The URL can be used to link to this page

Home My WebLink About265 16TH PL - Building Permits ' CITY OF COSTA MESA \,---. BUILDING DIVISION F• , ;� PER NUMBER )1 DEVELOPMENT SERVICES DEPARTMENT to F,C�sPERMIT• B06-01617 � (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ceu(LDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 265 16TH PL . • Status: ISSUED Suite: Applied: 09/26/2006 Vicinity: REAR PROPERTY LINE Issued: 09/26/2006 Primary Occ: • Type of Construction: Parcel Number: 42522104 Zoning: Applicant: SHINE, ROBERT Address: 265 16TH PL UNIT C Phone: 949-631-6636 ISSUED BY: COSTA MESA,CA ,Zip: 92627 Owner: SHINE FAMILY TRUST • Address 265 16TH PL , - - UNIT C Phone: 949-631-6636 , COSTA MESA,CA Zip: 92627 - Contractor: 'OWNER-BUILDER - Address: - ,', - . ,i. �/ - Phone: - ' License: 000000 Arch : Eng: TINDALL, GEORGE L : , Address: - Address: 2602 N MERIDIAN ST Phone: Phone: 714-921-2514 - , ORANGE,CA , Zip: License:' - - 92867 License: 19921 SCOPE OF PERMIT CONSTRUCT TH X 50 L.F.RETAINING BLOCK WALL AT REAR OF PROPERTY. FEE SUMMARY ' Plan Check:'- '$63.21 ,- Calc Valuation: 54,000.00 ' Permit: $97.25 - _ Claim Valuation: • $0.00 -SMTP Res: $0.50 - SMIP Com: $0.00 - Other: $0.00 Inspection: $0.00 — -- - Total: , . $160.96 - 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 ' Eaistinq: 0 `: .Required: 0 Proposed: 0 - / / is / ‘,/ 1 l .. 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. r 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(NM).,. . 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. ♦ r ❑ 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 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 Ca fornl-,en agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply.with.thesepr i I ns. applicant slgneture:—J ' : .ae o n Fate: 0?— (2.6-0 WARNING:FAILURE TO SE R WO- ��y� COVERAGE I5 UNLAWFUL AND SHALL SUBJECT AN EMPCOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS(5/00,000),IN AD. • TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,MD 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.LJc.# 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 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.II,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 end 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 Durto the C•ntractorslLicense Laws.). _ ftam exe ler c. IL Business and Professions Code for this reason: JJJ Owner ID verified by driv rs li•=nse`�"A Yes ❑No Driverst3censeNo. - zpues: '0^/ X07 Verification of Ownershi•by •e of docm- t,i.e.-property tax bill or deed): �R 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 Safely,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the 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 Cale,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). nt.._._._.0 .._ _ _ _ ...._ .__ 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 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 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 Govemment Code requires that the requested information be furnished on applications for non-residential building permits). _..._ under .._ ___ 6 Will any part of the facility to be constructed 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 end 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 prescnbed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (If'yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the Information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given Is correct.I agre 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-desc a pope for i pection ses.I agree not to occupy or allow occupancy of any building authorized by this permit until fin y inspection. 044 . j-c; Mu gal Own♦-1er(s)----^ And/Or Authorized Applicant Date • CODE I INSPECTIONTYPE PAM Emma CODE INSPECTION TYPE DAM IBIIMALTI 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 /GAer�i 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`p5�Me CITY OF COSTA MESA � � BUILDING DIVISION F • r.-rl^ ' �I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT , �. M05-00165 .4% (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 265 16TH PL Status: ISSUED Suite No Applied: 04/05/2005 Issued: 04/05/2005 Vicinity: 4PLEX Parcel Number: 42522104 ISSUED BY: _ . ./j:::Z/L Applicant: SHINE, ROBERT J - Address: P 0 BOX 3278 Phone: 949-631-6636 COSTA MESA,CA Zip: 92628 Owner SHINE, CARMELITA S Address: 265 E 16TH PL Phone: COSTA MESA,CA Zip: 92627 Contractor: OWNER-BUILDER Address: - - Phone: Zip: • License:000000 SCOPE OF PERMIT INSTALL 4 NEW A/C UNITS FOR 4-PLEX LOCATED AT REAR OF PROPERTY.REF.: E05-00286 , MECHANICAL TO INCLUDE:4 COMPRESSOR/ABSORPTION SYSTEMS UP TO 3 HP. - FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $0.00 0 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0 Inst/Rep.Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping $0.00 0 • Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace $0.00 0 ' 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box $0.00 0 . 30 To 50 hp/1,750 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 $58.80 4 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 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 I , 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 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 if the permit is valued at one hundred dollars($100)or less.) fa I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,end agree that if I Should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these prop od/s. (may/rl .(-� Applicant Signature: .7�w�F' f . to Date: 04 — t /c� L9 WARNING:FAILURE TO SECURE WORKER •• PENSATI COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND OOLLARE($l W,OW),IN AODITI r r THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706OF 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 a 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 herself or through his or her own employees,provided that such Improvements are not intended or offered for sate.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). Ern I am exempt Jr sec. Business and Professions Code for this reason: Signature: .... _ sT llA 44 Dat 0 --e)6 ©45 Owner ID verified by driver's lic•.nse ❑Yes 0 No Driver's License No. Expires: /&—1"/ "'O, Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: O I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the 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? 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 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 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 complypwith all state laws end city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described pro rt or in pection purpose .I gree not to occupy or allow occupancy of any building authorized by this permit until final inspection. c—I or os SI. : •f L ner(s) 0Date •• •sr Authorized Applicant Date CODE# INSPECTION TYPE PATE INTITIALS CODEC INSPECTION TYPE QAIE Emma 1616 Fixed System Final Fire Prevention 206 Final Mechanical (�L pry^C- 19' - 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 • 9 CITY OF COSTA MESA i 4 BUILDING DIVISION > y- , DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER F 1 a dC PERMIT ittbePodd YE05-00286 (714)754-5273 • Fax(714)754-4856 • www,cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 265 16TH PL • Status: ISSUED Suite No Applied: 04/05/2005 Vicinity: REAR OF PROPERTY Issued: 04/05/2005 Parcel Nunmber: 42522104 _ Applicant SHINE, ROBERT J ISSUED BY: �l1 / Address: P 0 BOX 3278 Phone: 949-631-6636 COSTA MESA,CA Zip 92628 Owner: SHINE, CARMELITA S Address 265 E 16TH PL , Phone: COSTA MESA,CA Zip: 92627 Contractor: OWNER-BUILDER Address: • Phone: Zip: License:000000 SCOPE OF PERMIT INSTALL 4 NEW A/C UNITS FOR 4-PLEX LOCATED AT REAR OF PROPERTY. REF.:M05-00165 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 $54.50 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 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 $163.50 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 $241.50 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days,or If work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 244646(6/00) DECLARATIONS 1 . WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the 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: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) tiO 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 Cali ryCali omia,end-.ree that I s outd become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these p/i. s. Applicant Signature: ft, 1 I =t,I ..A Date: O�D� OSS WARNING:FAILURE TO SECURE WORKE• '•• -ENSATI• COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,000),IN ADDI ION T.THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3le6 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 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). 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 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 property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). tJ I am exemg9inyder IF Business and Professions Code for this reason: 5...-- + L Signature: 1Cf3tr..7f 7,i .x 0 / Expires: J o—1/—07 Verification of Ownership . •:of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that n0 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)feel high.(Chap.3.2.Grp 2,Art 2.Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above.unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the 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 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 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 ❑No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No 8 (If"yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,end authorize representatives of the City of Costa Mesa to enter upon the above-descriroperty or insp ction purposes I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. plr Of —o,5" — nr 7 'f Sig acute• e Owner(s) Date nd/Or Authorized Applicant Date SODS I IIISPFCTION TYPE QATE INTRIAL$ CODE INSPECTION TYPE DAIL INTRIAI5 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing ,�-^ 200 Final Re-Roof 210 Final Electrical 9r&.J 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 _ F .CITY OF COSTA MESA ` BUILDING DIVISION f :� DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 1. 1 w.._�.. I 4• PERMIT B05-00548 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.caa..us UILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 265 16TH PL Status: ISSUED Suite: A Applied: 04/06/2005 Vicinity: Issued: 04/06/2005 Primary Occ: R Type of Construction: V-N Parcel Number: 42522104 Zoning: Applicant ROBERT SHINE lJ / ISSUED BY: Address: 265 16TH PL UNIT C Phone: 949-631-6636 COSTA MESA,CA Zip: 92627 Owner: SHINE FAMILY TRUST Address 265 16TH PL UNIT C Phone: 949-631-6636 COSTA MESA,CA Zip: 92627 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 000000 Arch : Eng: • Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT CONSTRUCT 18"HIGH PLATFORM FOR HEAT PUMP,CUT DOOR IN HALF AND CREATE AIR INTAKE VENT,DROP CEILING 6"TO 8"IN HALLWAY, INSTALL 3X3 SOFFIT LOCATED IN BATHROOM'S CEILING. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $2,000.00 Permit: $69.25 Claim Valuation: $2,000.00 SMIP Res: $0.50 SMTP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $69.75 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or 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(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,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: y(This section need not be completed i/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 C • mia,pand gree that I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these Pro ' / ®� Applicant Signature: r<„ A Date: F O/g- OBJ WARNING:FAILURE TO SECU E WORSE S' PENSA ON COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLAPE(S1OO,030),IN ADDI ON 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 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 Cale: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).): 113 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 pursuanAto the Contractors Lic:nse Laws.). I am exam•✓n�:r s• . O Business and Professions Code for this reason: Signature: ., OA. AnAlla • Dat:: / - — _. — S Owner ID verified by driver'erne. IJ Yes ❑No Driver's License No. Expires: 0—• — o7 Verification of Ownership by(type of docu en,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Gm 2,Art 2,Sec. 341,Title 8,Califomia Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safely Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Wilt the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes ❑No (Section 25505 of the Califomia Health and Safety Code requires, with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑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 Yes or will Me applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? 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? DI Yes L-1 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? El Yes ❑No 8 (If"yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-descri. .'sped/for in •action p V.. 5.`agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. g atur:Vireo!Owner(s) Date And/Or Authorized Applicant Date CODE I INSPECTWII TYPE PAIS INTRIAIv4 POE it INSPECTION TYPE D,IF. INTRDILS 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 /y 204 Final Demolition 250 Final Building/Occupancy ( 27-n5 (:J, 4` 9 CITY OF COSTA MESA it BUILDING DIVISION F , I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER t ai.!/ 1f PERMIT - ` 05-00549 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.caa..us UILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 265 16TH PL Status: ISSUED Suite: B Applied: 04/06/2005 Vicinity: Issued: 04/06/2005 Primary Occ: R Type of Construction: V-N Parcel Number: 42522104 Zoning: �j�� Applicant: ROBERT SHINE ISSUED BY: L-�' f Address: 265 16TH PL UNIT C Phone: 949-631-6636 COSTA MESA,CA Zip: 92627 Owner: SHINE FAMILY TRUST . Address 265 16TH PL UNIT C Phone: 949-631-6636 COSTA MESA,CA Zip: 92627 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 000000 Arch : • Eng: • Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT CONSTRUCT 18"HIGH PLATFORM FOR HEAT PUMP,CUT DOOR IN HALF AND CREATE AIR INTAKE VENT, DROP CEILING 6"TO 8"IN HALLWAY, INSTALL 3X3 SOFFIT LOCATED IN BATHROOM'S CEILING.UNIT B FEE SUMMARY Plan Check: $0.00 Calc Valuation: $2,000.00 Permit: $69.25 Claim Valuation: $2,000.00 SMIP Res: $0.50 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $69.75 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or 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(6/00) DECLARATIONS .) _ - a 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 end policy number are: Cartier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) WI 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 ofSection 3700 of the Labor Code,I shell forthwith 05WARcomply with these p�rx�r•Y" ns. Applicant Signature: 7 ' Date: 01- 0 6 - 06-- WARNING: NING:FAILURE TO SECURE WORKE S' PENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TO ONE HUNDRED THOUSAND DOLLARE(6100,De0),IN ADDIT ON 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 N 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 toe civil penalty of not more than five hundred dollars($500).): 40 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.). 0I am exe W ,.er s)c. Business and Professions Code for this reason: Signature: . •. _10111101A .. - . Expires: 1D'II—O Verification of Ownersh'•by •e 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,fatsework,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: 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 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)? o Yes 0 No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation.certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the 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 spermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? ICI Yes L-I No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described pr for icspec'on purposes(f�agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. 1` 01 0 6 -o-S S' na ur 01 L wner(s) Date Or Authorized Applicant Date ODE I INSPECTION TYPE PAIS INTRIALS CODE f INSPECTION TYPE PAU INTITIALS 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 —I'-ZT(� .,, CITY OF COSTA MESA 4 BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER ttyr/i PERMIT o ep' 805-00550 (714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.Bus UILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 265 16TH PL Status: ISSUED Suite: C Applied: 04/06/2005 Vicinity: Issued: 04/06/2005 Primary Occ: R Type of Construction: V-N Parcel Number: 42522104 Zoning: Applicant: ROBERT SHINE ISSUED BY: Address: 265 16TH PL UNIT C Phone: 949-631-6636 COSTA MESA,CA - Zip: 92627 Owner: SHINE FAMILY TRUST Address 265 16TH PL UNIT C Phone: 949-631-6636 COSTA MESA,CA Zip: 92627 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 000000 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT CONSTRUCT 18"HIGH PLATFORM FOR HEAT PUMP,CUT DOOR IN HALF AND CREATE AIR INTAKE VENT,DROP CEILING 6"TO 8"IN HALLWAY, INSTALL 3X3 SOFFIT LOCATED IN BATHROOM'S CEILING. UNIT C. FEE SUMMARY Plan Check: $0.00 - Calc Valuation: $2,000.00 Permit: $69.25 Claim Valuation: $2,000.00 SMIP Res: $0.50 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $69.75 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or 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 I cr..: ' a 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.) $ 1 certify that in the performance of the work for which this permit is issued,I shell not employ any person in any manner so as to become subject to the workers' compensation laws o a ornia,and e.ree that uld become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these pr isi ns. y� z� Applicant Signature: I r Date: x--06 `L)5.-- WARNING:FAILURE TO SECURE WORKS•. •• PENSATI COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($rogen%IN ADDIT• •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 g(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.R 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,altar,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 live 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 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 Cale: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.). 1 am exe P u •er 5.1 . • %, Business and Professions Code for this reason: Signature: to .•s. ._. ti J ��Date: 1 afar. ^4/ Owner ID verifi:d by drive' lice s Tli es 0 No Driver's License No. . — Expires: &— —p Verification of Ownershi•by( •e of docu ,I.e.-property lax 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? ❑Yes 0 No (Section 25505 o1 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 It 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 agermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ 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 pan 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 Safely Code Section 42303 been made? ❑Yes ❑No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardo .M.teriali and I missio Signature: • • .. St. A A o — Date: ®I' O L9 - O CERTIFICATE OF COMPUANC 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,end authorize representatives of the City of Costa Mesa to enter upon the above-described prope o insp:j tion pi poses. r e not to occupy or allow occupancy of any building authorized by this permit until final inspection. 1, ©9 S ©� — o And/Or Authorized Applicant Date CODE r INSPECTION TYPE DAIS INTRIALS 000E• INSPECTION nut Q$TE LNIQIA4$ 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 z� 204 Final Demolition 250 Final Building/Occupancy Lira,.Q.C ,51 CITY OF COSTA MESA 4 BUILDING DIVISION FMad I el grkl 41 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER Waili • PERMIT l B05-00551 4kbePoiense 44b (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.BUILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 265 16TH PL Status: ISSUED Suite: D Applied: 04/06/2005 Vicinity: Issued: 04/06/2005 Primary Occ: R Type of Construction: V-N Parcel Number: 42522104 Zoning: Applicant: ROBERT SHINE ISSUED BY: 'p - Address: 265 16TH PL UNIT C - Phone: 949-631-6636 COSTA MESA,CA Zip: 92627 Owner: SHINE FAMILY TRUST Address 265 16TH PL UNIT C Phone: 949-631-6636 COSTA MESA,CA Zip: 92627 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 000000 Arch : • ' • Eng: • • • Address: - Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT CONSTRUCT 18"HIGH PLATFORM FOR HEAT PUMP,CUT DOOR IN HALF AND CREATE AIR INTAKE VENT,DROP CEILING 6"TO B"IN HALLWAY, INSTALL 3X3 SOFFIT LOCATED IN BATHROOM'S CEILING. UNIT D. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $2,000.00 Permit: $69.25 Claim Valuation: $2,000.00 SMIP Res: $0.50 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $69.75 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§1,12.21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or 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(&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: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) lie 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 is ree that If I sho Id become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisio Applicant Signature: .( - LFA-/let b .0 Date: ©� — Dp — c5 WARNING:FAILURE TO SECURE WORKERS' PE ATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($1m.000),IN ADDITION TH COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 31060E 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).): la 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.). a I am exemp /.e'sec. Business and Professions Code for this reason: Signature: a m . _—\� P / Expires: '//- n7 Verification of Ownership by( .e of.ocu e-I.i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PE-MIT 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 thirly-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 end 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 thisa�ppplication 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? U Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the 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: Dale: 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 a!�llLL a 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-de'$e°.propel y tori pection • ..ox:s.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. iPa . ©�- 06-n� g ature gal Owner(s) ate And/Or Authorized Applicant Date CODE INSPECTION Type PAIL INTITIA1. ;ODE It INSPECTION TYPE PAIL INTITIALS 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 y "Z7'-Q) 1•C C/ 4`51 9 CITY OF COSTA MESA r BUILDING DIVISION • > • •.: .. DEVELOPMENT SERVICES DEPARTMENT PERMI UMBER 1. 1 ,.._�..>. i PERMIT 3-00514 -wabourrits0. 6. (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa. tLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 265 16TH PL Status: ISSUED Suite: Applied: 03/31/2003 Vicinity: ROOF Issued: 03/31/2003 Parcel Number: 42522104 Zoning: Applicant: PELLICIO, JEFFREY ISSUED BY: *4-- Address: 1653 SUPERIOR AVE Phone: (949)642-7222 COSTA MESA,CA Zip: 92627 Owner: SHINE, CARMELITA S Address 265 E 16TH PL Phone: COSTA MESA,CA Zip: 92627 Contractor: LEE ROOFING OF COSTA MESA Address: 1653 SUPERIOR AVE Phone: (949)642-7222 COSTA MESA,CA Zip: 92627 License: 349686 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT TEAR OFF EXISTING ROOF.INSTALL 20 YEAR,CLASS A,COMPOSITION SHINGLES,30#FELT.27 SQUARES INCLUDES ATTACHED GARAGE. . FEE SUMMARY Plan Check: $0.00 Calc Valuation: $5,000.00 Permit: $111.25 Claim Valuation: $5,000.00 SMIP Res: $0.50 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $111.75 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related • regulations. (Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or 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(Woo) DECLARATIONS WORKERS'COMPENSATION DECLARATION: 1 hereby affirm 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 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: 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' 1 compensation laws o alifomi gree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these pr. i /� Applicant Signature: /l7 I A i Date: WARNING:FAILURE TORE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SWILL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS(E rr),IN ADDITIONTOTHE 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.LW.x Class If Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affi that Cher:is a�onnsttrrluctttiio�n lending agency for the performance of the work for which this permit Is issued.(Sec.3097,Civil Code). Lender's Name: .• /' /�t/✓V✓1 • Lender's Address: Signature: �1 /• Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or Improves thereon,and who does such work himself or herself or through his or her own employees,provided that such Improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I.as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044.Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 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: ❑ 1 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,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? 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 feat 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? 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? LJ Yes LJ 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). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the Information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. .,/Si�Aalt r�Qt Legal Owners) to �A�nd//OIVrvAAututtt riz 1 do(Ncant 900E Ill CRONTYPE PAIS 'MALE CODE I INSPECTION TYPE • DATE EMMA 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final -��f �j� 208 Final Plumbing 200 Final Re-Roof y"'/w (,1� 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 PBYIECT ADDRESS: UNIT: • 265 : 6TH —' CITY OF COSTA ::ESA — BUILDING PER::IT PERM ::C: E 3E0637 OWNER'S NAME: E' A_t — .J - , ADDflE55: 2703 MELISSA L . PER::IT NO: E 060627 PLAN CHEC7. NO: N GOVT:N S^?. : .. WEST COVINA • CACONSTRUCTION TYPE: PERMIT TYPE: ELE PURPO2E: REP ARCH/ENGINEER: '" Y_ REG.NO.: _ ADDRESS: UNIT: JOB ZESCRIPTIOM : REPAIR LIGHT FIXTURE IN GARAGE .- -=60676 5,_. _ PERMITTEE: CLAIM VALUE: CALC—VALUE: GROUP OCC: R—: /M—: ADDRESS: ''P MORGAN III CONST. ( 714 ) 645-4460 945 W. WILSON ST COMMENTS: NO OTHER WORI; AUTHORIZED BY THIS PERMIT CORTA MESA CA 921.77 *************44'44********************************el-C Ar-;F�*******+**-1446 -rs;_-n,rr�i>****Fku LICENSED CONTRACTOR DECLARATION: 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section $ O N I .`� G R ° VR Y M E N S 7000)of Division 3 of the Business and Professions Code,and my license is in hull force and effect. CITY uc.'056348 STATEuc.:5II1388 CLASS:B S E 7 AC K S Date: Signature: MAIN BUILDING -- ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell-insure or a certificate of Workers' FRNT: FT IN REAR : FT IPC R\ Q e IN REAR: F T �' Compensation Insurance.or a certified copy thereof(Section 3800,Lab.C). ...t..17 T: FT IN RGHT: FT 'IN O, IN RGHT: FT IN POLICY ND.: :300933_9 9 EX : r - •04 703 COMPANY:CTATE FUND ( � .,� PARKING REO: PROV: PARCEL : 92524103 �:E: REF NO; ❑ Certified copy is hereby furnished. O Certified copy! filed 1st � f PLANNING NOTES> :ate'. Applicant: **********************************jE************45********************Sr-****453'**** EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). DEVELOPMENT Fi E :111 VICES P E O I R E ? E N TS I certify that in the performance of the work for which this permit is issued.t shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California. ° ZONING APPROVED BY DATE: Date: _ Signature: NOTICE:It.alter making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : DATE: Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: DATE C).is issued Dv. *********************************•-•e********-*****s*-74-*****1-F************44 s:r******* LENDER: ADDRESS: . **********************************4 **************#******************ii*ii******** LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT;:c OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reasonBLDGMT PLUMBING ELECTRICFIRE (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct.alter.improve,demolish,or rT PMT PLw.B_NG 7MECHANIC SMTP/RES GRADING repair any structure,prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed PLR•._ - 7 5 pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business T 50.; SNIP/NON-RES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by pLANN any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($5W). ISSUE FEE T 5 , 0 0 I. as owner of the 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 sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS————> 0 . 75 15 , 00 0 . (( :, 15 , 75 15 . 75 . 00 does not apply to an owner of a properly who builds or improves thereon,and who does such work himself/herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,h wever the building or _ improvement is sold within one year of completion,the owner will have the burden of proving he/s a, p. — �:'J E ..,`7 DIVISION TOTALS——> COLL EC TED: V L7ER/SHORT• . 00 for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC ' '' 1 .OT GRADING PLAN—CHECK I.as owner of the properly,am exclusively contracting with licensed contractors to construct the pro (Se 10!, i 15 , 75 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property wh ' f e n and whocontracts ftheirh Compensaithaconbaceshouldbeepursuant rovidedto the Contractors'State La a e *4 ******************************4E**************BF****'. '************ *CK******* that proof of their Worker's Compensation insurance should be provided to me. — ❑ I am exempt under Section: B.&P.C. I N D I V I D U A L F E r BR E AK DOWN for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: Owner: I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and ELE 1 FIXTURESLIGHTING 1 ST 20 EA. . 75 , 75 25534 and that I or any tuture building occupant will/will not(circle one)need to comply with said state codes and the requirements for a END OF FEES permit Mr construction or modification from the Air Duality Management District.Residential construction applications are exempt from these provisions. Date: Applicant: I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. Date: Signature: Driver's License or Social Security 1641,46 White—Building;Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor CONSTRUCTION AND PLANNING. ilii Date Inspector POOL A Date Inspector I I - APPROVALS Permit ;,- APPROVALS Permit ,- f 1. Temporary Electrical Service or Pole 52. Pool & Equiprvnt Locat:un C 2, So.' n ^e:Undrgrnd. ---- I • 53. Stec R. n4vcrmer,t•-- - --- ---_- l r I _, 3: cicclr,r.> Corot. .. :it 'rty Jnnrgr_:_� I 5fz Forms - __- . __ _I__- i 4 `_.ectr c.! Cor.omt-undrgrnd. I4 i 55. Electrical B.andinn• I - . F+,•�r S!. , d59Rce h Pi..�Tb n? & Pr .sure T orc:ment . --_ -7T 1 -- --- I I �- --1 G ° _--- -^d- • __ _ - _-_ 57. ,1P^clnV41--C COVER G=1T( _ I . 7. Foetr.. 58. E,cct':La! Cond.nt•urd!gr cci. - E. Fo„rc,.to^ - - L CrVS' 59. Gas F pc, L Undrgrnd.;Test � ___� I 9. ,:cter Pip;: Jndrernd. _ 60. Backwash tines. P-Trap, C'' Uocheri'd I-- - - - - ---1 I 10. Structural Floor System i 161. APPROVAL TO DECK 4. 11. Properly Sower Line & House Cnnne t• 62. Backwash & Receptor-Fin.i I 12. Sewer Cap fl ' 63. Heatcr & Vent-Final .. r T13. Boa!' FlSystem y. in C•as �r• 64. P;umnin sta -FIn„I - - V// • ,4. Rc..gn P,-„Iniir.g 65. ElectricalFinal I I i5. Ra.:gh =.ectr•c,.-Condu.t 66. Solar Systair F r :6. Rough Electric Wiring --_ I 67. Sena ag P: Pct' •.; '• •-. 1I __- I I ,7. Rough " nog Sr ----- '- 68. APPROVED FC. ' ER,: .. ---- i . P Rot 3" t:ect^c' Pa' C^• ea I 69. POOL/SPA SYi' 4AL -J ..^.a ;!` 'es;",.; & r Co-rig o^.,i.q t 1 FIRE DEPT. R. INEYEiV I • _.r F-ctat F :LO .,,t j APPRO VAi.S Peron _ P �..Ct<. 'n 5tr uCi Jrc � _ _-t___ 70. J' 72 D,.et,, t'ont,letrg __-_ _- - -r-_- �- _+ - 71. Product 7;;-.I y,'• :G.' , -, - 0; --_-_ I- -- - ---- -F- --------- -' I 23. 3a. PIP--img:a & 7'st HI 72. Undcrgro:r:u Fius__ • 774. Roc' F::-•m -3 - -__ _-- - -_r- �_ 73. Undergrnd.Stora uc Tank 'Ga. :(TI ' I : 5. Ir.au{ St.•atnicg 74 Overhead Hyrlrn i7E. i-Bat CeWmq IStructurall & nionoeoat 75. Dry Chem:La! r--27. Frame and Flashing 76. Dry S:a^uti . c 1 • I.--- :--5. _'_ath rg . Ed :,g - - I -----1- - -_ 77. FIXED `,YflE: r '.AL -- - - -- -_ 7J s' . an -_------ --- --- I 78. FIRE PRt\/ FINA --- _- - -- - - --I I --� i -ACTH DEPT F`,'soli-ill-It-7.3" '; - ' 31. P,a,tr- c i. - Co:.• . _{1 79. F ':4',. H'' 'On IC'- --- -- - -- - - -- - --- --' ! '_? - ect Pte. L -tt•• - ; - - 03. -D.J C. . Si,. .. 37-ii--(73i1 - ---G4 -LSE Notes: _-- - - - - - - -- - -.- __ - - :, : '-r. r• ., c a A r Ci .. i - - -3. L nE, Gil P e'Test p 1 t, <9 r 1 77, c,ris ct:; •:o• Fireta':ce / - --- -- --- ---- -- �In) - - - --vier ,. -Sz..,i-}_ -- .� �. Gas Seri. ce-Finai / 41. Solar Domestic-Final h ---_-� -------s-_- .._,....i. --- _ _ __ __-- �- _-- _1 47. 8ackflo,v Presenter --- 1---- - -- ----- - ----- ----- - 43. 9, •C-fica irriatior i •'' r,-,,,c,„, ..,. I gatior System I - --'- --- - _ - r45. So.nd - rter uat'on I 43. F:andlcz^_ Regulations --- -- - I - ---- ----- - - - - - --' '7. Eli.' L STRUCTURE & BUILDING ----- ------ ' ------- --- - -- - - -- --- ',:4u PLANNING - --- ------- - - --- - - - �� E ctr c 7;.c se to cdlson --- - ----j _ -- ----- - - - - - - -- - I53 Gas Relcase to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY -H No- Date a PROJECT ADDRESS: 2 - UNIT: CITY OWNER'S NAME: 55 16TH kg 1. CITY OF COSTA MESA — BUILDING PERMIT PERM NO; S 060637 ADDRESS: SLAIN CHUIJG • 2700 MELISSA ST PERMIT NO; 5 060637 PLAN CHECK NO; N GOVT; N SUPP; N WEST COVINA . • CA CONSTRUCTION TYPE; PERMIT TYPE; ELE PURPOSE; REP 813 ) 242-3723 ARCHIENGINEES: HEG.NO.: ADDRESS: UNIT: JOB DESCRIPTION : REPAIR LIGHT FIXTURE EN GARAGE RE; 860636 SQ FT: t ,, . IM VALUE; CALC—VALUE: GROUP OCC: k-1 /M- 1 PERMITTEE: R. P, MORGAN ICI CONST. ( 714 ) 6 , ` ' ' -P - • ADDRESS: 945 W. WILSON ST CO,''"NTS ; NO OTHER WORK AUTHORIZED 8Y :HIS o _ (t COSTA MESA CA 92627 ie*E - . if:E!f k*34-te 4Y#kaff4lf Eif4<+EM*:****4:fhk Af?f!Est k K•ktiF*if 4e4+Y-**'r*ie*fi**4it:te'!'f.i et *4i:f'E LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Charier '(commencing with Section r9 til) • I N G R 3 70001 of Division 3 of the Business and Professions Code,and my license is in full force and effe hi Q I R C. M \\ T S CITY LAC.:0563,18 STATE uc.:5 p31 3 8 8 CLASS:B S• E T B , C K S • nate• /,/y/i3 signature: .2l;'iS1v , ( ! 7 • --—-- ).''iN BUILDING — ACC0RY BUI .)iNG -- - WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of con A to self-insure ora certificate of Workers' FRNT: FT IN REAR: :yl IN FRN1'; FT INREAR `. FT IN Compensation Insurance.or a certified copy thereof(Section 3800.Lab.C). • LEFT; E' , IN RGHT: ",1 - 1N LEFT; FT IN RGHT; FT IN POLICY ND.: 1 3 0 0 9 3 3—9 2 EXP.DATE 06/0W1 COMPANY:S' (ATE FUND PARKING RET;': PROV; PARCEL. 42522105 ::NE; REF ;Jt; D Certified copy is hereby furnished. ZI Certified copy is filed with the city Building, 'sion. PLANNING +'-,+TES> • > I 1 date /26 Applicant �J/41/,‘..1?, • • fir******E:f' tEkti4:t:h*****kk E f . *E***4** *.< ^:-- itY;t° ...EH-i *xF:e4***4+ . ±i:*t Et''* . .F:s EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed P(IDgp'rmlt is for one hundred(SIW)or less). D V VEL OPMEN !' S E R 3 I C E S . R E Q U I R E ,4 N T J . I certify Wel in the performance of the work for which this permit is issued.I shall not employ an"t pit•n in any mannel so as to become subject to the Workers'Compensation Laws of California. ZONING APP ft_, BY • Date: Signature: _ • - - = DATE: -- NOTICE:If.after making this declaration,you should become subject to the Workers'Compensation?nnst N,a the Labor BUILDING APPROI t 7.- 1 : ' DATE: Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. - • CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performanr :moo Raifi(m k_., •=7.,-,,,,. .j... AT ION ISSUED B Y; which thrs permit i5 issues(Section 3097,CiV.CI. e ,, DATL; 1 1`I 9.3 tr:3iw. ************* x x• t '-i . x• . x'n Et*****.4t*=:t********t 3`'. . -.En' Tat* LENDER: .E****z*iitt**)fiE**N-XfiEel-k*ALEN-{k*?E#*k*iE-:*1f:E**.*;E*;f1f:{k4***if fat?Eke#?f3f<**:tE k k.t43.' '*)!af-:E*i'*.!'. • ADDRESS: LEGALIZATION; N F . E SUMMARY STRUCTU'k L SEGMEI.s';, OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/ticS , . • ING (Section 7031 5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish.or PERMIT repair any structure.Briar to its issuance.also requires the applicant far such permit to file a signed statement that he/she is licensed 7 pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 70001 of Division 3 of the Business .j01' SEMI P/, C, , ES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by P LAN ' any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE 15 , 00 I. as owner of the property or my employees with wages as their sole compensation, wilt do the work, and the BUILDING--DIV—> PERMIT ESSUE PLAN—CHECK TOTAL ''AID DUE • EJ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS——--> 0. 75 1 5 . 00 0. 00 1 5. 7 5 15 . 75 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or throughC 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 will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED; 15 , 75 `^'0 ER/SHORT : 00 'for the purpose Of sale). BLDG PMT PLUMBING ELECTRIC -+MECHANICFIRE y` /TOT GRADING PLAN CHICK I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 15 , 75 u and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon • and whocontracls ler Such projects with a contractor(s)license pursuant to the Contractors'State License Law),l am aware ;E.:k*****k**2****is****k********N.***-*i4**;#*T**** ,ua~ ****.***A*'**`4***.'**,f*44 y,*ii*,*,E is M,X-y',+f,(, that proof of their Worker's Compensation insurance should be provided to me. _ E] I am exempt under Section: B.8 P.C. • I N D I V I D U A L F ,Ir t BREAKDOWN • for this reason' TYPE QTY D E S C -R I P T I •r. f' - UNIT COST TOTAL COST Date Owner: • • f do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and Y L E 1 FIXTURESL ICitil L NG_ 1 ST_2 0 E.'�, 7 5 7 5 • 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a END OF :EES permit ler construction or modification from the Air Duality Management District.Residential construction applications are exempt from these provisions. Date: Applicant'. I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. In /'> g /2` Y✓/LLt/t-Vf Th.. r Dale: /,/9 /7 Si nature: 7, • Ui •7r7I3165 -(•31.3;4'=7 Tor T" .-3. Onver'S,Llcense or Social Security o:', 898083DATE:• 01/14'93 )1)'.E; tO;- 11.46 ,white—Bmining:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor OJECT ADDRESS: 265 16TH PL UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 060636 OWNERS NAME: ELAIN CHUNG ADDRESS: 2700 MELISSA ST PERMIT NO: B 060636 PLAN CHECK NO: N GOVT: N SUPP: N WEST COVINA CA CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE; REP ARCNIEWMEER: 818 ) 242-3728 REG.NO.: ADDRESS UNIT JOB DESCRIPTION : REPAIR DAMAGED WALLS IN BATHROOM SQ FT: 1,000 PERMITTEE: CLAIM VALUE: 1, 000. 00 CALL—VALUE: 1,000 . 00 GROUP OCC: R-1 /M-1 ADDREss:R,P. MORGAN III CONST. ( 714 )645-4460 945 W. WILSON ST COMMENTS; NO OTHER WORK AUTHORIZED BY THIS PERMIT COSTA MESA CA 92627 *****;lr**sr***********+E********itErit*****sr******it**itit************itit*+FSE**********it** CENfCONTORei DECLARATION: hereby affirm that am licensed uerprovisions 1.htpter 9(commencing with Section Z O N I N G REQUIREMENTS LIoDI3 oTBurAd Pr here Code.and licenseso force and CITY LIC.: STATE LIC. CIASS: S E T B A C K S 05 34 381388 2 �eeB ,��,( Dale:—/ f 14/4.3 Signature:_1_PVa'4 / MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm)hal I have a certificate o consent to sell-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT; FT IN REAR: FT IN Compensation Insurance.or a certified copy thereof(Section 3800,Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN POLICY ND.:1300933-92 EXP.DATE: 06/01/93 COMPANY:STATE FUND PARKING RE • PROV: PARCEL: 42522105 ZNE: REF NO: ❑ Certified copy is hereby furnished. n( Certified copy is filed with the city Building Division. PLANNING N TES> 1X13 /� .rale: //�-7 Applicant: Y {'1w(7'✓tn' **************>***************************************************************** / EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed it the permit is for one hundred($1W)orless). DEVELOPMENT SERVICES R E Q U I R E M E N T' S 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. ZONING APPROVED BY- . : DATE: ,.. Date: Signature: NOTICE:If.after making this declaration.you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY-: DATE: Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby allirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: \ti 4 1 °.3 which this permit is issued(Section 3097.Civ.Cl. DATE: # ******************************************** *********************** ******* ' LENDER: ******************************************************************************* ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 25. 0050 , repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 0l the Business SM I P/NON—RES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN 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 the 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 sale(Section 7044.Business and Prolessional Code: The Contractors'State License Law TOTALS----> 25. 50 0. 00 0. 00 25. 50 25 . 50 . 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through his or het 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 will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED: 25. 50 OVER/SHORT: . 00 for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK I.as owner of the property.am exclusive) contracting with licensed contractors to construct the project(Section 7044•Business 25 . 00 . 50 ❑ and Professions Code: The Contractors';Stale 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 ***.**,*.**,*,**•***,**•**.***•****.****.*.***,*.******.. ,**,*,*M,************,*,******,**,****,***,***,*,*, that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: B.s P.C. INDIVIDUAL F E E BREAKDOWN for reason TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: Owner: I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and SFR 1000 ALTER BY VALUE RESIDENTIAL NOZONE 1 .00 1 , 000. 00 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a END OF FEES permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from these provisions. Date: Applicant: I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes, / • - , Date: 1//q/`7.& Signature: AP�`,Jyw`Y ' Driver's License or Social Security r: • : ; • ; 1116. 1641.46 Whne—Building:Green—Code Enforcement;Canary—Applicant;Pink—Revenue:Goldenrod—Assessor (1 • .-uNSTRUCTION AND PLANNING POOL A APPROVALS Permit# Date Inspector APPROVALS Permit , Date Inspector 1. Temporary Electrical Servrebr Pole ' • 52. Pool & Equipment Location 2.. Sog l Pipe-Undrrndr- ' 53. Steel Reinforcement 3. Electrical Conduit-Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-1 ndrgrnd. 55. Electrical Bond.ng c 5. Steel Reinforce aient 56. Rough Plumbing & Pressure Test . 6•:Electrical UFE%Grad. . 57. APPROVAL TO COVERGUNITE 7. Footings .. 58. Electrical Conduit-Undrgrnd. 8. foundation • 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgind. 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 9 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrics;-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning ,:FIR. DkPT. REQUIREMENT 20Sirjh Pictoe Fi-}'-eplace "t,: - _ ;-> ., ,.APPROVA S":_, 'Permit# 21 Ducts, ir€Stra-tur6'- " " - 70: Undergrbunc(:Hycko 22.-Ducts,Ventil ting., r' • S ; 71. Product-Piping 0.-Gs DOil 23. Gas Pipe-Rough & Test i *'.. v -r - t •- i 72. Underground,Flush•- - 24. 'Roof Framing - r - :. 73. -Undergrnd.StorageTank 0 Gas 0 Oil 25. Roof Sheathing S • .n t74. Overhead Hydro 26._T-Bir Ceiling (Structural) &fi+l&rtpcoat „ " =x 75., or, Chemical ' • r. 27. Frame a.^.d Flashirp. ')t �: _ ,/ //-J2 > 76. Dry Standpipe ' 28.'Lathmg$ S¢img�: •= I/ '•• I " "�� ;` 77.':FIXEDSYSTEM:FINAL .- 29. InsulatiU '¢' _ f78.`FIRE PREV. FINAL ' ^ r. n r30. Drywall.('slailit�ig _`;` - , 'l ItEALTHDEPT, REQUIREMENT X31. Plaster BrowrrCoa`x- r- • I -• -, .-79. FINAL INSCECTION r;22.- lectric4Povaer 14eter Final ' i ' '80. Troop CERTIFICATE ISSUED . 33. Finds Electric _ I r Notes: _ . _ '34!-Final Heating& Atr-Conditionitig= 1 r. ' - 35. Final Gas Pipe.-Test. -T- .: I I = ' -. : 36. Hood or-Canopy•' - s- -37.:EinaLFaCtory Fireplace- - . - (� , - 38. Final Plumbing i r > i I . i _ ,; -_ 39. Water Service.-,Firtala _ („ - •40. Gas Service-Final -. - t ' A • ' ' :41. Solar Domestic-Fink] • -' 1, _ 42. Backflow Preventer it < I I - • 43. Backflow Irrigation: _ •' -, - n 4 r44. Landscape IrFigation System^ *'•: r '1r 1 > - • -_ -17 >: • - r - T r_ . -r , . _ • > 1. , - ' Attenuation „ 45. Sound AtteatioX 1 46. -Handicap-Regulations '1 1 r, . = •• 47. FINAL STRUCTURE & BUILDING L ' 48. FINAL PLANNING' 1/ . 49:Electric Release to Edison '• ' ' . I ' • ' ]-•50. Gas.Release to Southern California Gas Co • I I - • c51. CERTIFICATE OF'OCCUPANCY - \ No. Date F7 PROJECT ADDRESS: 265 16TH PL UNIT: CITY OF COSTA MESA - BUILDING PERMIT PERM NO: IB 060607 OWNER'S NAME:ELAIN CHUNG 1 ADOREss: 2700 MELISSA ST PERMIT NO: IB 060607 PLAN CHECK NO; N GOVT: N SUPP: Y WEST COVINA CA CONSTRUCTION TYPE: PERMIT TYPE: OTH STR PURPOSE; OTH ARCH/ENGINEER:818) 242-3728 REG.NO.: ADDRESS: UNIT: JOB DESCRIPTION : COMPLIANCE INSPECTION SQ FT: PERMITTEE: CLAIM VALUE; CALC-VALUE; GROUP OCC; R-1 /M-1 RUNESS:R•P• MORGAN III CONST. ( 714 ) 645-4460 945 W. WILSON ST COMMENTS- NOT A CONSTRUCTION PERMIT - COMPLIANCE ONLY COSTA MESA CA 9267 7 *****Sr;r;F�ESF�r******************�F�E****SF***********SH******SH+P�F�P********************* ' LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of hapter 9(commencing with Section z ONING REQUIREMENTS 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. SETBACKS CITY LIC.:05 348 STATE LIC.581388 CLASS:B /42/;_lignawre: ltin111"t' t, t i' MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby atfirm that l have a certificate of consent to selbinsure or a certificate of Workers' FRNT; FT IN REAR: FT IN FRNT; FT IN REAR; FT IN Compensation Insurance.or a certified copy thereof(Section 3800.Lab.C). LEFT: FT IN RGHT; FT IN LEFT; FT IN RGHT; FT IN POLICY NO.:13,313933_92 EXP.DATE •36/031 /93 COMPANY:STATE FUND PARKING REQ• PROV: PARCEL: 42522105 ZNE: REF NO; ❑ Certified copy is hereby furnished. x] Certified copy is filed with the city Building Division. PLANNING NOTES> /',� > dale: ` //2/4 R Applicant: P-1.414144.71,1....-. �1 * ***************************************************************************** EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred(5100)or less). DEVELOPMENT SERVICES R E Q U I R E M E 'N T S 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. ZONING APPROVED BY Aft DATE: ' Date: Signature: y/�� ////�/J\ _ NOTICE:II.after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY ; /5 (% _i- DATE; /7/� tLf Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. /J q CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY- Jj( r�' DATE: e']��e which this permit is issued(Section 3097, Civ.C) ************************** ** ***it�1F * * ** . ********************* ****** **** LENDER: ****************************************** - * ******,*************************** ADDRESS: LEGALIZATION:N F E E S U M M ' R Y STRUCTURAL SEGMENT: Y OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRAD ING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 30. 00 repair any structure,prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors'Stale License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business SMIP/NON-RES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN 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 he 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 sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 30. 00 0.00 0 .00 30. 00 30. 00 . 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himselt/herself or through his or her own employees,provided that such improvements are not intended or offered for sale. II,however the building or improvement is sold within one year of completion.the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED; 30.00 OVER/SHORT: 00 for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 30. 00 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon -I and who contracts for such projects with a contractor(s)license pursuant to the Contractors'Stale License Law).I am aware *************.*.**.*****,*.**.*.K.*,**.*.*******.**.******,******,***.*.,N.*.*.,**.*..N.**.****,*****,*,*,*,*,*,*, that proof of their Worker's Compensation insurance should be provided to me. ❑ am exempt under Section: B.a P.C. I N D I V I D UAL F E E B R I A K D O W N for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Dale'. OwnerINS 1 BUILDING RE-INSPECTION FEE 30. 00 30 . 00 I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES 25534 and that I or any future building occupant will/will not(circle one)need to comply with said slate codes and the requirements for a permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from these provisions. Dale: Applicant: kbycertify that I have read this application and state that the above information is correct.I agree to comply with all city and county nces and slate laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned rty for inspection purposes. Fs2/� ,7 4/-2/r3 Signature': ✓r'^41/t'e'F/l -r's License or Social Security Canary—Applicant:Pink—Revenue:Goldenrod—Assessor CONSTRUCTION AND PLANNING POOL A r W'PROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location . 2. Soil-Pjte-Undrgr- d.- 53. Steel Reinforcement arElectrical CondtnPtJtifity-Undrgrnd'.'- 54. Forms 4'.Electrical Conduit-Uny drgrnd. .'.; 55. Electrical Bonding m•.j _ 5, Steel Reinforcemem^ 56. Rough Plumbing & Pressure Test -- 0,'ElectriGal UFEfi-'G`r*, ' 57. APPROVAL TO COVER-GUNITE :. 7. Footings iC: „z 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 FIooFSystem 'L 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 ElectriccConduit 66. Solar System-Final ' 16. Rough Electric Viring .. 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 _ _ , _c 2= x _ FI ,- DEPT. REQUIREMENT 20. !Rough Facto,*' Fireplace , -�' I. x ~� �' ; ;dPPR V S" !:Permit# .: 21. Duct, in-Stratuiut• i _- -7-- ' 170. U_tdergrb�.nd•Hydro 22. pucts, Ventitating_k ` '-. 77 n -. e x 41. ProductPiping 0 Gas 0-Oil 23. Gas Pipe-Rough & Test ' ". - 1, x ; 72, Underground Flttsii , m 24. Roo!'Framing- r,:: . '' . '> 'P; .- '" •'/3.T,UndergrndrStorage,'Tatik `.1 Gas ❑Oil 7 - 25. Roof Sheathing •t <r e - - :_ 74.-:Overhead vHydro - _ _ 26.3-Bar Ceiling fStr'cSurall &lv17ipcoat - - g , 1 >. 2c 75.;{ Y Chemical D 27.Srame and Flash;ng. _ : ' 76. Dry Standjeirp_ - - ' - -1' t •~ v,c - •r „ -_ 28. Lathin $ Sidin 'L x r. '<t s: r: 5 •-•r - - 9 g,,, zi_ Y I I I. 77.- FIXED S EM 1NALF 29. Insulation . - _ J•• • ••• , ! x v 785-FIRE PREV. FINA . ` = -^ u c _ . 'r 11_' k 30. Drywall flailing - ! ,. HEALTH•DEPT 'REQOIREMENT '�; - x - . ~ 31. Plaster BrowmCoa't• ' ,cir - (I} l' x ,r79'"FINAL INSRECTIQ,,N x 32.'Electrical^P ger hlle4etTE�nal -'� I i * i'80.1OOD CERTIFI TE ISSUED •,33.-' • El strip 7.-m t n ! •: .s Notes: > • . Ci • .. _ . - - L >✓-^ •34.-F inat Heating& Air Conditioni?g> :r ' 7....' 1 I' `' `- - r-i ,X - ` 'c 35. 'final Ga4Pipe-Test= =' :. q _ I rz 36. Hood or Canopy = ' r .:Ca 37. Einaf Factory Fireplace .; _ r- . . 1 1 N. ,_ 4 38. Fina! Plumbing - • � - > x �r i Is x ' x 39. Water Service-Final- . (' ' • ,.. - :Inc - '40. Gas.Service-Final a 7 -Cy -• ! r j q -41. Solar Domestic-Final -' ' I t I " = 7. 42. Backf low Preventer• �� ,1 Ix . rC 43. Backflow Irrigations N t • > fJ J .44. Landscape Irrigation Systema•+': ' : .r : '7 x ` -� -• - r - .r V;- < ' 'v -45. :Sound Attenuation' ` = - _ 146.'Handicap Regulations 7 _ • - I ' .K T. 'C 'S C s 47. -FINAL STRUCTURE & BUILDING • 48. FINAL PLANNING i ' _ . _ -- 49.-Electric Rele@'se to Edison r, - l .a �� r C 50. Gas,Release to Southern California Gas Co +' - -- C. 51, CERTIFICATE OF-OCCUPANCY C ;'� -- - No. Date -Ci PROJECT ADDRESS: 265 16TH PL UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 060637 OWNER'S NAME: ELAIN CHUNG ADDREss: 2700 MELISSA ST PERMIT NO: E 060637 PLAN CHECK NO: N GOVT: N SUPP: N WEST COVINA CA CONSTRUCTION TYPE: PERMIT TYPE: ELE PURPOSE: REP ARCH/ENGINEER: 818 ) 242-3728 REG.NO.: JOB DESCRIPTION : REPAIR LIGHT FIXTURE IN GARAGE RE;B60636 SQ FT: ADDRESS: UNIT: CLAIM VALUE: CALC—VALUE: GROUP OCC; R-1 /M-1 PERMITTEE:R.P, MORGAN III CONST. ( 714 ) 645-4460 ADDRESS; 945 W. WILSON ST COMMENTS; NO OTHER WORK AUTHORIZED BY THIS PERMIT COSTA MESA CA 92627 I *;N******4** r****************;ex;E**+t*************+ ******************************* LICENSED CONTRACTOR DECLARATION: I hereby affirm That I am licensed under provisions of Chapter 9.(commencing with Sectio Z O N I N G REQUIREMENTS 7000)of Division 3 of the Business and Professions Code.and my license is in Lull force and effect. / SETBACKS CITY LIC.:05 34 STATE LIC.58138 8 �77��Y,.//CC/LL)ASS:B Dale: /�/q/8C3 Signature:_4 &tt/U " / MAIN BUILDING • ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell-insure or a certifica�Workers' FRNT; FT IN REAR; FT IN FRNT; FT IN REAR: FT IN Compensation Insurance.or a certified copy thereof(Section 3801.Lab.C) / LEFT; FT IN RGHT; FT IN LEFT; FT IN RGHT; FT IN POLICYNO.:1300933-92 EXP.DATE: 06/01 /93 / COMPANY:STATE FUND N/ PARKING_REQ• PROV: PARCEL: 42522105 ZNE: REF NO: ❑ Certified copy is hereby furnished. g1 Certified copy is filed with the city Building Division. PLANNING NOTES> Jate: ///9/473 Applicant /29/ 1ri ******************************************************************************* / EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed it the permit is for one hundred($100)or less), DEVELOPMENT SERVICES REQUIREMENTS 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. ZONING APPROVED BY DATE Date'. Signature: NOTICE:II,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : DATE; Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. p`�x.,X_/� `l p CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY. ' +`, DATE; , 1—1 L-2 which this permit is issued(Section 3097.Civ.C). *********************1f************.*****.****if iF*********************** ********** LENDER: ******************************************************************************* ADDRESS: LEGALIZATION;N F E E S U M MARY STRUCTURAL SEGMENT;N OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'Slate License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve.demolish.or PERMIT 75 repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed 5(..1% SMI P/NON—RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 70110)of Division 3 of the Business and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE 15. 00 I, as owner of the 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 sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS————> 0. 75 1 5 . 00 0 . 00 15,75 1 5 . 75 . 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through hr improvementis or her soln d within onees, yided that such yearr of completion,the owner will have intendedrovements are not thburden fol red lor povng he/she did not build or ir the improve REVENUE DIVISION TOTALS--> COLLECTED; 15.75 OVER/SHORT: 00 mnhepurposeolsae). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK I.as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 15 , 75 ❑ 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 F E E BREAKDOWN ❑ I am exempt under Section: B.8 P.C. for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: Owner: ELE 1 FIXTURES. LIGHTING 1 ST 20 EA. . 75 . 75 I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505.25533,and END OF FEES 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from these provisions. Date: Applicant: EXPIRED n1X_P I R E D I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county a Mote Inspections ordinances and slate laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned I� / property for inspection purposes. /� .1/L Date:_L�9/45 Signature: /21°141/ .-A -22` Date /]U1�LFy_ rF.-/L^+ - _ Driver's License or Social Security a: 1641-46 While—Building',Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor _ — _ _ _._-- - -- 1T CONSTRUCTION AND PLANNING POOL 'A - APPROVALS Permit 0Date Inspector APPROVALS Permit Date Inspectu• 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 1 I 2. SoilPipe-Undrgrnd. � -- 53. Steel Reinforcement 1 3. Electrical Condu:t.Utihty-Undrgrnd_ 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement, c�` 56. Rough Plumbing& Pressure Test t I 6.- Etectrical UFER-&end. 57. APPROVAL TO COVER-GUNITE ', ii 7. Footingsr 58. Electrical Conduit•Undrgrnd. 8. Foundation •- 59. Gas Pipe, 0 Undrgrnd., Test 1 9. Water Pipe-Undr0d. . 60. Backwash Lines,P-Trap, ❑ Undrgntd. 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 • Fina' • 14. Rough Plumbing 65. Electrical-Final ' 1 15. Rough Electrical-Conduit 9 66. Solar System-Final I 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 ANAL _� 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT ' L. 204Rough Factory Fire""place z s. ^ r 2 i - ` APPR' VACS' •• Permit # - R -�T _ . 1 - 21. Ducts,in-Strticturer •- : ` .r 's • - - ^ -70. Underg.%nr1 Hy?lro ' H 22.. Ducts, Ventitetiru '-i V V ! -'r C. - X71. Productc4ing [)Gas d'OIl 23. Gas Pipe-Rough & Test * 72 . Underground Flush •* . i - r 24. Rooi Framing ".. - , 1 25. Roof Sheathing `i - - . 573.-Undergrnd.StordyyTank Gas Otl . + veread : 74cOhd Hyro7. • 26.tT-Bar Ceiling (StrAtural) &`Tulonocoat - ;' 75y Dry Chemical ,j t __1 27. 'Frame ai J FlashiAg, .. T; e a •1. . 76. r - • - - _ Dry Stanpe _ ^ -28. Lathing$t Siding w -`+= - I': ' 77. FIXED S STEY;J3INAL;' r 29. Insulation ' . 7E?'FIRE PREV. FINAL ` : '• -I. 1 •30. Drywall Nailing . 1 - I • 1NEALTI- EPT",` REQUIREMENT 31. Plaster ?own Co82. .. •K , 79'FINAL INSPECTION . _ r_•-..- - 4 32. Electrical Poorer PAeter-Final '` t l' y r80.'FOOD CERTIFIqATE ISSUED -_ • 33.,Final Electric. -1 - . i 1' ,. Notes: - _ -. . . C -- -• c ••34i Final He7ting& Air ConditionThg ' v - _= c- ' = _ .. g .-O n.f 1 J 35. Final Gas Pipe-Test I - �'_ - •• n_ { 36. Hood ortanopv-^ - a t' I' 37.2Final Faitory Firaplace� - _ .- : r' 1 j L �-v . ' I i 1 _ -- - 1 38. Fina[ Plumbing ' +v= I •- I - - •' tL� T. 'a r t ',J 4 T X '� i 39. Water Service-Fihal; . c i 1 E„ ` r ' 1 ..40. Gas Service-Final Cr r- -- r 1 - - : . { { - 41. Solar Dgmestic-Finjh' I er -_ 42. Backfloia Preventers - r i I t * - 1 43. Backflow Irrigation,. • ' ' ; r v ,. - z §. t - 144. Landscape Irrigation System_.-..' t. r r. T. - 2"; * 3 ..0 • N - 45_ Sound Atteisuatioe _ r - ' „ ' 3 ; ` T r I ,.;46. Handicap Regulations r :C •.c 1 47.*INrAL STRUCTURE & BUILDING F I ' ' 48. FINAL PLANNING 49. Electric Release totdison ' 1 I II • `�• - 50. Gas Release to Southern California Gas Co . 1 I !- - 51. CERTIFICATE OF OCCUPANCY - ` _ - • - - No. Date I Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. • • .. CITY OF COSTA MESA ' CONSTRUCTION PERMIT ti< ` PER X I�NO. �O TRACT NO. LOT NO. UNIT NO. 4864 6/14/A5 pp�� 7 . Project Address .265'-�//g/� 2L f,/4.-c �^ N g r`C( f Applicant's Mailing Address -�4 O75 SAI°`•s 57 57,4 r TYPE OF CONSTRUCTION ' LI NEW ❑ ADD U ALTERATION_REPAIR I • Owner's Name II674:. tT Gs4te•s Phone 7Sy/7/y ❑ CONVERSION ❑ DEMOLISH ED OTHER A.P.# Zone �/ /424-4, /2,1i' etre.".(hed DESCRIPTION OF WORK/USE OF BLDG: We/ j'"e,-".- ‘4je'� AddressS Main Building: Accessory Building: E Z Arch/Eng. License No. TYPE OF PERMIT U GRADING FOUNDATION ❑ STRUCTURAL T Front O ti Address �/1J ,�• / ❑ TENANT ❑.ELECTRICAL PLUMBING ❑ MECHANICAL BA Rear - N Contractor's Name .11(.r7D4C5440 // hone14//V44 ❑OTHER I PROJECT DESCRIPTION SQ. FT. OCCUPANCY - C Right G 1 Address)mailing) �7, S-LIQi+ ST �.,,4/.,Z,.�1/2X'. K l.� 3�SSG C O N ST RUCTION TYPE VALUATION$ S Left IJ) City License No. • ZONE GRADING CU.YDS. ACRES E LICENSED CONTRACTOR DECLARATION _ Ping. Ref. # Parking Req./Provided , NI hereby affirm that I am licensed under provisions of Charter 9(commencing Remarks: Planning Notes: • QM with section 7000) of Division 3 of the Business and Professions Code,and - T ^_ my license is in full f ce and effect. _ OD License Class • 7G •�7 Li nse No.' y�g5 Y9 • Date C''"1N- ' Signature PLUMBING FEES ' WORKERS'COMPENSATION DECLARATION Bar Sink Showers ' I hereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL FEES of Workers' Compensation Insurance, or a certified copy thereof (Section - Backflow Preventer Service Sink. • 1800, Lab. C.) [ / Automatic Washer - - -- Transformer 0 15-50 KW - - Policy NOTJWCOa276fO '0C Company ..44-46.61.10‘.. Sk$ Backflow Irrigation Sewer Ca 0 50+ KW P Construction Pole Sub. Certified copy is hereby the cit r Certified copyfISJiled with the city BS=Divi fes/ ' Bathtubs Sewer Connection Cooking Unit - Meter ❑up td 100 amps Date r-/a/ 7` Applican �T/ • EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors . Dishwasher Meter Dover 100 amps •, (This section need not be completed if the permit is for one hundred ($100)or - . less). Dishwasher Solar Piping 'Dryers ❑Gas DElectric -Sub Panel I certify that in the performance of the work for which this permit is issued I - shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Fan Motors 00.1 HP 01%.8 Workers' Compensation Laws of California. . Date. Signature Floor Drains Swimming Pool w/Spa F.A.U. •_ Inc.Solar 09-15 HP ❑16-15+ 'NOTICE:If,after making this declaration, you should become subject to the • - Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks • . - - Urinal . - . Fixtures - Microwave ' comply with such provisions or this permit shall be deemed revoked. ' CONSTRUCTION LENDING AGENCY Gas Service Outlets ' Water Closet Device Boxes 1 hereby affirm that there is a construction lending agency for the performance Pole Light of the work for which this permit is issued (Section 3097 Civ. C-) Interceptors Water Heater Outlets Range Name - _. _- - Lender's Address . Kitchen Sink Water Service Switches Sign OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash following reason (Section 7031,5 Business and Professional Code: Any city or Garbage Disposal • ;$tending Sections • county which requires a permit to construct,alter,Improve,demolish or repair P-Trap - • Laundry Trays • . Generator ❑0.5 KW❑5-15 KW Trash Compactor any structure, prior to its issuance, also requires the applicant for such permit . �7` P to file a signed statement that he/she Is licensed pursuant to the provisions of ' 'Roof Drains / ern yy Z • the Contractor's License Law(Chapter 9(commencing with Section 7000)of W�ZE:�6r5 .. P1A'G� • Division 3' of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 131.5 by any applicant for a permit subjects the applicant to a civil ' • ' halty of not more than five hundred dollars($500). • --J I, as owner of the property or my employees with wages as their sole Reinspection Fee . I $15 Issue Fee' $ 3 ' compensation, will do the work, and the structure is not intended or offered _ _ __ _ - _ - Reinspection Fee . $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's , MECHANICAL FEES License Law does not apply to an owner of a property who builds or improves _ thereon, and who does such work himself/herself or through his or her own - - DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such Improvements are not Intended or offered for Boiler Hood or Type I 0 sale. If,,however, the building or improvement Is sold within one year of com- • Canopy Type II 0 Zoning Approved By Date pletion, the owner will have the burden of proving he/she did not build or im- Duct- Under GroundBuilding Approved By Date prove for the purpose of sale). • 0 I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By �� Date tractors to construct the project (Section 7044,Business and Professions Code: - The Contractor's License Law does not apply to an owner of'property who Duct-Ventilating 00-100)000 BTU 0100,000 BTU SUMMARY OF FEES builds or improves thereon, and who contracts for such projects with a con- tractors license pursuant to the Contractor's License Law). I am aware that . Exhaust System ❑ Multiple 0 System Repair/Alteration BUILDING'PERMIT $ SMIP $ proof of' ause their Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT 0 I am exempt under Section - B.& P.C.for this reason Firepl/Fact.Bit. ICBO# Fire Dampers PLUMBING $ 7 oo ISSUANCE $ • Date Owner Heating System& Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $ 1 hereby certify that I have read this application and state that the above 00.100,000 BTU.0100,00013T -. . - ELECTRICAL $ GRADING $ information is correct. I agree to comply with all city and county ordinances _ and state laws relating to building construction,and hereby authorize repre- - - PLAN CHECK 50% $ MICROFILM $ sentatives of this ity to enter upon the ab -mentioned property for inspection purp N ' MECHANICAL $ s 00 Signature N Date G-/Y'SS~ - TOTAL FEE $ Drivers' License or SS Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ de CMF •0865-46,rev.10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor - - - - • • CONSTRUCTION AND PLANNING POOL 'A r Date Inspector Date Inspector APPROVALS Permit# • APPROVALS Permit#• - 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. iElectrical UF ER Grnd. • 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. I . 8. Foundation , 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, ❑ 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 ❑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 •r 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 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing diyitr _39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final • A2. Backflow Preventer 43. Backflow Irrigation 44. ,Landscape Irrigation System • 45. Sound Attenuation • 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison • 50. Gas Release to Southern California Gas Co • 51. CERTIFICATE OF OCCUPANCY No. Date -OWNER CERF, R. C. DATE 3-11-59 JOB ADDRESS 265-67 UNIT C BUILDING PERMIT NO. 8765 GENERAL CONTRACTOR VALUE $ AP. No. LOT TRACT FIRE ZONE DESCRIPTION OF WORK Grir/UP TYPE ZONE PLAN NO. 8765 II._?ECT IONS DATE SUBCONTRACTOR PERMITS ISSUED DATE NUMBER Trench Former Steel 3/Y7./.n. Floor Sytem / Steel Reinforce Chimney Re-Rod Bond Beam Frame and Flashing rivi 6-9 Lathing, In 44 Ji_Out ire J U--p-r9 Plaster, brown coat /(' 'y- '771-T% Underground soil ,,$.fS W/G Pipe TesyJ//c2_2.3j-r. Top Out .3-Y,SY Furnace . //H ei 'Z fl ,' ,'� Gas Vents ` �( -79-59 /f5jry Rough Plumbing /VMS. '/-,SVS Cesspool Septic Tank . Prop. Swr. Line House Con. St. Swr. _ Sprinkling System Heating Final Wu.A � , 7{` i1 P1 sing Fixtures, Final /p'/ h4/ We so_fii , i� F Gas Test raga, &C'o/"c4 t Construction Pole / Underground Power T 7 1-7,nn Rough Wiring `p L .3-13—C9 ..1/54Lc/Ll Fixtures, Final 99 -1,--../Y _OCCUPANCY- `/_ uc0-q ' Form 2111-5M-1-57 • UNIT C 8765 OWNER ' CERF, R, •C. DATE 3_11-59 _ *JOB ADDRESS 265-67 E. 16th Pl. Unit D BUILDING PERMIT NO. 8765 GENERAL CONTRACTOR VALUE $ AP. No. LOT TRACT FIRE ZONE DESCRIPTION OF WORK G^`'UP TYPE ZONE PLAN NO. 8765 II ..r'ECTIONS DATE SUBCONTRACTOR PERMITS ISSUED DATE NUMBER Trenches ?#EormT Steel x712.7/ % Floor System Steel Reinforce Chimney Re-Rod Bond Beam Frame and Flashing . 4A/J-- .i/'/s7 Lathing, In /MN-Out4 $L 6-5-Jr Plaster, brown coat ( l /J.- 7-,7-1 4 Underground soil MIK W/G Pipe mow 3-ZS-tf9 . Top Out S-1-61 Furnace NHS 4- -2.-541y� ) � �� Gas Vents t.t/4)(F-a-CA".Vsr.9 i-n'S7 /7,5 7" Rough Plumbing /Y}/S S-/- 6-* Cesspool Septic Tank Prop. Swr. Line House Con. St. Swr. Sprinkling System k_ ) Heating Final tQ/ 9-15--19% 'Q1/41\I\ P2:;;;tjng Fixtures, Final (I/ 9...../c-4-, .17\r E,11::Gas Test /1 a_ 1,11 9,-/ '7 Construction Pole ?-2C-rc Underground Power ar �! Rough Wiring 0-3F-nrit AA,te e4 f. S/35-5 cPWcr Fixtures, Final 7 9—l3--if OCCUPANCY —}'..f-1- 9—tar—r9 Form 210-5M-1-57 UNIT D 8765 OWNER • CERF_, R. C. DATE 3-11-5 9 _ JOB ADDRESS 265-67 E. 16th P1. Laundry t BUILDING PERMIT NO. 8765 GENERAL CONTRACTOR VALUE $ AP. No. LOT TRACT FIRE ZONE DESCRIPTION OF WORK G"'SUP TYPE ZONE PLAN Na 8765 IN.,r'ECTIONS DATE SUBCONTRACTOR PERMITS ISSUED DATE NUMBER Trenches - Pms - Steel 2 9, Floor Sys m or ' Steel Reinforce Chimney Re-Rod Bond Beam t Frame and Flashing n-14' /r) fi'?' Lathing, In l_Out • ej(rl 6 'Y—19 Plaster, brown oat /re ill- 7-/'/-4- Underground soilm-15 W/G Pipe Te4flfl -2.3-3f Top Out 3-t$S1 _ Furnace Gas Vents ff(7s-t/ .� ,3-/f 5-9 .77,_5-540 Rough Plumbing �(/f/-j'St/_S'? \ l Cesspool Septic Tank ?..1 Sprinkling Prop. Swr. Line House Con. St. Swr. , " Sprinkling System \ �J/,'/ Heating Final W p./S P, ;;;iing Fixtures, Final i t i - J l x�� F Gas Test /4i'�,k W '-/S-.c9 'Y1 Construction Pole I Underground Power 'J ?-2(.47 I / / Rough Wiring . 7.-- .- O.rr Uhl ititl//Z6 E '1- . ,'3—/?i-. 7 /7 t j+ Fixtures, Final' '�?; • ,/,S.,.y "OCCUPANCY ,- ;' 0—.11--JS , Form 210-5M-1-57 Lain dry r-' 6765 OWNER ' CERF, R, C. DATE 3-11-59 _ 'JOB ADDRESS 265-67 E. 16th Pl. Unit B BUILDING PERMIT NO. 8765 GENERAL CONTRACTOR VALUE $ AP. No. LOT TRACT FIRE ZONE DESCRIPTION OF WORK Gr1UP TYPE ZONE PLAN NO. 8765 li__e'ECTIONS DATE SUBCONTRACTOR PERMITS ISSUED DATE NUMBER Trenches 'j.Forms' Steel 3/47/5'7/ Floor System Steel Reinforce Chimney Re-Rod • Bond Beam Frame and Flashing "' y/c,e/b� Lathing, In 4(/j/�put �,�^ '/t (---Q '51 Plaster, brown coat �j ,9 N- 1-/7 -37 Underground soil/41-C WIG Pipe Teswhi 2.-.3.3.-Sp Top Out 3-18:ST( _ Furnace /147L-5 4/--2y-5y - � Gas Vents f( gat-fX.ts.., 5f-SY _ / •Z 5 3 7 Rough Plumbing /r/Fjs_j--tr 1S1? /1,•, Cesspool Septic Tank J Prop. Swr. Line House Con. St. Swr. i Sprinkling System q Heating Final A LII O'./$j -31 ni /, P ping Fixtures, Final �(/4 U-' Q / / I- Fter ;zl', as Test id. b✓ e.,4-4.9 / I Construction PoleUnder /, Rough connd Power l,(_J•s Rough Wiring �` yf r R/+%l."�.c 3 /3— .9 3/ Fixtures, Final r" •ill:./ OCCUPANCY _ -.eV '4-!r-.)9 Form 210--So1-1-57 ' UNIT B 8765 OWNER • CERF, R; C. - DATE 3-11-59 _ JOB ADDRESS 265-67 E. 16th P1. Units ABCD & Laundry BUILDING PERMIT NO. 8765 GG1g7NgggqpL ONTRACTOR Richard H. Rice VALUE $ 21.006,00 lAP. No l LOT TRACT FIRE ZONE DESCRIPTION OF WORK Mutt,Dwell, LlApts.Cpt.Lw GInUP H & J TYPE V ZONE RLI PLAN NO. 8765 PERMITS ISSUED I,,_?ECTIONS DATE SUBCONTRACTOR DATE NUMBER Trenches Forms Le- Steel J17.401 Floor System Steel Reinforce Chimney Re-Rod enm p.� � r hic..i/Sr A-� G�. �I- e------- Frame andFlashing S'/�//�� Lathing, In eezL Out �I /fi_ 6-9-Si Plaster, brown coat ti(tN'N- 7.'(b`)I Underground soil NHS W/G Pipe Tes1424-$ILK;-5 Top Out 1 (fr Se/ I Furnace S —s-c A.), g-GLu -thSite 1 _ "-IV/'-/Gas Vents Rough Plumbing /y}ft'.S--,—4-9 Cesspool Septic Tank Prop. Swr. Line House Con. St. Swr. Sprinkling System Heating Final y(/ Q4P40 PI, Itif Fixtures, Final i 1.4 `45,-/4--fV 1 E Gas Test (lia v✓ei4h:412 tilii) Const ruction Pole , l!''' • t Underground Power ) -1 6_19 fd2,il Rough Wiring / -1G� �R/r/c..'-s-/5 _. 3-/i--' C7 X.1��.�Fixtures, Final I(��/Jtf •OCCUPANCY LI1%-P-f) Form 210-5M-1-57 UNIT A 8765 1AR Qnev .osTe.., 9a D ****61.50 • 8765 . -4 S. � COSTA MESA BUILDING DEPARTMENT P.O. BOX 317 COSTA MESA, CALIFORNIA FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT Ato) DREIN 26 &-_47(e1644 ?(Aaaed J`Aau"-17 BUILDING COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY RECEIPT NO. �RIT N ? OWNER -2 . C_ Ce • RECEIVED DATE RECEIVED AE ISSUE ADDRESS 1 e.„o, Pl, c72n a.4. Ao • - T- 7 3-//-sD MAIL TEL. (( i R.(' BUILDING CITY L I �� NO. d \�aA Dnp ADDRESS ARCHITECT 2_ LIC. OR ENGINEER " La ��` -� .1 ,NO.I C. L (J / COSTA MESA. CALIFORNIA ADD( . ac ` -L'r\4 Or 1'l p T Belk• ZONE (( 11 `} {K` 1 ZONEE,, NO OF •TYPE OR OVA CONTRACTOR R,(l-C�y4KJ:``. \CQTV NO. / (PLA NS n f ADDRESS I y(Ct QY..IC' TNO:OL .0s. 11 • BVPRROV F✓ 0774 DATE Oji )//S LEGAL LOT I'��/ 7! / // DESCRIPTION NO. BLOCK TRACT J CORRECTIONS : \ , A.P.NO. / 1-- / P71 9117j7�J .[}'��[Q�i y 11 " 4 SIZE NO.OF BLOCS. APPROVED f� R yy tl E'IIILLL"' 'b h 17 OF LOT Co )C136, B NOW ON LOT L.A_Oa...' _ C USE OF I t\CI 1 Y U1' 45T:� `.� ")�` EXISTING BLDG. . PI .:. \to 1 <G DEPT. EXISTING BL DG -._- -. �\li SETBACK LINE FROM ``� (0 SUBJECT TO BLDG. DEPT. KE6• CENTER OF STREET SJ REAR YARD I( 7 �/� 9 \y I SIDE YARD RIGHT LEFT JY' DA E S_� / �N DESCRIPTION OF WORK BY PLAN T..CH. C S` 1 y NEW L.----ALTERATION ADDITION ' kt REPA III (MOVING DEMOLISH l t? is I ^ 1 aa rp� !i A \,, LE .: BUILD({ 'l_G��•1'�/} NO.OF n -t Kv SIZE `b(/O4-4I, /may ROOMS 24 STORIES ` f ' to i. 7 I� :"; n ' n, n . 5• ! SI I o EXTERIOR WALL` 1 ROOF % f j1�� -r Q j� J - COVERING d'I'\,�`�1[_p COVERING OC Z.. I ,- 1 BUILDINGUSE OF (`A�L.I-F- 1 -AQ�,\ T /V�/.1 a/T,(�4 . C/C'/v�"�"� \O 4 NH-5 ,( V DijR. / I HEREBYAC KNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT.THE ABOVE IS CORRECT AND AGREETOCOMPLY WITH ALL FID III Iv'' I^ ` CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRVCnC7 J / TION. VALUATION PERMIT FEE SIGNATURE lc i� ^ / o PERMITTEE S ,a/i. J/ 0 O ‘J r PLAN CHECK S 2Q: v Q AUTHORIZED AGENT �[ / PLAN FEE $ 6,/,,ca `,"AE