HomeMy WebLinkAbout467 ESTHER ST - Building Permits.. -, � ` �
� J CITY OF COSTA MESA _
� BUILDING D/VISION
� � DEVELOPMENT SERVICES DEPARTMENT
� � PERMIT PERMIT NU R
��
698-01365
(714) 754-5273 • Fax (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626
JobAddress: 467 ESTHERST
Suite:
Vicinity:
Parcel Nunmber: 42632301
Applicant: LINSKY, PATRICIA
Address: 467 E ESTHER S7
COSTA MESA,Cq , .
Ownec LINSKY, RONACD�B TR
Address 467E�ESTHERS7�. -
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/ � �
_ � COSTA MESA,CA _ - �
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Contracfor: � , .
Address: � =�
i
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Arch / Eng :
Address:
BUILDING PERMIT
Zoning:
� � Ptione: (949) 6503431�
2ip: 92627
Phone: ,
� Zip: 92627
Phone:
Zip: ,
4'
Licenser.-
�,.
� � __
'Phone:
Zip;
License:
Status: ISSUED
Applied: 07/3111998
Issued: 09IO2/1998
� � ��.
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\
SCOPE OF PERMIT
, �354 SQ.Ff. ADD1710N TO THE PRONT AND SIDE OF EXISTING RESIDENCE �
FEE SUMMARY
Plan Check:
Permit:
SMIP Res:
SMIP Com:
Other:
Inspection:
$250.74 ` -- - ` Calc Valuation:
$385.75 =- � j Claim Valuation:
$2.89 - .
$0.00
$0.00
$0.00
Total: $639.38
PLANNING R ZONING
SETBACKS
MAINSTRUCTURE Front 22-0
ACCESSORY Front 0-0
PARKING Existinu: o
NOTES:
Rear 0- 0 '
Rear 0- 0
Required: 0
Left 0-0 Right
Left 0. 0 Right
Proposed: 0
15- 0
0
,
82a,951.00
so.00
����� � J��
��� � 1 `� e �� S�
9�',�r, `�S
�o
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or i1 work is suspended or abandonad
for a period of 180 days.
INSPECTIONS: In order ior the wak aulhorized urtder ihis permit to be considered legal, such work must comply with all appl'rcable codes, and all
requlred Inepectione and final epprovel must be obtained. Failure to obtain inspections and final approval wlll result in tha expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545628
�
WORKERS' COMPENSATON DECLARA710N:
I hereby ettirm under penelry of per�ury one of the following declarations:
❑ I heve entl wlll maintein e cenlNceta of consent to self-Insure for workers' compensatlon, es proWtled for by sectlon 3700 ot the Lebor Cotle, for Ihe pertortnence oi the
work for which Ihis pertnit 15 i55ued.
❑ I have arM will meintein workers' compensatlon insurance, as requireA by seMion 3700 of the LeOor Code, for Ne peAortnence ot the work for which NI9 peimit Is issuetl.
My workers' cOmpensetion Insurance carrier end policy number are:
Carrier: � Policy Number.
(Thls secUon need naf be canpleted /I Ne permit is velued et one huntlretl tlollars ($100J or /ess.J
❑ I certify Ihat in �he peAortnance of the work far whlch this pertnit Is luued, I shell not employ any person In flny manner so es to bewme sub�ect to the workers'
compensetlon �aws of Celilamla, end egree thet H I s�ould hecome subJecl to the workers' compensation proWsions of Sectian 3700 of Ihe Lebor Code, 1 s�ell fonhwith
compty with these provisions.
Applicant Signeture: Dete:
WARNINO: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UMAWFUL AND SMALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND GVIL FlNES UP TO ONE MUNORED
THOUSAND DOLURE (E100,000). IN ADDITION TO THE COST OF COMPENSATION, DAI.NDES AS PROVIDED f-0R IN SEGTION �OB OF THE tPBOR CODE, INfERE5T, AND ATTORNEI^S FEES.
LICENSED CONTRACTORS DECLARA710N:
f hereby effirm that l em licensad undar proJisions ot Chaptar 9(commancing w}m Sectfon 7000) of DlNsion 3 ot ihe Business end Protessions Cade, entl my Iicense is In full
force end ettect. Lic. k Class x
Contractor's Slgneture: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby atfirtn ihet Ihere Is e construction lending agency for the OeAormenca af ihe work for which this pertnit Is Issuad. (Sec. 3097, Civll Cotle).
Lentlers Neme: Lendefs Address:
Signetu�a: Date:
OWNER-BUILDER DECLARATIONS:
I hereby eHirm that u�tler penalry oi perjury ihat I flm E%EMPT FROM 7HE CONTRACTORS LICENSE LAW tor Iha following reason (Sec. 7031.5, eusiness anA Professions
Code: Any ciry or cou�ry w��ch requlres a pertnit to construct, alter, improve, demolish, or repair eny structure, pdor to its issuance, elso requires the applicant for such permit
to file e slgned statemem tha� �e or she is Iicensetl pursuent to �he D�ovislons ot Ihe Conirecrore LJcense Lew (Chapter 9(commencing with Section 7000) ot DlNslon 3 of the
Busineu and Profess�ons Code) or t�et he or she is exempt ihereirom end the basis tor the allegetl exemption. My Ndation o1 Section 7031.5 by any epplican� for a pertnit
subjects Me epplican� to e civil penelry of not more Ihan five huntlreC dollers (3500�.):
❑ I, es owner of Ihe properry, or my employees with wages as iheir sole compensation, WILL DO 7HE WORK, an0 ihe strudure is not Intentletl or ottered for sale (Sec.
7044, Busine55 end Protessians Cotle: The Coniractors License Lew tloes not appy to en owner oi property wha builCs or improves ihereon, end w�o tloes such work
hlmself or herseli ar ihrough his or her own employees, proNded Ihat such impmvements ere not Intended or ofrered for sale. It, however, the building ar improvement is
soltl wit�in one year ot compleNoq the owneo-builder will have the burtlen of proving that he or she tlitl not build or improve tor puryose oi sale.).
❑ 1, as owner ot Iha property, em EXCWSIVELV CONTRAC7ING WITN LICENSED CONTRACTORS to construct Ihe pmject (Sec. 7044, Business flnd Professions
Code: The coniractors License Law does nol epply to an owner af property who bullds or improves thereon, en0 who contracts for such project wlth e canirector(s)
Ilcense pursuaP� to the Contrectors License Laws.).
❑ I em e t u der s�c.
Slgnatura: � _ �n'�^
Owner ID veniied by tlnvefs license' ❑ Yes
Business antl Pmfessions CoAe tor Ihis
Verificetlon o1 OwnaYship by (rype of document, i.e. - property taz bill or deed):
Dnvefs Llcense No.
Date:
Explres:
DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION:
❑ I hereby certity Ihet no excavation Me (5) or more teet in depth Imo whic� a Derson is reqWretl to descend, will De mede in conneIXion wlth work euthoAzetl by t�is
pertnit, end Iha� no building strucWre, sceflolding, falsework, or demolition or dismentling thereoF, will be more than ihirty-six (36) feet high. (Chep. 32, Gry 2, Art 2, Sec.
34t, Tllle 6, Ca���amia Admialstretive Cotle).
❑ As ownerDulltler, I wlll not employ enyane to tlo work which would requlre a pertnit Irom ihe Divisian of Intlustriel Sefary, es noted above, unless such person has e
pertnit �o do such work from ihe tlivision.
SignaNre: Date:
Division of Indusirial Sefery Permit Number:
CERTIFlCATE OF COMPLIANCE AN� AUTHORIZATION OF ENTAV: I certiry under penelry oi perjury ihat I heve reed this applica�ion end stete ihat ihe infortnation given is
correct. I egree to comply with all state laws end ciry ordinances releting to building construction, and authorize representatives of ihe Ciry ol Costa Mese to enter upon the
ebove-tlescdbetl property for inspection purposes. I agree not to occupy or ellow occupancy of eny building authorized by ihis parmit until finel Inspection.
Sig re Of Leg Ownar(s) Dete
�,',J . ,v�� � � 9 � -�x /
And/ r Authonzed A licant Date
yppE,�� aee�rnnuME UA7E Itfl�lLS
_ Ims
1616 Fixed System Finel Fire Prevention
126fi
200
201
202
203
204
z44we
Pool Spa Final
Finel Re-RaP�
Finel BIocWReleining Well
Finel FectOry F��B Plece
Final Sign
Flnal Demolitlon
GOOEt INSPECTONTYiE
206 Finel Mechenicel
200 Finel Plumbing
210 Final Elaccriral
212 Final Fira Preventlon
220 Final Planning Approval
222 Fin01 Site
250 FinalBuiltling/Occupancy
�
PflOJECT POOflE55: q 6 7 ES THER ST
OWNEN'SNAME: LINSKY WALTER F
ADOHESS: 467 ES'1'HER ST
COSTA MESA,CA
pqCHIENGINEEfl: 3 8 �— 1 9 9 �
� AODflE55:
uxir:
92627
HEG.NO.:
uxir:
"E"minEE' GREATER PACIFIC ROOFING (714>836-1966
nooeess: 1016 E. FIRST ST
SANTA ANA CA 92701
IICENSEO CONTBACTON OECIAflATION: I �ere0y allirm I�a� I am Iicen5e0 un0er pmvisions of C�aD�e� 9 kammencing wilh $ectian
7000� ol Oiv'9M 3 of I�e Business and Pmfeuians CoOe, an0 my license is in full lorce dntl eflecl.
CITYIIC.:(�56858 sT"TE"c.:62136 `^SS� 9
oa�e�. ,1 .`� — q � signat . _ _ _
WOflNEBS'COMPENSPTIONOECLABATION: Ih eUyatfirm� a[ertilicateo�tonSen�IOSeI-in5ureoraCe�i�iWtea�Wotker5'
Compensation Insurance. or a rertifietl coDY �h eol (Sec � 0. LaG. C).
Poucrxo.: z85-93UNIT00 EX. ATE: OS�OLI94
comraNv: STATE FUND
❑ Cenifietl copy is nere0y Iumisne0. � Cenilied cooY is liled wit e ly Buildin ivision.
Date: �� T� � I� AVPiica -
ENEMPTIONFflOMWOPNEHS'COMPENSATIONOEC AiION: �T�i55ecli nol0ecomplete0i�thepermi�isloronehurbretl�5100�orlew�.
I ceNfy thai in Ihe petlormance of ihe work lor wh �his permil is' , I shall nat employ any person in any manner sa as �o become
sublecl to �he Workers' Compensalion Laws of Cah .
� Daie: SignaWre:
� NOTICE: II, after making ihis tleclaraiion, you shoultl �ecome Subleci �o �he Workers' Compensa�ion pmvisions of Ihe Labar
Cotle. you must fon�with comDly wilh suc� provisions or Inis Dermil shall be GeemeU revokeA.
CONSTPUCTION LENDINC AGENCY: I hereby alfirm I�al I�ere is a cons�mction IenAing agency lor �he pedormance o� Ihe work tor
wnich ihis oermit is i<suetl (Section 3097. Civ. C1.
LENDEP:
AOOPESS:
�
OWNEP BWLOEB oECLAflATION: I hereby aflirm ihal I am exempt Irom Ihe Contractors' State License Law lor tne tallowing reason
(Sec�ion 7031.5 Business antl Pm1e55ionai Cotle: Any city 01 county which repuires a permit �o ron5imcl, aller, im0�ove, tlemolish, or
repair any slmcWre, prior �o iis issuance. also reQuires I�e applicant br SucA permit to tile a 5igneU sta�emen� �hai �e/she is licensetl
pursuanl lo Ine pwvisions o� t�e Comracmrs' State Lic¢nse Law �Chapter 9(commencinp wit� Section 7000) ol Division 3 oi �he Business
an0 Prolessions Code) ar I�al �e/ihe is exempt I�erelrom antl ��e basis lor ��e alieged exemp�ion. Nny violation ot Section 7031.5 by
any applicant �or a Oermil subjec�s �he aODlicanl Io a civil p¢nally ol not more Ihan five hunErea tlollars (5500�.
I. as owne� ol Ihe pw0eny m my emyloyees wil� wages as Iheir sole compensation, will do lhe work, and �he
❑ simcture is not inlen0e0 or ollereC lor Shce (Seclion 70Ga, Business anA Proleuianal COtle: 7he Contractors' State License Law
Ooes not apoly to an owner ol a o�oPeny wno ouil�s or imo�oves Ihereon, and who Ooes such wod himseltlherself or inmug�
his or �er Own ¢m01oy¢¢5. OroviOetl ��al SUCh imD�Ovemen�5 are noi in�ena¢d or oil¢reU lar sale. I1, hOw¢ver ��e Duiltling ar
imOmvemenl I5 sdd wilhin ane year of compl¢IiOn. IAe awner will �ave Ihe Gurden o� pmving he/she Did no� �ui10 or impmve
for ine Durpose ol sale�.
I, as ownei ol the D�operty, am exclusively comraclinp wi�� licensed comracma ro consimct Ihe O�olec� (Seclion 70ad, Busineu
❑ an0 Piol¢Ssbns COAe' The fAniradors' Slaie LicertSe Law Oou noi appty to an ovmer o� D�apeM � bUilEs or improve5 t�ereon
an0 who conVac�s �or such prole��s wi�� a conlracioqs)lic¢nse pursuanl �o t�e ConVaclors' State License law�.l am aware
Ihal O�ool ol ��eii Worker'S Campensalion insuran[e 5hou10 Ue O�onCeE to me.
� I am exempi untler Seclion: B. 8 P. C.
lo� this reasan:
Da�e: Ovmer.
I tlo nereoy cenify ihat I am aware ol and unaerslana ine repuiremenls al Califamia Health an0 Salety Cotle Sections 2550.5, 25533, antl
2553G an0 t�a� I or any tuiure Ouilding occuDani will/will no� (tir[le one� neeC to com0ly vnth uiG s�ate codes and ihe requirements br a
permit far consimclion oi moailicalion imm Ihe Air Ouahry Managemeni UiSiricl. Fesidenlial conSVutlion apDlicaiions are exemD� ��om
inese pmNsions. �
Dale: Nppl¢anC _
I hereby cetlily Nal I �ave iead Nis applica�ian anA Slale Nal
ortlinances antl slate laws rela�ing �o butl0ing consimction ana �
pmperty( �loi inspecimn purposes
Oaie: `�Y' /'l � � � S'n�
�river's License or Social Securi�y a: �� �
�641-46 W���le—�uiltling; Grnen—Cotla Enlorcemenl:
is correci. 1 a complY `u%h all ci�y ana wunry
nlaliv Ciry�oenlerupon��ea�ove-meniionetl
Pink—Pevenue; Goltlenmd—Assessor
' I1
CITY OF COSTA MESA — BUZLDING PERMIT PERM NO; H 063866
PERMIT NO; B 063866 PLAN CHECK NO: N GOVT; N SUPP; N
CONSTRUCTION TYPE: 5—N PERMIT TYPE: STR PURPOSE: ALT
JOB DESCRIPTZON ; T/O SHARES,RESHEATH 1/2"CDX,APPLY COMPO SQ FT; 8,350
CLAIM VALUE: 8,350.00 CALC—VALUE: 8,350,00 GROUP OCC: R-3 /M—i
COMMENTS: SMOKE DETECTORS RE�UIRED PER 91 UBC REROOF 3200SF RESDI 6 GARAGE
x+t*�r�r�r�r+r�r�r+r�r�r�r�r�r�r�t�r+r�r�e�r�r�r�r�r�e �e�r�r�r*�r�r*�r+t�t*��t�r�r�t*�r*�r�e�t+r�r*�r��r*�r�r +t+r�r��rx�**�r*
Z O N I N GS ERTEBQAUCI](RSE M E N T S ���' iPp,
�l R ����
------------ MAIN HUILDING ---------- --------- ACCESSORY:B�I.T.LD�� �j
FRNT: FT IN REAR; FT IN FRNT: FT IN REAR; tP
LEFT: FT IN RGHT: FT IN LEFT; FT IN RGHT; FT IN _
PARKING REp • PROV; PARCEL; 92632301 2NE; REF NO:
PLANNING N(5T'ES> ,
��
iE if if if if if 1f if iF 3f M iF iF 1E if iF if if if if if ik if �f iF ik iE ik ik i! iE k if k if iF ik if iE if ik �f iF iE ik 1EiF iE �E �E �E iE iElE iE ik ik iF kiE iE if iE iF 1FlF ikif iE 1ElF !E iF ik ik iF �E it 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
ZONZNG APPROVED•BY DATE; '
BDILDING APPROV,ED BY ; DATE:
APPLICATION ISSUED BY• � DATE: �, P� ,
iE 1E iE iE iE iE 1E iE iE 1E if iE 1f k:k M� if if if k iE iE'�F'if'iFifiFiF�F3F3FiE'iF3E3f7FiFiFi�iFiFiF3F iF'if�F�F�FiFiF'{FiF7F if if iF ff iE iE if 1! if iF i! 1f
�fE iFiE if iE # if if iE iE if k 3f �F 1E if if if 1f if if iE if if k if iE iElE 3f �lF 1E if 1E iF if !E if if �E iE iF iF iE ik if if iE M itif iE �E if if iE 1E �E lf iE if if if it iF if 1F iE if iE iF iF !P 3E iE IE ik 1F iF
LEGALIZATION:N F E E S U M M A R Y STRUCTUiiAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC '�FIRE SMIP/RES GRADING
PERMIT 108.00 ,84
• SMIP/NON—RES
PLAN
ISSUE FEE
HUILDING—DIV—> PEAMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 108.89 0.00 0,00 108,84 108.84 ,00
REVENUE DIVISION TOTALS--> COLLECTED: 108,84 OVER/SHORT: ,00
HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
108.00 ,84
1F 1E iE 1E 1E it fE if IE iE ik iF iE if if iF iF iE iF �E �F �E iE 1E iE iE fE ik iE i! fE if iE iE 1ElE �E iE iE iFlE7E i! iE iE iE ik 1E iF iE if ik ff 1f it iF 1E iF iE iF 1ElE fE iE 1E iE iF iE 1Elk 1E 1E ff If iF 1f iE 1E 1f
I N D I V I D U A L F E E B R E A K D O W N
TYPE
SFR
QTY
8350
! �7 �^Si�;1� � i I� ���.i
REROOF BY VALUE RESIDENTIAL NOZONE
END OF FEES
IINIT COST TOTAL COST
1.00 8,350.00
O1 Q014b521-0014b522 Til T 108.E4
DATE: 6i/D3/43 TI17E: il:ib
i CONSTRUCTION ANU PLANNING
I APPROVALS Permit�
F
I 1. Temporary EI¢ttncal Serv�ce or Pole ,
2. $o�l Pipa-Undrgmd.
3 ElectriCal Conduit UP�ity�Undrgrnd.
V
i 4. ElCctrir2l COnduit•UndrGrnd.
5. Steel 7::in�o�czment
� G. E ^ct.c:.: LFER G•nd
I 7.'Poovn:;' . '
8. FaunGahon •
9. Viater Pipz�Undrgmd. � � '
70. S!•uctu�a' Floo: System
11. Pr�pe�t5' S'�ve� �_ine & Ho�sv C4nnect�on
� i2. Se:.e• .r,2p
. .�3. qc]Y (Jr3�n5 '
� ?4, Ro�g� Pl�mb,ng
� tfi �g'�^ E'eetripl-Condu�t
� - -
� 76. Rou�h ElectrittiV�rinq
77. Ru�gh�V�nng 9gn
18. Rou�h Eleetrie�l-T Bar Ceilmq
� i9 Ru�gh Hea[iag & A�r CqndiLoning
� 20. Fo.yr �qctory F�ren';ce � �
•-r--
21. Ducts, in Struttura i���
22. Ducts, V�ntiiyting'
23. ��ias Pipe�Rough & Tesi .
24.'�ioo` Framing' �
25. Roof Sh: athing
26. T�Ear Cci!inq �S[rccturall & Clonocoat
27. Fra,�ne r� Flash�^.g
2B. L'.thdnp G Siuing ' � �
29. Insul>tio� � .
30. Dryv:a�Pi\:ailydg ' ,
31. ?�astn Eronn.Co�.t•
- --.�__--�-
37 'E�t.,.t• �;� Po��lr• '.�.:ler�F -.a:'
--�
33.�F; ' •
i a: 5?:tr.c . i
-�-
34. F��nal i�cri,ng.�..� Ar Cu^.d�non�r.G �
�
�35. Finai Gas PipR�Test ,
- -�"--------
'36. Hocd o^ CanopY
37. Fira� Factary Fheplace '
3$ Fm;.. P��mbin9
39. C:ater S.,'nez�fina�
40. Gas Ser�,cu.F;;�a!
41. Salar Oomes:icFinal '
42. Backflo�.n P�evantcr
43. B2Ckflpv�lrngation
4C. L.:.ndscsp: Irnaation Svstcm
45. Sound F.!t:nUation .
46. Hand�ca��Re3olauons
47. fINAL STRUCTURE & BGILDING
4$ FINAL PLANNING
49. Elcctric Release to Etlison
--�- -
.
50 Gas Release to Southe�f� Cali(prnia Gas
51. CERdiFICATE 0f OCCUPRNCY
Daie
Date � Inspector
�
+ �.. ,
POOL A
APPROVAIS Permit -tr Date Inspector
52. Pooi & Equlpment Locat:on
53. S!eci Reinforcement
rJQ, �OimS
55. Electrical B�nd�ng
56. RouG'� Plumb�n3 & Pressure Test
57. A�P�C'JAL TC COVER GU�;:�TE
58. El:ctrical Cocd�4�Undrgrntl.
59. Gt•, P�p<, u U^�tlrgrnti., Test
60. Backwash Lines, P-Tra0. � Undrarnd
61. APPROVAL TO DECK
62. BaCc::�-o tii Reeau�o•�Fin��
G3. He�tc� & \':nt��inal
64. PI�m6ing Syi'ern . r.�al
65. F.::ctrreed�F;nal
G6. Safar System-F.na�
67. Fencing & ACccss Ar�p�usa�
68. APPROVED FQR PLASTERi!�'G
G9. POOL.�.�'iPASYSTE'.;SFIPJqL
FIRE DtPT. REQUIREMENT
r\PI�ROVqLS• Perm�t ,. '
70. Underg:o5rid'HYhro �
�71. ProductPip�i�[7Gas CiOil
72. Underqround Fhqs�� � �
'.73. � Undergrnd, Storag � Tank C Gas � 0� �
74e.O�erhedd HV�Iro
75. Ory Chem���a�
76. Dry Standp.i.e .
77. .FIXED SY�i EY�f tNA� , �
--i -78.- FIRE PREV. F- INH�� - �
--+I HEALTHDEPT.REQUIREJ�:IEn�7
I 79��FI�fAI !P;SPECT!J�v ------ � i � --;
1_..� __� -.- ,
8J''FOGD CENTiFIC`,TE ;SSUED -T- -� �
�--� --- r -�'-- � -'
iVotes: • . . �
�--� -�--T---- •
_�
�
- �
ApD���ant lo flll in all spaces exeepl those wi�hin heavy Dortle� Ilnes anE tlgn all aD0/o0��ale Eetlarallons.
Gi7Y.oF COSTn ME�S� CONST C ION PERMIT
Project Address �!!L �.
Applicant's Mailing Address -3
Owner's Name n Phone
Address �
Arch/Eng. License No.
Address �/��
Contractor's Name � �1��/-j�pj[ Phone q(�tl
Addreu (m 3���_/� _1 � 6�7L�fL_7��
Cit Licence'Nn' c �t rl 1�i 7��
LICENSEO CONTRACTOR DECLARATION
I hefeby ailifm [bal I am IiCenSetl untlar provi5iOn5 ot Chdrter 9(commGnCing
with section ]000� ot Divislon 3 of the Business antl Professlons Cotle, antl
my Ilcense is in (u11 t rce antl eflecL �
ucen:e :: 5en� o.
� Date ���..� 5�g � y �� �i
WORKERS' OMPENSATION DECLARATION
I hereby atiirm Nat 1 have a cerliticate of Consent t0 SeH�nmr! Or a certifiCate
�-� Wo�ke�s' CampensdtiOn Inmrance, o� a ce�tltietl copy thereot (5¢Ct/lon
= J0. Lab. ���^,�/�� , l� Com �1�.� - r_fQA�
iicy No. �r �� Pany
�e�rtitietl copY i5 hleEbwrthrth¢hc ty Bu in9A I
Date APPlitan[ /�-/y/����-1 � /
EXEM TIO,�RKEf25' CO�SATfON DECLARATION
(This section neetl not be completetl it Ihe pe�mit i5 for one huntl�atl (E100) Or
less).
I certiry that in [he pertOrmdnc¢ Oi Ih0 work !or wnlch this permR is ISSuetl, I
shall not employ any person in any manner so as lo become subject to the
Wo�ke�s' Compen5ation Laws at CaliPomia.
Date Si9nature
NOTICE: 11, after making [hiz Oeclaratlon, you shoultl b¢come sub�ect to the
Workers' Compenutlon provisions ot the Labor Cotle, you must forthwlth
comply with Such p�ovisions or thi5 p¢rmit shall De tleemetl �evoketl.
CONSTRUCTION LENDING AGENCV
I heroby ai(Irm that there is a construc8on lentling agoncy for tho oer(ormance
of lne work for which this permlt is issued (Saction 309] Civ. C.)
Lentler's Name
Lentler's Atl�ress
OWNER BUILDER DECLARATION
1 nereby altirm lhat I am exemp[ lrom tha Conlractor's License Law for tho
lollowing reason (Section 7031.5 Buslness antl Profassional Cotle: Any city or
county wM1ich requires a permit l0 COnstru<t, altOr, Improva, Etmollsh or rOpalr
any structure, prlor to lts issuance, alio roquires the appllcant tor such parmlt
to /ile a signed statement [hat ne/she I5 Iicensetl pursuant to tne provlsions of
the Contrattor's Llcenie Law (Chapter 9(commonUng wllh 5ection 7000) of
Division 3 ot [ho Business and Profozsions Cotlo) or l�at he/sho is exempl
!hgrefrom antl the basis for the a11e9eC exemplion. Any vlolatlon of Soctlon
��a1.5 by any applicant for a perm❑ sublects the applicant to a civil
.'�.alty of not more t�an five huntlretl tlollars (E500�.
��I, as owner ot tne prooerty or my omploYaez with wagas as thnlr solo
comoensatlon, will tlo the work, antl Ihe sVuc[ure is nol IntentleE or otfaratl
for sale (Section 7044, Business antl Prolessional Cotle: Tne Contractor's
License Law AoeS nOt apply t0 an owner 01 a property who builtlz Or Improv05
t�ereon, antl who tloes such work himsnll/horsoll or tnrough his or ner own
emploYces, provitlBd [tlal such improvomants are nol IntenGetl o� o/fOretl fo�
saie. Ii, however, lne builtling or improvement is soltl within one Yoar of com-
ple[IOq [he Owne� will M1ave tha bu�tlen OI provin9 he/she tlitl not buIIG o� IM-
prove fo� the purpoze of sale).
❑ I, as owner of the property, am axclusively contrattin9 wlth Ilcensetl con-
[ractors [o <onsV ucl lne Pro�ect (Section 7044, Business antl Aofesilons Cotle:
The ConVactor's license Law does not apply to an owner oi DroOerty who
bulltls or Imoroves tnerean. antl who contracts ior su<h oroiects wlth a ron-
tractor(z1 license Oursuant m me ConVactor•s Llcenu !aw). I am aware lhat
prooi o� lheir Wo�ker's CompansatiOn InsuranGa shoultl be provltled t0 ma.
❑ I am exempt unaer Section B. 6 P. C. for this reason
Date Own¢r
I hereby cer[ity tnat I have reatl
Informabon is wrrecL I a9ree lo <
antl state laws relatin9 to Duiltlina
sentatives ot Ihis ci}yq5a'jen�
r
5/e
TVPE OF CONSTRUCTION U NEW LJ ADD LJ ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE Of BLDG.
TVPE OF PERMIT LJ GRADING LJ�OUNDATION LJ STRUCTURAL
❑ TENANT ❑ ELECTRIGAL L�'PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION S�.FT. oCCUVANCY_
C O N ST RUCTION TV PE V ALUATI ON 5
ZONE GRADWGCU.VDS. ACRES_
Remarks:
Ber Sink
Backflow Preventer
Backflow Irrigation
Bathtubs
Jrinking Fountains
=1oor Drains
�loor Sinks
3as Service Outlets
Interceptors
Kitchen Sink
�avarories
P—Trep
Roof Dreins
Reinspaction Fee $15
Boiler
Duct- Under Grountl
Duct - Structural
Duct - Ventilatin9
Exhaust System ❑ Multiple �
Firepl/Fact. BI[. iCBO #
Heating System & Ducting
❑ ai oo,000 sTu � i oo,oao en
Reinspection Fee � 515
White - Bulltling; Canary - ApP���ant; Pink - Accountin9; GOltlenroG - Assessor
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collettors
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash
laue Fee
Hood or Type I ❑
Canopy Typell ❑
Refrigeration Sysiem
❑0.100,000 BTU ❑100,000 BT
System Repair/Alteratian
Fire Dampers
Registers
laue Fee
A.P. qW
S Main Buildi
E
T Front
B Rear
A
C Right
K Left
S
Ping. Rei. 5'k
Planning Notes:
Automatic Washer
Construction PoleSu6.
Cooking Unit
Dishwasher �'
Dryers OGas .�Elec[ric
Fan
F.A.U.
Fixtures
DEvicC BOx¢5 �
Outlets
Switches
Garbage Disposal
Generator �0.5 KW �5-15
Zone
Perking Req./Provided
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+ KW
Meter �up to 100 amps
Meter ❑over 100 amps
Sub Panel
Motors �0.7 HP 01 h- 8
Inc.Solar 09-15 HP �16�15+
Microwave
Pole Light
Standing Sections
Trash Compactor
� Roinspection Fee �$15 ' � luue Fae
DEVELOPMENT SERVICES RE�UIREMENTS:
g 3 r' Zoninq Approved By
FEES: � Building Approved By
T Application Issued By A
S 3
SUMMARV F FEES
BUILDING PERMIT $ SMIP
PLAN CHECK $ PERMIT
.° PLUMBING $ �O� ��UANCE
�� PLAN CHECK 25% $ 7 ENERGY P.C.
ELECTRICAL $ GRADING
PLAN CHECK 50% $ MICROFILM
MECHANICAL $ TOTALFEE
PLAN CHECK 25% $
��Z�I ! / . . .
I
N
G
R
E
U
M
T
$.
FEES
$ 3
: "' _ �' _ '
. . - : �'-� -: . .
, ,� .
�, CONSTRUCTION AND PLANNING ' POOL �oA
� APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector
' 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Elec[rical Conduit Utility-Undrgrnd. 54. Forms
4.�Electrical Condui[-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings . 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Test
; 9. Water Pipe-Undrgrnd! 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Svuctural Floor System 61. APPROVAL TO DECK
, 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
73. Roof.Drains ' � 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Elecvical-Conduit 66. Solar System-Final
1,6. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
1,8. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
�.19� Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
�20. Rough Factory Fireplace APPROVALS Permit #
r
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping OGas ❑Oil
23. Gas Pipe�Rough & Test 72, Undcrground 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. 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-Final 80.'FOOD CERTIFICATE ISSUED
33. Final Electric Notes: `-(a.�9' L��T�'.A�rj• L•fC•v
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Fin�l Factory Fireplace _
38. Final Plumbing �i � -
39. Water Service-Finat'?' �-
40. Gas Service-Final !T'
41. Solar pomestic-Fin,al��
42. Backflow Preventer� �/ ; �'
43. Backflow Irrigation:�
- ^;
44. Landscape Irrigation System '� �,� ,
45. Sound Attenuation �
46. Handirap Regulation�
47. FINAL STRUCTURE & BUILDING
4R. Sner.ial Rr.r�uirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co -' �'�
r
51. CERTIFICATEOFOCCUPANCY -
No. Date � ! _
QOSTA-�7ESA BUILDING DEPARTMENT N� 197 B
111 East 20th Street
Costa Mesa, CaliforNa ��` � %
Date........_r' ...-......� /.-....� J!._
GTV OF COSTA �MESA
CEdi�IFICATE OF OCCUPANCY
Building Permit
Use of Building
The building la
���
�
t............................................ Block............................................ TraEi��..�
(See reverse s�de for Metes and Bounds)
has been inspected and found to comply with the provisions oP all City of Costa Mesa Or-
di�^ac�s applicable thereto for a Group.........� ............:�Occupancy.
P. ED TO / A. J. V�D�Z //) � .%
� •7 �; +� �- �9 j i /,v � ,�, i City ut din /OTflcial � l
�.. .._. ... ..........�... � - - • -=-� � - `� =?�- � �/�,�.� _ �/�
� (OwnerofBuilding) B ...........................�_l=:.��/.�:F.i.%��.v
.... _ ..... . ......
CC: ❑ Oribdnal—Owner ❑ Ist copy—Gas Co. ❑ 2nd copy—�diso' o: --p 3rd copy—Flle
I'or.:v lUG (:-H Ihl 12-63 /
OWNER HOSdARD,_ LIAYD C. u}IAN 1��� DATE 1-1Z-S6 . .T �
JOBADDRESS 1�67 Esther BUILDINGPERMITNO. ZZI1j �II
GENERALCONTRACTOR Llovd C, Ho4rard VAWE $ 15.3(>�.0�
d
�� AP 118-29L1-71t e�ocK TRACT Residence & Dbl. �ara�e
GROUP I Bt J TVPE V ZONE Rli FIRE DISTRICT 22'rill ��
PERMITSISSUED
INSPECTIONS DATE SUBCONTRACTOR
DATE NUMBER lj
Footing Trench - � • �
Foundation Formsand Gradeto�Gar�ge Y+
o,.��..�.r.�mi�.. _ _ � �� !�
Plumbing, Rough to Slab ���� �
Plumbing, Rough Complete ,j -
Temporary Pole
Wiring, Rough ' -��.�-,
Heating, Rough � �
Heating, Final /LLIj, ' Ya'
Sewer, House Sewer, St.
SeD`�c Tank or Cesspool � �
L: g, I n Out' q„s�-� , ,
Plastering / ��G�
Plumbing, Final, Fixtures Compl em $� '� Q
Plumbing, Final Gas 7est -7'C
Wirina. Final � n �, /-
-ir_
_ .-� _
' 'C�osta Mesa Building Department
^ 711 EA8T 20kh STREET
� � COSTA MESA, CALIFORNIA
FOR APPLICANT TO FILL IN
Bulldin9 ��7�5��
Address
osta Mesa, Ca ' ornia
or
e Address
'Size of Lot
Use of
� I ^lor Wall
I hereby ac}
and state th.
with all Ci1
building con
Signatureof
Permittee 1
City Lic.
O�%/ 6' nlo.
� � /
Lot p I
No. / Block � Tract
md Bounds) �O ^ � �
No. of Bldgs.
O Nowon Lot
INo.of No.
Famflies � Roo
om �� Rear Vard f
O 'f Sitle Yard /p
cR�oN oF woRg
X I Alteration I I Addition
O No. of /
Rooms 6 Stories
Valuation
$ /5 36Q.
cnvnn �ns c_nn �nrt n_t
'PLICATION FOR PERMIT
BI�ILD;tNG '�
FOR OFFICE USE ONLY
Receipt No. Permit No.
�� � �
ed by Date Rec'd. Date Issued
u,Y /- io s � /-/�?-�1 �
Costa Mesa, California
_, I No.of I Type ,./ Grou� .
CORRECTIONS
I co�er�n9.,,.y�fs„ytG� APPROVAI.S
�L � Foundation Location Inspector
Forms, Materials,
� � Under-Pinning
Frame: Fire Stops,
Bracing, Bolts
I have read this Application
correct and agree to comply Lath. Int
and State Iaw�' regulating
� �% // Lath. Ext.
Permit Fee $ ,3 (D� • ° Masonry Rei
Plan Check $ � rr. n Bond Beam
Total [�'
Fee $ V �. � � FINAI
�,� �
•+�� M
Show Iocation and distances from
property Iine ahd hetween buildings.
. . '..
COSTA
J�hl 1�1 ?6PD�lE5�� 8u4a ;.••;•.;^. )L{.��
. �
.;