HomeMy WebLinkAbout3383 LARKSPUR ST - Building Permits� CITY OF COSTA MESA � '
.
� ""'�s BlIILDING DIVISION
> • � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax p14) 754-4856 • www.ci.costa-mesa.ca.us
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�. FOR INSPECTIONS CALL: (714) 754-5626
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PERMIT NUMBER: E09-00298
PERMIT TYPE ELEC
APN: 41218258
JOB ADDRESS: 3383 LARKSPUR ST CM.
Vicinity: BEDROOMS
STATUS: ISSUED
DATE ISSUED: 12/0912009
ISSUED BY: RMD
Suite/Unit:
SCOPE OF WORK: ELECTRICAL PERMIT TO RELOCATE 2 EXISTIMG OUTLETS AND ADD 2 NEW OUTLETS FOR LOCATED AT �
BEDROOMS FOR A ASSISTED LNING SINGLE-FAMILY DWELLING. � " "
OWNER: A B C MORTGAGE COMPANY
PHONE:
APPLICAN7: HALSTEAD, TRAVIS
PHONE: � 562�447-6308
CONTRACTOR: VENTURE ELECTRIC INC
Address: 13250 FLORENCE AVUnit: UNIT 1
City/State: SANTA FE SPRINGS, CA ZipCotle: 90670
ELECTRICAL PERMIT FEES
Electrical Plan Check Fee: $0.00
Electrical Permit Fee: $27.90
Reinspection Fee $0.00
TOTAL FEES $27.90
Address: 3383 LARKSPUR ST Unit:
City/State/Zip: COSTA MESA, CA
Address: Unit:
City/State/zZip:
License No. 883093
PHONE: 562-463-2456
CELL:
NOiICE: The work authonzed by this permit shall comply with all applicable handicap access requirements under Califomia 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 wiil result in the expiration of this permit.
GODEM. INSPE�PONTYPE OpTE INTITIALS COOEN INSPECTIONTVPE DRTE INi111pL5
1616 Fixetl Sysfem Final Fi�e Prevention 206 Final Mechanical
12fi6 Pool Spa Final 208 Final Plumbing —�/ /—
200 FinalRe-Roof 210 FlnalEleqrical ���
�CQLL�_
201 Final Block/Retaining Wall 272 Final Fire Preveniion
202 Final Factory Fire Place 22o Final Planning Approval
203 Final Sign 222 Final Sile
204 Final Demoli�ion Z50 FinalBuiltling/Occupancy
WORKERS' COMPENSATION DECLARATION:
I hereby aHirm untler penalry of perjury one of the following declarations:
❑ I have and will maintain a certifca[e of consen[ [o self-Insure for vrorkers'
compensation, as providetl for by section 3700 of Ihe Labor Code, for Ihe
peAormance of the work for which this permit is issued.
❑ I have and will main[ain workers' compensation insurence, as required by
sectbn 3700 of the Labor Code, for the perfortnance of the work for which this
pertnit is issued. My workers' compensation Insurance carrier and policy
number are:
ca� ��U s Fr D �u 7�i d- G u A./LeNr�. �
(T�i55Ml.M/1¢Ed�OIEP—W7mpIPfCO mepe�mnisvaluedatw�7enundi �Ilars(510plorlessJ
P�ytNumber. D�/��A/ C) C� � 1 l�
❑ I certify lhat in the peAormance o( the vrork for which Ihis pertnit is
issued, I shall not employ any person in any manner so as to become subject
to the workers' compensation laws of Califomia, antl agree Ihat if I should
become subject to the vrorkers' compensation pmvisions of Section 3700 ot
the Lab Code_ all forth � m ly with these provisions.
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Ap nl's5ignalure' -' [''� D�ale.��
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WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERP.GE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND
ATTORNEY'S FEES.
IICENSED CONTRACTORS DECLARATION:
I hereby aKrm that I am licensed under provisions of Chapter 9(commencinq
with Section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force and effect. /�
CLicr,#ix: - a i� Class.S�. Ci —/�
G� � /2— �7 � o `�
� �ConVStlorsSignawre ��tr.er�
CONSTRUCTION LENDING AGENCY:
❑ I hereby aifum ihat there is a constructbn lending agency for the
peAortnance of the aork fa which this permit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Adtlress:
OWNER-BUILDER DECIARATIONS:
I hereby a(firm Ihat under penalty of perjury that I am EXEMPT FROM iME
CONTRAC70RS LICENSE LAW tor the (ollowing reason (Sec. 7031.5,
eusiness and Professions Code: Any ciry or counry which requires a permit to
constmct, alter, improve, demolish, or repair any stmcture, pnor to its
issuance, also requires the applicant for such pertnit to fle a signed statement
that he or she is licensed pursuant to the provisions of Ihe Contractors
License Law (Chapter 9(commencing with Section 7000) ot Division 3 ot the
8usiness and Professions Code) or that he or she is ezempt therefrom and
Ihe basis (or Ihe alleged eaemption. Any violalion of Section 7031.5 by any
applicant for a permi[ subjects lhe applicant to a civil penalry o( not more than
fve hundred aollars ($500).�:
❑ I, as owner of lhe pmperty, or my employees with wages as their sole
compensation, WILL DO THE WORK, antl the stmcWre is not intendetl or
oRered for sale (Sec. 7044. Business anC Professions Code: The Contractors
License Law does not apply to an ovmer of propeAy who builds or improves
thereon, and who does such work himself or herself or throuqh his or her ovm
employees, provided that such improvements are not intended or ottered for
sale. If, however, the building or improvement is sold within one year of
completion, the ovmer-builder will have ihe burden of proving Ihat he or she
did not build or improve for purpose of sale.).
❑ I, as ovmer of ihe property, am EXCLUSIVELY CONTRACTING WITH
IJCENSED CONTRACTORS to consWct Ihe project (Sec. 7644, Business and
Pmfessbns Cotle�. The cont2ctas License Law dces not apply to an ovmer of
property who builds or improves thereon, and who conlracts for such project wilh
a cont2ctor(s) license pursuant to the Cont2ctors License Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
Owner ID venfied by driver s license. ❑ Yes ❑ No
Driver's License No. Expires:
Verification of Ownership by (rype of documenl, i.e. - pmperty tax bill or tleetl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby cert'rfy that no excavation frve (5) or more fee[ in tlepth into wfiich a
person is required to descend, will be made in connectbn with work authorizetl
by this permit, and that no huilding slrucNre, scaffdding, falsev.ork, or demolilion
or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 32, Grp
2, M 2, Sec. 341, Title 8, Califomia Atlminislrative Code�.
❑ As owner-builder, I will not employ anyone to do work which would
require a permit from Ihe Division of Indusirial Safety, as noted above, unless
such person has a permit to tlo such work from the division.
SignaWre Date
Division of Industrial Safety Permi[ Number.
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future building occupam need to fle and
certify a Business Plan for emergency response to release or threatened
release of a hazartlous material? ❑ Yes ❑ No
(Section 25505 of the Califomia Health antl Safery Code requires, with some
exceptions, that a Business Plan be filed with the Costa Mesa Fire
Deparlment by every business which has at any one time during a reported
year a quantiry of hazardous matenals equal to or greater than a weight of
500 pountls, or a volume of 55 gallons, or 200 cubic feet of compressetl gas
at standard tempereNre and pressure).
2. Does or will the applicant or preseM or future building occupant need to file
a registration form for acutely hazardous materials? ❑ Ves ❑ No
(Section 25533 of the Califomia Health and Safery Code, with some
exceptions, requires registration wilh the Costa Mesa Fire Department by
each business which at any one time has on hand a quantily o( acutety
hazardous materials equal [o or greater Ihan a weight o( 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 tor acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 0( the Califomia Healih and Safety Code provides that �he
Costa Mesa Fire Department may require the preparalion, certifcation and
fling with the Fire Department of an RMPP by businesses which are required
[o register awtely hazardous materials with [he Fire Department.
4. If an RMPP is presenlly required, has Sec[ion 25534 of the California
Health and Safety Cotle been fully complietl vrith? ❑ Yes ❑ No
5. Does or will the applicant or present or fuWre building occupant require for
Ihe work which is the subject of this application a permit for such construclion
or motlification from the South Coast Air Quality Management District or from
any other air polWtion control tlisMct or agency? ❑ Yes ❑ No
(Section 658502 of the Califomia Govemment Code requires that the reque5lEd
infortnation be fumished on applications (or non-residential building pertnits).
6. Will any part of the facility to be constructed under this permit be within
1000 tee[ from the ouler boundaries of a school? ❑ Yes ❑ No
Qf "yes", the facility must meet the requirement of Sections 25534 and 42303
of the Califomia Heal[h antl Safery Code�.
7. I( a permit from the South Coast Air �uality Management Dislrict or other
air pollution comml district or agency is required for the vrork which is the
subject of this application, have all of the disclosures prescribed by California
Healm and Safery Code Section 42303 been made? ❑ Yes ❑ No
8. Qf "yes", attach certificate of compliance from the appmpriate air pollution
contml oKcer).
CERTIFICATE OF COMPLIANCE: I certify that untler penalty of perjury the
information given above is correcc I agree to comply with all state laws and
ci[y ordinances regarding Hazardous Matenals and Emissions. �
SignaWre Oate
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalry of perjury that I have read this application and state that
the informa[ion given is correcL I agree to comply vnth all state laws and ciry
ordinances relating [o building construction, and authorize representatives o(
the Ciry ot Costa Mesa to enter upon the above-described propeny for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until fnal inspection.
Signa legalOwn ^ Date
Siqnamre Da�e ! /—^'��D �i
305]-46(3/0]I •Arrdlai:AWhwizetl.Appliwn�, . Pme
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- CITY OF COSTA MESA
t��pMfsq B!/ILDING DIVISION
r�� 77 FAIR DRNE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
:
� � FOR INSPECTIONS CALL (714) 754•5626
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PERMIT NUMBER: BX09-00278
PERMIT TYPE B MISC STATUS: ISSUED
APN: 41218258 DATE ISSUED: 12/15/2009
Zoning: R1, ISSUED BY: RMD
JOB ADDRESS: 3383 LARKSPUR ST CM Suite/Unit:
Vicinity: BEDROOMS Primary Occ: � Const Type :??
SQ. FT: 0 Valuation: -$2,000.00 � , " �
SCOPE OF WORK:
CONSTRUCTION OF A 120 SF 11" HIGH DECK IN CONJUNCTION WITH THE INSTALLATION OF (2) 6' X 6'8" SLIDING
GLASS DOORS (SAME HEADER) LOCATED AT,(2) BEDROOMS OF A NON-AMBULATORY ASSISTED LIVING FACILITY.
OWNER: A B C MORTGAGE COMPANY Address:: 3383 LARKSPUR ST Unit
City/State: COSTA MESA, CA - Zip Code: 92626 -
Phone:
APPLICAN7: KOSMICKI, ROBERT
City/State:
Phone: 949-254-4902
CONTRAC70R:
Address:
City/State:
Zip Code:
ARCHITECT:
Phone
ENGINEER;
Phone
OWNER-BUILDER
FEE SUMMARY
Building Plan Check:
Building Permit:
Electrical Permit:
SMIP Residential
SMIP Commercial
Bldg Std Admin Fund
TOTALFEES
Address:
Zip Code:
License No. 000000
Phone
License No.
License No.
$45.01
$6925
$0.00
$0.50
$0.00
$1.00
$115.76
Cell:
Unit:
Unit:
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 wnsidered legal, such work must wmply with all applicable codes, and all
required inspections and finai approval must be obtained. Failure to obtain inspections and fnal approval will result in the expiration of this permit.
CODE�. INSPECT�pNTYPE DATE IN1171AL5 COOE% INSPECTIONTYPE DRTE IN7171AL5
1616 Fixed System Final Fire Prevention 206 Final Mechanical
7266 Pool Spa Final 208 Final Plumbing
2W Final Re-Roof 210 Final Eleclrical
201 Final Qlock/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site ��
204 Final Uemolition 250 Final Building/Occupancy
•
WORKERS' COMPENSATION DECLARATION:
I here6y a(firm under penalty of perjury one of the follovnng declarations:
❑ I have and will maintain a certifcate of consent to selt-Insure /or workers'
compensation, as provitled for by seclion 3700 of Ne Labor Cotle, for [he
performance of the vrork for which this permit is issued.
❑ I have and will maintain vrorkers' compensation insurance, as required by
sectbn 3700 0( the Labor Code, for [he pedortnance of the work for which this
pertnit is issuetl. My workers' compensation Insurance carrier and policy
number are:
Carrier
(Tnrs seqion need irol Ee mmplete0 Athe peimrt is valued at one nuntlred dollars (E100) a less )
Policy Number:
��u—�'I�certi(y that in Ihe peAormance of [he work (or which Ihis permit is
issued, I shall nol employ any person in any manner so as to become subject
ro the vrorkers' compensation lavrs of Califomia, and agree that if I should
become subject to the vrorkers' compensation provisions of Section 3700 of
the Labor e, I shall forthwith comply wilh these provisions.
�� �} )�2�;./h-' �2-�s -v�
Appllwnl's5ignaWre S��Date'
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNL4WFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000�, IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affrm that I am licensetl under provisions of Chapter 9(commencing
with Section 7000) o( Division 3 of �he Business and Professions Code, and
my license is in (ull force and effect.
Lic. # Class #
Contrac�or's 9gnawre oa�e
CONSTRUCTION LENDING AGENCY:
❑ I hereby aKrtn that there is a cons[ruction lending agency fw the
pedormance of the v.vrk for wfiich ihis permit is issued. (Sec. 3097, Civil Cotle).
Lender's Name:
Lender's Address:
SignaWre
OW NER-BUILDER DECLARATIONS:
I hereby a(firm Ihat under penalty of perjury that I am EXEMPT FROM 7HE
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5,
eusiness and Professions Code: Any city or county which requires a permit to
consWct, alter, improve, demolish, or repair any slructure, prior to its
issuance, also requires Ihe applicant for such permit to fle a signed statement
Ihat he or she is licensed pursuant to Ihe provisions of Ihe 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
appliwnt for a permit subjecls the applicant to a civil penalry of not more Ihan
fve huntlred dollars ($500).):
��Iras owner of the property, or my employees with wages as their sole
compensation, WILL DO THE WORK, and the slrucWre is not intendetl 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, antl 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
complelion, the owner-builder vrill have the burden of proving that he or she
tlitl not build or improve for purpose of sale.).
❑ I, as ovmer of the property, am EXCLUSIVELY CON7RACTING WITH
LICENSED CONTRACTORS to construct Ihe project (Sec. 7044, Business and
Professions Code: The coniractors License Law dces not apply to an ovmer of
property who builds or impmves thereon, and who cont2cts for such project with
a coniracta(s) license pursuant to the Contractas License Laws.).
❑ I am exempt under sec.
Business and Professions Code for lhis reason:
�i� 2' �.�-1S-c�`I
SiB aWre Date
]OS]-461J/0]) �"- �•�`-'
Ovmer ID verified by tlrivei s license. Iyres ❑ No
DnveF's`�License�No."''� � 4Expires:�•� r�' a0'I�
Verification of Ownership by (type o( document, i.e. - property tax bill or dee ):
DIVISION OF INOUSTRIAI SAFEN PERMIT CERTIFICATION:
❑ I hereby certdy that no excavation frve (5) or more (eet in tlepth in[o wfiich a
person is required to descend, will be made in connection with work authonzetl
by this pertnit, and that no building slrucNre, scaFfdding, falsework, a tlemolition
or dismantling Ihereof, will be more than thirty-six (36) feet high. (Chap. 32, Gry
2, Art 2, Sec. 341, Title 8, Califomia Atlminis[2tive Cotle).
❑ As owner-builder, I vnll not employ anyone to do work which wvuld
require a permit from the Division o( Industnal Safety, as no[ed above, unless
such person has a permit to do such work from the division.
ApDlicanfs SignaWre Date
Division of Indusldal Satety Pertni[ Number.
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will Ihe applican[ or present or fuNre building occupant need to file and
certify a Business Plan for emergency response [o release or threatenetl
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the Califomia Health and Safety Code requires, vnth some
exceptions, that a Business Plan be fled with ihe Costa Mesa Fire
Depanment by every business which has at any one time during a reported
year a quantity of hazardous ma[erials equal to or grea�er ihan a weighi of
500 pountls, 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 fu[ure building occupant need lo (le
a regisVation form for acutely hazardous matenals? ❑ Yes ❑ No
(Section 25533 ot the California Health and Safety Code, with some
eaceptions, requires registration wiih the Costa Mesa Fire Depanment by
each business which at any one time has on hand a quantily of acutely
hazardous materials equal to or greater than a weight o( 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at slantlard
temperature antl pressure�.
3. Does or will the applican[ or present or future building occupant need to
prepare an RMPP (Risk Management and Prevention Program for aw�ely
hazartlous materials)? ❑ Yes ❑ No
(Section 25534 0( the Califomia Health antl Safery Code provides that the
Costa Mesa Fire Department may require [he preparatioq ceAification and
fling with Ihe Fire Department of an RMPP by businesses which are requiretl
to register awtely hazardous materials with Ihe Fire Deparlmen[.
4. If an RMPP is presentty required, has Section 25534 of Ihe Califomia
Health and Safety Code been fully complied with? ❑ Yes ❑ No
5. Does or vnll the appiicant or present or future builtling occupant require for
the work which is lhe subject of this application a permit for such constmction
or modification from the South Coast Air Qualiry Management District or from
any other air pollution coNrol district or agency? ❑ Yes ❑ No
(Section 658502 of the Califomia Govemment Code requires that the requested
in(ortnation be fumished on applications far non-residential building pertnits).
6. Will any part of the facility to be constructed under this permit be within
1000 feet trom the outer boundaries of a school? ❑ Yes ❑ No
(If yes", ihe facili�y must meet the requirement of Sections 25534 and 42303
of the Calitornia Health and Sa(ety Code).
7. If a permit from the South Coast Air Quality Management District or other
air polNtion control disMct or agency is required for the vrork which is the
subject of this application, have all of the disclosures prescribed by California
Health and Satery Code Section 42303 been made? ❑ Yes ❑ No
8. Qf'yes", a[tach certifcate of compliance from the appropriate air polWtion
contml oKcer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury Ihe
information given above is covecc I agree to comply with all state laws antl
city ordinances regarding Hazardous Materials and Emissions.
SignaNre Oa�e
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury that I have read lhis application and sta[e that
the information given is correcL I agree to comply with all stale laws and city
ortlinances relating to 6uilding wnstruction, and au�honze representatives o(
the City of Cosla Mesa ro enter upon the above-tlescribed property for
inspection purposes. I agree nol to occupy or allow occupancy of any buildinq
authorized by this permit until fnal inspection.
Wre ot Legal Owner Date
� ' _la-�5 -a9
��AndIMPulfian3eG I¢anl �ate'
DEC-10-2009 1E�38 " 45373�93 71a537-�93 ' P.02
12/IB!2009 14:04 171� 3660 STAPLES PA�E� B2/03
. . ,,;,,.�_..� �. .
-. C�ty of Costa �I�lesa <3uil�ing �ivision
-.
��S�a1` ����a 77 Fair Drive, Costa Mese, CA 82626
l��l 714-754-5273/Fax 7t4-754-4858
QWNER BU�LDER 1/ERIFICATIdN
Pelmit# 6�"O�DZ%�"
Disclosures 8� Forms foi� Owner, �ulfders Applying for ConshuCtion Permlts
(Q��QRrAN'�l' WO'TICB TD PROPERTY OWN�R .
Dear Properry Owner:
An a plleation fOr a buildi qetmR has biArtS� d in our name.listirl� oUi9eIL ao the builder of the
pmperty improvements eperiflejd aY ✓��?3 �Y ,/'� j� y ,
WB.e�'e Ofc+viding you with an Oxmer-6ulld�t Ackrlowfedgmentand Infbtmatlon Ve�ificadon Form ta make you,
uw8r� oPyour responslbillUea'shd possible•risk.you may Incur by,Hevlilg.this, permH issued in your nAme as tl+e
Ownar-Bufld'er; Wa•wilF nelt essue a building pemtit until you have tcad,,.inklalod your underatanding of.
aaeh provimion, signed;.ahd�retumotl.thls, foim:to us at our offitlllll hddFose indlcated; Arr agent ot 4he.
owner dnnoC execute.this naifee unlm5a you, the praperty'owrvu, ohtain th�. prior approval,of the pertnitting
authon'tY•
and Jnmel �aCh Stgfemenf belOw fe slgnlly ypv under5tand or vei�lfy fhls lnlortnetidn..
�I unaei�hand e f�equerr, practice of uNicensed persons ie co have the propert� owner,obtain an "Owrtet�
Bvflder, bullding'pOrMit that: erroneously ImpfleS that the property owneh is provlding. his or herown IabCr'and ..
rtiafell8l 'p9r8orfally. I, as an i)Wner-Build2r, may be held Ilgbla 2�tl 6ubjeCt to se[foue finanClaf riek fo� ahy:
injunes sustained by an unllc�naed:persori and h18' or her employees whilA worlcirlg on h+y propettq; Mg
homeownere innur�nce may rot prmlde cwerage for those inJuriea: � am wllifully acting as en Owner•Buiker
and am w8re oithe limits of rtiy ingurance coverage for Injurle8 to.workers on my propertyr
2. I understaYld building pertnits ere noE required to be 3lgned by proparty owners unl2ss they are
respanslblg for the constructior� and gr� �tot hiring a Ilceneed Conhacror to assume thls responaibility,
��! understend a9 an 'Ou�ner-BUflder' I�m fhe responslble peay ot record on the permlt. I undersNand thaf
1 may proteci my6elt from potentfal flnanalal Tisk by hiring a licensed Conhactor and havfng the permit filed in hls
or her nam2 instead ot. my own. ,
� unaerstan� Contractcrs are required by law to pe IicenseQ and bonded In Califomie and to Ilst thdr
licenst numdars on permi�s arn9 convacb.
0_5. I understand if i employ or oknervrise engage any peraons, other tltan Califbmia licensed Centractors,
and the total v01Ue of my consbvotloh is et ieast Ave hundr6d dollars (S500), includin0 labor and matelials, I may
be cor�sidered an'employer`u�Wer state and tetl�ral law.
v�8. I understand ii t am corv9idAred an "employar' under state and federel law, I mUet register with the arate
and fEQaral government, withholE payroll taxes, prwlde woricers' compensation disabiliry InsuranCe, and
contribute to unOMployment compensation for �aCh "employee." I alg0 understand my fallura to ebide by thesg
laws mAy aubject me to senous financlal dsk. ; .
� 7, I u�derstend under C21FomfA Canhactors' 9t�to �icansa �aw, an Own�r•9uilder who bullds Single-family
re'sidentlal shuctures cannat tec�ally build them wlth the Intent to ofter them for sele, unless a0 wdrk i5 perfwrmed
by lieensed auDcontredors and the number of atroctures does not �xceed four within any Celandar year, oi all of
the work la perfortned untlCr Contract wlth e lirensed general bullding Contiactor.
3148.30 CAL80 Jan 1, 200g OB F�acket template � Of 2
DEC-15-2009 12�07 7145373093 7145373093 , P.01i01
D�C-10-2804 16�38
1�/1B/2BB9 14:94
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71455'T3093 P.03
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�9. l undst�nd as an Cvwfm-Bullder N 1 sa11 th� propeAy kr Whroh thfs pslmlt la Issued I m�r h� hdd fi�l�
for anY fi�andi4 Or pllnon�d in�wisa sueuln�d by inY �e4uent ovmuhj Ih�t �nMt Mom any IMuit
wnllrudbn defads in die.woAmaamhlp a maOMah,
�a. i unaaramrm i may ohtein mcp �tlon nrg�npn0 my obupatlons b�n'en,ptoy�r hom tl�� Inhnwt
ReVa�ue B�iCe, the uni(e�i Btelee Sm9�� Builn�u A�mruatrellor� qte CelHomia Departme�ft o( B�n�19!
p�yeNny�, an0 th� Crtlh�n(e olNston of I�ueafal Aodeenn. I Wo une�nd I M�y e0e01b! tln Oidl�ernh
corroecmcs' sb�e �I�nee sne�a tcs�e� a� ,�oo-sz,-cs�e Sz�z) o� www.�a.aa.a� ror mob ntarr�aoon
� .beut tlansed aennab��
_�o. i em aware of and eeroent te �n Owner�ullde� buWllnp petmll �pplkd �or In n1y R�MR �nd undalsE�+d
lnet I mn tlN PsRY �BB�M ana enonoial�b�7 b► qroPw�4 �^ �Nlty �t �h� fvpad� addnn;
�11, I apree thqt, a� the psrty lepally and frnnd�ly �eepo�bl�k fOf Wi DrOpO�ed conaLrt+alon NCtlVlqq I wlll
s 6y Y�► �vplirable laws ar�d ropuiromen� lhat yawm Owehr�Bulldees e� well ea �mployen.
�2 I Aqbe po notlry the lasuer af Ifile fam immed�baly d erly 9dditlo�� delatlees, er ehan9es to srry of IM
hfonrntlon I have DrandW Gn tAl� Iwm, LIan�O opnetotors �n regulaaE oy 1� Coolgnod to p�bvt �Q
PubGc. tt you aantrea! w�h mmaonQ whe does rat,►ipve a IbensC, tl+e CanVactas' 31aEe Lloenw Boerd may be
uaab�a ie es�llat you ,x� a�ry �fn�ndW lon yeu mey weleln u� r�au� al a comPINM, Your only remetly ydM!
unliCenud Contradora mry loe in ciwl cauri N ia qfto irtl for YOU W undws�nd tlsdt 11 in un6DY1�d
Conaacmr or empinyee o} th�t inONldud Or Rrm Ip In whHe WefkNp on your propn�. yeu mey Ee hqld
ihble for aamage�. tf you oah�in a pumR es OwnanBullder �na wieh m hi�e Co��, you wiq be rcspone�M
far ve�9yb�p wheq�er or na; tho:e ConVaaeis' 1n! propedyr Ilcens�e and• th� �LI� Of B�U Mrofkero'
Eanpens�an In54►�rIC� ODW'iQo, • .
9�fot� � buHmnq p�nnM sai be lasued, !hw forni mus! W aOmpNfrd �nA slgnd �r tM prap�r awn�r
and rObu�d ED eh� +�M�71 1'MYonsible for �eadry VIt pennR. IMob: A copy o/ tll! prbpsAy �
atr�►'� Nor►so, ibmi no�A�fzeCon, or •ofhw v.�ksCOn aaa�phbla ta U+e �qy h hqWrrtl f0 0�
praeetuPd wh�n �In Pennlr Is ls�w4 te w�lly pN pnoprrq� o�nNYc a/giv�tor�,
saroeun. ar prov�r ��► �-' �' a� i z � �
oual�� \{�,.,
Nore: Ths Ibllowdnp Aufha�tetron Form Is required to be mmplsted by fhe pmpeRy amer oMy when
�lgnetlnp aA ag�nt W the property owrwrfo apply !br s oonshl�ion Permlt Ibr the Owr�-8ulfEer.
6cdudbfa tlle NaUce � PropOrty! (
Mrehy au�ocPra !he IbllOwpip pai
noeeaaery to abpin �n vwnea9u
9ooi�e of COrt�budlon Pm)eot (w
ma s+wauvan m wn�cn i uraasdno ia n1y O�eenel emPsn�lOGlb� 1
tv Aet es mY a9em(3) Do apply fa�, slgn, �nd flle lAe d00umon�
_�..�� --� -
� I,o�lan or Addrers: _ 3 3� S �w wc3l�S4�r�f
Nt�1M ef AU111w�ed Age� 1�.aixZr 1�eS n�rc19'_ Td No °�4 g•���/- N'�oz
MdroaeolAumor(zeaAgant. ��32 E7dU�y�e � 5' Cesi++ W1<sw °�AW.�
I�el�a UndY� p�nYlry 0r p�ljlny ��&n !h0 pfOp�rty OYM�r (iN {h� eddreee IIsOEd e0ovs and I peta011N�y Apep
ObtbM s00V0 IMorma{Ipn and Oprdlj/ 1(i i00uryYGy. NOAY: A aOPY�N110r71Brs drM%1 ii00f7A@, M11/1
noa/haRan, or oNfer w+bidfkr ioasP►eDp to Mo oppiwy IB roQurYed to bB proasrnsd wh�A M1Y.pwmd � 1�,tued
fa rrMY U�B Prope►�y mrn�1� alpn�Eiw
� � 6wn�r� s�9naw�; � vam: ` l
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zo�z
TOTRL P�03
TOTRL P.01
DEC-1�-20�9 16�51 ^��453^r._�93
ALL PURPOSE ACKNOWLEDGMENT
5TATE OF CALIFORNIA
COUNTY OF ORANGE
y
)ss
}
7145373093' P.eliel
On DECEMBER 10, 2009 beFore me ESTHER K. LEE, Notary Public, personally appeared QOUGlE15 4�QM
who proved to me on Me basis of satisfactory evidence to be the rson(s) whose name(s)�is/ re
bscribed to the within instrument and acknowledg�o me that�ie�he/they executed the same In
his er/their authorized capacity(fes), and that by his/ er/their Signature(s) on the instrument the
person(s), or the entity upon behalf of which the person s) acted, executed the instrument,
I certify under PENALTY OF PERIURY under the laws of the State oF California that the foregoing
paragraph is true and wrrect.
WITNESS my hand and o�cial seal.
Signature
ESTHER K. LEE
COMM. f1185t831
NOTANY YUBLIC � CALIFORNIA
LOSANGELESCOUNTV
;omm. Eso_ Jl1NE L 2013
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uNno� sa�3�Nv soi
� vineadnw�• JIl9fldAtlV10N
� �ee�se�a wwoo
j 33l 'H L13H1S3
(NOTARY SEAL)
ATTENTION NOTARY: Although the InfOrmatlon requested below Is OPTIONAL, It Could
prevent fraudulent aLiachmen! oF this ce�tificate to another document,
THIS CERTIFICATE MS�Q BE ATTACHED TO THE DOCUMENT DESCRIBED BELOW.
Title of Document Type �'^2�' �U��2✓ Y2V��c� <'�
Numlxr of Pages �- Date of Document
Signer(s) Other "fhan Named Above
All Purpose AcknowledgmeM
TOTRL P.01
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FACILITY SKETCH (Yard)
The yard sketch should show all buildings in the.yard including the home (with no detail), garage and storage building.
Include walks, driveways, play area, fences, gates. Show any potential haiardous area such as pools, garbage storage;
anima! pens, etc. Show the overaN yard size. Try to keep the sizes dose to scale. Use ihe space below.
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COMMUNT' GPRE UCENSING
FACILITY SKETCH (Floor Plan)
Appliqnts are required to provide a sketch of the floor plan of the home or faciliry and outside yard. The floor sketch must-label rooms
such as the kitchen, tiath, living room, eta Cirde the names of Me rooms that will be used by staff/2sidents/Gientslchildren. Door and
window exits from the rooms must be shown in case of an emergency (see Emergency Disaster Plan). Show room sizes�(e.g. 8.5 x
12).- Keeo dose to scale. Use the space below. See back for yard sketch.
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,. :
� CITY OF COSTA MESA
t �s`""'F, BUILDING DIVISION
>�±�� 77 FAIR DRIVE. COSTA MESA. CA 92626 •(774) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
� � �
� FOR INSPECTIONS CALL: (714) 754-5626
"FF45N[� �y6
PERMIT NUMBER: E09-00292
PERMIT TYPE . ELEC
APN: 41218258
JOB ADDRESS: 3383 LARKSPUR ST CM
Vicinity: .
STATUS:
DATE ISSUED:
ISSUED BY:
Suite/Unit:
ISSUED
12/04I2009
BJK
SCOPE OF WORK: INSTALL 7 SMOKE DETECTOR IN AN ASSISTED LIVING SIN6LE-FAMILY OWELLfNG.
OWNER: A B C MORTGAGE COMPANY Address: 3383 LARKSPUR ST UniY.'
PHONE: .- City/State/Zip: COSTA MESA, CA
APPLICAN7: HALSTEAD, TRAVIS
PHONE: 562-047-6308
CONTRACTOR: VENTURE ELECTRIC INC
Address: 13250 FLORENCE AVUnit: UNIT 1
City/State: SANTA FE SPRWGS, CA ZipCotle: 90670
ELECTRICAL PERMIT FEES
Electrical Plan Check Fee: $0.00
Electrical Permit Fee: $3120
Reinspection Fee $0.00
TOTAL FEES $31.20
Address: Unit: �
City/State/zZip: �
License No. 883093
PHONE: 562-483-2456
, CELL:
NOTICE: 7he work authonzed by this permit shall comply with all applicable handicap access requirements under California statutes and related
�regulations. (Ord. No. 92-28, § 1. 12-21-92)
EXPIRATIQN: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under ihis 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.
CODEp. MSPF�TIONTYPE UATE IN7ITIALS COOEN INSPEC710NTVPE UATE INTITIALS
1616 Fixetl System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roo( 210 Final Electfical ( LZ
201 Final Block/Retaining Wall 272 Final Fire Prevenlion -
202 Final Factory Fire Place 220 Final Planning Appmval
203 Final Sign 222 Final $ite
204 FinalDemolition 250 FinalBuiltling/Occupancy
WORKERS' COMPENSA710N DECLARATION:
I hereby aKrm under penalry of perjury one of the tollowing declarations:
❑ I have antl will mainlain a certifcale o( consent to sel4lnsure (or workers'
compensation, as pmvidetl for by section 3700 of ihe Labor Cotle, for the
performance of the vrork for which this permit is issued.
�I have and will maintain workers' compensation insurance, as repuired by
section 3700 of the Labor Code, for Ihe peAortnance ot the work fw which this
permit is issued. My workers' compensation Insurance cartier and policy
number are:
C'aiuer GtSl7e%�GITL � C�uA2A�,.�s6> c.J
(Th�ssectionneetlrwlbemnyee0dl�eperm<isvaNedatone Qundmd�aMars(5100)wless.)
P61icy:Number. 0 �- % �— � 0 C� � �v
❑ I ceriify that in Ihe pedormance of the vrork (or which this permit is
issued, I shall not employ any person in any manner so as to become subject
to the workers' compensation laws o� Califomia, and agree tha[ if I should
become subject to lhe vrorkers' compensation provisions of Section 3700 of
the bor �C de. I �sha rthwith wmply with these provisions.
�J>«"^-�c-"—"�7 / y - �/ - U %
Appl[an� f9'S�9naWre ��e
�': u
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrm that I am licensed under provisions o( Chapter 9(commencing
with Section 7000) of Division 3 of the Business and Professions Code, and
my license is in tull force antl effect.
;o-t���8 3 v 4 3 rcws5 a G—/ Q
���L..��--.�� % 2- �/—c� �i
`� Convactor�'sSignalu^eR: �te1(�,...t:
CONSTRUCTION'L'ENDING AGENCY:
❑ I hereby aHirtn that there is a constructbn lending agency for the
peAortnance of Ihe work for which this pertnit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lentler's Address:
SlgnaWre Dale
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT PROM THE
CON7RACTORS LICENSE LAW for the following reason (Sec. 7031.5.
Business antl Professions Cotle: Any city or county which requires a permit to
construct, alter, improve, demolish, or repair any swcWre, pnor to its
issuance, also requires the applicant for such pertnit to file a signed statement
that he or she is licensed pursuant to the provisions of [he 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 iherefrom and
ihe basis for the alleged exemption. Any violation of Section 7037.5 by any
applicant (or a permi[ subjects ihe applicant to a civil penally of not more than
fve hundred dollars ($500).):
❑ I, as owner of the property, or my employees with wages as iheir sole
compensation, WILL DO THE WORK, and the structure is not intended or
offered (or sale (Sec. 7044, Business and Professions Code: The Con[ractors
License Law does not apply to an ovmer of property who builds or improves
thereon, and who does such vrork himself or herself or ihrough his or her own
employees, provided that such improvements are not in[ended or oftered for
sale. If, however, the buildinq or improvement is sold within one year of
completion, the owner-builder will have 1he burden of proving that he or she
did not build or improve for purpose of sale.).
❑ I, as ovmer of the property. am EXCLUSIVELY CON7RACTING WITH
LICENSED CONTRACTORS to consiruct Ihe project (Sec. 7044, Business and
Professbns Code: The wntractas License Law dces not appty to an owner of
pmperty who builds or improves thereon, and v+ho cont2cts fw such pmject with
a cmtracta(s) license pursuant to the Contractors License Lavrs.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
Owner ID verifietl by tlrivei s license. ❑ Yes ❑ No
Driver's License No. Expires:
Verifcation of Ownership by (type of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify ihat no excavation (rve (5) w more feet in depth into wfiich a
person is required to descend, will be made in connection with v.ork aulhonzed
by this permit, antl [hat no builtling strucNre, scaffdtling, (alsework, a demolition
or dismantling thereof, will be more Ihan thirty-six (36) feet high. (Chap. 32, Gry
2, M 2, Sec. 341, Ttle 8, Califomia Adminis�2tive Code�.
❑ As owner-builder, I will not employ anyone to do work which would
require a permit trom [he Division of Intlusirial Safery, as noted a6ove. unless
such person has a permit to do such work from lhe division.
Applicdnfs SignaWre
Division of Industrial Sa(ety Permit Number _
HAZAROOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future building occupant need to file antl
certify a Business Plan for emergency response to release or threalened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the Califomia Healih and Safety Code requires, vnth some
exceptions, that a Business Plan be filed with the Co5[a Mesa Fire
Departmenl by every business which has at any one time during a reported
year a quantiry of hazardous matenals equal to or greater than a weight oF
500 pounds, or a volume of 55 gallons, or 200 cubic feet ot compressed gas
at standard IemperaNre and pressure).
2. Does or will the applicant or presen[ or fuNre building occupant need to fle
a registration form for acutely hazardous materials? ❑ Ves � No
(Section 25533 of the California Health and Satety Cotle, with some
exceptions, requires regis[ration 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 fee[ of compressed gas at standard
temperaWre and pressure).
3. Does or will the applicant or present or future building occupant neetl lo
prepare an RMPP (Risk Managemen[ and Prevention Program for acutely
hazardous materials)? ❑ Yes ❑ No
(Seclion 25534 of the Califomia Health and Sa(ety Cotle 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 ma[erials with the Fire Department.
4. If an RMPP is presently required, has Section 25534 of the Califomia
Health and Safely Code been fully complietl with? ❑ Yes ❑ No
5. Does or will the appliwnt or present or future building occupant reQuire for
the work which is the subject ot this application a permit for such construction
or modification from the South Coast Air Quality Management District or from
any other air polWtion contml disMct or agency? ❑ Yes ❑ No
(Section 658502 ot ihe Califomia Govemment Code requires that the requestetl
information be fumished on applications for nomresidential building permits�.
6. Will any part of the faciliry to be constructed under this permit be within
1000 leet from the outer houndaries of a school? ❑ Yes ❑ No
(If "yes", the /acility must meet Ihe requirement of Sections 25534 and 42303
of the Califomia Health and Safery Code).
7. If a permit from Ihe South Coast Air Quality Management District or other
air pollution conirol disUict or agency is requiretl for the work which is the
subject of this application, have all of the disclosures prescrihed by Califomia
Health and Sa(ely Code Section 42303 been made? ❑ Ves ❑ No
8. (I('yes", attach certificate of compliance (rom the appropnate air polNtion
control oKcer�.
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
information given above is correct. I agree to comply with all state laws antl
city ordinances regarding Hazardous Materials and Emissions.
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penally o( perjury Ihat I have read Ihis application and state that
the information given is covecL I agree to comply vnth all state laws and ciry
ordinances relating to building consWction, and authorize represenlatives of
the Ciry of Costa Mesa to enter upon the above-described propeny for
inspection purposes. I agree not ro occupy or allow occupancy of any building
authorized by this permit until fnal inspection.
naWre ol I Own Date
Signalure Date � ��-.�,�. (�^ y �-J9
305]�a6 (3/0�) qrypp�'p�Npryi¢d qpplirant OaL R�q
�.
PPLICATION FOR A BUILDING PF �T
Tract ��� I� I Block I Lot / U
Atl0�e55 � � � Z % ��%(/ �'/J( . //
ClO55
Area Street
Owner .{�V ;/Q/' f / v � i%��'_�•
/�
Atltlress � 3 � 3 � /��,�S�u,�
CItY ��5� ��Jc� ZiP9'162� Phone
Archltect/
Designer LiG¢ns¢ No.
Aatlress
CitY ZiP Phone
« Englneer� Licanse No.
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� LICENSED CONTRACTOR'S DECLARATION
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m I hereby aftirm that I am licensed untler provisions ot Chapter 9
S (commencing with Section ]000 ot Division 3 ot the Business and
w Professions COdu ntl my license Is in iull force antl e4tecH. �p
� License Clas �� License Number � �_L--
a Date 2-�4�X� Contractor ��9eil ��• W J/Q�
E Address �OZ4 /�haluro,.� G-
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j� CitVanAZiP `���` /��f4 �ZGL6 Phone �'
� CONSTRUCTION LENDING AGENCV
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� I hareby aftirm that there is a consbuction lending a9ency tor the
a performance ot the work for which this permit is issuetl (Sec. 3097,
' Civ. C.1.
y Lentler's Name
� Lender's Address _
� OWNER-BUILDER DECLARATION
:' I hereby affirm that I um eaempt trom the Conttactor's licanse Law
� for t�e following reawn:
❑ 1, as owner of the property, or my employees with wages as their
� O sole compenwtion, will tlo the work, antl ffie shucture is nat
�t„ intended or oftere�i tor sale.
3 ❑ 1, as owner of ffie property, am exclusively conSracUng with
licensetl conVactors to consbuct the prolect.
�d,. ❑ I am ex6mpt under Sec. , 8&PC for this reason
N
a Dat� Owner
E WORKERS'COMPENSATION DECIARATION
� I hereby affirm tha[ 1 have a cer[ificate Of consen[ m self�insure,
or a certiticeto oF Workers' Coinponsation Insurance, or a certifietl
C copy thereot
� Policy No, �vS �. ZV Company .ST�iTL /-� f�
�a Certified copy is hereby fumishetl.
6 Certifietl copy is filetl with Oran Coup y, EM
a Date 2_r9_�r Applicant_ ���- ��
CEfl71FICATE O�EXEMPTION
FROM WORKERS'COMPENSATIONINSURANCE
(This sectian neetl not be completed it permit is far $100 or less).
I certity thet in the Farformance of the work for which this permit is
issuad, I shall not employ any parson in any manner so as to become
sublect to the Workers' Compensation Laws of California.
Data Applicant
NOTICE TO APPLICANT: It, after making_ this Certificate of
Examption, you should become subject to the Workers' Compensa[ion
provisions of the labor Code, you must torthwith comply with such
provisions or this permit shall ba deemeA revoketl.
I CERTIFV THAT I HAVE READ THIS APPLICATION ANO STATE
THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO
COMPLV WITH ALL COUNTV ORDINANCES AND STATE LAWS
RELATING TO BUILDING CONSTRUCTION, AND HEFEBV AUTH-
ORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON
THE�ABOVE MENTIONED PROPERTV FOR INSPECTION PUR-
Pos%���,,.�. z��.�� a-ig-,�i
Siqnatur ot Applicant or Agent Date
Poqe,- i�. cati..rr�P, 3�0 �'
Print pplitant's/AgenYs Name
All spaces within this box must ba completed to process
CMF 0335-46 (BV48) rev. b/80
BUILDING PERM�T NO
v / �� /
T e of Project: ❑ New
❑ epair ❑ Convert
A.P.
Zone
SbuCE No.of
Height Stories
Park Fe¢S Ves
RequireC No C T.
Zoning Approvetl By:
Misc.
Proposetl U5C
of Structure
Occ. Type
Class Const.
USE/OCCUPANCV
1.
2.
3.
G.
iotal valuation
=ncroachment Permit I
Gratlin9 Pml.
Requiretl ❑ V¢s
Rou9h G�a�ing
Structural 5
Electriwl E
Plumbing E
Mecha WI $
Pre- atle S
Insp ction
Pr Gratle s
R c. No.
Plan
CheCk By:
Electrical W
Permlt No. C
6
Plumbing ��
Permit No. �p
Mechanical 1
Fermlt NO. d
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❑ Alter � Atltlitlon �
DCmo LI Oc[upancy Pmt.
Sup. DisL/
Insp. Area
SPI. PmL No.
Date
Vear
SIZE SQ. FT.
�d ❑ ves ❑ o
GraOinq
No Pmt. No.
oate
PERMIT FEES
Plan Check a
SPetial s
Invest.
Permit E
Issue
Issuance
Approvetl:
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y�iOWNER WILISAA6, Charles E.
JOB ADDRESS 33$3 Larkspur Street
GENERAL CONTRACTOR pwner�Bldr
, zAP No.l�.]'2_],$Q_5$ LOT TRAC'
jINSPECTIONS Si nat
SOIL
�GNS
�WATER
ROUGH PLl1MBING
PROP. $WR. LINE Q HOUSE CON.�
SPRINKLING SYSTEM
MISCELlANE0U5
ROUGH HEATING ANO AIR CONOITIONING
TEMPORARV SERVICE OR POLE
UN�ERGROUN� � POWER �
ROUGH WIRING
iRENCHES � FORMS STEEL REINF. � ��
FLOOR SYSTEM
BONO BEAM � STEEL REINFORCE
SHEATHING
FRAME AND FLASHING
LATHING - IN �I OUT
PLASTER, BROWN COAT
STRpCTURAL,FINAL
MEATING, VENT., REFRIG. AND A.C., FINAL
PLIIMBING, FINAL AND GAS TEST
ELECTRIC, FINAL
BWL�ING_ FINAL �. /'
DATE
SUBCONTRACTOR
ERMIT N0.
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' COSTA MESA BUILDING-SAFETY DEPARTMENT
� P.O.BOX1200 COSTAMESA,CALIFOHNIA92626
For Applicant to Fill in Completely - Use Ink� Onl
BUILDING• �� L�
ADDRESS
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CONSTRUCTION
BRANCN �
ADDRESS
ARCHITECT TEL.
ADDRESS
CONTRACTOR Q(J/,J�R 'J�I L.1.JCV �
ADDflESS
TEI.
CITV NO.
STATE � CITV
�IC. NO. LIC. NO.
OF LOT /��� ��G INOWONLO S, J
USE OF ,,�^
EXISfING BLDG. �O V' 1 E
Separate permits are required for �
electric; �plumbing and heating work. .
I haraby ecknowled8e thet I have reatl this application antl stata
that the above informetion is correct entl agrae to comp�y with
all laws re0ulatlnB building consvuction, and I shall not employ
any person in violation of Me workman's compensation lews of
the Stata of California.
I hereby certlfy that 1 am properly Iicensatl es a contractor under
ihe Siate of Callfornie Business entl P�ofesslons Cotle, Divlsion 3,
Chapter 9, and thet such licenses are in full force antl atfect, or I
am exempt fr m tha rovisions of the State of Californie B�siness
and Professi Code, IviSion 3, Cha ter
P
Sle�ature of (7�\ \
Pe�mlttee � LhA . \ �J
Authorizetl Ageni
FA i C� x ;; � rt irk
SFV -7_-75cr;;�00 052-� 5.50
)N. FOR STRUCTURAL PERM[T
DATE RECEIVED ncTF iscucr
TRACT '
N W ADD A R
OWNE [3C
SE a �
FIFE
ZONE
APPqOVED
BV
ZON NO.OF
PLANS �
VARDS APPROV ED
VALUE
USE OF N
BUILDING /1_�a �pn
/2
VARDS APPROVED
ACCESSORV BUILDING
FT
OISTANCE BET. BET. MAIN
MAIN BLDGS. ACCESS. 8L
VAR.� DATE
C.U.P.# _ APPROVED
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AMOUNTSHOWN VNDER VAIUATION IS FOR m
THE PURPC6E OF E5TABLISHING A PERMIT FEE ON
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VALUATION PERMIT FEE $ a
� N -
PLAN CHECK $ "�
0
$ �. TAX S L. LL
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� TOTAI_PAID $ � �
OWNER W�L�IAMS, Charles E.
� JOB ADDRE55 Larks ur Str +
�GENERAL CONTRACTOR Owner E31�
AP No. 412-182-58 LOT i rt�
INSPECTIONS Si
y SOIL
' g cns
�W ATER
ROUGH PLUMBING
PROP. SWR. LINE Q HOUSE CON. �
�SPRINK�ING SYSTEM
MISCELLANEOUS
FOUGH HEATING ANO AIF CONOITIONING
TEMPORARV $ERVICE OR POLE
UNOERGROUNO � POWER �
ROUGH WIRING
TRENCNES FORMS STEEL REINF. �
FLOOR SVSTEM -
BONO BEAM STEEL HEINFORCE i
SHEATHING
FqqME RNO FLqSHING �
LRTHING - IN OUT
PLASTER,BROWN COAT
STRUCTURAL, FINA�
NEATING, VENT., REFRIG. ANO A.C., FINAL
PLUMBING. FINAL ANO GAS TEST �I
DATE 12—I5-75
SUBCONTRACTOR
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
BUILDING � � � (^��n'^ �] S `
ADDFESS I�I r����
i.) 1 i . . .1 .
OWNER
MAIL
CITV � OS %
CAN5TRUCTION
BRANCH
ADDRESS
ARCHITECT
CONTRACTOR
ADDRESS
CITV
STATE
LIC. NO.
SIZE
OF LOT
USE OF
3
5 %
NOL �I,S/ d
TEL.
TEL.
NO.
CITV
LIC. NO.
INO. OF LB�DC'�.5.
NOW ON LOT
Separate permits are required for
electric, plumbing and heating work.
USE OF BUILDING AND WORK TO BE PERFOFA
J
PG1U
oFr. �5-75�„�,_00 SSF,� �-�*�*5.50
APPLICATION FOR STRUCTURAL PERMIT
RECEI� DATE FECEIVED DATE ISS ED
� /2-15u
(/ �.-i. PERMIT NO.
A.P.NO. ��� � I�J.�.�
BUILDINO •�'7�� �A
ADDRESS J
TRACT 7�I]j
�
OWNER
VALUE
FIRE
20NE
APPROVED
S
ZONE I, NO.OF USE OF NEW�- c
� PLAN$ -� BUILDING iT�L T L��Ci
YARDSAPPROVED �'AflDSAPPROVED
MAIN BVILDING AGCESSOFV BVILDING
VAR. #
C.U.P. #'�
A�PPROVED f�.��"
I hereby acknowletlge thet I heve reatl tnis application and state
that the ebove intormation is cor�ect antl agree to comply with
all laws regulating building construction, antl I shall not employ "
any person in violation of the workman's compensation laws of
the Sxate ot California. .
1 hereby certify xhat I am properly Iicensetl as a contractor untler' SQ. Fi
tha State at California Businass antl Professions Code, Division 3, THE AMOUNT:
Chapter 9, and that such licenses ere in full force and ettect, or I 'THE PURPOSE OI
am exempt from the provisions of the Steie of California Business VALUATION
antl Professfo Cotl Division 3, Chap(t�er 9.
Sipnacureo��� �` \ \�\� � �
Permlttee ��BJ\ n \.J ?.yJUo�n...11 S Q�
Authorized ABent .
BET. MAIN &
ACCE55. BLDGS.
�ATE
APPROVED �
ncrc �.� .-/s'.'
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"ABLISHING A PERMIT FEE ONLV: �
PERMIT FEE $ �1 `�
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PLAN CHECK $ �— ^�
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TAX $ ' � �
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TOTALPAID $ � O
OWNER gpBEKC NOVIELLI DATE 2/19/81
JOB ADDRESS 3383 Larkspur Stx BUII -� PERMIT N0. 51381
GENERAL CONTRACTOR RDc1er D. N tlex DESCRIPTION of WORK n Addition
APNo. 412-182^58LOT 104 TRACT 7718 FIRE ZONE VALUEE 7,530.00
GAS
ROWH PLlIM81NG
PPOP. SwR. LINE [� HOUSE CON.
SPPINKLING SVSTEM
MISCELLANEOUS I:AT��. ���
W:[�1:1�19L'<�bP.UI�R�IIIC[tl
POwER
� ROUGM WIRING
� TRENCHES FORMS STEEL REIN�
ro FLOOR SYSTEM
� BONO BEAM � STEEL REINFORCE �
� SHEATMING
FRAME RNO FLASHI! !
N LATHING — IN OI/T �
� PLASTEfl, 6ROWN COAT
aSTRUCTIJRqL, FINRL
HERTING, VENT., REFRIG. RNO R,C., FINAL
PWMBING. FINRL ANO GAS TEST �]
ELECTRIC, FINRL
BUILOING, FINRL
SUBCONTRACTOR
IN �� zi`i§iei
66.53
COSTA MESA BUILDINGSA. I DEPARTMENT APPLICA'fION�t �TRUCNRAL PERMIT "''
P.O. BOX 1200 COSTA MESA, c:ALIFORNIA 92626
REC BY PERMIT *jp 51381 �
For Applicant to Fill in Completely — Use Ink Only m i��
.BUILDING ^� Q'7 A.P. NO. '- `.CJ �s
ADDRESS � J l% J �- ��5�
OWNER OR / � / ADIDRE55 33d�3
TENANT n(� l�Q,-� /{/U (I( Q
UNIT OR
MAILING � w�G SPAGEN .
ADDRE55 iT TR.NOl � LOT l� BLK.
CITY
VCl (F �1G NOL b' O �
NEW ADD ALTER REPAIR MOVING DEMOLISH
CONSTRUCTION
LENDER
BRANCH • _ IIA r
OWNER ���
ADDRESS ALUE J^
ARCHITECT TEL. USE ��j(�� � S 7 S J
OR ENGINEER N ��,� �J
ADDRESS 20NE � TVPE V GROUP � J
APPROVED
CONTRACTOR Q ✓ BV DATE � ��
ADDRESS a�2 /�C� G/' G�i
TEL.
CITY � j�, NO. - ��
^A APPROVED SETBACKS
L C NO. �- 3 2, �' LICVNO. O+/��'
SIZE NO.OF BLDGS. (FROM CC[� $TREET)
OF LOT (� Q NOW ON LOT ONT�.�] i Fr.
USE OF /� �
EXISTINGBLDG. pl`�'
Separate permits are required for �. sioe FT.
electric, plumbing and heating work. ''')
REAR l FT.
USE OF BUILDING AND WORK TO BE PERFORMED P�ANNING ACTION �
� � OATE
APPROVED -
fPP�'w° 2L 1�t
I hereby acknowledge thet I hava reatl this application antl stata
thet the ebove information is correct and agree to comply wlth
all laws reguletinB building construction, �entl I shall not employ
any parson in violation ot the workman's compensation lawe of
the Stata ot California.
I hereby certity that I am proparly Iicensetl as a conttecior untler SQ. FT.
tha State af Celifornia eusiness entl Protessions Code, Divlsion 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chaptar 9, and that such licenses are In full force entl affect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV:
am ezempt from tha prov7sions ot the State of Californla Business
and Profassions Cotla, Division 3, Chapter 9. VALUATION PERMIT FEE S � ��
Signature of !^l / �p//q s/7 �r PLAN CHECK S Z� 0�
Perm�`tiee � /� .G./. �Ll�iwi(1'/A $ / .\ �� TAX $ O• S3
2_�q—�'I `� �
Authorizad Agent Date TOTAL PAID $ •� S3
TL
104 �
. ,• 35127
' COSTA MESA BUILDING-SAFETY DEPARTMENT
SOZB P�O. BOX 7200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fi!l iri Completely •
BUILDING � ���Larksnur Street
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CONSTRUCTION
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ARCHITECT
OR ENGINEER
ADDRESS
CONTRACTOR
ADDRESS
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STATE
LIC. NO.
SIZE
Of LOT (Q :
USE OF
EXISTING BLIX'i.
TEL.
NO.
L.
TEL.
"o. 986
CITV
LIC. NO. B
INO. O LF B�DG>.
NOW ON LOT
RV �(/<.J
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A.P. NO.
BUILDING
AD�RESI
FIRE
ZONE
APPR
PAI�
"iliG 15-72cnsn��1052'� r•x�14Z.s5
4TION FOR BUILDING PERMIT
V DATE RECEIVED DA ISSU
� � � / _
PERMIT NO.
TRACT
ZONE NO.OF
� PL4N5 C
VARDS APPflOVED
MAIN BUILDING
(FROM GL STFEET)
BLOCK
DATE
VSE OF NEW S�/U F' D U
BUILDING (v, � �y/�
. �� �
VARDS APPROVEO
H SIZE OF N0.9F �
Z NEW BLOG 1740 ROOMS STORIES 1 L. SIDE FT.
a EMERIOR WALL ROOF ' Qd ^ / T
V COVERING COVERING REAR dl�`FT.
J USE OF BUILDING AND WORK TO BE PEFFORMED DISTANCE BET. BET. MAI
n' MAIN BLDGS. ACCESS. I
a
Q VAR.# - • OATE
� e m' d ellin c.u.P.# APPROVE
� APPROVED ���1
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VI hereby acknowledge tnat I have reatl this application antl ste�e �-jOj,j) FOR SP[CIAL RE ,
� that tha above intormation is correct and a8ree to comply with
� all laws regulating builtling consttuction, antl I shall not employ
F any person in violation of the wOrkman's compensation laws of
&
STqTE
y. the State of Calitomia. �
zI hereby certify that I am properly licenud as a conttactor under SQ. FT. o 0
, cne State ot Caliiomia Business antl Protessions Code, Divisicn 3, THE AMOUNTSHOWN VNDER VALUATION IS FOR
Chapter 9, and that such licenses are in full force and effect, or 1 TNE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV: m
am exempt from the provisions ot the State of California Business ¢
and Protessions Cotle, Division 3, Chapter 9. ' VALUATION 0+�%,� y
PERMIT FEE $ � �
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SiB�ature of , / e� m
Perminee � ` � �_ D. DOWRS $�� I� PLAN CHECK $ � E
� fYp `o
Authorizetl Agent� � ` / �— LL
TOTAL FEE $