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HomeMy WebLinkAbout204 16TH ST - Building Permits V s -is 9- CITY OF COSTA MESA < BUILDING DIVISION F• &lad �) DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4 OK* • PERMIT P05-00749 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us. PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 204.16TH 0 Status: ISSUED Suite No A p4RGC Applied: 09/30/2005 „....--`-' Issued: 09/30/2005 Vicinity: Parcel Nunmber: 42520216 Applicant: WILLIAMS,RICHARD ,, ISSUED BY: / Address: TR i- COSTA MESA,CA Phone:- .562-243-1479 204 E 16TH PL STE A ' - Zip ', 92627 its - Owner WILLIAMS,RICHARD ‘ L /If Address ,TR - - a.COSTA MESA,CA Phone: 562-243-1479 ., DA - 204 E 16TH PL STE A . Zip: 92627 tx Contractor OWNER-BUILDER Address: - -- - Phone: Zip: License:. 000000 ' SCOPE OF PERMIT 1 SHOWER,1%TOILET AND 1 WASHBASIN. FEE SUMMARY .--AMT QTY - AMT.. QTY,.. ,, y a F 7 AMT 'QTY ISSUE FEE --$23.50 r Laundry Tub/Washer $0.00 0 Sump Pump ':$0.00 ---0 Backflow irrigation $0.00 0 'Landscape Irrigation -- $0.00 0 Swimming Pool .- $0.00 • 0 Backflow Preventer $0.00 0_ P-Trap $0.00 0 Trap Primer $0.00 •0' Bathtub .;,$000 •,.0=' Pressure Regulator $0.00 0 Urinal - $0.00 0 Clarifier,System `,` $0.00 '0--' Process Piping(per 10 ft)'•.. $0.00 0. Vacuum Brkr Bkflow(1-4) $0.00 - -0 Connect(Ice,Soda etc) $0.00 i0" - Receptors- $0.00 - 0 Vacuum BrkrBkflo\(5+) $0.00 0 1 Dental Units _$000 0 Septic Tank - _ $0.00 0 - - - - Wash Basin a ` $9.80 1 Dishwasher `-$000 ,.0"- Sewer Cap for Demo $0.00 0 - Wash Basin Set Drain,Floor '$0 OQ 0. , Sewer Connect -$0.00 0 Waste and Vent Systeme,-• . $0.00;, -.: 0 Drain;Rainwater , ' 'A,$0.00'' "0 Sewer Private Line $0.00 -`0 Water Closet(Toilet) -`$9.80- 1 Drain Roof - $0.00 - 0 Shower $9.80 '-"-1 Water;Heater/vent : $0.00 0 Drinking Fountain-. $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.)- $0.00- 0 Expansion Tank . --$0.00 0 Sink,commercial - $0.00 0 Water Re-pipe ' $0.00 0 Gas Earthquake Valve $0.00 0 Sink,Floor •• $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) $0.00 --0- Sink,kitchen $0.00 - 0 Water Softener - $0.00 0 Gas(Over 4 outlets) $0.00 - ,`0 Sink,service/mop. $0.00 0 - - - - -OTHER $0.00 Gas Repipe`° $0.00 ^ '-0 • Spa(private) - , $0.00 -0 - - VIOLATION - - $0.00 Gas Service $0.00 0 - Spa(public) .' $0.00 0 . , . PLAN CHECK. - -$0.00 Interceptors(Grease,Oil) $0.00 0 - - REINSPECTION $0.00 0 Interceptors(Sand Auto) `$0,00• "0 - - -- - - TOTAL CALCULATED FEES: $52.90 COMMENTS/SPECIAL CONDITIONS - . V •J\ :\ .-"a litilh lit NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1,12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2448-46(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'compensation Insurance carrier and policy number are: Carder: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Califomia,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: O I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lenders Address: Signature: - Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 9044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements ere not intended or offered for sale.If,however,the building or improvement Is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • O I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contract•rs License Laws.). es IC I a metn•:p sec. I Business and Professions Code for this reason's .�ature I T��r. t AAa —_�Expires: .'%�� Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: O I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). O As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every - business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aEermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑No 8 (If"yes",attach certificate of compliance from theft nate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that'lktderf7penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. t1/4W.,•4' )1,40• Signature: 4## tij ' ,-- Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify`uhde;penalty of perju t iet I have read this application and state that the information given is correct. I agre to c mply ith all,st, e laws and city ordinances relating to building, onstructionrandiauthorize representatives of he City f Costa Mesa to enter upon the above-diner d p arty r In •n purposes.I agree not to occupy or allow occupancy of auy.buildidg authorized by this er until fi i sp ' . �Pi`7 :•• • :r(s And/Or Authorized Applicant Date • CODE t. INSPECTION TYPE PAIS JNTRIALS CODE, INSPECTION TYPE RATE REAL& 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing IFN 1-05 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site • 204 Final Demolition 250 Final Building/Occupancy CITY OF COSTA MESA BUILDING DIVISION )' f '- DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT Po man 44. E05-00975 (714)754-5273 • Fax(714)7544856 • www.ci.costa-mesaxa.11sICAL PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRJob Address: 204 I6TH.ST Pf- Status: ISSUED Suite No A Applied: 09/19/2005 Vicinity: Issued: 09/19/2005 Parcel Nunmber: 42520216 Applicant: RICHARD WILLIAMS Address: Phone: „562-243-1479 �'"� •� ) Zip �'".41"+ I Y ; . Drat Owner HUNGERFORD, RAYMOND GUY Address TR COSTA MESA,CA„ - "Phone:, , 204 E 16TH PL STE A Zip: 92627 Contractor: Et I P • Address: I Phone: Zip: - License: - , - 'h • SCOPE OF PERMIT._ • 3 OUTLETS. - " FEE SUMMARY Quantity _ Quantity ISSUE FEE •. $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft $0.00 0 Res.a/c package , $0:00 - - - Standing Section $0.00 . 0 New Res"(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New.Res•(3+uriits) •,, . ; $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa - $0.00 0 up to 10 kva/kw $0.00 0 Lighting Fixts - $0.00 - 0 - up to 50 kva/kw - $0.00 - 0 - Recept Outlets $3.30 3 up to 100 kva/kw $0.00 0 Switches $0.00 0 over 100 kva/kw $0.00 0 " Non Res Appy $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 ' Service to 200a $0.00 0 Misc.Conduit $0.00 0 Service to 1000a _ $0.00 0 Misc.Conductor $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 '= 0 Motors to 1hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp _ $0.00 0 Communication drops - $0.00 • 0 Investigation Fee • $0.00 Sub panel to 200a $0.00 0:; Plan-Check Fee $0.00 Pole Light Pkg _ $0.00 0 ReinspectionFee ' $0.00 Sign Circuits $0.00 : 9 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $26.80 Intermed Pole $0.00 •0 COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Ls Issued. My workers'compensation Insurance carder and policy number are: Carrier: Policy Number: (This section need not be completed If the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,end agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADOmON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class It Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: 1 hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commenting with Section 7000)of Division 3 of the Business and Profess.: ,.,••e)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant. � penalty'FJfJ. lot mor RAer;N!hundred dollars($500).): ❑ I,as owner of Ih 'uni 2 X -fry,orlom�y de:Th ctges as License sole compensation,WILL DO THE WORK,and sheds or improves Is not Intended or offered for sale(Sec. 7044,Business an•plofessions Oboe:The c rs License Law does not apply to an owner of property who builds or Improves thereon,and who does such work himself or herself or if6ough histion,theer own rThuo%es,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion, owritdTbuilffelwill have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not appl to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to he C. racto Lice a .). ❑ I am ex rd•t un•�Msec. ■ • �/Y � Business and Professions Code for this reaso� r? Signature: `-'_ i_! .,tfM'f Date: tri Vwner verifiedf driver's license. 0 Yes 0 No Drivers License No. .._ Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title B,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the sublect of this application aagermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Coda Section 42303 been made? 0 Yes 0 No B '(If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. // / l,Sign ure I Owner(s) Dat- n r z pelican' Date POPE. Janina ATE IN7171AL$ COPE it INSPFCTIONTYPE PATE Ri1IDAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing / �4 200 Final Re-Roof 210 Final Electrical tl%' ! 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval • 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy is CITY OF COSTA MESA t 9 BUILDING D'MSION—" Y:� � P IT NUMBER ��.. DEVELOPMENT SERVICESDEPARTMENT.- PERMIT B05-02125 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.81k1LDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 204 16TH PL Status: ISSUED Suite: Applied: 11/28/2005 Vicinity: ROOF,ABOVE UNIT A AND C ONLY Issued: 11/28/2005 Primary Occ: R Type of Construction: V-N Parcel Number: 42520216 Zoning: Applicant: WILLIAMS, RICHARD Address: 15974 MARINER DR Phone: 562-592-1164 ISSUED BY: HUNTINGTON BEACH,CA Zip: 92649 ' Owner: WILLIAMS, RICHARD Address 15974 MARINER DR Phone: • HUNTINGTON BEACH,CA Zip: . 92649 Contractor: OWNER-BUILDER- - Address: . Phone: Zip: License:- 000000' Arch : Eng: Address: Address: • Phone: Phone: • Zip: • License: License: SCOPE OF PERMIT TEAR OFF PART OF EXISTING ROOF COVERING FOR EXISTING TRIPLEX.INSTALL 1 LAYER OF 30#FELT,40 YEAR SHINGLES,CLASS B,AND REPAIR/REPLACE SHEATHING AS NEEDED. 10 SQUARES ONLY ABOVE UNIT A ANDC.-— - • FEE SUMMARY Plan Check: $0.00 Calc Valuation: $2,776.00 Permit: $83.25 Claim Valuation: $2,776.00 SMIP Res: $0.50 • SMIP Corn: $0.00 - Other: $0.00 - Inspection: $0.00 Total: $83.75 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0.0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: -0 .Required: 0 Proposed: 0 • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result In the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 244&46(&00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: ' I hereby affirm under penalty of perjury one of the following declarations: ' • ❑ I have and will maintain a certificate of consent to sell-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed it the permit is valued at one hundred dollars($100)or less.) —1'certify that in the performance of the ork for hick this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' ( compensation laws of C to and gr t t If I should become subject to the workers'compensation provisions of S tion 3700.1 the Labor Code,I shall forthwith comply with these prows i1; � Zg- AppticanfSig�ture:�'� �� 1 �' �1/�.l .( Date: // ^[J U'7 WARNING:'FAILURE TO SEC E WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO IMINAL P '• TIES AND OvIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060 THE -•-CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full force and effect.Lic.# Class B Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,CMI Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and'Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to Its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of properly who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). - ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) _ license pursuant to the•Contr.ctors se Laws.). I`am exempt un/1- // /� Business and Professions Code for this reason: - -Si me: 3 LI . . - _Laerag < r x- /tare 'Owner ID verified by driver's license. Yes 0 No (Drivers Cicense No. /�.�� L Expires:- �,L�a _ Verification of Ownership by(type of doc mens,i.e.-properly tax bill or deed):"---r--. S DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which et any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification from the South Coast Alr Quality Management District or from any other air pollution control district or agency? Ul Yes No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ..t....t.c.o othero uo.. o.. 7 If a permit from the South Coast s Quality cri ed Management at or other airpollution coon 4l district3 agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? 0 Yes ❑No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I ogre: to c•' ply with : fie laws and city ordinances relating to building construction,and authorize representatives of the City of osta Mesa to enter upon the above-des ••d •r••erty •r i•/:cfon purposes.I agree not to occupy or allow occupancy of any building authorized by thisit ntil fi /` spect Ciggriature Of Legal And/Or Authorized Applicant Date CODE L INSPECTION TTPE- - ' 2AIE'•' INTRIALS CODE r ' INSPECTION TYPE' • QM ILLS• 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof ' /r-Orp-©6 w 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place • ` 220 Final Planning Approval ' 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy " ' Y1 ? � CITY OF COSTA MESA BUILDING DIVISION Y•, DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER t-. 4a PERMIT r BOS-01644 Stwromrw (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.gt$LDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 204 16TH PL Status: ISSUED Suite: A Applied: 09/19/2005 Vicinity: Issued: 09/19/2005 • Primary Occ: R-1 Hotels/Apts/Res>10 Occ Type of Construction: V-N Parcel Number: 42520216 Zoning: Applicant: RICHARD WILLIAMS Address: Phone: 562-243-1479 ISSUED BY: Zip: - • Owner: HUNGERFORD, RAYMOND GUY Address TR COSTA MH PLZip CA Phone: R R I P 204 E 16TH PL STE A Zip: 92627 • Contractor: - Address: Phone: Zip: License: Arch : Eng: • Address: Address: • Phone: , Phone: ' t Zip: ' -. License: ., License: SCOPE OF PERMIT ,7 WINDOW CHANGE OUT. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $2,000.00 Permit: $69.25 Claim Valuation: $2,000.00 SMIP Res: $0.50 SMIP Corn: $0.00 , Other $0.00 Inspection: $0.00 • Total: $69.75 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 - •-Rear 0-0 Left 0-0 Right 0-0 • PARKING Existing: 0 Required: 0 Proposed: 0 k. NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(WOO) DECLARATIONS 1 rf•j 0 0.1 WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. ❑ I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) . ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOL ARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNEE$RB�UILDER DECLARATIONS: I hereopaRlm that under penaltyof;�erju that I am,EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any or coultovhich retSYAleermit toy tj'its st,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed stateme that hdTd•sh Icensed: Jrs to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the properly,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale,If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not a•ply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to Con ii,ctors ice _ O I am exp{''.t und: •ac. \ Business and Professions Code for this reason: _ Signature: \1 C s�� �. —" Expires: •,s. . e/ Verification of Ownership by(type of document,i.e.-property tax bill or deed): ' DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: O I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any One time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with same exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application agermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes A No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described properly for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. e• sentativ . �, / / Date CODE# INSPECTIONTTPE all INUIIALS CODE# ' I•. #'. PAIL I[flll)ALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 7 — ( 204 Final Demolition _ 250 Final Building/Occupancy / (/�6 Applicant to fill In all spaces gacept.t4ise within heavy border lines and sign all appropriate declarations. . - CITY OF COSTA MESA . , PERMIT N , TRACT NO. LOT NO. BLDG.NO. ' CONSTRUCTION PERMIT 33/ 7 Pur 2.415 p. ( 33 2979 7/29/03 41075 Ti /J,=( f 1/�/lf Applicant's Mailing Address •-0r. C L 242 TYPE OF CONSTRUCTION U NEW U ADD U ALTERATION ❑ REPAIR • • r Project Address ��['7� �/,`t /C /C c( if ❑ CONVERSION :❑ DEMOLISH ❑ OTHER - - • ' Owner's Name —1 , 1"I" 0 R'D Phone L41-0-7DESCRIPTION OF WORK • , ZONING REGULATIONS Address 24 E!GMIy ,I�r 895M A&k CA-.g26L7 C //��77 ^t / }� r" `' TYPE OF PERMIT' U GRADING ❑ FOUNDATION ❑ STRUCTURAL A.P:via c/ 5—20 .--/6 i ZONE R Arch/Eng. - License No. • ❑ TENANT ❑'ELECTRICAL ❑ PLUMBING. ❑ MECHANICAL PLNG.REF.9V5 BUILDING -7 C .. cFTBACW rn cr .J Addf¢ss. y� • '❑ OTHER - TO BUILDING /1 /'1 /y REAR YARD (TO P/L) Contractor's Name' - n/8 Phone PROJECT DESCRIPTION SQ.,FT. OCCUPANCY PROPERTY LINE '--! -CJ' / fr ' CONSTRUCTION TYPE • VALUATION$ /y SDO �� LEFT SIDE YARD S --Oil RIGHT SIDE YARD3 - (� Address(mailing) i ZONE • GRADING CU.YDS. • ACRES ' - PKC.SPACE REQ. PROVIDED License No. - - ' - LICENSED CA NT RACTOR DECLARATION ( Remarks: - 1 - ' ' STREET WIDTH S 3 / - PARK FEE$ I with • ey section that0) Lam licensedion under provisionsBusnf CP ofes i (commencing - - �/� 61-0-e4 �{mss 4 with section 7000) of Division 3 of the Business and Professions Code, and SPECIAL CONDITIONS: 61.0- 4oi ' My Iicense.is in full force and effect. - : . License Class ' • . ' License Not PLUMBING •' ' Date Signature - - ) ELECTRICAL• 4 WORKERS'COMPENSATION DECLARATION • Bar Sink Sewer Cap thereby affirm that I-ha've a certificate otconsent to.selfinsure or a certificate. - -!- Backflow Preventer - --- - • Sewer Connection . - - _ . - Automatic Washer -_- - - Neter Dover 100 amps _.. 'Workers' Compensation Insurance, or-a certified copy thereof (Section - Construction Pole -• JO, Lab. C:) • Backflow Irrigation Solar_Collectors ( Sub Panel Policy No. • - Company Cooking Unit Sub Pole , . BCertified copy is hereby furnished, I I Bathtubs , Solar Piping , ; Certified copy Is filed with the city Building Division. Dishwasher Motors 00-1 HP CIVA-8 Date Applicant - , • Clarifiers ' Solar Tank i EXEMPTION FROM WORKERS'COMPENSATION DECLARATION I Dishwasher Swimming Pool w/Spa Dryers• ❑Gas ❑Electric - Inc.Solar 09115 HP 016-15+ ' (This section need not be completed if the'permit is for one hundred($100)or — less). Fan Microwave I , I cetify that in the performance of the work for which this permit Is issued I Drinking Fountains Urinal - shalt-not employ any person in any manner so as to become subject to the - F.A.U. Pole Light • Workers' Compensation Laws of California. - . I Floor Drains . •Water Closet I - i nate Signature Fixtures Range R1 NOTICE:If,after making this declaration,you should become subject to the - - -• Floor Sinks - - - Water Heater - - ' - - - - 9 - . Workers'. Compensation provisions of the Labor Code, you must forthwith, . , comply with, such provisions or.this permit shall be .deemed. revoked.; - Device Boxes Sign: , Gas Service 'Outlets' Water Service9 CONSTRUCTION LENDING AGENCY - - • Outlets ' I hereby affirm that there Is a construction lending agency.for the performance. Interceptors _ - , Standing Sections • of the work for which this permit Is issued (Section 3097 Civ. C.)- • _ Switches . Lender'si Name, ' - - - . ' Kitchen Sink - . . - . - ' •• . Trash Compactor I Lender's Address• • Lavatories Garbage Disposal • ' OWNER BUILDER DECLARATION _ • - • ' I hereby affirm that I am exempt from the Contractor's License Law for the I - - Generator ❑0.5 KW 05-75 KW • following reason (Section 7031.5 Business and Professional-Code: Any city or, • P-Trap - • •- - - county which requires a permit to construct,alter,Improve,demolish-or repair - - Transformer ❑15-50 KW any structure, prior to Its issuance,•also requires te applicant for such permit Roof Drains . -- - - to file a signed statement that he/she Is licensed pursuant to the.provisions of - 050-1.-KW the Contractor's License Law(Chapter 9(commencing with Section 7000)of Reins ectionlFee Reinspection Fee - $15 Division 3 of tho'Business and Professions Code) or that he/she is exempt ? • Showers - - - P $15 , -•efrom and the basis for the alleged exemption. Any.violation-of Section - - Meter ❑up to 100 amps Issue Fee -$ 3 1.5 by any applicant for a permit subjects the applicant to a civil . 1 1 yytt// p�( ` „ ' ilt of not more than five hundred dollars($500). i ' Service Sink• Issue Fee $ 3Zoning ApprovedBy (J/`('/!`/?( pate 7/��/ J Y I. J m I, as:owner of the property or my employees with wages as their sole --- MECHANICAL compensation will do the work,and the.structure is not intended or offered _ Application Approved By Date for sale-(Sec/Ion 7044, Business and l Professional Code:-The;Contractor's '/r_/ ?AlfJ ' License Law does not apply to an owner of a property:who builds or Improves Boiler I - - Refrigeration System Application Issued By • !/� .Data 7 IX / 4v thereon, and who does such work himself/herself or through his or her own • • employees, provided that such improvements are not intended or offered for Duct-Under Ground • ❑6100,000 BTU 0100,000 BTU sale. If, however, the building or Improvement is sold within one year of com- • SIUMMARY OF FEES ' - , elation, the owner will have the burden of proving he/she did not build or Im- rove for the purpose of sale). ' Duct-Structural System Repair/Alteration - BUILDING PERMIT $ of •"t SMTP • $ • 'S� D I, as owner of the property,am exclusively contracting with licensed c • on- Duct-VentilatingPLAN CHECK to.oYJ PERMIT i • tractors to.construct the.project (Section.7044,Business and Professions.Code:. - . . - - . . $ The Contractor's License Law does not apply to an owner of property who , • I ISSUANCE • ' $ • ' builds or improves thereon,and who contracts for such projects with a con- PLUMBING ' p P 1 Exhaust System ❑ Multiple❑ I I $ tractor(s) license pursuant to the Contractor's License Law). - PLAN CHECK $ GRADING $ � ' ❑ am exempt under Section B.& P.C.f• this reason r Fire Bit. ICBG# - • 1 ELECTRICAL $ $ Date •67/X4 - owner a i ... 4 .' Heating:System& Ducting MICROFILM I $ , I-hereby certify That-1 have read this app' .tion and stat- hat the above • - ❑O-100,000'BTU ❑100,000BTU - PLAN CHECK'. $ information is correct. I agree to comply with all city and county ordinances I ' MECHANICAL I $ 1 TOTAL FEE $ j and`state laws relating uiltling construction,and hereby authorize repre- Hood or Type I ❑ r • I 1 sentatives o city to ant r upon tt�6�bove.mentioned cop ty for I ' Reinspection Feed $15 PLAN CHECK $ LESS Signinspectiotar urp ees �` 4 Q \) , Canopy' TVPe II ❑ I f ADVANCED PC $ SI nature :, --.7�(� Dated 't-1 Registers • Issue Fee • $ 3 I • FINAL FEE $ Drivers' License or SS CMF 0865-46 rev.12/82 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod-Assessor - _ - - - `.;CONSTRUCTION-AND PLA NTNG _ __ _ - - POOL&da..- \ _ - - -- - g! .Dater Inspector - i - Date Inspector • . APPROVALS Permit - APPROVALS. Permit# " 1•. Temporary Electrical Service orPole - 52r Pool & Equipment Location • • " 2.' Soil Pipe-Undrgrnd.: .- . 53:- Steel Reinforcement . 3: Electrical Conduit Utility-Undrgrnd. - •.54. Forms • . --' 4'. Electrical Conduit-Undrgrnd' _ - _ • - -_ 55:. Electrical Bonding - 5: Steel Reinforcement' : ' - 56. Rough Plumbing & Pressure Test • •• 6. Electrical UF ER Grnd. - • - - 57: APP.ROVAL•TO COVER-GUNITE 7. Footings. , : _ 'N 7 • ,F i-,IFic-.. 58. Electrical Conduit-Undrarnd.- r 8. :Foundation i 59. Gas Pipe,O Undrgrnd., Test 9. Water Pipe-Undrgrnd. • 60. Backwash Lines, P-Trap, 0 Undrgrnd. 3, 10. Structural Floor System _ 61. APPROVAL TO DECK • 11: Property Sewer Line & House Connection r ..62. Backwash & Receptor-Final . - i 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains I 64. PlumbingSystem - Final 14. Rough Plumbing • - 65. Electrical:Final' 15. Rough Electrical Conduit 4- " - ' _ T" - 66:CSolar•System-Final ` ` - ' 116.'Rough-Electric Wiring ; _ - '- H. 67:Fencing&Access Approval '- '17. Rough Wiring Sign ' ' - , L 68. APPROVED FOR PLASTERING 18. Rough'Electrical-T Bar Ceiling i -• - i 691 POOL/SPA SYSTEMS FINAL ' 19..Rough Heating & Air Conditioning . - FIRE DEPT. REQUIREMENT ! 20. Rough Factory Fireplace " ' ' APPROVALS Permit# ' " 70. Underground Hydro 21..Ducts,in Structure • 22. Ducts, Ventilating : , . ! 71.1 Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test ' : 72. Underground Flush 24. Roof Framing. ' - • - . 73. Undergrnd.Storage Tank 0 Gas. 0 Oil 25. Roof Sheathing 74., Overhead Hydro 26. T,Bar Ceiling (Structural),& Monocoat r 75. Dry Chemical . 27. ,Frame and'Flashing : 1$ g-4,9i 76., Dry Standpipe - - - 28." Lathing& Siding _ 1 . ' . ' 77. FIXED SYSTEM FINAL 29. Insulation z - i 78: FIRE PREY. FINAL • 30. Drywall NailingNotes: - - 31. Plaster Brown Coat ' , 32.•Electrical Power Meter-Firial ' i 33. Final Electric 34. Final Heating& Air Conditioning , 35. Final Gas Pipe' --Telt ' - _ , 36. Hood or Canopy`, . , - : - - - • - - 37. Final Factory Fireplaces - 38. Final Plumbing'- _ t: - 39. Water Service-Final " 40. Gas Service-Final - 41. Solar Domestic-Final : ! ' • __-'_- _, - 42. Backflow Preventer t I. - ....... _ - , -- - _ - _ _ , - 43. Backflow Irrigation •• -. i - - 44. Landscape Irrigatiori;System - ' - - 45. Sound Attenuation' ' - . ' 46. Handicap Regulations' ' 47. FINAL STRUCTURE & BUILDING D S , 3ca^p• 48. Special Requirements Completed • , 49. Electric Release toEdison j _._ _ 50. Gas Release to Southern California Gas Co • 51. CERTIFICATE OF OCCUPANCY _ . . No - Date ' ' W eke City of Costa Mesa Building Dept. STRUCTURAL APPROVAL OfVLY, tj r n �^ W ,u \ BY ( Is DATE 4 Ts SEPARATE PERMITS ARE REQUIRED" O h o a i FOR ELECTRICAL, P WIRING, < _ THESE PLANS MUST BE ON JOB AT ALL TIMES I) Z MAKE NO CHANGES WITHOUT PRIOR APPROVAL HEATING, VE?\'TII ATIUG AND % o Z Q o i OF DEPT. REFRIGERATION WORK , QI 2 2ta THE ISSUANCE OR GRANTING OF A PERMIT OR APPROVAL OF PLANS AND SPECIFICATIONS SHALL NOT BE CONSTRUED "-'—` -`�-�—" '- -, a TO BE A PERMIT FOR, OR AN APPROVAL OF, ANY VIOLATION Permit # _8-2/ 2 7 OF ANY OF THE PROVISIONS OF THIS CODE. NO PERMIT PRE- � SUMING TO GIVE AUTHORITY 10 VIOLATE OR CANCEL THE s THIS NUMhTD �,'..�I ACCOMPANY PROVISIONS OF THIS CODE SHALL BE VALID, EXCEPT IN SO q I 1 ALL INSP .L:;t .' 72-IIIESTS FAR AS THE WORK OR USE WHICH IT AUTHORIZES IS LAWFUL V - THE ISSUANCE OF A PERMIT BASED UPON PLANS AND ( i FOR RGA.:e� . c •"S:SONS ARE TO SPECIFICATIONS SHALL)NOT PREVENT THE BUILDING OFFICIAL 8E Ei' PLL"'.ilittS.: r'. ''.:cST TH9T THE FROM THEREAFTER RE QUIRING THE CORRECTION OF ERRO S I( STATE OF Cit:,S 1:1.1 DO/MI OF a IN SAID PLANS ANO-,PECIFICATION3 OR FROM PREVEN G ' INDUSTRIAL s'I T'l ^f : urge FOrk 8QILOING OPERATION$BEING CARRIED ON THEREUNDER W N i c.‹ ADDITIONAL 8 .• 1'\-... IN VIOLATION OE 7HIS.CODE OR OF ANY OTHER ORDINANCE -- GE IRE COL Cir V Qv „ c� - Qr` ,_______ ^ •QCT J ° Sti 0" u\ 7C do (v lo‘ ./ Ih O (� d 1 or ' Ar.) l 2 4.V � I ct ue isk 1.4 nT � c`C� a 4 t4) - � 1 1 ^!-nae..,..., 1 I . PATIO COVER DETAIL 12/9/81 ' — NOT TO BE USED FOR SUNDECK, ETC. TYPICAL JOIST ANCHOR — SPAN RA Cna ' „�f—�vij;,„ _W SIZE SPACING I. N ` OVERHANG ° _ % 12 .� t' RAFTERS:�� i -0 FOR DRAIN Min. 1/4 �'` STATE LENGTH �•--SLOPED MAXIMUM 1/a SPAN % r A _ . ,;f:+ {,r, O 4 CONTINUOUS ' I::. 3/gx 5alags 32a/e LEDGER J �4' Flo MAXIMUM Predrill Ledger % G . . Predrill Eziating '/�-3 Deep ' tni JOIST HANGER / BEAM or other approved methods NOTE : USE REVERSE SIDE FOR PLOT PLAN. rain. of support a tie. S ATE SIZE RAFTER SIZE AND SPACING ALL LUMBER DOUBL AS No. 1 No.2 FIR ,b 3/16X2�r-T-STRAP UBC STD.TABLE UBC STD. TABLE At CONSTRUCTION GRADE FOR 25-21-J-6 25-21-R-1 iTABLE NO. 1 For open egg crate alumi- For solid sheathing. 1 x , num or plastic roof Shingles or built up X #2 OR BETTER FOR TABLE NO.2 covering. roofing. MAXIMUM SPAN SIZE SPACING MAXIMUM SPAN ZPOST-BEAM 17'2" 2"x 6" @ 12 o.c. 12'0" CONNECTION 15'7" 2"x 6" @ 16 o.c. 10'5" ' 1 -n 2"x 6" @ 24 o.c. 1 - POST 10' 11" 2"x 4" @ 12 o.c. - — `z 4 - I .4_ r " 9'.11 2"x 4" @ 16 o.c. _ 1 8' 8" 2"x 4" @ 24 o.c. SHOW SIZE SHOW SPACING til _ L, SHOW LOCATION ON REVERSE SIDE, /i , DROP PATIO FLOOR . — .. . " .:..-- MATE ' Iii -- SLOPE TO DRAIN 2" max.@door NOTE: FOR PROPOSED OR FUTURE ROOM,OR WHERE PATIO WALLS ?.�o o o `.34' THICK SLAB dj — ARE TO BE BUILT. USE NO.2 CHART ONLY. �_' T FOR PROPOSED OR FUTURE ROOM OR WHERE PATIO WALLS PUDDLED SAND FILL I %% 2 a ' ARE TO BE BUILT SUBMIT COMPLETE HOUSE AND ADDITION STRAP z . Remove Grass And Weeds Down To Natural Grade PLANS FOR APPROVAL. 12, CONCRETE MIX 1:3:4 MAXIMUM WATER CONTENT ; , POST ANCHOR I .,�.', 7i GALLONS PER SACK CEMENT. cc //�� For Pipe Post, Embed r12� Provide 26 Ga G.I. Flashing At Wood Floor Const. COSTA MESA BUILDING DEPT Pipe in Footing to within 3"of Bottom,and , Provide detail of Flange or Weld Plate Screwed or Bolted to Frame. 77 FAIR DRIVE INSPECTIONS: 754-5627 CMF 0012-46(Ell)40) rev.12/81 { • City of Costa Mesa Buiidina Safety Department CERTIFICATE O F OCCUPANCY- v- 05 ' P.O. Box 1200 - - - Costa Mesa,California , 1. The Building located at . 14 =>,«t rev=•. 1 ,Ver r - • has-been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto 1 fora Groups u ir Occupancy. a • Use of Building•. t.•2,.1.... u,/„At., ,,N..r r•..,..r ,...,i r,.,.,.:».. II Legal Description 71ra._sC4o.nt rrn . 11 i (See reverse side for Metes and Bounds) Building Permit!No 347. 2 'Electrical Permit No. 116b. Plumbing Permit No. ;11111=• 1 It • 'p - . Number of apartments — 3 and/or guest.roorns ISSUED TO: i' Building Official ;” • - by . .l itt6 .t .�elliti.a. µa.tic..- , _ ...T1.r.x.jLt t1.act, 1r,Rra „ ,t SPIZW.TAT.;z i , ;,t' 1' .. Date A11+*ttwt' l7. 10$1 This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the ' ' Building Official of the City of Costa Mesa under Sec. 306 lel U.B.C. Form BU 34 Rev. 11/70 - - , Hilliiiiiirl IP"` n •, -7-7Pal°00 192 ****62.04 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR BUILDING PERMIT For Applicant to Fill in Completely RECEIVED DATE ECEIVED A R f$f I '� ''�/t n _ DATE ISSUED BUILDING ADDRESS "I ✓ �� ' ell/ FJ—I / 3-a7-79- a Cif— (! �reo� // �7 / (// OWNER 4� A.P. NO. I l /s- IS�-I�� (� / //�� Po�St�oY.a s.:,O. MAIL Z Ill!Li _ ADDRESS pGJ. /O// ADDRESS BUILDING �Oy�((otG /q e_- �a 0 U CITY 7C s�/ y NO. Q3, , "V^C4' f LOT(fes/ BLOCK I- Z - Z C CONSTRUCTION NEW ADD ALTER REPAIR MOVING DEMOLISH O N_ LENDER / a m v J 7 BRANCH (� /� J fn - OWNER S. r 03 J - ADDRESS ,VALUE (.1 N ARCHITECT ����ss TEL. • S J` $ J tn OR ENGINEER Cf Wes Fes,/ NO. IIIIIIY� wQ / FIRE lY ADDRESS Sa>n �0� N0/� �� ZONE TYPE GROUF11 it' 0- 41 APPROVED J Z CONTRACTOR 9&, c +Q r BY DATE m Z (� , 7 J 2 ADDRESS S D A. rAo- �!'� "i �' S-7p- a3) / W LU ea, TEL ZONE rrpp NO.OF USE OF NE hat)r ZH CITY Gam,velem C ' k-C NO.53� lin t13- srCQPLAPS BUILDING/v_ - 0 STATE CITY YARDS APPROVED YARDS APPROVED to It LIC. NO. a 3 7 S ACCESSORY BUILDING Oy LIC.NO. MAIN BUILDING _ _ D 0 T (FROM C/ S REST) SIZE NO.OF RUGS. _{/.. OF LOT s----2s- �[ /a j INOW ON LOT O FRONT eO FT. / FT. USE OF � /J / EXISTING BLDG. AI, R,SIDE LOFT. FT. H SIZE OFfj VT) NO.OF 2 _ NEW BLDG. 4a ry ) ROOMS /^-7-.STORIES/22L.SIDEFT. FT. U COVEERIING RIOR ALL S .CIA f 'COVVERINGF /Ce. — 7 O REAR / FT. -- J US OF BUILDING AND WOR TO BE PERFORMED /I( DISTANCE BET. BET.MAIN& Q - `)bi f r�I,/e. s✓ MAIN BLDGS. ACCESS. BLDGS. o r C.V PVAR.�AK X07 APPROVED 3 -DATE �--7Y H REY/.r/ L �re/oM/ DA ..-7(-0-272."---- 2 C9 /zo STATE V I hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with l9---fr7 rr,I�-�L-yL�f��/ cc all laws regulating building construction, and I shall not employ Ii D FOR R SPECIAL I- any person in violation of the workman's compensation laws of Ls `s C/) the State of California. 7iik m — II hereby certify that I am properly licensed as a contractor under G SOri' . FT. / O • the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER V,%LUATION IS FOR 5 Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: E I am exempt fro the provisions of the State of California Business and Professio s Co D igloo Chapter 9. VALUATION at J PERMIT FEE $ N Signature of D m 1 Permittee .0/ en $ ` 4 s A PLAN CHECK $a o Authorized Agent 1/ ✓'f b1 if. ,. TOTAL FEE $ rP' J:r-7r, OOt2to *+* • 119.00 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR BUILDING PERMIT For Applicant to Fill in Completely RECEIVED BY DATE RECEIVED DATE ISSUED ADS ' j`/4 �''< //mss r AZ' / ADDRESS O �.� C_. �/J PERMIT NO. OWNER��7 - .77..Scj ., . ,%J /JY�S cet, A.P. NO. MAIL BUILDING Z ADDRESS ADDRESS W W TEL. Il TRACT I LOT BLOCK Z CITY NO. z C CONSTRUCTION NEW ADO ALTER REPAIR MOVING DEMOLISH LENDER am J J BRANCH J to OWNER m J ADDRESS VALUE -m ARCHITECT TEL. USE $ J Q OR ENGINEER NO. - 5,-n FIRE Z 2 ADDRESS ZONE TYPE GROUP 2 W APPROVED J CONTRACTOR BY DATE CCI Z J 2 ADDRESS W W TEL. ZONE NO.OF USE OF NEW 0= CITY NO. _ PLANS BUILDING ZH STATE CITY YARDS APPROVED YARDS APPROVED ) co CC LIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING Ili D O (FROM C/L STREET) SIZENO.OF BLDGS.OF OF LOT I NOW ON LOT FRONT FT. FT. USE OF EXISTING BLDG. R.SfDE FT. FT. I— SIZE OF NO.OF Z NEW BLDG. ROOMS STORIES L.SIDE FT. FT. VEXTERIOR WALL ROOF _ COVERING COVERING REAR FT. ., FT. J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& 1 MAIN BLOCS. ACCESS.BLDGS. Q c'M�(�%e�tJk/" VAR.+ DATE O l C.U.P.W. APPROVED F APPROVED Cr) _IY DATE Z 0 C~..) I hereby acknowledge that I have read this application and state O that the above information is correct and agree to comply with CC all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of Nthe State of California. m I hereby certify that I am properly licensed as a contractor under SQ. FT. o the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR 5 Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: a ft am exempt from the provisions of the State of California Business and Professions Code,Division 3,Chapter 9. VALUATION PERMIT FEE 4 //9- O ry Signature of m Permittee $ 80 PLAN CHECK 4 — E `o PeAuthorized Agent JJ � LL \ TOTAL FEE $ // D ,-•.< 34916 _ 79-P! [ h*it s-*br r..-�C 137 = .Cq COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 AP I ATION FOR BUILDING PERMIT For Applicant to Fill in Completely q CE E BY DATE RECEIVED /7 9 �j ) DATE ISSUED BUILDING 4 /„�(s �/J , % - 3-77 3- 77( ADDRESS ^2O �N f C�-� t_ c —en �' N 117-)Sa -Onto PERMIINc:] ; OWNER�jy ,„-,..GnJ f /�'I/J scicr/17E$ A.P.NO.MAIL yam, �{� BUIL NG ADDRESS / (5 C. I7�� ✓'•EEe7 ADDRESS r 1 Zo'f /6 f4 A.4c C W W TEL. pian- (ITS S I K1-c BLOCK 0 Z CITY Sf'JMr/1 jju4 , C.40-• NO. r :f 7964 CONSTRUCTION NEW ADD ALTER REPAIR I MOVING DFMOI ISH -fh LENDER III am J D BRANCH , 11 // JN OWNER (Nj., /G4SS C.JO LM ‘4rfec/Afrry CO J ADDRESS VALUE J Q ARCHITECT TEL. "ride_O'Gr< (...L..141—t—. $ _ � OR ENGINEER NO to U Q FIRE ..��/�tt/�' / w CC ADDRESS ZONE TYPE . / ,GROUP `/ 0- w /// W Z A APPR `E, y '/J O CONTRACTOR 4/o/J Ern/ ��/J fJG'J/erJ C U, BV ,tJ //��1�. DATE / �n�' ,�' ma _ �v� 'Ai; J ADDRESS 3 3 S. F(-.0 UE,Llei tL W TEL ZO NO.OF USE OF NEW O= PLANS r� BUILDING Zr CITY 5err7M A-AM NO.Sy3 /79y ��� o� 01Jo-trenti.Z• W STATE CITY YARDS APPROVED YARDS A__ RCOV D to O LIC.NO. L O 6 S 7 %� LIC. NO. MAIN BUILDING ACCESSORY BUILD G 512E NO.OF BLDGS. (FROM C/L STREET) OF LOT NOW ON LOT FRONT FT. a_ r a rot USE OF ...((( ///ttt r//V EXISTING BLDG. R,SIpE/tl/) F lifir,,AiriCfr, I— SIZE OF NO.OF EEE////"'///Ir ll 2 NEW BLDG. ROOMS STORIES L.SID �T. FT. EXTERIOR WALL I ROOF // �� i v.. COVERING COVERING RE•jr�^' FT. - J USE OF BUILDING AND WORK TO BE PERFORMED DISTANC: : T BET.MAIN& Q. MAIN BU ACCESS. BLDGS. IL AA Q (/- r// ` / VAR.# �7'F 72 DATE -s / // O ,V n(//,t",—///`/'-', 'fir/�//y��Jyt�� (a-.e- e C.U.P.# LiPt' /A-O� APPROVED 6(4.1SILN / V PROVED /, I7Z 2 WO SATE O I hereby acknowledge that I have read this application and state E *It'. av$ I EMENTS D that the above information is correct and agree to comply with HOLD FOR $P I l!w {�L CC all laws regulating building construction, and I shall not employ .tom I— any person in violation of the workman's compensation laws of V) the State of California. co ZI hereby certify that I am properly licensed as a contractor under SQ. FT. o the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR 5 Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY; CC am exem r the p ovisions f the State of liforn is Business VALUATION and Prof Bions d , ivisioapter 9. /--- W PERMIT FEE $ !/ Signature f " �r � m/J�` Permittee fi— ( $4/O PLAN CHECK $ `— E Authorized Agentu_ TOTAL FEE $