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Home My WebLink About2169 RURAL LN - Building Permits CITY OF COSTA MESA 0aeon kip�,! BUILDING DIVISION frtF 4 I R 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • w.vw.costamesaca.gov v FOR INSPECTIONS CALL: (714)754-5626 PERMIT NUMBER: P12-00064 PERMIT TYPE PLUM STATUS: ISSUED APN: 42612127 DATE ISSUED: 04/25/2012 ISSUED BY: RMD JOB ADDRESS: 2169 RURAL LN CM Suite/Unit: Vicinity: METER TO HOUSE SCOPE OF WORK: PLUMBING PERMIT TO REPLACE GAS LINE FROM METER TO HOUSE. OWNER: JACKSON,OWEN L Address: 2169 RURAL LN PHONE: City/State/Zip: COSTA MESA,CA APPLICANT: CORTEZ, EZEQUIEL Address: PHONE: City/State/zZip: CONTRACTOR: AMERICAN RESIDENTIAL SVS DBA RESCUE ROOTER License No. 765155 Address: 965 RIDGE LAKE BL SUITE 201 PHONE: 714-771-7481 City/State: MEMPHIS,TN ZipCode: 38120 CELL: 510-729-6000 ARCHITECT: License No. PHONE: ENGINEER: License No. PHONE: PLUMBING PERMIT FEE SUMMARY PLAN CHECK FEE: $0.00 PERMIT FEE: $33.30 TOTAL FEES: $33.30 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§ 1. 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. CODE[, INSPECT1ON TYPF DATE INTnIALS POEN INSPECTION TYPE Q/yg IN1I11AL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing —[T /-1"t 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 WORKERS'COMPENSATION DECLARATION: Owner ID verified by driver's license. 0 Yes 0 No I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires: ❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed): 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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a number are: 7-� ,,..�,,,.,q person is required to descend,will be made in connection with work authorized Ca ' : LI �&L� / A v/ v /r' L- by this permit,and that no building structure,scaffolding,falsework,or demolition (This seceon need not be completed d the penal is valued at one hundred dollars($100)ot less) or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2.Gm P,oficy1Aumber. WG7 63/SDb'63/ 2)/� 2,Art 2,Sec.341,Title 8,Califomia Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would ❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless issued. I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of California, and agree that if I should• become subject to the workers'compensation provisions of Section 3700 of Appl;wni's signature Date the Labor C .I shall fo hwit �JPly�with these provisions. _ ff'� LJ `Lf./-7 Division of Industrial Safety Permit Number: !!! p cant ipnatur(ee-^•• • / Date f..--"- �_-.h HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes 0 No (5100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE. INTEREST.AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. 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 LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000) of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file my license is in full force antl effect. C a registration form for acutely hazardous materials? ❑Yes 0 No Lic.# 7�� /S [Class'*' C-3 (Section 25533 of the California Health and Safety Code, with some 1/ Jexceptions. requires registration with the Costa Mesa Fire Department by ^�O �a �—7... ---/-..& each business which at any one time has on hand a quantity of acutely p c 1a ors Signature Date 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 CONSTRUCTION LENDING AGENCY: temperature and pressure). ❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? 0 Yes 0 No (Section 25534 of the California Health and Safety Code provides that the Lenders Address: 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. Signature Date 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 0 No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5. the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes 0 No 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 (Section obe furnished.2 othe onCaapplicationslGovernment not Code requiresbuilding thnt the permits).requested License Law(Chapter 9 (commencing with Section 7000)of Division 3 of the information be on for non-residential permits). Business and Professions Code)or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? 0 Yes 0 No applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes", the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the California Health and Safety Code). ❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec.7044, Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes 0 No thereon,and who does such work himself or herself or through his or her own 8. (If'yes.' attach certificate of compliance from the appropriate air pollution employees, provided that such improvements are not intended or offered for control officer). 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 CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. LICENSED CONTRACTORS to construct the project(Sec.7044, Business and Professions Code: The contractors License Law does not apply to an owner of Signature Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that ❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. cSJ�ature of Legal / r(s Date _ 3057+6(3/07) � Signature Date �,e J `... (/r—�2��) 1/- A�or Authorized Applicant Cgs . . . . . COUNTY OF ORANGE BUILDING DEPT. Permit No 636 No. Broadway Application for Building Permit Santa Ana, California Phone: KI 2-6211 AND FOR A Certificate of Use and Occupancy Daterdege g- / 7 1. OWNER'S NAME1--74,-- ..^1607.-C.-02-)„. 6. 1--e-' PHONE:4V" ).-- .1 '01 MAILING ADDRESS LC,:n---$40 3 3• CITY al-49-3.-0-- .../..Ccre 7u Nameeedaar.dst---n----c 41/5, 2Lai Name s5-ert,e_.--,1--- ----j -2-r--s--e.-m, (Architec or Engin r) (Contractor) Address reep,a..a.._._),: . Address.33 )---..r-e-f-- ---7 City -z . - z S....te.-e--e: City .‘ _,L) State State Lic. No. Phone Lic. No. Phone/-n-Y >-• 7" ? 1 - PROPOSED USE: a ., ee-e--e-.1-Acee.- ill, ea r i 2. JOB LOCATION 2 f 6 9 Cfs.d.A_CLR-__ ita",,...2-..- a-V-- -,z_ C/22- —ct_ (House No.) (Name of Street) (Town or School District) / 3. LEGAL DESCRIPTION: Lot 4r ---. Block Tract__ 7 .%-6" -. --. (Metes and Bounds Description—Use reserse side of form) 4. CORNER LOT ( ) INTERIOR LOT ( a" ) THROUGH LOT ( ) SLOPE OF LOT ( e ) c 1/4, 5. SIZE OF BLDG.: 6 6:_x 33 AREA. 4• 390 _ SIZE OF LOT:8_3..13:5.6 -1.1f1 AREA: 71Z az o q...i.... 6. HEIGHT OF BLDG.: 7/ / CEILING HEIGHT- S" / NO. OF STORIES / 7. NO. FAMILIES / Size of Smallest Bedroom: B 0 Size of Kitchen: 90 8. EXTERIOR WALL CONSTRUCTION- glist-t-t-c-e--- INTERIOR WALL COVERING iber--"-e-Ceer (Frame, Stucco, Etc.) (Plaster-Drywall, Etc.) 9. • SETBACKS: Front Yard from Center Line of Street •: ‘. (17 / Nearest Side Yard S.- Rear Yard 2-4IH Distance in Feet Between Bldgs. dm Same Lot 10. A COMPLETE PLOT PLAN IS REQUIRED, SHOWING ALL STRUCTURES AND USE OF EACH. 11. For (a) Footing: Width l'4-/ , 7 Depth in Ground / 7--- Width of Wall 6 Accessory Bldgs. and (b). Size of Studs: L'''Z $ 7 Spacing / "CC Material of Floor Similar Structures: (c) Size of Floor Joists:47. 41 Spacing /4 "CC (d) Size of Rafters: <2 iC Spacing ./4 "CC 12. VALUATION OF PROPOSED WORK: ,luding. all labor, plumbing, electrical wiring, heating, fire sprinklers, paint- ing and sewage disposal riertfterS? Core7•0- . 13. I HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE INFORMATION IN THIS APPLICATION IS CORRECT AND THAT THE CONSTRUCTION WORK WILL CONFORM TO ALL LAWS OF THE COUNTY OF ORANGE AND THE STATE OF CALIFORNIA APPLICABLE THERETO. Signed: 71/4--2.-46..., Plans Filed• i 71i 2/S-7) (Owner) -7.7--) By: ______.44:La.c. -daf---C--11/ (./r4/(--0• (Authorized A ent) FOR DEPARTMENTAL USE ONLY FEES: CHECKING BY $ 1 i r 1 0-e? GROUP recki Bldg. Permit - APPLICATIO.d0 / HEALTH Plan Check - $ 3 , at TYPE c.wir • 42E Total - - - $ 2ZONIN __... .....:0,72 0-0 DIST. 1 2..„." MARSHAL Receipt No. fl- 4 MAP , rPLANS ' NI ;ear SPEC'S Paid to - SHEET NO CORRE ' OUS : ENGINEER -thH12/ Date -/4*75-2)_ ..,D. VERIFIED, CAL / / PERMI : • COUNTY GU LUNG •• 1 ill NOFUJE thISP._OTOR . DATE __tort 2-) ' • 7k--3/4.-r' rs-pury 5M-7-50 Ci"k\ -- . --- . METES AND BOUNDS DESCRIPTION: • 11P 2IP 3IP 4I0 5!0 d, 1:11111ilimit- sten bin I """"011 II I I • up IL I CITY OF COSTA MESA 4 9•- BUILDING DIVISION > N r,,,'r.. I : DEVELOPMENT SERVICES DEPARTMENT PER IT NUMBER F t 104 01 i PERMIT ° 03-00432. (714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 2169 RURAL LN Status: ISSUED Suite No Applied: 07/09/2003 Issued: 07/09/2003 Vicinity: Parcel Nunmber: 42612127 ISSUED BY: Applicant: SZABO, KEVIN Address: Phone: Zip: Owner: JACKSON, OWEN L Address 2169 RURAL LN Phone: COSTA MESA,CA Zip: 92627 Contractor: COAST ROOTER PLUMBING HEATING &AIR CONDITIONING Address: 2737 S CRODDY STE D Phone: (714)241-1414 SANTA ANA,CA Zip: 92704 License: 529127 Arch / Eng: _ - - Address: • - Phone: • Zip: License: SCOPE OF PERMIT WATER HEATER CHANGE OUT. - 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 $0.00 0 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) $0.00 0 Drain, Roof $0.00 0 Shower $0.00 0 Water Heater/vent $12.30 1 Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 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 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 2446-49(6/00) 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 01 the Labor Code,for the performance of the w for which this permit Is issued. ve 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: / Cartier: 1v'#n'E r-v nl fl Policy Number: Ur.t to 2:6 O""Q 3 (This section need not be completed it the permit is valued at one hundred dollars($100)or less.) Y 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 s to becppppppme subject to the workers' compensation laws of C Ilia,and a hat If I should become subject to the workers'compensation provisions tio370 of the bor Code,I shall forthwith comply with these provis s. ,l -Applicant FAILURE Signature: /1/`- Date:R THOU WARNING: D FAILURE TE( SECURE IN A S'CO THE O MPENS IS UNDWFULAMAG ANA SHALL I DSUBJECT I N E EMPLOYER TO THE OR DI 5 AND CIVIL FIDES TP N ONE'SHUNDRED THOUSAND DOLLARS($100,000),INA DITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION OF3706THE 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 Professi s Code,and my license Is in full force and effect.Lie.# CZ-1 l 2-1 Class# C a irh.L 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: 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($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 exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e..property tax bill or deed): 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). O 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 Flre 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 en 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 presahr 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? U 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 pad of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 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 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? 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 •F COMPUANCE AND AUTHORIZATION OF ENTRY:1 certify under penalty of perjury that I have read this application and state that the information given is correct.I a r re: to comply wi- . .tat. laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-desc'•=d p operly for! .•actio purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. K�/- Signature O1Legal�Owln�er(s) / ^ / /� Date a na y 111 (/IPC/ (� -And/Or Authorized Applicant • Date CODE I INSPECTIONTYPg PAIL IIWT1ALE LODES IffSPECTION TYPE PATE EMLS 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 ¶6-7?-uTr-'00 853Rt****25.00 CITY OF COSTA MESA PLANNING DEPARTMENT A.P. No. UK! 11R-n11-n7 Bldg. Permit No. PARK AND RECREATIONAL FEES - Apartment Developments Fee Payment Receipt Project Address 2109 PTIAL LANE, COSTA ".CSA, CALIFORNIA Owner's Name OMEN L. JACKSON Bachelor or 1 - Bedroom Units 1 @ $25.00 = 325.00 2 - Bedroom Units @ $40.00 = 3 - Bedroom Units @ $55.00 = 4 - Bedroom Units @ $70.00 = 5 - or more Units @ $75.00 = Total number of Dwelling Units I Total Fee $25.00 Planning Department Approval Date 5_16-79 Park Area No.�_ By M.L.D. rb Applicant's Signatures' — -.— - s - grardo-- CITY OF COSTA MESA PLANNING DEPARTMENT '1116-7?e„5°00 853Rd****25.O0 A.P. No. KKR 110-^33-77 Bldg. Permit No. PARK AND RECREATIONAL FEES - Apartment Developments Fee Payment Receipt Project Address 1172 711 MC, =TA ::ESA, CALIFORNIA Owner's Name OWFN I .1ACKSroi Bachelor or 1 - Bedroom Units 1 @ $25.00 = 525.00 2 - Bedroom Units @ $40.00 = 3 - Bedroom Units @ $55.00 = 4 - Bedroom Units @ $70.00 = 5 - or more Units @ $75.00 = Total number of Dwelling Units 1 Total Fee b25.00 Planning Department Approval Date F-16-79 Park Area No. 2 By W.L.D. rb Applicant's Signature,ilJ ` - tOWNER JACKSON, Owen L. DATE 5-16-72 JOB ADDRESS 2169 Rural Lane BUILDING PERMIT NO. 34729 GENERAL CONTRACTOR Standard American Bldrs. DESCRIPTION of WORK Add Bedrm. & bath AP No. 118-033-07 LOT TRACT FIRE ZONE VALUE $ 3,900.00 INSPECTIONS Signature Date GROUP I TYPE V ZONE R-2 SOIL )17 c6.--Er--)2., I PERMITS ISSUED GAS SUBCONTRACTOR Date Number I Signature WATER 119414 -L _s,_-3.2, P1 mbinq ROUGH PLUMBING /14 St--2-6.. .21- L .J17. /./�/Y •y/!/i� . h_257 4 p333� PROP. SWR. LINE n HOUSE CON. 0U/' V SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND fl POWER fl ROUGH WIRING ru ' 9 ' p-- Heating and Vent. TRENCHES fl FORMS 0 -STEEL REINF. U /'S C .1 FLOOR SYSTEM^ --- . r ' 04� ' -/ 2— BOND BEAM Li STEEL REINFORCE n SHEATHING ti Q eh '7$— FRAMEAND FLASHING 77, 72 LATHING — IN 12 OUT 0 Irb 7'7f, 91. C "Ili- L/' MJ-PLASTER, BROWN COAT �J�� STRUCTURAL, FINAL /, Ele fiQ.lf" �q HEATING, VENT., REFRIG. AND A.C., FINAL /�/ / PLUMBING, FINAL AND GAS TEST IN Ai Z 7 ELECTRIC, FINAL _ ,��v� BUILDING, FINAL �r 4 ?-/Z_7" • G`f ? M°c= 00 852* ****39.28 qI ja 34729 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APP I ATION FOR BUILDING PERMIT For Applicant to Fill in Completely f BUILDING R CEI E BY DATE(ECEIVED DATE ISSUED ADDRESS 164 9.11-0,1 Lox__ 3-- (O 7F:ER/p f• T . A.P. NO. IO3 - o ? a 1. �91 I 8- OWNER AYE 1,,,,_ AricCf1n MAIL LQ �' t.prr'j�V, ' BUILDING ADDRESS Z ADDRESS J` a,b� V•Y• W W ` J +5 Wilt Staid NEL. TRACT 'yL LOT BLOCK C. U CITY ` J -l> \V1, NO. ZZ < CONSTRUCTION NEW IADD ALTER REPAIR MOVING DFMDIISH Q N LENDER `` i 0- m /� JO BRANCH J N OWNER/ C 1,..":7; "Olden LCrieke...AN m J ADDRESS r UE m ARCHITECT TEL. $ J < OR ENGINEER NO SU Q Z ROUPW 2 ADDRESSaw LJO CONTRACTORS'inc(r�r-�Ilk(1 Qr�(i rC�- E 5 /G" 72.--- _10 co (sem :5 CC ADDRESS?LK.'VO DI nrAOt ( `� - to-o3nn4 W W s lP. 'l• T"• ' ZON6y� NO.OF USE OF NEW NSW 4��-w ZFCITY '� �;NA NO./�3 �.o'� PLAN$ BUILDING ,� I(jATH —O STATE ^ ��l/I CITY `I YARDS APPROVED YARDS APPROVED y EL LIC.NO. pa, SIIJi LIC.NO. •9jJ MAIN BUILDING ACCESSORY BUILDING O O (FROM C/L�SjA@E7t) OF LOT 10 4 v in__ I NOW ON LOT NO.OF S. I FRONT �n'loJ•,tFT.T./ FT. USE OF EXISTING BLDG. v ��,Q h(Ie��,'�[I ,•�[�'/NO.OF —\s.�R SIRE etCO FT.?6Y FT. I- SIZE OF Z NEW BLOG..�,O X g 6 • ROOMS Z STORIES ' L.SIDE 35 FT.3 f qq FT. Kr F L7 COVEERINGRIOR A C( Q!COVERING c� REAR .ij FTi- FT. J U_$E OF BUILpINRK TO BE PERF- MED DISTANCE BET. �}- BET.MAIN& 0- /'-_V,w��_ �'►C-- n;�[y (�d r MAIN BLDGS. (,.LJ[l,(�lQ' ACCESS.BLDGS. a QVAR.# DATE o ncia0. n C r-Q04)JLb,JM fr�-. C.0-P.#E (lam APPROVED I- v.-to 4 3/d ba7 r I s ROVED 1 t s t ill DATE /I/71 o \11 l�J a l~.1 I hereby acknowledge that I have read this application and state I ef D that the above information Is correct and agree to comply with cc all laws regulating building construction, and I shell not employ F any person in violation of the workman's compensation laws of V) the State of California. '{ co Z ,-...q0,0S0, FT. W I hereby certify that I eproperly licensed as a contractor under - o m the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9. and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: e CC am exempt from the provisions of the State of California Business and Professions Code,Division 3,Chapter VALUATION 0= r PERMIT FEE $ t/� Signature of �^,r////]]]]��r,,,^www/ m Permittee $ v / V✓ -5-.1.---------1-----.LAN CHECK $ E / vapLL o Authorized Agent ,•• TOTAL FEE $