HomeMy WebLinkAbout191 BROADWAY - Building PermitsI
Job Address: 191 BROADWAY Status: ISSUED
Suite: Applied: 11/16/2005
Vicinity: THROUGH OUT HOUSE Issued: 11/16/2005
Primary Occ: R3 Type of Construction: V -N
Parcel Number: 42523209 Zoning:
Applicant: STERLING, LYMAN V TR
Address: 2345 E 16TH ST
Phone: 949-646-6499 ISSUED BY:
NEWPORT BEACH, CA Zip: 92663
Owner: STERLING, LYMAN VTR E+i�1 ED
Address 2345 E 16TH ST
Phone:
NEWPORT BEACH, CA - - Zip: 92663
Contractor: OWNER-BUILDER`S
Address -
Phone
Zip, License: 000000
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, 12-21-92)
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 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 penult.
FOR INSPECTIONS CALL: (714) 754-5626
DECLARATIONS
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to salt-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the
work for which this permit is Issued.
❑ I have and will maintain workers' compensation Insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
My workers' compensation Insurance carver and policy number are:
Carrier: Policy Number:
(This s Iron need not be completed 11 the permit is valued at one hundred dollars ($100) or less.)
r�a l cartiy Wet in the performance of the work for whl this permit is issued, I shall not employ any person in any manner so as to become subject to the workers'
' compensation laws of Celifomi ,end agree that if houl ,become subject to the workers' compensation provisions at Section 3700 of the Labor Cade, I shall fort Ith
comply with these provisio
AppfcTart(TS1re 0 d
1$.
WARNING: FAILURE TO SECURE r RKERS' COMPENSATION 00 S UNLAWFUL AND SHALL SUBJECT AN EMPL'eYER TTJ"ORIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000), IN ADDITION TO THE COST OF CO EN ATION, DAMAGES AS PROVIDED FOR IN SECTION W06 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full
force and effect. Lc. If Class q
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions
Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such pernit
to file a signed statement that heis licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Cotle) a or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil peAglry�, 5p t more than five hundred dollars ($500).):
❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure Is not intended or offered for sale (Sec.
7044, Business and Professions'Code: Thq),ontractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work
himself or herself or through his or her own employees, provided that such Improvements are not intended or offered for sale. If, however, the building or improvement is
old within one year of completion, the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
a owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions
y Code: The contractors License Law does not apply te'an owner of property who builds or Improves thereon, and who contracts for such project with a contractors)
license pursuant to the Contracto s License Laws:).r1. ,Q^ P
❑ I em exemp der se . 11 .
e Business and Professions Code for this reason: i
Ow D venfi by driver's license. V s [:1 No .i o!r Drvi ets Liceryse.No. - . Ex�eer ..1- 0
Verification of Ownership by (type of tlocume t, i.e. - property tax bill o(deed): 4—
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this
Permit, and that no building structure, scaffolding, talsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Title 8, California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
.........................................................................................................................................................................................................................................................................................................,.................................................................................
2 Does or will the applicant or present or future building occupant need to file a registration forth for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
........................ .................................................. ................... .......................................................... -..................... ............................... ......................... ............................................... .......................................................................................................
3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)?
❑ Yes ❑ No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire
...4..........Department.
enR.MP.P............................................................................................................................................-............................................................................
..................................................................................................
is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No
................................................. ................ ....... _...................................................... ......... ......
.............................................................................................................................................................................................................................................
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication appernit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes U No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
.....................................................................................................................................................................................................................................................................................................................-.......................................-....................
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
(If "yes", the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code).
.......................................................................................................................................................................................................-........................................ .... ......................
........ ............................................................. ...........................................
7 If a pernit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? [I Yes El No
........................................... ........................... .................................................................. .................................. ................................... ..................................... ..................................................... ..................................................................... _.............
B (If'yes", attach cartificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state lavig and c' o Inances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the
above-de cr - property for in action oses a roe not to occupy or allow occupancy of any building authorized� byy this permit untyfinal inspection.
M
t_�L,5lgnal6r*Ofteg her •) 'Date
And/Or Authorized Applicant Date
CODE t. INSPECTION TYPE PAN INITIIALS CODE INSPECTION TYPE RAM INTITIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pcol Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Well 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
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April 20, 2007
CITY OF COSTA MESA
P.O. BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 92628-1200
DEVELOPMENT SERVICES DEPARTMENT
BUILDING DIVISION
COURTESY NOTICE OF PERMIT EXPIRATION
Lyman V Sterling
2345 E 16" St
Newport Beach CA 92663-5404
PERMIT NUMBERS: 605-02066, B05-02067
FOR: Windows Change -out
PROJECT ADDRESS: 191 & 195 Broadway, 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.
Our records do not show an inspection for these permits within the last 180 days nor
have they had an approved final inspection. If you have a signed inspection card
showing that an inspection was made within 180 days, or that the final inspection was
approved, please contact this office so we may correct our records. If you do not have
an approved final inspection, your permits will expire on May 4, 2007. Additional fees
will be required to finalize expired permits.
Requesting an inspection—If you need to request an inspection please call our
Inspection Request Line at 714-754-5626.
Requesting an extension—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 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,
Mary Jane Weidenkeller
Office Specialist II
Building Division (714) 754-5273 • Code Enforcement (714) 754-5623 • Planning Division (714) 754-5245
FAX (714) 7544856 • TDD (714) 754-5244 •—.ci.cosla-mesa.ca.us
RealQuest.com ® - Report
Page 1 of 1
Property Detail Report RealQuesecom
For Property Located At
195 BROADWAY, COSTA MESA CA 92627-2815
Owner Information:
Bldg Card: 000 of 002
Owner Name: STERLING LYMAN V
Mailing Address: 2345 E 16TH ST, NEWPORT BEACH CA 92663-5404 CO29
Phone Number:
Vesting Codes: / / TR
Location Information:
Legal Description: TR 377 LOT 15 BLK A ALL - EX ST -
County: ORANGE, CA
APN: 425-232-09
Census Tract / Block: 633.0111
Alternate APN:
Township -Range -Sect:
Subdivision: 377
Legal Book/Page:
Map Reference: 31-D2 / 889-A4
Legal Lot: 15
Tract #: 377
Legal Block: A
School District: NEWPORT MESA
UNIF
Market Area:
Munic/fownship:
Neighbor Code:
Owner Transfer Information:
Recording/Sale Date: 01/12/1990111/1989
Deed Type: DEED (REG)
Sale Price:
1 st Mtg Document #:
Document #: 21256
Last Market Sale Information:
Recording/Sale Date: 06/30/1987 / 0611987
1 st Mtg Amount/Type: /
Sale Price: $215,000
1 st Mtg Int. Rate/Type: /
Sale Type: FULL
1st Mtg Document #:
Document #: 372890
2nd Mtg Amount/Type: I
Deed Type: GRANT DEED
2nd Mtg Int. Rate/Type: I
Transfer Document #:
Price Per SgFt: $101.18
New Construction:
Multi/Split Sale:
Title Company: GUARDIAN TITLE CO.
Lender:
Seller Name: NAVARETTE RUBEN
Prior Sale Information:
Prior Rec/Sale Date: /
Prior Lender:
Prior Sale Price:
Prior 1st Mtg Amt/Type: I
Prior Doc Number:
Prior 1st Mtg Rate/Type: I
Prior Deed Type:
Property Characteristics:
Gross Area: 2,125 Parking Type:
GARAGE/
CARPORTConstruction:
Living Area: 2,125 Garage Area:
Heat Type: FORCED AIR
Tot Adj Area: Garage Capacity:
Exterior wall:
Above Grade: Parking Spaces:
Porch Type:
Total Rooms: 28 Basement Area:
Patio Type:
Bedrooms: 18 Finish Bsmnl Area: Pool:
Bath(F/H): I/ Basement Type:
Air Cond:
Year Built / Eff: 1930/ Roof Type:
Style:
Fireplace: / Foundation:
Quality: AVERAGE
# of Stories: 1.00 Roof Material:
Condition: AVERAGE
Other Improvements:
Site Information:
SINGLE FAM
Zoning: Acres:
0.17 County Use: RESIDENCE
(1)
Flood Zone: X Lot Area:
7,500 State Use:
Flood Panel: 0602160268H Lot Width/Depth:
35 x 150 Site Influence:
Flood Panel Date: 02/18/2004 Res/Comm Units:
/ Sewer Type:
Land Use: SFR
Water Type:
Tax Information:
Total Value: $307,158 Assessed Year:
2006 Property Tax: $3,986.30
Land Value: $237,564 Improve %:
023% Tax Area: 15115
Improvement Value: $69,594 Tax Year:
2006 Tax Exemption:
Total Taxable Value: $307,158
http://www.realquest.com/j splreport.j sp?serverid=rg02&client=&action=confirm&type=g... 03/30/2007
April 20, 2007
Lyman V Sterling
2345 E 16`h St
Newport Beach CA
CITY OF COSTA MESA
P.O. BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 92628-1200
DEVELOPMENT SERVICES DEPARTMENT
BUILDING DIVISION
COURTESY NOTICE OF PERMIT EXPIRATION
PERMIT NUMBERS
FOR:
92663-5404
PROJECT ADDRESS:
B05-02066, B05-02067
Windows Change -out
191 8r 195 Broadway, 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.
Our records do not show an inspection for these permits within the last 180 days nor
have they had an approved final inspection. If you have a signed inspection card
showing that an inspection was made within 180 days, or that the final inspection was
approved, please contact this office so we may correct our records. If you do not have
an approved final inspection, your permits will expire on May 4, 2007. Additional fees
will be required to finalize expired permits.
Requesting an inspection—If you need to request an inspection please call our
Inspection Request Line at 714-754-5626.
Requesting an extension—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 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,
Mary Jane Weidenkeller
Office Specialist II
Building Division (714) 754-5273 • Code Enforcement (714) 754-5623 • Planning Division (714) 754-5245
FAX (714) 7544856 • TOO(714)754-5244 • u .ci.costa-mesa.ca.us
V
PROJECT 19DRESS: 191 BROADWAY UNIT:
OWNERS NAME: STERLING LYMAN V TR
ADDRESS:2345 E 11TH ST
NEWPORT BEACH,CA 92663
ARCNIENGIN EEO: 646-6797 flEG.NO.:
ADDRESS: UNIT:
PERMITTEE: C & B CON'T'RACTORS (714)567-4822
ADDRESS: 3971 CLAREMONT
IRVINE CA 92714
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
9000) of Dimsion 3 of he Bus ess and Professions Code, and my license is in full force and effect
.C(/z��(iJ��
CITY LIC.:O 1 o O O STATE LIC.:5 7 6 2 0 3 j]B // I'-7�
Date: — Z Signature:���'/��`'^� LC1
WORKERS'iOAPENSIT16N DECLARATION: I hereby affirm that I have a certificate of consent to self -insure or a complicate of Workers'
Compression Insurance, or a certified copy thereat (Section 3800, Lab. C).
POUCYNO.:1332677-93 EXP. DATE: 01/01/94
yOMPANY:STATE
'7 Certified co hereby furnished. ❑ Crimped copy isyfiled
/wit
the ity Building Divisions
Date. Applicant%-
E%EMPTIO E9OM WO KERS' COMPENSATION DECLARATION: (This section need not be completed it the permit is for one hundred($top) or less).
I termly that in the pellormance of the work for which this permit is issued, I shall not employ any person in any manner so as to become
subject to the Workers' Compensation Laws of California.
Dale: Signature:
NOTICE: It after making this declaration, you should become subject to the WorkersCompensation provisions of the Labor
Code. you must forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for
which this permit is issued (Section 3097. Civ. C).
LENDER:
ADDRESS:
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or
repair any structure. prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed
pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions Code) or that he/she is exempt therefrom and the basis tar the alleged exemption. Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penally of not more than five hundred dollars (5500).
I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the
❑ structure is not intended or offered for sale (Serum 7044, Business and Professional Code: The Contractors' State License Law
does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through
his or her own employees, provided that such improvements are not intended or offered for sale. If, however the building or
improvement is sold within one year of completion, the owner will have the burden of proving he/she did not build or improve
for the purpose at sale).
L as ownssionsC properly. Co exclusively contracting with licensed Contractors to owner
construct the projecthbuilds or
Prov Business
❑
and Professions Code: The Contractors' State License Law does not apply to an owner al properly who builds or improves thereon
and who contracts for such projects with a canballicense pursuant to the Contractors' State License Law),I am aware
that proof of (heir Worker's Compensation insuranceceshould be provided to me.
❑ I am exempt under Section: 8. 8 P C.
for this reason:
Date: Owner
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505. 25533. and
25534 and that I or any future budding occupant w Ayll not (circle ane) need to comply with said state codes and the requirements for a
permit for construction or modification from the Air Quality Management District. Residential construction applications are exempt from
these provisions
Date:
I npreby certify that
/demances and staa}}ee
pmterly far ins X,
Applicant:
this application and state that the above information is correct. l agree to comply with all city and county
Ito building construction and hereby authorize representatives of this city to a I upon the above-mentioned
Date: Signature:
Driver's Ycense or Social Security A:
1641 46 White—Bmtding: Green—Code Enforcement: Canary—ApphcanC Pink—Revenue: Goldenrod—Assessor
CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 061695
PERMIT NO: B 061695 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: V -N PERMIT TYPE: STR PURPOSE: ALT
JOB DESCRIPTION ; T/OFF REROOF W/COMP SQ FT: 1,000
CLAIM VALUE: 1,000.00 CALC-VALUE; 1,000,00 GROUP OCC: R-3 /
COMMENTS: SMOKE DETECTORS REWIRED
Z O N I N G S E T B A C K S R E Q U Z R E M E N T S
------------ MAIN BUILDING----------
FRNT; FT IN REAR: FT IN
LEFT: FT IN RIGHT: FT IN
--------- ACCESSORY BUILDING---------
FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN
PARKING REO• PROV: PARCEL: 42523209 ZNE: REF NO:
PLANNING N TES>
>
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
APPLICATION ISSUED BY:
LEGALIZATION:N
BLDG PMT PLUMBING
PERMIT 25.00
PLAN
ISSUE FEE
F E E S U M M A R Y
C MECHANIC
DATE;
STRUCTURAL SEGMENT:Y
FIRE SMIP/RES GRADING
SO
SMIP/NON-RES
BUILDING -DIV-> PERMIT ISSUE' PLAN -CHECK TOTAL PAID DUE
TOTALS ---- > 25.50 0.00 0,00 25,50 25.50 ,00
REVENUE DIVISION TOTALS--> COLLECTED: 25.50 OVER/SHORT: .,00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN=CHECK
25.00 .50
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
SFR 1000 REROOF BY VALUE RESIDENTIAL NOZONE 1.b0 1,000,00
UD OF FEES
EX�'IREDtion�
SMOKE DETECTOR In omP1ete giS
SB
REQUIRED
"'^xAl IVrPfjItIsii4.400A 3TIN0a 1=;49 25'50
CONSTRUCTION AND PLANNING
APPROVALS Permit Date
Inspector
POO ]PA
APPROVALS Permiti1� Date I
Inspecto•
l..Temporary Electrical Service orpole
Y
52. Pool &Equipment Location
2. Soil Pipe-Undrgrnd.
53. Steel Reinforcement
3. Electrical Conduit UU!rty-Undrgrnd.
54. Forms i
4. Electrical Conduct-Undrgrnd.
55. Electrical Bonding
5. Steel Reinforcement
56. Rough Plumbing & Pressure Test
'
6. Electrical LIFER Grnd
7. Footings
57. APPROVALTO COVER GUNITEE
58. Electrical Conduit.Undrgrnd.
l '
8. Foundation
59. Gas Pipe, 0 Undrgrnd., Test
_
9. "Yater Pipe-Undrgrnd.
60. Backwash Lines, P Trap, 0 Undrr,•nd.
10. Structural Floor System
61. APPROVAL TO CECK
11. Property Sewer Line & House Connection
62. Backwash & Receptor -Final
12. Sewer Cap _
63. Heater & Vent -Final
13. Roof Drains
64. Plumbing System - F,l-,al
-
14. Rough Plumbing
65. Electrical -Final
I
15, Rough Electrical -Conduit
66. Solar System Final
16. Rough Electric Wiring
67. Fencing & Access Approval
17. Rough Wiring Sign
18. Rough Electrical -T Bar Coiling
-
68. APPROVED FOR PLASTERING
69, POOL/SFA SYSTEMS FINAL
-�
I
--7
i
19. Rough Heating & Air Cor-ddi
9 9 9
FIRE DEPT. REQUIREMENT
APPROVALS Permit ,
20. Rough Factory F!replace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts. Ventitatmq
71. Product Piping 17 Gas C Oil
23, Gas Pipe -Rough & Test
72. Underground Flus,
24. Roof Framing
73. Undergrnd. Storage Tank DGas --,Oil
25. Roof Sheathing
74. Overhead Hydra
26. T -Bar Ceding (Structural) & i0iionocoat
75. Dry Chem cal
�
27., Frame and Flashing
76. Dry Standpipe
T
`
28. Lathing & Siding
77. FIXED SYSTE?^ FINAL
l
29. Insulation
78. FIRE PREY. FINAL
30. Drywall Nailing
HEALTH DEPT. REQUIREME?iT -
79. FINAL INSPECTION
80 FOOD CERTIFICATE ISSUED
31. Plaster Brown Coat
I
32. Electrical Power AM1cte. Final
33. Final Electric
Notes:
34. Final Heating & Air Conditioning
!
; i
35. Final Gas Pipe -Test
36. Hood or Canopy
>
37. Final Factory Fireplace
38. Final Plumbing
»
39. Water Service -Final
40. Gas Service -Final
i
41. Solar Domestic -Final
42. Backflow Preventer
43, Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
-�
46. Handicap Regulations
47, FINAL STRUCTURE & BUILDING
48. FINAL PLANNING
E X P I R E D 1
lncornplete-lnspections----
Lei! --.Z
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
�J
A
Propert
Owner
Contrac
I
CITY OF COSTA MESA
BUILDING DIVISION
ROOF COVERING CERTIFICATION
Permit No. B 6 1 6 —) S
State Contractor License Number �%� �� Classification
I hereby certify that I have installed, or caused to be installed, a minimum Class C roof covering at the
above address in conformance with Chapter 32, and Section 1704 of the latest adopted edition of the Uniform Building
Code, as amended in Section 5-17 Title 5 Costa Mesa Municipal Code, and the installation instructions of the
manufacturer.
I further certify that I am the owner of the property. (Owner -Builder permittee only).
I further certify that I am:
,�IV Owner of sole proprietorship company
/ EJFull partner of the company
❑ Limited partner of the company
❑ Officer of the corporation
I certify that as an authorized officer or agent of the company or corporation, I am empowered to make
this certification, which shall be binding on all successors or assigns of the company or corporation.
I shall deliver a copy of this Certification to the above listed owner, after submittal of form to the Building
Division for acceptance.
Received by Building Division
By:
0990-46 White -Building Div.; Canary -Contractor, Pink -Owner
1 Company or Corporate Na
AAA --
OWNER NAVARRETTE Rubin N DATE 11-15-76
JOB ADDRESS 191 Broadway BUILDING PERMIT NO. 44n t7
GENERAL CONTRACTOR OxmprlRllr
DESCRIPTION
of WORK Enlarge
Bedroom
0^ No. 117-122-24 LOT
TRACT
FIRE
ZONE VALUE $1 ,300.00
-CTIONS
Signature
Date
TYPE V GROUP I
ZONE -
Su.SUBCONTRACTOR
iDate
jUED
MNumber Si nature
GAS
WATER
Plumbing
ROUGH PLUMBING
PROP. SWR. LINE Lj HOUSE CON.
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND POWER
ROUGH WIRING
(.
•'�.}
Heatina and Vent.
TRENCHES FORMS STEEL REINF.
O�
FLOOR SYSTEM
BOND BEAM STEEL REINFORCE
SHEATHING
'iL•')
FRAME AND FLASHIN
LATHING — IN OUT
PLASTER, BROWN COAT
�TURAL, FINAL
p
.NG, VENT., REFRIG. AND A.C., FINAL
-)*7
PLUMBING, FINAL AND GAS TEST
ELECTRIC, FINAL
BUILDING, FINAL
C.",
0.4/.77
,
i50
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
OWNER
MAIL
CITY
CONSTRUCTION
BRANCH
ADDRESS
ARCHITECT
CONTRACTOR
APPLICATION FOR STRUCTURAL PERMIT
REC$j VEfp BY I DATE RECEIVED nATF ISBUFn
A.P. NO.
BUILDING
ADDRESS 9i
TRACT
OWNE
FIRE
ROVED
VALUE /
ly ` f t
ADDRESS
ZO
NO.OF
USE
TEL.
CITY NO.
PLANS
BUILDING
STATE CITY
YARDS APPROVED
YARDS APPROVED
LIC. NO. LC. NO.
MAIN BUIL G
ACCESSORY BUILDING
w SIZE NO. OF BLDGS.
(FROMC/L
4 OF LOT ` NOW ON LOT
FRONT T
FT.
Q
USE OF
.�., EXISTING BLDG.
R. SIDE F
FT.
FSeparate permits are required for
L. SIDE FT LG
FT.
electric, plumbing and heating work.
/
REAR Fr
Fr.
[w. USE OF BUILDING AND WORK TO BE PERFORMED
DISTANCE BET.
BET. MAIN &
QnA A
MAIN BLDGS.
ACCESS. BLDGS.
VAR.#
C.U.P. #
DATE
ROVED
Q
>
APPROVED
r
DATE 76
a
N
w
0 1 hereby acknowledge that I have read this application and state
I% that the above information is correct and agree to comply with
-
4 all laws regulating building construction, and I shall not employ
i
Z any person in violation of the workman's compensation laws of
a
the State of California.
3 I hereby certify that I am properly licensed as a contractor under
EW SQ. FT.
t�
the State of California Business and Professions Code, Division 3,
THE AMOUNT SHOWN UNDER VALUATION IS FOR
D
Chapter 9, and that such licenses are in full force and effect, or I
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from the provisions of the State of California Business
y
and Professions Code, Division 3, Chapter 9.
VALUATION
PERMIT FEE $
m
^
PLAN CHECK $ 0
•
Signature
jAr
TAX $ Q
Permittea,�d w Y7. �d/1A� -,
- w
$ / /
VVV ar v
U
TOTAL PAID $2,0
Authorized Agent