HomeMy WebLinkAbout252 16TH PL - Building Permits •0 CITY OF COSTA MESA
•
BUILDING DIVISION
Y •4 r,, : I DEVELOPMENT,SERVICES DEPARTMENT PERMIT NUMBER
J I --‘..17.1 • PERMIT E02-00584
Sabanizote
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
ELECTRICAL PERMIT
Job Address: 252 16TH PL Status: ISSUED
Suite No Applied: 06/27/2002
Vicinity: BACK YARD7.7G A acne' Issued: 06/27/2002
Parcel Nunmber: 42522223 in
Applicant: CRAMM, RUSSELL ISSUED BY:
Address: 252 E 16TH PL #C
.Phone: 949-646-0349
COSTA MESA,CA Zip: 92627-3838 EXTENSION
Owner: CRAMM, RUSSELL mior.:
Address 252 E 16TH PL #C PER
Phone: PER
COSTA MESA,CA Zip: 92627-3838 EXPIRES f/50/0/
Contractor: OWNER-BUILDER
Address:
Phone:
Zip:
•
License: 000000
SCOPE OF PERMIT
INSTALL MISC.CONDUIT AND UNDERGROUND GAS PIPE FOR FUTURE USE FOR UNITS A AND B AND
GARAGES.
REVISED 2/7/03:ADD 3-30 AMP SUBPANELS IN GARAGES,24 OUTLETS IN THE GARAGES AND 6
' LIGHTS IN THE GARAGES.ADD 3 SWITCHES IN THE GARAGES ALSO.
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 $6.60 6 up to 50 kva/kw $0.00 0
Recept Outlets $24.92 24 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 $18.20 1
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 50.00 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 $7.25
•
•
•
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 II work is not commenced within 180 days,or If work Is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6110)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I neve and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are:
Carder: Policy Number:
(This section need not be completed if the permit Is valued et one hundred dollars(S100)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 CML RUES UP TO ONE HUNDRED
THOUSAND COLLARE(S100,000).IN ADDIDCN TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR COOL 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.Uc.it Class 0
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 thathe 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 end 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).):
r
CII,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,end 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 drivers license. 0 Yes Q 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 live(5)or more feet in depth Into which a person is required to descend,will bo 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).
need-
_.t.. _..__
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 tJo
(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 then 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 Of will the applicant or present or futuree 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 materiels with the Fire Department.
,_as S 3_..of t_..._..._ _Safety —__—_--
4 -Ilan RMPP is presently required,has Section 25534 of the California Health end Safety Code been-fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 0No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No
(If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑No
_ _ _.
6 (If yes",attacha..._certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances •
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Signature Of Legal Owner(s) Date
And/Or Authorized Applicant Date
CODE I INSPECTION TYPE PEE DALE CODEI INSPECTION TYPE RAIL. li ALS
• 1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing 0
200 Final Re-Roof 210 Final Electrical
WI:1d
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
`(5� F 9 CITY OF COSTA MESA 9 //
E
BUILDING DIVISION
). -„' aa,. ; �tortant l DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER
PERMIT
4. E02-00584
ono
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR D- E.COSTA MESA,CA 92626
ELECTRICAL PERMIT
Job Address: 252 16TH PL Status: ISSUED
Suite No Applied: 06/27/2002
Vicinity: BACK YARD Issued: 06/27/2002
Parcel Nunmber: 42522223
Applicant: CRAMM, RUSSELL ISSUED BY: `: 01V--
Address:
0' -Address: 252 E 16TH PL #C
Phone: 949-646-0349
COSTA MESA,CA Zip: 92627-3838
Owner: CRAMM, RUSSELL \0
, ..)Address 252 E 16TH PL #C \ t
Phone: , =
COSTA MESA,CA Zip: 926 7-3838
he
Contractor: OWNER-BUILDERrj t
Address:
ilirr-
.
se:
OPE OF PERMIT
INSTALL MISC.CONDUIT AND UND'RGROUND GAS PIPE FOR FUTURE USE FOR UNITS A AND B.
• 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 $0.00 r up to 50 kva/kw $0.00 0
Recept Outlets $0.00 0 up to 100 kva/kw $0.00 0
Switches $0.00 0 over 100 kva/kw $0.00 0
Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0
Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0
Service to 200a $0.00 0 Misc.Conduit $18.20 1
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 $0.0' 0
Communication drops $0.0,0 0 Investigation Fee $0.00
Sub panel to 200a $0.00 0 Plan Check Fee $0.00
Pole Light Pkg 50/00 0 Reinspection Fee $0.00
Sign Circuits $0.00 0
Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $41.70
Intermed Pole `/50.00 0
COMMENTS/ SPECIAL CONDITIONS
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626 -
2446.46(aroo)
•
' DECLARATIONS (-1) ., .
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑ I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Cade,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are:
Cartier: Policy Number:
(This section need not be completed if the permit is valued et a hundred dollars($I00)or less.)
-codify that in the perfopna of the work I r w th' permit Is issued,I shall not employ any person in any manner so to become bject to the workers'
compensation laws of^ lit la,and ag t f sh Id become subject to the workers'compensation provisions f S Ion 3700 of t e Labor Code,I shall forthwith
comply with these pr ision A/A n ,/,,),qPa /, "�
rAppffcanl'Signature:� /IL CDate:�_ I Z v
I
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
TH G/SAND DOLLARE(51(10000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3700 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.Uc.4 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: 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 Ucense Law(Chapter 9(commenting with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
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 Ucense 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 o -e property,a• -• C USIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The(ant =ctors Lice -e :w•Des not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursue• to the Co ra•ors icense Laws.).
:❑=1.em;exel:' oder se•. ---iBusiness and Professions Code for this reason:
Signatilif II I_ Nile '--•Date: TlD/ 2.-7/U-Z
Owner ID verified by drivers license. V Yes 0 No CDrivarkIicenSe:No.. ••' �i/L 210S
Verification of Ownership by(type of d• : t,I.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFE PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title B,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to filo and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one lime 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).
_..._.._ _�_ m___
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 aterials)?
. ❑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? 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 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 L_I 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? 0 Yes 0 No
(If"yes',the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code).
o _..._ ii .t.._r._..._.._...__._
7 If a permit than the South Coast Air Quality Managementeal or other airpollution control district03bor agency is required for the work which is the subject of this
application,have all of the tlisdosures prescribed by CaliforniaCaliloia 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 COMPLNNCE D AUTHOR TION OF E Y:I certify under penalty of perjury that I have read this application and state that the information giv• is
correct. I agree to comp]twit I state laws and tyllorrfrian s relating to building construction,end authorize representatives of the City of to Mesa to enter u•• the
above-described prof Inspection u — gree not occupy or allow occupancy of any building authorized by this pe it until final in on•r_
/Slgnature'OflegafOwner(s) (L_ Date_._ " +„
v •
And/Or Authorized Applicant Date 1111111.
r
00DEI VISPECneff TYPE PATE Um. c 4^ a�l.I ••y�' 1 PAff�t ...“1P.I I..
1616 Fixed System Final Fire Prevention •6 Fine ei - -a
i
1266 Pool Spa Final 08 1Fi al 'I -'O g �.�.
200 Final Re-Roof ' 0 F. al Electrical ' 1 ,
201 Final Block/Retaining Wall / 212 inal Fire Prevention• `
202 Final Factory Fire Place 220 'inal Planning •••r
203 Final Sign _222 Final Si •
204 Final Demolition ' 250 • . Building/Occ ncy
attributes : Costa Mesa Parcels Page 1 of 1
Property Address •
Address 1 252 E 16TH PL
Address 2 COSTA MESA CA 92627
Parcel Information
Assessor Parcel Number 42522223
Legal TR 2996 LOT 20 POR OF LOT
Range
Township
Section
Quarter Section
Area 6365.4604200000003
Acres 0.14999999999999999
Owner Information
Owner CRAMM RUSSELL W
Owner Address 1 252 16TH PL
Owner Address 2 COSTA MESA CA 92627
Property Specs
Year Built 1960
Building Square Feet 3123
Building Count 1 •
Stories Number 2
Parking Spaces 0
Number of Units 3
garage Square Feet 520
Front Footage 51
Depth Footgae 125
Bedrooms 0
•
http://mesagis2x/website/costamesa/parcel/default.asp?opt=attributes&sessid={50924820-52CC-427C-9... 02/19/2004
Property Profile _ Pagel of 1
DataQUIC
land and property data ycu can buildar
Property Profile
Primary Owner: CRAMM,RUSSELL W&JOHANNA A
Secondary Owner:
Mail Address: 252 E 16TH PL ,#C
COSTA MESA, CA 92627
Site Address: 252 E 16TH PL ,#C
COSTA MESA, CA 92627
5.7:'t Telephone Number:
rAl" APN: 425-222-23
\4'F
4S4,1.,,": t.,6 a 1'r; Reference APN:
CA!IFOI NIA . j, Census Tract: 633.007
Housing Tract Number: 2996
Geo Level..0
Lot Number: 20 .
Page Grid Old: 31-03
Page Grid New: 888-J5
Legal Description: TR 2996 LOT 20 POR OF LOT
Subdivision:
Property Characteristics
Bedrooms: Year Built: 1960 Square Feet: 3,118
Bathrooms: Garage:Y Lot Size: 6,435 sq ft/0.15 acres
Total Rooms: Fireplace: Number of Units:
Zoning: Pool/View: Use Code: Multi-family Res(5+Units)
Heating/Cooling:
Sale& Loan Information
Transfer Date: 00-00-2002 Seller: Document: 0000265820
Transfer Value: Cost/Sq Feet: $0.00 Title Co.:
First Loan Amt: Lender: Western Fin Last Trans W/0$:
Loan Type: Interest Rate Type: Last Trans W/O$ Doc:
Assessed& Tax Information
Assessed Value: $347,274 Percent Improvement: 28.02 Homeowner Exemption: Y
Land Value: $249,968 Tax Amount: $4,230 Tax Rate Area: 15007 '
Improvement Value: $97,306 Tax Status: current
m 2004 QataQuick Information Systems.This information is compiled from public documents and is not guaranteed.
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CITY OR COSTA MESA
swit
BUILDING DIVISION
Ft fir•-• `I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
cb PERMIT P05-00484
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 252 16TH PL Status: ISSUED
Suite No B Applied: 06/20/2005
Issued: 06/20/2005
Vicinity: UNIT B /.►/"�)
Parcel Nunmber: 42522223 - ISSUED BY: ( "✓
Applicant: CRAMM, RUSSELL
Address: 252E 16TH PL #C
Phone:
COSTA MESA,CA Zip: 92627-3838
Owner: CRAMM, RUSSELL
Address 252 E 16TH PL #C
• Phone:
COSTA MESA,CA Zip: 92627-3838
Contractor: OWNER-BUILDER
Address:
Phone:
Zip:
License: 000000
•
SCOPE OF PERMIT
SEWER LINE REPAIR IN PRIVATE POPERTY ONLY.
FEE SUMMARY
AMT QTY AMT QTY AMT QTY
ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0
Backflow irrigation $0.00 0 Landscape Irrigation - $0.00 0 Swimming Pool $0.00 0
Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0
Bathtub $0.00 0 Pressure Regulator ' - $0.00 0 Urinal $0.00 0
Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units $0.00 0 Septic Tank $0.00 0 - Wash Basin $0.00 0
Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0
Drain, Floor $0.00 0 Sewer Connect $24.65 1 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: $48.15
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§ 1,12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-48(600)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit Is Issued.
❑ I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued.
My workers'compensation Insurance carder and policy number are:
Cartier: Policy Number:
(Thissectionneed not be completed if the permit is valued at one hundred dollars($100)or less.)
LIS�YEertity that in the•:rfo ante of the work to Ich this permit is Issued,I shall not employ any person in any manner so as to become subject to the workers'
i- _compensation la s of C Iliornia,and agr:'t;. If I should become subject to the workers'compensation provisions of/Sec'on 3700 f the Labor Code,I shall forthwith
comply with the - ro Ions. //^ tlr�/C // .
S
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 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.a Class 1t
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 end the basis for the alleged exemption.My 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.). '
owner of the property,am EXCL . ELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
ode:Th. rectors License Law dA not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
P
license Ito the Contracti. )
.Laws.).
❑ I am ex.1
der s: . a Business and Professions Code for this reason:
41/
SI nature;;.: 4. Ir 1 Date 7 7Cei05
inner9 �
E-ase S
r.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,Calitomla Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
Yes
❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application apgermit for such construction or modification
from the South Coast Alr Quality Management District or from any other air pollution control district or agency? 0 Yes LJ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
_..._ South
Coast
_...._..._._ ___._ t.r....__..r__ d _._....__ u.__
7 If a permit from the South oosr s Qualityced Management District or other airtpollution control district3bn agency is required for the work which is the subject of this
application,have allot the disclosures prescribed by CaliforniaCalitoHealth and Safety Code Section 42303 been made? 0 Yes 0 No
.............(..f_._.._..,._ ..._
e (If yes',attach certificate__ of compliance from the appropriate air pollution control officer). _
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFI TE OF MPUANCE • • A •R• TON OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. a r comp ith :I .to : an. city ordinances relating to building construction,and authorize representatives of the Ci of Costa Mesa to enter upon the
.�i
abov n �props��i •...i. • ,r•-:s.I a•r:.: •• - -- ••• • - •.. ••: • any building authorized b this pp�r,,,it until fi al insp
S .... (Z6/ U S
lySl gKre OEUvel Owner(s)�
Dae;
And/Or Authorized Applicant Date
CODE E, INSPECTION TYPE PM R{ILIAL4 CODE I INSPECTION TYPE EAU UMW
1616 Fixed System Final Fire Prevention 206 Final Mechanical p�
1266 Pool Spa Final 208 Final Plumbing /dam/N /Rya"
200 Final Re-Roof 210 Final Electrical �p
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Placa 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
���I' CITY OF COSTA MESA • •
4 BUILDING DIVISION
•
: DEVELOPMENT •
SERVICES DEPARTMENT PE IT NUMBER
! "4a PERMIT
V. r
06-00363
444ThoRmso.4*
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.SUILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 252 16TH PL Status: ISSUED
Suite: Applied: 03/03/2006
Vicinity: Issued: 03/03/2006
Primary Occ: U1 Type of Construction: V-N
Parcel Number: 42522223 Zoning:
Applicant: CRAMM, RUSSELL
Address: 252 E 16TH PL #C /�
Phone: 949-646-0349 ISSUED BY: C �"�
COSTA MESA,CA Zip: 92627-3838
Owner: CRAMM, RUSSELL
Address 252 E 16TH PL #C
Phone: 949-646-0349
COSTA MESA,CA Zip: 92627-3838
Contractor: OWNER-BUILDER
Address:
Phone:
Zip: License: 000000
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
REMOVE INTERIOR BEARING WALLS IN THE GARAGE AND TWO WOOD DOORS AND INSTALL ONE ROLLUP DOOR TO BRING BACK TO
ORIGINAL CONSTRUCTION.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $500.00
Permit: $23.50 Claim Valuation: $500.00
SMIP Res: $0.50
SMIP Corn: $0.00 -
Other $0.00
Inspection: $0.00
Total: $24.00
PLANNING & ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 , - Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 . Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§ 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
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
2446-46(WOO)
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations: -
❑ I have and will maintain a certificate o1 consent to self-Insure for workers'compensation,as pnvided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is Issued.
❑ I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed if the permit is valued at one hundred dollars($100)or less.)
❑ I certify that in tho 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 TOONE HUNDRED
THOUSAND DOLLARE($100,000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions 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.a Class R
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: 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 toe 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.). '
•e1\ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code .contractors License aw does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
livens.iii • rsuant to the Contr:c•rs License Laws.).
❑ I am pt un er-ea,/ A....
/ Business and Professions Code for this reason:
Sim / /�/���� I-te: (/ CO
• erified by drivers license. es 0 No Driv:rsgm, '. E " •5: C- . 0
Verification of Ownership by(type of document,i.e.-property tax bill or deed): , II
I :7) /f
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
El 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 n0 building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑Yes ❑No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 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 ❑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? 01 Yes LJ No
(Section 65850.2 of the California Government Code requires that the requested information be fumished on applications for non-residential building permits).
6 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No
8 (If yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: LLLL Date:
CERTIFICATE • COM' ANCE AND • I' OIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agre: to co, sly with all st: : aws d ity ordina es relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-descri... •.... . .p for's•ec(� • Moses. a,re: no to occu occupancy of any building authorized by this pe 1 u ill fin inspection.
-aka
3 Oh
Si• atu 7:4':" egal Owner(s) ---Date)
And/Or Authorized Applicant Date
CODE f INSPECTION TYPE Pali It{IIDALS CODE it INSPECTION TYPE PATE INf1TIAL$
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 e ini-
204 Final Demolition 250 Final Building/Occupancy
CITY OF COSTA MESA
;,, t BUILDING DIVISION
> • DEVELOPMENT SEAVICES DEPARTMENT PERMIT NUMBER
I v. _atm
J � T PERMIT B05-01328
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.rILUI1Vla 1'tKMI I 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 252 16TH PL Status: ISSUED
Suite: Applied: 08/05/2005
Vicinity: GARAGE B AND C Issued: 08/05/2005
Primary Occ: Type of Construction: V-N
Parcel Number: 42522223 Zoning:
Applicant: CRAMM, RUSSELL
Address: 252 E 16TH PL #C
Phone: ISSU. D BY: V r J
COSTA MESA,CA Zip: 92627-3:38
Owner: CRAMM, RUSSELL
Address 252E 16TH PL #C
Phone:
COSTA MESA,CA - Zip: 92627-::-:
Contractor: OWNER-BUILDER
Address:
Phone:
Zip: License: 000000
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCO• • OF PE-MIT
DEMO 1 NON LOAD BEARING PARTITION WALL BET EEN GARAG' : AND C 0 RETURN TO ORIGINAL FORM.
FEE SUM ' - -Y
Plan Check: $0.00 Calc Valuation: $500.00
Permit: $23.50 Claim Valuation: $500.00
SMIP Res: $0.511
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
•
Total: $24.00
PLANNING & ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
•
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord. No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections/and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754%5626
2446.46(6/00) I
DECLARATIONS '
•
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑ I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Ls issued.
My workers'compensation Insurance carrier and policy number are:
Cartier: Policy Number.
(This section need not be completed it 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:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDm0N TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 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.4 Class Si
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is Issued.(Sec.3097,Civil Code).
Lender's Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
sub 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,th' owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). •
❑ I,as ow ' • •e property,am EXC USIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the protect(Sec.7044,Business and Professions
Code: e cont actors License does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
licens•pursu: t to the Conti t''license Laws.).
❑ I am ,-: •. unde : , Business and Professions Code for this reason: n-'l -4�
Signetur&c . 015r Date:- '6( //
•
Owner ID"veri led by tlrivers license. I': es 0 Na D'vaCalicenseNo.-} 52Expires: j
�22 yU
Verification of Ownership by(type of document,I.e.-properly 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 e
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 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 Flre
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 Safely 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 thisapplication a ermlt for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? D 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).
..____.._. _.._f_._ _._. ...__. _.. erf.__c ?.._0Y_..._..___.....
6 Will any pert of the fedliry 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).
_._ i_.._.uaManagement
a f-this.
7 a permit from the South Coast Air Quality ed by Californiaeal or andother air pollution ooncontrol district03 or agency? is required for the work which Is the subject of this
application,have all of the disclosures prescribed by Celifoia Health Safety Code Section 42303 been made? ❑Yes 0 No
._.....
8 (If yes',attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIAN• AND • • ORIZATION 0' E Y: certify under penalty of perjury that I have read this application and state that the Information given Is
correct. I agree to comply wit all slat: aws and city ordi am:: rel ting to building construction,and authorize representativ: •f the •ty of Costa Mesa to enter upon the
above-described property f• s•e p rp0,08. :e of t• • py or allow occupancy of any building authorized by this '• it u d final inspection.
1 v
Stgnatnre:Ofl:egal-Owner(5>� •�
And/Or Authorized Applicant Date
ODE I, INSPEC110N TYPE '.t SOOEt i' • er'. •'. DAIL
1616 Fixed System Final Fire Pr: ention 206 -nal Mechanical
1266 Pool Spa Final 208 anal Plumbing -.
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevendo
202 Final Factory Fire Place 0 Final Planning Appr val
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Bullding/Occu cy
,i,-e
IR CITY OF COSTA MESA J
4 9 BUILDING DIVISION
oy et
> a,' DEVELOPMENT SERVICES DEPARTMENT P RMIT NUMBER
F ('�.yrr.."1t 1 2
f PEF(MIT • 806-00363 ray
(714)754-5273 • Fax (714)754-4856 • www.ci.costa-mesa.c BUILDING PERMIT •
77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 252 16TH PL Status: FINALED
Suite: Applied: 03/03/2006
Vicinity: Issued: 03/03/2006
Primary Occ: Ut Type of Construction: V-N
Parcel Number: 42522223 Zoning:
Applicant: CRAMM, RUSSELL
Address: 252 E 16TH PL #C
Phone: 949-646-0349
COSTA MESA,CA Zip: 92627-3838 ISSUED BY:
Owner: CRAMM, RUSSELL
Address 252 E 16TH PL #C ,1/
Phone: 949-646-0349 I'.
f
COSTA MESA,CA Zip: 92627-3838 l"V
i.4`- '
Contractor OWNER-BUILDER --• ;
Address: r ,' �' qtr`_•
Phone: '1 .4..' s. 'Zip: License: 000000 " A
/' '
+ •
,.!fit;:;,.' r \' r1 -_ .;'L :4'
it f. E t.,.•�,� 1^
Arch Eng st'u 3IiIt , it.4% dri
•
Address: �'dress:l'J, 1! 4 � • 1 ) .� ,�., -!
Phone • 1' 4 - Pliant.' (/(
Zip: License. 1 „� •'• 1' g',, -,� License: �. .�
r' iSCOPE OF PERMIT ' •".%
REMOVE INTERIOR BEARING WALLS IN THE GARAGE AND.TWO WOOD DOORS AND INSTRLL'ON ROLLUP DOOR TO BRING BACK TO
ORIGINAL CONSTRUCTION. 5 +iri 1 /
,
i • - -FEE SUMMARY ,4,
Plan Check:. $0.00$0.00 'ir�s 1,. 1•3,.,,.‘:i3:
,1�t4 Calc Valuation: : $500.00
Permit: $23.50 1 i•^' I: i� ;;E%, " !� r7, Claim Valuation: Y $500.00
SMIP•Resf `t '; $0.50 „ Vi'..' . .. •
'.
SMIP�Com ' ,i ,$0,00
'4-)+ ,i Other ,:r.rn 0100 r ! zt
In6pectiOR ` ' '$0.00 "} '
Jr 1
�:� Total: II
$24.00 ° "ig.1" ii
i
"y F',_- PLANNING]&ZONING
4 'SETBACKS tri "'• i t
it
t't MAIN STRUCTUREE[ont_. 0-0- ?-Ream ,• 0-0 Lek 0-0Right 0-0
i ] t113yi
"' ACDESSORY Frontjf 0-0 �^ Rear r 0-0 Left 0-0 Right 0-0
_<,�BARKING F-rEkIstinq: 0 `iJ IReduired: 0 Proposed: 0
7' ?
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
2446.46(6/00)
if
WORKERS'COMPENSATION DECLARATION:
I hereby anirm under penalty of penury one of the following declarations: '
O I have and will maintain a certificate of consent to sell-Insure for workers'compensation,as provided for by section 3700 of bre Labor Code,for the performance of the
work for whicn this permit is issued. .
O I nave and will maintain workers'compensation insurance,as required by season 3700 of the Labor Code.for thu performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number
(This section nape not be completed it the permit is valued at one hundred dollars($100)or less)
O I certify that in Ire performance cif the work for which this permit is issued,I shall nos employ any person in any manner so as to become subject to Ire workers'
compensation laws of California,and agree that if I should become subject to the workers'compensation provisions 01 Section 3700 of the Labor Code,I shall forthwith
comply with these provisions.
Applicant Signature: Date:
WARNING'FAILURE 10 SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUGJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP 10 ONE HUNDRED
1 HOUSAfID DOLLARE IS I00000),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 37080F 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 Rte Business and Professions Code,and my license is in full
tome and enact.Lic.•_ Class• " i /
GentraClur's Signature: Dale: ." / '
r
CONSTRUCTION LENDING AGENCY: , „ 1 • \ ;
rl
❑ I hereby atlitin mat there is a construction lending apency for the performance of the work for wnich Mie permn.is issued.(Sea;3097,1CINI Code).
Lender's Name: Lender's Address: -.,"' '-
Signature: - 1` Date: - ' ' !
OWNER-BUILDER DECLARATIONS: I
I hereby affirm fret under penally 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,altar,improva,.aemolish,or repair any shucture„prnoc.to its issuance,also requires the applicant for sucn permit
to the a signed statement that ne or she is licensed pursuant to tne provisions of the Contractors License Lai./(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Piotessions Code)or:bat he or see is exempt therefrom and the basis for Vie alleged exemption.% Any violation dl Section 7031.5 by any applicant for a permit
subjects toe applicant to a civil penalty of not more than live nundrsd dollars($500).): I • , / ., , I ;
❑ I.as owner of the propeny,or my employees with wages as trial,sole compensation,WILL DO/THE WORK,and the structure Is not Intended or offered for sale(Sec.
7044.Business and Protessiong Code:The Contractors License Law doge trot apply loan owner of property/who builds or improves thereon,and who does such work
Maisel'or herself Or through his or her own employees;provlded boat such Improvements are(not Intended or offered fur sale.II,however,the budding or improvement is
soli within one year of completion,the owner-builder will have the burden of proving that he oz she did not build or improve tor:purpose of sale.).
❑ I,as owner of the properly.am
se EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to con sued the project(Sec.7044,Business and Professions
(s)
Code: The contractors License Law does not apply lb an owner of ploixtrty,Who builds or Improves Naber,and wire Contracts for such project with a colorations)
license pursuant to trio Contractors License Laws.)! 1,.(I t,i ,l • I ) . ' J
0 I am exempt under sec. 'J” =1 I ,'Business ante Prefeaslons Cddo for this reason:
Signature: / ..: ' \ (..:.....2? 1 I- ' I 1 'I Date: v
Owner IU verified by diive%etlCeriee.t•l ❑yes ❑No ' I 4'Driver's License NO. ' Expires:
7, ' .I; t i ' � ..
Verification of Ownership by(type of document,Le.-property tax bill or deed):
DIVISION OF INDUSTRIAL-SAFETY PERMIT CERTIFICATION: �' ' I •'I
A'7 . l 1: . I ti 4
❑ i hereby certify Mena excavation five(5)or more feet In depth into whle t e person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scanolding,telsevioik,or demolition Or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,(irp 2,Art 2.Sec.
341,Title B,Caldpmia Administrative Code). ' .\ %r r Z/'
T I r I � )r /
❑ As owner-builder, I will not employ anyone to do woil (vltichlwould radium a permit'Irom the Division of Industrial :safety,as noted above, unless such person has a
poi and to do such work from the division. ., J
I . : � . /
Signaium: I..,i rr(J ! Date:
I' rl' I • '- I V '• . r
Division pf Industrial Safety Permit Number -
i
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
I Will the applicant or present of,fUtrhre building occupant need to lite and cenity a Business Plan far emergency response to release or threatened release of a nazardnus
material? ❑Yes ;❑No =. y
1 Soclion 25505 M the Califon-al Heallkand Safety Code requires.with sorne exceptions, that a Business Plan bo tiled with the Costa Mesa Fire Department by evury
business which ties at any one finks during a repand year a quantity of hazardous matenals equal le or gloater Nan a weight of 500 pounds.or a volume of 55 gallons.
or 230 cuoic Leet of compresses gas at standard temperature and pressure).
Does or will the apoltcant or presenter future building occupant need to file a registration toren for acutely hazardous materials? 0 Yes 0 No
uno
(Section 25533of ins da.quCalifornia Wealth andtSafety Gide,with some a+ual to or earegistration with the you Mdsse Fire volume
at Department by eachbusiness which at any
urn time has wt nand e-quaitllly of acutely hatamous materials equal to of greater than a weight UI 500 puunUs, or a volume of 55 gallons. or 200 cubic teat of
compresses gas at standard temperature and pressure).
.,..
9 Does or will me applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑\its 0 Ido
t Section 25534 of the California Healy'and Safety Code provides that the Costa Mosa Fite Department may require the preparation,certification and filing with the Fire
Dapanmont of an RMPP by businesses which are required to register acutely hazardous materials with 111e Fire Department.
4 1t an RMPP is presently requires,nas Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will me applicant or present or future buitang occupant require tot the work which is the subject of this_e plleahon aglarmn for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? U yea jJ No
(Section 65850.2 of the California Government Code requires That the requested information be fornrsheo on applications for non-residential building permits).
.. under
._._._......._....__.._.._.. .thi__..emibewi _..._..._
6 Will any part et bre facility to be Constructed udethis permit be within 1000 feet from the outer boundaries of a sanool? 0 Yes 0 No
Ili'♦yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit num Inn 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
eppliCanan,have all of the disclosures prescnbea by California Health and Safety Code Suction 42303 boon made? ❑Yes ❑Nn
ii lit'yes".attach certificate of compliance Imre the appropriate air pollution control ohicer).
CEO TIFICAIE OF COMPLIANCE:I cenity 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 teat the information given is
correct.r agree to comply witn all state laws and city ordinances relating to building construction,and amount 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 ouilomg authorized by this permit until final inspection.
Signature Of Legal°wnegs) Date
And/Or Authorzed Applicant Date
MILL b/SYlcTIONf?t pLiF INiniALS gm. IMSPEGIION TVP pale UIII1.614
1616 Fixed'syetmh FIr r re-Prevention 's•=^zit'.• ix Fier", 208 F1nal Mechanical�. 77,...,4, / �'":) 7
/r r .w pl 17i•si.k 5 1. _e,) , r'JI -r\ (r
1266/ Pool tta Find gfr. :Il'' �i�S 20B Final PWmN11g h\ - �. II` . /
2000 hilFIAAI RmROMf ..•^�• �\`'T. 216 r FInai,Electncat ' • •,. .: %�, .y
201 ,]IF`Ina1 Block/ltetaining Wall [{/.� ' SI '1 '. x•`` S '1 212 i' FInal FGe Prevention - \" ' l�
{{{��� .,ii w TYl R ifs h ri fit... - vx
2031,i'4 Final!Jittery Fire Pla61$ y.� \\r 1rJ`r t n / , - -f 220 Final�Planning Approval
} 1 �t )
203 ,.tFIAal Bipnl^t i ,�1• `iiV o 1 'aL'. tt' �I ,A m'n 2221., OnaLSiie r
�l tIbe NI f .. 1I'v' V ✓ '. rC ' t,41:"...!.,,'"•)1 • /�f
204 Pkgl Contdllgon; ���'_?' L -✓! 250aIA FlnelBuildinlyOccupancy L.,(Cpli�i�CYj
►a! - CITY OF COSTA MESA . ► /
4 a •. BUILDIING\DIVISION
F I r,_ala I:Iafah\ ' DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
V. PERMIT
ithevvv.invo . E06-00176
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
ELECTRICAL PERMIT
Job Address: 252 16TH PL Status: ISSUED
Suite No Applied: 03/03/2006
Vicinity: Issued: 03/03/2006
Parcel Nunmber: 42522223
Applicant: CRAMM, RUSSELL
Address: 252 E 16TH PL #C ISSUED BY:
Phone: 949-646-0349 r
COSTA MESA,CA Zip 92627-3838
Owner: CRAMM, RUSSELL '
Address 252 E 16TH PL #C
Phone: 949-646-0349
COSTA MESA,CA Zip: 92627-3838
Contractor: OWNER-BUILDER
Address:
Phone:
Zip:
License:000000
SCOPE OF PERMIT
REMOVE INTERIOR BEARING WALLS IN THE GARAGE AND TWO WOOD DOORS AND INSTALL ONE
ROLLUP DOOR TO BRING BACK TO ORIGINAL CONSTRUCTION.
REF 906-00363
4 OUTLETS
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 $0.00 0 up to 50 kva/kw $0.00 0
Recept Outlets $4.40 4 up to 100 kva/kw $0.00 0
Switches $0.00 0 over 100 kva/kw $0.00 0
Non Res Appl $0.00 0 . Low Voltage Equipment $0.00 0
Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0
Service to 200a $0.00 0 Misc.Conduit $0.00 0
Service to 1000a $0.00 0 Misc.Conductor $0.00 0
Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0
Motors to 1hp $0.00 0 Circus(mech ride or lights) $0.00 0
Motors to 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 $27.90
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)7545626
2446-46(8/00)
•
r
WORKERS' OMPENSATION DECLARATION: r/ -
I hereby affirm under penalty of perjury one of the following declarations: •• r
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.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed/t the permit Ls valued et one hundred dollars($100)or less.)
❑ 1 certify that in the performance of the work for which this permit Is Issued,I shall not employ any person in any mannor 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 UNUW FUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML RNES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDDION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE IAEOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I em 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.0 Class 0
Contractors Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: 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(5500).):
❑ 1,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
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.).
XI,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code: .. •ntractors License La does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
licens- ant to the Contrac•r License Laws.).
❑ I am .. - I und= 'co, 1 / Business and Professions Code for this reason:
cnali : I AA A4- .. -- 5 3 0 Co
Owner ID verified by drivers license. ra Yes ❑No Dom.is 'cense No. (( res: 1 1 2-7//0
Verification of Ownership by(type of document,i.e.-properly tax bill or deed): T-
V-
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 Safely 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 et 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 Calilomia Health and Safety Code been fully complied with? 0 Yes 0 No
_._ __.__ ..___..___.._._ _ __..i._ _.._ _ _.... __
5 Does or will the oast or QualityiMa or Management
buting o from at y air toe work which the Subject age of this a plication a eNnit for such construction or modification
from the South Coast Air Management District or from any other air pollution control district or agency? �Yes �No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 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 O- COMP IANCE AND AUTHOR • ON OF ENTRY:I certify under penalty of perjury that I have read this application and state that the Information given is
correct. I agre9 o corn•y with all state I:ws : . ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-descri.d pro.: • for ins•:c'• •u .os-. agree not to.. • . : ow occupancy of any building authorized by this pe it until final inspection.
EtSSignature l• Legal• er(s) ate
And/Or Authorized Applicant Date
CODE I INSPECTION TYPE PAIL =AU ;ODE k INSPECTION TYPE PAIS PBIDALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing /Z7
200 Final Re-Roof 210 Final Electrical .I #• �/.
201 Final Block/Retaining Wall 212 Final Fire PreventionMA
,(� '' / !
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition250 Final Building/Occupancy
,�.Y"j1`�'� ,� CITY OF COSTA MESA
� p BUILDING DIVISION
F • ,,,,•re-�' ,► DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
4, 11.11Ca PERMIT E05-00831
%Panto Ise
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ELJBCTRICAL PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 252 16TH PL Status: ISSUED
Suite No Applied: 08/05/2005
Vicinity: GARAGE Issued: 08/05/2005
Parcel Nunmber: 42522223
Applicant: CRAMM, RUSSELL
Address: 252 E 16TH PL #C i' A J
Phone: ISSUED BY:
COSTA MESA,CA • Zip 92627-3838
Owner: CRAMM, RUSSELL .
Address 252 E 16TH PL #C
Phone:
COSTA MESA,CA Zip: 92; 7-3838
Contractor: OWNER-BUILDER
Address:
Phone:
Zip:
License:01.004
SCOP F PERM
CONVERT 2 LIGHTING FIXTS TO RECEPT AN DD 1 Sr RINKLER TIMER CLOCK.
WORK TO INCLUD :3 RECEPT OUTLETS.
FEE SUMMARY
antity Quantity
ISSUE FEE $23.'4 Temp Dist System/Lighting $0.00 0
Temp service test $0.01 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 $3.30 3 up to 50 kva/kw $0.00 0
Recept Outlets $0.00 0 up to 100 kva/kw $0.00 0
Switches . $0.00 I over 100 kva/kw $0.00 0
Non Res Appl - $0.00 0 Low Voltage Equipment $0.00 0
Res Appl .. 0 Low Volt Wiring System/Ckt $0.00 0
Service to 200a $0.00 - I 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 $26.80
Intermed Pole $0.00 0
•
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord. No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work Is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2448-46(6/00)
DECLARATIONS-
WORKERS'
ECLARATIONS.WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit Is Issued.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued.
My workers'compensation Insurance carrier and policy number are:
LearHea ,°- N wngar: --
c(mlrssection neat'of be completed if the permit is valued et one hundred dollars($100)or less.)
❑ I certify that in the•:rformance of the work for which this permit is issued,I shall not e any person in any manner so as to become subject to the workers'
compensation laws o •Ilfomla,and agree that If I should become subject to th r ars'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisi•
ApPlicagtSignahlret
YSAR�' -
Jl!INltl O.'FAILURE E TO SECURE WORKERS' • • SATION COVE:•: IS UNLAWFUL AND SHALL SUBJECT AN EM%:OYELTTO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDITION TO THE••. OF'• PENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLA• •N:
I hereby affirm that I am licens:• •nder provisions of Chapter 9(commencing with Sec 0 of Division 3 of the Business and Professions Code,and my license Is in full
Jgrce'and ffcL.Cic.x
Y.Gontria5Ca SI••- re:
xexvr_ ter; t4- _..-r•
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 end the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
su jects the applicant to a civil penalty of not more than five hundred dollars($500).):
--c.a.- 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.
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 o, of the property,am EXCL,-I ELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Cad: The ontractors License Law oe not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
licen e pur uant to the Contract/y. oe e Laws.). ,• �/
❑ I am Ace '.t u der :c. ' I Business and Professions Code for this reason: Y/ si (C
S �i6- 7 C V J , ,.�_ j,
Owner ID verified by driver's license. es 0 N ' D'nvra _I,Icenljyo-_•" /( - Expires:-'•�a 1
Verification of Ownership by(type of document,I.e.-property tax bill or deed): !J' [ iv
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? ❑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 ❑No
5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application a ermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? DI 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 •F COM: INCE AND AUTHO ON F ENTRY:I certify under penalty of perjury that I have read this application and state that the Information given Is
correct.I kir.. t' car•ly with all state laws d i ,o nances relating to building construction,and authorize representatives of the C' of Costa Mesa to enter upon the
above-descri•:.'r• .pe for ins cl n p e .1 gr not to occupy or allow gscupaacy.otany building authorizeQky this pgfm it II iP on.
CI
;. Signet-g`Of LegaLOwner(d) pate 1y
And/Or Authod :d Applicant mate
CODE t. . '.al', I. PATE .0 u. . cooE• Q&1 ItiTTTW-S
1616 Fixed Syst:m Final Fire Preventi•n ' 206 Final Mechanical
1266 Pool Spa -nal / 208 Final Plumbing -.
200 Final Re-R..f 1 210 Final Electrical
201 Final Block/"etaining Wall / 212 Final Fire Prevention
202 Final Factory ire Place 220 Final Planning Approval
203 Final Sign . 222 Final Site
204 Final Demolitio 250 Final Building/Occupancy
�� CITY OF COSTA MESA
•
BUILDING DIVISION
F t ,,.;,,",,u I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUM R
tt. 11/1411 • PERMIT
P 4-00395
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 252 16TH PL Status: ISSUED
Suite No A Applied: 06/02/2004 ,
Issued: 06/02/2004
Vicinity:
ISSUED BY:
Parcel Nunmber: 42522223 /// '
Applicant: GRAMM, RUSSELL
Address: 252 E 16TH PL #C
Phone: 949-646-0349
COSTA MESA,CA Zip: 92627-3838
Owner: GRAMM, RUSSELL
Address 252 E 16TH PL #C
Phone:
COSTA MESA,CA Zip: 92627-3838
Contractor: OWNER-BUILDER
Address:
Phone:
Zip:
License: 000000
Arch / Eng:
Address:
Phone:
Zip:
License:
SCOPE OF PERMIT
GAS REPIPE AND 1 GAS(OVER 4)OUTLETS FOR UNIT ANLY.REF.:P02-00419
6/25/04:SUPPLEMENTAL PERMIT TO ADD 1 WATER HEATERNENT
FEE SUMMARY
AMT QTY AMT QTY AMT QTY
ISSUE FEE $23.50 Laundry Tub/Washer $0.00 Sump Pump $0.00 0
Backflow irrigation $0.00 0 Landscape Irrigation 50.00 Swimming Pool $0.00 0
Backflow Preventer $0.00 0 P-Trap $0.00 Trap Primer $0.00 0
Bathtub $0.00 0 Pressure Regulator $0.00 Urinal $0,00 0
Clarifier System $0.00 0 Process Piping(per 10 9) $0.00 Vacuum Brkr Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 Vacuum Britr Bkflow(5+) $0.00 0
Dental Units $0.00 0 Septic Tank $0.00 Wash Basin $0.00 0
Dishwasher $0.00 0 Sewer Cap for Demo $0.00 Wash Basin Set $0.00 0
Drain, Floor $0.00 0 Sewer Connect $0.00 Waste and Vent System $0.00 0
Drain,Rainwater $0.00 0 Sewer Private Line $0.00 Water Closet(Toilet) $0.00 0
Drain,Roof $0.00 0 Shower $0.00 Water Heater/vent $12.30 1 •
Drinking Fountain $0.00 0 Sink,bar $0.00 Water Piping(Inst or Rep.) $0.00 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§ 1, 12-21-92)
. EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626 t
2446-46(6/00)
\C"itil.!4-, CITY 0 COSTA MESA
4%M.Mp BUILDING•
aviSION
w , DEVELOPMENT SERVICES DEPARTMENT PERMI UMBER
., Ira .• PERMIT 05-00483
6.
(714)754-5273 • Fax(714)754-4856 • www.ci.coste-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 252 16TH PL Status: ISSUED
Suite No A • Applied: 06/20/2005
Issued: 06/20/2005
Vicinity: UNIT A
Parcel Nunmber: 42522223 ISSUED BY: 0.0
Applicant: CRAMM, RUSSELL
Address: 252E 16TH PL #C
Phone:
COSTA MESA,CA Zip: 92627-3838
Owner: CRAMM, RUSSELL
Address 252E 16TH PL #C
Phone:
COSTA MESA,CA Zip: 92627-3838
Contractor: OWNER-BUILDER •
Address:
Phone:
Zip:
License: 000000
SCOPE OF PERMIT
WATER HEATER CHANGE OUT.
•
• FEE SUMMARY
AMT QTY AMT QTY AMT QTY
ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0
Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0
Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0
Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0
Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1.4) $0.00 0
Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0
Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0
Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0
Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) - $0.00 0
Drain, Roof $0.00 0 Shower $0.00 0 Water Heater/vent $12.30 1
Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0
Expansion Tank $0.00 0 Sink,commercial - $0.00 0 Water Re-pipe $0.00 0
Gas Earthquake Valve $0.00 0 Sink,Floor $0.00 0 Water Service $0.00 0
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: $35.80
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
244648 lacc)
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
O 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.
O I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number: .
(This section need not be completed it the permit is valued t one hundred dollars($100)or less.)
41:1_ I certify that in the parlor nce 1 the work for.ih- h his permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of C litorni and agree t ti Is ould become subject to the workers'compensation provisions of Section 00 of the Labor Code,I shall forthwith
comply with these provi i9ns �— /� / 3II7
Applicant Signature: r 0,_,LA `t' 1 7C�I U
y / 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(Slalom,IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am 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.d Class C
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 the a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
O I.as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). '
/�9
I.as owner of the properly.am EXCLU VELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
�\ Code:The co tors License Law do:• not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license purs ant to he Contractors 'c. se Laws.).
❑ I am exemp aid sec. Business and Professions Code for this reason:'ST j7v/U?
1L/ 1
Skp.atum: (/ L Dale:
Owner ID verified by driver's license. E Yes 0 No DrlYe/e License No. /` Explres:
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 live(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,Ad 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has e
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be tiled with the Costa Mesa Fire Department by every
business which has at any one time during a reponed year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cuoic 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
S Does or wilt 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 Duality Management District or from any other air pollution control district or agency? 0 Yes LI No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any 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 (II"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 COMPLI CE AND RUTH•• 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 ith all state I. and ity ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the
above-described pe for in p- tion '-u,f..-es agree not to occypynrallon-accopancy of any building authorized by thispermi}until fin11 inspection.
Signature Of Legal Owner(s) , a G
And/Or Authorized Applicant Date
CODE•. INSPECTION TYPE DATE INTRIALS MEI Iti9PFCTIONTYPF RAIL INITIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical G'7
1266 Pool Spa Final 208 Final Plumbing (J TT._Vc
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
hili: . •
CITY OF COSTA MESA
4BUILDING DIVISION
w; ;.s. DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
J 'i; • PERMIT E03-01106
•
n'''''`.
•
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
ELECTRICAL PERMIT
•
Job Address: 252 16TH PL Status: ISSUED
Suite No A Applied: 11/24/2003
Vicinity: Issued: 11/24/2003
Parcel Nunmber: 42522223
Applicant: CRAMM, RUSSELL ISSUED BY:
Address: 252 E 16TH PL #C
Phone: 949-646-0349
COSTA MESA,CA Zip: 92627-3838
Owner CRAMM, RUSSELL
Address 252 E 16TH PL #C
Phone:
COSTA MESA,CA Zip: 92627-3838
�1 ds
Contractor: OWNER BUILDER ��..0 i a
Address: Otis->"
Phone:
Zip:
License: 000000
•
MISC ELECTRICAL FOR EXTERIOR OUT ETE P!ZM-IT 6L ,\
FEE SUMMARY•
J\
Quantity Quantity
ISSUE FEE $23.50 Temp Dist System 1 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 $2.20 2 up to 100 kva/kw $0.00 0
Switches $0.00 0 over 100 kva/kw $0.00 0
Non Res Appi $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 $18.20 1 •
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(meth 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
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations.(Ord.No.92-28,§ 1, 12-21-92)
EXPIRATION: 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
2445-46(6'00)
•
• ,
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
O I have and will maintain workers compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This tion need not be comple d if the permit is valued at one hundred dollars($100)or less.)
i
I certify that in the pe(forman of the work for which this per is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws t 9 li rnia,and agree that'l ould b oma subject to the workers'compensation provisions of Sectio 3700 of tlhe Labor Code,I shall forthwith
comply with these ons ' (- -- - � l f V I � a77_,......--)->
Applicant Signature: -2 Date: tID
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PEN LTIES AN CIVIL-FINES UP TO ONE HUNDRED
THOUSAND DOLLARS($ID0,00I),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 aftirm that I am licensee 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.a Class P
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 wnich 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
Busiss 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
s )acts the applicant to a civil penalty of not more than five honored dollars(5500).):
pp
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 tor sale(Sec.
7044,Business and Professions Code:The Contractors License Law(toes 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 ear 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 pf ch.properly,am EXCLUSIV LY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The conir ctors License La ...s ot apply to an owner of properly who builds or improves thereon,and who contracts tor such project with a contractor(s)
license pa sua to the Contracto. ce -e Laws.).
O I am ex:J pt der sec. / _Business and Professions Code for this reason:
Willa (y�
Signature: I! . �� �— Date: Z �J�J'
Owner ID venfie• •y Driver's license. 0 Yes 0 No Driver's License No. . Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,Ialsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 6,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires, with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? U YesIU 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 ot the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(It"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(Duality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No
8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COM IANCE AND AtfT14O" •TION F ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree t co ly with all state la - . d city or ipances relating to building construction,and authorize representative of the City of Costa Mesa to enter upon the
above-describod ,Darty for inpe• io .0 p• 'VI agr not to occu or I occupancy of any building authorized by this pe it n01 fin I i e Ion.
�� ,'�/ •
Signature Of Legal Owner(s) a
And/Or Authorized Applicant Date
iOoE • INSPECTION TYPE DSTI INTITIALS CODE. INSPECTION TYPE ILII INTITIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Root 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
•
204 Final Demolition 250 Final Building/Occupancy
9 CITY OF COSTA MESA •
4 BUILDING DIVISION
F . ,I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
�• �� PERMIT
Sbeft arso4+0' P02-00492
(714)754-5273 • Fax(714)754.4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT (} .}I,'G ,t^,Q'
Job Address: 252 16TH PL a , Status: ISSUED
Suite No B � U fi Applied: 07/29/2002
Sia 5�y Issued: 07/29/2002
Vicinity: BATHROOM l�
•
Parcel Nunmber: 42522223 ` ISSUED BY:
Applicant: CRAMM, RUSSELL •
1�11�,�NSION
Address: 252 E 16TH PL #C E1' r 1 I'jl.\
SION
Phone: 949-646-034927- 636 �T O
COSTA MESA,CA Zip: 92627-3836 L
PER • •
Owner: CRAMM, RUSSELL EXPIRES `X' 1
Address 252 E 16TH PL #C
Phone:
COSTA MESA,CA Zip: 92627-3838
Contractor: OWNER-BUILDER
Address: .�'/�t\
Phone: Sx S iBS /4
Zip: i / 6 , /
License: 0 pj1+'
Arch / Eng:
Address:
Phone:
Zip:
License:
SCOPE OF PERMIT
PLUMBING TO INCLUDE: 1 BATHTUB AND 1 LAUNDRY TUB/WASHER.REF.:802-01179
FEE SUMMARY
AMT OTY AMT OTY AMT OTY
ISSUE FEE $23.50 Laundry Tub/Washer $9.80 1 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 $9.80 1 Pressure Regulator $0.00 0 Urinal $0.00 0
Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0
Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0
Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0
Drain,Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0
Drain,Roof $0.00 0 Shower $0.00 0 Water Heater/vent $0.00 0
Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0
Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0
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: $43.10
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
2449-46(Woo)
U I nave ano wilt maintain workers'compensation insurance,as require°oy section 3/Uu or file Laoor Cale,for the performance of the work for whlcn this permit is issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: Pol mbar:
,,,AAA'''
(This... section need not be corn••Wed the permit i. ad at o 'hundred dollars(8100)or lass.)
I certify that in the pe •rman•=of the work for wlych thi permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws• ' alit• ia,and agree thy1/Y sho d become subject to the workers'compensation provisions of Section 3700 of a Labor Code,I shall forthwith
comply with these p ••isi• s.
Applicant Signature: k - Date: 7/'7 G7 G 2
WARNING:FAILURE TO SECUR ORKER ' PENSA COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIE AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(51 00,000),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.Lic.4 Class N
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).
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
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 o n employees,provided that such improvements are not intended or offered for sale.If,however,the building or Improvement is
sold within year of completion,the o ner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I,as ow r of tfle property,am U IVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code: a con actors Licensew 0 not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
licens rsu nt to the Con a rs.0 a Laws.).
❑ I am x under"cc J/• • 4 ! Business and Professions Code for this reason: r�
Signature: b, !7� ^ Date: �/2 9 0 4)
Owner ID yen ed by driver's license. Yes 0 No Driver's License No. /� /([)�� Expires: /7005
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 e
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires, with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
_hcnruct_..n...__.m.modification 5 Does or will the oast Air or Quality
a or future building occupant at requirer for the work which is the subject this a estion au Nnit for such construction or modilicatlon
from the South Coast Air Oualiry Management District or from any other air pollution control district or agency? �Yes LJ No
(Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If yes•,the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). .
r
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
B (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.
Signet Date:
CERnI- ATE OF OMPIJANC.E • D TION OF ENTRY:I certify under penally of perjury that I have read this application and state that the information given is
cone . I agree • comply w all-ta• cos a city ordinances relating to building construction,and authorize representatives of a City of Costa Mesa to enter upon the
abov.-da• i/ •prope,{ty • ii' •yy'• rpos I agree not to Qcjypysr-ake upancy of any building authorized by ptiis rni finalinspection.
t/ Ll/� �(J I 7(/
Signature Of Legal Owner(s) Date
And/Or Authorized Applicant Date
BODE I INSPECRON TYPt PAIL MOW Celli IN?ECT10N TYPE QAIE PALS
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 Black/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
ADORT5 omame& 252 16TH PL BIT: -Rae' CITY OF COSTA MESA - BUILDING PERMIT Z1,-1 l �'�7� '+lam
IsE.2 yE -
IcwaIN:RUSSELL CRAMM \ QQ PERM NO: E 086334
.DmtstPO BOX 5370 p S`J
BALBOA ISL 92662 92660 f PERMIT NO: E 086334 PLAN CHECK NO: N GOVT: N SUPP : N
646-0349
APR..AWLIVGAOORE33: CONSTRUCTION TYPE: PERMIT TYPE: ELE PURPOSE: OTH
ARCRRECT OR ENGINEER: UE.NO.: JOB DESCRIPTION : INSTALL 2 DISHWASHERS SQ FT:
ARM OR ENG.'S ADORESS: MMT:
CLAIM VALUE: CALC-VALUE: GROUP OCC: R-1 /
CONTRACTORS NATE
• CONTRACTORS IIMMO COMMENTS : X
ADORES& MC.NO.: itftftftitftftftitft#ft#ftftftftftftftft SEIFIE#1f1F3E1EIEif##iEiFlflElklElfif##1FK##3fM3flFN'#iEIEMiE1EiFiFIEiFiEiEiFiEiEMif#EIEM#iflEltltiFlE
wit ZONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby affirm soder penny d perjury that I em licensed order mo,ieon d Chapler 9 SETBACK S
(co imendng weh Section 7000)of Dimer 3 d the Business end Professions Cod.,and my Moan..S in full force and Nfed.
CITY sac.NO.: LIC.CLASS: sac.NO.: EXP : MAIN BUILDING ACCESSORY BUILDING
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Darr Contractor- LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
COWNER BUILDER DECLARATION:I hereby affirm under penelmfrom wrean
y of perjury that Ian throng the Cdon Lark Lew for de
following ream(Swion 7031.5 Business and Prde sCode:Any city a county wince reewee apenmi to Oonewd.slier,improve. PARKING REQ. PROV: PARCEL : 42522223 ZNE: REF NO:
e Steedorpu reealrani Iheprnada awle"dt eeCOdiradora L�the Nqa a(( erall commenca ing 7lcor d avian 3d theshe
PLANNING NbTES>
Business and Professions Code)or that hem the is exempt gsehom and the Weis for Be algid exemption.wry vblabn of Sova >
7031,5 by any applicant fora panne nhbfade the applicant to a dei penalty at rho more than free hundred doles RSOoD. M M*ft#*ft ft ft ft ft ft*ft ft ft ft ft It if ft ft ft#ft ft ft ft ft ft ft It ft ft tt ft ft ft SE ft ft SE#ft k 15 5E it ft ft ft It ft M ft#ft ft tt ft 55*%#iE tt N:M if M is f#iE k k*f#
❑ I.een.na althe Pr"pny ormy enpbyess w.hwapeeas thei.de compeeaion.wn0 do the work,and the.lmnn is not intended DEVELOPMENT SERVICES R E U I R E M E N T S
a off eredfor isle(Section 704u si.Beee Professions Code:The Contractors
e Law amend apply loan owner of propary Q
who beide or improves thereon,and ata the wail work tinsel or herbed a throach hi or b ovm enaloyew,Provided Ills with
i nurser.net lnlard.dadnred teraSt how.vr,tie• • wsanSw noreyeadmmpatm
it. ZONING APPROVED BY : DATE:
�[ er
onwhew
buikler will Ihe burden d or lis d W
Moving he or she did n • . • • for the purpose al.
[] I,a owner el the Weasel'''.
an uduvey oaured:q'alb .• a"Weed 0 a• •' . (3edvn 104.&eksse and
Prof.:.:• Code:The Connector,Licwrss Law does not •• d poperry or improve.thereon and wed BUILDING APPROVED BY : (/'/yr DATE:
Pt
unPrefect•rhem
a mrwv(a)licensed. Naar.�Ii 1F /
■ Prmd. APPLICATION ISSUED BY: 6
Section: B.APc., . sa.m: �.. DATE: �j1
2,-Zy—`r7 0.. v //
/ ftltrltftftftftlrftftltltftltftftltltftftftftltltftftftftftftftftftftftftlt ftftfrftrftftftttftftltltftftftftftltftftltftftit ft
LEGALIZATION:N F E E SUMMARY STRUCTURAL SEG ENT:
• reedy that I am.were d and wrdaa W the n"uveman d CaOari0 Health and Splay COM etas e,Sedans 21505.25533,and
far
• fordthat o eta Soh°mi ionIronthhebudding eN�-Maa(cede nC ted.needRenddesSa+will a°n ncitatiionsmd e ere wNaavewe BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 4 , 00
Date: Appian: 50% SMIP/NON-RES
• WORKER'S COMPENSATION DECLARATION:!hereby earn wider portly d e of perjury one de blowing dadeatcos: PLAN
ISSUE FEE 22 ,00
o lhn mmwganecaNcatedmrxoeairmebwaAerimmperaatbn.espoidedfabySediar370polhelaba BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
Code, dam,
ap. .K dthe with. . fawithma ."
w, the pade .d. TOTALS----> 4 . 00 22.00 0. 00 26 . 00 26 . 00 . 00
❑ I hew end wit marten workers'odmpeeeun imnaro,n required by Swim 3700 of Oa Labor Code.for the p.rfonmahn d the
work for Milch ms permit s issued.My waken'compensation insurance Genie and pony number we:
Cartier REVENUE DIVISION TOTALS--> COLLECTED: 26 .00 OVER/SHORT: . 00
PotiyNumen BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
(This sectio,need not be competed I the permd s for one hundred Coiled(Sf001 a w.) 26 . 00
❑ t coney that in 0e performers of the work for which tins permi a issued,I ran not employ M pernn in any mars so as b
becane*did to the ova TP Pa eraatiom Mw 0Caiaria.ardagreatsi tehodd ba Ons Ke ltolbe waken' itfftff1Efffttfkffff*ffffk•*%fff•*fff*fffffttttf it**1E$M1titft***it***3kf#f*fffktt#1k*M1t Si*ffflttt
compensation proviseos el Sedan MO d dm Labor Code.I.hell bMwnh comply wee coca.provisions. INDIVIDUAL F E E BREAKDOWN
Data: Applun:
Warning:Failure fosecure marten'cmroeosation coverer iseniawM•and Anaaub)ed nernidoya tcdminl penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
civil fines W to one hundred thousand dolMrs 0100.0000 n addition to the coat of compensation,damages as provided for In
Section aDdpfm.LOOT Cods,Mine.and.mm.y.flee ELE 4 RECEPT/OUTLET 1 ST 20 EA. 1 . 00 4 . 00
CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty el perjury that Ilse ie e mnmdion Moa;agency for the END OF FEES
performance of the work for which the pent is issued(Salon 3097.Cie C).
LENDER'S NAME
LENDERS ADDRESS:
I caddy Thal t he . .this application and side Iha the above eicemelion a correct I agree 10 comply wish alt city ed county ordinances
end state le g b Mildly cond•uamn and authorize tepresen acmes d this city to over upon the above-mentioned properly
fa »d "BUSS fbyAMM IUD
n _ .
�/�(/f Dale.! Z/—�7 ^`w! ,�(
` SIgnSlur / ent/APpbcenVComrwa DATE
awn51-wi.WP) Whn S Sdery:Oman-Rh Canary-Appkum:Pink-Revenue:Goldenrod-Amend
oiRUCTIGN AND PLANNING - y
F IT
PU L.- P. SPP ._
,r'PROVALS Permit $ Date Inspector /APPROVALS Permit ��'- Date I Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Locauon I
:
2. Soil Pipe-Undrgrrd. I 53. Steel Reinforcement 1 _ • l
_t: 3.-1Electr,cal Conduit Ut:l:;y-Undrgrnd. l 54. Forms I -I
• I4. El2ctricai CmtciutUrdrgrr.d. I 55. Electrical Bonding ;I. -.
5. .Steel Re,nforce:nent 56. Rough Plumbing & Pressure Ten I I
.. - 6. Feet-Arica, UFER Grn+. 1 I 157. APPROVAL TO COVER•GUNITL �^ :I'
_1 - 7- Footings i----_-�_-- 58. Electrical Condiul-Unnrgrnd. ---� -1 I
8. Foundation I - 59. Gas Pipe, 0 Undrgrnd. Test --_I
•
P. V:'ater P pe•Undrerr,d. -4-
I 60. Backwash Lines, P-Trap, ETUntlror nd. I I -
10. Structural Floor System I r , 61, APPROVAL TO DECK I - -_
-__-I
7I.tP;goer:•; Sewer Line & House Connection i 62. Backwash & Receptor-Final
II_-
12. Seer Ca- - I� -.-j
Sewer '---._-1
63. Heater & Vent-Final I 1 i
7:,', Roof Drains -_-r-_
64. Plumbing System • Final 1 .1
14. Rough Plumbing - 65. Electrical-Final I
15, Rough Elect,i..ai CJnduit ..--'-7---I 66. Solar System-Final 1-_---
�: ; 16. Rough Electric tA'irir' i 67. Fencing & Access Approval - ---_--!
17. Rough
Rpu ntn';ring Sign -68. APPROVED FOR PLASTERING_---1I 1rt
d
i 1E. Rough E!ecuical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
-1
19.-sough Heating &;Air Conditioning _j n ' EIRE_cBP-RcREGUlREMENT :-.-i
I
20. Rough Factory FFire?Oce _ _ , = •- r, APPROVAL'S_,_; Pit re # ' I I
^
21. Dicta, in;Structure . I I- .. + 70:Underground Hydro • -I 1
22..Ducts, 'Jentileting I I '- ", _l 71. Proclu�t Pipin_q.iliiiias I' Oil - '
23. Gas Pioe r3ou h &Test lu ,
9 r 1 rt '> , = 72. Underground Flush
24. Roof Framing I "- 73. Underyrnri.Storugi Tank: 0 Gas f1-1.011 I I
25..Roof.Sheethinr 'r; `. �'. : - -`-I - I
! 1 _ 74 Overhead Hydrec' , 1
26.-:T-Bar Ceiling (Structural) &Tvionocoat - r 1 - - . 75. Dry Che�„eal ="'� _
i
27. :Frame and Flashing:, I .- d ""r- , -- I- _.I
r .. . 76. Dry Stapd pJ Pz::-.
:1 28. Lathing & Siding - _ " 7Z'. FIXED-SYSTEM FINAIL' r 7
29. Insulatiod Io. 78. FIRE PREV. FAA 1. I. ( I I
30. Drywall Nailing i - I HEALTH.DEPT.REQUIREMENT i
• 31. Plaster Brown:Coat - '' . ..:- I • 79. FINAL INSPECTION i -,
' 32 Electrical:Power Meter-Fi•nal 80;. FOOD CERTIFICATE ISSUED- I I
33.-Final Electric. - - - ' Notes:
a." till-C-
34. Final'iieating:& A:r`Conditioninc- I • - - - c-•,: - 1
35. Final Gas Pine=Test ' - - 7 - _ > � '-• _ Pr
i t. _ :.r- ia.� 1
. 36..Hooij or Canopy - tib'-y
� 37. Flnal'Factory Fireplace I
- 38. Finah Plumnh ng .. .. a .. I ti - + - } ---�
I 39. Water Service-Final: ? -' _r _ er
I
' . 40, Gas Service-Fina! , • �. _ ;
. 41. Solar Domestic-Final • - ' ..
42. Backflow Prroventer. _ r - 1 }' - _
43. Backflnrov Irrigation' _ - j ` - `
.. r.
'44. Landscape Irr igat.on System-_ .: I_-t .: + . _ = - --
45..S
.uno .Attenuations . .' -- .'.' '-. ^• !. - _ -'` ,.
'q6. Handicap-Regulations - .
'47. FINAL STRUCTURE & BUILDING ' ii-
s
48.tEINAL PLANNING; - ,, . ..- . '--- --'----'--
• :49. Electric. Release to Edison .- " :I F u •., ------
• '50.-Gas Release to Southern Caiifornia,Gas Col _ - _ -__ •.,
51. CERTIFICATE OF OCCUPANCY I I
No. Daze 1
' tF - CITY OF COSTA MESA
49 BUILDING DIVISION
F DEVELOPMENT SERVICES DEPARTMENT PERMIT NUM R
0 PERMIT
%sonars" P 4-00395
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 252 16TH PL Status: ISSUED
Suite No A Applied: 06/02/2004
Issued: 06/02/2004
Vicinity:
ISSUED BY: ��./
Parcel Nunmber: 42522223 /
Applicant: CRAMM, RUSSELL
Address: 252 E 16TH PL #C
Phone: 949-646-0349
COSTA MESA,CA Zip: 92627-3838
Owner CRAMM, RUSSELL
Address 252E 16TH PL #C
Phone:
• COSTA MESA,CA Zip: 92627-3838
Contractor: OWNER-BUILDER
Address:
Phone:
Zip:
License: 000000
•
Arch / Eng:
Address:
• Phone:
Zip:
License:
SCOPE OF PERMIT
GAS REPIPE AND 1 GAS(OVER 4)OUTLETS FOR UNIT A ONLY.REF.:P02-00419
6/25/04:SUPPLEMENTAL PERMIT TO ADD 1 WATER HEATERNENT
FEE SUMMARY
AMT QTY AMT QTY _ AMT QTY
ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump ' $0.00 0
Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0
Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0
Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0
Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0
Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0
Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0
Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0
Drain, Roof $0.00 0 Shower $0.00 0 Water Heater/vent $12.30 1
Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord.No.92-28,§ 1, 12-21-92)
. EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6/00)
_nKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
O 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 is Issued.
My workers'compensation Insurance carrier end policy number are:
Carrier: Policy Number:
(This section need not be comple -. ' e permit is valued at one hum :d dollars($100)or less.)
yc I certify that in the perf•rmance o he work for w h, is pe is issued,I shall not employ any person in any manner so as to become s bject to the workers'
\compensation laws• Califon'',and agree tha f,/•ould be ome subject to the workers'compensation provisions of Section 3700 of Labor Code,I shall forthwith
comply with these p`` t) (//l,. ClApplicant Sgnature: A //_i _ ..._41 Date: V 7 /
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 DOl1ARE(5100,000),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.Lic.A Class N .
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).
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
subjects the applicant toe civil penalty of not more then five hundred dollars($500).):
O I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not Intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
(,)V,-as ow • of th• property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
v Code: • e contr ctors License Law.oe not :poly to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
livens: pursue toer the Contractor :'se .w6.). /
O I am :x: •oder se r Business and Professions Code for this reason:
Signature: tam
Date: l'/2C16/67
Owner ID verified by drivers license. ■ Yes 0 No Drivers License No. Expires: / / f,e/S
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,talsework,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 weigh)of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑yes ❑No -
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or wilt the applicant or present or future building occupant require for the work which Is the subject of thisplication 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 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 ❑No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
.7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No
8 Of"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 O'COMP CE AND A •' •• • •• ENTRY: I certify under penalty of perjury that I have read this application and state hat the information given is
correct, I ogre: . comp with all state laws • ord ances relating to building construction,and authorize representayyes of///hhha City sta Mesa to enter upon the
above-describ-•r..•. for in .:•ion.0 •. :•. gre not to ancy o any building authorized by th. per rtu(ifLltil final in je.rn _
Signatu : • Legal n.ner(s) (/
Da
�j
And/Or Authorized Applicant Date
CODE I INSPECTION TYPE ME INTmAL$ CODE. INSPECTIONTYPE gdtc INTIL66$
1616 Fixed System Final Fire Prevention _ 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing J I -19 -c 9
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
f CITY OF COSTA MESA •
4� 9 BUILDING DIVISION
> .'I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
1 or P
PERMIT
b+ro.mw�* PO4-00395
(714)754-5273 • Fax(714)754-4056 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 252 16TH PL Status: ISSUED
Suite No A Applied: 06/02/2004
•
Issued: 06/02/200
Vicinity:
ISSUED BY:
Parcel Nunmber: 42522223
Applicant: CRAMM, RUSSELL
Address: 252 E 16TH PL #C
Phone: 949-646-0349
COSTA MESA,CA Zip: 92627-3838
Owner: CRAMM, RUSSELL
Address 252E 16TH PL #C
Phone:
COSTA MESA,CA Zip: 92627-3838
Contractor: OWNER-BUILDER
Address:
Phone:
Zip:
License: 000000
Arch I Eng :
Address:
• Phone:
Zip:
License:
SCOPE OF PERMIT
GAS REPIPE AND 1 GAS(OVER 4)OUTLETS FOR UNIT A ONLY.REF.:P02-00419
FEE SUMMARY
AMT QTY AMT QTY AMT QTY
ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0
Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0
Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer - X0.00 0
Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0
Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0
Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0
Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0
Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0
Drain, Roof $0.00 0 Shower $0.00 0 Water Heater/vent $0.00 0
Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0
Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0
Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No.92-28,§ 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6/00)
DECLA``RAt/ONS ("
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This Pion need not be completed it the permit is valued at one hun• ad dollars($100)or less.)
rrt I certify that in the pedo 'an : .f the work for which this pe is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation taws of ,lifor .,and agree that' I sl•uld be ome subject to the workers'compensation provisions of Sectjon 37 of the Labor Code,I shall forthwith '
comply with these pro,-ion .
Applicant Signature: 1_ . /. -��` _ Date:
WARNING:FAILURE TO SEC 'E WORKERS'COMPENSATION COVERAI E IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND IVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARS(s100,000),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 lull
force and effect.Lic.a Class N
Contractors Signature: Date: •
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued,(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
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.).
at I,as owner• t :property,am EXCL SIVELY CONTRACTING WITH,LICENSED CONTRACTORS to construct the project(Sec.7044.Business and Professions
Code:T . con actors License Law s not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license,ursu. 1 to the Contr icense Laws.).
❑ I am e -mp nder sec. Business and Professions Code for this reason: /
Signature: ,�uia6 Oats: Co(2/tX-f
Owner ID v:ri led by drivers license. ❑Yes ❑No Driver's License No. / Expires: 1/?2-17a..gr
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑Yes ❑No
(Section 25505 of the California Health and Safety Code requires, with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds. or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑yes ❑No
(Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes U No
(Section 65850.2 of the California Government Code requires that the requested information bo furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No
(If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
B (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 CO LI AND AUTHO- 0 F ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to co ply ' all state laws . 1 inances relating to building construction,and authorize representatives of the City f Costa Mesa to enter upon the
above-described pr or inspection pu .. . a ee not to occupy or allow occupancy of any building authorized by this permityhtil fine inspection.
11 th
Ignature• • ner(s) le
And/Or Authorized Applicant Date
CODE 1 INSPECTION TYPE Pz1IE INTITIALS CODEINSPECTION TYPE DATE IMIELS
1616 Fixed System Final Fire Prevention _ 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing )1-19 -C'1 6.1q
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
4 ' NF CITY OF COSTA MESA •
BUILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER
1. 1 IF
W
PERMIT
02-01592
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa Eltni_DING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 252 16TH PL Status: ISSUED
Suite: B' Applied: 09/30/2002
Vicinity: Issued: 12/10/2002
parcel Number: 42522223 Zoning:
Applicant: CRAMM, RUSSELL
Address: 252 E 16TH PL #C ISSUED BY:
Phone: 949-646-0349
COSTA MESA,CA Zip: 92627-3838
Owner: CRAMM, RUSSELL
Address 252E 16TH PL #C
Phone:
COSTA MESA,CA Zip: 92627-3838
Contractor: OWNER-BUILDER
Address:
Phone:
Zip: License: 000000
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
CONVERT EXISTING BEDROOM 1 CLOSET INTO A NEW 39 SF BATHROOM;ADD CLOSET TO BEDROOM#2;ADD FAU CLOSET AT TOP OF
STAIRS.INCLUDES UPGRADE OF PLBG/MECH/ELEC.
REF.:B02-01179
FEE SUMMARY
Plan Check: $254.31 Calc Valuation: $25,000.00
Permit: $391.25 Claim Valuation: $25,000.00
SMIP Res: $2.50
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: $648.06
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 Existing: 0 Required: 0 Proposed: 0
•
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord.No.92-28,§ 1, 12.21.92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections end final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6woo)
NUJ. .VJlildiA . I i z......
. . I ,-, ' 4 ,
A-213-N
MQ "
WOtx tor wnlrn mn yennm.a mauve.mauve. v -.mun
. : -
❑ I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not be comp/e '•it the permit is v: ed t one hundred dollars(S100)or less.)
I
❑ I certify that in the ped• an•:of the wo f• ich his permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of :II, nia,and agr-: - If I ould become subject to-tbe workers'compensation provisions of Section 3700 tppppe Labor Code,I shall forthwith
comply with these Pr• • •ns. I •Zof I V+1 I
Applicant Signature: Date: L
WARNING:FAILURE TO SEC RE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES D CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am 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.a Class a
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
In 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
u, jects the applicant to a civil penally 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 awn 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,Ih•owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I,as owne • the properly, : - C SIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:T :
rla
CITY OF COSTA MESA
BUILDING DIVISION
Fk ;.s( DEVELOPMENT SERVICES DEPARTMENT PERMIT N MBER
v irrila
PERMIT
I
M03-00042
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
MECHANICAL PERMIT
Job Address: 252 16TH PL Status: ISSUED
Suite No B Applied: 01/30/2003
Issued: 01/30/2003
Vicinity: UNIT B
Parcel Number: 42522223 ISSUED BY:
Applicant: ZOMA, KEN
Address: 7252 GARDEN GROVE BL
Phone: 714-898-6629
WESTMINSTER,CA Zip: 92683
Owner CRAMM, RUSSELL
Address: 252 E 16TH PL #C
Phone:
COSTA MESA,CA Zip: 92627-3838
Contractor: KOOL AIR COMPANY
Address: 7252 GARDEN GROVE BL
Phone: 714-698-6629
WESTMINSTER,CA Zip: 92683
License:427923
SCOPE OF PERMIT
MECH PERMIT IN CONJUNCTION WITH CONVERTING AN EXISTING BEDROOM&1 CLOSET INTO
A NEW 39 SF BATHROOM;ADD CLOSET TO BEDROOM#2;ADD FAU CLOSET AT TOP OF
STAIRS.INCLUDES UPGRADE OF PLBG/MECH/ELEC.
1 INST FAU<100K BTU,COMPRESSOR UP TO 3 HP/100K BTU(SPLIT SYSTEM).REF:
B02-01179
•
FEE SUMMARY
Quantity Quantity
ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0
Inst FAU<100 k BTU $14.80 1 Repair/Alt Refrigeration Unit $0.00 0
InsLFAU>100 k BTU $0.00 0 Ventillation System $0.00 0
Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0
Inst/Rep.Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0
Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0
Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems
Gas Piping $0.00 0 Up to 3 hp/100 k BTU $14.70 1
Factory Fireplace $0.00 0 3 To 15 hp/500 k BTU $0.00 0
Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00• •0
VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0
Vent Fan/Single Duct $0.00 0 Over 50 hp/Over 1,750 BTU $0.00 0
Appliance $0.00 0 Boilers
Fire Dampers $0.00 0 Up to 3 hp $0.00 0
Smoke Dampers $0.00 0 3 To 15 hp $0.00 0
Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0
Air Handlers< 10000am $0.00 0 30 to 50 hp $0.00 0
Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0
Floor Furnace $0.00 0 Other Mechanical Fee
Floor or Suspend Heater $0.00 0 Investigation Fee $0.00
Plan Check Fee $0.00
•
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 end 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
2441646(6/00)
'•7i4W►r7,111•1:6
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
O 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.
(Q I h and will..((nmaintain 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 o re
otnpensatto Ins ce carne and policy number are:
WV-0
Carder t l ��C t' Policy Number: I/nnc I
(This section need not be completed the penbit is va/Led et one hundred dollars(S100)or less.)
O I certify that in the perform. .: of th ork to 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 Cali/ Se
ia,and agree at if I should become subject to the workers'compensation provisions of ctlpn 3700 p the Labor Code,I shall forthwith
comply with these pro is. s. 1 (3 J! 03
Applicant Signature: �' 0 v 1 Dale:
WARNING;FAILURE TO SECURE WORKERS'COM ATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOIURE(S100,003),IN ADDITION TO COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLAR• ON:
I hereby affirm that I am licensegp •er.rgvJ4tp p of Ch ler 9(commencing with Section 7000)a1 Division 3 of the Business an P1,oles ions Code,and my license is in lull
force and effect.Lic.C ‘+4.1(21.-41 5 - Class N (.
Contractor's Signature: •1 11 N Date: I /56/05
CONSTRUCTION LENDING AGENCY:
O I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code),
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
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 property who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
O I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ 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 ❑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 a plication a ermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes j�No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No
(If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No
6 (II 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 •••ORIZATION 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 w'h all : .to laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the
above-described pro.:rty Id!i ..action pu•oses.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
• /•
/ /Signet :O Legal Ownegs) / / Aa
l ,
"Ihorized Applicant ! Date
CODE I gISPECTIONTYPE RAIL INTmAL$ CODE. INSPECTION TYPE PML INTRULS
1616 Fixed System Final Fire Prevention _ 206 Final Mechanical 1-U-o 3 �
1266 Pool Spa Final _ _ 208 Final Plumbing _
200 Final Re-Roof • 210 Final Electrical
201 Final Block/Retaining Wall _ 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign _ 222 Final Site
204 Final Demolition _ 250 Final Building/Occupancy
•
CITY OF COSTA MESA
4q BUILDING DIVISION
y
f ,,,,, DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
/ty I PERMIT
02-00735
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 252 16TH PL Status: ISSUED
Suite No B Applied: 12/10/2002
Issued: 12/10/2002
Vicinity: UNIT B
Parcel Nunmber: 42522223 ISSUED BY:
Applicant: CRAMM, RUSSELL
Address: 252 E 16TH PL #C
Phone: 949-646-0349
COSTA MESA,CA Zip: 92627-3838
Owner: CRAMM, RUSSELL
Address 252 E 16TH PL #C
Phone:
COSTA MESA,CA Zip: 92627-3838
Contractor: OWNER BUILDER
Address:
Phone:
Zip:
License: 000000
Arch / Eng :
Address:
Phone:
Zip:
License:
SCOPE OF PERMIT
REF:B02-01592.CONVERT EXISTING BEDROOM 1 CLOSET INTO A NEW 39 SF BATHROOM;ADD
CLOSET TO BEDROOM#2;ADD FAU CLOSET AT TOP OF STAIRS. INCLUDES UPGRADE OF
PLBG/MECH/ELEC.PLUMBING TO INCLUDE:2 FLOOR DRAINS, 1 GAS SYSTEM(1-4 OUTLETS), 1
GAS RE-PIPE, 1 SHOWER, 1 KITCHEN SINK,3 WASH BASINS, 1 NEW TOILET, t SEWER CONNECT
ON-SITE. 1 LAUNDRY TUB/WASHER REPLACEMENT.
FEE SUMMARY
AMT CITY AMT OTY - AMT OTY
ISSUE FEE $23.50 Laundry Tub/Washer $9.80 1 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 $29.40 3
Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0
Drain,Floor $19.60 2 Sewer Connect $0.00 0 Waste and Vent System $0.00 0
Drain, Rainwater $0.00 0 Sewer Private Line $24.65 1 Water Closet(Toilet) $9.80 1
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No.92-28,§ 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446.46(6'00)
WORKERS'COMPENSATION DECLARATION: O
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of e..
work for which this permit is issued.
❑ I have and will maintgaMIn 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:
Carder: Policy Number:
(This section need not be completed I1 the permit is valued et one hundred dollars(3100)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 DOU_ARE($100.000),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION: -
I hereby affirm that I am 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 A
Contractors Signature: Dale:
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• the property,am EXCLUSIV- V CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044.Business and Professions
Code:Thco tractors License La d•�117 .of apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
i
license. rsu- t to the Contract. s • .e Laws.).
❑ I am e. m• under s.., ;I I-- . •-Professions Coda for this reason:
Signature: .(/ �
' 0 g�/ Date: S
Owner ID ye ified by d'Ger's license. • a •es 0 No Driver's License No. Expires: _222242S-
Verification
22 2 42
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date: _
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑Yes ❑No
(Section 25505 of the California Health and Safety Code requires,with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No .
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a,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 LU No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No
(1f yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No
B (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: -
CERTIFI•ATE OF OMPLIANCE AND : '•• •TION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. agree • comply with all st. s • d city ordinances relati.• • -.'.' • •nstruction,and authorize representa'yes oft e City of Costa Mesa to enter upon the
above- '.e•property r in .f'40,• ••o.es.I a. : - . . cupy or allow occupancy of any building authorized by th permit nyl,fi spection.
• It
Signature Of Legal Owner(s) c Dale
And/Or Authorized Applicant Date
CODE/ INSPECTONTYPE gA[E ItfTITIALS OBE Iy$PECTIONTVPE RALE Ifni&
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final _ 208 Final Plumbing /� ___d__4
200 Final Re-Roof 210 Final Electrical :IC 4 ,/_
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
- `5Tp 6 • CITY OF COSTA MESA •
4 BUILDING DIVISION
o•rf DEVELOPMENT SERVICES DEPARTMENT PERMIT MBER
PERMIT
2-01179
+y4t.ORMSO 41.
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesaBc UItDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 252 16TH PL Status: ISSUED
Suite: B Applied: 07/29/2002
Vicinity: Issued: 07/29/2002
Parcel Number: 42522223 Zoning: P�
Applicant: CRAMM, RUSSELL ISSUED BY:
Address: 252 E 16TH PL #C
Phone: 949-646-0349
COSTA MESA,CA ' . Zip: 92627-3838
Owner CRAMM, RUSSELL
Address 252 E 16TH PL #C
Phone:
COSTA MESA,CA Zip: 92627-3838
Contractor: OWNER-BUILDER
•
Address:
Phone:
Zip: License: 0
Arch : - - Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
REMOVE AND REPLACE APPROXIMATELY 350 S.F.OF DRY WALL,SUBFLOORING IN UPSTAIRS BATHROOM,AND REMOVE
SIDE LIGHT WINDOW(8 S.F.)AT FRONT DOOR AND REPLACE WITH DRY WALL AND STUCCO.REPLACE 2(2'X 3'),
2(3'X 6'),AND 2(4'X 6')WINDOWS,ALL VINYL CLAD, DUAL GLAZE.
FEE SUMMARY,
Plan Check: $0.00 Calc Valuation: $12,000.00
Permit: $209.25 Claim Valuation: ' $12,000.00
SMIP Res: $1.20
SMIP Com: $0.00
Other: $0.00
•
Inspection: $0.00
Total: $210.45 -
PLANNING &ZONING
SETBACKS ,
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTES:
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2448.48(WOO) •
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations: '
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,a4 provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit Is Issued.
❑ I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued.
My workers'compensation Insurance carrier and policy number are: '
Carrier: Policy Number:
(This section need not be co,pieta•if the permit is valued at one h ndred dollars($100)or less.)
pI certify that in the pe orma e of the work for w ' h this per it is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws•f Calif' nia,and agree that s/uld b come subject to the workers'compensation provisions of Secti 3700 of e Labor Code,I shall forthwith
comply with these• • isi• s.
Applicant Signature: r. 4 A 4 I - Date: 7 2 U 7--
WARNING:
WARNING:FAILURE TO SECURE WORKERS'••MPE •TION COVERAGE IS UNLAWFUL AND SHALL SUBIECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions 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.N Class k
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
Of----I,
�
subjects,� the applicant to a civil penalty of not more than five hundred dollars($500).):
0�,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 ow 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 o ner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I,as own: oft e property,am X•TU-VELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:T = con actors Licens. - •0: not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license • rsu- t to the Contr: •s is.nse Laws.).
❑ I am a • p nder sec, I Business and Professions Code for this reason: 1 ^
Signature: V 4 ./ _ :./_ Date: /2 S/U [—
Owner ID verified by driver's license. ❑Yes ❑No Driver's License No. (-� Expires: l/� a
Verification of Ownership by(type of document,i.e.-property tax bill or deed): GoC
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑Yes ❑No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 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? ❑Yes ❑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? ❑Yes ❑No
B (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 •• ANCE AND A R I ON 0 ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree •ly with all state la n• ordin es relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-describ..�' •,:rty for insp: ti� .agree to occupy or allow of any building authorized by this ermit until nal inspection.
4AL -7/ --e_cy O 7 _
Signature Of Legal Owner(s) Date
And/Or Authorized Applicant Date
CODE I INSPECTION TYPE OLE INTmALS CODE• INSPECTION TYPE PAIS =Ma
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 7//! /3 It
4) CITY OF COSTA MESA
4 BUILDING DIVISION
Y %1 i , DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
i1 1.17•1t
V PERMIT
02-00735
moo
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 252 16TH PL Status: ISSUED
Suite No B Applied: 12/10/2002
Issued: 12/10/2002
Vicinity: UNIT B
Parcel Nunmber: 42522223
ISSUED BY:
Applicant: CRAMM, RUSSELL
•
Address: 252 E 16TH PL #C
Phone: 949-646-0349
COSTA MESA,CA Zip: 92627-3838
Owner: CRAMM, RUSSELL
• Address 252 E 16TH PL #C
Phone:
COSTA MESA,CA Zip: 92627-3838
•
Contractor: OWNER BUILDER
Address:
Phone:
Zip:
License: 000000
Arch / Eng:
Address:
Phone:
Zip:
- License:
SCOPE OF PERMIT
REF: B02-01592.CONVERT EXISTING BEDROOM 1 CLOSET INTO A NEW 39 SF BATHROOM;ADD
CLOSET TO BEDROOM#2;ADD FAU CLOSET AT TOP OF STAIRS. INCLUDES UPGRADE OF
PLBG/MECH/ELEC.PLUMBING TO INCLUDE:2 FLOOR DRAINS, 1 GAS SYSTEM(1-4 OUTLETS), 1
GAS RE-PIPE, 1 SHOWER, 1 KITCHEN SINK,3 WASH BASINS, 1 NEW TOILET, 1.SEWER CONNECT
ON-SITE. 1 LAUNDRY TUB/WASHER REPLACEMENT.
FEE SUMMARY
AMT , QTY AMT QTY AMT QTY
ISSUE FEE $23.50 Laundry Tub/Washer $9.80 1 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 $29.40 3
Dishwasher $0.00 0 :. Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0
Drain, Floor $19.60 2 Sewer Connect $0.00 0 Waste and Vent System $0.00 0
Drain,Rainwater $0.00 0 Sewer Private Line $24.65 1 Water Closet(Toilet) $9.80 1
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord. No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work Is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6/00)
•
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is Issued.
O I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
is s on need not be.••p•ted if the permit is valu: at one hundred dollars($100)or less.)
certify that in the••rfo ance of the w• f/w•ch this permit is Issued,I shall not employ any person In any manner so as to become subject to the workers'
compensation law.of alifomla,and.e:, a f 1 should becomes •ject to the workers'compensation provisions of Section 300 of the Labor Code,1 shall forthwith
comply with e: I• .v.-ions ' 1 ^ 10,10
0/c7_
Applicant Signature: �i `�A Date: irfA/L/
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PE TIES D CIVIL RNES UP TO ONE HUNDRED
THOUSAND DOI,ARE($100,000).IN ADDMON 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.a Class If
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 a d 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
ubject a applicant to a civil penalty of not more than five hundred dollars($500),):
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..:year of completion,the o ner-builder wilt have the burden of proving that he or she did not build or improve for purpose of sale.). '
❑ I,as owns of he property,a • ' LU-IVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:Th: co'tractors Licen•e .w d.:s not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license• rsu-nt to the Con a .. L ense Laws.).
❑ lama mp nder s: ._ Business end Professions Code for this reason: ' ,x�/ ., ^
Signature: �� ��✓ Date: ( O U'-!
Owner ID v: ified by drivers license. 0 Yes 0 No Drivers License No. Expi s:
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 6,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 greeter 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 hes 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? 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 Eermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes IJ No
(Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No
B (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.
Signatu Date:
CERTIFl •TE •F COMPL IANC' • D A ORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I •gr,a to comply wy :I state I ws and city ordinances relatin ng construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-• sc.'.:d prop: o I a-rection rposes.I ogre py or allow occupancy of any building authorized b is ermit nti l"naspection.
Si.•
:tura 0 Legal Owner(s) Date
And/Or Authorized Applicant Date
CODE f I6SPECTION TYPE PAIS NIALS ;ODE I INSPECI1ONTYPC PATE IIIIITIAL$
1616 Fixed System Final Fire Prevention 206 Final Mechanical w
1266 Pool Spa Final 208 Final Plumbing I"-11-03
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
CITY OF COSTA MESA
4� BUILDING DIVISION
>• •,,;- .,1, - DEVELOPMENT SERVICES DEPARTMENT RMIT NUMBER
F t ...k.m7.,thillf•T lei i L PERMIT
" 1E04-00342
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
ELECTRICAL PERMIT
Job Address: 252 16TH PL Status: ISSUED
Suite No C Applied: 04/06/2004
Vicinity: Issued: 04/06/2004
Parcel Nunmber: 42522223 .
Applicant: CRAMM, RUSSELL ISSUED BY: d!
Address: 252E 16TH PL #C
Phone:
COSTA MESA,CA - Zip: 92627-3838
Owner: CRAMM, RUSSELL .
Address 252 E 16TH PL #C o
Phone:
COSTA MESA,CA Zip: 92627-3838
Contractor:
Address:
Phone:
Zip:
License:
SCOPE OF PERMIT
MISC.ELECT.ONLY;PERMIT FOR REPLACEMENT OF•2 LIGHT FIXTURES ONLY.
FEE SUMMARY
Quantity _ - Quantity
ISSUE FEE $23.50 - Temp Dist System/Lighting $0.00 0
Temp service test $0.00 Busway/100 ft $0.00 0
Res.a/c package $0.00 Standing Section $0.00 0
New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0
New Res(3-I-units) $0.00 0 Transformers up to 1 kva/kw $0.00 0
Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0
Lighting Fixts $2.20 2 up to 50 kva/kw $0.00 0
Recept Outlets $0.00 0 up to•100 kva/kw $0.00 0
Switches $0.00 0 over 100 kva/kw $0.00 0
Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0
Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0
Service to 200a $0.00 0 Misc.Conduit $0.00 0
Service to 1000a $0.00 0 Misc.Conductor $0.00 0
Service over 1000a $0.00 0 •
Circus(gen or ride) $0.00 0
Motors to 1hp $0.00 0 Circus(mech ride or lights) $0.00 0
Motors to 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
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No.92-28,§ 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work Is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6/00)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION: ,
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compenbation 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 provisions.
Applicant Signature: Date:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions 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.4 Class N
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
sutler!the applicant to a civil penalty of not more than five hundred dollars($500).):
I '0 ,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• the property,am EXCLUSIV:LY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code: .co tractors License La. do; 'of apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license• rsu. t to the Contract. i fT .e Laws.).
O.....-ram e:'m. under s:•. �] ,/ :I I : ' •Professions Code for this reason: .-_
Signature: wirer- Date:
`Owner ID ve ified by d •ars license. c lz es 0 No
(Briar's License No. IEapires: I/'Zz�iJ S_
Verification of Ownership by(type of document,i.e.-property tax bill or deed):: 1/
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).
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 ❑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 ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? CI Yes U No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No
(If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the 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? ❑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:
CERTIFI•ATE OF OMPLIANCE AND - • ZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. agree • comply with all st: - k s d city ordinances relati ' ' onstruction,and authorize representa'yes oft e City of Costa Mesa to enter upon the
( aabbo - � '•e•property,•r in .t 40 es.I a cupy or allow occupancy of any building authorized by th permit nyl fi spection.
1,1
1 . Signature Of Legal Owner(s) Date
And/Or Authorized Applicant Date
CODE t INSPECTION TYPE, RATE URRIAL$ CODEC INSPECTION TYPE RATE INTRIALE
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing /7� V�
200 Final Re-Roof 210 Final Electrical 14
:'II/�
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
6111 CITY OF COSTA MESA )
4 401W\ BUILDING DIVISION
>:j ,r' ; ,�a DEVELOPMENT SERVICES DEPARTMENT PERMIT N MBER
4 "n”--71 . PERMIT
M03-00042
(714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
MECHANICAL PERMIT
Job Address: 252 16TH PL Status: ISSUED
Suite No B Applied: 01/30/2003
Issued: 01/30/2003
Vicinity: UNIT B
Parcel Number: 42522223 ISSUED BY:
Applicant: ZOMA, KEN •
Address: 7252 GARDEN GROVE BL
Phone: 714-898-6629
WESTMINSTER,CA Zip: 92683
Owner CRAMM, RUSSELL
•
Address: 252 E 16TH PL #C
Phone:
COSTA MESA,CA Zip: 92627-3838
Contractor: KOOL AIR COMPANY
Address: 7252 GARDEN GROVE BL
Phone: 714-898-6629
WESTMINSTER,CA Zip: 92683
License:427923
SCOPE OF PERMIT
MECH PERMIT IN CONJUNCTION WITH CONVERTING AN EXISTING BEDROOM& 1 CLOSET INTO
A NEW 39 SF BATHROOM;ADD CLOSET TO BEDROOM#2;ADD FAU CLOSET AT TOP OF
STAIRS.INCLUDES UPGRADE OF PLBG/MECH/ELEC.
1 INST FAU<100K BTU,COMPRESSOR UP TO 3 HP/100K BTU(SPLIT SYSTEM). REF:
B02-01179
•
FEE SUMMARY
Quantity Quantity
ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0
Inst FAU<100 k BTU $14.80 1 Repair/Alt Refrigeration Unit $0.00 0
Inst.FAU>100 k BTU $0.00 0 Ventillation System $0.00 0
Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0
Inst/Rep.Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0
Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0
Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems
Gas Piping $0.00 0 Up to 3 hp/100 k BTU $14.70 1
Factory Fireplace $0.00 0 3 To 15 hp/500 k BTU $0.00 0
Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0
VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0
Vent Fan/Single Duct $0.00 0 Over 50 hp/Over 1,750 BTU $0.00 0
Appliance $0.00 0 Boilers
Fire Dampers $0.00 0 • Up to 3 hp $0.00 0
Smoke Dampers $0.00 0 3 To 15 hp $0.00 0
Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0
Air Handlers< 10000dm $0.00 0 30 to 50 hp $0.00 0
Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0
Floor Fumace $0.00 0 Other Mechanical Fee
Floor or Suspend Heater $0.00 0 Investigation Fee $0.00
Plan Check Fee $0.00
•
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord. No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)7545626
2446-46(&OO)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations: '
O 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.
Ds I h and will,,q(naintain 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 o kers'olnpensatio Ins ^co ccarrie /and policy number are: )
Carrier: re—E" C.1/y 1P�ale�� Policy Number: W /infQZ I
(This section need not be completed, the pe it is valved at one hundred dollars($100)or less.)
❑ I certify that in the perform:n.:of they47k fo which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of Cal'/. ia,and agree at If I should become subject to the workers'compensation provisions of Sectn 3700 p1 the Labor Code,I shall forthwith
comply with these prov-' Oki��' i.• .I — / P� /
Applicant Signature: - Date: / OS
WARNING:FAILURE TO SECURE WORKERS'COM ATION 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 COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES.
/I LICENSED CONTRACTORS DECLAR' ION: Z.--
I
hereby affirm that I am license •a ,•�rrQQ,,vl s of Ch ter 9(commencing with Section 7000)of Division 3 of the Business an Prof ions Code,and my license is in full
force and effect.Lic.0 -A `�I a Class M 2
Contractor's Signature: r /y ! i Date: / Jt103
CONSTRUCTION LENDING AGENCY:
0 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 properly,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 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,Califomia Administrative Code). .
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a
permit to do such work from the division,
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑Yes ❑No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication aaermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Di Yes U No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits),
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No
(If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No
8 (If yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND 2 ••.ORIZATION 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 vi h al : .te laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described pro.erty f•r i :.ection pu •oses.I agree not to occupy or allow occupancy of any building authorized by this permit until[final inspection.
.i ailSignet :O Legal Owner(s) // D /}talq
And/Oj'thorized Applicant Date
COPE A INSPECTION TYPE QLL INITIALS CODE r INSPECTION TYPE PAIS q `1hAL$
1616 Fixed System Final Fire Prevention 206 Final Mechanical b1-11-03 y-iN
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof • 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site .
204 Final Demolition ' - - 250 - Final Building/Occupancy
CITY OF COSTA MESA 4
4`
BUILDING DIVISION
F• own-if:Tries1 $, DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER
4 i PERMIT 02-01592
‘Thionmso 11°
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesaDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 252 16TH PL Status: ISSUED
Suite: B Applied: 09/30/2002
Vicinity: Issued: 12/10/2002
Parcel Number: 42522223 Zoning:
Applicant: CRAMM, RUSSELL
Address: 252 E 16TH PL #C ISSUED BY:
Phone: 949-646-0349
COSTA MESA,CA ' Zip: 92627-3838
Owner CRAMM, RUSSELL
Address 252 E 16TH PL #C
Phone:
' COSTA MESA,CA Zip: 92627-3838
Contractor: OWNER-BUILDER
'Address:
Phone:
Zip: • License: 000000
•
Arch : Eng:
Address: Address:
Phone: - - Phone:
Zip: License: License:
SCOPE OF PERMIT
CONVERT EXISTING BEDROOM 1 CLOSET INTO ANEW 39 SF BATHROOM;ADD CLOSET TO BEDROOM#2;ADD FAU CLOSET AT TOP OF
STAIRS.INCLUDES UPGRADE OF PLBG/MECH/ELEC. - -- - — -
REF.:B02-01179 '
-FEE SUMMARY
•
Plan Check: $254.31 Calc Valuation: $25,000.00
Permit: $391.25 Claim Valuation: $25,000.00
SMTP Res: $2.50 • -
SMIP Corn: $0.00 •
Other: $0.00
Inspection: $0.00 , ' •
Total: $648.06
•
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 Existing: 0 Required: 0 Proposed: , 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1,12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
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
2446-46(6/00)
DECLARATIONS
•
WORKERS'COMPENSATION DECLARATION:
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, 'ovided for by section 3700 of the Labor Code,for the performance of the
work for which this permit i5 issued. /FE.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not be compl: -.if the permit/s v: ed t one hundred dollars($100)or less)
1 )
❑ I certify that in the pert. :of the wo f. ich his permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of ia,and a.r:: : If I mild become subject e workers'compensation provisions of Section 3700 of t e Labr Code,I shall forthwith
comply with these pr. .ns. il f/ 1 U�O el../Applicant Signatura�. f Date: FI/
WARNING:FAILURE TO SEC RE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES A D 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 em 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,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 tor the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
u jects 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 oIthe property, : - C SIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code: ntractors Lia s: : does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
licenseant to the C•ntr.' .r License Laws.).
❑ amand=r.- - Business and Professions Code for this reason: n / f
Signature: f� AO.
I. • Date: '' /{ d f 01
Owner ID verified by driver's license. :!i'es 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 tile and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aggermit 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 LJ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No
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:
CERTIFI ATE "F COMPLIAN• r'D UTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct agre, to comply wit: a laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
abov-.�sc props for/ ti n purposes.I ree not to occupy or allow occupancy of any building authorize b thi pgrLniquntil final inspection.
kali,' /(u1 2
r w - — sig ature Of Legal Owner(s) Date
And/Or Authorized Applicant Date
;ODE f, 11121.210 12e PATE INTRIALS DODEf INSPECTION TYPE PAIS 1NTMAL$
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 7/r I 13
•
•
•
Ss. CITY OF COSTA MESA '
• BUILDING DIVISION
•F
t .anrr a- 41 ,, DEVELOPMENT SERVICES DEPARTMENT PERMIT NUM R
ii'r/�a PERMIT
=ISO P 4-00395
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 252 16TH PL Status: ISSUED
Suite No A Applied: 06/02/2004
Issued: 06/02/2004
Vicinity: '
ISSUED BY: J ,
o
Parcel Nunmber: 42522223 /�j -
Applicant: CRAMM, RUSSELL
Address: 252 E 16TH PL #C
Phone: 949-646-0349
COSTA MESA,CA Zip: 92627-3838
Owner: CRAMM, RUSSELL
Address 252E 16TH PL #C
Phone:
COSTA MESA,CA Zip: 92627-3838
Contractor: OWNER-BUILDER
Address:
Phone:
Zip:
License: 000000
Arch / Eng:
Address:
Phone:
Zip:
License:
SCOPE OF PERMIT
GAS REPIPE AND 1 GAS(OVER 4)OUTLETS FOR UNIT A ONLY. REF.:P02-00419
6/25/04: SUPPLEMENTAL PERMIT TO ADD 1 WATER HEATERNENT
FEE SUMMARY
AMT QTY AMT QTY AMT QTY
ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0
Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0
Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0
Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0
Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bktlow(5+) $0.00 0
Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0
Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0
Drain,Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0
Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0
Drain,Roof $0.00 0 Shower $0.00 0 Water Heater/vent $12.30 1
Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord.No.92-28,§1, 12-21-92)
EXPIRATION: This'permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626 •
244646(6/00)
11
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not be compl: -. e permit is valued et one hun•red dollars($100)or less.)
FIC I certify that in the pe •rmance o he work for w ' hx is pe is Issued.I shall not employ any person in any manner so as to become s bject to the workers'
r�compensation laws• Callforn',and agree the 1 •ould be oma subject to the workers'compensation provisions of Sectign 3707�h Labor Code,I shall forthwith
comply with these p♦•,' '• . I q (/en// (/
Applicant Signature: VA_ /_1 4 _ �/ Date:ii /
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION••VERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am 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,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
1•{ 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.).
{,n�..as ow , of th,property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044.Business and Professions
v Code: r e contr ctors License Law•oe not:pply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
licens: pursua to the Contractor :'se L.ws.).
❑ I am : roder se NI
_�,t Business and Professions Code for this reason: /2s-1.6,67
� �.
Signature: Date: S /
Owner ID verified by driver's license. ■ Yes 0 No Driver's License No. Expires: / 2T�
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 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 appermit for such construction or modification
from the South Coast Alr Quality Management District or from any other air pollution control district or agency? 0 Yes LJ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If yes',the facility must meet the requirement of Sections 25534 and 42303 of the 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 O COMPLI CE AND AlfiH••• . N ENTRY:I certify under penalty of perjury that I have read this application and state hat the information given is
correct. 1 ogre comp
with all state laws : ,ord. antes relating to building construction,and authorize representaa'es of,the City o sta Mesa to enter upon the
above-describ `r �r in •ion u .• gra not to ancy o any building authorized by tit' pem„•(gntil final in�t�n.
//cJ Slgnatur= •f Legal Qyiner(s) 2 Da !////
And/Or Authorized Applicant Date
CODE I INSPECTIONTYPE PATI )NTIALS 900E0 INSPECTIONTYPE PAIS INTmALI
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing j I -I I -di JX
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
' Ib S9 CITY OF COSTA MESA '
BUILDING DIVISION
).°
trz �' = DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
terra PERMIT
ammo 6' PO4-00395
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 252 16TH PL Status: ISSUED
Suite No A Applied: 06/02/2004
Issued: 06/02/2004
Vicinity:
Parcel Nunmber: 42522223 ISSUED BY:
Applicant: CRAMM, RUSSELL
Address: 252 E 16TH PL #C
Phone: 949-646-0349
COSTA MESA,CA Zip: 92627-3838
Owner: CRAMM, RUSSELL
Address 252 E 16TH PL #C
Phone:
COSTA MESA,CA Zip: 92627-3838
Contractor: OWNER-BUILDER
Address:
Phone:
Zip:
License: 000000
Arch / Eng:
Address:
• Phone:
Zip:
License:
SCOPE OF PERMIT
GAS REPIPE AND 1 GAS(OVER 4)OUTLETS FOR UNIT A ONLY. REF.:P02-00419
FEE SUMMARY
AMT QTY AMT QTY AMT QTY
ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0
Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0
Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0
Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0
Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0
Dishwasher $0.00 0 SeWer Cap for Demo $0.00 0 Wash Basin Set $0.00 0
Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0
Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0
Drain,Roof $0.00 0 Shower $0.00 0 Water Heater/vent $0.00 0
Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0
Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0
Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord. No.92-28,§ 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6/00)
DECLARATIONS
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.
0 I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(Thisiaction need not be completed if the permit is valued at one hum ed dollars($100)or less.)
I certify that in the perfo •.no: •I the work for which this pe - is issued,I shall not employ any person in any manner so as to become0subject to the workers'
\ compensation laws of :liband agree that' I s uld be ome subject to the workers'compensation provisions ofPSect' n 37 �otf the Labor Code,I shall forthwith
comply with these pro .ion . �/ n LPA wLC./
Applicant'Signature:--.pro/..ion
d/)/I4-(� \,Date:
WARNING:'FAILURE TO SEC -E WORKERS'COMPENSATION COVERA,E IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYERTO CRIMINAL PENALTIES AND IVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDRION 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.# Class#
Contractors Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant fore permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement Is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
raS �I!as owner. t -property,am EXCL SIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
v Code:T con actors License Law es not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license-,ursu. t to the Contr icense Laws.).
❑ I am e -mp nder sec..,, - Business and Professions Code for this reason: .
"Signature: ,14.,A.),( 1Date: i /G
-OwnerlD"v=riled by drivers :cense. ❑Vas 0 No Drivers License No.. -( Expires: -Z2 7c
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Gm 2,Art 2,Sec.
341,Title 8,California Administrative Code).
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? ❑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? ❑Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 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 CO LI AND AUTHO- 1 O F ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to co ply ' all state laws . .7 inances relating to building construction,and authorize representatives of the City f Costa Mesa to enter upon the
above-described pr . or inspection pu a ea not to occupy or allow occupancy of any building authorized by this permit til fins inspection.
�� a-• y
f Ignature•1 L:ga •• ner(s) (D to
And/Or Authorized Applicant Date
CODE It INSPECTION TYPE DATE INTRIALE CODE• INSPECTION TYPE DATE INITTIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical /
1266 Pool Spa Final 208 Final Plumbing 1(-)q -Z9 1)IV
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
,
olorLTM
F
B
A pS
C
DE D (ft
D 1 0 0 D
O 0 00
A - Kitchen Sink with dual 110v outlets under sink(ExisrwN Cr)
B - 36" Window
C i4eAC C - Remove Lower Cabinet, Install Dishwasher
D,E,F - Existing Electrical Outlets, Switches, LightsDR ��crp
G - Install new exterior dual 110v electrical outlets
c / I,
UWhI .moi" lri25 o_ 0N1T C. Z.sZ E J6-114--P LACE'
IS I"IIMA-6E- 6F. ai1/411.T C
INS >}t-L Z ELECTattcALoca-tt_is A Z?bisy-watE,es
j. M69 CITY OF COSTA MESA
4A BUILDING DIVISION
F ,i1 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
tq PERMIT
biovii a T so t P02-00492
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us ,Q 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT I, p ,�"
4.1
Job Address: 252 16TH PL ( Status: ISSUED
Suite No B 512521:12,01/
(("�L.'/' Applied: 07/29/2002
� (211r Issued: 07/29/2002
Vicinity: BATHROOM (�
Parcel Nunmber: 42522223 ISSUED BY:
Applicant: CRAMM, RUSSELL'
r TENSION 252 E 16TH PL WC - i,X
" Phone: 949-646-0349 T �
COSTA MESA,CA ' Zip: 92627-3838
ALLV-
PER
Owner: CRAMM, RUSSELL EXPIRES
Address 252 E 16TH PL #C ' ..
Phone:
COSTA MESA,CA Zip: 92627-3838
Contractor: OWNER-BUILDER
Address: \Y7
Phone: SI C YVIS )4
Zip: ftea1 Z 6 re
License: 0 COP''
Arch / Eng:
Address:
•
Phone:
. . Zip:., - -
License: _ _
SCOPE OF PERMIT
PLUMBING TO INCLUDE: 1 BATHTUB AND 1 LAUNDRY TUB/WASHER.REF.:B02-01179
FEE SUMMARY
' AMT QTY AMT QTY AMT QTY
ISSUE FEE $23.50 , Laundry Tub/Washer ' $9.80 , -1: _ 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 $9.80 1 . , Pressure Regulator $0.00 0 Urinal $0.00 0
Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units $0.00 0 Septic Tank $0.00 0 "Wash Basin $0.00 0
Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0
Drain, Floor $0.00 0 Sewer Connect " $0.00 0 Waste and Vent System $0.00 0
Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0
Drain, Roof $0.00 0 Shower $0.00 0 Water Heater/vent $0.00 0
Drinking Fountain $0.00 0 Sink, bar $0.00 - 0 " Water Piping(Inst or Rep.) $0.00 0
Expansion Tank $0.00 0 Sink,commercial $0.00" ' 0 Water Re-pipe $0.00 0
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: $43.10
COMMENTS/SPECIAL CONDITIONS
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord. No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6/00)
•
DECLARATIONS 041_
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations: - -
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
O I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not be comrated the permit is valued at o hundred dollars($100)or less.)
I;1 certify that in the pe •rman•-of the work for w 'ch thi permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws• 'alit• ia,and agree t t f sho d become subject to the workers'compensation provisions of Section 3700 of a Labor Code,I shall forthwith
comply with these p • isi• s. �j /'�
Applicant Signature: Date: L/7.g'0 2
WARNING:FAILURE TO SECUR ORKER '•s PENSA N COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMI L PENALTIE AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARS($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,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.# - Class#
Contractor's Signature: • Date:
•
CONSTRUCTION LENDING AGENCY:
O I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031,5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ 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 herserOr)hrough his or hero n employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within year of bompletion,�/ the o ner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
CnIi -
❑ I,as ow r of the property„/am rE"- 'U-IVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code: e con actors Licen 'II w d•snot apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
!teens p rsu ntrto the Con b•rs,Li•:hie Laws.).
❑ I am x under s• '••• ,7? Business and Professions Code for this reason:
Signature: / �r Date: "7/2 g/'U ?
Owner ID vert ed bygriver's license. MI Yes 0 No Driver's License No. / _ xpves: ( UOS
Verification of Ownership bV(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).
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? ❑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 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 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? IYes 101 No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? ❑Yes 0 No
8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:1 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.
Signet Date:
CERTI CATE OF OMP IAN , DA O TON OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
corre . I agree • comply w' all ta,- I ws a city ordinances relating to building construction,and authorize representatives of e City of Costa Mesa to enter upon the
abov=-•j- • -d props • i•s•'c •n ryos I agree not to ggcupy etalleworaipancy of any building authorized by�iss per I �finalinspection.
Signature Of Legal Owner(s) - 7 Date
And/Or Authorized Applicant Date
CODE t INSPECTION TYPE QLI€ •TRIALS ODE♦ INSPECTION TYPE DATE =AU
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
Amu mom .252 16TH PL ' DMT: •43.x" CITY OF COSTA MESA - BUILDING PERMIT '" / �
CWNEWS . IFMEATH:RUSSELL CRAMM T PERM NO: E 086334
ADDRESS: PO BOX 5370il-4'J
BALBOA ISL 92662 92660 t PERMIT NO: E 086334 PLAN CHECK NO: N GOVT: N SUPP: N
646-0349
APPL.MMUNG ADDRESS: CONSTRUCTION TYPE: PERMIT TYPE: ELE PURPOSE: OTH
ARCHITECT OR ENGINEER: UC.NO.: JOB DESCRIPTION : INSTALL 2 DISHWASHERS SQ FT:
ARCH.OR ENG:5 ADDRESS: UHT:
CLAIM VALUE: CALC-VALUE: GROUP OCC: R-1 /
CONTRACTORS NAME
• caNTRACTORSMMuND COMMENTS : X
ADDRESS: UC.NO.: **********************************SE**********************SE*********************
DMT: ZONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby eBkm under penally of perjury that I am licensed under provisions of Chapter 9 SETBACKS
(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in lull force end effect
CITY LIC.NO.: LIC.CLASS: LIC.NO.: EXP: MAIN BUILDING ACCESSORY BUILDING
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Date: Contactor: LEFT: FT IN RGHT: . FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby affirm under penally of perjury that I am exempt from the Contractors License Law for the
''ollowmg reason(Section 7031.5 Business and Professions Code:Any city or county which requires a permit to combed.alter,improve. PARKING REQ: P ROV; PARCEL: 42522223 Z NE; REF NO:
lemoleh,or repair any structure,prior to is issuance.also requires the applicant for such permit to file a signed statement that he Of she PLANNING NOTES>
' a licensed pursuant to the provisions a (commencing the Connectors License Law(Chapter 9(cmencing with Section 7000)of Division 3 of the
Business and Professions Cade)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section >
7031.5 by and applicant for a permit subjects the applicant to a mil penalty of not more then five hundred dollarslS50oD. *******************************************************************************
0 I,as owner of the properly or my employees wih wages as their sole compensation,will do the work,and the structure is not imended DEVELOPMENT SERVICES REQUIREMENTS
or offered for sale(Section 7044.Business end Professions Code:The Contractors License Law does not apply to en owner of properly
who bolds or improves thereon,and who does such work himself or hersel or through he or her own employees,provided(hat such
improvements are not intended or°farad for sale.If,however,the Sikh . . ' provement a solo within one yew of compation,the ZONING APPROVED BY DATE:
owner-builder will have the burden a proving he or she did not bui. . Ins. • for the purpose°sate). •
•
1I I,as owner of the property,amexdusvelycontmdngwith t.. .,.cont •. to construct the poi (Section 7O44,Business and BUILDING APPROVED BY : DATE:
Prof:.:ions Coda:The Contractors License Law does not to an. . of properly wit or improves thereon and who
-. trac for such proieds with a contr tw(s)licensed pure . t to the••n0of«e Li -1,___I
• lam . - pi under SecOon: B.ap.c.. • reasa : (/// APPLICATION ISSUED BY. - DATE:
Date: I 2,-2,—`77 0. �LL, `il ************************************** * *
* ********************** *
LEGALIZATION:N F E E SUMMARY STRUCTURAL SEG ENT:
Ido her . certify that I am aware of and understand the requirements of California Health and Safely Code Sections 25505,25533,end
25 • and that I or any future building occupant will/wil not(circle one)need to comply with said cote codes end the requirements for
a. )for constructionor modification from the Av anagemenlDistrictRaakergialoonatrudionapplcatkmsareexemptfmnthoe BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
oieions.
PERMIT .... 4 . 00
Date: Applicant: 5 0% SM I P/NON-RES
PLAN
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of pericarp one of the following declarations: ISSUE FEE 22 . 00
❑ Ihave and wil mantanacertifratacfconsent toself-insure tor workers'compensaton,apro�e
idforbySectona
Section 3700 BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
Code,fog the performance athe work for i
whthis m
permit is issued. TOTALS----> 4 .00 22 .00 0 , 00 26 . 00 26 . 00 .00
❑ I have and wil maintain workers'compensation insurance,as required by Section 3700 of the Labor Code,for the performance of the
work for whim this permit is issued.My workers'compensation insurance Tamer and policy number are:
REVENUE DIVISION TOTALS--> COLLECTED: 26 .00 OVER/SHORT: . 00
Carrier
dry Number: _ BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
(This section need nor be completed I the;semi is for one hundred dollars($107/or less.) 26 . 00
❑ I cantly that in the performance of the work for which this permit is issued.I shall nd employ any person in any manner so as to
become surfed to the workers'compensation laws of California.and agree lhat if I should become eubied tr the weeks *******************************************************************************
compensation provisions of Section 3700 a the Labor Code.I shall forthwith comply with those provision.
Date: Applicant INDIVIDUAL F E E BREAKDOWN
Warning:Failure to secure workers'compensation coverage is unlawful,and she sub/act an employer to criminal penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
civil fines up to one hundred thousand dollars(JIO0,000),In addition to the cost of compensation,damages as provided for In
interest, attorneys ELE 4 RECEPT/OUTLET 1 ST 20 EA. 1 . 00 4 .00
CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty of perjury that them is a construction lending agency for the • END OF FEES
performance of the work for which this pemd is issued(Section 3097,Ca.C).
LENDER'S NAME:
LENDER'S ADDRESS:
I certify that 1 this application and stale that the above information is coned.I agree to comply with all Sy and county ordinances
and state la. .to building construction and h by authorize representatives of the city to enter upon the above-mentioned propend
for lite Pt .' •..e. _
RUSS0 AMM EXE' 12-29 1997ft1PT42ai�taiT55
X10 ham— I ?— Zy � Y�1, B /90 PERMIT :�85
��� Data:
ign'hur. .r/A•enUApplicanVContrador
(5151'48 WP) Whit: :m .• ,A Safety;Green-Fie;Canary-Ape/ant;Pink-Revenue;Goldenrod-Assessor
•
• CONSTRUCTION AND PLANNING POL., & SPA
APPROVALS Permit# Date Inspector - APPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location r
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
;53.=Electrical Conduit Utility-Undrgrnd. 54. Forms •
n 4. rlectrical Conduit-Undrgrnd. - 55. Electrical Bonding
r, '5,-$ieel Reinforcement 56. Rough Plumbing & Pressure Test
_ •-. 6.Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
r
=
• Wednesday, March 03,2004 11:59 PM
Russ Cramm 949.646.0349 p.02
• Russell W. Cranun
• 252 16th Place, Unit C • Costa Mesa, CA 92627 '
949-646-0349 • rcramm ;,earthlinlcpet
March 3,2004 •
. Ed Pctros
Chief Building Inspector
City of Costa Mesa
77 Fair Drive
• Costa Mesa, CA 92628
RE: Request for Extension of Time '
Job Address: 252 16th Place '
Permits: E02-00584,P02-00492 .
Dear Mr. Pettus,
Thank you for talking to me on the phone this morning. Ail mentioned to you,nearly
all of the work on these permits is now complete. Unfortunately,my primary
employment as a teacher makes it difficult to be present at the jobsite to meet with the
inspectors until spring break. I request that you grant an extension for these permits
until April 30,2004. This will allow me to get the property inspected in early April,
and still have time to make corrections.
Thank you for considering my request..
Sin y, '
„AO , •
Russ Cranun
•
. .
•
Russell W. Cramm
• 252 16th Place, Unit C • Costa Mesa, CA 92627
•
949-646-0349 • rcramm@earthlink.net
March 3, 2004 • •
•
•
Ed Petros • -
• Chief Building Inspector ,
City of Costa Mesa . •
77 Fair Drive
• • Costa Mesa;CA 92628
RE: Request for Extension of Time
Job Address: 252 16's Place
Permits: E02-00584, P02-00492
•
Dear Mr. Petros,
Thank you for talking to nie on the phone this morning. As I mentioned to you, nearly
all of the work on these permits is now complete. Unfortunately, my primary,
employment as a teacher makes it difficult to be present at the jobsite to meet with the
inspectors until spring break. I request that you grant an extension for these permits
until April 30, 2004. This will allow me to get the property inspected in early April,
and still have time to make corrections.
Thank you for considering my request..
•
Sin y, •
•
Russ Cramm
f1I • CITY OF COSTA MESA
4` 9 BUILDING DIVISION
el Y • r,,,r ..4 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
ki. i4• PERMIT E03-01106
ittwftrealsose
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
ELECTRICAL PERMIT
Job Address: 252 16TH PL Status: ISSUED
Suite No A Applied: 11/24/2003
Vicinity: Issued: 11/24/2003
Parcel Nunmber: 42522223 }�
Applicant: CRAMM, RUSSELL ISSUED BY: Il/
Address: 252E 16TH PL #C
Phone: 949-646-0349
COSTA MESA,CA Zip: 92627-3838
Owner: • CRAMM, RUSSELL
Address 252 E 16TH PL #C
Phone:
COSTA MESA,CA Zip: 92627-3838
si41t. °6
Contractor: OWNER BUILDER .0
Address: OAST
Phone:
Zip: •
License: 000000
SCOPE OF P MIT
MISC ELECTRICAL FOR EXTERIOR OUTLET6 Cz ot,L(.e )
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(34-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 $2.20 2 up to 100 kva/kw $0.00 0
Switches 50.00 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 $18.20 1
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
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)7545626
2446-46(6/00)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is Issued.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: , Policy Number:
(This tion need not be camp/e••if the permit is valued at one hundred dollars($100)or less.)
I certify that in the pe-Orman••of the work for which his pe is Issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws •f •I • nia,and agree that I ould me subject to the workers'compensation provisions of Sectio 3700 ofa Labor Code,I shall forthwith
comply with(hese• •Pon �(`t(.1
Applicant Signature: Date: �"f`�/�
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PEN TIES AN CIVIL NES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is In full
force end effect.Lis.k Class a
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is Issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Bustss end 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
lxects the applicant to a civil penalty of not more than five hundred dollars($500).):
s
spb
I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not Intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of properly who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one ear of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). •
r
❑ I,as owner tr•property, se La • zs t CONTRACTING WITH LICENSED CONTRACTORS to and
the nt (Sec. Business and Professions
Code:The •rite ctors License La ••=s of apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license p/sua to the Contracto ce -e Laws.).
❑ l am ex/pt der sec. 14 c-siness and Professions Code for this reason: t �y •
Signature: c I " Date: t --
Owner ID ve ie• .y driver's license. 0 Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet In depth into which a person is required to descend,will be made In connection with work authorized by this
permit,and that no building structure,scaffolding.falsework,or demolition or dismantling thereof,wit 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:
I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 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 et any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP Is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application a ermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes 0 No
(Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 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 SoutK 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 COM INCE AND A •'r •TON •F ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree 1. co ly with all state la $ d •ty o iQ ances relating to building construction,and authorize representative of the City of Costa Mesa to enter upon the
above-describ •r arty for in p•. lop .0 I... - .I agr.•not to occu•ygc allow occupancy of any building authorized by this pe itAin 11' I i Ion.
Iie � It �
Signature Of Legal Owner(s) a
And/Or Authorized Applicant Date
CODE I INSPECTION TYPE DAIS I[mALa E,ODEf INSPECTION TYPE PAIR IIIMALa
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
a„ W'ty. CITY OF COSTA MESA ,
'a BUILDING DIVISION
> %f� ,I DEVELOPMENT SERVICES DEPARTMENT PERMI UMBER
o PERMIT 05-00483
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 252 16TH PL Status: ISSUED
Suite No A Applied: 06/20/2005
Issued: 06/20/2005
Vicinity: UNIT A /�►/�1
Parcel Nunmber: 42522223 - ISSUED BY: QI/I /
Applicant: CRAMM, RUSSELL
Address: 252 E 16TH PL #C
Phone:
COSTA MESA,CA - Zip: 92627-3838
Owner: CRAMM, RUSSELL
Address 252 E 16TH PL #C
Phone: '
COSTA MESA,CA Zip: 92627-3838
Contractor: OWNER-BUILDER •
Address:
Phone:
Zip:
License: 000000
• -
SCOPE OF PERMIT
WATER HEATER CHANGE OUT.
FEE SUMMARY
AMT QTY AMT QTY AMT QTY
ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0
Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0
Backflow Preventer , $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0
Bathtub $0.00 0 Pressure Regulator . ' $0.00 0 Urinal $0.00 0
Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units $0.00 0 - •, Septic Tank $0.00 0 Wash Basin $0.00 0
Dishwasher $0.00 .. 0. ` Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0
Drain,Floor , 7$0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0
Drain,Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0
Drain,Roof $0.00 0 Shower $0.00 0 Water Heater/vent $12.30 1
Drinking Fountain $0.00 • 0 '-Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0
Expansion Tank $0.00 0 , Sink,commercial $0.00 0 Water Re-pipe $0.00 0
Gas Earthquake Valve $0.00 0 3 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: $35.80
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
taws(6/00)
•
DECLARATIONS
WORKERS'COMPENSATION DECLARATION: I ..
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑ I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is lured.
My workers'compensation Insurance carrier and policy number are:
Cartier: Policy Number:
(This section need not be completed If the permit is valued t one hundred dollars($100)or less.)
i rtity that in the perfo ::nce'I the work for h h his permit Is issued,I shell not employ any person in any manner so as to become subject to the workers'
compensation laws of C.lifomi: and agree t :t I s ouid become subject to the workers'compensation provisions of Section 00 of the Labor Code,I shall forthwith
comply with these provi. :n
�Ifdi�ntLSlgnatureA / V. �Date;- =t'- / ?cl 0 S
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLDYER�TOrCFWUW.PENALTIES AND CIVIL RNES 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 em 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.N Class 0
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).
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
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 end Professions Code:The Contractors License Law does not apply to an owner of properly who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or Improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or Improve for purpose of sale.). •
<
�'":I;,gR owner of the property,am EXCLU VELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
ode:The co tors License Law d not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license purs nt to he Contractors se Laws.).
CI WI am exemp u d C. Business end Professions Code for this reason: Y _1 I /
Owner ID verified by drivers license. Yes 0 No Drp,--- Ea5' 's 1- -7- 9 v cr
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 ❑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 then a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
_.li__re _ ......
3 Does or will the a plicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous metedals)7
❑vas 0N
(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 en RMPP is presently required,hes Section 25534 of tho California 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 implication appermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? IYes LJ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑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 Safely 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 C PU CE AND AUTH•- TION OF ENTRY:I certify under penalty of perjury that I have read this application end state that the information given Is
correct. I agree to amp] ith all state. end ity ordinances relating to building construction,and euthodze representatives of the City of Costa Mesa to enter upon the
above-described e for in p= tion j �.es agree not to occ y of any building authorized by this permi until fin ins
40 � 7zc--- n
• Sigrlamre tillage]Owner(s) ' • 7 to , I
And/Or Authorized Applicant Date
SODE♦ INSPECTION TYPE PATE. CM CODF( INSPECRON TYPE DAME PIMA
1616 Fixed System Final Fire Prevention 206 Final Mechanical X777rO. T (1?
/��-�y�/ �
1266 Pool Spa Final 208 Final Plumbing h
200 Final Re-Roof 210 Final Electrical 77
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
PROJECT ADDRESS: UNIT:
OWNER'S NAME: 252 16TH PL CITY OF COSTA MESA - BUILDING PERMIT PERM NO; d 0:36451
ADDRESS: MARKEL& CROSS
2851 CLUBHOUSE RD PERMIT NO; B 056451 PLAN CHECK NO; 00811-92 S GOVT; N SU1rP; N
COSTA MESA
CA 92626 CONSTRUCTION TYPE; 5—N PERMIT TYPE: STA PURPOSE; ALT
ARCH/ENGINEER:
( 714 ) 966-1521
RED NO.:
ADDRESS: ACTEC ENGINEERING CORP, 17 uN1r9 JOB DESCRIPTION : NEW HIP ON GARAGE & REROOF WHOLE BLDG, SQ FT; 7, 500
1312 WEST COLLINS AV
PERMrrEE: ORANGE CA 92667 CLAIM VALUE: 7, 500 . 00 CALC VALUE; 7, 500 , 00 GROUP OCC: R-1 /
CHARLES MARKEL ( 714 ) 966-1521
t ADDRESS: 2851 CLUB HOUSE RD COMMENTS• SMOKE DETECTOR(S)* iF REQ �FUIRED IN EACH UNIT.
•
COSTA MESA CA 92626 *** **** ********************* ************* ****tis *** E**** t
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS 'Sf�10{�E D ETECTO R
7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect.
SETBACK T B A C K S
CITY LIC.: STATE LIC.: CLASS: REQUIRED
Dale: Signature: MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR; FT IN FRNT: FT IN REAR; FT IN
Compensation Insurance.or a certilied copy thereof(Section 3800.Lab.q. /LEFT: FT IN RGHT; FT IN LEFT; FT IN RGH2; FT IN
POLICY NO.: EXP.DATE:
COMPANY: PARKING REQ: PROV; PARCEL: 42522223 2NE• R3 REF NO;
❑ Cenined copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. PLANNING NOTES> CHANGE FLAT ROOF ON GARAGE TO A PITCHED ROOF.
date: Applicant: *********i4*-0E #'Y0E************3F****************************************x*!i*******
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be competed if the permit is for one hundred(5100)or less). D E• V E% L O P M E N T SERVICES R E Q U I R E M E N--F S
I certify that in the pert mance 1 the work for which this permit is is shall employ any pe son in ny anner so as to become /+ C p
subject to the Work int nsa2tron Laws of California. i/ . se ZONING APPROVED BY lQ .a l .<�� DATE: 'Z/>` //-2
l Date: / h 9/ Signature:
C%<i f p�,/��
NOTICE:If after king this declaration.you should visio become subject to the Worker Compensation provisions of lh¢Labor BUILDING APPROVED BY �/`/ DATE: 3/, /f.Z
Code,you must forthwith comply with such provisions or this permit shaft be deemed revoked. —� j
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY; - ,r� DATE; 3/s- 9.Z
which this permit is issued(Section 3097.Civ.C). **********************SF 4c* -x ' - • ' • ' �j - ,.***********1e*********3f
LENDER: ****************************************Wc***********************.***.*.**********
ADDRESS: LEGALIZATION:N F E E S U' M M A R Y STRUCTURAL SEGMENT: Y
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors State License Law for the lotowing reason BLDG PMT PLUMBING ELECTRIC. MECHANIC FIRE SM IP/RES GRADING
(Section 7031.5 Business and Professional Code: My city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 99 , 00 - . 75
repair any structure.prior to its issuance,also requires the applicant for such permit to file a signed statement Rut he/she is licensed
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business . . SM I P/NON—RES
and Professions Code)or that he/she is exempt therefrom and the basis for the ageged exemption.My violation of Section 7031.5 by PLAN 64 . 35
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE
I. as owner of Inc property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sate(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS————> 99 , 75 0 . 0 0 64 . 35 164 . 10 164 . 10 . 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himse0/herself or through -
himproveor mentissoldwemnoneyearofcompetioat such nrtheownerements are willhavetheot eed or offered burdenofprovinrghe/shedidnotboldorir the improve REVENUE DIVISION TOTALS--> COLLECTED; 164 . 10 OVER/SHORT: , 00
ler the purpose el sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TUT GRADING PLAN—CHECK
I.as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 99 . 00 , 75 64 . 35
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware ********.***********************************************************************
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL _FEE BREAKDOWN
Q I am exempt under Section:H p 7044 B.6 P.C. /�j� ��
ror This naso iL WORK BY OWNER .�' ,Rj'G5 /'/��!✓1/ / TYPE QTY DESCRIPTION UNIT COST TOTAL COST
Dale: 7 Owner / SFR 3000 ALTER BY VALUE RESIDENTIAL NOZONE 1 . 00 3, 000 . 00
Idohereby�that am aware of and understand the requrements01California Health and Safety Code tions 2 25533,and SFR 4500 REROOF BY VALUE RESIDENTIAL NO7.ONE 1 . 00 4, 500 , 00
25534 and 1 t I ora future building occupant witwitl not(circle one)need to comply with said state cod and the requirements for a
permit far construction or modification Irom the Air Quality Management District.Residential construction applications are exempt from END OF FEES
these provisions.
Date: Applicant:
I hereby certify that I have read this application and state that the above in:f.o.rm.ation is correct.I agree to comply with ail city and county
ordinances r in state laws re•ing to budding construction and hereby a ,_% oft city l � •above-mentioned - -
property Int idsta on su.Dies. -
Date: Signature: ' /i -.
Driver's Lir-nse ar .tial Security k:
•
1641-46 White—Building;Green—Code Enforcement:Canary—Applicant:Pink—Revenue;Goldenrod—Assessor
CONSTRUCTION AND PLANNING POOL .?A
APPROVALS Permit# Date Inspector APPROVALS Permit Date Inspector
1.1Temporary 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 UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit C 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts,in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing _ q... tali; 0 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing • 26 VI Ma74. 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 PREY. 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 thfcC "L Q •
35. Final Gas Pipe-Test
14-t- M!
•
36. Hood or Canopy - �6�
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backf low Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING bfr ! V�t_ p�/�
-
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
ADDRESS OF BUILDING: 252 16TH PL UST:
A, B, C CITY OF COSTA MESA - BUILDING PERMIT 69g. IOO 868 1/
OWNER'S NAME IFfOC : CRAMM RUSSELL PERM NO: B 087838
ADDRESS: 252 CRAMM RUSSELL
C.M. CA 92626 PERMIT NO; B 087838 PLAN CHECK NO: N GOVT: N SUPP; N
;APPL.MMUNO ADDRESS: 252 CONSTRUCTION TYPE: V-N PERMIT TYPE: STR PURPOSE: OTH
ARCNBECT OR ENGINEER: Lit NO.: JOB DESCRIPTION : MISC. DEMO FOR REPIPE/REPLACE 5 WINDOWS SQ FT: 22, 000
ARCN.OR ENG.'S ADDRESS: UNIT:
~ CLAIM VALUE: 22, 000 . 00 CALC-VALUE: 22, 000 , 00 GROUP OCC : R-1 /
CONTRACTOR'S NAME:
CCNTRACTOWSMASAI COMMENTS: INCLUDES GENERAL REPAIRS AND REPLACEMENT INCIDENTAL TO THE REPIPE
ADDRESS: LIC NO.: *************************************************3*3******************3***********
UNIT: ZONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby Wim wider penalty of perjury Nat I ern fuemed wider provisions of Charier 9 SETBACKS
(commencing with Section Toon)of Division 3 of the Business and Professions Code,and my license Is In fm fate and effect.
CITY uc.NO.: LIC.CLASS: uc.NO.: EXP: MAIN BUILDING ACCESSORY BUILDING
Dale: connaaM FRNT; FT IN REAR: FT IN FRNT: FT IN REAR; FT IN
NER BUILDER DECLARATION:I hereby Slum under penalty of perjury that I am exempt from The Contradors License Law for the
axing reason(Section 7031.5 Baseless and Professions Code:Any Cay or countywhich rprvu•panni to owtrud.Wer.imams, LEFT: FT
demolish,or reps any structure.prior is issuance.ebo requires applicant such permit to Neasiped atatemem that he or IN RGHT: FT IN LEFT: FT IN RGHT:
she PARKING REQ: PROV: PARCEL; 42522223 ZNE: REF NO: -
FT IN
licensed pursuant to the provisions of the Caursdors License Law[Chapter 9(commencing with Section 7000)of Deakin 3 of the PLANNING NOTES>
unman and Professions Coder or that he or she S exempt therahan and the basis for the stead exemption.My violation of Section > 't
/031.5 by any applicant kra permit subjects the epplicen n to a civil penalty of na mothen five hundred dollen 155001).
❑ I,as owner
dthe propoMamy employees with wages as their sole compensation,will do the work,and the atmdunbnot intended *******************************************************************************
or offered for sale(Section 7044.Business Professions Code:The Cathedra License Law does not applytoan owner o papery DEVELOPMENT SERVICES R E Q U I R E M E N 4T S
who builds or improves thereon,and who does such work himself or herself or through hi a her own employees,provided that such '
improvements are not intended a offered for sale.E,however.the building or improvement is sold wkhm one year of completion,the (•:
ownercuimerwiUha.athe budenel proving heo she ddnot buiwano
imprafathepurpsesale). ZONING APPROVED BY DATE:
)(] I,as owner of the properly,am exdusivey contracting with licensed contractors to construct the project(Section 7044,Buskwus end
Profession Code:The Contractors License Law does net as man• s d property who bui., ' inesoves'hereon and who BUILDING APPROVED BY : DATE:
contracts for such projects with a contredor(s)licensed pursuant to I ors License Law). � :y
Tem exempt pndOn Section: B. P.c..for lip
APPLICATION ISSUED BY: �.�' + DATE; .;' _ O
Date //2z S owner: Pa �. AG:ad *
*********************n********** ***************• * : ***************� to*+ Tr ir; *rt
I do ashy LEGALIZATION:N F E E SUMMARY M M A R Y STRUCTURAL EGMENT:Y
er
.end that I or any Mum building occupant will/wit not(drab one)need to comply with said state codes and the requirements for
a paint for construction or modification from the Ar anagementDistrct.Rede.ret:Ioammdlonappnakinare exempt from these BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
provisions. PERMIT 312 , 25 2 . 20
Dae: Applicant: SM I P/NON-RES
WORKERS COMPENSATION DECLARATION:I hereby WE=under penally of perjury one of the following declarations: PLAN
❑ Ihave and wumaintain a certificate oconsent meeB;nsurefor workers'compensation,aspraddedfor bySecar3700of the Labor ISSUE FEE
Code,kr the pedarmancedNework fowhich this pemwis issued. BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
1 Hum and weil naintin workers'compensation insure:loses required by Radian 3700 of the Labor COSS.for the perkernanca of the TOTALS----> 314 . 45 0 . 00 0 . 00 314 . 45 314 . 45 . 00
work for which this permit S issued.My worker.'compensation insurance carder and policy number are: .
IA Genian: REVENUE DIVISION TOTALS--> COLLECTED : 314 . 45 OVER/SHORT: 00
Petry"umber: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
'‘,,7his section need not be completed y the panne is for one hundred dollars WOO]or bats) 312 . 25 2 . 20
QI 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 snbjed to the workers'conpeof the laws of California.and agree that with
I should become maned to the wobre' **,**.*.**************_***.************,*********.***,*********************************
become s ion provisions d Section 3700 of the labor Cab,I shall fmhwih amply sitlh those pr
Date: App cant: INDIVIDUAL F E E BREAKDOWN
Warning:Faure to mecum mener'corrperrsadon=Mange Is unlawful,and shall subject en employee toafMml penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
civil lines up to one hundred thousand dollen(5700,000A in addition to the met of compensation,damages es provided ler In
Section 3706 of the Labor Code,Interest,and attomey a fees.
CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty of por[ay that there is a construction lending agency for the SFR 22000 ALTER BY VALUE RESIDENTIAL NOZONE 1 . 00 22 , 000 . 00
performance of the work fa which Ihb permit is issued(Section 3097.Civ.C). END OF FEES
LENDER'S NAME: -
LENDER'S ADDRESS:
77}}����GG''TT''��LyTT�TT� pp y'T'
la that lhere read Na eppthraUah aihdmere!itis'lhrs a�0ve a osmation m correct.IUagreee o comply with W city and county ordinances '
1''r to laws relating to building conmdldlJn endlwlety' mhdrbe representatives of this city to enter upon the dove-mentioned property •
ion purposes.
CR if ' US.SELL 04-22-1998/12:49 P0/$31 45
in •A 'ntName RCPT9:01-0? /
—. (L! • ons9/z- / r PERMIT:087'
Signature of r'AgenuAlplantUDamador
(5151'46.WP) White-Building A Soley:Green-file:Canary-Applicant:Pink-Revenue:Goldenrod-Assessor
CONSTRUCTION AND PLANNINk - - L PA
APPROVALS Permit# Date Inspector APPROVALS Permit# Da* 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 UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. - 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater& Vent-Final
13. Roof Drains - . • 64. Plumbing System - Final
14. Rough Plumbing - 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final •
16. Rough Electric Wiring - 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING •
18. Rough Electrical-T Bar Ceiling •
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts,in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank O 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
38. Final Plumbing
r 39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
- 44. Landscape Irrigation System
45. Sound Attenuation
.. 46. Handicap Regulations
47. FINAL STRUCTURE& BUILDING 11...3-‘2,7 t
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No Date
3,1
ADDRESS OF 9111LGNG: 252 16TH PL LINT' Sze.. CITY OF COSTA MESA — BUILDING PERMIT — _ n7-00
/32
DWNE.Sss: Pp'RUSSELL
5370 M P'tk( � PERM NO: P 086332
ss:
BALBOA ISL 92662 92660 PERMIT NO: P 086332 PLAN CHECK NO: N GOVT: N SUPP : N
646-0349
WPL.MAILING ADDRESS: CONSTRUCTION TYPE: PERMIT TYPE: PLU PURPOSE: OTH
ARCNRECT ORENONEER: UC.NO.: JOB DESCRIPTION : INSTALL 2 DISHWASHERS SQ FT:
MICK OR MG'S ADDRESS: UM:
CLAIM VALUE: CALC—VALUE: GROUP OCC: R-1 /
CCNIRACTORS NAME
CaURACTOIrS MAILING COMMENTS . X
ADDRESS: UC NO.: *******************************************************************************
UNC: ZONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 SETBACKS
(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license S in full lace and edea.
CITY UC.NO.: UC.CLASS: LIG.NO.: EXP : MAIN BUILDING ACCESSORY BUILDING
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Done: Contractor: LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby affirm under penalty of perjury that I ern exempt from the Contractors License Law for the
•.lowng reason(Section 70315 Busness and Professions Code:Any city or county which requires a permit to construct.alter,improve. PARKING REQ: PROV: PARCEL: 42522223 Z N E: REF NO:
mulish,or repair any structure,prior to is Saes.also requires the applicant for such permit to file a signed statement that he or she
licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Dsoion 3 of the PLANNING N TES>
:usiness and Professions Code]or that he or she is exempt therefrom and the basis for the alleged exemption.My violation of Section >
. 7031.5 by any applicant for a permit subjects the applicant lo acivil penally ofnol more than live hundred dollars[S500]). *******************************************************************************
o I.as owner of the propedy or my employees with wages as their sole compensation.will do the work,and the structure is not intended D E V E L O P M E N T SERV I C E $ - -R E U I R E M E N T $
or offered(or sale(Section 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of properly Q
who builds or improves thereon,and who does such work himself or herself or through he or her own employees,provided that such
improvements we not intended or offered for sale.I.however,the building or knprovemeM is sold within one year of completion,the ZONINGAPPROVED BY Y
owner-builder will have the burden of proving he or she did not build or im.rove for the purpose of sale). DATE:
o I,as owner of the properly,am exdusivey contracting with licensed.. tract. -to construct the p•'.• (Section 7044,Business and
•Irecis/a�pndlectCewiaaoth a �«(Lawliceo skimed ap�toh••.'of pre mf ,.y ill.«impovesthetemandwho BUILDING APPROVED BY : DATE:
exemptundersectonBP7044 B.AP.C..or� - ::-. :O N � it LDER APPLICATION ISSUED BY- DATE: lar,
'�lr /� *********************4******************4********�Ei'E�E****** �E�E ************�k*********
��-Z`7-4-/ owe a' �'.-- LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N
I do hereby cediy that I em aware of and understand the requirements of CeRomS Health and Safety Code Sections 25505.25533.and
25534.and that I or any future building occupant will/will not(circle one)need to comply with said bate codes and the requirements for
apemit for construction or modification from the As DimityMeneuement Doth.Residential construction WpEcetiom areexempt from t ase BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
provisions. PERMIT 17. 50
Date: Applicant: 25* SM I P/NON—RES
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one of the bgowirg declarations: P LAN
o (have«dwImmntenacenirarodoormmltosell4neurebw«ken'compenaatim,esprwded fix
bySwim 370od the Lab«
ISSUE FEE 22 . 00
Code,for thepedomunseoftheworkforwlichthispermtisSued. BUILDING DIV > PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
o IhaveandveilmaintanSection the Labor Code,for the performance of the TOTALS--- > 17 . 50 22 . 00 0 .00 39 . 50 39 . 50 .00
• work for which Mu permit is Sued.My workers'compensation insurance caner and policy number are:
Caller: REVENUE DIVISION TOTALS--> COLLECTED : 39 . 50 OVER/SHORT: . 00
Policy Hunter BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
• is section need nes be completed K the panel is lee one hundred dollars/4100)or less.) 39 . 50
' o I certify that in the performance of the work for which this permit S issued,I that not employ any person in any manner so as to
become eubled to the workers'compensation kiwi of California,ad Woe Mal lf I should bears eubjed to the worken. *******************************************************************************
compensation provisions of Section 3700 or the labor Code,I shall forthwith comply with those provisions.
Date: Applicant INDIVIDUAL F E E BREAKDOWN
Warning:Failure to secure workers compenesdon coverage la unlawful,and shall subject an employer fo criminal penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
civil gnu up to one hundred thousand dollars 01000001.In addition to Me cost of compensation,damages as provided tor In
Section 3706 of ms Labor Code,Interest,and attorney's foes. PLU 2 DISHWASHER 8 . 75 17 . 50
CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty of perjury that there is a construction lending agency for the END OF FEES
performance of the work for which this permit is issued(Section 3097,Cit C).
LENDER'S NAME:
LENDER'S ADDRESS:
I certify that I have read this application end bate that the above information is coned.I agree to comply with all dry and county ordinances
and stale laws relating to building consuuciion •hereby.ut orixe representatives of this thy to enter upon the above-mentioned properly
i«insPedionIWn�''RUSSEl.lA M
12-29-1997/C2:35 Pn/039.58
�afl �i RCPTN:a1 c017393
r D( 2-z5- 7 PERF9I X86332
ig •u 7of-...-,/•.en rpplcanVContrador
15151 dS.W P) White-Building A Safety;Green-File;Canary-Appicant:Pink-Revenue:Goldenrod-Assessor
A
j CONSTRUCTION AND PLANNING PGPA
Date Inspector Date Inspector
APPROVALS Permit#
, APPROVALS Permit#
Temporary Electrical Service or Pole ' 52. Pool & Equipment Location
�2)Soil Pipe-Undrgrnd. , 53. Steel Reinforcement
1w
,=;;3.'•Electrical Conduit Utility-Undrgrnd. 54. Forms
x m4?Eeetrical Conduit-Undrgrnd. - , 55. Electrical Bonding 'r
'S, St el Reinforcement ,�, 56. Rough Plumbing & Pressure Test
:': 6. 'Electrical OF ER Grnd. 57. APPROVAL TO COVER-GUNITE -
77j. ._Footings 58. Electrical Conduit-Undrgrnd. K•
8.(Foundation . 59: Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd. •
60. Backwash Lines,P-Trap, 0 Undrgrnd. •
10. Structural Floor System 61. APPROVAL TO DECK
, 11. Property Sewer Line & House Connection S ' 62. Backwash & Receptor-Final '
12. Sewer Cap 63. Heater& Vent-Final
13. Roof Drains - • _ - 64. Plumbing System - Final - •
14. Rough Plumbing M i 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 -
h.
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19.'Rough Heeting,&iAic,:Conditioning, Trc, x c •r, `�' FIRE'DEPTSREQUIREMENT
CrlC-:� `Q -..
20. "Rough Factory Fiieplace r.es L " C APP$OVAAES,t- Pe?mit#
- .1. • : i-4 -c L -.4 r-' t• J<C -1 4:
21.;Ducts, In-$tructure; ^,.
t t - 70.4,. i
-Underground Hydro
22. Ducts, Ventilating',* S •-"t' 71. ctiping•piGas Q Oil
p: :k y S i.' ProdutY a
23. Gas Ripe'Rough &.Lest - -.1-7.
J •} r - J�- c• 72. Undergrourxd Flush r
-. R : _
24. Roof Framing •' r' 1 t _ - _ �� . ' 73 Undergrnd.Stora eTank•OGas ❑Oil
25. RooCSheathin '' y :* - - ;uk - •
9 x . d 74. Overhead Hydro;s
4 . C .
26.t-BanCeiling IStructrral) & Mori000at i C,, - _ .... 79-r:79 Dry Chemical `^' _ * S CO
27. -Frame and Flashing x '' 76. Dry ''
1 o. ,--,; r, r Stand PiPe .: - . +: ti ��
28. Lathing& Siding _ - ;J .• ! 77 FIXED'SYSTEM:FfNA, --' :"..]
t 29. Insulation x _s ,t 78i.FIREPREV. PIN-AL
h
30. Drywall Nailing .-i < ,-' • - + ofHEALTH DEPT. REQUIREMENT
:: 31. Plaster Brown oat c I re 79. FINAL 1" SPECTJON : _ _,
.i ,
•c 32. -ElectricalPower Meter-Final , Ix 807 FOOD CERTIFICATE ISSUED'
33. FinaCElectric`: t. _ �,_, w I Notes: i
34. inar:Healing: Air Conditionings ;,j r 4 ,�t ..... - . --< x
.� is . n r, t .,.
35. Final Gas Pipe=Test t " F' •_ I - `-" T
X. -i .
J
36. Hood-or Canopy z-r 4 t
d- , J. ._
:; 37. Final'Factory Fireplace_•-7 F ` * av
. ; •• ;.1 ! •, - -
•
: 38. Finaf_Plumbing t X71 •: 7�/•s/ye ' . -t
• 39. Water•Service-Final i 2 • /t x . '4: :• _-
r:.
`'40. Gas Service-Final --- -- :. I i �s
41. Solar Domestic•Finah ra - - _ 7'
ro I' 7 - -
•42. Backf low Preventer H `u t.. , I 'r. ' '
t-,.-. ' -+ c .1 ft.J :' H
43. Backf low Irrijation +' v-
t , ; : r •
,t- ,i 44. ;Landscape Irrigation;System - < < i r • i _ - M, ,
<14- 45. Sound Attenuation-;# •• c - i ii -, r.n •,' r• • ;•-,
, 46. Handicap'Regulations S -. v <, ;; 0 - c
F a:
47. FINAL STRUCTURE & BUILDING * H ., 1,-,
r -F. I: . . 'A' 4' 7
48. FINAL PLANNING- ::".:4 ; i -7 .1.
•
49. Elec[ric Release to Edison -, -; .a • x
.. C i. "1 -
50. Gas Release to Southern California-Gas Co
. - 51. CERTIFICATE OF OCCUPANCY - ' -
No. Date
- /,,ill
O F CITY OF COSTA MESA a
F`n t BUILDING DIVISION
�i A _ DEVELOPMENT SERVICES DEPARTMENT
kPERMIT PE T NUMBER
�o�rm M98-00498 ✓
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
. MECHANICAL PERMIT
Job Address: 252 16TH PL Status: ISSUED
Suite No C Applied: 10/27/1998
Issued: 10/27/1998
Vicinity:
Parcel Nunmber: 42522223
Applicant: CRAMM, RUSSELL
Address: 252 E 16TH PL
Phone:
COSTA MESA,CA Zip: 92627
Owner: CRAMM, RUSSELL
-
Address: 252 E 16TH PL
Phone:
COSTA MESA,CA Zip: 92627
Contractor:
Address:
Phone:
Zip:
License:
Arch/Eng:
•
Address:
Phone:
Zip:
License: .
SCOPE OF PERMIT
3 BATHROOM VENTS REF B98-1150,&M98-00200."3 VENTELATION VENTS"
FEE SUMMARY
Quantity Quantity
ISSUE FEE $6.50 Repair/Alt Absorbtion Unit $0.00 0
Inst FAU<100 k BTU $0.00 Repair/Alt Refrigeration Unit $0.00 0
Inst FAU>100 k BTU $0.00 Ventillation System $0.00 0
Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0
Inst/Rep. Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0
Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0
Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems
Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0
Factory Fireplace $0.00 0 3 To 15 hp/500 k BTU $0.00 0
Hood w/Meth Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0
VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0
Vent Fan/Single Duct $19.50 3 Over 50 hp/Over 1,750 BTU $0.00 0
Appliance $0.00 0 Boilers
Fire Dampers $0.00 0 Up to 3 hp $0.00 0
Smoke Dampers $0.00 0 3 To 15 hp $0.00 0
Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0
Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0
Air Handlers> 10000cfm $0.00 0 • Over 50 hp $0.00 0
Floor Furnace $0.00 0 Other Mechanical Fee
Floor or Suspend Heater $0.00 0 Investigation Fee $0.00
Plan Check Fee $0.00
Reinspection Fee $0.00
•
•
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
far 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 (mm�1 ')
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,'1dNthe.oerformance of the
work for which this permit is Issued.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are:
Cartier: Policy Number:
(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 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($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3705 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.ft Class ff
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).
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
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�-r• completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
/fy'{ I, as owner,dl the p •perry, am EX U VELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044, Business and Professions
Code: The/contrac ars License la a•=- not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license pufsuan •the Contra,tar- Ice1-e Laws.).
❑ I am ex. 7 neer c J Business and Professions Code for this reason: //
Signature: I A. AA_ I
> Expires: 7/22/20Ct.,)
Verification of Ownership by(type of doc ment,i.e.-property tax'bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet In depth Into which a person Is required to descend,will be made In connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title B,California Administrative Code).
❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 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 then 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 en RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 if an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a pRemit 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 L]No
(Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No
(If'Yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No
8 (If yes',attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: _ Date:
CERTIFICATE/OF COMP CE ANT ' OR TON OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agr" to c y with all s -tel aws city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-descri•;'•pi• ert /e•'o puepo .I agree not to occupy or allow occupancy of any building authorized by thi permit uptil final inspection.
LJA
Signet'Of Legal Owner(s) Date
And/Or Authorized Applicant Date
QODEJ INSPECTION TYPE Doff !MALS CODEC INSPE[TON TYPE gDMZ C
1616 Fixed System Final Fire Prevention 206 Final Mechanical I[1—aL I �/Y
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
44/at
•�9 CITY OF COSTA MESA ,•
BUILDING DIVISION
Y • a,- `r DEVELOPMENT SERVICES DEPARTMENT PERMIT N ER
�7 j /� . PERMIT
!►;`O4.oamcs e4. 02-00419
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT .
Job Address: 252 16TH PL Status: ISSUED
Suite No Applied: 06/27/2002
Issued: 06/27/2002
Vicinity: BACK YARD -.
Parcel Nunmber: 42522223 ISSUED BY:
Applicant: CRAMM, RUSSELL
Address: 252 E 16TH PL #C
Phone: 949-646-0349
COSTA MESA,CA Zip: 92627-3838
Owner: CRAMM, RUSSELL
Address 252 E 16TH PL-#C
Phone:
COSTA MESA,CA Zip: 92627-3838
Contractor: OWNER-BUILDER
Address:
Phone:
Zip:
License: 0
•
Arch / Eng:
Address:
Phone:
Zip:
License:
SCOPE OF PERMIT
INSTALL MISC.CONDUIT AND UNDERGROUND GAS PIPE FOR FUTURE USE FOR UNITS A AND B.
. FEE SUMMARY
AMT QTY - AMT QTY AMT QTY
ISSUE FEE $23.50 -- Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0
Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0
Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0
Bathtub $0.00 0 , Pressure Regulator $0.00 0 Urinal $0.00 0
Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0
Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0
Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0
Drain,Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0
Drain, Roof $0.00 0 Shower $0.00 0 Water Heater/vent $0.00 0
Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0
Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0
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 $9.80 1 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: $33.30
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
• v
2446-46(6/00)
DECLARATIONS ( )
WORKERS'COMPENSATION DECLARATION: .
I hereby affirm under penalty of perjury one of the following declarations: .
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(Thisissection need not be com• ,fie. i t : •: as v lu:• :f. :hundred dollars($100)or less.)
I _71mK I certify that in the pe orma• e of the work to wh' 11 this•ermit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws•f Cal ornia,and agree at I I€hou•become subject to the workers'compensation provisions of Section 3700 of th Labor Code,I shall forthwith
comply with these%ro'Wons. g / /
ApP` I nt,Signature:> 4 % /">LL --- date:,c te:, (0 2-7 0- Z
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($1 W,t1cb),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.# 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,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 end 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.).
piI,as owner of.ihe p perty,am EXCLUSIV-LY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business end Professions
Code:The•ontrac rs License La'des'01 apply to an owner of property who builds or improves thereon,end who contracts for such project with a contractor(s)
license pu uant the Contract. s erne Laws.).
C❑-l:am:exev . der sea. / - Business and Professions Code for this reason:
Signature:—.-A i . ! -' MU. c---Dater--- (P/2 7/0 S
Owner ID verified by driver's license. G Yes 0 No CDrlveTs.Cicense:No. 3Expires:_ 1 /2'71 crC
Verification of Ownership by(type of docu• ent,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY ' RMI 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:
I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑Yes 0 No
(Section 25505 of the Califomia Health and Safety Code requires,with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑yes ❑No
(Section 25534 of the 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 ❑No
5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application aaermit 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 ❑No
(If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑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 Haze s Materials and Emissions.
Signature- Date:
��_/// n
CERTIFICATE OF MPLIANCE AND(p RI ON OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. ee-to comply with -eta f la /and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above- es ribedvproperty r,n pecti/n pu oses.� r a low occupancy of any building authorized by this permit until f• al inaction.
I Z/� �' (D / 77 05
rSignalure.OFLegal Owner(s) `_Data-----.)
And/Or Authorized Applicant Date
CODE r INSPECTION TYPE QAIE INTITIAL$ CODE I INSPECTION TTM p INTRIAL$
1616 Fixed System Final Fire Prevention 206 Final Mechanical (2)Ai
1266 Pool Spa Final 208 Final Plumbing 51-15-0A
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
CITY OF COSTA MESA
4 BUILDING DIVISION
>:f .4 DEVELOPMENT SERVICES DEPARTMENT PER IT NUMBER
J. j /f PERMIT
P03-00780
s4,
•
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 252 16TH PL Status: ISSUED
Suite No A Applied: 11/24/2003
Issued: 11/24/2003
Vicinity:
Parcel Nunmber: 42522223 ISSUED BY: 16-T(
Applicant: CRAMM, RUSSELL
Address: 252 E 16TH PL #C
Phone: 949-646-0349
COSTA MESA,CA Zip: 92627-3838
Owner: CRAMM, RUSSELL
Address 252 E 16TH PL #C
Phone:
COSTA MESA,CA Zip: 92627-3838
Contractor: OWNER BUILDER
Address:
Phone:
Zip:
License: 000000
Arch / Eng : ••
Address:
Phone:
• Zip:
License:
SCOPE OF PERMIT
GAS PIPE REPAIR FOR EXISTING FIRE PLACE.
FEE SUMMARY
AMT QTY AMT QTY AMT QTY
ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0
Backflow irrigation $0.00 0 - Landscape Irrigation $0.00 0 Swimming Pool $0.00 0
Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0
Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0
Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0
Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0
Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0
Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0
Drain,Roof $0.00 0 Shower $0.00 0 Water Heater/vent $0.00 0
Drinking Fountain $0.00 0 - Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0
Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0
Gas Earthquake Valve $0.00 0 Sink,Floor $0.00 0 Water Service $0.00 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§ 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days. •
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result In the expiration of this permit.
Y
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6/00)
DECLARATIONS f�") (--`1
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is Issued.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: SI Policy Number:
(This section need not be comp!.edit t o permit is valued at one hund:•dollars($100)or less.)
certify that in the pedo ance.f the work for which is::rmit s issued,I shall not employ any person in any manner so as to become subject to the workers'
61(I compensation laws of C.lifor•e,and agree that if I •
. •beco e subject to the workers'compensation provisions of Section 3700 of t Labor Code,I shall forthwith
comply with these pro�...--. I
Applicant Signature: V . .i . ,AI/ Date: , L n,ci-
all
WARNING:FAILURE TO SECUR RKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AN CML FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(5100,000),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.Llc.If Class If
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: 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 o 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 •ar.f completion,the owner uilder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I,as owner o he • operty,am EXCLUSIVE CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The •n r: ors License La n• apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pur• an o the Contract•Ag
ns:L:ws.).
❑ I am exe I der sec. ; � B •-.- .--Professions Code for this reason: ] 2 I '+�-7�
Signature: V Data: 1 I V
Owner ID verified.y driver's license. V Yes 0 No Drivers License No. xpires:
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(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 Calif omia 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 gpermit 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 1.1 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? 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 Alr Quality Management District or other air pollution control district or agency Is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑No
8 (If ryes",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 0 CO LIANCE AND A • '' IZATI•N 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 co ply withal state I. rid city •r)inances relating to building cons r ,and authorize representatives of the City of Costa Mesa to enter upon the
iii
above-describ Reny for''s•. ti. s s.I :gree not to occup . . . .'v upancy of any building authorized b(this permit Gntil i al inspection.
jV/� Signature Of Leg Owners) 7 q--
correct.
`(''IIT
And/Or Authorized Applicant Date
CODE 1 INSPECTIQNTYPg QAiE 1NTITIAIn4 CODE( RI5PECTIONTYPE PATE inWel4
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1268 Pool Spa Final 208 Final Plumbing
rt-ts-az -ar.
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
• •' ,r. $'.. CITY OF COSTA MESA
m ' BUILDING DIVISION
t' •...a : ✓
�--P
DEVELOPMENT SERVICES DEPARTMENT �8_nd15n
• � PERMIT PERMIT NUMBER
•
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 252 16TH PL Status: ISSUED
Suite: C Applied: 06/29/1998
Vicinity: Issued: 07/01/1998
Parcel Nunmber: 42522223 Zoning:
Applicant: CRAMM, RUSSELL
Address: 252 E 16TH PL
Phone:
COSTA MESA,CA - - ,Zip:. ,92627 —
Owner: CRAMM, RUSSELLi_'. — • ' ' ---7Address 252E 16TH,PL// - - , � // �
/Zi, 4/2 ' � \ Phone , ' �n 1 - \
COSTAMESA,'CA �� - Zip 92627 ' - ,_/---C,./.- / ���
/
Contractor.,// \,,,/i .---2-- _ 1-, ` / A
_ ---�� ' ii
Address:,,i � ' i
//j A N/���%/j Phone: ---,-\:,\,:‘,,,-:\--\-- //
i4�/ %%�i� Zip: \\��\�/
/nv �i- /, License:,r,, 1:�� -
, .
Arch/Eng: ','�i ✓,, _ ;
'Ai, fns, s , •
ddress:--) //%/i - .. '"' - '`\`
/ /h �- . 10. . - •,. ••'Phone_�.A i r\\v _ ,
q r : ��Z :
`' ,a % ' License: - ' y�. , ,r ):t: .
- , ,,/ v ,
' ';-�;I i7 �—`- SCOPE OF PERMIT - -7,--
,., \\, CONVERT EXISTING CLOSET TO A BATHROOM;ADD NEW CLOSET ON IND FLR&REMOVE WINDOW `
' DOWNSTAIRS TO FACILITATE NEW PLUMBING.REPLACE EXIST.SLIDING DOOR&ENTRY DOOR&
'REPLACE TWO BATHROOM WINDOWS,. ; n,<-,i'o � ) 1 : " •�'
ori
' �' ' ,_ FEE SUMMARY -7
r"
Plan Check: • . -- ,Calc Valuation: .$19,000.00
,$0.00 „...../,` '�'�_ �f� � "�, --�- `'., " �, + �,
Permit: . 7$274.75 :--•-_,_-_-_ _- -- --y / t. _Claimed Valuation: $19,000.00
SMIP Res:, ,$1.90
SMIP Comb • ' $0.00 -' 1
'. Other: ' x$0.00
Inspection: ' x'$0'00 i
Total: $276.65-, A. ` • ;,;
„.� AA\. � N.: _ p ? %/ ' _
\, Y� 'PLANNING &ZONING -',.':--//
�_� -10: , L i/ ,
SETBACKS /�� <
MAIN STRUCTURE Front 0-0: '-1� Rear _0-0 ''ti • Left_:- 0 0 - . Right ,o-0 -
' //-- - - __ -- _
ACCESSORY Front 0.0.,, • Rear . 0-0. ,Left 0-0 Right0=,,
PARKING .
Existing: 0 -Required: 0 Proposed: . 0'
NOTES: _. - - - -
•
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 expirat on,ohifiis permit.
:-"`�
FOR INSPECTIONS CALL: (714)754-5628
•
•
DECLARATIONS 1
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 sell-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the peormance of the
work for which this permit is issued.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carver and policy number are:
Carder: Policy Number:
(This section need not be completed 11 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 DOL ARE(S1c0,000),IN ADDmON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.AN0 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.Uc.a Class 0
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,CMI 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 Ucense 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 end Professions Code:The Contractors Ucense 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.).
�,.,(
V! I,as owner • e property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044, Business and Professions
Code:Th• ctors Ucense Law oes not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license• • to the Con cense Laws.).
cK] e :••- under s c. Business and Professions Code for this reason:
certJ,.t/ P -7///5r
r ID verified by drivers license. ❑Yes 0 No Driver's Ucense 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 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 Flre
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 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 Govemment Code requires that the requested Information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If"yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safely 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:
CERTIFICA OF OMPUANCE AN A •-RIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given Is
correct, I re= o comply with all . .t= $ and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-d-"ii •ed props or' s•• to • oses.I agree not to occupy or allow occupancy of any building authorized by this per it until final inspection.
FA -771
•nattire • LegaTOwnmf>)
And/Or Authorized Applicant Date)
CODE E INBPECTCN TYPE DATE MINA CODE INSPECTInN TYPF DATE RIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final - 208 Filial 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 Sign222 Final Site
204 Final Demolition 250 Final Building/Occupancy /
2446-46
ill
Ill
%�t.�• CITY OF COSTA MESA
,`a BUILDING DIVISION
t. an—y. .� DEVELOPMENT SERVICES DEPARTMENT RQR_n117A
�� PERMIT PERMIT NUMBER
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 252 16TH PL Status: ISSUED
Suite: A Applied: 07/01/1998
Vicinity: Issued: 07/01/1998
Parcel Nunmber: 42522223 Zoning:
Applicant: CRAMM, RUSSELL
Address: 252 E 16TH PL
Phone:
COSTA MESA,CA Zip: 92627
Owner: CRAMM, RUSSELL"- _
Address 252 E 16TH PL% .. "
Phone: '
COSTA,MESA,CA' - - ? Zip: 92627
/ - - _ \\
Contractor 7 1, ` - �: _ / ,
/1-'7// N �i -' -
% %, Phone: 7
i -� / /i;, Zip: - , .
' ; i%/i -
Intl i/ , K License::
Arch%Eng: ;�7 ,
Address:
- - , — -Phone:_ -
Zip:
- _License:
SCOPE OF PERMIT
•
REMOVE 8 REPLACE EXIST.WINDOW AT THE DINING AREA. .
" ) . .
FEE SUMMARY
Plan Check: ' $0.00 - Calc Valuation: $600.00
Permit: $23.75 r Claimed Valuation: 5600.00
''SMIP Res: f, $0.50
SMIP Corn: ' $0.00 -
Other- $0.00 ' /
Inspection: , $0.00 -.
',Total: $24.25
' PLANNING &ZONING
SETBACKS 7
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:
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 end 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 affiri,i under penalty of perjury one of the following declarations: • 1 '
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Coderfor the pt'formance of the
work for which this permit Is issued.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued.
My workers'compensation Insurance carder and policy number are:
Carder. Policy Number.
(This section need not be completed lithe 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:
WARMNG:FAILURE TO SECURE WORMERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37090F THE LABOR CODE,INTEREST.AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is In full
force and effect.Lie.N Class N
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,CMI Code).
Lenders 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 properly who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such Improvements are not Intended or offered for sale.If,however,the building or improvement Is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. ❑Yes ❑No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person Is required to descend,will be made In connection with work authorized by this
permit,and that no building structure,scaffolding,faisework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,An 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number.
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑Yes 0 No
(Section 25505 of the California Health and Safety Cale 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 then a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas et 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? El 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 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 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 I7 No
(Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No
(If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health end Safety Cale).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No
8 (If yes',attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under 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.
Signature Of Legal Owner(s) Date
And/Or Authorized Applicant Date
COOS r. W5PECT1oNTYPF DATE INTIDALS CDDEU INSEECTIONTYPE QA¢ D1IIOALS
1616 Fixed System Final Fire Prevention 208 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 /i f"pp' &OLL
244646
)
i_' ;. �, CITY OF COSTA MESA -
;`,, •INV->) BUILDING DIVISION
�. ^' ,' : DEVELOPMENT SERVICESPERMIT DEPARTMENT
P98-0
PERMITNUMB0538
ER
�
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: ' 252 16TH PL Status: ISSUED
Suite No C Applied: 07/01/1998
Issued: 07/01/1998
Vicinity:
Parcel Nunmber: 42522223
Applicant CRAMM, RUSSELL
Address: 252E 16TH PL „_--_ _ _ _
,%: _
. Phone: _ �
_ _ -,
COSTA MESA, CA $_- --,
/�,-, • 'Zip: 92627 - . - -
////,( - .--, =
Owner CRAMM;RUSSELL �v /i /
Address 252,E 16TH PL \ \ r/j - ,s. c. N.
'/��A V A - - - "Phone: _ �V A > A, vV\
/ i'. � v -/-,,, ---:"..-,/,:-..--/- '* NA A�,A
i ipCOSTA MESA,CA .2.,---5,-- Zip: 92627 .<:.:s..--::',.>*; %��� ,Av�
Contractor/ -/ $i% v ,
772,
r
Address: /Z J'' .0.;
A� Phone:✓/ r I
f
. - A
\
t _
License:
4ArchlEng" r v �,i t .' .,� '.� .
Address: �
: 4.' .� - 4.f V ')> Phone: 'V A
. 6
/ . . -License 'r 'i: I _ `
iSCOPE OF PERMIT / ‘
- LIGHTS,OUTLETS,SWITCHES,.UFGRADE.SERVICE;.RES:APPLIANCE&2 SUB PANELS. _ , A
V : _ -- FEE SUMMARYr/ '
\,1 ` _ `'JAMT QTY ; 'AMT_! QTY AMT QTY
ISSUE EE ( '$22.00 Laundry Tub/Washer 40.00 -0 Sump Pump. - $0.00' 0
Backflowtirrigation ' • \$0.00 0 i Landscape Irrigation $0.00 0 Swimming.Pool $0.00 0
Backflow Preventer- $0:00, 0 P-Trap $0.00 0 Trap Primer, 40.00 0
,,
Bathtub '7 N $8.75': 1 Pressure Regulator : /;--A$0.00 0 Urinal ': - ,/,$0.00 0
Clarifier System`. • $0.00-\\, 0 Process Piping(per 10 ft). '$0.00. 0 Vacuurn Brkr Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc) '$0.00 A�;,'0. Receptors, '. -'' .$0.00- 0 Vacuum Brkr Bkflow(5+)- , $0.00 0
Dental Units . ,. , $0.00 V'0,�� "Septic Tank,, A ?/ $000'' 0 - Wash Basin $8.75 1
Dishwasher $0 00/ 0- `v (Sewer Cap for Demo A $0.00_ •-0 Wash Basin Set - $0.00 0
Drain, Floor $0.00 ,' 0 ��-Sewer Connect ,,� c 3$22.00 . 1 c5-9-2-;-"Waste and�Vent System $0.00 0
Drain, Rainwater $0.00 ///0.,-, Sewer,Private Line ` ' •' _$0.00 0 ' ,Water Closet(Toilet)" $8.75 1
Drain, Roof $0.00 ' (0 i, Shower . . $0.00 --0 - Water_Heater/vent $0.00 0
Drinking Fountain $0.00 0 /, . -'NSink,liar - - $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. 7 - 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: $70.25
COMMENTS/SPECIAL CONDITIONS
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 pegnit.
FOR INSPECTIONS CALL: (714)754-5626 t*
MP
DECLARA7II ANS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued. .
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number.
(This section need not be completed 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($100,000),IN ADDMON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST.AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
1 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,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 :ctors License Law d.: not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s)
license pto the Contract.s .e Laws.).
49. I am ex: .nder sec. I I Business and Professions Code for this reason:
Signature: :. I # i Date: 7//i cr
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:
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,faisework,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 end 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 apgermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes ❑No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No
(If yes-,the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Cale).
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
B (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
F CO,PUMICE AN r LIO
•'OR N OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I ag :: to -amply with all s I: • an ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-desc'•,:: •roperty for insp:.• •rpo s. me not to occupy or allow occupancy of any building authorized by this rmit u it final a 'on.
/IA AI ' - r-
I Signature Of Legal Owner(s) Date
And/Or Authorized Applicant Date
GODS L INSPELTOH TYPE MATE IMALS gQPE1 jMSPFCTION TYPF PATE MALS
1616 Axed System Final Fire Prevention 206 Anal Mechanical
1266 Pool Spa Final • 208 Anal Plumbing )0-13-9a Z-T
' 200 Final Re-Roof • • 210 Final Electrical
' 201 Final Block/Retaining Well 212 Anal 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
u -‘ � �
It •
CITY OF COSTA MESA
,4p.?SWr BUILDING DIVISION
,..1 "^- ' DEVELOPMENT SERVICES DEPARTMENT
i• PERMIT PERMI NUMBER -
4."*•amim se. E98-01135 ✓
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
• ELECTRICAL PERMIT
Job Address: 252 16TH PL Status: ISSUED
Suite No C Applied: 10/27/1998 .
Vicinity: Issued: 10/27/1998
Parcel Nunmber: 42522223
Applicant: CRAMM, RUSSELL
Address: 252 E 16TH PL
Phone: 949-646-0349
COSTA MESA, CA Zip: 92627
Owner: CRAMM, RUSSELL
Address 252 E 16TH PL
Phone:
COSTA MESA,CA . Zip: 92627
Contractor:
Address:
Phone:
Zip:
•
License:
SCOPE OF PERMIT
3 BATHROOM VENTS REF B98-1150, 8 E96-696
•
FEE SUMMARY
•
Quantity Quantity
ISSUE FEE $6.50 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 $0.00 0 up to 50 kva/kw $0.00 0
Recept Outlets $0.00 0 up to 100 kva/kw $0.00 0
Switches $0.00 0 over 100 kva/kw $0.00 0
Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 '
Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0
Service to 200a $0.00 0 Misc.Conduit $0.00 0
Service to 1000a $0.00 0 Misc.Conductor - $0.00 0
Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0
Motors to 1 hp $12.75 3 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 $19.25 •
Intermed Pole $0.00 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
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
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations: � •
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the pertorinance of the
work for which this permit is Issued.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed 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 shell 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($100,OW),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.a Class it
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued.(Sec.3097,CMI Code).
Lenders 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 end 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 her - • 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 e year•f completion,the a ner-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 /roperty,am E CLU.IVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions
Code:The contr: tors License L. d•k- not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license Ours - to the Contra`I• s Lick.se Laws.).
0 I am exp pt under ec / i Business and Professions Code for this reason: ������
Signature: I / . A4.S � Date: F�sf/
Owner ID ve led by drivers license. !I es ❑No Driver's License No. / Expires: ® 00 O
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person is required to descend,will be made In connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title B,California Administrative Code).
❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds. or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ppermit for such construction or modification
from the South Coast Air Duality Management District or from any other air pollution control district or agency? C 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? ❑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 end Emissions.
Signature: Date:
CERTIFICATE OF/COMP • CE AND A O TON F ENTRY:I certify under penalty of perjury that I have read this application end state that the information given is
correct. I agree to corn! • with all state la 'sad city or antes relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-describe• •r••k rty for lisp:cti,p •• es-4 agre not to occupy or allow occupancy of any building authorized by this permit until final inspection.
( — 2-7 -5
Signature Of Legal Owner(s) Date
And/Or Authorized Applicant Date
BODE I INSPECTIONTYPE seg INTIDALS CODEC INSPECTION TYPF DAIS MKS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical A(0.2518-,t z%n" .
201 Final Block/Retalning 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
4.
TO: City of Costa Mesa
Building Department
FROM: Russell Cramm
Property Owner
DATE: October 27, 1998
RE: Statement of Revisions/Deletion to Plans for 252 E 16'h Place Unit C and Garage
The following items are deleted from the plans submitted to the City of Costa Mesa:
1. Cripple wall to roof rafter on common wall between units B and C is deleted.
2. All electrical changes to garage are deleted except setting garage on house meter.
Existing lights,switches,outlets and subpanel will remain.
3. House meter will service only the garage.
4. Timer for sprinklers will not be wired to house panel.
Re Ily submi
RI ssel C
CITY OF COSTA MESA •
' 'A, BUILDING DIVISION
t' ""-,i', ' DEVELOPMENT SERVICES DEPARTMENT
F9A-OOR96
o
PERMIT PERMIT NUMBER
%bows'49
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
ELECTRICAL PERMIT
Job Address: 252 16TH PL Status: ISSUED
Suite No C Applied: 07/01/1998
Vicinity: UNIT C Issued: 07/01/1998
Parcel Nunmber: 42522223
Applicant: CRAMM, RUSSELL
Address: 252 E 16TH PL
Phone:
COSTA MESA,CA - - Zip:-92627-- _ .- -
Owner CRAMM -RUSSELL
Address 252 E,16TH PLL-- \V v �� ' �• -„,,,i,,,,-..-:,
L / , ' A
/! Z(\
.„--- -Phone -._ - _,� ( �, i
„/).
/COSTA-MESA;�CA � . - Zip. 92627 _ '�V, - < / V�„ -
h1/ r /7/ZC < , A�-
Contractor'' H / ` v
Address T, �j/j ,�
/ C/ //c2/ �jr% Phone: ,�\ ,
/ �, ,r Zip,'r
11 ,/ ///�/ •License: .,;. I - ;
' / /-------„, /fit/�- -� ,
'' ' " "C-;r.4 -1- SCOPE OF PERMIT- NT '
LIGHTS-OUTLETS,SWITCHES, UPGRADE SERVICE,RES.APPLIANCE&2 SUB PANELS.' ' -
- :kr \A , 'fit -/ \ ' _ ,
�' r r r-) /� FEE SUMMARYT. .w ., -, -`rte
' { . , J � L' ',C ..': ,
Quantity_ Quantity -
ISSUE.FEE , $22.00 \ Temp Dist System Plighting $0.00 0 .
Temp servicetest '' $0.00 \, : ' Busway/100 ft /" $0.00 0 '
Res.a/c package" $0.00 '.-„f` r--";;a':�' '-StandingSeition'/..! $0.00 0 • '
New Res(1'-2 units) • r<I--• $0.00 1,2-0, - -, - - /Misc ElectricaLEquipment $0.00 0 , •
New Res- Units)-', ' :J . $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 Fixtst - \`�` '' $11.00 -- 11 - 'uprto 50 kva/kw $0.00 0 _ ,
Recept Outlets "?',v $35.60 ( 44 - up to..100 kva/kw $0.00 , 0 - - '
Switched,-`: A,'V'f$17.00 17 over 100 kva/kw
Non Res Apply --\` '- ..\�\$0.00 0 -Low,Voltage Equipment $0.00 /: ,0 - ,.1
Res Appl ,' .. 'V)$4.25 1 ;Low: Volt Wiring System/Ckt $0.00 y"'/ 0 /
Service to 200a $27.25 1 .. ' ,` / 'Misc Conduit $0.6,02/ 0 - '
Service to 1000a , $6.162::;‘, 0 , ,,�',i Misc:,Conductoi , -$0.00' 0 . ,
Service over 1000a $0.00 Ai�t,-0 • •*,:`Circus(gen or ride) - $0.00 0
Motors to 1 h
p ", $0 00 --..,..s,.\ -so. Yy � i Circus`(mech,ride.or lights) ,� $0.00 i 0 i'
Motors to 10hp ,$0.00 0\� -jChristmas Tree Stand $0 00 \-', 1,0
Motors to 50hp ' $0.00=? 0•-,' - � ` Fireworks Stand > $0.00 0 7
Motors to 100hp $0.00 /---,,„0 ' - .Other_Electrical Fee - . - $0.00
Motors over 100hp .0
Communication drops $0.00 -,0 . Investigation Fee - $0.00
Sub panel to 200a $54:50- '2 ` / , _Plan Check Fee ,' : $0:00
Pole Light Pkg $0.00. ,- - 0 , Reinspection Fee ;
Sign Circuits $0.00 . I0 -. _ , - - -
Temp Pwr Pole $0.00 0 ' -, - - - TOTAL CALCULATED FEES $171.60
Intermed Pole $0.00 0 - - -
COMMENTS/SPECIAL CONDITIONS
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
S
WORKERS'COMPENSATION DECLARATION: •
I hereby affirm under penalty of perjury one of the following declaiationso -
❑ 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.
❑ 1 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 canter and policy number are:
.Carrier: - - Policy Number:
(This section need not be completed/t 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 MD SHALL SUBJECT M EMPLOYER TO CRIMINAL PENALTIES MD CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARS($1 , ),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.N Class A
Contractor's Signature: Date: •
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: 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.My 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 end 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.).
Es_ I, as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044, Business and Professions
Code:The ctors License L:w does n.t apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s)
license p uant o the :-• :ws.).
Pk I am ex pt er sec.Conirac• / A Business and Professions Code for this reason:
Signature: Date: —77/79
Owner ID verifidlibl rivers license. ■ Yes 0 No Drivers License No. Expires:
Verification of Ownership by(type of document,i.e.-properly 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,wit be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title B,California Administrative Code).
❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number. _-
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure),
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP Is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit 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 p No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No
(If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If aermlt 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
6 (I1 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 • ••MPUANCE AND • O'IZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agr:• to •mply with all ,f:t: ems;nd city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-desci•e• •roperty i•r insp y ••pu ••sea.I agree not to occupy or allow occupancy of any building authorized by tills permit until I inspection.
7 /- t//7/
Signature Of L=gal Owner(s) Date
And/Or Authorized Applicant Date
CODE t. INSPECTION TYPE PATE MEALS CODFI INSPECTION TYPF CAIS . INImALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final _ 208 Final Plumbing �r�•
200 Final Re-Roof 210 Final Electrical /n•!i -
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
2446.48
DECLA •A7IONS •
•
WORKERS'COOMM�A^ENSATION DECLARATION:
I herebyoffttr4,r penalty of perjury one of the following declarations:
❑ 1 have `anu.:nil maintain a certificate of consent to sell-Insure for workers'compensation,es provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit U issued.
L9S 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 Sued.
workers'compensation1Insurance carter and policy number are:
4IyL�yt� J 1-A ' 7 — 2/"--7270000 2 33'
••'-section need not be completed If the penult Is valued at one hundred dollars/3100)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'
compen-.:• . • California,and agree that if I should become subject to the workers'compensation provisions o1 Section 3700 of the Labor Code,I shall forthwith
these pr• sione..tu t• ��,/ 47/
Applicant LURESlgaTO SECURE WOORKIRS'1706WE -TION COVERAGE IS UNLAWFUL AND SHALL SUBJECT EM'L MNAL 4/7TIES AND ONL FINES UP TO ONE HUNDRED
THOUSAND DOLLARS($10D,000),IN ADDMCN TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3/08 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 Divslon 3 of the Business and Professions Code,and my license Is In full
force and effect.Lic.s Z/2 792-23 � � Class s C -O
actors Si furs: t'l� 6/2/9`
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 ha 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,end 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 hereon 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 driver's license. 0 Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,I.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet In depth into which a person is required to descend,will be made In connection with work authorized by this
permit,and that no building structure,scaffolding,fabework,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
l 0 Yes ❑No the
applicantpresent future building occupant need to file and certifya Business Plan for emergency response to release or threatened release of a hazardous
(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 greeter 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 Flre Department may require the preparation,certification and filinjj 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 ami k:atlon a2ermit for such construction or modification
from the South Coast Alr Quality Management District or from any other air pollution control district or agency? areas Vas ❑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
(ff 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 la 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 (I1 yes-,attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penally 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 stale 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 Mese to enter upon the
above-described properly for Inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
l Signature 01 al Owner(s) Date
Cv .7l All l
M Authorizstl Applicant --Bap'
fA➢E'L HSPECnOK TYPE DATE 9®U§ TAOElIISEEMMUITE paTE .mm.
Op
1616 Fixed System Final Fire Prevention 206 Final Mechanical ;yvf
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 Rnal Demolition 250 Final Building/Occupancy
2448-48
1
- s", - - CITY OF COSTA MESA
y▪ ' '•- BUILDING DIVISION
. '�,- '• ' DEVELOPMENT SERVICES DEPARTMENT M98-00200 '�
p .. 4:
PERMIT PERMIT NUMBER
4*
(714)754-5273 • Fax(714)754-4858 77 FAIR DRIVE,COSTA MESA,CA 92626
MECHANICAL PERMIT
Job Address: 252 16TH PL Status: ISSUED
Suite No C Applied: 06/02/1998
•
Issued: 06/02/1998
Vicinity: .
•
Parcel Nunmber: 42522223
Applicant: LACEY. KENNY
Address:
Phone:
-
_ Zip:
owner: CRAMM, RUSSELL •
Address: ' ••
Phone:
Zip: 92660
•
Contractor: KOOL AIR COMPANY
Address: . 8871 ACACIA AV
• Phone: 714.6366111 •
GARDEN GROVE. CA Zip: 92841
. License:427923
Arch l Eng:
Address: •
Phone:
Zip:
License:
SCOPE OF PERMIT
• .. _ .. --INSTALL-< 100K BTU.EA.U.8 CONDENSER" ; ' t;
•
FEE SUMMARY
• ' Quantity quantity
ISSUE FEE $22.00 Repair/Alt Absortltion Unit • !'I $0.00
Inst FAU <100 k BTU $13.25 • r Repair/A8 Refrigeration Unit $0.00
• Inst FAU >100 k BTU $0.00 • • •• C Ventillation System - $0.00
Repair/Alt Cooling/Heat $0.00 0 .. • v Evaporative Cooler $0.00
•
Inst 1 Rep. Recess Wall Htr $0.00 0Commercial Incinerator $0.00
Refrig Sys <100 k BTU 513.25 1 - Domestic Incinerator $0.00
Refrig Sys >100 k BTU $0.00. 0. :.Compressors/Absorption Systems •
Gas Piping $0.00- 0 .•21.--€ Up to 3 hp/100 k BTU ' $0.00
Factory Fireplace $0.00 0' • •3 To 15 hp/500k BTU $0.00
Hood w/Mech Exhaust 50.00' 0 • • .. 15 To 30 hp/1,000 k BTU $0.00
VAV Box 50.00 -0 - 30 To 50 hp/1,750 k BTU $0.00
Vent Fan/Single Duct $0.00 0 Over 50 hp/Over.1,750 BTU $0.00
Appliance .50.00 0 - . y"Boilers .
Fire Dampers $0.00 0 . Up to 3 hp $0.00
Smoke Dampers $0.00 0 3 To 15 hp• , $0.00
Inst or Relocate Apol Vent $0.00 0 • , . ..15 to 30 lip $0.00
Air Handlers 4 10000cim 50.00 0 30 to 50 hp $0.00
Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00
Floor Furnace S0.00 0 Other Mechanical Fee
Floor or Suspend Heater 50.00 0 Investigation Fee $0.00
Plan Check Fee $0.00
Reinspection Fee $0.00
TOTAL CALCULATED FEES $48.50
COMMENTS/SPECIAL CONDITIONS
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 it.
FOR INSPECTIONS CALL: (714)754-5626 ° •
x
ter CITY OF COSTA MESA _.a
. • •, BUILDING DIVISION _
DEVELOPMENT SERVICES DEPARTMENT
t;� , • PERMIT PER UMBER
•gym P98-00630 Z-------
(714)
(714)754.5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 252 16TH PL Status: ISSUED
Suite No C Applied: 08/07/1998
Issued: 08/07/1998
Vicinity:
Parcel Nunmber: 42522223
Applicant CRAMM, RUSSELL
Address:
Phone: 949-646-0349
• Zip: ,
.//.
Owner: .CRAMM, RUSSELL - - ,
Address 252•E 16TH PL -
Phone: 949-646-0349 -
COSTA MESA,-CA. Zip: 92627 -• ., ,
_ 7
Contractor:" y ,
'Address:
' Phone:
a •Zip: -
. , / : - License:-
Arch IEng: '
Address: e - . ,
Phone: . .
Zip:
License: •
- SCOPE OF PERMIT
1,GAS OUTLET, REFB98-01150,SUPPLEMENTAL P98-00538. /
• FEE SUMMARY '
AMT QTY AMT - QTY AMT QTY
ISSUE FEE $6.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0
Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0
Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0
Bathtub " $0.00 1" 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 I Septic Tank . $0.00 0 Wash Basin $0.00 0
Dishwasher $0.00 0 • • Sewer Cap for Demo '$0.00 0 Wash Basin Set $0.00 0
Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0
Drain,Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0
Drain, Roof $0.00 0 Shower $0.00 0 Water Heater/vent $0.00 0
Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0
Expansion Tank $0.00 0 - Sink,commercial $0.00 0 Water Re-pipe $0.00 0
Gas Earthquake Valve $0.00 0 . Sink,Floor $0.00 0 Water Service $0.00 0
Gas(1-4 outlets) $5.50 1 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: $12.00
COMMENTS/SPECIAL CONDITIONS
I
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 •
%A/
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed 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 shell 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 DOLLARS(5100,1100),IN ADDr1ON 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.# 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: 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
.p 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 t e properly, am EXC SIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions
\Code:The • tra tors License Lard.es not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license pu : ant t.the Contractorc-nse Laws.). -
❑ a r : -. •t u••er sec. I Business and Professions C.,:for this reason: /
eture Pa . . II_irat a •ate:
Own: I verified by drivels license. ❑Yes 0 No •' ense No. _ Ex.res: _
c
•erificatlon of Ownership by(type of document,i.e.-property tax bill or deed
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet In depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Gm 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 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 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 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes 0 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 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 es 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 CO PUAN AND AUTHOR r '110 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 c• ply w all state law-t1)• i dinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described pr•.'= • or insp: '•n pup!'' II:-.I g e not to occupy or allow occupan of ny building euthodzeQ-by is perrtJlt uti tine)inspection.
Signature Of Legal Owner(s) ate
And/Or Authorized Applicant . Date
CODES INSPECTION TYPE DATE MMELS LODE I INSPECTIONTYPE DATE IMBALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical �,
1266 Pool Spa Final 206 Final Plumbing 11 -A-9(> 1 '{'1
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
•
h�1 T CITY OF COSTA MESA
v ., BUILDING DIVISION ✓
. ''1 DEVELOPMENT SERVICES DEPARTMENT M98-00200
�•,� "Rs PERMIT PERMIT NUMBER
WC
(714)7'54-52773 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
MECHANICAL PERMIT
•
Job Address: 252 16TH PL Status: ISSUED �Ase
Suite No C Applied: 06/02/1998
Issued: 06/02/1998
Vicinity:
Parcel Nunmher: 42522223
Applicant: LACEY. KENNY
Address: •
Phone:
Zip:
Owner: CRAMM, RUSSELL
Address:
Phone:
Zip: 92660
Contractor: KOOL AIR COMPANY
Address: - 8871 ACACIA AV
• Phone: 714-6366111
GARDEN GROVE,CA Zip: 92841
License:427923 -
Arch/Eng:
Address:
Phone:
Zip:
License:
SCOPE OF PERMIT
INSTALL< 100K BTU. F.A.U.&CONDENSER.
FEE SUMMARY
Quantity Quantity
ISSUE FEE $22.00 Repair/Alt Absorbtion Unit • $0.00 0
Inst FAU<100 k BTU S13.25 Repair/Alt Refrigeration Unit $0.00 0
Inst FAU>100 k BTU $0.00 Ventillation System $0.00 0
Repair/Alt Cooling/Heat 50.00 0 Evaporative Cooler $0.00 0
Inst/Rep. Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0
Refrig Sys<Wo k BTU $13.25 1 Domestic Incinerator $0.00 0
Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems
Gas Piping $0.00 0 ' Up to 3 hp/100 k BTU $0.00 0
Factory Fireplace $0.00 0 3 To 15 hp/500 k BTU $0.00 0
Hood w/Mech Exhaust 50.00 0 15 To 30 hp/1,000 k BTU $0.00 0
VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0
Vent Fan/Single Duct $0.00 0 Over 50 hp/Over 1,750 BTU $0.00 0
Appliance $0.00 0 Boilers
Fire Dampers $0.00 0 Up to 3 hp $0.00 0
Smoke Dampers 50.00 0 3 To 15 hp $0.00 0
Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0
Air Handlers< 10000cfm 50.00 0 30 to 50 hp $0.00 0
Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0 .
Floor Furnace 50.00 0 Other Mechanical Fee
Floor or Suspend Heater 50.00 0 Investigation Fee $0.00
Plan Check Fee $0.00
Reinspection Fee $0.00
TOTAL CALCULATED FEES $48.50
COMMENTS / SPECIAL CONDITIONS
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 unit.
FOR INSPECTIONS CALL: (714)754-5626
x
DECLARATIONS (t �l
• WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
Inc I have and will maintain workers'compensation insurance,es required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
workers'compensation Insurance carrier and policy number are:
atter. J }c- 'r F,.nJ edit Num r 0 ) 7 — 921-44-,=71lacc 33
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'
. compen • •f California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
• • with these previsions.
Applicant Signetur: >± / ..a,/ F- • �i/7�C�
LURE TO SECURE WORK S'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT •EM• •• •TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLIME(S1 C0,030),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 em 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.# /2 7 9 bJ Class It C L O
rector's Si ture: 7T2_ data; f
T
CON S RUCTION LENDING AGENCY: !C �/s`���
❑ 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 end 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 then 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,end 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.11,however,the building or improvement Is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I, as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,end who contracts for such project with a contractor(s)
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,lalsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: •
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a re
plication a_peit 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 ryes",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.
Signature Of Le al Owner(s) Date
6"-"° �J)
An Authorized Applicant -Bate
CODE1. INSPFC11ON TYPF OATF =ALB COOEL INSPFCTION TYPF gs¢p
1616 Fixed System Final Fire Prevention 206 Final Mechanical I�-(Z-9
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 Anal Planning Approval _
203 Final Sign 222 Final Site
204 Final Demolition • 250 • Final Building/Occupancy
2446.48
R1�-Qo2A2,
252 16TH PL °NT` A, B, C CITY OF COSTA MESA BUILDING PERMIT
Va .
I`IaavCRM RUSSELL PERM NO: P 087839
A'DREss2c2 CRAMM RUSSELL
C.M. CA 92626 PERMIT NO: P 087839 PLAN CHECK NO: N GOVT: N SUPP: N
ADDRESS: 252CONSTRUCTION TYPE: V-N PERMIT TYPE: PLU PURPOSE: OTH
ARCHITECT ORENONEER: UC.NO.: JOB DESCRIPTION : MISC. DEMO FOR REPIPE/REPLACE 5 WINDOWS SQ FT:
•
ARCH.OR END'S ADDRESS: UHT:
CLAIM VALUE: CALL-VALUE: GROUP OCC : R-1 /
CONTRACTORS NAME:
CONTRACTORSMMIga COMMENTS : REFG:B-87838
ADORES& UC.NO.: #KKKKKKKKKKiEKKKKKKKKKKKKKKKKKKKKKI(3EiFfEfE1EiE1E#1E***N-ttiEfE1E1E1EifaF9ElfiFiE#if#iEif#iE#iE1EKiRiflEiF#iFlfifif
DNR: ZONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby Nim wider penalty of Papery that I am licensed under provisions of Chapter g SETBACKS
(commencing with Section 7000)of Divhun 3 d the Business and Professions Code,and my Scene is in NO lace rd efts.
CITY LAC.NO.: UC.CLASS: UC.NO.: EXP: MAIN BUILDING ACCESSORY BUILDING
Date: c«sama FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT; FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby Sin..wider perWy of perjury that 1 am execs(from the Cerurenon License Law for the
idling reason Busies.end Professions Coda:Any aayocounty Midi respires a permit toaram.t mer,improve, PARKING REQ: PROV: PARCEL: 42522223 ZNE: REF NO:
. demolsh.or repel any structure.prix to n seem.abo requ'ves the applicant to such peened to Rea signed maemert that he or she
is licensed pursuant to the provisions a the Contractors License Law[Chapter 9(commencing with Section 7000)d Division 3 of the PLANNING NOTES>
Batten and Prdevons Code]or that he or she is soma therefrom and the beds for the alleged asempi0n.Any violation of Section > _
7031.5 by and applicant for aperms adlema the applicant medvi penally drat more than five hundred dogma 15500). KKK*ickKKKKKKREKKKKKKKKKKKKKKKKickKKKKKKKKKKKKKK-KKKKK3EKK*KKKKKKKKKKKKKKKKKKKKickKKKKKK
❑ oGl redfvvale(roperty 70r 44.Bad" sand ProesionCC0ode1The Compicenselaawe d" esnen apply( we nnis n"dnop'ertyeny DEVELOPMENT SERVICES . REQUIREMENTS
who bolds a improves Nweon,and who does such work tensed or herself or Brough his or her own employees.Provided that such
•
improvemowner Jdensrwwiilelwst burdended or Mpooin ho she didered for sale.a i baldohe r'ur"or nlworeffot eppopsedsae)eni is sold within�y�d en ZONING APPROVED BY DATE:
%(] I.as owner of the progeny.ern exclusively contrwig with"sensed contractors to construct the project(Swan 7044,easiness and -
PmtusiasCode;The Centred=Skeins Lew doesna apply a en orwdprupahywhboldsoanproves Thereon andwh BUILDING APPROVED BY : DATE:
contracts for sod,projects with a nmrwo(s)licensed puns Contractors License La _ ^n
❑ Iemexam under Section: B.AP.C., . APPLICATION ISSUED BY: . DATE: 4 cj'g
/2_z/" cc Owoen: .rit 'Y I' (.8% +tlEdEdEdl*dE dldlrt*?E?r:+l?rile-dlir rttlitvr uitsruitxxx�r+t+tal+lyl#sLiFdr dlx* �. S.,e dltr:**?tdE*?t+l+Ert?E .:+liE
Nyuwirmawredrdadrewdmangdr«mrrodcw«daNwuendsdmyCodeswasnsos.zssro•rd LEGALIZATION:N F E E S U M M A R Y STRUCTURAL EGMENT: N
,end that 1 at any future building ommenlwill f wit not Ririe one)need to comply with said sire codes and the requiremenh for
a permit for construction or mw
odi& alh
n frone AiRar Canagernent Dihdm.RvSmmnw
ideodobneppkelbroaeeasmprfrom Uwe BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
pa"sions. PERMIT 299 . 00
Date: Applicant: 25%5% S M I P/NON-RES
WORKER'S COMPENSATION DECLARATION:P hereby m der penally ally perpan d t
y one (dowing declarations: PLAN
arms
❑ I have and MI maintaina cent nate ofenure r consent to selfe for workers'compensation,as provided fa Sectionby 3700 d the Lance labISSUE FEE 22 . 00
Code,for lhadamants dthe week fawhichthspemmsi sped. BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
❑ IhaveandMImanhnwoken'oompensatonewrnce,vrequiredbySwim3700alaLaboCods,(rlhpedormanceofthe TOTALS----> 299 . 00 22 . 00 0 . 00 321 . 00 321 . 00 . 00
work for which the permit is Issued.My wavers'compensation insurance carrier and policy number are:
Carrier: REVENUE DIVISION TOTALS--> COLLECTED : 321 . 00 OVER/SHORT: . 00
Policy Number: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
(This samiao need not be completed I the perm*is ver one hawed*man MOO)or S5 321 . 00
❑ 1 certify that in the pMamance of the work for which this pend is issued.I shall w employ any person in sen'manner n as to
compensation provisions lothec4wtn aatoehwo CdeBshie.end ameethe/ those become wrbjwtoth waken' iEiElf3fillEitildFilitlElEjflllEiElfiEifi(if1E%1E#iE1Eil9f3E1tlfiflElk#k7Ell11il#iFifiEilieiE3Eil IFIEiEillEillFiE1f3E1E#IF1EiFkMif KifiElFiE3Fi ***
become
uaton subject
to the d Section 3700 d the Labor Coda,I dug forthwith comply with those provisions.(eco
Date: Apps W: INDIVIDUAL FEE BREAKDOWN
Wambg:Faun to secure workers'compensation concept isunlawful.and shall smyacten employer to crimirspaname end TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
civil fines w to one hundred thousand dollars(slog0d0A in addition ro the cont of wnpensabn dnmgsa as provided tar In
Seddon 3105 of tis Labor Cob,Interest and attorneys fees.
CONSTRUCTION LENDING AGENCY: I Iv/any affirm under math of ry Mal perjUis a mMnwion lendinggen
acy for the PLU 3 BATHTUB8 . 75 26 . 25
performance bissued(Section PLU 3 DI SHWASHER 8 . 75 26 . 25
n
LENDER'S NAME PLU 3 LAUNDRY TUB OR WASHER 8 . 75 26 . 25
LENDER'S ADDRESS: PLU 3 SINK, KITCHEN 8 . 75 W• 26 . 25
�I S'
TALL NEW. FIXTURE PLU 5 WASH BASIN 8 .75 43 . 75
I cemityshat l have reed theeppfrmnn mei Mantapen nor coned.)agree to comply wishNdty end county ordinances
end stale leve retain to building rrelwishy/Ahab.repn®raauws cities Sy to enter upon the abare.mereoned property PLU 5 WATER CLOSET (TOILET) 8 . 75 43 . 75
forinspecionpurposes. PLU 3 FIXTURE SET/TRAP W/PIPING & BACKFLOW 8 . 75 26 . 25
AA CR• NJ;2JSSELL PLU . 3 INSTALL/REPAIR WATER PIPING EQUIP. 4 . 25 a13%J12:452..i.7y
AI T Name PLU 3 LAWN SPRNKLER SYSTEM ON 1 METER 22 . 50 S i' Nl?I: 7:.2 :
9 4/_ �,. Date: END OF FEES E 51 L :087SaS
venae d iiii•Aqm/AppimnlICWrwa
(515t.46.WP) White-Building 8 Safety:Green-Fl;Canary-Appicant;Pink-Revenue:Goldenrod-Assessor
11C-
.:ONSTRUCTION AND PLANNING POO. 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
;111111
3 Electrical Conduit Utility•Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical OF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater& Vent-Final
13. Roof Drains _ 64. Plumbing System - Final
• 14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring • 67.. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
' 18. Rough Electrical-I Bar Ceiling - . • , 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts,in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough&Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 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 � g/� C�
35. Final Gas Pipe:Test S/c/se `&fl.q
36. Hood or Canopy !
37. Final Factory Fireplace
38. Final Plumbing IC1 i]/l%/
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
.47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING • - •
49. Electric Release to Edison
50. Gas Releaie to Southern California Gas Co -
51. CERTIFICATE OF OCCUPANCY
No. Date
p ' M CITY OF COSTA MESA ‘ti.-)
4 9 BUILDING DIVISION
> •
l,,:,�. 4 DEVELOPMENT SERVICES DEPARTMENT PE T NUMBER
p l w.�sL ,
PERMIT 02-00712
.1
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
ELECTRICAL PERMIT
Job Address: 252 16TH PL Status: ISSUED
Suite No B Applied: 07/29/2002
Vicinity: BATHROOM Issued: 07/29/2002
Parcel Nunmber: 42522223 ,�/
Applicant: CRAMM, RUSSELL ISSUED BY: ff/
Address: 252E 16TH PL #C
Phone: 949-646-0349
COSTA MESA,CA Zip: 92627-3838
Owner: CRAMM, RUSSELL
Address 252 E 16TH PL #C
Phone:
COSTA MESA,CA Zip: 92627-3838
Contractor: OWNER-BUILDER
Address:
- Phone:
Zip:
License: 0 .
SCOPE OF PERMIT
ELECTRICAL TO INCLUDE:4 LIGHTING AND 2 RECEPTACLE.REF.: B02-01179
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 $4.40 4 up to 50 kva/kw $0.00 0
Recept Outlets $2.20 2 up to.100 kva/kw $0.00 0
Switches $0.00 0 over 100 kva/kw $0.00 0
Non Res Appl $0.00 ' - • 0 Low Voltage Equipment $0.00 0
Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0
Service to 200a $0.00 0 Misc.Conduit $0.00 0
Service to 1000a $0.00 0 Misc.Conductor $0.00 0
Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0
Motors to 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 $30.10
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)7545626
2446-+0(8'00) / /
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued,
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: - Policy Number:
(This section need not be c. •et:•if the permit is valued a one hundred dollars($100)or less.)
76‘....:7.1 certify that in the-•erforna• e of the work-�,ch t is permit is issued,I shall not employ any person In any manner so as to become subject to the workers'
compensation law. o C.' •mia,and agre: I s uld become subject to the workers'compensation provisions of Sect! n 3700 of a Labor Code,I shall forthwith
comply with thea: •'• ' lens, / I
ApplicantSignature:—, Df ataj �1 �� O2-
WARNINGrFAIUL RE TO SEC•RE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060E 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,Civil Code).
Lenders Name: Lender's Address:
Signature: _ Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that 1 am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure!s not Intended or offered for sale(Sec.
7044,Business end 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• : •:ar of completion,the o ner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I,as ow •r of the property,am EX US ELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:T e contr:ctors Licens a Joe not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license•ursua to the Contr c 'ce se Laws.). -
❑ I am e e • nder sec. Business and Professions Code for this reason:
,Signature:"- > 7 �,Data:� •
OwnerlD v' ifi=d by•rivers I ense. ❑Yes ❑No Drivers Clcense,No.St (Explres:--. 1/2.0nC
v
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 Califomia 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.
4 if an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ No
(Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(!f 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' from
,attach certificate of compliance from thehe 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:
CERTFI'ATE • COMPLIANCE D ' I •RIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct I agr:. to comply with at.. law-and city ordinances relating to b '•Ing construction,and authorize representatives of the City of Costa Mesa to enter upon the
abov: ..es .ed prope f.' • ti. u ••ses,I agree n. . . ..• .r allow occupancy of any building authorized thi permit urVfl final jpspection.
Si a OLLegal Owner(s). Date— .
And/Or Authorized Applicant Date
CODE t INSPECTION TYPE PATE INTRIAL$ LODE( INSPECTION Mg LATE RAs
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing /AI
200 Final Re-Roof 210 Final Electrical 1 `/7
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
sin M CITY OF COSTA MESA i sit
4 A BUILDING DIVISION
F1.1114.1:1 �i $ DEVELOPMENT SERVICES DEPARTMENT PER NUMBER
PERMIT E02-01089
00
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 9262E
ELECTRICAL PERMIT
Job Address: 252 16TH PL Status: ISSUED
Suite No B Applied: 12/10/2002
Vicinity: UNIT B Issued: 12/10/2002
Parcel Nunmber: 42522223
Alt
Applicant: CRAMM, RUSSELL ISSUED BY: Al
Address: 252 E 16TH PL #C /
Phone: 949-646-0349
COSTA MESA,CA Zip: 92627-3838
Owner: CRAMM, RUSSELL
Address 252 E 16TH PL #C'
Phone:
•
COSTA MESA,CA Zip: 92627-3838
Contractor: OWNER BUILDER
Address:
Phone:
Zip:
, License: 000000
SCOPE OF PERMIT
CONVERT EXISTING BEDROOM 1 CLOSET INTO A NEW 39 SF BATHROOM;ADD CLOSET TO BEDROOM
#2;ADD FAU CLOSET AT TOP OF STAIRS. INCLUDES UPGRADE OF PLBG/MECH/ELEC.
REF: B02-01592. ELECTRICAL TO INCLUDE: 12 LIGHT FIXTURES,37 OUTLETS, 17 SWITCHES,2
COMM DROPS, 1 SUBPANEL(125 AMP).
' REVISED:2/7/03.ADD 8 LIGHT FIXTURES AND 4 OUTLETS.
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) S0.00 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 $22.00 20 up to 50 kva/kw $0.00 0
Recept Outlets $37.33 41 up to 100 kva/kw $0.00 0
Switches $18.70 17 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(mach 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 $7.25
•
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord.No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754.5626
2446-46(6/00)
'r714�•1.7'��C•].E
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
o I have and will maintain a certificate of consent to self-Insure for workers'compensation,:s provl:ed for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued. ,
o I have and will maintain workers compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are:
Cartier: Policy Number:
(This section need not be completed if the permit is valued at one hundred dollars($100)or less.)
o 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(SIO3,000),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3106 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 lull
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,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 drivers license. ❑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 Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 ❑ s or will the❑applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
o
(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 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 end 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 Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 No
B (If"yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Signature Of Legal Owner(s) Date
And/Or Authorized Applicant Date
CODE I INSPECTION TYPE QEL KM& CODE! INSPECTION TYPE PAIS Iti1II1$4S
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical 7/1.1(3
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 9 CITY OF COSTA MESA
4
BUILDING DIVISION
•• • "I DEVELOPME -r SERVICES DEPARTMENT PERMIT NUMBER
F t t
J PERMIT E02-01089
(714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa
ELECTRICAL PERMIT 77 FAIR DRIVE, OSTA MESA,CA 92626
Job Address: 252 16TH PL Status: ISSUED
Suite No B Applied: 12/10/2002
Vicinity: UNIT B Issued: 12/10/2002
Parcel Nunmber: 42522223
Applicant: CRAMM, RUSSELL ISSUED BY:
Address: 252 E 16TH PL #C
Phone: 949-646-0349
COSTA MESA,CA Zip: 92627-3838
Owner: CRAMM, RUSSELL
Address 252 E 16TH PL #C \ ,
Phone: );
/''�
COSTA MESA,CA Zip: 9 a --: 8 r
'")
. ilk ,
Contractor: OWNER BUILDER
f >
Address:
P•o e:
Zip
License: 000000
SCOPE OF PERMIT
CONVERT EXISTING BEDRO•M 1 CLOSET INTO A NEW 39 SF BATHROOM;ADD CLOSET TO BEDROOM
#2;ADD FAU CLOSET AT T•• OF STAIRS.INCLUDES UPGRADE OF PLBG/MECH/ELEC.
REF: B02-01592.ELECTRIC'L TO INCLUDE: 12 LIGHT FIXTURES,37 OUTLETS, 17 SWITCHES,2
COMM DROPS, 1 SUBPA L(125 AMP).
•
FEE SUMMARY :
• entity 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) r $0.00 0 Misc Electrical Equipment $0.00 0
New Res(34-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 $13 '0 12 up to 50 kva/kw $0.00 0
Recept Outlets $3•.41 37 up to 100 kva/kw $0.00 0
Switches $ 8.70 17 over 100 kva/kw $0.00 0
Non Res Appl 50.00 0 Low Voltage Equipment $0.00 0
Res Appl $0.00 0 Low Volt Wring 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
•
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days,or If work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6/00)
DECLARATIONS _ r
•
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑ I have and will maintain workers'comps on insurance,as required by section 3700 of the Labor Code,for the performance of the vvviiippprkk or which this permit is issued.
My workers' �
compen :do rl5ura r a Icy number are: !7�
Carrier. : VJ Policy Number: 13
is section need not be•. •a edit the its vat i• t one hundred dollars(8100)or less.)
�, I certify that in the •erfo .nce of the wo - lo' c this permit Is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation law: of C' fomla,and a' : 1/: I hould become subje t to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with rhes:,.•41 4 eA/'
Applicant Signature: ! A Date:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED
THOUSAND OOLLARE(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.Uc.# Class A
Contractors Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued.(Sec.3097,Civil Code).
Lender's Name: 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 tile a sign 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 d 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
bjec a 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 an rofessions 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 r hrough 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 ea of completion,the ow .r-b der will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I,as owner of e roperty,am EXC -1 CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The c tr tors License Law•o:• .t:ppy to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license purs an o the ContractorsA f s.).
IDI am exam d ec. z z a B •- and Professions Code for this reason: /1-'77
l /
Signature: _fir. - Date: � / /J (/�
Owner ID verified by drivers license. - 0 No Drivers License No. xpires:
Verification of Ownership by(type of docum t,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMtT 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,talsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,An 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 Wit 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 flied with the Costa Mesa Flre 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 Depanment by each business which at any
one time has on hand a quantity Of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 if an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? DI Yes DI No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No
(If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
ent.__if a scpollution et Codecontrol district3 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 Hazard° Materials and Emissions.
Signature: Date:
CERTIFICATE MPLIANCE ANA RIZA •N OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given Is
correct. I agre t omply with 611 a and ci, ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-descri pr arty f r' op c ses.I :gree not to . . . •' occupancy of any building authorized by this permiyuntilii I irm5 tion.
Signature Ofiegal Owner(s) 2 !/ U ate
llJl
And/Or Authorized Applicant Date
gnI1F•, INSPECTIONTYPF RATE IKMLS CODE( INSPECTION TYPF Mg Sf®Ai5
1616 Fixed System Final Fire Prevention / 206 Final Mechanical
1268 Pool Spa Final 208 Final Plumbing T
200 Final Re-Roof 210 Final Electrical I *,
W.
201 Final Block/Retaining Wall 212 Final Fire Prevent'. ,, t lir WO
202 Final Factory Fire Place 220 Final Plan '•.App 1. .1k .'t1 I 1
203 Final Sign 77 222 rte `�1.. ,-_1..1'
204 Final Demolition 250 Final Building/Occupancy , ,'
.. l _• . .I —.
-
•
�3 a` Q CA'> 21 1959
COSTA MESA BUILDING DEPARTMENT I IIMCE DEPT.
P.O. BOX 317 I"I ". '1PQiA ;
COSTA MESA. CALIFORNIA rice,
COSTA
FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT
ABUILD/NG .
DDRESS 252 — 16th Place BUILDING
COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY
RECEIPT NO. P�EgMIT NO.
OWNER Santa Ana Patio Homes. Inc. DATE 377
MAIL 1555 Placentia RECEIVED BY DATE 'R�ECCEEIVEDD l AISSU /D�
ADDRESS SDE/_7/ 3--.2/-S-
NG
CITY Newport Beach, Cal. TEL NII 6-3227 ADD EISS
ARCHITECT same LIC.
OR EP-"INFER NO. COSTA MESA. CALIFORNIA
FIRE n
ADDN._.,S same ZONE ,/
Co. 1217 ZONE PTYPE / GROUP
K W Koll Const. CCITY LIC. {�I PLANSOF Y/
CONFRACTOR NO. �J ,
‘---
TEL. APPROVE• �/ /
ADDRESS Same NO. same BY Sr % DATE
LEGAL LOT20 2996 y , CO ,
RRECTIONS - =
DESCRIPTION NO. BLOCK TRACT (E[. LL l�
A.P.NO. . V f� E.a dA1 .'..`i �.I •�.!
SIZE
OF LOT 102.5 X 125 NO.OF BLOCS. 0 SL ,? '� lj 4 IT 2:4 F7 In,
p
HOW ON LOT �1 4. / �� /O�
USE OF ,� u� L LJ E.)
EXISTING BLDG. Ey�.If7 c--; 77777449
� /�p / ,
SETBACK LINE FROM ' LL'�v 'I tO /. { f7 �/ / te r•/(/`-G`nI, • V
CENTER OF STREET REAR YARD15 U C/1I •
SIDE YARD RIGHT _�'¢� LEFT l0—!0 . I VA& X& ' °3mru 177: \ 1/45:- - z J
pp __
DESCRIPTION OF WORK -
X NEW ALTERATION ADDITION I
IIR EPA IN" MOVING DEMOLISH
BUILDING NO OF
SIZE 3123 ROOMS 16 STORIES 2
EXTERIOR WALL ROOF
COVERING stucco COVERING hot—mop
USE OF NEW •
BUILDING
Trinlexresidence and att. garage.
Plan 4—a A IC,
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL
CITY ORDINANC AND STATE LAWS REGULATING BUILDING CONSTRUC-
TION. VALUATION
SIGNATOR. • 1„,..44,1
rf PERMIT FEE S • Si
PERMITTEES / 26,378.00 PLAN CHECK S 23.00
AUTHORIZED AGENT TOTAL FEE 1 69.00 ,ra
.7 I NOV 28-66 "01201 7*****3.00
r 26410
' COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 -
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
BUILDING 45 9 R �/ 014 P� For Office Use Only
ADORHSS ./dl �O ft+•s RECEIPT NO. �r111671S Ny.
COSTA MESA. CALIFORNIA (f i I if 11
RE KIVED SY DATE RICNIVED DATE ISSUED
OWNER
MAIL a
BUILDING
ADDRESS /Q-4-/WI-R--../ ?
r L/,,�� TEL��/ �/C[.� ZONE C TYPE At GROUP
FIRE
CITY �61-d�'a-�^/ / 1�1-Ar' NO.�`/�"-(CYC ,P J�
ARCHITECT /� T8L BY APPROVED j • .ATE/1.G t�I II
NGINEER / I NQ. -.)-0g0
q Al !/ 4 Z• INO
MISS 3/712- / /'I 1 z0.q[ NO.OP UNE OFN (f1 �y� •
ail;
1 n A� _ � PLANS I RUILDINO
CONTRACTOR ( il; -OS,{JI / [{ hl-Li q LE J X99.6 VVV
nn//II��ff AI \r�{/I,/',.. Jf J LEGAL y� — Il- t �y
ADDRESS isle) A. //I�\f{/11etti l; DRRCRImON C//� /} ��77/J J�-t- /,
CITY /7iL(.! / A.P.NO. // / — /% 3- q'D
��jjNOTE: NO EAVE OVERHANG SHALL RE LESS THAN
STATNO.o2//71? NEO` .36- 336 6 30'TO SIDE&REAR P.L.
EAVES
SIZE \ I NO.OF BLDG/. ALLOWED (U.B.C.REQUIREMENT)
OF LOT NOW ON LOT
USE OF ((��� II . `- YARDS APPROVED YARDAPPROVED
EXISTING BLDG. (J+"LJ� MAIN BUILDING ACCESSORY BUILDING
(FROM C STREET)
SETBACK LINE FROM PRDN FT. 456/FT.
CENTER OF STREET REAR YARD ¢'T
SIDg YARDI LEFT RIGHT R.SID( TFT, FT.
DESCRIPTION OF WORK L SIDF /-f
T. T�✓ Fr.
: .
T - /R . - �///
ALTERATION_ ADDITION 1
- PT. / / FT.
DISTANCE BET. BET.MAIN&
REPAIR MOVING DEMOLISH MAIN BLDGS. ACCESS.SLOGS.
BUILDING 7 �/ --II NO.OF VAR.* DATE
SIZE /,/q._ ROOMS STORIES ) C.U.PAF APPROVED
EXTERIOR WALL I COVERING ROOF PROVED,\ /-1 -y� DATE /(--2?-64
COVERING1 _/�/'
USE OF qtJ I LOINS ANO WORK/ �
T/O RE PEERFFO�RM�E,tD P.
1
SQ.PT.
Ol
I HEREBY ACKNOWLEDGE THAT.I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND ACRE[TO CAN• PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION /�/�
BUILDING CONSTRUCTION. PERMIT FEE •(/(/ C1
SIGNATURE 0P JR�t`%�j '/-I' 0
PERMITTEE ^•"`�_ -`�-�'/( �_�
s /90, O-O PLAN CHECK S (2
AUTHORIZED AGENT
n
:FesTOTA3.FEE apt)( /