HomeMy WebLinkAbout407 COSTA MESA ST - Building PermitsCITY OF COSTA MESA
avn�►N� �►v�s�oN
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
��ia� �sa-s2�s • Fax (�ia� �sa-aess
,lobAddress: 407 COSTA MESA ST
Suite:
Vicinity:
ParcelNunmber: 42631102
nppliwnt: KLIORIKAITIS, GEORGE
Address:
Owner: KLIORIKAITIS, GEORGE A
Address 407 COSTA MESA ST
COSTA MESA, CA
Contracror: O �ltt N �iL
Address:
Zip:
ArCh : • '
Address:
Phone:
BUILDING PERMIT
Zoning:
Phone:
Zip:
Phone:
Zip: 92627
Phone:
License:
Eng:
Address:
PERMIT NUMBER �
77 FAIR DRIVE, COSTA MESA, CA 92626
ISSUED BY:
Status: ISSUED
Applied: 04/15I7999
Issued: 04I75/1999
Phone:
Zip , License: Zip: License:
SCOPE OP PERMIT
REROOF • T/O, NEW CLASS "C" COMP SHINGLE ROOF. INSTALL 2 LAYERS OF 158 FELT. INSTALL 12" CDX
PLYWOOD ON GARAGE ONLY. HOUSE IS SHEATED ALREADY.
FEE SUMMARY
Plan Check:
Permit:
SMIP Res:
SMIP Com:
Other:
Inspection:
Total
$0.00
$99.75
$0.50
$0.00
$0.00
$0.00
$100.25
SETBACKS
MAIN STRUCTURE Front 0. 0
ACCESSORY Front 0.0
PARKING Existina: o
NOTES:
Rear 0- 0
Rear 0-0
Required: 0
PLANNING 8 ZONING
Lefl 0- 0
Left 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation:
Right 0. 0
Right 0-0
55,000.00
55,000.00
NOTICE: The work authorized by this permit shall compty with all applicable handicap access requirements under Califomia statutes end related
regulations. (Ord. No. 9248, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or If work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: in order for the work eulhorized under this permit to be considered legal, such work must comply with all epplicable codes, end ell
requlred Inapectlone end tinel epproval must be obtained. Failure to obtain Inspectians and final epprovel will result in the expiration of ihis parmit.
FOR INSPECTIONS CALL: (714) 7545628
WORKERS' COMPENSATION DECLARATON:
f hereby ettlrm untler penelry ot perjury one of Iha following dedaretlons:
❑ I heve and will malnlein e cetliflcate of consent to self-Insure fo� workers' compensation, as provitletl for by section 3700 of the Lebor Code, for the pertormence ol the
work far which ihis permi� Is IssueC.
❑ I have aiW will meintein wwkers' compensa0on Insurance. as reqWretl by section 3700 of Ihe Labor Code. for the peAortnance of the wwk tw whltli ihis pertnii Ls Lswetl.
My workers' compensatlon Insurence cartier and pdicy number ere:
Cerner: Policy NumDer:
(Thls secNon need not be crompleted U Ne pemtif is veWed at me hunOred dol/ers ($100) or less.)
❑ I cenly thet In the pertormence oi the work far whic� thu pertnit Is iuueq I shall not employ eny person in any menner so as to Decome sub�ect to the workers'
compensetion laws ot Calitomia, end agree Uet if 1 should become sub�ecl ta the workers' compensetlon provlsions ot SecUon 3700 at Iha LaEar Cotle, I shall torthwith
comply wllh Ihese praNsian9.
Applicant Signeture: Date:
WARNINO: FAILURE TO SECURE WORKERS COMPENSATION COVERAGE IS UNLAW FUL AND SWLLL SUBJECf AN EMPLOYER TO CRIMINrI� PENALT7E5 AND CML FlNES UP TO ONE HUNDRED
THd1SAND DOLLARE (E100.ODO�.IN ADIX7IIXJ TO TNE CQST OF COMFENSATION, DAAMGES PS PROVIDED FIXi IN SECTION 3'l060F TME LABOR COOE, INTEREST, AND ATTORNEV5 FEES.
LICENSED CONTRACTORS DECLAFiATON:
I here6y eMirm thet I am Ilcensea under provlslons of Chepter 8(wmmencing wlih Sectlon 7000) of Dlvislan 3 af the Business end Professions Cotle, entl my Ilcense LSIn lull
farce and ettoct. Llc. a Cless q
ConVectors Signeture: Dele:
CONSTRUCTION LENDING AGENCV:
❑ I here�y eHirtn thellhere is e construdlon Iending agency tor the pedormance ot the work tor which this pertnit is Issued. (Sec. 3097, Gdl Code).
Lentlers Neme: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby atlirm �het under penalry of perjury thai l em EXEMPT FROM THE CONTHACTORS LICENSE LAW for ihe following reeson (Sec. 7031.5, Buslness antl Professions
Coae: Any ciry or county which requires a permit to consWct, alter, improve, demolish, or repair any structure, prior to its issuance, alw requires tha eppllcam tor such pertni[
to file a signed stetement that he or she is licensetl pursuant ro Itie provislons of Ne Contrectore Llcense Lew (Chapier 9(commencing wlih Seclion 7000) of DlNslon 3 01 Ihe
Busine en0 Professians Code) or t�at he or s�e is exempt iherefram end the hasis lar Ihe ellegetl exemptlon. Any violation of Sectlon 7031.5 by eny applicant tor e pertnit
sub s the epplicant to e civil penelry ot na more than Me hundred ddlars (5500).):
I, as owner of the property, or my employees with wages as their sde compensetion, WILL DO TME WORK, end the structure is not IntentleC or oflered br sale (Sec.
7044, Busineu enC Prolessions Code: The Contradors License Lew tloes not apply to en owner of property who huilds or improves iherean, entl who tloes such work
himself or hersetl or through his ar her own employees, prodded thet such Improvements ere not intended or ottered for sale. If, however, the building or impmvemant is
sold wit�in one year ol completlon, the ownerbuilder will have Ne burden ol proving that he or she did not build or improve for purpose of sale.j.
❑ 1, as owner of the property. em EXCLUSNELV C WfTH LICENSED CONTRACTORS to construct the project (Sec. 7044, Businass entl Pmfessions
Code: The contrectars License Lew does not ep y to en er I properry who buil05 or im0�oves thereon, and who cantreqs for such proJect with e cnntractoqs)
license pursuant to the Contractor; lice� Laws.
❑ I em exempt
Owner ID vetlfied by ddW
Verification of Ownerehip
Code tor ihi5 reason:
❑ Ves ❑ No`� � Drivefs License No.
nent, i.e. - properry tex blll ar deed):
Dale:
Expires:
DIVISION OF INDUSTRIAL SAFE7Y PERMR CER7IFICATION:
❑ I hereby certity Ihet no e.cevatlon fNe (5) or more leet in tlepth into whic� e Oereon Is requlretl to tlescentl, will be made in connecllon with work euthorized Dy this
permit, end thet no builtling structure, scallolding, falsework, or demditlon or dlsmentling thereof, wlll be more than thirry-six (38) teet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Ttle B, Callfomia Atlministretive Code).
❑ As owner-bulltler, I will not employ enyona to tlo work which would require e Dermlt from the Divlslon of IntlusMal Safery, es noted ebove, unless such person has a
permlt to Oo such work trom the division.
Signawre: Date:
Dlvision of Industriel Selery Pertnit Number:
CODE �. INSFEC710NTYPE
1876 Fized System Flnal Flre Preventlon
1266 Paol Spe Final
200 Flnel Re-Root
201 Flnal Block/Fletelninp Well
202 Finel Fectory Flre Place
203 Flnel Sipn
204 Final Demditlon
zaasra
PAIF It4�L5
`7 li--! "/ �
CODE I INSPECTION TYVE
208 Finel Mechenical
20B Finel Plumbing
210 Finel ElectAcal
212 Finel Fira PrevenUon
220 Finel Plenning Approvel
222 Final SIIe
250 Finel Building�Occupancy
Q� INfIfIRLS
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CITY OF COSTA MESA
BIIILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
(714) 754-5273 • Fau (714) 754-4856
Job Address: 407 COSTA MESA ST
Suite No
Vicinity:
Parcel Nunmber: 42631102
Applicant:
Address:
Owner:
KLIORIKAITIS, GEORGE
KLIORIKAITIS, GEORGE A
Address 407 COSTA MESA ST
COSTA MESA, CA
Contractor: O� N�
Address:
ArchlEng:
Address:
PLUMBING PERMIT
Phone:
Zip:
Phone:
Zip: 92627
Phone:
Zip:
License:
Phone:
Zip:
License:
PERMIT NUMBER
�/ P99-00227
77 FAIR DRIVE, COSTA MESA, CA 92626
ISSUED BV:
Status: ISSUED
Applied: 04/15/7999
Issued: 04/15/1999
SCOPE OF PERMIT
RELOCATING WASHER FROM KITCHEN TO OUSTSIDE, UNDER A COVERED PATIO COVER, INCLUDING
NEW HOT HOT & COLD WATER.
ISSUE FEE
Backflow irrigation
BackFlow Preventer
BathWb
Clarifer System
Connecl (Ice,Soda,etc)
Dental Units
Dishwasher
Drain, Floor
Drain, Rainwater
Drain, Roof
Drinking Fountain
Expansion Tank
Gas Earthquake Valve
Gas (1d outlets)
Gas (Over 4 outlets)
Gas Repipe
Gas Service
Interceptors (Grease, Oil)
Interceptors (Sand Auto )
AMT
$22.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
QTY
FEE SUMMARY
Laundry Tub / Washer
Landscape Irrigation
P-Trap
Pressure Regulator
Process Piping (per 10 ft)
Receptors
Septic Tank
Sewer Cap for Demo
Sewer Connect
Sewer Private Line
Shower
Sink, bar
Sink, commercial �
Sink, Floor
Sink, kitchen
Sink, service/mop
Spa (private)
Spa (public)
AMT
$8.75
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00.
$0.00
$0.00
QTY
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
COMMENTS / SPECIAL CONDITIONS
Sump Pump
Swimming Pool
Trap Primer
Urinal
Vacuum Brkr Bkflow(1-0)
Vacuum Brkr BkFlow(5+)
Wash Basin
Wash Basin Set
Waste and Vent System
Water qoset (Toilet)
Water Heater / vent
Water Piping Qnst or Rep.)
Water Re-pipe
Water Service
Water SoRener
OTHER
VIOLATION
PLAN CHECK
REINSPECTION
TOTAL CALCULATED FEES:
AMT
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$8.75
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$39.50
QTY
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
NOTICE: The work authonzed by this permit shall comply with all applicable handicap access requirements undar Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 1241-92)
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 penod of 780 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
requlred Inepectlone and Ilnal epprovel must be obtained. Failure to obtain inspections and final epproval will result in the axpiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
WORKERS'COMPENSATION DECLApATON: '
I hereDy attirtn under penalry of perJury one ot the following declaratlons:
❑ I heve and will malmain e cenificeie of consent to seli-Insure for workers' compensetion, as Drovitletl for by section 3700 of Ihe Labor Code, tor the pertortnance of Ihe
wo�k for which �his permit is issueq.
❑ I have end will melntaln workers' cpmpensation insurance, as required by section 3700 of �he Labor Code, for �he perfortnance of the work for which this pertnit is issued.
My workars' compensetlon Insura�ce carner and policy number ere:
Carner: � Policy Number.
(This section need not be completetl il tqe permit is velued ef one hundred dollars ($100) or less.)
❑ I certify that in lhe peAormance o� the work for which Ihis permit I5 Issuetl, I shell not employ eny person in eny manner so as to become subject [o the workers'
compensetion lews oi Califomia, and egree �hat if I shoultl become subject �o ihe workers' compensation provisions of Section 3700 of the Lebor Coda, I shall forthwith
comply with these provisions.
Applicent Signature: Dete:
WARNING FAIWRE TO SECURE WORKERS' �MPENSATIIXJ COVERAGE IS UNLAWFUL AND SHALL SUBJEGT AN EMPLOYEF TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED
THOUSANO OOLLAFE ($100,OOJJ, tNAOINTtOM1� 7p THE C0.SiOF COMPENSATIIXJ, OAM4GES AS PROVIOEO FOfl IN SECTION 31O60f iHE LABOH COOE, INTEFEST, ANO ATTORNEI^S FEES.
LICENSED CONTRACTORS DECLARq7ION: •
I hereby aHirtn that I am licensed under provisions of Chapter 9(commencing with Sectlon 7000) of Division 3 of the Busineu and Professions Code, and my license is in full
torce entl eHect. Lia x Cless x
Contractors Signature: Dete:
CONSTRUCTION LENDING AGENCY:
❑ I hereby aHirtn Ihe� ihere is a consimction lentling agency for the paAormance of ihe work tor which ihis pertnit is Issued. (Sec. 3097, Civil Code).
Lentlefs Name: Lendefs Address:
Signa�ure: Date:
OWNER-BUILDER DECLARATIONS:
I hereby eflirtn that under penalry ot perjUry thet I am EXEMPT FROM THE CONTRACTOfiS LICENSE LAW tor the following reason (Sec. 7031.5, Business antl Professions
Cotle: Any city or counry which reQuires a pertnit to construc�, alter, improve, demolish, or repair any structure, prior �o Its issuence, also requires the epplicant (or such permit
to file e signed stetement �he� he or she Is Iicensed pursuent to the provislons of Ihe Contradors License Lew (Chapter 9(cammencing with Sedion 7000) of Divlslon 3 of ihe
Business antl Protessions Code) or thet he or s�e Is exempt ihereirom end ihe basis for ihe allegatl exemption. My violation of Section 7031.5 by any applicant for a permit
sub' ts the epplicant to e clvil penalN oi not more ihan five huntlretl tlollere ($500).):
I, as owner of Ihe property, or my employees with wages es their sole compensetlon, WILL DO THE WORK, and the stmctura Is not Intentled or ottered for sale (Sec.
7044, Business and Professions Coda: The Contracmrs License Lew does not epply to en owner oi property who builtls or improves theraon, antl who does such work
himseli or herself or Ihrough his or her own employaes, providad ihat such improvements are not intendetl or oHeretl for sele. If, however, the building or improvament is
sold within one year of completion, the owner-builder will have ihe burden of proving Ihat he or she did not build or improve for purpose of sale.).
❑ I, es owner ol Ihe property, am H%CWSIVELY CONTRACTING WITH LICENSED CONTRACTORS to conStruCt ihe project (Sec. 7044, Business antl Professlons
Code: The contrectors License Law tloe I an owner of properry who builtls or impmves ihereon, and who coniracts tor such pmject with a con�ractor(s)
license pursuant to the Conirectorg Licen e Laws .
❑ I em ezempl u c. iness end Pmfessions Cotle for this reason:
Signalure: Date:
Owner ID verified by tl ve 'cense. ❑ Yes No Drivets License No. Expves:
Venfication of Ownership b%'�ly�pt document, i.e. - property taz 6ill or deed):
DIVISION OF INDUSTRIAL SAFETV P�qM17 CERTIFICATION:
❑ I hereby certiy Ihet no excavetion tive (5) or more teet in tlepth into which e person Is reQuired ro tlescenq wlll he made in connection with work authorized by Ihis
permit, and t�at no building stmctUre, scaHolding, telsework, or demolition or dismantling Ihereof, will De more ihan thirty-six (38) feet high. (Chap. 32, Gry 2, Ar12, Sac.
341, Title 8, Gallfomla Administrative Code).
❑ As owner-builder, I will no� employ anyone to tlo work which would require a permit from the Division of Indusirial Sefery, as noted ebova, unless such person has a
permit to do such work irom the diVision.
Signature: Date:
Division of Industnal Setety Permit Number:
CERTiFICATE OF COMPLIANCE AND AU7H0 Tl�pI OF NTRV: I certify under penelty ot peQury that I have reed this application flnd state that the intormation given is
correcl. 1 agrea to comply wit all s@te laws a ciry oi ina es relating Io buiiding consiructlon, and authorize representatives ot ihe Ciry ot Costa Mesa to enter upon the
above-descnbe fo s➢I lfe u os ^. I egr e n to occupy or ellow occupancy oi eny building authorizetl by this pertnit until finel inspection.
e� -�r.fT,�L. �q T/79
1 - Sinnahire f l ona de 9Jete
COOE 1. INSPECTION TYPE
1616 Fixed Sys�em Finel Fire Prevehtion
1266 Pool Spa Finel
200 Final Re-Root
201 Final BIocWRetainin9 Wall
202 Final Fectory Fire Plece
203 Final Sign
204 Finel Demolition . _
2446.a8
[11ej� �NTRUIS 4QpF� INSPEC710NTYPE
206 Final Mechanical
208 Final Plumbing
210 Finel Electrical
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 . Final Building/Occupancy
/LATE INTRULS
(714) 754-5273 • Fax (714) 754-4856
Job Address:
Suite No
Vicinity:
Parcel Nunmber:
Applicant:
Address:
Owner:
Address
CITY OF COSTA MESA
+ BUILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
407 COSTA MESA ST
42631102
KLIORIKAITIS, GEORGE
KLIORIKAITIS, GEORGE A
407 COSTA MESA ST
COSTA MESA, CA
Contrector. ��N�' n
�_i`
Address:
ISSUE FEE
Temp service test
Res. a/c package
New Res (1-2 units)
New Res (3+units)
Pool / Spa
Lighting Fizts
Recept Outlets
Switches
Nan Res Appl
Res Appl
Service to 200a
Service to 1000a
Service over 1000a
Motors to ihp
Motors to 10hp
Mators to 50hp
Motors to 100hp
Motors over 100hp
Communication drops
Sub panel to 200a
Pole Light Pkg
Sign Circuits
Temp Pwr Pole
Intermed Pole
ELECTRICAL PERMIT
Phone:
Zip:
Phone:
Zip: 92627
Phone:
Zip:
License:
PERMIT
77 FAIR DRIVE, COSTA MESA, CA 92626
ISSUED BY:
Status: ISSUED
Applied: 04/15/7999
Issued: 04/15/1999
SCOPE OF PERMIT
INSTALL UNDERGROUND ELECTRICAL CONDUIT FROM GARAGE TO HOUSE FOR CONVERTING OVERHEAD
TO UNDERGROUND FOR GARAGE POWER, INCLUDING ADDING 8 OUTLETS.
$22.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$8.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$o.00
$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
8
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
FEE SUMMARY
Temp Dist System / Lighting
Busway /100 k
Standing Section
Misc Electrical Equipment
Transtormers up to 1 kva/kw
................up to 10 kva/kw
.................up to 50 kvalkw
.................up to 100 kva/kw
..................over 100 kva/kw
Low Voltage Equipment
Low Volt Wiring System / Ckt
Misc Conduit
Misc. Condudor
Cirws ( gen or ride)
Circus (mech ride or lights)
Christmas Tree Stand
Fireworks Stand
Other Electrical Fee
Investigation Fee
Plan Check Fee
Reinspection Fee
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$76.25
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
TOTAL CALCULATED FEES 546.25
COMMENTS / SPECIAL CONDITIONS
Quantity
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and ralated
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permR 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 780 days.
INSPECTIONS: In order for the work euthorized under this permit to be considered legal, such work must comply with all applicable codas, and all
raqulred inepeetlons and final epproval mus� be obtained. Feilure to obtain inspections and final approvel will rasult in the expiration of this permit.
fOR INSPECTIONS CALL: (714) 7545626 �
WORKERS' COMPENS4TION DECLARATION: '
I hereby aflirtn undar penalry of perjury one of Iha following declaretions: � '
❑ I have and will maintein e cartificete of consent to selt-Insure ta workers' compensetlon, as providetl for by sectlon 3700 of ihe Labor Cotle,-for ihe pertormance of the
wark tor which this pertnit is issuetl.
❑ I have and will melntain workers' compensation insurance, as requlred by section 3700 of ihe Lehor Code, for ihe peAortnance ot ihe work for which this pertnit Is issued.
My workers' compensallon Insurance cerrier end policy number are:
Cerner. � Policy Number:
(This section neetl nof be completetl il the permit /s velued et one hundre0 dollars ($100) or less.)
❑ I certify that in the peAormence oi the work for which this permit is issuetl, I shall nm employ eny person in any manner so as to become subject to the workers'
compensation laws oi Celifornia, end agree ihat tl I shoultl become subject to the workers' compensetion provislons of Sectlon 3700 oi the Labor Code, I shall forthwith
comply with these p�ovislons.
Applicant Signature: Dete:
WARNING FAILURE TO SECURE WORKERS' COMPENSATION COVERApE I$ UNLAWFUL AND SHFLL SUBJECT AN EMPLOVEF TO CRIMINAL PENALTIES ANO CIVIL FINES UP TOONE HUNORED
THOUSAND DOLLARE (5100,ppp), IN AD�RION TO THE COST OF WMPENSATION, DAMAGES AS PPOVIOE� WR IN SECfIIXJ 3'IOfi OF THE LABOR COOE, INTEREST, ANO AiTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby attirm that I em licensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 of the Business antl Professlons Cotle, antl my Iicense is In full
foroe and eHect Lic. # Class N
Coniradofs Signature: Date:
CONSTRUCTION LENOING AGENCY:
❑ I hereby aHirm that there is a construction lending egency tor the pertormance ot the work tor which this permit is iuued. (Sec. 3097, Civil Code).
Lender's Name: Lender's Address:
Signature: Dete:
OWNER-BUILDER DECLARATONS:
I hereby aflirm ihat under penalry oi per�ury that I am EXEMPT FROM 7HE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions
Cotle: Any city or counry which requires e permit to consWct, alter, improve, demolish, or repair any structure, prior to ils issuence, also requires the epplicant tor such permit
b file e signed statement ihet he or she Is licensed pursuant to the provislons of Ihe Contredore License Law (Chapter 9(commencing with Seciion 7000) of Division 3 of the
Business and Protessions Code) or that he or she is enempt theretrom entl the bazis for Ihe elleged exemption. Any violation oi Seqlon 7031.5 by eny applicant tor a pertnit
sub s the applicant to e civll penalry of nol more than five hundred dollers ($500).):
I, as owner ot the property, or my employees with wages as ihelr sole compensation, WILL DO THE WORK, antl the strucwre Is not intended or oXered for sale (Sec.
7044, Business and Professions Cotle: The Conirectors License Law does not epply to en owner of property who builds or improves thereon, end who does such work
himself or herselt or through his or her own employaes, provlded thet such Improvements ere not intended or offered for sale. N, however, the building or improvement is
sold within one year oi completion, ihe owner-builder wlll heve the rden of proving that he or she did not build or improve br purpose of sele.).
❑ I, as owner of tha properry, am EXCLUSIVELV TN ITH IICENSED CON7fiAC70RS to construct the pro�ed (Sec. 7044, Business and Professions
Cotle: The contracbrs Ucense Law tloes not ap y to an n o property who huilds or improves iheraon, and who contracts for such proJect with a crontractor(s)
license pursuant to the Contractors Lic e Laws. .
❑ I am exempt un Professions Code tor ihis reason:
SiqnaWre� Dare:
Owner ID verified by driv sa. ❑ Ves ❑ No Driver's License No. Expires:
Venfication of Ownership �,(p� oT�ocumen�, i.e. - proparty taa bill or deed):
DIVISION OF INDUSTRIAL SAFETV PERMI7 CEHTIFICATION:
❑ I hereby certify thyt no excavation five (5) or more feet in depih into whlch a person is requlred to descend, wlll be matle in connection with work authorizetl by this
pertnit, and that no Duiltling siructure, scaHolding, falsework, or demolition or dismantling thereoi, will be more thfln thirty-six (36) teet �igh. (Chap. 32, Grp 2, An 2, Sec.
341, Titla 8, California Administrative Code).
❑ As owner-builder, I will not employ anyone to tlo work which would require e permit from tha Division of Indusinel Safery, as notetl ebove, unless such person has a
pertnit ta do such Work trom the division.
Signeture: Date:
Division of Indusirial Safsy permit Num6er:
CERTFlCATE OF COMpLIANCE AND AUiHO ON OP ENTRY: I certity under penelry of perjury that I heve read this epplication and state that the intormation given is
correct. I egree to comply with aJ� state laws a d ciry rdinan es releting to building construction, end euthodze representaNves of the City of Costa Mesa to enter upon the
ebove-descnDed r r i e[ie � puryos . I a ee no 0 occu y or allow wcupancy of any �uilding authonzed by �his pertnit until tinal inspection.
�PeA�- ��/99
Sionature eoal0 ller Date
CODE �. INSPECTIONTYiE QS¢, INTRIRLS
1616 Fiaetl System pnal Fire Prevention
1266
200
201
202
203
204
24a6d6
Pool Spa Final
Final Re-Rooi
Fine181ocWRetaining Wall
Finel Fedory Flre Place
Final Sign
Flnel Demolitiqn
CODE� INSPECTIONTYPE
206 Final Mechaniwl
208 Final Plum6ing
210 Final Elecirical
212 Final Fira Prevention
220 Final Plenning Approval
222 Final Site
250 Final Building/Occupency
� 1 11..
��il-I �i
♦4
� �. •� r
�.
COUNTY OF ORANGE � � �
BUILDING DEPT. � ���-%7_
636 No. Btoadway Permit No.___. .
Santa Ana� California Application for Building Permit ,
Phone: KI 2-6211 AND FOR A
Certifica+e of Use and Occupancy
Dare --'l ��/ y-(1 --'_""'-'-- ---------,-
OWNER'S NAME--------CAABI--DHA1iC�Si--�E�ES---------------------,------,-=-----'--------- PHONE: A.�A4QI1--�.. R.
MAILING ADDRESS-----i8g---Fi.__i��iYl._$YrL`88�--------- .................-----_.. .- CITY -----O40�fA_2'�Q��..,_.-----.-------
Name .....__..__.
Address
C[ry ----'
$tate
Lic. No
(Amhirect or Engincer)
Phone .._..
[Vame�e7l��0_.t�j�._Hole�e�n & 9on�
-------_-'_-----------------
(Concrac[or)
Address --��� Fi. _ 17th_Strevt-----------------------------
Cicy ---008�� _F'I@8F1- - -- - ---- - ------- ------------ ----------
Scacc 19?�
Lic Not.__...1-+...-----------��.--'-----. Phone8i3$QQS1_�.'�.�7---
PROPOS�D USE: ----ROQ%QOT140 ----_ -- -------------- -- -- ... ---_
-----_.-�---- --- - - - ._ ---- ------ •
2. JOB LOCATION_--- yQ7- ----G�.._�t-Flq.._/"IP-f4--°r�-.--------006$q_.If88a---------------�-----------------
(House No.) (Name oE Screet� (Town or School Districc)
3. LEGAL DESCRIPTION: Loc --_--�9 - --------------_-_----_----Block ---.-.--_.. ` _-- __Tract __1�°�.��
--- ----' ---'-- - — � ------- ---'--' - -
(Me�es and Bounds Description—Use reaenc side of form)
4. CORNER LOT ( ) IIVTERIOR LOT (�) THROUGH LOT ( ) SLOPE OF LOT ( )
5. SIZE OF BLDG.: �i./-_�r._.?4---_ AREA:____.___l�`la---------SIZE OF LOT: _..�G.�_X_L<�.CAREA:..7_��..__.._._.._.
6. HF_IGHT OF BLDG.: _.____�.BQ _.._________________CEILING HEIGHT:._._.__89__..__....______. NO. OF STORIES.____.__.�........._._
i. NO. FAMILIES ________.�__________________.....Size of Smallest Bedroom: ...9 (' _ /_Q-__ ' �---. �� �'
k_ S�ze of Kachen: _.. -:'.__._. __
8. EXTERIQR WALL CONSTRUCTIONFl°.8tA0_--.STiLt00Q..______.INTERIOR WALL COVERING ___._P].QB.�'i81`.....------
(Frame, Smcro, Ecc.) � . (Plaatcr-0rywall, Em.)
9. SETBACKS: Front Yard £rom Center Line of Street.__--��_--"-'-""___-----' _-_ ----------_---_'------_—_'---'---'--"' _-__"".--
p / i /
Nearesc Side Yard ___.__U._______._ Rear Yard ...__%�_____._. Distance in Feet Between Bldgs. on Same Lot ._�__.....____. ._ _.. ...
lG. A COMPLETE PLOT PLAN IS REQUIRED, SHOWING ALL STRUCTURES A[VD USE OF EACH.
�
11. For
Accessory
Bldgs. and
$imilac
Struc[ures;
(a) Footing: Wid�h ___..�,�iR__._.__....---_- Depth in Ground __.____..],QQ
(b) Size of Smcis: --'+t'-it--�---------..Spacing--1��-'-'-'---'-------"CC
�c) Size oF Floor Joists: __�:..-
13.
ci) Size o£ RaEters: ____._ _Q__R--�----�-
Spacing _....�:___.
Width of Wall _._...__gA____
Matcrial of Floor �._CQ.N[ •
"CC
sPa��„g .......84p------ ------"cc
�7F PROPOSF�,D WOR � Including all labor, plumbittg, electrical wiring, heating, fire sprinklets, painb
disposal ��---%.�-7-9-----_--------------------------
I HEREBY CERTIFY THAT TO THE BEST OF MY K[VOWLEDGE AND BELIEF THE INFORMATION IN
7'HIS APpLICATION IS CORRECT AND THAT THE COIVSTRUCTION WORK WILL CONFORM TO ALL
LAWS OF THE COUNTY OF ORANGE AND THE STATE OF CALIFORNIA P.PPLICABLE THERETO.
Signed: --- . . �-=" - ------ ----'-- `--�-�.."-------------
Plans F;led:
-- ------
- ---------"'----- Owner�
--- By:------ ----- •- " - - --- ------ ----- --------------
- - - ----
(Authori ed Ageno)
FOR DEPARTMEN`I'AL USE ONLY
FEES:
�
Bldg. Permit - �.__��t"'�__---_-
Plan Check - .�_��-__----
� -- -' �
To[al - . /
�-----f� �-:� ----
Rcceipt No. - - ------- --�-1.�_—__-
Paid to - -
----- ------ ----
e - 6-.s�
Dace ... .-------- 1-------- -
DA'
SM-9.30
GROUP- ---..L -- - ----
TYPE.------�-- ------
DIST.
MAP. ------ - ---- ------
SHEET NO.__._✓/___..___._
CH �CICING BY
`,C,
APPLICATION _____ �r/ HEALTH...
ZONING __.._�a� FIRE
--- - MARSHAL
PLANS AND
SPEC'5.---------------------._ STATE ----
CORRECT10N5 ENGINEER
PERMrI-T-ISS j-� ED•BY:
I V. !.�i. �,���; �.:. I��r COUf�T' BUILDING
i r W �. �CTOR
--- - _--------- ---------- -------------- - -------- ----------G°�
i �
' - __ D�PUTY
COUNTY OF ORANGE
BUILDING DEPT.
636 No. Broadway
Santa Ana� California
Phone: KI 2-6211
: __
Application for Bu,ilding Permit
AND FOR A
Certif�cate of Use and Occupancy
Permit [Vo._sl�s L.SJ-----_'
Date----------/�- --�-'-'r------------ �
I. OWNER'S NAME-- -OOA�T_ORN��E-A��iB! ------ --------------------- --- -- -- PHON�OAQOA-$�a�X--
z
3
4.
MAILIIVG ADDRESS------ZOC�._R�--�.*Ititt---S�Bti-------------------------------CITY.CO�Q-1iS909-------------- - -
.
Name . ---_
Address _
c��Y --- -
State
Lic. No. -_
(Archirect oz Engineer)
Phone .__-
Nam�r}Q--�r�i- -�1i�:0� ontrRactQ � �iiiji----- -----------------
- --- �+-
Address ��._�.,',ii -�.�%ijil-��'iiQ�'ii:----�-------------'-'--
c«Y _aooL�-I;eea
S[a[e
Lie. Nai�a�.Q�-.----,�i---------
PROPOSEDUSE: __dA�A.GFi -- ---- --- --- -- - ----- - ---- - --- -- ---- -------- --- -- - - ....- ----- - ------- -----
Jos LocnTiorr-- --'S�p7-- ---E- �'rf --�!1�a4--�7-`----Qost�-ils��--- - - -- ------- - -- --
(House No.) Q (Name of S[reet) (Town or School District)
LEGAL DESCRIPTION: Loc-_--_�_/_---_---_-------__----Blo<k._-....-.-__-- ------__------_------Tracc_-�,�- -..
(Me�es and Bounds Description—Use rererse side of form)
CORNER LOT ( ) INTERIOR LOT (�) THROUGH LOT ( ) SLOPE OF LOT ( )
5. SIZE OF BLDG.: _�._X_�____ AREA:_.��0_.SQ-iiPr. __ SIZE OF LOT:...�.?X_LaJ_- AREA: -ZTJ.-o�_______.._.__
6. HEIGHT OF BLDG.: __.1�'______.__.__ ____CEILING HEIGHT:.__________________._..__.__. NO. OF STORIES_�_
7. NO. FAMILIES __-_-__--__---__-_--------------Size of Smallest Bedroom: .-____-_-------_-----_. Size of Kitchen: --__-_-_....___--_--_--_
S. EXTERIOR WALL CONSTRUCTION:�B__$�yQQa_.__INTERIOR WALL COVERING._____._.'.,____.__________.__
(Frame, Smcco, Etc.) (Plaster-Drywall, Em.) �
9. SETBACKS: Front Yard from Center Liae of Street__.....____� 6��
-----------------------------'---'-------------------- �- --------
yi i i
Nearest Side Yard ___.J.___________.Rear Yar3.___._._.__�'_.__.Distance in Feet Between Blcigs. on Same Lot._<�.O__________. __._
IG. A COMPLETE PLOT PLALV IS REQUIRED, SHOWILVG ALL STRUCTURES AND USE OF EACH.
11. For (a) Footing: Width.�.�K____.._______.Depth in Ground._',�M__..____._.__.Width of Wall_$11____....._
Accessory
Bld s. and l/ � �
Sim�lax �b) Size of Studs: ____-LiS._�T.__.__Spacing_____��_.._.__.__.__"CC Material of Floor�pQ���_-...._._
$truCtures:
(c) Size of Floor ]oisa: -----------------------------.Spacing .--- ------'----------- CC . .
� (d) Size of Rafcers: _--'--p+-$-(i.----------------.Spacing .------�M-------�------ CC •
12. VALUATION OF PROPOSED WORK: Induding all laboq plumbing, ele<trical wiring, heating, Eire sprinklers, paino
in and sewa e dis osal _ �
S B P $---7��------------------------------
13. I HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE INFORMATION IN
THIS APPLICATION IS CORRECT AND THAT THE CONSTRUCTION WORK WILL CONFORM TO ALL
LAWS OF THE COUIVTY OF ORANGE AND THE STATE OF CALIFORNIA APPLICABLE THERETO.
D � � _ J—v (Owner) .
Plans Filed:.__ -'_�________.__.
----------------------
------- $y: ------ " --- --- -- -- ------- -- ----'--- ------- -
� ---
(Authorized Agenc)
FOR DEPARTMENTAL USE ONLY
Bldg. Permit
Plan Check
Total - -
Receipt No.
Paid ro '
Dace _____...
SM-9-50 ��
FEES:
$ - ----- ��---
� -----��—...�-
,�.
GROUP----- �- -- -
TYPE ------� ------ --- -
DIST. /�� �
MAP------ -��/�c-y-- --- --
SHEET NO._____�__._______
��ING BY
APPLICATION_______ _. HEALTH .__.__..______..___.
FIR�
ZONING __�_... , MARSHAL.._.___.______._._
PLANS AND
SPEC'S_------ -- -------- ---- STATE ---- --- ---------- -
CORRECTIONS ENGIIVEER
VERIFIEU _ --- ------- CAL. ---- _ ------------------
PER�$SUED BY:
CA I'1;�1 .
.'J'a. L?�Jn��'�'�,_ COU��Ty SUILDING
...___. __�__—_—_— �_______.J1�`?F_l�.TflR_____. _________________
' DEPU7Y ��