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HomeMy WebLinkAbout2054 MAPLE AVE - Building Permits J' 9 "'DCITY OF COSTA MF)SA • ' 4,l;fes .. BUILDINGITASION F I .,.,� I DEVELOPMENT SERVICES DEPARTMENT P MIT NUMBER t. �Ir��t PERMIT B03-00893 ittoftagrote (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa. a..uaNG PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDIJob Address: 2054 MAPLE AV Status: ISSUED Suite: B Applied: 05/29/2003 Vicinity: B Issued: 05/29/2003 Parcel Number: 42209230 Zoning: Applicant: BARKER, ERNEST E ISSUED BY: Address: PO BOX 966 Phone: LOMITA,CA - - Zip: 90717-0966 Owner BARKER, ERNEST E Address PO BOX 966 Phone: LOMITA,CA - Zip: 90717-0966 Contractor: OW NER=BUILDER Address: Phone: Zip: License: 000000 Arch : Eng: Address: Address: • Phone: Phone: Zip: - License: License: SCOPE OF PERMIT TEAR OFF COMP.SHINGLES, 1/2"OSB, 1 LAYER 30LB FELT AND 30 YEAR COMP.SHINGLES.UNIT B.800SF. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $2,000.00 Permit: $69.25 Claim Valuation: $2,000.00 SMIP Res: $0.50 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $69.75 - PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES; NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work Is 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. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued et one hundred dollars($100)or less.) ❑ .1 certify :t i 7 e paths ance of the • for which thi- ••.rmit is Issued,I •-I not employ any person In any manner so as to become subject to the workers' 'comp: sats• laws • ,lifomia,an• :gr:: that if I -.ul.become sus'- tot e workers'con sensation. • •ons of Sectio 0. • the Labor Code,I shall forthwith com• wl es: • ov ions. Applicant •I.•.tura. Date: WARNING: AILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($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: am Li6 licensed under provisions of Chapter 9(commencing with Section 7000)of Division usi ss and Professions Code,and my license Is in full i force nd ct.Lic. C0 � Class ft t+1ll/-lC. on rector Velure: v LU rOS-N - o3 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 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 havethe 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.). ■ -. 'xempl sec. Business and Professions Code for this reason: Signature Ez. rExplms' Verification of Ownership by(type of document,i.e.-property tax bill or deed): elms) 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 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 acutety 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 aEEermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 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? 0 Yes 0 No (if yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safely 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 ❑No 8 (if yes",attach certificate of compliance from the appropriate air pollution control oNicor). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with at state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owner(s) Date _S 3 ` And/Or Authorized Applicant \ Date " SORE 1 INSPECTION TYPE PATE 1NTIIALS BODE( INSPECTION TYPE PAIS IIfIENL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical • 1266 Pool Spa Final 7 7 208 Final Plumbing 200 Final Re-Roof —3 O (&Ilk 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 I r . nom CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT P MIT NUMBER 7. PERMIT B03-00892 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.BUILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2054 MAPLE AV Status: ISSUED Suite: Applied: 05/29/2003 Vicinity: Issued: 05/29/2003 Parcel Number: 42209230 Zoning: Applicant: BARKER, ERNEST E ISSUED BY: — Address: PO BOX 966 Phone: LOMITA,CA Zip: 90717-0966 Owner: BARKER; ERNEST E Address .PO BOX 966 Phone: LOMITA,CA - Zip: 90717-0966 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 000000 Arch : Eng: Address: Address: Phone: Phone: Zip: - License: License: SCOPE OF PERMIT TEAR OFF COMP.SHINGLES, 1/2"OSB, 1 LAYER 30LB FELT AND 30 COMP.SHINGLES. 1500SF FEE SUMMARY Plan Check: $0.00 Calc Valuation: $3,750.00 Permit: $97.25 - Claim Valuation: $3,750.00 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $97.75 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing:. 0 Required: 0 Proposed: 0 NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is 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) HECIMRATIONS j ° „ WORKERS'COMPENSATION DECLARATION: ' I hereby affirm under penalty of perjury one of the following declarations: J ❑ 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 pertormance ofIe 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,I 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($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 her licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Busing s and Professions Code,and my license is in full r ' a " v tr 4 HGF' Contractor's Sign 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 subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ 1,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 old 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.). cmcse I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business end 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 :r exempt dr sec. Business and Professions Code for this reason: �` al./ —.a /�Date: O 5— — fJ ti •• 'r ID vended by driver's license. Yes ❑No a se 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,Gm 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 ❑No (Section 25505 of the California Health and Safely Code requires,with some exceptions,that a Business Plan be tiled 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 end 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? LJ 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? 0 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? 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 slate 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 representefives 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 LegalciOwner(s) Date rBf7fGlForized AO" J Dat CODE 1 INSPECTION TYPE JPATE JNIITIALS CODES INSPECTION TYPE PAIS INTRIAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final �_ - 208 Final Plumbing 200 Final Re-Roof —3-93 1.1 " 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 DECLARATION OF AUTHORITY Bldg. Permit# FOR AGENTS OF PROPERTY OWNER TO APPLY FOR PERMITS This Permit# Street Address: 12 S2 6S4 B al 2 O3 //i 9-P rflf/ AP Number: 1. I (we),Y E Rmes IE BAA. /2 , declare that I am the Owner of Title of the above referenced real property, and that I (we)hereby authorize: Name: 1 tf JI r//�� f N( Telephone Number: ( 7/� 4 gi -LSO 0 Street Address: ( r0 0 cq v a) (- n 0 A— city: YYY City: 10 ()G.{ 7-11-CN V#u y State: fir Zip: "(t76 to obtain permits in my behalf,as owner/builder,for f4.0 R0 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 that the foregoing is true and correct. .°2-2Executed this 2 day of AAA > - 20 D 3 , at OS 74- Ad54 , California. Print Name: X neWriy E2 n3e--) 3C. Signature: �—/^4011/// Date: �( 8' " 03 Note: This authorization does not grant authorization to perform the work as owner, it solely provides for limited power of attorney to secure this permit in any behalf. 0779-46(rev 11/00) Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. PERMIT N TRACT NO. LOT NO. UNIT NO. / CITY OF COSTA MESA CON TR,}UCTION PERMIT �f A.P.# Zone Project Address 10.5V o#1a L1 M Pl€34 �� I Q S Main Building: Accessory Building: Applicant's Mail Address x063?6ns4awE lake au74.+5kw%e141dtaTYPE OF CONSTRUCTION r ❑ NEW U ADD U ALTERATION U REPAIR , I� ❑ CONVERSION ❑ DEMOLISH Li OTHER i T Front 0 Owner's Ni,'1AAA/ a. ' �N'Ler• Phone DESCRIPTION OF WORK/USE OF BLDG. B Rear N Address 410 or4e v.,r 966,egthm 64. 907/'7 A I TYPE OF PERMIT 0 GRADING 0 FOUNDATION 0 S C Right N TRUCTURAL Arch/Eng. License No. KG Address ' 0 TENANT '❑ ELECTRICAL 0 PLUMBING 0 MECHANICAL § . Left - ,.. �r� R Contractor's Nam��e1�s/ KYJ£/kL#,le Phondadat 7l ❑ 'OTHER Ping. Ref.# Parking Req./Provided - - E Address(mailing PROJECT DESCRIPTION SQ. FT. OCCUPANCY Planning Notes: _ O y`,b/G126ds4Awk4ape �/w,hwjlfw+�Qa�4Er9lby6 CONSTRUCTION TYPE VALUATIONS 9 M City License No. YT �S� ZONE GRADING CU.YDS. ACRES f S. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: • with section 7000) of Division 3 of the Business and Professions Code, and my license is in fur force{and effect. / • ELECTRICAL FEES License • ass - t/ a i -ns: ! o. /y 9 PLUMBING FEES • Date. _ A Signature - % � .'r :, ...i ' Automatic Washer Transformer ❑ 15-50.KW V WORKERS' COMPENSATION DECLARATION DOnSLlnptlOn Pole Sub. 0 50+KW ' '•: •R•••reby affirm that I have a certificate of consent to self-insure or a certificate 'Bar Sink I Showers • 'Workers' Compensation Insurance, or a certified copy thereof (Section • 1— Cooking Unit 1 Meter,Xup to 100 amps 'i g cT '- 'oo, Lab. C.) - Backflow Preventer Service. Sink - - l ?/ Policy No. Company Backflow Irrigation Sewer Cap . • Dishwasher Meter Dover 100 amps BCertified copy is hereby furn lshed. Dryers ❑Gas ❑Electric Sub Panel Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Date - Applicant Fan Motors 00-1 HP 01%-8 ' EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers . Solar Collectors - • (This section need not be Completed if the permit is far one hundred ($100)or Dishwasher Solar Piping F.A.U. Ina Sola! 09-15 HP 016-15+ less). I certify that in the performance of the work for which this permit Is Issued, I FixtUr¢5 7 shall not employ any person in any m ne so to be a subject to the Drinking Fountains Solar Tank Microwave Worker o tion Laws of Canto a 'bTA%IIaI"-'-_/ - i f�' l Device Boxes • Date (O Signature �• Floor Drains Swimming Pool w/Spa p()Ie,Light NOTICE:If,after making this declaration, you should beta a subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal _ _ Outlets :Range _ - comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Switches • Sign Q I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Garbage Disposal Standing Section Lender's Name -- Generator ❑0-5 KW❑5-15 KW Trash Compactor Lender's Address Kitchen Sink Water Service X OWNER BUILDER DECLARATION - I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories - Auto-Wash n following reason (Section 7031.5 Business and Professional Code: Any city or • county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays f any structure, prior to its issuance, also requires the applicant for such permit .M1 to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains ' �{ ..$ J.�1� "•e Contractor's License Law (Chapter 9(commencing with Section 7000)of I 'ision 3 of the Business and Professions Code) or that he/she is exempt Reinspection Fee ' $15 Issue Fee U refrom and the basis for the alleged exemption. Any violation of Section - I .31.5 by any applicant for a permit subjects the applicant-to a civil ' ' N v penalty of not more than five hundred dollars($500). - DEVELOPMENT SERVICES REQUIREMENTS:rT) .7 �� •❑ I, as owner of theproperty'or my employees with'wages as their sole Reinspection Fee I $15 • Issue Fee' • $'3 Zoning Approved By • - Date ' compensation, will do the work, and the structure is not intended or offered - r for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES Building Approved By s^ �1• Date License Law does not apply to an owner of a property who builds or improves thereon;and who does such work himself/herself or through his or her own Boiler •Hood or Type I. 0 • Application Issued By Date�9 employees, provided that such improvements are not intended or offered for ditEt sale. If, however, the building or Improvement is sold within one year of com- _ Canopy Type II 0 •• SUMMARY OF FEES pletion, the owner will nave the burden of proving he/she did not build or im- Duct- Under Ground - prove for the purpose of sale). BUILDING PERMIT' $ , SMIP 1 , $ 0 I,as owner of the property, am exclusively contracting with licensed con- Duct-Structural ' Refrigeration System • PLAN CHECK $ PERMIT tractors to construct the project (Section 7044,Business and Professions Code: • The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 0100,000 ...�,� BTU _ PLUMBING $ ISSUANCE e"-$', builds'or improves thereon:and who contracts for such oroiects with a con- .ENERGY P.C. $ tractor(s) license pursuant to me'Contractor's License Law). I am aware that . Exhaust System 0 Multiple 0 . System Repair/Alteration I PLAN CHECK 25% $ proof of their Worker's Compensation insurance should be provided to, me.. $ 3�j 10. GRADING $ • ❑ lam exempt under Section B.& P.C.far this reason • Firepl/Fact.Blt. ICBG# Fire Dampers • ELECTRICAL MICROFILM $ PLAN CHECK .50% $ DateOwner • Heating System& Ducting Registers SO I-hereby certify that-I have read this application and state that the above ❑al 00,000 BTU•0100,000BT _ _ . MECHANICALS. $ TOTAL FEE $ 3----• information is correct. I agree to comply with all city and county ordinances PLAN CHECK 25% $ and state laws rel ting to building construction,and hereby authorize repre- sentatives o chi city o enter on the above-mentioned pr per for inspection de �/ � • , Signature �L(/•� Date `� �1+ �-1nnn. n`ltsrtl 0865-46,rev. 5/88 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor - U t UODUOF71-0UQO6,71 TOT 33.513 CONSTRUCTION AND PLANNING PO ! SPA Date Inspector Date Inspector -'' APPROVALS Permit# APPROVALS Permit# 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location "•' 2. Soil P,%e-Undrgrnd.. ;- "' 53. Steel Reinforcement 3. Elec)ical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding " ! 5. Steel'Reinforcemknt' 56. Rough Plumbing & Pressure Test j , I 6., Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE I. 7. Footings / % ' ; 58. Electrical Conduit-Undrgrnd. 8. Foundation ..5' 59. Gas Pipe, O Undrgrnd.,Test t 9. Water Pipe-Undrgrnd. ' . 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10.,Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection ' ' ' 62. Backwash & Receptor-Final I 12. .Sewer Cap - • -- 63. Heater & Vent-Final ,. 13. Roof Drains : 64. Plumbing System - Final 14. RoughPlumhind• -' 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 7:6. Rough Electric Wiring 67. Fencing & Access Approval 10. Rough Wiring Sign 68. APPROVED FOR PLASTERING • "1!8. 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 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank D Gas D Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. PlastLr Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation c.71 I -•I J 44. Landscape Irrigation System EXPIRED 45. Sound Attenuation Incomplete Inspections 46. Handicap Regulations late '0/21._Sig47. FINAL STRUCTURE & BUILDING t 48. Soecial Requirements Completed !' j 49. Electric Release to Edison ) • ;r , 50. Gas Release to Southern California Gas Co I 51. CERTIFICATE OF OCCUPANCY •t I ' • " No. Date I. 1 1 • rAi Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. • STA,gN1ES CONST�I�y�J TION/ PERMIT{ a/� r PERMIT NO. TRACT NO. LOT NO. UNIT NO. Project Address ^iU�� o�[7lr•t 0105 /prl/1/"�-G� � � ,� I _ 5140 7/31,/04' p /691,3 Actew/wiw d/png,gn rx TYPE OF CONSTRUCTIRN • J NEW U ADD U ALTERATION Li REPAIR 5 00 �I Applicant's Mailing Address 'Y7- LJ � IILIjV ST 1'I(l✓ srmeNr ezwA2i3 O%0 ❑ CONVERSION DEMOLISH ❑ OTHER q,p,# c------------1 Zone Owner's Name E 'r'^"6n�d � 7 DESCRIPTION OF WORK/USE OF BLDG. Address /59V3 Pn'enLA wr3!/ Szaag. DA'PR7Anxn^r 9,1723 S Main Building: Accessory Building: Arch/Eng. License No. TYPE OF PERMIT 0 GRADING ❑ FOUNDATION ❑ STRUCTURAL T T Front _ Z 0 Address ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear N ❑ -OTHER A I . Contractor's Name PhoneC Right N Di 1� PROJECT DESCRIPTION SQ. FT. OCCUPANCY G Address(mailing) C> CONSTRUCTION TYPE VALUATION$ 5 Left City License NR o. ZONE GRADING CU.VDS. ACRES E LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided 0 I hereby affirm that I am licensed under provisions of charter 9 (commencing Remarks: Planning Notes: NI with section 7000) of Division 3 of the Business and Professions Code, and s— my license is in full force and effEc� 17 T License Class License No. • - S. Date Signature PLUMBING FEES 'rORKERS'COMPENSATION DECLARATION aereby affirm that I have a certificate of consent to self-insure or a certificate Bar Sinkye ELECTRICAL FEES .,f Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink 3800, Lab. C.) Automatic Washer - Transformer 0 15-50 KW • Policy rvo. Company Backflow Irrigation Construction Pole Sub. 0 50+ KW 8 Certified copy is hereby furnished. — Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Date Applicant EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher -- Meter ❑over 100 amps ' (This section need not be completed if the permit is for one hundred ($100) or less). Dishwasher Solar Piping Dryers DGas DElectric Sub Panel I certify that in the performance of the work for which this ermit isissued, I - ' shall not emp y y erson in any manner so as to bec subject t t e Drinking Fountains Solar Tank Fan Workers' Laws of California. finIJJ- - Motors 00-1 HP 0 h-8 Date Signature r/ Floor Drains NOTICE: I aft r ma ing this declaration, you should become su ject to the - Swimming Pool w/SpaF.A.U. Inc.Solar ❑9-15 HP ❑i6-15+ Workers' Compensation provisions of the Labor Code, you must forthwith Flo r8 — DaUrinal • UreS comply with such provisions or this permit shall be deemed revoked. Microwave CONSTRUCTION LENDING AGENCY as Service Outlets Water Closet I hereby affirm that there is a construction lending agency for the performance l� Device Boxes Pole Light of the work for which this pereTit is issued (Section 3097 Civ. C.) Interceptors Outlets Range Lender's Name ��tl{ //"}/ • Lender's Address Kitchen Sink Switches L OWNER BUILDER DECARATION • Sign • I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Garbage Disposal 'Standing Sections following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct,alter,improve,demolish or repair P—Trap any structure, prior to its issuance, also requires the applicant for such permit Generator ❑0-5 KW 05-15 KW Trash Compactor ,to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains ",he Contractor's License Law (Chapter 9(commencing with Section 7000) of • fcj,tvision 3 of the Business and Professions Code) or that he/she is exempt .z --herefrom 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 • Pry of not more than five hundred dollars($500). - as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 compensation, will do the work,and the structure is not intended or offered - Reinspection Fee I $15 Issue Fee $ 3 for sale (Section 7044. Business and Professional Code: The Contractor's MECHANICAL I FEES License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such improvements are not intended or offered for Boiler . Hood or Type I 0 sale. If, however, the building or improvement is sold within one year of com- Canopy Type II 0 Zoning Approved By -- Date pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground - Building Approved By Date LIrove for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By \Y-11� Date 7/A tractors to construct the project (Section 7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 0100,000 BTU SUMMARY OF FEES builds or improves thereon,and who contracts for such projects with a con- tractors) license pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple ❑ System Repair/Alteration BUILDING PERMIT $ SMIP $ proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT 0 I am exempt under Section B.& P.C.for this reason Firepl/Fact.BIt. ICBO# ISSUANCE $ Tip /� . PLUMBING $ S.0O Date �A //��j owner l'. y� Heating System& Ducting ENERGY P.C. $ 4 Q PLAN CHECK 25% $ I hereby c r ify tha I have read this application and state that the above ❑O-100,000 BTU ❑100,000 BTLELECTRICAL $ GRADING $ information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives PLAN CHECK 50%. $ MICROFILM $ pofu thi city to enter gpon the above-mentioned pro perty,for_ inspection purpot C.. . ..� /j�J/—/.-��>{/� - MECHANICAL $ TOTAL FEE $ S'0Q Signature tit-(a-Q--2J Date Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ _ Drivers' License or SS < CMF 0865-46,rev.4/84 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod-Assessor I CONSTRUCTION AND PLANNING PO S SPA APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector . Temporary Electrical Service or Pole ,i 52. Pool & Equipment Location • . Soil Pipe-Undrgrnd. - 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. - - 54. Forms • 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test ' 6. Electrical UFER Grnd. - 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd. 10: Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection - 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# 21..Ducts, in Structure 70. Underground Hydro { 22. %ucts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe . 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION . 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33/Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test gfgj/ 1 [,J 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final i 1- `r�M ? 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation . . 44. Landscape Irrigation System - 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date • - 4469 FEE RECEIVED COSTA MESA BUILDING DEPARTMENT (/'� P.O.80X 317 C9 i; .c^ r /\ COSTA MESA. CALIFORNIA FINANCE DEPT. `-y\ FOR APPLICANT TO FILL IN APPICITY,�ICTMMA PER MIT cfri ADDRELi: /�J`v //L �{/f , BUILDING eil"COSTA SA. CALIFORNIA FOR OFFICE USE ONLY 1 P RECEIPT NO. _ -SzA.3 OWNER ��o-'Y{�J X71 SU MAIL `` /_ y� St- ,s,... .., .RE BY DATE RECEIVED DATE ISSUED-‘c-7 ( ./F ADDRESS QV �P �arle T�^�S--J/ a7-2a V / /,Ayw/e wU. TEL. 2 BUILDI G CITY 41_I-4 it- NO�� 8 73 ADDRE S ARCHITECT LIC. OR ENGINEER NO. COSTA MESA. CALIFORNIA FIRE ADDRESS ZONE ZON NO.OF Tr GROUP CONTRACTOR I CCIT1`YL NOO. J PLANS �J�//+' // d 1y/� / I 5A NO ' yya BPPPRROOV D /V -DAlLT���2(�¢�V/ ADDRESS Q� _ iA LEGALLLOT �A���/1v'��'�(1(J DESC IPTION NDr� BLOCK HAi C EGTIONS A.P.NO. / I v _ G9 7/ `eg-- VELOT a 7 (7 NO.OF BLOCS. OF LOT �� ./\ I �J I NOW ON LOT y� USE OF ��{/ r EXISTING BLDG. " 0.20 /�� L,L SETBACK LINE FROM / // .^I CENTER OF STREET if y REAR YARD /0/ LQiei/- SIDE YARD RIGHT „/ LEFT /i V APP R®V L D DESCRIPTION OF WORK Ih CITY ©r COSTA MESA NEW ALTERATION 1 ADDITION PLANh1NG DEPT. . SUBJECT" TO BLDG. DEPT. Btu. REPAIR 6 MOVING IDEMOLISH BUILDING El • NO.OF � 7 SIZE ,250 Q ROOMS Jr STORIES / BYa /I 2✓�//�' DATE. _ / EXTERIOR W ROOF V t PLAN (gl rCOVERING COVERING ,T/Al�if��.�L� 'USE OF NEW j p�p- J ,J r 1 /�� C BUILDING as41:1 -e_______—• .SIJ I/- 4/ C1' `�• 1�3ic lire.q tel rt as 86 ass 4 r 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUC- TION. VALUATION c)2‘..-.- PERMITTEE ,�/^ _ E 1 PERMIT FEE 5 `� O PERMSIGNAITTEE TURE OF /,J z'w`J S /4,,z Q PLAN CHECK S /0 AUTHORIZED AGENT .,/ /V) `TOTAL FEE 5 S0 ,per • • -3 -j039 . 3.3.. • �'- - • ;9 ,a 3 /e el n- . . - . ._ . • • . . • • . . . . • • • . • • I . .. t#Ili t. `ii.Qr- 1 . I •^ '" • • • .-fit. • -^- ` 4TAO'.. -... . .- ,Ys• ± • • ,_ • • • . ' .; • -• . , I • y .