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Home My WebLink About442 16TH PL - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 JobAddress: 442 16TH PL Suite No Vicinity: BATHROOM ParcelNumber: 42514209 Applicant OLSEN, ERIC Address: 158 N GLASSELL ST SUITE 201 MECHANICAL PERMIT Phone: 714-7�1-8400 ORANGE, CA Zip: 92866 owner: ALSHULER,ROBERT WHEATON Address: 442 16TH PL Contractor: Address: COSTA MESA, CA OWNER-BUILDER Phone: 949-584-4573 Zip: 92627 Phone: Zip: License: 000000 ISSUED BY: StaWs: ISSUED Applied: O6/19/2006 Issued: O6/19/2006 SCOPE OF PERMIT MECHANICAL PERMIT TO REMODEL EXISTING LIVING ROOM AND ADD 1/2 BATH TO EXISTING S.F.D. NO ADDITIONAL SQUARE FOOTAGE. REF#: BD6-00934 WORK TO INCIUDE: 1 VENT FAN/SINGLE DUCT ISSUE FEE Inst FAU <100 k BTU Inst FAU >100 k BTU Repair/Alt Cooling/Heai Inst / Rep. Recess Wall Hir Refrig Sys <700 k BTU Refrig Sys >700 k BTU Gas Piping Factory Fireplace Hood w/Mech Exhaus� VAV Box Venl Fan / Single Duct Appliance Fire Dampers Smoke Dampers Inst or Relocate Appl Vent Air Handlers < 10000cfm AirHandlers> 10000cfm FloorFurnace Floor or Suspend Heater $23.50 $0.00 $0.00 $0.00 $0.00 50.00 50.00 50.00 $0.00 $0.00 50.00 5725 $0.00 50.00 so.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantity FEE SUMMARY Repair / Alt Absorbtion Unit Repair / Atl Refrigeration Unit Ventiilation System Evaporetive Cooler Com mercia l I n cine rato r Domestic Incinerator Compressors I Absorption Svstems Upto3hp/100kBTU 3 To 15 hp I 500 k BTU 15 To 30 hp / 1,000 k BTU 30 To 50 hp I 1,750 k BTU Over 50 hp / Over 1,750 BTU Boilers Up to 3 hp 3To15hp 15 to 30 hp 30 to 50 hp Over 50 hp Other Mechanical Fee � " Investigation Fee Plan Check Fee Reinspection Fee TOTAL CALCULATED FEES COMMENTS / SPECIAL CONDITIONS Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 80.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 50.00 0 $0.00 0 $0.00 0 50.00 0 50.00 50.00 $0.00 530.75 NOTICE: The work authorized by ihis permit shall comply with all apPiicable handicap access requirements under Califomia 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 sus{ for a period of 780 days. and related orabandoned INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all required inapectlona and tinal approval must be obtained. Fallure to obtain inspections and final approvel will result In the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 zaa�ae �eroo) WORKERS' COMPENSATION DECLARATON: I hereby aKrtn under penalry of perjury one of the following tleclarations: ❑ I have end will meintain e certilicate ol consent to self-Insure for workers' compensetion, es Orovbetl lor by section 3700 of the Lebor Code. tor Ihe performance of the work tor which Ihis permit is issue0. ❑ I have antl will maintain workers' compensation insurance, es required 6y sectlon 3700 of the Lebor Cade, for the perfomunce of tha work for which Nis pertnit is issued. My workers' compensation Insurance carrier and policy number are: Cartier. Policy Number. (This section need nof be completetl il (he permit is ve/ued et ane hundred tlollers (3100) oi less.) � I certify that in t�e pertortnance ol Ihe work for which Ihis permit is issued, I shall not employ any pereon in any manner so as lo bocome subject to the woMers' compensation laws oi California, and egree that II I should become sub�ect lo the workers' compensatlon pravisions oi Se lon 3700 pI tha Lebor Cotle, I shell forthwith comply with these provisio ��/�r/p � //O Appliwm Signeture: � / �.�"- Date: �t�• —6 WAfiNING FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UMAWFUL AND SNALL SUBIECT !W EMPLOYER TO CRI�NAL7fES AND CNIL FlNES UP TO ONE HUNDRED T/1IXISAND DOLURE (5100,000). IN ADDRION TO THE COST OF COMPENSATIIXJ. DMMGES AS PROVIDED FOR IN SECTION 3]08 OF THE UBOR COOE, IMEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirtn that I am licensetl under provisions of Chapter 9(commencing wilh Section 7000) af Dlvislon 3 of the Business and Professlons CoCe, end my license is in full forca end aNect. Lic. q Cless a Contractols Signature: Data: CONSTRUCTION LENDING AGENCV: ❑ I hereby attirm t�at there is a conslmction lending agency for the pedormance of ihe work lor which this permit is issued. (Sec. 3097, Civil Code). LendeYs Name: Lender's Address: SigneNre: Date: OWNER-BUILDER DECLARATIONS: I here6y aHirm ihet under penalty oi per�ury thet I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reeson (Sec. 7031.5, Business end Protessions Cotle: Any city or county which requires e permit to consimct, elter, improve, demolish, or repelr eny structure, prior to Its issuance, elso repuires Iha epplicant for such permit b file a signetl statement ihat he or she Is Ilcensetl pursuant to t�e provislons of the Contracbrs Licensa Lew (Chepter B(commencing with Section 7000) ot Division 3 of the Business end Proles5ion5 Code) or thet he or she is exempt iherefrom end the hesis for the alle9ad exemption. Any violation of Section 7031.5 by any epplicenl for e pertnit subjects the applicant to e civil penelry ol not more then tive �undred dollers ($500)J: ❑ I, as owner of Ihe properry, or my employees with weges es lheir sole compensatlon, WILL DO THE WORK, entl Ihe structure Is not intended or oHeretl for sale (Sec. 7044, Business and Professions Code: The Gontractors License Law tloes not apply to en owner of propeny who 6uild5 or improves thereon, and who does such work himself or herself or Ihrough his or har own employees, provided ihat such improvements are not inten0ed or oNeretl tor sale. Ii, however, ihe builtling or Improvement is sold within one year ot completion, ihe owner-builder wlll have the 6urtlen of proving that he or she tlitl not build or improve for purpose of sale.). , ❑ I, es owner ot the propetly, am E%CLUSIVELV CONTRACTING WITH LICENSEO CONTRACTORS Io constmct the projecl (Sec. 7044, Business and Professions Cotle: Tha contractors License Law does not apply to an owner ot propehy who builtls or Improves thereon, end who coniracts lor such proleci with a coniractor(s) license pursuant to the Contrectors License Laws.). ❑ I am exempt untler sec. Signature: Owner ID verified by tlriver's license. ❑ Vas ❑ No Business end Prolessions Code br this reason: Venfication ol Ownership by (type of daument, i.e. - property tez bill or deed): Drivar's License No. Date: Expires: DIVISION OF INDUSTRIAL SAFETY PERMIT LEFTIFICATION: ❑ I �ereby certity ihet no excevetion tive (5) or more Ieel in depth into which a person is requiretl to tlescenQ wlll be mede In connectlon with work authorizetl by this permit, antl ihat no building strucNre, scaHolding, falsework, or demolition or dismantling thereol, will be more Ihen thirty-six (36) feef high. (ChaD� 32, Grp 2, An 2, Sec. 341, Ttle 8, Califomia Atlminisiretive Code). ❑ As owner-huiltler, I will nol employ anyone to tlo work which would require e permit Irom ihe Division of Industnel Sefery, as notetl ebove, unless such person hes e pertnit to do such work irom Ihe division. SignaWre: �ate: Division of Intlustrial Safery Permit Num6er: CERTIFlCATE OF COMPLIANCE AND AUTHORVJITION OF ENTRY: I cehity under penalry ot perjury that I have read this epplication entl slate that ihe iniortnation given is correct I agree to comply with ell slate laws and city ardlnences rela�ing to bullding wnstruc�ion, and euthonze representatives of the Ciry of Costa Mesa ro enter upon Ihe above-described property tar inspeclion purposes. I agree not Io occupy or ellow occupanq of eny building authorized by ihis permit until final inspectian. ture OI Legal Owner(s) � • � Or Authon ed ADPlicant COpE1, INSPECTIONTYPE PArF II�LS 1616 Fi:etl System Final Fire Prevention 1266 Pool Spe Final ' 200 Final Re-Rool 201 FIneI BIacWRetaining Well 202 Final Fectory Fire Place 203 Final Sign 204 Final DamollUon COOE 1 INSPECTION TYPE 2os Final Mechanical 208 Final Plumbing 210 Final Electrical 212 Final Fire Preven�lon 220 Final Planning Approval 222 Flnal Sita 250 FinalBuilding/Occupency � 1 IW_ I � � �� (714) 754-5273 • Fax (714) 754-4856 • www.cicosta-mesa.PLUMBING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626 JobAddress: 442 16TH PL Suite No Vicinity: BATHROOM Parcel Nunmber: 42514209 Applicant: OLSEN, ERIC Address: 158 N GLASSELL ST SUITE 201 ORANGE,CA Phone: 714-771-8400 Zip: 92866 Owner: ALSHULER,ROBERT WHEATON Address 442 16TH PL COSTA MESA, CA Contractor: OW NER-BUILDER Address: Phone: 949-584-4573 Zip: 92627 Phone: Zip: License: 000000 Status: ISSUED Applied: 06/19/2006 Issued: 06/19/2006 ISSUED BY: Y SCOPE OF PERMIT PLUMBING PERMIT TO REMODEL EXISTING LIVING ROOM AND ADD 1/2 BATH TO EXISTING S.F.D. NO ADDITIONAL SQUARE FOOTAGE. REF#:B06-00934 WORK TO INCLUDE: 1 WASH BASIN AND Y TOILET. ISSUE FEE Backflow irrigation Backflow Preventer Bathtub Clarifer System Conned pce,Soda,elc) Dental Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roo( Drinking Fountain Expansion Tank Gas Earthquake Valve Gas (1-0 outlets) Gas (Over 4 outlets) Gas Repipe Gas Service Interceptors (Grease, Oil) Interceptors (Sand Auto ) 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 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 � FEE SUMMARY AMT Laundry Tub / Washer $0.00 Landscape Irrigation $0.00 P-Trep $0.00 Pressure Regulator $0.00 Process Piping (per 10 ff) $0.00 Receptors _� $0.00 SepticTank $0.00 Sewer Cap for Demo �. $0.00 Sewer Connect � $0.00 Sewer Privale 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) $0.00 Spa (public) $0.00 QTY 0 0 0 0 0 0 0 0 0 0 0 0: 0 0 0 0 0 0 COMMENTS / SPECIAL CONDITIONS SumpPump Swimming Pool Trap Primer Urinal Vacuum Brkr Bkflow(1-4) Vacuum Brkr Bkflow(5+) Wash 8asin Wash Basin Set Waste and Vent System Water Closel (Toilep Water Heater / vent Water Piping (Inst or Rep.) Water Re-pipe Water Service Water Softener OTHER VIOLATION PLAN�CHECK REINSPECTION AMT $0.00 50.00 $0.00 $0.00 $0.00 50.00 $9.80 $0.00 50.00 $9.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 TOTAL CALCULATED FEES: E43.10 on 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiraments under Calilomia 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 considerad legal, such work must comply,wkh all applicable codes, and all requlrad Inapactlons and tinal epprovel must be obtained. Fallure to obtain inspections and final approval will result'in the ezplration of this permit. FOR INSPECTIONS CALL: (714) 7545826 ssae-ae �aroo> WORKERS' COMPENSATION DELLAHATION: I hereby aflirtn under penalty of perjury ona of the tollowing declarations: . ❑ I �eve antl will main�ain a certilicate of consent to self-Insure for workers' crompensation, as provideA �or by section 3700 of �he Lebor Cotle, for ihe pertortnance ot Iha wOrk for w�ic� Ihis pertnit is issued. ❑ I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the perfortnance of the work for which ihis permit is issued. My workers' compensation Insurance carrler antl policy numher are: Carrier: Policy Number: (This sec(ion need not be completed /l fhe permit is valued et one huntlretl dallers ($100) or Iess.J �+I certify that in the performance of ihe work for which this pertnit is issued, I shall not employ any person in eny manner so as to become subject to lhe workers' � compensetion laws ot Calitomia, end agree that ii should become subject to Ihe workars' compensation provisions oi Section 3700 of the Labor Cotle, I shall forthwith comply with these provisians. �� Applican� Signeture: � �'a Date: II / WARNING:FAILURETOSECUFEWOFKERS'COMPENSATIIXJCOVERAGEISUNUWFULAN�SHALLSUBIECTANEMPLOVERiOCRiMI ENALTI�ANDpVILFlNESUPTOONEHUNDREO THOUSAND DOLLARE ($100,000�, IN ADDITION TO THE COST OF COMPENSATION, DPM4GE5 AS PROVIDED FOq IN SECTION 3'lO60F iHE LABOR CODE, INiEFEST, ANO ATiORNE`fS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensetl untler provisions oi Chapter 9(commencing with Section 7000) ot Divislon 3 of iha Business antl Professions Code, antl my license is in full torce and etteCt. Lic. # Class N Contractor's Signature: Date: CONSTRUCTION LENDING AGENCV: ❑ I hereby aflirm ihat Ihere is a consWdion lending agency tor the pedormance of ihe work for whic� ihis permit is issued. (Sac. 3097, Civil Code). Lentlefs Name: Lentler's Adtlress: Signeture: Date: OWNER-BUILDER DECLARATIONS: I hereby ettirm that under penalry of perjury that I am EXEMP7 FHOM THE CONTRACTORS LICENSE LAW for ihe following reason (Sec. 7031.5, Business antl Protessions Cotle: Any ciry or county which requires e permit to constma, elter, improve, tlemolish, or repair any structure, prior to its issuance, elso requires the applicant tor such permit ro file e signed stetement that he or she is litensed pursuanl to Ihe provisions of Ihe Contradors License Law (Chapter 9(commencing wllh Section 7000) ot Division 3 of ihe Business antl Protessions Code) or thet he or she is eaempt therefrom antl Ihe basis for the allegetl ezamption. Any violation ot Section 7031.5 by eny applicant tor e permlt subjecis the applicant to a civil penalry of not more than five huntlretl Collars ($500).): ❑ I, as owner of ihe property, or my employees with wagas as iheir sole compensation, WILL DO 7HE WORK, and ihe siructure is not intended or oHered for sale (Sec. 7044, Business and Professions Code: The Contrectors License Law does not apply to an owner of pmperry w�o 6uilds or improves Ihereon, end who dces such work himseN or herself or ihrough his or her own employees, provided that such improvements are not Intended or oHered tor sale. If, however, ihe building or improvement is sold within one year of completioq the owner-builtler will have the burden of proving iha� he or sha did not build or improve for Duryose of sale.). ❑ I, es owner of ihe propeny, am EXCLUSIVELV CONTRACTING WITH LICENSED CON7RAC70RS to consimct ihe project (Sec. 7044, Business antl Professions Cotle: The contraclors Licanse Lew does not apply to an owner oi pmpetly who huilds or Improves Ihareon, antl who coniracts lor such project with a contractor(s) license pursuant m the Contractors Licensa Laws.). ❑ I em exemp� under sec. Business end Protessions Coda for lhis reason: Signature: Date: Owner ID verified by tlriver's license. ❑ Yes ❑ No Drivefs License No. E:pir85: Ventication of Ownership �y (type of documem, i.e. - properry tax bill or deetl): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certity that no excavetion five (5) or more teet in depih into which e person is required to descend, will �e made in connection with work authorized by ihis permit, and ihat no building structure, scafloltling, talsework, or tlemolition or tlismantling thereof, wlll be more than Ihirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title 8, Califomia Adminisiretive Code). ❑ As owner-builtler, I will not employ enyone to do work which would require e permit from the Division of Induslnel Safety, es notetl e6ove, unless such person hes e permit to do such work from the division. SigneWre: Da�e: Division of Indusirial Safety Permit Number: CER7IFICATE OF COMPLIANCE AND AUiHORIZATON OF ENfRY: I certify under penalty of periury Ihet I heve read ihis applica�ion and s�ate that �he information given is correct I agree to comply with ell siate laws and city ordinances raleting to building consiruction, entl authorize representatives of ihe Clry ot Costa Mesa to enter upon Ihe above-described property for inspection purposes. I agrse not to occupy or allow occupancy of any building euthorized by ihis permit until finel inspection. Signeture Ot Legal Owner(s) � n�ho d Applicant COOE �. INSPECTIONTYPE 1676 Fixed System Final Fire Prevention 1266 Pool Spa Final - 200 Final Re-Roof 201 . Final Block/Retaining Wall 202 Final Faclory Fire Plate 203 Finel Sign 204 Final Demolition � QEI& irnrtia�s CO�E 1 INSPECTION TYPE 206 Final Mechanical 20B Final Plumbing 210 Final Electrical 212 Finel Fire Prevention 220 Final Planning Approval 222 Final Site 250 Finel Building/Occupancy � I[�A6fl `]-iA-c�C� �1L (714) 754-5273 • Fax (714) 7543856 • vnvw.ci.costa-mesa�ELECTRICAL PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626 Job Address: Suite No Viciniry: 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+units) Pool / Spa Lighting Fi#s Recept Outlels Switches Non Res Appl Res Appl Service l0 200a Service to 1000a Service over 1000a Molors to 1hp Molors to 10hp Motors l0 50hp Motors to 100hp Molors over 100hp Communiwtion drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole 442 16TH PL BATHROOM 42514209 OLSEN, ERIC 158 N GLASSELL ST SUITE 201 ORANGE,CA Phone: 714-771-8400 Zip 92866 ALSHULER,ROBERT WHEATON 442 16TH PL COSTA MESA, CA OWNER-BUILDER Phone: 949-584-4573 Zip: 92627 Phone: Zip: License: 000000 ISSUED BY: Staws: ISSUED Applied: 06/19/2006 Issued: 06/19R006 SCOPE OF PERMIT EIECTRICAL PERMIT TO REMODEL EXISTING LIVING ROOM AND ADD 1/2 BATH TO EXISTING S.F.D. NO ADDITIONAI SQUARE FOOTAGE. � REF#: B06-00934 WORK TO INCLUDE: 2 LIGHT FIXTS, 1 SWITCH AND 1 OUTLET. $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $220 $1.10 $1.10 $0.00 $0.00 $0.00 50.00 50.00 $0.00 30.00 $0.00 $0.00 $0.00 so.00 $0.00 $0.00 $0.00 50.00 $0.00 Quantity 0 0 0 2 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FEE SUMMARY Temp Dist System / Lighting Busway /100 ft . Standing Section Misc Electriwl 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 lighls) Christmas Tree Stand Fireworks Stand Other Electrical Fee Investi9ation Fee Plan Check Fee Reinspection Fee Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 50.00 0 so.00 0 $0.00 0 $0.00 0 80.00 0 $0.00 $0.00 50.00 $0.00 TOTAL CALCULATED FEES 527.90 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under regulations. (Ord. No. 92-28, § 1, 12-21-92) and related EXPIRATION: This permit shall aulomatically expire and become void if work is no[ commenced within 780 days, or if vrork is suspended or ebandoned for a period of 180 days. INSPECTIONS: In order for the work aulhorized under this permit to be considered legal, such work must compty with all epplicable codes, and all requlred inapeetlons and final approval must be obtained. Failure to obtain inspeclions and final epprovat will result in the expiration of this permit. FOR INSPECTIONS CALL: (719) 7545626 zs.s�+s �am> WORKERS' COMPENSATION DECLARATION: I herehy aHirm under penalry of Derjury one of Ihe tollowinq declarations: ' ❑ I heve antl will maintain e certificete of consent to sell-Insure lor workers' cnmpensallon, es pmvitled for by saction 3700 0l the Labor Code, lor the pertormence of the work tor w�ic� this permit is issued. ❑ I have and will maintain workers' compensation insurence, es requirea by sectlon 3700 0l Ihe Lahor Code, for tho peAormance of lhe work for which Ihis pertnit is issued. My workers' compensa�lon Insurance cartier antl policy num6er are: Cartier. PollCy Number: (This section need not be comp/etetl i/ the permit is veluetl al one hundred dollers ($100) or less.) � g I cenity Ihat in Ihe pertormance of the work for which ihis permit is issued, I shell not employ eny person in any menner so es to become suh�ect to ihe workers' /- compensation laws of Celilomia, erW egree that il I should become sub�ect to the workers' compansation provisions of Section 3700 ot Ihe Labor Cotla, I s�ell forthwith comply with t�ese provisions. � �/I �' n` � Applicam Signature: _�^�� Dete: ''� �,� WARNING: FAILURE TO SECURE WORKERS' CqMPENSATION COVEfiAGE IS UNIAWFUL PND SHALL SUBIECT AN EMPLOYER TO CRl IN PENALTIES AND GVIL FlNES UP TO IXJE HUNDRED i/iOUSW D DOILARE (5100.000), IN ADDITION TO THE CQST OF COMPENSATIIXJ, DAM4GES AS PROVIDED FOFi IN SECTION 3�O60F THE LABOR CODE, IMEPEST, MID ATTORNEYS FEES. �� LICENSED CON7RAC70RS DECLARATION: I I hereby eRirm i�at I am licensed under provisions oi Chaptar 9(commendng with Section 7000) oi Divislon 3 of the Busineu end Pmlessions Cotle, entl my license is in full '�, force and eflect. Lic. k Cless a Gontractor's Signature: Da�e: CONSTRUCTION LENDING AGENCV: �� ❑ I hereby aRirm ihat there is a consimction lending egency tor the pedormence oi t�e work for which Ihls Oermlt is issued. (Sec. 3097, Civil Cotle). LentleYs Name: Lenders Address: Signawre: Date: OWNER-BUILDER DECLARA710N5: I hereby aHirtn that untler penalry of perjury ihet I am EXEMPT FROM 7HE CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5, Business and Professions Code: Any ciry or counry which requires e permit to construct, alter, improve, tlemolish, ar repair any structura, priar to its issuance, also requlres the eOD�icant tor such pertnit lo file a signed slatemenl t�et he ar she Is Iicensed pursuant Io Ihe provi5ions of the Contrectors LiCenSe Lew (Chepter 9(commencing wllh Seclion 7000) of DIN51on 3 of the Business and Professions Cotle) or ihet he or she Is exempt theretrom antl Ne basis tor t�e ellegatl eaemption. Any violatlon oi Section 7031.5 by any applicenl for e perml� subjects the applicant to e clWl penelty oi not more then five hundred dollars ($500).): ❑ I, as owner ot the properry, or my employees with weges es Iheir sole wmpensation, WILL DO TME WORK, anOlhe siruciure is not Intendetl or oMerea tor ule (Sec. 7044, Business and Professions Cotle: The Conlractors License Law tloes not apply to an owner of Droperty w�o builds or improves Ihereon, and who tloes such work himselt or herselt or ihroug� his or her own employees, pmvidetl ihat such Improvements ere not Intentletl or oHeretl for sale. If, however, the building or improvement Is sold within one year oi completioq the owner-builder will �eve the burden ot proving that he or she tlid not huiltl or improve tor Ourpose of sela.). ❑ I, as owner ot tha properry, am E%CLUSIVELY CONTRAGTNG WITH LICENSED CONTRACTORS to construct the pro�ect (Sec. 7044, Buslne55 Bnd Prolessions Cotle: The wntractors License Lew does not epply to an owner oi property who �ulltls or Imprwes t�ereon, end who conirects tor such project with e contrector(s) license pursuani �o ihe Con�ractors License Laws.). ❑ I am exempi under sec. Signa�ure: Owner ID veritietl by tlnvefs licen58. ❑ Ves ❑ No Business and Prole55ion5 Code for thl9 rea5on: Veniication of Ownership by (rype oi documem, i.e. - properry tax bill or deed): Drivefs License No. Date: Expires: DIVISION OF INDUSTRIAL SAFETY VERMR CERTFICATON: ❑ I hereby canity that no excevation five (5) or more leat in depih into which e person Is required to descend, wlll be made in connectlon with work euihonzetl by this pertnit, and Ihat no building structura, scaHolding, lelsework, or demoli�lon or tlismantling thereol, wlll be more than thirty-slx (36) leet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title e, Celifomia Atlminisiretive Code). ❑ As owner-�uiltler, I will not employ enyone to tlo wark which would require a pertnit Iram the Division ol Indusirial Selery, es notetl eDove, unless suc� person hes e pertnit to do such work from tha division. SignaWre: Date: Division oi Indusirial Safery Permit Number: CERTIFICATE OF COMPLJANCE AND AUTHORIZATION OF ENTRY: I cenity under penalry of perjury that I have reed this apD��ion entl state Ihat Iha intormation given is correct. I e9ree to comply wlth ell sWte lews antl ciry ortlinances relating �o builtling consiruction, end euthorize representatives ol the City of Coste Mesa to enter upon the above-descnbed property for insDection purposes. I agree not to occupy ar ellow occupency ol eny building euthonzed by lhis permit until finel inspectlon. �. _ Sig Of Legal Owner(s) Date ��/Ni l/)/�' /� i A r AuthOdzetl Applican� D te COpE1, INSPECTIONTYYE . QS¢. IN�IIIELS 1616 Fixetl System Final Fire Prevention 1266 Pool Spa Final 200 Final Re-Roof 201 Final BIocWRetaining Well 202 Final Factory Fire Place 203 Final5lgn 204 Final Demolitian COUEA INSPEGTIONTYPE 206 Finel Mec�anical 20B Final Plumbing 210 Finel Electricel 212 Flnel Fire PrevenNon 220 finel Planning Approval 222 250 Finel Site Final Building/Occupaniy pA�. 1[�EL$ i : 1 • rafl (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.B�LDING PERMIT 77 FAIF DRIVE, COSTA MESA, CA 92626 JobAddress: 442 16TH PL Suite: Viciniry: Primary Occ: R-3 Dwellings/ Cong Res <10 Type of Construction: V-N Parcel Number: 42514209 Zoning: ,4pplicant ERIC OLSEN Address: 158 N GLASSELL ST SUITE 201 ORANGE,CA Owner: ALSHULER,ROBERT WHEATON Address 442 i6TH PL COSTA MESA, CA Contractor: OW NER-BUI LDER Address:� - - ' Zip: Arch : Address: Zip: Phone: License: Phone: 714-771-8400 Zip: 92866 Phone: 949-584-0573 Zip: 92627 Phone: License: 000000 Eng: Address: ISSUED BY: Stalus: ISSUED Applied: 06/14/2006 Issued: 06/192006 Phone: License: SCOPE OF PERMIT . REMODEL EXISTING LIVING ROOM AND ADD 1/2 BATH TO EXISTING S.F.D. NO ADDITIONAL SQUARE FOOTAGE�. FEE SUMMARY Plan Check: $6321 Calc Valuation: Permit: SMIP Res: SMIP Com: Other: Inspection: Total: $97.25 $0.50 $0.00 $0.00 $0.00 $160.96 SETBACKS MAINSTRUCTURE Front 0-0 ACCESSORY Front 0-0 PARKING Existina: o Claim Valuation: PLANNING & ZONING Rear 0-0 � Left �.-0-0 Right Rear 0-0 Left 0-0 . � Right Requiretl: 0 Pr000sed: 0 sa,000.00 Sa,000.00 NOTICE: The work aulhorized by this permit shall comply with all applicabte handicap access requiremenis under Califomia statutes and related regulatlons. (Ord. No. 92-28, § 1, 12•21•92) EXPIRATION: This permit shall aulomatically expire and become void if work is not commenced within 180 days, or if work is.suspended or abandoned for a pe�iod of 180 days. INSPECTIONS: In order for the vrork authorized under this permit to he considered legal, such work must compty with all applicable codes, and all required Inspectfons and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this pertnit. FOR INSPECTIONS CALL: (7/4) 7545626 ta6s6 �flroo� WORKERS'COMPENSATONDECLARATON: ' 1 hereby aHirtn untler penalry of perjury ane oi t�e following tledaretions: ❑ I have antl will maintein e certificate af consent to saltdnsure for workers' compen5ation, as provided for by section 3700 0l l�e Lebor Cotle, lor Ihe pertortnence ol Ihe work tor whith Ihis pertnit Is issuetl. ❑ I have antl wlll mainlain workers' compensation insurance, as requiretl Dy section 3700 oi Ne Labor Code, for lhe peAormance ol Ihe woAc for whlch Ihis pertnit Is issued. My workers' compensatlon Insurenca cerder enA policy number are: Cartier. Poliry Number: (fhis section need nof be compleletl il the permit Is veluetl et one hunOred tlollers ($ f00) or /ess.) �14�i1 cenity that in the performente of lhe work for whic� this permit Is issuetl, I 5hall not employ any person in eny manner so es to become sublect lo the workers' t� compensatlon laws ot Califomia, end egree that if I should become sublect to Ihe workars' wmpensation provisions of Sectlon 3700 0l the Labor Catle, I shall forthwith comply with ihese provi3jpns. ` 9 �ApplicanlSignelure: 3 � , Date:. � /, �b F/ARNINGCFAItURE TO SECURE WORKERS' COMPENSATIIXJ COVEMGE IS UNUWFUL MlD SHALL SUBIEGT PN EMPLOYER TO CRIMINFL�NALTIE AND CNIL FlNES UP TOONE HUNDRED TFKKISAND OOLLARE (5100,000). IN ADINiION TO THE WST OF COMPENSATION, DNM6ES AS PROVIOED FOR IN SECiION 3�O60F THE I.ABOR CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby eHirtn lhat I am licensed under provisions ot Chapter 9(commencing with Section 7000) ot Division 3 of the Business and Pmfessions Code, end my license is in tull force entl eHect. Lla M Class x Contwctor's Signature: Date: CONSTRUC710N LENDING AGENCV: ❑ I hereby eHirm thet Ihere is a constmction lending agency for lhe peAormance of ihe work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Atltlress: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby ettirm Ihat under penelry at perjury thet I am E%EMPT FROM THE CONTRACTORS LICENSE LAW tor ihe following reeson (Sec. 7037.5, Business entl Professions Cotle: Any ciry or counry which requires e permit to canstruct, alter, Improve, tlemolish, or repair any strucWre, pnor to its issuance, also requlras the epplicant for such permit to file a signea stetement that he or she is Ilcensed Dursuent to ihe provisions ol the Contrectors License Ww (Chapter 9(wmmencing with Section 7000) af Division 3 oi the Business and Professions Cotla) or that he or she is exempl therefrom and the basis for the ellegetl exemption. Any violetion of Section 7031.5 by eny epplicant for a pertnit subiecis the appllcenl to e civil penally of not more than tive hundred dollars ($500).): ❑ I, as owner ol the property, or my employees with weges es �helr sola compensation, WILL DO TME WORK, and the structure is not Intended or offered lor sale (Sec. 7044, Business end Pmfessions Cotle: The Contractors License Law does not apply to an owner of pmperty who builds or improves ihereon, en0 who does such work himself or herself or ihrouqh his or her own employees, provided that such improvements ara not intended or oHered for sale. If, however, t�e bulltling or impmvament is sold within ono year ot completion, the owner�builder will have ihe burden of proving ihat he or she did not build or improve tor purpose oi sale.). ❑ I, es owner ol Ihe proPerty, em E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construci Ihe Dro�ect (Sec. 7044, Business end Professions Cotle: The contractors License Lew does noi apply to an ownar oi properry who bullds or impmves thereon, end who contracis for 5uch project with a contrector(s) license pursuent to the Conirectoro License Laws.). ❑ I em exempt under 5ec. Business end Proleuions Code tor �his reason: SignaNre: Date: Owner ID verifietl by tlrivefs licensa. ❑ Y85 ❑ No DriveYs Licensa No. E:pire5: Verificatlan of Ownership by (lype of daument, I.e. - properry taz Dill ar tleetl): DIVISION OF INDUS7RIAL SAFETY PERMIT CERTIFICATION: ❑ I hereDy cenily that no excavation tive (5) or more feet in tlepih into which e person is required to descend, will be made in cannactlon wit� work euthorizetl Dy ihis pertni�, and thet no buildinq 5truclura, scaffolding, lalsework, or demoli�ion or dismantling thereof, will be more lhen thir�y-six (36) feet high. (Chep. 32, Grp 2, Art 2, SBc. 341, Title B, Calitomis AdminisireGve Cotle). ❑ A5 owner-6uilder, I wlll nol employ enyane ta tlo wark which would require e permit from the Division ot Industnal SafeN. as noted above, unleu such persan hes e permit to tla such work from the diWsion. Signatura: Date: Division ot Intlustnal Safety Pertnit Number. CEHTIFlCATE OF COMPLJANCE AND AUTHORIZATON OF EMAV: I certity untler Denalry of perjury ihat I have read this epplication en0 state t�et �he infortnation given is cortect. I egree to wmply wit� ell state lews and city ordlnances relating to building construclion, antl euthonza representalives of Ihe Clry of Coste Mesa to enter upon Ihe abova-described properry tor inspection purposes. I agrae not to occuDY or allow occupancy ot any building authorized by this pertnit unlil tinal inspecllon. �'A�V CODE I. INSPECTIONTYPE 1616 FixeO System Finel Flre Preventlon 1266 Pool Spa Final 200 Final Re�Rool 201 Final BIaWRetaining Wall 202 Final Factory Fire Place 203 Finel Sign 204 Finel Demolition PdIE INfRIALS cooe. ixsrecnoNnve 206 Final Mechaniwl 208 Final Plumbing 210 Final Elecincal 212 Final Fira Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupanry PAIE L�Lfl DECLARATION OF AUTHORITY FOR AGENTS OF PROPERTY OWNER TO APPLY FOR PERMITS Street Address: �� Bldg. Permit # This Permit # AP Number: 1. I(we), ��% �GSH��/C , dedare that I am the Owner of Title of the above referenced real property, and that 1(we) hereby authorize: Name: �1�� Telephone Number. ��• 77�• �+7�0 Street Address: �� "�� / s v�� City: �� •�� State: �1 Zip: to obtain permits in my behalf, as owner/builder, for at the above referenced property. 2. Should any person become an employee engaged in the improvement of the property, I(we) shall immediately provide Worker's Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa Mesa, as required by State of California laws. 3. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other person, company or corporation. 4. I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any claim resulting in damage or personal injury to myself or any other parties as a result of work authorized by the permits from the City of Costa Mesa. 5. I declare under the penalty of perjury that the foregoing is true and correct. Executed this �_ day of _�TLJ �':.� 20 �, at ��a , California. i � ��y ' � � � . ..r �� . . - r. �..� / , . ..- , � Note: This autlrorization does rat grant autlrorization to perform the work as ovmer, it solely provides for limited power of attomey to secxire this pertnit in any behaH. 0779-46(rev.11100) � � PFOJECT AUOPESS: 4 Q iZ 1 6TH PL OWNEF'SNpME:�TRACY, MARILYNN aooeess: SAME APCH/ENGINEEfl: AOORESS: HEG.NO.: UNIT: UNIT: PEFMITTEE:ALPINF ROOF ( 310 ) 437-328?. ADOPESS: % i 2 E ALTA WAY L.B, CA 90807, IILENSE� CONTBACTOB OECLABATION: I hereby allirm t�a� I am licensetl un0er pmvisions of C� 9 commencing with Sec[ion i�000) of Division 3 olihe Business antl Pmlessions Cotle, and my hc lullforce and e� !.,ITYLIC.: STATEU4SSZSOS s:C39 �a�e'. �� 4 1 Signature'. � — WOflKEflS' COMPENSFTION OECLABATION: I hereby a�firm �hai I have a ceei�icate o� consent m sel4insure or a cenilica�e of Workers' Compensalion,InW��nsq,p�� r,enilied�opy I�ereol (Section ]800. Lab�� 01 / 94 roucr na.:STATE 9 y EXP. DATE: COMPANY: ❑ Ceriified coDY is hereby lumishetl. � Certi�ied coDY is IileO - e city dinp Dry' -� f % Oa�e: �� L( � �7 � Applican�: l �=i E%EMPTIONFAOMWOFHEBS'COMPENSpTIONOECIANATION: (7hi55ec1ionneeAnotDecom0lele�ifthepermitisloronehunOreO(3100)orless). I retlify Iha� in Ihe perbrmance oi I�e work lor which �his permi� is issue4 I shall no� employ any person in any manner so as lo become su�le<i Io the Workers' Compensalion Laws ol Calitomia. Date'. SignaWre'. NOTICE: II. alier making �his tleclaration, you shoultl become subleci Io Ihe Workers' Compensalion pmvisions ol the Labor ' Catle, you musl fotlOwii� comO�Y wiih such pmvisions or Ihis permii shall �e 4eeme0 revoke0. CONSTFOCTION LENOING ACENCY: I hereby afiirm Ihat I�ere is a consimc�ion IenOing agency �or the pedormance oi the work for which IhiS permil is issuetl �SeciiOn 309Z Qv. C). LEN�Efl: aooness: OWNEB BUILOEP OECIAFRTION: I hereby affirm �hal I am exemp� irom �he CanVactors' S�ate License law �or Ihe �ollowing reason �Section 7031.5 Business and Pmlessional Code: Any ciiy al counly which requires a permi� to con5tmci. aller, improv¢. tlemolis�, or repair any s�mcture. prior to its issuance. also requires �he applican� lor suc� permii Io file a signed statement t�at he/she is Iicense0 pursuant to ihe provisions a� �he ConVacmrs' S�a�e License Law (ChaO�er 9(commencing wi�� Sec�ion 7000) ol �ivision 3 a� �he Business antl Pm�essions Cotle) or Iha� he/she is exemp� �herelmm antl Ihe hasis for �he allegetl exemp�ion. Any viola�ion of Section 7037 S �y any applicanl for a permi� 5u0jec�5 �he apP�ican� to a civil Oenalty of not more I�an tive hundretl aollars (5500�. I, as owner oi Ihe proOerlY ar my emplayees wi�h wages as iheir sale compensation, will Oo �he work, antl ihe ❑ slmaure is noi intenUed or ofieretl for sale (Sec�ion 704a. Business an0 Protessional Code: The Coniractors' State License Law Uoes not aDPly to an owner of a proPeny wh0 �uiltls or impmves Uereon, an0 who Does suc� work himsetl/herself or Ihrough nis ar her own employees. provi0etl Ihat suc� impmvemenls are noi iniende� or ofiered for sale. I�, hawever �he builaing or impmvemen� is sola within one year of comple�ian. Ihe owner wi0 have Ihe burden of pmving he/she tlitl nal build ar impmve for the purpose ol sale). I. as owner af ��e property, am exclusivety coniraciing wiU licensetl contradors �a cons�mct the pmle�� (Section 7044. Business ❑ antl Professions Cade: The ConVaclors' State License Law does nol apply to an owner o� pmperty who �ui105 or imOroves lhereon antl who conirocis lor such pmlecis with a coniractor(5) license pursuant �o ��e Contractors' Siale License Law�. I am aware Ihat pmof of iheir W�rker'S Campensation insurance 5hou10 be provitletl lo me. � I am exempt unaer Sedion: B. 8 P. C. � ror ihis reason: �ate: Owner I do �ereby ceni�y Ihai I am aware af and under51an01he requiremenis of Califomia Healih and Salety Cotle Seciions 25505, 25533, and 25534 an0 thal I or any fuiure building occupanl willlwill nol (circle one) neetl to comply wilM1 SaiA s�a�e codes antl ��e requiremenis br a permil loi consimction or moailicalion imm ihe Air Ouality Management o�strict. flesitlential consimclion avPlications are exempt 1mm Ihese provisions. Date: FOP�icanl: _ I hereby cehity Ihal I have read Ihis applica�ion and Slate ��at ihe ordinances antl slate laws relaling lo bwltlmg canslmction antl her pmperiy lor inspec�ion purposes. Daie: �' ��' �f Signat re: Orivefs License or Social Securily correct. I t64t <6 Whne—Boiltling�. Green—CoOe Enlorcement; Canary—AOPlicanl: Pink—Revenue: Goltlenroa—Assessor antl CITY OF COSTA MESA — BUILDING PERN,ZT PERMIT NO; B 063031 PLAN CHECK NU: N CONST'RUCTION TYPE; PERMIT TYPE; STR � N�; a �� i (i �1' ; N S U � ; N PUkPOSE; OTH JOA PESCRIPTION ; T/OFF SHEATH 6 REROOF W/COMP SHTNCLES SQ FT; 6,368 CLAIM VALUE: 6,368.00 CALC—VALUE; 6,308,00 GROUP OCC; R-3 /N-1 COMMENTS: REROOF 25005F RESIDENCE S GARAGE W/COMP SHING ��*��*�*��,�*.��.**��*�*x-x*��.�*�,��,��*.��*�.��.*��ifl#�� T��f4� 2 O N I N GS ERTE$QAUCIKRSE M E N T REQUIRED ----------- MAIN BUILDING ---------- --------- ACCESSORY BUTLDING --- ----- FRNT; FT IN REAR; FT IN FRNT; FT IN kEAR; FT IN LEFT: FT IN RGHT; FT IN LEFT; FT IN RGHT; FT IN PARKING RE�i • PROV: PAkCEL; 00000000 %NE: kEF' NO; PLANNING NOTES> 3 iE �k itlf Ik 1E iF if if iE k iE iF iFlE �1!!E iE !f iE !f if ff� iE %� 3F �E �)f 1F if 1tlE iE iF Ik !f k iF 3E IE!( iE 1(-if !h 1(-1F !F if if i( X-1F k%� )f %� k�lF !E # iF IE�lF !E id 3F k Sf�iE it # iF IE iE # �E jf if D E V E L O P M E N T S E k V I, C E 5 R E Q U I R fi M fi N��' S ZONING APPROVEp BY "� BUILDING APPROVED HY ; APPLICATION IS�SI3ED HY; ififlEifiElflElfitiEfEif�iElEiFiEiEitklfiFiEiFiFiF3F7FTf�F7F3FiF�F'iFiFiF'iF'R'iF'SFiFiF'iFit.� iF3FiFit�k�if��FiF3F�riEiE'.E iF 1E 7F iE iE iE IF iE iElf IElE iElE iE iF iF iflE 9ElFlE !f !F k!P iE k 1E if if !f iF iE it if it it 1F iF if if 9tlf !E iFlE if iE iE iE 1E iE k iE dk �F iEiE !E LEGALIZ;4TION:N F E E S U M M A R Y S BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE PERMIT 90.00 DATE; � � DATE: �� UATF.��i/IrU �S'> RUCTURAi: SEGMENT; Y v SMIP/RES GRADING .64 SMIP/NON—RES PLAN ISSUE F'EE BOILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS----> 90.64 0,00 0,00 90,64 90.64 ,00 HEVENUE DIVISION 7'OTALS--> COLLfiCTEA; 90,64 OVER/SHUkT; ,00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/T07' GRADING PLAN—CHECR 90.00 ,64 iE if iE 1F it �1F iF iE 1! 1Elt ik iklE iF 1E if 1E iE iE iE ik �F iElt iE ih?t iE iE fE if iE if iE iE if !E iE iE 1E iE if iF if iE ik i6 7E if it iF if if %� iE iElE i! %iFiF iE if iE 7F �IE if iE if-ih iF iF iE iP iF 1E 3(� 3f I N D I V I D U A L F E E: B R& A K D O W N TYPE QTY D E S C R Z P T I O N UNIT COST TOTAL COST SFR 6368� REROOF BY VALUE RESIDENTIAL ,V020NE 1,00 END OF FEES tt EXPIRED � � �ete I�spections �re �� $ig R �/�� j J 6,368.00 o: ooi<2ss�-aals2s�2 T p T 90.c4 DRTE: 07/14/43 TEME: 11:39 -- �' - COf�STRUCTiON AND PLANNING I APPROVALS Permit �;- Date 1. Temporary Electrical Service or Pole 2. Soil Pipe�Undrgrnd. 3. Eiectrica'� Co�d�it Ut�Ltv�Und�grr.d. 4. Etectrical Condu:t�Undry�nd. 5. Steel Re�nforc:ment 6. Electrical UFER Grnd 7 Fooungs 8. Fourdation 9. lYater P�pe-Undrgrrd. 70. Structural F�oor SYstem � �� 17. Praperty Sev,er Lire & Ha„se Connecnan 12. Se �+er Cap 13. Roat Ora�ns 14. Rough ?lumb�.�� 75. Rough 6ecvlca6Condu��[ . 16. Rau�hElectrc\V�nng �-- 17, Raugh \4-�ir.g Sign 18. Rough Electrical-T Bar �ii�ng 19. Rough Heating & A�r Cor.diiomng 20. Rosgh Factory Flrep'ace ' 21. D'..c?s, in Structure 22. Duns, Ventllatin9 23. Gas PiFe�Rough & Tesc _ 24 Roof Framing 75. Rn:�` She2thing �� 26. T�Bar Ce�ling 15[rucwrail & Mococoat /' 27. Frame and Flashing I28. Lath;ng & S�d;ng • � � 29. Insulatron �� 30. Dryv:aii Na�t�ng � J31. Plaster Brown Coat i 32. Electncai Po�ver Nieter�Pinai � 33. P�nal E�zctnc � 34. Fin�l Heatinc � A�� Cord�Yoni^.c� ' I_ 35. F�.^.al Gas Pip2�Test I --�- 36. Hood or Canopy I _ � 37. P,nal Fsctory F,repiace TI 38. Final Plumb�ng � 3°. l'Jater S^rv�ce�Final � 40. Gas Servme�Pmal � 41. Snia� Domest�o-Fm:.�. I � 42. Bacxflo'n Preve�',Et � 43. Bac!cflov� Ir::9auon 44. I..andscr.pe Irnyetien Syi[em � 45. Sound Attenuation' . i w6. Hard;cap Rcgu�at:o�5s • 47. FINAL STRUCTI.(BE FrBUILDiNG �/Z('f/d� �� , �$.PINALPLANNING�-' � 49. Elettric Release to Edison 50. Gas Release to Sou2hern California Gas Co Date __--_ POOI_..oVA Inspector AppROVALS Permit .:' _ 52. Pool � E4ulpmznt �ocabon � I Date Inspector ! 53. Steel Reiniorcemcnt I I 54. Forri�-� -� '--'-' -� • - -a--�- 55. E�ectricnl Ennd:^y � 56. Rough P�uinb�r.� A� Pr�;nurc T�st � ~ 57. APPROVAL TO CJVER�GU��!ITt , 'i , --__-_ _- __. -_ _ - ___ .F-. __ _ ' 58. kleC*ncd� Corau r��.��❑ '�r^.. � j , 59. Gu5 Rpu. �- Jr_' • -�d _Ti _ � ---i� � i -__ _ -_ _ _ -__ __ i --__ -� __' _ EO. OdC�t\'.LS�`. I "c.. P'.,�p " Ui.:. ,. � � � . 67. APPROVAL Tp UECI`-- -- - I -- I- `. -� - 62. Dack.:z,n tL R.ca..c,,. •.._. � � _- -__ -__ _ _ -_ .-�.,--i-_-_ 63. Heatci & Vent�' r,; I � u4. ?'�mbl�q 5ystrn, F.. . ---j--- -�----, 65. Etechical F.�al � I -------- -- -L-- -- � 66. $Olar $y5t�m-�ir„� � � ' 67. Fer.dng A1 Acc �_ A��n_a-� --- - � 1-- ---- 68. APPROVE7 FOR °L�.ST<<a:NG �' � ----------- h--- - 69. POCL�SP!,SYSTE".15FINAL. _-�--' ____ FIRE OEf•T. NEQUIRE(v'EidT I '� � le>PPROVALS P,..n-�; ,._ I --� 70. Undergro�,.-,�, N.�„ o --------�--� -- - , �77. Product ��,pinc� :: Ga• --� p�i � . 2_Undeiqio:,itd Fiush- __-_--___ �� -� _ - I .. _ . - . � - - � 73. Undergmd Sicr�,e Taru� ^ Gus .l Ou � � ��---- - - ---- --� t ---�-�- �- �/ 74. Overi-.cad ilyo�� ' 75. Dry Chun��cai-- -- �- �--- --� -- --�- - - -.. -' I 76. Dry Standp,ne - --- -- � : 77. FIXED SYSTCi:" FINAL - -- 1-.�_ - ,; � 7E. FIREPRr_V_�-i�AL -------�-'-_ 1-- -- , 1-IFqLT'.: DEPT. REQUIRE?l�EJ!T 79. FINAIIf::�'CCT'�;V �-- -- ----��--- --I-Y�---- --�-- -- ' - - - 80 FOOOCEli71�i�;,-,T�,SS�.fD � -�= -- --- -- - -- - ��-� . -j Nutus. - -- ---- - - - -- - ' 1 - - -- - -- -- - - - -- -- a..-�I-- - - ------- -- - -- - - - '.�".-J- ----- - -- - - - ----- - ---- - - - - - - AGD��ant to till in all spaces excevt thosa within heavy boraer lines ana sign all ao0�opriate tleclarations. CirY oF COSTA M�/ESa CONSTRpUCTION PERMIT j ProjectAddress �/� �� !/Q-LG. �, APPlicant's Mailing Address g mt��K<r �:1� %� .L/C✓/�c �c . Owner'sName �2G-� �� E � Phone �i�2-/�4 Address SG'+'•-°- Arch/Eng. ' � License No. Address i � Convactor's Nam � u� Phone - �OS- � _ y Address (mailing) City �icense Na .j G''7.3 ' � LICENSEU CONTRACTOft DECLAHATION I he�eby affirm that I am licensetl. untler provision5 of Charte� 9(tommencing v+ith sec[ton 7000) of Division 3 oi the Busine5s antl Protession5 Cotle, ane ' my license is in full (orce antl eftecL L LicenseClass C--3 L ' }�� enseivo ��y.��% Date ¢�23 rL'/__ c'anar rr ' � /�l _ _ I WORKERS' COMVENSATION DECLHRATION � � ' nereby atfirm tnat 1 have a certiticate oi mnsent to self-insure or a certificate f Workers' Compensation Insurance, o� a certifietl topy Ihereof. (Section , 3800, Lab. C.) ' ' PolicY No. CCS �9/O/ ComPanY� �n56�.K• , C"1 Certifletl copy is hereby furnishetl. C�'Certi pcopj� is filetl with the city Bu'I ing Divisi�gp, Date �i7'-Jf'%�'y APPlicant � - /�� r EXEMPTION FROM WORKERS' COMFENSATION DECLARATION (This section neetl not De completetl if [he permit is fo� one huntl�etl ($100) or less). I certify that in the pe�fo�man[e of Ihe work tor�which this pe�mi� is i55uetl, I shall not employ any parson in any manner so as to become subject to tne , Workers', Compensation Laws of California.. . � i Date Signature • � NOTICE: If, after makin9 this tleclaration, you snoultl become subject to the Workers' Compensation provisions ot the Labor Cotle, you must forthwith comply with such provi5ion5 or this pe�mit shall be tleemetl revoketl. CONSTRUCTION LENDING.AGENCV ' �" ' 1 hereby affirm that lhere is a mnstruction lentling agency for the pertormance ot the work for which this permit is issuetl (Sectidn 3097 Civ. C.) LenGer's Name Lentler's Atltlress OWNER BUILDER DECLAR/ITION� � ( � � � I hereby aftirm that I am exempt from the Contractor's License l.aw (or the following reason (Section �031.5; Business antl Pwfessional Cotle: Any city or county which requires a permit to construct, alter, improve, tlemolish or repair 'any s[ructure, prior to'its issuance, also requires-Ihe applicant tor Such permit 'to fiie a signed statement that he/she is licensetl pursuant to the provisions of the Contracior'S License Law (CbaD�e� 9(commencing with Sec[ion ]000) ot Oivision 3 of Ihe Buslness antl Professions Coae) or tha[ he/she is exempt therefrom ana the ba5i5 for the allegetl exemption. Any violation of Section 7031.5'by any applicant for a permit 5ubject5 the"apPlicant to a civil � eenalty of not more than five huntlretl tlollars ($500). .' � LJ 1, as owner of the prooerty or my employees with wa9es as meir sole compensation, will tlo the work, antl the sVucture is not intentletl or offered for sale (Section ]044, Business antl Professional Cotle: The Contractor's License Law tloes nol apply ta nn owner Of a Orop¢rty wno builtls o� improves tM1ereon; antl who tloes such work bimself/herselt or th�ough his o� her own employee5, prOvitletl tM1at such imOrovements are mt intentletl o� oft¢retl for sale. It, �howeve�, the builtling cr improvement is soltl within one year of com- pletioq the owner will have the burtlen of proving he/sM1e tlitl not builtl or im- �rove tor Ihe purpose of sale). I, as own¢r of tM1e property, am excluzively coM�acting witn licensetl con- tractorz to tonsttuct Ihe pwject (Sec[ion ]044, Business antl Professions Cotle: The_ConVactor's License Law tloes not apply to an owner of property who builtls or imptoves thereon, antl'who conVacts far such prOlects with a con- tractor(s1 license pursuant�to the Contractor's License law�. I am aware,that proof of their Worker'S Compensatlon insurance shoultl be provitletl to me. ❑'I am exempt untler Section B. & P. C. for this reason oate Owner — I nereby certify that I have reatl tM1is info�ma[ion is correct. I agree to com01 antl state laws relating to building wns sentatives of, this city to enter upon Siqnature dL�L/a„ . Drivers'�Licenze or SS � that tM1e above inty ordinances utharire repre- I property, tor TYPE OF CONSTRUCTION lJ NEW U ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER q.p, # DESCRIPTION OF WORK/USE OF BLDG. ' . - S Main Building: TVPE OF PERMIT ❑ GRADING FOUNDATION ❑ STRUCTURAL T Front ❑ TENANT ❑ EIECTRICAL � PLVMBING ❑ MECHANICAL A Rear ❑ �OTHER - C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY K CONSTRUCTIONTYPE � VALUATIONS S Left ZONE GRADINGCU.YDS. . ACRES Ping.Ref.# Rema'rks: � , . Planning Notes: Sink Preventer Irrigation Drinking Fountains Floor Drains . FloorSinks � Gas Service Outlets Interceptors KitchenSink �� Lavatories ' P-Trap Roof Drains Reirispection Fee I $15 Duct- UnderGround � Duct - Strucmral Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Blt. ICBO # Heating System & Ducting � ❑0-100,000 BTU 0100,000 Reinspection Fee � $15 CMF 0865-46, rev. 4/84 White - Builtling; Canary - Applicanp Pink - Accounting; Goltlenrod - Assessor Showers Service Sink � Sewer Cap Sewer Connection Solar Collecmrs Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinal - Water Closet . Water Heater �� Water Ser� Issue Fee Hoodor Typel ❑ Canopy Type I I ❑ Refrigeration System ❑0-100,000BTU ❑100,000 System Repair/Alt¢ration Issue Fee $ 3 $ 3 Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric F.A.U. Fixtures Device Boxes OuUets Switches Garbage Disposal Generator �0-5 KW 7245 B/28184 Zone Accessory Building: Parking Req./Provided ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Meter LJup to 100 amps Meter �over100amps Sub Panel Motors �0-1 HP �1 %� 6 Inc.Solar �9-75 HP �16-75+ Microwave Pole Light ' Range " Standing Sections 5 KW Trash Compactor � Reinspection Fee �$15 � � Issue Fee DEVELOPMENTSERVICES REQUIREMENTS: Zoning Approvad By Buildin9 Approved 6y' �"� Aoo��cacion luued By 1�"w 5.OA �L' FEES $ 3 SUMMARV OF FEES � BUILDING PEFMIT $ SMIP � $ PLAN CHECK $ PERMIT PLUMBING $ �S. �� ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING 5 PLAN CHECK 50% $ MICROFILM $ N nb MECHANICAL $ TOTALFEE $ J PLAN CHECK 25% $ Z O N I N � R E Q M T S. CONSTRUCTION AND PLANNING POOL n SPA APPROVAL.S Permit# Date Inspector AppROVALS Permit# Date Inspector 7. Temporary Electrical Service or Pole � 52. Pool & Equipment Location � 2. Soil Pipe-Undrgrnd. � 53. Steel Reinforcement � 3. Electrical Conduit Utility-Undrgrnd. ' � 54. Forms 4. Electrical Conduit-Undrgrnd. . � 55. Electrical Bonding • ' 5.-Steel Reinforcement � 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. _ 57. APPROVAL TO COVER-GUNITE 7. Footings . . 58. Electrical Conduit-Undrgrnd. � 8. Foundation " 59. Gas Pipe, O Undrgrnd., Test � 9. Water Pipe-Undrgrnd. . - 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Str.uctural Floor System � �61. APPROVAL TO DECK � . 11. PropertY Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap . , 63. Heater & Vent-Final 13. Roof Drains '� � � 64. Plumbing System - Final � 14. Rough Plumbing ' 65. Electrical�Final 15: Rough Electrical-Conduit � - - '- 66. Solar System-Final - 76. �Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 6S. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling . 69. POOL/SPA SYSTEIVIS FINAL � 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # � 21 . Ducts, in $tructure 70. Underground Hydro 22. Ducts, Ver�tilating � 71. Product Piping OGas ❑Oil 23. �Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing , 74. Overhead Hydro 26. T-Bar Ceiling �Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric � Notes: � 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy � 37. Final Factory Fireplace � 38. Final Plumbing ZYI�t L�a� 39. Water Service-Final , 40. Gas Service-Final ' � 41. Solar pomestic-Final 42. Backflow Preventer ' � 43. Backflow.lrrigation _. _ .. , ;. 44. ,Landscapa. Irrigation System 45. Sound Attenuation 46. Handicap Regulations ' . - � 47. FINALS7RUCTURE&BUILDING 48. Special Requirements Completed � � 49. Electric Release to Edison - -� � 50. Gas Release to Southern California Gas Co . ' 51. CERTIFICATE OF OCCUPANCY No. Date 29250 COSTA MESA BUILDING-SAFE'fY DEPARTMENT P.O. BOX 7200 COSTA MESA. CALIFORNIA 92l10 � For Appllcan! ro Flll In Completaly TYPE OR PRINT a��Na 4 �� T �-� �r��c ADDRE88 COSTA MESA. CALIFORNIA „ ,�lOWNER Newport Balboa Savings & Loan � MAIL BUILDINO ADDRH81 3366 Via Lido MDDRHBQ ��TM Newport Beach No 6733130 ioNe ARCHITEGT ll2iOR �erger T!L eYPROV[C 'NGINEBR No.5408833 — �ooaesa 4501 Birch St. , Newport Beach iON[ �M� R Fabre Construction Gorp. R-1 _______ 4501 Birch St, o�i wi.no uc No. 146423 No 540 8833 size $3� x 60� I xo.orn.ua OF LOT Now ON LOT USE OF oescwPnoN of woau BUILDINQ 1C328 NO.OP '] 1-1 81ZE ROOMH RI � EXT6RIOR WALL SYllCCO R�� shake COVERINQ COVHRINO U9Q OF OYILDINB ANO WORK M 06 P[RrORM[D Family dwelling w/at9ached garage Plan lA �,��y�p� �7Go/L 1 XEPlBY ACKNOWL6O06 TXAT 1 NI�V[ IIGD O APPLIGTION ANO eTATB THAT T11Q AGOV[ i� CORR[CT AND AO0.H[ TO COM• PLY WITH ALL CITY ��!! D T[ LAW/ R[OYLATiNO BUILDINO CONBTBUCTAON. /l � �� AUTHORIZiD AOtNT OCT 16-68PA7DOO 920� *** 170.75 cnsn APPLICATION FOR PERMIT BUILDINO fOr Office Use Only R[C[II� NO. Pi ZONIN(i MO.01 UY[OIN[W �LAfi� 7 lYILDINO - YARD! MPROVHD MAIN BUILDIN6 RRARZI•4 p'(. '(� DIHTANC[ !R. MAIN BLDOf. VM•� V-4O-HB G. U. P. .o...,,,��., w � , aHwu es �ess THwn YARDBAPPHOVED ACCEL80RY BUILDIN6 �a YL4 1'Ler. BR. MAIN Q ACCLSD. BL[ DAT! TH[ AMOUNT lXOWN UHOBR VA ■UHP086 O� UT/�GLI8XIH0 A —i4-(� 0. _ i,yv o n �e �on �rxe � ! P88 ONLY. l ,�v � _ �,a,� w