The URL can be used to link to this page

Home My WebLink About379 20TH ST - Building Permits♦ (714) 754-5273 • Fax (7/4) 754-4856 • www.ci.costa-mesa�p�DING PERMIT 77 FAtR DRIVE, COSTA MESA, CA 92626 Job nddress: 379 E 20TH ST Suite: Vicinity: KITCHEN PrimaryOcc: R3� Parcel Number: 42630407 Applicant: VAN ROOYEN, REAAN Address: 379 E 20TH ST COSTA MESA, CA Owner: VAN ROOYEN, REAAN Address 379 E 20TH ST COSTA MESA, CA Type of Construction: V-N Zoning: Comracror: O W N ER-BU I LDE R Address: Zip: Arcn : FRED Y DONG Address: DONGASSOCIATES SANTA ANA, CA Phone: 714-724-2716 3201 W WARNER AV � Zip: 92704 License: C7517 Phone: 949-2�9-7271 Zip: 92627 Phone: 949-279-7271 Zip: 92627 Phone: License: 000000 Eng: Address: SCOPE OF PERMIT DEMOISH EXIS7ING KITCHEN AND RECONSTRUCT 458SF KITCHEN. DRIVEWAY: 2,235 S� FT GARAGE: 625 Sp FT EXISTING BUILpING: 1,104 SQ FT , ADDITION: 485 S� FT LOT COVERAGE: 54 % Plan Check: $372.81 Permit: $573.55 SMIP Res: �4.23 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $950.59 SETBACKS MAINSTRUCTURE Fron� 20-0 ACCESSORY Front 0- 0 PARKING Existin : � FEE SUMMARY PLANNING & ZONING Rear 61-0 Left 31-0 Rear 0- 0 Left 0- 0 Required: 4 Proposed: 4 ISSUED BY: Calc Valuation: Claim Valuation: Right 16-10 Right 0- 0 Status: ISSUED Applied: 12/202005 Issued: 02/i6/2006 Phone: License: $42,319.20 So.00 . ��/ NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. g2-28, § 1, 12-21-92) / EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or i(((;�rrr��cccis suspended or abandoned for a period of 1 BO days. / / INSPECTIONS: In order for ihe work authorized under this permit to be considere d lega l, suc h wo r k mus t comp ly�vnt h a l l epp lica b le co des, and ell requlred Inepeetione end flnel approval must be obtained. Failure to obtain inspections and final approval will resuA in the expiration ot this parmit. FOR INSPECTIONS CALL: (714) 754-5628 26a6-48(8/00) WORKEqS' COMPENSAT�ON DECLARATION: ' � . I hereby e@irm untler penalfy of perjury one of the following tleclarations: ❑ I have entl will maint9�n e ceniticete oi cronsent to seli-Insure lor workers' compensetion, es provitled tor by section 3700 of ihe Labor Cotle, for the pertormance of the work far w�ich this pd�it is issued. ❑ I have antl will mainta�n workers' compensation insurance, as requlretl by section 3700 of the Lebor Code, lor Ihe petlortnance of Ihe work for w�ich [his permit is issuea. My workers' compen5alion Insurence carner entl pollcy number are: Carrier: et one hurrdred dollers ($100) or less.) Policy Number: p� I.cetlily`ihat in the peAortnence of ihe � f hich this permit is issued, I shell not employ any peBon in eny manner so as to become subject ro the workers' compensation laws o� Californi r igt if I should become sub�ect to the workere' compensatlon provisions ot Section 3700 oi the Lebor Cotle, I shall forthwith � comply with ihese pr0`risi � s �� / AppttcaNSignaWr�-e:-� � fDate: / � - ��n- �I� WARNINp^FA�CUREiOSECUP WORKERS'COMPENSATI GEISUNLAWFULPNDSFULLSUAIECTANEMPLOVERTOCRIMINALPENALTIESANDCNILFlNESUPTOONEHUNDRED hIOUSAND DOl1ARE (5100.000)� �N ADDITION TO THE WST OF GOMPENSATION, �NAAGES aS PROVIDED FOR IN SECTION 3'1O60F THE UBOR CODE, IMEPEST, AND ATTORNEV'S FEES. LICENSED CON7RACTOqS DECIARATON: I hereby aXirm Ihat I am lic�nsed untler provisions ot Chap�er 9(commencing with Section 7000) of Division 3 of the Business antl Professions Code, antl my license is in full torce antl eHect. Lic. # Class a ContractoYs Signature: Date: CONSTRUCTION LENDING AGENCV: ��. ❑ I �ereby aflirm Ihat there is e construction lending agency for Ihe pedormance of the work lor which this pertnit is issued. (Sec. 3097, Civil Cale). Lenders Name: Lendefs Atldress: Signa�ure: Date: OWNER•BUILDER DECLMATIONS: I hereby attirm thet under penalry ot perjury ihat I em E%EMPT FROM 7ME CONTRAC70RS LICENSE LAW lor the following reason (Sec. 7031.5, Business and Professions Code: Any ciry or county wpich requires e permit to construct, elter. Improve, tlemolish, or repair eny SlrucWre, prior to its issuance, also requires t�e applicaN for such pertnit to file e signed stetement tPat he or she is Ilcensed pursuant to the provisions of the Cantractors Licensa Lew (Chapter 9(commencing with Section 7000) oi Division 3 of the Busin s antl Professions Goda) or Ihat he or sha is exempt I�erefmm antl the �asis for tha allegetl ezemption. Any violation ol Section 7031.5 by any epplicant tor a pertnit su t� applicant to e G��I penalry of not more ihan tive �undred tlollars ($500)J: � �as owner of the pro0erty, or my employees wlth wages es Ihelr sole compensation, WILL DO THE WORK, end the simcture is not intentletl or ottered for sale (Sec. 7044, eusiness and Professions Code: The Contractors License Lew does not ep01y to an owner of propeny who builds or improves thereon, and who does such work himsetl or herself or Ip�ough his or her own employees, provi0etl that such improvements are not intended or oHeretl for sale. tl, however, the builtling or improvement is sold within one year o� complalioq the owner�builtler will have Ihe burtlen ol pmving that he or she ditl not build or improve for purpose of sale.). ' ❑ I, as owner ol Ihe pmperty, em EXCLUSIVELV CONTRACTING WITM LICENSED CONTRACTORS to constmct the project (Sec. 7044, Business and Profession5 Cotle: The coniractor license Law does not epply to en owner of proparty who builtls or Improves Ihereon, end who contracts for such project with a contractor(s) license pur§uer�l 0 Coniracbrs License Lews.). �=.`am��er sea Business antl Professions Code for ihis reason: �Signature. �'%f""+-. i 'Owner ID vanfied by driver'S1ic�se. ❑ Ves ❑ No LDriver'9 License No.- Verification ot Ownership by (�ype of document, i.e. � propeny Iax bill or tleed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby cenily that no excavetion five (5) or more feet in tlepN into which e person is required ro tle5centl, will be matle in connection with work authonzetl by this permit, and thet no 6uilding simcture, scaHolding, lalsework, or tlemolition or dismaNling Ihereol, will be mora then �hitly�six (36) feet high. (Chap. 32, Grp 2, An 2, Sac. 341, Title 8, Cali�omie Atlminlsirative Code). ❑ As owneo-builtler, 1 will not employ enyone to do work which would require e permit trom the Division ol Indusirial Safery, es notetl above, unless such person hes a permit to do such worN from Iho division. Signature: Date: Division ot Industrial Safety Permit Number: CERTIFlCATE OF COMPLIANCE ANqAU�HORIZATON OF ENfAY: I cenity under penalry of perjury ihat I have read ihis application and state that the infortnation given is cortect. I agrea to compty w��h �I�at ws and ciry ordinences releling to Duiltling consWction, antl authorize representatives of t�e Ciry of Costa Mesa to enter upon Ihe ebove-described pmpetly fo sUec � puRwses. I egree not to occupy or ellow occupancy ot any buildinq authonzed by this permil until final insDection. ��_--- ? - i 4. - �� r� �SyneNre Of L al Owner(s) 1DNe �- ��- � 7 -li,-vL GOUE �. INSPECTIONTYPE 1616 Fixetl System Final Fire Prevention 12fi6 Paal Spa Final 200 Finel FB-Root 201 Finel BIocWRelaining Well 202 Finel Fectory Fire Place 203 Final Sign 204 Final Demolition Q/yjE - �$ �� INSPECTIONTYPE 206 Final Mechanical 20B Final Plumbing 210 Fina� Electriwl 272 Finel Fire Prevention 220 Fina� Planning Approval 222 Final Site 250 Finel BuilUincyOccupancy P�SF I/� LR1�Lfl (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mes��TRICAL PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: Suite No Vicinity: Parcel Nunmber: ApplicanC Address: Owner: Address Contractor: Address: 379 E 20TH ST 42630407 VAN ROOYEN, REAAN 379 E 20TH ST COSTA MESA, CA VAN ROOYEN, REAAN 379 E 20TH ST COSTA MESA, CA OWNER-BUILDER Phone: 949-642-7575 Zip 92627 Phone: Zip: 92627 Phone: Zip: License: 000000 ISSUED BY: ' SCOPE OF PERMIT � DEMOISH EXISTING KITCHEN AND RECONSTRUCT 458SF KITCHEN. REF.: BOS-02340 ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool / Spa Lighting Fixts Recept Outlets. ' Switches� � Non Res Appl Res Appl , Service to 200a Service to 1000a Service over t000a Motors to 1hp � Motors to 10hp � Motors to 50hp Motors l0 700hp Motors over 100hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole Stams: ISSUED Applied: 04/26/2006 Issued: 04/262006 ELECTRICAL TO INCLUDE: '12 LIGHT FIXTURES, 14 OUTLETS, 6 SWITCHES, 1 MOTOR TO 1 HP, AND 1 SUB-PANEL TO 200 AMPS. � $23.50 $0.00 $0.00 $0.00 so.00 $0.00 513.20 $15.40 $6.60 $0.00 $0.00 $0.00 $0.00 $0.00 � $475 $0.00 $0.00 ` $0.00 $0.00 $0.00 $30.50 $0.00. $0.00 $0.00 $0.00 Quantiry 0 0 0 12 14 6 0 0 0 0 .0 1 0 0 0 0 0 1 0 � 0 0 0 FEE SUMMARY . Temp Dist System / Lighting Busway /100 ft --- Sfanding Section Misc Electrical Equipment Trans(ormers up to 1 kva/kw ................up to 10 kva/kw .................up to 50 kva/kw .................up to 100 kva/kw .:................over 100 kva/kw Low Voltage Equipment Low Volt Wiring System / Ckt Misa Conduit Misa Conductor � - - Circus ( gen or ride) Circus (mech ride or lighis) Christmas Tree Stand Fireworks Stand - Other Electrical Fee Investigation Fee Plan Check Fee Reinspection Fee duantiry $0.00 0 $0.00 0 $0.00 0 $0.00 0 so.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 so.00 so.00 $0.00 TOTAL CALCULATED FEES E93.95 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 1241-92) EXPIRATION: This permit shall automatically expire antl become void if work is not commenced within 180 days, or if work is suspended or abando en d 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 rAbes, and all required Inapectlons and final approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration oJ;t�iis permit. FOR INSPECTIONS CALL: (714) 7545626 zaaae (doo� WORKERS' COMPENSATION DECLARATION: 1 hereDy attirtn under penalry oi perjury one of the tollowing tleclarations: • - „ , ❑ I heve end will maintain a cartificate of consent b self-Insure for workers' compensation, es pmvided for by section 3700 of the Lebor Cotle, for iha pertormence of the worli for which this permit is i55uetl. ❑ I have end will mainfain workers' compensation Insurence, es requiretl by section 3700 of the Labor Code, for the pertortnance of the work for which this pertnit is issuetl. My workere' compensation Insurance carrier antl policy number are: , Carrier. Policy Number. (This section need nof be completed i/ the permit is valuetl at one hundred dollars ($100) or Iess.J ❑ I certity that in the pertortnance oF the work for which this permit is issued, I shall not employ any person in eny manner so as to become subjed to ihe workers' compensa8on laws of Califomia, and agree that it I shoultl bacoma subject to the workers' compensation provisions of Section 3700 of the Labor Code, I s�all forthwlth comply with Ihese pravisions. Applicant Signeture: �ata: WARNING FAIWRE TO SECURE WORKERS' CAMPENSATIdJ COVERAGE IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TO ONE HUNDRED THOUSNND DOLLARE ($100,OW), IN ADOITION TO THE CAST OF COMPENSATION, DANAGE$ AS PFOVIDED FOR IN SECTION 3]O60F THE LABOR CODE, INTEREST, AND AT70RNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirm Ihat I am licensed under provisions oi Chapter 9(commencing with Section 7000) of Division 3 oi Ihe eusiness and Professions Code, antl my license is in full force antl eNecL Lic. # Cless x Contrecmrs SignaWre: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby ettirm Ihat ihere is e constmction lendinq agency for Ihe pedormance of the work for which ihis permit is issued. (Sec. 3097, Civil Code). Lender's Name: � Lender'S Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hareby aMirm that under penalty of perjury t�et I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for ihe following reason (Sec. 7031.5, Business end Professions Code: Any city or counry which requires a permit to constmct, elter, improve, demolish, or repeir any stmcWre, prior to its issuance, elso requires the appticant for such permit to fila a signed statement that he or she Is Ilcansed pursuant to the pmvislons of Ihe Contrectors License Law (Chapter 9(commencing with Sectlon 7000) ot Division 3 ot the Business and Professions Code) or ihat he or she is e:empt therefrom and the basis for the elleged ezemption. Any violation of Section 7031.5 by any applicant tor a permit subjects Ihe applicant to a civil penalry of not more ihan five hundred dollers ($500).): ❑ I, as owner of ihe property, or my employees with wages as their sole componsa�ion, WILL DO THE WORK, end the stmcture is not intentlad or otteretl for sale (Sec. 7044, Business antl Professions Cotle: The Contrectors License Law tices not apply to an owner of properiy who builds or improves thereon, antl who does such work himseN or herself or through his or her own employeas, providetl I�at such improvements are not intended or offered tor sale. If, however, Iha building or improvement Is sold within one year of completioq the owner-builder will have Ihe burtlen ot proving ihat he or she did not build or improve for purpose oi sale.). � ❑ I, as owner of Ihe property, em EXCLUSIVELV CONTRAC7ING WI7H LICENSED CONTRACTORS to construct the project (Sac. 7044, Business entl Professions Code: The con�recmrs License Law tloes not apply to an owner of property who buiids or Improves Ihereon, and who comracts lor such project with e contractor(s) license pursuant� theFontractors License Laws.). Business end ProfeSsions Code tor this reason: Owne� ID ventied by driver' se. ❑ Ves ❑ No Verification of Ownership y(type of tlowmem, i.e. - propeny tex hill or DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: No. - ❑ I hereby certity ihat no ezcavetion five (5) or more feet in depth into which a person is required to descend, will be made in connection wiih work authonzed by Ihis permit, and �hat no 6uilding sWCNre, scaHoltling, lalsework, or demolition or dismantling thereoi, will be more than �hirry-six (36) teet high. (Chap. 32, Grp 2, An 2, Sec. 341, Titla 8, California Atlminis[rative Code). ❑ As owner-huilder, I will not employ enyone to tlo work which would require e permit irom the Division oi Intlustriel Sefety, es noted ebove, unless such person hes a permit to do such work irom the division. Signature: Date: Division of Intlusirial Sefety Permit Numbec CERTIFICA7E OF COMPLIANCE AND AUTHORVA710N OF EMRY: I certi(y under penalty of perjury that I have read this application and state iha� ihe intormation given is correct I agree to comply with ell st ws city ortlinances relating to building construction, and authonze represenia�ives ot the Ciry of Costa Mesa to enter upon the above-descn6ed pmperty tor in n p es. I egree not to occupy or allow occupancy of any building authonzed by Ihis permit until final inspeIXion. y/" 06. �SignaWia Of Legaf er(s� Cf I�Date'�"� . -; �.._"' __' _ And/OrAu�honzad Applicant " �f Date cooe., iNsvecnoNmre 1616 Fixed System Final Fire Prevention 1266 Poal Spa Final 200 Finel Re-Rool 201 Finel BIocWRetaining Wall 202 Final Factory Fire Place 203 Final Sign, 204 Finel Demolition _ , � IMRULS COOE 1 INSPECTION TYPE 206 Fin21 Mechanical � 20B Final Plumbing 210 Final Elecincal 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy o"re � / i G7, �il:' (714) 754-5273 • Fax (774) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job nddress: 379 E 20TH ST Suite No Vicinity: KITCHEN Parcel Number: 42630407 Applicant: VAN ROOYEN, REAAN Address: 379 E 20TH ST - COSTA MESA, CA Owner: VAN ROOYEN, REAAN Address: 379 E 20TH ST COSTA MESA, CA Contrector OWNER-BUILDER Address: MECHANICAL PERMIT Phone: 949-279-7271 Zip: 92627 Phone: Zip: 92627 Phone: Zip: License: 000000 ISSUED BY: Status: ISSUED Applied: 02116/2006 Issued: 02/i6/2006 SCOPE OF PERMIT MECHANICAL PERMIT TO DEMOISH EXISTING KITCHEN AND RECONSTRUCT 458SF KITCHEN. REF#:BOS-02340 WORK TO INCLUDE: 1 GAS PIPING, 1 HOOD W/MECH EXHAUST, 1 VENT FAN/SINGLE DUCT AND 2 DUCTS. ISSUE FEE Inst FAU <100 k BTU Inst FAU >100 k BTU Repair/Alt Cooling/Heal Insl / Rep. Recess Wall Htr Refrig Sys <100 k BTU Refrig Sys >100 k BTU Gas Piping Factory Fireplace Hood w/Mech Exhaust VAV Box Vent Fan I Single Ducf Appliance Fire Dampers - Smoke Dampers Insl or Relocate Appl Vent Air Handlers < t0000cfm AirHandlers> 10000cfm FloorFurnace Floor or Suspend Heater $23.50 $0.00 $0.00 50.00 so.00 $0.00 50.00 56.15 50.00 $10.65 $0.00 527.75 $0.00 $0.00 50.00 50.00 50.00 50.00 $0.00 $0.00 Quanliry FEE SUMMARY Repair I Alt Absorblion Unit Repair / Alt Refriqeration Unit Ventillation System Evaporative Cooler Commercia l I ncin e rato r Domestic Incinerator Comoressors / Absorotion Svstems Upto3hpl100kBTU 3To15hp/500kBTU 15 To 30 hp / 1,000 k BTU 30 To 50 hp / 1,750 k BTU Over 50 hp / Over 1,750 BTU Boilers Uplo3hp 3To15hp 15to30hp 3010 50 hp Over 50 hp Other Mechanical Fee Invesligation Fee Plan Check Fee Reinspection Fee �uantity $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 50.00 0 30.00 0 $0.00 0 50.00 0 50.00 0 $0.00 0 so.00 0 $0.00 50.00 $0.00 TOTAL CALCULATED FEES 562.05 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authonzed by ihis permit shall comply with all applicable handicap access raquiremenis under California statutes and,related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspend. or,e ab ndoned for a period oi 180 days. v INSPEC710NS: In order tor the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred Inapectiona and flnel approval must be obtained. Failure to obtain inspections and final approval will result in the expiration ot this permit. FOR INSPECTIONS CALL: (714) 7545626 <aaanalaw� WORKERS'COMPENSATON DECLAqAnON: _ I hereby effirm u�der penalry oi perjury one of the following declarations: ' ❑ I have end N'ill maintain e certificate of consent to self-Insure for workers' compensation, as proNded for by section 3700 of (he Labor Coae, tor ihe peAormance of the work for which Ihis permit is issued. ❑ I have end will maintain workers' compensation Insurance, es requlred by section 3700 of the labpr Cotle, lor Ihe petlormance ol the work for which thi5 partnit is 15suea. My workers' wmpensation Insurance carrier antl policy numher ere: Carrier Policy Number. (Tl�,s secflon neetl nof be comp/efed illhe peimit /s velued et one hundred tlollars ($f 00J or /ess.) .��_I c0tlity Me� �� ihe pertormance of the work tor which this pertnil is issued, I shall not employ any person in any manner so as to become sublect to ihe worker5' compensetion lews ot Califom nd e ee thet If I should become subject to the workere' compensetion provisions of Section 3700 of Ihe Labor Cotla, I shell torthwith Comply with Ih85e provis' �� Apyiwnt.sipnamre:_�� .� ifJi—`7�— �Date: ��— �n- �� WAfiHINp:'fAICUflEdOSECURE WORKERS' COMP ATION COVEMGE IS UNIAWFUL AND SHALL SUBJECT AN EMPLOVER TO CFIMINAL PENALTIES ANO GVIL FlNES UP TOIXJE HUNDFED THOUSAND DOLLARE (5100.000�, IN ADDITION TO THE COST OF CAMPENSATIQY, DAMAGES AS PROVIDED FOR IN SECTION 3]O60F iHE IABOq CODE, IPlrEREST, AND ATTOPNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aNirm ibat I am licensed under provisions ot Chapter 9(commencing with Section 7000) of Division 3 of t�e Business and Protessions Cotle, end my license is in full force entl eflect. �ic. a Cless A Contractor's Signeture: Oete: CONSTRUCTION LENDING AGENCV: ❑ I hereby aHirm that there is a wnshucti0n lending agoncy for the pedormance ot the work }or which this permit is issued. (Sec. 3097, Civil Code). LentleYs Name: Lender's Adtlress: Signature: Date: OWNER-BUILOER DECLARATIONS: I hereby eMirm thet undar penalry of perjury that I am EXEMPT FROM THE CONTHAC70RS LICENSE LAW br Ihe following reason (Sea 7037.5, Business end Protessions Code: Any ciy of �unty which requires e pefmit to Construct, alter, improva, demolish, or repair any stmcture, prior to its i55uance, elso requires ihe epplicant for such permit to lile e signed sletement that he or she is Ilcensetl pursuanl to ihe provisions of the Coniractors License Lew (Chapter 9(commencing with Section 7000) of Division 3 at the Business and Prolessions Code) or that he or she is axempt therefrom and the Dasis for the ellegetl exemption. Any violetion of Section 7031.5 Uy any epplicant for a permit su_ ihe applicant to a civil penalry of not more �han five huntlred dollers (5500).): es ow er of Ihe property, or my employees with wages as their sole compensation, WILL DO TME WORK, entl I�e sWcture is not intende0 or oflered for 5ale (Sec. —7044,-Business end Professions Cotle: The Contracbrs License Law dces not apply to an owner ol property who builtls or impwves thereon, antl who does such work himself or nerself or ihrough his or har own employees, provitlea t�at such improvemenis are not intendetl or oMered lor sale. If, however, the building or improvement is soltl within one year of comD�etion, the owner-builder witl have Ihe burden of proving ihat he or s�e dld no1 build or Improve for puryose ot sale.). � ❑ I, as owner ot Ihe Oroperty, em EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to consiruct t�e project (Sec. 7044, Business and Profes5ions Cotla: The contrac�ors Lic se,6aw does not apply to an owner of property who builds or Improves thereon, end who coniracts tor such p�oject wllh a contractor(s) license pursuant to th� � o tqactors License Lews.). ❑ I am ezemplund c/ Business end Professions Code for this reason: Signature: � i _— — Owner'ID'veritied by tlrivers license. ❑ Yes ❑ No Drivers.LiCense No:' Vedfiwtion ol OWnership hy (type ol document, i.e. - property tax bill or tleetl): DIVISION OF INDUSTRIAL SAFETV PERMR CER7IFlCATON: ❑ I hereby ce�ify ihal no excavation flve (5) or more teet in depth into which a person is required to tlescend, will De made in conneqion with work authonzed by Ihis permit, antl lhat no building swcWre, sWNolding, talsowork, or tlemolition or dismantling thereol, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title B, Calilornia Atlministra�ive Code). ❑ As owner-builder, I will not employ anyone to tlo work which woultl requira a pertnit Irom the Division of Industriel Safery, as noted above, unless such person has a permit to dtl such work tmm Ihe division. Signature: Date: Division of Intlustf�al Safety Permit Num6er: CERTFICATE OF COMPLIANCE AND AUTMOA�nON OF ENTHY: I ceniy untler penalry ol perjury thal I have reatl Ihis application and state Ihat the informetion given is correct. I agree to �p�y with all state s aM cily ortlinances relating w buildi�g construction, and authodze �epresantatives of the Ciry of Costa Mesa to enter upon the ebove-tlescnbed property tor insp�tion es. I egree not to occupy or allow occupanty of eny building euthorized by this pertnit until final inspection. �Jv'r 7 - .I6-=�G. Si9neture Of�Cegal LDate—d And/Or Authorized Applicem Date CODE 1. QISPE4Il4fiIYPE P� INTRIALS 1616 Fix80 SyStem Final Fire PreVention 1266 200 201 202 203 Pool Spa Final Final Re-Root Final BIaCWRetaining Wall Final Fac�ory Fire Place Finel Sign 204 Final Demoli�ion CO�E 1 INSVECTION TYPE 206 Pinel Mechanical ' 208 Flnal Plumbing 270 Finel Eleclrical 212 Final Fire Prevention 220 Final Plenning Approval 222 Final Site 250 Finel Building/Occupanry �111: � • . M�` (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa��MBING PERMIT �� FAIR DfiIVE, COSTA MESA, CA 92626 Job nddress: 379 E 20TH ST Suite No Vicinity: KITCHEN Parcel Nunmber: 42630407 App�icant: VAN ROOYEN, REAAN Address: 379 E 20TH ST COSTA MESA, CA Owner: VAN ROOYEN, REAAN Address 379 E 20TH ST COSTA MESA, CA Contractor: OWN ER-BU ILDER Address: Phone: 949-279-7271 2ip: 92627 Phone: Zip: 92627 Phone: Zip: License: 000000 SCOPE OF PERMIT REVISED PERMIT TO ADD 1 WATER HEATER AND 1 P-TRAP FOR WASHER. ISSUED BY: PLUMBING PERMIT TO DEMOISH EXISTING KITCHEN AND RECONSTRUCT 458SF KITCHEN. REF#:805-02340 Status: ISSUED Applied: 02/16/2006 Issued: 02/16/2006 WORK TO INCLUDE: 1 DISHWASHER, 1 GAS (1-4 OUTLETS), 1 SEWER CONNECT, 1 KITCHEN SINK. ISSUE FEE BaCkOow irrigati0n BackOow Preventer Bathtub Clarifier System Connect Qce,Soda,elc) Dental Units Dishwasher Drain, Floor . Drein, Rainwater � Drain, Root Drinking Fountain . Expansion Tank � Gas Earthquake Valve Gas (1-4 outlets) Gas (Over 4 outlets) Gas Repipe Gas Service Interceptors (Grease, Oil) Interceptors (Sand Auto ) AMT $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $9.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $6.15 $0.00 $0.00 $0.00 $0.00 $0.00 QTY 0 0 0 0 0 0 1 p , -.. 0 0 0 0 0 1 0 0 0 0 0 FEE SUMMARY AMT Laundry Tub / Washer $0.00 Landscape Irrigation $0.00 P-Trap $9.80 Pressure Regulalor � $0.00 Process Piping (per 10 ft) $0.00 Receplors $0.00 Septic Tank $0.00 SewerCapforDemo $0.00 SewerConnect $2a.65 Sewer Private Line $0.00 Shower $0.00 Sink, bar $0.00 Sink, commercial $0.00 Sink, Floor $0.00 Sink, kitchen 39.80 Sink, service/mop $0.00 Spa (privale) . $0.00 Spa (public) $0.00 � 0 0 1 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 COMMENTS / SPECIAL CONDITIONS Sump Pump Swimming Pool Trap Primer Urinal Vacuum Brkr BkFlow(1-4) Vacuum Brkr Bkflow(5+) Wash Basin Wash Basin Set Waste and Vent System - Water Closet (Toilet) Water Heater / vent Water Piping (Inst or Rep.) Water Re-pipe Water Service Water Softener OTHER VIOLATION PLAN CHECK REINSPECTION TOTAL CALCULATED FEES: AMT $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $12.30 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $O.Oo 596.00 QN 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) _ EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and tinal approval will result in Ihe expiration ot this permit. FOR INSPECTIONS CALL: (714) 75Y5626 zaafwe le�ool WORKERS' COMPENSATION DECLARATION: � � I hereby aRirtn under penalry of parjury one oi ihe toilowing tleclaretions: � , ❑ I heve and will maintain e certificate of consent ro seN-Insure tor workers' compensatlon, as provided for by section 3700 ot the Lebor Code, for the Dertormence of the work tor which this pertnit is issued. ❑ I have antl will maintain workers' compansation insurance, as required by section 3700 of Ihe Labor Cotle, fo� the peAormance of the work for which this permit is Issued. My workers' compensatlon Insurance carrier end policy number are: � Cartier: Policy Number: (This section need not 6e campletetl il the permit is velued af one hundred tlollars ($100J or /ess.) I certify that in the pertormance of.t e work tor which this permit is issued, I shail not employ any person in eny manner so as to become subject to the workers' ' �� compensa�ion laws of Cali enia nd agree that If I should become sublect �o �he woBers' compensation provisions of Sec�ion 3700 of ihe La6or Code, I shall forthwit� comply with these pro ' aris ,�,�� p ppw�ignature:--=� �f �uate:�_�Li �y.�-1 -�G� WARNING:FAIWRETOSEWREWORKERS'COI NSATIONCAVEAAGEISUNLAWFULANDSHALLSU&IECTANEMPLOVERTOCRI INA�PENALTIESANDCIVILFINESUPTOONEHUNDPED THOUSAND DOILARE (5100,0p0�, IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 31W Of THE IABOR COOE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aMirm that I am licensatl untler Drovisions of Chapter 9(commencing with Section 7000) ot Division 3 of ihe 8usiness and Protessions Cotle, ena my license Is in tull torce end eHect. Lic. N Cless q Comractor's Signature: Dete: CONSTRUCTION LENDING AGENCY: - ❑ I hereby aHirm ihat there is a construction lending agency for the pertormance of ��e work for which this pertnit is issued. (Sec. 3097, Civil Code). Lenders Neme: Lentler's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby eHirm thet under penelty of perjury that I em E%EMPT FROM THE CONTRACTORS LICENSE LAW for the foliowing reason (Sec. 7031.5, Business and Protessions Cotle: Any ciry or county which requires a pertnit to constmct, alter, improve, tlemolish, or repair any sirucNre, prior to its issuance, also requires the applicant tor such pertnit to file a signetl stetement that �e or she Is licensetl pureuent ro the provisions of the Comrectors License Law (Chepter 9(commencing with Section 7000) of Divislon 3 ot the Business end Professions Code) or Ihat he or she is e:empt iherefrom and ihe basis tor Ihe alleged exemption. Any violation oi Section 7031.5 by eny epplicant for a permit subjects ihe applicant to a civll penalry of not more then five hundretl dollars ($500).): ❑ I, as owner of the property, or my employees with wages as iheir sole compensation, WILL DO THE WORK, antl the stmcWre is not Intentled or oNered for sale (Sec. 7044, Business and Protessions Code: The Coniractors License Law does not apply to an owner of property who builds or improves Ihereon, and who does such work himsetl or hersetl or Ihrou9h his or her own employees, providetl that such improvements are noi Intended or oRered for sale. If, however, ihe building or improvement is soltl within one year oi completion, t�e owner-builder will have iha bwtlen of Droving that ha or she tlid not builtl or improve for purpose ot sale.). �� wner ot Ihe property, am E%CWSNELV CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business entl Pmtessions Code: The comractors License Law tloes not apply ro an owner of propeny who builtls or improves thereon, and who comracts for such projec� wlth a contractoqs) license pursuant to th�.Contractors License Laws.). ❑ I am ezempy+� ec. � Business and Professions Code for this reason: Sign�' at e� � _. .;�,�" -� mF•s< - Owner ID veniietl by tlnver's li sa. Yes ❑ No � Drivefs License No? � �__. _ Venfica�ion ot Ownership by (rype of tlocument, i.e. - property taz bill or deetl): �IVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certily that no axcavalion five (5) or more teet in depth into which a person is required �o descend, will be made in connection with work euthonzed by this permit, antl that no builtling swcture, scaflolding, falsework, or demoli�ion or dismantling thereot, will be more Ihan Ihirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 347, Title B, Califomia Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit trom the Division of Indusirial Salery, es noted above, unless such person has e parmit to do such work Irom �he division. SignaWre: Date: Division of Industnal Safery Permit Number: CERTIFlCATE OF COMPLIANCE D AUTHORVATON OF ENfFiY: I certity under penalty oi perjury ihat I have reatl ihis epplication and state ihat ihe information given is correct I agree to comply w al tat�'ws entl ci�y ordinances relating to building cons�ruction, antl authonze representatives of the Gry oi Cos�a Mesa to enter upon �he above-described property ' pe purposes. I agree not to occupy or allow occupancy of eny building authorized by ihis permit until final inspection. .. �/G � �M--/'%�r� 6ignature Of af(sj.i,R �-.�> .'+-: "' ( �'-tiDate_,.,_.,.a��t'"- �,;e.t� _,�.----' AnNOr Authorized Applicant Date CODE t. INSVECTIONTYPE � 7616 Fizetl System Final Fire Prevention 1266 Pool Spa Final 200 Final Re-Roof 201 Final BIocWRetaining Well 202 Final Factory Fire Place 203 204 Finel Sign Final Domolitian CO�E1 INSPECTONTYGE 206 Final Mechanicel 208 Final Plumbing 210 Final Electncal 212 Final Fire Prevention 220 Final Planning AOProval �222 Final Site 250 Final Building/Occupancy Q�jf, INRfIALS (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.�cLUMBING PERMIT n FAIR DRIVE, COSTA MESA, CA 92626 Job nddress: 379 E 20TH ST Suite No Vicinity: KITCHEN Parcel Nunmber: 42630407 Applicant VAN ROOYEN, REAAN Address: 379 E 20TH ST COSTA MESA, CA Owner: VAN ROOYEN, REAAN Address 379 E 20TH ST COSTA MESA, CA Contractor. OW N ER-BU ILDER Address: Phone: 949-279-7271 Zip: 92627 Phone: Zip: 92627 Phone: Zip: license: 000000 ISSUED BY: SCOPE OF PERMIT PLUMBING PERMIT TO DEMOISH EXISTING KITCHEN AND RECONSTRUCT 458SF KITCHEN. REF�:BOS-02340 Stalus: ISSUED Applied: 02/i6/2006 Issued: 02l16/2006 WORKTO INCLUDE'1 DISHWASHER, 1.GAS (i-4 OUTLETS), 1 SEWER CONNECT, 1 KITCHEN SINK. ISSUE FEE Backflow i«igation Backflow Preventer Bathtub Clarifier System Connect (Ice,Soda,etc) Denial Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Orinking Fountain Expansion Tank Gas Earihquake Valve Gas (1-4 outlets) Gas (Over 4 outlets) Gas Repipe Gas Service Imerceptors (Grease, Oiq Interceptors (Sand Auto ) AMT S23.50 $0.00 $0.00 50.00 50.00 $0.00 50.00 59.80 50.00 $0.00 50.00 $0.00 30.00 50.00 56.15 $0.00 50.00 80.00 $0.00 $0.00 QTY 0 0 0 0 0 0 1 0 0 0 0 - 0 0' 1 0 0 0 0 0 FEE SUMMARY AMT LaundryTub/Washer 50.00 Landscape Irrigalion 50.00 P-Trap $0.00 Pressure Regulator 50.00 Process Piping (per 10 fl) 50.00 Receptors 50.00 SeplicTank $0.00 Sewer Cap for Demo 50.00 Sewer Connect 524b5 Sewer Private Line $0.00 Shower 50.00 Sink, bar 50.00 Sink, commercial $0.00 Sink, Floor 50.00 Sink, kiichen 59.80 Sink, service/mop 50.00 Spa (private) 50.00 Spa (public) 50.00 � 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 COMMENTS / SPECIAL CONDITIONS Sump Pump Swimming Pool Trap Pnmer Urinal Vacuum Brkr Bkflow(1-4) Vacuum Brkr Bk(low(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (Toilet) Water Heater / vent Water Piping (Inst or Rep.) Waler Re-pipe Water Service Water Saftener OTHER VIOLATION PLAN CHECK REINSPECTION AMT 50.00 50.00 $0.00 50.00 50.00 $0.00 50.00 50.00 $0.00 $0.00 $0.00 50.00 $0.00 50.00 80.00 $0.00 $0.00 50.00 $0.00 TOTAL CALCULATED FEES: 573.90 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements regulations. (Ord. No. 9248, § 1, 12-21-92) EXPIRA710N: This permit shall automatically expire and become voitl if work is not commenced within 780 days for a period of 180 days. / QTY 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 statutes and related work is suspended or abandoned INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must�comply with all applicable codes, and all requlred Inapeetlons and final approvel must be obtained. Failure to obtain inspections and tinal approval will resu�t in the expiration ot this permit. FOR INSPECTIONS CALL: (714) 7545626 24t&a8 (fl�00) WORKERS'COMPENSATION DECLARAnON: � I hereby aXirtn under penalry of perjury one ot t�e following declarations: . ❑ I hava antl will melntain e certificate of consent to self-Insure for workers' compensation, as provitled for by seqion 3700 of iha Labor Cotle, for the pertormance of ihe wark for which this permit is issuetl. ❑ I have entl will maintain workers' compensation insurence, es requiretl by sectlon 3700 of Ihe Lebpr Gotle, for �he pertortnance of �he work tor whicti ihi5 pertnit i5 iuued. My workers' compensation Insurance carrier and policy num�er are: Cerriec Policy Number. (Tp ecf/on neeO nof be canpletetl i! (he pelmit is velued a! one huntlred tlallers ($100J or less.) 1 certify Ina(in the pertormance of N work lor which this pertnit is issued, I shall not employ any person in eny manner so es to become subject to the workere' � mpensallon lews oi Cel��a, agrea that if I should become subject to the workers' compensation pmvisions ol Section 3700 of the Labor Code, I shall forthwith tomply wiln Ihese,prov' Ons. AppflceM Signawre: -"��— �%�7'/J rDate: Z%�� - () 6 �_ WqRNING: FAILURE TO SECURE WORKERS' ENSA➢ON COVERAGE IS UNUWFUL AND SHALL SUBJEGr AN EMPLOYER TO CRIMINAL PENALTIES AND CML FlNES UP TOONE HUNDRED TTI�USAND DOLLARE (5100,000), IN RDDITIIXJ TO TME CAST OF CQNPENSATION, DAMAGES AS PROVIDED FOR IN SECTIIXJ 3]O60F THE L480R CODE, IMEREST, AND ATTORNEYS FEES. LIGENSED CONTRACTORS DECLARATION: I h9reby aRirm ihat I em licensed untler provisions of Chapter 9(commencing with Section 7000) of Division 3 0l the Buslness and Protessions Code, and my license is in full forGe and eMect. Lic. a Class a CoN�actors SignaWre: Dete: CONSTRUCTION LENDING AGENCV: ❑ I hareby affirm Ihet there is e construction lentling agency for Ihe peAormance of the work for which this permit is �ssuetl. (Sec. 3097, Civil Code). Lentler'S Neme: Lender's Atltlress: Signeture: Date: OWNER-BUILDER DECLARATIONS: I he�eby aHirtn Ihat under penalry of perjury thet I am EXEMPT FROM THE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Business and Profeulons Code: Any city or county which requires a permit to construct, elter, improve, demolis�, or repair any siructure, prior to its issuance, elso requires tha applicant for such permit to tile a signed statement that he ar she is liceased purwant lo Ne provisia�s ol the Conlrectors License taw {Chaptar 9(comme�ing wit� Section 7000) oi Division 3 ot the Bus�ness entl Prolessions Code) or Ihat he o� she is exempt therefrom end Ihe basis for Ihe ellegad e:emptian. Any violetion of Section 7031.5 by any applicant for a permit s 5 the applicant to e civil penalry of not more then five M1untlretl dollers (5500).): 1-as owne� of the pmperty, or my employees with wages as iheir sole compensation, WILL DO THE WORK, end the strucNre Is not intendetl or ottered for sale (Sec. _�704a', Business and Professions Code: The Coniractor5 License Law does not apply to en owner of propeny who builds or improves thereon, antl who does Such work himseN or hersefl or Ihrough his or her own employees, providetl that such improvements are not intendetl or oNered lor sale. If, however. the builtlinq or improvement is sold wiihln one year oi completion, Ihe ownervbuilder will heve Ihe burtlen ot proving ��a� he or s�e did not builtl or Improve for purpose of sale.). ' ❑ I, as owner of the pmparty, em E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to consimct the project (Sec. 7044, Business antl Professions Catla: The Conlractors LlcBnse Lew does not epply to en ownar of property who builds or Improves thereon, antl who coniracts for such project with e contracto�(s) licensa pursuant to ihe�Contractors license Laws.). ❑ lem Business and Profassions Code for this reason: Own'er ID venfied by tlriver's liCenl�� ❑ Ves ❑ No Drivers Cicense No. Ven�ication ol Ownerehip by (type of document, i.e. � pmperry tax bill or deed): L� - DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION: ❑ I hereby certify Ihet no ancavation fiva (5) or more faet in tlepth into which a person is required to descanq will be mede in connection wit� work authonzetl by Ihis pertnit, ana that no builtling sWctura, scaHoltling, talsework, or tlemolition or tlismaNling Ihereoi, will be mora than ihirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, Calitomia Administrative Code). ❑ As ownerbuiWer, 1 will not employ anyoae to tlo work which woultl require a permit irom ihe Division ot Industriel Setety, as notetl above, unless such person hes e pertnit to do such work from Ihe division. Siqnature: Da�e: Division of Industrial Safety Permi� Number: CER7IFICA7E OF COMPUANCE ANDAUTHORVATION OF ENTAY: I cenify untler penalry of perjury ihat I heve read this application antl state ihat ihe informa�ion given is correct. t egree to comply II dte laws flntl city urtliaances ralatiag to Guilding const�uction, anU aUUariza representatives ol the Ciry ot Casta Mesa m enler upon the above-described prop or i ection purposes. I eqree not to occupy or a�low occupancy of any building authodzed by this pertnit until final inspection. - � 2-16�06 SignaNre egal"Owne�(s)--'---�L Date�- �_.� �'_._ __..._ .._,_ _i �� INSVELTIONTYPE 1616 Fixetl Sys�em Final Fire Prevention �jF �,$ COpE � �jfj,tTION TYPE 20fi Finel MeChaniCal 1266 Pool Spe Finel �O8 Flnal PlumGing 200 Finel Re-floof 210 Final c'wl 201 Final BIocWRetaining Well nal Flr reventlon 202 Final Faciory Fire Place Fin lanning Approval 203 Final Sign 222 Final Site 204 Final Oemoli�ion 250 Final Building/Oaupanry PdIE II�L@ p�a) �5a-sz�s • Fax (714) 754-4856 • www.ci.costa-mesa.c�ILDING PERMIT ,lob Address: 379 E 20TH ST Suite: Vicinity: ROOF Primary Occ R3 � Type of Constmclion: V-N Parcel Number: 42630407 Zoning: Applicane NIELSEN, JACKI Address: 126 COMMERCIAL WY Phone: 949-548-5569 COS7A MESA, CA ' Zip: 92627 owner. VAN ROOYEN, REAAN Address 379 E 20TH ST Phone: COSTA MESA, CA :. Zip: 92627 Contractor.� G L R ENTERPRISES INC--DBA CRANK BROTHERS ROOFIN Address: �126 COMMERCIAL WY � - � - � " - Phone: 949-548-5569 � . -COSTAMESA;,CA: � " Zip: 92627 , License: 828379 Arch : " � " _ Eng: Address: . Address: Phone: Zip: . License: --'. 77 FAIH UHIVt, GVSTA MtSA, GA 9Z62ti Status: ISSUED Applied: 07/21/2006 Issued: 07/21/2006 ISSUED BY: \ �� Phone: , License: ' � SCOPE OF PERMIT TEAR OFF (E) 950SF ROOF MATERIALS AND REROOF W/HOT MOP SYST AND 4-PLY CAP SHEET AND F2EROOF OVER (E) W!4-PLY CAP SHEET ON NEW 1,050SF ROOF. REPAIR�AND REPLACE SHEATHING AS NEEDED. � � _ FEE SUMMARY Plan Check: $0.00 - Calc Valuation: $�,soo.00 Permit: $153.25 � Claim Valuation: s�,5oo.00 SMIP Res: $075 ' SMIP Com: � $0.00 , . ' Other. $0.00 — -- -:. - -- _ . - - Inspection: $0.00 - - Total: $154.00 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY_ Front�•. 0-0 PARKING Existina: o PLANNING 8 ZONING Rear .0- 0 Left 0- 0 � Rear 0- 0 Left 0- 0 Reouired: 0 Pr000sed: 0 Right 0-0 Right 0-0 . , � �, �%, / � NOTICE: The work authorizad by this permit shall comply wlth all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 9228, § 1, 12-21-92) EXPIRATION: This pertnit shall automatically expire and become void if work is not commenced within 1B0 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 requlred Inapectlone and finel approval must be obtained. Failure to obtain inspections and final approvel wlll result in the expiration of this pertnit. FOR INSPECTIONS CAIL; (774) 754-5628 zaae-as �sioo� WORKERS' COMPENSATION DECLARA710N: � , `� I hereby affirtn untlar penalry of perjury one of the tollowing decleretions: "� , ❑ I heve end will malntain e certiiicate o( consent to self-Insure for workers' compensation, es provlded for by sedion 3700 of Ihe Lebor Code, for ihe pertortnence of t�e work for which ihis pertnit is Issued. rs' compBnSation Insurence, as surence carrief.entl policy(��n r+P d- CGStid1y; not by seclion 3700 of the Labor Cotle, br the perfortnanca of the work ta which thLs pe�mit is iswetl. �P.olicyNumber`: �W��_�b�-C7 dollars ($700) or less.) �� ❑ I certify Ihat in the pertortnance oi t�e work tor which ihis pertnit is Issuaq I s�ell not employ any pereon in eny manner so as to become subject ro the workers' compensetlon laws oi Cellfornla, end egrae ihet II I shoultl become sub�ect to iha workers' compensation provisions oi Section 3700 oi Ihe Labor Code, I shell forthwlih complywiththese rovisi ns. --� ',,n�� —7� ,�/� ApplicanlSlgnature: 1�-✓�^-"�' �Date: '1 � �'��,w WMNING:�FAILURETO REWORKERS'CO�.IPENSATIONCOVEMGEISUNLAWFULAN�SHAl1SUBJECTANEMPLOYERSOCRIMINALPENALTIESANDCIViIFlNESUPTOONENUNDRED �THOUSAND DOLIARE (51 O), IN ADDITION TO THE C0.ST OF CAMPENSATIqJ, DAMAOES FS PROVIDED WR IN SECTION 3]Ofi OF THE LABOR CODE, INTEREST, AN� /TTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aNirm that I em Ilcensed under provisions of Chapter B(commencing with Section 7000) of Divislon force an_d elfect. LJc. a , . S� �- 7�A ., _ Code, and my Ilcense Is in tull CONSTRUCTION LENDING AGENCY: ❑ I hereby ettirm thel lhere is a construction lending egency for the performance oi ihe woAc tor which ihis perml� is issuetl. (Sec. 3097, Civll Code). Lendels Neme: Lender's Address: Signeture: Date: OWNER-BUILDER DECLARATONS: I hereby aNirm Ihat untler penalry of perlury t�et I am EXEMPT FROM THE CONTRACTOHS LICENSE LAW tor ihe following reason (Sec. 7031.5, Business and Professions Cotle: Any ciry or counly which requires e permit to construct, elter, improve, tlemolish, or repair any structura, prior to its Issuance, elsa requires the epplicant tor such permit to flle e signetl stetement ihat he or she is Ilcensed pursuent to the provisions of the Contrectore License Lew (Chepter 9(commencing with Section 7000) of Division 3 of the Business and Pmfeuions Code) ar that he or she is exempt therefrom end the besls for the elleged exemption. Any violetlon o� Sectlon 7031.5 by any epplicant for a pertnit suD�ects the epplicant to e civil penalty oi not mare than five �undretl dollers ($500).): ❑ I, es owner oi ihe property, or my employees wllh weges es ihelr sole compensation, WILL DO THE WOHK, end Ihe siructure Is no� intendetl ar oHerad for 9ele (Sec. 7044, Business and Protesslons Code: The Contractors License Law tices noI epply to en owner ot property who builtls or improves thereon, entl who does such work himself or harself or through �is or �er own employees, provided thet such ImOrovements are nat intendetl or ottered for sale. If, however, ihe building or improvement Is sold within one yeer oi completion, ihe owner-builder will heve ihe burden of proving that he or she did not builtl or improve tor Durpose of sale.). • ❑ I, es owner of tha proparty, em E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the Droject (Sec. 7044, Business entl Professione Code: The comrecbrs License Law does not epply to en owner at properry who builtls or improves ihereon, end who contracts br such project with e contreIXor(e) license pureuent to the Contractors License Laws.). ❑ I em exempt under sec. eusiness end Professions Code tor this reason: Slpnature: Daie: Owner ID venfled by tlrivefs license. ❑ Yes ❑ No Drivers Licensa No. Expires: Vedficetion of Owners�lp by (type of document, i.e. - pmperry tex blll or tleed): DIVISION OF INDUSTRIAL SAFETY VERMIT CERTIFICATION: ❑ I hereby certify Ihet no excevetion five (5) or more feet In depth into which a person is requirad to tlescen4 wlll be metle In connection wl�h work euthodzed by Ihis pertnit, end that no building simcture, swHoltling, falsework, or tlemolltion or tlismantling thereof, will be more than thirry-six (36) feet high. (Chep. 32, Grp 2, Art 2, Sec. 341, Tltle e, Celltomia Adminisirative Code). ❑ As owner-builder, I wiil not employ enyone to do work which would require e permlt irom ihe Division oi Intlusirlel Setery, as notetl ebove, unless such pereon hea a pertnit to tlo such work tram the division. Signeture: Dete: DiWsion of Indusinal Sefery Permit Number: CERTIFlCATE OF COMPLIANCE AND AUiHORIZATION OF EMRV: I certify under penalty of perjury Ihat I heve reatl this epplicetion and steta thet Ihe informetion given is correct. 1 agree ro comply with ell state laws end ciry ordinances relating to building consiructlon, and euthodze represantatives of the Ciry ot CaSte Mese to enter upon the ebove-described property for inspaction purposes. I agree not to occupy or allow occupancy of eny building authonzed by ihis pertnit until finel inspection. COOE I, INSPECTIONTYVE 1616 Fixed System Final Fire Preven�ion 1266 Pool Spe Final 200 Final Re-Roof 201 Finel BIocWRetaining Well "+Z�Fi 203 Final Factory Fire Place Finel Sign Finel Demolition. . . COUE/ INSPECTONTYVE 206 Final Mechanical 20B Finel Plumbing � 210 Final Electrical 212 Flnel Flre Prevention 220 Flnal Plenning Approvel 222 Final Site 250 Final BuildindOccuoen� 1- CJb r Date � ' PAIE It�ELd f � `\ (714) 754-5273 • Fax (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: Suite No Vicinity: Parcel Nunmbec 379 E 20TH ST 42630407 Applicant: VAN ROOYEN, REAAN Address: 379 E 20TH ST COSTA MESA, CA Owner: VAN ROOYEN, REAAN Address 379 E 20TH ST Contracror. Address: ISSUE FEE Temp service test Res. a/c package New Res (1-2 uniis) New Res (3+units) Pool / Spa Lighting Fixts � Recept Outlets Switches Non Res Appl Res Appl Service to 200a Service to 1000a Service over 1000a Motors to 1 hp Motors to 10hp Motors to SOhp Motors to 100hp Motors over 100hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole COSTA MESA, CA OWNER-BUILDER ELECTRICAL PERMIT Phone: (949)642-7575 Zip: 92627 Phone: Zip: 92627 Phone: Zip: License: 0 SCOPE OF PERMIT UPGRADE EXISTING ELECTR�CAL SERVICE TO 200 AMPS. 523.50 $0.00 $0.00 so.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 so.00 $30.50 $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 Quantity FEE SUMMARY Temp Dist System / Lighting Busway /100 ft Standing Section Misc Electrical Equipment Transformers up to 1 kva/kw ................up to 10 kva/kw .................up to 50 kva/kw .................up to 700 kva/kw ..................over 100 kva/kw Low Voltage Equipment Low Volt Wiring System / Ckt Misa Conduit Misa Conductor Cirws ( gen or ride) Circus (mech ride or lights) Christmas Tree Stand Fireworks Stand Other Electrical Fee Investigation Fee Plan Check Fee Reinspec[ion Fee TOTAL CALCULATED FEES COMMENTS / SPECIAL CONDITIONS Status: I SSU E D Applied: 05/23/2000 Issued: 05/23/2000 ISSUED BY: Quantity 50.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 so.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 so.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 50.00 50.00 $0.00 $0.00 E54.00 NO710E: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 9248, § 1, 12-27-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 1 BO days. INSPECTIONS: In order �or �he work authorized under �his permit to be considered legal, such work must comply wi�h all applicable codes, and all requlred Inapeetiona and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of �his permit. FOR INSPECTIONS CALL: (714) 7545626 WORKERS'COMPENSAnON DECLARAnON: I hereby eflirm untler penalty of perjury one of the tollowing declarations: ❑ 1 heve entl will meintain a certificate oi consent ro seN-Insure br workers' compensetion, as provitled lor by section 3700 of the Labor Cotle, for the pertormance of Ihe work for which ihis Dermit I5 issued. . ❑ I have and wlll maintain workers' compensation insurance, as requiretl by section 3700 ot Ihe Lebor Cotla, for the pedortnance ot Ihe work for which ihis pertnit is issued. My workers' compensation Insurence carner and policy number are: Carder. Policy Num6er. (This section need nof be comp/eted i/ the permif is valued af one hundred ddlars ($f00) or IessJ ❑ I certlfy that in tha pertortnence of tha work for which this permit is issued, I shall nol employ any person in any manner so es to become su6ject to the workers' compansetion lews of Celifomla, and agree Ihei if I should become subject lo Ihe workere' wmpensation provisions of Sectlon 3700 0l the Labor Cotle, I shall forthwith compty with Ihese provisions. Applicant Signawre: Dete: WARNING: FAILURE TO $ECURE WORKERS' WMPENSATION OpVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND OOLLFHE (5100,000), IN A�DRION TO THE COST OF COMPENSATION, DAh1AGES AS PROVIDED FOfl IN SECTION 3]W OF THE IABOR CODE. INfEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby aflirm that I am licensed untler provisions of Chapter 9(wmmencing with Section 7000) of Division 3 0l lhe Business and Protessions Cotle, and my license is in full �orce end BfletL Lia N CIa55 M Contractor's SignaWre: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby aHirtn thet there Is a consiruction lending agency tor ihe peAortnance of the work for which this permit is issuetl. (Sec. 3097, Civil Cotle). Lender's Neme: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby aHirm ihat untler penalty ot per�ury ihat I em EXEMPT FROM TME CONTRAC70RS LICENSE LAW for the following reeson (Sec. 7031.5, Business antl Professions Code: Any ciry or counry which requires a permit to construc6 alter, improve, demolish, or repair any siructure, prior to its issuenca, also requires �he epplicam for such pertnit to fila e signed statement ihat he or she is licensatl pursuant to the provisions ol Ihe CoNrectors License Lew (Chapter 9(commencing with Secllon 7000) oi Division 3 of Ihe Business end Professions Code) or thei he or she is ezempt iheretrom entl tha basis for tha alleged exemption. Any violatlon of Section 7031.5 by eny epplicant for a permit subJects the epplicani �o e civil panalty ol no� more ihan five hundred dollers ($500).): ❑ I, es owner ot the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and Ihe structure is not inten0ad or oHeretl for sale (Sec. 7044, Business and Protessions Code: The Contracrors License Law does not epply to an owner of property who builds or improves thereon, end who tloes such work himselt or herself or ihrough his or her own employees, provided thet such improvements are not intended or oflered for sele. If, however, the bulltling or improvement is sold within one year of completioq the owner-builtler will have the 6urden oi proving thet he or she did not bulltl or improve lor purpose ot sale.). ❑ I, as owner of the property, em E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to canstruct the project (Sec. 7044, Business antl Professions Code: The contrectors License Law does not apply to en owner of property who builtls or impmves thereon, end who contwcis for such project with a coniractor(s) licensa pursuant to the Conhnctors License Lews.). ❑ I am exempt un Siqneture: Owner ID verifietl by drivers Ves ❑ No Business antl Professions Code for this reason: Date: � '�l�-� � � Driver's License No. �� Expires: 11- O"l' 0� Verification of Ownarship by (type of document, i.e. - property tax bill or deetl): DIVISION OF INDUSTRIAL SAFE7Y PERMIT CERTIFICATION: 0 I �ereby certity that no excavation five (5) or more feat in tlept� into which a person is required to descend, will be metle in connectlon with work authorized by this pertnit, entl thet no building strucNre, scattolding, falsework, or tlemolition or Cismantling Ihereol, witl be more than thirty-six (3fi) feet high. (Chap. 32. Grp 2, Atl 2, Sec. 341, Title 8, Calitomia Administretive Code). ❑ As owner�builder, I will not employ anyone to tlo work which would require a pertnit from �he Division oi Indusirial Safety, as notetl above, unless such person has a permit to do such work from t�e division. Slgneture: Data: Divisian of Intlusirial Safery Permit NumOer: CERTIFICATE OF COMPLIANCE ANO AUiHORIZA710N OF ENTAY: I certity under penalry of perjury that I have reatl this epplication antl state that tha information given is correct. I agree to comply with all s�at s city ordinances relating to building consiruction, antl authonze repiesentatives of Ihe City of Cwta Mesa ro enter upon tha a6ove-described property tor insp i ses. I e ree n t to occupy or allow occupancy of any building authonzed by this permit until tinal inspection. �- �i'�- �0. SigneWreOiLj wner(s) Oata S And/Or Authonzed Applicent Date COpE �. INSPECTIONTYPE QRT� INTff1AL5 1616 Fizotl System Final Fire Prevention 1266 200 Pool Spa Final Finel Re-Roof 201 Fine181ocWRetaining Wall 202 Finel Fectory Fire Place 203 Finel Sign 204 Final Demolition 244&a8 OE I INSPECTION TYGE 206 Final Mechenical 208 Final Plumbinq 210 Final Electrical 272 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final euilding/Oaupanry �g " �11 �11' COUNTY OF ORANGE BUILDING DEpT. 636 No. Broadway Santa Ana, CaGfomia Phone: KI 2-6211 1. OWNER'S MAILING Application for Building Permic AND FOR A Certificate of Use and �ccupancy Date....c�xi�7��'� ��%-Si� ---•--•• . . .............. PHONE:--- .�.r�..�.�5_ �-SjS ... ... CITY..0 :�-.ef..,f2G��.... Permit No. .��.�7.__L..Y Name....�Y.!",.r�../.1,2��.i/.......--------"---�----------'-'-""----'--------- Name _lY�T�...Y�.l.rZi..-----"'--'---......"------'---..'-'-----"--------------'- (Archirec[ or Engineer) (��«or) Address...... -- -....... - ...............--------.... - -- -.... ----- .. Address ------.............................- ---- ....._.....----...............---.........-- City....---- -`-�--- --..... -- ......- - - _..._- -- ' '- -- --...... City ...............' ---"-- ........---......._....----:....._............-'--- - ---........ State State Lic. No ................................----- Phone_._-----------------------------. Lic. No.---------'---'-'-`............-----...... Phane---------.-'-"-'--....--------"--" PROPOSED USE:--�� --�--��---Y-�-....-Y��--�--v---------- -- '��Gc.r�icv---- � T� �---- y� '----------- - 2. JOB LOCATION.._J�<._ .--- --...._ �- - ------�-�--� /'.�� -�. �.�,.�-------'� ..............-��----------� (House t3o.) (Namc of Street) �J (Town or Sc,h,�orol Diatrict) _ NAME OF AND IRECTION O N�REST CROSS STREET...(„(.�.�,c�i...:".�.t...��. ��=- � ��/ — o ....- --.... 3. LEGALDESCRIPT'ION: Lot.y....�,../.._..... Zf r � . 7p ..------ � ------ ----.�ock -------- ................. . . .._�-------. Tract............�-�.l...O.._..----�--.... (Metce and Bounds Descnption—Use reverse side of form) 4. CORNER LOT ( ) INTERIOR LOT ( ) THROUGH LOT ( )�, SLOP� QP/�OT ( ) �! /�j' / S i. SIZE OF IILbG.:��_K1'!0--------AREA:___.��j��51ZE OF LOT:...�Pv.,X�.AREA:...�/�'�"'d�� O � �� /� � J --... - ........... :. G. HEIGHT OF BLDG.:�i ......__ ...............CEILING�HEIGHT:::far�' .. o'�iNO. OF STORIES......�......__............ �'� ,�---�- - 7 E:� NO. FAMILIES-------------------.--------------...Size of Smallest Bedroom:....---.-----------....--------,----- Size of Kitchen.........---....................._. EXTERIOR WALL CONSTRUCTION:..��-4�-�C�I.."�.._�N RIOR WALL COVERING..��........ (Prame. Stucco, Etc.) ' -' .... . ..............(Plastcr.Drywall. Eta) . / ROOFING COVERING _....._�'a�-d�. ............- ............ ...... 9. STATE HOW MANY BUILDINGS NOW ON LOT AND GIVE USE OF EACH... .Q`�Z�_:.-��-�e-..... � 10. SETBACKS: Front Yard From Center Line of Street------�-G.'7�------------------------.....------.....----..--------.----...-.---.--:-----...---------......... i / � Nearest Side Yard...P� :..............Rear Yazd.��.._.._Distance in Feet Between Bldgs. on Same Lot____. �..........._..__ :_....... (Property Line) (Property Line) I1. A COMPLETE PLOT PLAN IS REQUIRED, SHOWING ALL STRUCTURES AND USE OF EACH. �� / �i 12. (a) Footing: Width--�--...�-�--...Dep[h in Ground._1.�y-_ .............Width of Wall....---................._"---' b Size of Studs: /!.V_7- ��......S�adn a�^.._..._....:'CC Material of Floor�Q�f.'.'P(, ( ) o� ---- P g-_ . ----- .................... (c) Size of Floor foists:..- --....- --------- -- -----.....Spacing .......... .........- �--- --�-----....:'CC - -- �i�- �j . -' �i d Size of Rafters:--- .U.�. .X/D �---- � � � ,• --..... a.lY�.f.S acin .. ......--- ......__.... CC � ) - - � P g�- -..... -- 13. VALUATION OF PROPOSED WORK: Including all labor, plumbing, electrical wiring, hcating, fire sprinklcrs, painting and sewage disposal 5._. ..... .._. - g �/`�---`--- 14. I HEREBY CERTIFYTHAT TO THE BEST OF MY KNOWI.EDGE AND BELIEF THE INFORMATION IN THIS APPLICATION ]S CORRECT AND THAT THE CONSTRUCTION WORK WILL CONFORM TO ALL LAWS OF THE COUNTY OF ORANGE AND THE STATE OF CALIFOIjNIA APPLICABLE THERETO. Signed: Plans Filed :.............._..��_...'.�....5'...\.�S` �.`.....--"---"BY. (Owner) (Authorized Agent) FOR DEPARTMENTAL USE ONLY FEES: Bldg. Permit ' g-_--...... .� �%.� GROUP-_-.---' -- - --- . . . , Plan Check • $.....-- ---1 � ��-- TYPE....----� - --- - .. Total • • % $-----...---"� ��Q------- DIST. /�p_ ' Receipt No. �/ �' ....sl�c,Dx �'.�'.�q.._. . MAP------`.�'-- -... ---- - Paid to - • ......L.../15�.'^!�,,.. SHEET NO........._�:.. Date � :.�:.:' :'� PERMIT DATE........�.�_/�_S..'�_Z�:..- --.... --------..... s000-.,-s= C ECKING BY APPLICATIO .. . HEALTH ............................ ZONING ...................r.t.... FIRE PLANS ANJ� � MARSHAL ......................... SPEC'5...._.�J-C.�.�-.y�1ll.�'�G�STATE---------------� ......----- CORRECTIONS ENGINEER VERIFIED----------------------- CAL_---------- _ :�J ��`�'� Aoo�icant lo fill in all spaces except tnose within heavy Gortlar Ilnas antl sign all aoDropriala tleclarations. PER I N TRACT NO. LOT NO. UNIT NO. CITY OF COSTA MESA CONSTRUCTION PERMIT ' �j �� b P�.P• # 2ona Project Address �� %l0 �+ Sr�P�eT �'• /"'� _ � S Main Building: Accessory Building: Applicant's Mailing Address ' L TYPE OFCONSTRUCTION EW ADD ALTERATION REPAIR E Z ' / ��pe ❑ CONVERSION ❑ DEMOLISH ❑ OTHER T Front � Owner'sName PhoneLZ��9 DESCRIPTIONOFWORK/USEOFBLDG. IB Rear N Addreu 379 F..iArS SriCtt� lnsrn MPsA 9zFt-7 A � Arch/Eng. License No. TVPE OF PERMIT GRADIwG FOVNDA710Trv �STRUCTURAL �� K Righ[ G AddrEss ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING i(J-MECHANICAL g LeFt R ❑�OTHER Pln Ref. # . Parkin Re /Provided Q Contractor's Nam °F' Phone 6�/s3 i 3 0 9� 9 4� PRQIECT DESCRIPTION SGi. FT. oCCvanNCV Plannin Notes: Addre55 (mailing� ' i y� CONSTRVCTION TVPE VALUATION 5 9 M City License No. �'Z.Zyy L�OV7 ZONE GRADING CU. VDS. - ACRES , $, LICENSED CONTRACTOR DECLARATION I hereby allirm tM1at I am licensetl under provisions of CM1arler 9(commencing Remarks: �� ek ��. witn section ]000) ot Division 3 of the Business antl 7ro(essions Cotle, antl my Iicense is in lu}� torce na ef ect^ ELECTRICAL FEES License C ss `"3 � �— /'�0 Li�cf nse N�o.�� Date� Signature�,'�"I-��-�- /� n'+� PLUMBING FEES P.uromatic Washer Transformer � 15�50 KW - WOiiK RS'COMVENSATIONOECLARATION � BatSink ShOWers ConSLrUCtiOnPoleSub. �50+KW I hereby aftirm that 1 �ave a certlticate o( consent to selt-insure or a certlficate oi workers' Compensation Insurance, or a cartifietl copy thereol (Section Backflow Preventer Service Sink Cooking Unit Meter ❑up to 100 amps 3800, Lab. C.) Policy No. Company Backflow Irrigation Sewer Cap Dishwesher Meter ❑over 100 amps BCertifietl copy is nereby furnishetl. - Dryers ❑Gas ❑Electric Sub Panel � Certifietl [opy ii fil¢tl with [he city Bulltling Dlvislon. BdthtUbs S¢W¢� Connettian Date Applicant Fan Motors�0.7HPOiX-8 E%EMPTION PROM WORKERS' COMPENSATION DECLARATION Cldrifi¢rs SOldr Coll¢CtOrS (Tnissection neetl not be comple[etl It tne permlt is tor one huntlretl (y100) or Dishwasher � F.A.U. Inc Solar �9-15 HP �16-15+ Icsz). $olar Piping . I tertity that in th¢ Pe�Po�mance Oi th¢ wo�k fo� wM1lch NI5 Oe�m�t I5 IssueQ 1 FixtU�¢5 snall not emoloy any person in any manner so as to become subjecl to the Drinking Fountains Solar Tank Microwave Workers' mpens ion Lawz Of Calli i. Date yr�� Siqnatura��6� ��'0 Floor Drains Swimming Pool w/Spa � Device Boxes Pole Light NOTIC : If, a t maRing [his tleclaratlon, you s oultl bn�ct to the Workers' Comp nsation provisions of the Labor Cotle, you must forthwith Floor Sinks U�inal � Outlets � flange comply with such O�ovisions o� this pe�mit Shall bE tle¢mBtl revoketl. CONSTRUCTION LENDING AGENCV GaSSerVice Outlet5 WaterCloset Switch¢5 Sign I hereby affirm that [htr¢ is a con5ttuction lentling agenty (or the p¢rformdnC¢ m tne work �or whicn thls permit is issuetl (5e<tlon 3097 Civ. CJ Interceptors Water Heater Garbage Disposal Standing Sections L,entler's Name �entler's Atldress Kitchen Sink � Water Service Generator �0.5 KW �5-15 KW Trash Compactor OWNER 9UIL�ER DECLARATION I hereby aftirm lhat I am exempt from the Contractor'S License Law for th¢ LavatOfieS . AutO-WeSh following reason (Sectlon ]031.5 Buslness and Profes5ional Cotle: Any ci[y or , . counly which requires a permit to construct, alter, Improva, Cemolish or raoair P—Trap Laundry Trays ' any structure, p�lo� to its issuanG¢, also �equire5 the appllcant tOr Such permit lo file a signetl itat¢ment that he/sha Is Ilcenz¢tl pu�suant to [he provlsions Of ROOf D�einS ' the Contra<tor's License Law (Cnao�er 9(commenNn9 with Sectlon 7000) of Divizion 3 ot thc Business antl P�ofes5ion5 Cotle) or that ne/she is exemp[ Reinspection Fee $15 luua Fee $ 3 [herefrom antl tbe basis for tfie allegetl ex¢mption. Any violation of Section � ]031.5 by any applicant for a permit sub)ects the applicant to a civil enalty ot not more than five nuntlretl tloiiars ($500). ' DEVELOPMENT SERVICES REQUIREMENTS: .� I, as owner ot tM1e property or my employees with wages as their sole Reinipection Fee � $15 Issue Fee. . $ 3 Compensation, will tlo the wo�k, antl the struc[ure Is not intentletl or offeretl , ZoainB APP�oved By Date lor sale (Section ]Oaa, eusiness anC Protesslonal Cotle: The Contractor's MECHANICAL FEES BuildinB APProved 8y Data License Law tloes not apply to an owner of a proper[y who builtls or improves Ihereon, antl wM10 tloe5 sucn work himselt/herseH or throu9h hls o� h¢r Own - . AppIICdHOn IAued By �� pat v� employees, O�ovitletl Ihat such improvaments are nOt In[entletl or Otteretl to� ' BOiI¢� . HOOd O� Typ21 ❑ ' saie. It, however, the Dulltlin9 or Imo�o�ement is sola within one year of com- Canopy Type II ❑ - SUMMARV OF FEES oietlon, me owner wiil have tno burtlon ot Droving ho/shc tlitl not build or im- Duct - Under Ground rove for the purpose ot sale). BUILDING PERMIT $ SMIP $ � I, az owner ot the property, am exciusively contracting with Ilcensetl con- Duct-Structural Refrigeration System PLAN CHECK tractorsto construct tne project (Section ]044, Business antl Prote55ions Cotle: $ PERMIT The Contractor's License Law does mt aoP�Y �o an owner of property who Duct - Ventila[ing . ❑6100,000 BTU ❑100,000 BTU PLUMBING $ ISSUANCE $. builtls or iTprovez tM1e�eon. antl wM10 conf�acts fo� Suth oroi¢cts with a[on- - tractor(s1 I�cense pursuan< <o ene Contractor's Licenu Lnw). I am aware that Exhaust System ❑ Multiple ❑ System Repair/Alteration PLAN CHECK 25% $ ENERGV P.C. $ orooi o1 tneir Worker's Compensatlon insuranw shoultl oe orovitletl to me. ELECTRICAL $ GRADING $ ❑ I am exempt unaer Section B. & P. C. �or this reason Firepl/Fact. BIt. iC80 # Fire Dampers MICROFI lM $, PVINCHECK 50% $ Date Owner Hea[ing System & Ducting Registen � Q � I hereby certity that I have reaG mis application ana state that the above / �OO,OOO BTU �100,OOOBT MECHANICAL $� TOTAL FEE $ � in(ormation is correct. I agree to comply with all city antl county ortlinances P�AN CHECK 25% $ � an0 State laws �elatin9 to building conStruCtiOn, dntl he�eby authO�iie �ep�e- Sentatives of IhiS city to enl¢r upOn the abOve-mentionetl Pro e�ty or InsOection purposes. 30 Signature Date Reinspection Fee $15 IAue Fee Drivers' License � ss � �� $'a' Ol OD015749-G0�15749 TC�T 24.00 - DATF: 09/79fRR 77nCe tu :n oe65-ati, rev. o/nn wmie - ewiamg; canary - qppncanr, wnu - s�<counun9; uoiaenroa - v.ssesroi � CONSTRUCTION AND PLANNING POOL & SPA APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector 1. Temporary Electrical Service or PoIA ' 52. Pool & Equipment Location -��2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement ' 3. Electrical Condui� UtilitY-Undrgrnd. � 54. Forms n 4.. Electr,ical Conduif-Undrgrnd. 55. Electrical Bonding ' i 5�Steel Reinforcement 56. Rough Plumbing & Pressure Test 6� Electiical UFER Grnd. � ; 57. APPROVAL TO COVER-GUNITE � 7lFootings ' 58. Electrical Conduit-Undrgrnd. � � 8.- Foundation • � � 59. Gas Pipe, O Undrgrnd., Test ,' � 9�Water Pipe�Undr9md. ' 60. Backwash Lines, P-Trap, O Undrgmd. 10'�Structurel Floor System , 61. APPROVAL TO DECK 11r Property Sewer Line'& House Connection 62. Backwash & ReceptorFinal r 12. Sewer, Cap � � j �" 63. Heater & Vent-Final � . 1 1�" Roof Drains 64. Plumbing SYstem - Final • 14. Rough Plumbing 65. Electrical-Final 75. Rough Electrical-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/SPASYSTEMS FINAL �19. Rough Heating & A�r Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace ; • APPROVALS Permit # 21. Ducts, in Structure . � 70. Underground Hydro - 22. Ducts, Ventilating � 71. Product Piping OGas ❑Oil 23. Gas Pipe-Rough & 7est 72, Underground Flush 24 � Roof Framing � 73. Uadergr�d. Storage Tank � Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Strucwral) & Monocoat 75. Dry Chemical 27. Frame and Fl�shing 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. Electriral Power Meter-Final 80. FOOD CERTIFICATE ISSUED _ �S 33. Final Electric Notes: 34. Final Heating & Air Conditioning ��.�� /, 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar pomestic-Fina� 42. Backflow Preventer °�� • 43. Backflow Irrigation 44. Landscape Irrigation System ' 45. Sound Attenuation � 46. Handirap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison ' 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY - No. Date