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Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
\/ �� � PE I TRACT NO. LOT NO'. UNIT NO.
9208 7/ 10/86 69.00 IL
CITY OF CQSTAn�ESA CONSTR TION RM1IT ^ k � a S�So 9t 3 5-9 .
Project Address _ .3 o 0 < R )�4l l `� Ir.Y f �. - .
Applicant's Mailing Address _ J ^ /�/S TYPE OF CONSTRUCTION NEW ❑ ADD U ALTERATION LJ REPAIR / L.( '^ - ' -
S 0/J E �/e••/�1^) ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.#i, I�' — /O0. 1 --0C9 • Zone R'
Owner's Name PPhone O :�! DESC$LPT ION OF USE F DG. �r-
Address _ oJ6 0 u�� 1../.��G N (' Q,Ja r� (pooes-d//A 13L4CGJ •S Main Building: - .
Accessory Building:
Arch/Eng. . A z✓ A`t'i ' ' Liceen�seeyNo. TYPEOFOFPERMIT GRADING 0�FDUNDATION L' hTRUCTURAL • T Front . (O / 'IO Cl. .Ij16 o
Address - • Cdl'A P P N LT/` 0V EJJ I-7 TENANT ELECTRICAL L-PLUMBING 0 MECHANICAL B Rea! • / 3' - • ' N
• A (p9Q yf22 0 OTHER . • A I
Contractor's Name ;1,:740,,,[[[ �,,t�f', Phone PROJECT DESCRIPTION SQ. FT. • OCCUPANCY C Right 2.6 7 N
Address lmailing)_, 7 ?Z �T�-7 AlST L.5 coOUn �� K 1 - - 3v G
I
CONSTRUCTION TYPE VALUATION $ e..OVOJ S Left • R
City License No. _ ZONE GRADING CU.YDS. ACRES
LICENSED.CONTRACTOR DECLARATION /// Ping. Ref.# . Parking Req./Provided E
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: / / �• 0
l ,C . FES 32. c92 a G 2 7 /'tb Planning N fes: M
with section 7000) of Division 3 of the Business and Professions Code, and
-
my license is in full 1• ce and effect. R 19'03 / /^' 4M- )C 'C AA , ST
Licens' C .ss a LI ense [J ` .�V vsD /�
Date L1 a Signature 'Sri S. __ PLUMBING 1 FEES '
WOR • RS'C•MPENSATION DEC • -ATION ` Bar Sink Showers •
I hereby affirm that I have a cerllfic• • of consent to 31-insure or a certificate ELECTRICAL FEES
of Workers' Compensation Insur Ce, or a certifies copy thereof (Section BackflowPreventer Service Sink
3800, Lab. C.) Automatic Washer Transformer 0 15-50 KW •
Policy No. Company - Backflow Irrigation Sewer Cap '0 50+KW
Certified copy is here.• furnished, COnSVucti n Pole Sub.
H
Certified copy 15 fll:• with the city Building Division. Bathtubs Sewer Connection .
Cooking Un t Meter Duo to 100 amps ,
Date - Applicant -
EXEMPTION FR. WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps
(This section need not be completed if the permit is for one hundred($100)or -
less). Dishwasher - Solar Piping Dryers 0G4 DElectric Sub Panel
I certify that in the performance of the work for which this p mit Is Issued,I • •
shall not em loy an person in any manner so as toMeca subject to the Drinking Fountains Solar Tank Fan Motors 00-1 HP ❑1'h-5
Worker C e a ws of California.�/'y G/CL
Date Signature Floor Drains Swimming Pool wlSpa Fixtures
y r Inc.Solar ❑9-15 HP ❑1615+.
• NOTICE:if,after eking this declaration, you should b e subject to the F.A.U. 1
Workers' Compensation provisions of the Labor Code, ou must forthwith Floor Sinks Urinal F
comply with such provisions or this permit shall be deemed revoked. Microwave '
CONSTRUCTION LENDING AGENCYGas Service Outlets Water Closet Device Boxes
I hereby affirm that there is a construction lending agency for the performance , Pole Light ,
of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater 1 Range • i
Lender's Name /(/q Outlets
' Lender's Address MO/US Kitchen Sink Water Service • Switches Sign
- OWNER BUILDER DECLARATION - I
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories ' Auto-Wash Garbage Dispose{ Standing Sections ' '
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct,alter,Improve,demolish or repair P-Trap Laundry Trays Generator 00-5 KW ❑5-15 KW Trash Com actor
any structure, prior to its issuance, also requires the applicant for such permit �1 p
to file a signed statement that he/she Is licensed pursuant to the provisions of Roof Drains ST- 3 _
the Contractor's License Law(Chapter 9 (commencing with Section 7000)of sr DO
Division 3 of the Business and Professions Code) or that he/she is exempt — . /
• therefrorrLand the basis for the alleged exemption. Any violation of Section • I
7031.5 by any applicant for a permit subjects the applicant to a civil •
enalty of not more than five hundred dollars($500). 1 •
U I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 l
compensation, will do the work, and the structure is not intended or offered
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES Reinspection Fee I $15 Issue Fee $ 3
License Law does not apply to an owner of a property who builds or improves
thereon, and who does such work himself/herself or through his or her own - -- --_--- . DEVELOPMENT SERVICES REOUI' MENTS:
employees, provided that such improvements are not intended or offered for Boiler Hood or Type I 0 •
sale. If, however, the building or Improvement Is sold within one year of com- Canopy Type I I ❑ Zoning Approved y ` Date
pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground ' A ,ii-jse ,O
prove for the purpose of sale). Building Approve By Date
• �Iy)�y.,
❑ I, as owner of the property, am exclusively contracting with licensed con- . Duct-Structural Refrigeration System Application Issued By .1 Dat: 7177;Z:it
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 ❑0-100,000 BTU ❑100,000 BTU \ SUMMARY OF FEES
builds or improves thereon, and who contracts for such projects with a Con-/
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/AlterationBUILDING PERMIT • $ JVs So SMIP $ 0 tCo
proof of their Worker's Compensation insurance should be provided tome.
❑ I am exempt under Section B. & P.C.for this reason Firepl/Fact.BIL ICBG# Fire Dampers PLAN CHECK $ PERMIT
PLUMBING $ (O.OO ISSUANCE $
Date OwnerHeating System & Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $
I hereby certify that I have read this application and state that the above ❑0.100,000 BTU 0100,000 BT /2,GD GRADING $
Information is correct. I agree to comply with all city and county ordinances _ El1ECTRICAL $ _
and state laws relating to building co truction,and hereby authorize rep - / MICROFILM $
sentatives of this city - en r u the above-mentioned r erty or _ PLAN CHECK 50% $
Inspection purposes. fi/
Signature Dat Z�d b , MECHANICAL $ • TOTAL FEE $ &q'DO
Drivers' License or 55#
a
CMF 0065-46,rev.10/84 white - Building; Canary - Applicant; Pink -Accounting; 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 ,layl
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement �1�
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test , •
6. ElectricalUFERGrnd. • 57. APPROVAL TO COVE R-GUNITE
/ AV/ cit •
7. Footings - 58. Electrical Conduit-Undrgrnd. V it, IA- -
8. Foundation 59. Gas Pipe, ndrgrnd., Test Obt, e/NA- 1/4
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. D cts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough&Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank O 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:
��� 8G Pit j ops C r'i
ca•�
34. Final Heating & Air Conditioning sr/ Ott ar• (A, net � /r(, 16
35. Final Gas Pipe-Test v t
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
4. 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 .-__ $j{jB6
48. Special Requirements Completed 20 ft R. gczfg j/
49. Electric Release to Edison •- TSSr) aafr 8"e, CO-
50. Gas Release to Southern California Gas Co 804444-4f
, r `-
51. CERTIFICATE OF OCCUPANCY
No. Date
. . /
OWNER NIMPORT HOMES INC. • - - DATE 7-9-62
JOB ADDRESS 3060 Van Buren Ave. BUILDING PERMIT NO. - 17520 ✓
GENERAL CONTRACTOR S, V. Hunsaker & Sons VALUE $ 15,411.00
AP No. LOT 59 TRACT 4653 FIRE ZONE DESCRIPTION OF WORK Res/Att.Gar.
INSPECTIONS Signature DATE GROUP Mil TYPE V ZONE R_1
SoilK L PERMITS ISSUED
Gas S. �_G� SUBCONTRACTOR DATE NUMBER
Water 5 7- 2-
Rough Corn. Refrig. 0 Air Cond. 0 _ /� �/ �// �7 �/ /
Rough Heating �.W f_/ IO _ i / Y�IZG_�-_ -..xa-IY_!_Q.6j 6 �"
Rough Plumbin_ s-=9-G6, i J U' , 7_f-(<2 3z_ �-. v
Miscellaneous�ne7fi/L,r _-. � /_ f,
Prop.Swr.Line 0-House Con.Q-St. wr. 0 J `�y i�6N,_6� Y77 7 1-_3¢ el
Sprinkling System "/ a
Construction Pole `.�
Underground ❑ Power ❑ n y�,_q �nn _�
Rough Wiring,. ! - o'- //7 heeMt,hie,. e--.7.-0-17 /fl 0aV
Trenches L9� Forms & Thteel Reinf. 0 C7 //e.--er
Floor System
Bond Beam 0 Steel Reinforce 0
Sheathing ,lp - ,( 1rn'- 67
Frame and Flashing E-n-61-
Lathing
-6i2Lathing — In 17--- Out Fa-- e- --c L
Plaster, brown coat 19,/,1_/y
Refrig. ❑ Air Cond. 0 Final
Heating, Final ,c-a''' fn�/gc2,,
q�
Plumbing Fixtures, Final " // ;7-722/
Final Gas Test ZS--
Electric Fixtures, Finalgai
``
Building, Final /t 23-ca,
OCCUPANCY
FORM BU4-5M — 7.61 17520
17520 FEE RECEIVED
COSTA MESA BUILDING-SAFETY DEPARTMENT 10 } g
P. O. BOX 817 COSTA MESA. CALIFORNIA FINANAN r CE DEPT.
CIOF
For Applicant to Fill In Com letel,� FORRY COSTA MESA
PP P )�' APPLICATION PERMIT
TYPE OR PRINT
BUILDING
BUILDING 306'0 1/9N /',- -/i/ 'QVIADDRESS
��CC9S5 MESA. CALIFORNIA For Office Use Only
��� ,I. T �'// RECEIPT NO. Pt11/5 .�o
OWNE'�F 'V !/ �F/F-j ' .7741----
MAIL /l7 L/
// / RECEIVED/BY DATE RECEIVED DATE
ISSUED
ADORES V(7 O ? iv /)_/'/O4/I) !�I I 7- 7- E7/
TEL. BUILDING
CITY ��l NO. ADDRESS
ARCHITECT qq TEL. COSTA MESA. CALIFORNIA
OR ENGINEER/cam/6r/+^ �1Ou'[fr NOF, 74/;/ ---
212-)
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`RE S/) / FIRE /J ' V /
ADDRESS L J/ A • J / i ZONE TYPE I/ GROVP--)/VJJy/
CONTRACTORS. f. lic,4' Cj.Q !f^<' d-So//-r APPROVED DATE
ADD RES IOc S ELW/C) Y 2 Ace- ZONING
W.
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CITY —Tie i/i'/1/A/- A .-G /� �j / ZONES `I I PIO.NS ._ I BUILDINGS 1Z(4�
STATE 1/ NQL-7 NO. '{"/ V 1(// LESC,//R(`IMION r/ T% //d.1.7 ''!"�
L LL�� LeawL
LIC.NO. /I
SIZE
OF LOT ((� O X4 /02- I NO. OF BL ^]
NOW. ON LOOTST (/ A.P.NO.
USE OF YARDS EVES
EXISTING BLDGC _ __ ___ APPROVED ALLOWED
SETBACK LINE PROM ('' L (CENTER LINE ST.)
CENTER OP STREET 6C� REAR YARD J FRONT _Srte—FT. .� IN.
I / /// 1-'i _
SIDE YARD LEFT .� 6 /
RIGHT ( R.SIDE FT. / IN.
DESCRIPTION
IPTION OF IIWORK L.SIDE S- FT. v IN.
NEW I /I-ALTERATION I ADDITION I REAR Z 7 FT. — IN. __i
REPAIR I II MOVING I II DEMOLISH I APPROVED SP_ /ofi�-P DATE 7/..1-1/4-L.
BUILDINGrOX NO. OF ''7 S
SIZE ROOMS / STTO��RIES •
EXTERIOR WALLS7LCC(2 I ROOF Co/Nf-
COVERING CIA/N/(3COVERING O//1//YG
USE OF BUILDING AND WORK TO BE PERFORMED
/-L1/4)7r1 (AEAC, crate
ete -spp 'fl
A 41 99
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPUCATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO CON. PURPOSE OF ESTABLISHING A PERMIT PEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
BUILDING CONSTRUCTION. VALUATION
SIGNATURE OP /// 1.--1-1----14...-4-1 PERMIT FEE $
PERMITTEE �/V ,s e
////) / �// $ /�1/4 PLAN CHECK $ ��7 .SG 4
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AUTHORIZED AGENT Ii''// �� / a
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