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HomeMy WebLinkAbout452 SHADY DR - Building Permits 1 CITY OF COSTA MESA 4 BUILDING DIVISION > DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER IPPF 1. J PERMIT 05-02435 , aist (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.3fLOING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 452 SHADY DR Status: ISSUED Suite: Applied: 12/29/2005 Vicinity: MASTER BATHROOM Issued: 12/29/2005 Primary Occ: R-3 Dwellings/Cong Res<10 Type of Construction: V-N Parcel Number: 11737239 Zoning: Applicant: BOGART, EMMETT D JR Address: 452 SHADY DR Phone: 949-548-1315 ISSUED BY: G�.4 COSTA MESA,CA Zip: 92627-3228 Owner: BOGART, EMMETT D JR Address 452 SHADY DR Phone: COSTA MESA,CA Zip: 92627-3228 Contractor OWNER-BUILDER Address: Phone: Zip: License: 000000 Arch : - Eng: Address: Address: Phone: - Phone: Zip: License: License: SCOPE OF PERMIT REMODEL MASTER BATHROOM IN AN EXISTING SFD. FEE SUMMARY Plan Check: $72.31 Calc Valuation: $5,000.00 Permit: $111.25 Claim Valuation: $5,000.00 SMIP Res: $0.50 SMIP Com: $0.00 Other $0.00 Inspection: $0.00 Total: $184.06 PLANNING &ZONING SETBACKS . ' MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING EXistinq: 0 Required: 0 Proposed: 0 It Ip NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446.46(6/00) WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: O I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (Tins action need not be completed if the permit is valued at one hundred dollars($100)or less.) certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws o ornia,and agree t if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these p ions. -f- ---- / Date-? / L — 9 -' o 5- -WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUEJEcT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(S100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full force and effect.Lic.# Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom end the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subj is the applicant to a civil penalty of not more than five hundred dollars($500).): I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. ✓ 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exe u der sec. Business and Professions Code for this reason: rSl lure:_ Cater-ii /2- - ' -7 - d S Owner ID verified by driver's license. es 0 No DriversLiceneNoO —Ei res: Z_�G-o f _ - Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feel in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,t will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to of greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? DU Yes lJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Duality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribedby Caflfornia Health and Safety Code Section 42303 been made? 0 Yes ❑No Et (If yes",attach certificate of colgpr-gibe from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I rtify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding.HazardousMaterials and ce Emissions. , Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to co y wl all state laws and city inances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described prop for inspection purposes. e not to occupy or allow occupancy of any building authorized by this permit until final inspection. .__---- 979 /z - 2-," - O 5 Signature 01 Legal Owner(s) I _Date CV r-- _. And/Or Authorized Applicant Date EQQg.2+ INSPECTION TYPE Will )NTmAIa CODE. i INSPECTION TYPE PATE INRTIAIS 1616 Fixed System Final Fire Prevention 206 ' Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical • 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place ' 220 Final Planning Approval . 203 Final Sign 222 Final Site /�4;�T �L 204 Final Demolition 250 Final Building/Occupancy "L 4;1 -RC • Siii M ---.Th.- Ti . . 1 ... . ...i 1-ut-- r- 1 sti • / et I 4 4) . MASTER, SUITE • zfibwereammoi , :• , 00)4,7 _ e.-x,5 r in•srei c.// -at-4i ' li • ® co"s,5-•,_‘c.-7- ritc,t, ,5-4e,jcp._ .5 Ce.5 ' II LE. Co 7°/ - tr.44 : , 3 4.ep(cce •-e_x/s 75 fr-7 1/4-1,7 ie 2 24,4410#(< _,_7 • j / :/ / . .3 CO/1-se tre-4.ec tret,L) c ift)5 e rt • ad in,17a.)/ net 7 tile..,-, cloyet . , . ._.....4-frzt— i- -, . .. 0• i • . ..ii- , H • . . . 1 : t4 't--- — --YB A .1 ... . • !I,, a . ,. KITCHEN r 7 . 4c5-224sc t Er. WTI'S tt)It+-17 f 31 :1 WING SAFETY l -) 171 TY OF 0 TA MESA , licsL . • ., Ar.....L.,_,A • Dale 112--1— . • BA.2 I , • p. .1 g I'. ... le L ..air-..4".. on this job at Ittioies.aort jus,inlaiviulki.4 itj'3, 1 . make any changes or alterations on same witheid written permission from the Diviskin of Balking \--i°• and Safely,City ol Costa Mesa. Ear_ 0 2-43S— • II Be stamping'Allis plan and specifications SHALL NOT be held to permit or to be an apptoval .• Al ED of the violation of any proinsio • any City of Costa Mesa Ordinance and/or Slate law. CITY OF COS MESA These plans and permit shall ext ir. •, 0 i r;.• :,i• • - • . ‘.., ,',' • builiwp on; . . . i IL . .1 • PLANNING VISION work is not commoncod and mak . •Moe per LAU WUra tat at 030---r issuarce. ifj— , , i .SUBJECT TO BLD . EPT. REG. : (3 - 4 NOTE:ADDITIONS, ELETIONS, • E ,a . - •.•• _„.__. -..t„. `'-'-'" : .... . OR CORRECTION SHALL BE , • ._ . APPROVED BY THE P NNING DIV. . . .... , '‘. . , • : B Y 44% . . ATE{a/2 . I . • . „ { }'{3ED-RiM. 1 , . •zn+e„.... . I ,.;E3.;• E DIR4 M ...•2 _ i i h . This. makk.a, ,,--. • ..,krisos • I .':.p.p r Ch r. . and sae , 11 ?itif:il i i 1/4,,A„1 • III ' i., i The st of tie Therel . ..411--.--;----L-- All. j I . _. . 1 ',T:.:,:ts:, ...3. , .. - ' I . ••,5°...--- •- 9--ezr ..../P,c; ,/,..-,k_— - ---. ' • :I. - •-::L _J----- I 5-artrat 2,7.2-ii, - .5.er----,c77 ..z3,f-7,7/ iacitfotoek- 40-7 ' CITY OF COSTA MESA BUILDING DIVISION >;-, „mu A1 DEVELOPMENT SERVICES DEPARTMENT PE MIT NUMBER ON' PERMIT 1 E05-01401 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 452 SHADY DR Status: ISSUED Suite No Applied: 12/29/2005 Vicinity: MASTER BATHROOM Issued: 12/29/2005 Parcel Nunmber: 11737239 Applicant: BOGART, EMMETT D JR / Address: 452 SHADY DR ISSUED BY: . Phone: 949-548-1315 COSTA MESA,CA Zip 92627-3228 Owner: BOGART, EMMETT D JR Address 452 SHADY DR Phone: COSTA MESA,CA Zip: 92627-3228 Contractor: OWNER-BUILDER Address: Phone: Zip: License:000000 • SCOPE OF PERMIT REMODEL MASTER BATHROOM IN AN EXISTING SFD. REF:B05-02435 1 SWITCH FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 ' Temp Dist System/Lighting $0.00 0 Temp service test $0.00 . Busway/100 ft $0.00 0 .Res.a/c package $0.00 _ . Standing Section $0.00 0 ' New Res(1-2 units) $0.00 . . 0 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0 Lighting Filets $0.00 0 up to 50 kva/kw $0.00 0 Recept Outlets $0.00 0 up to 100 kva/kw $0.00 0 Switches $1.10 1 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0Low Volt Wiring System/Ckt $0.00 0 Service to 200a $0.00 0 Misc.Conduit $0.00 0 Service to 1000a $0.00 _ 0 Misc.Conductor $0.00 0 Service over 1000a $0.00 ' 0 Circus(gen or ride) $0.00 0 Motors to 1hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp ., - $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp . $0.00 -0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $24.60 Intermed Pole $0.00 0 COMMENTS/SPECIAL CONDITIONS it it . i A NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections end final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) WORKERS'COMPENSATION DECLARATION: 1 hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. My workers'compensation Insurance carrier and policy number are: - Carder: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) f/5 I certifythat in theperformance of the work for which this � permitecis issued,bjec I shall not employ any person in any manner a as to becomef subject to the,I haforthwith laws a fomia,and agree that if hould become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these pr ions. - q ApPli�nt Sign tue re: Date / Z — � / — d r— WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYE TR O CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE(S100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force end effect.Lie.4 Class It Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: 1 hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS UCENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit Jsub' s the applicant to a civil penalty of not more than five hundred dollars($500).): I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). I.am•ez t _der sec. Business and Professions Code for this reason: -Signature CDate: 1 /y— Z 5' —O3 Owner ID verified by drivers license. es No Drivers Licens__e No. � I1Ex—pines:tiZ —Z�'05' Verification of Ownership by(type of doc ment,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-Six(36)feet high.(Chap.3.2.Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). present _... 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely _hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time hes on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this as plication a ermit for such construction or modification from the South Coast Air Quality Management District or Irom any other air pollution control district or agency? LJ Vas 0 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 II a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,nave all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: - Date: CERTIFICA OMPUANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I nee o comply with all sta aws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-des ' rid properly for sp purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of taperOwner(s)-P ater1 And/Or Authorized Applicant Date QQQFL INSPECTION TYPE - DAIS INTIf1AL5 CODE! INSPECTION TYPE DAIS fMuhlALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 9'Z7"ob 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy r, CITY OF COSTA MESA 4 BUILDING DIVISION L1 � PER NUMBER DEVELOPMENT SERVICES DEPARTMENT 4. Ira PERMIT ro�se P05-01012 b . (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesePcLUMBING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 452 SHADY DR Status: ISSUED Suite No Applied: 12/29/2005 Issued: 12/29/2005 Vicinity: MASTER BATHROOM Parcel Nunmber: 11737239 , Applicant: BOGART, EMMETT D JR ISSUED BY: /� A Address: 452 SHADY DR /I> Phone: 949-548-1315 COSTA MESA,CA Zip: 92627-3228 Owner: BOGART, EMMETT D JR Address 452 SHADY DR . / Phone: COSTA MESA,CA - Zip: 92627-3228 . Contractor: OWNER-BUILDER Address: , Phone: Zip: License: 000000 SCOPE OF PERMIT REMODEL MASTER BATHROOM IN AN EXISTING SFD. REF:B05-02435 1 SHOWER, 1 WASH BASIN, 1 WATER CLOSET FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation • ..$0.00 0 Swimming Pool' $0.00 0 Backflow Preventer $0.00 0 - ._ P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $9.80 1 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain,Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain,Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $9.80 1 Drain,Roof $0.00 0 Shower $9.80 1 Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 . - Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.000' "-' Sink,commercial $0.00 0 • Water Re-pipe $0.00 0 Gas Earthquake Valve , ' $0.00 ' 0 • Sink, Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) , ;l$0.00- 0. . ' Sink,kitchen $0.00 0 Water Softener $0.00 0 Gas(Over 4 outlets) ' $0.00 ' 0 Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 ' Spa(private) $0.00 0 VIOLATION $0.00 Gas Service .- $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 . REINSPECTION $0.00 0 Interceptors(Sand Auto) ' $0.00 '0 TOTAL CALCULATED FEES: $52.90 COMMENTS/SPECIAL CONDITIONS . A A i'tRIP NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 244646(6/00) WORKERS'COMPENSATION DECLARATION: • I hereby affirm under penalty of perjury one of the following declarations: - ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed it the permit is valued at one hundred dollars($100)or less.) tI licertify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of C lifomia,and agree that' I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,1 shall forthwith comply with these v' ons. Applicant'SI lure', -- - / - C_Datic:4 / - WARNING FAILURE TO SECURE WORKERS'COMPENSATION ERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full force and effect.Lic.# Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: p I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: - Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit rs the applicant to a civil penalty of not more than five hundred dollars($500).): as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale,If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ' o 1,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exam u der sec. Business and Professions Code for this reason: Signature��--r� f- L - Z 5' • c S— Owner ID verified by driver's license. es ❑No Ddveesticense'N_o.. Expires:`7. ZG -o S' Verification of Ownership by(type of document,i.e.-property tax bill or deed): tr--1 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: O I hereby Certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). Q As owner-builder,t will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes ❑No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). .. .icant..r..... .. 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes LI No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? ❑Yes ❑No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION-OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I a comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-des ed property for inspe purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. / 2- z r — 0 5 -Signature.Ot le al Owner(s) Date And/OrAuthorized Applicant Date cE.. INSPECTION TYPE ➢9TE INTRIALS oRCOPE I INSPECTION TYPE DAT€ INTRIALS 1616 Fixed System Final Fire Prevention . 206 Final Mechanical • 1266 Pool Spa Final 208 Final Plumbing c7 Z7-06 .�.4- 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy I -- r ? MF CITY OF COSTA MESA , 4, 9 BUILDING DIVISION F tier`, ,; r` DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER 4• IPPKIIIPERMIT B05-00530 4kbibion'snsu e# (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesaillUMLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 452 SHADY DR Status: ISSUED Suite: Applied: 04/04/2005 Vicinity: Issued: 08/03/2005 Primary Occ: R-3 Dwellings/Gong Res<10 Type of Construction: V-N Parcel Number: 11737239 Zoning: Applicant BILL ANGELL Address: 27742 SOLLER Phone: 949-584-5919 ISSUED BY: MISSION VIEJO,CA Zip: 92692 Owner BOGART, EMMETT D JR • - - Address 452 SHADY DR . Phone: COSTA MESA,CA Zip: , 92627-3228 Contractor: 0/� - _ - - Address: . Phone: - Zip:^ License: ' Arch : ` Eng: RONALD WHARTON Address: Address: 601 S MILLKEN AV I. Phone: SUITE H Phone: 909-605-6865 ONTARIO CA Zip: _ License: . - 921761 . License: C32320 ' SCOPE OF PERMIT 2,510 S.F.INTERIOR ALTERATION TO EXISTING S.F.D.WORK TO INCLUDE:REMODEL EXISTING PORCH,ADD PITCH,REMODEL EXISTING MASTER BEDROOM AND REPLACE WINDOWS. ` k FEE SUMMARY •�'.n Plan Check ;•''' :-$254.31 Calc Valuation: $25,000.00 Permit: $391.25 Claim Valuation: $25,000.00 SMIP Res: $2.50 SMIP Corn: $0.00 Other: '- $0:00 . Inspection: $0.00 ,- `Total: ' $648.06 • - PLANNING &ZONING SETBACKS ' MAIN STRUCTURE Front 66-0 --`Rear. 8.0 . ''- Left 3-0 " - 1 'Right: :' 5-0 ACCESSORY ' -Front ` 0-0 Rear 0-0 - ' Left 0-0 Right 0-0 PARKING •Existinq: 4 Required. 4 Proposed.. ,0 ' NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained,Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(WOO) f DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. ❑ I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed If the permit is valued at one hundred dollars($100)or less.) I certify that in the pedo nce of the work for which is permit is Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws mia,and agree that if ould become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these p ' ions. / / Applicant Signature: Date: / .37CZi WARNING:FAILURE TO CURE WORKERS'COMPEN TION COVERA IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDRION TO THE COST OF COMPE SATION,DAMAGES AS PROVIDED FOR IN SECTION 37080F THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is In full force and effect.Uc.t1 Class a Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Cade). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors Ucense Law(Chapter 9(commendng with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): 71:0 I.as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. - 7044,Business and Professions Code:The Contractors Ucense Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or Improvement Is c Lsfild within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). 4,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuan he Contractors Licen ws.). ❑ I am exemp r sec. Business and Professions Code for this reason: et' 5 �P� \ :.1Slgnature /// � :" c -.. ' CDate - 5' Owner ID veri y driver's license. No Drivejs.UcenseNo.. CExpe `Z037 Verification of Ownership by(type of d ument,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application agpermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? lYes LJ No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 WIII any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or ether air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE MPUANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the Information given is correct. la et comply with all state law d city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-des ' property for inspection es.I agree n I to occupy or allow occupancy of any building authorizedthis ppermit�fina'inspe�n. — ����/�T�9-� _ Ca Signa roOftegaFO- ei( )—- Date And/Or Authorized Applicant Date CODE tINSPECTION TYPE DALE INTITIALE ;ODE( INSPECRQNTYPE RATE EMU 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy '92:14-014 L444-01 4`�yin b 9 CITY OF COSTA MESA BUILDING DIVISION C t ii ..` DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER 4. Picaee PERMIT E05-00819 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mss-eLtuTRICAL PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 452 SHADY DR Status: ISSUED Suite No Applied: 08/03/2005 Vicinity: BEDROOM Issued: 08/03/2005 Parcel Nunmber: 11737239 Applicant: BOGART, EMMETT D JR Address: 452 SHADY DR Phone: 949-548-1315 ISSUED BY: ,//r COSTA MESA,CA Zip 92627-3228 Owner: BOGART, EMMETT D JR Address 452 SHADY DR Phone: COSTA MESA,CA Zip: 92627-3228 Contractor:- OWNER-BUILDER Address: Phone: Zip: License:000000 SCOPE OF PERMIT 2,510 S.F.INTERIOR ALTERATION TO EXISTING S.F.D.WORK TO INCLUDE:REMODEL EXISTING PORCH,ADD PITCH,REMODEL EXISTING MASTER BEDROOM AND REPLACE.WINDOWS. REF:B05-00530 1 ELEC SWITCH FEE SUMMARY Quantity - Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft $0.00 0 Res.a/c package $0.00 Standing Section $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment - $0.00 0 New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0 Lighting Fixts $0.00 0 up to 50 kva/kw $0.00 0 Recept Outlets $0.00 0 - up to 100 kva/kw $0.00 0 Switches $1.10 1 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $0.00 0 Misc.Conduit $0.00 0 Service to 1000a $0.00 - 0 Misc.Conductor $0.00 0 Service over 1000a , $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1 hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand . $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand ' $0.00 0 Motors to 100hp , $0.00 0 - - -Other Electrical Fee $0.00' Motors over 100hp , $0.00 0 - Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 - 0 Reinspection Fee , $0.00 Sign Circuits $0.00 0 Temp Pwr Pole 50.00 0 TOTAL CALCULATED FEES $24.60 Intermed Pole $0.00 0 COMMENTS/SPECIAL CONDITIONS • • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180'days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446.46(6/00) DECLARATIONS 1 WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. My workers'compensation Insurance carder and policy number are: Carrier: Policy Number: section need not be completed it the permit Is valued at one hundred dollars($100)or less.) ccertify that in the perform ce of the work for which thi permit Is Issued,I shall not employ any person In any manner so as to become subject to the workers' ompensation laws of la,and agree that If I s Id become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these pr IIcant. A G TAPP Signature:-- -ri Dela: 3/ 2 S~ WARMNG:.FAILURE TO S WORKERS'COMPENSATION COVERA IS UNLAWFUL AND SHALL.SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is In full force and effect,tic.A Class it Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: O I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit Is issued.(Sec.3097.Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500).): "0-3 as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. "-7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or Improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • �/L as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions ✓7� Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license p nt to the Contractors 'cense Laws.). O I am a under se . Business and Professions Code for this reason: -StgnatUfr..Yx"- 1Date;. e - _.J.. - .2.-0°5 -Own ler ied by drivers license. Yes 0 No Drlvers'Ocens�a No Expires:z Z.-c, f Verification of Ownership by(type of doc ment.i.e.-property tax bill or deed): L-'---J--- DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person Is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Seim ss wh55'1005 of the anyoneHealth and anefeSafety aqutires,iwith some exceptions,ionthat a Business Plan be filed with the Costa Mesa Fire Department by every reportedyearquantity equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). .ehit 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? _ ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Flre Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No 5-Does or will the applicant or present or future building occupant require for the work which Is the subject of this.appilication aermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? .P Yes No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? b Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health end Safety Code). .._._..........._.._.._....._.— _ .... ._ ubject ...._this 7 If a permit from the South-boast Air y Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No _._...._ --._..__— _.. 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHOR • •ON OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree • •m• with all state laws an• %'• ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-describe. p.•-•rty for Insp La.U.,. pu.•.•s. ,gree not to•• u.y or allow occupancy of any building authorized by this permit until final inspection. gnature OI Legal Owner(s): male--e. e. And/Or Authorized Applicant Data ;ODE I INSPECTION TYPE 1261E IMAt5 ;ODE( INSPECTIONTYPE Mg QLIBLIa 1618 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing �.L �� 200 Final Re-Roof 210 Final Electrical r�' )M'O(g u t'\ 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Firo Place 220 Final Planning Approval 203 Final Sign 222 Final Site - 204 Final Demolition 250 Final Building/Occupancy Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. It' PERMIT NO. TRACT N LOT NO. UNIT NO. r 97E� -�I ��I • CITY OF COSTA MESA CONSTLRUC�pTIONTP7ERMIT �,r� B MI g O. 3 8 G3e•� Project Address V5 7 c%& of I/ P/✓' / ✓� �.xr�/ t Applicant's Mailing Address SQ /TI �r / A v TYPE OF CONSTRUCTION r NEW Li ADD U ALTERATION U REPAIR Owner's Name !�Q V(L� �7. l ��� /�Pllb er Sy�' �� ❑ CONVERSION ❑ DEMOLISH 0 OTHER BI4CR W I A P qIb 1'`1 372 — 3q I Zone 2/ DESCRIPTION OF WORK/USE OF BLDG.F H� qI Address r �.M ��I S Main Building: Accessory Building: Arch/Eng. License No. TYPE OF PERMIT U GRADING U FOUNDATION see STRUCTURAL E Front Z Address 0 TENANT 0 ELECTRICAL 0 PLUMBING 0 MECHANICAL B Rear N /� 0 OTHER A I Contractor's Name Q/, Phone C Right N Address(mailing) PROJECT DESCRIPTION SO. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION 5 /400.a $ Left C City License No. ZONE GRADING CU.YDS. - ACRES R LICENSED CONTRACTOR DECLARATION - Ping. Ref.546 Parking Req./Provided E I hereby affirm that I am licensed under provisions of Charter 9(commencing Remarks': Planning Notes: lies I ^r �r ' 1 1 1 11 0 with section 7000) of Division 3 of the Business and Professions Code, and u� t Oft y oC K kik M 'a. my license Is in full force and effect. 70 J T License Class License No. • S Date Signature PLUMBING FEES WORKERS'COMPENSATION DECLARATION Bar Sink Showers / 'hereby affirm that I have a certificate of consent to self-insure or a certificate _ _ ELECTRICAL FEES- 3f Workers' / Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink of Lab. C.) Automatic Washer Transformer 0 15-50 KW Policy No. Company Backflow Irrigation Sewer Cap - - 0 50+ KW Construction Pole Sub. 8 Certified copy is hereby furnished. Certified copy Is filed with the city Building Division. Bathtubs Sewer Connection Cooking Unit . Meter pup to 100 amps Date Applicant • EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps / (This section need not be completed if the permit is for one hundred($100)or less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel I certify that in the performance of the work for which this permit is issued, I - _ s shall not employ any person In any man er so as to ecom7subjec to the Drinking Fountains Solar Tank Fan Motors❑0.1 H 1'h-6 - Workers',Comp nsa ion Laws of Califor ia/ _ Date G—��- �/ Signature c/ .C/f'((��L( ^y�L�t� Floor Drains Swim Pool w/$ a I ix 9 P F.A.U. Ina.Solar -15 HP 016-15+ NOTICE:If,after making this declar You zho tl become subject to the �� workers' Compensation provisions the Labor Code, you must forthwith Floor Sinks UGn81 Fixtures Micro v¢ comply with such provisions or this permit shall be deemed revoked. _ ! , CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet ' Device Boxes I hereby affirm that there is a construction lending agency for the performance a Light of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets Lender's Name Range Lender's Address Kitchen Sink Water Service Switches Sign OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash following reason (Section 7031.5 Business and Professional Code: Any city or Garbage Disposal Standing Sections county which requires a permit to construct,alter,Improve,demolish or repair P—Trap any structure, prior to its issuance, also requires the applicant for such permit p Laundry Trays Generator 00-5 5.15 Kw Trash Compactor •-, file a signed statement that he/she Is licensed pursuant to the provisions of Roof Drai Contractor's License Law(Chapter 9(commencing with Section 7000)of Mon 3 of the Business and Professions Code) or that he/she is exempt .efrom and the basis for the alleged exemption. Any violation of Section 031.5 by any applicant for a permit subjects the applicant to a civil enaity of not more than live hundred dollars($500). I, as owner of the property or my employees with wages as their sole Reinspection Fee 1 $15 Issue Fee $ 3 pensation, will do the work,and the structure is not intended or offered r Reinspection Fee I $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SERVICES QUIREMENTS: "�. employees, provided that such Improvements are not Intended or offered for Boiler Hood or Type i ❑ sale. If, however, the building or Improvement Is sold within one year of com- Canopy Type I I ❑ Zoning Approved By Date pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground prove for the purpose of sale). Building Approved By /`j5(I . ' Date 6 16-8 7 ❑ I, as owner of the property,am exclusively contracting with licensed con- Duct'-Structural Refrigeration System • Application Issued By ����j� Date tractors to construct the project (Section 7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00.100,000 BTU 0100 BTU SUMMARY OF FEES builds or Improves thereon, and who contracts for such projects with a con- tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/ ration BUILDING PERMIT $ ZI 3 • 5O SMTP $ 0 • 50 proof of their WOrker's Compensation insurance should be provided to me. - PLAN CHECK $ (S, 2 O PERMIT ❑ I am exempt under Section ......B.& P.C.for th'11s reason Firepl/Fact.Blt. ICBG# Fire Da ers PLUMBING $ ISSUANCE $ 6'� Date 4. Owner nifbr le• %cna O 1/3 Ci/! /7 /.41 cf d r9 S_ Heating System& Ducting - '-gisters _ ENERGY P.C. $ PLAN CHECK 25% $ I hereby certify that I have read this application and state that the above 00.100,000 BTU 0100,000: GRADING $ information is correct. I agree to comply with all city and county ordinances ELECTRICAL $ and state laws relating to building construction, and hereby authorize repre- MICROFILM $ sentatives of is city to enter upon the wove-mentioned property for PLAN CHECK 50% $ inspection p ses. Alf TOTAL FEE $ 39 121 Signature CS- _ a - .../e'e __. Date 6 �4 v/ MECHANICAL $ Drivers' Age • SS# < -:inspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ CMF 0665-46,rev. 10/84 White . Building: Canary - Applicant; Pink -Accounting;Goldenrod - Assessor CONSTRUCTION AND PLANNING POOL& SPA APPROVALS Permit Date Inspector APPROVALS Permit Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings �_ 7 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK f 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final .. 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating& Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# • _ 21. Ducts,in Structure 70. Underground Hydro 22. Ducts, Ventilating , 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough& Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank ❑Gas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe . 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric • Notes: -r6',, � (z (g7 4k -rn Cavd � 34. Final Heating& Air Conditioning 35. Final Gas Pipe-Test 36.-Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final ' 40. Gas Service-Final 41. Solar Domestic-Final • 4�. Backflow Preventer _.. 43. Backflow Irrigation 44: Landscape Irrigation System • • 45. Sound Attenuation '46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING fl# Q4. ' 48. Special Requirements Completed •49. Electrid Release to Edison 50. Gas Release to Southern California Gas Co • . 51. CERTIFICATE OF OCCUPANCY • No. Date ' PARTY WILL AGREEMMT THIS AGREEMENT, made and entered into this / / day of \( /ti }if , 1987, by and between 4/Q vid C%ain46eerc hereinafter referred to as "LAND CWTER", ar•-0 ih! /iYQ /'! c72 p /n /(0), hereinafter referred to as "ADJACENT PROPERTY COINER". It is hereby agreed that a party wall will be constructed on the property line between 6/S a 7/a ey ;drive — a n da'- (Address of Adjoining Properties) -r 1194 r /t klt#y in the City of Ccsta Mesa, County of Orange, State of California, as per map recorded in Book , Page73'of Miscellaneous Maps, in the office of the County Recorder of said County. The party wall shall be permitted to encroach -r0Qfl /SCo/r, Tp ( OprwofE ty /2PA't // • IN WITNESS %HEREOF, the parties have entered into this Agreement the day and year first above written. LAND OWNER e.A PROPE . 1 ER / �,_O- J (Signature) gnature) AL//Ai rl C/1to/ /74)rs 1/ A V Name (Typed or Printed) Name (Typed or Printed) / / -59 f238/ rerj /l/ p y ck y fir,, ( n S/n /�if4 'I%0:/29 /I c (f//2/r C (Ad ess) ( (Address) IV PARTY WALL. ABIENT THIS AGREEMENT, made and entered int//o��this // day of p , 1987, by and between �xvin- C/7//0m (elerc hereinafter referred to as "LAND OWMER", and g()FD SANFoPNV) hereinafter referred to as "ADJACENT PROPERTY CWNER". It is hereby agreed that a party wall will be constructed on the property line between 9 5- 2 -Cwp c/, /2xIe' P — nazei- 4/6 / res Ad ' ., rProperties) in the City of Costa Mesa, County of Orange,State of California, as per map recorded in Book , Page of Miscellaneous Maps, in the office of the County Recorder of said County. The party wall shall be permitted to encroach TO EXaS ik)G wrxl Fn' Ok) WeVtY c) AG( A tie 1/4AY 4 PJ o. 2 " IN WITNESS WHEREOF, the parties have entered into this Agreement the day and year first above written. LAND OWNER ADJACENT PROPERLY Q4NER C) (Signature) ( ignatuiSUr`} sba v/ (1/2"eprf POD 5-ANFO Name (Typed or Printed) • Name (Typed or Printed) �/ Abl RS6 UJQY 27(5-07 .5.-Z24 er (QsZ avez O 9 Z 627 (Address) (Address) ' TYPICAL ' 6" CONCRETE BLOCK FENCE ' Cement Coning°°"a"' GENERAL— NOTES Cement Block With T.3/B¢Horizoni�; Fences al Top of all I ■ ■ !1 11 MORTAR; do Parf Pkntfe Cemt♦nt and Three Parts Sand For Fences 6•aLea 0 GROUT: One Port Cement Three and 4 I z I I I l I I COPING: Done Pet Cemealf Partsnt sand Vert Can>t/t" at 4'-0"O.0 d 0 For FerlaeHlSerTerlB' ill " u CONCRETE: WelParlSand MissedG2-1/2:3-1/2 •Vert,Can 3/8"m et 32.O.0 e s Maa. of 7-1/2 Gallons of Fi11CNbSolidWithGrout �� > = I I Water Per Sock of Cement Wen Sad Oxon r Reinforcing Steel Shell t e I I I I GROUT MAY SE POURED PROM THE TOP OF THE FENCE IN CELLS WHERE STEEL Conform to Sne,A.TS•38 u O OCCURS. AS.T.M. II 2 '-IV II I I I I I CELLS MID AREAS OF HORIZONTAL REIN. FORCEMAll SUFI to be Lapped FREE OF ALL MORTAR DEBRIS.CLEAN,SHALL OE ETC.CLEAN i 24"or to Cod � • 1 . I I N . " i NATURAL GRADE e i>►f �,,wir, c7 .z I I I TWO wet BARS �na i�r • . . , ... . • SS BOTTOCONTINM TOP Jam.-WIOTN TO 16. O.C. MAX. • �•• r SEE CHART •• •. •• .. 1 • llofea.STEEL MUST SE TIED IN BELOW ',:' ! ... H Or EARTHTCOTH PLACE AT TIME OF TRENCH iL a. • �1a,S. THE HE(13TH OF FENCE INSPECTION. •-•DECOR *BOTTOM OF FOOTING. ;4 'o' 4 _. C SCALE: I/2•• Is • FOOTING REQUIREMENTS CHART 1 WALL HEIGHT 6 5' - • ! 4' : 3' ' WIDTH 14' 14" I _I2`,,,,,, : , , • , • 12 a THICKNESS 10 10 t) G • DEPTH OF EARTHTOOTH . . . 24' 20" 16" . . : 12" ' SPACING OF EARTHTOOTH. . 12' 14' IS' /n 16' OWNERS NAME: SDQ.YLLJ ,. nors'_ .- _ City of Costa Mesa California JOBA°OADDRESS: �.��. �Cmi‘2'� PERMIT NUMBER:_ Building Department • staNATURE: '� 4,i&Z-e-__ — .nista •.,.:._,q_._., Rtvnra NW.St Inuit • :, ,,,Qr X i D y S -c 54 S 1 N --� r • A I A •1 O q 10�1Ot a 100101011 101/0101/ 1O1OM11 I. . i • I^I�/ L • S 14, yrT4a(. I G i tlt • Ina/{/4, -.:, 1 I r.___ bj1,1 . For Inspections APPROVED ' ,��f� City Call , of Costa Mesa Buildinc De' . nal co n rN e6 -/ By _a A . K h0. DATE 6!I G 19..1 1 L O / •/D n� . 75 4 THESE c' .",v;.MUST BE ON JOB AT ALL TV.^.FS OH:. '` .... �' 27 NO CHANGES W'iTHOUi' PRIOR APP.OVAL OL y • ETKp.LSr"AL ^." .,.Renrn.i- r.r. .A PFP:AD OR a"'... :.I " PiRA1 . O'. : AI'n ... b,0i' .,_ l; ��� AUC THORITY "i -.vo..A..: __ . , ' 'VHiCY II f l E[ / ® VIS, THE ISSUANCE OF A PER E !A AN :..VD L`J ( ILLl.. f. / [[ �II``4J ,.( SPECIFTCADONS SHALL NOT PREVE THE T, , - • ,a .;CIAL • l �O k (Jock.�(i FROM THEREAFTER REQUIRING (HE COnrtECTiO:'.C. ERRCFS IN CITY OF Co 'S�A MESA SAID PLANS AND SPECIFICATIONS OR FROM PREVENTING PLANNING DEPr.T.REG BUILDING OPERATIONS BEING CARRIED ON THEREUNDER WHENVIO•.,.TION OF THIS CODE OR OF ANY OTHER ORDINANCE OF 5U716CT TO OLDG. DEL i '3 C . I i DL',,,C...r2 OF FIANN/NO ' Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. ciTV 6F COSTA MESA CQNJTR yCTIOON PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT NO. Project Address 'T %/'%.VP E a 3 5 r� aP '9754 5/I '/'7 • Applicant's Mailing'- Address /+fez Yl? / ri TYPE OF CONSTRUCTION LI NEW U ADD Li-ALTERATION U REPAIR r Owner's Name 17010 In 10 l-A0 1'1?!J'PIeS Phone• rT-O 9 ❑ CONVERSION ❑ DEMOLISH 0 OTHER A,P.46 ` Zone DESCRIPTION OF WORK/USE OF BLDG. b Paan OL Address LIa fit La S Main Building: 'Accessory Building: E Z Arch/Eng. License No. TYPE OF PERMIT U GRADING U FOUNDATION U STRUCTURAL T Front D Address 0 TENANT ELECTRICAL 0 PLUMBING 0 MECHANICAL B Rear 'a N �j 0 OTHER Contractor's Name .�3 Phone PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right N Address(mailing) CON ST RUCTION TYPE VALUATION K G Left City License NO. ZONE GRADI NG CU.YDS. ACRES - R LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided E I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: O with section 7000) of Division 3 of the Business and Professions Code, and M my license is in full force and effect. [j C c g , Z g 4 2- /j S c P 7- 8-n c'R S License Class License No. '1 L T' .UTt s�/"� Y'� �" Date Signature PLUMBING FEES CORKERS'COMPENSATION DECLARATION Bar Sink Showers hereby affirm that I have a certificate of consent to setf4nsure or a certificate ELECTRICAL FEES of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) Backflow Preventer Service Sink Automatic Washer Transformer 0 15-50 KW Policy No. Company Backflow Irrigation Sewer Cap Construction Pole Sub. 0 50+ KW BCertified copy is hereby furnished. Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Date Applicant •EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps (This section need not be completed if the permit is for One hundred ($100)Or ' less). Dishwasher . Solar Piping Dryers ❑Gas ❑Electric f Sub Panel ,f 00 I certify that in the performance of the work for which this permit is issued, I — shall not employ any person In any manner so as to9pcome subject to the Drinking Fountains Solar Tan Fan Motors❑0-1 HP ❑1 4-8 Workers'.ypm socio ws of Calif°srttS) /// Date 4-- '-27 Signature Y>l•eei /�('t-4// 1 1. - Floor Drains Swim, ng Pool w/Spa F.A.O. Inc.Solar ❑g-15 HP ❑16-15+ NOTICE:If,after making this declaraT[inr, yeti show become subject to the Workers' Compensation provisions o the Labor Code, you must forthwith Floor Sinks mal Fixtures • comply with such provisions or this permit shall be deemed revoked. Microwave CONSTRUCTION LENDING AGENCY Gas Services Outlets Water Closet Device Boxes Pole Light I hereby affirm that there Is a construction lending agency for the performance 9 of the work for which this permit Is issued (Section 3097 Civ. C.) Interceptors Water Heater OutletsLender's Name Range Lender's Address Kitchen Sink Water Service Switches OWNER BUILDER DECLARATION Sign I hereby affirm that I am exempt from the Contractor's License Law for the Lavatorieso Auto-Wash Disposal Garbage following reason (Section 7031.5 Business and Professional Code: Any city or Standing Sections county which requires a permit to Construct,alter,improve,demolish or repair P-Tf'ap a." Laundry y Tre s G ❑0 any structure, prior to Its Issuance, also requires the applicant for such permit - Generator -5 KW ❑5-15 KW Trash Compactor 'o file a signed statement that he/she Is licensed pursuant to the provisions of Roof:Dr ' 5 e Contractor's License Law(Chapter 9(commencing with Section 7000) of vision 3 of the Business and Professions Code) or that he/she is exempt - •.- .,erefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). O I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 compensation, will do the work,and the structure Is not intended or offered Reinspection Fee I $15 Issue Fee S 3 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES/ License Law does not apply to an owner of a property who builds or improves thereon, and providdoes ed that such improvements Bare sor not intended ohir offered for Boiler Hood or Type I ❑ DEVELOPMENT SERVICES REQUIREMENTS: sale. If, however, the building or improvement is sold within one year of corn- Canopy Type II ❑ Zoning Approved By Date // '} pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By /7� L, Date //16L8 / pr ve for the purpose of sale). p�/ � D I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Applination Issued By Date tr tors to construct the project (Section 7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BT 100,000 BTU and who contracts for such projects _ SUMMARY OF FEES builds or improves pursuant thereon, ). iamwith a con-hat tractor(s) license to the Contractor's License Law). I aware thatBUILDING PERMIT $ SMTP $ proof of their Worker's Compensation insurance should be provided to me. _Exhaust System 0 Multiple 0 Syste epair/Alteration PLAN CHECK $ - PERMIT 0 I am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers PLUMBING $ ISSUANCE $ Date � -_ (�- 7 Owner - . sill. .Z vim. -r Heating System& Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $ I hereby certify that .1 have rea• is -pplicatl. and state that the above 00-100,000 BTU 01 , 00 BTL ELECTRICAL $ B•17p GRADING S information is correct- I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize repre- sentatives of this city to enter u on the above-mentioned property for PLAN CHECK 50% 5 Inspection poses. / rye e Signature 87 �. - / ✓ '// Date 6���j� - MECHANICAL $ TOTAL FEE $ O• �d - Drivers' -ns- or SS - spection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ CMF 0865-46,rev. 10/84 White - Building; Canary -Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING POOL & SPA APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement - 56. Rough Plumbing& Pressure Test 6. Electrical OF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd.,Test 9. WaterPipe-Undrgrnd. 60. Backwash Lines,P-Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling • 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# _ 21. Ducts, in Structure 70. Underground Hydro . 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank O Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro • 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL, 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION .. , 32. Electrical Power Meter-Final j 77 J G 80. FOOD CERTIFICATE ISSUED 33. Final Electric -4-Y7 jc. Notes: _. 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY - No. Date i . t/ Z CERTIFICATE OF COMPLIANCE . i ' 1. PAYMENT OF SCHOOL FACILITY FEES • ,4 NEWPORT/MESA UNIFIED SCHOOL DISTRICT , \ • , l , Developer/Applicant :. AT J'i n 4 ( . A�I/jl,�Pirc. Address : C/S 7 Sier (I/, �r. clic /Q JAciii m. Telephone Number : 5- %f - A, g Tract/Parcel and Lot Number(s ) : 4479 / 41 icor i/, • Location of Project : Ctin? -to t. L• • Number of Square Feet of -a d Residential Space 2 6 ix $1 . 50 Total /�Q ! 4/, Number of Square Feet of , Commercial and o (' '`. ' Industrial Space ` F x $0 . 25 ' Total . l r The provisions of Government Code Section 53080 are not applicable . -' This certifies that the above-named Devel per;/Applicant has paid , school facility fees 'in compliance with Government Code Sections '53080 and- 65995 . .k- Checks are to be made payable to Newport-Mesa7Unified School - - - - District . i cencesotecadrisil BuManager Newport-Mesa Unified School District C-.- .` The above representa[ion as to square footage is true . - 11 Developer/Applicant agrees that if itis later determined that such representations are not true then this certificate shall automatically terminate and the appropriate City/County shall be notified . . �. Date : .3----//--e7 Derkbper/Applicant • 1 . `_ 'I. Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA.MESA CONSTRUCTION PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT NO. r Project,Address' 7S c c%a l� 0/^. '�"F - 2 e4�2� '�(�A v'ri- �j �✓'1 I8 • 7655 5/ I''I /E7 1117,,V: • {lpplicant's Mailing//A�'�d__dress Sm 11']/`P. /l`, -'r TYPE OF CONSTRUCTION ❑ ,N`EEW" ADD ALTERATION U REPAIR f Owner's Name YL'—I/�Q �. C�`1Qmh �7�'i736b ❑ CONVERSION ❑ DEMOLISH ❑ OTHER• A.p.# Zone /e,� �ne - DESC PIIO�N O F WO /USE OF BLDG. N / �• �� • Address YY5 Shd.elt Dr. Costs na'o sn ••v-' i �iI�CY�-r�,9-Lc� trj$'tEej ' ler. . n�r - S Main Building: Accessory Building:�'uT �� �^/I � Arch/Eng. License No. r '-' TYPE OF PERMIT„, ❑ GRADING ❑ FOUNDATION STRUCTUR-L E Front . enaktufQ,, 1246 CNVVI-C.(/v Address • a r❑ TENANT 4L ELECTRICAL- ❑ PLUMBING ❑ MECHANICAL B Rear 'v��/�/�//qqqq/////�����C ,,/ ./.� ,, �_ �/ N Contractor's Name O LAM SOY Aect iris aN Phone `- - C Right d(%l.C/LLC� C.l.(..LOt/L/ (.GCi"' N Address(mailing/ ti '. PROJECT DESCRIPTION SQ.'FT// /2o OCCUPA/N_CV��/ ss OTHER A g n. .�-� . ' j CONSTRUCTION TYPE j . / VALUATION $ CIC r 3IZ.. S Left r'a' Qf nQ (an � hy-s.y � kw R City License No. ZONE • GRADING CU.YDS. ACRES Ping. Ref. # +^'r' Park(iJ1{g'^RB,q.'/P•rovided E LICENSED CONTRACTOR DECLARATION _ Q I hereby affirm that I am licensed under provisions of Charter 9 (commencing : Remarks: • Planning Notes: M with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. �' r, _ .yeC 276, _ 87 s . • / , T License Class License No. Date Signature - , PLUMBING _FEES 'ORKERS' COMPENSATION DECLARATION ' „.�,/ `' - hereby affirm that have a certificate of consent to self-insure or a certificate 1+ Bar Sink _ Showers - ELECTRICAL FEES - f of Workers' Compensation Insurance, or a certified copy thereof (Section - - — 3800, Lab. C.) r_ Backflow Preventer Service Sink . - . .. Automatic Washer Transformer 0 15-50 KW - �j Policy No. Company 'e' '� Backflow Irrigation Sewer Cap - - - 0 50+ KW Construction Pole Sub. IT Certified copy is hereby furnished. a Ls. -- ' Certified copy is filed with the city Building Division. i,4 �, p ' Bathtubs Sewer Connection / Cooking Unit Meter Cup to 100 amps • Date Applicant r /fes' / • ' EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors f Dishwasher Meter Lover 100 amps • (This section need not be completed if the permit is for one hundred ($100)Pr - - - ' • less). 1' y:' Dishwasher Solar Piping - : Dryers EGas ❑Electric • . Sub Panel ' I certify that in the performance of the work for which this permit is issuetl,'I - - - ___r____, - shall not employ any person'in any manner so as to b-come subject to the ' , Drinking Fountains Solar Ta Fan Motors❑0-1 HP ❑1Y-8 Workers' C`mpensation Laws of Califorra. ;. - X Date //-37 Signature / �� ' / . Floor Drains Swi ing Pool•w/Spa t F.A.U. Inc.'Solar ❑9 15 HP ❑16-15+' NOTICE: If,after making this declaragn, ou should become subject to the —" - _ Workers' Compensation provisions of the Labor Code, you must forthwith FOOT Sinks incl ,Fi tufeS comply with such provisions or this permit shall be deemed revoked. ,/: Microwave O Zo CONSTRUCTION LENDING AGENCY Gas Service Outlets - / Water Closet I Device Boxes I hereby affirm-that there is a construction lending agency for the performance Pole Light of the work forrwh -M1 thispermit is issued (Section 3097 Civ. C.) Interceptors - s� - / ' Water Heater Lender's Name _ . Outlets Range O�Q Lender's Address. - Kitchen Sink Water Service 2 Switches. -Sign 0 5v OWNER BUILDER DECLARATION - ' I hereby affirm that-I'am exempt from the Contractor's License Law for the Lavatories / Auto-Wash Garbage Disposal Standing Sections - following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct,alter,improve,demolish or repair P-Trap "' ' - - ' Laundry Trays Generator ❑0-5 KW ❑5-15 KW any structure, prior to'its issuance, also requires the applicant for such permit - T.rash Compactor to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains - ie Contractor's License-Law(Chapter 9(commencing with Section 7000) of • ivision 3 of the Business and Professions Code) or that he/she is exempt - . .nerefrom and'the basis for the alleged exemption. Any violation of Section • • 7031.5 by any applicant for a permit subjects the applicant to a civil 5,' — - pe ally of not more than five hundred dollars($500). - I I, as owner of the property or my employees with wages as their sole Reinspection Fee' II $15 Issue Fee $ 3 • compensation, will do the work,and the structure is not intended or offered _ - _ - _ - Reinspection Fee I $15 Issue Fee • $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's I MECHANICAL • FEES - License Law does not apply to an owner of a property who builds or improves s /\ I thereon, and who does such'work himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREME /71 y�v '! Is�• ss7 �+@,rJ,J) employees, provided that such improvements are not intended or offered for Boiler _ Hood or Type ,❑ q 0 t sale. If, however, the building or improvement is sold within one year of com- Canopy ' Type II ❑ Zoning Approved By Date pletion,the owner will have the burden of proving he/she did not build or im- prove Duct-Under Ground Building Approved By Date •for the purpose of sale). , L 1 ❑ I,as owner of the property, exclusively contracting with licensed con- Duct-Structural Refrlgera on System, Application Issued By " Date J// i�/e 7 tractors to construct the project (Section 7044,Business and Professions Code: _ . The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ' 00- ,000 BTU 0100,000 BTU _ SU MARY OF FEES • builds or improves thereon, and who contracts for such projects with a con- • - _ tractor(s) license pursuant to the Contractor's License Law). I am aware that .F BUILDING PERMIT $ Z' "o SMIP $ O•re proof of their Worker's Compensation insurance should be Exhaust System 0 Multiple 0 j Vystem Repair/Alteration p provided to me. • PLAN CHECK $ •• (ZPERMIT ❑ I am exeinpt under Section ' B.& P.C.for this reason. Firepi/Fact.Blt. ICBG# Fire Dampers PLUMBING $ ISSUANCE $ ,K Date -4+•_Zt7 Owner Ac. . . .. ./Act 0.., Heating System&Ducting Registers - • - • PLAN CHECK . 25% $ - ENERGY P.C. $ I hereby certify that I have rea"his .pplicati.wand state that the above 00-100,000 BTJTL _ ELECTRICAL Art,2o GRADING $ information is correct..) agree to comply with all city and county ordinances - $ and state laws relating to building construction, and hereby authorize repre- - PLAN CHECK 50% $ ©e Gl� MICROFILM $ sentatives of this city to enter ugon the above-mentioned property for - - /0e. D O• C inspection pins-gs, 2 / �(ai /.. . - Date 3 /��� + MECHANICAL • $ TOTAL FEE $ Q Z DSirivers' �/.or S CMF 0865-46,rev.10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING ; ' POOL & SPA APPROVALS Permit# Date Inspector APPROVALS Permit# 'Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location . • 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement • 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding , 5. Steel Reinforcement •56. Rough.Plumbing & Pressure Test . , 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings ' ma G nand- 7V_V ten 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe,'0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final , , 12. Sewer Cap 63. Heater & Vent-Final • . ' 13. Roof Drains .. 64. Plumbing System - Final ' Y • 14. Rough Plumbing t 65. Electrical-Final • 15. Rough Electrical-Conduit ' 66. Solar System-Final • 16. Rough Electric Wiring $' • ncing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING • 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT ' 20. Rough Factory Fireplace APPROVALS Permit# - 21. Ducts, in Structure 70. Underground Hydro 4 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro - • - ._ • 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical ' 27. Frame and Flashing ;./ f$'l O ;Q 76. Dry Standpipe28. Lathing & Siding IC/ 77. FIXED SYSTEM FINAL 29. Insulation . (/ 40.- 78. FIRE PREV. FINAL : 30. Drywall Nailing g"7 Pt HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat - / Pit 79. FINAL INSPECTION - _ 32. Electrical Power Meter.-.Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric ice,/g' 04 Notes: 34. Final Heating & Air Conditioning 2 c-ti -71.024-1 entako , _ 6 - ' . 35. Final Gas Pipe-Test �� O/ ,-¢- ) //ao 36. Hood or Canopy ft-4( a --�• 1 �� /� 37..Final Factory Fireplace J�Orei- // 38.' Final Plumbing • �a-s4- .SeQ e / _ i J C \ 39. Water Service-Final -�aj� ' 40. Gas Service-Final • • 41,. Solar Domestic-Final ' 42. Backflow Preventer • 43. Backflow Irrigation . • 44. Landscape Irrigation System . 45. Sound Attenuation - - 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING /%n O 48. Special Requirements Completed 49. Electric Release to Edison •- A GA 50. Gas Release to Southern California Gas Co 51.,CERTIFICATE OF OCCUPANCY, No. Date r n Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO. / TRACT NO. LOT NO. UNIT NO. Project Address 4/ 2 Sif&d "7P 30186 TRACT +�� Por //91 5074 9/11 /07 5000 TL Applicant's Mailing Address •SQnnhl/�C/ L .C' TYPE OF CONSTRUCTION U NEWEcADD H ALTERATION H REPAIR Owner's Name nlol V /./J .V, CACI JN6(a(fphona -O2� - ❑ CONVERSION ❑ DEMOLISH O HER A.P.# I Zone SB 1? DESCRIPTION OF WORK/USE OF BLDG. Address S Main Building: AccessoryBuilding: Arch/Eng. - --- - License No. TYPE OF PERMIT U GRADING���ggq❑ FOUNDATION U STRUCTURAL E Front 0 Address O TENANT ❑ ELECTRICAL yqr PLUMBING ❑ MECHANICAL B Rear N ❑ OTHER / ` A , I Contractor's Name-- ow n P it_ Phone C Right N PROJECT DESCRIPTION 5Q. FT. OCCUPANCY K Address(mailing) - -- CONSTRUCTION TYPE VALUATION$ s Left R City License No. -- ZONE _ GRADING CU.YDS. ACRES LICENSED CONTRACTOR DECLARATION -- Ping. Ref.# Parking Req./Provided - E I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: R E^ �C7/1 Z u Planning Notes: 0M with section 7000) of Division 3 of the Business and Professions Code, and f••� D _1 ` T my license is in full force and effect. License Class License No. S -`ale Signature PLUMBING - FEES I )RKERS' COMPENSATION DECLARATION Bar Sink Showers .lereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL FEES of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink 3800, Lab. C.) Automatic Washer Transformer 0 15-50 KW Policy No. Company Backflow Irrigation Sewer Cap Construction Pole Sub. 050+KW 8 Certified copy Is hereby furnished. . Certified copy Is filed with the city Building Division. Bathtubs Sewer Connection Cooking Unit Meter Cup t0 100 amps Date Applicant EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps (This section need not be completed if the permit is for one hundred ($100) or less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any ma. er so as becore subje to the Drinking Fountains Solar Tank Fan Motors ❑0-1 HP 1'/a-8 Workers' om ens�jl4�+ Laws of Califoa1i. (/�'/! _ Date /-)e- Signature 40/' L+ • atfC �r Floor Drains Swimming Pool w/Spa F.A.U. r NOTICE: If,after eking this declaron, ou s uld become subject to the - Inc.Solar -15 HP ❑1615+ Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal comply with such provisions or this permit shall be deemed revoked. Fixtures Micr ave . CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes ole Li ht I hereby affirm that there is a construction lending agency for the performance 9 of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Lender's Name - p / Outlets Range Lender's Address Kitchen Sink Water Service Switches - • Sign OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Caw-for the Lavatories Auto-Wash following reason (Section 7031.5 Business and Professional Code:'Any city or Garbage Disposal Standing Sections county which requires a permit to construct,alter,improve,demolish or repair P-Trap LaundryTray5 any structure, prior to Its issuance, also requires the applicant for_such permit y Generator ❑0-5 KW ❑5-15 KW Trash Compactor file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains e Contractor's License Law (Chapter 9(commencing with Section 7000)of .vision 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil - alty of not more than five hundred dollars($500). I p�pl�I, as owner of the property or my employees with wages as their sole Reinspection Fee f $15 ,Issue Fee $ 3 cdmpensation, will do the work, and the structure is not intended or offered 1 - Reinspection Fee I $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL I FEES License Law does not apply to an owner of a property who builds or Improves _ thereon, and who does such work himself/herself or through his or her own — DEVELOPMENT SERVICES REQUIREMENTS: • employees, provided that such improvements are not Intended or offered for Boiler Hood or Type I ❑ sale. If, however, the building or Improvement is sold within one year of com- Canopy Type II ❑ Zoning Approved By Date pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By Bath for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Date 9-I/--57 tractors to construct the project (Section 7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 0100,000 BTU SUMMARY OF FEE builds or improves thereon, and who contracts for such projects with a con- tractors) Exhaust license pursuant to the Contractor's License Law). I am aware that System El Multiple 0 System pair/Alteration BUILDING PERMIT $ - SMIP $ proof oftheir Worker's Compensation Insurance should be provided to me. _ PLAN CHECK $ PERMIT 0 I am exempt under Section B. & P.C.for this reason Firepl/Fact.Blt. ICBO# e Damper • s PLUMBING $ ($•••_GO ISSUANCE $ Date 2:1.-', 7 Owner a. .- J z i .,/-' ,' Heating System& Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $ I hereby certify that I have read this application and state that the above 00100,000 BTU 0100,000 _ ELECTRICAL $ GRADING $ information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- -- , PLAN CHECK 50% $ MICROFILM $ sentatives of this city to enter upo the ab-ve.mentioned property for inspection p oses. MECHANICAL $ TOTAL FEE $ .S (70 Signature •'S.. CA %- _ Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ - - CMF 0865-46,rev.10/84 White - Building; Canary - Applicant; Pink -Accounting;Goldenrod - Assessor CONSTRUCTION AND PLANNING POOL& SPA - - - APPROVALS Permit Date Inspector APPROVALS Permit Date Inspector • 1. Temporary Electrical•Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. ' 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement, 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. ' 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation • 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. - • 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final • 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# _ 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough& Test 72. Underground Flush 24. Roof Framing , 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical . - 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION , . 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: • 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace `/ 38. Final Plumbing p -`, 39. WaterS',ervice-Final 'r-. • 40. Gas Service-Final - :41. Solar Domestic-Final • 42. Backflow Preventer 143. Backflow Irrigation - • • '44. Landscape Irrigation System 1 • '45. Sound Attenuation 46. Handicap Regulations • 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed • 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date • Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. A MESA CONSTRUCTION PERMIT - PERMI NO. r r TRACT NO. L T NO. UNIT NO. s rI ysjShady Jivve G ten ' $ 2a¢ Nwptyfis dor ���• s ailing Address Sri m e TYPE OF CONSTRUCTION ICJ NEW u ADD H ALTERATION U REPAIR OF BL1 ❑ CONVERSION El DEMOLISH ❑ OTHER Owner's• ameba uM r4e, /YIP NS Phone b,4 A.P.# // 37 ] Ag • Zone ` / � ESCRIP NOF RK/U D Address C/S.Z • �OC�/ (Jr.n.. C m • 6a S Main Building: Accessory Building: Z Arch/Eng. 1 License No. TYPE OFPERMIT ❑ GRADING El FOUND TION ® STRUCTURAL 4- = T Front '51 G I 'b1 0 CR Address __ . _ ❑ TENANT ® ELECTRICAL PLUMBING ❑ MECHANICAL BRear i51 N A ❑ OTHER C Right • S( N Contractor's Name (5/4/f'1'P v Phone PROJECT DESCRIPTION SQ. FT. OCCUPAN Y Address(mailing) ae K 1 L G CONSTRUCTION TYPE VALUATION St.//1OO S Le 5 CA /JI City License No. ZONE GRADING CU.YDS. ACRES R LICENSED CONTRACTOR DECLARATION - - Ping. Ref.# Parking Req./Provided E I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: Fr-it/S1z^,L J aM with section 7000) of Division 3 of the Business and Professions Code, and _ n_' `7 /� '7 IM^ J f — my license is in full force and effect. ! �-. 2/a - e/ S. TS License Class License No. Date Signature - PLUMBING FEES RKERS'COMPENSATION DECLARATION w;7 Bar Sink Showers ELECTRICAL FEES %ereby affirm that I have a certificate of consent to self-Insure or a certificate _- AA., Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer 4 . Service Sink - 3800, Lab. C.) - Automatic Washer Transformer 0 1530 KW Policy No. Company Backflow Irrigation Sewer Cap. Construction Pole Sub. 0 50+KW 8 Certified copy is hereby thcity thie Certified copy Is filed with the citBuilding Division. Bathtubs Sewer Connection Cooking Unit ,F. Meter Oup to 100 amps 7 'Tb EXE ApplicantRSCv (This EM PTion e no WORKERS'd OMhE pSATION D onLA Clarifiers Solar Collectors _ Dishwasher M¢t¢r ]Over 100 amps yil section need not be completed if the permit Is for one hundred ($100) or / less). Dishwasher Solar Piping - Dryers ❑Ges ['Electric Sub Panel Icertifyshall thatm in the performance in f the work Cdr aswhich othis permit a issued,t,I ' employ anyiperson any manner so as to become subje t to the Drinking Fountains Solar Tank Fan Motors❑0-1 HP ❑1%-8 Workers' Compensation Laws of California`��� Date '+ —/i-fr'-, Signature �Y }l/•LAQl�1f! (j- • Floor Drains Swimming Pool w/Spa Ori F.A.U. NOTICE:If,after making this declara Fon,y u sho d become subject to the Inc.Solar ❑9-15 HP❑16-15+ Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures comply with such provisions or this permit shall be deemed revoked- • Microwave • CONSTRUCTION LENDING AGENCY Gas$Q.rvicel Outlets Water Closet Device Boxes I hereby affirm that there is a construction lending agency for the performance "- Pole Light of the work for which this permit is Issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets Lender's Name Range Lender's Address Kitchen Sink Water Service - Switches Sign OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories _ Auto-Wash Garbage Disposal Standing Sections following reason (Section 7031.5 Business and Professional Code: Any city or - county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays Generator ❑0-5 KW ❑5-15 KW Trash Compactor any structure, prior to Its issuance, also requires the applicant for such permit P to file a signed statement that he/she Is licensed pursuant to the provisions Of Roof Drains 'e Contractor's License Law(Chapter 9(commencing with Section 7000)of p q vision 3 of the Business and Professions Code) or that he/she is exempt s' - $tNllli/'t111'1J FOO.. Q 60 .,erefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil5r 4k. eenarty of not more than five hundred dollars($500). I, as owner of the property or my employees with wages as their sola Reinspection Fee I $15 Issue Fee $ 3 --collmpensation, will do the work, and the structure is not intended or offered - - ---- . Reinspection Fee I $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES License Law does not apply to an owner of a property who builds or improves - --_. thereon, and who does such work himself/herself or through his or her own "ler Hood or Type I 0 DEVELOPMENT SERVICES REQUIREMENTS: /�/ ria, -/ j] employees,If, ho ee r, that such improvements eves are not intendedihinoor ofr ofed for yp ZoningApproved Byy !r4 4- /'82 sale. If, the on, the improvement of pro i sold he within one year com- Canopy Type 0 i pp 4-ht Date p proven, the owner will have the burden of proving he/she did not build or im- Duct- Ground Building Approved By DateS/f)/ prove for the purpose of sale). (ii-I; as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By 1 Date 5 / !a'7 tractors to construct the project (Section 7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑0.100,000 BT 100,000 BTU SUMMARY OF FEES builds or improves thereon, and who contracts for such projects with a con- 61,f • tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 e '-pair/Alteration BUILDING PERMIT $ 92. 50 SMTP $ 0 ' 4- proof of their Worker's'Compensation insurance should be provided to me. PLAN CHECK $' Q• �'7 PERMIT I: am exempt under Section B. B.& P.C.for this reason Firepl/Fact.Blt. ICBG# ire Dam.: PLUMBING . $ _ G ' Q 0 ISSUANCE $ Date ,� bPrJ / ' a Ere -/INC Heating System& Ducting Registers, PLAN CHECK 25% $ 0 , 7 5 ENERGY P.C. $ I hereby certify t at I haveve ria read this application and statee that the above ❑0-100,000 BTU ❑ 00 BTU I 9 , 50 GRADING $ information is correct. I agree to comply with all city and county ordinances / iii ELECTRICAL $ and state laws relating to building construction, and hereby authorize repre- sentatives of this city to enter upon the a ove-mentioned property for p �7 inspection noses. q'�� �../�� MECHANICAL $ TOTAL FEE $ r 8 7 ! 7 Signature �r/n v(/(p �y��..r L1�i Date 7; Drivers' .Llr�'/'zebr SS (((/// / Reinspection Fee $15- Issue Fae $ 3 PLAN CHECK 25% $ CMF 0865-46,rev. 10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING POOL& SPA APPROVALS Permit#, Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location ''j// 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 02 OW' 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding .. 4//{f0 tSP 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6In/r7 Lail' 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE w wivt tiP 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test TAWS L 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final' . / 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit - 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign - 68. APPROVED FOR PLASTERING 1198/ ,iw 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL /ger O0 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT / 20. Rough Factory Fireplace APPROVALS Permit# _ 21. Ducts, in Structure - 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank D Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Powe cm, Final S-„1-fl J C 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes:o//9/Py 1% fo ,„ t.Ku 34. Final Heating & Air Conditioning / -T7yi ewe'" yi 35. Final Gas Pipe-Test 66c 8 L1&v- 01K �'i.c. !d-S`Y7 I 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final • 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations - 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed • 49. Electric Release to Edison 50. Gas Release to Southern California Gas CO 51. CERTIFICATE OF OCCUPANCY No. Date `1 UWNER UEAMBlSltb, DaV1Q D• LAiL' 1 O JOB ADDRESS 452 Shady Drive BUILDING PERMIT NO. 27122 GENERAL CONTRACTOR Owner-B].dr. DESCRIPTION OF WORK Add. Rec:Rm. & bath AP No. 117-372-39 LOT TRACT FIRE ZONE VALUE $ 2,350.00 INSPECTIONS Signature Date GROUP I TYPE V ZONE R-1 Soil /b tr��r�7 PERMITS ISSUED Gas SUBCONTRACTOR I Date Number Signature Water . --ti - PI ..bing Rough Plumbing T ! 7Z4_____ 1 . -.. Go _ Prop. Swr. Line fe House Con. 0 /4, / Sprinkling System Miscellaneous Rough Heating and Air Conditioning Temporary Service or Pole Underground 0 Power .0 Rough Wiring e /1<-) Tr—r'— Heating and Vent. Trenches gi Forms-a Steel Reinf. 0 ti' b.-27-67 Floor System Bond Beam 0 Steel Reinforce 0 Sheathing 050 1---J--67 Frame and Flashing/ 7„„ -/ Lathing —In(_q-out �a /47 67 Plaster, Brown Coat 1 -G Structural, Final ��� Electric Heating, Vent., Refrig. and A.C., Final f,('tJ.4j 1/ �,tcej 6-77-470,74 5 Plumbing, Final and Gas Test 0 �iG�J 7-�Y” Electric, Final /'/4 S /-Lf% Building, Final ,'ZIt .7#.2-8-C7 PAW 2'71.22 MAY 31-676—sa001491* ***?:18.00 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 9262E For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT BUILDING BUILDING /� For Office Use Only ADDRESS r. .5%,7 (f I/ (4)11 RECEIPT NO. PERMIT NO. COSTA MESA. CALIF ORNIA - 2 7/ 2 2- RECEI D BY DA REcgVE• DATE ISSUED OWNER 11Pi i IP 411 4,, Ao BUILDING L t/L�^T 1f/ ,. ,, ADDRESS ey �S P2 ) 4 4 r'/(/ D r MAIL ADDRESS 7a.lC�{ �4 - /` �yJ / TEL � ZONE .g TYPE .. GROUP �T CITY (Th sTQ (7/P tel NO.,-.C-VP-42 �/ ARCHITECT N„ J ,���11 TEL atAPPROVED/9 X- DATED G7 OR ENGINEER •q/c/ln A-el 124' NO.5 . #in//fj �i /> n ZONING ADDRESS /it/7 14,/,(7r ACTe 11 k SONES No.OP D9[DP NEW _(/.9r ,PC ( I PUN[ �. suamn _'�'L' CONTRACTOR n q/n ID r• PPP "` �J ..II � DESCRRIPTION 6(}-j .�r //�J ,( . ADDRESS )/ meq - ✓d/ CITY A.P.NO. (/ 7— B 722- 9 NOTE: NO KAVE OVERHANG SHALL BE LESS THAN STATE TEL Sr TO SIDE&REAR P.L LIC.NO. No. VES SIZE / OX ( I NO.OF SLDOS. 2 ALLOWED (U.B.C.REOUIREMENTI- OFLOT h / v O� NOW ON LOT v— YARDS APPROVED YARDS APPROVED USEOF ,/�I q--� MAIN BUILDING ACCESSORY BUILDING EXISTING BLDG. 'Lam' `-� I (FROM C/L STREET/ // SETBACK LINE FROM FRONT / Sr.FF / • FT. CENTER OF STREET REAR YARD SIDE YARD LEFT I RIGHT R.SIDE a/ FT. FT. DESCRIPTION OF WORK L.EIDE / PT. FT.PT.fd .--9--"la.--9--"la/l PT. Y REAR (D NEW TERATI N _ ADDITION /\ DISTANCE err. BET.MAIN a / REPAIR MOVING DEMOLISH MAIN BLDQS, ACCESS.BLDGB.�� BUILDING . / / NO OF VAR.4L DATE SIZE /(I X 12 ROOMS an eTOR1Ee / C.U.P.# APPROVED EXTERIOR WALLROOF APPRppyyED COVERING .p/qS/e r COVERING gra be / BY CU //6. 2V v DATE SA USE OF BUILDING AND WORK TO BE PERFORMED Eyry G M(V.n FfQ Cfl,,r,.j, r...--"----v / •re . OonI •vo_ E p 1 do Veit'I// / 4�,p . SQ.PT. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE j AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. i15 PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION BUILDING CONSTRUCTION. (//�) /f- / Q PERMIT FEE $ Z/ dCB PERMITTEE SIGNATURE•F 'LAS /C/GGi/L�C.i//lll..�rF�✓ _, // $ Z•.3fa PLAN CHECK S 10 ,O D W AUTHORIZED AGENT / [/ > RL TOTAL FEE $ /{J , 00 • /OWNER CHAMBERS, David D. DATE 6-10-63 JOB ADDRESS 452 Shady Dr. BUILDING PERMIT NO. 19876 • GENERAL CONTRACTOR Owner-Bldr. VALUE $ 5,676.00 Eri11iv. ., AP No. 117-371-27 LOT TRACT FIRE ZONE DESCRIPTION OF WORKArld fn.nn, t. INSPECTIONS Signature DATE GROUP I TYPE _y ZONE R-1 �� Soil -72? 8%' 13 SUBCONTRACTOR PERMITS ISSUED Gas DATE NUMBER Water _ Rough Com. Refrig. 0 Air Cond. ❑ Rough Heating Rough Plumbing `P Pa— • //- 63 _ c....,0.,n/ f',3-63 _ 3?/ce t� — Miscellaneous �, _i s s Prop. Swr. Line❑ House Con.�0 St. Swr. ,$' �_),,�n ...1 -L.6 ,9-;{ 3-c 3 moi-as= Sprinkling S stern Construction Pole _ Underground 0 Pow_ er ;0 _ Rough Wiring c.a.0p9-Z0.6.3 7 -.71 • .c'. :-, - 9 ,, %-,y-‘ 3 - oye/ — Trenches 2- Forms 2-"" Steel Reinf. • '41”0- x'(4-63 ¢'•(((Tema, 4. , 7.-7'-F% Floor System Bond Beam 0 Steel Reinforce 0 ,, _ Sheathing a- 3, ' -' , Q- c -1 Frame and Flashing 4 Q , y tp-t b /' Lathing— In ai Out 1 f / C / 3 E.-Cir •Z -zy-c y Plaster, brown coat - /� 3-.,M ,.. tf. Refrig. 0 Air Con. ❑ Final \ ( o "' Heating, Final \ Plumbing Fixtures, Final \ /Q-(-( Final Gas Test (,{ (0 'Cr Electric Fixtures, Final �(�-g � Building, Final lead %0-/-Cs' OCCUPANCY I . Form BU4-5M— -63—S-B P 1 n4mL 198 /6 FEE RECEIVED - 9STA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 317 COSTA MESA,CALIFORNIA JUN 1 0 1963 _ ,� ! FINANCE DEPT. 61A For Applicant to Fill In Completely ACIW/JIcitaft MSR TYPE OR PRINT BUILDING BUILDING5iiSS •IBJ For Office Use Only ADDRESS COSTA MESA��C'A� ORNIA rL'C•L.M. RECEIPT NO. PERMIT NO. OWNER Da vie/ P. ` Ad in hey..s i /1I 67 /. ISSUED, MAIL ADDRESS ADDRESS 3' n. hi e-- FIRE i CITY + TEL. TYPE GROUP/J\ - ARCHI CT C IQ Mr S TEL BY ( dent APPROVED ARCHITECT �j . TE -� OR ENGINEER /SIG '{''' —J(/L • O. ZONING �r�n 1 ADDRESS - ZO NO.OF USE OF NE \` ,. ^ od PLANS > BUILDINGfri 1 CONTRACTOR ' pp'`' LEGAL PO (� p -p /1 / ADDRESS ... DESCRIFTIQN /"OM1 L 0*I I O rN�(I/ I,�•(. CITY - A.P.NO. / 19- 3 / I - al / NOTE: NO HAVE OVERHANG SHALL BE LESS THAN STATE TEL. - 30'TO SIDE S REAR P.L. LIC.NO. NQ. EAVES S , I NO.OF SLOGS. NOW ON LAT ALLOWED (U.B.C.REQUIREMENT) (VIE-OT YARDS APPROVED YARDS APPROVED USE OFMAIN BUILDING ACCESSO U W7Iji / EXISTING BLDG. •i seMI j (FROM C/LS ;E� / SETBACK LINE FROM / �/ '] / FRONT L/ I FI, �I/, CENTER OF STREET fl. x REAR YARD 2 / .a." L/ ♦' SIDE YARDI LEFT / 3 T/, I RIGHT tr.'. R.SIDE Id . I / _ FT. DESCRIPTION OF WORK 0n. NEW ALTERATION ADD1T1•N �' ' FT. BET.MAIN Q REPAIR MOVING DEMOLISH ACCHSS.B 'GS. 1%14-DING/is,♦/A .4,01440.OF VAR.# DATE C aA''IIlROOMS / /J!STORIEESS. .JB /� C.U.P.4 / n APPROVEDEXTERIOR / COVERINGWaL eG(� COVERING /�/J /1(_7��/�f� �YPROVHD�, / i/// DATE () r-/Q SIO3 USE OF BUILDING AND WORK TO BE PERFORMED �/��L�� I .07 4 „c•e l i it rat 4 add TA en, ran add deJacAed 9atit? o_. N SO.FT. O I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE F AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. O PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION m BUILDING CONSTRUCTION. I PERMIT FEE $ )_ N SIGNATURE OP -• e ' � __ S �� 5 PLAN CHECK S /5 i Ca 0 AUTHORIZED AGENT L TOTAL FEE $ 3 ,5-0 kel OWNER TOBIAS & ORR DATE 7-20-54 JOB ADDRESS 452 Shady Drive BUILDING PERMIT NO. 408 GENERAL CONTRACTO ik Dike & Colgrove VALUE $ 9,000.00 LOT APP#117-371-20 BLOCK TRACT Residence GROUP I TYPE V ZONE R4 FIRE DISTRICT #404 INSPECTIONS A/W. SUBCONTRACTOR PERMITS ISSUED � DATE NUMBER C /��Footing Trench Foundation Forms and Grade to Garage ((�� Rough Framing le---C-#.5.--•- d/23�5� Plumbing,Rough to Slab Y/iC 72-, JS�cbs fcoat716-iV Plumbing,Rough Complete 8' �'.' CL xe. et-L6-9-17-a si 5.3 7 Temporary Pole / p Wiring, Rough )i.Z ,po 4, (-/J -SQL /40 re Heating,Rough GC t /3 .f 73/A-4 Heating,Final 1)1 G 1i. 2, - Sewer > - ' - J M•C. / c ti i I.1 h... / Septic Tank or Cesspool ,UC AU-c-_. _ Lathing q4 uj r, E Q Plastering L "1 Plumbing,Final,Fixtures Complete/h .c Plumbing, . _ I Plumbing,Final Gas Test /,‘-1/2 7L C"73 7/2- Li V ca CQ [+i( r...(_,,.‘ VliA-,9- Wiring,Final td C C "5 3 lc L— I------ Occupancy /< c, %f .31—(4‘. Form 210 C-H 1M 12-53 Costa Mesa Building Department APPLICATION FOR PERMIT `S 111 EAST 20th STREET• COSTA MESA, CALIFORNIA 404 BUILDING FOR• OFFICE USE ONLY . FOR APPLICANT150 FILL IN / 3 Receipt No. Ped�it,[Jo. Building /L, v`.'r' l g/ , .7/LL OOVV Address 452 Shady Lffair Costa Mesa, California Received by Date Recd. Date/Iles ed Nearest) 7'� -'1 cross O. Irvine Building Address i Owner Tobias & On Costa Mesa, California Mail Address 393 E. 17th St. Nearest Tel. Cross St. / City Costa Mesa No. Li 8-1139 zone v I No.o ype v I Group I Architect or Lic. Plan 1 Engineer Hupp (H MIR No. Approved by Date Address 441 E. 1st St. Ding Reneh CORRECTIONS City Lia - --- — Contractor Dike & Colegrove No. 170 Address 419 E. 17th St. Costa Mesa Legal art Lot 118 Ie�uort tele No. o ac City of Costa M (Attach Metes and Bounds) // �tg 7/- o.of Bldgs. a1,....... Size of Lot 60 x 135.09 I Now on Lot none Use of I No.of I No.of I', z Existing Bldg. • Families ]I Rooms 6 I) Setback Line from Rear Yard JUL12195A Center of Street 50;! Side Yard y r DESCRIPTION OF WORK - ��(� New I XI Alteration I I Addition I CITY OF COSTA MESA Repair I I Moving I I Demolish I COSTA 1f� Building No.of Size 11601 Rooms 6 Stories 1 Exterior I Wa!Llaster Roof Covering YY Covering Comp. APPROVALS ; Building Foundation Location inspector Date 9 Residence Forms,Materials, Under-Pinning Frame: Fire Stops, Bracing,Bolts • I hereby acknowledge that I have read this Application Lath. Int. and state that the above is correct and agree to comply Lath. Ext. with all City Ordinances and State Laws regulating building const on. Signature of wt�0_ ,r Plaster, Int Permittee ...[[[///""""'��� 7c.."`� • / Plaster, Ext. Authorized Agt. Masonry Reinforced Valuation Permit Fee $ Q Plan Check $ 2 / Bond Beam $ / '� Total ,...-- O-o— Fee $ -7.-3 FINAL II FORM 204 0-H 2M 5-54 Jc • o n G O. a Rc"fi �: , � J,\ J "Street PLOT PLAN ill { Is & Show locatlorrfande�dlstanoeg from \I ` . � . ,1 property line and between buildings. - . _ _ •