HomeMy WebLinkAbout1603 SEA HORSE CIR - Building Permits .ADORESSOEBMIOWO: 1603 SEA HORSE CIR WIT` CITY OF COSTA MESA - BUILDING PERMIT
•r'R:"4NlemJACOB PERM NO. B OR7267
x' 1603 SEA HORSE CI
CM CA 92626 PERMIT NO: B 087267 PLAN CHECK NO: N GOVT: N SUPP : N
APR.MAILING ADDRESS CONSTRUCTION TYPE: V-N PERMIT TYPE: STR PURPOSE: OTH
ARCNBECT ORENQNEER: UC'NO.: JOB DESCRIPTION : REINSTATE EXPIRED PERMIT BEP : 57521 SQ FT: 2, 658
ARCH.OR ENG.'S ADDRESS: UMT:
CLAIM VALUE: CALC-VALUE: 2,658 .00 GROUP OCC: R-3 /
CONTRACTOR'S NAME
CONTRACTORSDAMNS COMMENTS: IN GROUND SPA
ADDRESS: UC.NO.: ************************************************df******************************
WIT: ZONING REQUIREMENTS
UCENSED CONTRACTORS DECLARATION:I hereby affirm under penaly of perjay that I am licensed wider pronatus Of Chanter 9 SETBACK S
(commencing with Section 7000)of Division 3 of the Business end Professions Code.and my license is in full force and effect.
CITY UC.NO.: UC.CLASS: UC.NO.: EXP: MAIN BUILDING ACCESSORY BUILDING
Dae: ContractorFRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby affirm under penaly of perjury that I am exempt from the Contractors License Law for the
blowing reason(Section 7031.5 Business and Professions Code:Any city or county which requires a permit to construct.eller.improve,
emolsh,or repair any structure.prior to its issuance.also requires the epplimaforeixh Penni)to file a signed staementtha he o she PARKING REQ: PROV: PARCEL: 42519121 ZNE: REF NO:
e licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 d the PLANNING NOTES>
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.My violation of Section > �'�..�
7031,5 by any applicant for enermit subjects the applicant los civpenallylpenally
y of not more than five hundred dollars 1$5000. *********************************3fjL3kiE3EREit3E3EifjflL1E****1EiEaE****dE3E3E1EiE1E3EifjEiEdEiEdEr7fjE#******
El 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
o offered for sale(Section 7044,Business and Professions Code:The Contractors License Law does not appy to an Owner of propend DEVELOPMENT SERVICES R E Q 'U I R E M E N T.. S
who buids or improves thereon,andorhis or who does such work himselfherself or through her own employees,provided that such
improvements we not intended or altered for sale.U,however.the building or improvement is sold within one year of completion,the 't
owner-builder will have the burden of proving he or she did not build or improve for the purpose of sale). ZONING APPROVED BY •
• DATE: ••
O I,as owner of the properly.an exclusively contracting with licensed contractors to construct the project(Section 7044,Business end ,
Professions Code:The Contractors License Law does not appy to an owners properly who wilds or improves thereon and who BUILDING APPROVED BY : DATE: -' .1:-.4
contracts for such projects nth a contrado(s)licensed pursuant to the Contractors License Law). Q
404damPtund r13P 44 B.BP.C.,hxthis reaaonoW R B ILD?/,2/4. APPLICATION ISSUED BY: ***4************
DATE: ` ` 13
• Omer: **********************aE*********************** ****
ware of and understand the regui a of Calif h and Safety Code Sections 25505,25533,and
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
sitid t �/���y future building occupant will/will not( one)need to comply with said date codes end the requirements for
for construction or modifiation1mm the Ar a9emern Diann.Residential construction applintiere are exempt from these BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
prp s. PERMIT 74 . 75 . 50
Date: APDlkant: SM I P/NON-RES
WORKER'S COMPENSATION DECLARATION:I hereby affirm u
under penalty d perjury one d the following declarations: PLAN
v."�
ElI have and coil maintain a cemfkale of consent to self-insure for workers'compensation.as provided for by Section 3700 of the Labor ISSUE FEE
Code,forthe pedonnanceof the work for which this pennhis issued. BUILDING-DIV-> PERMIT ISSUE PLAN�CHECK TOTAL PAID DUE
o I have and nil maintain works's'compensation insurance.as required by Section 37C0 ol the Later Code,for the performance of the TOTALS----> 75 . 25 0 . 00 7..;0 . 00 75. 25 75 . 25 . 00
work for which this permit is issued.My workers'compensation insurance carver and policy number we:
Caner: 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(the penal is ler one hundred dollars(SIM or less.) 74 . 75 - . 50
o 1 certify that in the performance of the work for which this permit is issued,1 shall not employ any person in eny manner so as to
/9
become subject to the workers'cam»nation laws Ca"sir" .and spree'hal lf become
1 thee" suhisd'o the millers' *******************************************************************************
compensation provisions of Section 3700 ofLabor
the Code. anon forthwithcocoin*coin*with those provisions.
I N D I V I D U A L %F E E BREAKDOWN '
Date: Applicant:
Warning:Failure to secure wobas•conpersadoncoverage leunlawful,end shall subject an employer tocriminal penalties and TYPE QTY DESCRIPTION , UNIT COST TOTAL COST
civil fines up to one hundred thousand dollen($100,000).In addition to the coat of compensation.damages es Provided ler In
Section 3706 of the Labor Code Interest,and afromeyS lees. SFR 2658 ALTER BY VALUE RESIDENTIAL NOZONE 1 . 00 2, 658 . 00
CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty of perjury that there is a construction landing agency for the END OF• FEES
performance of the work for which this permit is issued(Section 3097.Cb.C). . ,•
LENDER'S NAME: �
LENDER'S ADDRESS: '
I certify that I have read this application and state that the above information is correct.I agree to comply with all dry 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.
JIM JACOBS
Name 03-12-1998/09:06 AM/575.25
�/�
g PT
,_ .11 Date T087267
ippr Sig ' �•
ent/Appn , mtractar v'
(5151.4e WP) White-Bu Safety:Green-Fle:Carry-Appicant:Pink-Revenue:Goldenrod-Assessor
Ill CONSTRUCTION AND PLANNING POL_ dr SPA
' APPROVALS Permit# Date Inspector, APPROVALS Permit # Date Inspector
•1. Temporary Electrical Service or Pole 52. Pool & Equipment Location `
2. Soil Pipe-Undrgrnd. ' 53. Steel Reinforcement
I=3; Electrical Conduit Utility-Undrgrnd. - 54. Forms -
-4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding •
- 52.Steel Reinforcement w • 56. Rough Plumbing & Pressure Test
6: Electrical OF ER Grnd. - 57. APPROVAL TO COVER-GUNITE
- 7^Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd-,Test •
9.'Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System ' G 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection -- 62. Backwash & Receptor-Final
12. Sewer Cap r 63. Heater &Vent-Final
13. Roof Drains - 64. Plumbing System - Final
14. Rough Plumbing t 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. POO VSPA SYSTEMS FINAL
19. Rough Heating.& Air Conditioning- a - 1, -sc' FIRE DE-T.'-REQUIREMENT ..1
20. Rough Patton/Fireplace _'T' z r S 7` `APPITOVp.LS "'� PeiMit# '•
21. Ducts;inrStructure-x ., .: • n.. • 70. 'Undergro• und Hydro ,
22. p'ucts, VetIttilang'r -1 •.i .7 tt • �; gtP
- 71. Produiping-D Gas 0Oil .
23. Gas P,pe-RougA& Test T,,^ t'- . n' c- - , : 72. Underground FJush.- -
•s . -
24. Roof Framing t: `• t•i+ . 73:. Undergrnd.Storagetank.O Gas O Oil
25. Roof;Sheathin --` V " I� - O
9 ti -1 may 74: .Overhead Hydra
26. T-Bar.Ceiling (Structural) & Mondcoat ' '- - 75:-Ory Chetpical `.' ;
27. Frame ant,Flashing , 76. Dry Standpipe �r , „ -•
-.28. Lathing& Siding . , j'1'- 0 ' x 77_,1 FIXED SYSTEM-FINA[; '-' . ' r`t
- 29. Insulation q 787 FIRE PREY. FINAL - -
30, Drywall Nailing s 'HEALTH DEPT.79EQUIREa MENT
-}31- Plaster Brown Coat ; ;_, !, 79. FINAL INSPECTION x •
--7-.., 1
32. ElectricalMeter
-Final Power M -Final - '- .'80.'FOOD CERTIFICATE ISSUED'
1'
_33. Final Electric„ - . . i N��1oppptes: ,';• - '
34. F1naIHeating•& Air Conditioning _ ./---
` -ti ^,tB_.��� - _. /
35. Fjnal.Ga{'Pipe=Test - - _ s.` • ' ;;; • ' E/i4.-i
-,36. Hoo(or Canopy - ;- - ^o ^, 1.-
„ . ..
•-37. Final Factory Fireplace.. `-' -' - ';
PRDIECT4JIE*SS: 1603 SEA HORSE CIR UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO; BEP 057521
OIER'S N ME: JACOB
ADDRESS:, 1603 SEA HORSE CI PERMIT NO: BEP. 057521 PLAN CHECK NO: 01949- 92 S GOUT: N SUPP; N
• CM CA 92E26
1 • CONSTRUCTION TYPE: V—N PERMIT TYPE: ELE PLU STR PURPOSE: O^'H
ARCNIENGINEER: REG.NO.: JOB DESCRIPTION ; IN GROUND PREFAB FIBERGLASS SPA SQ FT; 2 , 658
ADDRESS: UNIT:
CLAIM VALUE; 2, 658 . 00 CALC—VALUE; 2, 658. 00 GROUP OCC: R-3 /
PERMITTEE J & H SPAS ( 714 ) 898-1000
ADDRESS: 15122 BEACH BL COMMENTS: IN GROUND SPA
MIDWAY CA 92655 **xx*xa:x4*xxkx**#aF*******.x:E*-7c>Exxx***+ETcx******'>E**********x*****x*iE**#xa;'x>F***# *x
LICENSED CONTRACTOR DECLARATION: I hereby affir• at I. licensed under provisio.s of Chapter 9(commencing of Section ZONING REQUIREMENTS
7000)of Division 3 of the Business and Professions C••e.and • snse is in full for . nd effect. SETBACKS
CITY LI,, 3979? Euc.:47944 ,/ cuss: `' 3
Date: a '�/ / _ Signature ��_/ ± Q//. MAIN BUILDING ACCESSORY BUILDING
WORKER 'CO PENSATION DECLARATION: there.-affir at I have acerlific.e•consenro 4insure or ac' iticate of Workers' FRNT: FT IN REAR: FT IN FRA?T: FT IN REAR: FT IN
Compensation nsurance.or a certified copy there, (Sec 3000, Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT; FT IN
POLICY ND.: EXP.DATE: PARKING REO PROV: PARCEL: 42519121 ZNE: R2 REF NO:
%MPANY:
PLANNING NOTES> ADDING SPA TO AN EXISTING RES>Certified copy is hereby furnished. ❑ enilied copy is filed with the city Building Division.; Applicant:
EXEMPTION FROM WORKERS'COMPENSATION DECLARA tonne'• 3 b' ompleted if the per ' ' for one hundred 1$100)or less). 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=3' S
I certify that in the performance of the work for hick is mit is s:•.I
A employ any pers in any manner so as to become Af
subject to` orkers clip, nLaws•fCalor ZONING APPROVED BY �, E. DATE; _5 '( L
Date: / // !G sign pre:. UILDING APPROVED BY
NOTIC : I,aft- making this declaratiro,yo should •: ome sub)' B
Workers'Co pensalion provisions of the Labor : DATE
Code.you mu- forthwith comply with suc provisio• or this pen it S :II be deemed re oked. ! 't
CONSTRUCTION NOM AGENCY: I nereb alio at there is a on action lending agency for the performance of the work for APPLICATION ISSUED B Y: P TLC_ DAT—, 17 US
which this permit is issued(Section 3097.Ci .C *******'***********************w ir*ztr******'*k**********R7-**********iF*' r.x�ir**
LENDER: / '***********************************************-IF***********************x'*4'*****
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT;Y
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMI 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 - -54 , 00 2 , 00 30 ..0 0 ,50
repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed 25% 50 t SM I P/NON—RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN 35 . 10
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 penalty of not more than five hundred dollars($500). ISSUE FEE 3 . O U 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 PIAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS——--> 86 . 50 1.8 . 0 0 35 . 10 139 . 60 139 . 60 . 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through L
Ids or her own employees.provided that such improvements are not intended or offered or sale.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED; 139 . 60 OVER/SHORT:, 00
improvement is sold within one year of completion.the owner will have the burden of proving he/she did not build or improve
for the 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 54 ,00 5• O 0 45, 00 -` • . 50 35 , i0
❑ 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 prolecls with a contractor(s)license pursuant to the Contractors'State License Law).l am aware **********ri************'*****************'**************************** *******:****
that proof of their Worker's Compensation insurance should be provided to me. IND IV I D U A L ' : F E E BR EAKDOWN
0 I am exempt under Section. B.8 P.C.
for this reason: TYPE QTY D E S C RSI P T I O' N;; UNIT COST TOTAL COST
t e
Date', Owner; `.Fg 2658 ALTER BY., VALUE RESIDENTIAL NOZONE 1 . 00 2, 658 . 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and 'I ,, 1 SWIMMING POO) — IN GROUND NEW EA. 30 . 00 3O, 00
25534 and that l or any future building occupant wtlgwill not(circle one)need to comply with said state codes and the requirements for a PLU 1 SWIMMING POTMyaL - 2 . 00 2 - D 0
permit for construction or modification from the Air Ouality Management District.Residential construction applications are exempt from
these provisions. • _ .r_ END OF FEES
Date: ._ - Applicant: EXPIRED • ._
'I Mete fn•,:
hereby certify t .1 have read this application and re state Ih. the a�ovEyf .tion is correct. agree to comply'i n all city a • • my fps �t� dt( % •
oroperlyesn'1pe'ate ars relating tob gran. or�g(reckona i hereh authors presentatives of this city to enti oI Ii •..n e-mentioned "�'* -'
property for'epe•ion purpos ///
Date: /I • r Al 1 d 'Signator :� ,�A�i a 6 '
i' " r _
\ 1 License or So•al Security
AOolicJ4ink—Revenue:Goldenrod—Assessor t - . II
• CONSTRUCTION AND PLANNING - PCaA . 1
GPPR£=JALS Permit# Date Inspector APPROVALS Permit # Date Inspector
}1. Temporary Electrical Service or Pole -- 52. Pool & Equipment Location (e(f 1 -
o,W
2.'Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms •
_ I
4' Electrical Conduit-Undrgrrd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation - 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. • 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System - 61. APPROVAL TO DECK
11. Property Sewer-Line & Hbuse Connection - ' 62. ,Backwash-& Receptor-Final •
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign - 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling • 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning •
FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts,in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil �♦
23. Gas Pipe-Rough & Test 72. Underground Flush .t
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. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat - 79. FINAL INSPECTION
32. Electrical Power Meter-Final - 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: /yyn . i �p�-
34. Final Heating & Air Conditioning /// O-V _ �c 0hP �Nw 1' tG
35. Final Gas Pipe-Test U
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
•
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING ,t�. �..
48. FINAL PLANNING /J, 1
49. Electric Release to Edison _. .
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
:=i PR - , -F. 0 irt.1 1 C. ' PJ IJ E S . I L_ L. r. G' 1= .. ,
4'. c:11
4.1 { Hi.
,I r y. ...
1 0.,_;,,{
-f'4 t
....1(® 1 ,
,,
•
.1 a G-•1'.L'I I(
+�.+• ��.V , \ �(
. ® (-� • j
� ...--e..
i r
j.<-7..t
!1!L• .9� r' 3 }j�a` " 611— _r ' y" yam, e. �' (- '
4;(0� ,
City ! Coa ;> e�. G 9��"�
:L I T�� �.TE � ,1.,r_‘ ( ; .jZ.. ( „t .tett r.3rio - L—cif rel la •
-
C E ANS` US�Ur-6V';`IATM T7°r... �! �tGi�ll Ll;�' / ' :I. ,1 >41u
NCeS 4•••‘....d�� f 3i v7 �; x i
ii (th I'4H1 [F� / J Y ( C,
sunolcr- oR . an �Prp s---ir2 % b IG j {c ktrC{m.nh, 4`:31; m
-
S, VD SPECIFIC r, -V'7_I,C `• - I . , I, 1Ut C,= 1 L-�1
' EMIT 'GI7.(JH AN IPF' ' .S i COtJ?,. U dE A I `-{,", y C i
.:r PRi VISIG(IJS OP' 1US Cn:;, • °• '!.P.b),. ,.i AiJV G�' �y1 S}Z/n 1. I ill X17
•
Ji li0i TY 1'lI V!OL, 'I' OR l: 1`C' V. 't GIVE !/ -
•
-IJE S ALL GS VAI I! Ei,CEr; rit• '"` C` THiS I-
•HICH AJTHC - L '` `R r'" .•0.50.3 USE (14.
.1
rE Isst (�
':'FFCIFIC 1.%1 1 V. AT k�..�. aA.-D I PL;NS <'6L
i PECI INIREAF1'! I .HE Li:;t n,•i- CCI IC 6L
• TURING 1HE COHRE. W,,/ c n NN
'`•.D ''L NS AA;. `O�r`I ':ir7L'!f( `� IT� (,.0 •
:,.�n 10 1.<J911•1
11
'-L'ILD:r:c NPC AN ECPXIJA.RrEr C' Hr! r UIP ] I
BE�.!G CARRrFr t r. iFie, I
N l',UTAI LN OI NiJ ¢ ' r"��i•A',IAi /QAIy
THE CITY.'.JF`a�;N'R tlk0iNA1JCE OF
wl�Bc"t) `(•1 ` QO Afe2.
ti7
; PM,
) eY1y' 1 Are . APPR
O D
US fa ,/ ,---. OL.Jner CRY OF COSTA M -A
MAC! TO SIDCe. DEPT.
. 1 -- 7-Ac
‘.
'D
I If
�i •
�, l fafG�C �fJ;rl. Y e_ DA 1 cf
DIRECTO, Of- w,�H11M0
i Le.r
`N I SGC gliOhZ
15,.01,
OKT*7/E493ED WITH PLAt CHECK. 1W3 O '`sem �l rz-
THIS DOES NOT CONSTITUTE FINAL CT.Ik � ,
PLANNING APPROVAL. �/0. 92.
— IdNIZTI�ALS� D:1T)e:sr c 0 k) waeovite
t/'ys, s. l/_ �c 11_ rY1
ADDRESS Cf BMLIANG: 1603 SEA HORSE CIR DMT: CITY OF COSTA MESA — BUILDING PERMIT
GWNEIrSNAYElFQ10wN:JIM S MIKIE JACOBS PERM NO: B 087266
ADDRESS:SAME
PERMIT NO: B 087266 PLAN CHECK NO: N GOVT: N SUPP : N
642-3777
� APPL.WRING ADDRESS CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: 0TH
ARCHITECT OR ENGINEER: UO NO.: JOB DESCRIPTION : REINSTATE EXPIRED B-57702 SQ FT: 380
ARCH.OR ENG.'S ADDRESS: DMT:
CLAIM VALUE: CALL—VALUE: 380 , 00 GROUP OCC: R-3 /
CONTRACTORS NAYS
CONTRACTORS MAWS COMMENTS: X
********************** �*/
�**43 E /iq iE iiE 1 ELt
iiADDRESS: LUC ND: 3f iflf MiF iF iE iE lE if MiF�F 3EK iE ik it iE iE if iE�kkiE iE lE lF iE iE
• UNIT: ZONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penally of perjury that I an.licensed under provisions of Cheerer 9 SETBACKS
(commenting with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.
CITY UC.NO.: UC.CLASS: UC.NO.: EXP: MAIN BUILDING ACCESSORY BUILDING
Dae: Contractor LEFT:
FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby affirm under penally of perjury that I am exempt from the Contractors License Law for the
'ollowin9 reason(Section 70315 Business end Professions Code:Any city or county which requires a pend to construct,alter.improve. PARKING REQ: PROV: PARCEL: 93721018 Z N E: REF NO;
demolish,or repan any structure,prior to its issuance.also requires the applicant tor such permit to fib 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 DVS 3 of the PLANNING N TES>
Business and Professions Cale)or that he or she is exempt therefrom end the basis for the alleged exemption.My violation of Section >
70315 by any applicant for a perms subjects the applicant toecivil penally of not more than five hundred dollen lSSOOU. *********************************************************************L**********
❑ I,s owner d the properly or my employees with wages a mei sole compensation,will do the work.and the stmcture 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 and Professions Code':The Contractors License Law does not apply to an owner of properly
who bolds«improves thereon. Unmet who does such work himself or net or through his or her own employees,provided that such
improvements are not intended or offered for sale.If, the building of bmprovement is sold within one year of campetiun,the ZONING APPROVED BY
caner-builder will have the burden of proving he or she did not build or improve for she purpose of sale). • DATE:•
❑ Proufessions ner Codde: Contractors the ynnmeiaww doeesnn licensed contractors
bowwnner of pro wediated hoa be uilds (Section
ttereeon1eaho BUILDING APPROVED BY : DATE: ?_
contracts for such projects with a contractors)licensed pursuant to the Contractors License Law). ^
lam ode se ,,.:PSr'O q,e.S�Prtsa. «me OWN BUI ER�2//4g APPLIC*TION ISSUED BY; (`' DATE:
*********************************************** *** *****DATE**
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
ply e d end understand the requi d ndGalileo' and Safety Code Sectons 25505,25533, for
2"• shat I• re building occupant will/will mol(d le one)need to ply wlh said state codes and the requirements for
▪ d for•• •- or modification from the As u�DTe ananepament Mend.Residential construction appWL"am are exempt from these BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
P revisions. PERMIT 21 . 00 . 50
Date: Applicant: SMIP/NON—RES
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penally of perjury one of the fotowing declarations: PLAN
❑ I have adwil maintaina certificated consent toeeff-insure leendows'r sucs'compensation.as provided for by Section ion 3700 the Labor ISSUE FEE
Code,for the pedrm
oanceof the work fowl:wis
thispermiteaued. BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ I have and wil maintain workers'compensation insurance.as required by Section 3700 of the Labor Code,for the performance of the TOTALS----> 21 . 50 0 . 00 0 . 00 21 . 50 21 . 50 . 00
work for which this permit is Sued.My workers'compensation insurance canes and policy number are:
Carrier: REVENUE DIVISION TOTALS--> COLLECTED: 21 , 50 OVER/SHORT: . 00
Policy Number: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
(This section need not be completed I the pearl la for one hundred ddfars($1001 Of fess.) 21 . 00 . 50
o I candy 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'compeneetion laws d California,and Woethat R eho
1 utd become eubted lO the workers' *******************************************************************************
compensation provisions of Section 3700 o the Labor Code.1 shill fonhwih comply with those provisions.
Dae: Applicant: INDIVIDUAL F E E BREAKDOWN
Warning:Failure to secure workeri compensation Coverage is unlawful,and shall subject an employer to criminal penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
civil tines up to one hundred thousand dollars($1040001 In addition to The coat of compensation,damages as provided for In
Section 3706 of tis Labor Code,Interest and alronrsyl fees SFR 380 ALTER BY VALUE RESIDENTIAL NOZONE 1 . 00 380 . 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 the work for which this permit is issued(Section 3097.CN.C).
LENDER'S NAME:
LENDER'S ADDRESS:
I cattily that I have read this application and stale that The above information is cored.I agree to comply with all city and county ordinances
and state laws relating to building constructor.end hereby authorize representatives of this city to enter upon the above-mentioned property
for inspection purposes.
JIM JACOBS03-12-1998/09:04 AM/$21,50
�
Print Name / RCPT0:01-0020759
Z �' FEkMITe087266
—� —+�,`p / Date:
sairs AgenL/Appicanvcontmctor
' (5t51d6.WP) White-Building A Safety:Green-Fle:Canary-Appicant:Pink-Revenue:Goldenrod-Assessor
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit# Date Inspector. APPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. , 53. Steel Reinforcement
3, Electrical Conduit Utility•Undrgrnd. i 54. Forms
a
4. Electrical Conduit•Undrgrnd. - 55. Electrical Bonding r
' 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 7.
+6. Electrical OF ER Grnd. 57. APPROVAL TO COVER•GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
i.tr.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 ,T; 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains .J 64. Plumbing System -Final
14. Rough Plumbing - ' 65. Electrical-Final '
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
19. Rough Heating &igjr Conditioning c-; •• -t al -, ' - FIRE DEPT. REQUIREMENT
20.:Rough Factory Replace 'x`+ # LI I '-' r--''' APP1,i0 11 S'4 ' Permit# ' x
: ^21. Ducts, in:Structure,- c - - rept 70.7-Underground Hydro «
22.Ducts, Ventilating. -Y i ;- < ' 71. Product`Piping-0-Gas el Oil
23. Gas Pl pe too &,Test _; :•v * • - 72. Underground Plush• - . - -I
24. Roof Framing _ -? • m` -' ' 73i Undergrnd.Storape!ank OGas ❑Oil
25. RootSheathing ., - !-.. o 74.JOverhead Hydru-k
26._T•Bar•Ceiling (Structural) & MOO-coat " _ y a 75:-Dry Chez :cal _
27. Frame and Flashin ' R r
.. 9:c --%� t: j. 76. Dry StandpipeK _ ,.,
. 28. Lathing& Siding .� _ . 77i FIXED SYSTEMTFINA -'
29. Insulation 7.1i FIRE PREV. F./NAL
30. Drywall Nailing • • :« => HEALTH DEPT.REQUIREMENT
-j31. Plaster BrownCo, at-.- �,:� �; 79. FINAL INSPECTION j, •J _ • '
32. Electrical-Power Meter Final • 80' FOOD CERTIFICATE ISSUED' -
�� 33. FinaT:Elerzric� _,_� • ,1 Nates: 7-- `. "
7
: 34.finat Heating-& Air 6onditionirTg ,Tt a : I C y=, _ -•
35.,Final Gas-Pipe-Test ., " - - E"
' 36. Hood•or-Canopy r r z Z
n
1 37. Final Factory Fireplace i v c+ • ,
38. Fina LPlumbing - i -
39. Water Service-Final • t ' 5
n. . I , .
40. Gas Service-Final . ''� - '
. _ I �L
41II
. Solar Domestic•Final .--37..--37.-.3 _
42. Backflow Preventer " , , . . 4 m C --
43. Backflow Irrigation= - ^ tr, .r: ' _ t '
,44. :Landscape Irrigation,System .-i '... ' _ '1'. 'C i. _ _ •� -
45. 'Sound Attenuation' ' ' ^ 4. ` - - -
r_. ..- -, ' S r„ .. .. i '. . .I . r+
•
z;
46. Handicap Regulations ` .. t
i [t- c.. r. '..,_ r
47. FINAL STRUCTURE & BUILDING ).-(1:-.Cif (w
48. FINAL PLANNING- '
49. Electric Release to Edison • I '' : ' -
50. Gas Release to Southern Califorriia Gas Co - - r . .
51. CERTIFICATE OF OCCUPANCY -
No. Date
i '
PARTY WALL AGREEMENT
THIS AGREEMENT, made and entered into this // Tif day of '
lUht� , by and between _ I j WAS
hereinafter referred to as "LANDOWNER," and
hereinafter referred to as "ADJACENT PROPERTY OWNER."
It is hereby agreed that a party wall will be constructed on the property line
between /(n03 - b& C CIO%Le C5) --7J tZ7e'
(Address of Adjoining Properties)
/(ooh ,seg- idol st- cote- Cosqn-
in the City of Costa Mesa, County of Orange, State of California, as per map recorded
in Book , Page of Miscellaneous Maps, in the office of the County Recorder
of said County. The party wall shall be permitted to encroach �l2 CW CDIC
p2°*iY
IN WITNESS WHEREOF, the parties have entered into this Agreement the day and
year first above written.
LANDOWNER ADJACENT PROPERTY OWNER
C / /
ore)e (Signature) J.
VP
Name(Typed or Printed) Name (Typed or Printed)
_7603 sin- ase' Gtee CC V, 0-2_ SeA \l-One (itrc( e
(Address) (Address)
C ler iuc-sA f Qj tit Z6a'
NOTARIZATION REQUIRED
1906-46
'PRONE ADDRESS: 1603 SEA HORSE CIR UNIT:
OWNER'S NAME: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 057702
JIM ,& MIKIE JACOBS
4 , ADDREss SAME PERMIT NO: B 057702 PLAN CHECK NO: 02167-92 S GOVT: N SUPP: N
t CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: OTH
ARCH/ENGINEER: 642-3777 REG.NO.:
Y' ADDRESS: UNIT: JOB DESCRIPTION : 19LF-6FT HEIGHT MAX CITY STANDARD BLOCK SQ FT: 19
• PERMITTEE: CLAIM VALUE: 380. 00 CALC—VALUE; 380. 00 GROUP OCC; R-3 /
ADDRESS: PAT BUILDERS ( 714 )675-9742
501 36TH ST COMMENTS• X
,NEWPORT BEACH CA 92663 ********iF*******************************************�F******x�F�r�F�6�E�e�E�F�F+ESE***�F****
LICENSED CONTRACTOR C R 0 : I here y alum that I am licensed under provisions or Chapter 9(commencing with Section Z ONING REQUIREMENTS
70001 of Division 3 of the Business and Professions Code.and my license is in full force Gand effect
CITY LIC.: 178330 STATE LIC.: CLASS:
S E T B A C K S
0 2307 4 B
Date. Ce—1/42—9�� signawm:—�{�T �UF PiT .--�� 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.: 1159317_91 EXP.DATE: 10/01/92
'tOMPANY: STATE FUND PARKING REQ: PROV: PARCEL; 93721018 ZNE: R2 REF NO;
J Certified copy is hereby furnished. Certified copy is filed with the city Building Division. PLANNING NOTES> CONSTRUCT 6 ' HIGH 19 ' '3" HIGH WALL ALONG SIDE PROPERTY
4F_/O --9 ��rVULP Q `ice > LINE IN THE REAR PARD,
lase: Z A� pplicanl: r /iF**********************************************************fit*******************
CXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if permit is for one hundred($100)or lesDEVELOPMENTsr.----*
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.
Date: Signature: ZONING APPROVED BY 1, DATE; (Ip IC7( gZ
NOTICE:If.alter making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY DATE:
Code.you must forthwith comply will)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• 1
which this permit is issued(Section 3097:Civ.Cl. DATE: \ �� ( ***
,r. *********************iF************************* *************************{t
LENDER:DR *******************************************************************************
ADDRESS: LEGALIZATION;N F E E SUMMARY , STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE , SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 15, 00
repair any structure,prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed 1 . 50
pursuant to the provisions of the Contractors'Stale License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business SMIP/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 9 . 75
_
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE rr.
C
I. as owner of the properly 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----> 15. 50 0, 00 9 . 75 25 , 25 25. 25 , 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• 25. 25 OVER/SHORT• 0 0
, or 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 15 . 00 , 50', 9 , 75
_ I and Professions Code: The Contractors'State License Law does not apply to an owner of properly who builds or improves thereon
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law). l am aware *,*,*,*,**,*,*,*,x,**,K,***,**,**,*,*****************************************i*** **************
that proof of their Worker's Compensation insurance should be provided to me.
❑ I am exempt under Section: B.&P.C. IND I V I D UAL F E E BR EAK DOWN
Y
for this reason TYPE QTY DESCRIPTIO N UNIT COST 0 TOTAL COST
Date: Owner:
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and SFR, 19 RES—CONCRETE�I BLOCK WALL / FT• 20.00 380 , 00
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 $ r END OF FEES !1
permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from 4.
these provisions. EXPIRED r
Date: Applicant: Inc' 1p,ae Inspect. •n�C'. ` '%.
I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county , 00,
v' r '
ordinances and state laws relating to building construy��s++r'000n and hereby authorize representatives of this city to er upon the above-me ionetl / — ,
property lar inspection purposes. / y�j'/ //� � / Date( L. Sig ' 'ate
Date: ‘7--(0�(y Slgnature��////L/AZ ,��/ 1
o P
Driver's License or Social Security 4:
Canary—Applicant:Pink—Revenue:Goldenrod—Assessor
CCC
„ .'`ly _ _
CONSTRUCTION AND PLANNING PO & L
APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Servit('or Pole,_ - 52. _Pool & Equipment Location
2. ;foil Pipe-Undrgrnd. 53. Steel Reinforcement
;3_ Electrical Condu t-Ut+lity-Undrgrnd,• r 54. Forms
4--Electrical CondutYUiidrgrnd. 55. Electrical Bonding.
;- 'Steel Reinforcemejt- i • .-26 ....ctx_64Ar 56. Rough Plumbing & Pressure Test
6. Electrical UFERrGend. 57. APPROVAL TO COVER-GUNITE -
-77..Footings r N
9 _ z6-26as w 58. Electrical Conduit-Undrgrnd. ,t
6 Foundation 59. Gas Pipe, 0 Undrgrnd., Test
' 92r.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 t 64. Plumbing System - Final
14. Rough Plumbing" ' - 65. Electrical-Final
15. Rough ElectricaLConduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign - 66. APPROVED FOR PLASTERING
18. Rough Electricaf-T Bar Ceiling . 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
- r ' - L.
20. Rough Factor Fireplace ' r ,'• 4 . C' i APPROVALS -'Permit # r
- z. -
21. Ducts,in-Structure . ' . - - - .4 70. Underground�Hydro -
22. Ducts, Ventilating;•'. < x r •:"" r ; 71, Product Thing O Gas 0Oil
23. Gas Pipe;Rough & Test ;' . v . X `v >. n. Underground Flush - - -
c - - -
24. Roof-Framing • - y3. ,±Jndergrnd.Storage Tank O Gas 0 Oif
r 1125. Roof Sheathing z' n 2 0: •
;, s ,,# , 74. -Overhead Hydro . ..
26. T-Bar Ceiling (Structural) & Monocoat t- _ _ _ n st r 75 . DChil _
ry emca , -
27. I ra me and Flashing :_ r x c a. •- _' 76. Dry Standpipe,
. - -
28. Lathing &Siding r r r Y r m.' s •- A ; 77. 7FIXED SYSTEM FINAL t -. - , -•
.. . . ♦ . I 1:4- • r
29. Insulation - ,.i; , , 78.'.IRE PREV. FINAL - •
'30. Drywall Nailing y. I HEALTH_ _ DEPT. REQUIREMENT
-, EE • Y G • •1
'31. Plaster Brown-Coat • �'� F '" 79. FINAL INSPECTION r '
wry- "i!Y, - - LL
32. ElectricaJ:Power Meter:Final i - sx 4 k - 80. FOOD CERTIFICATE ISSUED
^
33. Fina(Electric * r - ,rzrr. r.. - It '' Notes: -% A
- •r
;34. Final Heating& Air-Co conditioning `a, = _ r _ - - '
35- -€incl Gas Pipe=Test ' _ z ` I " ' - '
-
36. Hood or Canopy - ,.• - �: >.
z v is
,37. Final-Factory Fireplace � ' _ t '•1• `r .. ic ,-
36. Fina-9lu[pbing ' ,t. r r• ' G. -v -:- • of
39. Water Service-Final • i " ' I p r • '
40. Gas Service-Final '. , it.
• - -
41. Solar Domestic-Final a - :•s 'r` '
42. r�ackflow Preventer '; _ . -' i 1 { .` • :. •
43. Backflow Irrigation .- ri, t " '
0. Landscape Irrigatiori.System q;.•',:, iv". Y Cr •.7" _ . - u. ,i`lite.B �,a 6, 1
X15. Sound Attenuation - = % ' : -* -t C-7C-7..z.-- B • '4 61-ca..ary
46. HandicapRegulatioris ii, .� . r, .� ` �ly
47. FINAL STRUCTURE & BUILDING J. - -
48. F.1NAL PLANNING _` > _ r 1
.49. Electric Release to Edison i . ; - I, •. ? •.r 1
,
I
'50. Gas Release to Southern California Gas Co t
- I - , _ •
51. CERTIFICATE OF OCCUPANCY' •, . . . . _
No. Date
. .
• .
_..... r
• r APPROVED .
(too o v, R._
City of Costa.Mosa Ouiteling Dept, • t so_ai3e, c, -/ACLIfr- 3 479
DATE B., ____ -- _______ LalisL- Ital.- C°C-nir k eg4 C4_ .:......._ .
.
PLANS MUST BE ,S.': JOE" PT All TIMES MAKE APPROVED
u,..NCES, WITHOuT F c.ieR APPROVAL OF DEPT. .
.
• .
'S---1 -10 t CITY OF COSTA MESA
I
5SUANFTAk TIRANA ' A ITT R1jII OM APNIOVAL OF I . PLANNING DEPT.
SPEGIF1GATIONE -•• •' < 1311 CON'S rpun TO BE A
SUBJECT TO OLEG. DM. RES.
. .1
FOR, OR AN ARNICA . '• A,.AA \ROUT 01'1 OF AN OF
.. .;ROVISIOI:S OF THIS 1...C.U1:•^. -. TAIT nr.;SLIMINC110 GIVE • :7
-RFT? TO VIOLATE OR c.v.:C.. ir1C.: pnavvitows OF'THIS • • ..---...-.....DA b LI It
. •. _ .. ALLBE VALID EXCEPT, 11•1:10 FAR AS THE AORK on USE A IF( (.1'r• Outlaw OF PLAMIN0
AUT HORIZES 15 LAACFUL. l,72 4... • -
, k CI •
/7
1 IC iZSUANCE OF A PE114.AIT BASED UPON PLANS AND •
' . '•.. .E.-TTONS SHALL Eat PLE:11ENT ARE euiLoNc urrici L n.111 bitva_ we, Ii ' . t
-:Il. iREAFFER R5GUIRINOATECOPRECTC14 OF F.FIROP.S ft•r(n)
- • : zA US AND SPECIF1CATNS OR FROM plitLirt vj OAP •I q I 3 II ' i
On s,..
.. • OPERATIONS BEING DARNED ON THF.t1::UNDER rtir
• ......•:ION or THIS 'ODE OR C.)F ANY OTHER 011DINIAbVY F
•
E-el3C ...
..; '
i . •
. ..
0 1 .
-
1 .
•
111
5_
AI .
i 1
c RESIDENCE RESIDENCE RESIDENCElb I •
• i- RESIDENCE
Lu
LU
t I- . .
tn tu
lu
\%••••.. wl° .'2 0 I 2 ec
v)
- •
1 .
• . •
STREET 6
• • . •. .-,--
,t,
;4-,
. • .
...•
TYPICAL 6" CONCRETE BLOCK FENCE
Cement Coping Optional :�ak —H GENERAL— NOTES
Channel Block With 1-3/895 II . �
Horizontal Top of all
Fences MORTAR: One Part Plastic Cement, and
Three Parts Sand
C GROUT: One Port Cement Three and
• For Fences 5'or Less f One Half Parts Stand
Vert.Bars 3/8"¢at 4' -D"O.c. Id� 0 _ "VIE=
COPING: One Part Cement, Three
Sand
For Fences Higher Than 5' CONCRETE: WelIs Mzed 1:2 I/2: 3 I/2
Vert.Bars 3/8"0 at 32" O.C. > wi re _ Max. of 7- 1/2 Gallons of
Fill Cells Solid With Grout f�il > Z " , Water Per Sack of Cement
Where Steel Occurs I > - aillReinforcing Steel Shall P 1D IGROUT MAV BE POURED FROM THE TOP
Conform to Steel S all 2 to _ _ OF THE FENCE IN CELLS WHERE STEEL
A.S.T.M. OCCURS.
CELLS AND AREAS OF HORIZONTAL REIN-
FORCEMENT SHALL BE CLEAR,CLEAN&
All Steel to be Lapped �� FREE OF ALL MORTAR DEBRIS,ETC.
24"or to Code111111
NATURAL GRADE ft
/--:' .- -.CQ� s":.1n p . A _t. ♦ .a a e
n
TWO3/8"0 BARS
....411. °A D ' t o ♦ ♦ e
CONTINUOUS TOP I -
&BOTTOM I
-*-.{ —a---WIDTH • TO 16 0. C. MAX.
SEE CHART ♦ - D. •
HOR72.STEEL MUST BE TIED IN BELOW , DEPTH or EARTHTCOTH
PLACE AT TIME OF TRENCH
.e I/3 THE HEIGTH OF FENCE
INSPECTION. L - BELOW BOTTOM OF FOOTING
km4:_i 10� f„ 2.,AI SCALE: 1/211 = I1
FOOTING REQUIREMENTS CHART
WALL HEIGHT 6 ' 5 41 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'
•
;I City of Costa Mesa, California
lb. Building Department
, r..,.__...——.
• • F=E.,:.15ED MOV.82.
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
PERMIT NO. T NO. LOT O UNIT NO.
CITY OF COSTA CO T C JON PERMIT Y f/ A.P.# yZ��v _�'� (/) zone
":Project Address Y� - \ S Main Building: Accessory Building:
Iicant's Mailing Address TYPE OF CONSTRUCTION U NEW U ADD U ALTERATION LI REPAIR , E Z
❑ CONVERSION ❑ DEMOLISH ❑ OTHER T Front 0
f er's Name Phone DESCRIPTION OF WORK/USE OF BLDG. I B Rear
ress
TYPE OF PERMIT 0 GRADING U FOUNDATION U STRUCTURAL C Right N
Arch/Eng. License No. K
Address ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL S Left R
Contractor's Nam¢ Phone 0 OTHER 'Ping. Ref.# ark ing Req./Provided E
PROJECT DESCRIPTION SQ. FT. OCCUPANCY • 0
Address(mailing) Planning Notes: V I�„ a ,F^r�
C ON ST RUCTION TYPE - VALUATION$ / M
City License No. ZONE G RADI NG CU.YDS. ACRES r0ss✓ee f t '�O Gek.dcS T
LICENSED CONTRACTOR DECLARATION S.
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks:
with section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force and effect. ELECTRICAL FEES
License Class License No. e....../ (�0 1124-1"----.1 4172--,-;- 4
Date Signature PLUMBING I FEES Automatic Washer Transformer 0 15.50 KW
1RKERS'COMPENSATION DECLARATIONDOnalrUCtlOn Po le Sub. 0 50+KW
reby affirm that I have a certificate Of consent to self-insure or a certificate Bar Sink Showers
Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink Cooking Unit Meter ❑up to 100 amps
3800, Lab. C.)
Policy No. Company Backflow Irrigation Sewer Cap Dishwasher Meter Dover 100 amps
B Certified copy is hereby furnished. —
Dryers ❑Gas ❑Electric Sub Panel
Certified copy is filed with the city Building Division. Bathtubs Sewer Connection
Date Applicant Fan Motors 00-1 HP 011/2-8
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifier Solar Collectors
tstssection need not be completed if the permit is for one hundred ($100) or Dish Solar Piping F.A.U.
eInc.Solar 09-15 HP 016-15+
I certify that in the performance of the work for which this permit is issued, I Fi%tures
shall not employ any person in any manner so as to become subject to the Drg ntains Solar Tank l Microwave
Workers' Compensation Laws of California.
Date Signature Swimming Pool w/Spa Device Boxes Pole Light
NOTICE:If,atter making this declaration, you should beco a subject to he eOutlets RanWorkers' Compensation provisions of the Labor Code, must fort thQi %rains
loor Sinks Urinal 9
comply with such provisions or this permit shall deemed Switches
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Sign
I hereby affirm that there is a construction lending a y for perfor nce
of the work for which this permit is issued cti 09 I C.) nterCeptOle Water Heater Garbage Disposal Standing Sections
Lender's Name
Lender's Address Kitchen Sink Water Service Generator 00-5 KW 05-15 KW Trash Compactor
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the COntracto ense Law for the Lavatories Auto-Wash
following reason (Section 7031.5 Business and Professi Code: Any city or
county which requires a permit to construct,alter,improve,demolish or repair P—Trap Laundry Trays
any structure, prior to its issuance, also requires the applicant for such permit
M file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains
•Contractor's License Law(Chapter 9(commencing with Section 7000)of
•inion 3 of the Business and Professions Code) or that he/She is exempt Reinspection Fee $15 Issue Fee $ 3
.erefrom and the basis for the alleged exembtion. 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). 3 DEVELOPMENT SERVICES REQUIREMENTS:
U I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ •
compensation, will do the work,and the structure is not intended or offered Zoning Approved By Date
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES Building Approved By Date
License Law does not apply to an owner of a property who builds or improves Issued
thereon, and who does such work himself/herself or through his or her own ApplicationBy Date
employees, provided that such improvements are not Intended or offered for Boiler Hood or Type I ❑
sale. If, however, the building or improvement is sold within one year of corn- Canopy Type II 0 SUMMARY OF FEES
pletion, the owner will have the burden of proving he/she did not build or Im- Duct-Under Ground
prove for the purpose of sale). • BUILDING PERMIT $ _ _ SMIP $
❑ I, as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System PLAN CHECK $ PERMIT
tractors to construct the project (Section 7044 Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 0100,000 BTU PLUMBING $ ISSUANCE $
builds or improves thereon. and who contracts for such oroiects with a con- ENERGY P.C. $
tractor(s) license pursuant to sne Contractor's License Law). I am aware that Exhaust System ❑ Multiple❑ System Repair/Alteration I PLAN CHECK 25% $
proof of their Worker's Compensation insurance should be provided to me. ELECTRICAL $ GRADING $
❑ I am exempt under Section B.& P.C.for this reason Firepl/Fact.Bit. ICBG# Fire Dampers MICROFILM $
PLAN CHECK 50% $
Date Owner Heating System& Ducting Registers MECHANICAL $
I hereby certify that I have read this application and state that the above 0o-100,000 BTU 0100,000 BTL— TOTAL FEE $
information is correct. I agree to comply with all city and county ordinances PLAN CHECK 25% $
and state laws relating to building construction,and hereby authorize repre-
sentatives of this city to enter upon the above-mentioned property for
Inspection purposes.
Signature Date
Drivers' License or SS Reinspection Fee $15 Issue Fee $ 3
0865-46,rev. 5/88 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor
- '
i:� 'CTION AND PLANNING P( & SPA
APPROVALS Permit # Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
'4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
.6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8.'Foundation 59. Gas Pipe, 0 Undrgrnd.,Test
9:-Water Pipe-Undrgrnd. 60a Backwash Lines, P-Trap, ❑ Undrgrnd.
10. Structural Floor System !61. APPROVAL TO DECK
11. Property Sewer Line & House Connection ° 62. Backwash & Receptor-Final
12. Sewer Cap
g3. Heater & Vent-Final
F�
13. Roof Drains ..64:-Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit ,66. Solar System-Final
16. Rough Electric Wiring 67;'Fencing & Access Approval
17. Rough Wiring Sign �•--, 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling { '! 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning ': FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplaces APPROVALS Permit#
21. Ducts, in Structure tf` 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
'23. Gas Pipe-Rough & Test f 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. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final,
40. Gas Service-Final
'41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation -�
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
,49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. " Date
_)
oSTp MFS CITY OF COSTA MESA
4L ,
�, $. CALIFORNIA 92628-1200 P.O. BOX 1200
( a
/$ DEVELOPMENT SERVICES DEPARTMENT
September 28, 1989
To:
Building Safety Division Pacific Bell (2)
Code Enforcement Police Dept. - Ping. & Research
Communications Santa Ana Heights Water Company
Copley-Colony of Costa Mesa Sanitary District Engineer
County Administration Office Southern California Edison Co.
County Clerk/Bd. of Supervisors Southern California Gas Co.
County Registrar of Voters State Board of Equalization
County Tax Assessor Street Division
Engineering Division (2) U.S. Post Office - AIS
Fire Prevention U.S. Post Office, Adams Avenue
Manager, MIS U.S. Post Office, Santa Ana
Mesa Consolidated Water Dist. Zip 4 - Santa Ana
Newport-Mesa Un. School Dist. (2) File (2)
The City of Costa Mesa wishes to advise you that the following
addresses have been changed or added:
OLD ADDRESS NEW ADDRESS A. P. NO.
358 East 16th Street 1600-1603 Sea Horse Circle 425-191-20
For your convenience we are listing the agencies above that we have
notified of the change. In addition to those listed, you are
advised to notify your correspondents of the change in order to
avoid any possible interruption of mail service.
Your cooperation in this matter is app-e---
rated.
- ci
Sincerely,
& . . ' /
JEANNE RUSSELL
Planning Intern
JR: j1 (ADDCHNGE. 52)
cc: Ms. Dana Lyons
Sea Horse Development Company
2915 Red Hill Avenue, Suite F203
Costa Mesa, CA 92626
77 FAIR DRIVE
Building Division(714)754-5626 • Code Enforcement/Business License(714)754-5234 • Planning Division(714)754-5245
1600 — 16)03 SEA HORSE. CIRCLE
r �.n^
0,54rn - IO,L x 7 7cbren. .
PA . — i
_4 -- ._ x II _q� -- - _ _ y.
,P
- - -- --f-- - rbri ' .
1
r 1r � I.
•
t \-, • - --1
I ,I
,I PE VEPSI 1
1 s" W
PLAN B I • -_ W
REVCPSE 6'
1 I I 1 - --. .'v
p
_ y
-J.yry1G1T ( 9 I 10
t d✓ q1)
__ — I SEA 1—iORSE CeRCLE
6 i- `r-- 'f ; =-- 1 A ___,__.=______,,,_ w
.
n f9✓ ..PAT.r.�a-yam --� �, -V`,
4.
I 1` AGGVEY.,LkIfL{3 • :.4-i' .MI`!'.Uh��(r I\ '\
PEAN B ` I II i .1 G S�2 y.1K NJ
I
Wtf.% !ti\ i ---- « r I) `9 I Aq%C'f.....," .
0.
1.1 7� 3A '� I �- I� \_o ,6, � f __, L'�'' _
_� .1 _ •11 I t PLANA '/B e4A / 1\ . I. �
1 .•JA • I ; 119 I/� 17 CSE '� o V 1 . .
.
1603 SEA HORSE CIR CITY OF COSTA MESA - BUILDING PERMIT ��$ �� I
ADDRESS a BaLDWa: an
OWNERS NAME IF KNOWN: JACOB PERM NO: E 087268
I •
. • • ADDRESS 1603 SEA HORSE CI
CM CA 92626 PERMIT NO: E 087268 PLAN CHECK NO: N GOVT: N SUPP: N
APPLMARINO ADDRESS: CONSTRUCTION TYPE: V-N PERMIT TYPE: ELE PURPOSE: OTH
ARCHITECT ORENtaIEER: UC.NO: JOB DESCRIPTION : REINSTATE EXPIRED PERMIT BEP: 57521 SQ FT:
ARCM OR ENG.'S ADDRESS: DMT:
CLAIM VALUE: CALC-VALUE: GROUP OCC: R-3 /
CONTRACTOR'S NATE:
CaNmACTORSMARBA COMMENTS: IN GROUND SPA , REF:B-87267
ADDRESS: LW NM: *************************** ***************************************************
wit ZONING REQUIREMENTS
UCENSED CONTRACTORS DECLARATION:I hereby Slim under penalty of perjury that I am licensed under provisions el Chapter P SETBACKS
(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my Sponse is in full force end oiled.
Cm LIC.NO.: UC.CLASS: UC.NO.: EXP : MAIN BUILDING ACCESSORY BUILDING
Dae: Contactor: LEFT:
FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby affirm under penally of perjury that I am exempt from the Contractors License Law for the
following reason(Sedion 7031.5 Business and Professions Code:Any ciy or county which rewires a Penni to cantata.cher.Improve, PARKING REQ. . P ROV: PARCEL : 42519121 Z N E: REF NO:
demolish.or repel any structure.prior to is issuance,also requires the applicant for such permit to fib a signed statement that he or she Q
is licensed pursuant to the provisions of the Contractors License Law[Chapter 9(commenting with Section 7000)of Division 3 of the PLANNING NOTES>
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.My violation of Section >
7031.5 by any applicant tor a permit subjects the applicant to aaril penalty of to more than five hundred dollars PON). ********.M.lf.lE.l(.1f.1f..MiFlFiflEiEltlflf.lf.MlFif(f1k!likN.lfN.lfi!lfiE#3ki4iF.M,3Fi63klFihihi(,ik3fihiEififiEil,3P#iflfih31,3FiEa(,Bh3hiF3kiki(,1EiEi(,***
❑ I.esowneroftheprogenyermyempfoyeeswithwagesasthe/solemmpensaticn,willdothework,endthestructurearutlntended DEVELOPMENT S E. R V I C E S R E �3 U T A E M E N T S
or offered for sale(Section 7044,Business and Professions Code:The Contesters License Law does not appy to an owner of property yd
who builds or Morons(hereon.and who does such work himself or herself or through his or her own employees,provided[het such _
improvements se not intended or offend for salad,however.the building or improvement a sold within one year d oomplebg.Ihe ZONING APPROVED BY r
owne.builder will have the burden of proving he or she did not build or improve for the purpose of sale). • DATE:
o owner
the
am
with licensed contractors
project
•
Professions Codds;Ths Contractors Licensee Lusiven aw dooees not apply toe an apro who builds or(Section7044.
tthhreeonannd and BUILDING APPROVED BY : DATE:
contracts for such projects with a mNradr(s)licensed pursuant to the Contractors License Law).
Pa,
' , a dr :P7044 B.APck -. :aEA H ILOmer . 3 E J **PL***T*ON *SS*EDHYDAT* 2::eLEGALIZATION:N F E E S U M M A R Y STRUCTURAL SGMENT:N
^Q' of and understand the _uirem. a.. Health end Safety Code sW hen.25505,25533,and
/. .that Mue building occupant will/veil • : .'one) o comply with said state codes and the requirements tor
rr
pmefow
aarwdr
ionmodirralidhfromtheAirDualityM. District.Residential muevtionapplications aro exempt from these BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
provisions. PERMIT 44 , 25
Date: Applicant 5 0% SM I P/NON-RES
WORKERS COMPENSATION DECLARATION:I hereby affirm ceder penalty of perjury one case following declaims: PLAN
o Ihave and wilmacMXa
ceof consent loselfnwnwelded ISSUE FEE 22 . 00
anlaih
Code.!or nc
theperformeeof ewadi frmm
which this BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
❑ Ihaw.andwYmeinteinwrkers'mnpsrsonumrace.nreeisedbySedvl37OOofteLaborCode.krthepdomwuadthe TOTALS----> 44 . 25 22 . 00 0 . 00 66 . 25 66 . 25 . 00
work for which this Damm is issued.My workers'compmelon insurance carrier and policy number are:
Carrier: REVENUE DIVISION TOTALS--> COLLECTED: 66 . 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 pamut is for one hundred dollars($1001 or ten.) 66 . 25
O I certify that in the performance of the work for which this prem is issued,I shall not employ any Penton in any manes so as le
becrre subject to the wakas'cornpeneetion laws d CSdorno, and agr a that i ould l shbecome subjectwr
to the kers' *******************************************************************************
compensation provisions d Sedan 3700 of the Labor Code,I shall forthwith comply with den provision.
Dale: Applicant: INDIVIDUAL F E E BREAKDOWN
Warning:Callum k secure workers'compensation coverage Is unlawhgend Shall*ogee:an we:dorm to Criminal Penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
civil Ries up to one hundred thousand dollars Magoon In addition to the coat of compensation damegas as provided for In
Section 3706 of the Labor Coes,Interest,and atrornaye feet ELE 1 SWIMMING POOL - IN GROUND - NEW EA. 44 . 25 44 . 25
CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty of perjury that there is a conatnudion lending agency for the END OF FEES
performance of the work for which this permit is issued(Section 3097.CW.C).
LENDER'S NAME:
LENDER'S ADDRESS:
/' !certify the I have read this application and rate that the above information is coned.I agree to comply with at city and county ordinances
end state leve relating to buidkg eonrmdon and hereby authorize representatives of IFe ply to enter upon the above-mentioned property
• for trupedicn purposes.
JIM JACOBS 83-12-1998/89:851111/$66.25
w c• P- Name
Dna:
-5/14/2.11--- PEkMITe087268
mg u t/Appirant/Cruractr
(5151-49.WP) While-Building&Safely.Green-Fle:Carry-Appicant:Pink-Review:Goldenrod-Asseesr
ir .
- 4k CONSTRUCTION AND PLANNING POOL& SPA .
APPROVALS Permit# Date Inspector • APPROVALS Permit # Date tnspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
43 :Electrical Conduit Utility-Undrgrnd. 54. Forms
-,4. Electrical Conduit-Undrgrnd. M .55. Electrical Bonding -- •
5; Steel Reinforcement T' 56. Rough Plumbing& Pressure Test
6: Electrical OF ER Grnd. 57. APPROVAL TO COVER•GUNITE
7: Footings 58. Electrical Conduit•Undrgrnd.
-1 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test
•
' 9: Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater& Vent-Final
13. Roof Drains - 64. Plumbing System - Final
14. Rough Plumbing - C 65. Electrical-Final
15. Rough Electrical-Conduit •• J
r 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing& Access Approval
17. Rough Wiring Sign 68. APPROVEDTOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating& Au Conditioi Ong. - 'n• - FIREDEPT:;REQUIREMENT
:r.n
20.'Rough Facto F$}place 4,' _• • y y . I. ^ APPROVALS Permit # f
21..Ducts, irl,Struuctur •- ' '--1 fl' 4- 70.'-Underground Hydro b
22..Duce, Ventilajini :'
9;; i. CI :r, .7.4.: ' 71. Prodtld Piping.gGas 0 Oil
23. Gas:Pi e:1io &_,T,est "t=- '� rn
_ P u9, ._ .,,tr ,� r -. r •_; •_ 72. Underground Flusfl
24. Roof Framing - n.F1 ` ` 03 ; • 73. Undergrnd.StdraieTanK:OGas OOil
25..Rzoof4Sheathing • `
�� x tr: 74. Overhead Hydrate
26. 1-Bar Ceiling (Structural) & MOO-coat > -'# 75.3 Dry Cher�iical ,:ice -- --
27. Frame and Flashin 9y° 'S s tel` - `"" - -
. • >. 76. Dry SiandPipe.t -4
k
(-, 28. Lathing& Siding .1"- - i I. 77. FIXEDSYSTEM FINA1. -' , r
, 29. Insulation - _ I 7$;. FIRE PREY. FINAL
30. Drywall Nailing r 0 -4 1 Ii' _. HEALTH,DEPT.REQUIREMENT
t; taster Browr� i;,Coa
r
79. FINAL INVSPECTIDN •r• 7_,r.- ---,
32. Electrical Power Meter-Final • - ' i 'r 80: FOOD CERTIFICATE ISSUED' -•
-1. •• I '1' 1 .. - ' K r
33, final.Eletric .. - / Nates: .,,
34. Fina(Heating& Air Conditionin`g� I'; �� " oC (,-*:•,';
.-t r -.
r
35. Final Gad'ipe=Test . '. i. .y 4 • =f t _, 7-- 9 `m
1 1 `. ,j .4. +..1 . 1 1.
36. Hood or Canopy - r ra t -^•
• a
37. F inal'Factory Fireplace.'-: 47; . ti.- ;,;''
< 38. Final Plumbing a L.
- I.- I": " 0. n;
40. Gas Service-Final ,;. ' -;�.', - 1 ; i1. - . "J;= a c,
l
' 41. Solar Domestic-Final:-Final: r l h' 1-• 4... • 71
7
42. Backflow Preyenter - - I „ %•1-: + - . . .
.. .H I
43. Backflow Irrigation : '
r ^J
T -
.44. Landscape Irrigation:System r r� -r, t •t 4.;.. . i. s , -< -
• 45. Sound Attent%ation 1 -' n'' ` • T `" `' r
1 46. Handicap Regulations `
li ' 47. F,INA'L STRUCTURE & BUILDING - '
x
48. FINAL PLANNING a- ,a - :. -
49. Electric Release to Edison 1. - ra
50. Gas Release to Southern Califortiia=Gas Co 0: • 7 -
51. CERTIFICATE OF OCCUPANCY
No. Date
PR9AECT ADDRESS: C , - ri ,;3,.:• -. UNIT: (• i-: Y (:E. t.(:-`: t . , v-- �, ili ':i \' _a , cJ i"
4 ' OWrER'S NAME: �'i` . ... .., ... ...i.. .-.(1, _a 1-571:21
� ADONESS:. - , . 1.E. Yr..::', : tl: L?r:E', rl.- J-..rl .•... - `.Ci: 01 u. 9 .J -rtr . . • nom' . R.
ARCHIENGINEER: REG.NO,: TOR. tp'-•'Oa: TN GROUND IC'.0 'AA PT ` - r`- + ' ::AA :•133
ADDRESS: UNIT: SO ' ' '
'-LA M A:,:-_ - 2, 6 : 3 . 00 rAL: '.AL..... - 2. .73-3. . .;3Oi,i' :)CC : B- 3 /
PERMITTEE: ,� - : ) _•'); n.),,.
ADDRESS: -. ., -.'i i;- .-25:;ND +;at?
LICENSED CONTRACTOR DECLARATION I hereby afbr hat I itisec under provisions of Chapter 9(commencing ' Section ,. s 1 4 _ • C LI t i _� •'
7000I of Division 3 0l the Business and Professions C e.and ei^se is n full far .nd effect. ,�
CITY LI_ r ) , :", - $T TE LIC - CUSS: .. .2 .. 3
Date' I 6/ Signature' / (/ ✓/ _.. . _ - _ .'!t'a+:� '1I, D_ tiG - . _ .. ----- i-.._.. .. .J.t Y• BG
,,.t (: ..
WORKER mpens 'CO PDECLARATION:ied here,•affir at have a certificate• consent t hinsure or a certificate of Workers' 1;L. :�l: L.i - t,� __ - _ ..v T
Compensation nsurance.or a certified copy there, (Sec m 3800,Las.Cl �- - - . .R C_7 - - -
r~ 'OLICY NO.: EXP.DATE:
COMPANY: :)A-. \i.. r-:.:: t:j(iu: .'ABC-:?L. : 42319121 ::,.1.:': - ' RE' NO;
I0 Certified copy is hereby furnished. 0 entified copy is filed with the city Budding Division. 2',A1'•.. -Nr: .:yr E % ADU : N: SPA :0 AN i'a . ST : '\C REL-: .
Applicant: , .. 3< . 4 r i, ..*.. .. .-'+ .. 'd a F Y+t . . k r.r . . _ .;'.s'.: k: • *'*4 : i - • - . .'... . _ , *.
EXEMPTIONFROM WORMERS COMPENSATION DECl4BAT.'': I - t omplelM it the per f foc one hundred IS700)or tessl. -I - V E . O V. E N v S .' R V . C E ' 't E (r - R' - V -•_
I certify that in the performance of the work for hich is r' it is'S'gWl s r l 1 employ any pers.;in any manner so as to become V
sugect to •"pikers'CeglD' Laws if Cal or Lu', 1:G �i`P:!OVEI• 3Y ♦ `__ 7 ,
Date: ' Sigv y/ ` t.
NOTIC : .ah: making this declaim'. ,yo. should"me subs e Workers Co pensation provisions of the Labor 3 L.: i Lx Di.:i(: ,i('8017'D 3Y ;_
'e�:f ii*•f DATE:
_ _
Code.you mu- forthwith comply with sue, provisia' or Ms pert• .N be deemed re fled. -- "-- '—
CONSTRUCTION L NOING AGENCY: 1 hereb dffir .I there i5 a lion klnifing agency for the performance of the work for A jr I L ;:7\ ?$j•, D J Y; �,� DATE: i�y.�e��
Which tis permit is issued(Section 3097. Ci C sE:t'if<ifF < .r.:' *k+**,*:.te i.t t y-WV; -hr SSSeee w .:f. -t••--.k-tTTs:ta.'"(k+!*A *. ., +.A-' k,✓:-CW Lr : . -x + <Y
LENDER: ***+EYaEn4'iN**kaf<'• t,F)( :Et A'ErEe<kkti{.t':+E k.afY.'° 'hlEtklkk 'iYt'.K.'i'lv1.><tEk'i+k'E11.1:4.1k 'c>v5(-5* k#aE
ADDRESS: LEGA_.IZATEON: N . - B. 5' G M v A YTRUC':URAL r' „=CY.5:N• , y
OWNER BUILDER DECORATION: I hereby affirm that I am exempt from me Contractors'State License Law for the following reason 31,06 .fi ''Mp b u y 9 .NG :(L EC TR T i,' . C HAil_C R 3 SMTP/RES %GRA _NC
•
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or --:-.75.k-:-.75.kV i T -3.,i4 , 00 2 00 30 , 00 '0
repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed i r
pursuant to the provisions at the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business = :=:'-0: ' !;v;fj,v- S
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by _ A N :3 -; . 10
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). - I E C`: 1 . 00 ' 15 , 00
''' i l,i)i DNC: -J L V-> PERMIT I SSGE L)i,ANCI-IRC'K TOTAL A'
I, as owner of the property or my employees with wages as their sole compensation, wit do the work, and the - „ 35 . 10 119 . S0 a ) ---f• •x:11 DUE
[T
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law ':O i'A:.,:: '-•-- > %3 6 . 50 . , . 0 0 1_ 'a0 . 60 . do
does not apply to an owner of a properly who builds or improves thereon.and who does such work himself/herself or through
his or het own employees.provided that such improvements are not intended or oIlered for safe.If,however the building or -, „r.C. .,) i I/'t p- cel'.. •pr)•,•1 r e -_ j `.O,•, �`.(_1 `rn - 1-10 . 50
-{,3 . 5 O OI/E'p/' - t t r r
-•i. • ft
improvement is sold within one year of completion.the owner mA have the burden of proving he/she did not build or improve -'-- • "•- ,i. ' _ , - Z = : ,1
Mr the purpose of sale), 3I„tsG ',-)M ' +.:;."I INC E 1.EC?Rid: MECHANIC ETRE c,`C • '/TOT ;,RAD:NG - i,t N—fl^0 : _GK
Las Owner of Ine property,am exclusively contracting w'In licensed contractors IO construct the Drojecl(Section 7014.Business �' O500a ' 0 0 5 , , l 0
❑ and Professions Code: the Contractors'Slate License law does not apply to an owner of properly who budds or improves thereon '
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware M...it-1("e +k 5- - + i ,t f ( '•. v -i ' '- 4•'r N .:a k -q.i A-'t( i k'"K't k* - ( > h'' v'i rE k•. + . .. y ,' IS '-vf -, E_ a-,p- r.+ ° .:.}'i -. e r
that Drool al their Worker's Compensation insurance should be provided to me. ;V t) V ;'y ii A c E ., R R E 4 :C ;) O N .V
❑ I am exempt under Section: B.A P.C. .
for this reason: 'yci -'' ;_Y S C _ - : r 0. 343. ...N=T i'CHT 'MIA:. C-Us'
Date' Amer: I .
j p = R A:-•„ R Bi• VALUE '?NS .DI.N"' iA:, NMONE ' , 0t) , ;>°•R , q:i
Ido hereby certify that t am aware of and understand the requirements at California Health and Safety Code Sections 25505,25533,and -j 1,`,, ,'y,;:.xa'j \:c' - J r', ' - :N i.R t)::+.i o - V E W :::.A. 1U . 00 O 30
25534 and
or that I or any future building occupant Air Duality
not(circle one)need to complyvontsaid state codes and the requirements fora T1: a V r •1
these for construction or modification from the Air Oualiry Management District.Residential construction applications are exempt from •� - ->W :••,• -:v(+ pcin -• . . n,) . •)J
these provisions. _ EXPIRED ENC.) O EES
Gate' Applicant: • ' •
,- hereby certify t .I have read this application and state th. thea , lion is Correct. agree to comply, all city a , my .-tri inn. 'Plaice (R':.. :'::)ti)Ila
ordinances an ate aws(Ndtmg to b tb ruction a •hereb' • p esentatives of this cdY to enc •:..,''mentioned _
property for.(pe•ion purpus- L/r-/�/,•'f q�►7 ```` ��II
Date' / / Signator . i%�� aSig4 `
/ ,
Driver's License or 50,a1 Security+: , %:�-- '$
- / - i1_....r..,,,,,_4oni,ranrr'P'nv-_Revenue:Goldenrod-Assnesnr '
------tetfl "41,-:
•
_ .
.:ON AND PLANNING POOI_^ r
•A - ----
--S': 1 Date Inspector Date I nsnrrtoi
f /r.'ALS Permit % - APPROVALS Permit -,N:
•CC F r
i e.mporary Electrical Service br Pole . . 52. Pool & Equipment Location (17(c$1-f
49/
2.':Sail Pina.1.; _'_..-_ __. _lli_- __
3. Elee(r. Conr:u;1 IJ;dity-Und53. Steel Reinforcement
ryrnd. 54. Forme
4' Fter..it Conduct Ur.d•g; rv'. 55. Electrical Bonding - �--
_ -'-
5. Steel !z;,,.`nrremerr° _ -- ---'----_. 56. Rough Plumbing & Pressure Test
- - ' --
R. Electric-:' UF ER Grnc{._..__• .--^-- -- -�----• 57. APPROVAL TO COVER GUNITE --- -
"/. Footings _�---�_---- -_-�_--_- 58. Electrical Cnntlui! Undrgmti. - --- __
8. Foundation 59. Gas Pipe, 0 U,ndrgrnd., Test
f0. Rack•rvash Lines P 1.'rt'. C'. i r"•l'm.rd.
., . . cl+. .4PIROvnL Tc• nl't'v -- - ---- --
• II 11. Pratrr•r iv •,•:•.vr r Lill" ,9 HOUSO C:ar,;, •ra•^r 82.'Backwash-& Receptor.Ftnai
1; ': war C:.+,r 63. Heater & VenbF innl •
�_____�_-_
11 r7 Lin' Dr•;ns 64. Plumbing System - Final
14, Rough nlumhiny .'.--- '_- 65. Electrical-Final '---'---------- --- -_.�
15. Rough Electrical-Conduit 66. Solar System-Final
15. Rough Electric Wirings 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 & Ai: Conditioning - FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit dt-
21. Ducts, in Structure 70. Underground Hydro
__- _
22. Ducts, Ventil:mine 71. Product Piping fl ow. 17Or1
._.._._____-__-
23. Cru PiPP-Hnugh & T,:-:1 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe •
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREY. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final .. 80. FOOD CERTIFICATE ISSUED -�
-L-
33. Final Electric Notes: ' - pZ .j_ • ce-v 4 A__
34. Final Heating & Air Conditioning_ , tJ
( O v c- ^
35. Final Gas Pipe-Test `---5l.F"^'
36. Hood or Canopy ,..,
37. Final Factory Fireplace ----_-
36. Final Plumbing
39. Water Service-Final
40. Gas Service-Final •
41. Solar Dometric.Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING 4 -
48. FINAL PLANNING _ r
49. Electric Release to Edison
50. Gas Release to Southern Caldor ma Gas Cn
51. CERTIFICATE OF OCCUPANCY
No. Date
ADDRESS OF BUILDING: 1603 SEA HORSE CIR DMT` CITY OF COSTA MESA — BUILDING PERMIT �5` I�Q4 ,
OWNERSaNAME IF POW JACO9 PERM NO P 087269
p - .. ADDRESS 1603 SEA HORSE CI
CM CA 92626 PERMIT NO: P 087269 PLAN CHECK NO: N GOVT: N SUPP : N
ADPL.MA1UNG ADDRESS: CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU PURPOSE: OTH
ARCNTTECT OREl 1LTA: UC.NO.: JOB DESCRIPTION ; REINSTATE EXPIRED PERMIT BEP : 57521 SQ FT:
ARCH.OR LING.'S ADDRESS: WIT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /
CONTRACTORS KALE:
GPM/COBS WARM COMMENTS: IN GROUND SPA , REF:B-87267
ADDRESS: M.NO.: **********************RE***RE ***************************************************
UM 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)DDD)of Division 3 of the Business and Professions Code,and my license is in full force and effect.
CITY MC.NO.: MC.CLASS: L/C.NO.: EXP: MAIN BUILDING ACCESSORY BUILDING
Dale: Contractor: FRNT: FT IN REAR: FT IN FRNT: FT IN REAR; FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby affirm under penally of perjury that I am esemp from the Contractors License Law for the
•
following reason(Section 7031.5 Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,
«
demolish.or repel any structure.poor to itsoauae,also requires the applicant for such permit to files signed statemeM that he or she PARKING REQ: PROV: PARCEL: 42519121 ZNE: REF NO:
is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division a of the PLANNING NOTES>
Business and Professions Code)or that he oe she is exempt therefrom and the basis for the alleged exempinn.Any violation of Section >
7031.5 by any appticanifoeparmi subjects the applicant toaavil penally ofathan five not more hundred dollars(SSOO]). *******************************************************************************
❑ I,as owner of the property or my employees with wages as thele sole compensation,will do the work,and the structure is nM intended
or offered for sale(Section 7044,Business and Professions Code:The Contractors License Law does not epPyto an bvmarof PnWad) DEVELOP M ENT SERVICES REQUIREMENTS
who bolds or'approves thereon.and who does such work himself or hersef or through his or her own employees.provided that such
improvements are not blended or offered to sale.t,however.the building or improvement is sold within one yew of completion,the
owner•builder will have the burden d proving he or she did not build or improve eau
r the purpose of sale). ZONING APPROVED BY DATE:
❑ I.as owner of the property,am°adheres&contradbg with licensed contractors to tamed the project(Section 7044.Business and
Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon and who BUILDING APPROVED BY : DATE:
contracts for such projects with a mntrad«(s)licensed pursuant to the Contractors License Law).
y[] I~ : rep ars B.aP.c.,f«Ian: LRS H LD°./ APPLICATION ISSUED BY:
e owner: �"�(!�I J /?��-8 ********************** �. I' ****D�*+EEiE* *
I certify I aware of and uderstandthe rey em dC Neannand SafeyCode Secions25505.25533.and
LEGALIZATION:N F E E SUMMARY STRUCTURAL S GMENT;N
that I or any tenure building occupant will/will n one)need to comply with said date codes and the requirements for
a permit to conswdionor modification from the AiQuality Management District.Residential construction applications are exempt from these BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
provisions. PERMIT 27,00
Dale: Applicant: 25% SMIP/NON—RES
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penally of perjury one of the following declarations: P LAN
❑ I have ed wilmamtac acenHoate of consentto ea-insure for workers'compensation.as provided for by Section 3700 d the Labor ISSUE FEE 22 . 00
Code.for the performance of the work for which thispermiisissue . BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ I have and wil maintain vorkers'compensation insurance,as required by Sesion 3700 of the Labor Code.for the performance of the TOTALS----> 27 .00 22 . 00 0 . 00 49 . 00 49 . 00 . 00
work for which this penin is issued.My woken'compensation insurance wrier and policy number are:
Canter: REVENUE DIVISION TOTALS--> COLLECTED: 49 . 00 OVER/SHORT: 00
Policy Number: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
(This section need not be completed y the permit is for one hundred dollars Al 00I or less) 49 . 00
o 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 eared to the workers'conpenatfon laws d Cdeomia, and Wm'thio t I shouldco
become subject to the wvrbn' *******************************************************************************
campersalion provision of Section 3700 o the Labor Code.I shall fonhwhh comp&with Nose provisions.
Date Applicant INDIVIDUAL F E E BREAKDOWN
Warning:Failure to secure workers'compensation coverage Is unlawful,and shall subject an employer to criminal penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
chill fines up to one hundred thousand dollars($104000),In addition to the cost of compensation,damages as provided for In
Section 3706 of the Labor Code Interest,and attorney's feu. PLU 1 SPA (PRIVATE) 27 . 00 27 . 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 the wok for which this permit is issued(Section 3097,Cir.C).
LENDER'S NAME:
LENDER'S ADDRESS: �i
^ I certifythat I have read this
application and stale that theb above information io iscorrect.st agree 1pcampy ails alta y and county ordinances
and stale laws relating to building construction and hereby authorize representatives of this dry to enter upon the above-mentioned ProPeny
for inspection purposes.
JIM JACOBS
03-12-1998/03:06
• RCFT4 -Oa28i61
• oat.: 3/2AA' FPERMIT:087269
ensl ref / eanvnNamepplirenvc«Ilraa« / _..
-( (5151'46 WP) White-Building&Solely;Green-Rle:Canary-Appian:Pink-Revenue;Goldenrod-Assessor I A
- I
'CONSTRUCTION AND PLANNING POOL & SPA
' APPROVALS Permit# Date Inspector r APPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2, Soil Pipe-Undrgrnd. 53. Steel Reinforcement
0-1:5,31 Electrical Conduit Utility-Undrgrnd. 54. Forms
_ i•4. Electrical Conduit-Undrgrnd. -- 55. Electrical Bonding
.
•
j 5`.":Steel Reinforcement 56. Rough Plumbing & Pressure Test _ •
61.-Electrical UFER Grnd" 57. APPROVAL TO COVER-GUNITE ._
- --.4--
0
TU 7r`: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 - "-, X61. APPROVAL TO DECK
+ 11. Property Sewer Line & House Connection7.
62. Backwash & Receptor-Final
m
12. Sewer Cap - 63. Heater & Vent-Final 0.......,; .1
13. Roof Drains = 64. Plumbing System - Final 7d
14. Rough Plumbing ',
9 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 - 7 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating,& APIConditionipg- ti S. n FLRE DEPT.-REQUIREMENT _
20. Rough FactorFiriplace 4 _ k a _ �, :;APPROVE$LS"c'".Per}nit# * r"- '
21. CLucts;intStructure- ¢ +: (' r' - 70. Underground Ftvdro
- - . _ _ ,
22. Ducts?Ventilating. 1.. : C t' :;a e, 71. Produq't'Piping 9-Gas 9Oil
'1 f '1•:. cr _. C::r 4: s -, -
23. Gas Pipe:Rough&Test r. '_, it 72. Underground Flush
24. Roof Framing -...r > T, ' 731 Undergrnd.StoiageTan4OGas OOil
• + L: •
25. Roof heathing rte'. a �- -, ill ..'' 74. Overhead Hydro;+r
26. T-Bar:Ceiling (Structt+ral) & Monbcoat _ 7�+`- Dry Chemical "...-:-.7.;„.. * _ d,
27. Frame antra";Flashing1 ; ;i' . . . ''. -s-, +'ti ~ �i e . t
>4,4 76. Dry Stard x�.PP *;..-.V
26. Lath ng &;Siding 11- :+'r. - v
_ . 1 S
771FIXED YSTEK1FINAL " :`
29. Insulatioi`H •r; > _ I 7S FIRE PREV. FINAL r. LL •
30. Drywall Nailing _ - - - , ..7-.-- '... --)"HEALTH,DEPT. REQUIREMENT
i 31. Plaster Brov.neCoat;:,l. � , ' 79. FINAL INSPECTION 4, - t."•
r 32. ElectricalyPower Meter-Final . •80"FOOD CERTIFICATE ISSUED-
.. , ...
''33. Final Electric; tw m c: i' .y 'r`' r 'i ` '9
+; x, - : �:- Notes: ` -n C'
I.;34. Final'Heating& Ai} Conditioning - .- i* ,3 • •y 4
. r
35. Final Gas,Pipe-Test _ '
1
e, •
36. Hoodor Canopy Ill
n .cr-i - ii ' - -- i :y
r Y :L ^J
137. Final•Faciory Fireplace, l , .• I„ r < +
-38. Final-Plumbing - -'1 7rr '
39. Water Service-Final -4. 'x 'r _-4 .-1/
r+ - .. ,r:
40. Gas Servics-Final C,:
y+41. Solar Domestic-Final+ r'. i ( 1. • r- * -`- -�
42. Backflow Preventer • -; a to O r - t
M 1
__ 43. Backflow Irrigation . - '• r i -
1 , _
44. Landscape,Irrigation System j - C X. c - :") 1: z 4- 5 r
- • ,t .
45. Sound Attenuation * -
k . Handicap'Regulations • ,: J , r ' - :: •
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING '. , • .. - - •r
49. Electric Release to Edison - . i +
50. Gas Release to Southern California Gas Co 4 ••• . _ ,� - • •
51. CERTIFICATE OF OCCUPANCY -
No. Date
A
PROJECT ADDRESS: tie . , .:-. • UNIT: (..if (-,_ r . . , N.:.... ,i) : ,i) - .... _:a • fi_..,.- `a): ._:: .1' - _.
OWiETCS NAME: j it
ADDRESS:. 71 • :in • 'i! - NO: 0.-T. 0-',7-.:21
r=,.`. r `.'1. Ci ) 'ti•' U p.' . ., ' '
J('"C ,Ov TtPE : N p,� Y;, R OJTOSE :
' ARCHIENGINEER: REG.NO.: .TOS 17:SCP7PTION TN i_RO'L )i1 P:('•. Ari r _D ..RC ,A_. .:2A SY hot.
ADDRESS: UNIT:
,A M VALUE: 2, r.63 . 00 ;i . , !'AS.,,,. . 2, `.58 . ROUP :DCC : it' /
PERMITTEE: t - ' - ( l I - ) (t')1' f)1,-:.
ADDRESS: — v C ^ tit) 'SPA
. . .. a ) , r-. x . 4r k4>. • s,v YN.* k•• . vox .: . kr-'ft . - r { ' v
. . . Yft- . . I.. . . . '.!-
4-:ft.W :; - . . a .
LICENSED CONTRACTOR DECLARATION I hereby atilt. at I . licensed under provisiogs of Chapter 9(commencing w. Section .• f) 'Cl T. • C C a ,I V • `
7000)of Division 3 at the Business and Professions C. and . nse rs in tutfor .nd effect. :, ? A (' ,
.J
CITY LI 1 '? ST TE LIC.: a CLASS: _,/
L _ ;..t) G/ %/ - _- _ _ :''A ,\ 3 )_ CO . . : oaY
Date: Signature' / REAR : _ ^
WORKER CO •ENSATION DECLARATION. I here.•atilt at I have a certificate• consent tr hinsure or a c ificat¢of Workers _ \ ..t _t N _ x. 'C:i T, - - �,
t Compensator nsurance.ora certified copy there. (Sec m MOO.Lab.Cl. ` - - -
POLICY NO.: EXP.DATE:
COMPANY: 2A :' \C is.'tJ' tSl)V: f - '?w ) ,.9 ; 71 :{.\E _ RE: NO;
El copy is hereby furnished. 1:1 untied copy is filed with the city Building Division. J U A:- .`. NG .c.,3-TES> ADO :NG SPA 'J r ..t - ) ' Nu •ZEE.
• >
Applicant: 4t.4N . ,:4X •. 44 t##r #ki .:Ex EkkX4'- i : 44{;.. k.4lilk k'. ,:** t.. -- __ f . -4.1! ' , te . q::
EXEMPTION FROM WORKERS'COMPENSATION DECLARAT lion r .t b. .mpkted if the per /for one hundred($100)or less). `) C ') y - .1 .r C t C :3 V '\' '
I certify that in the performance of the work for hick it is s 5•.11 it employ any pers.;in any manner so as to become / C I
subject to • Yorkers' 7p••.6. Laws f Cal / IO.N ' \G APPROVED 3Y ;, ;LLQ E. DA ��(,,1 ��L
Date: G Sign,' - ` .
NOTIC : .aft: making this declaration,yo- should .: one subj T 10 e Workers'Co pensation provisions of the Labor 3 U L L i)I Nlv A u P ROV c 1 S Y ; DATE:_—` __
Code.you mu- forthwith comply with sue, provisio• or this per.11 s ;II be deemed re eked. Q� ,Y ,�
CONSTRUCTION L NOM AGENCY: I hereb affir at there is a on ction lending agency for the performance of the work for APPLICATION CSE. ;ED 3 Y: L_,JC'� 11X-11X— i)A � ..C�
which this permit is issued(Section 3097,Ci C 4 it S**X•k:i 4 4*ere*R eve.4 k e M k-t—Frnir'e—lel It�F h 1.t. .t*4.k w 4*}`r:ti r.-*l'-M-1E$t. .. .f,a-K.t 4**-4)0(-€.44-`47-7 . .e 4 4 1E
UNDER: 444?f)e J(- k'i'.:4`FYWW-• k*iir::4*X* rNV,X-'4 .+Er:4i'4•EYhlf:ct%!kXtt'Xif'.FNk-.+y.>Ni:.ti!t4f MC4•)r!i..4Y-k>< 4.1(. E#
ADDRESS: LEGALI'ZATc_ON;N .r F' F SUMMARY STRUCTURA3, u_CM;NT: Y
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors State License Law for the following reason 3LDG PMT '' uM3_NG ELECTRIC Y:?Ct1AN_C . RE EM_P/RES C?AD-NG
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or i',ERV I j - '..;A . 00 00 30 . 00 . 30
repair any structure.poor to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed ];.-Z J'� )'. 'r/:V- V—
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business -
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.My violation of Section 7031.5 by "t e N _ �' • : 0
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). 1;S l;E Ft-7.E l . 0 0 ', `' 0l)
I. as owner of the property or my employees with wages as their sole compensation. wit do the work, and the ;4U L I^'=RC11 i V—> ?:::IRMIT i _LF PLAN,.-CHECK IOTA:. PAID DIJE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law /7:,...i'A�., :-.———> A6 . 50 1 '. , 0 0 . 3 5 . 1 0 ,3 9 , r++) 1. ;9 . 6 0 • 10
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 r,c./: r .c i) .;/—C. i C': pry'a t > C'•O L L.4 E�) - 1..-19 . ;i0 OVER/ H01-2' : , 0 r,
improvement is said within one year of completion, the owner will have the burden of proving he/she cid not build or improve -• ) 1. r•. • , - ( r '4 , 1
for the purposeol sale). 31.d,G `3 _,aG; .'3 C' MECiiANIC C :RF. S.. '/TOT t.\,t ..NC, LA.. <
I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 4 . 00 5 00 '=7 0 0 0 -IT10
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of properly who builds or improves thereon -
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'Slate License Law).I am aware 4 kk w* .W 4')fc 4. rt k f. rt •'Y k!. • i 4 M 4 ,'1 4 c 4 '-k 4?r:4 k 4 k 4 k 4 x a 4 4• 4 k•. .Y•-4 + • -,- s 1 a.y Y. 4-., r-Y 4.♦ S .- rt.r % . '•: 4 a
that proof of their Worker's Compensation insurance should be provided to me.comp 'v t' F, 3i A ? ' . F ,• R :3 F A { ) O W N
o I am exempt under Section: B. &P.C.
for this reason: ''t;'PE (it''? F S f: :Cv _ .'4'. .,�i:.r ins? ill,;:, COS'
t-
Date: Owner: !....7-`,}� ::4 ALTER ' Y• VA .CE 3 F l...: I IAL NO;:ONi•: .. . 00 , 5`.4 . L:i
I do hereby ceNly that I am aware of and understand the requirements of California Health and Safety Code Sections 25505.25533.and ,.., [{n i'.M-'CC: .21::x O -- :N t.;;').1.-):..`.I f) - Ni i1 i?i's, O• l) i 0 , !'i
,� 25534 and that 1 or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements tor a r
permit for construction or modification from the Air Duality Management Distract.Residential construction applications are exempt from �'•K) ;i W_V V l :N(; �i rp c, 7. . 00 2 . '10
• !-_Ni: it S L•"i?:i
these provisions. _
Date'. .. Applicant: EXPIRED
• •
,++�
I hereby cernly I .11 have read this application and state th. the a-N'i• . -tion is correct.I agree to comply all city a . : my .ii � . 'O�te )n'?' '.'"f.5.p'a
ordinances and. .Ie dw3 relating lob iidin..ruClien d i hereb author. pre5¢ntdnyes of INS my to eat. ... e-mentioned f ,
prooeny tar torr pow. • / 7 � .. -
Afirl 7Z ...._I • sig
Date: as
• Signator
k.I Driver's License or S..al Security ,.
•
..t• ,
...%
TON AND PLANNING . POOL 'A
Mkt-- Date Inspector Date Inspasto.
PALS Permit 4.''' APPROVALS Permit #
Temporary Electrical Service br Pole -- 52. Pool & Equipment Location (e•t qi 1-J. off
2.t•Soil Plpe.un,Ir 5-ad, • 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
.
- .
41 Flere•ira l Conduit-Undt Gelid, _
. 55. Electrical Bonding
5, 51.trer ra.rurdo-orrmen' 56. Rough Plumbing & Pressure Test
. ..,, ••
. .._ -. -. ..
.
F. Ei,,,--1,--1 (n-ER r3,-rid. • 57. APPROVAL TO Co1/EFTGUNITE •
7. Footings 58. Electrical Conduit-Undrgrnd.
B. Foundation -
59. Gas Pipe, 0 Undrurrvi.,Test
' 9. Vater Pine•Urdrgynd. .
- - 60. Backwash Lines, P-Tran, C Undrgrnd.
•
-__
01. APPROVAL TO DECK
• 11. Property SvVer Line & House Conriec5ion1 .-.- :
-_:
12 Sewer Can 63. Heater & Vent-Final
13, o i p cDui .
ns 64, Plumbing System - F•nal 42/q04 _.
14. Rough Plumbing . • 65. Electrical-Final
_ .
15. Rough Erectrical-Conduit . 66. Solar System-Final
16. Rough Electric Wiring ' 67. Fencing & Access Approval
•
• 17. Rough Wiring Sign .-- 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21, Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil . .
• .
23. Gas Pipe-Rough & Test2. Underground Flush .,1
24. Roof Framing 773, Unclergrnd.Storage Tank 0 Gas C Oil ..
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural' & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL .
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT •
•
31. Plaster Brown Coat ,
• 79. FINAL INSPECTION
_ .
32. Electrical Power Meter-Final -El 80, FOOD CERTIFICATE ISSUED.,;:-
33. Final Electric
- i_.?r__.1_ _7___..!..- _ar•eser041_ - . - ---
34. Final Heating al Air Conditioning .
; 0 0 1 orn0 L4Y _tLstL Cl( Gct 0.)1.-.. 04
35. Final Gas Pipe-Test
•
36. Flood or Canopy
37. Final Factory Fireplace ,
38, Final Plumbing ,
39. Water Service-Final
.
40. Gas Service-Final .
41, Solar Domestic-Final
42. 9ackf low Preventer
43. Backflow Irrigation .
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING 4 • ,i
48. FINAL PLANNING ' .
.
/- •
49. electric Release to Edison 4 1••• ••••.
56. Gas Release to Southern Ca lifor Ha Gas Co •
51. CERTIFICATE OF OCCUPANCY
No. Date
I'S CITY OF COSTA MESA
` BUILDING DIVISION
: Vie bliel VIA l ..�4 DEVELOPMENT SERVICES DEPARTMENT PER NUMBER
t. P-i-rar41 I PERMIT
' .a 0°t PO4-00067
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 1603 SEA HORSE CIR Status: ISSUED
Suite No Applied: 02/02/2004
Issued: 02/02/2004
Vicinity:
Parcel Nunmber: 93721017 ISSUED BY: 2
Applicant: NOCK PLUMBING
Address: 11612 KNOTT ST
SUITE 217 Phone: (714)895-1246
GARDEN GROVE,CA Zip: 92841
Owner: VISSMAN, STEVEN J
Address 1603 SEA HORSE CIR
Phone: 949-548-3389
COSTA MESA,CA Zip: 926274715
Contractor: NOCK PLUMBING
Address: 11612 KNOTT ST
SUITE 217 Phone: (714)895-1246
GARDEN GROVE,CA Zip: 92841
License: 707775
Arch / Eng :
Address:
Phone:
• Zip:
License:
SCOPE OF PERMIT
WATER HEATER CHANGE OUT.
FEE SUMMARY
AMT QTY AMT QTY AMT QTY
ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0
Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0
Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0
Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0
Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0
Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0
Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0
Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0
Drain,Roof $0.00 0 Shower $0.00 0 Water Heater/vent $12.30 1
Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0
Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0
Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord.No.92-28,§ 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work Is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
244646(WOO)
•
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
O I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
Itic
I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed it the permit is valued at on:hundred dollars($100)or less.)
❑ I certify that in the performance of the w f•. which thi- •eermit is Issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California, d a e• . ' I sh••d beco •',subject to the workers'compensation provisions of Secon 3700 f the Labor Code,I shall forthwith
comply with these provisions. / r vi O�
Applicant Signature: Date: —/tel
WARNING:FAILURE TO SECURE WOR RS'COMPENSATION COVERAGE IS WFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOUARE(5100,000),IN AD ON TO THE COST OF COMPENSA / DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARA •N:
I hereby affirm that I am licensed under..•visi•. s• C)••ter! commencing with Section 7000)of Division 3 of the Business and Proles ions Code,and my license is in full
force and effect.Lic.N // AClass tl
Contractor's Signature: •_.'7 / SEMI _r Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lenders Name: Lenders 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 mare 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 en 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,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. 0 Yes 0 No Drivers 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,Gry 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 California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure). _ _ _ _ _
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the 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 then 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 Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit for such construction or modification
from the South Coast Air(Duality Management District or from any other air pollution control district or agency? Yes U No
(Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code).
....permit
.. h.. o t..Ca....Air Quality
nag m..t....t..t..r.other
air pollution
ti n ..t..ldistrict
i..i.t..r. s e ie..for t..
7 application,a from the South Coast rManagement District or and Sr tpollution controloon 3i 3 been agency Is required for the work which is the subject of this
have all of the disclosures prescnbed by California Health Safety Code Section 42303 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:`ertify under penalty of perjury that I have read this application and state that the information given is
correct. 1 agree to comply with all stat laws a d ci , ordinances reify g to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspect'•purpo es. agree not to oc•, •y or allow occupancy of any building authorized by this permit until final inspection.
Sig tura 0(y/el.( .r - 2/1 l ^ / n to
/Arjd/Or Aut110rized Applicant L(I l/late
CODE I INSPECTION TYPE L PAIS INTITIALS LODE( INSPECTION TYPF PBX gfTrnAL7
1616 Fixed System Final Fire Prevention 206 Final Mechanical (]
1266 Pool Spa Final 208 Final Plumbing '7-13-o9 'LAN
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
CITY OF COSTA MESA
PARK FEES
p Fee Payment Receipt 001220
Project Address 36? f j L1 Th 5± is a7 -- ICn O 3 Sea. Horse_rse_ O'vci e)
A.P. Number 4a 5 - j1 I - 2. )
Building Permit Number CC QQ I ',, 7�,��,,
Owner's Name D .l'lG 1 ."�. -/ xQ +br rcv
Mailing Address 29 1's rid 4. F- Loa l or-,4-0— 14 cc-A_
FEE; Single Family * Number of Units
2-Bedrooms or Less @ $ 861.76 =
3-Bedrooms @ 1,205.67 =
4-Bedrooms @ 1,545.62 =
5-Bedrooms+ @ 1,810.50 =
Multiple Family **
Bachelor or Studio @ 474.37 =
1-Bedroom @ 573.18 =
2-Bedrooms �1. @ 881.51 =
3-Bedrooms+ -1 @ 1,229.38 = Z
/ g� Total Feia** ILr' ` `E. - Si.r .;t!'71
Planning Department Approval Date V2/..Z7 DI By 17t_LLLJt' l ) ,
Applicant's Signature
• City Ordinance 72-44 ** City Ordinance 72-45 ••• City Resolution 78-116 r���y����������0-- (7��j
CMF 0174-30,rev.7/85 white—Planning;Canary—Planning;Pink—Finance;Goldenrod—Applicant IJVVIJL II9?C
OWNER SUTTON. RICHARD DATE 6-16-70
-$JOB ADDRESS 358 E. 16th Street BUILDING PERMIT NO. 31957
GENERAL CONTRACTOR Bill Berry DESCRIPTION of WORK Pvt. Block Wall
AP No. 117-27L-03 LOT(pox g6 TRACT DPt.HgrkIRE ZONE VALUE $ 1,450.00
INSPECTIONS Signature Date GROUP J TYPE III ZONE R-2 _
SOIL PERMITS ISSUED__ _
GAS SUBCONTRACTOR Data Number I
Signature
WATER Plumbing
ROUGH PLUMBING
PROP. SWR. LINE ❑ HOUSE CON. n
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE •
UNDERGROUND 0 POWER 0
ROUGH WIRING Heating and Vent.
TRENCHES ] FORMS 0 STEEL REINF. pate 's//p/7p
FLOOR SYSTEM f
BOND BEAM n STEEL REINFORCE n
SHEATHING
FRAME AND FLASHING
LATHING - IN n OUT n
PLASTER, BROWN COAT
STRUCTURAL, FINAL Electric
HEATING, VENT„ REFRIG. AND A.C., FINAL
PLUMBING, FINAL AND GAS TEST n
ELECTRIC, FINAL
BUILDING, FINAL
w 21q51
.tPAI'
PIN 16-7('vt, J
OO.,
` 16119 <:=::a*15 1C
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely gECEI V BV DATE/RECEIVED
/ Zt41 -/lO- 70 DATE ISSUED
BUILDING Si-? _/�_ 7O
ADDRESS /���0�./ //��� �/yl� /� D ..�Iy� T ^/J fvM���
OWN ER ICS PI.LGII.t .figLa , A.P. NO. /17- �.[ !/-n3 3��f_/NO]'J
MAIL BUILDING a-5U d e / / L�R7! (/�,
ADDRESS (7 ,//
Z ADDRESS .{y /J� {)L' (',�J
0 0 CITY Caa&jeaa_ NO. ~/TF � L 4 BLOCK
~ f71 ISH
CONSTRUCTION —_
O co LENDER
0- co /�� ,,f/'//'� ,/
J
•
J OWNER J BRANCH W 4',4 ,o „Lie,
ct ADDRESS
m J VALUE
m ARCHITECT TEL. USE $
-J Q OR ENGINEER NO. _-
V Q FIRE T
w cc ADDRESS ZONE TYPE GROUP V
J O CONTRACTOR1, r BYPROVED 7reeXATE 4--)1,—7O
CO
:lir ADORES �03S- ywwO. Q�
w W TEL. ZON NO.OF USE OF NEVA
D = /J PLANS4 BUILDINGad /D
Z ., CITY 11�. ice.. , No6fQ..o,6.s- �� tom' , jj/QN
—Q STATE p CITY YARDS APPROVED YARDS APPROVED
NCC LIC. NO. /fi left/ LIC.NO..7a0 / MAIN BUILDING ACCESSORY BUILDING
DO (FROM C/L STREET)
SIZE i /� FlV
NO.OF BLOCS.
OF LOT NOW ON LOT FRONT FT. T. �-
USE OF
EXISTING BLDG. R.SIDE FT. FT. i
I- SIZE OF NO.OF , I/
Z NEW BLDG. • ROOMS STORIES L.SIDE FT. FT.
UEXTERIOR WALL I ROOF rt
_ COVERING COVERING REAR FT. FT.
J USE s OF BUILDING AND WORK/TO BE PE FORME DISTANCE BET. BET.MAIN&
a Q/8 Of p b 9-�4- / MAIN BLOCS. ACCESS.BLDGS.
a VVV '
Q VAR.# DATE
O alt V Poe 3 / .- Li" &sett, C.U.P.# APPROVED
I- . � ^"(^)`J APPROVED - / I-/- zQ
IA l.1.�' �Y /f/ DATE
z 1/
0
oI hereby acknowledge that I have read this application and state
✓ that the above information is correct and agree to comply with
CC all laws regulating building construction, end I shall not employ
F, any person in violation of the workmen's compensation laws of
N the State of California. B
Z I hereby certify that I am properly licensed as a contractor under SO. FT. p
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9, and that such licenses ere I force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: R
am exempt from the provisions of a State ,f California Business VALUATION
and Professions Code s ivislon 3, 'hapter 9. /� q,n CO
00 PERMIT FEE $ ✓ V &
Signature of —�� i ,�— m
Permittee i�`�.�/cam $ /��0 PLAN CHECK $ �— E
`o
Authorized Agent ` a
TOTAL FEE $ A5 '00
. OWNER SUTTON, R. L. DATE 6-25-70
JOB ADDRESS 358 . 16th Street BUILDING PERMIT NO. 32004
GENERAL CONTRACTOR' H. T. Wood DESCRIPTION of WORK Detached Garage
AP No. 117-271-03 LOT 56 TRACTNpt.Hgts FIRE ZONE VALUE $ 4,000.00 —
INSPECTIONS Signature Date GROUP J TYPE V ZONE R-2
� SOIL SUBCONTRACTOR Date PERMITS ISSUED
GASI Number ' Signature
WATER Plumbing
ROUGH PLUMBING
PROP. SWR. LINE❑ HOUSE CON. 0
SPRINKLING SYSTEM
MISCELLANEOUS I t
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND ❑ POWER 0
ROUGH WIRING /U 7- Heating and Vent.
TRENCHES FORMS 0 STEEL REINF. IX „..s i
1.4
FLOOR SYS d I
BOND BEAM n STEEL REINFORCE n �d
SHEATHING Y� i 17_v 7D
FRAME AND FLASHING 4'.cs' 7-5l70' �
LATHING — IN n OUT r' g. 0,�/�,/r/� G
PLASTER, BROWN COAT !!///OritF0'
STRUCTURAL. FINAL ��/�0// Elect 'c�j/L��� _
HEATING, VENT., REFRIG. AND A.C., FINAL `TM�r^^ c�f.l C/• tip Naps
PLUMBING, FINAL AND GAS TEST n _ (��J /
ELECTRIC. FINAL 2 _/L- t
BUILDING, FINAL 7.-.Z9- 4,
IIIP
32004
COSTA MESA BUILDING-SAFETY DEPARTMENT If"' ?::.-7(- 0fl29?4 *+:*,-,7C n1
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely RECEI V BY DATE RECEIVED
DATE ISSUED
BUILDING E -23 - Z
ADDRESS 35A 16th- Street, C. M. PE I O. r%
OWNER R L. Sutton A.P.NO. 117-971-03 r40C `/
MAIL BUILDING E
ADDRESS Same ADDRESS 358 16th. St. C. M.
WW TEL. Newpg DHeights LOT 56 BLOCK
0 U CITY C M NO.
Z CONSTRUCTION NEW ADD ALTER REPAIR (MOVING DEMOLISH
z 4 OLENDER None
am X
JV) BRANCH
J N OWNER R. L. Sutton
4w
ADDRESS //, – VALUE �.�y, 0
m ARCHITECT TEL. USE L'' NQ9 a— $ 7l�e
J OR ENGINEER Non NO.
V Q e FIRE
WCC ADDRESS ZONE TYPE GROUP/'
d ul APPROVED i �� 6 2. 70
LU
O CONTRACTOR H. J. Wood BY DATE
ix ADDRESS 212 Flower Street, C. M.
W WTEL. ZONE NO.OF USE OF NEW
0= CITY NO. R-2 PLANS 2 BUILDING Detached
Z I– rr''.�''
WO STATE CITY YARDS APPROVED YAREGanaQ8VED
NCL LIC. NO. 90400 LIC.NO. Yes MAIN BUILDING ACCESSORY Bb UILDING
DO (FROM C/L STREET)
SIZE NO.OF OF LOT I NOW ON LOTS
100 X 150FRONT FT. 100 + FT.
USE OF
EXISTING BLDG.Res- & Det- Garage
R.SIDE ET. 52 FT.
I– SIZE OF NO.OF
Z NEW BLDG. 21 X 46 ROOMS STORIES L.SIDE FT. 0 FT.
Q EXTERIOR WALL St O ROOF
V_ COVERING Con Bi COVERING COVERING Campo- REAR FT. 0 FT.
J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
d
O. MAIN BLDGS. ACCESS. BLDGS. 45 Ft.
Q VAR.# DATE
o Detached Garage D.U.P.# APPROVED
I–I- ROVED/// / e a nATF 6-25-70
2 YLa v//
0
0 I hereby acknowledge that I have read this application and state
D that the above information is correct and agree to comply with
CC all laws regulating building construction, and I shall not employ
F any person in violation of the workman's compensation laws of
N the State of California. mO
Z I hereby certify that I am properly licensed as a contractor under SQ. FT, 6
the State of California Business and Professions Code. Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: ¢
am exempt from the provisions of the State of California Business
VALUATION
and Professions Code,Division 3,Cho 6r p� CO
PERMIT FEE $
Signature of 1 s m
Permittee . ` �{/ S Ioile PLAN CHECK S / �� E
[[!!�� p ,sem— p
Authorized Agent – �/, I TOTAL FEE $ 2/• v V u