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Home My WebLink About437 16TH PL - Building Permits(714) 754-5273 • Faz (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 437 16TH PL Suite: Vicinity: Primary Occ: R-3 Dwellinqs/ Cong Res <70 Parcel Number: 42514113 Appli�ant: WOODMAN, DANIEL Address: 1541 W CHANTICLEER RD ANAHEIM,CA BUILDING PERMIT Type of Construction: - Owner: PALMQUIST, DAN AND LEANNE S Adtlress 437 16TH PL COSTA MESA, CA Contractor. PALACE BUILDERS Address: 1541 W CHANTICLEER RD ANAHEIM, CA Zip: 92802 Arch : Address: Zip: Phone: License: Status: FINALED Applied: 06/23/2004 Issued: 06/23/2004 Zoning: ISSUED BY: ,�.I � Phone: 714-520-5757 Zip: 92802 Phone: 949-433-4078 Zip: 92627 Phone: 714-520-5757 License: 755132 Eng: Address: Phone: License: SCOPE OF PERMIT INTERIOR REMODEL TO AN EXISTING SFR. SCOPE OF WORK TO INCLUDE: NEW 5 X 4 OPENING iN WALL BETWEEN KITCHEN AND FAMILY ROOM. REMOVE SLIDER IN FAMILY ROOM AND INSTALL A 5 FT WINDOW, INCREASE KITCHEN WINDOW SIZE ( MIN 4' SOLID WALL ON EITHER SIDE OF WINDOV�, REMODEL KITCHEN, REMODEL BATHS, MISC ELECTRICAL AND PLUMBING.. Plan Check: Permit: SMIP Res: SMIP Com: Other: Inspection: $190.61 $293.25 $1.80 $0.00 $0.00 $0.00 FEESUMMARY Calc Valuation: s�s,000.00 Claim Valuation: s�s,000.00 NOTICE: The work authorized by this permit shall comply with all applirable handicap access requiremenis under California statutes and related regulations. (Ord, No. 92-28, § 1, 12-21-92) EXPIRA710N: This pertnit shall automatically expire and become void if work Is not commencetl 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 permit to be considered leqal, such work must comply with all epplicable codes, and all requlred Inapeetiona and linal approval must be obiained. Failure to obtain inspeclions and f'inal approval will resull in the expiration ot this permit. FOfl INSPECTIONS CALL: (714) 7545626 zaas-as �voo� �� WORKERS'COMPENSAnON DECLARAnON: ' I hereby aHirtn under penalty ot per�ury one ol ihe following declerations: ❑ I heve entl will melntein a cenificete ol consent to self-Insure lor workere' compensation, as provided for by saction 3700 ot iha labor Cotle, for the pertormence of Ihe work for which this permli Is Issued. ❑ I have and wlll mainWin workers' compensetion insurance, as required by sectlon 3700 oi ihe Labor Code, for ihe peAortnance ot the work tor which this pertnit is issued. My workers' compensalian Insurence carrler and policy number are: Cerrler: Policy Number: (fhis secNan need nat be cromple(eU il (he pem�iNs veluetl et one hundred dollars ($100) or Iess.J ❑ I certly Ihet in the pertormence oi Ihe work tor whlch t�is permit is Issued, I shell not employ any person in eny manner so as to become subjed to t�a workers' compensation laws of Celifomle, end egree Ihat II I should become subject to the workere' compensetion provislons of Section 3700 of the Lebor Code, I shall torthwith comply with these provisions. Applicant Signeture: Oate: WARNINp: FAILUFE TO $ECUFE WORKE COVERAOE IS UNLAWFUL AND SHALL SUBIECT AN EMPLOYER TO CRIMINAL PENPLTIES AND CIVIL FlNES UP TOONE HUNDRED THOUSPND DOLLARE (5100,000), IN nDDITI C�ENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3]O60F THE LABOR CODE, IMERESi, AND ATTORNEI"S FEES. LICENSEDCONTRACTORSDECLAF I hereby aHirm that I am licensetl untler torce entl eNecL Llc. M Contractor's Signeture: with Section 7000) of Division 3 ot the Business antl Professions Code, antl my license is in full Class e De1e: CONSTRUCTION LENDING AGENCV: ❑ I here6y eNirtn Ihet there is e conswction lentling agency for the peAormance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lentlers Name: Lendefs Atldress: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby ettlrm that untler penelry ot perjury �het I em EXEMPT FROM 7HE CONTRACTORS LICENSE LAW tor ihe following reason (Sec. 7031.5, Business antl Professions Code: Any ciry or county which requires e permit to construcL elter, improve, tlemolish, or repair any strudura, prior to its issuance, also requires ihe applicant for such permit b tile a signeC stetement ihat he or she is Ilcensetl Dursuant to the DroNslons ot the Conirecrors License Lew (Chapter 9(commencing with Section 7000) of Didslon 3 ot Ihe Business antl Pmlessions Catle) or that he or she Is eaempt Ihereirom and the besfs br the elleged exemption. Any violatlon ot Section 7031.5 6y eny applicant for a permit subjects the eppllcant to e civil penalry of not more then five hundred dollars ($500).): ❑ I, es owner of the property, or my employees with wa9es es thelr sole compensation, WILL DO THE WORK, end the structure Is not intended or oHered for sale (Sec. 7044, Business and Professions Code: The Contrectors License Law tices not eppty to an owner of property who builds ar improves Ihereon, flnd who daes such work himsell or hersell or through his or her own emplayaes, provided the� such improvements ere not Intendetl or oHered for sale. If, however, �he building or improvement is sold within ona year of comDletion, Ihe ownerbuilder wiil heve the burden o� proving ihel he or she did not build or improve for purpose of sale.). • ❑ I, 85 owner of lhe proDerry, em E%CLUSIVELY CONTRACTINC WITH LICENSED CONTRACTORS to con5truct the project (Sec. 7044, Business antl Professions Cotle: The contrectors License Lew tloes not eppty ro en owner ol property who �ulltls or Improves Ihereon, entl who contracts lor such project wit� e wntractor(s) license OurSuant to the Contractors License LBwS.). ❑ I am exempt untlar sec. Business and Profossions Code for this reason: Signature: Date: Owner ID verifiatl by tlnvefs license. ❑ Ves ❑ No DriveYs License No. Ezpires: Veriticatlon ol Ownership by (type oi dwumem, i.e. - properry tax 6iil or deed): DIVISION OF INDUSTRIAL SAFETY PEHMIT CERTIFICATION: ❑ I hereby certify that no excavetion tive (5) or more fee� in tlepth into which e person Is required to descend, will be made in connectian with woAc euthorized by this permit, entl that no 6uilding swcture, sceHolding, talsework, or demolition or tlismantling ihereof, will be more than thirry-six (36) teet high. (Chap. 32, Grp 2, Art 2, Sec. 347, Title B, Calllornia Administrative Cotle). ❑ As owner-builder, 1 will not employ enyone to tlo work whlch would requlre e permit trom the Division ot Intlustriel Satery, as noted above, unless such person has e pertnit to do such work Irom Iha division. Signature: Date: Division ot Intlusirial Sefery Permit Number: CEBTIflCATE OF COMPLIANCE AND AIJTMORVATION OF ENTFiV: 1 certily untler penalty of perjury thal I have read thls application and stete that the infortnation given is correct. I egree to comply with all state lews and ciry ordinances relating to building construction, antl euthonze representatives of the Ciry of Costa Mesa to enter upon t�e above-descnbed property for inspection puryoses. I egree not to occupy or ellow occupancy ot eny building authorized by ihis pertnil until final inspection. SlgnaWre Ot Legal Owner(s) Date And/Or Authodzed Appllcem COOE �. INSYECTIONTYVE 1616 Fixed System Final Fire Preventlon 1288 Pool Spa Final 200 Finel Ra-Roaf 201 Finel BIocWRetelning Well 202 Final Fectory Fire Place 203 Final Sign 204 Finel Demolitlon Qsg nrrmn�s CODEt ixsvecnoxrrve 206 Finel Mechenical 208 Finel Plumbing 210 Flnal Electrical 212 Finel Fire Prevention 220 Flnel Planning Approval 222 Final Site 250 Final Bullding�Occupancy PdiE It�ELS I �. Total: $485.66 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0 - 0 PARKfNG Existin : o PLANNING & ZONING Rear 0-0 Left 0-0 Rear 0- 0 Lek 0- 0 Reauired: 0 Pr000sed: 0 Right 0 - 0 Right 0-0 (774) 754-5273 • Fax (714) 75a-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 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 Fixts Recepl OutleLs Switches Non Res Appl Res Appl Service to 200a Service to t000a Serv�ce over 1000a Molors to 1hp Motors to 10hp Molors to SOhp 437 16TH PL a2aiaiis WOODMAN, DANIEL 1541 W CHANTICLEER RD ANAHEIM,CA ' ELECTRICAI PERMIT Phone: 714-520-5757 Zip: 92802 PALMQUIST, DAN AND LEANNE S 437 16TH PL COSTq MESA, CA PALACE BUILDERS 1541 W CHANTICLEER RD ANAHEIM, CA Phone: 949-433-4078 Zip: 92627 Phone: 714-520-5757 Zip: 92802 License: 755132 Status: ISSUED Applied: O6/23/2004 Issued: O6/23/2004 ISSUED BY:� SCOPE OF PERMIT INTERIOR REMODEL TO AN EXISTING SFR. SCOPE OF WORK TO INCLUDE: NEN/ 5 X 4 OPENING IN WALL BETVJEEN KITCHEN AND FAMILY ROOM. REMOVE SLIDER IN FAMILY ROOM AND INSTALL A 5 Ff WINDOW, INCREASE KITCHEN WINDOW SIZE ( MIN 4' SOLID WAIL ON EITHER SIDE OF WINDOW OPENING), REMODEL KITCHEN, REMODEL BATHROOMS, MISC ELECTRICAL AND PLUMBING. REF: B04-01147. ELEC7RICAL TO INCLUDE: 20 LIGHT FIXTURES, 2 OUTLETS AND 2 SWITCHES. $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $22.00 $2.20 5220 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantity 0 0 0 20 2 2 0 0 0 0 0 0 0 0 FEE SUMMARY Temp Dist System / Lighting Busway/100 k Standing Section Misc Electrical Equipment Transformers up to 1 kva/kw ................up to 10 kva/kw .................up to 50 kva/kw .................up to 100 kva/kw ..................over 100 kva/kw Low Voltage Equipment Low Volt Wiring System I Ckt Misa Conduit Misc. Conductor CircuS ( gen or ride) Circus (mach nde or lights) Christmas Tree Stand Fireworks Stand Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 1241-g2) EXPIRA710N: 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. INSPEC710NS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlretl inspectlons and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2aas-as �aroo� WORKERS'COMPENSAnON DECLAAAnON: � I hereby eilirm under penalty oi perjury one of the following declarations: ❑ I heve end will maintain e certifira�e ot consent to sell-Insure for workers' compensation, es proNdetl tor by section 3700 0l the Labor Code, for t�e pertortnance of the work lar w�ich this permit Is issued. ❑ I �ave antl will maintain workers' cOmpensation insurence, es required by section 3700 of Ihe Lebor CaAe, for ihe pertortnance of the work lor which Ihis permit is issued. My workers' compensatlon Insurance carner and policy number era: Carner: Policy Number: (Thls secf/on neetl not De compleled i! (he perm/t is velued et one huntlred dollers ($100) or less.) �I certity thet in Ihe performance of the work for which Ihis pertnit Is issued, I shall not employ any person in eny manner so as to Decome suDjact to Ihe workers' compensation lews of Califomla, a�d egree ihat if I s�ould become subject to We workers' compensation pmvisions of Sectlon 3700 of the Labor Code, I shall lorthwith comply wllh t�ese rovi5ion5. n V t� Applicenl Signature: �A r� : . y � • �nl��e Date: � — d 2 —� � WARNINO: FAILURE TO SEGURE WORKERS' �OMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENPLTIES AND GVIL FlNES UP TOONE HUNOREO THOUSAND DOLLARE (5100,000�, IN ADDITIO�'1 TO THE COST OF COMPENSNTION, DAMAGES PS PROVIDED WR IN SECTION 3]OB OF THE LABOR CODE, IfJrEREST, AND ATiORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby eMirm that I em Iicensed under provisions of Chapter 9(commencing with Section 7000) ot Division 3 of the Busines� Professions Code, enA my license is in full brce end ettea. uc. x S S 1 3 2 C�ass a� Contraaors Signeture: � Date: �- a.� - O� I CONSTRUCTION LENDING AGENCV: ❑ I hereby aflirtn that there is a construction lending agency tor t�e peAormance of the work br which this pertnit is issuetl. (Sec. 3097, Civil Code). LenCer'S Name: Lender's Atltlress: Signature: Date: OWNER-BUILDER DECLARA710NS: I hereDy eHirm Ihet under penalry ot per�ury ihat I em EXEMPT FROM TME CONTHAC70RS LICENSE LAW tor ihe following reason (Sec. 7031.5, Business end Professions Cotle: Aay ciry or coiuiry which requires a permit to construct, alter, impmve, demolish, or repalr eny stnuW re, prior b its issuance, also requires the applicam for such permit to file e signed steteineN that he ocshe is licensed pursuant to the provisions oi the Contractors License Lew (Ghepter 9(commencing with Section 7000) ol Divislon 3 ot the Business antl ProfesslonSA&le), oqthe�'he or she is exempt therelrom end the basis for Ihe elleped ezemption. Any violation ot Section 7031.5 by eny epplicant for a permit subjects Ihe applicam to a ciJil penalry"d� not rimote than Nve hundred dollars (5500)J: _ '� !'4 �..6 ❑ I, es owner ot the property, or my`amployees•�with wages as their sole compensaiion, WILL DO 7HE WORK, antl the structure is not intendad or oNered br sale (Sec. 7044, Business and Protessions Gode: The Contractors License Law does not apD�Y �o an owner of property who builtls or improves Ihereon, entl who does such work himself or herself or Ihrough his or her,qwn employees, provided thet such improvements ere not intended or oHeretl br sale. II, however, ihe builtling or improvement is sold within one year of completion. the owrier-builtler will heve Ihe burden of proving ihet he or she did not build or impmve br purpose of sale.). ❑ I, e5 ownar of lhe property, am E%CIUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construtt Ihe projact (Sec. 7046, Busine5s and Profe55ions Cotle: The coNrectors License Lew tloes nat apply to en owner of property who builds or improves t�ereon, end who contrects lar such pmJecf wlih a cantracmr(s) license pursuant b the Contractor9 License Lews.). ❑ I em exempt untler sec. Business and Pmfessions Code tor Ihis reason: SignaWre: Date: Owner ID venfied by anver's license. � Yes ❑ No Drivefs Licensa No. Expires: VedBcetlon ot Ownership by (type oi document, La. - property tez bill or tleed): DIVISION OF INDUSTRIAL SAFE7V PEAMI7 CER7IFICATION: ❑ I hereby certity ihat no excavation five (5) or more feet In tlepth in�o which a person is requiretl to descend, will be made in connection with work authorized by t�is permit, end �hat no building strucu��e, scattolding, lelsework, or demolition or dismantling thereot, will be more then thirty-six (36) feet high. (Chep. 32, Grp 2, Art 2, Sec. 341, Title 8, California AdministratNe Code). � As owner-huiltler. I will noi employ anyrone to tlo work which would require a permit Irom ihe DiWsion of Intlustnel Sefery, as noted above, unless such pereon has a pertnit lo do such work from ihe di�ision. Signature: Date: Division ol Intlustrial Safery Parmit Numper. CEfi71FlCATE OF COMPIJANCE AND A�MORIZATON OF EMAV: I cenity under penalry oi perjury thal I have reatl this application and state Ihet the infortnation given is correct. I egree b compry with all state laws and ciry ordinences relating m buildinq wnslrucUon, end authonze representatives oi iha Glry oi Coste Mesa to enter upon the ebove-descnhed property lor inspection Puryoses. I agree not lo occupy or allow occupancy ot any building authorized by this permit until tinal inspecNon. 1 �� ignatura Of Legal wner(s) �; ' � )(l.:V�+� 0 � � � � �� —� And/ r Aulhonzed Applicant (,�' D� COUE 1, INSPECTIONTYPE 1816 Fized Sysiem Final Fire Preven�ion 1266 Pool Spe Final 200 Finel Re-Roof 201 Final Block/Retaining Well 202 Final Factory Fire Place 203 Final Sign 204 Finel Demolilion QdjE IMRIAL COpE 1 INSPECiION TYPE 206 Finel Mechanical 20B Flnal Plumbing 210 Finel Electncal 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Finel BuildincyOccupancy Q�, INniULs ■�LJ � •_ (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92826 Job Address: 437 16TH PL Suite No Vicinity: Parcel Nunmber: 42514113 Applicant: WOODMAN, qANIEL Address: 1541 W CHANTICLEER RD ANAHEIM, CA PLUMBING PERMIT Phone: 714-520-5757 2ip: 92802 � a. Owner: PALMQUIST, DAN AND LEANNE S Address 437 16TH PL COSTA MESA, CA Contractor: PALACE BUILDERS Address: 1541 W CHANTICLEER RD Arch / Eng : Address: ISSUE FEE Backflow irrigation Backflow Preventer Ba[htub Clarifer System Conned Qce,Soda,etc) Dental Units ANAHEIM, CA Phone: 949-433-4078 Zip: 92627 Phone: 714-520-5757 Zip: 92802 License: 755132 Phone: Zip: License: Status: ISSUED Applied: 06/23/2004 Issued: 06/23/2004 ISSUED BY: SCOPE OF PERMIT INTERIOR REMODEL TO AN EXISTING SFR. SCOPE OF WORK TO INCLUDE: NEW 5 X 4 OPENING IN WALL BETWEEN KITCHEN AND FAMILY ROOM. REMOVE SLIDER IN FAMILY ROOM AND INSTALL A 5 FT WINDOW, INCREASE KITCHEN WINDOW SIZE ( MIN 4' SOLID WALL ON EITHER SIDE OF WINDOW), REMODEL KITCHEN, REMODEL BATHROOMS, MISC ELECTRICAL AND PLUMBING. REF: 804-01147. PLUMBING TO INCLUDE: GAS PIPING (1-4 OUTLETS), 1 BAR SINK, 1 KITCHEN SINK, 2 WASH BASINS, 2 TOILETS. AMT $23.50 $0.00 $0.00 So.00 $0.00 $0.00 $0.00 FEE SUMMARY QTY AMT Laundry Tub / Washer $0.00 0 Landscape Irrigation � $0.00 0 P-Trap $0.00 0 Pressure Regulator $0.00 0 Process Piping (per 10 ft) $0.00 0 Receptors $0.00 0 Septic Tank $0.00 QTY 0 0 0 0 0 0 0 SumpPump Swimming Pool Trap Primer Urinal Vacuum Brkr Bkflow(1-4) Vacuum Brkr BkFlow(5+) Wash Basin AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $19.60 QTY 0 0 0 0 0 0 2 NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requiremenis under California statutes 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 ot 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, antl all required inspeettons and flnal approval must be obtained. Failure to obtain inspections and tinal approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (774) 7545626 264G46 (6/00) WOHKERS' COMPENSATION DECLARATION: I hereby attirm under penalry of perjury one ot ihe tollowing declarations: ❑ I have and will maintain e certificate of consent to selFlnsure for workars' compensetion, es provided lor 6y section 3700 oi the Labor Code, tor the pertormance of the work for which thi5 permit is issuetl. ❑ I have end wlll meintain workers' compensation insu2nce, as required by section 3700 oi the Lehor Cotle, for tha peAortnance of the work for which Ihis pertnit is issued. My workere' compensatlon Insurence carrier antl policy number ere: Cerrier. (This�st the permlt is valued et one hundred dollers ($100) ar less J Policy Number: � I certity that in the pedormanca oi the work for which this permit is issued, I shell not employ any pereon in eny manner so as to become subject to the workers' compensation lews of Calltornia, antl agree that if I should become subjact to th orkers' compensetion provisions of Saction 3700 of ihe Labor Code, I shell forthwith comply with ihes�e �ovisions. (/�/ n Applicent Signeture: '�)�M...`X C S��'�- Dete: C'—� 2^ ��i WARNING iAILUFE TO SECURE WORKERS' COMPENSATION CAVERAGE IS UNLAWFUL AND SHALL SUflIECT AN EMPLOYER TO CRIMINAL PENALTIES AND qVIL FINES UP TO ONE HUNDRED T}IOUSAND DOLLARE (510p,000), IN ADDITIIXJ TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOF IN SECTION 3]O60F THE LABOR CADE, IMEREST, PND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirm ihat I am Ilcensed under provisions of Chapter 9(commencing with Seclion 7000) ot Division 3 oi Ihe Business and Professions Code, anA my license is in tull force end eltect. Lic. a S S � 2 Class M � i� l�. ' contractors Signemre: t �y�° Date: G—� 2—� °� CONSTRUCTION LENDING AGENCY: ' ❑ I hereby aHirtn that ihere is a consiruction lending agency for ihe peAortnanca of the work tor which t�is permit is issuetl. (Sec. 3097, Civil Code). Lendefs Name: Lender's Address: Signature: Date: OWNER•BUILDER DECLARATIONS: 1 hereby aHirtn thet under penalry of perjury that I am EXEMPT FROM THE CON7RAC70RS LICENSE LAW for ihe following reason (Sec. 7031.5, Business end Protessions Code: Any city or counry which requires e parmit m construct alter, improve, demolish, or repair eny slmcture, prior to its issuance, also requires ihe epplicant for such parmit to file e signed statement ihat he or she Is licensed pursuant to the provisions ot ihe Contractors License Law (Chapter 9(commencing with Section 7000) oi Divislon 3 of the Business end Professlons Code) or ihat he or she is exempt tharafrom antl the 6esis lor the ellegetl ezemption. Any violation of Section 7031.5 by any epplicent for e permit subjects the epplicent to a civil penalry oi not more than tive hundred dollers ($500).): ❑ I, es owner ot the propeny, or my employaes with wages as thelr sole compensation, WILL DO THE WORK, and the stmcture is not intentletl or offered lor sale (Sec. 7044, Business and Professions Code: The Contractors License Law tloes not apDly to an owner of propetly who builtls or improves thereon, and who tloes such work himsalt or herselt.or Ihrough his or her own employees, providetl that such improvements ere not Intended or oHeretl for sale. If, however, ihe building or improvement is sold within one �eer`o� completion, ihe ownervbuilder will have the burden of provinq that he or she ditl not build or improve for purpose of sale.). � 4 � ,�I (t �.--J . ❑ I, as owner of ihe,prpperty, em EXCLUSIVELV CONTRAC77NG WITH LICENSED CONTRACTORS to consiruct the projact (Sec. 7044, Business and Protessions Code: The comrec(o`rs LIc9%se�i'ew*does'not appiy to an owner oi pmperty who builds or Impmves ihereon, antl who wniracts for such pmject with a contractor(s) IicenSe�purSueN to Ihe ConhaCt'o[fi CIce�5,g Laws.). � O ❑ I am exempt under.sec. `°'R eusiness antl Professions Code lor this reason: Signatura: ^ . �`�'."'a�-� Date: Owner ID veritied by tlnver's license. � Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type at docu�t, i.e. - properry taz 6ill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby cetliy that no eacavation five (5) or more feet in tlepth into which a person is requiretl to tlescend, will be matle in connection with work authonzetl by this permit, and that no building strudure, scaftolding, talsework, or demolition or dismantling ihereof, will be more than Ihirty-sia (36) feet high. (Chap. 32, Grp 2, Ar12, Sac. 341, Ttle B, Calitomia Atlminisirative Cotle). ❑ A5 owner-builder, 1 will not employ enyone to do work which would require a permit trom the Division of Indusirial Safery, as noted ebova, unless such person has e permit to do such work fram the division. Signature: Date: Division of Indusiriel Safety Permit Number: CERTIFlCATE OF COMPLIANCE AND AUTHORVATION OF ENTRV: I certity under penelty ot perjury ihat I have read ihis application and state ihat the information given is correct. I agree to comply with all state laws and city ordinances relating to building construaion, antl emhorize representatives ot the City oi Costa Mesa to enter upon the above-described property for inspection purposes. I agree no� �o occupy or allow occupancy of eny building authorized by ihis permit until finel inspection. �� Sign.a�ture OfI7�Y al Owner(s) Date 1�1U �� t a X1AR/M.�A-.� %o ' 2 Z— ��% AnNOr Authonzed Applicant Date COUE I, INSVECTIONTYPE Q�jF INfIiIRLS 1616 Fixed Sysiem Final Fire Prevention 1266 200 201 Pool Spa Final Final Ra-Raol Final BIocWRetaining Well 202 Final Factory Fire Place 203 Final Sign 204 Finel Demolition CODE� INSPECTIONTYPE 206 Final Mechanical 20B Final Plumbing 210 Final Elecincal 212 Final Fire Prevention 220 Final Planning Approval 222 FinalSite 250 FinalOuiltling/Occupancy G.aIE It�ELS (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: Suite No Vicinity: Parcel Nunmber: Applicanl: Address: Owner: Address Contractor. Address: ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+uniLs) Pool / Spa Lighting Fixts Recept Outle4s Switches Non Res Appl Res Appl Service to 200a Service to 1000a Service over 1000a Motors to 1hp Motors to 10hp Motors to 50hp Motors to 100hp 437 16TH PL 42514113 ANDREW PATTERSON 331 COSTA MESA ST COSTA MESA, CA KRENZ, WILLIAM AND SUSAN 437 16TH PL COSTA MESA, CA Phone: 949-294-9057 CELL Zip: 92627 Phone: 949-574-5312 Zip: 92627 PATTERSON CONSTRUCTION CORPORATION 331 COSTA MESA ST COSTA MESA, CA Phone: 949-294-9057 CELL Zip: 92627 License: 802367 Status: ISSUED Applied: 11/06/2003 Issued: 11/O6/2003 .: j1,� �� b,�4 � SCOPE OF PERMIT ADD A TOTAL OF 595 S.F. ( 295 S.F. TO 15T FLOOR OF AND 300 SQ.FT. TO 2 ND FLOOR) OF EXISTING S.F.D. WORK TO INCLUDE: EXPANDING EXISTING KITCHEN AND ADD NEW BATHROOM TO EXISTING 2ND STORY. REF.: B03-01637 ELECTRICAL TO INCLUDE: 20 LIGHT FIXTURES, 20 OUTLETS, 10 SWITCHES, AND 1 SERVICE TO 200 AMPS. $23.50 so.00 $0.00 $0.00 $0.00 $0.00 522.00 522.00 511.00 $0.00 $0.00 530.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantity 0 0 0 20 20 10 0 0 1 0 0 0 0 0 0 FEE SUMMARY Temp Dist System / Lighting Busway /100 ft Standing Section Misc Electrical Equipment Transformers up to 1 kva/kw ................up to 10 kva/kw .................up to 50 kva/kw .................up to 100 kva/kw ..................over 100 kva/kw Low Voltage Equipment Low Volt Wiring System / Ckt Misc. Conduil Misa Conductor Circus ( gen or ride) Cirws (mech nde or lights) Christmas Tree Stand Fireworks Stand Other Electrical Fee $0.00 so.00 $0.00 $0.00 $o.00 50.00 50.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 50.00 $0.00 Quantity 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 7, 12-21•92) EXPIRATION: This permit shall automatically expire and become void it work Is not commenced within 1B0 days, or if work is suspended or abandoned for a period of 780 days. ' INSPEC710NS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred inepeetlona end final epproval musl be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 zano-ae �doo� WORKEPS' COMPENSA710N DECLARATION: I hereby attirm under penalry ot perjury one ot the �o�lowing declarations: ❑ I have and will maintain a cenificate ol conseN to self-Insure tor workers' compensation, es pmvided for hy seclion 3700 of the Lebor Code, for Ihe peAormence of the work tor which this permit is issuetl. ❑ I have and wiil maintain workers' compensati� ��surance, as requiretl by section 3700 oi the Labor Cotle, tor t�e peAortnance ot the work tor whiU this pertnil Is issued. My workers' compensalion Insurence carner antl policy number are: Cartier. Policy Number. (—Th/is section neetl nat be comple(ed il the pertni '�alued e( one hundred dollers ($700) or less.) 7,� I certity that in ihe performance ol the ork � r which thi ertnit is i ued, I shall not employ any person in eny manner so as to become subject to the workers' � �aompansation laws of Calitomia, e ra that it I s uld becom ubject lo tha workers' compensation provislons ot Section 3700 ot t�e LaDor C e, I shall fotlhwith comply with these pravisions. Appliwnt Signature: Daie: �� /� 6 Z WARNING: FAILIIRE TO SECURE COMPEN COVERAGE IS UNLAWFUL AN SHALL SUBIEGT AN EMPLOYER TO CRI,WNAL PENALTIES AND GMl FlNES UP TOONE HUNDRED TFKKISANDDOLUAE�5100,000) AD01 ONTOTHE ��MPENSATIIXJ,DAMAGESASPPOVIDEDFORINSEGTION3IWOFTMELABORCODE,IMEREST,ANDATTORNENSFEES. LICENSED CONTRACTORS DECLARA710N: I hereby aHirtn that I am licensetl torce and eNect. lic. x ! Contractors Siqnawre: _ CONS7RUCTION LENDING (commencing with Section 7000) ot Division 3 of the Business and Pra sslons ��nd my license Is in full � Class�a Da�e: - //i 6 7 ❑ I hereby aflirm Ihat there is a consiruction lending agency for ihe pedormance of the work for which this pertnil is issuetl. (Sec. 30W, Civil Cotle). Lentler's Name: Lentlers Address: Signature: OWNER-BUILDER DECLARATIONS: Date: I hereby affirtn Ihat under penalry ot parjury that 1 am E%EMPT FROM THE CONTRACTORS LICENSE LAW for the followinq reason (Sec. 7031.5, Business antl Protessions Code: Any ciry or counry which requires e parmit to construct. alter, improve, demolish, or repair any simcture, prior to its issuance, elso requires ihe applicant for such pertnit to file a signetl stetement that ha or she is licensad pursuant to the provisions ol the Contractors License Lew (Chapter 9(commencing with Sectlon 7000) of Divisian 3 oi the Business and Professions Code) or that he or she is ezempt Iherefmm and the basis tor the alleged e:emption. Any violetion oi Sectlon 7031.5 by eny epplicent for a pertnit suDjecis ihe epplicant to a civil penalry oi not mora then live huntlred tlollars ($500).): ❑ I, as owner ot the property, or my employees with wages as iheir sole compensation, WILL DO T1E WORK, antl the siructure Is not intentleA or oNeretl for sele (Sec. 7044, Business and Brofessions Code: The CoNrecbrs License Law does noi applY �o an owner of property who 6uiltls or improves thereon, and who tloes such work himself or herself'or Ih?ough his or her own employees, pwvided ihat such improvements ere not intended or oNered tor sale. If, however, tha building or improvement is sold wit�in one year of completioq the�owno�-builtler will have ihe burdan of proving that he or she did not builtl or improve for purpose of sale.). � ❑ I, as owrrer ot iM1e propehy, am EXCIUSIVELY CONTRAC7ING W ITH UCENSED CONTRACTORS to constmct tha project (Sec. 7046, Businass ane PrMeuions Code: The contracrors License Law does �rio� apply to an owner of property who builds or Improves thereon, and who contracis for such pmject with a contrector(s) licen5a pur5uant to ihe Contrectors License Laws.). ❑ I am exempt under sec. Business and Professions Cotle for this reason: Signature: Dare: Owner ID venfi80 by dnvers licen5e. ❑ Ves ❑ No Drivefs License No. Expires: Verifiwtion ot Ownership by (type ol tlwument, i.�. - property tax bill or �eed): DIVISION OF INDUSTRIAL SAFETY PERMR CEF7TIFIGATION: ❑ I hereby cenity Ihat no excavation five (5) or more feat in depth into which a person is requireA to descend, wlll be made in connection with work authonze0 by this pertnit, and ihat no building structure, scallolding, falsework, or demolition or dismantling thereot, will be more ihan ihirry-six (36) feet high. (Chap. 32, Grp 2, Ah 2, Sec. 341, 7tle 8, Celifomia Administrative Cotle). ❑ As ownar-6uiltler, I will not employ enyone to tlo work which would require e permit from ihe Division oi Intlustrial Safery, es noted ebove, unless such persan hes e permit to do such work from the tlivision. SignaWre: Date: Division of Intlusinal Safery Partnit Number. CER7IFICATE OF COMPLIANCE AND R17A7�ON F ENTRV: I certity under penalty oi perjury ihat I have read this application entl stata �hat the iniormation given is correct. I agree lo comply with all s lews and ciry or mences relating to builtling constmction, end authorize representativas of the Clry of Coste Mese to enter upon the ebOve-de5tnbetl property For in cFon purposes. I a e n0� �o occupy or ellow occupency ot eny building auNorizetl by lhi5 permit until finel in5pettion. COOE I' INSPECTIONTYVE ` 1676 Fixetl System Final Fire Prevention 1266 Pool Spa Final 200 Final Re-fioof 201 Final Block/Retaining Well 202 Final Factory Fire Place 203 Final Sign Final Demolition D �� Da et ��j CODE1 INSPECTIONTYPE 206 Final Mechanical 208 Final Plumbing 210 Final Electricel 212 220 Flnal Fire PrevenNon Finel Planning Approval 222 Final Site 250 Final Buiiding/Occupancy PAIE II�ELS (714) 754-5273 • Fau (714) 754-4856 • www.ci.costa-mesa.c��ILDING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 437 16TH PL Suite: Vicinity: Parcel Number: 42514113 Applicant: ANDREW PATTERSON Address: 331 COSTA MESA ST COSTA MESA, CA Owner: KRENZ, WILLIAM AND SUSAN Address 437 16TH PL Zoning: Phone: 949-294-9057 CELL Zip: 92627 Phone: 949-574-5312 COSTA MESA, CA Zip: 92627 Contractor: PATTERSON CONSTRUCTION CORPORATION Address: 331 COSTA MESA ST COSTA MESA, CA Zip: 92627 Arch : Address: Phone: 949-294-9057 CELL License: 802367 Eng: Address: Status: ISSUED Applied: 09/26/2003 Issued: 11/O6/2003 ISSUED BY: C�� Phone: Phane: Zip: License: License: SCOPE OF PERMIT ADD A TOTAL OF 595 S.F. ( 295 S.F. TO 1ST FLOOR OF AND 300 SQ.FT. TO 2 ND FLOOR) OF EXISTING S.F.D. WORK TO INCLUDE: EXPANDING EXISTING KITCHEN AND ADD NEW BATHROOM TO EXISTING 2ND STORY. Plan Check: $104.69 Permit: $644.25 SMIP Res: $5.00 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $753.94 . , SETBACKS. MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0-0 PARKING Existinq: 4 Rear 10- 0 Rear 0- 0 Reauired: 4 FEESUMMARY PLANNING & ZONING Left 5- 0 Left 0- 0 Pr000sed: 4 Calc Valuation: Claim Valuation: Right 25- 6 Right 0-0 $50,000.00 so.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related regula�ions. (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 180 days. i 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 Inspeetions and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration ot this permit. FOR INSPECTIONS CALL: (714) 7545626 ta4s-48leioo) WORKERS'COMPENSA710N DECLARATON: + • I hereby ettirm under penalry of perjury one of the followinq declarations: ❑� I heve end will maintain a cetliticate of wnsent b self-Insure lor workers' compensation, es provitletl tor by section 3700 of Ihe Labor Cotla, for Ihe peAortnence ot the work for which this pertnit is issuetl. - ❑ I have end will maintain workere' compensation insurance, as required by section 3700 of the Labor Cotle, for the pertortnance of the work for which Ihis pertnit is issuetl. My workers' compensation Insurence carner antl policy number are: Cerrier: Policy Number: is ection need nof be comp/eted it fhe O/ermi�J tl et one hundred dollars ($100) or IessJ .. ertity ihat in ihe pertormence of p6work For iich Ihis permit is issued, 1 shall not employ eny person in any menner so as to become subject to the workers' ' co ensation lews of Califomi /dnd egree at it I sho come su ' ct b the workere' compansation provislons of Section 3700 the Labo1Code, I shall fotlhwith � comply with ihese provision � ` '�j �/� � �Applicent Signeture: Date': .-�� WARNINO: FAILURE TO SE RKE COMPENSA IXJ CAVE IS UNL4W L SUBIECT AN EMPLOVER TO CPIMINAL PENALTIESANO CIVIL INES UP TF OONE HpNpqEp THOUSANDDOLLARE(S ), AD IQVTOTHECOS MP ATION,DAM4GESASPROVIDEDFORINSECTION3]O60FTHELABORCADE,IPf�EREST,ANDATTORNEYSFEES. LICENSED CONTRACTORS DECLAFiATION: I hereby attirm lhat I am licensed under provisions of Chapter 9(commencing with Section 7000) oi Division 3 0l ihe Business and force and effed. Lia k7 Z :'Cless AT if Contrector' g eture: --'- �� , Date:-�� Code, end my license is in tull CONSTRUCTION LENDING AGENCI� ❑ I hereby aNirm that there is a construction lending egency for the pedormance of ihe work for which this permit is issued. (Sec. 3097, Civil Cotle). Lentlar's Name: Lender's Address: Signeture: Date:� I herehy ettirm thet undei.penelty of perjury thet I am E%EMPT FROM THE CONTRACTORS LICENSE LAW for the followinq reason (Sec. 7031.5, Business and Professions Code: Any ciry or counry which requires'a.Dermit to construct, alter, improve, demolish, or repair any strucNre, pnor to its issuance, also requires the applicant tor such pertnit to file a signetl slatement ihat he or.stie,is Ilcensetl pursuant to the provisions of tha Contractors License Lew (Chapter 9(commencing with Sectlon 7000) of Division 3 of the Business entl Professions Gotle) or ifiathe"or she is exempt t�eretrom and the basis for the allagetl exemption. Any violetion of Section 7037.5 by eny applicent for e pertnit sublects the applicent to a civil penalry of not mora than five hundred dollars ($500).): � r� ❑ I, es owner ot Ihe properry, or my employees with weges es their sole compensation, WILL DO THE WORK, antl the structure is not intentletl or oHered tor sale (Sec. 7044, Business and Professions Code: The Contredors License Law dces not appry m an owner ol properry who 6uilds or improves Ihereon, and who does such work himsetl or herselt or ihrough his or her own employees, provided ihat such improvements are not Intended or oMeretl for sale. If, however, the building or improvement is soltl within one year oi completion, ihe owner-builder will have ihe burden of proving ihat he or she tlitl not build or improve for purpose ol sale.). • � I, es owner of the properry, am EXCLUSIVELV CONTRACTING WI7H LICENSED CONTRACTORS to constmct ihe project (Sec. 7044, Business and Professions Code: The contractors Lice Lew tloes not epply to an owner ol property who builds or Improves Ihereon, antl who contracts tor such project with a contrector(s) license pursuant to th tract rs License Laws.). ❑ I am ezempt un s. Business and Protessions Code for ihis reason: Signature: � /% Expires: � n l. Verificatlo oJ,Owne�s ip (type o ocum t, i.e. - roperty laa bill or deetl): � OWTSION OF INDUSTRIAL SAFETV PERMR CERTIFICATION: ❑ I hereby certify ihat no excavation five (5) or more feet in depth into which a person is required to descend, wlll be made in wnnection wi�� work euthorized by ihis permil, antl �hat no building siructure, scettolding, falsework, or demolition or dismantling thereot, will be more ihan thirty-six (36) feet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Title e, California Atlministrative Code). ❑ As owner-builder, I will not empioy anyone to do work which would requira a permil from Ihe Division of Intlustrial Safery, as noted above, unless such person has a pertnit to do suc� work irom the division. Signature: Date: Division oi Industrial Safety Permit Numbec HAZARDOUS MATERIALS AND EMISSIONS CER7IFICA710N: 1 WIII tha epplicent or present or tuture building occupent need to fila end cartify a Business Plen br emergency response to release or Ihreetenetl releese ot a hazerdous me�erlel7 ❑ Ves ❑ No ' (Section 25505 of Ihe Calitornia Health antl Safety Code requires, with some ezceptions, that e Business Plen be tiled with [he Costa Mesa Fira Department by every busineu which has at any one time during e reportad year a quantiry oi hazardous matenals equel to or greater �han a weight of 500 pounds, or a volume o155 gallons, or 200 cubic feet ot compressed gas at stantlartl temperature end pressure). .................................................................................................................................................................................................................................................................................................................._.................................................................... 2 Does or will the applicant or present or fuWre 6uilding occupent need to file a registration torm for ecutely hazardous materials? ❑ Ves ❑ No (Section 25533 of Ihe Calitomia Health and Sefery Code, with some exceptions, requires regisiretlon with the Cwta Mesa Fire Department by each business whic� at eny one time hes on hantl a quantiry ot acutely ha�rdous meterials equal to or greater ihan a weight ot 500 pounds, or e volume ot 55 gallons, ar 200 cubic faet of compressed gas at stantlard temperetura antl pressure). ......................................................................................................................................................................................................................................................................................................................................................................................... 3 Does or will Ihe applicant or presem or future builAing occupant need to prepare an RMPP (Risk Management antl Prevention Program for aately hazerdous matenals)9 (Section 25534 of ihe Califomia Healih and Safery Code provitles ihat the Costa Mesa Fire Department may requii Department oi en RMPP by businesses which are required to register acutely hazartlous matenals with the Fire Dep; ........... ......................................................................................................................................................... 4 If en RMPP is presently required, has Section 25534 of ihe California Healih and Safery Code been fully complied wi .................................................................................................................................................................................................................................................................... 5 Does or will ihe applicant ar present ar future huilding occupen� require tor the work which is the subJect of ihis �F Irom Ihe South Coest Air Oualiry Manegement Distdct or irom eny other air polWtion conirol district or egency9 LJ (Section 658502 ot tha California Government Cotle requires ihat ihe requested iniormation be furnished on applica' ................................................................................................................................................................................................................................................................... 6 WIII any pert of the taciliry to he constmcted under ihis permit ba within 1000 feat irom ihe outer bountlaries of a sch� (tl'yes", ihe taciiity must meet ihe requirement of Sections 25534 antl 42303 of the Ca�ifornia Heelth antl Sefery Cod ................................................................................................................................................................................................................................................................... 7 If e pertnit irom the South Coest Air Quality Menegement District or other air pollution control distdct or egency the preparation, cenification an0 filing with the Fire ment. ......................................... ................................................................... 7 ❑ Yes ❑ No ......................................... _.................................................................... etion a Pertnit tor such consiruction o� modlficetian s �J ND ns tor noo-residentiel building pertnits). epplication, heva all of the tlisclosures prescribetl by Californie Health and Safery Cotle Section 42303 been mede? �J Ves �..J No .................................................................................................................................................................................................................................................................................................................._.................................................................... e Qf yes", ettech cenificate ot compliance trom ihe appropriate air polWtion wntrol oHicer). CERTIFICATE OF COMPLIANCE: I certity that under penalty ot perjury the information given above is correct. I agree to comply with all state laws end ciry ordinances regarding Hazartlous Materials and Emissions. Signewre: Date: CERTIFlCATE OF COMPLIANCE AUTHOR ON OF ENTRY: I cenify under penalry of perjury that I have read this epplication and siate that the information given is correct. I agree to comply wi II state laws an ciry o ces re ting to buildinq construction, ana euthonze representatives of the Ciry of Coste Mesa to enler upon the ebove-described property r inspection purpo s. I ree noi to oc py or allow occupancy of any building authorized by this permit until finel inspection. CQOE t. INSPECTIONTYPE 1616 Fixed System Final Fire Prevention 1266 Pool Spe Final 200 Finel RB-RoOf 201 Final BIocWRetaininq Wall 202 Final Fectory Fire Place 203 Finel Sign 204 Final Demolition h7.11�I:11tiL1�Y CODE� INSPECTIONTYPE 206 Final Mechanical 208 Final Plumbing 210 Final Electncal 212 Finel Fire Preventian 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy �. , i� •" ' PAiE UlIQ1SL$ m i NEWPORT-MESA UNIFIED SCHOOL DISTRICT CER7IFICATE OF COMPLIANCE OF DEYELOPMENT FEES PURSUANT TO AB 7600 AND AB 181 To: ( City of Costa Mesa ( City of NewpoA Beach ( ) Counry of Orange Applicant: Address: Telephone Number: �I / 2 \ ' O TracVParcel and Lot Number(s): � Z� d G% �� Location of Project: Number of Square Feet ot: Residential Space Commercial and Industrial Space CommerciaVlndustrial Project is: (Check One) _ Warehouse _ R8D _ Movie Theater _ Mini-storage _ Heavy Industrial _ Regional Shops _ Light Industrial This projed is exempt because �� x a,.sa z E .30 _ Motel Bank _ Neighbortiood Shops _ RacqueVHeatth _ Hotel Medical Otfice OfAce Park N° . 4908 DisUid Receipt No. Plan Check No�`_ �/�3 � Ta�� 1, �' �-1 �° Total _ Preschool _ Auto Repair _ Hospital _ Large Office _ Office Bldg. _ Restaurant _ Fast Food This certifies that the above-named Developer/Applicant has paid school hadNly fees in comptlance with Government Code sections 53080 and 65995. The Building Pemiits for this square footage in this proposed development may now be issued by your jurisdic6on. Checks are to be made payable to NewpoR-Mesa Unified School District. By The above represenqtion as to square footage is true. Appticant agrees that ii it is irue, then this certificate shall automatically terminate and the appropriate.` Cily/CS Dat : � Ei 6 � � � � AppticeM be that such representatlons are not 1894.88 -6123164 120883 (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa•mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 437 16TH PL Suite No Vicinity: Parcel Nunmber: 42514�13 Applicant: ANDREW PATTERSON Address: 331 COSTA MESA ST COSTA MESA, CA PLUMBING PERMIT Phone: 949-294-9057 CELL 2ip: 92627 Owner: KRENZ, WILLIAM AND SUSAN Address 437 16TH PL Phone: 949-574-5312 COSTA MESA, CA 2ip: 92627 Contractor: PATTERSON CONSTRUCTION CORPORATION Address: ' 331 COSTA MESA ST �- Arch / Eng : Address: ISSUE FEE Backflow irrigation Backflow Preventer Bathtub Clarifer System Connect Qce,Soda,etc) Dental Units Dishwasher Drain, Floor COSTA MESA, CA Phone: 949-294-9057 CELL Zip: 92627 License: 802367 Phone: Zip: License: Status: ISSUED Applied: 11/O6/2003 I ssued: 11 /O6/2003 ISSUED BY: �� Y � � � b ,�� „0 9� SCOPE OF PERMIT AbD A TOTAL OF 595 S.F. ( 295 S.F. TO 1 ST FLOOR OF AND 300 SQ.F7. TO 2 ND FLOOR) OF EkISTING S.F.D. WORK TO INCLUDE: EXPANDING EXISTING KITCHEN AND ADD NEW BATHROOM TO EXISTING 2ND STORY. REF.: B03-01637 PLUMBING TO INCLUDE: 1 BATHTUB, 1 GAS (1-4 OUTLETS), 1 SHOWER, 1 WASH BASIN SET, 1 WATER CLOSET. AM7 $23.50 $0.00 $0.00 $9.80 50.00 $O.OD $0.00 $0.00 $0.00 FEE SUMMARY QTY AMT Laundry Tub / Washer $0.00 0 Landsrape Irrigation $0.00 0 P-Trap $0.00 1 Pressure Regulator $0.00 0 Process Piping (per 10 k) $0.00 0 Receptors $0.00 0 Septic Tank $0.00 0 Sewer Cap for Demo $0.00 0 Sewer Connect $0.00 QTY 0 0 0 0 0 0 0 0 0 SumpPump Swimming Pool Trap Primer Urinal Vacuum Brkr Bkflow(1�) Vacuum Brkr Bkflow(5+) Wash Basin Wash Basin Set Waste and Vent System AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $9.80 50.00 QTY 0 0 0 0 0 0 0 1 0 NO710E: The work auth4rized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicabls codes, and all required Inspectlona and final approval must be oblalned. Failure lo obtain inspections and final approval will result in ihe expiration of ihis permit. FOR INSPECTIONS CALL: (714) 7545626 zao-ae (s�oo) WORKERS'COMVENSAnONDECLARAnON: I hereby aflirm under penalry ot perjury one ot the following Aeclarations: ❑ 1 have end will maintain e certllicate oi consent to self-Insure tor workers' compensation, es provided for by section 3700 of ihe Lehor Code, tor the pertortnence of the work for which Ihis permit Is i5sued. ❑ I have entl will maintain workers' compensetion Insurance, as required by sectlon 3700 oi ihe Lebor Code, Por the pedortnance of ihe work for which Ihis permit is Issued. My workers' compensation Insurence carrier end poliry number are: Certier. Policy Numbec (This section need nof be comp/eted i! Ne rmi s velued e! one huntlretl tlollars l$100) or IessJ �I cenify thet in t�e pertortnanc9.E1 ihe Qrk to� wh'ifAa�s pertrlit is issued, I shall not employ eny person in eny manner so as to become su6ject to the workers' compensatlon laws ot Calilo� rfe n grea t� N(I 5hould b bome sub�ect to Ihe workers' compensation provislons of Section 37 of tpe Lebor Cotle, I shall fotlhwlth comply with these provisi r(s //� ApPlican� Signa�ure: Date: � /� /!l � WAtiNING: FAIIURE TO S <ERS' CO ENS ON COVERAGE IS UNIAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL PE LTIES AND GVIL FlNES UP TOONE HUNORED T}IOUSANODOLLARE , ) I DDRIONTO OFCOMPENSATION,DMIAGESASPFWIDEDFOqINSECilON31WOFTHELABORCOOE,INTEflEST,ANDATTOqNE1"SFEES. LICENSED CONTRACTORS DECLARATION: I hereby aMirm ihet I em licansetl undejp�rovislons ol Cnepter 9(commencing wllh Section 7000) of Division 3 ot fhe Business and Professions Coda, and my Iicense is in tull torce antl attect Lic. q � 1SU �-3 Class M � / / ContrectaYs Signeture: � Data: - �� o i CONSTRUCTION LENDING AGENCY:v �� ❑ I hereby aflirm that there is e consimction lending agency for the pedormance of ihe work for which ihis permit is issued. (Sec. 3097, Civil Code). Lendar's Name: Lender's Address: Signature: Date: OWNEp-BUILDER DECLARATIONS: I �ereby aHirtn that under penalty of perjury Ihet I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business end Protesslons Code: Any Nty or coumy whic� requires e permit to consimct, elter, improve, demolish, or repair eny siructure, prior to its issuance, also requires the applicant for such permit to file a signetl stetement thet he or she Is Iicensatl pursuent to ihe provisions of the Gontrecbrs Llcense Law (Chapter 9(commencing with Sectlon 7000) of Divislon 3 oi Ihe Business end Prolessions Code) or Ihet ha or sha is exempt therefrom and the basis for the ellaged e:emption. Any violetion oi Section 7031.5 by any epplicent for a permit subjects the epplicant to a civil penelty of not more than Ilva hundred tlollars ($500).): � I, as owner oi ihe propeny, or my employees wit� wages es their sole compensa�lon, WILL DO 7ME WORK, and the siructure is not intende0 or otteratl for sale (Sec. 7044, Business and Professlons Code: The Coniraclors License Lew does not apply to an owner of property who builds or improves thereon, and who does such work himselt or herself or ihrough his or her own employees, providetl Ihat such Improvemenis ere nol Intendetl or offered for sale. If, however, ihe building or improvement Is sold within one year oi completlon, the owner-builder wlll have Ihe burden ot proving tha� he or she did not builtl or improve for purpose of sale.). ' ❑ I, as owner ot tAe propetly, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (SecJ044, Business antl Pmfessions Cotle: TTe cbntracbrs�License Lew tloes not apply to en owner ol property who builds or Improves thereon, and who contracts for such project with a contrector(s) license pursuent to the ContrActors,License LawsJ. ❑ I am exempt under sea ` ��.� =�+i Business and Professions Code br Ihis reason: Siqnature: �� Date: Owner ID venlied by tlrivels license. �.,❑ Ves � No Dnveis License No. Expires: Verification oi Ownership by (type ot tlacument, i.e. - property tex bill or tleed): OIVISION OF INDUSTRIAL SAFETY VERMIT CERTIFICATION: ❑ I hereby certity that no excavetion flve (5) or more leet in tlepih into which e person is required to descenq will be made in connection with work authoAzetl by this permit, and that no 6uilding structure, scaflolding, falsework, or tlemolition or dismantling t�ereof, will te more than thirry-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Ttle B, Celitomia Adminisiretive Cotle). ❑ As owner�builtler, I will not employ enyone lo tlo work which would requira e permit irom the Division of Intlustnel Sefety, as natetl above, unleu such person hes e pertnit to tlo such work from the divisian. Signature: Date: Division of Industnal Sefery Pertnit Numbar: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 7 Will tha epplicant or present or futura �uiltling acupant need to tile entl certity a Business Plan for emergency response to release or ihreatenetl releese of e hazartlous materlal7 ❑ Yes ❑ No ' (Section 25505 ot ihe Celifornie Heel�h end Sefety Code requires, with some exceptions, ihat a Business Plan be filed with the Costa Mesa Fire DepanmeN by every business which has at any one time dunng a repohed yeer e quantiry of hazartlous matenals equal to or greater than a weigh� 01500 pounds, or a volume o155 gallons, or 200 cubic feet of compressed gas et stendard temperature end pressure). .................................................................................................................................................................................................................................................................................................................._................................................................... 2 Does or will the applicant or present or luture builtling occupant need to lile e registration fortn for ecutely hazardous materialsl ❑ Ves ❑ No (Section 25533 0l Ihe Californle Heelth end Satety Code, wlth some exceptions, requires reglsirallon with ihe Costa Mesa Fire Department by each business which at any one time hes on hantl a quentity of acutely hezertlous metenals equel to or greater than e welght oi 500 pounde, or a volume of 55 gellons, or 200 cubic feet ol compressetl ges et stentlard temparature entl pressure). ........................................................................................................................................................................................................................................................................................................................................................................................ 3 Does or will the epplicam or present or future building occupant neetl to preDare an RMPP (Risk Management and Pre�ention Program lor acurely hazertlous metenals)7 ❑ Yes ❑ No (Section 25534 0l the Californie Healih end Safery Code provides that �he Costa Mesa Fire Department may require the preparation, cenification anO tiling wit� the Fire Depertment of en RMPP by businesses which ere requlred to register acutely �azardous meterlels with the Fire Department. .................................................................................................................................................................................................................................................................................... ......................... ................................................................... 4 If an RMPP I5 oresentiv reauired. has Section 25534 of ihe Calibmia Haalih and Safetv Code been fullv comolied with7 ❑ Yes ❑ No ooes or wlll �he appllcen� or prasent or fuWre builtling occupen� requi trom the Sou�h Coesl Alr Ouality Menagement Dlstdct or imm eny oth (Section 658502 of the Califomia Govemment CoEe requires that ihe information be tumis�etl on aoolications for nornresidentiel ni any part or ma racmry to oa cwstructed under tms pertnrt oe wimin iuuo ree� vom me ourer ooundanes ot a scnoorr LI res L yes', the faciliry must meet Ihe reduirement ol Sections 25534 antl 42303 of the Califomia Heal(h and Safery Code). .................................................................................................................................._...................................................._........................... ................................................... e permlt irom Ihe Sou�h Coasi Air Oualiry ManaBement Disinc� or other eir pollution wnirol disirict or egency is required for Ihe � iolicatlon. heve ell ot �he disclosures orescnbetl Ov Cellfornia Health antl SeteN Code Section 42303 been made7 ❑ �es ❑ No d CERTIFICATE OF COMPLIANCE: I certity Ihat under penelry ot perjury ihe inlortnation given aDove is correcL I agree to comply with all siate laws end ciry ordinances regarding Hazardous Materials end Emissions. Signature: Date: CERTIFlCATE OF COMPLIANCE AND AUTHORIZA710N OF ENTRV: I cenify under penalty ot parjury Ihat I have read this epplicalion end state that Ihe information given Is correct. I agree lo comply wiN all stai9 law ry orClnances releting to building construction, entl 9uthorize represenlatives of I�e Clry of Costa Mesa to enter upon �he ebove-described property for inspectio rposes. egree not to acupy or allow occupancy ot any builtling authonzed by this pertnit until finel inspection. cooe �. 1616 1266 200 201 202 203 Fised System Final Fire Preventlon Pool Spe Final Final RB-Rool Final BIocWRetaining Well Final Fectory Fire Place Finel Slgn 204 Final Demolition pAg — 1ti�8lS COOE� INSPECTIONTYFE 206 Final Mechanical 208 Final Plumbing 210 Final Elecirical 212 Final Fire Prevention 220 Final Planning Appro�al 222 Final Site 250 Final Building/Occupancy ,�/ .0 �3 � Dat P� IIfI�lLS e (714) 754-5273 • Fax (714) 75d-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 437 16TH PL Suite: Viciniry: Parcel Number: 42514113 Applicant: WOODMAN, DANIEL Address: 1541 W CHANTICLEER RD ANAH�IM,CA Zoning: Phone: 714-520•5757 Zip: 92802 Owner: PALMQUIST, DAN AND LEANNE S Address 437 16TH PL COSTq MESA, CA Contractor: PALACE BUILDERS Address: 1541 W CHANTICLEER RD ANAHEIM, CA Zip: 92802 Arch : Address: Phone: 949-433-4078 Zip: 92627 Phone: 714-520-5757 License: 755132 Eng: Address: Phone: Status: fSSUEO Applied: 06/23/2004 Issued: 06/23/2004 �S��G • ' �' � � � � . ,'. Phone: Zip: License: license: SCOPE OF PERMIT INTERIOR REMODEL TO AN EXISTING SFR. SCOPE OF WORK TO INCLUDE: NEW 5 X 4 OPENING IN WALL BETWEEN KITCHEN AND FAMILY ROOM. REMOVE SLIDER IN FAMILY ROOM AND INSTALL A 5 FT WINDOW, INCREASE KITCHEN WINDOW SIZE ( MIN 4' SOLID WALL ON EITHER SIDE OF WINDOW), REMODEL KITCHEN, REMODEL BATHS, MISC ELECTRICAL AND PLUMBING.. Plan Check: $190.61 Permit: $293.25 SMIP Res: $1.80 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $485.66 SETBACKS MAINSTRUCTURE Front 0-0 ACCESSORY Front 0. 0 PARKING Existina; 0 Rear 0- 0 Rear 0- 0 Re uired: 0 FEE SUMMARY Calc Valuation: Sis,000.00 Claim Valuation: S�a,000.00 PLANNING & ZONING Left 0- 0 Right LeN 0- 0 Right Proposetl: 0 7 � 0- 0 NOTICE: The work authorizetl by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become voitl if work is not commenced within 1 BO days, or if work is suspended or abandoned tor a period oi 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOH INSPECTIONS CALL: (71q) 7545626 24d6-4fi IN00) WORKERS' COMPENSATION DECLARATION: I hereby attirm under penalry of perjury one of the tollowing tleclarations: ❑ I have and will maintain a cerlificete oi consent ro seN-Insure for workers' compensetlon, es provided for by section 3700 of the Le6or Cotle, for the peAormance ot tha work tor which this permit is issued. ❑ I have end will meintain woAcers' compensation Insurence, es requireC Gy section 3700 of ihe Lebar Cotle, tor Ihe performance of the work for w�lch ihis pertnit is issued. My workers' compensation Insurance carner and policy number ere: Carrier: Palicy Num6er. /This section need nof be canp/eted U fhe permlt is veluetl et one huntlred tlollars ($100) or /essJ � I certity ihat in Ihe peAormance of the work for whith IhiS permit is i55uetl, I 5hell not employ eny parson in eny manner s0 a5 to become subject to Iha workers' compensation laws oi California, entl egree that if I shoul0 become sub�ect to 1 orkers' compensation provlsions oi Section 3700 oi Ihe Lebor Cotle, I shall fotlhwith comply with Ihese visiong �% /� / ^ AppliwniSignaWre: ��,,,K�X l" . �/ �' . _ Date: _ _l4 ' G2- 'v � WAFWING: FAILURE TO SECURE WORKERS' WMPENSATION COVERAGE IS UNLAW FUL AND SHFLL SUBJECT AN EMPLOYEP TO CRIMIWIL PENALTIES AND CNIL FlNES UP TO ONE HUNDRED h10U5AND DOLLRRE (5100.000). IN ADDITION TO THE CQST OF COMPENSATION, OAMAGES FS PROVIDED FOR IN SECTION 31OB OF THE IABOR COOE, INTEREST, ANO ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: � I hereby aHirtn Ihat I am licensad under provisions of Chapter 9(commencing with/� ection 7000) of Division 3 0l the Business and Prolessions Cotle, anA my licensa is in full larce end ettBCL Lic. A �%� 3 Z r� // CI85s N 3 Contrac[ors Signature: 1 _ �, oate: (� - 2 2- n y � CONSTRUCTION LENDING AGENCV: ❑ I hereby aflirtn that ihere is a wnsiruction lentling egency for the pedormance ol the work br which ihis Dermil Is issued. (Sec. 3097, Civil Code). Lentler's Name: Lentlefs Atldress: Signature: Date: OWNER-BUILDER DECLARA710NS: I hereby aHirtn�ihe4under penalry of perjury Ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for Ihe lollowing reason (Sec. 7031.5, Business antl Protessions Code: Any ciry or iounty which requires a pertnit to consiruct, alter, impmve, demolish, or repalr eny structure, pdor to its issuance, also requires the applicant tor such permit to file a signed�stetement that ha or sha is licensad pursuent to the provisions of the Contractors License Lew (Chepter 9(commencing with Sectlon 7000) of Division 3 ot the Business and Prolessiori.s Gode) or that he or she is eaempt theretmm and the basis lor ihe alleged ezemption. Any Wolatlon of Seclion 7031.5 by any epplicant for a pertnit subjecis Ihe appliwnt to a civi� pahalry'-ot nwmore than tive hundred dollare ($500�.): ❑ I, as owner oi Ihe pmperry, or myemployees wilh wages as iheir sole compensatlon, WILL DO TME WORK, end the strucWre is noi inlended or oNeretl for sale (Sec. 7044, Business and Professions Code: The Contractors License Law tloes not epply to en owner of properly who builds or improves theraon, end who does such work himselt or herseli or ihmugh hl5 or her own employees, provided thet Such Impmvemenis are not inlendetl or oNered for sale. If, however, Ihe building or imprOvemenl is sold within one year of completion, the owner-builder will heva the burden ol proving that he or she did not builtl or improve for puryose of sale.). ❑ I, as owner of the property, em EXGLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the projec� (Sec. 7044, Businass end Prolessions Cotle: The contractors License Lew does not epply to an owner ol propeny who builds ar improves thereon, end who contrects br such projeci with a coniractor(s) license pursuant to iha Contractors License Laws.). ❑ I am e:empt under sec. _ SignaWre: Owner ID verified by dnvers licen5e. Verificetion of Ownership by (�ype ot Business and ProfeSsions Code lor this reason: ves ❑ No i.e. - propehy tez bill or deetl): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: Driver's Licensa No. oate: Ezpires: ❑ I hereby certiy Ihat no ezcavation five (5) or more faat in aepth into which a person is required ro tlescend, will be mede in connectlon wilh work euthodzed by this permit, and that no building simcWre, scaHolding, lelsework, or demolition or tlismantling thereol, wiil 6e more than ihirty-six (36) feel high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title B, Calitarnia Adminlstrative Code). ❑ As awner-builder, I will not employ anyone to do work which wauld require e permit irom ihe Division of Intlustdel Sefety, es notetl above, unless such person has e permit to tlo such work irom the tlivision. Signawre: Date: Division oi Intlustrial Sefery Permit Number: CER7IFlCATE OF COMPLJANCE ANU AIJTTIOiiIZATON OF EMRY: I certify under penalry of perjury that I have reatl this eppliwtion entl siate that the information given is wrrect. I agree to wmply with all state laws and ciry ordinances relating to Duiltling consWction, and euthorize representa�ives ot Ihe Ciry ol Costa Mesa to enter upon the ebove-descnbad properry tor inspection purposes. I agree noi to occupy or ellow occupancy ol eny building authorized by lhis pertnit until linel inspection. �Si a re Oi Leg wner(s) Date �, +,�: . , C� •- 2z -ds� Antl/Or Aut�orize Applicant Dete COUE 1. INSPECTIONTYPE 7616 1268 Fixed System Final Fire Prevention Pool Spe Final 200 Final Re-Root 201 Final Block/Retaining Wall 202 Final Factory Fire Place 203 Finel Sign 204 Final Demolition fj�j�, INi1fIAL5 COUE I INSPECTION TYPE 206 Final Mechanical 208 Final Plumbing 210 Final Elec�ricel 212 Final Fire Preventlon 220 Finel Planning Approvel 222 Final Site 250 finalBuilding/Occupency �g �� a . � ��'..��l.C� B21IL� ��5 GeneralContractors Lic# B755132 June 22, 2005 City of Costa Mesa Development Services Department P.O. Box 1200 Costa Mesa, CA 92628-1200 Attn: Ed Petros, Chief of Inspection RE: 437 16th P1., Costa Mesa B04-01147, E04-00726, PO4-00447; Remodel With regard to your letter dated 6/14/O5, we have completed the above mentioned project. I am requesting an extension of this permit so that I may have time to obtain the signed inspection card from the homeowner. Thank you. Sincerely, �� ! Daniel E. Woodman General Contractor s 1541 `W C7fA9�77CL��,�D • A��I�[�IM Cs192802 •(714J 520-5757 •�ax (714J 635-6676 Ce!!(714J322-5937 • paGuz6uilders@netzero.com October 13, 2003 CITY OF COSTA MESA P.O. BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 92628-1200 DEVELOPMENT SERVICES DEPARTMENT OFFICIAL PUBLIC NOTICE OF ZONING APPROVAL RE: ZONING APPROVAL B03-1637 437 16`h Place, Costa Mesa The Planning Division has completed its review of the above-referenced project. The application has been approved based on the following project description. PRO✓ECT DESCRIPTION: The applicant is expanding the second floor of their house by 300 sq. ft. The addition will be made to the rear of the house; two dormer windows will also be added to the front of the house. The zoning approval will become final at 5 p.m. on October 2003, unless appealed by an affected party (including filing of the necessary application and payment of the appropriate fee) or by a member of the Planning Commission or City Council. If you have any questions regarding this notice, please feel free to contact the project planner, Willa Bowens Killeen, at 714-754-5153, between 8 a.m. and 12 noon. Distribution: William and Susan Krentz 437 16`" Place Costa Mesa, CA 92627 Jerry Piersall 438 E. 16`" Place Costa Mesa, CA Henry Thayer III. 443 16`h Place Costa Mesa, CA David Arnold 434 E. 16`" Street Costa Mesa, CA 92627 Viola Smith 444 E. 16`h Street 92627 Costa Mesa, CA 92627 Delmar Hurel 433 16`h Place 92627 Costa Mesa, CA 92627 Building Division (714) 754-5273 • Code enforcement (714) 754-5623 • Planning Division (774) 754-5245 Fwc ��ia� �sa-aess • roo pia� �sa-szaa • www.o�.00s�a-mese.ca.us PLANNING ZONING REVIEW SUMMARY Location: 437 16"' Place Plan Check: B03-01637 Request: To add 300 sq.ft. to the existing second floor of a single-family residence. SUBJECT PROPERTY: SURROUNDING PROPERTY: Zone: R1 North: General Plan: Low density residential South: Lot Dimensions: 60 ft. by 100.5 ft. East: Lot Area: 6,030 sq.ft. West: Existing Development: Two-story, single-family re DEVELOPMENT STANDARD COMPARISON Development Standard AII surrounding properties are zoned R1 and contain two-story, single- familv residences sidence Citv Requirement Proposed/Provided * Residential Design Guideline "* The new construction does not exceed 15 ft. in height within the 10 ft. left side setback area. CEQA Status Exempt- Class 1 Final Action Planninq Division Pfl0.1EtT RDDflESS: Q 3'� 1( L]j pj, OWNEP'S NRME: EDWA.RD D H£RNANDES FDOPESS: $�L RNCHIENGINEFfl: AUONESS: NEG.NO.: uxiT: UNIT: "EpmiTTEE: FERRARA ROOFING ( 714 ) 6?2-8233 nooness: j013 GARFIELD CM CA 92626 UCENSE� CONTBPCTOB DECUIBRTION: I �ere�y allirm ihat I am licensetl under pmvisions af Chapter 9(commencing witA Semion 70001 ol Oivisian 3 0l Ihe Business ana Pmfessians f,atle. and my license is in tull lorce anG efiect. ciTr uc.: q 1 7 9 STATF UC.: 3 Q � 7 4 Q (� ��ss: _— 3 9�J �— Oate: � I Signamre: —� 19i✓�°X —� wOBRENS'CO PENSRTIONOECIAflPTION: I�ereEya��irml�atlhaveacertilitaleolWnSent�oSeli-in5ure0raCertiliCalea�Worker5' Comoensation Ins�}r,aqc or3,c$rulieQ copy Inereol ISec�ion 3800. La�. POLICYNO.: SLb�S/�S—iS E%P.OFTE: 7�OSI9� comraxr: STATE ❑ Cerlilied copy is hereUy �umisAeU. � Certilied copy is Iiled wilA Ihe ciiy 9uiltling Oivisian. . �/ / ///� a�e: � � Aoolicant: !. ^J � i7�F�` E%EMPTION FR M WOB EHS' COMPENSATION OELIABATION: Qhis sec�ion neeE no� be compleiea ii ��e Oermit is �or ane Aundrea ($100) ar @55�. I ceriify Ihal in ihe petlormance ol Ihe work for whi�h I�is permi� is issued. I shall nol employ any persan in any manner so as �o become su�iect �a t�e Workers' Compensation Laws ol Caliromia. Dale: Signa�ure: NOTICE: II. after making inis tleclaration, you snoula �ecame su�iect to the Worker5' Compensation provisions af the Labar CoUe. you must lorthwil� comply wi�h such pmvisions or Ihis Dermil s�all Ue tleemed revokea. CONSTPOCTION LENOING PGENCV: I hereby allirm ��at I�ere is a cons�mc�ion IenOing agency �or Ihe pedormance oi Ihe work for which Ihis permil is issuetl (Seclion 3097. Civ. C�. LENOEN: aooness: OWNEfl BUILOER OECNBpTION: I hereby allirm ihal I am exemp� �mm Ihe Coniractors S�a�e License Law for the �ollowinB reason (Section 70J7.5 Business and Pmlessional Cotle'. Fny city at counly which requires a permit to consiNct, alter, improve, tlemolish, or repair any slNCWre. prior to ils issuance, also repuires �he apPlicant lor such permil lo lile a signetl statement ihat he/sAe is Iicense0 pursuan� �o �ne D�avisions ot i�e ConVaclois' Slate License Law �C�aD�er 9(wmmencinp wiih Section 70W) ol �ivision 3 0l t�e Business anU Prolessions Cotle� or that he/she is exempt �herefmm ane the basis for ihe alleAeU e�emption. Hny violatian oi Section 7031.5 Oy any applicanl lor a permi� SUDlecls Ihe apDli[ant �o a civil penaliy oi not more �han five hunUre� Gollars (SSIXI). I, as owner al Ihe pmpeny or my employees wi�h waqes as Iheir sole compensa�ion, will do �he wark. and �he ❑ slruciure is noi inientletl or o��ered lor 5ale (Seclion 7044. Busine5s and Pm�essional Cotle: The Contrac�ors' State License Law Ooes nol aDDly �o an owner of a pw0eny wAo UuilAs or impmves ihereon, and wAo Aoes such wofk himsetl/herself or thmugh his m her own em0loyees, pwvi0e0 I�at suc� impmvemems are not imendetl or offereA for sale. II, however ihe Ouiltlir.g or imp�Ovemenl is solA vnl�in one year o� cample�ion, t�e owner will �ave �he �ur0en o� pmving �e/50e di0 no� bui10 or improve lor I�e purpose ol sale�. I,as ownero�ihe propetly.am exclusively conlracling wilhlicensed conVactorslo cons�mc��he Orolec��Section 70d4, Business ❑ antl Pmlessions CoOe: The ConVac�ors' Slaie Licenu Law Ooes noI apply Io an owner of DroDehY who builds nr impmve5 ihereon and wAo ConbaCls lOr Sut� proletls wil� a ContraClor(5) litense pursuan� fo IAe Conlratiors' Slale License law). I am aware �� O�DoI of Ihei� Worker'S COmpensation in5uranCe SAoultl Ue pmvitleC �o me. � I am exempl un0er Section: B. 6 P. C. br Ihis reason: Oate: Owner: I �o hereUy cenily ihal I am aware ol anG untlerstand the requirements of Calitomia Health an0 Safery CoAe Sectians 25505, 25533, and 2553C and Inat IoranyluWre bml0ing occuDaniwilVwillnol (circle ane) nee0 lo com0ly vnt� Saitl state co4e5 an0 ihe requiremenisfora Dermit lor Con5lmcli0n ar moGilica�ion imm I�e AirOuality Manag¢meni OiSiricl. Fe5i0entialcon5imc�ion applications are eeempi tmm Ihese D�Ovi5ion5. Dale: AOOlicanL I hete�y tttldy Ihdt I nave reaa Inis aoGlication ana slale Itul tne aDove inbrmation is cOrrttL I agree ta tomON ��h all ciry and counry ortlinances anG staie iavrs re�ating �o Uuitling cansimc�ion antl here�y author@e re0 n�alivu o� ha uty �o ¢n�er upon t�e above-mentioned O�opetlY �or in50 ��ion Ou ses. �� n , Oate: � —Appl¢am: Pink—Revenue; GOIEanrotl—Auessor CZTY OF COSTA MESA — BUILDiNG PERMIT PERM NO: H 054�°: PERMIT NO; B 054893 PLAN CHECK NO; N GOVT; N SUPP; N CONSTRUCTSON TYPE: V—N PER:✓.IT TYPE; STR PURPOSE: ALT JOB DcSCRIPTION : T/ OFc AESHT REROOF W/ CONP SQ FT: 6,400 CLA:CM VALUE: 6,400,00 CALC—VALUE: 6,400.00 GROUP OCC: R-3 / COMM�ENTS: T/ OFF RESHT REROOF W/ COMP #�k iFif �lE �lE �K� �Yr�k 3c ic lf aE jE �1E �lf•je Y. #� �k 1E ic # iE if iE �)f -lE if iE lF�1f �k if �1E iE �k �% if iF if �1E-lE iE �lf # 9E �� jE �lE dE �)F �Ik # iE lE ii �M �lE i� jE if �IE �N� iE �fE dti iE x.l(� iE �% #�lf if �%�% M# 'l. O N T N GS ERTEA�AiJCIxRSE M E N T S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING --------- FRidT: rT 111 REAR: F1' IN eRNT; FT IN REAR: rT IN LEFT; FT IN RGHT; FT IN LEFT: FT IN RGHT; FT IN FARR�NG REQ• PROV: PAACEL: 00000000 ZNE: REF NO: PLANNING Ni3TES> ) � �t #?E iF 1E iF iF iE ie iF iE R iE'7f3f-�lE ii iF ic 1F � iF iE ie # ih iF 1F?E iE iElE iE 1i� if iF 3F 3h i! # iF iF if 3E if� iF if if ii iF?F * iM1 if if � IF ii� i't!F iE iE iF i't iE ie if i'r?E i� if 3E iE i�?'r 3f 1F 1f # D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N;T S ZONiNG APPROVED BY DATE: " �— HUILDING APPROVED BY : DATE; A[�P1,ICATION ISSLTED $X: —s—�—�—'-- �.,y_. DATE� I' � O 1 iEiFifiEi(�1Fi4�141Ei4#EiF1EiE�lfiPiEiFiE ifiE � �iFxa��n-x�x�n�iexn�iririfiElfiF#ifaEiFik�'�—i"tk�iE af1'tiFiE�iFififielEiE�iFfieii�i'ri!�3fiilt�iPiEiPlEiFiElEitiEK'%ii�'1Fif%�iFifiEiFlElf iEiE1fR1FiFIF-IfiFIFk3hiE�ifieifififlf�L�ieifi'ti4�)f3eiEK�3eiFlflEifiFRY.�#4 LEGALI2ATION:N F E E S U M M A R Y STRUCTt7RAL SEGMENT:Y '' BLDG PMT PLUMHING ELECTRIC' MECHANIC FIRE SMIF/kE5 GRADING PERt?_TT 90.00 , 64 S,MIP/NON—RES;. PLAN • iSSi7E FEE %' BUILDING—DIV—> PERMIT ISa^tJE P1,A —CHECR TOTAL PA1D .• DUE TOTALS----> 90.69 O,UO 0.00 90,64 90,64 .00 REVcNUE DIVISION TOTALS--> COLLECTED: 90.64 OVER/SHORi: ,00 fiLUG PMT PLUMBING ELECTRIC MECAANIC FIRE SMIP/TOT GRADING FLAN—CPIECK 90.00 .69 !f iF 3E iF ih ic 3'r if 1F 1f iE if IF i'r if iF iE i'r 1ElE iE aE IE 1f iF iF 1E )f 1F �le ic if ff IE If 1f iE ii� ii's.� iE iE iE if� if 1F lf aE if i! 1f i( N� iF ih N� iFi't iF i!' 1b-lf• 1i iF i' i4 k ii� 3E ii� ie 3E ic 3f 3f iF 3E if��lf Z N D I V I D U A L F E E H R E A K D O W Id TYPE QTY D E 5 C R 2 P T I O N SFR 6400 REROOF BY VALUE RESIDEhTiAL NOZONE END OF FEES lpo.l�? _ yaG� �7 i7NIT COSi 1.0� �•. . .,. .. �1 ','�1 TOTAli COST 6,QUO.OU � ! . �'_ ' �. • r CONSTRUCTION AND PLANNING POOL t > APPROVALS Permit # Date Inspector p�ppROVALS Permir # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Loca[ion 2. Soil Pipe�Undrgrnd.. ' 53. Steel Reinforcement " 3. Electrical Conduit UtilitY-Undrgrnd. 54. Forms 4. Electrical Conduit�Undrgrnd. 55. Electrical Bonding 5. Steei Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE 7. Footings 58. Electrical Cqnduit�Undrgrnd. 6. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe�Undrgrnd. 60. Backwash Lines, P�Trap, O Undrgrnd. ' 10. Structural Floor System � . 67. APPROVAL TO DECK 17. Property Sewer Line & House'Connection � 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 74. Rough Plumbing 65. Etectrical-Finai 15. Rough Electrical�Conduit , 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access ApProval 17. Reugh Wiring Sign 68. APPROVED FOR PLASTEftING 18. Rough Electrical�T Bar Ceiling � 69. POOI/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure , 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping OGas ❑Oil 23. Gas Pipe�Rough & Test 72. Underground Flush 24. Roof Framing 73.�Undergrnd.StorageTank OGas ❑Oil 25. Roof Sheathing /( 7..1.�� W�q, Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat . . 75. Dry Chemical ' 27. Frame and Flashing . 76. Dry S[andpipe - 28. Lathing & Siding 77. FIXED SYSTEM FINAL � . 29. Insulation 78, FIRE PREV. FINAL � 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 37. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final ' 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe�Test 36. Hood or CanopY 37. Final Factory Fireplace . 38. Final Plumbing 39. Water Service-Final � 40. Gas Service-Final 41. Solar pomesiicFinal � 42. Backflow Preventer , 43. Backflow Irrigation 44. Landscape Irripation SYstem _ 45. Sound Attenuation 46. Handicap Regulations 47. FINALSTRUCTURE&BUILDING ��i �'� � �j 48. FINAL PI.ANNING 49. Electric Release to Edison /� � '7�.4� � � �s� � / / 6"� 50. Gas Release to Southem Califurnia Gas Co ' ' 51. CERTIPICATE OF.00CUPANCY , No. Date � 29234 COSTA MESA BUfLDING-SAFETY DEPARTMENT P.O. BOX 7200 COSTA MESh CALIFORNIA Y2640 For Applicant fo Fi1! In ComplNaly TYPE OR PRINT ADDfiEiBD "C� / I �� `�L/TL� COSTA MESA, CALIFORNIA 1JWNER Newport Balboa Savings & Loan MAIL ADDRHHB V L� O ��Ty Newport Beach No•6733130 u n OREN'GI eN sn RombergerFAl?,.No 5408833 mea< 4501 Birch St.. Newnort BeacY OCT 16-68PA��00 879� *'a*1?_4.SG CMSk APPLICATION FOR PERMR BUILDiN(i ior OffJce Use On►y RfCQ1I1' NO. E M NO. _ �_ 4 %L °"13i";i`�`° " i� i� i ZONINO wooneos 4501 Birch St., Newport Beach o■; R�rnox Lot 13 a 7 �i.n, Newport Beach A.P•NO. — — $TATg 146423 THL x540 8833 90'rT08OROR8ARRH�N08?IALLBHL688TMAN LIC. NO. N . OFLOT 8'3� X 6�� „pp�N��• ALLOWBD W.B.C.HlGUIR6M8NTI- YARDIAPPROVCO YARDB MPROVHD VSEOP MAIN BUILDINO ACCHGLOflY BUILDINO EXI8TIN6 BLDO. �(FROMC LICTR[R) + f6TCACK L�Nt �110Y FRONT �Q PT r( PT cadi¢rt o� srRCR RfAR Y D BIDLYA DI L�Ff RIQliT R.lIDR S F�. Ff. DESCRIPTION OF WORK �. a�c S Fr. rr. (p `ni_ rr. N" -" X TC11AT1 N ADDITI N RGR � U� -� DIiTANCtlIT. 9[T. MAlfi Q MAIN BLD ACCE84. BLD08. REYAIR M IN 6M Ll8 BUILDINO No.o� ��R•� V-40-68 DATB 61Z6 1984 ROOMB 7 R 1 1'l�z' C. U. P. MPROVBO EXTHRIOR WALL I ROOP MPROV[O �— p COVERIN6 StUCCO COVBRINQ shake OT ' DAT! e UDR OP eU i LDINY AND WORK TO �6 PtRFORM�O a W amily dwelling w/attached garage � P b��v- �S b� / �Daarr. � /�v'O� � � XlR6BY IICKHOWI.tD06 TXAT 1 XAVi ��I10 TM16 APPLICA OH TMi AMOUNT ON 4NOHR VALUATON IB FOR TX6 j ANO BTAT6 TXAT TI[ AlOVC 1� COpp6R�AND AORB[ TO COM. �UNPOB¢ O� fdTAGLIGNINO A PHRMIT IEH ONIY. 5 PLY WITX ALL CITY O N RI1T6 4WY R[OULAi1N0 y�UAT1ON �� p0 � OUILDINOCONBiR ON PERMIT FEE PERMITfE �P � /��/ S� � AUTHORIZ6D AG[NT a�� / / � / S.9 TOTAL FEE