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HomeMy WebLinkAbout3069 YUKON AVE - Building Permits CITY OF COSTA MESA 11Ass BUILDING DIVISION ¢ I: ltI 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us FOR INSPECTIONS CALL:(714)754-5626 PERMIT NUMBER: P09-00133 PERMIT TYPE PLUM STATUS: ISSUED APN: 41806210 DATE ISSUED: 10/15/2009 • ISSUED BY: RMD JOB ADDRESS: 3069 YUKON AV CM Suite/Unit: Vicinity: GARAGE SCOPE OF WORK: PLUMBING PERMIT FOR A WATER HEATER CHANGE OUT, SAME LOCATION (GARAGE). OWNER: GONZALES, LUZ A Address: GONZALES,AMADO B JR COSTA MESA,CA PHONE: 714-429-1521 City/State/Zip: 3069 YUKON AVE APPLICANT: NOCK,TIM - Address: PHONE: 714 5324857 City/State/zZip: • CONTRACTOR: ORANGE INSTALLERS License No. 511971 Address: 905 E CHALYNN AV PHONE: 714.532.4857 City/State: ORANGE,CA ZipCode: 92865 CELL: • ARCHITECT: License No. PHONE: ENGINEER: License No. PHONE: PLUMBING PERMIT FEE SUMMARY PLAN CHECK FEE: $0.00 PERMIT FEE: $35.80 TOTAL FEES: $35.80 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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. 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. CODEI INSPECTION TYPE PAE INTITIA15 CODES INSPECTION TYPE, DATE IN1111ALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy WORKERS'COMPENSATION DECLARATION: Owner ID verified by drivers license. ❑Yes 0 No I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires: ❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed): compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. O I have and will maintain workers'compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a number are: 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 Carrieic or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Gm (This section need not be Competed d the period is valued at one hundred dollars($100)or less.) 2,Art 2,Sec.341,Title8,California Administrative Code). .OIIcy.Number: 0 )rxxico') I ZU0&3 J v 0 As owner-builder, I will not employ anyone to do work which would O I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless issued, I shall not employ any pe.r•,sqon in any manner so as to become subject such person has a permit to do such work from the division. to the workers' com.en .tion - of California, and agree that if I should become subject toy ulcersmpensation provisions of Section 3700 of — the Labor Code,I7#I .: 't .mply with these provisions. Appliwnl's Signature Date i.- tC, - iy- C7 9 Division of Industrial Safety Permit Number: adr ..'�nl's Signature Lie HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes 0 No ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. 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 LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons,or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file my license is in full force and effect. a registration form for acutely hazardous materials? 0 Yes 0 No 6 /nn1 : 367 L' a. () [ 7/ 1 / Class# C /62` RI fU (Section 25533 of the California Health and Safety Code, with some �iy\ exceptions, requires registration with the Costa Mesa Fire Department by c... / each business which at any one time has on hand a quantity of acutely %yon ;dots st tut %„%Dale 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 CONSTRUCTION LENDING AGENCY: temperature and pressure). ❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? 0 Yes 0 No (Section 25534 of the California Health and Safety Code provides that the Lender's Address: 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. Signature Date 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 0 No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes 0 No issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors (Section 658fu i the onCaliforniaappGovemment Code requires thnt the requested LicenseeLaw osr 9 e(commencing th Section is 0)ofDivisione3 of the information be furnished on applications for non-residential building permits). Business and Professions Code) or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes 0 No applicant for a permit subjects the applicant to a civil penalty of not more than (If'yes", the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the California Health and Safety Code). ❑ I, as owner of the properly, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec. 7044,Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by California License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes 0 No thereon,and who does such work himself or herself or through his or her own 8 (If"yes",attach certificate of compliance from the appropriate air pollution employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of control officer). completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code: The contractors License Law does not apply to an owner of Signature Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that ❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of Business and Professions Code for this reason: 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. Signzlur Legal ner(s) / /Date d Signature Date /9 ' Y L'" 3057.4613/07) - atallmd;lieu ppliwnt Gate' 061" MS.4 CITY OF COSTA MESA �@ BUILDING DIVISION y _ �_ DEVELOPMENT SERVICES DEPARTMENT PER NUMBER F1 . �.� �-�, . � PERMIT 4r,Rr111 B04-00750 also (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 3069 YUKON AV Status: ISSUED Suite: Applied: 04/19/2004 Vicinity: Issued: 04/19/2004 Parcel Number: 41806210 Zoning: R1 R1 Applicant: FAUBERT, TRACI ISSUED BY: v 411 , Address: Phone: Zip: Owner: GONZALES, LUZ A Address GONZALES,AMADO B JR . COSTA MESA,CA Phone: r • 3069 YUKON AVE Zip: 92626-2919 /14, Ortft' Contractor: STAR COURSE ROOFING COMPANY p' - Address: 8902 SAILPORT DR Phone: (800)954-0011 HUNTINGTON BEACH,CA Zip: 92646-2664 License: 532778 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT REROOF:TEAR OFF EXISTING ROOF, INSTALL NEW 1/2"PLYWOOD OVER EXISTING PLYWOOD 8;30 YR.COMP.SHINLGES.(HOUSE& ATTACHED GARAGE) FEE SUMMARY Plan Check: $0.00 Calc Valuation: $6,000.00 Permit: $125.25 Claim Valuation: $6,000.00 SMIP Res: $0.60 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 • - Total: $125.85 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 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. - INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) 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. i y r 'cofmrpeennsattiipn Insurance carder and policy number are: y.,�fJ, J ,?-0711- ('(This Corner: g -t 1 V,1//t , ,olidy. mbar. I J ('I �°5 (This section need not be cample d if the permit is valued at one hundred dollars(5100)or less.) ❑ I certify that in the Jorma e 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 I s f Calif() ia,an agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with th se o „Aptilliant Signature: /, D� --- ,WARNING:FAILURE TO SECURE WORK RS'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 hereb•affirm that I am licenysd u erRrovisi f Chapter 9(commencing with Section 7000)of Divirt of he Busin sapq Professions Code,and my license is in full Lof e a effect.Lic.N 17 .l-7 '/ ���&&&Class /•—) C Dtra is Signature: AAA* �.f ji^: t» LC- / f V. CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: _ _ Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm thaTtinda?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,whicfi.requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business end 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 en 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 driver's license. 0 Yes 0 No Drivers 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 material? ❑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 end Safety Code.with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes El 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 ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes U 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 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health end Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If'yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND 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 wi all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-descri d property for i spection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. M/ , at r Of eget,]wner(s) D.t� V' U� r � - r nd/Or uthonized Applicant k.y-" Dat: CODE I INSPECTION TYPE lag JNRRALS coDEI INSPECTION TYPE PAIS MGM 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing • 200 Final Re-Roof / ✓ _ / 210 Final Electrical 201 Final Block/Retaining Wall 2 !ldr. I = �_• -1 212 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 1 .- CITY OF COSTA MESA a ° BUILDING DIVISION F• ;. �( DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER ' PERMIT v -'"Iroaaisi Mol 00377 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 3069 YUKON AV Status: ISSUED Suite No Applied: 07/14/2004 Issued: 07/14/2004 Vicinity: - a Parcel Number: 41806210 ISSUED BY: Yom/A Applicant: BARKHO, MAHIR Address: Phone: 714-412-4926 Zip: Owner: GONZALES, LUZ A Address: GONZALES,AMADO B JR COSTA MESA,CA Phone: 3069 YUKON AVE Zip: 92626-2919 Contractor: OWNER-BUILDER Address: Phone: Zip: • License:000000 SCOPE OF PERMIT ADD 368 S.F.TO EXISTING S.F.D.WORK TO INCLUDE:ADD 2 NEW BEDROOMS AND 1 NEW BATH. CONVERT 3 BEDROOM,2 BATH S.F.D.TO A 4 BEDROOM,3 BATH S.F.D. 1 REPAIR/ALT COOLING/HEAT,2 VENT FANS/SINGLE DUCT REF:604-01042 FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $0.00 0 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $13.70 1 • Evaporative Cooler $0.00 0 • Inst/Rep.Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU $0.00 0 - Compressors/Absorption Systems Gas Piping $0.00 0 • Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace $0.00 0 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct $14.50 2 Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers Fire Dampers $0.00 0 : , , Up to 3 hp - $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp - $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(WOO) i y DECLARATIONS 1 \ j • 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 scaled. My workers'compensation Insurance carrier and policy number are: Cartier: Policy Number: (This sect' need not be completed if the permit is valued at one hundred dollars(S to0)or less.) ❑ certify that in the performance of the work for which this permit F .ued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and a• :e that - ould•: •r--subject•-n- •rkers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisi•• '/ Applicant Signature: /�f�/_ Date: 7/477 C7 WARNING:FAILURE T•- CU- •0- ERS'COMPENSA •COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CR I PENALTIES AND L FINES P TO ONE HUNDRED THOUSAND DOLL- ' ($100,o0o),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.N Class It Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: • Signature: Date: OWNER-BUILDER DECLARATIONS: • I hereby affirm that under penalty of perjury that I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the.applicant to a civil penalty of not more than five hundred dollars($500).): ❑ s 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 ex: •tun•. sec. - Business and Professions Code for this reason: / //�/v Signatur. - Date: /J Own: s I=-. . ±• .fi A Yes 0 No Driver's License N• / . : - Expires:)),� / Verification of Ownership by(type of d• m• t,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,fatsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 6,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely-hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aggermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 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 0 No (If'yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑yes 0 No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I 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•r allow occupancy of any building authorized by this permit until final inspection. p# nner(s) • Date // •,.O-' .;._.A.Y:r'cant"(,. .ate , CODE r INSPECTION TYPE PATE Q11IDAL5 CODE( INSPECTION TYPE gaff• If(f AL '" 1616 Fixed System Final Fire Prevention 206 Final Mechanical 0 04l 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final BIocWRetaining 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 IIt CITY OF COSTA MESA BUILDING DIVISION s.°r- f,I DEVELOPMENT SERVICES DEPARTMENT PERMIT UMBER 4 PERMIT 04-00484 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 3069 YUKON AV Status: ISSUED Suite No Applied: 07/14/2004 Issued: 07/14/2004 Vicinity: ISSUED BY: _�i Parcel Nunmber: 41806210 / • Applicant: BARKHO, MAHIR Address: Phone: 714-412-4926 Zip: • Owner: GONZALES, LUZ A Address GONZALES,AMADO B JR COSTA MESA,CA Phone: 3069 YUKON AVE Zip: 92626-2919 • Contractor: OWNER-BUILDER Address: • Phone: Zip: License: 000000 • Arch / Eng: - Address: Phone: Zip: • License: • SCOPE OF PERMIT ADD 368 S.F.TO EXISTING S.F.D.WORK TO INCLUDE:ADD 2 NEW BEDROOMS AND 1 NEW W BATH. - - CONVERT 3 BEDROOM,2 BATH S.F.D.-TO A 4 BEDROOM,.3 BATH S.F.D. 2 SHOWERS,2 WASH BASINS,2 WATER CLOSETS - REF:B04-01042 - FEE SUMMARY AMT QTY - AMT QTY AMT QTY ISSUE FEE " $23.50 . Laundry Tub/Washer $0.00 .0 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 -0 ' Swimming Pool, , $0.00 0 Backflow Preventer ' ,$0.00 0 - P-Trap $0.00 0 - Trap Primer: $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 '0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 _ Septic Tank $0.00 0 Wash Basin $19.60 2 Dishwasher $0.00 0 • Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain,Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $19.60 2 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.NO.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 244646(6/00) DECLARATIONS ` ) ", 1 • 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. ❑ 1 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 s on need not be completed if the permit is valued at one hundred dollars($100)or less.) I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should be e subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provi /7�/b Applicant Signature: - - Date: WARNING:FAILURE T• - - •-K " gA�• •IEERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CITIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DO-LARE($100,000),IN ADDITION TO HE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full force and effect.Lic.# Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the 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 fore permit subje s"the applicant to a civil penalty of not more than five hundred dollars($500).): I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ 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 Lic=nse Laws. ❑ 1 am exam• •r •- / Business and Professions Code for this reason: Signature: nit=- ieSS .. Date: ii Owner l• • rive li.. .:�I, Y o Driver's License N.. � � _ Expirey0 Verifica on of Ownership by(type.f docum:•t,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,Califomia Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aPermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes 0 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 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). .t..Ca....i Quality Management i g....n.. ism ..... 7 If a permit fromv the South Coast s Quality ed by gement Di al or other airpollution ooncontrol district3 agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑No 8 (It'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. ire Of ,.a10 er, •ate disi iv � •9r b- rz:. .p,., Date i CODE• INSPECTION TYPE DATE INTITIALE CODE t INSPECTION TYPE DATE INTITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical aJ 1266 Pool Spa Final 208 Final Plumbing /O-2 -D ` 4-4tM 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 4 ' M CITY OF COSTA MESA BUILDING DIVISION F• � II 8 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4 • PERMIT • - elf E04-00806 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 3069 YUKON AV Status: ISSUED Suite No Applied: 07/14/2004 Vicinity: Issued: 07/14/2004 Parcel Nunmber: 41806210 a Applicant: BARKHO, MAHIR• ISSUED BY: � Address: / • Phone: 714-412-4926 . Zip: Owner: GONZALES, LUZ A Address. GONZALES,AMADO B JR COSTA MESA,CA Phone: 3069 YUKON AVE Zip: 92626-2919 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 000000 , SCOPE OF PERMIT ADD 368 S.F.TO EXISTING S.F.D.WORK TO INCLUDE:ADD 2 NEW BEDROOMS AND 1 NEW BATH. CONVERT 3 BEDROOM,2 BATH S.F.D.TO A 4 BEDROOM,3 BATH'S.F.D. • 6 LIGHT FIXTURES, 12 OUTLETS,6 SWITCHES REF: B04-01042 FEE SUMMARY Quantity Quantity ISSUE FEE • $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 _ . Busway/100 ft $0.00 0 ' Res.a/c package $0.00 Standing Section $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 Transformers up to 1 kva/kw- $0.00 0 Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0 Lighting Fixts $6.60 6 up to 50 kva/kw $0.00 0 Recept Outlets , $13.20 - 12 up to 100 kva/kw $0.00 -.0 " Switches . - $6.60 6-; over 100 kva/kw $0.00 "-0 ` Non Res Appl $0.00 0 _ Low Voltage Equipment $0.00 ' 0 ' Res Appl ' $0.00 0, Low Volt Wiring System/Ckt $0.00 .; 0' / Service to 200a $0.00 0 Misc.Conduit $0.00 •0 Service to 1000a $0.00 0 Misc.Conductor $0.00 " '0 Service over 1000a $0.00 0 - Circus(gen or ride) $0.00 0 Motors to 1 hp $0.00 0 Circus(mech ride or lights) • '$0.00 0 Motors to 10hp $0.00 . 0 - Christmas Tree Stand - - $0.00 0 Motors to 50hp $0.00 0 - Fireworks Stand $0.00 0 . Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§1,12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 244646(6/00) DECLARATIONS I 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 s on need not be completed if the permit Is valued at one hundred dollars($100)or less.) I certify that in the performance of the work for which this p+;;: is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Colifor.a, • • ,1 ree t•,. if I sho • -:comes ,e to the workers'compensation provisions of Section 3700 of t1Le Labor Code,I shall forthwith comply with these prove / //� v ti- Applicant Signature: Z1? /fLi Date: / i -- WARNING:FAILURE Tsi CURE WO- ERS'COMP SATION •VEPAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO IMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lie.# Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: In I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business.and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit I,sub' s the applicant to a civil penalty of not more than five hundred dollars($500).): 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 u / B I •: and Professions Code for this reason: —a C Signature: /� t!! " Date: Owner IDi. i8 s .�.i�es Mw Driver's License .- Expires: Verification of Ownership by(type of do,:me ,I.e,-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. . 341,Title 8,California Administrative Code), O As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the 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? 0 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). 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_Eermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Ul Yes 0 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 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relatin• 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 oc •''r allow cupancy of any building authorized by this permit until final inspection. /// vny �� / Aut ..•fAp"plic / / ate d/ CODES ftSPFCTION TYPE LAIL INTRIALS CODES JNSPECTION TYPE DATE Riltt&J, 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Well 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 S • CITY OF COSTA MESA 4 , BUILDING DIVISION F • �I DEVELOPMENT SERVICES DEPARTMENT PERMITNUMBER S r ®C PERMIT 4 rarraa n* BO -01042 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 3069 YUKON AV Status: ISSUED Suite: Applied: 06/08/2004 Vicinity: Issued: 07/14/2004 Parcel Number: 41806210 Zoning: R1 R1 Applicant: MAHIR BARKHO ISSUED BY: Address: 1009 SECRETARIAT CI Phone: 714-412-4926 COSTA MESA,CA Zip: 92626 Owner: GONZALES, LUZ A Address GONZALES,AMADO B JR COSTA MESA,CA Phone: 3069 YUKON AVE Zip: 92626-2919 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 000000 Arch : - Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT ADD 497 S.F.TO EXISTING S.F.D.WORK TO INCLUDE:ADD 2 NEW BEDROOMS AND 1 NEW BATH. CONVERT 3 BEDROOM,2 BATH S.F.D.TO A 4 BEDROOM,3 BATH S.F.D.25'SETBACK PROVIDED TO BEDROOMS AT THE LEFT SIDE OF THE HOUSE. PLANNING: LOT SIZE=6,300 SQ.FT. TOTAL LOT COVERAGE=1,694 SQ.FT. OPEN SPACE=4,606 SQ.FT.(73%) FEE SUMMARY Plan Check: $392.50 . Calc Valuation: $45,922.80 Permit: $603.85 Claim Valuation: $0.00 SMIP Res: $4.59 SMIP Corn: $0.00 • • Other: $0.00 Inspection: $0.00 Total: $1,000.94 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 20-6 Rear 23-6 Left 6-0 Right 5-0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§ 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 suspe �a��ed for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-96(6/00) P.114V !:f'r1L.flS ,. 1 WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have end 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: (Thistlon need not be completed it the permit Is valued at one hundred dollars($100)or less.) .2(sec iertify that in the performance of the work for which this permit Is ssued,I shall not employ any person In any manner so as to become subject to the workers' •-------Compensatlon laws of California,and agree tha should bees:,:subje 0 t : •orkers'compensation provisions of Section 37 of the Labor Code,I shall forthwith �_comply.with4hese provisi••/� / �// Applicant Signature:_ /�1/ / / rDete:-- rlfl / d WARNING:FAILURE TO ECU-EWO•I' RS'COMP/TI. 2. ERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL P NALTIES AND IVIL RNES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,000).IN ADDITIONTOTHE COSH, COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class# Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or Improvement Is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ 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 driver's license. ❑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 material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has et any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutety hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑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_Pparmit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes u No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ..r..i....l..i.n...n r 7 If a permit from the South Coast res Duality eby CaliforniaDistrict or dhSr airtpollution control 4l district03 or agency is requiredsfor the work which is the subject of this application,have all of the disclosures prescribed by CelfoHealth and Safety Code Section 42303 been made? ❑Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I 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. Lo ��� /- Date f•ndtOr Aut "•":d Applicant I '•ate OOOE I, INSPECTION TYPF WC LNrmALs WOE€ INSPECTION TYPE gaff INIITMI$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 20B Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site /��/�� A 204 Final Demolition 250 Final Building/Occupancy f/Tar .077 CITY OF COSTA MESA BUILDING DIVISION >t•l r,,,., � DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER FS.I y . ./ PERMIT ' aha�. B04-01042 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 3069 YUKON AV Status: ISSUED Suite: Applied: 06/08/2004 Vicinity: Issued: 07/14/2004 Parcel Number: 41806210 Zoning: R1 R1 Applicant: MAHIR BARKHO ISSUED BY: Address: 1009 SECRETARIAT CI Phone: 714-412-4926 COSTA MESA,CA Zip: 92626 Owner: GONZALES, LUZ A Address GONZALES,AMADO B JR COSTA MESA,CA Phone: 3069 YUKON AVE Zip: 92626-2919 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 000000 Arch : Eng: Address: - Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT ADD 368 S.F.TO EXISTING S.F.D.WORK TO INCLUDE:ADD 2 NEW BEDROOMS AND 1 NEW BATH. CONVERT 3 BEDROOM,2 BATH S.F.D.TO A 4 BEDROOM,3 BATH S.F.D. PLANNING:LOT SIZE=6,300 SOFT. TOTAL LOT COVERAGE=1,694 SOFT. • OPEN SPACE=4,606 SOFT.(73%) FEE SUMMARY Plan Check: $320.29 Calc Valuation: $34,003.20 Permit: $492.75 - Claim Valuation: $0.00 SMIP Res: $3.40 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $816.44 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 20-6 Rear 23-6 Left 6-0 , Right 5-0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2448-48(8100) DECLARATIONS I ` - 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.) I certify that in the performance of the work for which this permit Is Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and:•ree that If I ould beco a subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these pr. " rs. — �/ / L Applicant Signature: Ale" i i .� Date: (2 WARNING:FAILURE TO ECURE• ORKERS'COMP •SATION COVE43E IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100000),IN ADDITION TO THE-COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class# Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097•Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5•Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business 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 to a civil penalty of not more than five hundred dollars($500).): N,( 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.It,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. in s and Professions Code for this reason: Signature: r(27/7„.2,<-0! X Date: /ftee-/- Owner /�7y Owner ID ve d erne. G e Drivers License — ExXppires: h/ng Verification of Ownership by(type of dotu en, .e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet In depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap,3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑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? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does....... oes .r........... 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 0 No (Section 25534 of the Califomia 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. ......n.RMPP i...r s n iy ..ir. .. 4 If an 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 apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If ryes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No .tr.l ........... 8 (If yoes",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 COMPUANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that ijRjnfornation 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-Mese 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 inspec'on. �nat Legal• '°r15/✓� - V /7r/ 7� Date ,r r A zed App rc-nt \ • to .406'- I CODE I IfISPECTION TYPE •_)J .frt11AL QomitSPEOTIONTYPE GATE . 1616 Fixed System Final Fire Prove • � - ' . 66-' Final Mechanical , & . .y 1266 Pool Spe Final 208 Final Plumbi • Tent 200 Final Re-Roof i w • 210 Final :l/ctri•i' ,9 201 Final Block/Retaining Wall A + 212 . Inal 'rev4ntion, ,, 202 Final Factory Fire Place 1.:00001. 220 i •- .- .' ing Approval 203 Final Sign 222 "J: Site l�- P 204 Final Demolition 250 Final Building/Occupancy • DECLARATION OF AUTHORITY Bldg. Permit# FOR AGENTS OF PROPERTY OWNER TO APPLY FOR PERMITS This Permit# Street Address: -7 0 CO / d 1 j v C (or! ' AP Number: 1. I (we), L IA Z A • 0 Nj r 4 c , declare that I am the Owner of Title of the above referenced real p roperty,,and that I (we) hereby authorize: Name: /l \11 1 Yha\ i CorI4C M Telephone Number: 7/7-—7/ ///CJ 4/2z7 Street Address: / ( 0 / Tn &T>C!A- ) City: ( re1-re M z.� <�� State: _A� Zip: /2 2- to obtain permits in my behalf,as owner/builder,for C C� ce\ at the above referenced property. 2. Should any person become an employee engaged in the improvement of the property, I (we)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. 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 parties as a result of work authorized by the permits from the City of Costa Mesa. 5. I declare under the penalty of perjury t t the forgoing is true and correct. fit g Executed this /3 day of ✓f 20n V at ( df/g I'/ S' , California. Print Name: LA /`'rAl' G (l / 't Signature: 62 7 Date: -/f1�7 J Note: This authorization does .t grant authorization to perform the work as owner, it solely provides for limited power of attomey to secure this permit in any behalf. 0779-46(rev.11/00) t`,6Tp MF 9 CITY OF COSTA MESA ha BUILDING DIVISION ► y• al I DEVELOPMENT SERVICES DEPARTMENT PERMIT NU BER -4. re. PERMIT E04-00 6 'rQ..memo (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ElLECTRICAL PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 3069 YUKON AV Status: ISSUED Suite No Applied: 07/14/2004 Vicinity: Issued: 07/14/2004 Parcel Nunmber: 41806210 Applicant: BARKHO, MAHIR Address: Phone: 714-412-4926 ISSUED BY: Zip: Owner: GONZALES, LUZ A Address GONZALES,AMADO B JR COSTA MESA.CA Phone: r. ' 3069 YUKON AVE Zip: 92626-2919 •-,e, ,� s Contractor: OWNER-BUILDER • '1, Address: • ~ ;$~` Phone: • './-'\ rA n . ik Zip: License: 000000 i f ,.• ' t+ v?,: (" • ..-. :ca.. :4'9 gopa 66 jj i0 EXISTI ".F.D.WO` O INCLUDE:ALs 2 NEW BEDROOMS AN 4 ' 4EW BATH. ilr•;ti�.ny A��'' r.:.,CONV T�3;1 EDRObM,2 BPTH S.F.D;TOA 4fBEDROOM,3 BATH S.F.D. - 44jGHT FJXit(RES, 2.OUT ETS,6 SWITCHES F:B04- 1042 i7 rQ7/20/04 REVISED: D t29 F.FORS A�T,OTAL OF5,97-8.F. I �Ly li , '(YNati ...%/V'MW1If . j EE SUMMARY t(. Quantity Quantity ISSUE FEE '1r Temp Dist System/Lighting $0.00 0 Temp servicest,{ 7Busway/100 ft $0.00 0 Res.a/c package (:,.f.W' 00 Standing Section $0.00 0 New Res(1-2 units)se $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0 Lighting Fixts $6.60 6 up to 50 kva/kw $0.00 0 Recept Outlets $13.20 12 up to 100 kva/kw $0.00 0 Switches $6.60 6 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $0.00 0 Misc.Conduit $0.00 0 Service to 1000a $0.00 0 Misc.Conductor $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1 hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temo Pwr Pole $0.00 0 TOTAL CALCULATED FEES $49.90 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 244648(6100) WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the to declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the Workers'compensation provisions of Section 3700 of the Labor Code,1 shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force end effect.Lic.s Class a Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: c' 1 I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Seci,,7IX11.5,,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 reigiibes the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(o91hm`encing with Seglbn 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 efoletlat of Section'7031.5.by any applicant fora permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): - r b.4.::;')/ El I.as owner of the property,or my employees with wages as their sole compensation.WILL DO THE WORK,and the,,..;':77.1`..-4‘ ITect@e k AEA . tled or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner'of propertyiNho builds or finproves!baleen,and who does such work himself or herself or through his or her own employees,provided that such improvements ata not Intended or Offered for eaii tf;'however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that hes she did not build or improve ter purpose of sale.). o I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to conmuclthe pro)ed(Sec:.7044,Business and Professions Code:The contractors License Law does not apply loan owner of property who buildc191or seen project with a contractor(s) license pursuant to the Contractors License Laws.). 4 ". . •I 1 . s or,bnpioves thereon,and who contrer .:', .r' ,, ',x f Q I am exempt under sec. ,'Business and Pietessions Cada for Mason: ason: ff' Signature: ' r.''•b: A 1 .. }. j(,rrlr;.. Date: 1.--', ' ( Owner ID verified by driver's license. 0 Yes ❑No .;;). -',,it-Drivel's License No. ` " 'f 1 . '" : '( Expires: • Verification of Ownership by(type of document,i.e.-property taTbill or doe- - /' ( - DIVISION OF INDUSTRIAI/f APETYPERMrT:CERTIRCAT10N: ` -:';'..14'.1 O I hereby certify that nb axc/Jatton five(5)or more feet In depth into MOS)a parson 6'ret$lietl to descend,will be made in connection with work authorized by this permit,and that rw ei llding strucWrer s affoldirq,fatsework,or demo9tlon a dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2.Sec. 341,Title 8,California Adminisirative Code). I.. ,- 'ik Jb 17) As owner-builder E WIY/not employ anyone to do,wale which ward iequi a per frac the Division of Industrial Safety, as noted above, unless such person has a permit to do such wertkifrom the division. ` 1-,rl' Signature: 1 / Date: I 3:'-I St .d': Division of Industrial Safety PAermit Nun ,'U HAZARDOUS MATERIALS'AND EMISSIONS CERTIFICATION: 1 W III the applicant or pros l Oi.tU1U1e.Uuilding occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? IDYee- t❑No.;/v, e (Section 25505 hf a any one time and report Code requires,quan,with some exceptions,that a oinr Plan filedigh the Costa Mesa Fire Department by lions, business which has 2t-ertY one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pountls,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 torm for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and tiling 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 app,ermit for such construction or modification from the South Coast Air(Duality Management District or from any other air pollution control district or agency? U 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 pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air(Duality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No et (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penally 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: Dale: 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(s) Date And/Dr Authorized Applicant Dale 600E S WSPECTt9N TYPE am INTmAL$ CODES INSPECTION TYPE on INTRIAL$ 1616 Fixed System Final Fire Prevention 206206 Final Mechanical 1266 �fPod: Final .. .�'f"" ,.:77277-.-i-7-- 2�B Flr}1alPNmbinp t6' ( .m‘31r ./. ,. 200 !' FbFial Rd-Roo '�•.�. f r ' "✓''L--- V 210( LMA EleclrlCsl • - NM., �ii. ,,AL ////// ' / z L r . 1 l .t•v' yyy 201 Final lock/Retaining Wall I' •j } 5 $12t, Mel Fire PtavBMlon .] *'' 7 ` • C / 202 Final Factory Fire Placa 7k. .1 J L " 2Lq•" Fbbd Plamtbng Approval 203 Final Stn '/-• '� ` ""'�+^+"!` Y'Flnel Site • . 204 Final psrnoliaon� ` •i -... _,Final Building/Occupancy 4. • -'. PROJECT SHREW 1.3069 YUKON AV UNIT: CITY OF COSTA MESA — BUILDING PERMIT —PPM NU; d UL,I49j OWNER';NAME:YOUNG, MARGARET F A ADDRESS: 3069 YUKON PERMIT NO: B 061243 PLAN CHECK NO: 00729-93 S GOVI : N SUkP; N COSTA MESA, CA 92626 CONSTRUCTION TYPE: 5—N PERMIT TYPE: 5TR PURPOSE: OTH ( 714 ) 434-2635 ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : 75 LIN FT OF RCMU WALL @ 6 ' HIGH SQ FT: 75 I ADDRESS: UNIT: CLAIM VALUE: CALL—VALUE: 1, 500 . 00 GROUP OCC; R-3 / t. PERMITTEE:KENNETH R. CURTIS. INC. ( 714 ) 879-0814 / ADDRESS: 2146 SKYLINE DR COMMENTS: SMOKE DETECTORS REQUIRED PER THE 1991 EDITION OF THE UBC , FULLERTON CA 92631 ***SPx**************-*********i��E*****S6**�E�E***�6*****#�6� *****�E�E***kE ye�c4SL**** *****>E LICENSED CONTRA OR DECLARATION: I hereby affirm that I am licensed . der provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS 7000)of Division of the Business and Professions Code,and my license . m fun force and effect. SETH ACKS CITY 3203 STATELIC.259915 uss:C— �.3—x-93 i L�i� �'— MAIN BUILDING ACCESSORY BUILDING Dat _ Signature:— FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN WORN S'COMPENSATION DECLARATION: !hereby, , in t . i nave a cenificate ol consent to sell-insure or a certificate of Workers' LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN Corn sati0n,nWranee.p rA g¢rtlll ,Copy thereof(Section .00.Lab r POLCYNO.:" "10]— L E DATE: "/01 /93 COMPANY:STATE FUND , S� PARKING REQ• PROV: PARCEL : 41806210 ZNE: R1 REF NO: I CeNfiedcopy ishereby lurnished, }u Certified c•ryis ecity euildim '� PLANNING NOTES> PROPOSED 75 LINEAR 6FT, HI , BLK. WALL ALONG THE SIDE PROP . o > LINE, SHARED BET. 3073 AND 3069 PROP, OWNERS, Date: —��/� Applicant ******************************************************************************* EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (Tel' ection need not be completed if the permit is for one hundred($100)or less). DEVELOPMENT SERVICESREQUIREMENTS I certify that in the performance of the work for which this per ' is issued.I shall not employ any person in any manner so as to become i subject 10 the Workers'Compensation Laws of Catifornia. ZONING APPROVED BY , (J/• L DATE; • 3 3 Date: Signature BUILDING APPROVED BY : L ,4, DATE; 3 .3 9 NOTICE:If.after making this declaration.you sib Id become subject 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 B Y: / t DATE: 7 which this permit is issued(Section 3097,Civ.C). ' *********************** * ' ***it *• ****'*n****************** • 'z .ir' 3'** LENDER: ***************************************** •************************************ ADDRESS: LEGALIZATION; N F E E SUMMARY STRUCTURAL SEGMENT:Y OWNER BUILDER DECLARATION: I hereby 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: Any city of county which requires a permit to construct.alter,improve,demolish,or PERMIT 35 . 00 , 50 repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed SHIP/NON—RES pursuant to the provisions of the Contractors'Slate License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN 22 . 75 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(3500). ISSUE FEE BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE I. as owner of the property or my employees with wages as their sole compensation, wit do the work, and the TOTALS----> 35 . 50 0 , 00 22 . 75 58 . 25 58 , 25 . 00 ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law 1 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 sate.U.however the building or REVENUE DIVISION TOTALS--> COLLECTED• 58 , 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 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK for the purpose of sale). I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044.Business 35 . 00 50 22 . 75 ❑ and Prwho tsdo The projects thState contraseLaw dens pursuant to hCrctorsrty abuildseLaw).oI as thereon ******N***********************************************,.N************************ and Prof ssions Cos for hContract Contractors' a e LicenserLa)w doest ly la the rContractors'Stateh uilds¢ improves em aware that proof of their Worker's Compensation insurance should be provided to me. I N D I V I D U A '1 F E E BREAKDOWN ❑ I am exempt under Section: B.&P.C. for this reason: TYPE QTY DESCRIPTIOCN UNIT COST TOTAL COST Date: Owner: SFR 75 RES—CONCRETE BLOCK WALL / FT. 20 . 00 1 , 500 . 00 I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505.25533,and END OF FEES 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from 1 K these provisions. Dale: certify Applicant. ycitycounty EXPIRED (^ I herebythat I have read this application and state that the above inf anon is correct I mpl with all and / ordinances and state laws relating to building construction and hereby act e representatives of th ' _ u a above-mentioned q/ / property for inspection purposes. DATE it � `` :it Date: 3 '3 [p Signature' ' r Driver's License or Social Security.: / 1641.46 Wtnle—Building:Green—Code Enlorceme .Canary--Applicant Pink—Revenue;Goldenrod—Assessor j • eoNSTRUCTIOIAND PLANNING POC SPA 'APPROVALS Permit fir- Date Inspector APPROVALS Permit# Date Inspector I' T. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement A. 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit•Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing& Pressure Test 6. Electrical UF ER Grnd. / APPROVAL TO COVER-GUNITE 7. Footings ejfr,,/d'lJ 58. Electrical Conduit-Undrgrnd. l ,, 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. Backe.ash & Receptor-Final , 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing , ' 65. Electrical-Final 15. Rough Electrical-Conduit •'I 66. Solar System-Final I 16. Rough Electric Wiring 67. Fencing& Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING T8. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping U Gas ❑Oil .T.a ;_ 23. Gas Pipe-Rough & Test 72. Underground Flush r at 'tt 24. Roof FramingT' '1 73. Undergrnd.Storage Tank 0Gas ❑Olt .. ;_=_. 25. Roof Sheathing 74. Overhead Hydro -•:. ~ 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical tr.' 7 27. Frame and Flashing • 76. Dry Standpipe _ '• 28. Lathing& Siding 77. FIXED SYSTEM FINAL 29. Insulation I 78. FIRE PREY. FINAL { 30. Drywall Nailing r . HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final I 80. FOOD CERTIFICATE ISSUED 33. Final ElectricI I Notes: 6!�� G/'a 7Il'I77 34. Final Heating& Air Conditioning l pp .ryt^ QQQ - � 35. Final Gas Pipe Test l'l /IAr c t.x 36. Hood or Canopy I • (J 37, Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final ' ' • 41. Solar Domestic-Final 42. Backflow Preventer I 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation • 1 46. Handicap Regulations -1 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 • 6 ' crtl., bfoc_.k wets I h \e}e, � j 01\ ED DE\at INE?LS" I;1G 9 . , rA')PR0Dfl � �BE pePRpVED CITY OF COSTA MESA I �o� L./....t • 4 PLANNING DEPT. • l E T TO BLDG. DEPT. I 1 n 1 L . ....... DATE_ 112 DI ER OP PLANNING • APPROVED d �- kik /.0-U • (- City of Costa Mesa Building Dept. / / �+ ' " ' i BY k/ DATE 3/3 19 / fat ij(/�( (q� • "ilitA7 t/`^�Q �1 L 1 L THESE PLANS MUST BE . N OB AT A,L TIMES MAKE / VV 1 J V NO CHANGES WITHOUT 2.jr'•' APPROVAL Of LEr I. .. cO THE ISSUANCE OR GRANT'. . : -4%iT OR APPROVAL OF GG • PLANS AND SPECIFICATION: ' . . -CC NSTRUED TO EE A �,//�VV PERMIT FOR, OR AN APPRI• - -. 'nON OF ANY OF Oy ' THE PROVISIONS OF THISCC'- - SLY"' "'C_,:VC s - /G ` AUTHORTY TO VIOLATE OR . .-• VIS!( NS OF THIS O _V \V\ CODE SPAR.BE VALID 3'JA•, .:: W MIK OR USE J sO _! WHICH IT AUTHORIZE 315 LAY.LI L. \V` `�"✓ le THE t;SUANCI. (.F A tO i.1 'LAHS AND SPECFICAJ IONS . '.LI N'.'',7 -' T(I�'ffi I: '•L`..' t: (RtMO[isct RESIDENCE ` ' RESIDENCE RESIDENCE r 7TNIER1iAIi'IERREC:IL::::', '.;'I;:.OPHECTi )i,r): ERRORS IN t a11T•L SIS 4,NO S:'cC t iC.:1, P. SM, '. i F REVENTING I` &ALOTNG OPERATIONS FM ,i.bi At „'•.D ON IN ETCU IDER WHEN 3073 3 o 6 ( 1.1 . 44 VIOLATOt4 OF THIS CODE ' lift ANY OTHE 1 ORUIIJANCE OF THE'GITYl. Qais I ' + vl F00� INSP E;TIONS caul 754-5626 • STREET 6. or j 2 zi \y/ (J ko 754-5677 Permit # V ' irtt . Lk o., I. . . THIS NUMBER MUST ACCOMPANY • MAY BE REQU'fl p ALL INSPECTION REQUESTS r- • TYPICAL 611 CONCRETE BLOCK FENCE • ® - GENERAL- NOTES ' Cement Coping Optional i i-71 _,�.1 Channel Block With 1-3/80 it .I Horizontal Top of all ( �i. MORTAR: One Part Plastic Cement, and ; • Fences II I Three Parts Sand .IIIFor Fences 5'or Less .a < GROUT: One HPart Cement Three and I COPING: One Part Cement, Three Vert, Bars 3/8"0 at 4' -0" O.C. ill o i �'. LL WEN Parts Sand For Fenees Higher Than 5' u __ CONCRETE: WelI Mixed 1:2 I/2: 3 I/2 Vert. Ban 318"0 at 32" O.C. > w�� > x " „-1Max. DP 7 ac Go Ce eof nFill Cells Solid With Grout > 2 Water Per Sack Of Cement Where Steel Occurs > — - — Reinforcing Steel$hall f 10 -' � GROUT MAY BE POURED FROM THE TOP fff��4 OF THE FENCE IN CELLS WHERE STEEL Conform to Sec.A-15-39 { w 0 ■ OCCURS. A.S.T.M. MI F- r - 1-�, �'s� CELLS AND AREAS OF HORIZONTAL REIN-, win FREE OF NT SHALL BE CLEAR,CLEAN Si, All Steel to d Lapped �� LLgli Si- FREE OF ALL MORTAR DEBRIS,ETC. 24"or to CodeMI NATURAL GRADE 'I • � I 0 TWO 3/8•"Q BARS -ail 7> t e • I� o CONTINUOUS TOP Si BOTTOM I.—WIDTH TO 16. O.C. MAX. . SEE CHART • ♦ p. • MOMS-STEEL MUST BE TIED IN BELOW DEPTH OF E ARTHTCOTH PLACE AT TIME OF TRENCH ',- I p 1:1 1/3 THE HEIGTH OF FENCE INSPECTION. o. L j • BLOW BOTTOM OF FOOTING "^I IOs —1- Z.. SCALE: I/211 - I' - 1 FOOTING REQUIREMENTS CHART WALL HEIGHT 6 ' 5 4' 3' WIDTH 14" 14" -12" .- . . . . . 12" THICKNESS 10" 10" B 8 DEPTH OF EARTHTOOTH . . . 24" . 20" 16" . . . . . . . . 12" SPACING OF EARTHTOOTH. . 12' 14' 16'. . . . . . 16' City of Costa Mesa California . 7 ,i t.'• • Building Departmenti; 17F,,,,::0 Nov.B:. ' 0 PARTY WALL AGREEMENT THIS AGREEMENT, made and entered into this ,2/26/93 day of // . .:t .._ . Yand betwee ���._- .<� • hereinafter referred to as "LANDOWNER," and hereinafter referred to as "ADJACENT PROPERTY OWNER:' • It is hereby agreed that a party wall will be constructed on the property line between _3069 kon.� 'o_s6o Gil PSCC- Cj±_926 26 (Address of Adjoining Properties) 30 73 Cora. A-ve Cosmo-Me_sfi_ C 92-6 26 in the City of Costa Mesa, County of Orange, State of California, as per map recorded in Book , Page • of Miscellaneous Maps, in the office of the County Recorder of said County. The party wall shall be permitted to encroach IN WITNESS WHEREOF, the parties have entered into this Agreement the day and year first above written. LANDOWNER L y ) ADJACENT PROPERTY OWNER (Signatur infra; Mit k a t-e t ,f LA„ it, ti ya- 131 _u:t rz.aiaro Name (Typed or Printed) • N e (Typed or Printed) 3 L'aa14 2 c - 31,73 • )(LA ken Cev` Mesa Q2426 (Address) U 9 ,•.“ (Address) NOTARIZATION REQUIRED 1906-46 I. PROJECT ADDRESS: n I—Trio: AV UNIT: ICITi' OF COSTA ..'ESA - EUI' - - ?^�•,_'" -, R.r :7r : B . ' A/WNEB?NAME: -; _ ,.._.. _,..... .. �� -- — — ,f) ADDRESS: 5—•6 `i"I' ?' Kr PER:.IT NO: B C6221C PLAN CHECK NO: N GOVT SU?: .. ` COCTA MEEA, CA 72526 CONSTRUCTION TYPE: 5—N PERMIT TYPE: STR PURPOSE: ALT 5402"87 ARCM/ENGINEER: REG.ND: JOE DESCRIPTION . T/C'FF RESHT REROOF W/ COMP SQ FT : 3, 900 ADDRESS: UNIT: CLAIM VALUE: 5, 900 . 00 CALC—VALUE: 5, 900. 00 GROUP OCC: R-3 /M-1 PERMITTEE: GREGC THOMAS ROOFING ( 714 ) 841-2290 ADDRESS: 15212 XACIER CIR rOMMENTS— : SMOKE TORS REQUT R=D PER THF " 99. ED dESTNI.STER CA 92638 ### #### ###� #** E**###amu##�**#**# ### ##x #t: : xx :s+:n##+ # ###+ n # r #:: yea.* -,. LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING R E U I a. E N E N T S 000)of Division 3 of the Business and Professions Code. license is in full force and effect. S E ]' AVC K S J ITY LIC.:042f 32 STATE LIC.:30(r8 . CLASS. �` O ate: _ _ V BUILDING BUILDING � �Q�I�3_ signature: �� AI B" :NG ACCESSORY b' LG WORKERS'COMPE ATIO ECLARATION: thereby affirm thatIhaveacertificleofconsent If-insure or a certificate of Workers' FRNT : FT IN REAR : FT <N FRNT: F. IN REAR: FT -:• Compensation Insurance.or a certified copy thereof(Section 3800,Lab.C). LEFT: F T I N R GHT: t: IN LEFT : FT IN RCH:: FT 'V POLICY NO.: 110 5 719—9 2 EXP.DATE: 1 /01 /9 3 ( COMPANY:STATE FUND PARKING REO:xPROV: PARCEL: 42632416 ZNE: REF NO: Certified copy i bereb furnished. Certified co. is fit'•with the cit g Division. PLANNING NOTES> ES> Date: 1P�O ADDIicanI • • #########+Elf##vi"rl`###if TF#####?E###i#<{E#+:.***####3c#####:`ixVY-****: ***::###:::,# ,91—:*###4,-.4*.K. EXEMPTION FROM 4fORKERS'COMPENSATION DECLARATION: (This section need not be complet the permit is for one hundred(POO)or less). D E V E-jL O P X E N S E R V _ 1. — S R E Q U I R E .N E :\ Js I cenily mat 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 /y 'ornia. subject to the Workers'Compensation Laws of ZONING APPROVED' BY DATE: `,i Date: Signature: NOTICE:If.after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING AP PROV±D BY : DATE: i Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. ,) �•—x11 CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency tor the performance of the work for APPLICATION ISSUED B Y: ��'� which this ermit is issued 3097.Civ.C. ��:— LATE: O r.( � .F3 P (Section1 ###########u#f########' .. ^' ---.-.. x+e iv-xrs xtrr i c'**** *u *i ##}:}#+A#r##,�*, ttl 3 ,:-,vr#t--- LENDER: ############4** Sof#±E##*##*##*###**#*#*kRE# :##?E##4****-it-*:i#:'•#!tiF*##-Fs id.i•4i"d#**-I' .. ##R-dv-,.• ADDRESS: LEGALIZATION:N F E E Sr MMARY STRUCTURAL SEGMENT: Y OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELEC.TR If MECHANIC FIRE SHIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve.demolish,or P DRY: ' 31 . 00 ` . 53 repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business ....I P/NON—RES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.My violation of Section 7031.5 by PLAN any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(S500). ISS-- "UE FEE I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the b-�- D+NV—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID D"F. ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS—---> 81 . 59 0 . 00 0 . 00 81 . 59 81 . 5 9 . 00 . 0 0 does not apply to an owner of a propeny 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 improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED: 81 . 59 OVER/SHOAT: . 00 for the purposeol sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SNIP/TOT. CRAD..ING PLAN-CHECK I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 81 . 00 . S9 ❑ 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 projectswilh a contractor(s)license pursuant to theContractors'State License Law).l am aware #:E.#+E##?fu####ii-####?f#:y#1f?E#?E#:f}if##+EiE#?i.{.#af#dE#rlEif rf3f:t 1 e, :;t** f4....r##**4.*. '***** * r'*:`i-}xY#a' that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL FEE B R _ A is D O " '? o I am exempt under Section: B.&P.C. for this reason. TYPE QTY DESCRIPTIO N UNIT COST TOTAL C32T Date: owner: -- SFR 5900 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 3C 5, 903 00 I do hereby certify that I am aware of and understand the requirements of California Health and Safely Code Sections 25505,25533,and END OF FEES 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from these provisions. Date: Applicant: I hereby certify that I have read this application and stale that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction. •by authorize represerrr///ggq111 sol this city to enter upon the above-mentioned J/property I�ir peelwnurpoSee. Date: ri. ig 17 Signature: 1` 01 00139358-00139359 TOT 81.59 Driver's Lice a or So al Security x: DATE: 05/18/93 TIME. 08:05 1641.46 While—Building;Green—Code EntorcemenC Canary—Applicant;Pink—Revenue;Goldenrod—Assessor r Ji STRUCTION AND PLANNING f" sPC Sr SPA j APPROVALS Permit�-` Date Inspector APPROVALS Permit Date Inspector 1 I 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. i 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing& Pressure Test -~ t 6. Electrical UFER Grnd 57. APPROVAL TO COVE R-G'al",TE i ~- -r 7. Footings 58. Electrical Conduit-UnJrgin I I8. Foundation '•\ 59. Gas Pipe, El 'Jrdrgrnd , Test 9. Water Pipe-Undrgrnd. -; 60. Backwash Lines, P-Trap, EllUndrgrnd. i 10. Structural Floor System • 61. APPROVAL TO DECK I 11. Property Sewer Line & House Connections - 62. Bacxs ash & Receptc- Pcial 1 � - -' 12. Sewer Cap - 63. Heater & Vent-Final `I 13. Roof Drains 64. Plumbing System - F - ? I 14. Rough Plumbing 65. Electrical•Final i 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERIP-G I 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL I • 19. Rough Heating & A.r Ccrdrt oning FIRE DEPT. REQUIREMENT ! • 20. Rough Factory Fireplace APPROVALS Permit it i --1 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping Cu Gas CI.Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 1 24. Roof Framing // 73. Undergrnd.Stnrage Tank a Gas C• 25. Roof Sheathing # t,.. ii 74. Overhead Hyurn 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing& Siding 77. FIXED SYSTEi.', FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Dry..a!I Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Pourer Meter-Final 80. FOOD CERTIFICATE ISSUED - -L H 33. Fin_I Electric Notes: 34. Final Heating& Au Conditioning 35. Final Gas Pipe-Test . 36. Hood or Canopy - ' 37. Final Factory Fireplace i 38. Final Plumbing 39. Water Service-Final 1 40. Gas Service-Final 1I 41. Solar Domestic-Final I 42. Backflow Presenter ~. --r 43. Backflow Irrigation l 44. Landscape Irrigation System _� 45. Sound Attenuation I 46. Handicap Regulations ,,,/// .. 47. FINAL STRUCTURE & BUILDING �"/i ,t93 ,fie -, 48. FINAL PLANNING V 49. Electric Release to Edison i 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date • 1 APPROVED MESA STRUCTURAL APPROVAL ONLYCrtPLAaNNING DEPT. SUBJECT TO BLDG. DEPT- REa SEPARATE PERMITS ARE REQUIRED G FOR ELECTRICAL, PLUMBING, • APPROVED er _LiD w oAT� HEATING, VENTILATING ANr REFRIGERAT" . / !I BY / _ DAT ( q_ Y frrit #,..,#4--4-- ( THESE PLANS MUST BE ON JOB AT ALL TIMES THI' - ,-. 7,. LCA PANY MAKE NO CHANGES WITHOUT PRIOR APPROVAL ALL Ii;S;:CgUiI REQUESTS OF DEPT. THE ISSUANCE OR GRANTING OF A PERMIT OR APPROVAL I'J , . 1 I ~ i'tifSONS ARE TO OF PLANS AND SPECIFICATIONS SHALL NOT BE CONSTRUED BE Nina QUSuCIEST THAT THE TO BE A PERMIT FOR, OR AN APPROVAL OF, ANY VIOLATION r ',r. OF ANY OF THE PROVISIONS OF THIS CODE. NO PERMIT PRE- ST: If OF C -irU ILIA DIVISION OF• SUMING TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE IIND.:SPIN S FETY BE (NNSUMT1-figLTFO FOR \ PDtICInMC no T1-fig CrV)F CHAT I BE VALID, EXCEPT IN SO ADDITiONA=REQUIREM ATS. J \ FAR AS THE WORK OR LHE WHICH IT AUTHORIZES IS LANFUL THE ISSUANCE Dr A PERMIT BASED UPON PLAN; AND SPECIFICATIONS SHALL I OT PREVENT THE BUILDING OFICIAL I":::::: ' '"C'.FTCR REQI IRINFF nu OnpprrnnN 7F E RORS_ I IN SAID PLANS At D SF ECIFICATIONS OR FROM ! REVENTINI BUILDING OPERATIrNS BJNG CARRIED ON THEREU ICIER WHEF IN VIOLATION OF NIS (ODE OR OF ANY OTHER ORDI JANC' 1) N' OF THE CITY. lb l- RESIDENCE o —RESIDENCE RESIDENCE RESIDENCE ti I-- WI" _W LI 2 CC 10 /- In y 2• STREET 6 TYPICAL 411 CONCRETE BLOCK FENCE TOP VIEW '-3/8 Bar InlillISIIII. eta 'M, "GENERAL— NOTES" 4" Blacks - 81�Blocks ; I i i MORTAR: One Part Plastic I/4° l Pencil Rod Below Top ., i i M _ . _- Cement And Three Parts Sand. Course Of All Fences ' - • GROUT: One Part Cement And 4" Concrete Block. Fence With B" —.- " '�i %_I_. Three And One Half Parts Sand. Pilasters. One 3/8 Vertical Bar . ' '_- _i , Three Ports Sand. 8' Pilaster. CONCRETE: Well Mixed 1:2 1/2, 3/8" Vertical Ties ' 2'- Long . r 1 -I_' ' 1 I i i S 31/2 . Maximum Of 7 1/2 Hpoked In Footing, And Grouted In I I ' Gallons Of Water Per Sack 4 Blocks 4' 0/C Maximum. ■.® i . I ' , Of Cement Provide Cleanout And Inspection I I , I 1 I i 1 REINFORCEING 'STEEL SHALL Hole At Pilasters. 1 1 I I i 1 .!--i-.I_--- —_ I 1 I_I _ CONFORM TO SEC. A- 15-39 i l i i A.S.T.M. ALL STEEL TO LAP ■, ; 1 ll `' 1 1 I I WHERE SPLICED, 21-0�• MINIMUM. -MEI-,-� ' i i . GROUT MAY BE POURED FROM TOP OF FENCE IN CELLS WHERE •',•o :p:r�.' ? ':< "•.r..n,'.e-:.'.4:••, c,, ?• i "'I v„: -to, d ” o. .' VERTICAL STEEL OCCURS. HOLES NATURAL GRADE i.o.,•.,:p .,',. Lor:et o. .. c opa I 0- ,.. ' ..0I 1N ..i , . J"i'. ., On o'• -1-. • v� o i -o. - o SHALL BE CLEAR , CLEAN , AND FOR WIDTH SEE CHART i' �� de ' r' -:te'�" ' ' —b;°-''__ b •C Q'_t FREE OF ALL MORTAR , DEBRIS, e_;o Ci :.r e _ ••:.I:be; �. � ,� '_i<_"�=Rl LQ_r ,. , . ear.- y �., ��r I'•) o•'ij ECT. WITH INSPECTION HOLES TWO 3/8 BARS CONTINUOUS lol :!1 TO 16•�O.C. MAXIMUM 1 dtjl AT BOTTOM. BOND SHALL BE Ih. 194' 1 aBio PROVIDED BY LAYING BLOCKS FENCE MAY VARY IN HEIGHT * :o• DEPTH OF EARTHTOOTH I/3 `:. IV" IN STRETCHER COURSES SO FROM 31 TO 6 1 P%• :e v,0 • o :�, THE HEIGHT OF FENCE c �: - THAT VERT. JOINTS ALTERNATE STEEL MUST BE TIED IN PLACE -t •o BELOW BOTTOM OF oov, IN EACH COURSE, AT TIME OF TRENCH INSPECTION L O"1 FOOTING. L�..J x ---311 CLEARANCE FROM BOTTOM , 1 " SCALE: 1/211= I� CHART HEIGHT . . . . . . . . . 6 . . . . . . . . . . . . . . . . 5 . 4 3 WIDTH . . . . . . . . . 14°. 14". . . . . . . . .12 . . . . . . . . . 12" • THICKNESS DEPTH OF EARTHTOOTH . . . . . .24' . . 20". 16 12' SPACING OF EARTHTOOTH . . . .112'. . . . . . . . . . . . . . . . 14' . . . .16' . 16' City Of Costa Mesa , California OWNERS NAME: jv(1(— JOB ADDRESS, _ 09_ -' pi._ Building Department PERMIT NUMBER: SIGNATURE: Form BUU-2M-4-64 5-BP Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA PERMIT NO. / �o TRACT NO. LOT rG.j�' •BLDG.NO. CONSTRUCTION PERMIT P frCj log ` 7876 4/27/83 5.00 TL Project Address -J0Lac) 4 U ICO TYPE OF CONSTRUCTION . \K Owner ♦l 1 OU `^ / Co , Phone•s eparj 70,t 0 NEW 0 ADD 0 ALTERATION -- ' Address SAMe As Aaogt,' 0 REPAIR 0 CONVERSION ❑DEMOLISH ZONING REGULATIONS Arch/Eng. :: License No. ' 0 OTHER Address - . DESCRIPTION OF WORK A.P. ' Sie ZONE PLNG. REF. Contractor'? et ds ,� 'Miss+a 11fµPhonegia-3113 TYPE-OF PERMIT 6 BIJTLDI NG - • Tp BUILDING • SETBACK C/L ST. PROPERTY LINE • Address OW F •Pp0ot,A goc 6 - 0 GRADING 0 FOUNDATION STRUCTURAL SIDE YARD LICENSED CONTRACTOR DECLARATION 0 TENANT 0 ELECTRICAL LUMBING ❑MECHANICAL 'SIDE YARD I hereby affirm that I am licensed under provisions of Charter 9 (corn- - RIGHT • • menclng with section 7000) of Division 3 of the 'Business and 0 OTHER - REAR YARD(TO P/L) Professions Code, and my license is in full force and_Viet •PROJECT DESCRIPTION • License lass U nseyN°.n/ II "SII a PKG.SPACE REQ. PROVIDED Date -1 -o1A _ Signature •• tQ /JLC.F4� SQ. FT. - - STREET WIDTH .PARK FEE$ • WORKERS'COMPENSATION DECLA ATION - • "OCCUPANCY _CONSTRUCTION TYPE - I hereby affirm that I have a certificate of consent to self-insure or a ZONING APPROVED BY • I DATE - certificate of Workers' Compensation Insurance, or a certified copy VALUATION ZONE _ thereof(Section' 8p 0 Lab C.)." zf / GRADING CU.YDS. ACRES SPECIAL CONDITIONS: • , • olicy No.-20 /t iJ Company •({•C�C/jII-4) - ' . . ert7fied copy Is hereby'furnlshed. ' ... REMARKS: - . Ifiliakcertified copy is filed with the city Building Division. _ EXEMPTION FROM WORKERS: COMPENSATION DECLARATION • - (This Section need not be completed-if the permit is for one hundred ($100) or less). . ^ , . _- . - I certify that in the performance of the work for which this permit Is Issued, I shall not'employ any person in any manner so as to become ,PLUMBING' PLAN CHECK ELECTRICAL PLAN CHECK ' subject to the Workers'Compensation Laws of California. - Uw ELZTN(G GARAGE - Date Signature - BATHTUBS SHOWERS SQ FT SO FT • . NOTICE: If afterlma king this declaration, you should become subject TOILETS URINALS GENERATOR 0.1 KW 1-10 KW to the Workers' Compensation provisions of the Labor Code,you must . TRANSFORMER forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE LAVS APPLIANCE "10.50 KW-50+ KW- -' revoked.. - - - - _ - CONSTRUCTION LENDING AGENCY KIT.SINKS 'DISHWASHERS MOTORS' 0.1 HP_1'=10 HP ' —' ' I hereby affirm that there is a construction lending agency for the per- SERVICE SINKS'^ , . SUMPS _ .(INC.SOLAR) 10-50 HP + HP - - " - • ' . formance of the work for which this permit.is issued (Section 3097 _ - Civ. C.). FLOOR SINKS FLOOR DRAINS FIXTURES ' OUTLETS SWITCHES Lender's Name - Lender's Address DRINKING FOUNTAINS - - GAS TUBE SIGNS • • . - - OWNER BUILDER DECLARATION INTERCEPTORS CLARIFIERS POLE LIGHTS •• - ' I hereby affirm that I am exempt from the Contractor's License Law for - • • the following reason (Section 7031.5 Business and Professions'Code: SWIMMING POOL - P TRAP . - - LUN>I tHUt-I IUN . _ - . • . . Any .city or, county which requires a..permit to construct, alter, POLES METERED SVB • - improve,demolish or repair any structure, prior-to its Issuance,also re- WATER SERVICE - ALTERATION' PANELS MAIN SUB' ' • quires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law _GAS SERVICE OUTLETS - ' -SERVICE ' ' • AMP - - - - " (Chapter .9 (commencing with Section 7000) of Division 3 of the ^ ^o _ _siness and Professions Code) or that he is exempt therefrom and the - WATER HEATERS BTU OUTPUT 00 _. - is for.the alleged exemption. Any violation of Section 7031.5 by S _ �_ - ' applicant for a permit subjects the applicant to a civil penalty SEWER CONNECTION - - ' ' " . . - not more than live hundred dollars ($500). - - _ - ❑ I. as owner of the property, or my employees with wages as'their SOLAR TANK - COLLECTORS , ' " 6 66 - . ' • I " sole compensation, will do the work, and the structure-is not intended ' . , or offered for sale. (Section 7044, Business and Professions Code:The SOLAR PIPING SYS. - ISSUE FEE / Contractor's License Law does not apply to an owner of a property - - o APPLICATION APPROVED BY ��4✓-1 DATE *'�N who builds or improves thereon, and who does Such work himself or ISSUE FEE ., ` . U `L /�3 through his own employees, provided that such improvements are not _ intended or offered for sale. If, however, the building or improvement MECHANICAL PLAN CHECK 1 SUMMARY OF FEES is sold within one-year of completion, the owner will have the burden • - - BUILDING of proving he did not build or improve for the' purpose of sale). HEATING SYSTEM 0-100,000_BTUPERMIT $ - . SMIP ' , $ la I, as own _ _er of the property, am exclusively contracting' with AND DUCTING ' • ' ' "- ' " " . " - licensed contractors to construct the project (Section 7044, Business 100,000 + BTU - PLAN CHECK $ - PERMIT. .151 and Professions Code: The Contractor's License Law does not apply to • '- - - an owner of proberty who builds or improves thereon, and who con- REFRIGERATION 0-100,000 BTU PLUMBING $.,�OO tracts from such' projects with a-contractor(s) Iicesned pursuant to SYSTEM - - - - GRADING $" the Contractor's License Law)_ 100,000+BTU PLAN CHECK $ - - ' ❑ I am exempt under Section - B.& O.C.for this -- ELECTRICAL $ $ _ - BOILERS BTU • MICROFILM $ reason - - - PLAN'CHECK '$ -" Date - -Owner _ .- SYSTEM REPAIR,ALTERATION TOTAL FEE$ - MECHANICAL $ -1 hereby certify that I have read this application and state-that the above EXHAUST SYSTEM MULTIPLE , PLAN'CHECK"$ LESS AD- information is correct. I agree to comply with all city and county '" VANCE ordinances state laws relating toconstruction,and hereby authorize _ _ • o representatives of this city to enter upon the above mentionetl' Property -for ins tion purpQ¢es. .I •f p 9 Signature �4 // Date •4—CIA 23 FINAL FEE $ Drivers' License o ss 7? ISSUE FEE - '- - - -- - - - -- - CMF 0865-46 White-Building;Canary-Applicant; Pink-Accounting;Goldenrod-Assessor 4 • CONSTRUCTION AND PLANNING .....r. POOL&SPA - APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole ' . 43. Pool & Equipment Location ' ' 2. Soil Pipe-Undrgrn. 44. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrn - 45. Forms 4. . Electrical Conduit-Undrgrn -- 46. Electrical Bonding . - . 5. Steel Reinforce- - 47. Rough Plumbing& Pressure Test' - ' _ . • t 6. Electrical UFER Grn .. 48. APPROVAL TO COVER-GUNITE - 7. Footings ._ _ 49. Electrical Conduit-Undrgrn 8. Foundation . - _ 50. Gas Pipe, ❑Undrqrn,Test , 9. Water Pipe-Undrgrn 51. Backwash Lines, P-Trap, ❑Undrorn - -- • '• 10. Structural Floor System 52. APPROVAL TO DECK 11. Property Sewer Line& House Connection " 53. Backwash & Receptor-Final 12. - Street Sewer Connection - - - - - - . -_ • • 54. Heater &Vent-Final - . 13. Rough Plumbing - ___55. Plumbing SPvtem - Final - ' ' `". ` " ' 14. Rough Electric-Conduit - • - - .56. Electrical-Final . 15. Rough Electric-Wiring - - • - • 57. Solar System-Final , 16. Rough Heating-&Air Conditioning - - - - . - 58. Fencing &Access Approval . , 17. Ducts, in Structure • -_ . .- _ - 59. APPROVED FOR PLASTERING • • 18. --Ducts, Ventilating - - - 19. Gas Pipe-Rough &Test - 60. POOL/SPA SYSTEMS FINAL . 20.- Roof Framing . , . ' 21. Roof Sheathing ' . - ' .. • 22. Frar-ie ind-Flashing • - - -- _ - ' ' " NOTES: . . - - r 23:- Insulation - -. • _ - 24. Lathing & Siding - - .. . . _ - . 25. Drywall Nailing_ .- . . ' , - 26. Plaster Brown Coat - . 27. Electrical Power Meter-Final .. . " - I I '_' . • - - • ' • 28. - Final Electric • . . ' 29. -Final Heating & Air Conditioning _- . . . -- - - • 30. Final Gas Pipe-Test - • - . , . 31. Final Plumbing _. _J/31/BN GEA - • 32. Water Service-Final - _ .. . - . 33. Gas Service-Final. - .. 34. Solar Domestic-Final 35. Landscape Sprinkling System . - , 36. Sound Attenuation _ _ • 37. Handicap Regulations • . , ' 38. FI NAL STRUCTURE& BUI LD I NG _ • • 39. Special Requirements Completed - - • ' 40. Electric Release to Edison' - - - . 41. Gas Release to Southern California Gas Co. • . • • - . ' 42. CERTIFICATE OF OCCUPANCY - , - No Date - - • ti OWNER YO_Un4, Glenn DATE 6-14-79 JOB ADDRESS 3069 Yukon BUILDING PERMIT NO. 48242 GF•'GRAL CONTRACTOR ,7amac Hart DESCRIPTION of WORK Bock wal l A 41$-962-10 LOT 2 TRACT 4674 FIRE ZONE • VALUES 1,000.00 INSPECTIONS Signature Date TYPE GROUP ZONE RI SOIL PERMITS ISSUED GAS SUBCONTRACTOR Date Number umber I Signature WATER Plumbing ROUGH PLUMBING PROP. SWR. LINE ❑ HOUSE CON. ❑ SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICEI� OR POLE I1 UNDERGROUND POWER ROUGH WIRING Heating and Vent. TRENCHES FORMS LJ STEEL REINF. 1 -10.7 FLOOR SYSTEM' &ry.M'r l"C •20• • EXPIRED BOND BEAM ❑ STEEL REINFORCE rl SHEATHING inCOntplet� In+pec�ns FRAME AND FLASHING Cdtlt'eI /J —_ LATHING — IN n OUT 4^3 l8 A �34g� `�Ig ��/` PI. 'R. BROWN COAT W �Y c Sl .URAL, FINAL Flectric HEATING. VENT., REFRIG. AND A.C.,l FINAL PLUMBING, FINAL AND GAS TEST L l ELECTR FINAL ___ COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FRQRS$$TR}JCTU A PERMIT '�— - _.•P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 Q559 F71 477Y I❑ 54 RECEIVED BY 'PERMIT *f0 48242 �° For Applicant to Fill in Completely — Use Ink Only /� N •AUILDINGy /TA.P.NO. 1l�—O6�JIADDRESSr9, /�S `�TWNER OR '/ O0' `/ ADDRESS /6 p�! TENANT (�7 �� UNIT OR MAILING SPACE NO. ADDRESS TR.NO� i LOT ^ BLK. TEL. /rLfV, of CITY NO. CONSTRUCTION NEW ADD ALTER REPAIR MOVING DEMOLISH LENDER ›c Lr// BRANCH OWNER/Jo/ ` R ] �� ADDRESS UE 111 UE /f)0Q ARCHITECT TEL. USErO $ OR ENGINEER NO I(/ ADDRESS //�� ZONE R I TYPE GROUP APpys¢.yy7 BY DATE DATE CONTRACTOR,� )) +// � y if ADDRESS C{/c' s' 45 / �a�/ / /�J TEL/�/yj._/3117 CITY LLC/ NO.(�((� 4-4 F STATE c [�///^^'/// CITY APPROVED SETBACKS gLIC. NO. %.7� / �{' LIC.NO. W SIZE [YQ� L I NO.OF BLDGS. [FROM C/L STREET) 0. OF LOT ax 17 NOW ON LOT FRONT —SFT Q USE OF V). EXISTING BLDG. R SIDEFT. F� Separate permits are required for L.SIDE "I• FT. / •I C electric,plumbing and heating work. REAR FT. t _ . USE fB U ILDI3�/O RK TO BPERFORMED PLANNING ACTION l/ r � 6 / AATE PPR//// /s ��(] DPPROVED / (,,1/} (.3-( `1`�l K �( / APPROVED EDC -W/C ( DATE b / / r ! 79 W 0 I hereby ecNnowledga that I have read this application and state n % that the above information is correct and agree to comply with 0. all laws regulating building construction, and I shall not employ Z any person in violation of the workman's compensation laws of ° S the State of California. m I hereby certify that I am properly licensed as a contractor under SQ. FT. N the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: e am exempt from th provision o the State of California Business siy VALUATION PERMIT FEE S // and Professions Cod- Division 3, apter •. b� a / O / �r PLAN CHECK S �.—p m Signature of �.� / /I4� S / / LL Porn,ltt ��/L / / _ C//�G TAX S 50 f or 2 \ / U Authors ed Agent Dale TOTAL PAID S /0.5-0 J `� TUUNG, Glen a. WAIL \JOB ADDRESS 3069 Yukon Avenue BUILDING PERMIT NO. 38074 GENERAL CONTRACTOR ACe Awning DESCRIPTION of WORK Patio Cover AP Mo. 418-061-11 LOT TRACT FIRE ZONE VALUES 500.00 II CTIONS Signature Dote TYPE Tv GROUP I ZONE R-1 SOIL SUBCONTRACTOR PERMITS ISSUED GAS Date I Number I Signature WATER Plumbing ROUGH PLUMBING PROP. SWR. LINE Q HOUSE CON. 0 SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND ❑ POWER ❑ ROUGH WIRING Heating and Vent. TRENCHES Li FORMS CT STEEL REINF. FLOOR SYSTEM BOND BEAM n STEEL REINFORCE n SHEATHING FRAME AND FLASHING LATHING - IN n OUT in PLASTER. BROWN COAT ST" 'URAL. FINAL Electric HI. G. VENT.. REFRIG, AND A.C., FINAL PLUMBING. FINAL AND GAS TEST n ELECTRIC. FINAL BUILDING, FINAL ,✓/ r ♦ - • ..4- 38074 'llR 11l-71,-A-t.00 467 *a**x-5.50 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 /AP ATION FOR BUILDING PERMIT For Applicant to Fill in Completely /cr/{/7- / //(J, R EI E BY DAFT`RE'EIVEfJ AT� = rt� ADDRESS BUILDING CJN 9 Xuxow �• v - •iI1 H� /HY 3 7 PERMIT NO. OWNER /e. i ., U A.P. NO. 4 , - OC9,- _ a'A . MAIL _ BUILDING / YAC ADORESS_ Oe.1 /,r/�/ro,v ADDREgS 4i 6/9 tit CVO / z O. U CITY T �� Npys j.s�l_ 7(e3t TRACT 3/46 /54 LOT.- BLOCK H Z Z Q CONSTRUCTION NEW IAp D ALTER AFFAIR 'MOVING DFMOI ISH - H LENDER , a. m J D BRANCH ,to OWNER ..47F--,c1-1 /.1/t/�/ 11 ADDRESSv VALU///83...".. /- • � J CO ARCHITECT TEL. USE Ye /S 6 4047-t 0 $ Q OR ENGINEER NO I FIRE Q ZONE TYPE � GROUP W K ADDRESS d ly /] N APPROVE / J O CONTR ACTON �I�/ - /� BY DATE /7 m2 77t3 ,•!3 ' ("/ L�/Y��.J // J Q• ADDR ES ���J W W T ZO ` NO.OF n USE OF NEW CPAMp•4V'Cr') 0= /� / IS 1 PLANS L BUILDING � Z F CITY /L6 _a_71.677 y ? lL O• STATECITY YARDS APPROVED YARDS APPROVED m K `7TL_LIC.NCL_Q 7 _y ///yyy��� 31J-„j LIC.NO. MAIN BUILDING — ACCESSORY BUILDING _ 0O SIZE � IND.OF BLDGS. (FROM CIL„ STREET) OF LOT II NOW ON LOT FRONT /C� FT. FT. USE OF �• EXISTING BLDG. 5 /-_ R.SIDF 57 FT. FT. I- SIZE OF �f Na OF 4 ! rt Z NEW BLDG. �y/�ROOMS STORIES L.SIDE FT.(C( FT. VEXTERIOR WALL I ROOF / , _ COVERING I COVERING REAR ?FT.tOr FT. I USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& MAIN BLDGS. ACCESS. BLDGS. O / -/4 X iS'G r ,,4L um C U.P..# APPROVED - I- APPROVED'O �)��)V 3 �” 7/71¢%/ U _BY _DATE Z / O SIP( U I hereby acknowledge that I have read this application and state „'1 D that the above information is correct and agree to comply with ry//U CC all laws regulating building construction, and I shall not employ F any person in violation of the workman's compensation laws of ` s CO the State of California. r/ •CAJ(' m 6Y m I hereby certify that I am properly licensed as a contractor under SO, FT. 0.- the the State of California Business and Professions Code, Division 3, TH AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, and that such licenses are In full force and effect,or I THE PURPC6E OF ESTABLISHING A PERMIT FEE ONLY: a cc am exempt from the provisions of the State of California slness �.qq_/ and Professions Cnoe, Division 3,Chapter 9. VALUATION 5 V� 0PERMIT FEE $ D Signature •S. Permittee -PC-'a2 $ 5--Oe PLAN CHECK $ _ E � i `o u. Author e• •gent 5 t� TOTAL FEE $ .! e 25097CITY OF CS A MESA COSTA MESA BUILDING-SAFETY DEPARTMENT • P.O. BOX 1200 COSTA MESA, CALIFORNIA 52526 • JAN 14 1966 For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT 4 BUILDING r/ / / // for I i}: 1 •r+. ADDRESS -5C7‘ / /Unel.i ihn.,!//e- R[C[IPT NO. PERMIT NO. COSTA MESA. CALIFORNIA ^`c16 �� " // R[G[IV/sp�ST DATE R[C[I BDA•/ /DAT&ISSUE OWNER L/ I S . FI .t,ct.YJ [+ I CQ _( //G� /1---/°2.�[.(�I /'I&G(b BUILDING ©/� {11.'rr�l� �UG MAIL �f �/ .[ ADDRESS �P ADDRESS LI cr Frni T S/rFr� c n TEL FIRE cinSt/) D 1 Q L /7 Oct��ilr/r,.NO.(�E q�p Qs ZONE TYPE GROUP I • APPROVED 7/73 2 //-/ RCHITECT no. BY DATE 0 C/�,FJ R ENGINEERS. p�/�L' NO.Tu_1:9319{ ZONING /J , ADDRESS a J _ . . . . . A. c ZONE) - NO.OF USE OF NEW .�,�/'(�( c / / I/ PLANS BUILDING SrI�// CONTRACTOR 1-.p W is 1'fl/ Je%441I0 y1� (/^ 'y/, ADERISSS VVo .$. !t" //4i/GJ/ s/-� DUC11AL 1 PT10N LID 1- L 1 Il Tf/j I^ / �I � CITY " 7C's c.f AL1 L g/U�r A.P.NO. ` 7� V S j4..{--- NOTE: NO EAVE OVERHANG SHALL BE LESS THAN STATE I, p�j TEL '/-1• G BO'TO SIDE a REAR P.L LIC.NO. ,�343 / -/ NQ K- i.s4.s7 SIZE / n/yHAVES OF LOT h ^ i/7 Q 1 NO.DW ON'was. Q ALLOWED (U.B.C.REQUIREMENT) USE OF YARDS APPROVED , YARDS APPROVED EXIST IRO BLDG. MAIN BUILDING ACCESSORY BUILDING I FROM C/L ERR E 1 SETRACK LINE PROM ..yy p CENTER OF STREET SSD / REAR YARD.,(3I 57 FRONT {XPi. J� L PT. I / R.SIDE ' ✓ FT. + PP. BIDE YARD I LEFT s I RIGHT / DESCRIPTION OF WORK _L.GIDE lz �Pr. Pr. .f x ALTERATION ADDITI N REARC)'' SPT. FT. DISTANCE BBT. BET.MAIN S REPAIR _MOVING DEMOLISH MAIN BLDOA. ACCESS.SLOGS. BUILDING DING.OF VAR.St DATE SIZE )71?,,.,24--ROOMSS STORIES / C.U.P.# � �..� APPROVED // EXTERIOR WALL CROVERING Q q• B 8PPROV[Q\//I"�'-"' " DATE /j<3-1/ COVERING Ill S. '"'�N���FYN��w✓✓✓✓"'"'��USE OF BUILDIPIS AND WOR TO BE PERFORMED I(1�,���, P .y// I+/J� {0 Z.C./ Q�f! p i Q N C- A �6D BG.PT. Oma` c/3 1 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OP ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS R[QULATIN VALUATION 6,(i BUILDING CONSTRUCTION. $ {/s.O — O SIGNATURE 01 AP PERMIT FEB lat PeRMB .. I -_ 472/yam PLAN CHECK $ 34- . AU •ORI ED AGENT TOTAL FEE $ 0 —