The URL can be used to link to this page

Home My WebLink About484 16TH ST - Building Permits1\ (774) 754-5273 • Fax (714) 754•4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, GA 92626 ELECTRICAL PERMIT .lob Address: 484 E 16TH ST Suite No Vicinity: KITCHEN Parcel Nunmber: 42515106 Applicant: BARON, RICHARD MARC Address: 484 E 16TH ST COSTA MESA, CA Owner. BARON, RICHARD MARC Address 484 E 16TH ST COSTA MESA, CA Contraclor: Address: � ISSUE FEE Temp service test Res. a/c package New Res (1-2 uniLs) New Res (3+units) Pool / Spa Lighting Fixts , Recept Outlets Switches Non Res Appl , Res Appl Service to 200a Service to t000a Service over 7000a Motors to 1hp Motors to 10hp Motors to SOhp Motors to 100hp Motors over t00hp Status: ISSUED Applied: 08122/2003 Issued: 08/22/2003 I . - .�� ' Phone: 949-64&9709 Zip: 92627 Phone: Zip: 92627 Phone: Zip: License: SCOPE OF PERMIT REMODEL EXISTING KITCHEN. REMOVE SOFFIT TO EVEN OUT CEILING, REPLACE 1 KITCHEN WINDOW WITH DOUBLE PANE GLASS WITH SAME DIMENSIONS, AND ADD ELECTRICAL OUTLETS. REF.: B03-01427 ELECTRICAL TO INCLUDE: 4 OUTLETS AND 2 LIGHT FIXTURES. $23.50 so.00 $0.00 $0.00 $0.00 $0.00 $2.20 34.40 50.00 $0.00 $0.00 50.00 50.00 $0.00 $0.00 $0.00 50.00 50.00 $0.00 Quantity 0 0 0 2 4 0 0 0 0 0 0 0 0 0 0 0 FEE SUMMARY Temp Dist System I Lighting Busway/100f1 Standing Section Misc Eleclrical Equipment Transformers up lo �1 kva/kw ................uP to 10 kva/kw .................up to 50 kva/kw .................up to 100 kva/kw ..................over 100 kva/kw Low Voltage Equipment Low Volt Wiring System / Ckt Misa Conduit Misc. Conductor Circus ( gen or ride) Circus (mech ride or lights) Christmas Tree Stand Fireworks Stand � - Other Electriral Fee Quantity $0.00 0 so.00 0 50.00 0 $0.00 0 so.00 0 so.00 0 $0.00 0 50.00 0 50.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 50.00 0 $0.00 NOTICE: The work authorized by Ihis permit shall comply wlth all appllcable handicap access requlrements under Califomla statutes and related regulations. (Ord. No. 92•28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire end become void if work is not commenced withln 780 days, or if work is suspended or abandaned for a period of 1 BO days. INSPECTIONS: In order for the work euthorized under this permit to be considered legal, such work must comply wlth all eppllcable cadea, and all required Inapeetione and final epproval must be obtained. Fallure to obtain Inspections and final approval will result in the e�iration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 zaaee0lerool WORKERS'COMPENSAnON DECLAqATON: �� w I �ereby eXirtn under penalry ot perjury one of Ihe following declaretions: ❑ I heve end will maintaln a cenificate oi Co�sent to salt-Insure for workers' compensetion, es provided for by section 3700 oi ihe Labor Cotle, for the peAortnence of the work for which this permit Is issued. ❑ I heve anA wlll malntain workers' compeM1Setlon insurence, as requiretl by section 3700 oi Me Lebor Cotle, lor the pertortnance of the work far w�icli this pertnit l9 issueC. My warkers' wmpensatlan Insurence carrier anC pollcy numDer are: Carrier: � PpliCy NumDer: (This section need not be complefed il the pem�� Is velued et one hundred tlollers ($700) or /ess.) � I certily ihet in Ihe pedormence ol t v�'o r�hich this permit is issued, I shell not employ any person in eny manner so es to become subject to the workere' compensetion laws o1 Celifomie, eI If I should become subJecl lo [he warkers' compansatlon pravisions ot Sectlon 3700 ot Ihe Lebor Cotle, I shell forthwlt� comply wit� t�ese provisions. AppllcantSigneWre: Dete: ��•O�j.U7� WARNINO:FAILURETOSECUPEWOR RS' P6`�SFTIONWVEMOEISUNLAWFULUJDSHALLSUBJECTPNEMiLOYERTOCRIMIWILPENALTIESANDGVILFlNESUPTOONEHUNDRED TYKKISANDOOILARE(5100,000),INAD fTIONTOTIIECQSTOFCOMPEN$ATION,DAA4IOESASPROVIDEDFORINSECTION31080FTHELABORCODE,INTEqEST,ANDATTORNEV'SFEES. LICENSEO CONTRACTORS DECLARATON: I here6y eHirm ihat I em Ilcensed under provislons of Chepter 9(commencing wit� Sectlon 7000) of Didslon 3 ot the Business end Professlons Cotle, and my license is In full larce ana eflect. Llc. M Cless M Contredor's Signature: � Dete: CONSTRUCTION LENDING AGENCV: ❑ I hereby aflirtn Ihet there is e constructlon Iending egency for Ihe Oertormence oi t�e work for which Ihis permit is issue0. (Sec. 3097, Civil CatleJ. Lentlefs Neme: Lentler's Address: Signature: Date: OWNER-eUiLDER DECLARATIONS: I hereby etilrtn thet under penelry ot perjury the� � em EXEMPT FROM THE CONTRAC70RS LICENSE LAW tor the following reason (Sec. 7031.5, Business end Professions Code: Any Ury or counry which requires e permit lo construct, alter, Improve, tlemolish, ar repair eny atructura, pnor to Its Issuence, also requires the epplicant for such pertnit b file e signed sletement Ihet he or she Is Iic�nsetl pursuant to t�e D�ovislons ot the Comractors License Law (Chepter 9(commencing wtlh Sectlon 7000) 01 DMslon 3 of ihe Busineu end Pmfessions Code) or that he of she is exempt therefrom and the basis tor the elleped e:emptlon. Any vlolation of Sectlon 7031.5 by any epplicant for e pertnit subjects the eppllcant to e civil penelty of not Riore than fiva huntlred dWlers ($500).): ❑ I, es owner of Ihe property, or my emploYees with weges es thelr sole compensation, WILL DO THE WORK, end Ihe structure Is not Intentled or oflered far sele (Sec. 7044, Busi�ss antl Protessions Code: Tha Corttractors license law does aot apply fo en owner of propeny who huilds or imprwes ihereon, anC who does such work himselt ar hersetl ar throuqh his or her own employees, provlded ihet such improvemenis ere not intenaed or offered for sele. If, however, the building or improvement is %old within one year oi completioq Ihe awnerbuilder will have ihe burtlen ot proving that �e or she did not huild or improve for purpose o1 sale.). ,� I, as owner of iha properry, am EXCLUS��ELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Cotle: 71�e contradors License Lew does not epply to an owner of propetly who bullds or Improves thereon, and who contracts for such pro�ect with e contradoqsj license pursuent jo}ty�Q9Jftrectors License laws.). ❑ I am azempt SiqnaNre: Owner ID verifi Business and Professions Code lor this reason: oa�e: oR 22 • U� ❑ ves ❑ No orwars uce�se No. Exp��py; fr.2 /. OS VeAlication of Ownership by (rype oi tlocumen4 I.e. - property tax bill ar deed): DIVISION OF INUUSTRIAL SAPE7V PERMIY CERTIFICATION: ❑ I hereby certity thet no ascavetion tive (5) or more teet In depth into which e person is required to tlescend, will be metle in connection wit� work euthorizetl by this pertnit, entl Ihat no building structure, scettolding, telsework, or demolltion or dismantlinp ihereoi, will be more than Ihlrty-six (36) feet high. (Chap. 32, Grp 2, An 2, Sec. 341, Ttle 8, Califomia Adminis�retNe Code). ❑ As owner-bullder, I wlll not employ enyo�e to tlo work which would require e permlt from the Division of Indusinel Selery, es notetl flbove, unless such peraon hes e partnit to tlo such work from the division, Signeture: Dete: Division of Industrial Salery Pertnit Number: I�Qpf�a, INSPELTIONTYPE PAIE IIi�LS S�OLEa INSVECTIONTYPE Q�¢ � I 1618 Fixed System Finel Fire Prevention 206 Flnel Mechenical 1268 200 201 202 203 Pool Spe Flnel Finel Re-Roof Flnel BIocWReteining Well Flnal Factory Fire Place Final Sipn 204 Final Demollilon 208 Finel Plumbing 210 Finel Electdcel 212 Flnel Fire Prevenlion 220 Finel Planning Approvel 222 FInaI5lte 250 Finel Bullding/Occupancy � , i (714) 754•5273 • Fax (774) 754-4856 • www.ci.wsta-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 484 E 16TH ST Suite No Vicinity: KITCHEN Parcel Nunmber: 42515706 npplicant: BARON, RICHARD MARC Address: 484 E 16TH ST COSTA MESA, CA i , Owner: BARON, RICHARD MARC Address 484 E 16TH ST COSTA MESA, CA Contractor. Address: Arch / Eng : Address: PLUMBING PERMIT Siatus: ISSUED Applied: OS/27J2003 Issued: 08122/2003 ISSUED BY: Phone: 949-646-9709 Zip: " 92627 Phone: Zip: 92627 Phone: Zip: License: Phone: Zip: - License: SCOPE OF PERMIT" REMODEL EXISTING KITCHEN. REMOVE SOFFIT TO EVEN OUT CEILING, REPLACE 1 KITCHEN WINDOW WITH DOUBLE PANE GLASS WITH SAME DIMENSIONS, AND ADD ELECTRICAL OUTLETS. REF.: B03-01427 � . PLUMBING TO INCLUDE: 1 WATER CONNECTION FOR REFRIGERATOR. ISSUE FEE , � BackFlow irtigation BackFlow Preventer � Bathtub Clanfer System ConnectQce,Soda,etc) Dental UniLs Dishwasher Drain, Floor Drain, Rainwater AMT $23.50 50.00 $0.00 $0.00 $0.00 $9.80 $0.00 $0.00 $0.00 $0.00 FEE SUMMARY QTY AMT Laundry Tub / Washer $0.00 0 " , Landscape Irtigation $0.00 0 P-Trap $0.00 0 � Pressure Regulator $0.00 0 Process Piping (per 10 ft) $0.00 1 Receptors $0.00 0 - Septic Tank . 50.00 0 Sewer Cap for Demo 50.00 0 Sewer Connect . $0.00 0 Sewer Private Line $0.00 QTY 0 0 0 0 0 0 0 0 0 0 SumpPump Swimming Pool Trap Primer Urinal Vacuum Brkr BkOow(1-4) Vacuum Brkr Bkflow(5+) Wash Basin - Wash Basin Set Waste and Vent System Water Closet (Toilep AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 aTY 0 0 0 0 0 0 0 0 0 0 NOTICE: The work authorized by ihis permit shall compty with all applicable handicap access requirements under Calitomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-27-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work aulhorized under this pertnit to be considered legal, such work must comply with ali applicable codes, and all required Inapectlona and final epproval must be obtained. Failure to obtain inspections antl final approval will result in the expiretion of this parmit. FOR INSPECTIONS CALL: (714) 7545828 2M&IB (BNO) WORKERS'COMPENSATON DECLARAnON: � � I hereby elfirm untler penalry ot perjury one af ihe tollowing declareilons: ' ❑ I �eve entl wlll meinteln e certifkate of consent to sell-Insure lor workers' canpensetlan, es proNOed lor by section 3700 ot Ihe Labor Cotle, for �he pertormence ot the wotk for whlch this pertnit Is issued. ❑ I have eM wIU maintein workers' compenseuon Insurence. es requlie0 Dy seclbn 3700 ot tne Lebor Catle, ror Ihe peAarmance of Na work for whlM Ws pertNt Lq LqsueA. My workers' compensetlon Insurencs cartier end poliry number ere: Cartler. Policy Number. �ectbn need not Ee comp/eted I! 1he permit is ve/uetl ef one hundretl tld/eis (S 100) w less.) I cenHy thet in ihe peAormence af the work fdr I is permit b IssuoO, I shall not employ any person In flny manner so es to betome sub�ect ro Iha workera' cronpensation lews ot Celltamla, erM apre F� oulC Eewme sub�ect to the workera' compensetion provislons o� SecUon 3700 of Ihe Lebor Cotlo, I ahell forthwlth compN with these provislons. 6 � Appllcent5lgneture: Dete: �O•�•� WARMNCi: FAILURE TO SEWRE WIXiNERS' ENSATIIXJ COVEWU3E IS UNLAWFlIL M!D SHALL SUBIEGf AN EMPLOVER TQ CRIMINAL PENALTIES AND CML FlNES UP TOONE HUNDRED T/IIXISAND OOLIARE (5100,000), IN ADDfTION TO CQST OF COMPENSATION, DAlMGES AS PRO��DED fOR IN SECfION �O60F THE UBOR ODOE, INiEREST, ANO ATTORNEI"5 FEES. IICENSED CONTRACTORS DECLABATION: � I hereby eMirtn Ihet I em Ilcensed under provisions oi Chapter 9(commencing with Section 7000) of Dlvision 3 ot t�e Business and Professions CoOe, end my Iicense is in full torce entl eXect. LJc. a Class k Comrectofs Signatore: � Dete: ' CONSTRUCTION LENDINO AGENCY: ❑ I hareby eHirtn Ihet there is a consiructlon lending eBency tor ihe pertortnance ot t�e work tor which INs permit Is issued. (Sec. 3097, Clvil Cotle�. �� LendeYa Name: Lender9 AAOresg: Signeture: Date: OWNER•BUILDER DECLARATIONS: I hareby elfirtn Ihet untler penalry ol per�ury Ihet I em EXEMP7 FROM THE CON7AACTORS LICENSE LAW for the following reason (Sec. 7031.5, Buslness flntl Professlons Cotle: My Gry or couny which requlres e permit to conswcL alter, improve, demdish, w repeir eny structure, pdor ro its Issuflnce, elm requlres the eppllcant br such pertnit to flle e sipneE atetement t�a� �e w she is Ilcensetl pursuant to t�e D��s�s a� Ne Con[reclon License Lew (Chapter 9(commendng wlth Sectlon 7000) of Divlslon 3 of ihe Bu5ine55 end Professbns Cade) or t�et he or she is e:empt Ihereirom and the besu lor tlie ellepeE eaemption. Any violedon ot Sectlon 7037.5 by eny appllcant for e pertnit subJects Ihe applicent to e Gvil penelry ot not more then five hunAretl ddlars (5500).): ❑ I, as owner of the property, or my employees with weges es their sole compensetlon, WILL DO THE WOHK, end Ihe struaure is not InieMetl or oHered for sale (Sec. 7044, Business and Professions Cotle: The Coniracbrs License Law Coes not flppty to an owner oi property who builds or imprwes Ihereon, and who doea such work hlmselt or hersell or Ihrough his or her own em0loyees, provided that such Imprwements are not intendetl or ottered lor sale. If, however, t�e building or improvement Is �Itl within one year of comDletian, the owner-builtler will have the burden at proving Ihet he or she ditl no� build or improve for Durpose ol sele.). es owner ot Ne properry, em E%CLUSIVELy CONTqACTING WRH LICENSED CONTBACTORS to construct the project (Sec. 7044, Business antl Professions CoCa: 7he contrectore lJcense Law doe noy6ppry to en owner of properry who �uilCs or improves ihereon, end who contrecis tor such pro�ect wit� e conirector(s) licensa pursuant to the Cantred{�s,Li�sqLaws.). ❑ I em exemp� under sec. Signa�uro: � Owner ID verifled by tlrlvefs Iic se. vedflcation ot Ownersnip by (rype or �Business entl Profession5 Code br Ihis reeson: � Expires: fl• L/. O i.e. - Properry tev DIII or deed): DIVISION OF INDUSTRIAL SAFETV PEIiM1T CER7IFICATION: ❑ I hereby certity Uet no exceveilon tive (5) or more feet In depth Into which e person b requlreO to descend, wlll Oe made Im m�nection wIN work euihoAzetl by Ihis pertnit, entl t�at no bulldinp strunure, sceXolding, falsework, or tlemolltion or dismeniling Ihereof, wlll be mora then ihlrty.six (36) laet high. (Chep. 32, Grp 2, Ar12, Sec. 341, Ttle 8, Cellfomia AOminisiretive CoGe). ❑ As owner-builder, I wlll not employ enyone to tlo work which would requlre e pertnit Irom Ihe DMslon ol Intlusinfll Sefery, es rwietl ebove, unless such person has e pertnit to tlo such work from Ihe tliW9ion. Signetura: Date: Division ot Intlu5lriel Setety Pertni� Number. COOE �. INSPECTIONTYPE 1616 Flxetl Sysiem Final Fira Preventlon 1288 Pod Spe Final 200 Final Re-Roof 201 Finel BIocWRelelNnp Well 202 203 Finel Fectory Fire Plece Final Slgn 204 Flnal Domolitlon PAIE It�L@ f�QQE,( INSPECTIONTYVE 208 Finel Mecheniral 208 Final PlumWng 210 Final EleMrical 212 Finel Fra Prevenlion 220 Finel Planninp Approval 222 Final Site 250 FinaIBullding/Occupenty �.1 911. J �, D � // (�ta) �sa-sz�a • Fa�c (714) 756-4856 • www.ci.coste-mesa.r��LDING PERMIT Job Address: 484 E 16TH ST Suite: Viciniry: KITCHEN Parcel Number: 42515106 ApplicanC BARON, RICHARD MARC Address: 4B4 E 16TH ST COSTA MESA, CA Owner: BARON, RICHARD MARC Address .484 E 16TH ST COSTA MESA, CA Contrector. Address: Zip: Arch : Address: Phone: Zoning: Phone: 9a9-64&9709 Zip: 92627 Phone: Zip: 92627 Phone: License: Eng: Addiess: 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 08/22I2003 Issued: 08I22I2003 . ISSUED BY: Phone: � Zip: License: License: SCOPE OF PERMIT REMODEL EXISTING KITCHEN. REMOVE SOFFIT TO EVEN OUT CEILING, REPLACE t KITCHEN WINDOW WITH DOUBLE PANE GLASS WITH SAME DIMENSIONS, AND ADD ELECTRICAL OUTLETS. Plan Check: S0.00 Permit: $38.75 SMIP Res: 30.50 SMIP Com: 50.00 Other: �0.00 Inspection: $0.00 Total: $39.25 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Front� 0. 0 PARKING Existin : 0 Rear 0. 0 Rear 0-0 Re uired: 0 FEE SUMMARY PLANNING & ZONING Left 0. 0 Left 0- 0 Pr000sed: 0 Calc Valuation: Claim Valuation: Right 0- 0 Right 0- 0 s�,000.00 S�,aoo.00 NOTICE: The work authorized by this permit shall compty with all applicable handicap access requiremants under Califomla statutes and related regulations. (Ord. No. 9248, § 1, 1247-92) EXPIRATION: This permlt shail eutomatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 780 days. INSPECTIONS: In order for the work authorized under this permit to be consfdered legal, such work must comply wlth all eppllcable codes, and all requlred Inapectlons and Iinel approval must be obtained. Failure to obtaln inspections and final approval will result in the expiretion of this permit. FOR INSPECTIONS CALC: (N4) 7545628 " zua�e terool WORKERS' CqM PEN5�1710N DECIARATION: � � j I hereby affirm Lnder pena�ry of perjury one ot Ihe following tledaratlons: ❑ I �ave end will meinteln e cenificate of corisent to se&Insure br workers' compensatlan, es proNded lor by sedion 3700 ot Ihe Lehor Cade, tor ihe peAortnenca ot t�e work foi whlU thfs pertnit Is issued. ❑ I have arM wlll melntain wwkers' canpensatlon Inwrerce, ps requtretl by sgctipi 3700 of Ne Lebor CaOe, tor Ne peAortnence ol the wwk for whkh UU�iss p¢rrnit Lv LSweE. My workers' compensation Insurence cartier end pdicy number are: Cartier. �'-� Policy Number: (This sectlon neetl irot De oump�etetll! Ne perrtJtls vefued et one n�iMred do4ers (S I00) a less.) � I ceNfy Ihat in Ne pertortnance of �. e a r Nhich Ihis pertnit L9 issued, I shali not employ eny person in eny menner so as to become sub�ect to the workera' compensation laws 0� Celitomla, tl I�j t I lt I should Oecome sub�ect to Ne woMers' compensetlon provisions of Sectlon 3700 of Na LeDor Cotla, 1 shall larthwith comply with Ihese proWsions. Y Applicant Sipnetura: � oete: B�+'L•h'�' O�'• 2L . O� WFflNINO: FNLURE TO SECURE WOW RS' COMPENSFTION WVEMOE I$ UMAW Rll M!D SHRl1 SUBJECT Ml EMPLOVER TO CRIMIWLL PENALTIES M!D CML FlNES UP TO ONE HUNDRED TFqUSAND DOLLARE (St00,000�, IN ADIXiION TO THE COST OF COAIPENSATION, DPANGE$ AS PiqVIDED FOR IN SELTION 370BOF THE Lr100R CO�E, INTEREST, Ml� ATTO{1NEY'$ FEE9. LICENSED CONTAACTOAS DECLARATION: ' �. I hereby ettirtn thet I em Iicensed under provisions ot Chepier e(commendnp with Seclbn 7000) of DMslon 3 oi the Business enO ProfesSions Code, erW my Iicense is In tull force end ettect. lJc. M Class N ContrectoYs Sipnature: Dete: CONSTilUCT10N LENDING AGENCY: ❑ I hereby attirm that tnere Is e construction Ientlinp apenty lor the peAortnance ot Ihe work far which ihis pertnit Is issuetl. (Sec. 3097, Civil CoAe). Lendefs Name: Lentlefs Atltlress: Signeture: Date: OWNER-BUILDER DECLAAATONS: � I hereby effirtn t�at under penalry oi pe�jury Net I em EXEMPT FROM THE CONTAACTORS LICENSE LAW tor t�e following reason (Sec. 7031.5, Buslness end Pmteulons Code: My dry ar cwnry whkh requires a pertnit lo construa, elter, Imprwe, demdlsh, or repair any siructure, pdor lo ita Issuance, elso requires the appllcant for such pertnit to file e slgned sfetement thet �e or she is Ilcensed pursuant to ihe pravislons of the Contredors LJcense Lew (Chepter 9(commendng wiN Sectim 7000) ol DiNsbn 3 of Ne Business end Professions Code) or thet �e or she is exempt therefrom end the Dasis for Ihe ellegetl exemption. Any Noletlon af SecUon 7031.5 by eny eppllcant for e pertnit subjects Ne epplkant to e�I penelry of not more �han five huntlratl Adlars (5500).): ❑ I, es owner ai ihe propeM• or my employeas with weges es thelr sde compense0on, WILL DO THE WORK, and the structure is not intenCeG or ottereO lor sale (Sec. 7044, Buslness antl P�ofessions Cotle: The Contradors L]cense Law does nol apply to an owner oi property who builds or improves thereon, flrnl who tloes such work himself or herselt or through �is or her own employees, provided that such improvements ere not intended or oNered for sale. II, however, �he bulltling ar Imprrnement is sold wiUin me yeer o� �mpletion, ihe owner-builder vNl have Ihe Curden of proving Ihat he or she did not build or improve tor puryose ot sale.). � � I, as owner at Ne property am EXCLUSIVELY COMRAGTING WI7Tf LICENSED CONTRACTORS to consWct the projecl (Sec. 70a4, Business and Protessions Code: The contractors �cense Lew does not appty to an owner of properry who builCs or Imprwes t�ereon, entl who contrects for such proJect wlth e contredor(5) licensa pursuant to tlte ContraqJyvLicense Wws.). ❑ I am exempt under se�. Slgnature: rn,.ner io ve�+ned cy a� s i��. Venficatlon of Ownershlp by (rype W _ Business and PrWessians Cotle for this reesan: Date: OQ. •Z1.0'3 ❑No o�ersu��sallo. �i�: oQ•Li•or' I.e. - property fex bi0 or tleeC): DIVISION OF INUUSTAIA4 SAFETY PERMR CERTIFlCATON: ❑ t hereby cerlify ihat no excavation fne (5) or more feet In depih Inio which e person Is requireA to tlescend, will be mede in connection wlth work euthorized by this pertnit, and Ihet no bu�ldinp struMure, sceXolding, falsework, or demolilion or tlismentling thereof, will be more then t�irty-six (38) teet high. (Chap. 3.2, Grp 2, Ah 2, Sec. 341, Tiile 8, CalitomlA AdminlsiretNe Cotle). ❑ As owner-OuilOer, I vAll not employ enyone lo tlo work which would require e permil from the DlWsion af Intlusirial Selery, es noted ebove, unless such peraon hes e pertnit to do such wofk from Ne tlivislon. Signature: Date: Division ollndusirial Safery Permit NumDer. CERTIFlCATE OF COMPLU�NC�D 710N OF ENTRY: I certity under penalry of perjury ihel I have reatl ihls epplicatlon end stete that the Infortnetlon gNen Ls correct. I agree ro comply with ell tl dry orCinances reiefinp ro Duiltling consWction, entl euthodze representatives ot the Ciry oi Coste Mese to enter upon the ebove-described properry fo� In50 es. I epree nat to occupy or ellow occupenq ot eny builtling aut�orized by Ihis permit until tinel inspection. Oi•1Z.0� 4 t r�01 Le al Owner(s) Date AnNOr Aulhorizetl Appllcant �QQE,y INSPECTIONT'PE 1616 Flxetl System Fina� Fire Prevention 1286 Pool Spe Final 200 Flnel Re-ROof 201 Finel BIocWRetelnlnp Well 202 Finel Factory Fire P�ace 203 Finel Slpn 204 Final Demolltion Qd¢ 7�$ �Qpf.� INSPECTIONTYFE 208 Finel Mechenicel 20B Finel Plumbing 210 Finel Electrical 212 Flnal Fire Preventlon 220 Finel Plenning Approval 222 Finel Site 250 Finel Bullding/Occupenty �g Q� (714) 754-5273 • Pax (714) 7544856 Job Address: Suite No Vicinity: � CITY OF COSTA MESA � 9UILpIN6 D/YISION DEVELOPMENT SERVICES DEPARTMENT PERMIT PLUMBING PERMIT 484 E 16TH ST MASTER BATHROOM @ REAR OF PROP. Parcel Nunmber: 42515106 Applicant: Address: JONES, DICK 517 RAMONA AVE. CA MONTEREY PARK Phone: ((818) 400.6351 Zip: 91754-3314 Owner: BARON, RICHARD MARC Address 484 E 16TH ST - Phone: • COSTA MESA, CA Zip: 92627 Contractor: DICK JONES CONSTRUCTION Address: 517 R4MONA AVE. CA � Phone: ((878)400-6351 MONTEREY PARK Zip: 91754-3314 License: 524408 Arch I Eng : Address: Phone: Zip: License: 77 FAIR DRIVE, COSTA MESA, CA 92626 ISSUED BY: Status: ISSUED Applied: 07/09/1999 Issued: 07/09/1999 SCOPE OF PERMIT REMOVE & REPLACE 1-SHOWER 8 1-WASH BASIN SET FOR MASTER BATHROOM REMODEL. REF: 899-01053 ISSUE FEE Backflow irrigation Backflow Preventer Bathtub Clarifier System Connect (Ice,Soda,etc) Dental Units Dishwasher Drain, Floor Drain, Rainwater Drain, Root Drinking Fountain Expansion Tank Gas Earthquake Valve Gas (1-0 outlets) Gas (Over 4 outlets) Gas Repipe Gas Service Interceptors (Grease, Oip Interceptors (Sand Auto ) AMT $22.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 QTY 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FEE SUMMARY AMT Laundry Tub / Washer $0.00 Landscape Irrigation $0.00 P-Trap $0.00 Pressure Regulator 50.00 Process Piping (per 10 k) $0.00 Receplors $0.00 Septic Tank $0.00 Sewer Cap for Demo $0.00 Sewer Connect $0.00 Sewer Private Line 50.00 Shower $8.75 Sink, bar $0.00 Sink, commercial $0.00 Sink, Floor , $0.00� Sink, kitchen $0.00 Sink, service/mop $0.00 Spa (private) $0.00 Spa (public) $0.00 Qn 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 COMMENTS I SPECIAL CONDITIONS SumpPump Swimming Pool Trep Primer Urinal Vacuum Brkr Bkflow(1-4) Vacuum Brkr Bkflow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (Toileq Water Heater I vent Water Piping pnst or Rep.) Water Re-pipe Water Service Water Softener OTHER VIOLATION PLAN CHECK REINSPECTION TOTAL CALCULATED FEES: AMT $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $8.75 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $39.50 QTY 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 NO710E: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or ebandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must comply with ell applicable codes, and all requlrad Inspeetlons and f�nal epprovel must be obtained. Failure to obtain inspections and final approval will result in �he expiration of this permi�. FOR INSPECTIONS CALL: (714) 7545628 WORKERS' COMPENSATION DECLAR�J;ON: � I hereby aHirtn untler penalry of perjury one of the tollowing tleclarations: - ❑ I �ave antl will mainiain a certifiwte ot consent b self-Insure for workers' compensetion, es pmvitletl tor by section 3700 of the Lebor CoCe, for t�e peAortnanca of ihe work for which lhis pertnit is issuetl. �I have antl will maintain woticers' compensatlon insurance, as requiretl 6y section 3700 ot the Lehor Code, for the pedortnanca of the work tor whbh ihis permi� is issuetl. My workere' com ensalion In renca ca�r6ne�r and policy number flre: Carrier. � r��2..✓ �.� l.0 Policy Numher: _ O % � � � % (This sect�n neetl not be comp/eted i! the permit is ve/ued e( are hundred dollers ($ f00) ar /ess.) ❑ I certity ihat in the peAormance ot the work lor which this permit is issued, I shell not employ eny person in any manner so as to become su6ject to the workers' compensation laws of Califomia, and agree thet if I should become subject to i�e workers' compensation provisions ot Section 3700 of the Lebw Cotle, I shall forthwith compy with these provisions. Applicant Signature: Date: WARNING: FAILURE TO SECURE WORKERS' WMPENSATION WVEPAGE IS UNLAWFUL AND SHALL SUBIECT AN EMPLOYER TO CRIMINAL PENALTIES AND GVIL FINES UP TO ONE MUNDRE� THOUSAND DOLURE (5100,000), IN ADDfTIqJ TO THE WST OF COMGENSATION, DAMAGES AS PFOVIDED WR IN SECiION 3)O6 pF THE IABOR CODE.IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATON: I hereby affirm that I em licensatl under provis of Chapter 9(commencing with Saction 7000) of Division 3 ot the Busir� end Professions Coda, entl my license is in full forca entl eNect Lic. # Z � Class x b ConirectoYsSignature: Dale: 7 ^ i�'� �,��f CONSTRUCTION LENDING AGENCY: l ❑ I hereby attirtn that there is a construction lentling agency for the peAortnanca of the work tor which this permit is issuetl. (Sec. 3097, Civil Code). Lendefs Name: Lentlefs Address: Signature: OWNER•BUILDER DECLARATIONS: Dete: I hereby aHirtn that untler penalry of perjury ihat I am EXEMPT FROM THE CONTRAC70RS LICENSE LAW tor ihe tollowing reason (Sec. 7031.5, Business and Professlons Code: Any ciry or counry which requires a pertnit to consiruct, alter, improve, demolish, or repair any structure, pnor to its issuance, also requires the applicant for such pertnit to tile a signetl statement Ihat he or she is licensetl pursuant to ihe provisions oi the Conirectors License Law (Chepter 9(commencing wit� Sectlon 7000) of Divislon 3 of [he Business antl Protessions Code) or ihat he or she is a:empt therefrom and t�e basis for the allegetl exemptioa Any violation oi Sectlon 7031.5 by eny epplicent for e pertnit subjeMs the applicant ro a civll penalry of not more ihan five huntlred tlollars ($500).): ❑ I, as owner of ihe property, or my employees with wages as Iheir sole compensation, WILL DO THE WORK, and the structure is not intentletl or offered for sale (Sec. 7044, Business and Pmfessions Code: The Contracbrs License Lew does not appty to en owner of properry who builds or improves thereon, end who does such work himself or herselt or through his or her own employees, provitled ihat such improvements are not intentled or ottered for sale. If, however, the builtling or Improvement is sold within one year oi completion, the owner-builtler will hava Ihe burden ot proving that he or she did not builtl or improve for purpose of sale.). ❑ I, as owner of t�e properry, am EXCLUSIVELV CONTRAC7ING WIT}I LICENSED CONTRACTORS to construct the projecl (Sec. 7044, Business and Professions Code: The contreciors License Law does not apply to an owner oi property who builds or improves Ihereon, and who conaacis for such proJect with a coniractor(s) license pursuant to Ihe Conirectors License LawsJ. ❑ I am exempt under sec. Busineu and Professions Cotle for this reason: Signeture: Date: Owner ID veritied by drivers licanse. ❑ Yes ❑ No Dnver's License No. Expires: Venfica�ion of Ownerohip by (rype of dwument, i.e. - proDerty tau blll or deed): DIVISION OF INDUSTRIAL SAFE7V PERMIT CERTIFICATION: ❑ I hereby certity that no excavation tive (5) or more feet in depth into which a person is reqWred to descend, will ba matle in connection with work authodzed by this partnit, and that no building structure, scaHoltling, falsework, or demolition or tlismantling thereoi, will be more than thirty-siv (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Tlle B, Celifomia Atlministralive Code). ❑ As owner-huilder, I will not employ anyone to do work which would require e pertnit from the Division of Industnal Safary, es notatl aDove, unless such person has a permit to do such work from the tlivision. Signawre: Date: Division of Industnal Setery Pertnit Number: CERTIFlCATE OF COMPLIANCE AND AIfTHORIZATION OF ENTAV: I certify under penelry of perjury ihat I have read Ihis application and state ihat Ihe information given is correct. I agree to comply with all state laws end ciry ordinances relaling to buildinq consiruction, and authorize representatives oi ihe Ciry oF Costa Mesa to anter upon ihe a6ova-descnbed property tor inspection pyryqses. I agree not to occupy or allow occupancy af any building auihorizad by this pertnit untll Ilnel inspection. COpE �. INSPECTIONTYPE pdjE IMRULS 7616 Fixetl System Finel Fire Prevention 1266 200 201 202 203 2446-bfi Pool Spa Final Final Re-Root Final BIocWRetaining Wall Final Fectory Fire Flace Final Sign Final Demolition Date 7- P- 9q Date ' CODE� INSPECTIONTYPE 206 Final Mechenical 20B Final Plumbing 270 Finel Electrlcal 212 Finel Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Builtling/Occupency PSIF. � (714) 754-5273 • Faz (714) 754-4856 CITY OF COSTA MESA � BUILDIN6 DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT BUILDING PERMIT Job Address: 484 E 16TH ST Suite: Vicinity: MASTER BATHROOM � REAR OF PROP. Parcel Nunmber: 42515106 ApplicanC JONES, DICK Address: 517 RAMONA AVE. CA MONTEREY PARK owner: BARON, RICHARD MARC Address 484 E i6TH S7 COSTA MESq, CA Contractor: DICK JON�S CONSTRUCTIO� Address: 517 RAMONA AVE. CA MONTEREY PARK Zip: 917543374 Arch : Address: Zoning: Phone: ((818) 400-6351 Zip: 91754-3314 Phone: Zip: 92627 Phone: ((818) 400-6351 License: 524408 Eng: Address: Phone: Zip License: Zip: SCOPE OF PERMIT INSTALL NEW GARDEN WINDOW (36"x51") IN MASTER BATHROOM. FEE SUMMARY Plan Check: Permit: SMIP Res: SMIP Com: Other: Inspection: Total: $13.65 $21.00 $0.50 $0.00 $0.00 $0.00 $35.15 SETBACKS MAINSTRUCTURE Front 0-0 ACCESSORY Front 0-0 PARKING Exlstinq: 0 NOTES: Rear 0- 0 Rear 0- 0 Reauired: 0 PLANNING 8 ZONING Lefl 0- 0 Left 0- 0 Pro osed: 0 ,' . PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 07I0917999 Issued: 07I0911999 ISSUED BY: Calc Valuation: Claim Valuation: Right 0- 0 Right 0-0 Phone: License: ssoo.00 Ssoo.00 NOTICE: The work authorized by this permit shall comply with ell applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § t, 12-27•92) EXPIRATION: This permit shall automatically expire end become void if wark is not commanced within 180 days, or if work is suspended or abandoned for e period of 180 days. INSPEC710NS: In ordar for the work authorized under this permit to be considered legal, such work must comply with ell applicable codes, and all requlred Inepeetlona end final approyal must be obtained. Failure to obtain Inspections end final epproval will result in the expiration of this permit. FOR INSPECTIONS CALI: (714) 75M5628 WORKERS'COMPENSATON DECLARAnvN: - I hereCy eMlrm under penelry of perjury one of lhe lollowing declaretions: ❑ I heve end wlll meintaln a ceAilicate of consent to self-�nsure lor workere' compensation, es praviCed for by section 3700 oi the Lebor Code, fw the pertortnence of Ihe work for which Ihis pertnit is 14suetl. � 1 have end will mainteln worke�s' compensatlon insurance, as requireC by sectlon 3700 of the Labor Code, tor ihe pertortnance of iha work tor which this pertnit Is iswed My wo cqrt�pensetlan nSurance�qrtier and iry number are: �o / � // 4( �� Cerrlar. Q�r�� 1�L�j L.!/ Polity Number. � � (This secNon need not be le i! the Oertnlf is ve/uetl af one huntlreU ddlers (S 100) or less,) ❑ I certily lhel in ihe peAormehce ot IhB work for whiU ihis pertnit 15 IuueA, I S�all not employ eny person in any manner so as to becrome sub�ect to the workere' compensatlon laws oi Celifomia, entl agrea Ihat if I shaul0 become suhject to lhe workers' cnmpensetion provisions af Section 3700 of the Lebor Code, I s�ell forthwiN comply with these provlsions. Applicant Signeture: Date: WARNINO: FNLURE TO SECURE WORKf�' �.�PENSnTION COVERAGE IS UMAWFUL AND SWLLL SUBJECT AN EMPLOVER TO CHIMINAL PEWILT7E5 AND pVIL FlNES UP TO ONE HUNDRED TMOUSAND DOLIAPE (E100,000�, IN ADtlR10N TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECiION 3]O60F THE IABOR CODE. INTEREST, AND ATTORNEVS FEES. LICENSED CONTRACTORS DEC4N7AT10N: I hereby affirm Ihet I am Ilcensetl under proNsl� lorce entl etteCt. Lla a_--�Z� Contrectofs Signeturo: ol Chapter 9(commencing wlih Sectlon 7000) of Dlvislon 3 of Iha Buslness qn�,Professions Cotle, end my licensa Is in tull Clessp �7 '� Dete: ^7 � rf �— �' G CONSTRUC710N LENDING AGENCY: / ❑ I heraby eflirm thet there is e Gonsimctbn lentling egency br the petlormance ol tho work for w�ich this permit Is Issued. (Sac. 3097, Civll Code). Lentler's Neme: Signelure: _ OWNER-BUILDER DECLARATIONS: Londers Address: �ate: I hereby eNirm �het untler penalry ol pe�ury Nat I em EXEMPT FROM THE CONTRACTORS LICENSE LAW tor �he tollowing reason (Sec. 7031.5, Business end Professions Cotle: Any ciry or county which requires e pertnit to mnstruct, alter, improve, tlemWish, or repair eny sWCWre, Pnor to its Issuence, elso reqNres the applicant tor such permit to tile e signed stetement ihet he or she is licensetl pursuant to the provisions of ihe Conirectors IJcense Lew (Chepter 9(commencing with Sectlon 7000) of DlNsion 3 of t�e Business end Proleuions Cotla) or thet ha or she is exempt therefrom end t�e besis tor the elleged ezemptlon. My violatlon oi Sealon 7031.5 aj eny epplkant far a permit sub�ects the epplicent to e civil penelry ot nol more Nan five hundrad dollers ($500).): ❑ I, as owner of the properry, or my employees with weges es their sole compenselion, WILL DO THE WORK, entl Ihe structure is not intentletl or oHeretl lar sale (Sec. 7044, Business end Prafessions COAe: The Contractors Licensa Law does not appty to en owner ol property who builds or improves t�ereon, end who doas such work himself or herself or thmugh his or her own employees, pmvided thet such improvements ere not intentled or oflered for sale. If, however, lhe bullAing or imprwement is sold within one year ol comple�ioq t�e owner-builder will �ave the burden ol proving that he or she did not builtl or improve for purpose of sale.). ❑ I, as owner of the property, am EXCWSIVELY CONTFiACTNG WI7H UCENSED CONTHAC70RS to construct the pmject (Sec. 7044, Business anA Professions Cotle: The conirectors License Law does not apDly to en owner ot properry who builds or improves thereon, and who contrects for such project with a contractor(s) license Oursuent to the Conirectors License LawsJ. ❑ I am exempt under sec. Businass enC Professions Cotle lar this reason: SigneWre: Date: Ownar ID vedfled by tldvers licensa. ❑ Yes ❑ No Dnver's License No. Vedflcetion of Ownership by (type of tlocument, i.e. - property ta�c bill or deetl): Expires: DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certlty Ihat no ezcava��on live (5) or more leet In depth Into which a Derson Is requlretl to tlescend, will be made in connectlon wlth work eutharizeC by this permlt, an0lhat no building slNciure, scattoltling, talsework, or demolitlon or tlismentlinp Nereof, wlll he more ihen thirty-siz (38) feet hlgh. (Chap. 32, Grp 2, Art 2, Sac. 341, Tltle 8, Celitamle AAmIniS�reUve Code). ❑ As owner-builder, I wlll not employ enyone to do work which would require e permit Irom the Divlsion of Industnal Safery, es noted aDove, unlass such person hes a permlt to do such work Irom Ne tlivision. Slpnelure: Date: DlNsion af Induslrial Selery Permlt Number: CERTIFICATE OF COMPLIANCE AND AUTHORIZATON OF ENTRV: I certify under penelty ot perjury �ha� I have read Ihis application and stete that the inlortnafion given is correct. I agree to comply wiih all s�ete laws antl ciry ordinances releting to building construction, and authorize representatives ot ihe Ciry ol Caste Mesa to enter upon Ihe above-tlescnbea pmperty lar InspecJw� Puryoses. I egree not to occupy or ellow occupency ot any bulltling authorizetl by this pertnil until Ilnal Inspectlon. CO�E I, INSPECTIONTYPE 1616 Fl:etl System Final Fire Pi 1266 Pool Spa Final 200 Finel RaRoot 20/ FInaI B1aWRetelnlnp Wel1 202 Finel Fectory Fire Plece 203 Finel Sign 204 Finel Demolition 2M&48 > Date ` ' % os�e Qd¢, �{�j S,QQF.a INSPECl10NTYYE 208 Final Mechanical 20B Finel Plumbing 210 Finel Electrical 212 Finel Fire Preventlon 220 Final Planning Approval 222 Final Slta 250 Finel Building�Occupancy aeie /� � e . .iVO�L ADDITf6NS. DELEi��iiS, GR CORRECTIONS SHALL gE.pppROVED BY 7HE PLANNING DIVISION u , , i ' ; ' i i . . . . . - \ .. . . _ _ _"' '"_ _'"�__ / .' . . . . . -..� . - .. _. :.._.. _ ...... . � . . . . � . . . ..... .. . _ . A�� CITY.C. �'- . .;, "•. �:;t:T.TE�, ui � V. 9-�� . . -y MESA Q;1'!_ ... . . _ . ; �T. REG. bTE�Q �� i. .. . . . .. USE COMPLIES ITH ZONIN_ PLANNER INIT�DAT q ' ' " " " � .�nn�u.6� lleiyu,cX:�.4_Q � �� • . --- - i1.�:- 'M'ca� Q �� ' . . _ . . ,��/..�. �� .Th. s' fr��.��', . �� '� €�� e � � �'' Ss' �� s.� = � 8 0 � c � � V � _ � `_'�� 4 s� g. �a �� W �� t �.�. �� c3 �. � �`6 $� � � � � �� R� � �� . �. o.� s U � m � � _ �� o 0 � o '�.,� O a •- � �jQ��4 . �\�� LS '�� q � O � �$ s `o � � � �� r: . � �� f; ��o��. . . . ....---�----. ..- --. _.. , , ; , ; . .. . . . ......... : � /. . .. . _. ... . , . . ( _ __. _ . ' �/�� _ _ �- - ----;- - - - -- � � - _ . : ,. . ; - - -- - . _ _..__ .. . . . . . . .-- . - - -- - . - : , ; , ! . , , ; , ' ... ... .... . ... -..__._.__. . . __. _... . _ ._. _ _... ..- - - - — -- - -- _; ' I � �� ^ f � -� , _ . _: ..�. .: .: � i � ; ' i ' ' � i � .. : . . . , ; j� , � , ; �;� ; k . . , , _....... ., --• -- ---__ ; ....._..._..--.. ..-•---- ._. .._, ......--�-- -- ._._._i�� l_=;—,..---�.._!_. � : ,..._ ............. . . ._ <,-.•- . � . . 'u� VIS[ON'OFL�-.,_il1NG Jt�rtiY C!?.:' OF CuSTA MESA APPROVED i i.i .i , , • � � ; , .. 31' Date , , . . : This set ot plana aM speclfic�tions MUST ba kept on this jop at aB limes aM H is inlaWul to �� eratbnonsamewahoulwid;en�ionhomlheDivSimd�m7srig �J The c!ar�g ol this p�n� tbr�s SHALI iJOT he held le pertn� m lo be an approval . ol Ulo vqWlbn C7 aej' ,. . k� � r-r � � �� n.e� ,_a�.. c.. Thzse pkns nnd perm � ' �I ihe h�'tr nr s.•!: � r.:t camma,ax, �,dna�rAtir:oC adivs oer U2C �,90.3 �T r�khi� t80 dz•a ol �ssanr.e ; � / � „ 5 I 3/y � � .. . . . . , � i i�i� , / i� � �E .. .>.� � w; . . : i .. . . � i� � . �r . . . . , . — i ��------- --- i � , ; ;� :; :; .i ; .' . i� ,� �', , �� . . ; .� ;; ' %. / % i �'� � . ..� ��=- � �. I� , I I.:; , ,;; . . . - . � ; ; . ; . , . . ._, : _ . , : , ; � �� ti' ,.. , , I i ��r�� i . , ; � � � - � . ' � kr -� . � , . . ---- ..... ... ..... _....... _ � . , . _. , �� ;a 1N 1 r � i , : , � , � i ; ' 1 .'. I ' J � � • I : ' � c� DiY�:i� 1vi : . _, .. ..... ' ._. _. , - , • � - - � , . �� . t i- . ` ; i � � . �Cj � , � , � � , , . , � , ; . ,. . ....:...� .....:. . ....:_.. -- -- - - ' . ' : � � ' _ ; � �- i i _ � i I � _, , : ..... . !.._ � .. I � -� --` - i � i� � �� I i � �' �'!� � � _ , . .. .... -.- .' ._. _ i. - -�••--- � .. . . _. '._.... _-.�..._ ._._�.... ---.i.._.. . .. - - � .... ... ........_...� . t._.. .._. ! � �� r r__�_-,---� � � � t� � � � i i-r--�- n u ; ��; �;� � . i. .�. i ;. . , - ; ..,- .:..,..... ,... . . . : i. ; . � i t I _..�_. i i. ; i.. ._... ._._..__� . � � n. 4 ;Q-DO1'�%, � -.I_ ; __ I I . � ��.... � . ! � I � -i-�-i- --�--�__ --i---I �--�_- -i--� --h----•- _�� -1:-�_�_ ; � (714) 754-5273 • Fex (714) 754-4856 Job Address: 484 E 16TH ST Suite No / '. CITY OF COSTA MESA \__: BI/ILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT ELECTRICAL PERMIT Vicinity: MASTER BATHROOM @ REAR OF PROP. Parcel Nunmber: Applicant: Address: Owner. Address 42515106 JONES, DICK 517 RAMONA AVE. CA MONTEREY PARK BARON, RICHARD MARC �484 E 76TH ST COSTA MESA, CA Contractor: DICK JONES CONSTRUCTION Address: 517�RAMONA AVE. ISSUE FEE Temp service tesl Res. a/c package New Res (1-2 units) New Res (3+units) Pool / Spa Lighting Fixts Recept Outlets Switches Non Res Appl Res Appl Service to 200a Service to 1000a Service over t000a Motors to 1 hp Motors to tOhp Motors to 50hp Motors to t00hp Motors over 100hp Communiwtion drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Inlermetl Pole Phone: ((818) 400-6351 Zip: 917543314 Phone: Zip: 92627 CA Phone: ((818) 400-6351 MONTER�Y PARK . Zip: 977543314 - License: 524408 PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 ISSUED BY: stac�s: ISSUED Applied: 07/09/1999 Issued: 07/09/1999 SCOPE OF PERMIT INSTALL 3-LIGH7 FIXTURES & 1-RECEP7ACLE OUTLET FOR MASTER BATHROOM REMODEL. REF: 899-01053 322.00 $0.00 $0.00 $0.00 $0.00 $0.00 $3.00 $1,00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 so.00 $0.00 so.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantity FEE SUMMARY Temp Dist System I Lighting Busway 1100 ft Standing Section Misc Electrical Equipment Transformere up to 1 kva/kw ................up to 10 kva/kw .................up to 50 kvalkw .................uP to 100 kva/kw ..................over 100 kva/kw Low Voltage Equipment Low Volt Wiring System I Ckt Misa Conduit Misa Conductor Circus ( gen or ride) Circus (mech ride or lights) Christmas Tree Stand Fireworks Stand Other Electrical Fee Investigation Fee Plan Check Fee Reinspedion Fee TOTAL CALCULATED FEES COMMENTS / SPECIAL CONDITIONS so.00 so.00 $0.00 50.00 $0.00 so.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 50.00 50.00 50.00 50.00 so.00 50.00 50.00 $0.00 E26.00 Quantity 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access �equirements under Califomia statutes and related regulations. (Ord. No. 92•28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for e period of 180 days. INSPECTIONS: In order for �he Woik aulhorized under Ihis pertnit to be considered legal, such work must comply with all applicabla codes, and all requlred Inepectiona end flnal approval must be obtained. Failure to oblain inspections and final approval will resul� in the expiralion of this permit. FOR INSPECTIONS CALL: (714) 7545628 � , WORKERS' COMPENSATON DECLARATION: I hereby efllrm undar penally ol peQury one ol the Iallowing deGaratlon9: ' ❑ I have entl will melntain e ceNficate ot consent to self-Insure tor workere' compensetlon, es provitletl lor by sectlan 3700 at the Lebor Catle, lor the pertormence ot the work lor which this pertnit Is issued. 'R� I have end will mainteln workers' compensation insurance, as required by section 3700 ot Ihe Lahor Code, br t�e poAortnance oi Ne work br which Nis permit is Issuatl. 7� My w�''��,,rs' o e Btlon In rence t�tl�r end po'ry number ere: Cerrlar' /�Q��0. ' � �a � Policy NumDer � % � / �/ � m,i�..,....i ... .... .._,.._ _."'..._._..,_„__,.......__'___' ❑ I certly t�at In the peAortnence af the wark lor which this permit is issueQ I shell not employ eny persan in eny manner eo es to become suC�ect to the workers' compensetion lews of Califomie, end agree thet if I s�aultl become suDject to ihe workerg' compensetlon provislons ol Sectlon 3700 oi t�e Lebor Code, I s�ell forihwith comply with these provisions. Applicant SlgnaNre: Date: WARNING: FAILURE TO SECURE WORKERS' Cq.1PENSATION COVERAGE IS UNLAWFUL M'D SHALL SU9IECT PN EMPLOVER TO CRIMINAL PENPLTIES AND CML FlNES UP TO IXJE HUNORED TiK)USAND DOLLAFE (5100.000), IN ADDITION TO THE CW^T OF COMPENSATION, OAMAGES 0.5 PROVIDED f-0R IN SECf10N 31060F THE UBOR CODE, INiEREST. M1D ATTORNE`fS FEES. LICENSED CONTRACTOFiS DECLARATION: I hereby attirm Nat I am licensed under provisions of Chepter 9(co�m @ncing vriN Section 7000) ot Division 3 ot Ihe Business force entl eHect. Lic. p � 9. U / / Class N Contrectofs Signature: �� Dete: Cade, entl my license is In full CONSTRUCTON LENDING AGENCV: � ❑ I hereDy eHirtn Ihat there is e construction lentling eqency for the pertormance ol the work lor which ihis permit Is IssueC. (Sec. 3097, Civil Cotle). Lentlefs Name: Lenders Addrass: Signetura: OWNER-BUILOER DECLARAT10N5: Date: I �ereDy ettirm Ihat under penelry of perjury Ihai I am EXEMPT FROM TT1E COMRAC70RS LICENSE LAW lor the lollowing reason (Sec. 7031.5, Business an0 Professlons Cotle: Any ciry or counry which requires a pertnit to consWcL alter, impmve, demolish, or repeir eny siructure, prior to Its issuance, also requires Ihe epplicsnt lor such permil to lile a signed atatemem that he or she Is licensetl pursuent to Ihe provLsians af che Contrectors lJcense Lew (Chepter 9(commenGng wlih Section 7000) of Divislon 3 at Ihe Buslness end Prolessions Cotla) or thet he ar she is exempt t�erefrom entl Ihe basis for the ellegeA a:emptlon. Any violatlon ot Sectlon 7031.5 by eny appllcant for e permll sub�ects the epplicant ta e ciWl penelry ol not more then Ilve hundretl tlollars (5500).): ❑ I, es owner ol the property, or my employees with wages as their sole crompensetion, WILL DO THE WORK, end the structure is not intended or oHaretl for sele (Sac. 7044, Business end Professlons Code: The Coniractors License Law tloes not epply to an owner of propeny who 6uiltls or improves thereon, entl who tloes such work himself ar hersell or ihrough his or her own employees, pmvided thet such improvements ere not intended or oHared br sale. II, however, ihe builtling or improvement Is soltl within one year ot completion, ihe owner-builder will have tha burtlen of proving ihat he or she tlitl not bulld or improve br purpose of sale.). ❑ I, es owner ot the property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to consiruct the project (Sec. 7044, Business end Protesslons Cotle: Tha contrectors License Lew does not epply to an owner ot pmperry who builds or improvas thereon, and who comrects for such proled with a contrecfor(s) license pursuant ta tha Contractors License LawsJ. � I am exempt under 9ec. Bu5in855 end Professions Cotle for this reason: Sipneture: Date: Owner ID venlied Dy dnvefs license. ❑ Ves ❑ No Dnver'S LJcense No. Venlication of Ownership by (type oi tlocument, I.e. - property tex bill or dead): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICA710N: Expires: ❑ I hereby certlty thet no esceve�lon five (5) or more feet in depth Into whlch a person is requiretl to tlescen0, will ba mede Im m�necilon wlth work euthorizetl by this pertnit, entl t�ai no Dulltling siructure, scafloltling, lalsework, or demolition ar dismentling t�ereol, wlil Oe more ihan (hirty-six (38) leet hlgh. (Chep. 3.2, Grp 2, An 2, Sec. 341, Tltle B, Celilomie Administretiva Cade). ❑ As owneo-6uiltler, 1 will not employ enyone m do work which would require e pertnit trom the Divislon ot Intlusiriel Salery, es noted ebove, unless such person �as e pertnit to tlo such work trom Ihe tlivision. Slgnatura: Date: DiNsion of Indus�rial Salery Pertnit Number: CERTIFlCATE OF COMPLIANCE AND AllTHORIZATION OF ENTAV: I certily undar penelry of perjury that I have read this epplication and stete thet the inlormation glven Is correcl I egree to comply wlih all state laws entl ciry ordinances rela�ing to bullding constructlon, entl authodze represemetives ol the Ciry of Costa Mese m entar upon the ebove-descdbed property tor Inspectlon purposes. I agree not to occupy ar ellow occupancy of eny bulltling euthodzatl by this permlt untll Ilnal InsDectlon. 7816 1268 200 201 202 203 204 YMNB INSPECTONTYPE (� Fixed System Finel Fire Preventlon Pool Spa Final Finel Re-Rool Flnal BIacWRetaining Well Final Fectory Fire Place Finel Sign Flnel Domolition D te �� 5� oeca Q�jf, J� 4QQEa INSPEC110NTYPE 206 Finel Mechanlcal 208 Finel Plumbing 270 Final Electdcal 212 Flnel Fire Prevention 220 Finel PlenninB ApProvel 222 Final Site 250 Final Builtling/Occupancy r/m�I, � ►�I � � .UJ� �;. - q�� .. � •.:..::: ; : �, (714) 754-5273 • Fex(714)754-4B56 CITY OF COSTA MESA � _ BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT Job Address: 484 E 16TH ST Suit�: Vicinity: WHOLE HOUSE/GARAGE Parcel Nunmber: 42515106 npplican�; WHITE, JON Address: Owner: BARON, RICHARD MARC Address 484 E i6TH ST COSTA MESA, CA Contractor. J W ROOFING Address: 12892 FIELDSTONE DR SANTAANA, CA Zip: 92705 Arch : Address: BUILDING PERMIT Zoning: Phone: Zip: Phorte: Zip: 92627 Phone: (714)538-4577 License: 436187 Eng: Address: PERMIT NUMBER � 699-00533 r 77 FAIR DRIVE, COSTA MESA, CA 92626 ISSUED BY: Status: ISSUED Applied: 04/19/1999 Issued: 04/19/1999 Phone: Phone: Zip License: Zip: License: SCOPE OF PERMIT REROOF - TIO, USING EXISTING SHEATING, INSTALL 2 LAYERS 15it FELT, INSTALL NEW 30 YR COMPOSITION SHING�E ROOF (2400 SF). Plan Check: Permit: SMIP Res: SMIP Com: Other. Inspectioh: Total: $0.00 $99.75 $0.50 $0.00 $0.00 $0.00 $100.25 SETBACKS MAIN STRUCTURE Front 0. 0 ACCESSORY Front 0- 0 PARKING Exfstinq: o NOTES: Rear 0- 0 Rear 0- 0 Required: 0 FEE SUMMARY PLANNING 8 ZONING Left 0- 0 Left 0- 0 Proposed: 0 Calc Valuation: Claim Valuation: Right 0- 0 Right 0- 0 $4,500.00 sa,soo.00 NOTICE: The work authorized by this permit shall compty with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § i, 12-21-92) EXPIRATION: This pertnit shall automatically expire and become void it work is not commenced within 180 days, or if work is suspended or abandoned for a period ot 180 days. INSPECTIONS: In order fo� ihe work aulhorized under this pertnit to be considered legal, such work must compty with all epplicabla codes, and all requlred inapeetlona and final approval must be obteined. Failure to obtain inspections and final epproval will result in the e�iration of ihis permit. FOR INSPECTIONS CALL: (714) 7545626 WORKERS' COMPENSATION DECLApAT10N: � I �ere�y eKrtn under penalry ol pe�jury one ot t�e Iallowing tlederetlons: ❑ I �ave arM will maintain e certltkale o1 cansent to setl-Insure fw wwkers' oompensatbn, az provitled lor by secfion 3700 of the Labor Cotle, for �he peAarmance of the �WOrk fOf whlch Ihis pertnil 19 issueq. I heve eM wlll meinteln wakers' compensation Insurence. es required 6y secUon 3700 ot Ne Le�or Code, iw Ne peAo�mence W the work tw wl�kh Mis pertnit is IssueA. My workers' opmpensation Insurarlce carrier entl pdiq number are: Carrler. Pdity Number. /Thls sectbn n ed not Oe oompleteO ll the oermil ls velued e! one hundred dd/ers l5100) w IessJ ❑ I certly t�at in the peAormence ol 1he work tor which Ihis pertnic is issued, I shell not employ eny person in eny menner so es ta bemme sub�ect to the warkers' wmpense�ion laws oi Celif mle, end agree that If I should become sub�ect to t�e workers' crompensation provisions of $eytion 3700 oi Ihe Lebor Cade, I shall forihwith comptywit�these ' s. y/� � _ Applicent Signetur I Date: ��7� � t' WARNING: FNLURE TO S WORKEW' CO�.IPENSATION COVEMOE IS UNLAWFUL rWD SMAll5UB1ECT AN EMPLOYER TO CRIIWNAL�TI 5 PND dVIL FlNES UP TO ONE MUNDRED 7ik7tJ$AND OOLLAFE (St00,0�, INAOORiQV TO iHE OOST OFC�OMPENSATIOY, OAMAGES AS PFOVIOED FOfi IN SECTIQV 31W OF THE IFBOH�E, fNTEREST, fN0 RTfORNEY'S FEES. LICENSED CONTRACTORS DECLARq710N: I hereby aHirtn that I am force end etteci. Lia x_ Comrector's Signaturey ot Chapter 9(commencing with Section 7000) of Division 3 of the E CI955 k Date: Code, and my Ilcense is in full I CONSTRUCTION LENDING AGENCV: ❑ I hereby aHirtn thet there Is a cansiructlon londing egoncy lor the peAortnence oi Ihe work for whlch Ihls Dertnit Is Issued. (Sec. 3097, Clvll Code). Lendets Neme: Landers Address: Signatura: Dete: OWNER-BUILDER DECLARAT10N5: I hereDy eNirtn Ihat untler Denalty ol perjury thet I em EXEMPT FROM THE CON7RACTORS LICENSE LAW for Ihe lollowing reason (Sec. 7031.5, Buslness end Professlons Code: Any ciry or counry which requlres e permit to consimct, alter, Improve. tlemWish, or repelr eny sWcture, prior to Its Issuance, elso requires the aDDlicent lar such permit ta (ile e sfgned stefement t�et �e ar she (s ffcensetl pursuenl to lha provistons of the Con[rectors lJcense Law (C�apler 9(commendng wifh Sect(on 7000) of DfNsion 3 ai the Business end Professions Code) or tha� he or she Is exempt therefran arM the basis far Ihe elleged exemptlon. Any Wolatlon of Sectlon 7031.5 by eny applicenl lor e pertnit sub�ecis the appllcant ro a civil penalry o1 not more then flve hundred dollars (5500)J: ❑ I, es owner ot lhe properry, or my employees wl�h weges es I�elr sde compensation, WILL DO THE WORK, and the strudure is not Intended or oHereA for salo (Sec. 7044, Business end Professlons Code: The Contrectors License Lew does not appry to en owner oi properry who builds or imprwes thereon, end who does such work himselt or herself or through his or her own employees, proWtlad that such improvements are not intended or oHered for sale. If, �owever, ihe building or improvement is sald within one year ot wmpletion, the ownerbullder will have the burden ot proving Ihet he or she did not build or improve lor purpose of sela.). ❑ I, as owner of the pmperty, em E%CLUSIVELV CONTRACTNG WRH LICENSED CONTRACTORS to construd tha pro�ect (Sec. 7p44, Buslness antl Pmtessions GOOe: The wntwctors License Law tloes not appty to an owner af property who builds or imD�oves Ihereon, and who contracts for suc� pro�ea with e cnntrector(s) license Dursuam to the Conirectore License Lews.). ❑ I em ezempt unOer sec. Buslness entl Professlons Code far this reason: SlqnaWre: Date: Owner ID verilietl by tlr'rve(s Iicense. ❑ Ves ❑ No Drivefs License No. Vedtication ot Ownership by (type ol doCument, I.e. - properry tac DIII or tleetl): Ezpires: DIVISION OF INDUSTRIAL SAFE7V PEqMIT CERTIFICATION: ❑ I here0y certlry thet no excevetion tive (5) or moro feel In depth into whlch e person is requlred to tlescenq will De matle in connectlon wit� work eutharizetl by tNs pertnit, end Inei rro bulldl� stntct4re, scatfotdtng, telsewark, ar tlemditbn rn dlsmenUing thereot, wlll De rtro�e then t�lrty-slz (38) leet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title 8, Celltomia Administretive Cotle). ❑ As owner-builder, I vrill not empby enyona to tlo work whlch woultl require e pertnit irwn the Division of Industrial Satery, as noted ebove, unless such person �as e pertnit to tlo such work irom the division. Slgnature: Date: DiWsion oi Indusirial Safery Pertnit Number. ICERTIFlCATE OF COMPLIANCE AND qUTHORIZATION OF EMRV: I cenity untler penalry at perjury t�at I have raetl ihis eppllcation end stete that Iho Inlormatlon glven Is I cronect. I agree m comD�' ��h all steie laws end ciry ordlnances releting to Euiltling canstructlon, end suthotlze representetives of the Ciry ot Caste Mesa to enter upon the above-tlescrlbed properry j6r Inspection ourposes. I agree not to occupy or allow oaupency ol any Dulitling euthorized by lhis permit unlll tinal Inspection. COOE /, INSPECTIONTYVE 1616 Fixed System Final Flre Prevention 1266 Paol Spe Final 200 Final RaRoof 201 Final Blak/Retelnlnp Well 202 Flnal Fectory Fire Plece 203 Flnal S(Bn 204 Finel Domolitlon 244Bde PLg �ffiAL3 �L � SOOE� INSPEC710NTYiE 206 Final Mechanical 208 Final Plumhing 210 Final ElecMcal 212 Finel Fire Preventi0n 220 Finel Plenning Aoproval 222 FinelSite 250 Finel Builtling/Occupanry PAIE 1t�915 APPLICATION FOR A BUILDING PERMIT • BUILDING PERMIT NO. E�ecviwi m Tracl Block Lot Pormlt No. � Builtling �/\'''�' (A/ /� J�^ Plum�in9 a Addfl55 �� / � v � • �/ /� Y ` �lT�I NO. �p v� � D poss Mecnanlcal a qrea Sbeet Rrmlt No. d m ❑ Alter � Owner ,�� TyDa o1 Rojetl: ❑ New ❑ AtlEition 23� S• /� �/ .�- / RePalr ❑ Conwrl ❑ DemO ❑ OccuPancY Pml. Atltlress L f , 6 a P SuD. Dlst./ ��(y �Ytp PhOne Insp. A�ea AKhltect/ ZOnO $P�. Pmt. No. Dasigner Llcpnse No. SetDacks P/� Fwnt GL SL $beel W tl[h Atldll55 Vartls Lett g ear City Zip Phone aw o�. e �9 Enginxr Lic@nTe No. � fk nq paRs !Gu re ovi 8 vare Q Aetlress m [iry Zip P�one SV ucl No. ol No. of HeiqM Srorbs Famil � LICENSED CONTRACTOR'$ DECLARATION Vark Feu �'e � T. qe< ipt I harobV effirm that 1 am licensatl urytlar provisiom of CheO�er 9 ReGulretl No m . �commancing with Seclion 7000 01 D{�iaion 3 0� rhe Busine�s antl �Zonlnq Acorovetl BY: O e Professions Cotl��e777 entl y liconro (s in f W� force anC et�ect). � 3 LicensGeCqlas1��G LicanfpNvmber �OZ � � T Deuyl.i�Con[rncto. 1 _ Misc. E ntleress 3 �� roposoa tlse �r �� i.L� o/ Siructure jy CitY end 2iP 6 Pnone _i� .+ CONSTRUCTION LENpING AGENCV � I here�y effirm tha[ thera is a construction lentling eBe^cV for t�o a performence oi 2�e wo.4 for w�ic� this parmix is izauetl ISec. 309], ��' TyGe Coae ' Civ, CJ. (�' Class Const. �'oar i CLentler's Namo � �� f�b�� ende.'s namosz 23y e (�% 7�'�' '�' �E/OCCUPANC SIZE S0. FT. � OWNER�BUILDER DECLARATION r 1 hereb eHirm tha[ 1 am aeamp[ Irom �� Y t�e Contrecror'a Licema Lew 10 for the tollowing .eason: � ❑ 1, as Owner OI 1�0 prOperty, Or my Omployeei with wepos es tnoir 2. sole cOmpxnsation, alll tlo i�e wOrk, anC the svucture is not t �a intentlaE o. ofteretl 10� mle. 3 iwI, as owner Oi the p�OParty, am avclusively tonVactinp wit❑ � Iicensed wnvactors ta consvaci t e projaci. � m ❑ 1 am eYem [ untlar Sec. B&P t reeton 4� _ �� R a Dat ^d0 �' 0� Owner E WORKERS' COMPENSATION ECLAHAT� N Totai Valuation I hereby eflirm tha[ I heve a cntiti e of wnsent IO +eibinswe, or e certiiicom oi Workari Compensation Insurante, or a cenilietl EntrOa[hment Permi[ ReQWr tl ❑�'�s ❑ No C �oOY thera0l. Gutlin9 Pmt. Gratlin � Policy No Co.npeny _ Requlretl ❑ Ves No Pmt. N. � ❑ C�rtiliea roov is har�by lurnt 3 � ' � Rou9M1 GraEin9 � Q❑ Cbtilietl coPV is Iiletl . � C OF C.N noo,oma ov: oaie 19 Dau G��"� Appll nt 3 CERTI CAT -� EKE �TION FROM WORKERS COMPENSqT1pN IN RANCE Z (T�is mction neetl not be complatetl iy Dermit is lor E100 or laasl. � I[wtity t�at in the perfor.nence o1 tb� h.ork lor w�ich thi� parmit i� Q iSSuetl, I thell not amplOy eny person iq eny mmner 50 aa t0 b�cOme � subjec� to the Worka�i Compansaeion LaN.s o� Celifornia. PERMIT FEES Date AoN�cant NOTICE TO APPUCANT� If, ef[er makinB this Certificete ol SVuttural 5 �lan Chetk f Eaemption, you shou�tl becoma �ublect to t�e Workori Companution provisions of t�o Labor Cotla, you mus� forthwith comply with such E�o�� SPecial provitiom or this permh ahall �a tleame� revoketl. s InvesL s � CERTIf V THAT I HAVE READ THIS qPPLICATION AND $7ATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO P�umDin S COMPLV WITN ALL COUNTY ORD�N4NCE5 AND STATE LAWS i1ELATINGTOBV�Lf)�NGCONSTRUC71pN.ANOHEREBVAUTH- Mecna Iwl S OiiIZE REPRE P'r,T1171VE5 OF THIS COUNTV TO ENTER UPON TNE MEN NED `PFOPERTy FOR INSPECTION GUR- qa• ratle P S . 6_�_8� ��, «�o� -5' u e o op��cam ABem pa�a a-GraCe S Perm❑ s c. No. Isiue P �zo Co, Print ApD �tant's/ Bent's Neme All spaees within thi� box must ba mmpleted to protass P�an Issuance Check By: Approvatl: CMF 0335-46 (BU48) rev. 6/80 ��s�liiant m fiu in an spaces exceo� those within heavy ooreer Iines antl si9n au aooroDriate tleclantfons. 11�rrOF COSTA MESA �O �U �Tlp—�E�RrMIT Project Address J � Applicant'sMailingAddress �?-'�4 e, � �'� $'�� Owner'sName —�� D Phoneie�L1O Address '� �1 7 *� S� Arch/Eng. License No. Address Contrector's Nam m D Phon�� Address (mailing) ��r City License No. f�� `Z � LICENSED CONTRACTOR DECLARATION I hereby af(irm t�at I am licensetl untler provl510n5 of Charter 9(commencing with seclion 7000) ot Divislon 3 ot the Busi ss antl Professions Code n0 my Ilcense is in full forGe antl effect. �� _„ _�� „�� !ORKERS' COMVENSATION dEC1��T10� . hereby aftirm that 1 have a certiticate of cons t to se -insure or a certiflcate � ot Workers' Compen55tion Insurance, or a ertifietl o0Y �hereof (Sectlon 3800, LabJJJ,rC�. \',1 f /y� y�(-/�A Ir Policy No�tC]�JWS�AJ��'I��QCompanyr„�'y„��Hj� 8 Certitie� copy is h¢reDy furni5fietl. Ce�ti �etl o0Y � til with the city B' pj on � �ate AOPlican - ' E%E PTION FRO WORKERS' C MP N DEC RATION (This section neetl ot be com0�etetl i ermi i5 for o untlretl (g100) or lezs). I certify that in the perto�mance of th¢ work or which this perm�t ISlssuetl, I shall no[ employ any person in any manne so as [o become subject to the workers' Compensation Lnws ol Calitornia. � Date Si9nature NOTI[E: If, aiter making thiz tleUaratlon, you shoultl become subject to the Wo�ke�s' Compensation provisions of tM1e l.abor Code, you muzt tOrthwi[b comply wilh zuch p�ovisions o� this permit Shall b¢ tleemetl �evoketl. CONSTRUCTION IENOING AGENCV 1 bereby dtflrm that there is a construclion lentling dgency fOr the pertormance ot th¢ 'work for which this permi[ iz issuetl (Sectlon 309] Clv. C.) Lentler's Name Lentler's AUaress . OWNER BUILDER DECILFRATION� I hereby affirm tnat I am exempt irom the Contractor'z License Law for the tollowinq reason (Section 7031.5 Business antl Protezilonal Cotle: Any clry or county whiCh rGquiras a permi[ [o consl�uct, dlt¢r, improve, tlemolizh o� �epalr any rtructure, pNor to its issuance, also reqWres the aOPlicant for such permit �o file a siqnetl 5[atemenl that be/she is Iicensetl pursudnl to the p�ovi5ion5 01 he Contraclor'z License Law (Chap[er 9(commenUng with Seclion ]000) of Jlvision 3 of [he Buziness antl Professions Cotle) or [hat he/she is exem0� therelrom dntl Ihe basis for the alleqetl exemption. Any violatiOn of $ectlon 7031.5 by any applicant tor a Oe�mi[ 5ubjeCtS the aOP�icant [o a civll �enalty of not more lhan fiv¢ huntlretl tlo11ar5 (5500). LJ I, as owner ot Ihe properry or my employees with wa9es as their sola compensation, will tlo fhe wo�k, antl [ho rt�ucture ii not intentletl or offeretl tOr sale (Section 7044, Busin¢55 antl ProfezSional Cotle: Tha Contraclor'S llcen5e law tloes not appty to an owner of a property who builtls or improves ehereon, antl' who aoes sucn work himself/hersell or tnrougn his or her own employees, proviaea that such improvements are not intentletl or otferetl for Sale. It, however, the builtlln9 �r improvement IS Soltl within one y¢ar of com- pletlon, the own¢r will have the burtlen of proving hc/sho CIE nof �uiltl or im- �rove for lne purpoze of zale). I, as owner of the property, am exclusively cont�acting with IicenSetl con- tractors lo wnstrucl the O�oject ($ectlon 7044, 8usinez5 antl PrO�e55ions COtla: Th¢ Cont�actor's License Law tloes not apply [o an owne� of proDerty who bulltls or improve5 tnereon, antl who conttacis for Suth projects with a Con- tractor(sl license pursuant�to-the Contractor'i Licenze Law). I am aware that proof o( their Worke�'s CompenSailon insurance snowa be provl4e0 to m¢. ❑ I am exempt untler 5ection B. G v. C. for this reason Date Owner pplication and itate that tha abova with dll City antl County ortllnances ruction, antl hereby authorize repre- Ihe above-mentlonetl /ppprop!erty,�t,o/[� �_ Date&7 " / _ 71 7� T—T TVPE OF CONSTRUCTION LI NEW U ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ �EMOLISH ❑ OTHER q.p,.�6 DESCRIPTION OF WORK/USE OF BLDG. S Main Building: E TVPEOFPERMIT GRADiNG FOVNDA7iON STRVCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ OTHER %� PROJECT DESCRIPTION 5Q. FT. oCCuaANCV C Right K Left CONSTRUCTIONTVVE VALUATIONS S ZONE GRADING CU. VDS. ACRES Ping, Ref. # Remarkz: '7� �a% (o Planning Notes: Sink Preventer Irrigation Drinking Fountains Floor Draina � Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspec[ion Fee � $15 Boiler Duct- Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple FirepllFact. Blt. ICBO # Heating System & Ducting ❑ ai oo,000 eru O i oo,oao Reinspection Fee � $15 CMF 0865�46, rev. 4/8 Whi[e - Builtling: Canary - Applicanf: Plnk - Accounting; Goltlenrotl - Assessor viBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Isue Fae Hoodor Typel ❑ Canopy Type I I �, Refrigeration System ❑o-ioo,000sTu ❑ioo,aoo System Repair/AI[eration Iswa Fee FEES Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric 1470 6/01/84 2one Accessory Building: Parking Req./Provided ELECTRICAL Transtormer ❑ 15-50 KW O50+KW Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator �0�5 KW �5-15 KW Meter�up to 100amps Meter ❑over100amps Sub Panel Motors �0-7 HP � 1 Yh - 8 Inc.Solar �9-15 HP �16-15+ Microwave Pole Li9ht Range Standing Sections Trash Compactor BoOU TL' FEES 2 O N I N G R E � M T S. $ 3 Reinspection Fee $15 luue Fee $ 3 FEES DEVELOPMENTSERVICESRE�UIREMENTS: � Zaning Approved By Data Building Approved By Date Appliwtion Issued By Dat �l �� SUMMARV OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING i $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ (�� GRADING 3 PLAN CHECK 50°� $ MICROFILM $ MECHANICAL $ TOTALFEE $ �� $ 3 PIAN CHECK 25% $ CONSTRUCTION qND PLANNWG P� �& SPA APPROVALS Permit # Date Inspector AppROVALS Permit # -- Date Inspector 1. Temporary Electricgl Service or Pole . 52. Pool & Equipment Location 2. Soil Pipe-Undrgrntl. � 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgmd. 54. Forms. � 4. Electrical Conduit-Undrgrnd. ' S5. Electrical Bonding 5. Steel Reinforcemeht _ 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. � 57. APPROVAL TO COVER-GUNITE . 7.�Footings : �' 58. Electrical Conduit�Undrgrnd. 8.-Foundation 59.. Gas Pipe, O Undrgrnd., Test ' 9rtWater Pipe-Undrgrnd. ' 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System ' 61. APPROVAL TO DECK 71. Property Sewer Line & House Connection �� 62. Backwash & Receptor-Final 12.Sewer'Cap . � 63.Heater&Vent-Final 13. Roof Drains , � 64. Plumbing System - Final , 74. Rough Plumbing - 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar�System-Final 16. Rough Elec[ric Wiring /� � 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS F�NAL 19. Rough Heating & qir Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. DuCts,in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping OGas ❑Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank � Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T�Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final �p 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: � 34. Final Heating & Air Conditioning � 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace � 38. Final Plumbing 39. Water Service-Findl 40. Gas Service-Final 41. Solar pomestic-Final � - 42. Backflow Preventer 43. Backflow Irrigation . . � 44. �Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINALSTRUCTURE.&BUILDING 48. Special Requirem0nts Completed 49. Electric Release to Edison � 50. Gas Release to Southern California Gas Co , � � 57. CERTIFICATEOFOCCUPANCY _ ., , No. Date � , � � . ' Aoplicant to flll In all spaees exceo� those w(lhin heavy eoraer Ilnes anO sign all apvroD/�ate aeclaralions. � CITY OF COSTA MESA . �• P qMIT NO. TRACT NO. L T NO. - BLD . . '�ON.�TRUCTION PERINIT . � ,��L- �02�/0 7 �% r' Project Address ^ 6 •� TYPE OF CONSTRUCTION NEW A� TERAT.ION REPA1 R ApplicaBt'sMailingAddreu. '?L�C. )%T�S� ❑CONVERSION ❑DEMOLISH ❑OTHER _ Ownef'S Name ��P�R� e� f Phone��i �ESCRIPTION OF WORK A�ddreu r • � Cn` �C � TVPEOFPERMIT GRADING FOUNDATION STRVCTURAL Arch/Eng. L> icense NO. ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL Add1255 p G � 7 ❑ �OTHER �Convacror'sNam /�.�r Sµ%��l R� Phon t3 �2a PROJECT DESCRIPTION 5,(ZF7. OCCUv Addre55�mailing) G 1 � CONSTRVCTIONTVPE-I� /�` -VALUATION$ � Qa / 20NE GRADINGCU.VDS. A( � City License No. ��ICENSEO CONTRACTOR DECLARATION � Remarks: —g I I hareby alfl�m t�at I am Ilcenze0 untler provislons of Charter 9(commencing wi[M1 5ectiOn 7000) of Division 3 Of the Bu5ine55 antl Prof¢sslons CotlO, an0 my Ilcense Is in tull forca antl efiect. License qass �o. OZ b PLUMBING Da[e — � ' Si9natur �� O (�'f�( / �� WORKERS' COMP NSATION DECLA ATI N BatSink ShOW¢r5 �ereby attirm tnat I have a certificate ot co ent to se insure or a certitiwte Backtlow P�eventer Service Sink f Workers' Compensation Insurance, or a�certifietl copy thereot ( ect' n 3800, I..ab. ) 6 ' gackflow Irrigation Sewer Cap Policy No ��-�� o � _��-s�d Company np� Certitietl copy is hereby fumishea. �^ � Sewer ConnecHon ¢+ Certi ie0 topy is qletl wiM Ihe city B� ivisi Date - {j['— Applicant � Clarifi¢r5 . SOlar COII¢CtOrS EXEMPTION�F OM WORKERS' COMPEN ATI N D LARATION OiShWash¢� SOId� Pi in (Thi55eCtion neetl not be completetl if the Oermi i5 for ne huntl�etl (5300) or P 9� Iess). Drinkin Fountains � I certify [hat In th¢ pertormance of [ne wo�l whi this�perm�t issuetl, I 9 $013� T3nk Shall no[ emolov anv oe�son in any ma r so �t� 6me SUDj�c[ to the mmply wlth su<h provls CONSTRUCTION LENDII I hereby alfirm t�at Ihere iz of the work for which l.entler's Name l.enaer's Aatlress OWNER BUILDER DECLI I hereby affirm thal I am � f011owing r¢ason (Sectlon ; county w�ich requires a pe any Structure, prio� to its 1 LJ I, as owner of th comoansatbn, wi11 Ca for sale (Sec[ion ]0� License l.aw tloes not theteon, ana who tlo employee5, provitle0 I sale. If, howev¢r, Ne O�etlon, the owner wi ��Ove to�the purpo5e I, a5 ownar of the tractors td construct t LJ I am exempt unaer Date �Z Orivers' LRronse�o�55� CMF 0865-46 rev. 12/83 f Callf ia. Floor Drains �ture leclara i ou sh la be me subject to tne Floor Sinks on5 01 Ihe L.dbor Gotle, bu must fOrthwith or this pa�mi shall ¢ tle¢metl �evoketl. (�idiS¢�Vic¢ AGENCV �nstructlon Iantlin9 agency for tne performanco Interceptors �` �� i� is Issuetl (Section 3097 Clv. CJ � Kitchen Sink TION �aVatOrieS ipt from the CoOtractor'S Lfcense �aw for Ihe P—Tfe .5 BuSiness antl Professional Cotle: Any city or P to conslruct, alter, improve, tlemoiish or repair nce, also requires the applicant for such oermit Roof Dreins a permlt zuo�ecxs ine appncanc io a crvu untlretl tlollars (E500). • ty o� my etnploy¢es with wdg¢5 as thei� sole <, antl the st�ucture is not Intentle0 or offer¢tl ess antl Protessional Cotle: The Contractor's an owner ot a property who builtls or improves �o�k nim5elf/hersalf ot Ihrouqh his o� he� own Improvements are� not intentletl or offaretl for >r improvomont is zaitl within one year ot com- e burtlen o1 proving he/she Citl not builtl or im- , am exclusively contracting wlth Ilcensetl con- (Section 7044, Business antl Professions Coae: does not apply to an ownur of Droperty who tl who con[�acts for SUGh projects with a COn- e Contractor's License Law1. B. 8 P. C. for this reason Owner at tne above [y ortllnances .horiie repre- ' property for� / %/-I�-�Y Reinspection Fee Swimming Pool w/Spa Urinal Outlets Water Closet Water Heater Water Service � Boiler Duct - Under Giound Dut[ - S[ructural Duct - Ventilating Exhaust System ❑ MWtiple ❑ Firepl/Fact. Blt. ICBO # Heating System & Du ing ❑6100,000 BTU O1 0 0 � ,/ I I Reinspection Fee �I $25 Canary - Appliwnt; vink - Accounting; GOltlenrod - Assessor Issue Fee Hoodor Typel ❑ Canopy Type I I ❑ Isue Fae FEES J FEES $ 3 A.P. � L cZ, `, S Main Buildi E T Front � 8 Rear A C Right SLeft �j Ping. Ref. # Parking Req./Pr< Use of Building: Planning Notes: �` 8707 4/17/B4 Zone - � . Accessory Building: � � Park.Fees $ . . ELECTRICAL Automatic Washer Transformer ❑ 15-50 KW Construction Pole Sub. ❑ 50+ KW Cooking Unit Meter ❑up m 100amps Dishwasher Meter ❑over100amps Oryers ❑Gas ❑Electric Sub Panel Fan Motors D O-1 HP � 1'h - 8 F.A':U. �G' InaSolar 09-75 HP 016-15+ Fix[ures '�" „ � Microwave Device Boxes , i Pole Light awi¢nes, � Sign Garbage Disposal�-Z Standing Sections Generator.�0;5 KW 05-15 KW Trash Compacmr �,'y�oil;� Y O N I N G R E 0 U I R E M E ' Reinspection Fae ` I$25 I Issue Fee I $ 3 I PUBLICSERVICES EQUIREM1ENTS: Zonine APVroved BY�� I � Date � i7 � Buildin8 �+PProved By � Date�i� Appliption luued By � - ' _Dat '/' ' SUM ARVybFEES � BUILDING PERMIT $ �� J�� SMIP '$ �'J� �, PLAN'CHECK $ _____T_Y'.��— PERMIT � " PLUMBING �. $ � ISSUANCE $ j. PLAN CHECK y�25% $ ENERGV P.C. $ ^ ELECTRICA'Li $ ,'2O GRAOING $ . PLAN.CHECK 50% $ FJ MICROFILM $ ' MECHANICAL $ TOTALFEE $ PLAN CHECK 25% $ �_'3 � L� . l \ ' '�CONSTRUCTION AND PLANNING ' POOL .PA . r �APPROV,ALS Permit # Date Inspector � p,pPROVALS Permit # � -. Date ' Inspector - � . ' 1.� Temporary Electriral Service or Pole 52. Pool & Equipment Location . - �2.. Soil Pipe-Undrgmd. �f �y L 53. Steel Reinforcement '` 3. Electrical Conduit Utility-Undrgrnd. 54. Forms �� ' '4. Electrical Conduit-Undrgmd. 55. Electrical.Bonding � b. Steel�Reinfarcement 56. Rough Plumbing & Pressure Test ' � � 6` Electrical UFER Grnd. i; -�p .a�� /� � 57. APP.ROVAL�TO COVER-GUNITE . � � 7. Footings ' d' S L /�..Cj' ti -�C -X�I � �^ 58. Electrical Conduit-Undrgmd. . . ', ' 8. Foundation . 59. Gas Pipe, O Undrgrnd:, Test � � . _ 9. Water Pipe-Undrgrnd. s" 9�/ 60. Backwash Lines, P-Trap, � Undrgmd. � �. � 10. $tructural Floor System 61. APPROVAL TO DECK - - , 11. Property Sewer Line & House Connection 51�jyti L� 62. Backwash & ReceptorFinal � 12. Sewer Cap 63. Heater & Vent-Final . '' .• 13. Roof Drains 64. Plumbing System - Final � . 14. Rough Plumbing �y �� 65. Electrical-Final ' � ' 15. Rough Electrical-Conduit . 66. SolarSystem-Final �- 16. Rough Elec[ric Wiring 3� 67. Fencing & AcceSs Approval� �'- ' ' . 17. Rough Wiring Sign �a 68. APPROVED FOR PLASTERING � ' 18. Rough Electriral-T Bar Ceiling ' 69. POOL/SPA SYSTEMS FINAL .� . ' ' 19: Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT `G ` ; ,� 20. Rough Factory Fireplace APPROVALS Permit # ' . � 27. Ducts, in Structure 70. Underground Hydro _ � �' 22. Duc[s, Ventila[ing � 71. Product Piping O Gas ❑ Oil � i � 23. Gas Pipe-Rough & Test `��+�y�gN �n 72. Underg'round Flush ' � ' i 24. Roof Framing 73. Undergmd. Storage Tank O Gas ❑ Oil - ' ' ♦ , 25. Roof Sheathing 74. Overhead Hydro , '�26. T-bar Ceiling (Structural) & Monocoat 75. Dry Chemical ' � � 27. Fr e and Flashing �/ �% q, �S `1- 76. Dry Standpipe . ' ' ' I i 28. Lathing & Siding 5'3�$� '�5 77. FIXED SYSTEM FINAL � ; � 29. Insulation '�". 78. FIRE PREV. FINAL 30. Drywall Nailing -` (p HEALTH DEPT. REQUIREMENT � � � 7.0 8�- >w , 31. Plaster Brown Coat' y� � 79. FINAL INSPECTION � 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED � 33. Final Electric � � � Notes p�` .�o ��, � � 34. Final Heating & Air Conditioning 3�' p-� �,� 35. Final Gas Pipe-Test � � �- .. 36. HoodorCanoPY ��e !'-�'',, B��nJSUG. �J,�=.'' =fVj�lA!� �Ci3iK� 37. Final FaMory Fireplace � ��i-� � r 38. Final Plumbing �i2/�,f�/ �' � � � ��' ' � 39. Water Service-Final . - � � 40. Gas Service-Final . � � 41. Solar pomestic-Final � � 42. Backflow Preventer . � ��' 43. Backflow Irrigation � '`' 44. Landscape Irrigation System 45. Sound Attenuation � � � � 46. Handicap Regulations , � 47. FINALSTRUCTURE&BUILDING b/y�� " 48. Special Requirements Completed . ' ' � 49. Electric Release to Edison �� 50. Gas Release to Southern California Gas Co � � 51. CERTIFICATE OF OCCUPANCY - � � ' � - - No. Date III � ! ��, . � Applicant t0 flll ln all SpdCCS e%cept ��Ose wit�in hldVy OO�Cl� lines anE fi90 dll aOP�aO�idtC OCCIa�ati005. �CIIYUF COSIA MESA CONSTRUCTION PERMIT PER NQ,� //�� TRACT NO. _ LOT NO. UNIT NO. `' 6/Ay F. �( n' �T. Cefrg /h�sA '� FProjectAddress � Applicant'S Mailing Address TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR ;7��,'��,��/ �( �d��p ❑ CONVERSION ❑ DEMOLISH ❑ OTHER q.p, � Owner'sName �—El•/7�R�� PhoneQZ-7 DESCRIPTIONOFWORKlUSEOFBLDG. Address S Main Buildi E Arch/Eng. License No. TVPE OF PERMIT GRA�ING FOUNDATION STRUCTURAL T Front Address ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear O OTHER A Contractor's Nam �� • Phone C Right PROJECT DESCRIPTION $Q. FT. OCCUVANCV K Addresslmailingl �,CONSTRUCTIONTVPE VALVATION$ g LCft City Licenu No. � LICENSED CONTRACTOR DECLARATION I hereby affirm ihat I am licensetl untler provisloni of Char[er 9(commencing with sec[ion ]000) of OiviSion 3 of the BuSiness antl PrOte55ion5 Cotle, antl my Iicense is in full torce ana effect. License CIa55 license No. Date Si9nature WORKERS'COMPENSATION DECLARATION 1 hereby aHirm that I have a certiticate ot <onsent to self-insure or a tertificafe of Worke�s' Compen5ation Inm�ance, o� a certifietl cOpy [he/eof ($ection 3800, Lab. G.) Policy No. Company 8 Certifietl copy is he�eby turnish¢a. Certifietl copy is fileA with the city Builtling Division. Date APPlicant EXEMPTION FROM WORKERS• COMPENSATION DECLARATION (This sectlon neetl not be completea if tne permit is tor one huntlretl ($300) or Iess). I cerlify that in [he pe�(ormance Of tlte wo�k fo� which thi5 perm�t is (ssued I 5M1a11 not employ any persOn in any ma r z t0 bec e subject to t{te Workers"C�o{npen tlon Laws o( Califo� � Date �b �7 Si9nature � NOTICE: H, after making tnis tletlarati n, you shoWU Decome subjett to the Worker5' COmpensatlon O�ovision5 of [he Labor CoUe, you must forthwith Compty -wit� such provi5iOn5 or this Oe�mit Shall be tleemetl revoketl. CONSTRUCTION IENDING AGENCV 1 hereby affl�m that th¢r¢ is a con5t�uction lentlin9 aq¢ncy for tne pe�to�mdnte of tne work lor whicn this permit is Issuetl (Section 309� Civ. C.) Lentler's Name �ender's Atltl�ess OWNER BUIL�Eft �ECLARATION I hereby affirm that I am ezempt irom Me ConVactor's License Law for the iollowing reason (Section 7031.5 Business antl Professlonal Cotle: Any city or county whiU requlres a Oermit [o construtt, alier, ImOrove, tlemolisn or repair any slruGture, prior to its izzuance, also requires the appliwnt for such permit to file a sianetl 5[alement [hat he/she I5 Ilcensetl OurSudnt to Ine provi510ns o( therofrom antl the basis tor the alle9etl exempLon. Hny vioiauon o� pecuon 7031.5 by any applicant for a permit subjects [he appllcant to a Clvil �enalty of not more than five nuntlretl tlollars (5500). I, a5 owner of Ihu property O/ my emplOyees with wa9os as [helr sole Wmpensatlon, will tlo the work, antl tne s(ructurn ls not intentletl or otferetl fo� sale (Section 7044, Business antl Professional CoAe: ThC Cont�acto�'S Lic¢nse Law tloes not apO�Y to an owner 01 a p�ope�tY `�'h� builtls or imDrows thereon, antl wno tloes sucb work himself/herself or through his or her own em0�oyces, provlCetl that Suth improvem¢nis are not in[entletl or offeree tor sale. If, M1owever, Ihe builtling o� Improvement i5 zoltl wlthin ona yea� of com- pletlon, th¢ Ownet wlll have the burtlen Of proving he/she tlitl not builtl or im- }p�la.ve fot tFle purpOSG Of Shce). 'p.l, as ownet of the property, am ¢xtluslvely COn[ractln9 wit� IicenseA con- tractors to construct the project (Sectlon 7044, Business anE Prolessions Coae: Thc ConVactor's License Law tloes nof apply to an owner of property who builtls or impwves lhe�eon, antl who conVaGts 1or such D/ojects with a con- tractor(sI ucense pursuanc ro the Contractor's Llcense Law). I am aware that proot o( their Wo�ke�'z COmPensation insurance Shoultl be provitletl [o me. ❑ 1 am exemp[ untler Sectlon B. 3 G. C. for this reazon oate /�-T�-"� owner 1 h¢reby c¢rtity thai I have rea information is correct. 1 agree to antl state laws relating to bulltlir SCpShc1VC5 O� 1 [O ¢11 E! in5pectlon r / Signature � Drivers' Lit nse or SS � this application ana state that the above omply wi[h all ti[y antl county Ortlinances construclion, antl hereby authorize repre- upon the above-mentionetl property for Date —/I /6-87 - GRADING CV.VDS. ACRES_ Remarks: ` Bar Sink • Backflow Preventer Backflow Irrigation ,- Baihtubs Clarifiers . Dishwasher Drinking Fountains � Floor Drains Floor Sinks � Gas Service Outlets Interceptors Kitchen Sink Lavatories P-Trep Roof Drains Reinspectian Fea $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Blc. ICBO # Heating System & Ducting ❑0.100,000 BTU 0100,000 BT Reinspection Fee � $15 CMF 0865-46, rev. 10/84 White - Builtling; Canary - Applicant: Pink - qccounting; Goltlenrotl - Assessor Showers Service Sink SewerCap Sewer Connection - Solar Collecrors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Warer Closet Water Heater Water Service Auto-Wash Issue Fae Hood or Type I ❑ Canopy Typell ❑ Refrigeration System ❑0.100,OOOBTU ❑100,000 System Repair/Alteration Fire Dampers Fiegisters laue Fee $ 3 $ 3 Ping. Ref. # Planning Notes: Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Elec Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generaror �0.5 KW � Fee � 9608 i l/16/87 Zone Accessory Building: Parking Req./Provided ELECTRICAL Trensformer ❑ 15-50 KW ❑ 50 + KW Meter Qup to 700 amps � Meter �over100amps 5 KW $15 Sub Panel Motors �0-1 HP 01'F, - 8 Inc. Solar �9-15 HP �76-15+ Microwave �Pole Light Range Sign Standing Sections Trash Compactor luue Fee DEVELOPMENTSERVICESRE�UIREMENTS: 2oning APProvad By BuildinB �+PProved By �� 5050 TL FEES $ 3 O N 1 N G R E Q M T S SUMMARV OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ �—�—'}� PERMIT PLUMBING $ � ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ � MECHANICAL $ TOTALFEE $ PLAN CHECK 25% $ � �CQNSTRUCTION AND';PLANNING FOOL & SPA APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector � 1r�Temporary Electrical�Serviceor Pole 52�Fool & Equipment Location 2. Soil Pipe-Undrgrnd. � 53. Steel Reinforcement � 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Elec[rical Conduit-Undrgrnd. 55. Electrical BonAing 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings ��, ! 58. Electrical Conduit-Undrgrnd. 8. Foundation• � 59. Gas Pipe, � Undrgrnd., Test 9. Water Pipe-Undrgn1d��:� , � 60. Backwash Lines, P-Trap, O Undrgmd. 10. Structural Floor SYsiem 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. ElectriCal�Final 15. Rough Electrical-Conduit 66. Solar System-Final 76. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign �-`, 68. APPROVED FOR PLASTERING n 18. Rough Electrical-T Bar Ceiling ' 69. POOL/SPA SYSTEMS F.INAL k% 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts,Ventilating 71. ProductPipingOGas ❑Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.StorageTank �Gas ❑Oil 25. Roof Sheathing 74. .Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL � 29. Insulation 78. FIRE PREV. FINAL � 30. Drywall Nailing HEALTH DEPT. REQUIREMENT '_ 31. Plaster Brown Coat � 79. FINAL INSPECTION �� 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED r- 33. Final Electric Notes: _�_ �- � � 34. Final Heating & Air Conditioning a �'" 35. Final Gas Pipe-Test � 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service�Final • • 41. Solar pomestic-Final � 42. Backflow Preventer � 43. Backflow Irrigation , ' 44. Landscape Irriqation System � � 45. Sound Attenuation � • 46. fiandicap Regulations ' � I 47. FINALSTRUCTURE&BUILDING . 48. Special Requirements Completed • r 49. Electric Release to Edison 50. Gas Release to Southem California Gas Co � i. 51. CERTIFICATE OF OCCUPANCY , � No. Date � � ,/..� .- ..� 66�5 COSTA MESA BUILDING ,DEPARTMENT P.O. BOX 31� COSTA MESA. CALIFORNIA FOR APPLICANT TO FILL IN _� � � s x� �,.� �q . COSTA MESA. CALIFORNIA OWNER ADDRE55 /(/ (;N:7� CONTRACTOR /�y.j//�/ LGr. ADDRE55 ( • ��/ LEGIL LOT OESCRIPTION NO. Bl A.P. NO. / � 7" 3P � � 5'ZE 7 S�z � OF LOT E%ISTING BLDG. � SETBhCN LINE FROM C. CENTER OF STREET NEW REPAIR BUI�DING l�bY� l��X^.l TEL. NO. LIC. NQ� u�� `�� 36.0 0 , �b�s S� �I�lA�10E DEPT. cmr o� cosrA r.�E�a APPLICATION FOR PERMIT BUILDING � FOR OFFICE USE ONLY RECEIPT NO. PEFMIT Ni � /s YCENEO BY OATE RECEIVED DATE ISSIIE� -Sd' �F-z/-_ " BUILDING (/' � // ADDRE55 7 / (CJ �� G G COSTA MESA. CALIFORNIA FIRE 3 ZONE LIC. %�// ` `y� �a , T / I q_�_ r�� L, U> a,s'2 � ev NO.Oi BLDGS. O NOW ON LOT `f-"�/} � Js REAR YARD 9�C� IGHT � LEFT � �_ b� �.RIPTION OF WORK ALTERATION ADDITION MOVING DEMOLISH NO.OF / ROOMS �� STOFIES � ROOF ��(� // %CGL� COVERING PC.JC K if� BY � ��j'�( DATE � `l� CORRECTIONS • QF ST�,. T4E5A n.ii'qi : i'�- r 7n t_ G. UEPT. REG. � � � I NEREBY ♦CNNOWLEDGE THaT I MqVE RE�D iH15 4PPLICaTION srvD / STl�TE TN4T TNE 400VE I$ COFRECT iN� iGflEE TO COMPLV WITH ALL � � � CITT OROINANCES AND STRTE L<WS HEGVLRTING BUILOING CONSTflUC� iiOrv. ,�/ � / VALUATION SIGNATURE OF / :� � ' !/l . �'fT� PERMIT FEE � � — PERMITTEE �V �'�'��'c ///yyy % ��— PLAN CHECK $ �� 5 /� / AUTHORIZED AGENT TOTAL FEE 5 �/� — `4M� . , , COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only ADIDRESS �+t v� 1 �/ �]�. OWNER OR �T �� TENANT � ADDRE S%�� ' I' �r �iT I O9 ��T� Gos�'a M�.,A. Noi�s•3� CONSTRUGTION A.P. NO. � BUILDING AODRE55 UNIT OR SPACE NO. TR.NO. 1 NEW AI BRANCH OWNER ADDFESS ARCHITECT TEL. USE FOR�S�RU��7'„UiR�LPERMIT103.62 TL PERMIT �� S — /Gi / � i/'.,, LOT � �BLK. �iLTER IREPAIR MOVING DEMOLISH ADDRESS c�rvt � i APPROVED CONTRACTOR BV ADORESS TEL. CITV NO. rFi STATE CITV APPROVED SETBACKS l�C. NO. UC. NO. (y SIZE � � NO.OF BLDGS. (FFOM C/L STFEET) S OF LOT NOW ON LOT I F OfYT . a USE OF /�j � / '�„N,� EXI5TING BLDG. 1 �'J / C.Y � /� 1' FSeparate permits are required for L. SIDE �/ Fr.� � electric, plumbing and heating work. REAR , FT. � (.W.i US F BUILDING AN� WOR TO B PERFORMED PI_P,NNING ACTION Q Q � ¢' � / � f- / . APPROVED i' � ..1 a w � I hereby acknowled8a thet I hava reatl this application end state y� t�at the above informailon is correci and agree to comply wlih �+ all lews reguleting building const�uction, and I shell not amploy z anY person In violation of the workman's compensetion laws of � t�e State of Califomie. ,� 1 hereby certify ihat I am prope�ly licensetl as a conbactor unAer SQ. FT. the State of California Business and Professions Cotla, Division 3, THE AMOUNT SHO\ Chapter 9, antl t�at suc iaeases ere in tull torce antl etfact, or I THE PURPOSE OF ES am exempt trOm prov �s'd �fii eSPdie of�alifornia Business and Profassi Co visi 3, CI e� VALUATION Sign ur Pe, ttee _ " $ 6, �� or Authorized AOent Date �� ; ALUE$ /' / �.,� (O mVV �' 3V cRouv �' DATE J � Q � DATE n 'm m J VN UNDER VALUATION IS FOR ot 'ABLISHING A PERMIT FEE ONLV: � PERMIT FEE $ Z � �� PLAN CHECK E D• U' L m 0 TAX E LL . �0 V TOTALPAID E /7.Z Ii