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Home My WebLink About732 WEELO DR - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT ,lobnddress: 732 WEELO DR Suite: Vicinity: PrimaryOcc: U1/R3 Parcel Number: 42417304 Applicant: DRURY,KATHRYN Address: 732 WEELO DR COSTA MESArCA owner: DRURY,KATHRYN�"- Address - 732 WEELO DR , �- i � � , _= COSTA MESA, CA � , , - Con tre ctor: O W N E R-B U I L D E R Address: � - i � /i: "�� , � Zip: Arch : Address: Phone: Type of ConsWction: V-N Zoning: Phone: 949-646-0442 Zip: 926273521 Phone: 949-64Fr0442 Zip: 926273521 Phone: �License: � � 000000 Eng: Address: ISSUED BY: Status: ISSUED Applied: 06/17/2005 Issued: O6/17/2005 Phone: Zip: , � License: ' License: � , - SCOPEOF PERMIT DEMOLISH NON BEARING BATHROOM-WALL TO WIDEN THE EXISTING BATHROOM AREA AND RELOCATE KITCHEN PONY WALL. Plan Check: Permit: SMIP Res: SMIP Com: Other: Inspection: Total: $25.19 _ $38.75 $0.50 $0.00 $0.00 $0.00 $64.44 .. FEE SUMMARY SETBACKS � ' � ' MAWSTRUCTURE front 0-0 , Rear- 0=0 �� .� ACCESSORY Front�,�;0-0 ��` -Rear 0.0 PARKING Existin :' 0 Reavired: o NOTES: PLANNING & ZONING Left 0- 0 Lek 0- 0 . Proposed: 0 Calc Valuation: Si,000.00 Claim Valuation: . S�,000.00 : Right 0- 0 " � � Right ' 0- 0 �� - 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 it work is not commenced within 180 days, or if work is suspended or abandoned , for a period of 180 days. I INSPECTIONS: In order for �ha work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all �, reqWretl inspectlons and flnal approval must be obtained. Failure to obtain inspections and final approval will result In Ihe expiretion of Ihis permit. �i FOR INSPECTIONS CALL: (714) 7545626 tms�n6 (r✓ao) WORKERS'COMPENSA�ON DECLARAnON: I hereby ettlrm under penalry of perjury ane of tha following tleclarations: ❑ I heve end will meintain e certificete oi consent to self-Insure for workers' compensetion, as provided tor by section 3700 ot tha Labor Code, tor the pertormence of the work for which lhis pertni[ is issued. ' ❑ I heve end will mainttin workers' compensation insurence, es required by sectlon 3700 of tha Labor Gotle, for the pertortnflnce of the work for which this pertnit is issuetl. My workers' compensatlon Insurence carder end policy number ere: Cartier: Policy Number: (This section need not be completed il the permlf is veluetl at one hundretl tlollers ($100) or less.) ❑ I certify ihat in the peAortnance of the work tor w�ich ihis pertnit is issued, I shell nol employ any person in eny manner so as to hecome subject to Ihe workers' compensetian laws ot Calitomia, and agree ihet i1 I should become sub�ect ro Ihe workere' wmpensetlon provislons of Sedion 3700 of the Lebor Code, I shall fonhwith comply with Ihese provisions. Applicant Signeture: Dete: WARNINO: FAILURE TO SECURE WORKERS' COMPENSATION CAVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER i0 CRIMINAL PENALTIES AND CIVIL FlNES UP TO IXJE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITIIXJ TO THE COST OF CAMPENSATIIXJ, DAMAGES AS PFOVIDED FOR IN SECTION 3]OB OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTOHS DECLAHATION: I hereby ettirtn ihet I am licensed under provisions oi Chapier 9(wmmencinp with Section 7000) of Division 3 ot the Business antl Professions Code, and my license is in full force end eHect. Lic. # Glass q Contrector's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I �ereby eHirm that ihere is a constmction lending agency for the DeAormence of the work for which ihis parmit is issued. (Sec. 3097, Civil Code). Lentler's Name: Lentler's Address: Slgnelure: Date: OWNER-BUILDER DECLAfiATIONS: I hereby ettirtn thet untler Denalry of perjury thet I am EXEMPT FROM TIiE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business end Professions CoOe: Any ciry or counry which requires e permit to conslrucL alter, improve, tlemolish, or repair any structure, prior to its issuance, also requires the eppliwnt for such pertnit to file a slgned s�atement ihat he or she is Iicensed pursuant to the provisions ol the Coniractors License Lew (Chapter 9(wmmencing with Seclion 7000) of Dlvlsion 3 ot iha Business end Pmfessions Gode) or lhet he or she is exempt therefrom en0 t�e basis Por the allegetl exemption. Any violetion of Sectlon 7031.5 by eny epplicant for e pertnit sub)ects Ihe epplicent to a civil penalry ot not mora than five hundred dollers ($500).): ❑ I, es owner of the properry, or my employees with wages as their sole compensation, WILL DO 7HE WORK, end the structure Is not Intended or otteretl for sala (Sec. 7044, Business end Professions Code: The Contractors License Lew does not apply to an owner of properry who builtls or improves ihereon, and who does such work himself or herself or ihrough his or her own employees, provided that such improvemenis are not intended or oHered tor sale. If, howevar, the builtling or Improvement is 5old within one year of completion, the owner-builder will heve ihe burden of proving Ihat he or She did not build or improve br purpose of sale.). ' ❑ I, as owner of the property, em EXCLUSIVELV CONTRAC7ING WITH LICENSED CONTFiAC70R5 to consiruct the project (Sec. 7044, Business antl Professions Code: The conirectoJs License Lew Ooes not epply ro an owner ot propeny w�o builtls or improves ihereon, enC who contracis tor such pro�ec[ wtlh a contractor(s) �icense pureuent to�fhe Cpntractors Lig9aee.�ews.). em Venfcation of Ownership by (type of Business and Professions Code for this reason: ❑ No Drivefs Licanse No. properry tax 6ill or deed): �—� DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify ihet no excavetion five (5) or more faet in depih Into which e parson is required to descend, will be made in connection with work euthonzed by this permit, entl that no building simcture, scaflolding, falsework, or tlemolitlon or tlismantling thereof, will be more than [hirty-six (36) fee� high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title e, Calitornia Adminisira�ive Cotla). ❑ As owner-buildar, 1 will not employ anyone to do work which would require e pertnit trom the Division of Industrial Safety, es nated ebova, unless such person hes e permit to tlo such work irom the division. Signature: Date: �ivision ot Industrial Safery Permi� Number: CEHTIFlCATE OF MPIJ CE AND AUTMORIZATION OF EMRY: I certify untler penalty ot perjury ihet I heve read this epplication and stete Ihat the Information given Is correc�. I agree t co �I�th� i t te ws and ciry ortlinances relating lo bullding consiruc[ion, and authotlze representatives of �he Clry of Costa Mesa to enter upon the above-describe e r ISs ��o oses. I agree not to xcupy or allow occupency of any building authorized by this permit until finel inspection. � i D I I% II T , ig eWreOf ga�s) * ata COOE �. INSPECTIONTYVE 1618 1266 Fixed System Final Fira Prevention Pool Spa Final 200 Finel R8-Roof 201 Final BIocWRetaining Well 202 Final Factory Fire Place 203 Finel Sign 204 Flnel Demolitlon Q�g �$ COUE I INSPECTION TYiE 206 Final Mechenical 208 Finel Plumbing 210 Finel Electrical 272 Final Fire Prevenlion 220 Final Plenning Approval 222 Finel Slte 250 FInelBuilding/Occupancy lha�Cy t' �� °� w � �� C� CITY PLAt SUB.IECT' NOTE:AD OR COR1 pppROVED BY: � (t��s se� �� ys o'. : t"S ��- (� � �a^�y G�p1��C. ��,% ��Slam''d`a�s��o1� at lhe v�o', S�eSeQ,�oScom�' l�� vio�� ZOV ED COS"fA M6SA NG DIVISION BLDG.DEPT.REG. IONS. DELET1oNs, TIONS SHALL BE THE PLANNING DIV. USE COMPLIES WITH ZONfN PLANNER INIT._��TE c G SAF�� Oo2i�� P /�j % �aL/J�- M�,S °� ¢e':y ";,,.- �ha��e*F .�edadc�e .,�d ma�o�� r 15 � I`�,�'/ZOv `^ ,' P�'�'�� ;��n (.'-�C1��i�i� iJC� 1�'^)�+..� �� . l�em�l�•sl-., n�� kj«.e:v,; ��ti11 � �k;l�( r ny � v�� rPr hev�� 1}�ti�� ` �1 � �1�0�,ie- � � nt s� �U��-u.� �I C21 � � 1a�� (714) 754-5273 • Fa�c (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR ORIVE, COSTA MESA, CA 92626 JobAddress: 7$2 WEELODR Suite No B Vicinity: Parcel Number: 42417304 Applicant: RICHARD LANGSETH Address: 1593 CORSICA�PL COSTA MESA, CA owner: ALEXANDER, PAUL- Address: 732 WEELO DR COSTA MESA, CA Contractor: OW NER-BUILDER Address: MECHANICAL PERMIT Status: ISSUED Applied: 08/10/2004 Issued: 08/11/2004 ISSUED BY: Phone: 714-751-8931 Zip: 92626 Phone: Zip: 926273521 Phone: Zip: License: 000000 SCOPE OF PERMIT CONSTRUCT 183SF ADDITION TO AN EXISTING SINGLE-STORY DUPLEX. SFD FOR UNIT B. WORK TO INCLUDE THE EXPANSION OF THE LIVING AND DINING ROOMS AND THE ADDITION OF A NEW BATHROOM. REF.: 604-01143 �� ' MECHANICALTOINCLUDE:1 REPAIR/ALTCOOLING/HEAT ISSUE FEE Inst FAU <100 k BTU . Inst FAU >100 k BTU Repair / Alt Cooling/Heat . Inst / Rep. Recess Wall Htr Refrig Sys <100 k BTU Refrig Sys >100 k BTU � Gas Piping Factory Fireplace Hood w/Mech Exhaust , VAV Box Vent Fan / Single Ducf ; Appliance , , Fire Dampers , Smoke Dampers Inst or Relocate Appl Vent Air Handlers < 10000cfm AirHandlers> 10000cfm Floor Furnace Floor or Suspend Heater FEE SUMMARY Quantity $23.50 $0.00 0 $o.00 0 $13.70 1 $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 $0.00 0 $0.00 0 $0.00 0 Repair / Alt Absorbtion Unit - Repair / Alt Refrigeretion Unit Ventillation System � � �� -EvaporetiJe Cooler " Commerciallncinerator Domestic Incinerator � Compressors / Absorption Systems Upto3hp/100'kBTU - � 3To15hp/500kBTU 15 To 30 hp / 1,000 k BTU' 30 To 50 hp / 1,750,k BTU� - � �� Over 50 hp I Over 1,750 BTU ��, ,-, , Boilers " . .. .. .. � Upto3hp - . � . - 3To15hp � 15to30hp - � ', 30 to 50 hp Over 50 hp Other Mechanical Fee `� � � - --Investigation Pee Plan Check Fee Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 �$0.00 � $0.00 $0.00 $0.00 $0.00 �' $0.00 $0.00 $0.00 $0.00 $0.00 NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requiremenis under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: 7his permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. / INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable code and all requlred inspeetlons and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiretion of;lliis permit. FOR INSPECTIONS CALL: (714) 7545626 !� zaas-as (s�oo� WORKERS' COMPENSATION DECLARATION: I hereby afFirtn under penalty of perjury one of ihe Following declarations: . ❑ I have end wili maintain a cetlificale of cons�nt to seli-Insure tor workers' compensation, as provitletl tor by section 3700 oi the Lebor Code, lor the pedormance of the work for which ihis permit is issuetl. ❑ I have and will maintain workers' compensation insurence, es required by section 3700 of Ihe Labor Code, for Ihe peAormance of ihe work tor which ihis pertnit is issuetl. My workers' compensation Insurence carner and policy numbar ara: Carrier: Policy Numbar. (fhis section neetl nof be complefed il fhe permit is valuetl ef one hundred dollars ($f 00) or Iess.J �I cenity that in ihe performance ot ihe work fpr which Ihis permit is issuetl, I shall not employ any pereon in any manner so as to become subjact to the workers' compensetion laws of Californie, end egrae ihat if I should become subject to Ihe workers' compensation provisions of Section 3700 ot the Lebor Code, I shall forthwith comply with these ws ns, ��j Q ApplicanCSignature:—�� Ls�- s.��V � ,Data:�--O ��/�� y WARNING: FAICURE TO'SECURE WORKERS' COMP 9ATION COVERAGE IS UNIAWFUL AND SHALL SUBJECT AN EMPIOYER TO CFIMINAL PENALTIES AND CIVI� FINES UP TO ONE HUNDqED THOUSANO DOLLARE ($100,000), IN ADDITION TO THE Cp$T OF COMPENSATION, DAMAGES AS PFiOVIDED FOP IN SECTION 3]O6 OF THE L400R CADE, INrEREST, AND FTTORNEY'S FEES. LICENSED CONTRACTORS OECLARATION: I hereby aNirm ihat I am licensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 of ihe Business and Professions Code, antl my license is in full torce antl eHect. Lic. # Cless # Contrector's Signeture: Dete: CONS7RUCTION LENDING AGENCY: ❑ I hereby affirm that ihere is a consiruciion lending agency tor ihe peAormance of the work for w�ich ihis pertnit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby eHirm that under penalry of perjury that I am EXEMPT FROM 7HE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires e permit to construct, alter, improve, demolish, or repair eny simcture, prior to its issuance, also requires the applicant for such permit b fila e signed stetement that he or she is licensetl pursuent to the provisions of Ihe Contractors License Lew (Chapter 9(commencing with Section 7000) ot Divislon 3 of the Business antl Professions Code) or that ha or sho is exempt ihereirom and the basis tor the allaged ezemption. Any violation o� Saction 7031.5 by any applicant for a permit subjects the applicant m a civil penalty ot not mora than five huntlred dollars ($500).): ❑ I, as owner oi ihe propeny, or my employees with wages es thair sole compensation, WILL DO 7HE WORK, antl ihe sWcture Is not Intended or oflered for sale (Sec. 7044, Business and Protessions Code: The Contractors License Law does not apply �o an owner of property who builds or improves thereon, and who does such work himseN or herseN or ihrough his or her own �mployees, provided ihat such improvements are not intended or oNered tor sale. If, however, the building or improvement is sold within ona yaar of completion, the owner-builder will have ihe burden oi proving that he or she did not 6uild or improve tor purpose ot sale.). ' ❑ I, as owner of the property, em E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct ihe project (Sec. 7044, Business end Professions Code: The con�ractors Llcense Law does not appty to an owner of propetly who builds or improvas ihereon, and who conUacis tor such prolecl wi�h a conlractor(s) license pursuant to the Contractors Licensa Laws.). ❑ I am ezempt under sec. Business antl Professions Code tor this reason: Signeture: _ Date: Owner ID verified by drivers license. ❑ Ves ❑ No Driver's License No. Ventication of Ownership by (type of tlocument, i.�. - property tax bill or tleetl): Expires: DIVISION OF INDUSTRIAL SAFETY PERMIT C�q7�FICATION: ❑ I hereby certify ihat no excavation five (5) or more teet in dep�h into which a person is raquired to descend, will be made in connection with work au�horized by ihis permit, and that no building strucWre, scaflolding, talsework, or demolition or dismantling ihereof, will be more ihan ihirty-six (36) teet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Title B, Calitornia Atlminisirative Code). ❑ As ownervbuilder, I will not employ anyone to tlo work which would require a permit irom the Division of Intlusirial Safery, as notetl above, unless such person has a pertnit to d0 such work irom Ihe division. SignaWre: Date: Division oi Indusirial Safety Permit Number: CERT1flCATE OF COMPLIANCE AND AUh10RIyATION OF ENTRY: I certify under penalry ot perjury ihat I have read this application and state that ihe intormation given is corract. I agree to comply with all state laws and city ordinances relating to builtling consimction, antl authorize representatives of ihe City of Costa Mesa to enter upon ihe ebove-described property for inspection puryoses. I agree not to occupy or allow occupancy of any building authorized by this permit until tinal inspection. COUE N. INSPECTION TYPE 7616 Fizetl System Final Fire Prevention 7266 Pool Spa Final 200 Final Re-Roof 201 Final Block/Retaining Wail 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition D te �=//-0'� �Date RIpL �Q E�t INSPECTIONTYPE , LAT� 206 Final Mechanical � /Li�%�� i 208 Final Plumbing 270 Final Elecirical 212 Final Fire Prevention 220 Final Planning Approval 222 FinalSite 250 Final Buiiding/Occupancy (714) 754-5273 • Fax (774) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: Suite No Vicinity: Parcel Nunmber: 732 WEELO DR B 42417304 Applicant: RICHARD LANGSETH Address: 1593 CORSICA PL COSTA MESA, CA Owner: ALEXANDER, PAUL Address 732 WEELO DR COSTA MESA, CA Contractor: Address: ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+uni4s) Pool / Spa Lighting Fixts Recept Outlets Swilches Nan Res Appl Res Appl Service to 200a Service to t000a Service over 1000a Mo[ors to 1 hp Motors to tOhp Motors to SOhp Motors to t00hp OWNER-BUILDER ELECTRICAL PERMIT Phone: 714-757-8931 Zip: 92626 Phone: Zip: 92627-3521 Phone: Zip: License: 000000 Status: ISSUED Applied: 08/10/2004 Issued: 08/11/2004 'i.�� ' SCOPE OF PERMIT CONSTRUCT 183SF ADDITION TO AN EXISTING SINGLE-STORY DUPLEX. SFD FOR UNIT 8. WORK TO INCLUDE THE EXPANSION OF THE LIVING AND DINING ROOMS AND THE ADDITION OF A NEW BATHROOM. REF.: 804-01143 ELECTRICAL TO INCLUDE: 3 LIGHT FIXTURES, 5 OUTLETS, 2 SWITCHES, AND 1 SUB-PANEL TO 200 AMPS. $23.50 $0.00 $0.00 $0.00 $0.00 50.00 $3.30 $5.50 $2.20 $0.00 $0.00 SO.00 50.00 $0.00 $0.00 $0.00 $0.00 50.00 Quantiry 0 0 0 3 5 2 0 0 0 0 0 0 0 0 0 FEE SUMMARY Temp Dist System / Lighting Busway /100 ft Standin9 Section Misc ElecMcal Equipment Transformers up to 1 kva/kw ....:...........up to 70 kva/kw .................up to 50 kva/kw .................up to 100 kva/kw ..................over 100 kva/kw Low Voltage Equipment Low Volt Wiring System / Ckt Misc. Conduit Misa Conductor Circus ( gen or ride) Circus (mech ride or lights) -� Christmas Tree Stand Fireworks Stand Other Electrical Fee Quantiry $0.00 0 $0.00 0 $0.00 , 0 $0.00 0 50.00 0 30.00 0 $0.00 0 $0.00 0 $0.00" 0 $0.00 0 $0.00 0 50.00 ' o 50.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 50.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. Nb. 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 780 days. INSPECTIONS: In order tor the work authorized under this permit to be consideretl legal, such work must comply with all applicable codes, antl all requlred Inepectlona and final epproval must be obtained. Failure to obtain inspections and tinal approval will result in the expiretion of this permi� FOR INSPECTIONS CALL: (714) 7545626 � zaae-as ��vao) // WORKERS'COMPENSAnON DEC�qppTON: I hereGy attirm untler penalry of perjury ona of the following Ceclarations: ❑ I have and will maintein a cenlficete of consent m self-Insure for workers' compensatlon, as provided for by sectlon 3700 of ihe Lebor Cotle, for t�e pertormence of ihe work tor which this permit is Issuad. ❑ I have and will maintain woAcers' compensetion insurence, as requiretl by sectlon 3700 ol the Lebor Code, for the pedortnenca of Ihe work tor which Ihis pertnit Is Issued. My workers' compensation Ins4rence cartier entl policy number are: Cartier: Poliry Numbar. (fhis section need not be crom0�eted i/ the permit is velued et one hundretl tlollars ($100) or Iess.J '[tj�`fcertily ihat in Ihe peAortnance ol ihe work tor which this pertnit is issued, I shell not employ eny person In eny manner so es to became subject ro the woBers' _�compensetlon lews of Califomie, enE egree that if I should become 5u6Ject to the workars' compensetlon provislons oi Sectlon 3700 of Ihe Lebor Code, I shell fort�wit� comply with these pr sian �y l / AppliCflnfSignature: �� : � ^�Q�� Date:----a ��—��–/ WAHNIN(3rFNNRE TO SECUflE WORK�qS' COMPENSAT N COVERAGE IS UNLAWFUL AND SMALL SOBIECT AN EMPLOVER TO CRIMINAL PENALTES AND CML FlNES UP TOONE MUNORED TFIOUSrWD DOLURE (5100,0OO�.IN ADDlnpry TO iHE WST OF COf.1PENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3]O60F THE UBOR COOE, IMEREST, AND ATiOHNEVS FEES. LICENSED CONTRACTORS DECL4RATION: I hereby aNirm that 1 am licensed unqar provisions of Chapter 9(commencing wilh Section 7000) ol Division 3 of the Business end Prolessions Cotla, entl my Ilcense is in tull force and ettecL lJc. N Class a Contractor's Signature: Date: CONSTRUCTION LENDING AGENCV: ❑ I here�y eHirtn Ihet there is a construction lending agency for t�e peAormance of the work tor which this pertnit is issued. (Sec. 3097, Civil Cotle). Lentlers Name: Lenders Atltlress: SignaWre: Date: OWNER-BUILDER OECLAftATIONS: I �ereby eHirm Ihet under penalry ol perjury thet I em EXEMPT FROM 7ME CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5, Business enA Protesslons Code: Any ciry or counry which reqmres a pertnit to constmc�, alter, improve, demolish, or repelr eny strucWre, pnor to Its luuance, elso requlres the epplicflnt iar such permit to lile e signed stetemant that �e or she is licensetl pursuam to the provisions o1 the Coniradors lJcensa Lew (Chepter 9(commencing with Sectlon 7000) oi Didslon 3 of ihe Business an0 Professions Code) or that he or she is e:empt t�eretrom antl t�e basis tor the alleged exemption. Any Woletlon ot Sectlon 7037.5 by any applicent tor e permit subjects the applicant ro a civil penalry of not more than five hundred tlollare ($500�.): ❑ I, as owner of ihe pmperry, or my employees with wages as their sole wmpensation, WILL DO 7HE WORK, end the structura Is not Intended or otteretl for sale (Sec. 7044, Business and Professiorls CoCe: The Coniractors License Law tloes noi apply to an owner ot property who bullds or improves thereon, and who does such work himself or herself or Ihraugh his or her own employees, provided ihat such Improvemenis ere not intended or oHered for sele. If, however, ihe building ar improvement is sold wiihin one year of comploiioq the ownerbuilder will have ihe burden ot proving thet he or she did not build or improve for purpose ot sele.). ' ❑ I, as owner of the property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct Ihe pro�ect (Sec. 7044. Business end Prolassions Gotle: The conirettore License I„ew does not apply to en owner af property who Dulltls or Improves ihereon, entl who conlracls tor such prolect with e contractor(s) license pursuent to ihe Contractors License Lews.). ❑ I em ezempt under sec. Signeture: Owner ID verified by dnvers license. ❑ Yes ❑ No Busineu and Pmlessions Code tor t�is reeson: Venfication of Ownership by (rype ot tlocument, i.e. - properry tex bill or deed): Driver'S License No. Date: Expires: DIVISION OF INDUSTRIAL SAFETy pERMR CERTIFICATION: ❑ I hereby certify Ihat no exwvation five (5) or more feet In tlepth into which a person Is require0 to descend, wlll he made in connection with work authorizetl Dy this permit, and that no building structure, scaflolding, falsework, or demolitlon or dismantling thereot, will be more than Ihirty-six (38) teet high. (Chap. 32, Grp 2, Art 2, Sec. 347, Ttle B, Calitomla Atlminisiretive Code). ❑ As ownervbuilder, I will not employ anyone to tlo work which would require a permit irom the Division ot Industriel Selety, es notetl e6ove, unless such person hes e permit to tlo such woric irom ihe division. Signature: Date: Division of Industnel Safery Permit Numher: CERTIFlCATE OF COMPLIANCE AND AUfHORQATION OF ENTRY: I cenily under penalry ot perjury Ihat I have read this ep011wUon entl state thet Ihe Informatlon given is correct. I agree to comply with all stete lews antl ciry ordinances relating ro building construction, entl euthorize representa�ives of Ihe Clry of Costa Mesa to enter upon Ihe ebove-descnbed property for inspection purposes. I agree not to occupy or ellow occupancy of eny building authonzed by this permit until tinel inspection. COOE /" INSPECTIONTYPE 1616 Fixetl System Final Pire Prevention 1266 Pool Spe Final 200 Final Ra-Roof 201 Final BIacWReteining Well 202 Final Factory Fire Place 203 Finel Slgn 204 Finel Damolltlon p� f�$ f�Qjjf,j INSPECTONTYPE Q�¢, 206 Final Mechanical 20B 210 212 220 Finel PIum6ing Finel Electncal Finel Flre Prevention Final Planning Approvel 222 FinalSite 250 FinelBuilding/Occupancy r. . / (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 7� FAIR DRIVE, COSTA MESA, CA 92626 lob Address: 732 WEELO DR Suite No B Vicinity: Parcel Nunmber: 42417304 Applicant RICHARD LANGSETH Address: 1593 CORSICA PL COSTA MESA, CA Owner: ALEXANDER, PAUL Address 732 WEELO DR COSTA MESA, CA Contractor: OWN ER-BUILDER Address: Arch / Eng : Address: ISSUE FEE BackFlow irrigation BackFlow Preventer Bathtub Clarifier System Connect Qce,Soda,etc) Dental Units Dishwasher Drain, Floor PLUMBING PERMIT Status: ISSUED Applied: 08/10/2004 Issued: 08/11 4 ISSUED BY: Phone: 714-751-8931 Zip: 92626 Phone: Zip: 92627-3521 Phone: Zip: License: 000000 Phone: Zip: license: SCOPE OF PERMIT CONSTRUCT 183SF ADDITION TO AN EXISTING SINGLE-STORY DUPLEX. SFD FOR UNIT B. WORK TO INCLUDE THE EXPANSION OF THE LIVING�AND_DINING ROOMS AND THE ADDITION OF A NEW BATHROOM. REF.: B04-01143 � � - � PLUMBING TO INCLUDE: 2 P-TRAPS, 1 SEWER CONNECTION, 1 SHOWER, 1 WASH BASIN, 1 WATER CLOSET AND 1 WATER HEATER. � AMT $23.50 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 FEESUMMARY QTY AMT Laundry Tub / Washer $0.00 0 Landscape Irrigation $0.00 0 P-Trap $19.60 0 Pressure Regulator $0.00 0 Process Piping (per 10 ft) $0.00 0 Receptors $0.00 0 Septic Tank $0.00 0 Sewer Cap for Demo $0.00 0 Sewer Connect $2a.65 QTY.. 0 0 2 0 0 0 0 0 1 SumpPump .� Swimming Pool� Trap Primer. " Urinal - .Vacuum Brkr Bkflow(1-4) Vacuum Brkr Bkflow(5+) Wash Basin Wash Basin Set Waste and Vent System AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $9.80 $0.00 $0.00 QTY 0 0 0 0 0 0 1 � 0 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-20, § 1, 1247-92) EXPIRA710N: This permit shall automatically ezpire and become void if work is not commenced within 180 days, or if work is suspended or a`bandoned for a period of 180 days. �- INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all appli ac ble codes, and all requlred inspections and (inal epproval must be obtained. Failure to obtain inspections and final approval will result in the� iation of this permit. FOR INSPECTIONS CALL: (714) 7545626 2446-4fi (6/00) WORKERS'COMPENSAhON DECLARAnON: I hereDy eHirtn untler penalty of perjury one of ihe following declaretions: ' ❑ I have antl wlll melntain e certificete oi cansent to selbinsure tor workers' compensation, es provided for by sectlon 3700 of the Lebor Catle, for the pertormence of the work lor which t�is pprmit 15 i5sued. ❑ I have entl wlll melntain workers' compensetion Insurence, es required by sectlon 3700 of Ne Lebor Coda, for Ihe peAortnflnce of Ihe work lor which this pertnit is issuetl. My workers' compensation Insurence cartier antl policy number ere: Cerrier: Poliry Number: (This section need nof be comp/eled i! Me permif is velued e( one hundred dollaro ($100) or Iess.) �'/ I certify t�et In the peMormenco of Ihe work fOr w�ic� this pertnit is issued, I shall not employ eny person in eny menner bo B5 to beCOme subject Ia Ihe workers' ' compensatlon laws of Calllornis, end egree that It I should become sub�ect to t�e workers' compensation provisions o1 Section 3700 ot t�e Lebor Code, I shell forthwNh comply wlth ihes �Ovi ion, '/ �AppllcantSigneture:��(��_j�'�y� Dete:. � ��/ � r .WARNIN(3: FNLURE TO SECl1qE WORKERS' COM NSATON COVEMOE IS UNLFWFUL AND SNA115U61ECT AN EMPLOYER TO CRIMIPUL PENN.TIES AND CML FlNES UP TOONE HUNDRED T/qU$AND DOILARE (5100,Opp�, IN AD�RION TO THE WST OF COMPENSIITION, �NMGES AS PRONOED FOR IN SECiION 3/OB OF TME UBOR COOE, IMEREST, AND ATTOHNEI"S FEES. LICENSED CONTRACTOpS DECLARATON: I hereby eNirtn thet I em Ilcensed under provislons al Chepter 9(commencing with Saction 7000) of Division 3 of the Business antl Protesslons Code, end my license is in full force and etteci. LJc. N Class k Contraciofs Signawre: Date: CONSTRUCTION LENDING AGENCV: ❑ I hereby ettirm thet there I5 e construction lending egency �or the pedormance of the work For which this permit is issuad. (Sec. 3097, Civll Cotle). Lenders Name: Lendefs Address: Signature: Dete: OWNER-BUILDER DEClARA710NS: I hereby aMirm ihet under penelry ot perjury thet I am E%EMPT FROM THE CONTRAC70RS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business antl Protessions Cotle: Any clry or county which requires e permit to constmct, elter, improve, tlemolish, or repair any simclure, prior to its issuence, elso requires ihe eppllcant for such pertnit to tile e signed stetement ihet he or she Is Ilcensed pursuem to the provislons of the Contracrors License Lew (Chapter 9(commencing wlth Sactlon 7000) of Dlvision 3 ot the Busineu entl Protesslons Gode) or thet he or she is exempt therelrom end the besis lor the elleged exemption. Any vloletion of Sectlon 7031.5 by eny epplicant for e permlt sublects the applicant to e civil pennlry of not more then tive �undred dollers (5500).): ❑ I, es ownar ol ihe properry, or my employees wlih weges es their sole compensa�ion, WILL DO THE WORK, entl the structure is not Intentletl or oMeretl lor sale (Sec. 7044, Business and professlons Code: The Contractors License Law does not appiy to an owner of property who builds or improves thereon, and who tloes such work himsalf or herself or through his or her own em0�oyeos, provided that such improvemems are not intended or oMered lor sale. If, however, ihe building or Improvement Is sold within one year ot complotion, ihe owner-builtler will heve ihe burden of proving that he or she did not build or impmve lor purpose of seleJ. ' ❑ I, es owner of the propeny, am E%CLUSIVELV CONTRAC7ING WI7H LICENSED CONTRACTORS to ConStrutt the prolBtt (Sac. 7044, eV5in855 end Pro1095ion5 Cotle: The wntractors Licensa Law does not epply to en owner of property who builtls or improves thereon, end who conirects lor such pmject with e contrector(s) licansa pursuant to the Coniractors License Laws.). ❑ I am ezempt under sec. eusiness and Professions Code for this reason: Signature: Dale: Owner ID verified by tlriveYs licenso. ❑ Ves ❑ No Dnver's License No. Veri(icailon af Ov.•nere�ip by (type oi tlocument, i.e. - O�operry tax bill or deed): ExD�reS: DIVISION OF INDUSTH10.L SAFETY PEHMfT CEH7fFICATiON: ❑ I hereby certity thei no excavation five (5) or more teet in tlepih into which a person is requiretl to descend, will6e mede in connection with work authodzetl by this pertnit, and that no building strucWre, sceHolding, felsework, or demolition or dismantling thereof, will be more than Ihirry-six (36) faet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Ttle B, CelBomia Administretive Cade). ❑ As owner-bulltler, I will no� emplay enyane to Co work which woultl require a pertnit irom �he Division of Industrial Safery, es noted above, unless such person hes e permit ta do such wOrk from lhe tliWsion. Siqnature: Date: Division oi Intlustnal Sefety Pertnit Number: ICERTIFlCATE OF COMPUANCE AND AIJfHORIZATON OF ENTHY: I certity under penalry of perjury that I have read ihis applicatlon antl stale thaf the informafion given is I wrrecL I agree to comply wit� all stete laws end clry ordinences rela�ing to Ouiltling coretruction, end authonze representatives of t�e Ciry at Costa Mesa to emer upon the above-descnbetl property tor inspection purposes. I egree not to acupy or ellow acupancy of any building authorized by t�is pertnit until linel inspection. CODE �. INSPECTIONTYPE 7676 Fixetl System Final Pire Prevention 1268 Pool Spe Final 200 201 202 203 204 Finel Re-Roof Final Block/Reteining Well Final Factory Fire Placa Finel Sign Pinel Demolition � INTIf1AL5 �Qpf,I INSPECTIONTYPE 206 Final Mechanical 20B 210 212 220 Finel Plumbing Final Elecirical Final Fira Prevention Final Planning Approval 222 Final Site 250 Final Building/Occupency PAg I�LS ,� (714) 754-5273 • Fax (714) 754•4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: Suite No Vicinity: Parcel Nunmber: ApplicanC Address: 732 WEELO DR 42417304 DRURY,KATHRYN 732 WEELO DR - - COSTA MESA, CA Owner:, DRURY,KATHF2YN� . Address "732 WEELO DR - ConUactor: Address: COSTA MESA, �CA y' `, OWNER-BUILDER Phone: 949-646-0442 Zip 92627-3521 Phone: 94364G0442 Zip: 92627-3521 Fhane: Zip: License: 000000 Status: ISSUED Applied: 06/17/2005 Issued: O6/17/2005 ISSUED BY: /// �� )) % SCOPE OF.PERMIT . . DEMOLISH NON BEARING BATHROOM WALL TO WIDEN THE EXISTING�BATHROOM AREA AND RELOCATE KITCHEN PONY WALL. _ ISSUE FEE $23.50 Temp service test $0.00 Res. a/c package � $0.00 New Res (t-2 units) $0.00 New Res (3+units) �, � $0.00 Pool / Spa $0.00 Lighting Fixts � \$0.00 ReceptOutlets, ' $3.30 Switches $1.10 ` Non Res Appl $0.00 � Res Appl � $0.00 , Service to 200a � � � _ $0.00 Service to 1000a � � $0.00 - Service over 1000a ��, �� _ $0:00 � Motors to thp '` - : � $0.00 � `� Motors to tOhp �� $0.00 �� Motors to SOhp ��$0.00' - Motors to t00hp $0.00 Motors over 100hp $0.00 Communica[ion drops $0.00 Sub panel to 200a $0.00 Pole Light Pkg $0.00 Sign Circuits $0.00 Quantity 0 0 0 0 3 1 0 0 p:. �. 0 �0 : 0 0 0 0 0 0 0 0 FEE SUMMARY Temp Dist System / Lighting Busway /100 ft Standing Section Misc ElecMcal Equipment 'Transformers up to 1 kva/kw .� .....:........up to 10 kva/kw ...............:.up to 50 kva/kw � .....:...........up to.100 kva/kw � � ..................over 100 kva/kw Low Voltage Equipment Low Volt Wiring System / Ckt Misa Conduit Misc: Conductor , ��Circus ( gen.or ride) � Circus (mech ride or lights) Christmas Tree SWnd 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 $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 go.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 $0.00 NOTICE; The work authorized by ihis permit shall comply with all applirable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 72-21-92) 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 ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred Inspactions 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) 7545626 2d46�bfi(fJ00) WORKERS'COMPENSAnON DECLARAnON: I here6y aflirtn untler penalry oi perjury one of Ihe tollowing declarations: ❑ I heve antl wlll maintain a certificate of consant to self-Insure for workers' compensation, es provitletl tor by section 3700 of the Lebor Code, for lhe pertormence of the work for which this permit is issuetl. ❑ I have and wlll maintain workers' compensation insurance, as require0 hy sectlon 3700 of �he Labor Code, tor the pedortnance ot the work for which this permit is issuetl. My workers' compensetion Insurence cerner and palicy number are: Cerrier: Poliry Number: (This section neetl nof be completetl il the permit is va/ued at one hundred dollars ($100J or less.) ❑ I certity ihat in the pedormanco oi the work for which this permit is issued, I shell not employ any pereon in any manner so as to become sublect to lhe workars' compensation lews of Californle, and egree ihat If I should become subJect lo the workers' compensation provislons of Section 3700 oi ihe Labor Cotle, I shell forthwith comply with ihese provislons. Applicant Signeture: Dale: WARNING: FAILURE TO SECURE WORKERS' CIJMPENSqTION COVEMGE IS UNUWFUL AND SMALL SUBJECr AN EMPIOYER TO CRIMINAL PENALTIES AND GVIL FINES lIP TOONE HUNDqED hKKISAND OOLLARE (5100,000), IN ADDITION TO THE Cp$T OF COAIPENSATION, DPMAGES AS PROVIDED FOP IN SECTION �Ofi OF THE IABOR CODE, INTEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aflirm ihat I am Ilcensed under provisions of Chapter 9(commencing with Sectlon 7000) of Dlvision 3 ot the Business antl Professlons Cotle, and my license is in full torce entl eHecL Lic. A Cless a Contwctors Signature: Date: CONSTRUCTION LENDING AGENLV: ❑ I hereby aflirm that there is e construction leryding agoncy for the performance of ihe work for which this permit Is issued. (Sec. 3097, Civil Cotle). Lenders Name: Lender's Atldress: SignaNre: Date: OWNER-BUILDER UECLARATONS: I hereby aftirtn ihel under penalty of perlury thet I am EXEMPT FROM THE CONTRACTORS LICENSE lAW for ihe following reason (Sec. 7031.5, Business end Professions Cotle: Any ciry or county which requires a permit to consimct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires ihe applicant for such permit to file a signed stetement thet he or she is licensed pursuant to the D�ovislons ol ihe Contractors License Lew (Chepter 9(commencing with Sectian 7000) of Division 3 oi the Business and Professlons Code) or that he or shB is axempt thereirom end the basis tor ihe allegetl exemption. Any violetion of Section 7031.5 6y any epplicant }or a pertnit subjecls ihe applicent to e civil penalry ot not more than Ilve hundred dollars ($500).): � ❑ I, as owner o� t�e proparty, or my employaes with wages as their sole compensation, WILL DO THE WORK, end the structura is not Intended or otterad for sale (Sec, 7044, Businass and Professlons Code: The Contractors License Law does not apply to an owner oF property who builds or imD�aves thereon, and who does such work �imself or hersefl or ihmugh his or her own employees, provitletl that such impiovements ere not intended or oNered for sale. H, however, ihe building or Improvement is sold within one year of completion, ihe ownar-builder will have ihe burden of proving ihat he or she did not build or improve for purpose ot sale.). � ❑ 1, as ownerW the properry, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRAC70RS to construct the project (Sec. 7044, Business and Professions Code: The contractors Licenso Lew noi apply to en owner of propeny w�o builtls or Improves thereon, antl who contrects for such project with e contrecroqs) ,�license pyreU�y�the�ntr 'ce�ise Lsws.). Bu5ine55 and Profe5si0n5 Code tor �hi5 ra8son: Owner ID verifietl'6y Ariver'�'Nc9ns'A;/ �f��es ❑ No Dnver�s'��',cen9e No. Veritication oF Ownership by (type ot document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CEqTFICATION: ❑ I hereby certify Ihat no excavatlon five (5) or more feet in dep�h into which a person is required to tlescenQ will be metle in connection with work auihonzetl by this pertnit, and ihat no building sWcture, scaRoldinq, falsework, or tlemolition or dismaniling Ihereof, wiil 6e more then thirty-six (36) leet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title 8, Califomla Atlminisiretive Coda). ❑ As owner-builder, I will not employ enyone to do work which would require e Oermit from ihe Division of Intlustnel Sefery, as notetl ebove, unless such person hes e permit to do such work from the division. Signature: Date: Division of Intlustnal Safery Pertnit Number: COUE �. INSPECTIONTYPE i616 Fixetl System Final Fire Prevention 1266 Pool Spa Final 200 Final Re-Roof 201 Finel BIocWRetelning Wall 202 Final Fedory Fire Place 203 204 Finel Sign Finel Demolitlon Qa�f. �� CODE� INSPECTIONTYPE 206 Final Mechanical 20B Final Plum6ing 210 Final ElecMcal 212 Final Fire Preventlon 220 Final Planning Approval 222 Final Site 250 Finel Bulldinp/Occupency P9g II�IDdlB � �� (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 732 WEELO DR Suite: B Vicinity: UNIT B(LIVING /DINING ROOMS & NEW BATH) Parcel Number: 42417304 Applicant: LANGSETH,RICHARD Address: 7593 CORSICA PL COSTA MESA, CA Owner: ALEXANDER, PAUL Address 732 WEELO DR COSTA MESA, CA Contractor. OWNER-BUILDER Address: Zip: Arch : Address: Phone: Zoning: ISSUED BY: Phone: 714-751-8931 Zip: 92626 Phone: 714-515-2132 Zip: 92627-3521 Phone: License: 000000 Eng: Address: Status: ISSUED Applied: O6/23/2004 Issued: 08/11/2004 Phone: Zip: , License: License: SCOPE OF PERMIT CONSTRUCT 183 SF ADDITION TO AN EXISTING SINGLE-STORY DUPLEX: SFD FOR UNIT B. WORK TO INCLUDE THE EXPANSION OF THE LIVING AND DINING ROOMS AND THE ADDITION OF A NEW BATHROOM. PLNG: MAXIMUM COVERAGE ALLOWED = 4,410 S.F. COVERAGE PROPOSED = 2,462 S.F. Plan Check: Permit: SMIP Res: SMIP Com: Other: Inspection: Total $172.41 $265.25 $1.59 $0.00 $0.00 $0.00 $439.25 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0- 0 Rear 0-0 Rear 0- 0 FEE SUMMARY PLP.NNING & ZONING Left 0- 0 Left 0- 0 Calc Valuation: Claim Valuation: R�gn� o- o � � Right 0- 0 $15,892.80 So.00 0 INOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related ' regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRA710N: 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 daya /,/ � INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all,applic� able� s, and all required Inepeetiona and final approval must be obtained. Failure to obtain inspections and final approval will result in th�eiipiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2446�4fi(N00) i WORKERS'COMPENSAnOND�CLARAnON: ' � I hereby eHirtn under panelry of perjury one ot ihe tollowing declaratlons: ❑ I have end will malnteln e certilicete of consent to selFlnsure br workere' compensetlon, as provlded for by sectlon 3700 0l the LeDor Catle, for the pertortnence of the wark tor which thi5 permit is issued. ❑ I have end will maintain workers' compensatlon insurence, as requiretl by section 3700 of the Lebor Code, for the peAortnance of Ihe work lor which Ihis permit is issued. My workers' compensation Insurance cerner entl policy number ere: � Carrier: Policy Numher: (Ti�is section need nof be completed il theOermit is velued at one hundred dollars ($100) or less.) ity that in the peAortna�� o� t�e work for which this pertnit is issued, I shell not emplay eny person in any manner so as lo become suDject to the workers' iensetion laws ot Calitomie, end e9rea that if I should becwne sub�ect to the workers' compensation provisions of SecOon 3700 ot the Lebor Code, I shell forthwit� tly with Ihese ov� ' nS � // /� iigneture� ��f�G.•-�i�T� Dete: �1�� 7 �NLURE TO SECURE WOpKERS' GYkd TION COVERAGE IS UMAW FUL AND SW1L� SUBJECT AN EMPCOYER TO CRIMINAL PENALTIES CML FlNES UP TO ONE HUNDRED DOLL4RE (5100,000), IN ADDRION TO TME CQST OF GYkAPENSATION. DAMAGES AS PROVIDE� FOF IN SECiION 31080F TME LABOq COpE, INTEREST, AND ATTORNENS FEES. ' LICENSED CONTRACTORS DECLARATION: I hereby eHirtn Ihai I am licensed Vnder provisions of Chapter 9(commencing with Saction 7000) ot Division 3 of t�e Business antl Professions Code, and my licensa Is in Full fofCe entl BNeCt. LiC. a Cless M Contradofs Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby attirtn tha� �here is a construction lending agency tor the pertortnance ol Ihe work for which this partnit is issued. (Sec. 3097, Civil CoCe). Lendefs Neme: Lentler's Atltlress: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby ettirm that under penalry af perjury that I em EXEMP7 FROM THE CONTRACTORS LICENSE LAW for Ihe fUlowing reason (Sec. 7031.5, Business antl Professions Code: Any ciry or counry which requires a permit ro conswct, alter, improve, demolish, or repair eny strucwre, pnar ro its issuance, elso requires the eDG��nt for such permit to file a signed statement thet he or she Is Ilcensed pursuant to the provisions of the Conlrectors License Law (Chepter 8(commencing with SecOon 7000) ot Divislon 3 of Ihe Bu5lness end Professions Cotle) ar that he or 5he is a:empt Iherefrom and Ihe be519 tor the ellegetl ozemption. Any violatlon af Soctlon 7031.5 6y eny appllcent for g pertnit su6jecis the epplicant ta e civil penalry of not more ihan live hundretl Aollars (5500).): ❑ I, es awner of t�e praperry, br my employees with wages as their sole compensetlon, WILL DO THE WORK, end Ihe siructure Is not intendetl ar oHeretl for sale (Sec. 7044, Business and Professions Code: The Coniractors License Law tloes not epply ro an owner of properry who builds or improves thereon, and who does such work himself or harself ar Ihrough his or her own employeos, proviaetl that such improvements ere not Intended or offered tor sale. If, however, the bullding ar Improvement Is sold within one year oi completion, lhe owner-builder will have Ihe burden of proving that he or she did not build or improve for purpose of sale.). ' ❑ I, es owner of the properry, gm E%CLUSIVELY GONTFACTNG WITH LICENSED CONTRACTORS to construct t�e pro�ect (Sec. 7044, Buslness antl Professions Cotle: The contractors License Law does not apply to en owner of propeny who bullds or Improves Iheraon, end who conirecls for such projact with e contractor(s) license pursuant to the Conlractors License Wws.). ❑ I am e:empt under sec. Business end Prolessions Code tor this reason: Signature: Date: Owner ID venfietl by driver's liCense. ❑ Ye5 � No Driver'S LiCen58 No. Expires: Verificatlon of Ownership by (type ot tlocument, i.e. - O�aPerty tax bill or tleetl): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby certify ihat no excavation five (5) or more feet in dep�h Into which a person is required to descend, wlll be mede in connection with work authodzed Dy ihi5 permit, and Ihat no building sWCWre, scaHoltling, talsework, or tlemolitlon or dismentling ihereot, will be more ihen ihlrry-sIx (36) feet high. (Chep. 3.2, Grp 2, Art 2, Sec. 341, Tltle B, Celifarnia Administretive Cade). ❑ As ownerv6uilder, I wlll not employ enyone to tlo work which would require a permit from the Dlvision of Indusidal Sefety, es noted ehove, unless such persan has e permit to tlo such work from ihe tlivision. SignaWre: Date: Division of Indusirial Setery Permit Num6er. CER7IFlCATE OF COMPIJANCE AND AUTMORVATON OF ENTRY: I certi(y under penalry of perjury thai I have read this flpplicalion and stete ihat the intortnation given is cortecL I egree to compty with all state laws and ciry ordinances rela�ing to 6uilding consiruction, and authotlze wpresentatives ol lhe Ciry ot Costa Mesa to enter upon the above-described property for inspection purpases. I agree not to occupy or allow occupency of any building eu�horized by this permi� until finel inspection. " � -P.nW'Or Autfiorized Applicant —" ' - � CO�E 1, MSPEGTIONTYPE Qaj� AL 1676 Fised System Final Fire Prevention 1266 Pool Spa Finel 200 Finel Re-Rool 201 Finel BIwWRetelning Wall 202 Final Factory Fire Place 203 Finel Sign 204 Finel Demolition COOEA INSPECTIONTYPE 206 Final Mechenical 208 Final Plumbing 210 Final Electrical 212 Final Flre Prevention 220 Finel Plenning Approval 222 Final Site 250 FinalBuiltling/Occupency Date � _ , � Pdffi II�LS DECLARATION OF AUTHORITY FOR AGENTS OF PROPERTY OWNER TO APPLY FOR PERMITS Bldg. Pertnit. This Permit # Street Address: /��-' B k1 ee� o�r � e u s 1'a YV1 e s z AP Number: 1. I(we), f�-.ti � /'7 �� X a.r.�� ✓ , declare that I am the Owner of Title of the above referenced real property, and that I(we) hereby authorize: Name: 1� � �� ar �- a v� a�SQ � Telephone Number. (7� �I / 7�� /.3 � Street Addres5: I-s/3 �O r S � c a �/. Ciry: �o S I 1%ij z S� State: to obtain pertnits in my behalf, as owner/builder, for i'1w I/'T I e�C a.hOPei� atthe abovereferenced property. n � _ 2. Should any person become an employee engaged in the improvement of the property, I(we) shall immediately provide Workers Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa Mesa, as required by State of California laws. 3. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other person, company or corporation. 4. I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any claim resulting in damage or personal injury to myself or any other paRies as a result of work authorized by the permits from the City of Costa Mesa. 5. I declare under the penalty of peryury that the foregoing is true and correct. Executed this . �1 day of �� + 20 �� , at (� o S�-� � c S 1 , Califomia. Print Name: �i�i,i / /� L Ex a w D t'/L Signature: V Gt��C L.LCc,F.c�,�c�acJ / Date: la —��-- � `i �� i Note: This authorizatan does rrol grant authorization to perfurm the work as owner, it solely provides for limited power of attomey to secure this pertnit in any behaH. O]]9d6 (mv.11100) ts Beam Final ■ � OF WORK '�'� SUBCONTRACTOR i a.'GG. -- - - 24987 tOSTA MESA BUIIDING-SAFtTY DEPAA7MENT �.0. BOX 1200 COSTA MESA� CALIFORNIA Y2620 For AppI1mM ro F711 /n ComplNoly TYPE OR PRINT DDR'QY 7 3 a ��.� � COSTA MESA. CALIFORNIA ..,.... �Avi� �LF_XAn�DB(Z �oR AT�� s (�v� ��.�s . � 2� Iq Lva.r+r�z.o q �w C�s� a Mt r s� iG'��3� 0�545-y443 50 � /� � � �o. o, o�o..,�o, NOW ON LOT O BLDO. ��- LIN6lROM S � � � 5 �pRRt6i v R6ARYAR � RQ LL�RY � NIQFiT � �, DESCRIPTION OF WORK �� WALL t i H� ANC PLY � � OF � �5 TA MESA DEC 10 1965 �BG�� rt ZONtNG ,v o.■ ewt iecueo �. No. / / % — ( P 7 —' �/ 7- '!: NOCAVHOVHRHAN08HALLE6Ll88THAN TO HIUH S REAR P. L ea AWCD (U. B. C. RBQUIREMBNT: VARD7MPROVED YARD9MPROV6D MAINBUILDINO AGCHBSORYBU�LOINO IOMC/ YTRi[T) INT R. .i/ _ vwn. # �� pl / G, . � C ✓ MrRO� ND P[p►pRMtD ,.,/ti,('vy 1 2 HnLD SPECIAL rwa wrounr IURPOGi O� _"��...' __.._..._ .._... � / 816NATURL�OR peR�,,,e - � 3 a� AUTNORIS[DAOtN7 s % DATB T. � �6 S EQUIREME.NT� � �,a..e �o' u,�- � � c.a � x v��u�non �e rort'n�¢ ' A PLIIYIT PE6 ONLY. � IT FH8 •� P]1 E �wP�K s 3 7.So w G �