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Jevclopmentall�'dl�pblod_AdulQ,.pereone rl[hln�nn cnlnting multlplc rrxLl�•uU:�l
canpte�-SmthQ"Rri�^Su6urdm'RceLientlnI" Ofe[cfcc anJ In the (1.41 liq;h I�:nsltv
Rcnidrn[1e1,C�[¢;op�oC�[Ae�iand tleo P.Imm[_oLthe Ccn.•riI Pian.
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SecN�m 7-9-Ufl.l(n) n( [he��LminR Code raqulns the [Iling mnl nppn�v:J of n u-v
Povm([ (or - Gre Ilme�'and;Locill[lca scrvin8��rv thnn nl� {r,) p�.rwm:�. nn �I..I lurd
1n ilcle 7C(I[; eeetlons:�0011tihrouRh 10019 of.cha l�llfurnln lulninlu[ra�lvo (i.lc.
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Thc s�ibJc<t pruperty �I+.pmeenUJ luprwed vtth�a IZ �uil[ ay:�ni.�ni ..,,m;.l�•o. and .�
J 6edroom Hngl¢ Cmaily drelllnK �lth vlll.�e[ve an IwuelnE l.�r I.,�th lLc � I I�:ntn
nrt veli ee �enfl' end pmv(de (ur a cmernl dlning r."n and il�ch.�n.
II� M w<w�w�� �IT �M �n�<�J �1�� �Iw �Ix<� i� Iw��1 MI� ��wl M.NI. In .n� a��� �I r�.11.t� �����n ny I.w��.�N �1 rn�•
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LF6�L D[SCRRTIOM .1 SU6ICCT �RO�FIITri See a[eached� +hcet
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C�1RE FACILITY
"'�t� Comnuni�y"Care��Facilities"'are'`an inte�r�l par[ of thc local
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health care delLeery.sys.em.�,J;RecoEnizing the ineffecci�-eness oC
�uc=:�r_ �.. '� - : �::,iY%.V`:R� ��l ?. `s:�:��w r;.�3� �y�yy;;:k -
�-"±-' lar�e instit�itions in_treating or rehabilitatin� patiencs, tte
�'.�::''� . ' .:j'.,.,y:t�';a'i:'`-:r��:�a'rK�.'�e^,.x,�.3tb':,:%..
i�::=.; diversc needs of persons entering'the health care systen, a�d
� the hi�'� cos; oC ^uildirg and ma:�ntainin� ins;i;ucions. se:�eral
years ago :he Sc�te dete^ineu the need co es[aSl:sh a diC=erent
[ype of set;i^,r,. Ccrr�unity Ca.-e Facilities ac� i-.ccr.ce� to i•�ouse
patiencs who do .^.o: :equire Lns[icucioncl c�:,. `". rnc��r r. ;e-
siGen[?a? settin; ..ic:� su;Bl'YL510�1. '
_ T`�ese `�citi_ies are lice::sed b.; ...- - -:.-- - , .--c.....� ,�i
Fealt`. ir,�r.:: ..::��: ,, CG::S:C�.^:d�12 �;�];'S1C.1: D�..^.L _PC'.]L_i.._��5.
� Cliencs xicc dece?o,::er.tal disaSilieies �.^e ,..:er-ed co _`:e
facili[ics b•: sccial ::orkers fro:n the S'.^gio-:nl `'^_::_ec o: G_an;;e
Coun[y. 7hese workers also monitor c? ie::c cz: e�r..' acci�•it? es
rou[inely.
The apnlicancs, Coli� ar,d `;ark :1sh1::��;, �-��;.osc =o cor.-
vert an exis[in� �parcmen: develo;;�enc ir.co a Co-��.:�tcy Ca;•c
Facility for borCcrlir.c ar.d r..i1C Cc�'c1u;.r.�enc311,• �is.:'::rC
adult�. The prepe: cy Ls a, �roxinace i� .63 ; �res ',98' :•: ? �:?' ;
ar.d contains 12 »arcmc.^.:s and a i bcdrooa i;o;:sc. T:•.e luc,-:�icr.
is Within valkl:t� discance to public transnor:aticZ, schools,
churches, and shopping.
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The aPplicancs a[e expertenced careprovtders specialtzin�;
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in trainin� cticnts to develop'�semi-independenc living skills
(Co;anunity :lssinilacion Pro�ra�).-= The si[e under consideration
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xould e�able the applicants�to p�rj!e�:vide clients wLch maxim�n
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indLvLdual gro�th and development because it is a small apart-
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ment co�pleC. In addition to the training provided by the
ap�licants, [Fe cltencs would have the onporcunic� to ltve tn
a seai-i�de,ende:it er,vi:onr.ent. A� such tine as che r.ec�ssar}•
living skills a:e acq�i;ed, �he clienis �.�ould establish �hei:
ow� res? Ge.^.ces in :he co-.R�lity.
?,it5cug5 tne p_-oresed sice was initiaily Ge:�elop=d �s an
a?ac:�::^::[, Che size and shape of �h� parcel a:;d �he scructums
are nC!=.^.L:.��C =0 ^C@L CY.^ licensin� :c�uire-ents of �ne S[r:=�.
2he existin� s�ruc:ures will be utilized Ln the :01:o:;inZ
ranner�
1. ;he 3 bedroo� house �:ill ceatain the celtra: Jin;n� ;oo.r.,
kitc':en, office, and staff quar[ers.
2. I'he four I-bedcoom aparcr,.ents uiYl be used for seri-inCe-
penGen: IL�•ing quarcers for 8 clLencs.
3. Seti•en of t!�e 2-bedroo� apartmencs will be used :or :esidea-
tial ca:c fo: 23 clicncs.
4. The re�aining 2-�edroom apar[rt:er.c �::11 serve as staff quarcers.
The S[ace will license up [o a maximu.^+ of 3G clicnts for this
location.
Approval of the proposed use xill not alter [he characcer of
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che proper�y or the nei�hborhood."-°'No physical alceracions to
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ihe site or chc structures are proposed. The operatian of �Fie
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:acility will not result in eYcessive notse, traffic or o�her
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adverse condi[ions for any,.adJacent uses. Since che clients Will
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no[ oen aucoaobiles,�[raffic.'rrill;,De limited to tha: generated
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by the care�roviders, employees:''and occasional visicors. The
resiCent activities will be closely supervised b:: :te care-
provtders so that noisc will not be a problen. �:xe the clien��
will be e-plo/ed or �ill a_tend vorkshops ,:r,d :ecreacic�al p:o-
gra-+s, thei: everyday acci•:ities will �e s:milar :c :;ese of
any c[he: aparcr..c^[ resi:'encs.
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FF: CCt`r.Y l_`� PCR!I^ H0. UP-7A-46-P. 3G<'-3E6 �AS;_ :���+ 3"' .t �-^',, IXr; ��•F-`'�.
C�±ntiv'�en:
:he City cf Costa Neaa appercintea ttm oFpocwnity to ca�++rnc m �.e refer
encrd Cae �cait acFlicetion. tleisxl arar+-' o� thc mn4lezity of :hc isa�rs
irno2ved viLh scFnxlnv m�nity eare facilities, rnc o: che cicy's c«�c^rns
Sa thet CSx citi:ens oL Q�etn Nesa who live in cne .,irrourc!inq reinhbor!:oo�i
be qiaen t3+e c�ocCa+ity te ettetd a puClic Tearirx� cxi the pc*�y»�.,� Use Per
RSL 2t Sa the Clty's ta�detsteiv]Sn� t'`at the nxv'ty vill cuil rotices to
suitw-r]Snq haxamers vii`�Sn the City o: CasW "ea� � identifiec' rn Che
laecat mtalize.d tax tolls.
Costa nem 6c1laves tl+�t �nu+ity e�r freilicir.w a=e eost ap�o�riatc vtien
ttiey �ecve the Me�de ot t!y Camunity and Fo[anClal 'cllenta.' 7hln cwn be
ed�ieved ++tcn ttie PLQx�ed eesa facility !s ac�epced ty e++d !s cxE{�etiblc rith
the eurxou�ir�9 nei�fboctXod and !s i'+enaged by ez;�erienc�ec'. 'cace Fiwi�Sers.'
11coo�din4 0o the lnfoi�etion �.twided vlth ttie subject a�.*'licttion, li aFpencs
to �eet tl�eae erioeria. IL nei¢�boctnoA ecceFter+ce af the fncility is qairn'.
tArotx� ttie publ�ehenrlry pcoeees. !talnuld � euc�cnasful.
Coste !+eea cequerta tfiat the Gounty aQvi!e ':x� Clty of the actia+ that is
�,Ncen re�arc!Srq the wbject aq:lication.
Verv ttvly yaure,
S' Lbrvf flell. Qfela:an
'.. Costa Mcaa P1em1n9 Q�iinslon
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(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR Di;IVE, COSTA MESA, CA 92626
PLUMBING PERMIT
Job Address: 362 E 20TH ST
Suite No
Vicinity: UNITS B 8 D@ ASHLINGS RESIDENTIAL VILLA
Parcel Nunmber: 42623104
Applicant: JENSEN, JOHN
Address:
Owner: ASHLING, COLIN TR
Address 980 MEADOWLARK LN
Phone: 714-554-2500
Zip:
Phone:
LAGUNA BEACH, CA Zip: 92651
Contractor: JENSEN HOME IMPROVEMENTS
Address: 14300 CLINTON ST
Arch / Eng :
Address:
GARDEN GROVE, CA
STE 187
Phone: 714-554-2500
Zip: 92843
License: 633106
Phone:
Zip:
License:
Status: ISSUED
Applied: OS/09/2001
Issued: 05/09/2001
ISSUED BY:
SCOPE OF PERMIT
REF: 801-00401. ALTERATION TO MULTI-FAMILY RESIDENCE. PLUMBING TO INCLUDE: 1 SHOWER,
1 WASH BASIN, 1 WATER CLOSET. - � �
ISSUE FEE
Backflow irrigation �, `.
Backflow Preventer �
Bathtub
Clarifer System
Connect Qce,Soda,etc)
Dental Units
Dishwasher
Drain, Floor
Drain, Rainwater
Drain, Roof
Drinking Fountain
Expansion Tank
Gas Earthquake Valve
Gas (1-4 outlets)
Gas (Over 4 outlets)
Gas Repipe
Gas Service
Interceptors (Grease, Oip
Inierceptors (Sand Auto )
AMT
$23.50
$0.00 '
$0.00
$0.00
so.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
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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 $0.00
Process Piping (per 10 ft) $0.00
Receptors $0.00
Septic Tank $0.00
Sewer Cap for Demo $0.00
Sewer Connect $0.00
Sewer Private Line $0.00
Shower $9.80
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
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0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
AMT
Sump Pump � '�$0.00
Swimming Pool � $0.00
Trep Primer� � ; ��� $0.00
Urinal- - $0.00
Vacuum Brkr Bkflow(1-4) $0.00
Vacuum Brkr Bkflow(5+) $0.00
Wash Basin $9.80
Wash Basin Set $0.00
Waste and Vent System $0.00
Wa[er Close[ (Toilet) $9.80
Water Heater / vent $0.00
Water Piping pnst or Rep.) $0.00
water Re-pipe $0.00
Water Service $0.00
Water Softener $0.00
OTHER $0.00
VIOLATION $0.00
PLAN CHECK $0.00
REINSPECTION $0.00
TOTAL CALCULATED FEES: $52.90
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0
0
0
0
0
0
1
0
0
1
0
0
0
0
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0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitornia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-27-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within /B0 days, or it work is suspended or abandoned
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 all applicable codes, and all
requlred inspectlons and final approval must be obtained. Failure to o6tain inspections and final approval will result in the expiration.of this permit.
FOR INSPECTIONS CALL: (714) 7545626
2446d8 (Ca�00)
WORKERS' COMPENSATION DECLARATION: , . �
I hereby ettirm under penalty of perjury one of ihe followinq declaretions:
❑ I hav nd will maintain e certificate ol conseN to setl-Insure tor woMers' compensation, as provided for by section 3700 of the Labor Code, for the peAormance of ihe
for which this permit is issued.
I have antl will maintai � rkers' compensa n Insurance, as requiretl by section 3700 of ihe Labor Code, for the performance of the work for which this pertnil is issuetl.
My workers' com t o Insurence ca[ r an olicy number are:
Carner: �'� Policy Number:
(This secfion need no( be completed i/ fhe s velued af one huntlretl tlollars ($100J or /ess.) , ,
❑ I certity that in the pedormance ot the vod for which this permit is issuetl, I shail not employ any person in eny manner so as to become subject to ihe workers'
compensatlon laws � lifcmi tl r e that If Oultl Deco e subject to ihe workers' compensation provisions of Section 3700 ot the Lebor Code, I shell forthwith
compty with the owsw . � / /
Applicent Signeture: Date: �
WARNING: FAILURE TO S RE WOFKE COMPE I VE pE 15 NIAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PEN LTIES AFD CIVIL INES UP TOONE HUNDRED
T/qUSANDDOLLARE�E ,OW),INAD ONTOTHECOST FCOMPENSAT N,DAMAGESASPFOVIDEDFpRIN5ECT10N31O80FTHELABOPCOOE,INTEREST,ANDATTORNEY'SFEES.
LICENSEDCONTRACTORSDECL A710N:
I hereby affirm that I am licensetl n r provisions of Chapter 9(commencing with Section 7000) of Divlsion 3 of fhe Business and Professions Code, and my license is in full
force and ettecG Lic. q Class #
Coniractor's Signeture: Date:
CONSTRUCTION L DING NC :
❑ I hereby afli that e is a co wn lentling agency for Ihe pedormance of the work for which this permit is issued. (Sec. 3097, Civil Cotle).
Lender's Name: Lentlefs Address:
Siqnelure: Date:
OWNER-BUILDER DECLARA710N5:
I here6y aHirtn thet untler penalry ot perlury thet I am EXEMP7 FROM 7ME CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions
Code: Any city or county which requires a permrt to consimc6 alter, improve, demolish, or repair any strucWre, pnor to its issuance, also requires the epplicant for such permit
ro file a siqned statement ihat he or she is licensed pursuant to the pmvisions of the Conirectors License Law (Chapter 9(commencing wi�h Section 7000) of Divislon 3 of ihe
Businass antl Professions Code) or that he or she is e:empt therefrom and the basis for the ailegetl azemptian. Any violation ol Seclion 7031.5 by any applicant for a parmit
subleds ihe epplicent to a civil penalty of not more than five huntlred dollars ($500).):
❑ I, as owner ot the proparty, or my employees with wagas as their sole compensetion, WILL DO THE WOfiK, antl ihe siructure is not intendetl or oflered for sala (Sec.
7044, Business and Pmfessions Code: The Contractors Licensa Law tloes noi apply to an owner of property who builds or impmves thereon, and who does such work
himself or herself or through his or her own employees, provitletl ihat such improvemenis are not intended or oHered for sate. If, however, the building or improvemant is
sold within one year of completion, the owner�builder will have ihe burden of proving that he or she did not build or improve for purpose of sale.).
❑ I, es owner ol �he propetly, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to constmct iha projec� (Sec. 7044, Business and Prolessions
Code: The contractors License Law does not applY to an owner of pmperty who builds or impmves thereon, and who contrads for such projac� with a coniraqor(s)
license pursuant to ihe Contractors License Laws.J.
u —,�
❑ I em exempt under,sec: ,� Business and Protessions Cotle for this reason:
Signature: ' � � Date:
Owner ID venfietl by dnver5license. '� � Yes ❑ No Drivers License No. Ezpires:
Vedlication of Ownership hy (type of dwument, i.e. - property �ax �III or deetl):
DIVISION OF INDUSTRIAL SAFE7V PERMIT CERTIFICATION: �
❑ I hereby cenify Ihat no excavation five (5) or more feet in depih into which a person is required to descend, will be made in connection with work amhonzed by this
permit, and that no building siructure, scaHolding, falsework, or tlemolition or dismantling thereoi, will be more than thirty-six (36) faet high. (Chap. 32, Grp 2, Atl 2, Sec.
341, Title B, California Atlministretive Cotle).
❑ As owner-builder, I will not employ enyone to do work which would require a permit }rom the Division of Indusinal Safery, as notetl above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division ol InduSlrial Satery Permit Number.
CERTFICA7E OF COMPLIANCE D AUTHORIZATION.OP ENTitY: I certiy under penalty of perjury ihat I have read ihis epplication and state ihat ihe information given is
correct. I agree to comply wi state laws and city ordinances relating to building cons�mction, antl authorize representatives oi ihe Ciry of Costa Mesa to enter upon the
above-descnbed property r i pection purposes. I aqree not m occupy or allow occupancy of any building authorized by ihis permit until tinal inspection.
COOE 1,
1616
1266
200
201
202
203
204
Fixetl System Pinal Fire Prevention
Pool Spa Final
Final Re-Root
Final BIocWRetaining Wall
Final Factory Fire Place
Final Sign
Final Demolition
PLL
� /O /Date
� Oate
IN�T j�¢ COpE♦ INSPECTIONTYPE
206 Final Mechanical
208 Final Plumbing
210 Final Eledrical
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
QAIE inrmn�s
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Costa Mesa
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CITY OF COSTA MESA
INSPECTION REQUEST SUMMARY
Address Permlt Twe Sub Twe Descri�tloo
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-00380
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(714) 754-5273 • Fau (714) 754-4856 • v+ww.ci.coste-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
MECHANICAL PERMIT
Job Address: 362 E 20TH ST
Suite No
Vicinity: UNITS B& D@ ASHLINGS RESIDENTIAL VILL
Parcel Number: 42623704
Applicant: JENSEN, JOHN
Address:
Phone: 714-554-2500
2ip:
Owner: ASHLING, COLIN TR
Address: 980 MEADOWLARK LN
Phone:
LAGUNA BEACH, CA Zip: 92651
Contracmr: . JENSEN HOME IMPROVEMENTS
Address: 14300 CLINTON ST
GARDEN GROVE, CA
STE 187
Phone: 714-554-2500
Zip: 92843
License: 633108
Status: ISSUED
Applied: OS/09/2001
Issued: 05/09I2001
ISSUED BY:
���
��,4/
Op'�
SCOPE OF PERMIT
REF: B01-00401. ALTERATION TO MULTI-FAMILY RESIDENCE. MECHANICAL TO INCLUDE 1
VENT FAN FOR BATHROOM.
ISSUE FEE
Inst FAU <100 k BTU
Inst FAU >100 k BTU
Repair/Alt CoolinglHeat
Inst / Rep. Recess Wall Htr
Refrig Sys <100 k BTU
Refrig Sys >700 k BTU
Gas Piping
Factory Fireplace
Hood w/Mech Exhaust
VAV Box
Vent Fan / Single Duct
Appliance , ,
Fire Dampers , , �
Smoke Dampers ,
Inst or Relocate Appl Vent
Air Handlers < t0000cFm
Air Handlers > 10000cfm
Floor Furnace
Floor or Suspend Heater
$23.50
$0.00
$0.00
$0.00
$0.00
50.00
$0.00
$0.00
$0.00
$0.00
$0.00
$725
$0.00
$0.00
$0.00
$0.00
so.00
sa.00
$0.00
$0.00
Quantiry
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
FEE SUMMARY
Repair / Alt Absorbtion Unit
Repair I Alt Refrigeration Unit
Ventillation System
Evaporative Cooler
Commercia l I ncinerator
Domestic Incinerator
Compressors / Absomtion Svstems
Up to 3 hp I 100 k BTU
3To15hp/SOOkBTU
15 To 30 hp I 1,000 k BTU
30 To 50 hp I 1,750 k BTU ,
Wer 50 hp / Over 1,750 BTU
Boilers
Up to 3 hp
3To75hp � . �
15to30hp � .
30 to 50 hp
Over 50 hp , .
Olher Mechanical Fee
Investigation Fee , �
Plan Check Fee
Reinspection Fee
TOTAL CALCULATED FEES
COMMENTS / SPECIAL CONDITIONS
Quantity
$0.00 0
$0.00 0,
$0.00 0
$0.00 0 .
so.00 0
50.00 0
$0.00 0
$0.00 0
$0.00. 0
$0.00'; 0
50.00� 0
� � $0.00 0
� .� '�50.00 0
$0.00 0
50.00 0
50.00 0
$0.00
$0.00
$0.00
E30.75
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 1 BO 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 Inapections and flnal approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration.of this permit.
FOR INSPECTIONS CALL: (714) 7545626
2dd6-08 (8�W)
. .
WORKERS'COMPENSATIONDECLARAnON: '
I hereby aHirtn under penalry of perjury one of the following declarations:
I ha ntl will malntain a certificate of consent to self-Insure lor workers' wmpensetion, es providetl for by section 3700 0l ihe Labor Code, lor the peAormance of the
tor w�ic� this permit is Issuetl.
I have antl witl maintein workers' cOmpenselion Insurence, es raquiretl by soctlon 3700 of the Labor Code, for Ihe peAortnanca of the work for which this permit is issued.
My workers' compansetion Insurence carner entl policy number ere:
Carriar: Policy Number.
(Thls seclion need na( be comp/eted i/ the permit is velued at ane hundred dollers ($100) or /ess.)
❑ I certiry that in the peAormance ot Ihe wo r hich Nis�pertnit is Issued, I shall not employ eny parson in any manner so es to become subject to Ihe workers'
compensation laws ot Califomie, �d �e h�come sub�ect to the workere' compensation provisions of Sectlon 3700 oi Ihe Labor Cotle, I shall forthwith
camply with th pm �ons. f/� /^/
!
Applicant Signature: Date: J 'V
WARNING: FAILUPE TO 5 URE WOFKEPS' ENSATION MGE IS UNLAWFUL AND SHALL SUBIECT AN EMPLOYER TO CRIMINAI. PE ALTIES AND CIVIL FINES UP TO IXJE HUNDRED
TMOUSAND pOLLARE (51 ,pOD), IN ADDITVON THE COST OF PENSA�ION, DAMAGES A$ PROVIDED FOFi IN $ECTION 3�W OF THE LABOR CODE, IMEREST, AND A7TORNEY'S FEES.
LICENSED CONTRACTORS DECLA ION:
I herehy aNirtn Ihai I am licensad u er p�ovisi s of iapter 9(commencing with Section 7000) of Division 3 of the Business antl Professions Code, antl my licensa is in full
force entl etteci. Lia Cless N
ComracblsSigneWre: � Date:
i
CONSTRUCTON LE ING AGE
❑ I hereby aflirtn t the � con ending agency tor Ihe peAormance of Ihe work for which this permit is issuetl. (Sec. 3097, Civil Code).
Lentlers Name: Lentler'S Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby aRirtn ihet under penalry of perjury that I am EXEMPT FROM THE CONTRACTORS IICENSE LAW tor the following reason (Sec. 7031.5, Busineu and Protessions
Cotle: Any ciry or counry which requires e permit to cons�ruct, elter, improve, tlemolish, or repair any structure, prior to its issuance, also requires Ihe applicant for such permit
to file a signetl stetement thet he or she is licensetl pursuent to the D�o�sions ot the Contractors License Lew (Chapter 9(commencing wlth Sectbn 7000) of Division 3 ot ihe
Business end Pmtessions Code) or that ha or sha is exempt thereirom and the basls for the allaged eaemption. Any violation oi Section 7031.5 6y any applicaN for a pertnit
sub�ects Ihe epplicant to a civil penalry a� �a� more than five hundred dollars ($500).):
� I, as owner of ihe properry, or my employees wlth wages as ihelr sole compensation, WILL DO 7HE WORK, and the structure is not intended or oHeretl for sale (Sec.
7044, Business�and;Professions Cade: The Contrectors License Law does not apply to an owner at pmperty who builds or improves ihereon, antl who dces such work
himself or herself.or ihrough his or her own employees, provitletl that such improvemenis ere not iNendetl or oflered for snle. It, however, the building or improvement is
soltl within one year of'completion, )he owner-builder will have the burden ol proving that he or she did not build or improve for purpose of sale.).
❑ I, as owner ot t�e pmperty, am EXCLUSIVELV CON7RAC71NG WITH UCENSED CONTRACTORS to construct the pro�ect (Sec. 7044, Business antl Professions
Cotle: Ttie contracmrs License Lew tloes not apply to en owner ol property who builtls or Improves ihereon, antl who comracts tor such project with a comractor(s)
license pursuant to the Contrector5 License Lews.).
❑ 1 am exempt under sec. ' Business and Professions Code for ihis reason:
Signature: Date:
Owner ID veniied by tlrivers Ilcense. ❑ Ves ❑ No Driver's IJcense No. Ezpires:
Verifiw�ion ot Ownershlp by (rype ol document, i.e. - properry tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PffRMiT CERTIFICATION:
❑ I hereby certify that no excavetion �ive (5) or more feet in tlepth into which e person is requiretl to descend, will be made in connection with work authorized by Ihis
permil, and Ihet no building siructu�e, scaffoltling, talsewodc, or demolition or dismanifmg ihereof, will be more ihan ihlrty-six (36) ieet high �Chap. 32, Grp 2, Art 2, Sec.
34 i, Ttle 8, Californla Administrati�e Cotle).
❑ As owner-builder, I will not employ enyone to do work which would require e permit Irom ihe Division of Industriel Sefety, as noted above, unless such person has e
permit to do such work from the division.
Signature: Date:
Division ol Indusinal Salely Permit Number:
CERTIFlCATE OF COMPLIANCE AND AUTHORIZA710�10F ENTAY: I certiy under penalry of perjury that I have read this application and sta�e �hat the information given is
correcL I agree to comply wi�h all te laws enC ciry ortlinances releting to builtling construction, ana euthorize re0resentatives ot ihe City ot Costa Mesa to enter upon Ihe
above-d85tribed prOpe 1' tion purposes. I egree no� �o occupY or allow occupancy of eny building authonzed by Ihis pertni� until final inspection.
cooe �.
1616
1266
200
201
202
203
204
Fi�ied.Syerm Final Fira Pr
Pool Spe Finel
Finel R8-Roof
Finel BIocWRe�aining Well
Final Faciory Fire Place
Final Sign
Final Demolition
�
� �/ �/Date
/ �� Date
�$ fQp� INSPECTIONTYPE
206 Final Mechanical
20B Final Plumbinq
210 Final Electdcal
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 � Finel BuildinyOccupancy
�
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.. �.
Costa Mesa
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CITY OF COSTA MESA
INSPECTION REQUEST SUMMARY
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• r � t C W • �
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-0o SO$
i-oo380
I-ao�ts�
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0
I
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(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.BUILDING PERMIT �� FAlfi DRIVE, COSTA MESA, CA 92626
Job Address: 362 E 20TH ST
Suite:
Vicinity: UNITS 8 8 D@ ASHLINGS RESIDENTIAL VILL4
Parcel Number: 426231 �4
Applicant: JENSEN, JOHN
Address: 14300 CLINTON ST
GARDEN GROVE, CA
Owner:
Address
Zoning:
Phone: 714-554-2500
Zip: 92843
Phone:
Zip:
Contractor: JENSEN HOME IMPROVEMENTS
Address: 14300 CLINTON ST
GARDEN GROVE, CA Phone: 714-554-2500
STE 187
Zip: 92843 License: 633108
Arch :
Address:
Phone:
Eng:
Address:
Status: ISSUED
Applied: 03/28I2007
Issued: OSI09/2007
ISSUED BY:
``��
�� Y
QA�
Phone:
Zip: License: License:
SCOPE OF PERMIT
CONSTRUCT AN AMBULATORY BATHROOM & CONVERTING A KITCHEN TO SLEEPING �UARTERS FOR A CARE GIVER IN
(BLDG 1) UNIT B. ALSO, REMOVE CABINETS IN (BLDG 1) UNIT D& REPLACE WITH A NEW CLOSET FOR "ASHLINGS
RESIDENTIAL VILLA" IN AN EXISTING BUILDING. LOWER THE CEILING.
Plan Check:
Permit:
SMIP Res:
SMIP Com:
Other:
Inspection:
Total:
$163.31
$251.25
$1.50
$0.00
$0.00
$0.00
$416.06
SETBACKS
MAIN STRUCTURE Front 0. 0
ACCESSORY Front 0.0
PARKING Existin : o
NOTES:
Rear 0-0
Rear 0. 0
Required: 0
FEE SUMMARY
Calc Valuation:
Claim Valuation:
PLANNING 8 ZONING : ; '" '
Left 0- 0 Right " 0- 0
Left 0- 0 � Right , 0- 0
Pr000sed: -0 �
515,000.00
315,000.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 7, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authonzed under this permil 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 antl tinal approval will result in the expiration of ihis permit.
FOR INSPECTIONS CALL: (714) 7545626
2d68d8 (NW)
WORKERS'COMPENSATON DECLARArON� �
I �ereby ettirtn untler penalry of perjury one o� tha following tleclarations:
❑ ave antl will maintain a certiticate of ��sent to self-Insure for workars' compensatlon, es providad for �y sedion 3700 of the Wbor Code, for ihe peAormence of ihe
work for which this permit is issue0.
I have and will maintain workers' compe�.sation insurance, as required by sectlon 3700 of t�e LaUor Cotle, for the peAormance of the work tor which ihis pertnit is issueC.
My workere' compensatlon Insurance rAmer antl pollcy number ere:
Cerner:
(This se
❑ I certify that In the
compansation law
comply with th e�e
Applicam Signetur�
WARNINp: FAILURE T SE
THOUSAND DOl1AR f510
UCENSEDCONTRACTORS
I hereby aHirm that I em licen:
torce entl eNect. L�
Cantractols Signeture:
CONSTRULTION
❑ I hereby eMir
Lentler's Neme:
Signalure: _
OWNER-BUILDER DECLARA710N5:
Policy NumOer:
ve/ued er one hunOred dollers (5100) or /ess.)
for whic� thls pertnit is Issued, I shell not employ eny person in eny manner so as to become su6ject to the workars'
ihat If I should become sublec� b t�e workers' compensetion provislons of Sactlon "37�00 ot Ihe L/apor Code, I s�ell forthwith
Dete: J / '/ / VI
SAiI COVEqAGE IS UNUWFUL ANO SHALL SUBJECT AN EMPLOVER i0 CRIMIWIL PENAL ES AND CNIL FlNES UP TOONE HUNDRED
OF COMPENSATION, OAMAGES AS PflOVIDED FOR IN SEGTION 3]O6 OF THE LABOq CODE, IMEREST, AND AiTOFNEYS FEES.
(commencing with Saction 7000) of Dlvlsion 3 of the Business entl Pmfessions Code, and my licensa Is in full
Class q
Dete: n I
lending agency for the pertormanca of ihe work Por which ihis permit is issued. (Sec. 3097, Civil Code).
Lender's Atltlress:
Date:
I here6y aHirtn that untler Denelry of perjury Inet I em EXEMPT FROM 7ME CON7RACTORS LICENSE LAW for the follawing reason (Sec. 7031.5, Business and Professians
Cade: Any ciry or counry which requires a permit to wnsiruct, alter, improve, demolish, or repair eny siructure, prlor to its issuance, also requires �he epplicant for such permic
to file e signetl statement that he or sha is Ilcensetl pursuent to the proWsions ot Ihe Contrectors License Lew (Chapter 9(commencing with Section 7000) oi Division 3 ot ihe
Business and Professions Code) or ihat he or she is eaempt therefrwn and the Eesis for ihe elleged ezemption. Any violation oi Section 7037.5 by any eppliwm for a pertnit
subjects ihe applicant to a civil penalry of not more then five hundred dollars ($500)J:
❑ I, as ow�er ot the proQerty, or my empl0yee5 with wages as lheir sole compensation, WILL DO THE WOHK, antl Ihe slmc[ure is not intentletl or otlaretl tor sale (Sec.
7044, Business end Professions Cotle: Tha Contractors License Law does not apply to an owner of property who builds or improves thereon, antl who does such work
himsetl or heiself or through his or her Own employees, provitletl that such improvements are not intended or oflered for sale. tl, however, the building or improvement is
sold within one year of comD�etion, the owner-builder will have ihe burden of proving that he or she ditl not buiid or improve for purpose of sale.).
❑ I, as owner of ihe pmperry, am E%CLUSIVELV CONTAACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions
Cotle: The comractors Llcense,Law tloes not apply to an owner of property who builds or improves thereon, end who contracts for such pm�ect with a contractor(s)
license pursuant to the Contraaors lic9nse LawsJ.
❑ I am exempt unaer sec. - Business and Professions Code for this reason:
Signature: Date:
Owner ID verilied by dnvefs Iicense. ❑ Yes ❑ No OriverS License No.
Verificetion oi Ownership by (type of tlocumeN, i.e. - properry t� bill or deed):
Expires:
DIVISION OF INDUS7RIAL SAfE7V PERMIT CERTIFICA710N:
❑ I hereby certlty iha� no exwvation five (5) or mora feef In depih imo w�ich e person is required to descentl, will 6e mede in connection with work authorized by this
partnit, and that no huiltling strucWre, scalloltling, talsework, or tlemolitlon or dismantiing thereol, will be more ihan thirry-six (36) feet hig�. (Chap. 32, Grp 2, Art 2, Sac.
341, Tltle B, Cellfomla Adminisiretive Gode).
❑ As awner-bullder, I will not employ enyone to tlo work whic� woultl require a permit irom Ihe Division of Industnal Safety, as noted above, unless such person has e
permit to tlo such work irom �he tlivision.
SignaNre: Date:
Division ol Industnal Sefery Pertnit Number.
CERTIFICATE OF COMPLIANCE UhiDRIZATON OF ENTRY: I cenity under penalty of perjury ihat I heve read this application and state Ihat tho infortne�ion given is
correct. I egree to comply with el e laws and ciry ordinances relating to building cons�mction, anC aNhorize representatives of ihe Ciry ol Costa Mesa to enrer upon the
above�tlescnbed property for i pe ion purp0.ses. I agree not lo occupy or ellow acupancy of eny building authorized by this permit until final inspeciion.
GO�E �. \
1616 Flxetl Sy ire Pr
1266 Pool Spa Finel
200 Final Re-Roof
20/ Final BIocWRetaining Well
202 Final Fectory Fire Place
203 Finel Sign
204 Final Demolilion
9 �dai
�—� Date
p� INiIilALS LODE� INSPECTIONTYPE
206 Finel Mechanicel
20B Finel Plumbing
210 Finel Electrical
212 Final Fire Prevention
220 Final Planning Approval
222 Final Sile
250 Final Building/Occupancy
BaIF II�Eki
s-. �
�
Costa Mesa
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CITY OF COSTA MESA
INSPECTION REQUEST SUMMARY
Address Permit Tvne Sub Twe Descriotioo
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(714) 754-5273 • Faz (714) 754-4856 • www.ci.costa-mesa.caB.u�ILDING PERMIT �� FAIFi ORIVE, GOSTA MESA, (:A 926'L6
V
.lob Address: 362 E 20TH ST
Suite:
Vicinity:
Parcel Number: 42623104
Applicant: ALEXSON, TROY
Address: 1653 SUPERIOR AVE
COSTA MESA, CA
Owner: ASHLING, COLIN TR
Address 980 MEADOWLARK LN
LAGUNA BEACH, CA
Zoning:
Phone: (949)642-7222
2ip: 92627
Phone:
Zip: 92651
Contractor: LEE ROOFING OF COSTA MESA
Address: 1653 SUPERIOR AVE
Arch :
Address:
Phone: (949) 642-7222
COSTA MESA, CA
Zip: 92627 License: 349686
Phone:
Eng:
Address:
Status: ISSUED
Applied: 02/18/2003
Issued: 02/1 812 00 3
ISSUED BY:
Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF EXISTING ROCK ROOF. REPLACE SHEATHING AS NEEDED. INSTALL NEW CLASS A BUILT UP HOT ASPHALT - 4 PLY ROOF
SYSTEM.
Plan Check: $0.00
Permit: $153.25
SMIP Res: $0.76
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $154.01
SETBACKS
MAIN STRUCTURE Fronl 0- 0
ACCESSORY Front 0- 0
PARKING Existinq: 0
Rear 0- 0
Rear 0-0
Required: 0
FEESUMMARY
Calc Valuation: 5�,600.00
Claim Valuation: S7,soo.00
PLANNING & ZONING
Lett 0- 0 Right
Lek 0- 0 Righl
Proposed: 0
0- 0
NO710E: The work authorized by ihis 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 ot 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspectiona and final epproval must be obtained. Failure to obtain inspeclions and final approval will result in the expiration of ihis permit.
FOR INSPECTIONS CALL: (714) 754-5626
2446d6 (N00)
WORKERS' COMPENSATION DECLARATION: �
I hereby attirm untler penalry of perjury one of the tollowing declarations: �
❑ I have and will maintain a ceniticate of consent to selt-Insure tor workers' compensation, es provided tor by section 3700 ot ihe Labor Code, for the pertormence of the
work for which this permit is issuetl.
have end wlll maintain workers' compensation insurance, es required by5ectlon 3Z?`0 of the Lebor Cotle, tor the peRortnanca of the work for which this pertnit is issued.
My workers' compensation Insurence carrier antl pollcy numher are: '
Carner: Policy Number:
(This sectian need nof be completed i7 fhe Oermif iavalued et ane hundretl tlollars ($100J or less.)
❑ I certiry Ihat' a e rmance ol the work for which t�is permit is issued, 1 shall not employ any person in any manner so as to become subject to the workers'
compensetlon s o litornie n egrea Ihat Ii I should become subjact to the workers' wmpensation provislons ot Sectb n 370 of the Labor Code, I shall fotlhwit�
Comply with these p ions. // P
Applicant SignaWre: � - Date: � I' �I ���
WARNING FAILURE TO SECURE W RKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL ENALTI S AND pVIL FlNES UP TO qJE HONDRED
THOUSAND DOLLARE (5100,000). IN ADDITION TO THE COST OF �1PENSATION, OAMAGES AS PfiOVI0E0 FOR IN SECTION 3]OB OF THE LABOR CADE, IMEREST, AND ATTORNEV'S PEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aHirm that I '�¢7J�cgpped.under provisions of Chapter 9(commencing with Section 7000) of Division 3 ot the Business and Professions Code, antl my license is in full
lorce and eHect. Lic. #`�: /•1n �, Class x
Contractors Signe�ure:�y� � Date: ( �
1
�
CONSTRUCTION LENDING AGENCY:
❑ I hareby attirm that ihere is a constmction lending aqency for the pedormance of ihe work for which ihis permit is issued. (Sec. 3097, Civil Code).
Lender's Name: Lender's Address:
Signeture:
Daie:
OWNER-BUILDER DECLARATIONS:
I here6y aHirm Ihet under penalry of perjury that I am EXEMP7 FFiOM THE CONTRACTORS LICENSE LAW for ihe following reason (Sec. 7031.5, Busiriess end Professions
Code: Any city or county which requires a permit to consirucf, alter, improve, demolish, or repair any structure, prior lo its issuance, also requires ihe applicant for such permit
to file a signetl stetementdhat he or she is licensed pursuent m the provisions ot the Contraciors License Law (Chapter 9(commencing wIM Sectlon 7000) ot Division 3 ot ihe
Business and Professions Code) or that �e or she is exempt therefrom and the basis br the elleged exemption. Any violation of Section 7037.5 by any applicent for a partnit
subjects the applicant to a civil penalty of not more�than five huntlred tlollars ($500).):
\r'✓
❑ I, as owner of Ihe properry, or my�employees with weges as their sola compensation, WILL DO THE WORK, and the siruclure Is not intended or offered for sale (Sec.
7044, Business and Professions Cotle: The Contractors Licensa Law does not apply to an owner of property who builds or improves ihereon, and who does such work
himself or herself or ihmugh his or her own employees, p�ovided that such improvements are not intended or oHerad for sale. tl, however, Ihe building or improvement is
sold within one year of completion, ihe owner-builder will have ihe burden of proving ihat he or she did not build or improve for purpose of sale.). '
❑ I, as owner ot Iha property, am E%CWSIVELY CONTRACTING WITH LICENSED CONTRACTORS ro constmct the project (SecJ044, Business and Protessions
Cotle: The contraclors License Lew tloes not apply to an owner oi property who bullds or Improves lhereon, and who contrecis for such prqect with e coniractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt untler sec. Business and Prolessions Code lor this reason:
SignaWre: Date:
Owner ID veritied by dnver's license. ❑ Yes ❑ No Driver's License No.
Varification ot Ownership by (type ot tlocument, i.e. - property tax hill ar deed):
DIVISION OF INDUSTRIAL SAFETY PERMITCERTIFICATION:
Ezpires:
❑ I hereby certify i�a� no excavation five (5) or more fae� in depih inm which a parson is required m descend, will be metle in connection with work authonzetl by this
permit, antl that no building simcture, scaHolding, talsework, or demolition or dismantling ihereot, will be more Ihen thirry-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Title 8, Calitomia AtlminislreNve Code). ,
❑ As owner-bullder, I will not employ enyone to tlo work which would require a permit irom the Division of Industriel Sefety, as notetl ebove, unless such person has e
permit to do such work fmm tha tlivision.
Signature: Date:
Division of Industrial Sataty Permii Number:
ICERTIFICATE OF COMPLIANCE AND AU7HORIZATION OF ENTRY: I cetlify under penalty ot perjury iha� I have read ihis application and stale �hat the information given is I
correct I agree to comply with ell state laws and ciry ortlinences rela�ing m �uilding consiruc�ion, antl authorize representatives of the City of Costa Masa to enter upon �he
ebove-described proDerty for inspection puryoses. I agree not to acupy or ellow occupancy of eny building au�honzetl by this permit until finel inspection.
�— .�
'� : • . •
l�.i��/���/.n
.•
CO�E 1. INSPECTIONTYPE
1616 Fi:etl System Final Fire Prevention
1266 Pool Spe Finel
200 Finel Re�Root
201 Final Block/Retaining Well
202 Final Factory Fire Place
203 Final Sign
204 Final Demolition �
�/ f I U
�
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_ �
COpE1 INSPECPONTYPE �
206 Final Mechanical
208 Final Plum6ing
210 Final Electncal
212 Final Fire Prevention
220 Final Planning Approval
222 Final Si�e
250 Final Building/Occupancy
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Costa Mesa CITY OF COSTA MESA
INSPECTION REQUEST SUMMARY
� � �� �, � �� � � � �
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i�. hno l- c�o� � 2 Q:�..4 �.a
(714) 754-5273 • Fa�c (774) 754-4856
�ob Address: 362 E 20TH ST
Suite:
Vicinity: HOUSE ONLY
Parcel Number: 42623104
CITY OF COSTA MESA ✓
BI/ILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT.
PERMIT
BUILDING PERMIT
Zoning:
Applicant: LEE ROOFING OF COSTA MESA
Address: 1653 SUPERIOR AV
COSTA MESA, CA
Owner: ASHL�NG, COLIN TF2
Address 980 MEADOWLARK LN
Phone:� (949)642-7222
Zip: 92627
Phone:
LAGUNA BEACH, CA Zip: 92651
Contractor: LEE ROOFING OF COSTA MESA
Address: 1653 SUPERIOR AV
COSTA MESA, CA
Zip: 92627
Arch :
Address:
Phone: (949)642-7222
License: 349686
Eng:
Address:
�
PERMIT NUMBER
I B00-00656
77 FAIR DRIVE, COSTA MESA, CA 92626
Status: ISSUED
Applied: 05/09/2000
Issued: 05/09/2000
ISSUED BY:
EXpI�ED `�
DA,� �I�
Phone: � Phone:
Zip: License: License:
SCOPE OF PERMIT
REROOF - T/O, INSTALL 1/2" CDX PLYWOOD SHTG, 1 LAYER OF 30# FELT AND NEW 20 YEAR GAF COMPOSITION
SHINGLE ROOF.
Plan Check: $0.00
Permit: $11125
SMIP Res: $0.50
SMIP Com: $O.OD
Other: $0.00
Inspection: $0.00
Total: $'111.75
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0- 0
PARKING Existinq: o
NOTES:
Rear 0- 0
Rear 0- 0
Required: 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Left 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation:
Right 0- 0
Right 0- 0
$4,850.00
$4,850.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void i( work is not�commenced within 180 days, or i( work is suspended or abandoned
for a period of 180 days.
� INSPECTIONS: In order for ihe work authorized under this permit to be considared legal, such work must comply with all applicable codes, and all
requlred Inapeetlona and finel approval must be obtained. Failure �o obtain inspections and final approval will result in the expiration of this permit.
'�� FOR INSPECTIONS CALL: (714) 7545626
�
" ' _ 1
WORKERS' COMPENSATION DECLAiiAT10N: �
I hereby aHirtn untler penalry oi perjury one of ihe following tleclerations:
❑ I heve end will maintain a ceniticate of conseni to self-Insure for workers' compensation, es provided for by sedion 3700 of ihe Labor Cotla, for the perfortnance of iha
work for which this permit is issuetl.
❑ I have antl will maintain workers' compensation insurence, as required 6y section 3700 of Ihe Labor Code, for the pertortnance of tha work for which ihis pertnit is issued.
My workercs' compensation Ins anca carrier antl policy number are: .
Carrier: .+��4�� ��� PolicyNumber:
(This section need not 6e completetl i/ the permit is valued at one Auntlretl tlollars ($100) or less )
❑ I certify that in the performance of the work for which this permit is issued, I shall not employ eny person in any manner so as to 6ecome su�ject to the workers'
compensation laws of California, and �Fe I ould become subject to the workers' compensation provisions oi Saction 3700 of ihe Labor Cotle, I shall forthwith
comply with ihese provisions. n �
ApplicantSignature: ��/ ��� ��4��1 Date:
WARNING FAILURE TO SECURE WORKERS' COMPENSATION COVERA6E IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE MUNDFED
THOUSAND DOLL4RE ($100,000), IN AODITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3]O6 OF THE LABOR CADE, IMEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby attirm that I am Iicensetl.e�U �e pmviet�anof Ghapter 9(commencing with Section 7000) of Division 3 ot ihe Busine�a�Prqfessions Cotle, and my license is in full ��
force and eHect. Lic. q �� � JX � Ctass # G. �
ContractoYs SignaWre: � - L( _ _ _ Date: .S�-�%—?iJ �
CONS7RUCTION LENDING AGENCV:
❑ I hereby aHirm thet there is a consimction lending agency tor the pedormance ot the work tor which ihis permit is issued. (Sec. 3097, Civil Code).
Lenders Name: Lentler'S Adtlress '
Signature: Date:
OWNER-BUILDEF DECLARATIONS:
I hereby aHirtn tha� untler penalry of perjury Mat I am EXEMPT FROM TME CONTRACTORS LICENSE LAW tor lhe following reason (Sec. 7031.5, Business antl Professions
Cotla: Any city or counry which requires a permit to construct, alter, improve, demolish, or repeir any simcNre, prior to its issuance, elso requires tha applicant for such permit
m file a signed statement that he or she is licensed pursuant to the provisions ot ihe Contractors License Law (Chepter 9(commencing with Section 7000) oi Division 3 of the
Business antl Professions Code) or Iha1 he or she is ezempt therefrom antl the �asis for the allegetl exemption. Any violation of Section 7031.5 by any epplicant for a permit
sub�ects the applicant to a civil penalty of not more ihan five hundred dollars ($500).):
❑ I,�as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and ihe stmcture Is not intandetl or otteretl tor sale (Sec.
7044, Business antl Professions Code: The Contractors License Law tloes not apply to an owner of propeny who builds or improves thereon, and who does such work
himself or herself or Ihrough his or her own employees, provided ihat such improvements are not intended or oHered for sale. If, however, the 6uilding or improvement is
sold within one year oi completion, tha owner-builtler will have ihe 6urden of proving Ihat he or she did not 6uild oi impmve for purpose of sale.).
❑ I, as owner of Ihe propeny, am EXCWSIVELY CONTRACTING WITH LICENSE� CON7RACTORS to constmct the project (Sec. 7044, eusiness and Pmfessions
Code: The conirectors License Law does not apply to an owner of property who 6uilds or improves ihereon, and who coniracis for such project with a contractor(s)
license pursuanf to the Comractors License Laws.).
❑ 1 am exempt under sec. Business and Professions Code for ihis reason:
Signawre: Date:
Owner ID verified by drivers license. ❑ Yes ❑ No Drivefs license No.
Verification of Ownership by (type oi document, i.e. - propehy �ax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
Expiras:
❑ I hereby certify ihat no excavation five (5) or more feet in depih into which a person Is requlred to descend, will be made in connedlon with work authorizetl by ihis
pertnit, antl that no building simcture, scattolding, lelsework, or demolition or dismantling thereot will be more than ihirty-siz (36) taet high. (Chap. 32, Grp 2, An 2, Sec.
347, Ttle B, Calitornia Administretive Cotle).
❑ As owner-builder, I will not employ anyone to tlo work which would require a permit irom the Division of Industrial Satety, as notad above, unless such person has a
permit to tlo such work from the division.
Signature: Date:
Division of Intlustrial Sefery Permit Number:
CERTFICATE OF COMPLIANCE AN� AUTHORVA710N OF EN7RY: I cenity under penelty of perjury ihat 1 have raad this application and state ihat the intormation given is
correct. I agree b comply with all state laws and ciry ordinances relating to buildinq constmaion, and authorize representatives of the Ciry ot Costa Mesa to enter upon the
above-descnbetl propeny tor inspection purposes. I egree not to occupy or allow occupancy of any 6uilding authorized by this permit until final inspection.
re ega er(s) Date
,rn S-9-c�
And/OrAuthorrz plicant Date
400E �. INSYECTIONTYPE
7616 Fixetl System Finel Fire Prevention
1266
200
201
202
203
Pool Spa Final
Final Re-Roo�
Final Block/Re�aining Well
Final Factory Fire Place
Finel Sign
204 Final Demolition
2a46-a6
�ATE INTIT11L5
%- � ��+�---�
J
COpEt INSPECTIONTYPE
206 Final Mechanical
208 Final Plumbing
270 Finel Elecirical
272 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
o� ixmin
,- �
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Costa Mesa
�3'.5�.9'C�w�.¢n
c,�'�"'.� �d
CITY OF COSTA MESA
INSPECTION REQUEST SUMMARY
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CIT�'� COSTA MESA
.= �i'1.ANNING D1V tSION
' SUBIECT TO BLDG. DEPT. REG.
NOT£: ADD1TiONS, DELE7lONS,
OR CORREC'CIONS SHAI.L 9E
APPRONED BY THE PLANNING DIV.
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(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address:
Suite No
Vicinity:
Parcel Nunmber:
Applicant:
Address:
Owner:
Addfess
Contrador:
Address:
ISSUE FEE
Temp service test
Res. a/c package
New Res (1-2 units)
New Res (3+units)
Pool I Spa
Lighting Fixts
Recept Outlets .
Switches � "
Non Res Appl �
Res Appl
Service to 200a '
Service to 1000a
Service over 1000a
Motors lo ihp
Motors to 10hp
Motors to SOhp
Motors l0 100hp
Motors over 100np
Communication droDs
Sub panel to 200a
Pole Light Pkg
Sign Circuits
Temp Pwr Pole
Intermed Pole
ELECTRICAL PERMIT
362 E 20TH ST
UNITS B& D@ ASHLINGS RESIDENTAIL VILLA
42623104
JENSEN,JOHN
ASHLING, COLIN TR
980 MEADOWLARK LN
Phone: 714-554-2500
Zip:
Phone:
LAGUNA BEACH, CA Zip: 92651
JENSEN HOME IMPROVEMENTS
14300 CLINTON ST
GARDEN GROVE, CA
STE 187
Phone: 714-554-2500
Zip: 92843
License: 633108
Status: ISSUED
Applied: OS/09/2001
Issued: 05/09/2001
ISSUED BY:
1��
���/
OA�
SCOPE OF PERMIT
REF: B01-00401. ALTERATION TO MULTI-FAMILY RESIDENCE. ELECTRICAL TO INCLUDE: 6
OUTLETS AND 6 SWITCHES.
$23.50
$0.00
$0.00
$0.00
$0.00
50.00
$6.60
$6.60
$0.00
50.00
$0.00
so.00
50.00
$O.DO
$0.00 '
$0.00
$0.00
$0.00
$0.00
so.00
$0.00
$0.00
$0.00
$0.00
$0.00
Quantiry
0
0
0
6
6
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
FEE SUMMARY
Quantity
Temp Dist System / Lighting $0.00 0'
Busway /100 ft $0.00 0
Standing Section $0.00 0 ,
Misc Eleclrical Equipment $0.00 0 .
Transformers up to 1 kva/kw $0.00 0
................up to 10 kvalkw 50.00 0
.................up to 50 kva/kw 50.00 0
.................uptot00kva/kw - 50.00 � 0 ..
..................over 1001iva/kw $0.00 , 0 �
Low Voltage Equipment $0.00 , 0
Low Volt Wiring System I Ckt :-' $0.00' ���0
Misa Conduit - $0.00 � 0 �
Misa Condudor � $0.00 ' 0
Circus ( gen or ride) �$0.00 - 0
Circus (mech ride or lights) � $0.00 0
Christmas Tree Stand $0.00 � 0
Fireworks Stand $0.00 0
Other Electrical Fee $0.00
Investigation Fee 50.00
Plan Check Fee $0.00
Reinspection Fee $0.00
TOTAL CALCULATED FEES 536.7U
COMMENTS / SPECIAL CONDITIONS
NOTICE: The work authorized by this permit shall comply with all applicable handicap access req�irements under Calitornia 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 undar this permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inspectlons end Iinal 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
zans-ae �aroo�
I •
WORKERS' COMPENSAPON DECLAfiAnON: .
I hereby irm under penelty of perjury one of tha tollowing declarations:
ave antl will melntain a certificate of consent to selt-Insura tor workers' wmpensation, es proWtletl for by section 3700 of the Lebor Cotle, tor the pertortnance of the
work 1or whith �hi5 permii i5155ued. ,
I have and will maintain workers' compensaGon insurance, as require0 by section 3700 ot ihe Labor Cotle, tor Ihe pertortnance of the work for which this permit is issue0.
My workers' compensetlon Insurence carrier and policy number are:
Certier: Policy Number:
(ihis sec(ion need nof be comp/etetl il the permit is velued ef one hundretl dollars ($100) or less.)
❑ I cartify t�at in t�e peAortn�P of Na work for which this pertnit is issueQ I shall not employ any person in eny manner so as ro become subiect to the workors'
compensetion laws of C tlfo a, end �ree th should become sub�ect to Ihe workers' compensetion provislons of Sectlon 3700 ot the Labor Code, I shall forthwith
complywit `�� ` /
Applicam SignaNre: Data: J 0
WAFWING: FAILURE T SECURE RK C0.VY SATI COVERAGE IS UNLAWFUL AND SH�1L1 SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES ANO GVIL FINES UP TOONE HUNDRED
TFKKISANODOUAR (5100,0OO�.INAD ONTOTHE OFCOMPENSATION,DNMNGESASPROVIDEDFORINSEGTON3]OBOFTHELABORCODE,IfJrEREST,ANDNTTOqNEY'SFEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aMirm that I am licensetl un er provisions ot Chapler 9(commencing with Section 7000) of Division 3 af Ihe Business antl Professions Code, and my Ilcense is in full
lorca antl eHect. Lic. Class M
CamractaYs Signawre: Dete: 9 Q/
� 7 �—
CONSTRUCTION LE ING A
❑ I hereby aHirm t is a c tructi ending agency for ihe pedormance of Ihe work for which this permit is issued. (Sac. 3097, Civil Code).
Lender's Neme: Lentlers Atldress:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby eNirtn that under penelry ot perjury �hat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business entl Professions
Code: Any ciry or counry which requires e pertnit to construc6 alter, improve, demolis�, or repair any strucWre, pnor to its issuance, also requires the epplicant br such permit
to file a signed statement ihat he or she Is licensed pursuem m the pmvislons of Ihe Contractors Licensa Law (Ghepter 9(commencing with Section 7000) ol Divlsion 3 ot Ihe
Business end Profession5 Cotle) or that he or 5he is azempt therelrom end the basis lor the allegetl ezemption. Any violalion of Section 7031.5 by any applicant for a pertnil
subjects Ihe epplicant ro a civil penalry oi nat more ihan live huntlred tlollars (5500)J:
i
❑ I, as owner of the properry, or my amployees with wages as their sole compensation, WILL DO THE WORK, end the strucwre is not intendetl or oHered tor sale (Sec.
7044, Business antl Protessions Cotle: The Contractors License Law does not applY to an owner of property who builds or improves iheraon, antl who does such work
himself or hersetl ar through his or �er own employees, provided t�et such improvements ere not intended or oHered for sale. If, however, tha building or improvement is
soltl wi�hin one year of completion, lhe owner-builder will have tha burden of proving ihat he or she did not build or improve br purpose o( sale.).
❑ I, as awner at the Oroperty, em E%CLUSIVELY CONTRACTiNG WITH LICENSED CONTRACTORS to consimct the Orojea (Sec. 7044, Business entl Protessions
Code: The contractors License Lew does not apply ro an owner ot pmpeny who builds or imOroves ihereon, entl who contracts for such project with e contrector(s)
license pureuant to the Comrectors License Laws.).
❑ I am exempt under sec. Bu5ine55 and Professions Code lor this reason:
SignaNre: Date:
Owner ID vaniietl by tlriver's licanse. ❑ Ves ❑ No Driver's License No. Expires:
Verification of Ownarehip by (type ol document, i.e. - property tax bill or tleeA):
DIVISION OF INDUS7RIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavetion fiva (5) or more feet in depth iNo which e person is required to descend, wlll be made in connection with work authodzetl by ihis
permi�, antl that no building structure, scaHolding, lalsework, or demolition or tlismantling ihereof, will be more �han ihirty-six (36) teet high. (CheO� 32, Gry 2, Art 2, Sec.
341, Title 8, Calilornla AdmlNs�reHve Cotle).
❑ As owner-builder, I will not employ enyone to tlo work whic� woultl require a permit from the Division of Industriel Sefety, es noted above, unless such person has e
permit to tlo such work irom the division.
Signature: Date:
Division of Intlustrial Safery Pertnit Number:
CERTIFlCA7E OF COMPLIANCE AND AUTHORPJITON.OF EMRY: I cenify under penalry of perjury that I have reeC this application and siate thai ihe information given is
correct. I agree to comply with ell sta lews end ciry ordinances relating to building construction, antl authorize representatives ot the City ot Costa Mesa to enter upon ihe
ebove-described property lor i c�ion purposes. I agree not to occupy or ellow occupancy of any building euthonzed by this Dermit until Final inspection.
CODE �.
1616
1266
200
201
202
203
204
Fixed System Finel Fire Preventlon
Pool Spa Final
Finel Re-Roof
Flnal Block/Retaining Wall
Final Factory Fire Place
Finel Sign
Final Demolition
D�TE' �yjQjai$ CODEI
206
208
210
212
220
222
S/� /�/ Date
/T� Date
INSPECTION TYPE
Finel Mechanical
Flnal Plumbing
Final Electrical
Final Fira Prevenlion
Final Planning AOProval
Final Site
250 Final Building/Occupency
DRTE INTRIpLg
March 15, 2001
�
e.:ITY OF COSTA M,��A
CALIFORNIA 8282&/200 P.O. BOX 1200
DEVELOPMEM SERVICES DEPARTAIEN7
Ms.Ashling
Ashlings Residential Villa
362 East 20`" Street
Costa Mesa, CA 92627
RE: PROPOSED CONSTRUCTION AT ASHLING'S RESIDENTIAL VILLA
362 EAST 20T" STREET, COSTA MESA
Dear Ms. Ashling: -
I wanted to take this opportunity to confirm in writing our conversation on
Monday, 13 March 2001 regarding the conversion of two existing kitchens in
your group home into bedrooms.
It is our understanding that these bedrooms will be used for additional caretakers
or for one of the existing r.esidents of your group home. It is important that the
additional bedrooms are not used to allow an increase in the capacity of your
facility. Currently, you are licensed for 37 residents. Your facility is located on a
property that is zoned for single-family residents -- an R-1 zone. The City of
Costa Mesa prohibits state-licensed care facilities with 7 or more residents in the
R1 zone. Because your facility was established prior to the Code change that
prohibited State-licensed facilities of 7 or more residents, you ere considered
legal, nonconforming; however, because your use is prohibited in the zone where
it is located, no further expansions in the number of residents can be approved.
I hope this clarifies this matter. If you have any further questions, piease call me
at 714.754.5153. The best time to reach me is between 8 a.m. and 12 noon.
Sincerely, -
I, ni
��l�' V ���✓���V
WILLA BOUWEN LEEN
Senior Pla
77 FAIR ORIVE
Buiking Division pl�) 75a-5273 • Cotle Enforcement (714) 754-5629 • Ptanning Divisbn (71a) 754-52a5
FA%(714) 754-4856 • TDD (71t) 754-5�.W
CITY OF COSTA MESA � �
, �. � aU1LpIN6 pMSION �
� DEVELOPMENT SERVICES DEPARTMENT
'�� PERMIT PERMI NUM ER
B99-00298
(714) 754-5273 • Fax (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92628
Job Address: 366 E 20TH ST
Suite:
Vicinity: REAR RIGHT HOUSE.
Parcel Nunmber: 42623104
Applicant: ROBERTS, WALT
Atldress:
Owner: ASHLING, COLIN TR
Address 980 MEADOWLARK LN
BUILDING PERMIT
Zoning:
Phone:
Zip:
Phone:
LAGUNA BEACH,CA Zip: 92651
Contractor: LEE ROOFING OF COSTA MESA
Address: 01653 SUPERIOR AV
COSTA MESA CA
Zip: 92627
Arch :
Address:
Phone: 949-642-7222
License: 349686
Eng:
Address:
Phone:
Status: ISSUED
Applied: 03/03/1999
Issuetl: 03/03/1999
Phone:
Zip: License: License:
SCOPE OF PERMIT
REROOF - T/O, NEW BUILT UP ROOF. 7 5# LAYER ROSIN, 1 25iF LAYER BASE, 2 17# LAYER PLY & 1 72# LAYER
CAP. (SUBJECT TO FIELD INSPECTION).
Plan Check:
Permit:
SMIP Res:
SMIP Com:
Other:
Inspection:
Total
$0.00
$124.75
$0.68
$0.00
$0.00
$0.00
$125.43
SETBACKS
MAINSTRUCTURE Front 0-0
ACCESSORY Front 0-0
PARKING Ezistina: o
NOTES:
Rear 0- 0
Rear 0- 0
Required: 0
FEE SUMMARY
PLANNING & ZONING
Lett 0- 0
Lek 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation:
Right 0- 0
Ri9ht 0- 0
$6,750.00
$6,750.00
EXPIRA710N: This permit shall automaticelly 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, antl all
requlred inepectlona end finel approvel must be obtained. Feilure to obtain inspections and final epproval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545828
WORKERS' COMPENSATION DECLARATION: � � ' -
I hereby attirtn untler penalty of per�ury one of the following declaralion5: . �
❑ I heve and wlll meinteln e certiticate ot consent to self-Insure br workers' compensatlon, as provided tor by section 3700 oi ihe Lebor Cotla, for ihe performenCe of ihe
work lor which ihis permit i9 issuetl. .
❑ I �ave and wlll maintain workere' compensetion insurance, as reqWretl by sectlon 3700 of Ne Lebor Code, for the pedormance of the wark for which Nis pertnit is IssueE.
My workers' compensatlon Insurance cartler entl palicy numher ere: .
Cartler. Pollcy Number:
/Th/s sectlar neetl not be comp/etetl !f the pemd! Is va/ued et one huntlretl tlollars ($100) or less.)
❑ I cenily that in the peAormence ot the work tor which Ihis permit Is issued, I shall not employ eny person in any mennar so es to become sub�ect to the workers'
compensetlan laws ai Celifomie, entl egree iJ� Itl become subJed to t�e workers' compensetlon provlslons of Section 3700 of the Lebor Code, I shell forthwlth
comply with thesa provisions�.rn �+
ApplicSnlSigneture: /�%- Date: '��'Z_J "�–/
WARNINQ: FAILUflE TO SECUHE WORKERS' COMPENSATION COVEMQE IS NLAWFUT AN� SNALL SUBIECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TO ONE HUNDRED
THOUSAND DOILARE (5100,000), IN ADOITION TO THE 00.ST OF COMPENSATION, DAMhOES AS PROVIDE� FOR IN SECf10N 3]OB OF THE LABOR CODE, INfEREST, PND ATfOfiNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby ettirm Ihat I em Iicensed under prap'sions oi Chapter 9(commencing with Section 7000) oi Division 3 oi the Busineu�`n� rofeulons Code, end my Ilcense is in full
forca antl ettect. Lic. M '�ic��'-/ �i Class x �
ContreaorsSigneture: (��(%�� ph� [/a � Date: .�—,?i
CONSTRUCTION LENDING AGENCY:
❑ I hereby effirm Ihat there Is e construcilon IenOing egency for t�e pertormance of t�e work for w�ich ihis permit Is issued. (Sec. 3097, Clvll Cade).
Lendefs Name: Lendefs Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby aHirtn that under penelry of perjury Ihet I am E%EMPT FROM THE CONTRACTORS IICENSE LAW tor the lollowing reeson (Sec. 7031.5, Business end Professions
Code: Any ciry or counry which requires e pertntl to canstruct, eltar, improve, tlamolish, or repalr eny structure, prior ro its issuance, elso requires the appliwnt for such permit
to flle a signetl stetement Ihat he ar she Is licensed pursuant to the provlslons of t�e Contrectors License Lew (Chepter 9(commencing with Sectlon 7000) ot Division 3 of the
Businass and Professions Code) or ihet �e or she is exempt theretrom antl the �asis for the elleged e:emptlon. Any Nolatlon of Section 7031.5 by eny applicent for e pertnit
sub�ecls Ihe applicant to e civil penalry of not more Nen five hunUred dollers (E500).):
❑ I, es ov:ner of the properry, or my employees with wages es their sole comDensetion, WILL DO TTIE WORK, anC Ihe structure Is not intentletl or ottered for sale (Sec.
7044, Business end Pmfeulons Code: The Contrecrors License Lew tloes not aDP�Y to en owner o1 proparty wha builds ar impmves thereon, end who does such work
hlmselt or hersetl or Ihrough his or her own emD�%'B�. DroNEetl ihat such Improvements ere not IntenEed or oMe�ed to� sale. 11, however, the builtllnp or improvement Is
sold wlt�in one year oi wmpleGon, the owner-builtler will have the burden ot pmving thet he or she tlid not build or improve far purpose ai sale.J.
❑ I, es owner of the proDerry, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to canstruct Ihe project (Sec. 7044, Business entl Professions
Code: The cantrectors LJcense Law does not epply to en owner of property who bullds or Impmves thereon, end who contracts for such pro�ect with e contredor(s)
licensa pureuant to the Coniractoro LJcense Lews.).
❑ I am exempt under sec. Business antl Prolesslons Code lor this reason:
SigneNre: Date:
Owner ID verifietl by drivefs license. ❑ Yes ❑ No Dnvels Ucense No.
Vedficatian of Ownership by (rype of tlaument, I.e. - properry tarz bill ar tleed):
DIVISION OF INDUSTRIAL SAFETV PERMR CERTiFICATION:
F�cplres:
❑ 1 here�y cently thet no excavetion tiva (5) or more leel In Oept� Inlo whlch e person Is requiretl to descend, wlll be made In connection wlth work euthoAzetl by this
pe�mit, antl that no building structure, scaflolding, lelsework, or demolition or dismantling thereof, wlll be more Ihen thirry-si: (3fi) feet hlgh. (Chep. 32, Gry 2, Art 2, Sec.
341, Ttle e, Celitomia Administretive Code).
❑ As owner-builder, I will not employ enyone to do work which would requlre a partnit fram Ihe DlWsion of Industrlal Saiery, as notetl above, unleu such person hes e
permit ta do such work from Ihe Civision.
Signature: Date:
Division o1lnGusirial Sefery Pertnit Number:
CERTIFlCATE OF COMPLIANCE AND AUfHORVA710N OF ENfAY: I ceM1ify under penelty of perJury that I heve reed this application entl state that the iniormetion given is
correct. I egree to wmply with ell slete lews end city ordlnences releUng to building constructlon, end euthodze representatives of the Ciry oi Costa Mesa ro enter upon the
ebove-descnbed properry for Inspectlon puryoses. I egree nat to occupy or allow occupancy of eny bulltling authodzed by this permtl untll final inspection.
n/ tur� Of Legel Owner(s)
�/ � �
AnNOiAuth edApplicent
LOUE �. INSGECTIONTYPE
1816 Fized System Finel Fire Prevention
1286
200
Paol Spe Flnel
Finel Re-Raof
201 Finel BIocWReteining Wall
202 Final Fadory Fire Place
203 FinalSign
204 Finel Demolltlan
2H&46
neie u�e�s
3_�a,a��
Dete
SQQ[1 INSVECTIONTYPE �jF II1I�lL$
206 Finel Mechanical
208
210
212
220
222
250
Flnel Plumbinp
Flnel Electrlcel
Finel Fire PrevenGon
Flnel Planning Approvel
Finel Site
Flnel Bullding/Occupency
�noxessa em�uxo: 3 6 2 E 2 0 TH S T
ovm�RsruuEiFa,u�m: ASHLING, COLIN TR
ADDFE55: 980 MEADOWLARK LN
LAGUNA BEACH,CA 92651
�rv�,wuura �ooxFss:
1qC ECTOpENtlNffR:
MCN�.rI FHO.'S ADDXE55:
uc ra.:
uxT: CITY OF COSTA MESA — BUILDING PERMIT
, ERM NO; B 079968
PERMIT NO: B 079968 PLAN CHECK NO: 04244-96 L� GOVT: N SUPP; N
CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE; CON
JOB DESCRIPTION : CONST. 448SF DETACHED PATIO SQ FT: 448
UM:
cTarswu� HBC CONSTRUCTION/CONSULTA ( 714 ) 642-5757
c� ncroxs�uu�+c 273 E 20TH ST
aoo�ss COSTA MESA CA ucxo.: 446415
92626 uHr:
LICENSED COMNACiOHS OECL�PATION: I Mnby ellim uMer panely d p�ury tM� I em IicenaeE uMm pwivime of Cheqar 9
(mmmer��p vn�� Section 100q N Dimion 9 M ihe Buaineav arM Profeasions Cada, eM my laerue u in tull twce eM aflea.
No.:068337 uc.cuss: g uc.No.: qq6 15 EXP: 09/97
om, o— - 9G c�o-�� � r 4� (30 ��� `i e�
�-OW NEH BUILDEH UECIANRTION: I he'eEy efirm uMer penely d pmFN�Y �� ���mq fmm lhe CoMretlaa Liwms law la ihe
:•=vrip reeson ($eqion 1031.5 Bui'vima ard Pral�iom Cade: My cN a�M'/ �� �eVuvee e parmil lo mmhucl. Mx.'unproue.
oloh, or repeir eny eVucturo, pior m iia ceuenca, ebo requirea tM epplirant im euch paimA lo fib e agr�ad etetement Ihet M a eM
ansad Wn�ant to iM Cwisiom d tM Conlreaae.liroiue lew ICheqer 9lmmmeni�B xnh Seaion'!OW) tl Divcun 3 d tlr
rwse enE Prdeseione Coda� rn thet he or sha is memq Ihsehom end ihe bavie la Ne elbpeE memqion. My violelon d Setlion
,....1.5 by eny epqiranl iw e permit eubpde Ihe epplira�t �o e tivJ perielry d m� mpe �han live hurdred ddWv �559�)).
❑ i.�.o.�.ainewewnvo�mremdw�„anwaoe:�ma:.w.�mw�m�,.w�naou»won�..oaubb��o�a�m�a
orareree �« sde (sx�ion la.. ewniew ene vrwe:swra cuee: rM ca,�retlw. Lican..laweoea na epwr�o en ow�wa pap«r�
who buide n inD�s �herean. eM xfio doee auch work himaeX a henA a ihraqA hs a her own emP�W��. tt�ed ihm mch
imqovamema era rat iniaMad a dleraE /or eeb. M, howovar, tM WiMinO a unpovemenl ie eoN wilhin aro yw d comda�nn. �he
owiwrLuildm xill lave tM buNen d povirp M or ehe dk �wl Wik w impove lor IM WN�e W eeb).
� I. ea awner d Ihe D�M. � ecduarvey coniren� wnh licensed convecion io cmn�ue iho pojen (beeon ]014. Bueimes aM
PMe�one Code: Tha Contree«e licrose law Eaae rot epply lo en owmr d qapeny xM buike or impovee iMreon and vAa
conVecM la vdi pqeaa vrilh e mnlredor(+) IcerueA.punuani io IM Conlretlae Licenee Lew).
� I em exempt uMer Sxiion: 8.-8 P.C�for Nie reevon:
Deie: Ownec
i eo n��y �nnv wm i� ew� a d,a ���d ma �a���am. a cmu«�b �nn d,a smmr coea seao�e usos. zssa. �a
25434, end Ihel I a eny Mure buildin0 �P�� �II / wdl nd (rircb aie) need �o camply wih eeiA etete oodp eM tM raquiremame M
epsmelamaleud'qnamoEifralionhamlMAi ue�y a�emen�0imritl.RaeidaMialwnqrvqianeGVke�ioneenusmqhamNsea
y,ovieiom.
/Du�a: Applicem�
�ytAKER'S COYPENSATION UECIARATION: I MreEy eifiim uMer penelly d prjuy an d Nw Idbw'vp Mdareloro:
� j I heve ard xil mvmen e eMificete d rareem to saXimuro hr waekert compenWion, u W�ed Ia W Seeion 3lOD af IM lebor
Cada, lor tM pe�lormerce d tM wwk Iw w1Jch ihie permA ie iaued.
� I hma eM ti� meinten xahen' compen�ion insurence. m raqui�ad by Saqim �)0p oi Me lebor Code. M 1M pafamence W IM
wark la xfi' h Nie partnn is esued. My warken' mmpenution ineurarrn ra�iar eM poliry number ara:
Cemm:
PdicY Numbar:
�.yissection need ria be comdetee l tM v�d 'u M are hunerei ddbn /Srwl w bn.1
� u I mnM Md in tn. o�mnvca oi iM work 1« which inie V�n ia iauad. I ahell roi amWW e^v v>� in em' mamx eo m �o
�ecane w4ea io ine workein• cwnv�� mr. d c.4lomia. ena wree um C � anw�a exm�e wDi.a �o �ne �.aan�
f�ampane im v� 'sone af Seaion �lao o1IM lebor Code. I ehell /on�wnh canv � ee proviaione.
D e/ r 9 A,w�,�: �r.u� ��y�--�
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Nvll llm� up ro om hwtlia0 fMua�nC JWWn (Sf00,000), M edllfbn b Ms ro�t ol romp�rwtb� Mmps� a� provlGaO br In
9setlon J106 0l fhs Le6or Cotls, Infersst, erM �ttomsy'e /su.
CON4TqUCTION LENDINO AGENCY: I hareEy effiim undar panelry d perM�Y �het t�ere is e mnArudion bMi�q epenq Iw Iha
penoimeMe a ine won �« wnlm �nm re�� ��e (secion ws). cH. cl.
LENDEH'S NAME:
LENOEP'S 1DDFE53:
I ce�ify ihel l hera reee ihu epd�ian end pme Ihm ihe ebove iMormmion ia corted. l epree to wmDh �h all dryad munry adinencee
and etele lexv rMmip tgiyikip wnWutlion eM here�lhonza repesanlalives W Ihis tity b eMm uqm IM eEwe-menliqiad papMy
(5151-18.WP)
TRAll BOt�Ct�EOIS
Date: � _ � ^ b
8 Sefety: Grear�Fb; Cenery-Appfunt: Pink-Reronue: Ooke veaor
CLAIM VALUE: 3,000.00 CALC—VALUE: 6,979.84 GROUP OCC: R-3 /
COMMENTS: DETACHED PATIO
***���***�����r**�*��*�*+�*****x+t��**�rt�**�*�***+�**��x��r*x*�x*�+�*+�*��*�*+�***�**�+�
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING --------- --- --- ACCESSORY BUILDING ---------
FRNT: FT IN REAR; FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ; PROV: PARCEL; 42623109 ZNE; R1 REF NO:
PLANNING NOT'ES> CONSTRUCT 392 SQ. FT. (28'X 14'), 10' HIGH PATIU COVER
> BEHIND RESIDNECE, NEXT TO GARAGE. SETHACKS. O.K.
iE iE aE �E iE iE iE iF iE �E iE iE iE jE ik iE jE iF iE iE if iF iE iE if iE iE jf 1t if 9f ik iF iE ib fE aE �E 3E iE 1F 1E if iE 3f iE iF if iE if iE if iE iE !k 3F aE iE jflf �E �E iE iE jE iE if 1f if�3f IE-IE if jE iE 1F if iE df
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N•T S
ZONING APPROVED BY �� DATE:
HUILDING APPROVED BY � DATE: �i� ( V
APPLICATION ISSUED BY: DATE: t
iE iE 1E iE 1E 1F iE if iF 1E 1E iE iE iE jF iE iE iE iE iE if if if iF jF iE� 1f 3f iE iF �E 1E7F�-��F�iF3E iE
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 124.75 .70
SMIP/NON—RES
PLAN 81.09
ISSUE FEE
HUILDING—DIV—> PERMIT ZSSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 125.45 0.00 81,09 206.54 206.54 .00
REVENUE DIVISION TOTALS--> COLLECTED: 206.54 OVER/SHORT: ,00
BLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMZP/TOT GRADING PLAN—CHECK
124.75 .70 81.09
iE fE if �F iE 1E iE iElE iE fE iE ff IE 1E Ik Ik IElE IE iE 1E fE 1E fE 3E 3E �f if iE iF 1E i! iF IE 1F iE fE �E fE �E 3E iE fE 1E IE iF 1E IE iE iE if 1E iE iF jE 1E �E fE ff iE fE IE �E iE fE fE iE iF it * IE IE fE iE 1E 3E iE iE
I N D I V 2 D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 448 RES—PATIO COVER—POST & TRELLIS 15.58 6,979.84
END OF FEES
41 00217134-00217141 T�3 T
dRTE: iQ/151F` TIME: IU:47
206.54 �
/,�
CONSTRUCTION AND PLANNING POOI '�PA
APPROVA�f =Permit # Date lospector qppROVALS�+ Permit # Date Inspector
i. Temporary Electricai Servicebr Pole 52. Pooi & Equipment Location '
2. Soil Pipe-Undrgrnd. �� 53. Steel fleinforcement '
3: Electrical Conduit Utilitv-Undrgrnd. 54. Forms � '
4. Electrical Conduit-Undrqrnd. 55. Elettrical Bonding
5. Steel Reinforcement 56. Rough Piumbing & Pressure Test .
6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE
7. Footings !Q!G_ 58. Electricai Conduit-Undrgmd. .
8. Foundation y�'G C� 59. Gas Pipe, � Undrgmd., Test `
9. 4Vater Pipe�Undrgrnd. 60. Backwash Lines, P-Trap, � Undrgmd. •
10. Structurai Floor SYstem ' 67. APPROVAL TO DECK '
t t. Property Sewer line & House Connection 62. Backwash & Recepmr�pinal �
�2• SQ`^'e` CaP 63. Heater & Vent•Finat
73. Roof Drains _ ' 64. Plumbing System � Finai
74. Rough Plumbing 65. Electrica6Final
75. Rough Electrical-Condult 66. Solar System�Final
�
76. Rough Electric Wiring � 67. Fencing & Access ApProtrel �
17. Rough Wiring Sign 68. APPROVED FOR Pt,ASTERING
78. Roue�h Eleclrical�T Bar Ceiling 69. POOUSPA SYSTEh4S FINA�
19. Rouyh Heating & Air Conditioning PIREDEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts,in Structure _ 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil
23. Gas Pipe�Rough & Test 72. Underground Flush
24. Roof Framing - 73. Undergrnd. Storage Tank O Gas ❑ Oii �
25. Roof Sheathing 74. Overhead Hydro
26. T�Bar Ceiling (Strucwral) & Monocoat 75. DrY Chemical
27. Frame and Fiashing 76. Dry Stacidpipe
28. Lathing & Siding � • 77. PIXED SYSTENI FINAL
29. Insulation � 78. FIRE PREV. FINAL
30. Dryv,�ali Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Browr Coat � 79. FINAL INSPECTION
32. Electrical Power Meter�F�nal 80. f00D CERTIFiCATE ISSUED
33. Final Electric No/-tes:
34. Final Heating & Air,Conditioning j� �%f„ /�6 �����
35. Final Gas Pipe-Test � �C ��-
36. Hood or Canopy � �
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Finai
40. Gas Service•Finai
41. Solar pomestic•Final �
42, Backflow Preventer � �
43. Backfiow Irrigation
A4. �andscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations /►� �
47. FINAI STRUCTURE & BUILDWG I.�'7.• yG //�'��
��� II�°�
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southem California Gas Co
51. CERTIFICATE OF OCCUPANCY
No Date
'