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Home My WebLink About384 LA PERLE LN - Building PermitsJob Address: $84 LA PERLE LN Suite: Viciniry: DETACHED WORKSHOP Primary Occ: U-1 Private GadCarport/Shed Parcel Number: 4253 j2�3 Applicant: MAT7HEWS, DOUG Address: 384 LA PERLE LN COSTA MESA, CA , owner: MAT7HEWS, DOUGLAS Address 384 Lq pERLE.LN , Type of Construction: V-N Zoning: COSTA MESA, CA _ Contractor: D� � Address: Zip nrcn : CRAIG MC INTOSF Address: 213 VALLEY VIEW TER MISSION VI�JO, CA Zip: -92692 ' Phone: 949-548-2933 ISSUED BY: Zip: 92627 Phone: 714396-2379 Zip: 92627 Phone: License: Status: ISSUED Applied: 12/23/2005 Issued: OS/08/2006 Eng: DANE RODIN AND ASSOCIATES �NC Address: 27181 MONFORTE Phone: 714-396-2379 Phone: 949-582-2746 MISSION VIEJO, CA License: C24591 - 92692 � License: C30823 SCOPE OF PERMIT CONSTRUCT A DETACH�D 444 SF�NONHABITABLE WORKSHOP AND STORAGE ROOM WITH A 190 SF PORCH AT THE�REAR OF AN EXISTING 'UTILITY SINK AND WATER HEATER IN"BE INSTALLED WITHIN THE STRUCTURE. DRYVJALL WILL BE INSTALLED, BUT NO INSULATION. STRUC ONE ' - ' ` STORY (BUILDING HEIGHT IS 12'-11"). NO, BATHTUB, SHOWER, OR TOILET IS PROPOSED. 50°/ REAR YARD LOT COVERAGE ALLOWED; 36% PROPOSED. ' � � � � Plan Check: Permit: SMIP Res: SMIP Com: Other: Inspection: �� Total: $15421 $237.25 $1.39 $0.00 $0.00 $0.00 $392.85 FEE SUMMARY . � F SETBACKS :, ' MAIN STRUCTURE Front 0- 0. `� �`�� Rear,' 0- 0.. ` _ �. �. ACCESSORY .Front 0-0, ,-. . . � Rear 2-0- PARKING Existina: z0 Reauired: 0. Calc Valuation: Sis,as2.00 ClaimValuation: ,'. S�z,000.00 VIIVV 0� LVIVIIVV - � ��C,.�, � . Le@ 0-0 -Right 0�0 � , - . Left 16- 8 Right -29- 0 . Pr000sed: 0 NOTICE: The work authonzed by this permit shall comply with all applicable handicap access requirements under Calitornia 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 780 days, or if work is suspended or abandoned for a period of 180 days. � ', � INSPECTIONS: In order for the work authorized under th��.,,ermit to be considered legal, such work must comply with all applicable codes, and all required Inapections end final approval must be obtained. Failura to obtain inspactions and final approval will result in the axpiration of this permlt. FOR INSPECTIONS CALL: (714) 7545626 - tnae�as (sioo) WORKERS' COMPENSATION DECLARATION: — . � I hereby attirm undeP penalty,of per�ury one oi the following declaratlons: . ❑ I have end wiU malntain a cenifiwte ot wnseM to se&Insure for workers' compensation, as provided for by section 3700 of the Lebor Gode, for the performence of ihe work tor whlch Ihi9 pertnit i5 iuuetl. , ❑ 1 have and will maintain workere' compensatlon insurance, as required by section 3700 of the Labor Code, for the peAortnance oi the work tor which Ihis pertnit is issued. My workera' compensation Insuranca cartler antl policy number are: Carner: � Policy Numbec (Thls section nee0 not be wmplered i/ the permi( is veiued af one hundred dollers (3/00) or less.) '�"a I certify that in Ihe pertormance ot Ihe work tor which ihis permit is issued, I shall not employ eny person in any manner so as to become sublect to the workers' compensatlon laws ol Califomia, and agree that H I shoultl b wme subject ro the workers' compensation provisions of Section 3700 of the LaDor Code, I shall forthwith comply with these p�ovisions. G G Appliwm'Sipnatuie: �� uv Da� .J — ZJ — �6 WARNING: FAILURE TO SEWHE WORICE ENSATION COVERACE IS UNLAWFUL AND 5lULL SUBIECT AN EMPLOYERT�CRIMINAL PENALTIES AND GVIL FlNES UP TOONE HUNOPED T/10USANOWLLARE(5100.OW),INADD TOTHEWSTOFCOMPENSATIIXJ,DAMnGES/SGROVIDEDFOqINSEGTION31060FTHEL4BORCOOE,INTERESi,ANDATTORNEV'SFEES. LICENSED CONTRACTORS DECLAFiAT10N: �, I hereby attirm Ihat I am licensed untler provisions of Chapter 9(commencing with Section 7000) of Division 3 ot the Business and Professions Cotle, antl my license is in full torce entl ettecL Lic. a Class x ContractoYs Slgnature: Date: . CONS7RUC710N LENDING AGENCV: ❑ I hereby atfirm that there is a consiruction lending agency for the peAormance ot t�e work for which ihis permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lenders Adtlress: Signeture: Date: OWNER-BUILDER DECLARATIONS: I hereby ettirm thei untler penalry of perjury thet I em E%EMPT FROM THE CONTFiACTORS LICENSE LAW for the following raeson (Sec. 7031.5, Businass entl Professlons Code: Any ciry or counry which requires a pertnit to construct, alter, improve, tlemolish, or repair any structure, prior to its issuance, also requires ihe applicant for such permit to file a signed stetement Ihat he or she is Iicensed pursuent to the provisions oi the Cantradors License Law (Chapter 9(commencing with Section 7000) oi Division 3 oi t�a Business end Professians Coda) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation oi Section 7031.5 by eny applicant for a pertnit su�s the epplicant to a civil penalry of not more than live huntlretl tlollare ($500).): /, es owner of Ihe Oroperry, or my employees with weges as thelr sole compensation, WILL DO TME WORK, and the siructure Is not intentletl or oNeretl for sale (Sac. + 7044, Business anC Professions Cotle: The Contraciors License Law does not apply to an owner of property who builds or improves thereon, and who tloes such work himsell or herself or t�rough his or her own employees, provided that such improvemenis ere not intentleA or otteretl tor sale. If, however, the building or improvement is sold within one year oi completion, the ownerbuilder will heve the burtlen of proving that he or she did not build or improve for puryose of sale.). ❑ I, es owner oi the proPerty, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the prolect (Sac. 7044, Business and Professions Cotle: The con[ractors License Law tloes not apply to an owner of property who builds or improves thereon, antl who comracts for such projea with a contractor(s) license pursuant to the Contractors License LawsJ. ❑ I am exempt under sec. Business and Protessions Code lor this reason: Signalure: Owner ID verilietl by tlrivef nsa. ❑ Yes ❑ No OrlvePs �cense No -�[ Venfication ol Ownership by (type of tlocument, i.e. - properry tax bill or deed): DIVISION OF INDUS7RIAL SAFETV PERMR CERTiFICATION: ❑ I hareby certity that na excevetion tive (5) or more feet in deD�h into which e person is required to descend, will be made in connection with work euthorized by this permi�, and that no building strucNre, scaffoltling, falsework, or demolition or dismantling thereof, will be more than thirry-six (36) feet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Tltle B, Calitomla Administrative Cotle). ❑ As owner-builtler, 1 will not employ anyone to do work which would raquire a permit irom ihe Division of Indusirial Safety, as notetl eDove, unless such person has a pertnit to da such work from the division. Signature: Date: Division oi Intlustnal Salety Permil Number. CEHfIFlCATE OF COMPLIANCE AND AUTHOR¢ATON OF EMAV: I certify under penalty of perjury Ihat I have read this application ana state that the infortnation qiven is wrrecl I agree to comply with ell sta�e laws and dry ortlinances relating lo building consiruction, and authorize representatives of the Ciry of Gosta Mesa to emer upon ihe above-descriDetl ro erty tor inspacti n purpos . I agree not to occupy or ellow occupancy oi any building euthonzed by Ihis pertnit until finel inspec�ion. - .. �.. , ,. �- �- � �o G �sig-peture Of Cegai'Ownerys>� _leDe19 le° � AnNOr Authonzed Applicant Date COUE �. INSYELTIONTYVE t61fi Fixetl System Final Fire Prevention 1266 Pool Spe Final 200 Final Re-Rool 201 Fina181acWRetaining Well 202 Final Factory Fire Place 203 Final Sign 204 Final Domolition CODE� �xsrernoxTrve 206 Final Mechanical 208 Final Plumbing 210 Final ElecMcal 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy PAIE �SOUTHENN CAL�F012NIA EDISON` M Ilp/,SpN fNTliftNd7'IONALa Compuny May 1, 2006 Douglas and Nancy Matthews 386 La Perle Lane Costa Mesa, CA 92627-3759 Attn: To Whom It May Concern SUBJECT: INTENT TO ISSUE ENCROACHMENT 386 La Perle Lane, Costa Mesa SCE File No: END06144234 In reference to the above mentioned project, this letter is being provided to you to acknowledge that we are in fact granting permission to the Matthews' to encroach with a building into our overhead distribution easement and are in receipt of an executed and notarized Encroachment document signed by the Matthews'. The document states, in part: ". .. Edison agrees to interpose no objection to the encroachment of a building �vithin its easement area upon the express conditions, ho��ever, that said building, including but not limited to wall and foundations, shall not (1) be nearer than 3.00 (three) feet to any pole(s) and (2) shflll maintain a minimum of 12.00 (twelve) feet, measured vertically, and 6.00 (six) feet, measured horizontally, to any wire or conductor of said Southern California Edison Company. Owoier, by the acceptance of this instrument, agrees for themselves, their heirs and assigns to release. .' This document will now be executed by our Manager of Title and Real Estate Ser: ices ard the^ sent to ±he County Recorde� s effice fer recordatic^. A Conformed Copy will be sent to the Matthews' after it is recorded. The oriyinai document will be scanned into our database and cross-referenced. If you have any questions, or require additional information, please contact me at 714.895.0216. �`-l;Q-�--� Beverly McCarthy Title and Real Estate Services Corporate Real Estate Department cc: M/M Matthews Intent_06144234.doc 14799 Chesmut Strcct 5/1/2006 Westmins(cr, CA 92683 1 ' �� RECORDING REQUESTED BY SOUTHERN CALIFORNIA EDISON COMPANY WHEN RECORDED MAIL TO SOUTHERN CALIFORNIA EDISON COMPANY 14799 CHESTNUT STREET W�STMINSTER, CA 92683-5240 A7 1'N: TITLE & REAL ESTATE SERVICES BEVERLY MCCARTHY END06144234 BUII.DING :•. SPACE ABOVE THIS IINE FOR RECORDER'S USE DOCUMENTARV TRANSFER TAX $ DiSTRICT FIM APN By COMPUTED ON FULL VALUE OF PROPERTV CONVEYED OR COMPUTED ON FULL VALUE LESS LIENS AND 3J 29-12A J25-J12-07 gMc ENCUMBRANCES REMAINING AT TIME OF SALE SCE AC��oved Map Srze DATE SO CALIF EDISON CO Dowmem or ESad1eReal q0-91 04/�6�06 SIGNATURE OF DECLARANT OR AGENT DETERMINING TAXFIRM NAME Oy5253 WHEREAS, Douglas M. Matthews and Nancy M. Matthews, Trustees of the Matthews Trust Dated July 11, 1991, are the owners (hereinafter referred to as "Owner'�, of that certain real property as described in that certain Trust Transfer Deed recorded on July 8, 2002 as Instrument No. 20020565757 of Official Records, in the Office of the County Recorder of Orange County, State of California, described as follows: `LOT 3 OF TRACT NO. 1175, AS SHOWIV ON A MAP THEREOF RECORDED IN BOOK 38, PAGE 4 OF MISCELLANEOUS MAPS, IN THE OFF[CE OF THE COUNTY RECORDER OF SAID COUNTY, CA," and WHEREAS, SOUTHERN CALIFORNIA EDISON COMPANY, a corporation, (hereinafter referred to as "Edison'), is the holder of an easement, (or public utility purposes affecting said land, recorded on May 12, 1948 as Instrument No. 20207 in Book 1634 page 506 of Official Records, of said County and State; and WHEREAS, Owner will construct a building on said ]and which will encroach upon Edison's easement area. The location of said building is more particularly depicted on the Exhibit "A' attached hereto and by this reference made a part hereof. NOW, THEREFORE, in consideration of the mutual covenants and conditions herein contained, the parties hereto agree as follows: Edison agrees to interpose no objection to the encroachment of a building within its easement area upon the express conditions, however, that said building, including but not limited to wall and foundations, shall not (1) be nearer than 3.00 (three) feet to any pole�s) and (2) shall maintain a minimum of 12.00 (twelve� feet, measured vertically, and 6.00 (six) feet, measured horizontally, to any wire or conductor of said Southern California Edison Company. Owner, by the acceptance of this instrument, agrees for themselves, their heirs and assigns to release, save harmless and indemnify Edison, its officers, agent or employees from and against, and loss of or damage to property, (including Edison's own property) or injury or death of persons, liability and/or expense, which Edison may sustain, incur or become liable for, resulting in any manner from the negligent exercise of the encroachment granted herein, except to the extent said damage and/or injuty is caused by the negligence of Edison. Encroachment (easement) Douglas M. & Nancy M. Matthews RP File No. END06144234 Affects SCE Doc. 095253 This encroachment should not be construed as a subordination of E`iiison's rights, title and interest in and to its easement. OWNER does hereby accept the above and foregoing Encroachment Agreement upon and subject to all of the terms, covenants and conditions therein contained, and does hereby agree to comply with and perform each and all of said terms, covenants and conditions. EXECUTED this � day of � �r �` , 2006. i��/. + Douglas M. Matthews Nancy . Matthews SOUTHERN CALIFORNIA EDISON COMPANY, a corporation � Rolando S. Diaz, Manager, Title and Real Estate Services Real Estate Operations Division Corporate Real Estate Department STATE OF CALIFORNIA COUNTY OF (�JykNAQ —� ) ss. On {�_p�, �"jt' p�pp6 , before me, personally appeared j�ouafa5 M. �..-F� ews,_(da. me on the basis of satis ctory evidence) to be t instrument and acknowled d to me that (��hc capacity and that b r/his signature on the : which the person acted, executed the instrument. son whose name executed the sai ment the person, a Notary Public, known to me (or proved to is subscr' d to the within ne in er/hi authorized or the entity upon behalf of WITNESS my hand and ofC,cial seal. HetErt KaznNctrvaw rar,wr Puauc • cauFo� - 4_ COM.MISSION 6 76869Bt OHANflECOUN7Y Sigll3tlliC My Ccmm. E�. June 24, 21i0q _2_ , F ': ' , , i , 1 5 . . " , , i ., ic.� i^ Y �. l i !. 1, :':'. :. i �;:., �' ! p: � � ..i � 1 i.: � S ft 1 � ...�. � r.:., u G r: � 1.�-�: .4 1 . : :.:. ... . a .e/ � .... '.i. :�\ Y ;�� _. ' ,N��a �zis : , , �: �; � , a � �1xaa v� 5 � .-- �,.. t. ` ' -aurt_ 'zaaaoaa „u ;oe > -- -- — ��. < a r S i..j Atlll3AIN4 (3) ' '� . .� > 2 , :�.;,� .. .,, ..,« , :.., ':, '.; t .'�i t;. +: . :: �' . � .�,�•. ��•.� ' . �'_.. f' �. _.. .. .. WAvI i I_— --__ � � � � . � � — ' — _ �� I � ' i . .� i ', , i i .- i ��: 3� � � -- ---f�� -;l + I � f . � ,�-�,� . �;I r I . I' ' �.(�: "�nJ : � � ,. i r��' �!. � r'' � I __ _— _r , ." I � , � � � - . � I � I _ , �9JN841538 �3),.. �"� .., � ' I . � 1 '=� I S � ;':I, � I '`,;I x � ._.� I � ;.'�I : I ; . `�,. _�' I ; - . .. ;.;.� , � %.3JN3UI53ll�(3�,1 ' I � � ..L , � � -�� ::Y i i �!,`j � � ;' �t �IG � I � I p �.' ;' . � i.,:( h i 3d �� .e�.l� ti :.� .d �� 1�. . .. � -' o' ' I . �,arvne arvrrs . t. � —E �aou xi': � 'niraoxv�ere .nzz �.._ I`T3 I -� ..�.� � -- — �� I . I I I - ..:' �' .; � .�} � :� I p � �. Y � : � 9I; I ._ ... , A E t . � --- �� I I � ,� ___ I � � -,Y�i � : I .' I :.I:,' aaois xi (a), I ��' dOHS 80Y (N) I ''-'I' �.. a _ t " :-� � � A� YE � ' � —. x��ras ar - —i r ' �� . . i _ n �, i . i :.i, �' } — — '1. :�� J,N3W35Y8 � 0 S L. ._ _ __ 1 �;. J � �Ni� �u.aaaoaa o 'o� 0 2. . � �, . . � , , � y� � : �I . - ,. . ,o o� . ,, , , „ , . _ . ,_. .. , .�; , u c a `' z� CERTIFICATION OF TRUST - PURSUANT TO CALIFORNIA PROBATE CODE SECTION 18100.5 I (We), �� µ Tmstee(s) of the _ Confirm !he foilowing (� 1. The _ �� is arrently in exislence and was created on 7 2. The setUa (s) of the Trust are as 3.The arrently acting Tmstee(s) of the truSf is (arej: �a uc �4 C/V/• /�la �%iBw S C�tirc� Li�4�✓us /�l /'rle�Yffi,ewS 4. The power of the tNstee(s) includes: (a) The powers to sell, convey and exchange �Yes No (check one) (b) The power to borrow money and encumber the trust property with a deed of trust of mortgage: �Yes No (check one) 5. The trust is revocable rrevocable (circle the applicable choice) and have the tollowing party(ies) if any , is (are) idenlified as having the power to revoke the trust — , . . . . ., � , , . ,v _r..i _ 6.The lrust a) does; (b does nol (circle the applicable choice) have multiple trus�ees. If the frust has mulliple lmstees, the signaWres of all trustees or o( any of �he trustees is required ro exercise lhe powers of the tmst. 7. The trust identifcation number is as 8. Title to lrust assets shall be taken in ihe following fashion: G- 53-o�f-8�'7 l The undersigned iruslee(s) hereby dedares (declare) that the tmst has not been revoked, modified"or amended in any manner which would cause Ne representa6ons contained herein to be inwrrecL This certificate is being signed by all oi the curreNly acting trustees and is being executed in conformiry with lhe provisions of California Probate Code Section 18100.5, Chapter 530, Statutes of 1993. Dated: . . _ STATE 0� CAUFORNIA ) COUNTY OF lN(� NA C ) ss. J ) On �� o1�r ?oOFi before me, �eH �zanCl�yGN personally appeared ��las M. .�JL�� N�..,. N. Ma4�{a.�personally known lo me (or proved to me on tt�basis of satisfactory evidence) to be the person(s) whose name(s) are subscnbed to the wilhin instrumenl and acknowledged b me that (shelhe/ �ry' executed Ihe same in (hedhisMfeiA auNorized capacil�ylies) and lhat by (hedhl eir signature�s) on the instrumeN the person�sJ, or the entity upon behalf of which the person(s) ac el lt, executed the insWment. WITNESS my ha d and official seal. Signature HELEN KAZANCNYAN NOTARY PUBLJC - CAL'FORNIA a COAA!A�SS10N f 1598981 T OflkNGE COUN71' Ny Comm. Ey�. Juna 24, 2609� V�� ATTENTION NOTARY: Allhough the informafion requesled below is OPTIONAL, it could prevent fraudulent atlachment of Ihis cedificale to another dacument. THlS CER7FICA7E MUST BE ATTACNED TO THE DOCt1MENT DESCRIBED BELOW: Tille of type of Nambero( Signer (s) Other Than Named Date of Document (714} 754-5273 • Fex (714) 754•4B56 • www.ci.costa-mesa.�L�CTRICAL PERMIT n FAIR DAIVE, COS7A MESA, CA 92626 ,lob Address: 384 LA PERLE LN Suite No Vicinity: Parcel Nunmber: 42531203 Applicam: DOUG MATTHEWS Address: Status: ISSUED Applied: 07/14/2006 Issued: 07l142006 ISSUED BY: � Phone: 949-548-8933 - ---' .�c_.,-, : -' _ - �, �i/_Zip _ ' ' � _ _ - ,��'� . . ,_. .., . _ � �j - _ - �. . �-. '�, �' ",r '. , � ;, .� j � Ownec MATTHEW,8; DOUGLAS ' � /� �`� �.� Address 3841A'PERLE W\ , A j 1 ' a i�' � (, `� � `� � /''�� 1 - 1 � .. ; A`�c�-.. �/'�� '`� �` % � :.,Bhone � 714396 2379 �� ` . \ ' ` � /��, ��A.\SA ji � i%... _ i Zip 92627� ��;;�, \ \� , �\,<��\� �� l �% % �i AC,�A �� V�� ontractoc �. �/��-;r�� '��:�,`�� V�� , i \ ''Addrese: //�j� <<��"\ / V� �� V �( � � r�� n /ii/j Phone:� ��\ � �\ \\ i�� , % � � /� �. � Zip: , � ' \�� i"> >A \ �, � � . /r . � �, ��• '� ��/%' . License." , .. ,_ � -�•� \) �� i�� , - ' _ �;. _v, �� , !h;;' � _ �, ;s' � �; � ,� ;, � ` ' � ?�,/� . ' "SCOPE OF PERMIT ;" � _ � , ` ' '•�- *--- � J� �i I/NSTACL 10 FIXTURE& 130UTLETS AND 7 SWITCHES�FOR RESIDENTIAL ADDITION RE.805 i � � �.i,' � � -:.o�- ' ,5,'�� '�F � C � '' FEE SUMMARY � �� \� ._ I �� /� i � .. � Quanldy � Quantit � , -ISSUE.FEE � � � i $23.50 ; - - - - � -- -- - Temp-Dist System / Lighting � $0.00 . � :Temp service test � -+ $Q00 � � ""t'*; � ^ f . ',� • +^' BUsway /100 fl; '�� ,`(� `�� $Q00 , i: ,Res. a/c package � `� $0.00 - ' �,J: ,; , � Standing Sechon� � :,1, : $0.00 INew Res (1-2 umts) ,', �� $0.00 -�- - -- 0 - - � Misc Electrical Eqmpment � -.' $0.00 �New Res (3+unitsj'�'. �r ; $0.00 ��, 0 , Transformers up to�t: kva/kw ' $0.00 Pool / Spa r $0.00 � 0 � . up to 10 kva/kw � $0.00 i ` r�' �'-. �: � u to 50 kva/kw -,,, $0.00' LighlingFizts � ��' $11.00 •,_.�10 � , . y - i � p Recept Outlets , ^ $14.30 . � 13^-- - -`--- � .. -.:-.......up to'100 kva/kw`-�'' $0.00 Switches .-"-, ; `',. : $770 � ^ `"7 " - ' --- ...:�........:�:...over 100 kva/kw� � $0.00 Non�Res`Appl J�� $0.00 0 Low Voltage Equipment � $0.00 � Res'Appl`� ��J`�. $0.00 0 LowVoH�WiringSystem/Ckt � $0.00 Ser`vice to 200a �� '.� $0.00 �� 0 Misc..Conduit �� r �I $0.00 Service�to 1000a ,. �� ` $0.00 '. 0 Misc Conductor � I $0.00 �� Service�over 1000a � � �` � � $0.00 ` 0 -4.. ;''"'.Circus ( gen or ride) �- $0.00 a��_ Motors to.1 hpA,.; ` �� .,$0.00 - 0 -'�:.'� �Circus (mech ride or lighis) ' $0.00„%': � � � - .a 7"'.::'�. " �i� / Motors l0 10hp ;�$0.00 � 0 ` Chdstmas Tree,Stand ,$0.00 i � Morore to�50hp �e' ` � �' �$0.00 0 -. ` . ' Fireworks Stand��: ;$0 OOl Motors to 100hp� � � $0 00�. , ^•-- 0� � � � ' --0ther Electrical Fee ; �' S0 00 Motors over'100hp� �� $O.00r� , - 0 ' � ,� = _��.� /-� Communicalioniirops /�$0.00�- � .,, 0 - � �=lnvesligation Fee . �� o /$0 00/� � Sub panel to 200a ' � � � $0.00 z .0��_ � � � � _Plan Check Fee " . -- � � 50.00 �� Pole Llght Pkg � � �. $0 00� -0= _- - �, � - � � Reinspechon_Fee - � .$OAO � �� Sign Circuits �� $0.00 �r�-. 0 � "'s .�. �-__.- � -". �' - � � % �� / Temp Pwr Pole ��$0.00� ( f I�O� -_ __=-70TAL CALCULATED FEES� $�50`� � Intermed Pole � , $0.00`�- � 0! �i \�;` ,/� �� /�,'l�}�i.� _ , �1` ,/%/t/� � `� _ � �COMMENTS /'SPECIAL CONDITIONS�i - �� ' \,� . � -- �, . ._. . .� _ _� � -_ �� j. ' � 1V ` 02382 � � ' �l't � � . � } � � � �„ i ��, �11, -}��1 �� 0 r' l � � � ��i �. . (.Jl ��I 0 �- i \i Oi ��i ��- � ',� � 0; f�li „ ;'��. 0 , �a,', � C�, ��,1�! � o�� , � ;= \� J:a' � O�� l_-, ` � � %!/ 0� r`' �� i �,:l�, � � � J :, r' � „ /'j� o -� i�,�� f `/ �� !/"i �i NOTICE: Tha work 8uthorized by this permit shall comply with all applicable handicap access requiremenls under Californla atatutes and related regulatlons. (Ord. No. 92-28, § 1, 12-21-92) � EXPIRA710N: This p0rmit snall automatically eupire and become void if work Is not commanced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In ortler for the work authorized under this pertnit to be considared legal, such work must eomply with all applicable codes, end all requlred Inapeetlone and flnel approvel must be obtalned. Failure to obtain inspections and tinal approval will result in the ezpiration of this permit. FOR INSPECTIONS CALL: (714) 7545826 . zaae�ae (arool `7 WORKERS' COMPENSATION OECLAFiATON: , . "� I hereby attirtn untler penelry o1 perjury one ot the fWlowing deGaiatlons:' � . � ❑ I heve and �wlll,malntaln e certitiwte of consem to selbinsure for workers' compensation, as proNtled for by seclion 3700 of the Lebor Cotle, for the pertortnenca ot the work tor which Ihis pertnit is issued. � I hava enA vAll maintein woAcere' compensetion Insurer�ce, as requlreU by section 3700 of tha Le6or Cotle, for Ue pertortnance of Me work for whlch thls permit is iswed. My workera' compensatlon Insurence caMer end policy number ere: � � Certler: Palicy Numher. (Thls section need nat be complete0 i! Nre permit rs velue0 et one hundred dollers ($f 00) or less.) ❑ I certity Nat In �he pertormence ot Ne work tor which Ihis permit is issuetl, 1 shall not employ any person in any manner so as to becoma subjec� to Ne workers' compensatlon laws of Celitomia, entl epree thet tl I shoultl become sub�ect to the workers' compensetion provisions o1 Sedlon 3700 oi the Le6or Cotle, I ahall fonhwit� compy with Ihese provisions. Applicent Signeture: Date: WARNMQ: FNLURE TO SECURE WOPo(ERS' COMPENSATION GUVEMGE IS UNUW FUL AND SHALL SUBIECT PN EMPLOVER TO CRIMINAL PENpLTIES AND CML FlNES UP TO ONE HUNDREO TFqUSAND DOLLARE (5100.000). IN AODRION TO TME C0.ST OF COMPENSATION, DMMGES AS PROVIDED FOR IN SECfION 31060F THE LFBOR CODE, INTEREST, ANO ATTORNEI"5 FEES. LICENSED CONTRACTORS DECLARATON: I herehy ettirm that I em Ilcensed under provisions of Chepter 9(commenGng with Section 7000) of Division 3 of the Business end Pratessions Code, end my license Is In full torce an0 etted. uc. a Cless A Contrectors Signature: Date: CONS7RUCTION LENDINO AGENCY: . ❑ I hereby ettlrtn thet there is e wnstructian lending agency tor the pertortnance of ihe work for which Ihis pertnit is issued. (Sec. 3097, Civil Code). LenOefs Nflme: Lendefs Address: Sipneture: Dete: OWNER-BUILDER DECLARATIONS: I hereby eNirm Ihet under penelry oi perjury Ihat I em EXEMPT FROM THE CONTAACTOFiS LICENSE LAW for ihe tollowing reason (Sec. 7031.5, Business entl Protesslons CoOe: Any Ury or wunry which requires a pertnit to consWct, alter, impmve, demolish, or repair any structure, pnor to its issuance, also requires the epplicant tor such pertnit to Ne e aigned atetement thet �e or she is Ilcensetl puBuent ro iha provlslons of t�e Conirectors LJcense Lew (Chepter 9(commencing with Sectlon 7000) of Division 3 of t�e Business and Profesaions Code) or that ha or she Is exempt theretrom end the basis tor the allegetl eaemption. Any violation of Sedion 7031.5 Dy eny epplicent for a parmit sub�ecle the epplicant to a civll penalty of no� more ihen iive hundred tlollars ($500).): ❑ I, es owner ot ihe property, ar my employees with wages fls their sole wmpensation, WILL DO TT1E WORK, and ihe structure Is not intendeC or oHered far sale (Sec. 70M14, Business and Protessions CoOe: The Contrectors License Lew does not appty lo an owner of properry who huilds or Improves thereon, and who does such work hlmselt or �erselt or through his or �er own emplqrees, provide0 ihat such Improvements are not Intended or ottered for sele. If, however, the builtling or Improvement Is solA within one yeer of completion, ihe owner-builtler will have ihe burtlen of proving ihat he or she did not build or improve for purpose o1 sele.). • ❑ I, es owner of lhe property, am EXCLUSIVELY CONTRACTING W17T1 LICENSED CONTRACTORS to construct the pro�ect (Sec. 7064, Businesa entl Professions Code: The conirectors LJcense Law tloes nat apply to an awner oi property w�o builds or Improves thereoq and who contracts tor such pro�ect wiih a cantractor(s) Iicense Oureuent to the Contractors License Lews.). ❑ lem Owner ID verlfied by driv.�fs Ilcense. ❑ Yes ❑ No Business end Professions Coda for this VBdiicatlon ai Oanership by (rype ol documeni, I.e. - pmperty taz bill Or deed): DriveYs License No. �Ires: OIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION: ❑ I hereby ceNry thet no axwvation five (5) or more feet in depth inta which e person is required to descend, will ba mede In connection wlth work euthotlzetl by t�is permit, antl tha� no building structure, sceXolding, felsework, or demolition or dismamling thereot, will be more Ihan thirty-sla (36) feet high. (Chep. 32, Grp 2, Art 2, Sec. 341, Title 8, Celifornla Administrative Cotle). ❑ As owner-builder, 1 will not employ enyone to do work w�ich woultl require a Dermit irom the Divisian of IndusMel Sefery, es notetl above, unless such person hes e pertnit to tlo such work from the division. Signature: Date: DlNslon ot Intlusidal Sefery Pertnit Number. CERTIFlCATE OF COMPLIANCE IWD AUiHORVA710N OF ENTRY: I certily under penalry of perjury that I hava read this applicatian end slete thet ihe Infortnation given Is wrrect. I egree to compty wlth ell state lews entl ciry ortlinances relating to bullding wnstruction, antl authorize representatives ot tha Ciry of Coste Mesa to enter upon the ebove-0escribed property for insEgctioryyurposesyYa9ree not to ocapy or ellow occupancy,of any huilding euthonzed by Ihis pertnit until Mel insyection. GOOE 1. INSPECTIONTYPE 1816 � Fixetl System Final Fire Prevention 1266 Pool Spa Final 200 Final RaRoof 201 Final BIocWRetaining WaII 202 Finel Fedory Fire Place� 203 204 Flnel Sign Finel DemoOUon �� COOE� INSPECTIONTYVE - � 206 Final Mechanical 208 Final Plumbing 210 FinalElectncal� 212 Finel Fire PrevenUon , 220 Finel Planning Approvel 222 Final Site 250 , Final BuilAing/Occupani � (714) 754-5273 • Fau (714) 754•4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 384 LA PERLE LN Suite No Viciniry: 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 � Contracror: OW N ER-BU I LD ER � ' Address: � � � PLUMBING PERMIT Phone: 714396-2379 Zip: 92627 Phone: 714-396-2379 Zip: 92627 Phone: ZIP License: 000000 Slatus: ISSUED Applied: OS/30/2006 Issued: OS/30/2006 SCOPE OF PERMIT - CONSTRUCT A DETACHED 444 SF NONHABITABLE WORKSHOP AND STORAGE ROOM WITH A 190 SF • �' , PORCH AT THE REAR OF AN EXISTING DUPLEX. A UTILITY SINK AND WATER HEATER IN BE INSTALIED WITHIN THE STRUCTURE. DRYWALL WILL BE INSTALLED, BUT NO INSULATION. STRUCTURE IS ONE STORY (BUILDING HEIGHT IS 12'-11"). NO BATHTUB, SHOWER, OR TOILET IS PROPOSED. 50% REAR YARD LOT COVERAGE ALLOWED; 36% PROPOSED. REF.: BOS-02382 PLUMBING TO INCLUDE: 1 SERVICE SINK AND t WATER HEATER.� ISSUE FEE Backflow irrigation . Backflow preventer BathWb Clarifier System �Connect Qce,Soda,etc) Dental Units � - Dishwasher.�� Draiq Ploor � , Drein, Rainwater Drain, Roof � Drinking Fountain Expansion Tank � Gas Earthquake Valve � Gas (1-4 Outlels) Gas (Over 4 outlets) Gas Repipe Gas Service Interceptors (Grease, Oil) Interceplors (Sand Auto ) �AMT $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 , $0.00 �. $0.00 50.00 $0:00 $0.00 $0.00 $0.00 $0:00 $0.00 $0.00 $0.00 $D.00 $0.00 L1�1 0 0 0 0 0 0 `: p �0' 0 0 0 0 0 0 0 0 0 0 0 - PEE SUMMARY AMT LaundryTub/Washer $0.00 Landscape Irrigation $0.00 P-Trap - $0.00 Pressure Regulator . $0.00� Process Piping (per 10 ft) � $0.00 Receptors $0.00 SepticTank ' $0.00 - ,,,,'Sewer Cap for Demo $0.00 . �- SewerConnect $0.00 . Sewer Private Line . - $0.00 � ��,Shower , . ' $0.00 , � Sink, bar � $0.00 � �Sink, commercial $0.00 � Sink, Floor - - $0.00 %Sink, kitchen $0.00 - Sink, service/mop � $9.80 � Spa (private) � $0.00 � ., Spa (public) $0.00 Qn 0 0 0 0 0 0 0 0_ 0� 0 0- 0 0 0 0 1 0 0 COMMENTS I SPECIAL CONDITIONS SumpPump Swimming Pool � � Trap Primer - � Urinal � . Vacuum Brkr Bkflow(7-4) Vacuum Brkr Bkflow(5+) Wash Basin , � --WasFrBasinSeb �� - Waste and Vent Syslem � Water Closet (Toilet) - � -Watar Heaterl venL � � Water Piping•(Inst or Rep.) WaterRe-pipe � , WaterService Water Softener OTHER VIOLATION � PLAN CHECK REINSPECTION TOTAL CALCULATED FEES: AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $12.30 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 E45.60 can 0 0 0 0 0 0 0 0 0 0 1 0 0 0 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 periotl of 180 days. � INSPEC71pNS: In order tor the work authorized under this permit to be considered legal, such work must comply with all applicable codes, ap�l requlred inapectlons and Iinal approval must be obtalned. Failure to obtain inspections and final approval will result in the axpiration of t��jjit. FOR INSPECTIONS CALL: (714) 7545626 zauas �doo� WORKERS'COMPENSAnON DECLARAnON: . � . � . I hereby eRirm untler penalry of perjury one oi the following tleclarations: . : -. ' ❑ I heve and will mainiain e cenificate ot consent to sel4lnsure tor workers' compensetion, as pravided tor by section 3700 of the Lebor Code, br the pertormence at Ihe work for which t�is permit i5 i55ued. � _ ❑ I have and will maintain wwkers' compensation insuranca, as requiretl by section 3700 ot Ne Labor Cotle, lor Ne peAormance of the work for which ihis pertnit is issuetl. My workera' compensatlon Insurence cartier antl policy number ere: � ' " Cerner: ' � Policy Number: (TM1is sectlon nee0 nof be com0lefed i! fhe permit is vaNeC af one hundred dollars ($100) or leuJ � I certify that in the peAortnance of the work tor w�ich Ihis pertnit is issuatl, 1 shall not employ any person in eny manner so as to become sublect to Ihe workere' compensetion laws of Califomie, end egree that tl I should become subjea to Ihe workers' wmpensation provisions of Section 3700 of the Lebor Code, I shell forthwith wmply with t�ese provisions. Applicant Signature: Date: WARNIN�: FAILURE TO SECUFE WORKERS' COMPENSATION COVEPAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENPLTIES AND GVIL FINES UP TO dJE MUNDRED TLIOUSPNO DpLLARE (E100,000), IN ADDITION TO iHE COST OF COMPENSATION, DAMAGES AS PHOVI�ED FOR IN SECTION 3]O60F THE LABOR CODE, INrEREST, AND ATTORNE'fS FEES. LICENSED CONTRACTORS DECLARATION: I I hereby eflirm that I am licensed untler Drovisions of Chapter 9(wmmencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is In tull '�� torce entl eXecL Lia a Class � Contractor's Signatura: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby aHirm that there is a construction lending agency br ihe pedormance ot the work tor which Ihis permit is issuetl. (Sec. 3097, Civil Code). Lendels Name: LendeYs Atltlress: SignaWre: Date: OWNER-BUILDER DECLARATIONS: I hereby eHirtn thet undar penelry of per�ury lhal I em EXEMPT FROM 7HE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7037.5, Business end Professions Code: Any city or counry which requires e permit to consWq, alter, improve, tlemolish, or repair any structure, pdor to its issuance, elso requires the epplicant for such permit to file a signed slatement iha� he or she I5 IlcenseC pursuant to the provisions of the Contractors License Lew (Chapter 9(commencing with Section 7000) of Division 3 ot Ihe Business en0 Profeulons Cotle) or that he or she is exempt theretrom and ihe basis for the allegetl ezemption. Any violation of Section 7037.5 by any epplicant for a pertntl subjpcts Ihe applicant to a civil penalry of not more Ihan five hundred dollars (5500).): '((� F, as owner of the property, or my employees with wages as iheir sole compensa�ion, WILL DO TF1E WORK, antl the struciure Is not intended or ottared tor sele (Sec. �+f'�. f7004, Business and Professions Code: Tha Contractors License Law dces not appty to an owner ot propeny who tiuilds or improves thereon, end who does such work himsetl or herself or through his or her own employees, provided Ihat such imprwemants are not imended or oHered tor sale. It, howaver, the building or improvement is soltl within one year ol completion, the owner-builder will have t�e burden of pmving that he or she did not build or impmve tor purpose of sale.). � ❑ I, as owner ol the property, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the projeci (Sec. 7044, Business and Prolessions Code: The wntractore LJcense Lew tloes not appty to an owner ol propeny who builds or impwves thereon, antl w�o contracts for such pmjea with a comractor(s) licensa pursuaN to ihe Contractors Licensa Laws.). sec. OwnervlB�veritied by tlrivels Venficatian ofOwnership by Busine55 and Professions Code for Ihis reason: �e. ❑ Ves ❑ No ot document, i.e. � property �ax bill or DIVISION OF INDUS7RIAL SAFETV PERMR CERTFICATION: ❑ I hereby certify Ihat no excavation tive (5) or mora feet in tlepth into which e person is requiretl to tlescenq wiil be mede in connection with work euthorizetl Dy this permit, antl t�at no building structure, scattolding, falsawork, or demolition or dismantling thereof, will he more than thirry-six (36) feet high. (Ghap. 3.2, Grp 2, Ah 2, Sec. 341, Ttle B, Calitomia Adminisiretive Code). � ❑ As owner-builtler, I will not employ anyone to do work which would require a permit from ihe Division of Indusinel Safery, es.notetl e6ove, unless such parson hes e pertnit to do such work Irom �he tlivision. SignaWre: Date: Division oi Intlustnal Safery Permit Number: CERTIFlCA7E OF COMPLIANCE AND AUiHORIZATON OF ENTRY: I cenify under penalry of perjury that I have reaG this application antl state that the iniortnation given is correct. I agree to comply with all slate laws and ciry ordinances relating to Duiltling construction, antl authodze representatives of che Ciry of Costa Mesa to enter upon t�e ^--described property for iyysp�U n purp�not to occuOY or allow occupanry of eny building au�honzed by this permit until tinel inspection. .�-r !/'�� -�,c3.�.o 6 �OfLegalOwner(s) , •'�'5^--�c,,,, �-Date�, � ;N'�' - ' - ,. ..., _ . _ '; - e` '- COOE I, i616 1266 200 Fi:etl Sysiem Final Fire Prevention Pool Spa Final Final Re-Roof 201 Final BIocWRetaining Well 202 203 204 � Final Fectory Fire Place Final Sign Final Damolition O�TE 4Q1� INSPECTIONTYVE 206 ' Final Mechanicel 208 Final Plumbing 210 � Final Elecirical � 212 Final Fire Prevention 220 222 250 Final Planning App�oval Final Sile Final Building/Occupancy PAg I[�LS . ��3�c14x �21� � � (714) 754-5273 • Fax (714) 754-4856 • www.ci.coste-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Jo6 Address: Suite No Vicinity: Parcel Nunmber: Applicant: Address: Owner Addres Contiactor 384 LA PERLE LN 42531203 MATTHEWS,DOUGLAS 384 LA PERLE LN Status: ISSUED Applied: 04/28/2005 Issued: 04/28/2005 ISSUED BY: � Phone:• 714 396 2379 '�.- -- .� �^�" "-,�-'-�,,. COSTA MESA, CA ��:;. .. ..-Zip 92627 . s�« i�,� 3 : ,� '� ;� ,�� , MATTHEWS,DOUGLAS ` � 5 384 LA �ERLE LN `"�.� 9�r .. ,< �{� .�� , � N � � �� ,'.,.,;�,�� .-�. ��' �' Phone. 714-396-2379 ,. , a p � COSTA:MESA, CA ,- , Zip: 92627 � �` ' h. 'x ': n�'p �':�� ` v�'�'� ,. � OWNER=6UILDER � ,� �� Address � 3s r f �Z ,p t �'� ' z= � ��' � � Phone p � +�� ' '; a ,,ur 3, �� .� ,. t Zip `v� ��.�- � r;. `�'��' � � License.000000 `�" ' �;�a _ `��. r � � �'��` � ' �. zE' � � ��i, ;� � u: , . � �t �. . , .� :�, •�SCOPE OF PERMIT ,� - ., � �� ,` � 5�,�`x REVISION TO PERMIT 07/25/OS ADD 3-LIGHTING FIXTS AND 1�RECEPT OUTLET 3 ; .: ....,�. ... ' . . � � . , `-i 1 REPAIR/REPLACE ELECTRICAL� MECH: AND PLUMBING REF :"BOS00608 ', ��-� � � �j 3� i'�;� n s �{ ._ � ;.� , _ �;, y 'e _ , e x _' � 3�ELECTRICAL TO INCLUDE:.6 LIGHT,,FIXTURES,22.OUTLETS AND 10 SWITCHES:SHROUGHOUT�,S.F-.D ,' �. �i '��'';'��^'� . -- .. ._ ,...,_ ,_ -� � .. �� a� .�,.. . . �*' '� FEE S "' - � � �� _Quantity ISSUE�FEE � �•" 823 50 - ' Temp ser'vice test � � �$0'00'-,% Res. a/c package •> �. Y 50 00 ��` - .. New Res (1-2�umts) �', �SO OQ "` 0 '$"°' � New Res (3+units) � 50 OO�i� 0 �, � '� � , Pool / Spa -� �� SO 00 ;. 0 -�. > �� LightingFixts '1 3990�;` 9��s�,� a�'�' ReceptOuUets -�'S24.19 � 23 �' Switches � 811:00 � 10 �p �': Non Res Appl $0.00 0 _��,�� „�i� Res Appl ��:��..,.� 50:00, .r� 0 Service to 200a '" ��50.00 0 �r:: �- -- Serviceto�000a �$0.00 0�,`-y�}��'"; �,,,, Service over 1000a 50.00 = 0�•n ya � Molors to 1 hp $0 00 -- 0 .� ,� Molors ta 10hp 50.00 """`�0��, -- '° Motors ro SOhp SO-00 0 r ��y_„ „--��_, _.-- Molors to 100hp �0.00 0 ' `��'`'`..,..,u _ _ P.lotors over 100hp $0.00 0 � � Communication drops 30.00 0 � �r � � — t System / Lighting 100 ft Seclion trical Equipment iers;up l0 7 kva/kw Investigation Fee $0.00 $0.00 $0.00 $0.00 Iuantdy "' "��'.. : 0 � 0 :fi, p ''. . � .',� �� ;. 7:- 0 � ', ��A. �� 0�� 0 '.. 0 �r_ rb � 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) � EXFIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned tor a period of 180 days. INSPECTIONS: In ortler for �he work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inepeetions and final approval must be obtained. Failure to obtain inspections and final approval will resufl in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7¢45626 WORKEPS' COMPENSATION DECLARATION: � hereby attirm under penelry of perjury one oi Ihe following tleclarations: ❑ I have entl wlll mainteln e ceM1ificate of consent to self�lnsure tor workers' compansation, es provided for by section 3700 ot Ihe Lebor Code, for the pertormenca of Ihe work tor which this pertnit is issued. ❑ I have and wlll maintain workers' ownpensatbn Insurer�ce, as required by secUon 3700 of Ne LeDor Code, tor the pertoimance of the work tor which this pertnit is issued. My workers' campensailon Insurance cartier anA policy number are: Certier. Palicy Numhec (Thls secNon need nof be completed i! Ne permit is velued af one bunOreO dollars ($100) oNess.) ❑ I certity that in the peAortnance of the work for which this pertnit is iuued, I shall not emplay eny person in any manner so es to becoma subject to the workere' compensatlon laws ot Celitomia, and egree Ihat if I should 6ecome sub�ect to ihe workers' compensation provislons ol5actlon 3700 ot ihe Labor Code, I shall tonhwith comply with these provisions. Applicant Slgnelure: Dete: WARNIN6: FWLURE TO SECURE WORKERS' COMPENSATION COVEMGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND GVIL FlNES UP TOONE HUNDRED THOl15AND DOLLARE (Et00.OW). IN ADDRION TO THE COST OF COMPENSATION, DNAAGES 0.S PROVIDEO FOR M SECfION 3lOfi OF THE LABOR ODDE, INTEREST, PND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: �� I hereby aMirtn Ihat I am licensed under pwvisions of Chapter 9(commencing with Section 7000) of Division 3 ot the Busineu and Professions Code, antl my license is In full torce ana eNect. Llc. a Class a Conlrectofs Signeture: Date: CONSTRUC710N LENDING AGENCV: ❑ I �ereby aflirm that Nere is a construction lending egency for ihe performance ot Ihe work for which this pertnit is issuetl. (Sec. 3097, Civil Cotle). Lenders Name: Lenders Address: Signawre: Date: OWNER-BUILDER DECLARAT10N5: I hereby eXirm thet under penelry of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business end Prolessions Cotle: Any city or wunry which requires a pertnit to construct, alter, improve, demolish, or repair any 5trucNre, pnor to its issuance, elso raquires Ihe epplicant br suc� permit to file a signad statemem thet he or she is IlcenseC pursuant to Ihe provisions of the Comrectors License Law (Chapter 9(commenUng with Section 7000) of DlNslon 3 oi t�e Business and Professions Cotle) or that he or she is ezempt therefrom and the Easis for t�e alleged eaemption. Any violation of Section 7037.5 by any epplicant for e pertnit subjects the applicant to e civil penalry ot not more than five hundred tlollars (5500).): I, as owner of Ihe praperry, or my employees wl�h wages es �heir sole compensation, WILL DO THE WORK, and the structure Is nat intentletl or oflerad for sele (Sec. - 7044, Business and Protessions Code: The Contreaors License Law does not apply to en owner oi properry who builds or improves ihereon, antl who daes such work himself or herseli or through his or her own employees, provided ihat such improvements are not intendetl or oNered for sale. If, however, Ihe building or improvement is sold within one year of completion, the ownerbuilder will have the burden of proving ihat he or she did not build or impmve for purpose of sale.). ' ❑ 1, es owner of ihe property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS lo consiruct the project (Sec. 7044, 8usiness end Professions COCa: The conirectors License Law �oes nm eppy to an owner ol propeny who bullds or improves ihereoq antl who comrecis tor such projeci with e contrector(s) license pursuam to the Coniracmrs License Lews.). sec. verifiad by �ers license. ❑ Ves ❑ No Business and Professions Code for ihis reason: Verificetion ol Owners�ID by (type of document, I.e. - property tax bill DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: Expires� ❑ I hereby cenity ihet no eacavation five (5) or more feet in tlepth into which a person is requiretl to descend, will be made in connection with work euthodzed by this pertnit, and that no building structure, swflolding, falsework, or tlemolition or tlismantling ihereof, will be more than ihirty-six (36) feet high. (Chap. 32, Grp 2, Atl 2, Sec. 341, Ttle e, Celifomia Administrative Cotle). ❑ As owner-builder, I will not employ anyone ta do work which would require e permit irom the Division of Intlustrial Sefery, es notetl above, unless such person hes e permit to do such work from the tlivision. Signature: Date: Division of Industrial Safery Permit Number: CERTIFlCATE OF COMPLIANCE AND AUTHORVA710N OF ENTAV: 1 cetlify under penalry ot perjury that I have read this epplication and state that t�e iniormetion given is conect. I agree to comply with all siate laws and ciry ordinances relating to building construction, and authonze representa�ives ot the Ciry of Costa Mesa to enter upon Ihe ebove-dexribed property fo in ion purpo . I agree not to occupy or allow occupancy ot any building authorized by this permit until final inspection. - � ��-a S L'�ISignature O1_Lepa40wnerts)�"'Y" - LOOE �. INSPECTIONTYPE 1616 Fi:ed System Final Fire Prevention 1266 Pool Spe Finel 200 Final Ra-Rooi 201 Final8lock/Retaining Wall 202 Final Factory Fire Place 203 Final Slgn 204 Final Demolition Q�¢ IM�ij�/� f�f� INSPECTONTYPE 206 Final MechaniCal 208 Final Plumbing 210 Final Electrical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupency Date Q��f. �$ �� (714j 754-5273 • Fa�c (714} 754-4856 •�www.ci.costa-mesa.ca.us- 77 FAIR DFIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT ,IobAddress: 384 LA PERLE LN Suite No Vicinity: Status: ISSUED Applied: 04/28/2005 Issued: 04/28/2005 Parcel Nunmber: 42531203 Applicant MATTHEWS, DOUGLAS ISSUED BY: Address: 384 LA PERLE LN - �i �� ' - - " � � � - , � -- - � ' ��- `l� - �, � Phone: 714-396-2379 �. i. ::, ` ,��'�t-_-` i, , ` �. _ COSTAMESA,�CA �,� ' ' �Zip, 92627 � '_/, � �� , , .. . � . -- - <; ,i. . � . • � � - - _, "� - _ owner , MATTHEWS, DOUGLAS ;,— ` ^` � � ;\�� ` ` �i `:;� Address' �. �384 LA PERLE CN,r%� ;i � ' '�.`-'. - ^- ' , / � '�-. _, � . . �. :i ; AA�_�� _ , _ . � Phone: 714-39G2379 , t i.-A` �ut -, ` � � � COSTA MESA, CA Zip: 92627 , ��,��, . � � �� " . � .. ' :: C" . . . , . �. � �. Contractor. OWNER-BUILDER - , ` \ . , _ �, , . Address:, . , ..�� j."' ' � �. � . . . d ,.�- , , _ . . � - - , - Phone �. _ _ . . . . , . , . ..- , . • . . . - � '. . . " ..-,.I ' . ` . .. . . . ' ZiP: _ .. l .'. , , . License:000000 ".. j � � ; , , . � �: > , � ' ,. . . . � , " ' ' _ -, \ . " . .: . . ��- ';' SCOPE OF PERMIT G^ '-:,.-K^"c�ix: t � REPAIR/REPLACE ELECTRICAL; MECH. AND PLUMBINGrREF:."8�08�:. - -' _ ,� -,-�� ,�` ELECTRICAL TO INCLUDE: 6 LIGHREIXTURES, 22 OUTLETS AND 10 SWITCHES THROUGHOUT S�F.D. ';' , � - - - �„ : .7 'r i. � . � . ,. ' - , — =FEE"SUMMARY ` , ; , � , . . Quantity � � Quantity , � , � ISSUE FEE � � � $23.50 - Temp Dist System / Lighting �._$0.00 - 0 � . � . . Temp service test $0.00 � Busway /100 ft " '� . $0.00 0 � � � � Res. a/c package $0.00 � Standing Section 50.00 0� -� , New Res (1-2 unils) , � $0.00 0 � Misc Electrical Equipment $0.00 , 0;�, � i �- ��• � New Res (3+units) " ' $0.00 0 �; �� ~ �. �� Transtormers up to 1 kva/kw $0.00 = 0: . � � Pool/Spa� � ' $0.00 0 -;, - � � ....up•toAOkva/kw $0.00,%.'�0 - � LightingFizts.�� $6.60 . 6 ." - .. -....upto50.kva/kw, ._ $O.00ii;�O •-��, j�� RBceptOutlets � ' ,$23.46,;- �''22^,R`^; . ' T �....uptol00�kVa/k�vn'ba��$0.00,� 0 �' � � Switches ; �� !$11.00. ��t0"�, :.., � ..over]OOkva/kvi�, �$0:00 /�0 Non Res Appl , ' ;� - ',� $0.00 � �0�__ = a � " ' Low VoltaBe_Equipment- _.�iii $0 00�� 0� ResAppl � ��' $0.00-- -,0:�� ' . , LowVoltWring�System�/,Ckt': $0.00�, �;0% /�' Serviceto200a . $0.00 �. 0 --, ' � Misc.Conduit�_ r� ,,'$0.00 ; , 0 ,� ,' Service to 7000a � $0.00 - � � 0., ' - - _ Misc. Conducto�'""� � � "-. ��' $0.00'. 0' � . � Service over 1000a . : $0.00 _ zi 0 -, � - � - Circus ( gen or.nde): � : 1 $0.00 /0 ;i � _. _ _ Motors to 1hp ,'$0.00 � I 0 _ . . Circus (mech,ride or lights) �'. � $0.00;;,. "0 � Motors to 10hp $0.00 �� '0� -- - � - ' CFiristmasTre'e�Stand.. l t $0:00'.' 0 Morors to SOhp � $0.00� �� ; 0 -- -- ' Fireworks Stand_;.�>>'� -'�%$0.00 0 Motors to 100hp $0.00 � --0 - _; __ ' � `Other Electrical Fee� j.�: �,�$0.00 Motorsovert00hp $0.00 �0� �`_'-�'- - - _ ------1'jC:'� • � Communication drops $0.00 0 ' �� . ,_ - ��Investigatiqri Fee� -' � $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and ralated regulations. (Ord. No. g2-28, § 1, 12-21-92) `-.,�' EXPIRATION: This permit snall automatically expire and become void if work is not commenced within 780 days, or if work is suspended.or-abandoneil for a period of 1 BO days. � � INSPECTIONS: In order foc lhe work authorized undec this permit to be considered legal, sucb work�must comply with all appwi cable codes, and all requlred Inspeetions and final approval must�be obtained..Failure to obtain inspections and final.approval will result in the expiration of this pertnit. FOR INSPECTIONS CALL: (714) 7545626�' 244&CB (8/00) WORKERS' COMPENSATION DECLARATION: — ' ' � � . ' I hereby aflirtn undar penalry of perjury one oi ihe followinq declarationsi . . .-� ' ' , . ❑ I heve and will maintain�a certificata ot consent b self-Insure for workers' compensation,�es provided for by section 3700 of tha Labor Code, fonthe pertormance of ihe work tor which this permit is iuued. ' . - . ❑ I have and will maintain workers' compensation insurance, as required by section 3700 of Ihe Labor Code, for the peAortnance ot ihe work For which Ihis pertnit is issuetl. My workers' compensation Insurence carner and policy number are: . .- Carrier. Policy Number: � � (This section neetl no( be comp/eted i! the permlt is valued af one hunaretl dollars ($700) or less.) ❑ I cenity ihat in the pertortnance of �he work for which ihis permit is iuued, I shall not employ any person in any manner so as to become subject to.ihe workers' compensatlon laws of Cali}ornia, and agree that it I should bacome subject to the workere' compensation provisions of Section 3700 of the Labor Cotle, I shall torthwith comply with lhese provision5. ' Applicant Signature: Date: WARNING: FNLURE TO SECURE WORKEPS' COMPENSATION COVEMGE IS UNL4WFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CNIL FlNES UP TOONE HUNDRED TFqUSAND OOLLAFE (5100,000), IN ADDITIpJ TO THE COST OF COMPENSATION, DAAUGES AS PROVIDED FOR IN SECTION 3lW OF THE LABOR COOE, II�REREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aflirm Ihat I am licensed under pmvisions ot Chapter 9(commencinq with Sedion 7000) ot Division 3 oi ihe Business and Professions Cotle, and my license is in full force antl eNecL Lia k Class # Contracmrs Signawre: Date: CONSTRUC710N LENDING AGENCV: � . ❑ I hereby affirtn Ihat Ihere is a construction lending agency for Ihe pedormance of ihe work for which Ihis permit is issued. (Sec. 3097, Civil Code). �� Lenders Name: LendeYs Atltlress: Signature: Date: OWNER-BUILOER DECLARATIONS: I hereby atfirtn that under penalry of perjury that I am EXEMPT FROM 7HE CONTRAC70RS IICENSE LAW for the following reason (Sec. 7031.5, Business entl Professlons Cotle: Any ciry or counry which requires a permit to consiruci, alter, improve, demolish, or repair any structure, pnor m its issuance, also requires the applicant for such permit to file a signetl statemem that he or she is Ilcensed pureuant ro the provisions of ihe Comractors License Law (Chapter 9(commencing with Sedlon 7000) ot Division 3 oi the Business antl Professions Code) or that he or she is azempt therelrom and ihe basis for Ihe alleqed exemption. Any violation of Section 7037.5 6y any applicant for a pertnit subjecis ihe applicant to a civil penalry ot not more ihan live hundretl tlollars ($500).): ❑ I, as owner of Ihe property, or my employees with weges as their sole compensatioq WILL DO TME WORK, antl iha strucWre Is not intentletl or ottered for sale (Sec. 7044, Business antl Professions Code: The Contractors License Law tices not apply to an owner of property who 6uilds or improves �hereon, antl who does such work himself or hersetl or through his or her own employees, provided that such improvements are not intentled or oNeretl for sale. H, however, ihe building or impmvament is sold within one year of completion, the owner-builder will have ihe burtlen of proving ihat he or she did not builtl or improve for purpose oi sale.). � ❑ I, as owner ot Ihe propeny, am EXCLUSIVELY CONTRACTING WI7H LICENSED CONTRACTOflS to constmct the project (Sec. 7044, Business and Professions Code: The contrectors License Law does not apply to an owner of pmpeny who builds or improves Ihereon, and who contracts for such project wii� a contracror(s) ��license pursuant to the Contractors License Laws.). D�Yafn.exempt under sea � Business antl Protessions Code tor Ihis reason: Owner ID verifiatl by tlriver� license. Yes ❑ No rDdver;s license'No. Verification ot Ownership by (type of doc me�t, i.e. - property tac Dill or daetl):�� UIVISION OF INDUSTRIAL SAFETY PLRMIT CERTIFICATION: ❑ I hereby cenity Ihat no excavation five (5) or more feet in depth into which a person is required to descend, wili be made in connection with work authorizetl by ihis permit, and that no builtling simcture, scettolding, falsework, or demolition or tlismantling thereof, will be more ihan ihirty-six (36) feet high. (Chap. 32, Gry 2, Art 2, Sec. 341, TUe 8, Calitomia Atlministrative Code). ❑ As owner-builder, I will noi employ anyone to do work which would require a permit from the Division of Industnal Safery, as noted a6ove, unless such person has e permit m do such work from the division. Signature: Date: Division ot Indusirial Safety Parmit Number: CERTIFlCATE OF COMPLIANCE AND AUTHORVATION OF ENTAV: I certify under penalry of perjury that I have read this application and state that the information given is correcL I agree to comply with all s�ate laws and ciry ordinances relating to building constmction, and authonze representatives oi ihe Gity of Costa Mesa to enter upon ihe above-describetl property for inspe tion purp ses. I agree not to occupy or allow wcupancy of any building authonzed by this permit until tinal inspection. �- : �. ..-..�...�- S__-2G�'-o� (�SignaWre'Of Legal Owner(s)�' ' - ( Date.�'� And/OrAut�onzed Applicant Date COOE 1, INSVELTIONTYPE ' ' ' 1616 �Fixed System Final Fire Prevention 1266 200 201 202 203 204 Pool Spa Final Final Re-Root � Final BIocWRetaining Wall Final Factory Fire Place Final Sign Final Demolition , , � QQQE� INSPECTIONTYPE � • � 206 � Final Mechanical � 208 Final Plumbing 210 Final Elecirical 212 Final Fire Prevention 220 Final Planning Approval 222 FinalSita 250 Final BuildincyOccupancy 1111_ / , � �' � ��-�z ��/�� J-��f�.�/iy �'�� s��'�1-, � ��► �� 1�1 sc�� . �� : S.�lon ph� � s�`�' ��5� 1 l ` � p o�e � �� o�c 1 ` � O C� ► - �°'h' x C7� � �� O%i � =��(�'�''�Z1 _ %0G' 1 � S�''' DOO �0 � �-S ( - �i na.�r� c1-...�-� � , �'1d rt� � `�c�� _ � � s�� pp�1 � � p� �N�� - � � � �� -a�,v, ��, _ � _ �� '�-� - � � c�' p� ��'1 s-�c�n•� 5, �j _ � ,� O O O� = O O S 1� 5�'? n-�-�» -a��.� �ci� �� S �,,a`'1�-�;>j �-,.�y � - � ��`Y' �� - �� t 01�1� �� b N a�. �'1-c> S� �,�-�� -��'-''1 � � �s�vv-��,s� •�''� -�`1�-a� �1 �� s�� r�,�� t - i ,, . � (714) 754-5273 • Fa�c (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 MECHANICAL PERMIT JobAddress: 384 LA PERLE LN Suite No Vicinity: Parcel Number: 42531203 „�, Applicant: MATTHEWS, DOUGLA3 Address: 384 LA PERLE LN " � � Phone: 714-396-2379 COSTA MESA, CA . _ Zip: 92627 Owner: , MATTHEWS, DOUGLAS Adtlress: 384 LA PERLE LN � COSTA"MESA, CA Contractor: OWNER-BUILDER . Address: Phone: 714396-2379 Zip: 92627 Phone: Zip: License: 000000 Status: ISSUED Applied: 04/28/2005 Issued: 04/28/2005 ISSUED BY: SCOPE OF PERMIT REPAIR/REPLACE ELECTRICAL, MECH. AND PCUMBING. REF.': B0� +rr',.t MECHANICAL TO INCLUDE: 2 HEATERS < t00K BTU ISSUE FEE Inst FAU <100�k BTU Inst FAU >100 k BTU Repair / Alt Cooling/Heat Inst / Rep. Recess Wall Htr Refrig Sys <100 k BTU Refrig Sys >100 k BTU . Gas Piping Faclory Fireplace Hood w/Mech Exhaust VAV Box Vent Fan / Single Duct � Appliance � Fire Dampers � Smoke Dampers ' - ' Inst or Relocate Appl Vent� , Air Handlers < 10000cfm AirHandlers> 10000cfm Floor Fumace Floor or Suspend Heater Quantity $23.50 $29.60 2 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00'--: 0 . $0.00 0 $0.00 0 " $0.00 .0_ ,. ,' $0.00 0� �' $0.00 0 �` $0.00 �0 - $0.00 0 $0.00 0 $0.00" 0 $0.00 0 $0.00 0 FEE SUMMARY � Repair/AltAbsorbtionUnit - Repair / Alt Refrigeration Unit Ventillation System � Evaporalive Cooler , � , Commerciallncinerator � � - . � -� Domestic Incineretor � . �. Compressors / Absorption Systems �. , �' Upto3hp/100kBTU ' " 3 To 15 hp / 500 k BTU �-. -' - " 15To30hp/1,OOOkBTU � � . 30 To 50 hp / 1,750 k BTU Over 50 hp / Over 1,750 BTU .-, Boilers � Up to 3 hp �- � � ' ' , � 3To75hp _ . � . 75to30hp - � " 30 to 50 hp ' . Over 50 hp � ' - � Other Mechanical Fee Investiga6on Fee � .Plan Check Fee Reinspection Fee Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 . $0.00 0. $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 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, § 1, 12-21-92) EXPIRA710N: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned for a period of 7 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 requiretl Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of ihis permit. FOR INSPECTIONS CALL: (714) 7545626 zaes-ae �voo� WORKERS'COMPENSAnON DECLARATON: � I hereby eHirm untlar penelry oi perjury one ot Ihe following declarations: ❑ I heve entl will mei��ein e certificete ot consent ta self-Insure for workers' compensalion, es provided for by section 3700 of the Lebor Code, far the pertormance oi the work tor which this pertnii is Issued. ❑ I have and will main�ain vrorkers' compensation insurance, as required by section 3700 of the Lebor Cotle, for tne pertormance of tne work for which this pertnit is issuetl. My worker5' comp0nsetion Insurence cerrier end pollcy number ere: Cerrier: Policy Number: (Thk sec!/on need not 69 �omp/eteC if Me permit is veNed et one hundred dollers (S I00J ar less. J ❑ I cetlify Ihat in ihe pertortnance oi the work for which this permil is issueQ I shall not employ any person in eny manner so as to Decome subject to Ihe workers' compensa�ion law4 ai Celifomie, end egree that il I shoUld become sub�ect to �he workers' crompensation prwisions of Section 3700 ot Ihe Lebor Code, I shell torthwlih comply with these provisions. ApplicaM SignaNre: Dete: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL NND SMALL SUBIECT AN EMPLOVEF TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOIXJE HUNDRED hKK15AND DOLURE (510p.0001. IN ADDITIIXJ TO THE COST OF COMPENSr1TION, DAMAGES AS PROVIDED FOP IN SECTION 31060F THE LABOR CApE. IMEREST, AND ATTORNEI"S FEES. LICENSED CONTRACT�AS DECLARA710N: I hereby aflirtn ihat I am licensed under provisions of Chapter 9(commencing with Sedlon 7000) of Division 3 oi ihe Businass end Profe55ions Code, and my license i5 in }ull force anA eftect. Lic. • Class n Contreqor's Signature: Date: CONSTAUCTON LEN�ING AGENCV: ❑ I hereby aRifm that �here is a consWaion lending agency tor the peAormance ol lhe work br which this permit is issuetl. (Sec. 3097, Civil Cotle). LenAer's Name: Sipnaiure: _ Lender's Address: Date: OWNER-BUILDER DECLARA710NS: I �ereby attirtn ihat untler penalry ot perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for Ihe following reason (SecJ031.5. Business and Protessions Cotle: Any ciry or counry which reduires e Oermit to construct, elter, improve, tlemolish, or repeir eny stmcture, prior to iis issuance, also raquires t�e applicant tOr suc� permit to lile e signed stetemen� thet he or she Is Iicensed pureuant to the provisions of Ihe Contrectors License Law (Chapter 9(commencing with Section 7000) of DlWsion 3 of Ihe BuSineu entl Pmfessions Coda) or lhe� he or she is exempt �herefrom and iha besis for the ellagetl axemption. Any violation oi Section 7031.5 by any applicant for a pertnit subjects Ihe ep0�icent to e civil penalty ol noi more Ihen five hundred dollers ($500).): ❑ I, es owner of ihe property, or my employees wlt� weges es Iheir sole compensatlon, WILL DO TNE WORK, antl the structure is not inientletl or ottered tor sale (Sec. 70aa. Business and Professions Cotla: The Contractors License Law does not apply to an owner of properry who builds or improves thereon, antl who tloes such work �imsetl or hersetl o� ihroug� his or �er own employees, providad that such improvements ere not intentletl or offeretl lor sale. If, however, ihe building or improvement is sold wit�in one year of completion, the owner-builder will have ihe Durtlen of proving lhat he or she did not build or imprrne for purpose of sale.). ❑ I, es owner ot Ihe property, am E%CLUSIVELV CONTRACTING WfTH LICENSED CONTRACTORS b cons�ruct Ihe prqect (SeG. 7044, Business and Professims CoCa: 7Te contraclors License Lew doBS not epply to en owner ot pmperty who builds or Improves thereon, antl who contracts br such prolaa with a contractor(s) license pursuani �o �he Conlreciors Licen)qW.ews.). ❑ I am ere Oer sac. T SignaWre: _ 1 � Owner ID venfietl by driveJ license. Venficalion of Ownership by (type ol Business antl Pro�essions Code for lhis reason: Ves ❑ No I.e. - property ta: bill or deed): DIVISION OF INDUSTRIN� SAFETY�PERMIT CERTIFICATION: Driver'S Litense No. Expires: ❑ I hereby certity ihat no eacavation five (5) or more feet in depih inio which a person Is required to tlescend, will be made in conneCtion with work authonzed by this pertnit, end that no building structure, sceflolaing, falsework, or demolition or tlismantling thereof, will be more than thirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title 8, Galifomia Adminisiretive Code). ❑ As owneo-builder, 1 will noi employ anyone to tlo work which would require a permit from the Division ot IndusMal Safery, as notetl a6ove, unless such person has a permit to tlo suc� work from the division. Signeture: Daia: Divi5i0n of InduSirial Saf��y Pertni� Number: CERTIFlCA7E OF CAMPUANCE AND AUINORVATON OF EMRV: I certity untler penalry of perjury that I have read this epplication entl state that the information given is wrrect. I agree to wmply with ell state laws end ciry orEinances relating to building construction, end euihorize representatives of ihe Ciry ot Casta Mesa ro enter upon t�e abova-described property lor inspection urposes. I gree not to occupy or allow occupency ot eny building authorizetl by lhis permit umil final inspection. �-� l�%!i� S�- Z�-O� ignature OI Legel Owner(s) Date AnNOr Authonzetl LOOE � INSVECTIONTYVE 1818 Fixea System Final Fire Prevention 1288 Pool Spa Finel 200 Final Re-Roof 201 Flnal Black/Retaining Well 202 203 Final factory Fire Place Finel Sign 20C Final Demolition GdIF INTRIALS Date COOE� INSPECTIONTYPE %� , , 20fi Final Mechanical ///A/� i — r 20B Final Plumbing 210 Final Eleclncal 272 Final Fire Prevention 220 Final Planning Approval 222 Final Si�e 250 FinalBuilding/Occupency �ollect inside the to a chimney flue 3ppliance. st provide other o complete your : e roof. Refer to . 12. 4./C.G.A. to be in- ved vent and type +r style terra-cotta, �e vent pipe can- ier type vent,pipe i draft, which wlll m products. Con- 3�I CO�t�O� SySt8R1 pace MUST be 'ow the free cir- . In some areas an attic shield. � ceiling�and roof finished floor on �mmended not to ate. vent pipe through 3t8. .. . late until it is com- �gage the groove -12- .... ....� �:._`. . ....�.._._ ..... r.r..�y ,.,...,.� ding it thr ti the roof. Use a 4 inch round tile wall (Type B) � -ipe, rpc: flatshing, storm coliar, �. rent top as shown. The vent cap must be at least 2 feef higher than any point that is within y0 feet horizontaliy of the vent cap. There must be at teast 1 inch ciearance between the vent pipe and any combustible material. TYPICAL VENT INSTALLA710N VEliT CAP MUST BE MINIMUM 2 FEET HIGHER 1HM1 AN`f POINT IM7111N 10 FEET OF VE]JT CAP -�.'� �� ,o t�r �C � HDdiT FROM HEADFR \ PUTE TO VE7JT CAP TOP. r' MUST BE 8 FEET IAINIMUTA 1 INCH MM. d.EARANCE TO CdABUSTiBlES » 11STFF� 4' RWND B�VENT • OYAL TO ROUND ADAPTER • OVAL B/W VETJT (DOU81E WAl1.) • PLATE SAACER- (RECESSED FAOUNI� 2 REG'D . e� au� (Hot�-�oww) oR �� STARTER PU17E SCREWE� DOWN TO HEADER PU7E � No1E ` He,�w� Pu� �w� cnsxErs �� own� w�ni Fuw+�cE TAKE CARE NOT TO DISTURB e GASKET GWm TO UNDERSIDE ° OF HEADFR GASKET MAIERIAL MUST NOT �.OdC Fl1JE EXTENSION ' GONTAINED IN OVAL BMI (STARTER) VENT KIT � ��R NO. 9901 �� " NC1i PROVIDED WITH KITS � AVAILABLE N� 50,000 BTUH FURNACE BELOW AND HEADER NOT SHOWN. Nf7TE: FLUE COLLAR GASKET, NOT REQUIRED ON' NIODECS 5009611; 5009612. 5008621 8� 5009622 �-1-e ' �e/�/�- G2 M USTE� �Z� / /� g ° �NL' � �ouF CAP • STOR�! �S l �lf��etit� » r� ��/9��-2°1.�3. (714) 754-5273 • Fax (714) 754-4856 • 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, DOUGLAS Address: 384 LA PERLE 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 L D E R Address: ISSUE FEE BackFlow irrigation BackFlow Preventer Bathtub Clarifer System Connect Qce,Soda,etc) Dental Units Dishwasher � Drain, Floor Drain, Rainwater Drain, Roof Drinking Fountain Expansion Tank Gas Earthquake Valve Gas (1-0 outlets) Gas (Over 4 outlels) Gas Repipe Gas Service PLUMBING PERMIT Status: ISSUED Applied: 04/28/2005 Issued: 04/28/2005 ISSUED BY: Phone: 714396-2379 Zip: 92627 Phone: 714-396-2379 Zip: ,92627 Phone: Zip: License: 000000 . . . ' - , _� f: . . . SCOPE OF PERMIT REPAIR/REPLACE ELECTRICAL, MECH. AND PLUMBING. REFi'805F0�060,8'6.^--�� PLUMBING TO INCLUDE:.2.BATHTUBS, INSTALL 1'DISHWASHER, 1 GAS (1--4 OUTLETS), t ,� � KITCHEN SINK, 1 WATER CLOSET AND 2 WASH BASIN$. � - � , - AMT $23.50 $0.00 $0.00 $19.60 $0.00 $0.00 $0.00 $9.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $6.15 $0.00 $0.00 $0.00 QTY FEE SUMMARY �AMT �TY � ' AMT Laundry Tub / Washer_ - - $0.00 0 � Sump Pump` . .. $0.00 Landscape Irrigation ' " ..$0.00 0 Swimming�Pool � . $0.00 P-Trap_ -�� $0.00,.;,.0 Trap Primer $0.00 PressureRegulator � $0.00 �70 . Urinal�;". . $0.00 � " • - � �� Process Piping (per 10 k) $0.00 � � 0 ^--. � - '��.'Vacuum Brkr BkFlow(1-4) � � $0.00 - Receptors - $0.00 0 � Vacuum Brkr BkBow(5+) $0.00 � Septic Tank �$0.00 0 Wash Basin $19.60 .� Sewer Cap for Demo $0.00 0 Wash Basin Set �. $0.00 =� Sewer Connect $0.00 0 �� Waste and Vent System $0.00 , Sewer Private Line � : $0:00�� "0 � , Water Closet (Toilet) $19.60 . - Shower - $0.00 0 -. Water Heater / vent $0.00 -- Sink, bar $0.00 . 0, �. Water Piping (Inst or Rep.) $0.00 Sink, commercial � $0.00 .0 � � Water Re-pipe $0.00 , �- Sink, Floor $0.00 0 � -Water Service $0.00 Sink, kitchen � $9.80 1 , Water Softener $0.00 � Sink, service/mop $0.00 - 0 ' � OTHER $0.00 Spa (private) . � $0.00 0 VIOLATION $0.00 Spa (public) $0.00 0 PLAN CHECK $0.00 QTY 0 0 0 0 0 0 2 0 0 2 0 0 0 0 0 NOTICE: The work authonzed 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 780 days, or if work is suspended or abandoned for a period of 180 days. �rc£"" ?- INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable�code�d all required inspectlons and finel approval must be obtained. Failure to obtain inspections and final approval will result in the expiratioryafhis permit. I FOR INSPECTIONS CALL: (714) 7545626 26a6d6(N00) WORKERS'COMPENSATON DECLARATON: I hereby eHirm under penelty oi perjury one oi the following declaretlons: ❑ I heve end will meintein e certificete ot consent to self�lnsure lar workers' compensation, es prwidetl for hy seclion 3700 of the Lebor Code, for the pertortna�ce ot the work for which Ihis pertnil is issued. ❑ I have en0 witl mSi��ain woAcers' wmpensalion insurence, as reqWretl by section 3700 of the Lebor Code, for Ne peAortnance of the work for which this pertnit is issued. My waBers' compensetlon Insurence cerder end pollcy number ere: Certier. Policy Number: (Th/5 sectlon need not be mmp/eted il the permif is valuetl al one hundred dollers (S I00) or less.) ❑ I certify thal in the pertormance of the work for which this pertnit is issue0, I shell not employ eny person in eny manner so as b become su6ject to the worknre' crompensetion laws ot Celitomie, end egree thel II I shoultl become sub�ect lo the workers' compensetion provisions of Saction 3700 of the Lebor Code, I shell forthwith comply with Ihese provisions. Applicant Signeture: Date: WARNING: FAILURE TO SECUFE WORKERS' OOMPENSATION COVEPApE IS UNLAWFUL AND SHALL SUBJECTlW EMPLOYER TO CRIMINAL PENALTIES AND CNIL FlNES UP TOONE HUNDRED T1iIX15M1D OOl1ARE (5100.0001. IN ADDI?ION TO THE COST OF COMPENSATIIXJ, DFMFOES AS PROVIDED FOR IN SECTION 3)O6 OF THE 1A80R CODE, IMEFEST, AND ATTORNEI^S FEES. LICENSED CONTRAGTORS DECLARATION: I hereby aHirm that I am licensetl under provisions of Chapter 9(commencing with Section 7000) ol Division 3 of the Business and Professions Code, and my license is in full torce entl eRect. Lic. � Class a Conirador s Signanre: Oete: CONSTAUCTON LENDING AGENCV: ❑ I hereby attirm that ihere i9 a consiruclion lending eBency for �he pedormanca of ihe work for which �his permit is is5ued. (Sec. 3097, Civil COde). Lentler's Name: Lender's AAtlress: ' Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby ettirm the� under penelry oi parjury Ihet I am E%EMPT FROM TME CON7RACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Business and Professions Code: Any ciry or counry whic� requires e permit to consWct alter, improve, damolish, or repair eny strucWre, prior ro its issuance, also requires the applicant for such pertnit to lile a signetl statem�nt thet he or she is Ilcensad pursuant to Ihe proWsions ot Ihe Contrectore License Law (Ghapte� 9(wmmencing with Seuion 7000) d Divtsion 3 ot the Business enC Protessions Cotla) or thet he or she is exempt Iherefrom end Ihe basis for the alleged exemption. Any violetion of Section 7031.5 by any aOP�icant for a pertnit subjects the ep0licant to e civil penelry ot not more then Ilve hundred dollars ($500).): ❑ I, es owner ol Ihe Property, or my employees with wages as their sole compensetion, WILL DO THE WORK, and the structure is not intentlatl or oNeretl for sale (Sec. 7044, Business and Professions Cotle: The ContraCtore LicanSe Lew does not apply to an owner o( property who builtls of improves thereon, antl who does such work himself or hersell or Ihrough his or her own employees, provitle0 that such improvements ere not inten0etl or oftered tor sale. If, however, the buildinq or improvement is sold within one yBer ot completion, �ha owner-builder will have �he burtlen ol proving ihat he or She did not build or improve tor purpose of sale.). ❑ I, es owner ot �he P�operry, em E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to consiruct ihe Orolect (Sec. 70d4, Business and Professions Coda: The contraciors License Lew does no� epply �o an owner af propetly who Dullds or improves thereon, antl w�o contracis for such pmject wIN a wniraaor(s) �license pursuan� to ihe Contreciors Licepse Laws�. — I Bm Bxempi untle� Sea ✓ Business and Prolessions Cotle tor ihis reason: Owner ID venfied by dri�er'�5.i(CBnSe. Yes ❑ No Driver's License No. _� ( �� Expires: L Veritication oi Ownersnip by (rype ol dw e, i.e. - properry tan bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I �ereby cenify Ihat no excavation five (5) or mora feet in depth into which a Derson is requiretl to descend, will be made in conneciion with work authorized by this pertnit, antl ihat no builtling structure, sceHolding, lalsework, or demWition or dismaniling ihereot will be more than thirry-s�x (36) teei high. (Chap. 3.2, Grp 2. An 2, Sec. 341, Ttle B, Califomia Atlministrative Cade). � As owner�builder. I will not employ enyone to do work which would require e permit irom the Division ol Indusinal SafeN• as noted above, unless such person has a permit �o tlo 5uch wOrk tmm t�e tlivi5ion. Signawre: Date: Drrision o1 Industrial SAfery Pertnit Number. MAZARDOUS MATERIALS AND EMISSIONS CERTIFILATION: 1 Will the applicant or present or fuNre building occupant neetl to tile antl certiry a Business Plan for emergency response to release or threatenetl release oi a hazertlous me�erial? ❑ YeS ❑ No (Saction 25505 ot 1he California Heal�h antl Safety CoOe requires, with some exceplions, thef e Business Plan be filetl with the Costa Mesa Fire Department by every business which has at eny one time dunng a reportetl year a quaniiry of hazardous matenals equal to or greater than a weight of 500 pountls, or a volume of 55 gallons. or 200 cubic feet di wmpressed gas ai standard temperaNre and pressure). "__...._........._............�-- ................"_______..........................._................._.................................................................................................................................................... ............................... 2 Does or will Ihe pliwnt or resent or future builtlin occupant neea to tile a re istration torm for acutel hazartlous metenals? �� ap P 9 g y ❑ Ves ❑ No (Sedion 25533 oi lhe Calilornia Healih and Safery Code, with some exceptions, requires registretlon with Ihe Costa Mesa Fire Department by eac� business which at any one time hes on hantl a quentiry ot acutely hazardous materiels equel Io or greeter then a weight ol 500 pounds, or e volume ol 55 gallons, or 200 cubic feet of compresse� gas a� standard temperature end pressure). ._._......_........_ ..................................................................................................................................... ...................................................... 3 Does or will the app�icani or present or tuture building occupant need to prepare an RMPP (Risk Managemenl a ❑ Ves ❑ No (Section 25534 of Me Calibmia Healih anG Safety Gode provitles thal the Costa Mesa Fire Depenment may i Department of en f1MPP by businesses which are requlred b register acutely hazerdous matedels wilh ihe Fire ......................................................................................................................................................................................................................................................... 4 If en RMPP is pre5enily requireQ has Section 25534 ot t�e Calibmie Heelih antl Safery Coae Ceen fully complii _............_ .................._...........,......_.................__.....................__................_...........................__...__._.........._............_._........................................ 5 Does or will Ihe epP��^� or present or tuWre �uilCinB �upam requlre tor the work whic� is the subjecl ol Ihi� trom Ihe South Coast Air Ouality Menagement DisitlC� or trom eny o�he� eir pollu�lon contrU tllsiric� o� e9enty9 (Section 650502 a� the Celifomia Govemment Code requires that the requestetl infortnation be fumishetl on ap ......................................................................................................................................................................................................................................................... acutety hazardous the preparation, cenifiwtion antl filing with the Fire Iment. ................................... .................................................................... 7 ❑ Ves ❑ No ...._._ ......................................_......................_._........._.........__._...... :etion a ermit for suc� consVuction or mOtlification is � No �ns tor non-resitlential builtling permits�. 8 Will any Oart ot the faciliry to be consimcted under tNs permrt be wltNn 10001eet fmm the outer boundarles ol e scnoor (II yes", Ihe facility must meet the requirement of Seciions 25534 and 42303 ot the Califomia Heal�h and Safety Coda). ......_ ..................................................................._................___..................._ .......................................................................................... 7 It e parmit irom tPe South Coast Air Ouality Manegement Disiria or other elr polWtion comrol district or agency is aoolication. have all ot Iha discloswes orescnbe0 DY Celltomia Healih and Safe�y Cotle Sectlon 42303 been matle9 C is the subiec� of this 0 Qt yes", ettach ceN�i��e m wmpaance �rom tne appro0�iaie air poiwuon comroi orticer�. CERTIFICATE OF COMPLIANCE: I cenity Ihat undar penalty of perjury ihe intormation given above is correcl. I agrae to comply with all state laws and ciry ortlinances regarding Haeartlous Materials and Emissions. SignaW re: Da�e: CERTIFlCATE OF COMPLIANCE AND AUTHORIZA710N OF ENTAY: I cenify untler penalty ot perjury that I �eve read ihis epplication entl s�ate Ihat t�e information given is wrred. I agree to wmp�y with all state laws and ciry ordinances releting to huilding consiruction, entl authorize representatives of t�e Clty of Costa Mesa to eNer upon t�e above-described propehy lor inspectio�nj urposes. I a ree �ot ro occupy or allow occupency ol any building eu�horized by this pe�mit until final inspec�ion. ��c ��(Q'�— �— Z�'jj —GS SignaWre OI Legal Owner�s) Date AfWlOr Authorized Applicant GOOE I. INSFEttIONTYY5 7878 Fized System Final Fire Prevention 1266 Pool Spe Fina� 200 Final Re�Rool 201 202 203 Final Blak/Retaining Wall Final Factory Fire Place Final Sign 20G Final Demoli60� PdIE IH1IIJaL@ COOE I INSYELTION TYPE 20fi Final Mechanical 20B Final Plumbing 210 Final Eleclrical 212 Final Flre Preven�ion 220 Final Planning Approval 222 Final Si�e 250 FinalBuiltling/Occupancy (714) 754-5273 • Feu (714) 754-4856 • www.d.costa-mesa. BUILDING PERMIT �� FAIP DRIVE, COSTA MESA, CA 92626 Job Address: 384 LA PERLE LN Suite: Vicinity: REAR OF HOUSE Primary Occ: R-3 Dwellings/ Cong Res <10 Type of ConsWction: V-N Parcel Number: 42531203 . Zoning: npplicant: MATTHEWS, DOUGLAS Address: 384 LA PERLE LN Status: ISSUED Applied: 04/15/2005 Issued: 04/15/2005 ISSUED BY: �I� �� Phone r�.714-396-2379 s . ,. COSTA MESA, CA �<., ��. �"'�" Zlp. 92627 Owner. MATTHEWS, DOUGLAS � � � "�-R � �`�s� •�A.'' 1 '.�Y2 Address 384 LA PERLE'LN e,.r� - '� '�." � 'S� Phone �714'396-2379 �'"%;,� .�ti-, COSTA MESA;,CA a• � " �'� r.iZip � " 92627�° �` ,.�, . �' 3 ".� r r3 ....m.,',�n � � �� c'� `r ; � ' ? " : �, ,��•::. �`� y VER-BUILDER , " "; "'' . ,�,. }. '�, .�,' � �e 2," W Y, � "' Phone: ,.�� '� �•:,.� >° e �a� � � ' License: 000000 �" ^ . : 9a" -�? •{a tg e.i � "F Eng: v ' � ��°�� u�" _ Address: -. 3 " x» � � Phone <,,.r.o A��,,;: � Phone � - _- .- �.� , = .�,. '�` `�_ 3 � � z" `�� ,'?� e� �'. . .- . . . . ; �...... =„�rn«r.,.:... .�a�.vrc vr..:rcnm�.� � .. : EVISION TO PERMIT07/25/O5, REPLACE AN'ADDITIONAL 4 WINDOWS AND 2 DOORS; DRY1h -:�; �'� :. u . .' v � ' .i`.,', .A�., ' � n✓"' � , ,_ e ' P EPLACE 4 WINDON/S & 2 DOORS REPLACE'PORTION OF��DRYWALL;�AND�REMOVE WATER ND,REPLACE WITH:PLASTER y. ., �--: .�_ �'+��.p� ,,. _ �-�„,... _ _ , <�� : . n _ ��,k �' id.=;�� , _ �- Plan. Check � � $0 00 � �Permit ;_ �.$18125, ��a� SMIP Res ' ;, �$1 00 �;„' `. SMIP Com �,:- $0^00 � M} "�� Other $0 00 Inspection ,�.,�0 00 �> ,� �a�` ��'� Total• , � $182.25 � > , xa. '��:: .;S '� *�. � ``�''�� PLANNING&ZONING �� SETBACKS �- � �� '� � �� '_ F ��s MAINSTRUCTURE Front 0 0�� `� Rear 0 0-�� ,y�a,� Left +� 0.0, _� Right j0 0?�' .,. ... -.: a � , � € �W., y� , .,�s,... Q 0 �� . �Left 0- 0� Right �� 0- 0 ,, rcc av�mnr�n � .. ..... ..iE - Cii CI � �33�� s '� ;: � µ 3 �l ACCESSORY PARKING Front 0- 0 Existin�: 0 F EXIS .a , .«v �, a � � ': �� $10.000.00 n � . s�o,000.00 `' � . �: "i � � (. : NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis undei California statutes and related regulations. (Ord. No. 92-28, § 1, 12-27-92) � EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned tor a period of 7 80 days. INSPECTIONS: In order for the work authorized undar this permit to be considered legal, such work must comply with all applicable codes, and all requlred inspections and finel epprovel must be obtained. Failure to obtain inspeclions and final approval will result in the expiration of thia permit. �� FOR INSPECTIONS CALL: (714) 7545826 zaas-se �siao� WORKERS'COMPENSAnON DECLARAnON: � I hereby atfirtn unGer penalry oi perjury one ol the lollowing declarations: ❑ I heve end will maintaln e cartlflcete oi consent to selt-Insure br workers' compensalion, as provided tor by sectlon 3700 0l ihe Labor Code, tor the pertormance of the work for whlc� this pertnil i5 is5ued. ❑ I have end will maintain workers' compensatlon insurance, es required by section 3700 of the Labor Cotle, for the peAortnance of the work tor which this permit is issuetl. My workere' compensatlon Insurence cerrier entl policy number are: Cartler: Polity Number: (ihls section nee0 not be comple(ed ll the permif is ve/ued et one huntlred tlollars ($t00) or /ess.) ❑ I certity ihat in the pertortnance of the work for w�ich tNs pertnit is issued, I shall not employ any person in eny manner so es to becoma subject to Ihe workers' wmpensation laws of Celifomle, entl egree thet il I should become sub�act to the workers' compensation provislons of Sectlon 3700 of ihe Lebor Cotle, I shall forthwflh comply with these provisions. Applicant Slgneture: Dete: WARNM�: FAILURE TO SECURE WORKERS' COMPENSATION COVEMGE IS UMAWFUL AND SHALL SUfiIECT AN EMPIOVER TO CRIMIWLL PENALTIES AND CNIL FlNES UP TOONE HUNDRED TYIOUSAND DOLURE (5100,000). IN ADDITIdJ TO THE COST OF COMPENSATION, OAMAGES AS PROVIDED FOR IN SECTION 3IO60F THE LABOR CODE. INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRAC70RS DECLARATION: I hereby aXirtn Ihat I em licensed under provisions of Chaptar 9(commencing with Sectlon 7000) of Division 3 of the Business and Proteuions Code, antl my license is in full force and ettect. Lic. # Cless N Contrectors Slgnature: Dete: CONSTRUCTION LENDING AGENCY: ❑ I �ereDy aHirtn that there is a wnsWction lentling agency tor che pertormance ot the work for which Ihis permit is issued. (Sec. 3097, Civil Cotle). Lentler's Name: Lendefs Address: Signeture: Date: OWNER-BUILDER DECLARA710NS: I hereDy aNirm that under penalry ot perjury lhat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for ihe tollowing reason (Sec. 7031.5, Business entl Protessions Code: Any ciry or counry whic� requires a pertnit to consirucL alter, improve, demolish, or repair eny structure, pnor to its issuance, also requires the applicant for such pertnit to flle e signed statement that he or she is Iicensed purwant to the pmvisions of ihe Contractors license Law (Chepter 9(commendng with Sectlon 7000) oi DlWsion 3 of Ihe Buslneu end Professions Gode) or iha� he or she Is ezempt therefrom and Ihe basis tor the ellegetl exemption. My violetion ai Section 7031.5 by any epplicant for a pertnit pppsu��b��.)ects the epplicant to a civil penalry of not more Ihan five hundred dollars ($500).): I�y� as owner ot Ihe proDerty, or my employees with wages as thelr sole compensation, WILL DO TME WORK, and ihe structure is not Iniended or oHered tor sale (Sec. / � 7044, Busineu antl Profeuions Code: Tha Contractors License Law does not apON �o an owner of property who builds or improves Ihereon, end who does such work himself or hersetl or through his or her own employees, provided that such improvemems are not Intentletl or oNered For sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will heve ihe burtlen of provinq ihat he or she did not 6uild or improve for purpose of saleJ. • ❑ I, as owner ot ihe property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct tha prolect (Sec. 7044, Business anA Prolessions Code: 7Tie comractors License Law tloes not eppry to an owner oi propany who builtls or Improves thereon, end who contrects for such project with a conlractor(s) license pursuant to the Contrectors License Lews.). ❑ I am ex�ot untler sec. ID vedfied by tlrfver's license. ❑ Yes ❑ No Business and Protessions Code for this reason: Vedlication of Owners�ip by (type of documenL i.e. - Droperry taz hill DIVISION OF INDUSTRIAL SAFETV PERMR CERTIFICATON: �E:pires;�— �^---�-.."RcF' ❑ I hereby cartity thet no excavatlon five (5) or more teet in depih into which e person is required to descend, will be matle in connection with work authorized by ihis permit, and Ihat no huilding siructure, scaHolding, falsework, or demolition or dismantling ihereof, will be more than thirty-six (36) leet high. (Chap. 32, Gry 2, Ar12, Sec. 341, 71t1e e, Califomia AdminisireWe Catle). ❑ As owner-builder, I will not employ anyone to tlo work which would require a pertnit from the Division of Industnal Safery, es notetl above, unleu such person hes e pertnii to do such work trom the division. SignaWre: Date: Dhrision ot Indusirial Safery Permit Number: CERTIFlCATE OF COMPLIANCE AND AUTFiORIZATION OF ENTRY: I certify under penalry oi peryury that I have read ihis application antl state that the intormatlon given is correct. I agree to compty wlth ell steta laws entl ciry ordinances relating to bullding construction, and euthonze representatives oi the Ciry of Coste Mesa to enier upon the ebove- escribed property for ins ection rposes. I agree not to occupy or allow occupancy of any building authonzed by this permit until fnal inspection. � �- Z= C'l� Signature Of egal Owner(s) Date COOE I, INSPECTIONTYPE PdIE IMITIpL3 1fi1fi Fixed System Final Fire Prevention 1288 200 201 202 203 204 Pool Spa Finel Final Re-Roof Final Block/Retaining Wall Final Factory Fire Place Final Sign Final Demolition CODE 1 INSPEGTION TYPE 206 Final Mechanical 208 Finel Plumbing 210 Final Electrical 212 Final Fira Pravention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupency GlIE 1t�ELS < � � : s (7/4) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DFIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 384 LA PERLE LN Suite: Viciniry: REAR OF HOUSE Primary Occ: R3 Dwellings/ Cong Res <10 Type of Construction: V-N Parcel Number: 42531203 Zoning: Applicant: MATiHEWS, DOUGLAS Address: 384 LA PERLE LN , COSTA MESA, CA - Owner: MATTHEWS, DOUGLAS Address , 384 CA,PERLE LN � � bOSTA MESA, Cd - _ � _ Contractor: OWNER-BUILDER Address: Phone: 714-396-2379 Zip: 92627 ' Phone: 714-396-2379� �� Zip: 92627 . . • Phone: Status: ISSUED Applied: 04/15/2005 Issued: 04/15/2005 ISSUED BV: '1:� 1 '�'� v Zip: - License: 000000 . Arch : • - �� Eng: � � � Address: ' ' � ' ' � Address: Phone: � Phone: Zip: - License: , License: _ _ _ SCOPE OF FERMIT.. REPLACE 4 WINDOWS & 2 DOORS, REPLACE PORTION OF DRYWALL, AND REMOVE WATER DAMAGED PORTION OF EXISTING SIDING AND REPLACE WITH PLASTER. � - - � FEE SUMMARY Plan Check: $0.00 . -- - Calc Valuation: Se,000.00 Rermit: $111.25 Claim Valuation: , Ss,000.00 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: . $0.00 - Total: $11175 ' � �. .. � SETBACKS MAINSTRUCTURE Front 0-0 � , Rear 0-0 ACCESSORY Front 0-0 .- Rear 0-0 PARKING Existin : �0 � . Required: 0 PLANNING & ZONING Left 0- 0 . LeR 0- 0' Proposed: .0� ' Right 0-0 " � ' Right - � 0- 0 NO710E: The work authorized by ihis permit shall comply with all applicable handicap access requirements under Calitornia 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 780 days. INSPECTIONS: In order for the work authorized under this pe�mit to be considered legal, such work must comply with all applicable codes, and all required inspeetlons 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) 7545626 'dd6d6(&00) WORKERS' COMPENSATION DECLARATION: I hereby eHirtn under penelty ol per�ury one oi the lollowing declarelion5: ❑ I heve end will meintein e certiticete oi wnsent m sell-Insure far workers' compensetion, es prwidetl for by section 3700 of Ihe Labor Code, for the pedortnence of Ihe work tor whi[h Ihis permit �5 i55ued. ❑ I have arb will maintein workers canpensetlon insursnce, es 2quired by section 3700 ol the LaDor Code, for the pertormanw of ihe work for which this pertnit is issued. My workers' compensetion Insurence cartier end policy number ere: Carrier: Polity Number: (Tbls�Sectlon need nof be completetl il the pertni! is velued et one hundred dollers ($100) or less J that in ihe pen �sation laws of WARNINGf' FJAILURE TO TT1IX15/ ND DOLL4RE (! ot ihe work for which this pertnit is issued, I shell not employ eny person in any manner so as Io becnme subl� �o Ihe workers' i, end egree t�e� II I should herome 5ublect lo the workers' compansation pmvisions of Section 3700 of the Lebor Co�e, 1 shell torthwlth �S' � �--�—�'/ f / �T RS' P SATION GWVERAOE IS UNLAWFUL AND SHALL SUBJECT AN EM%]OYER TO CiiIMINAL PENALTIES AND CIVIL FlNES UP TOONE HUNDRED l TOTHECOSTOFCOMPENSATION,DFMFOESASPROVIDEOFORINSECTION3lO60FTHElABORCODE.INfEFEST,ANDATTORNEI^SFEES. LICENSED CONTRAC70R5 DECLARA710N: I hereby aHirtn Ihat I am licensed under provisions ol Chapler 9(commencing with Seclion 7000) of Division 3 of the Business and Professions Code, and my license is in full forCe end ettecL Lit. k Class M Contractor's Signature: Dete: CONSTRUCTON LENDING AGENCV: ❑ I hereby aHirtn �hat �here i5 a ConsWclion lending agancy br ihe pedormance of �he work tor which �his permi� i5 i5suetl. (Set. 3097, Civil COtle). Lentler s Name: Lender's Address: SigneWre�. Date�. OWNER-BUILDER DECLARA710N5: I hereby aHirtn Ihat under penalry ol perjury that I em EXEMPT FROM THE CONTRACTORS LICENSE LAW lor the following reason (Sec. 7031.5, Business antl Professlons Cotle: Any ciry or county which lequires e permit to consiruct, alter, improve, demolish, or repeir eny simcture, prior to its issuance, also requires Ihe applicanf for suc� pertnit b file e signed 51e�ement ihel hd or 5he is Iicensed pursuan� to Ihe provlslons o� �he Coniractors Ucense Law (Chapier 9(wmmencing with Sec�ion 700p) ot DlWsion 3 of the Business anA Professions Cotle) or t�et ha or she Is ezempt therelrom end tha �esis tor che elleged e:emptioa Any dolation of Section 7031.5 by any applicant for a permit �su Is the epplicent to a civil penalty oi not more then five hundred dollers ($500).): 'aa�9�+ner ol t�e property. or my employees with weges as lheir sole compensation, WILL DO THE WORK, antl ihe structure is not intended or ottered for sale (Sec. ^^-7066. Business entl PmteSsions CoCe: The Contraciors License Lew does not apply to an owner of pwperty w�o builds or improves thereon, and who dces such work himseli or �erseN or through his or �er own employees, provi0ed ihat such improvements era not Intended or offered for sale. Ii, however, ihe builtling or improvement is SOIE wit�in one year ol wmpletion, t�e ownerbuiltler will �eve the 6urden ot pmving that ha or she did not build or impmve for purpo5e of sale.�. ❑ I, es owner ot Ihe property. am E%CIUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct ihe Orqect (Sec. 7044, Business antl Protessions Cotle: The contrectors Licdnse Lew does not epply to en owner o/ pmperty who bullds or Improves thereon, and who contracis for such Drol�i v+iN a contrector(s) licen5e DurSuent �o �he Co��rattors License Lews.). ❑ I em eremot unEer 58t. Business antl Professions Code lor ihis reason: awnaflD ventietl by tlriders license. ��yY�'� ❑ No Dri�%ec:s.license�No� %�� Expires: Veriticetion of Ownerehip by (type ot tlwument, i.e. - property tax bill or deed): f .A'-Ta,� DIVISION OF INDUSTRIAL SAfETY PERMIT CERTIFICATION: ❑ I hereby certity ihat no ezce�ation five (5) or more fee� in dep�h into which a person is required to descend, will be made in connection with work authonze0 Dy [his pertnit, and tha� no building sWcture, scaflolding, talsework, or demolition or tlismantling thereof, will be more ihan thirty-six (36) feet high. (Chap. 32. Grp 2, Art 2, Sec. 341, Title 8, Califomia Atlrri��istrative CoAe). ❑ As owner�Duiltler, I will nat employ enyone to do work which would require a pertnit from the Division ot IndusMal Safery, as noted above, unless such person has a pertnit to do such work fmin lhe division. Signature: Data: Division oi Intlustnal Safery Perm�� Number: CERTIFlCATE OF COMPIJANCE �1U AUTHORVA710N OF ENTAV: I cenity under penalty ot perjury tha� I have reatl �his application antl state Ihat t�e inbrmation given is correa. I agree to comply wi�h e�l siate laws entl city ordinances releting Io building consimclion, and aul�orize represematives of ihe Ciry ol Costa Mesa to anter upon l�e a mpeny tor i sp ion urposes. 1 gree not to occupy or ellow occupancy ol any building au�horized by ihls permit until tinal inspection. !f�/s�ds � nat—ure Of- , pel OwneRs)�_ . Date_� Authorizetl Applicant COUE t. IMSVECTIONTYVE 1618 Fixed System Final Pir6 Prevention 1268 Paol Spe Final 200 Final Re-Rool 201 Flnel BIocWReiaining Well 202 Final Fectory Fire PIac9 203 Final Slgn 204 Final Demolition QyF �yjp7�,$ �Qp�! INSPECiIONTYPE 206 Finel M8 anical 20 al PI hing I clrical 212 Finel Fire Prevention 220 222 250 Final Planning Approval Final Si�e Finel Building/Occupency DATE INTRII�L9 , City of �sta Mesa Planning Department. Oct 15, 2004 Re; 384 La Perle Lane Plan check no. B04-00800 1048 Irvine Ave #191 Newport Beac6, Cn. Mr. Burt Morgan; 92660.4602 I hand wrote a note to you, and delivered it at my last submittal on � 10/13/04 regarding a request for an extension. My records indicate that the plans are nearing 6 months, and I need to request an extension. We submitted for the first time on _Apri126, 2004, Octo- ° ` ber 26th mazks the 6 month period. 1� � We are only trying to finalize the landscape plans, and it is my understanding that the building department has approved the plans. Thank you for your efforts. Please ca11 if you have any additional questions. 714�396 2379 craigin677285" @sbcgiobal.net Line-arts.com • I �f►�� tAe�i»� I � G'� -D! - 008�D -Oo�S �.. � 26 2 � �-/�-aS .��--� � (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.��LDING PERMIT �� FAIR DFIVE, COSTA MESA, CA 92626 / Job Address: 384 LA PERLE LN '.I I ```��/ i � Status: ISSUED suite: �Al �I �� Applied: 04/26/2004 Vicinity: Issued: 11/17/2004 Primary Occ: R3 Dwellinqs/ Cong Res <�0 Type of Construction: V-N Parcel Number: 42531203 Zoning: Applicant: CRAIG MCINTOSH Address: 10481RVINE AV SUITE 191 NEWPORT BEACH, CA owner: MATTHEWS, DOUGLAS Address 384 LA PERLE LN COSTA MESA, CA Contractor: OW N E R-BU ILD ER Address: Phone: 714-396-2379 � Zip: 92660 � Fhone: 714-396-2379 Zip: 92627 � Phone: ISSUED BY: Zip: � . 'License: 000000 � . - nrch : CRAIG MC INTOSH -_ eng: Address: 213 VACLEY VIEW TER. � "� � Address: Phone: 714-396-2379 - Phone: MISSION VIEJO; CA - � � Zip: 92692 License: C24591 � License: � SCOPE OF PERMIT DEMOLISH ONE UNIT OF EXISTING DUPCEX; CONSTRUCT NEW 2628_S.F. (1266�SF�1ST STORY AND 1341 SF 2ND STORY) WITH A 485 SF ATTACHED GARAGE. ALSO INCLUDES 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: $1,242.90 Permit: $1,912.15 SMIP Res: $26.37 SMIP Com: $0.00 Other. $0.00 Inspection: $0.00 Total: $3,181.42 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0- 0 Rear 0- 0 Rear 0- 0 FEE SUMMARY PLANNING & ZONIIVG Left 0- 0 Le(t 0- 0 Calc Valuation: Claim Valuation: Right Righ� $263,681.26 So.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 it work is suspended oi 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 requlred inspectlons and final approvel must be obtained. Failure [o ob�ain inspections and final approval will result in the expiration ot this permit. FOR INSPECTIONS CALL: (714) 754-5626 244fi-O6(N00) WORKERS'COMPENSAnON DECLARATON: � I hereby eHirm under penelry oi perjury one of 1he tollawing declarations: � � ❑ I heve end will maintain a certifcate ot mn5ent l0 5ell-Insure br workars' compensatloq es pmvided lor by section 3700 of the Labor Code, for the pertormance of ihe work tor which �hi5 Derrti�� is iSsueA. ❑ I have en� wIA maintain woAcere' compensation insurance, es required by seclion 3700 oi the Labor Code, fo� the pedormance ot the work for which this permit is issued. My workers' tompense�ion Insurence certler entl policy number ere: Cartier. Policy Numbec (Thls secNon need no( be comp�efed i! the permit is velued af one hundred dollars ($100) or IessJ ❑ I certify that in the peAO�ance of Ihe work lor which this permit is issued, 1 shall not employ any person in any manner so as to Decome subject ro fhe workars' compensation laws of Gelifomia, end eqree that if I shoultl become sub�ect to the workers' compensetion pmvisions of Section 3700 ot the LaEor Code, I shell torthwith comply with these provisions. . , , Appliwnt Signature: � Dete: WARNING�. FAILURE TO SEd1FE H'�KERS' OOMPENSATION COVERAOE IS UNLAWFUL AND SHALL SUBJECT AN EMGLOVER TO CRIMINAL PENALTIES AND CNIL FlNES UP TOONE HUNDRED Ti0U5/.ND OOIURE (5100.000�, IN ADDIiION TO THE COST OF COMPENSATION, ONMApES NS PROVIDED FOR IN SECTION 3106 OF THE L40pR CODE, IMEREST, rWD ATTORNEV'S FEES. LICENSED CONTRACTOR$ DECLARATION: I hereby aRirm ihat I am licensed under provislons oi Chap�er 9(commencing wilh Seclion 7000) ol Division 3 of ihe Business and Professions Cotle, and my license is in full torce an� ettect. lic. x Contrecior's Signature: Glass u Oete: _ CONSTAUCTON LENDING AGENCV: ❑ I hereby aftirtn that there i5 a conslruciion lending agency br ihe pedormance of �he work tor w�ich �his permit i5 issued. (SeC. 3097, Civil Cotle). Lentler's Name: Lender's Atltlress: Signature: Date: OWNER•BUILDER DECLAqAT10NS: I hereby ettirm thet under penelry ol Derjury that I am EXEMPT FROM 7HE CONTRACTORS LICENSE LAW lor the lollowing reason (Sec. 7031.5, Business an0 Professions Code: Any city or munty whiCh raquires e pennit to wnstruct, alter, imprwe, tlemolish, or re0air any structure, prior to its issuanca, also requires the applicant for such permit to file e signed sietement iha� he or she is licensed pursuent to ihe provisions of the Contradors Licensa Lew (Chaptar 9(commencing with Section 7000) of Division 3 01 t�e 8usineu end Professions COde) or thet �ebr sha is exempt therefrom end lhe basis lor Ihe alleged exemOtion. Any violation ot Section 7037.5 by any aOPlicant for a pertnit subjects t�e epplicani to e ciNl penalry ol not more than five hundred dollers ($500).): ❑ 1, es owner of the proptl�ly. or my employees wi�h wages as their sole compensation, WILL DO TME WORK, and the structura is not intentled or otteretl for sale (Sec. 70a4. eusiness anC Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves t�ereon, ane who tices such work himself or �erself or ihr0ugh his or her own employaes, providetl that such improvements are not Intended or ofleretl for sale. II, however, ihe huiltling or improvement is soltl wi��in one year of Gomple�ion, the owner-builder will have �he burtlen of proving tha� he or she tlitl noi build or improve for purpo5e of sale.). ❑ I, as owner ol the propeM• am E%CLUSIVELV CONTRACTNG WITH LICENSED CONTRACTORS to constmct the Droject (SecJ04a, Business antl Professions Code: The contrectore License Lew tloas not epply to en owner ol property who builtls or improves thereon, and who wntrects lor such project with a wntractor(s) license pursuant to tha Conlraciors License Lews.). ❑ I e.m exempt under sec. Business and Prolessions Code lor this reason: Signeture: Date: Owner ID verifietl by tlrivers licensa. ❑ Yes ❑ No Onvars License No. Venficetion ot Ownere�ip by (rype of tlocumeni, i.e. � property tax bill or deed): ExDires: DIVISION OF INDUSTRIAL SNFETV PERMR CERTIFICATION: ❑ I hereby certity Ihat no �x��ation tive (5) or more feet in depih into which a person is requirad to descenq will be made in connection with work authonzetl by this permit, antl that no building siructure, scalloltling, talsework, or demolition or dismantling thereof, will be more ihan thirty-six (36) feet high. (Chap. 32. Grp 2, Art 2, Sec. 341, Title 8, Califomia Atlministrative Cotle). ❑ A5 ownerDuilder, I will �ot employ enyone to do work which would require e pertnit from the Division o� Intlustrial Safery, as noted above, unless such person has a pertnit to do such work f�om Ihe division. SignaWre: Date: Division ot Intlustrial Safety Permii NumCec CERTIFlCATE OF COMPLIANCE AND AUTHORVJITON OF EMAY: I conify under penalry of perjury ihat I �eva read this aOPlication antl state t�at Ihe information given is correct. I agree to wmply with all s�ate laws enC city ortlinances releting �o bullding consimcllon, and euthotlze represen�atives ot tha Ciry of Casta Mesa to enter upon the above-descnbed propetly br inspection purposes. I agree not to occupy or allow occupancy ol eny builtling auihonzed by this permit until final inspection. Ot Legal Owner�s) nhodzed Applicant CO�E I. INSYECTIONTYPE 1616 Fizetl System Pinal Fire Prevemion 1268 Pool Spa Finel 200 Final Re-Rool 201 Flnel BIocWRetaining Wall 202 Final Factory Fire Pla�e 203 Finel Sign 204 Finel Demolition PAIE INTRIAlS 44QE1 INSPECTION TYPE 206 Finel Mechanical 208 Finel Plumbing 210 Finel Electrical 212 Finel Fire Preven�ion 220 Final Plenning Approval 222 Finel Sile 250 Finel9uildinglOccupancy Q�F I�LIITI�LS (714) 754-5273 • Fau (714) 754-4856 • wv+w.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 384 LA PERLE LN Suite No Vicinity: Parcel Nunmber: 42531203 PLUMBING PERMIT 1 } V �,V � I V Applicant: MATTHEWS, DOUGLAS Address: 364 LA PERLE LN � COSTA MESA, CA Owner: MATTHEWS, DOUGLAS Address 384 LA PERLE LN COSTA MESA, CA Contractor: O W N E R-B U I LD E R Address: � - Phone: 714396-2379 Zip: � 92627 ' . Phone: 714396-2379 2ip: ; . 92627 Phone: Zip: License: 000000 - SCOPE OF PERMIT B04-01959.SEWER CAP. ISSUE FEE BackFlow irrigation ' Backflow Preventer Bathtub Clarifier System Connecl Qce,Soda,etc) Dental Units Dishwasher Draiq Floor Drain, Rainwater Drain, Roof , Drinking Fountain , Expansion Tank Gas Earthquake Valve Gas (1-4 outlets) � Gas (Over 4 outlets) Gas Repipe Gas Service Interceptors (Grease, Oip Interceptors (Sand Auto ) AMT QT $23.50 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 , 0 $0.00 0 $0.00 , 0 $0.00 0 $0.00 0' __,$0.00 0" $0:00 � 0 �$0.00 0 $0.00' A. 50.00 0 $0.00 0 $0.00 0 Status: ISSUED Applied: 11/17/2004 Issued: 11/17/2004 ISSUED BY: FEESUMMARY ' � . AMT' �QTY , AMT Laundry Tub / Washer 50.00 0 Sump Pump � $0.00 Landscape Irrigation �$0.00 0 Swimming Pool � - $0.00 P-Trap � 50.00 -: , 0 Trap Primer , ' � $0.00 Pressure Regulator $0.00 0 Urinal � $0.00 Process Piping (pe��10 ft) - $0.00 0 - Vacuum Brkr Bkflow(1-0) $0.00 Receptors � - � � ' �� ..50.00 0 Vacuum Brkr Bkflow(5+) $0.00 Septic T2nk ' � , $0.00 .- 0 Wash Basin' . $0.00 Sewer Cap for Demo 30.00 .0� . - Wash Basin Set� � $0.00 ' • �� Sewer Connect � $24.65 ' � 'I � � - �'. Waste and Vent System $0.00 - Sewer Pnvate Line $0.00 0 Water Closet (Toilet) $0.00 Shower $0.00 0 � ' �Water.Healer/vent � $0.00 �� Sink,- bar �" $0.00 0 Water Plping (Inst o� Rep.) 50.00 � Sink, wmmercial - $0.00 0 � � � Water Re-pipe , $0.00 � , Sink, Floor � "$0.00 0 - -� WaterService - " $0.00 , .- Sink, kitchen $0.00 0 � Water Softener. $0.00 , � Sink, service/mop $0.00 0 � OTHER� $0.00 , Spa (private) $0.00 0 VIOLATION 50.00 - Spa (public) b0.00 0 , PLAN CHECK $0.00 - � " REINSPECTION $0.00 � TOTAL CALCULATED FEES: E48.15 QTY 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 related regulations. (Ord. No. 92-28, § 7, 72-21-92) EXPIRATION: This permit shall automatically expire and become void it work is not commenced wlthin 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes. and all requlred 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) 7545626 2446-46(N00) WORKERS' COMPENSATION DECLARATION: I hereby ettirtn under penelry ot perjury one of the tollowing declaretions: ❑ I heve end will meintein e certificeta of wnsent to sell-Insure for workers' compensetion, es prwided tor by section 3700 of the Labor Cotle, for the performance of the work for which Ihis permit is issuea. ❑ I have entl will maintain workers' campensation insurance, es required by sec0on 3700 0l lhe LaDor Cotle, for tne performanw of Me work for which Mis pertnit is issued. My workers' crompensation Insurence caMer end pollcy number ere: Cerrier: Policy Number: /This sectlon need not be romp�eted il the parmit is velued et one hunOred dollars ($100) or less./ ❑ I certify that in the pertC�nance ot ihe work for which Ihis pertnit is issued, I shell not employ eny person in eny manner so as to become subject to ihe workers' compensation laws of Celifomie, end egree thet II I should become sub�ect to the workers' compensetlon provisions of Section 3700 ot the LaOor Code, I shaU tdrthwtth comply with Ihese pmvisions. Applicent Signature: �eta: WARNING: FAILURE TO SEIXIRB WORNERS' OOMPENS.CTION COVERApE IS UNLAWFUL RNp SMALL SUBIECT AN EMPLOVER TO CRIMINAL PENALTIES NND CML FlNE$ UP TOONE HUNDREO hIIX15AND OOItARE (5100,000�, IN ADDITIIXJ TO THE COST OF COAIPENSATIpJ, DFMAGES AS PROVIOED FOR IN SECTION 3)06 OF THE L48pR CODE. INrEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTOR$ DECLARATION: � I hereby attirtn ihat I am licensed under provisions of Chapler 9(commencing wi�h Seclion 7000) of Division 3 ol ihe Business and Professions Cotle, and my license is in full force antl ettect. lic. p. Contrector s Signature: Glass e Dete: CONSTRUCTION LENDING AGENCV: ❑ I hereby alfirm that ihere is a construction lending agency for ihe pedormanca of ihe work tor which ihis permit is issuetl. (Sec. 3097, Civil Cotle). Lender'9 Name: Lender's Atltlress: Signature: Date: OWNER-BUILDER DECLARATONS: I hereby attirm thet untler pedelry ol perjury thet I em E%EMPT FROM THE CONTFACTORS IICENSE LAW for the following reason (Sec. 7031.5, Business antl Professions Cotle: Any ciry or counry whiCh requires e permit to construct, alter, improve. demolish, or repair eny StmcNre, prior to its issuance, also requires the applicant for such pertnit to tile e signea statemeni Iha7 he or she is licensatl pursuent to I�e pmNsions ot ihe Contrectore License Lew (Chepter 9(commencing with Section 7000) of Didsion 3 01 Ihe Business end Professions COae) or thet he'Onshe is exemp� lherelrom end Ihe basis for ihe elleged eremption. Any violation ot Section 7031.5 by any epP�icant For a pertnit subjects the epplicant to e ciNl penelry otynat more then five �unCred dollers ($S00).): ^. 1/ ❑ I, as owner of ihe property. o�my�employees with wages as their sole compensetion, WILL DO THE WORK, antl the stmcture is not intentled or ottereC for sale (Sec. 7044, Business and Pr0lessions Cotle: The Contreciors License Lew does not apply lo an owner of propeM who builds or improves thereon, and who does such woM himself or �ereall o fthi0ugh,his;or her own employees, provi0ed ihat such improvements are not intendetl or o%eretl br sale. tl, however, the builtling or improvement is sold within one vv i 1.Gompletion, t�e owner�uilaer will have the burden of proving ihat he or she did not builtl or improve for purpose ot sale.). G ❑ I, es owner of the�property. am EXCLUSNELV CONTRACTING WITH LICENSED CONTRACTORS m constmct the project (Sec. 7044, Business and Pmfessions Cotle: The contreclors 4kense Lew does noI epply Io en owner ol pmperty who build5 or improves thereon, antl who contracts br suth prolect with a contractor(s) license pursueni to the Con�rec�ors LitenSa Laws�. ❑ I em exempt under sec. Business antl Protessions Code lor ihis reason: Signature: Date: Owner ID varified by drivar's licansa. ❑ Yes ❑ No Dnvars Licensa No. Vetlfication ol Ownarship by (ryPe of document, i.e. - property ta�c bill or tleed): Expires: DIVISION OF INDUSTRIAL $AFET' PERMR LERTIFICATION: ❑ I hereby cenity Ihat no 6x�evetion tive (5) or more feet in depth into which a person is raquired to descend, will be made in wnnection with work authonzed Dy [his pertnit, antl that no building structure, scaMolding, falsework, or demolition or tlismantling theraol, will be more than thirty-six (36) feet high. (Chap. 32. Grp 2, Art 2, Sec. 341, Title 8, Celifomia Adminisirative Code). ❑ As owneo-builder, I will �ot employ enyone to do work which would raquire a permit fmm the Division of IndusMal Safery, as noted a6ove, unless such person has a pertnit to do such work f�om Ihe division. Signature: Da�e: Divuion ol lntlustrial Safery Permit Number: CERTIFlCATE OF COMPLIANCE AND AUTHORI2ATION OF ENTFiV: I cenity under penalty of perjury t�a1 I ha�e reatl this applicalion antl s�ate ihai �he intormation given is wrrea. I egree to comply with all state laws end city ordlnances relating to builaing cons�mction, end euthorizB representatives of the City of Casta Mesa to enler uDon the above-descnbed property lor (�spection purposes. I egree not to occupY or allow occupanry ol any building aulhorized hy Ihis permi� until finel inspection. Legal Owner(s) A�dOr Authonzetl Applicant WOE 1. INSGECTIONTYPE 1618 Fixed System Fi�al Fire Prevention 1268 Pool Spe Finel 200 Final Ra-Roof 201 Final 81ocWRetaining Well 202 Final Factory Fire Place 203 Finel Sign 204 Final Demolilion PA7E INTRIALS �I CODE� INSPECTIONTYPE �j[ � 206 Final Mechanical 208 Finel Plumbing 210 Finel Electrical 212 Flnel Fire Prevention 220 Final Planning Approval 222 Final Sile � 250 Finel Building/Occupancy � � _ . (714) 754-5273 • Fa�c (714) 754-4856 • www.ci.costa-mesa.��LDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 384 LA PERLE LN Suite: Vicinity: Primary Occ: R3 Parcel Number: 42531203 Applicant: MATTHEWS, DOUGLAS Address: 384 LA PERLE LN COSTA MESA, CA Owner: MATTHEWS,.DOUGLAS Address 384 LA PERLE LN COSTA MESA, CA . - " Contractor. _OWNER-BUICDER Address: Type of Construction: V-N Zoning: Status: ISSUED Applied: 11/17/2004 Issued: 11/17/2004 ' �� W � � UED O Phone: 714396-2379 � Zip: 92627 \ \ �V O O �/� l� �, �V�� Phone:' 7.14-396-2379 Zip: 92627.:. Phone: Zip: - ' _ License: 000000 Arch : - - � Eng: Address: -' Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT DEMOLISH EXIST 1000SF SFD . , . � - _ , � _� ' � � _ FEE SUMMARY = Plan Check: $0.00 Permit: $38J5 SMIP Res: $0.00 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $38.75 SETBACKS . MAIN STRUCTURE Fronl 0- 0, ACCESSORY � Front , 0- 0: PARKING Existinq: o NOTES: Calc Valuation: $i,000.00 Claim Valuation: Si,000.00 . ;. PLANNING & ZONING ' - - ��Rear _ 0- 0' Left 0- 0 � Right 0- 0-. - , Rear 0- 0 Left . 0- 0� - Right= � 0- 0 � Required: , 0 � � Pro osed: � 0 ' , . �OOp � A NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis undei 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 inspeetions end final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 �aaws lvao� WORKERS'COMPENSAnON DECLARAnON: I hereby eNirm under penelry ot perjury one of the following declaralions: ❑ I have end will meintain e certitlwte a� �onsent to selFlnsure lor workers' compensatlon, es provided lor by section 3700 ot the La6or Code, for the pertortnance of the work ior whith ihis De�� i55ued. ❑ I have end will maintein workers' compensation insurence, es required hy section 3700 of the Labor Code, for the peAormanre of tne work for which this permit is issued. My worker5' compen5etion Insurenc0 cerder end policy number are: Cerrier. Policy Number. (Thls secfbn need nof be cortrO�efed i! the permit is veluetl e( one hunOred dollers (3700) or less.) 0 I certity ihat in the peAormence ot tha work for which this permil is Issued, I shell not employ any person in any manner so as to become sub�ect b Ihe workers' crompenselion lews ol Califomia, antl egrae Ihat If I s6oultl become subJect to Ihe workers' compensation provisions of Section 3700 of Ihe Lebor Cotle, I shell (onhwlt� comply with these pmvision5. Applicam Signature: Deta: WARNINp: FAIWRE TO SECUFE WOFiKERS' CpAPENS4ilON COVERAOE IS UNLAWFUL NND SHALL SlIB1ECT AN EMPLOVER TO CRIMINAL PENALTIES AND CML FlNE$ UP TOONE HUNDRE� TI/pUSAND DOLURE (5100,000), IN AWITION TO TME WST OF COMPENSATIIXJ, DAMAGES AS PROVIOED FOR IN SEC110N TO60F THE LABpR WDE, INTEREST, AND ATTORNEV'S FEES. LICENSEO CONTRACI I hereby attirtn that em torce and ettect. L. a Coniraaor's Sign � CONSTRUCTION LENDING AGENCV: 9(commencing with Section 7000) oi Division 3 of ihe Business and Pwfessions Code, and my license is in full � �� Cless x { S Date: ❑ I hereby aflirtn ihat ihere is a constru��on lending agency tor ihe pertortnance of the work lor which Ihis permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Addrass: __ _ Signature: OWNER-BUILDER DECLARATIONS: Date: I hereby ettirtn that under penalry of periury•�hat I am EXEMPT FROM THE CONTRAC70RS LICENSE LAW for the tollowing reason (SecJ03L5, Business and Professions CoOe: Any ciy or counry which raquires e permit b construct elter, Improva, demolish, or repair eny stmcture, pnor to its issuance, also requires the apD��f for suc� permit ro lile a signed stetement thai,he or she is Ilceri5ed pursuent to the pmWsions of Ihe Contrecrors Licensa Lew (Chepter 9(commencing with Section 7000) of Didsion 3 of Ihe Business en0 Protessions,Code) or Ihet hd�or'she is eaempt therefrom enA the besis for the ellegatl eaemption. Any violation of Section 7031.5 6y any applicant br a pertnit subjacts the epplicant �o e civil p� nalry of not more than /ive hundred dollers ($500).): ❑ I, as owner of the'property, or my emp�oyees with weges as thair sole compensetlon, WILL DO 7HE WORK, entl Ihe strucWre is not intendetl or oReretl br sale (Sec. 70a4, Business entl Professions Cotle: Tlie CoNreciors License Law tloes not apply lo an owner ot property who builtls or improves thereon, and who does such work himselt or hersell or Ihrough his or her own employees, provitletl that such improvemenis ere not intended or oHeretl for sale. If, however, the building or improvement is soltl wi�hin one year ol Comple�ion, the ownar-builder will have Ihe burtlen of pmving t�at he or she ditl not buiid or improve br purpose ot Sale.�. ❑ I, as awner ot �he properry. em E7(CLUSIVELV CONTRACTNG WITM LICENSED CONTRACTORS �o conslruct the project (Sec. 7044, Business and Professions Cotle: The contrectors License Lew does not epply to en owner ol propeny who 6uiltls or Improves thereon, antl who contracis lor such prolect with a comrector(s) license pursuant to ihe Contrectors License Lews.). ❑ I am exempt untler sec. Signature: Owner ID veniietl by tlriver s license. ❑ Ves ❑ Na Business entl Professions Code for ihis reason: Venlicetion ol Ownership Dy (type of document, i.e. - property tax bill or deed): Drivef5 License No. Date: Espires: DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: � I hereby cenity ihat no excavetion five (5) or more taet in depth into which a person is required m descend, will be matle in connection with work authonzetl by this pertnit, and thaf no building sWCWre, swfloltling, talsework, or demolition or dismantling Ihereot, will be more ihan thirty-six (36) (eet high. (Ghap. 32. Grp 2, Art 2. Sec. 341, Title 8, Califomia Adminisirative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit Irom ihe Division of Indusirial Safery, as noted above, unless such person has a permit to tlo such work irom the tlivision. SignaWre: Date: Division of Industrial Safery Pertnit Number: CER7IFlCATE OF COMPLIANCE AND AllTNORVATON OF ENTRV: I certify under penalry ol perjury thal I have read ihis application antl state that the information given is correct. I agree to wmply with all siate lews entl ciry ordinances relaiing to 6uilding conslmction, and euihorize represen�etives of the Cily of Cos�a Mesa to enter upon ihe ebove-described D�openy for inspection pulPoses. I e9ree not to occupy or ellow occupancy ot any building aulhorized by this permit until final inspection. Signature 014egal Owner(s) Date AnNOr Aut�o�ietl Applicant COOE I. INSVECTIONTYPE 1816 Fixetl System Final Fire Prevemion 1266 Pool Spa Final 200 Finel RB-Rool 201 FInaI BIocWRetalnlnp Wall 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition D1TE II�ld45 y00E� INSPECTIONTYPE 20fi Finel Mechanical 20B Final Plumbing 210 Final Eleclrical 212 Final Fire Prevention 220 Final Planning Appmval 222 Final Site 250 Final BuildinyOccupency D�TE u{jQ�i From: ❑ � ❑ ❑ ❑ Finance Building Safety Planning Public Services Community Services Other CITY OF COSTA MESA REFUND REQUESTFORM Vendor #: ermit #: 804-00800I604-01959 ��^ � Amount: $ 2,016.62 U Date: 10-11-2005 Department Signature Account Fund Or anization Pro ram Pro'ecUGrant Amount 415130 101 18300 20410 $2,016.62 Name and address of applicant: DOUGLAS MATTHEWS Phone: 386 LA PERLE LN COSTA MESA. CA 92627 - <_ .-' -_._.._,..�� //) j - � 1 ' / '-_ - pli� nt's Signature /O - //-OS Date REASON FOR REFUND: ORIGINAL S.F.D. WAS NEVER DEMOLISHED NOR WAS A NEW S.F.D. EVER BUILT. PLEASE REFER TO PERMIT NUMBERS 604-00800 AND B04-01959. PROJECT WITHDRAWN. ��f�� '��o/�s APPROVALS: Finance: City Manager: _ 2401-22 MW ONLINE �1 Date: 10-11-2005 CI�XX OF COSTA MESA P.O. BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 92628-7200 DEVELOPMENTSERVICES DEPARTMENT Transaction Receipt ACTIVITY NUMBER: 804-01959 TYPE: SITE ADDRESS: 384 LA PERLE LN Unit / Suite APPLICANT: MATTHEWS, DOUGLAS 384 LA PERLE LN OWNER COSTA MESA, CA 92627 714-396-2379 MATTHEWS, DOUGLAS 714396-2379 CONTR: �'Up � OWNER-BUILDER STATE LICENSE"-000000 qTY LICENSE � TOTAL FEES: $38.75 TRANSACT. AMOUNT: $38.75 BALANCE:(PERMITFEES) $0.00 PAYMENT METHOD: Check NOTATION: TRANSACTION RECEIPT DETAIL INFORMATION FOR TREASURY: 2000 Building Permi� Fee 0300 $38.75 B000043302 Building Division (714) 754-5273 • Cotle Enlorcemeni Qi0) 754-5623 • Planning Division (714) 754-5245 FA%p1<)756A856 • TDDptA)754-52d4 • waw.ci.costa-mesa.ca.us CAC CI�'Y O�' COSTA MESA P.O. BOX 1200 • 77 FAIR DRNE • CALIFORNIA 92628-1200 DEVELOPMENTSERVICES DEPARTMENT Transaction Receipt Date: 10-11-2005 ACTIVITY NUMBER: B04-00800 SITE ADDRESS: 384 LA PERLE LN Unit / Suite APPLICANT: CRAIG MCINTOSH 1048 IRVINE AV SUITE 191 NEWPORTBEACH,CA 92660 714-396-2379 OWNER: MATTHEWS, DOUGLAS 714396-2379 TOTAL FEES: TRANSACT.AMOUNT: BALANCE: (PERMIT FEES) PAYMENT METHOD: NOTATION: ' $3,181.42 $2,302.52 $0.00 Check TYPE: Add Single Family Res CONTR: OWNER-BUILDER STATE LICENSE 000000 CI1Y LICENSE TRANSACTION RECEIPT DETAIL INFORMATION FOR TREASURY: 2000 Building Permit Fee 0300 $1,912.15 2005 Building PIan�Check 0320 $364.00 2100 Building SMIP Fee 0340 $26.37 B000043296 � �p� Building Drvision (71C) 754-5273 • Code Enlorcement p14) 756-5623 • Pianning Division (71a) 75a-5245 FAX (714) 754-0856 • TDD (710) 756-5247 • www.d.costa-mesa.ra.us CAC (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 386 LA PERLE LN Suite: Vicinity: SIDE AND REAR OF RESIDENCE Parcel Number: 42531204 npp�icant: MATTHEWS, DOUG Address: 386 LA PERLE LN COSTA MESA, CA Owner: MATTHEWS, DOUG Address 386 LA PERLE LN COSTA MESA, CA Contractor: Address: Zip: Arch : Address: Phone: Zoning: Phone: 949-548-2933 Zip: 92626 Phone: 949-548-2933 Zip: 92626 Phone: License: Eng: Address: Status: ISSUED Applied: 04/02/2001 Issued: O6/75/2001 ISSUED BY: �� u Phone: Zip: License: License: • SCOPE OF PERMIT ADD 186 SQ. FT BEDROOM AT SIDE OF RESIDENCE AND ADD 225 SQ. FT. AT THE REAR OF THE RESIDENCE TO . CREATE A LAUNDRY AREA, A NEW BATHROOM AND EXTEND KITCHEN AREA. � � 'ADDITIONAL PARKING SPACE IS NOT REQUIRED BECAUSE IT IS AN OFFICE ADDITION (NO CLOSETS), NOT A � � BEDROOM. WS . -- - - - - — � � - - � Plan Check: $326.85 Permit: $502.85 SMIP Res: . $3.51 SMIP Com: $0.00 Other: $0.00. Inspection: $0.00 . Total: , „ �$833.21 � � � SETBACKS MAINSTRUCTURE Front 0-0 ACCESSORY Front 0- 0 Rear Rear � � � � PARKING Existin : 0 Reauired: 0 NOTES: FEE SUMMARY PLANNING & ZONING Left 0- 0 � Left 0- 0 Proposed: 0 Calc Valuation: ; Claim Valuation: , ; . i � �,, . � ' Right � 0 0 Right 0- 0 $35,140.50 so.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 1 BO days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all appliCable Codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration ot this permit. FOR INSPECTIONS CALL: (714) 7545626 26C646 (fi�00) WORKERS'COMPENSAnON DECLARAnON: �� , I hereby ettirm unaer penalry ot perjury one of the following tlaclaratlons: � ❑ I heve entl will maintain a certiticale of consent to self-Insure for workers' compensetion, as provi0ed for by saction 3700 oi tha Labor Code, for the pertortnence oi the work far which Ihis pertnil is issued. ❑ I have and will maintain workers' compensation insurance, as required by sectlon 3�00 ot N�Labor CoOe, for Ihe peAortnance of the work for which this permit is issuetl. My workers' compensation Insurance carrier end policy numCer are: Carrier. Policy number (lh/s sectlon neetl not be completed ll fhe permit Is veluetl et one huntlred Co/!ars ($ f00) or /ess.J ❑ I certity Ihet in the peAormance of the work lor which Ihis pertnit is issued, I shall not employ any person in any manner so as to become subject to ihe workers' compensetlon lews of Califomia, anC agree that It I should become sub�aci to t�e workers' wmpensation provisions of Section 3700 oi the Wbor Cotle, I s�all forthwith compty with Ihese provisions. Appllcant SlBnature: Date: WARNINO: FAILURE TO $ECURE WORKERS' COMPENSATION COVERAGE IS UNIAWFUL AND SHALL SUBJECi AN EMPLOYER TO CRIMINAL PENALTIES AND CML FlNES UP TOONE HUNDRED hKK15M1D DOLLARE (5100,000), IN ADDfiION TO THE COST OF CqAPENSATIqJ, DAMAGES AS PROVIDED FOR IN SECTION 3]OB OF THE LABOF COOE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby eHirm that I am Ilcensetl untler provisions of Chapter 9(commencing wit� Saction 7000) ot Division 3 of ihe Business and Professions Code, and my license is in full torce en0 ettect. Llc. # Class A Contreaors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby aHirm that there is a conslruction lending agency for the peAormance of the work for which ihis partnit is issuetl. (Sec. 3097, Civil Code). LanCers Name: Lendefs Address: Signetura: Date: OWNER•BUILDER DECLARATIONS: I hereby etlirtn thet untler penelry oi perjury that I am EXEMP7 FROM 7HE CONTRACTORS LICENSE LAW for ihe tollowing reason (Sec. 7031.5, Business end Professions Cale: Any ciry or counry whic� requires a permit to wnstruq, alter, improve, demolish, or repair any siruaure, prior ro its issuance, elso requires t�e epplicant for such pertnit to tile e signed statement that he or she is Ilcensetl pursuam ro Ihe provisions oi tha Contractors License Law (Chepter 9(commencing with Sectlon 7000) ol DiNsion 3 ot the Busineu and Professions Coda) or thet he or she is exempt therefrom and Ihe besis for Ihe allegetl exemption. Any violetion af Section �031.5 by eny applicant for e permit subjects the epplicent to a civil penalry of not more than five hundred tlollars ($500).): ❑ I, as owner ol the proparry, or my emploYees with waqes as iheir sole compensation, WILL DO THE WORK, entl �he sWCWre Is not intendetl or oflered for sale (Sec. 7044, Business end Professions Code: The Coniradors License Law tices not apply to an owner of property who builds or improves thereon, anC who does such work �imsell or harself or through his or her own employees, pmvitlea that such impmvements are not Intendetl or oNerad tor sale. tl, however, the building or improvement is �sold within one year of wmpletion, the owner-builtler will have ihe burtlen ot proving that he or she did not �uild or improve for purpose of sale.). .�� as owner of the properry, am E%CLUSIVELY CONTRACTING WfTH LICENSED CONTRACTORS to consWct ihe project (Sec. 7044, Business and Profassions ' Code: 7he contrectors License Lew tloes not apply to en owner of property who builtls or Improves theraon, and who contracts for such project with a coniractor(s) license pursuant to the COniractor5 LiCBnSe L2ws.). � I em ezem�r sec. Business and Professions Code tor this reason: ��, . Owner ID venfietl by tl' eYs license. �1(es ❑ No DriveYS�License N0. Verification ol Ownership by (rype ot do umem, I.e. - property ta: bill or deed): '-- Ezpires: DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION: ❑ I hereDy cenify thet no escavetion five (5) or more tee� in dapih into which a person is requireC to descend, will be made in connection with work euthonzed by Ihis permi�, end Ihat no 6uiltling structure, sceflolding, talsework, or demolition or dismamling thereoi, will De more than thirty-six (36) feet high. (C�ap. 32, Gry 2, Art 2, Sec. 341, Title 8, Califomia AdminlstratNe CoOe). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from ihe Division of Industriel Sefety, as noted ebove, unless suc� person has a permit to tlo such work fram tha tlivision. Signature: Date: Division af Industrial Satery Pertnit Number: � CERTIFlCATE OF COMPLIANCE AND AUTHORIIATION OF EMAY: I certity untler penalry of perjury that I have read this application and state thet ihe information given is correct. I agree to comply with all state laws end ciry ortlinances relating to building consiruction, and authodza represen�atives ot ihe Ciry of Costa Mesa to entar upon the abov - ' ��erty for in eyctfiohpu� ose�l agree not to occupy or atlow occupency of any building authorized by this�p—er.mi� u� �nal inspectio�. / ��/f �"Z/m!/� __— % � U �gna`fure Ot Legal Owner(s) Date a- AnrUOr Aut�otlzad Applicam Da�e COPE �. INSGECTIONTYPE QI¢, � 7678 Fixed SyStem Final Fire PreveNion 12fi8 200 201 202 203 204 Pool Spa Final Final Re-Roof Finel BIocWRetaining Well Final Fectory Fire Place Final Sign Finel Demolition LODEt ItlSPECTIONTYPE 206 Final Mechanical 208 Final Plumbing 210 Final Elacirical 212 Final Fire Prevenlion 220 Final Planning Approval 222 Final Site 250 Final BuildincyOccupancy Q/g INTITIAlS � (714) 754-5273 • Fax (714) 754•4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 386 LA PERLE LN Suite No Vicinity: Parcel Nunmber: 42537204 Applicant: MATTHEWS, DOUG Address: 386 LA PERLE LN COSTA MESA, CA Owner: MATTHEWS, DOUG Address 386 LA PERLE LN COSTA MESA, CA Contractor: Address: Arch / Eng : Address: PLUMBING PERMIT Phone: 949-548-2933 Zip: 92626 Phone: 949-548-2933 Zip: 92626 Phone: Zip: License: _�.� .. � .�.� ..... ._ � Status: ISSUED Applied: O6/15/2001 Issued: O6/15/2001 ✓` ISSUED BY: I I // I�- L% ^ Phone: - - - - ---Zip:. '.. �� -- - ' : '�� =" - - � � ' .. � License: . . - _ . , � . . 7 " � SCOPE OF PERMIT '- �- �� ` � � ' REF 801-00416. � % ; � � : � � ' i �' 2 BATHUB SHOWER COMBO. 1 DISHWASHER. 1 GAS�1-0 OUTLETS. 1 LAUNDRY/TUB ,1 SOILET 8 1� � � WASHBASIN. � - � � � � . ' � _ ,. _ . , ��_..-... . .,, . - �� ' �FEE SUMMARY� � ' ' -'� � :A ..'AMT/j QTY � ��: ': -, •' � AMT- QTY �'�-�% i"J �/=/ ; . / ISSUE FEE �, $23 50':" ' � Laundry Tub / Washer �� $9.80 . 1 - � � � Sump Pump . - i _ i Backflow irrigation - � $0.00 � 0 ' , �� Landscape Irngation . $0.00 '��0 ��-�� ' Swimming Pool ' - Backflow Preventer � $0.00 � 0 . . P-Trap $0.00 0 `� � Trap Primer: �� Bathtub � $19.60 2., � � � Pressure Regulator $0.00 0 ..�t . � Urina{� � �, " � Clarifier System $0.00� �� - 0 �. Process Piping (per 10 ft) $0.00 .� 0 �` Vacuum�Brki BkFlow(1-4) Connect Qce,Soda,etc) $0.00� , 0 . Receptors �� $0.00 � � 0 � �� -;Vaouum Brkr Bkflow(5+) Dental Units $0.00 0. ' Septic Tank . _ ' $0.00 0 , � 'VVash Basin Dishwasher $9.80 1 ��Sewer Cap for Demo $0.00 P, � --�� Wash Basin Sel Drain, Floor $0.00 0 -- Sewer Conned �. $0.00 � 0 ` Waste and Vent System Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet (Toilet) Drain, Roof $0.00 0 Shower $0.00 0 Water Heater / vent Drinking Fountain $0.00 0 Sink, bar $0.00 0 Water Piping (Inst or Rep.) Expansion Tank $0.00 0 Sink, commercial $0.00 0 Water Re-pipe Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service Gas (1-4 outlets) $6.15 1 Sink, kitchen $0.00 0 Water Softener Gas (Over 4 outlets) $0.00 0 Sink, service/mop $0.00 0 OTHER Gas Repipe $0.00 0 Spa (private) $0.00 0 VIOLATION Gas Service $0.00 0 Spa (public) $0.00 0 PLAN CHECK Interceptors (Grease, Oil) $0.00 0 REINSPECTION Interceptors (Sand Auto ) $0.00 0 AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $9.80 $0.00 $0.00 $9.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 TOTAL CALCULATED FEES: $88.45 QTY 0 0 0 0 0 0 i 0 0 1 0 0 0 0 0 0 NOTICE: The work authorized by this permit sIGOABM&NL3fS hISRE��@I� G:Q11i�11�iDIdG requirements under Cali�omia statutes and related regulations. (Ord. No. 92-28, § 1, 12-27-92) 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 ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, antl all requlred Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. POR INSPECTIONS CALI: (774) 7545626 244fi-46(6/00) WORKERS'COMPENSAnON DECLARAnON: ' + I hereby affirtn unde� penalry oi perjury one oi the tollowing tleclaretions: '�> ❑ I heve end will maintein a cenificate ot wnsent b sel4lnsure for workero' compensation, es provided tor by section 3700 of the Labor Code, tor the pertormance ot the work for which Ihls permit is i55uetl. ❑ I have flntl vrill maintain workers' compensatbn insurance, as requiretl Oy sectlon 3700 of Ihe Labo� Coda, for �he peAormance of t�e work lor w�ich this pertnit is Issued. My workera' compensatlon Insurance wrtier end policy number are: . Cerrier: Policy i�umber: (This secHon neetl not be cromplefed i/ the permiNs velued e( one Aundred doNers ($100) ar less.) ❑ I certity Ihat in the peAortnance o1 the work tor which this permit is issuetl, I shall not employ any person in any manner so es to become sublect to ihe woBers' compensation laws ol California, end egree that it I should become subjact to lhe workers' compensatlon proNsions of Saction 3700 of t�e Labor Cotle, 1 shell forthwlth comply with thesa provisions. Appllcent Slgnetura: Date: WARNINO: FAILURE TO SECURE WORKERS' CAMPENSATION COVERAGE IS UNIAWFUL PND SHALL SUBIEGT AN EMPLOVER TO CRINJNAL PENALTIES AND GVIL FlNES UP TO IXJE HUNDRED T/IOUSMlD DOIURE (5100,000). IN ADDfTION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR M SECTIIXJ 3lOe OF THE IJ�BOR COOE, IMEREST, AND ATTORNEI^S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aNirm Ihat I em licensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 ot Ihe Business and Professions Code, and my license is in tull force entl eHect. Lia x Class d Comrectofs Signature: Date: CONSTRUCTION LENDING AGENCV: ❑ I hereby effirtn ihat there is a construction lending apency tor ihe peAortnance oi the work for which this pertnit is issued. (Sec. 3097, Civil Cotle). Lendels Name: Lendefs Address: SignaWre: Date: OWNER-BUILDER DECLARATIONS: I �ereby eMirtn that under penalry ol perjury that I em EXEMPT FROM TME CONTRACTOFiS LICENSE LAW for ihe tollowing reason (Sec. 7031.5, Business antl Professions Code: Any ciry or counry which requires a pertnit to construct, altar, improve, demolish, or repair any structure, pnor to its issuance, also requires tha applicant for such permit to lile e signed statement Ihet he or 5�0 iSllcen50G OurSuant Io the provi5ion5 of Ihe Gonlrectors License Lew (Chapter 9(commencing with SectlOn 7000) of Division 3 of the Business entl Profe55ions Cotlej or ihel he or s�e is exempt therefrom antl t�e basis for the alleged e:emption. Any violation of Section 7031.5 by eny epplicant for e permit sublects tha epplicent to a civil penalry at nat more Ihan tive huntlred dollars ($S00).): ❑ I, es owner ol t�e property, or my employees with wages es iheir sole wmpensation, WILL DO TME WORK, and Ihe structure is not intended or oHered tor sala (Sec. 7044, Business and Protessions Code: The Coniractors License Law does not appiy to an owner of property who builtls or improves thereon, and who does such work himselt or herselt or Ihrough his or her own employees, provided ihal such improvemenis are nm Intendetl or ofleretl for sale. If, however, the builtling or improvement is 'sold within one year ot comD�etion, the ownarbuilder will have iha burden of pwving that he or sha tlitl not build or improve for purpose oi sale.). � I, as owner ol the properry. am E%CLUSIVELV COMRACTING WITH LICENSED CONTRACTORS to con5tmct the project (Sec. 7044, Busineu and Pmfessions CoCe: The contrectors License Lew tloes not apply to an owner oi property w�o builds or impmves thereon, antl who contracis for suc� prolect wit� a contracbr(s) license pursuant Io Ihe Contractors License LewS.). ❑ lam ID veritietl bwGnvels license. Vedflceiion ot Ownership by (type Business and Professions Code for this reason: s ❑ No �rivar's L'icensa No. i.e. - property tez bill or deetl): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby certily Ihat no excavation five (5) or more feei in tlepih into which e person is required to tlescend, will be made in connection with work authonzetl by Ihis permit, end ihat no builtling structure, scaHoltling, talsewoB, or demolition or tlismantling Ihereot, will be more than ihirry-siz (36) teet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Ttle B, Celifomia Administrative Coda). ❑ As owner-builder, I will not employ enyone to do work which would require a permit from the Division of Intlustnel Sefery, es notetl ebove, unless such person has a permit to do such work from Ihe tlivision. SignaWre: Date: Division of Industrial Selety Pertnit Number. CERTIFlCATE OF COMPUANCE AND Al7TTiORVATION OF ENfTiV: I cenity under penalry of perjury that I have read �his epplication and state that the informetion given is correct. I egree to wmply with all state laws and city ordlnances relating to building consiruction, end authorize represen�atives of ihe City of Costa Mesa to enter upon Ihe ebove-d ropeny for inspection urposes. gree not to occupy or allow occupancy of any building authonzed by ihis pertnit until final inspection. O'✓�s �l/�— ��5"�/ � <e�� Signeture�OYL'egal'Owner(s) Date AnNOr Authonzed Appliwnt Date CODE �. INSVECTIONTYPE i618 Flxetl System FInaI Fire Prevention 7268 Pwl Spa Final 200 Finel RB-Roof 201 Final BIocWRetaining Wall 202 Final Fectory Fire Place 203 Final Sign 204 Final Demolition o�re 1t�ALfl LOpE♦ INSiECTIONTYPE 206 Final Mechanical 208 Final Plumhing 210 Final ElecMcal 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupanry ��7\I� � !LAI � L!/ (714) 754-5273 • Fa�c (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: $SB LA PERLE LN Suite No Vicinity: ParcelNumber: 42531204 npp�icant: MATTHEWS, DOUG Address: 386 LA PERLE LN COSTA MESA,CA Owner: MATTHEWS, DOUG Address: 386 LA PERLE LN COSTA MESA, CA Contractoc Address: REF 601-00416. 3 VENTS. ISSUE FEE Inst FAU <100 k BTU Inst FAU �700 k BTU Repair / Alt Cooling/Heat Inst / Rep. Recess Wall Htr Refrig Sys <100 k BTU ' � Refrig Sys >100 k BTU Gas Piping Factory Fireplace , Hood w/Mech Exhaust , VAV Boz Vent Fan / Single Duct Appllance � , �� Fire Dampere � , �_, � � Smoke Dampers � , � � � � Inst or Relocate Appl Vent � Air Handlers < 10000chn � AirHandlers> 10000dm Floor Furnace Floor or Suspend Heater MECHANICAL PERMIT Phone: 949-548-2933 Zip: 92626 Phone: 949-548-2933 Zip: 92626 Phone: Zip: License: SCOPE OF PERMIT . . _� ( FEE SUMMARY Quantity $23.50 - - - � $0.00 -0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 so.00 0 $0.00 0 $0.00 0 � , '$0.00 0 _ � $0.00 0 'a' • $21 75 . 3 - $000 0 " � - $0 00 -. 0 ��' �� ' $0.00. 0 �� - , $0.00 0 "$0.00 0 ,� $0.00 - 0 ' $0.00 0 $0.00 0 Status: ISSUED Applied: 06/15/2001 Issued: 06/15/2001 ISSUEDBY: lI Gl��l� ,� � - , �Quantity - � Repair/.AltAbsorbtion Unit .-� r $0.00 0 ' ' Repair / Alt Refrigeretion Unit � $0.00 0 Ventillation �System �� $0.00 0 Evaporative Cooler � . $0.00 0 � Commercial'Incinerator ,�� $0.00 0 . Domestic Incinerator ✓i' � '$0.00 0 �-�--Compressors/AbsomtionSystems '�� ' ' Up to 3 hp 1100 k BTU , �$0.00 ' 0� 3 To 15 hp Iti500 k BTU %� ,. $0.00 ' 0 15 To 30 hp /.;1,000 k BTU. ,, -,' $0.00 0 "� 30 To 50 hp % 1 750�k BTU i' ' ' $0.00 � 0 �� Over 50 hp /,Over 1 750 8TU -� � $0.00' 0 �� , Boilers �, ' ; �/i�i' i��'jj�` � , _ Up to 3 hp � !i < �� ( � / � $0.00 0 ' '3To15hp`_'=�-'� �-'�.-' ,�,'i$0.00 0 � 15 to 30 hp � � - "$0.00 0 30 to 50 hp, �. �' - $0.00 0 , Over50 hp , ' $0.00 0 Other Mechanical Fee � , Investigation Fee , � - $0.00 Plan Check Fee . $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES 545.25 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requiremenis under California statutes and related regulations. (Ord. No. 92-28, § i, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must comply with all applicable cotles, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in tha expiration of ihis permit. FOR INSPECTIONS CALL: (714) 7545626 zaa6r51doo) WORKERS'COMPENSATON DECLARAnON: [ • I hereby aHirm under penalry of perjury one ol Ihe tollowing declarations: • ❑ I have end will maintain e certificate of consem to self-Insure for workers' compensatioq es provided for by section 3700 of the Labor Code, for the pertortnance ot ihe work for which t�is permit Is iuueC. ❑ I heve end will malntain workers' compensetion insurance, es requiretl by section 3700 of t�e LaGor Code, tor Ne perfortnance of the work for which this pertnit is iuued. My workers' compensatlon Insurence carrier antl policy number are: Cerrier: �� Polity Number: (This section need no! be cpmplered il (he permit Is valued et one hundred dallers (5100) or less.) ❑ I cerlify that in the pertormance ot the work for which ihis permit is issued, I shall not employ any person in any manner so es to becoma subject to the workers' wmpensation laws ot Celifomia, antl agree Ihat if I shoultl become subjec[ to Ihe workers' compensation provislons of Section 3700 0l Ihe Labor Cotla, I shall lorthwith comply with ihese provisions. ApP��eni Signeture: Date: WARNINO: FAILURE TO SECURE WORKE0.5' COMPENSATION COVERAGE IS UNUWFl1L AND SHALL SU6IECT PN EMPLOYER TO CRIMINAL PENA�TIES AND GVIL FlNES UP TOONE HUNDRED TFIOUSMID DOLLARE (S10D,000), IN ADOfiIIXJ TO THE WST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3)060F THE LqBOR CODE, IIJrEREST, ANO ATTORNENS FEES. LICENSED CONTRACTORS DECLARATION: I hereby eMirm thet I am licensetl untler provisions of Chapier 9(commencing with Section 7000) of Division 3 of Ihe Business antl Professions Cotle, end my license is in full force entl eHect. Lic. q Class q Contractors SlgneWre: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby aHirtn Ihat there is a construction lending agency tor Ihe peAormance of the work tor which ihis pertnit is issuetl. (Sec. 3097, Civil Code). � Lenders Name: Lender's ACdress: Signature: Date: OWNER-BUILDER DECLARATIONS: I �ereby eltirtn ihat under penelry ot per�ury Ihet I am E%EMP7 FROM THE CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5, Business and Professions Code: Any ciry or wunry which reQuires a Dermit to construct, alter, improve, tlemolish, or repair eny siructure, prior to its iuuance, also reQuires iha epplicam tor such permit to file e signed statement thet he or she Is Ilcensetl pursuant b the pmvisions at the Coniracrors License Lew (Chepter 9(commencing with Section 7000) of Divislon 3 ot Ihe Business and Prolessions Code) or ihat he or she Is exempt Iherefrom end Ihe basis for ihe alleged exemptlon. Any violation oi Section 7031.5 by any applicent tor e permll subjects the epplicent to e civil penalry of not more than tive hundretl tlollars ($500).): ❑ I, as ownar ot ihe properry, or my employees with wages es iheir sole compensetion, WILL DO TNE WORK, and ihe strucWre Is not intentletl or ofleretl tor sale (Sec. 7044, Business and Professions COCe: The Contractars License Law dces not epply to an owner of property who builds or improves Ihereon, antl who does such work himself or herself or through his or her own employees, providetl Ihai such improvemenis ere not intentled or oflered for sale. If, however, the builtling or improvement is /sdd within one year of completion, the owner-builder will have ihe burden of proving ihat he or she tlitl not build or improve for purpose oi sele.). 0�, as ownar of the property, em E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 70d4, Business antl Professions � Code: TTe contractors License Lew Does not apply to an owner oi property who bullds or Improves Ihereon, antl who coniracts for such projact with a contractor(s) license pursuent to the Comractors License Laws.). sec. Owner ID venfied by �p4er's license. Vedtiwtlon oi Ownership Cy (type of Business antl Professions Cotle for ihis reason: s ❑ Na Drivers'.Ckense No. i.e. - property tax bill or aeetl):'' / QiJ DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION: ❑ I hereby certity ihat no excavatlon Iive (5) or more feet in tlepih into which a person is required to descend, will be made in connection with work authonzed by this permit, an0 thet no builtling siructure, scaHolding, falsework, or demolition or dismantling thereof, will be more than ihirty-six (36) teet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title e, Celilomia AdministraWe Cade). ❑ As owner-huiltler, I will not employ anyone to do work which woultl require a permit irom ihe Division ot Industnal Safery, as noted above, unless such person has a permit to do such work trom the division. Signature: Date: Division oi Indusirial Safery Permil Numbar: CERTIFlCATE OF COMPLIANCE AND AllTMORIZATON OF ENTTiY: I certify under penalty of perjury that I have read this application antl state that the information given is correct. I agree to compty with all slate lews end ciry orGinances relating to building wnstruction, and authorize representatives ot the Ciry of Costa Mesa to enter upon the ebove-Uescribed property for ins ection puryas I agree not to occupy or allow occupancy oi any building authonzed by Ihis permit un�il final inspection. � �>cx `�� U� /.`S�,O/ � SignaWre Of:LegaLOwner(s) Data � AnNOr Authorizetl Applicant Date „ COpE �, INSPECTIONTYPE Qj�j$ I R 1616 Fixad System Final Fire Prevention 1268 Pool Spa Final 200 Finel Re-Roof 201 FIna181ock/Retaining Wall 202 Final Factory Fire Place 203 Flnal Sign 204 Finel Demolition CODE� INSPECTIONTYPE 206 Final Mechanical 208 210 212 220 Final Plumbing Final Electrical Final Fire Prevention Final Planning Approval 222 Final Site 250 Final Building/Occupancy • s- (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: Suite No Viciniry: Parcel Nunmber: ApplicanC Address: Owner: Address Contractor. Address: 386 LA PERLE LN 42531204 MATTHEWS,DOUG 386 LA PERLE LN COSTA MESA, CA MATTHEWS,DOUG 386 LA PERLE LN COSTA MESA, CA Phone: 949-548-2933 Zip: 92626 Phone: 949-548-2933 Zip: 92626 Phone: 2ip: License: Status: ISSUED Applied: O6/15/2001 Issued: O6/15/2001 ISSUED BY: � �� G� i •,� - % SCOPE OF PERMIT REFB01-00476. , . .t . - ' -�'- - -., 8 LIGHTS, 10 OUTLETS 9 SWITCHES. 3MOTORS UP TO 1 HP IN THE BATHROOMS. ISSUE FEE Temp service test Res. a/c package New Res�(1-2 units) � New Res (3+unita)..�' Pool / Spa . Lighting Fixts Recept Outlets Switches Non Res Appl '�. � , , � Res Appl Service to 200a - � � �` Service to 1000a Service over t000a � Motors to 1 hp Motors to 10hp Motors to 50hp Motors to 100hp Motors over 100hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole Quantity $23.50 $0.00 $0.00 $0.00 0 $0.00 0 � .$0.00 0 � � $8.80 8 $1.1.00� �-�-10-:� . . ,$9.90 �- ` �- 9` ".-% $1425 : � �- � 3 - ' $0.00 ;`�-0 � ., . .$0.00.: p��.,; c•, ., $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 so.00 0 $0.00 0 so.00 0 $0.00 0 FEE SUMMARY - - ,� �:: �. ; . . Quantity ' � Temp Dist System / Lighting . $0.00 0�� Busway /700 R�, • -$0.00 0� ;',- � StandingSection'- $0.00 ,,Oj',- � ��MiscElecMcalEquipment $0.00 �%.0! - Trensfortners up to 1 kva/kw $0.00 "� 0 �. .............::.up to 10 kva/kw $0.00 ', �0 ..........:......up to 50 kva/kw _ $0 00 % � 0 ..................up to 100 kva/kw �=:� ''$0.00' 0 �..� .........:.... :over 100 kva/kw =,,50.00 , �� 0 Low Voltage Equlpment , F�, j$OAO� ;% .0 / Low VOIt Wiring Systein 7 Ckt% $0.00 _ i�0 !� Misc: Condult � ,-�;$0 00: � �0 %'� - Misa Condudor � ��$0.00 � 0 � Circus ( gen or ride) . � . � . � $0.00 0 � Circus (mech ride or lights) � $0.00 - 0 Christmas Tree Stand �: � . $0.00 � 0 Flreworks Stand _ ' j. $0.00 0 Other Electrical Fee � � - $0.00 Investigation Fee 80.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES 567.45 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitornia statutes and related regulations. (Ord. No. 9248, § 1, 12-27-92) 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 unde� ihis permit to be considered legal, such work must comply with�all applicable codes, and all required Inapections and final approval must be obtained. Failure to obtain inspections and final approval will result in �he ezpiration ot this permit. FOR INSPECTIONS CALL: (714) 7545626 zaesre (voo) WORKERS' COMPENSATION DECLARATION: — � , I hereby eflirm under penalry of perjury one ot the following declarations: '. ❑ I �eve antl will melntein a ceAticale Of COnSent t0 5elf-InSure for workers' compensatlon, es provided for by sec�ion 3700 of the Lebor Cotle, tor �he performance of Iha work tor which lhis pertnit is issuetl. ❑ I �ave antl will maintain workers' compensation insurance, az required by sectlon 3700 oi the Labor Code, for tha peAortnance of tha work for which this permit is issuetl. My woMers' wmpensallon Insurance cerriar antl policy number are: .. Cerder: � Policy iJumber: (Tliis sectlon need no! be completed /l fhe permif is velued ef one hundred dollers ($100J or /eSsJ ❑ I certity that In Ne peAormance oi the work for which this pertnit is isSueQ I shall not amploy any person in eny manner so as to become subject to ihe workers' compensetlon laws of Celifomia, and egree that il I should become subject to the workers' compensation pmvislons o1 Sectlon 3700 af the Labor Code, 1 shall fotlhwith comply with these proWslons. Applicent Signature: Date: WARNINO: FAILURE TO SECUFE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND $Mr1LL SUflIECT AN EMPLOYER TO CRIMINAL PENALTIES AND GVIL FlNES UP TOONE HUNDRED TFIOUSFND DOLURE (E100.000), IN ADDfTIIXJ TO THE COST OF C/JMPENSATION, DMMGES AS PROVIDED FOfi IN SECTION 3]O60F THE LABOR CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereCy eflirtn that I am licensetl under pmvisions ot Chapter 9(commancing with Section 7000) of Division 3 of Ihe Business and Professions Cotle, and my license is in full force end ettect. Llc. a qass N Contrectofs Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby attirtn that Ihere is a construclion lending agency for ihe pertormance ol ihe work tor which this permit is issued. (Sec. 3097, Civil Code). Lentler's Name: Lentlefs AtlCress: Signa[ure: Dale: OWNER-BUILDER DEGLARATIONS: I hereby effirtn Ihat under penalry ot perjury Ihet I am E%EMPT FROM THE CONTRACTORS LICENSE LAW tor ihe tollowing reason (Sec. 7031.5, Business antl Professions Coda: Any ciry or counry which requires e permit to construct, alter, improve, demolish, or repair eny strucNre, O�ior to its issuance, also requires Ihe applicant for suc� pertnit to file a signetl sWtement Ihet he or she Is Iicensetl pursuant to the proWsions of the Contreclors License Lew (Chapter 9(commencing with Seclion 7000) ot Division 3 oi the Business entl Professians Cade) or that he or she is exampt thereirom anA the basis for the alleged e:emption. Any violetion o� Section 7031.5 by any epplicant for e pertnit sublecte Ihe epplicem to e chnl penalry ot not more than five hundre0 dollers ($500).): ❑ I, as owner of Ihe properry, or my employees with weges as Iheir sole wmpensatlon, WILL DO TME WORK, antl tha structure Is not intentletl or oHeretl for sala (Sec. 7044, Business entl Protessions Code: The Contractors License Ww does not apply to en owner of property who builds or improves thereon. and who tloes such work himsell or hersell or through his or her own employees, provided tha� such Improvements are not intended or oHeretl for sale. Ii, however, the building or improvement is sold wiihin one year of completion, the ov+ner-builtler will have ihe burden of proving ihat he or sha did not builtl or improve for Durpose oi sele.). � I/ e9 owner ot Ihe prOperry, em E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to conslmct the project (Set. 7044, BuSiness antl Pmfessians % COEe: The comrectore License Lew does not apply to en owner of property w�o builds or improves ihereon, antl who conirects tor such prolect with a contractor(s) license pursuent to the Comractors License Laws.). ❑ I em ezemgt under sec. Busineu and Professions Code for thi5 rea5on: Owner ID venfietl by driv�icense. .�s ❑ No Drivefs License No. VedlicetlOn of Ownershi b K� -�—� p y(rype ol document, i.e. � pmperry taz bill or aeetl�: DIVISION OF INDUS7RIAL SAFETV PERMIT CERTFICATION: ❑ I hereby cenily thet no excavation iNe (5) or more tee� in depih into which a pereon is require0 to descend, will be made in connection wi�h work authonzed by Ihis permit, and that no builGing sWcture, scaXolding, talsework, or demolition or dismantling thereot, will be more than thirry-six (36) feet high. (Chap. 3.2, Gry 2, Art 2, Sec. 341, Title B, Celifomla Adminisiretive Coae). ❑ As owner�bulltler, I will not employ enyone to tlo work which would require a permit fwm the Division ol Intlusirial Safety, as notetl above, unless such person has a pertnit to do such wark Irom Ihe division. Signature: Date: Division ol Induslrial Sefery Permit Number: CERf1FlCATE OF COMPLIANCE AND AUTHORIZATON OF ENTRY: I cenity under penalry of perjury that I have read ihis application antl sta�e ihat the information given is wrrect I agree to comply with sll stete laws end ciry ordinances retating to building consiruction, end amhorize represen�atives of ihe Ciry of Costa Mesa to enter upon the above- wperty lor insp c' n puryo es. I egree no� to occupy or allow occupancy of any building authonzed by this permi� until final inspection. c� /S a/ __—t ^ Sipnature OI Leqal Owner(s) Date � AnC/Or Aut�orizetl Applicant COOE �. INSPECTIONTYFE 1616 Fized System Final Fire Prevention 1268 Pool Spa Final 200 Final Re-Rool 201 Final Block/Retaining Well 202 Final Fadory Fire Plate 203 Final Sign 2�4 Final Damolition Qej$ �$ �� INSiELTI0NTY7E 206 Final Mec�anical 208 Final Plumbing 210 Final Elecirical 212 Final Fire Prevention 220 Final Planning Approval 222 FinalSite 250 Final Building/Occupancy P� € J1� (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa��LDING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 384 LA PERLE LN Suite: Vicinity: GARAGE Parcel Number: 42531204 Applicant: HAGGSTROM, RODNEY L Address: 17947 SUN HILL DR YORBA LINDA, CA Owner: EL-SADEN, M R TR Address %CFG INVESTMENTS, INC 17220 NEWHOPE ST SUITE 224 Contracror RODNEY L HAGGSTROM Address: 17947 SUN HILL DR YORBA IINDA, CA Zip: 92886 Arch : Address: Zoning: Phone: (714) 528-2797 Zip: 92886 Phone: Zip: 92708 Phone: (714) 528-2797 License: 553310 Eng: Address: Phone: ISSUED BY: Status: ISSUED Applied: 12/04/2000 Issued: 12/04/2000 Phone: Zip: License: License: SCOPE OF PERMIT CONVERT EXISTING NON-PERMITTED GARAGE CONVERSION BACK TO ITS ORIGINAL USE, PER CODE ENFORCEMENT. REMOVE EXISTING SLIDING GLASS DOOR, INSTAIL NEW DRYWALL TO CREATE 1-HR FIREWALL, ADD NEW WALL TO CREATE NEW WALK IN CLOSET, & INSTALL NEW GARAGE DOOR. Plan Check: $0.00 Permit: $54.00 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $54.50 SETBACKS MAINSTRUCTURE Front 0-0 ACCESSORY Front 0- 0 PARKING Existina: o NOTES: Rear 0- 0 Rear 0- 0 Required: 0 FEESUMMARY Calc Valuation: s�,soo.00 Claim Valuation: Si,soo.00 PLANNING & ZONING Lek 0- 0 Right Lek 0-0 Right Proposed: 0 �• NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitornia statutes and related regulations. (Ord. No. 92-28, § 1, 72-21-92) EXPIRA710N: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned for a period ot 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 requlred inspectlons and final approval must be obtained. Failure to obtain inspections and tinal approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 zaas-as �s�oo� WORKERS' COMPENSATION DECLARATION: � � I hereby attirm unaer penalry of perjury one of the lollowinq declarations: ❑ I heve entl will maintain e certificate ot consent to selt-Insure for workars' compensetion, as pmvided tor by section 3700 of the La6or Code, tor the peAormanca ot the work far which this permit is issuetl. ❑ I heve and will maintain workers' compensation insurence, as required by section 3700 ot Ne labor Cotle, for the pertortnance of lhe work for w�ich this pertnit is issuetl. My wollcers' compensatlon Insurance carder and policy number are: Cartiar: Poliry Number: (This sec(lon need no( be completetl il (he Oerm/t is valued at ane hundretl tlollars ($100) or IeuJ Ihat in tha pe a e of ihe work lor which sallon la i Ca' mi�nd egree that Ii I sl THIXISAND DOLIARE (5100.000), IN ADOITION TO THE CQST OF LICENSED CONTRACTORS DECLARATION: I hereDy eHirm thabl.am licensed under provisions of Chaptar 9 torceandenea.�Lic.u-% S� 33�U I shall not employ any person in any manner so es to become suDject to the workers' to Ihe workers' compensation provisions of Section 3700 oi the Lebor Coda, I s�all forthwlth �� oate: ^ � 2 ' y— �u IS UNLAWFUL AND SHALL SU&IEGT AN EMPLOVER TO CRIMINAL PENALTIES AN� GVIL FlNES UP TO ONE HUNDRED �TION, DAMAGE$ AS PROVIDED FOR IN SECTIIXJ 3�O60F THE IABOR CODE, INTEPEST, AND ATTORNEI"S FEES. with SeClion 7000) of DiviSion entl mv license isin full CONS7RUC710N LENDING AGENCV: ❑ I hereby attirm Ihat there is e consirudion lending agency for ihe peAormance of ihe work for which this permit is issued. (Sec. 3097, Civil Cotle). Lenders Name: Lender's Atldress: Signeture: oate: OWNER•BUILDER DECLARA710N5: I herehy effirtn that under penalty ot perjury ihat I am EXEMP7 FROM 7HE CONTRAC70R5 LICENSE LAW for ihe tollowing reason (Sec. 7031.5, 8usiness end Professions Code: Any ciry or county which reduires e permit to construct, elter, imprwe, tlemolish, or repair any structure, pnor �o its issuance, also requires the applicant ior such permit ro file e sipned atatement �het he or she Is licensed pursuant to the provisions of Na Contracrors License Law (C�apter 9(commencing with Sectlon 7000) of Division 3 of ihe Business anA Protessions Code) or thet he or she is exempt therefrom and ihe basis tor the alleged exemption. Any violation oi Section 7031.5 by eny applicant for a permit subJects Ihe epplicant to e civll penalry of not more than five huntlred tlollars ($500).): ❑ I, es ov+ner of Ihe property, or my employees wi�h wages as their sole compensation, WILL DO THE WORK, antl the siructure is not Intendetl or ofleretl for sale (Sec. 7044, 8usiness antl Pmtessions Code: The Contractors License Law dces not apply to an owner ot properry who builtls or improves thereon, and who does suc� work himselt or herself or through his or her own employees, provided that such improvemenis ere not intendetl or otteretl for sale. It, however, ihe builtling or improvement is sold within one year of completion, tha owner-builtler will have the burden of pmving Ihat he or she did not build or improve for purpose ot salaJ. ❑ I, as awner ol t�e property, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to consiruct tha project (Sec. 7044, Business and Professions Cotle: The conirec�ors Llcense Law tloes noi apply to an owner ot property who Duilas or Improves thereon, and who contracts for such pro�ect with e coniractor(s) license pursuam to iha Contracbrs License Lews.). ❑ I am e:empt untler sec. Business and Professions Code for this reason: Signeture: Date: Owner ID verilied by drivers license. ❑ V85 ❑ No Dnver's License No. Vedfication oi Ownership by (rype of document, i.e. � pmperty tax Dill or tleetl): Expires: DIVISION OF INUUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby cehify that no excavation five (5) or more feet in tlepth into which a person is require0 to descentl, will be matle in connection with work euthonzeC by this permii, end that no building strucWre, scaHolding, falsewoB, or demoliiion or tlismantling Ihereot, will be more than thirry-six (36) feet high. (C�ap. 32, Gry 2, Art 2, Sec. 341, Title B, Celifomla Administrative Coda). ❑ As owner-bullder, I will not employ enyone to do work which would require a permit irom ihe Division ot Indusirial Safery, es notetl above, unless such person has e permit fo do such work irom ihe division. Signature: Date: Divislon ot Intlusirial Safety Permit Number: CERTIFlCATE OF COMPLIANCE AND AllT}iORVJ1TON OF ENTRY: I cenity undar penalry oi perjury that I have read ihis application end sta�e that ihe infortnation given is correct. I agree to comply with all state laws entl ciry ordinances relating to building construction, and authonze representatives of ihe Ciry ot Costa Mesa to enter upon the ebove-descnbed p�rry ior inspection purpases. I egrea not to occupy or ellow occupancy of eny building authorized by ihis permit until final insDection. yQOE �. INSPECTION TYPE 1616 FixeO System Final Fire Prevention 1268 Paol Spe Flnel 200 Flnel Re-Rool 201 FInaI BIocWRetalning Wall 202 Final Factory Fire Place 203 Finel Sign 204 Finel Demolition PdIE ItIIII195S COOE 1 INSPECTION TYPE 206 Final Mechanical 208 Final Plumbing 270 Final Elecincal 212 Final Fire Prevention 220 Final Planning Approval 222 FinalSite 250 Final BuiltlingiOccupancy Q� � 0 � August 21, 1968 Costa I�sa Planning Department City of Costa Mesa P. 0. Box 1200 Costa Mesa, California 92626 Dear Sir: • I will provide parking on rqy lot at 386 La Perle Place for 2 cars in addition to my garage if needed by the City. Very truly yours, �9��.�.�.. i �tiV��,Qfl Lillian T. La Perle �-�r�%! �o�.,✓ CL�cC . C- . `l-r� . RECEIVED CItY OF COSTA MESA PLAN�IM(; Df.Pi. A.L^ 2 ' 1968 AM Ph� 7i3,9�10,11„2,I,2,3,4,5,6 � 1 � OWNER �p pEg�,E� LIIS,JAN �JOB ADDRESS �g6 La Perle E GENERAL CONTRACTOR Charles �Q AP No. ]17-2�+-42 LOT �� I.";,�2,;i.��CTI0N5 � '�,�t.s2.z. ��T7rz WATER ROUGM PLUMBING PROP. SWR. LINE � HOUSE CON. � SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING ANO AIR CONOITIONING TEMPORARY SERVICE OR POLE UNDERGROUN� � POWER � ROUGH WIRING TftENLHES � FORMS � STEEL REINF. FLOOR SVSTEM BON� BEAM ❑ STEEL REINFORCE ❑ SHEATHING FRAME ANO FLASHING LATHING - IN � OUT n PLASTER, BROWN COAT STRUCTURAL, FINAL H� '�G, VENT., REFRIG. ANO A.C., FINAL F NG, FINAL AND GAS TEST n DATE SUBCONTRACTOR � , . QOSTA MESA B IN �ETY DEPARTMENi �'1'2'6 v�Qi� 764 0�***2.�0 P.O. BOX 1200 COSTA MESA� CALIFORNIA 92E20 - OWNER I:G} G n„ ROUGH PLUMBING PROP. SWft. LINE OUSE CON. SPRINKLING SVSTEM POUGH HEATING NN� AIR CONOITIONING ONOERGROUND U POWER U ROUGH WIRING � j' TRENCHES � FORMS � STEELI FLOOR SVSTEM BON� BEAM n STEEL REINFORCE SHEATHING FRAME AN� FLASHING LATHING — IN ��}� f PLASTER, BROWN COAT M� VG, VENT., REFRIG. ANO A.Cr.-,� �FINAL F ,ING, FINAL AN� GAS TEST y-� DATE 1�._u_� BUILDING PERMIT FIRE ZONE VA SUBCONTRACTOR . �� - 284�1 p-, � COSTA MESA BUILDINGSAFETY DEPARTMENi P.O. BOX 12W COSTA MESA, CALIFORNIA 82610 J for Appllcont fo Ftll /n Complataly �TYPE OR PRINT eui�o�no •. ADDRESY COSTA ME3A, CALIFORNIA OWNER MAIL i .� .. ci —� . . / .. . ' " OF LOT � r �(j � I NO. oI �LOot. NO W On �,OT ^ USE OF �- EXISTIN6 BLDO. YETeACK LIX[ I110Y cBNT[R O� tTR[R � R[AR YA O HIDQYARDI LBRi RIOFf(' r DESCRIPTION OF WORK n �i EXTERIOR 1 HEqEBY ACKNOWL6O06 TNAT 1 XAVi I�ND BTAT6 TXAT TH8 �OOVC It COppl PLY WITX ALL CITY ORDINANCi� AND I OUILOIHO CONHTRYGTIO SIGNATUREOP � /�,� PERM1TT66 AUTHORIZCD AC6fiT APR -3- .68�p ;00 141+ *** 108.00� APPLICATION FOR PERMR BUILDING For Office Use Only 11[C[IM' NO. � PbIT NO. � .� ___. �,�,�vin ZONING [ NO.O� YY[OIN[W �(� � ;'l �NND � lUILDINY� CRITON � � �r � � I %y,� / � ILL C ' L +' ..Np. 1i7-- z,��4- A2 f6: NOHAViOV[RHAN68HALLBELE86THAN ' TO 9ID6 S NBAR P. L �EH .OWaD tU.B.G.REQU1RSMfiNT1 YARODMPROV[D YARDSMPROVBD MAIN BUILOINO ACCEDSORY BUILDINO oisrwNcc eir. _ esr. i MAIN BLD AGCE VAR.� �_- DATE / U'U s�4, i THH 11MOUNT O �UPPOCB OP I VALUA710fl ` s,�`� S/ - T �, a , �� VALUATON 18 POR TH6 A PERMIT FEB ONLY. .,� : . 1c�3�3 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 317 COSTA MESA. CALIFORNIA fOR APPL/CANT TO f/LL /N COMPLETfLY � TYPE OR PRINT BUILDING � ADDRESS � COSTA MESA, CALIFORNIA MAIL �� i // � A�pRE55 �I(iLC.-P/ TEI. CITY NO. AR� �ECT LIC. Of INEER NO. ADDRESS ° STATE CONTRACTO � LIC.NO. ..,..e«� n- vYn _ 1�� , , •�_ M . -P tecn� LOT I DESCRIPTION NO. ' A.P. NO. � r/ ��ZE„r .P>> � 9c � SETBTGK LINE FFOM FEE RECEiVE� R-i� —s� vsc fINANCE DEPT. CITY OF COSTA MESA,,,,, . APPLICATION FOR PERMIT BUILDING � � fo,e oFficE usF oNcy I RECEIPT NO. I //�R� /NO. RECEIVE� BY DATE RECEIVEO DqTE ISSUEO ��;�' �,9-,� S� � 9-- a� BUILOING � � AODRESS COSTA MESA, CALIFORNIA FIRE ZONE TYPE �/ GROUP � , APPROVED . . BY DATE ZONING � ZONE NO. OF u5E OF NEW //) � PLANS BUILOING 0////J/� �_ �� j � �10 -.� O APPROVED BY DATE �o. oF a�o�=. y yqRDS Now orv tor REQUIRED ICENTER LINE ST.) ='J ' FRONT EAR YARD __. R. SIDE DESCRIPTION OF WORK I✓ I ALTERATION I II AODITI :r�r.»F-�:i 5 ZE�ING �/, �'1 � ��ROOMS � STORIES / 4 7 EXTERIOR WAL�{.�, _ I ROOF ' � COVERING �ct,Cac,r� GOVERING USE OF BUILDING AND WORK TO BE P�RFORMED I NEREBY ACKNOWLEOGE THqT I HqVE READ THIS APPLICATION ANO STATE THpT THE ABOVE IS CORRECT ANO AGREE TO COM� PLY WITH ALL CITY OFDINANCES ANO STATE LAWS EGULqTING BWLOING CONST �ON. SIGNATURE'OF Q t i / PERMITTEE � � AUTHORIZED AGENT�(,.(�j`�Q,f"�(„Q/ V�� , f //`/.�// � � //�. �THE�AMOUNT SHOWN UN�ER VqLUAT10N IS FOR THE :PVRPOSE OF ESTABlIBHING A PERMIT FEE ONLY. VALUATION �0 _ .: PERMIT FEE $ ,,, $ ;j��5 p PLAN CHECK $ � D � J / � :' TOTAL FEE $ � � � �n�