The URL can be used to link to this page

Home My WebLink About406 20TH ST - Building Permits� (774) 754-5273 • Fax (714) 75n-4856 • wviw.ci.costa-mesa.c��LDING PERMIT �� FAIfl DFIVE, COSTA MESA, C:A 92626 Job Address: 406 E 20TH ST Suite: • Vicinity Primary Occ: R3 pwellingsl Cong Res <10 Parcel Number: 42624132 Applicant: SKIf22YNSKl, JOHN Address: 10782 S. MEATS AV ORANGE Owner: WHITFORD, WILLIAM Address 406 � 207H S7 COS7A MESA,CA Convactor. SHARP ROOFING Address: 10782 S. MEADS AV ORANGE CA Zip: 9286g Arch : Address: P/h, .r'-$� l�I'P.>. Zip: o-�5�,.�'�4� /;CL�nx '. r: -t ` r`£;i:� .. T/O EXIST; NEr ry2�SYR%GAF��OW1P SH��y6LE: tit.t;��! �+� �T.. rw2�r ` :�.y. Plan Check:�:"� $0.00 � Permil;�,k�, $87.2��SF.,.�I ••:u* SMIP Res•�a':'1 $0.5 �,��ry SMIP Com�ti+i't� $O.OAko�;f Total: �:�$$7.75 SETBACKS MAIN STRUCTURE Fronl 0- 0 ACCESSORY Fronl 0- 0 PARKING Exi,typy: o NOTES: Type of ConsW cUon: V-N Zoning: Phone: 714-771-0118 Zip: Phone: 949-722-9174 Zip: 92627 ��.�,� Phone:, �714-771-0118 � � License:. 57'1575� . r "� � �' ,, • �. �' � � � Eng� / r ..'.. � . Atldress:. / .^ . �.� t ' ' / ,�{��- tr ,C',�.f',✓ rs . d� 7 i �• ,:� S � / ��<..� ' �, � �'SCOPE OF PERMIT PER SPECS. p , , -. I i � '\�� "� FEE SUfMIVIARY �•.4 j� v� � PLANNING & ZONING Rear 0- 0 Left 0- 0 Rear 0- 0 Left 0- 0 Reauired: o p�Qpp��: o ISSUED BY: Calc valuation: Claim Valualion: Right 0- 0 Right 0- 0 Status: ISSUED Applied: 1 212 8/1 998 Issued: 12@8I7998 Phone: License: $3,700.00 53,700.00 NOTICE: The work authorized by Ihis permit shall comply wiih all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 72-21-g2) EXPIRATION: This permit s�all automatically expire and become void il work is not commenced within 1B0 days, or ii work is suspended or abandoned tor a period of 180 days. INSPECTIONS: In order for the work authorizetl untler this permit to be consitlaretl legal, such work must comply with all applicable codes, and all requlred Inepeetiona antl Iinal approvel must be obtained. Failure to obtain inspections and final approval will result In the expiration ol lhis permit. FOR INSPECTIONS CALL: (714) 75h5626 26a6�6 (6W) WORKERS'COMPENSATION �ECLARATION: "' � I h�±inpy yyirm untler penal!y ol per�ury nne of ihe loilowing tleclaralions' ❑ I hnve an�] v.ill maintein a cenilmale cl cnnsenl lu selbinsure lor workeis' ^,ompHns:iliOr. a5 P�uvicled to" hy 50c1i0n 3100 O' ihe Labor CotlO, tor the pChormance of Ihe v:or4 foi whir,i+ IhiS permil is issuetl. ❑ I ha•:e and vnil r.ninfain wur4.ei5' comnensauon Insur�nce. as reqmretl ny ser.lwn 3iIX) el !nc Lebe� Codn, ior Ihe peAormance� ol Ihe work �or which [hi= permit is issatd. ;dy v�oikorc' comn�nsabon Insuranco carner and pol7cy number are� Culrier Polmy MumGar: _ !lhic secbun neeo no� o:r cumplp[en rl ��e pxrm�l �s raWgd af on� hundinh,:ntlnrp i51001 ui h!ss 1 ❑ i cerld�' ibal m ih? peiio/mnno: ol Ihe wnrk bi +io2h Ihis permit is issaen I�hall not eniul��y any person in any nianner so as lo bocone sub�er,� to Iho worNcrS' r.�r��.�satirn I��vs ot Calilomia, antl ngran Ihal d 1 should 6acane suhjnr� �o LL•e wcrMers' rurnpeos.lion provisions of Sec�ion 3700 0l Ihe Labor Code. I snall tonhwith i.oiqOP/ willt :'tenn pipvisions. AI'q�ncnn� :;:i4naUea: Calrq ltlnFrnNG fNi.liP,H i0 ;Er,i�qF b'Nl1kFN5' CO�nnE�lSaiu;�� COVERnGE;S UmV.wFV� nuir SNaI l SL fliFE�1 2k E�,�nl O'IFR Tp fRIMiNA� P'cNALtIES 0.ND qViL FlHES UP tOONE HI.NDRED ��IUUti4lJC IX:t.1AHE (.110JV]I.In nDpitUY 10 T�i[ COS� OP CO;dPENSPdKk1, DAtdn�3E5 AS PR:WI[T D FOR iN SECiION 9�fY OF TNE 1A80F COOE, INfEFESi, AND AiIOqNEY'S FEES. LICENSED CON7RACTORS DECLARATION: I hmeCry.Jlvm Ihal I am 6q;nsen unUe: P�ovisions ol Ltiaul9� 9lcommenany a.nb SAcuo�i'p1i01 ot Urv�5i0n 3 ut Ih9 B��sine55 antl Pro�655in05 Cotlo, Bnd my LCense is in iuli . InrCe entl nl�ect I�c. a Ci&Ss d GunlraCtoi'S Siynuiuu?: _ _,_ Ua1e'. _ _ CONS7qUCTIUI: LE�lDING AGENCV: ❑ I h�:iubY aHum Iliat Lhero is a cons�ruct�m ianoinV Npency tar I�o pednundnce ui In�: v+ui< to� w:uth Nis pe�mil is issuetl. i$ec. JO�J7 Civil CoUo�. 1.onJ�:i s PL�nin. Len,lw'-� Adihass' 9iyiieil.uu. � �� Da10: _ OWNER-BUILDEI9 DECLARATIONS: I hoieGy alfirn Ihat miaei penalty ot per�ury ih3t I am E%EMPT FROM THE CON7RnCTORS LICENSE LAW for thr lollowiny rr3asnn (Sec: 7031.5. Business antl Prolnssions Coae: An)' r.iiy or r,ountv wnif.h requires a pe�mil b conSVuc�. aller, im0�o�e. U�:nmli,h. er rePair arry sVucture, pnor lo its is5uance, also rYjuires the apUlican� tor such permit to lile a siynetl s;aleni�nt thB� ho or she is iicensetl pursuanl to Ihe pravisions ol Ihe ConVaciD�s License Ldw (ChaplOr 9 �COmmencing with Settbn 7000) of Division J ol lhe S;usiness antl Protessions Co�ie) or mat he c: she is uxomp� thnretmm an� the basis tor Ihe annyatl eaemphon. Any violetbn ot Saction 7031.S�by any applicant br a Oermit subp:cis �no apphcanl lo a civil ponalry ol no; mora tban hve huntlretl aollars �55C01.1: , � . ❑ I, as ownnr of Ihe pioneny, or my employees wnh wages as Iheir sole wmpensalion. W ILL UO TME WORK, antl ihe stNctu2 15 no� intended or oReretl tor sale (Sec. ; na�i, Bu,iness and Piolessions Code: The Contraclors Licen;e Law does nol aoply lo an o+vner of property who 6uild9 or Im0«'es Iheieon, and who tloes such Nort. himvatl nr hnrseif or tomugh his or her cwn emGloyees, pmvineA that such unprovanen�9 are not Intanded or oflnred fo� 9818. if, however, Ihe building or impwvenem is soW wilhin one yea c! r.�npielron, Ihe cwnzr-owld=r will have ihe burden ol provmc� that ha or she did nOt �uIW or improve fot puryose ot sale.). ❑ I. a� owncr ci ;m. ��ec; c��y, am ERCLUSIVELv CONTRACTWG WILH IICENSED CONTRACTORS �o crnsirua Ihe projec� (Sec. 7W4, Business antl Pmtessions Cotl_: l he eOnVaeio�s Liaense Law uoos nol aFVlv to an owner o� p�op?ny who builds or Improvn: Ihoreon, and who eonVECts for 9uch prolecl with a wnlraetoe(5) I CBfS? PVlSiIdltl 10 �lle l'.JII�(2C�0I5 �ICEfISE �ftN'S.j. , � , � � . F i ' ❑ I am ex.=.rnpt uneei sec , Business and Protessiona Cotle for this reason: .' SrunaWr::: ' ' Uate: O.vnei ID m:nliad oy uriver', hcense. ❑ Yes � No .. Drlver's L¢ense No: � � �j E�pires: _ _ vaiinca�io� oi �)wne�ship b�� pype oi documom, i.e. � property isr bill or deed): � ' - � � �� _ DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFIGATION: r ❑ I heieby r.en:ty that no excevatbn live (5) or mwe laet in depih m1u whith e pBrson is requireU io Uescend, will Ue maoe m ronneaion with work aulhontotl by tni:' ne�mlt, ancf Inat no builtling siructure: scaHoltlmg, talsewoiN, or domolHion or tllsmaMing therer.L �vol be moie ihan Ihlny-sc� (96) teel nigh. (Chap. 3.2. Grp 2, nn 2, Se[ :fa L �i�te 9, Califomia Administrative Cotle�. . � . ., i ❑ As ownni-budJor, I will not employ [uryone lo tlo woA which would requirA a pnrmit Irom rt�e Uivison ot Indu:Arial Salaq�. as noiecl above. unless such porsor has a p�nm� tu w suCh wark ham Ihe divisiun. . � ;Siynobne: ____ �a�o', Uwisron o: Indusin:il Salery Permi� Num6er. � � � � . . __. _-_—___— H4ZARDqU:> MATERIALS AND EMISSIONS CERTIFICATION: i N.ill Ihn ;qiplu;ant 0� Dr0%nt Or NIu�O butltlinq ocwpant nontl lo hle nnd r.,r�ily a 8itiino,s Pl�n lui enmrpuncy iusUonse lo r�iloase or throalenxtl reloas? ol e ha: artlons -mieiiai? ❑ Yes ❑ No % (Secbon 2550; o• Ihe GalilornidHeal�h antl Sa�my CnUe reqvires. wnh soim� e,;�uua:s. Va:t a Busness PIHn be IileA wi;h me CuSie Mesa Fire Uepartmen� bv ew:ry Gu^.inosc y�nir.h hns d�'any Ono Inno Ounng a iCponetl yeai a �juaniily OI hltdr<lous ma1Pn..JS n,yuql W Or 4iBater Ihdn a we�Gh� ol SOU pounJs, or a voiume ol 55 i�^ullon5, o� 200 cuhic 1ee1 ol compresseA yas at s:antlaio iemperamre and pressure�. ' .......,,. , .............. .,........_. . ........ ... . ..... ........ ........... ......... ... ... ..... ........... . . . ....................... . O.�.e or .vdl Ihe npplir.anl or pie.eni o� �u W re bui�dinq occupanl neetl In �ile a royi5lnllon tonn �or aCuicly hn�adou5 malnnals? ❑'/es ❑ No lSnruon 2:i;93 ot rtre Gditomin Heallh antl Sa�e:y Cotle, with soino e.ceV��ons. requuog rnqisuulion wBh �ne Costa Mesn Fira Uopanmant Ly each businnss whicl: at any i��n prnr. htr,: nn harnl �.� nunnlny o� ar.nloly �aiartlous matnr6�ls eouai to rn qrontor ihan n woi3M nf 5f10 pnunns, or a volumo o� 55 gallon5. or 200 tubic fAel ol ccmore;sun �ias at st:,�nnrtl taniparnwie antl oressuret .... .... ................... .. . __....... . ................. .._.........._. ....__.. .._. .....,, ... ......._......... .. ........_.. ... .........,.... ,.,.... _.........,..... .............__.._.... j D:ms ar .rll IhC:�ppliGm� or p;�;<�pi or IuWre UUiltiin9 o[CUnanl nend W prnp:ue an RIAFP jili54. }danapentenl and PrBveNion Prograni br aLulely haZardUus malelals�? ❑ v,;9 ❑ r�� 15�!cunn 7557A ni Itic C.ddornia Health antl Snlely Gotlo provLms �hat Ihe Cusla Mesa Fuo Cnpamm�m mav requlie thn [roparallon. corldwa�ion and iding wi�h I�o Firo �. i)opartmont u1 an HM1�PP by businasses which ar� �e��ufietl b rBVisler.iculely h:aartlous mTk;iials ailh Ine Fiie Uepartmnnl. . . ... ... .._ ........ .. .................. ... .. ...... ..... .. _...._......... .....,.... ..... . .. .... , .... ..,,,. „ .,,,...... ....,............. ...... ............... .. ......... .......... .�� 1! <m RM11PP ia u�esenUy requvnd, has Secuon 255:w ol tne CalJomia Mealih aM Salety Cotle bcen `ully mmpbea wi�h? ❑ Y'es ❑ Nu . ............. .... . . ................ . . _.........._ ...... _..... . _.... ...... __... .. . ....,... ........... .................. ..... .._...._... ..._......_...._........._ I� I l,�er, oi adl Ilie ,�{iplica�tl o� DnJseif or lulure UudJiny ocCUPard requu� I[• Ine wcrM whu,b iE �hv S�bp3d OI Ihis d U��cBtion B $ermii lor such consirur.tion oi motli'icalion � tinirv ;ho SovVi Coa:� Aii Gualny ManuVemen� Oisldc� o� imm env olhm uir yullulium m�Cof ;1�shict cr egenGy� � Vtls �J No (`�oclion 55H50,^ n� Ihe CalJofnia Govemmen� Cotle fequilES lhd� Ih0 �2QuP5�E�1 inbrm3lion ile Ipntished on apP�icalions lot non-rosldun�ial buiiding pormits�. . ....._.. . .... _ ........ ....._._..... . ...__.._.. _.. _.... __.. _.. . . ........... ..............,.. ._....... _......... .. .. . ........... _....... G 4� II di V�� ! ��ul ty ,o be consmaetl an�et Ihis pe�mii b0 wrthin 1000 (6,� �rom 11'�e uu er b0�n�ario5 ol a Sthool? ❑ VOs ❑ Ivo ill'y05", thr. IncihPi musl meel IhB reqmremeni o' Secticns 2553d anc 4230J ol Ibe Galdornia HeaIN and Salely Code�. ... . .... ... .. . .. _.___ .. ..... ... ... ... ...._..._. ....... ........ . ... __ . .._.. _ . ... P a � erm' tr m ihe �owh Coast Air quali;y IJanogement Dis nc� or�aher ai oollu.ien o rzol tlutnct or aGPncy is roquired (or ihia work whic� is Ihe subject ol mis ?� {�.ati n, h.!va JI nl Ihe tllsclosures prescnbad by CelBomia HgaltY� antl SateN CoJe Se �uon e2�D0 bee i matle� ❑ Yes ❑ No _. . ....... _...__ _. . __ _ . ...._ ._._..__. _....._ .. . ......... ........._...... _...._ ........ . .... P. 111 y� i, aVach � i tl �icaic ul Gompfianc. bOm Ihe appmpria�2 a r p011uhOn cOniml O�li.ei I CEF � IFIC0.IE GF COIdFUl.NCE I u:rtity that under pena0y o� perjury �iie.imorma;ion yrven aoovs is mnea. i agree w comply w��h all =_late laws and cily oramances regar�hny F�a.:artlnus �Aalenals aritl Emis;ions. Sign::lura: Gale: CERTIFICATL OF CO�dPLIANCE AND AUTHORIZATION OF EMRY: I cervty unA?� penalty m G�'r�urv I�al I have read Ihis applicatwn antl stata tha� ihe inlorma�ion qiven is ::UIIBCi. ' iql+!1! IO COI'iply •.41Ih illl SIdiO IdWS df10 C1I}' O�tl1020CB5 lfllillillp 10 �lilk11f1(� COfLY11L11?fI.:IN1 al1I1110fILC f2uf25CIV2�1VP$ 01 IhP. CIIY O� C.USid M25d IO Cftl2f UU0�1 II1C nl)0✓o OescnUcO ;proL.^.�I'/ tor mspeclicn porpeses. I uy�ee nol lo ocr.upy or allo�x nccupam.y ol ;inv bwltlin�7 aumorizeel by Inis pErmit untll Ilnal inSpOction. 9yna��ua OI Lonal Ownor�sl �nU�Or AuthOnlUO AppLcant G,OD�� IN3F[CiIQiiYPE �hlti f''Ixed Sys'i0m Fin;J Fi�e Piev4nlinn t2fi�i VoolSpe'Flnal 200 Final Re-Roc� � ` . . , . . 20I Finel 81ock/Retaminy Vlall 20J . Finel Fecwry Fiio Placa '� .'!f� Final Sign - � . pnn Findi �emMilion . � pAiE IN ITIAL -... 1 A . / � � � JO[�E� IN$pE;TiONTVPE :;II� FiOill h1CChdfllf,iil �OB Final Plum6ing � . 210 Finel Elecirical � ' � � 212 Final Fire Preventlon ' 220 Final Plenning Approval ?.22 , Finei Si�� 250 Finnl �uiltlniWCccupanty � Lrtu ..' ' _' �. __ , -- , ' -- -J.- '�- Ai.l�; (714) 754-5273 • Fax (714) 754-aB56 • wviw.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 406 E 20TH ST Suite No Vicinity: Parcel Nunmber: 42624132 npp�icant: GRODSKE, STEVE Address: 2737 S CRODDY SANTA ANA, CA PLUMBING PERMIT Phone: 562-598-0745 Zip: 92704 Owner: FARRAGE, DAVID Address 406 E 20TH ST Phone: 949-5483345 COSTA MESA, CA Zip: 92627 Contractor: COAST ROOTER PLUMBING HEATING 8 AIR CONDITIONING Address: 2737 S CRODDY Arch / Eng : Address: STE D SANTA ANA, CA CHANGE OUT WATER HEATER. ISSUE FEE Backflow irrigation BackFlow Preventer Bathtub Clarifier System Connect (Ice,Soda,etc) Dental Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Drinking Fountain Expansion Tank Gas Earthquake VaNe Gas (t-4 outlets) Gas (Over 4 outlets) Gas Repipe Gas Service Interceptors (Grease, Oip Interceptors (Sand Auto ) AMT $23.50 $0.00 so.00 $0.00 50.00 50.00 $0.00 $0.00 so.00 $0.00 $0.00 50.00 50.00 50.00 50.00 $0.00 $0.00 $0.00 $0.00 50.00 QTv Phone: (714)241-1414 Zip: 92704 License: 529127 Phone: Zip: License: SCOPE OF PERMIT FEESUMMARY AMT Laundry Tub I Washer $0.00 Landscape Irrigation $0.00 P-Trap $0.00 Pressure Regulator 50.00 Process Piping (per 10 ft) 50.00 Receptors 50.00 Septic Tank 50.00 Sewer Cap for Demo $0.00 Sewer Connect $0.00 Sewer Private Line $0.00 Shower 50.00 Sink, bar $0.00 Sink, commercial $0.00 Sink, Floor $0.00 Sink, kitchen $0.00 Sink, service/mop $0.00 Spa (private) $0.00 Spa (public) $0.00 QTY 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 COMMENTS / SPECIAL CONDITIONS Status: ISSUED Applied: Oi/02/2002 Issued: 01I022002 ISSUED BY: • ' � i ./ ��/ •' SumpPump Swimming Pool Trap Primer Urinal Vacuum Brkr Bkflow(1-a) 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 AMT $0.00 50.00 50.00 $0.00 50.00 $0.00 50.00 50.00 $0.00 $0.00 $12.30 50.00 50.00 $0.00 50.00 $0.00 $0.00 $0.00 50.00 TOTAL CALCULATED FEES: 535.80 QTY 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 C NOTICE: The work authorized by th(s permit shall comply with all applicable handicap access requirements under Califomia statutes and related regutations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expira antl become void II work is not commenced within 180 days, or if work is suspended or abantloned for a period of 180 days. INSPEC710NS: In order for the work authorized under this permit to be wnsldered legal, such work must comply with all applicable codes, and ell requlred Inspeetlons end finel epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of ihis permit. FOR INSPECTIONS CALL: (714) 7545626 za�e�s�aoo� WORKERS'COMPENSAnON DECLARAnON: I hereby aflirm under penelry ot perjury one of the followinq tlecleretions: � ❑� I have entl will melntain e certificate oi consent ro self-Insure for workers' compensetion, es provitletl for 6y section 3700 of tha LaDor Code, for the peAartnance oi Ihe work for w�ic� this pertnit is issuetl. ' ❑ I heve end wlll meintaUi workers' compensatlon insurance, es requiretl by section 3700 0l Ihe LBUor Code, tor Iha partortnance ol the work for w�kh Nis pertnit is iswed. My warkers' compensatlon Insurance carrier antl pollcy number ere: Certier: Poliry Number: (ihis secHon need nat be awnpleted i� tne permir �s ve�ued et one hundred dW�ers (S l00) or less.) ❑ I certify Ihel in the pBAormance of l�e work lor which this pertnit is issued, I shell not empl0y eny person in eny manner so as to hecome SuD�ect to Ihe warkers' compensatlon laws ot C m a d egrae that It I s�oulE Decoma subject to the workers' compensetion provislons of Seaion 3700 of Ihe Lebor CoAe, I shell fonhwith comply wit� t�ese provi ns. Applicant SlgneWre: De1e: /� y� v �� WAqNINp: FAILURE TO SECUflE WORKE ' C MPENSATION COVERAGE IS UNUWFUL AND SNALL SU&IECT AN EMPLOVER TO CRIMINAL PENALTIES AND GVIL FlNES UP TOONE MUNDRED THOUSAN� DOI.LARE (5100,OW), IN ADDITIQV TO TIIE COST OF COMPENSATIpJ, DAN.4GES AS PFOVIDED FOR IN SECTION 37060F THE IABOR CADE, IMEREST, AND ATTOfiNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby eflirm thet I em Iicensetl r provisions of Chapter 9(commencing with Sectlon 7000) of Divislon 3 0l the Business and Professions Cotle, end my Iicense is In tull torce and eflect. Llc. a Class x Camrecrols Signeture: Dete: �— 2� U J� CONSTRUCTION LENDING AGENCY: ❑ I �eraby eflirtn t�at there is a constructian IenAing agenq tor Ne peAormance ot ihe work for which Ihis partnit is issued. (Sec. 3097, Qvil Cotle). Lendors Nama: Lenders Address: Signawre: � Date: OWNER•BUILDER DECLARA710NS: I hereby aHirtn thet under penalry ol perjury that I em E%EMPT FROM THE CONTRACTORS LICENSE LAW lor Ihe following reason (Sec.7031.5, Business antl Professions Code: Any ciry or counry whicti requires a permit to construct, elter, Improve, demolish, or re0eir any structure, prior to its issuance, also requires the applicant for such pertnit to tlle a signetl slatement Ihal he or she is Ilcensetl pursuant lo Ihe pravisions ot the Conlrectars IJcense Lew (Chapler 9(wmmencing with Sectlon 7000) oi DlNsion 3 oi Ihe Business and Protessions Cotle) or that he or s�e is e.empt therefrom end the basis for the eliegad e:emption. Any violetion of Section 7031.5 by eny epplicent for e pertnit sublects tha epplicent to e civil penalry at not mare Ihen five hundred dollars (5500).): ❑ I, as owner ot t�e properry, or my employees with weges as Iheir sole compensetlon, WILL DO THE WORK, antl the struclure I5 noI Intentletl or offered tor sele (Sec. 7044, Business entl Professions Code: The Contrectors License Levi does not apply to an owner ot properry who builds or improves ihereon, entl who does such work himsetl or �erself or through his or her own employees, provided Ihat such improvemenis are not intended or oHeretl for sale. It, however, ihe builtling or improvemenl is sold within ona year ot completioq the owner-builder will heve the burden of proving that he or she did not build or improve for purpose ot sale.). ❑ I, es owner ol the property, am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to consirucf the project (Sec. 7044, Business and Professions Code: The contractors License Lew does not apply to en owner of property who builds or im0�oves thereon, entl who coniracts tor suc� project with a contrecior(s) license pursuant to lhe Conlracbrs License Laws.). ❑ I em exempt under sec. Business and Professions Coda for Ihis reeson: SignaNre: Data: Owner ID varlfietl by tlrivar's license. ❑ Yes ❑ No Drivers License No. Verificetlon ol Ownership by (rype of daument, I.e. - properry tax bill or deetl): DIVISION OF INDUSTRIAL SAFETV VERMIT CERTFICATION: Expires: ❑ I hereby cortify that no e:cavation live (5) or more feel in tlepth into which a person is requirea to descen0, will be mede in connection with work euthodzed by this permit, end that no building sWcture, scaXoldinp, falsework, or demolition or dismantling Ihereot, will be more Ihen Ihirry-six (38) leet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Ttle B, Celifomie Atlministretive CaAe). ❑ As owner-builtler, � will not employ enyone ta do work which would raquire e pertnit from lhe Division of Industnal Sefery, as notetl ebove, unless such person has e pertnil lo do suU work Irom the division. Signature: Data: Dlvision oi Intlustrial Sefery Pertnit Number: CER7IFlCATE OF COMPLIANCE AND AUTMOROJRION OF EMRY: I cenify under penalry of perjury that I hava reatl this ap0lication and state that the informalion given is correct. I egree to compty vrith all stete laws end ciry ordinances relating to Duilding cons�ruction, end authodze re0�esenta�ives ot t�e Ciry ol Casta Meu to enter upon t�e ebova-descnbetl property for inspection purposes. I egree nm ro accupy or ellow occupancy of eny building authonzed by this pertnit umil tinel inspection. GODE �. INSPECTIONTYPE 1fi16 Flxetl System Final Fire Prevention 1266 Pool Spa Finel 200 Final Re-Rool 201 Flnel BIocWRetelning Well 202 203 Final Factory Fire Place Finel Sign 204 Finnl Demolilion 0 0 f({j�WC COOE2 INSPECTIONTYPE 206 Final Mechanical 208 Final Plumbing 270 Flnal Electdcal 212 Finel Fire Prevention 220 Final Planning Approval 222 Final Site . 250 . Final Building/Ocwpenq _ ydte Cl � 6 aeg u�s "l l - o� �p� (7�4) 754-5273 • Fax (714) 754-aB56 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 406 E 20TH ST Suite: Vicinity: REAR OF PROPERTY Parcel Number: 42624132 npp�icant: TRAVIGLIA, TONY Address: Owner: FARRAGE, DAVID J JR Address 406 E 20TH ST COSTA MESA, CA Contractor: A. J. CUSTOM POOLS Address: 12342 LOUISE GARDEN GROVH, CA Zip: 92641 Arch : Address: Zoning: Phone: 714-539-5824 Zip: Phone: Zip: 92627-23'I6 Phone: 774-539-SB24 License: 452652 Eng: Address: Phone: Status: ISSUED Applied: 03/24/2003 Issued: 03/25/2003 Phone: Zip: License: License: SCOPE OF PERMIT 330 S.F. INGROUND GUNITE POOL. Plan Check: $181.51 Permit: $279.25 SMIP Res: $1.70 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $462.46 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0-0 PARKING Existin : 0 NOTES: Rear 0- 0 Rear 0- 0 Reauired: 0 FEE SUMMARY PLANNING & ZONING Left 0- 0 Lefl 0- 0 Proposed: 0 Calc Valuation: Claim Valuation Right 0-0 Right 0- 0 sn,000.00 s»,000.00 NOTICE: The work authorized by this pBrmit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12•21•92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work Is suspended or abandoned for a period ot 1 BO days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred inepecNons and flnel epprovel must be obtained. Faflure to o6fain inspections and final approval will result in the expiratfon o( this permit. FOR INSPECTIONS CALL: (714) 754-5628 � WORKERS' COMPENSATION DECLARATION: � ' I hereby aNirm under penalty of perjury one of the tollowing decleretions: ❑ I have end will maintaln a ceeificate of consent to setl-Insure tor workers' compensation, es provided for by section 3700 ot the Labor Code, for ihe pertormance of Ihe wark for which ihis permit Is issuetl. ❑ I have antl wlll maintaln workers' compensation insurance, as requiretl 6y sectlon 3700 W the Labor Code, lor the peAormance ol the work for whic� this pertnit is issued. My workers' comp�nsation Insurence carrier entl policy number ere: Carnec � Policy Number: (This secfion need not 6e cam0/eted il the permit /s valued ef one hundred dollars ($100) or less.) �� I certiiy Ihat in ihe peAormance of the work tor which this permit is issued, I s�all not employ eny person in eny manner so as to become subject to ihe workers' compensatlan laws of Celifoml , d egrae Ihat II I should become sub�act to the workers' compensetion pmNsions of Section 3700 of the Lebor Cotle, I shall forthwith comply with ihese provisio ApplicanlSigneture: Data: ��Z� � � � WARNING: FAIWRE TO SECURE WORK S' CAMPENSATION COVERAQE IS UNLAWFUL AND SHAIL SU&IECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FWES UP TOONE Hl1NDFE0 TFKKISAND DOIURE (5100,000), IN ADDI ON TO THE COST OF COMPENSATION, DPM4GE5 AS PROVIDED WP IN SECfION �OBOF THE LABOR CODE, INTEFEST, PND ATTORNEVS FEES. LICENSED CONTRAC70R5 DECLARATION: I hereby aHirm that I am foma antl eRect Llc. N_ Conirectors SigneNre: ot Chapter 9(commencing with Section 7000) of Division 3 of Ihe Business end Protessions Cotle, and my license is in full Class u 6 — G5 � Date: 3� �j�0 j CONSTRUCTION LENDING AGENCY: ' ❑ I hereby attirm ihat ihere is e consiruction lending egency for ihe pertormance ot the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Neme: Lender's Atltlress: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby eflirm thet untler penalry oi perjury ihet I am EXEMPT FROM THE CONTRACTORS LICENSE LAW tor ihe following reason (Sec. 7031.5, Business end Professlons Cotle: Any ciry or counry which requires e Dermit to consWct, alter, improve, tlemolish, or repair any strucWre, pnor to its issuance, also requires the applicant tor such permit to tile e signed stetement ihet he or she Is licensetl pursuent to the provisions of the Contrectors License Law (Chapter 9(commencing with Section 7000) of Divislon 3 oi the Busineu and Protessions Code) or thet he or she is exempt therefrom antl the besis for the allegetl evemption. Any violation of Section 7031.5 by any applicant for a permit subjects the epplicent to a civil penalry of not more than tive hundred dollers ($500).): ❑ I, as owner of iha property, or my employees with wages as their sole compensation, WILL DO THE WORK, and ihe siruciure is not intendetl or oflered 1or sale (Sec. 7044, Business and Professions Code: The Contractas License Law does not apply to en owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvemenis are not intentled or oHerea for sale. If, however, ihe building or improvement is sold within one year oi completion, the owner-builder will havo the burden oi pmving that he or she did not build or improve for purpose of sale.). � ❑ I, as owner of the pro0erry, am EXCLUSIVELY CONTRACTiNG WITH LICENSED CONTRACTORS to construct iha project (Sec. 7044, Business and Professions Code: The contr[�ctors License Law does not epply to an owner of property w6o builds or Improves thereon, entl who contracts for such project with e coniractor(s) license pursuant to t�e Contractors License Laws.). ❑ I em exemD� under sec. Business and Protessions Cotle for ihis reason: SlqnaWre: Date: Owner ID verifiad by driver's Ilcense. ❑ Ves ❑ No Drivefs Licensa No. Expires: Verification of Ownership hy (type of daument, i.e. - property tax bill or tleedj: DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certity ihat no excevetion five (5) or more feet in tlepth into which a person is required to descend, will be mede in connection with work euthorizeC by ihis permit, antl Ihat no building slrucNre, scallolding, falsework, or demolition or dismantling ihereof, will be more Ihan thirry-six (36) feet high. (Chap. 32, Grp 2, Atl 2, Sec. 341, Ttle B, Calilornia Adminisiretive Cotle). ❑ As owner-builtler, I will not employ anyone to tlo work which would require e pertnit from the Oivision of Indusirial Safery, es noted above, unless such person has e permit to tlo such work irom the division. Signature: Data: Division ot Industriel Safery Permit Number: CERTFICATE OF COMPLIANCE AND AUTHORIIATION OF ENTHY: I certity under penelry ot perjury that I have read this application and sfa�e thal the infortna�ion given is correct I agree b comply with ell state laws end ciry ordinances relating to building construc�ion, end authonze representatives of ihe Gry of Coste Mesa to enter upon the ebove-descn6ed property for inspection purposes. I agree not to occupy or ellow xcupancy ot eny building authorized by this permit until final inspection. 40pE1, INSPECTIONflPE 1616 Fixed System Final Fira Prevention 1266 200 201 202 203 Paol Spe Finel Final Re-Roof Finel BIaWRetaining Well Final Fectory Fire Plece Finel Sign 204 Finel �emoli�ion QAjF INTRIALS 8�L-�+�- � CO�E I INSPECTION TYPE 206 Final Mechanical 208 Finel Plumbing 210 Finel ElecinCal 272 Final Fire Prevention 220 Final Plenning Approval 222 FinalSite 250 Final Building/Occupancy Date 3- z_�-o 3 Date OATE f� (714) 754-5273 • Fax (714) 754-4856 • wwv+.ci.costa-mesa.��LDING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 406 E 20TH ST Suite: Vicinity: Parcel Number: 42624132 Applicant: UNKNOWN Address: Owner: FARRAGE, DAVID J JR Address 406 E 20TH ST . COSTA MESA, CA Contractor: A. J. CUSTOM POOLS Address: 12342 LOUISE GARDEN GROVE, CA Zip: 92641 Arch : Address: Zoning: Phone: Zip: Phone: Zip: 92627-2316 Phone: 714-539-5824 License: 452652 Eng: Address: Sfatus: ISSUED Applied: 04/25/2003 Issued: 04/25/2003 i ISSUED BY: Phone: " Phone: Zip: License: License: SCOPE OF PERMIT INSTALL 34 LF, 6' HIGH, BLOCK WALL APPROX. 17' FROM THE FRONT PROPERTY LINE. Plan Check: $19.24 Permit: $29.60 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $49.34 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 LeR 0- 0 Proposed: 0 Calc Valuation: Claim Valuation: Right 0- 0 Right 0-0 ssao.00 so.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 9248, § 1, 12-21-92) 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 requlred inspeetions and flnal approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2aaba6 (6I00) WORKERS' COMPENSATION DECLARA710N: ' - I hereby eflirtn under penalry of perjury one of the following tleclarations: ❑ I heve antl will maintain e certificate of consent b self-Insure tor workers' compensetion, es provitletl tor by section 3700 of the Labor Cotle, for the pertorm.ance of the work for which t�is permit is issuetl. ' I have and will main�ain workers' cwnpensation insurance, as required by section 3700 of the Labor Code, for the pedortnance of the work for which this permit is issued. rkers' compensatlon Insurence carrler and policy number are: Cerrier� P icy� ber. (�7h�ction neetl not 6e comp/eted il the permit is veluetl at one hundred dollars ($100) ar less.) ❑ I certily that in ihe peAormance ol t1� work for which this permit is issued, I shall not employ any person in any manner so es to become su6ject to ihe workers' compensation laws of Celitor �, fid agree that if I shoultl become subleci ro tha workers' compensation provisions ol Section 3700 ot ihe Labor Code, I shall Forthwith �ea[6oTv�with th85e provisio . \ /, / � '�\ Date: 1 '-F��GJ � � � Applicam Sign ture: WARNIN ' URE TO SECURE WORK ' CQNPENSATION COVERAGE IS UNLAWFUL AND SHALL SU&IECT AN O CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE HUNDRED SANDOOLLARE�510D,000),INAD ONTOTHEWSTOFCOMPENSATION,DAhNGESASPROVIDEDFpRINSECTION3]OBOFTHEL4BORCODE,IfJrEREST,ANDATTORNEV'SFEES. LICENSED CONTRACTORS DECLARATION: ia(I am licensed under provisions ot Chapter 9(commencing with Section 7000) of Division 3 of iness �apd Pm ss�s Cotle, end my license is in full Lic. N Class N /5 �� i iaWre: � �� CONSTRUCTION LENDING AGENCY: ❑ I hereby aHirtn that ihere is e construction lending agency for the pertormance of ihe work for which this permi� is issued. (Sec. 3097, Civil Cotle). Lenders Name: Lentler's Address: Signeture: OWNER-BUILDER DECLARATIONS: Date: I hereby eNirm iha� under penalry of perjury thai I am E%EMPT FROM THE CONTRAC70RS LICENSE LAW for ihe following reason (Sec. 7031.5. Business end Professions Cotle: Any ciry or counry which raquires e permit to wnstruct, elter, improve, demolish, or repair any strucWre, O�or to its issuance, also requires the applicant for such permit to lile a signad statement thal he or she is licensed pursuem to the provisions of ihe Contractors License law (Chapter 9(commencing with Sectlon 7000) ot Division 3 oi the Business and Professions Code) or t�ei ha or she is enempt thereirom and ihe basis for the alleged ezemption. Any violatlon ot Saction 7031.5 by eny applicant for a permit subjects Ihe applicant to e civil penelry oi not more ihan fiva hundred dollars (5500).): ❑ I, as ownar of Ihe property, or my employees with wages as ihair sole compensation, WILL DO THE WORK, and the simcture is not intendetl or oNeretl tor sale (Sec. 7044, Business antl Protessions Code: The Contradors Licensa Law does not apply to an owner oi property who builds or improves thereon, and who tloes such work himself or hereelf or through his or her own employees, provided that such improvemems ere not intended or ofleretl for sale. If, however, ihe building or improvement is sold within one year of completion, ihe owner-builder will have iha 6urden of proving ihat he or she did not build or improve for purpose of sala.). � ❑ I, as owner of ihe property, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sac. 7044, Business end Professions Code: The contracbrs Licanse Lew tloes not apply to en owner of pmperty who builtls or Improves thereon, entl who contracts tor such project with a contractor(s) license pursuant b the Coniractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID veritied by dnvers license. ❑ Ves ❑ No Dnvers License No. Verification of Ownership by (rype oi daument, i.e. - properry tax blll or deed): DIVISION OF INDUSTRIAL SAPETY PERMIT CERTIFICATION: Expires: ❑ I hereby certify that no excavetion fiva (5) or more teet in tlep�h into which a person is required to descend, will be made in connection with work authorized by ihis parmit, and ihat no building stmcture, scaHolding, talsework, or demolition or tlismantlinq �hereof, wiil be more ihan thirty-siz (36) teet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title 8, Califomia Administrative Cotle). ❑ As owner-Duilder, I will not amploy anyone to do work whic� would require a permit from ihe Division of Intlustriel Safery, as notetl above, unless such person has a pertnit to do such work from ihe division. SignaWre: Dare: Division of Industnal Safery Permit Number: CER7IFICATE OF COMPLIANCE AND AUTHORIZA710N OF ENiAY: I certify untler penalty of perjury ihat I have read this epplication and state thet the intortnation given is correct. I egree to comply with ell state laws end ciry ortlinances releting to building consiructlon, and authonze representatives of Ne Ciry of Costa Mese to enter upon Iha above-described property for inspection purpases. I agree not to occupy or allow occupancy of eny building authorized by this permit until tinal inspection. COUE �, INSPECTIONTYPE 1616 Fixetl System Final Fire Pravention 1266 Pool Spa Final 200 Final Re-Roof 201 Final BIocWRetaining Wel� 202 Final Faciory Fire Place 203 Final Sign 204 Final Demolition psg iarm��s SODE� INSPECTIONTYPE � 206 Final MeChaniCal 208 Final Plumbing 210 Final Electrical 212 Final Fire Preven�ion 220 Final Planning Approval 222 Final Site 250 Final Building/Occupency PDI€ � ��u�!I�F (714) 754-5273 • Fax (714) 754-4056 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 406 E 20TH ST Suite No Vicinity: Parcel Nunmber: 42624132 Applicant: TRAVIGLIA, TONY Address: 12342 LOUISE GARDEN GROVE, CA Owner: FARRAGE, DAVID J JR Address 406 E 20TH ST COSTA MESA, CA Contractoc A. J. CUSTOM POOLS Address: 12342 LOUISE Arch / Eng : Address: ISSUE FEE BackFlow irrigation Backflow Preventer Bathtub Clarifer System Connect (Ice,Soda,etc) Dental Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Drinking Fountain Expansion Tank Gas Earthquake Valve GARDEN GROVE, CA PLUMBING PERMIT Phone: 714-539-5824 Zip: 92641 Phone: Zip: 92627-2316 Phone: 714-539-5824 Zip: 92641 License: 452652 Phone: Zip: License: SCOPE OF PERMIT 330 S.F. INGROUND GUNITE POOL. REF.: B03-00466 AMT $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $o.00 $0.00 $0.00 $0.00 FEE SUMMARY QTY AMT � Laundry Tub / Washer $0.00 0 Landscape Irrigation $0.00 0 P-Trap $0.00 0 Pressure Regulator $0.00 0 Process Piping (per 10 ft) $0.00 0 Receptors $0.00 0 Septic Tank $0.00 0 Sewer Cap for Demo $0.00 0 Sewer Connect $0.00 0 Sewer Private Line $0.00 0 Shower $0.00 0 Sink, bar $0.00 0 Sink, commercial $0.00 0 Sink, Floor $0.00 �TY 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Status: ISSUED Applied: 03/25/2003 I ssued: 03/25/2003 ISSUED BY: C� SumpPump Swimming Pool Trap Pnmer Urinal Vacuum Brkr BkFlow(1-4) Vacuum Brkr BkFlow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (Toilel) Wa[er Heater / vent Water Piping (Inst or Rep.) Water Re-pipe Water Service AMT $0.00 $60.75 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 QTY 0 1 0 0 0 0 0 0 0 0 0 0 0 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-27-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 7 BO days, or if work is suspended or abandoned tor a period of 1 BO days. INSPEC710NS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the ezpiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 zaas-as ��ao� WORKERS'COMPENSAnON DECLARAnON: — I hereby attirm untler penalty of perjury one of ihe tollowing tleclarations: ❑ I heve end will maintain a certificate of consent m self-Insure for workers' compensation, es provitletl for by section 3700 of the Labor Cotle, for ihe pertormence oi the work for which ihis permit is iSsuetl. ❑ I have and will maintain workers' compensation insurance, as required by section 3700 oF the Labor Code, For the perfortnance of the work for which Ihis permit is issuetl. My workers' compensation InSurance carrier and policy number are: Carner Policy Numbec (This secNon need not be completed �� the' p�e1rmit is valuetl at one hundred dollars ($700) or less.) � I ceniry that in the pedormance of tRa ork for which this permit is issued, I shall not employ any person in any manner so as to become subject to ihe workers' compensation laws of Calitor la, dd gree that if I should become sub�act to the workers' compensation provislons of Section 3700 of ihe Labor Cotle, I shall forthwith comply with these provision r �—��_ O� ApplicantSignaWre: - Date: WARNING FAIWRE TO SECl/RE WORKER ' COMPENSATIDN COVERAGE IS UNLAWFlIL AND SHALL SUBIECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND DOLLARE (5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMFGES AS PROVIDED F-0F IN SECTION 3]O60F THE LABOq CODE, IMEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DEC4AAATION: I hereby aHirm that I am force entl eNect Lic. # _ GontracbYs SignaNre: CONSTRUCTION LENDING AGENCV: of with Saction 7000) of Divislon 3 ot ihe Business and Professions Code, antl my license is in full Class a �J' �`��J _ Date: 3' z�— � � ❑ I hereby aflirm ihat ihere is a Construction lending agency for the peAormance oi the work tor which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby aHirtn that under penalry of Perjury Ihet I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for ihe following reason (Sec. 7031.5, 8usiness antl Professions Code: Any city or counry which reqoires e permit to constmct, alter, Improve, demolish, or repair any structure, pnor to its issuance, also requires the epplicant for such pertnit to file a signed statement ihat he or she is licensetl pursuant to Ihe provisions of Ihe Coniractors License Lew (Chapter 9(commencing with Section 7000) of Divislon 3 of iha Business end Professions Coda) or that he or she is exempt therefrom and the basis for the allegetl exemption. Any violation of Section 7031.5 by any applicent for a parmit subjects the applicant to a civil pena�ry of not more than five hundred dollers ($500).): ❑ I, as owner of the property, or my employees with wages as iheir sole compensation, WILL DO THE WORK, and ihe structure Is not intentletl or oXered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of propehy who builds or improves ihereon, and who does such work himsetl or herself or through his or her own employees, provitlad that such imp�ovements are not intended or oHe�ed tor sale. If, however, ihe 6uiltling or impmvement is sold within one year of completion, ihe owner-builder will have the burtlen of proving ihat he or she did not build or impmve for purpose ot sala.). � ❑ I, as owner of the property, art� EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the prqect (Sec. 7044, Business and Professions Code: The coniractors Licens6 Law does not apply to an owner oi property who builds or improvas thereon, and who contracis tor such project with a contrector(s) license pursuant to the Contra�tors License Laws.). ❑ I am exempt under sec. Business and Protessions Code for ihis reason: Signature: Date: Owner ID venfied by tlriver's license. ❑ �es ❑ No Driver's License No. Veritication of Ownership by (type ot document, i.e. - properry tax bill or deed): Expires: DIVISION OF INDUS7RIAL SAFET�' PERMIT CERTIFICA710N: ❑ I hereby certify that no excave�ion five (5) or more teet in tlepih into which e person is required to descend, will be made in connection with work authorized by this permit, and that no builtling sifucNre, scaffolding, talsework, or tlemolition or dismantling thereof, will be more than thirty-siz (36) feet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Title e, Califomia Atlminis�rative Cotle). ❑ As owner-builtler, I will not employ anyone to do woric which woultl require a permit from ihe Division of Indusirial Satery, as noted above, unless such parson has e permit to do such work From the division. SignaNre: Date: Divisian ot Indusirial Satety Permit Number: CERTIFICATE OF COMPLJANCE ANO AU7}10RIZA710N OF ENTRY: I certi(y under penairy of perjury that I hava read this applica�ion and state ihat the infortnation given is correct. I agree to comply with all slate laws and city ordinances relating to building construction, antl authodze representatives ot ihe City of Costa Mesa to anter upon the above-describad property for inspection puryoses. I egree not to oc�fpy or allow occupancy of any building authorized by this permit until tinal inspection. LOUEN, INSPECTIONTYPE 1616 Fixetl System Final Fire PrB�ention 1266 Pool Spa Final 200 Final Re-Roof 201 Finel BIocWRetaining Wall 202 Final Factory Fire Place 203 FinalSign 204 Finel Demolition pRTE INTRIAL CODEN INSPECTIONTYPE � 206 Final Mechanical 208 Final Plumbing 210 Final EleCiriCal 212 Final Fire Prevention 220 Final Planning Approval 222 250 3 -2.�-03 Date Final Site Finai Building/Occupancy QgjE INTITIALg (714) 754-5273 • Faz (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DAIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT ,lob Address: 406 E 20TH ST Suite No Vicinity: Parcel Nunmber: Applicant: Address: Owner: Address REAR OF PROPERTY 42624132 TRAVIGLIA, TONY 12342 LOUISE GARDEN GROVE, CA FARRAGE, DAVID J JR 406 E 20TH ST COSTA MESA, CA Contractor. A. J. CUSTOM POOLS Address: 12342 LOUISE 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 thp Motors to 10hp Mators to SOhp Motors to 100hp Motors over 100hp Communication drops Sub panel eo 200a Pole Light Pkg Sign Circuits GARDEN GROVE, CA Phone: 714-539-5824 Zip: 92641 Phone: Zip: 92627-2316 Phone: 714-539-5824 Zip: 92641 License: 452652 SCOPE OF PERMIT 330 S.F. INGROUND GUNITE POOL. REF.: B03-00466 $23.50 $0.00 $0.00 $0.00 $0.00 $49.50 $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 $0.00 $0.00 $0.00 $0.00 Quantity FEE SUMMARY Temp Dist System / Lighting Busway /100 ft Standing Section Misc ElecMcal Equipmen[ Transformers 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 lights) Christmas Tree Stand Fireworks Stand Other Electrical Fee Investigation Fee Plan Check Fee Reinspection Fee Status: ISSUED Applied: 03/25/2003 Issued: 03/25/2003 ISSUED BY: Quantiry $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 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 9248, § 1, 72-21-92) EXPIRA710N: 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 Inspectiona and flnal epproval must be obtained. Failure to obtain inspections and final approval will result in the ezpiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 zaassa(voo� WORKERS'COMPBNSATION DECLARATON: — I heraby eNirm untler penalty ol perjury one of the lallowing declarations: ❑ I heve end will meintain e certificate of consent lo self-Insure tor workers' compensatlon, as provided for by sectlon 3700 of the Lebor Cotle, for Ihe peAormance ol the wark tor w�ich this permit Is issued. ❑ I have antl will meintain workers' compensetion insurance, as reQuired by section 3700 of the Lebor Cotle, lor the perfortnance of the work for which Ihis permit is issuetl. My warkers' Compensatlon Insurance carder and pollcy number ere: Cartler. Poliry Number: (fhls sectian neetl nOt 6e completed i! fhe pertnit 75 valued et one huntlretl dollers ($700) or IessJ �I certity thel in the peAortnance of Ihe � rk tor which this peimlt Is issueQ I shall not employ eny person in any manner so es to becnme su6ject ta the workers' compensetlon laws of Celitomia, en0 gree I�al il I should hecome suD�act to Ihe workers' compensetlon proNslans of Sectlon 3700 of the LeDor Code, I shell forthwlth wmO�Y with Ihese proWsions. .[�,. Applicant SigneWre: Dete: _ � � z �G/ � WMNINQ:FAILURETOSECUREWOW( COMPENSATIONCAVERAOEISUNLAWFULMIDSHALLSUBJECiMIEMPLOVERTOCPoMINALPENALTESANDCIVILFlNESUPTOONEHUNDRED THOUSANDOOLLARE(4100.000),INAODfTI TOTHECOSTOFCOMPENSATION,DAA4IGESASPROVIDEDFORINSECTION3'7080FTNELABORCODE,IMEPEST,ANDATfORNE`fSFEES. LICENSED CONTRACTORS DECLARATION: I hereby afllrtn Ihat I am Ilcensetl under pmvisions ot Chapter 9(co�mencing with Section 7000) oi Didsian 3 oi the Business and Professlons Code, entl my license is in full force end enect. uc.» �{5Z-loSZ _// �� /� —GS3 ContreaorsSignawre: Date: ��7�—�Z CONSTAUCTION LENDING AGENCY: ❑ I hereby aHirtn thel lhere is a constructlon lending agency for the peAormanca ol the work tor which Ihis pertnit is is3ued. (Sec. 3097, Civil Catle). Lentler5 Neme: LentleYs AtlGress: Signe�ure: Date: OWNER-BUILDER OECLARATtONS: I here6y eHirm Ihet uhtler penalry ot perjury thet I am E%EMPT FROM THE CONTRAC70RS LICENSE LAW tor the following reason (Sec. 7031.5, Business entl Professions Code: Any ciry or cou��y which requires a permit to consiruct, elter, improve, demolish, or re0alr eny stmcture, prior to its issuance, elso requlras the epplicaN for such pertnit to tile e signetl stetemeN thet he or she is Ilcensetl pursuant to Ihe provlsions of the Contrectors Llcense Lew (Chapter 9(wmmencing with Sectlon 7000) ol Divlsion 3 at the Business end Prales5ions Code) or that he or she Is exompt therefrom antl the basis for the alleged exemptlon. Any violetlon af Saction 7031.5 by eny epplicent lor a parmit sub�ects t�e eppllcent to a civil penalry of not more than tive hundretl tlollars ($500).): ❑ I, es owner ol tl+e properry, or my employeas wiih wages es thelr sole compensation, WILL DO TNE WORK, and ihi> strucNre is nol In�enOed or ofleretl for sale (Sec. 7044, Business antl Professions Code: The Contractors License Lew tloes not apply to an owner of properry who builds or Improves thereon, and who Aces such work himself or hersetl or through his or her own employees, providetl that such improvements ere not IntendeA or oflered for sale. It, however, ihe bullding or improvement is sold within one year oi completion, the owner-buildor will heve the burtlen of Dmving that ho or she did not build or improve tor purpose of seleJ. � ❑ I, as owner of the property, am E%CLUSIVELV CONTRACi1NG Wf7F1 LICENSED CONTRACTORS to wnstruct the projec� (Sec. 7044, Business enC Profeuions Code: The contlectors License Law Aoes not epply lo en awner oi properry who builds or improves Ihereon, anA w�b contrects lor such prolect with a contrector(s) licensa pursuanl to the Contracbrs Ucense Lews.). ❑ I am ezempt under sec. Business and Profeuions Cotle for Ihis reason: _ SlgnaWra: Date: Owner ID verifietl �y d��er's license. ❑ Ves Q No Drivers License No. Expires: Vedilcation of Owner5hip by (rype af tlocument, I.e. - property tax bill or �eed): DIVISION OF INDUSTRIAL SAFETY PERMI7 CER7IFICATION: ❑ I hereby certify Ihe� no excavetion five (5) or more �eat in depth into which a person is requiretl to descend, will be me.de in connec�ion wlth work euthorized by this permli, and Ihat �o building stmcture, scaHolding, lalsework, or demolition or dismantling Ihereot, will be more Ihan U�irty-six (36) feet high. (Chep. 32, Grp 2, Art 2, Sec. 341, Titla B, Celi�omia Adminisiretive Cotle). ❑ As owner-builde�. I will not employ enyone ta do work which would require e permil Irom the Division of Intlustrial Satery, as notetl ebove, unless such person has e permit to tlo such work irom iha division. Signeture: Oate: Divislon ot Indusirial 5alery Pertnit Number: CER7IFlCATE OP COMPLIANCE AND AUTMOHVA710N OF ENTRV: I cehify untler penalry ot perjury thet I have read this appliwtion entl state that the iniortnation given is correct. I egree to coMply with all stete laws entl ciry ortlinences releting to building conswction, antl authodze represenlatives of Ihe Clry of Coste Mesa lo enter upon the ebove-descnbed pmpe�y �or inspection purposes. I egree not 6 occupy or allow occuDancy of any building euthonzed by this permit until tinel inspection. Signature Of Legal Ow er( 3`�Dajg p3 5 AnNOr Au nzed pli Date 40DE t. INSFECTIONTYPE PA1E INTRIALS 1618 Fixed System Final Fire Prevention 1288 200 201 202 203 Pool Spe Fin01 Flnel Re-Roof Flnal BIocWRetaining Wall Final Fectory Fira Place Finel Sign 204 Finel Demdition COUEN INSPECTIONTYPE 206 Flnal Mechanicel 208 Finel Plumbing 210 Finel Electrical 272 Finel Fire Prevention 220 Finel Planning Approval 222 Final Site 250 FinalBuildinryOccupan,ry � �$ ; • �Z (714) 754-5273 • Fax (714) 754-4856 • Www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Adtlress: 406 E 20TH S7 Suite No Vicinity: Parcel Number: 42624132 Appliwnk Address: Owner: TRAVIGLIA, TONY 12342 LOUISE GARDEN GROVE, CA FARR,4GE, DAVID J JR Address: 406 E 20TH ST COSTA MESA, CA Contractor: Address: A. J. CUSTOM POOLS 12342 LOUISE GARDEN GROV�, CA MECHANICAL PERMIT Phona: 714-539-5824 Zip: 92641 Phone: Zip: 92627-2316 Phone: 714-539-5824 Zip: 92641 License:452652 SCOPE OF PERMIT 330 S.F. INGROUND GUNITE POOL. REF.: B03-00466 ISSUE FEE Inst FAU <100 k BTU Insl FAU >100 k BTU Repair/Alt Cooling/Heat Insl / Rep. Recess Wall Hlr Refrig Sys <100 k BTU Refrig Sys >100 k BTU Gas Pipin9 Factory Fireplace Hood w/Mech Exhaust VAV Box Vent Fan / Single Duct Appliance Fire Dampers Smoke Dampers Inst or Relocate Appl Vent Air Handlers < 10000cfm AirHandlers> 10000cfm Floor Furnace Floor or Suspend Heater $23.50 $0.00 $0.00 $O.OD $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 �uantity FEE SUMMARY Repair / Alt Absorbtion Unil Repair / Alt Refrigeration Unit Venlillation Syslem Evaporative Cooler Commercial I n ci nerator Domestic Incinerator Compressors / Absorption Svstems Upto3hp/100kBTU 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 Upto3hp 3To15hp 15to30hp 30 to 50 hp Over 50 hp Other Mechanical Fee Investigation Fee Plan Check Fee Reinspection Fee Status: Applied: tssued: ISSUED 03/25I2003 03/25/2003 i,� / ■ • `��/ Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $27.15 1 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 TOTAL CALCULATED FEES $50.65 NOTICE: The work authorized by this pgrmit shall comply with all applicable handicap access requirements undar California statutes and related regulations. (Ord. No. 92-28, § 1, 7241-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 780 days, or if work is suspended or abandoned tor 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 requfreU inspectlons and final approval must be obtained. Faifure to obtain inspections and final approvai will result in the expiration of this permit, j FOR INSPECTIONS CALL: (714) 7545626 . I xaaaao �tiw� WORKERS'COMPENSAnON DECLARAnON: I hereby aHirm untler penalry of per�ury one of the IWlowing declarations: ❑ I have anA tll meintain a cetlificd�e of consent to self-Insure tor woBers' compensailon, es prodded for Uy sectlon 3700 of the Lebor Code, for the peAormence of ihe work for wh�h Ihis pertnil is issued. ❑ I have and wiRmeintain workers' c�pensa��w� irtsurence, es requlretl by sectlon 3700 ot Ue Lebor Cotle, for Ihe partortnence ol the work tor which this permit is issued. My workers' coiopensatlon Insurance cerder end policy number ere: Cartier. � Policy Number: (This section need nat b cample(ed il the permit !s velueU et one huntlreO tlollers ($100) or /ess.) � I cantly that in tha peAortnance o1 ork for which Ihis pertnit is issued, I shell not employ eny person in eny menner so es to becort�e su�ject to the woAcers' compensetion lews of Celifomi ntl a ree that ii I shoultl bewme subject to t�e workers' compensatlon provisions o1 Section 3700 of tha Lebor Cotle, I shell torthwith comply vrith Ihese provisio . � Applicant Signeture: Date: �� z� — �� WARNING: FAILUFE TO SECURE WORKERS' �MPENSATION COVEFUGE IS UNLAWFVL AND SFUl1 SUBJEGT AN EMPLOYER TO CRIMINAL PENALTIES nN0 CML FlNES UP TOONE HUNORED TFKKISANODOLLARE(5100,000),INADDfiION OTHEWSTOFpJMPENSATION,DAMAGESASPAWIDEDWRINSEGTION51080FTHELABOfiCADE,11�fEAEST,ANDAiTORNeYSFEES. LICENSEDCONTRACTORSDECLARAnON: I hereby effirtn Ihat I am Iicensetl untler Pro sio torce end eXect. Lic. � � Contrectors Signeture: CONSTAUCTION LENDING AGENCY: with Sectlon 7000) oi DINSion 3 0l tha Business� n� e, end my Iicense is in full Class a Date: Zj —�f7� ❑ I here�y aHirm that there Is e con5truction lending egency for the pedormance of the work for which Ihis permit Is issued. (Sec. 3097, Oivil Code). Lendefs Nema: Lendefs Aatlress: SignaNre: OWNER-BUILDER DECLApAT10NS: De�e: I �ere�y eNirtn Ihet under penalry ot pellury Ihet I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for ihe Iollowing reason (Sec. 7031.5, Business antl Professions Code: Any ciry or county which requlres e permit lo construct, elter, imprave, tlemolish, or repair any structure, prior to its Issuanca, also requires the applicent for such pertnit to iile a sipnetl statemeM that ha or shB fs Ilcensed pursuaM to the provfsfons W the Comrectors License Lew (Chaptar 9(commandng wiih Section 7000) ot D"rvislon 3 oi the Business end Profeuions Cotle) or t�et he or she Is exempt therefrom entl the besls for the alleged axemption. Any violetion ol Section 7037.5 by eny applicant for e pertnit subjacts the appllcent to a civil penalry oi not more Ihan five hundred dollars ($500).): ❑ I, es owner ol iha properry, ar my employees with weges es Ihelr sola compensation, WILL DO THE WORK, and the structure is not Intentled or otteraa for sale (Sec. 7044, Business end Pmfessions Code: The Contraciors License Lew does not apply to an owner ot property who builds or improves Ihereon, and who tloes such work himself or hersetl or through his or her own employees, provided ihet such improvemenis ere not IntenCetl or oHeretl tor sale. If, howover, the bullding ar improvement is so10 wit�in one year oi completion. the ownor-bullder will hava Me burtlen oi proving ihat he or she did not builtl or improve lor puryose oi sale.). � ❑ I, a9 owner oi the Oroperty, am EXCLUSIVELV GONTRACTING WITH l.ICENSED CONTRACTONS to con5truct ihe project (Sec. 7044, Business antl Profassions Cotle: 7Te comractors Llcense Law tloes not epply to en owner ol pmpeny who bullds or Improves thereon, end w�o contracis tor suc� project with a contrector(s) license pursuant to ihe ConirectoB Licanse Laws.). ❑ I am exampt under sac. Business antl Professions Code lor this reason: Signeture: Date: Owner ID venfietl by tlnver's Ilcense. ❑ �es ❑ No Driver's License No. _ Expires _ Verlfication of Ownership by (type ol document, I.e. - property tex bill ar tleed): DIVISION OF INDUSTRIAL SAFETV PERMIT CER7IFICATION: ❑ I hereby certity ihat no oxcavetion five (5) or more feet in depih Into whlch e person Is requlred to descentl, wlll De made in connectlon wi�h work euthorized by this permit, af W �hat no bulltling sWCW�e, sceHOlding, lalsewoAc, or demolilbn or tllsmflntling thereoi, will be more than thi�y-six (36) feel high. (Chep. 32, Grp 2, Art 2, Sec. 341, Title B, Californle Administrative Code). ❑ As ownervbullder, I will not employ anyone to do work which woultl reqWre e permi� from the Divislon ol Industrial Sefery, es noted above, unless such person has e pertnit to do such wark fmm Ihe di�ision. Signe�ure: Dete: Divislon of Industriel Safery Permit Numbec CERTIFlCATE OF COMPLIANCE AND A�MORRA710N OF ENfAY: I certily under penelry ol perjury Ihat I have reatl this epplice�ion nnd state Ihat the infortnation given is correct. I agree to wmpty with etl stete laws en0 Ury ordinences relating to bullding wnsiruction, entl euthodze representatives ot the Ciry ol Costa Mesa to enter upon Ne ebove-descnbed property for inspection purposes. I egree nol to occupy or ellow occupancy of eny building authorizetl by this permi� until final inspection. CQDE �. INSVELTONTYPE 1616 1288 200 201 Flxed System Flnal Fire Preven�ion Pool Spe Flnel Final Re-Rooi Final BIocWRetaining Wall 202 Final Fectory Fire Place 203 Final Sign 204 Final Demolition PAg It�A4S Dete ._3-ZS-03 Date �QQga INSPECTIONTYPE 206 Finel Methenical 208 Finel Plumbing 210 Finel Elet�rical 212 Final Fire Preventlon 220 Finel Planning App�ovel 222 F1na15ite 250 �Fina18ulltling/Occupency �. 1 111. • 1r�� (714) 754-5273 • Fex (714) 754-4856 • www.cl.costa-mesa.ca.us . 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: Suite No Viciniry: Parcel Nunmber: Applicant Address: 406 E 20TH ST 42624132 A. J. CUSTOM POOLS 12342 LOUISE GARDEN GROVE, CA Owner: ' FARRAGE, DAVID J JR Address 406 E 20TH ST � COSTA MESA, CA Contractor: A. J. CUSTOM POOLS Address: 12342 LOUISE 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 1000a Motors to 1 hp Motors to 10hp Motors to 50hp Motors to t00hp Motors over 100hp Communicatlon drops Sub panel to 200a GARDEN GROVE, CA Phone: 714-53&5824 Zip: 92641 Phone: Zip: 92627-2316 Phone: 714-539-5824 Zip: 92641 License: 452652 Status: ISSUED Applied: OS/09/2003 Issued: OS/09/2003 ISSUED BY: � SCOPE OF PERMIT CONSTRUCT 194 SF FAMILY ROOM.,..p�:�ci"i r�i inc„".Tl..".� ^:...'.:`._. REF 803-00794.4 LIGHTS, 4 OUTLETS AND 2 SWITCHES. 523.50 $0.00 $0.00 $0.00 $0.00 $0.00 $4.40 $4.40 $2.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantiry FEE SUMMARY Temp Dist System / Lighling Busway/t00ft Standing Section Misc Electrical Equipment Transformers 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 Misc. Conductor Circus ( gen or ride) Circus (mech ride or lights) Christmas Tree Stand Fireworks Stand Other ElecUical Fee Investigation Fee � Plan Check Fee Quantity $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 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 $0.00 $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calilomia statutes and related regulations. (Ord. No. 9248, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or it work Is suspended or abandoned for a period of 180 days. � INSPECTIONS: In order for the work authorized under this parmit to be considered legal, such work must comply with all applicable codes, and ali requlred Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of thls permit. FOR INSPECTIONS CALL: (714) 754-5626 2a46-a8(N00) WORKERS'COMPENSAnONOECLARAnON: I hereby efllrm untler penelty of perjury one of the following decleretions: ❑ I heve entl wlll melntaln e certlficate of consent to self-Insure for workere' compensation, es prodCetl br by section 3700 of Ihe Lebor Code, for the peAortnance oi �he work br wh�ch this permit I5 issued. ❑ I have end wlll maintain workers' compensetlon Insurance, as required by section 3700 oi ihe Lebor Cotle, Por tha peRormance of the work for which Nis pertnit is Issuetl. My workers' Compertallon InSurenCe Cerder end polity number ero: Cernec � Policy Number. (Thls sectlon need not be crompletetl il (he permi( Is valued et one huntlred dollers ($100) or less.) ('Si� I certity t�et in the pedormance oi Iha work for which Ihis pertnit is issued, I shall not employ eny person In any menner so as to become subject to the workere' T� compensatlon laws of Calitomla, d egree Ihet Ii I shoultl become suh�ect to Ne workars' compensetlon pmvlsions ot Section 3700 of the Labor Code, I shall fonhwith comply with these prov�sions. _/� Applicent Signeture: Dete: � % �' �.3 WARNINp: FAILURE TO SECUFE WOR RS' CAMPENSATION ppVERAOE IS UNLAWFUL M1D SHALL SUBJECT AN EMPLOVER TO CFIMINAL PENPLTIES AND CIVIL FINES UP TOONE HUNpRED TKKISAND DOLURE (510p.000). IN ADDITION TO TME COST OF COMPENSATION, DAhNGES AS PROVIDED FOR IN SELTION 3]OB OF TH� LAgpR CppE, IMEREST, AND ATTORNE'fS FEES. LICENSED CONTRACTORS DECLARATON: I hereby aHlrm that I em Ilcensetl untler provisions ot Chapter e(commencing with Section 7000) ol Division 3 ot the Business and Professions Cotle, anC my license is in full torce end attect. Lic. N �SZWS� Class» �7 ^�---`�� 3 ContrectorsSlgneWre:. Date:_S 9"L7� LONSTRUCTION LENDING AGENCY: ❑ I hereby ettirm t�et Ihere is a constmction lending agency for Ihe pedortnance ot the work for which this pertnit is issued. (Sec. 3097, Civil Code). Lendefs Name: Lentlets AOdress: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby aflirtn lhet untler penelty ot perjury that I em EXEMPT FROM THE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Business entl Professlons Code: Any ciry or counry which requires a pertnit to consWcL alter, improve, tlemolis�, or repair any structure, prior ro its issuance, also requires the epplicant br such pertnit to file e signetl statement that he or she is Ilcensetl pursuenl ta the proNsians of the Comractors License Lew (Chepter 9(commencing with Section 7000) of Division 3 0l the Business end Pmfesslons Cotle) or that he or she is exempt Iherefmm end t�e basis for the ellegatl exemption. Any vialation oi Secuon 7031.5 by eny applicam tor e pertnit su6�ecis Ihe applicent lo a civil penalry ot not more Ihen Iive hundretl dollers (5500).): ❑ I, es awner ol lhe Oroperty, or my employees wlih weges es Iheir sole compensatlon, WILL DO THE WORK, entl the siructure Is nat intended or offered tor sale (Sec. 7044, Business end Professions Code: The Coniractors License Law does not apply to an owner of property who builds or improves ihereon, and who does such work hlmsell or hersell or through his or her own amployees, pmvitletl thet such improvements ere nol imended or oflered tor sale. If, however, ihe builtling or improvement is sold wit�in one yeer of completion, Ihe ownerbuilder will heva.the burden of praving that he or she ditl not build or impmve for purpose of sale.). � ❑ I, es owner of the property. am EXCLUSIVELV CONTR11CT1NG WITH LICENSED CONTRACTORS to construct t�e pro�ect (Sec. 7044, Business end Professions Code: The comrectors Llcense Lew does not epply Io an owner ol propeny who builds or Improves thereon, enC who contracts tor such pro�ect with e contractoqs) license pur5uent to �he Contrectors License Lews.). ❑ I am e:empt untlar sec. Business entl Protessions Code for Ihis reason: ' Signature: Date: Owner ID verllietl by tlrivars Ilcense. ❑ Y85 ❑ No Drivefs License No. Expires: Vedlica0on ol Ownership by (type ol document, I.e. - property teu blll ar deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CER7IFICATION: ❑ I hereby certily thet no excavetlon five (5) or more feet In depth into which e person Is require0 to descentl, will ba mede In connection with wark euthonzed by Ihis permit, entl that no building structure, scaHolding, falsewark, or demolitlon or dismentlinp Ihereot, will ba more Ihen thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Tltle B, Celifomla AGministrative Cotle). ❑ As owner-bullder, I will not employ enyona to do work w�ich woultl require e permit frwn the Division of Industriel Selery, as noted above, unless such person has e permit ta tla such work Irom the tlivision. SlgnaNre: Date: Division ot Intlustriel Salety Permit Number: CERTIFlCATE OF COMPUANCE AND AllT}10RIZATON OF EHTFiY: I cenity under penelry oi perjury ihet I have read this appliw�ion antl state that the information given is correct. I egree to comply with all stete lews end ciry ordinences releting to buliding constructlon, antl authorize represenietives ol the Clry of Costa Mesa to enter upon the ebova-descn6ed properry for inspeclion purposes. I agree no� to occupy or ellow occupency ol eny building euthonzed by Ihis permit until linel inspection. �neture Of Legel Owner(s) � �—P--�� AnNOr Authodzed Applicent COOE �. INSPECTIONTYPE QAIE Il�l§ 1616 Fi:ed System Final Fire Preventlon 1266 200 Pool Spe Finel Finel Re-Rool 201 Finel Blak/Retaining Well 202 Finel Factory Fire Plece 203 Finel Sign 204 Final Demdilion �'S-c/�CS � Date COOE� INSiECiIONTYPE 206 Flnal Mechanical 208 Final Plumbing 210 Final Electncal 212 Flnal Fire Preven�lon 220 Finel Planning Approval 222 Final Site 250 Final Building/Occupency PA7E 1I�LH (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.BUILDING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 406 E 20TH ST Suite: Vicinity: Parcel Number: 42624132 Applicant A. J. CUSTOM POOLS Address: 12342 IOUISE GARDEN GROVE, CA Owner: FARRAGE, DAVID J JR Address 406 E 20TH ST COSTA MESA, CA Cantractor: A. J. CUSTOM POOLS Address: 12342 LOUISE GARDEN GROVE, CA Zip: 92641 Arch : Address: Zoning: Phone: 714-539-5824 Zip: 92641 Phone: Zip: 92627-2316 Phone: 714-539-5824 License: 452652 Eng: Address: Phone: ISSUED BY: Status: ISSUED Applied: OS/09/2003 Issued: OS/09/2003 Phone: Zip: � License: License: SCOPE OF PERMIT CONSTRUCT 194 SF FAMILY ROOM. � ruc - , Plan Check: Permit: SMIP Res: SMIP Com: Other. Inspection: Total: $217.91 $33525 $2.09 $0.00 $0.00 $0.00 $555.25 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY -Front 0- 0 PARKING Existinq: o NOTES: Rear 0- 0 Rear 0- 0 Reauired: 0 FEE SUMMARY PLANNING & ZONING Lek 0- 0 Lefl 0- 0 Proposed: 0 Calc Valuation: Claim Valuation Right 0- 0 Right 0-0 Szo,s2s.so so.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under Californla statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permlt 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 1 BO days. � INSPECTIONS: In order for the work authonzed under this permit to be considered legal, such work must comply with all applicable codes, and all required Inapectiona and final approvel must be obtained. Failure to obtain Inspections and final approval will result in ihe expiration of this pertnit. FOR INSPECTIONS CALL: (714) 7545626 zuaae �aroo> WORKERS'COMPENSATIONDECLARAnON: I hereby eMirtn uqtler penalry oi perjury one of ihe following declaretions: \ ❑ I have end will meintain e certiticeta ot consent to self-Insure tor workers' compensation, as provitled for by section 3700 of Ihe Lebor Code, for the pertormance ot the work lor whlch.this permit is issuetl. ❑ I have antl wlll maintain workars' compensa�ion Insurence, as required by section 3700 of the Labor Cotle, for the peAortnance of the work for which this pertnit is Issued. My workers' campenjietlon Insurance cerner entl policy num�er are: Cerrier. Policy Number. (This section need not be cromplered i/ the permit is veluetl at ane huntlretl tlallars ($100) or less.) �I certify Ihet in Ihe perlormence ol ihe work f hich Ihis permit is issued, I shall not employ any person in any mannar so es to become subject to Iha workers' compensatlon laws of Calllomia, entl egre II I shoultl become suD�ect to Ihe workere' crompensation provisions of Section 3700 oi the Labar Code, I s�all forthwith comply with Ihese provislons. ApplicentSigneture: Dete: .�— �� WA{iNING: FAILUFE TO SECURE WORKER$' COMPE AiION COVERAOE IS UNIAWFUL AND SHALL SUBIECT AN EMPLOYER TO CRIMINAL PENALTIES AND CNIL FINES UP i00NE MUNDRED TFK%ISAND OOLLARE (5100,0OO�.IN ADOITION TO COST OF WMPENSNTION, DAMAGES AS PROVIDED FOR IN SECTION 3]O60F THE IABOR COOE, INTEREST, AND ATTORNEI^S FEES. LICENSED CONTRACTORS DECLARATION: I �ereby eHirm that I em fOfCB BOtl BflBCt. LIt. M_ Contrecmrs SlgneWre: CONSTRUCTION LENDING AGENCV: oi Chapter 9(commencing with Sectlon 7000) of Divisian 3 at the Business antl P�essions Cotle, and my license is in full CIauM ii�CS✓�' oate: �—D 3 ❑ I hereby aNirm that ihere is e construction lending egency for Ihe peAormance ot Ihe work for whic� Ihis pertnit is issued. (Sec. 3097, Civil Code). Lendefs Neme: Lentler's Aatlress: Signature: OWNER-BUILDER DECLA(7ATIONS: Oate: I hereby aXirm that untler penalry ot perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for Ihe tollowing reason (Sec. 7031.5, Business entl Protessions Code: My ciry or caunry which requires a pertnii to consiruct, alter, imprrne, demolish, or reDalr any sirucWre, pnor to its issuance, also requires the aOGlicant for such pertnit to file e signed stetement thet he or she is Iicensetl pursuant ta the proNsions oi the Cantrectars License Law (Chepier 9(commencing with Section 7000) af DlNslon 3 0l the Business entl Protesslons Cade) or that he or she is exempt Iherefrom antl Ihe basis for the elle9ed e:emption. Any violation of Sectlon 7031.5 by any appliceM tor e pertnit su6jects Ihe applicent lo e civll penalry oi not more t�en five huntlretl tlollare ($500).): ❑ I, as owner ot the property, or my employees with wages as thelr sole compensation, WILL DO 7ME WOFiK, entl Ihe structure is not intentletl or oHeretl for sale (Sec. 7044, Business end Pmfessions Code: The CoNrectors License Law tloes not appry to an owner oi property who builds or improves t�ereon, antl who does such work �imselt or hersalt or through his or her own employees, D�ovidetl ihat such improvements are not intended or oNered for sale. If, however, ihe builtling or improvement Is sold within one year ot completion, the owner-builAer will heve.the burtlen of proving that he or she tlitl not build or improve for purposa ot sale.). � � I, e5 owner o� Ihe pmperty, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS �o consWc� the prqec� (Sec. 7044, Bu5in85s and Pmfessions Cotle: The coniractors LJcense Lew tloes not appty ro an owner ol property who bulltls or improves thereon, enA who wntraas for such prolect with a contrector(s) license pursuant to the Contractors Licanse Lews.). ❑ I em exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID venfied by drivers Iicense. ❑ Ves ❑ No DriveYs Licensa No. Vedticatian of Ownership by (rype oi dxument, i.e. - property tex bill or tleetl): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: Expires: ❑ I hereby certify ihat no exwvetion five (5) or mora feet in depth into which e person Is required to descend, will be made in connection with work euthonzed by this permit, antl that no builtling structure, scattolding, felsework, or demolition or tlismantling thereot, will be more than ihirty-six (36) teet high. (Chap. 32, Grp 2, An 2, Sec. 341, Titla e, Celllamia Adminisirativa Code). ❑ As owneo-builder, I will not employ enyone to do work whic� would requlre e pertnit iram the Division of Industnel Sefery, as noted above, unless such person �es a permit to tlo such work Irom tha dlNslon. Signeture: Date: Oivision oi Industnel Setety Permit Number. CERTIFICATE OF COMPLIANCE AND AUTHORVJ1710N OF EMRY: I certify under penalry of perjury tha� I have read this epplication antl state that the iniortnation given is correcl. I agree to comply wlt� ell state lews and clry ordinances releting to bullding conslmc�ion, end euthorize representatives ot ihe Clty of Coste Mesa to enter upon the ebove-described property tor inspedion puryoses. I egree not to occupy or ellow occupency of eny building authorized by Ihis permit until iinal inspection. ture 01 Legal Owner(s) Or Authonzed Applicem GOUE I, INSPECTIONTYPE 1616 Fi:ed System Finel Flre Preventlon 1266 Paol SDa Final 200 Finel Re-Roo1 201 Final BIocWRetaining Well 202 Final Factory Fire Plece 203 Final Sign 204 Final Demdition Q� � � 9-6 3 Date COUE I INSPELTION iYiE 206 Final Mechanical 20B Final Plum6ing 210 Final Electrical 272 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final BuilAing/Occupanry � lt�fl -t� �Z ,�2� Job Address: 406 E 20TH ST Suite No Vicinity: Parcel Number: 42624132 Applicant: A. J. CUSTOM POOLS Address: 12342 LOUISE GARDEN GROVE, CA Owner: FARRAGE, DAVID J JR Address: 406 E 20TH ST COSTA MESA, CA Contrecmr. A. J. CUSTOM POOLS Address: 12342 LOUISE GARDEN GROVE. CA MECHANICAL PERMIT Phone: 714-539-5824 Zip: 92647 Phone: Zip: 92627-2316 Phone: 714-53&5824 Zip: 92641 License: 452652 Status: ISSUED Applied: OSl09/2003 Issued: 05I09/2003 ISSUED BY: `� SCOPE OF PERMIT CONSTRUCT 194 SF FAMILY ROOM. "�' o^�".�`"�+.�+�' " rr;.^v"�r-o^r'".�2�-?:.coE, REF 803-00792. •FACi9RYFfRE-PtAE�AND ALTER 1 DUCT SYSTEM. F✓er.PL+tE 4tl.E7t%j FEE SUMMARY ISSUE FEE Inst FAU <100 k BTU Inst FAU >700 k BTU Repair I Alt Cooling/Heat Insl / Rep. Recess Wall Htr Refrig Sys <700 k BTU Refrig Sys >700 k BTU Gas Piping Factory Pireplace Hood w/Mech Exhausl VAV Box Vent Fan / Single Duct Appliance Fire Dampers Smoke Dampers Inst or Relocate Appl Venl Air Handlers < 10000cfm Air Handlers > 10000cfm Floor Furnace Floor or Suspend Healer 823.50 so.00 $0.00 51370 $0.00 50.00 $0.00 $0.00 510.65 50.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 50.00 �uantity 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 Repair I All Absorbtion Unit Repair I Alt Refngeration Unit VentillaUon System Evapo2tive Cooler Commercial In ci nerator DomesUc Incinerator Compressors / Absorotion Svstems Upto3hp/100kBTU 3To15hp/500kBTU 15 To 30 hp I 1,000 k BTU 30 To 50 hp I 1,750 k BTU Over 50 hp / Over 1,750 BTU Boilers Upto3hp 3To15hp 15t030hp 30 to 50 hp Over 50 hp Other Mechanical Fee Investigalion Fee Plan Check Fee Reinspection Fee TOTAL CALCULATED FEES Quantity 50.00 0 ao.00 0 50.00 0 50.00 0 50.00 0 50.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0. 50.00 0 50.00 0 30.00 0 E0.00 0 $0.00 0 $0.00 0 30.00 $0.00 $0.00 $47.85 NOTICE: The work authorized by this permit shall compty with all applicable handicap access requirements under Califomia statutes and related �egulations. (Ord. No. 92-28, § t, 72-27-92) EXPIRATION: This permlt shall automatically expire end become voitl il work Is not commenced wlthin 180 days, or If work is suspended or abantloned for a perlod of 780 days. � INSPECTIONS: In order for the work authorized under this permit to be consideretl legel, such work must comply wlth all appllcable cades, and all required I�specliona end 11ne1 epprovel must be obtflined. Failure to obtain Inspections and final approval will result in the expiration ot thls permit. FOR INSPECTIONS CALL: (714) 754-5828 zaae-ae �aroo� WORKERS'COMPENSAnON DECLARArON: ' I hereDy eHirm under penalry ot perjury one ol Ihe (ollowing declaratlons: ❑ I have entl will meintaln e certifiwte of consgnt to sell�lnsure tor workers' compensetlon, es D��ded for by seclion 3700 of fhe Labor Code, far the pertormence of the work lor which this pertnit Is issued. ❑ I heve entl will maintain workers' compensa6p� insurerice, fls required by seclion 3700 0l the Lebor Cotle, for ihe peAortnance of the work tor which Ihis pertNt Is issuatl. My workers' compensaUon Insurence cartier entl poliry number ere: Cerner. Poliry Number: (!h!s secNm need not be pomp/eted /l �he pemtitls vaNeC al me h�ndred ddlars (5100) a IessJ �I certlly thet in the pertortnance of the work ior which this pe�mit Is I55ueQ I s�all nat employ any person in any mannar so es to become sub�ect to the workers' compensation lews of Califomia, en gree Nat It I s�ould become Sub�BCi lo Ihe workers' compensation pmdsion9 of Seclion 3700 ot t�e Lebor CaCe, I shall tort�wl[h compty with these prahsions. Applicnm SignuWre; '�� ' oa,a: � —�''/ �G 3 WARNINO: FAIWRE TO SECURE WOiL(ERS' EN$ATIpN CpVEPAOE IS UMAW FUL M'D SHALL SU9IECT Ml EMPLOVER TO CRIMINAL PENALTIES AND CML FlNES UP TOONE HUNDqED T/IIXl$PND OOUARE (5f00,000), IN ADDfiIIXJ TO THE Cp$T OF COMPENS4TION, DAA41GE5 �S PROVIUED FOR IN SECiION 3]OB OF THE LABOR CODE.INfEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I horeby eMirtn that I em Iicensetl under provisions ot Chepter 9(cammendng with Sectlon 7000) ot DlNsion 3 of ihe Buslness and Professlons Code, end my litense is In tull force en0 eHect. Llc. p 2— Cless a�J� 5-� Cantrector's Slgneture: Dete: �_ S 7"(� � CONS7RUCTION LENOING AGENCY: ❑ I �oreDy eNirm thet lhere Is e constmaion lending egoncy tor the pertormanca ol the work for wNch ihis permit is issued. (Sec. 3097, Civil Code). Lenders Namo: Lentlefs Adtlress: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby ettirm Ihet untler penalry o1 perjury that I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business entl Prolessions Cotle: Any ciry or counry which requires e pertnit ta conswct, elter, improve, demUish, or repalr eny sWcture, prior to its issuance, elm requires lhe epplicant tor such permil ta lile a signetl stetement t�et he or she is licensed pursuant to ihe O��sions ol the Cantrectors License Lew (Chapter 9(commendng wlth Sectlon 7000) af DMsion 3 of Ne Business anC Professions Cotle) or that he or she is exempt Neretrom end Ihe besls for the alleqed exemption. Any violallon oi Section 7031.5 by eny appllcant for e pertnit su6�eds t�e epplicam Io a Gvil penalry of not morg than fiva hundretl CWlars (5500).j: ❑ I, es owner at the properry, or my employee5 with weges es Iheir sde compensetion. WILL DO THE WORK, and the structure is not Intended or oNered for ule (Sec. 7044, Business end Prolessions Cotle: The Contrectors Licanse Law Coes not appty to an owner of property who builds or improves Iheraon, antl who does such work himself or herself or ihrough his or her own employees, provideG that such improvements ere not intended or oHered lor sele. If, however, Ihe building or Imprwement is sold within one yeer of completion, the ownBr-builder will have�the burtlen ot pmving Ihal ha or she did not build or imprwe tor purpwe ot sele.). � ❑ 1, as owner of t�e pmperty, am EXCLUSN�LY CONTfiACTtHG WITH LICENSEO CON7HACTORS lo constmtl lhe prqect (Sec. 7044, Bo5lness end Professians Cotle: The coniractors Llcense Law tloes not appty to an owner ol pro0erty who Dulitls or Imprwes thereon, and who contracis for such project wlih e contractor(s) license pursuent to the Contractors License Lgws.). � I em exempt under sec. Business entl Professions Code tor Ihis reason: Slgnature: Date: Owner ID veritied by drivers license. ❑ Ves ❑ No Dnvers License No. Expires: Vedficetlon of Ownership by (type oi tlocumem, i.e. - property tex 6111 ar tleetl): DIVISION OF INDUSTRIAL SAFETY PERMR CEqTIFICATION: ❑ I hereby cenlry that no excavetim tive (5) or more feet in tlepih Into which e person Is required to descend, will be matle in wnnectlon with work euthodzed by Ihis pertnit, entl that no bullding structure, scaflqldinp, falsework, or demditlon or tllsmantling Ihereot, will be more ihan thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 347, 71t1e B, Cellfomia AdminlsiretNe Coda), ❑ As ownervbuiltler, I will nat employ flnyone to do work whlG� would roqWre e permit tmm the DiWsion ot Industdal Sefery, es noteC e6ove, unless such person hes e permit to do suc� wark trom the division. SignaNre: Date: Division ot Intlustriel Selery Permii Num�er. CERTIFlCATE OF COMPLIANCE AND AUiHOR4A71pN OF EHTRY: I certify under penelry oi perjury that I have reatl this epplication entl state thet the Information given is correct. I egree to compty with ell slate laws end ciry ordinances releting ro bullding constructlon, entl euthorize representztives oi the Ciry ol Costa Mese m enter upon Ihe ebwe-tlescribad properry lor inspeciion purposes. I agree not to occupy or ellow occupancy of eny huilding authoAzed by this pertnit until final inspectian. Signature " I� ner s S�l� � Date n r Authodz Applicant � Date COUE 1. INSPECTIONTYPE 1618 Flaed System Finel Fire Preventlon 1288 200 Pool Spe Final Finel Re-Root 201 Flnal Black/Relaining Well 202 Flnal Fectory Firo Place 203 Finel Sign 20C Finel Damolition Q�jE �� y,QpEa INSPECTIONTYVE 208 Finel Mechanlcel � 20B Finel Plumbinp 210 Final Electrical 212 Flnel Flre PrevenUon 220 Final Planning Approval 222 Final Site 250 Final Building/Oaupency � It� S-lS �3 Q� AGO��an[ to fill in all ipaces exeept t�ose wit�in heavy Dortle� Iines anG si9n all appropriate eeclarations. CITY OF COSTAI 1MESA CON TRSUU�TION PERMIT rerr ��a g 9 � nH�i IVV. LV I rvu. UNIT NO. A P# Project Address y� � � d � . _ S Main Building: � � 5.33 INC�� TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR E AppliCant'SMawngAddres5 ' ❑ CONVERSION ❑ DEMOLISH ❑ OTHER T Front 'Owner's Name�VN�. arra� U6 Phone 4V "uyg� DESCRIPTION OF WORK/USE OF BLDG. A Rear Addreu Arch/Eng. LicenseNa. TVPEOFPEHMIT GRADING�� FOUNDATION STRVCTURAL I K Right Address ❑ TENANT ❑ ELECTRICAL LYPLUMBING ❑ MECHANICAL , g� Left Contractor's Nam -S L hone 7�0 � oTHER . Ping. Ref. # �+?� PROJECTDESCRIPTION Sa.FT. oCCVPANCY Addre551mailing) �vy � • CONSTRUCTION TVPE VALUATION $ Planning NOtes: City License No. �� ZpNE GRADING CU VDS ACRES LICENSED CONTRACTOR DECLARATION I hereDy affi�m that I am licensed untler prOvi5ion5 of Chdrtlr 9(comm0nUn9 with se<tion ]000) of Divislon 3 of the Business antl Protesslons Cotle, anU my license is in full force,�nq,�tfect. /� oate �✓�3U 5.9� �� ' U eAyeAL .IX��7�DJ �% � � r �DP WORKERS'COMPENSATION DECLARATION � I hereby aHirm Ihat 1 have a certilicate of consent to self-Insure or a certlflcate � " Wo�ke�s' Compen5ation InSurante, Or d Ce,yt�ti¢tl Copy thereot (Seclion 0, LaD. C.)�I (� n ' )) 0 I�I.,icY No. lJ-1 S UV ComPanY 'r�c7U � r \ �7'Certifetl c�oPY is hl�letlbwlth�thehctY B1-1��rni DI i Iqn �A \ oate Applicant N �• � �� <�-��Q//�'�'S E%EMP ION FROM WORKERS' COMPENSATION DECLARATION (Thissection neetl not be completetl ii ihe permit Is for one huntlretl (E100) or Iess). I certify lhat in Ihe perlormance oi tho work for wnlch tnis pormR is issuetl I shall not employ any person In any manner so as to become subject to the Workers' Comp¢nsa[IOn Laws of Californid. Date Signature NOTICE: 1f, af[er makinq [his tleclara[lon, you shoultl become subject to the Workers' Compen5ation provisions of the Labor Cotle, you must forthwith comply witn such provisions or this permit shall be tleemetl rnvoketl. CONSTRUCTION LENDING AGENCV I hereby afOrm t�at there is a construction lentling a9enty for the pertorman<e of the work for wnich lnis permit i5 ISSuetl (Sec[iOn 3097 Civ. C.) lentler's Name Lender's AGtlress OWNER BUILDER OECLARATION I hereby afiirm lhat I am exempt from the Contractor's License Law tor the following reason (Seclion 7031.5 Bu5lness antl Pro/esilonal COAe: Any clty or county whith requires a Oermit l0 cons[rucl, alter, Improve, tlemoli5h Or repair any structure, prior to its issuance, also requires the applicant (orsuch vermit to tile a ziqnetl statement [hdt M1e/she is liG¢n5etl pu�suant to lh¢ provl5ion5 of Ihe Contractor's License Lnw (Chapler 9(commendng with Section 7000) of Division 3 of [ne Business antl Professions Cotle) or that he/she is exempt �^^refrom ane tne basiz tor tne allegetl exemptlon. Any vlolation oi Sectlon l.5 Dy any apP��ant for a p¢rmit subjecti Ihe appllcant t0 a civil ilty of not more than five huntlre0 tlollars (E500). u I, as owner o( the property or my employees with wa9es as lhelr sole compensation, will tlo [ne work, antl the structure is not in[onaetl or offeretl for sale (Se<tion 7044, Business anG Professional Cotle: The Contraclor's license �aw tloes nol apply to an owner of a proparty who builCs or improves thereon, antl who tloes such work nlmsell/hersetl or througb �Is or her own employees, proviaea tnat such improvements are not Intentletl or ofteretl for 5ale. It, howeveq the builtling nr improvement I5 soltl within nne year of com- pletion, the owner will have the burtlen of Proving he/she tlitl not builtl or im- prove for tne puroose oi zale). r tin with Iicensea con- ¢ clusivel cont ac ❑ owner oi lhe ro ert am x Y 9 I as P P Y, tractors to conSVutt the project (Sectlon 7044, Business anC Protessions Cotle: The Contractor's License Law does not apply t0 an owner Of prOperty who builtls o� impwves thereon. antl who conlra<[s lor SucM1 oroiects wilh a r.on- tlacto!(s Lcense pufsuant [o [ne ConlrattOf's LICen52 LdW). I am awdre [hai � proof o ineir Worker's Compensation InsuranGe s�oultl be Orovitl¢tl to me. ❑ I am exempt untler Section B. 8 P. C. tor tbis reason �ate I nereby certity tnat intormatlon is correct antl stale laws relatln sentatives of tnis It InSpeGtion pw s Signature Orivers' License or 55 OBfi5�46, rev. 5/88 — Owner _ I have r¢atl th15 I agree lo Comp to builtling mn ' to ¢n[!/ upOi r¢p�e- Y for Remarks: �A J S�TL� I� S� 11 �� ) Q Ti I� P�T S 17 low Preventer low Irrigation Clarifiers Dish�.vdsher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Dreins Reinspection Fae Under Ground $15 Duct - Ventilating Exhaus[ System ❑ Multiple ❑ Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑ 0-7 00,000 BTU � 100,000 BTi Reinspection Fee � $15 WM1ite - Buileing; Canary - Appli<dnh Pink - Accounting; GoltlenrOtl - Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto�Wesh Issue Fae Hood or Type I ❑ Cenopy Type I I ❑ Refri eration S s[em 9 V �0.100,OOOBTU ❑100,000 System Repair/Alteration Fire Dampers Registers Issue Fee FEES Automatic Washer Construction Pole Si Cooking Unit Dishwasher ' , Dryers ❑Gas �DEI Fan F.A.U. Fixtures Device Boxes - � Outlets Switches Garbage Dispoul Generator DO-5 KW Fae Zone Accessory Bu Parking Req./Provided EIECTRICAL Trans(ormer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100 amps Meter ❑over 100 amps Sub Panel Motors �0.1 HP � 1 h- 8 Inc. Solar �9�15 HP �16-15+ Microwave Pale Light Range Standing Sections 15 KW Trash Compactor $15 Issue Fee �$ 3 DEVELOPMENTSERVICESRE�UIREMENTS: Zoning Approved By FEES ' .�Buildine Approved By �,!` APPliqtion Issued BY � �� FEES $ 3 SUMMARV OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK S PERMIT PLUMBING $ 5UO ISSUANCE $ PLAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL § GRADING $ PLANCHECK 50% $ MICROFILM $ MECHANICAL $ 70TAL FEE $ � � � ' PI.AN CHECK 25% $ N I N G R E U M T S. S s r•� -�q:,l_' .-1''1?;c20 y,- � j';�;'" .,-; _. f • { "�;-"' :4.'d'c. _ TTfiES 1F:... . %;," >�` ' - , h , �.. . . .. . , , CONSTRUCTION AND PLANNING ' POOL' 'A -� � APPROVALS Permit # Date Inspector AppROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Spil Pipe-Undrgrnd. . 53. Steel Reinforcement � ' 3. Electrical Conduit�Utility-Undrgrnd. � 54. Forms 4. Electrical Conduit-Undrgmd. 55. Electriral Bonding �- 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6: Electrical UFER Grnd. ' 57. APPROVAL TO COVER-GUNITE 7.. Footings 58. Electrical Conduit-Undrgrnd. � 8. Foundation _ 59. Gas Pipe, � Undrgrnd., Test 9. Water Pipe-Undrgrnd. . 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK � ' 11. Property Sewer Line & House Connec[ion 62. Backwash & Receptor-Final 12. Sewer Cap . 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electriral-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval .'r 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 t 72. Underground Flush 24. Roof Framing 73. Undergrnd.StorageTank OGas ❑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. F.00D CERTIFICATE ISSUED 33. Final Electric Notes:L�_2'�.?fq �,I��T �j�¢�p• (.,{�I) 34. Final Heating & Air Conditioning s'' Z'?� � /�a �p.�/� (�pi,y ,� (�,,,�, () 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing � (�%N, 39. Water Service-Final �� • 40. Gas Service-Final � � t"? 41 . Solar pomestic-Final .. � •a. 42. Backflow Preventer 17l r-� 43. Backflow Irrigation .y; � 44. Landscape Irrigation System 45. Sound Attenuation � 46. HandicapFegulations� . 47. FINALSTRUCTURE�&�BUILDING 48. Special Requirements Completed 49. Electric Release to Edison �1�. 50. Gas Release to Southern California Gas Co ", 51. CERTIFICATE OF OCCUPANCY � � :' No. Date r.. 5art� c�� orion Specia[ Inspection Services loint Certified ICBO Reinforced Concrete ACI Concrete Field Tech DAILY REPORT N° 0459 Ph 714-895-1344 Fax 714-899-5684 Mobile 714-309-7304 OWNER FAIRLANE HOI�S INC �A'I'E 1-27-59 ]OB ADDRESS �QEj 20th Street BUILDING PERMiT NO. g��g� GENERALCONTRACTOR Rav(:nnc+.r VAL[IE$ lfi_177_Ml AP. No. TYPE ZONE DESCRIPTION OF WORK II ECTIONS I DATE I SUBCONTRACTOR Test PERMITS BER ,� .. � � . � " �39�S:L COSTA MESA BUILDING DEPARTMENT P.O.80X 31] COSTA MESA. CALIFORNIA FOR APPLICANT TO FILL IN OWNER MAIL ADORESS �� QTV ARCHITECT OR ENGINEER CONTRACTC ADDRE55 LEGaL DESCRiPTION A.P. NO. � BLDG 1 6 ZU'ru C � COSTA MESA. CALIFORNIA 2 LA�vF H�mtS 5 P Liac E N"r � r+ TNOM I 6`32.Z LIC. 3A`�' COi.vST NO� S ['LA c��,.'Tin N iB '�`" 109� i AME No. TEL. NO. IS BLOCH TRACT�SQ K � / NO.OF BLOGS. 6 NOW ON LOT SET9/CK LINE FPOM /� � � CENTEN OF STREET' L\ 7� 6 REAR YARD SIDE VARD RIGHT � I LF-FT 4 4 DESCRIPTION OF WORK NEW /� A�TERATION II ADDITION REPAIR I IIMOVING � OEMOLISH BUtLOING / NO.OF SIZE y O b ROOMS STORIES E%TERIOR WALL ROOF GOV[RINf: COVFRING �� !�i��.�'J��, JAN 2 71959�,,� FIN�',110E DEPT. �!ry p� '/1CTn P1CCq APPLICATION FOR PERMIT BUILDING FOR OFFICE USE ONLY COSTA MESA, CALIFORNIA APPROVEO BY CORRECTIONS he Amount shown under valua?ion is for the I MERE9V RCNNOWLEDGE TMAT I N1VE flE�D TM�S r�PPLICATION 1ND STRTE TNAT TNE I.BOVE IS COMRECT �NO FGREE TO COMPLY WITN �LL purpose ot esiablishing a permit ee on y. CITV ORD�NSNCES aNp STiTE 1�W5 FEGUL�TING BUILOING CONSTRUG rioH. VALUATION PERMIT FEE S � / SIGNATURE OF `� ' PERMITTEE / � — g /// /�� PLAN CHECK S — � � AUTHORIZED AGENT TOTAL FEE S �( — `9M� :