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Home My WebLink About392 16TH ST - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: Suite No Vicinity: Parcel Nunmber: u�'� .r��' 392 E 16TH ST 42519114 Applicant: SKAUG, JIM Address: 396 LA PERLE LN COSTA MESA, CA Owner. , ROSS, NEIL B Address 396 LA PERLE LN COSTA MESA, CA ConVactor: Address: - ISSUE FEE 7emp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool / Spa Lighling Fixts Recept Outlets Switches Non Res Appl Res Appl Service to 200a Service to t000a Service over 1000a Motors to 1hp Motors to 10hp MotorS to SOhp ISSUED BY: Phone: 949-701-0482 Zip: 92627-3759 Phone: Zip: 92627-3759 Phone: Zip: License: Status: ISSUED Applied: 04/30/2004 Issued: 05/04/2004 SCOPE OF PERMIT REF: 804-00439. CONSTRUCT NEW 473SF DETACHED GARAGE IN THE REAR WITH 405 SF SECOND STORY GAME ROOM.� ELECTRICAL TO INLCUDE: 3 LIGHT FIXTURES, 4 OUTLETS, 5 SWITCHES AND 1- 100 AMP SUBPANEL $23.50 $0.00 so.00 $0.00 $0.00 $0.00 $3.30 $8.80 $5.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantiry 0 0 0 3 8 5 0 0 0 0 0 0 0 0 FEE SUMMARY _ Temp Dist System / Lighting - � Busway /100 ft .� � StandingSection . � 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 Vollage Equipment� Low Volt Wiring System / Ckt Misc. Conduit Misa Conductor Cirws ( gen or nde) Circus (mech ride or lights) . ChnsGnas Tree Stand� � - Fireworks Sfand Quantity $0.00 0 $0.00 0 $o.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 NOTICE: The work authoiized by this permit shall comply with all applicable handicap access requirements under California statutes and relatad regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRA710N: This permit shall automatically expire and become void it work is not commenced within 1 BO days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order tor ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspeetlons and final epproval must be obtained. Failure to obtain inspections and tinal approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2446-46�6I00) WORKERS' COMPENSATION DECLARATION: I hereby eftirm under penalty oi perjury one of tha following declaretions: ❑ I have end will meintain a certificate of consent to self-Insure for workers' compensation, es providetl for by section 3700 of the Labor Code, for tha pertormance of ihe work for w�ich this permit is issuetl. ❑ I heve antl will maintain workers' compenseti ins ce, as required by section 3700 oi the Lebor Code, for tha perfortnance oF the work for which this pertnit is issued. My workers' compensatlorylqsurenca car policy numbar ere: Carnar: Policy Number: �(Th/is section need not 6e comple d/l the pc�mlf is valued et one huntlretl tlallers ($700) or less.) ' ' �I certity Ihat in the perto ance af ihe wark for wbjch thi ermit is issued, I shall not em oy eny person in any menner so as to become sub'ed ta the workers' compensation laws o alifomle, end agree t� I�i I s '10 acome sub�ect to the worker ' compensation provisions oi Sectlon 37 f ihe bor Code, I sha0 forthwith complywitht�ese isions. (� ' Applicent SignaNre: Dete: ,J WARNING: FAILURE TO CURE WORKERS' COMPENSATION COVE I$ NLAWFUL A SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FIN 5 UP TOONE HUNDPED THOUSANDDOWRE OO,OW),INADOITIONTOTHECOSTOFCOMP NSATI N,DAMAGESASPROVIDEDFORINSECilON3lO60FTHELABORCODE,IN(EREST,ANOATTORNE`fSFEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions ot Chapier 9(commencing wlth Section 7000) of Division 3 of tha Business and Professions Cotle, anC my license is in full force and ettect Lic. % Cless x ConlrectoYs Signature: � Date: CONSTRUCTION LENDING AGENCV: ❑ I here6y aHirtn that there is a consiruction lentling agency for the pertormanca of tHa work br w�ich this permit is issued. (Sec. 3097, Civil Code). Lendefs Name: Lenders Address: Signamre: Date: OWNER-BUILDER DECLARATONS: I hereby aHirtn that under penelty of perjury �het I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5, Business antl Professions Code: Any ciry or county which requires e pertnit lo construct, alter, improve, demolish, or repair any sWcture, prior to its issuance, elso requires the appliwnt for such permit to file e signed statement that he or she Is licensed pursuent to the provisions ot ihe Contrectors License Lew (Chapter 9(commencing with Section 7000) of Divislon 3 of the Business and Professions Cotle) or thet he or sha is eaempt thereirom end ihe basis lor the elleged exemption. Any violetion of Section 7037.5 by any appliwnt for e permit subjects the epplicant to a civil penalty of not more than five hundretl dollers ($500)J: ❑ I, as owner of ihe property, or my employees wlih wages as their sole compensation, WILL DO THE WORK, and ihe structure is not intentlea or ottered tor sale (Sec. 7044, Business and Protessions Code: The Contractors License Lew does not apply to en owner of property who builds or improves thereon, and who dces such work himselt or herselt or ihrough his or her own employees, provided ihat such improvements era not intended or otteretl for sale. If, however, ihe building or improvement is sold within one year oi completion, the ownar-builder will have Ihe burden ol proving ihat he or sha did not build or improve tor purpose ot sale.). � ❑ I, as owner of th roperry, am E%CLUSIV LV CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Protessions Cotle: The cont cmrs Licensa Lew tloe ot ly to en owner of property who builds or Improves t ereon, and who contracts for such pmject with e conirector(s) license purs t to ihe Coniractors ' nse ❑ I am exe nder sec. Bu ' end Profe 'ons ode fo ason: Signature: � Date: Owner ID va � ed by drivers license. No Drivefs Licanse No. Expires: Veritication f Ownership by (type oi documen , i. .- prop y taa bill or deed): DIVISIO OF INDUSTRIAL SAFETY PERMIT C TIFICATION: ❑ 1 here6y cenity Ihat no excavetion tive (5) or more teei in depth into which e person is required to descend, will be matle in connection with work authonzed by this pertnit, and ihat no builtling siructure, scaHolding, falsework, or demolition or dismantling ihereot will be more than ihirty-six (36) teet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Title 8, Califomia Atlminisirative Code). ❑ As ownervbuiltler, I will not employ anyone to do work which woultl require e permit Irom ihe Division of Industriel Sefety, es notetl above, unless such person has a pertnit ta do such work irom the dlvision. Signature: Date: Division ot Intlustrial Safety Permit Number. CERTIFICA7E COMPLIANCE A ORVA710N OF ENTAY: I certify under penalty of perlury tha� I have read ihis epplication antl state that the information given is correct I agr to comply with al et s d city ortlinances releting to builtling consimction, and authodze representatives of ihe Ciry ot Costa Mesa to enter upon the a6ove-des ed propeny for i ecf pu ses. I agree not to occupy allow occup cy of eny building authorized by t is it u til nal inspection. U 7 Signature Ot L Owne s) Date COpEI, INSPELTIONTYPE 1616 Fixed System Final Fire Prevention 1266 Pool Spa Final 200 Final Re-Root 201 Final Block/Retaining Wall 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition QdjF INTRIALS CODE� INSPECTIONTYPE 206 Final Mechanical 208 Finel Plum6ing 270 Final Elec�rical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupency �g ♦ � INTRIRLS (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT Job Address: 392 E 16TH ST Suite No Vicinity: DETACHED GARAGE AND GAME ROOM Parcel Nunmber: 42519114 Applicant: SKAUG, JIM Address: Owner: ROSS, NEIL B Address 396 LA PERLE�LN Contractor: Address: Arch / Eng : Address: ISSUE FEE BackFlow irrigation BackFlow Preventer� BathNb Clarifier System Connect Qce,Soda.etc) Dental Units Dishwasher D2in, Floor Drain, Rainwater Drain, Roof COSTA MESA, CA Phone: 949-584-6934 Zip: Phone: Zip: 92627-3759 Phone: Zip: License: Phone: Zip: License: SCOPE OF PERMIT REF: B04-00439. DETACHED GARAGE WITH GAME ROOM ABOVE. ISSUED BY: Status: ISSUED Applied: 04/30/2004 Issued: 04/30/2004 PLUMBING TO INCLUDE: 1 BACKFLOW PREVENTER, 1 WASH BASIN SET, 7 TOILET, WATER PIPING AND 1 WATER HEATER. � � ' AMT $23.50 $0.00 $9.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 FEESUMMARY �TY AMT Laundry Tub / Washer $0.00 1 Landscape Irngation $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 Pnvate Line $0.00 0 ShOwer - $0.00 aTY 0 0 0 0 0 0 0 0 0 0 0 SumpPump Swimming Pool Trap Primer Urinal Vacuum Brkr BkFlow(1-4) Vacuum Brkr BkFlow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (Toilet) Water Heater / vent AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $9.80 $0.00 $0.00 $9.80 $12.30 �N 0 0 0 0 0 0 1 0 0 1 1 NOTICE: The work authonzed by this permit shall comply with all applicable handicap access requiremenis under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire antl become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final epproval must be obtained. Failure to obtain inspections and tinal approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (774) 7545626 2446d6 I6/00) i WORKERS'COMPENSAnONDECLARA710N: I hereby eHirm under penalty of perjury one oi the following declaretions: ❑ I have entl will melntaln e certificete of consent to selt-Insure for workers' compensetlon, as pmvided tor by section 3700 ot the Labor Code, for the pertormence ot the work tor w�ich this permit is issued. ❑ I have antl will maintain workers' compensation insurance, as required by section 3700 oi the Lebor Code, tor the perfortnance oF the work for which this permit is issued. My workers' compensatlon Insurence carrler and policy number ere: Cartier. Pplicy Number. (This se ion need nat be complefed tl the permit is valued et one hundretlOollers ($100) or /essJ I certify ihat in the peAor Ance of the wo or hic� this permit is issued, I shell not employ eny person in any manner so as t become sublect to the workers' compensetian lews ol C Ifomla, antl aq � 'f I should become subjact to the workere' compansation provisions ot Sectio 3700 af t Labor o�e, I shall forthwith comply wlth these pro sions. A � Applicant Signeture: � Date: U WARNING: FAILURE TO S URE WORKERS' COMPENSAT ERAGE IS UNLAWFUL � SHALL SUBJECT AN EMPLOYER TO CRIMINAL P NALTIES D QVIL NES UP TOONE HUNDRED T/IOUSPNDOOLLAFE( ,OW�,INADDITIONTOTHE TOF MPENSATION,DAMAGESFSPFOVIDEDFORINSECTION3�O60FiHELABORCODE,INTEREST,ANDATTORNEV'SFEES. IICENSED CONTRACTORS DECLARATION: � I hereby aHirm that I am Ilcensed under provisions oi Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code, anC my license is in tull torce antl ettecL Lic. # Ciass # ContrecmYs Signeture: Date: CONSTRUCTION LENDING AGENCV: ❑ I hereby aHirm thet there is a constmction lending agency for the peAormance of ihe work for which �his permit is issued. (Sec. 3097, Civil Cotle). Lenders Name: Lendefs Adtlress: Signa�ure: Date: OWNER-BUILDER DECLARATIONS: I hereby eflirtn ihet under penelry of perjury that I am E%EMPT FROM THE CON7RAC70RS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business entl Professions Code: Any ciry or counry which requires e permit to construc4 alter, improve, demolish, or repair any structure, prior to its issuance, also requires ihe epplicant for such permit to file e signed stetemenl that he or she is licensetl pursuant b the provislons ot the Contrectors License Lew (Chapter 9(commencing with Sectlon 7000) of Division 3 ot ihe Busin s and Prolessions Code) or that he or she is exempt theretrom and t�e basis for the alleged exemption. Any violation of Seaion 7031.5 by any epplicant for e permit sub" ts the applicant to e civil penalry of not more ihan fiva huntlred tlollars ($500).): I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WOFiK, antl ihe structure is not intended or oHeretl for sale (Sec. 7044, Business and Professions Code: The Contractors Licensa Law does no� apply Io an owner of properry who builds or improves ihereon, end who does such work himself or herself or ihrough his or her own employees, provided that such improvements ere not intended or ottered for sale. It, �owever, the building or improvement is sold within one year of completion, the owner-builder will have ihe burden of proving that he or she tlid not Duild or improve tor purpose oi sale.). ' ❑ I, as owner of the properry, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Cotle: The comre rs Licanse Law does not apply to an ownar of propeny who bullds or Impmves thereon, and who comracts for such project with e comractor(s) license pur5uant the Coniractor5 en5 5.). ❑ I em exempt er sec. Business and Profes ' ns Code or t is reason: Signature: Dat : Owner ID verifie by dnver's license. ❑ Ve No DriveYs L ense No. E� ires: Vedfication oi bwners�ip by (type oi tlocumen�; i.e. - prpperty taz bill or tleetl): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby cartity thet no eacavetion tive (5) or more teet in depih into which e person is requirea m tlescend, will 6e made in connection with work euthodzetl by Ihis permit, and ihat no building structure, swHoldinq, talsework, or demolition or dismantling thereof, will ba more than thirty-six (36) teet high. (Chep. 32, Grp 2, Art 2, Sec. 341, Title B, Calitornia Atlminisirative Code). ❑ As owner-builtler, I will not employ anyone to do work which would require e pertnit from tha Division of Industrial Safery, as notad ebove, unless such person hes a permit to do such work from ihe division. Signature: Date: Division oi Intlusirial Sefery Partnit Numbar: ICERTIFICATE OF COMPLIANCE AND AIfTHORIZAl10N OF ENfTiY: I certiry under penalry of perjury that I have reatl this application and state that the informetion given is I correct. I egree to comply with all state laws and city ordinances relating to bullding consiruction, end authonze representatives of the City ol Costa Mesa to enter upon the ebove-descri6etl property for inspection purposes. I egree not to occupy or aliow occupancy of eny 6uilding authonzed by this permit until finel inspection. CODE �. 1676 1266 200 207 202 203 Fixed System Final Fire Prevention Pool Spa Final Final Re-Roof Final Block/Retaining Well Final Factory Fire Place Finel Sign 204 Final �emolition .111:5 40DE 1 INSPECTION TYPE 206 Final Mechanical 208 Final Plumbing 210 Final Eledrical 212 Final Fire Praveniion 220 Final Planning Approval 222 Final Site 250 Final Builtling/Occupancy PSIE INTIIIRLS � H � \ (714) 754-5273 • Fan (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 �ob Address: 392 E 16TH ST Suite No Vicinity: Parcel Nunmber: 425191�4 App�icant: SKAUG, JIM Address: Owner: ROSS, NEIL B Address 396 LA PERLE LN Contractor. Address: Arch / Eng : Address: ISSUE FEE BackFlow irrigation Backflow Preventer Balhtub Clarifier System Connect (Ice,Soda,etc) Dental Units Dishwasher COSTA MESA, CA PLUMBING PERMIT Phone: 949-584-6934 Zip: Phone: Zip: 92627-3759 Phone: Zip: License: Phone: Zip: License: ISSUED BY: Status: ISSUED Applied: 04/30/2004 Issued: 04/30/2004 SCOPE OF PERMIT REF: 804-00438. DEMOLISH EXIST. ATTACHED GARAGE AT THE FRONT AND ADD 391 SF TO THE 1ST STORY TO CREATE A STUDY ROOM, EXTEND KITCHEN AND LIVING ROOM WITH A NEW 399SF 2ND STORY MASTER BEDROOM, BATHROOM AND CLOSET. FOR A TOTAL OF 1702SF. PLUMBING TO INCLUDE: 1 BATHTUB, 1 DISHWASHER, 1 GAS (1-0 OUTLETS), 1 GAS RE-PIPE, 1 LAUNDRY TUB, 7 KITCHEN SINK, 1 SHOWER, 2 WASH BASIN SETS, 1 TOILET, 1 WATER HEATER, 1 WATER PIFING. AMT $23.50 $0.00 $9.80 $9.80 $0.00 $0.00 $0.00 $9.80 FEE SUMMARY QTY AMT Laundry Tub / Washer $9.80 1 Landscape irtigation $0.00 0 P-Trap $0.00 1 Pressure Regulator $0.00 0 Process Piping (per 10 ft) $0.00 0 Receptors $0.00 0 SepticTank $0.00 1 Sewer Cap for Demo $0.00 Qn 1 0 0 0 0 0 0 0 SumpPump Swimming Pool Trap Primer Urinal Vacuum Brkr Bkflow(1-4) Vacuum BrkrBkFlow(5+) Wash Basin Wash Basin Set AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $19.60 orv 0 0 0 0 0 0 0 2 NO710E: The work authonzed by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 9248, § 7, 12-21-92) EXPIRATION: This permit shall automatically expire end become void if work is not commenced within 780 days, or if work Is suspended or abandoned For a period of 180 days. INSPEC710NS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred inapeetiona and final approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 zaawe �woo� WORKERS'COMPENSAnONDECLARArON: I �ere�y eHirtn under penalry af perjury one oi t�e following declaretions: ❑ I have and wlll malntain e certiflcete ot consent ro selbinsure for workers' compensation, es provitletl for by section 3700 of the La6or Code, tor the pedortnance at the work for which this permit Is issuetl. ❑ I have and will meintain workers' crompensation insurance, as reQulred by saction 3700 of the Labor Code, tor Ihe pertortnance of the work for which ihis pertnit Is Issued. My workers' compen5atlon InSurance carder end poliCy number ere: Cerrier. Policy Number: his ectlon nee0 not be complefed ll the Oermlf is valued et one hundred dallers ($100) or IessJ 1 certity that in the peAorm a ol the work for hic thls permit is issued, I shall not employ eny person in eny manner so as to become subject to ihe workers' compensetlon laws of Cal mia, end agree t i s ultl become sub�ect to the workers' compensation provislons of Seqqq lon 3700 oi the Labor Cotla, I shell forthwith compty with t�ese pro ns. �/� /�` Applicant Signature: Date: f � � WMNINO: FAILURE TO SEG E WORKERS' COMPENSATION EMGE S UNLAW PND SMALL SUBJECT PN EMPLOYER TO CRIMINAL PEWJ.TIES PND L FlNES UP TO dJE MUNDRED TIqUSANOWLLARE(51 ),INADDRIONTOTHECOST COMPENATION,DAMAGESASPROVIDEDFORMSECiIONJN60FTHELA80RCO0E,INTEREST,ANDFTTORNEI"SFEES. LICENSED CONTRACTORS DECLARATION: I hereby eNirm Ihet I em licensed untler provisions of Chapter 9(commencing with Seciion 7000) of Division 3 oi Ihe Business and Pmfessions Code, anC my Ilcense Is in full force end efleci. Lic. M Class M Comrectors Signeture: Dale: �, CONSTRUCTON LENDING AGENCY: �� ❑ I hereby aHirm Ihat ihere is a cons�ruction lending egenty for the pedormance ot the work lor which �his Oermit is issued. (Sec. 3097, Civil Code). Lentlefs Neme: LentleYs Atltlress: Signatura: � Date: OWNER-BUILDER DECLARATIONS: I hereby eHirm that untler penelry at perjury thet I em EXEMPT FROM THE CONTRACTORS LICENSE lAW tor the following reason (Sec. 7031.5, Business entl Professians Cotle: Any ciry or county whicli requires e pertnit to conscruct, aller, improve, tlemolish, or repair any strucNre, pdor ta Its issuance, also requires the epplicant for such pertnit to tile e signed sietement thei �e or she is Ilcensed pursuent to the provisions of Ihe Contrectors License Lew (Chapter 9(commendng with Secllon 7000) 01 Divislon 3 at t�e Busi s end Professions CodeJ or Ihat he or she is e:empt therefrom and Ihe basis for t�e allegeA a:emption. Any violation ol Section 7031.5 by eny applicant for a pertnit s cts the epplicant to e civil penalry of not more than five hunAretl Aollars (5500).): I, es owner oi the property, or my employaes with wages es their sole compensation, WILL DO 7HE WORK, end Ihe structura is not intended or ofleretl lor sale (Sec. 7044, Business and Protessions Code: The Coniractors License Lew does not apply to an owner of proDerty who builds or improves �hereon, entl who doas such work himselt or herselt ar thmugh his or her own employaes, pravided Ihat such improvements ere not Intended or oHered for sele. If, however, Ihe building or Improvement Is soltl within one year of completion, the owner-builder will heve tha burden of proving Ihat he or she did not build or improve tor purpose oF saleJ. � ❑ I, es owner of the pro0erty, am EXCLUSIVELV CONTRACTINC WITH LICENSED CONTRACTORS to construcl the project (Sec. 7044, Business and Prolessions Code: The canir brs Llcense Lew es not apPly to en owner ol propetly who bulltls or Improves �hereon, end who con�rects for such project wlth e con�racbr(s) license pursua o Ihe Contracto ice e Laws.). ❑ I em e:empt ntler sec. Business antl Professions Coae for this reason: Signalure: . Ownar ID venli by driver'S licensa. Ves Drivefs Licensa No. Expires: Vedficetlon o nership by (type ot �ocument, i.e - pr erty tex bill or tleetl): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby ceritly ihat no excavaiion five (5) or more feet In depth Inlo which a person is requireA to descend, will be mede in connection wit� work authorized by this permil, and that no building siructure, scatfolding, falsework, or demolition or dismantling Ihereot, will be more Ihen ihirry-six (36) feet high. (Chap. 3.2, Grp 2, Ar12, Sec. 341, Title B, Calilomie Adminisirative Code). ❑ As owner-huilder, I will not amploy anyona to tlo work which woultl require e pertnit trom the Division ol Intlustrlel Salery, es noted above, unless such person �es e permit to da such work irom the division. Signature: Oate: Division of Industrial Safery Permit Number: CERTIFlCA7E OF COMPLIANCE AND AIITHORQA710N OF ENTTiV: I cetlify under penalry of perjury that I have read this application antl state thel Ihe intortnetion given is wrrect I egree to wmply wilh all sta�e laws end city ortllnances releting to building consiructlon, antl authonze representetives of Ihe Ciry of Cwia Mesa to enter upon the ebove-descnp4d property for inspection purpases. I e9ree not to occupy or allow occupancy of eny building euthonzed 6y this permit until final inspection. �/, INSPECTIONTYVE � 1616 Fixed System Final Fire Pi 1268 Pool Spa Final 200 Final Re-Root 201 FInaI8locWRetaining Well 202 Final Factory Fire Place 203 Finel Sign 204 Final �emolitian �jg �$ j�Qyf�( INSPECTIONTYPE 206 Final Mec�anical 208 Final Plumbing 210 Final Electncal 272 Flnal Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupanry v � � � • � \ (714) 754-5273 • Fa�c (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 392 E 16TH ST Suite No Vicinity: Parcel Number: 42519114 Applicank SKAUG, JIM Address: 396 LA PERLE LN COSTA MESA, CA owner: ROSS, NEIL B Address: 396 LA PERLE LN COSTA MESA, CA Contraclor: Address: �. MECHANICAL PERMIT Phone: 949-701-0482 2ip: 926273759 Phone: Zip: 92627-3759 Phone: Zip: License: Status: ISSUED Applied: 04/30/2004 Issued: OS/04/2004 ISSUED BY: SCOPE OF PERMIT REF: B04-00439. CONSTRUCT NEW 473SF DETACHED GARAGE IN THE REAR WITH 405 SF SECOND STORY GAME ROOM. . SCOPE OF WORK TO INLCUDE: 1 FAU < 100K BTU, GAS PIPING. 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 Refrig Sys >100 k BTU Gas Piping Factory Fireplace Hood w/Mech Exhaust VAV Box Vent Fan / Single Duct Appliance Fire Dampers Smoke Dampers Inst or Relocate Appl Vent Air Handlers < 10000cfm Air Handlers > 10000cfm Floor Furnace Floor or Suspend Heater $23.50 $14.80 $0.00 $0.00 $0.00 $0.00 $0.00 $6.15 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 _ Quantity 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 FEE SUMMARY Repair / Alt Absorbtion Unit Repair / Alt Refrigeretion Unit Ventillatlon System Evaporative Cooler Commercia l I nci nerator 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 to 50 hp Over 50 hp Other Mechanical Fee Investigation Fee Plan Check Fee Reinspection Fee Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 � $0.00 NO710E: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 72-21-92) EXPIRA710N: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period ot 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in tha expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 � 2d4646 (6/00) WORKERS' COMPENSA710N DECLARA710N: I nereby aHirtn untler penalry of perjury one of the following declarations: ❑ I have and wlll malntain e certificate of consent to self-Insura tor workers' compensation, as providetl for by section 3700 of the LaDor Code, for Ihe peAormance of ihe work for which this permit is issue0. ❑ I hava antl will malntein workers' compensation insurance s re uired Gy section 3700 of ihe Labor Code, Por the perfortnance of ihe work tor which this pertnit is issued. My workers' compensa ion In anre �a �ier a p��i n nb . Carrier. Policy Number: his sectlon need nat be comp il fhe permif is value et one hundred dollers ($100) ar less.) ertiFy thet in the pertor ance of the work for w'c this permit is issued, I shall not employ eny person in any manner so as to become subject to Ihe workers' compensetlon lews of alifomla, end agrea th d becoma sublect to the workers' compensation pmvisions of Section 3700 of the Lebor Code, I shell forihwith comply with Ihese p isions. � _ / Applicent SignaNre: Da�e: �— \ % WARNING FAILURE T 5 URE WOFll(ERS C/JAIPENSATION COVE IS UNLAWFUL AND SHA�L SUBJECt AN EMPLOYER TO CRIMINAL PENALTIE3 AND CN FlNES U TOONE HUNDRED THOUSANODOLLAFE(E ,OW),INADDITIIXJTOTHECOSTOF PENSAT ,DPM4GESASPROVIpEDFORINSECTIIXJ3lO60FTHELABpqCODE,IfJrEPEST,ANDATT FNEY'� LICENSED CONT/iACTORS DECLARATION: I hereby ettirm that I am licensed untler provisions of farce and eMect. Lic. a Con�rectols Signeture: with Section 7000) of Division 3 ot the Busineu and Professions Code, arC my license is in full _ Class # Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby allirm ihat ihere is e consiruciion lending agency tor the peAormance of ihe work for which this permit is issued. (Sec. 3097, Civil Cotle). Lender's Neme: Lender's Address: SigneNre: Date: OWNER-BUILDER DECLARATIONS: I hereby aHirm I�aI untler penalty of perjury that I am EXEMPT FROM THE CON7RAC70RS LICENSE LAW tor the tollowing reason (Sec. 7031.5, Business antl Professions Cotla: Any city or counry which requires a permit to con5truct, alter, Improve, demolish, or repair eny structure, prior to its IssuanCe, also requiras the appliCent for such permit to tile e signad statement Ihat he or she is licensetl pursuant to the provislons oi the Contradors License Law (Chapter 9(commencing with Sectlan 7000) of Division 3 of the BuSiness and Pratessions Cade) or that he or she is exempt therefrom end tha besis for the alleged exemption. Any violetion of Section 7031.5 6y any epplicant for a permit ubjecis the epplicent to a civil penalry of not more than tive huntlretl tlollars ($500).): I, as ownar of the properry, or my employees with wages es t�eir sole compensation, WILL DO 7HE WORK, and iha structure Is not Intentle0 or otfered for sale (Sec. 7044, Business entl Professions Code: The Contractore License Law does not apply to an owner of property who builds or improves ihereon, end who does such work himself or hereelf or thmugh his or har own employees, provided ihat such improvements are not intended or ottered for sale. It, however, ihe building or improvement is soltl wit�in one year ol completion, ihe owner-builder will have ihe burden ot proving ihat ha or she did not build or improve for purpose ol sale.). � ❑ I, as owner of lhe pr erty, am EXCLUSIVELY C TRACTING WITH LICENSED CONTRACTOFiS to conslruc� the projec� (Sec. 7044, BuSiness and Professions Cotla: The contre rs License Law does ep fo en owner of property who builds or improves ihereon, antl who contrads for such project wit� a contractor(s) license pur5ue o ihe Coniracmrs Lice e L .). ❑ I em exem der sec. Busin end Professions Code tor this reason: SignaWre: Date: � Owner ID venfie by dnver's license. ❑ Ves ❑ Driver's License No. E:pires: Verificetlon of nership by (type oi document, i.e. - p pert as bill or deed): DIVISION OF INDUSTRIAL SAFE7Y ❑ I hereby certify ihet no excavation five (5) or more feet in dapth into which e person is requi�ed to descend, will be made in connectlon with work euthorizetl by this permit, and that no building stmcture, swflolding, falsework, or tlemolition or tlismantling thereoi, will be more than thirty-sic (36) feet high. (Chap. 32, Grp 2, Ar12, Sec. 341, Title B, Califomla Administrative Cotle). ❑ As owner-builder, 1 wiil not employ enyone to tlo work which would require a permit from the Division ot Industrial Safety, es noted ebove, unless such pereon has a permit to tlo such work trom the division. Signature: Date: Division ol Indusirial Sefety Permit Number: CERTIFlCA7E OP C01�1PLIANCE AND TFIO ZA710N OF ENTHV: I certity under penalry of perjury Ihat I have reatl this application end state that the information given is correct. I egree to 6mply with ell sta aw n �ty o i�ating to 6uilding const ction, end authoriza representatives of �h� Ciry of Cos�a Mesa to enter upon ihe ebove-describe opert� inspe ' n po .� not to occupy or ellow occupan f any building authorized ¢yJAi�erm' upftil jip I�ection. � � / � Signa e Of Legal Own r(s) � Dat CODE t. INSPELTIONTYPE \ 1616 Fixetl System Final Fire Prevention 1266 Pool Spe Final 200 Final Re-Roof 207 Final BIxWRetaining Well 202 203 204 Final Factory Fire Place Finel Sign Final Demolition Q9jE INTRIALS OEt INSPELTIONTYPE 206 Final Mechanical 20B Final Plumbing 210 Final ElecMcal 212 Final Fire Prevention 220 Final Planning ApProval 222 Final Site 250 Final Building/Occupency �. L IIIL. • \ (714) 754-5273 • Faz (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Adaress: 392 E 16TH ST Suite No Vicinity: Parcel Number: 42519714 Applicant: SKAUG, JIM Address: 396 LA PERLE LM COSTA MESA, CA Owner: F20SS, NEIL B Address: 396 LA PERLE LN COSTA MESA, CA Contrador: Address: MECHANICAL PERMIT Phone: 949-701-0482 Zip: 92627-3759 Phone: Zip: 926273759 PAone: Zip: License: ISSUED BY: Status: ISSUED Applied: 04/30/2004 Issued: 05/04/2004 SCOPE OF PERMIT REF: B04-00438. DEMOLISH EXIST. ATTACHED GARAGE AT THE FRONT AND ADD 391 SF TO THE 1ST STORY TO CREATE A STUDY ROOM, EXTEND KITCHEN AND LIVING ROOM WITH A NEW 399SF 2ND STORY MASTER BEDROOM, BATHROOM AND CLOSET. FOR A TOTAL OF 1702SF. MECHANICAL TO INCLUDE: 1 FAU < 100 K BTU, DUCT WORK, GAS PIPING, 1 FACTORY FIREPLACE, 1 HOOD, 2 VENT FANS. REF: B04-00439 (NEW-GARAGE) ISSUE FEE Inst FAU <100 k BTU Insl FAU >100 k BTU Repair / Alt Cooling/Heat Inst / Rep. Recess Wall Htr Refrig Sys <100 k BTU Refrig Sys >100 k BTU Gas Piping Factory Fireplace Hood w/Mech Exhaust VAV Box Vent Fan / Single Duct Appliance Fire Dampers Smoke Dampers Inst or Rebcate Appl Vent Air Handlers < 10000cfm AirHandlers> 10000cfm $23.50 $14.80 $0.00 $1370 $0.00 $0.00 $0.00 $6.15 $10.65 510.65 $0.00 $14.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantity FEESUMMARY Repair / Alt Absorbtion Unit . � Repair / Alt Refrigeralion Unit - Ventillation System Evaporative Cooler Commercial I nci nerator Domestic Incinerator � Campressors / Absorplion 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 Bailers Upto3hp 3To15hp 15to30hp 30 to 50 hp Over 50 hp Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 0 0 0 0 0 NO710E: 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 automa[ically expire and become void if work is not commenced within 1 BO days, or i( work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for ihe work au�horized under �his permi� to be considered legal, such work must comply wi�h all applicable codes, and all required Inspeetions and final approval must be obtained. Failure to obtain inspections and tinal approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2446d6 (6/00) WORKERS' COMPENSATION DECLARATION: I hereby ettirm untler penelry of perjury one ol ihe following tlecleretlons: ❑ I heve end will melntain e cartiticete ot consent Io self-Insure br workers' compensetlon, es provided br by seclion 3700 of the Lebor Cotle, for the pedortnance ot the work lor which this pertnit is issuetl. ❑ I heve entl wiil maintein workers' compensation surence, es required by section 3700 of Ihe Lebor Cade, for Ihe peAortnance of Ihe wod for w'ch this permit is issued. M workers' com ensatio%� I�nsJ��e� c�e� �carna num0er ere: Carriar:Y p C JC/ l_.V A' PoliCy Number: � (Th/s secti ed nof be comp/e tl il the pe � is v� ed e one hundred dollars ($100) or less.) I certiTy that in the perfo ance of the work f hi Is parmit is issuad, I shell not employ any person in eny menner so es to hecome sublect to the workers' compensatlan laws oi Illomla, end egre at � ultl become subject to Ihe workers' compensation provlsions ot Sectlon 3700 of t Lebor e, I shall torthwi[h comply with Ihese D� �slons. Applicent Signetura: Data: WARNINO: FAILURE TO CURE WORKERS' COMPENSATION COVEM UNLAWFUL AND SHALL SUBIECr rW EMPLOVER TO CRIMINAL PENALTIES CML NES UP OIXJE HUNDflED TFKKISAND DOLLARE 00,000), IN ADDITION TO TME WST OF COMP ON, DAhNGES AS PROVIDED FIXi IN SECTION 3](IB OF THE LABOR CODE, IMEREST, AND ATT EV'S FEES. LICENSED CONTRAC70RS DECIARATION: I here6y eHirtn that I am Ilcensetl untler provisions of Chapter 9(commencing wlth Sectlon 7000) ol Division 3 oi lhe Business end Professions Cade, anC my license is in full force end etteci. Lic. 8 . Class a Contrectors Signature: Date: CONSTRUCTION LENDING AGENCV: ❑ I �ereby aHirtn ihat ihere Is e consiruction lending egency for the peAormanca ot ihe work lor which this pertnit is issuetl. (Sec. 3097, Civil Code). Lenders Name: Lentlers AOdress: Signature: Date: OWNER-BUILDER DECLARATONS: I hereby aHirtn thet under penalry ot perjury t�et I am EXEMPT FROM T1E CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Busineu flnd Pmtessions Code: Any ciry ar counry which requires e pertnit to construcl, alter, improve, demolish, or repelr eny structure, prior to its iuuance, also requires ihe epplicant for such pertnit b tile e signed siatement t�et �e ar she is Ilcensed pursuant to the proNsions of the Contrectors Llcense Lew (Chapter 9(commendng with Sectlon 7000) oi Division 3 oi the Busin 55 entl Prafessians Code) or that he or she is e:empt therefram antl the besis tor the ellaped ezemption. Any violetlon of Seciion 7031.5 by eny epplicent tor e permit su ' cts the eppliwni to a ciNl penalry oi not more Ihan five huntlretl Aollars ($500).): I, es owner of the property, or my employees with wages es their sWe compenseUon, WILL DO THE WORK, entl the structure is not intentletl or ottered tor sala (Sac. 7044, Business and Professlons CoOe: The Conirectors lJcense Lew does not epply to en owner ot properiy w�o builtls or improves thereon, antl who does such work himself or herself or Ihrough his or her own employees, provided Ihet such improvemems ere nat intentlatl or oHered tor sale. tl, however, the builtling or improvement is sold within one year ol completion, the owner-builder will heve ihe burtlen ol Droving thet he or she did not build or improve for purpose oi sale.). � ❑ I, as owner of lhe roperty, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS �o consiruct �he project (Sec. 7044, Business entl Profes5ion5 Cotle: Tha cont lors License Lew does nefeppW to an owner ol property who bullds or improves t�ereon, end who coNrecis br such project with e contractor(s) lirancw ninsu tn thw ConVxr.inrs Lirno�eiLevi51 / . ❑ I em ex0 tlef� SignaWre: Owner ID ve' ied by dnvers Ilcense. Verilicatian f Ownership by (type oi DIVISION OF IN�USTRIAL SAFETV PERMIT Bu5ine558n( 55i� Cotle �s ❑ No Orivefs cense No. i.e. - prope t c bill or deed): Date: ExO��es: ❑ I hereby cetliry that no ezcavetlon flve (5) or more feet In depth Into which e person Is requlred to descend, will be metle In connectlon with work authonzetl by this permit, and that no builtling strucWre, scaHolding, falsework, or demolition or dismentling thereof, will be more than ihirry-sic (36) faet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Trtle B, Califomie Adminisiralive Code). ❑ As owner-builder, 1 will not employ enyone to do work which would require e permit Irom Ihe Division ot Indusirial Salery, as noted above, unless such person has a pertnit to da such work tmm iha division. Signature: Date: �ivision of Indusirial Safery Permit Number: CERTIFlCA7E F COMPLIANCE /i VA710N OF ENTTiV: I certify untler penelty ol perjury that I have reed this epDliwtion and state that the infortnetion given is correct I egr to compty with ell efe ntl city ordinances relating to building consimction, entl euthonze represen�ative of iha Ciry o( Coste Mesa to enter upon �he e6ove-des ed properry tor� ectio u; ses. I egree n e�py or all w occupency eny 6ui ' uthorized by t is � M1 unti inal ins ection. ��°�'�J�O� SignaWre Ot Le�a wne s) � Dat COOEI, INSPECTIONTYPE ifi76 1266 Fixed System Final Fire Prevention Pool Spa Final 200 Final Re-Roof 207 Final Block/Retaining Well 202 Final Factory Fire Place 203 Final Sign 204 Final Demoli�ion PSiE It�ELS COUEI INSPECTIONTYGE 206 Final Mechenical 20B Final Plumbing 210 Final Electncal 212 Finel Fire Preventlon 220 Final Planning ApOroval 222 Final Site 250 Final Building/Occupancy � (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: Suite No Viciniry: Parcel Nunmber: Applicant: Address: 392 E 16TH ST 42519114 SKAUG,JIM 396 LA PERLE LN COSTA MESA, CA Owner: ROSS, NEIL B Address 396 LA PERLE LN Contractor: Address: ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool I Spa Lighting Fizis Recept OuUets Switthes Non Res Appl Res Appl Service to 200a Service to 1000a Service over 1000a MOlors l0 1 hp COSTA MESA, CA Phone: 949-701-0482 Zip: 926273759 Phone: Zip: 92627-3759 Phone: 2ip: License: ISSUED BY: Status: ISSUED Applied: 04/30/2004 Issued: OS/04/2004 SCOPE OF PERMIT REF: B04-00438. DEMOLISH EXIST. ATTACHED GARAGE AT THE FRONT AND ADD 391 SF TO THE 1ST STORY TO CREATE A STUDY ROOM, EXTEND KITCHEN AND LIVING ROOM WITH A NEW 399SF 2ND STORY MASTER BEDROOM, BATHROOM AND CLOSET. FOR A TOTAL OF 1702SF. REF: 804-00439 (NEW GARAGE) ELECTRICAL TO INCLUDE: 7 LIGHT FIXTURES, i6 OUTLETS, 11 SWITCHES, 3 RES APPLICANCE, 1 SERVICE TO 200 AMP AND RELOCATE SERVICE. 523.50 $0.00 $0.00 $0.00 $0.00 $0.00 $7.70 517.60 $12.10 $0.00 514.25 530.50 ao.00 $0.00 so.00 Quantiry 0 0 0 7 16 71 0 3 t 0 0 0 FEE SUMMARY Temp Dist System / Lighting Busway /100 ft Standing Section Misc Electncal Equipment Trensformers 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 I Ckt Misa Conduit Misc. Contlucror Circus ( gen or ride) Circus (mech ride or lights) Quantiry $0.00 0 $0.00 0 $0.00 0 $0.00 0 so.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 so.00 0 $0.00 0 ao.00 0 so.00 0 $0.00 0 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, 12-21-92) EXPIRATION: This permit shall automatically expire and become void it work is not commenced within 180 days, or ii work is suspended or abandoned for a pe�iod 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 Inspeetiona and finel approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of ihis permit. FOR INSPECTIONS CALL: (714) 7545626 2A46d8(N00) r WORKERS' COMPENSATION DECLAFiATION: I hereby eRirm untler penalry ot perjury one of Ihe tollowing tleclarations: ❑ I heve antl will maintain a certiticate of consent to sell-Insure for workers' compensation, es providetl for by section 3700 of the Lebor Code, for the peAormance ot the work for which Ihis permit is issued. ❑ I have and will maintain workers' canpensati n insurance, as required by section 3700 oi the Lebor Cotle, Por the perfortnance of Ihe work for which this pertnit is issued. My workers' com``pen tio uran,eFar9'9 a olicy number ere: arner: / � V� Policy Number: h/s section need not be comple d il the p it is velued at one hundretl tlollars ($100) or Iess.J certity that in the perfo nce of the work tor ic pertnil is issued, I shall not employ any person in any manner so es to become subject to Ihe workars' compensation laws o ifomia, end egree t If ou become subjact to lhe wp rkers' compensation provisions of Section 3700 the Labor otle, I shall forthwith comply with these � lons. �L.- (� i 1\ p Appliwnt Signature: '�X� Data: 7 V 7 WARNING: FAILURE TO S URE WOFKEPS' COMPENSATION COVERA UNIA UL rWD SHALL SUBJECTlW EMPIOVER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE HUNDRED THOUSANDDOLLAREI$ ,OOO),INApDITIONTOTHECASTOFCOMP TIQV,DAMAGESASPFiOVIDEDWRINSECTIdJ3]O60FTHElA80RCODE,INTEFEST,ANDATTORNEY'SFEES. LICENSED CONTRACTORS DECIARAT10N: I hereby eHirm that I am licensed under Orovisions of Chapter 9(commencing with Section 7000) ot Division 3 of ihe Business and Protessions Code, entl my licanse is in full lorce entl eHect Lic. # Cless N Conirectofs Signature:� Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby aHirm that there is a consiruction lending agency br the pedormance of the work for which this pertnit is issued. (Sec. 3097, Civil Code). Lender's Name: _ Lenders Address: SigneWre: OWNER-BUILDER DECLARATIONS: Date: I here6y aHirtn that under Oenalry of perjury that I am E%EMP7 FROM TME CON7FiACTORS LICENSE LAW tor the tollowing reason (Sec. 7031.5, Business and Professions Cotle: Any ciry or counry whic� requires a permit to construct, alter, improve, tlemolish, or repair eny struciure, prior to its issuance, also requires the applicant for such permit to tile a signetl statement that he or she is licensetl pursuant ro the provisions of ihe Contracbrs License Lew (Chapter 9(commencing with Section 7000) of Division 3 of tha Business and Professions Cotle) or Ihet he or she is exempt therefrom end the basis for the ellegad exemption. Any violation oF Section 7031.5 by eny applicant lor a permit subiects tha epplicant to e civil penalry of not more than five hundred dollars (5500).): ❑ I, es owner of the property, or my employees with wages es Ihelr sole compensation, WILL DO TME WORK, antl the structure is not intended or offered tor sale (Sec. 7044, Business and Professions Code: The Contradors License Law dces noi apply to en owner of property who builtls or improves ihereon, and who does such work himself or herselt or through his or her own employees, provided that such improvements ere not intentletl or oMered for sale. tl, however, the building or improvement is sold within one year ot completion, ihe owner-builder wili heve the burden of proving thet he or she did not build or improve for purpose of sale.). � ❑ I, as owner ot th property, em E%CLUSIVELV CONTRACTING WITH LICENSED CON7RACTORS to consiruct ihe project (Sec. 7044, Business and Professions Code: The con ctors License Law d s not ply to an owner of property who builds or Impmves thereon, and who coNrects for such prolect with e contractor(s) license pursu t to the Contractors cens s.). ❑ I am exem ntler sec. Business and Protes ' ns e for t 5 r son: Signa�ure: Daie: Owner ID veri ed 6y tlrivefs license. ❑ Yes Dnver'S LiC 5e No. Ezpire5: Vedfication�f Ownership by (type of tlacument, i.e./ pro�erty tex blll or deed): DIVISION OF INDUSTRIAL SAFEN PERMIT ❑ I hereby certify ihat no excavetion five (5) or more feet in depth imo which a person Is required to tlescentl, will be made in connection with work euthodzed by Ihis permit, and ihat no building simcture, scaflolding, falsework, or demolition or dismantling thereof, will be more then thirty-six (36) feet high. (Chap. 32, Grp 2, Ah 2, Sec. 341, Tula B, Calitornie Adminisiretive Code). ❑ As owner-builder, I will not employ anyone to tlo work which would require a pertnil from the Division of Industnal Setety, as notetl aDove, unlass such person has a permit to tlo such work fram Iha division. Signature: Date: Division of Intlustriai Safety Permit Number. CERTFlCA7E COMPLIANC� A ORI 710N OF ENTRV: I certify under penalry of perjury that I have read ihis epplication and state that Ihe information given is correct I agre o comply wlth ell te I � city ordinences relating to builtling consimction, entl authonze represematives of the Ciry of Costa Mesa to enter upon ihe ebove-descri d propeey for in ctio ury es. I agree not to occupy or allow occupency of eny 6uilding authorized by y�is per� u� I'na 'nspection. S/ T Si�nature Of Leaal Owner �— a�e COOEI, INSPECTIONTYPE 1616 Fized System Final Fire Pi 1266 Pool Spa Finel 200 Final Re-Root 201 Finel Block/Retaining Well 202 Final Factory Fire Place 203 Finel Sign 204 Final Demolition GdiE INi1TIAL5 COUE I INSPECTION TYGE 206 Final Mechanical 20B Final Plumbing 210 Final Electrical 212 Final Fira Prevention 220 Final Planning Approval 222 Final Site 250 Final Building�Occupancy �_� mi.. / , . `�� From: Sent: To: SubjeCt: SHIH, WENDY Friday, June 10, 2005 10:43 AM BUILDING INSPECTIONS 1392;E:;16th St.7(B04-00438 and 439) E � Y To Whoever will be the Final Building Inspector: I inspected the site today and found that they did not have their address numerals installed in the front. I signed the card anyway and told them I'd have the Buiiding Inspector make sure iYs in place before finaling permits. Also, I remember somewhere along the lines they started bootlegging a wet bar and shower? There is a very specific requirement that the bathroom contains toilet and sink only, definitely no shower or future shower. Thanks!!! Wendy � . 39Z �//�� . �` za,�oa-l�.t Water Quality Management Plan CwQ M P) For: Non-Priority Project Name: �o s 5��s1a�� GRADING PERMIT NO., BUILDING PERMIT NO., TRACT NUMBER, CUP, SUP AND/OR APN (SPEQFY LOT NUMBERS IF SITE IS A PORTION OF A TRACi� z�0 5�� 0a5/38 � �9 Prepared for: Owner/Developer Name: /(��i� ,�,� Address: � 9,2 � /( �- � City, State ZIP: G',� Telephone Number: C9��%S�-� �35� Prepared by: City of Costa Mesa 77 Fair Drive, PO Box 1200 Costa Mesa, California'92628-1200 (714)754-5323 Date Prepared: Wat+e� Qyal' anage t P/an (WQMP) Non-Priority Project Nam� �� Project No. OWNER'S CERTIFICATION ZA,.04-11 WATER QUALITY MANAGEMENT PLAN NON-PRIORITY PROJECT NAME: �� 5 � . FOR PEnMIT/PLANNING APPLICATION NUMBER & TRACT/PARCEL MAP NUMBER This Water Quality Management Plan (WQMP) for the Non-Priority Project Listed above has been prepared by the applicant. This WQMI' is intended to comply with the requirements of the City of Costa Mesa, Development Services, Tract/Parcel Map No. _ , Condition Number(s) , and/or Site Development Permit/ Application Number , Condition Number(s) requiring the prepararion of a Non-Priority Water Quality Management Plan. The undersigned, while it owns the subject property, is responsible for the implementation of the provisions of this-plan and will ensure that this plan is amended as appropriate to reflect up-to-date conditions on the site consistent with the current Orange County Drainage Area Management Plan (DAMP), and the intent of the non-point source NPDES Permit for Waste Discharge Requirements for the County of Orange, Orange County Flood Control District and the incorporated Cities of Orange Counly within the Santa Ana Region Stormwater Runoff Management Program. A copy of this WQMP will be maintained at the project site or project office. This WQMP will be reviewed with the facIlity operator, facility supervisors, employees, tenants, maintenance and service contractors, or any other party having responsibility for implementing porrions of this Water Quality Management Plan. Once tlie undersigned transfers its interest in the property, its successors-in-interest shall bear the aforementioned responsibility to implement and amend the WQMP. An appropriate number of approved and signed copie5 of this document shall be available on the subject site in perpetuity. NomPriority WQMP Model Version 1.0 Certification Prepared: July 16, 2003 Contents WadeM-dl�Management P/an (WQMP) Non-Priority Project Name. �S5 t��S Project No. Z A�0 4- 1 j N Section I Tract or Discretionary Permit Number(s), Water Quality Condition(s) Number(s) and Conditions........................................................................................................................................1 SectionII Project Desviption .........................................................................................................2 Section III Best Management Prectices (BMPs) .............................................................................3 Section IV Educadona! Materials Included ......................................................................................6 Attachments AttachmentA .................................................................................................. Educational Materials Non-Pnonty WQMP Mode{ Version 1.0 Prepa�red�.�July�16t2003 Section I Non-Pr�ority Non-Priori waterQua/it,•,v ��1e h'f'^�l�'tNana � ��(W�yp� f'^�.l�nt No. Tract or Discret�ona � Number(s), Vyater � Aerm�t Cond�tion(s) N�mber s�� Conditions � ) and Prolect Name: GRAd2MG PER� NO.. gVI�ING PE (SPECIFY !OT NUMBERS �FI S 7'E I�p pp RTION OF q� � �P, SUP AND/OR APN Q %"'� �S �c,�s rn za.o4-, Nan-Priority WQMP Mcdel Version t_0 Arepared: lul�ctiof7 I Y 16. 2p03 Wah- �uality Management P/an (WQMPJ Non-Priority Project Na,. , Project No. Section II Project Description i'his Project has been determined to be a Non-Priority Project within the City of Costa Mesa and is covered by this model Water Quality Management Plan. Section A.7.5 of the Local Implementation Plan accepted by the City Council on June 2, 2003 and as revised requires the development of a Water Quality Management Plan for all projects. This model plan has been developed by the City of Costa Mesa for those Non-Priority projects that are associated with an over the counter permit or have been determined as Non-Priority. Prior to issuance of grading or building permits, the City requires the project applicant to have an approved final Project WQMP. The City shall utilize the following checklist to identify the project as a Priority Project or Non-Priority. Figure A.7.2 of the Local Implementation Plan defined the following Checklist for Categorizing Development and Significant Redevelopment� Projects as Priority or Non-Priority impervious suAaces on an already developed site. Signi(cant redevelopment includes, but is not limited to: the expansion of a building footprint, addRion to or replacement of a struCure: replacement of an impervious surtace that is not part of a rouUne maintenance adiviry; and land disturbing activities re�ated with structural or impervious surtaces. Replacement of impervious suAaces inGudes any activity Ihat is not paA of a routine maintenance adiviry where impervious material(s) are removed, exposing underlying soil during wnstniction. Significant redevelopment does not include trenching and resuAacing associated with utility work: resuAaanq and rewnfiqunng surtace parking lots; new sidewalk wnslruclion, pedestrian remps, or bike iane on public and private existing roads; and replacement of damaged pavement. Environmsntally Sensitive Areas are shown in Figure A.l� of the Loca11mp1ementaHon Plan. The WQMP for a Non-Priority Project must address the following items, which have been incorporated in this Model WQMP: : Routine structural and non-structural Source Control BMPs; > Consideration of Site Design BMPs; and > The mechanism(s) by which long-term operation and maintenance of all structural BMPs will be provided. Section II Non-Priority WQMP Model Version 1.0 Prepared: ]uly 16, 2003 " ' Wate� ara/' anagement P/an (WQMP) - Non-Priority Project Nam. s � _ � . Projeci Na Section III Best Management Practices (BMPs) Source Control BMPs z nao �- ii � The following tables show source control BMPs (routine non-structural and rourine structural) included in this project and those that were not included. Routine BMPs Cheek One �f not applicable, state brief IdentiTier Name Not Ineludad reason Ieabla SC-10 Non-Stormwater Discharges � � SC-11 Spiil Prevention, Contral and Cleanup � � SC-20 Vehide and Equipment Fueling � � SC-27 Vehicle and Equipment Cleaning � � SC-22 Vehide and Equipment Repair � � SC-30 Outdoor Loading / Unloading � � SC-31 Outdoor Conlainer Storage � � SC-32 Outdoor Equipment Maintenance � � SC-33 Outdoar Storage of Raw Materials � � SC-34 Waste Handling and Disposal � � SC-35 Safer Altemative Produds � � SC-41 Building and Grounds Maintenance � � SC-43 Parking / Storage Area Maintenance � � SC-60 Housekeeping Pradices � � SC-70 Road and Street Maintenance � � SC-71 plaza and Sidewalk Cleaning � � � SC-72 Fountains and Pools Maintenance � � SC-73 Landscape Maintenance � � SC-74 Drainage System Maintenance � � SG76 Water and Sewer Uti(ity Maintenance � � Non-Priority WQMP Model Version 1.0 Prepared: ]ulyCi6, 2003 Wat�- Qua/ity Management P/an (WQMP) � Non-Priority Project Na. .. Project No. , � RouGne SWctural BMPs Check One Name Not �f not appticable, state brief reason Included APPlieable Provide storm drain system stenciling and ❑ � signage Design and conshud outdoor material storage ❑ � areas to reduce pollution inVoducfion Design and canstruct trash and waste storage ❑ � areas to reduce pollutian introduction Use eficient irtigation systems & landscape design, water conservation, smart controllers, � � and source wntrol Protect slopes and channels and provide ❑ � energy dissipation Incorporate requirements applicable to ❑ � individual projecl features a. Dock areas � � b. Maintenance bays � � c. VehiGe wash areas � � d. Outdoor processing areas � � e. Equipment wash areas � � f. Fueling areas � � g. Hillside landscaping � � h. Wash water wntrol for food ❑ � �preparation areas � i. Community car wash racks � � Site Design BMPs The following table shows site design BMPs that are included in this project. A description of each BMPs foliows: Technique �ious Area/Maximize Facror Reduction) or (Runoff Volume Reduction) Conserve Natural Areas (GFactor Reduction) Non-Prionty WQMP Model VerSion 1.0 Site Design BMPs Included? Yes No ❑ � ❑ � ❑ � Brief Description of Method Sedion III Prepared: ]uly 16, 2003 ,, . WaQer /' �Imr Management P/an (WQMP) Non-Prio�ity Project Name. . ProJect No. Treatment BMPs L A�,O 4- 11 The following table shows treatment BMPs that aze included in this project. A description of each BMP follows: TreatrneM BMPa Check One �f not applieable, state brief IdBndfier Name N� Included reason Appliwble 7C-10 Infiltration Trench � � 7C-11 Infiltration Basin � � 7C-12 Retentian / Irrigation � � 7C-20 Wet Pond � � 7C-21 Constructed Wetland � � 7C-22 Extended Detendon Basin � � 7C-30 Vegetated Swale � � 7C31 Vegetated Buffer Strip � � 7C-32 Bioretention � � 7C-40 Media Filter � � 7C-50 Water Quality Inlet � � 7C-60 Multiple Systems � � MP-ZO Welland � � MP-40 Media Filter � � MP-50 Wet Vault � � MP-51 Vortex Separator � � MP-52 Drain Insert � � Section III Non-Priority WQMP Model Version 1.0 Prepared: July 16, 2003 Wa� �ua/ity Management P/an (WQMP) Non-Priority Project Na...e: Project No. • ,� Section IV Educational Materials Included � The following is a list of educational materials, available from the County of Orange website (http://www.ocwatersheds.com/PublicEducation/pe .brochures.asp), included in this WQMP. ■ The Ocean Begins at Your Front Door ■ Do You Know Where the Water in Your Storm Drain Goes? ■ Landscape & Gazden ■ Keeping Pest Control Products Out of Creeks, Rivers and the Ocean . Pet Waste ■ Carpet Cleaners Sedion IV Non-Pnonry WQMP Model Version 1.0 ' Prepared: ]uly 16, 2003 (774) 754-5273 • Fa�c {714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 392 E 16TH ST Suite: Viciniry: Parcel Number: 42519114 Applirant: JIM SKAUG Address: Owner: ROSS, NEIL B Address 392 E 16TH ST COSTA MESA, CA Contraclor: Address: Zip: Arch : Address: � Phone: Zoning: Phone: 949-584-6934 Zip: Phone: Zip: 92627-3759 Phone: �icense: ISSUED BY: Eng: HAROLD LARSON Address: 1437 GLENNEYRE Status: ISSUED Applied: 02/26/2004 Issued: 04/30/2004 Phone: 949-497-5203 LAGUNA BEACH Zip: License: 92651 License: C33222 SCOPE OF PERMIT DEMOLISH EXIST, ATTACHED GARAGE AT THE FRONT AND ADD 391 SF TO THE 1 ST STORY TO CREATE A STUDY ROOM, EXTEND KITCHEN AND LIVING ROOM WITH A NEW 399SF 2ND STORY MASTER BEDROOM, BATHROOM AND CLOSET. FOR A TOTAL OF 1702SF REF: 804-00439 (NEW GAR4GE) Plan Check: $500.34 Permit: $769.75 SMIP Res: $6.80 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $1,276.89 SETBACKS MAIN STRUCTURE Front 16- 9 ACCESSORY Front 0-0 PARKING Existinq: z Rear 1S 0 Rear 0- 0 Required: 4 FEE SUMMARY PLANNING & ZONING Left 3- 0 Left 0. 0 Pr000sed: 4 Calc Valuation: Claim Valuation Right S 0 Right 0- 0 ss�,sso.00 so.00 NOTICE: 7he work authonzed 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 automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned for a period of 180 days, INSPECTIONS: In orqer for lhe work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all required inspeetions and final approval must be obtainetl. FaiWre to obtain inspections and final approval will result in the expiration of Ihis permit. � FOH INSPECTIONS CALL: (714) 7545626 24nb�d6(6/00) WORKERS' COMPENSATION DECLARA710N: I hereby ettirtn under penalry of perjury one ot the tollowing declarations: ❑ I have end will meintain e cetlificele oi consent to selGlnsure for workers' compensatlon, es provitletl for by section 3700 0l the Labor Code, tor ihe peAormance of Ihe work lor w�ich Ihis parmi� i5 i55uetl. ❑ I have end will maintain workers' comp nsation in rance, es raquiretl by section 3700 of ihe Lebor Code, for the peAormance of the work for which this Oertnit Is issued. My workers' co(mp9r('�s_a(tIon Insurenc arn d Oolicy number are: � Cerrier: \ V/`�% � PoISyNumbar: is s non need no e complefed il t e permif is valued af one hundred dollars ($100) or less.) I certity Ihat in the pedortn a of i�e work for hi this permit is issued, I shell not employ any pereon in any manner so as to become subject to �he workers' compensetion laws of Ce' mia. and egrae t' s Id becoma subject to the warkers' compensation provisions ot Sectlon 700 ot t e Lebor otle, I shall forthwith comply with these pro ons. Applicenl Signeture: Date: 4 O WARNING: FAILURE TO SEC E WORNERS' GUMPENSATION COV GE IS UNL4WFULlWD SHALL SUBIE4T AN EMPLOVER TO CRIMINAL PE TIES A D GVIL NES UP TOONE HUNDRED TFKKISAND DOILARE (Sl . ). IN r1DpITION TO iHE COST OF M NSATON, pAMAGES AS PiiOVIOED FOR IN SEGTIIXJ 3](I60F THE IABOR CODE, INTEREST, ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby eHirm t�ai I am licensed untler provisions oi Chapter 9(commencing wilh Section 7000) of Division 3 of tha Business entl Professions Cotle, anA my license Is in full t�orc,le tl flact. Lia b Cfass W ,c�c��,d$iqnakue: Date: CONSTRUCTION LENDING AGENCV: ❑ I hereby eHirtn that lhere is e constmction lending agency for the pertortnance ol the work br which t�is permit is issued. (Sec. 3097, Civil Code). Lentler's Name: Lender's Address: SignaWre: Date: OWNER-BUILDER DECLARATIONS: I hereby eHirtn Ihat untler penalry of perjury that I am E%EMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Buslness antl Professions Code: Any ciry or counry which requires e partnit to construct, afler, improve, tlemolish, or repair any structure, pnor to its issuance, elso requires the eppliwnt tor such pertnit to lile e signed statement thet he or she is licensed pursuant to the OroNslons ot the Gonirectors License Law (Chapter 9(commencing wit� SecUon 7000) of Division 3 ot ihe Busine d Protessions Code) or thai he or she is exempt therefrom and the basis for t�e alleged e:emption. Any viola��on af Saction 7031.5 by any applicant for a pertnit ubl the applicant to a civil penalry of not more ihan five hundretl Aollare ($500).): I, as owner oi the pro0erty, or my employees with wages as iheir sole compensation, WILL DO 7HE WORK, and the structure is no1 inteMed or oHeretl for sale (Sec. 7044, Business antl Professions Code: The Contractors Ucense Lew does not apply to en owner ot properry who builds or improves thereon, entl who tloes such work himself or herself or Ihrough his w �er own employees, provided that such improvements ere not intended or oHered tor sale. If, however, the building or improvement is sold within one yaar ot completion, the owner-builder will �eve the burden ol proving that he or she did not build or improve for purpose ol sale.). ❑ I, es owner ot lhe property, em EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the prqect (Sec. 7044, Business and Profeuions Cotle: The co ractors Llcense Le does not apply to en owner o� propetly who 6ulld5 or Improves thereon, and who contraqs lor such pm�ect wlih e contwctor(s) license purs � nt to the Contract ' nse Laws.). ❑ I em e:e under sec. Business antl Professions Code f thi r aso : Signature: D te: Owner ID ve ' ad by tlnvefs licen5e. es No DnvefS LitenSe No. ' Expires: Verilicetion f Ownership by (type ol daument i.e. properiy tez bill ar daedJ: DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIPICATION: ❑ I here6y certify tha� no excava0on five (5) or more feet in depth into which a person Is requlretl b descend, will be mede In connection wi�h work euthorized by this permil, and Ihat no building simcWre, scaHolding, falsework, or demolition or dismantling ihereot, will be more ihan ihirty-six (36) feat high. (C�ep. 32, Gry 2, Art 2, Sec. 341, Title B, Califomia Adminisirelive Code). ❑ As owner-builder, I will not employ anyone to do work which woultl require e permit from lhe Division o( Industnal Safety, as notetl ebove, unless such person has a pertnit to do such work Imm the division. SignaWra: Date: Division ot Industnal Salety Pertnil Number: CERTIFlCATE OF COMPLIANCE AND AIJfHORIZATiON OF ENTRY: I cetlily un0er penalry of perjury Ihat I have reatl MIs application end state that the infortna�ion given is correct I egree to comply with all state laws and ciry ordinences ralating to building construction, and authorize representatives of Ihe Ciry of Costa Mesa to enter upon the ahova-described property for inspection purposes. I agree not to occupy or allow acupancy of eny building authonzed by Ihis permit until final inspection. 1616 1266 200 201 202 203 ixsvecnoxTrve Fixetl System Final Fire Pool Spa Final Finel Re-Roof Finel BIocWRetaining Wall Final Faciory Fire Place Finel Sign 207 Final Demolition Legai Owneqs) �d icant Pd1E UIIIII�kff me CODE� INSPECTIONTYPE 206 Final Mechanical 20B Final Plumhing 210 Final Elecirical 212 Final Fire Preventlon 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy To: ., � NEWPORT-MESA UNIFIED SCHOOL DISTRICT CERTIFICATE OF COMPUANCE OF DEVELOPMENT FEES �UR$I�ANT TO AB 1600 AND AB 181 pF'll�-2�JI]4108:O.y Ht9 USE�:LE 001-OQ132054 . N° 4999 (�ily of CostB Mesa District Receipt No! �/� ( ) City o( NewpoR Beach � ( ) Counly of Orange Plan Check Na ��a�3 Applicant: Address: Telephone Number: � `1" " I — � V � - � �" O r� TracUParcel and Lot Number(s): Location of Project: Number of Square Feet of: Residential Space Commercial and Industrial Space Commercia�lndustrial Projed is: (Check One) Warehouse R8D Movie Theater Mini-storage Heavy Industrial Regional Shops Light Industrial _ This project is exempt because / �� x 31.84 x S .30 _ Motel Bank _ Neighborhood Shops _ RacqueVHealth _ Hotel Medical Of6ce Office Park To�� 1 '33� CX� Total Preschoal Auto Repair Hospital Large Office O/fice Bldg. Restaurent Fast Food This certifies that the above-named Developer/Applicant has paid school fadNty fees in comp6ance wiM Government Code sections 53080 and 65995. The Building Permils for this square footage in this proposed development may now be issued by your jurisdic6on. Checks are to be made payable to Newport-Mesa Unified School Distrid. By: ANM�i¢ad RepreseMative The above represenhation as to square footage is true. Appticant agrees that if k is later determined that such representations are not true, then this certificate shall auto �� te � e and the appro ' te City/County hall be notified. � Date: M (714) 754-5273 • Faz (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 392 E 16TH ST Suite: Viciniry: Parcel Number: 42519114 Applicant: JIM SKAUG Address: Owner: ROSS, NEIL B Address 396 LA PERLE LN COSTA MESA, CA Contraclor: Address: Zip: Arch : Address: Zoning: Phone: 94&584-6934 Zip: Phone: Zip: 926273759 Phone: License: ISSUED BY: Eng: HAROLD LARSON Address: 1437 GLENNEYRE Status: ISSUED Applied: 02/26/2004 Issued: 04/30/2004 Phone: Phone: 949-497-5203 � LAGUNA BEACH Zip: License: 92651 License: C33222 SCOPE OF PERMIT CONSTRUCT NEW 473SF DETACHED GARAGE IN THE REAR WITH 405 SF SECOND STORY GAME ROOM. REF: B04-00438 Plan Check: $432.09 Permit: $664.75 SMIP Res: $5.30 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $1,102.14 SETBACKS' MAIN STRUCTURE Front 1S 0 ACCESSORY Front 0- 0 PARKING Existinq: 2 Rear 10. 0 Rear 0- 0 Required: 4 FEE SUMMARY PLANNING & ZONING Lek 5- 0 Left 0- 0 Proposed: 4 Calc Valuation: Claim Valuation: Right 2& 0 Right 0. 0 $52,997.52 so.00 NOTICE: The work authorized by this permit shall comply with all applicable hantlicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRA710N: This permit shall automatically expire and become void if work Is not commencetl within 780 days, or if work is suspanded or abandoned for a period of 180 days. INSPEC710NS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspeetions 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 2666d6 (fi100) WORKERS' COMPENSATION DECLARATION: - I hereby aflirm under penalry of perjury one ot the tollowing declaretions: ❑ I heve and will maintain a certiticate of consent ro selFlnsure br workers' compensation, es pwvided for by sadion 3700 of the Lebor Code, for the performance of the work for which Ihis permit is Issued. ❑ I have antl will maintain workers' compensation insuran e, es required by section 3700 of the Labor Code, for the peAortnance of the work for which Ihis Oermit is issued. My workers' compensat�on Ir�qurerpe�arrier and pp1f� nember are: Carriar: 7his se nan need nof be c� I certify that in the per compensation laws ot compty with thes� Applicent Signature: of lhe entl WARNING:FAILUPETOS UREWOFKERS'GOMPENSnIIt Tl/OUSANDDOLLARE($1 ,000),INApDRIONTOTHECOST IICENSED CONTRAC70RS DECLARATION: ' � Policy Number: d at one hundred dona�s (St00) or iess.) h this permit is issued, I shall not employ eny person in any manner so es to bepome subject ro the workers' should becoma subject to the workere' compansation provisions of Sactlon 37 0 of Ihe bor o e, I shall torthwit� Date: Q bVE 6E IS UNLAWFUL AND SHP1L SUflIECT AN EMPLOYER TO CRIMINAL PENALTIES AND IL FlNES UP TOONE HUN�RED ENSATION, DAMhGES AS PROVIDED FOR IN SECTION 31W OF THE LABOR CODE, INTEREST, PND ATTORNEV'S FEES. I hereby attirm that I am licensetl untler provisions of Chepter 9(commencing with Saction 7000) ot Division 3 ot the Businass antl Professions Code, end my license is in tull force end eHecL Lic. # qass q CONractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby aHirm ihat Ihere is a constmction lending agency for the pertormance ol the work for which this permit is issuetl. (Sec. 3097, Civil Code). Lender's Name: Lenders Address: Signeture: Date: OWNER-BUILDER DECLARATIONS: I hereby atFirtn that under penalry of perjury ihat I am EXEMP7 FROM TME CON7RAC70R5 LICENSE LAW for �he following reason (Sec. 7037.5, Buslness and Protessions Code: Any ciry or counry which reQuires e pertnit to conswc6 elter, improve, demolish, or repair eny strucwre, prior to its issuance, also requires the epplicant tor such pertnit to tile a signed statement thet he or she Is licensetl pursuent to Ihe provisions ot the Contractors License Law (Chepter 9(commencing with Section 7000) of DlNsion 3 oi tha Business end Professions Code) or thet he or she is exempt therefrom and the basis for the ellegad exemption. Any violetion of Section 7031.5 by any applicant tor a pertnit ubj e applicant to a civil penelry of noi more than five hundred dollers (5500).): I, as owner of Ihe property, or my employees with weges es their sole compensation, WILL DO 7HE WORK, antl the structure Is not intended or oHeretl for sale (Sec. 704a, Business and Professions Code: The Contractors License Lew does not apply to en owner of property who builds or improves thereon, and who does such work himself or harself or through his or her own employess, provided that such impwvemanis are not intended or oflered for sale. H, however, �he building or Improvement Is sold within one year of completion, ihe owner-builder will have ihe burden of proving that he or she did not build or impwve for purpose of sale.). � ❑ I, es owner oi the property, em E%CLUSIVELV CONTRACTING WITM LICENSED CONTRACTORS to constmct the prolect (Sec. 7044, Business and Professions Code: The coniractors License Lew does not apply to en ownar oi property who bullds or Improves thereon, entl who contracts for such prolect wkh a contrector(s) license pursuanyj2 the Comragtors License Lews.). ❑ lam Signature: Owner ID � Vedfication sec. by (type of Business and Professions Code mr this reason: ❑ No i.e. - properry tax hill or deed): Driver5 LiCense No. Expires: DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no escavetion tiva (5) or more feat in depih into which a person is required to tlescend, will be made in connection with work authonzed by this permit, and that no building stmcWre, scattolding, falsewofic, or demoli�ion or dismantling ihereof, will be more ihan ihirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title B, Calitomia Administrative Gotle). ❑ As ownar-builder, I will no� employ anyone to do work which would require a permit trom the Division of Indus�nel Safery, as noted above, unless such person has a pertnit to do such work from ihe division. SigneNre: Date: Division oi Intlustrial Satety Permit Number: CERTFICATE OF COMPLIANCE AND AUIHORVA710N OF ENTAY: I certify under penalry of perjury that I have read ihis epplication antl state that iha infortnation given is correct I agree to comply wlth ell state laws antl city ordinances releting to builtling consiruction, end au�horize represematives of Ihe Ciry of Costa Mesa to enter upon the ebove-described property tor inspection purposes. I agree not to ocapy or aliow occupancy of any building amhorized by this permit until final inspection. 1616 1266 200 207 202 203 INSPECTIONTYPE I / l/ Fized System Final Fire Prevantion Pool Spa Final Final Re-Roof Final BIocWRetaining Wall Final Factory Fire Place Final Sign 204 Final Demolition �A� RL �� t � Da�e CODE� INSPECTIONTYPE 206 Final Mechanical 208 Final Plumbing 210 Final Elecirical 212 Final Fire Preven�lon 220 Final Planning Approval 222 Final Site 250 Final Building/Occupency PAIE IwmuLs (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 392 E 16TH ST Suite: Viciniry: Parcel Number: 42519114 Applicant: SKAUG, JIM Address: Owner: ROSS, NEIL B Address 396 LA PERLE LN COSTA MESA, CA ConVactor. Address: Zip: Arch : Address: Phone: Zoning: Phone: 94&584-6934 Zip: Phone: Zip: 92627-3759 Phone: License: Eng: Address: ISSUED BY: Sfatus: ISSUED Applied: 04/01/2004 Issued: 04/OS/2004 Phone: Zip: License: License: SCOPE OF PERMIT DEMOLISH EXISTING ATTACHED GARAGE AND MISC INTERIOR DEMOLITON AND EXTERIOR FINISH REMOVAL. ZA-04-'11 SHALL BE APPROVED PRIOR TO ANY CONSTRUCTION ON-SITE. 2-CAR GARAGE WITH 2 OPEN PARKING SPACES SHALL BE PROVIDED FOR THE SINGLE-FAMILY RESIDENCE. APPLICANT WILL COMPLY WITH AQMD REQUIREMENTS AND HAS RECEIVED THE AQMD FORM. Plan Check: $0.00 Permit: $83.25 SMIP Res: $0.00 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $83.25 SETBACKS MAIN STRUCTURE Front 0- 0 Rear 0- 0 ACCESSORY Front 0-0 Rear 0-0 FEE SUMMARY PLANNING & ZONING Left 0. 0 Left 0- 0 Calc Va�uation: Claim Valuation: Righl 0- 0 Right 0- 0 $3,000.00 $3,000.00 NO710E: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period o( 180 days. INSPECTIONS: In order for the work aulhorized under this permi� to be considered legal, such work must comply with all applicable codes, and all requlred Inepeetiona end final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 zaas-as �s�oo) WORKERS' COMPENSA710N DECLARATION: I hereby aflirm under penelty of perjury one ol iha tollowing declara�ions: ❑ I have entl will melnteln e certlticete ol consent to self-Insure for workers' compensatlon, as proWtled tor by sectlon 3700 0l the Lebor Code, for lhe pertortnance of the work tor which thi5 permil IS issuetl. ❑ I have end vnll maintain workers' compe tion insurance, as required by sedion 3700 of the Labor Code, for tha peAortnanca of Ihe w rk lor which Nis pertni� is issued. My workers' om sati n Insurence nd pollcy num6er ere: O, Carrier. �� Policy Numher: rs sectlon neetl nat be compl fe ed 1! tM1 ermitls velued ef ane hundrad dollaro ($100J or less.) - I certity that in the peAo nce of t�e wOrk r w ch this pertnil is issued, I shall not employ any person in eny menner so as Io become sub�ect lo [he workere' wmpensation laws ot Homie, end egr h shoultl become subject to Ihe workers' compensation provislans oi Sectlon 3700 ot the bor e, I shall torthwilh comply with these p 'sions. Applicant SlgneNre: Date: L� WARNING:FAILURETO ECUREWORKE 'COMPEN ATION E GEISUNLAWFVLPNDSW�LLSlIB1ECiPNEMPIOYERTOCRIMINALPENALTIES CMLFl ESUPT EHUNDRED hKK15ANDDOLIAR 5100,000),INADDRIIXJTOTHECQST COM SATION,DAhNGESASPROVIDEDFOfiIN5ELT10N3lOeOFTHEIABOFCODE.INiEREST,ANDATTORNE`fSFEES. LICENSED CONTRACTORS DECLARATION: I hereby ettirtn Ihat I em Ilcensed untler provlsions ol Chepter 9(commencing with Section 7000) ol Division 3 0l tha Businass and Prolessions Code, entl my license is in full farce and eXect. LJc. q Clau x Comrecrors Signature: Date: CONSTRUCTON LENDING AGENCY: ❑ I hereby eHirtn t�at there is a consfrucfion Iending epency for the Oertormance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lentlers Name: Lenders Address: SignaWre: Date: OWNER-BUILDER DECLARATIONS: I hereby attirtn Ihat under penalry of per�ury Ihet I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for ihe following reason (Sec. 7031.5, Business end Professions Cotle: Any ciry or counly which reQuires e permit lo construct, alter, improve, demolish, or repair any simcture, pnor m its issuance, also requires t�e epplicant tor such permit to file e signetl stetement t�et he ar she Is Ilcensed pursuent to the pmvisions ot the Comracrors License Lew (Chapter 9(cammencing wlth Sectlon 7000) of Division 3 ot ihe Business entl Professions Code) or ihel he or she Is exempt iherelrom end ihe basis for the allegetl exemption. Any violation of Sactlon 7031.5 by eny apP��ent for a permlt subjecis ihe eppliwnt m e civil penelty of not more than live hundred tlollars ($500).): ❑ I, as owner oi Ihe property, or my employees wl�h wages as their sole compensetion, WILL DO THE WORK, and Ihe siructure Is not Intended or offeretl far sale (Sec. 704a, Business and Professlons Cotla: The Contractors License Law does not apply to an axner of properry who builds or improves thereon, entl who does such work himself or herselt or thmugh his or her own employeas, provitletl �hal such Improvements ere not Imentletl or oHered for sale. If, however, the building or Improvament is sold within one year ol completion, ihe owneo-builder will have t�e burtlen of proving ihat he or she did not 6uild or improve for puryose of sale.). ' ❑ I, as owner of the property, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to consiruct t�e pro�ect (Sec. 70d4, Business and Profeuions Code: The comractors License Lew does not epply to an owner ol property who builds or improves thereon, end who contracts lor such pro�ect with e contrector(s) license Dursuant to the Contrectors lJcense Laws.). ❑ I am enempt untlar sec. Business antl Profassions Code for this reason: Signature: Date: Owner ID verilied by drivers license. ❑ Yes ❑ No Drivefs License No. Venfication of Ownership by (rype oi documem, i.e. - property tau bill or tleetl): Expires: DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION: ❑ I hereby certify t�at no excavation flve (5) or more teet in tlept� in�o which a person is required m descen4 will be made in conneciion with work euthodzetl by this permit, and that no building strucWre, scaMolding, telsework, or tlemolition or tlismantling ihereot, will be more �han ihirty-six (36) faet high. (Chap. 32, Grp 2, Art 2, Sec. 341, lltle B, Calitomia Administretive Cotle). ❑ As owner-builder, I will not employ enyone to do work which would require e permit from the Division of Intlustriel Sefety, es noted abwa, unless suc� person hes a permit to do such work from the division. Signature: Date: Division ot Industnal Salery Permit Number: CEHTiFlCA OF COMPLIANCE AND AUTMORQATiON OF ENTRV: I cenify untler penelty of perjury that I have read this applica�ion end state thet the infortnation given is wnect I ree to comply � a �tate laws end ciry ordlnences relaiing ilding construcf n, end euthodze representa�ives of e Ciry oi Coste Mesa to enter upon Ihe ebov�ert r i e' n puryoses. I agree noI m occupy� ello'°w acupency o building authonzed by thisy er� i�t ntd fi pe tion. ,. 1 /�'sr�;e,,� -T ��'(�'f Siana Of Leoal wner(sl �— 'J aie COpE �. INSVECTIONTYPE 1616 Fixetl System Final Fire Preventlon 126fi Pool Spa Final 200 Final Re-Rool 201 Final 81xWRetaining Wall 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition ➢A7E IMRIRLS CODE� INSVECTIONTYPE 206 Final Mechanicel 208 Final Plumbing 210 Finel Elecirical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy PATE II�IeLfl April 22, 2004 L' CITY OF COSTA MESA P.O. BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 92628-1200 DEVELOPMENTSERVICES DEPAFTMENT Neil Ross 392 E. 16`h St. Costa Mesa, CA 92627 RE: MINOR DESIGN REVIEW/ADMINISTRATIVE ADJUSTMENT AND MINOR CONDITIONAL USE PERMIT ZA-04-11 362 EAST 16T" STREET, COSTA MESA Dear Mr. Ross: The minor conditional use permit/administrative adjustment/minor design review for the above-referenced project has been completed. The application has been approved, based on the following project description and findings, subject to the conditions set forth below: PROJECT DESCRIPTION The property is located near the northwest corner of East 16`h Street and Tustin Avenue. It is developed with a single-story, single-family residence, a nonconforming single-car garage, and a detached shed in the backyard. The applicant proposes to demolish the single-car garage and shed, construct a detached 2-car garage with a game room and bathroom above, expand the existing residence, and add a second floor to the residence. Minor modification MM-04-16 was approved for a 4 ft. (20%) encroachment into the front setback (20 ft. required; min. 1 6 ft. proposed) for 4 support columns for a porch area in front of the house, a porte cochere over the driveway, and a 1 ft. (33 1/3 %) increase in maximum fence/wall height (36 in. max. allowed; 48in. proposed) above the highest grade along the front property line. ANALY5IS MINOR dESIGN REVlEW A minor design review is required for 2-story construction or 2nd floor additions that do not meet all the Residential Design Guidelines to ensure proper design consideration and compatibility with surrounding properties. Builtling Division (714) 754-5273 • Cotle Eniorcemen� (714) 754-5623 • Planning Division (714) 754-5245 FA% (714) 754-4856 • TDD (774) 754-5244 • www.ci.costa-mesa.ca.us 392 East 16'" Street April 22, 2004 Page 2 Main Building: J The design guidelines recommend an average of 10 ft. side setback for 2nd floor additions. Proposed is a 7.5 ft. average right (east) side setback for the 2n° floor addition to the single-family residence. There are several 2-story structures in the area with less than an average 10 ft. side setback. It is staff's opinion that the proposed construction would not be obtrusive from on- or off-site because it is only 399 sq. ft. in area and set back approximately 15 feet further from the street than the first floor. All elevations (including the right (east) side) incorporate multiple building planes and breaks in the roof to create visual interest. The right (east) side of the proposed construction incorporates non-viewing windows and overlooks the roof of the adjacent single- story residence. Accessory Building: The proposed 2-story accessory building (game room above garage) does not meet the recommended design guidelines of 10 ft. average side setback and 80% 2nd to 1�' floor ratio. The 2nd floor provides a 5 ft. left (west) side setback and an 88% 2"a to 1�` floor area ratio (405 square feet/462 square feetl. Due to the size, design, and location of the accessory building, staff believes that it will have minimal visual impact on the adjacent property to the left (westl. The second floor at 5 ft. left (west) side setback is only 18 ft. in Iength with one non- viewing, bathroom window. The second floor is also offset from the first floor to create a horizontal plane break for visuai relief. ADMINISTRATIVE ADJUSTMENT The applicant requests an administrative adjustment to encroach 2 ft. into the required left (west) side setback (5 ft. required; 3 ft. proposed) for two columns to support a porte cochere over the driveway. The requested administrative adjustment is for two columns only. Code allows a 2- 'h ft. encroachment into the 5 ft. side setback for roof overhangs. The columns will support an approximately 115 square-foot decorative lattice cover above. The lattice cover complies with Code in terms of setbacks. It is staff's opinion that the proposed architectural element enhances the design of the front elevation and provides visual interest and transition from the first to second floor. The 2 foot encroachment is necessary to provide the code-compliant 10 ft. driveway width. MINOR CONDITIONAL USE PERMIT A minor conditional use permit is required for an incidental residential use that includes a bathroom. Proposed is a game room with a'/z bathroom (toilet and sink only) above a detached, 2-car garage. 392 East 16`" Street April 22, 2004 Page 3 The game room above the detached garage is only 405 square feet with oniy a sink and a toilet. Access to the second floor is from the backyard area directly behind the residence. Staff has included a condition to require elimination of the "storage" area inside the bathroom so that it cannot be easily converted to a bathtub. Staff is also requiring a land use restriction to be recorded against the property to ensure and provide notice that the detached structure may not be converted to a separate dwelling unii. FINDINGS The information presented substantially complies with Section 13-291e) and 13-291g1114) of the Costa Mesa Municipal Code in that: a. The proposed development and use is compatible and harmonious with uses on-site as well as those on the surrounding properiies. The project meets or exceeds ali residential deveiopment standards and intent of design guidelines. b. Safety and compatibility of the design of the buildings, parking areas, landscaping, luminaries, and other site features including functional aspects of the site development such as automobile and pedestrian circulation have been considered. c. The project is consistent with the General Plan. d. The planning application is for a project-specific case and does not establish a precedent for future development. e. The information presented substantially complies with Costa Mesa Municipal Code Section 13-29(g1114) in that the project complies with the City of Costa mesa Zoning Code and meets the purpose and intent of the Residential Design Guidelines, which are intended to promote design excellence in new residential construction, with consideration being given to compatibility with the established residential community. This minor design review includes site planning, preservation of overall open space, landscaping, appearance, mass and scale of structures, location of windows, varied roof forms and roof plane breaks, and any other applicable design features. Both the single-family residence and the accessory structure incorporate plane breaks and other design features to break up the elevations and to provide visual relief. Consideration has also been given to the size, design, and location of the second floor areas to minimize visual and privacy impacts on adjoining properties. f. The intormation presented substantially complies with section 13-29(g1�1) of the Costa Mesa Municipal Code in that special circumstances applicable to the property exist to justify granting of the administrative adjustment 392 East 16`" Street April 22, 2004 Page 4 from side setback requirements (5 ft. required; 3 ft. proposed on the left (west) side) for 2 columns supporting a porte cochere over the driveway. Strict application of the zoning ordinance would deprive the property owner of privileges enjoyed by owners of other property in the vicinity under identical zoning classification. Specificaily, the porte cochere provides visual interest at the front elevation, as suggested by the design guidelines, and the encroachment is necessary to provide the Code compliant driveway width. Granting of the administrative adjustment will not allow a use, density, or intensity, which is not in accordance with the general plan designation for the property. g. The proposed development/use, subject to conditions, is substantially compatible with developments in the same general area. Granting the minor conditional use permit will not be detrimental to the health, safety and general welfare of the public or other properties or improvements within the immediate vicinity. Granting the minor conditional use permit will not allow a use, density or intensity which is not in accordance with the general plan designation for the property. 2. The project has been reviewed for compliance with the California Environmental Quality Act (CEQA1, the CEQA Guidelines, and the City environmental procedures, and has been found to be exempt from CEQA. 3. The project is exempt from Chapter XII, Article 3 Transportation System Management, of Title 1 3 of the Costa Mesa Municipal Code. CONDITIONS OF APPROVAL Ping. 1. A land use restriction (stating that the accessory structure) may not be converted to a separate dwelling unit) executed by and between the applicant and the City of Costa Mesa shall be recorded prior to the issuance of building permits. App�icant shall submit to the Planning Division a copy of the legal description for the property, and either a lot book report or current title report identifying the current legal property owner so that the document may be prepared. 2. Delete or raise the second floor game room window on the rear (north) elevation. 3. Street address shall be displayed on the fascia adjacent to the main entrance or front door in a manner visible from the public street. Numerals shall be a minimum 6" in height with not less than Y=" stroke and shall contrast sharply with the background. 4. All new and existing construction shall be architecturally compatible with regard to building materials, style, colors, etc. Plans submitted for pian check shall indicate how this will be accomplished. 392 East 16'" Street April 22, 2004 Page 5 5. 6. Eng. 7. � The conditions of approval and ordinance or code provisions of minor design review ZA-04-11 shall be blueprinted on the face of the site plan as part of the plan check submittal package. The applicant shall contact the Planning Division to arrange for a Planning inspection of the site prior to the release of occupancy/utilities. This inspection is to confirm that the conditions of approval and code requirements have been satisfied. Maintain the public right-of-way in a"wet-down" condition to prevent excessive dust and promptly remove any spillage from the public right- of-way by sweeping or sprinkling. CODE REQUIREMENTS The following list of federal, state and local laws applicable to the project has been compiled by staff for .the applicant's reference. Any reference to "City" pertains to the City of Costa Mesa. Ping. 1 . 2. Bldg. 3. 4. Fire 5 Eng. 6 Approval of the Zoning Action is valid for one (1) year and will expire at the end of that period unless building permits are obtained or the applicant applies for and is granted an extension of time. All contractors and subcontractors must have valid business licenses to do business in the City of Costa Mesa. Final inspections will not be granted until all such licenses have been obtained. Comply with the requirements of the California Code of Regulations, Title 24, also known as the California Building Standards Code, as amended by the City of Costa Mesa. Water Quality Order 99-08-DWQ; National Pollutant Discharge Elimination System (NPDES) Permit No. CAS000002 for Storm Water Discharges Associated with Construction Activity (General Permit); the California Regional Water Quality Control Board (RWQCB) Santa Ana Region Order No. R8-2002-0010 and NPDES Permit No. CAS618030; and, the City of Costa Mesa Ordinance No. 97-20 for compliance with NPDES Permit for the City of Costa Mesa. Such documentation shall include a Storm Water Pollution Prevention Plan if over 1 acre (if over 5 acres if submitted prior to March 10, 2003) and a Water Quality Management Plan (WQMP) identifying and detailing the implementation of the applicable Best Management Practices (BMPs1. Provide smoke detectors per 2000 CBC. At the time of development submit for approval an off-site plan to the Engineering Division and grading plan to the Building Division that shows sewer, water, existing parkway improvements and the limits of work on the site, both prepared by a civil engineer or architect. Construction access approval must be obtained prior to building or engineering permits being issued by the City of Costa Mesa. Pay offsite 392 East 16`" Street April 22, 2004 Page 6 II Trans 8 � plan check fee to the Engineering Division. An approved offsite plan and fee shall be required prior to engineering/utility permits being issued by the City. A construction access permit and deposit of 5350 for street sweeping will be required by the Engineering Division prior to the start of any on- or off-site work. Provide minimum distance of 20 ft. from new garage to new addition of existing residence to provide adequate space for vehicle maneuvering. Comply with "Walls, Fences, & Landscaping" standards for design of fence located within 10 ft. from front property line. Specifically, location and height of wall for clear visibility by the driveway. SPECIAL DISTRICT REQUIREMENTS The requirements of the following special districts are hereby forwarded to the appli- cant: Sani. 1. Applicant shall pay all current sanitary district sewer connection charges. School 2. Pay applicable Newport Mesa Unified School District fees to the Building Division prior to issuance of building permits. Upon receipt of this letter, your project has been approved, subject to the above- listed conditions. A copy of the conceptually-approved site plan is enclosed. The decision will become final at 5:00 p.m. on April 29, 2004, unless appealed by an affected party or a member of the Planning Commission or City Council, including filing of the necessary application and payment of the appropriate fee. If you have any questions regarding this letter, please feel free to contact the project planner, Wendy Shih at (714) 754-5136 between the hours of 1 p.m. and 5 p.m., Monday through Friday. Sincerely, Fi. MICHAEL ROBINSON Acting Zoning Administrator Enclosure: Conceptually-approved plans cc: Engineering/Development Services Jim Skaug Fire Protection Analyst 250 Cliff Drive Water District Laguna Beach, CA 92651 Building Division � �oonrssaeuiorc+c: 392 E 16TH ST °""E"9"""E"'Q'ov�'": KELLY RObERT HURRELL mow�ss:1603 'fUSTIN AVE COSTA MESA,CA 92b27 APPL. WUlINO �ODRFSk AXCNRECT ON �RIIlfffl: IlG NO_ ANCR ON EN6'4 ADDRE55: VNT: IIM: ��A0T0RSN"'E TUFF SHEL � ( 909 ) 988-8833 camacrwrs�uuua Z330 S CASTLE-HARBOUR HL A°°"� ONTARIO l'F1 ��' bbibb'i 91761 �� UCENSED COMRACTOFS DECLAFATION: I hareby dlim uMn panely d pmjury �hel 1 am licemed uMm yovieiam d Cheqm Y (mmmerid�p wdh Senion J000) ot Oivubn 3 d iha Budrieea eM Pmluaime Cope, e�d my liema u in lull Ma eM Mtetl. cm uc. 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Hmen.ne sero�r cme swon. z5sos, zssaa..ne IYSS�a. aM �I�m 1«ury Muie Wiki�q oa+�em xill / wll rid (ti2` �) �d to compy wYh veid ama mdw end IM rpuirtmanb br apemi�laconelruclionwmodifwionhanlM�i e�BTFiry aiepemeniDipiip.qenEenlielam4rudianeppictliwnvevemqlmmtlwa p�a�. Dma: ADW�: WONKER'S COYPENSATION DECI�P�TION: I hraby df udr pmeEy N prµry ona d tM b0ow�'vp dxLrm'vn: �] �nm.erowm.vu�.ceMw.amn.n,i�o..n;m�v.lo..un�e.•mnpamLL:.n..sw��o.MSWia�alaoa�n.leErc coa. ia me v.��. d m..w i�..�:m u,m wm+ 4 A.�,w. ❑ � new e�a w mmae6.ona.• oano«aman narence. m �+w� M saion �roo a me �en« coe.. a uie o«�«me�w a in. work la whitli Nia V�A u mueJ. �h waken' romVa�� imuraza mnir vd V�Y wmEr w: cam«: TIiF TRLITFT.T.FR� EXPIRES P"�"°m� US-784F6366 07/O1/98 , Th;: sen;o�„wee,wr ea oa,iaa�ae. w�rmx a ro. om n�,wme ewb,. /S,00� w.bn.� i❑ I cM/�/ Ne� in IM1ey erimmv�ce d �he work br wM1bh IFb perm4 ia i�0. I a1Wl m� e Iq pa�n in e�y menw n n �o became w4� S iM xakms' canDemabn lewe W CeNanie E Ons t ah beccne b the xvrMs' cwnpan ion vm d edion �100d�MleborCode.l a tA p pwui Ome: 7i MN�' W�mMy: F�I b roikw�i ronpwu�tlan rovwap Is imMrNl. 1�E/c! nr u�vlorr ro alm'M pNWtlp uM chM Mu ,p ro ons �uMrM NouuM OdunlS�W uooA b�Itlon m• cm� oi ronpw�u�Wn Winpn u prvrNM ror In S�ctlm �1P6 0l IM LeOa� Cotle, IirtwL � aRomsy'� tsu. CONSTFUC110N LENDINO AGENCY: 1 hxeby e1Nm uMx peiWiy d per�uy tM tlwe e e omv�uuion bnd'vq epenry br tlr perlameMe d IM xak la whirh �he pxmi b esuad (Saeun 309). Civ. CI. LENOEN'S NAME LENOEN'S ADONE59: I cenEy Rai I heve raed N'v applicelian ud mms ihet Ne eEwa iMammon u consp. I epne 10 mnpy wGh aA cey enE mmly ad'ewx.ae eM et�e lewa relmM m MriWM cmmvfion aM hereM aiOhace iaperon�etiwa H thu r+7 w wr upon iM ebv.a�mrviurd popaely lu irooetlion ourowes. . Dma __�� (515tJ6.WP) While-BuiNip d Selery: Grten-Fb: Cerely-AppSranl: Fnk-Rersiva: (3ddsua0.bwna CITY OF CGSTA MESA — bUILUING PERMIT PERMIT NO: B 084916 PLAN CHECK NO; 03A55-97 L CONSTRUCTION TYPE: V—N PERMIT TYPE: STR JOH DESCRIPTION : NEW STORAGE HUILDING 480 SF PERM NO: B 08491b GOVT: N SUPF; N PURPOSE: NEW SQ FT; 480 CLAIM VALUE: 10,395.00 CALC—VALUE: 10,320.00 GROUP GCC: R-3 / COMMENTS: NEW �«**�r*�r�r��*;��*;r;r�**fi*�r*�e;r�***��*�**�r*;r�c**�r�:+c�c**;r*;�*��r;��r;��;e****�a��;c*�**;��;c��;�� Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILLING ---------- --------- ACCESSORY bUILDING --------- FRNT: FT IN REAA: FT IN FRNT: 14 FT IN REAR: 5 FT IN LEFT: FT IN RGHT: FT IN LEFT: 5 FT IN RGHT: 26 FT IN PARKING REQ: -PROV: PARCEL: 42519114 ZNE: R2—M REF NO:•:' PLANNING NOTESy� CONSTRUCT A 320 SQ FT 13' HIGH WORKSHOP W/STORAGE ROOM. > SSO.�SF REAR YL COVERAGE OK• 30�3 Sc� FT. PROPOSEL. if if ik ikiE if iE iE if iF if if if iE iEiE if iF if iE iE iEiE iE iE Y 9f �]f i4 iE iE if if ii if iF iF iEil�iEiE if �k if iE tif iE if iE xiF iF iE 3kif� if if if ik ie if if if iE if it iF if ibiE if iF iE �7E ie ir tiE iE iE D E V E'L G P,.M E N T S E R V I C E S R E Q U I R E M E N T S ZONING APPROVED� HY ' GC1R„�C DATE: 2- C! HUILDING APPROVED HY : UATE: '} A / APPLICATZON ISSUED •HY: �, 1 LAI'E: 2.�I �I r ifif'sEifififihiFififiEifiE�iFiFififiEi(�'iEifi'riF�'Fi7FiF3F'iFiF"iFiF�F%�iFr��FIF�' �iFif��F+'F�F+FsT+e+FrFiffiifiEi�iE'sFlfiFif x iEai LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y BLLG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRt�uING PERMIT 174.75 1.G3 SMIP/NON—RES PLAN 113.59 ISSUE FEE BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID LUE TOTAL5----> 175.78 0.00 113.59 289.37 289.37 .00 REVENUE LIVISION TOTALS--> COLLECTED: 175.78 OVER/SHORT: .00 &LDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIF/TOT GRADING PLAN—CHECR 179.75 1.03 iF 3E ii �1F iF ik if 1f if 1F if if iE iE if if if if ik iF jF iF iE i't iF iF iF if ff if iF 1f ih if iE i'e if iE iF'k if iE 3f 4 ik'1F if sf if iF iF if it iF �E if iF iF if �f iE iE if iE if tif'lE it iE iF iF if �1f if # iE iE iF i'c I N D I V I D U A L F E E H R E A K D G W N TYPE QTY" U E S C R I P T I O N UNIT l".OST TOTAL COST SFR 480 RES—GARAGES TYPE V END OF FEES 21,50 10,320.OG u�'=i-.ii/�i�:.J ..�..�..r. Fc:..�:'"• �t.a:,z :'_=. /' CONSTHUCTION AND PLANNING �• P�� SPA APPROVALS Permit # Date Inspector qppROVALS Permit # Date inspector 1. TemporatY Electrical Service or Pole 52. Pool & Equfpmeni Location � 2. Soil Pipe�Undrgrnd. - 53. Steel Reinforcement ', . -�3. Electrical Conduit Utility-Undrgr,nd. 54. Forms � ' 4.'Eiectrical Conduii�Undrgrnd. 55. Electrical Bonding � 5. Steel Reiriforcement "� � `B��-�% �Gv� 56. Rough Plumbing & Pressure Test _ G EVectricaV UFER�Gmd. 57. APPROVAL TO COVER-GUNITE 7-Footin s �' 5B. Electrical ConduiCUndr rnd. - . 9 l�t� 2_7 �a' 9 �' 8., FouT n �dation C,�6+ �v� �8,��...� ��,C(�%� 59. Gas Pipe, O Undrgrnd., Test 7 ' 8. Water Pipe-Undrgrqii. „ �. 60. Backwash Lines,'P�Trap, E� Undrgrnd. l0. Structura� Floor Svstem r 81. APPROVAL TO DECK 7 7. Property Sewer Line & 4ouse Gonnection 62. Backwash & ReCeptorFinal 72. Sewer Cap i�' 63. Heater & Vent-Final � � 13. Roof Drains . • ' 64. Plumbin� System - Fina( 14. Roagh Piumting- r � 65. Electrical-Final � 15. Rough ElectricabCoriduit � ' 66. Sota* SVstem�Fina�, �� 76. Rough Electric Wiring. 67. Fencing & Access ApProval 77. Rough Wiring Sign � 68. APPROVED FO'f1;PLA5TERING - 18. Rough Electrical�T Bar Ceiling � 69. POOUSPA SYSTEMS FINAL � i9. Rough Heac(ng & Air Conditioning J r FIRE QEPT..ftEQUtREMENT - 20. Rougta P2ctor� Fitke�lace ' - � . , APPROVRI:�� : Permit # ` � - 21. Ductr, in Stru?3ure': � �•• � �- • _ � � 70. Undergrppqd Hydro ' 22. puccs, Vequlaiin ` ' _ _ -, r � ' 1 9,-„ ,j � 71. Produt�P,iping �Gas CdOil 23. 6as Pipe-Rough & Test _ • � '^ � � � 72, Undeiground Flush � 24. Rooffra"d?ing" :: `� ' ' "" , ' � - 73; Undergrrid.Smr3cjeTank�ClGas^OOiI 25. Roof Sheathing , . �..7�7� �'Wk. � 74: OverHead Hydr�? . ' 26. T�Bar�Cel!ing (StructGrall & Monocoa� ' z �� 7� Dry �heraicai ._ ' ' 27. Frarne and_ Flashing = �:� � `Qz�7 �,`w(�[;� 76. Dry StanHp�pe •` ' 26. Lathing E��Sid'mg � "' `= - -"' � .. . "� 77.� FIXED S,YSTEI6S"-�INAL ' 29. Insuiatiom • . ' �• 7" FIRE PREV. FfJVAL � - 30. Drywall Nailirt§ ` �` , ;�-IEALTH DEPt. REQUIREMENT ' 31. Plaster Brown Coat •- � �' i 79. PiNAL INSPECTION + ' 32. Electrical�ower Meter'�Pinai t.! ' K 80'.? FOOD CERTIFICATE Iy�SWED �'� 33. Fina1 Electric- � . � � r � � 'F iVoles: � "+T' + 7 _ � � � 34. FinaH Heating & Air Eonditioning - � � ^� -- � - ' - - _ �. 35. Final Gas P�Pe-Test � -. .. � - �,'ti - 36. Hood or Canopy � � � . ' � ' ' - , , 37. Final.Factory Fireplace � . . ' 38. Final,Plumbing ' , ' � ' - ' ' � � •' 39. LVater�Service�Final � � _ � � . � , - 40. Gas Service-Final � �• � = . _- • ' a • 41. Solar pomesticPina( � � , _ . � 42. Backflow Pceventer � , • ' �� ^ i e 43. Backflow Irrig2tion , .. - - s � � - 44. Landscape IrrfgatiornSystem ' � - � ^ ' �' "� _ � - 45. Sound Attenuation . _ T' - J ' ' ' , - � . ' � • ' r. � i � 46. Mandicap Regulatioru - ' F ' ' _ - � : 47. FINAL STRUCTURE & BUILDfNG /,q,��p.�'� � �� - tr� 48. PINAL PLANNING � � � ' � � " ' �, 49. Electric Release to Edison � � � � ' 50. Gas Release to Southem California Gas Co ' = - � - 51�. CERTIPICATE OF OCCUPANCY • � No. Date Counfy of Orange Building Department Room 322 CourF House Annex $anta Ana, California Phone: KI 2-6211 APPLICATION FOR PERMIT No. �. o / '� % ' 19� a 1. OWNER'S NAME��U�✓� �'v ��s��✓ J� PHONE:.� 2��d_ ��' MAILI[VG ADDRESS �� ' / �SA ��'� �P � CIT'Y ` -�� ~�'a ��- ($vaa[ or P. O. Box No.) ^ � NAME�� NAME —C> ��-� �(�[C�II[ /f � O!(� �C•Of14'tCtO[/�[ tS � CI ADDRESS �� ADDRESS � CITY � CIT'Y Sta:e Lic No. Phone State Lic. No. � � Phone�� 2. JOB LOCA � � 7�A (Houao No.) me of S¢eea) (1'own or Schoef D'utice) 3. LEGAL DESCRIPTION: Lo ' Block��`.. �_ Trac� 4. Meets anej Bounds Descciption — Use Reverse Side of This Form. % 5. CORNER LOT () INTERIOR LOT � T"HROUGH LOT () SLOPE OF LOT ` v THIS AFPLICATION CANNOT BE PROCESSED UNLESS LEGAL DESCRIPTION IS ACCURATE AND COMPLETE. 6. PROPOS$D WORK: New Building (� New Strutture ( ) Addition ( � Repair ( � f�teration� ( ) Move�( � A �mol�h ( � �version^ ( � /A I 7. PROP056D USE: a / _T t l/ d[+�� c� rrar�c� 8. SIZE OF BUILDING AREA��zz SIZE OF L�O�T, q,� 6 D pREA � d�-� � 9. CEILING HEIGHT--��OTAL BUILDING HEIGHT_/�_— NO. OF STORIES� 10. NO. LIVING UNITS— � SIZE OF SMALLFST BEDROOM y 0/ ��IZE OF KITCHEN�� I L_ � 11. EXTERIOR WALL CONSTRUC'I'ION: Brick () Concrete Tile () Monolithic Concrete () Wood Ftame (� Steel Ftame ( � Conciete Frame ( � 12. WALL COVERING: Wood O Metal ,( ) Stucco (%f Other_ 13. FRONT YARD SETBACK FROM CENTERLINE OF S/TREET 'rO f� 14. DISTANCE TO PROPERTY LINE: Side Yard J � Rear Yard �y � _ I5. SHOW ON PLOT PLAN EXISTING BUILDINGS NOW ON LOT, STATE USE OF EACH. 16. DISTANCE IN FEET FROM PROPOSED BUILDING TO NEAREST EXISTING BLDG.� -- 17. VALUATIO[V OF PROPOSED WORK: Intluding All Labor, Plumbing, Electrical Wiring� Heacing� Fire Sprink- lers, Painting, Sewage Disposal $ , ' .S-3Fr%� � 18. I HERE6Y CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE INFORMATION IN THIS APPLICATION IS CORRECI' AND THAT THE CONSTRUCT?ON WORK WILL CONFORR�1 TO ALI. �LAWS OF THE COUNTY OF ORANGE AND—THE�STATE. OF CALIFORIVIA APPLICABLE THERETO. � / �'��f .� i �"� ��. , �� Plan - SD BY. Owner or � FOR DEPARTMENTAL USE ONLY t9. GROUP_ � T'YPE �T_�ISTRICT MAP �� ,� NO. -1 PERMIT FEE $��`'-' RECEIPT NO. �� PAID TO �/� DATE 6—/l --f'Q CHECKING FEE $ ECEIPT IVO. PAID T.I��IL� _ N. rr � � 'c�_p__�OR PERMIT GRANTED � Z 19 s� PLANS CHECKED BY L! � i,�CHECK SHE D P APPROVED BY: HEALTH DEPT. 1 STATE �'IRE MARSHAI. STATE pIV. OF HOUSING_ \ sM—¢-as Z'l L�v ,t�L��. /G`:t �r A .Le.l, t�% �`y°"' � OWNER JOB ADDRE55 AP No. H PlUM81NG . SWR. LINE I-I HOl15E CON. ROUGH HEAiING RND AIR CONOITIONING TEMPORARY SERVICE OR POLE UNDERGROUNO � POWEH � jiOUGH WIRING TRENCHES FORMS fjrTEEL RE >THING ME RNO FLASHING HING - IN ( STER_ BROWN COAT HERTING. VENT., NEFRIG. AND A.C., FINAL PLUMBING, FIN/L ANO GAS TEST � ELECTRIC, FINAL BWLOING. FINAL DATE SUBCONTRACTOR T � F � W a a y � S F G � � � Q 7 � � � G. O � G. z � COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only ADIDRESS J �� '�/� � ' OWNER OR lti��I lPl G' T�., 1� TENqNT �r�TvK d' OV�V ADDRE55 a / Z � �ORa �Z� CITV �".�Z 1$ r ✓> '�' -� NO.��-L•�� CANSTRUCTION BRANCH ADDRESS ARCHITECT TEL. ADDRE55 CONTRACTOR -Yi\Tl� �^%t�v((�1' \ ADDRESS !7 /� EG6� �• � _ }-s ��A TEL./ pTV �"'rJSl�,t 1� NO.b�. STATE CITV , LIC. NO. LIC. NO. SI2E NO.OF BLDGS. OF LOT NOW ON LOT USE OF EXISiING BLDG. Separate permits are required for elec[ric, plumbing and heating work. USE OF BUILDING AND WORK TO BE PERFORMED /! / / -.L � / / !/ � APPLICATION FOR_,STRUCTUR,AL PERMIT Bo 5O TL RECEIV�'E/D PERMIT N° � 49,864 A. P. N O. I� 7� //�� VNIT OR SPACE NO. Tft.NO. LOT tlLK. � NEW ADD LTER REPAIR IMOVING DEMOLISH I hereby acknowletlBa thet I heva reatl Mis application antl stnta that ihe above informaiion is correct and apree to comply with all laws repuleNng builtlinp conrtruction, antl I shall not amploy any person in violat(on of the workman'z compensation lewe of ihe State of Californla. I hereby certity th I am properly licensetl es e contractor untler ihe Siate of Califo a Bus ness antl Proteuions Cotle, Division 3, Chapter 9, an tha ch li e ses ar in full torca and etfect, or I em exempt �m th rovts s ot t State of California Busineu and Profassi Code ivisl Cha ar 9. Signature ot (� Permlttea or Q A�thorizatl Agant Date OWNER � I.JG�%f I �TOMGN.GI�M�' USE R dS (�M�I G(. I VALUEE S� 20NE N TYPE� GROl1P R� � APPROVEDSETBACKS (FROM GL STQEE7) PLANNIIVG ACTION DATE on� MGROVED �l n i m [ �/ IV __ N SQ. FT. J THE AMOUNTSHOWN UNDER VALUATION IS FOR m � THE PURP�E OF ESTABLISHING A PERMR FEE ONLV: � VALUATION PERMIT FEE 5 �—� q n m PLAN CHECK E �� ^ O $ 7s�• --- LL TAX E a U TOTALPAID E �.,( (7