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Home My WebLink About297 LILAC LN - Building Permits r c.c4 CITY OF COSTA MESA 4 ? misp.'t,� BUILDING DIVISION r ' DEVELOPMENT SERVICES DEPARTMENT PER NUMBER „ s# PERMIT E99-00650 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 297 LILAC LN Status: ISSUED Suite No Applied: 07/13/1999 Vicinity: WEST SIDE OF SFD Issued: 07/13/1999 Parcel Nunmber: 42615109 ISSUED BY: h Applicant: ASHLEY, ROBERT W TR Address: P O BOX 10224 - . Phone: (949)767-1884 COSTA MESA,CA Zip: 92627 - - , Owner. ;.'ASHLEY,vROBERT W TR - Address� P 0 BOX 10224 . ' i . Phone: / ` '-COSTA MESA,_ -CA Zip: 92627 .1 V / - , Contactor:- , - _ . Address: ' - - Phone: - - S - ' Zip: , , License: � l _ ' SCOPE OF PERMIT , RELOCATE ELECTRICAL SERVICE METER FROM EAST SIDE OF SFD TO WEST SIDE OF SFD. r i FEE SUMMARY Y • Quantity _• _ Quantity t ISSUE FEE $22.00 -- - Temp Dist System/Lighting $0.00 0 , • .Temp service test - • $0.00 - Busway/100 ft : $0.00 0 1, Res.a/c package ' $0.00 Standing Section $0.00 0/ NewRes(1-2 units) . • $0.00 - " 0 Misc Electrical Equipment $0.00 0' New Res(3+units)` $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa (.', •,'', ', , $0.00 0 up to 10 kva/kw ' $0.00 - 0 , , Lighting'Fixts. .. ': $0.00 0 - up to 50 kva/kw $0.00 • 0 " Recept Outlets ,$0.00 0 • up to 100 kva/kw _ $0.00,- 0 ' Switches ,•v $0.00 0 over 100 kva/kw $0.00 - - 0 Non Res Appl. \$0.00 . - 0 " - ' Low Voltage Equipment $0.00/' 0 - ' Res Appl ' $0.00 O,. .- •: Low Volt Wiring System/Ckt.• • $0.00 0 - . Service to 200a. , -. .$27.25 - 1" Misc.Conduit - - $0.00 0 - Service to 1000a $0.00 0 Misc:Conductor $0.00 0 - Service over 1000,a= - $0.00 0 . - Circus(gen or ride) $0.00 . ' 0 Motors to 1hp . - $0.00 0 , . Circus(mech ride br lights) $0.00 0- , Motors to l0hp - $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp . . $0.00 0 - Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $49.25 Intermed Pole $0.00 0 COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related I 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 Irequired Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 • • DECLARATIONS f m -) WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: • ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. .- ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. My workers'compensation Insurance carrier and policy number are: - -- Carrier:. • Policy Number: (This section need not be completed if the permit Is valued at one hundred dollars(6100)or less.) .- ❑ I certify that In the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is In full force and effect.Lic.0 Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to Its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ ' I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or Improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pur t to the Co tractors Licens Laws.). ❑ 1 am exe n of sec. Business and Professions Code for this reason: Signature: Date: 9 — /3 - 9"9 Owner ID verified by driver's license. ❑Ye ❑No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thIrty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a ' permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes 0 No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes U No (Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and-Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to campth :I state aws a d city ord• ances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described prop: •r i •ectlo. .urpy�s.I agr no occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owner(s) / Date And/Or Authorized Applicant Date 800E P INSPFCTIONTYPE PATE INTTRAL$ CODE II INSPECTION TYPE PATE INTRIAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing n 200 Final Re-Roof 210 Final Electrical n Rik k 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval• 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 2446-46 :IS . � 4CITY OF COSTA MESA . • }?' '�, BUILDING DIVISION • F !r DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER J \// PERMIT \V/ B99-00556 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 297 LILAC LN Status: ISSUED Suite: • Applied: 04/22/1999 Vicinity: - Issued: 04/22/1999 Parcel Nunmber: 42615109 Zoning: /� Applicant: EDELEN, WILLIAM ISSUED BY: CAL I s Address: 03220 RIVERSIDE DR l Phone: 909-622-9580 CHINO CA Zip: 91710 Owner ASHLEY, ROBERT W TR Address P O BOX 10224 Phone: COSTA MESA,CA Zip: 92627 Contractor: CURTIS CUSTOM POOLS Address: 03220 RIVERSIDE DR Phone: 909-622-9580 CHINO CA Zip: 91710 License: 661075 Arch : Eng: RON LACHER Address: Address: • Phone: Phone: 714-630-6114 Zip License: Zip: License: SCOPE OF PERMIT CONSTRUCT GUNITE POOL AND SPA. FEE SUMMARY Plan Check: $154.21 Calc Valuation: $16,000.00 Permit: $237.25 Claim Valuation: $16,000.00 SMIP Res: $1.60 SMIP Corn: $0.00 Other $0.00 Inspection: $0.00 Total: $393.06 PLANNING&ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right. 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: INOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12.21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. IINSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. I FOR INSPECTIONS CALL: (714)754-5626 i 01 V DECLARATIONS () ) • WORKERS'COMPENSATION DEQLARATION: • I •_ 1 hereby affirm under penalty of perjury one of the following declarations: 0 I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of.the work for which this permit is issued. 2-- I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. My wo mmensatlo Insurance carrier and policy number are: CO .1 Carder: Policy Number: (.(� ,36 (This section need not be corn feted if the permit/s valued at one hundred dollars($100)or less.) ❑ I certify that In the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree at if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisi Applicant Signature: Date: 'y�n 9 /p WARNING:FAILURE TO SECURE °FINERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100.000),IN ADDMON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licens7�f der Avi of Chapter 9(commencing with Section-7000)of Division 3 of the u iness Prgfess"Iin Code,and my license is in full force and effect.LIc.I to Aviv 7 Class K / Contractor's Signature: YP(.x / Date: h1/7, CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.My violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ 1,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ 1, as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-properly tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,faisework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes ❑No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No (Section 25533 of the Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes 0 N (Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes L.)No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 W III any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (II yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above Is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. „...7;,..4)49^9 tura Of Legal Owner(s) ' 1 y a 24, ate \/ And/Or Authorized Applicant Li !irate JADE 4, INSPECTION TYPE PAIS INIDA45 CODE( INSPECTION TYPE PATE INTTIALS 1616 Fixed System Final Fire Prevention 208 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing• 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site • 204 Final Demolition 250 Final Building/Occupancy 2446.46 Cr _.!.r'— :I c:I =mac^_• ---_e::^ - . a : Girt-:a• ("•-': ice?ntcc=:nq St eel ( ) 31Ettb TO: CDSITO., Csn 11. ‘\ Address : ;'JIIE.i: AS1-1LV . PROJECT: St..J 1rrvh . 11131.--'''.4) *Cart .9a . Address : ‘)..t) Ls lel 1-04 Permii t No. 1\11 cnc s Architect: C Lkq+/s nth, Contractor: C.LtrT RA ) Address : address : _ • Engineer: ( tlAr4 Subconcrac:or: 'V&A) (Gunl ce) Address : Masonry cr Concrete) Insoac tor: k(�� Andress : PV.,,. c leAVO Mix Used: �•a ) RE EIVED s!uma , inenes : CITY OC COSTA MESA Admi x cure : —fa) RI III.DING DIVISIfN Nasigned Strengcn , PSI f1.)L� r JUL 13 1991, Cu. Yds . Ho. of _ • Yrr;� _ ,.. ,.:41; . SATE: P !aceo Cris . II .Aenarks S CLUZ1o1AuJi l > wo�(r�� :7.aits of le=or:s to: (Indicate which 31dg. Oaot . c furnish address of any lot • ; stea) • ll S.2 93 American Standards Testing Laboratories 4246 PHLOX STREET DOWNEY, CALIFORNIA 90241 (562) 862-3772 COMPRESSION TEST REPORT RECEIVED CITY OF COSTA MESA FI in DING DlvrctnN TEST MADE FOR: Max Sitter AUG 11 199J P.O. Box 3454 Fullerton, Ca. 92631 JOB IDENTIFICATION: 297 Lilac Lane, Costa Mesa LOCATION IN STRUCTURE: Swimming pool & spa — deep end. FIELD DATA Mix Designation: 42-1 Specified PSI @ 28 Days: 2000 Admixture : None Slump: NI Concrete Plant : *Vern Anthony Samples Made By: Steve Cement Type: , Portland., . Date Samples Delivered: 7/16/99 by Client Date Cesti 7/6/99 :,. LABORATORY DATA-- Gunite ___ ._ LAB. NO. MARK DATE - AGE ' AREA COMPRESSIVE REMARKS TESTED DAYS STRENGTH PSI 1668 IC 7/20/99 14 13.85 4060 Q /. �IatCei byc ✓ NO. ,;; Qu003955 x • . • • . ' . • . . Respectfully St • ' tu pl.3.31.2003 * \fC y \Q. 7j 1 ACS 2r 1 Liseckas , P. E . �" .. �.l- • CITY OF COSTA MESA FI) BUILDING DIVISION PERMIT NUMBER ' DEVELOPMENT SERVICES DEPARTMENTta. , �,• PERMIT !`,V/ M99-00196 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 297 LILAC LN - Status: ISSUED Suite No Applied: 04/22/1999 Issued: 04/22/1999 Vicinity: Parcel Number: 42615109 Cao (cr ISSUED BY: Cao Applicant EDELEN, WILLIAM Address: 03220 RIVERSIDE DR Phone: 909-622-9580 CHINO CA Zip: 91710 Owner: ASHLEY, ROBERT W TR Address: P O BOX 10224 Phone: COSTA MESA,CA Zip: 92627 Contractor: CURTIS CUSTOM POOLS Address: 03220 RIVERSIDE DR Phone: 909-622-9580 CHINO CA Zip: 91710 License: 661075 Arch/Eng: • Address: Phone: Zip: License: SCOPE OF PERMIT CONSTRUCT GUNITE POOL AND SPA.MECH ,RE:B99-00556. FEE SUMMARY Quantity Quantity ISSUE FEE $22.00 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $13.25 1 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0 Inst/Rep.Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace $0.00 0 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box $0.00 0 .30 To 50 hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct $0.00 0 Over 50 hp/Over 1,750 BTU $0.00 0 Appliance - $0.00 0 Boilers Fire Dampers $0.00 0 Up to 3 hp $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0 • Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $35.25 COMMENTS I SPECIAL CONDITIONS NOTICE: The.work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. IINSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. 1 FOR INSPECTIONS CALL: (714)754-5626 DECLARATIONS l / (-) WORKERS'COMPENSATION DECLARATION; I hereby affirm under penalty of perjury one of the following declarations: 0 I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. have and wit maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. My work/erss'empenssatii Insurance carrier and policy number are: 9() / 3 Carrier: Lint! o-eerypl Policy Number � g11 5. (This section need not be c plated if the permit is valued at one hundred dollars($100)or less.) - . ❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agr a that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these Pans.d�an�s.� �/ (, Applicant Signature: C- 4LL Date: / ZZ/7 ! WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,00 ).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am lice ed/u er Lro ess a ns of Chapter 9(commencing with Section 7000)of Division 3 of the Businrofessio C e,and my license is in full force and effect.Lie.# �f)jd / /7 Class# C � G- Contractor's Signature: Date: t7//2249 9 CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.My violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the properly,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of properly who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). . ❑ I, as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code:The contractors License Law does not apply to an owner of properly who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,Califomia Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apereit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LI No (Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Duality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with at state laws and city ordinances regarding Hazardous Materials and Emissions, Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described pro for inspect' ses.I agree not to occupy or allow occupancy of any building authorizC/J/gdby(his perm ntil final inspection. Signature Of Legal Owner(s) Date And/Or Authorized Applicant Date PORE I INSPECTIONTYPE OATS INTrRIALS CODEC INSPECTION TYPE Lt�R�I� 1618 Fixed System Final Fire Prevention 206 Final Mechanical /-ff-� /_ - 1266 Pool Spa Final 208 Final Plumbing • 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place • 220 Final Planning Approval - 203 Final Sign _ 222 Final Site 204 Final Demolition 4 250 Final Building/Occupancy 2446-46 A �. , � Yv L CITY OF COSTA MESA F t lIPERMIT NUMBER , BUILDING DIVISION J DEVELOPMENT SERVICES DEPARTMENT �; PERMIT %btoroE99-00333 • (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 • ELECTRICAL PERMIT Job Address: 297 LILAC LN Status: ISSUED Suite No Applied: 04/22/1999 Vicinity: Issued: 04/22/1999 Parcel Nunmber: 42615109 • ISSUED'BY: Cat' (S tO Applicant: EDELEN, WILLIAM Address: 03220 RIVERSIDE DR , Phone: 909-622-9580 •CHINO CA Zip: 91710 • Owner: ASHLEY, ROBERT W TR Address • P O BOX 10224 Phone: COSTA MESA, CA Zip: 92627 Contractor: CURTIS CUSTOM POOLS Address: 03220 RIVERSIDE DR Phone: 909-622-9580 CHINO CA Zip: 91710 License: 661075 SCOPE OF PERMIT CONSTRUCT GUNITE POOL AND SPA. ELECT,RE:B99-00556. FEE SUMMARY Quantity Quantity ISSUE FEE $22.00 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft $0.00 0 Res.a/c package $0.00 • Standing Section $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa $44.25 1 up to 10 kva/kw $0.00 0 Lighting Fixts $0.00 0 up to 50 kva/kw $0.00 0 Recept Outlets $0.00 0 up to 100 kva/kw $0.00 0 Switches $0.00 0 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $0.00 0 Misc. Conduit $0.00 0 Service to 1000a $0.00 0 Misc.Conductor $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1 hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 . Christmas Tree Stand $0.00 0 Motors to 50hp - $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $66.25 Intermed Pole $0.00 0 COMMENTS/SPECIAL CONDITIONS INOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1,12-21-92) IEXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. IFOR INSPECTIONS CALL: (714)754-5626 /-y V DECLARATIONS fl ) WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations:• ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. 8—'1 have and will maintain workers'Compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. My work poo�m.,penssa/ation Insurance carder and policy number are: p Carrier: CU7a'YJ./ - Policy Number. IA) Q$/iI 64 (This section need not bemisted I!the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these pr �isi�o/n]s�'��. Applicant Signature: �I�.cra'^^"' Date: y WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FiNES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am lic nsed under provisions of Chapter 9(commencing with D')� 2. Section 7000)of Division 3 of the Busl/r1�ess an.Profession§Code,and my license is in fulls force and effect.Lic.# � ' Class# `-'i5 t' Contractor's Signature: ^r..-- Date: y J),L� 59 CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lenders Address: Signature: Date: 'OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or Improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 6,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the givision. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the Califomia Health and Safety Code been fully complied with? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aaermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LI No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: • Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for Inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. re Of Legal Owners) I I Date Ci nd/Or Authorized Applicant ',`J/ Date cODE I INSPECTION TYPE PATE INmmALS CODE r INSPECTION TYPE pATTh INTT1AL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical / Q�� 4442- 201 Final Block/Retaining Wall 2t2 Final Flre Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition . _ 250 Final Building/Occupancy 2446.48 44410W' CITY OF COSTA MESA F I BUILDING DIVISION PERMIT NUMBER �sr�. DEVELOPMENT SERVICES DEPARTMENT � PERMIT P99-00241 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 • PLUMBING PERMIT Job Address: 297 LILAC LN Status: ISSUED Suite No Applied: 04/22/1999 Issued: 04/22/1999 Vicinity: /! Parcel Nunmber: 42615109 ISSUED BY: �t Applicant: EDELEN, WILLIAM Address: 03220 RIVERSIDE DR Phone: 909-622-9580 CHINO CA Zip: 91710 Owner ASHLEY, ROBERT W TR Address P 0 BOX 10224 Phone: COSTA MESA,CA Zip: 92627 Contractor: CURTIS CUSTOM POOLS Address: 03220 RIVERSIDE DR Phone: 909-622-9580 CHINO CA Zip: 91710 License: 661075 Arch l Eng: Address: Phone: Zip: License: SCOPE OF PERMIT . CONSTRUCT GUNITE POOL AND SPA. PLUMBING, RE:B99-00556. FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $22.00 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $54.25 1 Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Bdcr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank . $0.00 0 Wash Basin $0.00 0 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0 Drain, Roof $0.00 0 Shower $0.00 0 Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 Sink, bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) $0.00 0 Sink,kitchen $0.00 0 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 • Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 - REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $76.25 COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord..No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 /¢- V DECLARATIONS n fl WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. CI have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My wo . 'comp Insurance car rid polio' umber are: p Carrier: LQ.T Policy Number: W CL) 7 Fe/iffy (This sect! as no a completed lithe permit is valu t one hundred dollars($100)or less.) ❑ I certify that In the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provision ++^^ p Applicant Signature: V - Date: 'y7'2"2 /p WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS(S100,000).IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensedynperpr visions of Chapter 9(commencing with Section 7000)of Division 3 of the Business rofessi0ns CgQe,and my license is in full force and effect.Lia.p )pp ��e ) Q Class k / Contractor's Signature: 0,4) t,�✓ Date: y/ZZ/T CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the properly, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal t0 or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification end filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes LJ No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: • Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final Inspection. _/7 io pptte Of Legal Owner(s) H I z2Jc9 Date And/Or Authorized Applicant Date CODE I INSPECTION TYPE ILAIE INTmAL£ ODE E INSPECTION TYPE PATE thaW.MS 1616 Fixed System Final Fire Prevention 206 Final Mechanical Q 1266 Pool Spa Final 206 Final Plumbing /�l `6th 6a-;---0_ 200 Final Re-Roof _ 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 2446-46 F �l - " a t Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations. .. ' CQITY-OF''COSTA MESA - , P MIT-NO: ' ' `RACT NO. .LOT.^'A:, - :LDG.NO:' __1 - ' ,- _, .—- ^-' ' ' •CONSTRUCTION PERMIT �—'4S a `-ia ala -_ 6655 ''8/24/82 - -- 30.00 'TL '11 Project Address 21;11 LlLq C. LA) - - ' • TYPE OF C,OJISTRUCTION . • . ;t: ,�I s Owner ^_'u0 IIPY�,..r • Phone ,••4/,ql '❑ NEW /ILLYADD ❑,ALTERATION - Hie - '- - „ - - c`O( •Address- (i,Jen jr 4L; ❑ REPAIR ❑ CONVERSION DDEMOLISH r' �J a .❑OTHER' i t 1 •Arch/Eng. - - License No. A P - A\ IAddress"- - - DESCRIPTIONOF'WORI( �� • ;he' .4� L(r. '� / �•"• �% '� E � •LNG REF.7�„ "'Contractor-- -- - -Phone �� • •• — ._ ._ .-_ _ - _ _'B p -; _ ., �. � 0�'�.a5 � TYPE OFPERMIT - - -• --'�' 'G 'I DING �. s - ,i r __ �_ -SIDE YARD L T. 1P60 'TV LINE 'Address y!'Ri ,S.— (/�Qly`� s (y ILLS ❑ GRADING• ❑ FOUNDATION ❑'STRUCTURAL- - ASIDE VAftD LICENSED CONTRACTOR•DECLARATION {a" L _ I hereb9 affirm tt I am licensed under provisions of Charter 9,(com ❑ TENANT ❑- ECTRICF�L ❑ TNG--❑MECHANICA 1 MIGHT A'•a %A hamencing with•section. 7000):of-(Division• 3 of'-the Business 'and- - OTHER-- - .._ _- Professions_Code;; an license is ull force effect 0 dECT•D ESCRIP,TION _ , _y _ REAR YARD(TO P/L) O _ License as Li ,ieiro 1ls . 1 . --'I PKG.SPACE REQ " PROVIDED a9 „strt . ...._.,,t-.. I SG FT. •m^ri' �. Date ' •�r' gnature" .. - .,r ' ," - STREET WIDTH ^- PARK FEE $•- i ` • WORKE'S'.CO PENSATIONDECLARA . a ._. _ OCCUPANCY_CONSTRUCTION TYPE_ I hereby affirm that I have a certificate of consent to self insure ora '', "'ZONING-APPROVED'By /��/( >� DATE(✓� p� rtificate-of Workers'-Compensation--Insurance, or -certified-'copy VALUATION ZONE 1/lKsl4 ll•T ' ['7/�-_Cl f-• reof( eco n 38 ). t `SPECT AL'CONDITIONS T e. ., ��Q.�N -1 // �.�- GRADING CV ;YDS. ACRES olicY No. ZCo mpanY Z`Y - _- ___t__ - ertified.copy is hereby furnished. _ - _- . _ _ ."..• ! 1 CONSTRUCTION AND PLANNING Ps a{ , ' . POOL&SPA - Date Inspector ' - - - Date__.. __- Inspector APPROVALS Permit # APPROVALS. Permit# 1. Temporary Electrical Service or Pole 43. Pool & Equipment Location- - - ' 2. _Soil Pipe-Undrgrn_.• 44. Steel Reinforcement-- . . - - 3. Electrical Conduit Utility-Undrgrn- :. k • - - 45. Forms - - - 4. Electrical Conduit-Undrgrn _ - _, t . _ 46. Electrical Bonding . - - -- •- - - - _5. Steel Reinforce, 47. Rough Plumbing & Pressure Test - ' -%44)-10.- h 6. Electrical UFERGrn r_. . •_ _ _ 48. APPROVAL TO COVER-GUNITE - - r - --- -- • - - 7. Footings • _ _ • - _ 49. Electrical Conduit-Undrgrn' RA.' el-4-r.-1.�� " 8. _.Foundation. __• - .. 50. -Gas-Pipe,-C Undrgrn,Test - " / , __9. . Water.Pipe-Undrgrn _ . _ . . . 51. Backwash Lines, P-Trap. fl Undrgrn' ' ----" - . . .__10. Structural Floor System 52. APPROVAL TO DECK - _ . - _ I 11.-: Property Sewer-Line &.House'Cd'nriection_ - . _ . 53. Backwash & Receptor-Final ' .. 1 12.._Street Sewer-Connection,, _ ^,- . . . . . . _ - • • - 54. Heater& Vent-Final 13. Rough_Plumbing _ , - _ _ - -- ' --^ - - '55 'Plurnbiria System- Final - . - ' 14. Rough Electric-Conduit . - • . - - - -56. Electrical-Final - -- , ' 15. Rough Electric-Wiring - - " ' -- - - 57. Solar System-Final ,. • 16. Rough Heating &Air Conditioning - - - --= - • . - 58. Fencing &Access.Approval „ 17. Ducts, in Structure . . i .. _ 59. . APPROVED FOR PLASTERING • - ' , ' 18: Ducts, Ventilating. _ ' ' ' - _ 19. Gas Pipe-Rough &Test , _. _ - :-60. POOL/SPA SYSTEMS'F(NAL . , nn / ! 20. - Roof Framing - _. . . . _ _._ - _ . _. . - • . _ .. - �!/oLS �� ' •' 21. Roof Sheathing • ' - - - . _ - /n� -. 1 � •�., I,F p 1 0 NOTES. (J . ✓ 30 • l�1 r� t-g• 22: Frame and Flashing - ._ _ ,.� -. _ �G+j I C4"_' i3 •23. Insulation - -- - __ _ '� Uma. • L..ets.. /„:,A I-r-,a.4- Ca/r-: $-/33di 24: Lathing &.Siding. . - __ __ ' _ ._ • 25. - Drywall Nailing-- . - . . -- ._-- _. - . . . .26: Plaster-Brown Coat 'I' ' " ' ! `.,r ._ . .� • 27. Electrical Power Meter-Final . _ __ _ ._ . . -_ -• . ' • '- 28: --Final Electric • - - - - .. . . . - .... __. •• .: . 29' Final Heating & Air Conditioning ___ ... . _ . .. .' . _ - ' -30! "Final Gas Pipe-Test _ . _ _ .. ._ _ - _. • • - . , 31.` Final Plumbing _ .' . 321 Water Service-Final - - -- . . _._ . _ _ _ -__. - - _ . _.. . •' . 33: Gas Service:.Final - ._- • - _,--- ' • _ _ _ . . _ ,. • 34. Solar Domestic-Final rr.: - '•`' - - . . - ' ,�. .. - ' 35. -Landscape Sprinkling System • - - -- " -• - - ct 36. Sound Attenuation -� .• - ' 37. Handicap Regulations '. - • 38. FINAL STRUCTURE& BUIL_QING : , - • '• '. ;. t 39. Special-Requirements Completed " ' ` _ 40. Electric.Release to Edison -, _ ' ..-- - - 41. Gas Release to Southern California Gasto. - - - - ' - r . 42. CERTIFICATE OF OCCUPANCY _ - - -• - - - "' No:- Date - �_ - . . - - �-' -- - . ,34 i 4t ,• ..44.44.. i. ,,...? iv-1,.?„fA: 2:44lc.. 1,t4i. V.t.,,, !',...1.4.T..):1”,..:::..t.,,P..ItiFk':.,,?2VAI%-.4.7 ''41.*-1-VP',..gia‘.6"tiac.11.‘,NlYttriaticti-r,fokk `7 -g\C_Scis Del3t13,13. ii"t, . ,•,, , I , . 444444 " 4 I _,_. •...-. _44r ,. .....- , , i.• 3,4 • ..., / t . ..., 3 ... ..43"; 1 i . $.4-43 4, 3 Il 1 ' sr , , • .. 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F-02_. ft-, - Eff-itrat"/ Biartar 10-e' iccil-- , co-!eg- • ...,-,.-. tAftja) ROCK. WALL- _ li .r-,1 " wi-P eeck.cAp tb IN . Nevc, #64.trity,,,,p.I4w, . ...I - PLA Ql-to ti.ir k 440.--V-f-istc .-Nt -.:„,); _ . , /.;-1'jz:..,,•,-4j$4,.;tilps,:.A.. _ — iti ito :. '-e utiaeb FbC2At-14. Petit- id _ r.. . c Al .,-,se,,fri.t.• ,*:exiit,„;.4,, la II . ___ . .0-•-•3.AZI.t-iiint:il dr :a F irM 'tag Pcr st Ft-I& N: iii ktc ,:t4.2:44zcsattexi.,,Q-7:--, am fr4 X7Ct51) UP ----Th•- b -10 C15462, — "' , ]P:Le:\."0"YeketiVa, Vflti? r , . . • - -"i t‘-ii:PettiC..• Liter1.1 0,%1 ,t. . .) t t.:, dia .,- %s AtIt alba* L. "..- 1 1:P -I , (2)1.44a- - ,, •tibA44E ___. 7-2 box \ \e1;7,, 1 ____. za Nutt• . .. .., . -,,,, c..-:ir.,.., ..-tei7:777,77:2 if/;, -,••-t•ct.1 -- .21 I _ ri_isk,Ogi..611 • ' ,ty• . t At 1?)c-trit-ke.: *-;-..ci:'-,,, ! , — Mg oPtl,(511„ r,.?.:‘, l•- 4 FELM..„. , 1. __. HI; wAtv_. -at \-----/ - : n .. ' • $ S • ,i al to ti- err- r _ ,C0 Fen- (A(04c fOlI '3) kki "Ai 1., MEW EittaW, -„,..rogni-• cur Pe.. t-A4zeiTt3 t k•-) 4 - -- —I- -X- r i het le,-5S Si°c-- e AS PO e-- • n't4- I 1 ' ..2 'TviC M ___ . 'tied- At "1-- Rt{ (..• 4t- ...4 41.1 • • :Ea /DO ± otiufs-- - z Permit #.4eC_ __q_ 4 / . l' hott e46, -010€S1 2_906\Th k\VZ—• enun ti THIS NUMBER MUST AccomPANY ---)(il., Lc+ — brass -is.p At-P eArtp;cb.e.4., ALL INSPECTION REQUFSTS 0 hi Li- _________,_________ 230001-t- Dap ? ,,,.., . k ClaWs zk-\p trlr1/444-- 0 . ital Mu-i--EN laZ.et On. c..a. it 5E+8 c ‘' w vizi k..0, 4/ 2.G/01 0-1 PA .1 ti sr•-) • ...:,1 , 4.-.• .._ .. ko,,,,,6.e.--- 2- 1 -1 LA LAC l-do43E , ajcsV106\ NMer-o , A\ itIPSO Pa- - •irr , I:I 014 II 0 4.10.---• N. • ' Ocel-- , ,, V____ f- EQ 4.1:kt: IC fits ruck,. .,... ,.... ?7Ecz_coe• cPc9oL.c--- e-r-3 _ . Mc i pio 6, , 1 --- bt1b\ e • M 13.,•\ IC t- -c?r erc- , I V SA‘ • q--ic\ sunt,Wso- 141270-2_ 31( -49) i' ía! iti3.. el. "fte I As>..^-k 1 iii , matc8:::_tapt_icti:otinnoofs;snME:St.?.. I" 14 211 1:).6 _Ii ki•V Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. ______ ICL7 'F,COSTA MESA/ g0NST�tUCT ION PERMIT PE T'Nnle• - • TRACT NO. LOT NO. UNIT NO. • 6329 B/2'?/Z!' (�,ej,; "`I M:Prrjecctt Address OZ / 7 L/64'c- `ll. - ,,//,� - - ' _ - TYPE OF CONSTRUCTION ❑ NEW AL ADD L I ALTERATION. H REPAIR - ' • Applicant's Mailing Addrr s ,[n �� g- - .. • -J /et9D / '/LtCti Phone22�L/ ❑ CONVERSION ❑ DEMOLISH OTHER A.P.# • .1 Zone.Owner's NamerDESCRIPTION OF WORK/USE OF BLDG.A✓//Av -a%e�C�� Sia t-7-- Address 3/1/"UE- - - S Main Building: Accessory Building: • . Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING ❑ FOUNDATION ❑ STRUCTURAL .. T Front . • . - - O Address ❑ TENANT gE LECTRICAL CI PLUMBING ❑ MECHANICAL B Rear - ' ' ' ' - - ' N ❑ OTHER A I Contractor's Named SL.LC7'G/C Cp!>/J• Phone �¢�-y�li • .• q-'f PROJECT DESCRIPTION SQ. FT. OCCUPANCY •- C RightN Address(mailing/ 17. / ROArr'm .. 1,14 -te - CONSTRUCTION TYPE VALUATION $ _ G • Left City License No. R. ZONE • GRADING CU.YDS. ACRES LICENSED CONTRACTOR DECLARATION ` _ Ping. Ref. # Pafking Req./Provided • I M1ereby;affirm that I am licensed under provisions of Charter.9 (commencing Remarks: Planning Notes: • • M with section 7000) of Division 3 of the Business and Professions Code,and • I my license is in full f ce and effect. • • T "v License Class O eNo.'y�`��Z' - S' -lite 8'--2`/-Sr/ Signature2V7723—,..L....154:1-4,-tem.; • . PLUMBING ' - ' FEES . ; - ' _ ( NORKERS'COMPENSATION DECLARATION , - , N I hereby affirm that I have a certificate of consent to self-Insure or a certificate Bar Sink • Showers ELECTRICAL . FEES of Workers' Compensation Insurance,,or a certified copy thereof (Section , • �_ l 3800, Lab. - - - - • Backflow Preventer. Service Sink . . - a - Automatic Washer - Transformer-0 15-50 KW • - Policy No./� iV4 Yy Company 7ZEir'i 77+/ -�/vl CO Backflow Irrigation Sewer Cap - Construction Pole Sub. 0 50+ KW Certified copy is hereby furnished. , 1 • SL Certi led copy is filed with the city Bu'I n99 Division Bathtubs ' Sewer Connection ' ' Cooking Unit ' 'Meter [pup to 100,amps Date .(9--MV Applicant /��r /iYr-•rte _ yyyyyy . , EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers • Solar Collectors • • i Dishwasher I ,Meter y0over 100 amps��' �7 93 (This section need not be completed if the permit is for one hundred ($100) or- / less). Dishwasher Solar Piping Dryers ❑Gas DElectric Sub Panel • I certify that in the performance of the work for,which this permit is issued, I • shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Fan; Motors Do-i HP 0•1•4-'8 - , I Workers' Compensation'Laws of California. ; • Dale Signature Floor Drains - Swimming Pool w/Spa F.A.U. ,Inc.Solar 09-15 HP 016-15+ • NOTICE: If,after making this declaration, you should become subject to the - - - -- -- - Workers' Compensation provisions of the Labor Code, you must forthwith Floor-Sinks Urinal ' ' comply with such provisions or this permit shall be deemed revoked. - . . - Fixtures_ . ..... .Microwave . - CONSTRUCTION LENDING AGENCY -' l • Gas Service Outlets. Water Closet Device Boxes POIe Li h[ 1 hereby affirm that there is alconstruction lending agency for the performance - - - - 1 g of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets Ran e Lender's Name- _ g Lender's Address . Kitchen Sink Water Service - Switches Sign ' ' OWNER BUILDER DECLARATION r - -- ------ • I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories . ' following reason (Section 7031.5 Business antl'Professional Code: Any city or Garbage Disposal Standing Sections • county which requires a permit to construct,alter,improve,demolish or repair P-Trap - , - Generator 00-5 KW 05-15 KW Trash Compactor any structure, prior to its issuance, also requires the applicant for such permit to file a'signed statement that he/she is licensed pursuant to the provisions of Roof Drains , . the Contractor's License Law(Chapter 9 (commencing with Section 7000) of - - , Division 3 of the,Business and Professions Code) or that he/she is exempt • - _ • therefrom and the basis for,the alleged exemption. Any violation of Section • . • , • 7031.5 ,by any applicant for a permit subjects the applicant to a civil ' - penalty of not more than five hundred dollars($500). - $ 3 • LJ I, as owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee • • compensation, will do the work,and the structure is not intended or offered - Reinspection Fee $15 Issue Fee $ 3 for sale' (Section 7044, Business and Professional Code; The Contractor's (MECHANICAL • FEES • - License Law does not apply to an owner of a property who builds or improves __ __ - • thereon, and who does such work himself/herself or through his or her own . - DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such improvements are not,intended or offered for Boiler - Hood or Type I 0 sale. If, however, the building or improvement is sold within one year of com- Canopy Type II ❑ Zoning Approved By • - Date ' pletion, the owner will have the burden of proving he/she did not build or im- ' Duct-Under Ground Building Approved By Date move for the purpose of sale). • Ll I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued Bye Dat tractors to construct the project (Section 7044,Business and Professions Code: `� The Contractor's License Law does not apply to an owner of property who Duct- Ventilating 00.100,000 BTU 0100,000 BTU SUMMARY OF FEES builds or-improves thereon,-and•who contracts for such projects with a con- - , . . —. tractor(s) license pursuant to the'Contractor's License Law). I am aware that Exhaust System 0 Multiple ❑ System Repair/Alteratio• n BUILDING PERMIT $ SMIP $ • proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT ❑ I am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBG# PLUMBING $ ISSUANCE $ • Date ' Owner . ' ' Heating System& Ducting • PLAN CHECK 25% $ ENERGY P.C. $ • I hereby certify that I have read anis application and state that the above 00.100,000 BTU ❑100,00067 • ELECTRICAL $ /0 •SU GRADING $ information is correct- l agree to comply with all city and county ordinances and state laws relating to buildi g construction, and hereby authorize repre- - MICROFILM $ sentatives of'thi -city to ant upon the above-mentioned property for PLAN CHECK 50% $ inspection pun s./', - MECHANICAL ' $ 1 TOTAL FEE $ �a•CO Signature . C..0'. /�+�'- Date r�' u-fry ,, Drivers' License or SS# Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ • CMF 0865-46,rev.4/84 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod -Assessor ' '4CONSTRUCTION AND PLANNING 1-.....OL&SPA PPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location ' . 2. Soil Pipe-Undrgrnd. '53. Steel Reinforcement .3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. . 55. Electrical Bonding - 5. Steel Reinforcement . 56. Rough Plumbing & Pressure Test • 6. Electrical UF ER Grnd. - 57. APPROVAL TO COVER-GUNITE . - - 7. Footings - 58. Electrical Conduit-Undrgrnd: 8. Foundation - • 59. Gas Pipe, ❑ Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. • ' `10. Structural Floor System - •• 61., APPROVAL TO DECK . 11. Property Sewer Line.& House Connection - 62. Backwash & Receptor-Final 12. Sewer.Cap 63. Heater & Vent-Final • 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing - 65. Electrical-Final - . 15. Rough Electrical-Conduit - - 66. Solar System-Final ' 16. Rough Electric Wiring 67. Fencing & Access Approval - 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# • 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas' 0 Oil 23. Gas Pipe-Rough & Test - . - '72. Underground Flush 24. Roof"Framing73. -Undergrnd.Storage Tank'El Gas 0 Oil 25. Roof Sheathing - 74. Overhead Hydro ' ' 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical • 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation - - 78. FIRE PREV. FINAL . 30. Drywall NailingHEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat . • 79. FINAL INSPECTION I 32. Electrical Power Meter-Final80. FOOD CERTIFICATE ISSUED 33. Final Electric �3/�c� Notes: 34. Final Heating & Air Conditioning � I35. Final Gas Pipe-Test . 36. Hood or Canopy . 1 37. Final Factory Fireplace . 38. Final Plumbing ' 39. Water Service-Final 40. Gas Service-Final - 41. Solar Domestic-Final _ 42. Backflow Preventer I - • 43. Backflow Irrigation I44. .Landscape Irrigation System . I 45. Sound Attenuation .. . 46. Handicap Regulations - . 47. FINAL STRUCTURE & BUILDING - . 48. Special Requirements Completed 49. Electric Release to Edison . . I) 50. Gas Release to Southern California Gas Co , 51. CERTIFICATE OF OCCUPANCY - - Jo. Date / 1 • �•I ---_________ ADDRESS OF BUILDING: 297 LILAC LN WET: CITY OF COSTA MESA - BUILDING PERMIT -- DA'NERSNANElIOCNN: ASHLEY, ROBERT PERM -" -- - i,i`� ADDRESS: 797 LILAC LN NO: B 0837U9� COSTA MESA,CA 92626 PERMIT NO: B 083704 PLAN CHECK NO: N GOVT: N SUPP : N APPL.NAIUNGADORES& CONSTRUCTION TYPE; V-N PERMIT TYPE: STR PURPOSE: OTH ARCKRECT OR ENGINEER: _ LIG Na: JOB DESCRIPTION : T/OFF SHEATH & REROOF W/COMP SHINGLES SQ FT: 5, 949 ARCA.OR ENG.'S ADDRESS: WIT: CLAIM VALUE; 5, 949 . 00 CALC-VALUE: 5, 949 . 00 GROUP OCC: R-3 / COKTRACTapSMAE: DAVID ROOFING CO ( 714 ) 636-4515 WIITRACTORSMN@IO 11861 GAIL LN COMMENTS: REROOF 3200SF RESIDENCE W/COMP, SMOKE DETECTORS REQ PER 94UBC ADDRESS: GARDEN GROVE CA UC,IC: 509824 *********N*****NN******NSE***N***>E xat***+ *******#********±c******+t**SE******N***$ 92840 UMr: ZONING R EQU IR EMENTS LICENSED CONTRACTORS DECLARATION:I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 S ET BACK S (commenting with Section 7000)of Division 3 of the Business and Professions Code,and my license is in fun face and effect. CITY LIG.NO.: 069144 UC CLASS: C 39 UC.NO 509824 EXP : 01 /98 MAIN BUILDING ACCESSORY BUILDING Date: 7 is-y7 coon a« r ice(//�� FRNT: FT IN REAR: FT IN FRNT: FT IN REAR; FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN OWNER BUILDER DECLARATION:1 hereby affirm under nicely of perjury that I am exempt from the Contracture License Law 1«the following reason(Section 7031.5 Business and Professions Code:Any city«county which requires a permit to construct,atter,improve, PARKING REQ: P RO V: PARCEL: 42615109 Z N E: REF NO: 1 demolish.or repair any structure.prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law[Chapter 9(commencing with Section 7000)of Division 3 of the PLANNING NOTES/ (.--- • Business and Professions Cole)or that he or she is exempt therefrom end the basis for the alleged exemption.Any violation of Section > 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollen[MOD. ************** ******************-********************************** i *** ❑ I.as owner d the property or my emploes yewith wages as their sole compensation,will do the work,end the structure is not intended *n ****** ooferedforsale(Section7044,Business and Professions Contractors D E �. E jL OP MEN T SERVICES REQUIREMEN ,T S who builds or improves thereon.and who does such work himself or herself or through his improvements her own employees,provided that such _ • improveents are not intendedoroffered for sale.If,however.the hulking orinprovemen is sold within one yeadmmpletion,the ZONING APPROVED BY DATE: ownerbuilder will have the burden of proving he or she did not build a improve for the purposed sale). ❑ I,as owner of the properly.am exduervely contracting with licensed contractors to construct the project(Section 7044,Business and Professions Code:The Contractors License Law does not appy loan owner of property who builds or improves thereon and who BUILDING APPROVED BY : DATE: /.. contracts la such projects with a contractor(s)licensed pursuant a the Contractors License Law). j rr ❑ Iamexempt under SMion: B.a P.C.,f«this reason: APPLICATION ISSUED BY: � � DATE- l�( l� � Done: Owner: ****************************************cit******. *****************vin-* . **iF*-*** «ebycertify mmIamaware oand understandthe requiementsoCaliorniaHealth andLEGALIZATION:N F E E S U M M A R Y STRUCTURAL' SEGMEIJT ; Y Idon Safety Code Sections z55o5,aa5a3,and 25534,and that I or any future building occupant will/will nd(circle one)need to campy wih said mate codes and the requirements for apennifor construction or modification from the Ahawllyl�angemem District.Residential constructionapptcalions are exempt frau Nese BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING provisions. PERMIT 112 . 25 . 59 • Date: Applica t: S M I P/NON-RES WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one of the following derlerelons: P LAN ❑ I have end will maintain acertificateo consent to self-insure on,apr nsure workers' for by SecAon 3700 of the Labor ISSUE maintacertificateCode,fortleped«manceoftheworkforwhichmNpermitisisued. BUILDING-DIS > PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE ❑ I have and will maiden WOlitafte compensation insurance,as requized by Seclico 3700 of the Labor Cede for the psdomianda of the TOTALS----> 112 . 84 0 . 00 0 , 00 112 . 84 11''2 , 84 . 00 A wok for which this permit is issued.My workers'compensation insurance carrier and polity number are: Carver: 4TATF PIINf EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 112 . 84 OVER/SHORT: , :00 Policy Number: '7litR—o'7n_nnng79A 01 /01 /98 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SNIP/TOT" GRADING PLA -CHECK (This section need nor be completed 1 the panne is for one hundred dollars 151001 or less.) 112 . 25 . 59 o I codify that in the performance d the work 1«which this permit is saved,1 shell M employ any person n any manner iso as to become subject to the workers'compensation laws of California.end agree that K I should become subject to the workers' **"**********************************,******************************************* compensation provisions of Section 3700 of the Labor Code,I shall I 'wrath compl/`'WProvisions.. T Date: 7_ //- 9) yyA I N D I V I D U A- L F E E BREAKDOWN • Warning:Failure to secure workers'compensation coverage Is unlawful,and shall subject an employer to criminal penalties and TYPE QTY D ESCRIPTIO N UNIT COST TOTAL COST civil fines up to one hundred thousand dollars(S1C0,000).In addition to the cost of conpensatios damages a.provided for In Section 370sofineLabor Code,Interest,and attorneys lea SFR 5949 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 5 , 949 . 00 CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty of perjury that there is a construction lending agency ler the END OF FEES performance of the work for which this perms is issued(Section 3097.Civ.C). ' LENDER'S NAME: LENDER'S ADDRESS: I certify that I have read this application end slate that the above information is correctI agree to comply with all city and ooumy ordinances and mate laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned properly ' for inspection purposes. SAM DAVIS 87-11 1997/89:88 RWf112.84 Print RCPT8:01-0089814 �{ p4 ,.�..�_ Date: --it/ `S 7 PERMIT a 683704 / Signature of Ow adAgenuC Appi a m�« o • (5151.46.WP) While-Buildisg&Safely:Green-Fie:Canary-ApPRcam:Pink-Revenue:Goldenrod-Assessor - CONSTRUCTION AND PLANNING POOL SPA _ Date Inspector Date Inspector 7 APPROVALS Permit # APPROVALS Permit# 1. Temporary Electrical Service or Pole - ' 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement . 3. Electrical Conduit Utility-Undrgrnd. - 54. Forms _ • ' . . . 4. Electrical Conduit-Undrgrnd. - 55. Electrical Bonding . 5. Steel Reinforcement 56: Rough Plumbing& Pressure Test 6. Electrical LIFER Grnd. - 57. APPROVAL TO COVER•GUNITE 7. Footings .58. Electrical Conduit-Undrgrnd. 8. Foundation - 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe•Undrgrnd. . - - 60. Backwash Lines, P-Trap, ❑ Undrgrnd 10. Structural Floor System 61•. APPROVAL TODECK . • 11. Property Sewer Line & House Connection • :62. Backwash & Receptor-Final _ 12. Sewer Cap ' 63. Heater &Vent-Final 13. Roof Drains 64. Plumbing System - Final ( ' . 14. Rough Plumbing . - - .' _ - � 65. Electrical-Final 15. Rough Electrical-Conduit' ,. - 66, Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval , 17. Rough Wiring Sign 68. -APPROVED-FOR PLASTERING 18. Rough Electrical-T Bar Ceiling - -= 69. POOL/SPA SYSTEMS FINAL t • 19."R6uyh Heating-& Aii'Conditioning- - ' - - . ' . FIRE DEPT. REQUIREMENT- ' - 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 7-( -74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing& Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating& Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing I39. Water Service-Final • ,1 40. Gas Service-Final \ 41. Solar Domestic-Final 42. Backflow Preventer -43. Backflow Irrigation .44,. Landscape Irrigation System • 49..Sound Attenuation 45. Handicap Regulations 47i, FINAL STRUCTURE & BUILDING 7,-2.€1 -776 4 U 481..FINAL PLANNING ' 49. Electric Release to Edison i0'. Gas Release to Southern California Gas Co - ' t1.!CERTIFICATE OF OCCUPANCY r ' 1 Date i _ Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations. - CITY•-OF COSTA MESA P RMIT NO. TRACT NO.. J•iOT NO. BLDG.NO. ' ' _ - ' - ' - -6822 --8/27/82 19.47 TL. CONSTR/U)CTIO(wPERMIT• All L/�6{ .ap, = • $SCP 1& g4 ->�' 1_ r .• Protect A,dr'C( _ �v�-a - ��iv[ iy.rl� l ' I' tWOIJJ / TYPE OF CONSTRUCTION Owner //////�,yy��.,s time_ Ph—one afro 7�❑ NEW ❑ ADD ❑ALTERATION :1 er -- - ' - - - ' - '- 'Address Zq ] L1>� (I TZI -ijt 0 REPAIR ❑ CONVERSION ❑DEMOLISH •(/ —ZONING Arch/Eng:: - ` - . --• -- - License No.,,,TTT _ _ „ .0 OTHER - �t 'ZONING+REG�Uy��ATIONS" • _ —_ _ __ DESCRIPTION OFIWORK • _• AP''4' -n4 7:-Cot'---f N.017 : - ZONE CZi ' PLNG. REF: -: !'Contractor- � J- -,are - Phon: ,v 4�/ir.E,OFPERMIT , • BUILDING - Lie p.TO BUILDING - .tet•-0e f : Address-"� TSETBACK D/L ST. j,� '� PROPE RT V.LI NE -r__ f' ❑ GRADING 0 FOUNDATION - •❑ STRUCTURAL -- •SID YARD �( �,may/ - , 'LICENSED .O R CTO- .DECLARATION LEFT /7 0TENANT /E^�LECTRICALS❑PLUMBING •❑MECH AN C• RIDETARD -t-$CL� _-Y - - --- mencing:I hereby affirm that I am licensed under provisions of n 9 (corn- - ! 4 i..r) •I' RIGHT - 1) . $ Prancing ns -section a7000)lofice iDivisloI -3-of-the Business and ❑ OTHER n �' __ -- Professions Code, a • lice e is In full force an effect., REAR YARD(TO'P/L) 'z(^ Oil _ Llcen Cia r� PROJECT DE CRIP ION••. . _. . — - " _-_ "Sr]sI - 0 L'3 nse f4PKG.SPACE REQ. -" PROVIDED., '! XDate�) A L_rV Signature r'.�/ •_ 111 / J. SQ FT i• _ • _ _ - . ,_ - _ ,M I _y I . f7a' I STREET WIDTH .'OOP -Eta)! PARK-FEE-,$;`- • - ' WOR RS •MPENSATION DE • -A•�N ". _ OCCUPANCY' CONSTRUCTION TYPE_ _ _ d'herebyaffirm'that'I have a cert icate o onsent to self-Insure or a • `ZONING'APPROV ED BV DATE 'VALUATION z�1sd• ZONE - •1¢Cz'• •--,. sizllk�— '<esreof(Se f Workers'-Compensation Insura ncps or�p-certifiy� copy - .. .. - _ .. =real(Secypn 3$pLab. C.). r^R�.�.t. NI,JL.i .w V ;.GRADING CU.YDS. ACRES :SPECIAL CONDITIONS: :. • Icy Nb.•�({![J��/�CG/4 -'Companati /u•L1 t.V- ' _ _ -. .. _ - _ _. ._ •. _ _ - .-. /� p T _,-Certified opy.is hereby with thehetl._. _ _ _ REMARKS:", p•:� . 7 S/ '�v� _ - .- . _,. .. _- - L I Certified copy is filed the city Building Division. , , , EXEMPTION' •FROM-WORKERS' COMPENSATION"DECLARATION '- ---- '-" - "� - --- - ---- - - - - - _ - (This section need not be,completed,if-the,permit is for one hundred _ _ - - _ Z _ ^t -_ ($100) or less). . i I - - - '- - - -' - 'Lcertify that inthe performance of the work for which this permit'is _ . - _ Issued, I shall not employ any person In any manner so as to become ' PLUMBING - PLAN CHECK' - ELECTRICAL "" ' - -'- - PLAN'CHECK -;-,, - '" subject to.the Wori is-C-Compensation Laws of California.' - BATHTUBS - SHOWERS-- a - - .UW LLLINLe _ _ GA RAV E_ Date ' ` STjpature - S9 FT SO FT - -. .• NOTICE: If after making this declaration, you should become subject • TOILETS - .URINALS • - -- -GENERATOR -- 0-1'KW_1-30 to the Workers' Compensation provisions of the Labor Code,you must -TRANSFORMER _ .- r ( I forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE LAYS.-- '- -- -IAPPLIANCE -' 10-50 KW—.50+-KW - - - • -_ -- - { • ' KIT.SINKS- DISHWASHERS' ••' -- - MOTORS - ---- 0-1'HP=1-1 - herCONe y affix ON LENDING AGENCY { r •I ) f Hereby affirm th that there is a constructionhiprit si ng agency(S forithe Der SERVICE SINKS SUMPS-« _..-. . __ .. 4(INC.SOLAR)._. 30-50 HP --50.-1-.HP - - __ Civ:C : of the war for which this permit is Issued (Section 3097 - - - - Lin Lender's - - - - -' '-' "' -' FLOOR SINKS- 'FLOOR DRAINS 'FIXTURES --OUTLETS' SWITCHES'- Lentler's Name - Lender's-Address - DRINKINGFO VNTAINS' GAS TV BE SIGNS- - - OWNER-BUILDER DECLARATION--- - - -- -- ' - ' - -INTERCEPTORS • - CLARIFIERS- -"' •-- ' POLE LIGHTS- - - --- - -- - •-:-:-+.4:-•-•-•• - -- - I hereby affirm that I am exempt from the Contractor's License Law for - - I the-following•reason-(Section 7031.5 Business and-Professions Code: -SWIMMING POOL ' --P TRAP - - -I Any•city or county which requires a permit to construct, alter, -POLES METERED — SUB _ improve;demolish-or-repair any-structure, prior to its issuance;also re- WATER SERVICE . -" ALTERATION'-' - - • - ',PANELS - MAIN-- • -SUB-- - - - - quires the ap,.Ilcant for such permit to file a signed statement that he - - ' Is-licensed pursuant to the provisions-of the Contractor's-License Law GAS-SERVICE - - OUTLETS --- (Chapter 9 (commencing with Section 7000) of Division 3 of the 'SERVICE- -- -AMP - siness and Professions•Code)-or that-he is exempt therefrom and-theil - Is for the alleged exemption. Any violation of Section ] by - - _ applicant fora- ermit hundred dollars the applicant-to f not more than five Collars ($5 ) a civil-penalty -SEWER CONNECTIONS""^' - '-- --- - - - -- - - -- - -__. - - - • ❑ I, as owner of the property, or my employees with-wages as their' SOLAR-TANK - - - -COLLECTORS '- -' - ^ -}- - - - -- - - - --- - -�- ,-• -�-, -- soleCompensation,will do the work,,and the structure is not intended - " - ' or-offered for sale. (Section 7044, Business and Professions Code: The -SOLAR PIPING SYS: - - -' -` -- - ISSV E•FEE -�" _ - - Contractor's-License Law does,not.apply to an owner of a property _ _ _ - :AP Fp . ,I) y/ who builds or improves thereon,and who does such work himself or '" ISSUE•FEE • - PLICATION APPROVED B71A/ a -DAT Fdp- through his own employees, provided that such improvements are not / %%%%%% intended or offered for sale. If, however,the buildingorimprovement- -MECHANICAL PLAN CHECK I •T• SUMMARY OF,FEES _ is sold within one year of completion, the owner will have the burden - , of proving he did not build orimprove' for the purpose ofsale). - -.- - - '- BUILDING• - // St SIP:-•--. $- - S-O'•' air-as-owner- of the property,-am-exclusively. contracting with HEATING SYSTEM 0-100,000 BTU •, - PERMIT $ / I , .AND DUCTING 0 • -. __ _ _ _ _ . .. _ .. T. - { and- licensed contractors : construct the to s-Licet (Section 7044, lness • 100,000 + BTU _ ,PLAN CHECK $ -- �� PERMIT • •. and-Professions-Code:of property r Code: The-Contractor impro ese there does-not snot apply to - tracts- owner of uch• roj who a improves thereon,and who con- REFRIGERATION 0-100,000 BTU 'PLUMBING $ - s' - the C-ntom-such•cenje with a contractor(s) licesnetl-.pursuant to SYSTEM -- - - - B - — -. _ ••- . • JG_ i- [he Contractor's License Law). 100,000 4 BTU-- PLAN CHECK 5 W: : + . • I•ii 1 11` ❑-I am exempt"antler Section" -' -" "' - - B'& P.C.for this- - _ - - -'--" •"- ^ ]ELECTRICAL -S - — - "'--- _T_-�, _s '$' I BOILERS BTU , reason - -- -- - - - _ ._ _ _ . _ •• •••••MICROFILM g :� Date Owner - SYSTEM REPAIR,ALTERATION 9PLAN CHECK $ - - Q ,c. 'i? TOTAL FEE g'..:147. g7 I herebycertify that I have read this application and state that the above EXHAUST SYSTEM MULTIPLE • - -- Y_ PP •` - '{:' •'•LES$"AD-:r iacn 'i• correct.laI ol- -n tco stru with all'cityeryallth ize PLAN CHECK -$� - ----- VANCE'PC"$_ - - •- ' ordinances a •g��state laws rel ng to construction,and hereby autM1 tae J,. • ,_ . w, ' representati I •f s it J, a , -pt r" on' the abov ' menti d' •' • f`-1' " /�j •, ProPert Y,fo�Sy •,. I. . •ea __ 2 _ - FINAL FEE $L 7•'it7 X Signature Dat SSUE FEE- _ •_ -__ _.. _ -- - ---- - Drivers'Lic a or S' qF -" - - - - CMF 0865-46 White-Building;Canary-Applicant; Pink-Accounting;Goldenrod-Assessor - - • CONSTRUCTION AND PLANNINGPOOL&SPA - • - , ; ;.. Date ' Inspector - - - • - - • • Date Inspector • APPROVALS Permit# ,` APPROVALS: ,Permit# - - 1. Temporary Electrical Service or Pole `43. Pool & Equipment ilricatiori" ti: -. r ."':- - - ' 2. _ Soil r tIndrgrn_a_ - • _ _ - - -_ '• 44. Steel Reinforcement' • - ' • - ' - - - - \-r - 0 3. Electrical Conduit Utility.Undrgrn-. - _ ._ - - _ _ • 45. Forms - • - - - - -- - - - 4. Electrical Conduit-Undrgrn . _- - ! -- . , -. _ - _ 46. Electrical Bonding.; ç : . - -- - - . . - - 5. Steel Reinforce _. _ 47. Rough Pluriibing & Pressure-Test - - !- .- . . -- 3-.--' ..- - - 6. __Electrical UFER Grn _ 48._ APPROVAL TO`COVER:GUNITEL� ! IL' 1) ' 1 '- 4 7. ,Footings . . __ '. _-- - __ _- ; _- $ 3 ,Sl - ,tn, b,� 49.17Electrical Conduit-Undrgrn- -* r ., - I - , ,. --8. Foundation _ _ _ _ - ___ -_. _ _.. _ 50-. '-Gas Pipe„0 Undrgm,-Test L. ' _ i °• • 9. .Water Pipe:Undrgrn. . _ ._ _ _ -_. . 51. '''Sackwash•Lines, P-Trap, 0 Undigrm ' -!- ".'-!- - - -_ ` - `' - --.3 -. - 10. -_Structural',Floor_System •__, , _ _ , ,. , 52-.. APPROVALTO-DECK - - --,-'-! '." - . -'' ': ' 7•` 1:,1.1._ Property_Sewer Line,& House Connection -- ..... . - -- . .-_- - - . 51. Backwash& Receptor-Final' j_ 12._ Street Sewer_Connection _ .. _ _- '""_ '_ . --- - - - 54: Heater &Vent-Final, .13. Rough Plumbing , _ _ _ - . _. • __ .! = -- - _55.-i plum , . • 6ing•Svstem - Final 14. Rough Electric-Conduit -'- --- - -- - ,.. ` ' - -i -• •56. i Electrical-Final •• r' • '+' . - : -- ' ' 15. Rough Electric-Wiring - -- - ' - - - - - 57.- Solar System-Final "' 16. - -Rough-Heating-8i Air Conditioning : ' L- - _<- . - _ - 58. Fencing.& Access-Approval ,,. • ' - - 59,_ _APPROVED'FOR,PLASTERING ' . "' 177-Ducts,-imStructure- - _ • 'T - . - - -.. . -.. 18:-- DuctsrVentilating - ' _ - - _. -: - - -- 19. Gas Pipe-Rough &Test" -`"- 4 r _. _ 60. POOL/SPA'SYSTEMS FINAL „-., • E -20: Roof'Framing -- - - - --- -} - - - - - . . • _ _ '. ° t•( 21. Roof:Sheatfiing. ... . - '- - _: --- ---- -- • ,. :,: .• ' . • r--.,-• '1 L Nr . 22: Frameand-Flashing - --- OTES:- • _ - 23: Insulation _ - • 24. Lathing & Siding .. __ _ _ -_ _ _ _ y _ -4+- - _ - - _ -- - -- - -_ _T_ 25'. -Drywall Nailing - - - - - ,. , . r,:-.., - ' 1 -- -- . . . - h 26: - Plaster-Brown Coat- ' ' - -- !_ - •' 274 Electrical power Meter-Final - ._ - . . _-. _._ _ •l. .. ... +- 28: Final-Electric - --- -- - - - -- . , _ - -- - - - -- - il• ' 29. - Final+Heating &•Air Conditioning-- - - - - - -- -.• _-_- - -. - - - _. ' - : 301- -Final,Gas Pipe-Test - • _ .- 1 1 - - -_ - __ . _ - - • . - - 31i --Final;Plumbing - - _ _ _ - ° : " •. i -32:• Water Service-Final- _. _- -- ^� -- --- - -- - - - __ ----� -- ,�, �' _. `.33. • Gas Service-Final- - -- - - ° 1 : .. . - . _ .: . II' 34. Solar Domestie4Firial°r ' ' _ ' '--_ _ - t. " , • • . .. -. ", ' • '' 35. - Landscape Sprinkling System t---- - - •,�• + :. - - '. "' ,+ ' 36. Sound Attenuation -- . •' _ l _• ___ _ • • •,. ,"< - _ - .• 37. Handicap Regulations - L-------- .. , - ,. ••. ° . - ; r ' , •I 38. FINAL STRUCTURE & BUILDING -- '' -- '' '' I//R/P4- '_c;f--- 1 -- - - - _ r, _ - -- .39. Special Requirements Completed - - • i '40. Electric Release.to Edison .. ' 41. Gas Release to SoutherrSCalifornia.GafCo. I --J - - . . I A2. CERTIFICATE OF OCCUPANCY I. -- -.- -- -• • ,.'�F 1 - 1 +-L NO. ._ - Date --- - - .r,\r' ."y l_� :,.. • i i - 'r i . -r../.t'+- Jf - - .!.:( isL-1, t J' ,. . +-t • -' + . - • PATIO COVER DETAIL - 12/9/81 — NOT TO BE USED FOR SUNDECK, ETC. —" ' TYPICAL JOIST ANCHOR STATE—�-----may 'G i SPA® SPAN ';� !F": ,-c ; . SIZE NG OVERHANG - 12 F'' ;,r,r RAFTERS:® 111 FOR DRAIN--;Min- 1l4 �� •'..:, Izi STATE LENGTH .s-SLOPED r �v,r• O' MAXIMUM 7h SPAN / _ _ _ _ _ _ r / 3/gxS�Lags32% . .. LEDGECONTINUOUS - .'� • Blocking t �4' rr/t MAXIMUM Predrill. LedgerPredrill Existing '/-3•Deep JOIST HANGER • BEAM or other approved methods NOTE USE REVEfE FOR PLOT ' PLAN. of support ♦ tie. STATE SIZEIli • _ RAFTER SIZE AND SPACINr •((11� - ALL LUMBER DOUGLAS FIR No. 1 No.2 ` �Ci�iO 3/16 X 2"-T-STRAP - UBC STD.TABLE .. UBC STD.TABLE ��a CONSTRUCTION GRADE FOR 25-21-J-6 25-21-R-1 TABLE NO. 1 _ For open egg crate alumi- For solid sheathing. I num or plastic roof Shingles or built up *2 OR BETTER FOR TABLE NO.2 covering. roofing. X MAXIMUM SPAN SIZE SPACING MAXIMUM SPAN z - POST-BEAM 17'2" 2"x 6" @ 12 o-c. 12'0" \\ -�I CONNECTION 15'7" 2"x 6" @ 16 o.c. 10'5" j I n. \ !) - • 13,.8„ 2"x 6" @ 24 o.c. g,6,• POST • - - 10'11" 2"x 4" @ 12 o.c. - I�J 8. 8•, 2"x 4" @ 24 o.c. - .J ', SHOW SIZE SHOW SPACING ' • SHOW LOCATION ON REVERSE SIDE. - - ' DROP PATIO FLOOR PLATS2"max.@door NOTE: FOR PROPOSED OR FUTURE ROOM,OR WHERE PATIO WALLS f— SLOPE TO DRA lh 1 ] _ ARE TO BE BUILT. USE NO.. 2 CHART ONLY. + PUDDLED ' SAND FILLI FOR PROPOSED OR FUTURE ROOM OR WHERE PATIO WALLS 4�2 ��}4— / • . ' - .. ' ` . ARE TO BE BUILT SUBMIT COMPLETE HOUSE AND ADDITION • sTwwa ' I Remove Grass And Weeds Down To Natural Grade '- PLANS FOR APPROVAL. 12" . CONCRETE MIX 1:3:4 MAXIMUM WATER CONTENT I POST ANCHOR I •.._'.,: - 7t GALLONS PER SACK CEMENT. Far Pipe Post, Embed 1-12't Provide 26 Ga G.I. Flashing At Wood Floor Const. :4COSTA MESA BUILDING DEPT. Pipe in Footing to within 3"of Bottom,and Provide detail of Flange or Weld.Plate Screwed or Bolted to Frame. .. • 77 FAIR DRIVE INSPECTIONS: 754-5627 CMF 0012.46(BU 40) rev.12/81 • nV VNd b --C‘ o ,. 2 ...al .0t b M go Z o� ZD d � Q�n�� r_........ .„< , 0 o O D �v/ - E ,..., 11 FE ttv rill• .y �'' '' V�' ,g zo rte, • � 1 � ® City of O . . Iv ,l' r�M� Bui/l.'Dg Dept - MAKE NTHESO 5T ON BY DATE O OF DEPT, WITHOUT OR A7 ALL APP TIMES I PRIOR APPROVAL STRUCTURAL APPROVAL 0 LY w THE ISSUANCE i• 0 \ RUED OF 6E nUP AND SP ff 71NC OF A PERMIT 03 P.PP,70VAL SEPgRgTE PERMITS ARE ,RE�UI'ED • G OF ANY ERMIT FO , SHALL NOT'FE FOR ELECTRICAL, PLUft^„ �-- OF 7HE PROVISIONS NFAPPROVAL OF CONLATION D I I ROVI SIONS TO GIVE AUTHORITY TO VIOLATHIS DE NO PERbI1C�PREN RIN 's OFTIHS ��CODE • • ,1 � �rif - .,U�JG AND FAR AS THE WORK OR USE WHICB IT A�VALID R CA'VCEI THE nEeiF RATION WORK EXCEPT IN SO ,� THE ISSU 7110RIZES IS LAWFUL. �' _ SPECIFI ANCE OF A PE,CMIT B FROM THET•ION�s SHALL NOF ppq ASED UPON PLANS . PermBt �'� ea' fir N v' PLANS AND 'INC 1HE u, uNa OFF; Al �� L HIS NUMBER t',^,'Igo ACCOMPA B. 'I' IC LA SPECIFICA710J;CO FROM03 I C7 ENTI G Y 2 FNVIOLATIONERATIONSBEING 'ON PRETWil G ALL INSPECTION REQUESTS OF THIS CODE CARPoLOON 7 QUESTS 'TM Cid OR OF ANYHERUND[? WHIN OTHER OAOL1aN�E .__ FD.Y BU:LDiJ(r. :�i L-5:-F:i.30itS ARE ARE Ti SEENPLOYED, VIE SUGGEST THAT TH OF CALIFORNIA DIWSION 0' INDUSTRIAL SAFETY BE CONSULTED F0', ADDITIONAL REQUIREMENTS. • c�y� 9 CITY OF COSTA MESA 4 e. C A:�', CALIFORNIA 92628-1200 P.O.BOX 1200 • F I om I a,: r: J O; DEVELOPMENT SERVICES DEPARTMENT 4 - a •C�RPoini n�9. October 25, 1984 Mr. Miller 297 Lilac Lane Costa Mesa, California 92626 Re: Permit No. .Q 4/a2f1, Dear Mr. Miller: The Building Safety Division of the City of Costa Mesa has asked this office to prosecute legal action against you concerning the above- referenced permit. It is our Imderstanding that the permit has expired without completion of the required inspections and that enforcement personnel have tried to obtain your cooperation, without success. Please be advised that your failure to camply with inspection require- ments subjects you to criminal prosecution and penalties, as well as encumbering your property with an illegal structure. Please contact the Building Safety Division at 754-5273 immediately to arrange for compliance with legal requirements. Your failure to do so .within ten (10) days frau the date of this letter will result in the filing of criminal charges. Very truly yours, ELEANOR M. WEAVER Assistant City Attorney EWI:hwm (A-1-14) Code Enforcement/Business License (714) 754-5234 Building Division (714) 754-5626 Planning Division (714) 754-5245 77 FAIR DRIVE 4 __________ OWNER DUARTE, PRIMITIVO & LILA DATE 11-30-77 JOB ADDRESS 297 Lilac Lane BUILDING PERMIT NO. 145137 f` GENERAL CONTRACTOR Owner-Builder DESCRIPTION of WORK Familyroom Addition _ APNo.118-153-46 LOT TRACT FIRE ZONE VALUES 8,000.00 _ INSPECTIONS Signature Date TYPE V GROUP I ZONE R-2 SOIL GAS SUBCONTRACTOR PEfMITS ISI SQED Date Number Sign of ure WATER Plumbing LUGH . PLUMBING .�1' OP. SWR. LINE n HOUSE CON. RINKLING SYSTEM SCELLANEOUS + Z"UGH HEATING AND AIR CONDITIONING 1-. MPORARY SERVICE OR POLE - 45-€ i UNDERGROUND L 1 POWER Cj t ROUGH WIRING Heating and Vent. • TRENCHES 'fl FORMS Li STEEL REINF. CJ FLOOR SYSTEM J BOND BEAM ESTEEL REINFORCE f � SHEATHING in .. sees FRAME AND FLASHING p fl F, RI ,?Yki- IIna !$ I LATHING . IN [] OUT n _ kJ Ff 1 4 -h U h - t d I _ PLASTER. BROWN COAT LI ((�}t� % F1 V�4 U _ :1 E I - STRUCTURAL. FINAL "r GIec11FC d \J. 'J br a PL-..tri HEATING. VENT., REFRIG. AND A.C., FINAL 1 ^V� J q . ^ PLUMBING. FINAL AND GAS TEST I T /< A ( -24 ELECTRIC, FINAL I DATE JIV. BUILDING, FINAL -__ _ IO CnaA! 3'� :;w30-77—,;- OO r- �sao ****66.56 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 . nyl A ION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely — Use Ink Only yl( R ED V DATE RECEIVED E SSUED^ BUILDING )(J} / / ^� / ADDRESS �A/'// #77,47-3/ (l/ /�/�/ / � (/ 3 v �7Y �.�P�///%/VoY id 'awn? A.P.NO.fr _ IS .e RMITNO. OWNER / MAIL BUILDING 2[/7 ' G/L,4C �ni ADDRESS .....44,-/ ADDRESS /TEL. P / g re/n / r G ta4g ei C(nv.S / 0(j LOT'S,' 7 CITY GC,CT/n •F✓�} NO. (pit q / TRACT L T BLOCK CONSTRUCTION NEW ADD ALTER REPAIR (MOVING DEMOLISH LENDER - /�/ ,// ,I{ [./ BRANCH OWNER /�J te/ r////� t✓ Y IZ444Z� ADDRESS D /{A VALUE �/J(J/}'¢�� ARCHITECT TEL. USE h AV, $ /Jo v OR ENGINEER NO FIRE [� T ADDRESS - • ZONE TYPE5_ GROUP/ 4t.- .. APPROVE /////' (/–a't "'J CONTRACTOR BY DATE V /T' • ADDRESS ZON En iNO.�S BUILDING EWE�jµ�v� TEL. CITY NO. I STATE CITY YARDS APPROVED • YARDS APPROVED gLIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING ial SIZE NO.OF BLDGS. (FROM C.`STRE�T _ // �) Or OF LOT NOW ON LOT RONT/_7J/,Fur!s/+'�!7C FT. Q USE OF /�J 42, EXISTING BLDG. R.SIDE'S ` EL - FT. CA / HSeparate permits are required for L.SIDE�U FT. FT. electric,plumbing and heating work. Qyt REAR `ss yFT. FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& O MAIN BLDGS. ACCESS.BLDGS. Q �� ! �/r/� W VAR.4 • DATE C.U.P.AR. 6 APPROVED �r /`f' " _/` Cy' APPROVEq!/i.l� DATE // v` /^//�/J RY a w O I hereby acknowledge that I have read this application and state N fg that the above information is correct and agree to comply with m 64 all laws regulating building construction, and I shall not employ i Zany person In violation of the workman's compensation laws of 2 the State of California. 6 33 coI hereby certify that I am properly licensed as a contractor under SQ. FT. – N the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR 03 D Chapter.9,and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE Onf�ttLV am exempt from the provisions of the State of California Business r7�+ v and Professions Code, vision%Chapt r 9. VALUATION P� PERMIT FEE $ .--�+ • M Signature of , �� gm PLAN CHECK $ m /xV .C�< -CCI SI $ U. 2 Permittee TAX $ a U Author TOTAL PAID $ t its I FEERECEIVED COSTA MESA BUILDING-SAFETY DEPARTMENT 4.-- APR 26'"11 P. O. BOX 317 COSTA MESA. CALIFORNIA FINANCE DEPT. . For Applicant to Fill In CompletelyAPPLICATION FOR nr. 9STA MESA - TYPE OR PRINT BUILDING ADgig g 297 Lilac Lane COSTA MESA. CALIFORNIA For Office Use Only OWNER Irving C. Jordan f RECEIPT NO. MAIL RECEBY I DATE RECEIVED DATE ISSUED ADDRESS 3700- Ne Ort BlVd.1ii <st v /?-G/ APR o Q .. ' NBUILDINGCT,' Newport Beach ob8811 DDR A. ,EER D. .Southworth 4%LI85161 COSTA MESA. CALIFORNIA /�L ADDRESS Costa Mesa FIRE ZONE TYPE V GROUP �// /, V(�'i/ CONTRACTOR Owlenr J/ APPROVED ��ti� BY DATE J ADDRESS Same ZONING f---,--t„el ZONE R ./ NO.OF USE OF NEW (nZLo. `I---- CITY � CITY ' 1 if I PLANS 2...--I BUILDING Q yy / /, STATE B1-82517 NO. 0R3 8811 LEGAL _I T 'Me LSIZE (J{IIIA Y cI _ DESCRIPTION fly OF LOT 7s. .�LS X •/ I NOW ON LOTS O p A.P.NO.��I.i- qn-' wo '- Ch7 (fp�'JI USE OF YARDS'//��""� "0 if EVES EXISTING BLDG APPROVED�T,� .a's 5 ALLOWED SETBACK LINE FROM - (CENTER LINE ST.) �' CENTER OF STREET REAR YARD FRONT 6125-;T. IN. SIDE YARD I LEFT 20i 0" I RIGHT 16 1 011 //,, R.SIDE /7� 6FFT. IN. DESCRIPTION OF WORK �� L.SIDE 2-OPT. IN. W. I X V ALTERATION I II ADDITION I REAR T. -/-5 IN.I /- REPAIR I V MOVING I DEMOLISH APPROVED t/. 6 DATE 41-I 74)/ BUILDING SIZE • ROOMS 7 STORIES 2 HOW FOR SPECIAL R/crUIREMENT- EXTERIOR COVERING WA u.I L UCO I COVERING Shingles NO FINAL UNTIL USE OF BUILDING AND WORK TO BE PERFORMED 1. DellieaL.Luu of spautel Res. w/ att. garage P. Installation of res. sidewal.11s Plan #1615A I 1682 sq. ft. J 642 sq. ft. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. FLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING C SERMITUEE GNSTRUC�{pN. ,LI VALUATION 3 SIGNATURE OFLCV I (• ` �� PERMIT FEE $ 37.00 N l!I $ 17,752 PLAN CHECK $ 18.50 z AUTHORIZED AGENT/ �� 1 E ..- TOTAL FEE :. • 0 C \!