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Home My WebLink About277 KNOX ST - Building Permits 9 CITY OF COSTA MESA • BUILDING DIVISION • >4%d 4i'' DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER F I . . l -. e PERMIT E03-00549 I (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 277 KNOX ST Status: ISSUED Suite No Applied: 06/25/2003 Vicinity: Issued: 06/25/2003 Parcel Nunmber: 42516214 / Applicant: ABSHEAR, WILLIAM - ISSUED BY: �V Address: 3803 MARCUS AVE - - - '� - Phone: 949-650-2256 - - - NEWPORT,BEACH,CA- "- Zip: 92663 - - -� '-- _ .- - \ - �.,4`-A . Owner:!„ABSHEAR, WILLIA'M-S-TR - - . - `� \ Address', ,3803 MARCUS AVE; 'r .. Phone: - - \ NEWPORT BEACH,CA Zip: 92663 Contractor: / OWNER-BUILDER - - Address: / �,�" - - - ' " - -- Phohe: • - Zip: ' - License: 000000 - . - - SCOPE OF PERMIT LEGALIZE WASHER AND DRYER LOCATED IN EXTERIOR OF S.F.D. , ELECTRICAL TO INCLUDE: 1 OUTLET AND 1 MISC. ELECTRICAL'EQUIPMENT FOR WASHER/DRYER ' CIRCUIT. , FEE SUMMARY,/ •' ., i Quantity Quantity' • ISSUE FEE '. A A. v $23.50 Temp-Dist System./Lighting $0.00 <0 y , - Temp service test $0.00 Busway/100 ft $0.00 ;-0 ' Seion ing New Res(1 2 units)e �,$0.00 0 ::,c, , '1 - .MiscdElectrical Equipment $18.20; 7,1 New Res(3+units) , ' Transformers$0.00 0 Tnsformers up-to 1 kva/kw $0.00/, 0. ; Pool/Spay A$0.00 .__ 0,: - - up to 10kva/kwy T -$0.00 0 - ' , Lighting Fixts CC,V -" /, $0 .00,' $ ': 0 ' up to 50 kva/kw - $0100 0 ' Recept Outlets ,- ,' / $1.10: .', 1 _ - - - up to 100 kva/kw '`$0.00 • 0 • Switches , ' $0.00 0 - over 100 kva/kw - $0.00 0 Non Res Appl $0.00 , 0-, - Low Voltage Equipment. - $0.00 ' 0 / Res Appl - $0.000 - _ _ Low Volt Wiring System/Ckt ' $0.00 0, Service to 200a A •-�A $0.00;' - ' ' -0 - ' Misc.Conduit - • $0.00' ,''0' , Service to 1000a "N<_ $0.00 0 Misc.Conductor - - - Service over 1000a $0.00 0 - Circus(gen or ride) $0.00 . ' 0 Motors to 1hp $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 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)754-5625 2446-46(6/00) DECLARATIONS f i n WORKERS'COMPENSATION DECLARATION: • I hereby affirm under penalty of perjury one of the following declarations: O 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. 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 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' ' (O compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Sectio 3700 of the Labor Code,I shall forthwith comply with these pr '" ns.s.,.n. / Applicant Signature: o �i[/�`v- Date: Y-j /d 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 DOUARE($100,000),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that 1 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.k 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). Lender's 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).): ❑ 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 exemp�t--u�n^d�er sec. Business and Professions Code for this reason: Ig lure: yr ' �� o -t- /� ate: G /Y.-jn5 Owner ID verified by drivers license. Yes 0 No Drivers License No. [ / Expires: Y�/0-6 Verification of Ownership by(type of doc m t,i.e.-property tax bit 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 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 end 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 then 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 ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? IJ 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? 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 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 propert f ns•u agre of to occupy or allow occupancy of any building authorized by this mit until Anal inspection. Signature Of Legal Owner(s) Date And/Or Authorized Applicant Date CODE it, INSPECTION TYPE Mg INTIT)AUS CODER INSPECTION TYPE MI INTMAL$ 1616 Fixed System Final Fire Prevention _ 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing Q 200 Final Re-Roof 210 Final Electrical 644 03 201 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 CITY OF COSTA MESA ►9 BUILDING DIVISION o• �� • DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER f1 l 11104 . PERMIT %bows+, J P03-00395 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 277 KNOX ST Status: ISSUED Suite No Applied: 06/25/2003 Issued: 06/25/2003 Vicinity: Parcel Nunmber: 42516214 - ISSUED BY: Applicant: ABSHEAR, WILLIAM-.• Address: 3803 MARCUS AVE �'- Phone: 949-650-2256 / ' NEWPORT-BEACH;CA - - j / - - - - - - N •\ `�- Owner: /ABSHEAR,-WILLIAM S TR Address 3803 MARCUS AVE - ' - // Phone: ti \ NEWPORT BEACH,CA Zip: 92663 _ - ;Contractor: ' OWNER-BUILDER - .N - Address: , - - ' - - Phone: / t ' Zip: N License: 000000 'Arch / Eng:` ,�_ . __ ' Address: _. ,- Phone: . , _ - - Zip:' _ • • - License: - - . - .. - - - , \ - • ` ' SCOPE OF PERMIT , - ' •fi LEGALIZE WASHER AND DRYER LOCATED IN EXTERIOR OF S.F:D. , , .1 - PLUMBING TO INCLUDE: 1 LAUNDRY.=TUB/WASHER. - - ' _ FEE SUMMARY \v' '�\ AMT ` 'QTY ' ' - AMT OTY- � - = AMT QTY ISSUE FEE N - '$23.50 , - Laundry Tub/Washer $9.80 '"1 r• Sump Pump - = $0.00 0 Backflow irrigation NN •$0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventery . $0.00,', 0-, • -NP-Trap. - $0.00 0- Trap Primer $0.00 0 Bathtub �.-c'$000- • , 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. VacuumBrkr Bkflow(5+) $0.00 0 Dental Units $0.00 - 0 • Septic Tank ' - $0.00 0 Wash Basin $0.00 0 Dishwasher $0.00 - 0 -Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain, Floor $0.00 0 I 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) $0.00 0 Drain,Roof $0.00 0 Shower , - ' $0.00- - 0 Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 Sink,bar • $0.00 0 Water Piping(Inst or Rep.) $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 2446-46(6/00) DECLARATIONS f ' n 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: (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 Sec'on 3700 of the Labor Code,I shall forthwith comply with these prows) Applicant Signature: /�ill e_Gl/"--- Date: 6 - /'3 WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML 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 and effect.Lic.4 Class If 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 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: /� • n ure: .' / finer ID verified by driver's license. Yes 0 No Driver's License No. Expires: ��8 t-s Verification of Ownership by(type of docu en,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 B,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). ......Does o.will the applicant 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 et 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 ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0Yes 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 pan 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 B (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 prope • i ••• .. •ury• es.I/ree not to occupy or allow occupancy of any building authorized by this permit until finals/iinnspe ion. _/ Signature Of Legal Owner(s) Date And/Or Authorized Applicant Date ODE I INSPECRON TYPE PAIL INTRIAL$ 00054 INSPECTION TYPE PAIL INTmALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical � q 1266 Pool Spa Final 208 Final Plumbing tr"3"03 200 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 7111111W . • • P a ADDRESS: 277 KNOX ST ' _ ' , UNIT: 0 . ; CITY OF COSTA MESA - BUILDING PERMIT PERM NQ•: P 044938 OWNER'S NAME: WILLIAM"ABSHEAR , ' ." ' _. - •- ' •` r ' • • ADDREss: 3803 MARKUS AV • PERMIT' NO: P . 044938 i ••PLAN ••CHECK NO: N GOVT: - N SUPP : N � NB CA ' 92663 • . ,- - • CONSTRUCTION TYPE: - '• , . PERMIT TYPE: IPLU . PURPOSEc . ALT .ARCH/ENGINEER: • _• • ' ' REG.NO.: - -JOB DESCRIPTION : NEW WAT,ERI SERVICE ESQ FT: - 1'; ADDRESS: • ' , I , .UNIT: - _ •_ - • CLAIM VALUE: . - 300 . 00 • CALL-VALUE: GROUP OCC e: R 3 /, f • PERMTTEE: CC :COLE :PLMG. '6 IiTG. ( 71.4 ) 645-1161 • - ADDRESS: 2280- NEWPORT -BL; ` • • ' • - COMMENTS: SERVICE HOUSE TO STREET = • ' , CM CA 92627 *************9t*******•******#************ ****************#**#*************ie**#*• LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed ander provisions of Chapter 9(commencing with SectionZ O N I N -G' : R E' Q U I R E M :E N T S •f . •• _ 7000)of Division 3'of the Business and Professions Code,and my license is in full force and effect., • $, E 'T B A C K S . ' cmuc.:0)n,6748 sTATEuc.:375585 cuss: . .. . . • 1 )o> ^/1 : MAIN BUILDING , ACCESSORY 'BUILDING Date: I I I�'a�• • Signature: WORKERS'COMPENSATION OECLARATION: Ihereby aftirmself-insure affirmthat FRNT: FT IN REAR: FT ZN t FRNT: FT IN REAR: - FT . IN . Compensation Insurance,or a certified copy thereof(Section 3800,Lab.C). • LEFT: . ' FT , ,IN RGHT: FT IN LEFT: ' !FT' IN RGHT: : .. FT IN ^fLICYNO.i00,1608-89 EXP.DATE: 01 /01 /90 • ' 'PANY: STATE FUND PARKING REQ: - PROV: PARCEL : 42516201 ZNE.: REF NO: • ,ertifielcopy'is herebyherebyfurnished. ®-Certified copy i filed with the city Build' OOOii(viiy'on. • 'PLANNING •NOTES> • Oats:_ -I I/ `f- /O 1 • Applicant' 0%.--,�f� P/a�Q1 • • #**###1k###*##*#####**##*####eE##******#*#***######iFit#*##*#**######**##*#*#####*#. — . . EXEMPT!. ON OM YYYIII000111///MINERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred(S1W)or less). D E V E L O P M E N T' ,S E R V I -C E S 14:1,-E Q U I R F. M E N T S , I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California. • ZONING APPROVED BY h ,�' DATE: • , , Date: Signature: . .., - .. . . . .. . -- NOTICE:If,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor - BUILDING 'APPROVED BY t DATE: Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. ' - .,. 1 - • , CONSTRUCTION LENDING AGENCY: I hereby,affirm that there is a construction lending agency for the performance of the work for AP PL I CATION ISSUED BY: r- _ ' -4, 'DATE: 1 `3 which this permit is issued'(Section 3097,Cit.,: . ****** *************# # ' •!s %=7a-••�- LENDER: - **#************#*******#**#******###* *********#')f**####***********#*********** •' ADDRESS - - LEGALTZATION:N • TflE E S U M M A R.Y - STRUCTURAL SEGMENT:N OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Cohtractors State License Law for the following reason - ' ' ' BLDG PMT PLUMBING ,ELECTRIC MECHANIC FTRE 'SMIP/RES • GRADING (Section 7031.5 Business and ProfessionaFCode: Any city of county which requires'a.permit to construct,alter,improve,demolish,or p ERM I T ' ' 2 . 0 0 - ' repair any structure,prior to its issuance,also,requires the applicant for such,permit to file a signed statement that he/she is licensed' - - . ' pursuant to the provisions of the Contractors-State License Law(Chapter9(commencing with Section 7000)of Division 3 of the Business 2 5$ .$MIP/NON—RE$ . 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 live hundred dollars($500)., . ISSUE FEE 3 . 00 - I as• •owner of the property'or-.my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV-> PERMIT ISSUE „ PLAN—CHECK ; TOTAL PAID DUE ('Ti ewc Uro isnot intended or offered for sale(Section 7044,Business-and Professional Code: The Contractors'State License Law TOTALS > 1. 00 • 3 : 00, 0. 00 5. 00 5 . 00 0 0 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through . - • his or her own employees,provided that such improvements are not intended or offered for sale.If,however the building or '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: ' ' 5:00 ! OVER/SHORT:• • : . 00 • • 'for the purpose.ofsale). - BLDG PMT PLUMDING ; ELECTR'IC"'•MECHANIC' - FIRE ISMIP/TOT ,GRADING PLAN—CHECK • .1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business' . 5 • 0 Q • . ' '0 ' and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon , and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).l am aware :**************#***********'****9• f**iE*** *#*iE****************************#*****4e**ie that proof of Iheir.Worker'S Compensation insurance should be provided to me.' . T N D I V I ,D U A ' L F E E . BREAKDOWN.. 0 I am exempt under Section: 'forthisreason: • - TYPE QTY DESCRIPTION . • UNIT COST. I TOTAL COST Date: • Owner: • PLO 1 WATER SERVICE ' 2 . 00 • , 2 . 00 • ' • I do hereby certify that 1 am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and . - S . , • 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 - .- . . . END OF FEES , permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from h , these provisions. n . I h .• Date: • Applicant: - • • , • I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county • - . ' • ordinances and state laws relating to building construction and hereby authorize representatives of this city to enterppon the above-mentioned . - .. -- - . . • property for inspection purposes. • , Date: II/ 1 4/89 Signature: 0 l`..�+�-•I•�t� • .. 1 • °:'J 'irr tnr �. 'rr Ys.,-• '..• Driver's License or Social Security x: I - • - - D ers t 11-1-,.••,, TT i:L.. 1.t•'•.. 164146 White—Building;Green—Code Enforcement;Cane Revenue;Goldenrod—Assessor"- .. - - — • - - - -• — - — - 1 h - ry—Applicant;Pink—Revenue; � / V� � • CONSTRUCTION AND PLANNING: - PC • SPA - - APPROVALS Permit# • Date Insp•ector APPROVALS Permit_# - Date Inspector 1. Temporary Electrical Service Or.Pole:rJ - _ - 52.•Pool &Equipment Location : 2._Soil Pipe-Undrgrnd.- a. - 53. Steel Reinforcement - - .:Electrical Conduit'•Utility-Undrgrnd9 54. Forms 4.�EI'ectrical Conduit=Undrgrnd. 55. Electrical Bonding, • ' ' S 5.'Steel Reinforcement " - 56:•Rough.Plumbing & Pressure Test • '''6.KElectrical OF ERGrnd. 57. APPROVAL TO COVER-GUNITE - _ • - .r7L<Footings • a ond 58. Electrical Cuit=Undrgrnd. - 8. Foundation `r } 59. 'Gas Pipe, 0 Undrgrnd., Test : , . 9. Water Pipe-Undrgrnd. - 60. Backwash Lines, P-Trap, O•Undrgrnd. .`, 10. Structural Floor'System - 61. APPROVAL TO DECK • - l 11. Property Sewer Line& HduseiConrie'ction - _ 62. Backwash & Receptor-Final • • • 12. Sewer Cap u `'= • „ 63. Heater & Vent-Final 1, 13. Roof Drains ;•f .: - - 64. Plumbing System - Final • 14. Rough Plumbing t „ 65. Electrical-Final 1 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 --r.- > x . a -.FIRE-DEPT. REQUIREMENT 20: Rough Factory Fireplace j `= -'• ;. a w -APPROVALS: :Pe mit # - 21.-Ducts, in'Structure�` •. • k - -, "+'' a: - .....•1.-•d -, ' r, n .f -I. y70. Underground Hydro 22:yDucts, Ventilating - "'T : -i c 9 _ v: E+ r 171. Prod uct�P.iping Gas 'Oil _ 23.•GarPiperRou .gh & Test - ' C 5i ' ^ 7)2. Underground Flush' 24:Roof Framing -- �r , -c -•73^Undergrnd.Storage_Tank O Gas O Oil 25. Rob Sheathing _ �• ` x u = r�^ 7q JOverhead Hydro__ (/ 26. T-Bar Ceiling (St uctural) &-Monocoat c C' •-' C-i 4 75^Dry Chemical _ _ '3 r27.,Frame and Flashing i_ -- • 76. Dry Standpipe - 7'1 ' _ X28 Lathing& Siding: =r�,• r I ,x 4- 7774 FIXED SYSTEM FINAL+ - . c. X29. Insulation -. ( ' r 78 FIRE PR EV. FINAL - r'30. Drywall Nailing /-.14,' ,.-, c =- - ' 'x '-c;=- _.HEALTH-DEPT:. REQUIREMENT - 031. Plaster Brown Coat :1 _ V "79. FINALINSPECTION I <32:-Electrical Power,Meter-Final f- r' ',,L„ X80-FOOD CERTIFICATE ISSUED,_ _33SFinal Electric r - y 'C - ' - •. I - G It'.-1 A. y W34i,Final Heating& Aic Conditioning' e- _ I ,l: V L c its: _.r e 35^Fin-al Gas Pipe-Test+: _ t. �- ; t:/ `+ - :..-.c., `.:.1-• - ='36.. Hood or Canopy it -. r1 er ' _� r - "' '- ^37 Final Factory Fireplace'', - - -38. Final Plumbing a _ - ,. E.-+ , `^ • M 39. Water Service-Final• - +',V/ ^40. Gas Service-Final " u _:�, ` C "`' • :441. Solar Domestic-Final' , .� - '^c l.- r2 _ 42. Backflow Preventerr ' t-'` ; T 43. Backflow Irrigation: _ K '• r. r - .- > 1744..Landscape Irrigation System;•,:` r l' `- r, a Via, = a; - - v * '-‘15.,-.-Sound Attenuation - CI Y. - - -. .. `46.'Handicap Regulations = C ., _ A 27= - .47:FINAL STRUCTURE & BUILDING r - - ,- 48.=FINAL PLANNING ' `"'`' - =- • 4: ,.-C.;. - c' 49:,Electric Release to,Edison --,; . - .. --50=Gas,Release to Southern California Gas Co t` - . -51. CERTIFICATE OPOCCUPANCY a - No. Date OWNER BISSELL, RONALD L. DATE 3-3-59 JOB ADDRESS 277 KIIOX St. - - - BUILDING PERMIT NO. 871111 GENERAL CONTRACTOR Romar Builders, Inc. VALUE $ 9,556.00 IRV. 1�. LOT TRACT FIRE ZONE 3 DESCRIPTION OF WORK Res. w att/gar. _ lIP I & J TYPE V ZONE Hit PLAN NO. 871411 PERMITS ISSUED INSPECTIONS DATE SUBCONTRACTOR DATE - NUMBER Trench - Forms✓ Steel 'a//0//(47 Floor Syhtem Steel Reinforce 4:12,441 Chimney Re-Rod , Be+ed-81am -.l,a- 34i/s) Frame and ing Veli 0/60 ) / Lathing,str, rn coat 'WV Plaster, brown coat a Underground soil 1 C W/G Pipet-Tes //j 3-/y-377 ' r ) Top Out 1-.5",$y L \I Furnace W Furnace 2./O-5Y (1,4(4.4-,) 1 3-S ss x/_3/1 Gas Vents - l Rough Plumbing 2_ 14, $-/9'-6'? (P.-- cthh. 3-5-1 /7 3 dl 1Cesspool Septic Tank Prop. Swr. Line u House Con. St. Swr. • 1 Sprinkling System - I r '" ng Final f f /.S-Q ' " ging Fixtures, Final 0 p! / :!,-t;' _ ��,' basal Gas Test to 4-ev -54, Construction Pole Underground Power �i ' I Rough Wiring 3 7- -L>, C s�. " —cf'' s '-s 9 S 2 VS o 2.odo Fixtures, Final r- -24 Y9 J / -_OCCUPANCY LW A51oIs 1 Form 210-5M-1-57 traill • H rEE ECEIVED . 8 44 - f.., 3 1959 COSTA MESA BUILDING 'DEPARTMENT FINANCE DEPT. P.G. BOX 317 CITY OF COSTA MESA • COSTA MESA. CALIFORNIA FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT ADDRESS � ,�, �4/oy i BUILDING COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY _____' /J Th 0 / i RECEIPT NO. RBI OWNER OWNER ;"ne t, /-T . if 5 CeS h !l / � RECEIVED BTDATE RECEIVED DAT IV/ MAIL ADDRESS ICA a -,t 46/ell— ..-----7-1-7":7 3- J — N� 3 3 • /1 TL. /[�� ./�'I� ADDRESSBUILDING CITV �3KE Iatlnoo NO. ,f[ `Jj OR E -ER ARO- LIC. OR E COSTA MESA. CALIFORNIA C. FIRE ADDRESS ZONE 5OMAR BUILDERS, Mew LIC. r/ ZONE �T NO.OF TYPE i GRODP PLAN�i9 V �.4 — CONTRACT �. NO. (�- Al COSTA MESA.CALIF. TEL. APPROVED • dr...A_ 3 ADDRESS PHONE LI.8.9388 NO. - /�p� BY f ,i / DATE GEGAR LOT al '/ / /M UI 1/ LESCalpTlory NO. Ol 7` BLOCK// / TeRACT�n��Jyi',.,( `r" �p�aa�y��J��y�f/•�'7i /}•�� J (J Iy I/ A.P. NO 11 7- / 7 -! / [' R L a e2 k i- 4T V a g v e7- PAP,s e.i. t i i i SIZE �( M,�/ JD• n NO.OF !SLOGS.OGS. OF LOT �.'J (/� �rJNOW ON LOT 0 ^.)Fn.��///��fjjj g��Q USE OFk i t-, EXISTING BLDG. �/ SETBACK LINE FROM �.ai CITY O C'_ ! 01 \^.G2N CENTER OF STREET ...51; R REAR YAR Li,* pt .,.`„N0'Apr; I•LttIrL SIDE YARD RIGHT LEFT /a SUBJECT TO BLDG. DEPT. NC®, DESCRIPTION OF WORK /'/! ,/� _ _LIG sail i._'LA i NEW /ALTERATION ADDITION BY PLAN TeGH-0--27.1 4 REPAIR ' 0t4/OVING DEMOLISH A T/ a- NO.OF MELDING GJ ' •/ ROOMS �� STORIES/ ' EXTERIOR WALL ROOF COVERING ../ COVERING !� �y BU ILDINGUSE OF EW /V✓O— /3L-1)--&40.-z0.5 i-V27. /�5L OJ J I. • - i/�/s� CI 1.✓.Lhr////r L4/T.� /1'f/r� J ezia . 1/4- 7 19 y' . . _ ,�/ T7 / i2�- tc. Id RKIf •o :ut t tlo .. . tt' . . 11 1 I' I HEREBY ACKNOWLEDGE THA- I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL purpose of establishing a permit fee only. CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUC- TION. VALUATION SIGNATURE OF �J PERMIT FEE S 2 y-- PERMITTEE •il ��"-Q' 7 g S.S / PLAN CHECK S //2 / AUTHORIZED AGENT / CCCJJJ TOTAL FEE g 6 4--,