HomeMy WebLinkAbout2274 PLACENTIA AVE - Building PermitsOWNER Criswell, Chas. L, nnT�, 1�-28-59
JOB ADDRESS 2274 A& B Placentia Ave. BUILDING PERMIT N0. 9152
GENERAL CONTRACTOR OIrtBT' ui ers VALUE $ � '
AP No. � — 3 LOT TRACT FIRE ZONE DESCRIPTION OF WORK 'llp�.eX W 2. . 3T'.
11 ECTIONS .�,�,_�>, I DATE I GROiTP TYPE V 7.ONF. R
SUBCONTRACTOR
Form 210-3M—A-59
. . . ��. a2
COSTA MESA BUILDING DEPARTMENT
P. O. BO% 31�
COSTA MESA. CALIFORNIA �
FOR APPLICANT TO FILL IN
7� ��B ��.aG�
COSTA MESA. CALIFORNIA
OWNER (
MAIL
AODRE55
CITY II�liy `p�Iby7✓�%�/��i�-'TNO.
ARC ��CT LIC.
OR NEER " NO.
ADDRE55 ROMAR BU���ERS, INL'.
—ZA30 IVEVi••r�eT FI VD.
COSTA MESA• CALIFCirv uc.
CONTRACTOR nM�+nic LI. 8�9388 NO
TEI.
o[s<nivnor+ NOT ,�1,� IBLOCK � ITRAC
A.P.NO. S � OS/—' ��
SIZE fj ��1�� �/^ NO. OF BL�GS.
OF LOTJ `�l v ��OW ON LOT
SETBACR LINE FPOM
CENiER OF STNEET fO /n.+Y ���C REAR VARD
R ,
SIDE YARD RIGHT ,'J LEFT ���c�.
DESCRIPTION OF�WORK �
i
NE\ ALTERATION AODITION
REPAIR MOV
SIZE OING��R ¢ �
E%TERIOR WALL JT�U <,
rnvro�ur_
NO.OF
ROOMS
ROOF
COVERING
`%in _
�h�c b � �
n�✓, ,¢
1 MEREBY ACNNOWLEDGE TH4T I HRVL�
STnTE THRT TME BOVE 15 CORRECT RNO
CITV ORDIN/NCES qCjD STATE L�W"yBEGI
TION. /%/�� �__ f•1
���-� � J!
SIGNATURE OF /i
PERMITTEE ��
AUTHORIZED AGENT
TO
� �� �� CEI� �D�
FINAIVCE �DE�?F� �
APPLI'CATN�OfJ�' FOR PERMIT
BUILDING
FOR OFFICE USE ONLY
FIRE
ZONI
J�/ ZONE
�
■
STORIES /
COSTA MESA. CALIFORNIA
�./ J� DATE
CORRECTIONS
CITY
Y �'� �
� �f tr�1�
��T
6EP't. �8�
� TION �NO
�„ .�� purpose of esiablishing a permit fee enly.
C STRUC
VALUATION
�^` •i�%/`q � PERMIT FEE $
O'
OG
. ��OO� '' pLAN CHECK $ i
$ p '�
�!,/�T' � TOTAL FEE B��
�
`OM{
Pfl0.1ECTR00NESS: Zz74 PLACENTIA AV
OLbIIEN'SNAME: IST TEAM REAL STATE
aooeess:600 ANTON # 800
C.M. 92626
RflCH1ENGINEEfl:
flEG.NO.:
uxit: A E B
ROOflE55: UNIT:
PEpMinEE. I1553ATALBOTNDRRUCTION ( 714 ) 521-6697
FDOHESS: LA MIRADA CA 906�38
LICENSEU CONiBRtTOP OEClAMTION: I �ereUy a��irm t�a� I am Iicenu0 unGer pmvi5ion5 0l CAapter 9 �cammencinp mIA Sec�ion
7000� ol Oiv:sion � ol I�e Business an0 Pro�e�ssqnl 9 ae.8ne my lianu is in �B b¢e ane eEeX.� •
LITY LIC.: � /1 �STRTE LIC.:d ClASS:
at . �" l7=Z )— — Signaiure: � �
REB COMPENSFTION UEClABI1TI0N: I hereby allirm l� av¢ d C¢tlilitdl¢ o� t00S¢�I �O S¢I6inSU�¢ O� a t¢rti�it2le 01 WO�k¢f5'
Compensa6on �n��acg g� �rL6¢g �vY �nereoi (Sec6on 3800, Lan,61� / O 1/ 9 S
roucr xo.: STATE FUND E%P. URTE:
COMPRNV: }[
O Certi�ie0 coDY �5 �ereGy �umishetl. C7 CertilieC copy is filed wit� tAe ciry BuilOing Uvision.
/%�- J"'� �� / � ApDlicant % �' ���
E' %EMPTIONFBOMWOflREBS'COMPENSATIONOFCIAMTION: Qhi55etlionnee0no�b¢compl¢I¢dil�h¢permi�i5bronehunGr¢G�5100�orIe55�.
I certily that in t�e pedormance oi the work tor w�ich t�is Dermit is issuea, I s�all not emDloy any Derson in any manner so as lo hecome
subject �o the Workers' Compensation Laws ot Califomia.
�a�e: SignaNre:
NOTILE: 1�, afier making �his tleclara�ion. you shoultl Oecome SUCIat� �o Ihe Workers' Compen5aiion prmisions oi �he LaDor
Code. you musi fatlhvnih comply wiih such O�ovisions or Ihis permii s�all be tleem¢0 revok¢G.
CONSTNUCTION LENOING AGENCY: I hereby aifirm tha� ��ere is a COnsimttion lending a0enty lOr ih0 D¢�ormante 01 �AB wofk lor
which �his permil is issuetl (Sec�ian 3097. Civ. C).
LENOEN:
R�DflE55:
OWNEB BOILUEfl OECLABpT10N: I her¢by a��ilm ihat I am ¢xemp� Irom Ihe COntractof5' State License Law for t�e fallovnng reason
ISeclion 7031.5 Business ana Pmfessional Cotle: Pny ciry of county which reauires a permit lo constNci, alter, impmve, eemolish, or
repair any simcture. Drior lo ns issuance. also requires I�e applicam for sucA permit to lile a sipnetl statement that he/she is Iicense0
pursuant to Ihe pmvisions of ihe Contractors State License Law �Chapter 9(commencinp wl�� Section 7000) of Division 3 0l i�e Business
anU Pm�essions Co�e� or ihai helshe is exempi Iherelwm antl Ihe basis �or Ihe alleged eMemption. Any viola�ion o� Seciion 7031,5 by
any applicanl for a permit sublects the apDlicant lo a civil penalty of not more ihan five huntlretl dollars (5500�.
I. as owner of t�e pmpeny or my employees wit� wapes as t�eir sote compensation, will Eo the wark, antl Ihe
❑ stmcmre is not intenae0 or ofierea far sale (Section 7044, Business anA Pmfessional CoOe: The Comractori State License Law
aoes noI aDUly Io an owner of a pmpeny who builOs or impmves thereon, and wAo tloes such xroA him5ell/hersell or through
his or her own employees. pmviaeU Ihai suc� impmvements ar¢ nol intentleU or of�etetl �o� ule. I�, howevEr IAB builainq o�
impmvemeni is sola wilhin one year 0� completion, the owne� will hdve Ihe burG¢n OI pmvinp he/she Oitl n0i builE Or imprOv¢
for ihe purpose of sale�.
I, as owner oi the pmperty, am excWsively contracting with IicenseU coniractors to cons�mct iha pmlect (Seclion 704d, Business
❑ ana Pmlessions Code: The Coniracmrs' State License law tloes not appty ro an owner of pmpeny who hudAs or imOroves lhereon
and w�o comracts far such pmjects wit� a contractoqs)license pursuant m the Coniractors' State License Law�.l am aware
Iha� pmo� o� I�eir Worker'S Comp¢n5aiian insurance shoNC Oe prOviEetl to me.
� I am exempt unaer Seaion: B. 8 P. C.
for ihls reason:
Date: Ownec
I tlo nere�y cenity Ihat I am aware of ana untlerstantl ihe requiremenis of Califomia Heallh an0 Salety Coae Sections 25505, 25533, antl
25534 and �ha� I or any Wture building occupani wilUvnll no� (circle one) n¢eG lo Compty with SaiG slaie cotles antl IheleQuirements br a
permit for consiNction or m04ilication Imm ��e Air Ouatiry Manapement Oisirict. Fesidential wnsimctian ap0liWtions aa eNemp� �mm
I�ese�prDvisions.
Dale: AOV�icanl:
I her¢�y cerldy1ha11havereaDihis application and Slalei�al Ihe aboveinlormaiion is torret�. Iagr¢e�o campty vnlh alltily anE t0uniy
o�ainancesantlstaielawsielaungtobuildingconsimctionantl�erebyamhor@ereD�esemativesoithisciiyto eruponlhea�ove�meniionetl
pmpertY brin50e��wn Ourposes. �j
at' j� �� � � Signawre: � /
Driver's liwnse or Soua� Securi�y a:
t6Gb06 W�i�e—BwlGing: Green—CaCe Enlorcemem: Canary—AOPlicanl: Pink—Revanue; GolOenroa—Assessor
CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 070628
PERMIT NO: B 070628 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE; PERMIT TYPE: STR PURPOSE: REP
JOB DESCRIPTION ; REPAIR DUE TO HOUSING CODE VIOLATIONS SQ FT: 300
CLAIM VALUE; CALC—VALUE: 300.00 GROUP OCC: R-3 /
COMMENTS: INTERIOR REPAIRS TO DOORS & WINDOWS
if if if M M i: iE i! if if iE if if M 1f if if k it it if iF if if iE if iE iE if k%1f iE if iE if if M iE i! ff it if �If it 1f iF r if if if M%iF if ir if iE iF 1E iE iF 11� M 1F if r if �f -N-it iE if it if iE if ff �c
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 ---------
FRNT: FT IN REAA: FT IN FRNT: FT IN REAR; FT IN
LEFT; FT IN RGAT; FT IN LEFT; FT IN RGHT; FT IN
PARKING REQ: PROV: PARCEL: 42237208 ZNE: REF NO;
PLANNING NOTES>
> '
1fY M M 1fjliFiFlFkklf 1f itlf ifihltif lfifif ifffMifMff ifM ififiF M k M ihk 1f 1f1t 1f M ifififif k M M1f Mi! M itlf !f if ltif ifM M MM Mif itif Mif 7f M if lfif 1f ifiF
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
20NING APPROVED BY .
BUILDING APPAOVED BY :
DATE:
DATE:
APPLICATION ISSUED BY: /��^'� DATE: O� P�'
+t*+t*ir***�rr*r***�r*r****�F�TriF'��**�iFTF�iRir iF'fii�i'r�r +r���T�F'r�T**r*r*r**r* * * **
1f !f if if if ff k M 1E If ff M i! if 1f it f! 1f 1f if if M 1E j! if 1f 1E ff ff If if 1t 1f 1F if if if if M iE 1f if if %if if if if if 7E if 1f M if it M iF iE iF iF 1f It if 4 if M it 7f M iF iF 1f 1f {E 14 iE if if if
LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 15,00 ! .50
.- SMIP/NON-RES
PLAN
ISSUE FEE
BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
TOTALS----> 15.50 0.00 0,00 15.50 15.50 ,00
AEVENUE DIVISION TOTALS--> COLLECTED; /- I5.50 OVER/SHORT: ,00
HLDG PMT PLUMBING ELECTRIC MECHANZC FIRE SMIP/TOT GRADING PLAN-CHECK
15,00 ,50
iF if k if M if it 1t if 1f 1f 1F ik ff i! M iF it 1f M M i! iE �)f if iF iF it 1f if !f �f if 1E if if iklf it if iE M�F iF iF %iF af If iE �f M 1F iF M 1f if if i! M M ff ff %1f 1F if iF if i! if if if fi iF iE if if if
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 300 ALTER BY VALUE RESIDENTIAL NOZONE 1.00 300.00
END OF FEES
C1 �D1745B3-�0:745G•4 T C�3 15.SQ
C�HTL= 01;0�/95 TIflt� 11�4,°.
1 .
CONSTRUCTION AND PLANN,NG POOI :PF} , �
� APPROVAlS Permit # Date Inspector APPR�VALS Permit # Date Inspector
i. Temporary E�ectrical Service or Pole. ; 52. Pool & Equipmenc �ocation
2; Soil Pipe-Undigmd. - 53. Steel Reinforcement
�'3:�ElectricalConduit�Utility-Undrg�nd:�' � 54. Forms
= 4,',Elecirical Conduit,Undrgrnd. '=' 55. Electrical 8onding
�'5.'Stee! Reinforeemenc � 56. Rough Piumhing.& Pressure Test .
�•6. @(ectr.cal UFER Grnd. � 57. APPROVAL TO COVER�GUNITE
�'3. Footings 1� 58. Electricai Conduit�Undrgrnd. '
�= ;Bt Foandation -. � 59. Gas Pipe, O Undrymd., Test c>
��9. Water Pipe-Undrgrnd. � 60. Backwash Lines, P�Trap, � Undr9md. -'
�,
id. Structural Floor SYstem 67. APPROVAL TO DECK
71. Prape!cY Sewe�. line & House Connection � 62. Backwash & Receptor-Final �
12. Sewer Cap � 63. Heater & VenbFinal
13. Roof Drains • ', 64. Plumbing System � Final
74. Rough Plumbing ` ;, 65. Electrical-Final
15. Rough Electrical�Conduit 66. Solar SYstem�Final
76. Rough Eiectric Wiring 67. Fencing & Access Approval
� 17. Rough Wiring Si9n 68. APPROVED FOR PLASTERING
,.78. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEPAS f INAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
i' ' -�'+- � '
20.�Roi�h FBcto,�y F.irePlace �!''; s �! -' '=. .APPRQVA4S ; -'Pei;mit # "
- ��n x r+i ... :
21.;Ou'c•.s, in StFucture� �• •� i-i.> _ _ . r'' i 70. �Underground Hydro
�.
22. DuE2s, VentJlatin,4; �'�� �� � ,� ' `�' ,' "77. Product,Piping dGas QOiI
23..Ga3.�r fpe?Ro gh & Yesc � :� S . nt �� ', � + 72. Undergrai�nd Flusp �� � .
24:'Roof 'rraming • � '---' " ` -�' - �� �` ' � 73:� Under md. Stora T�nk Gas O Oil
i-, . y J� r a" > r-a �, . 9 �� c0
.i a ,t. i
25. Foo;t Sheathinq _ �' � � .� �-,i : �r ' 74 � Overhead�HYdrq,"' - � .
26. T-B�r Ceiling (St�uctural} & MO�ocoat k_� � '' •ri y, 75:. 6ry Chemjcal ; � r' -� _
27'.;;Frame and Flashing ..� J.n; + �� ,. � � : 76 Dry Stand'pipe ;:=� � �
�28. Lathing.&Siding^ �-� �•:�= 7� +" "� •' •'�q � 77;; p�XEDSY5TEM�-FINAL ��
"�29. Insulation '' �� �� •• y��� i I. . 78-;. FIflE PREV. FIN'fvL �
"30. Drywall�Nailing , ' j � "+ �HEALTH�DEPT. REQUIFZ�MENT
,31. Plasrer Brown Coai ��� , i��r�' ; �. . � 79.� PINAL INSPECTION . ' :�
-32.-EleccricalPoy'ver.Metzr�Finat " � �`• �80''FOODCERTIFICATEISSUED
�.
-33` Fin51 Electric . , , . n � > > Nofes: "} � . -y .
� ' �
�i34.- Finai Heating & Air� Condttiortlhg�. � � � �� s'�Ll's�" y�_ �"k �T¢K s[ /� 1
. �, , _ . . ,��
rl ' f '_ � �� '7 � � a i't r � v n 'F
, 35.. Final Gas Pipe-TesY, . „ _ � •� � c �; - �, ' ';•;'•���
^36. �Hood orCanoPY - � : - � - � •{` ' � -; "' . . . �
- � -r �• I � ' 1: . :,i -, ,
.. ... - i � �
_j37:;Fin$) Factory Fireplace � ;. � , ' � I; �� .
-38. Finai Plum6ing • � � _� I � I* " � : .• • .. •
�. � :�
39. Water Se'rvice�Final � ' ' ' ��"' �� � • •
. . �
.,+ _
=40. Gas Szryice-F,.inal ,.7 - �� � . I � t.' � .7r.� ., �, , .
1 r
..41. Solar potneiticFinal � ,�� ' -r � � � �„ �y.`-' ,'. ' �
i I"
� 42`Backflow Preventeo- �J • i * �� � � '� '�F • + �� �
n :ii - i i
43. Backflow Ir,rigation,' � - ' � ,. ° ,`, , •: �'.:: f •'� ,
;94. Landscape Irrigation Sysrem � -� � ' "'" � • � -
� v '� r
45,Sound Aiterivation '�: '�� ° -' .� .. _ , �' `� . -'� ..'.
, ,y . . rr, �; D7. . .
�A6..Handicap Regulatio�s � � �: • . �
- �: -
47.=FIf;IAL STRUCTURE & BUILO�NG �-?{-Cj� � �u =�� :
48.fIMALPLANNWG ���-� ��� y�- c ' �7 � • -
'-_ '" �
49. Elecfric Release to Edison I •°: • ' '
I �•.1�� ��
-50: Gas:Releese to Souihern Califorr+ia Gas Co � "' �- � -� � • :�.•i _ •
- .J
_51. CEfifiIFICATEOF-OCCUPANCY • ' � - " ' --
No. Date
reaecraooeess: 2274 PLACENTIA AV
OWNEfl'SNAME: IST TEAM REAL STATE
aoosess: 600 ANTON Jt 800
C,M, 92626
uxiT: A 6 B
FNCH/ENGINEEH: flEG.NO.:
RUOPE53: UNIT:
PEflMinEE: INTEGRITY CONSTRUCTION ( 714 ) 521-6697
nooxess: 1553 TALHOT DR
LA MIRADA CA 90638
LICENSEO CONTBRCT�B OELLAPATION: I hereoy alfirm Ihat I am IicenseU unGer pmvisions oi Chapter 9(cammencinp wii� Section
7000) oi Dirsion 3 oi I�e Busineu and Pmlessi0ns COAe. an0 my license is in tull lorce an0 ellect.
�uc.: sraTe uc.: 6 419 B 8�� B ��C �
i_(,- 9 r Sipnamre _ �—'
WOBKERS' COMPENSATION OELLANF710N: I hereby ailirm that I �ave a cenilicale ol consenl to selbinsure or a cenifiwte oI Workers'
ComOensaiiony�5 ilipg py I�et¢af (Section 38IX1. LaG.
POLILY NO.: 1��� ��� 7� E%P. DRTE: 7� O S I 9 S
comrnxr: STATE FUND,�(
� CeNhetl copy is hereUy fumishe0. L"� Cenifiea copy is lilea vnin ihe dry Builainp Oivision.
e: _ � AP7licant: � / ���
MPTIONFBOMWONNEflS'COMPENSPTIONOECUPPTION: (i�isseclionneeEnotDewmpleteaif0epermilisforone�uMreU�SlW�arless�.
I certity Ihat in �he perlo�mance o� Ihe work lor which this p¢rmil is iSSu¢E, I Shall noi emDloy any person in any manner 50 35 t0 become
su0jecl lo tAe Worker5' Compensation Laws ol Calitomia.
Oa�e: Siqnawre:
NOTICE:Ii. atter makinA �his declaration, you shoNC oecome suDRct �o t�e Workers' Campensalion provisions ol �Ae LaEor
Cotle, you must lanhxit� comply wii� suc� provisions ar INs Dermil shall Oe OeemeO revOk¢E.
CONSTPUCTION LENOING PGENCV: I hereUy allirm thal t�ere i5 a con9mclion lentlinp a0enty for Ihe p¢tlarmante o� IAe wOrk �or
wAich Ihis permil is i55ue0 (Sec�ion 3W7. Civ. C�.
IENOEN:
nooxess:
OWNEP 901LOE8 OECLPBPTION: I here�y allirm tlut I am eaempi trom t�e Camractors' State License Law for Ihe followinq reason
�Section 7Q31.5 Business antl Pmtessional CoOe: Any ciiy ol counry w�k� repuires a permit Io Con5lrucl, aller, imD�m'e. tlemol¢h. or
re0air any SVucture. prior �o i�s i55uanCe, also r¢QUires Ihe applitant lOr Sut� p¢rmi� lo lile a Siqn¢0 Slatemeni Iha� hdshe is liC¢nsed
pursuant m �Ae D�ovisions ol t�e Contractors' State License Law (C�apter 9(cammencing wiih Section 7000) ot �ivision J of Ihe Business
anU Prolessions Coae) or I�al helshe is exempt ihereimm and t�e Gasis lor the alleBed exemption. Any violation of Section 7031.5 hy
any apDlicanlfor a permii suhiecls ihe apDlican�lo a civil venalty ol not more than Iive huntlretl tlollars (E500).
I. as owner ol the OmOe�Y or my employees with waAes as their sole compensation, will do the wOrk, anA tAe
❑ simcwre is not imen0e0 or affereU for sale (Sectwn 70a4, Busineu and Pmfessional Cotle: T�e Contractors' Sute License Law
Ooes not apply to an owner ol a D/o0eny who Uuiltls or im0�oves tllerton, anA w�o Oces suc� woM himself/�erself or I�rough
his or her own employees. pmviOeE t�at such imprmemenis am noi intenOeE or oltereC br sale. II, �owever Ihe builaing ar
impmvemeni is saltl wi�hin one year ol compl¢tion, Ihe awner wiil have Ihe Dur�en ol pravinq �¢/S�e AiA no� huild or imOmve
�ar Ihe Durpose ol sale�.
I. as owner ol Ihe property, am exclusivel9 contracting with licensetl contractors to constmct tAe D�olect (Section 7604, Business
❑ antl Pmfessions Cotle: The Comraclors' Slate license Law Uoes not apDty ro an owner o1 pmDerty who bwltls or imDmves thereon
antl who conVat�slor SUth prOjetis wi�tl a tontratlOr�s�litense pur5uani �o �he ConVatfOrs' SIaiE Lit¢nSe Law�. I am aware
ihat pmot ol Ineir worker's Compensation insurance shoul0 �e provitleU Io me.
� I am exempl unEer Sec�ion: B. 8 P. C.
lor Ihis reason:
CITY OF COSTA MESA — BUILDING PERMIT PERM NO; E 070629
PERMIT NO: E. 070629 PLAN CHECK NO; N GOC�T: N SUPP; N
CONSTRUCTION TYPE; PERMIT TYPE; ELE PURPOSE: REP
JOB DESCRIPTION : REPAIR DUE TO AOUSING CODE VIOLATIONS SQ FT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /
COMMENTS; INTERIOR REPAIRS TO DOORS 6 WINDOWS �`{(�\2' \�—,��jP-U
�r****x�r****r**�r*r*****r�r******x**�r�r*�***x***M'* *4e*r*le****r�r*�***r*****+��****+�
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 ---------
FRNT; FT IN REAR• FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT; FT IN
PARRING REQ: PROV; PARCEL: 42237208 ZNE; REF NO:
PLANNING NOTES>
�
K4if ififif 1f M N if 1F 1f if if 1fiflFif 1f ff lfMif ifififif 1f ifif iEififif itiflfiF M1fk 1f 1f M MM M if 1f 1f Y if M ifMif4k k if MM7t iFif M i! lfif if iF1f 1f 1lifaf M1k iE
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 : DATE:
APPLICATION ISSUED BY; ` DATE; ��������9
M4MiffflfYlfkiflfiflliFif%iFffMlfiFlf MM1fMilMifMitif {F{{
kMiEiliffFlEilifilif�FifMiflf�fiflFifllffifitMMlfMilifififMif'if1FMltMifMitMifMitiflfififll4MltMfflfMMYkifik44iF4itifMifMiFifiF7fif4iE
LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT;N
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 3.00
` SOt SMIP/NON—RES —
PLAN
ISSUE FEE 15.00
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 3,00 15.00 0.00 18,00 18.00 ,00
REVENUE DIVISZON TOTALS--> COLLECTED: 18.00 OVER/SHORT: 00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
1 8 . 0 �
1fklfffiEiFifiFlfififlFiflfifikifffMiFififfEkiFikMifitlflEifMiFikilifMMlflfifiFM4if�FifiklfMMMlfiflfMifMififlfififiEillilEMMiflfitlfififMiEif
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY
�aie�. Ownec I ELE
I ao here�y cenily that I am aware ol antl unaers�antl Ihe reQuiremenis ol Calilomia Heallh antl Salety Code Sections 25505, 25533, antl
25534 and Ihat I or any lutme �uilding occu0ant willlwill noi (circle one) neetl �o comply wi�� saiU s�a�e cotles antl the requiremenis for a
permil for consimclion or modilicalion imm Ihe Air Ouality Management Disirict. Pesidential consimc�ion applica�ions are eKempi �mm
I�ese provisions.
Daie', AODlitanl:
I �ereby cetlify Ihat I have reatl �his applicaiion and Sla�e Ihal Ihe aDove in�armation is correci. I apree lo comply with all ci�y anA coun�y
orainances antl sla�e laws relating �o builtlinp conslmciion antl hereby aulhorize representalives o11Ais '��o en�er upon Ihe above�men�ionetl
�tly for inspec(tion puerposes.
�lJ' 7 � Siqnalure: �
�river s �irense oi Socia� Securi�y x:-
i6Gbd6 Wnite—BwlOinq; Green—CaCe Enlorcemant; Canary—Applicanl; Pink—Revenue�, GolEanmtl—Assesaor
n
�
D E S C R I P T I O N
FIXTURES, LIGHTING 1 ST 20
END OF FEES
UNIT COST TOTAL COST
EA, ,75 3.00
Ce a�!74565-110174`bS T C�T 13.U0
DAiE: GI/06/95 TI�iE: 11:4E
CONSTRUCTION AND PLAfJNING � POO . SPA
'APPROVALS Permit# � Date Inspector APpqOVAIS Permit?k Date inspector
i. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soii Pipe�Undrgrnd. �= Y 53. Steel Reinforcement
.i_�3�'E�e `. .
,� _ ., . ctrical Cqn�yljFJtility�Undrgrnd�. 54. Forms
- 4_;Electricai ConBuit•Undrgmd. �=� - 55. Electrical Bonding
..�
� 5.: �ceel Reinforce'rr`�ent '` . 56. Rough Ptumbing & Pressure Test
- .6. ElectricalllFERrGrnd. -. 57. APPflOVALTOCOVER-GUNITE �
=� .7, Footings � 58. Electrical Conduit�Undrqmd. '�
� ,8, �Foundation ;. �-�.'- �� � 59. Gas Pipe, O Undrymd., Test -
_: 9. Water Pipe-Un�}rgrnd. 60. Backwash Lines, P�Trap, C Undrgrnd. '
_�
1�0. Structural Floor System 67. APPROVAL TO DECK
17. Property Sewer line & HausB�Conaection ' 62. Backwesh & Recepcor-Finai "
12. Sewer Cap . �, � 63. Heater & Vent�Final
73. Roof Drains �� �! ' 64. Plumbing System - Finai
74. Rough Plumbing „ , � 65. Electricai-Final �
15. Rough Efect�icat-Conduit � 66. Solar System�Flnal
16. Rough Electric Wiring 67. Fencing & Access ApP�oval
17. Rough Wiring�Sign 68. APPROVED FOR PLASTEFING
18. Rough Electrical�T Bar Celling 69. POOU'SPA SYSTEMS FINAI
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
- �- i'�. �� . .
20'�Rough Emcto'ry F_irePlace i %'i � -1 � .7 _ .� �APPFjijVA�.$ -� = Pe�mit � * y
'r, i _: r •> � �� �. • �... . - -"'{-
21_;Ducs, in St�+ictwer �.• .. �:�� o �� �-,+ r i70. Underg oitnd H�tlro 4 ,
22. Ducts, Ventlatirig �: �-- :* _, , .� • k �77, produc{.P.ip�ng C'}�"f�''as �Oil
'Y � �1• I .. �_{ n . . � .
23.;Gaspfpe;Rough B� �esc . :,��; , r.� - �a . .72. Undergroc:nd Ptush. � �
24.1RobF FFaming ' � •- �� •' � �� <-> � F � ' } .73.'� Undergrrr�. Stord'9ee`rank* J Gas ❑ Oil
25. floo Sheathin '„ . � .,; „ '; �:� •� p ` - . ..
f 9�,= a . 74:,Overhead�Hydroi� .
26.--T-Bar Ceiling IStf.uttural) &".MOnocoat ` '� ' � '1'' + 75=Dry Chemycal . �� ' " �� �
27 Frame and Fiashi �� '_� 'r � ' �' ^ ° " , '.
P9 _� �:�; ;� �L„ � 76. Dry StandpiDe i. L .
28. Lathing:& Siding.� � -� -1 " �' . •• ^� 770' PIXEO SYSTEh'�',�EINACy .y � ��
'29. Insulation ��,„ � . ., :. r `�" �« �� 78:FIRE PREV. FINA�L x �, n: -
I �
�'30. Drywall�Nailing , ` y � � .� � �� 9iEALTt3UEPT. REQtlIREMENT
�,31. Plaster Brown CoaY � .n,;. * ��, . , 79 'FINAL i�$PECTIpN. ' ' ��
�
� 32..'Electricai Power Meter�FinaU � �'? � � ''''$0^iF00D CERTIFtCY�TE ISSUED '
33.'fina� Electriq ;;. •r i Z'�3.-9� � !° "Noies . - ;',� � ,, .
�
�34. Fina1 Heating�& Air Conditioni�g' :i � � I� . _ �.= fi�' �, .' �
r ii ryi <• � � la :1 '' > t
35.^Pin51 Gas Pi'pS-Tg�S;, y'ii �: : H j �•J, t_ � oo• ':i�:) �J-i ' n .•n.
36. Hood or,CanoPY ; �r ;_�� � -' { �� � � _'• t - :�,:� �r- �•
� .�. .., i t; > u - . �,� n
i '� .A i �.rl � x �' .l • .ii 1
.37. Final Fectory Fice,Place .. _. . � I �i5 , ,
-38. Final Ptumbing '' � , .. .. . a i � I' t � ` a , -----
� I �. � r
39. Water Service-Finai' � � " " � � ' .} ;' ".'� .
� . . � �..� _. ;a
40. Gas Service-Pinal � �� ,n• :• - � .r, ' � �• 1 - . .
♦ . `' S s
•41. Solar pomestic�in@I > - .. n �. � '= " ' -
�' � � Ix n^ `-j•: 9 .
42. "Backfiow Preventer. � ,�; � I . . i, t, , .7 �
+ fi T. 1
}� � •- , s 7: F. !
43. Backflow Irrigatio'n • , ,
�
.-;,44. Landscape I:rigation System�+ �1 "� �. '; '' �� ' r ° �' = c� � -
S' E "
45. Sound Attenuatior�. ���" ; .. �: ; �� - t �' ° ' ;
• '�, �-�
�46..Handicap Regulations : � • * 'r a, cr; � c� -
�. r
47'FIPTALSTREICTURE&BUILDWG ' ( - ' � , '
,. I � i' �' " '
48.�FINALPLA(�NING �'_. • , , , i--�e• �,? , r
49.=Elercric Release to Edison � � -�" � ' �
, + ' � -, �; . , ,
:50..Gas�Release to Southern California Gas Co � �. �� = • � . � �
r ;�
51. CER7IFICATE OF•OCCUPA�CY • • ., � =_ .� � , _ .
No. Oare t '�
PflOJECTR00flE55: 2274 pLACENTXA AV
OWNEH'S NpME: IST TEAM REAL STATE
aooaess:600 ANTON # 800
C,M, 92626
FflCNIENGINEEfl:
RDOPESS:
sec.No.:
uxiT: A
uxir:
reemirTee: INTEGRITY CUNSTRUCTION ( 719 ) 521-6697
nooeEss: 1553 TALBOT DR
LA MIRADA CA 90638
UCENSEo CON7HALTON DELLFNATION: I hereDy affirm tpat 1 am iicenseA un0er Orovisions ol CAapter 9(commencing with Section
70DI1) ol Dir. ion 3 0� t�e Busines5 anU Pmlessions CoOe, Pnd my IiCense is in lull force anA e��¢ci.
r,Kruc.:��j2�0 9sTa�uc.:64198 �� B� EXP�� �'q s^
�Oat _ f � � > Signamre: — � �
flKEHS' COMPENSF710N UEClAfla7lON: I here6y atlirm ihal I nave a cenilicate of consent to selbinsure or a certificate of worker5'
ComOensa�ion InSurance, or a certilieA coOY ��ereol (Section 3800. LaO. C).
Ivaucrwo.:1403320-94 EXP.U0.TE: Q%JOS/9S
comraxr: STATE FUND
7 Cerlilietl topy i5 hereby Nmishetl. � Certiliea caDY is IileO wilh ��e ci�y BuilOing Oivision.
osi : i— z v— 9� nnPi��m:
M7TION FflOM WOflKEPS' LOMPENSATION UECIAB�TION: RMs stt�ion nee0 iroi Ge comDleted if Nz permil is lor one hunare0 (5100) or less�.
I cenity (hai in Ihe Dedormante o� �he work br whith �his permii iS iS5ue4, I Shail noi employ any Derson in any mannef so as �a OeCome
suDiect to Ine workers' Compensation Lavrs of Calitomia.
Oaie: Signamre:
NOTICE: If. alter making t�is tleclaration. yau s�ould be�ome sublect to tAe Wofker5' Comp¢nsation Orovisions of the labor
Cotle. you mUS� totlAwiih comply wii� SUC� pmvi5ion5 0� thi5 Dermii 5ha11 �e tleemeE revaketl.
CONSTRUCTION LENOING AGENCY: I hereby a�firm Ihat Ihere is a conslmciion IenOing agency fof Ihe pedormance of �he work lor
w�ic� IMs permit is issueE (Senion 3097. Civ. C).
LENDEN:
ADOPESS:
OWNEfl BWLOEB OECIABAT10N: I �ereby al�irm thai I art� eK¢mpi Imm lhe ConVaC�ors' State License Law for ihe IallowinA reasan
(SeQiOn 103L5 BuSiness ana Pro�¢55ional COOe: Any u�y o� �unty wNth requirPS a p¢rmit to COn51NCC aller, imprave, Eem01i5�. or
�e0air any 9mcWre. prior lo its issuance. also repuires ihe applicant for such permit to file a 9gne0 statemenl ttidt hpJshe is litenutl
pursuam to the pmvisions of ihe Coniractors' Stale License Law (ChaD�e� 91�ommencing wiih Section 7000� oi Division 3 of ihe Business
antl Pmlessions CoOe) or that he/s�e is exempt thereimm a�tl i�e Casis far the alleged e�emption. Pny violation oi Section 7031.5 by
any applicant lor a ve�mit su0ie«5 Ine applicanl to a civil penalty of not more inan five I1unOretl tlollars (I500�.
I, as owner of ihe pmpeny ar my employees wilh waBes as iheir sole compensalion, will do ihe wofk, antl Ihe
❑ simcmre is not intentlea or oileretl for sale (Section 7�<. Business and Pmfewional Catle: 7he Cantractors' Slate License Law
Goes noi apDly io an owner ol a Omperty who builtl4 ar impwves thereon, and w�o Uoes such work himseli/Aerseli or throuAh
Ais or her own employees, pmviticG �hat such improvemenis am noi intenAee or ol�ered br sale. II, �owever I�e �uilaing 0�
improvemen� is sold wiihin one year o� compleiion, tAe owner will have ��e bur0en ol provinp he/s�e tliU no� Dui10 or improve
lor ihe Durpose af Sale�.
I, as owner ol ��e pwperty, am eKctusiveiy conirac�ing wit� licensetl conVactors m cansimc� Ihe O�oleci �Seclion 70a4, Business
❑ antl Pmleuiws CaOe: T�e Coniractors' State License Law Goes not aOPN �o an avmer ol pmperry wAo EuAQs or impmves theaon
ana w�o comrans �oi such pmlecis wii� a contracmr�s) license pursuam m ihe Coniractors' State Ucense Law). I am aware
Ihai pmo� ol Iheir Worker'S Compensation insurance should �e provi0etl Io me.
� I am evem0� unUer Seciion'. B, 8 P. C.
lor Ihis reason:
Date: O�ener.
I tlo hereDy terlily I�a� I am aware ol an0 untlerstana Ihe reduiremenis ol Caliiomia Healih anU Salery CA�e Settions 25505, 25533, antl
2553A antl ihat I or any futwe builAinp acupan� wilVwill not (�ircle one) neetl lo comDN wilh Saitl staie co0e5 anA ihe requiremenis for a
permil br wnslmction or moEiliWlion Imm t�e Air Ouality Managemenl Disiricl. Pe94entul tonsiruction appliWlions are eeem0� �rom
I�eSe pmvision5.
Date: Applicam:
I hereby ceriity Ihal I have reatl Ihis aDVlicalion antl slate tha� Ihe a�ave in�armalion is correct. I aAree to comply wi�� all city and county
ordinances antl state laws relating lo builtling conslmction an0 PereOy aN�orize representatives af Ihis ciry �a enler upon �he ahove-meniionetl
mp ty lor inspeclion purposes.
� 2 O
Oale: I y � / � SignaNre: � �
er's License or 5ociai 5ecmny x:
I6aLa6 While—BvilOing; Green—CaEe Enlorcemeni: Canary—AOPlicant: Pink—Revenue; GOltlenro0—ASSBSSOr
CZTY OF COSTA MESA — BUILDING PEAMIT
PERMIT NO: M 070846. PLAN CHECK NO; N
CONSTAUCTION TYPE; PERMIT TYPE; MEC
JOB DESCRIPTION ; REPAIR DUE TO HOUSING CODE VIOLATIONS
CLAIM VALDE;
CALC—VALUE:
PERM NO; M 070846
GOVT; N SUPP: N
PURPOSE: REP
SQ FT:
GROUP OCC: R-3 /
COMMENTS: REF; B-70628
*+r*+r�r*-�r�-****��*x���*�*****��r+c-***+r�***«+t*+r*.+r+r�.«*�r�t*�r**�****�r*+r�r*+r+��r*.***-�*r**+t+r*�r*
Z O N I N GS ERTEB�AUCIKRSE M E N T S
------------ MAIN BUZLDING ---------- --------- ACCESSORY BUILDZNG ---------
FRNT; FT IN REAR; FT IN FRNT: FT ZN REAR: FT IN
LEFT; FT IN RGHT: FT IN LEFT; FT ZN RGHT: FT IN
PARKING REQ: PROV; PARCEL; 42237208 ZNE: REF NO:
PLANNIPdG NOTES>
>
*+t**�r+e+�«�r�tfr�r*+rrtr***r+rrrirr***�e;r****�r+r+t*w*r+r**itvir*�e*�irr**r*�r*r�r«*r*+r***x�***;�r*+�**
D E V E L O P M E N T 5 E R V I C E S R E Q[1 I R E M E N T S
ZONING APPROVED BY DATE;
HUILDING APPROVED BY ; DATE:
APPLICATION ISSUED HY: ��1 S
it�t+rit*�rirr+t�t**�r�r***+t+t�r*+r x�***D�*�v�ac � �.�
ififiEMitjtififififififitirMifafrriFMififiEMiElfif�IhikitififififitiEifif�7FifififiFifafMaFrNiFlfitifiEKlFiFifMifaf�fiEifiRifiFiFrjfif ifiF�f aF�ic
LEGALIZATION:N F E E -S�U M M A R Y STRUCTURAL SE MENT:N
BLDG PMT PLUMBING ELECTRIC MECAANIC
PERMIT � 9.00
25Y
PLAN
ISSUE FEE 15.00
FIRE SMIP/RES GRADING
SMIP/NON—AES
BUILDING—DIV—> PERMIT ZSSUE PLAN—CHECK TOTAL PAID pDE
TOTALS----> 9,00 15.00 0,00 24.00 24,00 .00
REVENUE DIVISION TOTALS--> COLLECTED; 29,00 OVER/SHORT; ,00
BLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
24,0�
ifM�Eifitifitil�lEMlhififlfMlfitiFitMiFitifMilitlfffifMiflflE{flfitifM4Mifi�1lifit4%ifMliiflFifMififMlfMMiEIErMiFif4iFlfititlfifiFif�Ifitrif
I N D I V I D U A L •F E E H R E A K D O W N
TYPE
MEC
QTY D E S C R I P T I 0 N
1 INST/RELOC RECESSED WALL HEATER
END,•OF FEES
t�
UNIT COST TOTAL COST
9.00 9,00
C1 OO7.iS459—OOI7g459 T�3 T 2�.00
�aTE: Di124/45 TitiE: 10:56
�
CONSTRUCTION AND PLANNING � POO� � SPA
APPROVALS Permit # Date Inspecior APPROVAIS Permit # Date inspector
1. 7emporary Electrical Servicc or Pole, . 52. Pool & Equipment Location
2. Soil Pipe�Undrgrnd. • 53. Steel Reinfoicement
� 3.��Eiectrical Conduit Utility-Undrgrnd. � 54. Forms
4. Electrica� Conduit-Undrgrnd. 55. Electricat Bondinq
' 5. Sceel Reinforcement -' 56. Rough Plumbing & Pressure Test
6. ��Electrical UFER Grnd. - 57. APPROVALTO COVER�GUNiT[
7. Footings � 58. Electrical Conduit�Undrgmd.
8. Foundation 59. Gas Pipe, � Undrgrntl., Test .
, 9. Water Pipe-Undrgrnd. ' 60. Backwash Lines, P�Trap, L� Undrgrnd.
70. Structural Floor-�SYstem 61. APPROVALTO DECK
7 7. Property Sewer �ine & Ho�se Connettion - 62. Backwash & Receptor•Final
72. Sewer Cap . 63. Heater & Vent-Final
73. Roo( Drains • 64. Plumbing System - Finai
14. Fiough Plumbing . � 65. Electrical�Final
15. Rough Electrical-Condu�t 66. Solar SVstem-Final
16. Rough Electric Wiring 67. Fencing & Access Approvai
77. Rough Wiring Sign " 68. APPROVED FOR PLASTER WG
18. Rou9h Electrical-T Bar Ceiling 69. POOI/SPA SYSTEMS F1NAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20.'Rough Pattory F{cepiace �• -, . APPRqVALS Perrt�it # '
21. Ducts, in.Structure- . ,•� .. -i � ' 70. Undergrouhtl Hy�lro
22. Ducts, VA'ntilating ' - 77. Product Piping � Gas 0 Oil
23. Gas Pipe�Rough &�Tesc � � - . � � . qZ. Underground� �lush - -
24. Roof Framin5' .�;; ' '- � 73.� Undergrnd.�StorayeTank QGas ❑Oil
25. Roof Sheathing �� � . � . . • 74, �Overhead Flydro :
26. i�Bar Cefling (Structural) & Monocoat � � , „ 75. Dry Chemical � � ' '
27. Frame and Flashiikj � � 76. Dry Standpipe �. -� -�
28. lathing&Siding "� ;� _ � �� �' 77. �FIXEDSYSTEMFtNAL` �
29. Insulation �• - 78. FIRE PREV. FINAI '
30. Drywall Naiiing � F � , . HE'ALTH DEPT.°REQUIREN7ENT
31. Piaster Browo-Coat - �.• � 79. FINAL INSPECTION ��
32. Electrical Power Meter�Final '� 80. FOOD CERTIFICATE ISSUED '
33. Final Elecaic� � _. , '�Notes: J_�_SS�� G���;C;LOK.p
34. Final-Heating & Air Conditioning � " ,--�
. ,. , ' � ��-2? 9� ?� -1�.��,..`_�
35. Finai'Gas Pip�-Test � . , . :
86. Hood�or CanopY . � � � � = � ' �
�
37.'E�na{•Factory Fireplace' , , _ ' � � � :
38. Final.Plumbing ' • � � -
i•
39. Water Service�Final . , ' _, � ,
40. Gas Service-Final , . � � � • -
47. So�ar pomesticFinat ' " . � , -. �� .
42. Backfiow Preventer � • - �
43. Backflow Irrigation , , .
44. Landscape IrriQation System � ' , ' '
- �
45. Sound Attenuation ' � -�� � �� �
46. Handicap�Regulations �- ' ' � '
47. FINAL STRUCTURE & BUILDING � . , .
48. FiNALPLANNING. � ' �
49. Electric Release to Edison , , �
� 50. Gas Release to Southern California Gas Cv � ' ' � ' � � � •
51. CERTIfICATE OF OCCUPANCY �� � ` '
No-. Date
J
PflOJECTADONESS: zz74 PLACENTIA AV
+ OWNEP'SNAME: IST TEAM REAL STATE
aonness: 600 ANTON # 800
C.M. 92626
FNCHIENGINEEfl:
NEG.NO.:
uxiT: A 6 H
ROOflE55: UNIT:
venmiTree: INTEGRITY CONSTRUCTION ( 719 ) 521-6697
FODflESS: S S S 3 TALBOT DR
LA MIRADA CA 90638
LICENSEO CONTBRCTOB DECLABATION: 1 hereGy a��irm Iha� I am IicenseU un0er pmvisions of C�ap[er 9(commencing witA Sec�ion
7000) ot Drvision 3 af ihe 8usiness antl Pwlessions Code, antl my license is in full torce antl eflect.
cirr uc.: ))) nnn TE uc.:6 419 8 8 �a�55 H CP :
a�e'. /� Signa�ure:��'��
WOflNEBS' COMPENSATION DECUflPTION: 1 �ereDy aflirm I have a certificate oi consent ro selFinsure or a certilicate ol Workers'
Compensaiion r;�r�cg 9-� �rtiUm� pppy mereol ISection 3800, Lab.�1-� /Q 1/ 9 S
roucv no.: STATE FUND E%P. ORTE:
COMPpNY: }[
❑ Ceriifietl coDY is hereby fumishetl. ❑ Certitie0 coOY �5 filetl with the ci�y Builtling Oivision.
flate��� > AODlicant: � V/�iCs�'� C
E%EMPTION FAOM WOFNEFS' COMYENSATION DECLANPTION: (T�is sec�ian neea nm Ge completea if ihe De�mil is for one hunare0 (3100) or less�.
I certity t�al in the pedormance of ��e work tor which Ihis permit is issuetl. I shall no� em0loy any person in any manner so as to Oecome
subie�� �o Ine Workers' Comvensalion Laws of Calitomia.
Dare: Signature:
NOTICE: If. atter making ihis Oeclaration, you shoultl become sublect to ihe workers' Compensation pmvisions oi ihe Labor
CoOe, you musl torihwi�h comDly with such pmvisions or �his Oermi� s�all be deemed revokeU.
CONSTqUCTION LENOING RGENCY: I here�y aifirm Ihat �here is a construction lentling agency ior the peAarmance oi �Ae work �or
wnich ihis permi� is i=sued �Sedion 3097, Civ. C).
LENOEH:
AUGHESS:
OWNEF BUILOEfl OECLABPTION: I her¢by a0irm �ha� I am exempl from �he Comractor5' S�a�e LicenSe Law for �he lollowinp rea5on
�Seclian 7031.5 Business ana Pro�essional Code: Any ciry ol county which requires a permit to consimct, alter, impmve, demolish, ar
repair any stmcture, prior �o its issuance, alsa requires Ihe applicani br such permif to �ile a signetl s�a�ement �hat �elshe is licensed_
pursuant Io Ihe D�ovisions ol the Contraclors' State License Law (Chapler 9(commencing with Sec�ion 7000) o� Olvision 3 oi Ihe Business
ana Professions Code) or Iha� �e/s�e i5 ecempi Ihereirom and the basis for Ihe allege0 exemp�ion. Any viola�ion of Sec�ion 7031.5 6y
any applicanifor a Dermil subjecis Me applicanl to a civil penalty ot not more tnan five hundretl tlollars ($500).
I, as awner of Ihe pmDeny or my employees with wages as iheir sole compensa�ion, will tlo the woM, and the
❑ stmc�ure is no� in�entled or oHereU for sale (Section 7044. Business and Pfofessional Code: The ConVactors' S�a�e License Law
�, tloes no� aDPty Io an owner al a D�ope�y w�o builtls or impmves Ihereon, and who Ooes such work �imsell/�erseli or thmuBh
his or her own employees, pmvided tha� such impmvemen�s are not in[enOeA o� ofle�ea for sale. tl, howeve� Ihe builtlinp or
impmvemenl i5 soltl wit�in one year ot completion, the owner will have �he hurUen oi Orovinp he/she tliG not builtl ar impmve
tor the purpose ol sale).
I, as owner of the pmperiy, am exclusively canlrac�ing with licensed con�ractors Io cons�mct �he project �S¢ction 7U44, Business
❑ antl Prolessions Cotle: The Contradors' State License Law Ooes not apPly to an owner af Omperty who builtls or imD�oves t�ereon
anU who coniracls for such v�oiecis with a conlractor�s) license pursuant to the Contractors' Slate License Law�. I am aware .
ihat proof ott�eu Worker's Compensalion insurance shoul0 �e O�ovitle0 to me.
� I am e�emp� under Section: 8. 8 P. C.
for Ihis reason:
oy�¢: owner.
I do here�y certily Ihal I am aware of ana unaers�an0 �he requiremenls of Califomia Health antl Sa�ery CoOe Sec�ions 25505, 25533, antl
25534 and iha� I or any lulure building occupant will/will no� (circle one) need ro comply wi�� SaiJ s�ate cotles and �he requiremenls tor a
permil b� conslmclion or modification �mm the Air Oualiry Managemen� OiStricL Residenlial consimc�ion applicaiions are exempt imm
Ihese provisions.
Da�e: ApPlicanL
I �ere�y cetlify Iha� I have reatl Ihis aDDlicaiion antl slate �hat Ihe aDove info�maiion is correcL I agr¢e lo comply with all ci�y antl counly
oreinancesantlstalelawsrelaimgtobuiltlmgconsimctionandherebyauthorizerepresenlativesoltAisciryto terupontheaLove�mentianed
pro �ar mspeclion Ourposes.
Dal ' / 6- 9 r SignaWre: — / "" � �""
od�e�'s �icense or sociai security r:
16aF46 Whi�e—Boiltling: G�een—Cotle Entorcemem: Canary—Appli<ant Pink—Revenue; Goltlenrotl—Assessor
CZTY OF CO5TA MESA — BUILDING PERMIT PERM NO: P
PERMIT NO: P 070630 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: PERMIT TYPE: PLU PURPOSE: REP
JOH DESCRIPTION ; REPAIR DUE TO HOUSING CODE VIOLATIONS SQ FT:
CLAIM VALUE; CALC—VALUE: GROUP OCC: R-3 /
COMMENTS: REF: B-70628
+r+��r*x���****+r**�t+t****-�**�r**�t*+�*�r�r*+t+�+r+r*+t+t*+t+r*�r**�r*r+e+r�t+r*�r+e-�r+�*�r��r�r**+o-+r�r*x-+t**x�**�.�-
Z O N I N G R E Q U I R E M E N T 5
S E T H A C K S
------------ MAIN BOILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT; FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT; FT IN RGI-IT; FT IN
PARKING REQ; PROV: PARCEL: 42237208 ZNE: REF NO:
PLANNZNG NOTES>
>
****�r*�r�r�r�r�*ir*�r*i�*******�r***�r*�e+r�e+r�r�e*******+r�r***�*�r*x�***r*�r***x�***r*********+r��r
,_ D E C� 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 .
BUILDING APPROVED BY :
o'
DATE:
DATE;
APPLICATION ISSUED BY: ' DATE: �„0�,�,�,D��IY
1fM3Fffififlf�flF7fifikififltkifffifit�f4 iE1flEif�flflFiflF1F i�F'�1Fif
if 41f k if 7f �f 1f 4 it if if iF if if M 3f ff 1f if if it iF M iE if jF if iE it 1F if if if k it if ik if iE M if jt M j! iE i! it if if M 1! 1f if if 1f if i! af 1E iF 1E it it if R M iF iF 1! if ik jf M iF if iP iE if
LEGALI2ATION;N F E E S U M M A R Y STRUCTURAL SEGMENT:N
BLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 35,00
- - 25x - = -- SMIP/NON-RES
PLAN
ZSSUE FEE 20.00
BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
TOTALS----> 35,00 20,00 � 0,00 55.00 55.00 ,00
REVENUE DIVISION TOTALS--> COLLECTED: — 55.00 OVER/SHORT: .00
HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
55.00 '
ik ik ik M ik 1f it if i! it M ik if M i! M iE k if i! if if if i! iF it a! if M it it if ik if k if iF if if if it it M 1f iE it if iF it if if it it if if it if 1f 1f if iE iE if if if M if 1f %iF if 1E if if 1F jf M if if
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'
PLU 1 WATER CLOSET (TOZLET)'
PLU 2 WATER HEATER AND/OR'UENT
PLU 2 REPAIR/ALTER DRAINAGE/VENT PIPING
END OF FEES
UNIT COST TOTAL COST
7.00 7.40
7.00 19,00
7.00 19,00
�i �Q174566—Q0174566 T ti T 55.00
DATE� 02/Ch!95 TIl7E: i1.49
�
CONSTRUCTION AND PLANN�WG POO� & SPA ,' �.
APPROVALS Permit # Date Inspector APPROVALS Permit # Oate inspector �
7. Temporary Electrical $ervice or Pola„ � 52. Pooi & E4uipment Locatlon I
2. Sr�il Pipe�Undrgmd, �"'� 53. Steel Reinforcement
a� -
� _3:��lectrical Conduit Utility-Undrgrn�i��� 54. Forms
= -2:;Electrical Conduii-Undrgrnd. :� 55. Electrical Bondinn
�;6, Steel ReinforcemeriF '�-� 56. Rough Plumhing & Pressure Test ,`t,
��.6.��IectricalUPER�Grnd. _ 57.APPflO'JALTOCOVER�GUNiTE � I
-� °�. Footings - ' ' 58. Electriczl Conduit�Urdrgrnd. "
-�,Sr�Foundation . . � 59. Gas Pipe, O Untlrgmd., Tesc �
�
"�.=�. Water Pipe-Unclrgrnd. 60. Backwash Lines, P�Trap, Ci Undrgrnd. � "
ib. Structural floor System , . 61. APPROVAL TO DECK � �
it. Property Sewer lirie & HOLs�f,on�ection 62. Backwasli & Receptor-Fin�! � � �
12. Seever Cap � '1, i i 63. Heater & Vent-Final
�
73. Roof Drains '" � 64. Piumbing System - Fina�
74. Rough Plumbin,g � '.. � � - 65. Electrical-Final
15. Fough Electricai-Candurt ' 66. Solar SYstem-Finz!
i
16. Rough Elec:ric YJiring 67. Pencing & Access Approvat
77. Rough Wirinq Sign 68. APPROVED fOR PIASTERING
18. Rough Electricai-T Bar Ceiling 69. POOUSPA SYSTEPAS PINAL
19. Rough Heating & Air Conditioning RRE DEFT. REQUIREfvtENT I
- - - - :.��� �r ...
20"Rough Eacto�y Fireplace � ';h' " � $ ' � = ' ' :;App�pV1�I � -'Per'Pnit #
� i:u; `^! r �;,l�r-+.-•
27:,Ducts, in Stnucture �• �� - � _ . � -� i : i 70. Undergrountl HjrTlro � � I
22, Ducts. Ventilpting° � '- F-: �:�; q.77. Produc{yPSPing LGas C'JOii
23...Gas,Pipe•Rough & Test � �,j•_. : q - �. � f, 72, Underground Flusb � �
24;'Roof Framing " � �'b' '�r' � � � +�T � �73'.�Undergrnd.Stor`ageTank'OGas ❑Oil' �
r � _� .
�' -
25. Roof Sheathing �, ,. ,�� C? �� ,7 o e 74:� Overhead�Hydro-�
26. T�Sar Ceiling (Structural) &�Monocoat x - �:� " 75:: Dry Chemicai y "' ��'
,', -
27�;FrameandFlashtng r,�.• t' Ri, �� 76. DryStandpipe -.�� J � � m�r,;
�-�28 La.hing�&Siding � �� '�: 7� � %� " "� � 77�,-` FIXEDSYSTEM1I�FINAt�,
: r,� � .-i �. � � �, �. i . a ` -[.
�` 29�. Insulaii0n � ' - �� �� .. ; �� � 'x y 7��.FIRE P.REV. FINkL ; � '7. �_� ': �
'30. �Drywail�Naiiing ' i � �� = �'� '� � �HEALTH�DEPT. REQUIREM17I�ENT
,31. Plaster Brown Coat; � ,. � ; I �% i .r�9�.'FINRLyI�d;Sf?ECTIqN . " `
�'32.�'Electrical Power 69ete;�Final� _ ? ! � �` Y '7II0,'�FOOD CERTIF�_CATE ISSUED �� �'' �
: � ty � I M � Y ,
33: =Fir.a1 Electric , ��,� , `, ' 4 ; ' Notes: c�
��� -S -F� i-Clr1� �'Z�T.^.'fc�G
� 34. �Firtal Heating & Air Co[�ditianing: Y� .� � I ;s i �r' '0 `�„ • '•':`
.. � �. , . ,/:Z�.�S r_� .
� 35�;Final Gas Pipe-Test: - 'O �t � i • ' :C; Y - ' �,j;a �',., a ' :.;ip,
�.
� 36. Hood or CanoPY . _ ` � tr �-1 � +� �� � i •I� r 1: . : „ I
i ^•;n i n� .
:�37.;.Find1 Facmry Fireplace� ; ^ `'! ' �� I � ie � _ . F, 3
E-'1� I I i' � a�
-38. Final Pium6ing � � . .. . �2 S f�j: � ' - , .;' � ---
�.. ,� .:� •r �
^39. Wa%r Service�Pinar I. i � i, i ' .y • �-� . .� � . �
I I.
.-"r�40. Gas Se:vice-Finai � , .��,� - � r - + v.� _ .
� � it c. '
�=41. Solar 6omesticFinal�' � ' . �' i I �° � I�� t .
� �: .
_ :� J _
� 42.'Backfiow Preventer N * � ; • s s V �
�t1 �l 4
j���� ,� ` 'f.� a� ..�-i
43. 8ackflow Irrigation` . ; � ,a _� . . . .
:44. �andscape i�rigation System,,y,7 c; . - "'t � � i J :. _� .>>%
- ,� .
-45 �Sound qtteri�ation -~y^� .. y� k � �� F� e�" ` �� �; �� '�,. : ,r -� t �
t -� _
"p6:HandicapRegulations ;:� =� � _ • r n; e7 C!_. �s- - �
.. .- i � i. . s
47.=FtM1TqL STROCTURE & BUI�LDING � �-�. '; ' p1 `� T'
t.. ! • -
48rFIN:AL PLANNING i.� � i i_'�} i�I �,
-49.'•EleCtrie Release :o Edison � ' I I - „ � " '� ,' ' .
� � �t r7 �e; . . ,. _.
� 50. Gas:Release to Southern Califoroia Gas Co � ; ` .. ; � �:� • � :i r G �• • •
i. ,., .
:.51. CE9TIFICATE OF..00CUPAN�Y ' 3 `� �' .� 'i� ��. ' � -� - -
No. ' Dace