HomeMy WebLinkAbout1118 SANDI LN - Building Permits CITY OF COSTA MESA
os`°"'F BUILDING DIVISION
F• k L 77 FAIR DRIVE,COSTA MESA, CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
8 FOR INSPECTIONS CALL: (714)754-5626
PERMIT NUMBER: E10-00105
•
PERMIT TYPE ELEC STATUS: ISSUED
APN: 42204210 DATE ISSUED: 06/08/2010
ISSUED BY: BE
JOB ADDRESS: 1118 SANDI LN CM 'Suite/Uriit:;,
Vicinity: INTERIOR OF HOUSE •
SCOPE OF WORK: EXTEND EXISTING CIRCUIT FORSPACE HEATER
OWNER: STANSBURY,RALPH W JR TR .Address: 1118 SANDI LN• Unit:
PHONE: City/State/Zip: COSTA MESA,CA
APPLICANT: STEVE CAVENEE - , . - 'Address: - 1891 N LINCOLN.ST Unit:
PHONE: 714-974-7063 City/State/zZip: ORANGE CA
CONTRACTOR: STEVE CAVENEE License No. 467884
Address: 1891 N LINCOLN STUnit: • '-.,PHONE: 714-974-7063
City/State: ORANGE CA ZipCode: 92865 CELL:
ELECTRICAL PERMIT FEES
Electrical Plan Check Fee: $0.00
Electrical Permit Fee: $29.35
Reinspection Fee $0.00 -
TOTAL FEES . $29.35 •
•
•
•
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.
CODER. INSPECTION TYPE DATE INTITIALS CODER INSPECTION TYPE DATE INTITIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing O))�� �y�
200 Final Re-Roof 210 Final Electrical yr4Y—/a AT F1ri(Al2.
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 drivers license. ❑Yes El No
I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires:
O 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
scion 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:
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
Cartier: or dismantling thereof,will be more than thirty-six(36)feet high. (Chap.3.2,Grp
(This sector)need not be completed tithe permit is valued at one hundred dollars($100)or less.)
2,Art 2,Sec.341,Title 8,California Administrative Code).
Policy Number:
O As owner-builder, I will not employ anyone to do work which would
El 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 sha 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 wo s' compensa'• I.ws of California, and agree that if I should
become .:lett to the •rkers' compensation provisions of Section 3700 of
th- b•. Jr e,I sha orthwi comply with these provisions. Applicant's Signature Date
c. �—' 4.ri •
,v -• '•-8 SCO Division of Industrial Safety Permit Number:
/� •Applicar:
" '-�••a Dale 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? ❑Yes ❑ No
($100,000), 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
ATTORNEYS 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 IQr nand effect. a registration form for acutely hazardous materials? 0 Yes ❑No
���/!" (n/ wA po •
y Lic.# L '4 1 Class# C60 (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
Contractor's 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)? ElYes ❑No
(Section 25534 of the California Health and Safety Code provides that the
Lender's 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 Califomia
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑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? ❑Yes ❑No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the Califomia Government Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be fumished on applications for non-residential building permits).
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 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? ❑Yes ❑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).
O 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 ❑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
sale. If, however, the building or improvement is sold within one year of control officer).
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
o 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 p roses. I agree not to occupy or allow occupancy of any building
authorized • t is permit until final inspection.
�/�. ,'Znature o egal L..els) Dale
Signature Date ty �`�f `; �•- //s—vi /1)
0057-46(3107) And/or Auth.�.•cant tv Date
Applicant to fill in all spaces within heavy border lines and.sign all appropriate declarations. - 8606' 11/23/81 - _-I -7.00 -1 LI
•CITY OF COSTA MESA P MIT NO. TRACT NO. LOT NO. 'BLDG.NO.
•CONSTRUCTION PERMIT (P3/ -
Project Address .• � - TYPE OF CONSTRUCTION - . •
.Owner NI A400 Phone 03 03C ❑❑ NEW . - ADD ,ALTERATION .. - - -
•
Address C 11 -- / ' ' • 0r� REPAIR ❑ CONVERSION ❑DEMOLISH -• - 1
•
Arch/Eng. • - License NO.iii j . x bt+THER • •• - . f • 1 -- ZONING•Address f� '- DESCRIPTION OFWORK S Kti fe14-Y•
Cotractor r: 1 - e Phone •i:. TYPE OF PERMIT _____________________________________________
_ .•.
•Address Sr�� ^ C ❑,GRADING+ ❑ FOUNDATION
STRUCTURAL I• YARD
LICENSED CONT'ACTOR DECLARATION ' " - - 0-TENANT 0'ELECTRICAL ❑PLUMBING •❑MECHANICA SIQE YA-
I hereby affirm that,I am licensed under provisions of Charter 9'(com- )
mencing with section 7000) of Division 3 of the Business and -❑ OTHER - • ' - . . -
Professions Coddee,�annmy effect: •
d license is In full force and effe - - e
License Class r cense No.-a-,• �'v Q PROJECT DESCRIPTION-- - " .
Date i/•'7 I Q.1/.4N a -EP Signature /""'1 ' 444,-4'T .•.SO.FT:--r.. - • PKG.SPACE REQ. PROVIDED • '
_.
WORKERS'COMPENSATION DECLARATION' - ` OCCUPANCV=�CONNSTRUCTION-TYPE-
. ZONING APPROVED BY ,DATE
I,hereby affirm that I have a certificate of consent to self-insure-or a VALUATION'"'Sipa ZONE
certificate of Workers' Compensation Insurance, or a certified copy
ereof(Section 3800, Lab.C.). _ - _. _ 'GRADING CU.YDS. .ACRES SPECIAL
No. Com• pany
-; iiertifled copy is hereby furnished, '- - ' • REMARKS: _ " "' I •- - - '
_'"Certified copy is filed with the city Building Division. _ _ - t
•
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION - - - . -
(This sectoti n need not be completed if the permit Is for one hundred -- - - -- - , -- _._ . . _ .- - - '
X certify that in the performance of the work for which this permit is - •
issued, I s all not employ any person in any mannernso as.to become •PLUMBING •• •' PLAN CHECK ELECTRICAL PLAN CHECK - _f
subject j� ell
kers' Signature �K�f �s•1��dA�fa-!r BATHTUBS SHOWERS 'SD FT 50 FT
` i 1UWhLLING GAHAbh
Date
NOTIC If fter making this declaration, you should become subject -.TOILETS 'URINALS -GENERATOR0-1 KW_1-10 KW 'r ' ' '
to the Workers' Compensation provisions of the Labor Code,you must TRANSFORMER _- ._ -
forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE LAVs, _ APPLIANCE 10-50 KW_50+KW. -
revoketl: - - - - - r
CONSTRUCTION LENDING AGENCY KIT.SINKS DISHWASHERS MOTORS 0-1 HP 1-10 HP •-- .
I hereby affirm that there is a construction lending agency for the per- SERVICE SINKS SUMPS .(INC.SOLAR) 30-50 HP 50+HP,- •
-
formance of the work for which this permit.is issued,(Section 3097 .. •
-
Civ. C.). FLOOR SINKS FLOOR DRAINS FIXTURES OUTLETS SWITCHES '
Lender's Name _
Lender's Address DRINKING FOUNTAINS • GAS TUBE SIGNS '
OWNER BUILDER DECLARATION INTERCEPTORS CLARIFIERS POLE LIGHTS
I hereby affirm that I am exempt from.the Contractor's License Law for J -
the following reason (Section 7031.5 Business and Professions Code: SWIMMING POOL P TRAP t-uNSI Hut_I lUN -
Any city-or. county which requires a-permit to construct,. alter, POLES METERED SUB _
improve,demolish or repair any structure, prior to its issuance,also re- WATER SERVICE ALTERATION PANELS MAIN SUB
quires the applicant for such permit to file a signed statement that he _
is licensed pursuant to the provisions of the Contractor's License Law GAS SERVICE OUTLETS SERVICE AMP -
(Chapter .9 (commencing with Section 7000) of,.Division.3 of the - -
'ass and Professions Code) or that he is exempt therefrom and the WATER HEATERS BTU OUTPUT - , n -
'or.the alleged exemption. Any violation of Section 7031.5.by - -
splicant for a permit subjects the applicant to a civil penalty SEWER CONNECTIONS
more than five hundred dollars ($500).
-
l._. ,, as owner of the property, or my employees with wages as their SOLAR TANK COLLECTORS
sole Compensation, will do the work,and the structure Is not intended - - - - - - •
or offered for sale. (Section 7044, Business and Professions Code: The ' SOLAR PIPING SYS. ISSUE FEE
Contractor's'License Law does not apply to an owner of a property
who builds or improves thereon, and who does such work himself or ISSUE FEE 'APPLICATION APPROVED BY ' DATE/ '
through his own employees, provided that such improvements are not -
intended or offered for sale. If, however, the building or Improvement MECHANICAL PLAN CHECK SUMMARY OF FEES '
is sold within one year of completion,the-owner will have the burden • --- - ' _
of proving he did not build- or improve for the purpose of sale). -BUILDING A
o I, as owner of hie property, am exclusively contracting with HEATING SYSTEM 0100,000 BTU PERMIT_.. -s �•OO SMTP $ Ot-1 CJ •
•
licensed.contractors.to construct the project (Section 7044, Business AND DUCTING
.,100,000+,BTU PLAN CH6GK $ eM� •PERMIT •
and eof t: The Contractor's LicenseovLaw does a not apply to - • 11 ISSUANCE $
owner of property who with a or Improves thereon, and who con- 'REFRIGERATION. 0-100 00,BTU "PLUMBINo -
tracts from such projects with a contractor(s) licesnetl, pursuant to SYSTEM I 4: •$ - GRADING $the Contractor's License.Law). ..... •l 7}".'. •` :" _ 100,0 04+BTU PLAN CHECK $ '
o I am exempt under Section B.&.P.C.for this ELECTRICAL$ $ -
.BOILERS. BTU_ F , PIR i D
reason �t -- .' - - MICROFILM .S ._
•- • — 'Jr- SYSTEM REPAIR,'ALTERATION Int:nmr.ete Ins;eCt •IR6AN CHECK $ - TOTAL FEE$-
Date Owner , -MECHANICAL,$
Thereby certlfythat I have read this application and state that the-above - EXHAUST,SV STEM MULTIPLE . . - - LESS AD- ,- -
information is correct. I agree to comply with all city and county PLAN CHECK $ VANCE PC $ 4
ordinances and state laws relating to-construction,and hereby authorize - -- - -- - $1' - -- -
representatives of this city to enter upon, the above mentioned f �� �e .
property fpLLnspection"fpurpose - �-r / / - I FINAL FEE S
Signature 'L.J/(C ,AAs Date 1 ,�� - _ - - - . .. - _. _.. - . . -
/
�
e
CMF 0865-46 White-Building;Canary-Applicant; Pink-Accounting:.Goidenrnn_Acwwnr
■
1 • . ,. , , , . _ -
CONSTRUCTION AND PLANNING &SPA . ` .
- ' Date Inspector ' _ - - ,' Date -Inspector
APPROVALS
Permit# APPROVALS , • . 1' 'Permit# -
1. Temporary Electrical Service or Pole -- ' 43.' Pool & Equipment Location - 1 - _ - - •.
, 2. Soil Pipe-Undrgrn ,, - - -- - 44. Steel Reinforcement.- - . _ - . . -
3. Electrical Conduit Utility-Undrgrn -'- " _ '- 45:, -Fornis ' ' - ' _ . ..
4. Electrical Conduit-Undrgrn , . 46. Electrical Bonding - _. _ - _ ''' -
5. Steel Reinforce• ., • .- 47. Rough Plumbing & Pressure Test - . • `'
6. - Electrical UFER Grn ' -48. APPROVAL'TO COVER-GUNITE. _ ._ _ . _ _. _ _ _ __._
• 7. Footings - - •' ' "- 49. - Electrical Conduit-Undrgrn - • - .•
-- '
8. Foundation - ---- -- - -: ... .- „ -- - --- - - - ' --- - "'50-- 'Gas Pipe, ❑Undrgrn,Test
' 9. Water Pipe-Undrgrn .., 51. .-Backwash Lines, P-Trap, ❑ Undrgrn • - - - ---..- .- '-1
10. Structural Floor System 52. ' APPROVAL TO'DECK -- -- - • • --
11. Property Sewer Line & House Connection • - 51- Backwash&.Receptor-Final.'-.- . . ..
12. Street Sewer Connection - zn:•-.T'.,. • 1 r II 54. Heater&Vent-Final;
13. Rough Plumbing i X55. -Plumbing System -Final-- - -- - --- - - . - --
__ _ _ _ __ - -
14. -Rougfi Electric-Conduit ;- ; --_ ._._..-... X56._ Electrical=Final "" ..- , •- . ..• - . ,. .. '
--15:-- Rough-Electric-Wiring-----. - :_---- -- _ --._ 57._ .Solar System-Final_• '.. , A .-:o,: 30._ ,-
16. Rough Heating& Air Conditioning- _. { _ _ 58. _ Fencing&.Access Approval
' 17:- Ducts, in Structure •a ' .c• 1-r;..; . 1 • - -.. 59. APPROVED-FOR PLASTERING . -- - -
18: Ducts, Ventilating ..m,.7'• r. ! i i e•.. . _
19. Gas Pipe-Rough &Test _. ., " !..m... ' ( I - 60. P00L/SPA SYSTEMS FINAL , , •.A T : 1,T 1.
20: Roof lFraming' . - , -, . , , - ir" i �, ai ;•- - - -- _ .
I 21. Roof,Sheathip - - .• ' •- • . . ._ -,
22' Frame and-Flashing `- ' ' - . c.NOTES:. 4 ,
, 23. Insulation •• 'r' ' - y- -) - Y' • , i i • •• • •,
24. Lathing & Siding ..,t. r • ,
25. Drywall Nailing
' 26: Plaster Brown Coat , , „• ,,' , - • , .,• ,•a ', ." - r.r. ..
27. Electrical Pow& Meter-Final - . , 1 -" - . - • _ - _ .
28i Final Electric" -w- i • - '� ' . - ' .
29i FinaUHeating & Air Conditioning _ " -
30: FinaliGas Pipe-Test i , > . . ,..• a r.:,. ! "* .'�: r•• • - :�
311 Final:Plumbing - - „ .
• 32: Water Service-Final - -• - -- - • -. - - - '
• 33: Gas Service-Final- -• r,, p ., , •,-
34. Solar Domestic:Final �• .• - .r.F�.,.,--- .' .• ..,�, �r :,,. . • . „ . • .. . r .
«_ . • . .
1 35. . Landscape Sprinkling System ,. • z. t,
36. Sound Attenuation • _ - t
. 37. Handicap Regulations _ ,•„ F - „ .. • - •m, __ :-E X:P!I R E D . ' f. ' " . • -; ; Ti•• ' " 4 r'
38• FINAL STRUCTURE & BUILDING > Incomplete nsoections` " r• "'
( 39. Special Requirements Completed . r - r - - -- - ---- Q -._ •
i 40. Electric Release to Edison . . ` . • • , _ - ( '- • - , - ' Date.: GAIY - - - _. - _ .- . •
I 41. Gas Release to Southern California Gas Col • - _ - - •
-
( 42. CERTIFICATE OF OCCUPANCY _r _ _ _ t_ _ - _ .
.ti. - No - - Date .- _ _ . _ _ -.. ,•r , �„ •
. _- - - - -- -- - ' - -. 1- . . _. .` .i t -_ - - - • ,.. .
City of Costa Mesa Planning Department
Post Office Box 1200
• 77 Fair Drive
GOn nn Db��pp(raGj Costa Mesa, California 92626
iia n (714) 556-5245
I
REQUEST FOR OCCUPANCY
(Single Family Residential or
Condominium Units)
Tract No. /mak/ Date ?/ ,/7 7
Lot No. /6
Address // /6 Se,,7,-/, ' X e'Al e / COs 7;9 /7166
The developer of the above entitled tract desires to sell the above
set forth lot prior to the time that the tract has been completed and its streets
accepted by the City of Costa Mesa.
The undersigned, by executing this agreement, acknowledges that
(he, she, they) 51{_ (was or were) Gtl/I1 advised that this tract has
not been given final inspection nor has it been accepted by the City of Costa Mesa
as having complied with the conditions of approval which were imposed by the
City at the time(the final tract map was approved.
The City assumes no liability for the enforcement of the conditions
necessary for approval other than those conditions protected by surety bond.
The undersigned agrees to indemnify and hold the City harmless '
from any claim resulting in damage or personal injury to the undersigned by
reaso o the aforementioned uncompleted condition.
RECEIVED
CITY OF COSTA MESA --Se-4--(7761
p
By
AUG 1 8 1977 rchaser
PM '
AM
719191101111120.1213141516 �
�i .I
By .111.N 'A ► /I�
DV Rr and .1-Atr •wed
!� _ / Representative
By /' ' w
Le,:er
CMF 0569-26
7 � -
City of Costa Mesa Planning Department
^�'£t , i Post Office Box 1200 •
•
.l l� 77 Fair Drive • i, j1
1 �' .,'
�f l'A�'rft i�iwp Costa Mesa, California 92626 CV �� l ��
r�.��i))ry IFi�i',' l I;',.V jt 6.5245 - / '.<
• REQUEST FOR OCCUPANCY /�I"';','”,, •
(Single Family Residential or f 5 P _gt
Condominium Units) y�, , � - `7
ad' .l{
1 ANN{ :: Dc. PAry i MFN1 f^,
Tract No. 9.,' / Date /0 -./i '7%
Lot No. /i .
Address J/J JANE / -tie
-- - - - .. .. _- - -_ -_- - - - c . - .-...,-., :;',.,..„,:z,
-- The developer of the above entitled tract desires to sell the above
set forth lot prior to the time that the tract has been completed and its streets
accepted by the City of Costa Mesa.
The undersigned, by executing this agreement, acknowledges that .H
(he, she, they) <A (was or were) /{)f-5 advised that this tract has
not been given final inspection nor has it been accepted by the City of Costa Mesa
as having complied com with the conditions of approval
which were imposed by the
City at the time the final tract map was approved.
The City assumes no liability for the enforcement of the conditions ' .
necessary for approval other than those conditions protected by surety bond.
s
The undersigned agrees to indemnify and hold the City harmless ,i,.
from any claim resulting in damage or personal injury to the undersigned by
.. IS
reason of the aforementioned uncompleted condition.
zt/222
., 4 a
jt tenser •
i
s.
By , /I//%�I:\
Developer and/re'1t ,— .
-
Pepresentative • -
.,t
air
I
By a ...e LI :
r der
•
CPAF 0569-26 /! `?
i,- . . . . „ . . ,. . .., . ' . . 1...,::::
F
7
PROJECT ADDRESS: 1118 SANDI LN UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO; P 062696
OWNER'S NAME:BERGDOLL JOLETTA A
AOORE55: 1118 SANDI LN PERMIT NO: P 062696 PLAN CHECK NO; N GOVT: N SUPP: N
COSTA MESA,CA 92627
ii CONSTRUCTION TYPE: V—N PERMIT TYPE; PLU PURPOSE: OTH
.! ARCNIENGMEER: 642-5183 REG.NO.:
f ADDRESS: uxlT: JOB DESCRIPTION : REPLACE WATER HEATER SQ FT;
PERMITTEE CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /
PERM
aoDITTEERESS:A—AMES PLUMBING & HEATING ( 714 ) 530-2440
10422 TRASK AVENUE COMMENTS: NO OTHER WORK AUTHORIZED BY THIS PERMIT
GARDEN GROVE CA 92642 *;Her********** **st*+ ***************************x************it***********x**** **
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS
7000)of Division 3 of the Business and Prolessions Code.and my license is in full force and effect. SETBACKS
CITY LIC.:006f q ¢STATE LIC.:250307 C
Date:_CO' 1' Signature:_ MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR; FT IN FRNT: FT IN REAR: FT IN
Compensation Insurance.ora certified copy thereof(Section 3800.Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
POLICY NO.:PC 9 410 9 4 . 9 3 EXP.DATE: 03/O1 /94
COMPANY:REPUBLIC ^x� PARKING REQ: PROV; PARCEL: 42204210 ZNE; REF NO:
g�
Certified copy is hereby furnished. Certified copy is filed with the ci Building Division. PLANNING NOTES>
�, QQ�s
> s/
Dale:la —22A,1 Applicant: ******** **********************************************************************
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($1W)or less). DEVELOPMENT S E R V I C E S t j R E Q U I R E M E N T S
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 to become /
subject to the Workers'Compensation Laws of California. ZONING APPROVED BY DATE:
Date: Signature:
NOTICE:If,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : . DATE:
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. C ' ,x y� / p 1
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY• 11 Y(' 'i'" DATE-
which l.[ (LCL 1 S
this permit is issued(Section 3097.Civ.C). *Bf****iL.{L.**.)(.*.**.*.**.*..**.*�F..*.***.*.*******.*.*.**..***�F ii i♦ '9E*iF-�-*****************4* *{(
LENDER: *******************************************************************************
ADDRESS: LEGALIZATION:N F E E S U M M A' R Y STRUCTURAL SEGMENT:N
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 7,00
repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed 25% SMIP/NON—RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 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 PLAN
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE ' 20 . 00
I. as owner of the property or my employees with wages as their sole compensation. will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 7. 00 20 . 00 0 . 00 27, 00 27. 00 . 0 0
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 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 will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED: 27. 00 OVER/SHORT
mrthe purpose olsale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADI ,00
NG PLAN—CHECK
I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 27, 00❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law). l am aware **,*.**.*.**.*.***.*.*.*..*.*.**.**.**.*,*,**,*.**.**.*.****.*.*.*.*,*.**.*.*.*******.*.**.*.*****•******.*.*.****.I(,**,**
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
❑ I am exempt under Section: B.8,P.C.
\ for this reason:
TYPE DESCRIPTIOQTY .
I O N UNIT COST TOTAL COST •
• Date: Owner: PLU 1 WATER HEATER AND/OR VENT 7. 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and 0 0
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a END OF FEES
permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from
these provisions.
, Dale'. Applicant:
I hereby certify that I have read this application and slate that the above information is correct.I agree to comply with all city and county •
ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned
property for inspection purposes. 01 00141427-00141429 TOT 27.00
Date: 6—2.4..-4-3 Signature'.
DATE: 06/22/93 TIME: 12:25
Driver's License or Social Security , • /
164146 White—Budding:Green—Code Enforcement:Canary—Applicant;Pink—Revenue;Goldenrod—Assessor
J • � .
CONSTRUCTION AND PLANNING POC SPA '
Date Inspector Date. Inspector
APPROVALS Permit# ry APPROVALS Permit #
~
1. Temporary Electrical Service or Pole i 52. Pool & Equipment Location
✓t
2. Soil Pipe-Undrgrnd, . . ...'153. Steel Reinforcement ' ter
3. Electrical Conduit Utility•Undrgrnd. .. 54. Forms
• 4. Electrical Conduit-Undrgrnd. I • 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 '? - t' ,. 59. Gas pipe, 0 Undrgrnd.,Test N
9. Water Pipe-Undrgrnd. • 11.- 60. Backwash Lines, P-Trap, 0 Undrgrnd,
10. Structural Floor System !,„ . /
' 61. APPROVAL TO DECK r
•
• 11. Property Sewer Line & Hoose Connection 1 62. Backwash & Receptor-Final
12. Sewer Cap - 63. Heater & Vent-Final -
' '' 13. Roof Drains64. 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 Electric@)-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning _ FIRE DEPT. REQUIREMENT -,
20. Rough Factocy Fieeplace '. . : , :APPROVALS' - .Permit #
21. Ducts, in-Structure,r • • - - _ :70. Underground Hydro
22. Ducts, Ventilating • . t -r ;71_ product-Piling OGas 00i1
23. Gas Pipe-Rough & Test _. c i y • • : ,72. Underground Flush_
24. Roof Framing - Stora
' 73. Under
; ` ' grnd. ge:Tank 0 Gas 0 Oil
25. Roof Sheathing - • v•- - -. • 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
1
29. Insulation 1 78--FIRE PREY. FINAL '- .
. _
._ _ .
'30. Drywall Nailing I I I; : - HEALTHOEPT. REQUIREMENT
31. Plaster Brown Coates -, I I' -79. FINAL I'NSPECTION
32. Electrical Power Meters-Final I I I • - 80. FOOD CERTIF?CATE ISSUED -
-33. Final Electric- . - I I I. • Notes: •
34. Final Heating;& Air Conditioning I: •
35. Final Gas Pipe-Test, . I ' •I `
c - - -
36. Hood or Canopy. - - I 1 \dk . . _
37. Final Factory Fireplace ` _ I -Li l .;t
38. Final Plumbing • ' Q/,/ { 3
I i•
' 39. Water Service-Final: ! - I I1- '- _ -
40. Gas Service-Final - - - I i
I _
'41. Solar Domestic-Final '. i I<
_
42. Backflow Preventer - I I I- • - • _
43. Backflow Irrigation- .
_44. Landscape Irrigation System -c _ .
'45. Sound Attenuation ; . .- -
46. Handicap Regulations • - -
47. FINAL STRUCTURE & BUILDING - 44 I
48. FINAL PLANNING I
. .i
• 49. Electric Release to Edison I
50. Gas Release to Southern California Gas Co 4 I I T '2I• /
51. CERTIFICATE OF OCCUPANCY -
No. Date
r.
//DRESS OFBUILDWG: 1118 SANDI LN WIT: CITY OF COSTA MESA - BUILDING PERMIT
DNNERSwMElflO .m: GRISWOLD, JOLETTA A TR - PERM NO: B 081426 .
4- ' ADDRESS 20112 VIVA CIR
HUNTINGTON BEACH,CA 92646 PERMIT NO: B 081426 PLAN CHECK NO: N GOVT: N SUPP: N
714-956-2012
APPL.MAILING ADDRESS: - CONSTRUCTION TYPE: V-N PERMIT TYPE: SIR PURPOSE: OTH
ARCHITECT OR ENGINEER: UC.NO.: JOB DESCRIPTION : T/OFF & INSTALL FIBERGLASS SHAKES SQ FT: 1 , 537
ARCH.OR ENG'S ADDRESS: UMT:
CLAIM VALUE: 1 , 537 . 50 CALC-VALUE: 1, 537 . 00 GROUP OCC: R-3 /
CONTRACTOR'S NAME: J D JONES ROOF CRAFTER ( 714 ) 826-4827
CWTRACTOR5MAJUNG 6011 SAN YSIDRO COMMENTS: RESIDENTIAL REROOF -
ADDRESS: BUENA PARK CA UC.NO.: 435996 ***********it It-X->E*+t**suffer* Hit*+e It -iE** ieK•itit>fDHeF**at-*x-*****x-Bt**;tt**etas-**N*atx*at-i:** xBtrt****
90620 WIT: Z ONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby&flim under pensby of perjury that I sin licensed under provisions of Chapter 9 S E TAB ACK S
(commenting with Section 7000)of Division 3 d the Business and Professions Code,and my license sin full force and effect.
CITY LIG.No.: 029223 uc.cuss: C 39 uC.NO.: 435996 EXP: 09 /97 MAIN BUILDING ACCESSORY BUILDING
Dale: /--3/-_97 Contractor FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby affirm under needy of perjury I . •exempt from the Contredds License Law for the
.: «bWo,ror rapS any structure:prior to its issuanection 70315 anises and ce. requires AM city or
for such permit to file a�vganed statement mm'he or she am PARKING REQ: PROV: PARCEL : 42204210 ZNE: REF NO:
j`. licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commenting with Section 7000)of Division 3 of the PLANNING NOTES>
_4 ':Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section u>
7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than fie hundred ddtss 15500I). ********************************************************************SE.**********
❑ I.as owner o the property or my employees with wages as their sole compensation,will do the work, st
and the ictle ure not intended D EVELOPMEN 'IT S ER V IC ES R E Q U I R E M E N -T S
or offered for sale(Section 7044,Business and Professions Code:The Contractors License Law does not apply to en Owner of property
who binds or improves thereon.and who does such work himself or herself or through his or her own employees.provided that such
• impmvememe are not intended for��le.If,however,the buildingorknprovement is add within one yew completion,the ZONING APPROVED BY DATE: •
owner builder will have the burden of proving he or she did not build or improve for the purpose of sale).
❑ I,es owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044.Business and
Profession.Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon and who BUILDING APPROVED BY : DATE:
• contracts for such projects with a contractor(s)licensed pursuant to the Contractors License Law). / �,��/
❑ I am exempt under Section: B.&P.C.,for this reason: APPLICATION ISSUED BY: PIA DATE: I -7 3,-
Date: Owner ************,**********************************************************,**** ***
LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y
I do hereby certify that I am aware of and understand the requirements of Caldani Health and Safely Code Sections 25505,25533.and
25534.end that I or any Mum building cccupam will/will not(circle one)need to comply with said cote codes and the requirements for
apermit for cwdmcfion or modification from the Ai u y anagemenl Doted.ResideMMlmMrucion applications are exempt from Nese BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
provisions. PERMIT 51 . 25 . 50
Date: Applicant SMIP/NON-RES
PLAN
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penally of perjury one of the following declarations: ISSUE FEE
❑ 1 hays and wil maintain a certificate of consent lo self.insure for walkers'compensation,as provided for by Section37DodtheLabor BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
Code,for the performance of the work for wioch this pemt is Sued. TOTALS----> 51 . 75 0 . 00 0 . 00 51 . 75 51 . 75 . 00
QI have and elf maintain workers' requiredd workers'compensation insurance, by Section 3700 of the Labor Code,for the performance the
7S'' work for which this permit is issued.My workers'compensation insurance carrier and policy number are:
Carrier: STATE FUND EXPIRES REVENUE DIVISION TOTALS--> COLLECTED : 51 . 75 OVER/SHORT: 00
• Policy Number: '285-UNIT000243 01 /01 /98 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
(This section need not be completed if the penile is for one hundred dollars(5/001 or bas.) 51 . 25 . 50
❑ 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 to
become subject to the workers'compensation laws of California,and agree that D I should become subject to the workers' **************************************************************************1H****
compensation provisions of Sectiono3700 of the Labor Code,I shall forthwith cam . provisions. INDIVIDUAL F E E BREAKDOWN
Date: /— 3/— 'i / ApWnam: MIP--.^dam>-----
Warn/ng:Failure m azure workers'compensation coverage lis unlawful,and she lfre%eF an employer to criminal penalties and TYPE QTY DESCR IP T ION • UNIT COST TOTAL COST
civil fines upto one hundred thousand dollars maga:In addition to the cost ofM'npensatloni damages as provided for In
S«Uon3706oftheLaborCodsIntent,end&homersfen SFR 1537 ALTER BY VALUE RESIDENTIAL NOZONE 1 . 00 1 , 537 . 00
CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty of perky that there is a consrmaon lending agency for the END OF FEES
performance of the work for which this permit is issued(Section 3097.Cir.C).
LENDER'S NAME
LENDER'S ADDRESS:
I certify the I have mad this application and statethe at Ne above information isnan
correct.I agree to comply with all city and county ordices
and stale laws relating to buildingconstruction
and hereby authorize representatives of this thy to enter upon the above.mentioned property
for inspection purposes.REGINA JONES 0I-31-1997/12:54 PM/{
• RCPT8:81-BBB14eo
l Name PERMIT:081426
,1/472e_ __.
� Date: %-3 /-27
Sign of x/AgenUAppkranVConuector
•
(5151-45.W P) White-Building&Safety:Green-File:Canary-Applicant;Pink-Revenue;Goldenrod-Assessor
A -
CONSTRUCTION AND PLANNING . POC SPA
Date Inspector. - Date . Inspector
APPROVALS Permit# - APPROVALS Permit #
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
r
.5. Steel Reinforcement_ - ' 56. Rough Plumbing& Pressure Test •
76. Electrical LIFER Grnd. - 57. APPROVAL TO COVER-GUNITE .
'.7. Footings - d_uit
58. Electrical Con :Undrgrnd.
. •8:,Foundation = ' 59. Gas Pipe, Q.-,Undrgrnd-,Test. • •
9. Water Pipe-Undrgrnd. •7 - ' 60. Backwash---Lines.'P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVALTO.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 - " - • '1 APPROVALS Pei-mit# ' 'r
21. Ducts,in Structure • • .. _ - - • - 70.Underground Hydro
22. Ducts, Ventilating:- • : r _ - _ r- 71. Product'Piping 0-Gas 0 Oil
23. Gas Pipe-Rough& Test - e - - a. - - 72. Underground Flush• 2
24. Roof.Framing '- J •
• ' / .; ' 73: Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing '` L .7 �l i , • 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat - - -_;'" 75. Dry Chemical ' ' r-
27. Frame aid Flashing, _ - . 76. Dry Standpipe. t ` r
28. Lathing Siding -_ -_ r - 771 FIXED'SYSTEM FINAL _ - to
29. Insulation - .. _ .- ;' 78; FIRE PREY. FINAL , .:
30. Drywall Nailing - - -HEALTH DEPTrREQUIREMENT
Y •
31. Plaster Brown Coat . - . . - . ;x 79: FINAL INSPECTION - _
er,
32. Electrical PowerMetFinal - - 80: FOOD CERTIFICATE ISSUED
33. Final Electric _ Notes: -
- = -
34. Final-Heating;& Air Conditioning - . - A - - -
35. FinarGas-Pipe-Test - - ,. . ?- . ` _
36. Hood or Canopy - _ _-
37. Final Factory Fireplace - ',
38. Final Plumbing - - _
39. Water Service-Final - _ - - •• 7
40. Gas Service-Final •
41. Solar Domestic-Final - - • - 4 - -
42. Backflow Preventer - - _ -,
•
43. Backflow Irrigation r.- - -.
44. Landscape Irrigation System -• _
45. Sound Attenuation _ ' _.
46. Handicap.$egulations _ - - -
47. F(NAL STRUCTURE& BUILDING /aP/�i? /� .0L-- - -
48. FINAL PLANNING
49. Electric Release to Edison i = ' -
-50. -Gas Release to Southern California.Gas Co - - -•�,
-51. CERTIFICATE OF OCCUPANCY -
No Date 4-
OWNER PROPERTIES' WEST, INC. DATE 10-14-76
JOB ADDRESS 1116, 1118 Standi LaneI•^ING PERMIT NO. 40620
GENERAL CONTRACTOR Owne±/B'ldr. DESCRIPTION of WORM. :ex' w/3 Gars.
"SAP No. 115-031-17 LOT TRACT FIRE ZONE VALUE $'51,000.00
INSPECTIONS Signature Date TYPE V GROUP I &JJ ZONE PDR-MD
\GAS Si"$ /L 2L x SUBCONTRACTOR PE$MITS ISSL(ED
„)WATER (4 A 7.. Date I Number f Signature
„)WATER 'a A. 131,77 Ws_
Plumbing a.
ROUGH PLUMBING 7� 5 3 ,�'7P� /a• ,-?c, 7O / a'PROP. SWR. SINE: Q NOOSE CON. 7/J7 =W-� ;;�� )-1)- n?- 3 Y�^ SPRINKLING SYSTEM (1 7e�43 y
\)�J M ISC EL LAN EO US
ROUGH HEATING AND AIR CONDITIONING r,..5 x (zi 7 •
TEMPORARY SERVICE OR POLE /
UNDERGROUND El POWER 0 5-9/-12
ROUGH WIRING II 17 / Naafin .nnd Vent.ntn �. • 7 . .
TRENCHES Li FORMS Q STEEL REINF. g Y , ,j �5�yrp � j-2.3�J /ME9 Or
FLOOR SYSTEM C s f •/Z•71 ij(�4i(lltAn� 3:2Y-71 /370 7...----"
BOND BEAM n STEEL REINFORCE n
SHEATHING / ---.2.--se---.2.--sep
- 9*
FRAME AND FLASHING C 1-29,79
LATHING — IN n OUT n I 44u(., g }-31-77 '
PLASTER.'BROWN COAT 1 - ,
Si RUCTURALNAL wwww��`� ]y �. Elert i
HEATING, VENT., REFR IG.'-ANDSA.C., INAL '_ 3% AZ► ,�yv,aet•t/Y///���/�&PI,3-n -77 /1/71.0"-
PLUMBING.
1/vp��
PLUMBING. FINAL AND GAS TEST I GGG J /5,._,._, — /^-'_"`�' /
ELECTRIC, FINAL RC 141'2.
BUILDING, FINAL -
PAID
4n620 • SEP 30 75F 9.07
,s.00S381k h'.r*tea
COSTA MESA BUILDING-SAFETY DEPARTMENT •
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
A
. FOR STRUCTURAL PERMIT
For Applicant to Fill i o pletely Ink nl ECEIV •
�11r[ I DATE ISSUEDBUILDING �J`7 -1111[.! e )-�
ADDRESS 9
PE-
OWNER I '' �_ O A.P. N ! z • •
• 1
MAIL /+ BUILDING ■���i�]• / /��
ADDRESS J3 gr tad
•f•J ADDR. -�Ct� ei//J_Rtlee l:�.�atil .
CITY �Q��d,EL. NOLa lain TRACT L0790 BLOCK
CONSTRUCTION �/ ``• NEW ADD ALTER REPAIR MOVING DFMOLISH
LENDER i /
BRANCH x _
OWNERFF A 16-77 til l(1/4-c-
, ADDRESS /' c
ARCHITECT ����.,w. /�/��y/� TEL./.7.1 USE , &fin VALUE
00a
OR ENGINEER lT /4/4f'f.�A+. NO.iId" -ti L
FIRE � l GROUP J
ADDRESS Sc S _�� ZONE VPE, '✓'
G
APPROVED ts` /� -'7 J
CONTRACTOR it , /�� BY DATE • I 6./G
ADDRESS TEL. ZONE NE NO.OF USE OF NE "C'
CITY NO. • r(�-mt PLANS ` BUILDING'/
STATE CITY YARDS APPROVED YARDS APPROVED
LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING
W SIZEI NO.OF BLOCS. aa IFR C/LS REET
0. OF LOT 72 d doer, / NOW ON LOT U FR( FT. FT.
a USE OF I_
cfl EXISTING BLDG. _�GC�.-/I R.SIDE FT. FT.
CA
FSeparate permits are required for L.SIDE i Flier FT.
electric,plumbing and heating work. REAR ,
6. 5 FT. FT.
W u •
1.. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& .•
a MAIN BLDGS. ACCESS.BLOCS.
•
,l -/J7/� //�� q VAR.# DATE
a ..'.i/r//•i, ittA 1. '( ._Q. C.U.P. 7$-7 APPROVED /0-7-"S
APPROVED / 9�„J
z
w �ing 5 TOLD FOR SPECIAL RE�UJRr
0 I hereby acknowledge that I have read this application and state
n
g( that the above information is correct and agree to comply with n
L all laws regulating building construction, and I shall not employ m
Z any person in violation of the workman's compensation laws of i
LLII
the State.of California.
1:9410SQ.FT. 4 (r 40 Al 7c N61
I hereby certify that I em properly licensed as a contractor under
the State of California business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and that sect, licenses are In full force and effect,or II
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: _
am exempt from the provisions of the State of California Business y
VALUATION. PERMIT FEE $
and Professions C Iwslon 3,Cly or n
9r so M
/ /DDD PLAN CHECK $ LL
Signature of c
Permittee - $� TAX $ .1. .57 u
Authorized Agent TOTAL PAID $ 77 0J
A-n(4 2C7 I:r:L 4: .: 197 0a
r' . . . . Ci 1•! 761#-(l0 835 �.:,:
COSTA MESA BUILDING-SAFETY DEPARTMENT •
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 •
PP IC TION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely —Use Ink Only
R V DATE RECEIVED DATE ISSUED
•
BUILDING
ADDRESS O 1111411 Q AM D1
//�_ eltn ErEel I10 G PERMIT NO.
y,•
OWNER ,��F_Xn r Yv A.P. NO.
•
MAIL ADDRESS rj l\Y\ �J BUILDING I/1� et II a l of 1.1
ADDRESS .
TEL.
CITY NO. TRACT f LOT BLOCK
CONSTRUCTION fy EW ADD ALTER REPAIR MOVING DEMOI ISH
LENDER LidBRANCH P
OWNERWAST I U
UM
ADDRESS •//r/�,. /
ARCHITECT TEL. USE .G?Nobs cat,
OR ENGINEER NO.
FIRE
ADDRESS ZONE TYPE GROUP
APPROVED
CONTRACTOR BY DATE
ADDRESS
TEL. ZONE NO.OF USE OF NEW
PLANS BUILDING
CITY NO.
F STATE CITY YARDS APPROVED YARDS APPROVED
LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING
SIZE NO.OF BLDGS, (FROM C/L STREET)
OW. OF LOT NOW ON LOT FRONT FT. FT.
USE OF
EXISTING BLDG. R SIE FT. FT.
CA
FSeparate permits are required for L.SIDE FT. FT.
(;:i electric,plumbing and heating work. REAR FT. FT.
La
USE OF BUILDING AND WORK TO BE PERFORMED
F DISTANCE BET. BET.MAIN& -
'ICO MAIN BLDGS. ACCESS.BLDGS.
Q
VAR.# DATE
C.U.P.# APPROVED
7 APPROVED
)-. —ELY DATF
..1
L
4.1
4. I hereby acknowledge that I have read this application and state
n
O n
(y, that the above information is correct and agree to comply with
m
p+ all laws regulating building construction, and I shall not employ
Z any person in violation of the workman's compensation laws of
4] the State of California.
FT. ci
I hereby certify that I am properly licensed as a contractor under SQ.
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: e
am exempt from the provisions of the State of California Business VALUATION PERMIT FEE $ `I
and Professions Code,Division 3, Chapter 9. /g!. o u,
n
PLAN CHECK $ rn
Signature of o
Permittee $ TAX $ V.
!9/• D
Authorized Agent TOTAL PAID $