomle, and egree that If I should become sub�ect to the workers' campenselion provisions ot Section 3700 ot the Labor Code, I shall Iorthwith comply witn Ihese prqygQ � a�t5lgn�ie� �6 uunn 4�ii� lnrri�ln �pete��' �I�(1��/1 1NG:.FAILURETOSECUFEWOiU(ERS MPENSATIONGOVERAG I U WFULANDSWILLSUB1ECfPNEMPLOVERTOCRIMINALPENALTIESANDCIVILFlNESUPTOONEMUNDRED iAND Dq.LARE (5100,00p). IN ADDITION TO TME CQST OF COMPENSAiION, DAlMGES AS PROVIDED FOR IN SEGTON �O60F THE IABOR OODE, INTEREST, AND ATTORNEI"5 FEES. LICENSED CON�7ACTORS DECLARATION:. � . � I hereby aHirtn thet I em licansetl under provlsions af Chapter 9(commencing wilh Secilon 7000) ol Divislon 3 ot Ihe Business end Protessions Code, and my license is in tull torce and eNec�. Lic. 8 - Cless x Contrectors Signewre: Date: CONSTRUCTION LENDING AGENCV: ❑ I hereby aHirm that ihere is a canstruction lending agency tor Ihe peAortnance ol ihe work for which this permit is issued. (Sec. 3097, Civil Code). Lentlers Nema: Lentler's Address: Signature: Date: OWNER•BUILDEA DECLARATONS: I hereby aHirm thet under penelty of perjury that I em EXEMPT FROM TME CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business end Professions Code: Any city oY counry which requires a permit to construct, alter, improve, demolish, or reDeir any structure, pnor to its issuance, elso requires Ihe applicant for such permit to file e signetl stetement that he or s�e Is Ilcensed pursuent to the provlsions oi ihe Comractors Llcense Lew (Ghepter 9(commencing with Section 7000) ot Division 3 of the Business antl Pro�essions Cotle) or Ihet he or she Is exempi therelrom and tha Easis for Ihe elleped exemption. Any violation of Section 7031.5 by any epplicant for a pertnit su��ects tha epplicant to e civil penely of nol more Ihan five �undred dollers ($500)J: �„�I,es owner o� t�e D�aPerty, or my amployees wilh wages as their sole compensatlon, WILL DO THE WORK, and Ihe strudure Is not intentleC or otteretl for sale (Sec. 7044, Business antl Professions Code: The Coniractors License Law does not apply to an owner of property who builtls or improves Ihereon, and who tloes such work himself o� herself or through hls or her own employees, provitletl that such improvemenis are not Intendetl or offered tor sale. If, howaver, the 6uilding or improvement is sold within one year ol completion, the owner�builtler will have the Ourden ol proving that he or she did not �uild or improve for purpose of sale.). � ❑ I, 85 owner o� Ihe proparty, em EXCLUSIVELV CONTRACTING WITH LICENSED CONTqACTORS to construct the Oroject (Sec. 7044, Business and Professions Cotle: The Pontrectors Llcense Lew does not apply to en owner ol pwperty who builds or Improves thereon, and who contracis for such projeci with a contractor(s) license pursuent to the Conhectors Licanse LewS.). ventiad ❑ VeS� `fl No Business and Professions Catle lor ihis reason: Venficetion of Ownership by (rype of tlaument, i.e. - propeny ta: bill or DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I heraby ceAify thet no excavetlon flve (5) or more feet In depih imo which a person is required to descenq will be mede in connection wi�h work authorized by ihis pertnit, entl lhet no building structure, sceHolding, falsework, or demolition or tlismentling Ihereof, will be more �hen ihirry�six (36) feet high. (Chep. 32, Grp 2, Art 2, Sec. 341, Tltle 8, Celifornla Adminisiretive Cotle). ❑ As owneo-bulltler, I will not employ enyone to do work which would requlre a pertnit imm the Divislon of Industriel Sefety, as noted ebove, unless such person has e permit to tla such work irom the dlvision. Signature: Date: Divisian oi Indusinel Sefery Permit Num6er: CER7IFlCATE OF COMPIJANCE AND AUTHORVJ1710N OF EMRY: I certity untler penalty ol perjury that I have reatl this application and state that the information given is correct. I agree to comply with all stete laws en0 ciry orAinances relating to building consiruction, and authorize representatives of iha Ciry oi Costa Mese to ente� upon the eDovatlescrib�g�d/� pmperty br( �i�spection puryosas. I agrea not to occupy or allow occupanc� ol any buiWiog auttwrizetl hy this pertnit until final inspectiort. i6V�V.Unn, ?��'�6l'_fz 'n�rruGA_....�'.. _ R'�'1•�bf'�:� . �Si9nat� �eGel. n � s)t-�,r-=-y—+_- _ ' {.�Date„;yy AnNOr Authorized Applicani Date cooe �. UfSPEGII4MT?'PE 1616 Fixetl Sy6tem Finel Fire Preventlon 1268 Pool Spa Final 200 Finel Re-R�� 201 Finel Blo�k�Retaining Well 202 203 204 Final FeGiory Fira Place Finel Sig� Final Demolltion �E 1I�9L5 �ODE� INSPECTIONTYPE 206 Final Mechanical 200 Final Plumbing 210 Final ElecMcal 212 � Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final BuiltlincyOccupancy �� C�TY OF COSTA MESA BU/LD/N6 D/V/S/ON DEVELOPMENT SERVICES DEPARTMENT PEFiM1T (714) 754-5273 • Fax (714) 754-4056 • www.cl cosla-masa.w��ECTRICAL PERMIT JobAddress: S'IZS JEFFERSONAV Suite No Viciniry: . � Parcel Nunmber: 14165228 Applicant: NGUYEN, LONG N Address: 3125 JEFFERSON AV COSTA MESA, CA Owner: NGUYEN, LONG N Address 3125 JEFFERSON AV Contractor Address: 200a t000a er7000a Intermed Pole COSTA MESA, CA RENEWAL OF EX REMODEL BATH, REF:B04-01004. REF: B 081923, $0.00 $0.00 $0.00 $0.00 50.00 50.00 $0.00 50.00 $0.00 50.00 50.00 50.00 � � � 0 0 0 0 0 0 0 0 0 Phone: Zip 92623 Phone: Zip: 92623 Phone: Zip: License: FT. PERMIT NUMBER E04-00621 77 FAIR DRIVE, COSTA MESA. CA 926?6 status: ISSUED , Applied: O6/02/2004 �gpyly�r Is ued: 09/28Y2006 X� 1 L DATE � � / Lighting Misc Elect�ical:Equipment Trenstorme'rs�,up to 1 kva/kw ...... �'uS�up�lo;10 kvalkw .... ��'up t'o'�50 kva/kw .........�^T`�'uP�lo 100 kva/kw . ......... G�t�'.'.�.over 100 kva/kw Low Voliage Equipmenb Low Volt Wiring System / Ckt Misc. Conduit Misc. Conductor Circus ( gen or ride) ' Circus (mech ride oclights) Christmas Tree Stand Fireworks Stand Olher Elecirical Fee Investigation Fee Plan Check Fee Reinspection Fee ISSUED BY: ENTRY Quantlty $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 ' 0 30.00 0 50.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 $0.00 50.00 $0.00 TOTAL CALCULATED FEES E0.00 NOTICE: The work aulhorized by this permit shall comply with all apPlicable handicap access requiraments under Galifornia statutes antl relatad regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permil shall automatically e� pire antl become void it work is not commenced within 1B0 days, or il work is suspended or abandoned for a period ol 180 tlays. INSPECTIONS: In order tor the work authorized unde� this permit to be considered legal, such wo�k musl comply with all applicable codes, and all required Inepectlona end final approvel mus� t�e obtained. Failure lo obtain inspeclions antl linal approval will result in Ihe expiration ol Ihis permi�, FOR INSPECTIONS CALL: (71A) 7545626 iM6-4fi (N00) . WORKERS' COMPENSATION DECLARATION: � � _ I �ero0y aHirm untlar penally ot per�ury one of ;be lollowing tloclerations: ❑ I have entl will main�ain a cend¢ate of consenl to selldnsure br workors' compensalion, es provitled lor Ey sectior �3700 0l Ihe Labor Ca1o, br Ihe pertormance ol t�e woM lor wpicb IM5 Vermil is issuetl. , . ❑ I nevu end will me�mein workers' compen:ziion insurance, as requiretl by settion 3700 0l iho Labor Coda, tor Ihu pen�rtnance of �be work lor w�ich t�is permil is issued. My worhers' compensation Insurance cauier antl pobcy number are: Carrier. Policy Nu nber: (This ^.xcliun neu� no! be camplofea Al�e pannrt is valuetl ur ono hundix� Jollare (S i00J oi lessJ ❑ 1 Lellity II191 In IhB P��olmanCB 011h0 wcfk �o! whith Ihis pBfll�il �Is ISSu84, 1 Slldll n01 empl0y d/ly pef50n in Bny md lfl¢r So a5 IO �BComO Subjac� 10Ind wOlkBrs � compnnsa�i0n laws u� Calilornia, antl a9�ee Inai i� I shoultl become sub�e<� �o �M1e wo�kers' mmpensmion pwvisions ot Senion 3700 ol t�e Labor CWe, i snall fotlhwi�b :omyly wi�n I�esO O�ovisions. ' Applicani SignaWre: Dale: WARNING� FAILURF TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL IJI� $HALL SUflIECi AN EMPLOYER TO CNIMMQ PENALTIES AND CIVIL THOUSNID DIXURE �510�.�1. IN ADOIiIpJ TO THE C(rT OF COMPENSATION, DAMAGES n5 PROVIDED FOR IN SECTI(Nl J)W OF fNE LABOq GOpE, IMEREST,. LICENSED CONTRACTORS DECLARATION: � - I hero0y anirm Iha� I an� licensed untler pmvisions cL C�aptor 9 �commencmg wilh Sec�ion 7000) ol Division 3 0l Ihe Bu: iness to¢e antl ettecl. lia �� ' Class � Coniractur's Signaturn' CONS�RUCTION LENDING AGENCV: ❑ I hemby dHinn Ih�l Ihere is a consvuCtiOn lentling egonty br �he perl0rmance o� ��e work ta� Lenaer's Name: Lender's Adtleess: Signaluru: � .� OWNER-BUILDER DECLIIRATIONS: I �urnby aflirm I�at untler penalty of perjury ihul I am E%EMPT FROM THE CoDe: Any c�ly or counly wnich requires a Oormil to ton5��uc1, alter, improvl lo IJo n signe� slalnment IOaI ha or she is licensetl pursuani lo Ihe prONB10 Business entl P�olesmons Code) or tnai �a or she is eanmpt inerefram�en[ 5ub�eC�Slne applicanl iP a civil penalty ol not more Ihan live buntlrB(! �Ilptf /ymYNi�W' YM� ❑ I, es owner ot tne p�openy, or my employees wiin wages aa,tlrek ede 7Ua4, dusiness and Pmlessions Cotle: The Conlractors Lkerise�tew'� nimsell or nersbll o� Ihmugn his or ner own einployeas�piOvklBd Ihet i soltl wi�hin one year of cample�ion, I�e owner�huilder WIII liav9lie Gur v�i,�[-y ❑ I, as ownor nl the PiopenY. am E%CWSNELV CONTRACTING WIT CWe: The eonvactois Liwnse Law,tleee noi apply lo en owner ol pm licensa Fursuanl to me ConlracwTa Ckx.se Laws.) f�' gp'. .�t��a�s;FAI� f{3A'�'`'' ❑ I am eaomp� untla� sec. �!}Business ai SignaWre: Dwnor ID vorieetl Dy tl�ivi Venecalion ol OwnersMp DIVISION OF INDUS ❑ InefBbyCenityl permit, antl Iliat 3a1, Title B, Cal ❑ AS owner�builEl permil io tlo sui F Si9nawre: �[� Division ol Industriall! MAZARDOUS I Will Ihfl 0 matarinP! oill or valion live (Si or mora teet In tlept� imo sVucture, scaHolUing,".febewwk, ar der nisira�ive Coda). �q�� , Date: :TORS LICENSE LAW,lu.theiolowing reae , or r6pei%Bny'slructure� prioi,fn i s issuance omracloi� �lpnse Lew'(C�epler 9 (commei tor tlia`�elleped exem{itlai�:'qnr vi �la�ion ol : �'��`�� . �.ion, WILLrDO�THE�.WORKrend ne slrucWr �ply t0 an'oi+necol prupdiry�w�o Luilds or im ueme'iti ere;f1o4k1teededbt otlerod Wr sale. �ing Ili6t Iie�cn,Wla�tlitl'ilol�build ar improve to � ... r.�.w,..v:qJ ID COHiAACTOqB to conslmcl ne projec� niltl5�'Gs(f�ImplOVBp NB�6on, antl w lo coNracl 17�'�� ons �00o fa Nis reason: ��':� Dala: _ UP IOONE HUNOPED TORNEYS FEES. my license is in lull 31.5, Businoss anC Prolessions es Ine applicam ror sucn permit 3ction 70(lU� af �ivision 3 of �he .5 �y any applicant lor a permit ided or ottered lor sale (Sec. ion, antl who tloes such work Ine builtling or imprwemeni is sale.): Businoss antl Protessions rolect witb a coniranoqs) � Fapires'. 4ascenQ will be natle in connection with work euthorizxtl by Ihis will be more �han Ihuty-siK (36) lael high. (Chap. 32, Grp 2, Atl 2, Sec. employ enyone to tlb�wmk�:whl�il�wwMSreqWFe a pormit'Imm Ihe Division ol Indusv al Sefety, as notetl a�ove, unless sur,h person Oes a I�etliwslcn.�j ��".��''�`- � � ��4!..1 �'��F�}. a�h��4.?�� . . . Date: t#ia�� 4'�� - t Numhar.'�' \�'. �� -�`-�� rea_.. EMISSIONS CERTIFICATION: ' o;lujura�6uAding occupam neatl lo lile antl cendy a Business Plan lor omergancy resPo�se !o wlease or Ihrealenutl releasn of a nazertlous _ •- _.... _ . �Sucuon 25505 pf Ih0 elifi7rtp6:HaaMjentl Sataly Cotla requires, wi1� some exceplions, �hal a Dusiness Plan bo filatl wi�h Ihe Cosla Mesa Fira DeparimeM by evury business wnicn lie9;e1'&iy,an9,dma Ounn� a roponed year a quaNity ol nazartlous maienals epual to or g�eater man a weigln ol 500 pounus, or a volume of 55 gallons, or 20o cuore tee� uf �+W�se0�9ae b1 st,mtlartl temVerawre and pressure�. � .. ......... .... .. ...... -_._ ............. . ............. . . ......_... .......,... .. .......... .. .,. ... .... . .. ... . ............ [ Does ui will Ine appNceN Ot 4�eyarrt or IuW re Umitling occupant neetl lo itle a registration brm lor acutely �azartlou� ma�erials9 ❑ Ves O.No .. P L^��v:S+s�zW.m (Section 25533 0� i�a Ce�rtwMe Nealt� antl Salery Cotle, wM some eaceptions, requires registration wiih ine Casia Mesa Fire Depanmenl Dy enc� �usinuss which at any unn Iime h�s un nana:#iWanlny ot acwaly hazardoas mutnnals equal lo or g�en�or Ilinn e woight ol 500 pov�tls, or a volume ot 55 gallons, or 2U0 cubic Ibel oi compressetl yes al siantlartl temperaWre entl press�re�. 3 OOB5 ui wlll IhB dppllCan� Or pr05eni Or IUWre butltling OCcupant nau0lo prepdre Bn HMYY (Hisk Mana9¢inBn� 8ntl PrBveniiOn YI(H)fdm lof OCu101y hd2dftloUS fOdlBfidlS)7 ❑ Vea ❑ Nu ' . � 1Snction 2553a ol the CalJornia Heelih antl Salary Cotla provides Nat t�e Cosia Mesa Fire Department may requ re I�e prepaiation, cetlilication and tiling with t�e Fire Uapanmunt ot an FMPP Uy Ousinesses wnicn are requuetl to register aculely Oazardous malerials witn ine Fue De{ artmenL . � ........... ..,, _ . ................ ......... ....:_... ........... ......... . . .. .. ....... . 4 II an HMPP is prosamty require0, has SaClion 2559< 01 I�e CalAomia Heall� and Salaly COGe bean lully complied with7 ...._..._ .............._......_.._........_...................._........_...........................,................................_....._............_............_...................................._....._._...................._........_.... 5 Uuns or wdl IM1a npPlican� or presbnl or luwre builtling occupan� reqwra lor IOe wo�k w�ic� i5 IhB sublecl ot Ifiis a llica fmm me Somn Coasl Au (]uabty Managemenl Uisuin or tmm any othe� air pollution contml tlisvici or agancy? � Ve� 15emion s5nS0.[ ol Ino Cebromia Govemment CoOe requires ihal Ine requestecl inlormaiion be lumisnetl on applic:.liort .......... .. ........._............... ...._..__ .. . .__._........ .. ........... ... .. ............. . .......,... .... . .. ....... ,. . .............. 6 Wdl any pnrl ol Ibe �acdiry lo be cons�mctetl untler Inis permil be wil�in 10001aet �wm Iba oulur bountlaries ol a sc! 001'? �1I yei", Ine lacilny musl mnel Uie requireinenl ol Seclions 25530 end a2303 0l lne Calilornia Haapn antl Safety Cole). �J Yes �J NO ..............................._..........................._,............... OO d �16Rfli1 �Of SUCII COf151Nf.IlUl1 O� u N0 lor non��xsitlentiel builaing pBrmi�s). . .......... .. .... .. . ._........ ❑ Ves ❑ No N a pannit Uom Inu SoNh Coasl Ai� Ouo6ly Manegemenf �istrict w o�he� aii pWlution contml tlisVicl or eganc� is repui�ed b� fhn woik which is I�e subject ot ihi5 npylmauun, nevn nll oi me tlisciosures prnsaioeu by Wliiornia Mea110 antl Salery Ca�e Senion 42307 bnen made? ❑ Yas ❑ No . ......... . ................ ............._. .,. .. ........ .............. ., ... . .,,.,. ........ .......... . .........._ . ..... ..... ..... .,,.... ....._._ .. ........... QI yes e�tacn conihcete ol complianca fmm Ihn appropnale en pollutiom m�lrol oflicer). CFNIIFlCAT[ OF COMPLIANCE: I cetlily Ihal unaer penalry o� perjury Rie inlormalion given above is correc�. I e�reo to comply wilh ell Stala laws Bnd ciiy ominencas regarUinq HazdrtloUs Malf3�iaU tlnd Emi55iOn5. ' Signa�ura: Dalo: CERIIFICATE OF COMPLIANCE AND AUTl10RVA710N OF ENTRY: I cendy untler Denalty ol perjury I�at I have reatl Ihis epD�ication antl slalo t�al I�e intormalion given is corracL 1 agree to comp�y wnn all s�ate laws entl city ordmances relating Io building conslrudion, antl amnorize iepresanta�rves of tne Cny ol Cosla Mese to enter upon ihe a�ove�descrioetl propody br inspection purposes. I egree no1 to occupy or allow occupancy ol any building 5uthorizetl o�• t0is permii unul final inspoclion. [Qp�!, INSPECTIONTYPj i61fi F�e0,5�et11.1 F�re 203 2oa Signalure OI Leg�J Owneqs) AnNO� AUlnoriz0� uE10 �f, IHTITIA � SOpE � INSPECTION TYVE U�tE � INTRIAlS ��ia� �sa•s2�3 • Fax (714) 754-aB56 • www.ci cos�a-mesa.ca.�UMBING PERMIT JobAddfess: .3i2S JEFFERSONAV Suite No Vicinity: Parcel Nunmber: 74165228 /+pp�icant: NGUYEN, LONG N Address: 3125 JEFFERSON AV COSTA MESA, CA Owner: NGUYEN, LONG N Address 3125JEFFERSON AV Contractor: Address: ISSUE FEE Backflow irr Backflow Pr Bathtub 1.a5' COSTA MESA, CA RENEWAL OF EA REMODEL BATH, AMT V' $0.00 C vater $0.00 �C 50.00 C mtain $0.00 C 'ank 50.00 �0 iake Velve 50.00 �0 leis) 50:00 0 outletS) 50�001 0 ' '$0.00 0 ;��y3Q.�00 0 (GreaSe, OII)��'i,��50_00 0 (Sand Auto.),�4$0.00 0 Phone: . Zip: 92623 Phone: Zip: 92623 Phone: Zip: License: P-Trap Pressure F Process P Receptors Septic Tan Sewer Ca{ Sewer Cor Sewer Pri� Shower� Sink, bar,�' FT. $0.00 $0.00 50.00 $0.00 50.00 i i rh�n vn�vc� �.v.a �.. �.��.�... .... �..,.... � � Status: ISSUED Applied: O6/02/2004 ��q �7y Issued:. 09/28/2006 1 � �� DATE � �l b � 0 0 0 0 0 0 0 GOMMENTS / SPECIAL CONDITIONS IS:SUE� BY: 0 ENTRY AREA, Sump Pump �" Swimming Pool Trap Primer Urinal Vacuum Brkr Bkflow(1-4) Vacuum Brkr Bkflow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (Toileq Water Heater / vent Water Piping (Inst or Rep.) Water Re-pipe Water Service Water Soflener OTHER VIOLATION PLAN CHECK REINSPECTION TOTAL CALCULATED FEES: $0.00 50.00 $0.00 $0.00 $0.00 $0.00 S0.00 $0.00 $0.00 50.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 QTY 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 NOTICE: The work authorized by Ihis permil shall comply with all aOPlicable handicap acwss requiremenis undar Calilomia statutes and related regulations. (Ord. No. 92-28, § 7, 12-27-92) . � , EXPIRATION: Thi5 permil shall automatically e�pire and become void il work is not commenced within 1B0 days, or il work is suspended or abantlonetl lor a period ol 1 BO days. � - ' INSPECTIONS: In order tor the work authorized under this Deimii to be considered legal, such woik must comply with all appVicable codes, and all �I requlred inepectlona and flnal approvel mUst be obtained. Failure lo obtain inspec�ions and final approval will �esult in the expiration ol Ihis permil. FOR INSPECTIONS CALL: (714) 75456Y6 I ewe-ae �nup WORKEFS' COMPEHSATION pECLARATION: � ' _ 1 heroby aHirm untler penal�y ol per�ury one ol the �ollowing tleclarations: . ❑ 1 �eve entl will maintain a tenJiwie ol conseN Io sell�lnsure lor workors' compensa�ion,' as provltletl lor Dy setlior 3700 0l the LeDor Code, lor Ihe pertormance ol ihe work tor wnicn INs permn is issued. � ❑� I nave an0 will mainidin worker5' compBn:alion insuranca, as requiretl by section 3700 0l Ihe L2�or COtle, �or ibo pe�Jr(nance of Ihe work lor w�ictl I�is pBrinil is i55uaG. My wurMers' cOmpensa�ion Insurance cauiar antl polity number aie: . Carriar. Policy Nunb«r: /7bis :ncf�on neno iWlGe compioled J ��e pnnnrt is velued a( ona hunOrud tlolldis (8100) oi luss.) ❑ I,certdy I�et in tbe portormanCe of 1�0 wCrk lOr w0i[� �hi5 permil is i55ua4, I 5nall n01 em0�oy any pBrson in any.ma mer 5o as Io becort�e subleCl to Ihe workers' compensation 10w5 ot Calitomia, antl egiea IM1aI il I should bacomn sutryacl �o Ine workers' compensalion provisions ol Sec�ion 3700 0l I�e L'abor CIX16, I shdll totlhwil� comply wiln Inesx pmvisions. . Applicunt SignaWre: Dato: � W�HNiNG� FAIWRE TP SECURE WOpNERS' COMPENSATION CAVERAGE IS UNLAW FUL M10 SMALL SUBIECT uJ EMPIOYER TO CHIMINAL PENhI.TIES �ND CrviL FINES UP IOONE HIINDRED 7MOUSFND DU.LARE IS IOO.f00�, iN qD01TIIXJ TO THE CL)ST OF COMPENS�Tip{ DAMnGES AS PROVI�[D FOR IN SECTILW 3][b OF (HE UBOR COpE, IMEREST, ADW ATTOHNEY'S FEES. LICENSED CONTRACTORS DECLARATION: � • 1 �eroby aflirm �hat 1 am licensetl untlei piovision5 01 Cnap�e� 9(commencing wilh Secuon )000) ol Division 3 0l lhe Bu:lness to¢e ana enecl. Lic �_ Class ♦ Conlractur's Signaw�a: � ' � Datd: .L�". CONSTRUCTION LENDING AGENCV: ❑ I hereby aHiun �hal lhorb is a consvuction IcnAing agenty lor i�e porlormnnce ol Ihe work tor Lenoer's Nama: Lenaer's Adtlress: Signaiurv � .�=°� OWNER-BUILDEq DECLARATIONS: I �emoy aBirm mat Vntler penaliy o��perjury ihai I am EXEMPT FROM THE Cutle: Any cny a counly which requires a ponnit �o cons�mct, altar, improv� Io Itlo a signe� s�elament Ihnl ne or sne is licensetl pursuant to Ine prOvl'1k tlusiness ana PmteSsions Code) or ihat �a or sne is e.empl merefrOm'dru sub�ecis me ap0lican� �o a civil Oenalty ol no� more inan tive nuntlraiftlollarl to� ��,�� ❑ I, as owner o� Ihe propeny, or my employees wii� wages u tlwb sde 7Uaa, Business antl Pmlessions Cotle: 7 he Contracbrs LkBrroB'l.dw` Ilimsnit or herse�l or Ihrougb his ol her own employ6es!piONtlBA pl9t �. soltl wilhin ono year ol completion, ine ownerbuiltler �hev9�lfie pju ❑ I. es owner of Ihe propany, am EACWSIVELY CONTRACTING WITI Cotle: Tne con��aciors Gcense Law,tloes nol appry toen o'wner ol pm license Gursuant to ino CoNr&clon Ckense Laws.)�%pt�� ❑ I am e.amp� uPtler 5ac. ��`.��u�� t!s'�if�siness ai Signalure: �^��':�1C�dlhd e;'ixl.�i� Ownor ID venbed oy tliivei y fqensB ❑�,VBs D�No � �y�ra4�^..-F�4�»nr5n�; aCLa:r�4� Venlicatinn of Ownership bY.ltvue oi documeN�i.e. - ot0oetiv teM bill or aae DIVISION OF INDUSTRIAI°SAFETY PEqM1T CERTIFICATION: M��y� 4J •:. -slss.i,s ❑ I horaby ceniry Ifiet t10 9utavation five (Si or more f'eel N deplh Into permii, antl �nat iq�dillNn9 slmcture, scaflolding�fellew0ik, or tlen 341, Title B, CalAo`rnie;ACministra�i�e Cafo). �(�,�ij'.� , or lor ucWre; O�a,M 1 s issuance e Luw,(C�epler 9 (comme �.amptlai.'M� vi �tation of ,' ��:#�ic:;r� IE WOAK; entl ne slmcWr d�prtpeity�who huiltls or im �t6ntleC o' ottarotl Wr sala. i tlid flul�builtl or impmve ic ui�y RS to consvuc� �e projuct � tneieon, ontl wio convac reason: _ _ Dala: _ my license is in lull .5, Businoss an� Pmfessions Ine applicant tor sucn permit ion 70U0� ol Division 3 0l i�e by any ap0liCant lor a permit �detl or ofleretl br sala (Sec. ion, antl who tloes such work , me ouiltling oi impwvement is sale.). Buslnes5 antl PIo199sions. m�ec� with a conlrucio�(s) Expires: descen4 will be natla in connectioa with work amhorizeG �y this will be mora Ihan ihirty-siR (36) teel high. �Cliap. 32, Grp 2, An 2, Sec. ❑ As owner-buildx,l�will�pot employ enycne lo tlo;wark'NiicA�w � f�oy�jia a permit Irom the Division ol Intlusv al Salery, as notetl above, unless sur.h person �as a permrt Io ao suCh M'Olk��6om ihe tlrvis�icR y+� �� ='A '' ''� Siyna�uie: ��ii+ll f:Y.s�Crl ��• `U'Y•.�`u�n'r� � �ate: . . f 5 ^ � Y't <'l�'"�°�'�I �� "�`�'.`:�:�''.i�' Division ol Indusirial�5afery Parmit Numbar.+ s �.l:2f .cui,...,�� MAZARDOUS MATBR��IiS'AND EMIS910N$'CERTIFICATION: � � �!�M1?r�..Mt1\ J'i'+ly-t�•w ' 1 W ill Ihe applitanl w,p[menl o�lutma.buiding occupam naed lo lila anC cenity a Business Plan lor emergency response lo release or Ihreaienetl roloase ot a hazeftlous . . ... ,.,,.. . ...... _. . �Saction 25505 M;��e CNlforn�eiMaeM;entl Sefely Coda requims, wim some ercoplions, t�al e Business Plen �o lilad wiih Ihe Cosla Mesa Fire Depanmanl by evory business which hee�eflny on9,lim9 Oi�rin� a reponetl yoar a puemity ol hazartlous malerials equal lo or q�ealer ihan a weignl ol SOU pounds, or a voWme ol 55 gallons, or 2U0 cuDic teel W'Coinpr085etl�e6'01 slantlaitl temUeraWre antl pressure�. ........... .. . . ............ . � ��.._.,- ........ . ... ............. ..._....... . ......_. . ..... ........ . .... __......._... .. ... . .. ... .... .. ....... 2 Dces or will Ine app9ceni or preseiit or tuwre builtling occupam neetl io file a regisuaiion lorm lor aculely nazartlou: materials? ❑ Ves ❑ ND tr.a.u�*o,n.,,�w �Section 25533 P� mo CelilwMe Haali� antl Saleiy Cotle, wnn some eacepiions, requires registrauon witn Ine Cosia Mesa Fire Depanment by eac� Dusinuss which at eny onn ume has on nan'dia:Wienliry of acvloly iiazarCous metenals equal lo or greater Inan e weigru ol 500 pou�tls, or a volume oi 55 gallons, or 2W cubic teet ol compressea 9es at 5tan0aro iemperatwe antl pressure). � ............:................................................................___...................._..._...............................................,........_..........................................................................................................__......._.................................._..................................._................ 3 Doos or will Ilie apPlicanl or prosent or luture builtlmg occupanl noetl lo prepare an RMPP (Risk Managoment antl Preveniion Program lor aculoly haia�tlous maie�i315)7 ❑ Y'es ❑ PJu . .� ISnclion 255's0 of tha Cablomia Heallh and Sately Code provitles Ihat ihe Costa Mesa Fire Depatlmenl may requ re I�e preparalion, cerlilication and filing wilh Ihe Fire Oepanmenl ol an HMPP uy businesses wnich are requuetl to register acmely �azardous malerials wilh ine Rw Da{ enmem. ........... ............ .. ...._.._._.. _........ .... _.......... ...,.. ........... .._.._...... . ........ . ,........... .... ...... . .. ...... .......... 4 It an H�dPP is prosonily required nas Section 2553< of t�e Caldomia Heallh antl Salely Code 6een lully compliea wit�7 '� Ves ❑ No ...:................................._....,...,._..........__._....._._..._...................,.,..........................................................._......................................................_................................................._.........................._._.............................:........................ `,........... 5 Uoes or wi11 me applic5m or presnm or lumre butlaing occupam require br Ne work wnicn is Ine subjea ol lnis �Nitation apermn �or su:n consimr.tinn or mWilicaiion tmm tne Soum Goasi Au Oualny Managemont Oislnc� or trom any m�er air pollution comml disvici or agoncy? Ll �uv LJ No ISecuon e5B50 : nl me Calitomia Govermneni CoOe requires ihet Ine requestetl m�ormaiion be lumishetl on applica.iions lor norvresitlential �uiltling permits). ......, ........._ ......................___..................... .............................................................._.............................................._....................... .................._... ................................... 6 Will any part ot IM10 faaliry �o be consimctetl untler IM1is permil ba wil�in 1000 Inel hOm IOB ou1Bf �Ou0tl3�iB5 0l d SCI OUI'? ❑ YBS ❑ No QI "yas", the far.ilay must maet ihe requirement of Sections 25594 end 42303 0l �he Calibmia Heal�n antl Satoty ColoJ. . ........_ .. .. .. . ....._ . . . ....... . . . ......... . . .....:... . .. ........... ..... ....... . .......... . ... ........,.. 7 If a parmil iroin Inn Suul� Coasl Air Oualily Managemen� Disbicl or o�her au pollu�ion wntml distrin or aganq' is reqmretl br Ihn work whicn is Ihn subjact ol Itiis �pyhcauon, nave all ot me disaosures piescnUea by Calitomia Meallh nntl Salnly CWn Seclion 42303 baen made? ❑ Yes ❑ No .......... ........................................................................................_._.........._..__................................._......._............_._.._......_.........._.__........_..........,.................. _............................._......... . .......................................... 8 QI yes', attacn Lohdic&le ol complianCa fmm inn appropnala au pollulion coNrol otlitar). � CER7'IFICATF: OF COMPLIANCE: I cetlily Inal unoer Oenally ol pa�jury t�e inlormalion givan above is torrecl. I a3rea lo comply wilh ell state laws and city ominanr.e5 �egarOmg HazarQous MaWrials nnd Emiss�ons. Signalura: ' �� _ CERTIFICATE OF COMPLIANCE AND AUTNORIIATON OF ENTSiY: I ceni�y untler penalty ol porjury Ihal I have read Ihis epplication antl state Ihat Ihe inbrmalion qiven is correci. I agrea io cnmply wiln all siate laws entl city ortlmances rela�ing to builaing construqion, antl amnorire represlnlatrves ol ine Ciry ol Cos�a Mesa Io enler upon ihe aDove-descrioed pmpa�y �or inspeciion purposes. I agree not lo occupy or allow occupanry ol any �uilding euthorired b�• I�is parmil until tinal inspociion. LODE r. IXSPECTIOxTYPi i616 Fjae96M�J 20 203 20a Ot Lugal Owneqs) Datx AnNOr Autnunze7 ApPbcani etaininy Wall fire PIdEl�p DIiE I�iJ�S �QpE.� INSGECiIONTYPt ��iE ItlT�1dL5 nr or Date ,.� SUBCONTRACTOR . ! '- -� 2 COSTA AAESA BUILDINGSAfETY DEPARTMEM P.O. BOX 7200 COSTA MEBA� CALIFORNIA 92620 Po� AppUmM ro F(11 In Compl�Nly TYPE OR PRINT �ui�.o�Na '� J.?S �'F�� S�N A V � ADORH9Y CO3TA ESA, CALIFORNIA _.....__ M ta-R, �..o l�M /v! �'i-N� K� MAIL � A�DR 1 c�n 0 c ARCMITECT � ene�eK un� rnor �t"�I�SeN /� �� S�'? No'-545 �'y? O � no. or e MOW ON �S! �N� DESCWPiION OF WORK ea 1 N[R60Y ACNI/OWL[D06 TIAI ANO er�Te nur n�� wsov� i ►LY WITX ALL CITY 011DINANCI GYILDINO CONOTII ON. 810NATUR60r � � PHRMITfG� � AUTHORIZ[D AOtNi r AUG-5-66 00 373A7*�*�13.50 /1rPLICATION FOR PERMR BUILDINfi For OHfn U» Only ZONING n�7i, wo. or usa or Haw � ruw euaoiHo �(� �� 3 6, 7�,e;y� � / �// — C� S �— � a-- -, I! OVHNHANO SMALL EH LQ88 TXAN YARDOAPPROVED MAIN BUILDIN� YAflDBAPPROVHD ACCH890HYBUILDINO _✓J � R BLT. MAIN ACG888. B DATB L� ' ' ' � ' DATi V — V — ' a m � - .�� ea. rr. y TN� • uert �xowN ueoea uenox �s ron TMe ►UR [ OI f1TApYONIHO P6IIYIT I[8 ONLY. I VAWATION �j � �� PHHMIT FHB a a V�_ .J �% w � ao /��`{ TOT.tL PEH ! V S� � is752 COSTA MESA 9UILDING-SAFETY DEPARTMENT P. O. BOX 917 COBTA MEBA. CALIFORNIA For Appl)eani io Fiil in Compiefely TYPE OR PRINT Aoo E'88 12 e eneon Aven.ue � COS7A MESA. CALIFORNIA E RECEIV�D FEB L 9 1983 FINIINCE DEPt. GTY OF LUSTA ME3A APPLICATION FOR PERMIT BUILDING For Office Use Onlv ��r o�.�a m�a No �o o a��o�N� AODRE86 . � ARCHi78C7 TE�. COSTA MESA. CALIFORNIA OR ENGINEER NO. ,/ J ADDRE88 FIRE (/ ' �yn / AJ (_ ZONE TYPE GROUP//""� CONTRACTOR n� �r•" •'� ¢�4OM APPROVED �J BY DATE ADDRE86 2 O1 QPJ1.C�1.G'4 Q OIL ORCVC ZONING ZONC NO. OF UBE OP NEW $n 1ii�1! �. C�TY BGV � ��4 Q'��. OR/LLQ �� I ruNs � BUILD�NO � q� an. �T� NO. �� NO. R-68 4o O88CPIPTION �of �3� T�P y6os 81ZE I NO. OP BLpG6. OF LOT NOw ON LOT p, p, NO. USE OF VqRDS EVES EXIBTING BLDG APPROVED ALLOWED BRBALK LINB iHOM /. � �� IC[M[R LINC OTJ CHHiBR OP OTIHBT `r REAR YARD� FRONT S FT. � IN. SIDE YARD ILEFT IRIGHT R.SIDE -r FT. IN. DESCItIPTIOId OF WORK � S,oE S- FT. �� N. NEW I X IIALTERATIONI nADDITION I REAR �/ FT. � IN. % REPAIR I MOVING I IIDEMOLISM I BYPROVED� DATE �� —b BUILDING �.� , /,� NO. OF ,.y � — — �� G°� I XHRBBY ACKNOWL8P08 TH�i 1 NAV6 pBAD TNI6 APPLJGTION {M! AMOUM BXOWN UNDHR VALU�TION e FOR THe ANO 9TATH TNAT TX6 ABOVB 19 CORPBGT AND AON[8 TO COM• pURP098 OP EHTABLIBMiN6 A veqMlT IEH ONLY. PLY WITX ALL CITY NGINANCBB M1D 8TAT8 LAWB OULATNO OUILDIHO CONBTP N. VALUATION 816NATURE O PERMIT FEE $ � O'D P8RMI7TE a P $ ao 99� � PLAN CHECK $ ��' �� AUTHORIZBD AGE � � � a q TOTAL FEE �� LL �`1 � �� " �nun�ssaem�wra: 3125 JEFFERSON AV uxT: a�,�Rsx"nE'E'°'°"": NGUYEN TUAN N FLOOD: X 47 � �o"� 3125 1�EFEASON AVE COSTA MESA,CA 92626 406-7011 �cr�.Wuiwc �ooxEss: urcxrtecT ox �aw�w: u�cx. ox �s,�oo�ss: cax�n�cmxsw�: CONfP1CT075 YNIlNO MUIIF55: uc. w.: uxr: �: IJCENSEU COMR�CfON4 DECWi1nON: I hseby elfrm �Mx pwly d paryry Ntl I mn fceemaA �adr po�bom N Cheqa B (cammerciM xVh Saction )OW) d Oiwi'+� � d Ne Buuem end Pmlmeinm Code. uM mY 4oeme e in tWl bru vd e%etl. cmuc.No.: uc.cuss: uc.No.: EXP: ome: �ommeaor: OWNER BUILUEN DECIAPATION: I M�Y �� uMx psiuly d perjury �hu I em aaanq fmn tM CoMretlon liceme lew lar Ne Idbrnq nemn (Sepion �JtS Buni�ee+eM Prufmaima COEe: AMW a rnvqY wfiirh nywm e O�Y �o ouowf. ader.'unVm+. '�mdo�, a rpai anY atrunure. pia b A� iwerce. e6o raQwras tM epplimm la vch �wmu io fib a eqrotl sletemenl tMi M tt ahs .m tiwnaed w�N m �ne pwitim• d tlr cawac«s limn» ler �chaqa 9(mmm«v�u wan Swun'lam) d oire:�n a a �ne �ubiwee enE Prdueune Catlel «tAn M a eha b exemp therehan aM Ihe bmb b tlr aAepeA uemqion. My wlmun af Seaion 1W1.5 Oy enY aVPb�� la e parmil wEjede Ihe eppliceM to e aN pnalty d m� more Ihan Ms huMred Edlen �55001I. �] i.e+��dineworonr«mv«odw.a.wmweo�mma:.da�w��d,.»;neouawo�.�eme.wm�.m�a�maw.e or d1enE br eeb (�pn )OM. Buw�de�d Pmtseuone Gods: TMCpNrmore L.ioenee lew dom rot ryply loen owner d prapaity wno diM a inP� �Mnon. end Mn Ama euW xwk Nmeatl a hesM a Muph he a her am emWnlW. Pa'�d �hel aM imM��eem ere nd "unendeA n al�� la eab. Il. lrowmx. �M dultlinY a inpmaneM is mIC wnM ar Y� d mmVMiian. Ihs owrorLutlEar wtll hars �M buNen d pa+�q he a eM did nd buk a impove t« ths pvpme W ds). ❑ I. n owmr d tM D�M. am extlYWMY canlrediq xiN 4caneeA cmtraclm ro canMq tla M9b (Seriion NM. Busi�r� aM ww�m. coae�. rn. com�mw. ��,. �.w aom �a wWr a.� �e. a aw.nr �o w;m « �mpwn me�w�. m.a .Aw conVecla la wd� prqxb Wh e o e*) icavad punuam �o IM Cantredm Lim�ua lew�. � I em p un r Saclb : . 8 P.C.. br INe raemn: t n DNe: � Ow�w: � l \ l"1 7 I do hwebN �M tlw I em eware d u nuM rtn nV��r�b d CeDarie IbeM erd CaektY Cods 3Wiav �505. 255]9. md 255J1. eed thm I or ury /Uure Wikiiq Kapem.xill / wil rwi (ticb orie) naed to cpnply wih eaid atete mAw erd �M reyuinmame lor aommXlammwdionamodilratbnhM�iMAr�y v�yemxuDimrip.ReeidrXidmmtMuneWG'divrovsezanqlraniMes om.: acp��.m: WOPKEN'S COYVENS�iION OKUfl�TON: I hereby dhm unEer pxiepy d prMvy ons d iM bWv.inp Eetleietioro: ❑ I hse vd wil mvnien e ceM"rats d mmenl to seXinava br waken' mmpemetbn. m prmkatl la b� Sardm J]00 d tM leba Code. tu iM W�wnwice d Ne xork la wlich thu M�� u bued. ❑ in..<.�em�mdm�.�ona.•�mw�.mo��w�.m�.a��anrs.c�o�ooam.�n«com.ro,mev�o��dm. wak Iw wM1iM INs permn u ivued. MY ��*' �mpeneetion imurarwe mmar and pdiry wmber ve: c.� � Policy Number. ' ,rw ..a;� ,a.e,v a. �o,�d�ea i w n«m. v b. o� n�.e em.�. a�oo� a m.l � I oe�ly tlut in IM pMmrerce d �� M1 � Mich �hia peimtl u inueA, I dWl mi empb/ airy pr�on in xry meruw n n to bscome wbpa to �M xaNme' WmG�e�ian �ew d Celtlarve, vk ap�ss Nel E 1 diwM becans aAjea to tM xaYen' compeneaiion qwiaune W Setlion �100 M Ihe labor Coda, I ehall loh�xilh oomOH �h thoea prwivione. ' Dpa: Mo��: W�nrlip: FWw ro ucun wikri mmp�tlon cwwp� h un4rM. uW NNI r!(M an �rrplryx ro crlrtYrW pmtltlp aM , tlM 11nu 1p N aw h'nCM fMuaud �Vn (S1PqOWA N�� o/ rompinufbM1 Q�rrrpu n pvvMM bi In 9�etlm 9106 o1IM Lebo� Cotle, /ntrNL ��mqL Iw CONSTRUCTION LENDINO ROENCY: I henby elfirm uMer penelry d perjury �hel IMn is e mnslrupion NMiip epenry lor Ihe peApmeMe d iM xdk la xhitli thu pemiY u eauad (Seaion 309]. Civ. C). LENDEN'S NAME LENUEB'S ADDPE99: IcanilyiMllheeem iNiaeppliraibnudYe�eOimtlroeEowinlamationuc«rep.lepiselocamqyMil�NlaryeMmuMypdirw�oee sdeWalewfMelMbbuild'nYmvtrw ^udherebyai0horv��epeam�etrvetWMamYloeMxuD�IMebaw-mxtlioiqdG�Wab ��'D'�'�°�°�"'.TOAN t1GS7YEN ow: 2/ �/y �1 (5151�8 WP) While-Buibnp F Sdey; GreemFle: Genvy-Applrant: PinkJlermue; (3aldenmd-Mroev CI'fY OF COSTA MESA - BUILDING PERMIT PERMIT NO: H 081923 PLAN CHECK NO: 04684-96 L PERM NO: H 081923 GOVT: N SUPP; N CONSTRUCTION TYPE: PEAMIT TYPE: STR PURPOSE: ADD JOH DESCRIPTION ; EXTEND ENTRY 42SF UNDER EXISTING ROOF SQ FT: 5,000 CLAIM VALUE: 2,500.00 CALC-VALUE: 5,000.00 GROUP OCC: R-3 / *�**+Er****�r***��+Ar**+r*�*��t***�D**xH*��r+r*�*****x*******�r***�******�*�+�r**�*x+r*�rx�e* Z O N I N G A E Q U T A E M E N T S S E T H 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 PARKING REQ• PROV: PARCEL: 14165228 ZNE: Ri REF NO: PLANNING Nt5TE5> INTERIOR ALTERATIONS FOR AN EXISTING SINGLE FAMILY HOUSE, > MUSIC ROOM SHOWN ON PLANS TO BE DELETED B/C IN REQ. GARAGE 1f 7E If 1E 1k iE 1E iE 1E 1E 1E fh 1E 1E 1E iE fE 1E 1f 16 iE if if 1f If iF ik 1R iE 1E M 1E Ik 1E If iflklF ik ik iE dF 1P 1E 1f iF K 1Eik �E IE 1E 1E 1E 1Elf iE iE 1F iE dE 1E Ik iflf IE ik ik if 1E Ik if IE 1E iE 1F 1f iElf D E V E L O P M E N T S E R V I C E S R E(J U I R E M E N T S ZONING APPROVED HY `rG DATE: 3 �l BUILDING APPROVED HY ; DATE; APPLICATION ISSUED BY: DATE: i�t iflfi4ifiFii'lhii'1Fii'il'MiEiElFikikitli'ifiF1E IFihiEil'1%i4iF18i1'iE ikiE LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 99.75 .50 SMIP/NON-RES PLAN 64.84 ISSUE FEE BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE TOTALS----> 100.25 0.00 64,84 165.09 165.09 .00 REVENUE DIVISION TOTALS--> COLLECTED: 100.25 OVER/SHORT: ,00 HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK 99,75 ,50 IF7FiFikkiElEikiEklflfiEiElEiE1E1f1E1F1F1fiklflFiF1E1E1EiElE1ElE1E1EkiE1E1f1FiFiF1FiE1E1EiE1FlfiFiElEiEiflf4iEiElf161lfF �t� iE1EiFiE1E1f .. .. I. N._D I V I D U A L F E E H R E A K D�� \ `�i� �_71 FR � QTY _ D,� S C R I P T I O N 5000 ��5� A8i�9Rr BY VALUE RESIDENTIAL 5rin END OF F� �52 /(7NIT COST TOTAL COS E 1.00 �.j L5,000.0 O' V�� , l i ��/ / 1 83-�4-1997/18:28 IIM/f18@,25 PEkMITeT081923 �. CONSTRUCTION AND PLANNING t' P00 ;PA APPROVALS Permit # Date �nspector � qppROVALS Permit # Date Inspector i . � , 7. Temporary Electrical Service or Pole- � i 52. Pool & Equipment Location 2. Soil�Pipe-Undrgrnd. , 53. Steef fleinforcement � � � , . � .�:.'�lectrical Conduit UtilityUndrgrnd. � 54. Forms - '�4':'�lectrical Conduit�Undrgr'nd. � � � 55. Electrical Bonding . - � r,�teel Reinforcement � ; 56. Rough Plumbing & Pressure Test - . ^6: �-plectrical UFER Grnd. � 57. APPROVAL TO COVER�GUNITE . :Ta � � �'Z.j Footings - � 58. Electrical Conduit�Undrgrnd, - � •�'�8:. Foundation 59. Gas Pipe, � Undrgmd., Test � ,. 9: Water Pipe•Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor SYscem � 61. APPROVAL TO DECK i t. �Pioperty Sewer Line & House Connection 62. Backwash & Receptor-Final � � 2• Se�ve� CaP ,� 63. Heater & Vent�Final �.3. Roof Drains � fi4. Plumbing SYstem - Final -1'4. Rough Plumbing ;r, � � 65. Electrical-Final /5. Rough Electrical-Conduit -` 66. Solar SYstem�Final - ,t6. Rough Electric Wiring , . 67. Fencing & Access Approval ' 17. Rough Wiring Sign ' •� � 68. APPROVED FOR PLASTERING ' �"18. Rough Electrical•7 Bar Cc�l�ng • 69. POOL/SPA SYSTEMS F�INAL � 19. Rough Heating & Aii Conditioning M� m FIRE DE.PT_REQUIREMENT 7 - :0: .�; '� ( 20.'..ERough Facto� Fit�Slace ��r; �� fi � y Q't ;. APP�OV��F P�'rmit #�� 21.�Ducts, in:StrQMu�e � �• �� :: 'K "' C �-s � 70.:'Undeigreu�d F�dro ' r n !+. 22.,Ducu, Venti�ating"` _ �` Q � �,A. � 77, Prod�iGt�iping'17�as �Oil 23. Gas�PiperAough & Test -r�:., m-+ c� � �+� � 72. Undergrc'vnd Hu"sh- � � ' _ � ,� .� 24.'Rooi-Framing' '" t `` ',�.`*, � � ,_,'� . 73; Undergrii.St�ajejan�fc OGas �'Oii 25. Roo�Sheathing % e e� � x� `•7 > r�: 7i{.;:p�eihead Hyd2 �� c- 26. T-BS'r Ceiling (Structural) & IC46t5�coac � �; `� �, �� 7�,yDr��hernj,�a� F„ j `` ' 27. Frame and Flashing:. ,-;r.� � j K C r c< 76 Dry S[aacfpipe=�� _' ' 28. Lathing�&5�djng=;" � C�` F� �fi < ^. •• ••;� 7� FIXEq��STEfR�FINAL� - r � � 29. Insulation -. r';� �' S .. .. f+ : « � I I �� ' � ` �. Z8. FIRE PREV. F.INk\L � ' 30. DrywaIlT7ailing ��, , �'-,. �. � � 1 `� ^ -'HEALY]i DEP7.^REQ'UIREMENT . I 1 S lU.... :1 t S ..� , � . .-.'i' T; . l ' i � 31. Plaster 8rowtr,Coac �: - , �� r .^ ._ -� � `- . 7J, FINAL 1NSPEC'F.ION = � ' , � - _ _. ; 32.�Iectrica�Po�er MLgiev-Final � � � �z �- ' � ;* = 80? POOD CERTIEICATE I;SSUED. �. - -- J • 33.�inal,Electric- r: �: �� K � r � ' '� , _ �.� - � Notes: y �- �-- r�: 34.'Fin3�Heatin�& Air�Conilitionifig5 �"� " , v cr, ', � :� _. - �� , - ':7 �' � �.r '_ r (i f. F E � 1 35.;FinaTGatSP(Pe:Test � ?� -�. ., K �, � � � , �;; '' ..� j - . � 36. Hodcf or:�anoPY'= K = � R r! ��, ' K '�. `t � � � �M r i r s ' s .... < K ,.c t'7 %C n _ _ • � ' r: tr. ` ' r" , C. "` � J �'�'. !TI 1 ' .. t i , . , 37, f.ina) Facto�Y Fire'place;� �_(... �-,�� I � � - ' 38.�in3i'Plumbing �;:: - - �'+ (- � � � W - '--- i �.-t �^ �l r I .: C F•. -+C f� ' 39. Watei Su.vioe.�in`al r; L ' y ` ': z r . � � _ . � ' � � 40. GasService•Final,:.: r; 7Tt*� <<. �� cr: . � ='� _.�n: • �- • �r �. f . r � 41. Solar DamesarFir�a� = .-. ..� - �`� - � � �� ' . - � [r, ir . S Y. " 42. Backflow Preventgr^ - v. - ' ' , x ' . k � -- r - 43. Backflow Irr'�§atioaz r;=-' 'r t r. � ��c ;�` - .; � �44. LandscaAe Irsigati�n Sysiem _'r: �� '_' .' >;. " _ -' � ? ' "' '-� =� r * T _ i rT ✓ ��- s � C' �45.�ound Atte�?vatio`n° '� „ '�"'; � -` r r. � ' ' �'. "'� - . ..,': -, r . m , o• �- 7 �:46.��klandicap•Regulatio�s C� �x � � ': � a - �-= = ' r � �}7.�1l�LSTfiOCTU:IiE&BUILDING n �'�' ^ ' '� `�^ '� 1 :� _ �r � � x F. 48.;_EINRL PLAN'NING !�- r 'ri's,i- r. � �. ;n d * - L• t� - c C' =49. �lectrie Release to Edison ' '� t k - < � _ � ' - . _50.-Gas-Aelease to Soutfiem CalifoFnia Gas Cn x ' �'r - • � T' s: _ w - .. 51. CERTIFICATE OF OCCUPANCY • � > .�. - ' � � � No. Date aem�ara 3125 JEFFERSON �E�F�v,v"": NGUYLN, T(JAN N ,�oopEsx 3'125 JEFFERSON COSTA MESA,CA �vv�. xuuxo won[ss: IiflCNffECT OP B�tlNffA: AIMN. ON ENO: S MUXE55: AV uHT: FLUOU: X AVE 92626 uc. �a.: UNT: car�m�crars xu�: cam�crars�,uu'c 1DDXE55: UC. NO.: CIT'Y OF COSTA MESA - HUILDIPIG PERMIT 47 PERM NO: B 0824II5 PERMIT D10: B 082485 PLAN CHECK NO: 01568-97 L GOVT; N SUPP: D1 CONSTRUCTION TYPE; PERMIT TYPE: STR PURPOSE: CUtJ JOB DESCRIPTION ; CONST, 91LF BLOCK WALL & 78LF IRON FENCE SQ FT: 169 CLAIM VALOE; 2,000.00 CALC-VALUE: 2,600.00 GROUP OCC: R-3 / uxr: LICENSED COtlTRRCTOPS �ECLAflATION: I hereby eflFm uMx penally A parjury IMI I em licenaed under yoviabne o/ Chepler 9 (cammeewi�q wlh Seclion ]OW) d Oiv6ion 3 d iM Bueinea eM Pmleaaiau CoCe. end mY �Kenss u in IWI bew md eHetl. cm uc. r+o.: uc. cuss: uc. No.: E X P; D�e: GOMredw: OW NER BUILUEN DECIANRTON: I Mreby elfiim undx pane�Y d perjury Ihm I em a�emq ham �M CoMredas Lx.erae Lew lar iM iollow'vq roeaon (�an ]031.5 Bueiwea vM Pmfeaiom Code: Arry ciY a couMY �^'hich n9uiree a pefmn lo mraM1ucl. Mm. imprv.e. iemol'nh, or repei eny evuciwa. por b ne'sauerce, ebo reQuirea �he eppl'rent for auch permit to fib a sqned atebmant ihtl M a aM i limnsed Wrsuent to iM V�s d tlr Contretlon Liceme law IChaqs B(wmmmrin0 wn� Sedpn ]OW) d Divwion 3 d �ha duainen eM Prdaeaona CoEe� a �hn M a ehe ia eaamp thereimm anE ihe bmu la ihe elbped evemqion. Nry vidmion M Setlion ]031.5 by e�ry epplicem lor e permA wbpaa the eppliceM �o e wil pendry d ml mae ihen fwe hurMretl ddlen �5500�). .n I.maxrardiMpoqrrynmY�WoY��+'�hwepasm�heiadecompenselion.WldoMexak.eMthasbuctunenolinle1Med �" orofleradloreele(SecUon]MG.Bua�w»endPNeasionaCoda:TheConlreUonLimnaeLewtloeanMepplytoenwvnerWp�ape�ty who buida a inprnv thnean. vM who dom awh MwklimsNl a MneC aWwph he a her am amWnrem. G�'b� ihet wch impwameMe ere �a imended a o%ered Im aeb. tl, howewr, tM buiNi�q or'vnpwaneru ia eotl �tilhm ma yeer M completbn, tlro oxmer�W iker will heva iM buNen d provinB ha w ehe dk nd WiM ar im0� la iM WT�e ol eda). � I. m armer W �M PWMY. em eRdumdY oonlredM wilh Gcenasd wntrMon to mnm�utl Ma V�1� (Setlun ]W�. &ni�re eM Proleesione Code: Tha ConlreGae L'cenae law Joee nd epply �o en owmr d prupany xfio buitls a impwee ihereon eed wfio wnlrec�a br wM V�Mans xnh e mMredwle)1' WnuaM to iM CaLLraGan lioeve Lewl. q ��a �: e. a a.c.. m, me ,�: oma: wo«: lt � f�' q7 1 �yy cenily IMI I em ewar Meniend the requiremeMa o/ CelEomu HmAh eM Sefery Cade Seaiwu?5505,?55�, enE nsaa. d,e mm i« dn nnure w�w� om,o�. �u i.ii �a law arl �,aee �o candr w.n eeie e�a md« ena me �ww��«ro mr epermillwaonauuclionormodifra�ionhanthe�r ue�ST�anepemen�D'etrid.Ramdmiielmnst�ueioneppicetbmveeRemqtmmNma yoWebn.. Deie: ADW�: WONKEN'S COMPEN5ITION UKLAXATION: I hereby dfrm uMx penehy d pe'jury ane W IM Idbwinp dedvtl'vre: � I hew e�W Mip meintein a ceitilkele d coneeM to eaM-imun /w xwkae' cwnpenaelion, m proviEed fa by Setlian �100 of Iha lebor Cade, trc IM peAmnar¢e d IM xwk la MYc� Ihis permn a aaued. ' � I heve arN wil meinien woMe�s' comPenneiion ineureme. m reyuired by Seqron 3]00 d the labar Cade. br iM pMwmvwe d IM work Ia whidi the parmil u uauee. MY ��n' mmpaneetion imurerce ramer aM poliq number va: c��: Pdicy Number. �in;a searon neee �r ae mnv�ea r w a�+%+ ro. �. n��eree edwalsroo/ a bs,.� � I ce�ly Ihet in tha periwmv�ce d Ihe work 1« whch ihu permil ia ieaueE. I�MII nal empby eny penon In eny menner eo m to becw�n wEjaq �o �M MaYe�e' canpenWlon �awa d Catilamie. W eprea Nat'd I ehouN bxare abjee to IM Mvhe�s' eompanaeiion pewuiaro d Seaion �)00 M the labor Code. I ehall tpthwnh compy wnh tl�roe piwivons. ods �vw� Weminy: F�Nun ro��euro woilren'romperuetlon rnvenp� l� unMwM, entl ilull subHel en xnployer b MM�uI pmeltlw eM elHl llnu �p ro aro h�ndmtl MouauM 0W4n (S1IX{OW/, In etlJ/tbn ro tlro ewt of ronpr�u WM1 Gnxp� u povkNL br In S�cUon 9106 0l ths IeDor COW, Iirtenal, aM ertomsy's /su. coNsrnucnoN �aar�c noeNcr: i na�v �, w�a. w�n d v�wv �nn m.� e.��,a� �dnro .�.r ro� m. paAormerice M IM r.wk br which tho pemiY n ewad (`�� l. CM. C). LENOER'S NAYE: LENDEP'S ADUNES4: I uniy IMt I heva reeE ih'v epplicelian end 9ai� �het Na eEwe iNamNion b conetl. I eym to camply xiih ell ary end oounry adiwm �� eM ewe lews rele�m8 �o Wikvp wnaVudion eed herebY eullwr¢e repaeamativee d �his ary�o emer upon Ihe ebwa-manlionad pmparly i lorinspetlian Wrposes. TUAN NGUYEN ome: �..(1.�.�tL (5151�e.WP) Whna-BuiWip 8 Selery: Grear�Fle; Cenvy-Apptirani; Fnk-Ra`enue; Oddenrod-Assesmr COMMENTS: 78LF WRAUGHT IRON FENCE, HEZGHT NOT TO EXCEED 6' *-�*�x-*�-**x��-*ft*�rtat********+��*******+��*�x��x�ie+�*�t***+�*�x-irx�*x��t*�*�-x-***�-iE*x�***��x�*�** Z 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 -------�----- MAIN SUZLDING ---------- --------- ACCESSURY BUZLDING --------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT': f'T IN RGHT: F1' IN LEFT: FT IN RGHT: FT 1N PARKING REQ: PROV; PARCEL: 14165228 ZNE: R1 REF NO: PLANNING NOTES> CONSTRUCT A MAXIMOM 30" BLOCK WALL WITH WROUGHT IRON ON TGP. > PILASTERS - 18" WIDE X 6' HIGH MI�X, 6' HEIGHT MAX OVERALL. !F iE �F if 3E iE �IFlE !E 9E 1E �E �1Elf iElE �f'k fE 3E �(-fE 3E IE IE # iE 1E f41E �E iE �lE if �E 3E iE iE iE iE fE IE IE 3E 1E �IElE �E 1E �ElE �lE 1E iE �IE if !f i(- if iE'� �14 �lE 1E'lE 1E �f' iE �E iE iE iE 3E �iE iE 3E iE iE �, D E C� 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 \/�.I �� DATE: � BUILDING APPROVED BY : DATE: _-� APPLICATION ISSUED BY: DATE: *��x**x*��k**it�*��*�*x . *at*��f**ie��f��** LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y / ) BLDG PMT PLUMBING ELECTRIC MECAANIC FIRE � SMIP/RES GRADING PERMIT 74,75 �� ri ,50 PLAN 48.59 ,� ShtIP/NON-RES ISSUE FEE l%� .' BUILDING-DIV-> PERMIT' TSSOE PLAN-CHECK TOTAL `:;PAID DOE TOTALS----> 75.25 0,00 48,59 123.84 '.!, ],23.84 .00 ,Y REC�ENUE DIVISIOPI TOTALS--> COLLECTED: 123.84 OVER/SHOftT: ,00 BLUG PMT PLUMBING ELECTRIC MECAANIC FIRE SMIP/TOT,,, GRATJING PLAN-CHECK 74.75 .50;, 4�,.59 '� r IE iE 1ElE # 3E iE �E iElE !E iF �f if jE 1f 1E 1f if -IE if iE 1E 1E iE iE IE iE �H� if �E fE �E jE 3E 1E fF �f fE iE 1E jE 1E fE iE �E 1F fE M if 3E �E iE fElf �E 3Ele IE �E iE if.iE �E 1E �)F iE iE jE iE iE if fk 1E 1E 1f �f iE iF I N D I V T D U A L F E€ B R E A K D O Wl.N TYPE QTY D E S C R I P T I O N UNIT�.COS1' TOTAL COST !;� SFR 91 RES-CONCRETE BLOCK WI�LL / FT. 20,00 1,820,00 SFR '78 RES-W. IRON/CAAIN LINK FENCE / FT, 10,00.^ 780,00 END OF FEES �� ,� i' � �^ EXPIRED �. 84-]8-1997/11:21 pM/f123.84 � -�2.-�.p F'EkP1I TPi�Obl-0625628 DATE , ' 982485 r• " POO iPA �r' CONSTRUCTION ANDPLANNING�� . � APPROVALS Permit � Date Inspector � APPROVALS Permit # Date inspector i, •. t. Temporory Electrical Serv,icz or Pole _ - 52. Pool & Equipment Location 2. Soil Pipe•Un'd�gmd. -� •� 53. Steel Rei�forcement � � � 3. Electrical Conduit UtilitY-Undrgmd. " 54. Forms, � . 4. Electrical Conduit-Undrgrnd. , � - 55. Electrical Bonding - 5. Steel Reinforcement _� � 56. Rough Ptum6ing & Pressure Test . � I 6. Electrical UFER G�nd. , � ' . 57. APPROVAL TO COVER�GUNITE � . 7. Footings � 58: Elecxricai ConduirUndrgrnd. - 8. Foundation , �� : 59. Gas Pipe, O Undrgrnd:, Test B. Water Pipe-Undrgrnd. ,. � ��60. Backwash Lines, P-Trap, O Undrgrnd. . 10. Structural Floor Svstem . - 67. APPROVAL:TO DECK i t. Property Sewer �ine & House Connection � � � . 62. Backwash & Receptor-Final ' I 12. Sewer Cap � , � � � - 63. Heater & Venrfinal � � � 7 3. Roof Drains �� , 64', Plumbing System - Final � � 14. Rough Plumbing �_ . 65. Electrical-Final 15. Rough Electricai�Conduit � �. .- 66. Solar SYstem-Final . 16. Rough Electric Wiring . � 67. Fencing & Access Approvai ' ', . 17. Rough Wiring Sign � - �gg: APPROVEO'FOR PLASTERING . ., 18. Rough Electriral-T Bar Ceiling ; � . 69. POOUSPA SYSTEMS.FINAL .� . 19. Rough Heating & Air Conditioning - • FIRE DEPT. REQUIREMENT -� 20. Rough Factory Fireplace � . � APPROVALS -Permit # 21. Ducts, in Structure � 70. U�derground HYdro 22. Ducts, Ventilating 71. Product Pipiny C� Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 2A. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing 74, Overhead Hydro 26. T-Bar Ceilin9 (Structural) & MonocOat 75. Dry Chemicai 27. Frame and Fleshing . 76. Dry Standpipe 28. Lathing&Siding 77. FIXEDSYSTEMFINAL -�� 'r F `i.w. 29. Insulation 7$, FIRE PREV. FINAL �� 30. Drywaif Naiiing � _ HEALTH OEPT. REQUIREMENT ,,. ' i 31. Plaster Brown Coat 79. FINAL INSPECTION � �• l-, 32. E�ectrical Power MeterFinal 80. FOOD CERTIFICATE ISSUED �4� �,-') 33. Final Electric Notes: .�- � 34. final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy - � 37. Final Faaory Flreplace � � 38. Pinal Plumbing � 39. Water Service�Final 4Q. Gae Service-Final 41. Solar OomesticFinai 42. Backflow Preventer 43. Backflow trrigation . �-�j��7 Qy� %�p 9�� Y� 44. Landscape irrigation System �`,e� (�_ �� 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUI�DING 48. FINAL PLANNING - 49. Electric Release to Edison --- � 50. Gas Release to Southern Califomia Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date � l�1VIS10N OF BUILDWG S c�n' oF cosra r,�eSq'�ETY APPRO VED BY 4�I�Is rnts st� ,� .__ _---- -- 1 and �r ,.� . .: .., � .'r, ,Seeantications MUS7 be kept pi ��y � � � Nem.i�,;�.,, �w;;; r;:� Jrvision c� Butldins aakeraGon p� � � ihe < a, �;:,, 8 and Safery, Ciry �� f� or m hs an ;`1 °i rhis �pWhe rnl lateon(p �045 5{�qu I� �� u ovai h� Orfv�a�ce anNor SWte law. ��s af yA' (�a� �he our,din9� 4 o k is nof '� B�rce yy �� or w d) wi�hin 18p days o1 j�� !a R1 . �� 104« cortun �_ . nce. ��da�eea.�uv.e.,._ � I�OTE �rp gE pPPROVEDiBYfTHE PLAhtING IDIV S ON LL �,H- -j�,�L b�t.oc,c�. wau uqh.�t' i n.on -�h� 1��o v� w�.o� e�cw � G' �i I — �C,f � Cement Coping Ootional —' Channel Block With 1-3/8� Horizontal Top of all Fences for Fences 5' o� Leu Vert. Bars 3/8"yS at 4' -0" O.C. For Fenees Higher Than 5' Vert. Bars 3/B"� at 32" O.C. � Fill Cells Solid With Grout Where Steel Occurs Reinforcing Steel Shall Co�fo�m to Sec.A-15-39 A.S.T.M. All Steel to be Lapped 24" or to Code NATURALGRADE TWO 3/8"Q BARS CON7INUOUS TOP & BO7TOM HOR7ZSTEEL MUST'BE TIED IN P.LACE AT TIME OF 7RENCH INSPECTION. � TYPICAL 6�� CONCRETE BLOCK FENCE f 0 � x � � � r w a = a >Z > — a i � W O U F- 2 w n � e oA D ' �-�-" ` SEE CHART � s _...BELOW�..("�= o � ��'r•r��'•-*�Gkl _..J y: Ti _�0�, _ :i.. _ , "_^.-� r"i f: 'W`, F3 . . � ' . �d' � b ♦ � \� s ♦ ,. D � . � � L� z" �--- �� S CHART GENERAL- NOTES MORTAR: p�e part Plastic Cement, and Th►ee Parfs Sand GROUT; pne Part Cement TAree and One Half Ports S�and COPING: pne Part Cement, Three Parts Sand CONCRETE: W¢il M�xed 1:2-I/2:3-I/2 Mati. of 7-I/2 Goltens ot Water Per Sack of Cement GROUT MAV BE POURED FROM THE TOP OF THE FENCE IN CELLS WHERE STEEL OCCURS. CELLSAND AREASOF HORIZONTAL REIN- FOHCEMENT SHALL BE CLEAR, CLEAN & FREE OF ALL MORTAR DEBRIS, ETC. DFP7N OF E4RTNTCOTH �/3 ThIE HEiGTM OF FENCE ��LOW BOTTOM OF FOGT�NG. SCALE: I/2��= I� WIDTH . . . ,�I4�� . . . . . . . . . 14�� . . . 12��. . 12.. THICKNESS . . :`• . : ..�._10��-;-y . . . . . . . . .10" . . . . . . . .'. . . g" � 8�� DEPTH OF EARTHTOOTH . �:._'241.2y-�1.it . 20'� . . 16". . . . 12" SPACING OF EARTH700TH. _':1,2' 14' ..... 16'. . 16' City of Costa Mesa, California , Building Department • � !ZEv.�hED NOV.82 �oonEssaew�ooa: 3125 JEFFERSON AV,� pYNEA91W1EIiRlCMk NGUYEN TUAN N' '� � ' 'AD°"� 3125 J�FFERSON AVE COSTA MESA,CA 92626 " " 406-7011 �vx. �uia,o �oox�ss: 1RCNREtf OP ENdN6J1: ApC11.OR FNO: S ADDNF54: coNm�cran N��• CWfN�CfORB YYIDq �oowEss uxr: FLOOD: X 47 ZS � ue wo< VNT: ua rio: UNT: LICENSEU COMfl�CTOR4 DECLIHA(ION: I lx„syy �� vyer pyu�y d prjuiy tl�m I em Icemed ivdx po�'nuen d Cheqm B (commendM xN� Seclian 1000) d Oiveon � d Ne Bimiros eM Pmlw�im� Code. ud mY Gmrme u in iWl Mtt vd allw. cm uc. No.: uc. cuss: uc. No.: E X P; Dma: Gom�mar. OWNEP BUILOER DECUPATION: I hseby el(um uMr pnWy d perjuy �An I em emmq M1an tM Canretlan Lienss lew ip IM IMbwM �wm (Sedion ]W1S Bwima eM Rafaama'u Cods: Art/ Uy w aoWY W�iN eapum a V�� to wntrua. atls.'vnVor�. bmd'eR a rapv mry �U�c4va. P� n b vauvbe. e6o iep�nm iM appGv�tl Ip ad� pemW lo fda e vprE ebteneM ihtl he a�hs , timnre puwem �o �ne awmau d ma cw�eaa. liwroe lew �cluq« 91oomm«irno v.an Sseo� �000) a oivuion a d �M B�nvra md Pralmiaro CoEel a UW M a Ne u memp �hwdmn eM �M bea b C� �MG� nemqim MY vcW ion tl Swion )W 1.5 by eiry eppGcw tar e peims aEp6s IM eppfraru to e uvi prietly d nal mae tMn fwa MiM�aE tloAue �S.Srop. �I.00MnerdlAsO�WMYwmY�tiihM+WnNeiMemmO�^.NdoNer�vk.endlheWumvacnol'vtleMed a dlusd M eeb (SxYion'lDN. BimweM Pmlmdm�Coda:Ths Caarsumlinroa lew does m�ePW lo enowiwrd poprry ..no dm+«imwa++�na.o�..d .ro mm.w�.� nmw «n.w or ww� ne «nsr w.,� «�vMe.s. w� �nr w�n impwameMs va rot irueMetl a aMe�a! tar We, tl. howewr. �M dritl'vp a inqaanM is wtl wi1Nn one Yav d mmpbion. Ne ownm-0uitler W �cn IM duden d pw'up he a tln Eid nal bdd a'vnpv.a In tM pvpws d vb). � I. n wtw d Iha V WMY. em mdutlW/ cqVeaG�N Nh 6canaG cantrMan b mW W IM poMd (Sed'cn 101�. But"vw� end FWmbn� G�: The CaM�etlon lianae lew dom M aWb b an ovnw d D�Y Mn Molds a'vnpP'n Ite�aan eM Mp conVecta la wtl.�i.p/rojem wah e weumfa�a) liwnasd punuem to tM Co • e Liwas law em axemv uMer Se 'on: B. a P.C.. br Uiu �aeao . �Dme: ' Owiw: I cM?/ IIW I vn ewere d md indenW�E IM �apdsmam tl CaOaris f W� end SdMY ' 25505.255JJ, uM 51a. eM Nel I a ury Mun buiMiiq amipW MiA / wil na (mcb ana) nes! to mn�iy W� �eiE alela wdw and �he requ'ummaM� fa eo�4lamrovuclbnannEdrniantron�MN�Oitlriv. WddMwlmMwioneGOF'miomersuemqlmnNua om.: �oW�+�+: W OFKEN'9 COYppl9�TON DECWi�T10N: I�epy �� q�r �wWy y p�}ry on d tlro b0ow"vq ddveivu: � IhenendWm�'vuen�cMtl'ubtlm�x�awWltiwv�brMaY�n'cmp�m�u�.npo.idMtaEYS�tliaiJ]00dIMl�bar cod.. i« m. o.�a,�. a m..w m..ue� ms wm+v �d. ❑ � n.Y. w w meuv.n.on.,• oomc�vn'vm.enw..� ipiu�E M sw'ai mo a u.lebn coa.. m� u» w�on�w�n a �n. work la Wud� IM O�a u muM. M"R4en' mm0�4^ iovvio� faniae md D�Y mvnbar v�: c.m«: Pd'ry Numbr: (iNa pdian �pd nal M mnO�M l w P„�t b M�MMMd ENua �SIIXII > 40! ❑ � canN �na in u�s o«�mnv¢e d w wk k..nitl� �nu v� b bawe. � wu iv rnoM �^r v� a mn mervw .o n m baconro wbjen lo IM woM1SY mroaieqion Nrn d CWortie. W pn� tlW i I JquM berone Wpjat lo IM woMet�' cpnpmetian Wmvbm d Saion �)00 d �M leEa Coda. I�hetl lafhw'v� mmON'� Ihom povirms. ome�, �oa��: w.mina: c.xm ro..cun wo�.n• rn�w�non ew.nw �. w��,.nn, .�e.nn� neN«.� •+v�or« ro oxrrn.i n.�.m...ne eM� nn.a iq ro ar. rund.w trou..M ewhn lflo4aooA b��n ro m. eo.r or comoru.Wn d.�.p.. u prorwxe ror �n 9�ctlan 9106 oI 1M I.�Eor Co6. Infw4 ��t1om�Y� ��. CON9TIiUC110N LENMNO AOENCY: I haehry e15rtn uder penetr� M ps�.ry �ha �hre u e mntiuCbn 4M'vp apenry br tlr parlamerim d tM �wM br xhiN �h'v D�Y u eswd (Satlion J08'!. Cv. CI. LENDER'S NWE: LFNOEN'S �DONESS: I cenEy tM1m I luw nW Ni� epdkeYm md tlW UW Ihs abwa'udmro�ian b ooend. I ypw to canply oilh eA cry rq mivhy pi'vww uN �ws lew �dm�q m build'nY camrumu� md �ra1y u@vc� npaeve�w d Nu iN'm Wr upon �Ir ebaw�mrainrd p�apa�ry la imVaion WrWua. r. CUP_t�l NCUYEtd (S15tJ6.WP) Dau: '1 ( t.. D -I � • Seley; Green-�Fb: Ganery-/�pirsnl: Pink�is�eru»: 4MemoE-A+e�or CITY OF COSTA MESA — BUILUING PERMIT PERM NO: P 082576 PERMIT NO: P 082576 PLAN CHECK NU: N GOVT: N SUPP: Y CONSTRUCTION TYPE: PERMIT TYPE: PLU PURPOSE: ADD JOB DESCRIPTZON : SUPPLEMENTAL TO P-81925 SQ FT: CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 / COMMENTS: RELO FAU REMDL BATH, ENLARGE KITCHEN INTO EX, SPACE PLU ItB81923 �t****�r*��*�*�*�+tk�e��r***�*x*x�*x��***�r��e�t*x�t�t�t***x**tr****��4****��*+t*+��;e**� 'L O N Z 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 PARKING REQ: PROV: PARCEL: 14165228 ZNE: REF NO: PLANNING NOTES> 1 fE 1t iE 3E iE iElE if !E 1E �f fE iF if 1F fE # 1E if �E iE 1F IE ff if 1f iE !f ik iflFl: IE If k jE iE iE f' �E �E k if if iE iE k k k i(-1k 1E iF IE iElE 3F if iE iE 1Elf iF �f ib IE 1f 3f iE 1F 1! iE 3k iE f(-fE ik 3F 3F 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 APPROVECI BY . BUILDING APPROVEU BY : APPLICATION IS ********�*�*�* LEGALIZATION:N F E E S U M M A R Y DATE: DATE: � DATE: IEikiEiflfiFlFlt � STRUCTURAL EGMENT:N BLDG PMT PLUMBING ELECTRIC MECHF�NIC FIRE SMIP/RES GRI�DING PERMIT 17.50 25� �. � SMIP/NON—RES PLAN . ISSUE FEE 6.50 _ '�-+ BUILDING—DZV—> PERMIT ISSUE PliAN�CHECK TOTAL PAID DUE TOTALS----> 17.50 6.50 'i , 0.00 24.00 24.00 .00 � REVENUE DIVISION TOTALS--> COLLECTED: 24.00 OVER/SHORT: ,00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING FLAN—CHECK 29.00 f itit*�t�itxiErtie�*+�it*��x+�+�xxie�itic+r**it*it�rit�� it**itk*itititu�+��ir**�eu�*�+t�+tx�rxit�rx�rw�x*it**it*x I N D I V I D U A L'� �F E E H R E A K D O W N i TYPE QTY D E S C R I P T I tS�N,� UNIT COST TOTAL COST PLU 1 WASH DASI.N �%� 8.75 E1.75 PLU l. WATER CI�OSET (TOILET) FS.75 II.'75 END OF FEES � � .. hV I �� • �} ' �4-28-1997/1�:1A Ap/f24.C8 � � � RWT�:01-0085359 PEkMITe082576 •' ��O,NSTRUCTION AN� PLANNING � POO SPA � APPROVALS Permit # Date Inspector qpPROVALS Pe�mit # Date Inspector 1� Temporary Electrical Serv�ce or Pole . 52. Pool & Equipment Locatian , Z. Soil Pipe•Und�grnd. %_�a_4' � 53. Steel Re(nforcement O ! 3. Eiectrical Conduit Utility�Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical 8onding - 5. Steel Reioforcement � 66. Rough Plumbin9 & Pressure Test . I 6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgr�d., Tesc _, ' 9. Water Pipe-U�drgrnd. 60. Backwash Lines, P�Trep, O Undrgrnd. � 0. Structural Floor System 67. APPROVAl.70 DECK 1 t. Property Sewer Line & House Connection � , 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heate� & Vent�Final 73. Roof Dreins � 64. Plumbing System • Final 14. Rouqh Plumbing 65. Electrical�Final � 15. Rough Electrical-Conduit � 66. Solar System�Final 16. Rough Electric Wiring 67. Fencinq & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical�T Bar Ceiling 69. POOL/SPq SYSTEMS FINAL 79. Rough Heating & Air Conditioning FIRE DEPT. REQVIREMENT 20. Rough FactorY Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Oucts, Ventilecing 71. Product Piping �Gas OOiI 23. Gas Pipe-flouBh & Test 72, Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oi� 25. Roof Sheathing 74. Overhaad Hyclro 26. T•Bar Ceiling (Structurall & Monocoat 75. Dry Chemical 27. Frame and Fldshing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 7B. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT - 31. Plaster Brown Coat 79. FINAL INSPECTION .__.� , 32. Electrical Power Me[erFinai B0. FOOD CERTIFICATE ISSUED � 33. final Electric Notes: A�D�-��-G,-�,��w� ��- ix= 34. Final Heating & Air Conditioning • e�2/�-�L�(Q . 35. Final Gas Pipe•Test � ' -36. Hood or CanoPV ,� 37. Finat Factory Fireplace 38. Final Plumbing . 39. Water Service�Final 40. Gas Service•Final G"i�- . ._ ✓ 41. Solar pomestie•Final �% 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irripation System 45. Sound Attenuation . 46. Handicap Regulations � 47. FINALSTRUCiURC & 8UILDING 48. FINAL P�ANNING , 49. Electric Release to Ed�son I 50. Gas Release to Southern California Gas Co � 51. CERTIPICA7E OF OCCUPANCY No Date i� f� f" 7 i � ��p��a"�� 3125 JEFFERSON AV urr: «m�aar�wEii�u�wN:NGUYEN TUAN N_- • FLOOD: 7( 47 . .�o�� 3125 .7�FFERSON AVE COSTA MESA,CA 92626 406-7011 �vv�.Yuuxo�u: u�cxrtccr on aam�n: 1PCIl ON FHO.'8 /i00NE59: uc. ra, fANfXACTqfB WWE: CONfP�CTORBYIIWI� IOOPESS 11C.lq: urn: vur: LICENSED COMP�CTOfl4 DECLAflATON: I Mnb� Nim �aqx paWy d pmpvy Ntl I em Ilrwmed ude� paiYav d CMqr Y (cammerxi'q xiih Section ]000) d D'rvbion � d Ne BuvMu enE Pmladau Cods. end mY �^b � in IuA lacs erd eflq. cmuc.No.: uc.cuss: uc.No.: EXP: Dele: Cammor. OWNER BUILDEfl OEClAN�710N: I hrab/ etfum inEer DrWY d pa'Fvy tlW I mn e�emp Imm �M Canreem liaens� Lew la M IdbanO raaaon (Seaian ]OJ�s Buanm� end Pmlema�+ COEe: �mW n aouM/ wliiCi nau'uu e o�1 to muwc�. Mer. Lnpova. demdsh, p npei vy nructua, p'v b 4 e�uanu. eho �ePnw �M appGuR la acA prmu to fib s spM eW emenl NN M a�M • licrosed W�� lo tM povuiana d Ns Canirsem Lioenae ler jChepls B(aommenenp wilh 9edion )000) d �i+eion 3 d the Budiras end Adpe'ona CoEsl > thet M a eM w aaanq �hseM1um W �M bnw la tlr eWpeA mamqion. My violetion d SaGian ]031.5 Ey ary eppli en� la e perm� eubjMs �M eppfwu lo e dN peiWly d nal man ihen fxs Auik�sU Cdlen �3500�). •`,] �.mow,rrdin's'nwMv«nrv.moMw.Anwe{p�muri.demmo�...ummswk.eMme.wmn.6�a'vueneee lt udlareAbreebl&aclbn�Ou.BueNenWPMsedonoCode:ThoComreqasliorualewEwenoteWNmenownerdMowM wM Wid� n mpws� �Meeon. eM iMio dom �uM rak HmWI a MnM n Crwph he a hm own amWq'w. G�'� thet ac� improvemama era nol imeMed a a11meE Ia wb, tl. ho�aver. ihe buitliiq a inqv.ansX o�old x�lhm ppY� d mm0le�on. Ns cw�wr-0uiper will heva Re WNen d pwinp M a kr did nd hdd a'vnpwa la tM puryoea al Wsl. � I. m owror d iM C�WeM. em utlu�dY wn�em�q wG� 4oe'uM caV�eclm b mnVu1 IM MMN� (8eaon NM. Bu�inr� eM vmlemon. coae;rn. cnm.aon lio.w le. ro. na ewM ro., oM,w a ww.�r .no adld. «'vipwe. �ns.on .iw wno contrecle br wM pqeda wiM e mmmfor(s) licanwd puvuem to the Gonirepore Lioen�s Le � I em e�em/p� cuM7 /S�action: B. d P.C.. br Nu Deia: � 1 7 f "1 � �� _� I do MrsbY �M Nu I em ewen d md udanWk IM �aW'vamaa+d Cdiww VMeEh md S Y Js Satliaro 25505.255U. end E55�. vd thet I a eny Mun WikmO �N�^� will / wil rw� (mcY ana) roM b canWy wih uid qa�� mEu ud tM n0uirameMs M >�.�.2. J //q Deb: JI �/-1� �00��. _ uni N'biu0 WOHKEF'B COYPEN9�AON DECLAN�TION: I MraEy e1Mn uMa p�nepy W prNey ar d dwWmioro: ❑ i n.w.�e w�� mea,i.:�. �.ne�. a�..m �o.w�wr. ro� wona.• �o«�.nwn.. www.e i« M swn� s�ao d m. �eo� coa.. ia m. v��•�• d m. �.o�x ia w:e, w. o� b rowe. ❑ in.v..�e.um.w.:,w�w«.•mmo«vmu�maW.�we.e,nw:.eWa.aimaimam.i.encoe..wm.w��w.anr .al, �a Miitli mu camn : bi.e. Mr.mlw.• ampw�..�ion inwmrc. mrti..ne wlw.r m�mn. n.: Cemer: Pd'ry Numbr: ��m;, ..eu�,.w �a e. �.d r w a�+o m. o,. w�m.d mnd.ls�ool a� 1 � I mnW Nel in �M perlormenca al IM wwM lor rAikA ihh pmnn b I�wM. I WY nal anpby enY P� N NY memer �o u to pxme �ubj«f �o iM xvrYx�' mnpruelion lew d CelJomie. xtl apiw tlw Y I NnYE Eecmw aEjW 10 iM xoM1a�' compn�elbn prwieiem d SWian 3]00 d tM laba CaEs. I NWI IMhr.it� oomp�y xNA ihow paviau. om.: •navm: W�minp: F�Yun ro ucun noik,ri ronpw�u�tlon eovup� l� unMHul, �nd �IWI �W/cl �n wmplo�w ro cNMNI p1naMN �rM elHl Ilnu �p ro aM �,ndrM tlauuM 0d4n (t10qOP0A h WNdpn ro tln rosl ol rompxu�tbM1 Wmrp� u povMM br In B�cHon ]1P6 0l M� Ltlor Cob, IrrtNp4 uW /rtomh'� /�a. CONSTRUCl10N LENDINO AOENCY: I hreby e1Nm uMx p«�W d par'Ny �IW �hses u e omuewion WMinp aporwy M ihs y,nwmwKe a �n. won� ror wnim me v�� a:.�^a (seaiw, aw1, cw. cl. LENOEF'S NAYE: LENDEP'9 AUUHES4: I ceniN ihel I haw red Nia epd�� ptls ihet IM ebow inlamW bn b conad. l opiw io canply xnh dl dry uM munry adinenc» eM eble leMe Mtlnp b Gtikvq cmWunion eM Iwab' aWM1aas nptuametivm d Ihe dly b mtx upon �M ebwa-men�ia�od popsrly �o��p�°u�°��TOAN NGUYEN �( Pm� Nams �n. iy.i�lMa� ome: i/��q7_ Sqeelu d ApenVAppiranVGonireau (515tdp.WP) Whns-BuiMiq 8 SefMy:Oreerr-Fb: Cenuy-Appirant: Pink-Rewnus:0okenruA-Maeveor PERMIT NO: P CITY OF COSTA MESA - BUZLDING PERMIT 081925 PLAN CHECK NO: N CONSTRUCTION TYPE: PERMIT TYPE: PLU JOH DESCRIPTION : EXTEND ENTRY 42SF UNDER EXISTING ROOF CLAIM VALUE: CALC-VALUE: PERM NO: P 081925 GOVT: N SUPP: N PURPOSE: ADD SQ FT: GROUP OCC: R-3 / *�****�i�ti�i�***��+�r*+�i�k��***D�*B**�ir�r+Er*+Lr��it*f�i�*****�t***�***it*+St+Pti�i�f�t*it+t*f�[�*ft*H******�t�r�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 ------------ MAZN BUILDING ---------- --------- ACCESSOAY 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 PARKING KEQ• PROV: PARCEL: 14165228 ZNE: REF NO: PLANNING Nt5'TES> i 1E 1f iE 1F iE if %1f fE 1E 1E 1f 1E if if 1f If 1k if iF if 1E k 1klf 1E 1E 1E 1E 1f 1! 41! 1E iE 1k IE 1E 1f 1F fk 1(� fE iE 1E if� fE 1F 1E 1E 1E 1f iF 1f 1E 1t ik if 1E IF 1f 1E 1E 1E iE 1f iE 1f 1f 1E ik iE 1F 1f IE iE ik 1E f(� 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 HY : DATE: APPLICATION ISSUED HY: DATE: 3� il�MiflFiFihiElfiEM11�1I�1@ifiFlfiF1E1E1EiFif 1EiE1EMiFltiEiE1EM iFiFlfik LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTR�IC MECF[ANIC FIRE SMIP/RES GRADING PERMIT 45.00 ^ 252 � ^ SMIP/NON-RES 'PLAN ISSUE FEE 22.00 BUILDING-DIV-> PERMIT ISSUE PLAN�CHECK TOTAL PAID DUE TOTALS----> 45.00 22.00 ,,0.00 67.00 67.00 .00 REVENUE DIVISION TOTALS--> COLLEC'f-ED: 67.00 OVER/SHORT; ,00 BLDG PMT PLUMBING ELECTRIC MECHAtJIC FIRE SMIP/TOT GRADING pLAN-CHECK 67.00 r� � 1E1l1fMiliFiElFiEkiEiEiEifififlEltMMiEKfFiklkMiEkkMiflfifi6'KKM1Ek1EfEitiEiElEltifltklEiEikMlkkkifkikitiEiEltkitlBiEMiflfiFltititkitMikib I N D I V I D U A L=,� Fi 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 PLU 1 LAUNDRY TUB OR WASHER .- 8.75 8,75 PLU 7 SHOWER � 8.75 8.75 PLU 2 WATER HEATER ANn/OR�VENT 1t.00 22.00 PLU 1 GAS PIPING SYS OE=`� ] TO 4 OUTLETS 5.50 5.50 END�OF FEES � i' �Z_Citi �� (lj� / �j lJ � A3-24-1997/18:29 pN/f67.6A PERMITPT081925 � �. �. ,� POO� ;PA �ONSTRUCTION AND PLANNING - 4PPROVALS Permit # Date Inspector AppROVALS� � Permit # Date Inspector i: Temporary �lectrical Service or Pole ' 52. Pool & Equipment Location � � 2. Soil Pipe•Undrgrnd. ' 6../6 S�'� �'' 53. Steel Reinforcement � � .%j�.Flectriwl Conduit Utility-Undrgmd. � 54. Forms - ' �4% �lectrical Conduit-Undrgmd. 55. Electrical 8onding = � � 4; ''�j§tiael Reinforcement 56. Rough Piumbing & Pressure Test ' � '_ ��lectrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE .`,7?.Footings 58. Electrical Conduit-Undrgrnd. ' '=8: Faundation 59. Gas Pipe, O Undrgrnd., Test . � , t 9't Water Pipe•Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. ;0. Structural Floor Svstem 61. APPROVAL TO DECK t t. Ptoperty Sewer (.ine & House Connectlori - ' 62. Ba�kwash & Receptor�Final �Z. $eWe� CaP 63. Heater & Vent�Final �1,3. Roof Drains 64. Plumbing System - Final �1;4. RoughPlumbing ;r, fi5: Electrical-Final 'J'5. Rough Electrical�Co�duit - 66. Solar System-Final 76. Rough Electric Wiring � • 67. Fencing & Access ApProval -'. 17. Rough Wiring Sign 68. APPROVED FOR PLASTEFING :" '"i9. Rough Electrical�T Bar Ceiling 69. POOUSPA SYSTEMS FINAL 79. Rough Heatiny & AfrConditioning _ � _ � F�E D�PT REQUIREMENT - r x. - 20. �ough Factorv Fi�e�iace ' '�'_- � � { � � �, x ' APP�30V,P.L� � Pe.Trmit # � '' � - _ 21. �ucts,iT.SIrSMUfef�� •� �• y y�-� 70.'�EJnderyr jo�'id F�dro rt 22. Ductz, Ventilating: ; ' '�S x ^ - `Z�` ` m:�.:. '-' .� x•- �: �.,x 71. Produ6fi��p�ngL'�as �lOil 23. �Gas �Pipe=74ou0h & Test ... S . .,^ � C r. � 72. Undergraund Wifsh '� - �.�. 24. 'R00%Fremin9' _';* `- "�.`� r� ,� �:. �«` 731 Undergrd. Stq�a�e Tan� � Gas �bil 25. floof-Shegthing ' r � v�x � r? ji,�� 7q�, Overhead Hydio �� 26. T-Bar Ceiling (Strycf�urall & IN@.i�coat k� � � n�� 7�. Dry Chamical "� r'� ` �{.;- ._ V K 27.'Frame and Flashing, -�� r 76. Dry StaFrtlpipe�-s.� % � _,.� 28. Lathing8tSiding`�' �G� J a g ' "" 7`L`, FIXED`�``r$T�NkFiNP�L_ , : :� 29. Insulation -";� V . .. r � � � �: 78.�FIRE PREV. FINAL x' = �' - � 30. Drywall!Nailiog ',' �,� � ,� 5�". �;yH�ALY3iDEPT'RE�UIREMENT .� � 31. Plaster Brow(rCoaS � s '�t- * � �r • 73. FINAL tNSPECT�ON u � � - � � 32.�F�Iectrica�Power Meter�Final , '' �' � i ��' $Q' FOOD CERTI�JEATE [SSUEQ 7. . r...: c I tt 1 �_, �.� � . . 5%= C' .� [�t i e¢ . .� _' � . � . -• 33.;Fina1•EleFtric. -k t, I � ,x Nnces: � %6 n� �+, - - n ,/ � � . . : = ~ J Y _ : ! f-� J�--C� � _ �-rfJ �U _ . c• 34.rFin�'CHeating=& Ati>Conditipni&§S " I � � ^'/�/� S .,.., c - .�. _ � .i i' -A 4 � .�f . �K�_�� I 3 � r 35.�inaTGaYPipe.-Test�. -'L . � , � - �'� � ' _ - ' 36. Hood or-Canopv -A' :. -� � - � _ ` £ ric a y . - �:c � c��*' a. �' i m - a- ' ' �� 37. F.inal;FaMoryFir�yce- -'_ : ^ � � -; r �� 38. Final'Pluinbing -`'' �io . . `'- I ' '` g :• K'n _ . L� C: 4 39. Water Sei_vice-Firul;' _ ' ' � � �x ' '"-. f •- _ : 40. GasService-Finalr;•: - a.rrrn'r S +!'t � �': _:- �'� • - ' - ,. � �r c � .. c ; 41. Solar Ddmestic•Fin� = � " '' � ' ' ` _ - " ; m ,� � , ;,. F ' ' '. ,. ; . -. 42.�ackflow Preventer.• ^ %� n y , F c' ' E- +� '" � 1 I T T ,' 43. Backfiow Irr}gatipn;: ti,S- Y� - ' ` �'.' - C r � . ;y34. Landscape Ifrigat�oe Sysiem::t*..= 'fi k " r �• . ; � - -^„ ;� L�� _ . , ' .r �y+' . � r ,'1- r r '45.a�Sound Qtteduation'_ . .. � �: f -`' C F - �. � � c�• s r' C' � 6 46. Mandicap Fe9ulations - * �r _ - -- • c i = 47.=FINAL STRITCT RE & BUILDING _: i,,, � ' �' � � � � _ � .•. i 48.�f.INPL PLANNING i- � �, c' -. - .. =49.�-Elecfric Release to Edison ` � '= z � j 4 c; • 50. Gas-Release zo Southem Calitw�ia Gaz Ca i � ti =' • ' -, � - 51. CERTtFiCATE OF OCCUPANCY ' ' ' -� - - � No Date —_ ?wowc'ssosaa�owc 3125 JEFFERSON AV uNT: , ,. _ _ __, ____._ ., .CITY OF COSTA.MESA — BUILllING PERI4IT__ xrta�rsrz+eivaawrtNGUYEN, TUAN N FLOOD: X 47 .. . . _ __..__ . _ . - ,• .00xEss: 3125 JEFFERSON AVE COSTA MESA,CA 92626 PERMIT NO: E 081924 PLAN CHECK NO: N 406-7011 �.�uinawox�sf CONSTRUCTION TYPE: PERMIT TYPE: ELE NE �qCNRECTOP ENtlNEEN: YKN.OH EtMi'S 100NE55: uc. xo.: COMNACTqi'S MME . cartx�croxs�uuuc �noxEss ue rn_ VNT: urn: UCENSEO COHfNACTOHS DECLAflATION: I hereby ef14m uMs penetly d pe�ury ihet I em Icenssd �nMar prwieiwm d Cheper 9 (oommerui�p xilh SecEon )000) d Drvoion 3 d the Buameu erd Pmlmeiom Code. eM mY �� 4 in lull /acs ard elleq. cmuc.xo.: uacuss: uc.No.: _ EXP:_ .. , Deis: CaNmca: OWNEfl BUILDEP DECIJXATION: I hereby dfim uMer prWy d per'Fvy Out I em axemq hom �M Capretlm Limme Lew la tla IMbx�q reewn (Seeion 1Wts &sirose md Pralneia�v CoEe: MY M' a aouM/ whirA iaW'ves a Vermn lo muVur{ eXx. impaa. 1emW6�, a repai eny sVucWie. pia b ds eaueMe, a6o mpuim iM eppl'unt Im euch pamin to fib e eyned eWement Nel M a eM � IioweE purnunt lo iM pm�u d tlr CaMretlas Uconae lew �cn.q., e l�e�� .an swa, r000) a o�o� a a �ro Bu�'vwm vd VrMmsbre CoAel ar tIW M a sAe u ewemN iherehan eM iM beaie In Ne elbped mmmqun. MY vidmun d Sw'vi lW 1.5 by arry eppkn�tl ta e pemN MpCt tM eppliuN b e uri peiu4y d nal maa Ilun fxe hivdred doYare �S.SWp. �] I.mowne�dtheP�W�YamVanWn/e»wlhwep^+olMiwbcanV��ian.v.iqdolhawk.eMtMewminenavqeMeC a dived tar eeb (SecYon'lOM. B�ewvd PrdeemnsCaEs: TMtamrauon llows IsvEms nal nYD�Yto en ow�wrd pWMY who buld� a inpfwae theean, rd nAo Aom wN wak Ivmsetl a MnN a Wau� he a her am ampbyaw. D�'� �het aM impvianMv re m� iaanded a dtreA /a We, tl, howawr.IM dnli'vp a inpwanM o wtl wnM one yeer d mmpMun.IM ownmbuSis �n0 hevs ihe duden d pwiry M a ehe did m� EWE a impo.e la iM qvpwe d eda). � I. m ox�w d �M D�O�Y. em sstlu�ivMY conlretl^Y xd� Imnsed wnvec�we ro conp�ue Ma pqetl (Smion �ON. Bus'vieee ard PNan'vo Code: TM Caurmon licros ler Ooa nd eVVN ro en owna d D�W�Y Wa dtiN+�a yyp�Wm tlwean end who con�acn Ior aurh w9a+ wtlh e mrurariMs) IicemeE pmuem to iM Caureaa� �etaNr � I em ecemp under Seclion: B. 8 P.C.. W N' � Dme: � I �IQ' Oxnw: � imn«aM�rmmi.m�sa�a�.+.�eme�w��«a.ac.i/o��enwsv w� s,a�uws.as�a.�a 2553�. eM thei I ar em Mun buiki�q mapeM xiP / wll ria (�y �) �+3d �o canply W� eeid mte caEea entl tM ieyuiramams iar pMwora. / /��/ 11 Dms: � I ) l�1 / ADWceN: i/li IV/1rIL( WONKEP'S COMPEN411TION OECL/�N�TION: 1 Mreby elfi�m unEer penelly d pe�ury me d ih oll �p dedue�bna: � I heve uM wJ meiMen a cMtlicata d caneent lo vetlaiuuro In xaheri mmpwtbn, u prwiAeE la by Sadion 3100 d IM leEor coea. �« �ne o«torm.rce d u. wA in wlicm m� v� e M.uee. ❑ i n�.�d �,;e �m� �n�.• oomo�.m� �m�..�w. a. �.a��.a nv s.a� aroo a ma �n« cma. r« ms rond�. a m. woM M xAid� ihia peimtl ie ieaued. My waken' wmpenetlbn ine�rence mmer eM poliry number ere: c.�.: Pdry Number: (Tn'u .eaion rreed nw ne mnWme! / tne u«me u ro, w�. nund,w da�.,.ls,aol a'ru.) � 1 canry IM� in tM peRormerc:e d ihe woh br which thu parmn o u�ueE. I ehell nal empby ury perem n vy memw n m to bewne eubjeC io the wohan' canpevtlbn bx+ d CeWunia, vd yree Nr Y I ehatld becanie wibjetl to iM r.vfb�e' �m� a�+,o�. a swo� aroo a m. �.m� coe.. i wm m�n.nn �w ��+ v�. Dele: Md� W�mNp: FeHu� ro sscun+'ert.ri rorrpauetlon cov�np� l� unWM, uM �Irll ueJ�cl en nrrylqsr ro a1MrW p�rWtluW tlNl Ilnu'p ro ms h�nEndllnurM Gulhn lfIPqP00A b�� ro M ro't o/ roiryw�ufbn �pu n PmrltlW h/ In 9�ctlm 3](16 0/ tln LeOo� Cotls. lnM1n�4 �nd �f1om�Va /w�. eoNsrnucnoN �exmrw aoewer: i n«enr � ww« wroM d wriw �nm in.a e e�n�a� w,a�m m�v ro� m. p„i,�,�� a�n� .m� i« wed� w w�� n:aw �sw� �. c:. c�. LENDEN'S NAYE: LENDEN'S ADOflE39: I cantly ihel I M�a read Ne eppfr�ion enE tlW the� tlr ebova "udammion h mnw.l epiae �o oompy vrith e0 ary W rnvqy mlmence+ enO stme lene MetM ro huAJnO canmix�m eM hareby aNhaca �apewVeti�w d ihu dtY ro eNa upon the abwe�imNioneE prapeny �'��0"�""°�"'TUAN NGUYEN ♦� nN Nema p,/)/ IYAlluO� Otle: 3L�1/A7 Si9�ura rIRB�VApplranVConlrutar (5151J6.WG) 'M�ils6uiMip85de�y;OroemFb;Cenery-Appiranl:Pink-Rewnue:OdEe'wE-baeaaa PERM NO; E 081y24 GOVT: N SUPP: N PURPOSE: ADD JOB DESCRIPTION ; EXTEND ENTRY 42SF UNDER EXISTING ROOF SQ FT: CLAIM VALUE: . CALC—VALUE: GROUP OCC: R-3 / COMMENTS: RELO FAU, REMDL BATH, ENLARGE KITCHEN INTO E}C. SPACE, ELE #B81923 �r�r�ititit*it****itit�e�e�*��atx�x itr*itx it**itit�ritit**�err�r�r**��*+�+t�+�+�*�****at****�**�tetatitx�r�+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 5 ------------ MAIN HUILDING ---------- --------- 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 PARKING REQ: PROV: PARCEL: 14165228 ZNE: REE NO: PLANNING NOTES> > if iF IF IF if iE 1E 7E 1E 1f 1E 1F 1k 1F 1f 1k 141i iE 1E li 1E if 1F 1f 1E if 1E 1E 1E IE IE 1E 1f 1E iE i(� if 1E 1E fE 1f 1f iE 1E iE 1f 1E IF iE iF iF IF 1E 1F 1f if if iF iE 7F iE iE iE IE iE 1E if 1F iE iE 1f ik 1f if 1F iF iI� if 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 . BUILDING APPROVED BY : ��y�`��7\�� LEGALIZATION:N F E E S U M M A R Y BLDG PMT PLUMBING ELECTRIC MECHANIC PERMIT 9.25 SDE PLAN ISSUE FEE 22.00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTALS----> 9.25 22.00 0.00 DATE: DATE: DATE: � �{�1F1E1EIEfE1EiflEfflF iFfE STRUCTURAL SEGMENT:N FIRE SMIP/RES GRADZNG SMIP/NON—RES TOTAL PAID DUE 31.25 31.25 .00 REVENUE DIVISION TOTALS--> COLLECTED: 31.25 OVER/SHORT: ,OU BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 31.25 1E 1E If fk 1E 1E 1k 1t 1E 1E 1f 1t 1f 1E iF k 1f 1E 1E ik 1k iF 1F 1E 1t 1f 1ElF iE 1f 1klF 1k 1f IE 7E 1F 1k iF iE IF 1f 1F 1F ik 1k 1E iE 1ElE 1E 1E 1E i! 1E 7F 1E iE iE 1E 1E fE 1ElE 1E IElklf 1f 1E IE 1E 1f iE iE k iE k 1E I N D I V I D O 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 ELE ELE ELE 1 FIXTURES, LIGHTING 1 ST 20 2 RECEPT/OUTLET 1 ST 20 2 RECEPT/SWITCH 1 ST 20 1 MOTOR/POWR APPARATUS 0.0 — 1.0 END OF FEES 'r�ED��( �I�` 1� / 1.00 1.00 1,00 2.00 1.00 2.00 4.25 4.25 VC� 03-24-1997/1A:29 f1M/f31.25 / RCPTq:B1—BA03839 PERMIT:981924 ��G • �'CONSTRUCTION AND PLANNING -�' POC SPA �� APPROVAIS Permit # Date inspector AppROVALS Permit # Date Inspector � �: 't'. Temporary Electrical Service or Pole 52. Pod & Equipment Location r ' 2. Soii P(pe�Undrgrnd. 53. Steel Reinforcement ' = 3. �Electriwl Conduit Utility�Undrgrnd. , 54. Forms `4.'�Electrical Conduit�Undrgrod. 55. Electrical Bonding � � � r- < ' S, £teel Reinforcement 56. Rough Piumbing & Pressure Test =' < __ g � lectrical UFER Gmd. - .� 57. APPROVAL TO COVEfl�GUNITE . i� � • �'1; .Footings 58. Eiectrica_I Cqnduit�Undrgrnd. �"8: Foundation - ' 59�. Gas Pipe, t7 Undrgrnd., Test � g: Water Pipe-Undrgrnd. �� , 60. Backwash �ines, P-Trep, 0 Undrgrnd. 70. Structurel Floor System 61. APPROVAL TO DECK 11. Property Sewer �ine & House Connection ' 62. Badkwash &'Receptor-Final ' �2. -Sewe` CaP . 63. Heater & VenrFinal 13. Roof Drains ' f 64. Plumbing System - Final _i4. Rough Plumbing . m � . � :6�. ElectricabFinal 't5. Rough Electrica6Conduit ^' �- . 66. Solar System�Final ' 76. Rough Electric Wiring 67. �Pencing & Access Approval ' 77. Rough Wiring Sign , � 68. APPROVED FOR PLASTERING '18. Foogh Electrica6T Bar Ceiling � - 69. POOVSPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT - - � '�' - - � - T� 20.:Aough F,actory F ie`,�lace - a�'; +t, � '? _ ?� ;: qpRROVAL�'^, Permit # _ ._ , 21.-DucEs, in:StrQcture = • *-= 't� c - ^ t� 70.-Under`ground I��dro T '1' c- .1.' _ _.:k ti T C ' II n� �'� 22.,Ducts. Ventil�ting� r .� .-. � S ¢'� 71. ProduGt�iping��,-"'�_h.,as G] Oil 23. �Gas�Pipe�Rouph & T.est rj � K-, t� �, � r: `� 72. Underground Ffu'sh � - 24.i�oo�Fr3ming� "',�; " "� �=' v ' _K�; 73. Undergtnd.St�a�eTan�COGas �il 25. Roof,Sheatfiing '� c� �.��: �` _ ; f�'r. 7:A. Overhead Hydr�� r. 26.�T-Bar Ceiling (Strp6tural) &�ICi�'6'coat � � �, � '' 7b. Dry Chemiral _- �. �' �7'`{_ 27..°Frame aad Flashing�: � S� , a r c x 76. Dry Sta�sdc�ipe- Q a� 28. Lathing�& Siding�!' " �G� �' r� . ..�" 79�. FIXED�xST�'vYFINP�`L�. �y. � 29. Insulation =�> •• r � 'x 78. FIRE PREV. FINAL '« � � � �->3 � 30. Drywall;Nailing � x`. _, � �, � � c. �;�ALY.H DE7yi'.�iEQUIR�EMENT : � � 31. Plaster Brow{r Ca3I: - >m = � , �z .. 79. FINALt�tNSPECi�ON u _ -� 32."Electric�l Pob+er Me$x"F�al' '�` �� l�. •' gQ;. FOOD CERTIFJCATE �S,�UED �. � 33.�ina`}Eleytric Y� P �'� ' �� ` Notes: ? �` � . � �,?� =: c x � t � - 34. "Fin�C Heatint,[�& �riCoriditiohin`g� ,-, ' ' ; ' `i 'T . � __ �: �' • S y "_" --, - m m +'� K c• .,c r-e -- 'G - Ft S � :C ' . . . �•. .�: 1 .�., �, tJ 35.'Fina`PG23;Pip'e,Test, � .. �� _ � ��: ,;,p ;,.+ k -�Nc„c,T - � i ' 36. Ho6dorxanoPY'`^'- � . t�'� - r' i ' F CiC . _ - � GCn . -- -_"- cT - i i• r•. �o a T �1. :-i , 37.�f.inal�Factory Pir'�lace;- � Sr � .x `• � a.' `s x. ��y � �, ' . 38. PinaTPlumbing = � c� .� �ti ' &. I S � x� � " - . , Y' '�1 'k I �R .� Q� •� � -. 39. Watei Se7vice�Firiai;� .;. ' '� �`. C � � w` :' ^? � �' T n,T, � � • 40. Gas Service-Fina1CF ?' g^-� = ! r•' � � � - -��- %' 1 • • - i-� i� +� �� a n' � � :. 41. Solar pomestic�f,� �j �' : y .. ' �: " _:� '" `. - � �c. T w I t T ,� .- . 42. BackElow Prevenreri: �V �+ 'r, � + C . � - ..,. ., -. _. � t �.y �^ 43. Backflow Irrigation.`. -'� * � x ' � x ' .- .� . � � .• �,�- -44. Landscape Irripaiion SystemSmi: Y'. t" '` -> '' cc .'% n' - - v. x " z' - =45.:Sound Qtterivatio?,: "�:"� .. � ` � n �. � -� _ �y '�� r ` �6. Handicap�Regulat±ons r. - � � � "� - S � _. R _ , _47.�If�LSTRFJ�CT�l�E&BUftDiNG ; _, j � �. '�' `� � 48.fINC>LPIANNING -- �•,-= � '"':? n7 c . � ' ' i. C -49.�Elecirie Release fo �dison � �'� ' T• ' � � � v� �Y' - c; - :50. Gas Release to Soutfiem Califofnia Gas Co * �r - o• ' ' • - �r. - a " -�. 51. CERTIFICATE OF�OCCUPANCY r� # " �- !"� � ` - - - No. Date . ':' ' -imonEss'aemiomo: 37.'l5 JEFFERSON AC' °NT' �g?"1E1°� I�IGJYEN, TUAN N FLOOU: X 4'7 "°0"�u 3125 JEFFERSON AVE COSTA MESA,CA 92626 406-7011 �vv�. wuuxo wo�ss: u�cxrt[cr on ��x: CONLNICTOP'SNiWE: cam�croxsMuuxo �oonEsx uc. xo: uc No.: uNr: uxr: LICENSED COMNACTOHS DECWIATION: I Mraby ellim uMer pe�y a p�ry ry� I em limaed uMs pwi+bm M Cheqer 9 (cammmorq wilh Senun )0001 d Oi�un 3 d iM &�aron eM P�qaysp�y �e. dy my lironse o in lull l«u eM Wetl. cmuc.No.: uc.cuss: uc.No.: EXP: OWNEN BNIDEN DECLAHATON: I Mreby alfirm uMx penelly d perN�Y �� %�mq kan tM COMrepas liwme Lew ta the tdbxin0 rteaon (Setlbn 10.t1.5 &n'vreae uM Prdevione Code: Any ciY v coumy whiM n0uim e Oermil �o canhucl. ella.'unprove. iamoloh. m repei enY anucnire. prior ro ds ewema. e6o requiroe Ily ¢pOry'�t fw auch parmit ro fila a ey�d e�emenf Mel M orshe e liceneed Wnuenl b �he prwisiom d IM Conlretlwe Liceroe lay �Cheqer 9(rommendnB'�^�h Satlion )OW) d Divbion 3 d Iha Buaineas eM Prdeaaons Codal ar that ha v eha ia exemp iharelmn end the beein la tM elbpeE aremption. My vidmion d SeUion 1031.5 by eny epplicent lor e permil aubjWs �M epd�n� to e tivil p¢�aryy d nd more ihen �ive huMred dolW �SSW�). .Cl I, m ownar d Ihe pmpaM or my empbyeea W h wepes es Ihe'r Bole campense�ian, will do Uro wak, end tha el�ucturo ie iwl inteMed x•- orMaredbreale(Section]OId,BusnmaendProfessioneCoda;TheConVac�«aLivansalewEoeanMepplytoenownardpropMy wM10 buJEe w'unpaves Iherean, end Ma Eoee euch xdk Mmeery or Mnetl a Ilirouph he a her own amployeee, qoWdad Ihet such impwemeMs ara M intanEetl a WereE ta sde. q, howsver. ity puiMiip a'unqovemeM ia eotl wnhin aw yeer d campletion, Ne owner-builder vnll heva tha buMm d povi�p he w ehe did mt Wild « improva 1« �M WN�e d We�. � I. ea oMner d iM O�oPaM. em eRtluserey' conirm�q Mith lironietl cantreclae ro cansVuq tlr q9� (5etlion ldld. Bua'vma end PMeseiona COEe: TM Gomradon licaee lew doee M WNY ro en owner d qWe�Y xfio EuiMa ar'vnPwr tMraan eM xho conincta lar wch pqerls vAh e o �er(aqlicerue to tM Comreuaa liame lew). I em eze q er Sedio .8 P.C., br Ihro a: �., �t� 2$ �� 7 - i eo ne�en en�N mm i� e.are a end ,e ine rea��mm.m d ce��omu �.em, ene smerv cod. s.a�m. uws. zss�a. e�a thv I a vry Mure buiNirp omyeni will / wil rwl (drtb qy) �A to wnply wih ead mte mEn xM iM repuiremems br e Veemn lamrewnionor modifraionhwniMAi�Ge ty .�TareGamMt DiMrid. RevEanliel eon&�uqion ePW�iamen uemD� han ihoe warisrone. oe�e: noW�canc WORKEfl'S COMPENSATION OECL�FATION: I M�eEy elFrm uMer penelry d pa�ury ais W Me blloxi�p deduetion�: � I hew end xil meinlan e cenX'reta d mneent to esX�iroum br Wpl�ero' compenWon, u povitled la Ey Sepion 3)00 d Ihe lebar Code, /ar tM perlameze W ihe v.wk t« wkch t�ie pamtl ie lyued. ❑ � neve end xi� meimen v.on�e%mmo��^ �^w�^. %9'^7��a M s«xion slao w �ne lab« coJe. ror �ne w�.�oe a �ne wwk lor which thia pe1mil is isaued. My warke�e' wmpanemian inwreMe farrim enE pdicy num Wr ma: c�a Pd"ry NumCx: �rn;: seaim �e.d �a ae �o� r me v�• u ror me nune�ee adie�a R�mi a�e.� � I eMh Nm m iM P�oemeMe d �ha xdk far whioh ina M�nn e mued. I aheA nol emM�J e�y V� n eM' manmr eo ev �a become wbjw to iM xvAe�e' campen+e�ion �e+�+ d Celilpmy, yb apree thm J I Mouk beconro wbjea �o tM v.v�km' companspbn pv.iaions d Secion 3'ro0 0l lhe labor Coda. I qy�IlMhwilh campy xnh Uwm poviaiam. oma: now�c Weminp: F�llun ro a�c✓n wolksri rompnu�tlon cov�np� la u�NwNl, andaHll sW/�ct m m�plqn b MMIuI pxuMp �ntl c/v/l flnu up ro om �untlreJ tlwuanA Jolkn ISfOq0001, � btlltlon ro tlro ewt al rompmutlon, Cemvp� �� proNdM br In SxXon 9]P6 0/ fhs LeborCorb, Ilrtsrs�4 anC ettomsyY lss,. CONSTHIICTION LENOING AGENCY: I hereby eXi�m unEer paneryy o/ perlury ihel Ihere is e canelrWim NiMi�p pency for iM penamence d �ne work �or wnim �fiu cermi is oeued (seaon aan, cH. cl. IENDEN'S NANE: LENOEfl'S ��DflE54: 1 cenily ihet I heva meE Ne epplireiion aM slma the� tM eEare inlamyion ia correa. I egree Io compy wilh ell ay md counry �nenoea eM ateta bwe feklmp �o buikip conatrumon end hxebY eWwae �qq��ivm d �he riry to emw upon tM abow�meNionetl qaperly la irepeqion Wryoxa. T(7AN NGUYEN o�a: � 2A (a Z (5151�68.WP) While-BuilEvq 8 Setmy: Greeo-Fle; Ceneyrlppifanp Pink-Ravenua; OdEamoE-Meeexr CIT� OF CUSTk MESA - BUILDING PER1dTT PERMIT NO; E 082577 PLAN CHECK NO; N CONSTRUCTION T:PE: PERMIT TYPE: ELE JOB DESCRIPTION : SOPPLEMENTAL TO E-81924 CLAIM VALUE: CALC-VALUE: PERM FdU: E 0825'; ;` GOC�T: N SUPP; Y PURPOSE: AUU SQ FT: GROUP OCC: R-3 / COMMENTS: RELO FAO, REMDL BATH, ENLARGE KITCHEN INTO EX. SPI�CE, ELE #B81923 ******�t**i�*******at*�it*x�**�x-�-�*+�*x�*fe***i�****�t-*et*��t�**x�**it*�-�x�*+�*+��tfE*�iE**�x-*�-*r��+�* 'L 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 ------------ t4AIN HOILDING - -------- --------- ACCESSORY BUILDING -------- FRNT: FT IN REAR: FT' IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEF'I: FT IN RGHT: FT IN PARKING REQ: PROV: PARCEL: 14165228 ZNE: REF NO: PLANNING NOTES> i iE iE iFlk if ih if �E 1E If iF iE 3E if iF iE * if 7f iFlf IE N!E!E!E �E 1F 1F iE * jE 9f� �3f if iE iE if 1E iE 1f 1E # iE 3E iE 3E 3E if' if iE �E 3E �)E 1E IE iE �E 1E iE �E iE 1E �14 iE �E iE jE i� i:-if if 1f iE iE iF �f iE 1F D E V E L O P M E N T S E R C� I C E S R E Q U I R E M E N T S ZONING APPROVED BY , DATE; BUILDI:NG APPROVED BY : DATE; APPLICATION ISSUEU BY: ('/ � DATE; *��*��*��*,��,� ��g,��,��,�� *� LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N BLLG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADZNG PERMIT' 3,00 SOa SMIP/NON-RES PLAN ,!"7 ISSUE FEE �6.50 DUILDING-DIV-> PERMIT ISSUE P.i,laN-CHECK TOTAL PAID DUE TOTALS----> 3.U0 6.50 .✓: 0,00 9.50 9.SU .OU 1' REVENUE DIVISION TOTALS--> COliLECTED: 9,50 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC kl&CHANIC FIRE SMIF/TOT GRADING PLAN-CHECK 9.50 ` i l iE IE iF iE iE 1F iF iF iF �E # iE # i° #} iE # iE iE if k iE iE 1f if if 1E 1E 1E �)f iE �E,i(�J(�iE !E �F k fE IE �E i(� if IE iE ### iF iE iE iElf IE it 1ElE df !F iE iElE iF if iE iE ### iE iE 1f iE 3E iE it if 1f I N D I V I D U AfL 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 ELE 3 FIXTURES, LIGHT'7NGi 7. ST 20 EA, 1.00 3.00 rEND OF FEES � '� �� r E�� L � � 84-28-1997/10:18 Aq/f9.50 �n _ I 2 _ Cj� kCPT�:61-�'OG54�� DA PEkI�lIT: @82577 1 � i; �.1 r-,, CpNSTftUCFiON AND PLANN�NG , POC SPA - �� Date Inspeetor �- 4ate Mspectar._i ; -qPPROVALS Permit � ' . APPROVALS Permit # r� = t. Temporery Electricai Service or Po1e , - � . 52. Pool & Equipment Location - 2, SOiI PIpe�Undrgrnd. � 53. Steel Reinforcement ' ' 3. Electrical Conduit Uulity�Undr9rnd. � � , 54. Forms 4, Electrical Conduit�Undryrnd. � 55. Eleciricai Bonding - . ' i 5. Steel Rzinforcement 56. Rough Plumbing & Pressure TesY � i 6. Eiectrica� UFER Gmd. � 5�. APPROVAL TO COVER-GUNITE � 7. Footiogs � � �- 58. Electricai ConduirUndrgrnd. , � 8. Foundation �� 59. Gas Pipe, l7 Und�gmd., Test ' � - � 9. Water Pipe-Undrgmd. , " . � � 60. Backwash Lines, P�Trap, � Undrgrnd. 10. Stcuau{at Floor Svscem 61. APPROVAlTO DECK 1 t. Property Sewer Line & House Connecuon , � . � 62. Back�vash & Receptor-Final � 12. Sewer Cap -�_ , � 63. Neater & Vent�Finaf . � 13. Roof Drains ' � ; � � 64. Plum6ing System - Final � 14. flOugh Piumbing 65. Electrical-Final 75. Rough Electricai�Conduit 66. Solar System-Final � 16. ROugh Electric Wiring � �67. Fencing & Access Approvai . � 17. Rough Wiring Sign - � - 66. APPROVED FOR PLASTERING - i$, qpugh Elect�ical•T Bar Ceiling 69. POOL!SPA SYSTEMS FINAI. ' 79. ROugh Heatinq & Air Conditioning - FIRE DEPT. REQUIREMENT 20. Rough Factory Firepiace APPROVALS Permit # 21. Ducts,in Structure 70. Underground Hydro 22. Ducts, Ventilating 77. Product Piping O Gas G Oil 23. G0s Pipe-ftougfi & Test 72, Underground Fiush 24. Roor.Framing 73. Undergrnd. Storage Tank � Gas ❑ Oil 25. Roof Sheathing 7q, Overhead Nyclro 26. T-Bar Ceiling (Structuraq & Monocoat 75. Ory Chemical 27. Frame and Flashing ' 76. Dry Standpipe 28. �athing & Siding 77. FIXED SYSTEM FINAI 29. Insulation 78. FIRE PREV. FINAL 30. DrYN�ali Nailing - HEALTH DEPT. REQUIREMENT 31. Pi2ster Brown Coat 79. PINAI INSPECT�ON 32. Electricai Power Meter-Final 80. POOD CERTIFICATE ISSUED � '. ' 33. Fina! Electric Noter. / SL-�� !/[ C��o`��/`-r�� rU lr k^ 34. Final Heating & Air Conditioning � � - 35. Finat Gas Pipe-Test ' �� 36. Hood or fanopy � ' � . 'J . 37. Finai Factory Fireplace �- � "", ., � 38. Final Piumbing . � 39. Wacer Service-Finai . - ! 40. Gas Service-Finai �. 47. Solar pomestioFinai , 42. Backfiow Preventer . .�� 43. Backflow Irrigation " � 44. Landscape Irrigation System 45. Sour�d Attenuation �� 46. Handicap Re9ulations ` 47. FINAL STRUCTURE & BUILDING 48. FINRL PLANNlNG 49. Electric Release to Edison . ' 50. Gas Release ro Southern Calitomia Gas Co . 5L C6RTlFICATE OF OCCUPANCY No. Date ;�. ACD��anl �o fill in all spaces.except those within neavy Gortler lines anE sign all aOProptiate Ceclarations. CIFV OF COSTA MESA C NS CTION PJ�jJ��; MIT PERMIT NO. TRACT NO. LOT NO. , UNIT NU. . �Projeci Address � � ��'h /Yl�r� Applicant's Mailing Address �%�2 -SG-•"� A' Owner's Name d ✓e- phone � � Address S�"�'�-- Arch/Eng. Licenu No. Address Contracto� N �y � / - Ph '�T' Address (r^=��'^9� �1"`^�-�l�1�� L� !hr �''� .�.+�IF.�7 City license No. ' 3 �'�7 LICENSED CONTRACTOR D��LARATION ' - 1 be�eby affi�in thai I am licensetl un O�ovisi ot Charte� 9(comptenGing with Set[ion 7000) ot Divisioq 3 0( t e Busi yantl Professi s CoOe, antl my license _s In fulLtorce.prXl. effect. / 1 w ��y� �/� ! �-C Y / .L/ 7 oate �(7' O��' 1 Signature tL� �/V ""� �'L'�� WORKERS' COMPENSATION DEGLARATION '�ereby aHirm lhat I have a cerciticate f consent o self-insure or a certificate Workers' Compensation InSurance, r a cer ietl ropy th r of (Se on .800, Lab. Q.)n��.� � G� Co any Policy No. e��V 6 �Ce/ itietl copy i � reby turryishetl. I Cej d,4r�py s t I tl wi[h the city � ing Di sio 'Oaty t� Y_� /aPPlicant EJCEMPTION FROM WORKERS' COMP SATION DECLARATION (This Section neetl not De com0letetl i� the pe�mit is tor one huntlretl ($300) or less). i cerfify Ihat in the pe�(o�man�¢ of the wo�k (o� which this perm�t is issuetl, I shall not employ any person i� any manner so as to become subject to the Workers' Compensalion Laws p} California. Date Signature NOTICE:�If, after making this tleclaration, you shoultl become subject to the Wo�kerz' Compensation provig�on5 of the Labo� Cotle, you must fOrthwith comply with such p�oviSionS or this permit Shall be tleemetl r¢yoketl. CONSTRUCTION LENDING AGENCV 1 hereby aifirm that there is a construction lentlin9 agency tor tne pertormance ot the work for which tnis permit is issuetl (Section 3a9] Civ. CJ Lentler's Name Lentler's Atltlre55 � OWNER BUILOER �ECLARqT10N I hereby affi�m that I am ¢xeMpt irom tbe Contra[to�'s License Law tor the followin9 reason (Section 7031.5 Business antl Professional Gotle: Any city or county which requires a permit to construct, alter, improve; tlemolisn or repal any structure, prior to itz issuance, also requires the appliwnt for such permlt �., rin a cmnon ctatemen[ that neicne iz licrnsetl oursuant to the orovisions o/ 1,"ivision 3 oi [ne tluslness antl Yrote59ons Coae) or ina[ ne/sne i� exemp� ��s�'erefrom antl Ihe ba5i5 fOr [he alle9etl exemption. Any violation of Section �- `E31.5 by any applicant for a Permit sabjects the applicant to a civil '`�enalty of not more than five huntlretl dollars (g500). ❑ I, as owner ot the pvoperty or my em0loyee5 with wa9e5 as their sole compensation, wlll tlo the work, antl the structure is not intentled or ofieretl for sale (Section 7044, BuSinesS antl Protessional Cotle: The Contrac[or'S License Law tloes not apply to an owner of a property wno builtls or improves the�eon, antl who tloes sucM1 �yp�k himself/herself or throu9h his or ber own employees, providetl tM1at sucp improvements are not intended or ofteretl for ' sale. If, howeveq tha builtlinq or improvement is sold within one year of com- , pletlon, the owner wlll have the burtlen of proving he/5M1e ditl not bWltl or im- �1rove for the purpose of sale). �1 I, a5 owne� of the pro0erty, am exclusively cont�aciing with licensed con- tractors to construct the project(Section ]o44, Business antl Protessions Cotle: The Contractor's License Law tloes not apply to an owner of property who builtls or improves tnereon, antl who contracts for such projects with a con- Vactor(s iicense pursuant to the Convactor's �icense Law). I am aware that proot o� their Worker's Compensation Insurance shoultl be provitletl to me. ❑ I am exertpyt,untler Section B. & P. C. tor this reason 1\ . Date Owner I hereby cer if that heve � infOrma[ion i rrect. aqree, antl state la elatin tolbuiltl sentatives o is c t tl>, ent inspection pu . V� Signatur¢ Drivers' Licenie or 55 � above � '.SOCo 0 " : : TYPE OF CONSTRUCTION �NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH _❑ OTl{ER ' DESCRIPTION OF W RK/USE OP BLDG. ��✓ O S a'�S /iCGG y��c�u k 4 � � z' � TVPEOFPERMIT GRADING ❑ FOVNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLVMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION 5c?. F7 - oCCVPANCv CONSTRUCTIONTVPE VALUATION$ � ZONE GRAOINGCU.YDS. ACRES Remarks: Sink Backflow Irrigation Bathtubs Clarifiers Drinking Fountains Floor Dreins Floor Sinks Gas Service Outlets Interceptors Kitchen Sink - Lavatories � Roof Drains Reinspectian Fea Showers Service Sink .. 'Sewer Cap Sewer Connection Solar Collectors .Solar Piping � Solar Tank Swimming Pool w/Spa Urinal Water. Closet Waier Heater Water Service ' Auto-Wash $15� - Issue Fee Boiler Dua - Under Grountl . DIICt - $tfuC[uldl Duct - Ventilating Exhaust System ❑ Multiple FirepVFact. Blc ICBO # Heating System & Ducting ❑ ai oo,000 sTu O i oo,000 Reinspection Fee � $15 CMF OB65-46, rev. 10/84 Wnite - Builtling; Canary - Applicant; Pink - Accounting; Goltlenrotl - AsseSsor Hood or Type I ❑ Canopy Type I I ❑ Refrigeration System ❑6100,OOOBTU ❑100,000 System Repair/AI[eration Fire Dampers Registers Issue Fee $ 3 $ 3 A.r. # � S Main Buildi E T Front B Rear A _. C Right K Left S Ping. Ref, # Planning Notes: Automatic Washer Construction PoleSub. Cookin9 Unit � Oryers ❑Gas C Fan . F.A,U. Fixtures Device Boxes Outlets Switches Garbage Dispoul Generator �0-5 lectric 5�15 KW 69E7 IO/07/87 � �rone Accessory Building: Parking Req./Provided Transformer ❑ 15-50 KW ❑50+KW . Meter ❑up to 100 amps � Meter ❑over100amps � Sub Panel Motors 00.7 HP �1 X- 8 . Inc. Solar �9-15 HP 016-75+ Microwave Pole Light Range Standing Sections Trash Comoacmr � � I Reinspection Fee �$15 � I Isiue Fee DEVELOPMENT SERVICES REQUIREMENTS:� Zoning Approved By Building APProved By �%a�❑ T� Z O N I N G R E Q M T S FEES ' $�3 SUMMARV OF FEES BUILDING PERMIT $ SCn �JV SMIP $ � � PLAN CHECK $ PERMIT PLUMBING $ ��UANCE $ PLAN CHECK 25% $ ENERGV P.C. $ ELECTFICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $• � MECHANICAL $ TOTALPEE $ �•Jn PLAN CHECK 25% $ CONSTRUCTION AND�PLANNING � ' POOL & SPA ' ' .� ' ' APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector i 1. �Temporary Electrical Service or Pole 52. Pool & Equipment Location � � 2. Soil Pipe-Undrgmd. � 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 , 59. Gas Pipe, � Undrgrnd., Test ' 9. Water Pipe-Undrgrnd. 60. Backwash' Lines; P-Trap, � Undrgrnd. � 70. 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 � ]4. Rough Plumbing 65. Electrical-Final � . � 15. Rough Electrical-Conduit � 66. Solar SystemrFinal 16. Rough Electric Wiring 67. Fencing & Access Approval .� , 17. Rough Wiring Sign � 68. APPROVED FOR PLASTERING I 18. Rough Electrical-T Bar Ceiling � � 69. POOUSPA SYSTEMS FINAL � ., 19. Rough Heating & Air Conditioning � FIRE DEPT. REQUIREMENT � 20. Rough Factory Fireplace APPROVALS Permit # � r 21. Ducts, in Structure 70. Underground�Hyiiro �� - 22. Ducts, Ventilating . � 71. Product Piping �Gas ❑Oil . � 23. Gas Pipe-Rough & Test � 72, Underground Flush � , 24. Roof Framing 73. Undergrnd. Sto�age Tank � Gas ❑ Oil � �- 25. Roof Sheathing � �� G^/. - 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. Electriral Power Meter-Final 80. FOOD CERTIFICATE �ISSUED � .' , 33. Final Electric Notes: . . 34. Final Heating & Air Conditioning .� � 35. Final Gas Pipe-Test � � 36. Hood or Canopy " , 37: Pinal Factory Fireplace ' - , ' � � � . 38. Final Plumbing �, ` . � � � � 39. WaterService-Final , -� � , ' ii' 40. Gas Service-Final � i � • - � �47. Solar pomestioFinal . - - ' -• . � ¢2. Backflow Preventer - � '� � � . .- • � 43. �Backflow Irrigation , - � " � ' 44. Landscape Irrigation System �; � _ � , 45.'Sound Attenuation • � ' 46. Handicap Regulations � ' • � 47."FINALSTRUCTURE&BUILDING � ' ; / ly,'`�' ' ' 48., Special Requirements.Completed � � ' � � 49. Electric �Release to Edison � J' 50. Gas Release to Southern California Gas Co •- , � •. � � 57. CERTIFICATE OF OCCUPANCY . ., _ . - - No. Date - '' . . �' '' � .