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Home My WebLink About372 20TH ST - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 MECHANICAL PERMIT Job Address: Suite No Vicinily: Paroel Number: 372 E 20TH ST A 42623177 Applicant: BRIGGS,JOHN Address: 05457 CRENSHAW BL LOS ANGELES CA . owner: MOSS,JOHN. ':. � Address� MOSS, JOHN K , � LOS ANGELES,-CA . 4360 WORTH ST Contractor. ADEE PLUMBING & HEATING Address: 05457 CRENSHAW BL ' LOS ANGELES CA Phone: 800-554-5858 Zip: 90043 Phone: Zip: 90063-2536 Phone: 800-554-5858 Zip: 90043 License: 240186 Status: Applied: Issued: ISSUED 03/O6/2002 03/O6/2002 ISSUED BY: C_V'tC/ SCOPE OF PERMIT � REPLACE WITH 70K FAU. FOR UNIT A. . � � ,-� . ,-- �-- � '- , ._ . '" FEESUMMARY � ISSUE FEE Inst FAU <100 k BTU Inst FAU >100 k BTU Repair/Alt Cooling/Heat Inst/ Rep. Recess Wall Htr Refig Sys <700 k BTU Refrig Sys >100 k BTU Gas Piping Factory Fireplace . Hood w/Mech Exhaust VAV Box Vent Fan / Single Duct, Appliance Flre Dampers � `� ��. i -, Smoke Dampers. � Inst or Relocate Appl Vent �' Air Handlers < 10000cfm � Air Handlers > 10000cfm � � Floor Furnace Floor or Suspend Heater , Quantity $23.50 $14.80 1 $0.00 ` 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 30.00 0 �� $0.00 0 � $0.00_.- �0 , � $0.00 0 $0.00 0 � $0.00 '�-�0-: $0.00 0 ' , $0.00'�� 0 $0.00 0 $0.00 0 $0.00 0 Repair / Alt Absorbtion Unit � ; �Repair/AlfRefrigeraGorcUnit � -- - _ Ventillation System � Evaporative Cooler Commercia l I nci nerator . Domestic Incinerator - Compressors / Absorption Svslems - Up to 3 hp /'100 k BTU � _ ,.. �� -3To75hp/SOOkBTU - _� � 15 To 30 hp / 1,000 k BTU ' � 30 To 50 hp / 1,750 k BTU " - , ' Over 50 hp /�Oyer,1,750�BTU Boilers � Upto3hp " .: . � " 3To15hp - = - ,.%�, �15to30hp , � �- - 30 to 50 hp � � � ; , Over 50 hp - , - Other Mechanical Fee - , � Investigation Fee . . � Plan Check Fee - - . � Reinspection Fee , TOTAL CALCULATED FEES COMMENTS / SPECIAL CONDITIONS Quantity $0.00 0 $o.o0 0 $0.00 0 $0.00 0 $0.00 0 $0,00 0 $0.00 0 � �. $0.00 : 0 $0.00 0 $0.00 0 $0.00 , 0 ,$0.00 0 /��$0.00 0 ' so.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 $38.30 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 raquired Inspectlons and flnal approvel must be obtained. Failure to obtain inspections and final approval will result in the expiralion of this permit. FOR INSPECTIONS CALL: (714) 7545626 zaae-ae �eroo� WOflKERS' LOMPENSATION DECLARATION:' �� I hereby aHirm under penalry of perjury one of the following tleclarations: � � ❑ ve and will maintein a cetliticate of consent to self-Insure Por workers' compensation, as provitlatl For by section 3700 of the Lebor Code, for the pertormance of the rk for which this pertnit is issued. e antl will maintain workers' compensation insurance, as required by section 3700 of the Lebor Code, for the perfortnance of Ihe work for which this permit is issued. My workers' compensation Insurance carrier entl policy number are: . Carner: Policy Number: (7his section neetl not be wmp/eted i! fbe permit is valued at one hundred dollars ($100) or /ess.) ❑ I certi ertortnence of work for which this per it is issuetl, I shall not employ eny person in any mannar so as to become subject lo the workers' mpensation laws alifo i tl agree thet it I shoul come subject to the workers' compensation provisions ot Se/�p n 3700 f the Labor Code, I shall forthwl[h 5 ` ��/ �� Applicant ' . � ' _ � D te: WARNINGfAILURETO UREWORKERS' MPENSATIONCAVERA I NIAWFULANDSHALL5061 ERTOCiiIMINAL�PENALTIESANDCIVILFINESUPTOONEHUNOREO TFIOUSANDDOLL4R 100,000),INADDITIONTOTHECOSTOFCOMPENSATION,DAMqGESASPROViDEDFORINSECTION3]OfiOFTHELABOiiCOOE,IMEREST,ANDATTORNEV'SFEES. DECLARATiON: of Chapter 9(commencir� with Section 7000) of CONSTRUCTION LENDING AGENCV: ❑ I here6y affirm that there is a consiruction lending agency for Ihe pertormance of the work tor which this permit is issued. (Sec. 3097, Civil Code). Lender's Neme: Lendefs Address: Signature: OWNER-BUILDER DECLARATIONS: Date: is in tull I hereby eHirtn Ihat untler penalry of perjury Ihat I am EXEMPT FROM TME CONTqACTORS LICENSE LAW for Ne tollowing �eason (SecJ031.5, Business antl Protessions Code: Any city or county which requires a permit to consimct, elter, improve, demolish, or repair any simcture, prior to its issuance, also requires the applicant for such permit to tile a signetl stalement that he or sha is licensed pursuant to the pmvisions ol the Contractors License Law (Chapter 9(commencing with Sectlon 7000) of Divislon 3 of the Business and Pmfessions Code) or Ihet he or She is exempt iherefrom and lhe besis for ihe alleged ezemption. Any violetion ot Section 7031.5 by any applicant for a parmit sublecis the ep0licant to a civil penalry of not more than five huntlretl tlollare ($500).j: ❑ I, es owne� of ihe property, or my employeas with weges es their sole compensa�ion, WILL DO 7HE WORK, and Ihe siructure Is not intended or offered for sale (Sec. 7044, Business and Professions Coda: The Comractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or ihrough his or her own employees, provided that such improvements are not in�ended or oNered for sale. If, however, the building or improvement is sold within one year of completion, the ownerbuilder will hava the burden ot proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRAC70RS to constmct tha project (SecJ044, Business and Professions Code: The conlractors License Law tloes noI epply ro an owner of propetly who builtls or improves thereon, and who contracts br such project wiih a conirector(s) licensa pursuant to the Contraaors Licensa Laws.). ❑ I em exempt under sec. Signa�ure: Owner ID verified by driver's license. ❑ Yes ❑ No Business antl Protessions Cotle for this reason: Veniiwtion of Ownarship by (type of document, i.e. - property tax bill or deed): �IVISION OF INDUSTRIAL SAFETY PERMIT CERTIFIGATION: Driver's License No. Date: Expires: ❑ I hereby cetlify ihat no excavation fiva (5) or more feet in depth into which a peison is required to tlascend, will be mede in connection with work authonzad by this permit, and ihat no building siruc�ure, scaflolding, falsework, or tlemolition or dismantling thereof, will be more �han �hirry-six (36) teet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title 8, Califomia Atlminisirative Code). ❑ As ownervbuilder, I will not employ anyone to do work which would require a permit from the Division ot Industriel Safety, as noted above, unless such person hes e permit to tlo suc� work irom the tlivision. Signature: Date: Division of Indusirial SBtety Permit Numbec CERTIFlCATE OF COMPLJANCE AND AUTHORIZATION OF ENTRY: I cenity under penalty oF perjury that I have read this application and state that the infortnation given is corract. I egree to comply with all stete laws and city ordinances relating �o builGing consiruction, end authonze representatives ot tha Ciry of Costa Mesa to enter upon Ihe above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authonzed by this permit until finel inspection. COpE �. INSPECTIONTYVE 1616 Fixed System Final Fire Prevention 1266 Pool Spa Final 200 Final Re-Roof 201 Final Block/Retaining Well 202 Finai Factory Fire Place 203 Final Sign 204 Final Demolition Qj�JF INiIiI�LS COOE I INSPECTION TYPE 206 Finai Mechanical 208 Final Plum6ing 210 Final ElecMcal 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy � � (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT Job Address: 372 E 20TH ST Suite No A Vicinity: Parcel Nunmber: 42623117 ISSUED BY Applicant: GUTIERREZ, JUAN Address: 5457 CRENSHAW BL , Phone: 800-554-5858 LOS ANGELES CA Zip: 90043 Owner: MOSS, JOHN K Address 4360 WORTH ST Phone: LOS ANGELES, CA Zip: 90063-2536 Contractor: ADEE PLUMBING R HEATING Address: 5457CRENSHAW BL Arch / Eng : Addres5: Phone: 800-554-5858 lOS ANGELES CA Zip: 90043 License: 240186 Phone: Zip: License: Status: ISSUED Applied: 11/O1I2004 Issued: 11/O1/2004 SCOPE OF PERMIT COPPER RE-PIPE HOME- 8 FIXUTES & 2 HOSE BIBS (2 SHOWERS, 2 TOILETS, 2 LAV'S, 1 VJTR. HEATER, 1 LAUNDRY AND 2 HOSE BIBS) � FEE SUMMARY AMT �TY AMT QTY . ' AMT �TY ISSUE FEE $23.50 - Laundry Tub / Washer $9.80 1 � Sump Pump $0.00 0 BackFlow irrigation $0.00 � 0 Landscape Irrigalion 50.00 0 Swimming Pool $0.00 0 BackFlow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub , $0.00 �� 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System ��, - 50.00 0 � Process Piping (per 10 ft)' $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect pce,Soda,etc) , 50.00 0 Receprors $0:00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units 50.00 �0 Septic Tank $0.00 0 Wash Basin $0.00 0 Dishwasher � 50.00 � 0� Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain, Floor 50.00 0 Sewer Connect $0.00 0 Waste and Vent Sysiem $0.00 0 Drain, Rainwater $0.00� 0 � Sewer Private line $0.00 0 Water Closet (Toilef) 5�9.60 2 Drain,Roof $0.00 0-,' Shower� � $19.60 2 �WaterHeater/vent S'I2.30 1 Drinking Fountain $0.00 0 ' � Sink, bar $0.00 0 ' Water Piping (Inst or Rep.) 50.00 0 Ezpansion Tank 50.00 0 Sink, commercial .-. $0.00 0 Water Re-pipe 39.80 1 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requi�ements under Califomia statutes and related regulations. (Ord. No. 92-28, § 7, 12-21-92) EXPIRATION: This permit shall automatically explre and become void if work Is not commenced within 180 days, or if work Is suspended or abandoned for a period of 180 days. INSPEC710NS: In order tor the vrork aNhorized under this permit to be considered legal, such work must comply with all applicable codas, end all required Inapeetlona end finel epproval must be obtalned. Failure to obtain inspections end final approval will result in iha expiration of this permit. FOR INSPECTIONS CALL: (714) 7545628 zsaa�ae �aiWl WORKERS' COMPENSATION DECLARATON: . � ' ' � ' � , � ' _ • ( I hereby aflirm under penalty of perjury one of the following tleclaretions: � . �� / ❑ I have and will maintain a certificate oi consent ro seli-Insure tor workers' compensatlon, es pmvided for by section 3700 0l tha Labor Cotle, lor Ihe peAormer� of thA work lor which ihis pertnit is issued. .� .` ❑ I have and will meintain workers' compensation insurance, es requiretl by sectlon 3700 of the Labor Code, for Ihe perfortnance of �he work for which this permit is issued. My �o �e�j' comnpen,sat,l,on eInsura�i carn�er antl^po licy number are: Cerrier: V � �!�-I�-�A�--Q l .��-^-1 1 PolicyNumber: /,�7 �� (Tlris secfion need na( be complefer� d the permrt Is v etl ef one hundred dollars ($100) ar less.) ,.,' . . , ' ❑ I certity that in the pertormance ol ihe work for which this permit is issued, I shall not employ eny person in eny manner so es to become subject to the workers' compensatlon laws ol Celifomla, entl egree ia should become sub�ect to the workers' compensation provislons of Sectlon 3700 oi the Lebor Cotle, I s�all forthwith comply with Ihes vi51on5. Applicant Signewre: '.�-�— Dete: � // /— � � WARNING: FAILURE TO E RE WORKERS' COMPENSAiION C V� i' IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVII FlNES UP TO ONE MIINDRED TIqUSANDDOLLARE( ,OOO�,INADDITIONTOTMECOSTOFCOMPEI TION,DPhNGESASPiiOVIDEDFORIN5ECT10N31060FTHELABORCODE,IMEREST,ANDATTORNEY'SFEES. LICENSED CONTRACTORS DECLARA710N: I hereby aNirm that I am IlcensQ�l untler mNslons ot Chapter 9(commencinp with Section 7000) ol Dlvlsion 3 of Ihe Bu ' ss antl Professions Code, entl my liceese is in tull iorce end eHect Lic. a`��—y C7� �� Class a�%�! d' � C' .�(�i—n_, r Cornrector'sSlgneWre: Date: r� / _ -�.�_/� C-' -� CONSTRUCTION LENDING AGENCY: ❑ I hereby eHirtn thet there is e construction lending a9ency for Ihe pertormance of the work for which this permit is issued. (Sec. 3097, Cidl Code). Lentler's Neme: Lentlers Atldress: Signeture: Date: OWNER-BUILDER DECLARATIONS: I hereby eHirtn thet under penalry ol perjury thet I am EXEMPT PROM THE CONTNAC70RS LICENSE LAW br ihe foliowing reason (SecJ031.5, Business antl Professions Cotle: Any ciry or county which requires a pertnit ro construci, alter, improve, demolish, or repair any stmcWre, prior 10 its issuance, also requires the epplicant for such permit to file e signed stetement ihat he or she is licensed pursuent to the pwvisions oi ihe Conirectors License Law (Chepter 9(commencing with Section 7000) of Division 3 of the Business antl Professions Code) or that he or she is exempt therefrom antl the besis tor the alleqed exemp�ion. Any violetion of Section 7031,5 by eny applicant for e pertnit subjects the applicant to e civil penalry ot not more than tive hundred dollars (5500).): ❑ I, as owner of the property, or my employees with wages as Iheir sole compensation, WILL DO TME WORK, antl the strucWre is not intended or ottered for sale (Sec. 7044, Business and Protessions Cotle: The Coniractors License Law does not apply to an owner of propeny who builds or improves ihereon, entl who does such work �imseN or herself or through his or her own employees, provided that such improvemems ere not intendetl or oHeretl for sale. If, however, t�e building or improvement is sold within ona year of wmpletion, the owner-builder will have �he burden of proving that he or she did not build or improve for purpose of sale.). ' ❑ I, as ownar of the pmperty. am EXCLUSIVELV CONTRACTNG WITH LICENSED CONTRACTORS to consimct Ihe proiect (Sec. 704d, Business antl Professions Code: The contractors License Law doas not epply to en owner of pmpetly who builds or improves ihereon, and who conirac�s for such pmject with a coniractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Signature: Owner ID verified by dnvefs license. ❑ Y85 ❑ No Business and Professions Code for this reason: Venfication oi Owners�ip Dy (rype of document, i.e. - properry tar bill or deed): Dnvers License No. Dete: Ezpires: DIVISION OF INDUSTRIAL SAPETY PERMIT CERTIFICATION: ❑ I hereby cenity t�a� no excava�ion five (5) or more feet In depth into which e person is required to descend, will be made In connection with work euthorized by ihis permil, and ihat no building structure, sceHolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) leet high (Chap. 32, Grp 2, Ah 2, Sec. 341, lltle 8, Califomia Administrative Code). ❑ As owner-6uiltlar, I wlll nat employ enyone to tlo work w�ich woultl require e permit trom ihe �ivislon of Industrlel Setety, as noted ebove, unless such person has e permlt to tlo such work trom the division. Signature: Dala: Division ol Indusinel Safety Permit Number. CERTIFlCATE OF COMPLIANCE AND AIJTHORVATION OF ENTRY: I certify under penalry of perjury ihat I have read this application and state Ihat ihe infortnation given is correct. I agree to comply with all stete laws end ciry ordinances relating to building construction, antl euthorize representatives of the Ciry ot Costa Mesa to enter upon the above-descnbed property for inspection purposes. I egree not to occupy or allow occupency ol any building authonzed by this permit until tinal inspection. CQOE �, 1616 1266 Fixetl System Final Flre Preventlon Pool Spa Final 200 Finel Re-Roof 201 Final Block/Reteining Well 202 203 204 Finel Fectory Fire Place Final Sign Final Demolition GdIE u - i — ��oate e�a o �@ COOEA INSPECTIONTYPE 206 Finel Mechanical 208 Finel Plumbing 210 Finel Electrical 212 Final Fire Prevenlion � 220 Flnal Planning Approval 222 Finai Site � � � 250 � FinalBuilding/Occupency � � •' r } 1 (714) 754-5273 • Fax (��a) �sa-aess • www.cl.costa-mesa.BUILDING PERMIT �� FAIR �RIVE, COSTA MESA, CA 92626 Job nddress: 372 E 20TH ST Suite: A Vicinity: RESIDENCE ONLY Parcel Number: 42623117 Applicant: MILLER, DAVID Address: 3027 ROYCE LN Zoning: Phone: (949)631-7924 COSTA MESA, CA Zip: 92627 Owner: ��F�dSRE JACOBS, JAMES A d MICICIE A Address �RRb�—�lE COSTA MESA,CA 372 E 20TH ST il� Contractor: ORANGE COAST ROOFING Address: 3027 ROYCE LN COSTA MESA, CA 2ip: 92627 Arth : Atldress: Phone: Zip: 92627 Phone: (949) 631-1924 License: 434674 Eng: Address: ISSUED BY: Status: ISSUED Applied: 11/27I2000 Issued: 11/27I2000 Phone: � Phone: Zip: License: ' License: SCOPE OF PERMIT REROOF: T/O, 1 LAYER 15# FELT, REROOF WITH 30-YR GAF COMP SHINGLES. 12 SQUARES. /��_ _ • � . �� ( P.�/-1GCGl<-t-Pi Plan Check: $0.00 Permit: $83.25 SMIP Res: $0.50 SMIP Com: 50.00 Other: 50.00 Inspection: $0.00 Total: $83.75 SETBACKS MAINSTRUCTURE Front 0-0 ACCESSORY Front 0. 0 PARKING Existinq: 0 NOTES: Rear 0- 0 Rear 0. 0 Required: 0 FEE SUMMARY PLANNING & ZONING Left 0- 0 Lefl 0. 0 Proposed: 0 Calc Valuation: Claim Valuation: Right 0-0 Right 0-0 s2,soo.00 s2,soo.00 INOTICE: � The work authodzed by this permit shall comply with alt applicable handicap access requirements under Califomia statutes and related . regulations. (Ord. No. 92-28, § 1, 12•21-92) EXPIRATION: This permit shali automatically expire end become void if work is not commenced within 1 BO days, or if work Is suspended or abandoned for a pedod of 180 days. INSPECTIONS: In order for ihe work euthorized under ihis permlt to be Considerad lagal, such work must comply with all applicable code9, end ell required Inepeetiona end finel approval must be obtained. Failure to obtain inspections antl final approval will result in ihe expiration of this permit. i FOR INSPECTIONS CALL: (714) 7545628 >40&a8 (fl�00) WORKERS' COMPENSATION DECLARATION: I hereby aHirtn untler penalry ol per�ury one of the following dedarations: ❑ I heve and will maintain a cenificate oi consent to sell-Insure br workers' compensation, as proNAed br by sectlan 3700 ot lhe Lebor Code, for Ihe pedormance ol Ihe work tor which thls permit is IssueO. I have entl wlll maintain workers' Compens yon insu2nce, as requiretl by seMlon 3700 of the Lebor Cotle, Por I�e pedormanca o� Ihe work lor which NIS pertni� k issuetl. y workerg' to ensatlon nwrente 4r antl poliry numDer are: n �/— Certier. � PoIlryNumber. aW�J — �Z-� (Tlris sectlon need not be canplefed /l Me permi( fs va/uetl et one �undred dWl ($ f00) or Ieu.J ❑ I certlty that in Ihe pedarman ol lhe ork for ich tNs pe it is issu , I shell not employ any persan In eny manner so as to berqme sub�ect to the workers' compensatlon laws ot Cellf r la, entl ree t�a tl I s�ould b come su ct to the workers' compensetlon pmNsions oi Section 3700 of tha Lebor Code, I shall fonhwlth comply with these provislo s. /¢QJ Applicant Sipnoture: Date: Gl `� �— v — WARNINO: FAILURE TO SECURE WO KERS' PENSATION COVERAGE IS UNUWFl1L AND SMALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES ANO GVIL FINES lIP TOONE HUNDRED T1KKISAND DOLURE (E100,000). IN ADDRION TO THE WST OF COMPENSATION, DAMAGES AS PROVI�ED FOR IN SECLION �]OB OF TME LABOR CODE, IMEREST, AN� ATTORNEI"S FEES. LICENSED CONTRACTORS DECLARATON: I horeby aHirtn Ihat I am Iice tl untler r vLs C apter 9(commendng wlt ectlon 7000) ol Oivlslon 3 0l Ihe Business and Professlons Cotle, end my Iicense is in lull torce end eHect. Lic. p ae� a � G- '? 9 Contreaols Signewre: Data: i/— 1 �_cl�ci CONSTRUCTION LENDING AGENCV: ❑ I heroby aflirm ihat ihere is a construction lentling agency for the peAormence of the work br which this pormlt Is issued. (Sec. 3097, Civll Code). Londers Neme: Lentler's AOtlress: Signeture: OWNER-BUILDER DECLARATONS: oate: I hereby aHlrm Ihet untler penalry ol per�ury Ihai I am E%EMPT FROM THE COMRAC70R5 LICENSE LAW lar t�e following reason (Sec. 7031.5, Business entl Professions Code: Any ciry or counry whic� requires e pertnit ro canstruct, elter, Improve, demolish, ar repeir eny structuro, pdor to its issuance, elso reQuires Ihe epplicant for such pertnit to tile e signed slatement that he or she Is Ilcensed pursuant to Ihe provisions ot t�e Contraclors Llcense Lew (Chepter 9(commendng wit� Sectlon 7000) ot Dlvislon 3 ot Ne Business entl Prof855i0n5 Code) or thet he or she is exempt lherefrOm end Ihe besLs bt Ihe ellaged B:emptlon. Any violelion af Sectlon 7031.5 by eny eppliwnt Por e pertnit sublecis the applicant to a civil penelry at not more than frve hundred ddlers (E500).J: ❑ I, es owner of the properry, or my employees with wages as thelr sole compensation, WILL DO THE WORK, antl the structure is not Intentletl or otteretl for sale (Sec. 7044, Business and Prolesslons Code: The Contractors License Law does not apply to an owner of DroDerty who builds or improves thereon, end who does such work himself or hersetl or Ihmugh his or her own employees, pmvitled that such improvements are not intantled or oflered for sale. If, however, ihe bullding or improvement Is sold wit�in one year oi comple�ion, the owner-builder will have the burtlen of proving that he or she tlitl not build or improve for purpose ol sele.). ❑ I, as owner of the praperty, am E%CLUSIVELY CONTRACTING WITM LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Cotle: TTe contraqors Ucense Lew does noi appry to an owner ol propeny who builtls or improves thereon, and who croniracts tor such pro�ect with e contredor(s) license pursuant to the CoNreciors License Laws.). ❑ I em exempt under sac. Business antl Protessions Code tor this reason: Signeture: Date: Owner ID veriliad by driver5liCensa. ❑ Ves ❑ No Dnvels License No. Expires: Vedlication of Ownership by (type ol AxumeN, i.a. - pmperry tex bill or deed): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby cenity thet no excaveilon flve (5) or more faet in depih into which a pereon Is required to descend, wlll be mede In connection with work euthorize0 by ihis permit, and that no building strucWre, sceHoltling, falsework, or demolitlon or dismaniling t�ereol, wlll be more ihan thirty-six (38) leet hiph. (Chep. 32, Gry 2, Art 2, Sec. 341, Title B, Calilomia Atlminisimtive Code). ❑ As owner-builtler, I will not employ enyone to do work which would require e partnit fram t�e Oivislon ol Indusirial Selety, es notetl eDove, unless such person hes e pormit to tlo such work Irom Ihe tlivision. Signeture: Date: Dlvlsion ai Intlustrial Sefery Permit NumDer: COOE 1. INSPECTIONTYVE 1876 Fixetl System Final Fire Preventlon 1266 200 Pool Spe Final Final Re-Root 201 FIneI8locWRetaining Well 202 Flnal Fectory Fira Place 203 Final Sign 204 Final DemoliUon Bdg II�lELS L- -oo �L�- CODE� �xsvernoNTrae 206 Finel Mnchenicel 20B Finol Plumbing 210 Finel Elocirlcel 272 Finel Fire Prevention 220 Finel Plenning Appmval 222 Final Slte 250 Final Bulltling/Oaupanc/ �4]i�C1luGlkl (714) 754-5273 • Fex (714) 754-4856 • www.ci.costa-mesa.BUILDING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 372 E 20TH ST Suite: Vicinity: RESIDENCE 8 ATTACHED GARAGE Parcel Number: 42623117 npp�icant: MILLER, DAVID Address: 3027 ROYCE LN Zoning: Phone: (949) 631-1924 COSTA MESA, CA Zip: 92627 Owner. �NBiRf JACOBS, JAMES A 6 MIQCIE A Address � COSTA MESA,CA 372 E 20TH ST #� Contractor: ORANGE COAST ROOFING Address: 3027 ROYCE lN COSTA MESA, CA Zip: 92627 Arch : Address: Phone: Zip: 92627 Phone: (949) 631-1924 License: 434674 Eng: Address: ISSUED BY: Status: ISSUED Applied: 71/27/2000 Issued: 11/27/2000 Phone: Phone: Zip: License: License: SCOPE OF PERMIT REROOF: T/O, 7Ii6" OSB SHTG, 1 LAYER 151t FELT, APPLY 30-YEAR GAF COMP SHINGLES. 26SQUARES Plan Check: $0.00 Permit: $125.25 SMIP Res: $0.60 SMIP Com: $0.00 Othec 50.00 Inspection: $0.00 Total: $725.85 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 Pr000sed: 0 Calc Valuation: Claim Valuation: Right 0- 0 Right 0- 0 ss,000.00 ss,000.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and relatad regulations. (Ord. No. 9248, § 1, 1241-92) 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. INSPEC710NS: In order for the work authorized under this permit to be considered legal, such work must comply wNh all applicable codes, and ell raqulred Inepeetions end Iinel approval must be obtained. Failure to obtain inspections and final approval will result in tha expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 264&CB (8/00I WORKERS' COMPENSATION DECLARATION: I hereby aHirtn under penalry of perjury one of the tollowinq declaretions: ❑ I heve end will maintain a certificate of consent to setf-Insure tor workere' compensetion, es providetl for by sectlon 3700 oi the LaDor Code, tor lhe peAortnance of the work for which this pertnit is luued. � I have antl win maintain workers' com nsation insurance, as required by sectlon 3700 of Ne Labor Gode, for Ihe pertortnance ot ihe work tor which this pertnit is issued. �fv1y woAcer� or3np_e�n tion Insuren rner an olicy number are: q Cerrier. /Y�I PolicyNumber: iJ �S^� �,i� (This secfion need nof be campletetl il the permit is valued at one hundred tlollers ($100) or /ess.) ❑ I cenify ihat in the peAor nence of e w�Ic for which this pertnit is �ued, I shell not employ any person in eny manner so as m become subject to iha workers' compensatlon laws o1 C Iltomla, tl ag ea t�et tl I �ould becom sub�ect to the workers' compensetion pwvislons ot Sectlon 3700 oi the Labor Code, I shall toRhwlih comply with Ihese pro is ons. Applicant Signature: Date: �� — �. �% ' `% � WARNIN�: FAILUFE TO SEW S' M ATIIXJ COV GE IS UNLAWFUL AND SHALL SlIB1ECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE HUNDRED TFKKI$AND OdlARE (51 W, , IN ADDRI TO THE CQST OF WMPENSATION, �AM�iES AS PROVIUED FOP IN SECTION 3]O60F THE tABOR CODE, INfEREST, PND ATTORNEI^5 FEES. LICENSED CON7RACTORS I hereby ettirm thet I em Ilcen: force end ettect. Lic. a CantrectofsSigneWre: � Chapter 9(comm � g with Section 7000) ol Divislon 3 of Ihe Buslness and Prol @s�sions Code, and my Iicense Is in full _ aess a `i S ¢i _ Date: � /- 27 — �%'� CONSTRUCTION LENDING AGENCY: ❑ I hereby eHirm Ihat there is a consimction lentling agency for �he peAormance of the work br which ihis permit is issuetl. (Sec. 3097, Civil CotleJ. Lentlels Name: Lentler's Adaress: Signature: Da�e: OWNER-BUILDER DECLARATIONS: I hereby eflirm Ihet under penalty at perjury thet 1 am EXEMP7 FROM 7HE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business entl Professions Cotle: Any ciry or counry which requires a permit to consiruct, alter, improve, tlemolish, or repair any siructure, prior to its Issuance, elso requires the eOD�icant for such pertnit to file a signetl statement that he or she is Iicensed pursuant to the provisions oi Ihe Contrectors License Law (Chapter 9(commencing wilh Section 7000) ot D'Msion 3 ot ihe Business end Profeuions Code) or that he or she is exempt lherefrom and ihe basis for the elleged exemption. Any violation oi Section 7031.5 by any applicant for e pertnit subjects Ihe applicant to e civil penelry of not more than five hundretl Collars ($500)J: ❑ I, es owner of the property, or my employees with wages as their sole compensation, WILL DO T1E WORK, ana the siructure Is not intended or oHeretl for sale (Sec. 7044, eusiness and Pmfeuions Code: The Gontractors License Law does not apply to an owner of property who huilds or impmves theraon, antl who tloes such work himseN or herself or through his or her own employees, provided thet such improvements ere not Intended or oflered for sale. If, however, Ihe building or improvement is soltl wit�in one year ot completion, ihe owner-builder will have ihe burden of proving that he or she did not build or improve for purpose ot sale.). ❑ I, as owner of the property, am E%CLUSIVELV CONTRACTING WIT}1 LICENSED CONTRACTORS to consWct ihe project (Sec. 7044, Business and Profeuions Code: The comrectors License Lsw does not apply to an owner of pmperty who builds or Improves thereon, and who contracts for such project wlth e contractor(s) license pursuant to the Contractors License Wws.). ❑ I am exempt untler sec. Siqnatura: Owner ID veritied by tlnvef5license. ❑ Y85 ❑ No Business antl Professions Code tor this reeson: Veniication ot Ov.•nership 6y (rype of document, i.e. - property tax bill or tleetl): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: Drivefs License No. Da�e: Expire5: ❑ I hereby certify that no exwve�ion tive (5) or mora teet In dep�h Into which e person is requirad to descentl, will be made In wnnectlon with work euthonzeC by thls pertnit, end that no building stmcture, scaftolding, talsework, or tlemoll0on or dismantling ihereol, will be more ihen thirty-six (36) teet higR (COap. 32, Grp 2, Art 2, Sec. 341, Tl�le B, Celifomia Admini5irative Code). ❑ As owner-builder, I will not employ enyone lo do wurk which would require e permit from the Division of Intlus�riol Safety, as noted ebove, unless such perwn has e permit to do such work irom the division. Signawre: Date: Division of Intlustnal Safery Permi� Numhec CER71FlCA7E OF COMPLJAN E AND AIfTMOR1ZA710N OF E Y: I certify under penalty oi perjury that I have read this application and stete that the information given is correct. 1 egrae to mply wlt all state laws antl ciry ordlnance eleting to Duilding constmction, and euthodze represen�atives of the Ciry of Costa Mesa to enter upon the above-descnbed pr�perty br i�pectiar� purposes. I egree not t cupy or allow occupancy of eny builtling euthorized by Ihis permit until final inspection. Legel wner(s) Date n �l-2..'7-�v-'i idvwA Aoo nl 02�8 COUE I. INSPECTIONTYPE 1616 Fixetl System Final Fira Prevention 1266 Pool Spe Final 200 Finel Re-Root 201 FIneI BIocWReteinlnq Well 202 Final Factory Fire Place �g �§ !z -a� .��- EQQ� INSPECTIONTYPE 206 Final Mechanicel 208 210 212 220 Finel PIum6ing Flnel Electrital Flnal Fire Prevention Finel Planning Approval 203 Finel Sign 222 Final Site 204 Final Demalition 250 Final BuildinyOccupancy �II I�� I� 0 � CI7Y oF cosrA I� �a CNST��R�UC�G.ION PEf'iMIT'/ Project A�ss S �•' �'V 1 ! Applir.2nYs Mailin A dress � 3 //�'/ � Owner's Name � Phone 3J -/9�/ Address � ✓�7 F Arch/Eng. Licens¢ No. Address �� ., Convactor's Nam "' / y � � � � PhoneL-«�Z=� Address�mailingl�5?3 ,E--�� itlA��Gr/YI City License No. ��.�� LICENSED CONTRA�TOR DECLARATION I bereby affi�m that I am Ilcensetl untler provislons of Charter 9(commencing witM1 section ]000) ot Dlvision 3 of the Business antl Professions Cotle, antl my Iicense is in tun to ce a a ettect. 2� � L�7 Licens Class � ' t �icense e. Date � ��-�7 Si9naturq• � �-/�'`�%'�y WORKERS' COMPENSATION DECLARATION 1 hereby atfirm tha[ I have a certificate of cOnsent to self-insure or a Cortificate of Workers' Compensation Insurance, or a certifiee copy tnereof (Section 'eoo, �ab. cJ �,/�:5�� 3c,v��e�r' 1/�J.i. dicy No. Y Company Ll Certitietl F�o�py I5 hletlrywithrthehctly iltlln O visi Da[e �-/`�' -�� APPIi[an��ry�/� �� E%EMPTION FROM WORKERS' COMPENSATION DECLARATION (Thi55ectiOn neetl ml be comple[¢tl if the pBrmit is br One huntlretl (5300) or less). I certity that in the p@rfo�manGe Ot tM1e wo�k fo� wMth this pe�m�t is i55uetl, I shall mt employ any pe�son in any manner 50 as [o become subjeG[ to tne Workers' Compen5alion Laws ol Calitornia. Date Signature NOTICE: If. after mak�n9 ihis tleUaration, you shoultl bewme subiact to the Workers' Compensa[iOn provlsions of the Labor Cotle, you must Porthwith comply wilh such O�ovl51on5 0� this permi[ shall be tleeme0 revoketl. CONSTRVCTION LENDING AGENCV 1 hereby atfirm [hat there Is a construction lentling agency tor the perbrmance Of tne work tor which this permit is izsuetl (Section 3097- Civ. CJ Lentltr's Name LB�1dC�'S AUdf255 OWNER BUILDER C�ECLARATION I bercby atfi�m that I am exemP[ fiom the ConlraCtot's LlcenSe Law tor fhe following reason (Sectlon ]031.5 Business antl Protessional Cotle: Any city or county wM1ich reqWreb a p¢rmit to construct, alteq improve, tlemoli5h or repair any s[ruclure, prlor tp its Issuance, also requires the applicant for such permi[ to /ile a signetl stateTent that he/she is licensetl pursuant to th¢ provi5ion5 of the Contractor'z License Law (Chapter 9(commencing with Sectlon ]Oo0) of Division 3 ot the Buslne55 antl Profe55ion5 COtl¢) o� that he/she is exempt theretrom antl the bdsis for [he alleqetl exempHon. Any vlolation oi Section 7031.5 by any ap0�itant tor a pe�mit subject5 the aOP��ant lo a civil venalty o( noi more lhan five huntlretl tlollars (5500). ❑ I, as owner ot [rye p�opErty or my employees with wa9es as Ihair sole compensation, will tlq tne work, antl the structure is not intentletl or of(eretl IOr sal¢ (Sec[ion 70C4, gusiness antl P�ofessiOnal Cotle: The Contracto�'S LicenSe (2w tloes not apply to an owner of a ploperty who builtl5 OI Implove5 lhereon, antl who tloes sucM1 wo�k himself/hcrsolf or tM1rough his o� her own ¢mployees, provitletl that such improvem¢nts are nOl mtentletl Or ofteretl for sal¢. If, M1owever, the bulltling or Improvement Is soltl within one year ot com- . o�e��on, the owner wiii have tne burden ot provin9 he/she tlitl not bulltl or im- I prove fOrthe purpose plsale). ❑ I, as owner o( the property, am extlusivaly contracting with licenseq con- t�aclorz to construct Ihe projett (Secfion 7044, Busine55 antl Prote55ions Cotle: The ContracrorR License Law aoes not apply to an owner o( property who builtls or improves lpereon, antl who con(racts tor such prolects wl[n a mn- tractor(sl licenze pursuant to the Contractor's License Law�. I am aware lhat prqof of [hei� Work(�'S Compensation insuranc¢ shoultl be providetl to me. ❑ I am exempt untler Sectlon B. & P. C. for tbis reason Date Owner 1 nereby certify tnai I have reatl this applicatlon antl state that the above Inibrmation is correct. I agree to comply with all city antl county ortlinances antl state laws relating to builtlin9 conztructlon, antl hereby authorize repre- sentativos of is ci(y to enter uypnn n the above-mentionetl property for inSPection pr�5g�� L�.� . / /�_�'� Siqnature N ) /I ��yX/J/ oate Drivers' L 55 .� �' � . ..�.�liln all sOaces exee0t t0ose within nea�y borEer tines anE Si9n all apProO/�ate tleclara[ians. _. . ..a 9 a8's _. . - -- - �,... ..�. TYPE OFCONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER q,p,# DESCRIPTION OF WORK/USE OF BLDG. - S Main Buildi E TVPEOFPEHMIT GRADING�.�/FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL L� PLUMBING ❑ MECHANICAL B Rear ❑ OTHER Q PROJECT DESCRIPTION 54. Fr. OCCUPANCv C Right CONSTRUCTION TYPE VALUATION 5 S Left ZONE GRADINGCU.VDS. ACRES PIng.Ref.# Remarkz: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service �ULIEIS Kitchen Sink Lavatories � ?—Trap Roof Drains Reinspectian Fee $15 Boiler Duct- Under Ground Duct - Structural Duct - Ventilacing Ezhaust System ❑ MWtipl¢ � FirepVFact Blt. ICBO # Heating System & Ducting ❑o-i oo,000 eru Oiao,000 er Reinspection Fee � $15 CMF 0865-46, rev. 30/84 White - Builtling; Canary � Applicant; Pink - Accounting: Goltlenrotl - Assessor Showers Servite Sink Sewet Cap Sewer Connection Solar Collecmrs Solar Piping Solar Tank Swimming Pool w/Spa Urinal warer Closet Water Heater Water $ervice Auto�Wash LaundrY Trays Isue Fae Hood or Type I ❑ COnOpy Type I I ❑ Re(rigeration System ❑0-100,000 BTU ❑100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee FEES Automa[ic Washer Construction Pole Sub. Cooking Unit Dryers LJGas LJE Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generamr �0�5 KN lectric 17aE 7/' _; _" Zone • Accessory Building: Z O N 1 N G R Parking Req./Provided E Q M T ___ S ELEC7RICAL Transformer � 75-50KW ❑ 50+KW Meter ❑up to 700 amps Meter ❑over100amps Sub Panel Motors �0-1 HP 01 %- 8 Inc.Solat 09�15 HP �16-75+ Microwave Pole Light 5-15 KW Sign Standing Sections Trash Compactor $ 3 I �-9- Reinspection Fea $15 Issue Fae FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Appliption Issued By / $ 3 FEES 3 3 SUMMARY OF FEES - BUILDING PERMIT $ SMIP $ PLAN CHECK $ � PERMIT PLUMBING g �SSUANCE $ _ PLAN CHECK 25% 5 � ENERG� P.C. 5 ELECTPICAL $ GRADING B PLAN CHECK 50% $ MICROFILM 5 f MECHANICAL $ TOTALFEE $ �•�� P�AN CHECK 25% $ CONSTRUCTION AND PLANNING POOL & SPA APPROVALS Permit# Date Inspector AppROVALS Permit_#. Date Inspector 1. Temporary Electrical Service or Pole 52. 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.�est 6. Electrical UFEF Grnd� 57. APPROVAL TO COV�f7-GUNITE 7. Footings 58. Electrical Conduit-UndYgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd:, Te'st' 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P�Trap, �!Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK ;;,) 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Finel 12. Sewer Cap 63. Heater & Vent-Final , 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Elecvical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing &�Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # - 21. Ducts,in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72, Underground Flush � 24. Roof Framing , 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing � 74: Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical � � 27. Frame and Flashing 76. Dry Standpipe . 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test . . � 36. Hood or Canopy 1 37. Final Factory Fireplace � 38. Final Plumbing . 39.�Water Service�Final 40. Gas Service-Final � 41. Solar pomesticFinal � � 42. Backflow Preventer . 43. Backflow Irrigation 44. Landscape Irripation System 45. Sound Attenuation 46. Handicap Regutations . 47. FINALSTRUC7URE&BUILDING 48. Special Requirements Completed 49. Electric Release to Edison , J 50. Gas Release to Southern California Gas Co ,% 51. CERTIFICATE pF OCCUPANCY No. Date _