HomeMy WebLinkAbout3217 MICHIGAN AVE - Building Permits� �
. CITY OF COSTA MESA
o ""'F '' `' �" . BIIILDING D/VISION
i�� 77 FAIR DRIVE, COSTA MESA. CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
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� 4 FOR INSPECTIONS CALL: (714) 754-5626
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PERMIT NUMBER: E10-00259
PERMIT TYPE ELEC
APN: 13907312
JOB ADDRESS: � 32'17 MICHIGAN-AV-CM
vicinity: �
STATUS: ISSUED
DATE ISSUED: 10128I2010
ISSUED BY: CAC
Suite/Unit:
SCOPE OF WORK: UPGRADE EkISTING SERVICE UP TO 200 A,PS
OWNER: TANAKA, TEI TR Address: 3217 MICHIGAN AVE Unit:
PHONE: 714-545-0022 Cily/State/Zip: COSTA MESA, CA
APPLICANT: TANAKA, TEI TR
PHONE: 714-545-0022
Address:
Ciry/State:
OWNER-BUILDER
Unit: PHONE:
ZipCode:
ELECTRICAL PERMIT FEES
Electrical Plan Check Fee: $0.00
Electrical Permit Fee: $54.00
Reinspection Fee $0.00
TOTAL FEES $54.00
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Address: 3217 MICHIGAN AVE Unit:
City/State/zZip: COSTA MESA, CA
License No. 000000
CELL:
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NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia staNtes antl related
regulalions. (Ord. No. 92-28, § i, 12-21-g2) .
E%PIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authonzed under this permit to be wnsidered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and fnal approval will result in the expiration of this permit.
CODE/. INSPECTIONTYPE DAT N�1filALS OEO INSPELlIONTYPE OA� INllna�s
i616 Fized System Final Fire Prevention pp6 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
zoo Final Re-Roof zio Final Elec�ncal X� 2- 3" � U 12f°� C3J
201 Final BlocklRetaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place yp0 Final Planning Approval
203 Final Sign 222 Final Site ' ^
204 Final Demolition 250 Final Building/Occupancy
WORKERS' COMPENSATION DECLARATIo�
I hereby aHirm under penal[y of perjury one of Ihe lollowing declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'
wmpensation, as provided for by section 3700 0! the Labor Cotle, for the
peAortnance ot the v+ork tor whic� this permit is issued.
❑ I have and will maintain wvrkers' compensation insurance, as required by
section 3700 0( the Labor Code, (w the pedortnance of the wnrk (a which Ihis
permit is issued. My workers' compensation Insurance cartier antl policy
number are:
Carrier:
(in�s se[fion neetl rot �e competetl A tne pe�mR a valued af one Iruntlretl tlollars (St00) w less �
Policy Number:
❑ I certify thal in the peAormance o� Ihe work for which this permit is
issued, I shall not employ any perwn in any manner so as to become subject
to the workers' compensation laws of Califomia, and agree that if I should
becOme subject to the vrorkers' compensation provisions of Section 3700 of
the Labor Cotle, I shall forthwith wmply with these provisions.
Appliwm's SignaWre
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrm Ihat I am licensed under provisions of Chapler 9(commencing
with Section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force an0 eftect.
Lic. # Class #
Convaclor's SignaWre
CONSTRUCTION LENDING AGENCY:
❑ I hereby aKrm that there is a consWction lending a9ency for the
pedormance of Ihe vqrk for which this permit is issued. (Sec. 3097, Civil Cotle).
Lender's Name:
Lender's Address:
Da�e
OW NER-BUILDER DECLARATIONS:
I hereby aKrtn that under penalty of perjury that I am EXEMP7 FROM 7HE
CONTRACTORS LICENSE LAW for Ihe following reasOn (Sec. 7031.5,
Business and Professions Code: Any cily or county which requires a permil to
consWct, alter, improve, demolish, or repair any strucNre, pnor to its
issuance, also requires the applicant for such permit to �le a signed statement
that he or she is licensed pursuant to the provisions o( the Contraclors
License Law (Chapter 9(commencing with Section 7000) of Division 3 0( the
Business and Professions Code) or that he o� she is exempt therefrom and
the Dasis lor the alleged exemption. Any violation of Seclion 7031.5 by any
applicant (or a permit subjec[s the applicant to a civil penalty o! not more ihan
five undred dollars ($500).):
I, as owner of the property, or my employees with v,ages as their sole
c pensation, WILL DO THE WORK, and the slruclure is not intentled or
offe d for sale (Sec. 7044, Business antl Professions Cotle: The Contractors
Licen Law does not apply to an owner of property v+ho builds or improves
thereon, and who does such vrork himself or hersel� or through his or her own
employees, provided Ihat such improvements are not intended or oflered for
sale. If, however, the buildinq or improvement is sold vrithin one yeai of
completion, the ownerbuilder will have the burden of proving that he or she
d'd n�ot �bJuiltl or improve for purpose of sale.).
�� ''_ ovmer of the property, am EXCLUSIVELY CONTRACTING WITH
SED CONTRACTORS to consWct the projecl (Sec. 7044, Business and
fessions Cotle: The contractas License Law does not apply to an owner ot
• property who builtls or improves thereon, and who contracts for such pmject with
a cmtracta(s) license pursuant to the Com2ctors License Wws.).
❑ I am exempt under sec.
Business and Protessions Code for this reason:
�O
SignaWre
]OS]-4fi(]IO)�
Owne � y driv� se. ❑ es ❑ No -
D ver's Licen xQ�r�s "'-�`�_ �
Ve a ion of Ownership by pype of document, i.e. - property tax bill or tleetl):
DIVISION OF INDUSTRIAL SAFETV PERMIT CER7IFICATION:
❑ I hereby certdy that no excavation frve (5) w more feet in depth into wfiich a
person is required ro descend, will be matle in connection with work authorizetl
by this pertriit, and Ihat no 6uilding strucNre, scaffoldinq, falsewnrk, or tlemolition
or dismantling thereo(, will be more than thirty-six (36) (eet high. (Chap. 32, Grp
2. M 2, Sec. 341, Title 8, Cali(omia Administ2tive Cqde).
❑ As owner-builder, I will not empby anyone to tlo work which vuoultl
require a permit from the Division o� Intlustrial Safety, as noted above, unless
such person has a permit to tlo such work from Ihe tlivision.
Appliranl's SignaWre pa�e
Division of Industrial Safery Permil Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or fWure builtling occupant need to file anC
certify a Business Plan for emergency response to release or mreatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the Califomia Health antl Safety Code requires, with some
excep[ions, that a Business Plan be filed with the Costa Mesa Fire
Depanment by every business which has at any one time dunng a reportetl
year a quantity of hazardous materials equal to or greater than a weight of
500 pounds, or a volume o( 55 gallons, or 200 cubic feet of compressed gas
at standard temperature and pressure).
2. Does or will Ihe applicant or present or future builtling occupant neetl to file
a registration (ortn (or acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 ot the Calitomia Health and Satety Code, vnlh some
exceptions, requires registration with Ihe Costa Mesa Pire DepartmeM by
each business which at any one time has on hand a quaniiry of acutely
hazardous materials equal to or greater Ihan a weight of 500 pounds, or a
volume o/ 55 gallons, or 200 cubic feet of compressed gas al stantlard
temperaNre and pressure).
3. Does or will [he applicant or present or (uture building occupant neetl to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of Ihe Cali(ornia Health antl Satery Code provides Ihat the
Costa Mesa Fire Department may require the preparalion, certification and
filing with the Fire Department of an RMPP by businesses which are required
to register acutely hazartlous materials vnth the Fire Department.
4. If an RMPP is presently required, has Seclion 25534 0/ the Califomia
Health antl Safety Code been fully complietl with? ❑ Yes ❑ No
5. Does or will [he applicant or present or (uWre builtling occupaN require lor
Ihe work which is the subjec[ of Ihis application a permit (or such wnstruction
or modifcation fmm the Soulh Coasl Air Qualiry Management Dislric[ or from
any other air pollution wntrol tlistricl or agency? ❑ Yes ❑ No
(Section 658502 of the Califomia Govemment Code requires that the requeste0
information be fumished on applications for non-residential building permits).
6. Will any part of the faciliry to be constructed under this permit be within
1000 feet from Ihe outer boundaries of a school4 ❑ Yes ❑ No
Q( "yes", Ihe facility must meet ihe requirement of Sections 25534 antl 42303
o! Ihe California Health and Safety Cotle�.
7. It a permit from the South Coast Air Qualiry Management District or other
air pollution contml district or agency is required for the work which is the
subject of Ihis application, have all of the disclosures prescribed by Califomia
Health antl Safery Code Section 42303 been made? ❑ Yes ❑ No
8. Qf'j�es", attach certificate of compliance from the appropriate air polNtion
contml oKcer).
CERTIFICATE OF COMPIIANCE: I certify that under penalty oF perjury the
information given above is correct. I agree to comply with all state lavrs and
city ortlinances regarding Hazardous Materials and Emissions.
SgnaNre �aie
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalry oi perjury that I have read this applicatian and s[ate that
Ihe information given is correcl. I agree to comply with all state laws and ciry
ordinances relating to building construction, and authorize representatives of
the City of Costa Mesa to enter upon the above-described propeAy for
mspection purp esrl�agree not to occupy or allow occupancy of any building
�ed by iis per fll until (nal inspection.
� %.�,�1� �D-Zgt-��
C SiB�a� egal er�s) Date
An�Por Autbonzetl ApPlicanl
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Costa Mesa
City of Costa �l�lesa �uilding 1�ivision
77 Fair Drive, Costa Mesa, CA 92626
714-754-5273 / Fax 714-754-4856
OWNER BUILDER VERIFICATION
Permit #
Disclosures & Forms for Owner- Builders Applying for Construction Permits
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the
property improvements specified at
We are providing you with an Owner-Builder Ack�owledgment and Information Verification Form to make you
aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the
Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of
each provision, signed, and returned this form to us at our official address indicated. An agent of the
owner cannot execute this notice unless you, the propeRy owner, obtain the prior approval of the permitting
authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
DIRECTIONS: Read and initial each statement below to signify you understand or verily this information.
��Gl✓1._I. understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-
Builder" building permit that erroneously implies that the property owner is providing his or her own labor and
material personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any
injuries sustained by an unlicensed person and his or her employees while working on my property. My
homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder
and am aware of the limits of my insurance coverage for injuries to workers on my property.
� 2..1 understand building permits are not required to be signed by property owners unless they are
responsible for the construction and are not hiring a licensed Contractor to assume this responsibility.
�3: I understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that
I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit fled in his
or her name instead of my own.
�9. I,understand Contractors are required by law to be licensed and bonded in California and to list their
license numbers on permits and contracts.
�5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors,
and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may
be considered an "employer" under state and federal law.
%�' �� . 6. I understand if I am considered an "employer" under state and federal law, I must register with the state
and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and
contribute to unemployment compensat'ron for each "employee." I also understand my failure to abide by these
laws may subject me to serious financial risk.
�7_I understand under California Contractors' State License Law, an Owner-Builder who builds single-family
residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed
by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of
the work is pertormed under contract with a licensed general building Contractor.
3148-30 CALBO Jan 1, 2009 OB Packet template 1 of 2
.,_ �:.
�8., I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable
for any financial or persqnal injuries sustained by any subsequent owner(s) that result from any latent
construction defects in the workmanship or materials.
�9. I understand � may obtain more information regarding my obligations as an "employer" from the Internal
ReOenue Service, the United States Small Business Administration, the California Department of Beneft
Payments, and the Califorhia Division of Industrial Accidents. I also understand I may contact the California
Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information
about licensed contractors.
10. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understartd
t t"I am the party legally and financially responsible for proposed construction activity at the following address:
r�,—,,1�1. I agree that, as the party legally and financially responsible for this proposed construction activity, I will
abide by all applicable laws and requirements that govern Owner-Builders as well as employers.
/� 12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
mform'ation I have provided on this form. Licensed contractors are regulated by laws designed to protect the
public. If you contract with someone who does not have a license, the Contractors' State License Board may be
unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against
unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed
Contractor or employee of that individual or firm is injured while working on your property, you may be held
liable for damages. If you obtain a permit as Owner-Builder and wish to hire Contractors, you will be responsible
for verifying whether or not those Contractors are properly licensed and the status of their workers'
compensation insurance coverage.
Before a building permit can be issued, this form must be completed and signed by the property owner
and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's
driver's license, form notarization, or other verification acceptab/e to the agency is required to be
presented when the permit is issued to yzrify�he property owner's signature.
Note: The following Authorization Form is required to be completed by the property owner only when
designating an agent of the property owner to apply for a construction permit for the Owner-Builder.
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I
hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents
necessary to obtain an Owner-Builder Permit for my project.
Scope of Canstruction Projeci (or Description of Work):
Project Location or Address:
Name of Authorized Agent:
Address of Authorized Agent:
Tel No
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled
out the above information and certify its accuracy. Note: A copy of the owner's driver's license, form
notarization, or other verification acceptable to the agency is required to be presented when the permit is issued
to verify the property owne�'s srgnature.
Property Owner's Signature:
Date:
3148-30 CALBO Jan 1, 2009 OB Packet template 2 Of 2
PBQIECTROOflESS: 3ZS I MZCHIGAN AV
OWNEN'SNAME: jANAKA� TEI TR
nooness: 3217 MICHIGAN AVE
COSTA MESA,CA 92626
545-0022
ANCH/ENGINEEH:
ADOflESS:
NEG.NO.:
uxir:
UNIT:
PENMITTEE: MGM CONTRACTORS ( 714 ) 760-7696
aooeess: 38 AMISTO
RSM CA 9Z668
LICENSFO CONTHRCTOfl OEClAM710N: I �ereby allirm Iha� I am IicenSeG unCei prov¢ions ol Chap�er 9(commentinp wilA Seclion
7000� o� �iN9on 7 0� I�e BuS�neu an0 Pmlessions Cotle. antl my license is in lull lo¢e antl elfect.
c�Truc/.:P5997R srnTeuc.:b21479s^/ B
(�d7 /� � Sipnaiure: _/� ��
WOBREP3 fA ENS�TION OELIAMT10N: I �ere�y aflirm ��ai t �ave a certiliute ol consent �o selbinsure or a cetlificaie ol Workers'
CAmOensdlion InSurante, ot a cenilieE tApy ihereol (Section 3800. LaC. C�.
POLICY NO.: E%P. ORTE:
COMPRNY:
❑ Cenifiea mDY � �e�eby tumisliea. ❑ CertilieE coDY is IileA unlh Ihe ury BuilGing Oivision.
,. Appliwni:
c.(EMVIIONFflOMWOBKEPS'COMPENSIITIONOELUIIATION: (Thi55ectimneWnotGecanpkteGitNeperm161aanehutlr¢O�S100�a1ess�.
I cenily itNt in ine ce�ormdnte nf tne work for whicn Ihis permit is i55ue0. I shall not empl y am/ ver50n in arry mdnner 50 as to become
5u�jecl Io I�e War' rs mpenution laws ol Caiiiamia. ^
ya� b z_ Signama:�/ / �
NOTICE:I' atler ,aking iNs EecWration. you S�oNA 6ecame subject to I�e Warkers' Campensatlon prwisians ol I�e laDor
COae. y0u mLLS� toritrcnl� comD�Y w+�� suc� provisions ar I�is p¢rmii s�aA Oe Eeemltl rEVOklA.
CONSTHUCTION LENOING �GENCV: I �ere�y aflirm t�ai t�ere is a consiruction IenOinq apenty ta t�e pedormance af lhe work for
wnicn tnis ce�mit is asued (�ibn 7097, Gv. CI.
LENOEfl:
nooeEss:
OWNEB 6UILOEN �ECLAM710N: I trereGy alfirm tlut I am eKemO� �mm tAe Caniractori State Liceiue Law ta ihe I011owin0 �eason
ISectbn 7IX{1.5 Bu9ne55 anC PmIe55ional COGe: A�y cily ol touniy whicn repuire5 a ptrmil to constNct, alier, improve. O¢molisn, or
repdir any siruGute, yi0r lo i6 i55uance. al5o reQuires Ine appliWnt lor sucll permillo Iile a 9pnee statement tllat nUsAe is licensed
pursuam to tM wwisiws o� i�e Contraclorz' State License Law IClupter 9lwmmenurp wi�n Sectian 7000) ol Division 3 0l ine Business
an0 Prol¢55ions CoOe) or Itut tMJ511e is exem0� ��eRlrom anE I�e Oa5i5 tor t�e allept0 exemptbn. My vqlatbn of SCttion 7031.5 by
any a00�icanllat a oermil su0jecis Ihe appliwn� Io a livil penaliy ot nol moa Ilwn five �unOreE OqWrs (5500�.
I, as owner ol Ne D�oDeny or my emyloyees wt� wa➢¢5 as tluir sole compensatqn, vM Go 1�e work, anA lhe
❑ sirucmre 6 wt intenEeG or oBereG iw ule (Section 704J, Business anE PmfestiotNl Cotle: IDe ConVaciws' Sta�e Licenu Law
Goes not apply la an owne� of a ptop¢ny wM EuilAs or improves ItrcreOn, anE who Oces suN wDM kmsell/hersell or throuph
�is or �er mm emDbY�s. provAeG tlut Suc� imOravemen�s are noi intenEM or oflereO lot sale. II. Ipwever Ihe OuilGinp Or
impwvement is sdU vnthin one yea� ol compleiion. 1he owner will �ave I�e OurGen ol Orovirq ANSAe Ui0 noi builU or improve
for �ne o�rpose of sale�.
l as owner ai the pmpeny, am ezUuvveN conVactinq vnt� licensetl contractors Io wnstmp t�e pmkct (SecGon 70n4, Business
,� � atb Proteitions COOe: TM CAnvxiots' $tate LiCensC Law Oces no1 dppty to an Own¢r oi w4Mrty �Mtl eaIGS or im0« ��e2on
antl wtw contrac�slor such projects vntA a caniractoqs�lkense Dursuantlo tM Caniractws' SWte Lkerrse Law),I am aware
I�ai 0��� of I�eir Wmker's Compensation insurance sMulU 6e proviOeA Ia me.
� I am eRemp� uMer S¢Ctbn: B. d P. C.
lor tnis reason:
Oate: ' Owner.
I eo nereey ceniry Vut I am aware of ana unaersiana ine repuirements al Catdomia Meatln ana Safery Cotle Sections 25505, 25533, ana
2553< anOlhai I or any lulut¢ DuilOinp occupan� wiNwill n01 �ti¢le One) ne¢O Io [omDN Y^�� �4 Slaie coOes anE I�e repuiremen�s lai a
pttmil lar tonslmttqn w modilicaiion Imm ihe Nir Oualiiy ManaAemCnl USInt�. Ne5i0Bniul con5lmtiion apD������ are evempl �mm
IIIeS¢ OrOvi5iM5.
Oate: pp��icanl:
I IICfCEy CCfll�y IINI I lldv! RdE �IIR dppllWlqfl d�U SIdiP IIWI IhC dUOVE NIOfrtldli0p 5 fAffCLi. I d0�� �0 COlpply Wlill dll CIIY dOE COMIY
orainances antl 51ate laws rela�ing Io building ton5imtlion anG �¢ieby au�lpra¢ rep�eSenUlives ol �his qry IO ent¢r upan I�e abov¢�meniianed
pmperry lor ins�.'cuo^ purposes.
� / �� Signaiure: ��
Drive�'s Ucense o� saoai securuy .:
t6aba6 W�ne—BUAEing: Green—CoOe Enbrcement; Canary—ApO���C Plak—Revanue; Gdtlenro0—Assessor
CITY OF COSTA MESA — HUILDING PERM�T
PERMIT NO; B 059397 PLAN CHECK Nt�; N
COhSTRUCTION TYPc; V—N PERMIT TYPE: STR
JOB DESCRIPTION : T/OFF REROOF O/1 LAYER W/COMP
FERM NO: B 05939�/
GOVT; N SUPP; N
PURPOSE; ALT
SQ FT: 3,000
CLAIM VALUE: 3,000.00 CALC—VALUE: 3,000,00 GROUP OCC: R-3 /
COMMENI'S: SMOAE DE7'ECTOR RE�UIREn
iE%if%#�KKit#!lEl(iti(%ki(iFiEIE�%�%#lEik�%�iE1t �1F�%�1f�lE%IEiE�N1f�JE7Cif�X�lfiEif�K%#�If9E#%�#'X-�1!��f1f-%)f%if1E%%%X-%�%ifi(ki(#�IEIF-Nk3F1(
7. O N I N G F2 E Q[J I R E M E N T S
S E T D A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDTNC ---------
FRNT; FT IN REAR; FT IN FRNT: FT IN REAR: cT IN
LEFT: FT TN RGHT: rT IN LEFT; FT Ih AGH'Y; FT 1N
PAR3CING REp• PROV; PARCEL; 1390731?. ZNE; REF NO;
PLANNING NO'iE$� �-.
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D E V E;'L O P M E N T S E R V 1 C E S R E Q U I R E„ E N-''�' S
20NING APPROV'r.� BY DAiE; <'!
BUILDING APPRq�iED BY _ DATS; �
APPLICATION ISSUED HY; ' DATE• I�� �— �Z�
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LEGALI2ATIUN;N F E E S U.: M A R Y Si'RUCTliRAL SEGM.EN'i •Y
BLDG PMT
PERMIi' S4.00
PLAN
PLUMBING ELECTRIC MECHANIC
-� '
FIRE SM.IP/RES GRADING
. .50
�.`, SMIP/NON—RES
ISSUE FEE �
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL fi�+ PAID DUE
TOTALS----> 54,50 0,00 0.00 54.50 •:i 54.50 ,00
REVENUE DIVISION TOTALS--> COLLECTED: 54,50 OI�ER/SHORT: .00
BLDG PMT PLUMBING ELECTRiC MECHANIC FIRE SMIP/TOT GRADING PLAN—CAECK
59 . 00 ��•50
ih it IF ik # 1E # iE 1E iF # iE i(� 1f #!f iE it 1e �IF iF iE # N� k 1E iE 1k iE iE # 3F IE iF 3E 1E ## iE 1't!f iF iF 1F 1E ##!E iF # IE if i'� IF iF if iE�'�E # 3!-iE it if iF iE iF �1f 1E �1f iE iE if� fE if ik iE # ik if
I N D I V I D U A L F E E B R E A R D�O W N
TYPE QTY D E S C R I P T I O N UN�rf COST TOTAL COST
SFR 3000 REROOF BY VALUE RESZDEN'iIAL NOZONE f�1�00 3,OOU.OU
END OF FEES ��
r �
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/:
� }
, j�
/
CONSTRU�TION AND PLANNING , POOL &
APPROVALS Permit # uate �Inspector AppROVALS Permit # Date Inspe�tor
), Temporary Electrical $ervice or Pole _ 52. Pool & Equipment Location �
2, Soil Pipe-Undrgrnd. . 53. Steel Reinforcement , '
3. Electrical Conduit Utility•Undrgrnd. 54. Forms '
4. Electrical Condu�t�Undrgrnd. 55. Electriwl 6ond�ng
5. Steel Relnforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE
7. Footings 58. Electrical Conduit•Undrgrnd.
$, Fo�ndation 59. Gas Pipe, O Undrgrnd., Test .
9. Water Pipe�Undrgmd. 60. Backwash Lines, P-Trap, O Undrgrnd. '
10. Structural Floo� System 61. APPROVAL TO DECK
77, Property Sewer Line & House Connection . 62. Backwash & Receptor�Final
12. Sewer Cap � 63. Heater & Vent•final �
13. Roof Drains 64. Plumbing SYstem � Final
i4, Rough Plumbinq 65. Electrical-Final
15. Rough Electrical-Condu�t 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access ApP�oval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAI
19. Rough Heatinq & Air Conditioning FIRE DEPT, REQUIREMENT
20. Aough Factory Fireplace APPROVALS Permit #
21. OuCts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Pipin9 O Gas O Oil
23. Gas Pipe-Rough & Tes[ 72. U�derground Flu:h
24. Roof Framing 73. Undergrnd.StorageTank OGas OOii
25. Root Sheathinq !� l�9i 6,,,,�� 74• Overhead Hydro
!�
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding � 77. fIXED SYSTEM FINAL
29. Insulation � 78, FIRE PREV. FINAL
30. Drywall Nailing -' HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat . 79. FINAL INSPECTION
32. Electrical Power Meter-Finai . . 80. F000 CERTIFICATE ISSUED
33. Finai Eleciric ��; � Notes:
34. Final Heating & Air Conditioning '
35. finat Gas Pipe-Test ',
36. Hood or Canopy ' �
37. Final Factory Fireplace � � '
-.. i
38. F�nal Plumbing
39. N/ater Service�Final
40. Gas Service-Finai
47. Solar pomestic-Final
42. Backflow Preventer ' l� � �qL,� C�� ��
L !
43. Backflow Irrigation O�� „� �(��
44. Landscape IrriQation System
45. Sound Attenuation
46. Handicap Regulations
47. FINALSTRUCTURE&BUILDING 1�..!(�O� �u%//
I-/v !
48. FINAL PLANNING •
49. Electric Release to Edison :�
50. Gas Release to $outhern California Gas Co � �
51. CERTIFICATE OF OCCUPANCY
No. Date
Lor 5 - TR 2
� I :1.�,.��
�-
CbSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 917 C08TA M88A. GALIRORNIA
For Applieani to Fill In Compleiely
jZl (.� HVENUE
COSTA MESA. CALIFORNIA
CALIF. No.MI 6-
qo�pess 1 t'LACENTIA AVENUE
a7Y NEWPORT BEACH CALIF.
LTG.TNO. O� � NO. M � 6- 22
SIZE OOX � OO I NO. OP BLDGB.o
OF LOT Now oH LOi
USE OF
EXISTING BLDG.
BHTBACK LINE FROM O � 20 �
ceNTER op BTReET � REAR YARD
SIDE YARD I LEFT �� I RIGHT S�
DESCRIPTION OF WORK
' BB ZE DING � 5g5s F ROOMS � STORIES �
EXTERIOR WALLSTUCCO ROOF �CK
.... ....... I ......�.......
. FEE RECEIVED
��-:�aR z4�;
FINANCE DEPT,
CIiY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
For Offiee Use Only
neceivr Ho. .�aY�q�rml('1
�' Jt 1 �7
BY I �Al� NEC�IYEO, .I DATE IBSUED
BUILDINC �
ADDRE88
COSTA MESA. CALIFORNIA
ZONING
ZONH I NO. OF I USE OF N
R�1 PLANB /� BUILDING
LEOAL
oeecnirr�orv IAt 5� Tx'&Ct
A. P. NO. nnna
YARDS EVES
APPROVED ALLOWEC
merma urve sra _ __
ATTACHED GARAGE // � .
V
PLAN No. 3-�
1 H8R8BY ACI(NOWLmOH TH�T 1 XAV6 RBAD TXIB APPLIGTION {Hg AMOl1M BHOWN UNDEp VpLUAT10N 19 PON TXB
AND 9TATE THAT THe ABOVH I8 CORREGT Atm AGREE TO COM- pUflP088 OP E8T/�BLI9HING A PERMIT FEC ONLY.
PLY WITH /.LL CITY OIiDINANCE9 AND 8T E LAW9 REOULAT�NO
Bu1tDINo CONeTRurnoN. VALUATION �J/'
SIGNATURE OF PERMIT FEE $ .7 V'�
PERMITTB � / / � � j� /J o
$ 6r PLpN CHECK $ /J'r £
AUTHORIZED AGENT L� ' o
TOTAL FEE J a
JOB ADDR�SS ,3217 M 3
GENERAL CONTRACTOR C
nP No. i39-o73-i2 LOT
1 `I'CTIONS
i.
AVe. BUILDING PERb1IT NO.
.dt. VALUE $ 158.00
TRACT FIR� ZON� DliSCRIPTION OF WORK :
Signature DA1`F. GROUP TYPE 7.ONE
SUI3CON7'RAC.7'OR PERMP.
DATP
OCCUPANCY I I I I I
�OIiM BU4 - 5M — 7�61 ' i
Wall
�
. iso�� F E RECEIVED
C�5}',�%dESA BUILDING-SAFEfY DEPARTMENT MAB .2 0 1963
P.O.BOX91] G09TAM68A.�A��FopN�A �FINANCE DEPT.
For Applicant to Fill In Completefy APPLICATIQ'�liFQR� P��Sd�Fh MESA
TYPE OR PRINT BUILDING
BUILDIN6 ] For Offite Use Only
ADDRESS J ��1 i�'<«a«� AVE
N[C61'T NO. P
COSTA MESA. CALIFORNIA
�v�o er oerc mcrve �r isaue
OWNER E� AtiIAKA �'
BUILDING
AOORES8 ��� bt�Cu�bqi.l AVE ADDR6L8
FIRE
CITY COSTW MESA NO. GDOZ ZONE TYPE GROUP
APPROVED�y,�,�,/�
ARGHITECT TEL. �� BY I"- / DATE C /'�
OR ENGINEER � NO. �
ZONING �
ADDRESS '���
8 NO.OP� / UB80PNHW
� PUNB(/ CUILDINO
GONTRAGTOR G¢GCY.LE/L
t 7 l�p-1 LeO�L
ADDRESS 'J�'� / �/C/�%�` AN J� DEecrtlFiloN
CITY ' I� ,t" S-{!j A. P. NO. � O �
NOTE: NO EAV E OVERHANG 6HALL BE LE88 THAN
STATE _��� TEL. - 90• TO SIDE @ REAR P. L.
LIG. NO. � NO.
EAVES
OFLOT �Q'X (OD I NO.OPBLOOB. ' ALLOWEU (U.B.C.REQIIIREMENT)
NOW ON LOT
YARDSAPPROVED YARDSAPPROVED
USEOF �� MAIN BUILOIN6 ACCE ORYBUILDING
EXISTIN6 BLD6. �%L � L�� Cf
(FROM C/LHTREET)
BETBACK LINE FROM 'i� -- FRONT PT.
<ENTER OP BTREhT REAA YARD
��/ �� R. SIDE FT. -'���
SIDEYARDI LEFT �" 2 I RIGHT '--
//
DESCRIPTION OF WORK �. s�oe �. Fr.
NEW X ALTERATION � DEMOLISH REAR iT. Ff.
D16TANG6 BET. BET. MAIN 8
REPAIR MOVIN6 MAIN BLDGB. ACGESS.BLOGB.
BUILOIN6 NO.OP VAR.SC oATE
SIZE ROOMS BTORIE6 C. U. P.ix APPROVED
E%TERIOR WALL I ROOF n APPROVE
COVERING COVERINO K�� BY DATE
USE OF BU ILDING AND WORK TO BE PERFORMED
4" b ' �(-� '
n
sa. �r. �
1 HEREBY ACNNOWL8008 THAT I NAVH REAO TX19 APpLIGTION TH8 AMOUNT 9HOWN UNOER VALUATION IB ROR TH! �'
ANO 9TATE THAT THE A90V8 IH COHHECT ANO AOqEH TO COM� PUPPOBB OF BBTABLI8HIN0 A PHqMIT FH8 ONLY. Q
PLY WITH ALL CITY OpDINANCHB BTAT6 UW8 R80ULAi�NO ypLUATION ^' � q
BUILDINO CONBTPI�G
SI�NATUREOF� , PERMITFEE $ � j
m
PERMI7TE /� � �. i
$ 0
AUTHORIZED A6ENT % B'C'7 �`
TOTAL FEE J