Loading...
HomeMy WebLinkAbout1620 SANDALWOOD ST - Building Permits ...ctiiiir4. CITY OF COSTA MESA y' +, BUILDING DIVISION p t r � rd r DEVELOPMENT SERVICES DEPARTMENT /PERMIT �• PERMIT V PERMIT NUMBER E98-00885 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 1620 SANDALWOOD ST Status: ISSUED Suite No Applied: 08/19/1998 Vicinity: Issued: 08/19/1998 Parcel Nunmber: 13921208 . . Applicant: PUCCINI, DANIELLA • Address: Phone: " • • Zip: - Owner: HUMPHREY, JOHN V III TR ' Address 1620 SANDALWOOD ST ," _ - Phone: 714-751-6552 ' ' COSTA MESA,CA - Zip: 92626 _ ' Contractor: ALPS AIR CONDITIONING & H Address: 00675 ECKHOFF . ' Phone:,,' ORANGE CA - . : - Zip:' 92668" --License: 667953 SCOPE OF PERMIT INSTALL F.A.0&AC UNIT. • . ' FEE SUMMARY ' . • QuantityQuantity. ISSUE FEE - $22.00 • - . .� m - Temp Dist Syste ./Lighting,. $0.00 0 Temp service test $0.00 = Busway/100,3- + - $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 Transfor ners.dp to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 "up told kva/kw $0.00 "0 . Lighting Fists , $0.00 0 up to 50 kva/kw $0.00 - 0I - • , Recept Outlets $0.00 - 0 up to 100 kva/kw $0.00 0 Switches - - $1.00 1 over 100 kva/kw $0.00 0 . Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $0.00 .0 - Misc.Conduit • $0.00 0 Service to 1000a - $0.00 0 - Misc.Conductor $0.00 0 Service over 1000a $0.00 ' 0 Circus(gen or ride) $0.00 0 Motors to 1 hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $11.00 1 . . Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 - 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $34.00 Intermed Pole $0.00 0 COMMENTS/SPECIAL CONDITIONS • 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 DECLARATIONS • I , WORKERS'COMPENSATION DECLARATION: - I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and willmaintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'comp:nsation I s: 'ran•policy n mber are: Carrier: gn.ISZO:; ii / Policy Numbe J—O/7 (This section need no •e comp/:(-r if the pe It/s valued at one hundred dollars($100)or less.) 0 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 C:'•rnia, : e that If I should become subject to the workers'compensation provisions of Section 3700 of thee Labor Code,I shall forthwith cdrosi• •mv :?0 - Dale: qg LURE TO SECURE WORKS' •• PENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EM- • : • --IMINAL PENALTIES •CIVIL RNES UP TO ONE HUNDRED THOUSAND DOLLARS(5100,OOO),IN ADD ON 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 aft ads•. :•• cen ed under pr.visions.1Cha•ter 9(commencing with Section 7000)of Division 3 oft : : siness an• Professions Code,and my license is in full • a and effect.Lic.a —sea 0 Contractors . ure: �laJrA _ _ Date: _ a • 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 properly,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. ❑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,talsework,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 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? ❑Yes 0 No (Section 25533 of the Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 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? LJ Yes LJ No (Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 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? ❑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 properly for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ' ature Of Legal Owner(s) ////�a� V/A •r ,uthorized Applica• ue p COOL L INSPECTION TYPE DAff REALS ODE INSPPCTION TYPE PATE ItllDALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 1011., I1 PT 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 2446-48 I CITY OF COSTA MESA 0r ) BUILDING DIVISION ti , DEVELOPMENT SERVICES DEPARTMENT 4. rult PERMIT PERMIT NUM R M98-00383 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 1620 SANDALWOOD ST Status: ISSUED Suite No Applied: 08/19/1998 Issued: 08/19/1998 Vicinity: Parcel Nunmber: 13921208 Applicant: PUCCINI, DANIELLA Address: - Phone: Zip: - . Owner • HUMPHREY, JOHN V III TR Address: 1620 SANDALWOOD ST _ " - _ Phone: - COSTA MESA,CA Zip: 92626 ' . , Contractor: . ALPS AIR CONDITIONING & H Address: 00675 ECKHOFF Phone: ORANGE CA . . Zip:' •92668 License: 667953, .. Arch/Eng: . ‘ ., Address: • .' Phone: - Zip: License: SCOPE OF PERMIT. - INSTALL F.A.0&AC UNIT. ' _ . _ i - FEE SUMMARY' ' , •• ' • Quantity __ - . : % / Quantity ISSUE FEE $22.00 Repair/Alt Absorbtion Unit $0.00 0 Inst FAO<100 k BTU $13.25 Repair/,Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 Ventillation.System $0.00 0' Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0 Inst/Rep. Recess Wall Htr $0.00 0 . Commercial Incinerator $0.00 ,0 Refrig Sys<100 k BTU $13.25 1 Domestic Incinerator $0.00, 0 Refrig 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 $0.00 0 - , 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 i Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $48.50 COMMENTS/SPECIAL CONDITIONS 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 DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: . O -,1 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. Code, fY I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor for the performance of the work for which this permit is Issued. 4 My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number (This section need not be completed if the permit Is valued at one hundred dollars($100)or less.) ❑ I certify that in the 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 Calif• 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 provisi• / 9 �y p Applicant Signature: Date: gE /O WARNING:FAILURE TO SECURE WORKERS' `ENSATION COVERAGE IS UNLAWFUL AND SHAH SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am Ilcens=• under provislions of Chapter 9(commencing with Section 7000)of Division 3 of the Business�nd PTojpssions Code,and my license is In full force and effect Lic.# '& S7 / S Class a L - GCd Contractor's Signature: ✓��/7�i. _ 4a Date: a"Wkli 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.). O 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, end 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. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑No 5 Does or wilt the applicant or present or future building occupant require for the work which Is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes LI No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 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,nave all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: 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 at 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. a /1✓ Signature 01 Legal Owner(s) 9/1?/4a0 rir And/Or Authorized Applicant Da eee CODE I 111$SPEEQIILaD2E PAIE I81lA15 GOOF it INSPFCIION TYPE lO.'DA>f4� lyp➢fi69 1616 Flied System Final Fire Prevention 206 Final Mechanical S" (AL)YI•Y/ 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 2446-46 ADDRESS OF BUILDING: 1620 SANDALWOOD ST DHT: CITY OF COSTA MESA - BUILDING PERMIT CANNERS NAME IF KNOWN: HUMPHREY, JOHN V 3RD PERM NO: B 081149 ADDRESS: HUMPHREY, SALLY A 1620 SANDALWOOD ST PERMIT NO: B 081149 PLAN CHECK NO: N GOVT: N SUPP: N 'OSTA MESA,CA 92626( 714 ) 751-6552 APPL.MAIIuNG ADDRESS: CONSTRUCTION TYPE: V-N PERMIT TYPE: SIR PURPOSE: OTH ARCHITECT OR ENGINEER: UC.NO.: JOB DESCRIPTION : REPLACE 9 WINDOWS/1 NEW/STUCCO PATCH SQ FT: 3,000 ARCH.OR ENG.'S ADDRESS: INT: CLAIM VALUE: 3,000 . 00 CALC-VALUE: 3, 000 . 00 GROUP OCC: R-3 /U-1 CONTRACTOR'S NAME: CCHIRACTORS MAILING COMMENTS: COVER ALL WOOD SHEATHING W/2 LAYERS OF GRADE D PAPER. ADDRESS: UC.NO.: **alkMckdkdkdEdkdkkdkdkdkck#dkdk96dk*liikik*9k#*dk9k9b*9b*dbdk*alk**dk9b*9b9E#dkdk*dkdkdkikdkdEdkckdkiFdE**dk#iklEMdklk9k Bkdk*##ik MdkdE wit ZONING REQUIREMENTS LICENSED CONTRACTORS DECLARATION:I hereby elfim under penalty of perjury that I am licensed under provisions of Chapter 9 SETBACKS (commencing with Section 1000)of Division 3 d the Business and Professions Code,and my license is in full force and effect. CITY LIC.NO.: UC.CLASS: LIC.NO.: EXP: MAIN BUILDING ACCESSORY BUILDING FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN Date: Contractor. LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN OWNER BUILDER DECLARATION:I hereby affirm under penalty of perjury that I am exempt from the Catradors License Law for the ,following reason(Section 7031.5 Business and Professions Code:Any coy or county which requires a permit to construct,alter,improve, PARKING RE PROV: PARCEL: 13921208 Z NE: REF NO: . r 'lemoleh,or repel any structure,prior to its issuance,also requires the applicant fa such permit to file a signed statement that he or she ' a licensed pursuant to the provisions d the Contractors License Law[Chapter 9(commenting with Section 7000)of Diveion 3 d the PLANNING NotES> • '' Business and Professions Coda]or that he or she is exempt therefrom and the basis for the alleged exemption.Amy violation of Section > I: ' • '. 7031.5 by anyapplicant for a permh subjects the applicant to a civil penalty of not more then bre hundred dollars(WOG. dE#dkcklkikik#iEdkdkdkik*ik4ikdiik.lk:Miik M:.*kkdkiblkiEdEdk***iF*MiFMdkiklEikdi*iE9kdk Rkik9k9E*dPRP#1b*1E*9696ckdk*4*M1k*dE*ifdk*dick* o I,as owner al the property Of my employees with wages as their sole compensation,will do the work,and the structure is not intended D E V E L O P M E N T' ' SERVICES 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 an Omer of propeM f who builds or inprod vea thereon,awho does such work Nmsef or heves or through his or her own employees,provided that such " improvements are not intended or offered for sale.If.however,the Wilding a inprovemet is sold withmme year s completion.the ZONING APPROVED BY :, : WA DATE: L.:43 _97 owner'butder will have the burden of proving he or she did not build or improve for the purpose of sale). . xo I,as owner of the properly,an.exclusively contracting with rammed contraction to construct the profed(Sect' 7044.Business and BUILDING APPROVED BY ' VISP> ,0'.1!i) DATE: i R3 - 97 Professions Code:The Contractors License Law does not apply to an owner of groped o builds or ion es thereon end who contracts for such projects with a contractor(s)licensed pure Contractors se Law). r ' r; •- ❑ I am exempt under Section: B.&P.C. APPLICATION ISSUED BY::, 11C DATE: J=%/3- 92 Date: Owner: ix."'Y6 LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y I do hereby certify that I am aware d and understand the requiremed Cal'ostia Health and Safety a Sections ,25533,and 25534.and that I or any future building occupant will/wit not(circ ova)need to comply with said codes and the requirements for a permit for construction amodification from me AG anagement Dmda.R•sid«uial mrmrwionappN•miaw ere exempt from Mese BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING provisions. PERMIT 74 . 75 . 50 Date: Applicant: PLAN SM I P/NON-RES WORKERS COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one of the following dederatiorw: ISSUE FEE o Ihave and MImaintain ace3wedmmf+re enttosoumforwoke canperwion,asprovidedfobySection 3700dthe Labor BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE Code, the pedam. ndweawhichk thispermit is issued. TOTALS----> 75. 25 0 . 00 0 .00 75. 25 75 . 25 . 00 ❑ I have and wit maintai workers'compensation insurance,as required by Section 3700 of the Labor Code,kr the performance of the work for whish this fermi'is issued.My makers'compensation insurance carrier end policy number are: Carrier: REVENUE DIVISION TOTALS--> COLLECTED: 75, 25 OVER/SHORT: .00 Policy Number. BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK (This section need not be completed I the permit is for one hundred dollars Al ml or leas) 74 , 75 . 50 )0 I certify that in the performance of the work for whioh this permit Is i- ed,I shall • amploy anY Pe any manner se as to become subject to the waken'Campensstionlees d Cal4om'- • ag-. t ' I should 5-• bjed to Me woskea• *****M•*******************************************k****jf*3I**1E****1ECE*4EW**1F*IE***** aunpenaation proveins d Section 3700 d the labs Code,I Dasa. . INDIVIDUAL F E E BREAKDOWN Date: Applicant: / 4I . 4 4. �I a . Warning:Failure to secure worker'compensation coverage Isunl I,and shall sub/sct an. .,.•foyer tocdns penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST dell fines up to one hundred thousand dollars(Sf00,000),M addition to the cost o/compensa 04 damages as provided for In Secdon 3706 of the Labor Code,interest,and attorneys lees. SFR 3000 ALTER BY VALUE RESIDENTIAL NOZONE 1 .00 3, 000 .00 CONSTRUCTION LENDING AGENCY:I hereby,farm under penalty of perluy that there is a construction lending agency for the END OF FEES performance of the work for which this permit is issued(Bodkin 3097,Cy.C). LENDERS NAME: LENDER'S ADDRESS: I canary that I have read this application end slate that the above information is correct.I agree to campy with ell ply 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. JOHN HUMPHREY / mNam81-14-1997/18:52 AM/$75.25 4 /ASRCa 081149 �i 7 _44 a e as Dale: 7 PERMIT Signature of•' 'r/Agent/App i t/Contractor - (5151 i' P) While-Building 8 Safety:Green-File:Canary-Appicant:Pink-Revenue:Goldenrod-Assessor CONSTRUCTION AND PLANNING , x_ • POC SgA Date Inspector Date Inspector i APPROVALS Permit # APPROVALS Permit # a 1, Temporary Electrical Service or Pole. - 52. Pool & Equipment Location I • 2. SO Pipe-Undrgrnd. 53. Steel Reinforcement =E Electrical Conduit Utility-Undrgrnd. - 54. Forms r -^'r4:'Electrical Conduit-Undrgrnd. 55. Electrical Bonding _ . ;!15Seel Reinforcement56. Rough Plumbing & Pressure Test ,, 6/Electrical UF ER Grnd. - 57. APPROVAL TO COVER-GUNITE tr r`'7'; Ftings 58. Electrical Conduit-Undrgrnd. Dsa_•Eoundation 59. Gas Pipe, 0 Undrgrnd., Test + 1 , -,..mer. =% N ter Pipe-Undrgrnd. • 60. Backwash Lines, P-Trap, 0 Undrgrnd. tD. Stc ctural Floor System _ _ . 61. APPROVAL TO DECK • ' 11. Pr scerty Sewer Line & House Connection 62. Backwash & Receptor-Final I 12. Sewer Cap . 63. Heater & Vent-Final • 13. R df Drains 64. Plumbing System - Final 14. Rough Plumbing to 65. Electrical-Final i 15. Rough Electrical-Conduit b 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 1 19. Rough Heating& Aiirr. Conditioning r-.� < r - FIRE_ DEPT. REQUIREMENT I 20. Mot! h F�-ntory Fr lace r -7';tri.,.. ''..7..1 'r O C' F APP O LEG Permit # r '" r .., Q `II L�` S L^ •C. t H c a (, SLS+., .6.. -. w !- «. - '.•.. .j - - 1C• ,- : tv 21. &iucl'&,in'Strtrtucei n . •• •- --iS z C -+�: 70.�Underrgroti d f3, dro 22. .Duds, Vdittil in ;= 1 :J. S a:? 71. Produce' inin ri as �70il : , . j I (J x: 0 4 7 E•:ra 9 23.`Gas Paperllo -. & Test __ S '- m t - _ --t- 72. Underground Photo X :- 0 24.(RooFr31hing' ?x I €-±- > d ri ti-f . 7,3; Undergrrld.Sts a eL7an4' 0 Gas (_Pail a -u Y V: :(I V wv. S v +-.r v 25. Roof-Sh gthing IC-„-:: n: v v-r ' Cu ; t 741:-Overhead Hydra •t: C r l-1 r. .- . r7 26.C -BSR Ceiling (Str6eTural) & I�QiS�l;oat - O ::-.9 r Et-11: 7E. Dry Chemical L. 17" }''.' '-' v `, 27, ram a FI shin �' W x t^'LI 'r'� C.,2_ .: m t- .� 4a ^^:� 76. Dry Stardpipei-•r7. - - 28. LatangSiSiecngQ; r.- '^C: ,s11242:-.T". 6,64.4---.7 ., FIXED5- YCcT4'!'FINpp'_ - 29. Insulatign 0- 6: c S .. .- > -t _ ,I - _ .� ✓ ik 7� RIVALFIRE PREY. RIVAL o 30. Drywall Nail trig T'': - V. I �_K r- '--tEAL1P DEP tREOUILMENT 31. Plaster Browrr;CoaZx S ,, r `y Z Y� /-7 tr '79. FINAL Lt18PEC'I110N , . . 32. :ElectricaPPovi+�er r etef F4pal i ` N ! h t' 801 FOOD CERTIF.tEATE t�USEQ m 33. •Final-Ele`g'tr. 1 'u r I C' x ;^ rt. tr m '..t rc i r: r- •,i ` I Ix • Notes: J ,--.a1 t - 0 ti:m x e.: . tc .. . « � t r it 34.tFina•£Heatin ( ,7...:.... rConttiotlir' iS r; ; k =. S r.w x s Gr- 1• 7: 1-4 :.. V r, i1 m X 1 1 tr t'- r1 I r- Q K '" 35. in 1'Gas.Pip`e"Testx -7 I r' L , s; 5 .. - ,.) 36. Hood orr-anopy >' i v , Tom, - C- I I ,z I C P Cr r 1,1 -rc, , C-m u I I t* r: :0 ;: R• j-'- C X h1 I S R' (1 4 m - x' \ '^.�--t.. ., 37. -E.ina(:Faetory Fireplace , Ff.- :•, a: I r _ 1: - 38. FinaYPlumbing C.t -v • e--. 1 1 r` S r• r cl a-- 39. Water Selwice.-Final s` S x k'' - " tet' �. C. L. „40. Gas Service-5rnalte •c;,:- r S. >: r•. I !X s. Ci _ n .• _. . rlti .Th r...1- rn s I .q -'S , ✓~; 41. Solar DoriiestibFr'Ra S it; 0' ,,.., --:v * S - �• (., 1. r- - w S I 42. 'Backflow Preventers N .r i A tr, >F- Y r% 43. Backflow Irrtipti441/4 ,• * n - • Jv V.J. ` - :44. -'• Landscape_ IrrigationSystems_ LT'C; I.T. -x m C C 0a: tftC• s:� a is - ! G C X ^ T % C a: c . I.- - ,- Y -Qt-. r^ X' 1 (- c-,is ;• F' F t' '7J 4".ti. 1: . d5. ,Sound A,ttentiation; .. .. x ;t n7 .t.s F 'X r• • Li * • rt S 4. 0, :J .. 46. HandicapRegulatior s a tr cc •S CI S I- X 4 1 1 .t. e... Frio, C.: .5 - 47, FIN L STRIJOTUIi�E & BU14?DING -��-�"� '-�/�i 5-; * F n C 48. .E•INZL PLANNINGs i r+t-- r t I ;i rn 1: .- �. -.. k _ I1: r r, " S -t v 49. • �i Elec felease to Edison x. iI I t'• • -- .. - -r l 4F r C .L , X •D F. 50. -Gas Release te'Southern California•Gas Co .t- I I "' t- t-+ r s C • 51. CERTIFICATE0F:O00UPANCY t T ) r -v.::: 7- - No Date et ADDRESS OF BthL INO: 1620 SANDALWOOD ST D"T' CITY OF COSTA MESA — BUILDING PERMIT OWNERSIA:IEIFIINOMN: HUMPHREY, JOHN V 3RD PERM NO: E 081150 AD0NESS HUMPHREY, SALLY A 1620 SANDALWOOD ST PERMIT NO: E 081150 PLAN CHECK NO: N GOVT: N SUPP: N OSTA MESA,CA 92626( 714 )751-6552 APPL.MMUNG ADDRESS: CONSTRUCTION TYPE: V—N PERMIT TYPE: ELE PURPOSE: OTH ARCNRECTOR ENGINEER: LIG No.: JOB DESCRIPTION : REPLACE 9 WINDOWS/1 NEW/STUCCO PATCH SQ FT: ARCS OR ENG.'S ADDRESS: UNIT: CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /U-1 CONTRACTORS NAME: CONTRACTORS MN= COMMENTS: REF B— 81149 ADDRESS: EO NO.: ******************************************************1E*********************ik$55 UNIT: ZONING REQUIREMENTS LICENSED CONTRACTORS DECLARATION:I hereby affirm under panty of perjury that I am licensed under provisions of Chapter 9 SETBACKS (commencing with Section 7000)of Wain 3 of the Business and Professions Code,and my license is in full force end effect. CITY LIC.NO.: UC.CLASS: UC.NO.: EXP : MAIN BUILDING ACCESSORY BUILDING Date: cerdnao 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 dhnn under penely ci perjury that I em exempt horn the Contractors license Law for the anw;tg reason(Section 7031.5 Business and Professions Code:Any city c county whim requires a panne to conamal,alt,,improve, PARKING RE : PROV: PARCEL: 13921208 Z N E: REF NO: smash,«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 PLANNING N TES> Business and Professions Code(or that he or the is exempt therefrom and the beam for the alleged exemption.Any violation of Section > -r 7031.5 M any applicant for a permit subjects the applicant to a civil penally of not more than five hundred dollars($500)). ******************************************************************************* ❑ I.as owner of the propenyor my employees With wages as their sole compensation,will do the work,and the structure is not intended D E V E L O P M E N T S E R V I C E S A 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 loan owner of property who builds or improves thereon.and who does such work Nmseff or herself or through ha or her own employees,provided that such pr imovements ere not intended or offered for sale.ff,however.the building or improvement is sold within one year of completion,the ZONING APPROVED BY a t • DATE: , owner-builder Will have the burden of proving he or she did coimproveosd t build or for the purpe sale). I I,as owner of the property.am exclusively contracting with licensed connectors to contain the propel(Section 7044.Business and Professions Cede:The Catnedwith cin'ors License Law does napply to an owner property with or improves thereon and who BUILDING APPROVED BY : DATE: ds contracts for suprojects with a contractor(s)licensed pure to IM License Law). � /❑ lameem+ual«Section: e. APPLICATION ISSUED BY: DATE: ********************************************** E******************* ***YI* 3*I * * Date: Idohereby caddy that lemaware dand understand the requr tsOfCalifornia Health and etyCode Sect' 25505,25533,and LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT: N 25534.and that ler any Mum building occupant will/will not(ci one)need to comply with ' date codes the requirements for apenn for construction or modification from the Air-0 WEltrnagement District.Residenlidcondrudunapplations are exempt from these BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING provisions. PERMIT 1 .0 0 Date: Applicant: 50* SM I P/NON—RES WORKER'S COMPENSATION DECLARATION:I hereby affnn under penally of perjury one of the following declarations: ISSUE FEE 22 . 00 ❑ (have and wDerfinc thewdmrhito thismuniswakes'courtperwatian,eaproddedf«bySectnnS700dtMlabar BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE Code,for the performance of the work for which this permit is®use. ❑ I have ed ail maintan workers'compensation insurance.es required by Section 3703 at the Labor Code,for the performance of the TOTALS----> 1 . 00 22 .00 0 . 00 23. 00 23 .00 . 00 work for which this permit is issued.My workers'compensation insurance ant,and policy number are: Carder: REVENUE DIVISION TOTALS--> COLLECTED; 23. 00 OVER/SHORT: .00 Polky Number: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK (This section need not be completed I the permk is for one hundred dollars($100)or lase.) 23 . 00 )❑ I eerily that in the perfomence d the work for which this wnmit is issued,I shall ltd employ any eeee����pppp=77:::1; in arty manner iso es to become subject to the workeri cernpenWion ler of C and sprues h g l ahold eubjed to the worke ******************************************************************************* compensation provisions of Section 3700 d the Labor on with(Mee prow INDIVIDUAL F E E BREAKDOWN Date: A Warning:Failure to secure workers'compwwdon coverage Is I,and shall eject an foyer to cd penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST civil lines rpt to one h«,dred thousand dollars(5t0 4000),In •Ilion to rhe cost of co f/o4 damages as provded ler/n Section 370Golthe Labor Code,Interest,and atoey'siNa. ELE 1 RECEPT/OUTLET 1 ST 20 EA. 1 .00 1 .00 CONSTRUCTION LENDING AGENCY: I hereby affirm under penally of perjury that there is a construction lending agency for the END OF FEES performance of IM work for whim this permit a issued(Section 3097.Cir.C). LENDER'S NAME: LENDER'S ADDRESS: I certify that I have read this application end state that the above information is corned.I agree to comply with all city and county ordinances and state lawn relating to building construction and hereby authorise representatives of this city to enter upon the above-mentioned properly for inspection purposesA. � Ad N HUMPHREY 81-14-1997/18:51 qct/f23.8B 'ar�� % . ✓ Date: /�/��7 PEkMIT T :81 8@28444 gnalare d OwnerlAgenvRpplandDomrad.4 '981 150 (5151Ja.WP) White-Building A Safely:Green-File:Carry-Applicant;Pink-Revenue;Goldenrod-Assessor ra r. . CONSTRUCTION AND PLANNING x pc & S ., co Date Inspector Date Inspector APPROVALS Permit # , - APPROVALS Permit # 1. Temporary Electrical Service or Pole - 52. Pool & Equipment Location - 2, Sdi Pipe-Undrgrnd. 53. Steel Reinforcement • qt.-_3;-,Frjecirical Conduit Utility-Undrgrnd.' _ 54. Forms • ,'=Electrical Conduit-Undrgrnd. - 55. Electrical Bonding • ,jtr.5•,�j Leel Reinforcement56. Rough Plumbing & Pressure Test 0. 6.•'Electrical UF ER Grnd. 57. APPROVAL TO COVERGUNITE a _ 7iFiw - W4ings 58. Electrical Conduit-Undrgrnd. lcT D_B-i F_nund ation . 59. Gas Pipe,0 Undrgrnd.,Test- >,ri er . C=9,r Iyaier Pipe-Undrgrnd. • • • 60. Backwash-Lines, P-Trap, 0 Undrgrnd. • -+11'0. StrFrctural Floor System • 61. APPROVAL TO DECK • 11. Pr©perty Sewer Line & House Connection . 62. Backwash & Receptor-Final -. 12. Sewer Cap • 63. Heater & Vent-Final ' • 13. Rodf Drains . 644.' Plumbing System -.Final . . 14. Rough Plumbing to 65. Electrical-Final 'i: - - 15. Rough Electrical-Conduit rr 66. Solar System-Final 16. Rough Electric Wiring gilt's- )--/K lA.6i 67. Fencing.& Access Approval 17. Rough Wiring Sign yJJ Y.�- (- Y�l��, 68. APPROVED FOR PLASTERING • 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL . ' 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT a 20. 1$ou6b FL.tori Fite4• lace ' Sr,- < * ? r- 9* 'APP(OVgSrci Pgmit# * 21. bucFst intStrtnturer « i •• •• .' S O `t 70. 'rJndergf6 M 1 I-kdro x r- r- c x c._ .-, r,y, -.., r_ 22. Duct?, V&,til ingt�t i. 1 `- N * c < 0 E.r: < 71. Produ Figing!2as Cie Oil 23. Gas Pype- oug-f't & Test r•;'_. r rrl r 'C G* H 72. Undergr&irtd F4tic'a ii- c- H. t • t--.." C '� r^. C S-s , _--Iv 24. 'Roof raining' [a W F+ i~ r .• O b - 7; Under r d.Stoy� e Tan {O Gas ❑til r. to x: ~ Q i_.,',1„. 9 ij Ce�, ijr r *. V %,:4. S -'c-I a 25. Root.Shetthing .;.« 2. v v* ill O >_ n;:s 7C Overhead Hydr6S « e .-. .7;-r S r*' * 26. -BarlCeiling (Str Co tr Coral) & NF.z.. oat * p C'7 7 Dry Che131ical F� H -J* icy * cc 3 F- .-, c 2, * _ i ' 27. Frame ari& Flashing;* ;•xc, *.. e 0* 76. Dry Statiatpipe:-m : _ on .rte ,. C- - 28. Lathing &'Siding C. c• �4� ^ * £ "I 7g FIXED •`YSTEj}15-FINAT ,., r, - 29. Insulatio1 pig n �r `' S Hi -• •• 7t FIRE PREY. FINAL * i 47: .-::: 30. Drywall Nailing '` f `r I it'. - ALTS DEP7.FREQ"UIipMENT 1 iii a 31. Plaster Scowl-Coat T. sr" -. I I r1 7tM3P cd 7 9. FINAL ECY&ON :., 32. •ElectricaRove,r Met r'Pnal 1 r•N I +'. r• 8i''• FOOD CERTIFod{A?E I...S,�.IED r 33. "i naF.Ele frici-, m 1 w• /i 7IV{- Notes: t;,i+ �R7 # ;, ['1 u 34. 1FinaliHeating-& Air Eondrtionigz: f• I r.: I ; •ru •S 4-i= * S C ,r w .1 III a: P; '-loo c ! F-,C * ,-I 3 W -F i, ( IJ?. L-t : rim 't, rr ,J ii,. -GasjipetTest « 0 .. * F., I f: c ^0 p•-., r; pito 36. Hood•or;Canopy x % ' ;n'-t -' f j `r: < F r to * r n mot ti -... fir -Ir-Ir. - P: x t-I ' st=- w n I I* t I .� :Jr•: 37. Einal.Faetory Fireplace z r..t_- 1 t* w * ni rr i c. r I le C s w 38. Finat"PIu+tlbing w ,-n ! I .r: t' _ Il; 'J r I^ x I ¢ 't' '* ri _!r7 .c i.•., 39. Water'Service-Final ,_ z * co ( l,; :,J * r! s: '-- - 40. Gas Service-Final x r- CIT'r` S * [a : k L.,-., Ott c r: r1 r-,c. r. x E. • 0 F « ki y 41. Solar Domestic-Fina)K` S m •• * "' I - rt r -o c * ;c 72 1.42. E ackflow Preventer F N I rt. , - -1- r-. . -.- '.. * In rl0 * F., 43. Backflow Irri _tion ': SSS * « tt r O $? �. ii * G * C; i * i1 S - 44. Landscape IrrigatiomSystem t.rl E. 'r, * t'i a r_, =- c: n; N "-G 0 --' ' ,� r -c r44, r.-r rc < Ic•* Cl _5- `L t6 4r: r, S F, * _.t 1 r H 6., r_,'* (1 H i-, t:t=J x c. Y: 45. Sound Atten'tation t H ,• ,• 'I; -' t=: i;, �,, c, cr `- c, •• i-.0 * g6. Handicap•Regulatioris . . t a: 5 CC S -- � ,. r _ I. X '41 - C1 @ t 47. TiNQILSTRUTCTURE & BUILDING r : I I ,,*. -I RI i' u p 48. EIN.3L PLANNING; ' I-i - x i. I [�`�` Di C i*" r--- - - _ 3: ' 1� t' n 1.. S , =* 49. •Elecu-ic Release to E$ison ' " I It lx. I * • .. .. I 'e t1 ,C •r. 50. Gas Release to-Southern Califmcrda-Gas Co t I * i-+ • ' F � �.c m x . - v-r. 'If'; * 1 C 51. CERTIFICATE OF OCCUPANCY mo x « i- c No Date 4L4r LrA. S , r aa • 1 II i i I 1 I i I illitirs i l'" L v_41 i + 1 — I { 1�/ t I ' ©' pi ( ! ti { T i I -----1-1-7-1 I �' HflMHJ — 1----1---T---i---4E-1--- I r ' Tw --�--i— I- -J, 1 1 - --- I ; + — I- 1 I I ! I j 1 I { i ; l — -----1---1---1-7-1-----1-----!---1 L — i , - 1 - , • ; I i , , _ { I I i I — — I I i i —r 1 f J I � I i — 7 — J f 1 I ! --I C� • i — I t — - -- - - — 1 ( { -1--- -1_ ' �- t- —� �- —1 --- i 1--- , I i - l - --1-- _j _4 -- 1 . , 1 i— _ �r ; --r _1 j— - ; j r L �-- !— — I i I I I ( I ` i !itthJftLtHI_-- ._---{..__- ._-_ -_-_ 4__ __.. _ _ _ I _ — -- I J_ I j h- 1—_1 1 _L L__ _ 1 1 r— i -i ' I � t! _-:- esicotior I I I I i I to _`ii adeuence Resort 7700 East McCormick Parkway • Scottsdale,Arizona 85258-3497 • Toll Free(800)528-0293 • (602)991-9000 A Management Property of International Conference Resorts,Inc.01986 ADDRESS OF BUILDING: 1620 SANDALWOOD ST WIT: PERMIT NO: B 074894 CITY OF COSTA MESA – BUILDING PERMIT OWNER'S NAME IF KNOWN: HUMPHREY, JOHN V 3RD PERM NO: B 074894 mDRESs HUMPHREY, SALLY A 1620 SANDALWOOD ST PLAN CHECK NO: N GOVT: N SUPP : N OSTA MESA,CA 92626 ( 714 ) 751-6552 APPL.SWUNG ADDRESS CONSTRUCTION TYPE: V–N PERMIT TYPE: STR PURPOSE: OTH PARCHRECT OR ENGINEER: UC.NO.: JOB DESCRIPTION : T/O ROCK & APPLY NEW 25YR CLASS A COMPO. SQ FT: 4, 250 ARCH.OR ENG.'S ADDRESS: UMT: CLAIM VALUE: 4, 250 . 00 CALC–VALUE: 4, 250. 00 GROUP OCC : R-3 /M-1 caxmACTDRSNAME: A 1 ALL AMERICAN ROOFING ( 310) 546-7663 cONPACTOR'SMMLRf0 5024 KATELLA AV COMMENTS : TIO AND REROOF / SMOKE DETECTORS REQUIRED ADDRESR LOS ALAMITOS CA uCNO.: 693307 *****' *******'K'*****+ *****'+E'*' ********************************+E+Eu-**+E*********+P*+B* 90720 uNT: 150 Z ONING REQUIREMENTS LICENSED CONTRACTORS DECLARATION:I hereby affirm under penalty of perjury that I em licensed under provisions of Chapter 9 SETBACKS (commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is In lull toms end effect CITY LIC.NO.: 065182 uc.cuss: C 39 uc. 46433 7 P: 06/96 MAIN BUILDING ACCESSORY BUILDING — /� �4FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN Date: Contractor FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN OWNER BUILDER DECLARATION:I hereby affirm under penalty of perjury that exempt from the Contractors License Law to the following reason(Section 7031.5 Busness and Professions Code:Any city or ty which requires a permit to construct,alter,Improve, PARKING REQ: PROV: PARCEL: 13921208 Z NE: REF NO: lemolsh,or repak any structure,prior to hs issuance,afro requires the applicant for such permit to file a signed statement that he or she PLANNING NOTES> a licensed pursuant to the provisions of the Contractors License Law[Chapter 9(commenting with Section 7000)of Division 3 of the • Business and Professions Code)or that he or she is exempt therefrom end the basis for the alleged exemption.My violation of Section > 7031.5 by any applicant for a permit subjects the applicant to a civil penaltyd ata more than five hundred dollar(35001). ******************************************************************************* ❑ I,as owner of the progeny or my employees with wages as thew sole compensation,will do the work,and the structures not intended DEVELOPMENT SERVICES REQUIREMENTS or offered for sale(Section 7044,Business and Professions Code:The Contractors License Law does not apply to an owners property I, who bolds or improves thereon,and who does such work himself or herself or through he or her own employees,provided that such improvements we rot intended«dieted for sale.N,however,the building or improvement is sold within«re year el completion,the ZONING APPROVED BY DATE: ownerbuiler will have the burden of proving he or she did no build or improve 1«the punpase of sale), ❑ 1,as owner of the properly.am exdusively contracting with licensed contractors to construct the project(Section 7044,Business and BUILDING APPROVED BY Professions Code:The Contractor License Law does not apply to an owner of progeny who builds« and w improves thereon aho DATE: contracts for such projects with a contractor-is)licensed pursuant to the Contractors License Law). / ❑ lamexempunder Se ions B.AP.c..lo this reason: APPLICATION ISSUED BY: •� `%I/ DATE: l�l iE it • **PLIC******ISSUE******* 40W-11 :541W ** **** ******DATE: * ** L * ** Date: Owner LEGALIZATION:N F E E S U M M A Y STRUCTURAL SEGMENT:Y I do hereby ceniy that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25513,and 25534,and that t«any Hoare building occupant will/colt not(circle one)need to candy wlh said state codes and the requirement for BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING a permit lorconstruction or modification from the Ai Gustily Management District.Residential construction applications are exempt from these provisions. PERMIT 72 . 00 . 50 Date: Applicant: PLAN SMIP/NON–RES WORKER'S COMPENSATION DECLARATION:I hereby affirm under penally of perjury one of the following declaration: ISSUE FEE o Ihave and will maintain acenNrateof consent toself-insure for workerscompensaton.asprovedoft ' idedforbyRion3700heLabor BUILDING–DIV–> PERMIT ISSUE PLAN–CHECK TOTAL PAID DUE Code.Ice the performance athe work for which this permit is issued. TOTALS----> 72 . 50 0 . 00 0 .00 72. 50 72 . 50 . 00 A-1 I have and willworkers' maintain compensation insurance,as required by Section 3700 of the Labor Code,leof r the performancethe }� work for which this permit is issued.My workers compensation insurance carrier and policy number are: Carrier LIBERTY MUTUAL EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 72 . 50 OVER/SHORT: . 00 policy Number: WA191041b120015 04 /01 /96 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN–CHECK (This section need nor be completed V the permit is for one hundred dales(3100/or less.) 72 . 00 . 50 o I ceniy that in the perormance of the work(or which this permit is issued,I shall noe employ any person in any manner so as to become subject to the workers'compensation laws of California.and agree that H I should become ed to he workers' SEIEESEELPUL**CPE**S*IC*IS*********PEEL*PPIEIIEE**************i i ********Ig ***** compensation provisionso $eehir5n 3700 of the Labor-Code,I hwnh ply with provisions INDIVIDUAL F E E BREAKDOWN ---- Date: /V''eY2^ /1 Applicant: 2,1 Warning:Failure to secure workers'compensation coverage Is unlawful, subject an employer to criminal penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST civil Biros rap to one hundred thousand dollars(St00,000),In add/tion to the cost of compensation damages es provided ler In Secrl n3706oftheLaorCode,interest,andatromey'sfees. SFR 4250 REROOF BY VALUE RESIDENTIAL NOZONE 1 .00 4, 250 . 00 • CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty of perjury that there is a construction lending agency ler the END OF FEES performance of the work for which this permit is issued(Section 3097.Civ.C). LENDER'S NAME: LENDER'S ADDRESS: I cenif that I have read this application and stale that the above information is correct.I agree to comply with all city and county ordinances end state laws relating to building constriction and hereby author ze representatives of this city to enter upon the above'mentioned property for inspection purposes. ANDY MARSHALL p 01 00193203-101' 3206 FrAY 72.50 //C owe:/b– -7-‘11-7LH?E: 20'2 /v. T?' E: 14:51 `._I//a /_ Date: 'immure of OenerlAgenUApplicent/Comractor (5151ae.WP) White-Buildkg A Safety:Green-Rte:Canary-Applicant:Pink-Revenue:Goldenrod-Assessor CONSTRUCTIONANDPLANNING POG_ .s SPA APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location • 2. SojJ Pipe-Undrgrnd. 53. Steel Reinforcement -•J3pE ectrical Conduit Utility-Undrgrnd. 54. Forms -47'Electrical Conduit-Undrgrnd. 55. Electrical Bonding '6-Steel Reinforcement., 56. Rough Plumbing &Pressure Test 6.•Electrical UFEFI4fmnd. 57. APPROVAL TO COVE R-GUNITE 77 FoGiings `• ;C 58. Electrical Conduit=Undrgrnd. A:: Foundation _ 59. Gas Pipe, 0 Undrgrnd.,Test r _ '-9..WSier Pipe-Undigrnd. `' 60. Backwash LineCP,Trap, 0 Undrgrnd. 10. Structural Floor-System _ 61. APPROVAL TODECK 11. Property Sewer tine & HouseConnection 62. Backwash & Recetilsor-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 Nlirintg , 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED F$R PLASTERING 18. Rough ElectricaiLT Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT r - r r - S U'HT;- c. r 20. `Rough Factory Fireglaca 7;T �: ' 2 : t. '-'APPROVALS-- Permit# , 21. .bucts, in,Structure _ f a- 70. 'Undergiound I- dro 22. Qucisr Ventilating_cTj r• te•{ t3 71. Product ging'OGas b Oil 23. Gas Pipet&oug & Test _ .. ttr.I r r h . UndergrOundFl ' 72Hugh'. r 24. Roof:Framing* - "' t T T , ,x - 7t3� Undergrnd.Storagg tants;t7 Gas ❑Oil 25. RoolSheathin - ^ :.t0. "J .. 9 , ? t T/01 991 • 74-Overhead Hydro - _ k 26. T-Bar'Ceiling (Structural) & Mct1 oat �j r_. - - " y :"_ -, ,,, t• y 7E6hy Chemical _� - r 27. Frame an Flashin' - r '' - �_ .. .. d - .: zm r' 76. Dry Standpipe i-c.. I - . 28. Lathing & Siding -- ' = kt.---. -• " -'i' 71, F IXEDSYSTER`�FINAL _ -- 29. Insulation ' . . - •• - • - 78. FIRE PREY. FINAL 4 M '- 30. Drywall Nailing r , i F;• • ��yEALTti DEP�','REOUl9EMENT --, 31. Plaster 8 own-Colt cnn- i < r- 79. FINAL INSPECTION r i . 7• --S ' ; 32. 'ElectricalPover Meier-Fig& ' x CV :* t"1 80;: FOOD CERTIFICATE I$S�JED . _ r . •, I T. • ._ 33. Final-Electric �;, c.' 'z ~ Notes: �I -+til 34. Final Heating & Air Conditioning -c * r c- r cT, ,r a -":0 35. :-Final Gas•Pipe:Test.. 0, :tr. _q. 36. Hood or Canopy -• - •' • !. s • .c' - -_ 37. Finai:Fadtory Fireplace>. c.r ., a-• 2' -- - 38. Final Plumbing . 'k z- _ 'I' C. • , 39. Water SetVice-Fina( _ r • r . 40. Gas Service-Final k •-• - ' - • c kr, j�o•. 41. Solar Domestic-Final Id r• 42. Backflow Preventer - a -. - 4 r 43. Backflow Irrigation �;' ' r it' r _ _ ' i44. Landscape Irrigation,System --••-:r. - 1 -, J •-, t1;70 e . ', ..;." _ -- IV ._ • _. _ F-.s . N r ry kr 45. Sound Attenuation ' '-i Y.. ,. t- •At .Il :;' . " 46. Handicap Regulations = 47. F1NTa{j.STRUCTURE & BUILDING /i&-?_ 6.44 , _ j . er - r. 48. FINAL PLANNING= • . - f"-' - '� r '+ `r - -' - r 'k i . i.. Ci - k 49, Elecffic Release to Ed•ison • ' 50. Gas Release to Southern California-Gas Co - r .51. CERTIFICATE OF OCCUPANCY - •• = No. Date ' /11111.76411.11111, ! sr -G - Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. Sal • PE IT NO. . : TRACT NO. LOT NO. UNITNO. 9661 ' 12/31/06 I53.6%. TIN CITY OF.COSTA NlE A _CONSTRUCTION PERMIT —2.— C/ LO^ q t Prdec�Address • L• f7 ►,LD W oab Applicant's Mailing Address TYPE OF CONSTRUCTION U NEW LJ IA DD LI ALTERATION U REPAIR f - .y�� / • ■ [- r_� ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P-# •2' 2 p Zone z� OOvner's Name -.1•V• V�'�p Phone"7S ' lY d _ / 3 Cr 0 v /` \1 DESCRIPTIO • . W•RK/USE OF : Address ' Lib Rp,KTOal lel 00-9 Cc st/4 I��'�� / er (at/ �•�i mss__ ai(/E Sra S A�iR-BuBd^t9: /2M /1c©0/'J-/p.0 Accessory Building: Z Arch/Eng. License No. TYPE OF PERMIT I GRADING = FOUNDATION Ex STRUCTURAL T Front A,T ' l 0 • Address . n �s '/) ` 'CITENANT ELECTRICAL ❑ PLUMBING El MECHANICAL B Rear 7• y / / N Contractor's Name 1 w� l.:I/` /'+ Phone S`1 1�k�1 ❑ OTHER lQ� Z9 C Right [f!a _// ° N Address(mailing) ty, O E"i+ l C N'T�J�'� PROJECT DESCRIPTION SQ. F•'77'-�Gl OCcupAN V /'C•� K G • ^`/S/ CONSTRUCTION TYPE �[ VALUATION $ �/ ) $ Left 9'/ -wq City Licen Se No. CC//WW :ZONE GRADING CU.YDS. ACRES R LICENSED CONTRACTOR DECLARATION • - Ping. Ref. # Parking Req./Provided E ci I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: { �jAt ���� M with"section 7000) of Division 3 of the Business and Professions Code, and / /Y-_J /t my license is in full forceitao• effect. [�! C s C['�(-L- �C -C+ /��./ -i��j �r � ,moi / \ T `•}V• License Cla �j( t_ I I se No.22 + • (/— v !7 V [ G -(! ` ./ _ $ I Date 12_'1�ois Signature , i - . _ ' - V PLUMBING I FEES _ WORKERS'COMPENSATION DECLARATI•N ♦ Bar Sink' Showers ELECTRICAL FEES I hereby affirm that I have a certificate of consent to self-insure or a certificate - of Workers' compensation Insurance, or a certified copy thereof (Section • Backflow Preventer Service Sink 3800, Lab. C.) Automatic Washer Transformer0 -1 15-50 KW • -- PP�olicy No. Company_ Backflow Irrigation Sewer Cap _ 0 50+KW - N y Certified Copy is hereby furnished. COnStrUctiOn POIe$ub. /K-`l Certified copy is f d with the city Bu sng �Iygy�i& Bathtubs Sewer Connection Cooking Unit Meter pup to 100 amps Date 1•2_,-3/6-41,„ Applicant C. =�/V_C'-���' EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors • Dishwasher Meter Dover 100 amps . (This section need not be Completed if the permit is for one hundred ($100) or r less). Dishwasher Solar Piping Dryers DGas ❑Electric Sub Panel I certify that In the performance of the work for which this permit is issued, I - shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Fan Motors❑0-1 HP ❑1''4-8 Workers' Compensation Laws of California. Date Signature Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar 09.15 HP 016-15+ NOTICE:If,after making this declaration,you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal I� Fixtures comply with such provisions or this permit shall be deemed revoked. Microwave O Zo CONSTRUCTION LENDING AGENCY / Gas Service / Outlets Water Closet 2 • Device Boxes Pole Light 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.) Interdeptors Water Heater • • s� Outlets Range` / 6G Lender's Name c — Lender's Address Kitchen Sink' Water Service / Switches aSign O z0 OWNER BUILDER DECLARATION _ - I hereby affirm that I am exempt from the Contractor's License Law for the - Lavatories Auto-Wash • following reason (Section 7031.5 Business and Professional Code: Any city or Garbage Disposal Standing Sections county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays - Generator ❑0-5 KW❑5-15 KW any structure, prior to its Issuance, also requires the applicant for such permit • Trash Compactor 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 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 en alty of not more than five hundred dollars($500). • I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 compensation, will do the work,and the structure is not intended or offered Reinspection Fee I $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES License Law does not apply to an owner of a property who builds or improves / ' thereon, and who does such work himself/herself or through his or her own - Hood or TypeDEVELOPMENT SERVICES REQUIREMENT ( /n / employees,hprovided that such improvements eves tie not within or r of c for Boiler ❑ Zoning Approved By Date a pleti If, however,wthe wilbuildingntisone yearIIwill the burden Of proving he/she did not build or im- Duct-Under Ground Building Approved By Date // prove for we purpose of sale). - i2`3i eg ❑ t as owner of the property,roject t 7 44, sinesscontracting with licensed con- Duct-Structural Refrigeration System Application Issued By Date (O hetors construct the project (Section 7044,Business and Professionsf Code: ❑0.100,000 BTU ❑100,000 BTU The sContractor'smproLicense Law does notgraapply to ran owner projects e isproperty who Duct-Ventilating SU AR OF FEES builds or improves thereon,and who contracts for such I t5 with a that '7 tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple 0 System Repair/Alteration • BUILDING PERMIT $ �• SMTP $ O•6/ proof of their Worker's Compensation insurance should be provided to me. `1 PLAN CHECK $ S-42. 8Z PERMIT . O 1 am exempt under Section —B. $ P.C.for this reason 7 Firepl/Fact.Bit. ICBG#25 fe Fire Dampers T COPLUMBING $ S,co ISSUANCE $ HeatingSystemDucting RegistersPLAN CHECK 25% $ O5 So ENERGY P.C. $ Date Owner & I hereby certify that I have read this application and state that the above 00-100,000 BTU 0100,000 BT ELECTRICAL $ S So GRADING $ Information is correct. I agree to comply with all city and county ordinances _ 1 tate laws relating to building construction, and hereby authorize repre- PLAN CHECK 50% $ �• 00 MICROFILM $ as of this c to a eon the above-mentioned property for purposes.\ _ 12_•,� _ MECHANICAL $ .74.6-0 TOTAL FEE $ /s7 ' .62.m C"License or SS of Date Reinspection Fee I $15 Issue Fee $ 3 PLAN CHECK 25% $ /r l3 v.10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING POOL& SPA • r, APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement x 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4: Electrical Conduit-Undrgrnd. e . !!! 55. Electrical Bonding 5. Steel Reinforcement 1/13)47. /if/47. 56. Rough Plumbing & Pressure Test • - 6. Electrical UF ER Grnd. 01,7 "`••�"'/ 57. APPROVAL TO COVER-GUNITE 7. Footings i J/ ti 58. Electrical Conduit-Undrgrnd. 8.'Foundation / 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final ' 13. Roof Drains" 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final - 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiringa-a•SL1'1 A/ 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 34"-W? tWO FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace 3.:S'1(7 L.40 APPROVALS Permit# - 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough& Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tanki0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoaf 1 / �/9 75. Dry Chemical 27. Frame and Flashing 3//J� /Y/ 76. Dry Standpipe 28. Lathing & Siding 777 l6�rr/ 77. FIXED SYSTEM FINAL 29. Insulation 3�//�? 78. FIRE PREV. FINAL , 30. Drywall Nailing f fff77!///"'y� HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat ' //z/7 �% 79. FINAL INSPECTION 32. Electrical Power Meter-Final + r /`�1 80. FOOD CERTIFICATE ISSUED 33. Final Electric 14n C41 Notes: NW" 7 FOY 34. Final Heating & Air Conditioning 5/j tj CA!' /� i �� 35. Final Gas Pipe-Test �] LED ifil4 1%1 at 36. Hood or Canopy 37. Final Factory Fireplace (01 G0 - 38. Final Plumbing r'7 ( , , 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final • 42. Backflow Preventer • 43. Backflow Irrigation 44.-Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations / • 47. FINAL STRUCTURE & BUILDING .5.07 ' ' 48. Special Requirements Completed / • /' 49. Electric Release to Edison 50 -as Release to Southern California Gas Co r 51 RTIFICATE OF OCCUPANCY _�. No. Date I INSULATION CERTIFICATION a 1620 Sandalwood Costa Mesa nrnnr5o Number and Street City County • Subdivision Lot Number DESCRIPTION OF INSTALLATION • ROOF Material Brand Name Thickness (inches) Thermal Resistance (R Value) EXTERIOR WALL Material Fiberglass Brand blame Or i Thickness (inches) 32 Thermal Resistance (R Value) 11 CEILING w'. L Batt or Blanket Type Fiberglass Brand Name Oc Thickness(inches) 61 Thermal Resistance (R Value) 19 Loose Fill Type Brand Name Minimum Thickness(inches) Number of bags Weight per bag lb. Area Covered (ft2) Thermal Resistance (R Value) FLOOR,ELEVATED Material- Brand Name -Thickness(inches) Thermal Resistance (R Value) FLOOR,SLAB Material Brand Name Thickness (inches) Thermal Resistance (R Value) Width (inches) FOUNDATION WALL Material Brand Name Thickness (inches) The,"loci resistance (R Value) DECLARATION • I hereby certify that the above insulation was installed in the building at the above location in conformance with the current regulations setting Energy Conservation Standards for new residential buildings(located in Title 24 of the California Administrative Code). Forcier Construction Company B-1 Lic. #270785 General Contractor(Builder) License Number • 5-7-87 Signature and Title Data ai,C9Mt/PR -Tr6,Sir 2,615i/IArrnir/ - _ 1.4a9?9 Sub Co (Insulation Applicator) License Number ///� ` /ir- 7Luice%1 3-11-87 Signature and Tit Date r • D S m . A 2-9 71- / e r�tiD�s \� �`l73 T �lwoo) S . c A an oz • /] . 1 -, 9 V! 1 /_ __ �YJ L 1 / I O I , °ni I .� i _ _ _ _ !/V � � ,: iw Com' i ^ n f F 6Zr i / C, r rC' r /r�lZ G �Z I -I - - is:-. • um 0 en lG�/ �, iGZ0 l6 /6 o � . ����.n�o( �.�oo �' �h�vrair(wooa . t.) .5AL ADkaa,1 S,L R9 3• 0 4) • D '' O • 3 n ( hey/ 1 :islet-. shZ-5 Fr f 8A-Le.p 51- fxa �'�/o 721--4.- G/r c.-1.... aGG/.17- rj G , .Co Fc.!�y D w.d.ai .-r \ ttot �L . / 6 i 'L, S.,1-,./.e,A-,i�..,O0a Gi✓its Qo„jS,--J✓— "YJ ,Bh a c oc.c.c,.,a-vL co S. 0 e aoA+ M.a / co/' y 1..✓4 • /i- C'O.l jf�i /S .✓aT 6.c/a: • f7 TUf-1'iz- ...ii+-c.L- L ..--,/6 �, 6...7 c.L A/ie/ / e.l o..!e — o.✓.' ,l�` eel_e y !,•✓.rte o-✓ /G/6 S.'?A/-0.n-4-s a. si A I Arnar-iStone Laboratories inc. 0. �. . 4 I Vs 3 � N ' ��, — r ----\ C-: - _ _ \4`` 1 — o) ---._ t.. • 1P * \ _._ ". — . �' -t- 1., h • X �; --\-1 W -� 1 - ./. 3 O2 C.1. � ��oNs 1 �. ��� -I w 7j[ liCACt. y• - �y t .: r0 601 EAST KENSINGTON ROAD MOUNT PROSPECT,ILLINOIS 60056.U.S.A./TELEPHONE 312-255.0300/CABLE ARSTOLAO 1.6, 3SIDIARY OF AMERICAN HOSPITAL SUPPLY CORPORA HON I a . a - A Arnar-Stone Laboratories Inc. S A_ 2. i • • 4 `' 6/ 711C_ + rJ£.vtC_i ,,z j •a n.� ' // / • J `I ov12 /�20y9�rt. 1. /as •rGrrk.i ' 7- /v"toll 4-frtti/ ,Y 17£g x007" ��- cTS , / ' ()_ (L y� 1'l r (T- U ( / f2 he ,7,-Lt r[hwv." /G7v' Sit'nb./lvoeb 5.A. A;/6 �� - 979-723a 04. eo5tsq G/c "� C.A F� 94L4.07_\ re, -7s/-4.S-semi y - ' G - / ; ✓ �CL GL� i'� / Y .7 —� � J ,2p7 vGrlit'cJ to /b .0 V / 1 0 � aXwe?u i tee, er�cz �rj ^-2e i co 57- 1-7esa../a fy� – ���� 75y -- ? ? 7z 61,Q 62G 3-Y6-9SoV 2i / % 7 _ ri 7 ,2/ 1;;73 �e '-i‘' ,t7 Sy?0162_ •v22 GV s f 77 - 601 EAST KENSINGTON ROAD.MOUNT PROSPECT,ILLINOIS 60056,U.S.A./TELEPHONE 312-255-0300 i CABLE ARSTOLAB SUBSIDIARY OF AMERICAN HOSPITAL SUPPLY CORPOPATION APPLICATION FORA BUILDING PERMIT BUILDING PERMIT NO. Electrical co Tract Block Lot Permit No. C Building Plumbing S. Address // __// SO / i ^ Permit No. al r ,,tt fr Cross / / / Mechanical G Area (4Af -SI I/£WD� Street ei9 /!/tcr, ori Permit No. to Owner ":To o vlh tC . /kat6✓et .e; (-// ///777��,ttt'rr••x"""'^^^""" Type of Project: New 0 Alter U Addition # Address /6 1.-.0 saI fru()0, Q1on lJ Sr 0 Repair ❑ Convert ❑Demo 0 OC pancY Pmt. City C€ 4.44,g_/44 f s� Zip/x2z Phone 76-gs.Sp_ A.P. SUP.Dist./ UP.Insp.Area 'chitect/ Zone SPI.Pmt.N.. signer License No. Setbacks P/L Front C/L St. Street Width Address Yards Left Right Rear t City Zip Phone I Eave Rol. Leff Right F.P. ( ` Engineer License No. C parking Spaces Required Provide Covered �0. Address T m CityZip Phone Struct No.of No.of • Height Stories Family o LICENSED CONTRACTOR'S DECLARATION Park Fees H Yes Fee co m I hereby affirm that I am licensed under provisions of Chapter 9 Required No C.T. Receipt L (commencing with Section 7000 of Division 3 of the Business and Zoning Approved By: Date ♦• Professions Code,and my license is in full force and effect). License Class License Number - - - _? Date Contractor Misc. E Address Proposed Use of Structure Li. City and Zip Phone to CONSTRUCTION LENDING AGENCY OA N I hereby affirm that there is a construction lending agency for the 0- •erformance of the work for which this permit is issued (Sec. 3097, Occ. Type Code iv.C.1. - Class Const. Year y - vender's Name USE/OCCUPANCY SIZE SQ.FT. E Lender's Address J OWNER-BUILDER DECLARATION Y I hereby affirm that I am exempt from the Contractor's License Law 1. 1e fq/the following reason: I, as owner of the property,or my employees with wages as their 2. c sole compensation, will do the work, and the structure is not « intended or offered for sale. ❑ I, as owner of the property, am exclusively contracting with 3' licensed contractors to construct the • oject. • ✓ 0 i a e nder Sec. a '.&PC for i s reason 4. a Date� a(Hyi' Owner l719. . • • . /- - - - AI / E RKERS'CO 'ENSATION DEC ARATION Total Valuation 3 I hereby affirm that I have a certificate of consent to self insure, / ❑ No or a certificate of Workers' Compensation Insurance, or a certified Encroachment Permit Require d ❑ yes c copy thereof. Grading Pmt. Grading 3 Policy No Company Required ❑Yes c7INo Pmt.No. 'Q 0 Certified copy is hereby furnished. Rough Grading 0, 0 Certified copy is filed with Orange County, EMA. / re Q Approved by: Date Date Applicant / 3 CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE / Z (This section need not be completed if permit is for $100 or less). C I certify that in the performance of the work for which this permit is 3 issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California. / PERMIT FEES re Date - -- Applicant NOTICE TO APPLICANT: if, after making this :Certificate of Structural /$ Plan Check $ Exemption, you should become subject to the Workers'Compensation provisions of the Labor Code, you must forthwith comply with suchSpecial Electrical provisions or this permit shall be deemed revoked. $ Invest. $ I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO Plumbing •$ COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS RELATING TO B LOING CONSTRUCTION,AND HEREBY AUTH- Mechanical / $ O- REPRES- TATIV OF THIS COUNTY TO ENTER UPON E • :•VE NTIONE ' PROPERTY FOR INSPECTION PUR- Re-Grade 'OSE' - y Inspection $ � i44,a1 • a� G Pre-Grade Permit Si. ature of Applicant •r Agent a 7'9� Rec.No. $ Issue $ Print Applicant's/Agent's Name Issuance All spaces within this box must be completed to process Plan Check BApproveY: (_'s',l/(/ Approved: CMF 0335-46(BU-28) rev.6/80 • • TYPICAL 611 CONCRETE BLOCK FENCE Cement Coping Optional f,�,— — ,Channe 'V/ith. 3!d - 7 ' 'gfF11 GENERAL- NOTES 0 Horizontal Top of all I '' _1_Fence I MORTAR : '1.-----1- - Ore Part Plastic Cement, and _ Three Parts Sand G" Concrete Block Fence 1.-.--. I � L - _. — - ---- ort Cement Three una -- a - GROUT : One r � S � For Fences 5' or Less 1 zl One Half Parts Sand vert. Bars 3/8" 0 at 4'-0 0.C; oiz _� COPING One Part Cement, Three For Fences Higher Than 5 u.; � Parts Sand Vert. Bars 3/8" 0 of 32" OC --- I ]— -- __11_____ - � CONCi ETE' Well Mixed 1:2 I/2 : 3 I/2 of Provide Inspection and >-, 1 i 'j) WaterMoeof e I/2 Gallons Cem14 ent .- _ Per Sack of Cement Cleanout Hole at Location > - of Vert. Reinforcement E PF ,NLLPC•Ns SIEEL SIAL. corJrcRM, . o Grout-2=- 1 I� r ! I _ � 1�. _ _ .EC T+-i5-313 S T M Fill Cells Solid 'Nah Grout- o SPL;CED,1.L.- STEEL '. _ P WHERE --G Where Steel Occurs I z , II�� z r 'A Nr.+UM I J._-- _—____ _ '� L. GROUT MAI BE POURED FROM TOP OF — 1 FENCE IN CELLS WHERE STEEL OCCURS. N _ -_ _ _ I HOLES SHALL BE CLEAR, CLEAN, AND FREE OF ALL MORTAR, DEBRIS , ETC.,WITH NATURAL GRADE t— INSPECTION' HOLES AT BOTTOM. x-1 _. ;.,�,.F ,I �I BONDS SHALL BE PROVIDED BY LAYING ?-!x t; 1: ° --- - s °— o - ' BLOCKS IN STRETCHER COURSES SO —• ,,;(•.-,;-7 °. =0 N a • e ° THAT VERTICAL JOINTS ALTERNATE IN TWO 3/B 0 BARS :� yE l o • e b Lt 1 _ EACH COURSE. CONTINUOUS 1 l- -�i . WIDTH 10 IE 0 C MAX. L.L SEE CHART e • STEEL MUST BE TIED IN BELOW DEPTH GE EARTHTCOTH PLACE AT TIME OF TRENCH I +I r +/3 THE HEIGTH OF FENCE INSPECTION. P L -e, L - . I • L BELOW BOTTOM OF FOOTING. o'L.AkiD20.112 + SCALE: 1/2 I' CHART HEIGHT . 6 ' 5' 4' 3' WIDTH 14" 14" 12" 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 JOB ADDRESS PERMIT NUMBER:— Building Department SIGNATURE: _ _ _ _ — — APPROVED City of Costa Mesa Building Dept. k STRUCTURAL APPROVAL ONLY BY— Lev( DATF�ZP�...1 SEPARATE PERMITS ARE REQUIRED THESE PLANS MUST BE ON JOB AT ALL TIMES ELECTRICAL, PI.!1':°0' :n MAKE NO CHANGES WITHOUT PRIOR APPROVAL OF DEPT- HEATING, VENT!LaTING AND APPROVED_ THE ISSUANCE OR GRANTING OF A PERMIT OR APPROVAL REFRIGERATION WORK OF PLANS ANO SPECIFICATIONS SHALL NOT BE CONSTRUED '� CRY OF COSTA TO BE A PERMIT FOR, OR AN APPROVAL OF. ANY VIOLATION ASA OF ANY OF THE PROVISIONS OF THIS CODE. NO PERMIT PRE- Permit # 3-0 (7-tj }'+2-• PLANNING D . SUMINC TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE ! THIS NUMBER MUST ACCOM ANY ; r VIM 19 'LOG. DOM PROVISIONS OF THIS CODE SHALL BE VALID. EXCEPT IN SO i • ALL INSPECTION REQUESTS '%�(�/,(' FAR AS THE WORK OR USE WHICH IT AUTHORIZES IS LAWFUL '��Otlr `W DA THE ISSUANCE OF A PERMIT BASED UPON PLANS AND ! ... .. ._-.,. . SPECIFICATIONS SHALL NOT PREVENT THE BUILDING OFFICIAL ' r —"CS V•.`HE.•E PEFSONS ARE TO FROM THEREAFTER REQUIRING THE CORRECTION OF ERRORS ' : _; WE SJR�iEST THAT THE IN SAID PLANS AXD Si`:GIFICATIONS OR FROM PREVENTINGIF) ti!A DIVISION OF BUILDING OPERATIONS BEING CARRIED Of: THEREI:NDER WHEN V - j G. N$JLTEO FOR II IN VIOLATION OF THIS CODE OR OF ANY OTHEP OsDINN�f,E 1.1..h.,D OF THE CITY .ADD,I,.. , MENTS. ,� CPt- � C pcs712a / AODRBS•�Ia3F�BMLOPIO: 1620 SANDALWOOD ST UNIT: CITY OF COSTA MESA - BUILDING PERMIT ksNANEIFIINOWN: HUMPHREY, JOHN V 3RD PERM NO: IB 071591 ADDRESS HUMPHREY, SALLY A 1620 SANDALWOOD ST PERMIT NO: IB 071591 PLAN CHECK NO: N GOVT: N SUPP : Y ',COSTA MESA,CA 92626751-6552 APPL.MAIUNG ADDRESS: CONSTRUCTION TYPE: V-N PERMIT TYPE: OTH STR PURPOSE: OTH ARCHITECT OR ENGINEER: UC NO.: JOB DESCRIPTION : BATHROOM REMODEL SQ FT: ARCH.OR ENG.'S ADDRESS: UNIT: CLAIM VALUE: CALC-VALUE; GROUP OCC : R-3 / CONTRACTORS NAJIE CONTRACTORSMAIIING COMMENTS: REINSTATE EXPIRED B-55244 ADDRESS: TIC.NO_ *********aF ah********ref**ah*it*ih ih*****iE**if3iH****if iF if iEMir if ih***3**3****ib3******if iF***AF**33 UNIT: ZONING REQUIREMENTS LICENSED CONTRACTORS DECLARATION:I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter S SETBACKS (commencing with Section 7000)of Divisbn 3 of the Business and Professions Code end my license b in full force and effect CITY UC.NO.: UC.CLASS: UC.NO.: EXP : MAIN BUILDING ACCESSORY BUILDING FRNT; FT IN REAR; FT IN FRNT: FT IN REAR: FT IN Date: Contractor LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN OWNER BUILDER DECLARATION:I hereby eKum under penally of perjury that I am exempt front the Contractors License Law for the ' following reason(section 7031.5 Business and Professions Code:Any cAy or county which requires a permh to obstruct,atter,improve, PARKING REQ: P RO V: PARCEL: 13921208 Z N E: REF NO: demdbh,a repel any atmcture,prior tom issuance.also Wares the applicant for such perm to fie a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)d Dssion 3 Of the PLANNING NOTES> Business and Professions Codel or that he or she is exempt therefrom and the basis for the alleged eaemgion.Any violabn of Section > 7031.5 by anY applicant for a permit subjects the applicant so a cid pests of not more than five hundred dollars(55001). ih**chit***ih33#******M33kihih33 iF***4***if if ie********ik*******Mir ih****iE*iFif**k*iEiEiE*iEifififiHiE* El I.s owner d the progeny or my employees wlh wages as thei sole oompandon,ea do the work.end the structure is not intended D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S or offered for sale(Section 7044,Business end Professions Code:The Contractors License Law does not raspy toan ownerof progeny who bolds or improves thereon. herself or through and Wdoes such work himself or herself his or her own employees.provided that such improvements are not intended«offered for sM«Yroddnpt�Wi«i�q�rwfor�entt iissoesold a )one year of mmddion.the ZONING APPROVED BY DATE; ownerbuilder wit have the burden d proving o I.as owner of the popery.am exclusively contracting with licensed contractors to construct the project(Sedim 7044.Business end Professions Code:The Contractors License Law does not apply to an owner ol property who bums or improves thereon and who BUILDING APPROVED BY . DATE: contracts for such projects with a contredor(s)licensed pursued to the Contractors License Law). exempt der Sectio .:P�049 B.apc.,bNbreson: LL ORK B OWNER APPLICATION ISSUED BY ; DATE: 1,� ./ MMMMMMMMMMMMMMMM MM MM M MMMMMMMMMMMMMMMM MMM MMMMMMMMMMMMMMMMMMMMMMM - - " i�._ MM a. ownw.`� �Ir l�' 2 LEGALIZATION:N F E E S U M M A R Y STRUCTURAL CEGMEN :Y erreby candy that I em aware of end understand the requirements d Celonb h and Safety Code Sedbns 5.25533,and 25534,and that 1prerry Murebuikinfom theMwittywAl not(circle os)needa wAhsddatatemdssand reptfrommsfd BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING e534, ndor thI r an fturedimonhofsbeAman(drcnnte)nee toeoan+lel mMrudistaappdticsaree remgemethese provisions. PERMIT 30 . 00 Date: Applicant: S M I P/NON-RES WORKER'S COMPENSATION DECLARATION:I hereby affirm under penally d perjury one d the following declarations: PLAN ❑ I have and willmaintain a certificate d canedto selfinsure for rakers'compensation,as provided for Section 3700 d the Labor ISSUE N G E Code,for the performance oft work for which thispermaisisued. BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE ElIhave and wit mainnnworker: Sectioncompensation insurance, dthe Labor Code,for the ped«manceofthe TOTALS- --> 30 , 00 0 , 00 0 , 00 30, 00 30 , 00 00 work for which this permit is issued.My workers'compensation insurance carver and policy number are: Cartier: REVENUE DIVISION TOTALS--> COLLECTED: 30 , 00 OVER/SHORT: . 00 Policy Number: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK (This section need not be completed tit permk is for one hundred demean/5 tool or Am.) 30 . 00 El I maty 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 became subject to the workers'comperseron laws of Cdtlamia.and agree Mat workers' if dI should become subject to the workers' kifiEiEifMMMkk MifiEiEMitifttititifiEififififisifitMMiE#ttififiEiltifitifMKiFifiEkiFMif NiltNMMifitiM1MttiE#itif#MiFififitMiFif ViEif## compensation provisions of Section n 3700 IM Labor Code.I shall forthwith oompy with those provisions. INDIVIDUAL F E E BREAKDOWN Date: Applicant: Warning:Failure to secure workers'compensation coverage/s unlawful,and shall subject an employer to criminal penalties end TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST civil fins rpt to one hundred thousand dollars(5104x%ii addition to the cost Cl conpawtlors damages as provided ler In Section 3705 of the Labor coda,Interest,and stromey'a/ms. INS 1 BUILDING RE-INSPECTION FEE 30 . 00 30 . 00 • CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty of perjury that there is a construction larding agency for the END OF FEES performance of the work for which this petrol is issued(Section 3057.Civ.C). LENDER'S NAME: LENDER'S ADDRESS: I certify that I have read this application and state that the above information is coned.I agree to comply with all Pry and county ord'mancee and state laws relating to Wilding construction end hereby authorize representatives of this city to enter upon the ebove'mentoned properly for inspection pun...... l at Ad / /ti s !pis tt.... / E /. . I♦• Date: - /9.1 01 00178/62-0017$562 TOT 30.05 Signature of `I: A•• - rector DATE: 03/22/95 TItl=: 15:38 (5151-e,6 WP) Whhe-Building&Safely;Green-Fle Canary-Applicant;Pink-Revenue;Goldenrod-Assessor _ C CONSTRUCTION AND PLANNING POOL & SPA • -" APPROVALS Permit # Date Inspector r APPROVALS Permit# Date Inspector .11, ' 1. Temporary Electrical Service or Pole , 52. Pool & Equipment Location j 2. Soil Pipe'-Undrgrnd. .' ' 53. Steel Reinforcement • ; .a. Electrical Conduit Utility-Undrgrnd. 54. Forms I 4. Electrical Conduit-Undrgrnd. I 55. 'Electrical Bonding ) • 5: Steel Reinforcement 56. Rough Plumbing & Pressure Test 1 , '6r Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE r -.7: Footings 58. Electrical Conduit-Undrgrnd. } ' , ' • 8, Foundation .I 59. Gas Pipe, 0 Undrgrnd., Test i � ' 9. Water Pipe-Undrgrnd. • 60. Backwash Lines, P-Trap, 0 Undrgrnd. ' 10. Structural Floor System '1. 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection • I -62. Backwash & Receptor-Final 12. Sewer Cap _ I 63. Heater & Vent-Final 13. Roof Drains ' ; 64. Plumbing System - Final 14. Rough Plumbing t: I 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 '.'r: .. ; APPROVALS Permit # _ r - 21. Ducts, in.Structure' - ' - 70. Underground Hydro • 22. Ducts, Ventilating,' ' - : - '' 71. Produet.Piping DGas 0 Oil 23. •Gas Pipe-Rough & Test - 72. Undergrobnd Fluih- - 24. roof Frariting' l. - - , , •,. 73. Undergrnd.StorageTank 0 Gas 0 Oil 25. Roof Sheathing - - 74. Overhead Hydro - 26. T-Bar Ceiling (Structural) & Monbcoat r .. . 75. Dry Chemical , ' ' 27. -Frame and Flashing• - 76. Dry Standpipe , t. 28. Lathing& Siding ' • ' ' ' 77. FIXED SYSTEM FINAL 29. Insulation ‘ 78. FIRE PREV. FINAL • ' 30. Drywall Nailing - - I. HEALTH DEPT. REQUIREMENT 31. Plaster Brown-Coat i . - ' t; • 79. FINAL INSPECTION . . 32. Electrical Power Meter-Final i` 80. FOOD CERTIFICATE ISSUED 33.lEinal Electric - i Notes: . i 34. Final Heating& Air Conditioning= - .r - '. / 35. Final Gas Pipe,,Test . .'O .. i . 36. Hood or Canopy :: - , - . ... - 7 - ' It, S 03 :.f. 37. !Final,Factory Fireplace • - • 1 1 I. _,• 38. FinaiPlumbing - i -• • - ; - ; 39. Water Service-Final - 40. Gas Service-Final _ ' - - - 5 41. Solar Domestic-Finan • - 42. Backflow Preventer 43. Backf low Irrigation, 44. Landscape Irrigation System : ' ; 45. Sound Attenuation ' t-• . . , 46. Handicap:Regulations - ���777 47. FINAL STRUCTURE & BUILDING .0C�� l ' 48. FINAL PLANNING• , - , -49. Electric Release to Edison - • t 50. Gas Release to Southern California Gas Co �- •51. CERTIFICATE OF OCCUPANCY . . - - - No Date " CITY OF COSTA MESE- .32, Electrical Power r-Anal BUILDING SAFETY DIVISION 33. Final Electric N . POST IN CONSPICUOUS PLACE 34. Final Heating & Air Conditioning 0 ON THE JOB 35. Final Gas Pipe-Test NOTICE 36. Hood or Canopy You must furnish PERMIT NUMBER and the JOB ADDRESS FOR EACH RESPECTIVE INSPECTION. CALL 754-5627. 37. Final Factory Fireplace APPROVED PLANS SHALL BE ON JOB AT ALL TIMES. ' (38)Final Plumbing A. P. NO. DATE ISSUED I 39. Water Service-Final I / \ (_ ... Ll 1 - TYPE GROUP PERMIT NO. ,Iy 40. Gas Service-Final • 1 \ ' _� jI '7, `, i.4-'--} 41. Solar Domestic-Final BUILDING ADDRESS 42. Backflow Preventer TRACT LOT BLOCK 43. Backflow Irrigation NEW ADD ALTERLTREPAIR MOVING DEMOLISH 44. Landscape Irrigation System - 45. Sound Attenuation OWNER ndicap Regulations 41 lit\ \ y 47/INAL STRUCTURE & BUILDING USE-- 7 �� LS'V--ri-v- 1v\ S�C- I`'"\(-+V) CT. L_ 48. FINAL PLANNING POOL&SPA SETBACKS • I VA S Permit# Front Yd. Side Yd. L R C � // a . Pool & uipment Location Side Yd. L R .-tciCr 50. Steel Rein rcement CONSTRUCTION AND PLANNING0I\\ ; r>.\-\• 51. Forms 01 APPROVALS Permit# ` Date InspBctgrt•'a ISA- 52. Electrical Bon ing 1. Temporary Electrical Service or Pole 05�3Z1Rough Pj g & Pressure Test f A J 1 2. Soil Pipe-Undrgrnd. 15" 54 (A�OVO COVER-GUNITE 3. Electrical Conduit Utility-Undrgrnd. 5 . cal Conduit-Undrgrnd. 4. Electrical Conduit-Undrgrnd. `'G , G�'p , Undrgrnd.,Test 5. Steel Reinforcement yO (t�r57.�,yckwash Lines, P-Trap, 0 Undrgrnd. 6. Electrical UFER Grnd. S'` ck`�58. APPROVAL TO DECK 7. Footings 59. Backwash & Receptor-Final 8. Foundation 60. Heater & Vent-Final 9. Water Pipe-Undrgrnd. 61. Plumbing System - Final 10. Structural Floor System 62. Electrical-Final 11. Property Sewer Line&House Connection 63. Solar System-Final . 12. Sewer Cap 64. Fencing & Access Approval f13. Roof Drains 65. APPROVED FOR PLASTERING ` �4" Rough Plumbing I�i��` d�e 66. POOL/SPA SYSTEMS FINAL �.1t5.\ Rough Electrical-Conduit !�// /� FIRE DEPT. REQUIREMENT ( 16. /I Rough Electric Wiring /2J /` !1;) j /JI/ttl APPROVALS Permit# X17. Rough Wiring Sign 67. Underground Hydro 18. Rough Electrical-T Bar Ceiling 68. Product Piping OGas ❑Oil 19. Rough Heating & Air Conditioning 69. Underground Flush 20. Rough Factory Fireplace 70. Undergrnd. Storage Tank 0 Gas 0 Oil 21. Ducts, in Structure 71. Overhead Hydro 22. Ducts, Ventilating 72. Dry Chemical 23. Gas Pipe-Rough & Test 73. Dry Standpipe 24. Roof Framing ' 74. FIXED SYSTEM FINAL ' 25. Roof Sheathing 75. FIRE PREV. FINAL 26. T-Bar Ceiling (Structural) & Monocoat Notes: cal,/ s1Q�,.,.v j 02.7,4,1 27. Frame and Flashing �(6-(�L ( l . • -4.....,- -8� Lathing & Siding 6� � ./ Iiale 29. Insulation ' ,-^ f .4 Drywall Nailing S/..{:/, '-1 �,j� ( ( jt.// 31. Plaster Brown Coat (see reverse for additional notes) CMF 0559-46,rev. 12/82 AD SSQFSIIILOPtO: 1620 SANDALWOOD ST Ute: CITY OF COSTA MESA — BUILDING PERMIT I Dvax3SI4ElvDaxm: HUMPHAEY, JOHN V 3RD Ila( PERM NO: IP 071593 ADDRESS: HUMPHREY, SALLY A `7' 1620 SANDALWOOD ST . PERMIT NO: IP 071593 PLAN CHECK NO: N GOVT: N SUPP : Y COSTA MESA,CA 92626751-6552 APPL.LAADDM ADDRESS: CONSTRUCTION TYPE: V—N PERMIT TYPE: OTH PLU PURPOSE: OTH ARCHITECT ORETKANEER: LD.NO.: JOB DESCRIPTION : BATHROOM REMODEL SQ FT: ARCH.OR ENG.'S ADDRESS: UNT: , CLAIM VALUE: CALL—VALUE: GROUP OCC; R-3 / CONTRACTORSNAME CIINTRACTOI'S MIMING COMMENTS : IB-71591 & EXPIRED P-55245 ADDRESS IAC NO: MMMiiilMMifttltiFlflf1f1f1ffE11lEMM1fiEMiflflEiEMihififfflfif#1ElFitMiE#1ffElEif#1fMMiFiFlei!#IEifM7f#ififitlf4ifffMttffttiflfffiflElfifif UMT: ZONING REQUIREMENTS LICENSED CONTRACTORS DECLARATION:I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter S SETBACKS (commencing with Section 1000)of Division 3 d the Business and Professions Code,and my license is in lull lace and effect. CITY UC.NO.: LIC,CLASS: UC.NO.: EXP: MAIN BUILDING ACCESSORY BUILDING Dona L i contractor LEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT; FT IN OWNER BUILDER DECLARATION:I hereby affirm under penally of perjury that I em exempt Nom the Contractors license Law for the following reason(Section 70315 Busipss and Profession Code:My city or county whidt requires a panne to construct,atter.improve, PARKING REQ• PRON.,: PARCEL : 13921208 Z N E; REF NO: ' emolsh,or repo any savours prior to is issuance,also requires the applicant tat such permit to file a signed statement that ha or she (} A licensed pursuant to the provisions of the Contractors License Law[Chapter 9(commencing with Section 7000)d Division 3 of the PLANNING N TES> Business and Professions Code]or Mal he or the S exempt therefrom and the basis for the alleged exemption.My violation of Section > 7031.5 by any applicant for a permit srblods the applicant to acid penally of not more than five hundred dollars[1.5001). M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M MM M M M M M M M MM 0 I.asowtw of the proPerlYer my employees with wages as their sole compensation,will do the work.and the soucture is not intended DEVELOPMENT SERVICES REQUIREMEN TS or offered for sale(Section 7044.Business and Professions Code:The Contractors Lome Law does not apply to an owner of property who bolds or inproves thereon.and who does such work bussed or helmet or through his or her own employees.provided that arch improvements are not intended or offered for sake.If,however.the Wilding or inpmanet ls sold within one Year of completion.the ZONING APPROVED BY owner-builder will have the burden d proving he or she did not build or improve for the purpose d sale). DATE: 0 I.as owner of the property.am exclusively oontradkq with licensed contractors to construct the peed(Section 7044.Business and Prdeasions Coda.The Contractors License Law does not appy to an owner d m property ppbuilds or improves thereon and who BUILDING APPROVED BY DATE; contracts for such projects with a contractor(a)licensed pursuant to the Contractors se Law).alOp ® . e • age BP7044 B.aP.c.,ro M, easoni. {LL ORK B}/( OWNER APPLICATION ISSUED BY; • DATE; Oew: WA AA vt Q4•!�/ itiFiFiF******* titiF****iFiFiFiFYiFit***MitiFiFi *** i iF#iFM#itiFiFiFiFitititiFiFiFi **TiFrr ' "^- it# I do hereby.. Mm I em aware d ad td.atad the requirements d Cadre. and Splay Cd.Seri255OSz S33.and LEGALIZATION;N F E E U M M A R Y STRUCTURAL EGM:NT; N a gam endonsturany rfuture mod WikinpontMaAkant fll/wDMegerbdp)need to ply wiheeitlstaemdrad the requirements tor BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING ep34,for and hatwdanofmaeibruilion mg occuaAk will/*R.o ecnot rceone) rid. oeidenpil wilt said andns exempt rlmet for provisions. PERMIT 30 . 00 Date: Applicanp 2 5% SMIP/NON—RES WORKERS COMPENSATION DECLARATION:I hereby affirm under penalty of perjuryone of the folfowng dedackms: PLAN ISSUE FEE 0 Ihawadwmahnanacentoatodcorsettoselinsursforwokers'tendeesation.asProMedfobYSaAon3700dtheLeber BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE Code,to the performance of he work for which this permit is issued. 0 Ihave and MImaintain workers'compensation insurance,asrequired bySection 3700dthe Labor Code,for the performance dthe TOTALS 30 . 00 0 . 00 0 . 00 30 . 00 30 . 00 . 00 work for which this permit is issued.My workers'compensation insurance wrier and policy number are: Center: REVENUE DIVISION TOTALS--> COLLECTED: -- 30 . 00 OVER/SHORT: . 00 Policy Number. BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK (lois sedan need not be completed I the perm:is for one hundred dollars(11001 or Isla,) 30 . 00 0 I centy that in the performance d the work for which Iha permit is issued.I shall not employ any person in any manner so as to become woad to the welters'ccmpenston Lan California.and agree that if should vdd beas subject to the workers' iFitiFiFttifiEttitiFiFitttiFMiFiFttitiFiFiEiEiFitiFiFiF#iFitiFiFiFiFiFiFiFiFiFiFMMiFitiFitKiFit#itit Mit M•tt MiFiFiF#it Mit MiFMiFiFiFiF#itiFititiFM compensation provisions of Section 3700 d the Leber Code.I shell forthwith campy with those emulsions. INDIVIDUAL F E E BR EAKD OWN Data: Applicant: Warning:Failure to secure workers'compensation coverage hs unlawful and shall subject an employer to criminal penalties and TYPE QTY D E S C R I P T I O' N UNIT COST TOTAL COST civil fines W to one hundred thousand dollars(41080001,M addition to the coat of compensation damages as provided ler In , ISection3rosolteLabor Codaattorneys 30, 00 30 . 00 . CONSTRUCTION LENDING AGENCY: I hereby affirmunder putty d perjury Mal there S e construction lending agency for the END OF FEES performance of the work for which this pend is issued(Section 3097.Civ.C). LENDERS NAME: LENDERS ADDRESS: PLU 1 PLUMBING RE—INSPECTION FEE I cedy that I have read this application and state that the above irsornaton is coned.)agree to comply with all city and county ordinances end stale lets regaling to bugdig construction and hereby authorize representatives of this city to enter upon the above-mentoned property (or inspection purpaes. . z.P nl Nam:• Cl 001785,0-10178560 TOT 30.00 • .a r Drat 4.42e.1DATE: 03/22/95 TIDE: 15:37 Sp d / ..0... •. . tractor (5151<6.WP) Whae-Building 8 Safety:Gree-Fle:Carry-Appicat:Pink-Revenue:Goldenrod-Assessor . ,•I r CONSTRUCTION AND PLANNING POC. .l SPA h APPROVALS Permit # Date Inspector ' PPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. ' 53. Steel Reinforcement - ":3: Electrical Conduit Utility-Undrgrna. _ . 54. Forms 4, Electrical Conduit-Undrgrnd. • c ' 55. Electrical Bonding !. t '5: Steel Reinforcement 56. Rough Plumbing & Pressure Test ' ' •6' Electrical OF ER Grnd. - . 57. APPROVAL TO COVER•GUNITE • •., 2. Footings 58. Electrical Conduit-Undrgrnd. -'.5 8: Foundation 59. Gas Pipe, 0 Undrgrnd.,Test . 9.(Wafer Pipe-Undrgrnd. • 60. Backwash Lines, P-Trap, 0 Undrgrnd. •T0. 'Sttuctural Floor System 61: APPROVAL TO DECK 11. Property Sewer. Line & House Connection : I -62. Backwash & Receptor,-Final - 12. Sewer Cap - I 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 1 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 Ficealace ; I. .. , L'.... ' APPROVALS' , Permit # 21.'Ducts! in Structure' - - - -• ' : _ 70. Undergroui.id H:: dro 22. Ducts, Vehtilating,:k _ . . _ ' : 71. Product Piping ❑Gas 0 Oil 23. Gas Pipe-Rougk $, Test i K 72. Underground Flush 24. -Roof Framing" ' - , • 73, Undergrrid.Stoiage Tank 0 Gas 0 Oil 25. Roof Sheathing -. '- ' ' 74.. Overhead Hydro 26. 1-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical , 27. Frame and Flashing y - ' 76. Dry Standpipe : -• * 28. Lathing al Siding ,,' : • �:; - i , " • 77:: FIXEDSY.STEM:FtNAL . , -1 29. Insulation - •• - I+ 78. •FIRE PREV. FINAL • 1 ' • 30. Drywall Nailing .i'_1 , HEALTH DEPT.-REQUIREMENT 31. Plaster Brawn Coat - 79. FINAL INSPECTION • - "' 32. 'Electrical Power MeterFinal • 80_ FOOD CERTIFICATE ISSUED. 114 . 33. Final Electric- _ _ Notes: _rj,-,-5---- .v la--=l�, 764:1-/o) 34. Final Heating& Air Contlitionirig ' a - �' 35. final Gas PipeeTest : .. r-- ,r - o 36. Hood•or Canopy - i' - p r"' 37. Fina'I:Factory Fireplace .• .,•, . , i '• v. :: 38. Final Plumbing '23 J' (r,'/,��' _ 39. Water Service-Final ' - ' 40. Gas Service-Final - . .. ' - - 1. 41. Solar Domestic-Final ; I� , -- . • . 42. Backflow Preventer 43. Backflow Irrigation - . 1 � . - • 44. Landscape Irrigation System T. ' _ - • 45. Sound Attenuation ; : - : r ,-• 46. Handicap Regulations • . SII 47. FINAL STRUCTURE & BUILDING • ,• 48. FINAL PLANNING - • - 49. Electric Release to Edison " ,, 50. Gas Release to Southern California Gas Co i •-•1 • ' 51. CERTIFICATE OF OCCUPANCY . ' No Date . N CITY OF COSTA MEF. .32, Electrical Power `er-sinal , BUILDING SAFETY DIVIb.JN 33. Final Electric POST IN CONSPICUOUS PLACE 34. Final Heating &•Air Conditioning ii4` ON THE JOB 35. Final Gas Pipe-Test NOTICE 36. Hood or Canopy You must furnish PERMIT NUMBER and the JOB ADDRESS FOR EACH RESPECTIVE INSPECTION. CALL 754-5627. 37. Final Factory Fireplace APPROVED PLANS SHALL BE ON JOB AT ALL TIMES. f . • 31/ Final Plumbing I A. P. NO. DATE ISSUED 39. Water Service-Final \ \ LC. L. - I l TYPE GROUP- _ PERMIT NO. 40. Gas Service-Final • �' \L '3 1:?) (_1,-,21",-7..71-71- 41. Solar Domestic-Final BUILDING ADDRESS l'- % .-/ - V \,''- ,-,;\c_.c l'>c:\7 42. Backflow Preventer TRACT LOT BLOCK 43. Backflow Irrigation NEW ADD ALTER REPAIR MOVING DEMOLISH 44. Landscape Irrigation System � �� 45. Sound Attenuation OWNER ' andicap Regulations ` �\ I-i1 1--. v r•\p1\ "".C. i. 47. INAL STRUCTURE & BUILDING USS i I�t..1-1-11-42--:-.Th ;" V. 1- `r ' 1`''\C-0V> CL 48. FINAL PLANNING POOL&SPA SETBACKS p�VA S Permit# 0' • Front Yd. _Side Yd. L R ,-t�'-��1 pool & uipment Location _Side Yd. L R -+ 50. Steel Rein rcement CONSTRUCTION AND PLANNING 'Ff. 1 1 IAN' 51. Forms APPROVALS Permit# \ i Date Inspectgr� tk- 52. Electrical Bon ing 11. Temporary Electrical Service or Pole O j-54„.--AP-11,9•0'1/4 5�3L�Rouggh g & Pressure Test 2. Soil Pipe-Undrgrnd. 1�'Jh 5 Fj,$J t 0 COVER-GUNITE 3. Electrical Conduit Utility-Undrgrnd. 5 #ftal Conduit-Undrgrnd. 4. Electrical Conduit-Undrgrnd. �c /\\y'e't Undrgrnd., Test 5. Steel Reinforcement ��O e58Acckkwash Lines, P-Trap, O Undrgrnd. 6. Electrical UFER Grnd. S,' " 58. APPROVAL TO DECK 7. Footings 59. Backwash & Receptor-Final 8. Foundation 60. Heater & Vent-Final 9. Water Pipe-Undrgrnd. 61. Plumbing System - Final 10. Structural Floor System 62. Electrical-Final 11. Property Sewer Line&House Connection 63. Solar System-Final 12. Sewer Cap 64. Fencing& Access Approval 13. Roof Drains 65. APPROVED FOR PLASTERING 14 Rough Plumbing OfritS 66. POOL/SPA SYSTEMS FINAL 15 Rough Electrical-Conduit FIRE DEPT. REQUIREMENT c16. J Rough Electric Wiring /77/,/in /Jf_Jj., APPROVALS Permit# 17. Rough Wiring Sign �1 67. Underground Hydro 18. Rough Electrical-T Bar Ceiling 68. Product Piping 0 Gas 0 Oil 19. Rough Heating & Air Conditioning 69. Underground Flush 20. Rough Factory Fireplace 70. Undergrnd. Storage Tank 0 Gas 0 Oil 21. Ducts, in Structure 71. Overhead Hydro 22. Ducts, Ventilating 72. Dry Chemical 23. Gas Pipe-Rough &Test 73. Dry Standpipe 24. Roof Framing • 74. FIXED SYSTEM FINAL 25. Roof Sheathing 75. FIRE PREV. FINAL /T / 26. T-Bar Ceiling (Structural)& Monocoat Notes: c la y,. ,✓ ( 4, L/ / `/ 27. Frame and Flashing 11-46-4P-, 1(6- lL ‘�/,/ �t !/ Lf'0� CYY y ( 282),Lathing& Siding CAP/�i erer.., 29. Insulation • cii Drywall Nailing '1.331. Plaster Brown Coat 7 L f (see reverse for additional notes) CMF 0559-46,rev.12/82 • 'DDREss OF BUILDING: 1620 SANDALWOOD ST MT; CITY OF COSTA MESA - BUILDING PERMIT 041IER$NAMEIrmmt HUMPHREY, JOHN V 3RD PERM NO: IE 071592 ADDRESS: HUMPHREY, SALLY A 1620 SANDALWOOD ST PERMIT NO; IE 071592 PLAN CHECK NO: N GOVT; N SUPP; Y COSTA MESA,CA 92626751-6552 APPL.Mul1NO ADDRESS: CONSTRUCTION TYPE; V-N PERMIT TYPE; ELE OTH PURPOSE: OTH ARCHITECT OA ENGINEER; LIC NO.: JOB DESCRIPTION ; BATHROOM REMODEL SQ FT; ARCH.OR ENG'S ADDRESS: uflT: CLAIM VALUE: CALC-VALUE: GROUP OCC: R-3 / CONTRACTOR'S NAIL: CONTRACTOR'S WRUNG COMMENTS: REF: IB-71591 & EXPIRED E-55246 ADDRESS UG NO.: ******************************************************************************* DMT: ZONING REQUIREMENTS LICENSED CONTRACTORS DECLARATION:I hereby ellrm under penally of perjury that I em licensed under previsions of Chapter 9 SETBACKS (commencing with Section 7000)of Division 3 d the Business and Professions Code,and my license is in full force and effect. CITY Lt.NO.: uc.CLASS: LIC.NO.: EXP: MAIN BUILDING ACCESSORY BUILDING Dae: Contractor LEFT: FT IN REAR; FT IN FRNT; FT IN REAR; FT IN 4 LEFT: FT IN RGHT: FT IN LEFT; FT IN RGHT: FT IN OWNER BUILDER DECLARATION:I hereby affirm under penally of perjury then em enema from the Contractor'License Law for the following reason(Section 7031.5 Runless and Professions Code:Any city or oounywhich requires apemd to construct alter improve, PARKING RE PROV; PARCEL13921208 ZNE: %mash.or repel any structure.prior to Eit s issuance.also requires the applicant for such permto Be a signed statement that he or she : REF NO: a licensed pursuant to the provisions of the Contractors License Law[Chapter 9(commencing with Section 7000)of Division 3 of the PLANNING N TES> Business end Professions Code)or that he or she is enema therefrom end the bass tor the alleged exemption.My violation of Section > 7031.5 by any applicant for a permit subjects the applicant to a avid penalty of not more than rem hundred dollars IS5001). ****************************itil.***.**************.7E******.Er****.N.RT.*********,)F******** ❑ I,as owner ofthe property or my empoyees with wages as their sole compensation,will do the work,and the etmcture is not intended DEVELOPMENT S E, R V I C E S R E 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 appy loan Owner of property Q who buids or inproves thereon,end who does such work himself or herself or through his or her own employees,provided that such improvecnentsare rat intended or offered forsale.5,however,the building or improvement issold within one year oconviction,the ZONING APPROVED BY DATE: owner bolder will have the burden of proving he or she did not build or improve for the purpose of sale). • . ❑ L as owner of the properly,am exclusinfy contractthg with licensed contractors to construct the project(Section 7044.BUSiness and BUILDING APPROVED BY profession Coda:The Contractors License Law does not apply to an owner of property who builds or improves(hereon and who DATE; contracts for such projects with a contractors)licensed pursuant to the Contractors 'cense Law). o .ma .. section:'P7044 B.ap.c.,mthisreeso 'ALL WORK B, OWNER APPLICATION ISSUED BY: DATE; !� 5.-, AfcLEGALIZATION;N F E E ez A R Y STRUCTURAL SEG ENT:N A that Dam aware of and understand the requirements of Call ' and Safety Code Sect' 25505,25533,and 25531,and that I o any Mure Wilding cmlant will/will not(drab one)need to with said date codes and the requirements for a permit for construction or modification from the Ar euaably anagemem District.Residential construction appkrati«a areexema from Nees PERMIT BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING provisions. 30 00 Date: Applicant: 5 0% SMIP/NON-RES WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one of the following declarations: PLAN ISSUE FEE ❑ I have and MI maintain a near-crate of consent to self-insure for WOrkere compensation.=provided for by Section 3700 of the Labor BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE Code,for the parlament.ddie wekfor which this permit%issued. TOTALS----> 30 . 00 0 , 00 0 , 00 30, 00 30 , 00 , 00 ❑ I have and will maintain workers'compensation insurance.as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued.My workers'compensation insurance carrier and policy number the Carrier REVENUE DIVISION TOTALS--> COLLECTED ; --- 30, 00 OVER/SHORT: . 00 Policy Number: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK (nus section need not be co nplered I the penal is for one hundred dales/510.1«lass.) 30 . 00 ❑ I certify that in the pedomersce of the work for which this permit is issued,I shall not employ any person A any manner so as to become aubled to the workers'compensation laws o California,and agree that if D should become subject lo the workers' ******************************************************************************* compensation Prevsons of Section 3700 d the Labor Code,I Ball forthwith comply with than Provisions. INDIVIDUAL F E E BREAKDOWN Deter Applicant: Warning;Failure to secure workers'compensation coverage/s unlawful,and shell subject an employer to criminal penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST de gnu ry to«ie hundred thousand dollars($500,000),In addition to the cost or corrperaatlprm damages es provided for In Seddon 3705 07 the Labor Cods,Interest and attemey'a less ELE 1 ELECTRICAL RE-INSPECTION FEE 30 , 00 30 , 00 CONSTRUCTION LENDING AGENCY:I hereby afn under penally of perjury that there b e construction lending agency for the END OF FEES performance of the work for which the perms is issued(Section 3097,Civ.C). LENDER'S NAME; LENDER'S ADDRESS: I candy that I have read this application and date that the above information is coned.I agree to comply with all city and county ordinances end state taws Walesa to building construction and hereby authorize representatives of this thy to enter upon the above-mentioned properly for inspection purposes. / 4111O1 00173551-00178561 TOT 30.00 /rint eros ..,..7* • � Q� BATE: 03/22/95 TThE: 15:38 .w s G � Data '-7�.0/91 - Signature—,C -crit gen A.pucanvcont...or I (5151-46.WP) White-Building A Safety:Green-He Canary-Appicant:Pink-Revenue;Goldenrod-Assessor . c* • 11Iir 1 CONSTRUCTION AND PLANNING POL,_& SPA I Date Inspector Date Inspector • APPROVALS Permit+ APPROVALS Permit # , 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location i 2. Soil Pipe-Undrgrnd. - I 53. Steel Reinforcement i !i: Electrical Conduit Utility-Undrgrnd. i 54. Forms I 4. Electrical Conduit-Undrgrnd. _ • 55. Electrical Bonding ; i 1 5. .Steel Reinforcement c • 56. Rough Plumbing& Pressure Test 1 6: 'Electrical UFER Grnd. • 57. APPROVAL TO COVER-GUNITE P . -7.-Footings 58. Electrical Conduit-Undrgrnd. f'8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test 1 - -'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 - _ 1 • 62. Backwash & Receptor-Final .. - . 12. Sewer Cap , 63. Heater& Vent-Final 13. Roof Drains ' 64. Plumbing System - Final 14. Rough Plumbing I 65. Electrical-Final 1 15. Rough Electrical-Conduit „ 1 _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 I 19. Rough Heating & Air Conditioning _ _ FIRE DEPT. REQUIREMENT 20. ;Rough Factory Fireplace • - 74, 1 IT APPROVALS ':.; Pe,mit# _ 21."Duces, in'Structure 1 1 ' • • 70. •Underground Hydro ° 22. Ducts, Ventilating _ , . - - ' ;- 71. Produce PipingD'Gas 7 Oil 23. Gas Pipe-Rough& Test <- . �. - - 72. Underground Flush - 24. Roof Framing' ;; ; ' ' - .• • 71 Undergrnd.Storage Tank Q Gas ❑Oil . '25. Roof:Sheathing - - ' • - 74•.. Overhead Hydro 26. T-Bal Ceiling (Structural) & Monocoat ' . - 75. Dry Chemical i 27. Frame and Flashing _, ; 76. Dry Standpipe 28. Lathing Siding • `"` & y. _ 4 = " "i; 77. FIXED'SYSTEM FINAL -. _`; • 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing •`:•' ' , y I I; ,;HEALTH DEPT. REQUIREMENT 31. Plaster Browp Coat .. ,. . I. • 79. FINAL INSPECTION 32. Electrical Power M2ter-Flnal ' ` ' , • 80' FOOD CERTIFICATE ISSUED 33. FinabElectric; 1, ,• : 3 .,0�� Notes: - - . ' 34. Final Heating& Air Conditioning S. %�. ' I .. . n 35.rFinal`Gas Piper Test .. - - - _ 36. Hood or Canopy -" moi,. - . n•-,- - _ 37. FinatFactory Fireplace ., . ' , I. 38. Final Plumbing I '- , • " -'' i 39. Water Service-Final ' -_ , i , ' - 40. Gas Service-Final - I - 41, Solar Domestic-Final 2 .` . . ', 42. Backflow Preventer ' - - r 1 •' 43. Backflow Irrigation' ' " , , -. 44. Landscape Irrigation System •• - -- ' _ ri 45. Sound Attenuation' :; r •• •1: ; _ 46. Handicap.Regulations -, - -. 47. FINAL STRUCTURE & BUILDING .. . 48. FINAL PLANNING1• i " Il` , '; ' 49. Electric Release to Edison - _ ; -50. Gas Release to ShCalifornia Gas Co - outern - 51. CERTIFICATE OF OCCUPANCY • ._ _ - - No- Date . CITY OF COSTA MES .32; Electrical Power er urinal BUILDING SAFETY DIVISION 33. Final Electric • 1s POST IN CONSPICUOUS PLACE 34. Final Heating & Air Conditioning ON THE JOB 35. Final Gas Pipe-Test NOTICE 36. Hood or Canopy You must furnish PERMIT NUMBER and the JOB ADDRESS FOR EACH RESPECTIVE INSPECTION. CALL 7545627. 37. Final Factory Fireplace APPROVED PLANS SHALL BE ON JOB AT ALL TIMES. 38.,i Final Plumbing A. P. NO. DATE ISSUED 39. Water Service-Final 1 J. (__ =1 TYPE GROUP PERMIT NO. 40. Gas Service-Final \, t\ i- , - `-, 7- 144 41. Solar Domestic-Final BUILDING ADDRESS I f(: /( / _'/\,;..,�%,'.0.,�.30 c ic) 42. Backflow Preventer TRACT LOT BLOCK 43. Backflow Irrigation NEW ADD ALTER REPAIR MOVING DEMOLISH 44. Landscape Irrigation System ___.----- 45. Sound Attenuation OWNER -46.Tandicap Regulations k \ \''1\ "-'� -\ USE-) + 47/FINAL STRUCTURE & BUILDING H• t 1�1-v-.^_ .' -�'.1 \t- 1`"\i': VD l= L 48. FINAL PLANNING POOL&SPA SETBACKS / VA S Permit# Front Yd. _ Side Yd. L R lS �l . Pool & •uipment Location Side Yd. L R tr+i 50. Steel Rein •rcement CONSTRUCTION AND PLANNING kc � r tt 1. Forms • APPROVALS Permit# ate Inspec[�r 1A' 52. Electrical Bon%Ing I 1. Temporary Electrical Service or Pole O 5�3,1Rouggh P!wi! g & Pressure Test 2. Soil Pipe-Undrgrnd. 19 5 fj,OV( ALI COVER-GUNITE 3. Electrical Conduit Utility-Undrgrnd. 5 ` cal Conduit-Undrgrnd. 4. Electrical Conduit-Undrgrnd. IL::. G Ic+p Undrgrnd.,Test 5. Steel Reinforcement 1P0� r57�`pIckwash Lines, P-Trap, 0 Undrgrnd. r �1 VV 6. Electrical UFER Grnd. �` ic;C 58. APPROVAL TO DECK 7. Footings 59. Backwash & Receptor-Final 8. Foundation 60. Heater & Vent-Final 9. Water Pipe-Undrgrnd. 61. Plumbing System - Final 10. Structural Floor System 62. Electrical-Final 11. Property Sewer Line&House Connection 63. Solar System-Final 12. Sewer Cap 64. Fencing& Access Approval 13. Roof Drains 65. APPROVED FOR PLASTERING 142 Rough Plumbing /447) , 66. POOL/SPA SYSTEMS FINAL 16� Rough Electrical-Conduit 4/447)„,X,,- �/� JJ 1g( (jFIRE DEPT. REQUIREMENT ( 16. Rough Electric Wiring /2/,'IA) , APPROVALS Permit# 17/ Rough Wiring Sign /, U 1 67. Underground Hydro • 18. Rough Electrical-T Bar Ceiling 68. Product Piping 0 Gas 0 Oil 19. Rough Heating & Air Conditioning 69. Underground Flush 20. Rough Factory Fireplace 70. Undergrnd. Storage Tank 0 Gas 0 Oil 21. Ducts, in Structure 71. Overhead Hydro 22. Ducts, Ventilating 72. Dry Chemical 23. Gas Pipe-Rough & Test 73. Dry Standpipe 24. Roof Framing • 74. FIXED SYSTEM FINAL . ' 25. Roof Sheathing 75. FIRE PREV. FINAL / / 26. T-Bar Ceiling (Structural) & Monocoat Notes: 5 '5 4,..„1„...- '• ,� / 01/7 /) 7 `at�/�,/,. 27. Frame and Flashing (6._{JL /(,/,/ g��� L �85. Lathing& Siding ` f2 ( 6://81/4100r O 29. Insulation • � Drywall Nailing s-/-k-,/.0( � ' - 31. Plaster Brown Coat (see reverse for additional notes) CMF 0559-46,rev. 12/82 -. - / I (cap c 1 R-t woo n.i APPLICANT: DO NOT FILL IN SHADED AREAS: . LITY OF COSTA.MESA CON It PERM!/ UNIT MODEL A.P.# Zone • fL JOOQ OJ S Main Building Accessory Protect Address: •• • _ —.—"- -• - - _ Franc Owner's Name: t 1,M2 Iry re V PURPOSE: ❑ NEW 0 ADDITION 0 ALTERATION 0 REPAIR Address: lD 1Q I 5R 1 s od C_IR to MMS{' ❑ CONVERSION 0 DEMOLITION 0 OTHER Arch./Engineer: Rae.Na: Address: Unit: DESCRIPTION OF WORK/USE OF BLDG. . Ping. Ref.it Parking Req./Provided E Permlfee:tt a 4s4A 9 p\u. -kb t N ekPlanning Notes: M • Mdreu. 0 7 - 5 t, e'/y_t 0 R TYPE OF PERMIT: ❑ GRADING ❑ FIRE 0 STRUCTURAL 0 SIGN S. UCENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing 0 ELECTRICAL 0 PLUMBING 0 MECHANICAL 0 REINSPECTION with Section700 0)of Piton 3 of the Business`a/�Professions Code,and my license is in full force and effect. ELECTRICAL FEES CITY uc 37 S C) t STATE UC.:"C(CSAO a \�CLASS1: C-3 JOB DESCRIPTION: ❑ SO.PT. OCCUPANCY GROUP ■ t ■ t HP Carel I-COP -AT ON9 TIONture: ISS` •■ e t ■ 50-100 HP or a RS' of Workers' DECLARATION: I h affirm that I have a certificate of consent to self-insure CONSTRUCTION TYPE VALUATION $ GRADING CU. YDS. Christmas Tree Lot ora certificate of W rkers'Compensation Insurance,or a certified copy thereof(Section 380),Lab.C). Construction Pole ■ over 100 POLICY NO.: EXP.WE: CATEGORY: 0 MINOR CONSTRUCTION 0 MAJOR CONSTRUCTION(Under 200,000 sq.N.) Sub Pole • , COMPANY: Light -D Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. 0 MAJOR/HIGH RISE(Over 20Q000 sq.ft.) - Dishwasher Date: Applicant: Remarks: dryer ik.i4rxmur EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less).I certify that in the performance of the work for which this permit is issued, PLUMBING FEES F.A.U. Standing Section !shall not employ any person in any manner so as to become subject to the Wo Compensation Laws of California. Backflow Prevention RepipeFireworks Date:,) -29-F19 Signature: /ACYC0Backflow Irrigation I Roof Drain Swimming Pool/Spa - NOTICE:If,after making this declaration,you a become subject to the Workers' pensation prow Bar SinkService Sink .: Disposil Switch store of the Labor Code.you mat faihath comply with such pronsons or this permitshall deemed Ceded. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the perfor- Bathtub Sewer Cap ' 'Generator:Size • Temporary Work With mance of the work for which this permit is issued(Section 3097,Civ.C). Clarifier Sewer Connection Meter ■ up to 200 amps . Transformer LENOEN: ADDRESS: Dishwasher Shower Meter El overre amps Size • OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law Drinking Fountain Solar Collector for the following reason(Section 1031.5 Business and Professional Code: Any city of county which requires aMicrowave Trash Compactor permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the appli- Floor Drain Solar Piping cant for su pe i to file a signed statement that he/she is licensed pursuant to the provisions of the Contract tors Stat LI (Chapter 9t,commencing with Section 7001 of Division 3 of the Business and Professions Floor Sink • Solar Tank • Code) she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 70315 - :: $30 Issue Fee S1S by sty m for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). Gas Service - Swimming Pool w/Spa 1,a owner of the property or my employees with wages as their sole compensation,will do the work,and Gas System ( Outlet 2.., Toilet DEVELOPMENT SERVICES REQUIREMENTS: the structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Con- tractors' az • State License Law does not apply to an owner of a property who builds or improves thereon,and Interceptor Urinal A who does such work himself/herself or through his or her own employees,provided that such improvements Zoning Approved By Date are not intended or offered for sale.It.however the building or improvement is sold within one year of corn- Kitchen Sink Wash Basin pletion,the owner will have the burden of proving he/she did not build or improve for the purpose of sate). Building ApprovedBy 3 I.as owner of the property,am exclusively contracting with licensed contractors to construct the project Laundry Tray Washing Machine 9 '^^` Date (Section 7044,Business and Professions Code: The Contractors'State License Law does not apply to aniii P-Trap . . Water'Heater Application Issued By1,`t by �q owner of property who builds or improves thereon and who contracts for such projects with a contractor(s) pP X� Date 'i D E license pursuant to the Contractors'State License Law).I am aware that proof of their Worker's CompensaWeter Service - tion insurance should be provided to me. �``A / ❑ I am exempt under Sectio : B. .C. t. V Y SUMMARY OF FEES for tis reason:...� - BUILDING PERMIT $ MECHANICAL $ Date Owns. Boiler - e • PLAN CHECK $ PLAN CHECK 254b $, I do hereby certify that I am aware of and understand the requi menu of California Health and fety Code Sec- e ■ 0-100000 e i e r ■ 100000 C T tions 25505.25533,and 25534 and that I or any future building occupant ndllOmtnat(circle one)need to coma!), a PLUMBING $uct-Structural Hood or _J .Do SMTP $ with said state cedes and theQuality ge- e 1 ■ requirementsioforations forxmptfron oresedpragsinmo the Air Uuali Mena PLAN CHECK 25% $ GRADING $ Manage- ment District.Residential construction applications are exempt from these provisions. a - ■ Exhaust System •■ Multiple 0Refrigeration System ELECTRICAL $ 4, Date: Applicant: Fan ■ ttr rtr ■ 100,000 : I hereby certify that I have read this application and state that the above information is correct.I agree to comply PLAN CHECK 50% $ TOTAL FEE $ with at city and county ordinances and state laws relating to bolding construction and hereby authorize teptesen- Fire Damper System R- - Wtives of this city to enter upon the above-mentioned property for inspe tan purposes. - Fireplace/Fact. Bit. ICB0 if Date:1 I- 2 C) .95.- Signature: ki Ocher's License or Social Security/ Reinspection Fee $30 !sine Fee $15 • 01 00048554-00048554 TOT _ 5.00 oeGs-48 rev.10/89 White-Building:Green-Code Enforcement: Canary-Applicant: Pink-Revenue: Goldenrod-Assessor DATE 11/29/89 TIME 14$23 JJ, POO SPA �• ' CONSTRUCTION AND PLANNING111 ; r- APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector 1. Tempdrary Electrical Service Or Pole 52. Pobl;& Equipment Location i 2. 'SoiLPipe-Undrgrnd. I 53. Steel Reinforcement i 3. Electrical Conduit Utilit• y- Undrgrnd. I 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding '� :'Steel Reinforcement 56. Rough Plumbing & Pressure Test • • •N', . 6;;;•Ele4rical UFER Grnd. ' 57. APPROVAL TO COVER-GUNl+TE 7';footings .. 58. Electrical Conduit-Undrgrnd. • 8?i Foundation - 59. Gas Pipe, 0 Undrgrnd., Test ' •! -'1 " 9:.Water Pipe-Undrgrnd. • 60. Backwash Lines,P-Trap, ❑ Undrgrnd. 10't Structural Floor System 61. APPROVAL TO DECK 11 Property Sewer Line'& House Connection • 62. Backwash & iieceptor-Final , I , .-' 12.;Sewer Cap 63. Heater & Vent-Final 131 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 8/Access Approval 1W-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 , v 20'. Rough Factory Fireplace APPROVALS Permit# . .1'. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test • 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing • 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywdll Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION . 32. Electrical Power Meter-Final 80. FOOD GE'k!tTIFICATE ISSUED , 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test POthq tei0 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 'IAoiit C40 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final /7-1 .1 42. Backflow Preventer 43. Backflow Irrigation • 44. Landscape Irrigation System 45. Sound Attenuation `SD/ . 46. Handicap Regulations • ' 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING • 49. Electric Release to Edison nj - 50. Gas Release to Southern California Gas Co , 51. CERTIFICATE OF OCCUPANCY _., J. No. - Date -ti' PROJECT AIDRESS: i 1620 SANDALWOOD ST UNIT: CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 055244 vr)WNER•S NAME: HUMPHREY, JOHN V 3RD ADDRESS: HUMPHREY SALLY A PERMIT NO: B 055244 PLAN CHECK NO: N GOVT: N SUPP: N 1620 SANDALWOOD ST COSTA MESA, CA 92626 CONSTRUCTION TYPE: V-N PERMIT TYPE: STR PURPOSE: OTH ARCH/ENGINEER: 751-6552 REG.ND.: ADDRESS: UNIT: JOB DESCRIPTION : BATHROOM REMODEL SQ FT: 500 PERMITTEE: CLAIM VALUE: 500 . 00 CALC-VALUE: 500 . 00 GROUP OCC: R-3 / ADDRESS: JOHN HUMPHREY ( 714 ) 751-6552 1620 SANDALWOOD COMMENTS: BATHROOM REMODEL CA .92E26 ****************************************************TP*******TP***********TF****** LICENSED CONTRACTD CLARATION: I hereby affirm that I am licensed under provisions 0 per 9(commencing with Section Z O N I N G R E Q U I R E M E N T S 7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. CITY LIC.: STATE UC.: CLASS: SETBACKS Dal(: Signature: MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I herebyaffirm that)have a certificate al consent to sell-insure or a certificate of Workers' FRNT: FT IN REAR; FT IN FRNT: FT IN REAR: FT IN Compensation Insurance.or a certified copy thereof(Section 3800,Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN POLICY NO.: EXP.DATE: •OMPANY: PARKING REQ• PROV: PARCEL : 13921208 ZNE: REF NO: Certified copy is hereby turnished. 0 Certified copy is filed with the city Building Division. PLANNING NOTES> > • Applicant: ********************3E*****•ih*****************************************3E***** **** •cXEMPTIDN FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit a for one hundred(Sl00)or less). D E V E L O P M E •N 'T SER VICES REQUIREMENTS I certify that in the performance of the work for which this permit is issued,I shag not employ any person in any manner so as to become , sublect to the Workers'Compensation Laws of California. ZONING APPROVED BY �• DATE: Date: Signature: NOTICE:If.atter making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : DATE: Code,you must lonhwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY- - ....e. _ — DATE: I Z Z` which this permit is issued)Section 3097,Civ.C). ********************* . --__- - • *********** *******1** LENDER: ******************if************** ********************************************* ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT;Y OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ' LECTR IC 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 repair any structure.prior to its issuance.also requires the applicant for such permit to lile a signed statement that he/she is licensed PERMIT 15 , 00 . 50 pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business SM I P/NON-RES 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 I, as owner of the property or my employees with wapes 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----> 15 . 50 0. 00 0 . 00 15 . 50 15 . 50 . 00 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: 15 . 50 OVER/SHORT: . 00 for the purpose ol sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 15 . 00 . 50 ._I 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 protects with a contractor(s)license pursuant to the Contractors'State License Law).l am aware ******,***_****.*_********************_*,***,******,*********************************.** that proof of their Worker's Compensation insurance should be provided to me. I am exempt under Section: B.A P.C. INDIVIDUAL FEE BREAKDOWN Q for this reason: ALLBWORK4BY OWNS TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: ///727/9/ Owner. / ✓ A - _ I do hereby certify that lam aware of and understand the requirements of Ca •rua Health and Safety Code Miens 25505. 5533,and SFR 500 ALTER BY VALUE RESIDENTIAL OZONE 1 , 0 0 500. 00 25534 and that I or any future building occupant wilt/will not(circle one)need to comply with said state codes and the requir ments for a END OF FEE K permit for construction or modification from the Air(Maw Management District.Residential construction applications are exempt from these provisions. • EXPIRE Date: Apphcanl: I plots inspections hereby s and thathavelaws :elating this application and state that the above Irze representatives ist t es of I agree to complyteruwith all city andcounty Ode /� � Ih ireby sand stale) v read globmWingcaandcstatandttreba ove infomation wire t.this city to coruponthe above-mentionednd - // property for inspection purposes / , Date: /V”-- 4/ Signatu y 4 VR G//.S _ , .. Driver's license or Social Security+: sae• �� + S 5 [a . j l 1641.46 white—Budding:Green—Code Enforcement:Canary—Applicant:Pink—Rev: ue:Goldenrod—Assessor ,'CONSTRUCTION AND PLANNING r POt,.. f APPROVALS Permit # Date Inspector APPROVALS Permit # Date Inspector r 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location . • 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit.Uiility-Undrgrnd. 54. Forms •/ 44 Electrical Conduit•.Undrgrnd. 55. Electrical Bonding 5. Steel"Reinforcement 56. Rough Plumbing & Pressure Test - . ' 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITl �. ;7. Footings •- 58 2. . Electrical Conduit-Undrgrnd. -8.' Foundation 59. Gas Pipe, ❑ Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 1. 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 4 20. Rough Factory Fireplace - : • APPROVALS'- - Permit# ' 21.-Ducts,in-Structure - - . 70. Underground Hydro • 22. Ducts, Vehtirating _ _ • -. ' 71. Product Pitting 0-Gas 0 011 t 23. Gas Pipe-Rough& Test 72. Underground Flush- 24. Roof Framing : ' 773. Undergrnd.Storage Tank O Gas 0 Or? . 25. Roof Sheathing ' L . `74. Overhead Hydro I26. T-Bar Ceiling (Structural) & Monocoat 7' •• • > 75.'Dry Chemical - 27. Frame and Flashing. �e.-qZ w�• 76. Dry Standpipe ' 28. Lathing & Siding • _ 77,:FIXED SYSTEM•R1NAL 29. Insulation • 78.>FIRE PREY. FINAL 30. Drywall Nail r7g �f - HEALTH DEPT. REQUIREMENT B 31. Plaster own-Coat , �-r r 79. FINAL INSPECTION , - , - _ - -rte= 32. ElectricarPower Meter-Final - - • 80. FOOD CERTIFICATE ISSUED 33.'Finaf EleEtric • r - Notes: y ' A ad 134.,Final Heating& Air Conditioning - /%� 35. Final Gas Pipe-TestW Q 36. Hodd or Canopy . . - . . i 37. Final Factory Fireplace - - '• '' 38. Final:Plumbing - .•. a _ ^ 39. Water Service-Final - • ' - a . - 40. Gas Service-Final • , . ., . • . .,• 41. Solar Domestic-Final - > _ '1 L 42. 'Backflow Preventer. J - 43. Backf low Irrigation - - • _ 44. Landscape Irrigation System t - t 1-; . 45. Sound Attenuation' • > i z A 46. Handicap Regulations . . - - $ . . y 47. FINAL STRUCTURE & BUILDING .� 48. FINAL PLANNING A9. Electric Release to Edison 50. Gas Release to Southern California Gas Co I ..1 51. CERTIFICATE OF OCCUPANCY -- No. Date 1 1 PROJECT ADUNIT: ER NAME 1620 SANDALWOOD ST CITY OF COSTA MESA — BUILDING PERMIT PERM NO: P 055245 OWN s NAME: HUMPHREY, JOHN V 3RD L ' ADDRESS: HUMPHREYSALLY A PERMIT NO: P 055245 PLAN CHECK NO: N GOVT: N SUPP: N 1620 SANDALWOOD ST COSTA MESA,CA 92626 CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU PURPOSE: OTH ARCHIENGINEER: 751-6552 REG.NO.: ADDRESS: UNIT: JOB DESCRIPTION : BATHROOM REMODEL SQ FT: PERMITTEE: CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 / ADDRESS:TTEEJOHN HUMPHREY ( 714 )751-6552 1620 SANDALWOOD COMMENTS: REF B55244 92626 ********************************************************************* ********* LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under v1F provisions of Chapter 9(commencing with Section Z O NI N G R E U I R E M E N T S 70001 of Division 3 of the Business and Professions Code.and my license is in full force and effect. ' S E T BQA C K S CITY LIC.: STATE LIC.: CLASS: • Date: Signature: MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a cenificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN Compensation Insurance,or a certified copy thereof(Section 3800.Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN POLICY NO.: EXP.DATE: COMPANY: PARKING REQ: PROV: PARCEL: 13921208 ZNE: REF NO: Certified copy is hereby furnished. 0 Certified copy is tiled with the city Building Division. PLANNING NOTES> > Applicant: ******************************************************************************* EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed it the permit is for one hundred(5100)or less). DEVELOPMENT SERVICES REQUIREMENTS I certify that in the performance of the work or 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: Signature: DATE• : NOTICE:If,alter making this declaration.you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY ; __—a._ ,._—___ ... DATE: Code.you must tonhwiih comply with such provisions or this permit shall be deemed revoked. _ CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lendingagency for the performance of the work for �r which this permit is issued(Section 3097,Civ.C). g *******M**APPLICATION ISSUED B ��`� —Z • DATE: 1` (ZZ�1 1 ***3FifiFlElFiel4ifiFieiF1s3FiF*** -r-e•2.2.s.s.a.z•-- —._._. . . . . • . . . . . • . • . . . • . .*lF1FiF3FaEjf#lEif****tE3tlFiriE*** LENDER: ****************IF*%***3t***94%***te*** *E************3*3t***3Ht9e**3F**9t*3e************** ADDRESS: LEGALIZATION:N F E E SUMMARY 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 ECTR I C MECHANIC FIRE SM I P/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 4 . 00 repair any structure:prior toils issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed Pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000(of Division 3 of the Business 25 t SM I P/NON—RES and Professions Code)or That he/she is exempt therefrom and the basis far 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 3. 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----> 4 . 00 3, 00 0 .00 7, 00 7 , 00 . 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/hersell or through 11, his or hen 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: 7, 00 OVER/SHORT• 00 mrmepurpose ofsale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 7. 00 and Professions Code: The Contractors'Stale 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). I am aware ***************************************************************************** that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN IR I am exempt under Section:B P 7044 B.8 P.C. for ma re/x5out L WORK BY OWNERn//A . TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST ,�_ Date: // 7 tin/ Owner: / / ,4 .`til I do hereby certify that I am aware of and understand the requirements of Calif or Hearth and Safety Code Secti 25505,25533, d PLU 1 WASH HAS I N 2 00 2 00 25534 and that I or any future building occupant will/will not(circle one)need comply with said state codes and the requirements for a PLU 1 NATE t CLOSET (TOILET) 2 . 00 2 . 00 permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from END OF FEES, these provisions. EXPIRED Date: AI . Pie e Inverts I hereby certify that and have read this application and slate that the above information is correct agree to comply with all city and county s ordinances and state laws relating le building construction and hereby rrepres2.ati s r this city to enter rdn the above-memioned late /• property for inspection purposes./ tit! (v;,, _ Date: ////i7i/r, Signature: .� 'i �- _ .L`t �^6 •. ' -- Driver's tic knse or Soo(al Security 9: Applicant;Pink—Revenue;Goldenrod—Assessor _ 1 'CONSTRUCTION AND PLANNING POC . APPROVALS Permit ate Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location ' 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit,Utility•Undrgrnd. 54. Forms -4;.; Electrjcal Conduit_Undrgrnd. 55. Electrical Bonding :f5;Staer'Reinforcement 56. Rough Plumbing & Pressure Test ,. 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE ' -T, Footings 58. Electrical Conduit-Undrgrnd. =8: Foundation 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line-& House Connection 62. Backwash & Receptor-Final ' 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing s_%„-hem, 4:-/7-9,g_MIC 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 z - _ APPROVALS ; Permit # - - - 21. Duct's, in Structure - . . - • 470. lindergrour{d4Hydro 22. Ducts, Ventilating - - • 71. Product Piping 0Gas ❑Oil 23. Gas Pipe-Rough& Test , _ 72. Underground Flush- - 24, Roof Framing . - • - ,73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing - r - '74. -Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat • - 75.. Dry Chemical _ r 27-'Frame and Flashing76. Dry Standpipe 28. Lathing & Siding - _ - >' . 77. FIXED SYSTEM.FINAL• _ r 1.i.•29. Insulation 78.;FIRE PREV.`FINAL , 30. Drywall Nailing . - .HEALTH DEPT. REQUIREMENT ; 31. Plaster Brown Coats ' 79. FINAL'INSPFCTIQN - 32. •ElectricaftPower Meter-Final I • . .80.,-FOOD CERTIFICATE ISSUED - .t " 33- Final Electric' - Notes: - r ^7' •34. -Final Heating-f& Air•Cohditioning, - J. - . - •r -s 35. Final Gas Pipe-Test - t -' _ •` - 36. Hood.or Canopy - . - - 37. Final Factory Fireplace - - ' 38. Final Plumbing ; - •" •39. Water Service-Final • - - r t `- ,?0. Gas Service-Final • • :41. Solar Domestic-Final - - - • --c • . - C -42. Backflow Preventers " _ , _ 43. Backflow Irrigation= • . . , _ ' q $44. Landscape Irttgatiop System. •A5.1.'$ound Attenuation _ - r� r i .46- Handicap Regulations -• . , , - '47. FINAL STRUCTURE & BUILDING . - • 4B-;EIN•AL PLANNING: , , ; - „i„ -49. Electric Release to Edison , i 50. Gas Release to Southern California Gas Co t - - _ 51. CERTIFICATE OF:OCCUPANCY - - - No. Date PROJECT kWR'ADDRESS: 1620 SANDALWOOD ST UNIT: OWNER'S CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 055246 ADDRESS: HUMPHREY, JOHN V 3RD a HUMPHREY SALLY A PERMIT NO: E 055246 PLAN CHECK NO; N GOVT: N SUPP: N 1620 SANtALWOOD ST COSTA MESA,CA 92626 CONSTRUCTION TYPE: V—N PERMIT TYPE; ELE PURPOSE: OTH • ARCH/ENGINEER: 751-6552 REG.ND.: ADDRESS: UNIT: JOB DESCRIPTION ; BATHROOM REMODEL SQ FT: PERMITTEE: CLAIM VALUE: 500 .00 CALC—VALUE; GROUP OCC; R-3 / ADDRESS: JOHN HUMPHREY ( 714 ) 751-6552 1620 SANDALWOOD COMMENTS; BATHROOM REMODEL CA926 6 ******************************************************************************* LICENSED CONTRALTO CLARATION: I hereby affirm that I am licensed under provisions o per 9(commencing with Section 'L O N I N G R E Q U I R E M E N T $ 7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. CITY LIC.: STATE LIC.: CLASS: SETBACKS Date: 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.or a certified copy thereof(Section 3800.Lab. C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN POLICY NO.: EXP. DATE: COMPANY: PARKING REQ. PROV: PARCEL: 13921208 ZNE: REF NO: ESPTIONFROMWORKERS'CDMPE Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. PLANNING N TE$> Applicant. NSATION DECLARATION: (This section need not be completed if the permit is for one hundred(3100)or less). DEVELOPMENT SERVICES REQUIREMENTS 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. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the peAormance:ol the work for APPLICATION ISSUED BY? ----•--- :�—W DATE• 1 which this permit is issued(Section 3097.Civ.C). • LENDER: ADDRESS: ************************************** .' *************************************** LEGALIZATION:N F E E UMMARY STRUCTURAL SEGMENT:N OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from theContractors'State License Law for the following reason BLDG PMT PLUMBING EL ECT'• IC 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 repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed PERMIT , 75 pursuant la the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business 5 0% SM I P/NON—RES 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(8500). ISSUE FEE 1 5. 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 3 . 75 15. 00 0. 00 18 . 75 18 . 75 . 00 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 40 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: 18 .7 5 OVER/SHORT• 00 for me purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 18 . 75 and Professions Code: The Contractors'State Licensh 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). I am aware **************************.**********,**,*********,******************************** •that proof of their Worker's Compensation insurance should be provided to me. am exempt uncle Section: B.a P.C. INDIVIDUAL F E E BREAKDOWN f. is,j i ALL BP(l�ORI�4BY OWNER �/J�y/ TYPE QTY DESCRIPTION UNIT COST TOTAL COST � Date 4 4 /..../ 4 Owner: ,/ I do hi,'.y certify that I am aware iof and understand the requirements of California H ;,ealth and Safety Code Sections 25505,25533.and ELE 1 RECEPT/SWITCH •'44 1 ST 20 EA. . 75 . 75 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 ELE 4i 1 ....:.MOTOR/POWR APPARATUS 0 . 0 — 1 . 0 HP 3. 00 3 . 00 permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from •END OF FEES these provisions. EXPIRED • • Date: Applicant: 1 plate Inspections heron c certify that I wsr Latin this building and state that the a authorize information prion i ' eofagree to comity with all city and county alj�/r•T Sig f�J I hereby sand stale laws read bpplicgionatnd stonand htheb above info atCYi avee correct.thisIree to en with a a city and ny Pine (!(JJJ �I( JLD KA-��• property for inspection ppurpossess, / / Dale: ///.2.2-/(/. Signatu ' _ Driver's License or Social Security$: II 4 / 1641-46 White—Building:Green—Code Enforcement;Canary—Applicant:Pink—Revenue;Goldenrod—Assessor \.— S _ CONSTRUCTION AND PLANNING POO%. 'APPROVALS Permit# -rate Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement i1 3, Electrical Conduit.Utility-Undrgrnd. 54. Forms ' .'4: Electrical Conduit-Undrgrnd. 55. Electrical Bonding i • :5 Steel Reinforcerpent 56. Rough Plumbing & Pressure Test 6. Electrical UFERGrnd. 57. APPROVAL TO COVER-GUN.TE •7: Footings 58. Electrical Conduit-Undrgrnd. 0 '8. Foundation - 59. Gas Pipe, 0 Undrgrnd., Test ,9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line;& House Connection 62. Backwash & Receptor-Final • 12. Sewer Cap • 63. Heater & Vent-Final - i 13. Roof Drains . . 64. Plumbing System - Final 14. Rough Plumbing •- - 65. Electrical-Final 15. Rough Electrica&Conduit 66. Solar System-Final 16. Rough Electric Wiring X1/2 t/ G ..,ef,401. 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL .s 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace -: - *APPROVALS- •.Permit # a •: 21. Ducts, in Structure'. .. . - - x • �7 y y" ' _ 70. Undergrouttd Hydro 22. Ducts, Ventilating _ ‘: -C 71. Product Piping ❑Gas 0 Oil 23. Gas Pipe-Rough & rest - 72. Underground Flush; ' - 24. RoofvFraming • '-_-- - '73. •Undergrnd.Storage Tank D Gas ❑On -. 25. Roof_Sheathing z , . ' •, - - , 74.-Overhead Hydro -• "} 26. T-Bar Ceiling (Structural) & Monocoat ,.♦. - :11 • 75. Dry Chemical - r % t ; _ 27.'frame and Flashing ' _ „ ; ; 76. Dry Standpipe - , .- 'c "i> , - J , 128. Lathing& Siding,. : i % .- >' •• -* ' 77, - FIXED SYSTEM F#NAL• - 29. Insulation g r " :. , ' I - - 78.-FIRE PREV. FINAL -, - 4.' • • 30. Drywall Nailing • * HEALTH DEPT,REQUIREMENT - 31. Plaster Blown-Coat ; - ` ,79.'FINAL INSPECTION - - - = 32. ElectricapPower Meter-Final • .. I ' < . -80. FOOD CERTIFICATE ISSUED ' 33. inaf Electric r ' Notes: 34. •Final,Heating& Air Conditioning , J. . : 1e226 FEE RECEIVED ,,/• NOV 15•'44 COSTA MESA BUILDING-SAFETY DEPARTMENT ^ FINANCE DO P:O. BOX 917 COSTA MESA. CALIFORNIA WY Y a tb r MESI� For Applicant to Fill. In Completely APPLICATION FOR PERMIT TYPE OR PRINT . BUILDING BUILDING ADDRESS Ito"in 4nnT»L'vOoo ST. COSTA// MESA. CALIFORNIA For Office Use Only +OWNER ma. &,£.0. Co jca1 I RECEIPT NO. I PERMIT NO. MAIL RECEIVES BY DATE RECEIVED DAT ISSUED ADDRESS 1(0'2 C5 SARYOAr L,'V/no , SI. LV //-/5- — 3dJ / -h•� TEL. , BUILDING // 00 /id, _ CITY C05T/a /A.SC/' NO.KI 9-MS5 ADDRESS LL JL 4 ,, e yVH,/ - ARCHITECTTEL.ICI 9-/nc COSTA MESA. CALIFORNIA OR ENGINEER J. \\MC'SV <NOPFI, lS , /� . ADDRESS lQigo TEAK kine 7j • C.M. ;TREE IRE '� . IL L�a]gIO L.• AE/ULEV ZONE TYPE y GROUP/ /K CONTRACTOR �c'// L �j/ BBYPROVED -±�- DATE /J /C� ADDRESS ?OS /�e;9.4411z7O4J Sr ZON"`I'�11NG • CITY Cos /ol /A/"/jenr,f . ,y ^ / O -I I PLANS I BUILDING HU �a -t,�/S' LIC.iENO. c O 0 / / U l NO. /'/,C CO DI 177 / LEGAL 2.' ?J�. 7/1 z CJ -2-^L DESCRIPTION SIZE 6,-S /'-� L° //Ir I NO. OF BLDGS. OF LOT NOW ON Loi 1 A.P.NO. USE OF YARDS EVES EXISTING BLDG S2£Sl ni•xtrr APPROVED ALLOWED SETBACK LINE FROM / / (CENTER LINE ST..)L,�( / L' �X Jy,'/ CENTER OF STREET 51) REAR YARD ryJ7j FRONT //j //4 CS FT. I V I� / •I N. SIDE YARD I LEFT 10I RIGHT 4J/ R.SIDE FT. IN. DESCRIPTION OF WORK L.SIDE /G FT. IN. NEW I II ALTERATION I H ADDITION I x 9 REAR / FT. C? t IN. : REPAIR I II MOVING I II DEMOLISH I BYPROVED - /��mp DATE //�dA BUILDING I 90tit NO. OF ROOMS / STORIES / (�•� l EXTERIOR WALL ROOF M14i4T u,C COVERING 'STD C-Cr-5 I COVERING USE OF BUILDING AND WORK TO BE PERFORMED A/Jn, r/os , 05 0, JL&1 + Q/n . 7 Q/ 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 COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. FLY WITH ALL CITY ORDINANCES AND STATE LAWS - GULATING BUILDING CONSTRUCTION. VALUATION SIGNATURE O ,, , i PERMIT FEE $ 9. 0-0 PERMITTEF I�, Z(((���rs`^'71 .. Ar AUTHORIZED AGENT�4 =pC a $/C;oo ft) PLAN CHECK $ rr0 R. Viri '11/1 / /3.52 Z L E TOTAL FEE D 4 1 OWNER CORICH, George DATE 1-3-63 JOB ADDRESS 1620 Sandalwood St- BUILDING PERMIT NO. 18226 GENERAL CONTRACTOR Donald L. Henley VALUE $ 1900.00 V AP No. LOT 2114 TRACT 2822 FIRE ZONE DESCRIPTION OF WORK 1-n INSPECTIONS Signature DATE GROUP I TYPW V ZONE R-1 Soil PERMITS ISSUED Gas SUBCONTRACTOR DATE NUMBER Water Rough Com. Refrig. 0 Air Cond. 0 Rough Heating Rough Plumbing Miscellaneous Prop.Swr.Line 0 House Con. 0 St.Swr. 0 Sprinkling System Constructiail Pole Underground ❑ Power ❑ tough Wirigg /�C'�%r �—/^-76:7-‘3- �INCIZLOt�/9 /"/ l-) /9/2 --- Trenches l Forms d Steel Remf. ❑t(,j •r j-h�h7T Floor System l3ond Beam 0 Steel Reinforce 0 Sheathing /' - i Frame and Flashing , 1I (- . Lathing — InIS Out i` 4. /-Z 2 .;,3 Plaster, brown coat "L'7 2 -/- G9 Refrig. ❑ Air Cond. 0 Final Heating, Final Plumbing Fixtures, Final Final Gas Test _ Electric Fixtures, Final / 7 /- 477 _ Building, Final if K 9-1-‘• V OCCUPANCY rneu Gain _Ste _ ]g, I nlvfl 1 FE RECEIVED • • - I 18543 JAN 8 1963 COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT. P. O. BOX SI7 COSTA MESA. CALIFORNIA CITY OF COSTA MESA For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT BUILDING //� '/ ' / "� BUILDING ADDRESS /6 "t"4/57/y J�[e/,lljOh r5r COSTA MESA. CALIFORNIA For Office Use Only �R no. COP/0N I RECEIPT NO. I PEW F /^ OWNER l/9.• `c, /_//JT-i/5 MAIL )/ RECEIV BY 7TE RRECEIVED. DATEpI SUED ADDRESS 1�O.ZC SQA}JVfl �n sr //../Z.26 j/1 �f/)�O�-G�/J��j/I/J,(�/{j,(O�-� CITY ('0s74 /�72 S.5Z TNO.If I YI Gc5 BUILDING ADDRESS / G�(J.K.[1//W"'�G�"1' / C ARCHITECT SLL/ Sw U Tr ?/(/1s COSTA MESA. CALIFORNIA OR ENGINEER lub .6TP}glj �y ADDRESS /J 7C rt'N/Y!v/J OIi Pt, C/� FIRE I/ �� '/ ZONE �J TYPE ( GROVP �T CONTRACTOR tb/U.Q//) Ll A1Al2Ey APPROVED /Y"l.':// DATE" ✓ ADDRESS SOC-44-5-a71.17-6N ST ((( ,,,✓/J ZONING CITY COS! ' ins, ZONE NO.OP - I USE OF NEW Q1...4) '�- I PLANS / BUILDING Lon STATE L_ //�� TEL r/ / ^� p LEGAL GGG��1���111/ I T✓✓✓✓a llll2-S�1- LIC.NO.CO I/ / /O/ NO. CJ/ Ga Z(y `1'/ DESCRIPTION I j ,.(14 OFSIZLOT (�D �']ll/ f' ` /O.0 q.. / 7 I NO. OF SUGGS. OF NOW ON LOT A A.P.NO. USE OF WES/DCIF. YARDS EVES ,EXISTING BLD APPROVED ALLOWED SETBACK UNE FROMS y / (CENTER LINE 8TJ `1 ,, _ / CENTER OF STREET REAR YARD p 3 FRONT C J(-) �K��•/J-SAI N-. SIDE YARD ILEFT / 6 / I RIGHT F! R.SIDE 35Th. IN. DESCRIPTION OF WORK L.SIDE /7. '9LFT.- IN. NEW I (ALTERATION I II ADDITION I REAR /1 /� /O. 7 FT.t IN. REPAIR I IIMOVING I II DEMOLISH I APPROVE / y \., , .! DATE BUILDING NO, OF 1wy UY'\ v�.J}lM/� SIZE ROOMS STORIES {. r(------ EXTERIOR WALL I COVERING / -,`�j.p(,M lib Wn COVERING -7 USEOFL ITU.LDIN j 'T T R TO E PE{tFORMED e li k 4 (r6 n f71 re 17&c. 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 COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL GITY 0 !RANGES AND STATIC WS REG TING BUILDING coNSTRU VALUATION r SIGNATURE OF �.D ,/Q PERMIT FEE $ . PERMITTEF all/24 ° - $ PLAN CHECK $ �- *' AUTHORIZED AGENT SOD' N TOTAL FEE - . a / 0 OWNER CORICA, George DATE 1-8-63 JOB ADDRESS 1620 Sandalwood St. BUILDING PERMIT NO. 18543/ GENERAL CONTRACTOR Donald L. Henley VALUE $ 500.00 AP No. LOT 214 TRACT 2822 FIRE ZONE DESCRIPTION OF WORK Pat. I . alt to BPS INSPECTIONS Signature DATE GROUP J TYPE V ZONE R-1 Soil PERMITS ISSUED Gas SUBCONTRACTOR DATE NUMBER Water Rough Corn. Ref rig. 0 Air Cond. ❑ Rough Heating Rough Plumbing Miscellaneous Prop.Swr.Line 0 House Con. 0 St.Swr. Sprinkling System Construction Pole Underground 0 Power ❑ Rough Wiring 9TH / 77 _y—n _ _7 / Trenches 0 Forms 0 Steel Reinf. ❑ _ Floor System Bond Beam 0 Steel Reinforce 0 Sheathing Frame and Flashing Lathing — In 0 Out 0 Plaster, brown coat Ref rig. 0 Air Cond. ❑ Final Heating, Final Plumbing Fixtures, Final Final Gas Test Electric Fixtures, Final Building, Final -C`�M OCCUPANCY FORM FORM BU4•5M — 7-61 l Rch2 • 9864 . COSTA MESA BUILDING-SAFETY DEPARTMENT .L 13 13J0 P.O.BOX 317 COSTA MESA, CALIFORNIA "111- 1')7 737 FOR APPLICANT TO flit /N COMPLETELY APPLICATION FOR PERMIT TYPE OR PRINT BUILDING • ADD EISS 1620 Sandalwood St. t COSTA MESA, CALIFORNIA EOR Off/CE USE ONLY ..,,'� Co. RECEIPT NO. PERMIT NO. OWNER Rosslane Land CI (��) 'e ,p MAIL (� R ED BY DATE RqE`CEIVE�D--� DAICSD� ADDRESS 419 E. 17th St. I 7— - / I /—,'-Si' cITY Costa Mesa TND.L183159 ABltDDRESS ARCHITECT Carlson & LIC. COSTA MESA, CALIFORNIA OR ENGINEER Middl1LruukFIRE NO. ADDRESS Garden Grove ZONE 9 . Colegrove, Inc. ATE 167293 APPROVED CON MO LIC.STNO. BY DATE ADDRESS 419 E. 17th St., Costa MesarZONING LEGAL LOT 2�1 I 2822 ZONE///��1 NO.OF USE OF NEW DESCRIPTION NO. A'E'I' BLOCK TRACT 0?) I PLANS _L ( BUILDING &La) (( A P NO. APPROVEDn,/_ 0 1(1/V DATE 7. /3- J SIZE NO.OF SLOGS. YARDS //��ll��/�I7 EVES OF LOT 65 x 102 I NOW ON LOT none REQUIRED ALLOWED USE OF (CENTER LINE ST.) EXISTING BLDG. FRONT 3-0 FT. IN. SETBACK LINE FROM 33' CENTER OF STREET 50' REAR YARD R.SIDE ,J FT. IN. i 51 (( SIDE YARD LEFT 10! I RIGHTL.SIDE 3 FT. IN. DESCRIPTION OF WORK REAR a'0 FT. IN. NEW I X II ALTERATION I II ADDITION REPAIR I II MOVING I II DEMOLISH I 5 ZE DING 1560 NO.OF ROOMS 7 STORIES 1 EXTERIORiCOVERING Rock COV U OFBUILDING ND WORTO BE PERFORMED Single family residence with attached garage. Plan 12nC I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ADOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTION. • � J /v,{�%�(p4–._ VALUATION rnrn PSIGNATURE ERM ITTEE OF ( /��,/�`�`_ PERMIT FEE $ 35.50 Inc. $ lC'S71 PLAN CHECK S 17.50 AUTHORIZED AGENT Dike & Colegrove. I \ l TOTAL FEE 5 52.50 — OWNER ROSSLANE LAND CO. DATE 7/9/59 _ JOB ADDRESS 1620 Sandalwood St• BUILDING PERMIT NO. 986)4 GENERAL CONTRACTOR Dike & Colegrove, Inc. VALUE $ 15,571.00 AP. No. LOT 21)4 TRACT 2822 FIRE ZONE DESCRIPTION OF WORK Res. Watt. gar• INSPECTIONS -,-7/_y9 DATE GROUP T ,P` ,T TYPE 1] ZONE R1 Underground Soil'/VISU.G. Water 41.15 9..-1-'37 PERMITS ISSUED Underground Gas SUBCONTRACTOR DATE NUMBER Overhead Water and Gas Rough Heating 4*5 7-29r9 iv _ it_ "; S-.24-s7 0bd17 Rough Plumbing /11,40 'a-/-6"4 7f ,( nJ £ .(l 7244/-,)-9 7.6/SS✓ Miscellaneous Prop. Swr.fLine- IIgdde'Con. St. Swr. rigegyet Pk4,M &.* 7/7oI, Y /G/ _r Sprinkling System efi -- t Heating, Final II'' Finmbing Fixtures l vi 6— Final Gas Test 5 r q Construction Pole _ Underground Power Rough Wiring 423 %i 19/ YY )lid /ii.'. n . 9-//1 Y— /0 AC5K V Trenchesa{' Forms US' Steel06i/ l] ;-3-T9 Floor System Steel Reinforce Chimney Re-Rod Bond Beam '/ Sheathing -10'/,4 --1=7 y Frame and Flashing Jhr����/lffff'9�1I /�j 9-'S7 Lathing, In/1' Out OJe'/�/x-22-Kra Plaster, brown coat /41/- ti-9-111' Plumbing Fixtures, Final A_�Jj P. Electric Fixtures, Final L Building, Final Ike OCCUPANCY Form 410-3M-4.5996614 986]4 Xerox copies: 2972 Jacaranda, 2973 Teakwcc4, 1624 Sandalwood, 1616 Sandalwood • 'C P.O COSTA COSDING-SAFETY TA MESA,CALIFORNIA 9 626 DEPARTMENT APPLICATION FOYSrTR7�267b1>-PERMIT 66,50 1k RECEIVED PERMIT N° , 50424 For Applicant to Fill in Completely —Use Ink Only f BUILDING / y (�// A.P.NO./37 )/ 2,.- O 0107 ADDRESS /G / eN,Oq„oC .?'— fy� L' // / W BUILDING' ' (1 OWNER OR • / ADDRESS TENANT T l 'Aro,/ if 7 v v UNIT OR MAILING y C�� �/� / Y SPACE NO.2�,�J f/ '-7-4rj y ADDRESS t�/2o Q+•Y""V.r./.-.9/t'1 ' l��fl�/ / I TEL. �j���� CITY �CTION srt �/,,8 /7 NO. pJ�.ri+ �J{ NEW fDD ALTER REPAIR MOVING DEMOLISH CONSTRUCTION -' i ST ( / LENDER BRANCH J s V. /4-4,44444/9 , ohr-t • OWNER /� r/L_ ADDRESS ARCHITECT TEL. USE /3 ADC At LIMA/ VALUE / §7os6'_ OR ENGINEER NO ADDRESS /p�� ZONE �� / ,�sTVPF iN GROUP iti AP CONTRACTOR O// J BVPROVED /-, (/ ,s,/ DATE 'Lt' ADDRESS 1/ /ska_i e;J'TV✓ TEL. 7y /Ad /& CITY NO. // S �// F STATE CITY APPROVED SETBACKS LIC.NO. LIC.NO.i—i f C raj SIZE NO.OF BLDGS. (FROM C/L STREET) ,y:J 0. OF LOT NOW ON LOT FRONT FT. 1 y EXISTING BLDG. R SIDE Fes. 1�� h FSeparate permits are required for L.SIDE P��� Ca electric,plumbing and heating work. j r FT. �. USE OF BUILDING AND WORK TO BE PERFORMED CANNING ACTION Q C] DATE Q E f O t. /cc/cool/ 41`71(/ jA ttnA0 _ ) APPRO�-,h/7@�pi/ 7a�' 1 9"41 hM 50r !/✓v//tOW lf< RYP7ADa/4 DATE / A'D a I hu QI hereby acknowledge that I have read this application and state n I4 that the above information is correct and agree to comply with 0. all laws regulating building construction, and I shall not employ i Z any person In violation of the workman's compensation laws of 2 Sthe State of California. 7056.E a I hereby certify that I am properly licensed as a contractor under ��`/ f FT, t..l the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR ro Chapter 9, and that such licenses are in full force and effect,or) THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: e am exempt fro provisions of t State of California Business and Profession ode,Div's' n 3 C apter 9. VALUATION PERMIT FEE § [,�(f, v., n Signature of PLAN CHECK $ 2/t ^. 0 Permittee /'---' � `!L'� $ ( os‘.� TAX E or U Authorized Agen Date TOTAL PAID $ ,S0 .OWNER. J. V. HUMPHREY DATE 7/28/80 JOB ADDRESS 1620 Sandalwood Street (See back of Card) BUILDING PERMIT NO 50424 GENERAL CONTRACTOR Owner-builder DESCRIPTION of WORK Block wall (5 Property Owners) AP No. 139-212-09, 08: 07,31 ,24TRACT 2822 FIRE ZONE VALUE E 74055 00 INSPECTIONS Sig Date TVPEV—N GROUP M ZONE R-1 SOIL PERMITS ISSUED GAS SUBCONTRACTOR Data I Number I Signature WATER Plumbing ___ rig ROUGH PLUMBING rO PROP. SWR. LINE n HOUSE CON. ❑ SPRINKLING SYSTEM MISCELLANEOUS ON ROUGH HEATING AND AIR CONOITIONING 1/40 TEMPORARY SERVICE OR POLE UNDERGROUND ❑ POWER ❑ 0 ROUGH WIRINGcn Heating and Vent. 4a TRENCHES I�ri FORMS Fir. STEEL REINF. 'a :LN/ Y): saccepg: EXPIPFD FLOOR SYSTEM �J %"t d .1G[BOND BEAM n STEEL REINFORCE ElIn umplc e In'.pBCtIDRS USHEATHING Cancel rd FRAME ANO FLASHING Date (_L3-EI 1Slg LATHING — IN n OUT n —PLASTER. BROWN COAT WSTRUCTURAL, FINAL Electric HEATING. VENT.. REFRIG. AND A.C., FINAL .-(PLUMBING, FINAL AND GAS TEST n a ELECTRIC. FINAL BUILDING. FINAL 2972 Jacaranda, 2973 Teakwood Place, 1624 Sandalwood St. , 1616 Sandalwood St.