HomeMy WebLinkAbout1090 WESTWARD LN - Building Permits ir
•
LC9"tft.i CITY OF COSTA MESA
p ot,. CALIFORNIA 92626 P.O. BOX 1200
a;
4°2.
'A 'r�;,. '. FROM THE OFFICE OF THE DEVELOPMENT SERVICES DEPARTMENT/
x'4.0 oy."., BUILDING SAFETY DIVISION
December 18, 1979
M„, tetrina
10 Westward Lane
osta Mesa, Ca 92627
RE: Compliance Inspection at 1096 Westward Lane, Costa Mesa, Ca.
Dear Mr. Petrina:
Here is a list of conditions to be met in order to bring the above mentioned
p a £ Sa. property up to code.
Ira Gic>ss ]
s1;��_" A 5 '0" x 6'8" sliding glass door was cut into the rear wall of the garage
1...3 ;'t4‘ a / fQ o the atrium. Permits and removal of drywall for structural inspection
I be required for this improvement.
ix/ afaitAM
OK. 2. Garage floor is approximately 30" lower than the sill of the door. Place
permanent stairway in garage area, subject to Planning Division approval ,
if encroaching into required parking space(s) . Plans will be required.
o„k 3. Hand rail at entry from garage to kitchen must be securely fastened.
The balance of the property appears to lie in conformance with codes.
Sincerely, '
teite &,`�
Structural Inspector
01'314 14010C ,2bo4,.e LeAs 44 6o" /'le,qae2
INs7gt/eel _ OTtiaR_ co.,<10/sa4Va Not ecote treed?,
if9/1477 .
77 FAIR DRIVE (714) 754-5273
aitpMFS4 CITY OF COSTA MESA
p ACe CALJFORNIA 92626 P.O. BOX 1200
} '
vNi' %e
t FROM THE OFFICE OF THE DEVELOPMENT SERVICES DEPARTMENT/
pyp BUILDING SAFETY DIVISION
oreann
January 8, 1980
Mr. etrina
1.096 estward Lane
sta Mesa, California 92627
RE: Compliance Inspection at 1096 Westward Lane, Costa Mesa, CA.
Dear Mr. Petrina:
Be advised that the conditions have been met to bring your
property up to the satisfaction of the Uniform Building Code and
the required improvements by the City of Costa Mesa.
Respectfully,
gc
Victor C. Newton
Assistant Building Safety Director
VCN:nih
V9 W7
77 FAIR DRIVE (714) 754-5273
•
CITY OF COSTA MESA
**at: BUILDING DIVISION
t' 'fl”-?' ''1 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
PERMIT
diti:%s,u d° 99-00446
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 1090 WESTWARD LN Status: APPLIED
Suite No Applied: 08/04/1999
Issued:
Vicinity: MASTER BATHROOM II''•
Parcel Nunmber. 93523005 V"`--
ISSUED BY:
Applicant: LA CHAT, ROBERT G .
Address: 1090 WESTWARD LN
CA Phone: (949)722-6898
COSTA MESA ' Zip: 92627 . .. ,
Owner:// LA HAT, ROBERT G `
C - _ -
Address-.-1090 WESTWARD LN - ,- _
Phone: (949)722-6898 _
,,;i tOSTA'MESA,z Zip: 92627 . -
" .
�
,.s % „,,,,,/,V
•
•
•
Contractor: ,
Address: -
' F , - Phone:
Zip: •
License:
Arch/En r
Address:, - "
Phone:
Zip: .
License:
' SCOPE OF PERMIT
\, ' 1 BATHTUB, 1 SHOWER,-1 WATER CLOSET&2 WASH BASINS FOR REMODEL MASTER BATHROOM-
EXTEND 1-INTERIOR WALL&ADD PLUMBING FIXTURES FOR EXISTING SINGLE FAMILY
. RESIDENCE.
REF:B99-01218 •
FEE SUMMARY
AMT QTY AMT QTY AMT QTY
ISSUE FEE - $22.00 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 "$8.75 1 - Pressure Regulator ' $0.00 0 Urinal - $0.00 0
Clarifier System - ' I , $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0
Connect(Ice,Soda,eto). - $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 $17.50 2
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) $8.75 1
Drain, Roof $0.00 0 Shower $8.75 1 Water Heater/vent $0.00 0
Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0
Expansion Tank $0.00 0 - Sink,commercial -$0.00" 0 Water Re-pipe $0.00 0
Gas Earthquake Valve $0.00 0 Sink, Floor $0.00- 0 Water Service $0.00 0
Gas(1-4 outlets) $0.00 0 Sink,kitchen $0.00 0 Water Softener $0.00 0
Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00
Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00
Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00
Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0
Interceptors(Sand Auto) $0.00 0
TOTAL CALCULATED FEES: $65.75
COMMENTS/SPECIAL CONDITIONS -
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia 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 1,1, , 4
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
O 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 If the permit is valued at one hundred dollars($100)or less.)
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 subject to the workers'
compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with these provisions.
Applicant Signature: Date:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lica# Class#
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
O I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date: '
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects pplicant to a civil penalty of not more than five hundred dollars($500).):
I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
O I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions
Code: The contractors License Lbw does not apply to an owner of properly who builds or improves thereon,and who contracts for such project with a contractor(s)
licens t t the ontra License Laws.).
O 1 am xemr s . Business and Professions Code for this reason: 9 n
Signature: fr
� Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
O I hereby certify that no excavation five(5)or more feet in depth Into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec,
341,Title 8,California Administrative Code).
O As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
..3__--.._e-.-_twill the
applicant
nt..or u_.rebuildnocne-_-__prepa.___ sr..__-mor--..cazadou.__aeia_._._.
3 Does or will the applicant or present future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application agermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 0 No
(Section 65650.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
..._. _If a..p_-rmi____ the Souteh__._—_-_ _—__.__._i___rage_carp _pep_ _.___--e._ -_ _.
•
7 a a patron from South Coastlosres Quality Management is Healthat or other air pollutionoection 4 303 bt been agency ii-required Yesed for the work which is the subject of this
application,have all of the disclosures prescribed by California and Safety Code Section 42303 made? 1:1 Yes 0 No
8 (If yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND A ORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct.I ompl wits all state c's and city ordinances relating to building construction,and authorize representatives of the City of Co to Mesa enter upon the
above-de milled pew r -.•esti• •• napes/glee not to occupy or allow occupancy of any building authorized by this permit V6{il fin I in ctip� 53
A., O /(/X I �/!
S a ature Of Legal Owner(s) Date
And/Or Authorized Applicant Date
CODE t INSPECTIONTYPE DATE INTRIALS 000F It INSPECT1ON TYPE D INTRIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical n n�
1266 Pool Spa Final 208 Final Plumbing 9-1319 RN
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign ' 222 Final Site •
204 Final Demolition • 250 Final Building/Occupancy
2446-46
tC.w• CITY OF COSTA MESA \ '
:#"7-110.0171. BUILDING DIVISION
F' ""'i' , DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
TA SPC*
PERMIT
wan 9-00729
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
. ELECTRICAL PERMIT
Job Address: 1090 WESTWARD LN Status: ISSUED
•
Suite No Applied: 08/04/1999
Vicinity: MASTER BATHROOM Issued: 08/04/1999
Parcel Nunmber: 93523005 n '
Applicant: LA CHAT, ROBERT G •
ISSUED BY: �/Y
Address: 1090 WESTWARD LN _ , . .
CA 'Phone: (949)722-6898
COSTA MESA. 2 Zip: 92627 ,
Owner: , LACHAT, ROBERT G - ,
Address /,1090 WESTWARD LN _
, /CAPhone: (949)722-6898
COSTA MESA . "- Zip: 92627 '
'
Contractor:, - -
'Address:
Phone: • .
•
. . Zip:
_License:
.
1 ..
SCOPE OF PERMIT
' INSTALL 1-MOTOR FOR VENT FAN(LESS THAN IHP)& 1-MOTOR FOR NEW JACUZZI TUB(1-10 HP) ,
FOR MASTER BATHROOM REMODEL.
/ ,
' - REF: B99-01218 .
FEE SUMMARY ' .
Quantity . / , . Quantity
ISSUE FEE - $22.00 Temp Dist System/Lighting $0.00 0 `
Temp service test $0.00 .' Busway/100 ft $0.00 0
Res. a/c package $0.00 Standing Section $0.00 0 ,
New Res(1-2 units) $0.00 0 - Misc Electrical Equipment $0.00 0
New Res(3+units) $0.00 0 - • • Transformers up to 1 kva/kw $0.00 . 0
Pool/Spa' $0.00 0 . up to 10 kva/kw $0.00 0
Lighting Fixts $0.00 0 . up to 50 kva/kw $0.00 0
Recept Outlets - $0.00 0 up to 100 kva/kw $0.00 0
Switches . $1.00 1 , over 100 kva/kw $0.00 0
Non Res Appl . $0.00 0 Low Voltage Equipment $0.00 0
Res Appl $0.00 - 0 Low Volt Wiring System I Ckt $0.00 0
Service to 200a $0.00 0 - Misc.Conduit $0.00 0
Service to 1000a $0.00 0 Misc.Conductor ' $0.00 0
Service over 1000a $0.00 0 Circus(gen or ride) $0.00 ' 0
Motors to 1hp $4.25 1 Circus(mech ride or lights) $0.00 0
Motors to 10hp $11.00 1 Christmas Tree Stand $0.00 0
Motors to 50hp $0.00 0 Fireworks Stand $0.00 0
Motors to 100hp $0.00 0 Other Electrical Fee $0.00
Motors over 100hp $0.00 - 0
Communication drops $0.00 0 Investigation Fee $0.00
Sub panel to 200a $0.00 0 Plan Check Fee $0.00
Pole Light Pkg $0.00 0 - Reinspection Fee $0.00
Sign Circuits $0.00 0
Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $38.25
Intermed Pole $0.00 0
COMMENTS/SPECIAL CONDITIONS
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
DECLARATIONS
•
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑ I have and will 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:
Carder: Policy Number:
(This section need not be completed it the permit is valued at one hundred dollars($100)or less.)
0 I certify that in tfle performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisions.
Applicant Signature: _ Date:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,o00),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lic.# Class U
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Busine 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
sub is the applicant to a civil penalty of not more than five hundred dollars($500).):
I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and'Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
O I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions
Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s)
license to the Contractor ense Laws.).
❑ I am exempt er ec. /��'i„rqq' /'/ Business and Professions Code for this reason: 8 - '49 .'/; 9
Signature: F- /. k/)-.�(Al-e ,
Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
O As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
•
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the Califomla Health and Safety Code requires,with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
..-----._._s _ __e_ present
ionn._._.__.._- t__...
5 Does or willthe applicant present ar future building occupant at requirehfor the work which is the subject this application a ermlt for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? �Yes �No
(Section 65850.2 of the Califomia Govemment Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
.___-_-_...P _____._..—___—_._..______......_9 pollution ...—.__ _ ,
7 If a ermit from the South Coast Air QualityManagement District or other air control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No
8 (If yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct.I a ee to mply with II state w nd ci ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-desdribed pert or actio s.I ee not to occupy or allow occupancy of any building authorized by tbjg pe irrrl ty7l fyl}I 9ppection.
Sign ure Of Legal Owner(s) (// �(1- Dater
And/Or Authorized Applicant Date
^^.`,4
CODE Y INSPECTION TYPE ��"r! INTRIALE CODES INSPECTION TYPE DAT INTRIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical 7-/3-f9 rk r7-'t/1
201 Final Block/Retaining Wall 212 Final Fire Prevention _
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
2446-46
C
4 CITY OF COSTA MESA I
w mom. �, BUILDING DIVISION
�•'�"4 - DEVELOPMENT SERVICES DEPARTMENT P IT NUMBER
.'.r *wPERMIT
- s„o� M99-00369
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
MECHANICAL PERMIT
Job Address: 1090 WESTWARD LN Status: ISSUED
Suite No Applied: 08/04/1999
Issued: 08/04/1999
Vicinity: MASTER BATHROOM
Parcel Number: 93523005 I/VI
ISSUED BY:
Applicant: LA CHAT, ROBERT G - • . -
Address: 1090 WESTWARD LN , -
CA Phone: (949)722-6898
COSTA MESA Zip: 92627 -
Owner: / LA CHAT, ROBERT G
Address:',."1090 WESTWARD LN _ ,
.,� ' ' CA Phone: (949)722-6898
COSTA MESA'' - • Zip: 92627 - "
Contractor: -
•
Address:. - _ ,
Phone:
. . Zip: ,
License:
Arch/Eng:
Address: . _
I • - Phone: ' .
`. Zip: '
, License: ,
SCOPE OF PERMIT
1 VENT FAN FOR REMODEL OF MASTER BATHROOM-EXTEND 1-INTERIOR WALL&ADD
PLUMBING FIXTURES FOR EXISTING SINGLE FAMILY RESIDENCE.
' REF:B99-01218. - - . •
_
'
FEE SUMMARY
-Quantity Quantity
ISSUE FEE $22.00 Repair/Alt Absorbtion Unit $0.00 0
Inst FAU<100 k BTU $0.00 0 , - Repair/Alt Refrigeration Unit - $0.00 0
Inst FAU>100 k BTU $0.00, 0 Ventillation System $0.00 0
Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0
Inst/Rep.Recess Wall Htr $0.00 0 . Commercial Incinerator $0.00 0
Refrig Sys<100 k BTU $0.00 0 - Domestic Incinerator $0.00 0
Refrig Sys>100 k BTU $0.00 '0 i Compressors/Absorption Systems
Gas Piping $0:00 0 Up to 3 hp/100 k BTU $0.00 0
Factory Fireplace- $0.00 0 3 To 15 hp/500 k BTU $0.00 0
Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0
VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0
Vent Fan/Single Duct - $6.50 1 Over 50 hp/Over 1,750 BTU $0.00 0
Appliance . $0.00 0 Boilers
Fire Dampers $0.00 0 Up to 3 hp $0.00 0
Smoke Dampers $0.00 0 3 To 15 hp $0.00 0
Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0
Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0
Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0
Floor Furnace $0.00 0 Other Mechanical Fee
Floor or Suspend Heater $0.00 0 Investigation Fee $0.00
Plan Check Fee $0.00
•
Reinspection Fee $0.00
TOTAL CALCULATED FEES $28.50
•
COMMENTS I SPECIAL CONDITIONS
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 issuspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
'
FOR INSPECTIONS CALL: (714)754-5626
DECLARATIONS •:
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit Is issued.
❑ I have and will 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 ere:
Carrier: Policy Number:
(This section need not be completed I/the permit is valued et one hundred dollars($100)or less.)
❑ I certify that in the performance of the work for which this permit is issued, I shell not employ any person In any manner so as to become subject to the workers'
compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisions.
Applicant Signature: Date:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(5100,000),IN ADDITION TO THE WS i OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lic.k Class M
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
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 a 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
subject e applicant to a civil penalty of not more than five hundred dollars($500).):
I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions
Code:The co actors 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 purs.-nt thejontractors Lic:' :ws.).
o I am exempt ur•.r! / __.444ff IfBusinessand Professions Code for this reason: '/ L� a
Signature: a-C� A<�L
Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
O I hereby certify that no excavation five(5)or more feet in depth Into which a person Is required to descend, will be made In connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No
(Section 25533 of the Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
....._...__-.oll theapplican.t.oprefutue,bu.il..i_g._.cupa._..ndopreaan..............(RskMament.....).
3 Does oand Program for acutely hazardous materials)?
❑yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No
(If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 if-a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATIO' OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to c ply all a- laws and i.-ncesl�lating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described pr arty fD flan 2•. :••.of tp?6ccupy or allow occupancy of any building authorized by this perryriAuntll fi In ps5n.
R ��/,/ Y/T *JS
I�) •
Signature Legal Owner(s) Date
And/Or Authorized Applicant Date
00011 INSPECTION TYPE PATE lamp S SoDEE INSPECTION TYPE �t1 [� A
1616' Fixed System Final Fire Prevention _ _ 206 Final Mechanical R-/319
1266 Pool Spa Final _ 208 Final Plumbing
200 Final Re-Roof _ 210 Final Electrical
201 Final Block/Retaining Wall _ 212 Final Fire Prevention
202 Final Factory Fire Place _ 220 Final Planning Approval
203 Final Sign _ 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
2426-46
- ^4 -
t CITY OF COSTA MESA -
siOW t, BUILDING DIVISION /
�' " ' DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 1
J if
^,t I' PERMIT
�ro.�w 699-01218
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 1090 WESTWARD LN Status: ISSUED
Suite: Applied: 08/04/1999
Vicinity: MASTER BATHROOM Issued: 08/04/1999
Parcel Nunmber: 93523005 Zoning:
Applicant: LA CHAT, ROBERT G ISSUED BY: 1
Address: 1090 WESTWARD LN . - - . - -
CA , ' Phone: (949)722-6898 " -
COSTA MESA/. r .' , Zip: 92627 '
Owner: LA CHAT,'ROBERT G
Address 1090-WESTWARD LN
CA Phone: (949)722-6898,
i ,' COSTA MESA - - - - - Zip: 92627 ' .
i _ . - - .
Contractor: -
/ ,
2 , .Address: //" ;
Phone:
1 Zip: . License:
Arch : Eng:
Address: - - Address:
- Phone: - Phone:
e N Zipr - License: Zip: 1 License:
SCOPE OF PERMIT
-/ REMODEL MASTER BATHROOM-EXTEND 1-INTERIOR WALL&ADD PLUMBING FIXTURES FOR EXISTING SINGLE FAMILY
RESIDENCE.
FEE SUMMARY
Plan Check: $48.59 - / _ Calc Valuation: $3,000.00
Permit: . $74.75 - a` i Claim Valuation: $3,000.0o
` SMIP Res: ' $0.50
. `SMIP Com: $0.00 .
Other $0.00 _ ,
Inspection: , $0.00 .
,Total: - $123.84 ,. , . .
PLANNING &ZONING
SETBACKS . -
MAIN STRUCTURE Front 0-0 Rear 0-0 Left '0-0 Right 0-0
ACCESSORY Front" 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0 .
NOTES:
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
WORKERS'COMPENSATION DECLARATION:
(hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued. -
❑ I have and will 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 if the permit is valued et one hundred dollars($100)or less.)
❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisions.
Applicant Signature: Date:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARS($l00.000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lia# Class#
Contractors Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: 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
bj e applicant to a civil penalty of not more than five hundred dollars($500).):
I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.11,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions
Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s)
license rs t tie Contractor Li se Laws.).
❑ I am exemp d sec Business and Professions Code for this reason: 99Signature: i' ('
Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes ❑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 et 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).
the or
__ _..... -.l- -.. -... ..._..__.. ...........
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or 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).
............. '—.. e p t..o.r....p future occupant _. do als 3 Does or will the applicant or present or future building occuneed to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
...4........-. ---.Ps air ... echo -f-the-- .. aHeal Safety C .._o .___ ___.._.. ---_."-_ ... ............. ...............
4 If an RMPP is presently required,has Section 25534 of the California Health and Code been fully complied with? ❑Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? DI Yes LI No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
to...b.. ructed n...10- -..--tboundaries hoof e---__..-
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Ves 0 No
(If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 No
..f compliance pollution
cer)-.- --------- --------- --- ---------- _-----.....- .----..... .-.. ......
e (If'yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND A O- -TION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree o co ly wi state city Qrdinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-describe pro y 1 in _ •.I ee not to occupy or allow occupancy of any building authorized by this permit un' 1inaFvinpyection.
A., 06/ !tel -7
/ Signa ure Of Legal Owner(s) Date
And/Or Authorized Applicant Date
CODE#, INSPECTION TYPE • PATE INTRIALS CODE# INSPECTION TYPE PATE INTITIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical _
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
•
203 Final Sign 222 Final Site
204 Final Demolition , 250 Final Building/Occupancy Z
2446-4s
.,
.
DIVISION OF BUILDING SAFE._ 1
CITY OF COSTA MESA
APPROVED (t / c
Sy — Date_ Cf `-t I I�
This set of plans and specificatixrs MUST be kept on this job at ail tines and it is unlawful to
make any changes or alteration on same without written permission fran the Division of Building
end Safety,City of Costa Mesa.
The stamping of this plan and specifications SHALL NOT be held to permit or to be an approval
of the violation of any provisions of any City of Costa Mesa Ordinance and/or Slate law.
These plans and permit shNi,exphb by limitation and become null and void if the bulking or
. wcrk Commenced and detain)active per-UBC 9303(dl wlhin 18D.days of.issuarxa. -y,
-d9" '
-as". 4
,9, \ ,
L ,,,,..,..,_FCi1 \ v.‘121/
- .--.efl
NrrE : f24vvtVE =LEA otag caJ- '
A A LI'1-H'Tl u- ( 'la c. 'CD
ISt ,
`ort t,d Ll-o Lula,EN /wa-t r
_3 ' -CST_
iii wt woo
GIA-ss.
,
V V
C 34v --?
14o1Q &SSS&' 00/Nva-r'Fi tAc_-
?----
LAP a 10o -er uit py�i-t 1 ac 1
I 0 90 \A/Gtr D LSI .
RT c . LA Co-pc-i--
ADDREssc.mma: 1090 WESTWARD LN UMT: CITY OF COSTA MESA - BUILDING PERMIT
5WNEWSNAMEWIwa"M WESTBLUFF HOMEOWNERS ASSO PERM NO: B 076829
"ma& 111 PACIFIC #250
IRVINE CA 92714 PERMIT NO: B 076829 PLAN CHECK NO: N GOVT: N SUPP : N
727-26$0
ACPL.MMINlS ADDRESS: CONSTRUCTION TYPE: V-N PERMIT TYPE: STR PURPOSE: OTH
ARCHITECT OR EMSMEER: LIC,NO.: JOB DESCRIPTION : T/OFF & REROOF W/BUILT-UP SQ FT: 6, 800
ARCM.OR ENG.'S ADDRESS: WIT:
CLAIM VALUE: 6, 800 . 00 CALC-VALUE: 6, 800 .00. GROUP OCC: R-1 /
c uuma1stwt R.P. HIRSCHMAN ( 714 ) 960-8329 . -
CaITRACTORSNuuNG 8855 ATLANTA COMMENTS : REROOF 5UNIT CONDO ADDRESS INCLUDES/1092,(109,4'-1096 1098 WESTWARD
ADDRESS: HUNTINGTON BEACH CA uCNO.: 475948 ****************+E********+ **k+E*****+E**********AN*****.�E+F*x*******+ESE -**�E**�N*�E*�E+E*
92646 DMT: 285 Z ONING R E Q U I R E M E N T S
LICENSED CONTRACTORS DECLARATION:I hereby epim under penally a penury that 1 am licensed under provisions of Chapter 9 SETH AC K S
(commencing with Section 7000)of Division 3 of the Business and Professions Coda,and my license is in full force and effect.
CITY Lit Snl: 038468 uc.cuss: C36 LIC.NO. 475948 EXP : 04 /96 MAIN BUILDING ACCESSORY BUILDING
T FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Dale '�-II-IC com
��rt���$ ���yy// LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
"''+vten:;.,Oveitg reason E(S DECLARATION:
713amessa�Professir ons Code:Annally of y cty or that
countysAud,requires athe
permit to construct,atter,mfor
prove,
u'.aindsh.or repro any structure.prior to its SsMsIce.also requires the applicant for such permit to file a signed statement that Moshe PARKING REQ: PROV: PARCEL: 93523005 INE: REF NO:
is licensed pursuant to the provisions of the Contractors License Lew(Chapter 9(commencing with Section 7000)of Division 3 of the PLANNING NOTES>
Business end Professions Code)or that he or the is exempt therefrom and the basis 1«the alleged exemption.Any violation of Section '>
7031,5 by any applicant for apermleu ect°the applicant to aavi penally onO more than l'we hundred tan 15500)). *********************************************************************IE*********
❑ I,as owner of the property or my employees with wages as thei sole oompensmion,will do the work,and the structure is not intended DEVELOPMENT SERVICES R E !1 U T A 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 property M
who bolds or improves thereon,end who does such work himself or hersel or through his or her own employees.provided that such
improvernantsare not intended or offered for sale.If, the building or improvement S sold within one year of completion.the ZONING APPROVED BY '
improvements
will have the burden of proving he or she did not build or improve for the purpose of sale). DATE:
❑ i.es owner of the property,am exdusively oontncti g with licensed contractors to corvmud the project(Section 7044,Business end
Professions Code:The Contractors License Law does notappwho builds to an owner a property wbuilds or improves thereon and yelpBUILDING APPROVED BY : DATE: 1., '
contracts for such projects with a contractor(s)licensed pursuant to the Contractors License Law).
❑ Iamexempt under Sectiom: B.AP.C..lot this reason: APPLICATION ISSUED BY: DATE: .�
********************************************** ****************** Cl/ **
Dm°: Owner: LEGALIZATION: N F E E SUMMARY STRUCTURAL SEGMENT:Y
I do hereby pally that I am aware dead a,dretend the requirements of California Health and Safety Code Sections 25505.25533,and /
25534,and Oral I or any haute building occupant wit/wit floe(dreb one)need to comply with said state codes and the requirements for
a permit for construction or modification Iron Use Aiansgement District.Re'MmtblmMmaionappf� m ioare exempt from them BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
provisions. PERMIT 90 . 00 , _ . 68
Dale: Applicant: SMIP/NON-RES
WORKER'S COMPENSATION DECLARATION:I hereby alfum under penally of perjury one a ermm
the following dedio :
PLAN
ISSUE FEE .
❑ dve°MwMmeirmnceftiewaoomemthSto peritSSued.n'compenemion,mpraidedlabySedion47aoathetebar BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
Code,for the performance of the work for which this permit S issued.
❑ Have and MImainsail workers'compensation im ®
oran ,aereoatedbyseao,a7mathe Labor Code,for the ped alm
«naea9n TOTALS----> 90 . 68 0 . 00 7; i 0 . 00 90. 68 90 . 68 . 00
work for which this permit is issued,My waken'compensation insurance caner and policy number are:
Carrier: STATE FUND EXPIRES REVENUE DIVISION TOTALS--> COLLECTED : 90 . 68 OVER/SHORT: . 00
Policy Number: 1722R90-94 10/01 /96 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
(Thisxedr«n need net beconpaed if thepam.is for one hundred dmars1510Oj o less) 90 . 00 / . 68
❑ I pertly that in the conformance of the week for which this permit is Sued,I shall not employ any person in any manna so as Io '
became subplot to the workers'compensation laws a Cafdoma,and ages*that d I should become subpd to to workers' ***************************************i(**************1E************************
compensatic.,ppro cions a a Section 3700 the Labor an comply with those pro siom. B R E A K D O W N
Date: 3-19-1c ApNIND I V I D U A L' -( '.F E E
Kerdh���.i -
Warning:Falun to secure workers'conyensedon coverage is unlawful,and shall subject an employer to criminal pens/fes and TYPE QTY DESCRIPTION - UNIT COST TOTAL COST
civil lines yes to one hundred thousand dollars(5100,000),M addition to the cent of compenmtlon,damages as provded for In
s«tion37P6ohthe Labor Code,Interest,and*romryalees. SFR 6800 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 6, 800 . 00
CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty of perjury that there is a construction lending agency for the END OF FEES
• Performance of the work for which this perms is issued(Section 3097,Cir.C).
LENDER'S NAME:
LENDER'S ADDRESS: I
•
I certify that I have read this application and stele that the above information is correct.I agree to campy with all city and county ordinances
and state laws natnp to building consirnbn and hereby authorize representatives a this city to enter upon the above-menlnned property
for inspection purposes.
BOB HIRSCHMAN '
.. :n l
Punt Name U' ..4_,:0u _ am.
Dale:g—/S^�(.0 .. _ .
pnalare a owrodAaenuAfpAaenb'convad« _ - --- - ._ - - - -
r •
(5151.46.WP) White-Buildig 8 Safety:Green-File:Canary-Appkcent:Pink-Revenue:Goldenrod-Assessor
CONSTRUCTION AND PLANNING ' PO..� & SPA
APPROVALS Permit Date Inspector APPROVALS Permit# Date Inspector
, r
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement •
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings • 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe,0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System -Final
14. Rough Plumbing - 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric 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 - -
24. Roof Framing II • 73.. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing I..34.,/kg„ f . • 74. Overhead Hydro
26. T-BarCeiling (Structural) & Monocoat • 75. Dry Chemical -
27. Frame and Flashing • • 76. Dry Standpipe " •
28. Lathing& Siding 77. FIXED SYSTEM FINAL
29. Insulation • 79., FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79, FINAL INSPECTION •
32. Electrical Power Meter-Final • - 84. FOOD� CERTIFICATE ISSUED
33. Final Electric • Notes:0/* z;?cJ/ ,_ - s ly eery
34. Final Heating& Air Conditioning ry aftyi�����
35. Final Gas Pipe-Test J !`
36. Hood or Canopy •
37. Final Factory Fireplace •
38. Final Plumbing ' •
39. Water Service-Final - •
40. Gas Service-Final -
41. Solar Domestic-Final
42. Backf low Preventer
43. Backf low Irrigation -
44. Landscape irrigation System •• . .
45. Sound Attenuation r •
46. Handicap Regulations ' •
47. FINAL STRUCTURE & BUILDING
t - -
48. FINAL PLANNING - •
49. Electric Release to Edison
50. Gas Release to Southern California-Gas Q - •
51. CERTIFICATE OF OCCUPANCY
No. Date
-
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA MESA PERMIT NO. TRACT NO. LOT NO. BLDG.NO. I�"I L I a/i •./ 1- .. 4-
CONSTRUCTION PERMIT / ic - SYS" /
Project Address. /O 90 /t1Q-S-"'tax-/•4._ TYPE OF CONSTRUCTION U NEW LJ ADD ❑ TEVATION ❑ REPAIR
Applicant's Mailing Address/
— / '[ ❑ CONVERSION ❑ DEMOLISH IR u HER VOO 1 G�1 -
A P # _ (Zone
Owner's Name W I O /t+ ^Obe„Phone DESCRIPTION OF WORK C non. /� $(�^'i�f-'!� - .
S -ID (�-. (4' 5' tel-// (tn/tis p ` (ifnt i-S Main Building: Accessory Building:` ' Z
J/ �� O
Address TYPE OF PERMIT ❑ GRADING ❑ FOUN ATION STRUCTURAL / T Front N
\ Arch/Eng, License No. ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B • I
Rear N
Address /J ❑ BOTHER ' A •
I\- Contractor's Name CLSar^'�/ /Co (-4-) Phone+1-17/-0....Q2(4 PROJECT DESCRIPTION SQ. FT. -4-0°15-7 r rOCCUPANCY _ C Right . G
"U ,!/�/ /� K R
Address(mailing) /Vila( �d S - G\o CONSTRUCTION TYPE VALUATION$ ' /D,rl7 S Left E
\ City License No. 9/ / ZONE GRADING CU.YDS, ACRES Ping. Ref,# Park.Fees $ Q
U
LICENSED CONTRACTOR DECLARATI N Remarks: Parking Req,/Provided I
I hereby affirm that I am licensed under provisions of Charter 9 (commencing R
with section 7000) of Division 3 of the Business and Professions Code, and Use of Building: E
M my license is In full force and effect.
License Class C- Am
/3noC PLUMBING FEES Planning Notes: M
2
Date /7- -g3 Signature 1----..-r ,
WORKERS'COMPENSATION DECLARATION Bar Sink Showers - N
' hereby affirm that I have a certificate of consent to self-insure or a certificate Backflow Preventer Service Sink S •
f Workers' Compensation Insurance, or a certified copy thereof (S coon ,
3800, Lab. C.) a-/` /1 Backflow Irrigation • Sewer Cap ELECTRICAL FEES •
Policy No. Company T T p-��••---�� - •'
Certified copy Is hereby furnished. Bathtubs Sewer Connection Automatic Washer Transformer 0 15-50.KW
entified ca y( iled with the city B g Di ///
-
�p 5 {� ❑ 50+ KW
Date /Z--/L-O Applicant a e _ / Clarifiers Solar Collectors Construction Pole Sub.
EXEMPTION FROM WORKERS'COMPENSATION DECLA ATION Dishwasher
(This section need not be completed if the permit is for one hundred ($100)or Solar Piping Cooking Unit Meter ❑up to 100 amps
less).
I certify that in the performance of the work for which this permit is Issued I Drinking Fountains Solar Tank Dishwasher Meter Dover 100 amps
shall not employ any person in any manner so as to become subject to the
Workers'.Compensation Laws of California. Floor Drains ' Swimming Pool w/Spa Dryers EGas ❑Electric Sub Panel
Date Signature -- - -+
NOTICE: If,after making this declaration,you should become subject to the Floor Sinks Urinal Fan Motors❑0-1 HP Diva.-8
Workers' Compensation provisions of the Labor Code, you must forthwith -
comply with such provisions or this permit shall be deemed revoked. Gas Service "Outlets, Water Closet F.A.U. - Inc.Solar 09-15 HP ❑16-15+
CONSTRUCTION LENDING AGENCY •
I hereby affirm that there is a construction lending agency for the performance Interceptors Water Heater - Fixtures - Microwave '
of the work for which this permit is issued (Section 3097 Civ. C.) -
Lender's _Name Kitchen Sink Water Service Device Boxes Pole Light
Lender's Address •
OWNER BUILDER DECLARATION • Lavatories t Outlets Range
I hereby affirm that I am exempt from the Contractor's License Law for the P-Trap reason (Section 7031.5 Business and Professional Code: Any city or p Switches Sign •
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 Roof Drains Garbage Disposal Standing Sections .
to file a signed statement that he/she is licensed pursuant to the provisions of - •
-
the Contractor's License Law(Chapter 9(commencing with Section 7000) of
rivision 3 of the Business and Professions Code) or that he/she is exempt • Generator 00-5 KW 05-15 KW Trash Compactor '
ierefrom and the basis for the alleged exemption. Any violation of Section • •
/031.5 by any applicant for a' permit subjects the ,applicant to a civil
LJenalty of not more than five hundred dollars($500).. . Reinspection Fee $25 Issue Fee $ 3
I, as owner of the property or my employees with wages as their sole • Reinspection Fee $25 Issue Fee $ 3
compensation, will do the work,and the structure is not intended or offered MECHANICAL I FEES
for sale (Section 7044, Business and Professional Code: The Contractor's — PUBLIC SERVICES REQUIREMENTS:
License Law does not apply to an owner of a property who builds or improves Boiler Hood or Type I 0
thereon, and who does such work himself/herself or through his or her own Zoning Approved By nate—
employees, provided that such Improvements are not intended or offered for - ' Canopy Type II 0
sale. If, however, the building or improvement is sold within one year of com- Duct-Under Ground Application Approved By Date
pletion, the owner.will have the burden of proving he/she did not build or im- - _
LJrove for the purpose of sale). Duct-Structural I Refrigeration System Application Issued By �L!''( / Date/3//a/8--._S
/\\I, as owner of the property, am exclusively contracting with licensed con- • ❑0-100,000 BTU ❑100,000 BTU
tractors to construct the project (Section 7044,Business and Professions Code: Duct-Ventilating .SUMMARY O FEES
-The Contractor's License Law does not apply to an owner of property who Y
builds or improves thereon,and who contracts for such projects with a con- Exhaust System 0 Multiple ❑ System Repair/Alteration BUI LDING PERMIT $ ? Or SMIP "• $ -COtractor(s) license pursuant to the Contractor's License Law). - PLAN CHECK $ PERMIT
❑ I am exempt under Section B.& P.C.for this reason -Firepl/Fact.Bit. ICBG# PLUMBING $ • ISSUANCE J $
Date • Owner Heating System&Ducting PLAN CHECK $ - ENERGY P.C. $
I hereby certify that I have read this application and state that the above -00-100,000 BTU 0100,000 BTU - GRADING --t $
Information Is correct. I agree to comply with all city and county ordinances - ELECTRICAL $
and state laws relating to building •ns ruction,and hereby authorize repre- PLAN CHECK MICROFILM $
sentatives o is city 'nter 3 the above-mentioned property for $
inspettion -es. -/� syr MECHANICAL $ TOTAL FEE $ a-o,.S-�
Signature Date /Z'/Z"mJ
Drivers' License or S5* Reinspection Fee $25 Issue Fee $ 3 PLAN CHECK $ i
CMF 0865-46 rev. 7/83 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod -Assessor . . - \
CONSTRUCTION AND PLANNING POG. .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 UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System 61, APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
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 0Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL -
30. 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: -4c-
2-,M43 a0E-Tr/�o6F /V�.
34. Final Heating & Air Conditioning
C.
•
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 8/x188j .v . Pie �, gO 3o9 IL9�Jr8 Q 01
48. Special Requirements Completed !
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No, Date
_____
•
42685 cFP ?O-7F� -L00 90; 1 tr,*757.30
4 COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
® APPLICATION FOR STRUCTURAL PERMIT
For Applic t to Fill in Completely — Use I Only
/ I. �I RECEIVED BY DATE RECEIVED DATE ISSUED
BUILDING - Cyt -/���_//j/(-�
ADDRESS /'�{L / p'
1/ j / PE�d ,Np
OWNER / ■ 1 I s z A.P.NO. M ,15
/y_ / BUILOINr
MAIL II/ 6 f ' &i/ (, AR 7 ADORES •.
L ..,'' �iLM '
ADDRESS Q�/(�/
CITY Pa /ff NOL 0O�j// 2— TRACT —I LOT BLOCK
CONSTRUCTION NEW_ l / ADD ALTER REPAIR MOVING DEMOI LSH
LENDER ..
BRANCH OWNER / ry~ mfen— 140-1/10.40 •
ADDRESS
ARCHITECT `TEL. n�5 UAp/AGL/LUS V
I
j
OR ENGINEER atie d ." NO. USE h,
FIRE
ADDRESS ZONE TYPE 4GROUP
/{� /� � APPROVED
CONTRACTOR tJW r w --- BY GATE
ADDRESS
TEL. ZONE INO.OF USE OF NEW
PLANS BUILDING
CITY NO.
* STATE �� �� CITY YARDS APPROVED YARDS APPROVED
LIC.NO. 2 LIC.NO. MAIN BUILDING ACCESSORY BUILDING
SIZE NO.OF BLDGS. (FROM C/L STREET)
S OF LOT cad, INOW ON LOT _FRONT FT. _ FT.
Q USE OF
Ca EXISTING BLDG. It SIDE FT. FT.
VI
FSeparate permits are required for L.SIDE FT. FT.
electric,plumbing and heating work.
D REAR FT. FT.
CO USE OF BUILDING AND WORK TO BE PERFORMED '
F DISTANCE BET. BET.MAIN&
Qn MAIN BLDGS. ACCESS. BLDGS.
S.
��la / VAR.# DATE
CrVQK(�(� C. C.U.P.# APPROVED
6
APPROVED
} __BY II t DAT
W �1,INTr55F-t^,-7(1 @.� T sn, 0,JAWi A
0I hereby acknowledge that I have read this application and state C0tiirh1.--12.1d Tr-511 oP Tr-511 4+0
Ix that the above Information Is correct and agree to comply with �7
M. all laws regulating building construction, end I shall not employ
Z any person in violation of the workman's compensation laws of / o
L Li the State of California.11 t 7 � ,S 57rD / ie (j m
I hereby certifythat I am7 0 SO. FT. PJ S/ 3 (
properly licensed ase ontractor under
the State of Calif. la Busln-.F and Pro •ssi n rode, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m •
Chapter 9, an• at suc II • ses are i ful • a and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
to
am exempt om th- p•-vi •ns of the-ta alifo nla Busine st
and Professions Co•e, IM/ •n Chm:•ter VALUATION PERMIT FEE $ (VI_
%
Signature of / PLAN CHECK $ 2 '^
ill , /
Permittee i S / �d TAX E //xL rJY\
7 LL U /b
6
U
Authorized Agent TOTAL PAID $26% gp
•
FA 10 J p
jig 4025 )AN 31-77���.001311! r:e';r•'•"r3 8.5Q
.F J COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely— Use Ink Only
RECEIVED BY DATE RECEIVED DATE ISSUED
BUILDING/ ?_4 `_ Y / went o by
ADDRESS/�y(���s p,r2 p
OWNER '/ ke et/�t4tal ,J/ ERMIT NO.
A.P.A.P, NO. Q �r (� / Q,�s,/y��,,
MAIL ADDRESS/01.11-2,y"4 r7Cil� Lb/
ADDRESS
TEL.
CITY NO.ETRACT I LOT BLOCK
rr
CONSTRUCTION NEW (ADD ALTER REPAIR [MOVING DEMOLISH `
LENDER f,VY\J //----/rII �/�,���MM
BRANCH OWNER AIVT -OPAL /7s's+rri(LO r
ADDRESS U1 ALUE /ay
ARCHITECT TEL. USE ��KAd i $
OR ENGINEER NO
FIRE
ADDRESS ZONE TYPES GROUP Pic
APPROVED
CONTRACTOR BY DATE
ADDRESS
TEL. ZONE INO.OF USE OF NEW
PLANS BUILDING
CITY NO.
# STATE CITY YARDS APPROVED YARDS APPROVED
LIC. NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING
W SIZE NO.OF SLOGS. (FROM CA.STREET)
C. OF LOT NOW ON LOT FRONT FT. FT.
Q USE OF
CR# EXISTING BLDG. R.SIDE FT. FT.
La
jEl F Separate permits are required for L.SIDE FT. FT.
electric,plumbing and heating work.
REAR FT. FT.
4.1
E,. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN&
(:) MAIN BLDGS. ACCESS.BLOCS.
VAR.# DATE
C.U.P.# APPROVED
7 APPROVED
>'. BY DATE
..1
CL
.,
0 I hereby acknowledge that I have read this application and state n
IX that the above information is correct and agree to comply with m
O. all laws regulating building construction, and I shall not employ
Z any person in violation of the workman's compensation laws of s
v
14 the State of California. ^;
3 I hereby certify that I am properly licensed as a contractor under SQ. FT. w
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:s e
am exempt from the provisions of the State of California Business $
VALUATION PERMIT FEE 3 7 1AS v u,
and Professions Code,Division 3,Chapter 9.
rn
r1s ........
PLAN CHECK $ ^r
Signature of Z/J_f� o
Permittee $ TAX $ LL
U
u
Authorized Agent TOTAL PAID $ 37P,sv
.. _ _ _ _
•
Sao Fs . .. .
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
For Applicant to Fill in Completely —Use Ink Only APPLICATION FOR STRUCTURAL PERMIT
/ RECEIVED BY DATE RECEIVED DATE ISSUED
ADDRESS v f.(
BUILDING /070 jU�7L(�(^ j
/ 40-/i47
n- / -( A� n-e 0a PERMIT NO.
OWNER /4h-/..{-.4 of Cr/i//We/ta,
BUILDING d'
B
MAIL ADDRESS 0 �A - IM.'O Ar : it
ADDRESS �r// W, �_
TEL �j rli/tlo L/25
CITY A/_i , NO. 01.,it 2. TRACTe 5j L T�s�j/ `$LBSK
CONSTRUCTION / r tVEW ADD ALTER REPAIR MOVING!` I , DFMO/1 ISH
LENDER H//Ifjs.e_ r l\X`/ J// //�
BRANCH Sf1 �h .r1ifOr+/� /�id �,JI
ADDRESS i7,2:tl y AgeriiN OWNE �-�'"� ��-CyA/`sy/NA�Ua
OR ENGINEER LARCHITECT ( , �'M f +4 NOL/44-2-'IIJA �� ni2f/,/ ��
FIRE VV
ADDRESS 2g)43 1.4/e,c'}'� Vn S ZONE TYPE
Jr GROUP,4r
APPROVED
CONTRACTOR Ow/HF - BY DATE
ADDRESS /y/g /') USE OF r��/���/��/J/�J' '- r
CITY TOTEL. 0....pI PLANS _ / BUILDING- - (V ��GCJ/
F. STATE CITY I` YARDS APPROV E(D/ YARDS APPROV "� .
LIC. NO.2.1,2213 LIC.NO. MAIN BUI D NG ACCESSORY BUI INC
U SIZE /�- NO.OF BLOCS.
(FROM C/L T)
0. OF LOT S" ' e I NOW ON LOT Q FRONT FT. FT.
a USE OF //tt
in EXISTING BLDG. R.SIDE 5L)T. FT.
CA
F Separate permits are required for L.SIDE a 7T.bti4 FT.
electric,plumbing and heating work. REAR 47T. FT.
(W-, USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
QQ CS
MAIN BLOCS. ACCESS BLOCS.
.IVAR. DATE
Q -' )l / / C.V.P. ter. APPROVED - /
>>-. � Ii er-
_K`PROVE��, 1� DATE / e-a- 7
-CC
a ICFA .al 4 i . M I OLD FOR SPECIAL REQUIREMENTS
O I hereby acknowledge that I have d this application and state n
ig that the above information is correct and agree to comply with m
O, all laws regulating building construction, and I shall not employ
i
Z any person in violation of the workman's compensation laws of a
the State of California.
..--•2 1r ,��s
I hereby certify that I am properly licensed as a contractor under /✓��SO. FT. �/ �xix
W ."13ry
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY; e
am exempt from the provisions of the State of California Business a
and Professions Code,Division 3,Chap -r 9. VALUATION PERMIT FEE $ en
m
Signature of
lh /�i' PLAN CHECK $ o
Permittee ��� / TAX S F
U
Authorized Agent TOTAL PAID $