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Home My WebLink About348 16TH ST - Building Permits� (714) 754-5273 • Fax (714) 754•4856 • www.cl.costa-mesa.ca.us 77 FAIF �RIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: 348 E 16TH ST Suite No Viciniry: Parcel Nunmber: 42521113 Appiicant: GLIFFORD DAGLEY Address: Owner. FRESCH, TROY D&-KELLY R Address 348 E 16TH ST� ', ;, .. COSTA MESA, CA Contracror. J. D. CONSTRUCTION Address: 545 E. HOOVER AV ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool I Spa Lighling FixLS Recept Outlets Switches Non Res Appl Res Appl Service to 200a Service to 1000a Service over t000a Motors l0 1hp Motors l0 70hp Motors to SOhp Motors to 100hp Motors over t00hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole � ORANGE,CA Phone: 8753495 Zip Phone: 94&650-2678 Zip: 92627 Phone: 639-9986 Zip: 92867 License: 806521 Status: ISSUED Applied: OS/20/2005 Issued: 05/20/2005 ISSUED BY: _�_ � SCOPE OF PERMIT ADD 7FIXTURES, 90UTLETS AND 7SWITCHES FOR A RESIDENCE ADDITION, RE:BOS00656 $23.50 50.00 50.00 50.00 50.00 50.00 $7.70 59.90 57.70 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 so:oo $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantity 0 0 0 7 9 7 � ' 0' 0 0 0 0 0 0 0 '" 0 0 0 0 0 0 0 FEE SUMMARY ' Temp Dist System / Lightlng Busway /100 ft Standing�Section Misc ElecVical Equipment Trensformers up to 1 kva/kw ................up to 10 kva/kw .................up to 50 kva/kw .................up l0 100 kva/kw ..................over 100 kva/kw . Low Voltage Equipment � � � -' Low Voll Wiring System / Ckt Misc. Contluit . � Misa Conductar -. , ' Circus ( gen or nde) - Circus (mech ride or lights) � Christmas Tree SWnd Fireworks Stand- Other Eiectrical'Fee � , Investlga0on Pee . . " � Plan Check Fee "� Reinspection �Fee �uantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 50.00 0 50.00 0 50.00 0 $0.00 0 50.00 0 $0.00 0 50.00 0 ao.00 0 $0.00 0 $0.00 0 $0.00 0 so.00 0 $0.00 $0.00 $0.00 $0.00 TOTAL CALCULATED FEES $48.80 NOTICE: The work aulhorized by ihis permit shall compry with all applicable handieap aeeess requirements under Califomia statutes and related regulations. (Ortl. No. 92-28, § 1, 1241-92) EICPIRATION: This permit shall automatically expire and become void if xrork is not commenced within 180 days, or if work is susperMed or abandonetl for a period of 180 days. INSPECTIONS: In order for the work authorized un0er this pertnit to be considered legal, such work must eompty with ail epplicable codes, and all requirad Inspections and final epprovel must be obtained. Failure to obtain inspecUons and final approval will result in the expiration ol this permit. FOR INSPECTIONS CALL: (714) 7545628 2ae+e (amol WORKERS'COMPENSATONDECLAqAnON: '— � � 1 hereby eXirtn under penalry ot perjury ona ol lhe following tlecleretlons:. . . , +. ❑ I hava entl will mainteln e certilicale ol consent to selFlnsure lor workers' campensatlon, e5 proNtled lOr by 6etlion 37pp ot lhe Labor Code, tor the peAortnence of Ihe � work br w�ich tNs pertnit is issue0. ' � � � ❑ I have end will mainlain vrorkers' compensatlon Insurance, as roquiretl Ey sectlon 3700 0l Ihe Lebor Cotle, lor the pertortnance ot Ne work lor which this pertnit Lv issued. My workers' compensetlon Insuren�g ca�der anC ppliry number ere: l � ^ � ' . Cartier. one or less.) Policy NumD9r. ❑ 1 certify Ihel in Ihe peAormance ol Ihe work lor which this pertnil is IssueQ I ahall noI employ eny per9on in eny menner so es to becwne'suDject to t�e viorkere' � compensailon laws oi Calllomla, entl eggree that N I spp(�ou10 becana sub�ect to the workers' compensatlon provlsions of Sectlon 3700 of t�e Lehor Code, 1 shall tort�wit� compty vrith thesa provisio� �� r � _` Applicem Signawre: � CAIn inl_,( �'fo ✓�� Date: J� �� • U� / � 7 WRRMNG: FAILUHE TO SECURE WOfiKERS' WfdPENSATION �pVEMGE IS IIMAW FUL D SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTES ANO CML FlNES UP TOONE HUNDRED TMOVSAND DOl1AFiE (E100,000), IN ADDITION TO THE COST OF COMPENSATION, DMNGES 0.5 PROVIDED FOR IN SECTION 3](IB OF THE IABpR WOE, W{EpE$7, qyD A7TORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I I hereby attirm that I am torce end eflect. uc. a_ � Gomrectors Siqnawre: ot Chapter 9(commencing with Secti 000) ol DiWsion 3 ot the Busineu antl Prygssions Catle, antl my license Is in full Clau a � 5 � / Date: — _ � — %(7 � Q . . CONSTRUCTION LENDING AGENCY: ❑ I hereby aHirtn Ihat Ihera Is a constructlon lentling agenq lor Ihe peAortnance ot t�e work for whic� ihis pormit Is issued. (Sec. 3097, Civil Cade). Lenders Neme: Lenders Address: Signeture: Dete: OWNER•BUILDER DECLAfiAT10NS: I here�y eflirtn Ihat under penelry ol perjury �hat I em EXEMPT FROM TME CONTfiACTORS LICENSE LAW lor ihe following reeson (Sec. 7031.5, Business antl Pratesslons Cotle: Any ciry or counry whit� requires a permlt to constmct, eller, Improve, dom0lish, or ropair any slmcwro, prior Io ita issuance, elso requlres t�e eDDlicant for suCh permii to flle e signetl sietement thet ha or sha Is Ilcensed pursuant to ihe proNsions ol ihe Contrectors License Lew (Chepter B(commenUng with SecUon 7000) oi Divislon 3 of the Business end Prolessions Cotle) or thet �e or she Is exempt therelrom end t�e besis tor Ihe allegetl exemptlon. Any violetlon ol Section 7031.5 by eny eppliceN for e Dertnit sublects the applicant to a civil penalty ot not more Ihen Ilve hunGred ddlers ($500).): ❑ I, es owner ot t�e property, or my employees with weges as Ihelr sole compenselion, WILL DO TME WORK, end the Structure is not Intentled or oHered for sale (Sec. 7044, Business and Protessions Code: The Contractors License Lew does not epply to an owner of property who bulltls ar imprwes thereon, and who tloes such work hlmseif or herselt ar through his or her own employaes, provided thet 5uch improvements Bre not Intended or offered lor sale. It, however, the building or impravement is sold within one year of completion, the owner-builtl6r will heve the Durtlen ol proving that he or sha did not builtl or improve for purpose of sale.). ' ❑ I, as owner ot Ihe property, em EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to wnstruCl the projeq (Sec. 7044, Business antl Pmteuions Code: The contractors Llcense Lew tloes not apply �o en owner oi propeny who Dulltls or Improves thereon, antl w�o contracts for such pro�ect wit� a coniractor(s) license pursuant to the Comrectors License Laws.). � I em exempt under 58t. Signaiuro: Business end Prole551on5 Code tor IhiS re05on: Owner ID veritied by dnver's licensa. ❑ Yes ❑ No Drivofs License No. Venfication at Ownership by (type of tlocumen6 I.e. � property tex blll or deetl): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: D8�9: Expires: ❑ I hereDy cenity that no axcevetlon Ilve (5) or more feet in tlepth imo which e person is required to descand, wlll be metle In connec0on with work euthonzed by ihis permit, entl that no bulltling strucwre, sceMolding, talsework, or tlemolitlon or tllsmanUlnp Uereol, wlil be more Nan ihirty-six (36) leet hig�. (Chap. 3.2, Grp 2, Ah 2, Sec. 341, 71tle B, Celltomia Adminisiretive CoCe). ❑ As owner-builder, I will not employ enyone to do work which would reduire e Dermit Irom ihe Division of Intluslriel Selery, as note0 abava, unleu such person hes a permit to Co suc� wark trom the division. Signature: Date: Division ot Industrial Sefery Permit Num6er: CERTIFlCA7E OF COMVUANCE AND AUTHORVATON OF EMRY: I certily untler Oenalry al perjury t�et I heve roaG this epplicatian antl state Uat the information given is correct. I egree lo campty with ell stete laws en0 city ordinances ralating to building construction, end euthorize representatives ol t�e Gry of GaSta Mesa to enter upon Ne ebove-describetl property for inspeciion purposes. I agroe not to occupY a ellow occupancy ot eny building euthorized by ihis permit until tinel inspection. SI e re OI Legel Ow 5) / ,..� �°--Qn L� �• �-. � AnNOr Authorizetl Applicant COOE �' INSPEC710NTYPE ` ' - " 1676 Fi:etl System Final Fire Prevention 1266 200 201 202 203 204 Pool Spa Finel Final fie-Root ' Final BIocWRelaining Wall Finel Fectory Fire Placa. ' � Final Sign Final Demolitlan QAIE .' . '1N�EL: ' . COOE� INSPECTONTYPE 206 Final Mechanicel 20B Flnal Plumbing 210 ' Finel Elecirical 272 Finel Fire Prevention 220 Final Planning A{iproval 222 Finel Site 250 Finel Bulltling/OccupanCy v (714) 754-5273 • Faz (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 MECHANICAL PERMIT Job Address: 348 E 16TH ST Suite No Vicinity: Parcel Number: 42521713 Applicant: GLIFFORD DAGLEY '' Address: � ` � Owner: FRESCH, TROY D 8 KELLY R Address: 348 E 16TH ST �� COSTA�MESA, CA Contrecror. J. D. CONSTRUCTION Address: 545 E. HOOVER AV � ORANGE,CA Phone: 8753495 Zip: Phone: 943650-2678 Zip: 92627 Phone: 63&9986 Zip: 92867 License: 806521 ISSUED BY: - SCOPE OF PERMIT ALTER HEATING SYSTEM, I VENT FAN FOR A RESIDENCE ADDITION, RE:BOS-00656 ISSUE FEE Insl FAU <100 k BTU Inst FAU �700 k BTU Repair / qlt Cooling/Heat Inst I Rep. Recess Wall Htr Refrig Sys <100 k BTU Refrig Sys >100 k BTU Gas Pipi�g Factory Fireplace Hood w/Mech Exhaust VAV Box Vent Fan / Single Duct Appliance Fire Dampers Smoka Dampers Inst or RElocate Appl Vent Air Handlers < 10000cfm Air Handlers > 10000cfm Floor Fumace Floor or Suspend Heater $23.50 $0.00 $0.00 $13.70 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $7.25 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Duantiry 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 FEE SUMMARY - - Repair / Alt AbsorbUon Unit Repair / Alt Refrigeration Unit Ventillation�System Evaporative Cooler Commercial I ncinerator Domestic Incineretor Compressors / Absorption Svstems Upto3hp/100kBTU 3To15hp/500kBTU 15 To 30 hp /:1,000 k BTU . 30 To 50 hp / 1,750 k BTU Over 50 hp / Over 1, 750 8TU Boilers Upto3hp -� - � 3To15hp 15 to 30 hp 30 to 50 hp, � Over 50 hp , � � ONer Mechanical Fee Investigation Fee " Plan Check Fee . Reinspection Fee TOTAL CALCULATED FEES Status: Appiied: Issued: ISSUED O5/20/2005 05I20/2005 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 50.00 0 $0.00 0 $0.00 0 50.00 $0.00 $0.00 $44.45 NOTICE: The work aulhorized by this permit shall comply with all applicable handicap access raquirements under Califomia statutes and related regulationg. (Ord. No. 92-28, § 1. 12-21-92) EXPIRATION: This permit shall eutomatically expire and become void if work is not commenced within 780 days, or If work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorizetl under this permit to be considered legal, such xrork must compty with all applicable codes, and all required InspxGona and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiretion of this permit. FOR INSPECTIONS CALL: (714) 7545828 �.,o-„ �� WORKERS'COMPENSAnON DECLARAnON: � � �� . I hereby eHirtn untler penalry oi perjury one ot tha lollowing daclaratians: , , � ' ,' ❑ I heve entl will meintain a certilicate ot consent to seli�lnsure lor.workers' cwnpensation, as pmvided for by section 3700 0� �he Lebar Co�e, for Ihe pertormance o� ihe work for which this permit is issuetl. � -� � • ❑ I have and will meintain workers' compensation insurance, es required by sectlan 3700 oLthe Lebor Cado, br the perlormence of t�e work for which Ihis permit is IssuaG. � My workers' mpensation Insurer7ce�ca� e��d policy num6er ere: / - � Carner: c �n' � / PolicyNumber. `��6% � �. (76is secfion neetl nat be completetl i/ the permi( is valued et one huntlretl tlollers 100) or /ess.) �� ❑ I certiry tliat in the peAortnence of the work for which t�is pertnit Is issued, I shall not employ eny person In eny manner so es to become sub�ect to t�e workora'� compenseiion laws of Celifamla, end egrea lhet If I should hetome 5ubjetl t0 �he workers' compenselion provislons ot Section 3700 0l Ihe Letior Code, I shell fort�wlt� ' compty wit� these provisions. Applicant Signature: 0 / Date: S^ �� WARNINCi: FNLURE TO SECURE WORKERS' CAMPENSqT�pry �pyERAGE IS UNIAWFUL AND SHAl1 SUBIEGT AN EMPLOYER TO CRIMINAL PENALTIES AND GVIL FlNES UP TO IXJE MUNDRED THOUSMlD DOLLFRE (5100.000�. IN ADDITIIXJ TO THE Cq$T OF CAMPENSATION, DAlMGES AS PROVI�ED FOR IN SECTION 31ae OF THE LABOR CO�E, IMEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: 1 heieby aKnn that I am foma antl eHect. Lic. q_ _� ComractoYs Signature: � ChaO�er 9(commancing with Section 7000) ot Division 3 of the Business Class q _ W. { ,(3�,�., i Dete: and my license 7s in tu71 CONS7PUCT10N LENDING AGENCY: . ' � I �ereby eHirm that there is e construction lending agency for Ihe pedormance ol the work br w�ich this permit is issued. (Sea 3097, Civil Code). Lender's Name: Lender5 Addre55: Signeture: Dete: OWNER-BUILDER DECLARATIONS: ' I hereby eHirm ihat untler penelry of perjury t�et I em E%EMPT FROM THE CONTRACTORS LICENSE LAW br ihe following reason (Sec. 7031.5, Business entl Professlons Code: Any city or counry which requires e permit I6 construct, alter, improve, demolis�, or repair eny slrucWre, prior to Its issuance, also requlres the epplicant tor such permit to tile e signed Sletement that he or she Is licensetl pursuent to Ihe provisions of Ihe Contractors Ucense Lew (Chapter 9(wmmencing with Sectlon 7000) ot Dlvlsion 3 oi the Business and Professlons Code) or thet he or she Is exempt lherelrom antl the �asis tor the ellegetl ezemption. Any violetlon oi Section 7031.5 by eny applicant tor e permit subjecis the applicant to e civil penalry oi nat more than five hundred dollars (5500)J: ❑ 1, as owner ot Ihe property, or my employees with weges as their sola compensation, WILL DO THE WORK, end the sWcture is not intentletl or oflerea tor sale (Sec. 7044, Business and Profeuions Code: The Contractors LJcense Law tloes not appy to an owner of property who builds or improves Ihereon, end who does such work �imselt ar herself or Ihmugh his ar her own employaes, providea that such improvements ere not Intended or oflered for sele. It, however, ihe building or improvemem is sold within one year of completion, the owner-6uilder will have ihe burden of proNng that he or she tlitl not build or improve tor purpose oi sala.). � ❑ I, as owner oi the properry, em EXCLUSIVE�y CONTRACTING WITH LICENSED LONTRACTORS to construct ihe prolect (Sec. 7044, Business and Prolessions Cotle: The contracmrs License taw Uoes not apply to an owner of pmperty who 6uilds or fmpmves ihereon, an0 who coniracis for such pwjeci wiih a conlracior(sJ license pursuant to ihe Contractors License laws.). ❑ I am exempl under SeC. Business and Proleuion5 Code tor Ihis rea5on: Signature: Date: Owner ID ventiad by anvefs license. ❑ Yes ❑ No Orivers Licensa No. Expires: Vedlication of Ownership �y (rype ol document, I.e. � pmperty taa bill or tleetl): DIVISION OF INDUSTRIAL SAFETY PERMIT CEpTIFICATION: ❑ I hereby ceNfy that no excavation flve (5) or more feet in depth into w�ich e person is required to descend, will be made in connection with work authorized by this pertniC and Ihet no building sWCWre, scaHolding, talsewoB, or demolltlon or tlisman�ling thereof, will be more than Ihirty-six (38) leat high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title B, Celifomla Atlminisiretive Code). ❑ A5 owner-6uilder, I will not employ enyone to tlo work which would require e permit trom the Division of Indusiriel Salery, es notad ebove, unless such person hes a permit to tlo such work tram ihe division. SignaWre: Date: Division oi Intlusirial Safery Permi� Number: ICERTiFICA7E OF COMPLIANCE AND AUfHORI;p�ION OF ENTRY: I certity under penalty of Derjury that I heve read this epplication and state that Ihe iNorma�ion given is I correct I agree to comply with ell stete laws end city ortlinances relating to building construction, end authorize representatives ot the City of Coste Mesa to enter upon the ebove-described D�operty for inspection purposes. I agree not to occupy or ellow occuDency ol eny builtling amhonzed 6y t�is pertnit un�il finel inspectian. COOE �. INSPECiIONTYPE 1616 Fixed System Final Fire Prevention 12fi6 Pool Spa Final 200 Final Re-Roof � - 201 Final Block/Fietaining Wall 202 Final Factory Fira Place , 203 Final Sign 204 Final DemoOlion • •.• pe¢, � - IN�IfiRL9 1� � �—�� ' �,QjIFj 9NSPECTIONTYVE 206 Final Mechanical 208 Final Plumbing � 210 Final ElecMcal - 212 Final Fire Prevention 220 Final Planning Approval � 222 Final Site � 250 Final BuildingiOccupancy .u. ,y � ' • �l ; (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT Job Address: 348 E 16TH ST Suite No Vicinity: Parcel Nunmber: 42521'113 Applicant GLIFFORD DAGLEY. �-- Address: - �" . - ` Owner. FRESCH; TROY D& KELLY R Address 348 E 16TH ST � COSTA MESA, CA Contractor: J. D. CONSTRUCTION. Address: 545 E. HOOVER AV. �' ORANGE,CA Phone: 8753495 Zip: Phane: 949-650-2678 2ip: 92627 Phone: 639-9986 Zip: 92867 License: 806521 - . / ISSUED BY: SCOPE OF PERMIT ADD 1 GAS OUTLETS, iSHOWEf2, 1. WASHER FOR A RESIDENCE�ADDITION, RE:B05-00656 ISSUE FEE Backflow irrigation Backflow Preventer ' BaNtub Clarifier System Connect Qce,Soda,etc) Dental Units Dishwasher � Drain, Floor Drain, Rainwater ' Drain, Roof Drinking Fountain Expansion Tank Gas Earihquake Valve Gas (1-4 outlets) Gas (Over 4 outlets) Gas Repipe Gas Service Interceptors (Grease, Oip Interceptors (Sand Auto ) AMT $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0,00 $0.00 $0.00 � $0.00 $0.00 $0.00 $0.00 $6.15 50.00 $0.00 50.00 $0.00 30.00 - FEE SUMMARY Qrv AMT Laundry Tub / Washer $9.80 0 Landscape Irtigation $0.00 0 P-Trap $0.00 0 Pressure Regulator $0.00 0 Process Piping (per'10 ft) $0.00 0 Receptors $0.00 0 . _ Septic Tank $0.00, �0� � � Sewer Cap for Demo $0.00 0 � � Sewer Connect $0.00 0 �� Sewer Private Line � $0.00 0 � Shower � $9.80 0 Sink, bar $0.00 0 � Sink, commercial $0.00 0 Sink,�Floor $0.00 1 . Sink, kitchen $0.00 0 Sink, service/mop $0.00 0 Spa (private) $0.00 0 Spa (pu6lic) $0.00 0 0 QTY 1 0 0 0 0 0 0 0 0 0 - 1 0 0 0 0 0 0 0 ' Status: ISSUED Applied: OS/20/2005 Issued: OS/20/2005 SumpPump Swimming Pool Trap Primer Urinal Vacuum Brkr BkFlow(t-4) Vacuum Brkr BkFlow(5+) � -, Wash Basin � ' Wash Basin Set �Waste and Vent System , �� Water Closet (ToileQ Water Heater / veot � Water Piping (Inst or Rep.) , Water Re-pipe Water Service Water, Softener OTHER VIOLATION PLAN CHECK REINSPECTION TOTAL CALCULATED FEES: AMT $0.00 $0.00 $0.00 $0.00 ao.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 E49.25 �TY 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 NOTICE: The work authorized by this permit shall compty with all appiicable handlcap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 7, 12-21-92) EXPIRATION: This permit shall automatically eupire and become void if work is not commenced within 180 days, or if vrork 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 vrork must comply with all applicable codes, and all required Inepeclione and final approval must be obtained. Failure.to obtain inspectlons antl final�approval wlll�resultin the expiratlon of this permit. FORJNSPECTIONSCALC: (714)7545826 zaaae (aroo) WORKERS' COMPENSATION DECLARATION: � - ' `— I hereby aHirm under penalry of perlury one ot the following declarations: , �. � � � ' � ❑ 1 have and will maintain a certiticate of consent to self-Insure for workers' compensetion, es provitletl for by section 3700 of the Labor Code, for the pertormence of the work for which this permit is issued. ' � � ❑ I have and will maintain workers' compensation insurance, es required by sectiom3700 of Ne Labor Cotle, tor the pertormance of the vrork tar which this permit is issued: My workers' compensation Insuran carrier end policy number are: I n .1�� Carrier: �'�� Policy Number I �O I'-V b�Y ' ' (This section need not be completetl il the permit is valuetl af one hundretl dollers ($100J or /ess.) � ❑ I certity that in Ihe performance of t6e work tor which (his pertnit is issuetl, I shell not employ any person in eny manner so es to become subject to Ihe workers' ' compensetlon laws oi Celifomia, and agrae that if I should become subject to the work�rs' compensation provislons of Section 3700 of the Labor Code, I shell forthwith comply wilh these provision�� / Applicant Signature: �R "] L.1. �✓� _� Date: 5— Z� ' V� � �WARNING: FAILURE TO SECURE WORKEiiS' CAMPENSATION CAVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CFIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND DOl1ARE (5100,000). IN ADDITION TO THE C0.ST OF COMPENSATION, DAMAGES AS PFiOVIOED FOR IN SECTION 3�O60F THE IABOR CODE, IMEREST, MID ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I I hereby aftirm that I am licensed}!�d�erf rovislon ot Chapter 9(commencing with Section O) of Division 3 of Ihe Business forca antl attect. Lic. # %S� b i Z� � Class N � ContrectoYs Signeture: dca.0 ✓• 1 � Date: Professions Code, end my license is in full CONSTRUCTION LENDING AGENCV: � ❑ I hereby ettirm ihat ihere is a consWction lending agency for ihe peAormance of the work for which this pertnit is issuetl. (Sec. 3097, Civil Code). Lentler's Name: Lender's Adtlress: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby aHirm thet under penalry ot perjury Ihat I am E%EMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business end Professlons Code: Any ciry or counry which requires e permit to construct, elter, impmve, tlemolish, or repair any sirucNre, prior to its issuance, also requires the applicant for such permit to file a signed statamem thet he or she Is licensed pursuent to the pmvisions of the Comractors License Law (Chapter 9(commencing with Section 7000) of Division 3 oi the Business end Protessions Cotle) or that he or she is exempt thereirom and the basis for �he alleged exemption. Any violetion of Section 7031.5 by any applicant tor e permit subjects the epplicent to a civil penelry of not more ihan five hundred dollars ($500).): ❑ I, as ownar of ihe properry, or my employees with wages as Ihair sole compensation, WILL DO 7ME WORK, antl the strucWre Is not intenCed or oflered for sale (Sec. 7044, eusinass and Professions Code: The Contrectors License Law does not apply to an owner of property who builds or improves t�ereoq antl who does such work himseli or herseN or through his or her own employees, provi0etl thet such impmvements are not intended or ottered for sale. tl, however, the builtling or impmvement is soltl wit�in one year of completion, ihe owner-builder will have the burden ot proving ihat he or she did not build or improve for puryase of sale.). � ❑ I, as owner of ihe property, am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to consiruct the prolect (Sec. 7044, Business antl Protessions Cotle: The contrectors License Lew tloes not epp�y to en owner of property who builds or Improves ihereoq antl who conirects for such pmjad with e contrector(s) license pursuant to ihe Contractors License Laws.). ❑ I am exempt under 5ec. SignaNre: Owner ID verified 6y driver's license. ❑ Yes ❑ No 8usiness end Pmfessions Code for this reason: Verification ol Ownership by (rype of document, i.e. � pmperty tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: Driver's License No. Date: Expires: ❑ I hereby certiy that no excavetion five (5) or more feet in depth into which a person is required to descentl, will be matle in connection with work euthonzed by this permi�, and that no builtling simcwre, sceHolding, falsework, or tlemolition or tlismaNling Ihereof, will be more �han ihirty-six (36) teet high. (Chap. 32, Gry 2, An 2, Sec. 341, Title B, Calitornia Administrative Code). ❑ As owner-builder, I will not employ enyone to tlo work which would require e permit from the Division of Industnal Sefely, as noled above, unless such pereon hes a pertnit to do such work irom the division. Signature: Date: Division of Indusirial Safety Permit Number: CERTIFlCATE OF COMPLIANCE AND AUTHORIZA710N OF ENTAY: I certify under penalry of perjury that I have read Ihis application and state that ihe information given is correct. I agree to comply with all stete lews entl city ordinances relating to building consiruction, end authorize representatives ot the City of Costa Mesa to enter upon the a6ove-described pmperty for inspection purposes. I a9ree not to occupy or allow occupancy of any building authonzed by this permit until final inspection. COpEX, INSPECTIONTYPE'" ' " ' 1616 Fixed System Final Fire Prevention 1266 Paol Spa Finel 200 Final Re-Root ' 201 Final Block/Reteining Wall 202 Final Factory Fire Place � 203 Final Sign 204 Final Demolition "UATE' ' INTRIAL9' � � �� INSPECTIONTYPE � � 206 Final Mechanical � 20B Final Plumbing 210 'Final ElecinCal 212 Final Fire Prevention 220 Final Planning-Approval 222 250 Final Site Final BuildinyOccupancy pdE IIII�LS (714) 754-5273 • Fau (714) 754-4856 • www.ci.costa-mesa.��LDING PERMIT n FAIR DRIVE, COSTA MESA, CA 92626 Job nddress: 348 E 16TH ST Suite: Vicinity: REAR OF PROPERTY Pnmary Occ: R3 Dwellingsl Cong Res <10 Type of Construction: V-N Parcel Number: 42521113 Zoning: Applicant CLIFF DAGLEY Address: 545 E HOOVER AV ORANGE,CA ' � � Ownec FRESCH, TROY D& KELLY R Address 348 E 16TH ST . "- "� COSTA MESA, CA �. - - Contracror. J. D. CONSTRUCTION Address: 545 E. HOOVER AV ORANGE,CA Zip: 92867 . . Phone: 714-639-9986 Zip: 92867 .- Phane: 949-650-2678 Zip: 92627 . . Phone: 639-9986 License: 806521 Status: ISSUED Applied: 04/21/2005 Issued: OS/20/2005 ISSUED BY: ��'T Arch : ROBERT ERNEST GLAUSER Eng: Address: 25021 SUNSET PLACE WEST �' Address: , , , � Phone: 949-837-3064 . Phone: LAGUNA HILLS, CA � Zip: 02753 � � License: C21628 License: ' "� SCOPE OF PERMIT , � ADD 493.3 S.F. TO EXISTING S.F.D. WORK TO INCLUDE: MASTER BEDROOM/8,4TH, WALK-IN CLOSET, AND CREATE NEW LAUNDRY ROOM LOCATED AT REAR OF PROPERTY. � SINGLE FAMILY RESIDENCE � • � PLANNING: . - .. .� .. LOT SIZE = 7,830 SQ. Ff. . RESIDENCE & GARAGE = 1,150 S�.FT. � DRIVEWAY = 410 SQ.FT. LOT COVERAGE = 1,560 SQ. FT. (20%) OPEN SPACE = 6,270 SQ.FT. (80%) Plan Check: $98.13 Permit: $603.85 SMIP Res: $4.55 , SMIP Com: $0.00 Other. $0.00 Inspection: $0.00 Total: $706.53 FEE SUMMARY "' Calc Valuation: Claim Valuation �. � 1 $45,553.20 30.00 NOTICE: The work authonzed by this permit shall comply with all applicable handicap accass raquirements untler Califomia statutes and related , regulations. (Ord. No. 92-28, §�1, 12-21-92) . EXPIRATION: This�permit shall automatically expire.and�become void iFwork is not commenced�within 180 days, orif work is suspended or abandoned ' for a period of 180 days. INSPECTIONS: In orderfor the work.authorized.under�this permit�to be considered.legal, such work must comply with all epplicable codes, and all ! requiredinepectlone�and final approval'must be obtained. Fallure to obtain inspectlons�and.flnal approval will result in the expiration of this permit. � FOR INSPECTIONS'CALL:. (Z14) 7545628� 2as�a �amo� WORKERS' COMPENSATION DECLARATION: � '� " . I hereby aHirm under penal�y of perjury one of the following tleGaretions: .. _ . .' � ❑ I heve end will melnlein e certificate oi consent to seli-Insure for workers' compensetion, es provided br hy section 3700 oi the Lebor Code, for ihe peAormence of �he work tor whiCh IhiS permi� I5 issued. ' � � ❑ I have and will maintein workers' compensetion insurance, as requiretl by section 3700 of Ihe Lebor Code, for ihe pertormence of the work Por whic� this pertnit is Issued. My workers' compensetion Insurance arnar and policy number are: (� . ' carrier: `3� 1"�'r�i, �.S..,n .� Policy NumDe�: � �� `N,� �i ' (This sectlon need nof be completetl i/ the permit is veluetl et one huntlretl tlollars /00) or less.) �� ❑ I certity ihat in Ihe peAormence of the work for which this p�ermit is issueQ I shall �not employ any person in�eny menner so as td become subject to the workers' ' compensatlon lews ol Californiq, and agree that it I should becoma su6ject �o the workers' compensalion provislons of Section 3700 of ihe Labor Cotle, I s�eli forthwlth comply with these provJ'�sion�s. �� Applicam Signawre: l�1/�{-�Ui17 CJ � f Ei(�.1n / Data: S' �it� -�_ -� � WARNING: FNLURE TO SECURE WORKERS' COMPENSATION COVERNGE IS UNIAWFUL AND SHALISU&IECT PN EMPIAVER TO CRIMIWIL PENALTIES AND GVIL FlNES UP TOONE HUNDHED TF10USrWD OOLLARE (SIOO,OOO�.IN ADDfiION TO THE COST OF COMPENSAiION, OAAWGES AS PflOVIDEO FOR IN SECiION 3)OB OF TME LABOR WOE, IMEREST, AND FTiORNEY'S FEES. LICENSED CON7RACTORS DECLARATION: I I hereby aHirm ihat 1 em Iicen eA under provisians of Chapt`r 9(commencing wit� Section ) ol Division 3 0l ihe Business a rotessions Cotle, antl my license Is in torca antl eflect. Lic. M �n S�.� Class p � .—.� comrectors signamre: (' t w Cd17 L. �• i e �•r�� oete: S- 7.0 - nt� rI CONSTRUCTION LENDING AGENCY: � ❑ I hereby eHirtn that Ihere is e construdion lentlinq aqency For the performance oi t�e work for which this pertnit is issued. (Sec. 3097, Civil Cotle). Lender's Name: Lenders Address: Signature: Date: OWNER•BUILDER DECLARA710N5: I hereby eMirm thet under penalry of per�ury Ihet I em EXEMPT FROM 7HE CONTRACTORS LICENSE LAW far the tollowing reasan (Sec. 7031.5, Business antl Professlons Code: Any ciry or counry which requires e permit to construct, alter, improve, tlemolish, or repair eny structure, prior to its issuance, also requires the applicam for such permit to flle a signed statement thet he or she Is Ilcensetl pursuent to the provisions al the Contractors License Lew (Chapter 9(commencing with Secllon 7000) of Dlvlsion 3 at the eusiness end Pmfessions Code) or the! he or she is exempt therefmm and �he basis for the elleged e:emption. Any violeNon ol Section 7031.5 by any epplicant tor e Dertnit subjects the epplicent to e civll penelty oi not more Ihan tive hundred tlollars ($500).): ❑ I, as owner of the properry, ar my employees with wages as Iheir sole compensatlon, WILL DO THE WORK, and the structure is not intentletl or ofleretl lor sale (Sec. 7044, Business end Protesslons Code: The Coniractors License Law tloes not apply to an owner of propeny who builds or improves thereon, end who does suc� work himself or herself or Ihrough his or her own employees, proviaetl that such improvements are not Intendetl or offered lor sale. If, however, ihe building or improvement is soltl wit�in one year of completion, tha awnerbuilder will have the burden ot proving that he or she tlitl not Duild or improve tor puryose of saleJ. � ❑ I, as owner of the property, em EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Cotle: The conlrectors Llcense Law does not epply to an owner of property who bullas or Improves thereon, end who contracis for such project with a contractor(s) license pursuant to tha Contrectors License Laws.). ❑ I em exempt undar sec. Business and Professions Cotle for ihis reason: SignaWre: Dale: Owner ID verified by tlrivef5lican5e. ❑ Ves ❑ No Drivars License No. E:pires: Verilication of Ownership Dy (type ol document, i.e. � property tae bill or deatl): DIVISION OF INDUSTRIAL SAFETY PEflMR CERTIFICATION: ❑ I hereby certiy thet no excavation tive (5) or more teet in tlept� into which a person is requiretl to descend, will be mede in connection with work authorized by this pertnit, antl that no 6uilding siructure, scaflolding, talsework, or tlemoli�ion or dismantling Ihereot, will be more than thirry-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 347, Tule B, Celltomia Administretive Cotle). ❑ As owner-builder, I will nol employ enyone to do work which woultl require e permit fmm the Division at Industrial Safery, es notetl a6ove, unless such pereon hes a permit to Oo such work irom the division. SigneNre: Dale: Division of Intlustrial Sataty Permit Number. ICERTIFlCA7E OF COMPLIANCE AND AUTHORIZ4710N OF ENfAY: I certify untler penelty of perjury that I heve read Ihis epplication and state Ihet ihe iMormatlon given is I corred. I egrae to comply with all stete laws antl ciry ordinances ralating to building consiruction, end aulhonze representatives o( the Ciry ol Costa Mese to enter upon t�e ebove-described property for inspedion puryoses. I egree not to occupY or eilow occupancy ol any huilding authorized by fhis Dermit until finel inspection. LII CODEt. INSPECTIONTYPE' �� ' ' " �PAIE INTITIILS 1616 FixeO System Final Fire Prevention � 1266 200 201 202 203 Pool Spa Finel Final Re-Roo1 ' Final Block/Retaining Well Final Factory Fire Place ' Final Sign 204 Final Demolition � CODEt INSVFCiIONTYiE 206 Finel Mechanical 20B Finel Plumbing 210 Final Electrical 272 Final Fire Preveniion 220 Final Planning Approval 222 Final Site � 250 Final Builtling/Occupanq o"re �i (714) 754-5273 • Fau (714) 754-4856 • www.cl.costa-mesa.c��ILDING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626 ,lob Address: 348 E 16TH ST Suite: Viciniry: Parcel Number: 42521113 Applicant: STELLINO, MANNY Address: 348 E 16TH ST COSTA MESA, CA Owner: STELLINO, MANNY Address 348 E 16TH ST COSTA MESA, CA Contractor: O W N E R-BU I LD E R Address: � Arch : Address: Zoning: Phone: 949-650-2678 Zip: 92627 Phone: 949-650-2678 Zip: 92627 Phone: License: 000000 Status: ISSUED Applied: 12/08/2003 Issued: Ot/OS/2004 Eng: ARIV NATHANIEL WONG Address: 2489 SAN SIMON ST Phone: Phone: 774-734-9888 TUSTIN, CA Zip: License: 92782 License: C55045 SCOPE OF PERMIT INTERIOR ALTERATION TO S.F.D. WORK TO INCLUDE: RAISE CEILING IN LIVING ROOM AND DINING ROOM. CREATE A COUNTER TOP OPENING BETWEEN KITCHEN AND LIVING ROOM, PARTIALLY REMOVE NON-LOAD BEARING WALL. ADD A GARAGE DOOR TO REAR OF EXISTING GARAGE. Plan Check: $90.51 Permit: $13925 SMIP Res: $0.70 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $230.46 SETBACKS MAINSTRUCTURE Front 0-0 ACCESSORY Front 0- 0 PARKING Ezistin : o Rear 0- 0 Rear 0-0 Required: 0 FEESUMMARY PLANNING & ZONING Left 0- 0 Left 0- 0 Proposed: 0 Calc Valuation: Claim Valuation: Right 0- 0 Right 0- 0 57,000.00 s�,000.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitornia statutes and related regulations. (Ord. No. 92-28, § 1, 1241-92) 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 penod ol 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 a�l requirad Inapectlona and final approval must be obtained. Failure to obtain inspections and tinal approval will resuH in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 za+s+e �aroo� WORKERS'COMPENSATONDECLARAnON: I �ereby eXlrm unde� penalry of perjury one ot the following tleclaratlons: ❑ I have end will malntein a cenificate ot consent to self�lnsure for warkers' compensetion, es provided Por by sectian 3700 of the Lahor Code, for tha peAartnance of ihe work lor which ihis permii is Issued. ❑ I have enE wlll malntain workers' compensation insurence, as requiretl by section 3700 ot ihe Labor Cotle, for the pedormance of the work for which this permit is luued. My workers' compensatlon Insuranca cerrier end policy number are: Carner. Policy Number: (Thls section need nof be cromplered i/ the permit !s veluetl af one hundred dollers ($100) ar less.) Q 7 certify that in the peAormance oi e Work for which this pertnil is issueQ I shell not employ any person in eny manner so as to become subject to the workers' ��wmpensatlon laws ol Celifomia, �d Agi that il I shoultl bacome sub�ecl to Ihe workers' compensetion provisions of SectloP 3700 f the Labor Cotle, I shall larthwlth comply with these pravisions. � \� '�� PQ 4 Ap"plicant SIOn%ture: 'Date�� WARNING FAILURE TO SECURE WORKERS' CO�.I�ENSATION COVERAOE IS UNIAWFUL ANO SHALL SUBJECT AN EMPLOVER TO CRIMINAL PE TIES AND GVIL FlNES UP TO ONE HUNDRED T/10USAND DOLLARE (5100.000), IN ADdTION TO�YtiE COST OF COMPENSATIIXJ, DAAINGES PS PliOVIOED WR IN SECTIIXJ 31O60F THE LABOF COOE, INiEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirm that I am licensed under provisions ot Chapier 9(commencing wi[h Section 7000) of Divislon 3 ot the Business end Professions Code, antl my Iicense is in full torce entl etlecL Llc. x Class N Contractors Signature: Dete: CONSTRUCTION LENDING AGENCY: ❑ I here6y attirm tha� there is e consiruction lending egency for the pertormance of the work tor which this permit is issued. (Sec. 3097, Civil Code). LentleYs Neme: Lender's Atltlress: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby eftirm that untler penelry of perjury Ihat I em EXEMPT FROM THE CON7RACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business end Pratesslons Catle: Any ciry or counry which raquires a pertnit to construct, elter, improve, demolish, or repair any structure, pdar m its issuance, elso requires the epplicant for such pertnil to lile a signetl statement that he or she is Ilcensed pursuent to che provisions of ihe Contractors License Lew (Chepter 8(cammenUng with Section 7000) at Dlvision 3 oi lhe Business antl Professions Code) or thet he or she is exempt therelrom and Ihe �asis for the elleged exemption. Any vialation of Section 7031.5 by eny epplicant for a permit subjects the epplicant to e civll penalry of not more than flva hunAretl Oollars ($500).)r ❑ I, as owner ot the property, or my employees wlih weges as their sole compensation, WILL DO 7HE WORK, entl the structura is not intentled or otteretl for sale (Sec. 7044, Business entl Professions Code: The Contractors Licansa Law does not apply to an owner ot property who builds or impmves Ihereon, and who tloes such work himsell or herself or through his or her own employees, provided that such improvements ere nat imentletl or oNered lor sale. If, hawever, tha 6uilding or Imprwement is sold within one year ol comp}etipn, the owner�Duiltler will heve ihe burden of provinq Ihat he or she did not buila or improve for purpose of sale.). • ❑ I, es owner of the property m E%CWSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business entl Professions Code: The Contreclor ic se Lew tloes not epply to en owner of propehy who 6ullds or Improves Ihereon, antl who Con�rac�s far such projec� wl�h e con�racior(s) �license pursuant to th�o ac(brs License Lews.). under Owner ID veritied by dnveYs lican . ❑ Ves� Vedfication of Ownership by (ryp i tlocument, i.e. Business end Professions Code tor t�is reason: tex bill DIVISION OF INDUS7RIAL SAFETV PERMIT CERTIFICATION: � � I hereby certify that no exwvetion tive (5) or more leel in depth imo w�ich e person is required to tlescenq will be made in connection with work authorized by this pertnit, end Ihat no 6uil0ing siructure, scaHolding, telsework, or demolition or tlismantling thereof, will be more ihan thirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, TIIIe 8, Celifomia Adminisirative Catle). ❑ As owner��uiltler, I will not employ anyone to do work which would require e permit irom the DiWsion of Intlusirial Selery, es notetl above, unless such persan hes e permit to do such work from the divisian. Signature: Dala: Division of Industrial Sefery Pertnit Number: FOOE �. INSiECTIONTYPE 1616 Fixetl System Finel Fire Prevention 1266 Pool Spa Final 200 Final Ra-Raol 201 Finel Block/Retaining Well 202 Finel Fectory Fire Place 203 Final Sign 204 Final Demolition �.I7�i�r,irir.��9 CO�E� INSPECTIONTYPE 206 Finel Mechanical 20B Finel Plumbing 210 Finel Electrical 272 Finel Fire Prevention 220 Final Planning Approval 222 250 Final Site Final Bullding/Occupancy PAiF ItiID�Lfl (714) 754-5273 • Fax (714) 754-4856 • www.ci.00sta-mesa.��ILDING PERMIT n FAIR DRIVE, COSTA MESA, CA 92626 .lob Address: 348 E 16TH ST Suite: Viciniry: Parcel Number: 425211 13 Applicant: STELLINO, MANNY Address: 348 E '16TH ST COSTA MESA, CA Owner: STELLINO, MANNY Address 348 E 16TH ST COSTA MESA, CA Contractor: O W N E R-B U I L D E R Address: Zip: Arch : Address: • Phone: Zon'ing: Phone: 949-650-2678 Zip: 92627 Phone: 94&650-2678 Zip: 92627 Phone: License: 000000 Eng: Address: ISSUED BY: Status: ISSUED Applled: 11/10/2003 Issued: 11/10/2003 Phone: Zip: License: License: SCOPE OF PERMIT CHANGE OUT 6 WINDOWS AND 1 SLIDING GLASS DOOR THROUGHOUT S.F.D. WILL COMPLY WITH 1997 UNIFORM BUILDING CODE REQUIREMENTS. Plan Check: $0.00 Permit: $83.25 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $83.75 SETBACKS MAINSTRUCTURE Front 0-0 ACCESSORY Front 0-0 PARKING Existinq: o Rear 0- 0 Rear 0- 0 Required: 0 FEE SUMMARY PLANNING & ZONING LeR 0- 0 Left 0- 0 Pr000sed: 0 Calc Valuation: Claim Valuation: Right 0- 0 Right 0-0 $3,000.00 $3,000.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-27•92) �� / EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended ocabandoned for a period of 1 BO days. /� INSPECTIONS: In order for the work authorizetl under this permit to be considered legal, such work must comply with all applicable�codes, and all requlred Inapectiona end final epproval must be obtained. Failure to obtain inspections and final approval will result in the ezpiratlon�ot this permit. FOR INSPECTIONS CALL: (714) 7545628 zaae�ae (a�oa� WORKERS' COMPENSATIO!(DEC4� RATION: I hereby aftirtn untler penalty ol perjur�one af the following declarations: ' ` ❑ I heve end will melnteln e certificete of consent to self-Insure for workers' compensetion, as provitlatl for by sectian 3700 of ihe Labor Code, tor the peddrmanca of the work for which lhis permit I5 Issuatl. ❑ I have an0 will meintain workers' compensatlon insurance, es required by section 3700 of the Lebor Code, for ihe pedormance of the work for which this pertnit is issuetl. My workers' compensetlon InSurence carner antl policy number are: Certier. (i/1is fion neetl no! be Complefe / [$ I certify that in IhB pertormen� � compansation laws o1 Celifon comply wilh Ihese provision5. Appliceni Signeture: WMNING:�FAIIURE TO SECURE wOW TFKKI54ND DdAARE (5100,000�, IN ADI veluetl at one or 1e55.) Policy Number: which Ihis pertnit is issueQ I shall not employ any person in eny menner sa es to become subject to the woAcers' 1 it I s�oultl become subject to the workers' wmpensation praWsions ol Sectlon 3700 of the Labor Catle, I shall totlhwith � � Date: \. �\ a I a 2 ION COVERAGE IS UNLAWFUL AND SHALL SUflIECT AN EMPLOVER TO CRIMINAL PENALTIES ANO VIL FlNES UP TO ONE HUNDRED T OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECiION 3%OB OF THE IABOR COOE, INiEREST, ANO ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I herehy affirm ihat I em Ilcensatl untler provislons of Chapter 9(commencinq with Section 7000) oi DiNsion 3 0l iha Business and Professions Code, and my license is In tull force and eHect. Lic. q Class k Contractofs Signature: Date: CONS7RUC710N LENOING AGENCV: ❑ I hereby aHirm thet Ihere is a wnstruction lending egency for the peAormance of lhe work for which this permit Is issuetl. (Sec. 3097, Civil Cotle). Lender'9 Name: Lender'S Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby eHirtn Ihet untler penelty ol perjury thet I em E%EMPT FHOM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business entl Pro}esslon: Cotle: Any ciry or county which requires e permit to construct, alter, improve, tlemolish, or repair any sWcture, prior to its issuance, also requires the applicant lor such permf to tile a slgnetl statement that he or she Is Ilcensea pursuant to the provislons of the CoNrectors License Lew (Chapter 9(commencing with Sectlon 7000) oi Divislon 3 oi the Business end Professions Code) or that he or she Is ezempt therefmm and the basis for the alleged e:emptlon. Any violeHon ol Section 7031.5 by any applicant tor a permi�. s�ub/�cts Ihe applicant to e ciNl penalty of not more then tive hundred dollers ($500).): Ly I, as owner ol the property, or my employees with wages as iheir sole compensation, WILL DO TME WORK, entl Ihe structure is not inientletl or oflered lar sale (Sec. . 7044, Business end Professions Code: The Contractors License Law does not apply to en owner of propeny who 6uilds or improves thereon, antl who does such work -� himself or herself or through his or her own employees, provided that such impmvements are no� Intended or oflered tor sele. If, however, ihe builaing or improvement is soltl wit�in one year I com0 n, the ownar-builder will have the burtlen of proving ihat he or sha Eitl not build or improve tor purpose ot sele.�. � ❑ I, as ownar of the o e %CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the prolect (Sec. 7044, Business end Professions Code: The contrac r Li�c�n e w does not epply to an owner of property who builds or Improves thereon, antl who contrects lor such project with e contraaor(s) licensapursuentt ' --"-----'-� - ❑ I am exempt under 'Owner ID verifietl by tlrivefs Vedlicatlon of Ownership by � Business antl Protessions Code br ihis reason: rE:pires. �0 li O'7 � . � - � T/— a6 i.e. - property te�c bill or deed): - DIVISION OF INDUSTRIAL SAFETV PERMR CERTIFICATION: ❑ I �ereby certity ihat no excaveNon five (5) or more feet in depth into whic� e Oerson Is required to tlescend, will be mede in connection with work authonzed by this pertnit, and that no builtling structure, sceHolding, falsework, or demolition or dismantling �hereof, will be more than t�irty-si: (36) leet high. (Chap. 32, Gry 2, Art 2, Sec. 341, 71tle 8, Celllornla AtlminislreNve Code). ❑ As ownea6uilder, I will not employ anyone to tlo work which would require e permit irom ihe Division ol Industrial Sefery, es noted ebove, unless such person hes e permit to do such work from the division. SignaNre: Dete: Division ot Indusirial Setety Permit NumDer. COOE �. INSPECTIONTYPE 7678 Fi:etl Syslem Finel Fire Preventlon 1266 Pool Spe Final 200 Final RaRoof 201 FInaI8locWRetaining Well 202 Final FeCtory Fire PlaCe 203 Finel Sign 204 Final Demolition P�� COOE� INSVECTONTYPE 206 Finel Mec�anical 200 Final Plumbing 270 Finel Elettrical 212 Finel Fire Prevention 220 Finel Planning Approval 222 Final Site 250 Flnal BulltlingiOccupancy Pdg ItIIIDELS (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: 348 E 16TH ST Suite No Viciniry: Parcel Nunmber: Applicant: Address: Owner: Address Contractor: Address: ISSUE FEE Temp service test Res. a/c package New Res (7-2 unils) New Res (3+units) Pool / Spa Lighting Fixts Recept Outlets Switches Non Res Appl Res Appl Service to 200a Service to 1000a Service over 1000a Motors to 1 hp Motors to 10hp Motors to 50hp Motors to 100hp Motors over t00hp 42521113 STELLINO, MANNY 348 E 16TH ST COSTA MESA, CA STELLINO, MANNY 348 E 16TH ST COSTA MESq, CA OWNER-BUILDER Phone: 94&650-2678 Zip: 92627 Phone: 949-650-2678 Zip: 92627 Phone: Zip: License: 000000 ISSUED BY: Status: ISSUED Applied: 11/10/2003 Issued: 11/10/2003 SCOPE OF PERMIT CHANGE OUT 6 WINDOWS AND 1 SLIDING GLASS DOOR THROUGHOUT S.F.D. WILL COMPLY WITH 1997 UNIFORM BUILDING CODE RE�UIREMENTS. REF.: 803-01941 ELECTRICAL TO INCLUDE: 26 LIGHT FIXTURES, 10 OUTLETS, 6 SWITCHES, AND 1 SERVICE TO 200 AMPS. $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $26.3g $11.00 $6.60 $0.00 $0.00 $30.50 $0.00 so.00 $0.00 $O.oO $0.00 $0.00 $0.00 Quantity 0 0 0 26 10 6 0 0 1 0 0 0 0 0 0 0 FEE SUMMARY Temp Dist System / Lighling Busway /100 ft Standing Section Misc Electrical Equipment Transformers up to 1 kva/kw ................up to 10 kva/kw .................up to 50 kva/kw .................up to 100 kva/kw ..................over 100 kva/kw Low Voltage Equipment Low Volt Wiring System / Ckt Misa Conduit Misc. Conductor Circus ( gen or ride) Circus (mech nde or lights) Christmas Tree Stand Fireworks Stand Other Electrical Fee Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 . 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21•92) � EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or ii work is suspended or� doned 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 appliceble codes, and all required Inspectlons and (inal approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 zaasns �aroo� WORKERS' COMPENSATION DECLARATION: I hereDy eflirm under penalry of perjury one of the following declarations: � ❑ I heve entl wlll meintain e certiticate of consent to seli-Insure for workars' compensaHon, as provided for by section 3700 0l the Lebor Cotle, lor the pertormance of Ihe work tor w�Ith thi5 permli is issued. ❑ I have end will meintain workers' compensatlon insurence, as raquiretl by sectlon 3700 of the Lebor Catle, far Ne perfortnance ot the work lor which Nis pertnit is issuetl. My workers' compensetion Insurance cerner entl policy number are: Cartiec [?j 1 certify thet in the peAormance oi compensatlon laws ot Caltlomla, e comply with these provisions. Applicenl Signature: WNRNINO: FAI�URE TO SECURE WORKERS' TMOUSAND OOLLARE ($100,000�, IN ADOITIIX ane orless.J Poliry Number: ermit is issuetl, I shall not employ Bny person in eny menner so es to bacoma 5ubject to lhe workere' become suD�ect to Ihe workers' compensetion provlslons at Sec(uon 3700 Q1 Ihe Lebor Cotle, I s�all forthwith Oale: �� 1� � 1 V 3 GE IS U AND S WILL SU6IEGT AN EMPLOYER TO CRIMINAL NALiIE AND CML FlNES UP TO IXJE HUNDRED NSATION, OAMAGES AS PHOVIDED FOR IN SECTION 3]O60P THE IABOR CODE, IMEREST, AND ATTORNE`fS FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirtn that I am licensed under provisions ot Chapter 9(commencing with Section 7000) ot Division 3 of ihe Business and Professions Code, anC my license is In full force ena eflecL LJc. q Cless N Comractofs Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby aHirtn that there is a consWction lentling a9ency for the pedormance of Ihe work tor which this permit is Issued. (Sec. 3097, Civil CoOe). LentleYs Name: Lentler's Atltlress: Signawre: Date: OWNER-BUILDER DECLARA710NS: I hereby atfirtn thel under penelry at perjury that I em EXEMP7 FROM 7HE CONTRACTORS LICENSE LAW for the following reeson (Sec. 7037.5, Business antl Professions Cotle: Any ciry or counry which requires a pertnit to construct, alter, improve, tlemolish, or repair eny strucWre, prior to its issuance, also repuires the epplicant tor suc� permit to ille e signetl statement thet he or sha is Ilcensed pursuant to Ihe provisions of the Contrectors Ucense Lew (Chapter 9(commenGng with Sectlon 7000) of Divislo� 3 oi the Business and Professions Code) or that he or she is exempt therefrom and the besis for ihe allegetl ezemption. Any violetlon oi Section 7031.5 by eny applicant for a permit sub' Is t�e appliwnt to a civil penalry ot not more than five hundred dollers ($500).): I, as owner ol ihe property, or my employees with wages es iheir sole compensation, WILL DO TME WORK, entl ihe slructure Is nol Intendetl or oMeretl for sale (Sec. 7044, 8usiness entl Professions Code: The Comractors License Law does noI apply to an owner ol properry who huilds or impmves ihereon, and who does such work himself or hereelf or through Is or her own employees, providad ihat such improvements are not intended or oHered for sele. If, however, the hulltling or improvement is sold wit�in one year of com tion, owner-builder will have the burden of proving that �e or she tliC not build or imDrove tor purpose ol sele.). • ❑ I, es owner of the property, E IVELY CONTRACTING WITH LICENSED CONTRACTORS to ConSiruct ihe proleci (SecJ044, Business and Professions Cotle: Tha contradors Lic 5 la o s not eppty to en owner of propetly who builds or improves thereon, entl who coNrects lor such pro�ect with a contractor(s) license pursuant b the Co tra or �c nse Laws.). ❑ I em exempt untler sec. � Signemre: Owner ID vedfietl Dy Onver's licensa. Vedflcetlan at Ownership by (rype of Business and Professions Cotle for this reason: ves ❑ No I.e. - properry tax bill or daed): DIVISION OF INDUSTRIAL SAFETV PERMIT CEFTIFICATION: Driver's LicenSe No. �'+- Ezplres: �O 122- v7 ❑ I �ereby certiy thet no excava�lon five (5) or more feet in depth inro which a person is required to descantl, wlll be matle in connection wit� work eulhonzed by this permit, and that no building simcture, scaHolding, falsework, or demolition or dismantling ihereof, will �e more than thirty-si: (38) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Ttle B, Califomie Administrative Code). ❑ As owner-builder, 1 will not employ enyone to tlo work which would require e pertnit irom ihe Division of Indusirial Safery, es noted ebove, unless such person hes e permit to tlo suc� work irom the division. SignaNre; Date: Division of IndusMal Satery Pertnit NumUer. CODE t. INSFECTIONTYPE 1676 Fixed System Final Fire Prevention 1268 Pool Spe Final 200 Finel Re-ROot 201 FIneI8lwWRetaining Well 202 Final Fecmry Fire Place 203 Finel Sign 204 Finel Demolilion PdIE 1tQ�L5 COpE 1 INSPECTION TYYE 206 Final Mechanical 208 Finel Plumbing 210 Final Electrical 212 Final Flre Prevantlan 220 Final Planning Approval 222 Finel Site 250 Finel Builtling/Occupancy PdIE It�L9 (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 348 E 16TH ST Suite No Vicinity: Parcel Nunmber: 42521113 Applicant: STELLINO, MANNY Address: 348 E 16TH ST COSTA MESA, CA Owner: STELLINO, MANNY Address 348 E 16TH ST COSTA MESA, CA Contractor: OW N ER-BU I LD E R Address: ' Arch / Eng : Address: ISSUE FEE Backflow irrigation Backflow Preventer BathWb Clarifier System Connect (Ice,Soda,elc) Denlal Units Dishwasher Drain, Floor Drain, Rainwater PLUMBING PERMIT Status: ISSUED Applied: 11/10I2003 Issued: 11/10/2003 .�,. / . I'�/� - Phone: 949-650-2678 Zip: 92627 Phone: 949-650-2678 Zip: 92627 Phone: Zip: License: 000000 Phone: Zip: License: SCOPE OF PERMIT CHANGE OUT 6 WINDOWS AND 1 SLIDING GLASS DOOR THROUGHOUT S.F.D. WILL COMPLY WITH 1997 UNIFORM BUILDING CODE REQUIREMENTS. REF.: 803-07941 PLUMBING TO INCLUDE: 1 BATHTUB, 1 DISHWASHER, 1 FLOOR DRAIN, 1 GAS (1-0 OUTLETS), 1 LANDSCAPE IRRIGATION, 1 SHOWER, 1 KITCHEN SINK, AND 1 WATER CLOSET. AMT $23.50 $0.00 50.00 $9.80 $o.00 $0.00 $0.00 $9.80 $9.80 $0.00 FEESUMMARY QTY AMT Laundry Tub / Washer $0.00 0 LandscapelrrigaUon $14.80 0 P-Trap $0.00 1 Pressure Regulator $0.00 0 Process Piping (per 10 R) $0.00 0 Receptors $0.00 0 Septic Tank $0.00 1 Sewer Cap for Demo $0.00 7 Sewer Connect $0.00 0 Sewer Pnvate Line $0.00 QTY 0 1 0 0 0 0 0 0 0 0 SumpPump Swimming Pool Trap Primer Unnal Vacuum Brkr Bkflow(1-4) Vacuum Brkr BkFlow(5+) WaSh Basin Wash Basin Sel Waste and Vent System Water Closet (foilet) AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 59.80 QTY 0 0 0 0 0 0 0 0 0 1 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 ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred Inepeetions end finel approval must be obtained. Failure to obtain inspections and tinal approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 zaa6as(amol WORKERS' COMPENSATON DECLARAYION: I hereby eMirtn untler penalry ol perjury one of the following declarations: � ❑ I heve antl will malntein e cenificate oi ��sent to selt-Insure tor workers' rnmpensation, as D�o�ded for by section 3700 of the Lebor Cotle, br �he pertormance of the work lor whiCh Ihis pertnil Is iuued. ❑ I have antl will intain workers' compOnsation insurence, as requiretl by sectlon 3700 ot the Labor Code, tor Ihe peAortnenca of Na work tor which this pennit is issued. My workers' co ensalion Insurance Farner and policy number ere: Carner: t Policy Number: (�Th/is� section neetl not e camp/eted i/ t p it's veluetl et one hundred dallers ($100J or /ess.) [d I ceRify t�et In Ihe peAarmance o t e or which this permit is issuetl, I shall not employ eny person in any menner so es to become suDject to IhB workers' compensatlon laws of Celllornia, n a hat ii I s�ould become subject to the workers' compensation provlslons of Sactlon 370p of the Lebor Catle, I shall forthwith comply with Ihese provisions. Applicam Signature: Date: �� I� 0?j WMNING: FAILUPE TO SECURE WORKERS' 6 PEI ATV UNUWFUL AND SHALL SUBJECT AN EMPLOYEP TO CHIMINAL PENALT S PND pVIL FlNES UP TOONE HUNORED TFIOUSANDDOILARE�3100,000),INADDITIONTOTIIE 0.5TOFCOMPENSA710N,DAM4GESASPROVIOE�FORINSECTION3�O60FTHElABORCODE,IMEFEST,AN�ATfORNEY'SFEES. LICENSED CONTRACTORS DECLARATItlN: I hereby eHirm that I am Ilcensed under provisions ot Chapter 9(commencing with Section 7000) of Division 3 ot Ihe Business end Professions Code, end my license Is In full tofCe Bntl Bftett. U0. M CIes9 p Contractofs SlgnaNre: Dete: CONS7RUC710N LENDING AGENCY: ❑ I hereby ettirtn that Ihere is e wnstrucdon lending agency lar ihe peAormance of the work for which ihis pertnit is Issued. (Sec. 3097, Civil Code). Lentlals Name: LenAer's Address: Signeture: Date: OWNER-BUILDER DECLARA710NS: I hereby eMirtn that under penalty of perjury ihat I am E%EMPT FROM TME CON7RACTORS LICENSE LAW for the following reason (Sec. 7031.5, eusiness end Professions Code: Any ciry or county whic� requires e permit to constmct, elter, improve, demolish, or repair any siructure, pnor to Its Issuance, also requires the eppliwnt for such permit Io file e signed stetement thal he ar she Is li�ensed pursuanl to the provisions ot the Contrectors License Lew (Chapter 9(commendng with Sedlon 7000) of Division 3 of the Business and Professions Code) or thet he or she is ezempt therefrom and t�e basls tor the ellegetl ezemption. Any vloletlan ol Section 7037.5 by any epplicant for e pertnit sub cts the applicant to e civil penalry oi nol more than live hun�red dollars ($500).): � I, as owner of the property, or my employees with wages es Iheir sole compensation, WILL DO 7ME WORK, and the stmcture I5 aot iateatletl or otferetl tor sale (Sec. 7044, Business entl Professions Code: The Contractors License Lew does not apply to en owner of property who builds or improves ihereon, and who tloes such work himsell or herseN or through his or her own employaes, provided ihet such improvements ere not intendetl or oHeretl tor sele. If, however, ihe building or improvement is sold within one year c pletion, the owner-builder will heve �he burden oi proving that he or she did not build or improve for purpose oi sele.). ' ❑ I, as ownar ol ih ro rt , em E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the prolecl (Sec. 7044, Business end Protesslons Cotla: Tlie contr c rs ic se Law tloes not epply to an owner ol proparty who bullds or Improves thereon, and who contrects tor such prolect with e contractor(s) license pursuam o e o rectors License Laws.). ❑ I am exempt un r c Business and Prolessions Cotle for ihis reason: Signawre: . Expires: �� Z� a� T'� Vedflcetlon of Ownership by ( e ol tloc ment, i.e. � property tax bill or tleed): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby certify ihat no excavation five (5) or more feet in depih into which a person is requirad to descend, will Ce made In connection wiih work euthorized by Ihis permit, and �hat no building siructure, ScaHoltling, talsework, or tlemolition or dismamling I�eraoF, will be more ihan thirty-six (38) feet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Title 8, Celilornla Atlministrative Code). ❑ As owner-builder, I wil� not employ anyone to do work whic� woultl require e pertnit irom �he Division ol Industnel Sefery, es noted abova, unless such persan hes e permit to do such work irom t�e tlivisio�� Signalure: Dete: Divislon of Industnal Salery Permit Number: COOE �. INSPECTON TYYE 1818 Fixed System Final Fire Prevention 1266 Pool SOa Finel 200 Finel Re-Rool 201 FIneI BIxWRetaining Wall 202 Finel Factory Fire Plece 203 Final Sign 204 Final Demalition In��r,iiiinfl CODE� INSPECTIONTYPE 20fi Final Mechanical 208 Final Plumhinp 210 Final Electrical 212 Final Fire Preventlan 220 Final Planning Approval 222 Final Site 250 Final BuiltlingiOccupancy � Iti� (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, GA 92626 Job Address: 348 E 16TH ST Suite No Viciniry: ParcelNumber: 42521113 Applicant: STELLINO, MANNY Address: 348 E 16TH ST COSTA MESA, CA Owner: STELLINO, MANNY Address: 348 E 16TH ST COSTA MESA, CA Contractor: OW N E R-BU I LDE R Address: MECHANICAL PERMIT Phone: 949-650-2678 Zip: 92627 Phone: 94&650-2678 Zip: 92627 Phone: Zip: License: 000000 ISSUED BY: Status: ISSUED Applied: 11/10/2003 Issued: 71/10/2003 SCOPE OF PERMIT CHANGE OUT 6 WINDOWS AND 1 SLIDING GLASS DOOR THROUGHOUT S.F.D. WILL COMPLY WITH 1997 UNIFORM BUILDING CODE REQUIREMENTS. REF.: 803-01941 MECHANICAL TO INCLUDE: 1 INST FAU < 100K BTU, 1 GAS PIPING AND 7 VENT FAN/SINGLE DUCT. ISSUE FEE Inst FAU <100 k BTU Inst FAU >100 k BTU Repair/Alt CoolinglHeat Inst / Rep. Recess Wall Htr Refrig Sys <100 k BTU Refrig Sys >100 k BTU Gas Piping Factory Fireplace Hood w/Mech Ezhaust VAV Box Vent Fan / Single Duct Appliance Fire Dampers Smoke Dampers Inst or Relocate Appl Vent Air Handlers < 10000cfm AirHandlers> 10000cfm Floor Furnace Floor or Suspend Heater $23.50 $14.80 $0.00 $O.DO So.ao $0.00 $0.00 $6.15 $0.00 $0.00 $0.00 $7.25 $0.00 $0.00 $0.00 $0.00 so.00 $0.00 $0.00 $0.00 Quantity FEESUMMARY Repair / Alt Absorbtion Unit Repair / Alt Refrigeretion Unit Ventillation Syslem Evaporative Cooler Commercia l I nci nera tor Domestic Incinerator Compfe5sor5 ! AbSorpti0n SyStBms 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 " 3Tot5hp 15to30hp 30 to 50 hp Over 50 hp Other Mechanical Fee Investigation Fee Plan CheCk Fee Quantity 50.00 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 so.00 0 $0.00 0 $0.00 0 $0.00 $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRA710N: This permit shall automatically expire and become void if work is not commenced vnthin 180 days, or if work is suspended or abandoned for a period of 180 days. � j INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply�wit ell applicable codes, and ell raquired Inepectiona and final approval must be obtained. Failure to obtain inspections and tinal approval will resul4iirt e expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 zaaws (sioo) WORKERS'COMPENSAnONDECLARAnON: I hereby aHirm under penelty of pe�ury one oi the following declarations: ❑ I heve entl wlll meintain e cenificate of consent to sal4lnsure for workers' compensation, es pwvided for by section 3700 of ihe labor Code, for the peAormence of the work tor whlch this permit Is issuetl. ❑ I �ave and wlll meinWin workers' wmp�nsatlon insurance, as requiretl by sectlon 3700 of the LeDor Cotle, for the petlortnance of ihe work for which this pertnil is issued. My workers' compensation Insurence Wrrier and policy number are: Certier. t Policy NumCec (Th/is section neeL not b � mp/eted i/ the � i✓ ed et ane huntlretl tlallars ($f 00) or less.) Q I certity that in ihe peAortnance of th ork o w ich this pertnit is issued, I shall not employ any person in eny menner so as to become subject to the workers' compensatlon lews of Callfomla, en 64 e ' I s�ould become subject to Ihe workers' compensetion provisions oi Sectlon 3700 of t e Labor Code, I shall forthwith comply with ihese provisions. Applicant Signeture: Date: � 1 1\Q � 3 WARNING:FAILURETOSECUREWOPKERS'COMPEN ON UNLAWFULPNDSMALl5U8JECTANEMPLOYERTOCRIMI�ESANDCMLFINESUPTOONEHUNDRED T/%%1SAND DOLURE (5100,000�, IN ADDfTION TO TME OF COMPENSATIIXJ, DAMAGESlS PROVIOED FOR IN SEGfION 31O80F THE UBOR WDE, INiEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirtn that I em Ilcensed under pmv�sions of Chapter 9(commencing with Section 7000) ot Division 3 0l the Business and Pmfessions Code, and my license is in full force and ettecL Uc. M Cless a Contractofs Signeture: Date: CONS7RUCTION LENDING AGENLY: ❑ I hereby ettirm that there is a consimction lending egency tor ihe peAormance of the work br which I�is permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signeture: Date: OWNER-BUILDER DECLAfiA710NS: I herehy ettirm ��al under penalty ot perjury thet I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business end Protesslons Code: Any city or counry which roquires e pU�mit to construct alter, improve, tlemolish, or repeir eny stmcture, prior to its Issuance, also requires ihe applicenl for such parmit to ille a signed statement that �e or she is IlOensed pursuent to tha provisions of tha Contrectors Licensa Lew (Chepler 9(commendng with Section 7000) ai DlNslon 3 of the Business entl Pmfeulons Code) or that �e or she is exempt therefrom antl the basis for the elleged exemption. Any violation of Section 7031.5 by any applicant for e pertnit sub' cts the epplicant to e civil penalry ol no1 more ihan five hundred dollers (5500).): I, es owner of Ne property, or my employees with wages as Iheir sole compensatioq WILL DO THE WOAK, aM che sUucwre Is not intended or otteretl iw sale (Sec. 7044, Business and Protessions Cotla: The Coniractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himsetl or herselt ar through his or he awn amployees, provitletl thai such improvements ere not Intendetl ar otteretl lor sale. If, howevar, ihe building or improvement is sold within one year of completi e w�er-builder will hava the burtlen of proving that he or she did not build or improve for purpose of sale.). ' ❑ I, es owner ot the property, m U ��ELY CONTRAC7ING WITH LICENSED CONTHACTORS to construct the project (Sec. 7044, Business and Protessions Code: The conirectors Ll�e w s not apply to an ownar of property who �ullds or impmves thereon, end who coniracts lar such pmject with a conirector(s) license pursuent to ihe Codtr ct L �se Wws.). ❑ I am ezempt untler sec. . Signa�ure: Owner ID venfied by dnver's liten5e. Vedficatlon ot Ownership by (type of '^� Business and Protessions Code for t�i5 reason: � � Ex ires: � a �' � ��7 i.e. - property tax bill or dead): DIVISION OF INDUSTRIAL SAFETY PERM�T CERTFICATION: ❑ I hereby cenify t�et no exwve�ion tive (5) or more feet in depih into which a person is required to Aescentl, will be mede in connec�ion with wark eutho�zed Dy this permit, and that no huiltling sWcture, 5�nolding, falsework, or demolition or disman0ing thereot, will be more Ihen thirry-six (36) feet high. (Chap. 32. Grp 2, Ar12, Sec. 341, 7tle B, Callfornia Adminisiretive Cotle). ❑ As ownar-�uiltler, I will not employ enyone m tlo work which would require a permit trom Ihe Division of Indusiriel Setety, as notetl above, unless such person hes a permit to do such work from �he tlivisioP. Signeture: Date: Division of Indusirial Sefery Permit Number: CO�E I, INSPECTIONTYPE 1818 Fixetl System Final Fire Prevention 1288 Pool Spa Final 200 Finel Re-Raol 207 FIneI BIocWReteining Well 202 Final Fectory Fire Place 203 Final Sign 204 Final Demolition �g �� COOE I INSPECf10N TYPE 208 Final Mechanical 208 Final Plumbing 210 Finel Elecirical 212 Final Fire Prevenlion 220 Finel Planning Approval 222 Final Site 250 Final Building/Occupancy �_ I .1111_ : r • (714) 754-5273 • Fax (714) 754-4056 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 348 E 16TH ST Suite No Vicinity: Parcel Number: 42527113 Applicant: Address: BRASON.ALESHA 3801 LENAWEE AV CULVER CITY� CA MECHANICAL PERMIT ISSUED BY: Phone: (310)253-5229 Zip: 90232 owner: SAWYER, IRENE BENEDICT TR Address: 306 SNUG HARBOR RD Phone: NEWPORT BEACH, CA Zip: 92663 Contractor: , GEORGE BRAZIL PLUMBING, HTG. Atldress: � 3801 LENAWEE AV Arch / Eng : Address: CUWER GTY, CA Phone: (310)253-5229 Zip: 90232 License: 679898 Phone: Zip: License: SCOPE OF PERMIT 1 WALL HEA7ER CHANGE-OUT & VENT. ISSUE FEE Inst FAU <100 k BTU � Inst FAU >100 li BTU Repair / Alt'CoolinglHeat Inst / Rep.�Recess Wall Htr Refrig Sys <100k BTU Refrig Sys >100 k BTU � Gas Piping ' � � Factory Fireplace � � Hood w/Mech Exhaust � � VAV Box Vent Fan / Single Duct Appliance Fire Dampers Smoke Dampers Inst or Relocate Appl Vent Air Handlers < 10000cfm Air Hantllers > 10000cfm Floor Furnace Floor or Suspend Heater Quantity $23.50 $0.00 0 $0.00 0 $0.00 0 $0.00 0, $0.00 0 $0.00 0 � $0.00 � �0 ' � $0.00 �� 0 ` � $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00- 0 $0.00 0 ao.00 0 $0.00 0 so.00 0 $14.80 1 FEE SUMMARY _ Repair/AltAbsorbtionUnil Repair / Alt Refrigeration Unit Ventillation System Evaporative Cooler Commercial Incinerator -., - ' Domestic Incineiator � � � Compressors / Absorotion Svstems, "Upto3hp/t00kBTU'''/ . ' �3To15hp/500k�BTU� � 15 To 30 hp / 1,000 k BTU � 30 To 50 hp / 1,750 k BTU Over 50 hp / Over 1,750 BTU " � Boilers Up l0 3 hp � , � 3To15hp � -, � 15 to 30 hp 30Jo 50 hp Over 50 hp Other Mechanical Fee Investigation Fee Plan Check Fee Reinspection Fee TOTAL CALCULATED FEES COMMENTS / SPECIAL CONDITIONS Status: ISSUED Applied: 02/132001 Issued: 02/13/2001 , � � �- Quantity � �� - � L0.00; 0 ' so.00 o ,' $0.00 , 0 ' $0.00' 0 ' � $0.00 � : 0 � $0.00� 0 i ; / 50.00 0 � S0.00 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 $0.00 $0.00 538.30 NO710E: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-27-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the wo�k authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspectiona and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration.of this permit. FOR INSPECTIONS CALL: (714) 7545626 2d46-06(W00) WORKERS' COMPENSATION DECLARATION: I hereby eflirm untler penalty of perjury one ot the tollowing tledarations: ❑ I have end will maintain e certi}icate ot consent to self-Insure for workers' compensation, as provided for by section 3700 of tha Labor Cotle, tor the performenca of Ihe work for which this pertnil is issuetl. �I have and will maintain workers' compensation insurence. as required by section 3700 of Ne Labor Cotle, tor the DeAortnance of the work for whic� ihis pertnit is issued. /`My workef5 com ensation I rence carrier and policy number ere: � � l,` R_�— (I // 'l Carner: 6��iT �r�'S� PolicyNumber. ((O� ��`"� (This secfion nee of be completed il the pertnit is valued at one hundred dollars ($100) or /ess.) ❑ I certify that in the pertormance of ihe work for which this pertnit is issued, I shall not employ any pereon in any manner so es to become subject to Ihe workers' compensation laws of Califomia, entl egree Ihet it I should owe�subject to Ihe workers' compensaiion pmvisions oi Section 3700 0l ihe Labor Code, I shell torthwith comply with these provisions. � Applicant Signeture: � oe�a: 2� J l 3I d WARNING FAILURE TO SECURE WORKERS' CAMPENSATION COVERAGE IS UNL4WFUL AND SH4LL SUBJECT AN EMPLOYER TO CRIMI PENA IES AND CIVIL FINES UP TO ONE HUNDRED T}KKISAND DOILARE (5100,000�, IN ADDITION TO THE CQST OF COMPENSATION, DAMAGES AS PROVI�ED WR IN SECTIIXJ 3'l06 OF THE LABOR CODE, IN7EflEST, AN� ATTORNEV'S FEES. LICENSEU CONTRACTORS DECLARATION: I hereby aMirm ihat I am licensed untler provisions of Chepter 9(commencing with Section 7000) of Division 3 of the Business antl Pmtessions Cotle, and my license is in tull fome antl eHect. Lic. k Class a Comrectofs5ignaWre: v!L Date: CONSTRUCTION LENDING AGENCV: ❑ I hereby aHirtn that there is a consWction lending agency for the peAormance of the work br which Ihis permit is issuetl. (Sec. 3097, Civil Code). LendeYs Name: Lender5 Address: Signature: OWNER•BUILDER DECLARATIONS: Date: I hereby eHirtn that untler penalry of perjury Ihat I am E%EMP7 FROM 7HE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or counry which requires e permit b constmct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires Ihe applicant tor such permit to tile a signetl statement tha[ he or she is licensed pursuent to ihe provlsions oi ihe Coniractors License Lew (Chepter 9(commencing with Sectlon 7000) ot Division 3 oi the Businass and Protessions Code) or that he or she is exempt Iherefrom and the 6asis for ihe alleged exemption. Any violation of Section 7031.5 by any applicent for e pertnit su6jects ihe applicant to e civil penalry ot not more Ihan tive hundretl tlollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, antl the stmcture is not intanded or oHered for sale (Sec. 7044, eusiness an0 Professions Code: The Coniractors License Law tloes not apply to an owner oi property who builds or improves thereon, and who tloes such work himsetl or hersetl or �hrough his or her own employees, provided that such improvements are not intendad or oHered br sele. If, however, ihe building or improvement is sold within one year oi completion, the owneabuilder will have the burtlen of proving ihat he or s�e did not 6uild or improve for purpose oi sale.). �, as owner ot ihe property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to consimct the prolec� (Sec. 7044, Business and Protessions Cotle: The contractors Licensa Law does not apply to an owner ol property who builds or impmves thereon, and who wntracts for such project with a coniractor(s) license pursuant b lhe Coniractors license Laws.). ❑ I am exempt under sec. SignaWre: Owner ID verified by driver's liCensa. ❑ Ves ❑ No Business and Professions Code for this reason: Venfication of Ownership by (rype of document, i.e. - property tax bill or tleed): Driver's License No. Date: Expires: DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hareby cetlify Ihet no excavation five (5) or more feet in depth into which a person is required to dascend, will 6e made in connection with work authonzed by ihis permit, end ihat no building simdure, scaffolding, lelsework, or tlemolition or dismamling thereof, wiil be more than thirry-six (36) leet hiqh. (Chap. 32, Grp 2, Atl 2, Sec. 347, Title 8, Califomla Administretive Code). ❑ As ownar-builtler, I will not employ anyona to tlo work which would require e permit irom the Division ot Intlustriel Safety, as noted a6ove, unless such person has e permit to do such work from ihe division. Signature: Date: Division of Indusirial Salety Permit Number: CERTIFlCA7E OF COMPLIANCE AND AU7}fORIZA710N.OF ENiRY: I certity untler penalty ot perjury that I have reatl this application and state tha� ihe iMormation given is wrrect. I agree to comply with all state laws antl ciry ordinances relating m building construction, and authonze representatives ot Ihe City of Costa Mesa to enter upon ihe above-described property tor inspection purposes. I agree not to occupy or allow occupancy of any building authorized 6y this permit until final inspection. � i na�ure Of Legal Owner(s) And/Or Authorized Applicant COpE N. INSPECTIONTYPE 1616 Fixed System Final Pire Prevention 1266 200 201 202 203 Pool Spa Finel Final Re-Roof Finel BIocWRetaining Wall Final Factory Fire Place Finel Sign 204 Pinal Demoiition pATE' TIAL COpE� INSiELTIONTYPE 206 Final Mechanical 208 Final Plumbing 210 Final Electrical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final BuiltlinryOccupancy � OW NER BENEDdCT� HARLF;Y DATE �_�_5� JOB ADDRESS 348 E. 16th Street BUILDING PERMIT NO. #4%99 GENERALCONTRACTOR H1CkOry HOIDBS VALUE E 6,8Lo.00 APllr%-271-1 L( 76 BLOCK TRACT Npt• HgtS. R89. H�BLt. �aI'• GROUP I & J INSPECTIONS Footina Trench � Plumbing, Rougl Plumbing, Roug Temporary Pole Heating, Rougl Heating, Final Sewer, House( Septic Tank or �,..•q9�ln P, ering Plumbing, Fin: Plumbing, Fin: Wirinn. Final G Fixtures St. DATE _ i rn i � FOflM 310 3M 10-vi -S"7 ZONE RL( FIRE DISTRICT �dO� PERMITSISSUED SUBCONTRACTOR DATE � NUMBER 799 -48�4 COSTA MESA BUILDING DEPARTMENT P.0.60X 31� � COSTA MESA. CALIFORNIA FOR APPLICANT TO FILL IN � ,:, a��.. ��. COSTA MESA, CALIFORNIA owNea nnraoy MAIL 5909 r.i ADDRE55 ��r�.paradise� � C ARCHITECT OR ENGINEER . , -� NO LIC. NO. Hickory Homes T� N`o: t� CONTRACTOR ADDRESSZlrb l�e Qrt TEL. NO. �ecn� LO grc• Pt• oesceianorv NO. �p BLOCK 7RACT A.P. NO. I 7 I�� S��E 5g x 135 �o. oF a�o��. oF �or riow orv w, n USE OF EXISTING BLDG. SET9ACK LINE FROM CENTER OF STXEET 5O' REAR YARD 7 SIOE YARO T RIGHT 7 LEFT 7 DESCRIPTION OF WORK NEW s ALTERATION II ADOITION REPAIR MOVING I DEMOLISH BUILDING • NO.OF SIZE 9 a f` ROOMS � STORIES EXTERIOR W(��OOd ' ROOF J f, COVERING w �$Ll1C QpVERING �QQy S�y. USE OF NEw _ . _ . ST/�TE THAT CITV�QRDIN� TION.� AUTHORIZEVAGENT I$ CORNECT w ST�TE LnwS fll �-CN F�RECEIVED a, �r8-� � r7 -�,� FINANCE DEPT. A P P I��.yA�l Q�TI�IW&$A P E R M I T BUILDING FOR OFFICE USE ONLY flECEIPT NO. PEFMIT NOy Z! BUILDING ADORE55 COSTA MESA. CAUFORNIA FIRE ZONE 20rvE NO.OF TYPE � G PL4N5 APPROVED BV � DATE /� CQRRECTIONS ClTY ♦ �� PL=�Wn°I _ nc�,.. 5 VAL�TIO� O _ pERMiTFEE $ �d � s _ l__ � PLAN CHECK $ 9 �*`_;ylL�1G TOTAL FEE S pj � - `9'"