HomeMy WebLinkAbout426 FLOWER ST - Building Permitst
(714) 754-5273 • Fax (714) 754-4856 • v+ww.ci.costa-mesa.c���LDING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626
JobAddress: 426 FLOWERST
Suite:
Vicinity:
Parcel Number: 11734146
appiicant: GOODMAN, LAURA
Address: 1527 1/2 W BALBOA BLVD
NEWPORTBEACH,CA
Owner: GOODMAN, LAURA
Address 1527 1l2 W BALBOA BLVD
Contractor:
Address:
�
Arch :
Address:
NEWPORTBEACH,CA
Phone:
Zonin9:
Phone: 949394-3999
� Zip: 92663-4509
Phone: 949-631-0105
Zip: 92663-4509 '
Phane:
License:
Eng:
Address:
SWtus: ISSUED
Applied: Ot/27/2003
Issued: 01/27/2003
ISSUED BY:
�
Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF ROCK ROOF INSTALL 2 15L8 FELT AND 50 YEAR COMP. SHINGLES.
Plan Check: �6321
Permit: $97.25
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $160.96
SETBACKS
MAIN STRUCTURE Fmnt 0- 0
ACCESSORY Front 0- 0
PARKING Exi_stinq: p
NOTES:
Rear 0-0
Rear 0-0
Re uired: 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Left 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation
Right 0- 0
Right 0- 0
53,600.00
S3,600.00
NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requiremenis under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void il work is not commenced within 180 days, or if work is suspended or abantloned
for a penod 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
requlred Inspectiona and itnal approvel must be obtained. Failure to obtain inspections and final approval will result in the expiratlon of ihis permit.
FOR INSPECTIONS CALL: (714) 754-5626
2aae�se �amo7
WORKERS' COMPENSATION DECLARATION: ' �
I hereby affirtn under penalry ot perlury one ol the followinq declarations: '
❑ I heve entl will malnialn e certificate of wnsent to self-Insure lor workers' compensation, es provltle0 tor by section 3700 of the Lebor Code, for the pedortnance of the
work far which this permit is issuetl. ,
❑ I have entl will mainiain workero' compensatlon Insurence, az required by secUon 3700 ot ihe Lehor CoOe, for ihe peAormance of the work for which this permit is issued.
My workers' compensatlon Insurance cartier end poliry numDer are:
Carner. Policy Number.
(lhis section need nat be completed i! the permif !s valued et one hundred dollals ($100) oi lessJ
❑ I cenity that in tha pertortnance ot t�e work lor which this pertnit is issued, I shall not employ eny person in eny manner so as to bacome subject to the workers'
compensation lews ol Califomia, and egree that It I should become sublect to the workers' compensetion provisions of Section 3700 oi the Labor Cotle, I shall fort�with
comply wlth these provisions.
Applicant Signature: Dale:
WARNINp: FAILUFE TO SECUFE WORKERS' COMPENSATIIXJ COVERAGE IS UNUWFUL AND SHALL SUBIECT AN EMPLOVER TO CRIMINAL PENALTIES ANDGVIL FlNES UP TOONE HUNDRED
THOUSAND DOLLARE (5100,000). IN ADDITION TO THE CAST OF CAMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3�O60F THE LABOR CODE, IIJrEREST, AND ATTORNE`f5 FEES.
LICENSED CONTRACTORS DECLAqATION:
I hewby attirm thai l em licansetl untler provisions of Chaptar 9(commencing with Section 7000) ot Dlvlsion 3 0l iha Business entl Professions Code, entl my license is in full
lorce end eflect. Lic. a Cless a
Comrectofs Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby ettirtn that there is a consWction lending agency for the pedormance ot the work for which this permit is issued. (Sec. 3097, Civil Code).
Lentlefs Name: Lenders Address:
519nature: Date:
OWNER-BUILDER DECLARA710NS:
I hereby effirm thet under penelry of perjury Ihat 1 em EXEMPT FROM THE CON7RAC70RS LICENSE LAW for ihe tollowing reason (Sec. 7031.5, Business antl Profeuions
Cotle: Any ciry or county which requires a permit to construcL alter, improve, demolish, or repair eny strucWre, pnor b its issuance, elso requires the applicant for such permit
Io file a slgned stetemBN ihet he or 5he 15 Ilcensed pur5uen� to ihe provisions of the ConVectore License Lew (Chapter 9(commencing wilh Sectlon 7000) of Divislon 3 of t�e
Business flnd Profeulons Cotle) or thet he or she Is exempt t�eretram antl the basis tor the ellegetl ezemption. Any violalion of Section 7031.5 by eny epplicant for a pertnit
suEjects the epplicant to e civil penelry of not more Ihen five hundred dollars (5500).):
❑ I, es owner of the property, or my employees with wages es iheir sole compensatlon, WILL DO THE WORK, antl Ihe siructure Is not intended or oHeretl For sale (Sac.
7044, Business end Professions Code: The Coniractors License Law tices not apply to an owner of propeny who 6uilds or improves Ihereon, and who tloes such work
himself or herselt ar thwugh his or her own employaes, provided ihet such improvements ere not Intentletl or oReretl tor ule. If, however, ihe builtling or improvement is
soltl wiihin one year ot completioq Ihe owner-builtler will heve the burden of Dmving ihat he or she did not build or improve for purposa of sele.). �
❑ I, es awner ot the pro0erty, am E%CLUSIVELY CONTRACTINC WITH LICENSED CONTRACTORS to construct ihe projeci (Sac. 7044, Business antl Profeuions
Code: The contrectors License Lew tloes not apply to en owner of property who builtls or Improves thereon, and who con�racts lor such project with e contractor(s)
� license pursuant to the Conirectors License Lews.).
antl Professions Cotle lor lhis reason:
Owner ID vedlietl by dnvefs license. f]r�e5 ❑ No DriverS LiCenSe
�
Verificetion ol Owners�ip by (type af documenL I.e. - property �ax blll or deed):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION:
❑ I hereDy certify that no excavation five (5) or more feet in dep�h inio which e person is requiretl to descend, will be made In connection with work eu�honzed by ihis
permit, end that no building sWdure, scalloltling, talsework, or demolition or dismamling thereot, will be more than thirty-si: (38) teet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Title B, California Atlministretive Cade). .
❑ As owner-builder, I will not employ enyane to do work which would require e permi� trom the Division oi Industrial Satery, es noted abova, unless such person has a
permit to do such work from �he tlivision.
SignaNre: Date:
Division ot Indusinal Sefery Pertnit Number:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATON OF EMRV: I cenity under penalry of perjury that I have read ihis epplication and state Ihat the information given is
cortecc I gree Io comply with all stele laws and ciry ortl1nences relating to builtling wnstruction, and euthonze re0�esentatives ol the Ciry ol Costa Mesa lo emer upon Ihe
above-d cn d ro erty or' pe iertpar�a . I �re n t b pcupy or allow ancy ol eny building au�horized by this pertnit until finel inspaction.
''' � -� �-�) 3
Si nature Ot Lega Owner ) �� Date
And/Or Authorized Applicant Dato
COOE /. INSPECTIONTYPE .
1616 Fixetl System Final Fire Prevention
1266 Pool SDa Final
200 Finel Re-Roof
201 Finel BIocWRetaining Wall
202 Final Factory Fire Place
203
204
Final Sign
Final Demolition �
PdIF IamuLS
COOEI INSPECTIONTYPE �
206 Final Mechanical
208 Flnal Plumbing
210 Finel EletMwl
212 Final Fire Prevention
220
222
250
Flnal Planning Approval
Final Site
Final BuiltlinryOccupancy
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.
(714) 754-5273 • Fax (714) 754-4856 • wv+w.ci.costa-mesa.ca.us 77 FAIR DRIVE, GOSTA MESA, GA 92626
BUILDING PERMIT
Job Address: 426 FLOWER ST
Suite:
Vicinity:
Parcel Number: 11734146
Applicant: GOODMAN,LAURA
Address: GOODMAN, LAURA
CM,CA
426 FLOWER ST
Owner: GOODMAN,LAURA
Address GOODMAN, LAURA
CM,CA
426 FLOWER ST
Contractor.
Address:
Zip:
Arch :
Adtlress:
Zoning:
Phone: 949-631-0105
Zip: 92626
Phone: 949-631-0105
Zip: 92626
Phane:
License:
Eng:
Address:
Status: ISSUED
Applied: 07/23/2002
Issued: 07/23/2002
ISSUED6Y: ��L
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
RESTUCCO FIRE PLACE. '
Plan Check: $0.00
Permit: $23.50
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $24.00
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0-0
PARKING Existinq: o
NOTES:
Rear 0-0
Rear 0- 0
Required: 0
FEE SUMMARY
PLANNING & ZONING
Lek 0- 0
LeR 0- 0
Propased: 0
Calc Valuation:
Claim Valuation:
Right 0- 0
Right 0- 0
$300.00
$300.00
NOTICE: 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, 1247-92)
EXPIRATION: 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 ihe work authonzed under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inspectlons 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) 75h5626 .
2446�46 (8/00)
� ;
WORKERS'COMPENSAnONDECLARAnON: ,
I hereby ettirm untler penalty of perjury one ot the following declaretions: "" ' •
❑ I heve end will mainlein a certificate ol consent to selt-Insure tor workers' compensatlon, es provided tor by section 3700 0l the LeDor Cotla, lor the peAortnance of Ihe
work tor which this permlt i5 issuetl. .
� I have entl wlll malntein workers' compensatlon insurence, as requiretl Oy sectlon 3700 of Ihe Labor Code, for the perfortnenca of Ihe work for which ihis pertnit is issued.
My workers' compensation Insurance carriar end policy number are:
Carrier. Policy Number:
(This secflon neetl not be comp/etetl i! the permit is velued at one hundred dollers ($100) or /essJ
�
of tha work tor which this pertnit is issueQ I shall not employ eny person in any menner so as to become subject to the workers'
i, end egrea thet Ii l should 6ecome sub�ect to the wolkers' compensation provislons of Sectlon 3700 of the Lebor Coda, I shall forthwlth
�
'FtCDFETO SECURE WORKERS' CqMPEN5ATI0N COVEPACaE IS UNU SHALL SUBJECi M�E7APl9YEA30.ron•�
DOLLARE�$100,000),INADDITIONTOTHECOSTOFCOMPENSA AMAGESASPROVIDEDFOPINSECTION3�O60FTHE
amnn
FlNES UP TO ONE HUNORED
WO NTTORNEY'S FEES.
of Chapter 9(commendng with Section 7000) of D" '� o e Business end Pmfessions Cotle, entl my license is in full
�[2�te,'
CONSTRUCTION LENDING AGENCY: �
❑ I hereby attirtn that ihere is e construction lending agency for Ihe performance of the work tor which t�is pertnit is issuetl. (Sec. 3097, Civil Code).
Lenders Name:
Signawre: _
Lender's Atltlress:
Dete:
I hereby afllrm thel under penelrybt perjury ihat I am EXEMPT FROM THE CONTRACTOHS LICENSE LAW for ihe following reeson (Sec. 7031.5, Business antl Profession:
Cotle: Any city or counry which regulres e�permit to wnsiruct, elter, improva, demolish, or repair eny structure, prior to its issuance, elso requires ihe epplicant tor suc� permi�
to file e signetl sletement Ihat �e or she is licensatl pursuent to Ihe pmNsions ot ihe Conirectors License Law (Chapter 9(commencing wll� Sectlon 7000) ol Division 3 oi the
Business end Professions Code) or that he oi she is exempt therefrom ena the 6esis for the alleged e:emption. Any violatlon of Section 7031.5 by any epplicant for a permi�
subjecls the appllcani to e civil penalry of not more than five hundred dollers ($500).):
�.
❑ I, es owner oi iha property, or my employees wl�h wages es �helr sole compensation, WILL DO 7HE WORK, and �he structure Is not Intentled or ottered tor sale (Sec.
70d4, Business antl Professions Code: The Conirectoro Llcense Law does not apply to an owner of properry who builds or improves ihereon, and who does such work
himself or herself or ihrough his w her own employees, provided ihet such improvemeNs are not Intentletl or oXered tor sale. If, however, Ihe builtling or improvement is
sold within one year of completion, the owner-builtler will heve Ihe burtlen of proving that ha or sha did not builtl or improve far purpose of sale.).
❑ I, as owner of ihe properry, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTAACTORS to consiruct the project (Sec. 704d, Business antl Protessions
� Cotle: The cnmractors Licanse Lew tloes not appty to an owner ol property who �ulltls or Improves thareon, and who contracts for such proJect with a contraaor(s)
license pur5uen� �o �he Contractors License Laws.).
Bu5ine55 and Professions Code lor this reason:
by dnvers license. �s� ❑ No
Vedlication ai Ownership by (rype of dacument, i.e. - property tex bill
DIVISION OF INDUS7RIAL SAFETV PERMR CERTIFICA710N:
No.
❑ I hereby certify ihat no excevation five (5) or more feet in dep�h Into which e person is required to descend, will be matla in connection with work eu�horizetl by ihis
permi�, end that no building siructure, swMolding, talsework, or demolition or dismantling thereof, will be more Ihan thirry-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Title 8, Celifomia Atlminisirefive Cotle).
❑ As owner-builder, I will not employ anyone to tlo work whic� woultl require a permit irom �he Division of Indus�nel Sefety, es noted eDove, unless such person hes a
permit to do such work from tha division.
SignaWre: Date:
Division oi Intlustnal Salery Permit Number:
CERTIFlCA7E OF COMPLIANCE AND AUTHOfiIZA710N OF ENTAV: I ceniy under penalry ot perjury that I have read this epplication antl state that ihe information given is
correct I agr e �o comply wllh all siate laws and city ordinances relating �o bullding consWction, end euthonze representatives ol t�e Ciry ol Costa Mesa to enter upon Ihe
ebove-des ed prope �r' pection uryoses. I egree not to occupy or allow occupency of any building authonzed by ihis permit until final ins ection.
�, � -� `��
Slpna legal s) Date
COOE t. INSGECTONTYPE � '
1618 Finetl Sysrem Flnal Fire Prevention
1286 Pool Spa Finel
200 Finel Re-Rooi
201 FIna181ock/Reteining Wall
202
203
204
Final Factory Fire Place
Finel Sign
Final Demolitian
Pdg �1�4$
GppE� INSPECTIONTYPE
206 Final Mechanicel
208 Final Plumbing
210 Final Elecirical
212 Final Fire Prevention
220 Final Planning Appraval
222 Finel Site
250 FinalBuilding/Occupancy
U�TE �L$
1
ADP��canl lo fill in all spates except those wilhin heavy Cortler lines antl sign all approDriale tlecla�ations.
.CITY�f C�OSTA ME A CO�j TRUCTION PERyM'IT' �
PToject Address '�'F� � / ' � W � � S /
Applicant'sMailingAd�dpress `!�%� ��'19n�?�,F/C,,.��_.���� /O���'� ��G C/J
Owner's Name �C��/�1'� �� �� � `�—�XRNroFe ' <: / �r'r
Address �.��/-<s-tp-e=�: S�T � �
Arch/Eng. � License No.
Address
ConVactor's Nam 5 ,r� Phone
Address�m���'n�l q�z�r��2� mQ,� �/�• Q-�
City License Na =LL� �T
LICENSED CONTRACTOR DECLARATION
� 1 hereby affirm that 1 am licensetl untler provisions of Charte� 9(commencing
with section �000) of Division 3 of the Business antl Professions Cotle, antl
my license is in tull for e af tl� etfect.
License Class '"' y�' Qicen o.1��s_lf��
Date ' s. � t 1�1 s.,Nt�.tl
WORKERS'COMPENSATION DECLARA ION
I hereby affirm [nat I have a certitica[e of mns¢nt to sel(-insure o� a ce�tificate
t Workers' Compensation_ Insurance, or a certifietl copy tbereoi (Section _
300, Lab.,CJ ' .
Policy No. ' Company
Certifietl copy is hereby furnishetl.
Certifi¢tl copy is file0 with the city Builtling Division.
Date AOPlicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(Thisse<tion need not be completetl if the permit is for one huntlred,($300) or
less).
I certify lhat in the pertormanc¢ of th¢ ork (or whlclhthis Derm� i ssuetl, I
5M1a11 not employ any person in any m nne� so as to{become s�' ct to thE
Worke[g_Co�mpa�(Mion L"aws of Califot i��t� 1' _.. d/
Date� g � Signature �•�0�'�'�"'
��NOTICE: If, after making this decla�atio you oultl become su ject to the
�� Worke�s' Compensation O�oviSions Of Ihe Ldbot Cotle, you must fo�thwith
comply with such provisions or this permit shall be tleemetl �evoketl.
�� CONSTRUCTION LENDING AGENCV �
I hereby affi�m that there is a construction lentling aqency fo� [he perfo�mance
of the work for_ which this permit is issuetl ($ection 309] Civ. C.) .
Lentler'S Name
Lentler's AtltlreSs � �
OWNER BUILpEN DEGLARATION ' �
I M1eteby affi�m that I am exempt frOm the ConVactor'S License Law tor the
followin9 reason (Section 7031.5 Business antl Professional Cotle: Any city or
county wM1ich. requires a permit to const�uct, alter, improve, tlemolish o� repair
any structure, prior to its issuance, also requires the appiicant for such permit
to file a siqned slatement that he/she is licensetl pursuant ro the provisions o(
tne Contractor's License Law (Chapter 9(rommencmg with Section 7000) o(
Division 3 of the Bu5ine55 antl Professions Cotle) or ihat he/she is exempt
'herefrom antl the ba5i5 to� the allegetl exemption. AnY violation of Section
)31.5 by any applicant for a pe�mit subjects [M1e apPlicant to.a civll
tnalty ot not more than tive huntlretl tlollars ($500).
❑ I, as owner of the properry or my employee5 with waqes as [heir sole
mmpensation, will tlo the work, antl the structure is not intentledbr offeretl
for sale (Sec[ion ]044, Business antl Pro�essional Cotle: The ConVaclor'S
License Law tloes not apply to an owner of a properry who builds or improves
tnereon, antl who tloes su�h work himself/herself or through his or her own
emplOyees� plOvitletl tha[ su[h improvelnent5 dIe no[ in220tletl OI Oft¢Ietl fOI
sdle. If, bowever, the building o� improvemen[ is soltl within one year of com-
pietion, [he owner will have the bu�tlen Of proving he/she tlid no[ builtl o� Im-
prove for the purpose of sale).
❑ 1, as owner of the property, am exclusively contractinq with iicensetl con-
ttactorsto mnst�uct the p�oject (Section ]004, Business antl Professions Cotle:
Tne Contractor's License Law tloes not appry to an owner of prop2rty who
builtls or improves thereon, antl who mnVncts fcr sucn projects witn a com
tractor(sl license pursuant�to the ConVactor's License LawJ. I am aware that
proof o� thei� WorkeYs Compensatlon insurance shoultl be provitletl to me.
❑� 1 am exempt untlet Section 8. & P. C. for Ihis reason
Date Owner
I hereby certify that 1 have reatl this application antl state that the above
information is mrrec0 I agree to cornpty with all city antl county ortlinances
antl state law relating to bui�tling construction, antl hereby authorize repre-
sentatives of his city to edter upon t e-above-menkioned pvoper�Br
Inspection p po5es. ( � �
Signature �• � Oate—�
Drivers' Li ense or 55 � �
� �„�.�, � ...,..,. .._. __. .._. �. .
Pl�fd�3
TYPE OFCONSTRUCTION NEW ADD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG.
TVPEOFPERMIT LJ GRADING LJ FOUNOATION LJ STRUCTVRAI. -
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER �
PROJECT DESCRIP710N 5(?. FT. ocCVvaNCv
CONSTRUCTION TVPE VAWATION $
ZONE GRADINGCU.YDS. AGRES
Rema�ks:
Bar Sink
Backflow Preventer
Backflow Irrigation
Bathtubs
Claritiers
Dishwasher � '
Drinking Fountains
Floor Drains
Flaor Sinks
Gas Service ' ' Outlets
Interceptors
Kitchen Sink� � ,
fioof �rains
Reinspection Fee ' � , $75
Duct- UnderGround
Duct - Structural
Duct - Ven[ilating
Exhaust System ❑ .MWtiple ❑
Firepl/Fact.6lt. ICBO # �
Heating System & Ducting
❑4700,000 BTU 0100,OOOBTi
Rainspection Fee � $15
CMF OB65-46, rev. 30/84 White - Builtling; Canary - Applicant: Pink - Accounting; Goldenrotl - Assessor
Showers
Service Sink
Sewer Cap
Sewer Connection '
Solar Collectors
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet �
Water Heater
Water Service '
Auto-Wash
Laundry Trays '-
Issue Fee
Hood or Type I ❑
Canopy Type I I ❑
Refrigeration System
❑0-100,OOOBTU ❑100,000
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
$ 3
FEES
$ 3
A.P. #
S' Main Buildi
E
T Front
B Rear
A
C Ri9h[
K
S Left
Ping. Ref. #
Planning Notes:
Automatic
.Cooking Unit �
Dishwasher "
,Dryers ❑Gas'�
F.A.U.
Fixtures
Device Boxes
O ut leu
Switches
Garbage Disposal
Generator �0�5 KW
Fee
3202 5/20/B5
�.
_� Zone
Accessory Buildin9:
Parking Req./Provided
ELECTRICAL �
Transformer ❑ 15-50 KW
❑ 50+KW
Meter ❑up Lo 100 amps �
Merer ❑over700amps
5KW
$15
Sub Panei
Motors OO-7 HP � 1 X- 8
Inc.Solar �9-15 HP �16-15+
Microwave
Pole Light
Ran9e
Sign
Standing Sections
Tresh Compactor
Issue Fee
DEVELOPMENTSERVICESREQUIREMENTS:
Zoning Approved By
8uilding Appraved By �
Aoolication luued Bv
5.E0 TL
FEES
$
SUMMARV OF FEES
BUILDING PERMIT $ SMIP $�
PLAN CHECK $ PERMIT
PLUMBING $ S• �� ISSUANCE $
PLAN CHECK 25% $ ENERGV P.C. $
ELECTRICAL $ GRADING $
PLAN CHECK 50% $ MICROFILM $
MECHANICAL S TOTALFEE $ S-.J�Z�i
PLAN CHECK 25% $ '
2
O
N
I
N
G
R
E
Q
M
T
S
-� r'�,
' CONSTRUCTION AND PLANNING POOL PA �
' l�1PPROVALS Permit# Date Inspector AppROVALS Permit# Date Inspector
1. Temporory Electrical Service or Pole � 52. Pool & Equipment Location
2. Soil Pipe� Undrgrnd. �, � 53. Steel Reinforcement -
3.;�.Electrical Conduit, Utility-Undrgrnd: - 54. Forms '
4.� Electrical Conduit-Undrgrnd. � 55. Electrical Bonding
5. Steel R"einforcement 56. Rough Plumbing & Pressure Test -,..
6.'El�ctr,ical UFER Grnd. 57. APPROVAL TO COVER-GUNITE ��
7.� Footimgs� .' � _. ' 5S. Electrical Conduit-Undrgrnd. '
8. Foundation i '� 59. Gas Pipe, � Undrgrnd., Test '
,
9. Water Pipe-Undrgrnd. " " 60. Backwash Linee, P-Trap, O Undrgmd. �
10. Stiuctural Floor System ' . 61. APPROVAL TO DECK '
11. Prope"rty Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Se�ver�Cap ' � 63. Heater & Vent-Final
13. Roof Drains � 64. Plumbing System - Final
14. RougFi Plumbing ' � 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16..Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
78. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning �. FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Duc:ts, Ventilating 7.1: Product Piping O Gas ❑ Oil
23. Gas Pipe�Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank � Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frameand Flashing . 76. DryStandpipe
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-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning ' � �
35. Final Gas Pipe-Test $� 2/ 7(S �A
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing 5 u�`J ��
39. Water Service-Final
40. Gas Service-Final -
41. Solar pomestio-Final �
i
42. Backflow Preventer .
43. Backflow Irrigation
44. �Landscape Irrigation System � '
45. Sound Attenuation
46. Handicap Regulations
47. FINALSTRUCTURE&BUILDING �
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY �
No. Date
�-
' � r 1���2
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 31] COSTA MESA. CALIFORNIA
FOR APPL/CANT TO f/LL /N COMPLETELY
TYPE OR PRINT
BUILDING
ADDRESS ^
COSTA MESA. CALIFORNIA
MAIL
A�pRESS � � ' .LIa �J
TEL.
CITV - ^ ����� NO.
ARCHITECT , .// ,y� _ A LIC.
CONTRACTOR IC. NO. / �
1
ADDRE55 � �'
�ec�� I LOT �� I I
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A.P. NO.
SIZE . n�'y / 7.�� I NO.OP e�ocs..
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CENTER OF $TFEET V V REAR YAI
n( /
SIDE YARO LEFT �+ RIGHT
DESCRIPTION OF WORK
..�.a�_��.i
:RIOR WALL IROOF
ERING COVERING
OF BUII�ING AND WORK TO BE PERFORMED
I HEFEBY ACKNOWIEDGE TMAT I MAVE flEAD THI6 APPLICATION
pND 6TATE THAT THE �BOVE 18 CORHECT ANO AGREC TO COM-
PLY WITH ALL CITY OPOINANCEB �� BThTE LAW9 NEGULATING
eUILOING CON6TRUCT � / '
/
SIGNATURE OF � � � � �
PERMITTEE
AUTHORIZED AGENT
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, �, � ��; '� 1�; �' �� �.. �
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��IY��iIYV� CJLI �.
APPLICAT I ON`�FQR I',PERM IT
BUILDING
fo,e officF usE oacy
RECEIPT NO. P.F�RbltT
�t�7'1`,
ftECEIVEO BY OATfi CEIVED ATE IS:
�� � .�l _ �.a —_,�9� %/)— �
M ESA,
v A:If'� ZONING
ZONE L� I NO. OF I USE OF NEW
PLANB � 6UILOING
APPROVED
BY DATE
YARDS EVES �
REQUIRED ALLOWED
(LENTEN LINE ST.)
FRONT �S� 7�' FT.
��
n.�
THE AMOUNT BNOWN UNOER VALUATION IB FOR THE
PUHPOBE OF EST/�BLISHING q PERMIT FEE ONLV.
VALUATION
` PERMIT FEE S �O •�'
g //� PLAN GHECK $ S �
�` aO ��v TOTAL FEE $ IS �
,� �_ 1���J
COS7A MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 31� COSTA MESA. CALIFORNIA
fOR APPUCANT TO F/[L /N COMPLETELY
TYPE OR PRINT
ADORE55 ^ O WCR
COSTA MESA. CALIFORNIA
MAIL
ADDRE55
LIC.
� ADDRE55
■ LEGAL
A.P. NO. ' � �
512E �OX I�� S INO �F BLDGS.
OF LOT • now on wi ,
USE OF n`�,,D t�`L
EXISTING BLDG. /r� � c �.-.
SETBACK LINE FflOM r � .S
CENTER oF STREET �/ O REAR YARO�
SIDE YARD ILEFf � IRIGHT
DESCRIPTION OF WORK
NEV _
REPAIR
BUILDING
SIZE
BE
I HEflEBY ACNNOWLEDGE TMAT I HqVE REAO THIS APPLICATION
/�ND STATE TX/�T THE �BOVH IB COFRECT AND AGPEE TO GOM�
PLY WITH ALL CITY ORDIN�NCES ANO BTATE LAWS REGULATINO
BUiLDINO CONSTRUCTIO
SIGNATURE
PERMITTEE
AUTHOR ED AGENT
��� RE����, �3 .s %
fINANCrE OEPT•
APPLICA�T,I'O�IS FORA EE MIT
BUILDING
FOR OFF/CE USE ONLY
I FECEIPT NO. � PERMIT NO.
COSTA MESA, CALIFORNIA
FIRE
ZONE
ZONING
ZONE I NO. OF � U9E OF NEW
PLANB BUILDINO
APPRO
BV � � D TE
VARDS ' EVES
REOUIRED ALLOWED
(CENTEH LIN! BT.1
FRONT ��FT.
R. SIOE ' S F'f.
r.e
«�� —.�.syv�.._. �� .r.7.
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t '
�„� � ����nvFn — �`S
' — — — �-." � ^ -'
��
THE �M NT 9HOWN UNOER VALUATION I6 FOR THE
PURPOS OF CBT�BLIBNING � PERMIT FEE ONLY.
VAIUATION
f7 � � /D PERMIT FEE S ��v �
g ' / D �' PLAN CHECK $ ��J �
TOTAL FEE S `?(� �
r "''�. 53U6
COSTA MESA BUILDING DEPARTMENT
P.O. BO% 31]
COSTA MESA. CAIIFORNIA
FOR APPLICANT TO FILL IN
BUILDING /J+/� � ��OIU��(
ADDRESS 7U�C
COSTA MESA. CALIFORNIA
MAIL
ADDRE55 �
CITV �
ARCHITEGT
OR E�"'NEER
ADDk�,aS
�EGAL
OESCRIPTION
A.P. NO.
SIZE
EXISTING O�DG.
SETBACK LINE FROM
CErviEF OF STFEET
LIC.
� �//ij. NO. 7/O
CITY LIC.
6 No. iY
TEL.
C . NO.
� BLOCK TRAC
— S
^ NO.OF BLOGS.
/ �IOW ON LOT
vb:v7i� L
1
REAR VARD
DESCRIPTION OF WORK
NEW ALTERATION ADDITION
REPAIn MOVING DEMOLISH
BUILDING (� NO.OF
SIZE /' ROOMS STORIES
EXTERIOR WALL ROOF �<', j-S7r�
COVEf21NG COVERING ALuM
�
FEE RECEIVED
FINANCE D P,�� f� r 9. ��
APPLI'�,4'1'TF9f��R PERMIT
BUILDING
FOR OFFICE USE ONLY
REGEiPt NO. PEFMIT NO.
a fO BV DaTE RECENED AiE ISSIIEO
,-.5 -s k
3UILD NG , '
40DRE55
COSTA MESA. CALIFORNIA •
FIRE I
APPROVE
C�
PLANtG��IG DCt'T.
ST<TE THAT TNE �BOVE 15 CORRECT �NO nGXEE TO COMPLY WITN �LL
CITV ONpIN/.NCE9 AND STATE L�WS REGULnTING BUILOING CONSTRUC�
1wn. V q W ATI ON
� PERMIT FEE S � ,_
SIGNATU1iE OF '/
PERMITTEE j
/�/ PLANCHECK S
S � n .
AUTHORI ED AGENT TOTAL FEE 5 O� ��' �°'��