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Home My WebLink About318 16TH ST - Building Permits(714) 754-5273 •� Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: Suite No Viciniry: Parcel Nunmber. 318 E 16TH ST B 42521119 Applicant: KINDRAT, ARCHIBALD TR Atltlress: 21467 VIA FLORESTA LAKE FOREST, CA Owner: KINDRAT, ARCHIBALD TR Address 21461 VIA FLORESTA LAKE FOREST, CA Contractor: OWNER BUILDER 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 to 1 hp Motors to 10hp Motors to SOhp Mators lo t00hp Motors over 100hp ISSUED BY: Phone: 949-768-8980 Zip: 92630-2015 Phane: Zip: 92630-2015 Phone: Zip: License: 000000 Stams: ISSUED Applied: 04/07I2003 Issued: 04/01/2003 SCOPE OF PERMIT LEGALIZED ADDITION OF 192 S�. FT TO AN EXISTING DWELLING. ADDITION TO EXTEND TWO UPSTAIRS BEDROOMS AND DOWNSTAIRS LIVING ROOM. INTERIOR REMODEL TO INCLUDE LEGALIZATION OF 1ST FLOOR BATHROOM TO COMPLY WITH FIXTURES CLEARANCES. ELECTRICAL TO INCLUDE 1 IIGHT SWITCH AND 5 OUTLETS. $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $1.10 $5.50 $0.00 $0.00 $0.00 so.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantiry FEE SUMMARY Temp Dist System I Lighting Busway/100ft SUnding Section Misc Electrical Equipment Transfortners up to 1 kva/kw ................up to 10 kva/kw .................uP to 50 kva/kw .................up to 100 kvalkw ..................over 100 kva/kw Low Voltage Equipment Low Volt Wiring System / Ckt Misc. Conduit Misa Conductor Circus ( gen or ride) Circus (mech ride or lights) Christmas Tree Stand Fireworks Stand Other Electrical Fee �uantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 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 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis 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 1 BO days, or if work is suspended or abandoned for a period of 7 BO 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 Inepections end final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2C<&<B (8r00) WORKERS'COMPENSA710NDECLARATION: ' � I hereby ettirm untler penalry 0� Oerjury one at the following declaratlans: ❑ I have and wlll mainteln e certifcata ol consent to self-Insure for workers' compensetlon, es provided for by section 3700 0l the Lebor Code, lor lhe pertormenca ot ihe work far w�lch this pertn�t Is issued. ❑ I �ave antl wlll maintain workers' compensation insurance, es required by sectlon 3700 of Ihe Labor Code, for the pertormance of ihe work for which Ihls permit is issued. My workers' comperisatlon Insurence carner antl policy number are: Carriar. po��ty Number. (This section neetl not be comp�efed it (he permit is va/ueAat one hunOred dWlers ($100J or less.) ❑ I certify ihat In the Oertortnance of Iha work for which this pertnit is issuod, I shell not amploy eny person in any manner so as to �ecome subjact to the workers' wmpensation laws oi Callfomia, end egree ihat II I should become suD�acl to Ihe workers' compensation provisions of Sactlon 3700 of t�e Lebor Cotle, I 5hall toRhwith compty wfth Mese provis��s. Applicent Signature: Dete: WARNINO: FAILURE TO SECURE WORKERS' COMPENSATIIXJ COVERAGE IS UNIAWFUL AND SHALL SUBIEC� rW EMPLOYER TO CRIMINAL PENALTIES ANDGVIL FlNES UP TOIXJE HUN�RED TYIOUSAND DOLLARE (E100,000), IN ADDITION TO THE WST OF COMPENSATION, OMUGES AS PROVI�ED FOR IN SECTIqJ 3'1060F THE IABOR COOE, IMEREST, ANO ATTORNE`fS FEES. LICENSEO CON7RACTORS DECLARATION: I hereDy ettirm Net I em licensed under provisions of Chapter 9(commencing wl(h Sectlon 7000) of Division 3 of the Business and Professions Code, entl my license is in full force end eflect. Lic. N Cless N Contrecrors SigneWre: Date: CONSTRUC710N LENDING AGENCV: ❑ I hereby ettirtn ihat there is a construction lending agency lor �he peAormence ot Ihe work for which this permit is issuatl. (Sec. 3097, Civil Code). Lentlefs Neme: Lender s Aatlress: Signeture: Oata: OWNER-BUILDER DECLARATONS: I hereby eHirtn �het untler pendlry ot perjury that 1 am EXEMP7 FROM THE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Business antl Professlons Cotle: Any ciry or wunry w�icp requires e permit to consWct, alter, imprrne, tlemWish, or repair any strucWre, prior to its issuance, also requires ihe eppliwnt for such pertnit to file a signed stetemem that he or she is Ilcensetl pursuant to ihe pravisions oi ihe Contrectore License Law (Chapter 9(commandng with Sectlon 7000) of Division 3 of Ue Business end Prolesslons CoCe) or thet he or she is exempt therefrom end the �esis for the allegetl exemption. Any violation ol Section 7031.5 by any epplicent for e permit suh�ects t�e epplicent to e dvll penelry of not more then tive huntlretl tlollars ($500)J: ❑ I, es owner ol the propeAY, o� my employees wlih wages as Iheir sole compensation, WILL DO THE WORK, and ihe siruciure is not intentletl or offeretl for sale (Sec. 7044, Business and Professions Cotla: The Coniractors License Law does not epply to an owner of property who builds or improves thereon, end who tloes such work himself or hersalf or thmugh his or her own employees, pmvided that such improvemenis are not Intended or oHered tor sala. If, however, the building or improvement is sold within ane year o� completion, Iha owner-builtler wiil have ihe burtlen of proving that he or s�e did not build or improve lor purpose ol saie.). � ❑ I, es owner ol iha pro0erry, em EXCLUSNELY CONTRACTNG WITH LICENSED CONTRACTORS to construct ihe pmject (Sec. 7044, Business entl Professions Cala'. The wntractors Ucense Lew does noi apply to an awner ot pmperty wha 6ulltls or Improves thereon, antl who cwrtracts bo such prqect wlth e contrector(s) license pursuam to Ihe Gontractoro License Laws.). ❑ I em exempt under sec. Business entl Professions Code lor this reason: Signature: Date: Owner ID verified by dnver's IlGense. ❑ Yes ❑ No Driver's License No. Expires: Verilicetion of Ownership by (type ot tlocument, i.e. - properry tax blil or deed): DIVISION OF INDUSTRIA� SAFEN PERMIT CER7IFICA710N: ❑ I hereby certify thet no e%��ation five (5) ar mare feet in tlepth into which a person is required to descentl, will be made In connectlon with work euthanzetl by this permit, ana that no bull0ing structure, swflolding, talsework, or tlemoll�lon or tlismemling thereof, will be more than ihirty-six (36) feel high. (Chep. 32. Gry 2, Art 2, Sec. 341, Title 8, Calilomia Administrative Cotle). ❑ As owner-6uilder, I will not employ enyone to do work which woultl require e permit Irom ihe Division of IndusMal Setery, es noted ebove, unless such person has a permit to tlo such work Irom Ihe division. Signature: Date: Divisian af Industnal Safery Pa�it Numbar: CER7IFlCATE OF COMPLIANCE AND AUTHOR�ON OF EMRV: I cenify under penalry of perjury that I have read Ihis ep0�iwtion and state thet ihe informelion given is correct. I egree to c ly with all state laws d y ortlinances relating to bulltling consiruction, and authorize representatives of ihe Ity of ste Mesa to enter upon tha ebove-described pr to pectio urp s. I a�ree not to occupy or allow occupency of any 6uiltling authorized by ihis permil un�inal i pection. / � D7 �� Signa�ure`Of Legal Owner(s) '�� AnNOr Authonzed Applicant Date GOUE �. INSPECTIONTYYE PLIE 161fi Fixetl System Finel Fife Prevention 1266 Pool SOe Finel 200 Final Ra-Rooi 201 Final Block/Retaining �'�'all 202 Final Fectory Fire PIaGe 203 Final Sign 204 Final Demolition �$ �( INSPECTIONTYPE � 20fi Final Mechanical 208 Final Plumbing 210 Final Electrical 212 Final Fire Preventlon 220 Final Planning Approval 222 Final Site 250 Final BuildinyOccupancy �g �� . a � . �R. (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ce.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job nddress: 318 E 16TH ST Suite: Vicinity: REAR OF PROPERTY Parcel Number: 42521119 Applicant: SISSON, GLEN Address: 17233 NEWHOPE STE F FOUNTAIN VALLEY, CA Owner: KINDRAT, ARCHIBALD TR Address 27461 VIA FLORESTA LAKE POREST. CA Contracror. C P I DESIGNS INC Address: 17233 NEWHOPE STE F FOUNTAIN VALLEY, CA Zip: 92708 Arch : Address: Phone: Zoning: Phone: 714-545-4995 Zip: 92708 Phone: Zip: 92630-2015 Phone: 714-545-4995 License: 786684 Eng: Address: ISSUED BY: Status: ISSUED Applied: 08/21/2002 Issued: 09/17/2002 Phone: Zip: License: License: SCOPE OF PERMIT . CONSTRUCT 407 S.F. NEW 2 CAR. ATTACHED GARAGE TO EXISTING DUPLEX UNIT AT REAR OF PROPERTY. - REF: B02-00512 �10% OPEN SPACE REQUIRED. 43% PROVIDED � Plan Check: $163.31 � Permit: $251.25 SMIP Res: $1.50 SMIP Com: $0.00 • Other: $0.00 Inspection: $0.00 Total: $416.06 SETBACKS MAIN STRUCTURE Front 21- 0 Rear 80. 0 FEE SUMMARY PLANNING & ZONING Left 1Cr0 Caic Vatuation: Claim Valuation: Right 5- 0 Sis,000.00 315,000.00 NOTICE: The work authorized by this permit shall comply with ali applicable handicap access requirements under Califomla statutes arW relatetl regulations. (Ord. No. 92-28, § 1, 12-21-92) E7CPIRATION: ThIs pertnit shall automatically axpire and become vold it work is not commenced within 180 days, or il work is suspended or ebandoned for a period of 180 days. INSPECTIONS: In order for Ihe work authorized under this permit to be eonsidered legal, such work must comply with all applleable codes, arW ail requlred Inspeetiona and tinal approvel must be obtalned. Failure to obtain inspections and final approval will result in Ihe wcpiration ol this pertnit. FOR INSPECTIONS CALL: (714) 754-5626 2as�ee (e�ool WORKERS'COMPENSAnON DECLAFiATON: ` ' I he 06y effirtn under penatry of perjury one ot the following tleclarations: ❑ I have entl wlll meintaln a certilicate at consent to sell�lnsure tor workers' compensation, as proNded for by section 3700 of the Lebor Cotle, for the perfarmence of the work for which this permit is issued. � I tiave antl will maintain workers' compensetion insurance, as requlretl by secUon 3700 ot Ne Lehor Code, for Ihe pertortnance oi Ihe work for wNch Ihis pertni� Is issugd. My workers' compensation Insurence carrler aM poliq number ere: Cernor. Policy Number: (ihis sectlar need not be completetl il fhe permlfls va/�erl et one hundred dollers (5/00) or less.) ❑ I cenity Ihat in the peAortnan of the work br which this pertnit is issuea, I shall not employ any person in any menner sa es to become ubject to 1ha workers' compensetlon laws of Cali ia, a egree thatt� I s�oulE becwne sub�ect to Ihe workers' compansatlon provislons of SactlOn 37pB.pf tl e Lehor de. I shall fonhwlih rnmply with these provis" //� //� M � AppllcantSigneWre: � J^� Date: � V �� WARNINO: FAILURE TO SE RE WORKERS' ENSATIOH COVEqACE IS UNLAWFUL AND SHNL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AN CML FlI ES UP TOONE HUNDRED THOUSAND OOLLARE (5100.000�. IN ADDfTION TO THE COST OF COMPENSATION, DAA41CaES AS PROVIDED FOR IN SECTION 3]OB OF THE LABOR CODE, INrEFEST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARA710N: I hereby eMirm that I em force end eMect. Llc. a_ Comreaols Signature: 9(mmmandng with Sectlon 7000) of DlNsion 3 ot the Business enC Prolessions Cqde, an0 my Ilcense Lq in lull Glass q � � �/� Date: � ' / CONSTRUCTON LENDING AGENGY: ❑ I heroby aHirm that Nere is e construction lending egenry tor the peAortnance ot t�e work tor which this pertnit is luuetl. (Sec. 3097, CiWI Cotle). Lender's Neme: Lendei s Address: Signaturo: Date: OWNER•BUILDER DECLARATONS: I hereby eMirtn ihat untler penalry of perjury that I flm E%EMPT FROM TME CONTRACTORS LICENSE LAW for the follawing reeson (Sec. 7031.5, Business end Professions Cotle: Any ciry or wunry whicti requires a permit to conslmci, alter, improve, demolish, or repeir eny siructure, prior to its issuance, elso repuires the applicant tor suc� pertnit to file e slgned stetement thet he ar she Is licensetl Dursuant to ihe prmdsions af ihe Contractors Llcense Lew (Chepter 8(commenGng wit� Seccion 7000) ol DiNsion 3 at the Business end Prolessions Gode) or Ihet he ar she is exempt therefrwn antl the ba5is lor the alleped e:emptian. Any violetion ol Section 7031.5 by any epplicant For e permit su6jecu the epplicent ta e civil penalry of not more Ihfln frve hundred dWlars (5500).): ❑ I, es ownar ot the property, or my employees with wages as iheir sole compenselion, WILL DO THE WORK, entl ihe structure Is not intentletl or oHered for sale (Sec. 7044, Business and Protessions Cade: The Coniractors License Law tloes not apON �a an owner ot properry who builtls or improves Nereon, and who tloes such work himseH ar hersell or Ihrough his or �er own employees, provitled that such improvements ere not intended or oHereO lor sele. II, however, the Duiltling or Improvement is sold within one year ot completion, the owneo-Duiltler will �ave tha burden of provinp thet ha or she did not 6uild or improve for purpose of sale J. ❑ I, es owner ol the pwperty, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct t0e O�ojact (Sec. 7044, Business and Pmfesslons CoEe: The contractors Llcense Lew tloes not eOPly to an owner oi property who bulltls or Improves t�ereon, end who coniracls for such project wit� a conlractor(s) license pursuant to the Contrectore License Lews.). ❑ I em e:empt under sec. Business antl Professions Cotle tor �his reason: Signeture: DBte: Owner ID verilied by drivers license. ❑ Yes ❑ No DriveYs IJcense No. Expires: Vedlicatlon ol Ownership by (type of documenL i.e. - properry tax 6ill or deed): DIVISION OF INDUSTRIAL SAFETV PEAMR CERTIFICATION: ❑ I hereby certlty that no excavatlon frve (5) or more feet In depih into which e persan is requiretl to descen0, will be meCe In connection with work authorizetl by t�ls pertnit, entl that no builtling swcture, sceMdtling, faLSewark, or demolitlon or tlismantling thereof, will be more Ihen thirty-siz (36) feet high. (Chap. 32, Gry 2, Ari 2, Sec. 341, Ttle 8, Celifomla Administrativa Code). ❑ As owner-builder, I will not employ enyone to do work which woultl require e permit trom t�e Divislon ol Industrlel Sefety, es nated ebove. unleu such person has e permit to tlo such work irom Ne tlivislon. Signeture: Date: Dlvlsion ol Indusirial Selery Permit Number: CERTIFlCA7E OF CAMPLUWCE AND AUTHORIZA710N OF ENTRY: I cenity undar penelty of perjury that I have reatl l�is epplicallon enA state that Ihe infortnetlon given is correct I egree to compty with ell stete lews end ciry ordinances relating to bulltlinp consiruction, and authorize representatives ot t�a Ciry of Costa Mesa to enter upon Ihe ebove-descnbed properry tor inspection purposes. I egree iwt to occupy or allow occupanry ol any builtling euthorizetl by this pertnit until linal inspection. i� aWre OI Lege Owner(s) �� n r Aut�onzed ApPlksnt COpE1, INSPECTIONTYPE Qdg UiI�L$ II➢e 1818 Fizetl System Final Fire Preventlon 1268 200 201 202 203 Pool Spe Final Flnal Re-Root Final BIocWReteining Well Flnel Factory Fire Place Final Sign 20a Finel Demolition �,. � �' , � �� .: � f�QQF„( INSPELTIONTYVE 208 Final Mechenical 208 Finel Plumbing 210 Final Electdcal 212 Finel Flre PrBvBnllon 220 Finel Plenning Approval 222 Final Site 250 Final Building�Occupancy PLg Q�lL,4 WEIDENKELLER, MARY JANE From: LEE, MEL Sent: Tuesday, March 07, 2006 9:1 S AM To: W EIDENKELLER, MARY JANE Subject: RE: 318 E 16th St - 602-01335 Not for Planning. Mel -----Original Message----- From: WEIDENKELLER, MARY ]ANE Sent: Tuesday, March 07, 2006 9:11 AM To: LEE, MEL; WONG, GARY Subjed: 318 E 16th St - 802-01335 Does Planning or Engineering need to sign off on this new 2 car attached garage? Thanks for letting rne know so I can file it in the closed file if thaYs what should happen. Mary Jane Fxt. 4879 � WEIDENKELLER, MARY JANE From: WEIDENKELLER, MARYJANE Sent: Tuesday, March 07, 2006 9:11. AM To: LEE, MEL; WONG, GARY Subject: 318 E 16th St - B02-01335 Does Planning or Engineering need to sign off on this new 2 car attached garage? Thanks for letting me know so I can file it in the closed file if that's what should happen. Mury Jajae E�-t. 4871 (714) 754-5273 • Fax (774) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DtiIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT ,lobAddress: 318 E 16TH ST Suite No Vicinity: Parcel Nunmber: Applicant: Address: 42521119 SISSON, GLEN Owner: KINDRAT, ARCHIBALD TR Address 21461 VIA FLORESTA LAKE FOREST, CA Contracror. C P I DESIGNS INC Address: 17233 NEWHOPE STE F FOUNTAIN VALLEY, CA 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 to 1hp Motors to 10hp Motors to 50hp Motors to 100hp Motors over 100hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole Phone: 714-545-4995 Zip: Phone: Zip: 92630-2015 Phone: 714-545-0995 Zip: 92708 License: 786684 SCOPE OF PERMIT ELEC PERMIT FOR TEMP POWER POLE AT $7.25 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $23.50 $0.00 Quantity 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 FEE SUMMARY Temp Dist System / Lighting Busway/100ft Standing Section Misc Electrical Equipment Transformers up to 1 kva/kw ................up to 70 kva/kw .................up to 50 kva/kw .................up to 100 kva/kw ..................over 100 kva/kw Low Voltage Equipment Law Volt Wiring System / Ckt Misa Conduit Misa Conductor Circus ( gen or ride) Cirws (mech ride or lights) Christmas Tree Stand Fireworks Stand Other Electrical Fee Investigation Fee Plan Check Fee Reinspection Fee Status: ISSUED Applied: 07/03/2002 Issued: 07/03/2002 ISSUED BY: � � � �1 •� _ �! � � r' Quantity $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 50.00 0 $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 50.00 $0.00 $0.00 $0.00 TOTAL CALCULATED FEES $30.75 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements unde� 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 780 days, or if work is suspended or abandoned for a period of 100 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 inspeetlons and finel approval must be oblained. Failure to obtain inspections and final approval will result in ihe expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 . 2946d8 (6I00) � WOHKERS' COMPENSATION DECLARATION: ' I hereby aHirtn under penalty ol perjury one of the following tleclarations: ❑ I heve antl will maintain e cehificate ot consent to self-Insure for workers' compensation, es provided tor by seclion 3700 of the Labor Cotle, tor the pertormence of ihe rk for whic� this permit is issued. I heve and wlll maintain workers' compensation insurance, as requiretl by section 3700 of the Labor Code, for the peAortnance of the work for which this pertnit is issued. My workers' compensatlon Insurance carner an0 policy number are: Carner: ST-Q-T�.< ,��(��J� ��.T? Policy Number. �le � YJ — O (This section need nat be compl eef d il the permit'�is velued ef one hundred dollers ($100) or IessJ � p3 ❑ I certity ihat in the perforn e of the work for which ihis pertnit is issued, I shall not employ any person in eny manner so es to becoma subje t to ihe workers' compensation lews oi C f mia � egree Iha ' should b�come subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shell lorthwith comply with ihese provi I ApplicantSigneture: _ Da�e: �%��/��_ WARNING: FAILUFE TO CURE WOAKERS' CAMPENSATION COVERAGE IS UNLAWFUL AND SHALL SU&IECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED TFIOUSAN� OOLLARE (5100,000), IN Aq01TIIXJ TO THE COST OF COMPENSATION, DAMAGES AS PROVIOEO FOR IN SECTION 3�O60F THE LABOfl CADE, INTEREST, ANO ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby eNirm that I em licensed 4ndar provisions force and eflecl. Lic. k%8�� 8!1 Conirectors Signeture: with Section 7000) of Division 3 of Ihe Business entl Protessions Coda, antl my license is in full � Class a � �/G � Date:��3�0�_ ___ __.___. CONSTRUCTION LENOING AGENCY: ' ❑ I hereby attirm that there is a construction lending agency tor �he perlormance of the work for which this permi� is issued (Sec. 3097, Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby eHirm ihat untler penalty bt perjury Ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, eusiness antl Professlons Code: Any ciry or county which wquires e pertnit ro consWct, alter, improve, demolish, or repair any strucmre, pnor to its issuance, also requires the applicam for such pertnit to file e signed stetement ihet he Or she Is licensed pursuant to Ihe provisions of the Comrectors License Lew (Chapter 9(commencing with Section 7000) ot Division 3 of the Business and Professions Cotle) br ihat he or she is ezempt therefrom and the basis for Ihe alleged ezamption. Any violation of Section 7031.5 by eny epplicant tor e permit subjecls ihe app�icant to a civil penalry of not more than tive hundred dollars ($500).): i ❑ I, es ownecot the�properry, qr my employeas with weges as iheir sole compensation, WILL DO THE WORK, and the sWCNre is not IntentleC or oHered tor sale (Sec. 7044, Business and�Professions Code: The Coniractors License Law tloes not apply to an owner oi property who builtls or improves t�ereon, and who does such work himselt or herseN or through his oqher owri employees, provided that such improvements are not intended or ottered for sela. If, howevar, ihe building or improvement is sold within one year of completion,"tfie owher-builde� will have ihe burden of proving that he or she did not build or improve for purpose ot sale.). ❑ I, as ownet oi the propetly, am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS lo consWct the project (Sec. 7044, Business and Professions Coae: The contracmrs Licanse Law doas not apply to an owner of property who builds or Improves ihereon, antl who contracis for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I em exempl under sec. eusiness antl Professions Code for this reason: Signawre: Date: Owner ID venfied by tlriver's licenge. ❑ Ves ❑ No Drivels License No. Verificetian ot Ownership by (type o1 document, i.e. � property taz bill or deed): E:pires: DIVISION OF INDUSTRIAL SAF�7y pEHMiT CERTIFICATON: ❑ I hereby certify that no eacavation five (5) or mora feet in depth into which e parson is required to descend, will be matle in connection with work authorized by ihis permit, and ihat no builtling Swcture, scaffolding, falsework, or demolition or dismantling thareof, wiil be more than ihirty�six (36) teet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Ttle 8, Calitomia Adminisirative Cotle). ❑ As owner-builder, 1 will not employ anyone to do work which would require a pertnil (rom ihe �ivision of Intlustnal Safery, as noted ebove, unless such person has a permi� to tlo such work from the division. Signamre: Date: Division oi Industnal Sefety Parmit Number: CERTFlCATE OF COMPLIANCE qND AUiHORVATON OF ENTAV: I certify under penalty oi perjury ihat I have read this epplication and state that ihe infortnation given is correct. I agree to comply with all state laws end city ordinances relating to bulltling constmction, antl authorize representatives of the Clry of Costa Mesa to enter upon the above-described propeAy for inspedion purposes. I agree not to occupy or allow occupancy of any building authorized by this permif until final inspection. nature Of Legal Owner(s) Date iy-•-- '7��0 � —% � � AndiOrAuthonzed Apphcant � Date CODE �. INSPECiIONTYPE � INT 1616 Fixetl System Final Fire prevemion 1266 200 201 202 203 204 Pool Spe Final Final Re-Roof Final BIocWRetaining W ell Final Factory Fire Place . Final Sign Final Demolition COUE 1 INSPECTION TYPE 206 Final Mechanical 208 Final Plumbing 210 Final Electricel 212 Final Fire Prevention 220 Final Planning ApDroval 222 250 Final Site Final Builtling/Occupancy' QejF INTm�LS (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DFIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT JobAddress: 318 E 16TH ST Suite No Vicinity: GARAGE Parcel Nunmber: Applicant: Address: 42521119 SISSON, GLEN 17233 NEWHOPE SUITE F FOUNTAIN VALLEY. CA Owner: KINDRAT, ARCHIBALD TR Address 21461 VIA FLORESTA LAKE FOREST, CA Convactor: C P I DESIGNS INC 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 1000a Motors to 1hp Motors to 10hp Motors to SOhp Molors to 100hp Motors over 100hp Communicatlon tlrops Sub panel to 200a Pole Light Pkg 17233 NEWHOPE STE F FOUNTAIN VALLEY, CA Phone: 714-545-4993 Zip: 92708 Phone: Zip: 92630-2015 Phone: 714-545-4995 Zip: 92708 License: 786684 ISSUED BY: Status: ISSUED Applied: 08/22/2002 Issued: 09/17/2002 SCOPE OF PERMIT ELECTRICAL PERMIT FOR NEW 2-CAR GARAGE TO INCLUDE: 2 LIGHTING FIXTURES, t OUTLET, AND 2 SWITCHES. 802-01335 $23.50 $0.00 $0.00 50.00 $0.00 $0.00 $2.20 $1.10 $2.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 50.00 $0.00 $0.00 Quantity 0 0 0 2 1 2 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 ElecUical Equipment Trans(ormers up to 1 kva/kw ................uP to 10 kva/kw .................up to 50 kva/kw .................up to 100 kva/kw ..................over 100 kva/kw Low Voltage Equipment Low Volt Wiring System / Ckt Misc. Conduit Misa Conductor Circus ( gen or nde) Circus (mech ride or lights) Chnstmas Tree Stand Fireworks Stand Other ElecMcal Fee Investigation Fee Plan Check Fee Reinspection Fee Quantity 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 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 $0.00 NOTICE: The work aulhorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Orcf. 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 orcfer for the work aulhorized under this pertnit to be considered legal, such work must compty with all applicable codes, and ali requlred inspeetiona end flnal epproval musl be obtained. Failure to obtain inspections and final approval will result in the axpiration ot this permit. FOR INSPECTIONS CALL: (714) 7545626 zaaaea �aroo) WORKERS'COMPENSATION DECLARAnON: ` ' — I hereby attirtn untler penalry of perjury one oi t�e fbllowing declaretions: I h ve and will maln�aln a Certlficeta of ConSen� �o Self-InSure for worker5' Compensetion, es provlded tor by section 3700 0� Ihe Lebor Cotle, for the performflnce of ihe rk tor which t�is permit i9lssue4. have end will maintain workers' compensetiop Insurance, as requiretl by sectlon 3700 of the Lsbor Code, for the pertortnance ol the work for w�ich this permlt Is issued. My workers' compansatlon Insurence cardar entl policy number ere: Cerner. Policy Number: (Thls sectlon need nof be comp/efed il fhe permif ls velued et one huntlred dollers ($100) ar less.) ❑ I caniy Ihet in Ihe paAormen a of the work Iqr which this permit is issued, I shell not employ eny person in eny manner so as to become sublecl to ihe workers' compen5ation lews of Ce' la, d eqree that '{ s�oultl becafne sub�ect to Ihe workers' compen5etion pmvlslon5 ot SacUon 3700 of the Lebor Catle shall forthwith comply with these provi a. ��/�J J �/�—I �/ AppliCen� SignBWre: ('///// .��% Dele: V 1 � � WARNINO: FAILURE i0 SE RE WORKERS' COMPENSATIIXJ CAVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES FND dVIL FINES lIP TOONE MIINDRED TFIOUSPND DOLURE (5100,000). IN ADDfiION TO TME Cd$7 pp �pENSATION, DMNGES AS PROVIDED FOR IN SEGTON 3]W OF THE UBOR CODE, IMEREST, AND ATTORNEI"S FEES. LICENSED CONTRACTORS DECLARATON: t hereby eMirm thet 1 am force entl eHecL Lic. q_ ContrecloYs Signature: (crommencing with Sectian 7000) of Divisian 3 at the Business and Professions Code, and my license is in tutl Class M 1A_�-�------ Date: � I �I ./l�I CONSTRUCTION LENDING AGENCV: ❑ I hereby aflirm that there is e constmctlon lending agency tor the peAortnance ot Ihe work for which ihls pertnit is issued. (Sec. 3097, Civil Cotle). Lender's Neme: LentleYs Atldress: SignBiure: _ _ _ _ Dale: OWNER-BUILDER DECLARATONS: I hereby eHirtn ihet untler penalry of perjury Ihet 1 em EXEMPT FROM TME CONTRAC70R5 LICENSE LAW tor t�e followin9 reason (Sec. 7031.5, Business end Professions Code: Any ciry or counry which raquires e permit t6 construct, elter, improve, tlemdish, or repeir any strucWre, prior ta its issuenca, also requires t�e applicant for such permit to tlle e signed stetement ihat he or she is Ilcensep pursuent lo the pravlsions ol the Contractars License Lew (Chapter 9(commencing with SeMion 7000) at Divislan 3 0l the Business end Pmfessions Cotle) or t�et �e or she is exempt therelrom end the Desis for the ellege0 ezemption. Any violatian of Secilon 7031.5 by eny applicaN for a permit sub�ects Ihe epplicenl lo a clvil penelry of not more than tive �undred tlollers (5500).): ❑ I, es owner ol the property, or my employees with weges as Ihelr sole compensation, WILL DO 7HE WORK, antl t�e structure is not intentletl or oHered tor sale (Sec. 7044, Business enA Prolessions Code: The Coniractors License Law tloes not apply to an owner ol proparty wha builds or impraves thereon, end who tloes such work himsetl or hereelf or Ihrough his ar her own employees, provitletl that such improvements ere not Intended or oMered tor sale. If, however, the building or improvemen� Is soltl within one year of com0�etion, Ne owner-builtler will heve the burden at proving that ha or she did not build or imD�ove for purpose of sale.). ❑ I, as owner af the property, em E%CLUSIVE�Y CONTRACTING WITH LICENSED CONTRACTORS to consiruct the project (Sec. 7044, Business and Pmfessions Cotle: The contrectors License Lew does nol epP�Y lo en owner of property who bulitls or Imprwes thereon, and who contracts for such prqect with a wntractor(s) license pursuent to the Comrectors Licensa Lews.). ❑ I am eaempt under 5oc. BuSiness antl Pmfessions Cotla tor Ihis reason: Signeture: . Dete: Owner ID verilietl by tlrivels Ilcense. ❑ Yes � ❑ No Drivers License Na. Venficatlon ol Owners�lp by (type ol tlxumenl, i.e, - prpperry lex bill ot tleetl): DIVISION OF INDUSTRIAL SAFETV PERMR CEp7�FICATION: Expires: ❑ I hereby certify that no excava�ion live (5) or more teet in depth Into which a person is required to descend, will be made in connection with work euthorizetl Dy ihis pertnit, and Ihat no builtling structure, scaMoltling, felsework, or Gemolition ar dismamling thereot, will ba more than thirty-six (36) leet high. (Chap. 32, Grp 2, Art 2, Sac. 341, Title 8, Calllomle Adminlstrative Cotle). ❑ As owner-Duilder, I will not employ anyone �o tlo work which would require a permit from the Division ot Intlustrial Sefery, es noted above, unless such person hes a permit to do such work from Ihe division. Signeture: Date: Division ol InOustrial Sefety Permit NumEer: CERTIFlCA7E OF COMPLIANCE /WD AUTHORIZATON OF ENTAY: I certify undor penalty of perjury thet I heve reeC this epplicetion end s�ate ihat the information givan is correct..l egree to comply wlth ell sta�e laws end ciry ortlinances releting to builtling conswction, entl eu�horize representatives ol the Ciry of Cosle Mese to enter upon the above-descnbed property for inspection purposes. I agree nat to occupy or ellaw occupency of eny building euthorized by this permit until linel inspection. Si ne re Ot Legal Owner(s) .��VL� l�l�_��ti �� ' JinNOr Autharrzed AbD�icant CQOE �. INSPECTIONTYPE Q�¢. j�LS 7876 Fi:ed System Final Fire Prevantion 1268 200 201 202 203 Pool Spe Finel Final Re-Roof Finel Block/Rataining Well Finel Fectory Fire Place Finel Sipn 204 Final Demolition /1 Date —�� Date cooer wsvecnoxme 206 Final Mechenical 208 Finel Plumbing 210 Finel Electricel 212 Final Fire Preventlon 220 Final Plenning Approval 222 Final Site 250 FinelBulltling/Occupency � �%1 II�E4@ (714) 754-5273 • Fau (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 318 E 16TH ST Suite: Vicinity: Parcel Number: 42521119 Applicant: SISSON, GLEN Address: Owner: KINDRAT, ARCHIBALD TR Address 27461 VIA FLORESTA LAKE FOREST. CA Convactor. C P I DESIGNS INC Address: 17233 NEWHOPE STE F FOUNTAIN VALLEY, CA Zip: 92708 Arch : Address: Phone: Zoning: ISSUED BY: Phone: 714-545-4993 Zip: Phone: Zip: 92630-2015 Phone: 714-545-4995 License: 786684 Eng: Address: Status: ISSUED Applied: 04117/2002 Issued: O6/18/2002 Phone: Zip: License: License: SCOPE OF PERMIT CONSTRUCT 370 SF ADDITION TO AN EXISTING ONE-STORY SFD. RELOCATION/EXPANSION OF THE MASTER BED/BATH AND ADDITIONAL BEDROOM, ADDITION OF A 3RD BEDROOM AND REMODEL OF A SERVICE PORCH. Plan Check: $300.59 Permit: $462.45 SMIP Res: $3.16 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $766.20 SETBACKS MAIN STRUCTURE Front 0. 0 ACCESSORY Front 0. 0 PARKING Existinq: o NOTES: Rear 0. 0 Rear 0. 0 Reouired: 0 FEE SUMMARY PLANNING & ZONING Left 0. 0 Left 0- 0 Pr000sed: 0 Calc Valuation: Claim Valuation: Right 0- 0 Right 0- 0 $31,635.00 so.ao NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related regulations. (Ord. No. 92-28, § 1, 72-21-92) EXPIRA710N: This permlt shall automatically expire and become vold 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 required Inapectione end final epproval must be obtained. Failure to obtain inspections end final approval will result in the expiration of this permlt. FOR INSPECTIONS CALL: (714) 7545628 , � ? WORKERS' COMQENSATION DECLARATION: I hereby ettirtn under penalry of perjury ana ot Ihe following dedaretlans: ❑ I �ave end will malntein e certiticate of consent to self-Insure lor workers' compensatlon, es providetl for by seqlon 3700 oi the Lebor Code, tor Ne pertortnance at Ne /�ork for w�ich tlVs permlt is Issued. �' I heve entl will malntein warkers campensatlon insurar�ce, es requlretl �y section 3700 of the Labor Cotle, for the pertortnence ol Ne work far whlch ttis pertnit is iswetl, My workers' comper�Eatlon Insurance wrrier and poliq numher ere: Certier. STL! �'/l.[/� PolicyNumDer. /6�i6l�Oi - �%''L (Thls secNon neetl not be compl ted i/ the permltls ve/ued et one hundred dollers (§f 00) or less.) ❑ I cenily thet In Ihe peAo nce oi the work tor which Ihis permit is Issuetl, I shell not employ eny person In eny manner ao es to become subject to Ihe workers' compensetlon lews ol om ntl egree t i I s�ould become su6�ect w t�e workers' compensatlon provisions o1 Sectlon 3700 0l tne Labor COCe, I shell fonhwlt� comply wlth Ihese pro ApplicentSiBnature: �� Date: ��/i��ri� WARNINO'. FFILURE TO CURE WORNERS' COMPENSATION COVERAOE IS UNUWFUL rWD SHALL SU8IECT AN EMPIOYER TO CRIMINAL PENALTIES AND dVIL FlNES UP TOONE HUNDRED TFKKISAND DOLURE (5100,000�. IN AODRION TO TME CO6T OF COMPENSATION, DAA4IGES AS PROVIDED FOR IN SECTION 3]080F THE UBOR COOE, IfJrERESi, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARA710N: I hereby eMirm Ihat I am lorce entl eHect. IJc. p_ Conirector's Sipneture: Chapter 8(commenUng with Sectlon 7000) of Divislon 3 ot the Business entl Prol§ssions Cade, end my Iicense Ls in full - Class q I3 f�{/C . i i3-�--- Dete: �_�L�l�y__. _ CONSTAUCTION LENDING�AGENCY: � ❑ I hereby eMirm Ihet there is e cansiruction lending egenty tor the peAortnanca ol the wark lor w�ich Ihis permit is Issuetl. (Sec. 3097, Civil Code). Lenders Neme: Lentler's AtlOress: Sipnature: Dete: OWNER-BUILDER DECLARATIONS: I hereby eMirtn ihat unGer penelry ot per�ury that I em El(EMPT FROM THE CONTRACTOHS LICENSE LAW for ihe following reason (Sec. 7031.5, Business end Pratesslons Code: Any ciry or counry which requires a pertnit to construct, alter, Imprwe, demollsh, or repair any structure, prlor to Its Issuance, elso requires Ihe epplicant tor such pertnit b tlle e slqnetl stetement thet he or sha is Ilcensed pursuant to ihe proNsions ol ihe Contrectors License Lew (Chepter B(commencing with Secilon 7000) of DlWsion 3 of Ihe Business end Professions Cade) or thet he or she I5 exempt t�erefrom entl Ihe besls for the ellaged eaamptlon. Any violetlon at Sectlan 7031.5 by any epplicant far e permit subjects ihe appllcant to e clvll penalry af not more ihen tNe hundred dollars ($500).): ❑ I, es owner ol ihe property, o� my employees with weges es Ihelr sole compensatlon, WILL DO THE WORK, entl the s�ructure Is not intended or otteretl for sele (Sec. 70a4, Business antl Prolessions Cade: The Coniradors Licensa Law tloes not appty lo en owner of property who 6uiltls or ImDroves thereon, and who does such work himsalt or hersetl or Urough his or her own employees, provided that such impmvemems are not Intended or ofleretl tor sale. tl, however, the huiltling or Improvemem is sold within one year of completion, the owner-builder will have ihe burden of proving that he or she did not build or improve for purposa ot sale.). ❑ I, 85 owner oi the property, am EJ(CWSIVELY CONTRACTNG WI7H LICENSED CONTRACTORS to construct the project (Sec. 7044, Business flntl Professions Catle: Tha coniractors Ucense Law tloes not eppty ta en owner ot pmperty who builAs or improves thereon, antl who contrects lor such pwject with e contractor(s) license pursuant to the Contractors License Wws.). ❑ I em exempt under sec. Business end Prolessions Code for t�is reason: Signaiuro: Date: Owner ID verilied Dy tlrivers Ilcense. ❑ Yes ❑ No DAvers LJcense No. Fxpires: Venfication ot Ownership by (type at document, i.e. - praperry tar bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATON: ❑ I hereby certlly t�et no excavation five (5) or more leet in tlepID into which e person is require0 to descentl, wlll De matle In connection with work aut�odzed by this permit, end Ihat no bullding siructure, scaMolding, lelsework, or demdition or dismentling theraof, will ba more than thlrty-si: (36) leat high. (Chap. 3.2, Grp 2. Art 2, Sec. 341, Title 8, CeOfomia Administrative Code). ❑ As owner-bullder, I wlil not employ anyone m da wark which would require e pertnit trom the Dlvision ol Industrial Selery, es no�etl a6ove, unless such person hes e permit to tlo such work Irom the division. Slgnature: Dato: Divislon ot Industdel Satery Permit Numher: CERTFlCATE OF COMPLIANCE AND AUTHORIZATON OF EMAV: I certity unGer penal�y ot perjury that I have reed this apDlicetion enC siate that tha infortnatlon given is correct. I agrea to comply wit� ell stete laws end clry ordinances relating Io bulltling consiruction, entl authodze representatives ul ihe Ciry of Coste Mesa to enter upon Ihe ebove�described pioperty fa inspection puryoses. I agree not to occupy or ellow acupency of any 6uilding authorized by this permil until tinal ins0ection. � �%neture Of Legel Owner(s) Date ,��. 6�/8�02 AnNOr Authorizetl Applicent -�� Date CODE �. INSPEC710NTYVE tfi76 Fixetl System Finel Fire Preventlon 1288 Pool Spe Final 200 Finel Ra�Root 201 Flnel BIocWReteinlnp Well 202 Final Fectory Fire Place 203 Finel Sign 204 Finel Demolition GOUEA INSPECTIONTYVE 206 Finel Mechenicel 208 Final Plumbing 270 Final Electdcel 212 Finel Flre Preventlan 220 Final Plenning Approval 222 Final Slte 250 Finel Building/Occupenc PAIf i 3_03 It�L9 � .a Y .. o � - � � SPECIAL INSPECTOR'S REPORT CITY OF COSTA MESA DEPARTMENT OF PUBLIC WORKS BUILDING AND SAFETY DIVISION EACH INSPECTOR MUST COMPLETE THIS REPORT AND MAIL IT TO THE DISTRICT OFFICE OF THE BUILDING AND SAFETY DIVISION. WEEKLY X FINAL BUILDING PERMIT NO.602-00512_ JOB ADDRESS: CONTRACTOR: TYPE OF WORK: 318 E. 16th St., Costa-Mesa� C.P.I. Designs, Inc. CONCRETE FIREPROOFING DESCRIPTION AND LOCATION OF WORK INSPECTED: MASONRY WELDING G7�c1_17 EPDXY X OS/15/02 Inspected epoxy: Installed 5/8" x 24" all-thread bolts through bottom plates into existing foolings of north wall perimeter. All walls except front. Front was completed last week per Detail E on Page 2 of plan. Epoxy: Simpson Strong Tie E.T22 All wo�k on this job to date has been satisfactorily completed and conforms to the appi'oved plans and requirements of the Costa Mesa City Building Code. Date 08/17/02 � �� I.D. #0076 Deputy Inspector KENNETH L. BALCOM 501 MARIE AVE., LOS ANGELES, CA 90042-1305 (626) 795-0770 y, � � SPECIAL INSPECTOR'S REPORT CITY OF COSTA MESA DEPARTMENT OF PUBLIC WORKS BUILDING AND SAFETY DIVISION EACH INSPECTOR MUST COMPI ETE THIS REPORT AND MAIL IT TO THE DISTRICT OFFICE OF THE BUILDING AND SAFETY DIVISION. WEEKLY X FINAL BUILDING PERMIT NO. B02-00512 JOB ADDRESS: 318 E. 16th St, Costa Mesa— CONTRACTOR: TYPE OF WORK: C.P.I. Designs, Inc. CONCRETE FIREPROOFING DESCRIPTION AND LOCATION OF WORK INSPECTED: IJi/_FY�7�1:�1 WELDING REBAR EPDXY X 08/08/02 Inspecting epoxy: Installed (15) 5/8" x 24" all-thread bolts through bottom plate into existing footing 10". All on front perimeter wall per Detail E. on Page 2. Epoxv: Simpson Stronq Tie E.T22 All work on this job to date has been satisfactorily completed and conforms to the approved plans and requirements of the Costa Mesa City Building Code. Date 08/10/02 � �� I.D. #0076 Deputy Inspedor KENNETH L. BALCOM 501 MARIE AVE., LOS ANGELES, CA 90042-1305 (626) 795-0770 INSULATION CER'. ;ICATE � IC-1 _�/�3 ,E !� �'t' �� C-��n �t�l�.s�. Number and Street �ry � E52A/�l�ec RC7' 4F�2 �% Counry Subdivision Lot Number Description of Installation 1. TtOOF Material r'�,�SS — C Cc.�..�.��, Thickness (inches) 2. CEILING att r Blanket Type �R �T' Thickness(inches) T�— 36 Loose Fill Type Brand Name p(i(/ N— l' ni/�/ � Thermal Resistance (R-Value) Brand Name Thermal Resistance (R-Value) Brand Contractor's min installed weighUft' Ib Minimum thickness Pnches Manufacturer's installed weight per square foot to achieve Thermal Resistance (R-Value) 3. EXTERIOR WALL Frame Type �/�/6 � � A. Caviry [nsulation Material �j��r� _�Li��S Thickness (inches) �? —l'� $ . Exterior Foam Sheathing Material Thickness (inches) 4. RAISED FLOOR Material �jc/ST[/�!C Thickness (inches) 5. SLAB FLOOR/PERIMETER Material /�l�q Thickness (inches� Perimeter Insulation Depth (inches) 6. FOUNDATION WALL Material ^/�� Thickness (inches� Declaration Brand Name Thermal Resistance (R-Value) Brand Name Thermal Resistance (R-Value) Brand Name Thertnal Resistance (R-Value) Brand Name Thertnal Resistance (R-Value) Brand 1Mame Thermal Resistance (R-Value) I hereby certify that the above insulation was installed in the building at the above location in confortnance with the current Energy E�ciency Standardr for residential buildings (Tide 24, Part 6, Califomia Code of Regulations) as indicated on the Certifica[e of Compliance, where applicable. . ✓ y%iG�� G.� /. 1?�"�/cr.I.s %NG , Item #s Signature, Date � Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner �'��_ SLl-N �.4J�,�/EL �ii/SULAT/v�, Item #s � ignature, Dat Installing Subcontractor (Co. Name) OR � �� ' [[em fts nature, Date General Contractor (Co. Name) OR Owner �A-N �4�,�/�L �NSz/L;�JTI�� Installing Subcontracror (Co. Name) OR General Contractor (Co. Name) OR Owner Revised March 1, 1996 ' ' ' ' SUBCONTRACTOR LIST City o� Custa Mesa — Planning Division P. O. Box 1200, Costa Mesa, CA 92628-1200 BuiiderlX� t�SI�3'��yS I�C Address ��"��7 Nern1�1�� SGt(!E j= Phone ��— `��5-�3 Job Si[c y��R G I�D �;lf ��f�/\ 1� 1QS0� Da[e.��,�� Permit #�flZ `��J 5/2 Valuation TRADE t\SPHALT CA131NC-TS CARPETS CARPE\'TKl' CEMENT CONT. CEMENT TRANSIT CLASSIFI�D SPEC. CLEANUP/HAULWG DOORS (GARAGE) DRAPERIES DRY WALI� ELECTRICAL GLGVATOK EXCAVATION FENCING FIRE EXTWGUISHER FLOORWG/DECKING FORMICA FOUNDATIONS GLAZ[NG IiEATING INSULATIdN LANDSCAPING LATHING LWOLEUM/ASPHALT TILE/GUNI'rE MASONRY. PA I NTI NG PLASTERING PLUb1B1NG YOOL REFRIGERATION ROOF[NG SANDBLASTING SEWER SHEET METAL SIIOWER llOOR SOLAR SPRINKLERS STEEL REINFORC. STEEL STRUCT. S1'UCCO TRUSSES/GLU-LAMS TV ANTENNAS WALL COVERINGS WEATHER $TRIPPING OTHER SPECIALTY MF O]01-30, rev. 30/85 SUBCONTRACTOR owne-✓ pWnPX �So�� Con�r �I �P E .------- O ul i1 � �rnbl 1i� ADDRESS I PNONE � %� Yr�n�r�a n� F.V. I R�f-g34� I�vs S M m.o�a,wc G{.ue CITY OF COSTA MESA DEVELOPMENTSERVICESDEPARTMENT PLANNING DIVISION OWNER BUILDER CERTIFICATE OF EXEMPTION I am fully aware of the responsibilities as owner buildec Thc persons named below are my employees and 1 agree to withhold the following required deductions: Federal and State Income Taxes, Social Security payments, �nd Workmen's Compensution [nsurance Premiums. My employer's number is . Further, I hold no objection to a copy of this certificate being forwarded to any governmental a�ency upon their request for same. Employee's Name Address Social Security No. Under penalty of perjury, I declare [hat the above s[a[ement is true and correct to the best of my knowledge and belief. Signature Address Date (714) 754-5273 • Fa�c (774) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: Suite No Vicinity: Parce1 Nunmber: Applicant: Address: Owner: Address 378 E 16TH ST 42521119 SISSON, GLEN 17233 NEWHOPE STE F FOUNTAIN VALLEY. CA KINDRAT. ARCHIBALD TR 21461 VIA FLORESTA LAKE FOREST, CA Contractor. C P I DESIGNS INC Address: 17233 NEWHOPE ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+uniLs) Pool / Spa Lighting FixLs Recept OWets Switches Non Res Appl Res Appl Service to 200a Service l0 1000a Service over t000a Motors to 1hp Motors to 10hp Motors lo SOhp Motors to 100hp Motors over t00hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole STE F FOUNTAIN VALLEY. CA ELECTRICAL PERMIT Phone: 714-545-4995 Zip: 92708 Phone: Zip: 92630-2015 Phone: 714-545-4995 Zip: 92708 License: 786684 Status: ISSUED Applied: 06/18/2002 Issued: O6/18/2002 ISSUED BY: a SCOPE OF PERMIT CONSTRUCT 370 SF ADDITION TO AN EXISTING ONE-STORV SFD. RELOCATION/EXPANSION OF THE MASTER BED/BATH AND ADDITIONAL BEDROOM, ADDITION OF A 3RD BEDROOM AND REMODEL OF A SERVICE PORCH. 9 LIGHT FIXTURES, 19 OUTLETS, 13 SWITCHES. REF: 802-00512 $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $9.90 $20.90 $14.30 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 ao.00 $0.00 $0.00 $0.00 Quantity 0 0 0 9 19 13 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 Eleclrical Equipment T2nsformers 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 Equipmenl Low Volt Wiring System / Ckt Misc. Conduit Misa Conductor Circus ( gen or ride) Circus (mech ride or lights) Christmas Tree Stand Fireworks Stand Other Elecviwl Fee InvesUgaUon Fee Plan Check Fee Reinspeclion Fee 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 TOTAL CALCULATED FEES $68.60 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitomia statutes and related regulations. (Ord. No. 92-28, § 1, 1241-92) EXPIRATION: This permit shall automatically expire antl 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 tor the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inapectiona and tinel epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 , � 2eas-ae (a�oal / / � WORKERS'COMPENSATON DECLARAnON: I �eraby eHirm under penelry of Oer�ury one oi Ihe following declaratlons: ❑ I have end will rtFeintain e cehiticate of con5ent to selt-InSure for workers' compensation, es provided for Dy sedion 3700 of the Labor Code, for the perfortnanca oi Ihe work for which this permlt is issuetl. . ti I have entl wlll melr�in workers' compensetlan insurenca, as requiretl Gy section 3700 of Ihe Labor Cotle, tor I�e peRortnance of the work tor whiU this permit is issued. My workers' wmpensatlon Insurance caMer entl pollcy number ere: Cartier. ✓r--%—�%E f�L�N/� PolicyNumber. 1�aQ.�l�CJ2 — OZ (This section need not be complefed /f e Oerm/f Is velued ef one hundred dollars ($100) or less.) ❑ I certity that In the perform nca oi Ihe work lor which this permit Is issuod, I shell nol employ any pereon In any manner so es to become sublect to Ihe workers' compensetion laws of C omi end egree the i I s�ould Decome sub�ect to the workers' compensetlon provislons of Section 3700 ot t�e LaDor Code, I shell lorihwlth camply with these pro on . //��/O� ApplicanlSigneWre: c Q E Date: fd WAiiNING FAIWRE T CUFE WORKERS' COMPENSnTIdJ CAVERAOE IS UNL4WFUL ANO SMALL SUBIECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE HUNDRED TTKKISAND DOLLARE (5/00,000), IN ADDfTION TO TME COST OF COMPENSATION, DPM4GE5 AS PROVI�E� WR IN SECTIIXJ 31O60F iHE L4BOF CODE, INrEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARA710N: I hereby affirm Ihet I am licensed under provislons � Chepter 9(commencing with Section 7000) of Divislon 3 of t�e Business entl Pm�fe§sions Code, and my license Is in full , torce and ettecL Lic. M � G 8,'�- Class # � LL/G !ContractolsSigneture: �� O/��!-sr�-- Date: �'y%��di_ CONSTRUCTION LENDING AGENCV: � ❑ I hereby eXirm ihe� there is e construction lending eqency for ihe Oerformence ot Ihe work for which ihis permil is issued. (Sec. 3097, Civil Cotle). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILOER DECLARATIONS: I hereby aHirtn thet under penalry of per�ury that I em EXEMPT FROM THE CONTiiAC70R5 LICENSE LAW for ihe following reason (Sec. 7031.5, Business end Professions Code: Any ciry or counry which requires a pertnit b construct, elter, Impmve, demolish, or repeir any siructure, pnor to its issuance, also requlres the appliwnt tor such permit to file a signed stetemen� thet he or she is Ilcensed pursuent to ihe proNsions of the Coniradore Llcense Lew (Chepter 9(commencing with Section 7000) af Divislon 3 of the Business and Protessions Code) or thet he or she Is exempt theretrom end the besis tor the alleped exemption. Any violation of Section 7037.5 by eny applicant for e pertnit subl��s the epplicent to a civll penelry af not more then five hundred dollers ($500).): ❑ I, es owner ol ihe properry, or my employees with weges es thelr sole compensation, WILL DO THE WORK, entl the siructure is not intended or offeretl lor sale (Sec. 7044, Business and Professions Code: The Contractors License Lew does not apply to en owner of properry who builtls or improves ihereon, end who daes such work himselt ar herselt or ihrough his ar �er own emplqrees, Orovitled lhat suc� improvements are not Intentletl or oXered tor sale. Ii, howaver, the building or improvement is sold within one year of completion, Ihe owner-buildor will have Ihe burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, es owner af Ihe properry, am E%CLUSIVELY CONTRACTNG WITH LICENSED CONTRACTORS to construct the project (Sec. 7040, Business end Professions Code: The contrectars Licanse Law does not epply to en awner ot propeny who bullds or Improves ihereon, and who contracts for such pmject wit� e wntraaoqs) license pureuam to the Contrectors License Lews.). ❑ I em exempt under sec. Business end Pmfessions Cotle tor t�is reeson: Signature: Date: Owner ID veritied by dnvef5license. ❑ Ves ❑ No Dnvefs License No. Veriticetion oi Ownership 6y (type of tlacumem, I.e. - property lex blll ar tleetl): � DIVISION OF INDUSTRIAL SAFETY VERMIT CERTIFICATION: Expires: ❑ I hereby certify that no excavation flve (5) or more feet In depth into which a person is required to descen4 will be matla in connection with work euthodzed by this permit, and that no building sWCWre, scaHolding, falsework, or tlemolition or dismantling thereoi, will be more than Ihirty-six (36) teet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title 8, Celifomia Atlministretive Cotle). ❑ As owner-6uiltler, I will not employ enyone to do work whic� woultl require a permit irom Ihe Division oi Industnel Safery, es notad above, unless such person has a pertnit to do such work from the tllNsion. Signature: Date: Division of Industrial Sefery Pertnit Numbar: CEHTIFlCA7E OP COMPLIANCE AND AUTHORVATON OF ENfAY: I certity under penalry of perjury that I have read this application and state ihet the inlormation given is conecL I egrae to comply with all state laws end clry ortlinences relating to builtling wnstruction, end euthonze representaWes of the Ciry of Coste Mese to enter upon ihe ebove-descnbetl property tor Inspection purposes. I egree not to occupy or allow occupency of eny building authorized by ihis permi� until tinal inspection. �� S ia�� t Lega� r(s) —�//� /O � . ��nd/Or Authodzad Applicent Da e COUE �, INSPECTIONTYPE PAiE 1676 Fi:etl System Flnal Fire Preventlon 1286 200 Paol Spe Flnal Finel Re-Rooi 201 Finel8locWReteining Wall 202 Final Fectory Fire Plece 203 Finel Sign 204 Finel Demolition �� ixsrecnonTrve 206 Final Mechanical 208 Flnal Plumbing 270 Final ElecMcal 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 FinalBuilding/Occupancy a� u�i � � (714) 754-5273 • Fex (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 .lobAddress: 318 E 16TH ST Suite No Vicinity: Parcel Number: 42521 N9 Applicant: SISSON, GLEN Address: 17233 NEWHOPE STE F FOUNTAIN VALLEY, CA Owner: KINDRAT, ARCHIBALD TR Address: 21461 VIA FLORESTA LAKE FOREST, CA Contractor: C P I DESIGNS INC Address: 17233 NEWHOPE STE F FOUNTAIN VALLEY. CA MECHANICAL PERMIT Phone: 714-545-4995 Zip: 92708 Phone: Zip: 92630-2015 Phone: 714-545-4995 Zip: 92708 License:786684 ISSUED 8Y: Status: Applied: Issued: SCOPE OF PERMIT CONSTRUCT 370 SF ADDITION TO AN EXISTING ONE-STORY SFD. RELOCATIONIEXPANSION OF THE MASTER BED/BATH AND ADDITIONAL BEDROOM, ADDITION OF A 3RD BEDROOM AND REMODEL OF A SERVICE PORCH. 1 INST FAU < t00K BTU, t HOOD W/MECH EXHAUST, 7 VENT FAN/SINGLE DUCT. REF: B02-00512 ISSUE FEE Inst FAU <100 k BTU Inst FAU >100 k BTU Repair / Alt Cooling/Heat Inst / Rep. Recess Wall Htr Refrig Sys <100 k BTU Refig Sys >100 k BTU Gas Piping Faclory Fireplace Hood w/Mech Exhaust VAV Box Vent Fan / Single Duct Appliance Fire Dampers Smoke Dampers Inst or Relopte Appl Vent Air Handlers < 10000cfm Air Handlers > 10000cfm Floor Fumace Floor or Suspend Heater $23.50 $14.80 $0.00 $0.00 $0.00 $0.00 $0.00 $6.15 $0.00 $10.65 $0.00 $7.25 $0.00 $0.00 $0.00 so.00 $0.00 $0.00 $0.00 $0.00 Quantity 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 FEE SUMMARY Repair / Alt Absorbfion Unit Repair / Alt Refngeration Unit Ventillation System Evaporative Cooler Commercia l I nci nerator Domeslic Incinerator Compressors / Absorption Svslems 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 Upto3hp 3To15hp 15to30hp 30 to 50 hp Over 50 hp Other Mechanical Fee Investlgation Fee Plan Check Fee Reinspection Fee TOTAL CALCULATED FEES COMMENTS / SPECIAL CONDITIONS ISSUED O6/18/2002 O6/18/2002 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 so.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 $62.35 NOTICE: The work authonzed by ihis permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ortl. No. 92-28, § 7, 7247-92) EXPIRATION: This permit shall automatically expire and become voitl if work is not commenced within 180 days, or if work is suspended or abandoned for a period ot 180 days. INSPEC710NS: In order tor the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspecliona and flnel epproval must be obtained. Failure to obtain inspections end final approval will result in the expiration of this perm(t. FOR INSPECTIONS CALL: (714) 7545626 , �- �..,�-..�, �W,�,� WORKERS'COMPENSAnON DECLARAnON: I hereby eHirtn under penalry of perjury one of ihe following declarations: ❑ I heve antl wlll maintein a certificate of consenf lo self-Insure for workers' compensation, es provi0ed for by saction 3'I00 of the Labor Code, for the peAormanca of the /'�ork tor which lhis pertnit is issuetl. �' I heve end will mainlain woAcers' compensation insurance, as requiretl by section 3700 of ihe Labor Code, for tha pedortnance of Ihe work for which this pertnit is issued. My workers' compensation Insurance carrier end policy number are: Cerder. ST/�T� �UAIl) PolicyNumber: /�l�6 ¢Oi� — �J2 (This secfion need nof be com eted il Ihe permit ls velued ef one hundred dollars ($f00J or less.) ❑ I certify that in tha peAormance of the work tor which this permit Is issued, I shell not employ any person in eny manner so as to become subject to the workers' compensetlon laws of omia, antl egrae � at it I s�ould become subject to the workers' compensation provislons ot Section 3700 ot the Labor Cotla, I shell torthwlth comply with these pr on Applicant Signeture: � Date: _G�- �%��lJ� WARNINO: FAILURE T ECURE WORKEPS' COAIPENSATIdJ COVEMGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINA� PENALTIES AND CIVIL FlNES UP TO qJE HUNDRED THOUSAND DOLL4FE ($1 W,OW), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3]O60F THE LABOF CODE, INrEPEST, AND ATTORNEV'S FEES. LICENSED CONTPACTORS DECLARATION: I here6y aHirtn that I am force and eflect Lic. e_ Conirector'S Signewre: of C�apter 9(commencing with Section 7000) of Division 3 ot the Business end Professions Code, end my license is in full Cless k / �, �— Date: � /�, ��a CONSTRUC710N LENDING AGENCV: � ❑ I herehy aflirm that Ihere is a construciion lending agency for ihe peAormance ot Ihe work for which ihis pertnil is issued. (Sec. 3097, Civii Cotle). �� Lenders Neme: Lentlers Address: Signatura: Date: OWNER-BUILDER DECLARATIONS: I hereby ettlrm Ihei under penalry ot perjury Ihet I em EXEMPT FROM THE CONTAACTORS LICENSE LAW for �he following reason (Sec. 7031.5, Business flnd Protessions Code: Any ciry or counry which requires e permit to construct, eltar, improve, tlomolish, or repeir eny slmcture, prior to its issuance, also requires the applicant for such permit to iile a signed statement that he or she Is Ilcensed pursuent to ihe provlsions ot ihe Contradors License Lew (Ghepter 9(commencing with Section 7000) ai Divislon 3 of Ihe Business and Professions Cotle) or that he or she is exempt therefrom and the �asis for the elleged ezemption. Any violatlon of Saction 7037.5 by any epplicant for e pertnit subjecis ihe appllcent to e civil penelry oi not more then five hundred dollers ($500).): ❑ I, as owner af the property, or my employaes with weges es their sole compensatlon, WILL DO THE WORK, entl the structure Is not Intended or oXered for sale (Sec. 7044, Business and Professions Code: The Contrectors License Law tloes not appty to an owner of properry who builds or improves thereon, antl who tloes such work himself or herseit or t�rough his or her own employaes, provitletl that such improvemenis are not intended or oHered for sale. tl, however, Ne builtling or improvement is sold within one year ot completion, Ihe owner-builder will have ihe burden of proving ihat he or she ditl not build or imDrove for purpose of sele.). ❑ I, as owner of the properry. am EXCLUSIVELY CONTRACTNG WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Pmfessions Code: The contrac�ors License Lew does not appry m en owner of propeny w�o builds or Improves lhereon, end who contrects for such project with a contracmqs) license pureuenl to ihe Coniradors Licensa Laws.). ❑ I am exempt under sec. Business and Professions Cotle for ihis reason: 57gneture: Date: Owner ID verified by tlnvefs license. � Ves ❑ No Driver'9 LlcenSe No. Venfcation ot Ownership by (rype of document, i.e. - pmperty taz bill or deed): Expir85: DIVISION OF INDUS7RIAL SAFEN VERMIT CER7IFICATION: ❑ I hereby cenity ihat no excavetion fiva (5) or more Fee� In depth into which a person is required to descend, will be mede in connection with work authorized by this permit, and ihat no building structure, scaHoltling, falsework, or demolition or dismantiing t�ereof, wiil be more ihan Ihirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, 71t1e e, Celifornia Adminis�rative Code). ❑ As owneo-buildar, I will not employ anyona to do work which would require e permit from ihe Division of Indusirial Satery, as noted ebove, unless such person hes a permil to do such work from the division. SignaNre: Data: Division of Industrial Safety Pertnit Number: CERi1FlCATE OF COMPLIANCE AND AUTHORVA710N OF ENTAY: I certify under penalry of perjury that I have read this application and stata ihat the information given is correct I egree �o comply with ell stete laws antl ciry ordinances releting to building construction, end au�horize representatives of the Ciry of Costa Mesa to emer upon Ihe ebove-descnbed propetly for inspection puryoses. I egree not to occupy or ailow occupancy of any building authorized by Ihis Dermit until finel inspection. y naWre Of Legal Owner(s) - � � �,llAir>� ��y� "„� And/Or Authonzed Applicent COOE t. INSPECTIONTYPE 1fi16 Fixed System Finel Fire Prevention 12fi6 Pool Spe Final 200 Final Fe-Roof 207 Finel BIocWRetaining Wall 202 Final Factory Fire Place 203 FinalSign 20d Final Demolition Qsj[ TIN IiIALS ate �� O z � Date CODE• INSPECTIONTYPE 206 Finel Mechanical Z� Z 20B Flnel PlumDing 210 Final Electrical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final BuiltlincyOccupancy _,� (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 318 E 16TH ST Suite No Vicinity: Parcel Nunmber: 42521719 Applicant: SISSON, GLEN Address: 17233 NEWHOPE STE F FOUNTAIN VALLEY, CA Owner: KINDRAT, ARCHIBALD TR Address 21461 VIA FLORESTA LAKE FOREST. CA Contractor. . C P I DESIGNS INC Address: 17233 NEWHOPE STE F Arch / Eng : Address: FOUNTAIN VALLEY, CA PLUMBING PERMIT Phone: 714-545-4995 Zip: 92708 Phone: Zip: 92630-2015 Phone: 714-545-4995 Zip: 92708 License: 786684 Phone: Zip: License: ISSUED 8Y: Status: ISSUED Appl ied: O6/1 B/2002 Issued: O6/18/2002 SCOPE OF PERMIT CONSTRUCT 370 SF ADDITION TO AN EXISTING ONE-STORY SFD. RELOCATION/EXPANSION OF THE MASTER BED/BATH AND ADDITIONAL BEDROOM, ADDITION OF A 3RD BEDROOM AND REMODEL OF A SERVICE PORCH. 2 BATHTUBS, 1 GAS OUT�ET (1-4), 1 LAUNDRY TUBNVASHER, 1 KITCHEN SINK, 2 WASH BASINS, 2 WATER CLOSETS, 1 WATER HEATER/VENT. REF: 602-00512 ISSUE FEE BackFlow irrigation BackFlow Preventer BathWb Clarifier System Connect Qce,Soda,etc) Dental UniLs Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Drinking Fountain Expansion Tank Gas Earthquake Valve Gas (1-4 ouUels) Gas (Over 4 outlets) Gas Repipe Gas Service Interceptors (Grease, Oil) Interceptors (Sand Auto ) AMT $23.50 $0.00 $0.00 $19.60 $0.00 $0.00 $0.00 50.00 30.00 $0.00 $0.00 50.00 50.00 50.00 56.15 50.00 50.00 $0.00 $0.00 $0.00 Qn NOTICE: The work authorized by ihis pe regulations. (Ord. No. 92-28, § 1, 72-21•92) PEE SUMMARY AMT Laundry Tub / Washer $9.80 Landscape Irtigation $0.00 P-T2p $0.00 Pressure Regulator $0.00 Process Piping (per 10 ft) $0.00 Receptors $0.00 Septic Tank $0.00 Sewer Cap tor 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 $9.80 Sink, service/mop $0.00 Spa (private) $0.00 Spa (public) $0.00 QTY 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 SumpPump Swimming Pool Trap Primer Urinal Vacuum Brkr Bkflow(1-4) Vacuum Brkr Bkflow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (Toilet) Water Heater / vent Water Piping (Inst or Rep.) Water Re-pipe Water Service Water Softener OTHER VIOLATION PLAN CHECK REINSPECTION AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $19.60 $0.00 $0.00 $19.60 $12.30 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 TOTAL CALCULATED FEES: E120.35 QTY 0 0 0 0 0 0 2 0 0 2 1 0 0 0 0 0 requirements under Calitornia statutes and related 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 orcler for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlrad inspectlons end flnal approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545628 . � 1 � 240&0818/00) ��_ WORKERS' COMPENSATION DECLARATION: I hereby etfirtn under penalry of perjury one oi ihe lollowing tleclaratlons: ❑ 1 have entl wlll�naintain e certilrcate ot consenl to sell�ln5ure tOr workers' compensallon, as provided for by seCtion 3700 0l the Lebor Cotle, tor lhe pertortnflnce ot Ihe w for whichihis permit is issued. I have arW wlll melntain woAcers' oompensatlon Inwrance, as required by seclion 3700 ot Ne Lebor COUe, tw t�a peAormance af the woM for which this pertnll is issued. My workere' wmpensation Insurence cerder end policy numDer ere: Car�ier. �.7iAT�� f�/ /�( Policy Number:��Pl��O¢lJ 2—F� J (TTIs sect(ar need not be completed i/ e pe�mit la velu e! me huntlretl tld/ers (5100) w Ie55J ❑ I ceniy chet in Ne peAorme of the work for whlch Ihis pertnit is issued, I shall not employ any person in any menner so es to become sub�act to ihe workers' compensetlon laws of C la, ntl agree th 1 I shoulA become suD�ect to Ihe workers' cnmpenselion provlslons of Sectlon 3700 of the Lebor Cotle, I s�all forthwlih cwnpty with Ihese D�aW s. Applicem Signeture: A �-� - � � Date: G� �l /d? WARNINO: FAIIURE TO CUFE WORNERS' COMPENSATION dJVERAOE IS ONLAWFUL M!D SHAl1 SUBIECT AN EMPLOVER TO CPIMI PENALTIES AND CML FlNES UP TOONE MUNORED TFKKISPND DO�LARE (f100,000). IN r1DOfTION TO TNE W5T OF COMPENSATION, DAIMGES AS FROVIDED FOq IN SECTION 3]OB OF THE UBOR OOOE, INTEREST, AND �TTORfJEVS FEES. LICENSED CONTRACTORS DECLARATION: I hereby eflirtn that I am lorce ano enect. uc. a_ Contractofs Slgnature: CONSTRUCTON LENDING AGENCY: (commencing wlih Secllon 7000) ot DlWslon 3 0l the Buslness end Professlons Code, end my license Is In tull ClassM � 1l/r'_ p Dete: � _LLL3_L��` ❑ I hereCy eHirm that there is a conslruction lending egenty lor the perfartnence ot Iha work lar whic� this pertnil is luued. (Sec. 3097, CNO CoOe). Lenders Neme: Lentlefs Atltlress: Slgnature: OWNER-BUILDER DECLARATIONS: Date: I �ereDy aHirm t�al under penalry of per�ury thet I em EXEMPT FROM THE CONTRACTORS LICENSE LAW tor the tollowing reesan (Sec. 7031.5, Business antl Professions Cotle: Any ciry or counry which requires e parmit to construct, elter, improve, demolish, or repair eny siructure, prlor to Its issuance, elso requlres the epplicent for such pertnit ro flle e signed stetemen� thet he or she Is IlcenseC pursuant ro t�e proNslons ot the Contrectore LJcense Lew (Chepter 9(commencing wlth Sectlon 7000) of DMslon 3 ot ihe Business entl Professlans Code) or Ihat he or she is e:empt therefrom and the basis for the alleged eaemptlon. Any violation o1 Sectlon 7037.5 by eny epplicant Por e pertnit sub�ects Ihe epplicant to e clvil penalry oi not more than Me hundretl dollers (5500).): � I, as owner of t�e Oroperry, or my employees with weges es Iheir sole compensation, WILL DO THE WORK, antl the structure Is not Intended or oNeretl for ule (Sec. )044, Business entl Professions Code: Tha Contrectors License Lew does not apDly to en owner of property who builtls or improves thereon, antl who tloes such work himsell or herselt or t�rough his or her own emplayees, prwided ihet such improvements ere nat imended or oNeretl for sale. II, however, the �uilAing or impwvement is sold within one year oi completion, ihe owner-builder will have the burden of proving thet he or she did not build or improve tor purpose of saleJ. ❑ I, as owner ot t�e praperty, am EXCWSIVELY CONTRAC7ING WI7H LICENSED CONTRACTORS to consiruct the project (Sec. 7044, Business and Professions Code: The conireciors Llcense Law tlaes nat eppty to an owner of pmperry who builds or impmves thereon, entl who contrects for such pmject wliti a contraaor(s) license pursuant to the Coniractors License Laws.). ❑ I am e:empt undar sac. Business antl Professions Cade lor this reason: Slgnature: Date: Owner I� verNled �y tlrivals licensa. ❑ Ves ❑ No Dnver's License No. Verilicetion ol Owners�ip by (typa of document, i.e. - properry tax 6ill or tleetl): DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION: Ezpires: ❑ I �ereby cenlly thet no excava�lon five (5) or more teet In depth Into which a person Is requlred to descend, will be made in wnnectlon with work euthorized by this pertnit, and t�at no Duiltling structure, sceflolding, tfllsework, or Cemolitlon or Oisman0ing thereof, wlll be more then ihirry-si: (38) teet high. (Chep. 32, Grp 2, Art 2, Sec. 341, 71t1e 8, Celltomia Administrative COEe). ❑ As owner-Duiltler, I will not employ enyone lo tlo work which would require e pertnit Irom the Divlsion of Industrial Satery, es noteA eDove, unless such person hes e pertnit to do suc� work tram Ihe division. Signeture: Date: Didslan of Indusidol Safery Pertnit Number: CERTIFlCATE OF COMPLIANCE AND AUTMORQA710N OF ENTAY: I certity under penalry of Oerjury that I �ave read this epplication antl stete Nat Ne infortna[ion given is cortect. I egree to compty with all stete laws end dry ortlinflnces relating ta bullding consWctlon, and euthodze representelives ot Ihe Clry ot Coste Mese to enter upon the ebovo-descriDetl property lor inspection puryoses. I egree not to occuDY a� allow occupenty of eny bullding euthorized by this pertnit until linel inspection. ---`v�;s� Sign Wre01� ner(s) lo/%�/ e � FJ2 � And/Or Authodzetl Applicant � % Dete COOEI, INSPECTIONTYPE 1618 Fixed System Final Fire PrevenUon 1268 Pool Spe Finel 200 Finel Re-Rool 201 Finel Blxk/Fletalning Well 202 Final Fectory Fire Place 203 Finel Sipn 264 Finel Demolitlon PAIE It�dLfl CODE I IN9PECTION TYPE 208 Finel Mechanicel 20B Flnal PIum6ing 210 Finel Elettricel 212 Flnel Flre Preventlon 220 Final Plenning Approval 222 Final Slte 250 Final Building/Oaupency PdiE It�li (714) 754-5273 • Fax (714) 754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 318 E 16TH ST Suile No B Vicinity: Parcel Number: 42521179 ApplicanC Address: Owner: KINDR.4T, ARCHIBALD TR 21461 VIA FLORESTA LAKE FOREST. CA KINDRAT. ARCHIBALD TR Address: 21461 VIA FLORESTA LAKE FOREST, CA Contractor: OWNER BUILDER Address: MECHANICAL PERMIT Status: ISSUED Applied: 04/07/2003 Issued: 04/01/2003 ISSUED BY: ' � � Phone: 949-76&8980 Zip: 92630-2015 Phone: Zip: 92630-2015 Phone: Zip: License: 000000 SCOPE OF PERMIT LEGALIZED ADDITION OF 192 SQ. FT TO AN EXISTING DWELLING. ADDITION TO EXTEND TWO UPSTAIRS BEDROOMS AND DOWNSTAIRS LIVING ROOM. INTERIOR REMODEL TO INCLUDE LEGALIZATION OF 1ST FLOOR BATHROOM TO COMPLY WITH FIXTURES CLEARANCES. MECHANICAL TO INLCUDE: 1 VENT FAN FOR BATHROOM. ISSUE FEE Inst FAU �100 k BTU Inst FAU >100 k BTU Repair/Alt Cooling/Heat Inst / Rep. Recess Wall Hlr Refrig Sys <100 k BTU Refrig Sys >100 k BTU Gas Piping Factory Fireplace Hood w/Mech Exhaust VAV Box Vent Fan / Single Duct Appliance Fire Dampers Smoke Dampers Inst or Relocate Appl Vent Air Handlers < 10000cfm Air Handlers > t0000cfm Floor Furnace Floor or Suspentl Heater $23.50 50.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 50.00 $0.00 $725 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantity FEESUMMARY Repair / Alt Absorbtion Unit Repair I Alt Retrigeratlon Unit Ventillation System Evaporative Cooler Commercia l I nci nerator Domestic Incinerator Compressors / Absamtion 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 Upto3hp 3To15hp 15to30hp 30 to 50 hp Over 50 hp Other Mechanical Fee Investigation Fee Plan Check Fee Reinspeclion Fee 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 $0.00 $0.00 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, 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 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 final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 zaacrc �doo) WORKERS'COMPENSAnON DECLARAnON: I hereby aNirtn under penelty ol perjury one oi Ihe lollowing tleUaretions: ❑ I heve and will mainiain e certiticete at consent to self-Insure tor workers' compensation, es proWtletl br by section 3700 ot t�e Lebor Code, tor tha peAormanca o( Ihe work for w�ic� (hi5 permil Is issuetl. ❑ I heve antl wlll maintain workers' compensation insurence, es requirad by section 3700 af tha Lebor Cada, for Ihe peAormance of the work for which this permit Is issued. My workers' cor�pensatlon Insurence carner and policy number ere: Cerrier: Poliry Number. (ihis sectlon neetl no� be completed i( Ihe pertNf (s valuatl at one hundretl 0o/lars ($700) or /ess.) ❑ I cenify that In Ine pertortnance ol ihe work lor whic� ihis pertnit is issued, I shall nol employ eny person in eny manner so es to become subject to the workers' compensallon IBws of Celllomie, entl egree thet II I should 6ecome sub�ecl to the workers' compenution proNslons of Sectlon 3700 0l Ihe Labor Cotle, I shall forihwlth comply with theSe Drovisions. Appllcant Signeture: Dete: WARNINO: FAILURE TO SECURE WORKERS' CAMPENSATION COVERAGE IS UNUWFUL AND SHALL SUBIEC� rW EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TO IXJE HUNORED TFKKISAND OOILARE (E��•�1. �N AODITION TO THE COST OF COMPENSqTION, DAM4GE5 AS PROVIDED FOR IN SECTIIXJ 3'IOB OF THE LABOR CO�E, IMERESi, AND ATTORNEYS FEES. LICENSED CON7RACTORS DECLARATION: I hereby aflirtn that I em licensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code, end my license is in full force antl etlect. UC. M CI855 k CoNrectofs Slgnetur9: Date: CONSTRUCTION LENDING AGENCY: ❑ I �erebyattirm that ihere is e consiruction lending egency for the pedormance oi Ihe work for which this parmlt is issuetl. (Sec. 3097, Civil Code). Landers Name: Lender's Atltlress: SignaNre: Date: OWNER-BUILDER OECLARATONS: I hereby eNirm t�at untler penelry at per�ury thei I am E%EMPT FHOM THE CON7RACTORS LICENSE LAW for the following reeson (Sec. 7031.5, Business entl Professions Cotle: Any ciry or counry which requires e permii to construct alter, improve, Uemolish, or repair any siructure, prior to its iuuance, also requires �he epplicani for such permit to file a signed stetement thet he or she is Ilcensed puBuant b tha provisions ol the Contrectors Ucense Law (Chapter 9(commencing with Sectian 7000) of Divislon 3 of t�e Business antl Professions Cotle) or ihet he or she is exempt therefrom antl t�e basis tor ihe allagetl eaemption. Any violation of Saction 7031.5 6y eny applicant for e pertnit su6jects the appllcant to e civil penalry of not more Ihen tive hundred dollers ($500)J: ❑ I, es owner of the property, or my employees wlih wages as t�eir sole wmpensetion, WILL DO THE WORK, and the structure is not intended or oNered for sale (Sec. 7044, Business antl Profeuions Cotle: The Coniractors License Law does not appty to an owner of properry who builtls or improves t�ereon, and who tloes such work himself or hersel� or Ihrough his or her own employees, providea thai such improvements are not Intendetl or oflered tor sale. If, howaver, Iha building or improvement is soltl within one yeer ot completion, the owner-builder will have the burtlen of pwving lhet he or she did not �uild or improve lor purpose of sale.). � ❑ I, es owner of ihd property, Bm E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the prolect (SecJ044, Business and Profeuions Cotle: The contractors License Lew tloes noi epply to an owner of pmperty who huiltls or Improves thereon, antl who contracts for such pmject with a conirector(s) license Dursuent �a �he Coniractors License Laws.). ❑ I am exempt under sec. Business and Professions Code tor this reason: Signature: Date�. Ov.ner ID venfietl by tl��ef511cen5e. ❑ Ves ❑ No DriveYs Licen50 No. Expires: Vetlflcetian oi OwnersPip Dy (type of OocumenL i.e. - properry tex Dill or deed): DIVISION OF INDUSYAIAL SAFE7V PERMIT CER7IFICATION: ❑ I hereby certlty inat no excavation five (5) or more teet in dep�h into which e person Is required to descend, will be matle In connection with work authorized by ihis permit, end ihat no building sirucNre, scaflolding, talsework, or tlemolition or dismamling thereof, will be more ihan ihirty-six (36) teet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Title B, Calllornla Atlministrative Cotle). ❑ As awner-buildef, � will not employ enyone to do work which would require e permit from ihe Division ol Industnel Sefety, es noted a6ove, unless such person hes e permit to tlo sucp work irom the tlivision. Signature: Date: Division of Intlustrial Safery Pertnit Number: CERTIFlCATE OF COMPLIANCE AND AUTHORVAT OF EN7RY: I cehity under penalry of perjury Ihat I heve read this epplication antl state ihat the infortnation given is correct I egree to comp Ith ell state laws end it rdinances releting to building construction, entl euthodze represenietiv s of Ihe City of Costa Mesa to enler upon ihe ebove-descnbed prope y r in ion pu ose egree ot to acupy or ellow occupency of eny building au� rized yy�hi �� it until final inspec�ion. r� � Signeture Ot Legal Owner(5) Daie COUE �. 1616 7266 200 201 202 203 204 AnNOr Authonzetl Applicant FizeU System Final Fire Prevention Pool Spe Fina� Final Re-Roat Final BlocklR@laining Well Final Fectory Fire Place Finel Sign Final Demolitio� � IN(RIALS CODE� INSPECl10NTYVE 206 Flnal Mechanicel 208 Final Plumbing 210 Final EleciriCel 212 Plnsl Fire Piavemion 220 Final Planning Appro�al 222 Final Si�e 250 Finel Building/Occupancy �� (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 1ob Address: 318 E 16TH ST Suite Na B Vicinity: Parcel Nunmber: 42521119 Applicant KINDRAT, ARCHIBALD TR Address: 21461 VIA FIORESTA LAKE FOREST, CA Owner: KINDRAT, ARCHIBALD TR Address 21461 VIA FLORESTA LAKE FOREST, CA Contractor. Address: Arch / Eng : Address: ISSUE FEE Backflow irrigation BackOow Preventer Bathlub Clarifer System Connect Qce,Soda,etc) Dental Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roo( OWNER BUILDER PLUMBING PERMIT Phone: 943768-8980 Zip: 92630-2015 Phone: Zip: 92630-2015 Phone: Zip: License: 000000 Phone: Zip: License: ISSUED BV: Status: ISSUED Applied: 04/01/2003 Issued: 04/01/2003 SCOPE OF PERMIT LEGALIZED ADDITION OF 192 SQ. FT TO AN EXISTING DWELLING. ADDITION TO EXTEND TN/0 UPSTAIRS BEDROOMS AND DOWNSTAIRS LIVING ROOM. INTERIOR REMODEL TO INCLUDE LEGALIZATION OF 1ST FLOOR BATHROOM TO COMPLY WITH FIXTURES CLEARANCES. PLIMBING TO INCLUDE: 1 SINK AND 1 TOILET. AMT $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 FEESUMMARY QTY AMT Laundry Tub / Washer $0.00 0 Landscape Irrigation $0.00 0 P-Trap 50.00 0 Pressure Regulator $0.00 0 Process Piping (per 10 k) $0.00 0 Receptors $0.00 0 SepticTank $0.00 0 Sewer Cap for Demo $0.00 0 Sewer Connect $0.00 0 Sewer Private Line $0.00 0 Shower 50.00 QTY 0 0 0 0 0 0 0 0 0 0 0 SumpPump Swimming Pool Trap Pnmer Urinal Vacuum Brkr Bkflow(14) Vacuum Brkr Bkflow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (Toilet) Water Heater / vent AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $9.80 $0.00 $0.00 $9.80 $0.00 QTY 0 0 0 0 0 0 1 0 0 1 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements untler 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 withln 780 days, or il work is suspended or abandoned for a period of 1 BO days. ��_� INSPECTIONS: In order for the work authorizetl under this permit to be considered legal, such work must comply with all applicable codes, and all requlred inapactlons end finel approvel must be obtained. Failure to obtain inspeciions and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545628 zaa�ae (s�oo) WORKERS'COMPENSAnON DECLARATON: I hereby ettirtn untler penalry of perjury ona ot the following declarations: ❑ I have antl wlll meinteln a certificate oi cons8ni Io self-Insure lor workers' compensellon, es proNdetl tor by SeCtion 3700 Of ihe LeDor Code, lor the pertormence of Ihe work lor which �his pertnit 15 is5ued. ❑ I have antl wlll meintaln workers' compensation insurance, as required by sectlon 3700 0l ihe Labor Code, for Iha pertormance of ihe work for which this pertnit is issuetl. My workers' Compensatlon Insurence cerner antl policy number ere: Cartier: + Policy Number: (71rls secHon need not be compl��ea il fhe permif is valuetl et one hundred dollars ($700) or less.) ❑ I certify that in tha peAormance ol Ihe work for whic� this pertnit is issued, I shall not employ any person In eny manner so as to become subject to Ihe workers' compensatlon lews ol Califomia, entl egrae thet If I shoultl become sub�ecl to the workers' compensetion provlslons of Section 3700 of the Lebor Cotle, I shall torthwlth comply with Ihese provisions. Appllcant Signeture: Dete: WARNWG FAILURE TO SECURE WORNERS' COMPENSATION COVEMGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND qVll FINES UP TOONE HUNDRED THOUSMID DOLLARE (5100,OW). IN A�OITIIXJ TO THE C0.5T OF COMPENSATION, DAN.4GES AS PROVIDED FOR IN SECTION 3]OB OF TNE LABOR WOE, IMEFEST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirm t�at I em licensed under provisions of Chapter 9(commencing wllh Section 7000) ol Divlslan 3 of Ihe Business and Professlons Code, and my license Is in tull torce end ettect. Lic. q Cless M Contractors Signeture: Date: CONSTRUC110N LENDING AGENCY: ❑ I hereby aNirm ihat there is a construction lentling agenty lor Ihe perfortnance of ihe work lor which this pertnit is issued. (Sec. 3097, Civil Cotle). Lenders Name: Lentler's Address: Signeture: Date: OWNER-BUILOER DECLARA710NS: I hareby eHirm ihat untler penelry of per�ury that I am EXEMP7 FROM THE CONTRACTORS LICENSE LAW tor the followinq reason (Sec. 7031.5, Business entl Professions Cotle: Any ciry or wunry whic� requires e Oermit to construc6 alter, impmve, demolish, or repair any swciure, pdor to its issuance, also requires ihe eppliwN for such pertnil b tile e signed stetemem thet ha or she Is Iicensed pursuant to the pmvisions ot Ihe Contractors License Lew (Chepier 9(commencing with Section 7000) oi Divlslon 3 ot the eusiness entl Professions Cotle) or Ihet he or she is exempt thereirom and the basis for t�e elleged azemption. Any violation o� Section 7031.5 by any epplicanl tor a permit subjects the epplicent to e civll penelty oi not more ihan five hundred dollars ($500).): ❑ I, as owner of Ihe property, or my employees with wages as iheir sole compensatlon, WILL DO 7HE WORK, end the structure is not Intendetl or ofleretl for sale (Sec. 7044, Business and Protes5ions Cotla: The Coniractors License Lew does not apply to en owner of property who builds or improves �hereon, antl who does such work himselt or herself or through his or her own employees, provided Ihat such improvemen�s are not Intentletl or offeretl for sale. If, however, the building or Improvement is sold within one year of comp�o�ion, ihe owner-builder will have �he burden of proving that he or sha tlid not build or improve for purpose of sale.). ' ❑ I, es ownar of the property, em E%CLUSIVELV CONTRACTMG WITH LICENSED CONTRACTORS to construct the prolect (Sea 7044, Business and Professions Cotle: The contrectors License Law does not apply to an owner of property who bulltls or Improves Ihereon, end who contrects tor such projeci with a coNractor(5) licensa pursuant to the Con�ractors License Laws.). ❑ I am evempt unCer sec. Signature: Owner ID veniied by tlnvefs license. ❑ Yes ❑ No Business antl Protessions Code for this reason: Venlication of Ownerehip by (rype o� tlocument, i.e. - properry ta: blll or deetl): DIVISION OF INDUSTRIAI. SAFET' PERMR CERTIFICATION: DnveYSLicense No. Date: Expire5: ❑ I hereby cenify Ihat no exca�ation five (5) or more feet in depth into which e person Is required ro descentl, wlll be matle in connection with work authorizetl by this pertnit, and Ihat no building structure, scaHolding, talsework, or tlemolition or dismantling �hereof, will 6e more Ihan �hirry-six (36) leet high. (Chap. 32, Grp 2, Art 2. Sec. 341, Ttle B, Califomla Atlml�istrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit irom the Division ot Industrial Salery, as noted above, unleu such person hes e pertnit to do such wark tmm Ihe division. Siqnature: Date: Division ot Industriel Safety Permit Number: CERTIFlCATE OF COMPLIANCE AND AUTHORIZATON OF ENTAY: I certity untler penelty of perjury Ihet I have read this application and state that Ihe informetion given Is correct. I egree to co y wlth ell state lews end cit rdinances ratating m building conslmction, entl authonza representatives of Ihe Ity of sta Mese to entar upon �he ebave-descnbetl pro y for inspaction purpos gre not to o upy or ellow occupancy of eny building euthonzed by this permit mi inal i pection. �� ",.�� 4 � 1 m 3 i eture f L aFOwner(s) 7 Date AndOr Autharized Applicant . Date COOE �. INSPECTONTYPE 1616 Fixed System Final Fire Prevention 1268 Pool Spe Flnal 200 Final Re-Roof 201 Final BIocWRetaining We�� 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition OATE �$ fQpf�( INSVECTIONTYPE 206 Finel Mechanical 20B Final Plumbing 210 Final Elecirical 212 Final Fire Prevention 220 Final Planning Appro�al 222 Final Site 250 Final Building/Occupancy P� ItlI�LS (714) 754-5273 • Fa�c (714) 754-4856 • www.ci.costa-mesa.�iLDING PERMIT » FAIR DRIVE, COSTA MESA, CA 92626 ,lob Address: 318 E 16TH ST Suite: B Viciniry: Parcel Number: 42521119 Applicant: KINDRAT, ARCHIBALD TR Address: 21461 VIA FLORESTA LAKE FOREST, CA Owner: KINDRAT, ARCHIBALD TR Address 21461 VIA FLORESTA Contractor. Address: Zip: Arch : Address: LAKE FOREST. CA Zoning: Phone: 949-76&8960 Zip: 92630-2015 Phone: Zip: 92630-2015 Phone: License: Eng: Address: Phone: Slatus: ISSUED Applied: 04/Ot/2003 Issued: 04/O1/2003 ISSUED BY: a Phone: Zip: License: License: SCOPE OF PERMIT LEGALIZED ADDITION OF 192 SQ. FT TO AN EXISTING DWELLING. ADDITION TO EXTEND TWO UPSTAIRS BEDROOMS AND DOWNSTAIRS LIVING ROOM. INTERIOR REMODEL TO INCLUDE LEGALIZATION OF 1ST FLOOR BATHROOM TO COMPLY WITH FIXTURES CLEARANCES. Plan Check: $0.00 Permit: $363.25 SMIP Res: $227 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $365.52 SETBACKS MAINSTRUCTURE Front 0-0 ACCESSORY Front 0- 0 PARKING Existin : 0 Rear 0-0 Rear 0- 0 Required: 0 FEE SUMMARY PLANNING & ZONING Left 0- 0 Lefl 0- 0 Proposed: 0 Calc Valuation: Claim Valuation: Right 0- 0 Right 0- 0 s22,7ao.so $o.00 NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requiremanis under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. � 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 inspecttons and (inal 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 zaasds 15roo) z, }: : r. WORKERS'COMPENSAnONDECLARAnON: ��- I hereby ettirtn under penalry of per�ury ane ol tha tollowing Oecleratians: ❑ I heve entl wl�l malntein a cenllicate oi consent to sell-Insure lor workers' compensatlon, as proNded tor by section 3700 ot the lebor Code, lor the paAortnance of the wark fpr which this pertnit is Issued. , ❑ I �ave antl will malntein workers' compensation insuranca, as requiretl by sect�nn 3700 of ihe Lebor Cotle, for Ihe peAortnence ol Ihe work for which this pertnil Is issuetl. My warkers' wmpensetion Insurence carrier entl policy number are: � Cerrier: Policy Number: (Tlris sectlon nesd not be comp/efed �� the permiNs veluetl ef one hundretl tlollars ($100) or /ess.) ' ❑:. I certity Ihat In the pertormance oi Iha work tor which this pertnit is issued, 1 shall not employ any person in eny manner so as lo Decome subject to the workers' '; compensatlon laws q�.Celifomle, antl egree thel if I should become sub�ect to ihe workers' compensation provisions oi Sectlon 3700 ot the Lebor Code, I s�all forthwith e:-Complywithihesepf,ovisions. � � ' AppdcentSlgnelure: �', — Date: WARNINQ: FAIWRE TO SECuRE WORKERS' COMPENSATIdJ COVERAGE IS UNLAWFUL AND SHALL SU6IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE HUNDPED TIIpU5AND OOLLARE ($1 W�C00�, IN ADOITION TO THE COST OF CAMPENSATIqJ, DAMAGES AS PROVIOED FOR IN SECTION 3�O60F THE LABOR fADE, IMEFEST, AND ATTORNEY'S FEES. D CONTRAOTORS DECLAAAnON: . - � . ' . �'., . . .. , ttirm that I em.lidensed under pmvisions ol Chapter 9(commencing with Sectlon 7000) of DIvlslon 3 0l IM1e Buslness and Professions Cotle, and my license is in full eflact. Lic. N. '^ .. CIa5s M � � rsSignature:' � �Date: � � UCT10N LENDING AGENCY: ' � � � I hereby eNirtn �hai Ihere is a cA�struction lending agency for ihe pedormance of tha work For which Ihis permit is issued. (Sec. 3097. Civil Cotle). �rs Neme: � Lentlers Address: ture: � ___ Data: OECLARATIONS: 'Lhereby ettlrtn Ihet under penalry ot perjury that I em EXEMPT FROM THE CONTFiACTORS LICENSE LAW for the lallowing reason (Sec. 7031.5, Business and Professions Lode: Any ciry or counry which requ�res e permit to construct, alter, Improve, demolish, or repair eny strucWre, prior to its issuance, elso requires t�e aOVlicant for such pertnit ta tile a signed sletement thet he or she is Ilcensed pursuant lo the pravisions of the Contractore License Lew (Chapter 9(commencing with Section 7000) ot Divislon 3 of t�e �Business end Prolessions Cada) or Ihat �e or she Is exempt iherelrom antl the basis br the ellegetl exemptlon. Any violetion oi Seclion 7031.5 Dy any eppliwnt for a pertnit subjecis ihe appllcent to a cldl penelry of not more than five hundred dollars (5500).): ❑ I, es owner of the properry, or my employees wit� wages as their sole compensation, WILL DO THE WORK, and the structure Is not Intentletl or oflered tor sele (Sec. 704d, Business and Professions Coda: The Contractors License Law does not appy to an owner ot properry who builds or Improves ihereon, entl who does such work himsetl or �ereelf or through hls or her own employees, provitleA ihat such improvemenis are not In�ended or oHered for sala. It, however, the builtling or improvement is 5old within one year of comple�ion, ihe owner-builder will have the burden of proving ihat he or s�e tlid not builtl or improve lor purpose ol sele.). '' ❑ I, es owner of tha pmperty, em EXCLUSIVELY CONTRACTNG WITH LICENSED CONTRACTORS lo cons(ruct the pmjBCt (Sec. 7044, Business end Prolessions Cotle: The contreaors License Lew tloes nat epply to en awner ot pmpeny who builds or Improves Ihereon, entl w�o comrects tor such project with e contractoqs) license pursuant to ihe Conirao�ors License Lews.). ❑ I am ex8mpl under seC. Business and Professions Catle for thi5 rea5on: SignaWra: Date: Owner ID veniietl by tlriver's licenso, ❑ Yes ❑ No Driver's License No. Expires: Veriticetion of Ownership by (type ot document, i.e. - properry taz bill or tleed): DIVISION OF INDUSTRIAL SAFEN 7ERMIT CERTIFICATION: ❑ I hereby certify t�at no excevedon flve (5) or more fael in depih into which a person is required to descentl, wlll be mede in connection with work authorizetl by Ihis permit, and that no huilding slNCWre, scaRoldinq, falsework, or demolition or dismantling ihereot, will be more ihen ihltly-siz (36) feet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Title B, Celifomia Atlminis�retive Code). ❑ As owner-builder, I wlll not employ anyone to do work which would require e permit fmm the Division ol Industriel Setety, es notetl e6ove, unless such person hes e permit to tlo such work from t�e division. SignaWre: Date: Division oi Industnel Sefery Permit Number: CERTiFlCA7E OF COMPLIANCE AND Alff}IORVA710N OF NTAV: I certity under penalry of perjury that I have reatl �his appliwtion entl stata ihat the infortnation given is correct I egree to comply wlth stale laws and ciry ordi ces relating to builtling consiruction, and euthodze represent tives ihe Ciry of Costa Mesa to enter upon Ihe ebove-descnbed property tor i p ction u ases. eg not � y or allow occupancy oi eny builtling authorized b t per iyt until finel inspection. �� 0/ Signeiu�e OI Legal n r(s) Date Antl/Or Auihorized Appliwnt COOE I. INSPECPONME 1616 Fixetl System Final Fire Pre�ention 1268 Pool Spe Finel 200 Finel Fe-Roaf 201 Finel BIacWRetaining Well 202 Flnal Factary Fire Place 203 Final Sign 204 Final Demolition o"re �RI Q �Qy�{ INSFECTIONTYPE 206 Finel Mechanical 208 Finel Plumbing 210 Finel Electrical 212 Flnal Fire Preventlon 220 Final Planning Approval 222 Final Site 250 Finel Builtling/Occupency WT� L�lfl OWNER WILLIAMS,� Barry DATE 12„3�_�F, JOB ADDRESS 318 East 16tF SrroAr BUILDING PERMIT N0. i.znno GAS 117-231�17 LOT TRACT SUBCONTRACTOR M VLUMBINi'i . SWR. LINE HOUSE CON. •HD �IR CONDITIONING UN�ERGROUN� U POWEN ROUGN WIHING FLOOH SVSTEN BONO 9EAM [ SNEATHING FRAME RNO FL LRTMING - �N )RMS U STEEL STEEL REINFORC IING ` OUT COAT MEA.,-.u. VENT., RE�RIG. ANO A.C., Flp�� V PLUMBING. FINAL �NO GAS TEST � FINAI - --- ' — - —' _ --- -- - -- D COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.HOX720U COSTAMESA,CALIFORN1A92626 For Applicant to Fill in Completely — Use ]nk Only BUILDWG Q G / I.rj ADDRESS Ci � i .1� OWNEP/III�_�V�Y� Wl(�LXy/rJ ` CITY BqANCH AODRESS ARCHITECT ��[R ADDRESS I CONTRACTOR TEL. NO. TE BUILDING � ADDRES� TRA( ` W/ AD[ ✓ _ �} OWNER.[� � FIRE 20NE APPROVED PAlu �Ec3n-76�„—< OD�ks6•� *��11E.CC FOR STRUCTURAL PERMIT D�TE RECEIVEO DATE ISSV i ' ' ��' ^ �� — PE T NO_ � I/o�S-f- '3 � TEL. P�� . CITV NO. F STATE CITV VARDSAPPROVED (.{� �IG NO. LIC. NO. MAIN BUILDING W SIZE , �/ _� NO.OF BL�GS. ` (FROM C/L STREET) 1 OF LOT (/�p � O NOW ON LOT qpf.JT T. a USE OF �! ..N, EXISTING BLDG. JF y FSepara[e permits are required for � sio Fr. � electric, plumbing and heating work. REAR T. � USE OF BUILDING AND WORK TO BE PERFORMED F DISTANCE BET. QMAIN BLDCS, VAR. #` a � C.U.P.qe Q 7 APPIiOVED _ / } < < W HOLD FOR SPI � I he�eby acknowletlBa that I have reatl this appl�cation antl state 0 y� thet cha abova informetion is correct and aBrea to comply with � ell lawc raBule[InB b�ildinp construcHo�, entl 1 s�all not Bmploy O Lr Z any paraon In vio�aSion of Me wOrkman's compensaNpn lawa of J 5 th0 State of Celifornle. 3 1 hareby certif that � em prOparly Ikensatl as a tontractoY untlar SQ. FT. tha Stata ot e fornia Busin end PrOfaulona Cotla, Divielon 3, THE AMOUNT SHO� Chaptar 9, e d het wch llcen s are In full force a�d affect, or 1 THE PURPOSE OF E5 am exompt �eprovls ns f the State f Celitornia Business VA4UATION anE ProfaSsi g C Ee, DI�i o 3, pter 9. Slpnaiura o . � � � Parmlttoe 5 ��'%% Authoriaetl Aqent � „ " 1, � I. � " vALVE �µ S GROUP DAT O ` E OF NEW � . '�LDING r-. VAROS PPROVED CCESSOPV BUILDING FT BET. MAIN & ACCE$$,BLOGS. DATE APP(iOVED PERMIT FEE S PLAN CHECK $ TAX E TOTALGAID $ n � w m N IS FOR y� ONLv: � � a N n n 0 LL F U