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Home My WebLink About271 16TH ST - Building Permits I �5�' 9 ! CITY OF COSTA MESA1110 4 BUILDING DIVISION >y .,4i DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER eviami I. 1 P 4 , PERMIT Jroamc+ P01-00228 I (714)754-5273 •• Fax(714)754-4856 •• www.ci.costa-mesa.ca.us FAIR DRIVE,COSTA MESA,CA 92626 I PLUMBING PERMIT I I Job Address: 271 E 16TH ST Status: ISSUED I Suite No Applied: 04/16/2001 Issued: 04/16/2001 Vicinity: Parcel Nunmber: 42516418 ISSUED BY: Applicant: MAROLT, JIM Address: Phone: 714-556-5511 Zip: Owner: POPICK, CHARLES B Address 271 E 16TH ST Phone: COSTA MESA,CA Zip: 92627 • *.r • �• �'19 ✓'�I Contractor: ALL PHASE CONTRACTORS AND BUILDERS Y I 1 Address: 206 VILLANOVA RD Phone: (714)556-5511 9 COSTA MESA,CA Zip: 92626 License: 722975 Arch / Eng: - , Address: . Phone: Zip:' License: • SCOPE OF PERMIT REF: B01-00505.PLUMBING FOR KITCHEN REMODEL.TO INCLUDE; 1 DISHWASHER, 1 KITCHEN - , , SINK. - FEE SUMMARY . AMT OTY AMT OTY ; % ' AMT OTY ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump' j$0.00 0 Backflow irrigation- : $0:00. 0 Landscape Irrigation $0.00 0 : Swimming Pool, ;,/,' 7 $0.00 0 Backflow Preventer. - $0.00 0- KP-Trap $0.00 0 - - Trap Primer, • '/ $0.00 0 Bathtub $0.00 - ' 0 Pressure Regulator $0.00 0 - -Urinal- - $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0 Dishwasher $9.80 1 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain,Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0 Drain, Roof $0.00 0 Shower $0.00 0 Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Ins(or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) $0.00 0 Sink,kitchen $9.80 1 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 • Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $43.10 COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration.of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) r ' DECLARATIONS /`r> (-"",,, WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I eve and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the ork for which this permit is Issued. I have and will maintain workers'corn dense'15n insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'compensatio saran®card d Icy number are: Carrier: Policy Number: (This section need not be completed i/t it is valued at one hundred dollars($100)or less.) ❑ I certify that in the perform a of the ark for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Ca' ni. :•. .gree the ' I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith ' comply with these provi s til / —/62 l 0 Applicant Signature: / Date: l_/j- WARNING:FAILURE TO SE E WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($ ),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DEC ARATION: I hereby affirm that I am license der p 'visions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is In full force and effect.Lic.# // i Class# 0 Contractors Signature: �� f �,t4. Date: q"-No -(O / CONSTRUCTION IfeRDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued.(Sec.3097,Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). O I,as owner of the property;"am,EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors'License,Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors'License Laws.). .J\////r/r a y 0 I am exempt under sec. Business and Professions Code for this reason: Signature: �(,):.a Date: Owner ID verified by drivers license. 0 Yes`Y❑No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: O I hereby certify that no excavation five(5)or more feel in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title B,California Administrative Code). O As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 WIII the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this appplication a permit for such construction or modification from the South Coast Air Duality Management District or from any other air pollution control district or agency? (J Yes 0 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Duality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescnbed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above Is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION.OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for insii?tion purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. And/Or Authorized Applicant Date ;ODE 1 . •_ .4•. ■' DATE INITIALS CODE1 INSPECTION TYPE MI 1NTITIAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical �1, n 1266 Pool Spa Final 208 Final Plumbing 4 8 J I 9, 200 Final Re-Roof _ 210 Final Electrical -�^'� 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval • 203 Final Sign 222 Final Site 204 Final Demolition - - 250 Final Building/Occupancy MF` CITY OF COSTA MESA 4� 9 BUILDING DIVISION > �' , DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER F 1 ��!+s� � PERMIT J • 6. MDI-00201 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 271 E 16TH ST Status: ISSUED Suite No Applied: 04/16/2001 Issued: 04/16/2001 Vicinity: Parcel Number 42516418 ISSUED BY: Applicant: MAROLT, JIM Address: Phone: 714-556-5511 Zip: Owner: POPICK, CHARLES B Address: 271 E 16TH ST Phone: COSTA MESA,CA Zip: 92627 is 9 7 1 sip,i / Contractor: ALL PHASE CONTRACTORS AND BUILDERS ) •f /��y Address: 206 VILLANOVA RD Phone: (714)556-5511 COSTA MESA,CA Zip: 92626 License:722975 SCOPE OF PERMIT REF: B01-00505.KITCHEN REMODEL.MECHANICAL TO INCLUDE AN APPLIANCE VENT FOR MICRO-HOOD. FEE SUMMARY • Quantity Quantity ISSUE FEE $23.50 - Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $0.00 0 Repair/Alt Refrigeration Unit " $0.00 0 Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0 Inst/Rep.Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator -$0.00 0 Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace $0.00 0 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust - $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box $0.00 0 30 To 50 hp/1,750-k BTU $0.00' '0 Vent Fan/Single Duct $7.25 1 Over 50 hp/Over 1,750 BTU 50.00/ 0 Appliance - $0.00 0 Boilers - Fire Dampers ' . $0.00 0 -' Up to 3 hp - �' $0.00 0 Smoke Dampers - - / - -$0.00 0 3 To 15 hp • • - • /' $0.00 0 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp - $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee - $0.00 Plan Check Fee $0.00 Reinspection Fee $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 under California statutes and related regulations.(Ord. No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work Is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result In the expiration.of this permit. FOR INSPECTIONS CALL: (714)754-5626 / 7 2446.46(6/00) // WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ ve and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is i ued. typd I have and will main in worke - pensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is incited. My workers'compo n Ins ran rier and policy number are: Carrier: • Policy Number: (This section need not be complef ( the permit is valued at one hundred dollars($100)or less.) ❑ I certify that In the performance!. the work for which this. it is Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Califo • : :n. :..:: I s•o,..%become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisi.• // Y-/C,0 � /_ /� Applicant Signature: U i Date: ! —/lL — lJ I WARNING:FAILURE TO SE Ay! ORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES MID CML FINES UP TOONE HUNDRED THOUSAND DOLLARE(S1,y.•.).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES. + LICENSED CONTRACTORSCTDECLARATION: I hereby affirm that I am licensed and''60 'si. s of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is In full force and effect.1.1c.0 / ./� Class 0 Contractor's Signature: a //ss t��`�/ Date: r l CO — 0 I CONSTRUCTION LE�e AGENCY: ❑ I hereby affirmthatthere is a construction lending agency for the performance of the work for which this permit Is issued.(Sec.3097,CMI Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom end the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors license Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herselfior through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is v sold within one year oftdmpletion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). (o 'rt ❑ I,as owner of the properry;,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License.Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors Licerise:Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: ,T Dale: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,faisework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap,3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health end Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). _ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any ono time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to pre-Pare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safely Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? lin Yes 0 No (Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 if a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION.OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described prope ./or inspection�TJpurposes.pu� I agree not to occupy or allow occupancy of any building authorized by this permit until final insspection. //J�i�I�� rr�- eget Owner(s) / (,—"Da/ And/Or Authorized Applicant Date .. , 1, . I.. I' PAM' INTIRALS LODE! INSPECTION TYPE D.AII IfTWAL 161• Fixed System Final Fire Prevention 208 Final Mechanical _!j'a,Y -01 MI I ) 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy CITY OF COSTA MESA BUILDING DIVISION >: tviat ..sr DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER �: tinie i� t PERMIT loIt M00-00523 (714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 302 E 16TH ST Status: ISSUED Suite No F Applied: 12/0112000 Issued: 12/01/2000 Vicinity: Parcel Number: 42521503 ISSUED BY: Applicant: HANSEN, CARL Address: Phone: 949-279-5575 Zip: Owner RICHARDS, JOHN Address: 302 E 16TH ST#F Phone: COSTA MESA,CA Zip: 92627049 IS' S4413‘49 ll' Contractor: COAST AIR Address: 14 SANTA CATRINA Phone: (949)589-6592 9 RANCHO SANTA MARGARITA,CA Zip: 92688 License: 355425 Arch/Eng: Address: Phone: Zip: License: SCOPE OF PERMIT FAU CHANGE OUT FOR UNIT F FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $14.80 1 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0 Inst/Rep. Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace $0.00 0 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct $0.00 0 Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers Fire Dampers $0.00 0 Up to 3 hp $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $38.30 COMMENTS /SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work Is not commenced within 180 days,or if work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754.5626 2446.46(6/00) I WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insur ceras required by section 3700 of the Labor Code,for the performance of the work for ichlhis permit is Issued. My workers'compensation Inscarrier and Icy n er are: z�^ ex 1 / Carrier: Vire-(rylc�y�' �-- �./�-�� Policy Number: (J1' (This section need not be completed if tR4 permit is va d at one hundred dollars($100)or less.) O I certify that in the perfopn once oft work foretch this permit Is Issued,I shall not employ any person in any manner so as to beco e subject to the workers' compensation laws of Qelifomi ,a agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these pr in (1 / rApplicantl_SlgneWre: -�, " Date: WARNING:FAILURE TO SEC RE WO ER 'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100, ).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATIO : I hereby affirm that I am llcenseg under ro ions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is In full force end effect.Lic.a // r Class A CContrectolsSlgnature:- lkr�L� v Date: ha/ i / 073 CONSTRUCTION LENDING AGENCY: O I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued.(Sec.3097,Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property;army employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or thrdugf his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,ttie owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). O I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License-Laws.). ❑ l am exempt under sec. Business and Professions Code for this reason: Signatpre: Date: Owner lb verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership tintype of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). _ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. — 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication a_aermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes LI No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). _o_ ...__is the.__.._ - 7 Ifa a permit from the South Coast res Quality ed Management Californiaal or dhSr air pollution control district3 agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Califoia Health and Safety Code Section 42303 been made? ❑Ves ❑No _ 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-descr ed property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. fIIII Signature Of Legal Owner(s) Nn, V'llA � r-- to —/D ate b� C._And/Or Authorized plicant i Date CODE/ NSPECRON TYPE PATE INITIALS CODE( INSPECTION TYPE PATE aril. 1616 Fixed System Final Fire Prevention 206 Final Mechanical ir-,73-07 hy A Ialr 1 1266 Pool Spa Final 208 Final Plumbing l 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 44. 5«M@ 9 ` CITY OF COSTA MESA BUILDING DIVISION > 4 � DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER t• t I. I tb• PERMIT B03-01257 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.uUILDING PERMIT 77 FAIR DRIVE, COSTA MESA,CA 92626 Job Address: 271 E 16TH ST Status: ISSUED Suite: Applied: 07/24/2003 Vicinity: REAR OF EXISTING SFD Issued: 07/24/2003 Parcel Number 42516418 Zoning: air Applicant: BURKE, MICHAEL ISSUED BY: ��s.1 Address: 1653 SUPERIOR AVE Phone: (949)642-7222 COSTA MESA,CA Zip: 92627 Owner POPICK, CHARLES B Address 271 E 16TH ST Phone: COSTA MESA,CA Zip: 92627 Contractor: LEE ROOFING OF COSTA MESA - Address: 1653 SUPERIOR AVE Phone: (949)642-7222 COSTA MESA,CA Zip: 92627 License: 349686 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT REROOF EXISTING SFD(REAR OF RESIDENCE ONLY)NOT INCLUDED UNDER B02-01654(ADDITION):T/O EXISTING ROCK ROOF, INSULATE WITH 1-1/2"INSULATION, 1/2'OSB SHTG,2 LAYERS 15#FELT,APPLY"30-YEAR COMP SHINGLES.'13 SQUARES FEE SUMMARY Plan Check: $0.00 Calc Valuation: $4,123.00 Permit: $111.25 Claim Valuation: $4,123.00 SMIP Res: $0.50 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $111.75 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92.28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections 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)754-5626 2446-46 WOO) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the ork for which this permit is issued. I have and w0 maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Ls'gelled. My work 1s'compensa on Insuranc��sarrier ajpid policy number are: Carrier: ��71° (brag tCINQ. Policy Number: t709o—ZOO (This section need not be comple if the pemlif is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the wo •J hich this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of ••mi: d a• '' t if l s ould become subject to the workers'compensation provisions of Section700 of t Labor Code,I shall forthwith comply with these• • '/ •� Applicant Signature: /' - j Date: //Z 7 J WARNING:FAILURE TO SECURE W- ERS ENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINA?'PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND OOLLARE($100,000) ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisionsr hapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is In full force and effect.Llc.#1 _est - /I _ Class M C Contractors Signature: /SY/S5i�w� -, Date:7 Aira, CONSTRUCTION LENDING A ' CY: ❑ I hereby affirm that the • is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to Its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business end Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of properly who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or Improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). - ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more then thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above.unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to filo and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the Califomia Health and Safety Coda requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to filo a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes U No (Section 65850.2 of the Califomia Government Code requires that the requested Information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Cone Air Quality Management District or other air pollution control district or agency Is required for the work which is the subject of this application,have all of the disclosures prescnbed by Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. .gn.t L Of Leg f• ner(s) VDat ateA d/• Autho etl Applicant %ODE6 INSPE ••N TYPE DATE !MALI CODE It INSPECTION MPC PATE DIALS 1616 F' •d System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof ]0t44).3210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy CITY OF COSTA MESA _\ 4c ►9 BUILDING DIVISION ::rvialltA, DEVELOPMENT SERVICES DEPARTMENT i PER NUMBER %; ,-:PERMIT • B02-01654 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 271 E 16TH ST Status: ISSUED Suite: Applied: 10/09/2002 Vicinity: Issued: 03/17/2003 Parcel Number: 42516418 Zoning: Applicant: POPICK, CHARLES ISSUED BY: Address: 271 E 16TH ST Phone: 949-722-8176 COSTA MESA,CA Zip: 92627 Owner: POPICK, CHARLES B Address 271 E 16TH ST Phone: COSTA MESA,CA Zip: 92627 Contractor: Address: Phone: Zip: License: Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT ADD 588 S.F.TO EXISTING S.F.D.ADD NEW ENTRY,LAUNDRY ROOM, POWDER ROOM AND MASTER BEDROOM AND BATH.NEW ROOF CONSTRUCTION OVER EXISTING ATTACHED GARAGE.MINOR ALTRATIONS TO THE INTERIOR AND EXTERIOR(NEW CLOSET,NEW WALL REMOVE WINDOW AT THE WEST SIDE AND REPLACE WITH DOUBLE DOORS AND REMOVE EXIST. ROOF OVER LIVING AREA A ND REBUILT) FEE SUMMARY Plan Check: $486.69 Calc Valuation: $64,331.20 Permit: $748.75 Claim Valuation: $0.00 SMIP Res: $6.43 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $1,241.87 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work Is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 i 2446-46(WOO) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ t have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Cede,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Cartier: Policy Number: ((This section need not be completed if the permit is valued at one hundred dollars($100)or less.) 111, I certify that in the performance of the work for which this permit is Issued,I shall not employ any person in any manner so as to become subject to the workers' I compensation laws of California,and agree that If I uld become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these r�outs ns. L� ,.f Applicant Signature: i /S• At Date: 3- / .. 2-00 g WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(S100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lia# Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I.as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt u der sec. Business and Professions Code for this reason: Signature: !%i "- I .tet. Date: 3-)'l --2-OO 3 Owner ID verified by driver's license. ' 1: Yes 0 No Driver's License No. Expires: I I-27- 2o01 Verification of Ownership by(type of doc a.t,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY P RMIT CERTIFICATION: 9 I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATCRIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration fort;for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safely Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP Is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a, rmit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? j�Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes.,attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPUANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-desc ibed pro erty for inspection purposes.I no),to ocgupy or allow occupancy of any building authorized by this permit until final inspection. #0.? ' 3 gnature Of Legal 0 ner(S) ! Date And/Or Authorized Applicant Date CODE t INSPECTONTCPE PAM QrO9L$ CODE t INSPECTION TYPE PATE 1NTR1AL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site .� ✓' 204 Final Demolition 250 Final Building/Occupancy JCYtXOS. (5) l . L NEWPORT-MESA UNIFIED SCHOOL DISTRICT N2 4231 CERTIFICATE OF COMPLIANCE OF DEVELOPMENT FEES y( PURSUANT TO AB 1600 AND AB 181 To: (/ `)City of Costa Mesa District Receipt No. ( ) City of Newport Beach �1�,' ( ) County of Orange o Plan Check No.a2-016 / Applicant: x �11�nQ( V{.� I Fj . 1I O Q t C.K ca Address: � 2- t- 1 E . 1 t h 5 -rGG� I COS�GI mcea i CA ! ( Telephone Number: )( ( c � ) ¶f- 22 - g ) 947 Tract/Parcel and Lot Number(s): Location of Project: / 21-1 I G - � Ltl S4(e.�^Y Number of Square Feet of: (� Residential Space i x $1.84 Total `1> I ( � a Commercial and Industrial Space x $.30 Total Commercialilndustrial Project is: (Check One) Warehouse _ Motel _ Preschool R 8 D _ Bank _ Auto Repair Movie Theater _ Neighborhood Shops _ Hospital Mini-storage _ Racquet/Health _ Large Office Heavy Industrial _ Hotel _ Office Bldg. Regional Shops _ Medical Office _ Restaurant Light Industrial _ Office Park _ Fast Food This project is exempt because This certifies that the above-named Developer/Applicant has paid school facility fees in compliance with Government Code sections 53080 and 65995. The Building Pemits for this square footage in this proposed development may now be issued by your jurisdiction. Checks are to be made payable to Newport-Mesa Unified School District. By: Authorized Representative The above representation as to square footage is true. Applicant agrees that if it is later determined that such representations are not true, then this certificate shall automatically terminate and the appropriate City/County shall be notr'Sd17 2883/3:42 Pll/t 1681.92 RCPTi:61-@116527 J 124236 Date: n 3 — I r-— 2-0°3 It .q . • / I ` Applicant OoniS CITY OF COSTA MESA at*a raga BUILDING DIVISION s. :j'^�- • DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER FI ... r t � ERMiT 601-00505 ftownscee (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 271 E 16TH ST Status: ISSUED Suite: Applied: 04/16/2001 Vicinity: KITCHEN Issued: 04/16/2001 Parcel Number: 42516418 Zoning: Applicant: MAROLT, JIM ISSUED BY: Address: Phone: 714-556-5511 Zip: Owner: POPICK, CHARLES B Address 271 E 16TH ST Phone: COSTA MESA,CA Zip: 92627 Contractor: ALL PHASE CONTRACTORS AND BUILDERS Address: 206 VILLANOVA RD Phone: (714)556-5511 COSTA MESA,CA Zip: ' 92626 License: 722975 - Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT KITCHEN REMODEL.REMOVE SOFFETS IN KITCHEN AND DRYWALL.ADD VELUX SKYLIGHT IN KITCHEN. ROUGH-OUT PASS THROUGH IN KITCHEN TO EXTEND WIDTH.CONTRACTOR WILL UPGRADE HEADER SIZE IF REQUIRED. • FEE SUMMARY Plan Check: $0.00 Calc Valuation: $7,400.00 Permit: $153.25 Claim Valuation: $7,400.00 SMIP Res: $0.74 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $153.99 - PLANNING &ZONING SETBACKS '//' MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 - Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 - Required: 0 Proposed: 0 NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or If work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections 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)754-5626 244646 WOO) c. WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ Ie and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the xIork for which this permit Is issu:•. -� have and will maintain workers••mpensction Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'compensa'in Insur:nce ca.,r and policy number are: Carrier: Policy Number: (This section need not be completed'1,: •:reit is valued at one hundred dollars($100)or less.) ❑ I certify that In the performan :o work for which this permit is Issued,I shall not employ any person In any manner so as to become subject to the workers' compensation laws of Cali f ia, : agree that if should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provis• Li—/ (o Applicant Signature: u`. Date: 0 I WARNING:FAILURE TO SE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML RNES UP TO ONE HUNDRED THOUSAND DOLLARE(Sr )IN ADDmON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed er provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is In full force and effect.Lk.4 Class a / - Contractor's Signature: C'!/ iba Date: —/l!/ - O 1 CONSTRUCTION L ING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that 1 am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant fore permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I.as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property.am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes ❑No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reponed year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification end filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required.has Section 25534 of the California Health and Safety Code been fully compiled with? 0 Yes 0 No _ 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes j�No (Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No (if'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ...._t..___ _._..._ e.._.. wo....._. ......__ 7 Ifa a permitn fromv the South Coast res Quality cn ed by CaliforniaHeal Or anddhSr airpollution ooncontrol districtbeen or agency? is required for the work which is the subject of this application,have all of the disclosures prescnbed by Caliloia Health Safety Code Section 42303 made? ❑Ves ❑No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the Information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION.OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described propertypefor inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. / �• J- - ager Owner(s) / z Date ` And/Or Authorized Applicant Date ^: illir1•• I PATE' ItIIIIIELS §OGEE INSPECTION TYPE PIE 1NTITAL9 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval . 203 Final Sign 222 Final Site ��-J--- /` 204 Final Demolition 250 Final Building/Occupency 'T Ic/~- • 1 ' Cell(949) 291-3912 0ffice(949) 366-9452 . . . Fax(949)481-5866 Deputy Inspection 1903 Via Pimpollo Rick Paquette Inspections San Clemente, CA 92673 A Professional Inspection Service REGISTERED ❑REINFORCED CONCRETE ❑STRUCT. STEEL WELDING ❑SHOP ❑ FIELD INSPECTOR'S 0 REINFORCED STEEL [EPDXY REPORT OF: ❑POST TENSION CONCRETE ❑'FINAL REPORT ❑REINFORCED MASONRY ❑OTHER JOB NAME /' BLDG.PERMIT0 CITY OF PERMIT � PClL Rm- O(C0SiI O0s r1 )Nr5ta JOB ADDRESS CONTRACTOR -g----�, ?� -. sI _ tYS . _ L r� 14ASi- cCNtf? . E 13 cc Ic(r/J ARCHITECT - -SUBCONTRACTOR eUc(b1 Ni Cui2eficIC. -e ENGINEER LAB TESTING SAMPLES rbsQuect fen- -r,r' o4 R's , t l:N2 A. f,�t1h S" En \Rt., . 'a- r a7S/4- 3 /txwmAvdf,J/,-bv F. Slur14.1 ) Do j�.. ('/!',7.J Ana. % (.irfl� Mf1 cA \fl . ch Q CSCAh -P -I Pc_ f (./1o✓ • i 1;3 ) t Iia � ,,AL /�;�,��( 2s /A13 { a I \ AR's s/E Li fi,_nt( — 7 I HEREBY CERTIFY THAT I HAVE INSPECTED ALL OF THE ABOVE REPORTED WORK,UNLESS OTHERWISE NOTED,AND TO THE BEST OF MY ABILITY,I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED PLANS,SPECIFICATIONS&APPLICABLE BUILDING LAWS. MATERIAL INFORMATION: CONCRETE O GROUT 0 MORTAR 0 OTHER 0 SUPPLIER: MIX NO.: ADMIX: SAMPLES CAST: SPEC.P.S.I.: TYPE: SLUMP: YDS.PLACED: • AIR-TEMP: CONC TEMP: MIXING TIME: DATE START STOP REG. HOURS O.T. HOURS x-.273 10• ' S� All inspections based on a minimum of 4 hours and over 4 hours-8 hour minimum,in (hoz:7s- addition,any inspection extending past noon hour will be an 8 hour minimum.All late `/" SIGNATURE OFjREGISTERED INSPECTOR accounts will be charged the highest legal rate of interest,including all collection costs !/// and attorney fees.All returned checks will be subject to a$20.00 fee. 2— 7- d O v G Approved By DATE OF REPORT REGISTER NUMBER • 4`, ' 6 9 CITY OF COSTA MESA bh fl BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PER NUMBER fl a 0.114 • PERMIT �nm"F P02-00641 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 271 E 16TH ST Status: ISSUED Suite No Applied: 10/10/2002 Issued: 03/17/2003 Vicinity: Parcel Nunmber: 42516418 ISSUED BY: Applicant: POPICK, CHARLES Address: 271 E 16TH ST Phone: COSTA MESA,CA Zip: 92627 Owner: POPICK, CHARLES B Address 271 E 16TH ST Phone: COSTA MESA,CA Zip: 92627 Contractor: Address: Phone: Zip: License: Arch / Eng: Address: Phone: Zip: License: SCOPE OF PERMIT ADD 588 S.F.TO EXISTING S.F.D.ADD NEW ENTRY,LAUNDRY ROOM, POWDER ROOM AND MASTER BEDROOM AND BATH.NEW ROOF CONSTRUCTION OVER EXISTING ATTACHED GARAGE.MINOR ALTRATIONS TO THE INTERIOR AND EXTERIOR(NEW CLOSET,NEW WALL REMOVE WINDOW AT THE WEST SIDE AND REPLACE WITH DOUBLE DOORS AND REMOVE EXIST.ROOF OVER LIVING AREA A ND REBUILT) PLUMBING TO INCLUDE: 1 BACKFLOW PREVENTER, 1 BATHTUB,2 GAS(1-4 OUTLETS), 1 LAUNDRY TUB/WASHER, 1 SHOWER, 1 WASH BASIN, 1 WAS BASIN SET AND 2 WATER CLOSETS. REF.: B02-01654 FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $9.80 1 Sump Pump $0.00 0 Backflow irrigation $0.00 1 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $9.80 0 P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $9.80 1 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION:"This permit'shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of thispermit. FOR INSPECTIONS CALL: (714)754-5626 / 2446-46(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. ❑ I have end will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'compensation Insurance cantor and policy number are: Carrier: Policy Number: (This sect/on need not be completed it the permit Is valued et one hundred dollars($100)or less.) XI certify that in the performance of the work for which this permit Is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that If I should come subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these p sions. A y Applicant Signature: •AC_ Date: 3I ,. / T-2003 WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COV RAG IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS(Swum,IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is In full force and effect.Llc.# Class k Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to Its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not Intended or offered for sale(Sec. 7044,auainess and Professions Code:The Contractors License Law does not apply to an owner of property who builds or Improves thereon,and who does such work himself or herself or through his or her own employees,provided that such Improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exemp unthr sec. ^ Business and Professions Code for this reason: Signature: -• 1 I . i .A Date: 3 - I ri-- 2-00 3 Owner ID verified by drivers license. P. Yes 0 No Drivers License No. Expires: I)-29 - 2oo7 Verification of Ownership by(type of docu e i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner/builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Sectionntime has on the alifomia Healthaacutely d Safeze do s materials exceptions,requires registration with the Costa Mesa Fire Department by each business which at any quantity equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aEEermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LI Yes LI No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No B (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the Information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-describe property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. �- /7• PP��? it 3-14- - 20003 Signature Of Ol4ner(s) Date And/Or Authorized Applicant Date PODS I giSPECTJON TYPE PAIS If1IIDAU CODEI INSPECTIONTYPE UTZ INTIDELS 1616 Fixed System Final Fire Prevention 206 Final Mechanical �f �� 1266 Pool Spa Final 208 Final Plumbing �0. ,o,3 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 0 ly CITY OF COSTA MESA BUILDING DIVISION > DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER rtrigh.. . PERMIT 41t)40, gpj0 /03-00337 (714)754-5273 • Fax(714)754-4656 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 271 E 16TH ST Status: ISSUED Suite No Applied: 07/18/2003 Issued: 07/18/2003 Vicinity: Parcel Number 42516418 ISSUED BY: (4). Applicant: MAROLT,JIM Address: 206 VILLANOVA RD Phone: (714)556-5511 COSTA MESA,CA Zip: 92626 Owner POPICK, CHARLES B Address: 271 E 16TH ST Phone: COSTA MESA,CA Zip: 92627 Contractor ALL PHASE CONTRACTORS AND BUILDERS Address: 206 VILLANOVA RD Phone: (714)556-5511 COSTA MESA,CA Zip: 92626 License:722975 SCOPE OF PERMIT REF B02-01654.FOR NEW ADDITION.ALT.DUCT SYSTEM AND 2 BATH FANS. FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $0.00 0 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $13.70 1 Evaporative Cooler $0.00 0 Inst/Rep.Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refdg Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace $0.00 0 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct $7.25 1 Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers Fire Dampers $0.00 0 Up to 3 hp $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Fumace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $44.45 //) NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446.46(EV00) WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: •. ler Policy Number: • =:• ••I be completed it the permit Ls valued at one hundred dollars($100)or less.) VA I certify that In the perto ante of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' ' compensation laws of tom's', nd agree that if I should become subject to the workers'compensation provisions of Section 3700 of t Labor Cod.-e-yI shall forthwith comply with these pr ons. (")/, J Applicant Signature: /� i Date:- WARNING:FAILURE TO RE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE 000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37090F THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirni-thelf aril licensed u •er provisi•ns of Cha jgs$-(commencing with Section 7000)of Division 3 of the Busines> pd Professions Code,and my license is In full force and effect.Lie.I/ Class 4 �.� Contractors Sigria�e: �• Date: — loP- U S CONSTRUCTION LE • 'G AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of properly who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). .._.__..__ ..... .— r..... 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a_pPermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 8 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast-Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the Information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. SwnaNr Le al r(s) / bate3 Cic! AnWOr Authorized Applicant Date INSPEC110N TYPE PATE =aLE CODE( INSPECTION TYPE ' nfan 1616 Fixed System Final Fire Prevention 206 Final Mechanical )n-91 -c 1268 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 9 CITY OF COSTA MESA • BUILDING DIVISION e r� ! �. DEVELOPMENT SERVICES DEPARTMENT P RMIT NUMBER TA. 1.1411 PERMIT /E02-00935 nD (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 271 E 16TH ST Status: ISSUED Suite No Applied: 10/10/2002 Vicinity: Issued: 03/17/2003 Parcel Nunmber: 42516418 Applicant: POPICK, CHARLES ISSUED BY: Address: 271 E 16TH ST Phone: COSTA MESA,CA Zip: 92627 Owner: POPICK, CHARLES B Address 271 E 16TH ST Phone: COSTA MESA,CA Zip: 92627 Contractor: Address: Phone: Zip: License: SCOPE OF PERMIT ADD 588 S.F.TO EXISTING S.F.D.ADD NEW ENTRY,LAUNDRY ROOM,POWDER ROOM AND MASTER BEDROOM AND BATH. NEW ROOF CONSTRUCTION OVER EXISTING ATTACHED GARAGE.MINOR ALTRATIONS TO THE INTERIOR AND EXTERIOR(NEW CLOSET, NEW WALL REMOVE WINDOW AT THE WEST SIDE AND REPLACE WITH DOUBLE DOORS AND REMOVE EXIST.ROOF OVER LIVING AREA A ND REBUILT) ELECTRICAL TO INCLUDE: 33 LIGHTING FIXTURES,21 OUTLETS,AND 27 SWITCHES LOCATED IN MASTER BEDROOM/BATH, POWDER ROOM AND LAUNDRY ROOM. REF.:B02-01654 FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft $0.00 0 Res.a/c package $0.00 Standing Section $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0 Lighting Fixts $31.49 33 up to 50 kva/kw $0.00 0 Recept Outlets $22.73 21 up to 100 kva/kw $0.00 0 Switches $27.11 27 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $0.00 0 Misc.Conduit $0.00 0 Service to 1000a $0.00 0 Misc.Conductor $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1 hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or If work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 r 2446-46(6/00) DECLARATIONS I WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'compbnsatlon Insurance carrier and policy number are: Cartier: Policy Number: �(TJhis section need not be completed if the permit 1s valued at one hundred dollars($100)or less.) 48. I certify that in the performance of the work for which this permit Is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these vision . n Applicant Signature: p___A�� J /AN Date: 3 - /7 - .2ot3 WARNING:FAILURE TO SECURE WORKERS' PENSATION COV RAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in lull force and effect.Lic.# Class 4 Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she Is exempt therefrom and the basis IOr the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044.Business end Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exam. under :c. • : siness and Professions Code for this reason: Signature: aW/ Date: 3 -/7" 200 3 mr Owner ID verified by drivers license. 74 Yes ■ No Driver's License No. Expires: 11-2 q-20 Or Verification of Ownership by(type of doe • t,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet In depth into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file end certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes ❑No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greeter than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application agermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? IJ Yes A No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? CI Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I eerily that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the Information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described ropers for inspection purposes.I pima rea not to occupy or allow occupancy of any building authorized by this permit until final inspection. ��}n' K/J.� 3 - n -2003 Sii ure Of Legal Owne s) Date And/Or Authorized Applicant Date CODE I JNSPECTION TYPE off. INTITIALS CODE I INSPECTION TYPE . PATE ' PMAl& 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing dr 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place _ 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 4Lo Mac 9 CITY OF COSTA MESA , BUILDING DIVISION F �' DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER t j PERMIT /E01-00294 +tyoe.Trio 6* (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 271 E 16TH ST Status: ISSUED Suite No Applied: 04/16/2001 Vicinity: Issued: 04/16/2001 • Parcel Nunmber: 42516418 `/��J( � Applicant: MAROLT, JIM ISSUED BY: J/ V Address: Phone: 714-556-5511 Zip: Owner POPICK, CHARLES B Address 271 E 16TH ST Phone: COSTA MESA,CA Zip: 92627 Contractor: • ALL PHASE CONTRACTORS AND BUILDERS , Address: 206 VILLANOVA RD Phone: (714)556-5511 ` COSTA MESA,CA Zip: 92626 License: 722975 SCOPE OF PERMIT REF: B01-00505. KITCHEN REMODEL. ELECTRICAL TO INCLUDE;2 SWITCHES,2 OUTLETS,2 SWITCHES,2 CIRCUITS FOR APPLICANCES. FEE SUMMARY Quantity - Quantity , ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 ' Temp service test $0.00 Busway/100 ft - $0.00 0' Res.a/c package $0.00 Standing Section $0.00 0 - New Res(1-2 units) • $0.00 0 Misc Electrical Equipment New Res(3+units) $0.00 0 - Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0 Lighting Fixts $2.20 2 up to 50 kva/kw $0.00 0 ' Recept Outlets $2.20 - 2 up to 100 kva/kw -- $0.00 , 0 \ . /7 Switches $2.20, 2 over 100 kva/kw $0.00 0 , , Non Res Appl -\ $9.50 - „2.- ' ' Low Volt Res ApplN; Wiring System/Ckt=z $0.00) 7/,',,O, / ; Service to 200a $0.00 ` -0- - Misc:Conduit Service to 1000a $0.00 0 Misc.Conductor . 4 $0.00 ' o' 7/ Service over 1000a • . $0.00 0 Circus(gen or ride) $0.00 ' 0 Motors to 1hp $0.00 . 0 Circus(mech ride or lights) $0.00 0; Motors to 10hp ' $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee ; $0.00 Motors over 100hp $0.00 0 • Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $39.60 Intermed Pole $0.00 0 COMMENTS I SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration.of this permit. FOR INSPECTIONS CALL: (714)754-5626 .------/- 2446.46(6/00) DECLARATIONS /" l WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: O I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the or which this permit is issued. I have and will maintain worke - compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'co;.enation In ranee carrier and policy number are: Cerner. 1111.a a Policy Number: (This section need not be complett if the permit is valued at one hundred dollars($100)or less.) O I certify that in the perfarman:%, the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Califo -, ` :- that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisio .. / i , l — /Go — 0 I Applicant Signature: , / /,� Date: �/-{� WARNING:FAILURE TO SE,-E WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($,•:',000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES. LICENSED CONTRACTORS D un pro .s' I hereby affirm that I am licensed un pro �s' ns f Chapter 9(commencing with Section 7000)of Division 3 of the Business end Professions Code,and my license is in full force and effect.IJc.A Class it Contractors Signature:If/ Date: y_ n n — 1 CONSTRUCTION LE!}f/AGENCY: ❑ I hereby affirm at there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of properly who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). O I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: ' 1 Will the applicant or present or future building occupant need to file end certify a Business Plan for emergency response to release or threatened release of a hazardous ' material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds. or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? • ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP Is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a pe for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 0 No (Section 65850.2 of the California Government Code requires that the requested information bo furnished on applications for non-residential building permits). 6 WIll any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above Is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUiHORIZATION.OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to corn•y with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described pro.+ y for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. /S'c. ,f egal Owner(s) (76—/ 6Date 0/ And/Or Authorized Applicant Date ;ODE r 1N5PECTIOf{TYPE DATE' . JNTITIALS CODE! INSPECTION TYPE PA E LAS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy plicant to till in all spaces except those within heavy border lines and sign all appropriate declarations. lirr.2PrQjcp°AFaCdress OSTA MESA CONSTRUCTION PERMITPER NO. TRACT NO. LOT NO. UNIT NO.3a7 is 7285 3i.-�i ; 271 — 16th St. . C.M• ,ant's Mailing Address 126 Commercial, C.M. 92627 TYPE OF CONSTRUCTION U NEW U ADD [XI ALTERATION LI REPAIR Owner's Name George R Shaffer Phone 545-0448 ❑ CONVERSION ❑ DEMOLISH ❑ O�eR10Ve existing. A 1 R • A.P.# .Zone • DESCRIPTION OF WORK/USE OF BLDG. Apply 1 -Address . - - r - u •_ - _ - roe — — •• ••_ _•• • _ - L _ _ S• Main Building: Accessory Building: Z Arch/Eng. r _ License No. TYPE OF PERMIT I. GRADING I♦ FOUNDATION N STRUCTURAL T Front O ❑ TENANT ❑ ELECTRICAL LI PLUMBING ❑ MECHANICAL B. — N S�Address Rear t.ontractor's Name Crank Bros. Rfq. Co. Phone 548-5569 ❑ OTHER , A C Right • N Address(mailing) 126 Commercial• C.M. 92627 PROJECT DESCRIPTION SQ. FT. 1,900 OCCUPANCY single K CONSTRUCTION TYPE reCi dent a1 VALUATION$ 2 799 nn $ Left G City License No. 005993 ZONE _ GRADING CU.YDS. ACRES R LICENSED CONTRACTOR DECLARATION Ping. Ref.# • Parking Req./Provided E Q I hereby affirm 7 that i am licensedsion under provisionsBusnssf Charter 9 (cns code, nRemarks: • Planning Notes: M with section 7000) of Dau( n 3 of he Business and Professions code, and _ T my license is in full fors.? effect. �' Lice ns lasLicense N. .4 4..•t. 7 _ S Date f -- ---- • '17� . � �S - PLUMBING - FEES Q` 'YORKERS' COMPENSATION • TION :.r Sink Showers • - q , preby affirm that I have a c: lfica e of consent to self-insure or a certificate ELECTRICAL FEES (SO Workers' Compensation nsura•ce, or a certified copy thereof (Section Backflow Preventer • Service Sink l .3800, Lab. C.) Automatic Washer Transformer 0 15-50 KW :• Policy No. 285%22Y. company S7,ate Fund Y Backflow Irrigation Sewer Cap .- 0 50+ KW . • Construction Pole Sub. ' c I Certified copy is hereby furnished. _ x..Ce led P, lsrfi(gd�jp.ith the city�dT„ebpi sio/fc e _ Bathtubs. Sewer Connection Cooking Unit: Meter Duo to.100 amps Date 3 !L Ofd Applicant l(yr/([-rte/` '>,Y'� - EXEMPTION FROM•WORKERS'CO PENSATION DECLARATION Clarifiers Solar Collectors - Dishwasher Meter Clover 100 amps (This section need not be completed If the •- - it is for one hundred s0) o - less). // Dishwasher- Solar Piping Dryers ❑Gas DElectric Sub Panel I certify that in the performance of the •�f or hi .JV. r+ / I shall not employ any.person In any mit, Drinking Fountains Solar Tank - • Fan ' Workers' Compensation Laws of Califoe/ /- g - — - __ Motors❑0-1 HP ❑1X:8' Date Signature s Floor Drains Swimming Pool w/Spa F,A.U. Inc.Solar ❑9-15 HP ❑16-15+ ' NOTICE: If,after making this deciara - , ••u should b- one ubject to the - ' Workers' Compensation provisions he Labor Code, you must forthwith Floor Sinks Urinal Fixtures Microwave - comply with such provisions or is permit shall be deemed revoked. - CONSTRUCTION LENDING A CV Gas Service Outlets Water Closet s Device Boxes Pole Light I hereby affirm that there is a cons ruction lending agency for the performance 9 of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors -Water Heater ' Outlets Range Lender's Name Lender's Address - Kitchen Sink- Water Service • Switches Sign -- OWNER BUILDER DECLARATION •• I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposal Standing Sections , following reason (Section 7031.5 Business and Professional Code: Any city or _ county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays Generator ❑0-5 KW ❑5-15 KW Trash Compactor any structure, prior to its issuance, also requires the applicant for such permit . to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains - the Contractor's License Law (Chapter 9(commencing with Section 7000) of t • - 'ivision 3 of the Business and Professions Code) or that he/she is exempt - - -- ierefrom and the basis for the alleged exemption. Any violation of Section , /031.5 by any applicant for a permit subjects the applicant to a civil _ enalty of not more than five hundred dollars($500). I 3 • O I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee, $ - compensation, will do the work, and the structure is not intended or offered 111 - Reinspection Fee I $15 Issue Fee $ 3 ` for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL ' FEES Ili License Law does not apply to an owner of a property who builds or improves . thereon, and who does such work himself/herself or through his or her own - DEVELOPMENT SERVICES REQUIREMENTS: ' • employees, provided that such improvements are not intended or offered for Boiler Hood or Type I 0 • sale. If, however, the building or improvement is sold within one year of cam- Canopy Type II ❑ Zoning Approved By Date pletion, the owner will have the burden of proving he/she did not build or in- Duct-Under Ground Building Approved By - Date prove for the purpose of sale). - ❑ I, as owner of.the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System • Application Issued By - - �� Date tractors to construct the project (Section 7044,Business and Professions Code: - The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 0100,000 BTU • SUMMARY FEES builds or improves thereon, and who contracts for such projects with a con- _ tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUI LDING PERMIT $ S4.n SMIP $ . ,...RD of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT ❑ I am exempt under Section - B.& P.C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers - PLUMBING $ ISSUANCE $ Date Owner Heating System& Ducting Registers • PLAN CHECK .25% $ ENERGY P.C. $ I hereby certit that I have read this appli 10 and ate that the above 00-100,000 BTU 0100,000 BTL GRADING $ ' information ect. I agree to comply w . city county ordinances ELECTRICAL $ and state law' ing to building cons ,and by authorize repre- - PLAN CHECK 50% -$ MICROFILM $ sentatives of •- city to enter u•• - ,bove- •tined property for inspection purpo •-. �r/, ?.2? Qom/ MECHANICAL $ .TOTAL FEE $ 54.50 Signature Via/ - , CMF 0865 •I. ev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTIOJD'PLANNING POOL& SPA , Date ' Inspector7 Date Inspector 'APPROVALS Permit'# ( APPROVALS Permit# i,tjemporary ElectiicaUService or Pole 52. Pool & Equipment Location f 2. Soil Pipe-Undrgrnd.i 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms • ' 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding ' ' • 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO'COVER-GUNITE ' 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. _ 60. Backwash Lines, P-Trap, 0 Undrgrnd. • 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final ' 16. Rough Electric Wiring 67. Fencing & Access Approval • • 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING - • 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL • 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace - APPROVALS Permit# _ 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 0il 23. Gas Pipe-Rough & Test � -72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank O Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro / 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical • 27: Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION - 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED .a 33. Final Electric Notes: 0 90 14 nu. , 34. Final Heating & Air Conditioning `/�'_' _ '_ _ es .�1 fE 35. Final Gas Pipe-Test 36: Hood or Canopy ) 37. Final Factory Fireplace 38. Final Plumbing • 39. Water Service-Final - - 40. Gas Service-Final ' 41. Solar Domestic-Final 42.; Backflow Preventer , - 43. Backflow Irrigation 44. Landscape Irrigation System - - 45: Sound Attenuation - ' 46: Handicap Regulations yip. g _ _...k ,/; ' 47: FINAL STRUCTURE & BUILDING 30%D. 49 V09` � y48. Special Requirements Completed D. ' • 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co n 51. CERTIFICATE OF OCCUPANCY i No. - Date - y . . I . PROJECT ADDRESS: 271 E 16TH ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO; B 06349: OWNER'S NAME: GARRETT, GEORGE A ADONEY$: GARRETT JULIA L PERMIT NO: B 063497 PLAN CHECK NO: N GOVT; N SUPP; N p 271 E 16TH ST COSTA MESA, CA 92627 CONSTRUCTION TYPE: 5—N PERMIT TYPE: STR PURPOSE; OTH j ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : PERMIT TO REPLACE EXPIRED REROOF PERMIT SQ FT: 2, 799 I v. ADDRESS: UNIT: CLAIM VALUE: 2, 799 . 00 CALL—VALUE: 2, 799 . 00 GROUP OCC: R-3 /M-1 PERMITTEE: JULIA L . GARRETT ( 714 ) 650-6450 ADDRESS: 271 E. 16TH ST COMMENTS: THIS PERMIT REPLACES EXPIRED PERMIT B32712 FOR REROOFING COSTA MESA CA 92627 +tit+ESE***#4***********se+E#********; *****************>E*****#*** #* u LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIR E N E N T 6 l/ ro 1�1 7000)of Division 3 of the Business and Professions Code,and my license is in toll force and effect. SETBACKS 'ryF..{ CITY LIC.: STATE LIC.: CLASS: EEQ Date' Signature: MAIN BUILDING ACCESSORY B BU ,L, i.ficA WORKERS'COMPENSATION DECLARATION: I herebyaffirm that I have a certificate of consent to selbinsure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN Compensation Insurance.or a certified copy thereof Section 3800.Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN POLICY NO.: EXP.DATE: i -DMPANY: PARKING REQ: PROV: PARCEL: 42516418 ZNE: REF NO: Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. PLANNING NOTES> > n Date: Applicant: *****************!E******************************i(*ft***************#iE 1P3F******** EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be competed if the permit is foe one hundred 15100)or less). DEVELOPMENT SERVICES R E Q U I R E M E 'N 5_ S I certify that in the performance of the work for which this pe sued.I shall not employ any person in any manner so as to become l; subject to theheWorrkers'Com yenssalionn Laws of Calitorn' ZONING APPROVED BY DATE: i �• Date: D / er 7/ s J Signature: Mir 9- / - 7t'^�iu/�J NOTICE:II after making this declaration,you should ome subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY DATE: .----) Code.you must forthwith comply with such provisions or this permit shalt be deemed revoked, i CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: A _ -1"....i...—.- - DATE: tg/!31/7 which this permit is issued(Section 3097.Civ.C). *********************�E ' ' xx ' ' ' ' • ' - - ' A-ft - 4 " ' heir " *************** tf ie•** LENDER: ************************************3E*******3E**3 ('*****lE********************!f*** ADDRESS: LEGALIZATION:N F E E S U M MAR Y STRUCTURAL SEGMENT;Y OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from theContractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: My city of county which requires a permit to construct.alter,improve,demolish.or PERMIT 54 . 00 . 50 repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant la the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business SM I P/NON—RES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE I. as owner of the progeny or my employees with wages as their sole compensation, will do the work, and Inc BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE ❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS————> 54 , 50 0 , 00 0 . 00 54 . 50 54 . 50 , 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however the building or eBLDGPMT PLUMBING ELECTRICMECHANICFIRESMIP within one year of completion,the owner wit have the burden of proving he/she did not build or improve REVENUE `7TOTALS— OD54 . 50 /OT/S GRADING PLAN—CHECK hepurpose of sale). I.as owner of the properly.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 54 . 00 . 50 0.4 and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).l am aware ******************************************************************************* that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN o I am exempt under Section: B.S P.C. / for this re on: • TYPE QTY DESCRIPTION UNIT COST TOTAL COST Date: la 3 owner. / ' ;io �' SFR 2799 REROOF BY VALUE RESIDENTIAL NOZONE 1 , 00 2, 799 , 00 I do hereby certify mIo at (n aware of and understand the requirements of aifomia Health and Safety Code Sections 25505.25533.and END OF FEES 25534 and that I or any future building occupant wil0will not(circle one)need to comply with said slate codes and the requirements ler a ' permit for construction or modification from the Air Duality Ma ent District.Residential construction applications are exempt from these pr: /__40._==_____. ooviisionnss.� a Date: [ S J Applicant: I hereby cer/fy that I h ve read this application and state that he above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction and hereby authorize representatives of His city to enter upon the above-mentioned property for inspection purposes.zz Date: 6 3/�j Signature: 01 00144955-00144956 TOT Driver's uc se or Social Security a: 500 DATE: 08/13/93 TIME: 12:32 4,50 164146 White—Budding:Green—Code Enforcement:Canary—Applicant;Pink—Revenue:Goldenrod—Assessor p CONSTRuCTIORI AND PLANNING PO{ SPA AP9ROVALS Permit#_ Date Inspector APPROVALS permit - Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts,in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank O Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76, Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL • 30. Drywall Nailing i . HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final • 80. FOOD CERTIFICATE ISSUED • 33. Final Electric Notes: 34. Final Heating& Air Conditioning - 35. Final Gas Pipe-Test • ' 36. Hood or Canopy 37. Final Factory Fireplace • 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final - 1 41. Solar Domestic-Final 42. Backflow Preventer 43. Backf low Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING Vigo 0 , 48. FINAL PLANNING 49. Electric Release to Edison 1 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date OWNER GATES, CYRUS H. & E. MERLE DATE 2/20/56 , JOB ADDRESS 271 16th Stl. BUILDING PERMIT NO. 2397 GENERAL CONTRACTOR Dike & Colegrove VALUE $ 9,000.00 LOT 17 BLOCK TRACT 2934 Residence & garage : C_ lP I & J TYPE V ZONE Rh FIRE DISTRICT 2!118 PERMITS ISSUED INSPECTIONS ��,{ DATE SUBCONTRACTOR DATE _ NUMBER Footing Trench �C✓ , 4 ' 4 J6 Foundation Forms and Grade to Garage. Rough Framing __ f-C-CCC Plumbing,Rough to STaa dLu- )µ/f - 1' Plumbing, Rough Complete ` --5- ' - ..a."--15 N/',t'g„ i :y g/.2 a/.f/ ')c1Oo7, ' - Temporary Pole Wiring, Rough Z.-.,... lit , 2 P• R .3 ' ' Heating, Rough int-=,,,, I 41/ / S_ e-a/ Heatin , in -e-t3/2- Z, e-l--‘-cra Sewer s Sewer,St. �✓_ 4A-nix- 77 1 f 1.‘e)1.‘e) 9 7 - 549.5 9-- Septic Tank or Cesspool S�;- Lathing, In Out o Plastering 1 " -• l^)%�S P' hing,Final,Fixtures Complete4,fl/ 2-//�a P . .ping,Final Gas Test %fj, ,/- £cz e,,c, _J�,,,_/ 7-/ -S G .-re-tr./ AA Wiring,Final i' -,"-n 1 ..,/..4.�.� /e+/ —C"/ _ ...On_ J Occupancy STA 7.4- -- FORM 210 3M 10.55 c /questa Mesa Building Department2418 APPLICATION FOR PERMIT 111 EAST 20th STREET BUILDING 'I COSTA MESA, CALIFORNIA FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY Receipt No. Permit No. Building Address 271 Sixteenth Street 9� Costa Mesa, CaliforniaRebel by )74eey/ Date Issue� �/� Cross St. Santa Ana Avenue /e ildi Address Owner Cyrus H. & E. Merle Gates Costa Mesa, California Mail Address 306 Ramona Place Nearest Tel. Cross St. City Costa Mesa No.I4 8-7976 Zone.f7, / I Plans No.of I Type ,031 Architect or Lic. Engineer Carlson & Middlebro /1"olb. Approved`1' by Date Address Garden Grove CORRECTIONS City Lie. 2707 Contractor Dike and Colegrove No. Address 419 E. 17th St., Costa Mesa LegalLot Description I No. 17 I Block I Tract 29311. (Attach Metes and Bounds) No.of Bldgs. Size of Lot 531 1127.5' I Now on Lot none o Use of No.of No.ofS Existing Bldg. none Families Rooms 02 6 Setback Line Center of Street from 501 Side Yard 63.St 5t - - - - y DESCRIPTION OF WORK - - + New I X I Alteration I I Addition I Repair I I Moving I I Demolish I '" Building No.of • Size 1205 sq.ft. Rooms 611 Stories 1 Exterior Wall Roof Covering Fr. Stucco I Covering Comp. APPROVALS Use of Ne Building dingle Family Residence & Garage Foundation Location Inspector Date Forms,Materials, Under-Pinning Plan # Z54AR Frame: Fire Stops, Bracing,Bolts I hereby acknowledge that I have read this Application Lath. Int. and state that the above is correct and agree to comply Lath.Ext. with all City Ordinances and State Laws regulating building construction. Signature of Plaster,Int. Permittee .. Authorized Agt. C Plaster, Ext. - -=-a ,., Masonry Reinforced Valuation . Permit Fee $ •a - Plan Check $ // - Bond Beam $ 9,000.00 Total ] ' Fee $c..t7 FINAL FORM 204 G-H 2M 5-54 ,q p.cosrr' 3. d rrZtH. .t1=7Fl I�r;rc-- ':SCuK. ;•7 o n a a • •• I 3 - I ^ • • Street - ' r• r . . I. I L. PLOT PLAN Show location and distances from • property line and between buildings. - .• "' .{ . i a' - - _ . • • - -• -3 39276 'nv ?5-7L:�ACLOU 857^ ****19.53 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 TION FOR BUILDING PERMIT For Applicant to Fill in Completely - RE/AI/0(6:- D TE REC V DATE ISSUED ADDRESS a7/ A /6 sT (7057.4 41€5.4 //-2'6'� /�- �y� OWNER 719001/13 A. BAuME rTA A.P.NO. Ut 1 _12J1-- 1g PE ,Try AMAIL DDRESS /9/"..5 RI bets lde. BUILDING ��/ /� / / /=i h ADDRESS C 6, v TEL el- TRACT 25134- LOT L`1 BLOCK Z -0 C/]CITYuJew Ylnrt $'PACK 5,246e40. 30/ CONSTRUCTION NEW ADD' ALTER REPAIR MOVING nmol LSH Z I- LENDER ../(.47A-1 es /\7C1 / _. am J 7 BRANCH m J ADDRESS OWNER ///0M/A'�-S AL-in&VALUE /3-t12-• ARCHITECT ...,t. ,^ // TEL. USE 1RP� • $ /(jv r� J Q OR ENGINEER / (� l3:Cll?>h l— U Q FIREeV. W a ADDRESS ZONE T PE GROUP T a. W. //�'qq APPROVED w 12-10-.94'!//L Z CONTRACTOR BY DATE (J 4f J 0 CO J cc ADDRESS �j CU W TEL. - ZO n NO.OF USE OF NEWIHM•�M. Z CITY NO. C� PLAKS BUILDING ^ lS�. wO STATE CITY YARDS APPROVED YARDS APPROVED co a LIC. NO. �+ LIC. NO, MAIN BUILDING ACCESSORY BUILDING 0 0• OF LOT �,J � / /371 I NOW ON LO�• / (RONTOM ST RFTt) . FT. USE OF /2- EXISTING BLDG. FT. F SIZE OF 7�r�X /(/0 J _NO.OF / . Z NEW BLDG. fgayb Fi ROOMS / STORIES / FT. EXTERIOR WALL <"r ROOF (IJ� _V COVERING 5 I COVERING Rte.14- taJ FT. J USE OF BUILDING AND WORK TO BE PERFORMED • BET.MAIN& 1 ACCESS-BLDG& d DATE Q J^ O /' �I1. I I�+l7TJyL` -- APPROVED / \ / h !SE'S [♦� �L9'( tt( \Ll�M •.-• • �.� DATE / at t Z i 0 P_ I hereby acknowledge that I have read this application and state D that the above information is correct and agree to comply with all laws regulating building construction, and I shell not employ i_ any person in violation of the workman's compensation laws of fA the State of California. q m U9 Z I hereby certify that I am properly licensed as a contractor under SQ. FT. 0 the State of California Business and Professions Code, Division 3, HE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, end that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: t[ am exempt from the provisions of the State of California Business VALUATION and Professions Co ivision 3,Chapter 9. m PERMIT FEE $ N D Signature ofo D eft/ m Permittee 999 / l.S.�A $ 7an PLAN CHECK $ / / ./ E ei Authorized A ant u TOTAL FEE $ s — .. 01727/ '. ;C 10 74� <L00 573 cJi+^"=38. '0 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 P 1 TION FOR BUILDING PERMIT For Applicant to Fill in Com letely �f / c RE E DATE RECEIVED DATE ISSUED�f ADDRESS G 3 / ��()/�/6 `Jr 77 c / //'10`71 OWNER /rd IT1 ALJ/'iV M �' A.P.NO. PES2/ t 4 /V/ � M�NO MAIL BUILDING ADDRESS ADDRESS W W TEL. 0- U CITY NO. TRACT I LOT BLOCK f- Z CONSTRUCTION NEW DD AITFR REPAIR MOVING nFMOI ISH O N LENDER d m J D BRANCH /}j /s��5),s��y/ J(n OWNER " / JT((//!/r COszt Ill J ADDRESS VALUE CO ARCHITECT TEL. S $ '-I Q OR ENGINEER NO. V cn FIREalter_w cc ADDRESS ZONE GROUP ytt Ul APPROVED W Z CONTRACTOR BY DATE r?Fni-7 J O m Z J cc ADDRESS W w TEL. ZONE INO.OF USE OF NEW 0= CITY NO. PLANS BUILDING ZH W-O STATE CITY YARDS APPROVED YARDS APPROVED to 2 LIC. NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING _0 SIZE NO.OF SLOGS. (FROMC/L STREET) OF LOT NOW ON LOT FRONT FT. FT. USE OF EXISTING BLDG. R.SIDE_ FT. FT. 1— SIZE OF NO.OF Z NEW BLDG. ROOMS STORIES ,L,SIDE FT. FT. CE EXTERIOR WALL ROOF t _ COVERING COVERING REAR FT. FT. J USE OF BUILDING AND WORK TO BE PERFOR ED DISTANCE BET. BET.MAIN& 1 0- MAIN BLOCS. ACCESS BLOCS. Q ^ ' / VAR.SDATE /�0 O >'(,(iyy( C.U.P.tp APPROVED F APPROVED (n RY DATF 1 I hereby acknowledge that I have read this application and state r that the above information is correct and agree to comply with - 1/1111 / CC ell laws regulating building construction, and I shall not employ I— any person in violation of the workman's compensation laws of CO the State of California. to ZI hereby certify that I am properly licensed as a contractor under SQ. FT. o the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: sr CC am exempt from the provisions of the State of California Business VALUATION `��f l0 and Professions Code,Division 3,Chapter 9. PERMIT FEE $ N Signature of m Permittee $ / PLAN CHECK $ E 0 Authorized Agent ` TOTAL FEE $ t qg " a