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HomeMy WebLinkAbout207 16TH ST - Building Permits • • CITY OF COSTA MESA • BUILDING DIVISION br DEVELOPMENT SERVICES DEPARTMENT PE NUMBER • PERMIT B06-01286 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesase IL DING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 207 E 16TH ST Status: ISSUED Suite: Applied: 08/01/2006 Vicinity: ' - Issued: 08/01/2006 Primary Occ: R3 Type of Construction: V-N Parcel Number: 42533405 Zoning: Applicant: MILEY, SIDNEY • Address: 24706 EVEREVE CIRCLE �J , ^ Phone: 949-533-7538 ISSUED BY: A!J LAKE FOREST,CA Zip: 92630 Owner BOND, SUSAN J Address 207E 16TH ST Phone: 949-275-1548 COSTA MESA,CA Zip: 92627 Contractor: MILEY HOME IMPROVEMENT Address: 24706 EVEREVE CIRCLE Phone: 949-533-7538 -LAKE-FOREST,CA Zip: 92630 - License: 875796 - Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT BUILDING PERMIT FOR FOR FIRE DAMAGE REPAIR AND REBUILD TO A SFD.WORK TO INCLUDE:REPAIR AND REPLACEMENT OF FIRE DAMP WINDOWS THROUGH OUT HOUSE,BATHROOM REPAIR,DRYWALL REPAIR,REPLACEMENT OF'FIRE DAMAGED JOISTS AND REMOVAL OF(E NEW STUCCO WORK. E0006-007 FEE SUMMARY - Plan Check: $0.00 Calc Valuation: $134,600.00 Permit: $1,189.75 Claim Valuation: $134;600.00 SMIP Res: $13.46 • SMIP Corn: $0.00 • Other $0.00 • Inspection: $0.00 Total: $1,203.21 - • 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 Existind:- 0 Required: 0 Proposed: 0 -.. • • • • • • 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 most 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)7545628 • 2446-46(aroo) 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. L0 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 worers'compensation Insurance carder and policy number are: Cartier- LPolicy Number. - - - (Thlysecflon need not be completed If the permit/s valued at one hundred dollars($100)or less.) IV^�J\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 nd agree that III should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these pro ns. � /J 41 -Applicant Signature: (/yr� Dat /'Ytr rte' / a o 0. 9 _THOUSAN:FAILURE TE( SECURE W RXEADDm0/TO T E SO OE TIS UN.UNLAWFUL AND SHALL SUBPROVIDED FOR I AN SECTION EMPLOYER TO THECRIMINAL PENALTIES AND CIVIL FINES UP ONEHUNDRED. THOUSAND DOLLARS(5100,000),IN ADDRION TO THE COST OF COMPENSATIdJ,DAMAGES AS PROVIDED FOR IN SECTION 31080E THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am license under provislorys of Chapter 9(commencing with Section 7000)of Division 3 of.the Buslne and Professions Code,and my license is In full force and effect.tic.# •� •� (S 7 9 0 class* �Contredors signature : �r �j rDate: A-E,9 / e (JCR 6 — CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:My 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 Ls 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 Ls exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such Improvements are not Intended or offered for sale.If,however,the building or improvement Is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-properly tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,faisework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ 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 t0 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 materiels? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aggermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? IJ 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). _.._.___ _ ._....._r._ _ __.. _ 7 application,If a permit from the South Coos?res Quality ed by CaliforniaHealtheal or otherd airpo Code S control 303 ben agency is wired for the work which is the subject of this have all of the disclosures prescribed by Celifola and Safety Section 42303 been made? 0 Yes0 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. `�$igf atttuure OI Loyal Qw s) f ig / D e 006 ._ /YS(t Anf/dOf.Aulhoriizzzeedz Apg " " ✓ ('- Date CODE 6 INSPECTION TYPE PATE ELM SODFit IWSPECRON TYPE 2ATE ROMS& 1616 Fixed System Final Fire Prevention ' 206 Final Mechanical 1268 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 • c o - • 4 • A • Me CITY OF COSTA MESA 1 • 4 66 BUILDING DIVISION > ..r, DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER •1 1;; • I PERMIT V. I B06-kbemoRmsoI00054 .y� (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.BU' R-DING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 207 E 16TH ST • Status: ISSUED Suite: Applied: 01/12/2006 Vicinity: Issued: 01/12/2006 Primary Occ: R3 Type of Construction: V-N Parcel Number: 42533405 Zoning: Applicant: JULIAN ALEXANDER MULLEN n Address: 1636E EDINGER AV SUITE B Phone: 714-241-3700 ISSUED BY: SANTA ANA,CA Zip: 92705 Owner BOND, SUSAN Address 207 E 16TH ST Phone: COSTA MESA,CA Zip: 92627 Contractor: KEVIN BARRY AND ASSOCIATES INC Address: 1636 E EDINGER AV SUITE B t::: 949-496-24 1 SANTA ANA,CA \Zip: 77 374 Arch : E g: Address: Addre s: Phone: Phone: Zip: License: License: S4 OPE OF • R IT DEMO PERMIT FOR FIRE DAMAGE REPAIR TO SFD.WORK'0 NCLUDE REMOVAL OF FIRE DAMAGE,INSULATE AND REPLACE ALL DRYWALI SFD.REPLACE ALL WINDOW AND DOORS INCLUDING THE •• - •GE DOOR.ALL FIXTURES WILL BE REPLACED AND BATHROOMS TILED.FAL AND WATER HEATER REPLACED. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $58,000.00 Permit: $699.75 Claim Valuation: $58,000.00 SMIP Res: $5.80 SMIP Corn: $0.00 Other $0.00 Inspection: $0.00 Total: $705.55 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 • ` u NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) WORKERS'COMPENSATION DECLARATION: 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. L My workers'compensation Insurance carder and policy number are: Carder: at. ^ ', ♦ II sa,11.s4 A, ! Policy-Number: /.f9L/7IV (This-action need not be completed r the permit Is':toed et one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that it I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. M Applicant Signature: YER . EN 4' �O THOUS ND DOL A ET( SECURE RS'COMPENSATIONTWOT ERASE 11S UNLAWFUL AND SHALL PROVIDED SUBJECT I AN EMPSECTION TO CRIMINAL PENALTIES AND CIVIL AND Al UP TO ONE'SHUNDRED THOUSAND DOU.ARE(5100,000), ADDriION TO THE COST OF COMPENSATION,DAMAGES AS FOR IN SECTION 3700 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic n -7-7913 ?4r' LCass a B Contractor's Signature. /.7 — D /•t2 . O(n 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.(Soc.3097,Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500).): ❑ 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 proporty 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 Drivers License No. Expires: Verification of Ownership by(type of document,Ice.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feel 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: 1 HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be tiled with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,ora 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 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 ag$ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes 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 De constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No _ 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for Inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owner(s) Date ndlOLIzed Applicant—' Data CODE f INSPECTION TYPE PAIL INTRIALS LODE. INSPECTION TYPE PALE MIMS 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 Well 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 ht q147�' CITY OF COSTA MESA __ 44 % BUILDING DIVISION >:�",.,,,. F; `, DEVELOPMENT SERVICES DEPARTMENT P IT NUMBER ft ... r t PERMIT 0 M06-00476 *ttobowrigoe / (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 207 E 16TH ST Status: ISSUED Suite No Applied: 08/01/2006 Issued: 08/01/2006 Vicinity: • Parcel Number: 42533405 • i A. /1 ' ISSUED BY: ,l✓ / Applicant: MILEY, SIDNEY Address: 24706 EVEREVE CIRCLE • Phone: 949-533-7538 _ . . - LAKE FOREST,CA Zip: 92630 ' Owner: BOND, SUSAN J Address:= 207 E 16TH ST - - ' - Phone: 949-275-1548• , - - 'COSTA MESA,CA Zip: 92627 , • Contractor MILEY HOME IMPROVEMENT i Address: 24706 EVEREVE CIRCLE ' ' - Phone: 949-533-7538 . LAKE FOREST,CA Zip: 92630 • License:875796 . SCOPE OF PERMIT MECHANICAL PERMIT FOR FOR FIRE DAMAGE REPAIR AND REBUILD TO A SFD.WORK TO INCLUDE: REF :EOCO6-007 , REF#:806-01286 • WORK TO INCLUDE:1 INST FAU< 100 K BTU,1 HOOD W/MECH EXHAUST,2 VENT FAN/SINGLE DUCT. • FEE SUMMARY Quantity - Quantity ISSUE FEE $23.50 . Repair/Alt Absorbtion Unit' $0.00 0 Inst FAU<100 k BTU $14.80 1 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0 Inst/Rep.Recess Wall Htr $0.00 0 Commercial Incinerator • $0.00 0 Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00, 0 Refrig Sys>100 k BTU $0.00 0 ' Compressors/Absorption Systems... ' Gas Piping $0.00 0 Up to 3 hp/100 k BTU ' $0.00 0 Factory Fireplace $0.00 0 3 To 15 hp/500 k BTU ' $0.00/ 0 Hood w/Mech Exhaust $10.65 115 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 $14.50 2 Over 50 hp/Over 1,750 BTU , $0.00, 0 Appliance $0.00' 0 Boilers . ' Fire Dampers $0.00 i 0 Up to 3 hp ' $0.00 0 Smoke Dampers $0.00 0 ' . 3 To 15 hp .. . $0.00 0 Inst or Relocate Appl Vent $0.00- 0 15 to 30 hp i , '$0.00 0 Air Handlers< 10000cfm'/ • ,,$0.00• 0-- • 30%50 hp. . _/ 7,, -7 $0.00 0 Air Handlers> 10000cfm $0.00, 0 - Over 50 hp _ ' $0.00 0 Floor Furnace ' $0.00 0 ' Other Mechanical Fee ' . . ' Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 , Plan Check Fee - - $0.00 Reinspection Fee • - . $0.00 TOTAL CALCULATED FEES $63.45 • /. • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under/California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work Is not commenced within 180 days,or If work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result In the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2448-46(6WW) . .. DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penally of perjury one of the following declarations: - ❑ .1 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 win 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: L Policy Number. -(Th/s section need not be completed If the permit is valued at one hundred dollars($100)or less.) I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that If 1 should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these pr ions Applicant Signature: r ,, �!LL'ri,� i-- Date: ( 0C) C, WARNING:FAILURE TO SECURE W/ AIPENSATION E IS UNLAWFUL MD SHALL SUBJECT AN EMPLOYER TO CRIMINAL TES AND CML FINES UP TO ONE HUNDRED UF10USAND DOLLARS($100,0011),IN TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3/06OF THE LABOR CODE,INTEREST,MD ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am license der provisi9gs of Chapter 9(commenting with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Uc.tl 7 7 Y Class.N B _Contractors Signature: iX'f Date: Ati.a / 2 0?)k CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,CMI Code). 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.My violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ' ❑ 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: ❑ I hereby certify that no excavation INe(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires.with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater then a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑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 thnte applicaor present or future building occupant need to prepaan re RMPP(Risk Management and Prevention Program for acutely hazardous materials)? No (Section 25534 of the California Health and Safely Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP Is presently required,has Section 25534 of the Califomia Health and Safety Coda been fully complied with? ❑Yes ❑No 5 Does or-al the applicant or present or future building occupant require for the work which is the subject of this application ap�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 LJ No (Section r5R50.2 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 ladliry w to be constructed under thiss permitrmit he within 1000 feet from the outer boundaries of a school? ❑Vas_ 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 prescnbed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No _ _._...._.._.._ __.._ ._...._ ..__ B (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPUANCE: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. SOr Au0ignature Legal ner(s) Date J/r�fyO /lJ/ l a 0O� nt Dale CODE L INSPECTION TYPE DAB ICAO gODF( INSPECTION TYPE RAIL MIITA�L$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical .9 J�-)7-Q} _AZ 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 - 4151Pt - CITY OF COSTA MESA ( + 4�eakikt® BUILDING DIVISION 4 $ DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER F 1 'r-=wak l ' PERMIT M06-00016 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 • MECHANICAL PERMIT Job Address: 207 E 16TH ST Status: ISSUED Suite No Applied: 01/12/2006 Issued: 01/12/2006 Vicinity: . Parcel Number: 42533405 Ma 1 L ISSUED BY:�'I Applicant: JULIAN ALEXANDER MULLEN Address: 1636 E EDINGER AV SUITE B Phone: 714-241-3700 SANTA ANA,CA Zip: 92705 Owner: BOND, SUSAN J Address: 207 E 16TH ST Phone: COSTA MESA,CA Zip: 92627 Contractor: KEVIN BARRY AND ASSOCIATES INC Address: 1636 E EDINGER AV SUITE B Phone: 949-496-2421 SANTA ANA,CA Zip: 92705 License:779374 f; )SCOPE OF PERMIT DEMO PERMIT FOR FIRE DAMAGE REPAIR. REF:1306-00054 1 INST FAU< 100K BTU,1 HOOD W/MECH EXHAUST,2 VENT FANS/SING E DUCT FEE SUM ' ARYARY Quantity \ Quantity ISSUE FEE $23.50 R pair/Alt Absorbt'on Unit $0.00 0 Inst FAU<100 k BTU $14.80 1 Repair/Alt Refriger 'on Unit $0.00 0 Inst FAU>100 k BTU $0.00 0 Veptillation System $0.00 0 Repair/Alt Cooling/Heat $0.00 0 Eva orative Cooler $0.00 0 Inst/Rep.Recess Wall Htr $0.00 -D Com ercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0". Dome tic Incinerator $0.00 0 Refrig Sys>100 k BTU $0.00 0 Compr ssors/Absorption vstems Gas Piping $0.00 0 '. Up to 3 /100 k BTU $0.00 0 Factory Fireplace $0.00 0 3 To 15 h /500 k BTU $0.00 0 Hood w/Mech Exhaust $10.65 1 • 5 To 30 h 1,000 k B $0.00 0 VAV Box $0.00 0 , 3,O To 50 hp/ 0 U $0.00 0 Vent Fan/Single Duct $14.50 2 •.. Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers Fire Dampers $0.00 0 U to 3 hp $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00 0 \ 15l30 hp $0.00 0 Air Handlers< 10000cfm $0.00 0 \ 30 too 50 hp $0.00 0 Air Handlers> 10000dm 50.00 0 \ Over 50 hp $0.00 0 Floor Furnace $0.00 0 they echanical Fee Floor or Suspend Heater $0.00 0 InVest ation Fee $0.00 Plan heck Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $63.45 COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections end final approval must be obtained.Failure to obtain Inspections and final approval will result in the expiration of this permit. /, FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) t�� DECLARQTIOHS 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. ,51 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: 1Carrier--., ST•4TE PIA v) (.m M ..7iS4 h47),--/ Policy umber: in w7f y (Affliction need not be completed If the permit Is valubcl at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person In any manner so as to become subject to the workers' compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisi Applicant.Slgnature: n Date: /. LS . 0 L WARNING:FAIRE TO SECU DIMERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND DOLLARE(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.a 1,9•Iiii)5) 6 Contractor'sgnet_r1a. VL �_ Data !•/2 • 0 E. 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 penally of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of 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 com4letion,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 end Professions Code for this reason: Signature: Date: Owner ID verified by drivers 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 five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(38)feet high.(Chap.3.2,Grp 2,Ad 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has e permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 WIII the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). _ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons. or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Depanment. 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 prosent or iuture building occupant require for the work which is the subject of this application apermuch it for sconstruction or modification from the South Coast Air Quality Management District or Iron any other air pollution control district or agency? D 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). 8 Will any pan 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 Coest 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 alt of the disclosures ptescnbed by California Health and Safety Code Section 42303 been made? ❑Yes ❑No B (If yes%attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF 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 properly for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. • tire Of Legal Owner(s) Date ///7 / • /2 •dlo nd/OpllbTriaized Applicant_jam Date CODE I IISPECTION TYPE PAIL E®9& CODEC INSPECTION TYPE QAIE UMBAL5 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 iLI'r CITY OF COSTA MESA 4 % .. BUILDING DIVISION >:j",,,,, ..,1 DEVELOPMENT SERVICES DEPARTMENT PER UMBER -t In . PERMIT 4F • P06-00607 (714)754-5273 • Fax(714)754.4856 • www.cl.costa-mesa.cp,us ,MBING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 207 E 16TH ST F Ll1 Status: ISSUED Suite No Applied: 08/01/2006 Issued: 08/01/2006 Vicinity: • • Parcel Nunmber: 42533405 " • Applicant: MILEY, SIDNEY ISSUED BY: le-AA 'J Address: 24706 EVEREVE CIRCLE Phone: 949-533-7538 • LAKE FOREST,CA Zip: 92630 Owner: BOND;SUSAN J Address ,207E 16TH ST - ' . -i - - Phone: 949-275-1548 - - �-\ COSTA MESA,CA, Zip: 92627 • - - Contractor: MILEY HOME IMPROVEMENT • ' ,Address: , 24706'EVEREVE CIRCLE - Phone: 949-533-7538' . ' LAKE FOREST,CA . Zip: -- 92630 • " License: 875796 • - " h ' SCOPE OF PERMIT . PLUMBING PERMIT FOR FOR FIRE DAMAGE REPAIR AND REBUILD TO A sFp.WORK TO INCLUDE: REF#:E00061007 - _ REF#:806-01286 , FEE SUMMARY ' • AMT QTY •AMT QTY . - , AMT -QTY ISSUE,FEE $23.50 Laundry Tub/Washer $9.80 ' 1 -Sump Pump $0.00 0 Backflow irrigation 50.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 • P-Trap - -$0.00 0: „ Trap Primer _ $0.00 . 0 Bathtub. $9.80 1 - Pressure Regulator - - $0.00 0" - •Urinal $0.00 0 ' Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors ,$0.00 • 0 Vacuum Brkr Bkf]ow(5+) $0.00 0 Dental Units , $0.00 0 Septic Tank ' $0.00 0 Wash Basin $19.60 2 Dishwasher • $0.00 0 Sewer Cap for Demo .$0.00 0 Wash Basin Set .$0.00 0 Drain,Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System ' $0.00 0 Drain,Rainwater $0.00 0 Sewer Private Line . " , $0.00.. 0 t Water Closet(Toilet) $19.60 2 Drain,Roof $0.00 0 Shower $9.80 1 Water Heater/vent $12.30 1 Drinking Fountain $0.00 0 Sink,bar $0.00 • 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank ' $0.00 0 Sink,commercial $0.00 . 0 `'Water Re-pipe " " . / $9.80 1 Gas Earthquake.Valve $0.00 0 _ ' Sink,Floor $0.00 0 ' • Watei Service , $0.00 0 Gas(1-4 outlets) ' ,/$0.00 0 , Sink,kitchen $9.80 1 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00' 0 , ' OTHER ' " ' $0.00 Gas Repipe $9.80 1 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service . $0.00" 0 Spa(public) $0.00 0 PLAN CHECK, ' $0.00 Interceptors(Grease,Oil) $0.00 -. 0 - REINSPECTION / 50.00 0 Interceptors(Sand Auto)v, .$0.00 " 0 - - /� TOTAL CALCULATED FEES: $133.80 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) i EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work:Must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 i 2448-48(8b0) i! DECLARATIONS WORKERS'COMPENSATION DECLARATION: • • I hereby-affirm under penalty of perjury one of the following declaratloiis : • ❑ 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: 4Camer Policy.Number. (yTh�/s section need not be completed if the permit is valued at one hundred dollars($100)or less.) I certify that in the performance of the work for which this permit Is issued,I shall not employ any person In any manner so as to become subject to the workers' compensation laws of : fomia,end agree that III should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provillt _ _ ,�l/�1 Applicant Signature: S. -.�.i �Z Date: Aryl l / .2 l J 0 6 WARNING:FAILURE TO SECURE W-,t COMPENSATION GE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND OWL FINES UP TO ONE HUNDRED THOUSAND DOIARE(5100,000),IN AD•MON TO THE COST•' PENSAT10N,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Busln�and Professions Code,and my license Is in full force and effect.LJc.q LCIass s Q_,� ,Contractors Signature: .— �'1..,/ — Date: /�"7 / td—U 0 6. L CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this pormit is issued.(Sec.3097,CMI Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any oily or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to Its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ' ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health 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? El 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 agernit for such construction or modification from the South Coast Alr Quality Management District or from any other air pollution control district or agency? U Yes LU No (Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits). 8 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes-,the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No ___.._ t.rofficer). 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. Am ' Signature Of Le rat Owner(s) / Datta 1_�, r. .An And/O._uthonzed Applicant N ( Date- -_-,Y LODE/, INSPECTION TYPE MAIL iliflALI LODE I INSPECTION TYPE —DS UAL$ 1618 Fixed System Final Fire Prevention 206 Final Mechanical �1 '7 p 1268 Pool Spa Final 208 Final Plumbing -''7'1) 1 d.l - 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 ,. ' 00 F CITY OF COSTA MESA 4 BUILDING DIVISION Y 4 r,,,,' i DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER F t jis PERMIT -afr,,, 04. m P06-00025 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ccLUMBING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 207 E 16TH'ST Status: ISSUED Suite No Applied: 01/122006 Issued: 01/12/2006 Vicinity: Parcel Nunmber: 42533405 '. Applicant: JULIAN ALEXANDER MULLEN ISSUED BY: It /G,. Address: 1636 E EDINGER AV SUITE B Phone: 714-241-3700 SANTA ANA,CA Zip: 92705 Owner: BOND, SUSAN J Address 207 E 16TH ST Phone: COSTA MESA,CA Zip: 92627 Contractor KEVIN BARRY AND ASSOCIATES INC Address: 1636 E EDINGER AV SUITE B Phone: 949-496-2421 SANTA ANA,CA Zip: 92705 License: 779374 ' SCOPE OF PERMIT DEMO PERMIT FOR FIRE DAMAGE REPAIR. 1 REF:B06-00054 -\ \ 1 BATHTUB, 1 DISHWASHER,1 GAS REPIPE,1 LAUNDRY TUBNVASHER, 1 SHOWER,1 KITCHEN SINK,2 WASH BASINS,2 WATER CLOSETS, 1 WATER HEATERNENT, 1 WATER REPIPE FEE SUMMARY AMT QTY AMT AMT gLY ISSUE FEE $23.50 Laundry Tub/Washer $9.80 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $9.80 1 Pressure Regulator $0.00 0 • Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $19.60 2 Dishwasher $9.80 1 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain,Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain,Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $19.60 2 Drain,Roof $0.00 0 Shower $9.80 1 Water Heater/vent $12.30 1 Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $9.80 1 Gas Earthquake Valve $0.00 0 Sink,Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) $0.00 0 Sink,kitchen $9.80 1 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $9.80 1 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $143.60 COMMENTS I SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92.28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 ` 2446-66(6'00) // DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. 44 I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Ls Issued. L— My workers'compensation Insurance carrier and policy number are: Carder:, Si-*-gb g ted if LSM pC/IJI�r�/J� POI�icyNuglber. (5,yPIY (Thissecadn need not be compleI the permit is alued at one hum red dollars(sf 00)or less.) ❑ I certify that In the performance of the work for which this permit is Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with those provisio Applicant-Signature: . G ....2.----...t /2 '._- Detb, (•/L' 04 WARNING:FAILURE TO SECURE ORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDmON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.AND 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,� -77mJJ19 rClas a /3 Contractors.Signat%re. Date. I . i a • 0 CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license, ❑Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,I.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,Celifomia Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to tile and certify'a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes ❑No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions.requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes 0N (Section 25534 of the California Health and Safely 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 II 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 aQermit 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 Celifomia 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 II a permit from the South Coast Air Duality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials end Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owner(s) Date / -I2 •o6 nd/Or"Alrlhorized.App nt— Date CODE 1 INSPECTION TYPE WI 1NTRMLS CODE( INSPECTION TYPE PETE XIMBLS 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 5'01 6 CITY OF COSTA MESA 4`, 6� BUILDING DIVISION 't ..• DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER • 1 / 1 I PERMIT J• x`V 416 F • E06-00031 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT • Job Address: 207 E 16TH.ST Status: ISSUED Suite No Applied: 01/12/2006 Vicinity: Issued: 01/12/2006 Parcel Nunmber: 42533405 Applicant: JULIAN ALEXANDER MULLEN _4").4_,_ Address: 1636 E EDINGER AV ISSUED BY: SUITE B Phone: 714-241-3700 SANTA ANA,CA Zip 92705 Owner: BOND, SUSAN J Address 207 E 16TH ST Phone: COSTA MESA,CA Zip: 926 t7 Contractor: KEVIN BARRY AND ASSO• •TE IIJC Address: 1636 E EDINGER AV SUITE B Ph ne: 949-496-2 21 SANTA ANA,CA Zip: 92705 / Licen e: 79374 .- Sr OPE O PERMI DEMO PERMIT FOR FIRE I •MAGE AN; REPLAC WITH NE . REF:B06-00054 15 LIGHT RIXTURES,57 OUTL:TS,22 S ITCHES, MOTO S TO 1 HP FE. SUMMARY Quantity Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft $0.00 0 Res.a/c package $0.00 Standing Section $0.00 0 New Res(1-2 units) $0.00 0 isc Electrical Equipment $0.00 0 New Res(34-units) $0.00 0 '-nsformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0 Lighting Fixts $16.50 15 up to 50 kva/kw $0.00 0 Recept Outlets 549:01 57 up to 100 kva/kw $0.00 0 Switches $23.46 22 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 $14.25 3 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $126.72 Intermed Pole $0.00 0 COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days,or if work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 / 2446-46(woo) // WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate 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. TFC 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: Carrera_ — 9P/-TO FyvtD CO Ari t=.s SiQ--T�Q./J Policy Number: J5-'/17f`/ (7)iu.section need not be completed it the permit is valued at one hundred dollars($100)or less) ❑ I certify that in the performance of the work for which this permit is Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Callfoml agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisi Applicant.Signature: / mate' a /./7 ,8/ WARNING:FAIL TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE($l00,000),IN ADORKIN TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Prole ions Code,end my license is In full force and effect.�k 7 T 11 7y Class p (3 Contractors Signature ��— 04.-7 y yZ •49 f l 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 toe civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property.or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under Sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding.falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file 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 Califomia Health and Safety Code requires,with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). _ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 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 Meapplicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazflMous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit 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 f.J No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the SouthCoast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑No 8 (If yes",attach certificate of compliance from the appropriate air polution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for Inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owner(s) Date / r/2 "e6 �utbodzed Apelicanl 'Date CODE I INSPECTION TYPE g.6IE INRRAL$ CODE. INSPECTION TYPE PATE fLMALS 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 P. 01 `7; EWE July 28, 2006 Blob City of Costa Mesa Building Division 77 Fair Drive P. O. Box 1200 Costa Mesa, CA 92628 Re: Building Permits for 207 E. 16th Street, Costa Mesa, CA 92627 To Whom It May Concern: —� This letter is to request that you now issue building permits to Ted Miley, Inc. He has been replaced as my contractor and needs to start work rebuilding my fire damaged house. On January 12, 2006, I had hired Kevin Barry & Associates, a contractor, to rebuild my fire damaged house. He applied for and received building permits in order to begin work on the property. But on January 20th, I cancelled my contract with Kevin Barry & Associates and therefore they never began reconstruction of my property. On June 28, 2006, I hired Ted Miley, Inc. as a contractor to rebuild my home. Please issue him permits now so he can begin reconstruction work on my property at 207 E. 16th Street in Costa Mesa. Thank you very much. If you have any questions, call me at 949 275-1548. Sincerely, l4 / •.d i Susan J. Bond • PROJECT ADDRESS: 207 E 16TH ST UNIT: . CITY OF COSTA MESA — BUILDING PERMIT PERM NO: P 047117 OWNER'S NAME: CHRISTINE RICKMERS ADDRESS: SAME AS ABOVE PERMIT NO: P 047117 PLAN CHECK NO: N GOVT: N SUPP : N • CONSTRUCTION TYPE: PERMIT TYPE: PLU PURPOSE: OTH 714 /631-5330 ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : WATER HEATER INSTALLATION SQ FT: ADDRESS: • UNIT: CLAIM VALUE: CALC—VALUE: GROUP 9 1ca / PERMITTEE: GENERAL INSTALLATION ( 714 )753-2541 ADDREss: 6558 CA 90043 COMMENTS: MAIL IN PERMIT tpT'�'."'� ** itOMMENTS:iE MAIL6E IN4E PERMIT BE et dE iE dE 9E iE iE 1E 9E iE iE iE dE iE iE BE 9FiE 1E iE iE BE G�r+*v^IF^R�'' iE iE iF It iE iE lE iE V jFiEiF ik it iE iE lE 1E 1F 9E-7e i4 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 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 CRY UC.: 0/0�S 3 sSATE uc.:1518 3 9 cuss: C Date: !Q7.Y 90 Signature: ( jO �—��-r✓ MAIN BUILDINGAACCESSORY EAILDING FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN WORKERS'CDM ENSATION ECURATION: I hereby affirm that I ave a certificate of co Ito self-insure or a certificate of Workers' LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN Compensation s(�Pp,,or a,t� a copy thereof(Section 3800,Lab.fy� POLICY NO.: `•J"7 u U � EXP.DATE V4 /01 /91 COMPANY: NMIC ,YY PARKING REQ: PROV: PARCEL: 00000000 ZNE: REF NO: Certified copy is hereby furnished. IU Certified copy is filen with the dry Building "ion. PLANNING NOTES> • r • t > iiiiiEE1iiiiiitt eElEiEiiEE**** Eiii4iiiiiiEiiiiiEEiEiE ****ttiikllEEEEi4EEEEE1E**,uate - 4:11 A 57? /ADPicanL DEVELOPMENT SERVICES - REQUIREMENTS EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the perm for one hundred($100)or less). I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become • subject to the Workers'Compensation Laws of California. ZONING APPROVED BY DATE: Date: Signature: BUILDING APPROVED BY : DATE: NOTICE:If,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. Jr, I p,T CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: DATE: ( (f which this permit is issued(Section 3097,Civ.C). 'k'1Ei()FjEiE4(>t'lEjEiEil'iE%iEiEiEiEiEitIE4'1E****#tE10')E1F#iEiE1Ey('3E8('3 *** "lfie'ki('iEiE4f's('1Ei('e('e('ki(k'k4E'le*4* ** UNDER: iE iE dE 1E 3E 1E iE iE iE tt k iE iE 1E 1E iE iE 4E iE 1E iE iE BE iE iE 3E 4E 1E iE iE BE 1E iE BE 1E iE iE BE*iE BE eE BE 1E 4E 4E 4E BE iE iE 4E*1E iE 4E iE 1E 1E eE 4e iE#iE iE 1E 9E 9E 4E 9E 3E iE iE iE 1E 9E#9E iE iE ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N 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: My city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 2 . 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 25% SMIP/NON—R E S pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.My violation of Section 7031.5 by ISSUE FEE 3 ,00 any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE • I, as owner of the property or my employees with wages as their sole compensation, wit do the work, and the TOTALS----> 2 . 00 3 . 00 0 . 00 5 . 00 10 . 00 —5 . 00 ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State 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 employees,provided that such improvements are not intended or offered for sale.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED: 5 .00 OVER/SHORT• . 00 improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or Improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK for the purpose of sale). I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 5 . 00 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon ***************************, *,*, ******,* ****,*,N ******************************* 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 Dale: Owner: PLU 1 WATER HEATER AND/OR VENT 2 .00 2 . 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 state codes and the requirements for a • permit for construction or modification from theAirAlr Quality 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 01 00063506-00063506 T n T5.CIU ordinances and state laws relating to building construction and hereby authorize representatives o city to enter upon the above-mentioned property for inspectiioog purposes //7�/) �/,A 7 DATE: 06/19/7g_ TIME: 15:25 Date: h� c----/ /) Signature: !/// //// ..__.._... .• 5_•,' �;.,,. Driver's License or Social Security 4: �s uVUo ULU^VUlbJJt OVuw�_aen_ 1641.46 White—Building;Green—Code Enforcement;Canary—Applicant;Pink—Revenue;Goldenrod—Assessorr at;17;0‘, U MMilt—4 R ...".� CONSTRUCTION AND PLANNING POOL .,PA APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electric& Service or Pole:' - - 52. Pool & Equipment Location 2.,.Soil Pipe-Undrgrnd. - ' - , 53. Steel Reinforcement '3. Electrical Conduit Utility-UndrgrndR 54. Forms 4.-Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test _ 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE • ,7. ,Footings rt 1 -... 58. Electrical Conduit-Undrgrnd. - ":8. Foundation - 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. . 10. Structural Floor System 1 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 gar Ceiling 69. POOL/SPA SYSTEMS FINAL 19,,_Rough Heating & Air Conditioning _ _ _ FIRE DEPT. REQUIREMENT _ 20, Rough Factory Fireplace k -- . . =APPROVALS ,Permit # 21. Ducts,in Structure; :, _ •4, , .70. Underground Hydro 22. Ducts, Ventilating a -71. Product-:Piping DG_as 0 Oil 23. Gas--Pipe;Rough & Test _ _, ' '72- Underground Flush 24. Roof Framing > , , 773..Undergrnd.Storage'Tank DGas 0Oil 25. Roof Sheathing _ • - , - 74, Overhead Hydros_., ': 26..T-Ba,r Ceiling (Structural) & Moriocoat `,. % 1. . ,9' ;. 75•:Dry Chemical : -t L 27. •Frame and Flashing t - + , 76. Dry Standpipe = - T. '28. Lathing,& Siding-4-.4 - • c " .• - 'r t: 77,7 FIXED SYSTEM FINAL- . 29. Insulation _ - '• - .. 78?-;FIRE PREV. FINAL "30. DrywalllNailing r5 c ,� -:.HEALTH DEPT.. REQUIREMENT 31- Plaster Brown Coat; i 1' '79. FINAL INSPECTION - -32.4Electrical Power Meter-Final ' :;: ' 80.'•FOOD CERTIFICATE ISSUED 33: Final Electric It. * Notes: _--1 y " 34. Final Heating & Air Conditioning . .- - ' `.-Final Gas Pip 35e-Testx ,. 36. Hood or'CanoPY - - /...; ;4. ' r . :37. Final Factory Fireplace.: - •---'; _ -38. Final Plumbing , _ ` n V4R00 (AR - •t• nal 39. Water Service-Final -- / _ . -"40. Gas Service-Final=- - - • + _ - 41. Solar Domestic- nal ' ' ' I.Fi - : _ 42.. Backflow Preventer- = t_ ' 43. Backflow Irrigaton, , :_244. Landscape Irrigation System zi, rr ' " ` ' _ `45. Sound .Attenuation - .r.. 03 ±'46.-Handicap Regulations ., . -. . _-47.•FIN AL STRUCTURE& BUILDING - ' •48. .FINAL PLANNING _ , 4.49. Electric Release to:Edison ; •50. Gas Release to Southern California Gas Co k 51. CERTIFICATE OF OCCUPANCY ` ' • - No. Date 1 PAIo IN 12.-77cf.r.00 417: 12726 43292 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 • 'I LI TION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely—Use Ink Only y. =1V: V D•TE RECEI Es BUILOING ADDRESS �,�tl� ,1y_�/ _ 1 Tl / /� , / //T R - / r,�l �j OW NE R•�I A. rY G. '3000/6✓-pr Lt( A.P. NO.�7�// / �/S P J. • AUIODIEG_ /Cif/ //'M MAIL �� ADORES �/ � !' ADDRESS r+i//")j.�_.� /t,�,j. nr� ' S_QS MQ S:L r V . Nw ^ACT' • pgLOT ] BLOCK CITY L•3/-0443 CONSTRUCTIONe NEW ADD,ALTER REPAIR MOVING nFMOI ISH 46 n LENDER ✓\J�\/ BRANCH {� pp^ OWNER ' I'. H 800.14 (74-61 CUO ODLUAe0 ' ADDRESSARCHIT CT TEL. USE 'VDD LV /JOQ{'1 C7q rjLUE /[ovt! l OR ENGINEER OLy it r- NO. I F ADDRESS ZONE TYPE GROUP J, APP ROV 111 CONTRACTOR an LAI H Q Ira��' r, BY DATE J 2 - 4 ADDRESS TEL. ZOn NO.OF 41%.USE OF N ' 1 t CITY NO. �� PLAN BUILD > STATE CITY YARDS APPROVED YARDS APRO < � VE• LIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILD;'• "pett W SIZE NO.OF BLDGS. n, OF LOT , C A I S'O NOW ON LOT / (FROM ClL$TREED ,/, .. H EXISTING BLDG. hive 1/N % /Oren. T." IFF/TT� ul ES•-• Separate permits are required for L.SIDE FT. electric,plumbing and heating work. REAR r, FT. USE OF BUILDING AND WORK TO BE PERFORMED F DISTANCE BET. BET.MAIN& MAIN BLOCS. ACCESS.BLDGS. r r VAR.#'• DATE Q A1.UQtil`� AC/41410‘t Y�)-t I /� V C.U.P.#FTp(�(/�t /F�^/ APPROVED LIVINCT K1/4k. / 13l7 1201.) I3I� .L[UJLR.1 APPROVI+ ! ` D TE&42-7 7 - /// cC RIM t c AttAtC 5. 1 m P. I hereby acknowledge that I have read this application and state N N. that the above information Is correct and agree to comply with m C. all laws regulating building construction, and I shall not employ i Z any person in violation of the workman's compensation laws of o Is7I the State of California. /e�Q� T-=-- / / ^' I hereby certify that I am properly licensed as a contractor under `^ SO. FT. (J h �?/c[,/F // m the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from : p ovisions of the State of California Business a VALUATION PERMIT FEE $ y41 t a and Professions, e •'vision ,Chapter 9. w Signature of 4 / / 111 PLAN CHECK $ f/� ^ Permitee Vat.ei i ....•......m.,4116„. $ ) J/n TAX $ / ,, U. Authorize• Agent TOTAL PAID /a 7 af4