HomeMy WebLinkAbout382 LA PERLE PL - Building PermitsAttributes
Property Address
Address 1 382 LA PERLE PL
Address 2 COSTA MESA CA 92627
Parcel Information
Assessor Parcel Number 42531127
Legal N TR 1175 LOT 15
Range
Township
Section
Quarter Sec[ion
Area
Acres
Owner
Owner Address 1
Owner Address 2
Year Built
Building Square Feet
Building Count
Stories Number
Parking Spaces
Number of Units
garage Square Feet
Front Footage
Depth Footgae
Bedrooms
7198.97599
0.17
Owner Information
MILES BRETT M
16630 CALLE ARBOLADA
PACIFIC PALISADES CA 90272
Property Specs
1957
1732
1
1
2
Page 1 of 1
http://mesagi s2x/website/costamesa/parcel/popup. asp?opt=Attributes& Hi storyID= {2FC 7... 02/25/2003
(714) 754-5273 • Fax (714) 754-4856 • www.ci.cosla-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
lob Address: 384 LA PERLE LN
Suile NO
Vicinity:
Parcel Nunmber: 42531203
Applicant MATTHEWS, DOUGLAS
Address: 384 LA PERLE LN
COSTA MESA, CA
Owner: MATTHEWS, DOUGLAS
Address 384 LA PERLE LN
COSTA MESA, CA
Contractoc OWNER-BUILDER
Address:
BO4-01959. SEWER CAP.
ISSUE FEE
BackFlow irrigation
Backflow Prevenler
Bathtub
Claritier System
Connect (Ice,Soda,etc)
Dental Units
Dishwasher
Drain, Floor
Drein, Rainwater
Drain, Roof
Drinking Fountain
Expansion Tank
Gas Earthquake Valve
Gas (i-4 outlets)
Gas (Over 4 outlets)
Gas Repipe
Gas Service
Interceplors (Grease, Oiq
Interceptors (Santl Auto )
AMT
$23.50
50.00
50.00
$0.00
$0.00
$0.00
$0.00
50.00
50.00
$0.00
$0.00
$0.00
50.00
50.00
$0.00
$0.00
50.00
50.00
50.00
$0.00
�TY
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
PLUMBING PERMIT
Phone: 714-396-2379
Zip: 92627
Phone: 714-396-2379
Zip: 92627
Phone:
Zip:
License: 000000
SCOPE OF PERMIT
FEESUMMARY
AMT
laundry Tub / Washer 50.00
Landscape Irrigation 50.00
P-Trap 50.00
Pressure Regulator 50.00
Process Pipiny (per 10 tt) 50.00
Receptors 50.00
Septic Tank $0.00
SewerCapforDemo 30.00
Sewer Connect $24.65
Sewer Pnvate line 50.00
Shower $0.00
Sink, bar 50.00
Sink, commercial $0.00
Sink, Floor 50.00
Sink, kitchen $0.00
Sink, service/mop 50.00
Spa (private) 50.00
Spa (public) 50.00
r; \`�.-�
`J � ) �
��� ��h/``�
V
QTY
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
SlaWs: ISSUED
Applied: 1 111 7/2 0 04
ISSUBd: 11/77I2004
ISSUED BY:
v��l\
\`/ O
�
SumpPump
Swimming Pool
Trap Primer
Urinal
Vacuum Brkr Bkflow(1-4)
Vacuum Brkr BkOow(5+)
Wash Basin
Wash Basin Set
Waste and Venl System
Waler Closet (Toilet)
Water Heater / venl
Water Piping Qnst or Rep.)
Water Re-pipe
Water Service
Water Softener
OTHER
VIOLATION
PLAN CHECK
REINSPECTION
TOTAL CALCULATED FEES
AMT
50.00
$0.00
$0.00
$0.00
$0.00
50.00
$0.00
$0.00
50.00
50.00
50.00
$0.00
50.00
50.00
50.00
50.00
50.00
50.00
50.00
E48.15
OTY
0
0 ,
0
0
0
0
0
0
0
0
0
0
0
0
0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and ielated
regulations. (Ord. No. 92-28, § t, 12-21-92)
EXPIRATION: This permit shall automatically expire antl become void if work is not commenced wi�hin 180 days, or if work is suspended or abardoned
br a period of 180 days.
INSPECTIONS: In order lor the work authorized under this permil to be considered legal, such work must comply with all applicable codes, ++nd all
required inspections and tlnal approval must be obtained. Failure to obtain inspections and linal approval will result in ihe ezpiration of Ihis perniit. �
FOR INSPECTIONS CALL: (714) 7545626
.�v � ��w�
�714) 754-5273 • Fax (714) 754-4856 • w�vw.ci.cos�a-mesa.��LDING PERMIT �� FAIR DRIVE, COSTA MESA, CP 92626
JobAtldrOss: 384 LA PERLE LN
S�iite:
Vicinity:
Primary OCG: R3
ParoelNumber. 42531203
App�ican�: MATTHEWS, DOUGLAS
Addr¢ss: 384 LA PERLE LN
COSTA MESA, CA
Ownec MATTHEWS, DOUGLAS
Address 384 LA PERLE LN
COSTA MESA, CA
Contrador. OW NER-BU ILDER
AddrCss:
Zip:
Arch :
Address:
Phone:
Type of Conslruclion: V-N
Zoning:
Phone: 714-396-2379
Zip: 92627
Phane: 714-396-2379
Zip: 92627
Phone:
License: 000000
Eng:
Address:
Status: ISSUED
Applied: 77/77/2006
Issued: 11/17/2004
ISSUED BY:
���1J1%�
V
Phone:
Zip: license: Litense:
SCOPE OF PERMIT
DEMOLISH EXIST t000SF SFD .
Plan Check: $0.00
Permit $38.75
SMIP Res: $0.00
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $38.75
SETBACKS
MAIN STRUGTURE Front 0- 0
ACCESSORY Front 0-0
PARKING Existinq: 0
NOTES:
Rear 0- 0
Rear 0- 0
Required: 0
FEE SUMMARY
PLANNING 8 ZONING
�ell 0- 0
Lefl 0- 0
Proposed: 0
Calc Valuation:
Claim valuation
Right 0- 0
Right 0- 0
�` �p�
si.00n.00
si,00u.00
INO710E: The wo�k authorized by this permit shall comply wiih all applicable handicap access requiremenls untler Calitomia statutes antl 'elatatl
regulations. (Ord. No. 92-20, § 1, 72-21-92)
��. EXPIRA710N: This permit shall automatically expire and become void il work is not commenced wi�hin 180 days, or if work is suspendetl or abandonetl
� lor a period of 780 hays.
INSPECTIONS: In order lor the work aulhorized under this permit to be coasidered legal, such work must compfy with a�� applicable codes, and all
required inspectlons and tinal approval musl be obtained. Failure lo obtain inspections and final approval will resutl in ihe expiration ot this permit.
FOq INSPECTIONS CALL: (714) 7545626
mU ay �yW�
(�tb) �50-52�3 • Fax (7ta) 754-oe56 • www.ci.cosla•mesa.��iLDING PERMIT �� hAIH UMIVt, GVJIA MtJA, GA yC0[O
Job nddress: 384 LA PERLE LN
Suile:
Vicinily:
Primary Occ: R-3 Dwellings/ Cony Res �70 Type of Construction: V-N
Parcel Number: 42531203 Zoning:
Appiicanc CRAIG MCINTOSH
Address: 10481RVINE AV
SUITE 191
NEWPORT 6EAGH, CA
Owner: MATTHEWS, DOUGLAS
Address 384 LA PERLE lN
COSTA MESA, CA
Contractoc OWNER-BUILDER
Address:
Zip:
Arch : CRAIG MC INTOSH
Address: 213 VALLEY VIEW TER
Phone: 714-396-2379
Phane: 714-396-2379
Zip: 92660
Phone: 714-396-2379
Zip: 92627
Phone:
License: 000000
Eng:
Address:
Stalus: ISSUED
Applied: Oa/26/2003
Issued: 11/17/200 S
ISSUED BY:
Phone:
MISSION VIEJO, CA
Zip: 92692 License: C24591 License:
SCOPE OF PERMIT
DEMOIISH ONE UNIT OF EXISTING DUPLEX; CONSTRUCT NEW 2628 S.F. (7266 SF 1ST STORV AND 1341 SF 2ND STORY) WITH A 485 SF
ATTACHED GARAGE. AL50INCLUDES 38 S.F. BALCONY ON 2ND FLOOR AND 150 S.F. PATIO. UNIT IS 2 BDRM AND 2.5 BATH. ALSO
INCLUDES REROOF OF .
EXISTING HOUSE WITH �IFETILE (10PSF).
REF: ZA-03-112
Plan Check: $1,242.90
Permit: $1,912.15
SMIP Res: $26.37
SMIP Com: $0.00
Other: $0.00
lnspection. $0.00
Total: $3,181.42
SETBACKS
MAINSTRUCTURE Front 0-0
ACCESSORY Fronl 0-0
Rear
Rear
FEESUMMARY
Calc Valuation: S2s3,sei.zs
Claim Valuation: gc�.o0
PLANNING 8 ZONING
0- 0 Left 0- 0 Right 0- 0
0- 0 Left 0- 0 Right 0- 0
C��p�
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calilornia staWtes antl ie�ated
regulations. (Ord. No. 92-28, § 1, 12-27-92)
EXPIRATION: This permit shall automalically expire antl become void if work is nol commenced within 180 days, oi il work is suspendetl or ahaodoned
for a period ot 180 days.
INSPECTIONS: In ortler for the work authorized under this permit to be considered lagal, such work must comply with all applicable codes, and all
required inspectlons and flnel approval must be obtained. Failure to obtain inspections and tinal approval will result in the expiratlon of this pemiit.
, FOR INSPECTI�NS CALI; (714) 754•5626
,
0
From: � Finance
�Building Safery
Planning
❑ Public Services
❑ Community Services
❑ Other
0
CITY OF COSTA MESA
REFUND REQUEST FORM
, Vendor #:
Permit #: p0 S- [70 2 �'�_
p.R,o��r. $ 355 8°
Date:� �I�i/�S
��
- o�rN.�-`/
Departm nt Si ture
Name and address of applicank f. ����� T��t
�S .3� (��C4^fOV"0. ^l'+'� ti jU'-1�C (
fJ��,�a�-1' ��z�it'. , L� jd-�E.3
Phone: I��I' �Y� - I n I ��
%/�( G 1�i �//.��/o�
Applicant's Signature Date
REASON FOR REFUND:
I�jX��r:Jt�ro'+' . /� / /�
Ptr•n,'-I'S � a✓ �� 6 ���i^'aV ��-, ltiy�r.y G-ri,�-6i �.- :'h lt�ln �G�� o T �o oS.
�YS;-Cs2� ��I /� S l` �- P, h�i�ji�n�' pf" �� ��^�q"c.� E,�c; GY � `l-L�
i I
�yr�, �f'Mlr�� � I �CZ.17.'%�'� "!'� (�p`7:VIn .$ I�RK 0./K.e!�' �✓! %.^�!� �✓
I 1 �
Per�,;�- huM�rS GS�:�Y�2�, �r, �rM,-i$ N.v�✓.'�ri C-l��.rf-�`�� -l-O --�'�c'i
n n
�,z��„zK}. r�r wi�r� �� 1.�-� ar� 6Z�in'Slfl�:� �. Y"�,�r�/ �c rc �- -�o��al✓�Yr.
�t'C{1awTa � � ���- (.�'�a-O`� /Flrc-�'.r�� � �OS�- On.Xn �y /����M.�'y : PD� ' 00:3 j S
APPROVALS:
Finance:
City Manager: _
]a01Q2 MW ONLINE
(774) 754-5273 • Fax (7ta) 754-aB56 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 178 FLOWER ST
Suite No
Vicinity:
Parcel Nunmber: 42523404
Applicani: WALLACE, MATT
Address: P.O. BOX 10714 �
COSTA MESA, CA
PLUMBING PERMIT
Phone: (949)294-0902
Zip: 92627
Owner: FOX, LAWRENCE & BROOKE M
Address 178 FLOWER ST
Phone:
COSTA MESA, CA
Contractor: KIEGGO CONSTRUCTION INC
Address: P.O. BOX 10714
ISSUE FEE
Backflow irngation
Backflow Preventer
BathNb
Clarifier System
Connect(Ice,Soda,etc)
Dental Units
Dishwasher
Drain, Floor
Drain, Rainwater
Drain, Roof
Drinking Fountain
Expansion Tank
Gas Earlhquake Valve
Gas (1-4 outlets)
Gas (Over 4 outlets)
COSTA MESA, CA
2ip: 92627
Phone: (949)294-0902
Zip: 92627
License: 773135
Status: ISSUED
Applied: 04/25I2005
Issued: 04/25/2005
ISSUED BY: -�
SCOPE OF PERMIT
PLUMBING PERMIT FOR NEW 3504 SF SINGLE FAMILY RESIDENCE. INSTALL 3 BATHTUBS, 1
DISHWASHER, 2 GAS OUTLETS, 1 WASHER, 1 LANDSCAPE IRRIGATION, 1 P-TRAP, 3 SHOWERS, 10
WASH BASINS, 1 KITCHEN SINK, 1 SEWER CONNECTION. 6 WATER CLOSETS. 1 WATER HEATER, 8
1 WA7ER SERVICE.
REF: 805-00034
AMT
$23.50
$0.00
So.00
$29.40
$0.00
$0.00
50.00
59.80
50.00
$0.00
30.00
50.00
50.00
$0.00
$6.15
$0.00
FEESUMMARY
QTY AMT
Laundry Tub / Washer $9.80
0 Landscape Irrigalion $74.80
0 P-Trap $9.80
3 Pressure Regulator 50.00
0 Process Piping (per 10 R) $0.00
0 Receptors $0.00
0 Septic Tank 50.00
1 Sewer Cap for Demo 50.00
0 Sewer Connect $24.65
0 Sewer Private Line $0.00
0 Shower 529.40
0 Sink, bar 50.00
0 Sink, commercial 50.00
0 Sink, Floor S0.00
1 Sink, kitchen $9.80
0 Sink, service/mop 50.00
�TY
1
1
1
0
0
0
0
0
t
0
3
0
0
0
1
0
SumpPump
Swimming Pool
Trap Primer
Urinal
Vacuum Brkr Bkflow(1-4)
Vacuum Brkr Bktlow(5�)
Wash Basin
Wash Basin Set
Waste and Venl Syslem
Water Closet (Toileq
Waler Heater I venl
Water Piping (Inst or Rep.)
Water Re-pipe
Water Service
Water Soflener
OTHER
AMT
50.00
$0.00
50.00
$0.00
$0.00
50.00
598.00
50.00
50.00
558.80
S i 2.30
50.00
50.00
$9.80
50.00
50.00
I�� ��
c,/z �/5 �
QTY
0
0
0
0
0
0
10
0
0
6
1
0
0
1
0
NOTICE: The work authorized by this permit shall comply with all applicable hantlicap access requirements under California statutes antl relatetl
ragulations. (Ord. No. 92•28, § 7, 12•21-92) ,
EXPIRATION: This permit shall automatically expire and become void il work is not commenced wi�hin 180 days, or il work Is suspended or abandoned
for a peiiotl of 1 BO days.
INSPECTIONS: In order for the work authorized under this permit to be considered legel, such work must comply with all applicable codes, antl all
requlrad Inepeetlone end final approval mus� be obtainad. Failure to obtain inspections and final approval will result in the expiration ot this permit.
FOR INSPECTIONS CALL: (714) 7545626
z�ae�ae �eroa�
1)
WORKERS' COMPENSATION DECLAFATION:
I here6y eHirm unuer panal�y of perjury one nl ihe following doclaralions:
❑ I have and will mnintain a ceni(icate of consen� to sell-Insure for wnrkars' compensatinn, as pmvided tor 6y soc�ion 3700 0l the La6or Cotle. br the pertormance of Ihe
wor4 br whicd ihis permn is issuetl.
� I havn and w� I maintain workers' compensation insurance, as reQuiretl Ly section 37IX1 of �he Labor Cooe. for tha �ertormanco of Ihe work for which this pertnit is issued.
A1y wo�MerS compansalion InsUranCe Carrier antl polity numSBr aro: �
Carrior: ' ' � %����� " PoliCyNumber: ' ' ' ' �
(This secfion neod nof Do cbmplelstl d fhe permrt is vaNerl af one buntlrntl Jo�lers (5 i00) or IcssJ
❑ 1 cerUty Ihat in Ihe pr.tlormance ol lhe work tor wniUi Ihis permit is issuetl. I shall not employ any person in any manner So as �o beCome subjecl to the workers'
compAnsation laws ol California, and agree that �I I shoultl betoma subjacl lo me workars' compensation provisions of Section 3700 0l Ihe Labor Code, I shall lonhwith
COmply wtlft IhP.Se prOvi:iOns.
Applicant Si<li���m,,; Datn: '
WAPNING: FAILUiiEi TO SEGURE IVORHERS' CqMPENSP iION GOVERqGE IS U�'LA`•vFUL AND SH<LL SUBJECT aN EMPLOVER TJ CPIMINAI PENALilES FNp GIVIL FWES UP TO ONE HUNORED
THOUSANO DOLLARE (Si0000U1, IIJ ADDITION i0 THE COST OF CAMPENSATIIXJ, D.�MPGES RS PRJVIpED FOR IN SECiION J]O6 OF THE LABOF fAOE, IMEflEST. AND ATTORNEYS FEES.
LICENSLD CONTRACTORS UECLARA710N:
I hare�y aflirm Ihnl I nm liCensotl under pmvisions of Chapter 9(comrnnnciny with Suclion 70n0� ol Uivision 3 of Ihe �usiness an� Profassians Code. antl my license is in lull
lorcn ano atfecl. Lic. a -' i� Class a '
Con;racmr'S Signawre: � � J� � ` �; �� Dale: �
CONSTRUCTION LENDING 11GENCY:
� I herecy etlum Inai the.m is a constmaion lenoing ayency for Ihe petlnrmance ol th�� wo�k lor whic� Ihis permit is issuetl. (Sec. 3097, Civil CodeJ.
I.enAer's Nxmr,; Lendei!: AtlOrC55:
SignawrP: ._ Daie:
OWNER-BUILOER DECLAR4TIONS:
1 hereby ntlirm �ha� uncer penalry ol per�ury ihat I am E%EMPT FP.OM TNE CON7RACTURS LICENSE LAW tor Ihe lollowing reason (Sec. 7031.5, Business antl Prolessions
Code: Any r,iW or r.ounty which requires a pnrmit to consirucl, aller, impiova. tlemolish, or repair any simcture, prior Io ils issuanca, also requires ihe applicanl lor such permii
�n �ile a sionnd sl��omeN �hul he or she is licansed pursuanl lo ihe pmv�sions of �he Contractors License Law (Chapte� 9(commen[ing wilh Seclion 7000) ol Division 3 of Ina
Business ane Prolr,ssinns Cotle) or that he or she is ��rornpt Iherolrom and Ihe basis for the alleqetl e�amplion. Any violetion ol Section 7031.5 by any applicam for a parmit
sublecis Iha aoolir,nnl to a civil penalty ol no� more than hvo huntlretl Oollar�. �5500).):
❑ t, as c�nnar o� Ihe pwperty, or my em�loyees wilh w:��o5 a5lhCir sole Compens:tlion, WILL DO THE WORK. antl Ihe SimCWre is not inlantle0 or ofleretl lor sale (Sec.
7044. Business anA Prolessions Cotle: The Comracmrs Llcenso Law tlues not appPi to an owner of property whn builds or improves ihereon, and who dr,es such H�ork
himsr.lf nn c�sell or thmugh his or her own employees. pmvitletl Ihat such improvemenls are not in�entled or ofleretl lor sale. II, howaver, �he building or impmvemnnt is
sold wlihin one year o' completlon, ihe owner-builder will have Ihe burtl�n ol provinp Ihal he or sho tlitl not bulld or improve lor purpose of sale.�,
� I, a!; Cwnrr nl lhr p�o�eny, am EXCLUSIYELV CONTRALTING WITH LICENSED CONTRACTORS to construCt the pro�eci (Sec. 7044, BuSiness and Frolessions
Codo: 7'ha contractors License Law tloes no� applv lo ar. owner ol proo0ny who builds or inG�ovas Ihereon, and who coniiacts br such pmjecl wilh a conlraclor�s)
license Oursuani lo Iho CONracbrs License Law�s.l.
❑ I am eFemcl undei sr,;,. 6usinp55 antl Profn�siorc: Cnde for Ihis reason:
Signatum: _ Date:
Owner ID v�:rifintl by drrvei �, Ocense. � Ves ❑ No Dnvar's License No. Expires:
Veriticaticn ol Own�rsniC by (t)'pe ol tlxumanL i.e. - pmpArly lax bill or deetll: _
DIVISION OF INDUSTqIAL SAFETY PERMIT CEFTIFICATION: �
❑ I herehy cenity thai no eMcava�ion �ive (5) or morg teet in tleplh inlo wnich a Oerson is re�uiretl ro descentl. w.11 be matle in connaciion wilh work aulhoriz�tl by Ihis
perinii, anA that no building simcture, scallolding, lalsewo�k, or demo�iti�n or disma�tlina thereof. will be more Ihan ihirty�six (36) leet high. (Chap. 32. G:p 2, Art 2. Sec.
3a�, li�le 8, Calilomia Aaminisirative Cotle).
❑ Ps nwnerUirlder, I will no� employ anyono Io d.� work «hich would •e�uire a permii ham Ine Division ot Induslrial Salety, as noted above, unless such porson has u
{teOn'll to tl0 SVch Work Ilom �he d'IviSion.
Siqnalure: Uate'.
Divi�ion ct Intlus��ial Sale�y Permit Number:
HAZAqDOUS MATERIALS ANO EMISSIONS CERTIFICATION: ��
1 Will Ihe nOPI cani or prnsenl or fuWre builtling oc<upant need to ble artl conAy a 9u :iness Plan tor emergonty rasponsa lo reloase or threatened reiease of a hazarAous
material? ❑ Yes ❑ No
(Seciion 2550i ot Ihe Calibmia Heallh and Salery Code reCuires. wiih some mceptions. Ihat a Business Pan be liletl wilh the Costa Mesa Fire Depanment by ^very
husinoss whic� ha5 at any one �ime during a reponed year a quamily nl hazamaus ma�erials equal lo or gma�ei Ihan a weigh� ol 500 pountls. or a voiume o� 55 gallons,
or 200 �uBic Inel of compressed gas at standard ieinpnralwe and pres;urc��.
. ......... ... ... ........ ........_...... . ._.............. .......... , .......... ............_....... .. ......... . .......... . ....__.... ....._........... .. ._.........._......
2 Uoes or will �he applicant or present or tuwre buildinq occupant noed �o file a reyistration lorm tor ncu�ety hazartlous ma�erials? ❑ Yes ❑ No
(Seciion 255J8 0l the Calilomia Healih and Safetv Cotla. wiN soma eMcepiions, requires registration wuh iho Cosia Mesa Fire Depatlment by each business which a; any
one Iimo ha; on hanA a quanbry ot acuteiy ha:ardous maieriais ec�ual io or greater man a waighi of 500 pountls, or a volume of 55 gallons, or 2W cubic leet ol
compressatl gas ai siandartl �emoera�ure and pressurol.
..........__ ... .. ........... ...._..... . ............._... .............. ............ ...._...._...__......... ...... .......... , ............ . .......... ,..... ................
3 Does nr will the apolir,am nr presem or luture building occupam nnetl io G�epare an FMPP (Risk Management and Prevenlion Program tor acutely hazartlous materials)?
❑ Ves ❑ No
(Sociion 25531 of ihe Califomia Health and Saletv Cotle provides Inat Iha Costa Me,sa Pire Uapanmen� may require iha preD�raiion, certilication and filing wilh th� Fire
Dapanmenl nl an F71APP by businesses which are recuiretl b reyister aculely ha[ara�us ma�erials with ihe Fira Depariment.
................ . ... ............. . ... .........., , ..... ......... .... .. ............ ....... .._...... . ......._...._... . . . . ..._._.... . . .........._..._ .... . ......... . .............. . ....... ..........
4 II nn HtdPP is ornsnnlly rr.�uiretl. has Seclion 25534 0l Ihe Calilorni� henlih and Saicly Code 6een Iuliv compli5tl wnh? ❑ Vos ❑ No
................. .............__...... . .......... . .........._..... ........... ,,......,,,.., ,......_._._....... ............... ............. .......... . .... ............. .... ....................
5 Does or will ;ho applioani or presenl or WWre bub,dlm� occupnn� raquir�a loi tlw wo�k whic� is Ihe subjer.t ot Ihls a�.pplicatlon a armi� for such consimctiori or modllicatlon
Pom tne Souih CoFist Aii Oualiry Monayamont �Istilc� or Imm .�ny o�i�or en poiWlion contioi disu�cl or agoncy? u Ves � No
(Seclwn 65[i502 nt Ihe C.tlilornia Govemment Cedo reyuires that Ne ie4uesl.:d inlornaiion t� lumishetl on apphcauons lor non�resitlential builtling permns).
......., _ . . . .. ........ ... .._......._. __ .. ................. .., . . ....,. . ,... .... ....... .. _....._..... _.. ... .............. ........ . ... ......_.. _.. . . . ......_._ . , ... _.......... .._......
f, W ill :mv pah oi ihe lacility lo bo consimcted undei Inis pormit ba within I OGO teet Iron Ihe outei boundaries of a school? ❑ Yes ❑ No
(It'yo.s". �ho lacilay musi ineet tne requiremem ot Seciions 25534 and �a2303 0l �nr. Califania Health and Sate:y Cotle�.
............. ... ...._..._. . . ,............. _....._...._._......,. ....., ... . .. ........... .................. ....... ........... .,,. ......... ........._.. . ......... ... ....................
7 I! � pnrnvl hnm tha $nulh Coasl An Oualily Mnnapemnnt Dislricl or nlbai aii poll.ition coNid tlislrict or a�Bncy is requi�etl for ihe work which is Ihc suhjecl of Ihis
applicalion. havg all ol tho tlisclosuras prescnbatl by Calitornia Hnalih antl Salory CoJa Seclion A2303 been matle9 ❑ Ves ❑ No
......_. . .. . . . ........ ......_..._... ....._... . ................................... ........... .. . ......... . ,
... . ......... ..........
8 (II yes , alta_h r.Pr�ilir,aie ot mmplianCe imm'he appropnale air pollulion tOnlrol oNiceq.
CERTIFICATE OF GOMPLIhNCE: I cenify ina; untler oenalry ot pequry• Ih? infn�malien yiven above is cormr.t. I agree In �omDty wiih all slaie laws and ciry ortlinancns
regaitlmg Ha�artlous Materials and Emissions
Si�UH�Nr�t. _ Da10:
CER71FICeTE OF COMPLIANCE AND AUTHOi±IZA710N OF ENTRV: I cnnity untler penuliV c� oe:jury Ihai I have reaa Ihi9 applicdliOn and S�aie Ihal �ne in�oimation oiven i5
corrocl. I agine tn r,omory wilh all siate laws antl r,i1y orOmances relalinq tn bmltlinc conmmcuon, an<f aulhorrze represenlatives oi the Cily of Costa Mesa Ie entar upon Iho
ubove-Aesr,ribetl piooeay lor inspeclion purposes. I agiue noi to oocuov or nllu�+.� or,��p�ncy ot any 6uilnmg aWhori::etl 6y this permit unlil linat inspeaion.
/ :iigrufIlire O Legal Owneqs) . ' Dato �
% � /. (•%�/ . , ..
And/Or Aui�untetl Applicanl Date
QOOE �. INSFE�TIQNiYPE O�E
i516 Fi.ed Scslem Final Fire PreveNion
1266
200
2ai
202
203
2oa
Pool SOa Final
Fina� Rp.�tr,pl
Final0lcck/Relaining Wall
Final Far,tory Fira Placa
Finnl Sicn
FiniJ Derrcliiion
�NiIiIALS C��E� INSPECiIONTYPE
2G6 Final A1echanir.al
__ z08 rinal Plumbi�g
210 Final EleClri�al
212 Final Fire Prevemi0n
�20 Final Planning 4pproval
2£2 Final Si�e
250 Final BuildinqlOccupency
pAtE n+ rti
9
From: ❑ Finance
�Building Safety
Planning
❑ Public Services
❑ Community Services
❑ Other
,
CITY OF COSTA MESA
REFUND REQUEST FORM
; Vendor#:
Permit #:
Amount: $
Date:
�-f(?��s
-T
�. + . s
Departm �nt S' ature
Account Fund Or anization Pro ram Pro'ect/Grant Amount
p /ol 00 0470 ��
Name and address of applicant: k• ����� T���
�S� 1�IL`I^f'O'J�0. ^lYC- 1 .�U�-1`i �
��U-�� �a��, , CdE �d-�h..>
Phone: ���� �y�- �n / �'
�� �/./� ��.;�/o.r
AppVicaM's Signature Date
REASON FOR REFUND:
� (�y���-r��I��i�'N^.^ _ / /�
Pc'rwt�T S 1� a�( �� 6 h��JwcV �t-. U3'�r Git,^tQ -�r :'k /2�1n rG�` o t- .�o oS",
�(N 4+-c f R� ,`I (� S l� s- P h C� y n�- p� .t�(.� �, �r„� E,a,; cQ � `l-I_,_
� L�?J'M��-�'.� ild I CCCLI �Z'�O� "r�w Pny;V�ti'S I'IR� a/Kn��nl �L✓+ 1'.`'�rte[.<- �
// � �
P�r,�;k hvM;rv-s �sS��he.c�� -7�<- {'P''M�1� N.�w;�•rs c-����c-r-��� -�-o .-�1-�
� /^/ cy,�� In� /
� R.N N`L it'�' �tX �1! L�1 IrTC Cl f L- 6Z �Vf.$ �� c r-= t�� v\N �C K !_` -c b I(Dl✓ i✓1 .
� ! p
l�t'C�1rtNi4a � �D�- �' c�-O�/ /�kL-�'.ti-„I � �'OS- �n,`..ln � / ����m.�^y . I �� ' DOv �f S
f J
APPROVALS:
Finance:
City Manager: _
2.01-22 �M/ ONIINE
/
p�a) 754-5273 • Fax (7�4) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
Jo0 Adtlress:
Suite No
Vicinity:
Parcel Number:
Applicant:
Address:
178 FLOWER ST
42523404
WALLACE, MATT
P.O. BOX 10714
COSTA MESA, CA
MECHANICAL PERMIT
Phone: (949)294-0902
Zip: 92627
Owner: FOX, LAWRENCE 8 BROOKE M
Address: 778 FLOWER ST
COSTA MESA, CA
Contractor: KIEGGO CONSTRUCTION INC
Address: P.O. BOX 10774
COSTA MESA, CA
Phone:
Zip: 92627
Phone: (949)294-0902
Zip: 92627
License: 773135
Status: ISSUED
Applied: 04/25/2005
Issuetl: 04/25/2005
ISSUED BY: � �✓
SCOPE OF PERMIT
MECHANICAL PERMIT FOR NEW 3504 SF SINGLE FAMILY RESIDENCE. INSTALL 2 FAU'S, 1
FIREPLACE, 6 VENT FANS, 2 APPLIANCES, & 1 A/C CONDENSOR.
REF: BOS-00034
ISSUE FEE
Inst FAU <700 k BTU
Inst fAU >700 k BTU
Repair/Alt Cooling/Heat
Insl! Rep. Recess Wall Hlr
Refrig Sys <100 k BTU
Refrig Sys >100 k BTU
Gas Piping
Factory Fireplace
Hood w/Mech Exhaust
VAV Box
Vent Fan / Single Ducl
Appliance
Fire Dampers
Smoke Dampers
Insl or Relocate Appl Vent
Air Handlers < 70000cfm
Air Hantllers � 10000cfm
Floor Furnace
Floor or Suspend Heater
$23.50
$29.60
ao.00
$27.40
$0.00
$0.00
$0.00
$0.00
310.65
510.65
$0.00
$43.50
521.30
ao.00
$0.00
50.00
50.00
30.00
$0.00
$0.00
Quantity
FEE SUMMARY
Repair / Alt Absorbtion Unit
Repair / AII Refrigeretion Unit
Ventillation System
Evaporative Cooler
Com me rcia l I nci ne ra Ior
Domestic Incinerator
Compressors / Absorption Svstems
Up to 3 hp I 100 k BTU
3To15hp/500kBTU
15 To 30 hp / 1,000 k BTU
30 To 50 hp / 1,750 k BTU
Over 50 hp / Over 1,750 BTU
Boilers
Upto3hp
3To15hp
75to30hp
30to50hp
Over 50 hp
Other Mechanical Fee
�Invesligation Fee
Plan Check Fee
�uantity
50.00 0
50.00 0
50.00 0
50.00 0
$0.00 0
$0.00 0
50.00 0
50.00 0
$0.00 0
50.00 0
50.00 0
5ia.�o �
$0.00 0
50.00 0
50.00 0
50.00 0
50.00
$0.00
� � � 4/z�/5
��
NOTICE: Tha work authorized by this permit shall comply with all applicable handicap access requirements under Calilornia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void it work is not commenced wi�hin 780 days, or if work is suspendetl or abandoned
tor a period ot 180 days.
INSPECTIONS: In order for the work euthonzed under Ihis permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inspectiona and final epprovel must be obtained. Failura to obtain inspections and final approval will result in the expiration ol this permit.
FOR INSPECTIONS CALL: (714) 754-5626
2aGd6 (6U0)
WORKERS' COMPENSATION DECLARATION:
i here6y aNirm under penalC/ of perjury one of the tollo.ving declaralions:
❑ I hav� and �u II maimain a corlJicale ot consenl lo seli-Insure br workors' compensn�ion, as providetl for by seclion 3700 of �he Labor Code, lor ihe pedormance ol I�e
work �o• wh¢h this permil i5 issued.
� I hav� ynd will maintain woM1ers' componsalion insurance, as requirod try snction 370U of the Labor Cafe, br iho podortnance of the work br which ihis permii is issuetl.
A�y workars' componsalion Insuran�e carner antl policy numbar aro: �
�i � .
Carrior �•" ' ' Policy Number. ' � - � '
(TMs seClion neod nor po compleletl d rhe permR is veluev al one hunarntl Aolla�s (5100) or less.)
❑ I cemry Ihal in ihe pnrtormance ol I�e work lor which this Oertnil is issuetl. 1 shall nol employ any person in any manner so as to become su6jec� to Ihe workers'
compansaao� laws ol Calilornia. an0 agrea Ihai d I^.haultl bemme subjer.i to ine wnrkers' tompensalion provisions of Saction 3700 of the Wbor Cotle, I sha0 torthwith
complv witF th95e pmVl5iar5. . � � �
�'._ ' .i i ' . -
Applicam Sir�naarn: ' Date:
YJARNING: FAILURf ip SECUPE WORKEPS' CAMPENSAiION CAVERPGE IS UN�AJ.'FUL 4N0 SH<LL S'J91ECT AN EA:PLOYEP TO CRIMINAL �ENAI.TIES AND CIVI� FWES UP TO ONE HUIJDRED
T40USAND �OLLA9E (S10C.00O�.IN AOOITIdJ i0 TNE COSi OF GOMPENSNTION, D461nGE5 AS PRT�IOEO FOR IN SECTION�iJ60F THE LA00F GODE, IMERESi, AND AiTOPNEY'S FEES.
LICENSED LONTRACTORS �ECLARATION:
I herety aHirm Ihat I am liconsnd untler provlsions ol Chapror 9(commencing �nilh Seclion ?000) oi Division 3 0l Ihe Business antl Pmtessions Codo, end my bconse is in tull
lorce antl etlncl. Li�. � ' _ Glass x �
Goniracror'sSignature: ��+-: •'�' Date: '
CONSTRUCTIOIJ LENDING FGENCY:
❑ I hrreby altirm that therr, is a conslruciion lentline� apenty lor ihe pednrmnnce ol Ihe work for which this permit is issued. (Sec. 3097, Civil Cotle).
I.enAer's Name: L8n]2r's AACr255
Signaturc Date:
OWNER-BUILD[R DECLARATIONS:
1 hereby aH��m ih.=.i under penally of parl���Y �hal I am E%EMPT PROM TME CONTRACTOPS LICENSE LAW for tne lollowing raason (Sec. 7031.5, Business antl Pmfessions
Cotle Any ritv cr r.eunly wnir,h requires a permil to constmct. aller, improve. demohsh, or repair any stmcwre, prior �o ils issuance, also requires lhe epplicant tor such permit
io tlla a 5i0ned siefgmnnt Ihqt he o� slie Is liexnse�tl purSuanl ;o Ihe provlslons n� Iho Conirac�ors License Law �Chaptei e(eommencing wllh Sectlon 7000) of Olvlsion 3 of ihe
Business antl Prntrssions Cotle) or that ho or she i5 avompt Iherelrom Pnd th�� besis lor the allegetl axemption. Any violation ot Seclion 7031.5 by any applicanl br a permi�
sublacls thn ap0�'�canl to a civil penally ol not more Nan fiva hundred alnlla:s (5500�.):
❑ I, as owner ol the propeny, or my employees wiih w:ipes as iheu soie compen;ation, W IlL �O THE WORK, antl Ihe slmcWre is not intentletl or oHaretl'or sale (Sec.
T044. Businr.ss anA Prolessions Code: The Convaclors Lir,ense Law tloes not apply lo an owner of propeny who builds or improves ihereon, antl who dn�s such wor4
himsNl or hersell or ihmugh his or Oer own employees, orovideh Ihat such improveinenis are not intendetl or oNeretl for sale. If, however. the huilding or improvement is
�old vd�hm ona yo�r o� r.ompletion, Iho ownorbulldor will have tho buiden ol pioviny Lha1 he or she dltl not bulld or imprwe lor OurOose of saln.).
❑ I, as ownnr nf ihe pmUeny, am E%CLUSIVELV CONTRACTING WITH UCENSED CONTRACTORS 10 conslr�ct Ihe proletl (Sec. 7044. Businass antl Pmfessions
Code: Tha �onlraciors I icnnse Law doas nol apoly lo an owner ol propony who bui tls nr impmves ihereon. and who coniracts lor such proloct with a coniractor(s)
liwnse m��:uaN �o fhr. Comractors License Lax�s �.
❑ I am e.empl untler sec. 6usiness ano Protessiom Co�ie inr Ihis reason�
Signawre: Date:
Ownor ID verilied by driver's license. ❑ VC5 ❑ Wo Unve�'s Lir.ense No. Expiros:
Veriticaiion ol Owrership 6y pype of tlocumenl, i.e. - properiy �aa bill or deea�:
OIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION:
❑ I herabv co�ily ihal no oxcavation five (5) or mo�e fea� in tleplh into wnir,h a person is repuiretl w tlescen4 will be made in conneciion with work authorizotl by Ihis
permil. and Inqt no building simcWre, scalioltling, lalsework, or demolilion o� dismanlling Ihereof. will be more Ihan Ihirty�sir (36) feet high. (Chap. 32, Grp 2, Ari 2, Sec.
3d1, Tifle B. Cah;omia Atlminislretive CWe).
❑ Fs ownerbuilder. I will nol employ anyone to du woik which would requiie a o�rmit irom the Division ol Industrial Salety, as noted above. unless su::h vArson has a
permi� lo tlo ;ur,h worr Irom Ihe tlivision.
S�gnaWre: Dai¢
Division ut Indusmal Salery Permit Numher.
HAZARDOUS MATERIALS AND EMISSIONS CEFTIFICATION:
1 W ill ihn, apphcant oi presen� or future builtlinp occupanl neetl io hle antl carlily a Business Plan b� em?raenry response ro release or threatenetl releaso of a hazertlous
malerial'+ jJ Ves ❑ No
(Seclion 25505 of �he Caldornia Heallh and Safery Code requims. wilh soma e.ceotions. ihal a Business Plan be filed K'ilh Iho Cos�a Mesa Fire Depanment by every
husiness whicn has A� any one time during a reporlea year a quantity ol hazaraous malerials equal to or qreaior than a weight oi 500 pountls, or a volume of 55 gallons.
or 200 cunir, Inet of compressatl gas at slantlartl Iemperature and pressure).
. .......... ........,.,........ ,.., ........... ._ . ............ .. .............. ., ............... ................. .,........._.._._.._ .......__.. ._...._........ . ..... ......... .. ... ................
2 Does a will Ihe applican� or Oresen� or IUNre building occuOaN noed In file a repislrati�n iorm tor acutely hazartlous materiais7 ❑ Ves ❑ No
�Saclian 25'39 ol the Caldornia Heal�h antl Satoly Codo, wilh soma mceplions. requiras regisiration with �he Cnsta Mesa Fim Depanmem by eaeh businass wnich at any
ona time has on hnntl a quanliry ol acuiely harardous materials equal Io or gro.iter �han a weighl ot SOU oounds, or a volume of 55 gallons, or 200 cubic toet ot
comprossod qas at standnrtl tempernlurn and prossure).
.... ........... .. . . ........... ... ..... . ......... . .......... . .,.,........ ........... ............. .....__......... . ................_ .... ............ . ,. ...,....... , . , , .......,...........,...
3 Does er v�ill ihe appiicam or pros�nl nr Imure 7uildiny occupant noed In pmpare an HMP� IRisk Management antl Prevamion Pmqram for acutoly hazartlnus malerials)?
� Vns ❑ No
�Ser.tinn 255Jn of the Calilomia Flnallh and Safery Cntle prowtles �hal Ihe Costa Masa Fire Depatlment may r?quire ihe prepara�ion, cetldication and Lling with �he Fire
[)epanment oi nn RMPP hy businesses which are requiretl lo iegist�r acmely huamous maienals with ine Fire UeD�nment.
...._.... , ......... ....._.... . .....,.... .... ......__... .... .... . . .............. ,,...,......_ .. ...,.... . ,....................
.... _.....
n II an HAAI P�s nr�sentiv r,qwretl has Sor.tion 25534 ot Iha, Calitor�ia Heelth and Safcry Code bean fullv tamplir�tl with? ❑ Ves ❑ No
............. . . .... ............. . . . .............. „ ................. ............... . ......_. _. . ................. ,....... ... . ,.,, ......... ,,, ., , ,............ . .......... „ . ....................,.....
G DneA Or wlll IYie applir,:ml Or presnnl or 1uWre bwltlinq ocr,upaN rOquirq lo� Iha wnik whlqh is �h� sublec� ot Ihis �plicalior aparmil lor such constmction or motlihr.alion
�mm Ilio Soulh Coasl Air OuBlily Manapnmont �utrict or from any olher ah pollu�lon ;,rontrol tlishict nr agancy% LI �as LI No
�ceaion FSBS[12 nf Inn l:alilomia Govemment Code wQuires that Iho �enuesied inlormanon be lumished on apolica�ions lor nornresidential builtling perrrns�.
......._. .. ... ............. .... ...... .......... ......._._... .,........_.. .. _....... . ............. ......... . .......... , ............ .
6 W AI any nan of Ihe �actluy lo Ue conslrucled uncer �h s permil be wnhin 1U00 set I om ihs ouler boundaries of a school? ❑ Yes ❑ Na
�II "yeti', �t�e �aciliiy must mael Ihe rec�uirernent ol Sections 25534 and ae9i�3 cl Ihe Gaii�omia Healih and Sate�y Codei.
...._._.._. ..........._ .......... ...__...... ...... .........,., ,............. .........._.._ ........... ..,..,............ .._.:_.... . ................... .. ............. . . ........................
7 II a peimJ Lnm the $ov�h Coasl Air OuNily Mnnapomont Districl oi clher eir pollulion conlml rlisiricl or ayiancy is rgQuirod lor Ihe woik whir,h is Ihn sublec� a� fiis
applicatinn, havo a�l nl lho discloswos proScnCod by Cabbmia Hnalth and $at�ly Cotle Section d2903 baen mada? ❑ Ves ❑ No
............... .... ............... . . ......... . ..... ......_. . ...,., . ........_ . .......... ......... ................. , _.,.. .. .... ... ...,. .... ..., . .. ..... ,.. . . ....... ..........
8 (If "y?,s', allatn certihcate of compliance irom ihe appropriale air pollution coniral oHicer).
GEPTIFICP"fF Of COMF�IANCE: I Certi�y �hal imdr.r penally ol pequrv �he inlormalion given dbove is c0�rect. I agr¢e 10 COmply wilh dll S�d�C IaWS antf Ctly pftllnanCeS
regar�in� HntarCous Malr,rials antl EmiSsionS.
SiVnaluro: "__ Date:
CEiiTIFICATE OF COMPLIANCE AND AUTHORIZA710N OF ENTRV: I r,pruhi untler pen�hy oi pequn• Ihat I have reaa ihis application antl slate Ihal ihe informati0n qrvEn is
r.orre[I. 1 nU�AH �� comply wilh all Slaie Id'rs and city oi0indnCeS relaling Io owWin� conslmdion, antl aulhorize iCpreSentaiive5 ot Ihe Ci�y ol Cos�a Mesa b en�er u0on Ihe
above-tlesr,nUnA prnp�rtv fa iiupection purposes. I a4��� not In cccupy or allurv oecupar.cy ol any bwlding authonzed 6y this permit unlil tinal inspociion.
'� / . ' � SignaWre OI legal Own�r151
i •./ �-
nnd�Or AulOonzetl Apphcanl
CspE r. I�jP�4TIONTYPE
i616 Fixetl Sislem Final Fra Preveniion
1266 Pool Spa'rinal
200 Final Ro-Rno�
201 Final Blnck/Ralaining Wall
202 Final Fac;ory Fre Placa
203 Flpal Siyn
204 Final DemNition
p�iF� INO_IPLS CD�E� IHSPECiIONiYPE
�G6 F�nal �techanical
208 Final Plumbing
2Io Fina1 El=clrical
212 Final fire Prevenlion
220 Final Plannino Approval
222 Final Site
SO Final Building�Occupancy
Daio
D�iE Mi�$
e
.�
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Job Address: 384 LA PERLE LN
Suite:
Vicinity:
Parcel Number: 42531203
npp�icant: CRAIG MCINTOSH
Address: 10481RVINE AV
SUITE 191
NEWPORT BEACH, CA '
Owner: MATTHEWS, DOUGLAS
Address 384 LA PERLE LN
COSTA MESA, CA �
Convactor: OW N ER-BU I LD ER
Address:
Zip:
Status: ISSUED
Applied: 04/26/2004
Issued: 11/17/2004
Zonin9:
ISSUED BY: �
Phone: 714396-2379
Zip: 92660
Phone: 714-396-2379
Zip: 92627
Phone:
License: 000000
Arch : CRAIG MC INTOSH Eng:
Address: 213 VALLEY VIEW TER Address:
MISSION VIEJO, CA
Zip: 92692
Phone: 714-39&2379
License: C24591
Phone:
License:
SCOPE OF PERMIT
DEMOLISH ONE UNIT OF EXISTING DUPLEX: CONSTRUCT NEW 2628 S.F. (1266 SF iST STORY AND 1341 SF 2ND STORY) WITH A 485 SF
ATTACHED GARAGE. ALSO INCLUpES 38 S.F. BALCONY ON 2ND FLOOR AND 150 S.F. PATIO. UNIT IS 2 BDRM AND 2.5 BATH. ALSO
INCLUDES REROOF OF `
EXISTING HOUSE WITH LIFETILE (10PSF).
REF: ZA-03-112
Plan Check:
Permit:
SMIP Res:
SMIP Com:
Other:
Inspection:
Total:
� 1,242.90
$1,912.15
$26.37
$0.00
$0.00
$0.00
$3,181.42
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0-0
Rear 0- 0
Rear 0- 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Left 0- 0
Calc Valuation:
Claim Valuation:
Right 0- 0
Right 0- 0
3263,68126
so.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiiements under Calitornia statutes and related
regulations. (Ord. No. 92-28, § 7, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced withln 780 days, or if work is suspended or ebandoned �I
for a period of 1 BO days.
INSPEC710NS: In orde� for the work aulhorized under this permit to be considered legal, such work must comply with all applicable codes, and al!
requlred inspeetlona end final epproval must be obtained. Failure to obtain inspections and final approval will result in the expiretion of this permit.
FOR INSPECTIONS CALL: (714) 7545626
24{616Ifi/00)
WORKERS'COMPENSATION DECLARATON: _
I hereby aHirm under penelry of perjury one af the following declerations:
❑ I have entl wlll melmein a certlficete of consem to self-Insure tor workers' com0ensation, es provided for by sectlon 3700 ot the Labor Code, tor the pedormence of the
work for which ihis permit is issued.
❑ I have antl wlll malntain workers' crompensation Insurence, as requiretl by sectlon 3700 of the Lebor Code, for t�a peRortnence of the work lor which Ihis pertnit Is Issuetl.
My workers' compensation Insurence carder and policy number are:
Cerrier: PoliCy Number:
(This section need nat be canpleted i! (he pertni( is ve/uBd et ane hundred dollers (S100) or less.)
❑ I certity that in the peAormanca ol t�e work for which t�is permit is issued, I shell not employ eny person in any manner so as to become subject to ihe workers'
compensatlon lews ot Callfomie, entl egree that il I shoultl become subject to the workers' compensatlon provislons ot Seclion 3700 oi the Lebor Cale, I shall torthwith
camply with Ihese pmvisions.
Appliwnt SlgneWre: Dete:
WARNING: FAILUFE TO SECURE WORNER$' COMPENSAiION COVERAGE IS UNLAWFUL AND SHALL SUBIECT AN EMPLOVER TO CPIMIWIL PENPLTIES AND GVIL FINES UP TOONE HUNDRED
THOUSAND DOLLARE (5f 00.000�, IN ADDRION TO THE COST OF COMPENSAiION, DAhUGES AS PROVIDED FOR IN SECTIIXJ 3108 OF THE LABOR CODE, IMEREST, AND AiiORNE1"S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby ettirm that I em licensed under provisions of Chapter 9(commencing wit� Section 7000) ot Division 3 0l Iha Business and Protessions Code, and my licensa Is in full
force end eXact. Lic. N Class a
Contractor's SignaNre: Date:
LONSTRUC710N LENDING AGENCY:
❑ I hereby aXirm that there is a consimction lending agency tor the pertormance of the work for which ihis permi� is issued. (Sac. 3097, Civil Code). i
Lentler's Name: LendePs Address:
Signature: Date:
OWNER•BUILDER DEGLARA710NS:
I hereby afllrm Ihet untleJ penal�y of perjury fhet I am EXEMPT FROM THE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Business end Professlons
Cotle: Any ciry or county,whicfi requires e permit to consimct, alter, improve, tlemolish, or repair any sirucNre, prior to its issuance, elso requires the applicaN tor such permil
to file e signed stetement thet he or sfie Is licensetl pursuant to ihe provisions ot �he Contractors License lew (Chapter 9(commencing with Section 7000) ol Divislan 3 of ihe
Business and Pmfessions CoGe).br tha� he orishe is exempt iherefrom and �he basis for the elleped exemption. Any violation ot Section 7031.5 by any appliceN for a permil
sublec�s ihe epplicant to a civil penelty ot no�'mora Nan five hundred dollars ($500).):
P perty. or m em IV �� .
❑ I, as owner of �he ro y p oy0es wrth wages es their sole compensation, WILL DO TME WORK, and the strucWre is not intendetl or oflered tor sale (Sec.
7044, Business an0 Pmfessions Cotle: lTe"Coniractors License Law tloes not epply to an owner of pmperty who builtls or impmves thereon, antl who does such work
himselt or herself or Ihrough his or IieiEvrn employees, provitled ihat such impmvements are not intendetl or ofleretl lor sale. H, however, Ihe building or improvement is
sold within one year of completion, ihe owner-builtler will have ihe burden ol proving thal he or she did not build or improve for purpose ot sale.). '
�I, as owner of the property, am E%CLUSIVELY CONTRACTING WITM LICENSED CONTRACTORS to constmct the p�olect (Sec. 7044, Business antl Pmtessions
Cotle: The coMractors License Lew tloes not apply to an owner of property who builtls or Improves Ihereon, entl who conlracis for such project wlth a wntrector(s)
license pursuant to the Coniractors License Laws.).
�
Owner ID verifiad by
❑ No
Business and Professions Code lor this reason:
Verificetian ol Ownershlp by (type of documem, i.e. - property tu bill or deetl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certily thet no ezcavation five (5) or more feet in depth imo which a person is requiretl to tlescend, wlll be mada in connectlon wi[h work authorizetl by ihis
pertni�, enC ihat no building stmcture, scaHolding, falsework, or demolition or tlismamling ihereol, will Ce more ihan thirry-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Title e, Cellfornla Adminlstrative Code).
❑ As owner-6ullder, I will not employ anyone ro do work which would require a pertnit from the Division of Industrial Safery, as noted ebove, unless such person has a
permit to do such work from ihe division.
Signature: Date:
Division of Indusirial Sefery Permi� Number:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATON OF ENTAY: I ceniy under penalty of perjury that I have read this application and state ihat the information given is
correct. I agree to comply with ell state laws antl city ordinances relating to Duiltling cons�ruction, entl euthonze representatives of the Ciry oi Costa Mesa to enter upon Iha
above-des ' .p rty for ins ti �. gree not to occupy or allow occupancy oi any building authorized by Ihis pertnit until final inspec�ion.
C r . -� `��
Sig e IOwner�s) Da�
" And/Or AUNonzetl Applicant Date
COOE 1, INSPECTONTYPE
1616 Fixed System Final Fire Prevention
1266 Pool Spa Finel
200 Final Re-Root
201 Final Block/Retaining Well
202 Final Fectory Fire Place
203 Final Sign
204 � Finel Demalition �
pAIE
�r+ ELS
COOEI INSPECTONTYPE
206 Final Mechanical
208 Finel Plumbing
270 Final Elactrical
212 Final Fire Preventian
� 220 Final Planning Approval
222 Final Site
' 250 Finel BuildingiOccupency
PAg It�E4fl
NEWPORT-MESA UNIFIED SCHOOL DISTRICT
CERTiFICATE OF COMPLIANCE OF DEVELOPMENT FEES
PURSUANT TO AB 1600 ANO AB 181
To: �Cily of Costa Mesa
( ) City of NewpoR Beach
( ) Counry of Orange
Applicant:
Address:
TelephonE
+..r�__ -L�._ 1 _ _ .
• •
N� _ 5173
District Receipt No.� 2 7 900
Plan Check No�c� _ oo goo
TracUParcel and Lot Number(s); `-f 7 'i - � � - %n �
Location of Project:
Number of Square Feet of:
Residential Space 2 G 2(�
�'r��i�l 1=�� CX�S� � O�v S�
hA17�7�h� q�Ch
Commercial and
Industrial Space
CommerciaUlndustrial Project is; (Check One)
Warehouse
R8D
Movie Theater
_ Mini-storage
_ Meavy Industrial
_ Regional Shops
_ Light Industrial
_ This project is exempt because
16Z�' xE1.84
x $ .30
_ Motel
_ Bank
_ Neighborhood Shops
_ RacqueUHealth
_ Hotel
Medical Otfice
O(fice Park
1
To�� 29�i�� �
Total
_ Preschool
_ Auto Repair
_ Hospital
_ Large Office
_ OtRce 81dg.
_ Restaurant
_ Fast Food
?his certifies that the above-named Developer/Applicant has paid school facifity fees in comp6ance with Government Code sections
53080 and 65995. The Building Pemiils for this square footage in this proposed development may now be issued by your jurisdictlon.
Checks are to be made payable to Newport-Mesa Unified School Disfict.
(
CJ
C.1 •
M' �
AWariteA Represerdative ���' F ,
C"� c�
i �
The above representa6on as to square footage is We. AppBcant agrees that ii k is later detemtined fhat such representations are not
true, then this certificate shall automatically terminate and the appropriate Ciry/Counly shall be notified. `' `
i, � �
1 r . .
Date: �� �� GZ%�
Pamitp�,: 605-0O60B II Addea: 3661A PERLE LN CM �I
Status ISSUED J OWNER: MATTHEWS.DOUGIAS II
oMG ansrzms il � �"�'°P rJ
Desciipion:
TadBxOrdn
;�I�
'PERMI'I'S' Ptus�32-Bit e zan� - n«�i., �. an Q�Fie e�.�a
licer�see COSTA MESA. G� qT}' OF ' Serial Nwrber 6013 Users: Od01 Vasiart v. d.718 ��
FOR
M JS
OF -
PHONE
/ �.li
� PHO E CAL
PHONED
PLEASE CALL
Item ODiI
�� �`� ( 5 CAI,c..�'� �OJ h 7' Zo A. .w
�L�F'� dn�sry�fm� �F��/t,•-� C�-n..�nrir.,�a r�1C� R?i.eov�?-�- F•p2
��'1L0 a7EL..
`-�((S �o� C��c,�c.l l 55�� • �05—OO�o��
�02 ��n6'��,•
(714) 754-5273 • Fax (714) 754-4856 . www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Job Address: 384 LA PERLE LN
Suite:
Vicinity:
Parcel Number: 42531203
Applicant: MATfHEWS, DOUGLAS
Address: 364 LA PERL� LN
COSTA MESA, CA
Owner: MATTHEWS, DOUGLAS
Address 384 LA PERLE LN
COSTA MESA, CA
Con tractor: O W N E R-B U I LD E R
Address:
�'
Arch :
Address:
Phone:
Zoning:
Phone: 714396-2379
Zip: 92627
Phone: 714396-2379
Zip: 92627
Phone:
License: 000000
Eng:
- Address:
Status: ISSUED
Applied: 11/17/2004
Issued: 11/17/2004
ISSUED BY: ��-�
V �
��Q�'�� � �
� �'L ap �
A 'T
D
Phone:
Zip: License: License: .
SCOPE OF PERMIT
DEMOLISH EXIST 1000SF SFD .
Plan Check: $0.00
Permit: $38.75
SMIP Res: $0.00
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $38.75
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0- 0
PARKING Existinq: p
NOTES:
Rear 0- 0
Rear 0- 0
Required: 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Left 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation:
Right 0- 0
Right 0- 0
$1,Ooo.00
s�,000.00
li NOTICE: The work authorized by thig permit shall comply with all applicable handicap access requirements under Califomia statutes and related
�� regulations. (Ord. No. 92-28, § 1, 1241,92)
� 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 lagal, such work must comply with all applicable codes, and all
�� required Inapectlons end final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of ihis permit.
�I FOR INSPECTIONS CALL: (�14) 7546626
aaa-aa t�vw�
WORKERS' COMPENSATION DECLARATION:
I hereby ettirm under penelty of pe�jury one of Ihe following declarations: . �
❑ I heve entl wlll melnfeln a c@hiflcate of consent to sel4lnsure for workers' compensation, as provlded lor by section 3700 at the Lebor Cotle, for ihe peMormenca of the
work for which ihis permit is �ssued.
❑ I hava entl will melntain woMers' compensation in5urance, as requirea 6y section 3700 of the Lebor Coae, lor Ihe peAortnance ot Ihe work for which Nis pertnit is issued.
My workers' compensatlon Insurance carrier and pollcy number ere: .
Cartier: Policy Number:
(This sectlon need not be completeU il (he permit is velued ef one huntlred dollars ($100) oi less.)
❑ I certify ihat in Ihe pertormance of the work for which this permit is issueq I shall not employ eny Derson in eny manner so es to become suhject to the workers'
compensation laws ol Califomia, end egree t�at tl I should become subject to the workers' compensatlon proWsions oi Section 3700 oi Ihe Labor Cotle, I shell forthwlth
comply with these provision5.
Applicant Signeture: Dete�.
WARNINO: FAILURE TO SECURE WORKERS' CAMPENSATIIXJ COVERAGE IS UNLAWFUL AND SHALL SUBIEGT AN EMPLOYER TO CRINJNA� PENALTIES AND GVIL FlNES UP TOONE HUNDRED
hKK15rW D DOILARE (5100,000). IN APDRION TO THE COST OF COMPENSATION, OAMAGES AS PROVIDED FOR IN SECiION 3708OF THE LABOR CODE, IMEREST, AND ATTORNEI"S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aHirm that I am Ilcensed under provislons of Chapter 9(commencing with Section 7000) ol Division 3 of t�e Business and Professions Code, and my license is in tull
torce end eMect. Lic. q Class q
Contrector's SlgnaNre: Date:
CONSTBUCTION LENDING AGENCY:
❑ I hereby aNirm �hat ihere is e construction lending agency tor ihe peAormance of ihe work for which ihis permit is issuetl. (Sec. 3097, Civil Cotle).
Lenders Neme: Lendefs Atltlress:
Signature: Date:
OWNER-BUILDER OECLARATIONS:
I hereby ettirm thet wdej penalry of perjury that I am EXEMPT FROM THE CONTRAC70RS LICENSE LAW for ihe tollowing reason (Sec. 7031.5, Business end Pwfessions
Code: Any ciry or co'Unty' which,requires a permit to consWct, alter, improve, demolish, or repair any structure, pnor �o its issuanca, also requires ihe appiicant for such permit
to tile e signetl stetem`ent.thet M1ebr-She is licensed pursuant to the pmvisions of the Contrectors Llcense Lew (Chapter 9(commencing with Sectlon 7000) of Divislon 3 oi the
Business end Professions Code)br thet heior.she is exempt theretrom end ihe besis for the alleged ezemption. Any violetion of Sectian 7031.5 by eny applicent tor a pertnit
subjects Ihe applicant to e civil penelty ol not mpoi�than tive hundred dollars ($500).):
❑ I, es owner of the property, tl� my employee9 with wages as Ueir sole compensation, WILL DO THE WORK, enC the siructure is not intended or otteretl for sele (Sec.
7044, Business and Professions Cotle:,The Comractors License Law dces not appy to an owner of property who builds or improves thereon, and who does such work
�'mself or herself or ihrough his or hei own employees, provided thet such improvemenis are not intentletl or oHerad tor sale. If, however, ihe building or impmvement is
tl within one year ol comp�etion, ihe owner-builtler will have ihe burden of pmving ihat he or s�e tlitl not build or impmve for purpose of sale.). •
I, es owner of Ihe property, am E%CLUSIVELY CON7RAC71NG WITH LICENSED CONTRACTORS to construct the projec� (Sec. 70a4, Business and Prolessions
Code: 7Te coniractors License Lew does not apply m an owner of propeny who �ullds or Improves thereon, antl who contrects lor such prqect with a contractor(s)
license pur uan o t Co tractors License Laws.).
n s 8usiness end (�te�o�j,�ode t r t�is reason:
iqnaWra – -c.-r ,� G-Daie�•�G%17—CJ t�
.a�-
Owner ID venfiad by tlriver's icense. ❑ Yes ❑ No Orive s icT�' ense No. �Expires: �
Venficalion of Ownership by (rype oi tlaument, i.e. - proparty tu bill or deed):
DIVISION OF INDUSTRIAL SAFEn' PERMIT CERTIFICATION:
❑ I hereby cerlify �hat no excavation five (5) or more feat in depth imo w�ich e person is required to tlescend, will be made in connection with work authorizeE by �hi5
permit, end ihat no builtling StNcture, scafloltling, falsework, or demolition or tlismantling thereol, will be more ihan thirry-six (36) teet high. (Chap. 32, Grp 2, Art 2. Sac.
341, Ttle 8, Calitomla Atlmin�sirative Code).
❑ As owner�builder, I will not employ enyone to do work which woultl require e permit trom the Division of Indusirial Sefery, es noted ebove, unless such person has a
permit to do such work irom ihe division.
Siqnature: Date:
Division ol Industnal Sefery Pertni� Number.
CERTIFlCATE OF COMPLIANCE AND AUTHORVA710N OF EMAY: I certify under penelry of perjury that 1 heve read this epplication and state that the information given is
correct. I agree to comply with all stete laws enC ciry ordinances relating to building construction, an0 euthotlze represeNatives of the Ciry of Costa Mesa to enter upon the
above�describetl er IIy1 r inspectio urp or allow acupency of any builtling au�horized by this permit until final inspection.
�"��-�, �%Sl�i����-- ,�i -/ �`�---�Y
SI � _dWre. .Lepal�Ownar(s� —� .:._�
�
And/OrAuthorized Applicant Date
GODE �. INSVECTONTYiE
161fi Fixetl System Final Fire P�eventlon
1266 Pool Spe Finel
200 Finel Re-Foai
201 FInaI BIocWRBtelning Well
202
203
Finel Fectory Fire Place
Final Sig�
204 Final Damolilion
PAIE IIIIID9L5
COOE 1 INSPECTION flPE
206 Finel Mec�enical
208 Finel Plumbing
210 Finel Eledrical
212 Flnal Fire Prevention
220 Finel Planning Appro�al
222 Final Site
250. FinalBuilding/Occupancy
PflIE ItllIDdL@
(714) 754-5273 • Fax (714) 7544856 • www.Ci.COsta-mesa.ca.US 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 384 LA PERLE LN
Suite No
Vicinity:
Parcel Nunmber: 42531203
Applicant: MATTHEWS, DOUC
Address: 384 LA PERLE LN
COSTA MESA, CA
Owner: MATTHEWS, DOUC
Address 384 LA PERLE LN
COSTA MESA, CA
Contractor:
Address:
Arch / Eng :
Address:
ISSUE FEE
Backflow irrigation �
Backflow Prevenler
Bathtub
Clanfer System
Connect(Ice,Soda,etc)
Dental Units
Dishwasher
Drain, Floor
Drain, Rainwater
Draiq Roof
Drinking Fountain
Expansion Tank
Gas Earthquake Valve
OWNER-BUILDER
$0.00
$o.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
0
0
0
0
0
0
0
0
PLUMBING PERMIT
_ FEE SUMMARY
I,� � AMT
�L�1ndry Tub / Washer $0.00
f�ndscape Irrigation 50.00
�� Trap $0.00
Pressure Regulator $0.00
Process Piping (per 10 ft) $0.00
Receptors $0.00
SepGc Tank $0.00
SewerCapforDemo $0.00
Sewer Connect $24.65
Sewer Private Line $0.00
Shower $0.00
Sink, bar � $0.00
Sink, commercial $0.00
Sink, Floor $0.00
QTY
�'
0
0
0
0
0
0
0
1
0
0
0
0
0
ISSUED
11/17I2004
11/17/2004
i � L
Sump Pump
Swimming Pool
Trap.Primer
Urinal
Vacuum Brkr BkFlow(td)
Vacuum Brkr BkFlow(5+)
Wash Basin
Wash Basin Set
Waste and Vent System
Water Closet (Toilet)
Water Heater / vent
Water Piping Qnst or Rep.)
Water Re-pipe
Water Service
AMT
$0.��
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
QTY
�
0
0
0
0
0
0
0
0
0
0
0
0
0
NOTICE: The work authorizetl by this permit shall comply with all applicable handicap access requiremenis under Calitornia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void it work is not commenced within 1 BO days, or if work is suspended or abandoned
for a period of 1 BO 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
requlred InepeCtlone and final approval musl be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
zane�ae (eroo)
WORKERS' COMPENSATION DECLARATION:
I hereby ettirm untler penalty of perjury one o� ihe following declarations: �
❑ I have end will malntein a certificate ot consent to seN-Insure for workers' compensation, es provided for by section 3700 of the Labor Code, for ihe peAormence o( ihe
work for which Ihis permit is issued.
� I have end will maintaln workere' compensation insurance, as required by section 3700 of tha Labor Cotle, for Ihe pedortnance of ihe work for which this pBrtnit is issued.
My workers' wmpensation Insurance ca��er antl policy number ere:
Carrier: Policy Number:
(This sectlon need nof be complefed I! fhe pe�i� is velued af one hunOred dollars ($100) or /eSsJ
❑ I certify that in the pedormance of t�e work Por w�ich this permit is issued, I shall not employ any person in any manner so es to become subject b the workers'
compensation laws of Califomia, and ag�ea that if I shoultl 6ecome subject b the workers' compensation provisions oi Sectlon 3700 of the Labor Code, I shall forthwith
comply with these provisions.
Applicant Signeture: Data:
WAFNING FAIWRE TO SECURE WORKERS' CAMPENSATION CAVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES ANp CIVIL FINES UP TOONE HUNDRED
THOUSAND OOILARE (§100,000), IN ADDITION TO THE COSi OF COMPENSATION, OAMAGES AS PROVIDED FOP IN SECTION 39060F THE LABpR CODE, IMEREST, AND ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aNirm that I am licansed under provisions of Chapter 9(commencing with Sec�ion 7000) of Division 3 of the Business and Professions Code, and my license is in full .
force and eflect. Lic. N Class # ii
Contrector's Signature: Date:
CONSTRUC710N LENDING AGENCV:
❑ I hereby affirm ihat there is a construction lending agency for ihe pertormance of ihe work for which this permit is issued. (Sec. 3097, Civil Code).
Lender's Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby aHirtn that untler penalry of perjury tnat I am E%EMPT FROM 7HE CONTRACTORS LICENSE LAW for the following reason (Sec. 7037.5, Business and Protessions
Code: Any ciry or counry which requires a peR�it to constmct, alter, improve, tlemolish, or repair any strudure, prior to its issuance, also requires the applicant tor such permit
m file a signed statement Ihat he or she Is licansetl pursuant to the provisions of the Coniractors Licensa Law (Chapter 9(commencing with Sectlon 7000) oi Division 3 of tha
Business end Protessions Code) or thet he o� she is exempt thereirom end the basis for Ihe alleged exemption. Any violation of Section 7031.5 by eny applicent for a permit
subjects the applicant to a civil penalry of not more than tive huntlretl dollars ($500).):
❑ I, as owner of Ihe propeny, or my employees wi�h wages as iheir sola compensation, WILL DO THE WORK, end �he sWCWre Is not intended or oflered for sale (Sec.
7044, Business antl Professions Code:'�he Contractors License Law dces not apply to an owner of property who builds or improves thereon, and who tloes such work
imsalf or hersalf or through his or her own employees, provitletl Ihat such improvemenis are not intended or offered for sale. If, however, the building or improvemant is
sold within one year oi completion, the Owner-builder will have the burden ot proving that he or she did not build or improve for purpose of sale.). •
I, as owner ot ihe property, am E%CLUS��ELV CONTRACTING WITH LICENSED CONTRACTORS to construct ihe projact (Sec. 7040, Business and Professions
�Code: The contractors License Law does not appry to an owner of property who builds or improves thereon, and who comrects tor such pmject with a comractor(s)
license pursuam to Ihe Contractors License Laws.).
sec.
Business and Professions Code tor �his reason:
Owner ID verified by tlnver's fic�ense. �es ❑ No
Venfication of Ownership by (rype of tlocume ; i.e. - properry tau bill
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify ihat no excavation five (5) or more feat in tlepih in�o which a person is requiretl to descend, will be made in connec�ion with work euthorized by Ihis
permit, and that no building stmcwre, sGeHolding, talsework, or demolition or dismantling thereot, will be more then ihirry-sia (36) feet high. (Ghap. 32, Grp 2, Art 2, Sec.
341, Ttle B, California Adminisirative Code).
❑ As owner-builder, I will not employ enyone to do work which would require a pertnit from ihe Division ot Industrial Safery, es noted above, unless such person has a
permit to tl0 such work from the divi5ion.
SignaNre: Date:
Division of Industnal Safery Permit Number:
CERTIFlCATE OF COMPLIANCE AND AUTHPA�TON OF ENTAV: I certity under penal�y of perjury Ihat I have read this application and state that ihe infortnation given is
correc�. I egrae �o comply with all sta�e laws end ciiy ordinances relating to building cons�ruction, end au�honze representa�ives of Ihe City of Costa Mesa �o enter upon the
ebove-descnbetl roperty for inspeqio oses. I e ree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
c-� � � O �/
Signat e Ot D�
" And/0r Aut�orized Appllcant Dale
CODE N, INSPECTIONTYPE
1616 Fixed System Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Root
201 Finel BIocWRetalning Wall
202
204
Final FaCtory Fire PlaCe
Finel Sign
Final Demoli�ion
D1TE
�
INTRIALS �� INSPECTIONTYPE
206 Final Mechanical
208 Final Plumbing
210 Final Elecirical
212
220
Final Fire Prevention
Final Planning Approval .
222 Final Site
250 � Final Building/Occupancy , .
Q6iE 1[i�ELS
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.c��ILDING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626
.lob Address: 382 LA PERLE LN
Suite:
Viciniry:
Parcel Number: 42531204
Applicanr. YOUNG, KATIE
Address: 1015 E CHESTNUT
Zonin9:
� Phone: (714)953-5444
SANTqANA,CA � Zip: 92701
Owner: MILES, BRETT AND MADELON M
Address 16630 CALLE ARBOLADO
PACIFIC PALISADES - .
Contracror: YOUNGS ROOFING CO, INC
Address: 1015 E CHESTNUT
SANTq qNA, CA
Zip: 92701
Arch :
Address:
Phane: 310-230-0350
Zip: 90272
Phone: (714)953-5444
License: 568560
Eng:
' Address:
Phone:
ISSUED BY:
Status: ISSUED
Applied: 01/2Z2003
Issued: 01/22/2003
Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF ROCK AND COMP. INSTALL FELT AND APPLY 30 YEAR COMP SHINGLES. INCLUDES 382 AND 384 LA PERLE lN. PROJECT IS A
DUPLEX.
Plan Check: $0.00
Permit: $97.25
SMIP Res: $0.50
SMIP Com: $0.00
Other. $0.00
Inspection: $0.00
Total: 597.75
SETBACKS
MAIN STRUCTURE Fronl 0- 0
ACCESSORY Front 0- 0
PARKING Existina: p
Rear 0- 0
Rear 0- 0
Re uired: 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Left 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation
Right 0- 0
Right 0- 0
$3,500.00
$3,500.00
NOTICE: The work authorizeq by this permit shali comply with ali applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 9248, § 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 applicabla codes, and all
requlred Inspections and finel approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of ihis permit.
FOR INSPECTIONS CALL: (714) 754-5626
2446�d6 (6/00)
WORKEflS'COMPENSAnON DECLARAnON:
I here6y aHirtn under penalry ol perjury one ot t�e tollowinq declarations: � ' -
❑ I heve end will maintain a certilicate of consenl lo sell-Insure for workers' compensation, es provitlad tor by sedion 3700 of the Labor Cotle, for Ihe peAortnance of the
\ work tor which this permii I5 issuetl. f
'Q, I hava entl will meintai �rk s' comp ation ms nce, as req ' ed 6y sectlon 3700 of ihe Ls6or Cade, for ihe peAortnance of the work tor which this pertnii Is issued.
�My workers' comp sation In u c e er and po num�er e:
Cerrier: Policy Number:
(Th/s section need nof be cromp/efed i! fhe permit Is velue al one hundred dollars ($100) or less.) .
❑ I certity t�at in the pertortnence of the work for which Ihls pertnil Is issued, I shell not employ any person in any manner so as to b ome subjact to ihe workars'
compensetion laws oi Cellf rpi� entl egree thet II I should be rfie sub�ect to Iha warkers' compensation provisions oi Section 37 D of ihe La or Cotle, I shell forthwith
comply with these provlsi S 1 n^ r\
ApO�icant Signatwe: Date: L�� �1
WARNINGFAILURETOSECUR WORKER' OMPENSATIONCOV EISUNLAWFULANDSHALLSUBJECTANEMPLOVERTOCRIMINALPENALTIESANDCIV FINES TOONEHUNDRED
THIXISANDDOLLARE(5100.0OO�,INADDITI� TOTHECOSTOFfAMP NSATIIXJ,�AMAGESASPROVIDEDFORINSECTIqJ3]O60FTHELABORCODE,IfJrEREST,ANDAT70iiNEY'SFEES.
LICENSED CONTRACTORS DECLARATION:
I hareby attirm ihat I am licensed
force entl eHect. Lic. q�
Contractor's Signature:
CONS7RUC710N LENDING
of Chapter 9(com fencing with Section 7000) of Divlsion 3 of the Business antl Prote�ions Coda, antl my licensa is in full
Class #
_ _ Da�a: � �% , Y�
� I hareby attirtn that ihere is e constmction lending agency for Ihe peAormance oi ihe work for which this permi� is issued. (Sec. 3097, Civil Code).
Lendofs Neme: Lenders Adtlress:
SignaWra:
Date:
OWNER-BUILOER DECLARATIONS:
I hereby affirtn Ihel under penalry ot peryury ihet I am EXEMPT FROM T1E CONTRAC70RS LICENSE LAW tor Ihe following reason (Sec. 7031.5, Buslness entl Professlons
Cotle: Any ciry or county which requires e permit to consiruct, elter, improve, demolish, or repalr any siructure, prior to its issuance, also requires ihe applicant lor such partnit
to file a signed statement ihat he or she Is Iicensed pursuent to Ihe proWsions of tha Cantrectors License Lew (Chapter 9(commencing with Section 7000) of Divlslon 3 of Ihe
Business entl Proteulons Cotle) or thal he or she is exempt iherefrom and the basis for the alleged ezemption. Any violation of Section 7031.5 by any epplicant for e parmit
suDjects the epplicant to e civil penelry ol not more then five huntlred tlollers ($500).):
❑ I, as owner of the property, or my employees with weges es thelr sole compansatlon, WILL DO THE WORK, and tha structure Is not intentled or oNered lor sale (Sec.
7044, Business end Prolessions Code: The Conirectors License Lew does not apply to an owner ot properry who builtls or improves theraon, an0 who does such work
himsetl or hereelf or through his or her own employees, provided ihet such improvemen�s are not Intended or ottered tor sale. If, however, the builtling or improvement Is
sold within one year of completion, the owner-builder will heve the burtlen of proving that he or sha did nat �uild or impmve for purpose of sale.). '
❑ I, a5 owner oi the property, em E%CLUSIVELY LONTRACTING WITH LICENSED CONTRACTORS to construct the prolecl (Sec. 7044, Busine53 end Profe55ion5
Cotle: The cantractors License Lew does not apply to en owner ol property w�o builtls or Impmves thereon, and who wntrects lor such project wlih e coniractor(s)
license pursuant to the Contrector5 Litense Laws.).
❑ I am exempt under sec. Business and Professions Code tor this reason:
Signature: Date:
Owner ID verifiad by dnvers license. ❑ Yes ❑ No Drivets Licensa No.
Vedfication of Ownership by (type of tlocumem, i.e. - pmperry tax bill or deetl):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION:
E:pires:
❑ I hereDy cartity that no excavation tive (5) or more fael in depth into which e person is requireC to descend, will be matle in wnnection with work euthonzed by this
permit, and that no building siructura, scaXoltling, falsework, or demolition or dismantling Ihereot, will be more ihan thirty-six (36) feet high. (Chap. 32, Grp 2, Ar12, Sec.
341, Ttle B, Calilornla Adminlstrative Code).
❑ As owner-builder, I will not employ enyane to do work which would require e pertnit from the Division ot Indusirial Safey, as notad above, unless such person has e
pertnit to do suc� work from Ihe tlivision.
Signature: Date:
Division of Indusinal Sefery Permit Number:
CERTiFlCATE OF COMPLIANCE AND AUTMORVJITON OF EMRY: I cehity under penalry of perjury that I have read this apDliwtion and stata that the infortnetion given Is
correct. I agree to comply with ell state lews end ciry ordinances relating to 6uilding construaion, antl authorize representatives ol t�e Ciry of Costa Mesa to enter upon the
above-descnbed property lor insDection purposes. I agree not to occupy or ellow occupancy of eny building authonzed by this permil until finel inspection.
COOE I, INSPECTIONTYPE
1616 FI:eC System Final Fire Preventlon
1266 Pool SOe Final
200 Final Re-Raol
201 , Final Block/Retaining Well
202 Final Fectory Fire Place
203
20M1
Finel Slgn
Finel Demolltion'
PdIE It�4S
�-7�05 ��
CO�E� INSPECTIONTYPE �
206 Final Mechanical
208 Final Plumbing
210 Final Elec�ncal
212 Final Fire Prevention
220
222
250
Final Planning Approval
Final Site
Final BuildinglOccupency
I'7-���
1[�
OWNER I.A P�R.LE�LILLIAN DATE li-1Q-57
JOBADDRESS gBh�La Perle Place BUILDINGPERMITNO. #(y(j(S
GENERALCONTRACTOR ArmaAve_ Inr._ VALUE 5 ])�_E�KE�_On
L�'— 11}
GROUP I Sc J
INSPECTIONS
Footing Trench
Foundation Forms and Grade to
Rough Framing
Plumbing, Rough to Slab
Plumbing, Rough Complete
Temporary Pole
Wirinq, Rough
Heating, Final
Sewer, House Sewer, St.
Septic Tank or Cesspool
Lathing,ln Out
PI •ing
PWmbing, Fin�al, FixturesComplel
Plumbing, Fin.al Gas T@st/S ./�
Wiring, Final
Occupancy
FONM 210 3M 10-^v5
DATE
7
�
TRACT
SUBCONTRACTOR
N �-
AS' PE'R U. B. C.
FIRE DISTRICT
PERMITSIS:
DATE I N
7
... �r' �ia8�
i °,.
COS7lr. MESA BUILDING DEPARTMENT
P.O. BOX 3t�
COSTA MESA, CALIFORNIA
FOR APPL►CANT TO FILL IN
BUILDING
ADDRE55
COSTA MESA. CALIFORNIA
i i
OWNER .�Ow�,.._. . 1 ew.
CITV (�.6Q�
ARCHITECT
OR ENGINEER
AD '
CONTRACTOR
AO�RE55 O/
LEGhL (�[
OESCRIPTION N(
A.P. NO.
SIZE �
OF LOT
USE OF
E%ISTING BLOG
l.C�✓V� TN�J(/ q(-/ a`
LIC.
NO.
CITY LIC.
NO. ZI
1J S, A . TEL.
N NO.
�
BLOCK A T
��/� � NO.OF BLDGS
!J now oN �or NON �P
SETBPCK LINE FROM �� I
CENTER OF STREET �� �� REAR YARD /�
�
SIDE VARD RIGHT S�_ LEFT �.
DESCRIPTION OF WORK
NEW ALTERATION ApDITION
REP. qI IIMOVING I IIDEMOLISH
BUIIDINGf7�K OYk(� NO.OF
SIZE � ROOMS STORIES
EXTERI R WALL ROOF
COVERING COVERING �
USE OF NEW
BUILDING
a
FEE RECEIVED `��
' �6 , yr� � J
F ANCE DE�T.
APP CICATIO�NTFOR�PERMIT
BUILDING
FOR OFFICE USE ONLY
RECEIPT NO. PEPMIT NO.
BUILDING �
AOORE55 '
COSTA MESA. CALIFORNIA
FIRE
ZONE
ZONFE�� NO.OF TYPE
A/ PL4N5 . /
%l � �
SUBJECT TO
�
T�
:.l
STATE THAT TME ABOVE IS CORRECT >rvD PGREE TO COMPLY WITH FLL
CITY ORDINPNCES AND STTTE LAWS REGULPTING BVIIOING CONSTRIIC�
riorv. ' � VAWATION
SIGNATIJRE O
� PERMIT FEE S
PERMITTEE
/. % /- S/ PLAN CHECK 5
$ `f'- lf b
AUTHORIZED AGENT � TOTAL FEE 8
yBMi
r
�
OWNER � LA PERLE, I.ILLIAN T. SEP 2�1 1957 DATE l�-17-57
JOBADDRE58 381� La Perle Place BUILDING PERMIT NO. {II�HSC)
GENERALCONTRACTOR �,yck Thunstrom VALUE$ _______
AP11%-263 07 .
i Por, o£ 1$ BLOCK TRACT ll75 Demo Barn
GROUP J TVPE V ZONE RLl FIRE DISTRICT iS90 ~
I DATE I SUBCONTRACTOR I PERMITSISSUED
INSPECTIONS ,
Footing Trench
Foundation Forms and Grade to Garage �
Rough Framing v
Plumbing, Rough to Slab �
Plumbing, Rough Complete
Temoorarv Pole — ..f, ��� / n
Wiring, Rough
Heating, Roug
Heating, Final
Sewer. House
La•`:�9, In Out
P. ring
Plumbing, Final, Fixture5 Coi
Plumbing, Final Gas Test
Wiring, Final
Occupancy
FORM 310 3M IO�O'+
i
1�856
' � � � 4890
COSTA MESA BUILDING DEPARTMENT
P.O.80X 31>
COSTA MESA. CALIFORNIA
FOR pF�LICP�JVT T,Q FILL II���„"
OUILDING .sa S� . 1 –
ADDRE55 4 L . � w. . .
COSTA MESA, GWLIFORNIA
�1
OWNER �tiQ Q t!f .�A ` ' ��\. 0.
MAIL �`, � ^�. .- �
AO�RE551 � {�i..Q � � � �
C�lYai
IAD
�ccnt LOT �YU
OESCFIPTION NO
A.P. NO. •�
SIZE
OF LOT
USE OF
E%ISTING BLOG.
yCTB4CK LINE FFOM
LIC.
TEL.
' NO.
BLOCK TRACT
r�
� r+o. or e�ocs. '
NOW ON LOT
SIDE VARD FIGHT LEFT
DESCRIPTION OF WORK
NEW ALTERATION I ADDITION
REF MOVING I DEMOLISH
BUILDING NO.OF
SIZE ROOMS STOftIES
EXTERIOR WALL ROOF
COVERING COVERING
FEE RECEIVED
- ���yr�9�Q .
F N� �EPT�.S�
APPC7�A�I�T'Fr71Y` PERMIT
� BUILDING
FOR OFFICE USE ONLY
COSTA MESA. CALIFORNIA
APPROVED
BY
DATE
�►i Y i! `V V a+ L
CITY OF COSTA KL:...
' �_
SUBJECT TO DG. UE;'T. REG.
195UED,'
7 � � �
• 0 , � �
)
NENEBY .�C NOWLEDGE TM�T I E F A TM PPLIC�TION � .
SiwiE TMnT T E ABOVE IS COFNECT NO �GREE TO COMPLV W!TH sLL
CITY OROIN�NCES �MD ST�TE L�WS GIII�TING BUIL�ING CONSTXUC�
TION. %� VALUATION
SIGNATURE OF�� . � l PERMIT FEE 5 �_
PERMITTEE -�/' – "
PLAN CHECK 5
S
AUTHORIZED AGENT TOTAL FEE S —
�e�i
v��1Y141 vvu..v��vJ r�u
Out
LA'1"S �-1 ��
\•I
SUBCONTRACTOR
• L_.__�
'COSTA MESA BUILDINGSAFET' DEPARTMENT
P.O. BOX 7200 •�COSTA MESA. CAL�FORNIA 92E2E
For Applitan► to F(11 In ComplNdy
TYPE OR PRINT
COSTA MESA, CALIFORNIA
(
BETBACK LINB IROtl
f
!FY ?7 RIOHT
DESCRIPTION OF WORK
1 X61i6lY ACKNOWL�DO[ iMAT.I XAV6 RGD YXI/
AND 8TAT6 TMAT TN� ApOVt,19 CORp6CT A D AO
PLY WITH I1LL CB I��ROINA�C� 11ry��N'�
GUIL�INGCON OM. (�
AUTHORIZ[D
�
r
�
.• ;i �• , ii
APPLICATION FOR PERMR
BUILDINa
Por Offic� Us� Only
ZONING �"�`
xo. or u.c o. x�w �
-�j,i �uns v sunoirm %
1RION �„r- � s r�� ��,
NO. I� �; l L+ `i '� C� �
: NOEAVHOVERHAN08HALLD8LQ88THAN
YAHD! MPROV FD
MAIN BUILDINO
o�srwNeQ asr.
MAIN BLDOB.
VAR. #
�
YARCBAPPROVHD
:CH880RY BUILDIN6
BET. MAIN Q
ACCES9. BLI
OATB
U� / " ' a
m
�
w. Pr. �
T18 IIXOYMi tXOWN UNOlR VALUATION 19 IOp n�a �
►URPoB[ OI �HiAp4oXINO A PCpY1T P6H ONLT. �
VALUATION a
/j� PEpMIT FE8 �' �
s U O!/ � `_ w
Tor.� Pee � '�
OWNER MC EATHEROPI��-.�. DATE 9-?1-59 -
JOB ADDRESS 3H(y-B L2. P2T'18 L2I12 ' BUILDING PERMIT NO. 103I13
GENERAL CONTRACTOR
AP_ No. 11%-ZC)Z-OIl
V
INSPECTIONS %/y$i�-q I oATE I GROUP I TYPE V ZONE
�rground Soil�y-j•5 U.G. Water/vt'ijl4-t$ S(� I I PERMITS ISSU
._ i SUBCONTRACTOR
Form 210-3 —4-59