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Home My WebLink About326 16TH PL - Building Permits(714) 754-5273 • Fax (7/4) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 dob Address: 326 E 16TH ST Suite No Vicinity: Parcel Nunmber: Applicant: Address: Owner: Address ELECTRICAL PERMIT MASTER CLOSET AT REAR OF SFD 42521118 GUSTAFSON, LISA 326 E 16TH ST - COS7A MESA, CA . Phone: 949-64G6158 Zip: 926273257 MILLER, DRINO AND GUSTAFSON, LISA 326 E 16TH ST " � ' COSTA MESA, CA Contractor: O W N E R-B U I L D E R Address: ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+uniis) Pool / Spa' Lighting Fixts Recept Outlets � Switches Non Res Appl . Res Appl Service to 200a Service to 1000a Service over 1000a Motors to 1hp Motars to 10hp Motors lo SOhp Motors l0 100hp Motors over 700hp Communication drops Sub panel to 200a Pale Light Pkg Sign Circuil5 Temp Pwr Pole Intermed Pole Phone: 949-646-6158 Zip: 92627-3257 Phone: Zip: License: 0 Status: ISSUED Applied: 02/13/2002 Issued: 02/13/2002 ISSUED BY: , Y��n� �� V DA�, SCOPE OF PERMIT ELEC PERMIT FOR ADDITION OF AN 132 SF WALK-IN-CLOSET IN P.N EXISTING SFD; WORK TO AlSO INCLUDE RELOCATION OF AN EXISTING EXTERIOR'LIGHT. 5 UGHT FIXTURES, 4 OUTLETS, 2 SWITCH.REF:BO1-0'I548 . $23.50 $0.00 50.00 $0.00 50.00 50.00 $5.50 $4.40 52.20 50.00 $0.00 $0.00 50.00 $0.00 $0.00 50.00 50.00 so.00 $0.00 $0.00 50.00 50.00 50.00 50.00 $0.00 Quantity 0 0 0 5 4 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FEESUMMARY Temp Dist System! Lighting Busway /100 ft Standing Section Misc ElecMcal Equipment Transformers up to 1 kva/kw ................up to 10 kva/kw .................up to 50 kva/kw .................up to'100 kva/kw ..................over 100 kva/kw Low Voltage Equipment Low Volt Wiring System / Ckt Misa Conduit Misc. Conductor Circus ( gen or ride) Circus (mech ride or liqhts) Chnstmas Tree Siand Fireworks Stand Other Electrical Fee - InvestigaGon Fee Plan Check Fee Reinspection Fee Quantity 50.00 0 $0.00 0 $0.00 0 50.00 0 So.00 0 $0.00 0 30.00 0 $0.00 0 $0.00 0 50.00 0 50.00 0 50.00 0 50.00 0 50.00 0 $0.00 0 30.00 0 50.00 0 50.00 50.00 50.00 30.00 TOTAL CALCULATED FEES $35.60 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this pertnit shall comply with all applicable handicap access requirements under Calilomia statutes and related regulations. (Ord. No. 92-28, § 1, 72-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or ebandoned for a period of 1 BO days. INSPECTIONS: In order for ihe work authonzed under this permit to be considered legal, such work must comply with all appliceble codes, and all required Inapections end final epproval must be obtained. Failure to obtain inspections and final approval will result in the expiratlon of this pertnit. FOR INSPECTIONS CALL: (714) 7545626 zanaae �a�m� WORKERS'COMPENSAnON DECLAPATION: � I hereby aflirm under penalry of perjury one of the following declarations: ❑ I heve end will maintain e certificate of consent to self�lnsure for workers' compensation, as pmvided for by section 3700 of the Lebor Code, for the pedormance of the work tor which this permit is issuetl, ❑ I have and will maintain workers' compensation Insurance, as reQuiretl by section 3700 of the Lebor Code, tor the performance of Ihe work for which this permit is issuetl. My workers' compensation Insurance carner and policy number are: Cerner. Palicy Number: (This section need not be campleted i! fhe permit is valued et one hundred dollars ($700J or less.) ❑ I certity ihal in ihe peAormance of the work for which lhis permit is issuetl, I shall not employ any person in any manner so as to become subject �o the workers' compansation laws of California, antl agree that if I should become subject to ihe workers' compensation provisions of Section 3700 of the Labor Cotle, I shall forthwith comply with ihese pravisians. Applican� Signe�ure: Date: WARNING: FAIWRE TO SECURE WORKEPS' fAMPENSATIIXJ CAVERAGE IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSANO DOLLARE ($100,000), IN ADDITION TO THE COST OF CAMPENSATION, DAMFGES AS PFOVIDED FpR IN SECTION 3]Ofi OF TME LABOR CADE, IMEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirm that I am iicensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 of Ihe Business antl Professions Code, and my license is in tull , toma and aHecL Lic. N Class k ' CONractor's SignaNre: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby eHirm that there is a constmction lending aqency for the pertormance oi the work tor which this permit is issued. (Sec. 3097, Civil Code). LentleYs Name: Lentler's Adtlress: Signature: ' Date: OWNER-BUILDER DECLARAiIONS: I hereby aMirm ihat untler penalry of perjury that I am E%EMPT FROM THE CONTRACTOtiS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Cotle: Any ciry or county which requires a permit to constmct, alter, improve, tlemolish, or repair any simcture, prior to its issuance, elso requires ihe apDlicant for such permit to file a signetl statement ihat ha or she is Ilcensed pursuant to the provisions of ihe Contractors License Law (Chapter 9(commencing with Section 7000) oi Divislon 3 01 the Business antl Professions Code) or thet he or she is e:empt therefrom antl the besis tor the alleged e:emption. Any violation ot Section 7031.5 hy any epplicent for a pertnit subjecls ihe epplicant to a civil penalry of not more than fiva huntlred dollers ($500).): ❑ I, as owner ot ihe propeny, or my employees with wages as their sole compensation, WILL DO THE WORK, antl the structure Is not intended or oXerad for sale (Sec. 7044, Business and Professions Code: The Contracbrs License Law tloes not appty to an owner of property who builds or improves ihereon, antl who tloes such work hi seli or herselt or ihrough his or her own employaes, provitled ihat such improvements are not intended or offered lor sale. If, however, the building or improvement is Id within one year of completion, ihe owner-builder will have the burden of proving that he or sha tlitl not build or improve for purpose of sale.). I, as owner of the property, am EXCLUSIVELV CONTRACTING WITH UCENSED CONTRACTORS to constmct the project (Sec. 7044, Business antl Protessions Code: The contracmrs License Law tloes not epO�Y �o en owner o/ property who builds or impmves thereon, and who Coniracts for such project with a contractor(s) license pursuant to th� Contractors Liceqse Laws.). ❑ I em exemp� Signe�ure: Owner ID ventie Verification ot� Business and Protessions Code for ihis reeson: �rs licen5e. ❑ Ves �1Vo Dnvefs License No. 6y (type of document, i.e. - propetly tea bill or deetl): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby certity ihat no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work euthorized by this permit, and that no building structure, scaHoltling, talsework, or tlemolition or tlismantling ihereot, will be more than ihirty-siz (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, TiOe 8, Celifomia Adminis�retive Code). ❑ As ownervbuilder, I will not employ anyone to do work which would require e permit from the Division of Indusirial Safery, es noted ebove, unless such person has a permit Io do such work from �he division. Signature: Date: Division of Indus�riai Safety Permi� Number: CER7IFICATE OF COMPLIANCE AND AUTHORIZA710N OF ENTAY: I certity under penalty of perjury ihat I have read ihis application and state that the informa�ion given is correct I agree � comply with all state laws and ciry ordinances relating to building constmction, and authorize represematives of Ihe Ciry of Costa Mesa to enter upon Ihe above-de ri prope ins on pur bses. I egree not to occupy or allow occupancy of any building authorized by this permit until f�^al inspection. � S �,��3 /�s 2 Signature egalOwne�(s) Date AnNOr Authonzed Applicant Data CQDE �. INSGECTONTYPE 1616 Fized System Final Fire Prevention 1266 Poal Spa Finel 200 Final Re-Rooi 201 Finel BIocWRe�aining Wall 202 203 204 Final Factory Fire Place Final Sign Final Demolilion OATE irmru�s LOpE I INSPECTION TYVE 206 Final Mechanical 208 Final Plumbing 210 Finel Electriwl 212 Final Fire Prevention 220 Final Planning Approval 222 Finel Si�e 250 Final Building/Occupency pAg LNIIDSLS (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 326 E 16TH ST Suite: Vicinity: Parcel Number: 42521118 Zoning: npp�icant: GUSTAFSON, LISA Address: 326 E 16TH ST � . - -" ' " ' � . � Phone: 949-646-6158 COSTA MESA,_CA � ' Zip: 92627-3257 Owner: MILLER ,DRINO & GUSTAFSON, LISA Address �326 E16TH ST Contractor. Address: Zip: Arch : Address: COSTA MESA, CA � Phone: Phone: 949-6466158 Zip: 926273257 Phone: License:- Eng: Address: Stalus: ISSUED Applied: 03/01/2002 Issued: 03/01/2002 ISSUED BY: l /'O � Fhone: , Zip: , � � License: � License: SCOPE OF PERMIT � INSTALL 21X21 SKYLLIGHT NER 550, AND OPEN THW WALL TO THE GARDEN IN THE WALKING CLOSET AREA TO CONSTRUCT A DOOR. FEE SUMMARY ' Plan Check: $15.28 Calc Valuation: Saoo.00 Permit: $23.50 - Claim Valuation: Saoo.00 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 inspection: $0.00 Total: $39.28 , , . _ SETBACKS ' ' MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0- 0 PARKING Existin : 0 NOTES: Rear 0-0 Rear 0- 0 Required: 0 PLANNING & ZONING Left 0- 0 Left 0- 0 Proposed: 0 Right 0-0 Right 0-0 NO710E: The work authorized by this permit shall comply with all applirable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 9248, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or it work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under ihis permit lo be considered legal, such work must comply with all applicabla codas, and all required inapectiona end final approval must be obtained. Failure to obtain inspections and final approval will result in the expiratlon of ihis permit. FOR INSPECTIONS CALL: Q74) 7545626 � WORKERS'COMPENSAnON DECLARATON: ' ' • I hereby aHirtn under penalry oi perjury ona af the following declarations: ❑ I have antl will maintain a certilicute of consent to sell-Insure for workers' compensation. es provided for hy section 3700 of the Lebor Code, lor Ihe peAormence of the work for which Ihis permit is issued. . ❑ I have and will maintain workers' compensation Insurence, es required by section 3700 of ihe Lebor Code, for the pertormance ot ihe work tor which this pertnit Is issued. My workers' compensation Insurence wrner and poliry number ere: Cartier: Policy Number. (This secfion need no( be cromOletetl il the permif is valued et one hundretl dollers (5100) or less.) ❑- I certify that in Ihe pedormance ol the work lor which this pertnit is issued, I shall not employ any person in eny manner so as to become subject to the workers' compensation lews of Celifornia, entl egree that If I should become sub�ect ro ihe workers' compensation provislons of Section 3700 of the Lebor Code, I shall forthwlth comply with Ihese provisions. Applicant Signeture: Date: WqRNING FAILURE TO SECUFE WORKERS' COMPENSATION COVERAGE IS UNIAWFLL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENPLTIES rWD GVIL FINES UP TOONE HUNDRED TI-IOUSAND DOLLARE (5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMhGES AS PROVI�ED FOR IN SECTION 31060F TME LABOF CODE, IMEREST, AND ATfORNEVS FEES. LICENSED CONTRACTORS DECLARATION: I hereby attirm Ihat I em Ilcensad under provisions oi C�epter 9(commencing with Section 7000) of Division 3 of the Business and Protessions Code, and my license is in tull force and eflect. Lic. k Cless a Contrectors Signeture: Date: CONSTRUCTION LENDING AGENCV: ❑ I hereby attirm ihat ihere is a consimction lentling agency for Ihe pedormance oi the work br which this permil is issued. (Sec. 3097, Civil Cotle). Lender's Name: Lender's Adtlress: Signeture: � Date: OWNER-BUILDER DECLARATIONS: I hareby aHirm tha� under penalry oi Perjury that I am EXEMP7 FROM 7HE CON7RACTORS LICENSE LAW for ihe following reeson (Sec. 7031.5, Business entl Professions Cotle: Any city or county which requlres e permit to consimct, elter, improve, demolish, or repeir eny stmcture, prior to its issuance, elso requires Me epplicent lor such permit to file a signed statement thet he or she Is Ilcensetl pursuant to the pmvlsions of ihe Contractors License Lew (Chepter 9(commencing with SecNon 7000) oi Divislon 3 of the Business and Professions Code) or thet he or sha is axempt therafrom end the basis lor Ihe ellegetl ezamption. Any violation o� Section 7031.5 by any epplicant tor e parmit subjects the epplicent to e civil penalry of not more than five hundred dollers ($500).): ❑ I, as owner ol the property, or my employeas with wages as their sole compensation, WILL DO THE WORK, entl t�e strucWre Is not Imendetl or oflaratl for sale (Sec. 7044, Business end Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves ihereon, and who does such work himself or herselt or ihrough his or har own employees, providetl �het such improvements ere not intended or offered lor sale. If, �owever, ihe building or improvement Is �old within one year of complation, the owner-builtler will have ihe burden of proving thet he or she tlid not build or improve tor purpose of sele.). , a5 owner oi the property, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRAGTORS to con5truct Ihe project (Sec. 7044, Business and Protessions �� Cotle: The contractors License Lew does not apply to en owner ot propetly who bullds or Improves Ihereon, entl who wntracts for such project with a contractor(s) license pursuant to the Camractors Licensa Laws.). � I am exempt er s Business antl Professions Cotle for this reason: � naWre: a No. res: Verificeti of Ownership by (type of tlocument, i.a. � pmperty tez bill or tle ):— DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATON: ❑ I hereby cenify that no excavetion five (5) or more feet in Gepth into which a person is required to descena, will Ee made In connection with work euthorized by this permit, antl Ihat no building structure, swRolding, lalsework, or demolition or dismantling thereof, will be more ihan thirty-sia (36) feet hig�. (Chep. 3.2, Grp 2, An 2, Sec. 341, Tltle B, Celilamia Adminisiretiva Code). ❑ As ownerbuilder, I will nat employ enyone to do work which woultl require e permit Irom ihe Division of Indusiriel Sefery, es noted above, unless such person hes e pertnit to tlo such work from the tlivision. Signature: Date: Division af Indusinal Safery Pertnit Number: CEHTIFlCATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I cenify under penalty of perjury that I have read ihis epDlication antl state t�at the informa�ion given is wrrect. I agr e o comply with all s; te laws and ciry ortlinences relating to bullding construc�ion, antl euthonza representetives ol the City ol Cosla Mesa to enter upon the above-de c��prope, a�r i i n puryases. egree no 0 occupy or ellow occupancy of any building authorized by ihis permil until linal inspection. C �— �l —Q / re Ot } e AnNOr Authonzetl Applicant Date COUE I, INSPECTIONTYPE 1616 Fixed System Final Fire Prevention 7266 200 201 202 203 Pool Spa Final Final Re-Roof Final BIocWRetaining Well Final Factory Fire Place Final Sign 204 Final Demoli�ion pAIF It�ALS � CODE� INSPECTIONTYPE 206 Final Mechanical 20B Finel Plumhing 210 Final Electncal 212 Final Fire Preventlon 220 Final Planning Approval 222 250 Final Site Final Building/OxuDency -- ` c�i8�r ,4 8• @ ca�-�u D.G. MAX � �----- � I��X24u .�AG%E55 GRAWL HoLE �2xbFJ Cf��l uc�DATIoN /� LiNE oP r�oT�4-I� SE�ow � :� ,�.-ci�..S/�YL G i�Ne vC� u x �Z 2 Tt,uF G �. �ic .�' .- 7 SU / t,�, 1 � p i I DNiS�C��YOFCOSTAIMESAA�TY ., ppPROVED 5 �-AL� F _G ;,, _ �� This set of plans and spedficatrons MUST be kept � Ihis all �imes end il ' �;12kBffilY�«8�10ffl�1M0lISa�IBYlIIh01AWfIl1Bf1��I1I65Wi}IDRIihB� a.,d Sataty, C�ly of Costa Mesa. ��aO� � � �; b�g{p�,��pTheheldtopertnAartot � �h �,(„�,„, • Jo �Ci}� of Costa Mesa Ordinance a'C ,�„�Y., o i � n� a� p�� .,,,,, �� , Nr�1 ron and become m�ll aroJ.:ad it i ( ��9_ y�y �py;;�lrr,..:n`. %>4 7 dl we . ...1M:�wea :Otl �'� f0i : , . . `J .,r.�-e .�� '_ — _ _., � ti,' E inJ � i` !V�Z-Q��F I ,VV`�(!D LA/'i7ir/L 'r" ,. '3 � i� LJG� �� " fF Ft� � � � � 4 -�� i� � i: I�it' •%�- � I: SHELF:' , � N�;,� - - - _ --�"��s��s ,�,<.,¢� � i ; p� FoL� � I' _ `24 T �I -. Z�x��- U�F�.�E Mo�NT v G YP j, Ii n��,�=� _ l.��H1 FIxTuP.E � i ' " � 5 ; c�� :._. I�I� l�d W��-K- �� `� �v�� _ ,. ��tr . , r.��.�. = I1 ` � - mlawlui � \ -=- k E3 0� BIII�dP•, � — t;\•�! m approvc. : Slete Wr: ��'C yuilGiN+ o. \ r U Y c�! i � +G � 2 � ,�� . --..-�— J �'� ._� . � ��,� 'Z-X iiL ,1 e^ I("� � ... . — --- �r — � i � .�.y,�i � —� I...1 ��.o�n CITY OF COSTA MESA PLANNING DIV. SUBJECT TO BLDG. DEPT. REG. BY IJ✓`�"" DATE � ��/ � I 5 % ,4 F5 ni✓ � •c-(. � D E L..� i - '� i. _.._ --� 5IK-'�'! �� H T r�-�D -- - _ `` ��o,� �a��ri�N _ ��02 � �i,,; � � G , � 3� /; �- . �oor � P�M I �Ja �L �I�! - — , , 11 i u . ..---- ----- i (714) 754-5273 • Fa�c (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT .lob Address: 326 E 16TH ST Suite: Vicinity: REAR OF DWELLING Parcel Number: 42521118 Zoning: Applicant: GUSTAFSON, LISA Address: 326 E 16TH ST Phone: 949-646-6158 COSTA MESA, CA ' Zip: 92627 Owner: MILLER, ORINO AND GUSTAFSON, LISA Address �326 E'16TH ST ' - , , . . . Phone: 949-64G6158 COSTA MESA, CA � Zip: 92627 Contractor: O W N E R-B U I LD E R Address: Phone: 2ip: � License: � 0 nrch : JOHN B PFEFFER ' Eng: Address: � ' Address: Slatus: ISSUED Applied: 10/Ot/2001 Issued: 02/13/2002 ISSUED BY: � � Phone: . Phone: Zip: - License: C25761 License: SCOPE OF PERMIT � ADD 132 SQ. FT FOR WALK-'IN�CIOSET AT REAR OF DWELLING. . PROP OWNER WILL BE INSTALL ONE 2' X 3' (NONOPENING) SKYLIGHT IN THE CLOSET (ICBO #). Plan Check: Permit: SMIP Res: SMIP Com: Other: Inspection: Total $136.01 $209.25 $1.13 $0.00 $0.00 $0.00 $346.39, , .. SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0=0 PARKING Existin : 0 NOTES: Rear 0- 0 Rear 0- 0 Reouired: 0 FEE SUMMARY PLANNING & ZONING Left 0- 0 Left 0- 0 Proposed: 0 Catc Valuation: Claim Valuation Right 0-0 Right 0-0 $11,286.00 So.00 NO710E: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § /, 72-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred Inepeetlons and final approvel must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5628 200648 (fvDO) WORKERS' COMPENSA710N DECLARA7ION: I hereby eRirm untler penalty oi perjury one oi the following deciarations:� ❑ I have antl will maintain a certificale of consent to 5elbinsure for workers' compensetlon, es provided for by section 3700 of the Lebor Code, for the peAormence of t�e work for which this permit is Issued. � ❑ I have antl will maintain workere' canpensetion insurance, es required by section 3700 of the Lebor Cotle, for the peAormance of the work for which this permlt is issuetl. My workers' compensation InSurance carrier and policy number ere: Carner: Policy Numbar. (This sectian need not be crompleled i! the permit Is velued et one hundretl dollars (5700J or less.) ❑ I certify thet in Ihe peAortnance ol the work for which this pertnit is issued, I shall not employ any person in any manner so es to become subjact to ihe workars' compensatlon laws of Celifornia, end egree Ihat if I should 6ecome sublecl to Me workers' compensation provisions ol Section 3700 oi the 1.abor Cotle, I shall forihwlih comply wiN these ptovisions. Applicant Signawre: Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS IINLAWFUL AND SHALL SUBIEC� AN EMPLOVER TO CRIMINAL PENALTIES NND CIYIL FINES UP TOONE HUNOREO TIqU$AND DOILARE (5100,000), IN ADDITION TO THE COST OF CqMPENSATION, DPM40E5 AS PROVIDED FOR IN SECTION 3]OB OF THE LABOR CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I I hereby atfirm that I am licensed under provisions of Chap�er 9(commencing with Section 7000) of Division 3 of iha Business and Protessions Cotle, and my license Is In full � force end eHect. Lic. q Class x ComrectoYs SignaWre: Date: CONSTRUCTION LENDING AGENCV: ❑ I hereby eHirm that there is a constmction lending aqancy br the peAormence ot the work br which ihis pertnit is issued. (Sec. 3097, Civil Cotle). Lendefs Neme: Lentler's Atldress: Signature: � Date: OWNER-BUILDER DECLARATIONS: I hereby etlirtn thet under penalry of perjury that I em E%EMPT FHOM THE CONTRACTORS LICENSE LAW for the tollowing reeson (Sec. 7031.5, Busineu end Professions Cotle: Any ciry or counry which requires a parmit fo construcL alter, improve, tlemolish, or repair any structure, pnor to its issuance, also requires the applicant for such pertnit to tile a signed statement ihat he or she is Ilcensetl pursuent to the provisions al the Contrectors License Ww (Chapter 8(cammencing with Sectlon 7000) of Division 3 of Ihe Business end Profeuions Code) or that he or she is axempt therefrom and the basis tor Iha allagetl e:emption. Any violation of Section 7031.5 by any epplicant for a permlt subjects the applicant to e civil penalry ot not more Ihan five huntlretl dollars ($500).): ❑ I, as owner ot t�e property, or my employees with wages as Nelr sola compensation, WILL DO 7HE WORK, antl �he sirucwra is not imentletl or oHeretl for sale (Sec. 7044, Business and Professions Code: The Contrectors Licensa Law tloes noI apply to en owner of pmpeny who builds or impmves thereon, and who does such work himself or �ereelf or thmugh his or her own employees, pwvided that suc� impmvemen�s ere not in�ended or oMered for sale. tl, however, Ihe building or improvement is d within one year of completion, the owner-builder will have ihe burden of proving that he or she did not build or improve for purpose of sale.). I, a5 owner of lhe pwperry, em EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construc� Ihe pmject (SecJ044, Business end Pmfessions Cotla: T�e contractors License Law tloes not epply to en owner of proparty who builds or Improves Ihereon, antl w�o contracts for such proiect with a contrector(5) licensa pursuant to e Coniracbrs License Lews.). ❑ I am exempt u r sea ��,q Business and Professions Code for ihis reason: Signature: Owner ID venfi dnvels license. V No Drivers License No. Veritication o nership by (Iypa of document, i.e. - propeey tau bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation live (5) or more feet in depth into which a person Is raquiretl to tlescend, will be made in connection with work euthonzed by Ihis permit, and that no building structure, scaflolding, talsework, or tlemolition or tlismantling ihereoi, will be more ihan ihirty-six (36) leet high. (Chap. 32, Grp 2, Ar12, Sec. 341, Ttle 8, Calitomia Atlminlsiraiive Cotle). ❑ As owner-buildar, I will not employ anyone Io tlo work which would require e pertnit Irom the Division of Industriel Sefery, es noted above, unless such person has e permit to tlo such work from �he division. Signe�ure: Dete: Division of Intlus�nal Salety Permil Number: CERTIFlCATE OF GOMPLIANCE AND AUTHORVATION OF EMRV: I cenify under penalry ot peryury that I have reaa Ihis applicetion end state that ihe Informatlon given is conect. I egree lo omply with ell s• te lews end ciry ortlinances rela�ing to builtling construciion, end authorize representatives ot ihe Giry ot Costa Mesa to enter upon the ebove-tlesc: 'o �erty.f t pOu o s. I agree not to occupy or ellow occupancy ot any building authonzed by this permit yntil t�al-ipspection. G I/ /CJ 2 Slgnature egal wner(s) -�' ate And/Or Authorized Applicanl Date GOUE 1, INSPECTIONTYPE 1678 Fi:ed System Final Fire Prevention 1266 Pool Spa Final 200 Final Re-Roof 201 Final BIocWRetaining Well 202 Final Factory Fire Place 203 Final Sign 20d Final Demolition QLijj INTRIALg CODE� INSPELTIONTYVE 206 Finel Mechanical 20B Final Plumbing 270 Final Electrical 212 Final Fire Preventlon 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy � It� (774) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DiiIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 326 16TH PL Suite: Vicinity: BATHROOM, KITCHEN AND LAUNDRY RM Parcel Number: 42521221 Applicant: COX, JEFF Address: 326 E 16TH PL COSTA MESA, CA � Owner: COX, JEFF AND PEGGY Address 326 E 16TH PL COSTA MESA, CA Convactor: O W N E R-B U I LD E R Address: Zip: Arch : Address: Phone: Zoning: Phone: 949-645-9301 � Zip: 92627 Phone: Zip: 92627 Phone: License: 0 Eng: Address: ISSUED BY: Status: ISSUED Applied: OB/12/2002 Issued: 08/12/2002 Phone: Zip: , � License: License: SCOPE OF PERMIT ADD A TOTAL OF 112.5 S.F. WORK TO INCLUDE: EXPAND KITCHEN 28 S.F., AITER EXISTING BATHROOM (CHANGE OUT AND ADD FIXTURES AND INSTALL A SKYLIGHT, ICBO #ER4063), ADD A 84.5 S.F. LAUNDRY ROOM ADJACENT TO KITCHEN. CHANGE OUT 6 WINDOWS IN 2 EXISTING BEDROOMS AND LIVING ROOM AND REPLACE WITH DUAL GLAZE. HEADER WILL REMAIN THE SAME (APPROXIMATELY 2.5' X 4'). Plan Check: $117.81 Permit: $18125 SMIP Res: $0.96 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $300.02 � SETBACKS MAIN STRUCTURE Front 0. 0 ACCESSORY Front 0- 0 PARKING Ezistinq: o NOTES: Rear 0- 0 Rear 0-0 Re uired: 0 PLANNING & ZONING Left 0- 0 Left 0- 0 Proposed: , 0 Calc Valuation: Claim Valuation: Right 0- 0 Right 0- 0 Ss,s�s.00 So.00 NOTICE: The work authorized by this pertnit shall comply with all applicable handicap access requiremenis under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In ortler for ihe work authorized untler ihis permit to be considered legal, such work must comply with all applicable codes, and all required Inapeetlona end final epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this� ! FOR INSPECTIONS CALL: (714) 7545626 «� �au,� WORKFAS' CO'R��fdSATION DECLARATON: � I hereby aHirm under penalry of perjury one ot the tollowing declarations: ❑ I have and will maintain e certificate of consent to selbinsure for workers' compensation, es provided far by section 3700 ot the Lebor Code, tor the peAormance of ihe work for whiCh this pertni� is issuetl. ❑ I heve and will maintain workers' compensation insurance, es required by section 3700 0l the Lebor Code, for Ihe peAortnance o� the work for which Ihis perml� 15 i55ued. My workers' wmpensation Insurance carrier and policy num6er ere: Cerrier: TFIOUSAND DOLL4RE Policy Number: Y the Oermit is valued et one huntlred dollars ($ f 00) or IessJ of the work for which this permit is issueQ I shall not employ eny person in any menner so es to 6ecome sublect to the workers' , gnd a ree that if I shoultl become suDjact to the workers' compensation provislons of Sectlon 3700 of the Labor Code, I shall forthwli� �Daie:�g''�2 _v'i' S' COMPENSATION CAVERAGE IS UNL4WFUL AND SHALL SUBIEC� AN EMPI.OYER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TO ONE HUNDRED ION TO THE COST OF COMPENSATIIXJ, DAMAGES NS PROVIDED F-0R IN SECTION 3]O60F THE LABOR fAOE, INTEREST, AND ATTORNEI^S FEES. LICENSED CONTRACTORS OECLARATION: I hereby effirm that I am licensetl under provisions of Chapter 9(commencing with Section 7000) of Division 3 of Ihe Business entl Professlons Code, entl my license Is in full force end ettecG Lic. q Class tl Con�reciors Signature: Date: CONSTRUCT70N LENDING AGENCY: ❑ I hereby aHirtn that thera is a consiruction lentling agency br the perlormance of the work for which this permit is issued. (Sec. 3097, Civil Cotle). Lenders Name: Lentlefs Address: Signature: � Date: OWNER•BUILDER DECLARATIONS: I hereby ettirm ihat under penelty of perjury fhat I am EXEMPT FROM THE CON7RAC70RS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business anC Professlons Coae: Any ciry or counry which requires a permit to construct. alter, improve, demolish, or repair eny strudure, prior to its issuence, also requires the epplicant for such permit to tile e signed statement that ha or she is licensed pursuant to the�pwvisions of the Contractors License Law (Chapter 9(wmmencing with Sectlon 7000) ot Divislon 3 af the Business end Professions Cotle) or that he or she is ezempt t�ereirom end the basis lor Ihe elleped exemption. Any violetion ol Section 7031.5 Dy eny epplicant for a pertnit su6jects the epplicant to a civil penalry of not more than five hundred dollars ($500).): ❑ I, as owner oi ihe pmperry, or my employees with wagas as iheir sole compensation, WILL DO THE WORK, end Ihe sirucmre Is not intended or ottered lor sale (Sec. 7044, Business and Professions Code: The Contractors license Law does not apply to an owner of properry who builds or improves thereon, and who does such work himself or herself or through his or her own employees, providea that such improvements ere not intendetl or oNaretl for sale. If, however, the builtling or Improvement is sold within one year ot completion, ihe owner-builtler wiil have the �urden of proving ihat he or she did not builtl or improve for purpose of sele.�. ❑ I, as owner of Ihe property, am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct ihe prolect (Sac. 7044, Bu5ine5s end Protassions Coda: The contractors License Lew does not apply to en owner ot property who bullds or Improves Ihereon, antl who contrects for such projeci wllh e contrectar(s) Jjcanse�pureuant to the Contractors License Laws.). � Ks license. by (type of Businass and Professions Code for ihis reason: Yes ❑ No i.e. - pmperty tes bill or deed): DIVISION OF INDUSTRIAL SAFETV �ERMIT CERTIFICATION: Licanse ❑ I hereby canity ihat no excavetion fiva (5) or more feet In depth into which e person Is required to descend, will be matle In connectlon with work authodzetl Dy ihis permit, and ihat no building sWcture, scaflolding, falsework, or demolition or tlismamling thereot, will be more then thirty-six (36) teet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Ttle B, CaliFomia Atlministrative Cotle). ❑ As owner-builder, I will nol emploY enyone to do work which would require a parmit trom Ihe Division oi Industnel Safety, as notetl ebove, unless such person hes e pertnit to do such work from the division. SignaWre: Date: Division of Indusirial Safe�y Permit Number: CERTIFlCATE OF COMPLIANCE AND AUfHOR¢AT10N OF EMRV: I cenity under penelry of perjury ihat I have reatl this eppliwtlon end siate t�et ihe inlormation given is conect I agree to comply with al stet§.1aw nd ciry ordinences relating to building construction, and euthonze represemetives of Ihe Ciry ol Coste Mesa to enter upon iha abova-descnbed property for i_ ecfi6n�s. I agree not to occupy or ellow occupanry ol eny building authorized by t�is permit until finel inspection. (_ �'-/L- D'z� �nat eOfLegalOwner(s) � Date--3 �� — _ �—_ . And/Or Aui�orizetl Applicant Date COOE t• INSVECTIONTYPE 1616 Fixed System Final Fire Prevention 1266 Pool Spa Final 200 Final Re-Roof 201 Final BIocWRetaining Wall 202 Final Factory Fire Place 203 Finel Sign 204 Final Demolition IIeIE 1t�4 CODE� INSPECTIONTYPE 206 Final Mechanical 200 Finel Plumbing 210 Finel Elec�ricel 212 Finel Fire Prevention 220 Final Planning Approval 222 Final Si�a 250 FinalBuilding/Occupancy � (z_z9-d� It� (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 MECHANICAL PERMIT Job Address: 326 16TH PL Suite No Vicinity: KITCHEN, BATHROOM & LAUNDRY ROOM Parcel Number: 42521221 Applicant COX, JEFF Address: 326 E 16TH PL COSTA MESA, CA Owner: COX, JEFF AND PEGGY Address: 326 E 16TH PL COSTA MESA, CA Contrector: Address: OWNER-BUILDER Phone: 949-6459301 Zip: 92627 Phone: Zip: 92627 Phonei Zip: � License: 0 Status: ISSUED Applied: OB/72/2002 Issued: 08/12/2002 SCOPE OF PERMIT MECHANICAL TO INCLUDE: 1 GAS PIPING, 1 HOOD W/MECH EXHAUST, 1 VENT FAN, 1 APPLIANCE, AND REPLACE GAS, WALL HEATER. REF.: 802-01249 - ISSUE FEE Inst FAU <100 k BTU Inst FAU >100 k BTU Repair / Alt Cooling/Heat Inst I Rep. Recess Wall HV Refrig Sys <100 k BTU Refrig Sys >100 k BTU Gas Piping Faclory Fireplace Hood w/Mech Exhaust VAV Box Vent Fan / Single Duct Appliance Fire Dampers � Smoke Dampers Inst or Relocate Appl Vent Air Handlers < 10000cfm AirHandlers> t0000cfm Floor Fumace floor or Suspend Heater $23.50 $14.80 $0.00 $0.00 so.00 $0.00 50.00 36.15 $0.00 $10.65 $0.00 $725 $10.65 $0.00� $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantity FEE SUMMARY Repair / Alt Absorbtion Unit Repair / Alt Refngeration Unil Ventillation System Evaporetive Cooler Commercia l I ncine rator Domestic Incinerator Compressors / Absorption Svstems �� Up to 3 hp / 700 k BTU 3To15hp/SOOkBTU 15 To 30 hp / 1,000 k BTU � 30 To 50 hp ! 1,750 k BTU - Over 50 hp / Over 1,750 BTU Boilers Upto3hp 3To15hp 15 to 30 hp 30 to 50 hp Over 50 hp Other Mechanical Fee Investigation Fee Plan Check Fee Reinspection Fee Quantity so.00 0 $0.00 0 50.00 0 so.00 0 50.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 50.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 $0.00 $o.00 TOTAL CALCULATED FEES $73.00 COMMENTS I SPECIAL CONDITIONS NOTICE: The work authorized by this pertnit shall compty with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21•92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 1 BO days. INSPECTIONS: In order for the work authorized under Ihis pertnit to be considered legal, such work must comply with all applicable codes, anC all requlred Inepeetiona end final approvel must be obtained. Failure to obtain inspections and final approval will result in Ihe expiration of this pertnit. „ FOR INSPECTIONS CALL: (714) 754-5626 // �.....� �,.�,,,� WORKERS'FOMPENSAnON OECLARATON: � I hereby aNirm�untler panelry of perjury one of the following tleclaretions: ❑ I have end will maintain e certilicate ol consent to setl-Insure tor workers' compensation, as provitled For hy section 3700 0l Iha Labor Cotle, for the pertormence oi Ihe work for which Ihis pertnit is issued. ❑ I have and wlll maintain workers' compensation insurance, as requireA by sectlon 3700 of t�e Lebor Cotle, for the pertortnance ot ihe work for which Uis pertnit is issued. My workers' compen�atlon Insurenca carder and policy number are: Cartier. '+i Policy Number. (This secfion need not be comp/eted il the permit is valuetl a! one hundred dollars ($700J or less.) in the peAarmance of the work fOr which thi5 permit i5 issued, I shall not employ any person in any manner so as Io bacome suDjett to the workers' m laws of Calilomia, and egree Ihal il I should become sub�ect to the workers' compenution provisions oi Settlon 3700 ot tha Lebor Cotla, I shall forthwith � p�lz —�L Data: COMPENSATIIXJ COVERAGE IS UNIAWFUL M1D SH4LL SU&IEGT AN EMPLO ER TO CRIMINAL PENALilES AND GVIL FlNES UP TOONE HUNORED I TO THE WST OF GYIMPENSATION, DAMAGES AS PROVIDED fOR IN SECTION 31060F THE LABOR CODE, IMEREST, AND /TTORNEY'S fEES. LICENSED CONTRACTORS DECLARATON: I here6y aHirm that I am licensed under provisions of Chepter 9(commendng with Section 7000) ot Division 3 0l ihe Business antl Professions Code, and my license is In tull force and eHecL LIc. N Cless x Comractor's Signatura: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby attirm ihat there is a construction lending agency for the peAormance ot the work for which this permit is issued. (Sec. 3097, Civil Code). Lentlefs Name: Lender'S AOdress: Signeture: � Date: OWNER-BUILDER DECLARATIONS: I hereby attlrm ihat under penelty of perlury Ihet I em E%EMPT FROM THE CONTRACTORS LICENSE LAW br ihe following reeson (Sec. 7031.5, Business end Professlons Cotle: Any ciry or coumy which requires e permit to construct, aiter, impmve, demolish, or repair any structure, pnor to its issuance, elso requires ihe applicant tor such pertnit to file a signed stetement that he or she is licensed pursuanl to the pmvisions of the Contractors License Law (Ghepter 9(wmmencing wlth Sectlon 7000) of Division 3 ot the Busin855 end Pmfe55ions Code) or thet he or 5he i5 Bxempi therefrom antl Ihe basis tor �he ellegetl exemp6on. Any violalion af Seclion 7031.5 by eny epplicant for e pertnit subjects the epplicent to a civil penalty of not more Ihen five hundretl dollars ($500).): ❑ I, as owner oi Ihe propeny, or my employees with wages as their sole compensation, WILL DO THE WORK, end the structure is not intentleC or ottered tor sale (Sec. 7044, Business and Professions Code: The Contractors Licensa Law tloes no� apply to an owner of property who builds or improves thereon, end who tloes such work �imsalf or herself or through his or her own amployees, pmvidetl t�at suc� improvements are not Intendetl or ottered for sala. If, however, Ihe builtling or improvement is sold within one year ot completion, the owner-builder will have ihe 6urden of proving that he or she did not build or improve for puryosa of sale.). ❑ I, as owner of Ihe properry, em E%CLUSIVELV CONTRACTNG WITH LICENSED CONTAACTORS to con5truct ihe projeci (Sec. 7044, Business end Prote55ions Code: The coniractors License Lew does not epply to en owner of property who 6ullds or improves Ihereon, antl w�o contracts tor such projact with e coniractor(s) /Iicense pursuam to the ComreGors License LewsJ. by driver's licen5e. Verification af Ownership by (rypa ot Business and Professions Code for this reason: s ❑ No �Dnvets Ucense i.e. - properry tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify Ihat no excave�ion five (5) oi more feet in tlepth into whic� a person is required to descend, will be meda In connection with work authonzetl by �his permii, and that no building siructure, scaHolding, lalsework, or demolition or dismantling thereoi, will be more Ihan �hirry-sia (36) feet high. (Chap. 32, Grp 2, An 2, Sec. 341, Ttle B, Calitomia Adminisirelive Code). ❑ As owner-builder, I will not employ anyone lo do work which would require e permit from the Division of Industnel Sefery, as notetl above, unless such person has e permit to tlo such work trom the division. Signature: Date: Division of Indusirial Safe�y Permit Number: CERTIFlCATE OF COMPLIANCE AND AIfTMORVATON OF EMRY: I certily under penaly of perjury Ihat I have read ihis epplication and state Ihel �he informa�ion given is correct I agree �o comply with usate aws and ciry ordinances relating to builtling constructlon, end authonze representatives of the Ciry of Coste Mesa to enter upon ihe ebove-descnbed property for' aec�pur s. I egree not to occupy or ellow occupancy of eny builtling authorized by ihis pertnit umil tinal inspection. ._ $-/2 'd2 ignature f Legal Owner(s) Data � �� — And/Or AUNorized AppliWn� Dale GOUE I. INSPECTIONTYPE 1676 Fixed System Final Fire Prevention 1266 Pool Spa Finel 200 Final Re-Roof 201 Final8locWRetflining Well 202 203 204 Final Factory Fire Place Final Sign Finel Demolition �eiE u�s COUE I INSPECTION TYPE 206 Final Mechanical 208 Final Plumbing 210 Final Electncal 212 Final Fire Prevention 220 Final Planning ADP�oval 222 Final Site 250 FinalBuilding/Occupency (714) 754-5273 • Fa�c (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT lob Address: 326 16TH PL Suite No Vicinity: BATHROOM, KITCHEN, & LAUNDRY ROOM Parcel Nunmber: 42521221 Applicant COX, JEFF ' Address: 326 E 16TH PL �- COSTA MESA, CA. Owner: COX, JEFF AND PEGGY Address 326 E 78TH PL � . . COSTA MESA, CA Contractor: OWN ER-BUILDER Address: - � � �� Arch / Eng : Address: Phone: 949-645-9301 2ip: 92627 � . Phone: Zip: 92627 Status: ISSUED Applied: 08/12/2002 I ss ued: 08/12/2002 ISSUED BY: • � � - Phone: - . . , . � , Zip: � . - � ' License: 0 , � , � _ . .-- -- _ . _ � -. / �. . : Phone: � � ` � � Zip: � - �. __- --� ` - - �"- - . . � License: � - _ SCOPE OF PERMIT PLUMBING TO INCLUDE: 1 BATHTUB, 1 DISHWASHER, 1 GAS (1-4 OUTLETS), 1 LAUNDRY TUB/N/ASHER, 3 P-TRAPS, 1 SHOWER, 1 KITCHEN SINK, 2 WASH BASINS, 1 WASTE AND VENT . � ' SYSTEM, t WATER HEATER, AND 1 WATER PIPING: REF.: B02-01249 ,- _ - � FEE SUMMARY . - - � � � ' AMT QTY �� . AMT QTY�� AMT ISSUE FEE $23.50 � laundry Tub / Washer - $9.80 1 Sump Pump $0.00 Backflow irrigation` �$0.00 0 � Landscape Irrigation $0.00 0 Swimming Pool $0.00 Backflow Preventer $0.00 0 � P-Trap $29.40 3� � Trap Primer , $0.00 Bathtub � $9.80 1.. Pressure Regulator $0.00 0� Urinal . $0.00 Clarifer System $0.00 �0 ProcessPiping (per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 Connect pce,Soda,etc) $0.00 0 Receptors $0.00 0, Vacuum Brk[Bkflow(5+) $0.00 Dental Units $0.00 0 � Septic,Tank � $0.00 � 0 Wash Basin� $19.60 Dishwasher $9.80 1 - Sewer Cap for Demo $0.00 0 � Wash Basin Set $0.00 Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $9.80 Drain, Rainwater $0.00 0 � Sewer Private Line $0.00 0- Water Closet (Toilet) $0.00 Drain, Roof $0.00 0 Shower . $9.80 �� 1 Water Heater / vent $1230 Drinking Fountain $0.00 0 Sink, bar $0.00 0 Water Piping (Inst or Rep.) $9.80 Expansion Tank $0.00 0 Sink, commercial $0.00 0 Water Re-pipe $0.00 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 Gas (1-4 outlets) $6.15 1 Sink, kitchen $9.80 1 Water Sokener $0.00 Gas (Over 4 outlets) $0.00 0 Sink, service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa (private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa (public) $0.00 0 PLAN CHECK $0.00 Interceptors (Grease, Oil) $0.00 0 REINSPECTION $0.00 Interceptors (Sand Auto ) $0.00 0 TOTAL CA�CULATED FEES: $159.55 QTY 0 0 0 0 0 0 2 0 1 0 1 1 0 0 0 .�7 I V� L f1V VVI\VI�IVIYJ NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspeetiona and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 � 2a4ri4a 15�00) WORKERS' COMPENSATION DECLARATION: . � . — , I heraby aHirm untlar penalry of perjury one of the following declarations: � � ❑ I have and will maintain a certificate of consent to setl-Insure br workers' compensation, as provided for by section 3700 of the Labor Code, for the peAormance of the work tor which lhis permi� is issued. . ❑ I have and will maintain workere' compensation insurance, as required hy saction 3700 of the Lebor Cotle, For the pedortnance of the work for which this pertnit is issued. My wakers' compensation Insurance carrier and policy number ere: Carrier: need nof be completed il fhe permit is valued at one huntlred dollars ($100) or less.) Policy Number: '.8 PI certify that in the peAormance 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' L�compansation laws of California, and agree that if I should become subjec� b t�e workere' compensation pmvisions of Sec�ion 3700 ot ihe Labor Code, I shall fotlhwi�h compiy with these pr wn p. iApp�Signatur—e:� ' � Dete:f o ` �Z–' � Z-- WARNING: FAILURE TO S RE WORKEPS' CAMPENSATION CAVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDREO THOUSANDDOLLARE($1 ,000),INADDITIONTOTHECASTOFCAMPENSATION,DAMAGESASPROVIDEDFOFMSECTION31060PTHELABORCODE,IfTEREST,ANOATTORNEV'SFEES. LICENSED CONTRACTORS DECLARATION: . I hereby aftirm ihat I am licensed untler provisions of Chapter 9(commencing with Section 7000) of Division 3 oi the Business and Protessions Cotla, and my license is in tull torce antl e%ect. Lic. # Cless N Contrecrors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hareby attirm that there is a consVuction lentling agency for the performance of the work for which ihis permit is issuetl. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature: � Date: OWNER-BUILDER DECLARA710NS: I here6y attirm ihat under penalty of perjury thet I am EXEMPT FROM THE CON7RAC70RS LICENSE LAW tor ihe following reason (Sec. 7031.5, Busineu and Professions Code: Any city or county which requires a permit to constmct, alter, improve, demolish, or repair any stmcture, prior to it5 issuance, also requires ihe applicant for such permil ro file a signed statement that he or she is licensed pursuant b the provisions of Iha Contractors License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business end Professions Code) or ihat he or she is exempt therefrom and the basis for Ihe alleged exemption. Any violation ot Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalry of not more than five hundred dollars ($500).): ❑ I, as owner ot ihe property, or my employees with wages as iheir sole compensation, WILL DO THE WORK, and ihe siructure is not intentletl or otteretl for sale (Sec. 7044, Business and Protessions Code: The Contractors License Law does not apply to an owner of property who huilds or improves ihereon, and who tloas such work himself or herself or through his or her own employees, provided Ihat such improvements are not intended or oHered for sale. If, however, ihe building or improvement is sold within one year o� completion, the owner�6uilder will hava ihe burden of proving ihat he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRAC70RS to constmct ihe project (Sec. 7044, Business and Professions Code: The conirac�ors License Law does not apply to an owner of propetly who huiltls or improves �hereon, antl who coniracts for such pmjac� wi�h a con�ractor(s) `license pureuant to the Coniractors License Laws.). 6y tlnvAr's license. Veritication of Ownership by (type ot Business and Professions Code for ihis reason: s ❑ No �Drivefs LiCense i.e. - properry tax bill or deed) � Z 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 dascend, will 6e made in connection with work authonzed by this permit, and that no building simcture, scaftolding, falsework, or demolition or tlismantlinq Ihereoi, will be more ihan thirty-siz (36) feet high. (Chap. 32, Gry 2, Art 2, Sac. 341, Title 8, California Administrative Code). ❑ As owner-builtler, I will not employ anyone to do work which would require e permit from the Division ot Industrial Satery, as notetl above, unless such person has a permit to do such work from Ihe division. Signature: Date: Division of IndusUial Safety Permit Number: CER7IFICA7E OF COMPLIANCE AND AU7HORIZATION OF ENTRY: I cehify under penalty of perjury ihat I have read Ihis epplication and state ihat Ihe information given is correcL I agree to comply wi�h all state lews and ciry ordinances relating to building constmction, and authorize representatives of the Ciry of Casta Mesa to enter upon the above-described property toyJ sp ti urposes. 1 agree not to occupy or allow occupancy of any building authorized by ihis permit until finel inspection. �,(_�� - /2 � O Z. Sig ature Of Legal Owner(s) Date � AnNOr Aulhorized Applicanf Date COpEI, INSPECTIONTYPE � Qy1$$ INT IA 1616 Fixetl System Final Fire Prevenlion 1266 200 201 202 203 Pool Spa Final Final Ra-Roof Final BIocWRetaining Wall Final Fadory Fire Place Finel Sign 204 Final Damalition CODEY INSPECTIONTYVE 206 Final Mechanical 208 210 212 220 Final Plumbing Final ElecMcal Final Fire Prevention Final Planning Approval 222 Final Site 25o Final BuildincyOccupancy 1111.� A � � � (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIF DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: Suite No Vicinity: Parcel Nunmber: 326 16TH PL BATHROOM, KITCHEN & LAUNDRY ROOM 42521221 Applicant: COX, JEFF Address: 326 E 16TH PL COSTA MESA; �CA, � owner: '. COX, JEFF AND PEGGY Address 326 E 16TH PL � � COSTA MESA, CA Contractor: OW N E R-BU I LD ER Address: ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool / Spa � Lighting Fixts Recept Outlets Switches Non Res Appl , Res Appl Service to 200a � Service to 1000a Service over 1000a Motors to thp Motors to 10hp Motors to SOhp Motors to 100hp Motors over 100hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole Phone: 949-645-9301 - - Zip: 92627 , " . Phone: Zip: 92627 � , . � ,, r Phone: . . . - Zip: - � . � _ � License: 0 Status: ISSUED Applied: OS/12/2002 Issued: OB/12/2002 ISSUED BY: SCOPE OF PERMIT ELECTRICAL TO INCLUDE: 9 LIGHTING FIXTURES, 10 OOTLETS, 5 SWITCHES, AND SUB-PANEL TO 200AMPS. REF.: B02=01249 - - . -- - _ -� - � $23.50 $0.00 50.00 $0.00 $0.00 $0.00 ' . $9.90 $11.00 $5.50: . $0.00�, $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $30.50 $0.00 $0.00 $0.00 $0.00 Quantity 0 0 0 9 10 . i� �5. 0 0 '0 0 0 0 0 0 0 0 0 1 0 0 0 0 FEESUMMARY Temp Dist System / Lighting Busway /100 ft Standing Section Misc Electrical Equipment _.,.. � -.,Transformers up to 1 kva/kw � .,.`. " �....up to 10 kva/kw � ............ ..........�...._.up to:50 kva/kw .................up to 100 kva/kw,._ ..................over 100 kva%kw ' Low Voltage Equipment Low Volt Wiring System / Ckt � Misa Conduit � MisC. Conductor Circus ( gen or ride) Circus (mech ride or lights) Christmas Tree Sfand � Fireworks Stand OtherElectricaPFee � Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 , 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 Investigation Fee . , $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $80.40 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or it work is suspended or abandoned tor a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval mus� be obtained. Failure to obtain inspections and final approval will result in the expiration of this permtt� w FOR INSPECTIONS CALL: (714) 7545626 zaaere�dao� WORKERS' COMPENSATION DECLARA710N: I hereby aHirm under penalry of perjury one of the tollowing declarations: - - . ❑ I have and will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for ihe peAormance of the work far which ihis permit is issuetl. ❑ I have antl will maintain workers' compensation insurance, es requiretl by section 3700 of the Labor Code, for the perfortnance of the work for which this pertnit is issued. My workers' compensation Insurence carrier and policy number are: Carrier: Policy Number: �(This ction need not be completed il the permit is valued at one hundred dollars ($ f 00) or /essJ c�ertity that in the peAormance of the work for which Ihis permit is issued, I shall not employ any person in any manner so as to become subject to ihe workers' oompensetion lews of California, and gree [hat if I should become subject to the workers' compensa[ion provisions of Sadion 3700 of ihe Labor Cotle, I shall fotlhwith comply with these pr on p - Applicant Signat—ure � Date: O �L � � Z� WARNING FAILURE O URE WOR RS' COMPENSATION CAVERAGE IS UNLAWFUL ANO SHALL Sll&IECT AN EMPLOYER TO CRIMINAL PENALTIES AND qVIL FWES UP TOONE HUNDRED THOUSANDOOLLAFE( 00,000),INAD TIONTOTHECOSTOFCOMPENSATION,DAMAGESASPROVIDEDFORINSECTION3]O60FTHELABOqCADE,IMEPEST,ANDATTORNEV'SFEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirm ihat I am licensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 of ihe Business and Professions Code, antl my license is in full force and eHect. Lic. # Class N Comractor's SignaNre: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby attirm that there is a construction lending agency for the pertormanca of the work for which ihis permit is issued. (Sec. 3097, Civil Code). Lendefs Name: Lender's Address: SignaWre: � Date: OWNER•BUILDER DECLARATIONS: I hereby attirm ihat under penalty ot perjury ihat I am EXEMPT FROM THE CONTRAC70RS LICENSE LAW tor ihe following reason (Sec. 7031.5, eusiness and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any stmcture, prior to its issuance, also requires ihe applicant for such permit ro tile a signetl statement that he or she is licensetl pursuant to ihe provisions oF the Contractors License Lew (Chapter 9(commencing with Sedion 7000) of Division 3 ot ihe Business and ProFessions Code) or that he or she is exempt therefrom and tha basis tor the alleged exemption. Any violation of Section 7031.5 by any epplicant for a permit subjects ihe applicant to a civil penalty of not more Ihen five hundred dollars ($500)J: ❑ I, as owner of Ihe property, or my employees with wages as iheir sole compensation, WILL DO THE WORK, antl the structura is not intended or oHered tor sale (Sec. 7044, Business antl Professions Cotla: 7he Contractors License Law dces not apply to an owner oi property who builds or improves thereon, and who does such work himself or herself or ihrough his or her own employaes, pmvitled that such improvements are not inlended or oftered for sale. N, however, the building or improvement is sold wit�in ona year of completion, ihe owner-builder will have the burtlen oi proving that he or she did not build or improve for purpose of sala.). ❑ I, as owner of the property, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct tha project (Sec. 7044, Business and Professions Cotle: The coniractors License Law tloes not apply to an owner of property who builds or Improves thereon, and who contracis tor such project with a contrector(s) � license pursuant to Ihe Contraclors License Laws.). by driv�f's license. Ownership by (type of Business and Professions Code for this reason: Yes ❑ No 1t, i.e. - propeny tax bill or tleetl): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certity ihat no excavation tive (5) or more feet in depih into which a person is raquired to descend, will be matle in connection with work authorized by this permit, and ihat no building strudure, scalloltling, falsework, or demolition or dismantling thereoi, will be more than ihirty-six (36) teet high. (Chap. 32, Grp 2, Ar12, Sec. 341, Title 8, California Atlministretive Cotle). ❑ As ownervbuilder, I will not employ anyone to do work which would require a permit from the Division of Intlustrial Satary, as noted above, unless such person hes a permit to tlo such work from the division. � SignaWre: Date: Division ot Indusirial Sately Permit Number. CERTIFICA7E OF COMPLIANCE AND AUTHORIZATION OF EN7RY: I cenity under penalty ot perlury ihat I have read this application and state that the information given is correct I agrae to comply with all state laws and city ordinances relating to building constmction, and authorize representatives of Ihe City of Costa Mesa �o anter upon the above-described property tor' s—tion es. I agree not to occupy or allow occupancy of eny building authorized by this permit until final inspection. G��Z- o Z Sign� re Of Legal Owner(s)t Date And/Or Authonzed Applicant Date CODE t. INSPECTIONTYPE 1fi16 � Fixetl Sys[em Final Fire Prevention 1266 Pool Spe Final . 200 Final R8-Root � 201 Finel Block/Retaining Wall 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition D�TE IMRIRLS COOE� INSYECTIONTYPE 206 Finel MeChaniCal 208 Final Plumbing 270 Final Elecirical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy UATE o(�� INTRIALS (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa. BIJILDING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626 ,lob nddress: 326 16TH PL Suite: Vicinity: ROOF Parcel Number: 42521221 npp�icant COX, JEFF Address: 326 16TH PL COSTA MESA, CA Owner. COX, JEFF Atltlress 326 16TH PL Zaning: ISSUED BY: Phone: 949-645-9301 Zip: 92627 Phone: 949-645-9301 COSTA MESA, CA Zip: 92627 Contractor: LEE ROOFING OF COSTA MESA Address: 1653 SUPERIOR AVE COSTA MESA, CA Zip: 92627 Arch : Address: Phone: (949) 642-7222 License: 349686 En9: Address: • Status: ISSUED Applied: 10/14/2002 Issued: 10/14/2002 Phone: Phone: Zip: License: License: SCOPE OF PERMIT TEAR OFF EXISTING ROOF. INSTALL TWO 15# FELT LAYERS, 30 YEAR, COMPOSITION SHINGLES. 2,200 S.F. INCLUDES DUPLEX AND 2 ATTACHED GARAGES (7 DWELLING). Plan Check: $0.00 Permit: 38325 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $83.75 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0-0 PARKING E,�sUnq: o Rear 0- 0 Rear 0- 0 Reouired: 0 FEE SUMMARY PLANNING & ZONING Left 0- 0 Left 0- 0 Proposed: 0 Calc Valuafion: Claim Valuation: Right 0- 0 Right 0- 0 52,500.00 52.500.00 � ' NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 7, 12-27-92) EXPIRA710N: 7his permit shall automatically expire and become vold if work Is not commencad within 180 days, or if work is suspended or abandoned tor a period of 180 days. INSPECTIONS: In ortler for the work authorized under this permit to be consldered legal, such work must comply with all applicable codes, and all required Inspectlona end final epprovel must be obtained. Failure to obtain inspec�ions antl final approval will result in ihe expiration of Ihis permit. FOR INSPECTIONS CALL: (714) 7545626 ?04&48(8/00) WORKERS' COMPENSATON DECLARAYION: � `� I hBreDy BHirtn untler penalry of perjury One 01 !he following declaration5: ❑ I have entl will maintein a ceNticate ol �sent to self-Insure br workere' compensation, as pmvided for by sealon 3700 0l the Lebor Cotle, for ihe pertormance of the work for w�ich this permit is issued. ❑ I hevo end will maintain workors' compensatlon Insurar�ce, es require0 by section 3700 of ihe tahor Cotle, br the peAormance ot the work tor which Nis pertnit is issuetl. My workers' wmpensation Insurence Gerner entl policy number are: Cerdor: Policy Number: �(T/his sectiar neetl nat be cUmple(ed 1! (he OB�� 7s valuetl et ane huntlred tlollars ($f 00J or /ess.) 0! I certlty t�et in the pertortnence af l�e work lor which NIs pertnit is issuetl, I shall not employ eny peraon In eny manner so es to become sub�ect ro the workers' �l compensation laws ol C§Ijfomia, end ag�ee that it I s�ould becoma sub�ect to the workers' wmpenSaUon provislons of Section 3700 of Ihe Lebor Code, I shall IOMwith IGU➢bY_CI.] oaia: /i7 % S�' • U z� COVERAGE IS UNUWFUL AND SWLLi SUBIECT fW EM%.OVER TO CRIMINAL PENALTIE rWD CIVIL FlNES UP TOONE NUNDRED � COMPENSATION, DFMAGES AS PROVIDEO F-0R IN SECTION 3108OF THE IABOR OODE, IMEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECIARATION: I hereby eflirm that I am licensed under pmdslons of Chepter 9(commencting with Section 7000) ol DiNsion 3 0l lho Business antl Prolosslons Cotle, entl my license Is In full IO�LB BOd OflBCi. LiC. N CIB59 N Contrector's Signeture: Dele: CONS7RUC710N LENDING AGENCY: ❑ I hereby eHirtn that there is e conslruaion lentling egency tor the pedormance ol the work lor which this permit is issued. (Sec. 3097, CiNI Catle). Lentlefs Name: Lentler's AtlAress: Signeture: Dete: OWNER-BUI�DER DECLARATIONS: I hereby efllrtn thet under penalry of Derjury thet I em E%EMPT FROM TME CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business antl Professions Cotle: Any ciry or county whiCh requires e pe�� to COnStrucl, elter, improve, tlemolish, or repair any stmtWro, prior lo its issuanco, elso requires t�e epplicant lor such pertnii lo lile e signad statement Ihal he or she Is IlGensetl pursuant to Ihe provislons ol Ne Contracbrs Ucense Lew (Chaptar 9(commenGng with SecUon 7000) ot DMsbn 3 0l Ihe Business end Professions Cotle) or thet he Or she is e:empt Iherefram and the basis for the ellepetl ezemption. Any violetion of Section 7031.5 by eny aOP��t for e permlt subjects the applicant to a cNil penelry ol not more than frva huntlreA Aollars (3500).): ❑ 1, es owner ol Ihe property, or my emplPyees with wages as iheir sole compensation, WILL DO THE WORK, ana Ihe sWCWre is not intentled or ottered far sele (Sec. 7044, Business and Pwfessions Coae: me Contraaors License Lew aoes not eppty to an owner of propeny who builds or improves lhereon, antl who does such work himselt or herself or through his or �er own employees, pmvidetl t�at such improvements ere not IntenCed or offered tor sale. If, however, the builaing or imprwement is �9Itl within one year ol completion, the a'�'�er-builder vrill have ihe burtlen ol provinq that he or she ditl not huild or improve tor purpose of sale.). I as owner oi the pmperty, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to wnstruct the project (Sec. 7046, Busineu and Professions �^�Code: The contractors License Lew tlods not epply to an owner ot pro0erty w�o bullds or Improves Ihereon, antl who contrects lor suc� proJact with e wniractor(s) license pursuant to the Contradors LicBnse LawsJ. Owne� ID ve�(ed by driveF's license Verificatlon ot Ownership by (rype of Business end Professions Code for this reeson: Yes ❑ No i.e. - pmperry tax bilt or DIVISION OF INDUSTRIAL SAFETY PERMIT CEiiTIFICATION: ❑ I hereby certily t�a� no excavatlon flve (5) or more feel In depth Into which e perwn is required Io descend, will be made in connectlon with work euNodzed by Ihb permit, antl ihat no Duiltling siructure, s�eHolding, falsework, or tlemolllion or dismantling theraof, will be more Ihan thirry-sia (38) feet �ig�. (Chflp. 32, Grp 2. Art 2, Sec. 341, 71tle 8, Celitomia Adminlstretive Code). ❑ Aa ownervDuiltler, I will no� employ enyone ro do work whlch would roquire e pertnit Imm Ihe Divislon oi Industnel Sefery, es natetl ebove, unless such person �es e permit to do such work Irom t�e tlivislon. SignaWro�. Date: Divislon ol InCustrial Safery Permit NumDer: CERTIFlCATE OF COMPLIANCE AND AUTHORIZA710N OF ENTHY: I certity under Denalty oi perjury that I have read this epplication entl state that Ihe infortnatlon given Is correct. I agree to wmpty wlth ell stete lews and ciry ordinances relatlng to Dullding constructlon, and eulhorize representatives ot the City af Costa Mesa lo enter upon Ihe ebove-descnbed properry for in cti �Durp e s. 1 agree not to occupy or ellow occupancy of eny 6uiltling authonzetl by this perml� until finel inspection. <- �d -.�mi ; ��- ign$tui D-16ege� Owner{s)' ^,Date � ,w�.,� � AnNOr AuthorlZed AP7��Can1 Daie COUE �. INSPECTIONTYPE 1818 Fixed System Finel Fira Pravenlion 1268 Pool Spe Final 200 Final Re-Roof 201 Final BIocWRetelning Well 202 Final FaCtory Fire Placa 203 Final Sign 204 Final Demolition r7.E� COOE I INSVECTION TYPE 206 Finel Mechanical 200 Finel Plumbing 210 Flnel Eleclncal 212 Flnel Fire Preventlon 220 Final Planning Approval 222 Finel Site 250 Final BuildinglOccupenty �� CITY OF COSTA MESA BIIILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT (714)754-5273 • Fax(714)754-4856 Job Address: 326 16TH PL Suite No Vicinily: Parcel Nunmber: 42521221 App�iwnt: BOYER, TOM CO Address: 1656 BABCOCK COSTA MESA CA Owner: AURURO CONTRERAS Address �� 326 16TH PL Contractor. Address: ISSUE FEE Temp service test � Res. a/c package New Res (1-2 units) New Res (3+units) Pool / Spa �ighting Fixts Recept Oullets Switches Non Res Appl Res Appl Service to 200a Service to t000a Service over 1000a Molors l0 1 hp � Motors to 10hp Molore to 50hp Motors l0 100hp Motors over 100hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intertned Pole C.M. CA � , ` BOYER, TOM CO 1656 BABCOCK ELECTRICAL PERMIT �Phone: 949 642-2431 Zip: 92627 Phone: 949-464-0442 Zip: 92663 Phone: 949 642-2431 COSTA MESA CA Zip: 92627 License: 566902 SCOPE OF PERMIT NEW 200 AMO SERVICE AND 3 NEW SUBPANELS. $22.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 50.00 $0.00 $27.25 $0.00 $0.00 50.00 50.00 50.00 $0.00 50.00 $0.00 581.75 50.00 50.00 $0.00 50.00 Quantity FEE SUMMARY Temp Dist System / Lighting Busway/100 R Standing Section' Misc Electrical Equipment Transformers up to 7 kva/kw ................up to 10 kvalkw .................up to 50 kvalkw .................up to 100 kva/kw ..................over 100 kva/kw Low Voltage Equipment Low Volt Wiring System / Ckt Misa Conduit Misa Conductor Cirws ( gen or ritle) Circus (mech ride or lights) Christmas Tree Stand Fireworks Stand Other Electrical Fee Investigation Fee Plan Check Fee Reinspection Fee PER�MBER 9-00689 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 07/23/1999 Issued: 07/23/1999 ISSUED BV: Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 30.00 0 50.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 so.ao 0 $0.00 0 50.00 $0.00 $0.00 S0.00 TOTAL CALCULATED FEES E131.00 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall eutomatically expire and become void it work is not commenced within 780 days, or if work is suspended or abandoned for e period of 780 days. . INSPECTIONS: In order tor the work authorized under this peimit to be considared lagal, such work musi comply wi�h all applicable codes, and all requlred Inapeetlone and flnel epprovel must be obtained. Feilura to obtain inspections and final approval will result in the ezpiration of this permit. FOR INSPECTIONS CALL: (/74) 7545626 WOAKERS'COMPENSAnON OECLAHAnON: � I hpreby afllrtn under penelry oi perjury ona oi tne tdlowing tleclaretions: . ❑ I heva entl wlll maintein e Gerti(icete oi cronsent to salf-Insure for workers' compensation, es provitletl lor by section 3700 of the Lebor Cotle, for the pertormance ot Ihe work fOr whith IhiS permil is issuad. �I have antl will mflintein workers' compensatim insurance, as reqWred by secUon 3700 ot tha Lebor Gotle, for ihe performanca of tha work for which NLs pertnit 45 issued. . My workere' compensatlon Insurance cartier end poliry number are: Cfllder. Pollcy Number. (This secNon need rrot be complBted i! the perml! ls ve/ued ef one hunEred tlollers (5100) or less J ❑ 1 ceNly that in the peAortnance ot Ne work tor which Ihis permlt Ls Issuetl, � shell not employ any person in any manner so es to become subject to the workers' compensetion laws , entl e thet If I shoultl beowne sublect to the workers' compensatlon pravisions of Section 3700 of the Lebor Code, I shall lanhwllh �rom/��p•p��h� o Pm " ns. �� qpplice" nt Signnt ��7 ta--� LURE TO SECURE W ' OMPENSATION ODVEPA�E IS UMAW FUL AND SHALL SUBJEGT AN EMPL ER TO PL PENALTIES AND GML FlNES UP TO ONE MUNDRED THOUSANDDOLLARE�S/00,000),IN IONTOTHECOSTOFCOMPENSqTON,DAM4GE5lSPROVIDE�FORINSEGfION31 FTNEIABORCODE,IMEREST,ANOATTORNEY5FEE5. LICENSED ol Chapter 9(commencing wlth Sectlon 7000) af frce antl ettect. Lic. a, con�rectors signature: Cotle, entl my Ilcense Is In full Lp�/9TRtlCTfON LENDING AGENCV: ❑ 1 hereby eMirm that there is e conswnion lentling egenry br the pertormanca ol the work tor which this permlt Is issued. (Sec. 3097, Chril Cade). Lentlefs Neme: Lentlefs AtlAress: Signeture: Dete: OWNER-BUILDER DECLARATIONS: I hefeby effirm that untler penalry ot perjury ihat I am EXEMP7 FROM 7HE CONTRACTORS LICENSE LAW tor the lollowing reason (Sec. 7031.5, Busineu antl Pro�essions Code: Any ciy or counry which requires a permi� to consiruct, elter, improve, demolish, or repair any strucWre, pnor to ils issuence, elso requires the applicant tor such pertnit to tile a stgned statement that he or she is ticensed pursuant to the proNsbrts ot the Contractors License Law (Chepter 9(comme�i`g with Sectlon 7000} ot Divisbn 3 ot the eusineu entl Prolessions Coda) or that he or she is ezempt theretrom entl the basis for the alleged exemption. Any violetion ol5ecilon 7031.5 6y any applicant lor e permit sub�ects the applicaN to e civll penelry of not more than flve �untlred tlollars (5500)J: ❑ I, es owner ol ihe property, or my employees wilh weges as �heir sole compensatlon, WILL DO THE WORK, entl Ne alructure I5 �ot intentletl or offeretl for sale (Sec. 7044, Business end Protesslons Code: The Contrecrors IJcense Lew does not eppty to an owner oi propeny who builds or improves thereon, anC who does such work himself or herself or �hrough his or her own employees, provided ihat such Improvements are not Imended or otteretl for sale. It, however, the builtling or improvement is soltl withln one year of completion, ihe owner�builtler witl heva ihe burde� oi provinq ihat ha or she tlid not 6oiltl or improve for purpose ot saleJ. � I, es owner oi the property, am E%CLUSIVELV CONTFiACTING WITH LICENSED CONTRACTORS to consiruci ihe profect (Sec. 7044, Business and Protessions Cotle: The contractors License Ww tloes not epply to an owner ot property who builds or improves ihereon, and who comracts tor such project with e con(ractor(s) license pursuant to ihe Contrectors License Lews.). ❑ I em exempt untler sec. Business en0 Professions Code for this reason: Signatura: Date: Owner ID veAfied by tlrivefs license. ❑ Yes ❑ No Driver's License No. Verili�eGon of Ownership by (type of Cocument, i.e. - proDerry tax bill or deetl): Ezpires: DIVISION OF INDUSTRIAL SAFEN PERMI7 CERTIFICA710N: ❑ I �ereby cenlly Ihat no excavation live (5) or more leet In tlepth Into which e person is requiretl to tlescend, will De mada in connection with work aut�orizetl by Ihis permit, entl IM1at no builtling siructure, scattoltling, talsework, or tlemdition or dismaniling Ihereof, will be more then ihlrry-six (36) leet high. (Chap. 32, Grp 2, An 2, Sec. 341, Title 8, Celitomia Administrative Cotle). ❑ As owner•bullder, I will not employ enyona lo Do work whiCh woultl requlre u permit Irom t�e Division of Intlusirlul Satety, as notetl above, unless such person has e pormit to do such work Irom ihe division. Slgne�ure: Date: Divis�on af Intlustdal Satety Permit Number. CERi�FICATE OF COMPLIANCE AND AUTHORIZATION OF ENiAY: I certity under penalry ot perJury that I have read this appliwtlon and stata that the intortnation given is correct. I agree to compty with all state laws end dry oNinances relating to building construction, antl authodze representatives of Ihe Ciry of Costa Mesa to enrer upon t�e eDove-tlescribed properry lar inspectlon purposas. 1 egree not to occupy or allow occupancy ol any buliding eut�orizetl by this pertnit untll Ilnal inspectlon. rn"c �. INSPECTIONTYPE Q�¢, ��^ 1616 Fixetl System Finel Fire Preventlon 1268 200 201 202 203 204 2N&d8 Pool Spe Finel FIna1 Re-Root Final BIocWReteining Well Finel Fectory Fire Place Flnal Sign Final DemWitlon COOE 1 INSPEC710N TYPE 206 Flnal Mechenlcal 200 Finel Plumbing 210 Finel EfectAcal 212 Final Fire Prevention 220 Final Plenning Appro�al 222 250 Finel SIIe Finel Bulitling/Otcupa�cy BdTE