Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
223 LILLIAN PL - Building Permits
, , ly' 9 CITY OF COSTA MESA T 4 BUILDING DIVISION > .� „,,. ,I DEVELOPMENT SERVICES DEPARTMENT PERMIT NU ER 0. P'' . PERMIT i soO. EO 1152 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 223 LILLIAN PL Status: ISSUED Suite No Applied: 11/02/2004 Vicinity: REAR OF PROPERTY Issued: 11/02/2004 Parcel Nunmber: 43921110 Applicant: ROLSHEIM, RICHARD LEE ISSUED BY: Address: 223 LILLIAN PL - - , 2/ Phone: '949-903-0386 CELL COSTA MESA,'CA•' . . Zip: 92627 . Owner:/•ROLSHEIM, RICHARD LEE. _- _ ` Address 223 LILLIAN PL - - _ Phone: r ' - '-COSTA"MESA,CA Zip: 92627 - , Contractor: OWNER-BUILDER ' Address: - - " . " Phone: " (*Zip: ,Zip: _ . License: 000000 - - - SCOPE OF PERMIT INSTALL ABOVE GF:OUNDSPA.; - -- -- - - ' ' ELECTRICAL TO INCLUDE:1 MISC_-CONDUIT,-1'MISC.-CONDUCTOR AND 1MISC. ELECTRICAL, ' EQUIPMENT. - - " � . - 1,. -- - FEE SUMMARY / -- - • Quantity / Quantity, , •� < " ISSUE FEE • $23.50 Temp Dist System/Lighting ,$0.00 0,,,/ C, - Temp service test $0.00 Busway./100 ft• , ,$0.00 .0,/. , .� Res.a/d package \A , $0.00 Standing Section � New Res:(1-2-unds) ''� A $0 00 0 - 2MiscElectrical Equipment $18.20 /,11' -, > fi r New Res(3+units)' V'\"-So oo 0 .,�:I.."'% Transformers up to 1 kva/kw $0.00/2,/710 "�- / 'rI r Pool/Spa'.-., 'I.'$0 00 0 - up to 10 kva/kw $0.00,f- 0„ , Lighting Fixts:, '$0.00 0 ,_ "• - ' ` -up to.50-kva/kw-,a, -. ,$0:00; 0 ' Recept Outlets i, $0.00', • 0'" - - -up to 100 kva/kw :� .,$0.00 0 Switches V-;'; „.' 'i$0:00 1 0 , - " I over100 kva/kw ./$0.00 , 0 /"' ' Non Res Appl ' - - $0:00 - '-.0 - Low Voltage Equipment - $0.00-%, 0 , 7 �' Res Appl 'V-.,( '- ' $0.00 .r '0 - - Low,Volt Wiring System_/Ckt- $0.00-v i. 0 / Service to 200a \ ;`" - ' ;$0.00" �0 Miso.Conduit-.r • .$18.20/ 1 ' II- , Service to 1000a N $0.00,/,` 70_ - Misc.-Conductor ` •'-'$18;20' -A- / Service over 1000a -$0.00 0 Circus•(gen or ride), • - •$0.00 0' Motors to 1 hp A $0.00 ' ,0,/ C -', „Circus(mech ride or lights) ' $0.00`' 0 Motors to 10hp "$0.00-x.• 0_., ' ChristmasTreeStarid / - $0.00'' 0 Motors to 50hp $0.00,,,,,,I',* -_"0 , -_ . 'Fireworks Stand ' $0.00 0 Motors to 100hp $0.00�"=- 0/ -- _ ' Other Electrical Fee -' $0.00 Motors over 100hp $0.00 -, - - - - - - Communication drops $0.00 0 . . ": -'Investigation Fee $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 244646(6/00) . 1 ., DECLARATIONS in n WORKERS'COMPENSATION DECLARATION: - ' • I hereby affirm under penalty of perjury one of the following declarations: O I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. O I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: This section need not be completed if the permit is valued at one hundred dollars($100)or less.) i - ` 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 . fomia,and-• 'e that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these p .vi '•ns —'— •Applicant Signature: / Y�v(// //—)- Date: (/ JZ` /,`f` 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($100,010),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060E 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.Llc.# 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 Busines nd 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 subje 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 ursuant to the Contractors License Laws.). lam pt under . 4) Business and Professions Code for this�rgeason::/�//� //i r�Z 0 j///����y� comer ID verified by driver's license. i5 Yes ❑No Driver's License No. ! .Expire . Ali/v '� 1 Verification of Ownership by(type of docu .n,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: I 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 Califomia Health and Safely 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? ❑Yes 0 No 5 00137 0r 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 California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-d' ribed propertyf• ' spectre •urposes.I agree not to occupy or allow occupancy of any building authorized by this permi)un final insp ction. �. :,� , .A.41 // //�r7td/ .yr 7,1r-re N Legal Owner(s) D AncUOr Authorized Applicant Date pODE L INSPECTION TYPE Oa ItIDB6Lk ;ODE It INSPFCTION TYPE DAIS )ISS 1616 Fixed System Final Fire Prevention _ 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing . _ 200 Final Re-Roof 210 Final Electrical • VI15 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 _ /-/ 7 72( t'[kcet" 7'i //f W / / ---- %./' .-71 .1 (1:17:4-6,TH(i i:or:16`-‘....-1: / i -1' (.74 ',FA C krill . 7 (I Cc-{=0fc5IL CF7 { LAA• Ai'i°1,(44.) ki) r� CITY OF COSTA MESA ( 1~ 21 PLANNING DIVISION s if; n SUBJECT TO BLDG. DEPT. REG. 1 1 ;� I 1 I I i • I NOTE: ADDITIONS, DELETIONS,.-1,-, .�;�� - . ^r , '-. " ,, OR CORRECTIONS SHALL BE ,--IL;� 3 ' 11 N 1APPROVED BY'TNE PLANNING DI \�\��E.SN / C, 3�\w II o, 4°:,. vy,;.. . XJ ,26 -eHpvr,,cfr l 'iti C.L t // 5f /0 • Q .yt 'ROVED 6' 1"k,�,i- 3 C 1 Y OF COSTA ss.4 '---- , _ILfr_ I�p AS OJ ANNING DI\, ON �, - -' V moi' _> SU13JE T TO BLDG. DEPT. kEG.-- , 9- 9 . A NOTE: DDJTIONS, DELETIONS, r\---;----- -;\ - i s OR l 'RRECTiONS SHAH. P,F. APPROV D BY THE PLANNING DIV. (-w I '�' r BY: 1_ DATE; -2/ �o al i3/ / aL/ � �JI[lL/ i . = i Cv NE AI CITY OF COSTA MESA r' -.4. 4 BUILDING DIVISION Fi „; , ,) DEVELOPMENT SERVICES DEPARTMENT PERMIT MBER 4 PERMIT / 4.k.bo o,p' PO4-00505 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT , • Job Address: 223 LILLIAN PL Status: ISSUED Suite No 'Applied: 07/20/2004 Issued: 07/20/2004 Vicinity: Parcel Nunmber: 43921110 - _ ISSUED BY: Applicant: ROLSHEIM, RICHARD LEE . _ - Address: 223 LILLIAN•PL f „ I - • • - Phone: 949-903-0386- _ - - COSTA MESA,CA • Zip: 92627 , . , Owner / ROLSHEIM,�RICHARD-LEE Address N223 LILLIAN PL • Phone: , N- - , COSTA MESA,CA Zip: 92627 Contractor: /OWNER BUILDER - . Address: , _ - � . , Phone: - , Zip: License: 000000 , . , Arch / Eng: . y � ._ - - Address: - - -- .• -- - - , Phone: , . Zip: . , . . - _ License: _ __ ' i -- . SCOPE OF PERMIT- - GAS PIPING FOR FUTURE USE. ' - - • ..FEEISUMMARY /`;" '• , .o:d,,•r• ,- /i',' „ a AMT QTY - - - - AMT-+ QTY ::--,4/ j. /AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $0.00 in. -..4.,^:;,,.Sump,Pump \ • $0.00 0 Backflow irrigation ' $0.00 . 0 --`Landscape,Irrigation r" $0.00- '0 `;. Swimming Pool' --; $0.00 0 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'j./6/,\ /7/// $0.00 0 Clarifier System \ N„, $0.00 0_ Process Piping(per„10 ft) $0.00 0 ,i7-2-:.,-/' Vacuum-Brkr,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 V,,-$0.00 0' - Septic Tank '.`''_- - .$0.00 - 0 c.`::Wash Basin 'j $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 - 7 Sewer Connect ,-- .-$0.00.40.000 'N' . Waste and,Vent System $0.00 0 Drain,Rainwater $0.00 - 0 `Sewer Private Line i '$0100 , .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 /,.i/Water Piping(Ins(or Rep.) $0.00 0 Expansion Tank $0.00 0 ' .Sink:coriimerciaf - --_ $0.00, 1 0 - Water Re-pipe $0.00 0 / Gas Earthquake Valve $0.00 0 Sink,-Floor_ - __r_ •; "$0.00---0 Water Service $0.00 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 244646(6/00) 'DECEARATIONS ( ) ( ) 4. 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 work compensation ins ance,as' uired by section 3700 of the Labor Code,for the performance of the o fo which this permit is issued. My workers'co n 1 ce carrier an I ber are: Cartier: Policy Number: (This section need no e pl t he permit Is lued 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 be e subject to the workers' mpensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Se Ion 3700 f the Labor Code,I shall forthwith comply with these isions. 7 2J� O-.7 Applicant Signature: __- Date: / � WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND S •LL SUBJECT AN EMPLOYER TO CRIMINAL PENALTI 5 AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDRION 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.# 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: 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,em EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business end Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuantur/ua� to the Contractors License Laws.). ❑ I am etlerypyand sec. Business and Professions Code for this reason: Signature: VV �,,,((.•�t �� [' / Expires. /2-71(r1 e 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,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 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? 0 Yes 0 No (Section 25533 of the Califomia Health and Safely 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 end 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 en 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 aapermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ No (Section 65850.2 of the California Govemment Code requires that the requested information be 1umished 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 Califomia Health and Safety Code). 7 If E-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 end Emissions. Signature: Date: CERTIFICATE OF COMPLUWCE 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 sore: • comply with a state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-d:' •e• •roperty fedi tion puu se�not to occupy or allow occupancy of any building _ orjzed by id rm' until final inspection. Signature Of Legal Owner(s) Date And/Or Authorized Applicant . Date rnOE A INSPECTION TYPE MI INTRIALS CODE( INSPECTION TYPE DAIS 1lIIIDAL6 1618 Fixed System Final Fire Prevention 206 Final Mechanical [� 1268 Pool Spa Final 208 Final Plumbing 7(• I1+J I • 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 7 11 —1 Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. PS.R IT O. TRACT NO. LOT NO. UNIT NO. CITY 0.E-COSTA MESA CONSTRUCTION PERMIT .� __ A.P.# Zone I ..- 4aq - .211 10 I 21 P•ro e t Address 22.3 L/tUAN "ACC .\, •5 X36700 i I to 10 f S pq D l eg. ��' Accessory Building: ( � A i . `$/9s11t6 TYPE OF CONSTRUCTION LtJ NEW U ADD L ALTERATION' LI REPAIR E f Z I)ner's 'a MailingAddre55 . 40,e_sticem /,/ _r ❑ CONVERSION ❑ DEMOLISH ❑ OTHER T Front S2/ 'b vies-Mena_ O Owner's Warne �1, DESCRIPTIO OF WORK/USE OF BLDG. / -- -----. .et /Jt B / N Address !a23 LILpL/q A/ /Q/a'�./ CAST iI�SIG .,.� - ' 0w— a ✓,. f;n /. A Rear CJ �l(1l}01.4t-M. •ei� -) I • Arch/Eng.UON/✓ SCfOFM License No. TYPE OF PERMITS MI GRADING SII FOUNDATION el-STRUCTURAL - C Right 31 CI G Address 906 K04/0.4 Sr f•9Lx�r fav€6tcK ❑ TENANT R ELECTRICAL• I�PLUMBING ❑ MECHANICALS S . Left '� R CM/Q / L7 OTHER Oy .1. Pln Ref.# 'Parkin Contractor's Name / Phone OJC7. OCCUPANCY M g g Req./Provided E • PROJECT DESCRIPTION SQ. F7. Planning 0 Address(mailing) T Q Notes: �MQ. M CONSTRUCTION TYPE J— ) VALUATION$ �3 [.C9/• In � n "'�- `^'` _��1,- `�,¢�,� m `q%'I,� CityC NLiSense No. - ZONE GRADING CU.YDS. ACRES k/•J 111vs' 10-13-44- room Y��G�Y'1') IG �✓t11(7 VW1-- LICENSED CONTRACTOR DECLARATION • ...„„„ �����. ��� � LL� (�1,,`�,,Ytsf hereby affirm that I am licensed un• . isions of Charter 9 (commencing Remarks: to • D 4 / I JLen- 11..04. i/'e�s�"y bv� Yeett-d Cly R'KV " wi '•• 000) of DI ' : o the Business and Professions Code,and t • _ 1A -' license is in I•-. t, ELECTRIC/W •x•OR bred- . FEES se - ° PLUMBING FEES Automatic Washer Transformer 0 15-50 KW Signature -_ 0 50+KW WrRKERS'COMPENSATION DECLARATION ' Construction Pole Sub. • bb affirm that I have a certificate of consent to self- Bar Sink Showers _ y insure or a certificate 1�Q tup Compensation Insurance, or a certified copy thereof (Section Cooking Unit Meter tup to 100 amps it 0, Lab. C.) ,s..- icy . Backflow Preventer I Service Sink ..... ''�`io. -- •. I / V�'a icy No. Company Backflow Irrigation Sewer• Cap ;Dishwasher ,...// Meter Dover 100 amps 8 Certified copyis herebyf'f urn ishetl. ..• --II 'Dryers ❑Gas-i Electric;'- Sub Panel • (/ Certified co py,is filed with the city Building Division. Bathtubs I Sewer Connection r OFJ ( I !, / Date -- •'Applicant -• .--- -__ - I ,Fan '' Clarifiers Solar Collectors • - It Motors Lf0.1 HP 01%-8 3 Utr) �j EXEMPTION FROM WORKERS'COMPENSATION DECLARATION " "' (This section need not be completed.it•the permit is for one hundred ($100)or Inc.Solar 09.15 HP❑16-15+ less). - Dishwasher Solar Piping • •� F!A.U. I certify that in'the performance of the work for which this permit is issued;.l` Fixtures w ' shall not employ any person in any manner so a to became subject to the ` Drinking Fountains Solar Tank J `.. }�(y, 14 Microwave ., to Workers' oyy��ggeen5 Laws of Calif _ /z/' / Device Boxes • Date [LJ(s �� Signature t as 4lO'elC NSA Floor Drains Swimming Pool w/Spa Pole Light • NOTICE:If,6 fte making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal 11 Outlets Range 1 a-e75-- comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Gas Service Outlets Switches Water Closet ? eio 1 Sign (,/ BO I hereby affirm that there is a constructions agency for the performance L of the work for which this permit is issued (Section 3097 Civ. C.) Ini¢rCeptOrs Water Heater Garbage'Disposal Standing Sections Lender's Name - Lender's.Address - , - Kitchen Sink Water Service Generator 00-5 KW 05.15 KW Trash Compactor OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the 1 Lavatories Auto-Wash U O() Owing reason (Section 7031.5 Business and Professional Code: Any city or I • rty which requires a permit t0 construct,alter,improve,demolish or repair Z P-Trap Laundry Tracts cc)_ structure, prior to its issuance, also requires the applicant for such permit lea signed statement that he/she is licensed pursuant to the provisions of Roof Drains ontractor's License Law (Chapter 9(commencing with Section 7000)of - t70 :ion 3 Of the Business antl Professions Cotle) or that he/She is exempt Reinspection Fee I $15 Issue Fee $ f efrom and the basis for the alleged exemption. Any violation of Section - J 11.5 by any applicant for a permit subjects the applicant to a civil DEVELOPMENT SERVOD/, fly of not more than five hundred dollars($500). - 1O`\/ UIREME NTS: . - as owner of the propertyor my employees with wages as their sole Reinspection Fee $15 Issue Fee $ 3 i - - • 9 Zoning Approved By Date /1 compensation, will do the work, and the structure is not intended or-offered for sale (Section 7044, Business and Professional Code: The Contractor's . MECHANICAL FEES Building Approved By �� Date .lM $a. License Law does not apply to an owner of a property who builds or improves - j \ _ thereon, and who does such work himself/herself or through his or her own Application Issued By Imo]. V Date — . . , employees, provided that such Improvements are not intended or offered for Boiler Hood or Type I 0 - 1 sale. If, however, the building or Improvement is sold within one year of coin- Canopy Type II 0 SUMMARY OF FE- pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground prove for the purpose of sale). BUILDING PERMIT $ /,3 • 00 SMIP $ • 7 D p f 0 I, as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System • ' PLAN CHECK '1J tractors to construct the project (Section 7044,Business and Professions Code: $ I O PERMIT The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑0-100,000 BTU 0100,000 BTU PLUMBING $ '1L(. on ISSUANCE $ - builds or improves thereon.and who contracts for such oroiects with a con- __ 7r(s) license pursuant to the tractors Li nse Law). I am aware that Exhaust System ❑ Multiple ❑ Sys - Repair/Alteration PLAN CHECK 25% $ • •� ENERGY P.C. $ pr f o their Worker's Compe a on insuran .uld p •video to me. /y -/ ELECTRICAL $ 3 .etc GRADING $ a t nder Section ,( . ^•`his reason Firepl/Fact.Blt. ICBG# ire Dampers r �7 /J- . PLAN CHECK 50% $ MICROFILM $ ,� Date Ownor .nit Heating System& Ducting Registers - MECHANICAL $ TOTAL FEE $ 36©s13 I hereby erti that I have read this application and state that the above El 0-100,000 BTU 0100,000 BTL $ Information is correct. I agree to comply with all city and county ordinances '.PLAN CHECK 25% and state laws relating to building construction, and hereby authorize repre- sentatives of is city t enter u on the above-mentioned property for Inspection oses. Signature "`✓ - Reinspection Fee $15 Issue FeeT 'st 1 7 . — $ 3 _ 01 00021307-GL0_18�1 TOT $0,ii ` 0865-46,rev. 5/88 White - Building; Canary - Applicants\-Accounting; Goldenrod - Assessor •„ --. DATE: 12/12/88 TIME% 04:59 1H lir_ . _ V ain't, ! CONSTRUCTION AND PLANN 4=`A ir) - Date LS Inspector .( Date' Inspector Iiik ROVALS Permit # APPROVAermrt#tic I 1l,i,, '-1."temy E porarlectrical Service or Pole ' Pool ' . 1 52. & Equipment Location fif- f1./. /7 2. Soil Pipe-Undtgrnd. II;0 iii/qhtt tib 53. Steel Reinforcements !13/ ' �7 3cElectt&a'l Conduit Utility-Undrgrnd. . n 'n 54c. . Forms .�� /} 4(0lectical CAn'uit'jUndrgrnd. (s - 5-9-8? ry� 55. Electrical Bonding a, 5%S>;eel Reinforcement I i 56. Rough Plumbing & Pressure Test --7 /., �v •62Etectr`ica1 UFER Grnd.. I `¶tr 1 (61 6-74-...) 57. APPROVAL TO COVER-GUNITE tiny( la: • 7r)Fa ting • 1' k cc-0_4 t ` r. `lb \ Q ' ' 58. Electrical Conduit-Undrgrnd. 4 'r` 71.U It. Foun iatidn 'A \ c' 59. Gas Pipe, 0 Undrgrnd.,Testk. 2- 92Water Pi a-Unilr rnd. ter' (Y 'r 11 j ;? r9 / ( if�h'9 Lee) 60. Backwash Lines, P-Trap, 0 Undrgrnd. i 10. Structural Floor System t 61. APPROVAL TO DECK -,M✓, 11. PropertyaSewel Line & House Connection tilnigf Lara 62. Backwash & Receptor-Final 'r 41; l ll a 12. SewettCap - 1 - '11 1../.. i 63. Heater & Vent-Final 13. Roof�Drains• i 64. Plumbing System - Final ' i '. 2- 14. Rough Plumbing Ida(1y L 65. Electrical-Final , ''o 15. Rough Electrical-Conduit _ 66. Solar System-Final 118)Rough Electric Wiring 67. Fencing & Access Approval 71,.e Rough Wiring Sign 68. APPROVED FOR PLASTERING 118:-Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19?Rough I.9 ting & Air Conditioning r. FIRE DEPT. REQUIREMENT 20'Rough Factory Fireplace APPROVALS Permit# I 217 Ducts, in'Structure 70. Underground Hydro in: structure Ducts, Ventilating (j /o 71. Product Piping 0 Gas ❑Oil 233 Gas Pipe Rough & esi tO _ _. 72. Undergrour d Flush , 241. Roof Fra&ning 7l (V � 73. Undergrnd.Storage Tank ❑.Gas ❑Oil 25. Roof Sh4thing tt A .3i2, ) , pVV/ 74. Overhead Hydro - ' / , 26. T-Bar Ceiling (Structural) &!1onocoat _ 75. Dry Chemical ` ' 25 Frame, nd Flashing ,/p jv0� pit 76. Dry Standpipe .• , - n (p/ 28. Lathi u&lSidin q9 nr 9 1_-`IO dfa/g- .77. FIXED SYSTEM FINAL 29. Insulation -78. FIRE PREY. FINAL , 30. Drywal�Nailing 1-•"/.. ili' .('� fJ� - HEALTH DEPT. REQUIREMENT 31% Plasterj83 wn Coa. l/ 79. FINAL INSPECTION . • 32. Elect I' lgPower Meter-Final .. � 80. FOOD CERTIFICATE ISSUED ' 'dr 1 33. Final Electric U j 007/90 , :1),- (Idles: c `✓7 n 34. Final Heating & Air Conditioning .� i . ' is 35. sinal Gas Pipe-Test .3 5 1p/iciel tit° • •' 36. liiood or Canopy ] �' ,4 4✓ C a , �,l/ I 2r/9" ' 37. final F.actoryttFireplace U 38. Final Pluribirig v T wIfgi ( ci a 39. Wate'S& vice-Final 4 .j .E - 0-- e 40. Gas Ser ice-Final ii, '7 /2I100 440 F .41. SolatDornestic-Final .„..*i...3 . - 4 ti -. r. 42. :Backflow:Preventer --'':' '- -""-' r \ ;•j y • j.'-} � r • F 43. Backflow Irrigation : - . .- • U y ,^ f/ ' 44. landscape Irrigation System' Vii,,, ( - t • 45. Sound.Attenuation ' Zi 46, Handicap Regulations . ' ; 47. FINAL STRUCTURE& BUILDING 1� / .•� • 48. Special Requirements'Completed ./- -z �j��, -- • ' 49. Electric Release to Edison / t 1 �a z-J . 50.tGasRelease toSouthern•CaliforniaGas Co ,. _ '.rir ;,r Lr/. ,,t 51. CERTIFICATE OF OCCUPANCY ^' ,` - - r r-' ` n, - - - t. No. Date .� c r _ ^ _ - _ Applicant to fill in all spaces except those within heavy borderlines and sign all appropriate declarations. - - - -. - -- _ - PERMIT NO: TRACT NO. LOT NO. ' UNIT NO. . „I_ .CI 3859 4/25/BE ;'7;11 ' crry OF COSTA MESA CONSTRUCZION PERMIT Project Address 2.23 L(.G4JAe ) [4c&1COs'(pmem PE 33S"S5 f -. ` Applicant's Mallin ddress 14.--e. A/�z'- `4 14 - /r• L• ' TYPE OF CONSTRUCTION LJ NEW-❑ ADD ALTERATION $.REPAIR ' �q,,(q `� -❑ CONVERSION-El DEMOLISH' ❑ OTHER A.P:# - - - zone _ Owner's Name • iC. I14",20 - 01(5 F/Efrk- Phone�p5`5CS7 - DESCRIPTION OF WORK/USE OF BLDG. " - • Address '1f5O42. Akfr /q(-rts4 L�•t y'/n( A'4 AJ/CoL�L • . • - - - S Main Building: Accessory•Building:. - , Arch/Eng: License No. - TYPE OF PERMIT ❑ GRADING" -FOUNDATION ❑ STRUCTURAL . E Front - ZO, _ y� Address - ❑.TENANT r/+r LECTRICAL - PLUm BING ❑ MECHANICAL ' ' B Rear - - N l�� - _ Phone • ❑ 'OTHER' A • _ _ - I Contractor's Name - C Right " N• • • PROJECT DESCRIPTION SQ. FT. OCCUPANCY G Addre55.(mailing) - CON ST RUCTION,TYPE VALUATION$ K Left - City License No. - 1 ' S - R • LICENSED CONTRACTOR DECLARATION • ZONE GRADING CU.YDS. : ACRES Ping. Ref. # Parking Req,/Provided - E' I hereby 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 ' • ' _ - T,, my license is in full force and effect. _ • r ' i Si' License Class - License No. Date Signature' - . PLUMBING • FEES _ 1 •YORKERS' COMPENSATION DECLARATION 63r Sink Showers ' ' lereby affirm that I have a certificate•of consent to self-insure or a certificate ELECTRICAL FEES 1 • I Workers' ,Compensation-Insurance,-or a certified-copy thereof.(Section..-.- - - - - - - -- - ' - 3800, Lab. C.) •• t,., , Backflow Preventer ® Service,Sink • •� •/ Automatic Washer' • Transformer 0 15-50 KW Policy No. - Company - " Backflow Irrigation Sewer CapI - ❑ 50+ KW ' 8 Certified copy is hereby furnished. • i - • Construction Pole$ub. Certified copy is filed with the city Building Division. ' - ' Bathtubs 1 Sewer Connection Cooking Unit' , Meter yup to 100 amps Date - Applicant - • ' — - =�' EXEMPTION FROM WORKERS'COMPENSATION DECLARATION - • - =- Dlafif sets_ - •_ - Solar Collectors _- _. /. Dishvva Sher - -•-'• - Meter ❑over 100 amps- •- (This section need not be completed if the permit is for one hundred ($100)or , ( • _ — 1 • less). f ! Dishvvasher ; • Solar Piping Cr Dryers ❑Gas ❑Electric Sub-Panel ' I I certify that,in the performance of the work for which this permit is issued-1, ' - ' • shall not employ any person in any manner soy as to become subject to'tia'e Drinking Fountains ' Solar Tank Fan Motors 00.1 HP ❑1%�8 ' Workers' Compensation Laws of California: - " '• " ` 1/ - ^5 , • ..Date Signature Floor Drains Swimming Pool w/Spa F.A.U. 'NOTICE:If,after making this declaration,you should become subject to the _ - Inc.Solar 09-15 HP 016-15+ 'Workers' Compensation-provisions of the Labor Code, you must forthwith Floor Sinks, Urinal Fixtures ' comply with such.provisions or-this permit shall ,bei deemed revoked. - - , ' - Microwave ' CONSTRUCTION LENDING 'AGENCY - • - Gas SerWce .Outlets, ' Water Closet Device Boxes Pole Light I hereby affirm that there is a construction lending agency far the performance - •- = 9 , of the work for •which this permit':-is issued: (Section':3097 Civ. C.) ' Interceptors ! si '.Water Heater ill , Lender's Name ' '- - _ - L CA'/� '�' Outlets Range / • Lender's Address ' -- - , Kitchen Sink .0 _ ' • ' a :Water Service -. - Switches Sign , OWNER BUILDER DECLARATION ♦ - _ - - , I hereby affirm that I am exempt from the ontractor'i License Law for the ' Lavatories AUtO-Wash following reason (Section 7031.5 Business and Professional Code: Any city or • • Garbage Disposal Standing Sections county which requires a permit to construct,alter,improve,demolish or repair P-Trap - ' I Laundry Trays Generator ❑o-s KW❑5-15 KW ,any structure, prior to its.issuance, also requires the applicant for such-permit - Trash Compactor • • .to file a signed statement that he/she is licensed pursuant to the provisions of • Roof Drains - • r fJ, /f I •',the Contractor's License Law (Chapter 9 (commencing with Section 7000).of (TCp/ 2 ' Qnivislon 3 of the Business and Professions Code) or that he/she is exempt - - / ' /'-I,herefrom and-the basis for the alleged exemption. Any violation of Section • 2 •• - • ( `7031.5,by any applicant fora permit subjects the applicant'to a civil - " I • ' , - ' ' ally of-not more than five hundred dollars ($500). I -. 3 - I as owner of the property or my employees with wages as their sole Reinspection.Fee I $15Issue Fee - $ ce rpensation, will do the work, and the structure isnot intended or offered 1 • - Reinspection Fee 'I $15 Issue Fee1 • t $ 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 - • 3 - 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 • I Date prove for the'purpose of sale). ' - , 1 ,,,_�/q/ I D i, as'ownef of$he property, am exclusively contracting with licensed con- ' Duct-Structural ' Refrigeration System Application Issued By //L(T • Date yYy�-1-/ 5�/ 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 ❑0-100,000 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). am aware that Exhaust System _ - BUILDING,PERMIT $ SMIP ' $ I y 0 Multiple 0 System Repair/Alteration proof of their Workers Compensation insurance should be provided to me. _ i PLAN CHECK $ PERMIT i 0 jam exempt under Section ' B.& P.C.for this reason ' Firepl/Fact..Blt. ICBO'# Fire DaMpers • I PLUMBING $ 45-1-r. ISSUANCE ' $ ; , Date Owner' Heating System& Ducting • Registers r ' ' tee" ENERGY P.C. $ 1 • _ PLAN CHECK -25% $ -1 hereby cers correct1 have read this application and state that the above r 00-100,000 BTU 0100,000 BTL / �[ ' information is correct.-I agree to'comply with all city and county ordinances , ' ELECTRICAL ; $ • f dg 7O GRADING $ and-state law elating:to building construction, and'hereby authorize repre- • - • l , MICROFILM $ ' sentatives s cit to nte ' upon the above-mentioned property for I PLAN CHECK 50% $ �° , • inspection s s. r, K'L�A� MECHANICAL $ TOTAL FEE 1 $ // G� Signature ' _ , Reinspection Fee_ $15 -Issue Fee $ 3 PLAN CHECK 25% $ - CMF 0865-46,rev. 10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod -Assessor „� • . . . . 1 CONSTRUCTION AND PLANNING .. POO._.SPA Date Inspector Date Inspector APPROVALS Permit# - APPROVALS Permit# • jj 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement s 3.'Electrical.Conduit Utility-Undrgrnd. 54. Forms r 4. Electrical,Conduit-Undrgrnd. - 55. Electrical Bonding Jr. 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test - f;T ( 6.'Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE ;'- .1) 7. Footings 58. Electrical Conduit-Undrgrnd. , _ of 8. Foundation - 59. Gas Pipe, 0 Undrgrnd., Test ?:V 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 - "'f 13. Roof Drains 64. Plumbing System - Final . r 14. Rough Plumbing ,S2a-a° L4.t7 65.- Electrical-Final - 15. Rough Electrical-Conduit 66. Solar System-Final • - 16.; Rough Electric Wiring 67. Fencing & Access Approval 17. sough 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. Undergnd.Flush ' 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing • 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat . 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final . - 80.- FOOD CERTIFICATE ISSUED 33. Final Electric (.0750/gra L'4'4 Notes; . , . . 34. Final Heating & Air Conditioning y,_•- 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 4,-.3O.$6 L.,E-D 39. Water Service-Final ' 40. Gas Service-Final • 41. Solar Domestic-Final • 42. Backflow Preventer c _ 43. Backflow Irrigation 44. Landscape Irrigation System • 45. Sound Attenuation - 46. Handicap Regulations - - 47. FINAL STRUCTURE & BUILDING - 48. Special Requirements Completed - 49. Electric Release to Edison , 50. Gas Release to Southern California Gas Co -:t . fr. • 51. CERTIFICATE OF OCCUPANCY ' - - . No. Date _ ��� • • w CITY OF COSTA MESA >w �V, BUILDING DIVISION • DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 004PERMIT • +izoi 00-00716 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 223 LILLIAN PL Status: ISSUED Suite: Applied: 05/18/2000 Vicinity: NOTH EAST CORNER AT GARAGE Issued: 05/18/2000 Parcel Number: 43921110 Zoning: Applicant: ROLSHEIM, RICHARD LEE ISSUED BY: Address: 223 LILLIAN PL Phone: 327-7477 COSTA MESA, CA Zip: 92627 Owner: ROLSHEIM, RICHARD LEE Address 223 LILLIAN PL Phone: ' COSTA MESA,CA Zip: 92627 Contractor: Address: Phone: Zip: License: Arch : - - Eng: Address: - Address: Phone: Phone: . • Zip: License: License: SCOPE OF PERMIT PARTIAL ROOF DEMOLITION DUE TO FIRE REPAIR. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $400.00 Permit $23.50 Claim Valuation: $400.00 SMIP Res: $0.00 SMIP Corn: $0.00 Other: $0.00 - Inspection: $0.00 Total: $23.50 • 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: • EXPIRED DATE a 5 0 - �o T�` 3 `t 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 novcommenced 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 • lairalirMallet WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: o I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code.for the performance of the work for which this permit is issued. o I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'compensation Insurance carrier and policy number are: Carrier: • Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that In the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' 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 ADDmON 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.a Class k Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Cale). 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(5500).): ❑ 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 pursue the Contractor 'cense Laws.). ❑ I am exemp under ec. ' / Business and Professions Code for this reason: Si ur • A1/f'111,1P. 7� r - W: W 00 O' er ID verifie by drivers license. ❑No A se No. Expires Z—/V-63 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? ❑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 ❑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 Califomia Health and Safety Code been fully complied with? ❑Yes ❑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? U Yes u No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 8 Will 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 (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No 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. c Signature: >"-fi. r .a:•, ./ >{ 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 agr., to omply 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-des bed p sporty for' action•. ....' ,• r'not to occupy or allow occupancy of any building authorized by this permit ntil Njpal-I• ppectior. eiv I ii.„., F€”) i'to And/Or Authorized Applicant Date CODE r INSPECTIONTYPE DATE INTRIALC CODES INSPECTION TYPE Q&1 JNTmAIi 1616 Fixed System Final Fire Prevention 206 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