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Home My WebLink About1617 SANDALWOOD ST - Building Permits .0"MF CITY OF COSTA MESA • BUILDING DIVISION o , DEVELOPMENT SERVICES DEPARTMENT P MIT NUMBER .1141 PERMIT B06-01410 dattvisonroot (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.®II$LDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 1617 SANDALWOOD ST Status: ISSUED Suite: Applied: 08/18/2006 Vicinity: ROOF Issued: 08/18/2006 Primary Occ: R-3 Dwellings/Cong Res<10 Type of Construction: V-N Parcel Number: 13921304 Zoning: R1 Applicant: BARNETT, CHRIS Address: 126 E 18TH ST UNIT C103 Phone: 714-724-1938 ISSUED BY: COSTA MESA,CA Zip: 92627 Owner: FRIEDLAND, BARRY S Address 1617 SANDALWOOD ST Phone: COSTA MESA,CA Zip: 92626 Contractor: BARNETT ROOFING Address: 126 E 18TH ST UNIT C103 Phone: 714-724-1938 COSTA MESA,CA Zip: 92627 License: 661981 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT TEAR OFF EXISTING ROOF. INSTALL 1 LAYER OF 30#FELT,4:12 PITCH,30 YEAR FIBERGLASS SHINGLES,AND REPAIR/REPLACE SHEATHING AS NEEDED.25 SQUARES INCLUDES ATTACHED GARAGE AND DOES NOT INCLUDE ROOM ADDITION. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $8,000.00 Permit: $153.25 Claim Valuation: $8,000.00 SMIP Res: $0.80 SMIP Corn: $0.00 -- - Other: $0.00 Inspection: $0.00 Total: $154.05 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 Existing: 0 Required: 0 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 24443-46(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: . I hereby affirm under penalty of perjury one of the following declarations: 4 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. :)a—1 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 verrka.pe\orn natio Insurance carrier and policy number are: /' /,..1 C _Carrier:- ,,-D 1" v to tt/0-C/ �"Polity Number ` �I Ge{-7 1-06 L ,(Rus section need not be completed i/the permit is valued at one hundred dollars($100)or less.) • ❑ 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,an gree that it I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these pr vi i s. c6 r I C - Applicant Applicant Signature: (Date:-- h W W„BRNING-FAILURE TO SEC E WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100000),IN ADDMON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed undecoroxisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business a d_Prpfessions Code,and my license is in full -force act effect.Lic.s - ' Ir. Class tl 6- J { >Contractors Signature: l et--TI "1�_/b4 Deter--�-( X6-(7 G 17 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. ❑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: ❑ 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,Califomia 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 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? ❑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 greeter 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 Cede 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 apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Li Yes U 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 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). — __ amort ._. controlo.._.._ l.._.._ _...._ for _h.__ _ 7 Ifa a cation fromn the South Coast s Qualityt ed bygement District or and Sr airpollution oon district03been or agency is required the work which is the subject of this - application,have all of the disclosures prescribed by California Health Safety Code Section 42303 made? ❑Ves 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 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 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-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. S' n tura Of LegalOwner(s) / Jaate('G. /yam �j I 'And/OcAuthorized Applicant (Date CODE# INSPECTION TYPE DATE 1tfff19L5, CODE It INSPECTION TYPE DaIE INTBIAL5 • 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 53":36464 4r 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory FirePlace - • 220 Final Planning Approval 203 Final Sign 222 Final Site 204. .Final Demolition . 250 Final Building/Occupancy 0 �5 CITY OF COSTA MESA 4. BUILDING DIVISION : 2 r.,,ro .-` DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER t MK* PERMIT 05-01103 ost (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.B.tULDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 1617 SANDALWOOD ST Status: ISSUED Suite: Applied: 07/05/2005 Vicinity: FRONT OF PROPERTY Issued: 09/02/2005 Primary Occ: R-3 Dwellings/Cong Res<10 Type of Construction: V-N Parcel Number: 13921304 Zoning: R1 Applicant: OFER SAM SHOSHANA Address: 5301 BALBOA BLVD 411 Phone: 818-581-9580 ISSUED BY: ENCINO,CA Zip: 91316 Owner: FRIEDLAND, BARRY S Address 1617 SANDALWOOD ST Phone: 714-754-6975 COSTA MESA,CA Zip: 92626 Contractor: ORANGE INNOVATION INC I Address: 5301 BALBOA BL - UNIT C8 Phone: 818-461-9078 ENCINO,CA Zip: 91316 License: 832810 , Arch : Eng: Address: Address: Phone: Phone: Zip: • License: License: SCOPE OF PERMIT ADD 496 S.F.TO EXISTING S.F.D.WORK TO INCLUDE:EXTEND EXISTING ENTRY,NEW MASTER'BEDROOM;BATH AND WALK-IN CLOSET.REt EXISTING WALL FROM A BEDROOM TO CONVERT IT INTO AN OFFICE. f CONVERT EXISTING 3 BEDROOM,2 BATH S.F.D.TO A 3 BEDROOM,3BATH S.F.D. PLANNING: • LOT SIZE=-6,060 SOFT. RESIDENCE+GARAGE=1,926 SQ.FT. ' DRIVEWAY=414SQ.FT. LOT COVERAGE=2,340 SQ.FT.(39%) - -_ OPEN SPACE=3,720 SOFT.(61%). • FEE SUMMARY Plan Check: $392.50 Calc Valuation: $45,830.40 Permit: $603.85 Claim Valuation: $32,500.00 SMIP Res: $4.58 • SMIP Com: $0.00 , • Other $0.00 Inspection: $0.00 Total: $1,000.93 - PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 23-0 - Rear 24-8 Left-' 5-0 Right 5-0 ACCESSORY Front 0-0 Rear 0-0 ` ,Left," 0-0 Right 0-0 • 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 244648(WOO) 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 aintain 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 works c pensatlQD In_sur& ce carrier and policy number are: _y CCarrier:-- SS C �l'A"�` Pabcy.NumbAr: \S On'- (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance 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 California a agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these pro ions. 7 Applicant _ Oate: C1 -2- O S WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBIECi AN EMPLOYER TO CRIMINAL PENALTIES AND CML FlNES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter S ommencing with Section 7000)of Division 3 of'the,Business and Professions Code,and my license Is in full force and effect.Lia#��'7 Z Yah 0 `` Class# t5 Contractor's'Signature:"..-" ��N%--/ Date-7' —Q —o_S 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: Lenders Address: Signature: ._+^% Date: H*, OWNER-BUILDER DEC `` I hereby affirm thatAder pe AjTFpe ury that. m EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any.city orcp�ity which y,ui 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 stoped statement that •v,r she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business agd Profsgs�is 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 s subjects t�i'�pplicanVt5a civil penalty of not more than five hundred dollars($500).): ❑ I,as er 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 driver's license. t .Yeas ❑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: ❑ 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 e permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 WIII 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). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑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 end 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 aggermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 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 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 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 comply with all s laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspecti urposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. SjpndWrq egat-Owner(srm Data And/Or Authorized_ icant ✓•Date�- ;ODEA INSPECTIONTYPE DAIS MALE ;ODE( INSPECTION TYPE PATE IKEDAL5 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1288 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 tetOG f/)Z/ sin M 9 CITY OF COSTA MESA • 4 BUILDING DIVISION 11.14e) $ r4 ) DEVELOPMENT SERVICES DEPARTMENT P MIT NUMBER 1. 1 s.rr.‘ t PERMIT i1V105-00506 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 1617 SANDALWOOD ST Status: ISSUED Suite No Applied: 09/02/2005 Issued: 09/02/2005 Vicinity: • Parcel Number: 13921304 ISSUED BY: Applicant: SHOSHANA, OFER Address: 5301 BALBOA BL UNIT C8 Phone: 818-461-9078 ENCINO,CA Zip: 91316 Owner NABARRY S 16 Address: 16177 SANDALWOOD ST • Phone: COSTA MESA,CA Zip: 92626 , Contractor: ORANGE INNOVATION INC it p Address: 5301 BALBOA BL UNIT C8 Phone: ,818-461-9078 ENCINO,CA Zip: 91316 License:832810 • SCOPE OF PERMIT ADD 496 S.F.TO EXISTING S.F.D.WORK TO INCLUDE:EXTEND EXISTING ENTRY,NEW MASTER BEDROOM,BATH AND WALK-IN CLOSET.REMOVE EXISTING WALL FROM A BEDROOM TO CONVERT IT INTO AN OFFICE. CONVERT EXISTING 3 BEDROOM,2 BATH S.F.D.TO A 3 BEDROOM,3 BATH S.F.D. REF:B05-01103 1 REPAIR/ALT COOLING/HEAT,3 VENT FANS/SINGLE DUCT FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 .Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $0.00 0 - Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $13.70 1 Evaporative Cooler $0.00 0 Inst/Rep.Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Ref rig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Ref rig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace $0.00 0 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct $21.75 3 Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers Fire Dampers $0.00 0 Up to 3 hp , $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00 0 - 15 to 30 hp $0.00 0 Air Handlers< 10000cfm $0.00 0 •- 30 to 50 hp $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 _Investigation Fee $0.00 • Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $58.95 • 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 codas, 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(MO) • DECLARATIONS ' 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 Ls issued. r 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 workyrs' _^paiP{1sation Insurance\ carrier and policy number are: �� Carder:_ S c C., \yv") POI1cy.N^umber:�s`�4�' -ILO OS Ma-section need not be completed If the permit Is valued et one hundred dollars($100)or less.) ❑ I certify that In pert; nee 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 la of C mia,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these rods' Aprplicant Slum��'" a- J Da tetw-CI1P`2 - CD WARNING:FAILU RE WORKERS'COMPENSATION COVERAGE IS UNIAW FILL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,000),IN ADDMON 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.lam jcensed under slons of Chapter 9(commencing with Section 7000)of Division 3 of.the,Buslness and Professions Code,and my license Is in full force and effect.Llcr#J cr---i`Z,9%\ lcige,t4 'I 'IContrector's;Signatuie:-- , Date:'^°'r-'7 -0 S ‘_------ l 1- 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). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that 1 am EXEMO 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 cdrisiriict ter,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 lI rased pu he provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or t�,iatiierer,she is ex t refrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a t, I penaly,ct n&t"ore than des hundred dollars(5500).): s.lpl f✓' ❑ Busthe d Profty,essions io my ploy with wages as their soledoes not compensation,WILL DO THE WORK,and the structuresimIs not intendeder , offeredo for sale(Sec. 7044,Business and Nth 8e: a Contractors License Law does not apply a is owner of property who builds or Improves thereon,and who does such work himself or herself or of5oyh 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`olie year of mutation,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ' 44 ❑ I,as owner of the property,em 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. Y.Yes 0 No Drivers 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 bo more than thirty-six(38)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). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑No (Section 25533 of the Calitomia 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. ___........._........_._..____ _ _ _,_—__, been 0 Yes .__ 4 If an RMPP is presently required,has Section 25534 of the Calitomia 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 akermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes 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? ❑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 Califomia 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 OF COMPLIANCE AND A ' ORIZATION 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 complywith all state I: and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described prope - • inspection p• •es.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. • al Owner(s) Date R" '1 -b S And/Or Au F"Applicant , Date cODS I, INSPEC11ON TYPE PAIL Pa4S COOE( UISPECRON TYPE /^� D`TE •;tI. 1616 Fixed System Final Fire Prevention 206 Final Mechanical AC' C96 a IV 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 5T "F CITY OF COSTA MESA • BUILDING DIVISION F f •"_w...w_ani,.'• ,i DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER al 4• PERMIT P ; //�05-00685 fi /i (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesafteMBING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 1617 SANDALWOOD ST Status: ISSUED Suite No Applied: 09/02/2005 Issued: 09/02/2005 Vicinity: Parcel Nunmber: 13921304 at Applicant: SHOSHANA, OFER Address: 5301 BALBOA BL ISSUED BY: ..4/4S.. UNIT C8 Phone: 818-461-9078 / ENCINO,CA Zip: 91316 Owner FRIEDLAND, BARRY S Address 1617 SANDALWOOD ST Phone: .COSTA MESA,CA Zip: 92626 A' A• ., . i Contractor • ORANGE INNOVATION INC p Address: 5301 BALBOA BL UNIT C8 Phone: '818-461-9078 ENCINO,CA Zip: 91316 License: 832810 SCOPE OF PERMIT • ADD 496 S.F.TO EXISTING S.F.D.WORK TO INCLUDE:EXTEND EXISTING ENTRY,NEW MASTER BEDROOM,BATH AND WALK-IN CLOSET.REMOVE EXISTING WALL FROM A BEDROOM TO CONVERT IT INTO AN OFFICE. " CONVERT EXISTING 3 BEDROOM,2 BATH S.F.D.TO A 3 BEDROOM,3 BATH S.F.D. . REF:B05-01103 . 1 BATHTUB, 1 FLOOR DRAIN,3 P-TRAPS,1 SEWER CONNECT,1 SHOWER, 1 WASH BASIN,1 WATER CLOSETS FEE SUMMARY AMT QTY - ... AMI QTY - AMT CITY 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 $29.40 3 Trap Primer $29.40 3 Bathtub $9.80 1 , 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• . i $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 $9.80 1. ,`H - •Sewer Connect $24.65 1 . Waste and Vent System $0.00 0 Drain,Rainwater $0.00 0 • Sewer Private Line ,- - $0.00 " Q-. Water Closet(Toilet) $9.80 1 Drain,Roof $0.00 0 i , Shower $0.00 0 ' 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 $0.00 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 Gas(1-4 outlets) $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: $146.15 Cr1MMrIuTC /CDFCIAI CAMrLTI/1MC 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 / 2448.46(6/00) 1..,_./ 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 end 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 work mpen tion In'{kuurance carrier and policy number are: Cartier: r\ 0.> j\AJY�', Policy Number: \S 1D�• -2 0O s N(Thls seoNon need not be completed 11 the permit is valued et one hundred dollars($100)or less.) t-"-" ❑ I certify that in the performance of the work for which this permit is Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provislotte. ,. YY � '----Si p`ateZ - -oS WARNING:FAILURE TO SECURE WOREER9'COMPENSATION ERAOE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOHRAND DOLLARE($l00,000),IN ADDRION 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 Chan er 9(commencing with Section 7000)of Division 3 of the Bus' ess and Professions Code,and my license Is in full force end effect. 4,__� 0 1 Cassa Contractors Signature: 'r Date: 014 2 ^ o $ \ ___- (—,- .,- CONSTRUCTION "vCONSTRUCTION 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: y.• I hereby affirm that under penalty of perjury thaUi�Tdci,,- PT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which re a perm%."•"•'" Cl,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that '�s iicense.gi -•t to the provisions of the Contractors license Law(Chapter 9(commencing with Section 7000)of Division 3 o1 the 'pr Business and Professtons Code ,u.r,le Or sh.,if ex.- .t therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicailtiq a civil pen" 1d of mor an five hundred dollars($500).): ❑ 110mer of t Ie operty,,j'_my: ployees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. '7D$.4lBusiness en Profess ons Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work •I sat`r herser&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 wOli 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: yµ Owner ID verified by drivers license. MMM Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bit 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,faisework,or demolition or dismantling thereof,will be more than thirty-six(38)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 6,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 e permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Wit 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 then 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 II an RMPP is presently required,has Section 25534 of the Celilomia 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 application agernit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Il Yes IJ 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 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 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 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-described property fo 'nspectio oses.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ilk S eture :al Owner(s) Date AnWOf.AOrthorize. •.plicant ( Date-` CODES IflSPECTION TYPE PAIL INTmALS CODE It ItlsPECTIONTYPg PALE METALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical ^ Rp 1266 Pool Spa Final 208 Final Plumbing 9 cQ-oh N 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 CITY OF COSTA MESA ,• ��@@@ BUILDING DIVISION >4-(„r 4, DEVELOPMENT SERVICES DEPARTMENT PE MIT NUMBER 4. !4 I PERMIT 1►� E05-00926 • 40 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesaEcp fTRICAL PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 1617 SANDALWOOD ST Status: ISSUED Suite No Applied: 09/02/2005 Vicinity: Issued: 09/02/2005 Parcel Nunmber: 13921304 Applicant: SHOSHANA, OFER dr Address: 5301 BALBOA BL ISSUED BY: ./2/_ UNIT C8 Phone: 818-461-9078 / ENCINO,CA Zip 91316 Owner: FRIEDNBARRY S Addresss 1617 SANDALWOOD STiiie Phone: COSTA MESA,CA • • Zip:-_ 92626 ' Contractor. ORANGE INNOVATION INC Address: 5301 BALBOA BL UNIT C8 Phone: 818-461-9078 ENCINO,CA Zip: '91316 License:832810 • • SCOPE OF PERMIT ADD S.F.TO EXISTING S.F.D.WORK TO INCLUDE:EXTEND EXISTING ENTRY,NEW MASTER BEDROOM,BATH AND WALK-IN CLOSET.REMOVE EXISTING WALL FROM A BEDROOM TO CONVERT IT INTO AN OFFICE. :CONVERT EXISTING 3 BEDROOM,2 BATH S.F.D.TO A 3 BEDROOM,3 BATH S.F.D. - . . REF:B05-01103 , 15 LIGHT FIXTURES(INCLUDES 3 SMOKE DETECTORS), 19,OUTLETS,7 SWITCHES,,1 MOTOR TO 1 • 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 $16.50 15 up to 50 kva/kw $0.00 0 Recept Outlets $20.90 19 , , - . - up to 100 kva/kw $0.00 0 Switches 87.70 . • 7 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 1hp $4.75 1 - -Circus(mech ride or lights) -'$0.00 . ' 0 Motors to 10hp $0.00 _ 0 Christmas Tree Stand 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 $73.35 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: 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 fir/ 2446.46(6/00) DECLARATIONS 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:-• • 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 w rkers'comps atlon Insurance carrier and policy number are: Carrier 5itc,�4. '7w.`; Policy�N bier. \5r.'b nC _ 2 0'3 S •-Inflation need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance o he work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Calico 'a, agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with rhes ApplicanPSlgneture: - ,Date y "1v•-•1 — 0 5 WARNING:FAILURE TO SECURE WORKERS'COMP T1ON COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,000),IN ADDmON TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES. UCENSED CONTRACTORS DECLARATION: I hereby affirm that. r licensed under provisions of Ch ter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effectrLfc.If 1)3r1'%\0 -' C4ass�w b Contra ignature:a , --- /�f Deis: c — 9 — a S CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: Iv it, fe.I hereby affirm that under penalty e reit$ that I .,'-Li.7 FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which t4,n 1Ptpernit to Jr st•Y',alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed stateroen that h: .:-:;('?.(jcens:•- 'rsuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professloo Code) •.111:t 'r Tor 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 16.a I pe ':4'of of more than five hundred dollars($500).): ❑ ti owner of the H arty,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 an rofessions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself onherself 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.). O I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. Yes 0 No Drivers License No. Expires: 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? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be tiled 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 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 appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? IYes U 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 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 OF COMPUANCE 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 comply with ell state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspectio-muses.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Sig;tura O al 0 ner s Date �e- --..__ q - 2 — OS And/Or.Adthorize$Applicant /Date CODE 0 EVICTION TYPE RITE INTRIALQ CODES INSPECTION TYPE DATE IMRULH 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 2"gel% ' _ 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 Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. • • --------77_ CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO.�� T ? LQvO._ UNIT N0. A P # /2c,- — Q-\ ") — OLl zone iii] 13 Project Address � �7 r/'}'/1//�. - 3/1J f ) CT/ t rr IIS Main Building: . eula - Accessory Building:Applicant'sMailingAddress/6 - 4 TYPE OF CONSTRUCTION U NEW ADD J ALTERTION u REPAIR Front E❑ CONVERSION ❑ DEMOLISH ❑ OTHER ____ Gr/r 'LL T "Owners Name / t� �� _ 'hone DESCRIPTION OF WORK/USE OF BLDG. 0/ /0 ro L1'ZI^ I B Rear 11. )J Address -. /l tA T /Arch/Eng. License No. _• . _ TYPE OF PERMIT U GRADING U FOUNDATION ❑ STRUCTURAL I K Right 1£Address ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL S Left 2p _Contractors Name C ' Phone ❑ -OTHER Ping. Ref.# Parking Req./Provided -PROJECT DESCRIPTION SQ. FT. OCCU PANCV Q � -Address(mailing) Planning Notes: �Sl0 c '- r CONSTRUCTION TYPE �T` N VALUATION$ gGe • �City License No. - ZONE GRADING CU.YDS. ACRES LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9(commencing Remarks: pg_tia_CotJ-9—•r ' 74:/)0 with section 7000) of Division 3 of the Business and Professions Code, and Q ELECTRICAL FEES my license is in full force and effect. License Class License No. Date Signature _ PLUMBING FEES Automatic Washer Transformer 0 15-50 KW • •� WORKERS'COMPENSATION DECLARATION Construction Pole Sub. 0 50+ KW I hereby affirm that I have a certificate of consent to self-insure or a certificate Bar Sink Showers • ;./ Workers' Compensation Insurance, or a certified copy thereof (SectionBackflow Preventer Service Sink Cooking Unit Meter ❑up to 100 amps ' "300, Lab. C.) ''`Flolicy No. Company Backflow Irrigation Sewer Cap DishwasherMeter .Clover 100 amps ,.. Certified copy is hereby furnished. f -•/ Certified copy Is filed with the city Building Division. Bathtubs Sewer Connection Dryers ❑Gas ❑Electric Sub Panel Date Applicant Fan Motors 00-1 HP ❑1 h-6 .� EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors (This section need not be completed If the permit is for one hundred ($100)or Dishwasher Solar Piping F.A.U. less). Inc.Solar 09-15 HP ❑16-15+ 4. 1 certify that in the performance of the work for which this permit is issued I Fixtures shall not employ any person In any manner so as to ecggre s fact to the Drinking Fountains Solar Tank Microwave / DateWor },-- tipp�ws of Cauf is I/' _ / Device Boxes Pole Light 1 ' Date '/ C oLl[ "x4 Signal � _ Floor Drains Swimming Pool w/Spa 9 f NOTICE:If,after making this declaration, y should become subject to the Outlets Range Workers' Compensation provisions of the bor Code, you must forthwith Floor Sinks Urinal g t '1 •comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCYSwitches Sign - 'I hereby affirm that there is a construction lending agency for the performance Gas Service Outlets Water Closet 'of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Garbage Disposal Standing Sections "Lender's Name Lender's Address Kitchen Sink Water Service • Generator 00-5 KW 05-15 KW Trash Compactor - OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories - Auto-Wash fouowing 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 any structure, prior to its-issuance, also requires the applicant for such permit _ to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains • the Contractor's License Law(Chapter 9(commencing with Section 7000)of - Division 3 of the Business and Professions Code) or that he/she is exempt Reinspection Fee $15 Issue Fee $ 3 'herefrom and the basis for the alleged exemption. Any violation of Section )31.5 by any applicant for a permit subjects the applicant to a civil nalty of not more than five hundred dollars($500). • DEVELOPMENT SERVICES REQUIREMENTS: /�N s owner of the property or my employees with wages as their solo Reinspection Fee $15 Issue $ 3 Fee _ Zoning Approved 9 By Date / 1 compensation, will do the work, and the structure is not intended or offered MECHANICAL for sale (Section 7044, Business and Professional Code: The Contractor's FEES Building Approved By Date License law does not apply to an owner of a property who builds or Improves , s • thereon, and who does such work himself/herself or through his or her own Boiler Hood or Type I ❑ Application Issued By- Date 7 �o employees, provided that such Improvements are not intended or offered for sale. If, however, the building or Improvement is sold within one year of com- Canopy Type II ❑ pletion, the owner will,have the burden of proving he/she did not build or Im- Duct- Under Ground SUMMARY F F S prove for the purpose of sale). BUILDING PERMIT $ /os 00 SMIP $ • . S-0 ❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System PLAN CHECK $ S. ID PERMIT 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 PLUMBING $ ISSUANCE $ builds or improves thereon.and who contracts for such oroiects with a con- tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration PLAN CHECK 25% $ ENERGY P.C. $ proof of their Worker's Compensation insurance should be provided to me. ELECTRICAL $ GRADING $ f`�Ta-m exempt under Section B.& P.C.for this reason Firepl/Fact.Bit. ICBO dk Fire Dampers MICROFILM $ HeatingSystem& DuctingRegisters PLAN CHECK 50% $ Date _ —��— Own g MECHANICAL $ /�. 60 I hereby certify that I have read this ap lication and state that the above ❑0100,000 BTU ❑100,000BTL TOTAL FEE $ information is correct. I agree to comply ith all city and county ordinances PLAN CHECK 25% $ and state laws relating to building construction,and hereby authorize repre- sentatives of t s city to enh up• th; above-mentioned property fqr� Inspection pun- es. — Drivers' T_�_ a /✓✓/. ._ Date Drivers' License or _ gpplicant; Pink -Accounting;Goldenrod - Assessor 01 00010733-00010735 TOT 143.60 DATE: 07/28/88 TIt1E: 16.24 ' `' CONSTRUCTION AND PLANNING POOL PAft t APPROVALS Permit# Date Inspector APPROVALS Permit'# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. , I 53. Steel Reinforcement 3., Electrical Conduit Utility-Undrgrnd. • 54. Forms r 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 ' • i 12. Sewer Cap. - 63. Heater & Vent-Final • • 13. Roof:Drains' ' 64. Plumbing System - Final • 14. Rough PluRibing 65. Electrical=Final . 15. Rough Electrical-Conduit 66. Solar System-Final 16�• Rough Electric Wiring 67. Fencing & Access Approval 171. 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 I 71. Product Piping 0 Gas 0 Oil • 23. Gas Pipe-Rough &Test 'I 72. Underground Flush 24. Ro9f Framing I 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing -..r'"4 74. Overhead Hydro 26: T-Bar�Ceiling (Structural) & •Moriocoat 75. Dry Chemical 27) ' raIrn'eand Flashing -- ' - 76. Dry Standpipe 28: Lathing& Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing - HEALTH DEPT. REQUIREMENT r . 31. Plaster Brown Coat 1_ -'1 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 FactoryiFireplace 38. Final Plumbing i •• 39. Water Service-Final f 40. Gas'Service-Final ' I ;J 4I. Solar Domestic-Final: i+• 42. Backf low Preventet•: :� I 43. Backf low Irrigation . 44. Landscape Irrigation,System ... ;- 45. Sound Attenuation • '• 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING //et' (71: -a. 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY �Sn , ';No. Date ,O(7 , NOTE: SHOW AND DIMENSION PROPOSED .--- -----S--462:3_1THIS NUMBER MUST IACCOMNY PATIO COVER AND YARD AREAS ALL INSFECTION REQUESTS E DETAILS ON REVERSE SIDE ` N , •.,,�,�' ROOF SHEATHING V ....,.�� OVERHANG I \ ii_r_ /Ja� 4. --ILC /I \ —X—RAFTERS--" .""...`.... -c �, .� •\ AT_O.C. A APPROVED \ _x_ BEAM • \ T-STRAP EA. SIDE CI o,ff//Cos!c Mesa Buildin Dept. FOR POST- BEAM BY L � p \ CONNECTION. re o O '1 DATE aY 9__ o \ a z z z a I 1 THESE PLANS MUS" BE TTN JOB AT ALL TIME: MAKES \ M CC Lu CC LU .y a z '' 1•10 CHANGES WITt"OUTIPRIOR APPROVAL 0' DEPT.° \ -I _ a OO CC i \ U) THEI ISSUANCE OR GRANTIN OF A PFRM:T OR APPROVAL OFN \ O O R = b PLANS AND SPECIFICATIONS S ALL NSW:C9NSTP.UED TO SE AX. 2 e O O LL -I $J PERMIT FOR, OR AN ABPRDVA OF, A. Y i(IXATION OF AN:. OFW 0 - F- THE PROVISIONS OF Thd5 COD NO PERMIT PRESUMING TO GIVE \ a J O N 0 m W AUTHORITY TO VIOi.ATE OR C NCE: THE PROVISIONS DF DOS DROP PATIO• J LL _Z X _1 W O CODE SHALL BE VALID,EYCEFT N SO FAO AS THE WORI 02 USE \ FLOOR 2" — \ O O - C 03 I WHICH Ii AUTHORIZES IS LA UL pp == Q • \ Tay O SLOPE TO DRAIN PLATE 1"-----• 6. E CF A PE�ARIT BASED UPON PIF. :S AN: p �� ABOVE SLAB'4�'� t st, c• •W� N: spit'/ n•']j 1REVENT THE BUILDING )F':CIAL 7 �cOU•q!13�i TME CCde;E �iO!v vi Ei i:1=.:iN o...: `d/.` '.o.`i ' . . . : .. ��{yV, 1rici TIONS, CN FROM ERE 'EN.fiN3t6 • • , lly, ,` r ��b3 4aN CARRIED ON THERFUI:p R'.YHEN . . t r L'4. I IN vIOLA,i ION OF THIS CODE R OF ANY OTHER ORDIN NCE Or 26 GA. G. I. FLASHING�I a 1 I CITY FHCOSTA MESA -, WOOD FLOOR _ J CONSTRUCTION PIERS 12' SOJT w `+EJECT TO BLDG. D�EP�/. **R ix Q BY —DA LL "' "- �t+: SIDE ELEVATION PLOT PLAN CONSTRUCTION DETAILS 201bs.ROOF CONNECTION DEVELOPh+ENT DETAILS SERVICES DEPP,RIMEPPT • PATIO COVER • • BUILDING SAFETY DIVISION T Y P. PLANS CONT. SOLID BLOCK LEDGERlielte OWNER: DATE : Niv ADDRESS: PHONE: I/2" DIA. X 5" LAG SCR. CONTRACTOR: LIC. NO. AT 32" O.C. ADDRESS: PHONE: DETAIL I RAFTERS RAFTERS APPROVED FOR CARPORT, PORCH OR PATIO LIGHT WEIGHT ROOF COVER OF BUILDING PERMIT NOT SUPPORTING CEILING LATH, FIBERGLASS, ALUM, By Date SIZE. SPACING SPAN SIZE SPACING SPAN 2"x4" 12"O.C. 9'-6" � 2"x4" 16"O.C. 9'-6" CR 8 CL "TECO' gENERAL NOTES: GRIPS OR JOIST 16" 8'-0" 24" 8'-0" ••••• HANGER 24" 6' -6" 32" 6'-6" 1. These plans must be CONT.LED ,� 32" 6'-0" 48" 5'-6" kept on the job at ' ��t 48" 2 5, _0„ 16 2"x6" 16,, . 24" 16,_6„ 14 all time during „x6„ 12„ ,_6„ ' ,_6„ construction. 1 " 16" 14'-6" 32"• 12'-0" 2. All framing to be 34" DIA. X 5" LAG SCR. 24" 12' -0" 48" 10' -0" Douglas Fir N22 AT 16 " O.C. 32" 10' -6" 2"x8" 24" 19'-0" grade minimum. ' 48" 8' -0" • 32" 15'-6" 3.. Rafters may not DETAIL 2 2"x8" 24" 15' -6" 48" 13'-6" attach to facia ex- • 32" 13'-6" cept for 10]bsroofs 48" 11'-6" as shown on details; IOIes.OR . LIGHT WEIGHT ROOFS 4"x6" 24" 17' -0" HEADERS 2Ol,sroofs must use ONLY CONNECTION DETAILS 32" 15'-0" a continuous ledge 36" 14'-0" LIGHT WEIGHT ROOF ONLY attached as shown 2" X FACIA-MIN.REO. 4"x8" 24" 21 ' -0" SIZE POST SPACING on details #1E+#2. 32" 19'-0" 4x4 6'-0" 4. Light weight roofs 1 • 36" 18'-0" 4x6 9'-0" may attach to facia �! 48" 16'-O" 4x8 12'-0" for 14' span max. , gavel :ittn 4"xl0" 32" 22'-0" 4x10 15'-0" spans over 14' must ' 36" 21' -0" use a continuous CARPORT, PORCH OR PATIO ledger as shown in APPROVED METAL 48" 20'-0" SIZES POST SPACING detail #3. HANGER 72" 17' -0" 4x4 5'-0" 4x6 8'-0" DETAIL 3 4x8 10'-0" 4x10 12'-6" . -ash i GApplicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA COS RUCTION PERMIT PERMIT• 7 2_91TRACT r,a� LOT NO. UNIT NO. A.P.# 39— aI 3 _V5f, j,l n ,/ �j b cN Zone -aProj•bIdress le n of WA� S Main Building: Accessory Building: •f$7jplicant's Mailing Address . .r., TYPE OF CONSTRUCTION ® NEW U ADD U ALTERATION U REPAIR E Z ❑ CONVERSION ❑ DEM 6LISH ❑ OTHER Front T 0 Owner's Name/ r `•- /on Phone 7 - • DESCR PT w•/ 0 WO:K/USE OF BLDG. •• • WSW I B Rear o' N Address 1(ch JA alw00 a • N. - !..r of. a- A 1N Arch/Eng..�� {� License No. TYPE OF PERMIT III GRADING III O NDA ION M STRUCTURAL C Right 0' G Address cLjl I�''r'-00`4- ❑ TENANT ❑ ELECTRICAL 0 PLUMBING 0 MECHANICAL S • Left TFJL(M� ❑ OTHER I Pin Ref. # Parkin Re R • Cont a r'z / •• • . •' Phone 7677-":1246# /J 9 g q./Provided E PROJEN S DESCHIPTION SQ. FT. 60 OCCUPANCY , ` 3 Planning Notes: )� I ///7��t ��' ,,azzz��' O Address(mailing) 7 rp �l1. e/ i N/ Fillitan I 0 , / u L/ c- vid'!� M CON STRUCTION TYPE Il a VALUATION$X57 (J T City License No. y-y' 2s 9 5 ZONE GRADING CU.YDS. ((��ORES Cp'J ALO-A) •` • S. LICENSED CONTRACTOR DECLARATIONGLAA , I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: /��st,.�z ^ �,s with section 7000) of Division 3 of the Business and Professions Code, and T`00t 10 ' i t 1.L , •age /A/• .J A 1/ ELECTRICAL FEES my license is in full force d effect. r,,,( ,�f 1< 1 • u `J f�IGd v !/ Dale ss C• I� c n No. 1110 "l�1 PLUM NG ' FEE$ Automatic Washer Transformer 0 15-50 KW Dale _ • Signature �!/-1� ✓ _/'! _ _ — — ;RKERS'COMPENSATION DECLARATION DOnSI(UCtIOn Pole Sub. 0 50+KW areby affirm that I have a certificate of consent to sell-insure or a certificate Bar Sink Showers % of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink \ Cooking Unit Meter Dula to 100 amps 3800, Lab. C.j,,.,, ,t /� Dishwasher Meter Dover 100 am s coli No. 1, '(J t/1' _ Company --O:-C• .7.....1.,004-y Backflow Irrigation Sewer Cap \ p '. Certified copy Is hereby furnished. Dryers ❑Gas ❑Electric Sub Panel - Cert'Qfed c gv is filed with the city ,Idin Bathtubs Sewer Connection IL Date I{,1-bl`6'I Applicant Fang I Motors 0-1 HP ❑1'h-8 EXEM ION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors (This section need not be completed if the permit is for one hundred ($100) or Dishwasher Solar Piping F.A.U. \ I .Solar ❑9-15 HP ❑16-15+ less). I certify that in the performance of the work for which this permit is issued, I Fixtures \ shall not employ any person in any manner so as to become subject to te Drinking Fountains Solar Tank Microwave Workers' Compensation Laws of California. \ r Date Signature Floor Drains ) 2I ,g Pool w/Spa Device Boxes Pole LightNOTICE: If,after making this declaration, you should become subject to the Outlets altge -Workers' Compensation provisions of the Labor Code, you,must forthwith Floor Sinks nal _ -Comply with such provisions or this permit shall be deemed revoked. Switches - _CONSTRUCTION LENDING AGENCY Gas Service Outlets ater Closet Sign I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Garbage'Dispusal Standing Sections Lender's Name Lender's Address itchen Sink Water Service - Generator 00-5 KW 05-15 KW Trash Compactor OWNER BUILDER DECLARATION r 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 county which requires-a permit to construct,alter,Improve,demolish or repair P-Trap Laundry Trays C • any structure, prior to its issuance, also requires the applicant for such permit -- 'o file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains -n le Contractor's License Law (Chapter 9 (commencing with Section 7000)of • , Ji vision 3 of the Business and Professions Code) or that he/she is exempt Reinsp¢etionFee $15 Issue Fee $ 3 therefrom and the basis for the alleged exemption. Any violation of Section - 1 7031.5 by any applicant for a permit subjects the applicant to a civil chatty of not more than five hundred dollars($500). $ 3 DEVELOPMENT SERVICES REQUIREMENTS' I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee Zoning Approved By ✓`--f`•-rDate/-cad_�/ compensation, will do the work, and the structure Is not intended or offered - r for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES_ -Building Approved B ca / 4 Date 1 License Law does not apply to an owner of a property who builds or improves -_ - - - - - - - - PP Y - '�/�%��//,�_ -Date thereon, and who does such work himself/herself or through his or her own Boiler Hood or pe I ❑ Application Issued B �_ _ �� _ employees, provided that such improvements are not intended or offered for ' sale. II, however, the building or improvement Is sold di one year of im- Canopy Type II 0 • `J SUMMARY O' FE"F , pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground - r ve for the purpose of sale). - BUILDING PERMIT $ 3 7. 00 SMTP $ tI��9 I, as owner of the property, am exclusively Contracting with licensed con- Duct-Structural R igeration System PLAN CHECK $ 7--4 �� PERMIT Lraclors to construct the project (Section 7044,Business and Professions Code: 1 The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 0-100,000 BTU 0100,000 BTU PLUMBING • $ ISSUANCE $ builds or improves thereon. and who contracts for such oroiects with a con- ENE ENERGY P.C. $ tractors) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple System Repair/Alteration I PLAN CHECK- 25% $ ptoof o their Worker's Compensation Insurance should be provided to me. GRADING;' $ ❑ I am exempt under Section B. & P.C.for this reason Firepl/Fact.Blt. ICBO# Fire Dampers ELECTRICAL $ (( .�/ �y PLAN CHECK 50% $ - MICROFILM 'S; Date __5�. Owner 4AA7aT /l/YIA.• Heating System&Ducting Registers g I I hereby certify that I have read this application and state that the above 00-100,000 BTU ❑100,000BT MECHANICAL $ TOTAL FEE • $ wSis Information is correct. I agree to comply with all city and county ordinances PLAN CHECK 25% $ • and state laws relating to building construction, and hereby authorize repre- sentatives of t 's city to enter' upon the above-mentioned property for .• ..1'1.1..1'1.1.1inspection pure es. Signature _ / Al. Date/ 27-84 Reinspection Fee $15 Issue Fee $ 3 Drivers' License or SS t / - '.,. Jin^' ''L'.^_J1.t• -..--71- .a .- 0865-46,rev. 5/88 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor d a: D?! TIC:-'. LY Ti : 11-... ` N "j.,` CC(•NSTRUCTION AND PLANNING x P. - & SPA . ' .Date Inspector Date Inspector PROVALS 'Permit# APPROVALS Permit# 1. Temporary Electi-ical Service or Pole 52. Pool & Equipment Location • 2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement I • .. 3alElectrical Conduit Utility-Undrgrnd. 54. Forms . 4C Electrical Conduit-Undrgrnd. ' I .1 55. Electrical Bonding 5. •Steel •Re nforciment. " 56. Rough Plumbing & Pressure Test ,6.:.Electrical UFErR Grnd.. . I 57. APPROVAL TO COVER-GUNITE 7. ;Footings' • I sr/ P' ,e, 58. Electrical Conduit-Undrgrnd. • 8. 'Foundation59. 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 I 63. Heater & Vent-Final 13. Roof Drains • -. I 64. Plumbing System - Final • 14. Rough Plumbing ' • 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16.1-Rough Electric Wiring . kr' 67. Fencing & Access Approval 17. Rough Wiring Sigh, 4 68. APPROVED FOR PLASTERING 18.. Rough Electrical-T Bar Ceiling • . 69: POOL/SPA SYSTEMS FINAL 19. Rough Heating &'Air Conditidni?g FIRE DEPT. REQUIREMENT 20.. Rough Factory Fireplace , •>/ APPROVALS Permit# 21' Ducts, in Structure t� 70. Underground Hydro . 22. Ducts, Ventilating • ) eI A. 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe<Rough &Test " 72: Underground Flush r' 24. Roof Framing ri '13. Undergrnd.Storage Tank 0 Gas ❑0,11' 25. Roof Sheiathing . 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame:and Flashing -: 76. Dry Standpipe 28. Lathing & Siding i ~ 77. FIXED SYSTEM FINAL 29. Insulation -' 78. FIRE PREY. FINAL I 30. Drywall Nailing ; `) HEALTH DEPT. REQUIREMENT 31. Plastery Brown Coat' i �1 79. FINAL INSPECTION -- 32. Electrical Power'Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric • e. Notes: �� N5O'Yt e h' \-7----k-- 34. Final Heating & Air Conditioning olc 71--ii Gyot,1- Z.--(ZJR q/`� 35. Final Gas Pipe-Test 36. Hood or Canopy 'LS `` d Fria A e ,. i. z..A s e. 37. Final Factory Fireplace , Sr..oro balk-et-L._ Z18`r 38. Final Plumbing i 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final I 42. Backflow Preventer 43. Backflow , \-7----k• 44. -Landscape Irrigation-System 45. Sound Attenuation 1 46. Handicap Regulations // / I 47. FINAL STRUCTURE & BUILDING 2,404/ � ��0 9 - 48. Special Requirements Completed %" 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY • . No. Date - .t ' . . . - �l PARTY Matt. AGREEMENT • SIS AG EDC T, made and entered into this S i X "f ' I day of i469 -Lorry T% V y y , by and between S , 7fr, C.i l n nJ hereinafter referred to as •S CA ER•, and Fro.n loin Vir9;n hereinafter referred to as •AIIJACDTT PRCPERUY 6diER•. �p It is hereby agreed that a party wall will be constructed on the prcpertj line between /613 &kr! fwoo.* n.r,j. 1616 wl,,-fe 'i, c (Address of Adjoining Properties) SFreeCS Ccs-t,. ide2626 in the City of Costa Mesa, County of Orange, State of California, as per map 3—(8 • recorded in Hock (((y , Page of Miscellaneous Maps, in the office of the County Recorder of said County. The party wall shall be permitted to encroach IN WITNESS WIEREOF, the parties have entered into this Agreement the day and year first above written. LAND CANER ADJACENT PROPERTY MINER -4 )4-) 2.11a. (Signature) (Signature) • Barr, S rI e :.jaK Ield FRAN4-11Aft 1$0 Name (tided or Printed) Name (Typed or Pruhted) /6 ( ? San:;Iwo. . 6e-ecerccC, o,cvtia41. ,-77J` C ()Jagless) &rt.% Mesal CA %z6z6 (Address) JAN 2 a '^R9 JAN 2 6 1989 • filets a — flPPROVED APPROVED PLANNING DwPi. yUElECT TO BLDG. DEPT. 'ae ' City of Costa Mesa Building Dept. / 9+CTORCT06 O! memo BY DATE � 7 9 Permit #_3 7c..� THESE PLANS MU T BE ON JOB AT ALL TIMES MAKE THIS NUMBER MUST ACCOMPANY NO CHANGES WITHOUT PRIOR APPROVAL OF DEPT, ALL INSPECTION REQUESTS ✓ _,. THEIISSUANCE OR GRANTING OF A PERMIT OR APPROVAL OF 0TE PLANS AND SPECIFICATIONS SHALL NOT BE CONSTRUED TO BE A PERMIT FOR, OR AN APPROVAL OF, ANY VIOLATION OF ANY OF THE PROVISIONS OF THIS CODE.NO PERMIT PRESUMING TO GIVE e , OR CORRECTIONS SHALL AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF THIS ADDITIONS, QELETtOiIrJ^ CODE SHALL BE VALID, EXCEPT IN SO FAR AS THE WORK OR USE U WHICH IT AUTHORIZES 15 LAWFUL. f3E APPROM av THE MIMING DEPARTMENT THE ISSUANCE CF A PERMIT BASED UPON PLANS AND SPECIFICATIONS SHALL NOT PREVENT THE BUILDING OFFICIAL FROM THEREAFTER REQUIRING THE CORRECTION OF ERRORS IN SAID .PLANS AND SPECIFICATIONS OR FROM PREVENTING BUILDING OPERATIONS BEING CARRIED ON THEREUNDER WHEN IN VIOLATION OF THIS CODE OR OF ANY OTHER ORDINANCE OF THE CITY. 641 On &or Prof. • R[f10ERt[ RESIDENCE RESIDENCE X61 RESIDENCE 01063 Q Soadah.acoeP W • I'- W 4q714104961 5t, N 2 I N _ STREET 6 • TYPICAL 6" CONCRETE BLOCK FENCE Cement anne CopBlock With Optional.3/ a an GENERAL- NOTES Channel Block With 1.3/8 f�i, , � _� Horizontal•Top of all Fences =N •� II MORTAR; One Part Plastic Cement, and . Three Parts Sand For Fences 5'or Less Me GROUT: One Part Cement Three and e++ f One Half Ports Shand Vert.ears 3/s"0 at a' -o"o.C. %d!y a ,� COPING: One Part Cement, Three For Fences Higher Than 5' laII • Parts Sand vert.Bars 3/8"95 at 32" O.C. CONCRETE: Well Mixed 1:2-1/2: 3-1/2 II " Max. of 7- 1/2 Gallons of Fill Cells Solid With GroutWhere Steel Occurs � _— _ _ Water Per Sack of Cement Reinforcing Steel Shall ' � GROUT MAV BE POURED FROM THE TOP OF THE FENCE IN CELLSWHERE STEEL Conform to Steel S 5.39 — OCCURS. A.S.T.M. CELLS AND AREAS OF HORIZONTAL REIN- FORCEMENT SHALL BE CLEAR,CLEAN& All Steel to he Lapped til y, Ii FREE OF ALL MORTAR DEBRIS,ETC. 24"or to Code • NATURAL GRADE I� MI_-"1 1 ill I /vim --- <Q� Ern Qe iet .n . ' d a _ TWO 3/8"0 BARS 'Mr I" ' CONTINUOUS TOP . &BOTTOM I+WIDTH ',- •• TO 16' 0.C. MAX. SEE CHART 't .- -1QQ1=.STEEL MUST BE TIED IN BELOWDE PTH OF EARTHTCOTH PLACE AT TIME OF TRENCH LI t 1/3 THE HEIGTH OF FENCE INSPECTION. . . I . -BELOW BOTTOM OF FOOTING. o;4 10'' j.. l .. 0--- SCALE: 1/2" r• I' FOOTING REQUIREMENTS CHART + WALL HEIGHT 6 ' 5 ! 4' 3' •• WIDTH 14" 14" i _I-2".,-, , . ,. 12 ' THICKNESS 10" 10" 8" 8 " DEPTH OF EARTHTOOTH . . . 24" . . . . . . . . .20" - 16 . . • 12" SPACING OF EARTHTOOTH. . 12' 14' Dr 16' 16' yy�� /� ALO ' I OWNERS NAME: .B a & Il 1 K. D L Jd ALO City of Costa Mesa, California JOB PE RMITDNUMBER: 1 -(¢ ._ a 11L l k/ e2 V0 - Building Department' SIGNATURE: • - • • . .. I?r.,. cn .tnt: .,. • . L" APPFOR INSPECTIONS ?t 0�E ChF COSTA M A- �� i PLANNING DEPT. APPROVED CALL fl $Uwta TO BLDG. DEPT. REG. 754-5626 ' BY -' DATl'- 23 -11Ci off Costa Mesa Building Dept. or I Y,W p1EEaOR OP ?wawa By ATE 6 19 i ir 754-5627 on THESE PLANS M c w�_. " =472 =r="' trici NO CHANGES.WITHOUT PRIOR APPROVAL OF DEPT. Q� THE'ISSUANCE OR GRANTING OF A PERMIT OR APPROVAL,OF �� PLANS AND SPECIFICATIONS SHALL NOT BE CONSTRUED TO BE A��,� PERMIT FOR, OR AN APPROVAL OF, ANY VIOLATION OF ANY OF THE PROVISIONS OF THIS CODE.NO PERMIT PRESUMING TO GIVE Ad61ii :", DfiETlD:JS, Q,T CORRECTIONS SHALL AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF THIS COCTHIS NUMBER MUST ACCOMPANY 13 BE APr;J, q.s. T11[ f LANNING DEPARTMENT, WH H SNT AUTHORIZES IS LAWFUL.ALL BE VALID, EXCEPT IN O FAR AS THE WORK OR USE ALL INSPECTION REQUESTS -- THE ISSUANCE OF A PERMIT BASED UPON PLANS AND permit # SPECIFICATIONS SHALL NOT PREVENT THE BUILDING OFFICIAL FROM THEREAFTER REQUIRING THE CORRECTION OF ERRORS IN • SAID PLANS AND SPECIFICATIONS OR FROM PREVENTING BUILDING OPERATIONS BEING CARRIED ON THEREUNDER WHEN IN VIOLATION OF-THIS CODE OR OF ANY OTHER ORDINANCE OF THE CITY. / ) • 60' On fen/ it I tif, Ii AS • l �1 RESIDENCE RESIDENCE RESIDENCE Q RESIDENCE tU CC CC1.... 1- y y • //1 7 I • • �r/id wV ed S:' STREET A TYPICAL 611 CONCRETE BLOCK FENCE - - Cement Coping Optional :71. GENERAL— NOTES Channel Block With 1-3/80 11 pii 1 . Horizontal Top of all Fences Iegep MORTAR; One part Plastic Cement, and :EC R Three Ports Sand For Fences 5'or Less i0 GROUT: One Port Cement Three and Vert.Bars 3/8"95 at 4' -0"O.C. in o �'_ _ , t 2 One Half Parts Stand a x COPING: One Port Cement, Three • Parts Sand For Fences Higher Than 5' ;' ` J- O -, I CONCRETE: Well Mixed 1:2 I/2: 3 I/2 Vert.Ban 3/8"0 at 32" O.C. > w - - --— — - c = Max. of 7 I/2 Gallons of Fill Cells Solid With Grout �� > Z _ Water Per Sack of Cement Where Steel Occurs > - Jill r Reinforcing Steel Shall f f w GROUT MAY BE POURED FROM THE TOP Conform to Sec.A-15-39 w O -�— _ OF THE FENCE IN CELLS WHERE STEEL OCCURS. A.S.T.M. II i ~' 1 e CELLS AND AREASOF HORIZONTAL REIN- 141 n FORCEMENT SHALL BE CLEAR,CLEAN& All Steel to be Lapped I w - . FREE OF ALL MORTAR DEBRIS,ETC. 24"or to Code NATURAL GRADE • n TWO 3/8"OBARS 'tial D . r e .� •.. . CONTINUOUS TOP ' &BOTTOM '- -1.-- � { WIOTH . TO 16. 0.C. MAX. SEE CHART . �. HOQIZSTEEL MUST BE TIED IN BELOW DEPTH OF EARTHTCOTH PLACE AT TIME OF TRENCH '•'�FC1/3 THE HEIGTH OF FENCE . � [1. INSPECTION. , c, e . . OW BOTTOM OF FOGTING. o� o"1. 2..� SCALE: 1/2" : I' • FOOTING REQUIREMENTS CHART WALL HEIGHT 6 ' -5 4' - 3' WIDTH 14" 14" I -.I_2°_. _, . . _. .- . . 12" = ' THICKNESS 10" 10" • , 8" 8 " DEPTH OF EARTHTOOTH . . . 24" . . . . . . . . . .20" 16" 12" SPACING OF EARTHTOOTH. . 12' 14' 16' • 16' OWNERS NAME: City of Costa Mesa, California PO:MR -- NUMBER' Building Department-- SIGNATURE, _ _ • _ ' Fac..:.: cn Plr P_.. • OWNER ROSST.ANE LAND M. DATE 7/9/59 JOB ADDRESS 1617 Sandalwood S t• BUILDING PERMIT NO. 98711 _ GENERAL CONTRACTOR •D' , - Z. C. -. • - F VALUE $ '552. AP. No. . LOT 2014 TRACT 2;22 FIRE ZONE DESCRIPTION OF WORK Res. w/att. gar. INSPECTIONS 7s-y9 DATE I GROUP T & .1 TYPE V ZONE Rl _ Underground Soil/1.17/C U.G. Water 444s. 9 --6,-icy_ PERMITS ISSUED Underground Gas SUBCONTRACTOR DATE NUMBER Overhead Water and Gas Rough Heating / it#5 /o-/Sq .. It-. .n (-QM-S-2 .264‘ Rough Plumbing /WS 00-5-S5? )4ir/c/v), \.4," - ( . 7-,2!/-s-9 J. C/t/C ie Miscellaneous "{� / Prop. Swr. ine_ HeCon. St. Swr. b/i�-t t/�L 4_1c- 4�i..3j`— `7/3 o/S'9 / 6-L1Y Sprinkling ystem `� Heating, Final ((/ -/ Plumbing Fixtures LU Q a' Final Gas Test l L- ul�,-/o- O _ Construction Pole Underground Power Rough Wiring O//r.-', /0'Y9/ a/ab.S/ ai/mi717.th y-/4!-S9 /6/if( ✓ Trenches d( Forms/,' Steel � Jx(..54 Floor System ( Steel Reinforce Chimney Re-Rod (i )11 Bond Beam r Sheathing Tt- /0-4-r9 L LP Frame and Flashing � /p -t 3 -Sp 1' / a i Lathing, In /4 Out - (gam¢C -67 6 n Plaster, brown coat ak.P9;/- /H0.-I--f /o -` Plumbing Fixtures, Final k /4-60 1 Electric Fixtures, Final [� Building, Final4,15-o-(� OCCUPANCY 1 Form 210-3M-4-59 - 9874 989 ,• 11v ..� - JUL 131959 COSTA MESA BUILDING-SAFETY DEPARTMENT I p,I rl��L. �}��T, P.O.BOX 317 COSTA MESA. CALIFORNIA 1 tt r"� 9,-s p, FOR APPLICANT TO FILL IN COMPLETELY APPLICATION FOR PERMIT TYPE OR PRINT BUILDING ADDRESS 1617 Sandalwood St. COSTA MESA, CALIFORNIA FOR OFF/CE USE ONLY OWNER Rosslane Land Co. I RECEIPT NO. I 9gfdth'�[i0• ' MAIL R �E}\VED BY PATE RECEIVED DATEGISSUED ADDRESS 419 E. 17th St. / 7 / 7 7-- NG CITY Costa Mesa TEL. LT81159 ABODRESS ARCHITECT Carlson & LIC. COSTA MESA. CALIFORNIA OR ENGINEER Middlebrook NO. . ADDRESS Grove FIRE D�t� ZONE . CONTRACTOR ORe & Colegrove, InLIC.NO. 1STATE 67293 APPROVEDEDATE `.ADDRESS 49 E. 17th St, Costa Mesa� ZONING LEGAL LOT / I I TRAC822T ZONE //�� F I NO. I USE OF NEW v DESCRIPTION NO. '2GA♦ BLOCK TRACT K f PLANS BUILDING// ✓/�1/✓�''O�/ BYPRrO`V ,4,j /.9-__.../DATE —Ai—.5 I SIZE /� NO.OF BLOCS. {�// E/EVE S OF LOT 6 I x 101 I NOW ON LOT none REQUIRED ALLOWED USE OF (CENTER LINE ST.) [�' • EXISTING BLDG. FRONT ;J Q FT. IN. • SETBACK LINE FROM CENTER OF STREET 53' REAR YARD 25' R.SIDE .5— FT. IN. '' SIDE YARD I LEFT ' I RIGHT ' L.BIDEqq _.3FT. IN. DESCRIPTION OF WORK • • REAR O 0 FT. IN. I. NEW I X II ALTERATION I II ADDITION I REPAIR I II MOVING I II DEMOLISH I SIZE BUILDING NO.OF 114.50 ROOMS 6 STORIES 1 • EXTERIOR WA ROOF ' COVERING Q LUCCO COVERING shingle USE OF BUILDING AND WORK TO BE PERFORMED Sing1P manly residence id.+h • attached garage. Plan 14.0 BR • • I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO CON. ,• PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. , BUILDING CONSTRUCTION. /� /� VALUATION • SIGNATURE OF //? .0 /i PERMIT FEE $ 34.00 % PERMITTEE `�-/`(W,/ rove, j,,, $ 14,552 3nPLAN CHECK 5 17.00 AUTHORIZED AGENT Dike c. TOTAL FEE $ 51.00