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Home My WebLink About3201 WASHINGTON AVE - Building Permits(714) 754-5273 • Fa�c (714) 754-4856 • vnvw.ci.costa-mesa.ca.us 77 FAIF DRIVE, COSTA MESA, GA 92626 �obnddress: 3201 WASHINGTONAV Sulte No Vicinity: HALLWAYCLOSET Parcel Number: 13909608 Applicant BANK, BLUE Address: 1351 E POMONA SANTA ANA, CA owner: USHER, ANTHONY L Address: .3201 WASHINGTON AVE � � COSTA MESA, CA� ' contractor: SWIFT SERVICE CO Address:- 1351-E POMONA � �... SANTA ANA, CA MECHANICAL PERMIT ISSUED BY: Phone: 714-560-0700 Zip: 92705 Phone: Zip: 92626 Phone: 714-560-0700 Zip: 92705 License: 725240 , SCOPE OF PERMIT , FURNACE CHANGE OUT (SAME LOCATION, HALLWAY CLOSE� FOR SFD. WORK TO INCLUDE: 1 INST FAU <100 K BTU. ISSUE FEE Inst FAU <100 k BTU Inst FAU >100 k BTU Repair/Alt CoolingMeat Inst / Rep. Recess Wall Htr Refrig Sys <100 k BTU Refrig Sys>100 k BTU Gas Piping - � Factory Fireplace Hood w/Mech Exhausl � . VAV Box Vent Fan / Single Duct � Appliance , Fire Dampers, ; A Smoke Dampers Inst or Relocale Appl Vent , Air Handlers < 10000cfm � � Air Handlers > �10000dm_ � � � Floor Fumace - � Floor or Suspend Heater`, - . Quantlty.' � $23.50 $14.80 1 $0.00 0 $0.00 0 $0.00 �0 - -� so.00 ,o $0.00 0 50.00 0 80.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 �� $0.00 . 0 " 50.00 : 0 ' $0.00 � 0� , ! $0.00� 0 - _ . FEE SUMMARY Repair / Alt Absorbtion Unit Repair I Alt Refrigeration Uni� Ventillation System Evaporative Cooler Commercia l I n cine retor Domestic Incineretor ComDressors / Absorption Svstems Upto3hp/t00kBTU 3 To 15 hp / 500 k BTU 75 To 30 hp / 1,000 k BTU 30 To 50 hp / 1,750 k BTU Over 50 hp / Over 1,750 BTU Boilers Up to 3 hp 3To15hp 15to30hp 30 to 50 hp Over 50 hp Other Mechanical Fee Investigation Fee � ' Plan Check Fee Reinspection Fee TOTAL CALCULATED FEES COMMENTS I SPECIAL CONDITIONS S W tus: ISSUED Applied: O7/262007 Issued: 0126I2007 Quantity $0.00 0 50.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 30.00 0 $0.00 , 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 50.00 0 $0.00 $0.00 $0.00 536.30 NO710E: 7he work authorized by this permit shall comply with all applicable handicap access requirements under Calilornia 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 suspentled or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under thi5 permit to be considered legal, such work must comply with all applicable codes, and all requlred Inspeetlona and final approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 244fW8 (BNO) WORKERS'COMPENSAnONDECLARAnON: I here0y eftirtn under ponalry ot perjury one of che fdbvring tleUarations: � ❑ I have antl will md�nWin a certificate of con5ent to setl-Insure lor workers' compensetion, es provitlatl /or Dy section 3700 ot Ihe Lehor Cotla, tor the pertormance oi the work tor which this pertnit i5 issuetl. ❑_,..1 heve antl will ma�� wwkers' compensatbn Insurance, as required by section 3700 0l Ne Lebor CoOe, for Ihe perfortnance of the work for which this permit is (ssued. My.workers' com �sefion Insurence carrier end pdicy number are: Poliry Number: � $'.T �^£ C U UZ.O �, bn cerrier.-' �A 145�+ rcH.ca. S 1 �7hls sectlon need nof be compfated i! Me pertnit 7s valued at me hundred ddlare (3700) or IessJ �;1 _^ _ F ❑ I cartily Ihet in t�e Po�ormance ol the work for which lhis Oermit is issued, I shall not omploy eny person in eny menner so as ro become sub�ect to l�e workers' compensetion laWs of Califomle, en� agree Ihet il I bhoul0 co e sublect to e wo ers' compensetlon provisions of Section 3700 ot Iho Labor Cotla, I shell lorthwith cOmply wlih Ihese O�ovisians. �(� AppllceN SlpneWre: —�19C5affe`^ Cc. �v�o:_.� ( /2 � /U� i WARNINCi:FAILURE TO SECURE WORKERS' COMPENSATION OVEMGE IS UN FUL rW� SMALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES PND GVIL FINES UP iOIXJE HUNDRED �SANO DOLLARE (5100.0006 �N AODITION TO THE WST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3]O6 OF THE LABOR CADE, IMEREST, AND ATiORNEV'S FEES. LICENSED CONTRACTORS DECLAPATION: I hereby ettirtn Ihat I em �kensed under pravisions ot Chapter 9(commencing with Section 7000) ot DlWsion 3 0l the Business and Prolessians Code, and my license is in lull CONSTRUCTION LENP�NG AGENCV: ❑ I hareby aflirm that Ihero is e construction lentling egency tor the perlormance ol the work tor which this pormit is issued. (Sec. 3097, Civil Cotle). Lentler's Neme: Lentlefs Address: Signature: OWNER-BUILDER DECLARATIONS: Date: I hereby attirm that under penalry at perjury thet I am E%EMPT FROM TME CONTRACTORS LIGENSE LAW br ihe tollowing raeson (Sec. 7031.5, Busineu end Professions Cotle: Any ciry or counry which requires a permit to consWct, elter, improve, tlemolish, or repair eny structure, prior to its issuanca, also requires lhe appliwnt for such permit to (ile a signed stetement that ha or she is licensed pursuant to t�e O�eWsians of the Coatractors License Law (Ghapter B(commancing with Sectlon 7000) ot DlWsbn 3 at the Business antl Professians Code) or that he or sha is axempt therefrom antl the basis tor the alleged exemption. Any violation of Section 7031.5 by eny applicant lor a Oertnit subjecis Ihe ep0�icant t0 a civil penaly of noi more than liva �untlretl Oollars (5500).): ❑ I, as owner oi the Property, or my employaes wit� wages es Iheir sole compensation, WILL DO THE WORK, and t�e structure is not intendetl or ofleretl tor sale (Sec. 7044, Business and Professions Code: Tha Contractors License Lew does not apply to en owner ol propeny who builds or improves thereon, and who tloes such work himsell or herselt or through his or her own employees, prwitled Ihai such improvements are not intended or oHeretl for sale. If, however, Ihe building or improvement is sold within one year of completioq the owner�Duiltler wlll have Ihe burtlen ot pmving Ihal he or she did not build or improve for purpose ot SalaJ. ❑ I, as owner of t�e properry, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRAC70R5 to constn�ct the project (Sec. 7044, Business and Professions Code: TTe wntraCtors �censa Law does not epON �o an owner ol property who 6ulld5 or improves ihereon, and who contrads for such project with a coniraaor(s) license pursuant ta �ha Contmciors License Lews.). ❑ I em eaempt unde� sec. Business antl Professions Code lor this reeson: Signature: Data: Owner ID verifletl Dy tln�ers license. ❑ Ves ❑ No Drivars Licensa No. Vedticatlon of Owners�ip by Qype of tlaument, i.e. - property tax 6ill or deetl): DIVISION OF INDUSTRIAL SAFETV PERMR CERTIFICATION: Ezpires: ❑ I hereby cenity Iha� no excavetion tive (5) or more teet in Oepth into which e person is requiretl to Aescend, will be matle in connection wilh work authorizetl by ihis pertnit, end Ihat no building structure, sceNoltling, talsework, or demolition or tlismanlling I�ereof, will bo more than thirry-siz (36) feet higR (Chap. 3.2, Gry 2, An 2. Sec. 341, Title 8, Califomla AtlmiNstrative Code). ❑ As ownar�builder, I will not employ anyone lo do wo�k which woultl require a permit Irom t�e Division ol Intlustnal Satery, as noted above, unless such person has a permit to tlo such work Irom Ne divLsion. Signaturo: Dato: Divislon ol IndusUlal Salety Permit Number: CER71FlCA7E OF COMPLUINCE AND AUTHORIZA710N OF ENTAV: I cenify untler penalry of perjury Ihat I �ave read Ihis application antl state Ihat the infortna�io� given is correct. I agree to compty with alI stare laws and ciry ordinances relating to builtling cronstructlon, antl euthonze representatives ot the Ciry ot Casta Mesa ta enter upon the ebove-doscribod propeny br inspection purposes. I agree not to occupy or allow occupancy ol eny 6uiltling au�horized by (his permit until linal inspection. � /A Signa�ur��Legal wner(5) / N �i �- —?4j IAn O�-A ihodzed Applicant CQDE �. INSYECl10NTYPE 1618 Fixed System Fi�al Fire Prevention 1266 Paol Spa Final 200 Final Re-Roof Qe¢, �$ COpE1 INSPECTIONTYPE 206 Final Mechanical i/j u. �r - 20B Final PlumDing 210 Final Eloctncal 201 Flnal BIocWRetaining Well 212 Final Fire Preventian �u � u��u.. .. ...... .. ... ua... ��. ...o :v._ v., : r�. � i• . .; ..: fe..q�u vW"eJ I:Un nNW 9"q -.OI IbU1J Ill r.iVl I JOYcnI . �. .. .. � .n_.a.0 a..... 202'im�Final;FecloryFirePlace�d:,�:imCw':r•.' .'^.•.•.....'if•..•...'�.i:.i:[�,j:220i�,.iFinelPlanningApproval;Sv0lqq�lan'."..."-'"-"'^�°"':.._— 203 Final Sign 222 Final Site - dSud•D2C (PfC� ..,.,-„ �...., � J3�, .,�� .,., � Final Demolition�,.-. r w CITY OF COSTA MESA P.O. BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 92628-1200 DEVELOPMENT SERVICES DEPARTMENT -- BUILDING DIVISION- COURTESY NOTICE OF PERMIT EXPIRATION January 18, 2008 Anthony L Usher 3201 Washington Av Costa Mesa CA 92626-2225 PERMIT NUMBERS: M07-00057 FOR: FAU PROJECT ADDRESS: 3201 Washington Av., Costa Mesa Our records indicate the above listed permits were obtained for property improvements or alterations at the above address. Per the 1997 Uniform Building Code, Section 106.4.4 Expiration, permits are valid for 1 SO days from the date of such permit, or the date of the last inspection for the project. Our records do not show an inspection for these permits within the last 180 days nor have they had an approved final inspection. If you have a signed inspection card showing that an inspection was made within 180 days, or that the final inspection was approved, please contact this o�ce so we may correct our records. If you do not have an approved final inspection, your permits will expire on February 4, 2008. Additional fees will be required to finalize expired permits. Requestinq an insPection—If you need to request an inspection, please call our Inspection Request Line at 71d-754-5626. Renuestinn an extension—If you wish to request an extension, requests must be made in writing addressed to Ed Petros, Chief of Inspection, at the above address, detailing circumstances and listing an estimated date of completion. If you have any questions, please contact the Building Division at 714-754-5273, between 8:00 a.m. and 4:30 p.m., and a staff inember will assist you. The accuracy of records affecting your property is our goal and we appreciate your working with us to resolve this matter. Sincerely, Mar Jane Weidenkeller Office Specialist II � cc: Swift Service Co 1351 E Pomona Santa Ana 92705 Bulding Drv�sion (71d) 754-5273 • Code Enlorcement p14) 75G-5623 • Planning Division (774) 75a-52a5 FAX(77a)754-a956 • TODQ1a)75a-524a • www.G.costa-mesa.ca.us �»a� �sa-sz�s • Fa: (�ia� �sa-aass Job Address: Suite No Vicinity: CITY OF COSTA MESA BDILDIN6 DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT 3201 WASHINGTON AV GISLER 8 WASHINGTON Parcel Nunmber: 13909608 Appliwnt: THOMPSON, JIM Address: ELECTRICAL PERMIT Phone: Zip: Owner: USHER, ANTHONY L Address 3201 WASHINGTON AVE Phone: COSTA MESA, CA Zip: 92626 Contractor: THOMPSON AND THOMPSON Address: 1835 WHITTIER COSTA MESA, CA Phone: (949) 548-1735 SUITE A-12 . Zip: 92627 License: 550936 ISSUE FEE Temp service test Res. alc package New Res (1-2 units) New Re5 (3+units) Pool I Spa Lighting F�cts Recept Outlets Switches Non Res Appl Res Appl Service to 200a Service to 1000a Service over 1000a Motors to ihp Motors to tOhp Motors to SOhp Motors to 100hp Motors over t00hp Communiwtion drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole t PERMR NUMBER 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: O612911999 Issued: 0612911999 ISSUED BY: � SCOPE OF PERMIT ELECTRICAL SERVICE FOR CAN POWER SUPPLY. (GISLER & WASHINGTON). $22.00 $0.00 $0.00 $0.00 so.00 50.00 $0.00 $0.00 $0.00 $0.00 50.00 527.25 50.00 50.00 50.00 50.00 $0.00 $0.00 $0.00 $0.00 50.00 50.00 50.00 30.00 50.00 Quantity FEE SUMMARY Temp Dist System / Lighting Busway /100 ft Standing Section Misc Eledriwl Equipment Transformers up to 1 kva/kw ................uP to 10 kvalkw .................up to 50 kva/kw .................up to 100 kva/kw ..................over 100 kva/kw Low Voltage Equipment Low Voll Wiring System / Ckt Misc. Conduit Misc. Conductor Circus ( gen or ride) Circus (mech nde or lights) Christmas Tree Stand Fireworks Stand Other Electrical Fee Investigation Fee Plan Check Fee Reinspection Fee Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 $0.00 $0.00 $0.00 TOTAL CALCULATED FEES E49.25 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable hendicap access requlrements under Califomia stetutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This pertnit shall automaticaity expire and become void if work is not commenced within 180 days, or if work is suspended or ebandoned for a period of 180 days. INSPECTIONS: In order for ihe woik aulhorized under this permit �o be considered legel, such work must comply wi�h ell applicabla codes, and ell requlred inapeetlone and Ilnal epprovel must be obtained. Failure to abtain inspections end tinal epprovel will result in the axpiration ot this permit. FOR INSPECTIONS CALL: (714) 754-5828 �ORKERS'COMPENSAnONOECLARAnON: - , ereby attirm under penalry ot per�ury one of fhe following tlaclaretions: ❑ I have antl wlll maintain e cenificate oi conseni to self-Insure for workers' compensation, as provided tor by section 3700 of the La�or Code, lor the pertortnance of the work for which this pertnit is issued. ' �i I have and will maintain workers' cnmpensetion insurance, as required by section 3700 of the Labor Cotle, lor ihe perfortnance of the work for which this permit is issued. My workers' compensation Insurence carrier and policy number ere: Carrier: , Policy Number: (Tri/s section need nat Oe comp/eteO i/ the permlNs vefued ef one huntlred dollers ($100) or less.) ❑ I certily Ihat in the performance of lhe work for which this permit is issued, I shall not employ any person in eny manner so as to become subject to the workere' compensetion lews Calibmia, and egr thet it I should become sub�ecl to ihe workers' compensation provisions of Sectlon 3700 of the LeGor Code, I shall fonhwith comply with Ihese isions. / /� Applicant SigneWre: Date: (O— 7--�i � 7� WNRNING: FAILURE TO S RE WORKERS' COMPENSAT101 OpVEMGE IS UNIAWFUL AND SNALL SU&IECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE HUNDRED THOUSANDDOLIARE�51 ,000),INADOITIONTOTHEC0.STOFCOMPENSATION,DAMAGESASPROVIDEDFORINSECTION3]O60FTHELABORCO�E,INrEREST,ANDATTOfiNEY'SFEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirtn ihat I em brce entl eHect. Lic. M_ Contractofs Signature: 9(commencing wlth Sec�lon 7000) of Divislon 3 0l the Business�d Professions Cotle, and my license is In full Cless N _ _.. . CONS7qUCTION LENDING AGENCV: ❑ I hereby aHirm t�at ihere is a construction lending egency tor t�e pedormence oi the work for which Ihis permit is Issuetl. (Sac. 3097, Civil Code). Lender's Name: Lendefs Address: Signature: OWNER-BUILDER DECLARAT10N5: Date: I hereby aHirm Ihat untler penalry ot perJury ihet I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for iha following reason (Sec. 7031.5, Business and Professions Cotle: Any city or counry which requires a pertnit ro construc6 elter, improve, tlemolish, or repair eny slrucNre, pnor to its issuance, elso requires tha applicant for such pertnit to tlle a signetl stetement that he or sha is licensed pursuant to Ihe provislons oi the Contractors License Law (Chapter 9(wmmencing with Section 7000) of Division 3 of the Business and Professions Code) or thet ha or she is e:empt iherefrom antl the basis tor the alleged exemption. Any violation ot Section 7031.5 by any applicant for a pertnit suh�ects ihe applicant to e civil penaly ot not more than five �untlretl tlollars ($500).): ❑ I, as owner of the property, or my employees with wages as iheir sole compensation, WILL DO 7HE WORK, end the structure is not intendetl or oHered lor sale (Sec. 7044, Business and Pmfessions Code: The Contractors License Lew dces not apply to an owner ot propeny who �uiltls or improves Ihereon, and who does such work himself or herself or through his or her own employees, provided ihat such improvemenis are not intended or oHered for sale. If, however, the builtling or improvement is sold within one year of completion, the owner-builder will have the burden of proving ihat he or she ditl not build or improve for purpose of sale.). ❑ I, as owner of Ihe properry, em EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business end Professions Cotle: The contrectors License Law does not appty to en owner of property who builtls or improves thareon, antl who contracts for such projact wilh a contrector(s) licen5e pursuant to ihe Contrectors License Lews.). ❑ I am exempt untler sec. Business entl Professions Cotle for this reeson: Signature: Date: Owner ID verifietl by dnvers license. ❑ Ves ❑ No Dnvefs License No. Venlication of Ownership by (type of documem, i.e. - property tax bill or deed): DIVISION OF INDUS7RIAL SAFETY PERMIT CERTiFICATION: Expires: ❑ I hereby cenity ihat no ezcavation tive (5) or more tee� In Oepth into which a person is required m descend, will 6e matle in connection wlth work authorized by this pertnit, antl ihat no bullding slrucNre, scaflolding, telsework, or demolition or dismentling Meraof, will be more Ihan ihirty-six (36) feet hlgh. (Chap. 32, Grp 2, An 2, Sec. 341, Ttle B, Califamia Adminisiretive Code). ❑ As owner-bullder, I will not employ anyrone to do work which would require e Oermil trom the Division of Intlustrial Safery, es notaa aDove, unless such person hes a permit ta do such work from the division. Siqnature: Date: Division of Indusidel Satety Permit Number. CERTIFICATE OP COMPLIANCE AND AUTHORQATON OF EMAY: 1 certify untler penalry of perjury thal I have reatl this application and state [hat the intormation given is correct. I agree to comply with all state laws and ciry ordinances ralatlng to building conslruc�lon, antl authorize represeniatives oi the Ciry of Casta Mesa to enter upon ihe aDove-describetl pmperty for Inspec�ion purposes. I eBree not to occupy or ellow occupancy of eny buildinq authorizetl by this pertnl� until linel inspection. COOE �. INSPECTONTYVE 1616 Fixetl System Final Fire Prevention 126fi Pool Spe Finel 200 Finel Re-Roof 201 Final BIxWRetaining Wall 202 Final Fectory Fire Place 203 Final5lgn 204 Final Demolition 24a6d6 Date �D-zS— 4cr Date Q�jE �$ COpE1 INSPECTIONTYPE 206 Final Mechenical 20B Final Plumbing 270 finel Elec�rlcal 212 Finel Flre Preventlon 2zo 222 250 Finel Planning Approvel Final Site Final Building/Occupancy '-0� /�� .ti -=� S � � � , , � ( � O.�'�� .:� 1��4 ��IL.�,� _� }�1 D � ,� .� ��--J� D �, i�� D LJ� � t, � - � , i _, 3201 RISER No Pole #BCO2791 � CA"fV Prnuosed P/S Locatinn n� sioeu 5'GREENBBLT � � �°�Q}.. �� ........�� 1t5 ��)� 10' '� no rnkKirvc CONSTRUCTION NOTE #5 5' GREENUELT EXCATION ANU REVI.ACEMHNT PERCCM Sl'U. UWG. 815 MO�IFYASFOLLOWS S.E. = q Jb 90°/, COMPACI'ION �� t� � Not To 8cale 027B/858G4 y_t,� Trench Detail cnTvza� �;� y��± 3G'SCG � � w U ; xw �, m a � � `� 20 � ;� � � � 117' � � GISLER DR 20 n�rn M v w w > ¢ z 40' � 25 C7 � MPII � d 3 �-- 32' .� � g. , 30' 60' Media�ne� '1'Lie ie Urondboud.7'hin ie i6e wuy. Urian Catrm ISRI Cununc�ccS'P Comre,CA 91720 Phonc 909-5493977 cxl 106 �`Lo\ �.l 0��r �a ..� � �' , � (714) 754-5273 • Fex (714) 754-4856 • www.d.cos�a-mesa.ca.us BUILDING PERMIT ,lob Address: 3201 WASHINGTON AV Suite: Vicinity: Parcel Num6er: 13909608 Appliwnt: USHER, ANTHONY L Address: 3201 WASHINGTON AVE COSTA MESA,CA Owner: USHER, ANTHONY L Address 3201 WASHlNGTON AVE Contractor: Address: Zip: Arch : Address: COSTA MESA,CA Zoning: Phone: 7-825-0412 Zip: 92626 Phone: 7-825-0412 Zip: 92626 Phone: License: En9: Address: 77 FAIR DPIVE, COSTA MESA, CA 92626 Status: ISSUED Applietl: 01/23/2007 Issued: Oi/23/2001 ISSUED BY: // ' Phone'. Phone: Zip: License: License: SCOPE OF PERMIT TERA OFF & INSTALL 25 YEAR COMP. SHINGLES. FEE SUMMARY Plan Check: Permit: SMIP Res: SMIP Com: Other: Inspection: Total: $0.00 $97.25 $0.50 $0.00 $0.00 $o.00 $97•75 SETBACKS MAIN STRUCTURE Front 0. 0 ACCESSORY Front 0- 0 PARKING Ezistin : 0 NOTES: Rear 0- 0 Rear 0-0 Re uired: 0 PLANNING & ZONING Left 0- 0 Left 0- 0 Proposed: 0 Calc Valuation: sa,soo.00 Ciaim Valuation: S3,soo.00 Right 0-0 Right 0- 0 NOTICE: Tha work authorized by lhis permit shall comply with all applicable handicap access requiremenis under Callfornia statutes and related regulations. (Ord. No. 92•2B, § 1. 12-21-92) EXPIRATION: This permit shall automatically ezpire antl become void if work is not commenced within 180 days, or if work is suspended or abandonetl for a perlod of 7 BO days. 'i INSPECTIONS: In order for the vrork authorized under this permit to be considered legal, such work must comply with all epplicable codes, and all � requlred inepeetlo�e and final epproval must be obtained. Failure to obtain inspections and tinal approval vnll result In the expiration of Ihis permit. FOR INSPECTIONS CALL: (714) 7545626 :aaa�ae �eroo� e WORKERS'COMPENSATIONDECLARATON: � I hereby eHirm under penalry of perjury one ot Ihe following tleclaretions: ❑ I have entl will meintain e certilicate ol consent to sell�lnsure tor workers' compensation, es provided for 6y section 3700 of ihe Lebor Code, br Ne pertormance of the work lor whiCh thi9 permii Is 15suetl. ❑ I have antl wlll meintaln workers' compenseUon insurance, as required 6y sectlon 3700 0l ihe LaDor Cotle, lor the peAortnance of the work for which ihis pertnit Is Issuetl. My workars' compensatlon Insurence cerder antl policy numher ew: Cartier. Policy Number: (Thls secflon neeU not be comp/ered i! the perml( fs valued et one hunaretl dollais ($100) or less.) � I ceRify ihat In the pertormance af Ihe wark tor which t�ls permil Is Issuod, I shell not employ eny parson in eny manner so es to Decoma subject to Ihe workere' compensetlon laws of Celitomle, entl egree that tl I should become sub�ect to the warkers' compensation provislons ot Sectlon 3700 0l the Lebor Catle, 1 shflll forthwith comply with these prodsions, Appllcent Sipneture: Dete: WMNINO: FAILURE TO SECURE wORKEFS' COMPENSATION COVEMGE IS UNUWFUL AND SHnLL SUBIECT rW EMPLOVER TO CRIMINAL PENALTIES PND GVIL FlNES UP TOONE HUNDRED TFIOUSAND OOLIARE (5100.OW�.IN ADDRION TO TNE COST OF COMPENSATION, OAMAGES AS PPOVIDED FOR IN SECfION 3]OB OF THE IABOfl CODE, IMEREST, AN� ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirm Ihat I am Ilcensetl under proWsions ol C�apter 9(commendnp wlt� Sectlon 7000) ol DlNsion 3 of Ihe Business end Prolessions Catle, end my license Is in full forca entl eHect. Lic. A Class a ContrectoYs Slgnature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby ettirm thet there is e constructlon lendinp egency lor Ihe peAartnance ol the work lor which this pertnit Is Issuetl. (Sec. 3097, Civil Code). Lontler's Neme: Lentlar's Address: SignBlure: Dete: OWNER-BUILDER DECLARA710NS: I hereby aHirtn Ihat unAer penelry of per�ury Ihat I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for Ihe lallowing reason (Sec. 7031.5, Business end Protesslons Gode: Any Clry or Counry which requires a permit ro tOnstruci, alter, improve, demolish, or repair eny StrutWro, prior to ils issuance, elso require5 �he epplicanl for such permit to ille e slgneC stetement that ho or s�e is Iicensed pursuant to the provislons oi ihe Conirectors License Lew (Chapter 9(rqmmencing with Section 7000) of Division 3 of Ne Business end Professions Code) or ihat �e or she is ecempt therelrom entl tha �esis tor t�e allegetl a:emptlon. Any Nolation ot Section 7031.5 by any epplicant tor a permit suti�els �he eppllcant Io e civil penelry ot not more then �Ne hunOreC Oallers ($500).): � I, es owner ol the D�operty, or my employees with weges as t�elr sole wmpensation, WILL DO 7HE WORK, end Ihe swcture Is not Intentle0 or oHered tor sale (Sec. 7044, Business entl Professlons Gode: iTe Conirectors License Law does no1 apply to an owner oi property who builds or improves theraon, antl w�o tloes such work himsell or herself ar t�rough his or har own employees, provided Ihat such improvemenis ere nat intentletl or oHereO for sale. Il, however, the builtling ar Improvement is sold within ono yeer of completion, the ownerbuilder will heve ihe hurtlen of proving Ihat he or she did not builtl or impmve tor purpose of seleJ. ❑ I, es owner ot Ne property, am E%CLUSIVELY CONTRACTiNG WITH LICENSED CONTRACTORS to construct the pro�ect (Sac. 704a, Business and Professions Cade: The contrectors Licensa Lew does not appty to an owner ol property who builds or impmves Ihereon, antl who contrects tor such projact with a conirector(s) licen5e pur5uant to ihe Contrectors LicenSe LBwsJ. ❑ lem Signawra: Owner ID Vedlltelion ol OwnerShip by (rype BuSiness and Prolessions Code for this reason: s ❑ No Ddvere�Ucense No. i.e. - properry tex bili or deed): �� DIVISION OF INDUSTRIAL SAFETY PERMR CERTFICATION: ❑ I �ereby ceNfy that no e:cavatlon five (5) or more leet In Oepth into whlch e person is required to tlescend, wlll Oe made In connection wlth work euihoAzetl �y Ihis permit, end that no building structure, sceHdding, falsework, or tlemditlon or Alsmantling I�ereol, wlll ba more than Ihitly-sia (36) feet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Tltle B, Celllomis Atlminlstrative COAe). ❑ As owner-builtler, I will not employ enyone to tlo work which would requlre a permit irom ihe Divislon ol Indusirial Sefety, es natetl above, unless such person �es e permii to tlo such work trom ihe tlidsion. Signature: Date: Divisian ot Industrial Salery Pertnit Number. CERTIFlCATE OF COMPLIANCE AND AUTHORQATON OF EMRY: I cenity un0er penalty ol perjury thet I hava reed this application and state that the intortnation given is wrrecL I egrea ro campty wit� ell state laws entl dty ordinances relating to building consiructlon, and authodze reD�esentatives oi the Ciry of CosW Mesa to enter upon ihe above-described properry tor Inspection purywes. I egree not to occupy or ellow occupancy of eny building euthonzed by Ihis pertnit until tinel inspectian. .� � ' yi•P.i�79� 161fi Fixetl System Final Fire Prevention 1268 Pool Spe Final 200 Final Re-Roof 201 Finul BIocWReteining Well 202 Finel Factary Fire Placo 203 FinalSign 20d Finel Demditlan � It� - D - l �� COOE 1 INSPECTION TYPE 206 Finel Mec�anicel 20B Finel Plumbing 210 Final Electdcel 212 Final Flre Preventlon 220 Final Planning Approval 222 Final Site 250 Final BuiltlingiOccupancy Q!g It�LS ` ~ ,X, C.a� I'U COSTA MESA BUILDING-SAFETY DEPARTMENT P. O. BOX 3f7 C08iA MEBA. GLIFORNIA For Applicanf fo Fill In Complefely TYPE OR ,RINT BUILDWG � L�� ADDRESS i�etes & Bounds e attached COSTA MESA. CALIFORNIA E. 17th St. ta Meea No' Li rlson & Middlebra,�'c' rden Grove . Dike & Colee.rove. Inc. ��T. Costa i4esa ucTrEio. 167273 No: Li. s-1159 s�ze 100' % 65' I "'. `" "OGenone OF LOT NOW ON LOT U8H OP none EXIBTING BLD 96TBACK LINH FRPM CO� REAR YARD �r t CHNTCR OP BTrtBeT J SIDE VARO I LBFT 1� � I RIGHT S� DESCRIPTION OF WORK NEW I x II ALTERATION I � ADDITION I REPAIR ( II�MOVING I IIOEMOLI6H I SZeD�N � 9.ft�ROOMS 6 STORIES 1 EXTERIOR WAL4 ROOF COVERING St.l1CC0 COVERIN6 COIIL • U8H OR BUIL�ING AND WORK TO BE PERFORMED iE �ECEI�� -3 - /sS" ^ ( �J FI AN�E n�pr APP�iC�T,O�GFSOH' M�� IT BUILDING For Office Use Only R8C81PT NO. /YBRM / /� �Y I DA'[�rHG/StG/lI .�T.� -t BUILDING ADDRH66 COSTA MESA. CALIFORNIA FIRE ZONE TYPE GROU APPROVED ^ BY DATE .+� S Z NING 20N8 —� I NO. OR I U88 OP NHW/�/� � PLANB �� BUILDINO � I sa PIPTION See Attached � A. P. NO. i I L.(�ry\ � YARD6 EVE6 FPPROVED ALLOWED (CGNTBR YN8 BTJ / � FRONT .�� FT. /%�___/{/� R.91DE .Lj F7. 'v�� -- L.SIDE /O FT. � n � APPROVED Single faznily residence with attached ��• ara e. Plan CR 1 HeReBY �CNNOWL8D6H THAT 1 MAVB PHAD TIIB APPLIGTION TNE AMOUNT BXOWN UNDeR VALYATION le POP TN8 AND 8TAT8 TH�Y T�1E ABOVe 18 CORPeGT �ND AORBH TO�COM- pUliP09E OP HBTABLJ9HIN0 • PBRMIT F88 ONLY. PLY WITN ALL GITY ORDINANC 8 AND HrATE LAWB R¢O LATINO ouuo�no coNe'lRociPoN. � I VALUATION q �OO 81GNATURE OF �/ �� PERMIT FEE S JS PERMI7TC g 15,045.00 PUN CHECK s 17.5� AUTHORIZED AGENT Dike & Colegrwe, IRC� �7 qn �S : O t