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HomeMy WebLinkAbout2507 LEHIGH PL - Building PermitsI Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. . CITY OF COSTA MESA O ST ETI N PERMIT PERMIT O. T27:+0:7) 2j N LOT O. UNIT NO. I C. r Ii I.Project Address .SC� Gam+.try � a2��`� `� Z - 4265 5/01/2.6 , TYPE OF CONSTRUCTION- NEW ❑ ADD ALTERATION H REPAIR ApOwner's Na Mallin ddress nG e ❑.CONVERSION ❑ DEMOLISH ❑ OTHER A,P,# 4/ - Z/� Zone Owner's Name Phone DESCRIPTION OF WORK/USE OF BLDG. G-F- ((///��)//// Address S Main Building: _ /Adcessory Building: / E Z Arch/Eng. •r License No. TYPE OF PERMIT - -❑ GRADING ❑ FOUNDATION STRUCTURAL T Front 0 ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL 8 N Address //� , + - � Rear Contractor's Name J• % p np'd . 21 ❑ OTHER C Right N q •'s /�o - PROJECT DESCRIPTION SQ. FT. OCCUPA ,CY K G AddCity Licenses lNgl/�'T Z1.. C t i��{"t /-t>•'f4 • CONSTRUCTION TYPE VALUATION$�J�'O Left 2�1cr� s City No. •I+ ZONE GRADING CU.YDS. ACRES ping. Ref.# Parking Req./Provided • E LICENSED CONTRACTOR DECLARATION / / O I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: / 1� �� /� Planning Notes: M with section 7000 of Division 3 of the Business and Professions Code, and (J �-� my license is in 121porce and effect. T License Class Icense No3•'934-.2_ 1 1 - S Date9/^l�v Signature ` PLUMBING FEES / WORKERS'COMPENSATION D to ATION Bar Sink Showers ELECTRICAL FEES \ r hereby affirm that I have a cer irate of consent to self-insure or a certificate t Workers' Compensation surance, or a certified copy ereof (Sec - _— C 4800, Lab. �j���/(/ a • Backflow Preventer Service Sink • Automatic Washer Transformer 0 15-50 KW Folic ' r^'�-�"� [0J03�V Compan ��_ / L g Sewer Ca ❑ 50+"KW Y P Y Backflow Irri ation eR'C ertitietl copy ";.- ��� p Construction Pole Sub. is hereby furnished. Ce�(lfie leis is filed with the city Build'. ��•.• n. Bathtubs Sewer Connection , �l Cooking Unit Meter pup to 100 amps Date { jrFR Applicant ' r. EXEMPTION FROM WORKERS'CO. • 'SATION DECLARATION - Clarifiers • . .. Solar Collectors - Dishwasher • Meter Dover 100 amps (This section need not be complete• the permit is for one hundred ($100) or less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel • I certify that in the performer of the work for which this permit is Issued, I - • --'--II ` shall not employ any person in any manner so as to become subject to the Drinking Fountains • Solar Tank Fan Motors❑0-1 HP ❑1'/a-,8 Workers' Compensation Laws of California.. • __ _ Date Signature ' ' Floor Drains Swimming Pool w/Spa• F.A.U. . 'NOTICE: If,after making this declaration, you should become subject to the _ Inc.Solar 09-15 HP 016-15+ • Workers' Compensation provisions of the Labor Code, you must forthwith' - Floor Sinks Urinal Fixtures comply with such provisions or this permit shall be' deemed revoked. Microwave CONSTRUCTION LENDING AGENCYGas Service Outlets Water Closet Device Boxes 1 hereby affirm that there is a construction landing agency for the performance - Pole Light of the work for which this permit is' issued (Section 3097 Clv. C.) Interceptors Water Heater - Outlets Range Lender's Name 9 Lender's Address • Kitchen Sink - Water Service • `• Switches Sign OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash ' - Garbage Disposal following reason (Section 7031.5 Business and Professional Code: Any city or 9 P ;Standing.Sections . county which requires a permit to construct,alter,improve,demolish or repair P—Trap LaundryTrays any structure, prior to its issuance, also requires the applicant for such permit • Generator 00-5 KW 05.15 KW Trash Compactor , to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains the Contractor's License Law(Chapter 9(commencing with Section 7000)of , '+ivision 3 of the Business and Professions Code) or that he/she is exempt _ , I erefrom and the basis for the alleged exemption. Any violation of Section - , 131.5 by any applicant for a permit subjects the applicant to a civil - ' +penalty of not more than five hundred dollars($500). • LJ I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 - - compensation, will do the work,and the structure is not intended or offered - , MECHANICALReinspection Fee $15 Issue Fee • $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's I FEES - . - t License Law does not apply to an owner of a property who builds or improves • thereon, and who does such work himself/herself or through his or her own - DEVELOPMENT SERVICES �[ae I� ENTS: employees, provided that such.improvements are not intended or offered for Boiler Hood or Type I. 0 sate. n, however,wthe ave improvement of pro isg he/she one year of com- Canopy Type II 0 Zoning Approved By 'L ��} Date Pa provef rth owner will have the burtlen of proving he/she did not build or im- Duct-Under GrPUndBuilding Approved By � f Y ` Date prove for thewn r of the f oe). 0 I, as owner the property,rojectam exclusively contracting ing with licensedioncon- Duct-Structural Refrigeration System Application Issued By Data he[ors t constructctors the project (Sections 7044,Businessto ane Pf t code: The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑0-100,000 BTU ❑100,000 BTU SUMMARY OF FEES builds or improves thereon, and who contracts for such projects with a con- _ tractor(s) license pursuan(to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration t- BUILDING PERMIT $ _- SMIP- proof of their Worker's compensation insurance should be provided to me. • PLAN CHECK $ PE$'� 0 I am exempt under Section • B.& P.C.for this reason Firepl/Fact.BIt. ICBG# Fire Dampers ' PLUMBING $ $ . Date owner' Heating System& Ducting Registers • ...PLAN CHECK 25% $ i E ERGV P.C. $ I hereby certify that I have read this application and state that the above DO-100,000 BTU D100,000 BTL. ELECTRICAL $�� GRADING information is correct. . agree • comply with all city and county ordinances and state laws relati•- to Ing construction, and hereby authorize repre- PLAN CHECK 50% $ MICROF' I sentatives of [hi sty ter upon the above-mentioned property for inspection our. �'s �^ / p MECHANICAL $ Signature f / • _ Date sl '�( '�O` , ,{ ' OOTAL FEE $ Drivers' Aro 5•# _ Reinspection Fee $15 ' Issue Fee $ 3 PLAN CHECK 25% $ (v CMF OB.:-46, ev. 10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING • POO. ,PA APPROVALS Permit Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location , Yca` 2. Soil Pipe-Undrgrnd. _ 53. Steel Reinforcement 3: Electrical Conduit Utility-Undrgrnd. 54. Forms • 4. Electrical Conduit-Undrgrnd. • 55. Electrical Bonding • • 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. ,Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings .4_ S7-e.eL. S7'9/t6 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK • 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains • 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough& Test 72. Underground Flush 24. Roof Framing • 73. Undergrnd.Storage Tank ❑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 Notes: 34. Final Heating & Air Conditioning s/' •"� 'o 't a oL 35. Final Gas Pipe-Test � ,.(�ri3/ s.T �cote. YL! eflc' 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 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations • 47. FINAL STRUCTURE & BUILDING V �7•. J11f` 48. Special Requirements Completed 49. Electric Release to Edison • 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY , No. Date • (i PROJECT ADDRESS: 2507 LEHIGH PL UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO; B 051472 OWNER'S NAME: le"I NE MARY N ' ' —:ADDRESS: 2507 LEHIGH CTR PERMIT NO; B 051472 PLAN CHECK NO: N GOVT: N SUPP: N COSTA MESA,CA 92626 • CONSTRUCTION TYPE: V—N PERMIT TYPE; STR PURPOSE; ALT 9662790 ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : PARTIAL REROOF ADDRESS: UNIT; SQ FT; • 1 , 700 • CLAIM VALUE: , 1 , 700 . 00 CALC—VALUE: 1, 700 . 00 GROUP OCC: ' R-3 / PERMITTEE: CHRISTOPHER CONSTRUCTION ( 714 ) 498-1417 ' ADDRESS: 2932 HIERRO COMMENTS: REF B51126 • - SAN CLAMENTE CA 92672 ***** **4* fx##x*XP*** *>E#****** >f##x-#x####******###kE#******#•aE###xxx*** R# **.x**** . LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ON ING R E Q U I, R EMENTS 7000)of Division 3 of the Business and Professions Cod -.ad Loz license is in full force and effect SE TB A �. K S CITY LI : 30 • 5• STATE LIC.:40 707 LJ CLASS: B / — Oate: as ( Signature. 3�V MAIN BUILDING ACCESSORY BUILDING WORKERS' OMPENSA ON DECLARATION: I hereby affirm that l have a certificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN Compensation Insurance.or a certified copy thereof(Section 3800.Lab.C) LEFT: FT IN RGHT: FT IN LEFT: FT IN RGH T: FT IN i POLICYNO.: 1079663-90 EXP. DATE: 07/01 /91 ' ICOMPANY: ATATE PARKING REO: PROV: PARCEL: 14142419 ZNE: REF NO: ® Certified copy is hereby furnished. 0 Certifie y is • d with the city Building Division. ' PLANNING NOTES> 1a **********#*aE##****iE#*#****#************#*************************##*****#3F*#*x EXEMPTION ROM WORKE S'COMPENSATION DECLARATION: .(This section need not be completed if the permit i or one hundred($100)or less). DEVELOPMENT SERVICES R E Q U I R E r M E N T S I certify that in the performance of the work for which this permit is issued.I shall not employ any perso n any manner so as to become subject to the Workers'Compensation Laws of California ZONING APPROVED BY DATE: Date: Signature: " ' - NOTICE:If.after making this declaration,you should become subject to the Workers'Co pensation provisions of the Labor BUILDING APPROVED BY . • DATE: Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. swerie CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B . • DATE.... 0 3 Z-6' which this permit is issued(Section 3097, Civ.C) ******* iE***M' ***** fl• '-3=.0:1M-4' '/ -7E******3Ei! 'iF3EibiFfi#iFiF***—WWWWW(3F�ciFlF9c#. LENDER: Lit****r**$*l4************3E?E*)E**?F*****IE** -IE#**iflEie3Esf3k*!F***.*KIe?i*****34*****9@****#ME3E:YB4 . ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL 'SEGMENT:Y OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELF' TRIC 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 39 , 00- ' 5 0 repair 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 the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business SM I P/NON-RES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption Any violation of Section 7031.5 by PLAN - any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS—---> 39 . 50 0 , 00 0 . 00 - 39 . 50 39 , 50 . 0 0 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through . his roher mnt employees.witin provided thatsuch improvements are not intended hedeoof pr for she/. Ie not bald or building REVENUE DIVISION TOTALS--> , COLLECTED• 39 . 50 OVER/SHORT': . O0 improvement is sold within one year of completion.the owner will have the burden of proving he/she did not build pr improve for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TGT GRADING -PLAN—CHECK I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 39 , 00 $0 ->! • ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law). l am aware **#***#*#******ii******#*********#*******-*********M.****#.X.**f:.******************** that proof of their Worker's Compensation insurance should be provided to me INDIVIDUAL F E E BREAKDOWN ❑ I am exempt under Section' B.&P.C. tor this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date owner: SFR 1700REROOF BY VALUE`, RESIDENIAL NOZONE 1 , 00 00 I do hereby certify that I am aware Of and understand the requirements of California,Health and Safety Code Sections 25505.25533,and 1 , 709 . 00 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 END OF FEES permit far construction or modification from the Air Duality Management District.Residential construction applications are exempt from these provisions. EXP 1 14 ED Date: Applicant: Ineo7 plete s 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 horse authorize representatives of this city to enter upon the above-mentioned C properly for ins ection purposes. Date .....1.------Sipevctions 6,\ _ Dale 3 /I! Signature: '�� Inl; ' 01 00083 52-00003453 G O1 ?4,`'L 1 DATE: 03/26/91 TINE: 13:.,7 Driver's License or Social Secunty#: 164146 White—Building,Green—Code Enforcement;Canary—Applicant:Pink—Rev, ue',Goldenrod—Assessor _ � / ,a CONSTRUCTION AND PLANNING - -'POOL _ SPA ,S Date Inspector Date Inspector APPROVALS Permit# APPROVALS Permit #• _ 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location - • 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation - 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap - 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final . 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. 'Rough Factory FireplaceAPPROVALS Permit# 21. Ducts, in Structure • _ 70. Underground Hydro 22. Ducts, Ventilating ' • - 71. Product Piping 0 Gas 0 Oil - 23. Gas Pipe-Rough & test • 72. Underground Flush - 24. Roof Framing - 73. •Undergrnd.Storage Tank 0 Gas 0 Oil - 25. Roof Sheathing • - • 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 R 31. Plaster Brown Coat . 79. FINAL INSPECTION 32. Electrical Power Meter-Final •80. FOOD CERTIFICATE ISSUED . .33. Final Electric - 'Notes: 34. Final Heating & Air Conditioning - T . - - 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 43. Backflow Irrigation . 44. Landscape Irrigation System. - - 4' 1 45. Sound Attenuation i. . EXPIRED 46. Handicap Regulations Incomplete Inspections 47. FINAL STRUCTURE & BUILDING q • Date ��- Y 48. FINAL PLANNING 49. Electric Release to Edison = 9 50. Gas Release to Southern California Gas Co I . • 51. CERTIFICATE OF OCCUPANCY No. Date • ity of Costa Mesa Calif ornia 92628-1200 P.O.Box 1200 .I • Insulation Certificate ` • Permit Number " I5 — O ` V 4110 Number and Street 6 City l County Subdivision Lot Number Description of Installation ROOF Material e4aS Brand Name1. Thickness (inches) (Q Thermal Resistance (R-Value) —L� EXTERIOR WA1 ±-j./a--ti —� Material 2✓_ Brand Name � tN .1�1 "�� � L4 Thickness (inches)-- ° Thermal Resistance (R-Value) CEILING Batt or Blanket Type Brand Name, \L Thickness (inches) t o Thermal Resistance (R-Value)—\ —dc\ Loose Fill Type Brand Name Contractor's minimum installed weight/ft2 .lb. Minimum thickness inches Manufacturer's installed weight per square foot to achieve Thermal Resistance (R-Value) RAISED FLOOR Material V-V-IPASS Brand Name atil LU `..- Thickness (inches)_G2 u Thermal Resistance (R-Value SLAB FLOOR Material es Brand Name Thickness (inches) Thermal Resistance (R-Value) Width (inches) • FOUNDATION WALL Material CD Brand Name Thickness (inches) Thermal Resistance (R-Value) • Declaration I hereby certify that the above insulation was installed in the building at the above location in conformance with the current Building Energy Efficiency Standards for new residential buildings contained in Title 24 of the California Adminstrative Code. (� 6 ! sC. Th se( 1 General Contractor(Builder) License Number Q Signature and Title Date 9 1 o— n� �ZYZrKiLc Q— �Qcn—Lc�� .bub-Contractor(Insulation Installer) License Number Signature and Title Date 190746 COSTA MESA BUILDING DEPARTMENT P 0. BOX 317 ' r COSTA MESA CALIFORNIA r.EE RE EVE® I 8045 . I I 1 tk i-s % --I- FOR APPLICANT TO FILL IN C.L. OF STREET i � �,5'Qr7 Ls ./, GH P1-4c-6.i MAW aDE 1• I BUILDING ADDRESS • I_ __ __J.�PROP LINN`E _ : in T, CITY OF COSTA 1E:Ia Owner J 4M ES 13. O'KEE-FE r 10 FT. FOR 60 F S RELT— r FT. 6 II�FbV i Mail Addresc 2S LFA �H P L lT'� F.0 FT. STREET :a R a City Cos rn Mei A Ph. No it 1 -5-3005- Hod Qli I • Contractor Ott Ph, No. `- q o nr � cc" �' " ► • Address CLI uQt. C1�v 50 F IF FRON City Lic. No. _ State Lic. No. t:LI a �I I0F PROP. F �-i �/ 1'q '3.9 ,/[� 150 FTS, .eg I:: .33. m - ,, :e:.5. z w Size of Lot d ��ofS gO+7/AP No. lI 3� �7 / u , J �o � moi/ u ill \ I- Setbacks: C/L Street 7 Rear / JI `� a Side Yard - Right ,0���%� C- Le l ° / ai r � /� � h a-I v Type of Fence L/J pp � LL ALLEY OR P�TQP./J CYi�e ccI ci ',s cjt /1 Vf - - 7 h C `-evYn„_„ O. al I='-: -1 U I hereby acknowledge that I have read this application and state CD a J = I that the above is correct and agree to comply with all City Ord- v j rp inances State Laws regulating building construction. \ ' O ar I Signature - 10 I of Permittee 6 Agenti r� -e-a4 L I I Al. 37 611N. IFOR OFFICE USE ONLY FT. Iw I 40 IE IIFT 1 J IPerntiE p j 5 is60 FT ST. R ed by ate iv d f/ Date In edd Lai I I Q �� I� F T. ST. La I ! I I I VALUATION PROP LINE Permit Fee $ 2— \ _ - - =-- y-- -- - - - - - - - - -� I in $ g0 d \ Plan Check $ P------- 1 C.L. OF STREET, 2 I TOTAL FEE $ ' - — MAXIMUM 4 F.T. FENCE MAY BE PLACED ON DOTTED LINES -- - --- MAXIMUM 6 FT. FENCE MAY BE PLACED ON SOLID LINES USE REVERSE SIDE FOR DETAILS 7- 4 04111141 'i - CITY OF COSTA MESA BUILDING DIVISION • ��n,�.r. � DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER t • 4i r PERMIT JB02-01876 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us NG PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDIJob Address: 2507 LEHIGH PL Status: ISSUED Suite: Applied: 11/18/2002 Vicinity: ROOF Issued: 11/18/2002 Parcel Number: 14142419 Zoning: Applicant: BURKE, MICHAEL ISSUED BY: Address: 1653 SUPERIOR AVE Phone: (949)642-7222 COSTA MESA,CA Zip: 92627 Owner: KLINE, MARY N TR Address 2507 LEHIGH CIR _ Phone: COSTA MESA,CA Zip: 92626 Contractor: LEE ROOFING OF COSTA MESA Address: 1653 SUPERIOR AVE Phone: (949)642-7222 COSTA MESA,CA Zip: 92627 , License: 349686 Arch : Eng: Address: 'Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT TEAR OFF FRONT SIDE OF RESIDENCE ONLY. INSTALL 30#FELT,20 YEAR,COMPOSITION SHINGLES. 1,500 S.F. INCLUDES PORTIONS OF RESIDENCE AND ATTACHED GARAGE. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $3,414.00 Permit: $97.25 Claim Valuation: $3,414.00 SMIP Res: $0.50 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $97.75 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 ' Required: 0 Proposed: 0 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(6100) • D - -(@?TIONS . C 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' mpensatio��Insurance/Girder a policy number are: _ ' / artier: ,'7Tt° /S2L? t({J C Policy Number:Z6a5 OZ aty f io ZL'i�/z•5 (This section need not be completed',d the permit is valued et one hundred dollars($100)or less.) ❑ I certify that in the performance of the wor. 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 C.iforni. :nd:. /hat if .uld become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these,. •. )0.. Applicant Signature: 4.001 _.a Date: //7t_c WARNING:FAILURE TO SECURE ' •RKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,..., N ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full q force and effect.Lic.x 3 _ /l Cp • Class aG/ *39 Contractor's Signature: Ka/ ...- I Date: //—/a—or?— CONSTRUCTION LENDING • ENCY: ❑ 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 ❑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.lalsework,or demolition or dismantling thereof,will be more than thirty-six(38)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 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 akermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit unfit final inspection. :e - Of Legal Owner(s) Date //-/r // And/Or Authorized Applicant Date RODE# DATE JNTRIAL$ 0061 INSPEC110N TYPE PAI& ILLS 1616 /Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final -01:92---7—a— ../ ��,� ,6JI 208 Final Plumbing 200 Final Re-Roof /2 1 b"t'L— (!.F'• 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 >•i tan r ..`r, DEVELOPMENT SERVICES DEPARTMENT • PER IT NUMBER Jt mit • PERMIT %Pismo*et PO4-00538 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 2507 LEHIGH PL Status: ISSUED Suite No Applied: 08/04/2004 Issued: 08/05/2004 Vicinity: Parcel Nunmber: 14142419 • ISSUED BY: Applicant: CANDY NOCK Address: 11612 KNOTT ST' - SUITE 217 Phone: (714)895-1246 GARDEN GROVE,CA Zip: 92841 ' - _ - Owner: KLINE, MARY N-TR ' Address 2507 LEHIGH CIR Phone: COSTA MESA,CA Zip: 92626 ' Contractor: NOCK PLUMBING Address: 11612 KNOTT ST SUITE 217 Phone: (714)895-1246 GARDEN GROVE,CA Zip: 92841 License: 707775 Arch / Eng : . , ' Address: - Phone: Zip: License: SCOPE OF PERMIT CHANGE OUT WATER HEATER . FEE SUMMARY , AMT QTY - , AMT QTY 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 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,et ), $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 $12.30 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 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 j ( I) WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I e 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 ork for which this permit is issued. I 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. y workers'compensation Insurance carrier and policy number are: Carrier: • Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is Issued,I shall not employ any person in any manner so as t ecome subject to the workers' compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Sectio 3700 the Lab r Code,I shall forthwith comply with these provisions. Applicant Signature: Date: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENAL ES AND CIV FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTERES 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 e,and my license is in full force and effect.Liu a Class x Contractor's Signature: Date: 7O CONSTRUCTION LENDING AGENCY: El 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 ❑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,Gm 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? D Yes ❑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 tile a registration form for acutely hazardous materials? ❑Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ....... .. o... 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification end filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑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 appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes LI No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes El No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. 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. Signature Of Legal O r(s) 0 ate And/Or Au horized Applicant Date COPE t INSPECTION TYPE PAAIF INTITIALS CODE( INSPECTION TYPE DATEINTRIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical (� 1266 Pool Spa Final 208 Final Plumbing 9-)7-oil a- 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy +- i t-1---t. CITY OF COSTA MESA 4 A \ BUILDING DIVISION „' }:Miti, DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER in t ....' i�y� PERMIT /M05-00602 itt(714)7554-5227�o733j1�• Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 2507 LEHIGH PL Status: ISSUED Suite No Applied: 10/17/2005 Issued: 10/17/2005 Vicinity: Parcel Number: 14142419 ` I J r ISSUED BY: \d /I ) Applicant: BILL KOWERTZ - Address: 17709 SAMPSON LANE Phone: 714-969-8212 HUNTINGTON BEACH,CA;,' Zip: .92647 . Owner KLINE MARY N TR Address: c 2507 LEHIGH CIR ; _ Phone: - - COSTA MESA,CA Zip: 92626 Contractor: SOUTHERN CALIFORNIA ENERGY SERVICDES INC Address: 20592 EGRET LN Phone: 714-969-8212 ' HUNTINGTON BEACH,CA Zip: 92646 License:612389 - , , . SCOPE OF PERMIT MECHANICAL PERMITFOR FURNACE CHANGE OUT FOR SFD. 1 INST FAU LESS THAN 100 K BTU AND 1 REPAIR/ALT COOLING/HEAT . , . REF#:E05-01090 - _ , -- , .FEE SUMMARY Quantity Quantity ISSUE,FEE. '. :: - $23.50 Repair/Alt Absorbtion Unit Inst FAU<100 k BTU. $14.80 1 :Repair/:Alt Refrigeration Unit . '$0.00. 0 Inst FAU>100 k BTU ' $0.00 0 ; -,Ventillation System. -. $0.00 0 Repair/Alt Cooling/Heat $1370 1 Evaporative Cooler . - 4 $0.00' 0 ' Inst/Rep.Recess Wall Htr $0.00 0 Commercial Incinerator , $0.00.. 0 Refrig Sys<100 k BTU. $0.00 0 Domestic Incinerator - - $0.00 0 Refrig Sys>100 k BTU • $0.00 0 Compressors/Absorption Systems Gas Piping $0.00 0 Up to 3 hp/100 k BTU - , .$0.00 0 Factory Fireplace $0.00 0 - 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 , 15 To 30 hp/1,000 k BTU - $0.00 0 VAV Box $0.00 0 30 To50hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct ' $0.00 0 - Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $0.00 - :-0 ' Boilers • - Fire Dampers ' $0.00 0- • Up to 3 hp, - $0.00 0 Smoke Dampers , $0.00 0 3 To 15 hp- $0.00 0 Inst or Relocate Appl Vent . - $D00 ,,-0-'' - 15 to 30 hp ' - - - $0.00 0 Air Handlers< 10000cfm $0.00 0 - - • - 30 to 50 hp . - $0.00 0 Air Handlers> 10000cfm $0.00 0 - - -- • ' Over 50 hp _ $0.00 0 Floor Furnace $0.00 `:0:: .. Other Mechanical Fee . Floor or Suspend Heater $0.00:--.-0., , Investigation Fee - ' - - $0.00 Plan Check Fee - - $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $52.00 • COMMENTS/SPECIAL CONDITIONS /' i NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calif is 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 _ rk 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) • • DECLARATIONS 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 salt-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. 40 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: E A� 3 PWICy Numba= 1\� I in n/ On (rhis-s'ection need not be completed it the permit Is valued at one hundred dollars($100)or less.) t--- - ❑ 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. ('�(�(��^ \ /(^p ''� /� �� Applicant'Si9'ature: 9`:J-K-KYQ'V\'1 `C s:\oc:P_r-a._a_.T^`!9 �^Dete ,. �� l� WARNIN• G FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER.TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions ot_COapter 9(commencing with Section 7000)of Division 3 of the Business and Professions C e,and my license is in full force a`nd effe'dtsCic:# \,'7 ' '3 �--� (Glass#,C-'± G- • Contractor's Signature: ♦a C1(19.).a. V7 0 VQ Z,.n cr (,Daie1" / • 1i • Os CONSTRUCTION LENDING AGENCY: El 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 em 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 properly who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ' ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of 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: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes ❑No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. i.natur= • Legal Owner(s) Date,, ©n • • ,Ad onzed,_:..p icant F10"' I Datifcci-,,, CODE#, INSPECTION TYPE DATE INTRIALS COPE! INSPECTIONTYPE 1616 Fixed System Final Fire Prevention 206 Final Mechanical / ' 1r / 1266 Pool Spa Final 208 Final Plumbing ,4 f u p 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 ._ • - s ACV V CITY OF COSTA MESA 4 '�'` ' BUILDING DIVISION F 41 DEVELOPMENT SERVICES DEPARTMENT PERM/IT/NUMBER • PERMIT / ' .4r'" fE05-01090 (714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 2507 LEHIGH PL Status: ISSUED Suite No Applied: 10/17/2005 Vicinity: Issued: 10/17/2005 Parcel Nunmber: 14142419 Applicant: BILL KOWERTZ /��/� Address: 17709 SAMPSON LANE ISSUED BY: 1011e1 . Phone: 714-969-8212 HUNTINGTON BEACH,CA Zip 92647 - - .. Owner: KLINE, MARY N TR Address 2507 LEHIGH CIR Phone: COSTA MESA,CA Zip: 92626 Contractor: SOUTHERN CALIFORNIA ENERGY SERVICDES INC Address: 20592 EGRET LN Phone: 714-969-8212 HUNTINGTON BEACH,CA Zip: 92646 License:612389 4 . • SCOPE OF PERMIT ELECTRICAL PERMIT FOR FURNACE CHANGE OUT FOR SFD. ` 2 RECEPT OUTLETS • REF#:M05.00602 FEE SUMMARY Quantity agility - ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft .0r 0 Res.a/c package' - $0.00 _. . .. Standing"Section . eta 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment eL'i I 0 New Res(34-units) $0.00 0 Transformers up to 1 kva/kw 'T4c.ditti 0 Pool/Spa - $0.00 0 up to 10 kva/kw $0.06 0 Lighting Fixts $0.00 " 0 up to 50 kva/kw $0.00 0 Recept Outlets $2.20 2 up to 100 kva/kw $0.00 0 Switches " $0.00 0 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 • 'Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $0.00 0 Misc.Conduit $0.00 0 Service to 1000a $0.00 " 0 Misc.Conductor - - .$0.00 0 Service over 1000a $0.00" 0 Circus(gen or ride) $0.00 - 0 Motors to lhp $0.00 - 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp . $0.00. • 0• i., Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 . Fireworks Stand . , • $0.00 0 Motors to 100hp $0.00- 0 - Other Electrical Fee $0.00 Motors over 100hp $0.00 " 0 Communication drops $0.00 - , '0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee ' $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00" 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $25.70 Intermed Pole $0.00 0 nnuueUTt I 'entre lir nn•,neTenne'e • 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) Z. 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 es, 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)754-5826 2448-48(WOO) DECLARATIONS ° 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,es provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. a �I have and wille maintain workers' su tecompensationer insurance,oli required are: by section 3700 0l 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. - Cc -r �l Ae� 7- Policy Number.... k (,fl3 (Thi`icQ'need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. _1 ///��� Applicant•Signetbre j% PKC1C'i1t n ()C� � paler WARNINOTFAILU O SECURE W ERS'COMPENS TION CO�(�ERAGE IS UNLAWFUL AND HALL SUBJECT AN EMPLOYER O CRIMTJAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under prow ion Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force.and-effed..Lic.p Loy-73 ,1/4a, Class✓!' C •20 C.' t v Contractorsignature: • •_ +� . . ••• :�� Dein:'— \l7 ' 1 'l - 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: r.J 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). anr ❑ As owner-builder, I will not em4oyJanyone 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 CERMTIFICATION: 1 Will the applicant or present Or future;bm_Idirrg•ocoupent 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 al 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 Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application apermlt for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LI Yes ❑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 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? 0 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 property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Si' . n • eget Owner(s) Date 1110 a .' - -'t \0 • n ' DS --_AA.Q11Authariz=d'App leant_,..-•- 1 Date . CODE f IfiSPECTION TYPE s_--� gdg Iti1mALE CODE• 165PECRON TYPE BATF IHIma9 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing ' 200 Final Re-Roof 210 Final Electrical th/ 5 ,`/.f / 201 Final Block/Retaining Wall 212 Final Fire Prevention .�_ iM # MLW 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Ocoupancy- - - • - PROJECT ADDRESS: 2507 LEHIGH PL UNIT: p CITY OF COSTA MESA -- BUILDING PERMIT - PERM NO: P 046176 OWNER'S NAME: MARY N. KL I NE "' • .ADDRESS: SAME AS ABOVE PERMIT NO: P ' 046176 .PLAN CHECK NO: N GOVT: N SUP P.: N •• CONSTRUCTION TYPE: PERMIT TYPE: PLU. ' PURPOSE: 0TH 714 /642- 3710 - - ARCH/ENGINEER: REG.NO.: ,JOB 'DESCRIPTION : WATER REPIPE .. SQ FT: • ADDRESS: . UNIT: . CLAIM• VALUE: CALC—VALUE :: GROUP OCC: R- 3 / ' PERMITTEE: CC COLE PLMG. & HTG. ( 714 ) 645-1161 ' ADDRESS: 2280 NEWPORT BL COMMENTS : • • CM CA 92627 - • ***********************44******************************************************* LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ON ING REQUIREMENTS 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. S ET BACK S CITY LIC.: 06748 STATE LIC.:37555' - CLASS: e-36 ' • Date: Zo —7c) Signature / L/iu = MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I he•iy affirm that I have a certificate of consent to self-insure or a certificate of Workers' E'RNT: FT IN REAR : FT IN FRNT: FT IN REAR: FT IN Compensation Insurance or a certified cop thereof(Section 3800,Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT, IN RGHT: FT IN; POUCY NO.: 4 6 0 016 0 8—90 mom: 01 /01 /91(., :OMPANY: STATE FUND PARKING REQ: PROV : PARCEL : 42516201 ZNE: REF NO: ' _) Certified copy is hereby furnished. ® Certified cop ' d with the city Building Division. PLANNING NOTES> Date: 2 - 7.--.0-1- Applicant: It. I- .a......: I I I I I I 1lli/. . -__-t . *******************K*****************************l;***************************** EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred(K100)or less). D E VELOP MEN T SER V I C E S- -_'. -R--•-E Q 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 rye 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,you must forthwith comply with such provisions or this permit shall be deemed revoked. F _ / CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for ' APPLICATION ISSUED, B Y : _ DATE: 'C—/ 2177 a which this permit is issued(Section 3097,Civ,C). • **********************7€R i * " ************WWW"F *' ** LENDER: *************************%*******?t****** *****************************iF****ie*** ADDRESS: LEGALIZATION:N ' ' 'L F .E E SUMMARY STRUCTURAL SEGMENT:N" • 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 PERMIT2 00 - , repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed ;5.5% SMIP/NODI—RE.ei • pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE 3. 00 • as owner of the property or my employees with wages as their sole compensation, will do the work, and the ' BUILDING--DIV-- > PERMIT ISSUE PLAN—CHECK TOTAI, PAID DUE ❑ structure is not intended or offered for sale (Section 7044,Business and Professional Code:.The Contractors'State License Law TOTALS--——> 2 , 0 0 . 3 , 0.0 0 . 0 0 5 . 0 0 - 5 , 0 0 . 00 • 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 employees,provided that such improvements are not intended or offered for sale.If, however the building or REVENUE DIVISION TOTALS-- > COLLECTED : 5 . 00 OVER/SHORT: . 00 improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve for the purpose of sale). • BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK I,as owner of the property,am exclusively contracting with licensed contractors to construct the project( Section 7044.Business 5 - ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon • t • and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware **************************'N'%************************************************%*% , that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E Bit E A K :D OWN ' ❑ I am exempt under Section: B.8 P.C. for this reason: • TYPE • QTY DESCRIPTIO N UNIT' COST TOTAL COST • Date: ' Owner PLU 1 WATER RE—PIPE 2 , 00 2 . 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 willlwill not(circle one)need to comply with said state codes and the requirements for a . . • permit for construction or modification from the Air Ouality 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.• .•to comply with all city and county . ordinances and state laws relating to building constmctio.. . .•, authorize representatives is. to enter upon the above-mentioned property fororinspection purposes.�E��f� • ' Date: L- 7-e) `" signamr:. -/.. - / "� 01 00054464-00054464 1"C)11— 5.00 Driver's License or Social Security x: • DATE: 02/20/90 TIME: 15:21 164146 White—Building:Green—Code enforcement:Conary—Applicent:Pink—Revenue;Goldenrod—Assessor — • - - . . . - CONSTRUCTION AND PLANNING POi.0& SPA F 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 1 Electrical Conduit Utility-Undrgrnd. 54. Forms 4.. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6: Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE • 7. Footings • I 58. Electrical Conduit-Undrgrnd. 8. Foundation • 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11, Property Sewer Line & House Connection • 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater,& Vent-Final 13. Roof Drains - 64. Plumbing System.- Final 14. Rough Plumbing 65. Electrical-Final ' 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring, 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling • - 69. POOL/SPA SYSTEMS FINAL • • i9. 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 I 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 Notes: 34. Final Heating & Air Conditioning - 35. Final Gas Pipe-Test 7-7; _ -36. Hood or Canopy - . 37. Final Factory Fireplace + _. .38. Final Plumbing 33/0. &ea 39. Water Service-Final - ;'/,./�44 tec , - 40. Gas Service-Final -; 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System _. • 45. Sound Attenuation • 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING • "i 48. FINAL PLANNING l l: 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY /} No. Date • OWNER OIKEEFE-, JAMES B. DATE 11-20-58 .— JOB ADDRESS 2507 Lehigh Place BUILDING PERMIT NO. #5045 T.F.NERALNTRACTOR Owner Builder VALUE $ 1100.00 AP. No. LOT TRACT FIRE ZONE DESCRIPTION OF WORK Block Wall GROUP TYPE ZONE PLAN NO. INSPECTIONS DATE SUBCONTRACTOR ___ PERMITS ISSUED p },� DATE NUMBER Trenches p� orms Steel /ay//, Floor System in Steel Reinforcer".44— C /V/ON Bond Beam V Frame and Flashing Lathing, In Out Plaster, brown coat Underground soil W/G Pipe Test Top Out Furnace Gas Vents Rough Plumbing Cesspool Septic Tank Prop. Swr. Line House Con. St. Swr. Sprinkling System Heating Final Plumbing Fixtures, Final _1 Final Gas Test _ Construction Pole Underground Power Rough Wiring Fixtures, Final OCCUPANCY c47 k— ti))/Oka Form 210-5M-1-57 8045