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Home My WebLink About323 22ND ST - Building Permits(714) 754-5273 • Fa�c (714) 754-4856 • www.c�.costa-mesa.�3L`�JMBING PERMIT n FAIR DRIVE, COSTA MESA, GA 92626 ,loba.ddress: 323 22NDST Suite No Vicinity: REAR YARD Parcel Nunmber: 42616121 Applicant: SIGLIN, IRVIN STEVEN JR Address: 323 22ND ST COSTA MESA, CA Owner: SIGLIN, IRVIN STEVEN JR Address 323 22ND ST Phone: 949-515-8895 Zip: 92627-1863 Status: ISSUED , Applied: 09l222005 Issued: 0922/2005 ISSUED BY: � EgPIREDi DA'PES:�+--- Phone: COSTA MESA, CA Zip: 92627-1863 Contre�tor. OWNER-BUILDER � � Address: Phone: Zip: License: 000000 SCOPE OF PERMIT PERMIT FOR EXTENSION OF GAS OUTLET FOR BBQ GRILL OUTSIDE. ISSUE FEE Backflow irrigation BackOow Preventer Bathtub Clarifer System Connect Qce,Soda,etc) Dental Units Dishwasher � Drain, Floor Drain, Rainwater Drain, Roof Drinking Fountain Expansion Tank Gas Earthquake VaNe Gas (1� outlets) Gas (Over 4 outlets) Gas Repipe Gas Service Interceptors (Grease, Oip Interceplors (Sand Aulo ) AMT $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $6.15 $0.00 $0.00 $0.00 $0.00 50.00 � FEE SUMMARY AMT Laundry Tub / Washer $0.00 Landscape Irrigation $0.00 P-Trap $0.00 Pressure Regulator $0.00 Process Piping (per 10 R) $0.00 Receptors $0.00 SepticTank $0.00 Sewer Cap tor Demo $0.00 SewerConnect $0.00 Sewer Private Line $0.00 Shower $0.00 Sink, bar $0.00 Sink, commercial $0.00 Sink, Floor ' $0.00 Sink, kitchen + $0.00 Sink, service/mop $0.00 Spa (private) 50.00 Spa (public) $0.00 on 0 0. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 COMMENTS / SPECIAL CONDITIONS ' I� SumpPump Swimming Pool Trap Primer Urinal Vacuum Brkr Bkflow(1-0) Vacuum Brkr Bkflow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (Toilet) Water Heater / vent Water Piping (Inst or Rep.) Water Re-pipe Water Service Water SoRener OTHER VIOLATION PLAN CHECK REINSPECTION AMT $0.00 $0.00 50.00 $0.00 50.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 80.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 so.00 TOTAL CALCULATED FEES: 529.65 QTY 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 NOTICE: The work authorized by this p�rmit shall comply with all applicabla 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 ihe work authonzed under lhis permit to be considered legal, such work must comply with all applicable codes, and all required Inspectlorts end fina! approval must be obtained. Failure to obtain 7nspections and linal approval wi!! result in the expiration oi this permii. FOR INSPECTIONS CALL: (714) 7545626 2418i8 (B�W) . ,., . WORKERS' COMPENSATION DECLARATION: � ' � I hereby ettirm under penalty oi perjury one of ihe following declarations: ❑ I heve end will maintein a certificate oi consent to self-Insure for workers' compensation, es provided for by section 3700 0l the Lebor Code, lor Ihe pertortnence of the work tor which Ihis pertnit is issued. . ❑ I have and wiil maintain workers' compensation insurance, as required by section 3700 oF the Labor Code, for the pedortnance ot the work tor which this pertnit is issued. My workers' compensa�ion Insurance carrier and policy num6er ere: Cerfier Policy Number. (Thi ect�on need wt be crompleted il the permit is valued et one hundretl tlollars ($100) or Iess.J � µl certify that in tha pedortnance of the work for which this permit is issuetl, I shall not employ eny person in any manner so es to 6ecome su�ject to the workers' compenselion laws of Celifomia, entl egree t it I shoWtl become subject Io Ihe workers' compensalion pmvislons of SeCtlon 700 of the Labor Code, I shall torthwith comply with lhese provi ' \ Applica tn Slgneture: [Dale: — --� SLif • �h �Q D � WARNINO: FAILURE TO SECURE WORKERS' ENSATI COVERAGE IS UNLAWFUL AN� SHALL SUBIECT AN EMPLOVER TO CRIMINAL PE�TIES AND IVIL FWES UP TOONE HUNDRED TqUSANDOq1ARE(5100,000),INADDI TOTHECOSTOFCOMPENSATION,DPM4GESASPROVIpEDFORINSECTIIXJ3]O60FTHELABORCODE,INrEREST,ANDATTORNEI^SFEES. LICENSED CONTRACTORS DECLARATION: I hereby aftirm that I am licensed under provisions of Chepter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full forca ana eHect. Lic. # Class A Coniractor's Signature: Date: CONSTRUCTION LENDING AGENCV: ❑ 1 hereDy aNirtn ihat there is a construction lentling agency for the pedormance of ihe work for which this pertnit is issued. (Sac. 3097, Civil Cotle). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby aHirm that untler Denelry of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for iha following reason (Sec. 7031.5, 8usiness entl Professions Cotle: Any ciry or counry which requires a pertnit to construct, alter, improve, demolish, or repair any structure, prior to its iuuance, also requires tha applicant for such pertnit to tile e siqned statement thet he or sha Is Ilcensed pursuant to ihe provlsions of ihe Contrectors License Law (Chepter 9(commencing with Sectlon 1000) of Division 3 oi the Bus�s antl Proteuions Cotle) or that he or she is exempt therefrom entl the basis tor the alle9ed e:emption. Any violetion of Section 7031.5 by any applicant For a pertnit sub' ls ihe epplicant to e dvFl penalry ot not more than five hund�ed dollers ($500).): I, as he property, or my employees with wages as'iheir sole compensation, WILL DO TNE WORK, and the siructura Is not intentled or oHeretl tor sale (Sec. 7044 ��' and Piofessions Code:4�ie Contracbrs Li se Law does not apply to an owner of properry who builds or impmves �hereon, end who does such work himsef eN or Ih�h his oq�r'�oryq�employees; pr�ed ihat such improvements are not intendetl or oNered for sate. If, however, the building or improvement is soltl within yeer of pletioryyilie oiviSer-builde��will h� the burden ot proving that he or she did not build or improve for purpose of sele.). • ❑ I, as owner of the property, am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to consiruct the project (Sec. 7044, Business antl Protessions Cotle: The conirectors Licensa Law does nol apply to en owner ol pwperty who builas or improves lhereon, antl who contracts tor such project with a contrector(s) license pursuant to the Comractors License Laws.). ❑ I am exempt r sec Siqn t rua e1� Owner ID verifietl by drivers Venficetion of Ownership by _ Business antl Professions Code for this reason: � � _ " �. 1, 1n� `—�' 1-1N-0 ❑ No Dnvers�Cicense�No: �' � � Eapires: � __ �. of documen�, i.e. - property tau bill or deed): DIVISION OF INDUSTRIAL SAFE7Y PERMI7 CERTIFICATION: ❑ I hereby cetlity ihat no axcavation Five (5) or more feet in depth in�o which e person is required to tlescend, will be made in connection with work euthorized hy �his permit, and that no building sirucWre, scatfolding, falsework, or demolition or dismantling ihereot, will be more than thirty-sia (36) feet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Ttle B, Califomla Atlministrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit fmm the Division of Industrial Safery, es noted above, uniess such person has a permit to tlo such work irom the division. Signature: Division oi Industnal Safery Permit Number: Date: CERTIFlCA7E OF COMPLJANCE AND AUTHORIZATON OF EMRY: I cenity under penalry ot perjury that I have reatl this application antl state that the infortnation given is cortect. I agree to comply with,eI� state lews and ciry ortlinances relating to 6uilding construction, end authorize re0resentatives of the Ciry of Costa Mesa ro enter upon the ebove- cribed�arly for irbo�c�ion puryoses. 1 agree not to occupy or allow occupancy of any building authoriz� is permit until final in pection. � ?` �aa a a o � �S`ignature Of Cegal Owner(s} � � Date'—� _'--------__—_'" L�_J COUE �, 1616 1266 Ficed System Final Fire Prevention Pool Spa Final 200 Finel Re-Rool 201 FInaI BIaWReteining Wall 202 Final Fadory Fire Place 203 Final Sign 204 Finel Demoli�ion PAL INTRIALS CO�E� INSPECTIONTYPE 206 Final Mechanical 208 Final Plumbing 210 Final Electrical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final BuildingiOccupancy Date �l.tl. �i� � ,� (714) 754-5273 • Fex (714) 754-4856 • www.c�.costa-mesa.c68lILDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Jobnddress: 323 22NDST Suite: Vicinity: THROUGH OUT HOUSE PrimaryOtc: R3 Parcel Number: 42616121 Applicant: SIGLIN, IRVIN STEVEN JR Address: 323 22ND ST Type of Construction: V-N Zoning: Phone: 949-515-8895 COSTA MESA, CA Zip: 92627-1863 Owner SIGLIN, IRVIN STEVENaJR - � `� � Address 323 22ND ST °' � " .. " � �� Phone:�� 949-515-8895 COSTA MESA, CA � Zlp: . 92627-1�863 Coniractor: OWNER BUILDER ```�� ° ;,„ _'_ _ Address _ � _ , ' � . ��' - - Phone: � �� 'Zip: "��-� License: 000000 Arch : Address: ; ��_ �' Phone: F , , � � License: � CHANGE OUT 8 WINDOWE GARAGE: ALL WINDOWS ; MEET Eng: Address: za; ' , Status: ISSUED Applied: 12/01/2005 Issued: 12/07R005 ISSUED BY: "/ �. * �`` Phone::� ' ' license; � SCOPE OF PERMIT � -< � � ORS (1 SLIDING DOOR) AND REMOVE SIDING AND INSTALL�HARDY PLANK�ON HOUSE'AND UBCEGRESSREQUIREMENTS =- '��"��, � - '��n� '�., 3..:: . , , , . �•.hEE SUMMARY �,-. '.E �Plan Check �_ $0.00 �� x a Calc Valu ' �` '� _ s2 ooaoo � � , �_ � �� Permit ' � $69 25 � � �� " ` ��C�VaI sz 000.00 SMIP<Res ' $0 50 * � SMIP Com $0 00 � Other � , _$0 00 . . .. ., . :� . - _,� Inspection "$0.00 �, � Total: � � �$69.75 ,� ; . � ;;, = PLANNING & ZONING SETBACKS fi> �` '��: " ,` � MAINSTRUCTURE Pront 0-0 �� '.Rear �0=0 Lefl,� 0 0,�s-. '�RighE_-. 0-0 ` �+`�`�"' ,' . -- �.. � :aa� `n`. t�f,"1, d - � - -. . ox, �- ACCESSORY =_Front 0'0 �Rear 0 0 Left_ 0 0 •�Right 0 0�� _ ' _ , �, �.,, , . . - , PARKING Exstina� ,.0 � •� Reauired "�-� 0, Pr000sed '�`0`- ' - • •_ , , .•. t; ;< „� „ - � ,`b 'y'<<3 �i �� n �9. . m�:.'': - . . .. - � " ;�� - ---<:.�� - . � .,� NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requiremenis under Californla statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or If work is suspended or abandoned for a period of 1 BO days. INSPECTIONS: In order for the work authorized under this peimit to be considered legal, such work must comply with all applicable codes, and all required Inspectiona and final approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of ihis permit. FOR INSPECTIONS CALL: (714) 7545626 .aao-aa law� WORKERS' COMPENSATION DECLARATION: ' I hereby eHirtn under penalty of perjury one of ihe following declaratlons: , ❑ 1 heve and will meintaln e ceNticete of consent to self-Insure for workers' compensatlon, es Orovidad for by sectlon 3700 of the Lebor Catle, for ihe pertormance o1 ihe wark tor which this pertnit is issuetl. ❑ I have end will malntain workers' compensatlon Insurence, as requiretl by section 3700 ot t�e Letwr Code, for Ne pertortnance of t�e work tor w�lc� Nis pertnit Is Issued. My workers' compensatlon Insurance cartler entl policy number are: Carrier: Policy Number: (Th� sectlon neetl nof be cromp/eted il the permit is veluetl e( one hunOred dollers ($700) or less.) �`^��certify Ihal in the peAormance of the work lor which this pertnit Is issued, I shell not employ any person in eny menner so as lo becoma sub�ect to Ihe workars' compensation laws Calitomia, end egree that I s�auld becoma subject lo the workers' compensetlon Drovislons at Sectlon 3700 oi the Labor Cade, I shell forthwith �comply wilh i�hese pro ' s. � ( Appliran- '"-t�5l�tufe: �� ^ Dete:. 1 I.7 i\j 1 � 1F1i: [:w� WMNIN�: FAILURE TO SECURE WORKERS' COA1 ATION COVERAGE IS UNIAWFUL AND SHALL SUBIECT AN EMPLOYER TO CRIMINAL PENALTIES ANO G L FINES UP TO ONE HUNORED TiK%15PNDOOLLARE(E100,000),INADDITIIXJ ECQSTOFCOMPENSATION,DAMAGESASPROVIOEOFORINSECTION3%080FTHElABORCODE,INiEREST,ANDATTORNEV'SFEES. LICENSED CONTRACTORS DECLARATION: I hereby eMirm that I em Ilcensed under provislons oF Chepter 9(commencing with Sectlon 7000) of Divislon 3 ot the Business end Professions Code, end my Ilcense Is in full torce antl eHect. Lic. a Class p Contreaors SignaWre: Date: CONSTRUCTION LENDING AGENCV: ❑ I hereby ettirtn t�al there is a construction lending egency for Ihe peAortnanca ol the work br which this permit is Issued. (Sec. 3097, Civil Code). Lenders Name: Lender's Adtlress: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby eHirtn that under penalry ot perjury thet I em E%EMPT FqOM THE CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business end Professlons Cotle: Any ciry or county which requires e parmit to construct, alter, improve, tlemolish, or repair eny structure, prior to iLv issuence, elso requires Ihe epplicant for such permit to tile a signetl statement thet he ar she is licensed pursuent to Ihe provislons al the Camrectors Licanse Lew (Chapter 9(commencing with Section 7000) oi Dlvlsian 3 of the Businass and Professions Code) or that he or she Is enempt thereirom end the besls for the elleged ezemptlon. Any violetion oi Sectlon 7031.5 by any epplicent for e permit sublects the applicant to e civil penalry of nat more than five hundred dollers ($500).): ❑ I, as owner at the praperty, or my employees with weqes as their sole compensalion, WILL DO 7ME WORK, end Ihe siructure Is not intended ar aHarea for sala (Sec. 7044, Business and Professions Cotle: The Conirectors License Law Ooes not e001y to an owner ot property who builds or improves thereon, end who does such work himself or herself or Ihrough his or her own employees, providetl t�at such improvemenis ere nat Intended or oHered for sale. If, however, the building ar improvement is �sold within one year of completioq the owner-builder will heve the burden of proving t�at he or she did not huiltl or improve for purpose ot sale.). ' �as owner oi ihe property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to consiruct t�e pro�act (SecJ044, Business end Professlans Cotle: The conirectors Llcense Lew does not apply to an owner ol pmperty who hullds or Improves therean, ena who contrecis lar suc� projett with a contracbr(s) license pursuant to t�e Contraaors License LewS.). Owner ID verified by dnv s licens�: Venfication ot Owner ip by (type of Business entl Pmtessions Code tor this reason: ves ❑ No i.e. - properry tax blll or DIVISION OF INDUSTRIAL SAFETY VERMIT CERTIFICA710N: ❑ I hereby certiy ihe� no excavetion five (5) or more feet in depih Into which e person is requlretl to tlascentl, wlll be mede In connection with work authorizetl by �his permit, antl that no building structura, scaHolding, lalsework, or demolition or dismantling thereol, will be more Ihen thirty-sia (36) faet hig�. (C�flp. 32, Grp 2, Art 2, Sec. 341, Ttle B, Callfomie Adminisiretive Cotle). ❑ As awner-buildar, I will not employ enyone to tlo work which woultl require a permit irom the Division of Industnel Sefaty, es noted ebove, unless such person has e permit to tlo such wark trom iha division. Signature: Date: Division oi Intlusinal Satery Permit Number: CERTIFlCATE OF COMPLIANCE AND AIfTHORIZA110N OF ENTAY: I certily untler penalry ol perjury that I heve read this epplicetion end state Ihat the informetion given is cortect. I a ree to comply with all slate laws end clry ordlnances releting to building conswction, antl euihodze representatives of the Ciry at Costa Mesa to emar upon iha above-tlescn rope or specti urposes. I egree not to occupy or allow accupency ol eny building authonzed by this D rmit until finel inspecti � �Q ��u�.,��n_�.yao� �'��: u e� �. egal Owner(s) � �D- e COOE I, 7616 1266 200 201 202 203 Fixed System Final Fira Preventlon Pool Spa Finel Final Re-Rool Finel BIocWRetelning Wall Final Factory Fire Place Final Sign 204 Final Demolition Q�jE �NTRIALS CODEA INSPEC710NTVPE 206 Final Mechanicel 20B Final Plumbing 210 Final Electrical 212 Final Flre Preventlon 220 Final Planning AOPrOval 222 Final Site 250 Final Building/Occupancy D�TE It�EL$ (714) 754-5273 • Fex (714) 75a-4856 • www.ci.costa-mese.��LDING PERMIT 77 hAIH UHIVt, IiVJIA MtJA, GA tlLOGO JobAddress: $2$ 22ND ST Suite: Viciniry: RESIDENCE AND DETACHED GARAGE Primary Occ: R3 Dwellings/ Cong Res <10 Type of Construction: V-N Parcel Number: 42616121 Zoning: Appiicant: GALITSKI, GUY Address: 19792 POTOMAC HUNTINGTON BEACH, CA . . _ Owner: SIGLIN, IRVIN STEVEN JR Address 323 22ND ST , COSTA MESA, CA -.� contractoc 'G G ROOFING CO INC Address: 79792POTOMAC"��` -- - HUNTINGTON BEACH, CA . Zip: � 92646 Arch : Address: - � . . , � Phone: - �s� �, � . . . �� 2ip: . ' License: � Phone: 714-965-2387 ISSUED BY: _, 2ip: 92646 Phone: _ 'Zip: 92627-1863 _ Phone: 714-965-2387 License: 364151 Eng: Address: Stalus: ISSUED Applied: '11/15/2005 Issued: 11/152005 - Phone: � License: " SCOPE OF PERMIT REROOF RESIDENCE AND DETACHED.GARAGE: T/O EXISTING WOOD SHAKE ROOF, 1/2" CDX SHTG, 1 LAYER 3Q# FELT, APPLY "40-YEAR CEF PRESIDENTIAL COMP�SHINGLES" NEN/ EDGE METAL AND VENT FLASHINGS. �, . 40 SQUARES . � -- ` � - - - FEE SUMMARY ' Plan Check: $0.00 " Rermit: , $265.25 _ SMIP Res: $1.55 - - SMIP Com: '' $0.00 Other. $0.00 Inspection: ' $0.00 Calc Valuation: Claim Valuation: sis,soo.00 �� . . $15,500.00 Total: , $266.80 , PLANNING 8 ZONING SETBACKS MAIN STRUCTURE Front 0- 0 � �'. Rear 0• 0 :LeR D-�0 -��Right 0- 0 - ACCESSORY � � Front' 0-0 � --� Rear 0•0� �'�Ceft 0-0 ' �Right 0-0 . , PARKING �Existina( _ 0, _ x�- Required: 0 -' Pr000sed: - 0'�� R R ♦ � I NOTICE: The work authodzed by this permit shall comply wlth all applicable handicap access requiremenis under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall eutomatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred I�speetions end tlnel epprovel must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2++aae �eroo� WORKERS'COMPENSAnON DECLARAnON: ' , ' . .. I he�aby eHirm untler penalty oi perjury one oi ihe following declarations: � �� ❑ I heve end will maintain a ceniticate of consent to seif-Insure tor workers' compensation, as provided lor by sectlon 3700 of ihe Labor Cotle, for the peAormence of the �� w r which Ihis parmit is issuetl. . '�I have entl will maintain workars' compensation insurance, as required by section 3700 of the Labor Cotle, for the perfortnance of �he work for whic� this pertnit is issued. �' � My workers' compensation Insurance cartlar antl policy numbe� are: / �e ��i�:� � L � ' PollcyNumDer. �Z–h�� I ��`� �(Thisaectian�need not be complefed il (he permit is velued at one hundretl tlollars ($100) or less.) l''""�r - � . ❑ I certity that in Ihe peAormanca of t�a work tor which this pertnit is issued, I shall not employ any person in eny manner so as to become subject to the workers' compensation laws of Calitomia, end egree thet ii I should become sub�ect to Ihe workers' compensatlon provisions of Section 3700 of the Lebor Code, I shall forthwlth comply with Ihese prOvisions. � r^ /� �lL `pp�ICen��` ,Si 9ture: _ Dale:".� �.•cJ WARNINO: FAILURE O SECUR O� FS' ATIdJ COVERAGE IS J�AWFUL ANO SHALL SUBJECT AN EMPLOYERdOCRIMINAL PENALTIES AND CIVIL FINES UP TOONE MUNDREO THOUSAND DOLLARE ($100,000), INADDITION TO THE CAST OF COMPENSATION.DAM4GE5 AS PROVIDED FOF IN SECTION 3]OB OF THE LABOR CADE, IMEREST, AND ATTORNEY'S FEES. LICENSED CON7RAC70RS DECLARATON: I hereby affirtn that I am licensed under provisions of C�apter 9(commencing with Section 7000) of Division 3 ot.ihe Business antl Profe ions Cotle, antl my license is in full forceanaeHect.�Lic-u� �G-�C 1S l ClassN� �—�� Cornyrectors,signatuie:�� / �7 �_ DaYa:� � 1"' /S -0 "z CONSTRUCTION LENDING AGENCY: ❑ I hereby eHirm ihat Ihere is a constmction lending agency for the performance of the work for which ihis permit is issuetl. (Sec. 3097, Civil Cotle). Lender's Name: Lender's Atltlress: Siqnature: Date: OWNER-BUILDER DECLARATIONS: I hereby aHirm that untler penalry of perjury ihat 1 am EICEMPT FROM THE CONTRACTORS LICENSE LAW tor ihe following reason (Sec. 7031.5, Business and Professions Code: Any city or wunry which requires e permit to consiruct, elfer, improve, tlemolish, or repair any sWcture, prior to its issuance, also requires ihe applicam for such permit to file e signed stelement thet he or she is Ilcensetl pursuant to Ihe pmvisions of Ihe Contractore License Lew (Chapter 9(commencing with Sectlon 7000) of Division 3 of Ihe Business antl Professions Cotle) or that �e or she is e:empt iheretrom and Ihe basis for Ihe alleged ezemption. Any violetion of Section 7031.5 by any epplicant for e pertnit subjecis the applicant to a civil penalry of not more than fiva hundred dollars ($500).): ❑ I, es owner of the property, or my employees with wages as iheir sole compensation, WILL DO THE WORK, and ihe structure is not intende0 or oflered for sale (Sec. 7044, Business and Professions Code: The Coniractors License Law does not apply to an owner of propetly who builds or improves thereon, entl who does such work himself or harself or ihrough his or her own employees, provided thet such improvements are not Intended or oHeretl for sale. If, however, tha bullding or improvement is soltl within one year of completion, ihe owner-builder will heve the burden uf pmving that he or she ditl not build or improve tor puryose of sale.). • ❑ I, es owner of ihe property, am EXCLUSIVELV CONTRAC7ING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Cotle: The coniractors License Lew does noi apply to an owner of property who huilds or Improves thereon, end who conirects for such pro�ect with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business end Protessions Code for �his reason: SignaNra: Date: Owner ID verified by dnvers license. ❑ Ves ❑ No Dnvers License No. Expires: Verification at Ownership by (rype ot tlocument, i.e. - property taz bill or deed): DIVISION OF INDUSTRIAL SAFETV PERMIT CER7IFICA710N: �� ❑ I hereby cetlity Ihat no excevation flve (5) or more feet in depth into which n person is required to descend, wlll be made in connection with work euthonzed by this permit, antl ihat no building sirucNre, sceHolding, falsework, or demolition or dismantling ihereof, will be more lhan Ihirty-six (36) feet high. (Chap. 32, Gry 2, Ar12, Sec. 341, Title e, Califomia Atlministrative Cotle). ❑ As owner-buildar, I will not employ enyone m tlo work w�ich would require e permit from the Division of Industnel Sefery, as notatl ebove, unless such person �es e pertnit to tlo such work irom the tlivision. SignaNre: Date: Division oi Indusinal SafeTy Pertnit Number: HAZARDOUS MATEflIALS AND EMISSIONS CERTIFICATION: 1 Wlil ihe epplicant or present or Future builtling occupant neetl to file end certity a Business Plen for emergancy response m release or threatened release oi a hazertlous meteriel? ❑ Ves ❑ No (Section 25505 oi the California Healih antl Safe�y Code requires, with some exceptions, ihat a Business Plan ba filed with the Coste Mese Fire Depertment by every business which has et any one time dunng a reported year a quantity of hazartlous materials equal to or greater than e weight o1500 pountls, or e volume of 55 gallons, or 200 cubic teet ot compressed gas at standard temperaWre and pressure). ........................................................................................................................................................................................................................................................................................................................................................................................ 2 Does or will the applicant or present or Future building occupant naetl to file a registration torm for acutely hezertlous materialsl ❑ Ves ❑ No (Section 25533 ot ihe Califomla Heelih end Safery Code, with some exceptions, requires registration with the Costa Mesa Fire Depariment by eac� Dusiness whlch et eny one tima hes on hand a quantiry of ecutely hazerdous materiels equel to or greater ihan e weight of 500 pounds, or a volume ol 55 gellons, or 200 cubic feet oi compressetl gas at stantlartl tempereWre entl pressure). (Sec�ion 25534 of the California Healih and Safery ( Departmen� ot en RMPP by busines5es which ere re ............................................................................................................................ 4 IF an RMPP is presently required, hes Section 25534 ........................................................................................................................... 5 Does or will Ihe epplicant or present or tuWre buildir trom ihe South Coast Alr Oualiry Menagement DisM< (Section 658502 of the Celifornie Govemment Code . ........................................................................................................ 6 W ill eny part of t�e facility to be conswcted undar ih Qt yes", Ihe tacility must meet the requirementpt�4'e 8 Qf "ye5", aflach CER7IFICATE regartling Heza Signature: _ an :osta Mesa Fire Department may i y hezerdous metenals wilh tha Fire ........................................................................... end SefeN Gode been fullv comoli� ihe with7 ❑ Ves hazar00us matenal5)7 certifice�ion and filing wi�h ihe Fire FTi �m eny other elr polWtion roniml distdct or egency? ❑ Ves ❑ No es that the requested intormation be turnishad on epplications for non-residential bi ................. ..................................................... ....................... .... nil be wi�hin 1000 feet irom the outer bountlaries of a school? ❑ Yes ❑ No 25534 entl 42303 ot the Califomia Heelt� antl Setery Code). or agency is reduired tor the work which is the 3n madel ❑ Yes ❑ No penalry oi parjury the information given a�ova is correct I agree to comply with ell state lews and ciry ordinences Date: CERTIFICA7E;OF COMPLIANCE AND AUT}iORIZA710N OF ENiAY: I certify untler penalty of perjury ihat I have read this application end stete that the infortnetion given is correct I agree to comply wilh ell s�a�e laws entl city ordinances relating to building consiruction, antl authodze representatives of the Ciry of Costa Mesa to enter upon Ihe ebove-described property for inspection purposes. I egree not to ocwpy or ellow wcupancy of any building authorized by this pertnit until finel inspection. COUE I, INSPECTIONTYiE - 1616 Fixed Sys�em Final Pire Preventlon 1266 Pool Spe Final 200 Final Re-Roat 201 FInaI8locWRetaining Wa11 202 Final Feqory Fire Place 203 204 Final Sign Final Demolition �� o"� -// /T—o`f " 400Et INSPECTONTYPE - 206 Finel Mechanical 20B Finel Plumbing 210 Finel Electrical 212 , Flnal Fire Prevention _ 220 Final Plenning Approval 222 Final Site 250 Finel Builtling/Occupancy' � ➢AIE 1[�EL9 (714) 754-5273 • Fax p7a) 754-ae5s • www.ci.costa-mesa.��,SCTRICAL PERMIT �� hAIH UHIVt, GVJ IA MtJA, l:A BLtiLti Job Address: Suite No Vicinity: Parcel Nunmber. Applicant: Address: Owner: Address Contractor: Address: ISSUE FEE � Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool / Spa Lighting Fixls Recept Outlets Switches Non Res Appl Res Appl Service to 200a Service to 1000a Service over 7000a Motors l0 1 hp Motors to 10hp Motors to 50hp Motors to 100hp Motors over 100hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole 323 22ND ST FRONTPORCH 42616121 SIGLIN, IRVIN STEVEN JR 323 22ND ST COSTA MESA, CA � SIGLIN, IRVIN STEVEN JR 323 22ND ST COSTA MESA, CA ; OWNER-BUILDER LEGALIZATION OF ELECTRICAL EXISTING LIGHTING FIXTURES. 1 MISC CONDUIT. $23.50 $0.00 $0.00 $0.00 50.00 50.00 $0.00 $0.00 $0.00 so.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 so.00 $0.00 $0:00 $0:00 $0.00 $0.00 Quantiry 0 0 0 0 0 0 a 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0• Phone: 94&5�5-8895 - Zip 92627-1863 Phone: Zip: 92627-1863 � Phone: Zip: . License: 000000 Status: ISSUED Applied: 09222005 Issued: 09/22/2005 ISSUED BY: RI REPLACEMENT OF CONDUIT FOR FEE SUMMARY Temp Dist System / Lighting Busway /100 fl Standing Section Misc Electrical Equipment Transformers up l0 1 kva/kw ................up to 10 kva/kw .................up to 50 kva/kw .................up to 100 kva/kw ..................over 100 kva/kw Low Voltage Equipment Low Volt Wiring System / Ckt Misc. Conduit Misc. Conductor Circus ( gen or ride) � - Circus (mech ride or lights) Christmas Tree Stand Fireworks Stand � Other Electrical Fee �uantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $1820 1 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 � � Investiga�ion Fee $0.00 Plan Check Fee-. $0.00 Reinspection Fee $0.00 � ` TOTAL CALCUTATED FEE3 � E41.70 COMMENTS / SPECIAL CONDITIONS �� NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitornia statutes and related regulations, (Ord. No. 92-28, § 1, 12-21-92) EXPIRA710N: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all requlred Inapeetiona end flnal approval must be obtained. Failure to obtain inspections and tinal approval will result in ihe expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2448d8 (NW) WORKERS'COMPENSAnON DECLAHAnON: I hereby aflirtn under penalry of perjury one ot the tollowing declarations: 4 - ❑ 1 heve end will maintain e certificate ot consent to selt-Insure for workers' compensatlon, es provitletl for by section 3700 of the Labor Code, tor the pertortnence of Ihe work for which Ihis pertnit is is5uetl. ❑ I have and wlll meintain workers' compensation insurance, u required by section 3700 of the Lebor Catle, for the peAortnance of ihe work for which this permit is issued. My workers' compensatlon Insurence carner antl policy number are: Cerner: .. . .. .. .._.. .. . . . . . .. .. PolicyNum�ec one or less.) of the work for which this permit is issued, I shall not employ eny person in any manner so as to become subject to tha workers' i, end gree that it I shoultl become subJect to the workere' compensa�lon provisions Secti 3700 of �he Labor Cotle I shell tonhwl�h comply with thesa provisions. � ^ \ ' Applicen(_,_Signeture:. . � �Date:—'= ^ - da . d�O O � r �� WAPNINGFAIWRETOSECUREWORKERS'CAMPENS ONCAV RAGEISUNIAWFULANOSHALLSUBJECTPNEMPLOVERTOCRIMINALP LTIESANDCIVILFINESUPTOONEHUNDPED TLK)USANDDOLLARE(5100,000),INADDITIONTOTH 0.STOPCOMPENSATION,DAMAGESASPROVIDEDFORINSECTIQV3]060FTHELABOFCODE,IMEFEST,ANDATTORNEV'SFEES. LICENSEDCONTRACTORS I hereby aHirm that I em Ilcensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 of Ihe Business and Protessions Code, antl my license is In full force entl etlect. Lic. x Cless q Contrectors Signature: Date: CONSTRUCTON LENDING AGENCV: ❑ I hereby aNirtn that ihere is a construction lending agency for the performance of the work for which this pertnit is issued. (Sec. 3097, Civil Cotle). Lentler'S Name: Lender5 Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirtn thet under penalry of perjury that 1 am EXEMP7 FROM 7HE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Protessions Cotle: Any ciry or counry which requires a permit to construct, alter, improve, tlemolish, or repair any stmcture, prior to its issuance, also requires ihe applicant for such pertnit to file a signed stetement that he or sha Is Ilcensed pursuant to the provisions of iha Contrectors License Law (Chapter 9(commencing with Section 7000) of Divislon 3 of the eusiness en �ons C or ihat is exempL( �[etrom antl the basis tor the allaged ezemption. Any violation ot Section 7037.5 hy eny applicant for a permit ,� su cts the o e civ nalty oM1 han tive`fiU ieil dollars ($500).): I; es o prope .or my em G¢S�wi�h wage�'S�t.aS„tlieir sole componsation, WILL DO TME WORK, antl the simcNra is nm intended or oHeretl for sale (Sec. 7044, Busines9snd Prof ions Cowd�'Contractq�GicAnsa Law does not apply to en owner of property who builtls or improves ihereon, and who does such work hlmsetl or heis�A or ihro' his or h6�f`bwn employeds'� rowded that such improvemenis are not intendetl or oflered for sale. If, however, the building or improvement is sold within one year oi completion, ihe owner-builder will have ihe burden oi proving ihet he or she did not build or improve for purpose ot sele.). � ❑' I, es owner oi ihe property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to constmd the project (Sec. 7044, Business and Professions Code: The contredor5 License Lew does not epply to an owner of property who bullds or Improves ihereon, and who coniracts for such project with e conireclor(s) license pursuant to ihe Contrectors License Laws.). ❑ I em exemp er Signature:" Owner ID verified by driv� Verlfication ot Ownership 8usiness and Professions Code for ihis reason: � � Ves ❑ No of document, i.e. - property tax bill or deetl): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavetion five (5) or more feat in depih inro which a person is required to descenq will be made in connection with work euthonzed by Ihis pertnit, and Ihat no 6uilding strucwre, scaHoltling, falsework, or tlemolition or dismantling thereof, will be more Ihan thirty-six (36) feet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Title 8, California Adminisirative Code). ❑ As owner-bullder, I will nol employ anyone �o do woric which would reQuire a permit �rom Ihe DiviSion of Induslrial Safery, as no�ed above, unla5s such parson has a permit to do such work irom the division. Signawre: Data: Division of Indusirial Sefery Permit Number: CERTIFICA7E OF COMPLIANCE AND AUTHORIZA710N OF ENTFlY: I certity under penalry of perjury that I have read Ihis application and state that the information given is correct. I agr o comply wlth all state la and ciry ordinances rela�ing to builtling construction, entl authorize representatives of the City of Costa Mesa to enter upon ihe ebove-described eny in ction pu ses. I agree nm m occupy or ellow occupancy of any building euth ed b his permit until tinal inspection. �� .11.a n n � Signa e Ot Leg'al Owner(s)_ _.� � LDaj -� d/Or Authorized Applicanl Date LOOE t. INSPECTIONTYPE 7616 Fi:etl System Final Fire Prevention 1266 Pool Spe Final 200 Finel R8-Rooi 201 Finel BIocWRetaining Wall 202 Final Factory Fira Place 203 Final Sign 204 Final Demolition �jF IN RI COOE 1 INSVECTION TYPE 206 Finel Mechanical 20B Final Plumbing 210 Final ElecMcal 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 FinalBuildincyOccupancy : � - (774) 754-5273 • Fax i714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRNE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: Suite No Vicinity: Parcel Nunmbec Applicani�. Address: Owner: Address Contractor: Address: ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool/ Spa LigMing Fixts Recept Outlets Swilches Non Res Appl Res Appl Service to 200a Service to 1000a Service over t000a Motors to i hp Molors to 10hp Molors to 50hp Motors to 100hp Motors over 100hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole 323 22ND ST 42616121 ROBERT COX 21552 NEWLAND ST HUNTINGTON BEACH, CA SIGLIN, IRVIN STEVEN JR 323 22ND ST COSTA MESA, CA Phone: 714-374-8310 Zip 92646 Phone: Zip: 92627-1863 R D C CONSTRUCTION SERVICES INC 21552 NEWLAND ST Phone: 714-374-8310 HUNTINGTON BEACH, CA 2ip: 92646 License: 648183 SCOPE OF PERMIT TEMPORARY POWER POLE W/METER. REF.: B05-02374 $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $23.50 $0.00 Quanlity FEE SUMMARY Temp Dist System / Lighting Busway/100ft Standing Section Misc Electrical Equipment Trensformers up to 1 kva/kw ................up to 10 kva/kw .................up to 50 kva/kw .................up to 100 kvalkw ..................over 100 kva/kw Low Voltage Equipment Low Volt Wiring System / Ckt Misc. Conduit Misa Conductor Circus ( gen or ride) Circus (mech ride or ligh�s) Christmas Tree Stand Fireworks Stand Other Electrical Fee Investigation Fee Plan Check Fee Reinspection Fee status: ISSUED Applied: 03/t4/2006 Issued: 03/14/2006 ISSUED BY: Quantity $D.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 $0.00 TOTAL CALCULATED FEES 547.00 COMMENTS / SPECIAL CONDITIONS �� NOTICE: The work authorized by ihis 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 1 BO days. INSPECTIONS: In ofder for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS GALL: (714) 7545626 � WORKERS'COMPENSAnON DECLAAAnON: I hereby affirm under penalry of perjury one oi the following declara�ions: , � ❑ I have and will maintain a certificate of consent to self-Insure for workers' compensation, as provided lor by section 3700 oi ihe Labor Code, for the peAormance of the work for which t�is permit is issuetl. �"fhave and will maintain workers' compensation insurance, as requiretl by section 3700 of ihe Labor Code, for ihe perfortnance of ihe work for which ihis permit is issued. ---My ivorkers' compensation Insurance carrier and popcy number are: Carriar. 5 I'�J '7NSv/�-A-•c.r� �6+"�•�sS PolicyNumtier� Lfb -c�o ��tr� -o�-�r (This section need not be completed il fhe permit is valueO at one hundred dollers ($700J or less.) � ❑ I cenity ihat in the pertorman o� �he work tor which t�is permit is issued, I shall not employ any person in any manner so as to become su�ject to the workars' :ompensation laws of Calit i, antl agr�at if I shoultl become subjact b lhe workers' compensation pmvisions ol Section 3700 of !he Labor Code, I shell forthwith comply with ihese provision �� ApplicanYSigneture: Oate: �� WARNING:'FAICURE TO SECUPE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SIIBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND DOLLARE (5100,000), IN ADDITIOr1 TO THE COST OF CAMPENSNTIQV, �AMAGES AS PROVI�ED FOR IN SEQION 3]O60F THE LABOR fAOE, INTEREST, AND ATTORNEV'S FEES. LICENSED CON7RACTORS DECLARAnON: I here6y aNirm that I am licensed unde� provisions of Chapter 9(commencing with Section 7000) oi Division 3 of the Business and Professions Code, and my license is in Full fOfCea`ndBftBCLLit.a� l�p�—.��t�S� tCIa55'# �� Co�tors�SignaNre: � +�,�—��. �Dare: �-��di� CONSTRUC710N LENDING AGENCY: ❑ I hereby aHirm that there is a conbiruction lending agency for the pedormance of Ihe work for which this pertnit is issued. (Sec. 3097, Civil Cotle). Lentler's Name: Lender's Atldress: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby aHirtn that untler penalty oi perlury ihat I am EXEMPT FROM 7HE CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business and Professions Code: Any ciry or county which repuire5 e permit to constmct, aller, improve, tlemolish, or repair any structure, prior to its issuance, also requires the ap0licant tor such pertnit to file e signed statement ihat he or she is licensetl pursuant to the pmvisions of the Contracmrs License Law (Chapter 9(commencing wilh Section 7000) of Division 3 of iha Business and Protessions Code) or the� he or she is exempt therefrom and the Aasis for the alleged e:emption. Any violation ot Section 7031.5 by any applicant for a permit subjacis ihe applicant to a civil penalry o� not more than five hundred dollars ($500).): ❑ I, as owner of ihe property, or my employees with wages as iheir sole compansation, WILL DO 7ME WORK, antl the s�mcture is not inie�tled or oHaretl for sale (Sec. 7044, Business antl Professions Code: The Coniractors License Law does not apply to an owner of property who builds or improves �hereon, and who does such work himself or herseN or ihrough his o� her own employees, provitletl that such improvemenis are not intended or otteretl for sale. If, however, ihe builtling or improvement is sold within one year of completion. the owner-builder will have the burden of pmving ihat he or she did not build or improve for purpose ot sale.). ❑ I, as owner of the property, am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTOpS to constmct the projed (Sec. 7044, Business and Protessions Cotle: The coniractors License Law does not apply to an owner of proparty who builtls or improves thereon, antl who coniracts for such prolect with a contractor(s) license pursuant to the Coniractors License Laws.). ❑ I am exempt under sec. Business and Professions Coda for this reason: Signature: Date: Owner ID venfietl by tlrivefs license. ❑ Yes ❑ No Driver's License No. Verification of Ownership by (type of tlocument, i.e. - pmpetly taa bill or tleetl): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: Expires: ❑ I hereby certity ihat no excavation five (5) or more teet in depih into which e person is required to descend, will be made in connaction with work authorized by ihis permit, antl tha� no building stmcWre, scattolding, talsework, or demoli�ion or dismamling ihereof, wiil be more ihan thirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title 8, California Atlminisiralive Code). ❑ A5 ownervbuilder, I will not empl0y anyone to tlo work which would require a permit from the Division of Intlustrial Sefety, as notetl above, unless such person has a permit to do such work from ihe division. Signawre: Data: Division ot Intlustnal Safery Pertnit Number. CERTIFlCATE OF COMPLIANCE AND AUTMORVA710N OF ENTRY: I certify untler penalry ol perjury ihat I have read this epplication antl s�ata �hat Ihe intormation given is correct I agree to comply with all state laws and city ordinances relating to building construction, antl authonze representatives of Ihe City of Costa Mesa to enter upon ihe ebove-described property tor inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. COUE�, INSPECTIONTYPE D9TE 1616 Fixetl Sys�em Final Fire Preven�ion 1266 Pool Spe Final 200 Final Ra-Roof 201 Final BIaWRetaining Wall 202 Final Fectory Fire Place 203 Final Sign 204 Final Demoliiion � ''y-a CO�F� INSPELTIONTYPE 206 Final Mechanical 208 Final Plum6ing 210 Final Electncal 212 Final Fire Preven�ion 220 Final Planning Approval 222 Final Site 250 Final Building/Occupency pRTE �� (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 MECHANICAL PERMIT JobAddress: 323 22ND ST Suite No Vicinity: ATTIC Parcel Number: 42616121 Applicant: SIGLIN, IRVIN STEVEN JR Address: 323 22ND ST - � - - 'z � Phone:� 949-575-8895'=� COSTA MESA, CA �� . Zip: 92627-1863 Owner. SIGLIN, IRVIN STEVEN JR Address: 323 22ND ST - _ ., COSTA MESA, CA Contrac{oE' OWNER-BUILDER Address: `Fhone: � �--' Zip: 92627-1863 Phone:• Zip: License:000000 ' Status: ISSUED Applied: 12/Ot/2005 Issued: 12/Ot/2005 1 � ISSUED BY: ° SCOPE OF PERMIT , ` ` � . - MECHANICAL PERMIT TO REPLACE AND RELOCATE FURNACE FROM CLOSET TO ATTI0. FAU . � � SHALL COMPLY W/!HE FOLLOWING UMC: 22"X30" ATTIC ACCESS�WITHIN 20'-0" OF UNIT, " - CONTINUOUS SOLID WALKWAY AT LEAST 24" WIDE AND A LIGHT MUST BE OVER UNIT WITH � SWITCHATACCESS ' WORK TO INCWDE: 1 INST FAU LESS.TNAN 100 K BTU, 1 REPAIR/ALT COOLING/HEAT AND 1GASPIPWG. � "" � � � ISSUE FEE Insl FAU <700 k BTU , Inst FAU >100�k BTU RepairlAlt Cooiing/Heat Inst / Rep. Recess Wall Htr Refrig Sys <100 k BTU � Refrig Sys>100 kBTU � Gas Piping �, Factory Fireplace � Hood w/Mech Exhaust - VAV Box Vent Fan / Single Duct Appliance Fire Dampers Smoke Dampers Inst or Relocate Appl Venl �•- Air Handlers < 10000cfm AirHandlers> 10000cfm Floor Furnace Floor or Suspend Heater Quantiry 523.50 $14.80 1 . $0.00 0 $13.70 . 1 50.00 0 $0.00 0 $0.00 0 $6.15 1 �$0:00 0 $0.00 . 0 $0.00 - 0' ' , $0.00 0 $0.00 - 0 $0.00 0 $0.00 0 ...�:�$0.00� 0 $0.00,. 0- � �-$0.00-� 0: �. $0.00. 0 $0.00 � 0 � FEE SUMMARY ` � _ . . . _Repair/AltAbsorbtionUnit ' _ - � Repair / Alt Refrigeration Unit - Ventillation System Evaporative Cooler Commercial I ncinerator Domestic �ncinerator ' . Comoressors / Absorption Svstems ` Upto3hp/100kBTU . , - �� . 3To•�15hp/500kBTU � - 15 To 301ip / 1,000 k, BTU " ��. . � 30To50hpH,750k�BTU Over 50 hp ! Over 1,750 BTU Boilers � Up to 3 hp� � � . 3To15hp,. � -� � � ' ��.15 to 30'hp . . � - --�301o50hp � . . . .. , . Over 50 hp .. ' ., . . � ' Other Mecfianiwl Fee ' _ - .- Investigation Fee �. � Plan Check Fee . . Reinspection Fee � TOTAL CALCULATED FEES Quantity so.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 � $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 Ess.� 5 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Callfomia statutes and related regulations. (Ord. No. 9248, § 1, 1241-92) EXPIRATION: This permit shall automatically ezpire 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 ell applicable codes, and all required Inspeetlons and final epproval must be obtalned. Failure to obtain inspectlons and final approval will result in the ezpiration ol this permlt. FOR INSPECTIONS CALL: (7/4) 7545826 , , zasas (e�ao) WORKERS'COMPENSAnON DECLARAnON: � � 1 �ereby ettirtn unAer penairy of pe7ury one of Ihe following decleraffons: ❑ I have end will maintain e certlNcete ot consent to sel6lnsure tor workers' compensatlon, es prodtleA for by sectlon 3700 ot Ihe Lebor Cotle, for the pedormence of the work for which this permit I5 issuetl. . ❑ I heve end will maintain workers' compenseGon Insurance, as required by secGon 3700 oi Ne LeDor CoUe, for �he peRormance of Ihe woAc for which [his pertnit Is issuetl. My workers' compensatlon Insurence carrier entl pollcy number ere: Carri9r: need not be or less.) Policy Number. I,ca7lity that in Ihe peAortnance of t�e work for which ihis pertnit is Issued, I shall not employ eny person in any manner so es to become subjact lo the workers' compensetion laws ot Celifomia, end agr Ihat if I s�ould become subject to the workers' compensellon prpvislons ol Section 3700 of the Lebor Code, I shell torlhwith campty wit� thesa proDi�ons � I 1n F� ant3ignatun� bate�� F.66tYip�. . I� J Q y� jMO:FAICURE TO SECVFE WORKE OMPENSATION COVEMGE IS UNUWFl1L AND SHALlSUBIECT rW EMPLOVEFlTp'CRIMINAL PENALTIES AND CMI�NES UP TOONE HUNDRED iAND00LLARE($100,0OO�,INAD IONTOTHECOSTOFCOMPENSATION,DAMAGESASPROVIDEDFOqINSECfION3lp50F7HELNBORCODE,IMEREST,ANDATTORNEY'SFEES. LICENSED CONTRACTORS DEClARA710N: I hereby eHirtn ihet I am licensed under provisions of Cheptar 9(commencing wlth Section 7000) of Dlvislon 3 of ihe Business antl Professions Cotle, antl my license is In full torce end eHecL Lic. # Class x Cant�ecmfs Signature: Date: CONSTRUCTION LENDING AGENCY: ' ❑ I hareby aMirtn that there is e consWction lentling agency tor t�e pedormance of the work tor which Ihis permit is issued. (Sec. 3097, Civil Cotle). Lender's Neme: Lentler's Address: Slgneture: Date: OWNER-BUILDER DECLARATIONS: I hergby aflirtn lhat under panelry ot per�ury that I em E%EMP7 FROM THE CONTRAC70RS LICENSE LAW for ihe lallowing reason (Sec. 7031.5, Business and Professions Code: Any ciry or counry which requires a permit to construct, alter, Improve, demolish, or repalr eny struaure, pnor to its Issuance, also requlres t�e applicant tor such pertnit to til9 e si9netl statement that �e ar she Is Ilcensed pursuant to the prodsions of the Contrectors License Lew (Chapter 9(commancing with Sectlon 7000) ol Division 3 ot the Business end Protessions Code) or t�at ha or `she is e:empt therefrom entl t�e basis for the allegetl e:emption. Any Nolatlon af Sectian 7031.5 by any epplicant for e pertnit subjbcts !he applkant ro a c1Nl penalry of Irot more than frve hundred Colla�s (3500).): ❑ I, es owner oi iha properry, or my employees with weges es their sole compensation, WILL DO THE WOFiK, and Ihe siructure Is not Intended or oHered tor sele (Sec. 7044, Business and Professions Code: The Contractors License Lew does not apply to an owner of property who builds or improves Ihereon, antl who tloes such work himseN or herseN or through his or her own employees, providad thet such improvemenis ere noI intendea or oNared for sele. II, however, the 6uilaing or improvement is / sold wilhin one yeer of completioq Ihe owner-builder will heve the burdan of proving that he or she did not huild or improve tor purpose ot sele.). ' M I, as owner of the m e y��> p p rty, em E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, eusiness antl Professions � Cotle: The coniracfors Ucense Lew does noi epply fo en ownar of propeny wha buflds or improves thereon, and who contracis for such pmject with a contrector(s) l licanse pursuant to ihe Contrectors License Lews.). ❑ I em e:erTpUn 9ignBtu�e-_� Qme1'ID veritietl by Vedficetion ot Ownei Business antl Protessions Cade IOr ihis reason: � nse.� ❑ Yas ❑ No (type ol daument, i.e. - properry te: blll or deed): DIVI610N OF INDUSTRIAL SAFETV PERMR CEHTIFICATION: ❑ I hereby certify that no excevetion five (5) or more teet in depth into which a person Is required to descend, will ba mede In connection with work euthodzetl by this permll, and that no building sirucWre, scafloltling, talsework, or demolition or dismemling ihereoi, will ba more than thirry�six (36) feet high (Chap. 32, Gry 2, Atl 2, Sec. 341, Title 8, Califomia AdmlNSlretive Code). ❑ As owner-Duiltler, I will not employ enyone to do work which would require a pertnit irom t�e Division of Indusirial Salery, es notetl above, unless such pereon �as a permit to do such wark trom the divislon. S�9^aWre: Date: Division of Industrial Sefery Permit Number: CEqT1FlLATE OF COMPLIANCE AND AUTHORQATION OF ENTRV: I cenity under penalry ot perjury that I have read this eppliwtion and stete Ihat the infortnetion given is wrrect. I a rae to comply with ell sietgggJJJ��ws end ciry ortlinances relating to building consiruction, end auihodze representatives of the Clry of Costa Mesa to enter upon Ihe ebove-desc ro for � Dectio�es. I aqree not to occupy or ellow occupancy of eny building authorized by t's permit u il fi�pection. � � �� , N�/ � � SI ure OI gaI �6r(s) ' Date f�QQi�(, INSPECTIONTYPE 1618 Fi:etl System Final Fira Prevention 1266 Pool Spa Final 200 Final Re-Root \ `7 Finel Block/Retaining Well \ Final Factory Fire Place � Final Sign Sinel Demolition �jE �� j�Qp� INSPECTIONTVPE 208 Final Mechanical 208 Final Plumbing 210 Final Electrical 212 Final Fire Preventlon 220 Final Planning Approval 222 Final Slte . _ 250 Finel Building/Occupancy f / \ (714) 754-5273 • Fax (714) 754-4856 • w�wi.ci.costa-mesa�DING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 JobAddress: 323 22NDST � Slatus: ISSUED Suite: �� , Applied: 12/222005 Vicinity: k Issued: 1229/2005 Primary Occ: R3 Type of Co�stt'T V- Parcel Number: 42616121 �1 m . Applicant: COX, ROBERT Address: 21552 NEWLAND ST Phone: 714-374-8310 ISSUED BY: HUNTINGTON BEACH, CA Zip: 92646 Owner: SIGLIN, IRVIN STEVEN JR Address 323 22ND ST COSTA MESA, CA Phone: 949•515-8895 Zip: 92627-1863 Contractor. R D C CONSTRUCTION SERVICES INC Address: 21552 NEWLAND ST HUNTINGTON BEACH, CA Zip: 92646 Phone: 714374-8310 License: 648183 Arch : GARY MAXWELL Eng: Address: MAXWELL AND ASSOCIATES Address: HUNTINGTON BEACH, CA Phone: 949-632-6018 Phone: 8941 ATLANTAAVENUE Zip: 92646 License: C13785 License: SCOPE OF PERMIT REVISED 02/08/O6: ADD 71 S.F. FOR A TOTAL OF 373 S.F. REVISION TO INCLUDE: REMOVE POP-OUT BAY WINDOW AT FRONT OF HOUSE OFF THE NORTH BED ROOM AND ADD 71 SQ FT TOTAL IN TWO AREAS -ALONG THE EAST WALL OF THE HOME INCLUDING A MASTER BED ROOM, TWO CLOSETS, A SECOND BED ROOM TO THE NORTH AND TO THE MASTER BATH AREA ALONG THE SOUTH WALL OF THE HOME INCLUDING AN ENCLOSURE FOR THE WATER HEATER ACCESSIBLE FROM THE EXTERIOR ONLY. ADD 3025F TO SFD. WORK TO INCLUDE: RELOCATE (E) MASTER BEDROOM TO REAR ADDED AREA, EXTEND KITCHEN AREA AND ADDITION OF NEW FRONT ENTRY WAY. EXISTING 3 BEDROOM, 32 BATHROOM SFD TO REMAIN. DRIVEWAY: 1,748 SQ FT GARAGE: 460 SQ FT EXISTING BUILDING: 1,500 SQ FT ADDITION: 373 SQ FT LOTCOVERAGE:40% Plan Check: $32029 Permit: $492.75 SMIP Res: $3.45 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $816.49 SETBACKS MAIN STRUCTURE Front 30- 2 ACCESSORY Front 0-0 PARKING Existin : a Rear 27-4 Rear 0- 0 Reauired: 4 FEE SUMMARY Calc Valuation: 53a,ass.2o Claim Valuation: so.00 PLANNING & ZONING Lefl 5-4 Right left 0- 0 Right Pr000sed: 4 27- 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California staNtes and related regulations. (Ortl. No. 92-28, § 1, 1241-92) EXPIRATION: This permit shall automatically expire and become void it work is not commenced within 180 days, or if work is suspended or aban�ed for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable�es, and all requlred Inapeetlons end final approval must be obtained. Failure to obtain inspections and final approval will result in the expirat(on.of Ihis permit. FOR INSPECTIONS CALL: (714) 7545626 �� WORKERS' COMPENSATION DECLARAiION: I hereby afrirm untler penalty of perjury one ol ihe following tleclaretions: : ❑ 1 have end will maintain a certificate ol consent ro sell-Insure tor workers' compensation, as pmvided br by section 3700 of the Labor Code, for ihe pedormance ol tha work for w�ich t�is parmit is issuetl. ❑ I Aave and will maintain workers' compensetion insurence, as required by seaion 3700 of Ihe Labor Cotle, for ihe peAortnance of the work br which this pertnit is issued. -- � My workers' compensation Insurence carriar and p°i iCy number ere: ' I/ �O �� S1 Carner: �'�% �Nw'�-�� JE'�-�1�L7 rPOlicyNumber: �V /This section need nof be completed i! fhe permif Is valued at one hundred tlollers ($f 00J or less.) _ ) ❑ 1 certity that in the pedormance ol the work br which this permit is issued, I shall not employ eny person in any manner so as to become subject ro the workere' compansation laws oi Califomla, end agree that it I should become subject to the workers' compensetion provisions of Section 3700 0l Ihe LaDor Code, I shall lonhwith complY with these ovisions Ap_�licant SignaWre: �v � Date: � -��- d � WNRNING FAIIURE TO SECURE WORKERS' WMPENSATION CAVERAGE IS UNLIWFUL AND SHA�L SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FMES UP TO ONE HUNDRED THOUSAND OOLLARE (5100,OW), IN AODITION TO THE COST OF COMPENSATION, DAMAGES AS PfiOVIDED FOR IN SECiION 3]OB OF THE LABOR CODE, INiEREST, AND NTTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: 1 here6y aflirm�ihat I am lIic�enseyd under provisions of Chapter 9(commencing with Section 7000) ot Division 3 otthe Business end Pmfessions Cotle, and my license is in full {force end ettect LIc..N �o�"�n � fi� �Class a ��,f ConiracbfsSignaWre: �� Dete: �'-/4-05- CONS7RUCTION LENDING AGENCV: ❑ I hereby aHirm that there is a consiruction lending egency for ihe pertormance of Iha work tor which ihis permit is issued. (Sec. 3097, Civil Code). Lendefs Neme: Siqnawre: _ OWNER-BUILDER DECLARATIONS: Lender's Atldress: Date: I hereby aflirm Ihe� under penalty of perjury ihet I em E%EMPT FROM THE CON7RAC70RS LICENSE LAW br �he following reason (Sec. 7031.5, Business end Professions Code: Any ciry or counry which requires a permit to constmd, elter, improve, tlemolish, or repair any simclure, pnor to its issuence, also requires Ihe epplicant tor such permit to tile a signed statement thet he or she Is licensed pursuant b the provisions of the Contractors Llcense Law (C�epter 9(commencing with Sedion 7000) of Divislon 3 ot the Business and Protessions Code) or thet he or she is ezempt therefrom antl Ihe basis br the ellegetl enemption. Any violation oi Section 7031.5 Dy any applicant for a permit sublecis Ihe epplicent �o e civil penelty ol noi more Ihan live hundred tlollere ($500).): ❑ I, as owner oi �he property, or my employees with wagas as iheir sole compensation, WILL DO THE WORK, end the siructure is nol Intended or oXeretl for sale (Sac. 7044, Business antl Professions Cotle: The Contractors License Lew does nol apply to an owner of Oroperty who builds or improvas thereon, and who tloes such work himself or herself or through his or her own employees, provitletl that such improvemems are not intended or ofleretl for sale. If, however, Ihe building or improvement is sold wilhin one year ol completion, the owner-builder will heve the burtlan of proving thel he or she tlitl not build or improve for purpose ol sale.). ❑ I, as owner of the properry• em E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construcl Ihe Orolect (Sac. 7044, Business and Professions Cotle: The coniractors License Lew tloes not apply to an owner of pmperty who builtls or Improves thereon, entl who coNracts for such project with a contrector(s) license pursuant to the Coniractors License Laws.). ❑ I em exempt under sec. Business antl Profossions Code for ihis reason: Signa�ure: Date: Owner ID ventied by drivers license. ❑ Ves ❑ No Drivefs License No. Verification of Owners�ip by (type ot tlocument, i.e. - property taz bill or deed�: DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: Ezpires: � I hareby cenity t�at no axcavation five (5) or more feet in depth imo which e person is required to descend, wi�l be matle in connection with work authorizetl by �his permit, and ihat no building sirucNre, scaffolding, falsework, or demolition or tlismantling Ihereof, will �e more than thirty-six (36) feet high. (Chep. 32, Grp 2, An 2, Sec. 341, Ttie 8, Calitomia A�minisiretive Cotle). ❑ A5 owner-6uiltler, I will not employ anyone to tlo work which would require e Dermit Irom Ihe Division of Indusiriel Salety, es noted above, unless such person has e pertnil fo do 5uth work tmm the divi5ion. SignaWre: Date: DiviSion ot InduSldel Sete�y Permi� Number. CERTIFlCA7E OF COMPLIANCE AND AUTMORIIATON OF EN7RY: I certily under penalry of perjury that I �ave reatl this applicalion and state Ihat ihe information given is correct. 1 agree to comply wlih all sta�e laws and city ordinances relaling to builtling constmction, entl euthorize representatives of t�e Ciry ol Casta Mesa to enter upon the above-descnbetl propeny for inspection puryoses. I agree not to occupy or allow ocwpancy of eny building authonzed by Ihis permil until final inspection. Si re Of Leqal Owner(s) -� And/Or Authorized Applicant - COOE1, INSPECTIONTYPE 1616 Fixetl System Final Fire Prevention 1266 Pool Spa Final 200 Finel Re-Rool 201 Finel BIocWRetaining Wall 202 Final Factory Fire Plece 203 Finel Sign 206 Final Demolition PaIE IrmruLS 3 ��`o��.o . Date 40DE� ixsvecnoxnae 206 Finel Mechanical 208 Final Plumbing 210 Final Electncal 212 Final Fire Prevention 220 Final Planning Approval 222 Final Sita 250 Final Building/Occupancy Q�iE I[�LS (774) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa��DING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 323 22ND ST Suite: Vicinity: Primary Occ: R3 Type of ConsWction: V-N Parcel Number: 42616121 Zoning: Applicant: SIGLIN, IRVIN STEVEN JR/�l(�� Address: 323 22ND ST Phone: 949-515-8895 COSTA MESA, CA Zip: 92627-1863 Owner: SIGLIN, IRVIN STEVEN JR Address 32322NDST COSTA MESA, CA Contrector: OW N ER-BU I LD ER Address: Zip: Phone: 949-515-8895 Zip: 92627-1863 Phone: License: 000000 ISSUED BY: SlaWs: ISSUED Applied: 12/22/2005 Issued: 1229Y2005 �� Arch : GARY MAXWELL Eng: Address: MAXWELLANDASSOCIATES Address: HUNTINGTON BEACH,CA Phone: 949-632-6018 Phone: 8941ATLANTAAVENUE ' Zip: 92646 License: C13785 . License: SCOPE OF PERMIT REVISED 02/08/O6: ADD 71 S.F. FOR A TOTAL OF 373 S.F. REVISION TO INCLUDE: REMOVE POP-OUT BAY WINDOW AT FRONT OF HOUSE OFF NORTH BED ROOM AND ADD 71 SQ FT TOTAL IN TWO AREAS - ALONG THE EAST WALL OF THE HOME INCLUDING A MASTER BED ROOM, N CLOSETS,A SECOND BED ROOM TO THE NORTH AND TO THE MASTER BATH AREA ALONG THE SOUTH WALL OF THE HOME INCLUDING AN ENCLOSURE WATER HEATER ACCESSIBLE FROM THE EXTERIOR ONLY. ADD 302SF TO SFD. WORK TO INCLUDE: RELOCATE (E) MASTER BEDROOM TO REAR ADDED AREA, EXTEND KITCHEN AREA AND ADDITION FRONT ENTRY WAY. EXISTING 3 BEDROOM, 32 BATHROOM SFD TO REMAIN. DRIVEWAY: 1,748 SQ FT GARAGE: 460 SQ FT EXISTING BUILDING: 1,500 SQ FT ADDITION: 373 SQ FT LOT COVERAGE: 40% Plan Check: $320.29 Permit: �492.75 SMIP Res: $3.45 SMIP Com: $0.00 Other: $0.00 Inspectian: $0.00 Total: $816.49 FEE SUMMARY PLANNING 8 ZONING Calc Valuation: 53a,nss.zo Claim Valuation: So.00 NO710E: The work authorized by this permit shall comply with all applicable handicap access requiremanis under Calitomia statutes and related regulations. (Ord. No. 92-28, § t, 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 requlred Inapectiona end finel epprovel must be obtained. Failure to o6tain inspections and final approval will result in the expiration of this parmit. FOR INSPECTIONS CALL: (774) 7545626 � WORKERS' COMPENSATION DECLARATION: � . • 1 hereby aflirtn untler penalry oi perjury one at the fWlowing tleclaretions: ❑ I have antl will maintein a certificate ol consent to self-Insure lor workers' compensetion, as provitlad for by section 3700 ot the Labor Cotle, for the pertortnance of Ihe wark tor which this permit is issued. ❑ 1 have and will main�in workers' compensatlon insurance, as requiretl by sectlon 3700 ot Ne Lebor Cotle, for the pertwmanca of the work tor whkh this permit is issuetl. My workers' compe�sation Insurence cartier and policy number ere: Carrier. Policy Number: i n secnar neeo nor ue cromp�ereo n me pelmrr �s vamed et one nunaretl tlonere (S7o0J or less.) �'"'fcertity�t�e� in the pedarmance of the work tor w�ich ihi rtnit is issueQ I shall not employ eny person in any manner so as ro become subject to tha workers' �compensatfon laws oi C litorn' , entl egree thet I I sho become subjecl lo tha workers' compensation provisions of Section 3700 ot the Labor Cotle, I shell totlhwith tomply wit� the555aaa...��rov' oRs ��/�/�/ ApptlCen15ignet�� " Date: n WARN�£AICORE TO SEGURE WO 5' PENSATI EMGE IS UNUWFUL AND SHALL SUflIEGT AN EMPLOVEFi TO CRIMINAL PENALTIES AND CIVIL FlNES LIP TOONE HUNDFED THOUSANDDOLL4RE�5100,�),INADDITIONTOTHECOS COMPENSAiION,DPMAGESASPRWIDEDFORINSECTION3'lO60FiHELABORCODE.I1JrEREST,ANDATTORNEY'SFEES. LICENSEO CONTRACTOAS DECLARATION: I hereDy aflirm ihat I am licensed undar provislons of C�apter 9(commencing wit� SecOon 7000) of Division 3 oi the Business and Professions Cotle, and my license is in full force end eHecL Lic. R Class a ConlractoYs Signeture: Date: CONSTAUCTION LENDING AGENCV: ❑ I hereby aflirm ihet there is e construclion lending agency for Ihe peAormance of the work for which ihis permit is issued. (Sec. 3097, Civil Cotla). Lentler's Name: Lender's Address: SignaWre: Date: OWNER-BUILDER DEC4AAATIONS: I hereby attirm thet untler penalty ol perjury ihat I em E7(EMPT FROM TME CONTRACTORS LICENSE LAW for Ihe tollowing reason (Sec. 7031.5, Business entl Professions Cotle: Any city or county which requires a permii to construct, alter, improve, domolish, or repair any siructure, prior to its issuance, also requires Ihe applicant for such permit to lile a signetl statement Ihat he ar she is licensetl pursuant to the provisions oi Ihe Contractore lJcense Law (Chapier 9(commencing with Section 7000) ot Division 3 oi the Business end Professions Code) or that he or sha is exempt therefrom and the basis for the elleged ezemption. Any violation of Section 7037.5 by any eppllcant for a permit subjects the applicant to 0 �ivil penalry ol not more than live huntlred dollers ($500).): ❑ I, as owner ot the Oropeny, or my employees with wages es t�eir sole compensation, WILL DO 7HE WORK, antl the s�ructure is no� intendetl or oNeretl for sale (Sec. 7044, Business antl Pmtessions Cotle: The Contractors License Law tloes not appy to an owner of property who builtls or Improves Ihereon, end who does such work himseli or hersell or through his or her own employees, provided thet such improvaments are not intendetl or ottered for sale. tl, however, ihe building ar improvement is L sold wi�hin one year o� completion, ihe owner��uiltler will have tha burden of proving that he or she did not build or improve for purpose of sale.). yJ ,�as awner ot the properry, em E%CLUSIVEIV CONTRACTING WITH LICENSED CONTRAC70R5 to consiruct the pmject (Sec. 7044, Business antl Professions XCotle: The comractors License Lew tloes noi epply ta en awner ot properry who builds or Improves thareon, and who comracts tor such project with a contrecmr(s) license pursuant io the Comradors License Lews.). ❑ I em ezem t r Sac. Business and Professions Cotle for Ihis reason: Si9� e _ � :1- L� OvmaFtD venfied by driveYs lic n e. ❑ Ves No Oriver's lJtenSe No F�c`pirea� _ Venfiwtion of Ownership by (type ol tlocumeN, i.e. - roperty tax hill or deetl): �� _ DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby cenity thet no exwvetion live (5) or more feet in depih into which a person is required to descand, will De made in connection wi�h work authonzetl by ihis permit, and ihat no building slructure, scattoltling, lalsework, or tlemoli�ion or dismantling thereof, will be more than thirty-six (36) teet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Titla e, Calilorda Adminisirative Code). ❑ As owner-6uilder, I will not employ anyone to tlo work which would require a permit Irom the D'msion of Indusirial Safery, as noled above, unless such pereon has a permit to do such wo�k fmm Ihe division. Signature: Date: Division of Indusirial Safery Petmit Number: CER71FlCA7E OF COMPL�ANCE AND AUTMORI 710N OF EMAV: I certify under penalry of perjury that I have read ihis application and state that ihe informa�ion given is correct. I a ree to comply with all state lews en city ordlnances ratating lo building wnstmclion, and authorize represenlatives of the qty ot Coste Mesa to enter opon the e e-d e�bed p perty f i pec' �0. � ry� . gree not to acupy or allow occupanq oi eny buildinq authonzed by this pertnit until final inspe ion. �� r-�,/.5��(0 1. iqneWr Of �galOv.ner(s)_ '-" Date ° �-- L i �. And/Or Autl nzatl Applicant Date CODE �. INSPECTIONTYPE � QdIE /��LALS E4P.EL I�PYCTIONTVPE �l �QdjF 7(�$ 1616 Fixetl System Final Fire 12 yPool Spa Final � Finel�Sign�� U ` 222 U Final'Site' LJ �' Final Demolition Z50 Final BuiltlincyOccupancy (714) 75a-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.�y�DING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 32$ 22ND ST Suite: Vicinity: � � ' Primary Occ: � R3 3� of Construction: V-N Parcel Number: 42616121 Zoning: Applicant: SIGLIN, IRVIN STEVEN J Address: 323 22ND ST Phone: 949-515-8895 COSTA MESA, CA Zip: 92627-1863 Owner: SIGLIN, IRVIN STEVEN R Address 32322NDg7 COSTA MESA, CA Contractor. OW NER-BU! LDER Address: Phone: 949-515-8895 Zip: 92627-1863 Phone: Status: ISSUED Applied: 12/22/2005 Issued: 12/29/2005 �� ISSUED BY: L� Zip: License: 000000 Arch : GARY MAXWELL Eng: Address: MAXWELL AND ASSOCIATES Address: HUNTINGTON BEACH, CA Phone: 949-632-6018 Phone: 8941 ATLANTA AVENUE Zip: 92646 License: C13785 License: SCOPE OF PERMIT ADD 3025F TO SFD. WORK TO INCLUDE: RELOCATE (E) MASTER BEDROOM TO REAR ADDED AREA, EXTEND KITCHEN AREA AND ADDITION OF NEW FRONT ENTRY WAY. EXISTING 3 BEDROOM, 32 BATHROOM SFD TO REMAIN. DRIVEWAY: 1,148 SQ FT GARAGE: 460 S� FT EXISTING BUILDING: 1,500 SQ FT ADDITION: 302 SQ FT LOT COVERAGE: 39% Plan Check: $274.33 Permit: $422.05 SMIP Res: $2.79 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Totai: $699.17 SETBACKS MAINSTRUCTURE Front 0-0 ACCESSORY Front 0-0 PARKING Existina: 0 Rear 0-0 Rear 0-0 Reouired: 0 FEE SUMMARY Calc Valuation: Sz�,soa.ao Claim Valuation: $o.00 PLANNING & ZONING Lek 0-0 Right Lek 0-0 Right Pr000sed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-g2) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 780 days, or if work is suspended or abandoned for a period of 1 BO days. INSPECTIONS: In order for the work authorized under ihis permit to 6e considared legal, such work must comply with all applicable cod �� requlred inepectlona and flnal approval must be obtained. Failure to obtain inspections antl tinal approval will result in the ezpiration qf�.this permit. FOR INSPECTIONS CALL: (714) 754-5626 V/ zaawe ldoo� WORKERS'COMpENSAnON DECLARAnON: _ � . • • I hereby attirm untlor penalty of perjury ona of ihe �ollowing declaretlons: � ❑ I have and will malntain a certificate at consant to self-Insure for workers' com{, tlon, es provided lor �y section 3700 0l the LaDor Gotle, lor t�e periormance of the work for whicq this permit is issuad. ❑ I have antl will �intain workers' compensation insurance, es requiretl by section 3700 of the Lebor Cotle, tor the pertortnance ol the work for which this permit is issuetl. My workers' compensation Insurance carrier and policy number ere: Carrier: Poliry Number. jTi1'�s section neetl not be crompleted it the pertnit is veluetl ef one �untlred dollers ($100) or /ess.J / tfiat in the per nsation laws of r wi�h Illese pro TO SECURE �i the work �or which this Oertnit is IuueQ I s�ell not emplay any person in eny manner so as to became su6ject to the workere' end egrea t t it I 5houltl bacOme suDject to Iha warker5' Compen58lion provislon5 of Section 3700 ot the Labor Code, I shall forihWith � r0ate: ��_ �"1 �h � S' PENSATI �N COVERAGE IS UNUWFUL 4Np SHALL SUBIECT AN EMPCO�ER TO CRIMINAL PENALTIES AND GVIL FINES UP TOONE HUNDRED TO THE COST OF COMPENSATION, DAAMGES AS PROVIDED FOR IN SEGTION 3lOB OF THE LABOR ODDE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTHACTORS DECLARATION: 1 hereby attirm that I am licensed under provisions af Chapter 9(commenciig with Section 7000) ot Division 3 of the Business antl Pmfessions Cotle, an0 my Ilcense is in tu11 fome and eHecL Lia a Class M Comrecrofs SignatU�e: Oare: CONSTRUCTION LENDING AGENCY: ❑ I hereby aHirm that there is a consiruction lentling agency br ihe pertormance ol the work for which ihis Dertnit is issuetl. (Sec. 3097, Ci�il Code). Lenders Name: Lentlefs Adtlress: Signature: Dere: OWNER-BUILDER DECLARATIONS: I hereby aHirtn t�at u�der penalry of perjury that I em E%EMPT FROM 7HE CONTRACTORS LICENSE LAW lor the following reason (Sec. 7031.5, Business and Professions Cotle: Any ciry or cdunty which requires a permit to construct, alter, improve, demolis�, or repair eny structure, Prior to its issuence, also requires the epplicant for such permit to file e signetl statement Ihat he or she is licensatl pursuam ro the pmvisions of the Comrecrore License Law (Chapter 9(commencing wit� Sectlon 7000) ol Division 3 0l the Business and Profe%�ons Code) or ihat he or sha is exempt Iherefrom entl the besis tor the alleged exemption. Any violation ol Section 7031.5 by any applicent for a permit subjects the applicant to a civil penalry of not more than tive hundretl dollars ($500).): �I, as owner of the property, or my employees with wages es their sole compensation, WILL DO THE WORK, ena the siructure I5 not intentletl or oMeretl for sale (Sec. �-7044, Business antl Professions Code: The Contractors License Lew tloes not apply to en owner of property who builtls or improves lhereon, antl who does such work himselt or herself or thmugh his or her own employees, provided Ihat suc� improvemems are not imendetl or oflered lor sale. If, however. the building or impwvement is soltl wi�hin on9 year of completion, tha ownerbuilder will heve Me burden of proving �hat ha ar she did not �uiltl or improve for purpose of sale.). � ❑ I, as owner ot the property, am E%CLUSIVELY CONTRACT7NG WITH LICENSED CONTRACTORS to consir�cl t�e project (Sec. 7044, Business and Prolessions � Code: The con��aaors License Lew tloes noi appty to an owner ol property who builds or impmves Ihareon, end who cnmracts for such project with e contraaor(s) �licensa pursuant to the Comractors license Lews.). I am exempt under sec. Business and Pwlessions Code br ihis reason: � r Owner ID verified by tlrivers license. ❑ Ves ❑ Na �Drive?s License No. Venfiwtion ot Ownership hy (type of document, i.e. - property ta: hill or daetl):-�� DIVISION OF INDU57RIAL SAFETV PEHMI7 CERTIFICATION: � Expires:- � � ❑ I �ereby cenify Iha� no excava�ion five (5) or more feet in depth imo which a person is required to tlescend, will be maae in connection with work euthonzed by this permit, antl that fw builtling structure, scaHdding, talsework, or demWition rn dismamling thereoi, witl ba mora than thirly-six (36) 5eet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Ttle 8, Celifomia Administrative Cotle). ❑ As owner-builder, I will not empioy anyone m do work which would require a permit Irom the Division of Intlustrial Safery, es noted above, unless such person has e permit to tlo such wodc fmm the tlivision. Signature: Date: Division ot Intlus�rial Safery Permi� Number: CERTIFlCATE OF COMPLIANCE AND AUTHORIZATION OF EN7AY: I cenity under penalty ot perjury ihat I ha�e reatl ihis epplication entl staie Ihat t�e inlortnation given is correct. I agree to compy wi�h all state laws antl ciry ordinances relating to builCing consWc�ion, and authorize representatives of Ihe Ciry of Cwta Mesa to enter upon Ihe ebove-tlescnhed property to ecii ur es. I- gr not to occupy or allow occupancy at any building authorized y this pertnil until finel inspection. .-�`�._ -. �a,(�r � SignaWre.Of.� . wner ),___ — _ ` D tl e �—.` _ . \/ `--� Antl/Or Au onzed App�icant Date 400E �. INSFECf10NTYPE 1616 Fixed System Final Fire Prevention 1266 Pool Spe Final 200 Final RaRooi - 201 Final8locWFeWining Wall 202 203 204 Final Factory Fire Place Final Sign Final Demoli�ion Q�¢ INTITIRLS �i77d 206 Fin I Mechanical 20B Fi I Plum ' g 2 F' al Elett cal 212 Inel ' ventlon 22� Final anningAppr al 222 Final Site 250 Finel Building/Occupency PeIE IL+�ELB 1 . Cl"CY Ok' COS'('A ��1ESA f)EVELO�h1ElV"f' SI��tVICF.S BU[[,DING S,1E�F,TI' DI��ISION 77 F:�IR URIVt:, P.C1. BO\ 1200 CUSTA. R1GSA, d�;1t�IFORNIA 92G28-121)b 714-7S4-S293 Nre-F'r:uning inspectiun site mee�iny/pYan requirement comments IAA'('E: 4-4-OG M'RO.IECI�: 5iglen residenco ADUR�SS: 323 22nd St PLAN CHECK NUn1BF.H: KOS-02374 I�15PF_C7'OR: Brn Elliugsun I� �1 c) '�) ,) �S) ��) 3) I'Ie.ise shuw beam sizes, locations, bi�aiing puims. and pust beam connt:ctiuns. Please sho�� header sizes lor ��indo�v and door upenings. Check spans over d.5 ft.Chcck liea�cr for interiur closei at �rid puint F bclwecn I and 3. Specify �ize and type uf hanSers f2�r be.ims, RR, CJ at neiv and e�isting framing. Rcmove deleted footiriq tiom pt�n, and speci�y li�uting detail for froni kitchen area. Ke�•icw overham� :u ea.^,i elevation for dis�ancc iu PI_. Sce sections CBC 705, I204,tablc 5- A,and 5p3.^.I. I HR o� H'1� construction reqwr�d. Delail Calit�irnia 1Taming. Raftcr spans and br�cing. Re-visit lateral analysis. Verify the. pians retlect �he calculatious. At Ieast one shear wall is not indicated un the plan. No drag stnits requircJ ? Perforated shcar �vall detaling' Is the dutch gable adeyuate to transfer shear'? Low u� high roof details. t�0'I'E THAT THIS I:: NOT A FRAMI�'G INSPGCTION, AND MORE fUh1hIL•N'1'S �Y FOLLO\4'. WHf:N'T f�E `d'ORI� IS RCi:1DY F'OR INSPECTION . (714) 754-5273 • Fax (714) 754-4856 • www.cl.coste-mesa.ca.us 77 FAIH UHIVt, GUS IA MtSA, GA 82ti2ti ELECTRICAL PERMIT Jobnddress: 323 22NDST Suite No Vicinily: Parcel Nunmber: 42616121 Applicant: SIGLIN, IRVIN STEVEN JR ' Q Address: 32322NDST �� on . 714-336-4501 COSTA MESA, CA Zip 92627-1863 owner: SIGLIN, IRVIN STEVEN JR Address 323 22N0 ST COSTA MESA, CA Contractor. OW NER-BUILDER Address: ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool / Spa LigMing Fixls Recept Outlets Swilches Non Res Appl Res Appl Service to 200a Service to 1000a Service over 1000a Motors l0 1hp Motors to tOhp Motors l0 50hp � Motors l0 100hp Motors over 100hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Inlertned Pole Phone: Zip: 92627-1863 Phone: Zip: License: 000000 Status: ISSUED Applied: 12/302005 Issued: 12/30/2005 / / �' ' � _- SCOPE OF PERMIT ADD 302SF TO SFD. WORK TO INCLUDE: RELOCATE (E) MASTER BEDROOM TO REAR ADDED AREA, EXTEND KITCHEN AREA AND ADDITION OF NEW FRONT ENTRY WAY. REF.: BOS-02374 � ELECTRICAL TO INCLUDE: 36 LIGHT FIXTURES, 68 OUTLETS (INDOOR AND EXTERIOR), 30 SWITCHES, 7 ATTIC FAN, 1 SERVICE TO 200 AMPS, 6 COMMUNICATION DROPS, AND 1 LOW VOLTAGE WIRING. - . $23.50 $0.00 $0.00 $0.00 $0.00 50.00 $33.68 $57.04 $29.30 $0.00 $4.75 530.50 $0.00 50.00 50.00 50.00 $0.00 $0.00 $0.00 $6.60 $0.00 so.00 $0.00 $0.00 $0.00 Quantiry 0 0 0 36 68 30 0 1 1 0 0 0 0 0 0 0 6 0 0 0 0 0 FEE SUMMARY Temp Dist Syslem / Lighting Busway I100 N Standing Section Misc Eledrical Equipment Transformers up to 1 kva/kw ................up to 70 kvalkw .................up to 50 kva/kw .................up l0 100 kva/kw ..................over 100 kva/kw Low Voltage Equipment Low Volt Wiring System / Ckt Misa Conduit Misa Conductor Circus ( gen or ride) Circus (mech ride or lighis) Christmas Tree Stand Fireworks Stand Other Eleclrical Fee Investigation Fee Plan Check Fee Reinspection Fee Quantiry $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 so.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $25.00 1 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 so.00 TOTAL CALCULATED FEES SZ70.37 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, 12-27•92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1B0 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under ihis permii to be considered legal, such work must comply with all le�and all requlred Inepections end final epprovel must be obtained. Failure to obtain inspections and tinal approval will result in the e ratlon of ihls permit. FOR INSPECTIONS CALL: (714) 7545626 2446d6 (fl�00) WORKERS' COMPENSA710N DECLARA710N: _ I he�aby ettirm untler penelry oi perjury one of the tollowing tleCleratlons: ❑ I heve end will maintein a cahiticate of consenl to self�lnsUre for workers' compensetion, es provitled for by section 3700 of the Lebor Gode, for the pertormance of ihe work tor which Ihis permit is issued. ❑ I have and will maintain workers' crompensation insurence, as requiretl by sectlon 3700 0l lhe Lebor Cotle, Por the petlortnence oi the work for which this permit is Issuetl. My workers' compensetlon Insurance carrier end policy number are: Car�ej Policy Number: at one huntlretl tlollers (S100J or less.) ,y�c�er�t�ifyttiat in iha peAormance of lhe work for which this permit is iSsueQ I shall not employ eny person in any manner so as to become subject to the workers' reom�ensetion lews ol alifornia, end agree t if 1 shoultl 6ecome subject to lhe workers' compensation provislons ot Saction 3700 of the Labor Code, I shall forthwith comply with ihese pro_ is c. ` - � ��a�a,�'k._�< oa�a: ��30 o S :FIIRG AILURETOSEWREWOPKERS'CO ENATIO COVERAGEISUNUWFLLMIDSHALLSU&IECTANE CRIIAIWllrPEaALTIE ANDCIVILFINESUPTOONEHUNDRED SPND OOLLAqE (5100.ODO�, IN AODITION THE COST OF �MPENSATION, �AMAGES 0.S PROVIDED FOR IN SEGTIIXJ 3lOfi OF THE 1A90R CODE, INrEREST, AND ATTORNEI"S FEES. LICENSED CONTFACTORS I hefeby attirm ihat I am licensed untler provisions ot Chapter 9(commendng with SeMion 7000) oi Division 3 of the Business and Professions CoOe, entl my license is in FNf forcB and eRecL Lic. N Class N Contractor's Signature: Date: CONS7RUC710N LENDING AGENCY: ❑ I �ereby eflirm that Ihere is a construction lending egency for Ihe pedormence ol the work ior which �his Oertnil is issued. (Sec. 3097, Civil Code). LenGers Neme: Lender's Atldress: Signature: Daie: OWNER-BUILDER DECLARATIONS: I hereby ettirm thet untler penalty of parjury Ihet I em E%EMPT FROM TME CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business end Professions CodP: Any ciry or county whic� requires a permit to construct, etler, impmve, tlemolish, or repair eny slrucWre, prior ta its issuance, also requires Ihe applicant for such pe�it b tild a signed stetement thet he or she is licensetl pursuent to the provislons ol l�e Contracrors Licanse Lew (Chapter 9(commencing with Sectbn 7000) of Divislon 3 of the Business and Prolessions Code) or t�ai he or she is eaempt iherefrom and c�e basis br the elleqed exemption. Any violation ol Section 7037.5 by any epplicant for e pe��t snbjBcts the applicant to a civif penafry at not mae than five hundred tlollers ($500)J: ❑ I, es owner ot the properry, or my employees with weges es Ihair sole compansatlon, WILL DO THE WORK, and the swcture is not intended or oflered tor sale (Sec. 7044, Business end Professions Code: The Coniractors License Law tloes not appty to en owner ol property who builds or improves thereon, and who does such work Nmsetl or hersell or through his or her own employees, pro�ided thet such improvemenis are not intended or oNered lor sale. If, however, ihe building or improvement is sold within one year of completion, ihe owner-Duiltler will have the burden ol proving that he or she tlid not builtl or impro�e for purpose ot sale.). � ner ot tha property, em EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the projact (Sec. 7044, Business and Professions Gotle.`The contractors License Lew does not epply to en owner of property who builds or impmves ihereon, and who contracts tor such project with a contrector(s) license pursuant Io Ihe Conir�gobrs License Laws.). ❑ lam VenNcation of Business antl Professians Code for Ihis reason: �ense. � ❑ VB5 ❑ No (type o� ticeumenL i.e. � proparty �ax bill or DIVIS�ON OF INDUSTRIAL SAFETY PEHMIT CERTIFICATON: ❑ I hereby canify ihat no excavation flve (5) or more leet in depih into which a parson is requiretl Io tlescend. will be made in connection with work authorized by this pe�mil, antl Ihat no building siructura, scafloltling, falsework, or demolltion or dismanUing Ihereof, will be more Man Ihirly-six (36) fee[ high. �Chap. 32, Grp 2, Art 2, Sec. 341, Title 8, Celifomie Administretive Code). ❑ As owner-builder, I will not employ anyone Io do work w�ich would require e permit hom t�e Division ol Indusirial Safery, es noted ebove, unless suc� person has a permit to do such work from ihe division. Signa�ure: Oate�. Division of Intlusinal Setety Permit Number: CERIIFlCATE OF COMPLIANCE AND AIJTHORIZATION OF ENTRY: I certity under panalry W perjury tfiai I have reatl t�is application and state Nat the infortnation given fs correC�. � agrea to comply ith all siate lews end city ordinances relating Io builtling construction, and authonze representatives ot ihe Ciry o� Cosia Mesa to enter upon Ihe ebove-described property lor i ectio rp es. a e not to occupy or allow occupancy of eny 6uilding authonzed by this p it until final inspection. �� 0-.ao_o( �SignatU�e;O(Ce ner �'�,,,� �a�e�—� rA....LL.,_ _- _•_ CODE L INSVECTIONTYPE PAIE IiiIID�LS 1676 Fixed System Flnal Fire Pre�entlon 1266 200 201 202 203 204 Pool Spe Finel Final Re-RoOf Final BIocWRetaining Well Flnal Factory Flre Pface Final Sign Finel Demoli�ion SODE� INSPECl10NTYPE 206 Final Mechanical 208 Final Plumbing 210 Final Elactrical 212 Final Fire Prevention 220 Fina{ Planni�g Approval 222 Final Site 250 Finel Building/Occupancy 'L :e� ItIlIDd15 (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 JobAddress: 323 22NDST Suite No Viciniry: ParcelNumber: 42616121 Applicant: SIGLIN, IRVIN STEVEN JR Address: 323 22ND ST COSTA MESA, CA Owner: SIGLIN, IRVIN STEVEN JR Address: 323 22ND ST COSTA MESA, CA Comractor: O W N ER-BU I LD ER Address: MECHANICAL PERMIT Slatus: ISSUED Applied: 12/30I2005 Issued: 12/30/2005 � � i � : �a.� Phone: 714-336-0501 Zip: 92627-1863 M �"-', � � Phonen'r��:y � Zip: �9287�1863 � Phone: Zip: License: 000000 SCOPE OF PERMIT 03/27/O6 REVISED: ADD 1 EXHAUST FAN FOR DRYER. ADD 302SF TO SFO. WORK TO INCLUDE: RELOCATE (E) MASTER BEDROOM TO REAR ADDED AREA, EXTEND KITCHEN AREA AND ADDITION OF NEW FRONT ENTRY WAY. REF.: BOS-02374 MECHANICAL TO INCLUDE: 1 REPAIR/ALT COOLING, 1 HOOD W/MECH EXHAUST AND 4 VENT FANS. ISSUE FEE Inst FAU <700 k BTU Inst FAU >100 k BTU Repair/All CoolinglHeat Inst I Rep. Recess Wall Htr Refrig Sys <700 k BTU Refrig Sys >100 k BTU Gas Piping Factory Fireplace Hood w/Mech Exhaust VAV Box Vent Fan / Single Duct Appliance Fire Dampers Smoke Dampers Inst or Relocale Appl Vent Air Handlers < 10000cfm Air Handlers > 10000cfm Floor Furnace Floor or Suspend Heater $23.50 $0.00 $0.00 513.70 $0.00 $0.00 $0.00 $0.00 y0.00 $10.65 50.00 529.00 $10.65 so.00 $0.00 $0.00 $0.00 50.00 $0.00 50.00 Quantiry FEE SUMMARY Repair / AN Absorbtion Unit Repair / Alt Refrigeralion Unit Ventillation System Evaporative Cooler Commercia l In cinerator Domestic Incinerator Comoressors I Absorotion Svstems Upto3hp/100kBTU 3To15hpI500kBTU 15 To 30 hp / 7,000 k BTU 30 To 50 hp / 1,750 k BTU Over 50 hp I Over 1,750 BTU Boilers Up to 3 hp 3To15hp 15to30hp 30 to 50 hp Over 50 hp Other Mechanical Fee Investigation Fee Plan Check Fee Reinspection Fee TOTALCALCULATEDFEES COMMENTS / SPECIAL CONDITIONS Quantity $0.00 0 30.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 so.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 $0.00 50.00 E87.50 NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under California statu�es and related regulations. (Ord. No. 92-28, § 7, 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 100 days. INSPECTIONS: In order �or the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all r0qulred Inspectlona and flnal epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of ihis permit� FOR INSPECTIONS CALL: (714) 7545626 �� zaas-ae fs�oo) WORKERS'COMPENSAnON DECLARAnON: � I hereby affirtn under penalty of perjury one of the tollowing tleclarations: � ❑ I hava and wlll maintain 0 cenificate ol consent to solt-Insure br workers' compensation, as pmvided for by section 3700 0l the Labor CoEe, tor the pedormance ot Ihe wark far which Ihis pertnit is issued. ❑ I have end will maintain workers' compensation insu2nce, as required by section 3700 of the Lebor Cotle, tor ��e peAormance of the woB for which this pertnit is issuetl. My workers' compensati0n Insurance carrier entl policy number are: Sr: pp�icy Number. secfion neetl not be complefed i! fhe Oermit is valued et one hundred dollars ($700) or less.) �"I'qetlity ihet In the pedorrtiance of the work for which ihis pertnit is issuetl, I shell not employ any person in any manner so as to become subject to the workers' _--_cdmpensation laws of CaOfomia, end agR&�het if I should become subject to the workers' compensation provisions of�5 ction 700 oi iha Labor Code, I shall torthwlth ' comO�Y with ihesa pro� � � � � Applicem5lgneture:—.– oete`_. (��t �� Cj �.�__ WARNIN(Y'FAILURE TO SECURE WORKERS��ENSATION COVEMGE IS UNLAWFUL AND SHALL SUBIECT PN EMPLOVEF TO CRIhUNAL PENALTIES AND CML FlNES U:' TO ONE HUNDRED THOUSAND DOl1ARE (5100,000). IN ADDIPON TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED WR IN SECTION 3�O60F THE IABOR CODE. IMEREST, ANp ATTORNEY'S FEES. LICENSED CONTRACTORS OECLARATION: I hereby aNirm t�at I am licens�d under provisions ol Chapter 9(commencing wilh Section 7000) ot Division 3 of the Business and Professions Code, antl my license is in lull force end effect. Lic. # Class» Comrecrors Signewre: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby aHirm ihat Ihere is a consimction lentling agoncy for ihe performance of the work for which this permit is issuetl. (Sec. 3097, Civil Code). Lenders Name: Lender s Address: Signeture: Date: OWNER•BUILDER DECLARA'�10NS: I hereby aHirtn that untler penalry of perjury thet I am EXEMPT FROM 7HE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business antl Professions Code: Any ciry or county which �eQuires a permit to wnstruct, alter, impmve, tlemolish, or repair any strucWre, pnor to its issuance, also requires the applicant for such permit �o file a signed statement that be or she Is licensed pursuant to the pmvisions of the Contractors License Lew (Chapter 9(commencing with Section 7000) ol Division 3 of the Business entl Professions Code) or that he or she is e:empt ihereirom antl the basis lor the ellegetl ezemption. Any violation ol Section 7031.5 by any appliwnt for a permit subjects the epplicant to e civil penalty of not more than five hundred dollars (5500).): ❑ I, as owner of t�e property, or my employees wlih wages as Iheir sole compenselion, WILL DO 7HE WORK, antl the siructure is not Intended or oNered for sala (Sec. 7044, Business antl Professions Code: 7he Contractors License Law tloes not epply to an owner of property who builds or improves Ihereon, and w�o dces such work himself or herseli or ihrough his or her own employees, pmvided that such improvemems ere not intendad or oHeretl lor sale. If, however, ihe builtling or improvement is old within one year of compietion, the owner-6uildor will heve ihe burden ot proving ihat he or she tlitl not build or improve lor purpose of sele.). —I'es owner ol the property, em E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct Ihe ptoject (Sec. 7044, Business antl Professions __Gotle: The contractore Liceose Law tloes not apply to an owner ot property wtw builds or improves thereon, antl who contrecis tor such pmject wNh a contractor(s) license pursuent to the Cqul�acrors Ucense Laws.). C ❑ ves ❑ No Business and Professions Code tor �his reason: Verilication of Owner�p Dy (typa ot documenl, i.e. � property tax Dill or deed): License No.� DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICA710N: ❑ I hereby cenify that no ex0avation five (5) or more leet in tlepih into which a person is required to tlescend, will be matle in conneaion with work aNhonzetl 6y ihis pertnit, end Ihat no building sirucWre, scaHolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 32, Grp 2, An 2, Sec. 341, Title 8, Califomia Atlininistrative Code). ❑ As ownerbuilder, I will not employ anyone to do work which would require a permi� 1wm the Division of Indusirial Selety, as noted above, unless such person has a permit to do such work irom the division. Signature: Data: Division of Intlustnal Safety Permit Number: CEB7IFICA7E OF COMPLIANCE AND AUTHORIZA710N OF ENTAY: I certify under penalty of perjury that I have reatl t�is application and state that the information given is corred. I egree Io wmpty wiN all s�ate laws arrr�ppd��iry ortlinances relating to builtling wnsWc�ion, and authorize represeniatives of ihe City ol Costa Mesa to enter upon Ihe ebove-tlescnbetl p for in�gVUryos�egree not to wcupy or allow occupancy of any building authonzed by Ihis permit yntil final inspection. \-�— -�_--- 111 ,I�a'►-� no.l `ignature O Owner�s)_. : -_, _''_.,. —�T� � ate _.v" COOE �, INSPECTIONTYPE 1616 Fixetl System Final Fire Prevention 1266 Poal Spa Final 200 Final Re-Root 201 Finel BIocWReiaining Wall 202 Final Factory Fire Place 203 Finel Sign 204 Final Demolition Applicant �jF INTRIALS CODE� fNSPECTIONTYPE 206 Final Mechanical 208 Final Plumbing 210 Final Elacirical 212 Final Fire Preventlon 220 Final Planning ApOroval 222 Final Site 250 Final Builtling/Occupancy (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 323 22ND ST Suile No Vicinity: Parcel Number: 42616121 Appliwnt: Address: Owner: Address: Contrador. Address: SIGLIN, IRVIN STEVEN JR 323 22ND ST COSTA MESA, CA SIGLIN, IRVIN STEVEN JR 323 22ND ST COSTA MESA, CA OWNER-BUILDER MECHANICAL PERMIT � ��-�+�r,.p� Status: ISSUED � APPlied: 12/302005 � �� V � Issued: 12/302005 ISSUED BY: Phone: 714-336-4501 Zip: 92627-1863 Phone: Zip: 92627-1863 Phone: Zip: License: 000000 SCOPE OF PERMIT ADD 302SF TO SFD. WORK TO INCLUDE: RELOCATE (E) MASTER BEDROOM TO REAR ADDED AREA, EX7END KITCHEN AREA AND ADDITION OF NEW FRONT ENTRY WAY. REF.: BOS-02374 MECHANICAL TO INCLUDE: 7 REPAIR/ALT COOLING, 1 HOOD W/MECH EXNAUST AND 4 VENT FANS. ISSUE FEE Insl FAU <700 k BTU Inst FAU >100 k BTU Repair / Alt CoolingMeat Inst / Rep. Recess Wall Htr Refrig Sys <100 k BTU Retrig Sys �700 k BTU Gas Piping Factory Fireplace Hood w/Mech Exhaust VAV Box Vent Fan / Single Duct Appliance Fire Dampers Smoke Dampers Inst or Relocate Appl Vent Air Handlers < t0000cfm AirHandlers> 10000cfm Floor Furnace Floor or Suspend Heater 523.50 $0.00 50.00 573.70 30.00 50.00 $0.00 $0.00 30.00 510.65 $0.00 529.00 $0.00 so.00 $0.00 $0.00 50.00 50.00 $0.00 50.00 �uantily 0 0 1 0 0 0 0 0 1 0 4 0 0 0 0 0 0 0 0 FEE SUMMARY Repair I Alt Absorbtion Unit Repair I Alt Refrigeration Unit Ventillation System Evaporalive Cooler Commercial I ncinerator Domestic Incineralor Comoressors I Absorulion Svstems Upto3hpl100kBTU 3 To 15 hp I 500 k BTU 15 To 30 hp /1,000 k BTU 30 To 50 hp / 1,750 k BTU Over 50 hp I Over 1,750 BTU Boilers Up to 3 hp 3Tot5hp i5to30hp 30 to 50 hp Over 50 hp Other Mechanical Fee Invesligation Fee Plan Check Fee Reinspection Fee TOTAL CALCULATED FEES COMMENTS / SPECIAL CONDITIONS Quantiry 50.00 0 50.00 0 50.00 0 80.00 0 $0.00 0 $0.00 0 so.00 0 50.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 so.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 576.85 NOTICE: The work authorized ty this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No.�92-28, § 1, 12-21•g2) EXPIRATION: This permit shall automatically axpire and become void if work is not commenced within 780 days, or it work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order tor the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlrad Inspactlone and finel epproval must be obtalned. Failure to obtain inspections and final approvat will resuN In the expiration of this permit. FOR INSPECTIONS CALL: (714) 75q-5626 �_ zaaaae�aoo� WORKERS' COMPENSATION DECLApATON: � � .. � I hereby flNirm untler penalry ot per{ury one at Ne lollawing tleclarations: ` ❑ I have end will melntain a certilicate ot consent to selt-Insure for workers' crompensallon, es providetl br by section 3700 ot the Lebar Code, tor the peAormance ot the work far w�ich this pertnit is issuetl. ❑ I have antl will maintain workers' compensatian insurance, as required by sectlon 3700 ot the Labor Cotle, for Ne peAortnance ol Iha woAc la whlch Ihis p¢rmit Ls iswed My workers' compensation Insurance cerrier end policy number are: Carrier: pa�'icy Number: �(Tpls ection nsed not be comp/etetl il fhe permifls va/ue0 er ane hundred dollars (5700) or /essJ certily Ihet In the peRortnence of the work tor which this pertnit is issuetl, I shall not amploy any person in any manner so as to become subject to Ihe wOrkers' compensatlan laws ol Calitomia ntl egree t�at II I sho become subjoct b Ihe workers' compensetion provisions ol Sectlon 3700 of t�e Lebor Catle, I shell forihwlth comply with Ihese provisions. � ��0� / qpplicent SlgnaWre: �ele: j WqRNIN(3: FAILURE TO SEWRE WORKERS' COMPENSATI EMGE IS UNIAWFUL AND SW1LL SUBJECT AN EMPIOVEP TO CRIMINAL PENALTIES AND G`/IL FlNES UP TOONE HUNORED i1qUSFNDDOLLARE�5100,000),INADOfiIONTOTHE OFCO�dPENSATIIXJ,DANJIGESASPROVIDEDFORINSECTION3lOeOFTHEIABOFCADE,IlJrEREST,ANDATTORNEV'SFEES. LICENSED CONTAACTORS DECLAfiAT10N: 1 hUreby aHirm that I em licensetl under proNs�ons ot Chepter 9(commencing with Sectlon 7000) ol Division 3 of the Business antl Prolessions Code, entl my license Is in full IorGe end eMect. Uc. a Class M ConlrBctoYs Siqnature: Dele: CONSTRUCTION LENDING AGENCV: ❑ I horeGy ettirm �hat Ihere is a constructlon lentling agency br ihe peRormance of ihe work tor which t�is permil is issuod. (Sec. 3097, Civll CotleJ. Lendefs Namo: Lo�der'c Adtlress: Signeturo: Date: OWNER•BUILDER DECLARATIONS: I hereby eflirm Ihet under penalty of perjury thet I am EXEMPT FROM TME CONTRACTORS LICENSE LAW for t�e following reason (Sec. 7031.5, Buslness and Pmtesslons Code: My ciry ar county wtuch requires a pettnit to consduct, alter, improve, tlemolish, or aepair any stnicture. priw to ita issua�e, also requires the appficant lor suc� permit to lile e signed stetemem t�at he or she Is IlcenseA pursuant ta the provisions of Ihe CONrectors License Lew (Chepter 9(wmmenGng with Seaion 7000) ot DlNsion 3 of Ne BuB��ess and Professions Cotle) or that he or she is e:empt theretrom antl the besis Por the ellegeU exemption. Any violation ol Section 7031.5 by any applicant tor e pertnit sublects lhe epplicent to e civil penalry of not more Ihan five hundred tlollars ($500).�: ❑ I, es owner o� l�e properry, or my employees wlih wages as Ihair sole compensatlon, WILL DO THE WORK, and Ihe structure Is not intendetl or offeretl for sale (Sec. 7 aa, Business entl Professions Code: Tha Contraciors License Law does nol apply to an owner of properry wno builds or Improves t�ereon, antl who does such work imself or �ersell or through his or �er own employees, provitletl tha� such improvemenis ere not intendetl or oNeretl for sale. If, �owever, the building or i�nprovemeM is sold within one year ol completion, the awner-builder will have the 6urtlen of proving Ihat he or she did not build or impmve for purpose of sale.). � I, es owner ot the property, am E%CLUSIVELV CONTRACTING WITM LICENSED CONTRACTORS to construct Ihe prqect (Sec. 7044, Business and Professions Cotle: The coniractors Licensa Lew tloe5 not epply to dn owner of propeny who builds or Improves thereon, and who contracts lor suc� pmject with a conRector(s) license pursuant to the Comrapla�s License Lews.). ❑ lem Signeture: . � � Owner ID verilied by dnvefs Vedflcation ai Ownarship 6y; DIVISION OF Business and Professions Code lor thls raason: `lDate � O .e ❑ Ve5 ❑ No Drivefs License No. _ � Expires: �� of document, I.e. - pmperty tax bill ar tleed): SAFETY PERMR CERTIFICATION: ❑ I �ereby cenity Ihal no excavation five (5) or more teel �� depih inm which e person is requiretl to tlescend, will be made in connection wiih work authodzed by this permit, entl Mat no builtling s�ructure, sceHOlCing, lelsework, or demolition or tlismamling ihereof, will he more Ihen thirry-six (38) teet �igh. (Chap. 32, Grp 2, A� 2, Sec. 341, Ttle B, Califomia Adm�nistrative Code). ❑ As owneo-builtler, I will not employ enyone m tlo work which woultl require e permit imm Ihe Division of Indusinel Sntery, as notetl a6ove, unless sucb Oerson hes a permit to tlo 5uch wark from lhe division. Signature: Dale: Divis�on ol Indusinal Sefery Permit Number: CERnFlCATE OF COMPLIANCE AND AUiHORVJ1710N OF EMRY: I certity under penalty of perjury that I have read this epplication and state Ihat Ne inlormaUon given is corre��. I agree to comply with sll stete laws antl ciy ortlinances relating to bullding conswction, entl authonze representativas of the Ciry ot Costa Mesa m enter upon the ebove-descnbetl property tor inspeciion p s. I egree nU t upy or ellov.• occupanry of eny �uilding authorizetl by this rtnit until final inspectbn. �SC _ � ��.. �'� a 0 0 � SinnaWre Of Leael Ownerts Date �QQ��, INSPECTIONtYPE 1616 Fized System FI 1286 P�I Spa final ppp Flnel Re-Rool 201 Final BIocWReta ppp Final Feciory Fir 203 Finel Sign ppq Final Demo��lion e'i„ QdjE f�$ �QQE! INSPECTIONTYPE p 208 Final Mechanic n �`II 20B Fi I Plumbino 222 Final 250 Finel BuiWingiOaupancy (714) 754-5273 • Fax (774) 754-4856 • www.ci.costa-mesa.ca.us 7� FAIR DRIVE, COSTA MESA, CA 92626 .lobnddress: 323 22NDST Suite No Vicinity: Parcel Nunmber: 42616721 Applicanr. SIGLIN, IRVIN STEVEN JR Address: 323 22ND ST COSTA MESA, CA Owner: SIGLIN, IRVIN STEVEN JR Address 32322NDST COSTA MESA, CA Coniractor: O W N E R-B U I LDE R Address: PLUMBING PERMIT Phone: 714-336-4501 Zip: 92627-1863 Phone: Zip: 92627-1863 Phone: Zip: �icense: 000000 Stalus: ISSUED Applied: 12/302005 Issued: 12/30/2005 ISSUED BY: '�/ SCOPE OF PERMIT 03/27/06 REVISED: DELETE 1 BATHTUB AND ADD 1 SHOWER; ADD 1 WATER SOFfENER. '�a ADD 302SF TO SFD. WORK TO INCLUDE: RELOCATE (E) MASTER BEDROOM TO REAR ADDED AREA, EXTEND KITCHEN AREA AND ADDITION OF NEW FRONT ENTRY WAY. REF.: BOS-02374 PLUMBING TO INCLUDE: 2 BATHTUBS, 1 DISHWASHER, 1 GAS (1-4 OUTLETS), 1 RE-PIPE, 1 LAUNDRY TUBM/ASHER, 10 P-TRAPS, 1 SEWER CONNECTION, 1 SHOWER, 1 BAR SINK, 1 KITCHEN SINK, 4 WASH BASINS, 2 WATER CLOSETS, 1 WATER HEATER, AND 1 WATER RE-PIPE. ISSUE FEE BackFlow irrigation Backflow Preventer Bathtub Clarifer System Connect (Ice,Soda,etc) Dental Units Dishwasher Drain, Floor Drain, Rainwater Drain, Root Drinkinq Founiain Expansion Tank Gas Earthquake Valve Gas (1-4 outlets) Gas (Over 4 outlets) Gas Repipe Gas Service Interceptors (Grease, Oil) Interceptors (Santl Auto ) AMT $23.50 50.00 50.00 59.80 50.00 50.00 50.00 $9.80 50.00 $0.00 $0.00 $0.00 $0.00 50.00 $6.15 $0.00 $9.80 $0.00 $0.00 $0.00 � 0 0 1 0 0 0 1 0 0 0 0 0 0 1 0 1 0 0 0 FEE SUMMARY AMT LaundryTub/Washer $9.80 Landscape Irrigation $0.00 P-Trap $98.00 Pressure Regularor $0.00 Process Piping (per 10 ft) $0.00 Receptors 50.00 SepticTank $0.00 Sewer Cap for Demo $0.00 SewerConnect $0.00 Sewer Private Line $24.65 Shower $19.60 Sink, 6ar $9.80 Sink, commercial $0.00 Sink, Floor 50.00 Sink, kilchen $9.80 Sink, service/mop $0.00 Spa (private) $0.00 Spa (public) 50.00 � 1 0 10 0 0 0 0 0 0 1 2 1 0 0 1 0 0 0 COMMENTS I SPECIAL CONDITIONS e p 'c.'s+ SumpPump Swimming Pool Trap Primer Urinal Vacuum Brkr Bkflow(1-4) Vacuum Brkr Bkflow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (Toilet) Water Heater / vent Water Piping (Inst or RepJ Water Re-pipe Water Service Water Sokener OTHER VIOLATION PLAN CHECK REINSPECTION AMT $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $39.20 $0.00 $0.00 $19.60 $12.30 $9.80 $0.00 $0.00 $9.80 $0.00 $0.00 $0.00 So.00 TOTAL CALCULATED FEES: 5321.40 � 0 0 0 0 0 0 4 0 0 2 1 1 0 0 1 NO710E: The work authorizad by Ihis permit shall comply with all applicable handicap access requiremenis under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-27-92) EXPIRA710N: This permit shall auromatically expire antl become void if work is not commenced within 1 BO days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for Ihe work authorized untler this permit to be consitlered legal, such work musl comply with all applicable codes, and all requlred InspecUons and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiretion of this permit. � FOR INSPECTIONS CALL: (i14) 754-5626 � �--"� �/ ..�.. �..�„ !� f WORKERS' COMPENSATION DECLARATION: I �ereby eHirtn under p9nalry ot perjury one of Ihe lollowing declarations: ❑ I have entl will maintain a certificate of consent to self-Insure tor workers' compensation, as provitled for by section 3700 of the Labor Code, for the pertormance of Ihe work tor which this pertnit is issued. ❑ I have antl will maintain workers' compensetion insuranca, as required by sectlon 3700 of the Labor Cotle, lor ihe performance of ihe work for which this pertnit is issuetl. My workers' compensation Insurance carner and policy number are: CarneJ: Policy Number at one hundred dollars (5700) or less.) $ I.cenity t�at in t�e PeAortnance ot ihe work for which this pertnit is issued, I shall not employ any person in eny manner so as to become sublect to the workers' �compensation laws oi Califomia, entl egreeQ,,��e that if I should bewme suDjaa to the workers' compensation pmvisions of S ct on 3700 1 the Labor Code, I s�all totlhwith comply with ihese p�o��' ps. �� ;\ q,, ^ p ApprtcanlSigneture:,?==.._. � �. oete:.-.. �- � l�� U\ .� / �U%l fi, WARNINQ:�FAILURE TO SECURE WORNERS' PENSATION CAVERAGE IS UNLAWFUL M1D SHP1L SUBJECT AN EMPLOYER TO CHIMINAL NALTIES AND CIVIL Fl ES�ONE HUNORED TFIOUSANDDOLL4RE($1W.OW),INADDI TOTHECOSTOFCOMPENSATION,�AMAGESASPROVIDEDWRINSECTION3IOBOFTHELABORCODE,INTEREST,ANDATTORNEI^$FEES. LICENSED CONTRAC70RS DECLARATION: I here6y attirm t�a� I am licensed under provisions of Chapter 9(commencing wilh Section 7000) of Division 3 of the Business antl Professions Code, and my license is in full force and eHecL Lic. a Cless q Contracmfs SignaWre: �ate: CONSTRUC710N LENDING AGENCY: ❑ I hereby aNirtn that there is e construction lentling agency for the pedormance ol ihe work for which ihis pertnit is issued. (Sec. 3097, Civil Cotle). Lenders Name: Lender's Atltlress: SignaWre: Date: OWNER-BUILDER DECLARATIONS: I hereby aHirtn that untl@� Penalry of OerJury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW lor the following reason (Sec. 7031.5, Business and Professions Cotle: Any ciry or counry which requires e permit to constmct, alter, improve, tlemolish, or repair any strucWre. Drior to its issuance, also requires Ihe applicant for such pertnit ro lile a signed statemeni that he or she Is licensed pursuam co the pmNsions ol the Coniractors License Lew (Chapter 9(commencing with Section 7000) of Division 3 of the Business end Pmtessions Code) or that �e or she is e:empi Ihereirom antl Me basis ior the allagetl exemplion. Any violation ol Saction 7031.5 by any applicant tor a permit sub�ects the applicant to a civil penalry of nat mora t�an five hundred dollars (5500).): ❑ I, as owner oi the p�operry, or my employees with wages as their sole compensation, WILL DO 7HE WORK, end [he siructure is not Intendetl or oNerad for sale (Sec. 7044, Business antl Professions Code: The Coniracfors License Law tloes not apply ro an owner of pmpeny who builds or improves ihereon, and who dces such work imsell or herseH or Ihroug� his or her own employees, provitled that such improvements are not intended or oNered for sa1e. If, however, the 6uilding or improvemem is sold within one ye8r ot completion, the owner-builder will have the �urden of proving that he or she did not build or improve �or purpose of sele.). � Ras'owner of the p�o0erty, em EXC WSIVELY CONTPACTING WITM LICENSED CONTRACTORS to constmct tha pmject (Sec. 7044, Business and ProfeSsions s%�-Cotle: The contrac�ors License Law does not apply to an owner of property who builds or Improves ihereon, and who contracis br such project with e conirector(s) license pursuant to the Contractors License Laws.). . �� VeriPiw[ion of Business antl Pmfessions Code for this reeson: iicense. ❑ Yes ❑ No �Drivers L.icense No: (type oi tlocument, i.e. � property tax biil or tleetl}�"- --` DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby cenity Ihat no eacavation five (5) or more feet in tleplh into which e person is requiretl to descend, will be matle in connection with work euthonzetl by ihis permit, and ihat no building stmcture, scallolding, falsework, or demolition or tlismantling ihereof, will be more ihan thiny�six (36) faet high. (Chap. 32, Grp 2, Nrt 2, Sec. 341, Title 8, Califom�a Adminisirative Cotle). ❑ A5 ownervbuilder, I will not employ anyone ro tlo work which would reduiro a permit fmm the Division ol Industnal Safety, as noted ebove, unless such person �as a permi� to do such wark fmm ihe division. Signature: Date: Division of Indusinal Safery Permit Number: CERTFlCATE OF COMVLIANCE AND AUTHORIZA710N OF ENTRV: I cenify untler penalty oi perjury thet I have read ihis application entl state ihat ihe information given is correct I agree m comply with all state laws endFiry ortlinances relaUng to buildin� consimction, end authorize representatives of Ihe City of Costa Mesa ro enter upon ihe ebove-described property � ecti oses I ree not to occupy or allow occupancy of any building authonzed b t permi until final inspedion. � �, ts��a--7- �� 0 t� � �SignaWre Ot L�n (s) ` � � l ate � -.��i. COUE 1. INSPECTIONTYPE 1616 Fized System Final Fire Prevention 1266 Pool Spa Final 200 Final Re-Roof 201 Final BIocWRetSining Well 202 Final Factory Fi�e Place 203 Final Sign 204 Final Demolition 4dL IMRIRLS COpE� INSPECTIONTYPE 206 Finel Mechanical 208 Final Plumbing 210 Final Elecirical 212 Finel Fire Preventian 220 Finel Planning Approval 222 FinalSite 250 Final Builtling/Occupancy Date P� � (774) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 JobAddress: 323 22NDST Suite No Vicinity: Parcel Nunmber: Applicant: Address: Owner: Address Contraclor. Address: 42616121 SIGLIN, IRVIN STEVEN JR 323 22ND ST COSTA MESA, CA SIGLIN, IRVIN STEVEN JR 323 22ND ST WSTA MESA, CA OWNER-BUILDER PLUMBING PERMIT Phone: 714-336�501 Zip: 92627-1863 Phone: 2ip: 92627-1863 Phone: Zip: - License: 000000 Slatus: ISSUED Applied: 12/302005 Issued: 12/302005 ''S// � �• SCOPE OF PERMIT ADD 302SF TO SFD. WORK TO INCLUDE: RELOCATE (E) MASTER BEDROOM TO REAR ADDED AREA, EXTEND KITCHEN AREA AND ADDITION OF NEW FRONT ENTRY WAY. REF.: 805-02374 PLUMBING TO INCLUDE: 2 BATHTUBS, 1 DISHWASHER, 1 GAS (1-4 OUTLETS), 1 RE-PIPE, 1 L4UNDRY TUBNVASHER, 10 P-TRAPS, 1 SEWER CONNECTION, 1 SHOWER, 1 BAR SINK, 1 KITCHEN SINK, 4 WASH BASINS, 2 WATER CLOSETS, t WATER HEATER, AND 1 WATER RE-PIPE. FEE SUMMARY AMT QN ' AMT �7Y AMT �N ISSUE FEE $23.50 Laundry Tub I Washer $9.80 1 Sump Pump $0.00 0 Backflow irrigalion 50.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 BackFlow Preventer 50.00 0 P-Trap $98.00 10 Trep Primer $0.00 0 Bathtub $19.60 2 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 Connecl (Ice,Soda,etc) 50.00 0 Receptors � $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank 50.00 0 Wash Basin $3920 4 Dishwasher 59.80 1 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain, Floor $0.00 0 Sewer Connecl $0.00 0 Waste and Vent System $0.00 0 Drain, Rainwater $0.00 0' Sewer Private Line $24.65 1 Water Closet (foileq 519.60 2 Drain,Roof $0.00 0 Shower $9.80 1 WaterHeater/vent $12.30 1 Drinking Fountain 50.00 0 Sink, bar 59.80 1 Water Piping (Inst or Rep.) $9.80 1 Expansion Tank 30.00 0 Sink, wmmercial $0.00 0 Water Re-pipe 50.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor 30.00 0 Water Service $0.00 0 Gas (1-4 outlets) �� 56.15 1 Sink, kitchen $9.80 1 Water Softener $0.00 0 Gas (Over 4 outlets) � $0.00 0 Sink, servicelmop $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 Inierceptors (Grease, Oil) $0.00 0 REINSPECTION 50.00 0 Interceptors (Santl Auto ) 50.00 0 TOTAL CALCULATE� FEES: E311.60 COMMENTS I SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related regulations. (Ord. No. 9248, § 1, 1241-92) � EXPIRATION: This permit shall automatically expire and become void it work is not commenced vnthin 180 days, or if work is suspended or abandoned for a period oi 180 days. INSPECTIONS: In order tor the work authorized under this permit to be considered legal, such work must comply with all required Inspeetlona and flnal epproval must be obtained. Failure to obtain inspections and final approval will result in the e: POR INSPECTIONS CALL: (714) 7545826 2C4&48 (fl�00) WORKERS'COMPENSATON DECLARATON: � � I hereby ettirm under penalry of perjury one of the following dedarations: ❑ I heve antl will meintain a certificefe of consent to self�lnsure tor workers' compensation, as provitled for by section 3700 0l the Lebor Code, for the petlormance of the work ftl� which �his pertnit is i5sue0. ❑ I have antl will maintain workers' compensation insurence, as required by soclion 3700 0l Ne Lahor Catle, tor the perfortnance of ttw woAc tor which Nis pertctit is issuetl. My workers' compensation Insurence carner and poliq number are: Cartier: Policy Number: (�Th/isye cNon need not be completed i/ the Oermif is velued et one hundretl tlollars ($100) or less.) LiV I cenify thet in the pedormance of the work for which ihis permit is issued, I shall not employ any person in any manner so as �o become subject to tha workers' compensatlon lews ol Califo a, antl agree thatJf I hould become sublect to the workers' compensetion provislons ot Sectlon 3700 0l the Lebor e, I shall forthwlth comply wit� these provisions��_ � � ApplicamSig�eWre: _ . � Date: ��! _�• � a�� WARNlNpt FMLURE Tp SEGURE WORKERS' CApt ENSATI�tJ WVERACE IS UNLAW FUL AND SHNLL SUBJECT AN EMPtOVER TO CAIMINAL PENA�TIE$ AND CYYIL FINES UP TO ONE HUNDREO TiN)USAND OplARE (5100,000�. IN ADOITION Tb THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTIIXJ 31O60F THE LABOR CODE, INiEFEST, AND ATiORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirm ihat I em licensed under provlslons of ChaO�er 9(commencing wilh Section 7000) ol �ivision 3 oi the Business antl Professions Code, and my license is in tull force end eMBCL Lic. a Class M Comreaor's 5�gneNre: Date: CONS7RUCY�ON LENDING AGENCY: ❑ I hereby aNirm ihat there is a constmction lending agency for the peAormance of the work br which �hi5 permit is issuetl. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signawre: Da�e: OWNER•BUILDER DECLARATIONS: I here6y eMirm ihet under penalry ot perjury ihat I am EXEMPT FROM THE CON7HACTORS LICENSE LAW for ihe following reason (Sec. 7031.5, Business end Professions Code: Any ciry or counry which requires a permit to construc�, altar, improve, demolish, or repair any siructure, prior to its issuance, elso requires Ihe applicent for such permil to file e signed statement thet he or she is licensed pursuent to the provisions of Ihe Contraaors License Ww (Chaptar 9(wmmencing with Sectbn 7000) ot Division 3 0l tha Business end Profeuions Code) or that he or she is azempt Iherefrom and the basis br the elleped e:emption. Any violation of Section 7031.5 by any applicant for e permit sublects Ihe applicant to a civil penalry of not more then five hundred dollaro ($500).): ❑ I, es owner ot Ihe property, or my employees wlih wages as their sole compensation, WILL DO THE WORK, and the struc�ure is not intendetl or oHeretl tor sala (Sec. 7044, Business and Professions Code: 7he Contractor5 License Law does not apply to an ownar of property who builds or impmves thereon, and who does such work ,i�imself or herselt or Ihrouqh his or her own employees, piovided that such imp�ovements are not intended or oNered lor sale. If, however, the building or impmvemem is �//s.old witPin one year of completion, the owner-builder will have ihe burden of proving that he or she tlid not builtl or improve lor purpose of sale.). ' LH i, as owner of the property. am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to constmct the project (Sec. 7044, Business and Protesslons Code: The contrectors License Lew tloes not apply to an owner of property who builtls or Improves ihereon, antl who conirects for such proiecl with a contractor(s) license pursuant to ihe Contrac}prs License Laws.). ❑ I am exemp r Signature: Owner ID veri�ied by tlnw ❑ V85 ❑ No Business antl Pmfessions Cotle br this reason: Da�e: � 7 � Driver's Licen50 No. � Expires: O�' aY `f1 � Venfication oi Owners�ip �(rypa of tlocumenL i.e. - properry ta�c bill or tleed): DIVISION OF �NDUSTRIAL SAFETV PERMIT CERTIFILATION: ❑ I hereby cenify that no excavation five (5) or more feet in depih into which e person is required to descend, will be made in connection with woB authonzetl by �his permit, and that no building strucWre, swttolding, falsework, or demoli�ion or dismantling Ihereof, will be mora than �hirry�six (36) leet high. (Chap. 32, Grp 2, Art 2, Sec. 341, TIOe B, Calilornia Atlminisirative Cotle). ❑ As own�r-builtler, I will not employ enyone to do work which would require e permit from the �ivision oi Industnal Safery, as noted ebove, unless such person has e permit t0 do such work irom the division. Slgnature: Dete: Division of Indusinal Safery Permit Numbar: CERTIFlCATE OF COMPLJANCE AND AUTHOFiVAT10N OF ENTRY: I certity under penalry of perjury that I have read this aOD�ication antl state that Ue intormation given is wrtect. I agre@ lo compty with all stale Wws ead ciry ordinances relating [0 6uilAing construction, ead authorize represenlatives ol Ne Ciry ot Cosla Mesa to enter upon the above-descnbed proparty for inspection pu�� ip c y or ellow occupancy ot any building authonzed by this pe mit until final inspection. �, 30.an��, Signature Of Legel Owner(s� �- Date � cooe ", i�nuNTYPE 1616 Fivetl System final Fire Pi 1266 Pool 5Pa Finel 200 Final Re-Foof 201 FIne16�oCWRetaining Well 202 Final Factory Fire Place 203 Final 5ign 204 FinalOemolition INTITIALS �ODEj INSPECTIONTYPE � � 206 Final Mechanical � 1al 20 i Fl\\a�bing /� � \`tl� 210 Finel.Electrical �( / � 1+ 212�\\ Final Fi�re Preventio�n / ' � 220 \\ FlnefRenning pr�o aip �L 222 FinalSite 250 Final Building/Occupancy Date