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Home My WebLink About2130 FEDERAL AVE - Building Permitst - � _ (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: Suite No Vicinity: Parcel Nunmber: Applicant: Address: Owner: Address Contractor: Address: 2130 FEDERAL AV REAR OF SFD 42245416 FOSTER, REX A 2130 FEDER4L AV COSTA MESA, CA FOSTER, REX A 8 TERESA E 2130 FEDERAL AV COSTA MESA, CA OWNER-BUILDER Phone: 949-514-0072 Zip: 926273350 Phone: Zip: 92627-3350 Phone: Zip: License: 0 ' SCOPE OF PERMIT � CHANGE SERVICE TO 200A IN AN EXISTING SFD. �-� -- 1 SERVICE TO 200A ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units).. Pool I Spa Lighting Fixis Recept Outlets Switches Non Res Appl � ResAppl , �� Service to 200a Service to 1000a Service over 1000a Motors to 1 hp Motors to tOhp Motors to SOhp Motors to 100hp Motors over 100hp Communication drops Sub panel to 200a Pole Light Pkg Sign Cirwits Temp Pwr Pole Intermed Pole Quantity $23.50 $0.00 $0.00 50.00 0 $0.00 0 50.00 0 50.00 0 50.00 � 0 $0.00 0 50.00 �'�, - �0 $0.00-. �� ; - 0= $30.50� .-, ��1��' $0.00 0 $0.00 0 $0:00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 FEE SUMMARY status: ISSUED Applied: 07/13/2001 Issued: 07/13/2001 ISSUED BY: Quantity Temp Dist System / Lighting i0.00 0� Busway /t00 ft - , � $0.00 0 Standing Section - $0.00 � 0 . � ' Misc Electrical Equipment $0.00 � 0 � �� Transformers up to 1 kva/kw $0.00 0 -; -; .. - ............ .:r:up to 10 kva/kw $0.00 " 0 �, .................up to 50kva/kw_ - , $0.00 " " 0 _. � .................up to 100 kva/kw • $0.00 0 � ...........:......over 100 kvs/kw " $0.00 - �. 0 - , Low Voltage Equipment, = - :-$0.00 % - 0 . , Low Volt-Wiring Syatem,l-Ckt� � $0.00 �� 0 � - Misa Conduit _ _ ,-.$OAO" 0 '� � Misc. Conductor " $0.00 0 Cirws ( gen or ride) -� $0.00 0 - Circus (mech ride or lights) • $0.00 �� 0 Christmas Tree Stand $0.00 0 , Fireworks Stand � 50.00 0 � Other Elecfrical Fee $0.00 Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $54.00 COMMENTS / SPECIAL CONDITIONS NO710E: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 1241-92) EXPIRA710N: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period oF 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2466-48(6/00) WOBKERS'COMPENSAnON DECLARAnON: — � I hereby attirtn under penelry of perjury one ot the following declarations: ❑ I have end will maintein e certificate of consent to self-Insure for workers' compensatlon, es provided for by section 3700 of iha Labor Code, for the pedormance oi the work for which ��Is permit Is issued. ❑ I hava antl will malmain workers' ctlmpenseiion insurance, es required by SeMion 3700 of Ihe Labor Code, for Ihe pertortnance oi Ihe work for which this pertnit is issued. My workers' compensation Insurance cerner and policy number ere: . Carrier: Policy Number _ (This section need no! be completetl il fhe permif is velued et one hundred dollers ($100) or less.) ❑ I certity t�et in Ihe pertormenca of ��e work for which ihis permit Is issued, I shell nol employ any pereon in eny menner so as to become 5u6jea to the workers' compensetion laws of Califomla, end egree thet II I should become sub�ect to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwtlh comply with ihese pravisions. Applicant Signeture: Date: WARNINO: FAILURE TO SECURE WORKERS' �PENSATION COVERAC+E IS UNIAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FMES UP TOONE HUNDRED THOUSAND DOILAAE ($1C0,000), IN ADDITIONTOTHE COST OF COMPENSATION, DPM4GE5 AS PRW IDED FOR IN SECTION �IOB OF THE IABOR CADE, IMEREST, AND ATTORNEI"5 FEES. LICENSED CONTRACTORS DECLAfiATION: I hereby aNirm that I em Ilcensed under p�ovisions of Chapter 9(commencing with Section 7000) of Division 3 of �he Business and Professions Code, and my license is in full force end ettecL Lic. q Class # Contracmfs Signetura: Da�e: CONSTRUCTION LENDING AGENCV: ❑ I hereby affirtn that thare is a conslruction lending egency for the peAormance ot Ihe work for which this permit is issued. (Sec. 3097, Civil Cotle). Lentlers Name: Lentlers Address: Signeture: Date: OWNER-BUILOER OECLARAT10N5: I heraby alfirtn that under penalry ot perjury �he� I em EXEMPT FROM THE CONTRAC70RS LICENSE LAW for Ihe following reason (Sec. 7031.5, Busineu and Professions Code: Any ciry or counry which requires e permit to consWci, elter, improve, demolish, or repair any siructure, pnor to its issuance, elso requires ihe epplicant tor such pertnit to Tile e signed statement ihat he or she Is Ilcensetl pursuant ta Ihe provlsions ol iha Contreqors License Lew (Chepter 9(commendng with Sectlon 7000) of Division 3 of the Business antl Professions Code) or that he or she is exempt therefrom anA the basis for the ellagetl e:emption. Any violation of Section 7031.5 6y any appliwnt tor a permit suqlecis ihe apP�icant to e civil penelry o� not more Ihen tive hundred dollers ($500).): aI, as owner of the property, or my Bmployees with wages es their sole wmpensation, WILL DO TME WORK, antl the strucWre is not intentled or oflered for sale (Sec. 7044, Business end Profeuions Code: The Coniractors License Lew does not eppty to an owner of property who builds or improves thereon, and who does such work himsell or hersell or through his or her own employees, provitled Ihet such improvements are not Intendetl or oHered for sale. If, however, �he building or improvement is sold within one year of completioq Ihe owneabuiltler will heve the burden ot pmving Ihat he or she did not build or improve tor purpose ot sale.). ❑ 1, es owner oi the property, am E%CWSIVELY CONTRACTING WIT11 LICENSED CON7FiACTORS to consiruct the projeci (Sec. 7044, Business antl Pmfessions Code: The comractors License LaW tloes not appty m an owner of Omperty who builtls ar improves Ihereon, end who contracts br such projeci with a contractor(s) license pursuant lo Ihe Contrectors �cense Lews.). ❑ I am exe� t� u�nder sec. —�� Business end Professions Cotle for this reason: Signeture: 11�Y• CI -��4�– Date: – I� —O Ov+ner ID verified by tlnvers licensa. ❑ Ves ❑ No Dnver's License No. Expires: Verification ol Ownership by (rype af tlocumeN, i.e. � property tex blll or deed): DIVISION OF INOUSTRIAL SAFETY PBRMIT CERTIFICATION: ❑ I hereby certity thet no excavetion O�e (5) or more feet In depih into which a person is required to descend, will be made in connection with work authorized by ihis permit, antl Ihat no building structu�e, scattolding, lelsework, or demolition or tlismantling thereof, will be more than ihirry-six (36) teet high. (Chap. 32, Grp 2, Art 2, Sec. 341, 71t1e B, Calitomla Adminislrative Cotle). ❑ As ownar-buildar, I will not employ enyone to do work which would require a permit irom ihe Division of Intlustnal Sefery, as noted above, unless such pereon hes e permit to do such work fmm tha diNsion. Signature: Date: Division ot Intlustrial Safety Pertnit Number: CERTIFlCATE OF COMPLIANCE AND A�MORIZA710N OF ENTRV: I cenity under penalty of perjury ihat I have reatl this appliw�ion and state that t�e information given is wrrect. I agree to compty with all state laws entl city ordinances relating to building construction, anC authonze representatives ot the Ciry ot Costa Mesa to enter upon ihe above- nbed propeny lor in�p ction purposes. I egree not to occupy or ellow occupancy ol eny building authorized by this pertnit until final inspeclion. � . `�-o�_ '7 - l'3 -O ) SignaWre O� Legal Owner(s) Date AnNOr AutPanzed Applicam COOE �. INSPECTIONTYPE 1616 Fizetl System Final Fire Prevenlion 1266 Pool Spa Final 200 Final Re-Roal 201 Finel BIacWRetaining Well 202 203 Final Feclory Flre Place Final Sign 204 Finel Demolition Pdg II�1dL5 COpE I INSPECTION TYGE 206 Final Methanical 208 Final Plumbing 210 Final Electrical 212 Final Fire Prevention 220 222 250 Flnal Plenning Apqrovaf Final Site Final Building/Occupency DSIE II�ELfi March 31. 2006 .� , CITY OF COSTA MESA P.O. BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 92628-1200 DEVELOPMENTSERVICES DEPARTMENT BUILDING DIVISION COURTESY NOTICE OF PERMIT EXPIRATION Teresa E Foster 2130 Federal Av Costa Mesa CA 92627-3350 PERMIT NUMBERS: FOR: PROJECT ADDRESS: E01-00627 Change Service to 200A 2130 Federel Av., Costa Mesa Our records indicate the above listed permits were obtained for property improvements or alterations at the above address. Per the 1997 Uniform Building Code, Section 106.4.4 Expiration, permits are valid for 180 days from the date of such permit, or the date of your last inspection for the project and additional fees wiil be required to finalize expired permits. According to our records, the permits listed above have not had an inspection for a period exceeding 180 days. If you have a signed inspection card indicating an inspection was conducted within 180 days from the date of this letter, please contact this office so we may correct our records. If you need to request an inspection please cail our Inspection Request Line at 714-754-5626. If you wish to request an extension, requests must be made in writing addressed to Ed Petros, Chief of Inspection, at the above address, detailing circumstances and listing an estimated date of completion. If you do not have an approved final inspection, your permits will expire on April 14, 2006. If you have any questions, please contact the Building Division at 714-754-5273, between 8:00 a.m. and 4:30 p.m., and a staff member will be happy to assist you. The accuracy of records affecting your property is our goal and we appreciate your working with us to resolve this matter. Sincerely, c�Y�l;��..�,ti��'� Mary Jane Weidenkeller O�ce Specialist II Building Division (714) 754-5273 • Cotle Enforcemenl (714) 754-5623 • Planning Division (714) 754-5245 FAX(71A)754-0856 • TDDp14)75-0-5204 • www.ci.costa-mesa.ca.us � �� r9 PPOJECT AO�HESS: z 1 3 O F ED ERAL AV OWNEH'SNAME: FOSTER RObERT J �ooness: 510 CALLE BARANDA � SAN CLEMENTE,CA 92672 UNIT: APCHIENGINEEN: NEG.NO.: ADOflES$: — \ UNIT: PEflMITTEE: ROBERT FOSTER C")1q)q2'7—q192 aooeess: SLO CALLE BERANDA SAN CLEMENTE CA 92575 UCENSED CONTXRCTOfl UELNHATION: I hereGy atlirm �hat I am ficense0 unAer DmNsions ol Chapier 9(commencing wit� SKiion lIXp) ol Uivision 3 0l I�e Business and Prolessions COAe. antl my iicense is in lull lorce an0 effed. CITY LIC.: STFTE LIC.: CIA55: Date: SignaNre: WOBNEflS' COMPENSATION OECIAflFTION: I �ereby aflirm �ha� I �ave a cerlificaie ol consenl to sell�insure or a certilica�e ol Worker5' ComDensalion Insuran[e. or a certifi¢E caDY �hereol �Section 3800, La�. C). POLICY NO.: E%P. OATE: COMPRNY: � Cenilied coDY is �ereby Nmishetl. ❑ CertitieA coOY is �iletl with Ne ci�y BwlOing Oivisian. Dale: Applicanl: EXEMPTION FNOM WOflREflS' COMPENSRTION DECIANATION: (IDis seclion neetl not Ge complete0 if t�e permit i51or one hun4re0 (510�) ar 1e55). I ceriity Iha� in I�e edormance oi the work lor w�ich Ihis permi issue4l shall no� Oloy any person in any manner so as to �ecome Su�le�� o ��e k@r5' Jq¢n lion Laws oi Calilomia. ,/ �� /J ( � �// %�I�CTVJL,�� Oale: � ' / � SignaWre: � � NOTICE: L a�ter making ihis tleclaration, you shoultl become subject lo the Workers' Compensation pmvisions ol Ihe Labo� Code. you must �onnwilh comvly wiln such pmvisions or ihis Oermil shall be tleemeA revokeA. CONSTPUCTION LENOING ACENCY: I �ereby allirm I�a� there is a consimction lentling agency lor Ihe pedormance ol t�e work �or w�ich ihis permit is issuetl (Seclian 3097. Civ. C�. LENOEfl: AOOHE55: OWNEN BUILDEN OECLAXR710N: 1 hereby allirm t�ai I am exempt imm t�e Contacmrs' Slate license Law lar ��e lollovnnq reawn �Section 7031.5 Business and Pmlessional Cotle: Any ciry ol counry which reQuires a permit to conitmc�, atler, improv¢, demoliSR or repair any simctu�e, prior lo its iRuance, also BQuires IAe apDticant bt suc� permit ta file a signe0 statement ihdt ONshe is licens¢d pursuam lo I�e pmvisions al ine Gonlracmrs' SIaIe License Law (C�apter 9(commencing vnih Sec�ion 71100) ol 0ivision 7 0� Ihe Business an0 Pmtessions CoOe) or Itu� �els�e is e�empt t�ere�mm an0 ��e basis lor ��e allege0 exemption. Any violation ol Section 7031.5 by any applicani �or a permit 5u01e��5 I�e appliunt lo a civil penalty of nol more I�an INe hunGreG dollars (5500�. I. as awner ol Ine pmpeny or my employees with wages as iheir sole com0ensation, will tlo t�e wOrk, antl I�e Q stmcWre is no� intentleU ar ollerea lor sale (Section 70aa, Business an0 Pmtessional Code: T�e Coniracbrs' Staie License Law does no� apo�Y to an owner o� a propeny who buil�s m impmves thereon, antl who does 5uch work himself/herseif or lhmupA �i5 Of �C( OWO CIIIpI�'QCS, pfOVIQEd l�dl SOL:I IIIIPIOVQI11COf5 dfE OOI I(1f2fIQEd Of O�ICfCd �Of Shc2. I�, hOWCVCf ��E OUlldlllg Of improvemenl is sold within one year ol completion. Ine owner vnll have Ihe burtlen ol proving ne/she Aitl not builA or impmve lor ihe purpose ol salel. 1, as owner ol Ihe pmpetly, am extlusively contracting with IicenseA contractors to cans�mci Ihe D�ole�� (Section 704a, Busine s ❑ anC Pw�euions CoOe: T�e Coniracmrs' Stare License Law Goes not apDN �a an awner of pmperty who buAAs or improves there n antl w�o conlratls for such prole��s wilh a conlracior�s) license pursuani �o Ihe Coniractors' Slale License Law�. 1 am aw e I�ai D�ool ol �Aeir Worker'S Compensa�ion insurance S�oWG be pmvidetl to me. � I am exempt unaer Sec�ion: B. 8 P. C. Iar �hi5 re an: �� / � Date: Owne ` I tlo hereby ce �ify Iha1 ani aware ol anU unUerstantl Ihe reQuiremems o� California Heallh antl Salety Code Seciions 25505, 255J3, a tl 25534 ana Iha� I o� any future Uuilding occupanl willlwill no� Icirtle one) neetl to comply with SaiA s�a�e codes antl Ihe reQuir¢ments fo a permil lor canstmclion ar mo0ificaiion Imm Ihe Nir Ouahry Managemen� �istrict. Residenlial cons�mction applications are exemp� Ir� ihese pmvisions. �ate: ApplicanL — I �ere�y cer�ily I�al I �ave read Ihis aOPlication antl sia�el�at ��e above inlormalion is wrrecl. lagree lo comply wi�� allciiy an0 counly ordinancesantls�atelawsrelalingiobuiltlingcon9ruc�ionantl�9 yauthor¢ereDreSenta�ivesoll�i5citytoenlerupon��eaDove�mentionetl pmperty �a� in pec�ion o ��ases. � � / /i. oate:��C� signamre. o '�/ � L�/L Oriver's ��cense or Sociai Security +: ibana6 Whne—ewlaing; Green—eoee Enmrcemem: Canary—Aoo�icant: ainx—Revenue: Goleenrotl—nssessor CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 06505E PERMIT NO; B 065056 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: OTH JOH DESCRIPTION ; T/OFF 6 REROOF W/COMP, SHINGLES SQ FT: 3,500 CLAIM VALUE: 3,500.00 CALC—C�ALUE: 3,500.00 GROUP OCC: R-3 / COMMENTS: SMOKE DETECTORS ARE REQUIRED AS PER 1991 U.B.C. itit*****�*ir*ir*fr�r�rit�r�r�r**�r*ritit�rit**#*�-ia**�t*�**�tt***+F**�c*�**it******�-r****+�+tar**k�*+r�x-*x� 2 O N I N GS ERTEBQAUCIKRSE M E N T 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: 42245916 ZNE: REF NO: PLANNING NOTES> �-�' > �t***�e*�t�t�t�t�rir�r*�tit***irit**ie*x�it***�t�x�**�t**�tv�t+r�r�tit*�f*�-�t+rxir+t****i�*iti�***�r�r�t*�r�*****�*u- D E V E L O P M E N T S E R V I C E S R E Q U 2 R E M E N'T S ZONING APPROVED'HY DATE: BUILDING APPROVEP BY : DATE: � T �� _ ' APPLICATION ISSUED BY; ��. DATE: II�� if�fiEiEiEafifififiFifiEiFiFiEifiEiFififiEiE7F��iFx+t . . . . iF . itiFiFifi4KifIFY.iG�f'�.�Ti �' iT'�iEif� if if if 3E �E IP iE 9E * 9E �f iE iE IE ii� iP iF iE dE �f fF �1f ff !f iF 1f ik if iE iF * 1E �E iE jE if 3F jF jE if if iE iF iE jE iE fE i(� 3E iE if �G *{f af if if �f if i: iF iE 14 # aF 1F i4+F?f YE i4 i if:f iF iF K if +F 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 63.00 ,50= SMZP/NON�RES PLAN ISSUE FEE .' BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID f DUE TOTALS----> 63.50 0.00 0,00 63.50 63.50 .00 OR t�SPECTtONS iE if !E 1E 1E iE if if it if if !E it ik i! if iE i! 1f !E CAII I N TYPE �54�56Y26 D E SFR p'00 RERC 754-5627 LS--> COLLECTED: 63.50 OVER/SHORT: .00 NG ELECTRIC MECHANIC FIRE SMIP/TOT GRADING �PLAN—CHECK .S� . 'r. k%� iE �E iE iF iF M it 1! �t k if if iF iF iF if iE ff iE iE iE if i4 iE iE if if iE i4 if %if iE iE if iF iR if iE ff if If� iL if at iE ff #t if iF if iE jt iE iE if I V I D U A L F E E B R E A K D O W N C R I P T I O N UNIT COST ��'OTAL COST BY VALUE RESIDENTIAL NOZONE END OF FEES �:l��C� t�L��"ECTOR REQU(RED 1,00 3,500.00 i �' �1 0015L252—GO1S1253 T �� T 63.50 DATE: 11/24/43 TIME: 09:3E CONSTRUCTION AND PLANNING �APPROVALS Permit � ► 1. Temporary EIecY�icai Service or Pole 2. Sod Pipe-Undrgmd. 3. Electrical Cond��c UC.tity�Undrgrr.d. 4. Electrital Cond,,�FUndrgmd. 5. Stcel Reinfo�cEme^.t 6. Ee:V�ea! UFER Gmd. J. Footings 8. Foundation 9. Water P�pe�Undrgmd, 10. Struct��al Floor System 7 t. Properry Sewer Line & House Connection 12. Sewer Cap 13. Roof Drains 14. Rough Piumb�na 75 Ro��h �lectrica!•Conduit i6. fto�gh ElectricN•'�ring ll. Rough !�i:nr.g $�gn 78. Rough Electritai-T Bar Ceil�ng 79. Ro�gh Heaun� & Air CondiLoning 20. Rough Factory Fireu�ace 2L Ducts, in StructU�e 22. Ducts, Ventilating 23. Gas Pipe�Rough & Test 24. Rooi Framing 25. Roct Shea[hing Z6. T-Bar Ce�iing (St�ucturatl & i\ionocoat 27. Frama and Flash�ng 28. Lathing & Siding 29. Insulation 30. D�ywall P,a�ling 37. Piaster Brown Coat 32. Electrica� Power Meter-Final 33. Final Electric 34. Fir,al HeaLng & Air Contlitionirtg 35. Finai Gas Pipe�Tesi 36. Hootl or Canopy 37. Pinal Fattory Firepiace 38. Final Plumbing 39. \Yater Service-Final 40. Gas Service-Fina� 41. Solar pomestiaFinal 42. Backflow Preventer 43. Backflow Irriyat�on 44. Landscape IrrigBtion System 45. Sound Attenuat�on 46. Handicap Regulations 47. FINALSTRUC7URE&BUILDWG /', 48. FINAL PLANNING 49. Electnc Retease to Edison 50. Gas Releasa to Sou[hem California Gas Co 51. CERTIFICATE OF OCCUPANCY Oate Date � Inspector zkl 1' - � � s POOI PA APPROVALS Permit # 52. Pcol & Equ�pme�t Location 53. S!ee! Re�nforcement . 54. Forms I 55. Eleetrieal 6onci ng � 5G. Flo�gh Plumbing & Pressure Test � 57. APPROVALTOCOVER-GUNiTE 58. Etectrical Condu;rUndrgmtl. 59. Gas P�pe, � Undrgrnd., 7est 60. Backwash Lines, P�T�ap, � Undrgrnd. 61. APPROVALTODECK � 62. Backwash & Receptor-Final ' 63. Heater & Vent-Final � 64. Plumbing System - F�nal � 65. E!cctrical-Final _.` 66. Salar S+�stem Pina� 67. Pcnc�ng � Access Approval 68. APPROVED FOR PLAS7EFIhG 69. POOL/SPA SYSTEWiS-Ft?VAti-- - � FIRE DEPT. REQI�tR£MENT • --. APPROVALS Permit� ' � 70. Underground Hydro 71.ProductPipingO(',as�`LiOd�-� - ^y •=r-- • 72. Underground Flus'� =y � -` �,� �� '+� �� . ) f� 73. Undergmd. Storage T4n'�tc O Gas Li'01� i 74. Ovcrhead Hydro � "m �`� 75. Dry Chemicai � _; � .s I 76. Dry Standpipe ' 77. FIXED SYSTEAt FI�AL � 76. FIRE PREV. FINAL HEALTH DEPT. REQUIRE2�IENT 79. FINALINSPECTION _ I 80. FOOD CEHTIFICATE ISSUED � Notes: Date � Inspector 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 to issuing a building permit, require the completion and require the return oi, an owner-builder verification. Attention Property Owner: An 'owner-builder' building permit has been applied for in your name and bearing your signature. Please complete and return this iniormation 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 rBceived. 1. I personally plan to provide the major labor and materials for construction of the pro- posed property improvement. �Yes O No 2. I(have/have not) {�jGiVe- v�o� signed an application for a building permit for the proposed work. 3. I have contraCted with the following person (firm) to provide the proposed construction: Name Address Phone ( Ciry Contractor's Lic. No.. 4. I plan to provitle portions oi the work, but I have hired the following person to coordinate, supervise anq 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 1, Address � i�-�1-P c 3 � Phone Type of I hereby affirm that I have received a copy of the information set forth in Section 19830 of the State oi California Health and Safety Code and have completed the above information to the best oi my per- sonat knowledge, in ��m lia� c ith State law. Signed: E��`'7'�..J � �v�—� Date: ��- � % - � ` Name: /1m.6e.�� /�5J'�R (Printed or Typed) C.D.L. # or S.S. #.� � 754-5273 ,o.:� a� "�''�' �' ��]�� L/� .. �. � 'l�)JL L_�S� �M�7t_.�F:'.L. . ^�� d .A �, 4 �O—a /'�y �' ��'� Yy � Zi t �` COSWA MESA BUILDIN6-SAFETY DEPARTMENTi [ �': �"� i;�y �j,j �� j� � P.O. BOX 31') COSTA MESA. CALIFORNIA ��I.CL OE PT. 'J 'V/� -� ^��Tf lp��l?a.a'_% ,3___��T ' " FOR APPUCANT TO f/CL /N COMP[ETELY fCA ,ION ��2�R PERM TYPE OR PRINT valt. No.�j�.��p��VED _!�-✓�/—' BUILDING � �O C�nE Y� ADDRESS / COSTA MESA, CALIFORNIA fOR OfF/Cf USE ONLY OWNER iRoBERT V� FOSTE AECEIPTNO. �RMI�NOI / C%� ( ADDRE55 .:Z �30 HECEIV BY DAT6 REGEIV6D DwTE 189UE0 � hEOE,�A� Avr. � ��y�S /. ��: CITY G � � T/�' /�i ES /-J TNO. � BUILDING �� Q _ A � b'� ys� ADDRE55 vLdX ARCHITECT LiG. COSTA MESA. CALIFORNIA OR �INEER DRRk6 ♦ �SSOG. NO. ADDRESS •S�/ b.1 h o � rf�ct F- wESTmiN�na ZONE J TYPE GROUP pl/� CONTRACTOR Vw�Y" BI[1J. CNO. ByPROVED •/ DATE�/ / ADDRE55 O�'�� J �Ci�n`C r � NING p �/�3 20NE NO.OF USE OF NEW/ `�/ DESCNIP�ION INO. 11 � IBLOCK ITRACT IPLANS (2I BWLDIN6 �f«� L A.P.NO. b�'"7 �� O� BVPROVEDII�� `-" � DAf E'/I=TJ KL� /?-� t, SIZE No. oF BLDGe. � ypRDS ��CS OF LOT � 8 X� O 7. 5-Z.S Now oN �OT REOUIRED ALLOWED EXISTINGBLDG. nCS �OEIVG�' (CENTERLINE8T.) FRONT �J�F7', IN. SETBACK LINE FflOM cervicn oF sirs[ei REAR YARD R. SIDE FT. IN. SIDE YARD ILEFT IRIGHT L.SIOE J••� FT. IN. DESCRIPTION OF WORK ____ • „�,� ___ REPAIR -+� I IIMOV/ING 1 IIDEMOLISH � 5 Z'E O'N ,/ {�� IC �v ROOMS _ STORIES � EXTERIOR WALL ROOF 6 N � COVERING STs%KnICOVERING � /A% USE OF BUILDING AND WORK TO BE PERFORMED �a�. R,....,,,. �,. ct�i , c.� - - _ 1' :,�v �G'� ��'3,� ae �3,. aqr ��''�"Yao'9' ,d ,3 1 HEflEBY hCl(NOWLEDGE THAT I H�VE READ THIS APPLIChTION TMH AMOUNT BHOWN UNOER VALUATION IB FOH THE AND STATE THAT THE ABOVE 19 CONPECT /�ND /�GqEE TO COM� pUflP082 OF EBTRBLIBHINO A PERMIT FEE ONLY. PLY WITH ALL CITY OPDINANCES �ND STATE LAW6 NEGULATINO em�mrvc corvarnucn H. VALUATION SIGNATURE OF� - / �,'�SI � PERMIT FEE $ �O� PERMITTEE - 5� D U O—� pLAN CHECK $ �� AUTHORIZED AGENT p� � s y��. TOTAL FEE $ � � 1�6�2 C09TA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 31] COSTA MESA. CALIFORNIA fOR APPL/CANT TO f/LC /N COMALfTECY TYPE OR PRINT eui�oiN� a/,�d FEDER�L �iU[=• ADDRE55 COSTA MESA. CALIFORNIA OWNER RQ �SERT -�J , �OSTE� ADDRESS �� 0 (GbtR�L' � ' ciTv CosTA /+��5 g TNo`: /.� Y�6y5 ARCHITECT /�n LIC. OR 'INEER {/ICAKC V ASSOC. NO. nooRess .S r19� Roc�e!!e - WPatw„H �' CONTRACTOR //UJ/llGti- p �� CT NO. ADDRESS v ��1 CG7F'C oescA�PnoH I NO. O � I BLOCK I TRACT , A.P. NO. I � —� '�' �/ `--� SIZE % O y/ a ry�� I NO.OF BLOGS. / OF LOT h� /' i� NOW ON LOT U5E OF R ES J O e NG C EXIST�NG B�OG. 6ETBRCK LINE FROM DESCRIPTION OF WORK REPAIR I IIMOVING I IIDEMOLISH I BUIL�ING NO.OF , SIZE �V X �� ROOMS � STORIES EXTERIOR WALL ROOF �m / COVERING $7uCW COVERING SH/N6 LC USE OF BUILDING AND WORK TO BE PERFORMED I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION qNO STATE THAT THE ABOVE IS CORRECT AND PGflEE TO COM- PLY WITH AlL CITY OROINpNCES ANO ST TE LAWS��11 LATING BOIL�ING CONSTRO�� SIGNATURE OF � AUTHORIZE� AGENT � ,=�t �tCti��tD /c-a7'SY Vu FItVANCE OEPT. CITY OF COSTA MESA APPLICATION FOR PERMIT BUILDING Fo,e ofFic� usE aNcy I RECEIPT NO. . I �D GT Go RECEIV'E�O Bc DAT RECEIVEO DATE ISSUEC F:/ I � _25f- /l _�•s 6UILDING � `� � �_ /P //A ADDRESS ��_ �/(}'Y� COSTA MESA, CALIFORNIA APPROVED �� BY � � ATE ZONING ZONE /� NO. OF '''JJJ111 USE OF NEW /y� / PLANS � BUILDING� Y � APPROVED (//.� � / O BY !J � DATE u: L.SIDE ��//�FT. IN. THE RMOUNT 6HOWN IINDER VALUqT10N I6 FOR THE PfIRP09E OF ESTqB�ISHING A PEfiMIT FEE ONLY. VALUATION /y PERMIT FEE $ � � PLAN CHECK $ '�� $�a73— TOTAL FEE S �02 � �L, ORANGE COUNTY BUILDING DE2ARTfv1ENT � .APPLICATION FOR PERMIT � . 636 North Broadwey � � � p � ' � � . SANTA ANA, CALIFORNIA ` ".�� . ._. . , '" i�. �J • '� . . 1 ♦ Jr. � . .� • Y \�.. .. . • . . .I' . _ - . Li _'. .. . •_ � .. ` .:i".., . - .... .:,..,. _ ...,... �, . r . •�7.. S.�'Y0,3�.fV . . . . �� . , ._.;I :'^'' ,.�� .cv_� :,:�r;,:l'i �. - , � f , .. _ �.!_ i.`: � _r, �. :_ � .. f..... ..•y— -.t�-:y_,;�,_., '.:�q�- ---._ ---- .... ,...," �.- -��::a.. .� .:fC - f . ., , ;;i'�-I 0`/ ,' - ,r _._. " _ .:��i' :v.. �. ._ �.ii._:i'.'. :''. � ,. f'" ( . . . ,. . . . � .. ' � f f x f'.:. ._ -. 1' ,.. J : ' .. �.;�. .. �_.� __ 1 �. - C�:t:.:J - _.. • "_'..:.IE:' ''�' "'. _ _ L'�=�.: � • . 1 - �� F � �'+ 3�n3Ll�:,i .._ . ' . _^ '_'_ . . _ _ '.' _,-. v.�nt _ . . . _ � - . c: � . ' . . - - . . . , . - . . - • � . 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