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Home My WebLink About255 BRENTWOOD PL - Building Permits�, (714) 754-5273 • Fan (714) 754-4856 • www.ci.cosfa-mesa.ca.us 77 FAIR DRIVE, GOSTA MESn, GA s2s2ti PLUMBING PERMIT Job Address: 255 BRENTWOOD ST Suite No Vicinity: REAR YARD Parcel Nunmber: 43933229 Applicant: MILLER, LILLIAN Address: 255 BRENTWOOD ST COSTA MESA, CA Owner: MILLER, KEITH VAN DYKE TR Address 255 BRENTWOOD ST COSTA MESA, CA Contractor: OW NE R-B U I LD ER Address: Arch / Eng : Address: ISSUE FEE Backflow irrigalion Backflow Preventer Bathtub Clarifier System Connect(Ice,Soda,etc) Dental Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Drinking Fountain ISSUED BY: Phone: 949-722-9738 Zip: 92627-1305 Phone: 949-722-9738 Zip: 92627-1305 Phone: Zip: License: 000000 Phone: Zip: License: Status: ISSUED Applied: 07/10I2003 Issued: 07/70/2003 SCOPE OF PERMIT PLUMBING PERMIT FOR A 9AR SINK FOR A 36" HIGH BAR-B-� AND AN ADDITIONAL GAS OUTLET FOR A FIRE PIT. 1 GAS OUTLET (1-4), 1 BAR SINK AMT $23.50 50.00 so.00 so.00 $0.00 50.00 50.00 50.00 $0.00 50.00 $0.00 $0.00 FEE SUMMARY QTY AMT Laundry Tub / Washer $0.00 0 Landscape Irrigation $0.00 0 P-Trap 50.00 0 Pressure Regulator S0.00 0 Process Piping (per 10 fp 50.00 0 Receptors 50.00 0 Septic Tank 50.00 0 Sewer Cap for Demo 50.00 0 Sewer Connect 50.00 0 Sewer Private Line 50.00 o Shower So.00 0 Sink, bar $9.80 �TY 0 0 0 0 0 0 0 0 0 0 0 1 Sump Pump Swimming Pool Trap Primer Urinal Vacuum Brkr BkFlow(1-4) Vacuum Brkr BkFlow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (Toilep Water Heater / vent Water Piping (Inst or Rep.) AMT $0.00 50.00 50.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 50.00 $0.00 $0.00 QTY 0 0 0 0 0 0 0 0 0 0 0 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRA710N: This permit shall automatically expire and become void i( work is not commenced within 180 days, or il work is suspended or abandoned for a period of 180 days. INSPEC710NS: In orqer for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inapeetlons 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 244646 (N00) WORKERS' EOMPENSATION DECLARATION: ! I hereby affirtn under penalry oi perjury ona of the following declarations: ' ❑ I heve antl will mainlain e cenificate ol consent to selt-Insure for workers' compensation, as provided tor by section 3700 of the Labor Code, for the pertormence ot the work lor whic� t�is permit is issuetl. ❑ I have and will maintain workers' compensetion Insurance, as requiretl by SecUon 3700 of the Labor Code, for Ihe pedortnance of the work for which Ihis permit is issuetl. My workers' compensation Insurence cerner entl policy number are: Carrier. � PWicy Number. (This section need nof be comp/efed i! fhe permit is va/ued at one huntlretl dollers (5/00) or /ess.J .C] I certity thet in the peRormence of Ihe work for which Ihis permit is issuetl, I shall not employ any person in any manner so as to become subject to t�e workers' campensation laws ol litomia, n h I shoultl b sub�act to t�e workers' wmpansation provisions oi Section 3�00 pf the LeDor Code, I shell torthwith rqmpy wit� the r'� 0 7//� /O � Applicant Signatura: � Date: �� vl� WARNINO: FAILURE TO SE R (ER ' C MPEN N CAVERAGE IS UNLAWFUL ANO SHALL SUBJECT fW EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED TFIOUSAN� OOLLARE (E100.000�, IN ADDITION TO THE �AS OF COMPENSATION, DMMGES AS PROVIOED FOR IN SECTION 3]OB OF THE LABOR COOE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby eNirm that I am licensed under provisions oi Chapter 9(commencing wilh Section 7000) oi Division 3 0l the Business end Professions Coda, end my license Is in full force end eflect. Lic. N Cless a Contractofs SignaWre: Date: CONSTRUC710N LENDING AGENCV: ❑ I hereby aNirtn Iha� there is a construction lending agency for ihe pedormance of Ihe work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: SigneWre: Date: OWNER•BUILDER DECLARATONS: I hereby aftirm ihat under penalry of perjury Ihai I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Cotle: Any ciry or counry which requires e permit to construct, elter, improva, tlemolish, or repair any structure, prior to its issuance, also reQWres the epplicant tor such permit to file e signetl stetemeN Ihet he or she Is Iicensed pursuant to the pmvisions of Ihe ContreIXors License Law (C�epter 9(commencing wit� SecUon 7000) of Division 3 of the Business and Professions Code) or Ihel ha or she is exempt therefrom end Ihe basis for the alleged exemplion. Any violation of Section 7031.5 by any epplicent for e permit subjects Ihe applicant to a civil penalty ol not more ihan fiva hundred dollars ($500).): ❑ I, es owner ol the pmperty, or my employees with wages as thelr sole compensetion, WILL DO 7HE WORK, end the strucwre is nol Inlended or oHeretl for sale (Sec. 7044, Busineu antl Protessions Code: The Contrectors license Law does not apply lo an owner of property who builds or improves ihereon, end who tloes such work himself or herself or ihrough his or her own employees, providetl �het such improvements are not Intended or oHeretl br sale. It, however, ihe builtling or impmvament Is soltl wit�in one year of compietion, the owner-builder will heve�ihe burden ol pmving that he or she did not build or improve for purpose of saie.). � � I, 05 owner Of ihe property, am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Busine59 end Professions -Cotle: The contractors License Lew does not apply to an owner of proDeny who bulltls or impmves thereon, end who contracts tor such project with a contractor(s) licensa pursuant to the Contractors License Lawa�. ❑ I em exemq Signature: _ Owner ID venfied Verilicetlon ot Ownership 6y (type oi document, i.e. - property taa bill or tleed): DIVISION OF INDUSTRIAL SAFETV PERMI7 CER7IFICA710N: ❑ I hereby certiry that no excevation five (5) or more feet in tlepth into which a person is requiretl to Gescentl, will be matle in connection with work euthonzed by this permit, and that no building swcture, scettolding, falsework, or tlemolition or dismantling ihereoi, will be more ihan thirty-six (36) feet high. (Chap. 3.2, Gry 2, Art 2, Sec. 341, Title B, Celifornia Administrative Cotle). � As owneo-builtler, I will not employ anyone to do work which would require a permit tmm Ihe Division of Industrial Safery, as notetl ebove, unless such person has e pertnit ta do such work Irom the diWsion. Signature: Date: Division ol Intlustrial Safery Permit Number: CERTFICATE OF COMPLIANCE AND AUTHORIZA710N OF ENiRV: I ceM1ih/ untler penalry of perjury that I heve read this epplication and stete that the informe�ion given is correci. com ty with al stete lews end city rdinances releting to building consiruction, and authorize representatives of Ihe Clty of Costa Mesa to enter upon Ihe above n tor in tio pu se gr e not to occupy or allow occupancy of any buildinq au�horized by this pertnit untiyfinal inspection. /� 7��°/D� SigneWre Ot Legal Ow Date AnNOr Authodzed Appliwnt Date COOEI. INSPEGTIONTYVE QBj� INTRIALS 7616 Fixad System Final Fire Prevention 1268 Pool Spe Final 200 Final Re-Roof 201 Final BIocWHetaining Well 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition COUE I INSYECTION TYPE 206 Final Mechenical 208 Flnal Plumbing 210 Final Electdcal 272 220 222 250 Final Fire Prevention Final Planning Approval Final Site Final Building/OccupanCy PAIE INIITIALS � � 9 r � A L v �s�a � ��:s � K � •.ac . .'i �c ��.� a��bg -y-� �v2�-1 �r 6N�i!,5 ��'''.�.�-9n �o� d�• »aoK St�`� O C� ; �.��,1 -aGV''�`' `arpb� � �1 '1��jr-� `�N�..`..�.'.S y1'�OZ$ O�,l ��v n1 � (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 ConVactor. Address: ISSUE FEE Temp service lest Res. a/c package New Res (1-2 units) New Res (3+units) Pool / Spa Lighting Fixts Recept Outlets Switches Non Res Appl Res Appl Service to 200a Service to 1000a Service over 1000a Motors to 1hp Motors to tOhp Motors to 50hp Motors to 100hp Mo[ors over 100hp Communication drops Sub panel to 200a Pole Lighl Pkg 255 BRENTWOOD ST 43933229 MILLER, KEITH VAN DYKE 255 BRENTWOOD ST COSTA MESA, CA MILLER, KEITH VAN DYKE TR 255 BRENTWOOD ST COSTA MESA, CA OWNER-BUILDER Phone: 949-722-9738 Zip: 92627-1305 Phone: 949-722-9738 Zip: 92627-1305 Phone: Zip: License: 000000 ISSUED BY: Status: ISSUED Applied: 04/29/2003 Issued: 04/29/2003 SCOPE OF PERMIT UPGRADE ELECTRICAL SERVICE FROM 100 AMPS TO 200 AMPS. ADD 5 OUTLETS TO THE EXTERIOR (REAR OF PROPERTY). $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $5.50 $0.00 $0.00 $0.00 $30.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantity 0 0 0 0 5 0 0 0 1 0 0 0 0 0 0 0 0 0 0 FEE SUMMARY Temp Dist System / Lighting Busway /100 ft Standing Section Misc Electrical Equipment Transformers up to 1 kva/kw ................up to 10 kva/kw .................up to 50 kva/kw .................up to 100 kva/kw ..................over 100 kva/kw Low Voltage Equipment Low Volt Wiring System / Ckt Misc. Conduit Misa Conductor Circus ( gen or ride) Circus (mech ride or lights) Christmas Tree Stand Fireworks Stand Other Electrical Fee Investigation Fee Plan Check Fee Reinspection Fee Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 $0.00 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, 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 authonzed 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: (7t4) 7545626 2AO6i6(N00) WORKERS'COMPENSAnON DECLARATON: I hereby aflirm untle� penalty oi perjury one at the Following declarations: ''• 1 ❑ I have end will meintain a cenifiwte of consent m self-Insure for workars' compensation, as providetl for by seaion 3700 ot the Labor Cotle, for ihe pertortnance of the work for whicn �his permii i5 issuetl. ❑ I have entl will maintain workers' compansation insurance, as requiratl by section 3700 oi ihe Lahor Code, for t�a pedormance of the work for which this pertnit is issuetl. My workers' compensation Insurance carrier antl policy number ere: Carrier: Policy Number: (71irs section neetl not be completetl it the permit is �aluetl a! one huntlretl dollers ($100) or less.) �1 certify that in ihe performance of the work tor which this pertnit is issuea, I shall not employ any person in any manner so es to become subject to Ihe workers' bompansetion laws of California, antl agree ihat it I should hecome su6�ect to the workers' compansation provisions o1 Section 3700 of the Lebor Code, I shall forthwith comply with iHese provis ns. X�� Applicenl Signeture: � -' ` w ia Date: �/ 2 H�� WARNINO: FAILURE TO SECURE WORKERS' COMPENSATION CAVERAGE IS UNLAWFUL AND SHNLL SUBJECT AN EMPLOYER TO CRIMINAL P NALTIES AND CIVIL FMES UP TO ONE HUNDRED THOUSAND DOLLARE (5100.00OI. IN ADDITION TO THE COST OF CAMPENSATIIXJ, DAMAGES AS PROVIDEO F9R IN SECTION 3]O60F THE LABOq CODE, IPfrERE5T, AND ATTOFNEY'S FEES. UCENSED CONTqACTORS DECLARATION: I hereby aHirtn that I em licensed under provisions of Chepter 9(commencing with Section 7000) of Division 3 oi �he Business and Professioas Cotle, and my license is in full force and eflect. Lic. M Class A Contrectors SlgnaWre: Date: CONSTRUCTION LENDING AGENCV: ❑ I hereby eHirm Ihat there is a consiruction lending agency for ihe pertormance of Ihe work tor which ihis permit is issue0. (Sec. 3097, Civil Code). Lendels Name: Lenders Atltlress: Signeture: Date: OWNER-BUIIDER DECLARA710N5: I hereby ettirm that untler penalty of perjury that 1 am E7(EMPT FROM 7HE CONTRACTORS LICENSE LAW for ihe following reason (Sec. 7031.5, Business and Professions Coda: Any ciry or county which reQuires a permit to constmci, alter, improve, demolish, or repair any simcture, pnor to its issuance, also requires the applicant for such permit to file e signed statemant that he or she is licensed pursuant to ihe provisions oi ihe Contractors License Law (C�apter 9(commencing with Section 7000) of Divislon 3 of the eusiness end Professions Code) or that he or she is ezempl therefrom end ihe besis For ihe allegetl exemption. Any violetion of Section 7031.5 by any applicant for a permit sublecis ihe apPlican� �o a civil penalty of not more Ihen five huntlretl doilars ($500).): ❑ I, es owner of the property, or my employees with weges es thelr sole compensation, WILL DO 7HE WORK, antl the siructure Is not intentletl or offeretl for sele (Sec. 7044, Business and Professions Cotle: The Coniractors License Law does not apply to an ownar of property who builds or improves thereon, and who does such woik himself or her5elf or ihrough his or her own employees, providetl that such improvements are not intended or oHered for sale. N, however, the building or improvement is sola within on� year of complation, ihe owner-builder will heva the burden of proving that he or she did not build or improve for purpose of sale.). � ❑ I, a5 owner of 1he propetly, am EXCLUSNELY CONTRACTING WITM LICENSED CONTRACTORS to con5tmct the project (Sec. 7044, Business and Professions Code: The con�rac�ors License Ww does not apply to an owner of propeny who builds or improves ihereon, antl who comracts for such project with a contractor(s) license pureua�i to the Coniractors license Laws.). lam Owner ID Business antl Professions Code for ihis reason: �% Expires: Verificetion oi Ownership 6y (type of doc�im�nt, i.e. - properry tax bill or deed): DIVISION OF INDUSTRIAIL SAFETY PERMIT CER7IFICATION: ❑ I here6y certify ihat no excavation five (5) or mora feet in tlepth into which a person is required to descend, will be metla in connec�ion with work authonzed by this permit, and th0t no building sirucNre, scattolding, falsework, or demolition or tlismantling ihereof, will Oe more than thihy-six (36) faet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title 8, California Atlministrative Code). ❑ As owner-bullder, I will not employ anyone to do work w�ich would require e permit irom ihe Division ot Industriel Sefety, es noted a6ove, uniess such person has e permit to do such work irom the division. Signature: Date: Division of Industnal Safety Pertnit Number: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OP ENTRV: I certify under penalty of perjury ihat I have read this epplication and state that ihe information given is correct I agree to cOmply wi�h all state laws and ciry ordinances relating to building cons�ruction, antl authonze representatives of the Ciry of Coste Mesa to enter upon ihe ebove-tlesa ed property for inspection purposes. I agree not to occupy or allow occupancy oi any building authorized by this permit until final inspeclion. �� y�a��3 Signature Of Legal Owner(s) Date And/OrAuthonzed Applicant Date cooE �. msc[cnoxr[fE 7616 Fixed System Final Fire Prevention 1266 Pool Spa Final 200 Finel Re-Rao� 201 Finel Block/Retaining Wall 202 Final Factory Fire Place 203 Finel Sign 204 Finel Demolilion AAIi VQII166i g11 t pISPEGTIONTYPE � 206 Final MeChaniCal 208 Final Plumbing 210 Final Electnwl 212 Final Fire Preventlon 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy 4LTE IMtnr.l3 r 1 e UJECTRODflESS: L55 HRENT4100D PL � OWNEP'SNPME: WULLER, JAMES A TR �,� aooxess: 255 HRENTWOOD ST COSTA MESA.CA 92627 FNCNIENGINEEfl: RUOflE55: NEG.NO.: UNIT: UNIT: PEflMITTEE: NOCK PLUMBING ( 714 ) 895-1246 AODPESS: i S G S O S EABOARD C I R STANTON CA 90680 IICENSEO CONTHALTOP OECIABRTION: I hereby alfirm �hai I am licensed unaer pmvisions ol C�ap�er 9(commencing with Sec�ion 71100� of Divison 3 0l ihe Business ana Pmfessions CAOe, anA ' ense is �n �� ce and elfect. �uc.:`050385 STqTE c.:51197 cuss: :6 E:{P�/95 Da' _p/=2c� r� � Signawre: � Y— �� NEPS' COMPENSATION OECLABATION: I �ere6y a��irm Ihat 1 have a ceriilitale ol Consenl Io 5elbinsure Or a teM1i�iCa�e a� Worker5' � Compensation Iqsufa t tibeQ�c py tAereol (Seciion 3800. Lao. C. POLILY NO.: 1 1�� — J� E%P. UATE: � 3/ O S/ 9 S camrnxr: STAT E 4Cenii� �� is �ereey lu�he� Cerlihe0 cooy is lil vnt� e ciry BuilEing Pivic'� r/ 1 n i �K 27 Applican�: l EXEMPTIONfflOMWOflREflS'LOMPENSATIONOECUflRTION: (T�issedionneeGno�OecompkleAiltAepermilislorone un orless�. 1 cehity Ihat in I�e OeAnrmanre ol lhe woB for w�ic� Ihis permil is i5suea. I s�all not empioy any person in any mann¢r sa as lo become suolect lo the workers' CAmpensation Laws of Cabfomia. Daie: Signawre: NO710E: II, al�e� making t�is Ueclaration, you shaula �ecome su0lect to t�e Warkers' Compenution provisions of ihe LaOor Co�e. you must �on�witn comply wit� suc0 pmvisions or t�is permit sAall 6e Aeemetl revokeE. LONSTflULT10N LENOING pCENLY: I her¢Oy allirm Ilui IAere is a consiruclion IenGinA agency for lhe peAOrman[e ol IAe work lor w�ic� I�is Dermi� is iSsueG (Seciion 3W7. Civ. C�. LENOEfl: aooxess: OWNEF BWLOEA �ECLANA710N: I �ere6y allirm ttut I am exempi imm tAe Coniracmrs Siate License Law lor t�e followinp reason (Sec�ion 7031.5 Business and Pwiessional Coae: Any cily oi counry which repuires a permil Io con5imct. al�er, improve, tlemobsh, or repair any slmtture. O��or to its issuance. also repuires IAe aODlicant lor sucA permil to file a signetl statement thdt hPlshe is licensetl pursuant to t�e pmWsions ol the Comracmrs' S�ate License Law �C�apter 9(commencinp vntA Section 70W) of Oivision 3 ot ihe Business antl Prolessions Cotle) or inal he/she is exempt therelmm anA �ne basis for ihe altegetl exemptian. Any violalion of Section 703L5 by any apPlicant for a permit suDlecis Ihe applicant to a civil penalty of not mare ihan live nunared dollars (5500�. I, as owner ol tne Dropeny or my emDloyees with waAes as Iheir sole compensation, wlll do ihe woM, and tne ❑ SINLIU(E151101 IfIf211AC0 Ot O��ClCGIOf5dl2�S¢c�ian 70E4, Busineu anU ProleSsionalCoCe: T�e Coniraclars $IdtE UCCI15¢ LdW aoes nol apo�Y �o an awner ol a propeny wno �uiids or improve5 tAeaon, anU who Ooes sucn wark nimselt/Aerself or �nroupn �is or �er own emploVees. D�ovidetl Ihat sucA impmvemenis are not inten4e0 or ollered lor sale. II, �owever the huiltling ar impmvemen� is 5old within one year ol completion, the owner will �aue the EurOen af Dmvinp �elshe Gid not huild or impmve lor ��e Durpose ol saie�. I. as owner oi tne pmDerry. am exclusively conVac�inp with licensed con(ractors �o constmc� �he pmlect (Section 7M4, Business ❑ ana Prolessions Coee: 7he Coniractors' Sta�e License Law tloes not aDDly to an ovmer ol proOe�Y'� �uilds or impmves thereon anU who conlracis lor suc� prole��s wit� a conlractor(s) license pursuant to Ihe Coniractors' State Litense Law). I am aware I�al D�ool o� Iheir Worker'S Compensatian insurance should be pmvitled Io me. � I am ecem0� unaer Seclion: B. 8 P. C. mr �Ms rezson�, _ �ate: Owner. I do �ere6y certify Ihat I am aware oi antl undersland t�e repuirements of Calibrnia Healih an0 Safety Cotle Sections 25505, 25533, ana 2557a an0lhat I or any Iutwe Ouiltling occupam will/will not (circle one) nee0 to com0ly wilh said state codes anA the reQuiremen[s tor a permii �or conslmclion or mo�ilicalion Imm I�e Air �uality Managemenl District. FeSiUenlial cons[mction applica�ions are axemp� hom I�ese provisions. �ale: ApPlicanl'. I h¢ieby C¢dity I�ai I �ave ieatl I�is apPOcalion and Slala Iha� Ihe ordin;mces antl slaie Nws relating la buil0ing conslmction antl �e y auth m epy br mspeclion purposes ��7 9 Daie: I L — L Signalure: i�e�'s License ai SOGai Security a: I agree to comply wit� all ciry antl county Ihis city �o enter upon ��e above-mentianed 16<L46 WM1ile—Bwl�inq: Green—Cotle Enlo¢emenl: Canary—Ap0licanC Pmk—Revenue: Goltlenrotl—Asseswr CITY OF COSTA MIESA — BUILDING PERMIT PERM NO; F G70U7i PERMIT NO: P 070071 PLAN CHECK NO: N GOVT: N SI)PP: N CGNSTk[ICTION TYPE; V—N PERMIT TYPE: PLU PURPOSE; OTH JOB DESCRIPTION : CHAD7GE OUT OF A DISHWASHER SQ FT: CLAIM VALUE; CALC—VALUE; GROUP OCC: P,-3 / CUMMENTS; NO OTHER WORK AUTHORI2ED BY THIS PERMIT 'If' �'k' i!'H'}!' if l� i'x' �f'If {FY,� �(' i! iM1 if k'IF iF iY 1{' il' J1 iF if')F 1f 1f')F if if if # if 1(' 1f 1f'IF M iY 4 if Y{!' {I' {("7{ 1f'If M' �F if'1! �F'IF'M if i1' �!' if �1' �f Y�'K't i� iE M tf �f if'M' 1F if af �F Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN bUILDING ---------- --------- ACCESSORY BUILDING --------- FF.rIT; FT IN REAA; FT IN FRNT: FT IN REAR: FT IN LEFT; FT IN RGHT; FT It�7 LEFT; FT IP] RGHT; FT IN PARKING RECI• FROV; FP.RCEL; 43933229 ZNE: REF NO; PLANh7ING 1ddTES> > �af+fiF#*iE1FifM�tfiE#'i!�1f+Fitif?fi�ifiE#tafiFil�Y�ix+E+F�lllf�fMMifihiEifih�fM4iFifif#iEfaFfR4ltitifi4#f'EiEiflfifif-+FiFir�ciFiEaFlfiflflf�fMiE�)t D E V E L O P M E N T S E P. V I C E S P. E Q U I R E M E N T S 2C�NIi]G AFPRGVED BY , DATE; BUZLDING APPkOVED BY : DATE: APPLICATIt]N ISSUED BY; /7LJ1 DATE: l C_ l/��/ iEjc�t*,t�E*�fi�*�triE+r�7f�*r,r*r*?F';Fit�riF ri'�F r�Fi 7F8'iF1e�r7F1?�17++�ir+�iF�tiiz�r�r�+T�*tex*at*.i��,. +c+ *,�'i/*� iEiEafiflMiFiFiF14'�FiEifi(�1fiEifltMiFlf')(-iElfihiFiFlkifiFYifY�ifil�ififiFafdEififiF�ltiFiliEiFlf�V1FiFMiE'N�1f�lfifif'lfifiFiEiFiF�f'IF�i{clfah ifiEiFif�E'M�KA4 LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMEPdT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADIP7G PERMIT 7,00 253 SMIF/NON—RES PLar� ISS[)E FEE 20. QO BUILDING—DIC�—> FERMIT ISSUE PLAN—�HECY. TOTAL PAID DUE TOTALS----> 7.00 20.Q0 0.00 27,00 27,Q0 ,00 REVENUE DIVISION TOTALS--> COLLECTED; 27.00 OVERISHOP.T: .OU BLDG PMT F'LUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRALIING F'LF.P7—C'r.ECY. 2%,�� if iF iF'1! �l1f Mif if M1f 1FiE'If'kif 1f 1f al-Y'k iFif il'iE ih if'M ih if if M iE 1f ie 1f iF iF�kif it ]t1f if if iF if Y If tF'k'ifif'1M1f'If i! 1f'If iF iF i! 4if if�1l�M-')f 1f Y-i4 1f s#'i[-]f+f�Y�1f I N D I t� 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 PLU 1 DISHWASHER 7,00 7,00 END OF FEES ei Ob172512—OOY7?.572 TCo"II' ?7,�7Q UA7E' !1/29/yi TIP1E: 13:43 CONSTRUCTION AND PIANNWG APPROVAlS Permit # 1. Temvorary Electriwl Service or Pote 2. Soil Pipe-Undrgrnd. 3. Elecvicai Conduit Utility-Undrgrnd. 4. Electrical Conduit-Undrgmd. 5. Steel Reinforcemen; 6. Electricai UFER Gmd. 7. FoOtings 8. Foundation 9. 4Vater Pipe-Undrgrnd. 10. Str�ciural Floor SYstem 7 7, proPerty $ewer Line & House Connection 72. Sewer Cap 13. RoOf Orains 14. Rough Plumbing 15. Rough Electrical-Condu�t 16. Rough Electric Wiring 17_ Rough Wiring Sign 18. Rough Electricai-7 Bar Ceiling 19. Rough Heating & A;r Condicion�ng 20. Rough Factory Fireplace 21. DuCis, in Structure 22. Oucu. Ventilating 23. Gas P�Pe-Rough & Test 24. Roof Framing 25. Foaf Sheathing 26. T�Bar Ceiling jStruct�raq & A�onocoat 27. Frameand Flashing 28. Lathing & Siding 29. Insulation 30. Drywali Nailing 37. Plaster Brown Coat 32. Electrical Powzr Me[erFinal 33. Fina� Electric 34. Final Heating & Air Conditioning 35. Finai Gas Pipe-Test 36. HoOd or Canopy 37. Final Fac:ory Fireplace 38. Final Plum6ing 39. Water Service-Final 40. Gas Service-Final 47. Sola� Domestic-Finai 42. 8ackflow Preventer 43. Backflow Irrigaiion 44. Landscape Irrigation System 45. SoUnd Attenuation 46. Handicap iiegulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southem Caiifornia Gas Q 51. CERTIFICATE OF OCCUPANCY Date Date Inspector POGL24JrA � APPROVALS Permit # 52. Pool & Equipment Location 53. Steel Reinforceme�c 54. forms 55. Electrical Bonding 56. Rough Plumbing & Pressure Test 57. APPROVALTOCOVER�GUNITE 58. Electncal Conduit�Undrgmd. � 59. Gas P�pe, O U�drgmd., Test 60. Backwash Lines. P�Trap, �: Undrgrnd. 61. APPROVALTOD`eCK 62. Backv:ash & Receptor�final 63. Heater & Vent�Final 64. Plumbing System - Final 65. Electrical-Final 66. Solar SYstem-Final 67. �encin9 & Access A�proval 68. APPROVED FOR PLASTEFING 69. POOL/SPA SYSTEP.IS FINAL FIREDEPT.REQUIREMENT APPROVALS Permit # � 70. Underyround Hyctro 71, Product Piping :.] Gas G Oit 72. Underground Flush 73. Undergrnd. Storage Tank O Gas � 0�: 74. Overhead Hvdro 75. Dry Chemical 76. Dry Standpipe 77. FIXED SYSTEM FINAL 78. FIRE PREV. FINAI HEALTN DEPT. REQUIREMENT 79. FINAL INSPECTION 80. FOOD CERTIF!CATE iSSUED Notes: �/.,./��- -r� � Date � I InsPector I y� .�\ AODlicant to fill In all CITY OF COSTA MESA - a�aw T-nx CONSTRUCTION PERMIT C .'? Addres Address Contrector wilhin �eavy Gortler linei antl sign all appro0riate Gecla�ation TRACT NO. LOT NO. ' BLDG. NO. 7T. VPE OF CONS7RUCTION PhOne ❑ NEW ❑ ADD ❑ ALTERATION ❑ REPAIR ❑ CONVERSION ❑DEMOLISH LiCense No. ❑ OTHER DESCRIPTION OF WORK ' Phone AddfKS ' �� ' ❑ GRADING' ❑ FOUNDATION ❑ STRUCTURAL LICENSED CONTRACTOR DECLARATION ❑TENANT�ELECTRICAC•�PIVMBING ❑MECHA�. d herebv attirm tnct I am licansetl untler provislons of Charter 9(com- � r118nCing wlth SectiOn ]000) af Dlvislon 3 0! the Busin¢ss and ❑ OTHER • Professions Cotle _.and my license is In tull torte antl ettect. pROJECT DESCRIPTION . _ . License Class License No. _ . . Da[e Signa[ure � - SQ. FT. _, _ _ WORKERS'COMPENSATIONDECLARATION - OCCUPANCV_CONSTRVCTIONTVPE 1 hereby aftirm lhat t have a certificate of consent to self-insur8 or a VALUATION � ZONE ,certififate of Workers' Compensatlon Insurance, or a certltietl copY �- -- thereof (Section 3800, Lab. C.). GRADING CU. YDS. ACRES Policy No. Corripany - ;, Certilietl�copy i5 h¢reby fumiShGtl. - REMARKS: � . . ' 'y'.Certifletl cOpy IS filetl with the tlty Builtling DiviSiOn. ��_.�'d.EMPTION F0.0M WORKERS' COMPENSATION DECLARATION (Tnis.sectlon neetl.no[.be completetl if the permit is lor one nuntl�ea _, (E100) or leu). - 1 ClrL(y Ihdt In th¢ PGrtOrTance of [he work for which this permlt is issuetl, I shall not employ any person in any manner so as [o become �PLUMBING subject to [he Workers' Compenzation l.aw5 of.Calitornia. - ��.Date � � Si9nature BATHTUBS NOTICE: Ii after makln9 �n�s tleclaration, you snoultl become sub�ect TOILETS to the Worker5' Compen5ation provi5ion5 Of the Labor COde, you mus[ PLAN CFiECK SHOWERS URINALS " forthwith comply with such provislons or this permit shall ba tleemetl LAVATORIES DOVBLE LAVS " revoketl. ' _ _ ,CONSTRUCTIONLENDINGAGENCY KIT.SINKS ' -- DISHWASHE0.5� -� 1 hereby atfirm that there iz a construction lentling agency for the perv SERV ICE SINKS SUMPS' ' ' ' " ;formance of the work tor whith this permit is issuetl (Setlion 309] �Civ. CJ. -' - ' - - FLOOR SINKS � FLOOR DRAINS iLentler'S Name �L.entle�'s Atl0�es5 � DRINKING FOUNTAINS � � �OWNER BUILDER DECLARATION - - - INTERCEPTORS �� CLARIFIERS I hereby affirm that I am exempt from the ConVactor's License Law for tbe•following reason• (Section ]031.5-Business antl Professions Cotle:- SWIMMING POOL " P'TRAP - '' Any ci[y or County which reqwres a Oe�mit to construct, alter, imernve'tlemollsn or reoair anv strutture. orior to its Issuance also re- yyqTER SERVICE - ACTERAT'^^' -� ess and araeszions Code� or for Ihe allegea exemp[ion. , nt�that hC tense Law 'GAS SERVICE � �� OUTLETS 3 of tne im antl tne yyqTER HEATERS - 8TU OUTI d,[�Y applicanf Por a pGrmit sub�ects the applitant to a civil penalty �%snot more inan live nuntlretl tlollars (5500). �-- • I as owner of the prop¢rty, or my employee5 with wage5 a5 lhMr �''•^ �compensalion„will �o the wo�k, antl the st�uc[u�e I5 not Intentle0 i�i'"ofleretl for zal0. ($ectlon ]044, Businezs antl P�'ote55ion5 Cotle: The Contrac[or's Liceuse Law tloes not appty lo an owner of a property who builtls or imprOves [h¢reon, antl who tloes such wotk himself or throu9h hi5 own employee5, Orovitletl Ihat Such improvement5 are nOt intentletl or olleretl for sale. I1, howeveq tM1e builtling or improvemant is soltl wilM1l� one year of completion, tne owne� will have the burtlan of proving h¢ tlitl nol buib or improve tor the purpose of sdle). ❑ I,-as owner�of �ne prope�ty, am exclusively conlractin9 '�'��h li<ensetl cOni�actors lo mnslruct the projeC[ �(Section ]044, Business an� Pwfessions Coae: The Contracror's License Law tloes�not apply to an owner of property who builtl5 or improves thereon, antl who cOn- iraGts from such pro�ect5 with�a contracto�(s) licesnetl pursuant to the Contraclo�'s LicenSC I�w�. ❑ I am exempt untler Section ' ''B. & P. C. for thi5 1 reason - - - - Dato Owner lhal 1 hdv¢ r¢ad thi5 application antl state that [he CorrecL I agr¢e to comply with all tlty antl � state laws relating to construction, antl hereby aut of this cily to ¢nter'upon "Me a0ove men SEWER CONNECTIONS " ' ' SOLARTANK-\ \ COLIECTORS�- SOl_AR PIPING SV�� ISSUE FEE � MECHANICAL P�AN cHECK HEATING SVSTEM 0-300,000 BTV _ AND�VCTING- 100,000+BTU_ REFRIGERATION 0-100,000 BTU_ SVSTEM� 100,000+BTU_ BOILERS BTV SVSTEM REPAIR,ALTERATION EXHAUST SVSTEM MULTIPLE - � � ' �ISSUE FEE D�ivers' L' ense or 55 � � CMF 0865-�16 White-Builtlin9: �nary-ApP��cant; Pink-Accaun[ing; Goltlenro�-Assessor 5450 5/04/82 8.0� TL+ .�: ZONING REGULATIONS � A.P. � ZONE PLNGp. R�E/F. p� ' - � SETBACKC 5T. �ROPE�RTVNLINE LIDE VARD' , EF SI�EY - RI HT � . REAR YARD (TO P/L) PKG. SPACE REQ. 20NING APPROVED BV SPECIAL CONDITIONS: PROVIDED PARK FEE S ELECTRICAL-' � - � " PLArv Ct+ECK ' 50.FL .GENERATOR " Od KW_1-30•KW �TRANSFORMER � ��APPLIANCE 30-SOKW_SO+KW '- IMOTOR$ 0-1 HP=1=30'HP ,-(INC.SOLAR) � 10-SO��HP �50-+FIP� - �FIXTVRES "" OUTLETS 'SWITCHES" GASTUBESIGNS - - ' - --' 'POLE LIGHTS ' — -' PANELS ' - MAIN SVB SERVICE ' ' -' ' /Q� —AMP � ISSUE FEE ' ' - � �AFPI_ICHTION AGPROVED BV ' � � �DATE-- - SUMMARV OF FEES . BUILDING- - •� � ' - - � - - PERMIT S $MIP �$ 'PLAN CHECK S PERMIT.. - � �PLUMBING E ' ISSUANGE $ ' GRADING $ 'PLAN CHECK E + � ' ELECTRICAL $ , • �� , � " a PLANCHECK $ - MICROFILM $�' ' . � MECHANICAL E _,.TOTAL FEE $ PLAN CHECK E�- ' GE55 AD- � _ VANCEPC $_ _ FINAL FEE S • � � , .,� � CONSTRUCTION�AND PLANNIN�G'��,,�,�`/� POOL & SPA • . ' APPROVALS Permit #� Date Inspector qppROVALS .� Permit # - Date Inspector 1. Temporary Electrical Service or Pole 43. Pool & Equipment Location - - -- - �� 2. Soil ipe-Undrgrn 44. Steel Reinforcement � - - -- -- • 3. Electrical Conduit Utility-Undrgrn 45. Forms . 4. Electrical Conduit-Undrgrn 46. Electrical Bonding - . tee ein orce . 47. Rough Plumbin & Pressure Test � 6. Electrical UFER Grn 48. APPFOVALTO COVER-GUNITE - 7. Footings � 49. Electrical Conduit-Undr rn . 8. Foundation 50. Gas Pipe, ❑ Undr rn; Test . 9. Water Pipe-Undrgrn 51. Backwash Lines P-Tr ❑' ndr rn � - � 10. Structural FloorSYstem 52. APPROVALTO DECK - ' - , 11.. Property Sewer Line & House Connection � 53. Backwash & Rece tor-Firial � 12. Street Sewer_Connection - 54. Heater & Vent-Final � _13. .Rough Plumbing - - � � 14. Rough Electric-Conduit � -56. Electrical-Final 15. Rough Electric-Wiring 57.- Solar System-Final ' ' - 16. Rough Heating & Air Conditioning � encing & Access Approval 17. Ducts in Siructure ' APPROVED FOR PLASTERING 18. �Ducts, Ventilating � � __ 19. GasPipe-Rough"&Test � •• 60. POOL/SPASYSTEMSFINAL ,.� � 20. Roof Framing-- _ .. � � • 21. Roof Sheathin - ' - ' - 22. Frame and Flashin - NOTES: ' . 23. Insulation � -. _ - - 24. Lathing & Siding � ' - - � 25. Drywall Nailing - 26. Plaster Brown Coat 27. • Electrical Power Meter-Final - / - � � � - 28. �Fi�al Electric � � 29. Final Heating &-Air Conditioning '- � - 30. Final Gas Pipe-Test 31. Final Plumbing � ' '' � 32.-- Water�Service-Fina1 ' ' � . 33. Gas Service-Einal � ' ' 34. Solar pomes[ic-Final �^ 35. Landsca e S rinklin S stem � ' � ' 36. Sound Attenuation � � � � ' 37. Handicap Regulations " - - 38. FINALSTfiUCTURE&BUILDING � � � � - 39. Special Requirements Completed � -� 40. Electric Release to Edison � � 6 3 � � 41 . Gas Release to Southern California Gas Co. 42. CERTIFICATE OF OCCUPANCY .� . - ' No Date 17289 �COSTA MESA BUILDING-SAFETY DEPARTMENT P. O. BOX S17 COBTA MESA. CALIFORNIA For Appliean+ fio Fill In Complefely 7'YPE OR PRINT BUILDING � / A�DRESS � `�S � �L �/ COSTA MESA. CALIFORNIA TEL. NO. OF 6LDG8. USE OF EXI8TING BLDG. BHTBACK LIH6 PPOM � �7 CENTER OF BTReeT J� D REAR YARD J/ I �� I �/ • SIDE YARD LEFT RIGHT :S F DESCRIPTION OF WORK NEW I x II ALTERATION I II ADOITION I siie v /.3 L'� �f 9 DD riooMs / EXTERIOR WALL ROOF COVERING S�- IGOVERING � USE OF BUILDING AND WORK TO BE PERFO � ...�;,� ��% � ' ; �r lvl• C- + JUN 7 4 i9�� g c� ,�� ; v,,,�:cc ��i�:�: CIi1' Of COS1N h��cSA APPLICATION FOR PERMIT eua�iN� For Offiee Use Only necerysq ar � t� BUILDING „ au%i COSTA MESA. GALIFORNIA ZONING ZONE I NO. OF J I U6E OF NEW Si' 3�A R�/ PLAN9 [_. BII�LOING W�Rnh�� ,`,F`,�o�,,�,,,, �i� � //% TR 3oa urve sr.� .S–O � 3 �� _° u/�o�. — iN. IN. IN. I N. re `s� L/� L LU.i� � l' �I oX—/S3� d, �/�dQ. 1 HEREBY ACKNOWLEDGE TXAT 1 HAVE R THIB APPLICATION TXE �MOUNT eHOWN UNDER VqLUATION IS FOR THE ANU 6TFTE TH�T THE �00VE IB CORR¢CT AND PGREE TO COM- PURPOBE OR EBTABLIBHING A PEftMIT FEE ONLY. PLY WITH ALL C1TY OBDINANGEB /.HD STATE LAWB 1iH6UV31NG BUILDIN6 coNSTRUCiION. VALUATION SIGNATURE OF /`�C PERM17 FEE $ t�� PERMI'RE . $ /� `��—_ � PLAN CHECK $ AUTHORIZED AGENT �—