HomeMy WebLinkAbout3218 MICHIGAN AVE - Building Permitsr-
'IOJELT RDONE55: 3'1 1 Q M ICH I GAN AV
�WNEfl'S NAME: PJ�KER MARTIN A
nooness: 3218 M�CHIGAN AVE
COSTA MESA,CA
662-1762
ABCHIENGINFEfl:
p00flES5:
UNIT:
92626
NEG.NO.:
UNIT:
' PEflMITTEE: �RTIN PARKER ( 714 ) 662-1762
aooaess: 3218 MICHIGAN AV
CM CA 92626
LICENSEO CONTBRLTOP DECLANATION: I �er¢Oy alhem Itwi 1 am licen5ea unUer Omvisions ol Chapter 9(crommencing vnl� Seclian
7000� o� Dm9on J o� t�e Business an0 PmIe55�ons Coae, anU my license is in WII �o2e antl eflec�.
CITY LIt.: $TRTE LIC.: CIASS:
Oaie' 9qnamrt:
wONKEPS' COMPENSRTION UECLAPAiION: I nertoy alhrm tlut I nave a cenificate al cansent �o sel4insure ot a cenifiwte al Workers'
comoertatun Inmrance. or a anuiea coov ��ereol �Sectbn �800. Lao. q.
POIILY NO.: E%P. OATE:
1 COMPPNY:
❑ C¢tlilie0 CODY is her¢Uy lumi5�c4. ❑ C¢niliea wpy a IileE wil� tM1e cily BuilOinp Oiv¢ion.
�ate: ApO�icanl:
E%EMPTIONFpDMWOXREflS'fAMPENSATIONOECLAflATION: (Thi55eclionneeGnolbecam^�^�edifNepemtilalaonehuMreO(5100�orleu�.
1[eriily I�al in Ihe peAarrtunte al Ihe wark �or w�it� 1�3 U¢rrtni i5 is5ue4. I Shail r em� y any permn in atry manner m as to �ecome
SUDIe�� �o lh¢ WOrke/r3' Compensaiion Laws of Calitor�Na.yJ� /� p��� � �
Oate: _�V_� � Siqnature: ' ��� —'�L • ��'""'��✓
NOTILE: 11. attet making IAis declaralion, you s�oulC Decame wClect to Ihe Workers' CamOensation prwisions of t�e Labor
C04¢. you musl Iotl�wiih ComDly wil� Sut� prOvi5ion5 or Ihis permii S�all �e OeemeA revOkeO.
. CONSTBOCTION LENOINC PGENCV: I �ere0y allirm I�ai I�ere is a consimc�ion lenaing agency for Ihe Oetlormance ol t�e work �or
w�ich ��i5 Dermii is issueC (Seclion 3097, Civ. C).
LENUEfl:
FOOHESS:
OWNEB BWLOEH OECLAPpTION: I nere�y allirm ihat I am exempt Imm Ine Conlractors' State License Law for ine lollowing reason
(Secimn 703t.5 Business ana Pmfessional CaCe: Any cily ol caunty whicn reQuires a permit lo constmct, aiter, improve, tlemolish, or
repair any 5iructure, prior Io its i5suante, also repuires t�e aOP�IWn1 �Or 5uch permii to file a signeG sia�ement Iha� he/she is Iicense0
pursuanl to IM pwvRions ol tne Convactors' State License Ldw (Chapter 9(cammencinq witn Section 7qp) ot oivision 3 oi tne Business
anC Professions Cotle) or that he/she is e�emD� ��e�e«om anE �he basis lar the allegetl exemption. Any violation af Section 7031.5 by
any appliCdnt lor a permit su�jecis ihe appiicanl to a civil penalty ol not more �han five hunEred dollars (5500).
I. as owner of the propeny or my employees vntn waAes as Iheir sole compensatian, vnll Uo the work, antl me
O struciure ¢ noi imenaetl or ollerea for ule (SecUon 70a4, Busness and Piolessional Cotle: TAe Contracrors' Sute License Law
aoes �roi aooW to an owner ol a pmpeny wtw Oales or imWoves tAereon, antl who Ooes such xrod Nmsell/�erself or inmugn
�is or �er own employees, provideA ihat such impwvemems are not intentle0 ar attereU tar sale. If, Aowever the huiltlinp or
improvement R SOIa wilAin one yeai al cam0leiion, t�e owner will Ilave Ine 6urUen ol pmvinp �e/Slie Eitl not �ui10 0� im0�ove
lor Ine pmpo5e ol sale�.
I. az awne� ai t�e pwperly, am eetlusiv¢Iy cOniraclinp wil� Iicense0 wniraclar5 io con5tmci Ihe pwje[I (Seclion 70EE, BuSiness
❑ anE Prafesvms CoGe: The Coniraclars' State �kmu Law Eces nol ao7W �o an ovmer ol properrywho OWQs or impmves Ihereon
ana wno comrans for sucn pro�ecis vnm a comracmqsl license pursuant io ine Comractors' S�ale license Law1. I am aware
tlut pr00� of Ih¢Y Warker'S GomVenution insurance SOoula Oe D�ovitle� 10 me.
� I am ¢x¢mpt utMe� Sec�ion: BP704 4 B. 8 P. C.
tw mrs �Pawn: ALL WORK HY OWNE�-R-�//�
Da�e� IL• O(j •� U pwner ���4.L_
I tlo �ereEy cendy Itui I am av�are ol an0 untlerslanE I�¢ �epuiremenis o� Califomia Heali� antl Sa�ery COUe Sectims 255[I5, 25533, antl
2553� and that I or any fulure OuilOinp acupant wilVwill rwt (drele one) nee0 lo comO�Y wilh SaiA siate coGes anG the r¢puirements tor a
permii lor consimclion Or moailicalion Imm Ole Air Ouahly Manaqem¢nl DiSiricl. flesiQential cOnstmc�ion appfiw�ions are exemD� Irom
inese provisians.
Oa�e'. AOV�icam.
I her¢py cetlily IIWI I IWve rea0 Iliis applicati0n an0 slale ItWI l�e a00ve inlotmalion is carrecl. I agr¢e Io [omply wiN all cily an0 couniy
orGmances anC s�aie laws relaimg �o builAinp construciron an0 hert�y autlroriie representativr^ .. � w�ter upon the above-men�ioneG
pmp¢tly bt mSYeciwn purposes
oa�e. �z• � 6 • 90 s�aoaw�e�n �. �'w(�
Iori.er's uce�se o� sociai Sewrity x.�
i6a�<6 White—ButlCmg: Grean—Cotle Enloewmenl: Canary—Applicam: Pink—Revenue; Golaenrotl—Assessor
CITY OF COSTA MESA — BUILDING PERMIT PERM NU; H 05019
PERMIT NO: B 050192 PLAN CHECK NO: N GOVT; N SUPP: N
CONSTRUCTION TYPE; V—N PERMIT TYPE: STR PURPOSE: DEM
JOB DESCRIPTION ; DEMO PATIO ENCLOSURE WALLS SQ FT:
CLAIM VALUE: CALC—VALUE: 1,000.00 GROUP OCC: R-3 /
COMMENTS: SUPPORT EX RFTRS/FUTURE COVER OR ENCL
�t***+t**�r�t�t�**�t�r�r�r�r�r�r**�**�*�t*****�****��e**�r*�*�x�t*�t**�t****�**�t�t*�**+t*�*****�t*+�*
Z O N I N G R E Q U I R E M E N T S
sETBAcxs
------------ 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: 13907303 ZNE; REF NO:
PLANNING N(51'ES>
�
M af if M if iF 3f af iE�f iF ik iF it if iE if 1E M iF 1! k If �f fE if IF ik if �E 3f iE iF 1f !E IE iE �F �f 1f �E if if If �F �E 1f 1f 1E it 1E if �E if iE iF k iF K iE iElf iF iF iklE k 3f If IE if iE k iE 3EiE iE�F 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 DATE: ��'..
HUILDING APPROVED BY ;�on.... G D� B.,z.d �� DATE: lZ'06'`3D
APPLICATION ISSUED HY: DATE •� U� •�%�
ifififafkMiFifMiFkkifMkilMlfiflflfiF ififKiflFkiflFiFk kiF
±lM1flElflFfkiflfiFMMlFiEiFiFitifMkMitkifkiEiFifitiFiFifiFKlEiFiEif 1E�kkifififkifMlflikifikMiFififiFMiFifiFlEifiFlFikiEiflflEMiPiEiElfiFMiF
LEGALIZATION;N F E E U M M A R Y STRUCTURAL SEGMENT:Y
BLpG PMT PLUMBING ELEC IC MECHANIC FIRE SMIP/RES GRADING
PERMIT 25,00
.
PLAN
ISSUE FEE
HUILDZNG—DIV—> PERMIT ISSUE PLAN—CHECK
TOTALS----> 25.50 0.00 0.00
REVENUE DIVISION TOTALS--> COLLECTED:
BLDG PMT PLUMBING ELECTRIC MECHANIC
25.00
./
SMIP/NON—RES
.50'
TOTAL PAID �' DUE
25.50 25.50, .00
25.50 OVER/SHORT: ,00
FIRE SMIP/TOO GRADING PLAN—CHECK
k k k�f k M M M!f if k 1k if if k if iF iF iF 3f if iE iF aF if k if iE if ik iFif iFiE kif iF k iF af M if 1E iE 1E iE Kif iE iE k if IE If IF if 1E If M 1f iF IE 1f IF ff if iF iE iE iF iE iF iE �E if if iF iF iE
I N D I V I D U A L F E E B R E A K D O W N .
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
NO FEES WERE SELECTED FOR THIS PERMIT "'
0
c� cn.��s�:,i-r�n?en�:: �- _G-. . .
ra�E� izroa�4o r.n�• ze:�� "
-. � � � I
� CONSTRUCTION ANDPLANNING � PO( SPA r;
APPROVALS Permit�h Date Inspector APPROVALS Permit;f`- Date Inspector
1. Temporary Electriwl Service or Pole 52. Pool & Equipment Location ' ;�
Q, $qil Pipe-Undrg�nd.� 53. S[eel Reinforcement ' �
3.�Electrical Cqnduit�Utility-Undrgrnd. 54. Forms .: �
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
c
' 5�,Stee1 Reinfarcement 56. Rough Plumbing & Pressure Te3t' �;
� 6: ElEctrical UFER�Gind. 57. APPROVAL TO COVER�GUNISE ..
.
� 9' Spotings ';.'� � 58. Electrical Conduit�Undrgmd. ^ }
� � •-
�8. Foundation ' 59. Gas Pipe, � Undrgrnd., Test r� '
9. Water Pipe�Undrg�nd. 60. Backwash Lines, P-Trap, � Undrgrnd. '+
10. St�uctural Floor System 67. APPROVAL TO DECK -� i ,�
77. Property Sewer Line & House Connection �' 62. Backwash & Receptor-Final �'
c �
12. SO�ver Cap 1 �� � 63. Heater & Vent-Final 'i`• ,"�
13. ROof Drains '�� 64. Plumbing System • Final , �
i
74. ppugh Plumbin"g ` ) 65. Electrical•Final �r
15. ROugh Electrical•Conduit 66. Solar SYstem-Final J. F�
16. ROugh Electric� Wiring 67. Fencing & Access Approval � �
17. Rough Wiring Sign 68. APPRpVED FOR PLASTERING .
18. Rough Electricat;T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rpugh Heating & Air Conditioning FIRE DEPT. REQUIREMENT
- - r� s
20.^Rough Factory Fi?eplace i " `"' �� � + APPROVAL•S= -+Permit # ` "
21. ,1 i.� �� ' l i� l�lu \ • 1. M G.�'- �
,iJ + ' _ ' _ IA • �l. T r i
Ducts, irr-Structui;e ; i �.. .. _ ,� �� , ,r .. ' 70. Underground-Hydro .
22. Ducts, Ventil�tiny,� "-� ' S -�° ':77, Product`Piping QGas ❑�Oil
23. ;Gas�?ipe�Rough & �est - �y , l ,_7y. Underground FlusFr, � . - �
24.�ROof Framing ` : - �'�. • � y � ' �73.�UndergmdiStoreg�Tank OGas ❑Oil
25. Roof Sheathin ; , ' T " �
8 � ia . � cU�� • ��4:;Qverhead Hydror .
26.�T�Bar Ceiiing (Structuraq &:Monocoat � _ �a ^ '�� • � 75.sDry Chemical _ " � �
27.�Frame and Flashing 1 r x ' r� �y.7, y 76. ��ry Standpipe ;,L " -
� 26. �Lething;& Siding. .. . _.;^ : �� �' • ��, 77 -'FIXED SYSTEM-FINAL�- _
29. Insulation - -� ; � '"� : A 76„'FIRE PREV. FINAL x �. u. '
�30. DryWaII.Nailing - . � �� � � `'� , :� HEALTH�DEPT?REQUIREMENT
`-31. Plaster Brown Coat' , , ., _ �_ � ; � y�; ,79:�'FINAL INSP.ECTION ° - '
f
� 32..�Electrical.Povier Meter.�Final � � : •�� � � �� 80. �FOOD CERTIFIC/�TE ISSUED� �
i� �
- � � � ' .:5 . .
,33.,:Pinal Electric -- � . =� '� " i': l�fi� � �'Nofes: ' � �y
�
.' . _ . y .•. ; .- • V �,
�•34.,-FinafHeating.&Air',Conditioni�g� - '�-i+ : �•"- , ,=,i . � _
. . . P' r: ' d c [T7 � 'i i
35.'Final Gas Pipe-Test, ��• • � , ��.� ' �.; ` � , � • _
,36. Hood or'Canopy , �' . � , i � � �� s• >_ ' A � �
37:-Fin2l Fa�tory Fireplace�., � � � a. •. �T , � N " �, - • `
f
- � • '1 i .. . � . �. . ` . .
38. Final Plumbin9 -. r ., > � � � � � + c S �- � �-
"39. Weter Service�Final� � - �j` �� - - • " •�
c � . . � .
'40. Gas Service-Pinal ; ' ' . � ' ` � � � ' "
. y,� �: g � '.� . �,.
�41.SolarpomestirFinal'. �� • ` i �' � ' ''
�r I � e - Cn •- a.
42 �Backflow Preventer'; - ''" ; i � �, i . � _ ' ��
43. Backflow Irrigation• '�•`-�.� ' ` " � '� _ �
. :.. �.
'44. Landscape Irrigatio� System , ;' � . , - - - i.. �*j - ,. � �,
45.�:Sound Attenuation - - � ' �, _ ,- • -' ' - - c � i i -
- ',� i:• �� x. - -
46.'HandiwP Regulatioqs - � � �� � , y �,• = , _ �' �
47.,FINAL STRUCTURE & BUItDING � � G�� � � � S.' , Q _ �
a8.`FINAL PLANNING; � '��"� � � �� " . �
, _ . L ,1�� . ', �r- ,S.
49._Eleciric Release to Edison I�, '� : t. >'
50. Gas Release to Southem California Gas Co : I ��� ��", . S _ _ �' > _
51. CERTIFICATEOF�OCCUPANCY rt " . > - ,.,,, - • .
No. Date
vxaecT�ooness: 3218 MICHZGAN AV
owxen�s Nnrne: M. A. PARKER
nooeess: SAME
r. 662-1762
RflCNlEN01XEEfl:
� ROUflESS:
xea.Ho.:
uxir: CITY OF COSTA MESA — HUILDING PERMIT
PERMIT NO; MP 048498 PLAN CHECK NO: N
CONSTRUCTION TYPE; PERMIT TYPE: MEC PLU
uxrt:
reernmee: M. A. PARKER ( 714 ) 662-1762
nooeess: 3218 MICHIGAN AV
C.M. CA 92626
LICENSEU CONTMC70B OFCUMTION: I hereCy attirm that 1 am licensetl un0er provisions oi ChaO�er 9(wmmencinA'��� Sectlon
7000) ol D'Msion 3 ot Ihe Business anA Pmlessions CaEe, an0 rtry Ikense rs in lull lo¢e anE ellect.
Cltt LIC.: ST�TE IIC.: CL�SS:
Date: Siqnature:
WONKEBS' COMPENLITION OECUMTION: I here0y allirm tlut I Aave a cerUfiate al consent Io Selbinsure or a certificate oi Warkers'
,Gompensation Insuance, or a cenified copy thereat (Seclion 3800, LaE. C�.
pOLICY NO.: �P� D�T��
COMPRHY:
❑ Certifietl w0Y is hereby furnisheA. ❑ CeNiied copy k fileU vnt� the dry BuilEinq Division.
Daro: pPO�����
IXEMPfION FNOM WOBKFIIS' COMPENSITION OFCWIATION: (Ris sec6on neM irot Ee mm0�� �� Pemm is lor one hundreE (E700) w less�.
I certity thai in lhe pertormante of Ihe wOrk �Or wAich WS Defmii is issued, I sAall n0 loy any persan in any manner so as t0 OeCOme
sublect to Iphe Workers' Campensation Lavrs Califomia.
�ate: _+,� Sipnatur�// . � ��J� � : �
NOTICE: If, after malonq tAis Geclarztion, you shoulG Gerome subject to �M Warkers' Compenutan pmdsians of ihe La�or �
Cotle, yau must fort�with compty wit� suc� provWans or tNs permit shall Ge GeemeE revoke0.
CONSiHUCT10N LENUIN6 �GENCY: I �ere6y aKrm Ihat Nere is a consWctian IenEinp aqency br the Dertormance o� the urork for
w�ich lhis Oe�mit is issueU (Section 3097. Civ. C).
LENOER:
►ooeess:
PERM NO; MP 048498
GOVT: N SUPP: N
PURPOSE: OTH
JOB DESCRIPTION ; REPLACE GAS RANGE 6 WATER HEATER SQ FT:
CLAIM VALUE; CALC—VALUE: GROUP OCC: /
COMMENTS: NO STRUCTORAL WORK PERMITTED
**�r****��x *�*��r+��**�+r�r�r��r�**+r�r*�rjr�**�**+r� �r��*�r*�**��* �*�r��r��**�c�r�r�*�*���+�� �+��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
------------ 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 RE(�: PROV: PARCEL: 13907303 ZNE: REF NO:
PLANNING NOTES>
>
!f if it iE iF dElt if dF it iE iF iF iE ik dF it iE �E ff �k 3k!! 3! i! �E iE it if !f it �! ik ik iE iE iE i! iE iE iE it iE i! it if it iE jt k ih iF if iE iE if �E 1t iE iE iE it iE �t iE iE if 9f ff 3F iF ik ik iE jE iE 3E iF iE
D E V E L O P M E N T S E R V I C,E S R E�Q U I R E M E N T S
ZONING APPROVED BY DATE;
BUILDING APPROVED BY : DATE:
APPLICATION ISSUED HY: � DATE:
* * * *+r+r �r �r � �r �r x �r+r �r �r �r x �r �r � �r * � x �r * x �r �r �r �r ��F�t��r �
if iE k ik k if �t it iE it M It fF M ib it jk if if �k it �t iE iE it fk iE �E iE fk 1! k�! iE ik IE iE iE iE ik if iE if iE k if 1E iE 1E ik iF iElt iF iE iF iE M 3E iE it fE iF if IE iE iF if 1E iE iE 3E iF iE it iE 3E i! ik
LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT:N
OWNFB BUII➢EB OECUMTION: I Aereby aKrm that I am exem0� irom tAe Caniractars' S�ate License Law for ihe rollowino reawn H LDG PMT PLUMH I NG EL EC TR I C MECHAN I C
(Section 7031.5 Business anA Professional CoOe: My riry of counry wAc� r[puirM a permit to consimct, atter, imD�ove, demolish, or P E RM I T 4 0 � 6. 5 0
repair any stmcture. D�o< <o fts issuance. also requues I�e applicant lar suU permit to lile a a0ned statemen� thaf �Nshe is Iicense0 � z S� Z 5$
pursuanl to the pmvisions ol the Contractars' State License Law (Chapter 9(commencinp vAtA Section 7000) of Division 3 0l iha 9usines5 pLAN
an0 Prolessions Code) or I�ai AUs�e is ezempt tAerefmm anC t�e hasis for Ne alle0� eKemptlm. My Wolation ol Sectlon 7031.5 Oy
any aDDliwnt lor a Dermit subjects t�e aDP���nt to a ciWl penalry oi not mom than five �untlre0 tlollars (5500�. I S S U E FE E
I, az owner ai ine D�overry or my emp�oyees wiN waoes az ineir sole compensauon. will eo tne work, ano iha HUILDING—DIV—>
� swcWm is not inren0e0 ar onered lor uIe (Secuon 70aa, Busineu anE Profeuional Coda: TAe Contracrors' Staro Licanse Law TOTAL S---->
, Oces not aODN �a an avmer al a D�a7enY � hWlQs or improves t�ereon, anA wM Eoes wc� work Nmsell/herselt or NrauOh
FIRE SMIP/RES GRADING
SMIP/NON-RES
3,00 15.00
PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
10,50 18,00 0.00 28.50 28,50 ,00
his or Aer awn employees, O�ovitleE ttwt SucA imprwements are not imen0e4 or affera0 lor sale. If, �owever tAe Emltlin0 ar RE V ENU E D I V I S I ON TOTALS -- > COLL ECT ED • 2$, S � OV ER / SHORT • 0 0
improvemenliswlEwltAlnaneyearolcompletion,Nemmerwillluveehebur0enofpmvui0�e/she0idnotGuOEorimpmve bLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
for t�e purpose ol ule�.
I, as owner of tAe O�WeM. am exclusively coniracGn9 �� IlcenseE contractors ta wnsimct the Omlect (Secllon 7047, Business
❑ and Pmleuions CWB: The Caniapors' State Laense Law tices not appN to an v.mer of D�Oarrywno bmlOs or im0� ��ereon
an0 wta cantrac6 forsuch O�W�� �d� a convactor(s)license Dursuantto ihe Contractors' State L¢ensa Law�.l am awara
that prool al Iheir Worker's ComOensttion insurance s�oulU �e provi0ad to me.
� I am exemD� unOer Sedion: B. 8 P. C.
lor Ihis reason: (� ( ��,� //
oate: _�— I '— { � �Q+mer� /U! • CL _ ��� w �./ 1
I Oo heahy certiry tnat I am aware ol anC unaerstantl the roquiaments ol Calitomia HealtA and Safery CoOe Sections 25505, 25533, ana
25534 anG tAat I or any luture UuilCinp occupam witUvrill not (prde one) netd to campty with uitl state coAes antl the reQuiremenls lor a
permit for consimctian or moditication irom t�e N'r�ual�ry Manapemenl Disinct. Hesi ial consimction applications are axemD<«om
these pmvisQions. /�' /�
Oate: !, "� "/ — G � pyplicani' /� � L( � / .
I here6y certiry t�at I �ave rea0 t�is apDlicatian antl stata t�at tAe a�we Information is correct. 1 aqrea to comDly wit� all ciry an0 counry
orainances ane state Wws reWunO �o Euilainq consVuclian antl hereGy aWpr¢e represent;th�s ol� ta �r upon the ahovtm� oned
pmDehY �or inspection Durposes. �
Oaie: � � SipnaWa� � �� n
oriver's Licenm or Social Secumy x:
1641-AB W�ite—BuilEinBl Green—COEe En�orcemen�; Cenar/—ApPlican�; Pink—Revenue; GolEanroC—Assessor
7,00 21.50
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I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
MEC 1 INST HOOD W/DUCTS FED BY MEC EXHAUST 6.50 6.50
PLU 1 WATER HEATER AND/OR VENT 2,00 2,00
PLU 1 GAS PZPING SYS OF 1 TO 4 OUTLETS 2,00 2,00
END`OF FEES
0! 0."j76?'J?—CCOt7"e02 '��""' ,
DATE: U�:'09/9G TItIEs O;,:c.',
1
1
CO�UCTION AND PLANNING �
APPROVALS Permit# Date Inspectar
1. Temporary Electrical Service or Pole
2. $oil Pipe-Undrgrnd.
3. Electrical Cpnduit Utility-Undrgrnd.
4. Electrical Conduit�Undrqrnd.
5. Steel Reinforcement
6. Electrical UfER Grnd.
7. Footings
8. Foundation
9. Water Pipe�Undrgrnd.
10. Structural Floor System
11. Property Sewer Line & House Connection
72. Sewer Cap �
13. Roof Drains
14. flough Plumbing
15. flough Electrical-Conduit
16. Rough Electric Wiring
17. Rough Wiring Sign
18. Rough Electrical�T Bar Ceiling
19. Rough Heating & Air Conditio.ning
20. Rough Factory Fireplace .
21, pucts, in Struaure
22. Ducts, Ventilating
23. Gas Pipe�Rough & Test
24. �Roof Framing
25. Roof Sheathing �
26.. 7•Bar Ceiling lStruciural) & Monocoat
27. Frame and Flashing
28. Lathing & Siding
29. Insulation
30. Drywall Nailing
31. Plaster Brown Coat �
32. Electrical Power Meter�Final
33.�Final Eleciric
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or-6er+ep+r
37.-Final Faaory Fireplace
38. Final Plumbin9 �
39. Water Service-final -
40. Gas Service-Final
41. 5olar pomestic-Final
A2. Backflow Preventer
43. Backflow Irriqation
44. Landscape Irripation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
46. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
_ Date
. ..Dl & SPA
APPROVALS Permit # _
52. Pool & Equipment Location
53. Steel Reinforcement
54, Forms
55. Electrical Bonding
56. Rough Plumbing & Pressure Test
57. APPROVALTOCOVER�GUNITE
58. Electrical Conduit�Undrgrnd.
59. Gas Pipe, O Undrgrnd., Test
60. Backwash Lines, P-Trap, O Undrgrnd.
61. APPROVALTODECK
62. Backwash & Receptor�Final
63. Heater & Vent•Final
64. Plumbing System - Final
65. Electrical-Final
66. Solar System-Final
67. Fencing & Access Approval
68. APPROVED FOR PLASTERING
69. POOL/SPASYSTEMSFINAL
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
'70. Underground Hydro
�71. ProductPiPingOGas ❑Oil
72. Underground Flush
73. -Undergrnd. Storage Tank O Gas O Oil
74. Overhead Hydro
75. Dry Ghemical
76. Dry Standpipe � ,
77. FIXED SYSTEM FINAL
78. FIRE PREV. FIfVAL
HEALTH DEPT. REQUIREMENT
79. FINAL INSPECTION
80. � FOOD CERTIFICATE ISSUED
Notes:
0
Oace �laspector
CITY OF COSTA MESA
BUILDING DIVISION
OWNER-BUILDER VERIFICATION
A city or county, which is required to give notice pursuant to Section 19830, shall attach to such
notice, and, as a condition precedent W issuing a building permit, require the completion and require the
return of, an owner-builder veri(ication.
Attention Property Owner:
An 'owner-builder' building permit has been applied for in your name and bearing your signature.
Please complete and return this information in the envelope provided at your earliest opportunity
to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued
until this verification is received.
1. I personally plan to provide the ajor labor and materials for construction of the pro-
posed property improvement.�Yes ❑ No
2. I ave have not) signed an application for a building permit for the
prop sed work.
3. I have contracted with the following person (firm) to provide the proposed construction:
Name _
Address
Phone (
City
Contractor's Lic. No..
4. I plan [o provide portions ot the work, but I have hired the foNowing person to coordinate,
supervise and provide the major work:
Name _
Address
Phone (
City
Contractor's Lic. No..
5. I will provide some of the work but I have contracted (hired) the following persons to pro-
vide the work indicated:
Name
Address
Phone Type of Work
I hereby aftirm that I have received a copy of the information set torth in Section 19830 of the State
of California Health and Safety Cod and have completetl the above information to the best of my per-
sonal knowledge, in complianc ith�� h�isp State law.
Signed: �h - � • /�t"/L,/� —. ) Date: ��— � a
Name: �� �a�r%� r
(Printed or Typed)
c.o.�. a o� s.s. a��
754-5273
i
�
Lc�T 3H — TR 2
��� �r'�
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. 60X 9f7 C08TA MEBA. CALIFORNIA
For Applicant to Fill In Completely
TYPE.OF,2 PRINT
BUIL�ING 2j8 / / /�VENUE
ADDREBS �
COSTA MESA. CALIFORNIA
� MAIL
BEACH. CALIF.No�I
� ARCHITECT
FIRE
F RECEIVED
� �'+'•A� 24{3Gd
fINANCE OEPT.
C�TY Of COSTA MESA
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
. RECEIPT NO. .� 9 Ap6RNfT�1
BV
COSTA MESA CALIFORNIA
CONTRACTOR K,W. KOLI CONSTR. GO. INC, a�'Prcoveo
BY DATE
ADDRES6 � PLACENTIA AVENUE ZONING
zoNe NO. OF use ov n
ciTY NEWBORT BEACH CALIF. R_1 PLAN82 euao�Ha
LIC.TNO. O� � NEO. M I O- Zz oescRiPrloN IAt. V T
OF LOT f OX � OO I Now oN oTe �
A. P. NO.
1158 OF � YARDB EVES
EXISTING BLDG APPROVED ALLOWEC
96TB�c1( L�Ne FROM �O � za f ICEN*en utue ar.)
ceNT6R oF SRteET REAR YARD J FRONT FT.
t t
91DE YAR� ILEFT ,O RIGHT '� R.SIDE O FT.
DESCRIPTION OF WORK . _.__ /i7 __
BUILDING / NO. OF
SIZE � O� �. S F ROOMS STORIES j
EXTERIOR WALL,� ROOF 'ROCK
COVHRING JTWCCO COVERING
USE OF BUILDING AND WORK TO BE PERFORMED
SINGLE FAMILY RESIDENCE AND
ATTACHED GARAGE
PLAN No. 7-GR
1 HEREBY ACKNOWLE�OE THAT i HAVE PCAD TH�e APPLIWTION
ANO 8Tq}¢ THAT TH8 ABOVE 18 CORPECT RND ApREE TO COM-
PLY WITH ALL GTY O�INMICES AND 9TATE WB RE6ULATING
BUILDINO CONBTRU/�y ON.
SIGNATURE OF / �{ � �n� �
PERMITfE �
� AUTHORIZED
APPROVED
THE AMOUNT 9XOWN UNUeR VALUAT�ON 18 FOp TH¢
PURPOBE OF E9TqB416HING A PERMIT FEE ONLY.
VALUATION
// � PERMIT FEE $ ��_
$ ��� � � PLAN CHECK $ ! e �
...,..... "' .. . �^ �