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I �� !, � a1 ) ' i'°"+ X11 � D � • r � .7_i '"i (111 •��`' } AJS * - \ °, ,J. --:t•-•'1sI ;1 •; it $ i� yt�l�l4 i 1 rT , kVA it 't ` i �r I..---1. - �' lYi�awrEF7 F _ I��Q�; LYQua r'i!t� G t �4. t t r.•........,. ip - - - . t 1 .y • • • • .. • ( .e. • - • 'm.. -•� ' G 't' j ? II 6 t t i; (Mai 1y A CITY OF CC 'A MESA TELECOMMUNICM 1 IONS DIVISION REPAIR NOTIFICATION Maint. Svs. Water Trf. Eng. Animal Cntl. Facilities /�, ,`"Other B N > / �1Prsz tag 1.: Trouble 4 go/L-i/Akr— Airn/?&e / u / - r-A-T 4-c-u AIT Location in 7o77 is PL —M �(Th IL--- -S//Go (d�t ive' 6I 6- Informant tl.//T/9/�..//US Address Phone Received: Date )71—;`,5---.67. Time 7g Comm. Officer n� / L� 7 . Remarks ��,(� ,415/14/, jUy //� ( 4-777 Notification: /G-"Ln Who Notified/1,,e4'4,-J CHP TSI Date 007 Time X75/S Remarks Comm. Officer Supervisor / � � 0472-50 (rev.10/03) • /1110,1i) `p F 9 CITY OF COSTA MESA BUILDING DIVISION F • •„z- 41 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER r/� PERMIT / kvbePORMSD lit 302-00669 B02-00669 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT • Job Address: 178 WELLS PL Status: ISSUED Suite: Applied: 05/13/2002 Vicinity: ROOF Issued: 05/13/2002 Parcel Number: 42541314 Zoning: ±...7e:*k Applicant: KIM, SIMON ISSUED BY: Address: 751 S STATE COLLEGE - , STE 50 Phone: 714-680-0043 FULLERTON,CA'" ' Zip: 92831 ' Owner: WEST,'RUTH' Address ,188E 17TH ST - - ' Phone: COSTA MESA,CA Zip: . Contractor: CALMINN EXTERIOR CO Address: 751 S STATE COLLEGE . STE 50 Phone: 714-680-0043 . ,FULLERTON,CA Zip: 92831 License: 806394 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT . TEAR OFF OLD SHINGLES AND RE-ROOF WITH ASPHALTSHINGLES.2400 S.F. DOES NOT INCLUDE DETACHED GARAGE. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $2,400.00 Permit: $83.25 Claim Valuation: $2,400.00 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $83.75 .. 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 no%mrnmenced 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)7546626 244646 WOO) • - 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: Carrier: ' Policy Number: (This action need not be completed if the permit is valued at one hundred dollars($100)or less.) / • r3I 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 it .. •- ome subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. — _ ApplicanVSignati. % TDafei 1 _: '' 4 ' 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 underrovis ns 7f Chapter 9(commencing with Section 7000)of Division 3 of the Business and2dofessions Code,and my license is in full force and effect Lic. C <._. Class - j 1 4 Contractors Signature:- z , -.-- • Date: 1 -� �'— 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 tile a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant toe 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 contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,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 materiel? ❑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 ❑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). ....r... .... 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 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Ll 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? ❑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 Califomia 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 AUTHORIZATION 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 comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owner r Date tAnd/OrAuthorized'Applicanl_ rDete-m CODE it INSPECTIONTYPE DATE IMRIAL$ CODE IN$PFCTION TYPE PAIE =Ma 1616 Fixed System Final Fire Prevention .206 Final Mechanical 206 Final 1266 Pool Spafl • 5--21-0Z G�Z 210 Final ng 200 FinalRe-RoofElectrical 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 PROJECT ADDRESS: 178 WELLS PL UNIT: CITY OF COSTA MESA - BUILDING PERMIT PERM NO: BP 047497 OWNER'S NAME: MR. JAMES WEST AD0RESs: 178 WELLSPL PERMIT NO: BP 047497 PLAN CHECK NO: 04180-90 S GOVT: N SUPP: N • . COSTA MESA CA 92627 CONSTRUCTION TYPE: 5-N PERMIT TYPE: PLU STA PURPOSE: ALT i (714 )968-3856 - ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : DEMO OFFICE/RESTORE GARAGE/ADD 2 WINDOWS SQ FT: 400 ADDRESS: UNIT: CLAIM VALUE: 400 .00 CALC-VALUE: 400 ,00 GROUP OCC: M-1 / PERMITTEE: JAMES WEST ( 714 ) 968-3856 ADDRESS: 178 WELLS PL COMMENTS: COSTA MESA CA 92627 .tE*******+rix*****************iE***************x*+r*it**+r****************+r********** LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ON ING REQUIR EMENTS 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. SETBACK S , CITY LIC.: STATE UC.: •CUSS: • Date: Signature: MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN Compensation Insurance,or a certified copy thereof(Section 3800, Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN POLICY NO.: . EXP.DATE: COMPANY: PARKING REQ• PROV: \ PARCEL: 42541314 ZNE: C2 REF NO: ) Certified copy is hereby furnished. 0 Certified copy isfiled wlththe city Building DiMsion. PLANNING N TES> CONVERTING EXISTING GARAGE BACK INTO A GARAGE FOR FUTURE > USE AS .AN AUTO. DETAILING SHOP. - ., Date: Applicant: **********************************'************************************"********* EXEMPTION FROM WORKERS'COMPENSATION OECIARATION: (This section need not be completed r the permit is for one hundred($100)or less). DEVELO P M E N T' SERVICESR E Q U T A E M E N T' S I certify that in the performance of the work for which this permit' issued,I shall not employ ani person in an manner so as to become -1 subject to the Workers'Compensation Laws of/California. j7�i.i�w--�r^�fX ZONING APPROVED BY :': ,. ., S(-! t. DATE: c---L71-41D ...71 1 D Date: 5-2'5 'Signature: I4 s31' BUILDING APPROVED BY DATE: NOTICE:It,after making this declaration,you should became subject t the orkers'Cumpen ion provisions of the Labor .. Code,you must forthwith comply with such provisions or this permit sha deemed.revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: : - c'' a et IA (K� DATE: S-1. p which this permit is issued(Section 3097,Civ.C). ******************************,*****r******* *{F3F3F************************* **** LENDER: ***********************************;***********if******************************** ADDRESS: LEGALIZATION:Y F E E SUMMARY STRUCTURAL SEGMENT:Y OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 3 0 , 0 0 4 .00 .. 5 0 repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed • 25% SMIP/NON-RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN 19 . 50 and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(S500). ISSUE FEE 3 . 00 I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 34 . 50 3 . 00 9 .75 47 , 25 47 . 25 , . 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through his or her own employees.provided that such improvements are not intended or offered for sale.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED• 47. 25 OVER/SHORT• ,00 improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044.Business 30 . 00 7• 00 . 50 9 • 75 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects tith a contractor(s)license pursuant to the Contractors'State License Law).l am aware ******************************************************************************* that proof of their Worker's Compens:0on insurance should be provided to me. IND IV ID UAL F E E BR E AK DOWN ® I am exempt under Section:B p 7044 B.&P.C. for this reason: NO EMPLOYEES / TYPE QTY DESCRIPTION • UNIT COST TOTAL COST Data: 5_21/45.. 90 ( Owner: / SFR 400 ALTER BY VALUE RESIDENTIAL NOZONE 1 , 00 400 ,00 I do hereby certify that I am aware of and understand the requirements of California Heat an Safety Code Secti ns 25505,25533,and PLU 1 SEWER CAP / DEMOLITION EACH 2 . 00 2 . 00 25534 and that I or any future building occupant will/Minot(circle one)need to comply wit aid state codes and the requirements for a . permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from END OF FEES these provisions. Date: Applicant: I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction and pereby authorize representatives of this city er upon the above-mentioned property for inspection purposes. Date: S'L5-10 ( Signature: 01 00061718-00061721 TOT 47.75 • Driver's License or Social Secudty rt: DATE: 05/25/90 TIME: 11:26 1641-46 White-Building;Green-Code Enforcement;Canary—Applicant:Pink—Revenue;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' r;6.. Electrical UFERGrhd. 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 _ (/'r((% c 2 63. Heater & Vent-Final - 13. Roof Drains 'll 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final ' 15. Rough Electrical-Conduit 66. Solar System-Final T • 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 "t -� FIRE DEPT. REQUIREMENT_ i 20:Rough Factory Fireplace r= -- -- _ r ` -APPROVALS -. Permit # - - 21. Ducts, ifStructure: ' 1 - - ,70. Underground]Hydro ,. 22. Ducts, Ventilating ' • r-1 .c .. '- .. -71, Product-Piping 0 Gas 0.Oil 23. Gas Pipe-Rough & lest r . .4 ;72. Underground Flush ; 24.-Roof Flaming w l ,- x 1 ::73.-Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 4 - x. y 74,-Overhead Hydro-. .1 -1;J 1 _ : m f r 7 a 26'T-Bar Ceiling (Structurall &NMonocoat = - J C! _ x 75vDry Chemical _ ;� 27._Frameand Flashing' _ _ , ^ &-f9--go e3 76. Dry Standpipe -'`1=- I: ,_ 28. Lathing;& Siding `� : G;-lp to Fjw�: 77. ;FIXED SYSTEM:FINAL= - 29. Insulation - - - 78.FIRE PR EV. FINAL ,. - • 30. Drywall.Nailing .. •-410; f4/-i& C(4/ft ;crJ HEALTH-DEPT, R EQUIREMENT ..;31. Plaster Brown t Coa . T?' .• G_22.4o 6 tx,14 79. FINAL INSPECTION ' - - ':32:.ElectricaCPower Meter'Final = ji ;. ., ' 80.-FOOD CERTIFICATE ISSU.ED,. :'33.:Final Electric= I 4-,c:, G-a-exp 4 Notes: i•-: - 5 `34t_Final Heating& Air,Conditioning to -- _ '' s r7,� 35i-Final Gas Pipe-Test: •tct - r, ' • ,: - - '< - " f36.,Hood or,Canopy 1 '-1 ' -a ' - ` t• - - -- -., tro • 37.•Final Factory Fireplace- Et i:- a.< ' " 'cr. "" :3B;Final Plumbing ` .� - G-(9--40 'L C'D4 - , `39. Water Service:.Final,. •"S - .- _ . . . - . .- 40. Gas;Service-Final • _ ' " I - - '"41.'Solar Domestic-Final -' t '4- r" ,'') ." 'r .-. y. . -" -1 - . . 42. BackflowPreventerk '3 --:C . ' - x1, :: >F • ` Y. a .-P-i .-1 . X I-'. ETT 0"..., 2 43. Backflow Irrigation.:. >,,-" ? V ' '1 ;44. Landscape lirigation System:'.,fir: m• .i. 6 <; , .., Z „ttr: ; "45:1Sound Attenuation. -7 •' - M -.,_ �� _46.•Handicap Regulations - y * ` _ _ .47-FINAL STRUCTURE & BUILDING ; t,20,,, '✓ pulj,Y� f• 48.FINAL PLANNING' - 1 r L )7y" ' _ c , . , ..r ,} ti T49.,Eleciric Release to Edison i. • - 50._Gas-Release to Southern California Gas Co ; ' ? I- ` - = ' -51. CERTIFICATE OF OCCUPANCY _ No. Date LIMITED STATEMENT OF RESPONSIBILITY Bldg, Permit # TO WHOM IT MAY CONCERN: This Permit # • ` 7s ll9tub' R./ X11 ef) 3 AV Street Address AP Number I, C4-iinEs (p• l cS/ , as Owner in Title of the above referenced property, do hereby authorize: 14-ern QM 64,mVM� P) 9(3-%91 ame ) Telephone No. �V i )X l Street Address ►—viY CAC\ �l� CA 6y k6 Qt State Zip to obtain permits in my behalf, as owner/builder, for at the above referenced property. Should any person become an employee engaged in the improvement of the property, I shall immediately provide Worker's 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. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other per- son, company or corporation. 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 parties. t..1744tE5 &. w Printed Name Date AI I I" i•' ature MAY 2 5 WO MAY 2 5 1990 0]]9-46,rev.6/87 PROJECT ADDRESS: 178 WELLS PL UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 047685 OWNER'S NAME: MR, JAMES WEST ADDTIkst 178 WELLSPL PERMIT NO: E 047685 PLAN CHECK NO: N GOVT: ' N SUPP : N • COSTA MESA CA 92627 CONSTRUCTION TYPE: 5—N PERMIT TYPE: ELE PURPOSE: OTH ( 714 ) 968-3856 ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : DEMO OFFICE/RESTORE GARAGE/ADD 2 WINDOWS SQ FT: ADDRESS: UNIT: CLAIM VALUE: CALC—VALUE: GROUP OCC : M-1 / PERMITTEE: JAMES WEST ( 714 ) 968-3856 ADDRESS: 178 WELLS PL COMMENTS : RE: B47497 PRIMARY BLDG. PERMIT. COSTA MESA CA 92627 ************iE*************************** ************************** *********** LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. SE T B ACK S CITY UC.: STATE LIC.: CUSS: Date: Signature: MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT : FT IN REAR: FT IN FRNT: FT IN REAR: FT IN Compensation Insurance,or a certified copy thereof(Section 380 .Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN POLICY NO.: EXP.DATE: COMPANY: PARKING REQ: PROV: PARCEL : 42541314 ZNE: REF NO: U Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. PLANNING NOTES> > Date: Applicant: ************************************,******************************************* EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (this secden need not be completed if the permit is for one hundred(5100)or less). DEVELOPMENT S .E;'R. V I C E S REQUIREMENTS I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California. ZONING APPROVED BY - • DATE; Date: Signature: BUILDING APPROVED BY : DATE: NOTICE:If,after making this with you should becomersubject to the Workers'Compensation provisions of the Labor Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. /� CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: ` DATE- C. '4'rtC2 which this permit is issued(Section 3097,Civ.C). ************************c *** BE*�* *** ***********************iF**** LENDER: ******************************************** ********************************* ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N OWNER BUILDER DECLARATION: Ihereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: My city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 1 , 5 0 repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she Is licensed 5,C)% SMIP/NON—RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.My violation of Section 7031.5 by . any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE 15 . 00 PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE 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(Section 7044,Business and Professional Code: The Contractors'State License Law c TOTALS---->————> 1 , 0 15 . 00 0 ,00 16 . 50 16 , 50 . 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through BUILDING—DIV—> his or her own employees,provided that such improvements are not intended or offered for sale.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED • 16 , 50 OVER/SHORT; ,00 improvement sold within one year of completion,the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK for the mpurpose of sale). I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 16 . 50 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects vith acontractor(s)licensepursu t to the Contractors' tate License Law). l am aware ******************************************************************************* that proof of their Worker's Compensction insurance should be prow d to me. INDIVIDUAL F E E BREAKDOWN 0q I am exempt under Section: B P 7 04 4 B.&P.C. for this reason: NO EMPLOYEES TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST ' Date: —/to -t'O — Own¢ !_Al. .._ Alli.41/1.1 ' ELE 2 RECEPT/SWITCH 1 ST 20 EA. . 75 1 . 50 I do hereby certify that I am aware of and understand the requirements of California Health an Safety ode Sections'5505,2 END OF FEES 25534 and that I or any future building occupant will/will not(circle one)need to comply with s id state codes and the requirements for a permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from these provisions. Date.. ApDlicant: I hereby certify that I have read this application and state that e above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction an. rely authorize representatives of this city to enter he above-mentioned property for inspection purposes.0 Date: r Cr—w Signature: 0 Ait •• Driver's License or Social Security x: 01 00062778-000062773 T E1 T 16,.50 164146 White—Building;Green—Code Enforcement;Canary—Applicant;Pink—Revenue;Goldenrod—Assessor DATE: 06/08/90 TIME: 14.3E • CONSTRUCTION AND PLANNING - POC 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 - 75. Steel Reinforcement 56. Rough Plumbing & Pressure Test • 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. ; • 8. Foundation - 59. Gas Pipe, 0 Undrgrnd., Test - 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, D Undrgrnd. . 10. Structural Floor System 61. APPROVAL TO DECK =--' 11. Property Sewer Line,81.House Connection 62. Backwash & Receptor-Final -> i . 12. Sewer Cap 63. Heater & Vent-Final _-._..._ 13. Roof Drains - 64. Plumbing System - Final - _i 74. Rough Plumbing 65. Electrical-Final -IS ~\ 15. Rough Electrical-Conduit 66. Solar System-Final > __ ', 16. Rough Electric Wiring 67. Fencing & Access Approval i,-c\ 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING i'\\ 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 1 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 D Oil 23. Gas Pipe-Rough & Test - - 72. Underground Flush 24. Roof Framing • • 73. Undergrnd.Storage Tank 0 Gas D 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 I,.r-. 78.:FIRE PREV. FINAL 30. Drywall Nailing - . - HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION' 32. Electrical Power Meter-Final - r•-• 80..FOOD CERTIFICATE ISSUED 33. Final Electric - i/3/51)ta Notes: -34. Final Heating & Air Conditioning - 35.; Final Gas Pipe-Test - 36. Hood or Canopy - - - ` ';-" - . - 37. Tina] Factory Fireplace - -! 38. Final Plumbing • - , 39. Water Service-Final • . , - - 40. Gas Service-Final - . 41. Solar Domestic-Final • . 42. Backflow Preventer • 43. Backflow Irrigation . - . •44. Landscape Irrigation System- • - ' 45. Sound Attenuation - • . 46. Handicap Regulations - 47. FINAL STRUCTURE & BUILDING ' 48. FINAL PLANNING 49. Electric Release to Edison . • 50. Gas Release to Southern California Gas Co - 51. CERTIFICATE OF OCCUPANCY • No. Date a3914 1 PAID +ICT 25-74001O83* ****53.00 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 For Applicant to Fill in Completely APPLI TION FOR BUILDING PERMIT ABUILDING DDRESS '� is WCIL4 �t ' RECE/OJZ �'IV /,'yE ging DATE OWNER 1111 A.P.NO. II l -ItrzU�-[7-114 PERMIT NO. T. K.UL .1Z MAIL \\\////�� 11 BUILDING /I^^J//Ls- -�p / 2 ADDRESS DA V' 1 -I/749 ADDRTRAG / l �I�LOT )(/ RLO w w TEL.'S CL CITY , fL'✓' NO. CONSTRUCTION + II^_ ^ NEW ADD ,/57l REPAIR MOVING DFMOI LSH Z-m LENDER nJY/'�s' n.m J C BRANCH 'R /' J N OWNER Q W ADDRESS yn_ L CO m ARCHITECT TEL.-7141 USE JAI G •a.�f.W�/ VALU$ ,�r^�'Q� JQ OR ENGINEER1IM \-bwe(l NO. 4C1 -2I39 /vlx/_ y N n FIRE J� W CL ADDRESS W-`4 No CMS{ IArk fI ZONE / TY ii GROUP 7 0-W �sytlJC / wZ Tfl a Ce _ YPROV ED '(..l_ J O CONTRACTOR V " l.fT'LS fl t BY _ DATE`O�L✓ CO JCC ADDRESS 1 w W I'�y'II�II TEL. 20/1^ NO.OF USE OF NEW �Y/r ek VCS- O= CITY CL NO. 421L (� PLANS BUILDIN G ,,.! Z H ��.��-tttt CCJ W-O STATE CITY YARDS APPROVED YARDS APPROVED j co LIC. NO. \24r 49 is LIC.NO. G,Z9� MAIN BUILDING ACCESSORY BUILDING SIZE ANO.OF BLL / (FROM C/L STREET) -- OF LOT WON LOT FRONT FT. FT. USE OF 11 EXISTING BLDG. /1 q,SIDE FT. �I - • FT. I— SIZE OF 2 NEW BLDG. I D�S7Sie ROOMS 1 �� FT. Q � STORIES({`/ L.SIDE U EXTERIOR WALL QS,T7 I ROOF 4 /// T v' COVERING •VERING /n• / / T REAR FT. FT. J OF BUI 1 G AND WOR .i • BE PER ORM CL ' r DISTANCE BET. BET.MAIN& d I _ / A/ MAIN BLDCS. ACCESS. BLOCS. Q / / ^ VAR.# DATE O ,p.s_ (-1 i t I ` z' C.U.P.# APPROVED 2 - _1 —BY ROVEfI \C 10—"� �f p HOLDFORSBECIA DATE STATE UI horeby acknowledge that I have read this application and state I�1�LL�..r M that the above Information is correct and agree to comply with fA)—` CC all laws regulating building construction, and I shall not employ / any person in violation of the workman's compensation laws of V) the State of California. IAX ?? s I hereby certify that I am properly licensed as a contractor under 10 SO. FT. ` the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR 4 Chapter 9, and that such licenses are in full force and affect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE /O�N(Il Y: R am exempt from the provisions of the State of California Business VALUATION 7^ and Professions Code, Division 3,Chapter 9, 35" m O d PERMIT FEE $ D Signature of 11 / )� e5 1 ^7j _. 1 •//JO, �js 0 m Permittee 1 W . LLC J $ / PLAN CHECK $ /i/ E Authorized Agana TOTAL FEE $ ` r 33831 'UN -8-7'c7F• COSTA MESA BUILDING-SAFETY DEPARTMENT rnr 00 381'r• t,a' -:7?" ^� P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR BUILDING PERMIT For Applicant to Fill in Completely RECEIVED Eli DATE RECEIVED DATE ISSUED BUILDING 17 �i- 4-7J `/-- P— 7/ ADDRESS I S Ludlam; I . C. 14PPERMIT NO. OWNER c(cMZ Corp, A.P. NO. MAIL ti BUILDING 7 w 2 . ADDRESS \es G, 1—I�' St ADDRESS I,Q &I g er,4 0 / S O CITY C, 114 NOL Ln-42.10 TRACT///, LOT/F BLOCK Z NEW ADD ALTER REPAIR MOVING DFMOI LSH z< CONSTRUCTION RCTION Nvrr a Cil LENDER 'V J D BRANCH 'J �M '\ ^ J to OWNER CS�I'' t . aN J ADDRESS VA ^t- ARCHITECT •, TEL. S VA $ /�� -U N OR ENGINEER Geoq C. t.0\Sentry, NO Ly2-SSy4 ' �`` / 2 FIRE Zw Q ZONE TYPE, GROUP / 2- Z 2 ADDRESS d W ^ APPROVED �j (, /J W Z CONTRACTOR T, 4, `�sysi; BY `ted DATE/ — O� /) J Q Vt CCI Zr Ww ADDRESS 1$S L 1-11L c\ ZO NO.OF USE OF NEW Z= TEL. /r _� PLANS D BUILDING C'/��li .}� Zi CITY Cs NO. (o4�4ZI/t l/ A(/ii}sq STATE CITY YARDS APPROVED YARDS APPROVED N K LIC. NO. 1 Zip L12(„ LIC. NO, 1;13 MAIN BUILDING ACCESSORY BUILDING D O SIZE (FROM C/L STREET) NO.OF BLDG& OF LOT 11.8 x Co -h NOW ON LOT 2— FRONT FT. FT. USE OF V'�t EXISTING BLDG. QCa^'k.� B_SIDE, FT. FT. I— SIZE OF NO.OF Z NEW BLDG. 2o X 20 ROOMS 3 ST RIES 1 L.SIDE T. FT. VEXTERIOR WALL,}— ROOF ' COVERING I COVERING # REAR F FT. 1 US F BUILD G AND O TO BE PERFORMS —DISTANCE B BET.MAIN& ELI MAIN BLOCS. ACCESS.SLOGS. VA O L.L I� C.U.P.3W ) APPROVED 1— y� NROVED/�/ DATE // 7/ 'I� Z (L p A UI hereby acknowledge that I have read this application and state 9It D that the above information is correct and agree to comply with ¢ all laws regulating building construction, and I shall not employ F any person in violation of the workman's compensation laws of COI— the State of California. m 0 1 — I hereby certify that I am properly licensed as a contractor under SQ. FT. O the State of California Business and Professions Code, Division 3. THE AMOUNT SHOWN UNDER VALUATION IS FOR b Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: 2 am exempt from the provisions of the State of California Business VALUATION and Professio Code,Division 3,Chapter 9. C. 0 PERMIT FEE $ it N D CO Signature of k' K &. E Permittee AAN'3 $ \ PLAN CHECK $ V , Ce�-, /(of w Authorized Agent l „„ TOTAL FEE $.2'4