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Home My WebLink About326 16TH ST - Building Permits�_�-F�� G� �- - oC�.�7� � CL�-, ►�C� 6 l� �'�2_�-u� `�C� � � z�- � � G�/ � ro��- �fi �� C L�ct.S� �� --f- � �1 wo � �d l c � e ct� �� S� - l Y'�'�'- � ��SS, �� G � C �� L� S �-- � G�S��S� V"�� , z�� ( �°�� _ 1�-`-� � . FROM : PHONE NO.�: • Jun. 14 1998 11:31RM P1 September 25, 2007 To: Ed Pevos I was down at the city rhe other day and found out that a walk in closet we added on was never signed off. I need to renew the permits so 1 can get a final inspection. The permit numbers are 80 1-0 1 548, B02-00300 and �02- 00125. Thank�you, � Gusta on 326 Fast 16�' Sueet Costa Mesa, CA 92627 949.646.6158 home phone 949.646.4684 fax (7i4) 7�Yi-$273 • Fax (714) 754-4856 • www.ci.costa-mesa.caB.UILDING PERMIT �� tAIH UMIVt, IiVJIA MtJA, l:A yLtiLti ,Iob Address: 326 16TH PL Suite: Viciniry: Parcel Number: 42521221 Applicant: COX, JEFF Address: 326 16TH PL COSTA MESA, CA Owner: COX, JEFF Address 326 16TH PL COSTA MESA, CA Contractor. Address: Zip: Arch : Address: Zoning: Phone: 949-645-9301 Zip: 92627 Phone: 949-645-9301 Zip: 92627 Phone: License: Eng: Address: ISSUED BY: Status: ISSUED Applied: Ot/27/2004 Issued: Ot/27/2004 Phone: Phone: Zip: License: - License: SCOPE OF PERMIT ADD 77 5�. Ff. LAUNDRY ROOM. � Plan Check: $99.61 Permit: $153.25 SMIP Res: $0.71 SMIP Com: $0.00 Other: $0.00 inspection: $0.00 Total: $253.57 SETBACKS MAIN STRUCTURE Frant 0- 0 ACCESSORY Front 0- 0 PARKING Existinq: o NOTES: Rear 0- 0 Rear 0- 0 Reauired: 0 FEESUMMARY PLANNING & ZONING LeR 0- 0 Left 0- 0 Proposed: 0 Calc Valuation: Claim Valuation: Right 0- 0 Right 0- 0 S�,i�a.so so.00 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) EXPIHATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandonetl for a period of 1 BO days. INSPECTIONS: In order for the work authorized under this permit to be considared legal, such work must comply with all applicable codes, and all requlred Inspeetlona and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of ihis pertni�. FOR INSPECTIONS CALL: (714) 7545626 2aa�ae (a�oo) WORKERS' COMPENSATION DECLARATION: I hereby attirm untler penalty of perjury one of tha following declarations: ❑ I have and will meintain a certificele ot consent to sell-Insure for workers' compensatlon, 85 provided for by section 3700 of ihe Labor Cotle, tor the peAormance ot ihe work for which ihis permit is issued. ❑ I have antl will maintain workers' compensatio insuranca, as required by sectlon 3700 of Ihe Lebor Cotle, for t�e pedortnance of lhe work br which ihis pertnit is issued. My workers' compPns�an �su�nce carr��ntl policy number are: ' Cartier. nof one or less.) Policy Number: � I certify ihat in the pertormence ol the work for which this permit is issuatl, I shell not employ eny person in any manner so as to become subject to the workers' compensetlon lews o alIj�la, e agrae that If I should become subJect to the workers' compensa[ion provislons of ection 370 of the L bor Code, I shell fotlhwith �plywithth_esey� is'6ns ( A,pplicanLSignaWre: �� Date: WqRNWG FAILURE SECURE W� qKERS' COMPENSATION COVERAGE IS UNLAWFUT AN� SHALL SUBJECi AN EMPLOYER TO CRIMI PENALTI 5 AND GVIL FINES UP TOONE HUNDRED TTIOUSANDOOLLAR (5100.OW),INADOITIONTOTHEWSTOFCOMPENSATION,DAMAGESASPROVI�E�FORINSECTION3]OBOFTHEIABORWOE,IMEREST,ANDAiTORNE`fSFEES. LICENSED CONTRACTORS DECLARATION: I hereby aNirm that I am licensed under provisions of Chepter 9(commencing with Section 7000) ot Division 3 of the Business and Pmfessiore Coda, and my license is in full force antl eNect. Llc. N Cless u Gontrecrofs Signature: Date: CONSTRUCTION LENUING AGENCY: ❑ I hereby aMirtn that there is a conslmction landing egency for the pedormence of the work tor which this permit is issued. (Sec. 3097, Civil Code). Lentlefs Name: LenOer'S Aadress: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby aHirm lhe� untler penalty of perjury Iha� I am E%EMPT FROM THE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Business end Professions Code: Any ciry or counry which requires e permit b constmct, elter, improve, demolish, or repair eny strucwre, prior to its issuance, also requires the applicant far such pertnil to file a signed statement Ihat he or she I5 Iicensed pursuent to the provi5ions ol lhe Contrectors License Lew (Chapter 9(commencing with Section 7000) of Division 3 ot the Busines and Professlons Code) or thet he or she is exempt therefrom en0 the Desis tor the allegeA axemption. Any vlolation of Saction 7031.5 by any applicant for a pertnit subj s the applicent to e civil penalry of not more than tive hundred dollers ($500�.): I, as owner ot the properry, or my employees with weges as Iheir sole compensation, WILL DO THE WORK, and the siructure Is not intendetl or oNeretl tor sale (Sec. 7044, Business end Proteuions Cotle: The Contraciors License Lew tloes noi epply to an owner of property who builds or improves thereon, and who does such work himself or hersell or through his or her own employees, provided that such improvements ere nat intentletl or otteretl for sale. If, howaver, Me building or improvement is sold within one yeer of completion, ihe owner�Duiltler will have �he 6urden of pmving that he or she did not build or improve for purpose of sale.). ' ❑ I, as owner ol iha pmperty, am E%CLUSIVELV CONTRACTNG WITM LICENSEO CONTRACTORS �o construct the pmject (Sec. 7044, Business and Profes5ion5 Cotle: The comremors License Lew does not appty to en owner ot Dmpeny w�o builds or Improves thereon, antl w�o contracis for such project with a contracwr(s) license purs ent lo t�e Contractom License Laws.). ❑ I am e:e un r se� Business and Professions Code lor this reason: - gnature: �� Date: Owne�C� n ietl by ver's licensa. ❑ Yes ❑ No Drivefs License No. E:pires: ol Ownership by (type ot tlacumem, i.e. - propeny ta: bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify ihat no excavation Me (5) or more feet in depih imo which e person is requiretl to descend, will he matle in connection with work authorized by [his pertnit, and thet no building structure, scaflolding, telsework, or demolition or tlismantling thereof, will ba more ihan thirty-six (36) fee� high. (Chap. 3.2, Grp 2, An 2, Sec. 341, Title B, Califomia Atlministrellva Cotle). ❑ As owner-builder, I wlll not employ enyone to tlo work which would require e permi� from the Dlvision of Intlustrial Safery, as noted above, unless such person has e pertnit to do such work irom Ne didsion. Signature: Date: Division of Industriel Safety Permit Num6er. CERTIFICATE OF COMPLIANCE ANU AUTHORVATON OF ENTRY: I cenity under penalry of perjury that I have read this application and state ihat the intormatlon given is corred. I a9ree m wmply with ell state lews and ciry ordinances relating to bulltlinp consiruction, end authorize rep((esentatives of the Ciry of Costa Mesa to enter upon the ebove-descnbed property fo 'nspselibn pu ses. I agree not to occupy or ellow occupency of eny building authon� (I bythis�e�itOu til fi al inspection. � I / / Signe e 1 Lega�ar(s�--�� —� ate A Or Aut�onzed Applicent Date COUE t. INSFECTIONTYPE 1616 Fi:ed System Final Fire Prevenlion 1266 Pool Spa Flnal 200 Final Re-Roof 201 Final8lock/Retaining Well 202 Final Fectory Fire Place 203 204 Final Sign Final Demoli�ion Q�. �`i COOE� INSPECTIONTYPE 206 Final Mechanical 208 Final Plumbing 210 Final Electncal 272 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy Q�ff U�ELS 1.1-� Y1� (714) 754-5273 • Fax (714) 7543856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Adtlress: 326 16TH PL Suite No Vicinity: Parcel Nuinber: 42521221 Applicant: COX, JEFF Address: 326 16TH PL COSTA MESA, CA Owner: COX, JEFF Address: 32616TH PL COSTA MESA, CA Con(ractor. Address: OWNER-BUILDER MECHANICAL PERMIT Phone: 949-645-9301 Zip: 92627 Phone: 949-6459301 Zip: 92627 Phone: Zip: License: 000000 Status: ISSUED Applied: 08/13/2003 Issued: 08/13/2003 i� �: �� SCOPE OF PERMIT ADD 399 S.F. TO EXISTING REAR DUPLEX UNIT. WORK TO INCLUDE: EXTEND EXISTING LIVING ROOM AND MASTER BEDROOM, ADD MASTER BATH, AND RELOCATE EXISTING KITCHEN AND BATH. CONVERT 2 BEDROOM, 7 BATH DUPLEX UNIT TO A 2 BEDROOM, 2 BATH DUPLEX UNIT. REF.: 803-01370 MECHANICAL TO INCLUDE: 1 INST FAU<t00K BTU, 1 GAS PIPING, AND 1 HO00 W/MECH EXHAUST. ISSUE FEE Inst FAU <100 k BTU Inst FAU >100 k BTU Repair / Alt Cooling/Heat Inst / Rep. Recess Wall Htr Refrig Sys <100 k BTU Re(rig Sys >100 k BTU Gas Piping Factory Fireplace Hood w/Mech Exhaust VAV Box Vent Fan / Single Duct Appliance Fire Dampers Smoke Dampers Inst or Relocate Appl Vent Air Handlers c 10000cfm 823.50 3�a.8o 50.00 $0.00 $0.00 $0.00 $0.00 56.15 $0.00 $10.65 50.00' 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantity FEE SUMMARY Repair / All Absorbtion Unit Repair / Alt Refrigeration Unit VenUllation System Evaporative Cooler Com mercial I ncinera lor Domestic Incinerator Compressors / Absorption Systems Upto3hp/100kBTU 3To15hp/SOOkBTU 15 To 30 hp / 1,000 k BTU 30 To 50 hp / 1,750 k BTU Over 50 hp / Over 1,750 BTU Boilers Upto3hp 3To15hp 15to30hp 30 t0 50 hp �uantity $0.00 0 so.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 7, 12-21•92) EXPIRATION: This permit shall allomatically expire and become void if work is not commenced wi�hin 180 days, or i1 work is suspended or abandoned tor a perlod of 180 days. INSPECTIONS; In order for the work authorized under this permit to be considered legal, such work must comply with all applicabla codes, and all required Inapeetlona and flnal approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of ihis permit. FOR INSPECTIONS CALL: (714) 7545626 2d4666 (8/00) WORKERS' COMPENSATION DECLARATION: � � I �ereby eNirm untler penalty of perjury one of the toltowing daclarations: ' . ' ❑ I heve entl will malnteln e certilicate of consent to self-Insure lor workers' compensatlon, es provitletl tor by sectlon 3700 of the Labor Cotle, for the pedormence of the wark tor which this permit is issuetl. ❑ I hava antl will maintain workers' crompensation Insurance, es requlretl by sectlon 3700 af the Labor Code, for the pedortnance ol tha work for which this pertnit is issued. My workers' compensation Insurence carrier antl pollcy number ere: Garner: PoliCy Number: (This cflon need not be completed 1! (Ae permif Is valued et one huntlred dollers ($f 00) or less.) 1 certify ihat in ihe peAormance ot I�e work for which Ihis pertnit is issuetl, I shell not employ eny person in any menner so as to become subject to tha workers' compensation laws of C yfomiay� d e Ihat If I shauld become sub�ect to the workers' compensatlon proNsions of Saction 3700 of ihe Labor Code, I shall forihwith comply with these D �ons. / Applicanl Signeture: ' �' � oa,a: �� r 3- a.� WARNING FAILURE TO RE WORKERS' COMPENSATIQV COVERAGE I$ UNLAWFUL rW0 SHQL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE HUNDRED TIi0U5AND DOLURE (5100,000�. IN ADDITION TO THE COST OF COMPENSATION, DPM4GE5 A$ PROVIDED FOR IN SEGTION 3108OF THE LABOR CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aNirm that I am Ilcensed under provisions of C�epter 9(commencing wi�h SecUon 7000) ot Division 3 of the Business and Professions Code, end my license is in full I torc0 antl effect. LiG. M Cless a � Contradofs Signamra: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby aXirtn that there is a conSlructlon lentling agenty for Ihe peAortnanca of the work for which this permit is issued. (Sec. 3097, Civil Cotle). LentleYs Neme: Lentlefs Atltlress: �' SignaWre: Date: OWNER-BUILDER DECLARATONS: I hereby eflirm that under penelry ot perjury thet I em E%EMPT FFOM 7HE CON7RAC70RS IICENSE LAW br Ihe tollowing reason (Sec. 7031.5, Business and Pmtessions Code: Any ciry or counry which requires e permit to construcL alter, impmve, demolish, or repair eny strucWre, pnor to its issuance, elso requires the applicant tor such pertnit ro file a signed slelement Ihat he or she Is Ilcensetl pursuent ro the provlslons ot Ihe Contrectors License Lew (Chepter 9(commencinq with Sectlon 7000) of Division 3 oi the Busin s end Professions Cotle) or ihe� he or she is exampt therelrom and Ihe basis lar Ihe allegetl ezemption. Any violation of Section 7031.5 by eny applicant for e pertnit su ' cts the epplicant to a civil penalry of not more than live hunCretl tlollars ($500) J: I, es owner of the property, or my employees with wepes as thelr sde compensallon, WILL DO TME WORK, entl the structure Is not intentle0 or ottered for sale (Sec. 70a4, Business and Professions Cotle: The Contrectors License Law dces not epply to an owner ol properry who builds or improves Ihereon, and who does such work himself or herself or ihrough his ar her own employees, providetl t�at such improvements ere not Intended or ottered for sale. II, however, tha builtling or improvement is sold within one year ol completioq lhe owner-builder will have�the burden ol pmving Ihat ha or she Aitl not build or improve for purpose ot sale.). � ❑ I, as owner ot the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS lo consfruct tha prolect (Sec. 7044, Business antl Professions ode: The cantrettors LicenSe Lew does not 8071y lo en owner ol property who bulids or improves thereon, antl who contracts for such projact with a coniractor(s) license pursua t to th�e Contractors License Laws.). I am exe u tlar e�4c. Signawre: � � Owner ID v'f' d by tlrivef icanse. Verification of OwnerShip by (rype of Bu5ine55 end Proleuion5 Code tor lhis reason: Date: — / 3 -- O Ves ❑ No Driver's License No. �� %�/ Expires: %- �I - R i.e. - pmpeny taz bill or tleetl): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certity ihat no excavation flve (5) or more feet in depih into which e person Is required to descend, will be made in connection with work authorizetl by Ihis permit, and that no builtling structure, scaHoltling, lalsework, or tlemolition or dismantling thereoi, will be more than Ihirty-sla (36) feet high. (Chap. 32, Grp 2, An 2, Sec. 341, Tltle 8, Califomla Adminisirative Code). ❑ As owneo-huiider, I will not employ anyona to do work which would require e permit from the Division of Intlustnel Satery, es notetl a6ove, unless such person has a permi� to do such work from the division. Signature: Date: Division of Indu5lnal Safety Permit Number: CEHTIFlCATE OF COMPLIANCE AND AUTHORIZA710N OF ENTRV: I cenity under penelry oi perjury ihat I have reatl this application and state that t�e information given is wrrect. I egre �� comp with ell state laws entl ciry ardinances relating to builtling construction, antl euthonze representatives of t�e Ciry of Casta Mesa to enter upon Ihe above-desc � e pro�torj�spection purposes. I egree noi to acupy or ellow occupancy of any building authorize� ,his �� un�il finQal i`n35pection. � U Signature OI Legal Owneqs) Date And/Or Authorized Applicant Date 40pE t. INSPECTIONTYPE Qd¢. " 'II�AL9 1616 Fixetl System Final Fire Prevention 1266 Pool Spa Finel 200 Final Re-Root 201 Finel BIocWReteining Well 202 Final Factory Fire Place � 203 Final Sign 204 Final Demoli�ion COUEI INSPECTIONTYYE . . j�ff, J�LS 206 Final Mechanical I !�� 'f(Ji a 20B 210 212 220 222 250 Finel PlumCing Final Elecirical Finel Fire Prevention Final Planning Approval Final Si�e Final Building/Oaupancy (714) 754-5273 • Fa�c (714) 754-4856 • www.ci.costa-mesa.ca.us �� rAIM U1i1Vt� GVJ IH MCJX� liH tlL0<O Job Address: 326 16TH PL Suite No Vicinity: REAR UNIT Parcel Nunmber: 42521221 Applicant: COX, �EFF Address: 326 16TH PL COSTq MESA, CA Owner: COX, JEFF Address 326 16TH PL COSTq MESA, CA Contractor: OWNER BUILDER Address: Arch / Eng : Address: ISSUE FEE Backtlow irriqation Backtlow Preventer Balhtub Clarifier System Connect pce,Soda,etc) Dental Units Dishwasher Drein, Floor Drain, Rainwaler Drain, Roof Drinking Fountain Expansion Tank PLUMBING PERMIT ISSUED BY: Phone: 949-645-9301 Zip: 92627 Phone: 949-6459301 Zip: 92627 Phone: Zip: License: 000000 Phone: Zip: License: SCOPE OF PERMIT REF: Qp4-00259. ADD 77 SQ. Ff. LAUNDRY ROOM. PLUMBING TO INCLUDE: 1 LAUNDRY TUBNVqSHER, 1 GAS LINE. REAR UNIT AMT sza:so $0.00 $0.00 $0.00 30.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 FEE SUMMARY QTY AMT Laundry Tub / Washer 59.80 0 Landscape Irtigatlon 50.00 0 P-Trap 50.00 0 Pressure Regulator $0.00 0 Process Piping (per 10 ft) 50.00 0 Receptors 50.00 0 Septic Tank $0.00 0 Sewer Cap (or Demo $0.00 0 Sewer Connect $0.00 0 Sewer Private Line $0.00 0 Shower $0.00 0 Sink, bar $0.00 0 Sink, commercial $0.00 �N 1 0 0 0 0 0 0 0 0 0 0 0 0 Status: ISSUED Applied: 01127/2004 Issued: 01/27/2004 SumpPump Swimming Pool Trap Primer Urinal Vacuum BrkrBkflow(1-0) Vacuum Brkr Bkflow(5+) Wash Basin Wash Basin Set Waste and Vent Syslem Water Closet (ToileQ Water Heater / vent Water Piping (Inst or Rep.) Water Re-pipe AMT 30.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 QTV 0 0 0 0 0 0 0 0 0 0 0 0 0 NOTICE: The work authorizeq by this permit shall comply with all applicable handicap access requirements under California statutes and related regutations. (Ord. No. 924B, § 1, 12-27-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days, or if work is suspended or abandoned tor a period of 180 days. INSPECTIONS: In order tor ihe work authorized under this permit to be considerad legal, such work must comply with all applicable codes, and all requlred Inspections and final approval must be obtained. Failure to obtain inspections and tinal approval will result in ihe expiratlon of this permit. FOR INSPECTIONS CALL: (714) 7545828 24C8d8 (6W) WORKERS' COMPENSATION DECLARATION: , I hereby aHirm under penalry of perjury one of the tollowing declarations: ❑ I heve antl wili maintain a certificate of consent to selt-Insure for workers' compensation, as provitletl tor by section 3700 ot Ihe La6or Code, for ihe peAormence of the work for which t�is parmit is issued. ❑ I have and will maintain workers' compensatio insurance, as required by section 3700 of the Labor Cotle, for ihe performance of the work for which ihis permit is Issuetl. My workers' compen5 'o nSuranc c ri �olicy number ere: Ca�ner. Poliry Number: his ecbon need not be com lefed il fhe pe f is valued at one hundred dollars ($100) or less.) I certity ihat in ihe pedormance of lhe work for which Ihis permit is issued, I shall not employ eny person in any manner so es to become suhject to ihe workers' compensetion laws of liforppp�� rea Ihat If I shoula becoma subject to Ihe workers' compensation provisions ot Se ion 3700 0l e Labor Code, I shall forthwith comply with ihese pr slon/f. f �7 Applicent SigneW�e: L Dete: `�� I�Q� WApF71NG'. FAIL�RE TO CUPE WO ERS' CAMpENSATION COVERAGE IS UNLAWFUL AND SHALL SU&IECT AN EMPLOVER TO CRIMINAL ENALTIES AND CNIL FINES UP TO ONE HLINDRED THOUSANDDOLLARE 00,000),INA DITIONTOTHECOSTOFCOMPENSATION,DAMAGESASPROVIpEDFORWSECTION3)O60FTHELA00RCODE,INiEREST,ANDATiORNEY'SFEES. LICENSED CONTRACTORS DECLARATION: I hereby eNirm that I am licensed under provisions of Chapter 9(commencing with Section 7000) ot Division 3 ot the Business and Pmfessions Code, end my license is in tull force and eflec�. LIc. # qass a QMractofs SlgnaWre: Date: CONSTRUCTION LENDING AGENCV: ❑ I hereby affirm that there is a constmcti6n lending egency br the peAormance of the work for which this permit is issued. (Sec. 3097, Civii Code). Lender'S Name: LendeYs Atldress: Signaiure: Date: OWNER-BUILDER DECLARATIONS: I heraby affirm thet untler penelry of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Pmfessions Code: ny ciry or counry which requires a permit to consiruct, alter, impmve, demolish, or reDair any sirucNre, pnor to its issuance, also requires the epplicant for such permit to file signed statement that he or she I5 licgnsed pursuant to the provisions of the Contrectors License Law (Chapter 9(wmmencing with Section 7000) of Division 3 oi the Busi ss and Profes5i0ns Code) or iha� he o� she is exempt therefrom and the basis for �ha alieged ezemp�ion. Any violalion ot Sec�ion 7031.5 by eny epplicant �or a permi� sub' cts ihe appllcant to a civil penalry of not r�ore ihan tive hundrad dollars ($500).): I, as owner ot tbe property, or my employees with wages as thei� sole canpensatiar, WILL DO 7HE WORK, antl ihe structme is not intendetl o� oMeietl �or sala (Sec. 7044, Business and Professions Code: 7Fie Contractors License Law does not apply to an owner ol properry who builds or improvas ihereon, and who does such work himself or herself or through his or her own employees, provided that such improvemenis ere not imended or ottered tor sele. If, however, the buiiding or improvement is sold within one year of completion, the owner-builder will have ihe burden o( proving that he or she did not build or improve tor purpose oi sale.). ' ❑ 1, as owner of the property, am EXLLU$NELY CONTRACTING WITH LICENSED CONTRACTORS to consimct the project (Sec. 7044. Business and Professions Cotle: The coniractors License Ww does not apply to an owner of propeny who builtls or improves Ihereon, entl who coniracts tor such project with a contractor(s) license pur5uan lhe ntractors License Laws.). �.--.I.am-exem t er s c. Business and Pmtessions Code for this reason: Signalure: � . . Date: Owner ID v'f� d Dy dnver's cense. ❑ Yes ❑ No Drivers License No. Ezpires: Ownership by (type of documem, i.e. - pwperry taa bill or deed): DIVISION OF INDUSTRIAL SAFETV PERM17 CERTIFICATION: ❑ I hereby ceniy that no eacavation five (5) or more feet in depih into which e person is requiretl to descend, will be matle in connection with work authorized by this permit, and that no building stmcwre, sCaHoiding, talsework, or demolition or dismamling ihereof, will be more ihan thirty-six (3fi) teet �iqR (C�ap. 32, Grp 2, An 2, Sac. 341, Title B, Calitornia Atlminisirative Cpde). ❑ As ownervbuilder, I will not employ enyone to do work which would require e pertnit from the Division of Indusirial Safery, as noted ebove, unleu such person has e permit to do such work tmm ihe tlivision. Signature: Date: Division of Indusinal Safery Permit Number: CERTIFlCATE OF COMPLIANCE AND AUTHORIZATON OF ENTRY: I cenity under penalry of perjury ihat I have read this application and state that the information given is correcL I agrea to comply with al state laws enqde�ciry ordinances relating to building consimction, antl authorize representatives ot ihe Ciry of Costa Mesa to entar upon Ihe above-described property for in ctioryQrpps , I egree not to occupy or allow occupency of any building authoriz�d by ihis perr�it until tin inspection. � =Y' ��1 � � igneMe�Of egaFOwner(s)�} —� ate COOE 11. INSPECTIONTYPE 1616 Fixed System Final Fire Prevention 7266 Pool Spe Final 200 Final Re-Roof 201 ' Final BIocWRetaining Well 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition Q,jf, IM CODEt INSVECTIONTYPE 206 Final Mechanical 208 Final Plumbing 270 Final Elecirical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Builtling/Occupency PAIE L�LS ��---1 „ ` - � (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIFi OHIVt, GO51 A MESA, GA 9'L6"L6 ELECTRICAL PERMIT Job Address: Suile No Vcinity: Parcel Nunmber: Applicant Address: Owner: Address Contrector. Address: ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool / Spa Lighting Fixts Recept Outlels Switches Non Res Appl Res Appl Service to 200a Service to t000a Service over 1000a Motors l0 1 hp Motors to 10hp Motors to SOhp Motors to 100hp Motors over 100hp Communication drops Sub panel l0 200a 326 16TH PL 42521221 COX, JEFF 326 16TH PL COSTA MESA, CA COX, JEFF 326 16TH PL COSTA MESq, CA OWNER BUILDER Phone: 949-645-9301 Zip: 92627 Phone: 949-645-9301 Zip: 92627 Phone: Zip: License: 000000 ISSUED BY: Status: ISSUED Applied: 01/27/2004 Issued: 01Y17/2004 SCOPE OF PERMIT REF: B04-00259. ADD 77 SQ. FT. LAUNDRY ROOM. ELECTRICAL TO INCLUDE: 3 OUTLETS, 1 LIGHT, 3 SWITCHES, 1 SUBPANEL (RELOCATE), $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $1.ip $3.30 $3.30 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 so.ao $0.00 $0.00 $30.50 Quantiry FEE SUMMARY Temp Dist System / Lighting Busway /100 ft Standing Section Misc Electrical Equipment Transformers up to 1 kva/kw ................up to 10 kva/kw .................up to 50 kva/kw .................up to �00 kva/kw ..................over 100 kva/kw Low Voltage Equipment Low Volt Wiring System / Ckt Misc. Conduit Misa Conductor Circus ( gen or ride) � Cirws (mech nde or lights) Christmas Tree Stand Fireworks Stand Other Electrical Fee Investigation Fee Plan Check Fee Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 30.00 0 $0.00 0 $0.00 0 So.00 $0.00 $0.00 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-g2) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. � INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred Inspeetions antl final epproval must ba obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 75M5826 2446-481fl�00) WORKERS' COMPENSATION DECLARATION: � I hereby eHirm under penalry ot perjury one ot the following declara�ions: ❑ I heve and wiil malntein a certificate of consent to selbinsure for workers' compensation, es provitletl for by section 3�00 oi ihe Labor Cotle, tor the performance of the work for which ihis permit is issued. ❑ I have and will maimain workers' compensation insurance, as required by section 3700 oi the Lebor Code, for Ihe pertortnance oi the work for which this pertnit is Issued. My workers' compensalion Insurance carder and policy numbar ere: Carrier. Policy Number. `(This/ section neetl not be canpleted il the permit is valued at one huntlred Oollars ($100) or Iess.J I�Y/ I certity ihat in ihe peAormance of Ihe work for which this permit is issued, I shall not employ eny person in any manner s as to hecome sublect to ihe workars' _� compensation laws alitoy�ia, a�ja ree Ihal if I should become subject to the workers' compensation provisions oi 5 ction 3700 f the Labor Code, I shall forihwit� comply wilh these �isio�fs� / � O AppliCenl�SignaNre: ' � Date: \ WARNING FAILURE T� CURE WOR ERS' COMPENSATION COVERAGE IS UNLAWFUT AND SHALL SU&IECT AN EMPLOVER TO CPIMINA PENALTIES AND qVl� FINES UP TO ONE HUNDRED THOUSANDOOLLARE� 100,000),INA DITIONTOTHECOSTOFCOMPENSATION,�AMAGESASPROVIDEDFOHINSECilON310fiOFTHELABORCADE,IMEREST,AN�ATiORNEY'SFEES. LICENSEO CONTRAC70RS DECLARATION: I hereby aRirm that I am Ilcensed under provisions of Chapter 9(commencing with Sectian 7000) of Division 3 of the Business end Professions Cotle, and my license is in full force and eHecL Lic. # Class # Con�ractor's Signature: � Date: CONSTRUCTON LENDING AGENCY: ❑ I here6y aflirm that there is a construdion lending agency for Ihe pedormance of the work tor w�ich this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lentler's Adtlress: Signature: Date: OWNER-BUILDER DECIARATIONS: I hereby aHirm that under penalry of perjury that I em EXEMPT FROM 7HE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any ciry or counry which requires a pertnit to construct, alter, improve, tlemolish, or repair any sirucNre, prior to its issuance, also requires the applicant for such pertnit to file a signetl statement ihat he or sha Is licensed pursuant to the provisions oi ihe Contrectors License Law (Chapter 9(commencing wilh Seclion 7000) of Division 3 oi the Business end Professions Code) or ihai he or she is exempi therefrom and the Casis for the alleged e:emption. Any violetion of Section 7031.5 by any applicant For e pertnit sub' ts the applicant to a civil penalry of not more than five hundred dollers ($500).): I, as ownar oi the property, or my employees with weges as ihelr sole compensation, WILL DO TME WORK, antl the structure is not intended or oHered tor sale (Sec. 7044, Business end Profassions Code: The Contractors License Law does not apply to an owner of property who builds or improves thareon, and who does such work himself or herseN or Ihrough his or her own employaes, provitled that such improvemenis ere not imendad or oHered for sale. If, however, the 6uilding or improvement is sold within one year of completion, the owner-builder wili have the burden of proving Ihat he or she did not build or improve tor purpose ot sale.). ' ❑ I, as owner of ihe property, em EXCLUSIVELY CONTRACTING WITM LICENSED CONTRACTORS to consiruct Ihe project (Sec. 7046, Business and Professions Cotle: The contrectors License Law does not apply to an owner of propeny who builds or impmves thereon, and who contracts for such project with a contractor(s) licensa pursu to t Contr �tors License Lews.). ❑ I am ezem ntla se . Business and Professions Code lor this reason: Signat� Date: Owner ID v' ied by driver' icense. ❑ Ves ❑ No DriveYs Licensa No. E:pires: (type of tlocument, i.e. � pmperty tax bill or tleed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certity that no excavation five (5) or more feet in depih into which a person is required to descend, will 6e made in connection with work authonzed by ihis permit, and ihat no building structure, scaHolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feat high. (Chap. 32, Grp 2, Ari 2, Sec. 341, Title 8, California Adminisirativa Cotle). ❑ As ownervbuilder, I will not employ anyone to tlo work which would require a permit from the Division of Industrial Sefery, as noted above, unless such person has a permit�o do such workimm the division. Signature: Date: Division of Industnal Safery Pertnit Number: CERTIFICATE OF COMPLIANCE AN� AUTHORIZATION OF ENTRV: I certify under penalty of perjury iha� I have read Ihis applica�ion and state Ihet ihe information given is correct. I agree b comply with I state ws end ciry ordinances relating to building cons�ruction, and authonze r presentatives ot the Ciry ol Costa Mesa to enter upon the ebove-descnbed propetly tor i ecti purpos . I agree not to occupy or allow occupancy of eny building authori ed by this p unti inel inspection. �� %�� .'SlnnahvAOi nnelOwnerlsl`—. �� D2IB CO�E I, INSPECTONTYPE 1616 Fixed System Final Fire Prevention 1266 Pool Spa Final 200 Final Re-Root 201 Final Block/Retaining Well 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition pRTE ftljfL9L4 �QQ�„(i INSPECTIONTYPE 206 Final Mechenical 208 Final Plumbing 210 Final Electrical . 212 Final Fire Preventlon � 220 Final Planning Approval 222 Final Sita 250 Final Building/Occupancy OAre I[f�dL@ + �s1t (714) 754-5273 • Fax (774) 754•4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESn, cn s2s2s Job Address: 326 16TH PL Suite No Vicinity: Parcel Nunmber: 4252'1221 Applicant: COX, JEFF Address: 326 167H PL COSTA MESA, CA Owner: COX, JEFF Address 326 16TH PL COSTq MESA, CA Contractor: OWNER-BU ILDER Address: Arch / Eng : Address: ISSUE FEE BackFlow irrigation Backflow Preventer Ba[htub Clarifier System Connect Qce,Soda,etc) Dental Units PLUMBING PERMIT Status: ISSUED Applied: 08/13/2003 Issued: 08/13/2003 Phone: 949-645-9301 Zip: 92627 Phone: 949-645-9301 Zip: 92627 Phone: Zip: License: 000000 Phone: Zip: License: SCOPE OF PERMIT ADD 399 S.F. TO EXISTING REAR DUPLEX UNIT. WORK TO INCLUDE: EXTEND EXISTING LIVING ROOM AND MASTER BEDROOM, ADD MASTER BATH, AND RELOCATE EXISTING KITCHEN AND BATH. CONVERT 2 BEDROOM, 1 BATH DUPLEX UNIT TO A 2 BEDROOM, 2 BATH DUPLEX UNIT. REF.: B03-01370 PLUM9ING TO INCLUDE: 1 BATHTUB, 3 P-TRAPS, 1 KITCHEN SINK, 2 WASH BASINS, 1 WATER HEAT�R, 1 WATER CLOSET AND 1 WATER PIPING. AMT QTY $23.50 $0.00 0 $0.00 0 $9.80 1 $0,00 0 $0,00 0 $0.00 0 FEE SUMMARY AMT QTY Laundry Tub / Washer $0.00 0 Landscape Irrigation $0.00 0 P-Trap $29.40 3 Pressure Regulator $0.00 0 Process Piping (per 10 ft) $0.00 0 Receptors $0.00 0 Septic Tank $0.00 0 SumpPump Swimming Pool Trap Primer Urinal Vacuum Brkr BkFlow(1-4} Vacuum Brkr BkFlow(5+) Wash Basin AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $79.60 QTY 0 0 0 0 0 0 2 NOTICE: The work authorized by ihis permii 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 considerad legal, such work must comply with all applicable codes, and all required inspeetfons and final epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 zaas-as (e�oo� WORKERS' COMPENSATION DECLAFAnON: �� I hereby afFirm under penalty of perjury ona of the following decleretions: , ^' � ' ❑ I have and will maintain a ceniticate oi consent lo seli-Insure br workers' compensation, as provitletl for by section 3700 of Ihe Labor Cotle, tor the pertormence of the work tor which t�is permit is issued. ❑ I have antl will maintain workers' compensation insurance, as required by section 3700 of ihe LaDor Cotle, for the performance of ihe work for which this pertnit is issuetl. My workers' compensation Insurance carnar and policy number ere: Carrier: Policy Number: (,JThis� ection need nat be camplefed i! the permit is valued ef one hundred dollers ($100) ar less.) �"J I ceniry that in the pedormance of �he work for which this pertnit is issuetl; I shell not employ any person in any manner so as to become subject to the workers' compenution laws of litomi antl agree that If I shoultl 6ecome sub�ec� to the workers' compensation proNsions oTSection 3700 of tha Labor Code, I shall torthwith comply with thase pr io Q Applicflnt Signature: Date: U — � � "� �� WARNING: FAILURE T CURE WO RS' COMPENSATION COVERAGE IS UNIAWFUL AND SHFLL SUBIECT rW EMPLOVER TO CRIMINAL PENALTIES ANO pVll FlNES UP TO IXJE HUNDFED THOUSANDDOLLARE( t00,000�,INA OITIONTOTHECOSTOFCOMPENSATIIXJ,DAMAGESASPROVIDEDFORINSECTIpJ3%OBOFTHELABORCODE,IMEREST,ANDATTOHNEYSFEES. LICENSED CONTRACTORS DECLAFiAT10N: I hereby afFirm that I am licensed under provisions oi Chapter 9(commencing with Section 7000) of Division 3 of the Business and Pmfessions Code, and my license is in full '�.. force and eHect Lic. q Class M �' Coniractofs Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby aflirm that Ihere is a consiruction lending agency tor Ihe peAortnanca of tha work for which ihis pertnit is issued. (Sec. 3097, Civil Cotle). Lenders Name: Lendefs Address: SigneNre: Date: OWNER-BUIIDER DECLARATIONS: I hereby eHirtn that under penalry of perjury Ihat I am E%EMPT FROM 7HE CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5, eusiness and Professions Code: Any ciry or county which requires e permit to construct, elter, improve, demolish, or repair any siructure, pnor to i�s issuance, also requires ihe applicant for such pertnit b file a signed statement that he or sha Is licensed pursuent to the provislons of the Contrectors License Law (Chepter 9(commencing with Section 7000) of Division 3 ot the Business and Profassions Code) or that he or she I5 e:empt ihereirom end the basis lor the elleged exemption. Any violation ot Section 7031.5 6y any appliwnt for e permit �sub' cis the applicant to a civil penalty of not mare than five hundred tlollars ($500).): I, as owner of the property, or my amployeas with wages as their sole compensation, WILL DO 7ME WORK, antl ihe siructure Is not intended or oHered tor sale (Sec. 7044, Business and Professions Coda: The Contracrors License Law does not apply to an owner of property who 6uilds or impmves Ihereon, and who dces such work himself or herself or through his or her own employeas, provided thet such improvemants are not intentletl or oHered for sale. N, however, the building or improvement is sold within one year of completion, ihe owneo-builder will have�the burden oi proving ihat he or she did not build or impmve for puryose of sala.). - ❑ I, as owner ot the property, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions ode: Tha contrectors License Law does not epply to an owner ol proparty who bulids or Impmves thereon, and who comracts for such project with e coniractor(s) license pursuant to the Contrectors License Laws.). 1 am ex t urydBr se . Business and Professions Code for this reason: Signature: << Date: — � Owner ID ified by drivers license. Ves ❑ No Drivefs License No. %�� ^ Ezpires: �-%� O P� Veritication of Ownership by (type of docu enf, i.e. - propetly tex bill or deed): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby certity that no excavation five (5) or more faet in depth into which a person is required to descend, will be mede in connaction with work authorized by this pertnit, and ihat no building siructure, scaHolding, falsework, or demolition or disman0ing thereof, will be more then ihirty-six (36) teet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title 8, California Atlministretiva Code). ❑ As owner-builtlar, I will not employ anyone to do work which would require a permit irom the Division of Industriel Sefety, as noted above, unless such person has a permit to do such work from the tlivision. Signature: Dala: Division ot Industrial Safety Permit Number: CERTIFlCATE OF COMPLIANCE AND AUTHORIZA710N OF ENTAY: I cehity under penalty of perjury �hai I have read this application and state ihat Ihe infortnation given is correcL I agr to comply wiM all state laws end ciry ortlinances rela�ing to Duilding consiruction, and euthonze representatives of Ihe Ciry ot Costa Mesa to enter upon Ihe above-de ( ed gre(Sbrty}e� inspection purposes. I agree not to acupy or ellow occupancy oi eny building authorizepny Ihis rtnit until finel inspection. < <r c�� l3 —03 Signature Ot Legal Owner(s) Date And/Or Authorized Applicant Date CODE t. INSPEC110NTVVE " 1616 Fixed System Final Fire Prevention 1266 Pool Spa Final 200 Final RB-Roof 201 Final Block/Retaining Well 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition CO�EI INSPECTIONTYGE � 206 Final Mechanical � 20B Finel Plumbing 210 Finel Eledrical 212 Finel Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Builtling/Occupancy Q�¢ IMI(IRLS (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, GOSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: Suite No Vicinity: Parcel Nunmber: Applicant: Address: Owner: Address Contractor: Address: ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+uniLs) Pool / Spa Lighting Fixts Recept Outlets Switches Non Res Appl Res Appl Service to 200a Service to t000a Service over 1000a Mators to 1 hp Motors to 10hp 326 16TH PL 42521221 COX, JEFF 326 16TH PL COSTA MESA, CA COX, JEFF 326 16TH PL COSTA MESA, CA OWNER-BUILDER Phone: 949-645-9301 Zip: 92627 Phane: 949-645-9301 Zip: 92627 Phone: Zip: License: 000000 status: ISSUED Applied: 08/13/2003 Issued: 08/13/2003 � -• • I�i-/- SCOPE OF PERMIT ADD 399 S.F. TO EXISTING REAR DUPLEX UNIT. WORK TO INCLUDE: EXTEND EXISTING LIVIN6 ROOM AND MASTER BEDROOM, ADD MASTER BATH, AND RELOCATE EXISTING KITCHEN AND BATH. CONVERT 2 BEDROOM, 1 BATH DUPLEX UNIT TO A 2 BEDROOM, 2 BATH DUPLEX UNIT. REF.: 803-01370 ELECTRICAL TO INCLUDE: 14 LIGHT FIXTURES, 21 OUTLETS, 15 SWITCHES, 3 MOTORS TO 1 HP AND 1 SUB PANEL TO 200 AMPS. $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $15.40 $22.73 $16.50 $0.00 $0.00 $0.00 $0.00 $0.00 $14.25 $0.00 Quantity 0 0 0 14 21 15 0 0 0 0 0 3 0 FEE SUMMARY Temp Dist System / Lighting Busway /100 fl Standing Section Misc Electrical Equipment Transformers up to 1 kva/kw ................up to 10 kva/kw .................up to 50 kva/kw .................up to 100 kva/kw ..................over 100 kva/kw Low Voltage Equipment Low Volt Wiring System / Ckt Misa Conduit Misc. Conductor Circus ( gen or ride) Circus (mech ride or lights) Christmas Tree Stand Quantity $0.00 0 $0.00 0 so.00 0 $0.00 0 50.00 0 50.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and relatad 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 ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspectiona and finel approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CA�L: (714) 7545626 zaas-as (�voo� WORKERS' COMPENSATION DECLARATION: � ' � I hereby aHirm under penalry of perjury one of ihe following tleclarations: �� ' ' � - ❑ I have and will maintain a certificate of consent to self-Insure for workers' compensation, es provided for by section 3700 of ihe Labor Cotle, tor the pertortnence of ihe work for which t�is permlt is issued. ❑ I have end will maintain workere' compensetion insurance, as requiretl by section 3700 of the Labor Cotle, for the parformance of Ihe work for which this pertnit is issued. My workers' compensation Insurence carrier antl policy number are: � Carriar: Policy Number: � �(Thi sectian need not be completetl il fhe permif is valued et one hundred tlallars ($100) or /ess.J I certify that in the peAormenca of ihe work for which this permit is issued, I shall not employ eny person in eny manner so as to become subject to the workers' compensation lews of Califomla, end agree that it I should becoma subject to Ihe workere' compensetlon pmvisions of Saction 3700 oi tha Labor Code, I shell forthwith comply with Ihase p�roy/��gjon�' D ApplicantSigneture: F�• �7 Da�e: �� ?' �`3 WARNING: FAILURE TO �URE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDFED T/10USAND DOLLAHE (E 00,000), IN ADDITIIXJ TO THE COST OF WMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3�W OF THE IABOR CODE, IMEREST, AND ATTORNE`fS FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirtn that I em licensed under provisions of Chapter 9(commencing with Section 7000) oi Divlsion 3 0l Ihe Business antl Professions Code, and my license is in tull force and eRect. Lic. a Class a Contracrors Signatu�a: Dare: CONSTRUCTION LENDING AGENCV: ❑ I hereby a%irm ihat there is a consVuction lentling agency for the pedormance ot the work for which this permit is issuetl. (Sec. 3097, Civil Code). Lendefs Name: Lender's Address: Signeture: Date: OWNER-BUILDER DECLARATIONS: I hereby aflirm Ihet under penalty ot perlury thal I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business antl Professions Cotle: Any city or counry which requires a permit to constmct, alter, improve, demolish, or repair eny structure, prior to its issuance, also requires the applicant for such pertnit to file e slgned stetement thet he ar sha is licensetl pursuant to ihe pravisions ot the Conirectors License Lew (Chapter 9(commencing with Section 7000) af Division 3 of the Busi ss entl Professions Cotle) or that he or she is exempt thereFrom and the basis for tha eliegad ezemption. Any violetion of Section 7031.5 by any applicent tor e pertnit su " cts Ihe applicent to e clvil penelty of not more ihan five hundred dollars ($500).): I, as owner of the pmperty, or my employees with wages as Iheir sole compensation, WILL DO TME WOFiK, antl ihe strucWre is not intentled or ottered tor sale (Sec. 7044, eusiness end Professions Code: The Coniractors License Law does not apply to en owner ot property who builds or improves thereon, and who tloes such work himself or herself or through his or �er own employees, provitletl ihat such improvements are not Intentled or oflered tor sele. If, however, ihe building or improvement is sold within one yeer ot wmpletion, tha ownerbuilder will have the burden ot proving that he or she tlid not build or improve for purpose oi sale.). � ❑ I, as owner of the property, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to consiruct the project (Sec. 7044, Business antl Profes5ion5 de: The contrecbrs License Law tloes not epply to en owner of property who builtls or Improves Ihereon, end who contracts tor such pmject with a contractor(s) license pursuant to the Contractors License Laws.). I am ezemp ntler ec. Business antl Professions Code for this reason: Signature: � � Date: - � 3 - O ' Owner ID v�ed by dn ers license. ❑ Ves ❑ No Drivers License No. Ezpiras: % 4 Venficaiion of OwnerShiD by (type ot documen�, i.e. - property ta< bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFILATION: ❑ I hereby certily thet no excavatian live (5) or more feet in depth into which a person is raquired ta descend, will be made in connection with work authorized by this permit, and that no building siructure, scaHolding, falsework, or demolition or tlismantling Ihereof, will be more ihan ihirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, 7tle 8, Calitomia Atlministrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit irom the Divislon ol Industrial Safery, as no�etl a6ove, unless such person hes e permit to do such work irom the division. SignaNre: Da�e: Division of Indusirial Safety Permit Number: CER7IFICATE OF COMPLIANCE AND AlliHORIZA710N OF ENTTiY: I certity under penalty of perjury ihat I have read ihis application and state that the infortnetion given is correct. I egree to comply wit� ell state laws entl ciry ordinances relating ro huilding constmdion, antl euthorize representatives of the City of Costa Mesa to anter upon ihe above-de �'pTqp9(ty tor inspection purposes. I agree not to occupy or ellow ocapancy ot eny building authorized by ihis permit until final insp`ezction. ��--%L/ � _ �3 _ �`'' Signawre Ot Legal Owner(s) Data And�Or Aut�orized Applicant Date QOpE �. INSPECTONTYFE - -' � " � p 1676 Fixetl System Final Fire Prevention �� 1266 200 Pool Spa Final Final Re-Root 207 Final BIocWRetaining Well 202 Final Factory Fire Place , 203 Final Sign 204 Final Dem QODE�' INSPECl10NTYPE� ' 206 Final Mechanical 20B Finel Plumbing 210 Final Eledncal 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Oaupancy DATE �¢ I 1-1 �-o� ad+�� (714) 754-5273 • Fax (714) 754-4856 • wv+w.ci.costa-mesa.c�ILDING PERMIT » FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 326 16TH PL Suite: Viciniry: Parcel Number: 42521221 Applicant: COX, JEFF Address: 326 16TH PL COSTA MESA, CA Owner: COX, JEFF Address 326 76TH PL COSTA MESA, CA Contractor: O W N E R-BU I LDER Address: Zip: Arch : Address: Phone: Zoning: Phone: 949-645-9301 Zip: 92627 Phone: 949-6459301 Zip: 92627 Phane: License: 000000 Eng: Address: Stalus: ISSUED Applied: 08I13/2003 Issued: 08/13/2003 � i, � : �� Phone: Zip: License: License: SCOPE OF PERMIT ADD 399 S.F. TO EXISTING REAR DUPLEX UNIT. WORK TO INCLUDE: EXTEND EXISTING LIVING ROOM AND MASTER BEDROOM, ADD MASTER BATH, AND RELOCATE EXISTING KITCHEN AND BATH. CONVERT 2 BEDROOM, 1 BATH DUPLEX UNIT TO A 2 BEDROOM, 2 BATH DUPLEX UNIT. Plan Check: $399.07 Permit: $613.95 SMIP Res: $4.69 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $1,017.71 SETBACKS MAINSTRUCTURE Frant 0-0 ACCESSORY Front 0-0 PARKING �xistin : 2 Rear 30-10 Rear 0- 0 Required: 0 FEE SUMMARY PLANNING & ZONING Left 5- 0 Lek 0- 0 Praoosed: 2 Calc Valuation: Claim Valuation: Right 23- 0 Right 0- 0 $46,867.60 so.00 NO710E: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitomia statutes and related regulations. (Ord. No. 92-28, § 7, 12-21-92) EXPIRATION: This permit shall automatically expire and become voitl if work is not commenced within 180 days, or if work is suspended or abandoned for a penod of 180 days. INSPECTIONS: In order for the work authonzed under this permit to be consideratl legal, such work must comply with all applicable codes, and all requlred inspeetfons and tinal approval must be obtained. Failure to obtain inspections and final approval will result in the expiretion of this permit. FOfl INSPECTIONS CALL: (714) 7545626 2a4WG (eq0l WORKERS'LOMPENSArON DECLARAnON: � � / I hereby eHifm untler,penalry ot perjury one oi the following tleclarations: . � �"` I ❑ I have and wlll maintein a certificate of consen� �o salf-Insure for workers' compensa�ion, es provitleA for by 50tlion 3700 ot t�e Labor Code, for the peAortnance oi �he work for which this permlt is issued. ❑ I have and will maintain workers' compensation insurance, es reQuiretl by section 3700 of the Labor Code, for tha pertortnance of Ne work lor which this pertnit Is Issued. My workers' compensatlon Insurance cerrler and policy number era: . Carner: PoliCy Numbar: (�Th/ls section need nof be comp/eled i! the permit ls ve/ued et one hundred dollers ($100) or less.) p? I certify ihet in the pertormance of ihe work for which this permit is issued, �I shall not employ any person in any mannar so as to become subject to ihe workers' compensatlon laws ol CelUar la, en gree that it I should becoma subJect to the workers' compensetion provislons of Saction 3700 of the labor Cotle, I shell forthwith compty with these pyro is(� Applicent Signature: L—.! ` � oa,a: �r' • r 3-03 WAFNINp: FAILURE T RE WOFKER ' CAMPENSATION CpVERAOE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSANDDOLURE OO,OOO�,INADDITIONTOTHECOSTOFCAMPENSATIOtJ,DAMAGESASPROVI�EDWPINSECTION3]080FTHEUBORCADE,INTEREST,ANDFTTORNEV'SfEES. LICENSED CONTRACTORS DECLARATION: I hereby affirtn thet I em licensea untler provisions oi Chapter 9(commencing with Seclion 7000) of Division 3 0l �he Business antl Protesslons Code, antl my Ilcense is in full torce and ettect. Lic. q Class a Comradols Signature: Date: CONSTRUCTION LENDING ACENCY: ❑ I hereby eflirtn t�at there I5 a construction lending agency for the pertormance of Ihe work br which Ihis permil is issued. (Sec. 3097, Civil Code). Lentlers Name: Lenders Address: Signeture: Date: OWNER-BUILDER DECLARATONS: I hereby aftirm Ihet under penalry of perjury Ihet I am EXEMPT FROM THE CONTRACTOHS LICENSE lAW tor Ihe following reason (Sec. 7031.5, Business end Professions Cotle: Any ciry or counry which raquires e permit to conswct, alter, improve, tlemWish, or repair any structure, prior to its issuance, also requires the epplicant for such pertnit to file e signetl stetement thet �e or she Is Ilcensed pursuent to Ihe provisions oi tha Contrectors License Lew (Chapter 9(wmmencing with Section 7000) oi Divlslon 3 of the Business an0 Profeulons Code) or that ha or sha is exempt therelrom antl the basis for the alleged ezemption. Any violation of Sectlon 7031.5 by any epplicaN br e pertnit subjgCls Ihe applicant Io a civil penalry of not more Ihan five hundred dollars ($500).): � I, as owner oi Iha property, or my employees with wages es Iheir sole compensation, WILL DO THE WORK, antl the structure Is not Intended or oHeretl tor sflle (Sec. 7044, Business and Prolessions Cotle: The Contraciors License Law does not apply to an owner of property who bui105 or improves ihareon, and who tloes such work himselt or hersalf or thwugh his or �er own employees, proviGed iha� such impmvemems ere not intendetl or ofleretl br sale. It, however, the building or impmvement is soltl within one year ol completion, the owner-builtler will heva t�e burtlen oi proving that he or ahe did not build or improva for purpose of sale.). ' ❑ 1, as owner oi Ihe property, em E%CLUSIVELV CONTRACTNG WITH IICENSED CONTRACTORS lo cOnStrutt the project (Sec. 7044, Business end Professions oda: The contractors Licanse Law does not epply to an owner of pmparty who bulltls or impmves thereon, entl who coniracts tor such pro�ect wlth e contrector(s) license put nt to�on �or5 LiCense Laws.). I em ex p unde se Business and Pmfessions Code for Ihis reason: Signatura: ' Dete: ' " Owner ID tietl by drive s liten5e. Yas ❑ No Drivers License No. Expires: — � � Veniication af Ownership by (type of tl m t, i.e. - properry ta: bill or deed): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFILA710N: ❑ I hereby cartity that no excavetion tive (5) or more leet in depih into which a person is requiretl to tlescentl, will be metle in connection with work authorized by Ihis permiL antl ihat no huiltling structure, scalloltling, lelsework, or demoli�ion or dismantling thereof, will be more Ihen Ihiny�six (36) teet �igh. (Ghep. 32, Grp 2, An 2, Sec. 341, Title 8, Colifornia Atlminisiraiive Code). � As ov+ner-builder, I will noI employ enyone to do work which would require a permit from Ihe Division ol Industnel Sefery, as notetl above, unless such person has e pertnit to do such work tmm the division. SignaWre: Dele: Division a� Industnal Safery Pertnit Number: CEHTIFlCATE OF COMPLJANCE AND AUTHORVA710N OF EMRV: 1 cenity untler penalry of perjury that I have raad this epplication and state that lhe infortnation given is correct. I egree to wmply wilh ell state laws end city ordinances relating to building cons�ruc�ion, and euthorize representalives of Ihe City of Costa Mesa to enter upon the above-tlescribe wperty.wr ins e tion purposes. I e9ree not to occupy or allow occupancy of eny building au�horizetl by this permit un�il linel inspection. -C� F�'/3 -d�, Signature Ot Legal Owner(s) Dare And/Or Aut�orized AppliCent Da�e 40oE r. INSPECTONTYPE PAL � ��RLS 1616 Fized System Final Fira Preventlon 1266 Pool Spa Flnal 200 201 202 203 204 Final Re-Rool Flnal BIocWRetaining Well Final Fectory Fire Place Final Sign Finel Demolition COOE� INSPELTIONTYiE 20fi Final Mechanical 208 Final PlumCing 270 Final Electdcal 212 Flnal Fire Prevention 220 Final Planning Approval 222 Final Site 250 Finel Building/Occupancy Qejf. IlrtifIALS OWNER jyg_ �T.T.Fg JOB ADDRESS 326 Fast 16 GENERAL CONTRACTOR gpY Ci A'' "o. ll7-231-16 LOT 1' 11 1CTIONS SOIL GAS W RTER ROUGH P�UMBING PROP. SWA. LINE ❑ HOUSE CON. � SPRINKLING SVSTEM MISLELLANEOUS . �� ROUGH HEnTING ANO nIR CONOITIONING UNDERGROUND � I POWE ROUGN WIRING TRENCMES FORMS FLOOR SYSTEM BONO BERM � STEEL R SHEPTHING FRAME RNO FLASNING LATNING — IN OUT PUSTER. BROWN COli F9��Ii�:I�l:ifl NFORCE G. VENT., FEFRIG. ANO A.C., fINAL ING, FINAL FN� GAS TEST (� DATE SUBCONTRACTOR �1; • F�+ W L Q q h F � W F a c � � a a � a O C a z x 3 ^' COSTA MESA BUILDINGSAFETY DEPARTMENT P.O. BOX 1200 COS7A MESA, CALIFORNIA 92626 For Applicant to F01 in Completely — Use Ink Only BUIIDING �/)/ �/ I� �� ADDRESS ({0 {O OWNER OR �L.� . NI L�G1� TENANT �",T( MAILING 32G 1(oT�Q S�re�tt ADDRE55 CV71K �C�S%� TEL. CITY NO. CONSTRUCiION 1 1 D�`� LENDER �.I l BRANCH ADDRESS ARCHITECT CONTFACTOR � ADORESS CITV STATE ��. No. 23 � 512E OF LOT �jD X USE OF � NOL�q5-3L' CITV LIC. NO. NO.OF B�DGS ( NOW ON LOT Separate pecmits are required for electric, plumbing and heating work: . I hereby acknowledge that I have �ead this application entl state that the ebove intormation is correct and agree to comply with all laws regulatlnB builtling consbuction, entl I shell not employ any parson in violation of Me workman's compensation laws of She Stata of California. I hereby certify that I am properly licensatl as a contractar untler the State of California Business and Professions Code, Division 3, Chaptar 9, antl that such licensas are in full force and effett, or I am exempt fr S e provisions of the State o alifornia Business antl Profession 3, C er Signature of Permittee or Q Authorized Agent Date APPLICATION FOR STRUCTUR�4L PERMIT60, 5C TL RECEIVE BV PERMIT N° � 50288 A.P.No. i 7-a3�-i� BUILDING � � ADDRESS UNIT OR SPACE NO. TR.NO.O LOT � BLK. NEW ADD ALTER �REPAIR MOVING DEMOLISH OWNER I%� M/ ��C.% VALVE VSE Q�y 'iyf., � D!� E APPROVED APPROVEDSETBACKS R. SIDE ` �FT. � L. SIDE a FT. U FEAR % � FT. � PLANNING ACTION APPROVED m C . �.SI^ m CCiQ � �� m SQ. FT. �`+ � THE AMOUNT SHOWN UNDER VAIUATION IS FOR IL THE PURPpSE OF ESTABLISHING A PERMIT FEE ON�V: � VALUATION PERMIT FEE y a G� � .. � PLAN CHECK $ '^ Q.�� o $ �JO TAX S �. �� 6/ /�! �� TOTAL PAI D $ �� U �0.5'O Costa Mesa Building Department PLICATION FOR r�:�cMIT . '`• 111 EAST 20th STREET ��;i� g U 1 L D �� N G ' • q COSTA MESA, CALIFORNIA � �'OR OFFICE USE ONLY � FOR APPLICANT TO FILL IN I Receipt No. Permft No. ewia��9 Z /� =- ` -� //�- 3 nddre� Costa, Mesa, C3�1fO1T118� Reeeived by Date Rec'd. Date Issue! Nearest y�- J�- // - S CrossSt. y[. ri.d7:,� � Building � j� / /iX Address t� b �c�/' Own6r ��•�� Costa Mesa, California Mail / � � Nearest S� , /j _ „ . Address �,.-. � � Tel. �v. J. . _.., Cross St. //`"�""� ■ Address ■ New �G , ��,�,. �,�1� G o� �.G. < � '/ .,. - -!; GC, i � �ocSE�y, a • pyt tion I No�� „� Blxl! I Tract(/, metes and Bounda) ��// `�. a 3/ -, / No. of Bldga .ot p� �( i? 5 Now on LM � No.of No.of Bldg. I Families I Ro ma Line from — Rear Vard - f Strcet �� Side Yard � DESCRIPTION OF WORR _ I%� I Alteration I I Addition I I I Moving I I Demolish I � No. of Rooms SJtories/ W211 t',1'/II Cn��inn �C�%�i/� Plans I // CORRECTIONS �� o,� � ,y"' � ArrRovAr.s Forms, Materials Under-Pinning Frame: Fire Stops, Bracing. Bolts I hereby acknowledge that I have read this Application and state that the above is correct and agree to comply Lath. Ext. with all City Ordinances and State Iaws regulating building constructlo i. � Signatureof Y� f�% Plaster�lnt. Permittee i�� Plaster, Ext. Authorized Agt. �%.d%'I�/�./ Masonry Rei Valuation �� Permit Fee $ ,Y O. o 0 ,J� Plan Check $ ,� a Bond Beam $ , '� d �' Total � � Fee $ �' S • � � FINAL FONM 20A p-H 2M 9-54 O z G) _ �� . k' ' ' • r . . . •~ • • l. �' l � r . ;F . , . � ,.,� .. . . c u c I , J ' _ G 7 � � o - �nA�i_C4P�COS'fAZ�ia i}::tfi2J.00 a a i- � - --.- - -- . -, . . ... � . . . . �.;:... ' . ' � � , . .y � -.or,c �7'� . j,' � _ . . , . . . . _ u . !� � n ., ' p Street .. . . .. . . . o� . t . ` PLOTPLAN �',_ - � --- _ '..,', ,.,) . _. _. \:` `'''_�:._ � (' Show Iocation and distances from � � r: . . - � � �'�' � property line and between buildings. , . � ,� ��i ,,,.. . � � ;�.^ . : � � • .. � •.� ll �� .. _ .a � � ,'\ ' � � `. ' ^ I . _ . . ..1- � � I. . � .. ` • .�'