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HomeMy WebLinkAbout1661 UTAH CIR - Building Permits • 4. J CITY OF COSTA MESA 'os`""'F= " `1 BUILDING DIVISION :4411a_• F• , 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 'r FOR INSPECTIONS CALL: (714)754-5626 .�'•. 4% m fi PERMIT NUMBER: M09-00063 1 PERMIT TYPE MECH STATUS: ISSUED APN: 13907339 DATE ISSUED: 07/30/2009 ISSUED BY: RMD JOB ADDRESS: 1661 UTAH CI CM Suite/Unit: Vicinity: REAR OF HOUSE AND HALLWAY CLOSET SQ. FT: 0 SCOPE OF WORK: MECHANICAL PERMIT TO INSTALL A NEW NC UNIT< 100 K BTU TO BE LOCATED AT REAR OF HOUSE AND CHANGE OUT FAU < 100 K BTU, LOCATED IN HALLWAY CLOSET. ELECTRICAL PERMIT TO BE ISSUED TO ELECTRICAL CONTRACTOR. OWNER: SPARKS,GARY E TR Address: 1661 UTAH CIR Unit: PHONE: City/State/Zip: COSTA MESA,CA APPLICANT: JACOBY, ERIC Address: 2952 CENTURY PL Unit: • PHONE: 714-997-1800 City/State/zZip: COSTA MESA,CA CONTRACTOR: DEPENDABLE GRAHAM AIR CONDITIONING License No. 472690 Address: 2952 CENTURY PLUnit: PHONE: 714-997-1800 City/State: COSTA MESA,CA ZipCode: 92626 CELL: MECHANICAL PERMIT FEE SUMMARY MECH ITEM FEE: $53.10 PLAN CHECK FEE: $0.00 INVESTIGATION FEE: $0.00 • REINSPECTION FEE: $0.00 TOTAL FEES: $53.10 • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. CODE C. INSPECTION TYPE DATE INfTIALS CODEC INSPECTION TYPE, i DIN 5 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 WORKERS'COMPENSATION DECLARATION: Owner ID verified by drivers license. ❑Yes 0 Ncf I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. F Expit s: ❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed): compensation, a: provided for by section 3700 of the Labor Code, for the performance f die work for which this permit is issued. '' 07Thave will maintain workers'compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a number are:n s // person is required to descend,will be made in connection with work authorized `ier:�etalt ( %A,2 by this permit,and that no building structure,scaffolding,talsevmrk,or demolition parrssection need not 0e completed r tthe permit is valued at one hundred dollars($fOOJw less) or dismantling thereof,will be more than thirty-six(36)feet high. (Chap.3.2,Grp �� b700 �� 2,Art 2,Sec.341,Title 8,California Administrative Code). Policy Number: 4' 7 d5-/ ❑ As owner-builder, I will not employ anyone to do work which would ❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of Applicants Signature Date the Labor Code, --i •rth 7th comply with these provisions. / Division of Industrial Safety Permit Number: Applicanr5Sfgn Dale s. _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO - • RE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND S- LL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes 0 No ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST,AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of LICENSED CONTRACTORS DECLARATION: 500 pounds, or a volume of 55 gallons,or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000) of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file my license rsiisin full force and effect. a registration form for acutely hazardous materials? 0 Yes 0 No LiL c�— • /-/ Z`i 0 _CCI8i5.N-ss,�-Z J (Section 25533 of the California Health and Safety Code. with some �7 � �� 7/3 / exceptions, requires registration with the Costa Mesa Fire Department by (hw' 3o�iJ'ili each business which at any one time has on hand a quantity of acutely L-Cemractr nature —'Date-'—" hazardous materials equal toc or greater than a weight of 500 pounds, or a r volume of 55 gallons, or 200 cubic feet of compressed gas at standard CONSTRUCTION LENDING AGE CY: temperature and pressure). ❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work for which this permit is issued.(Sec.3097.Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? 0 Yes 0 No (Section 25534 of the California Health and Safety Code provides that the Lender's Address: Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. Signature Date 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 0 No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes 0 No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Government Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits). License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code) or that he Or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes 0 No applicant for a permit subjects the applicant to a civil penalty of not more than (If yes", the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the Califomia Health and Safety Code). ❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec. 7044,Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes ❑ No thereon, and who does such work himself or herself or through his or her own 8. (If"yes",attach certificate of compliance from the appropriate air pollution employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of control officer). completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code: The contractors License Law does not apply to an owner of Signature Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that 0 I am exempt under sec. the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. pat re o(Legal r(s) ate Signature Date '/ 305746(3/07) MQ/0rAz pnt.--- / p�a�/`'� APPROVED -1 .r 1 OF COSTA MESA PLANNING DIVISION ! SUBJECT TO BLDG. DEPT. REG. /' NOI F \UDITIONS, DELETIONS. OR ( 1)KRECTIONS SHALL BE APPROVED BY THE PLANNING DIV. �/ oPos o , BY: fig_..- DATE: INC"-SL °C. Aft Ea) Pc / 6 / / q 3 : Z.z( 2 leic t • / 66 / UTAH C c2c LC - Sr k?r7 - CITY OF COSTA MESA 44.s. BUILDING BUILDING DIVISION 140-11111E% 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us eicaFOR INSPECTIONS CALL: (714)754-5626 '% m fi PERMIT NUMBER: P09-00095 PERMIT TYPE PLUM STATUS: ISSUED APN: 13907339 DATE ISSUED: 08103/2009 ISSUED BY: RMD JOB ADDRESS: 1661 UTAH CI CM Suite/Unit: Vicinity: KITCHEN SCOPE OF WORK: PLUMBING PERMIT FOR THE INSTALLATION OF A NEW GAS LINE FOR FUTURE KITCHEN STOVE. OWNER: SPARKS,GARY E TR Address: 1661 UTAH CIR PHONE: 714-540-6314 City/State/Zip: COSTA MESA,CA APPLICANT: SAYER, STEVE Address: PHONE: 714-310-0605 City/State/zZip: CONTRACTOR: PLATINUM PLUMBING SERVICES CO License No. 813697 Address: 1345 NORTH RED GUM STREET UNIT 1 PHONE: 714-632-7000 - • City/State: ANAHEIM, CA ZipCode: 92806 CELL: ARCHITECT: License No. PHONE: ENGINEER: License No. PHONE: PLUMBING PERMIT FEE SUMMARY PLAN CHECK FEE: $0.00 PERMIT FEE: $39.45 TOTAL FEES: $39.45 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. cQDE#. INSPECTION TYPE DATE INTIALS CODE# INSPECTION TYPE C� DATE —INTMALL$T5 1616 Fixed System Final Fire Prevention 206 Final Mechanical �1-L— JN- 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final BlocklRetaining 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 WORKERS'COMPENSATION DECLARATION: • Owner ID verified by driver's license. ❑Yes ❑No I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires: ❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed): compensation, as provided for by section 3700 of the Labor Code. for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a number are' person is required to descend,will be made in connection with work authorized -1 (1 by this permit,and that no building structure,scaffolding, highork,or demolition (Carrier: -,C ce�yY s or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp (This section need not be mmpetedatne isvalued at one hundred ars(S100)07 fess) 2,Art 2,Sec.341,Title 8,Califomia Administrative Code). Policy-Number: (30\-\\L\1.--)0 1 --��ry - -- 0 As owner-builder, I will not employ anyone to do work which would ❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of Applicant's Signature Date the Labor Code,I rthwith comply with these provisions. -1) _ra,0 Q1 Division of Industrial Safety Permit Number: Appn�nfa Sign -'� awre_ ( l¢ti:r: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes 0 No ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE. INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons,or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file my licenseiisQs''in1full force and effect. •^yam/ a registration form for acutely hazardous materials? 0 Yes ID No Licr# .. ucl " 3� CIlssn#.- a . C--seg-3 (Section 25533 of the California Health and Safety Code, with some 16 3_C54‘ exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely Contr_rac—IW,.Signature.. .- cpA,tt--�pi. .� hazardous materials equal to or greater than a weight of 500 pounds. or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard CONSTRUCTION LENDING AGENCY: temperature and pressure). ❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work far which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? 0 Yes 0 No (Section 25534 of the California Health and Safety Code provides that the Lender's Address: Costa.Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. Signature Date 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes 0 No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5. the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes 0 No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Govemment Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits). License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes ❑No applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes", the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the California Health and Safety Code). ❑ I, as owner of the properly, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec.7044,Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes 0 No thereon,and who does such work himself or herself or through his or her own 8 (If"yes", attach certificate of compliance from the appropriate air pollution employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of control officer). completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of Signature Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that ❑ am exempt under sec. the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Si. azure of L-.. • ¢r(s) -S3ate _/k j /�� Signature Date r` a__ _ .- _(`rl 3057-46(3/07) Ane/IXAuthoe Mdaoceicancr. C.--nAn—...x-. 40 9 CITY OF COSTA MESA BUILDING DIVISION - /j.{,a� ',1tb. PK* DEVELOPMENT SERVICES DEPARTMENT PER NUMBER F ( 'i 1 PERMIT ` two P05-00124 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 1661 UTAH CI Status: ISSUED Suite No Applied: 02/11/2005 Issued: 02/16/2005 Vicinity: - 1 ISSUED BY: 2e! DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one o1 the following declarations: ❑ I have and will maintain a certificate of consent to sell-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. bhave end 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. ML?workers'compensation Insurance carrier end policy number are: Carrier:_–$t-�'r -- �V lJ CPolicy.Number:, 11 to 8 SSO' ZOO C -(Thls.sectlon need not be completed if the permit is valued of one hundred dollars($100)or less.) 3 ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California.and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provi Ions. Applicant Signature: Dela:. Z\j to C S WA NLNGZEAJUJRE TO SECURE ERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE(Stc0,000),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions 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.Llama- 5, C\ (Z1 ` CClass/. C–b b Contractor's Signature: 'Vim• Date: ri a\ ([o I h c 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 sate.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ' ❑ 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: 9 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,Sac. 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: r Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one lime 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. ..........MPP s presently e..ir d, Section to.. 5 4 o....... lif r.i Healthy 4 It an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Ves 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes ❑No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 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. 7SjgriarOf gal Owner(s) Date 1ReIba Or dzed'Appllcant----:'- - Dele-- CODE I INSPECTION TYPE DATE 1NrIALS CODE t INSPECTION TYPE DEE [MALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical i.. 1266 Pool Spa Final 208 Final Plumbing y®7 it 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 oCITY OF COSTA MESA Ate,_ _ BUILDING DIVISION PERM! NUMBER 1-1 "�"" ' DEVELOPMENT SERVICES DEPARTMENTreati PERMIT 99-01625 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 1661 UTAH CI Status: ISSUED Suite: Applied: 10/8/1999 Vicinity: REAR OF HOUSE Issued: 10/25/1999 Parcel Number: 13907339 Zoning: Applicant: ROTHMAN, RICH ISSUED BY: Address: 6232 SHIELDS DR CA Phone: (714)846-3188 HUNINGTON BEACH Zip: 92647 Owner: SPARKS, GARY E Address 1661 UTAH CIR Phone: COSTA MESA,CA Zip: 92626 Contractor: LIGHTHOUSE CONSTRUCTION INC Address: 1118 E.WALNUT ST. SANTA ANA,CA Phone: (714)571-0411 SUITE R Zip: 92701 License: 753071 Arch : RICH ROTHMAN Eng: Address: 6232 SHIELDS DR Address: Phone: (714)846-3188 Phone: HUNINGTON BEACH,CA Zip: 92647 License: License: SCOPE OF PERMIT 193 SF SUNROOM ADDITION AT REAR OF HOUSE. 343 SQ.FT REAR YARD COVERAGE PERMITTED; 152 SQ.FT.REAR YARD COVERAGE PROPOSED. FEE SUMMARY Plan Check: $72.31 Calc Valuation: $5,000.00 Permit: $111.25 Claim Valuation: $5,000.00 SMIP Res: $0.50 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $184.06 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 Existino: 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 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. Al 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 wor{ke�rs'qom cation Insurance carrier and Icy number aar�e::�� -7� "/ Carrier: L - °''' �10- or. ICY// Policy Number. / `v (This sec n 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 Califomia,and agre t If should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these p :42 /y .z ,,/ Applicant Signature: � Date: Oc,y ,G.S; %9 WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(S100.000),IN ADD1ON 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 pro ' ins of Chapter 9(commencing with Section 7000)of Division 3 of the Business d Professions Code,and my license Is In full force and effect.Lia kClass» Contractor's Signature: �� Alai i4t ta. ✓ Date: q55 Li,z1 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(5500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person Is required to descend, will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 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 at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the Califomia Health and 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 in No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication a_aermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? j�Yes LI No (Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes,attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that 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. /C J {61g L Owner(s) Date A d/Or Authorized Applicant • Date CODE i INSPECTION TYPE PATE INT1IAL$ ;ODE! INSPECTION TYPE PATE INTmALS 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 Flre Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy /20-10 2446.46 O' • list q CITY OF COSTA MESA 4pt' BUILDING DIVISION F 1 ' I . DEVELOPMENT SERVICES DEPARTMENT PE NUMBER ° PERMIT 99-01269 Sb*Pom27 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 1661 UTAH CI Status: ISSUED Suite No Applied: 12/29/1999 Vicinity: REAR OF HOUSE Issued: 12/29/1999 Parcel Nunmber: 13907339 Applicant: KELSY NEVES ISSUED BY: rl Address: 1118 E.WALNUT ST.#R SANTA ANA,CA Phone: (714)571-0411 Zip: 92701 Owner SPARKS, GARY E Address 1661 UTAH CIR Phone: COSTA MESA,CA Zip: 92626 Contractor: LIGHTHOUSE CONSTRUCTION INC Address: 1118 E.WALNUT ST. SANTA ANA,CA Phone: (714)571-0411 SUITE R Zip: 92701 License: 753071 SCOPE OF PERMIT FOUR OUTLETS,THREE SWITCHES AND ONE LIGHT FOR SUN ROOM ADDITION. REF:B99-01625 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 Fixts $1.10 1 up to 50 kva/kw $0.00 0 Recept Outlets $4.40 4 up to 100 kva/kw $0.00 0 Switches $3.30 3 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $0.00 0 Misc.Conduit $0.00 0 Service to 1000a $0.00 0 Misc.Conductor $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $32.30 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 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 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. fiTir have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these pro cions. // Applicant Signature: d. /V2CA-19-- Date: l Z-f//rr2 WARNING:FAILURE TO SECURE W RS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO GRIMPENALTIES 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 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,end my license is In full forcet and effect. Lie. Class a b Contractors Signature: C(n/� Date: /?/7/r/fs 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 properly.or my employees with wages as their sole compensation.WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ 1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of properly who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,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 end Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature end pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes 0 No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the Califomia Health and Safety Code been fully compiled 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? Yes 0 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 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. A(,J' Signature Of Legal Owner(s) Date ely,yr✓LvWs- /7/2f/SS And/Or Authorized Applicant Date • CODE• INSPECTION TYPE DATE XVI§ CODE II INSPECTION TYPE 291E 1MRIAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical i -17-®o 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 2446-46 OWNER MODULAR Technology, Inc. DATE 7_15_71 JOB ADDRESS 1661 Utah Circle BUILDING PERMIT NO. 33315 GENERAL CONTRACTOR Same DESCRIPTION of WORK Re .Watt*gar. AP No. LOT 2 TRACT 6613 FIRE ZONE VALUE S26,000 .00 INSPECTIONS Signature Date GROUP I & J TYPE V ZONE R-1 SOIL Ø.4rr-,/-7/ SUBCONTRACTOR PERMITS ISSUED GAS Date Number Signature WATER , / Plu ROUGH PLUMBING 0 jes/ y �/ J . . �/'//�JT/�, /r/2E 7/ .7-Z/)/Y7 PROP. SWR. LINE Q HOUSE CON. t C�Q p.J iP�-y 17-19-7/ _,5%S/3 SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING ! ...".4.Z./... .%,/,,77..---- TEMPORARY SERVICE OR POLE / - UNDERGROUND 0 POWER f ) ROUGH WIRING / Y/r5/y • Heating a Yen .M /,/1 50�/�/_72 (5(//,.�y/- FLOOR S S 0."--FORMS STEEL REINF. �" ji, / /!„ / 7 ,•'4./'/ FLOOR SYSTEM • BOND BEAM n STEEL REINFORCE n SHEATHING -2-7/ FRAME FRAME AND FLASHING, 9� ) ,,Q/.V LATHING — IN I� OUT it- / G—7'0PLASTER, BROWN COAT +/%/ 'L..,_•f'1` STRUCTURAL, FINAL -/` TL,c rlg +J HEATING, VENT., REFRIG. AND A.C., FINAL et-77/J ZrJ'� /l- .4J . (J/ & /2-/1// � . j/7 PLUMBING, FINAL AND GAS TEST n -9'jJJ. S'�j2�,uar 72. ELECTRIC, FINAL r L,/577- 333 I b PAID JUL 20-71CF7--001755' ,r 137.25 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR BUILDING PERMIT For Applicant to Fill in Completely /// �i D /� ly CS RE Dy Y.II DATE RECEIVED �%J /$S( BUILDING / U/ 6/ -2. ( ,C/ �1-It / 6j �-.2— / ) D/ �/ ✓ E7/ D ADDRESS t✓ PERMI3$3 I OWNER Modular Technology, Inc. _ A.P. NO. �JJ�� MAIL BUILDING / // '�/ s_ /, Z ADDRESS 1104 E. 17th Street ADDRESS /Q G[ (-��[_[�(�/J W W t-U CITY Santa Ana, TEL.547-9673 TRACT 6613 LOT 2 BLOCK ZZ < CONSTRUCTION NEW ADD ALTER REPAIR MOVING DFMOI ISH O 1- LENDER 0- m X J 0 BRANCH Jin OWNER Modular Technology, Inc. CO J ADDRESS U N OR ENGINEER Kermit Dorius, AIA•03 ARCHITECT NEL.644_7111 USE Residence. ll , 6,CCU • FIRE TJ W ADDRESS 3111 2nd Ave. , Corona Del Mar ZONE TYPE GROUP CLLy W Z APPROVED J O CONTRACTOR Owner BY DATE CO YGF��JCC ADDRESS Same W W TEL. ZON NO.OF USE OF NEW [d(^^ - H - - Cr PLANS 2— BUILDING CITY Same NO. /I ( -O STATE CITY YARDS APPROVED YARDS A ROVED fwn cc LIC. NO. 252549 LIC.NO. 1690 MAIN BUILDING ACCESSORY BUILDING 7 O (FROM C/L STREET) SIZE NO.OF BLOCS. n — OF LOT 69 x 122 I r NOW ON LOT FROM /0 FT. • G� FT. USE OF EXISTING BLDG. -- B.SIDE FT. FT. I� SIZE OF NO. OF 2 r Z NEW BLDG. 1770 SF ROOMS 5 STORIES 1 L.SIDE 12-. � . FT. T FT. EXTERIOR WA1LROOF _V COVERING ter Plans COVERING Wood Shingle REAR ;,),I FT.4 FT. . J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN St 0_ a MAIN BLDGS. ACCESS.BLDGS. Construct new residence withP# v .25"--&,s, AAPPROVED v7. (o 2' 0 ~ attached garage. Apps /I�^// N BY �i l�/- /� DATE —( x'71 o HOLD FO[2"S�EEIAL REOUTAFMFNTS f~.1 I hereby acknowledge that I have read this application and state D that the above information is correct and agree to comply with CC all laws regulating building construction, and I shall not employ F„ any person in violation of the workman's compensation laws of eM the State of California. n m jqZ I hereby certify that I am properly licensed as a contractor under /Q SO. FT. �3 0.- the the State of California Business and Professions Code, Divisicn 3, THE AMOUNT SHOWN UN ' R VALUATION IS FOR Chapter 9, and that such ' enses are in full fort. and effect,or I THE PURPOSE OF ESTABLISH G A PERMIT FEE ONLY: m am exempt from the p • ions of e Ste - • ' : ifornia Business 1 VALUATION c a N m and Professions Cod: • inion 3, apt: 9 /l V PERMIT FEE $ D sSignature of ' Permittee ��tA `" 4r//.L $ / ,1�,� PLAN C CK $ 6 p Authorized Agent U �/7 !/ V P\y / 32 is LL ., ` TOTAL FEE CITY COSTA MESA REQUEST FOR OCCUPAh,, TRACT NO. 6 �(� DATE 2-2-f---2 Z— LOT NO. Z ADDRESS 4 I 7,662 CaL--g72 The developer of the above entitled tract desires to sell the above set forth lot prior to the time that the tract has been completed and its streets accepted by the City of Costa Mesa. The undersigned, by executing this agreement, acknowledges that (he-she-they) (was or were) advised that this tract has not been given final inspection nor has it been accepted by the City of Costa Mesa as having complied with the conditions of approval which were imposed by the City at the time the final tract map was approved. The City assumes no liability for the enforcement of the conditions necessary for approval other than those conditions protected by surety bond. The undersigned agrees to indemnify and hold the City harmless from any claim resulting in damage or personal injury to the undersigned by reason of the aforementioned uncompleted condition. BY Purchaser BY 46110II�I4 RECEIVED Developer and/or a hors ed CITY OF COSTA MESA representative PLANNING DEPT. —8? FEB 2 2 1972 Lender AM ppb 718,9.IIf $4l,t,q,4,5,6