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Home My WebLink About215 23RD ST - Building Permits '(-,.., (ATV OF COSTA MESA 4 BUILDING DIVISION o rt,�r,4 F • ,,,,� 1 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER . PERMIT B06-01338 wars;*`° (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.cBJILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 215 23RD ST Status: ISSUED Suite: Applied: 08/07/2006 Vicinity: Issued: 08/07/2006 Primary Occ: R-3 Dwellings/Cong Res<10 Type of Construction: V-N Parcel Number: 42607404 Zoning: Applicant: HALL, CHRISTOPHER Address: 215 E 23RD ST Phone: 949-683-4255 ISSUED BY: COSTA MESA,CA .Zip: 92627-1809 Owner: HALL, CHRISTOPHER: • ' 7' _ Address 215 E 23RD Si. - i / Phone: 949.683-4255' COSTA'MESA,CA, Zip: .92627:1809 N - - .. Contractor OWNER-BUILDER i' Address 2,5,7/7/ A\ \C7/7i-17,2,71 - / U � �v / ) �, Phone: ��, ' \ ‘,' 'Zip:. ',2-7,,,,/,./ License: 000000 , ::ii 'Arch' : / / , Eng: `7 ',� Address: - a / i' Address:• 7 /i/ Phone:; Phone: - 'Zip: �. License: License: - .� ' - ' SCOPE OF PERMIT - , INSTALL HARDI-PLANK SIDING,.ICBO#NER405,FOR S.F.D. , A ./ A . - -� � _ FEE SUMMARY N', - . ' Plan Check:: ' $0.00 . , -.- - - . - - . ,. ;. Calc Valuation: ' ssboo.00 Permit: $125.25 . i - . .ll. ` / . •_.Claim Valuation: $6,000.0o , 'SMIP Res: , $0.60 SMIP Corn: ' ' $0.00 ` • - , Other:, - $0.00 , Inspection: $0.00 ---- - - , Total: $125.85 PLANNING & ZONING ' SETBACKS, -�• • / MAIN STRUCTURE Front' 0-0 i Rear 0-'0 - Left 0-0 Right 0-0 - ' i.ACCESSORY .J Front 7o\0 . Rear 0-0 Left 0-0 - ..:Right .-- 0=0-7 / �� i\-,,', a _ �-�E_. ,, - �/ PARKING Exishnq„ 0� ,,Required: 0 Proposed: 0 • \ - • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION; This permit shall automatically expire and become void if work is not commenced within 180 days,or If work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspection 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 e. WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,es provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. ❑ 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 Ls Issued. My workers'compensation Insurance canier 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.) t I,certify.that in the performance of the work • .. h this permit Is issued,I shall not employ any person in any manner so as to become subject to the workers' `4l compensation laws of California,and e. :e t t. I should become subject to the workers'compensation provisions of cCIllpppn 3 00 of the Labor Code,I shall forthwith comply with these provisions. - aarc:_plicanfSigbaj - -`: / - -..Dalai-� 7, J(/"O _ WARNING:FAILURE TO SECURE W•- ''at: � ENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPL�EYYBR TO GRIM!" L PE ALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITI•" 0 THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060f THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lie.N 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). 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 for a permit subj is the applicant to a civil penalty of not more than five hundred dollars($500).): I,ras 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 end Professions Code:The Contractors License Law does not apply to en owner of property who builds or improves thereon,and who does such work s- k 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) licenseti pursuant to the Contractors License Laws.). ' 0�' I am exempt under Business and Professions Code for this reason: LgTlaltlre:r—' - _ SUM:--...7( 0 6 �/ Ownet:ID:verified by npt fes license. es ❑No Drlvers•Licensa.No. U LLE- uya�-,-;,»�/Vr/h Verification of Ownership by(type of document,i.e.-property tax bill or de "` -+' - 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(38)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the 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 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 Duality Management District or from any other air pollution control district or agency? Yes D 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 AUTHOR _TION 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 W..::: city ordi :. :s relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspect�/jyl�yjy1�1• :- ••ree not to occupy or allow occupancy of any building authorized by this permit until f' l inspection. yr ..a6-____ %'�gn. ure Of Legal Owl-toffs) ' , ' "r.' And/Or Authorized Applicant Date CODE E INSPECTIONTYPE DAA KO36LS CODE, INSPECTION TYPE ME =ALE 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 / £6:yzj IY PP V/l MS• CITY OF COSTA MESA °y ,, BUILDING DIVISION , DEVELOPMENT SERVICES DEPARTMENT B98-00929 PERMIT PERMIT NUMBER (714)754-5273 • Fax(714)754-4856 BUILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 215 23RD ST Status: ISSUED re\ Suite: Applied: 05/29/1998 Vicinity: SECOND FLOOR OF RESIDENCE Issued: 05/29/1998 • Parcel Nunmber: 42607404 Zoning: Applicant: RULE, HARRY J Address: 215E 23RD ST Phone: COSTA MESA,CA Zip: 92627 Owner: RULE, HARRY J Address 215E 23RD ST Phone: • COSTA MESA,CA Zip: 92627 Contractor: Address: Phone: Zip: Licenser Arch/Eng: - Address: • Phone: - Zip: License: • SCOPE OF PERMIT LEGALIZE PRIOR INTERIOR ALTERATION WHICH INCLUDED CONSTRUCTION OF 2 WALLS. CONVERT EXISTING LIBRARY ON 2ND FLOOR TO FIFTH BEDROOM FEE SUMMARY Plan Check: $13.65 Calc Valuation: $500.00 Permit: $21.00 Claimed Valuation: $500.00 Other: $0.00 Inspection: . $0.00 Total: $35.15 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: • • lectl 124 tsic)0 • 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: II . I hereby affirm under penalty of perjury one of the following declarations: -T ❑ 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'co —pen,s�&x Ion I r and policy number are: Carder: ns�Sle 6 Policy Number: (This section nee of be comeletled f the permit is valued et one hundred dollars($100)or less.) ❑ I certify that In the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: 5-2 9- WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND OVIL FINES UP TO ONE HUNDRED THOUSAND DOU ARE(5100,000),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,and my license is in full force and effect.Lic.# Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Chid Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work - himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or Improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the-property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) _ license pursuant to the Contractors License Laws.). pc I am exempt/ua/tler s c. Business and Professions Code for this reason: Signature: `/(r Date: ..9'r- Z 2—f'9" Owner ID vee y driver's license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or dead): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet In depth into which a person is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Gm 2,Art 2,Sec. 341,Title 8,California Administrative Coda). ❑ 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 t0 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 Mil 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 e application a r it for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 8 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 o1 Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 if a permit Irom 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 Inspect' purpgs@s.I agrge not to occupy or allow occupancy of any building authorized by this permit until final ins ction. /g(Ji Owner(s) 5—.z ?— 9K gnature Of Le al Date And/Or Authorized Applicant Date CODE I IKWFebeN TYPF DAli =ALB CODE I INSPECTION TYPF WI MALS 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 2446-46 • CITY OF COSTA MESA P.O. BOX 1200 77 FAIR DRIVE • CALIFORNIA 92626-1200• Y — -- • DEVELOPMENT SERVICES DEPARTMENT BUILDING DIVISION June 4, 2007 Reuben Gulledge Prudential CA Realty 1400 Newport Center Dr, Ste 200 Newport Beach CA 92660 Re: 215 23rtl St., Costa Mesa Permit numbers: B98-00929, E98-00469, P98-00602 In reference to your letter of May 31, 2007, the three permits for the property at 215 23id St. would need to be reinstated. We would need to charge for two hours of inspection time for each permit. Fees payments are made at the Building counter. Once the permits have been reinstated, inspections can be requested. If you have any questions, please contact the Building Division at 714-754-5273, between 8:00 a.m. and 4:30 p.m., and a staff member will be happy to assist you. We appreciate your working with us to resolve this matter. Sincerely, )/94-rL Mary Jane Weidenkeller Office Specialist II Building Division(714)754-5273 • Code Enforcement(714)754-5623 • Planning Division(714)754-5245 FAX(714)754-4356 . TDD(714)754-5244 • www.ci.costa-mesa.ca.us MAY.31.2007 11:32 9497172885 PRUDENTIAL CA REALTY #0480 P.001 /001 5/31/2007 ,/�I Ed Petros / �`�"\ bq City of Costa Mesa n �1 �C n_ Building Division R 1 a .'Vy b0 iqq%,op Mr. Petros, Y 'b I am representing David Snowden Jr. and his wife Angela in the purchase of 215 23'd St. in Costa Mesa. We are currently in counter-offers, but are very close to an agreement. However, this property appears to have some expired permits for remodel work done. How do we go about re-instating permits and/or having Final approval obtained for the remodel work done. We would like to have an inspector from the City view the property and give us a clear idea of what would need to occur to bring the property up to code(if it is not already). Can we do this, as prospective purchasers...or must it be done by the homeowner? Any guidance you can give would be greatly appreciated. you, ilink 0, eubenG 1.ge Prudential CA Realty 1400 Newport Center Dr. ste 200 Newport Beach, CA 92660 (949)230-8708 reubengulledge®a hotmail.com •. l e �',. I fri � A. CITY OF COSTA MESA ' P4._�, •, BUILDING DIVISION r `""". , DEVELOPMENT SERVICES DEPARTMENT E98-00469 • PERMIT PERMIT NUMBER la (714)754-5273 • Fax(714)754-4856 - 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT • • Job Address: 215 23RD ST Status: ISSUED Suite No Applied: 05/29/1998 Vicinity: Issued: 05/29/1998 . Parcel Nunmber: 42607404 Applicant: RULE, HARRY J Address: 215 E 23RD ST •• Phone: COSTA MESA,CA Zip 92627 Owner: RULE, HARRY J Address 215E 23RD ST • Phone: COSTA MESA,CA Zip: 92627 Contractor: Address: ' • Phone: _ • Zip: License: SCOPE OF PERMIT ADD TWO ELECTRICAL OUTLETS. RE:B98-00929. FEE SUMMARY Quantity . Quantity ISSUE FEE $22.00 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 $0.00 0 up to 50 kva/kw $0.00 0 Recept Outlets $2.00 2 up to 100 kva/kw $0.00 0 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 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 $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 $24.00 Intermed Pole $0.00 0 COMMENTS/SPECIAL CONDITIONS div tstD • . • 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: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Cale,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 workersn'co nsattio�n Ins rice carrier and policy number are: Cartier, eo !.Y Policy Number: (This sectionAeed not be Slated if the permit Is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code.I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED • THOUSAND DOLLARE(S100.000).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.Uc.it Class 8 Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: •Signature: Date: OWNER-BUILDER DECLARATIONS: • I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the properly,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or Improves thereon,and who does such work himself or herself or through his or her own employees,provided that such Improvements are not intended or offered for sale.If,however,the building or Improvement Is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code:The contractors License Law does not apply to an owner of properly who builds or improves thereon, and who contracts for such project with a contractor(s) —/license pursuant to the Contractors License Laws.). Z. I am exemUpj,yu�n�ar see —7�j� Business and Professions Code for this reason: Signature: / """' 6ij . '' Date: _c-a1'cr Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: , 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). o As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the 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 Fre 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 a plication apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes ❑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 penally of perjury that I have read this application and state that the information given is correct. I agree to comply:wiih: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 op Ins tion pugo ses.;agree not to occupy or allow occupancy of any building authorized by this permit until final inspeioa Signature Of Legal Owner(s) Date .v:'n And/Or Authorized Applicant Date CODE# OiSPFPTImN TYPF DATE IfIIDAL8 coat IISPFPTLON TYPE DATE DISIDAU 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 2446-46 • �W CITY OF COSTA MESA ? BUILDING DIVISION ti ' '' W DEVELOPMENT SERVICES DEPARTMENT GD1- ti• PERMIT PERMIT NUMBER e `� .mm P98-00602 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 215 23RD ST Status: ISSUED Suite No Applied: 08/03/1998 Issued: 08/04/1998 Vicinity: Parcel Nunmber: 42607404 Applicant: NOCK, RON Address: Phone: , Zip: - . Owner /RULE,HARRY J - - --- . - , Address' 215 E 23RD ST - - '• - - / Phone: -COSTA MESA,CA Zip: 92627 contractor/ NOOK PLUMBING J,'Address: f 11612 KNOTT ST ' Phone: 714 89571246 , GARDEN GROVE,CA - Zip: 92841 . i - License: 707775 - Arch/Eng: ' Address: / . Phone:- - N , - _ • 4 ' , . - • • License: - ' SCOPE OF PERMIT , " INST DISHWASHER. - - . >j / • FEE SUMMARY -- - , . \\,AMT QTY AMT "QTY AMT QTY ISSUE FEE ' - - $22.00 Laundry Tub./Washer $0.00 0 Sump Pump $0.00 0 Backflow irrigation . $0.00. 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P-Trap . $0.00 0 Trap Primer $0.00 0 Bathtub - ' $0.00: ^ 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0',. , - Process Piping(per 10 ft)' $0.00 0 - -Vacuum Brkr Bkflow(1.4) $0.00 0 Connect(Ice,Soda,etc) $0.00. -0, ',, Receptors - , $0.00 0 "Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 - 0 - Septic Tank: $0.00 0 - Wash Basin $0.00 0 Dishwasher - $8.75 '- 1. - 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 Gas Earthquake Valve $0.00 -0 Sink, Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) $0.00 0 Sink, kitchen $0.00 0 • Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $30.75 COMMENTS/SPECIAL CONDITIONS Si?�,�ED I. 48 L DATE EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned fora 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: O I h ve and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Cade,for the performance of the rk 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'coo�mpee(ns/Palo/p Insurance carter and policy number are: /�79 Cartier: 44 (/ ,_Oi'-�. t Policy Number: 7 i e3 Z LV:2 (This section need t be completed If the polit 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 provisirn _ Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST.AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under• •vi ions of Cha. :r 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is In full force and effect.Lic.4 a Class N [[ G Contractor's Signature: ' a' — Date: 5.--- //7' ' ' / CONSTRUCTION LENDING AGENCY: - 13 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 Lew does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: - Signature: Date: Owner ID verified by driver's license. ❑Yes 0 No Driver's License No. Expires: Verification of Ownership by(type-of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,Califomia Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safely,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the Califomia Health end Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the Califomia Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit 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 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 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,wlthall state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-describedprroPerty for.lns�pectlon purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. SI,,, re Of Legal • d: (s) at � . Lg And/Or AuthodzedrApp a . Date LODE 6 INSPECTION TYPE PATE IN 6l,S Oaf INSPECTION TYPE DAB 101:1A1S 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 2446-46 i9 CITY OF COSTA MESA• BUILDING DIVISION 4 • > • •-2r DEVELOPMENT SERVICES DEPARTMENT PERMIT MBER 4. P* PERMIT yp 0 -01598 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 215 23RD ST Status: ISSUED Suite: Applied: 09/13/2004 Vicinity: RESIDENCE ONLY Issued: 09/13/2004 Parcel Number: 42607404 Zoning: Applicant: LEMUS, RAFAEL ISSUED BY: 4'///• a Address: 2016 WALLACE AV UNIT B Phone: 949-642-7057 COSTA MESA,CA Zip: 92627 Owner: RULE, HARRY JOHN Address 215 E 23RD ST Phone: COSTA MESA,CA Zip: 92627-1809 Contractor: LEMUS ROOFING Address: 2016 WALLACE AV UNIT B Phone: 949-642-7057 COSTA MESA,CA Zip: 92627 License: 826813 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT REROOF RESIDENCE ONLY:T/0 EXISTING COMP ROOF,REPAIR/REPLACE SHTG AS NEEDED, 1 LAYER 154 FELT ON 1ST FLOOR SECTION AND 2 LAYERS 154 FELT ON THE 2ND FLOOR ROOF,APPLY"30-YEAR COMP SHINGLES."25 SQUARES FEE E SUMMARY Plan Check: $0.00 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: $111.75 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days,or it 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 2448-46(8/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: - ,r I hereby affirm under penalty of perjury one of the following declarations: ❑ I have end 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. aI 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 ns rance/1carrier and policy number are: Cartier: 7�Nr!p i/✓1,l4 Policy Number: -1-7,6 £73(--?6, (This section eed not be compl fed 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 the 'f I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these p ' - n Applicant Signature: C_' Date: L - 13-�y WARNING:FAILURE TO SECURE WORKERS'COMPENSA ION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND nnLI ARE(s10Q000),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.Lic.it e e s' y Class a ' G' 3e1 oV vv C\5 Contractor's Signature: — - -i ' Date: - '' - CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: • Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit 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. L\Yes ❑No Driver's License No. Expires: Verification of Ownership Py(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation fNe(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)feel high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No (Section 25533 of the California Health 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 spoliation a rmit 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 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 pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which Is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penally 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. nature Of egad Owner(s) Dat d/Or Authorized Applicant Date CODE f, INSPECTION TYPE MTh • IIIID965 CODE t INSPECTION TYPE QAIE II03:16.IeS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final p208 Final Plumbing 200 Final Re-Roof {—i 7-19 210 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 - T rlpplicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITYQE ! TA MESA CONSTRUCTION PERMIT — PERMIT Z33 (� TRACT NO. LOT NO. UNIT NO. SBI P 2/26/09 ?_5p 50 IL P'olect Address a iS E a 3 `-�% 4' . • Applicant's Mailing Address TYPE OF CONSTRUCTION ❑ NEW U ADD L TERATION H REPAIR f Owner's Name )oh Ra I-e-- PhonnIn-0 . 0 CONVERSION �DEDEMOLISH ❑ OTHER� 1 A.P.# Zone Z/S'6Z 3 DESCRIPTION OF WORK/USE OFBLDG. �'ti r� t S ja✓A5-� Address `1 S Main Building: AccessoryBuilding: E Z Arch/Eng. ° License NO. TYPE OF PERMIT El GRADING H FOUNDATION LJ STRUCTURAL T Front Q /(/ Address ❑ TENANT 0 ELECTRICAL ❑�PLUM/B INC 0 MECHANICAL B Rear N '1. O6/ Phone ❑ OTHER C Right N Contractor's Name PROJECT DESCRIPTION SQ. FT. OC PANCV G Address(mailing/ ir_ K CONSTRUCTION TYPE _LL--- VALUATION$ 1 000 s Left R City License No. ZONE GRADING CU.YDS. ACRESE LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks:1 I r I ) F 0 'I Planning Notes: M a with section 7000) of Division 3 of the Business and Professions Code,and .�,/ I M T my license is in full force and effect. License Class License No. - S Date Signature PLUMBING FEES WORKERS'COMPENSATION DECLARATION Bar Sink Showers I hereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL FEES of Workers' Compensation insurance, or a certified copy thereof (Section Backflow Preventer Service Sink 3800, Lab. C.) Automatic Washer Transformer 0 15-50 KW Policy No. Company Backflow Irrigation Sewer Cap Cons8truction Pole Sub. 050+KW Certified copy Is hereby tcity copy is filed withh the the city Building Division. Bathtubs Sewer Connection Cooking Unit Meter Cup to 10 amps Date Applicant — EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers ' Solar Collectors Dishwasher Meter Dov 00 amps _ (This section need not be completed if the permit Is for one hundred ($100)or - less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Pa I certify that In the performance of the work for which this permit is Issued,I 1r shall not employ antY�person In any m niter says [ ecome subject to the Drinking Fountains Solar nk , Ran Workers' o ccgppersp�ldon Laws of Califo !a /-/pe ors 00-1 HP ❑i'A-8 pate �°— Signature yCl�/r!/I Floor Drains S mming Pool w/Spa F.A.U. Inc.Solar ❑9-15 HP 016-15+ NOTICE:It,al{ter making this declaration,you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures comply with such provisions or this permit shall be deemed revoked. Microwave CONSTRUCTION LENDING AGENCY . Gas Service Outlets Water Closet I hereby affirm that there is a construction lending agency for the performance Device Boxes Pole Light of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Lender's Name P Outlets Range Lender's Address Kitchen Sink Water Service Switches Sign OWNER BUILDER DECLARATION / I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash following reason (Section 7031.5 Business and Professional Code: Any city or Garbage Disposal Standing Sections countywhich requires a permit to construct,alter,improve,demolish or re air any sructure, priior'to itissuance, also requires the applicant for such permit P—Trap Laundry Trays Generator 00-5 KW 05-15 KW Trash Compactor to file a signed statement that he/she Is licensed pursuant to the provisions of Roof Drains the Contractor's License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt lerefrom and the basis for the alleged exemption. Any violation of Section , 031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee $ 3 compensation, will do the work, and the structure is not intended or offered -- $15 Issue Fee $ 3 — for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL Reinspection Fee License Law does not apply to an owner of a property who builds or improves FEES thereon, and who does such work himself/horsolf or through his or her own DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such improvements are not Intended or offered for Boiler Hood or Type I 0 sale. If, however, the building or improvement is sold within one year of tom- — Canopy Type II ❑ Zoning Approved By Date pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By �� Dara grove for the purpose of sale). p-/ O I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeratio . stem Application Issued By — � a1--lDatea —.2-6 — tractors to construct the project (Section 7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-111,100 BTU 0100,000 BTU • SUMMARY OF FEES ' nuilds or improves thereon, and who contracts for such projects with a con- tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 ystem Repair/Alteration BUILDING PERMIT $ D--.S` dO $MIP $ `-5 t7 proof of their Worker's Compensation insurance should be provided to me. sI am exempt under Section lq 30 B.& P.C.for this reason Firepl/Fact.Bit. ICBO# Fire Dampers PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ Date Owner Heating System& Oucti t Registers PLAN CHECK 25% $ ENERGY P.C. $ I hereb certify that I have read Is application and state that the above 0o-100,000 BTU 0 60,000BTL GRADING $ information is correct. I agree to comply with all city and county ordinances ELECTRICAL $ and state laws relating to building construction,and hereby authorize repre- sentatives of this city enSvJ upon the above-mentioned property for PLAN CHECK 50% § inspection nae purp es. (•)7Vt((( .V�y/f`� .P�7/``I'/tri Signature ________ Reinspection Fee I $15 Issue Fee $ 3 PLAN CHECK 25% $ r CMF 0865.46,rev. 10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod -Assessor �----- —' CONSTRUCTION AND PLANNING POOL&SPA APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement ' 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation r 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line.& House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT ' 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0Oil 23. Gas Pipe-Rough & Test 72. Underground Flush r; 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy • 37. Final Factory Fireplace t 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation I . 46. Handicap Regulations 47. FINAL STRUCTURE& BUILDING .ti 48. Special Requirements Completed P'�' i 49. Electric Release to Edison ,C 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border Ines and sign all appropriate declarations. .g X3'7 \, C�(+',ty;—i ` PERMIT NO. 7gACT N LOT UNIT NO. 11 . \ i?oSTA MESA-. �T�yj.; ION PER / 5 e 9, . -- q/_ Q ' A.P.#Lr26�-o7�i.i Zona R �, ,�erolectlAdd esn ,!C h 1 .. • r_c1' _G �ytj, Fors-...) 3 w .• ._� .i - �..- • TVP F CONSTRUCTION ADD U ALTERATION U REPAIR E Main Building: Accessory Building:. Z Ap llicaht•s'+Mailing Address -a- S 'o r Owner's fV�me atQ 4, ai �U L C. sL�p-oZy/ ❑ ON V6�t510N ❑ DEMOLISH ❑ OTHER T Front N _ _ Phone DJSCRIPTTIIOtN OFyW(PJ RK`/USE OF �.e.A. I B Rear rn � I Address /� !i 7 (,.,� -y1 �/�XCTSN� l,{J]t`� A -7rN /s�1 f uuC Right / Arch/Eng./'/� �'9.1i 1j��,/>+r� /11"� License No. TY OF PERMIT• GRADING ❑ FOUNDATION STRUCTURAL K / r/ G Address Y'%7 f� / 1 'r / --&to /� ,/ TENANT -❑,ELECTRICAL ❑ PLUMBING+❑ MECHANICA,Lt S Left R Contractor.;Name "SO A AO lin 4-e- 01U Phone 5t ��Z97 ❑ ' HER 3?t ( 534.4'&ui 10\Si� '1 $2- S Ing. Ref.# Parking Req./Provided E O Address(mailing) 2 �'� PROJECT DESCRIPTION O. FT. OCCU PAN,CIV Planning Notes:2, r ea, A� �� r `,c - M CONSTRUCTION TYPE y VALUATION$ (47,Q s a r s'd - •r " k,d I` - T City License No. ZONE GRADING CU.YDS. ACRES it LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: C it- �' I r ' �1�`��1 fir• i•^rh action 7000) of Division 3 of the Business and Professions Code, and '{L�3 ` ELECTRICAL FEES cense is in full force and effect. /J/ � ' / r•t _'9S , ase Class License No. 1\'l /Y•/•• 1{ `�Il ++ Automatic Washer Transformer 0 15-50 KW Ljate Signature PLUMBING FEES 1 3 112 WORKERS'COMPENSATION DECLARATION - 1 /1 Construction Pole Sub. ❑ 50+KW I hereby affirm that I have a certificate of consent to self-Insure or a certificate Bar Sink Showers /' .� of Workers' Compensation Insurance, or a certified copy thereof (Section /I 00 Cooking Unit 3 Meter Duo to 100 amps I %`0, Lab. C.) ..- Backflow Preventer 2 Service Sink - "l• .y No. Company Backflow Irrigation• Sewer Cap • - t Dishwasher - Meter Dover 100 amps 3 43 1..( Certified copy Is hereby the y Gas ❑Electric �— Sub Panel • 3, p U Certified copy Is filed with the city Building Division. Bathtubs Sewer Connection /t �: Dryers Date Applicant - / Fan Motors❑0-1 HP 01%.8 .3 dG EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors • (This section need not be completed if the permit is for one hundred($100) orr .� ' F.A.U. Inc.Solar 09.15 HP 016-15+ less). f Dishwasher Solar'Piping- I certify that in the performance of the work for which this permit is issued, I - - Fixtures Microwave not employ any person in any manner so aS to become subject to the Drinking Fountains'; Solar Tank - ' Workers' Compensation Laws of California. .•_ I Date} �-2.a� sSignature> 4/ 61 I?/id� Floor Drains Swimming Pool w/Spa • , ' Device Boxes Pole Light NOTICE: 1/,after making this declaration,you should become subject to the - f� Workers' Compensation provisions of the LaborOutlets Range 2$ Code, you must forthwith Floor Sinks Urinal f -N g - • cOmply with such provisions or this permit shall be deemed revoked. r.. CONSTRUCTION LENDING AGENCY ' pp -�j p� ��d Switches - Sign a� 1 herebyaffirm that there is a construction lendingagencyGas Service Outlets D Water Dldset 1 �+t� c for the performance C..) p Garbage Disposal StandingSections of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors ! Water Heater g p - Lender's Name Lender's Address I Kitchen Sink Water Service f, ' Generator 00-5 KW 05-15 KW Trash Compactor 'OWNER BUILDER DECLARATION , - (*:i,eby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash . -.-.wing reason (Section 7031.5 Business and Professional Code:Any city or . '510`:•- ty which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays jtructure, prior to its issuance, also requires the applicant for such permit = ll. to .Ne a signed statement that he/she is licensed pursuant to the provisions of Roof DrainsIn the Contractor's License Law (Chapter 9 (commencing with Section 7000)of Division 3 of the Business and Professions Code) or that he/she is exempt Reinspection Fee $15 Issue Fee $ therefrom and the basis for the alleged exemption. Any violation of Section • 7,-".5 by any applicant for a permit subjects the applicant to a civil - - y of not more than five hundred dollars($500). - DEVELOPMENT SERVICES REOUIREMENQjS:, ti leHAIS7 A as owner ofthe property or my employees with wages as their sole Reinspection Fee ` $15 Issue Fee $ 3 Zoning Approved By 1.i Date compensation, will do the work, and the structure is not intended or offered - va fol sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES Building Approved By J • Date License Law does not apply to an owner of a property who builds or Improves _ , thereon, and who does such work himself/hersolf or through his or her own Application Issued By 1 Date ' employees, provided that such improvements are not Intended or offered for Boiler Hood or Type I 0 sale. If, however, the building or improvement is sold within one year of corn- Canopy Type II 0 - SU.M��/MARY QE_FEES ,1 plgtion, the owner will have)the burden of proving he/she did not build or im- Duct-Under Ground l Q Q y preve for the purpose of sale). BUILDING PERMIT $ !!100000 SMTP $ —` ❑'I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System • tractors to construct the project (Section 7044,Business and Professions Code: PLAN CHECK $ ,'` PERMIT The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 0100,000 BTU PLUMBING $ oe O,.sa-1 ISSUANCE $ builds or Improves thereon. and who contracts for such oroiects with a con- 1 tractors license pursuant to me Contractors License Law). I am aware that (J • PLAN CHECK 25% $ ENERGY P.C. $ pro o their Worker's Compensation in ra ce should be providedw to me. Exhaust System ❑ Multiple ❑ System Repair/Alteration ( 6 p� r 7 OJ$ ELECTRICAL $ Ere,.ern GRADING $ I am exempt under Section B.& P.C.for • this reason Firepl/Fact.Bit.ICBG#3/qs- Fire Dampers ��(�� MICROFILM $ tr�� PLAN CHECK 50% $ 7- ,yam Date ,,, � Owner ye�(4L's'1 rYrti Heating System& Ducting Registers ' MECHANICAL $ 55a TOTAL FEE $ . I hereby certify that I have read thii'application and state that the above ❑0-100,000 BTU ❑100,000671 1lformation is correct. I agree to corrddply with all city and county ordinances • - PLAN CHECK 25% $ and state laws relating to uildinq construction,and hereby authorize repre- sentatives of t is city to n t upon the above-mentioned Property for Inspection puttee",5 f, p ri Signature lj7 G (� / Date3/J/ • ,� `Drivers' Lie se or S$ ^- `Reinspection Fee $15 - - Issue Fee _-- - -- 3- - _- _ _ - '•a-_.rev. 5/88- White - Builtline:.r.-.•-• - --u�.--. •- •ten - Assessor • 7 7•CONSTRUCTION AND PLAN �- yOOL & coq APPF�OVALS Permit# - Jate' Inspector `, Date Inspector p, - / APPROVr.�� Pen, ,t` 17 1.`1efnpnrajy,EItrical Service or Pole 52. Pool & Equipment Location r 2!- Soil Pips-Uhdrgrnd. 53. Steel Reinforcement - 3.,Electrical Conduit Utility-Undrgrnd. 54. Forms . - , 4.Electrical Conduit-Undrgrnd. 55. Electrical Bonding .. • 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test , 6. electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE t 7. Footings 58. Electrical Conduit-Undrgrnd. d 8. Foundation 59. Gas Pipe, O Undrgrnd.,Test .' 1, 19. Wgter Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final , 12. Sewer Cap 63. Heater & Vent-Final , 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing /1,/". 65. Electrical-Final 151 Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring // 67. Fencing & Access Approval --- t • 1.7ugh Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69.69. POOL/SPA SYSTEMS FINAL ■. 1p. Rough Heating`& Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Eactory.Fireplace ' - 9q/gq GV APPROVALS Permit# 21. Ducts, in:Structure "� 70. Underground Hydro , •22: Ducts, Ventilating - 71. Product Piping 0 Gas OOiI I 23,..Gas Pipe=Rough &Test '' - ' \,1 72. Underground Flush r 24.-Roof Framing , -- 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing: " / _ • ••• 21 es.9 •- 74. Overhead Hydro : •26. T-Bar Ceiling (Structural) & Monocoat I 75. Dry Chemical Y t7. Frame and Flashing 47147 0 7 76. Dry Standpipe ,28. Lathing& Siding 77. FIXED SYSTEM FINAL t/29. Insulation - -- /-Z- fa r/' 78. FIRE PREY. FINAL 30. Drywall Nailing '� HEALTH DEPT. REQUIREMENT 11-240 6'w� • 31: Plaster BrownCoat -" 9. FINAL INSPECTION 32. Electrical Power Meter-Fina)/ 112/92. �,JO. FOOD CERTIFICATE ISSUED 7 I 33. Final Electric _ - 11025 I/' 4 No -5: 0'6 `kk� cA-R�c- S 34. Final Heating & Air Conditioning tfri 43 LID , 66 7.6r -5 0/` P/PC V Fl-OQ' 35. Final Gas Pipe-Test /1. (..�f/(� �/ p-J� / J /7_ - - F �1/ 117 � o�•�� 4U pbL/a:r lfyA'7`/ 1T f Ent Ul /�/r "36. Hood or Canopy // • GI-no a�eke�/n vsSc-rra,,R n0 l�e.,- .Ci,r.,or.l4 --37. FinaLFactory Fireplace.. /'1H 93 Uri i -38. Final Plumbing p'-dt3 Lid/ ft--2-ro - of 7b ',nary - 5i /(y- -441 ' fig. Water Service-Fin-at' 2 j40- Gas Service-Final Y Øc/n J)p-• Vi 'i //lam -41. Solar Domestic-Finat �,„/ t 42. Backflow Preventer-: , .__ 1 • _i 43. Backflow Irrigation, r-,-- 44. Landscape,Irrigation System ' • 45. Sound Attenuation- 'l 46. Handicap Regulations. •- II/ ' i 47. FINAL STRUCTURE&BUILDING A/Z,7/Ot Ali 48. Special Requirements-Completed '/ /7 � ' 49. Electric Release to Edison - , 'S0. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY I ' . No Date . , ', . ' I' , r_ • - • City of Costa Mesa • California 92628-1200 P.O.Box 1200 • Insulation Certificate Permit Number G 6 02 ( 5 64Sf v2. 3 C054 CI Pits_A • Number and Street City QRNG F . pa 32-3 County Subdivision Lot Number • Description of Installation ROOF • Material Brand Name /29/4/4)&"•'//-t— Thickness II4 U&"•r//t—Thickness (inches)__t_k ¶ Thermal Resistance (R-Value) / EXTERIOR WALL • Material Brand Name M%-//U%G�2, Thickness (inches) iZ t (• Thermal Resistance (R-Value) !/ CEILING /Ad A$1 Batt or Blanket Type Brand Name Thickness (inches) -K1 Thermal Resistance (R-Value) ( 7 Loose Fill Type Brand Name Contractor's minimum installed weight/ft2 lb. Minimum thickness inches Manufacturer's installed weight per square foot to achieve Thermal Resistance (R-Value) RAISEDMatFLOOR Brand Name /t't A t ",at. Thickness (inches) ) Thermal Resistance (R-Value) r SLAB FLOOR Material Brand Name Thickness (inches) Thermal Resistance (R-Value) Width (inches) FOUNDATION WALL Material Brand Name Thickness (inches) Thermal Resistance (R-Value) • Declaration I hereby certify that the above insulation was installed in the building at the above location in conformance with the-current Building Energy Efficiency Standards for new residential buildings cont- n'ed in Title 24 of the California Adminstrative Code. General Contractor(Builder) License Number Signature and Title Date Sub-Contractor(Ins lation Installer) License Number Signature and Title `/ Date • 1907-46 . 02 3 3,/, C. :IFICATE OF COMPLIANCE PAYMENT OF SCHOOL FACILITY FEES 4 • NEWPORT-MESA UNIFIED SCHOOL DISTRICT ,, Developer/Applicant : ),,'/1/YJJQCCAD • . �/ Address : 02/56- n `� C.� L 4213 CeS' 7't 14'f2O7 72S9 g/ Telephone Number : 59 e,2_1-/L/ • Tract/Parcel and Lot Number(s) : n /� Location of Project : Z/ 5 a 3 LDI�� " �P34Di 9t z • Number of Square Feet ofHod s� Residential Space / o v l S x $1 . 50 Total' c2 7cc , c5D Number of Square Feet of Commercial and Industrial Space x $0. 25 Total Commercial/Industrial Project is : (Check One) Mini-storage Motel Preschool Movie Theater Bank Auto Repair Racquet/Health Neighborhood Shops Hospital Warehouses R & D Large Office Heavy Industrial Hotel Office Bldg. Regional Shops Medical Office Restaurant Light Industrial Office Park Fast Food The provisions of Government Code Section 53080 are not applicable. This certifies that the above-named Developer/Applicant has paid school facility fees in compliance with Government Code Sections 53080 and 65995 . Checks are to be made payable to 4Lt Mesa Unified School District . ?ti Busirf(ss Manager Newport-Mesa Unified School District The above representation as to square footage is true . Developer/ Applicant agrees that if it is later determined that such representa- tions are not true then this certificate shall automatically terminate and the appropriate City/County shall be notified . Date : ! / / �r // �� D veloper//Applin _r 33i// iu Ate. • City of Costa Mesa MEASURE "G" EXEMPTION • Plan Check # 167-8% Exemption # 89-323 • Permit # Case # Address: 215 East 23rd Street Unit: Applicant: John Rule • FACTS: • O Residential ❑ Commercial/Industrial ❑ Other ❑ Existing Lot Not Part of Larger Project Project Description: Two story addition to existing house with two car gacage No. of Dwelling Units NA Gross Floor Area NA Square Feet F.A.R. NA Estimated Traffic Generation: NA Avg. Trips/day FINDINGS: The above described project is exempt from compliance with Measure "G" for the following reasons: ❑ 1. Project is a commercial/industrial development which meets all of the following criteria: gross floor area is equal to or less than 10,000 square feet or has an average daily trip generation of less than 130 daily trips, has buildable floor area ratio of less than 0.5, on an existing lot, and is not part of a larger project. (l 2, Project is a residential project of four dwellings or less on an existing lot. 3, Project is residential construction that does not increase the number of permanent housing units on the parcel where the construction takes place, such as remodeling or rebuilding of an existing house. n 4, Project is commercial/industrial construction that does not increase the footprint or square footage or change the use on the parcel where the construction takes place, such as remodel- ing or rebuilding an existing structure. ❑ 5. Project is a public benefit facility, which is defined as public libraries, public administration facilities, public parks, public utilities, and religious facilities. ❑ 6. Project is a facility serving the health and safety of the people, which is defined as hospitals, police, fire and safety facilities, and schools. Exemption ratified by: X Planning Commission Date April 10, 1989 ❑ City Council Date Ali uIna 164930 . II PAID 38292 'OR 16-71,PA: 04 661"1- *****5.50 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 For Applicant to Fill in Completely At ATION FOR BUILDING PERMIT RE I ', ev DATE RECEIVED' TE SSU-8427 211/� BUILDING.2/6--e23,6,1 C V. /, 771 ADDRESS �s C�r/�/ nn b OWNER 5O1)4 Ru LL A.P.NO.l R— i ?c/_ i9 Z MAIL /� ' /� -,s/�• BUILDING ADDRESS Ili / 2I.3 623 'Z , ` r"r�/,y/ ADDRESS S C. —�Jn[I O O •CIT'W 71)9 S N0...cv The,fvqµpA T ^' '/ TRACT ne[sg LOT BLOCK 4. HZ Z eCC CONSTRUCTION s�•� NEW ADD ALTER REPAIR MOVING f1FMOl ISH O m LENDER X- 0_ m , J 7 BRANCH /lbi J to OWNS RT��fn " m J ADDRESS l/J IYYY ��• VALUE �5 '�/+�1& m ARCHITECT TEL. USE a 1 $ •J✓�+ J < OR ENGINEER NO. T T W IL ADDRESS FIRE ZONE TYPE GROUP—ie d w � APPROVE W Z CONTRACTOR a�/_/eL BY OAT*i14•7 J Q CO J et ADDRESS W W TEL. ZONE NO.OF USE OF NEW Z / CITY NO. / PLANS BUILDING I j/In11O 1 —0 STATE CITY YARDS APPROVED YARDS APPROVE /1/ N m LIC. NO. LIC.NO. MAIN BUILDING ACCESSORY BUIL 7 O 1 (FROM C/L STREET' SIZE / n • NO.OF BLOTS OF LOT l.IoD X�2O 'NOWONLOT FRONT F 1' USE OF �) �EXISTING BLDG. �i-/e/ R.SIOF �1 ,tel\leii. T. 1— SIZE OF NO.OF 1 V (/J`yo. 2 NEW BLDG. ROOMS STORIES L.SIDE T �/��/f CC EXTERIOR WALL ROOF ` l 1` COVERING COVERING I 7 ,p� �s REAR FT. FT. 1- USE G Fa TLDING AND IG 4 Cre W ORF/oOBE N R F/C a. Add MAIN BLDGS.ANCE ACCESS BLOCS. 0 /yam .rlT �ySiete." O /\E'y /ti Pi 'Zoe/� .�c•Q.77�� CURD DATE APPROVED I— 77•• //�� „� L/ /� // fn fRoeml— F.12 e.Woo lL CeN t�e,� YROVE�_ ) / (l r DATE -7—/4--7- o WA ll (/V!� VI hereby acknowledge that I have read this application and state 5•(p`� �] D that the above information is correct and agree to comply with (+✓mss/_(/ cc all laws regulating building construction, and I shall not employ F„ any person in violation of the workman's compensation laws of a F V) the State of California. t� . Z I herebycertifythat I am SO. FT. 0 properly licensed as a contractor under the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR i Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: C am exempt from tl a provisions of the State of California Business 2 VALUATION and Professions Gnus,Division 3,Chapt L�0�-+ r PERMIT FEE $ LJ D Signature of �a CO Perm lttee 9 { $5fePLAN CHECK $ E `�T� LL`o 1 Authorized A ent TOTAL FEE $ Ctr..�J _