The URL can be used to link to this page

Home My WebLink About467 16TH PL - Building PermitsJob Address: 467 16TH PL ' Suite: Vitini�y: Primary Occ: R-3 Dwellings/ Cong Res ype of Consiruction: V-N Parcel Number: 42515114 Zoning: Appiicant: FISH, FRANK N TR Address: 467 16TH PLACE COSTA MESA, CA Owner: FISH, FRANK N TR Address 467 16TH PLACE COSTA MESA, CA Contractor. O W N ER-B U I LDE R Address' Zip: Arth : Address: Phone: Zip: License: Phane: 949-631-7116 Zip: 92627-3216 Phone: Zip: 92627-3216 Phone: License: 000000 Eng: Address: SCOPE OF PERMIT CREATE VAULTED CEILING WITHOUT CHANGING CURRENT PITCH OF 3.5:12 OF S.F.D. Plan Check: 572.31 Permit: $111.25 SMIP Res: $0.50 SMIP Com: 50.00 Other: $0.00 Inspection: $0.00 Total: $184.06 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0-0 PARKING Existin : 0 Rear 0-0 Rear 0- 0 FEE SUMMARY PLANNING 8 ZONING lefl 0- 0 left 0- 0 Reauired: 0 Pr000sed: 0 � Slalus: ISSUED Applied: 10/10/2006 Issued: 70/10/2006 ISSUED BY: Calc Valuation: Claim Valuation: Righl 0- 0 Righl 0- 0 Phone: License: $5,000.00 $5,000.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 9248, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced withln 180 days, or if work is suspended or abandoned tor a period of 180 days. INSPECTIONS: In order tor the work authorized under this permit to be considered legal, such work must comply with all epplicable codes, and all required Inepections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of ihis permit. FOR INSPECTIONS CALL: (714) 7545626 2666LB 18�00) WORKERS'COMPENSAnON DECLARAnON: ' „ I hereby eNirm untler panalty ol perjury ane of the following tlecleretlons: � ❑ I heve end wlll melntaln e ceNficate ol cronsent to self-Insure tor workers' campensation, es provitletl far Cy sectlon 3700 of t�e Labor Code, lOr the pertortnence of the work lor w�lch lhl9 permi� Is issuetl. ❑ I have antl wlll malntain workers' cwnpensetion Insurence, es repuiretl by section 3700 of Ne Lebor Cotla, tor iha pertortnance ot the work tor which this pertnit Is Issuetl. My workers' compensatlon Insurance carrier and Dollcy number ere: Gartier: Policy Number: (ihls secHon need not be completed i! the permif is velued et ane huntlreC tlollers ($100) or Iess.J .0=- I certify Ihat in Ihe peAormance of Ihe work for which t�is permit is issued, I shall not employ eny pereon in eny manner so as to �ecome subject to t�e workers' �crompensetion lews ol Califomia, antl qqq��ea that I should bewme subject to the workers' compensetion provislons of Section 3700 of Ihe Labor Coae, 1 shell lort�wlth cromply with Ihese pravi�icjis. /� Applicenl Signemre: /�%� �� rDatei �D //D //9 ,� WMMNO: FAILURE T ORKERS' SAT10N COVERAGE IS UMAWFUL AND SHALL SU9IEGT AN EMPIOVER TO CRIMI P T1ES AND CML FlNES UP TO dJE HUNDRED THOUSANDDOLLARE( 00,000),INADDfiIIXJTOTHECOSTOFCOMPENSATIIXJ,OAANGE5P5PHOVIOEDFORINSEGfION3]OBOFTHEIABORCODE,IPfrEFEST.ANDATTORNEY'SFEES. LICENSED CONTRACTORS DECLARATION: I hereby eHirtn that I am Ilcensad under provisions ot C�epter 9(commencing with Sedion 7000) oi Divisian 3 of the Business entl Professions Code, entl my license is In tull force end eMect Lic. a Class a Contrectors SlgnaNre: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby ettirtn thal there is a construction lendinq egency br Ihe peAortnance ot the work for which this permit is issued. (Sec. 3097, Civil Code). Lentlefs Neme: Lenaers Address: Signature: Date: OWNER-BUILDER DECLARATONS: I hereby eHirtn that under penalry ot perjury lhat I am E%EMVT FROM THE CONTRACTORS LICENSE LAW tor the lollowing reason (Sec. 7031.5, Business entl Professions Code: Any ciry or counry which requires a pertnit to construct alter, improve, demolish, or repair any sWcture, prior to its issuance, also requires t�e applicant lor such permit to file e slgned stetamenl thet he or she is licensetl pursuanl to the provisions ol tha Contractors License Law (Chaptar 9(commencing with Section 7000) ot DlNslon 3 of Ihe Business end Professions Code) or thel he ar she is exempt therefrom entl Ihe besis for the alleged esemption. Any Nolation oi Section 7031.5 by eny applicant for a permlt suhjecis the epplicant to a clWl penalry M not more then ilve hundred dollers (5500).): ��I, es owner ot the property, or my employees with weges as thelr sole compensation, WIIL DO THE WORK, entl iha structure is not intended or ottered for sele (Sec. ---��7044, Business and Profeuions Code: The Contracbrs License Lew tloes not appty to an owner of property who Duilds or improves thereon, and who does such work himself or herself or Ihrough his or her own employees, providetl ihat such improvements are not Intendetl or oHeretl for sele. If, however, the huilding or improvement is soltl wilhin one year of completion, the owner��uiltlor will heve the 6urden ol proving that he or she did not build or improve for purpose ot sele.). ❑ I, as owner of Ihe property. am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS �o consiruct ihe projeci (Sec. 7044, Business an0 Pratessions Catle: The contrectors License Law tloes not apply to en owner ol property who builds or improves Nereon, end who contrects lor such project with a contrector(s) license pursuant to ihe Coniraclors License Lews.). Business entl Professions Code for �his reason: Owner IBYieritiAtl Dy tlriveYstlicense.'� ❑ Ves ❑ No r_-Drivefs License No. Verification of Ownership by (rype ot document, i.e. - pmperry tax bill or deeE) �— DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby cenify Ihat no excavation five (5) or more feet in depih into which a person is requiretl to descend, wlll be made in connection with work euthoAzetl by this pertniL end ihat no builtling structure, scaXolding, lalsework, or demolition or tlismantlinq �hereot, will be more Ihan thirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title 8, Calitomia Atlminisiretive Cotla). ❑ As owner-buildar, I will not employ enyone to do work which would require a permit from the Division ol Industnal Safery, es notad ebove, unless such person has e permit ro da such work from the division. Signature: Date: Division of Industrial Safery Permit Number: CERTIFlCATE OF COMPLIANCE AND AUTHORVATON OF ENTAY: I cenify under penalry oi perjury that I have reatl this ap0liwtion and stete thet the intortnetlon given is correct. I egree to wmpty with all stete laws entl ciry orAlnances relating to building consiruction, entl euthodze representatives of Ihe Ciry of Costa Mesa to emer upon the ebove-tlescnbed � erty for' tio s. I egree not to occupy or allow occupency of eny building authonzed by this pe^9it until final inspection. ��_ //��/� /i,��, � � Sign ture OI �egal Owner(s) � � Date _ ' And/Or Authorized Applicent Date COUE �. INSPELTION TYPE 7676 Fixed System Final Fire Prevenllon 1266 Pool Spe Final 200 Finel R8-Roo� 201 Finel BIocWRetaining Wall 202 203 204 Finel Factory Fire Place Final Sign Finel Demolition p47E INTITIRLS CODE� INSYECTIONTYPE 206 Final Mec�aniwl 20B Finel Plumbing 210 Finel ElacMcal 212 Final Fire Prevemian 220 Final Planning Apprwal 222 FinalSite . 250 Final Building/Occupancy �F �� ;. (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa��sCTRICAL PERMIT ,�� FAIR DflIVE, COSTA MESA, CA 92626 Job Address: 467 16TH PL Suite No Vicinity: Parcel Nunmber: 42515114 Applicam: FISH, FRANK N TR Address: 467 16TH PLACE COSTA MESA, CA Owner. FISH; FRANK N TR Address 467 16TH PLACE � COSTA MESA, CA � ' . Contractor: OWNER-BOILDER Address: � � ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool / Spa Lighting Fixts Recept Outlets Switches Non Res Appl . Res Appl Service to 200a Service to 1000a Service over 1000a Motors l0 1hp Motors lo tOhp. Motors lo SOhp Motois to 100hp Molors over 100hp Communication drops Sub panel to 200a ��, Pole Light Pkg Sign Cirouits Temp Pwr Pole Intermed Pole Phone: 949-233-7769 Zip 92627-3216 Phone: Zip: 92627-3216 Phone: Zip: License: 000000 REF:B06-01707.MISC ELECTRICALTO SKYLIGHTS, 8 OUTLETS, 9 SWITCHES. 523.50 $0.00 $0.00 50.00 30.00 $0.00 $22.00 $8.80 89.90 50.00 50.00 $0.00 $0.00 $0.00 $14.25 50.00 S0.00 $0.00 $o.00 $0.00 . .�$0.00�-. $0.00 $0.00 $0.00 50.00 Quantity 0 0 0 20 8 9 0 0 0 0 0 3 0 � -.. � 0 0 0 0. 0 0 0 0 FEE SUMMARY Status: ISSUED Applied: 11/14/2006 Issued: 11/14/2006 ISSUED BY: .Ct.�� t':j...,.. ,� t`� � �... �. 3 MOTORS FOR Temp Dist System / Lighting Busway /100 ft Slanding Section Misc Electrical Equipment Transformers up �0 7 kva/kw ................up to 10kva/kw .:.- ....:.........up to 50 kva/kw .................up to 100 kva/kw ..................over 100 kva/kw Low Voltage Equipment Low Volt Wiring Sysiem / Ckt Misc. Conduit Misa Condudor Circus �( gen or ride) Circus (mech ride or lights) Christmas Tree Stand Fireworks Stand Other Electrical Fee Investigation Fee Pian Check Fee Reinspection Fee Quantiry $0.00 0 50.00 0 50.00 0 50.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 50.00 0 50.00 0 $0.00, 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 so.00 � �� G� I� .� � TOTAL CALCULATED FEES $76.45 COMMENTS / SPECIAL CONDITIONS `�si NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void it work is not commenced within 180 days, or if work is suspended or abandoned tor a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspectlons and final approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2M6-4fi (W00) WORKERS' COMPENSATION DECLARATION: I hereby affirtn under penelty oi perjury ane of the following tlecleretions: � ❑ I heve entl wlll�melnlein a centlicate oi consem to self-Insure Por workers' compensation, es pmvided for by secNon 3700 of the Lebor Code, for the pertormance of the work far which this pertnii is i55ued. ❑ I have and will maintain workers' comPensation insurence, es requiretl by section 3700 of the Labor Code, for the poAortnance of tha work lor which this pertnit I5 Issuetl. My workers' compensation Insurance carrier and policy number ere: Certier. Policy Number: (Thi�tion neetl not be completed il the permit is veluetl et one hundred dollers ($100) or less.) �I certify thel In ihe pertormance ol tha w�q which Ihis permit is Issued, I shall not employ eny person in any menner so es to become subject to the workars' compensetlon laws of Caliior � e ree Ifa ii I Id bewme u6�ect to Ihe workere' compensation provisions oi Secti n 3700 ihe Labor Code, I shell forthwith comply with these pro ie1R�� l ^ 'fA.p�pliCant Sigaelure: � Datet �� '�" � �LJ ARNW ING: FAILURETO'SE RE WORKERS' COMP �SATGIODVERAGE IS UNLAWFUL AND SHPLL SUflIEGT AN EMPLOYER TO CRIMINPL PENALilES D CML NES UP TOONE HUNORED TIIOUSAND DOLIARE (5100,000), IN ADdmON TO THE GUST OF COMPENSATION, DAhNGES 0.S PROVIDED FOR IN SECTION 3)O60F TME LABOR COOE, INTEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby eHirtn ihat I am licensetl untler pmvisions of Chepter 9(commencing with Section 7000) of Division 3 oi Ihe Business and Pmlessions Code, and my license Is in full lorce end eflect. Lic. q Class A Comrectofs Signewre: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby eHirtn that there is a Gonstruction lending egency far the pertormence ot the work for whiCh Ihis permit i5 i55ued. (Sec. 3097, Civil Code). Lenders Neme: Lender's AOdress: Signeture: OWNER-BUILDER DECLARATIONS: Date: I hereby eXirtn thel under penalry oi Perjury Ihat I em E%EMPT FROM 7HE CONTRACTORS LICENSE LAW for the lollowing reason (Sec. 7031.5, eusiness entl Professions Cotle: Any ciry or counry which requires e permit to construct, elter, improve, tlemolish, or repair any structure, prior to its issuance, also requires ihe applicent for suc� permil lo file e signetl sietement that he or she is licensetl pursuant to the provislans af the Contractors License Lew (Chepter 9(commenGng with Sedlon 7000) oi DlNsion 3 ot the Business and Profeulons Cade) or �hat he or she Is exempt therefrom antl I�e besis for Ihe allegetl exemption. Any Wolation of Section 7031.5 by any appllcant for e pertnit su6 cts the epplicant lo a civil pena�ry ci not more then five hunCred dollars ($500).): ' �I, as awner ot the properry, or my employees with weges es their sole compensation, WILL DO THE WORK, an0 the siructure Is noI Intendetl or offered lar sale (Sec. 7044, Business entl Professions Cotle: The Contractors License Lew doas not apply to an owner of property who bullds or improves ihereon, and who does such work himself or herself or through his or her own employeas, provitletl iha� such improvements ere no� intended or oNered lor sale. If, however, Ihe builtlinq or Impmvement is sold within one yeer of comple�ion, tha owner-buildar wlll have the burtlen ot proving ihat he or sha did not build or improve tor purpose oi sale.). ❑ I, as owner of the property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7046, Business end Professlons Code: The contrectore License Lew tloes not epply �o en owner ol propeny who 6uilds or Improves thereon, entl who contracts for such project with e contractor(s) license pursuant to the Gontr�Plw�s �cense Laws.). u Business end Prolessions Cotle lor this rea5on: Data: � Ddvers license No. xpires. Verificatian ai Ownership by (type of document, i.e. - property lez bill ar tleea): DIVISION OF INDUSTRIAL SAFET' PERMR CER7IFICATION: ❑ I hereby certity Ihet no excavation five (5) or more fee� in tlepih into which e person is requiretl to descend, will be metle in connection with work authorized by Ihis permit, entl t�et no building sin�clure, swHolding, lalsework, or demolition or tlismantling thereof, will be mora then thirry-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Tltle 8, Cellfornia Adminis�rative Code). ❑ As owner-bulltler, I wlll nat err�p�a/ enyone to do work which would require a permit irom the Division of Industriel Setery, as notetl ebave, unless such person hes e permil t0 do such work from �he division. Signature: Date: Division of Indusinal Setety Pertnit Number: CERTIflCATE OF COMPLIANCE AND AUTMORIIATION OF ENTRY: I certify under Oenalry ot perjury ihat I have read Ihis application end siate that the Iniormation given is wrrect. I egree to omply tate laws and ciry ordlnences relating ro bullding construction, end euthonze representetives ot ihe Ciry of Costa Mesa to emer upon the ebove-describe ope or ins ctio u s. I ag�jre�u41 to occupy or ellow occupancy ot any bullding euthonzed by this p it uniil inel ins0ection. . � -� i � 7`i ��t�:� ^ gePOwner(s) Date AnNOr Authorized Applicent COOE �, N{SPEC�IONTYVE 1676 Fizetl System Final Fire Pre�ention 1268 Pool Spe Final 200 Finel Re-Roo� 201 FIneI8locWRetaining Well 202 Final Fectory Fire Place 203 Final Sign 204 Final Damalition 4AL It�ALi GQOE! INSPEGTIONTYPE 206 Final Mechanlcal 208 Finel Plumbing 270 Finel Electricel 212 Finel Fire Preventlon 220 Final Planning Approval 222 Final Site 250 Finel Building/Occupanry 4ALE Il�ALS f�D,i �T+ 1 � . (7/4) 754-5273 • F� (714) 754-4056 • www.ci.costa-mesa.��LDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 JobAddress: 467 76TH PL Suite: Vicinity: Primary Occ: R3 � Parcel Number: 42515114 Applicant: FISH, FRANK N TR ` Address: 467 76TH PLACE ` COSTA MESA, CA Owner: FISH, FRANK N TR Address 467 16TH PLACE COSTA MESA, CA Contractor: OW NER-BUILDER Address: Zip: Arch : Address: Phone: Zip: License: Type of Construction: V-N Zoning: Phone: 949-233-7769 Zip: 92627-3216 Phone: 949-233-7769 Zip: 926273276 Phone: License: 000000 Eng: Address: SCOPE OF PERMIT Status: ISSUED Applied: 12/28/2005 Issued: 12/28/2005 ISSUED BY: � • EXTENSION .AL�.O,�TED PER ��`� � EXPIRES 2 � Phone: License: INSTALL 3 SKYLIGHTS NER 216. � FEE SUMMARY Plan Check: $45.01 Calc Valuation: $2,000.00 Permit: $69.25 Claim Valuation: $z,000.00 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $114.76 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0-0 PARKING Existina: o � L.y PLANNING & ZONING Rear 0- 0 Left 0- 0 Rear 0- 0 Lefl 0- 0 Required: 0 Pr000sed: 0 Right 0-0 Righl 0- 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access raquirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRA710N: This permit shall automatically expire and become void if work is not commenced within 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 required Inapectlona and final epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2aw<s �r�oo� WORKERS' COMPENSATION DECI;ARATION: I hareby aflirtn under {�enelry of perjury one of the tollowing tleclarations: � - ❑ I have entl will maintain a certificate of consent to self-Insure for workers' compensetion, as provided for by saction 3700 of the Labor Code, for tlte pedormsnce of the wark ior which this permit is issued. , ❑ I have antl will maintain workers' compensation insurance, as required by sectlon 3700 of the Lebor Code, tor the peAortnance of the work for which ihis pertnit is issued. My workars' compensation Insurence carrier antl policy number are: Carrier: Policy Number. (This sectlon need no! be cdmpletetl i/ fhe permit is valued at one hundred dollers ($100) or /ess.J ❑ I certify Ihat in the pertormance ol Ihe work for which this permit is issueQ I shall not employ eny person in any manner so as to become subject to the workers' compensation laws of California, antl agrea that if I should become suhject to the workers' compensalion provisions of Section 3700 of ihe Lebor Cotle, I shall lorihwith tomply with t�ese proV�sions. Applican� Signature: Da�e: WARNING: FAIWFE TO SECURE WORKERS' COMPENSATION CAVERAGE IS UNLAWFUL PNO SHALL SU&IECT AN EMPLOYER TO CRIMINAL PENAlTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000�. IN ADDITION TO THE COST OF CAMPENSATION, �AMAGES AS PROVIDED FOR IN SECTION 3�O60F THE LABpR CODE, INrEREST, ANO ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hareby aHirm that I am licensed under provisions of Chapter 9(commencing with Section 7000) of Dlvision 3 of the Buslness and Professions Code, and my licensa is in full force and eHact. Lic. p Class x Contrectofs Signature: Date: CONSTRUCTION LENDIN6.4GENCV: ❑ I herehy aHirm that Ihe�e is a conslruclion lending agency tor the padormance of the wosk tor which ihis permit is issued. (Sec. 3097, Civil Cotle). LentleYs Name: Lenders Address: y Signawre: Date: OWNER-BUILDER DECLAqAT�ONS: I hereby attirm that under penalry of perjury thaf I am EXEMPT FROM THE CONTRAC70RS LICENSE LAW for Ihe following reason (Sec. 7031.5, Business and Profession: Code: Any ciry or counry which requires e permit to construct, alter, improve, demolis�, or repair any structure, pnor to its issuance, also requires the applicant tor such pertni b file a signetl statement �ha� he or sha Is Ilcensetl pursuant to �he pmvlsions of the Coniractors License Law (Chapter 9(commencing with Sec�lon 7000) of Divlsion 3 ot �he Business end Professions Code) or thet he or she is e:ompt therefrom an0 the basis tor ihe allegetl exemption. Any violafion oi Section 7031.5 by any applicent for a permi' su6jecis ihe applicant to a clvil penaitypf not more than five hundretl tlollars ($500).): ❑ I, as owner of ihe property. o� my employees with weqes as iheir sole compensation, WILL DO THE WORK, and ihe stmcwre Is not imentletl or otteretl for sale (Sec. 7044, Business and Professions Code: The Comracrors License Law tloes not apply to an owner of property who builds or improvas Ihereon, and who does such work himself or herseli or through his or her own employees, provided that such improvements are not in�ended or ofleretl for sale. It, however, ihe building or improvement is sold within one year of completioq the owner-builder will have ihe burden of proving that he or she did not Duiltl or improve tor purpose of sele.). I, as owner of the prop�hy, am EXCWSIVELY CONTRACTING WITH LICENSED CONTRACTORS ro constmct the project (Sec. 7044, Business and Professions Code: The coniractors License Law does not apply to an owner ol property who builds or improves ihereon, end who coniracts for such project wlth a contracror(s) � license pursuant to the Contractors Licanse Laws.). Busine55 and Professions Code br ihis reason: Ov�R8Pl65e('ift�'by tlriver's license. Yes ❑ No D' �Lice e No. Venfication of Ownership by (rype of document, i.e. �- property tax bill or daed): DIVISION OF INDUSTRIAL SNFETV VERMIT CERTIFICATION: ❑ I hareby certify ihat no excavation five (5) or more feat in depih into which a person is requiretl to tlesGend, will be made in connection with work authodzed by this permit, antl that no building structure, scaHolding, talsework, or demolition or tlismantling Ihareol, will ba more ihan Ihirty-siz (36) feet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Title 8, Caiifomia Adminisirative Code). ❑ As ownervbuilder, I will not amploy anyone to tlo work which would require a permi� from t�e Division of Indusirial Safery, es noted above, unless such person has e permit to do such work from ihe division. Signature: Date: Division of Industrial Safery Permit Number: CERTIFICATE OF COMPLIANCE ANO AUTHORIZATION OF ENTRV: I certity under penalty of perjury ihat I have reatl this application and state ihat Ihe information given is correct. I agree to comply with all state law�gsqasntl city ortlinances relating to buiitling consimction, ana amhonze representatives of ihe Ciry of Coste Mesa to emar upon the above-d�rop 1'ns n pu es. I agree not to ocwpy or allow occupency of any building auth�z�b� is Dermit ntil fi eJpspection. / � /�� ig a, Of Owner(s) � D And/Or Authorized Applicant Date CQOE N, INSPECTIONTYPE 1616 Fixetl System Final Fire Prevention 1266 Pool Spa Final 200 Final Re-Roof 201 Finel BIocWFetaining �Nall 202 203 Final Factory Fire PI3ca Finel Si9n 204 Final Demalition Q�jE INTITIRLS W�� 1 COOE 11 INSPECTION TYPE 206 Final Mechanical 20B Final Plumbing 210 Final Electrical 212 Final Fire Preventlon 220 Final Planning Approval 222 Final Sita 250 , Final Building/Occupancy PAIE 1Mrt��s (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ,lobAddress: 467 16TH PL Suite No Vicinity: Parcel Number: 42515174 Applicant: FISH, FRANK N TR Address: 467 16TH PLACE COSTA MESA, CA . Owner: FISH, FRANK N TR Address: 467 76TH PLACE COSTA MESA, CA Coniractor: O W N ER-B U I LDE R Address: REPLACEFAU. Quantity ISSUE FEE Inst FAU <100 k BTU Inst FAU >700 k BTU Repair/Alt Cooling/Heat Inst / Rep. Recess Wall Htr Refrig Sys <100 k BTU Retrig Sys >100 k BTU Gas Piping Factory Fireplace Hood w/Mech Exhaust VAV Box Vent Fan / Single Duct Appliance Fire Dampers Smoke Dampers Inst or Relocate Appl Vent Air Handlers < 10000cfm AirNandlers> 10000cfm Floor Furnace Floor or Suspend Heater 523.50 $74.80 $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 MECHANICAL PERMIT Status: ISSUED Applied: i2/28/2Q05 Issued: 12/28/2005 ISSUED BY: \ Phone: , � ZiP: 9 6. . 6 R JEXTENSIOl� Phone: Zip: 926273216 Phone: Zip: License: 000000 SCOPE OF PERMIT FEE SUMMARY l'1LJHJ� EXPI Repair / Alt Absorbtion Unit Repair / Alt Refrigeration Unit Ventillation System Evaporative Cooler C ommercia l I n cinerato r Domestic Incineretor Comoressors / Absomtion Svstems Upto3hp/100kBTU 3To15hp/SOOkBTU 15 To 30 hp / 1,000 k BTU 30 To 50 hp / 1,750 k BTU Over 50 hp / Over 1,750 BTU Boilers Uplo3hp 3To15hp 15to30hp 30 to 50 hp Over 50 hp Olher Mechanical Fee Investigalion Fee Plan Check Fee Reinspeclion Fee TOTAL CALCULATED FEES COMMENTS / SPECIAL CONDITIONS '� Quantiry $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 538.30 NO710E: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 7241-g2) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned tor a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred Inspections and ilnal approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 2048-681fl�00) WtlRKER'J COMPENSATION DECLARATION: � � �� I hereDy ettirm untler penalry of pe�ury one of the lollowing tleclerations: ❑ I have entl will maintein a certilicate oi consent to self-Insure for workers' compensatioq as provided fof by section 3700 at Ihe Lebor wark lor w�ich this permit Is luuetl. ! ❑ 1 have antl will malntain workers' compenution insurance, as requiretl by section 3700 0l lhe Lebor Code, for the peAormance ol t�e work lor My workers' rAmpensation Insurance carner antl policy number are: Car�er. Policy Numbec ((his section neetl nof be compleled il fhe permif is valuad ef one hundred dollars ($100) ar less.) of lhe pertnit Is issued. ❑ I catlity Ihat in the peRormance ot t�e work for which this pertnit is issued, I shall not employ eny person in any manner so es to become su6ject to the workars' compensation laws oi Celifomia, and agrae that II I shoultl become sublect to the workers' compansation provisions ol Sectlon 3700 of Ihe LeDor Code, I shall forthwith comply with thesa provisions. Applicam Signature: Date: WApNIN6: FNLURE TO SECURE WOflKERS' COMPENSATION COVERAGE IS UNLAWFUL PND SHALL SUBIECT AN EMPLOYER TO CRIRUNAL PENALTIES AND CML FlNES UP TO ONE HUNDRED TFIOUSAND DOLLARE (5100,000). IN ADDfTION TO THE COST OF CQIIPENSATION, DAMAGES PS PROVIDED FOR IN SECTION 31060F THE IABOR CODE, IMEREST, PND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARA710N: I hereby atfirm that I em licensed u�der prwisions oi Cfiepter 9(commencing with Section 700D) of Dlvision 3 of ihe Business entl Prolessions Code, entl my Ilcense is in full lorce antl ettect. Lic. N Class x Con�ractor'S Signaiura: Date: CONSTRUC710N LENDING AGENCY: ❑ I hereby affirm that there is a cons lender's Nama "��-°• Signa�ure: T OWNER-BUILDER DECLARATIONS: IBnding egency for the performance of ihe worN for which ihis permit is issued. (Sec. 3097, Civil Code). = Lender's Address: i � Y -. ` , .✓nx.•... Date: I hereby eHirm thet untler penelty of per�ury thet I em EXEMPT FROM THE-CONlY7!(CTORS LICENSE LAW for the (ollowing reeson (Sec. 7031.5, Business end Protessions Code: Any ciry or counry which requires e permit to constmct, elter, improve, demolish, or repair any structure, prior to its issuance, elso requires the epplicant for such permit to file a signetl stetemant thet he or she Is licensetl pursuant to the pwvisions oi ihe Contreaors License Law (Chapter 9(wmmencing with Sectlon 7000) ol Division 3 ot ihe Business antl Professions Code) Or that he or she is axempt therefrom and ihe basis for the ellegad ezemption. Any violation af Section 7031.5 by any epplicant lor a permit subjects the applicam to s civil penaHy o1 not more than five huntlretl dollars (5500) J�. ❑ I, es owner oi the propeny, or my employees with wages as thelr sole compensation, WILL DO TME WORK, antl Ihe st�ucture Is not in�ended or oflered lor sale (Sec. 7044, Busine5s and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves Ihe�eon, an0 who doas such work himself or herself or through his or her own employees, provided ihat such improvements are not imendetl or oMered for sale. II, however, ihe 6uiltling or improvement is sold within one year ol completioq Ihe owner-builtler will heve the burden of proving ihat he or she did not build or improve for puryose of sale.). � ❑ I, as owner of the proporty, am EXCLUSIVELV CONTRACTING WITH LICENSED CON7RACTORS to construct the projecl (Sec. 704a, Business end Prolessions Code: T�e coNractors License Lew does not apply Io an owner of propeny who builds or Improves t�ereon, and w�o conlwcis for such project with e contrector(s) , license pursuant to the Conlrectors License Laws.). Business antl Professions Code tor this reason: �er�nf+ed by tlnver's license. �❑ Yes ❑ No ( Venfi��ion of Owners�ip 6y (rype of tlocumbn6 i.e. - property tex bill or tleed): DIVISION OF INDUSTRIAL SAFETV PERMR CERTIFICA710N: ❑ I hareby certify that no excovetion five (5) or more feet in depih in�o which a person is requireG to descenq will be mede in connection with work euihotlzed by this permit, end ihat no builtling siructure, scattolding, talsework, or demolition or dismantling Ihereot, will be more than thirry-six (36) leet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Ttle B, Calitornia Atlminis�retive Cotle). ❑ As owner�builder, I wiil nol employ anyone to do work w�ich would require a permit trom Ihe Division of Indusirial Se�ety, es notetl above, unless such pereon has e permit to do such work Irom Ihe tlivision. Signature: Dala: Division oi Industnal Safery Permit Num6er: CER71FlCA7E OF COMPLIANCE AND AUTHOfiIZA710N OF ENTAV: I cenity under penalry ot perjury that 1 have read Ihis eppllcation and state [het Ihe infortnation given is correct I agree Io c ly with ell state laws end ciry ordinences relating to building construction, and authonze representa�ives of the City ot Cos�a Mesa to enter upon lhe a -d nbe op or' ( ction pu�l� e no� to acupy or allow occupency of any building authonze��it ` � inspection. �1 Sig tur ga Ow s) AnNOr Auihonzed App�iCani COOE !. INSPECTION TYPE 7676 Fixed System Final Fire Preven�ion 1266 Pool Spa Final 200 Final Re-Roof 201 Finel BIocWRetaining Wnll 202 Final Factory Fire Plece pp3 Finel Sign 264 Final Demalition P�ff It�lA15 � eooe� ixsvecnonrrve 206 Final Mechanical 20B Final Plum6ing 210 Final ElectnCal 212 22D Final Fire Prevention Flnal Planning Approval 222 Final Site 250 Final Building/Occupancy � 6 ( • (714) 754-5273 • Fan (714) 7541856 • ww�v.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 467 16TH PL Suite No Vicinity: Parcel Nunmber: 42515114 Applicant: FISH, FRANK N TR Address: 467 16TH PLACE COSTA MESA, CA Owner: FISH, FRANK N TR Address 467 16TH PLACE COS7A MESA, CA Contractor: OWNER-BUILDER Address: Arch / Eng : Address: PLUMBING PERMIT Phone: 949-631-7716 Zip: 926273216 Phone: Zip: 926273216 Phone: Zip: License: 0 Phone: Zip: License: SCOPE OF PERMIT EXTEND EXIST. 6ATHROOM BY 9SF. REF 802-00963. FiEPLACE WASH BASIN AND 1 A NEW BATHTUB. ISSUE FEE BackFlow irrigation Backflow Preventer Bathtub Clarifier System Connect Qce,Soda,etc) Dental Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Drinking Fountain Expansion Tank Gas Earthquake Valve Gas (1-4 outlets) Gas (Over 4 outlets) Gas Repipe Gas Service Interceptors (Grease, Oip Interceptors (Sand Auto ) AMT $23.50 $0.00 $0.00 $9.80 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Qrr FEE SUMMARY AMT Laundry Tub / Washer $0.00 Landscape Irrigation $0.00 P-Trap $0.00 Pressure Regulator $0.00 Process Piping (per 10 ft) $0.00 Receptors $0.00 SepticTank $0.00 Sewer Cap for Demo $0.00 Sewer Connect $0.00 Sewer Private Line $0.00 Shower $0.00 Sink, bar $0.00 Sink, commercial $0.00 Sink, Floor $0.00 Sink, kitchen $0.00 Sink, service/mop $0.00 Spa (private) $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 Status: ISSUED Applied: O6/27/2002 I ssued: 06/27/2002 ISSUED SY: �. SumpPump Swimming Pool Trap Primer Urinal Vacuum Briv Bkflow(1-4) Vacuum Brkr Bkflow(5+) Wash Basin Wash Basin Set Waste and Vent Syslem Water qoset (foilet) Water Heater / vent Water Piping (Inst or Rep.) Water Re-pipe Water Service Water Softener OTHER VIOLATION PLAN CHECK REINSPECTION TOTAL CALCULATED FEES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements 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, for a period of 180 days. �� i AMT $D.00 $0.00 $0.00 $0.00 $0.00 $0.00 $9.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 �TY 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 C statutes and related work is suspended or abandoned INSPECTIONS: In order for ihe work authorized under this permil to be considered legal, such work must comply with all applicable codes, and all requlred inspectlone end tinal approval must be obtained. Failure to obtain inspactions and tinal approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 . /� 24d6-48�fl�00) WORKERS' COMPENSA710N DECLARATION: I hereby eflirm untler penalty of Oerjury one of ihe following declarations: ❑ I heve entl will melnlain a cetlificale of consent to selFlnsura tor workers' wmpensetion, as pmvided for by section 3700 oi the Lebor CoOe, lor Ihe peAortnance of ihe work to! whiCh �his pgrmlt IS issuetl. . ❑ I heve erW will maintafn workers' compensatlon in5urence, as requiretl by section 3700 of Ne Labor Cotle, For Ne peAortnance oi Iha work for whkh IhiS pertnit is issuetl. My workers' comp sa " Insuren ' r and policy number are: ��^ Cartier. l Policy Number: �,`� (This secpon need no( be como et i! e nermit is valued ef one hundred dollars lS100) oi lessJ certify Ihat in Ihe pdrtortnance o( the work for which this permit I5 ISsueQ I shell not amploy any person in any manner so as ro become subject lo che workers' compensetion lews ol Celitomia, end agrea at If I s�oul ewme subjea to the workers' compensation pmvisions of Sectio 3700 ot the Lebor Cotle, I shall torthwith comply with lhese prp ' n5. /' � P^ +� O� Appllcant Slgneture: f /��''� Date: ��,L i WARNINO:FAILURE SECqqEWORKERS'COMPEN TiONCOVERAGEISUNIAWFULANDSHALLSU&IECTANEMPI.OVERTOCWMINALPENALTIESANDGVILFlNESUPTOONEHUNDRED T/1IX15AND DOLIARE R��A00). IN PDDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR M SECTION 3)Ofi OF THE LABOR GODE, IMEREST, AND ATTORNEI"S FEES. LICENSED CONTRAC70qS DECLARATION: I hereby etlirm that I em licensed under provisions of Chapter 9(commencing with Sectlon 7000) ot Dlvislon 3 of ihe Business and Professions Code, end my license is in tull torce entl ettect. Lic. M _ . ___ . _ _ _ Glass k . _ Contrector's SlgnaWre: Da[e: CONSTRUCTION LENDING ACaENCV: ' ❑ I hereby eflirtn that there is a construction lending agency tor the pertortnance ol the work br w�iU t�is permit is issued. (Sec. 3097, Civil Code). Lentlefs Name: Lentlels Adtlress: Signature: OWNER-BUILDER DECLqqA710NS: Date: I hereby eHlrtn thet untler penelry of perjury Ihat I am EXEMPT FROM TME CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5, Busineu and Prolessions Code: Any Gry ar counry which requires e pertnii to consiruct, alter, improve, tlemalish, or repeir eny strucNre, pnor to its issuance, elso requires the applicant for such pertnit to tile e signed statement thet he ar she Is Iicensed pursuant to the proWsions oi the Contrectors IJcense Law (Chepter 9(commencing with Sectlon 7000) ol Division 3 ot the Business entl Professions Cotle) or Ihet he or she is exempt Iheretrom entl the besis for the alleped e:emption. Any violation oi Section 7031.5 by any epplicent lar e partnit blecis the epplicant to e civil penalry ot not more than five hundred dollers ($500�.): s owner ot tne prOperry, or my employaes with wages as their sole crompensation, WILL DO TiIE WORK, end the structure 7s rrot interMeO or oHered tor sele (Sec. 7044, Business antl professions Code: The Contractors License Law Cces not apply to an owner of DmPerry who builds or improves ihereon, and who tloes such wark himself or herselt or Ihmugh his or her own employees, provideC t�et such improvements ere not intentled or ottered for sale. II, however, Ihe building or improvement is sold within one year of completion, the owner-builtler will hava tha burden ol proving ihat he or she did not build or improve tor purpose oi sale.). ❑ I, as owner ot the prOperty, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct Ihe project (Sec. 7044, Business end Protessions Cotle: The contrectors License Lew does not apply to an owner ol property who bulltls or Improves Iheraan, end who contracts for such proJect with a contractar(s) license pursuaN to the Comractors ense Laws,y ❑ I em exempt u sec. '^_�'� Business and Professions Coda for this reeson: SignaWro: �- � � Date: Owner ID ied by tlrrveYs license. ❑ Yes ❑ No Driver's License No. apires: Verificetlon ol Ownership py (rype ol tlocument, i.e. - pmperty t� bill or tleetl): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certity ihet no excavation live (5) or mora teet in tlepth into which a person is requlred to descenq will be made in connection wilh work authorized by this pertnit, and lhat no buildinq structure, scaffolding, falsework, or demolition or tlismantling t�ereol, will be more �han thirty-six (36) teet hiqh. (Chep. 32, Grp 2, An 2, Sec. 341, Trtla 8, Califomla AdministreGve Cotla). ❑ As owner-builder, I will not employ enyone to do work which would require e pertnit from the Division ot Indusirial Safery, es noted above, unless such person hes e permit to tlo such w6rk from tha tlivision. Signamre: Date: Division ol lndustnal Safety Permit Number: CERTFlCATE OF COMPUANCE AND AUTHOR1ZA710N OF EMAY: I cenity under penelty of perjury ihat I �ave read Ihis application and stete ihet the infortnation given is correct. I egree to ply wlt II srete lews and ciry ordinances releling to building consiruction, end authonze representatives ol Ihe Ciry of Costa Mesa lo enier upon the above-desa' rope r i p�e�ctio oses. I agree not to occupy or allow occupency of eny building authorized by this pemip until final inspection. � -Z-��-��' (Q ! �� 0 �_ tu Oi Legal Owner(s) /Da - - t•-- / And/Or Au�horized Applicani Date COpE 6 INSPECTIONTYPE / �1 a 1616 Fixed System Final Fir/e Prevention 1266 Pad Spe Finel ,/' 200 Flnel Re-Roo�� 201 Final Block/Retaining Well y 202 Final Factory Fire Place 20�Finel Sign 204 Final Damolition � f�� LOpE1 INSPECTIONTYPE 206 Final Mechanical 208 Final Plumbing 210 Final Electrical 212 220 222 250 Final Fire Preventian Final Planning Approval Final Site Final Builtling/Occupancy Q� lt� (�-5-03 � attri�iutes : Costa Mesa Parcels Property Address Address 1 467 E 16TH PL Address 2 COSTA MESA CA 92627 Parcel Information Assessor Parcel Number 42515114 Legal N TR 1714 LOT 10 Range Township Sec[ion Quarter Section Area Acres owner Owner Address 1 Owner Address 2 Year Built Building Square Feet Building Count Stories Number Parking Spaces . Number of Units garage Square Feet Front Footage Depth Footgae Bedrooms 6000.0465599999998 0.14000000000000001 Owner Information FISH FRANK N 467 16TH PL COSTA MESA CA 92627 Property Specs 1956 1561 1 1 3 0 0 75 80 3 � Pa�e 1 of 1 http://mesagis2x/website/costamesa/pazcel/default.asp?opt=attributes&sessid= {50924820-52CC-427C-9... 02/19/2004 Property Pirofile Property Profile Property Characteristics Bedrooms: 3 Ba[hrooms:2.0 � Total Rooms: 5 Zoning: Heating/Cooling: Sale & Loan Informatiar Transfer Date: 07-15-1980 Transfer Value: $117,500 First Loan Amt: Loan Type: , DataQuick°* ,�.�..�, �....,, �ana aia vou+tv wu vou cen wia ar Primary Owner: FISH,FRANK N 8 JOANNE M Secondary Owner: Mail Address: 467 16TH PL COSTA MESA, CA 92627 Site Address: 467 16TH PL COSTA MESA, CA 92627 Telephone Number. APN: 425-151-14 Reference APN: Census Tract: 633.004 Housing Tract Number: 1714 Lot Number: 10 Page Grid Old: 31-D4 Page Grid New: 889-AS Legal Description: N TR 1714 LOT 10 Subdivision: Year Built: 1956 Square Feet: 1,567 Garage: Lot Size: Fireplace: Number of Units: 1 PoolNiew: Use Code: Single Family Residence Seller: CosUSq Feet: $74.98 Lender: In[erest Rate Type: Assessed & Tax Infor�ttation Assessed Value: $211,944 Percent Improvement 45.00 Land Value: $116,569 Tax Amount $2,361 Improvement Value: $95,375 Tax Status: current Document: 0136641822 Title Co.: Last Trans W/O$: 04-14-2003 Last Trans W/O$ Doc: 0000413735 Homeowner Exemp[ion: Y Tax Rate Area: 15007 6 2004 DafaQuick Information Systems. This intormation is compiled from public documents and is not guaranteetl. [ Report Menu ], [ Select New Target Prope_r[y ] http://www. gotitle.com/cgi-bin/profile. asp?rmt=TOPS&graphic=%2Faccounts%2FT07378%2Fcompan. , Page 1 of 1 02/19/2004 (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 467 16TH PL Suite: Vicinity: Parcel Number: 42515114 Applicant: FISH, FRANK N TR Address: 467 16TH PLACE COSTA MESA, CA . owner: FISH, FRANF< N TR Address 467 16TH PLACE COSTA MESA, CA � Contractor: � OWNER-BUILDER Address: Zip: Arch : Address: Zoning: Phone: 949-631-7116 Zip: 926273216 Phone: Zip: 92627-3216 Phone: License: 0 Eng: Address: Status: ISSUED Applied: 06/27/2002 Issued: 06/27/2002 ISSUED BY: � � Phone: � Phone: Zip: . License: License: f SCOPE OF PERMIT EXTEND EXIST. BATHROOM BY 9SF. " � Plan Check: $54.11 Permit: $83.25 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $137.86 SETBACKS MAINSTRUCTURE Front 0-0 ACCESSORY Front 0- 0 PARKING Existinq: 0 NOTES: Rear 0- 0 Rear 0- 0 Required: 0 FEESUMMARY PLANNING & ZONING LeR 0- 0 Lek 0- 0 Pro osed: 0 Calc Valuation: Claim Valuation: Right 0-0 Ri9ht 0- 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California regulations. (Ord. No. 92-28, § 1, 1241-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is susF 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�a� requlred Inspeetions and final approval must be obtained. Failure to obtain inspections and final approval will result in the�expirat FOR INSPECTIONS CALL: (714) 7545626 , U 2446-4fi(6/00) . $2,soo.00 Sz,soo.00 �. �� rtutes and related / ied or abandoned >le codes, and all of this permit. WORKERS' COMPENSATION DECLARATION: i I hereby eRi�m under pgnalry of perjury one of the following declaretions: � 3 ❑ I have antl will m7intain a certificate of consent ro seN-Insura for workers' compensalion, es provided tor by section 3700 of the Labor Code, for the pertormance of ihe work for which thTs pertnit is issuetl. ❑ I have and will maintyn workers' wmpensation insurance, as required by section 3700 of the Labor Catle, for ihe perfortnance of ihe wo ; for which this pertnit is issued. My workers' compensnati,o,n fI s ��nc�e� carri/erj� �d_policy number are: Carriec L YY/ X ��Y�""Y�T Policy Number. his section need no1 be canp eted i1 the pe 7 is valued a1 one hund�ed daUars ($100) orless. J ertify �hat in th� peAormance of Ihe work for which this permi� is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laWs of Calitornia agree that if should beco e subjecl to the workers' compensation provisions of Section 3700 of the Labor Cod , I sha0 forthwith comply with ihes� provisio / �� / � I Applicant Signature: / Date: �� 27 �D WARNING: FAILURE TO SE RE WORKERS' CAMPENSATION (YJVERAGE IS UNLAWFUL ANp SHALL SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES�UP i0 ONE HUNDRED THOUSAND OOLLARE ($1pp,ppp�, IN ADDITION TO THE COST OF COMPENSATION, DAhNGES AS PFOVIDED FOR IN SECTION 3]OG OF THE LABOR CADE, INTEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirm ihat I am licensed untler provisions ot Chapter 9(commencing with Section 7000) of Division 3 of the Business and Protessions Cotle, antl my license is in full force and eHecL Lia % Class # Cantredor's SignaNre: Date: CONSTRUCTION LENDING AGENCY: � ' ❑ I hereby aHirm ihat there is a construction lending agency for the pedormance oi ihe work for which this permit is issuetl. (Sec. 3097, Civil Cotle). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER D�CLARATIONS: I hereby attirm ihat untler penalty of perjury that I em E%EMPT FROM THE CONTRAC70RS LICENSE LAW for ihe following reason (Sec. 7031.5, Business and Protessions Code: Any ciry or county which requires a permii lo consimct, alier, improve, demolish, or repair any slrucNre, prior to ils issuance, also requires Ihe applicani for such permit to file a signed statam�nt ihat he or she is Ilcensed pursuant b the provisions of tha Conirectors License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business flnd Professivns Code) or that he or she is exempt therefrom and ihe basis for the aileged exemption. Any violetion of Section 7031.5 by any applicant for a permit subjects the applicent lo a civil penalry ot not more ihan tive hundretl dollars ($500).): ❑ I, as owner of ihe property, or my employees with wages as Iheir sole compensation, WILL DO 7HE WORK, antl the stmcture is not intended or oHered tor sale (Sec. 7044, Business antl Professions Code: The Coniractors License Law does not apply to an owner of proparty who builds or improves ihereon, and who does such work himself or hereelt or through his or her own employees, provitletl ihat such improvements are not intended or ottered for sele. If, however, the builtling or improvement is sold within ona year of completion, tha owneo-builder will have lhe burden of pmving that he or she did not build or improve tor puryose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY LONTRACTING WITH LICENSED CONTRACTORS to consiruct the project (Sec. 7044, Business antl Professions Cotle: The contrqctor License Law does not apply to an owner of property who builds or improves thereon, end who contracis tor such projed with a conirector(s) license pursuant to tl�e Contractors License Laws.). ❑ I em exempt un ec. Business and Professions Code tor ihis reason: SigneNra: � � � � Daie: Owner ID rdied by driveYs licensa. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (rype of dowment, i.a. - properry tax hill or tleetl): DIVISION OF INDUSTqIAL SAFETY PERMIT CERTIFICA710N: ❑ I hereby certify that no excavation five (5) or more feat in depth into which a person is required to descentl, will be made in connection with work authorized by this permit, and ihat no builtling simcture, scallolding, falsework, or tlemolition or dismantling thereoi, will be more than ihirry-sia (36) feet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Title 8, Califomia Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit irom ihe Division of Intlustrial Satety, as noted above, unless such parson has a permit to do such work from the division. Signature: �ate: Division of Intlusirial Safety Permit Number: CERTIFICATE OF COMPLIANCE AND AUh10RIZATION OF ENTAY: I cehify under penalry of perjury that I have read ihis application and state that the intormation given is correct I agree to ly with I state law and ciry ortlinances relating to building constmction, and authonze represematives ot ihe Giry of Costa Mesa to enter upon Ihe above-descri ropa � ins�ecti� �oses. I agree not to occupy o� allow occupancy of any bui�ding authorized by this permd ntil final inspection. �/�� __ C�y -�3 7/ � a, .O. alOwner(s) Datef- And/Or Aulhorized Applicant Data COOE �. INSPECTION TYPE Q.LLE 167fi Fized System Final Fire Prevention 1266 Pool Spa Final 200 Final Ra-Roof 207 Final Block/Retaining Wall 202 Final Factory Fire Place 203 Final Sign 204 Final Demoli�ion INTRIAL 0 CODEY INSPECTIONTYPE 206 Finel Mechanical 208 Final Plumbing 210 Final Electrical 212 Fine7 Fire Prevention 220 Final Planning Approval 222 FinalSite 250 FinalBuilding/Occupancy � 1NIIIlsk@ -Z �--� �! � (714) 754-5273 • Fau (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DFIVE, COSTA MESA, CA 92626 Job Address: 467 16TH PL Suite No Viciniry: Parcel Nunmber: 42515114 Applicant: FISH, FRANK N TR Address: 467 16TH PLACE COSTA MESA, CA Owner: FISH, FRANK N TR Address 467 16TH PLACE � � COSTA MESA, CA 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 Outlets Switches Non Res Appl Res Appl Service to 200a Service to 1000a Service over t000a Motors to 7 hp Motors to 10hp Motors to 50hp Motors to t00hp Motors over 100hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole OWNER-BUILDER ELECTRICAL PERMIT Phone: 949-631-7116 Zip: 92627-3216 Phone: Zip: 92627-3216 Phone: Zip: license: 0 ISSUED BY: SCOPE OF PERMIT EXTEND EXIST. BATHROOM BY 9SF. REF 802-00963. 3 LIGHTS, 1 OUTLET, 2 SWITCHES AND UPGRADE SERVICE TO 200AMP( COMBINATION Of SUBPANEL A ND METER) $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $3.30 $1.10 $2.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $30.50 $0.00 $0.00 $0.00 $0.00 Quantity 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 Valt Wiring System / Ckt Misa Conduit Misa Conductor Circus ( gen or ride) Circus (mech ride or lights) Christmas Tree Stand Fireworks Stand Other Electrical Fee Investigation Fee Plan Check Fee Reinspection Fee Status: ISSUED Applied: O6/27/2002 Issued: 06/27/2002 Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 $0.00 TOTAI CALCULATED FEES $60.60 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Californie 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 1 BO days, or if work is suspended or abandoned for a period of 180 days. �. `7 INSPECTIONS: In order for �he work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 244636(N00) WORKERS'COMPENSATION DECLARATON: I hereby attirm under p�nalry oi perjury one oi the Following declarations: ❑ I heve end will maintain a certificate oi consent to self-Insure for workers' compensatioq es pmvided for by section 3700 oi the Labor Code, tor the pertormance of the work for which this permit is issuetl. . , . ❑ I have and will maint n workers' crompe satio urance, as required by section 3700 of Ihe Lebor Cotle, for the peAortnance of ihe work to hich Ihis pertnit is issued. My workers' com e�s I Ins r n and policy numbet ere: errier: �, �� Policy Number: his se ion need not be campleted 1! t e perm�t is valued et one huntlred dollars ($700) or less.) I certily that in the pertormance of the work for which t�is permit is issued, I shell not employ eny person in any manner so as to become subjact to tha workers' compensation laws of� agr'e th� becoma subject b t�e workers' compensation pmvisions of Section 3700 of the WboOr Cod� II fonhwith comply wit� these prov � y%/� / � / ApplicantSigneWre: _l��7i / — " Date: L(� i WARNING: FAILURE RE WORKERS' COMPEN IqJ WVEPAGE IS IINLAWFUL AND SHALL SUBJELT PN EMPIOYER TO CRIMINAL PE�AND VIL FlNES UP TOONE HUNDRED THOUSAND DOLLARE (E100,000), IN AD�ITION TO THE CQST OF COMPENSATION, DAM4GE5 AS PROVIDED FOR IN SECTIqJ �OS OF THE UBOR CODE, IMEREST, AND ATiOFNE1"S FEES. LICENSEO CONTRACTORS DECLAHATION: I here6y aHirm ihat I am licensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 of ihe Business and Professions Code, end my license is in full force and eHecL Lic. # Class k Con[ractors Signature: Date: CONS7RUC710N LENDING AGENCV: � ❑ I here6y aHirtn that Ihere is a consWction lentling agency for the pertortnance ol ihe work for which this permit is issued. (Sec. 3097, Civil Cotle). Lendefs Name: Lendefs Adtlress: SigneWre: Date: OWNER-BUILDER DECLARATIONS: I hereby eHirm ihat under penalty of perjury ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Business entl Professions Cotle: Any ciry or counry which requires a permit to construct, elter, improve, demolis�, or repair eny strudure, pnor to its issuance, also requires the applicam tor such permit to file a signed sWtement that he or she Is Iicensed pursuem to the provisions ot ihe Comractors License law (Chapter 9(commencinq with SecOon 7000) of Division 3 ot ihe Busine end Professions Code) or Ihai he or she is exempl iherelrom end ihe hesis lor the elleged exemption. Any viola�ion of Seciion 7031.5 by any applicent for a pertnit bj s the epplicant to a civil penalry of not more ihan five hundretl tlollars ($500).): I, es owner of the property, or my employees wi[h wages as their sole compensation, WILL DO THE WORK, end the strucWre is not intended or offered tor sale (Sec. 7044, Business and Professions Code: The Coniractors License Ww does not apply to an owner of property who builds or improves thereon, and who does such work himself or herselt or Ihrough his or her own employees, provided ihat such improvements are not intended or oRered for sale. N, however, t�e builtling or improvement is sold within one year ot completion, ihe ownervbuilder will have ihe burtlen ot proving ihat he or she tlitl not build or improve for purpose of sale.). ❑ I, es owner ot the pmperty, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to constmct tha project (Sec. 7044, Business end Professions Code: The contractors License Lew does not apply to an owner of pmperty who bullds or Improves thereon, and who contrecis for such projeci wlth a contrector(s) license pursuant to the Contrectors License Laws.). ❑ I am ezem sec. Business and Professions Cotle tor Ihis reason: Signature� �^ f �� / Date: Owner I venfied by dnvers license. � ❑ Yes ❑ No Drivers License No. Verifiwtion of Ownership by (rype of document, i.e. - properry tex bill or deed): Expires: DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify ihat no eacavetion five (5) or more feat in depth in�o which a person is requiretl to descentl, will be made in connection with work euthonzed by this permit, and ihat no building s�mcture, scallolding, falsework, or demolition or dismantling ihareot, will be more than thirty-six (36) teet high. (Chap. 32, Grp 2, Ar12, Sec. 341, Title 8, Calitornia Atlministrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permi� from Ihe Division of Industnal Safery, as noted above, unless such person has a permit to tlo such work from tha divi5ion. Signature: Date: Division of Industnal Safery Permit Number: CER7IFlCATE OF COMPLIANCE AND AUTHORIZATION OF EMAY: I certify under penalry of perjury ihat I have read ihis ap0lication and state ihat the infortnation given is corract. I egree comply with all state laws end ciry orainances relating to builtling constmction, and authonze representatives of the City of Costa Mesa to enter upon Ihe ebove-des propeAy specti rpose . I egree not to occupy or allow occupancy of eny building authorized by this permi� until fina} inspection. � �a ��7 / (� �— nat re Ot Lagal Owneqs) � D e � ��'__ And/OrAuthonzed Ap0licant Date COOE �, INSPECTIONTYPE 1616 Fizetl System Final Fire Prevention 1266 Pool Spa Final 200 Final Re-Roof 201 Flnal BIocWReteining Well 202 Final Factory Fire Place 203 204 Final Sign Final Demolition D�TE INTffIALS COOE� INSiECTIONTYPE 206 Final Mechanical 208 Final Plumbing 210 Final Electrical 212 Final Fire Prevention 220 Final Planning Approval 222 250 Final Sita Final Building/Occupency uw- (714) 754-5273 • Fax (774) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT Job Address: 497 16TH PL Suite No Vicinity: Parcel Nunmber: 42515109 Applicant: HOUSEPIAN, RONALD DEE TR Address: 497 E 16TH PL COSTA MESA, CA Owner: HOUSEPIAN, RONALD DEE TR Address 497 E 16TH PL COSTA MESA, CA Contractor: OWNER BUILDER Address: Arch / Eng : Address: ISSUE FEE BackFlow irrigation BackFlow Preventer Bathtub Clarifier System Connect pce,Soda,etc) Dental Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Dnnking Fountain Expansion Tank Gas Earthquake Valve Phone: (949) 64G8560 Zip: 92627 Phone: (949) 64&8560 Zip: 92627 Phone: ZIP License: 000000 Phone: Zip: License: SCOPE OF PERMIT ADD SPA INSIDE EXISTING POOL. RELOCATE POOL E�UIPMENT. 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 �N 0 0 0 0 0 0 0 0 0 0 0 0 0 FEE SUMMARY AMT Laundry Tub / Washer � $0.00 Landscape Irrigation $0.00 P-Trap - � $0.00 Pressure Regulator " $0.00 � � Process Piping (per 10 ft) . $0.00 Receptors $0.00 , Septic Tank $0.00 Sewer Cap for Demo $0.00 - Sewer Connect $0.00 Sewer Private Line $0.00 � �Shower $0.00 � Sink, bar , $0.00 Sink, commercial $0.00 Sink, Floor $0.00 QTY 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Status: ISSUED Applied: 11/07/2002 Issued: 11/07/2002 ISSUED BV: SumpPump Swimming Pool Trap Primer Urinal Vacuum Brkr Bkflow(1-4) Vacuum Brkr Bkflow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (Toileq Water Heater / vent Water Piping Qnst or Rep.) Water Re-pipe Water Service AMT $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 QTY 0 0 0 0 0 0 0 0 0 0 0 0 0 0 NO710E: 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, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 780 days, or if work is suspended or abandoned for a period of 1 BO days. INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required fnepections and final epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 2448�d6�8/00) WORKERS' COMPENSATION DECLARA710N:� � I hereby eflirm undar penelry ot perjury one oi the followinq declarations: ❑ I heve end will mein�ain a certificate ot consent to self�insure for worker¢' compensa�ion, as providad lor by seclion 3700 ot the Le6or Code, for the pertortnence of t�e work for which Ihis permit is issued. ❑ I have and wlll maintain workars' compensation insuren , as required by section 3700 ot the Labor Code, for Ihe pertortnance of the work torw ic� this pertnit is issuetl. My workers' compenseiion In r rner a i nu ber are: Carner: • � .�� Policy NumCer. This section need not be comple(� i! tAe permit is v etl at ane hunared dollars (S100J or less.) ❑ cenify Ihet in t�e pertortnance ot t�e work for which t�is permit is issued, 1 shall not amploy any person In eny manner so es to become subject to Ihe workers' compensation laws oi Cellfo , d agree that ii I should become sub�ecl ro ihe workers' compensation provisions oi Sectlon 3700 1 Ihe Labor Cotle, I shall forthwith com I with these r' s. PY P Applicant Signeture: ,� ..-��-�-� Date: � 1�� Z� WARNING�, FAILUPE i0 SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINQ PENALTIE AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000�, IN ADDITION TO THE COST OF COMPENSATION, OAMAGES AS PfiOVIDED FOR IN SECTIQY 3]Ofi OF THE LABOR CODE, IMEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I here�y aflirm Ihat I am licensetl untler provisions of Chapter 9(commencing with Section 7000) of Division 3 ot the Business antl Professions Code, end my license is in full force antl effect. Lic. # Class a Coniractor's Signeture: Da�e: CONSTRUCTION LENDING AGENCV: ❑ I hereby aHirm ihat there is a consiruction lending agency lor ihe pertormance of the work br which ihis pertnil is issuetl. (Sec. 3097, Civil Code). Lenders Neme: Lentler's Atltlress: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby eHirtn that untler penalry of perjury that I am EXEMPT FROM 7HE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Business and Protessions Code: Any city or county which roquires a permit to constmct, elter, improve, demolish, or repair any structure, prior to its issuance, also requires ihe applicant for such permit to tile a signed statement Ihet he or she is licensetl pursuant to the provisions of the Contrecmrs License Lew (Chepter 9(commencing wit� Sectlon 7000) of Divisian 3 of the Business end Professlons Code) or that he or she is exempt therefrom and the basis �or the alleged axamption. Any violation of Sectlon 7037.5 by any applican[ for a pertnit subjects ihe eppllcant to a civil panalty of not more than five hund�etl tlollers ($500).): ❑ I, es owner ot Ihe propeny, or my employees with weges as their sole compensetion, WILL DO THE WORK, end the structure Is not Intentled or oHered for sale (Sec. 7044, Business and Protessions Code: The Contractors Licensa Law does no� apply Io an owner ot property who builds or improves thereon, and who does such work himselt or hersatl or ihrough his or her own employees, provitletl that such improvements are not intended or oHeretl for sale. If, however, ihe builaing or improvement is �sold within one year oi completion, the owner-6uiltler will have ihe burdon of proving ihat he or she ditl not builtl or Improve for purpose of sale.). owner oi the property, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the pro�ect (Sec. 7044, Business and Professions Code: The comracbrs Licensa Law tloes not apply to en owner of proparty who builds or improves thereon, antl who contracis lor such proiect with e contractor(s) licen5e pur5uan� �o ihe Con�ractors LicenSe LawS.). ❑ I am ex u r se - Business and Protessions Cotle for this reason: SignaNre: �..L� G r_ v. _ � �� Expires: ,i /3 C.Yj Venfication of Owners�ip by (rypa of tlocument, i.e. - property tax blll or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certity ihat no eacavation tive (5) o� more feet in deplh imo which a person is required to descend, will be metle in connection wilh work authonze0 by ihis permit, and that no building simciure, scallolding, falsework, or demolition or dismantling thareof, will be more then ihiny-six (36) feet �igh. (Chap. 32, Grp 2, Art 2, Sec. 341, Title B, Californie Atlministrative Code). ❑ AS ownerbullder, I will no� empioy anyone to do work which would require a permit irom the Division of Indusirial Safety, as notetl ebove, unless such person hes a permit to da such work irom the division. SignaNre: Date: Division oi Industrial Sefety Permit Number: CEAi1FlCATE OF COMPLIANCE AND AUTHORIZATON OF ENTRY: I certify untler penalty ot perjury ihat I have read this application and state that ihe infortnation given is correct. 1 egre ��I with all sf�te laws antl city ordinences ralating to building consimction, antl authonze represente ives ot ihe Ciry of Costa Mesa to enter upon ihe above- ri �d prtfperty r i isp� fion puryoses egr e no�py or ellow occupancy ot any building authonzed 6y'hi� pertn�t un�tll final inspeCtion. A �. I , �/ -� SignaNre Of Legai Owner(s) Date And/Or Authonzetl Applicen� COUE t. INSiECTONTYPE 1616 � Fized System Final Fire Prevention 1266 Pool SDe Final 200 Final Re-Roof 201 Final BIocWRelaining Wall 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition Q� �$ f�Qp�� INSPECTIONTYPE 206 Final Mechanicel 208 Final Plumbing 210 Final EleciriCal 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Finel BuiltlinryOccupancy Dag 1i�8 'Zo^03 � OWNER �'isher� W. E. JOBADbRES3 �lb% lbth place GENERqLCONTRACTOR W• E. Fisher t lO BLOCK GROUP Z & J INSPEC710NS Foundation Forms and Grade to Rough Framing Plumbing, Rough to Slab � Plumbing, Rough Comple e� Temporary Pole Wirina. Rouah Heating, Final 1� �ewer, House Sewe Septic Tank or C sspool L ��g.lnx Out P, _ering Plumbing, Final, Fixtures Co� Plumbing, Final Gas Test �. W iring, Final OccupanCy FORn 210 3M 10-•v5 ' DATE -ai-� -;',5 - - 2: �d s.xi-� TRACT 1%1�1 SUBCONTRACTOR DATE 6-12-56 BUILDING PERMIT NO. VALUE $ 13,830. Residence w/ att e PERMITS ISSUED I NUMBER - Costa Mesa Building Department APPLICATION FOR PERIVIIT P.O.Box3�� 31�� BUiLDING � � ~ COSTA MESA, CALIPORNIA FOR OFFICE USE ONLY FOR APPLICANT TO FII.L IN Reeeipt No. Permit No. Address �� —��'� /�Ly cE I .�/ 7 iL Costa Mesa, Ca�liOPRla � Rec^iied by I / Dat hec'�' I' Date Issued Cross St �Til�/// ,tJ,E Owner (.()_ L ��S �E�Z Mail Address301.� r, eO�q$T�L(/O c�ty i�0/tD.�1A .DEL H�4.L nTio�.ffA. So3 Architector Lic. ND Enaineer /�� nio. Gty LIC. Contrector �(�. C FjSi/E�� No. Address30�{' G. CpQST/.'Y.e//J Description I No., �� I Block j Traet � (Attach Metes and Bounds) �� %– �tr� � �' �� O No. of Bldgs Size of Lot �� i� O� Now on Lot � 45eaf I No.of I No.of Existing Bidg. — Familles Rooms Setback Line fram r– Rear Yard / Center oT Street SQ '�' Side Vard 7 Address Costa Mesa, Califomia No. of � 0 nepa�r � i moving � � I oemmisn I Building�[ a( No.ot � � Size 7� x `�p Rooms � StOries Exterior W II � Roof SNA�e Covering �TJcCp s�0�✓ Covering APPROVALS Use ot New eui�ding D(NE�[.,,��...r �''�GZ . Foundacion�ocation Inspeeto Forms, Materials, Under-Pinning , Frame: Fire Stops, 8racing, Bolts I hereby acknowledge that I have read this Application and state that the above is co M and agree to rnmply Lath. Int. � with all City Ordinances d ta aws regulating bullding constructi �. � Lath. Ext. Signatureof Permittee __ Plaster.tnt Valuation PermitFee S �p� � `$ / �� 3 D Plan Check $ �i � Tota /� ^ , -... .,.. �,. .. .. e . o Fee d" Beam O A � 2 D r 9 - YLV'1' YLE11�I Show Iocation and disFancea irom property Iine and between buildlnps cosrn �•- lUC-7 `5 -r? m n_....�,,8."�1 � �nFsn L'� • . �• �. , , , . , . . � . , . . . -.. , - `, ' ' � , - . n � � � 0 (714) 754-5273 • Fex (714) 754-4856 • www.ci.costa-mesa.��LDING PERMIT �� FAIH DHIVE, GV51 A MtSA, GA BZtiZti Job Address: 4s7 16TH PL Suite: Viciniry: Primary Occ: R3 Parcel Number: 42515114 Applicant: FISH, FRANK N TR � Address: 467 76TH PLACE COSTA MESA, CA Owner FISH, FRANK N�TR. � - Address 46716TH PLACE � � COSTA MESA, CA - Contredor: � � OWNER-BUILDER�� - Address:� � :% - �� ,.i, , - , ,/ Zip: Arch : Address: Zip: Type of Construdion: V-N Zaning: _. , . � -� - ` � Phone> . - _ . . . - -�_"� � � " � . �License: � - Status: ISSUED Applied: 12/282005 Issued: 12/28I2005 � Phone: 949-233-7769 ISSUED BY: Zip: 926273216 EXTEl�S�ON Phone: 949-2337769 �� Zip: 926273216 PER Pho�e: EXPIRES �a a � a6 , License: 000000 Eng: Address: SCOPE OF PERMIT TEAR OFF INSTALL 1l2" OSB WITH 2-15LB FELT AND LIGHT SHAKE 5.6PSF ICBO 2656 Phone: License: FEE SUMMARY . Plan Check: $0.00 , - ' , Calc Valuation: $i3,000.00 Permit: $223.25 Claim Valuation: 5i3,000.00 SMIP Res: $1.30 , `. SMIP Com: $0.00 , Other: $0.00 - " � _ ' Inspection: $0.00 � Total: $224.55 -PLANNING 8 ZONING SETBACKS MAINSTRUCTURE Front �0-0 Rear � 0-0 � LeN 0-0� Right 0=0 �, �.. r . . , .. . .. ACCESSORY Front 0- 0�� Rear 0- 0 LeN' 0- 0 Right 0- 0 � � -�%- . _ . . _ :. . - . i PARKING � Existlna: �. 0 �>�Reauiied: 0 Pr000sed: 0 j"- �� : � . , _ � � _ � - , � � , , � , � NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned for a period of 180 days. � INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all , requlred inapeetlona and finel approval musl be obtained. Fallure to obtain inspections and tinal approval will result in the expiration of ihis permit. IFOR INSPECTIONS CALL: (714) 754-5626 zaes-as �ama> WORKERS' COMVF� SAnON DECLARATION:� � I �ereby attirm untler�en3ltp•ut perjury one ol the followinq declarations: ❑ I have end will maintein e certificate ot consent to setl-Insure for workers' campensetlon, as pmWdeA for by section 3700 ot the Labor Code, tor the peAormance of Ihe work for which t�is Permit is issuetl. ❑ I have end wlll main�in workers' compensatlon insurence, az requireA Dy sectlon 3700 of the Labor Cotle, for the pertortnance oi the work tor whlch Nis pertnit Is Issued. My workers' wmpensatlon Insurenca carder end policy number are: Carrier: Policy Number: (lhis sec(ion nesd nof be �omp/eted i7 the permit is valued et one hundied dollers (5100) or less.) ❑ I certify ihet in Ihe pertortnence of tha work lor which this permit is Issued, I shall not employ any person io eny manner so as to hecome su6jocl to the workers' compensetion lews of Celifomla, and egree that if I shoultl become subject to the workers' compensatlon provisions of Saction 3700 oi the Lebor Code, I shall forthwlth camply wiM these provisions. Applicent Signeture: Dete: WAqNING: FAILIIPE TO SEGURE WORKERS' COMPENSATION COVERr1GE IS UNLAWFUL ANO SHALL SUBJELT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE HUNDFED T}IOUSAND DOLLARE (5100,000). IN ADDITION TO THE COST OF COMPENSATION, OAMAGES AS PiiOVIDED FOR IN SECTION 3]O60F THE LABOR CA�E. IFIrEREST, AN� ATTORNEV'S FEES. LICENSED CONTRACTOAS DECLARATION: I hereby aXirm that I am licensed untler pmvisions of Chapter 9(commencinq with Section 7000) ot Division 3 ol the Business and Pmfessions Cotle, end my license is in tull force end BtteCi. Lic. q Cless q ContractoYs Signature: Dete: CONSTRUCTION LENDING AGENCV: ❑ I hereby aHirm ihat Ihere is a construction lentling agency for ihe performance of Ihe work tor which this permit is issued. (Sec. 309J, Civil Cotle). Lantlefs Name: LenAer's Address: Signeiure: Da�e: OWNER-BUI�DER DEC4N7A710NS: I hereby atfirm thet under penalry of perjury thal I am EXEMPT FROM THE CONTRACTORS LICENSE LAW lor the following reason (Sec. 7031.5, Business antl Protesslons Code: Any ciry ar couny which requires e permit to construct, alter, improve, tlemolish, or repair eny sWCWre, pnor to its issuance, elso requires the appliwnt lor such pertnit m file e signed stetement ihet he or sha is Iicense0 pursuam ro the provisions ol tha Contractors License Lew (Chapter 9(commencing with Sectlon 7000) oi DlWslon 3 oi Ihe Business antl Professlon9 Cotla) or thaLhe ar she is exempt thereirom end the besis Por the alleged ezemptlon. Any violation o� Section 7031.5 by eny applicaN for a permit subjects the applicant to a clvil penalry of not more Ihan five huntlred dollars ($500)J: ❑ I, es owner of the p(operty, or my emD�oYees with waqes as Iheir sole compeosatloq WILL DO TME WORK, antl tha strucWre Is not I�tendetl or otteretl tor sale (Sec. 7044, Business end Professions Cotle: The Coniractors License Lew does not apO�Y �o an owner of property who builds or improves thereon, end who does such work himself or �erself or �hrough his or her own employeas, provitled that such Impmvements ere not Intended or oHered for sale. II, hawever, the building or Impmvemenl is sold within one year of complatioq the owner-builder will have �he burden ol proving ��at he o� she tlitl not build or improve for purpose oi sale.). ' ❑ I, as owner of iha p�operty, em E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS lo constmct the prqecf (Sac. 7044, Business entl Pmlessions Code: The contracto�s License Lew does not eppty to an owner ol propeny who builtls or impwves Ihereon, and who contrects lor such project with a contrector(s) rticense pursuent to Ihe Con�ractors License Laws.). �f� I am ce tler 5 Business antl Pwfeuions Cotle tor this reason: 15� � � "� � � Or.ner ID verilie by tlrivers icensa. RYes ❑ No rve(s Lice o. � % Expires: y/ �� Y'7� Verificatlon 01 Ownars�ip by (type ol GocCnt, i.e. - property tax bill or deetl): � DIVISION OF INDUS7RIAL SAFETY PERMIT CER7IFICATON: ❑ I hereby cenify �hai no excavation five (5) or more fee� in depih into which a person Is requiretl to descend, will be matle in connection wi�h work authonzetl by Nis permit, end Iha� no builtling structure, scattoltling, talsewo�k, or demolition or tlismamling Ihereof. will be more than Ihiriy-six (36) teet high. (Chap. 3.2, Grp 2, A� 2, Sec. 341, Ttle B, California Atlminisirative Code). ❑ As ownar-builtler, I will not employ anyone to tlo work which woultl require e pertnit trom t�e Division ol Industrial Safery, as noted ebove, unleu such person hes e permit to do such w0�k Irom the tlivision. Signature: Date: Division oi Intlusirial Sefety Permit Number: CERTFlCATE OF COMPL��ICE AND AUTHORIZATON OF ENTRY: I cenity untler penalty of perjury Ihal l have reatl this applicalion a�d state ihat the fntormetfon given is correct I agr e to com th ell state laws and ciry ordinences relating to Duiltling conswction, and euthonze representetives of the Cily of Costa Mese to enter upon the ebov - s ad pr rt f inspp.,c�ionpgrposes. I egree not to occupy or allow occupancy ol eny building authodzed by ihis pe � until finel inspection. %JR,!%X \ � nat Of er(5) Date Antl/OrAuthorized ApPlicant Date CODE t. INSYECTIONTTPE 1616 Fixed Sys�em Final fire Preven[ion 1266 Pod Spa Final 200 Final Re-Root 201 Fine181acWRetain��g Wall 202 Final Factory Fire Place 203 Finel Sign 204 Final Demolition PA� 1NIID�43 1 -EJ? �c7,� COOE 1 INSVECTION TYPE 206 Final Mechanical 20B Finel Plumbing 210 Final Electrical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy PAg 1[�lL9