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Home My WebLink About229 LILLIAN PL - Building Permits • r , 110 IIlb , . CITY OF COSTA MESA t BUILDING DIVISION F 9 r ,II 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us °. • FOR INSPECTIONS CALL: (714)754-5626 S•h°'°soe PERMIT NUMBER: M08-00006 PERMIT TYPE 9 E109 MECH"as. STATUS: ISSUED 1 DATE ISSUED: 01/15/2008 �.: y 107 ISSUED BY: BJK Drat . JOB ADDRESS: 229 LILLIAN PL;_CM ; Suite/Unit .-:, Vicinity: SQ. FT: 0 r- _ ni; SCOPE OF WORK: INSTALLATION OF A NEW 75,000 BTU FAU IN THE ATTIC WITH THE ADDITION OF NC. 1 INST FAU < 100K BTU, 1 ABS UNIT 3-15 HP' . NO OTHER WORK AUTHORIZED',WITHTHIS PERMIT. , , f 77 . OWNER: DAVIDSON,ICONS TANCE W� Atldress ., 229 LILLIAN PL UmL-'": + ;', PHONE: ``'r r - -- 'City/State/Zip: COSTA MESA CA- . APPLICANT: BEEKER,ANDREW / Address: '1308'LOGAN Umt SUITE H PHONE: 714-979-2070 City/State/zZip: COSTA MESACA , - �••'i ` '-' `-, 6 CONTRACTOR: KLONDIKE AIR INC, ' r -- License N - o. 754456 , - ' L Address: 1308 OGANUnit:•'SUITE/H ".1 '': : : - . PHONE: 714-979-2070` ',), City/State: COSTA'MESA;CA,. , -ZipCode: 92626 . • , CELL: , MECHANICAL PERMIT FEE SUMMARY ' MECH ITEM FEE: "' $65.45 . - - PLAN CHECK FEE: INVESTIGATION FEE: ' $0.00 ' - ` r''. , r;LI REINSPECTION FEE: 'L )$0.00 TOTAL FEES: $65.45 • . 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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. • ' 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. CODE S. INSPECTION TYPE DATE INTITIALS CODE II INSPECTION TYPE DATE ' : A.'. <'INnTIALs 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 ' ':'1,'{,ii t{` 204 Final Demolition • 250 Final Building/Occupancy WORKERS'COMPENSATION DECLARATION: Owner ID verified by driver. ❑Yes El No I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires: ❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed): 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 Sion 3700 of the Labor Code,for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: • permit is issued. My workers' compensation Insurance carrier and policy El I hereby certify that no excavation five(5)or more feet in depth into which a number are: Cartier: - person is required to descend,will be made in connection with work authorized 91'n_JN by this permit,and that no building structure,scaffolding,falsework,Cr demolition or dismantling thereof,will be more than thirty-six(36)feet high. (Chap.3.2,Grp (This sedbn nelled Trot be completed ithe permi is valued at one hundred dollars/(SIDO)or less.) 2,Art 2.Sec.341,Title 8,California Administrative Code). Policy Number: 19 — 4 fJ GoD 3 fla�c7 ❑ As owner-builder. I will not employ anyone to do work which would O I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of Ca'omia, and agree that if I should become bj- t to the • 'compe• a on provisions of Section 3700 of the Lwit,-•or C•..,I shall fi •wi ompl , these provisiggns. / Applicant's Signature Date 9/ 1 Division of Industrial Safety Permit Number: • Applicant's Signature ` (( Date l! HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? El Yes ❑ No ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. 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 LICENSED CONTRACTORS DECLARATION: 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file my license is in full force and act. a registration form for acutely hazardous materials? 0 Yes 0 No Lic.# 75 Lt"(J'i lass# —1—0 (Section 25533 of the California Health and Safety Code, with some \ l / / exceptions, requires registration with the Costa Mesa Fire Department by (----2.--•--i•—.../ V��///��--- // �y�! each business which at any one time has on hand a quantity of acutely Contractor's Signature bate /// 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 CONSTRUCTION LENDING AGENCY: temperature and pressure). ❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? ElYes ❑ No (Section 25534 of the California Health and Safety Code provides that the Lender's Address: 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. Signature Date 4. If an RMPP is presently required, has Section 25534 of the Califomia OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes 0 No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes ❑ No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the Califomia Govemment Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be fumished on applications for non-residential building permits). 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 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes ❑No applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes",the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the California Health and Safety Code). ❑ I. as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec.7044, Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by California License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? El Yes ❑ No 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 8. (If"yes",attach certificate of•compliance from the appropriate air pollution sale. If, however, the building or improvement is sold within one year of control officer). - completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of,perjury the did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. ❑ I, as owner of the LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of Signature Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that ❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of • Business and Professions Code for this reason: 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 thi .- mit unti •-I inspecti.n. .Ignature• Legal •a W 4 to I Signature Date �/S/ ( JX 3057.46(3/07) r+mr Au orized Applicant Date l 1( " C ) LLQ 11:72i .Art • U USE :OMPL S WITH ZONING DFtvi OS o ,e) cc' BY:__. DATE: I_� SI 6 CITY OF COSTA MESA ` ee BUILDING DIVISION F AIf 77 FAIR DRIVE, COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us � . FOR INSPECTIONS CALL: (714)754-5626 • PERMIT NUMBER: E08-00081 PERMIT TYPE ELEC STATUS: ISSUED APN: 43921109 ( DATE ISSUED: 03/1412008 ` ISSUED BY: JOB ADDRESS: 229 LILL L CM' Suite/Unit: • Vicinity: SCOPE OF WORK: ELECT FOR:NC UNIT-RUN 220 VOLT REF: M08-00006 INSTALLATION OF A NEW 75,000 BTUFAU IN•THE ATTIC WITH THE ADDITION OF NC. 1 INST FAU<`100K BTU,•.T ABS UNIT 3-15 HP OWNER: DAVIDSON;CONSTANCEW 7 Address: 229 LILLIAN.PL.•Unit.!'. PHONE: `'"- City/State/Zip: COSTA MESA'-CA APPLICANT: BEEKER,ANDREW •- " 'Address: • - Unit: 1'�t PHONE: 714979-2070 - City/State/zZip:. . • CONTRACTOR: KLONDIKE AIR INC - _ License No. .' 754456 Address: 1308 LOGANUnit: SUITE H -• - PHONE:- .714-979.2070 - City/State: COSTA'MESA CA ,`-, 'ZipCode:, 92626 - CELL: ELECTRICAL PERMIT:FEES ' Electrical Plan Check Fee $0:00 Electrical Permit Fee: $35:80 Reinspection Fee TOTAL FEES $35.80 .' 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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION: 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. CODE O. INSPECTION TYPE DATE INTITIALS CODES INSPECTION TYPE DATE INTITIALS 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 I - 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy WORKERS'COMPENSATION DECLARATION: Owner ID verified by drivers lict.....e. ❑Yes ❑No I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires: O I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed): compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. le I have and will maintain workers'compensation insurance,as required by Gtion 3700 of the Labor Code,for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a number are: person is required to descend,will be made in connection with work authorized i C ,�� by this permit,and that no building structure,scaffolding,falsework,or demolition Cartier: ../��y7T� or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp (This seam n edltot be complied a the pe rid is valued at one hundred do0ars(E tOe)a less.) �� 1 2J"t �� Z 6 2,Art 2,Sec. 341,Title 8,California Administrative Code). cy.Policy Number: "� ❑ As owner-builder, I will not employ anyone to do work which would ❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of California. and agree that if I should become sub' t the won a rap• :tion provisions of Section 3700 of — - Applicant's Signature Date the Labor e,I hall fort wit•• )- these provisions. •i',- I/it Lsn6 Division of Industrial Safety Permit Number: Applicant's Signature bate ��/ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes ❑No ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. 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 LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons,or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000) of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file my license is in full force and effect. a registration form for acutely hazardous materials? 0 Yes 0 No `i Lic.# Sir L'1 J toClass#f V` (Section 25533 of the California Health and Safety Code, with some --'- C3-PfrO s l - exceptions, requires registration with the Costa Mesa Fire Department by (:)/......—...." (-7 each business which at any one time has on hand a quantity of acutely v contractor Date 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 CONSTRUCTION LENDING AGENCY: temperature and pressure). ❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work for which this permit is issued.(Sec.3097.Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? 0 Yes 0 No (Section 25534 of the California Health and Safety Code provides that the Lender's Address: 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. Signature Date 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes 0 No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? ❑Yes ❑No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Government Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits). 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 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes ❑No applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes', the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the California Health and Safety Code). ❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other compensation. WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec.7044, Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes ❑No thereon,and who does such work himself or herself or through his or her own 8. (If"yes", attach certificate of compliance from the appropriate air pollution employees, provided that such improvements are not intended or offered for control officer 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 CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and El I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. LICENSED CONTRACTORS to construct the project(Sec.7044, Business and Professions Code: The contractors License Law does not apply to an owner of Signature Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that El I am exempt under sec. the information 'ven is correct. I agree to comply with all state laws and city ordinances r ti to building .. struction nd authorize representatives of Business and Professions Code for this reason: the City o Cost Mesa to e, upo above-described property for inspectio urpo s. I agree t • c • allow occupancy f any building authoriz by chi rmit unf in- s• -_1 3 Pi of3 L / Signature of Legal Owner(s) D e Signature • Date 3057<8(3/07) Ana/or Authorized Applicant Date A ,�i1LL - :' ' -'' CITY OF COSTA MESA • ., 4 BUILDING DIVISION .E- 1F-e: - 1F- " DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER f tu:nsi i .4* B04-02017 B04-02017 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 229 LILLIAN PL Status: ISSUED Suite: Applied: 11/30/2004 Vicinity: Issued: 11/30/2004 Parcel Number: 43921109 Zoning: Applicant: •HN LER ISSUED BY: Address: 751 # IR CANYON RD - - SUI 462 -Phone:• 714-280-0195 .. , • IAHEIM, ' Zip: 92808 - , .. Owner: PLUMMER, ANTHONY K JR TR % Address 229 LILLIAN PL ` . -. 'T COSTA MESA,CA - Ph Zip: 92627 EX,, - or Contractor: "SOUTH.PACIFICCONSTRUCTION , 'CIA2E 1D 7 �� Address: -751 S WEIR CANYON RD - - ,. SUITE"157-462 Phone: 714-280-0195 , --, ' , ANAHEIM,CA Zip: 92808 License: 534813 - - Arch : Eng: .. - Address: " ' Address: • Phone: - Phone: , - - Zip: License: ,,License: - ' SCOPE OF PERMIT - CHANGE OUT 6 WINDOWS THROUGHOUT S.F.D.TO MEET 1_997 U.B.C.EGRESS REQUIREMENTS. REPLACE WITH VINYL/DUAL PANE,`AND HEADER WILL REMAIN THE SAME. ELECTRICAL WORK ALSO INCLUDED.- ' / ' --,W..1S..i>4I - . - •....P —z -2.-, • -t---;f2-.:.,"2-Y.77-.;---. - N^ -1 --•-7�''1-•.. • '11/30/04-PERMIT SUPPL•:TO-INCL'UDE' NEW'DRYWALV@ FRONT.BEDROOM WALL QCEILING'NEW,DRYWALL @ FAMILYROOM$.KITCHEN WALL-&CELING;DRYWALL'REPAIRi'@LIVING-ROOM&1DINING ROOM;AND REPLACE BATHTUB&SILETAROUND BATHTUB •I' 7‘ �I i.,r r. - - - 77 - - - FEE-SUMMARY" . Plan Check: $0.00 Calc Valuation: , $2,30&00 .Permit: ' $83.25 - Claim Valuation: : ,' : $2,300.00 SMIP Res: . $0.50 -. - SMTP Corn: $0.00 r " ,.vOther: - $83:25 "' " ' ;;;/ Inspection: $0.00, _ i ," . . Total: $167.00.: ' - -,,, , \� ,/ , - 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 • 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. yer FOR INSPECTIONS CALL: (714)754-5626 /G 2446-66(6/00) • CO WORKERS'COMPENSATION DECLARAT . 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: his section need not be completed it the permit is valued at one hundred dollars($100)or less.) • I certify that in the performance of the work for which this permjyis issu ,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, nd agree that If I should b me ject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these 1st Gl j r / 7 +� Applicant Signature: / V 6/ Date: '�( � > Q ^ WARNING:FAILURE TO SE ORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(S1 ),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 glide(provi;jE7sRf Chapter 9(co cing with Section 7000)of Division 3 of the Busineg and Professions Code,and my license is In full force and effect.IJc.If 0 5 y— x! - "• Class if Contractors Signatur ' 1 / r Date: /1^S 0 —O"7b CONSTRUCTION LEN AGENCY: • O 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 hoar 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 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 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 Processions 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,1,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). O 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 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 II 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 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 jJ 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 E 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 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. 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 ordinanc relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I green o occupy or allow occupancy of any building authorized by this permit until final inspection. ii— /( SO dill L1T§2 0 r(s) ate /_ And/Or Authorized Applicant Date CODE f INSPECTION TYPE gA7E R(T1 ALS CODEC INSPECTIONTYPE 2ATL tti uiAi& 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 r - 220 . Final Planning Approval 203 Final Sign 222 Final Site - 204. Final Demolition . 250 •Final Building/Occupancy ' �. J.4 A iv /.( /C/C.5,'1 c-Se;Uri A/17C (.;n-51 /SA -0/, L c ec7.,-06: it.c E J f<k CS K Flier_ Ar-rt in e4 4 ,'-p oc Z.1-11) (1 zeut,lb/. n /1i A /i/1 (/E(` C; "Jr( (lc (6c C �• i 53'I773 7/i - ?/ s -Yo2 i. CITY OF COSTA MESA • BUILDING DIVISION >tit ,rStria. DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER F r rya ./ PERMIT J �,� �111� '"ramRo�' B04-02017 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 229 LILLIAN PL Status: ISSUED Suite: Applied: 11/30/2004 Vicinity: Issued: 11/30/2004 Parcel Number: 43921109 Zoning: �j e__________ Applicant: JOHN MILLER ISSUED BY: `� / Address: 751 S WEIR CANYON RD SUITE 157-462 Phone: 714-280-0195 -, ANAHEIM,CA Zip: 92808 - . Owner: PLUMMER;ANTHONY-K JR TR " Address 229 LILLIAN PL . Phone: - - - COSTA MESA, CA Zip: 92627 _ - Contractor: SOUTHPACIFIC CONSTRUCTION Address: 751 S WEIR CANYON RD . SUITE 157462 Phone: 714-280-0195 ANAHEIM,CA ' ' Zip: 92808 License: 534813 Arch : Eng: Address: -- - Address: Phone: -. Phone: Zip: License: License: - ' SCOPE OF PERMIT CHANGE OUT 6 WINDOWS THROUGHOUT S.F.D.TO MEET 1997 U:B.C. EGRESS REQUIREMENTS.REPLACE WITH VINYL,DUAL PANE,AND HEADER WILL REMAIN THE SAME.ELECTRICAL WORK ALSO INCLUDED. - - FEE SUMMARY Plan Check: . I $0.00 Calc Valuation: $2,300.00 Permit: $83.25 Claim Valuation: $2,300.00 SMIP Res: $0.50 SMTP Com: ' $0.00 • Other: $83.25 Inspection: ' $0.00 , " Total: $167:00 / , PLANNING &ZONING !/ SETBACKS - 1 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 • 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) • 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 et one hundred dollars($100)or less.) • certify that in the performance of the work for which this peprit is' ed,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Califors>�rl%agree th i I shout e subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith complywith these provis ons. 1\/ "aft ' -'`r Date:: 4-(l WARNING:FAILURE TO SEqu$ORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBIECT AN E OVERMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND DOLLARE(Sl ),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 licensed under•r•visio s• Cha ter 9(commencing wi,zi-ec'- 7000)of Divisio o e.Susiness ar Professions Code,and my license is in full u•15::)QTI7-(r act. ....p..-,1^v 5 • / -,air ass CS ContractorsSiane(urm-^••-+r•--..1.5 -��/L� ,Detet,.-_,_. /1- 3 `J —0`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: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): . ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ' ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes 0 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: 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 California Health And Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which et 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 akPermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? al Yes LJ 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 an, state at 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 C' of C.•to Mesa t• enter upon the above-described property for inspection purposes.I agree not to occ •y or low occupancy of any building authorized by this permit until fi•al insp' tion. r rtgnature Of Le•..I• '_r(srer Date ' AF 0 • 1 V CODE ItteItalLECEE gdTf. I.•usa. •. 1 N +.a• I- , PAM :r!u.: - 1616 Fixed System Final Fire Prove ti.n 06 ' al Mechanipal 1266 Pool Spa Final / - / •08 Final Plumbing ti 200 Final Re-Roof , 1 I Final Electcal 1 1� 201 Final Block/Ret.ining Wall Fin: F'a '�:v=�"on ger 202 Final Factory Fire •� ce r .,,,,, t • Fina�nl;!Approval 1 203 Final Sign S 2 2 Fina I .,.I 204 Final Demolition 250 Fi :uilding/Occupancy . . t , .5111 CITY OF COSTA MESA 4 BUILDING DIVISION fa rf s DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER t • 1 V.:1 P PERMIT • 04-00808 4coaroRano (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 229 LILLIAN PL Status: ISSUED Suite No Applied: 11/30/2004 Issued: 11/30/2004 Vicinity: Parcel Nunmber: 43921109 ISSUED BY: � - _ Applicant: CHRISTENSEN; SHANE Address: _ • , Phone: -949 689-6404 - - Zip: Owner: PLUMMER, ANTHONY K JR TR , , ' Address 229 LILLIAN PL Phone: COSTA MESA,CA Zip: .92627 _ Contractor: - - : - Address: Phone: Zip: License: . SCOPE OF PERMIT -- REF: B04-02017-CHANGE OUT 6 WINDOWS THROUGHOUT S.F.D.TO MEET 1997 U.B.C. EGRESS • REQUIREMENTS.REPLACE WITH VINYL, DUAL PANE,AND HEADER WILL REMAIN THE SAME. ELECTRICAL WORK ALSO INCLUDED.. ._ . • 11/30/04-PERMIT SUPPL.TO INCLUDE: NEW DRYWALL @'FRONT BEDROOM WALL&CEILING; NEW DRYWALL @ FAMILY ROOM&KITCHEN WALL&CELING;DRYWALL REPAIR @ LIVING ROOM&DINING • ROOM AND REPLACE BATHTUB&TILE AROUND BATH. - , 3/.75/05=ADD•WATER'HEATER TO.EXIST.ING PERMITi - ' " . PLUMBING PERMIT IS FOR REPLACEMENTS OF: 1 BATHTUB,]:SHOWER,.1 WASHBASIN& 1 WATER , ,' CLOSET. '- - , FEE SUMMARY . , AMT QTY AMT QTY . ' AMT OTY ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump" - $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 - P-Trap $0.00 0 Trap Primer.- $0.00 0 Bathtub $9.80 '1 ' Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 - 0 Process Piping(per 10 ft) $0.00 ' - 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 - Receptors - $0.00 0 .Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 - 0" Wash Basin $9.80 1 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 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) • DECLARATIONS L) 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 ere: Carder: Policy Number: (This tion 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 pr • ions. �^ AMEZMnatur0: '- WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIM Al PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F 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.Lit.# Class It 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 subys' is the applicant to a civil penalty of not more than five hundred dollars($500).): tdtiI,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.). O 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 em exam 1 u der sec. Business and Professions Code for this reason: signylure: / Expires)--01 102 to Co 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? 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 feel of compressed gas at standard temperature and pressure). 3 Does or will chs applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes DNo (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 l..thi applicant future __..._..__..__.__require for .___...._ 5 Does or will iha ap st Air or present or emebuilding occupant frm othr the work which is the or application auPeNnit 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 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 (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-d ribed property for inspection purpo es..`I ayree not to occupy or allow occupancy of any building authorized y this P$mit until final inspection. Siggramre'OtLegal:OWner(s) a4I airi,,, " ` And/Or Authorized Applicant Date ODE 1 INSPECTION TYPE Puff. U0E181.5 SODEI INSPECTION TYPE PAIS I$TtTIALS r 1616 Fixed System Final Fire Prevention 206 Final Mechanical ^/j 1266 Pool Spa Final 208 Final Plumbing• 200 Final Re-Root 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 �,' CITY OF COSTA MESA BUILDING DIVISION Ft'„��._,.,,`„�,' li DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT 4 „beoeh* PO4-00808 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 229 LILLIAN PL Status: ISSUED Suite No Applied: 11/30/2004 Issued: 11/30/2004 Vicinity: Parcel Nunmber: 43921109 ISSUED BY: Applicant: CHRISTIANSEN, SHANE , , - Address: _ - - - Phone: 949 669-6404 . Zip: - I.- - • Owner: PLUMMER;ANTHONY-K JR TR , ` • Address ' 229 LILLIAN PL - - - - Phone: - COSTA MESA,CA Zip: 92627 'a` • Contractor: i" '' . . . , Address: - - • Phone: Zip: License: Arch /,Eng : , - -- :. .'Address: - - - _ l . Phone:_ . .. _. _-. - - ._ Zip: - . , - ,- License: - , , SCOPE OF PERMIT REF:B04-02017-CHANGE OUT 6 WINDOWS THROUGHOUT S.F.D.TO MEET:1997 U.B.C.EGRESS t 'REQUIREMENTS. REPLACE WITH VINYL, DUAL PANE;AND HEADER WILL REMAIN THE SAME:r - ' - ELECTRICAL WORK ALSO INCLUDED. - - V . 7' r . , 11/30/04-PERMIT SUPPL.TO INCLUDE:'NEW DRYWALL @ FRONT BEDROOM WALL&CEILING:NEW //,'"i"'/ DRYWALL @ FAMILY ROOM&KITCHEN WALL&CELING; DRYWALL REPAIR @ LIVING ROOM&DINING .I j ROOM AND REPLACE BATHTUB-&TILE'AROUND BATH. r•" "-//,' , ' PLUMBING PERMIT ISFOR REPLACEMENTS OF: 1.BATHTUB, 1 SHOWER, 1 WASH BASIN&1 WATER CLOSET.. " • .. - FEE-SUMMARY - ' AMT QTY I , , - AMT on, AMT QTY ISSUE FEE $23.50 Laundry,Tub/Washer - .$0.00 . 0 " Sump Pump. $0.00 0 Backflow irrigation $0.00 • - 0. • Landscape Irrigation ' " $0.00 1 0 ' Swimming Pool $0.00 0 Backflow Preventer $0.00 - 0 P-Trap $0.00 - 0 Trap Primer $0.00 0 Bathtub $9.80 1- . - Pressure Regulator" ' " ' $0.00. 0 - Urinal $0.00 0 Clarifier System $0.00 0 . Process Piping(per 10-ft) $0.00 " 0 • . ` Vacuum Brkr Bkflow(1-4) $0.00 0 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)764-5626 2446-46(6/00) . DECLARATIONS ('1 cm WORKERS'COMPENSATION DECLARATION: • I hereby 6ffirm under penalty of perjury one of the following declarations: . ' ❑ I have and wiYmalntaln a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of tf!d 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 ll 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 ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 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.Lie.1i 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). 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.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).): L(�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. c- 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:tu Signature: �• W`.&__ C. �.�(� Date:_ it 13010j Owner ID verified by driver's license. rLe Tes 0 No (_Drivers License No. Erzplresi":O I l ot!09 Verification of Ownership by(type of document, uument 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 feel 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 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 apernit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? lYes LJ 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 have rea(),this application .•. state that •e info ation gi . is correct. I agree to comply with all state laws and city ordinances relating to building construction,and -• horize repress tatives of •. City of Costa M' . t. :nter ••n the above-described property for inspection purposes.I agree not to occupy or allow occ ncy of ny•• ding authorized by his per•• until final inspection. ./P • `C i natur Owner(s) • I O ICS Date �� iir • ("And/or Authorized Applicant 1 ( Oat: A .CODE t INSPECTION TYPE `I DATE k..:r : •• • :.4 . I , PATE dllt. 1616 Fixed System Final Fire pr t incl Mechanical / I 1266 Pool Spa Final / 1�• i1: Final Plumbing 200 Final Re-Roof `\ I h_/ .10 Final Elect 1 201 Final Block/Retaining f.I\ V , '12 Final ire •� en,• III 202 Final Factory Fire Place . '20 Final : :nn•g ••i'royal 203 Final Sign RW' 2' Final Si: • 204 Final Demolition • • 250 Fina B •ding/Occupancy. `,1 r . '. DECLARATION OF AUTHORITY Bldg. Permit# — V.LI✓�� FOR AGENTS OF PROPERTY OWNER P 04,Q)' D� TO APPLY FOR PERMITS This Permit# Ir Street ic Address: )( 22.9 LI LP L\ ' �+ AP Number: 1. I (we), N��1 `�v� PL-UMME. , declare that I am the Owner of Title of the above referenced real property,and that I (we)hereby authorize: Name: S 1 v tz C1 t .t S `B SE1 V Telephone Number: Street Address: ` '1 +75 5 * - .V1��NC \ too .1_ City: �V I N`r E State: Ca. Zip: 92.f0kt' to obtain permits in my behalf,as owner/builder,for \�� /4, ►v1 at the above referenced property. T J 2. Should any person become an employee engaged in the improvement of the property, I (we)shall immediately provide Worker's Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa Mesa, as required by State of California laws. 3. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other person, company or corporation. 4. I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any claim resulting in damage or personal injury to myself or any other parties as a result of work authorized by the permits from the City of Costa Mesa. 5. I declare under the penalty of perjury that the foregoing isntrue and correct. th Executed this 'l Mt. . day of Oute t ev 20 ( ,at Sk. titejet._ , California. • Print Name: / \ 1`'N ` "l 0\ l R M MM ER. Signature:. (\P der Date: /c k\ 130 (0 Note: This authorization does not grant authorization to perform the work as owner, it solely provides for limited power of attorney to secure this permit in any behalf. 077946(rev.11/00) CITY OF COSTA MESA • 04 a BUILDING DIVISION A • r�.ik �r DEVELOPMENT SERVICES DEPARTMENT PER T NUMBER JtPillir/� PERMIT !► �Ap 04-01245 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 229 LILLIAN PL •-Status: ISSUED Suite No Applied: 11/30/2004 Vicinity: KITCHEN Issued: 11/30/2004 Parcel Nunmber: 43921109 5 �\ Applicant: •HN MI R ISSUED BY: -�> Address: 751 S • IR CANYON RD SU 15 -•.2 Phone: 714-280-0195 AHEIM,CA Zip: 92808 , Owner: PLUMMER, ANTHONY K JR TR . - ' Address 229 LILLIAN PL . Phone: COSTA MESA,CA Zip: 92627 Contractor SOUTH PACIFIC CONSTRUCTION Address: 751 S WEIR CANYON RD . SUITE 157-462 Phone: 714-280-0195 ' ANAHEIM,CA Zip: 92808 . License: 534813 - ' SCOPE OF PERMIT ' CHANGE OUT 6 WINDOWS THROUGHOUT S.F.D.TOMEET1997 U.B.C.EGRESS REQUIREMENTS. . REPLACE WITH VINYL, DUAL PANE,AND HEADER WILL REMAIN THE SAME. ELECTRICAL WORK ALSO • INCLUDED. REF.: B04-02017 --- - ELECTRICAL TO INCLUDE:ADD 8 LIGHT FIXTURES IN THE KITCHEN AND 2 SWITCHES. . FEE SUMMARY / Quantity Quantity' . ISSUE FEE $23.50 Temp bist 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 }40 • New Res(1-2 units) ' $0.00 0 - '.,' - Misc Electrical Equipment $0.00 42,,,,T-0 _ ' , New Res(31-units) -$0.00 0 Transforrners'up':to 1 kva/kw $0.00 y/ 0 Pool/Spa $0.00 0 up to 10kva/kw, $0.00 0 Lighting Fixts $8.80a 8 up to 50 lora/kw .$0.00 0 Recept Outlets / ; $0.00, 0 - ' '' ' up to 100 kva/kw ' '_$0.00/) -0 ' Switches - $2.20 2- over 100 kva/kw; " $0.00. ,0; /4 , Non Res Appl '',-. $0.00 0- Low Voltage Equipment . ' $0.00 0 . - / Res Appl -$0.00 ' . 0 - - - Low Volt Wiring,System/Ckt ' $0p0 ", 0' Service to 200a - $0.00 . 0 - Misc.Conduit- 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 1hp $0.00 . 0 Circus(mech ride or lights) - $0.00 0 Motors to 10hp $0.00. ' -0 -Christmas Tree Stand '$0.00 0 . Motors to 50hp $0.00 - 0 Fireworks Stand ' $0.00 0 Motors to 100hp $0.00 0 - _ Other Electrical Fee - $0.00 Motors over 100hp $0.00 0 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: INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 ,/ 2446-46(6/00) . l/ DECLARATIONS n 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($100)or less.) /,X�7/ I certify that in the performance of the work for which this p it i ' ued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Celifomi nd agree that if I shou e subject to the workers'compensation provisions of Section 3700 of the t bor ode,I shall forthwith comply with rhes ns b / -5 d Applicant Signature: 111111Date: WARNING:FAILURE TO 5 E WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOLLARE(S1 ,000),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed undpr prosions of Chapter 9 m ing with Section 7000)of Division 3 of the Business Professions Code,and my license Is in full force and effect.Lic.11 3y s,? / Class N Contractors Signatur 6~�i Date: /i-30--Jy CONSTRUCTION L ING 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 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 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 California Health end 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 end Safety Code been fully complied with? 0 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 permit for such construction or modification from the South Coast Air Duality Management District or from any other air pollution control district or agency? LJ Yes IJ 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 Ouality Management District or other air pollution control district or agency is required for the work which Is the subject or 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 1 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 agr::no, .•occupy or allow occupancy of any building authorized by this permit until final inspection. Sig ur* • Leg as• , . /150 _Da� ` , —,� • •nd/Or Authorized Applicant Date�/-1 •• INSPECTION TYPE MI MNLS jou INSPECTION TYPE . MI fNTQISL5 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing - � 200 Final Re-Roof 210 Final Electrical —1 L.A1FA 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 • • p vt" CITY OF COSTA MESA BUILDING DIVISION H r•„z DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT . ............_/: ) J' ,e ot ,�F E04-01258 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 229 LILLIAN PL a Status: ISSUED Suite No Applied: 12/02/2004 Vicinity: Issued: 12/02/2004 Parcel Nunmber: 43921109 Applicant: SHANE CHRISTENSEN ISSUED BY: ' ' / Address: 229 LILLIAN PL ' - • - - I , 'Phone: 949-689-6404 - COSTA MESA,"CA - Zip 92627 , Owner: ' P,LUMMER, ANTHONY FUR TR Address 229 LILLIAN PL . - _ - Phone: , COSTA MESA, CA Zip: 92627 Contractor: OWNER-BUILDER Address: , "" . ' - Phone: Zip: License:000000 SCOPE OF PERMIT . ELECTRICAL WORK TO INCLUDE:6 OUTLETS AND 3 SWITCHES. REF.: B04-02017 AND E04-01245 . . -- - : 3/15/05=17'ADDITIONAL'L'IGHT'FIXTURES&MISC.CONDUIT ADDED TO EXISTING ELECTRICAL - FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Temp•Dist System/Lighting $0.00 0 • - , Temp service test • $0.00 Busway/100 ft $0.00 •0 Res.a/c package $0.00 - . Standing Section $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; 7 0 Pool/Spa $0.00 __ 0. - up to 10'kva/kw .. - '$0.00 ' 0 . • Lighting Fixts . $18.70 .' • 17 - ' • up to 50 kva/kW $0.00 0 ' Recept Outlets $6.60 6 ' up to 100 kva/kw - . $0.00. 0 Switches $3.30 ' 3 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 ' N $1820 ,. 1 Service to 1000a $0.00 0 . Misc.Conductor. $0.00 0- Service over 1000a . $0.00 0 Circus•(geri or ride). ' $0:00 0 Motors to 1hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 ' 0 Christmas Tree Stand , /$0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee - $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(600) DECLARATIONS �1 f 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 carder and policy number ere: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) _03-(rtify that in the performance of the work for which this permit is issued,I shell 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 _ircompl�y with these prowl ,. _ ApplicantSTgneture: v � '�� G (Datgq,> 31 nil) 105 WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL ONES UP TO ONE HUNDRED THOUSAND DOLIARE($100000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F 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 I 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 nd Professions Code)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 subje he applicant to a civil penalty of not more then five hundred dollars($500).): .;11S 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 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 sate.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 aI a ,flx��under sec, Business and Professions Code for this reason: 1 VtGL.�+� C _ Expires:, O(1011-11 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,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high,(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: • Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds.or a volume of 55 gallons, or 200 cubic feel 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? Cl 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 a plication 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? j�Yes 0 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑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 pro erty for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this p rmit until*tat inspection. c � I Ids Sfgnatui 'O SagaL.ONneF(s) Dine- y. a And/Or Authorized Applicant Date cane F INSPECTION TYPF DATE INTITIAL$ CODE I INSPECTION TYPE METE INTITUL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing tJ ,I 200 Final Re-Roof 210 Final Electrical { &'Q S— IL l 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 f c �y CITY OF COSTA MESA BUILDING DIVISION F ,r; DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER J riell PERMIT . 1,e E04-01258 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 229 LILLIAN PL • Status: ISSUED Suite No • Applied: 12/02/2004 Vicinity: Issued: 12/02/2004 Parcel Nunmber: 43921109 , i),,r___ Applicant: SHANE CHRISTENSEN ISSUED BY: Address: 229 LILLIAN PL _ Phone: 949-689-6404 COSTA MESA,CA ' " Zip: 92627 . ' Owner: PLUMMER, ANTHONY K JR TR Address 229 LILLIAN PL • - - Phone: . ' , " COSTA MESA,CA Zip: 92627 ' Contractor OWNER-BUILDER Address: Phone: Zip: License: 000000 , SCOPE OF PERMIT ELECTRICAL WORK TO-INCLUDE:6 OUTLETS AND 3 SWITCHES.REF.: B04-02017 AND E04-01245 . • FEE SUMMARY - - Quantity �'� - Quantity ISSUE FEE $23.50 `- - -` - : Temp'Dist System/Lighting $0.00 0 . Temp service test $0.00 • - Busway/109 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 tot 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 - ' $6.60 6 - - ' up to 100 kva/kw $0.00 ,--'7%'-0 Switches $3.30 3 - ` 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 1hp - $0.00 ' 0 - Circus(mech'ride or lights) $0:00 ' 0 ' Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 ' Other Electrical Fee $0.00 Motors over 100hp . $0.00 , 0 Communication drops $0.00 . --0 . - Investigation Fee .. '$0.00 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 . 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 expirat mites` FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) . WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the follow, g 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($100)or less.) 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 pro • 'a s. etpplh:WITISicuizsc C_ 2 - 23- 01 j✓o L0, etc C0Tit '-A o f j2€c o 2D 6vc_. a 9 (-, y// %�/�fC.rek -a,�c / 2414 /4 ,Co 0/.2 yy- s6J� J117 4/ en 4 /� o4/ -oa 8/7 T`i Zs Peeze-tl i -76 .c%iu Ap(bitcirf4 '/(1 /-e--1/- c.,rY ( ,6c 03 --eil-, 53'17/ 3 7/y- v3 - o2 V Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. PER ITN TRACT NO. LOT NO. UNIT NO, /reTY CIF'COSTA MESA QCO/N-STR,UCTI PERMIT , A.P.# IZone ' Project Address 9g9 Z-///tg/✓ r/2e ,/� - 1 Lr S Main Building: Accessory Building: Owners ,. Mailing •d• • s TYPE OF CONSTRUCTION U NEW LJ ADD U ALTERATION H REPAIR E Z ,) ❑ CONVERSION ❑ DEMOLISH ❑ OTHER T Front 0 Owner's Name w L. w .. i -. Phone `I nC�i; 744 ��;� `� DESCRIPTION OF WORK/USE OF BLDG. I B Rear N Address d.P Arch/Eng, License No. TYPE OF PERMIT El GRADING El FOUNDATION ❑ STRUCTURAL I C Right G Address ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL $ • Left ' R Contractor's Name 1 ❑ OTHER - f g- Parking Req./Provided E y/L //e/� Phone 1,PIn Ref.# Address(mailing) �`r L' •C / /,�(�D/ ,� PROJECT DESCRIPTION SQ. FT. OCCUPANCY Planning Notes: - M C • CONSTRUCTION TYPE VALUATION$ T City License No. ZONE GRADING CU.YDS._ ACRES S. LICENSED CONTRACTOR DECLARATION / - • I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: 36-6 1(;`3 s with section 7000) of Division 3 of the Business and Professions code,and \J 1' - my license is in full force and effect. - ELECTRICAL FEES License Class _License No. Automatic Washer Transformer 0 15-50 KW ' Date Signature • • PLUMBING FEES eoBarRKERS'COMPENSATION DECLARATION Construction Pole Sub. 0 50+ KW nereby affirm that I have a certificate of consent to self-insure or a certificate Sink Showers • f workers' Compensation Insurance, or a certified copy thereof (Section Cooking Unit Meter ❑up to 100 amps 3800, Lab. C.) Backflow Preventer Service Sink „ . - - , Policy No. Company Backflow Irrigation Sewer Cap Dishwasher Meter Dover 100 amps BCertified copy is hereby furnished. • 1.. Dryers ❑Gas DElectric Sub Panel Certified copy is filed with the city Building Division- Bathtubs Sewer Connection • Date Applicant -- Fan - Motors 00-1 HP ❑1'F,-8 EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers - Solar Collectors — (This section need not be completed if the permit is for one hundred ($100) or Dishwasher F.A.U. Inc.Solar ❑9-15 HP ❑16-15+ - less): Solar Piping - I certify that i the performance of the w• f fora/hich th = mit is Issued, I 2 Fixtures shall not em operson in anym. r :/. • - •'- t t. the DrinkingFountains '� Microwave I Sc y y V Solar Tank .i Worker • Laws of Calif') /� Date Signature .,*�� u I/ ,; Device Boxes Pole Light 9 Floor Drains Swimming Pool w/Spa •c 9 NOTICE: f,after making this declaration, you sh Itl come subject to the - n Workers' Compensation provisions of the Labor ode, you must forthwith , . Floor Sinks Urinal - Outlets Range 3- a comply with such provisions or this permit shall be deemed revoked, ^^/ CONSTRUCTION LENDING AGENCY' - Gas Service Outlets - Water Closet \T Switches Sign I , se I hereby affirm that there Is a construction lending agency for the performance r of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors 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 Lavatories • Auto-Wash following reason (Section 7031.5 Business and.Professional Code: Any city or ' county which requires a permit to construct,alter,improve,demolish or repair P—Trap Laundry Trays 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 ofRoof Drains - ' 'he Contractor's License Law(Chapter 9(commencing with Section 7000)of i '� $A,)ivision 3 of the Business and Professions Code) or that he/she is exempt . Reinspection Fee $15 Issue Fee ,j� ,herefrom 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), DEVELOPMENT SERVICES REQUIREMENTS: LJ I, as owner of the property'or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 • Zoning Approved By Date 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 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 • Application Issued By Dat 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 0 SUMMARY OF FEES pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground , pve for the purpose of sale). - - BUILDING PERMIT $ SMIP $ _ I,:as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System-- PLAN CHECK $ PERMIT ractors 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 BT.U+`❑:100,0.00BTU PLUMBING $ ISSUANCE $ — builds or improves thereon, and.who contracts for such oroiects with a con- - - ., ENERGY P.C. $ _ tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple ❑ System Repair/Alteration.:, , I • PLAN CHECK 25% $ •� DD proof of their Worker's Compensation insuranc should be provided to me. ELECTRICAL $ p.'' GRADING $ _ ❑ I am exe t u der Section B. & , .for this reason Firepl/Fact.Blt, ICBG dk Fire Dampers •- MICROFILM $ _ yp/��Jpj(y I. i PLAN CHECK 50% $ Date�G �-- rte_ Owner Heating System& Ducting Registers MECHANICAL $ TOTAL FEE $ aL oa I hereby certify that I have read this applicatio and state that the above 00-100,000 BTU 0100,000 BTL • PLAN CHECK 25% information is correct. I agree to comply with al city and county ordinances $ and state laws nlatin• '0 buildinsgs i structlon, and hereby authorla' repre- , sentatives of is i• to .r - ••• the above-mentioned pr.. rty •o - , Inspection p L �1 Signature iii/�/ � Da � d' X , � 1 r 0865-46,rev. 5/88 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod -Assessor DATE: 04/10/89 TInE: 14:18 CONSTRUCTION AND PLANNING PG. & SPA .1, APPROVALS Permit Date Inspector APPROVALS Permit# 1 Date Inspector n • 2 •,1. Temporary Electrical Service or Pole 52. Pool & Equipment Location . I 2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement , • 3. .Electrical Conduit Utility-Undrgrnd. / - 54. Forms 4..'Electiical Conduit=Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. •ElectiicalUFERGInd. 57. APPROVAL TO COVER-GUNITE ..:1. j. ,' 7. Footings - t % , 58. Electrical Conduit-Undrgrnd. l'„ ., 2 vi." 59. Gas Pipe, .0 . 8'Foundation Undrgrnd.,Test %� / 9.,Water.Pipe-Undrgrnd, .f . 60. Backwash Lines, P-Trap, 0 Undrgrnd. i1 • 10.Structural Floor System ., 61. APPROVAL TO DECK - '4 11. Property Sewer Line & House Connection , _- 62. Backwash & Receptor-Final .... ' eceptor-Final ' ' r 12. SewerCap i 63. Heater & Vent-Final 13. Roof Drains '� 64. Plumbing System - Final C 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final (6� Rough Electric Wiring • 67. Fencing &Access Approval • 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 78. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 1.9-. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace • ) APPROVALS Permit# 21. Ducts, in Structure - J 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 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 02/87 OA Notes: 34. Final Heating & Air Conditioning ' `) 2-2 '-tr C; 35. Final Gas Pipe-Test 36. Hood or Canopy 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 •J 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations - ',...7.! . 47. FINAL STRUCTURE & BUILDING ,-. 48. Special Requirements Completed 49. Electric Release to Edison - , err, U; '50. das Release to Southern California Gas Co n. 51. CERTIFICATE OF OCCUPANCY t. ' " f* -- No. Date !1i a 412 -";r' Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA CO STRUC ION PERMIT MITT NO. TRACT NO. LOT* UNIT NO. A'P'#y3 9,-2—I / _0q - • Zone • 2 /Q3 / - �Project Address 4� _ S Main Building: Accessory Building: 1 Applicant's Mailin• Addre s 9. '1 _ TYPE OF CONSTRUCTION U NEWIgqH ADD U •L RATIO .K REP•I• E Z Owner's Name 4 �a. �'y4 hi 'hone 4 4. �� ❑ CONVERSION ❑ DEMOLISH Z OTHER ..e. - � -� - - A T Front On I^' • g, Q ��[], / DESCRIPTION OF We-K/US OF BLDG. A Rear -c�� Q to pp N Address 22/ Z /lam sit ,fl J' ��_�tt� + [ •�� _ Arch/Eng. License No. TYPE OF PERMIT GRADING ❑ FOUNDATION of 'TRU TURALLi'�• w K Right- n.Q pro. u'/'(L0 G. ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ' S ' t +X' • Fta '- Address • R: Contractor's Nam Phone - CI OTHER '' p I Ping. Ref. # Parking Req. Provided . E• q�c- PROJECT DESCRIPTION SQ. FT. OCCUPANCY /t3 . /� — _ Address(mailing) 7.� - �/ /r.l .t c7s•• Planning Notes: b/n Uri 7��I�./ / M /rte ry CONSTRUCTION TYPE �L�-' VALUATION'$ Ji 017r).-------- �7 - T City License No. (!J "� ZONE GRADING CU.YDS. ACRES 15. 4- '17' $ LICENSED CONTRACTOR DECLARATION 1 zt I hereby affirm that I am licensed under provisi• • Charter 9 (commencing Remarks: rimy.. .- I� amss• t //5 2 7'0,ir^. ¢: with section 7000) of Division 3 of the Susi rofessions Code, and l '- V ddd"'^^^^'^^`��--_ ttt^^^ CCC . my license is in full/orc- and effee / )�`!L{)t/_ 7 • ELECTRICAL FEES Licen ,CI. s i- �J o.2•+2527/7‘, Date -. -tat: Signature-_�twi�•• /' PLUMBING FEES Automatic Washer Transformer 0 15-50 KW � WORKERS'COMPENSATION DECLAR• ION Construction •Pole Sub. El 50+ KW . ,jlereby affirm that I have a certificate of consent to self-insure or a certificate Bar Sink Showers x^f Workers' Compensation Insurance, or a certified copy thereof (Section Cooking Unit Meter Dup to 100 amps 380), Lab. C.) Backflow Preventer Service Sink - • • !1 Dishwasher I Meter Dover 100 amps Policy No. Company Backflow Irrigation Sewer Cap 8 Certified copy is hereby furnished. ' Dryers ❑Gas. DElectric Sub Panel • Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Date Applicant - - Fan Motors 041 HP ❑1'/a-8 EXEMPTION FROM WORKERS'COMPENSATION '.E LARATION Clarifiers Solar Collectors (This section need not be completed if the permit is •r •ne hundred ($100) or- F.A.U. 'Inc.Solar 09-15'HP ❑16-15F less). ,+ _ Dishwasher Solar Piping I certify that in the performance • "e • for h"el his permit is Issued, I Fixtures Microwave • shall.not employ any person in y a jr s• as -come subject to the Drinking Fountains Solar Tank - - k} Woren . , n Laws of alifo + Device Boxes Pole Li ht Date 7 Signatu - •- - .=A' i Floor Drains wimming Pool w/Spa 9 ' NOTICE:If,after making this declaration, should become subject to the Outlets Ran e Workers' Compensation provisions of th-, Labor Code, you must forthwith Floor Sinks noel g . comply with such provisions or this .•ermlt shall be deemed revoked. !!!` CONSTRUCTION LENDING AGENCGas Service Outlets Water Closet Switches Sign I hereby affirm that there is a construction lending agency for the performance 'of the work for which this permit is issued (Section 3097 Civ. C.) - Garbage Disposal Standing Sections Lender's Name Interceptors • - Water Heater Lender's Address - Kitchen Sink Water Service n Generator 045 KW 05-15 KW Trash Compactor OWNER BUILDER DECLARATION • I hereby affirm that I am exemptfromthe Contractor's License Law for the Lavatories • Auto-Wash • following reason (Section 7031.5 Business and Professional Code: Any city or ' county which requires a permit to construct,alter,Improve,demolish or repair P-Trap- Laundry Trays - J~ .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 ' -he Contractor's License Law(Chapter 9 (commencing with Section 7000) of -� • 'vision 3 -of the Business and Professions Code) or that he/she is exempt - - v Reinspection Fee $15 Issue Fee $ 3 arefrom and the basis for the alleged exemption. Any violation of Section - -- - .. J31.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars($500). DEVELOPMENT SERVICES REQUIREM +TS: LIZoning Approved By I,'as owner of the property or my employees with wages as their sole Reinspection Fee I $15 ' Issue Fee ' $ 3 4,_44Date R c a'8? compensation, will do the work,and the structure is not intended or.offered - - for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICALFEES-; Building Approved By �T///i� - Date '-..3.-$-- , 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 Application Issued By Pgit,��AMS:�- _ eat - - - - -TY; .employees, provided that such improvements are not Intended or offered for Boiler , - Hood or- Type I ❑ ---- �_�� sale. If, however,the building or improvement is sold within one year of com- ---- Canopy , Type II 0 ,1 •SUMMARY OF FEES , .pletion, the owner will have the burden of proving he/she did not build or im- - Duct-Under Ground - - proveforthepurposeofsale). • ` BUILDING PERMIT $ 3.00 SMIP $ . . 0 I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refr' eration System PLAN CHECK $ YO •9�ERMIT 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 4100,000 BTU ❑100,000 BTU t. PLUMBING $ ISSUANCE $ builds or Improves thereon.and who contracts for such oroiects with a con- • - - I ENERGY P.D. $ tractor(s) license pursuant to;me Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 / System Repair/Alteration PLAN CHECK . 25% $ ' proof of their Worker's Compensation insurance should be provided to -me. LLL//// 'r` ELECTRICAL $ ' GRADING $ .❑ lam exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBO dk Fire Dampers MICROFILM $ PLAN CHECK 50% $ // • Date Owner - Heating System&Ducting Registers • MECHANICAL $ TOTAL FEE $ /0g. 7 I hereby certify that I have read th application and state that the above - ❑4100,000 BTU 0100,000 BTL - /1 information is cox t. I agree to co- ply with all city and county ordinances - PLAN CHECK 25% $ 'and state I. 5 r. g to buildm• o•,)ruction,and hereby authorize repre- .� 5entative o ity to ente u•t.# the above-mentioned prop rty for inspection. ¢ r ¢ V - Signature --• / �i•ti AAL_ Date Drive s' Icen +m ✓ Reinspection Fee $15 Issue Fee $ 3 - 1 Q = — • 01n06�J1FJ67d 454115672 Z e dT 1{t-.4.a — 0865-46,rev. 5 :8 ite - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor DATE: 09/28/38 TIME: 14%56 CONSTRUCTION AND PLANNING PO. S SPA Date Inspector Date Ins ector• APPROVALS Permit# ^• ry, APPROVALS Permit# p � 1. Temporary Electrical Service or Pci e * 52. Pool & Equipment Location L/ 2. Soil Ripe-Undrgrnd. ,fl, 53. Steel Reinforcement /•/ ''i f• r V ,3' Electrical Conduit•Utility-Undrg^nd. ice, _54. Forms . J•. '4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding " 5�•Steel'Reinforceme�4-- ,� 56. Rough Plumbing & Pressure Test f.te, ' '� - '_\ 57. APPROVAL TO COVER-GUNITE '- I ' 6: •Electricdl UFER-Grntl"' 7. f ooiings C /• . ' ' �T!� n.- ;, ., /58. Electrical Conduit-Undrgrnd. ' 'Fountiation �-�.•j '/ 1 / �8; `' 59. Gas Pipe, 0 Undrgrnd., i Test .' e 9"Water Pipe-Undrgr / '_ k f 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 1 `- '- - , 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection I 62. Backwash & Receptor-Final • 12. Sew„ Cap r^63. Heater & Vent-Final Ai 13. Roc:MDrains 9 it '"-+ 64. Plumbing System - Final 14. Rough Plumbing`, 65. Electrical-Final 15. Rough Electrical-Conduit - 66. Solar System-Final L76. Rough Electric Wiring 67. Fencing & Access Approval • t1,7. Rough Wiring Sign 68. APPROVED FOR PLASTERING • t18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 49: Rough Seating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough•Factory Fireplace APPROVALS Permit# ' '21. Ducts, iri Structure ~" 70. Underground Hydro - 22. Ducts„Ventilating `-I 4. /71. Product Piping0Gas 0 Oil 23. Gas Pipe,Rough & Test ' 72; Underground Flush • •' 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil- ' 25. Roof Sheathing ' 'r 74. Overhead Hydro 26. T-Bar Ceiling (Structural) &.Monocoat 75. Dry Chemical 7, Frame and Flashing 76. Dry Standpipe 28.• Lathing&"-Siding (A 77. FIXED SYSTEM FINAL 29. Insulati_gn � 78. FIRE PREV. FINAL 30. f3rywall_JVailing 4' HEALTH DEPT. REQUIREMENT 31_*Pl sterBrown Coat] " 79. FINAL INSPECTION 32. Electrinal.PowerMeter-Final - 80. FOOD CERTIFICATE ISSUED 33. Final Electric ? Notes:q_ 7�c'di 72 t/ ,�7nd '/'.--i £' 34. Final Heating & Air Conditioning J !�' �L - 35. Final Gas Pipe-Test - - 36. Hood or Canopy ,-l ' 37. Final Factory Fireplace', , 38. Final Plumbing - t• - -39. Water Service-Final ' _40. Gas Service-Final - l'":: i ' 41- Solar Domestic-Final: _ / c/� 42. Backflow Preventer%, 7/ 1 1• 1...143. Backflow Irrigation - ! - . a rr r 1 - - _.. 1 .' -7 44. Landscape,Irrigation,System '�-c� . • 45. Sound Attenuation . - , -1 46. Handicap Regulations j 47. FINAL,STRUCTURE-&BUILDING fQ//,��F ^ 48. Special Requirements Completed ,49. Electric Release to Edison 'i `1 „/ X60. Gas Release to Southern California Gas Co - -. ;;; ;•' ;,./ %,�- 51. CERTIFICATE OF OCCUPANCY • - + '• No. Date ' � �10 v C�Sh' l O 4 L: �d\t';St7 tiyiiiiGiC,� i3ept. .. ,` n City of Costa p t . • __ v.. /7�Q 19 SS %//�� _ ,ATE...,-- Z APPROVED 6Y - �Ea /' ❑ `N JOB AT ALL Ttt.^,ES MAKE THESE PLAN Vi!TH '-t 0' 3S� f NO CHANGES V%!THOI,'T PRIOR APPROVAL 0` 6EPi. Permit � F 4 A t, BEC OR RUED TO OF PLANNIN> DEPT. THE I ISSUANCE.OR GRANTING OF FE.:, THIS NUinBER MUST ACCOMPANY• lUNEC'f To BIDG. DEPT EEO. . NPPROVAL OF.NOT VI :LAI I NOF TO BEA U ESTS OF. A.N.w: AnoN OF Arr, of ALL INSPECTION REQ PLANS AND SPECIFICATIONSc PERMIT FOR, OR io AT op C ITE FRESUIIUNS TO GIVE O r rpi�E.NO FERMI nJ OF THIS �,------' "1A36� _ DATFG-4- ` THE PROVISIONS Oh T4115 � ;�.,..(�NJ�1.r-- 1 AUTHORITY TO VIOLAft CC Ci;t_iso 1N_ P••"IrL: _! R, COs U<E DIRECTOR OF PUNNING CODE SHALL TIE VALID, E%CEFT 474 SO FAG T.5 THE\'VO 1 • WHICH IT AUTHORIZES IS LAv.'"FUL. NS PERMIT coN1n-I 'PON PC, OF- ATA THE KSUANCE G•' A r `,HE SUI.Di FL OFFICIAL ,•YT��•� ND I _$cCCh: 1^i SROM,TH REART SHAH Nli: . r.;_CTIn;4 or ERRORS y FSI`,�i=..I•.:-v CR 'r?G�;L FREV C"I;:iJi.' I SAID FLANS RAraATI IL,v CA4a;_D ON WEREUNDER WHEN I•\ II L BUILDING OPERATIC/FIE C8 •AN{OTHER RDINANCE OF CC `� 11 r �^/•� II I' AU61i�:i�, CELETIbNS, OZ CORRECTIONS SHALL' f !N VIOLP,TIGN OF TMLS CO,:E"" me CITY. ... n. - at APfpi\P,iW BY THE PLAfJiflflG DEPARTMENT J ovm mrp oI ccYrrlT p - _CVif� • �� / Ail L �I RESIDENCE N.` _ _ RESIDENCE _ 4 RESIDENCE RESIDENCE I- �.T r l ili 11uy It F Q 5L in .5 Lg 1988 purr - F 2+ STREET a- ? n�,�� 7 7 - . TYPICAL 6" CONCRETE BLOCK FENCE Cement Coping Optional :�q . .— Il GENERAL— NOTES Channel Block With 1-3/80 119 � Horizontal Top of.all - - - - Fences _ MORTAR; One Part Plastic Cement, and Three Parts Sand For Fences 5'or Less- Q GROUT: One Part Cement Three and f One Half Parts Stand Vert.Bars 3/8"¢at 4'-0"0.C. . di o _ COPING: One Part Cement, Three A = • I For Fences Higher Than 5' I` �. , ' ®, Parts Sand Vert. Bars 3/8"O at 32" O.C. > w_ =—— — - --5 CONCRETE: well Mixed 1:2-1/2: 3-1/2 il " ' Max. of 7-1/2 Gallons of Fill Cells Solid With Grout > Z . Water Per Sack of Cement Where Steel Occurs > - at" Reinforcing Steel Shall • f ID GROUT MAYBE POURED FROM THE TOP I - OF THE FENCE IN CELLS WHERE STEEL Conform to Sec.A-15,39 w o --- - - - - - - OCCURS. A.S.T.M. S�1 Z ~ ' CELLS AND AREAS OF HORIZONTAL REIN- w to) FORCEMENT SHALL BE CLEAR,CLEAN& All Steel to be LappedIfl! w '� I -- - - - r - FREE OF ALL MORTAR DEBRIS,ETC. 24"or to Code S� .I NATURAL GRADE agge ' pA�11 v, 11 /vim,„ ,($' IV_ oe o n - TWO3/e"$BARS 'fSal D`. r e. .� a ... . . - • CONTINUOUS TOP � 1 . .. &BOTTOM - "�-i WIDTH - TO 16' 0. C. MAX. , - SEE CHART �. .H0217-STEEL MUST BE TIED IN BELOW a DE PTH OF E ARTHTCOTH PLACE AT TIME OF TRENCH e• l . e. e. I/3 THE HEIGTH OF FENCE INSPECTION. L • •-.1ELOW -BOTTOM OF FOOTING.'� D`P o" 2 —�1.� SCALE: I/2 I' FOOTING REQUIREMENTS CHART WALL HEIGHT 6 ' 5 i ! 4' 3' i .. • WIDTH 14" 14" I 12" 12 THICKNESS 10" 10" 8 " • 8 DEPTH OF EARTHTOOTH . . . 24" 20" . 16" . . . . -. . . . . 12" SPACING OF EARTHTOOTH. . 12' 14' 16' - 16' • NAME: OWN RS City of Costa Mesa California JOB EADDRESS: ZZ /L/ s e.. __ __ _ _ — PERMIT NUMBER. �. Building Department SIGNATURE: art _ _. • CEv!SEO Nov.az • i Z CITY OF COSTA MESA �`y • BUILDING DIVISION I.' " ' DEVELOPMENT SERVICES DEPARTMENT 798-00387 JPERMIT MIT NUMBER. ' ". (714)754-5273 • Fax(714)754-4856 PLUMBING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 229 LILLIAN PL _ -- Status: ISSUED Suite NoApplied: 05/20/1998 Issued: 05/20/1998 Vicinity: Parcel Nunmber: 43921109 • Applicant PEREZ, FERNANDO Address: . " , Phone: . : _ . Zip: _. Owner: PLUMMER, ANTHONY K JR TR Address 229 LILLIAN PL` - - - -., ) .- Phone: COSTA MESA,CA Zip: 92627 ..."1...':',„`' '3 / Contractor: EARL'S PLUMBING INC , `` Address: 01526 NEWPORT BL Phone`. i COSTA MESA CA Zip:,%-,92627 " •i• ' i 'License: 7", 17657 ' - " 1 , Arch/Eng: • " , - I ' - _ _ - , Address: , Phone: ` ` - Zip: - r ` • License: - ' • SCOPE OF PERMIT i . INSTALL,NEW WATER HEATER: %:.. _ ' • FEE SUMMARY' AMT QTY AMT-I_ 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 $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:" ' $0.00 0 Clarifier System • $0.00 0 Process Piping(per 10 ft) ' $0.00 , 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00> 0 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 $11.00 1 . 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: $33.00 COMMENTS/SPECIAL CONDITIONS • E/'IBD - II 1100 DA's 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 rDECLARATIONS ) ) ( � 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. EC 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: Carder: 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 co ., these pro Zc-p' ns. 9 r. re. l�ifiy�a�J r' Date: Shad d FAILURE SECURE WORKERS'CSATI ERAGE i6 UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,000),IN ADDITION T THE 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 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 a flier* Class# ntractor ignature: Date: c'Zs J77 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,CMI Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that 1 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 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 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 Processions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes 0 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 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 Califomia 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 appermit for such construction or modification from the South Coast Alr Quality Management District or from any other air pollution control district or agency? j�Yes LJ 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? ❑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 agencis 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 B (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: . Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for Inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. �--' ZO: 7/ SI a Of Legal Owner(s) Date -�-'AnWOr Authorized Applicant Date seats Ies&ECTION TYPE • DATE =ALE LA➢E! INSPFCTInN TYPE• aAiE IDIS • 1616 Axed System Final Fire Preventionni' 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof - 210 Anal 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 .1`i C ) Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. AA 'IESSA C,O/N`STRU(�`�JIO�N PERMIT PERMI .ss TRACT NO., LOT NO. UNIT . A.P. /1 Ar- -- �' I _ �� Zona �i 'Pim - _! /4/J'/QN //.�QGe, J j "11 llDD3Buil1 , i ff � rr II_ I� S Main Building: Accessory Building: Ap( atnt's Mallin• Address ,M M`,J • TYPE OF CONSTRUCTION. IJ NEW�u ADD I_J LT R TION sa{ REPAIR' E Z Owner's N. e MI 77104) �u")1,9 � i C5/tl2 /7 ❑ CONVERSION E DEMOLISH KOTHER T Front Q �I n - • 0 • p Jffn, i Pho ie 2c DESCRIPTION OF WORK/USE OF BLDG. IB Rear (a/ J.,r� •ex` �1t— N Address / _.•-'.. ... - L� ,2 2.7- IX A J t� ea'.rGL-5%t(— - 1, Arch/Eng. - - _License No. • TYPE OF PERMIT�,�s�y�_y/� GRADING ❑ FOV NDATION IDI STRUCTURAL C Right Z3/ V - G Address ❑ TENANT IR:ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ' $ • Left 32-C - R 0 v✓/�✓• �3�SIs/D ❑OTHER q E Contractor's Nam' - --� _Phone - qqqq^ Ping. Ref.# • Parking Req./Provided _- Address(mailing. � J• - " PROONST RUCTION TY 50. FT._d lLL�TION$ CV �- ) Planning Notes: It.r. O City License No. CONSTRUCTION TYPE V.•N!' VALUATION$ �� Ver '� YPl�Y • M ZONE GRADING CU.YDS. ACRES c �( lire) • LICENSED CONTRACTOR DECLARAT - N _ - U - - S. I hereby affirm that I am.licensetl ur r provisions of Ch. er 9 (commencing n ^__A^ _ I1 �- - with section 7000) of Division 3 of C4 ( d Remarks: `$TVy •Y-� !-GL.L.•O e a..iness and r -r 9(c Code,and _�_ my license is in full sit:and effe _ •� p / rp �Q p ELECTRICAL FEES License Cla s �� - . ice .e .- P7 \, _ ({7 70 UCO S r oat. 0.' 5•=+ Sign. -19:774111#. 01 ri/+�r'-7 PLUMBING FEES Automatic Washer Transformer ❑ 15-50 KW - WORKERS'COMPENSAT i - 0 50+ KW - yr' TIG Construction Pole Sub. o-oreby affirm that I hay- •:HIN:HINTBar Sink Showers ,f Workers' Com ensati• oo cons: t fi d self-insure or a certificate _ f Insure ce, or a ertified copy thereof (Section Cooking Unit Meter glue to 100 amps _ e; 3800,- Lab. C.) _ - Backflow Preventer Service •Sink _ • • - , - - g S Policy No. .r "1 Company Backflow Irrigation SevaerCap '• _ '' %. .r. Dishwasher Meter Dover 100 amps ' HCertified coy)is hereby,f urn fished. •• ' _ - - CertifieC ropy is filed with the city Building Division.--, Bathtubs S• ewer Connection. r:- Dryers ❑Gas ❑Electric Sub Panel Date— " Applicant - - - - Fan Motors❑0-1 HP OVA- ' EXEMPP ION FROM WORKERS'COMPENSATION DECLARATIO Clarifiers � Solar Collector3 • - •'(ThS•section need not be completed if the permit is for one hundre- :.100) or - - F.A.U. - - Inc:Solar 09-15 HP 016-154-- ess). Dishwasher Solar Piping. 7; - , , - I certify that in the performance of • or hich,this pe - s issued,I •. Fixtures . shall not employ any person in a• ma as to beco • s •�i t to the DrinkingFountains _ •' Microwave worke C ion'Laws of 'al eta: - . /� Solar Tank _%, ^„ rrggJJ�� oq��,,�y�� ',70 / ''// - - Device Boxes Date-/L,'7-�� Signa• re iii/!i: U -fifllub/ Floor Drains Swimming Poofw/Spa ?, Pole Light ,:NOTICE: If,after moon' this tl•cl. alion, • should .yome subject to the - _ , • •\Workers' Compensation' provisi• of t e •mbor Cotl=/.you must forthwith Floor Sinks Urinal ! Outlets Range, . ._ Comply with such provisions or chi- •ermlt shall be deemed revoked. Switches CONSTRUCTION LENDING AGENC' Sign Gas Service Outlets Water Closet I hereby affirm that there is a construction lending agency for the performance • - • Garbage Disposal of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater - g p 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_af firm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash . - following reason (Section 7031.5 Business and Professional Code: Any city or , - ' county which requires a permit to construct,alter,improve,demolish or repair P-Trap -Laundry Trays • - - • 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. I % �i '•e Contractor's License Law(Chapter 9 (commencing with Section 7000)of - _ . - - l p�� vision'3 of the Business and Professions Code) or that he/she is exempt • - - Reinspection Fee $15 Issue Fee .r- s refrom and the basis for the alleged exemption. Any violation of Section . ' -631.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars($500).' - DEVELOPMENT SERVICES REQUIv/COMMENTS: . � 3 I, as; of the property or my employees with wages as their sole Reinspection-Fee $15 Issue Fee $ V5J •.� compensation, will do the work,and the structure is not intended or-offered r Zoning Approved By ll Date© CJ U for sale (Section 7044, Business and Professional Code:' The Contractor's MECHANICAL FEES , Building Approved By Date 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 • Application Issued By ----A . Datej.. 313 1 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 0 SUMM RY r�ipp FEES '� pletion, the owner.will have the burden of proving he/she did not build or im- ' Duct:Under Ground „ • SKI FEES for the purpose of sale). BUILDING PERMIT, $ SMIP $ ' 7--1 SI) I, Ss owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System • PLAN CHECK $ q f7 ` -PERMIT • 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 ❑0-100000 BTU ❑100,000 BTU PLUMBING $ ISSUANCE $ builds'or improves thereon, and who contracts for such oro leets with aeon- - _ __ tractor(s) license pursuant to me Contractor's License Law). I am aware that - PLAN CHECK 25% $ - ENERGY P.C. $ Exhaust System ❑ Multiple ❑ System Repair/Alteration � j} proof oftheir Worker's Compensation insurance should be provided to me. GRADING $ • ( • 7'," "� ELECTRICAL , $ - - ❑ I am exempt under Section B. & P.C.for this reason Firepl/Fact.BIL ICBG# Fire Dampers - p' - 4 ' PLAN CHECK 50% $ ' MICROFILM $ ` Date Owner Heating System&Ducting Registers . sir,�,•� I hereby certify tha have read this . .plication and state that the above ❑0-100,000 BTU ❑100,000BT _ _ MECHANICAL $ TOTAL FEE $ I J 1 �'�' • information is corr. . I agree to com• ith all city and county ordinances , , - PLAN CHECK 25%. $ .and state laws r- . i • to building c• ction,and hereby authorize repre- sentatives • t- 5 • y'to enter ' e above-mentioned property'for • • .inspectio - 'Si9natuie �I;i: Ali!�� Date �'1/423 • y Drivers' cen-: o- � Reinspection Fee $15 Issue Fee $ 3 01 0IIClla335 OQOib33II -14t01 T TOT ,13735 _ 0865�• •,rev. 88 White - Building; Canary -Applicant; Pink - Accounting; Goldenrod - Assessor DATE: 1!]/Q /EE TIME: 1 .01 t i ' PG 3 SPA • CONSTRUCTION AND PLANNING ' AP9ROVALS Permit# - I Date ( Inspector APPROVALS Permit# Date Inspector Temporary Electrical Service or Pole r f, , 52. Pool & Equipment Location , .`Soil Pipe-Undrgrnd. I&I i' Co 53. Steel Reinforcement . r v 3. Electrical Conduit Utility-UndFgrnd. / 54. Forms 4:Electrical Conduit-Undrgrnd. I fe455. Electrical Bonding •�. • . • �lvlZ � 5:.•Steel Reinforcement ,' . , 56. Rough Plumbing & Pressure Test . ,6: Elecirical UFER,Grnd:. •11/'•j• t' 57. APPROVAL TO COVER-GUNITE - '� 7. Footings " t_t t r58. Electrical Conduit-Undrgrnd. -. J. Foundation \; •2./ 2 59. Gas Pipe, 0 Undrgrnd.,Test i , 9; Water Pipe-Undrgrn •4t '!: 60. Backwash Lines, P;Trap, 0 Undrgrnd. ' '1 • ' 10. Structural Floor ystem e ' to_t#6,_,) f 61. APPROVAL TO DECK • 11. Pr ewer Line & House Connection `� - •, 62. Backwash & Receptor-Final -12. Sewer' Cap •1 - '- ; 63. Heater & Vent-Final - '� 13. Roof 1Drains i i 64. Plumbing System - Final , 14. Rough Plumbing 65. Electrical-Final Z. 15. Rough Electrical-Conduit 66. Solar System-Final 1.6! Rough Electric Wiring _ 7Y � c � 7_ L./ 07- Fencing& Access Approval ' I4r '17. Rough Wiring Sign 68. APPROVED FOR PLASTERING - ' rr, 18. Rough Electrical-T Bar Ceiling - 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT • P. 4; • • 20. Rough Factory Fireplace ,• T: APPROVALS Permit# . 21. Ducts, in Structure •_ - • , . 70. Underground Hydro 22. Ducts, Ventilating ' ''• - 71. Product Piping 0 Gas 0Oil • 23. Gas Pipe-Rough Si Test - Cj 72. Underground Flush • 241. Roof Framing '(1 " r, t\ 73. Undergrnd.Storage Tank 0 Gas ❑Oil 25. Roof Sheathing- - - ' ' (Q�y7/�/ ��, N, 74. Overhead Hydro ' 26. T-Bar Ceiling (Structural) &,Monocoat �d 75. Dry Chemical 27. Frame and Flashing • ti� /74-g$ w� 76. Dry Standpipe • 28. Lathing&` /Siding ' j_7Icr c( ale 77. FIXED SYSTEM FINAL ; 29. Instilation Jy cikr 6 ri 78. FIRE PREV. FINAL 30. Drywall Nailing (l1 f2ji2 t 44✓ HEALTH DEPT. REQUIREMENT 31.rPlaster Brown Coat f y •dQ 79. FINAL INSPECTION 9( /sB 2r 32. Electrical Power Meter-Final n � 80. FOOD CERTIFICATE ISSUED • 33. Final Electric ' • j/ V ■ Notes: $ncec, p cc?cc c24-c2 , r-�t • 34..Final Heating & Air Conditioning h� !`-^- �C `f-�"/ - 35. Final Gas Pipe-Test i . . . /36. Hood or Canopy 37. Final Factory'Fireplace- ,38. Final Plumbing , 39. Water Service-Final, 40. Gas,Service-Final••"" ,• ., ' , .. 1 41. Solar Domestic-Final - ' " r • .,, �,,, ,,, 42. Backflow Preventer - _- -21 it • 43. Backflow Irrigation ' • I ' : - G ..', 44. Landscape Irrigation System - - ti �' • I' ' 45. Sound'Attenuation I • 46. Handicap Regulations 4) - • 47. FINAL STRUCTURE & BUILDING 6 . , . 48. Special Requirements Completed - 49. Electric Release to Edison -. -- 50. Gas Release to Southern California Gas Co I V2 ! .- 51" CERTIFICATE OF OCCUPANCY ;i - 1( ' I No. - Date 1" ,. ;l PROJECT ADDRESS: 229 LILLIAN PL ti/ : ) II s CITY OF COSTA MESA — BUILDING PERMIT PERM NO; tl.. • Ubil l / OWNER'sNAmEPLUMMER ANTHONY K JR TR ADDREss: 229 LILLIAN PL • PERMIT NO: B 063117 PLAN CHECK NO; N c ovT: N SUP?; N 8 COSTA MESA, CA 92627 CONSTRUCTION TYPE: V—N PERMIT TYPE; STR PURPOSE; ALT 548-2647 ` .y ARCH/ENGINEER: REG.ND.: JOB DESCRIPTION : T/OFF REROOF W/FIBERGLASS SHINGLE SQ FT: 3, 500 ADDRESS: UNIT: CLAIM VALUE: 3, 500 . 00 CALC—VALUE: 3, 500 . 00 GROUP OCC; R-3 / PERMITTEEBURR ROOFING ( 714 ) 548-2.965 ADDRESS: 711 WEELO DR COMMENTS: SMOKE DETECTOR REQTeUIRED IN THE HOME REROOF 2000SF P ^ CM92627 CA 92627 ***************** ******** *****************&*x#* ***** #** '•, '40a tib�F.iOp it LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. SETBACKS REQUIRED CITY LIC.:0116 71 STATE Lb ,:3 0 215 7 LJLss:C Date: 7 / ? Signature: MAIN BUILDING ACCESSORY BUILDING a�s3 FRNT: FT IN REAR: FT IN FRNT; FT IN REAR; FT IN WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN Compensational rance,Tor.a AeNf opy(hereof(Section 3800,Lab POLICY NO.:1 1 0'J 3 V— '3 UP.DATE: I/0 l /9 4 COMPANY: PARKING REGI• PROV: PARCEL; 43921109 ZNE; REF NO; 1:1Certified copy is hereby furnished. M Certified copy is fit h tie city Division. PLANNING N TES> Dale: 7!'�6-3 Applicant ( **********************#*************************************#******* ********** 7 EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed it the permit is for one hundred($100)or less). DEVELOPMENT SERVICESREQ U I R E M E N T S • I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become • subject to the Workers'Compensation Laws of California. ZONING APPROVED BY DATE; Date: Signature: BUILDING APPROVED BY : DATE: NOTICE:If.after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor Code.Uyou must NGcomply with such provisions there is permit shall nending deemed gency o. APPLICATION ISSUED BY: DATE• 7l'� I `,1 CONSTRUCTION LENDING AGENCY: hereby Cfirm that(here is a construction lending agency for the performance of the work for which this permit is issued(Section 3097,Civ.Cl- *x#*#*#'##*#** #x'*'#*********#*#******�#**#*ft #*****#�#*#*#***iE*******�xux,)t it it***x ?f LENDER: ************************************#***#********************x-*****4f;i66**#***#** ADDRESS: LEGALIZATION: N F E E SUMMARY STRUCTUR''AL%SEGMENT:Y / 1 OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 63 . 00 50 repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed SMIP/NON—RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business P LAN and Professions Code)or that he/she is exempt Therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by Z S SU E FEE any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE I. as owner of the properly or my employees with wages as their sole compensation, will do the work, and the TOTALS----> 63 . 50 0 . 00 0 . 00 63, 50 63 . 50 . 00 ❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law does not apply to an owner of a properly who builds or improves thereon,and who does such work himself/herself or through )r, his or her own employees, provided that such improvements are not intended or offered for sale. If however the building or REVENUE DIVISION TOTALS——> COLLECTED; 63. 50 OVER/SHOR'T• ,00 improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK for the purpose of sale). 63 , 00 , 50 I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business ❑ and Professions Code: The Contractors'State License Law does notapply rsuant0 an owner of property who builds or improves thereon **************#* x************************************9E************************* and who cls for such projects with a e License )license pursuant 10 the Contractors'Slate License Law).I am aware Thal proof of(heir Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN ❑ I am exempt under Section: B.8 P.C. for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: owner: SFR 3500 REROOF BY VALUE RESIDENTIAL NOZONE 1 , 00 3, 500 . 00 I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505.25533,and END OF FEES 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from these provisions. Date: Applicant: I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction and hereby a horize represantxtives of this city to enter upon the above-mentioned properly for m eclion umpsrs. r Date: �/Z0/`13 signature O 1 00143203-00143204 1-01— 63.50 Driver's License or Social Security x: DATE: 07/20/93 TIME: 11:58 164146 White—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor CONSTRUCTION AND PLANNING - POOL & SPA APPROVALS 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-Uncrgrnd. 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 • • -v 59. Gas Pipe, 0 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 & Hrjuseconnectiop, - 62. Backwash & Receptor-Final 1: I ' r (.3 12. Sewer Cap L' - 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 Framing • 73. Undergrnd.StorageTank OGas C Oil 25. Roof Sheathing 74. Overhead Hydro -t 26. T-Bar Ceiling 1Stsucturall & 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 i HEALTH DEPT. REQUIREMENT 31. Piaster Brown Coat ' 79. FINAL INSPECTION 32. Electrical Power Meter-Final 1 80. FOOD CERTIFICATE ISSUED 33. Final Electric I Notes: 34. Final Heating& Air Conditioning . 1 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbingi39. Water Service-Final • • 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer i 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation • 46. Handicap Regulations , 47. FINAL STRUCTURE& BUILDING 1 Obi - � a. 48. FINAL PLANNING 49. Electric Release to Edison ; 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY - No. _ Date VVYALGAL 01tLL,1r0j WLVV111LG 11111G ' VYI — JOB ADDRESS 229 Lillian Pl. BUILDING PERMIT NO. . 23056. --. - GENERAL CONTRACTOR House Beautiful VALUE $ 1210.00 AP No.119-121-9 LOT TRACT FIRE ZONE 3 DESCRIPTION OF WORK-MC GarageToRe IF"-'ECTIONS Signature DATE GROUP J TYPE V ZONE R1 Gas SSUED SUBCONTRACTOR DATERMITS NUMBER Water Rough Cont. Refrig. ❑ Air Cond. ❑ Rough Heating 1. ri Roug Pl e Miscellaneous Prop. Swr. Line ❑ House Con..❑ St. Swr. ❑ i, 1 I 4 Sprinkling System Construction Pole e 17 Underground 2 Power 0 !('J�i lo-f-6Q Rough Wiring (J{ll co-07-&l el ��°-✓ /D -' 6 - 3 - ..2.-9. Trenches 0-. Forms FI- Steel Reinf. Q' n f /Q.-lf.2.J Floor System /��3 1 Bond Beam 0 Steel Reinforce ❑ ,,// RY' a , Sheathing 4:4 0_ 1. . r� . . Frame and Flashing v Ma a o .. 7 -- Lathing — In$. Out-.❑ ,,fl 69 .,� ?' . f` _Plaster, brown coat Q- (' a crt C. c.L \1l 7- ` C❑ Air Con. .❑ Final ag, Final Plumbing Fixtures, Final Final Gas Test _ Electric Fixtures, Final e (• a -6 Building, Final Jr, _ Li-/a-M FEE RECEIVED ... 3n2F OCT 15 1964. ,COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT. P.O.BOX 317 COSTA MESA,CALIFORNIA CITY OF COSTA MESA For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT BUILDING w / /V^ For Office Use Only DD AEISS 2F� /I /t 7 ris- / . RECEIPT NO. PERMIT NO,_ COSTA MESA, CALIFORNIA _ o/%/ yY�-y'�y� RECEIV$DJY DATEREf.EIVED� DATE I8$UE%5�']/ OWNER �f / '/�qy��S r//vJ/ Cir/.5- (//J/ / MAIL 2 -2/ /,vM,z ,/ I BUILDING 2-29 2I LLIA,\.� Pc ADDRESS /n /4•/ &p 1 NO. , . i FIRE CITY [ V �J_/T //7 PII/7' 6._O J�O ZONE V YPE - GROUP APPROVED 1 `/� // Ci A' TELT - TEL. BY 4 DATE ff�� LO O ;INEER NO. - ZONING ADDRESS /{/�.f�• ' EO NO.OF /�/1 USE OP NEW)._ /}`''"LL \1 //Q C' e //</J^-04/�t../ / • ... / I PLANS 1 I EUILOINGC/,I A( � / CONTRACTOR J /v�V1l-\L / ADDRESS//fi�d/i-14'9,46.7_,6%444,#.11- DEBCRIPNON' I•--0 T 7 I / l)3 CITY OFT-rJ - rei Cr 2 r A.P.NO. 114 491 I 9 NOTE: NO EAVE OVERHANG SHALL BE LESS THAN STATE -; Rl Y-7�l NO. 6��.•�`1O0 30"TO SIDE a REAR p.L. EAVES SIZE 72 Y' /' I NO.Or BLDGS. / ALLOWED (U.B.C.REQUIREMENT) OF LOT �I !yO O NOW ON LOT _ USE OF / _ �I/ YARDS APPROVED - YARDS APPROVED EXISTING BLDG. R•Cc//�a-cr/c/G � /J�� '9UILDING ACC SSORY BUILDING SETBACK LINE FROM /1 5~l i • r/ FRONT 7(FROM C/ STREET) (I , FT. CENTER OP STREET / REAR YARD / FT. /o �/d"// SIDE YARD I LEFT 2// "I RIGHT -S- 'cd " R.SIDE • 6 Fr. PT. DESCRIPTION OF WORK L.SIDE( Fr. Fr. NE v — ALTERATION ADDITION REAR FT. FT. DISTANCE BET. BET.MAIN 9 REPAIR ',VYING DEMOLISH MAIN BLDGS. ACCESS.BLOCS. BUILDING 25.4_2.2+ NO.OF 2 / VAR'$ DATE SIZE ROOMS STORIES C.U.P.# APPROVED EXTERIOR WALLS ROOF co_ PO APP 1 l ��A ,y/ COVERING J�G CC- COVERING V///4 /es i BY /�"" I DATE �O / I / USE OF BUILDIN AN WORK TO BE PERFORMED/ l/ (// - .9 Yo 6Q.FT. - N D I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE X' AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. O PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION m BUILDING CONBTgU ION, N O �J PERMIT FEE 5 O SIGNATURE OF [0r ))) m PERMITTEE / ^ /7' c'1 § /� Gam/ /(/ •� PLAN CHECK § / ./ V 0 AUTHORIZED AGENT a L ' TOTAL FEE ' 5 a 5-V OWNER S'PAMPS, LOEAINE M. DATE 9-25-69 .a JOB ADDRESS 229 Lillian Place BUILDING PERMIT NO. 30854 GFMERAL CONTRACTOR Owner-Builder DESCRIPTION of WORK Conv.Gar.-Fam.Rm.& Leg.Patio 119-121-09 LOT 9 TRACT 1163 FIRE ZONE VALUE $2,500.00 Cover IN�rECTIONS Signature Date GROUP J TYPE V ZONE R-1 � SUBCONTRACTOR GASL PERMITS ISSUED Date Number Signature WATER Plumbing ROUGH PLUMBING PROP. SWR. LINE Q HOUSE CON. 0 SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND n POWER ❑ ROUGH WIRING Heating and Vent. TRENCHES n FORMS CI STEEL REINF. n FLOOR SYSTEM BOND BEAM n STEEL REINFORCE Ti SHEATHING FRAME AND FLASHING LATHING - IN n OUT n P ER, BROWN COAT !URAL, FINAL Electric HEATING, VENT., REFRIG. AND A.C., FINAL PLUMBING, FINAL AND GAS TEST n ELECTRIC, FINAL _ ' BUILDING, FINAL Al inilE' ft 308F4 SEP 25fi9Pa-690798* ****34.50 cesa COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR BUILDING PERMIT For Applicant to Fill in Completely �s pp�� I(�� r/I � � `//leo- n RECEIJ�'ED V DATE RECEIVED�yDATE/SISSUEDBU ADILDING DRESS ail W..CxcM/y,. 1�L.L ��^�J'fr�"/ Net OWNER 67J 4 f P1. A.P. NO. '-/.02 t• O ' > iJ�64" i BUILDINGMAIL . / ADDRESS * v/ t • I -e- - ADDRESS / _e� �, Z LBWn ii/y�� S U CITY L ✓7 //ens K NO. gjjo TRACT / LOT 9 BLOCK. ZZ l C CONSTRUCTION / // f NEW ADD ALTER REPAIR MOVING DFMOI ISH O N LENDER (��iS iv CI. CO BRANCH • rte➢ ) //2. ./ OWNER � � m ADDRESS it 0 ALVE CO• ORENGINE T1'I.O'I<.�lL F71tZu.�+RW TEL �J�./f� $ D� J Q OR ENGINEER P N . U cn FIRE 7 -./��r Z ZONE TYPE i GROUP �^ W C ADDRESS ///aar�� /� J Z CONTRACTOR y az,f 'rlBZ _ Su. . APPROVED Ll- DATE 1-5‘im Z WW W W ADDRESS ZONE NO.OF USE OF NEW C-el'I'vintia.: Z1 CITY NO. ( / (PLANS a BU9IJNJ �`yY�l A D LL O STATE CITY YARDS APPROVED VAR DS APPROVECF j O LIC.NO. LIC.NO. MAIN BUILDING ACCESSORY$UILOING SIZE INO.OF BLDGS. (FROM C/L STREET) /F, // OF LOT NOW ON LOT FRONT FT. y / USE OF EXISTING BLDG. R.SIDE FT, FT. I- SIZE OF NO. OF Z NEW BLDG. ROOMS STORIES L.SIDEAFT. Q EXTERIOR WALL ROOF COVERING COVERING REAR FT. FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTAN BET. BET.MAIN& 1 MAIN BLDGS. ACCESS. BLDGS. Q /��r /� VAR.# DATE O 6..sfVyyV. .ae.'ro f'/sittenyi /ZOoii C.U.P.# / APPROVEDI- // lA i.za P4�a d ,a a^�t(Or/:# APPROVED/./,4/1 DATE C-'S I� l Z (EaAt e exam NG) � C if 0 U I hereby acknowledge that I have reed this application and state ✓ that the above information is correct and agree to comply with EC all laws regulating building construction, and I shall not employ I- any person in violation of the workman's compensation laws of C/3 the State of California. • B ZI hereby certify that I am properly licensed as a contractor under SQ. FT. o the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR • Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: R am exempt from the provisions of the State of California Business VALUATION 0 0 and Professions Code, Division 3, Chapter 9. - �J 3 �� N I t PERMIT FEE $ L� .J 3 Signature of !;(rata_ ta- 47/• _tO_ntr f r `/ l— m Permittee 9,;);(rat !. -"';tvr.(J, $.• J"C�/_ PLAN CHECK $ { -/s-o� E Authorized Agent (� ` 3C1 So u. TOTAL FEE $ T