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HomeMy WebLinkAbout3063 TYLER WAY - Building Permits • CITY OF COSTA MESA BUILDING DIVISION > • .. ,I DEVELOPMENT SERVICES DEPARTMENT P RMIT NUMBER Ire. PERMIT B06-01889 � (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.SIIULDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 3063 TYLER WY -- Status: ISSUED Suite: )� rl- �, -/ F,,,_ Applied: 11/09/2006 Vicinity: I I � ,-"`1 Issued: 12/14/2006 Primary Occ: R3 r Type of Constructions'_:�" Parcel Number: 14160454 4. �, Jonir--a R1 Applicant: LINDA SCHILLING411. / Address: 3063 TYLER WY '. Phone: 714.557.7251 ISSUED BY: a. COSTA MESA,CA Zip: 92626 Owner SCHILLING, STEVEN J Address 3063 TYLER WY Phone: 714-557-7251 COSTA MESA,OA Zip: 92626 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 000000 Arch : JAMES ROBINSON Eng: Address: 151 KALMUS DR Address: SUITE 151 Phone: 714-751-0492 Phone: COSTA MESA,CA Zip: 92626 License: 05286 License: SCOPE OF PERMIT ADD 778SF AND INTERIOR REMODEL OF A SINGLE STORY SFD.752.50SF MASTER BEDROOM AND MASTER BATHROOM AT THE REAR OF SFD AND EXTEND THE FRONT ENTRANCE BY 25.50SF,CHANGE DINING ROOM WINDOW TO A SLIDING GLASS DOOR AND INTERIOR REMODEL OF SFD. PLANNING: • LOT SIZE=8,048 SO.FT. • RESiDENCE=2,084 SO.FT. GARAGE=430 SQ. FT. DRIVEWAY=532 SQ.FT. LOT COVERAGE=3,046 SO.FT.(38%) REAR YARD COVERAGE=550 SQ.FT.(23%) FEE SUMMARY • Plan Check: $518.54 Calc Valuation: $71,887.20 Permit: $797.75 Claim Valuation: So.00 SMIP Res: $7.19 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 • Total: $1,323.48 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 12-0 Rear 10-0 Left 10-0 Right 5-0 ACCESSORY Front 0-0 . Rear 0-0 Left, 0-0 Right. 0-0 PARKING Existing: 4 Required: 4 Proposed: 4 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 expirati. of this permit. e FOR INSPECTIONS CALL: (714)754-5626 - 2446-46(8W00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: .I I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Cartier: Policy Number: is section need not be completed It the permit Is valued at one hundred dollars($100)or less.) -IR_.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 shoal•beco(ne subject to the workers'compensation provisions of Section 3700 oft e Labor Code,I shall forthwith comply with these pr Islons.��//� d / �oO 'Applicant Signature: (l C.. l�` `� j�f rDatoi'��/�� -WARNING:FAILURE T E RE WORKERS'COMPENSATI• COVERAGE IS :L'Tj' `r SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND DUlL FINES UP TOONE HUNDRED 71. THOUSAND DOLLARS(5100,000).IN ADDmON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full force and effect.Lie.a_ Class a Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commenting 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 ects the applicant to a civil penalty of not more than five hundred dollars($500).): 1,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. C-- 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work ' himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I.as owner of the property,em 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,exe t and sec. i / Business and Professions Code for this reason: I`nature. r A. a iV vim'%l. - t Expires:it/as/O7 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 then 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 e permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). _ .._ _..______._..___�____...._.._._ _ _._____..__._______.—N__-_ _ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes 0 N (Section 25534 of the California Health and Safely Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP Is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a_pgorermit for such construction modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? PI Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 if a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If'yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: _..- CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-d gibe property for/Imre• u "see.I agree not to occupy or allow occupancy of any building authorized by this permit unlit final in„sspect�on. CCOeC-.CC _. /6/44/0 60 ” Signe a Of Legal Gate_ _ And/Or Authorized Applicant Date LODE I INSPECTION Tr% gaff, INUHALH LODE I INSPECTION TYPE gra EOM 1816 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Signm i 222 Final Be 6/248 204 Final Demolition 250 Final Building/Occupancy • 12-14-2004/W:S.. 41 J USER. 001-001'67452 - NEWPORT-MESA•UNIFIED SCHOOL DISTRICT N° 6341 CERTIFICATE OF COMPLIANCE OF DEVELOPMENT FEES K PURSUANT TO AB 1600 AND AB 181 To: (I City of Costa Mesa District Receipt No. ( ) City of Newport Beach ( ) County of Orange Plan Check No Applicant: v^ L I n d a- C . SC,H ft t r�cl e �Co-01g��I Address: k So 41 3 lly�j��jL ie a ,/ V ea r/9 /77 -.SA 2fl,& 4 [ C l , Telephone Number: `1l `� Tract/Parcel and Lot Number(s): Location of Project: Number of Square Feet ofa_a _ 7723 Residential Space x $1.84 Total 1q3( Commercial and Industrial Space x $.30 Total Commercial/Industrial Project is: (Check One) Warehouse _ Motel _ Preschool R 8 D _ Bank _ Auto Repair Movie Theater _ Neighborhood Shops _ Hospital Mini-storage Racquet/Health _ Large Office Heavy Industrial _ Hotel _ Office Bldg. Regional Shops _ Medical Office _ Restaurant Light Industrial _ Office Park _ Fast Food This project is exempt because This certifies that the above-named Developer/Applicant has paid school facility fees in compliance with Government Code sections 53080 and 65995. The Building Pemits for this square footage in this proposed development may now be sued by your jurisdiction. Checks are to be made payable to Newport-Mesa Unified School District. I By: — � Author ed Representative The above representation as to square footage is true. Applicant agrees that if it is later determined that such representations are not true,then this�certificateshall automatically terminate and the appropriate City/County shall be notified. Date:1V enE1C_- • 14 2AO/ a i • 113e. CITY OF COSTA MESA \ BUILDING DIVISION • 4; �I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 1. 1 11 r PERMIT 606-01459� �.#6 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesaStLeCTRICAL PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 3063 TYLER WY Status: ISSUED Suite No Applied: 12/14/2006 Vicinity: l/j /M ! / V Issued: 12/14/2006 1 u � Parcel Nunmber: 14160454 L, /:....). Applicant: SCHILLING, LINDA Address: 3063 TYLER WY Phone: 714-557-7251 ISSUE Ve-�- COSTA MESA,CA Zip 92626 �� Owner: SCHILLING, STEVEN J Address 3063 TYLER WY Phone: 714-557-7251 COSTA MESA,CA Zip: 92626 Contractor: OWNER-BUILDER Address: Phone: Zip: License:000000 SCOPE OF PERMIT ELECTRICAL PERMIT TO ADD 778SF AND INTERIOR REMODEL OF A SINGLE STORY SFD. REF#:B06-01889 WORK TO INCLUDE:25 LIGHT FIXTURE, 19 OUTLETS, 13 SWITCHES, 1 SERVICE TO 200 AMPS, 1 SUB PANEL TO 200 AMPS,AND 1 LOW VOLT WIRING. FEE SUMMARY Quantity Quantity ' ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft $0.00 0 Res.a/c package $0.00 Standing Section $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0 Lighting Fists $25.65 25 up to 50 kva/kw $0.00 0 Recept Outlets $20.90 19 up to 100 kva/kw $0.00 0 Switches $14.30 13 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $18.20 1 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $30.50 1 Misc.Conduit $0.00 0 Service to 1000a $0.00 0 Misc.Conductor $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1 hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $30.50 1 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 $163.55 Intermed Pole $0.00 0 • COMMENTS /SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related 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 codesrand all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration ofrmit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(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 self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued, My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed ll the permit/s valued at one hundred dollars($100)or less) I certify that in the performance of the work for which this permit is Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of C tom's',and agree that if I sh uld become subject to the workers'compensation provisions of Section 3700 of the Labor e,I shall forthwith comply with these p o ns. A Applicant Signature: (V/ (.77/76.— l ��LhrF, Date: / 2//V 2c)C7 CD WARNING:FAILURE TO SECU WORKERS COVERAtf AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100, ),IN ADDITION TO THE T OF COMPENSA GES AS PROVIDED FOR IN SECTION 906 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business end Professions Code,and my license is in full force and effect.Lic.If Class M Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant fore 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 exam under sec. .— Business and Professions Code for this reason: Si nature: -14.4.‘,C— A1" "Mr ....' � xpires: _a_4_547._ Verification of Ownership by(type of docnt,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL.SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2.Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does o❑ r will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? B 0 No (Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No __ _._....._..._ or w_.._........._..___ _._._ __ -._ _ . 5 Does or will the applicantsAiru lity or n building occupantm require for the woe which Is the subjectage of this a YesManagementdistrict �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). AirQuality.._.__.___..._ ..___._ _ —.. _ __...._._ ..-_.... ..._e._ _ 7 Ifa a ication from Nl South Coast reManagement Di Heal or ectdistrictisprescribedCalifornia Safety Code Section 42303 been made? 0 Yes 0 No _ __ __ i._ _ ___.._...__._,. ...._._ 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 end state that the information given is correct. I a ree 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 abov ibed property for Ins tion pu .1 agree not to occupy or allow occupancy of any building authorized by thts rmit unti final inspection. `/ 16/''7/)CooCo Signal Legal Date And/Or Authorized Applicant Date CODE# INSPECTION TYPE PAIL IIIImd15 CODE# IRSPECTIQNTYPL 12Erl Pint LS 1616 PSystem Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 5121$ -E 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval u 203 Final Sign 222 Final Site 204 Final Demolition 250 ' Final Building/Occupancy • CITY OF COSTA MESA 4 BUILDING DIVISION • „,,,'Me: 4r DEVELOPMENT SERVICES DEPARTMENT P MIT NUMBER v. 41PERMIT '� M06-00836 ~` (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT V-3 Job Address: 3063 TYLER WY (_\ status: ISSUED Suite No '�J Applied: 12/14/2006 Issued: 12/14/2006 Vicinity: Parcel Number: 14160454 • `� Y. Applicant: SCHILLING, LINDA Address: 3063 TYLER WY Phone: 714-557-7251 COSTA MESA,CA Zip: 92626 Owner: SCHILLING, STEVEN J Address: 3063 TYLER WY Phone: 714-557-7251 COSTA MESA,CA Zip: 92626 Contractor: OWNER-BUILDER Address: Phone: Zip: License:000000 • SCOPE OF PERMIT MEHCANICAL PERMIT TO ADD 778SF AND INTERIOR REMODEL OF A SINGLE STORY SFD. REF#:806-01889 WORK TO INCLUDE: 1 REPAIR/ALT COOLING/HEAT, 1 GAS PIPING, 1 HOOD W/MECH EXHAUST,AND 2 VENT FANS. FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $0.00 0 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $13.70 1 Evaporative Cooler $0.00 0 Inst/Rep.Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping $6.15 1 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 $10.65 1 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct $14.50 2 Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers Fire Dampers $0.00 0 Up to 3 hp $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater • $0.00 0 Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $68.50 COMMENTS /SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(600) ®' 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,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. My workers'compensation Insurance carder and policy number are: Cartier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars(5700)or less.) 1 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 ifomia,and agree that if I sh Id become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with the Ee p ons. n /"��'n('� �y z/ Applicant Signature: / ;;,/4 (EµC r EB�J-L= Date: /a/� //2-00:� WARNING:FAILURE T WORKERS'COMP ON COV Y AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADOPTION TO THE OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is In full force and effect.Uc.If Class It Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county Which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit sjects the applicant to a cMl penalty cf 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 Cade: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 Cade: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 =ws.). I am x I under c. _ Business and Professions Code for this reason: Ignatu HI �-����� - Date: /o2//1710(a / Owner ID ye ed by drivers license. Yes 0 + Driver's License No. Il� /f/15 d 7 Verification of Ownership by(type d docu ent,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 notod 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 orr future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). .._._. ._....._...___._..........._..___._._. _ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 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 acutety 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 end pressure). appl ___ _ _._ ._ ...._ __ 3 ❑Yesr will the applicant or present or future building occupant need to prepare an RMPP(Risk Menagoment and Prevention Program for acutely hazardous materials)? No (Section 25534 of the California Health and Safety Cade provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If en RMPP Is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 0 No (Section 65850.2 of the Califomia Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑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 abov es bed property for Ins ti u .I agree not to occupy or allow occupancy of any building authorized by this permit until final i ction. C- r /2//v/c 6. C—...--". Signatur Legal Own Date And/Or Authorized Applicant 1 Date FORE I INSPECTION TYPE PAIS Ionia CODE I INSPECTION TYPE 5/gdg� 401+21., 1616 Fixed System Final Fire Prevention 206 Final Mechanical (/�—/J 1266 Pool Spa Final _ 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final BIocklRetaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval ' 203 Final Sign 222 Final Site 204 Finei Demolition 250 Final Building/Occupancy • • �- CITY OF COSTA MESA BUILDING DIVISION . : 7 ..� DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER F tPERMIT 444*PJoamw°`' 1706-01040 (714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 3063 TYLER WY Status: ISSUED Suite No r Applied: 12/14/2006 ii.....5? Issued: 12/14/2006 Vicinity: ,LS4--_. Parcel Nunmber. 14160454 Applicant: SCHILLING, STEVEN J g '4� ISSUED BY: Address: 3063 TYLER WY Phone: 714-557-7251 COSTA MESA,CA Zip: 92626 Owner: SCHILLING, STEVEN J Address 3063 TYLER WY Phone: 714-557-7251 COSTA MESA,CA Zip: 92626 • Contractor: OWNER-BUILDER Address: Phone: Zip: License: 000000 SCOPE OF PERMIT PLUMBING PERMIT TO ADD 778SF AND INTERIOR REMODEL OF A SINGLE STORY SFD. • REF#:B06-01889 WORK TO INCLUDE: 1 DISHWASHER,2 ROOF DRAINS,1 SHOWER, 1 KITCHEN SINK, 1 WASH BASIN, 1 WASTE AND VENT SYSTEM, 1 WATER CLOSET AND 1 WATER RE-PIPE. 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 50.00 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) 50.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $9.80 1 Dishwasher $9.80 1 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain,Flobr $19.60 2 Sewer Connect $0.00 0 Waste and Vent System $9.80 1 Drain,Rainwater $0.00 0 Sewer Private Line $24.65 1 Water Closet(Toilet) $9.80 1 Drain,Roof $0.00 0 Shower $9.80 1 Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $9.80 1 Gas Earthquake Valve $0.00 0 Sink,Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) ` ' $0.00 ' '0. Sink,kitchen $9.80 1 Water Softener $0.00 0 Gas(Over 4 outlets) `. , $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $136.35 COMMENTS/ SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned. for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable c , 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 2446-66(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 self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which This permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'compensation Insurance carrier and policy number are: Carver: Policy Number: (This section need not be completed it the permit is valued at one hundred dollars($100)or less.) jm�I ertify 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 Cal a,and agree that If I ul osubject to the workers'compensation provisions of Section 3700 of thethLabor Code,I shall forthwith _co 'Si;ith.these- ` ome � 1!i9,s N� /9-/V 0 Ap IiSi9nature: �- /.tC� - Date:= WARNING:FAILURE TO SECUR ORKERS'COMPENSA COVERAGE I N D I SUBJECT ANEMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,000,IN ADDmON TO THE OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.tic.# Class# Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil 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 t0 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. R 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,end who contracts for such project with a contractor(s) --_-licensee pursuant to the Contractors License Laws.). Lam axe ?ender sec. Business and Professions Code for this reason: -. = %c plan l' /� expires:= 3S O 7 Verification of Ownership by(type of doc ent,i.e.-prape y : bi •r deed)1 F% DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). __ __ _ _ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the Califomia Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this a plication apermlt 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 IJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑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 ❑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 prop for Inspection. •t y es.I ea not to upy or allow occupancy of any building authorized by this per it inAl il fiDenssppection. Signature_OL :,. Owner -., (Date-'—'-- - a.. lr And/Or Authorized Applicant Date CODE t, INSPECTION TYPE QM IMALS QOM# INSPECTION TYPE. RAIL 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing r/2_/8 200 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 MAIRY -_ _ _ From: BOUWENS-KILLEEN, WILLA Sent: Tuesday, May 06, 2008 12:41 PM To: WEIDENKELLER, MARY JANE Subject: RE: B06-01889 13063 Tyler Way Go ahead and delete it. Thanks! Willa From: WEIDENKELLER, MARY JANE Sent: Tuesday, May 06, 2008 12:18 PM To: BOUWENS-KILLEEN, WILLA Subject: B06-01889/ 3063 Tyler Way There is a Final Planning Approval requirement on the Inspection Screen for this addition. Can you please tell me if this has been done or can the requirement be deleted? Thanks, Mary Jane Weidenkeller Office Specialist II City of Costa Mesa 77 Fair Drive,Costa Mesa 92628 Ph(714)754-4871 Fax(714)754-4856 mweidenkeller of�ci costa-mesa ca us Costa • ktee . :.a1,Y M i►. ,4R 2220--NJ RICHARD LUIZ Sup D/TqOS 5071 LOYOLA AVENUE v/sip�q WESTMINSTER, CA 92683 Report • • _ of Specia"ll Inspection • P:exec; Fame & Address SCa\ �� ±o L, —' OIIA CcCpc..-lycsr M e ?. Nu.mber ao — 02-1-13 !aspect:on Types)) Cunite t nspe:.ion Date(s) a I—O£'1 [ ) Periodic [ XXX 3 Continuous D:scrib: In cetion Made, including Locations: Ins•ection of the Swimmin. @ the above address on 3.—\ 1 • :s'. Tess Made: CE "' `" _ Q ri.74, Will (T1>C 4& 0(�eN !/V `oal Inspection 'lime Each Day: Date Hours I 4, t/L. I _ !'.e^.; Requiring Correction, include uncorrected items previously listed tn.,: best of my knowledge, the work inspected was in accordance with the Building Departmen1 r.provee design drawings, speciicatio and applicable workmanship provisions of the U.B.0 as noted above S:gn:d. Date I . C. B4O. B Fu!! Namc: Richard T. Luiz Registration No. 1075691-49 Concrete FORM $1.07.3C 28 CITY OF COSTA MESA • 4 " BUILDING DIVISION ..�I DEVELOPMENT SERVICES DEPARTMENT P RMIT NUMBER F t PERMIT S. � P03-00832 itt*Pangnsil(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT • Job Address: 3063 TYLER WY Status: ISSUED Suite No Applied: 12/19/2003 Issued: 12/19/2003 Vicinity: Parcel Nunmber: 14160454 ISSUED BY: v� Applicant: LISA ZOSCZK Address: 24512 BRIDGER RD Phone: (949)859-8466 LAKE FOREST,CA Zip: 92630 • Owner: SCHILLING, STEVEN J Address 3063 TYLER WY Phone: COSTA MESA,CA Zip: 92626 Contractor: SWAN POOLS OF SOUTHERN CALIFORNIA Address: 24512 BRIDGER RD Phone: (949)859-8466 LAKE FOREST,CA Zip: 92630 License: 440333 Arch / Eng: Address: Phone: Zip: License: SCOPE OF PERMIT INGROUND GUNITE POOL&SPA(494 SO.FT),FIREPIT,AND FUTURE BBQ.B03-02173.HEATED POOL AND 1 GAS OUTLET. 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 $60.75 1 Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System „ $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 • Wash Basin $0.00 0 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain,Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0 Drain,Roof $0.00 0 Shower $0.00 0 Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 244646(6/00) DECLARATIONS 1 WORKERS'COMPENSATION DECLARATION. I hereby affirm under penalty of perjury one of the w„owing 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. 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 w r�ers' pMoe ation In rance carrier and policy number are: Carrier: cJI Wil%t'W IN Policy Number: /1(`[W 7 0 Q i I (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) J ❑ 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 o California,and agree that If I should be ome subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with thes pr ' i n ,,,///��� ��/ ` ,tQ �? Applicant Signature: YAt� / Date: l d 1 1 `-' J WARNING:FAILURE TO SECURE WORKERS'CO NSATION 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 affirmee thatt.Liam lice ed under ovjsioIls o (commencing with Section 7000)of Division 3 of the BusinpBs x o> s, p,and my license is in full force and effect.Lic.# ,`�Qy'[y�-"Jf iJ/7 Class# ( In`F'zi-'ll Contractors Signature: C Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that 1 am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the 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 Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Gm 2,Art 2,Sec. 341,Title 8,Califomia Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes ❑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 et 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 ❑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? U Yes LJ No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑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. 4),.) S ria ur Of al Owner(s) I v.vilate A0 5 And/Or Authorized Applicant Date goon INSPECTION TYPE DAM !MALS PODEt INSPECTIONTYPE PAIS =ALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 6-4(1-04 et? 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 • yJ� CITY OF COSTA MESA BUILDING DIVISION :t ..t DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER t PERMIT 403-00663 (714)754-5273 • Fax(714)754.4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 3063 TYLER WY Status: ISSUED Suite No Applied: 12/19/2003 Issued: 12/19/2003 Vicinity: Parcel Number 14160454 _ ISSUED BY: (/�d'�- Applicant: LISA ZOSCZK Address: 24512 BRIDGER RD Phone: (949)859-8466 LAKE FOREST,CA Zip: 92630 Owner: SCHILLING, STEVEN J Address: 3063 TYLER WY Phone: COSTA MESA,CA Zip: 92626 Contractor SWAN POOLS OF SOUTHERN CALIFORNIA Address: 24512 BRIDGER RD Phone: (949)859-8466 ' LAKE FOREST,CA Zip: 92630 License:440333 SCOPE OF PERMIT INGROUND GUNITE POOL&SPA(494 SO.FT), FIREPIT,AND FUTURE BBQ.B03-02173. HEATED POOL. FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $0.00 0 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0 Inst/Rep. Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping $0.00 0 - Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace ' $0.00 0 3 To 15 hp./500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box $0.00 0 30 To 50 hp/1,750 kBTU $0.00 0 Vent Fan/Single Duct $0.00 0 Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $10.65 1 Boilers Fire Dampers $0.00 0 Up to 3 hp $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp • • $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $34.15 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 i 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 WORKERS'COMPENSATION DECLARATION. I hereby affirm under penalty of perjury one of the tunowing 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. 12r1 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 wers' m e tion Insur ce carder and policy number are: �-I q Carrier: . Policy Number: 4 ' 1 O (This section need not be completed lithe permit/s valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws f California,and agree that if hould become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with the p IonsApplicant Signature: ��f�`/��J/ ate: WARNING:FAILURE TO SECUREWORKERS'CAMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYYER TO CRIMINAL ��TIESAND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,030).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am li n e e o i s of Chapter 9(commencing with Section 7000)of Division 3 of the Busin scand ro/n�ra9�5�iio CQse and my license Is in full force and eis ect.Lia# ` 04 Dlassate: # D•1 Y3 I 1 L C-- Co Contractor's Signature: �/� ��_ Date: i e�'� �� 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 fore 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,Grp 2,Art 2,Sec. 341,Title B,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 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification from the South Coast Air(Duality Management District or from any other air pollution control district or agency? Pi Yes D No (Section 65650.2 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 ❑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 ' ' - Si na re Of L gal Owner(s) I a-vl_/D 3 And/Or Authorize Applicant Date CODE# INSPECTION TYPE On INTITIAI$ CODES INSPECTION TYPF // I.ME IyLJIA $ 1616 Fixed System Final Fire Prevention 206 Final Mechanical C-1�7'nN /VSJ/J�� 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof • 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy CITY OF COSTA MESA • o,. BUILDING DIVISION )• ,,,,' -toaervws i DEVELOPMENT SERVICES DEPARTMENT P RMIT NUMBER 4 PERMIT E03-01163 %%Roo, (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ELECTRICAL PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 3063 TYLER WY Status: ISSUED Suite No Applied: 12/19/2003 Vicinity: - Issued: 12/19/2003 Parcel Nunmber: 14160454 61407C - ISSUED LISA ZOSCZK ISSUED BY: (/Vo Address: 24512 BRIDGER RD Phone: (949)859-8466 LAKE FOREST,CA Zip: 92630 Owner SCHILLING, STEVEN J Address 3063 TYLER WY Phone: COSTA MESA,CA Zip: 92626 Contractor: SWAN POOLS OF SOUTHERN CALIFORNIA • Address: 24512 BRIDGER RD Phone: (949)859-8466 LAKE FOREST,CA Zip: 92630 License: 440333 SCOPE OF PERMIT INGROUND GUNITE POOL&SPA(494 SQ.FT), FIREPIT,-AND FUTURE BBQ.B03-02173 FEE SUMMARY Quantity - Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft $0.00 0 Res.a/c package $0.00 Standing Section $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3-I-units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa $49.50 1 - up to 10 kva/kw $0.00 0 • Lighting Fixts $0.00 0 - up to 50 kva/kw $0.00 0 Recept Outlets $0.00 0 up to 100 kva/kw $0.00 0 Switches $0.00 0 over 100 kva/kw : $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $0.00 0 Misc.Conduit $0.00 0 Service to 1000a $0.00 0 Misc.Conductor $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 1Ohp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 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 WORKERS'COMPENSATION DECLARATIOI I hereby affirm under penalty of perjury one of the,,,,,owing 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. LGJ I I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My wo rs'cmQ�Lmmpg� tion Insu ante carrier and policy number are: /�/ 11 Carrier:- "`-' Policy Number: _t(01 I 1 (This section need not be completed it the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation law 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 the e o 0 Applicant Signature: ✓VV .tf Date: (a likele WARNING:FAILURE TO SECURE WORKERPENSATION 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 li e, _• rd. p ovi ions of Chapter 9 ommencing with Section 7000)of Division 3 of the BusinppsaLld Pjgfgsssi•• Cpde,and my license is in full force and effect.Lic.# I Class# d{�1�{`-��3t?�'�,�}(l!%oa� •fr-l/')L Contractor's Signature: W,��/ 710 PP Date: 1 CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ' ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 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,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes ❑No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the 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 a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No e (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. 1q9flflwner(s) And/Or Authorized pplicant l •"',..7Z Date CODE# INSPECTIONTYPE PATE INTITIALS CODE# INSPECTIONTYPE PAIS INTITIALS 1616 ' Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing (,-N-0-1 200 Final Re-Roof 210 Final Electrical Off 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 ' M CITY OF COSTA MESA ' t ►9fl BUILDING DIVISION 411. DEVELOPMENT SERVICES DEPARTMENT f ERMIT NUMBER PERMIT V B03-02173 %bomem 44. (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.fLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 3063 TYLER WY Status: ISSUED Suite: Applied: 12/19/2003 Vicinity: Issued: 12/19/2003 Parcel Number: 14160454 Zoning: R1 R1 Applicant: UN Address: ISSUED BY: V�J Phone: Zip: Owner: SCHILLING, STEVEN J Address 3063 TYLER WY Phone: • COSTA MESA,CA Zip: 92626 Contractor: SWAN POOLS OF SOUTHERN CALIFORNIA Address: 24512 BRIDGER RD Phone: (949)859-8466 LAKE FOREST,CA Zip: 92630 License: 440333 Arch : Eng: Address: • Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT INGROUND GUNITE POOL&SPA(494 SQ.FT),FIREPIT,AND FUTURE BBQ FEE SUMMARY Plan Check: $245.21 Calc Valuation: $24,000.00 Permit: $377.25 Claim Valuation: $24,000.00 SMIP Res: $2.40 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $624.86 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: 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(8ro0) • DECLARATIONS WORKERS'COMPENSATION DECLARATION. I hereby affirm under penalty of perjury one of the following declarations: 0 I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Er"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 �yprrlk�e��99g�y,qLooypmp�patatllonn ins rance carrier and policy number are: Q I Carrier: Q(j'A illjt+4tf Policy Number. • 0 ` (This section need not be completed if the permit Is valued at one hundred dollars($100)or less.) - ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I sho Id become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with the6e p si ,1 JQ -63 Applicant Signature: v6r! r/V Date: 1 a�l 1 WARNING:FAILURE TO SECURE WORKERS MPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE(S100,003),IN ADDf ION 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 lice gs�tl u(� er rovisi s of Cha to 9(commencingwith Section 7000)of Division 3 of the Busi P f s"Qoge nd my license is in full force aceffect Lac.N 'Ti u-1��'J1 (J Date:x ` / 'tl�l'� Contractors Signature: �`.L/ ��(6!/� '/'`� Date: CONSTRUCTION LENDING AGENCY: TUB O I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that 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).): O 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.). O I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers 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: O I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the 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 aermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 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? ❑Yes 0 No (If'yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. 1 �B,aIe Sig tura Le al ner(s) ).94q Or Authorized Applicant . Date ;ODE 1 INSPECTION TYPE DATE INTRULE COW( INSPECTION TYPE QAIE IDLs 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy C + _ 4`aY GENERAL REQUIREMENTS 1. If capacity is 750 gal. Or more, backwash and P-Trap shall be installed. 2. All P-Traps shall tie in at lower terminus of house drain. 3. If permanent fill line is not installed, nearest hose bib shall have an anti-siphon valve. 4. All PVC shall be 18 inches underground. 0. 5. PVC gas lines shall be tested at 60 P.S.I. 6. Pressure test required on entire system(35 P.S.I. air test or water fill) prior to back fill. TYPICAL SETBACK REQUIREMENTS Equipment: 4 ft. from property line 4 ft. from doors/windows 4 ft. from attic vents 18 inches from house/garage Pools/Spas: Above-ground pools and spas shall not be located in the required front yard setback from a public street and are subject to 5-foot side and 10-foot rear yard setbacks for main structures. Any deck that is raised higher than 6 inches above grade will also be subject to the 5-foot side and 10-foot rear yard setbacks for main structures. In-ground pools and spas shall be located 5 feet from any property line. Please consult with the Planning Division regarding any in-ground pool and/or spa that are proposed to be located in the front yard. All pools and spas shall be located 5 feet from any structure. 1. Overhead Edison drops shall be installed per NEC 680-8 (see attachment). 2. It shall be unlawful for any person to install, remove, alter, repair or replace any plumbing, gas or drainage piping or any fixture, swimming pool heater or treating equipment in a building or premises without first obtaining a permit to do such work from the City Building Division. 3. Clarification or additional information may be obtained by telephone: (714) 754-5273, between 8:00 a.m. and 4:30 p.m. FENCE AND GATE REQUIREMENTS (see attached) I 1039-46 (REV.7/98) Elii :.: 1•.4:-....... tut Hu Vagade altiii �, POOL AND SPA REQUIREMENTS , The following information is required in a clear and legible manner. All information shall be complete and on the plans. Three sets of plans showing all of the following with measurements shown from property lines, buildings, patio covers or other structures. 1. Name, address, phone number of owner. 2. Name, address, phone number, type of license of any contractors or subcontractors. 3. Pool and/or spa location. 4. Equipment location. 5. Gas and electrical meter locations. 6. Overhead service lines and serving pole location. 7. Type of gas and electrical conduits to be used. 8. Size of main electrical service (if less than 100 AMP, service is probably inadequate and will have to be upgraded to minimum City requirements.) 9. Rating (horsepower, voltage, amps)of all electrical equipment. 10. BTU rating of gas heater. lir 11. Distance and size of gas line. 12. All electrical outlets within 15 ft. of pool/spa. 1 13. Capacity of spa (spas only). 14. Handrails. ladders, slides and diving boards (if any). 15. Location and details of solar panels (if any). 16. Location of doors and windows within 5 ft. of pool/spa. 17. The type of construction—gunite, poured concrete, prefabricated fiberglass or other. l8. The pool dimensions, including the depth and adequate cross-sections drawn to scale. 19. Computations, stress diagrams and other data sufficient to show the correctness of plans: including reinforcing steel schedule and details. 20. A statement by the applicant concerning the anticipated nature of the soil under and around the pool structure (expansive, moderately expansive, non-expansive). (A soils report may be required by Building Division prior to permit issuance.) 21. The Engineer's wet ink signature is required on pool plans and calculations. 22. All semi-private pools and spas shall conform to California Administrative Code Title 24 handicapped j requirements (hotels, motels, recreation areas for lease to public or publicly funded projects). l 23. Where a permanently installed pool is constructed, at least one 120 volt receptacle shall be installed a minimum of 10 feet and not more than 15 feet from the'inside wall of the pool and shall be protected by a ground fault circuit interrupter. 24. Indoor installation of spas and hot tubs, receptacles shall not be closer than five(5) feet to spa/tub. 25. Receptacles located within twenty(20) feet of a spa or hot tub shall be G.F.C.I. 26. Receptacles for spa/hot tub motors shall be G.F.C.I. protected. 27. Comply with Costa Mesa City ordinance 93-12 requiring protective barriers, fencing and/or enclosures. 1039.46 (REV.7/98) otanom ma an sY1t:r . , nsrisrn. • 1 , . 1 1 1 ee®1,- TEST SPECIMEN AND COMPRESSIVE STRENGTH DATA SHEET Ci0051 ty Op CO 2 2 '140/ 'us?. O.4 411 PROJECT NAME: Schilling INSPECTOR'S NAME: Richard Luiz V/ylli, PROJECT ADDRESS: 3063 Tyler Way INSPECTOR'S LICENSE NO.: N/A �l Costa Mesa,CA INSPECTOR'S SIGNATURE: N/A PERMIT NUMBER: 803-02173 SET IDENTIFICATION NUMBER: N/A CAST DATA(ATTACH DATA SHEET OF OTHERS WHEN AVAILABLE) CAST DATE 3/11/04 DESCRIPTION Concrete I Grout mortar Sllotcrete Masonry Prism Omer:GUNITE CONTRACTOR- Swan SPECIFIED Pc-PSI 2,000 CEMENT TYPE V SUBCONTRACTOR Woody Douglas CAST BY Jose ADMIXTURE N/A ENGINEER D.M. Pasol NO.OF SAMPLES 2 WATER ADDED N/A CONC.SUPPLIER N/A TOTAL YDS.PLACED WA SLUMP WA PLANT N/A TICKET NUMBER N/A AIR CONTENT N/A MIX DESIGN NO. 41/2-1 CAST TIME N/A AIR/CONC.TEMP. N/A LOCATION IN FLOG.: Bottom of the Swimming Pool NOTES: NR=Not Reported Test specimens were 3-in.x 3-In.x 3:in.cube samples cast using wire mesh(no mold used). COMPRESSIVE STRENGTH DATA DATE SPECIMENS RECVD. 3/22/04 EQUIPMENT USED Forney DR2000 REPORT DATE 3/25/04 SN OF EQUIPMENT 99108 TECHNICIAN NAME C. Henriquez-Supervisor CALIB.I REGAL.DATE 2-04/2-05 SPECIMEN AGE AT TEST TEST SPECIMEN DIMENSIONS-IN.' AREA LOAD Pc BREAK IDENTIFICATION TEST DATE TIME 1 2 3 4 SQ.IN. LBS. PSI TYPE' NUMBER DAYS 5 6 T a 1 (MI 2.950 3.373 2.959 3.369 9.96 13002805A 14 3/25/04 5:15pm – 29,747 2,987 d 3.589 3.590 3.589 3.590 tint 3.311 3.357 3.315 3.351 11.11 D002805B 14 3/25/04 5:18pm — 25,713 2,314 d 3.697 3.695 3.696 3.695 nit) Avg.F'c14= 2,650 1 Specimen dimensions 1-4=width and length of each face at midheight;4 through 8=specimen height at midwidth. 'Break type designation per ASTM C39 Figure 2:a=Cone,b=Cone and Split,c=Cone and Shear,d=Shear,e=Columnar COMPLIANCE WITH SPECIFIED STRENGTH/COMA.' TS:Compiles AUTH c-IZED SIGN• 4 R 12102 VI 1nann Pint-ion Rnldovard_ Suite G • Santa Fe Sorings. California 90670 • (562)903-0032 Fax (562)903-3534 V OWNER LEWIS, ROBERT DATE 4-23-64 JOB ADDRESS 30663 Tyler Way BUILDING PERMIT NO. 22023 / "GENERAL CONTRACTOR Omner-builder VALUE $ 150.00 Ch.. No.141-604-54 LOT TRACT FIRE ZONE 3 DESCRIPTION OF WORK Patio Cover INSPECTIONS Signature DATE _GROUP J TYPE V ZONE R 1 cr PERMITS ISSUED G SUBCONTRACTOR DATE NUMBER c Water Rough Com. Refrig. 0 Air Cond. 0 Rough Heating 71 Rough Plumbing Miscellaneous Prop. Swr. Line 0 House Con. 0 St. Swr. 0 Sprinkling System Construction Pole Underground ,0 Power 0 Rag Trenches 0 Forms 0 Steel Reinf. 0 Floor System Bond Beam 0 Steel Reinforce 0 Sheathing . Frame and Flashing _ Lathing— In.0 Out 0 Plaster, brown coat R O. 0 Air Con. 0 Final .Thrr%„tig, Final Finn bing Fixtures, Final Final Gas Test Electric Fixtures, Final _ p _ 7 Building, Final is Comya ' '7I� -Lzy OCCUPANCY • Form BU4—SM-3-63-5-B P nnM9 • • 22023 FEE RECEIVED • ,COSTA MESA BUILDING-SAFETY DEPARTMENT 41114 2 3 1964 P.O.BOX 917 COSTA MESA,CALIFORNIA UA rI FINANCE(�F ; DEPT. \ For Applicant to Fill In Completely A7FLI ccP4NSFOR PERMIT TYPE OR PRINT BUILDING BUIING For Office Use Only ADDLDRESS 3067 // RECEIPT NO. P NO. COSTA MESA. CALIFORNIA /e23 J/ RECEIV EY DATE RECEIVED _DATE ISSU ED.// OWNER /1-7,6e9-1�J /(/exi/.S —as`c6f- 7 zU47 • AMAILDDRESS3o63 7/ ht' ADDRESS BUILDING 3063 LerZ UAL. /J e / TEL..''/ ZONE TYP- I GROUP FIRE CITY ( OSGr7 P.So� N0.3�J'1 70 -d�� r R APPROVED �.�{ /�S/ ARCHITECT TEL. BY '/ '. DATE °//fir."/-�J"A( OR ENGINEER TNO. EL ZONING ^ r. / AL SS z I NO.OF . I USEOFNEW W PAP I PLANS BUILDING CONTRACTOR n LV n e I^ iz. P/I l J JT ,�((�//�� �/(/ DESCRIPTION 0 / ((� I / \ �5 F7 ) ADDRESS / L/f !!! ll//^' ,{+ CITY - A.P.NO. / y / — �✓v 1 y NOTE: NO EAVE OVERHANG SHALL BE LESS THA STATE TEL. SO'TO SIDE @ REAR P.L. LIC.NO. ` S a J NO. A EAVES SIZE LI �5 Zig 1,6' NOW ON LOTS / ALLOWED (U.B.C.RDS APPROVENT) ED OF LOT 7J U 1 USE OF1 YARDS APPROVED YARDS APPROVED EXISTING BLDG. MAIN BUILDING ACCESSORY BUILDING (FROM C/L BTIj. CER LINE FROFRONT (^�C�,`'' 1,�"-�--( FT. CENTER OF STREET REAR YARD SIDE YARD I LEFT RIGHT R.SIDE aon. FT. DESCRIPTIONESOF WORK L.SIDE LOT. FT. NE"" _ _ ALTERATION _ ADDITION REAR x FT. FT. DISTANCE BET. BET. MAIN& REPniR MOVING DEMOLISH MAIN BLDGS. ACCESS.BLDGS. BUILDING NO.OF VAR.# DATE SIZE ROOMS STORIES C.U.P.# APPROVED EXTERIOR WALL ROOF APPROVED Le- ` '] --‘ 44- COVERING / / COVERING COVERING BY �( ,„ ADATE Q'J ^�J `y" US BUILDING ANMRK TO BE PERFORMED Of/ 'Q 1 D t'e 0-__ N SO.FT. D I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. O PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTION. VALUATION 3 - SIGNATURE OF�(�/)e".. ` PERMIT FEE $ B PERM ITTEF "/ � '�%� /G`��1 /1° E $ ✓h V C CI p AUTHORIZED AGENT W TOTAL FEE $ OWNER SE:v'VIEW HOMES, INC. „ , , .. DATE 6-19-62 JOB ADDRESS 3063 Tyler Way BUILDING PERMIT NO. 17335 GENERAL CONTRACTOR S;V. Hunsaker & Sons VALUE $142523.00 AP No. LOT 44 TRACT 4565 FIRE ZONE DESCRIPTION OF WORKReS.W/att.Gar. INSPECTIONS Signature r�DATE�y GROUP I&J TYPE V ZONE Rl � F - 7 - ' Ad 1 --7-4,- _ 1ferez1.7 PERMITS ISSUED 1 r s 1.,....2__(,. L/ SUBCONTRACTOR DATE NUMBER Water /LC_ Mtc ?-r!'/,1 Rough Corn. Refrig. 0 Air Cond. CI Rough Heating /VH-S r-/.3-6-2- s .—X197)-7/./ OV- 7- �, _z Yer1 .y) Rough Plumbing j_jr _ r .7-2 -6 02_aace --'I Miscellaneous Prop.Swr.Line R-House Con..-g-St.Swr. 0 4 Y--- S1gel(LL A_2&, r..... - Jr/QR. 4 d ü 7t7C1 'I r Sprinkling System IP Construction Pole Underground 0 Power ❑ _ /�- Rough Wiring - -7-,-014; 1 1011,1-1,7v! �:471- � . 7--ZS-6,'e-----alo7r✓ '1 renc ies Forms Ur Steel Reinf. 0 Cid 7f %-4-1i?' _ Floor System V Bond Beam 0 Steel Reinforce 0 Sheathing /1'/4k' A-Z. - 62--- Frame and Flashing 1i'&Tr% Berea -62- Lathing — In m---- Out E- tui- -*-7-3'b)- Plaster, brown coat IQ,tu /a-/-47.-Refrig. 0 Air Cond. 0 Final I 'ng, Final /4- )/4r-/w7 FinalbGa Tesures, Final 7 *,,,,,..- Electric Final Gas Test � J//� Electric Fixtures, Final _ /1.• 14 "f 7J Building, Final "I r 4- . k c I7. 1 r-I -- 3. OCCUPANCY I. - . FORM BU4•5M — 7-61 1 e-i-iLl 17335 FEE. RECEIVED COSTA MESA BUILDING-SAFETY DEPARTMENT dUti 171962 P. O. BOX 917 COSTA MEGA. CALIFORNIA FINANCE DEPT. Applicant to Fill In Completely CITY OF COSTARMIMESA For P Y APPLICATION FOR PERMIT TYPE OR PRINT (G(- BUILDIRES8NG.3063 TyGE/L i9-y� ,, / BUILDING ADD COSTA MESA. CALIFORNIA J/ For Office Use Only OWNER Seaview Homes, Inc. I RECEIPT NO. I PERMIT NO.73.^ MAIL RECeIVr I DTE RVEYED I J/ D ADDRESS1602 W. Almond !/T G TEL. BUILDING CITY Orange NO. ADDRESS ARCHITECT OR ENGINEER RambergTEL.& Lowery ND. KI.7613 COSTA MESA. CALIFORNIA /I ADDRESS2127 N. Main St. . Santa Ara Z . /i i ZONE TYPE GROUP 1/4¢ CONTRACTOR S. V. Hunsaker & Sons APPROVEDADATE ADDRESS 15855 E. Edna P1. ZONING ii ZONs/ NO.OF USE OF NEW...1%:, a-„A..CITY •. 1.: ff -4 I PLANS Z I BUILDING w/o-4r, STATE TEL. 164929 TNO. ED. 87361 LEGCNIPTI ON Lot_ y,ii, 771 Y - 6C,- SIZE (i �C e -/ I O a‘ I NO. OP BLOCS. OF LOT NOW ON LOT Q A.P.NO, USE OF YARDS EVES EXISTIN BLDG _//�� / (J / / APPROVED ALLOWED CENTESETBR I-INSTR ETM ' Z) REAR YARD jd FRO TR LINE BT.) 0 FT. IN. / [� / (O SIDE YARDI LEFT I RIGHT �,] R.SIDE r7— FT. -- IN. DESCRIPTION OF II L.SIDE /o FT. N. NEW i X II ALTERATION I II ADDITION I REAR /O FT. IN. ' REPAIR /I DMMOV�IN�1G I II DEMOLISH I APPROVED "� DATE C/,Z/CZ SIZE BUILDit ll' ��'>" l`ROOMS STORIES 1 EXTERIOR WAL -tUCCO I ROOF comp. p rryy�� COVERING - •_ P! COVERING . • c ,6%.5.. . /= 3a7p /- USE OF BUILDING AND WORK TO BE PERFORMtD J,.L • / _Single _fanny dwellin• with .. /I ce = 4�3n O. attached garage�+ ^� Plan 6 p - D I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT PEE ONLY. PLY WITHUL ALL CITY ORDINANCES AND STATE LAWS REG MATH BUILDING CONSTRUCTION. VALUATION PER ATTUR OF 5. V. AKE; ',SONS PERMIT FEE S It— R N / ,_i'$ / '23- PLAN CHECK $ p? �.— AUTHORIZED AGENT V - ipe E TOTAL FEE 0 18602 FEE RECEIVED COSTA MESA BUILDING-SAFETY DEPARTMENT JAN 2 4 1983 ( P.O. BOX 917 COSTA MESA. CALIFORNIA FINANCE DEP1. 0Lw For Applicant to Fill In Completely 2RI&TIII liCW`YERMIT TYPE OR PRINT BUILDING BUILDING 3063 77Le.i- (Jce/ ADDRESS COSTA MESA. CALIFORNIA For Office Use Only PP het` T F RMy�'n� OWNER D he Cl/ I > I RECEIPT NO. I P // RICH VEO !Y DATE ECHI TR ISSUED MAIL 5B ADDRESS .5.a-��H e� '�"-'�� /��j6 3 :� `r C"_� TEL. BUILDING CITY NO. ADDRESS ARCHITECT�� —TEL— COSTA MESA. CALIFORNIA OR ENGINEER NO. n FIRE '/ _ // ADDRESS ^�T /tom / Jp y, ZONEIRTYPE p GROUP G/�CONTRACTOR I,CU PfP 19(L; LCFP/ ' APPROVEDBY DATE fir)ADDRESS --� ZONING / I TR_ (_ NO.O UBUILDING • LICE LEGAL.NO. r NO. r DESCRIPTION '1 ce /, IC. ti.57,r SIZE ,• {�� X [ OT I NO. OF NOW ON LOTS. OF LOT Q L A.P.NO. /-1/1/4-4•^-J---) USE OF w YARDS EVES EXISTING BLDG. JCA--/V 4.C�. APPROVED ALLOWED SETBACK LINE FROM -��•-�/!-� o/ (CENTER LINE ST.) ...�}�/��_�'' lit CENTER OF STREET nit REAR YARD Q pp FRONT of( YFT. O: 17 IN. SIDE YARD LEFT 9.v /T I RIGHT .2 D "r T R.SIDE '.41 l FT.11h1, IN. DESCRIPTION OF WORK L.610E �/ O FT. N. NEW I (II ALTERATION I II ADDITION I) REAR ` W TFT. IN. • REPAIR I II MOVING I II DEMOLISH I APPROVED �. // ./ 1 /_ BY SBZELDING /t'"+(/ ' QI RNO. OF OOMS -- STORIES ` L(� (•/[,/ ajlin L(' EXTERIOR WALL -_= I ROOF COVERING COVERING USE OF BING AND WORK TOB PERFORM D add/ SG.A- 0 i /-• I c' Ta k e QaCX-( 7Dm 73 fC.Y/d'eHCf I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PLY WITH ALL CITY O INANCSS AND STATE LAWS REGULATING PURPOSE OP ESTABLISHING A PERMIT PEE ONLY. BULGING CONSTRU 0 VALUATION C-0 SIGNATURE OF !//l��2l, �� PERMIT FEE $ S. PERMITTER TGG 9.7e-..2.1.1/ O C' /!O .-- .1 S �0? 0? • PLAN CHECK $ Y AUTHORIZED AGENT3 - .1-a O TOTAL FEE $ OWNER LEWIS, Robert J. DATE 1-24-63 JOB ADDRESS 3063 Tyler Way BUILDING PERMIT NO."118602 GENERAL CONTRACTOR Owner-B.1dr. VALUE $ 122.00 /411-giab-for , AP No. LOT 44 TRACT 4565 FIRE ZONE DESCRIPTION OF WORK fu•tllr_C-Sddr to 1 INSPECTIONS Signature DATE GROUP I TYPE V ZONE R-1 is 9 PER ZITS ISSUED C SUBCONTRACTOR DATE NUMBER Water Rough Corn. Refrig. 0 Air Cond. 0 Rough Heating Rough Plumbing Miscellaneous Prop.Swr.Line 0 House Con, 0 St.Swr. 0 Sprinkling System Construction o e Underground 0 Power Rough Wiring Trenches Et For.. uI Steel Reinf. 0 Floor Bondond Beam 0 Steel Reinforce 0 Sheathing Frame and Flashing Lathing — In 0 Out 0 Plaster, brown coat Re rig. 0 'Jr on.. 0 Fina ' ing, Final J. nbing Fixtures, Final Final Gas Test Electric Fixtures, Final Building, Final Uri ;-to-VI OCCUPANCY FORM BU4•5M - 1.61 1 4:24nn • a \ SITE 'LAN N� I �� LEGEND EXISTING \ ,,,,��,,�y,�11n�r.1 JN 'eel P: 1•-' 88- 5' WOOD FENCE S. a"`7""'(� P/LN S.\ \ F.F. FINISH FLOOR ELEVATION • \ Aaron J. it:n R. . . 55578 • \\\ 6• RBB '.. sneering Inc. F.G. FINISH GRADE ELEVATION \ t-I. - • \ 6' EASEMENT • . T.C. TOP OF COPING ELEVATION FOR PUBLIC UTILITIES /\ EXISTING 12' \\ \ PLANTER-40 REMAIN WALL \\\ I� X11 A�[ T.D. TOP OF DECK ELEVATION \ c�Vy / \ \. (•j \ . T.V. TOP OF WALL ELEVATION \ • � � � � \ ELEC. LINE / ° \ • i • teleIrient \ \\\ NW.r GAS LINE .N:a 41101fri ` :;ru�� ��• \� 6' EASEMENT 11/ © \Ai.FOR PUBLIC UTILITIES allf 407 'CI? r dir. •\tNATURAL ROCK WATERFALL \\ EXISTING 10' VIDE x 4' HIGH x 5' BALK , \5' WOOD FENCE 4.... . : \: . stew R N, i -bra, EXISTING OVERHEAT j'111/4 e* \ UTILITY LINES 4 E%iSTING TATE PALM \_ 3.�, P w• TO REM• N• \\ 411111.14111*--a- -1 Or TII E NOM \ \ 111 ` , • SWAN TILE ON \ \ , �\ THE FIRST STEP • -and i1'_ �A � G EXISTING SERVICE DROP \ J-BOX PP a H LOCATION • ■ - BMW . ) MI 1J11 L�l� �I a a • c c i � o . — I- 1 F I / t) ° ° G / t a • i . ��' n p ALARMS PER UBC / Ci _ - ° ° / ilik GAS AND ELEC. • �I _ G a e STUB BY SWAN • pl . a - G - // '• �- _,,,(7. a ° a / 1$ CLOSET / a \ ° ° • / • a I ir . <1 • . 4 4 N./1 I 1 al 907 oit ORKING HOSE BIB / � • EXISTING ° . I ;TIS \ / ' NON WORKING HOSE HIB 5' WOOD FENCE • P/LN F I r!/ 9'S IIP . lir • ALARMS PER UBC FFNFRAI NOTES' • -BBQ NOT BY SWAN -LANDSCAPE NOT BY SWAN EXISTING 5' WOOD GATE•• -ALL DEMO NOT BY SWAN SELF-CLOSE AND LATCH -TREE REMOVAL AND HAULING NOT BY SWAN SWING AWAY FROM POOL -ACCESS FENCE REMOVAL AND REPLACEMENT NOT BY SWAN O -ALL SECURITY GATES, FENCES, AND ALARMS NOT BY SWAN NG 5' WO 5' WOOD FENCE APPROVED\ y • NEV 3• CLEANOUT CITY OF COSTA MESA \ EXISTING HARnscABE TO REMAIN DIVISION OF I UI - iNnTsxmtv PLANNING DIVISION CITY OF CO. A MESA SUBJECT TO BLDG. DEPT. REG.- , A P 1' R (I IS I) NOTE: ADDITIONS, DELETIONS, � Date I �21 leN OR CORRECTIONS SHALL BE specifications MUST be keit• this job at all times and a is unlawful to APPft /EDBYTHEPLNG \ alterations on same r aV en permission fromineDmsrnot g• . Z11t PERMIT USE ONLY: aandspecifipt• -S . L OTbeheldtoortobanapoval aAotvilaton of any provisiorys.4kny . : Grsta Mesa Ordinance and/or Stale law. SQFT. BYfri L AA DATE: \ • w ••- - s Theseylans-arlJper•Rlfshall$spite by limitatio a••bovine u I and void if the building or - HTR. RUN SEWER work a tx> is nrmnenced and manlained alive• . BC 5303( )within 1 80 days of',sumer - LIGHTS Oa - ir - PUMPS 11�� \ RESIDENC -MOVE SPAGzf �� \ MOVE FIREPIT g0%i l ` • -MOVE GAS AND ELEC. STUB dJ 1 / \ EXISTING DRIVEWAY HOA \ To REMAIN DATE: FRONT -RIFA - \ LOT:44 TRACT:4565 \ jH ^ I 1 IEIIINSIDE P/L WALL t 1INSIDE WALL JunctionLandscape Deck Equipment T as' SWAN POOLSReference Ba. Drain Drain CD R ORNAMENTAL IRON ' ,s. a - WOOD FENCE T T OF SOUTHERN CALIFORNIA Gas Skimmer Dee. Neared LightJ 7 LIC.N44G333 Meier Meier Hose Bye - . — . — . — . - SAW CUTS REV DATE SCHILLING.DWG CHANGES scALE:r'_B' BUYER/S SCHILLING,LINDA AND STEVE H/W PHONE (714)557-7251,606-3108 2 01-12-2004 CHNG SPA, HARDSCAPE,AND MOVE GAS STUB AND FIREPIT PER ADD: 1 12-16-2003-CHANGE START DATE PER ADDENDUM ADDRESS 3063 TYLER WAY DESIGNER MITCH ' 0 12-15-2003 ENGINEERING UPDATE CITY COSTA MESA,92626 MAP PAGE 859 B5