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Home My WebLink About421 20TH ST - Building Permits� �. (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 421 E 20TH ST Suite No Vicinity: Parcel Nunmber: 42631246 Applicant: NOCK, RON Address: 11612 KNOTT ST GARDEN GROVE, CA Owner: BARNETT', PETER & KIRIN Address 421 E 20TH ST UNIT B COSTA MESA, CA Contractor. NOCK PLUMBING Address: 11612 KNOTT ST GARDEN GROVE, CA Arch / Eng : Address: WATER HEATER CHANGEOUT ISSUE FEE Backflow irrigation � Backflow Preventer �� Bathtub Clarifier System Connect (Ice,Soda,etc) Dental Uniis Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Drinking Founlain Expansion Tank Gas Earthquake Valve Gas (1-4 outlets) Gas (Over 4 outlets) Gas Repipe Gas Service Interceptors (Grease, Oip Interceprors (Sand Auto ) AMT $23.50 $0.00 ' $0.00 , 50.00 , $0.00 50.00 50.00 so.00 50.00 $0.00 50.00 $0.00 50.00 50.00 $0.00 $0.00 $0.00 so.00 30.00 50.00 QTY PLUMBING PERMIT Phone: (714)895-1246 Zip: 92841 Phone: Zip: 92627 Phone: (714)89St246 2ip: 92841 License: 707775 Phone: Zip: License: SCOPE OF PERMIT FEE SUMMARY AMT Laundry Tub / Washer $0.00 Landscape Irri9ation , $0.00 , P-Trap $0.00 "�PressureRegulator � $0.00 Process Piping (per 10 k) � $0.00 Receptors 50.00 Septic Tank 50.00 Sewer Cap for Demo . $0.00 SewerConnect $0.00 Sewer Privale Line $0.00 Shawer $0.00 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: O41i6@001 Issued: 04I16I2001 ISSUED BY: � SumpPump � Swimming P.00l . , �- Trap Primer� � � � '�- � Urinal� - �Vaiuum Brkr Bkflow(7-4) � Vacuum Brkr Bkflow(5+) ' Wash Basin Wash Basin Set . Waste and Vent System � .Water Closet (Toilet) Water Heater / vent Water Piping (Inst or Rep.) Water Re-pipe water Service Water Sokener OTHER VIOLATION PLAN CHECK REINSPECTION AMT $0.00 / 50.00 $0.00 50.00 50.00 50.00 30.00 50.00 50.00 50.00 S 7 2.30 50.00 50.00 $0.00 S0.o0 50.00 50.00 $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 0 NO710E: The work authorized by this permit sheil comply wNh all applicable handicap access requiremenis under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This parmit shall automatically expire and become void if work Is not commenced within 1 BO days, or II work is suspended or abandoned for a period of 1B0 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, antl all requlred Inepeetione and finel approvel must be obtained. Failure to o6tain inspections and final approval will result in Ihe expiratiortof this permit. FOR INSPECTIONS CALL: (714) 754-5626 zaaas �eroo� WORKERS'COMPENSAnON DECLARATON: � . �— I hereby aflirm under penelry oi perjury one ot the tdbwing tledarations: ' ❑ I �e end will main�in a certificata of cansent to setl-Insura far workers' compensetian, es provided lor by saction 3700 0l Ihe Lebor Code, tor the pertortnance ot the rk for w�ich t�is pertnit is issuetl. I�t+eve flnd will malnWin workers' compensatbn Insurance, es requiretl by sectlon 3700 0l Ihe Labor Code, for the peAortnence ol Ihe work tor which ihis permit is iswed. � My workers' compe�sa^tion I�urance carner end poJl'�+y,�—{mber ere: '! Cerner: /'li��/V I�[.J� rPolicyNumDer ��C�7� 3� YQ-� valued at one hundred Oollers ($100) or less.) � ❑ 1 cartVfy Ihat in ihe peAormanca W the wofrc Yor wtilch Ihis permit Is issuetl, 1 shell not omploy eny person in eny manner so as lo becomo suDject to ire workers' tAmpensetion lews ot Callfomia, end egree Ihei If I should become sub�ecl lo �he worker9' compensa�lon provislons ot SetilOn 3700 01 e Lebor ode, I shall torthwit� Comply with Ihese p�ovislon // 2 / Applicanl Signature: �`�� 5�� I '— Dete: % U WARNINp: FAILURE TO SECURE WORI¢�5' COMPENSATIOtJ COVEM�E IS UNUWFUL AND SHr1LL SU9IECT AN EMPLOYER TO CRIMINAL PENPLTIES rWD GVIL FlNES UP TOONE HUNDRED TNOUSAND WLLAFE (St00,P00),IN AUDINOfd TO THE COST OF COMPENSAiION, DAMAGES AS PROVIOED FOR IN SECiION 3]O60F TME LABOR CODE, INTEREST, M1D AiiORNE1^5 FEES. LICENSED CONTRACTOAS DECLARA710N: I hereby aNirm that I am licensed undacqoy�sior� of lorce end etlect. Lic. a ' �(/ � Conirectofs Signature:�� with Section 7000) ol Division 3 ot lhe Business en rol�s�sioye Code, enA my license ISIn lull Class A � l� f Date: C.4 --s � / CONSTRUCTION LEN�ING AGENCV: ❑ I heraby eHirtn ihat Ihere is a consimction lendinp egency br ihe Oedormence ol Ne work for which ihis permit is issuotl. (Sec. 3097, Civil Cotle). Lentler's Nemo: �entlers Address: Signeture: Date: OWNER•BUILDER DECL�7AnON5: I �ereby eXirtn ihet untler Penalry ol perjury thet I em EXEMPT FROM 7ME CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Prafeulons Code: Any ciry or county w�ich requires a permi� to consWct, elter, imprwe, Oemolish, or repair any siructure, pnor to its issuance, also �equires Me epplican� tor such pertnit to lile e signeA stetement lhat he or she is licensed purauant to the provisions of the Contrectors License Lew (Chapter 9(commencing wlih Sectlon 7000) oi Division 3 ot the Business end Prolessions Code) or thet he or she is ezempt therefrom and the besis tor the ellepetl exemption. Any viWation of Sectlon 7031.5 by any applicanl for e pertnit sublects Ihe apPlicam to 9 civil pene�ry of noI more thnn live huntlretl dollars ($500)J: ❑ 1, as ownar of Ihe proper[y, or rtry employaes wrih wagas es iTeir sole compensation, WILL DOlHE WORK, and �he struciure 15 noYimentled or ofleretl tor sale (Sec. 7044, Business end Professions COAe: The Coniractors License Law tloes not apply to en owner of property who builds or improves Ihereon, end who does such work himselt or herself or ihrough his or her own employees, providetl that such Improvements ere not intended or oNered lor snle. Ii, however, the Duilding or improvemeni Is soltl within one'.year ol completion, the ownerbuilEer will heve the burtlen ol proving �het he or she did not build or improve for purpose of sale.). ❑ 1, es ownei of the propetly, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to consiruct the project (Sec. 704d, Business and Pmfessions Cotle: Tha contraCtars LicenSe Law tloes nat appty to en owner of property who 6uild5 or Improves thereon, and who contracls lor such project with a coniractor(s) license pursuant to the Coritradors Ucense WwsJ. ❑ I am exempt under sea �� Business end Pmlessions Cotle for this reason: Signeture: Dale: Owner ID verified by drivers license. ❑ Yes � No DAvefs License No. Ezpires: Vedflcatlon ot Ownership by (rype ol tlocumeni, I.e. - D�operry tax bill or tleed): DIVISION OF {NDUSTRIly SAFETY PERMIT CER�IFICATION: ❑ I hereby certlty Ihat no excavation tive (5) or more teet in tlepth into which a person Is requiretl to tlescend, will be matle in connec�lon with work authorizad by this pertnit, end that no building swcWre, scattoltling, telsawork, or demWitian or tlismantling t�ereoi. wlll be more than thirry-sl: (38) leet high. (Chap. 32, Grp 2, Art 2, Sec. 34 i, Tl�lo B, Callfomia AdmInlSlraUve Code). ❑ As ownorbuiltler, I will not employ enyone lo do work which would requlre e permit from iha Divislon of Indusirial Selety, es noted ebove, unless such person hes e permit to do such wo�k from the tlivision. Slgnature: Dete: Division of Indusiriel Safery Pertnit Number. CERIIFlCATE OP COMPU�INCE AND AUTHORVATION.OF ENfFiY: I cenity under penalty ot perjury that I have read this applicetion antl state that Ne intortnatlon given Is correci. I agree to comply with all state laws end ciry ordinances relating to building conswction, entl authorize represeniatives ot Ihe Clty ot Costa Mesa to emer upon the ebove-descnbed property far inspec�ion purposes. I agree not to occupy or allow occupenty ot eny building emhonzed by this permit unlil linel inspection. I Signature Ot Le n s� e --Antl/Or Authonzed A wnt _Date__ COOE 1. INSPECTIONTYPE 7616 Fixed System Final Fire Preventlon 1268 Paol Spe Final 200 Flnal RB-Rool 201 Finel BIaWRetein�ng Well 202 Finel Factory Fire Place 203 Flnel Sign 20a Final Demolition p�g' Itfi1TI1L9 COOE I INSPECTION TYYE 208 Finel Mechanical 20B Finel Plumbing 210 Flnal Eleciricai 212 Finel Fire PrevonGon 220 Flnel Planning Approval 222 Final Si�e 250 FinalBuiltlinryOccupency �� '�-�--�i "°�_.l- � 421 E 20TH ST Ea3��.�^�": SUZANNE LUCK - �oaEs�-q21—B E 20TH C.M 92627 �vr�. Yuiwo woxrss: MCXRECTOR BlCdIFFA: !KK OX FlA'S �DOPES4: uc. ra.: CONIFACTORS WWE: cam�croas �uiva wo�ss: uc. rio.: uHi: g UNf: UNT: IJCEN4E0 CONTPACTOFS DECL�flATION: I MrWy dlim uMr pruly d pajivy Nel I am liwmed under prwidona tl Cheqr B (mmma�q �ith Sectian ]WO) W Oiveion 9 d Ne Buainm� end Pmlu�au COEe. erd mY Yoenro u in tu0 Mce eM Wac. cmuc.r+o.: uc.aw5s: uc.No.: EXP: Dmm eaveeoa: OWNER BUILDEP DECLARATION: I Iweby dfirm uMx paiWy d pe�vy �he� I em aaemq han iM Caureqon lirrue law la tlr IoOoxTq �uaon (SMion ]W 1.5 &mipna enE Rafauiom COEe: MY dY n oouNY wfiiN nG�w e W�G to mmhud. eller.'unMave. �ndeh, a raqi em/ Nruqwe. p'v b h bwm.e, ebo rpwem iM appli'aM la weh peimd lo fib a eqmd etmement �hat M a sM kemed puivueM Io IM pwieiona d IM Caniredon Licenfe Law �Cl�eplm 9(oommenriiq wilh Sadion ]000) d Divebn � d �M iainev eM PrWesebne Codel a�� a ehe'v usmq thsslmn vd tM bmo la Ne dleped ssemqion. My vidmion d Saeun !W 1.5 by eiry eppli�am tor e permil rbpW ihe eppliunl Io e tivil penelly d nd mae tlan INe huMred tlollen �5500�). � I.avavmardtMpropenYamYa^V�W�+�hwepeemtAaisobmmpemeiion.WldoNawA.eMiMeliuclurouMinieMeE adlmadtareebl��a^)�.B vinee�enCPrdaeennaCode:TheCanireaorsLicemelewdoearotepplybanovmerdpope�ly wla WICa a inpewee Iheroon. uM who daea eueh wk h'uneell or Mnatl «Mraph hc a Mr ovm ampbpse, povided thel euM impovememe ve na immCeE a dlaed la eab. tl, howewr. IM buitlirq a inp�mvinau u edd wnAn ans yeer d mmplMnn. Ns " owmrbuiker �A hew �he buNen M P�'�^Y M a eM d'd m� diN n impwe la Ihe VaV�a d ade). �Lj I.a�owwdiMpW�Y.amuh�w�aoMred'nOr.iNfcaroMoonVanmmrnwudtheO�M�ISatlun]Du.&n'vmaeM a,a�. coee: rne cw�.e� u�M. i.w ao.. �a ropr w.o o�.,�« a wawnv wno waa. a�po.« m�o� .�a .e�o wurew la wdi P4a� wnN e wNrepMe) Iceroed Wnueni io �M Caumaon L'vaa lew�. exynp ur�Mi Ssction: B. b P.C.. br mro re o�; �a I a��- �� : �� ..� c:� n�M �r mm i.m ewe,e a w wam.w�d u,e �a��eM. a cdrom .�a sd�r coa. s.c�. zsws. uva..m 255�6. eM that I a enY �um buikiip ocapani xill / wil rw1(dreb aw) neaE ro Mh eek pete coEe� eM IM �pwrtmeM la eGermnlammVuelimamoEifimtianhomiheAr e�iy e�pemeniDiueid.R�daailmnnrwionWN�bmwexemMiromthaee m�.' Deie: ApqicaM: WOFKEN'S COYPEN9AT10N DECIAX�TION: 1 Mreby efFrm unEar perol�y W parjury one d iM tdbvArp Jetlumbm: � I heve anE W mei�uen e caW'ctls d mumi �o setli�wre br Maken' m�qenaation, u paided ta by be�on 9]W d �M lebar Code, la �M peAn�nence d Ihe xak la which �he permn n inueE. ❑ ina,b.od.u�m,:�.aw�.•�o.rom��.�.a.r.m�=.anvs«a�s�aoem.i.escoa..ro,in.wm.�am. woek lor wAitli Nu Porm� u usueE. MY wnFen' oomVMwian imuranea urter W O�Y numbr en: c�.,: Pdiey NumEx: iTia seaian neM m� Ge candered / fMO�i u br wro hurMd ddlen Iti00I a Am.l � I omlYy IMI in tha pe�lame�we W IM w«k br whkh ihu permit ie ueued. 1 eheA mi ampby eny panon in ury men�nr so m to becwne eubjed lo iM xv�Fare' compenaetian lawe d Cddaniq vN apree Nq A I a1puN beconr mibjad to tM xoMe�e' compsnxtion pwieiam d Setlion J]00 d IM leEor Code, I Mell IMhwilh comp�y wilh None pwisioro. ova: �od�: Wem/rp: F�Nun b ucun wortsn'roiry�ruatlon rovxp� I� unbwNl, mG �IWI ub)�ct an �mploy�r to cNMml pxultlq en0 dHl flnu iq ro crh �inerW Ilrous��d Jo/kn (Sf00,P00A M�Wltlon b tln cwf ol rompxwtbR ��wp� u povlbtl Ier In Sxtlon 91G6 0/ M� 1.�6orCod. Inhnaf, erM artomsy'� I�u. u CONSTtiUC710N LENDINO AOENCY: 1 MreEy elfirm uriEer pmeXy d per'�vy Ihel Ihae u e mMiuqion Irid q pmry 1or the perlamencs W iM xak la xfiiM the pem�i u¢eueE (Seaion 9081, CF. C�. LENDER'S NAME: LENOER'S �UDNE55: I eenJy ihm I M1rw me! Nu epplceum e�d wte ihm Na ebove inlame�ion c earq. I eprea �o comply Mil� M dry vW mumyadireeKes eM e�nb bwa reW'vp to buJE�v �� eby aullrorixe repaeenteMev d Ihb My ro amer upon IM ebwa�meMiorieE piope�ty �o��sv�+��wrv��SOZANNE LOCK n (St51iG.WP) _r Wh4e-Buddip65de1y,G�semF4:Canery-AppiwY:Pink�iew�ua:OddruoA-A�asuar CITY OF C6STA MESA — BUILllING PERMIT PERMIT NO: P 080991 PLAN CHECK NO: CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU SOB DESCRIPTION : REPLACE WATER HEATER CLAIM VALUE; CALC—VALUE: � PERM NO: P 060991I GOVT: N SUPP: N PUAPOSE: OTH SQ FT: GROUP OCC: R-3 / COMMENTS: X �itirititat*�***at*�it**�rit*atat*it�*itiFit�etitatat****at�*�*��***�*ft*tt**it�***�*it�at**kio-et**�it*at�it Z O N I N G R E(J U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING --------- FRNT; FT IN REAR; FT IN FRNT: FT IN REAR: FT ZN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ: PROV; PARCEL: 00000000 ZNE: REF NO: PLANNING NOTES> i iF iF iF 1E 1E iE aE iE 1E 1E IE iE 1E iE 1E 1F iE 1E 1E 1E iE 1f 1E iE �E 1E iE ik iE if iF ib if if if iF ib if iE if if i! iE if if if 1E iE IE it iE iE 1E if iF fE� 1E IE iE �E iE �E 1E If ik 9E fE iF if 1f if iE 3E jE 1F iF IF iF if D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S ZONING APPROVED HY DATE: BUILDING APPROVED BY : APPLICATION ISSUED BY: / %�—� ��*�**��***��**�� LEGALIZATION:N F E E S U M M A R Y BLDG PMT PLUMBZNG ELECTRIC MECHANIC PERMIT 11.00 258 DATE; DATE: 1 � 1�F3Fi�****�-itx�** *5e I STRUCTURAL SEGM NT:N FIRE SMIP/RES GRADING SMIP/NON—RES PLAN ISSUE EEE 22.00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS----> 11.00 22.00 0.00 33.00 33.00 .00 REVENUE DIVISION TOTALS--> COLLECTED: 33.00 OVER/SHORT; ,00 HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 33.00 !E iE iE 1E 1F �E 1E iF aE iE iE 1E iE jF 1ElE 1E 1E iE iE if iF iE if iFlF if ff �F iE 1E iF 3E 1f ft iE it iElf iE fE 1E IE iElE iE 1E 1E ik if * ik 1E iE iF fF 3f IE fE IE iE iE 1ElE 1E 1E iE fE iE iE iE iE jE iE if iE 1E 1F iE I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E 5 C R I P T I O N UNIT COST TOTAL COST PLU 1 WATER HEATER AND/OR VENT END OF FEES E�PIR.� DATE 11.00 11.00 � O1 002?1605-002?1605 T O T 33.00 DATE� 12/27/9S TIflE: 03:44 � . CONSTRUCTION AND PLANNING �. APPROVALS Permit # �, 1. Temporary Electrical Service or Pole i , 2. Soil Pipe�Undrgrnd. 3. Electrical Conduit Utility•Undrgrnd. 4. Electrical Conduit-Undrgrnd. 5. Steel Reinforcement - 6. Elecirical UFER Grnd, i 7. FOo[ings �!, 8. Foundation '�.. 9. Water Pipe-Undrgmd. '�� 10. Structural Floor Svstem 1 t. PropertY Sewer I.ine & House Connection 12. Sewer Cap 13. Roof Drains 14. Rough Plumbing 15. Rough Electrical•Conduit� ` 76. ftough Electric Wiring 17. Rough Wiring Sign 78. Rough Electrical•T Bar Ceiling 79. Rough Heating & Air Conditioning 20. Rough Factory Fireplace 21. Ducts, in Structure 22. Ducts, Ventilating 23. Gas Pipe-Rough & Test 24. Roof framing 25. Roof Sheathing 26. T-Bar Ceiling 1Structuraq & Monocoat 27. Frame and Flashing 28. Lathing & Siding ' 29. Insulation 30. Drywall Nailiny 31. Plaster 8rown Coat 32. Electricai Power Meter�Final 33. Final Electric 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Serv(ce-Final 40. Gas Service-Finai 41. Solar Oomestic�Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINA� STRUCTURE & BUILDING 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co Date Date POO PA Inspettor AppROVALS Permit # Date Inspector 52. Pool & Equipment Location � 53. Steel Reinforcement 54. Forms 55. Electrical8ondinq 56. Rough Piumbing & Pressure Test 57. APPROVALTOCOVER�GUNITE 58. Electrical Conduit�Undrgrnd. 59. Gas Pipe, O Undrgrnd., Test 60. Backwash Lines, P-Trap, � Undrgrnd. � 61. APPROVAL TO DECK - . 62. Backwash & Receptor�Final 63. Heater & Venx�Final 64. Plumbing SYstem - Final 65. Electrical�Final 66. Soiar System�Final 67. Fencing & Access Approval � 68. APPROVED FOR PLASTERING 69. POOL/SPASYSTEMSFINAL � FIRE OEPT. REQUIREMENT APPROVALS Permit # 70. Underground Hydro 71. Product Piping O Gas ❑ Oil 72. Undeiground Flush 73. Undergrnd.StorageTankOGas OOiI 74. Overhead Hvdro 75. Dry Chemical 76. Dry Standpipe 77. FIXED SYSTEM FINAL 78. FIRE PREV. FINAL HEALTH DEPT. REQUIREMENT 79. FINAL INSPECTION 80. FOOD CERTIFICATE ISSUED Notes: PHOJECT FDOflE55: OWNEfl'S NAMF: nooeess: bPCHIENGINEEfl: AOOflFSS: 1 � PEflMITTEE: aooaess: REG.NO.: UNIT: UNIT: UCENSEO CONTHACTOfl OECLABATION: I here�y affirm IAai I am licensetl untler provisions o� Chap�er 9(commencing with Seciion 7W0) ol �ivision 3 0l Ihe Business antl Professions CoOe, anU my Iicense is in full �orce antl etlecl. CITY LIC.: STFTE LIC.: CLASS: �ale: Signaiure: WONREHS' COMPENSRTION OECUflATION: I here�y ailirm Ihal l have a[eriilita�e Of con5eni to 5¢Ibinsure or a cetlifi[aie al Workers' Campenution Insurance. o� a cenifiea coOY �hereot �Se[I�On 3800. LaU. C). POLICY NO.: E%P. UATE: `COMPRNY: �� C¢rlilieG copY �5 hereby �umi5hetl. ❑ Ce�tlie0 coDY is Iiied vnl� Ihe city 9uiltling Orvisian. �ale: ApDlicanl: E%EMPTION FNOM WOPKEBS'COMPENSRTION DECIAflATION: (Thissec�ion neCd natbecomple�edi�ihe permitisla ane�undfeA�511p)orle55). I cenily Ilul In ihe oe�ormance ot Ihe work lor w�icil Nis De�mit is issueA. I shall noi employ any persan in any manner so as ta �ecame Suble[1 Io ��e Vlorkers' ComOensalion LawS 01 Calilomia. Da�e: Signaiure: NOtICE: I�. alter making tllis Oeclaralion, you s�ou10 become sublecl to ihe Workers' Compensation provisions of ihe La6or Coae, you mus� fonhwilA comply wii� suc� pmvisions or Ihis permi� shall be tleeme0 revoke0. CONSTPUCTION LENOING AGENCY: I hereby aflirm Ibat I�ere is a tonsimction lending agenCy lor Ihe De�ormanCe ol �he work tor wAich Ihis permil is issuea �Seclion 3097. Civ. C). LENOEfl: AD�flE55: OWNEB BUILOEB OECLABATION: I hereby allirm Ihai I am exemp� �mm �he CanVactors' Slale LiCenSe Law �or Ihe �ollOwinA �CaSan (Sec�ion 7031.5 Business and Pmlessional CoOe: Nny ci�y al county whi[� repuires a permi� to consVucl, alter. impmve, tlemolish, or �¢pait any StmtWre. O�ior to iI5 issuance, a150 require5 t�e apptican� IOr Such permii Ia �ile a 9A�e4 5tatemenl Ihdl hC/She i5 1i[¢n5ed pursuant la Ine pmvisions ol tne Cantractor5' Slale Litense Law (Chdpler 9 �wmmenting wit� Secibn 7000) ol 0ivi9on 3 af Ihe Business anG Pmlessions Code) or �Oal he/s�e is eeempt Iher¢Imm an0 ��e GasiS �or ��e aliegea exempiian. Any violaiion a� Setlion 7Q31.5 by any applicam lor a permil 5ublec�s Ihe apDlicanl to a civil penal�y ol not more Ihan five hunJreA Aollars �5500�. I. as nwne� o� ��e pro0eny or my employ¢es wii� wages as their sole compenSation, vnll 00 I�e work, an0 the i5trucWreiS no�intenGetl arottere0lar sal¢�Seclion 7044, 9usine55 antl Prof¢55i0nalCoae: T�¢ Conira[tars' S�ate Li[¢nse Law does nol apD�Y Io an owner ot a DmOe�y who �uilUs ar impmveSlAereon. an0 who tla¢5 Such wOrk hims¢If/�er5ell Or Ihmugh � his or her own employee5, pmvidea Ihai SUCA impmvemenis are no� intentle0 or ofiefed lor Sale. II, howev¢r �he UuilOing or impmvement is solA wit�in one year of completion, iAe owner will have ihe 6ur0en ol Dmving he/she Oitl not builU or imDmve �or the purpose o� sale�. I. as owner of Ihe propetlY. am exclusively conlractinB wi�h licensetl contraclor5 ia con5imcl IAe pmleci (Seclion 7044, Business ❑ and Professions CoOe', The Coniracbrs' Slate License Law does nOt appry to an owner o� propetly who bmlds or impmve5 thereon antl who convacts inr xur.h projecis wiih a conlrac�m�s) license pursuant �o ��e Contraclors' Slale License law). I am aware Ihal pmo� ol their WorkeYs ComDensali0n insurance shoultl Ue pmvi0ea to me. � I am eKempt untler Seclion: B. 8 P. C. �Or IhiS fea5on: �ate: Ownec I tlo nereDy cenily �ha� I am aware ai antl unaerstane Ine reQuiremenls af Califomia Healih an0 Safety CAOe Sections 2550.5. 25533, antl 2553E an0 Ihat I or any fuiure UuilOing occu0anl wilVwill noi (circle one� neea �o comply wilh said s�a�e coae5 an0 i�¢ BQuirem¢n�s �or a peimit lor con5lmciion or moailication imm Ihe Nir Oualily Managemen� OiSUicL He5i0en�ial con5�mclion applications are eKempi �mm inese omvisions. Ua@: ADDlitani: I h¢reby ceruly I�at I have rea0lhis applicalion an0 state t�ai Ihe a6ove in�orma�ion is correcL I aA�ee to compty wit� all ci�y antl coun�y orOman[es antl s�atelaws relatinglo buil0ing con5iruclion antl here�y authoree representa�ives of�hi5 cilylo en�eruponlhe aUove�mentione0 pmDeny lo� mspection purposes �ate: SignaWre: �iiver's Li[ense or Satial SeCurily q; PERMIT NO: G 050258 PLAN CHECK NO: 06076-90 S . �rx�*�***�t*+t�t**�tr**�t**��t�t*�*�r�e*�t***�***r*��*x��e**�r+r***�r��t�*�r��t*��r�r�t*�*�x�*�****�t+�* TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST PLU PLU PLU WATER CLOSET (TOILET) 2;00 SEWER BUILDZNG / TRAILER 5.00 GAS PfPING SYS OF 1 TO 4 OUTLETS 2,00 END OF FEES 1641�a6 WM1ne—Bmltlmg�, Green—Cotle EnlorcemonL Canarv—A�PlicanC Pmk—Revenue: Goltlanraa—Assessor �� —�— ��' —. ... ' �+ i 1 � s, aE� 10 1990 ; � CITY OF COSTA MESA �?' - .. 6.00 5.00 2.00 CONSTRS�CTIC:LAND PLANNING ^ P�. A APPR,OVALS Permit # Date Inspector AppROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe�Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility�Undrgrnd. 54. Forms 4. Electrical Conduit�Undrgrnd. 55. Electrical Bonding 5. Steel Feinforcement 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, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, � Undrgrnd. 10. Structural Floor SYstem 61. APPROVAL TO DECK 17. Property Sewer Line & House Connection 62. Backwash & Receptor�Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing SYstem - Final 74. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduii 66. Solar SYstem�Final 76. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceilin9 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning � FIRE DEPT. REQUIREMENT 20:�Rough Factor.y Fireplace APPROVALS Permit # x - 21: Dutts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping �Gas OOiI 23.`;Gas�Pipe-Rough & Test 72. Underground Flush 24."Roof Framing -• 73. Undergrnd.StorageTank OGas ❑Oil � 25. Roqf Sheathing 74. Overhead Hydro 26.• T�Bar Ceiling;(Structural) & Monocoat 75. Dry Chemical 27` Frame and Flashing 76. Dry Standpipe 28. Lathing'& Siding� 77. PIXED SYSTEM FINAL -• ' � 29. Insulation ,� _; � 78. FIRE PREV. FINAL - 30. Drywall Nailing_�� HEALTH DEPT. REQUIREMENT-�, �.. 31. Plas`ter Brown Coat 79. FINAL INSPECTION -' 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED ' - 33.�Fin`al Electric- ' Noter. . - 34�Final Heating,&?Air'Conditionind "' ' ')- � � 35.-,FinalGasPipe-Test;- -�-"' ��' l �: 36:>Hood or Canopy�' „ 37:�.Final Fattory Fire(ilace 38.�Final Plumbing C� 39::Water Service�Final r 40: ; Ga s;Se r vi ce- F i na f�' 41 . �Solar pomestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Laridscape I'rr,iqai n System 45. Sound Attenuation 46. Haridicap Regulations 47. FINAL STRUCTURE & BUILDING r 48.;FINAL PLANNING 49. Electric�Felease to Edison 50. Gai Release to Southern California Gas Co 51. CERTIFICATEOFOCCUPANCY No. Date Insulation Certificate City of Costa Mesa California 92628-1200 P.O.Box 1200 Permit Number �� (� / �/ �',!� � �y�5 i -� � Cs2��4 m� . Number antl Street Qry �, � � - . Caun y Subdivision Lot Number Description of Installation ROOF Material ��,1Q Brand Name Thickness (inches) Thermal Resistance (R-Value) EXTERIOR WALL ��. Material F/��i2(o,[1�SS BrandName�wv-r!%S Cv.2a/�G . Thickness (inches) � � �� Thermal Resistance (R-Value) �� CEILING Batt or Blanket Type Fl t� �P (o(��i_ Brand Name % "viL%U v Thickness (inches) %6�� Thermal Resistance (R-Value .h^,�i� Loose Fill Type Brand Name Contractor's minimum installed weightlftz_ Ib. Minimum thickness inches Manufacturer's installed weight per square foot to achieve Thermal Resistance (R-Value) RAISED FLOOR fDA�CA�'� �LVU� Material �'I�ilC2(nr�5 Brand Name ��fi'V ' Cv Thickness (inches) �! �� Thermal Resistance (R- aluel �' SLAB FLOOR ��/ Material /�%/�� Thickness (inches) Width (inches) Brand Name Thermal Resistance (R-Value) FOUNDATION WALL Ma[erial �� Brand Name Thickness (inches) ' Thermal Resistance (R-Value) Declaration I hereby certify that the above insulation was installed in the building at the above location in conformance with the current Building Energy Efficiency Standards for new residential buildings contained in Title 24 of the California Adminstrative Code. • �j ) � oN�% �v N�r- � �9� 5 3 =� Gen I Coniractor (Builder) � License Number ��_ _ /�n �� / � SignaWre antl Title Daie Sub-Coniractor (Insulation Installer) SignaWre and Title 190]-a6 License Number Date � �� CERTIPICATE OF COMPLIANCE PAYMENT OF SCHOOL FACILITY FEES NEWPORT-MESA UNIPIED SCHOOL DISTRICT Developer/Applicant: iUgDA/��b,,()� Address: /o�% � �� J�• ��lJNl�� Telephone Number: /ab ��3Sfo Tract/Parcel and Lot Number(s): Location of Proje'ct: �d.� � oc.U� � Number of Square Feet of Residential Space x $1.50 Number of Square Feet of Commercial and Industrial Space Commercial/Industrial Project is Mini-storage Movie Theater Racquet/Health Warehouses Heavy Industrial Regional Shops Light Industrial Total x $0.25 Total (Check One) Motel Bank Neighborhood Shops R & D N� i:el Medical Office Office Park _ ./oo/ a �� OO Preschool _ Auto Repair Hospital Large Office Office Bldg. Restaurant Fast Food The provisions of. Government Code Section 53080 are not applicable. This certifies that the above-named Developer/Applicant has paid school facility fees in compliance with Government Code Sections 53080 and 65995.' Checks are to be made payable to Neiaport-Mesa Unified School District. Newport-Mesa Unified School District The above representation as to square footage is true. Developer/ Applicant agrees that if it is later determined that such representa- tions are not true then this certificate shall automatically terminate and the appropriate City/County shall be notified. Date: ��—S ��(J / // �� Dev r icant .�vba,�' No�rv'»+R% .� �421 E 20TH ST °M1` INGALLS, CHRIS 6 KAREN Egg SAME i 714-650-6810 MPI. YA111N0 �DURE54: uxr: D mcxrtecron�aa�n: DARLENE LA COMB �� 17069 �xowr,w•s�oo��s: Z376 COLLEGE DR 4350525 ��+T C.M. CA 92626 �^"�T�g"� MARK DEYDEN DEVELOPMENT (714)434-4927 CQAFACTOIfSYYIplG 1707 SAMAR DR �oopEu: C.M. CA uc.xo: 325027 92626 uNr: LJCENSED CONTNACTOHS DECLANITION: I hereby eflvm uMar penelY d pe�ury ihet I em licaiued uMer proviaiona d Cheqar 9 (comme�q wnh Sectun )OW) d Gvnion � d tM Buvrian e�d Pmleseipu Codp. erd mY �� s� full Ipu aM eHetl. c No.:,02045p5 uc.cuss: H uc/.No.):_ �325027 EXP: 12/95 Dme: `�/' / � Gormaev: � �� /� .�� IER BUILOEN OECL�R�TION: I henby efNm �vder per�ely d pr'µy � I em eRemq hom tM Commfon lioenes tew ta the lo0ownp �maon (�� ]0�1.5 Buviwa� rd Prdeedoiu COEe: R�ry cry a ooueuy wlddi ipu'vas a permC lo mnuun. eEer. "vnprova. Mmdeh, v reyi vry evuqwe, pia b ai ewvKe, abo repuem iM xpqirau la wcA pmd to fJe e uprod swemeM Nal he a sM 'v 4cemeE Wmiien� lo IM V�ow�e d IM CaNreclaa Licenae lew ICheqa 9(Oominenc^i xvh Sedian )000) d Oirvebn 9 at �M emev eM Rdmuru Cadal a ihm he a ehe ia mamq th>ekwn vM �M bexe la Na eIMeW examqbn. �m'vulmion d Seqion J1.5 by e�ry eppli aM Iw e permil wEpdn iM epqicant to a tivil pmelry d m� mae Ihen (ve huMmE AOAen �SSOOU. Q 1. ea o�mer d IM propenY a�^Y empbyeea xin wapea m IMi ade mmpeveibn. xill Eo Ihe wak. enA IM nuuclure e nd imeeded a ollmed la eab (Seciion )01.. Buviwn eM PMaeeiona Code: The Conlreaon livnse Lew dma mt eGVN �oen oxner d propMy wM bu/de a mMo'�as �hmean. eM nfio Cooe euch xork Fimaetl a Mnel n Nrpp� he a hm own emPbMs. pa'�dad �hm euch improvemew ere nd inienEeE a a11waE la eab. tl. Inwv.er.11n WiMilq n inpmeinmq b eold xilhin me Y� d oompMion. the owrorb�iNsr wJl heve ihe buNen d pai�p M w ehe d'd na buJd «impwe loe �M puryme W aebl. � I. u o.ner d the NW�Y. un u'M�MY m4rad�q wM licensed cantrxbn b mimw Ihe pqea (Satlun )Oa,. &smma eM Pmimaima Coda: The GaqrarJm L'cmee law dou nd WbY ro en ovmer d VrWe�Y xfio bu�lde a uMa'a 1lwsan and who convecu la ew3i pqee� vnN e mnreeor(e) IicemW W�aueru to tM CpYraCor� L'xwue law). ❑ I am evemq wEp Section: B: 8 P.C., b Uua reem: Dele: Owner: I do Mraby cenily ihm I em ewue d vd unEentarM iM requimmems d Callomie Hml�h e�d Sdaty Coda Seniwn 25W5, 255J3, aM TSSN, eM � I a eny Mun WiMinp ompenl will / wil rol (urtb aro) nsed lo canply wiM1 se'd 9a1e oodef enE iM reQuiiemenn bt epermnlammuunianormadifmianhan�MAi e�iy erepementDinria.RedEenlielmnaiueioneppiratianenuamplmmRma yadauiu. Dete: �ppiceN: WORKEF'S COYFENS�TION OECL�N�TION: I Mr�by affvm wdr penepy tl peejvy one d ihe IaGowinp Eetleretum: n IbwuMWmein�einecMifictl�MmiwnlloWlimu2laworkrimmpemqian.nOrmidedtaGYSatlun3lWd�Mlebor �r Gods. la tM parlartunca d IM wk la wlih Nb pxmY u roued. ❑ � n..<ene w menuen.onw.• oomoenwon �raurdw.. e.,ea��b M seeo� a�oo d m.lnno, coa.. a in, o.no.merce a ub work lor vA�i1i iAu pertnd'u mued. MY wwkere' compewtion imurerca fanier uN pdie� wmEa ero: ce,�.,: STATE F[7ND EXPIRES Paryr+�m�.: n��anan—aF O1/O1/97 ia secfiar need nof ba comdefed / �he pmmd ia M ana hundreC ddlers /5100) w bss.) J 1 cenAy Ihet in IM perlormeMe d ihe work br whch ihia pam�n u ieweE. I ehell nd emplq erry penan in ury menner w m ta e«� .�,Ww m�n� ..o,�n �w�..�� i.•. a cm��. �d m.« mm e i.nWu n�a dq,�a w ma �• . co penaelqn pwisqm d Setlion 3100 d Ine Lebo� Cade. I ehetl fwNwGM1 compl/ /wi1M1 t w�+� Dve: � `31 _�i L ��%'�R�/� �i� emin0� F�llun ro��c✓n wortw�'rorrpwwtlon eoverep� l� unNwNl, en� loyw ro crlminl paultlu eM clvll flns �q ro m� h,nGrM Ilwuuntl0dl�n lflpp,ppOA In Wltlon ro N� ro�( o! rompxwfbn, Aunpa u pvvMM br In SxHon 9)fb' ol M� LeUo� Code, Inrons( �M �ttomey'� Isea. CONSTPUCiION LENDINO RGENCY: I MreEy eHim uMm peneMy d perjury thm Ihme u e mnstivabn brdi�p epency la Ne parlormeMe d iM xwk lar whrch ih'v peiml h caueE (Sedian �09). CM. C). LENDEP'SNAME:ALSO ZND FLR WI CLOSET G LENDEfl'SFODFESS: STAIRWAY, EXTEND GARAGE I cenily Il�et I heve reed Ihia eppliceiion end eteis ihel �M1e ebave iniwmelion ia mnep. I epree ia cwnpy wnh dl dly enE munry adinancea arM eime ler.s rele�ip �o buikvp canavuaion end Mreby eu�Mr¢e repawnle�ivee d thie dry lo enler upon tM ebwa�mamunad proparty lorinspoc�ion o��D�s. MARK DEYDEN Pn eme �✓/Q.��„ e Da�e: ,Spw e d r/RBenVAppYent/Co a (S15t-aB.WP� Whno-Buildiip85elely:Oreeo-Fle;Cenery-Applicenl:Pink-Revenue;Gddenrod-Asxmr CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 076241 PERMIT NO: B 076241 PLAN CHECK NO: 02885-95 L GOVT: N SUPP: N CONSTRUCTION TYPE: V-N PERMIT TYPE: STR PURPOSE: ADD JOB DESCRIPTION : ADD 2ND FLR MAST BEDRM, BATH,SITTING RM SQ FT: 1,347 CLAIM VALUE: 55,000.00 CALC-VALUE: 61,897.30 GROUP OCC: R-3 /M-1 COMMENTS: 685SF 2ND STORY + 82SFSTAIRWAY 6 EXTEND EXISTING GARAGE BY BOSF +�+��*+�**x x *�***x *�r�******x ********�x �+�x x *x **x **�r+�«�+r*�rx��***�r**�r�+�� rx�**+r+�*�x �*+�** Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN HUZLDING ---------- --------- ACCESSORY HUILDING --------- FRNT: 16 FT 1 IN REAR; FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: 5 FT ZN LEFT: FT; IN RGHT: FT IN PARKING REQ: PROV: PARCEL: 42631249 ZNE: R1 REF NO:� PLANNING NOTES> 897-SF ADDYTION TO HOUSE. ' i iE fE 1E 1E 1E IE 1F iE �)F iE 1ElE 1E 1ElF 1E 1E iF iE.l61F fE'!E 7E iE 1E 1E 1E i! IE IE iE iE fE iE iE 9E ff 1E 1E iF if 1E 1!!E iE iE iE 1F 1E iE iE 1E iE 1E fE 1E 1E fE iE 1E 1E if �E iE ik 1E if 1E jE iE 1E 1E fE iE iE fE 3E iE D E V E L O.P M E N'f� S E R V I C E S R E Q U I R E M E N T S ZONING APPROVED� BY .�' � ' ' I/�f�l DATE: �-/ J/'' 1% BUILDING APPROVED BY :=, '' � �J� DATE: � -�/ APPLICATION ISSUED BY:' �- % •• �/�#� DATE: /-3I'g u. IEiE1ElEififlElFiEiElEiflElEkiElflEififiEif��f��fiFiF�3F3FiF�F �i ifiF��7F��f��f7f�F7f7f1EiElfiEifiElFikikiEiF�FTF3FTF�F�F�f1E1E LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y BLDG PMT PLUMBING ELECTRIC MECHANIC�� fFIRE � SMIP/RES GRADING PEEiMIT 468.50 - . • �' ' . 6.19 � SMIP/NON—RES PLAN 304.53 , J ' .. ISSUE FEE , �-_ BUILDING—DIV—> PERMIT ZSSUE PLAN=CHECK' ;�'OTAL '. PAID DUE TOTALS----> 474.69 0.00 304.53 .779.22 7,79,22 .00 REVENUE DIVISION TOTALS--> COLLECTED: � 474.,69 'OVER/,SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE �SMIP/TOT� GRADING PLAN—CHECK 468,50 ' . 6.19 -, , ' ' 1 'i if fE iE �E jE iE 1E 1E IE IE * 3E iE iE �E fE iE iE IE iE if iE 1E 1E 1E iE 1E if iF 1F ik i6 ik 1E 1E if 1E iE fE 1E iE iE iE iE iF 1E iE iE iF iE ik iE iE iE fE.fE 1E iE 3E if�iE 1E �f fF iE 1E if !E!F 1f �E �E �E iE IE iE ik jE 1E I N D I V I D U A L F=;E E B R E A K D 0 W N TYPE QTY D E S C R I P T I O N �',' J UNIT COST TOTAL COST SFR 767 DWE—TYPE V—WOOD FRAME � —GOOD 77.9'0 59,749.30 SFR 80 RES—GARAGES TYPE V ''� � 20.60. 1,648.00 SFR 500 ALTER BY VA�1�o ESIDENTIAL NOZONE 1.,00� 500.00 ��ND OF FEES • -) �; t � �.: �. .. � ��`�FCf��j � �� - - _ - ^� ' 7 .. ' ��f �' � � ` �- - v�,._. ,;.�_ ��Y1 r� .STRUCTION AND PLANN(NG f PROVA4S Permit # � 7�.mporary Electrical Service or Pote 2. Soii Pipe-Undrgrnd. - 3�.� Electrical Goniiuit UtilityUndrgr�d. _4, EleCtrical Conduit-Undr9md. 5. Steel Reinforcement 2• 6. Electrical"UFER Gr�d. . 7. Footings �, � �" � •8. Poundatifln � 9. Water Pipe�Undrgrnd. � � 10. Structural Hoor Svstem tl. Property Sewer Line & HouaeConnection 12. Sewer Cap � . 13. Roof Draios ' 74. Rough Plumbing - 75. Rough Electrical-Conduft 76. Rough E(ec2ric4Viring 17. Rough Wiring Sign 18. Rough Electncai;T Bar Ceiling 19. -Rough Heating & Air Conditioning .� 20. Rough FaGtory Fir,eplace . -_ _ 21. DuCts, in 5trutture � • •• . . 22. Ducts, Vent�iating�_. 23. Gas Pipe-Rough & Test �- 24. Roof Fra�ming' � � ' � 25. Rooi Sheathing � � � 26. T�Bar Ceiling {StruqtUral) & Mop'ocbat 27. Frame and Fiashing - ,- . � 28. Lathing & Siding . ,� 29. Insulation � • ' �� 30. Dryevall NSiling ` 5 37. Plazier Brown Coat • � � 32. Electrical Power Meter•Fi�al -33. Final:Electric ' � - �34. Final �Heating & Air Conditioning '- � 35. Final Gas Pipe;Tesi''_ - � 36. Hood or Canopy :` - 37. Final Factorv Fireplace - � . �38. Final Plumbing � � 39. Water Seryice�Finai � ' 40. Gas Servica-Pi�al ... - ° •41. Solar pomestioFinal 42. Backflow�Preventer. - 43. Backfiow Irrigetion, � 44: Landscape Irriqation System � _ 45. Sound Attenuation' '� 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING G 48. FINAIPIANNING � 49. Electrie RElease to Edison 50. Gas Release to Southem California Gas Q 51. CER7IFICATE OF OCCUPANCY Date Date � Inspector �� -q 6 _q� _q� -RE \ POOL i > APPROVALS Permit # Date Inspector 52. Pool & Equipment Location 53. Steel Reinforcement 54. Forms 55. Electricat Bonding 56. Rough Plumbing & Pressure Test � 57. APPROVAL TO COVER�GUNITE 56. Electrical Conduit.Undrgrnd. 59. Gas Pipe, � U�dre�rnd., Tesi 60. Backwash �ines, P•7rap, Li Undrgrnd. , � 61. APPROVALTODECK • fi2. Backwash & Receptor-Final 63. Heater & Vent-Final 64. Plumhing System � Final - 65. Electrical-Final 66. Solar System-Finai 6�. Fencing & Access ApProval 68. APPR4VED FOR PLASTERING 69. POOL/SPASYSTEMSFINAL FIftE OEPT. REQUIREMENT . �o APPROVALS Permit # � � 70. Underground Hydro " 71 . Product Piping O Gas ❑ Oil 72. Underground Flusfi � - 73. Undergrnd.StorayeTank,L�Gas ❑OiP 74: Overhead HVdro ' 75. �ry Chemical ' 76. Dry Standp'tpe • ' 7T.� FIXED SYSTEM�FINAL - 78.-. FIRE PREV. FINAL ' HEALTH DEPT. REQUIREMENT �79. PINRLINSPECTION • j. I 80. FD00 CERTIFtCATE ISSUED � Notes: -- � : � ' • II / TO: Applicant: Address: NF" ��ORT-MESA UNIFIED SCHOOL DISTBICT 1757 CERTIFICATE OF COMPLIANCE OF DEVELOPMENT FEES '} PURSUANT TO AB 1600 AND AB 181 (,x) Ciry of Costa Mesa District Receipt No. a�% 3�7 ( ) City of Newport Beach ( ) County of Orange Plan Check No. Telephone TracUParcel and Lot Number(s): `� �m�` S C�-1. C� F} � Z�� a� Location of Project: �� S Number of Square Feet of /� Residential Space _! 3 x $ 1.72 Total � ��° � - � `� Residential / Sr. Citizen Space Commercial and Industrial Space , Warehouse Space Commercial / Industrial Project is: (Check One) Warehouses R&D Movie Theater Mini-storage Heavy Industrial Regional Shops Light Industriat This project is exempt because x $ .28 x $ .28 x $ .2235 Motel Bank Neighborhood Shops Racquet / Health Hotel Medical Office Office Park Total Total Total Preschool Auto Repair Hospital Large Office Office Bldg. Restaurant Fast Food This certifies that the above-named Developer/Applicant has paid school facility fees in compliance with Govemment Code Sections 53080 and 65995. The Building Permits for this square footage ' t i roposed development may now be issued by your jurisdiction. , � Checks are to be made payable to Newport-Mesa Unified , � District. i��,, The above representation as to square footage is true. Applicant agrees representations are not true then this certificate shall automatically terminate notified.' '�� M M Date: �- � � X/ ,e,'pplicbnt it is later determined that such appropri�e City/County shall be � I . Insulation Certificate Cit� of Costa Me��. California 92628-1200 P.O.Box 1200 Permi� Number _i�--� � � �� / 421—'� j�-S`� 2�'T"� S� C� s'� vh E S� Number and Street Ci�y �9 �L2r�+G� Counry Subdivision Lot Number Description of installation ROOF ,,/,� , � Ma[erial ,�_rl % ��S Brand Name �A��` Thickness (inches) 6• �"� " Thermal Resistance (R-Value) �'� 9 EXTERIOR WAL� Material Brand Name iI%/��✓�� Thickness (inches) Y � �� Thermal Resistance (R-Value) ��— CEILING , Batt or Blanket. Type '�� Brand Name ./�f%i✓��v Thickness (inches) ' �� Thermal Resistance (R-Value) —.e '/J�' Loose Fill Type Brand Name Contractor's minimum installed weighUftz_ Ib. Minimum thickness inches Manufacturer's installed weight per square foot to achieve Thermal Resistance (R-Value) RAISED FLOOR Material Thickness (inches) SLAB FLOOR Material Thickness (inches) Width (inches) _ FOUNDATION WALL Material Thickness (inches) Brand Name Thermal Resistance (R-Value) Brand Name Thermal Resistance (R-Value) Brand Name Thermal Resistance (R-Value) Declaration I hereby certify that the above insulation was installed in the building at the above location in conformance with the current Building Energy Efficiency Standards for new residential buildings contained in Title 24 of the California Adminstrative Code. � ��Yn�✓ � // / neral C/9� ractor (8uilder) _ � � /l�✓' /LiL� �L`-'�•"� ` / � SignaWre and Ti�le ��Cfi�.�l7�11� C_�O �.v�'' Sub-Co actor (Insula�i n Inst Iler)� Signa�ure and TNe 190] 46 3ZSb ��/ LicBnse Number ��/ g � Date S'Ps�9a License Number � �-� 9,� Date . �noxFss a eawc�o: q Z 1 E 2 0 TH S T w.T+ERsruaEi�.pav,N: 2NGALLS, CHRIS 6 KAREN �ooness: SAME 714-650-681U ,vn. iumwo �ooxess: uxr: ANCXRECT ON FN�IFfA: {� �j 11L. NO.: JICN.OPENQ'BMDflESS: ��PI��f�EV��I7R 4350525 ��069 C.M. CA 92626 coNm�erareruue: MARK DEYDEN DEVELOPMENT (714)434-4927 CpRN1MOR8M41JN0 1707 SAMAR DR anoxess: C. M. CA umxo.: :12 5 f) 2 7 �%lfj%1f �: uMr: 110EHSED COMF�CTOqB DECI.�PATON: I MiaEy eI1Fm uMx p�nely d paijury NE I em IbnwE uMx peo�iMm� W Cheqv B (aommam.iip wllA Bacibn ]000) d OWbbn a al N� Butlrop vq Pmla�cm Coda. W my liosnw b In h0 tpcs uM NIM. cmuc.No.:020455/ uc.cuss: g uc.No.: 32502�7/] EXP: 12/96 Dtla: �— �� y COMreqn:� ��' O -�%' — OWNER BUILOEP DECLINITION: I Mnb/ eMrtn urMx qeWy d parWry 1 Ihei em a�mnq Irom �hs Contmtlm Lbm� law la tM � Idbwip rsann (�lon ]a91.5 Bwien eik PMaabna Coda: My ciy a mumy which �puim a peimu Io eorotrutl. ellx. Impvn, Mmd'sh. a npv arry �iructun, pior W rtt Y�wnoe, ebo nQuim IM epqlum Im wch pamiE m fil� a�ipiwE tltl�msm NY M a �M u IiosnrE W��t lo IN pwiriom d IM Comreqon lJroms lew �Cheqx G(oommeMip wNh SM1ion ]000) af DNbbn ] M �M Busin�a uM ProMnbm Gody or Ihd M or �h� b ex�mp Ihrshom enA IM bun la N� dlpM axemption. My vbletbn of 8wlion �091.6 by eny eppliranl lor � p�rmil �ubNd� �h� applkanl �o a dvil pnelly W nd mps IMn IN� hunEnO dotl» �SS00�). � I, u owner d Ihs OropMy or my ampbyws wNh wapae m ihW rola oompenutlon, wlll do �b work, end Ihe �ImcWn b nol Inlandad or MueE br W� (9�cUon 1W1, BuYnw eM Prolw�bn� Cods: TM Comredwe Licana� Lew dom nM epplyto en oxn�rol Dropahy who buYd� a 4nprow� iharwn, uk xfio don �uch wwk Iim�aM ar henel or Ihrouph hb m Mr own amqoysa�, proNdW IIW wch Improvomanb u� nd ImeM�tl a dbied br �ds. H, howwer, iM buiNlnp or impovemanl b wk wit�in one yw M oompletbn, ib owner-0uiNw MII luva t�e WNen d prwirp M a�he tlk nal WiN or Improw Iw iM puryae d Ws). � I, n owiw d IM wWeM, am ucdaMMY oomieeeq xdh licanwd contrMon m mrutrW IM pdb (6eeion loU. ButLis� W Profpslon� God�: TM GomreGm lkarw lew Eros na epply Io en ox*wr d papMy who buM� a Impwr Ilr'wn end Mq mn��ecl� M aM pajW� wiN e aqXMor(�) litsnaad punuenl lo IM Conlieqae UCM�s lAwl.� ❑.�, I em azemq urdu banbn: B. 8 P.C., br Nn ruson: � � Ovc Owner. i ro n.�.W uwr uw i.m .�..r. a.ne wda.�.�d u. �.a��.m d c�iomi. Hmw�.w sdm cod. s.ann. assoe. nva..m P5511. end tM� I a�nY Mun driNmO moiD�. wi0 / wil na (tlicY me) roed ro canG�Y wi� uid pNs mEr W �M rMUInm�M br Dme: Applicent: WOFKEN'9 COMFEN9�TION DECLARATION: I MrMy elfirm uMar p�nMy W perjury pr d iM IoDowi'p Etlu�tun�: � I han ud xil m�imen � c�rlifctl� d oonwN to uXLnun tar v.ark�n' canpnWion. u prmW�d ta by bwion ])00 d IM leba CoN. Ip �M pulmiuna d tM work la wNch ihu pemw u fqusd. ❑ � n....na.a m.im.:� w�w.• mno.�w4, um�.�w.., na� M sec� a�oo a m. �an« cod.. a. m. o.dam.nc. a �n. work In v.�idi Uu� 0�� u umwE. MY waken' canGe�ion imuruice mnix uk i�Y num Wr m�: ce�r. STATE FUND EXPIRES aa� r�mn«: - 01 / O 1/ 9 7 �m„ .«.;o� �..d �a w�dxee r u. w�x n w. w�. n��e,.e don.,. rsiool w ie.a.l � I dnN �� in IM pMormuKe d tM work br whch Ihb pemin h i�aued. I 4WI iwl �enplq ury peipn in ury menner n q to bscmp wbjw b iM xaMna' canpv�wion lews M CaIEom4. end eyna tlw G I Mouk Eemnie wbpp to IM xwken' compen^mlion po+ieiwn d Seeion 3'!00 d Ihs Lebor CaEe. I ahetl IMhMdh mmpf� wilh tlias pivvi�io'm. Oms: T L' S� Appiranc Waminp: F�Nvn ro��cun wo�lr�n'romp�ru�tlon rovsnp� 1� unNwNl �iM �lull aub/�cf �n xnployx ro cNMn�l pm�/tlw �M clvll flrws up ro on� huntlM lhouxntl Edl�r� (S10QOp0A M M11tlan b M� ro�t ol rompnwtbM1 tlemep� �� pvvMM br In 9�cMon J108 0/ M� L�4or Codp /nfx�iq mtl �ttomry's l�u. CON9TBUCTON LENDINO 10ENCY: I Mreby elRrm uMer peneMy d parNrY �� Ihen b e mMmdion bnEinp epency Im iM peAormenm d Ihs wM la whiM tha prml ia eeuetl (SaGion 309], Cv. C). LENOEF'9NAME: ALSO 2ND FLR WI CLOSET & LENOEP'9ADDPESS: STAIRWAY, EXTEND GARAGE I cenM �� I hme nM this epplicetian uW pe�e Ihet IM abova intamuqn ia coind. I epiae lo comply hith ell rny and munty adinaMas uM �ide k� reW inp b W iWnp wnsUuqion erd hereby eNhorrze npeeemmivea olthie ary io anter upon ihe ebws�menloneE propaM �w m.aeab� o�,ro.e.. MARK DEYDEN �� //��INeme '2^�j—/� .._ /'li� om.: Sqnetun d O�nedApenVAppirenuConireaa �5i51�al.WP) Whils-BuilEip 8 Sdety:OreerrFle: Cenery-�ppirant: Fnk-Rewnw: (3olden�od-An�em CITY OF COSTA MESA - BUILDING PERMIT PERM NO: P 076317 PERMIT NO: P 076317 PLAN CHECK NO: N GOVT: N SUPP: N 4_��SS�i��ii�r�'�t�� T�'�'�� T-� Y��l�T i'�'%�: �'��i� E'URPt]SE: ADD JOB ❑ESCRIPTIUN ; ADD 2ND FLR MAST BEDRM, BATH,SITTING RM SQ FT: CLAIM VALUE: CALC-VALUE: GROUP OCC: R-3 /U-1 COMMENTS: 6855F 2ND STORY/ SANITATION DIST PERMIT #13277 REF B-76241 74iFiFiFatiF�i�#FiFlfi�iti�i��c{C�G�C�C�c�C�C�C�f.�C�c{Ciii�c{4ic1F��3fi�?�i�lFi�Fi�#,k.i��lE�f#*xiF?F#��*i�#3Fi�*iEit{F��i��i�i��jFrt 7, �J N I N�3 R E� U I R E M E N T S S E T B'A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY HUILDING --------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ: PROV: PARCEL: 42631249 ZNE: REF NO: PLANNING NOTES> i �1 if if 1F 1E if if iF iF if !k if 1E iF 1E iF iE if 1E iF 1F if jE 1F iF 1E iE iE fE IE 1t IE IE 1E 3E iE iE aE 1E iE 1E iE ik 1f iE if IE if iE IE iE iE 3E iE iE 3E �E fE fE iE jF iE ib 1E 1f 1E 1E ik iE iF IE k� iE if fF iE �E 1E iE 1F D E V E L O P M E N T S E R V I C E S— R E Q U I R E M E N T S ZONING APPROVED BY %� DATE: BUILDING APPROVED BY : r,� DATE: '!-jol APPLICATION ISSUED HY: ��-}1,' DATE: Z�� 1flEififif�ifi(�iFifiklkiEiEif3EiFiE1E1EiE16iE7F��F3F�F7F�F3f3f7F7F7FiF�F7F�F3FTF7�f�3f3FTf�F3FiF3F ��F fTF�3F1E3flfiflflElhiEiElf 1k1E LEGALIZATION:N F E E S.0 M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRT;C� MECHANIC FIRE SMIP/RES GRADING PERMIT 74�� ;� � - SMIP/NON-RES PLAN G" �• •- ISSUE FEE 20. 00 '� , • ` BUZLDING-DIV-> PERMIT ISSUE PL4AN-CAECK r'"' TOTAL PAID DUE TOTALS----> 74.00 20.00 0`:00; '� 94.00 94,00 .00 A ^ REVENUE DIVISION TOTALS--> COLLECTED; 94.00 OVER/SHORT: 00 BLDG PMT PLUMHING ELECTRIC MECHP:NIC , FIRE SMIP/TOT GRADING PLAN-CHECK 94.00 , � : IE iE 1E IE 1E iE iE iE iE 1E �E 3E 1E fE fE fE fE ff fE �E �E iE iE iE 1! iF iE iE iE 3E fE jE iF 1E 1E iE 1F.iEiE iE if iE if�iE iEl61E 1f if iElElF iE �E 3f 1E �E fE jE iE ik k iE iF iE iE 1E iF 1F 1E iE �E �E 3E jk 1E fk 1E iE I N D I V I D U A L� ��F E E�=B R E A K D O W N TYPE QTY D E S C R I P T I O�,N,�i 'l ''� UNIT COST TOTAL COST � � i/ � � PLU 1 HATHTUB ,_ �' 7,00 7,00 PLU 1 LAUNDRY TUB OR WASHER _ 7,00 7,00 PLU 1 SHOWER , ,.^ 7,00 7,00 PLU 2 WASH BASIN ^ � � 7,00 14.00 PLU 1 WATER CLOSET (TOILE'�) � 7.00 7.00 PLU 1 WATER HEATER AND/ORtiVENT' 7.00 7,00 PLU 2 GAS PIPING SYS OF 1,T0 4 OUTLETS 5.00 10.00 PLU 1 SEWER, CONNECTION T,O HU3LDING EACH iA_,15.00 ,,_, ._�15.00 END OF,% SEE5 _ _ - . - d � -_ . i' . ... � � /J� - � - ` .. ,✓ � ` CONSTRUCTION AND PLANNING POOL & SPA APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector � A. Temporary Electricai Service or Pole 52. Pool & Equipment Location .� " 2. Soil Pipe�Undrgrnd. 53. Steel Reinforcement � 3. Electrical Conduit� Utility-Undrgrnd. 54. Forms 4. Electrical ConduioUndrgrnd. 55. Electrical Bonding - - 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electriwl UFER Gmd. 57. APPROVAL TO COVER-GUN�TE 7. Footings 58. E�earical Conduit�Undrgrnd. 8. Foundation � 59. Gas Pipe, O Undrgrnd., Test �9. Water Pipe�Undrgrnd. 60. Backwash Lines, P-Trap, � Undrgrnd. 10. Structural Floor System ' 61. APPROVAL TO DECK ' 11. PropertY SRwer Line & HouSeConnection 62. Backwash & Receptor�Final 12. Sewer Cap 63, Heater & Vent-Final 13. Roof Oreins �.v�� }S� c: ,. ' 64. P�umbing System - Final 14. Rou9h Plumbing - I/?,�'�F �,l/ 65. Electrica6Final 15. Rough Eiectrical-eonduit 66. Solar System�Final 76. ftough EleGtric Wiring 6�. Fencing & Access ApProval 77. Rough Wiring Sign 68. APPROVED FOR PLASTERING 78. Rou9h EleGtrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditionin9 FIRE DEPT. REQUIREMENT ... 20. Rough Factory Firepiace . � . APPROVALS Permit # 21. Duc[s,in 9tructure-� - 70. Undergrouod Hydro 22. Ducts�, Ventilating �� 71, Product Piping OGas ❑Oil 23. Gas Pipe-Rough & Test � - � 72. Underground Flush 24. Roof Fram�ng' _� 73, Undergrnd. Storage Tank � Gas ❑ Oil 25. floof Sheathing - � • 74. Overhead HYdro 26. T-Bar Ceiling (Struc2uraq & Monocoat '. . 75. Ory Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding . � 77. FIXED SYSTEM FINAL 29. Insulation � 78. FIRE PREV. FINAL � 30. Drywa�l Nz��ing � HEALTH DEPT. RE�UIREMENT . 31. Plaster BroWn Coat � 79. FINAL INSPECTION 32. Electrical 7ower MeterPinal ' �''� B0. FOOD CERTIfICATE ISSUED 33. Final Electric - Notes: 2--� � -�d-s�� r� �-�-M-r 34. Final Heating & Air Conditioning , �I �..�/ ' - Ca.�F`.-i?'�E tJ_��_� 35. fina� Gas PiPe-Teat • �--4 'QzG-s-�-�v��-i�l - - 36. Hood or Canopy S-z� G/ ��iK,/L�L�� %�-� _ < <O 37. Final Factory Fireplace f�=�{--�6 �G�<:�-c� 38. Final Plumbing ' , � -�{ �6 39. Water Service-Final � 40. Gas Servica-Final - , 41. Solar pomesticFinal . � . � . 42. Backflow Preventer � i '43. Backflow Irrigatiog � � � 44. Landscape Irriaation System' • _ . 45. Sound Attenuation ' . � 46. Handicap fiegulations � 47. FINAL STRUCTURE & BUILDING , � 48. FINAL PLANNING � � 49. Electric Release to Edison � ♦r 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date � � "°°"�s a e"a°'"°: . q 21 E 2 0 T H S T wmexsNueeRa�avr�: INGALLS, CHRIS 6 KAREN ADDRESS: S��' 714-650-6810 �PPL. M.UUIW IDDIIE44: VNi: D CITY OF COSTA MESA - HUILDING PERMIT PERM NO: M 076316 PERMIT NO: M 076316 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: V-N PERMIT TYPE: MEC PURPOSE: ADD urcxRecTox�m�x: DARLENE LA COMB �G�= 17069 RCX.ORElq.'BAODNE89: z37Fj COLLEGE DR 4350525 uNr: cartx�crarewure MARK DEYDEN DEVELOPMENT 926714 ) 434-4927 cam�croxeuuuxa 1707 SAMAR DR moeesm C.M. CA uaxo: 325027 92626 UNT: 110EN9E0 COMPACTORS DECLANITION: I M�eW NFm uMx pnely d px�ury tIW I un IbnMd uMo prwidoro d CAeqx G (camm�ndrp wNh Bection ]OW) d DM�bn J W iM Bwlnw uM Profaum� Cad�, enE mY Ilnm� b In Iu01ac� uM Nl�q. emuc.No�.:7020455/ ue.cuea: g ue.wo.: //3JJ2502�7�/ EXP: 12/9b om.: T/%/� b canrcao��J' /�v�' _7._._ OWNER BUILOEX DECLAR�TION: Ilw�by ifirm u'Wr prWy W par�u}'Jlhtl I am wmp Irom �M CamreCon Uum� Lew la iM Idlowirp rauan (�ion ]W 1.6 BueM� enE PMa��bn� Cotl�: AnY ciya munty whltl� npulm � qrmq to oon�UucY. 111er. ImWow. demd'uh. a npai Yry �INtluro. p'w b Ea's�WM. eb0 npWix IM eppliranl Ip tWi pimtl to fJ� e dpnW M�ment UW M a�h� u rio.n..e w�.m io in. pw+�m� w N. com'm«. �k.n.. tnw �Cnw� e loomm.z;�v wnn seawn rorol a dww� a a tlr Buvinsea eM Rdenione COEa� ar ihtl M w�he is eremq iMreM1om eM Iha Eeeh ta Na NIpaE uamqM. My videtbn ot 6atlion �m1.s b' anv Vd�t I« e o+�mY akpue iM epW'rsm m e rhil W�Y a ro1 mm Ihen fna hundrsd ddlen R'+�11. ❑ I.noxnerdiMpeops�yamyanpby+a�v.thwapumiMiedeeompsme�bn.willEotMxwk.andlM�WetunwnaliM�Med or oRerod la aeb (Seclbn ]aA, Budnew uM Pmimums Code: TM Canirmon 4mnee lew doee nd eppyioen ormard popery wM10 buiCa a inprova ihwson, end rAa doas euM vM Fim Wt a Mnd a Ihraph he or Am own empb/s�, povidW �het ach impwpnema ua nd'unended a dlxed la eeb. tl. Mwaver. iM dnNieq a Mpapnwq w wld xilhin ons Yw d eanplalbn. IM ow�wr-0uitler xiil heva iM burAen d poviep he or eM did rol Wiltl a impiwe la �M Wrywa ol We�. � I. o owner d the PW�Y. em mtlnirW mureuiq wuh YoenmE emtrecbn to canatrud No Volb (SWian ]Ou.Buaiiw� end Profeaeims COEe: The Conlreqon L'ewe lew Eme na WV�Y �o en ovmx d popenY wAo bn1i� a im0�'a Ihaean uW wM10 conUecla M ath W9�a wiM e caM�edor(s) IcmfeE WnueN lo IM Canl�etlm Lioanfe lewl. � I am eaemp under Seclian: B. 8 P.C.. br Ne reeaon: Dale: Owner. 1 do Mreby cenily Nel I em awera M vk ivdeiaiend the requiremww d Celfomie Headh arq Sdery CoM Sediom 25b05. t55J�. aM 255H. vM tlw I«ury haura buikvp oowpu�t xill / wil M(arcb aw) neeE to mmyy wY� uiE pms ooda enE iM nQuiremenh br ome: ncd�a: WONKEN'S COYPENSATION OKL�N�TIOH: I Mreby aMvm uMx penelly d peijury one d Ns idlowi�p EWereiiom: �] I Naw xN N meiNv� � ceni'rste W ovnenl to �Ninaws M wakere' canWmnim. ea V��b la M Sectim 3)00 d iM leEu cade. �« m. v«�m�c. a me �wk �« w:u, mo o� o aa�.e. ❑ i n�.�a �;� �m.:,,.onen oomw�.mo�, ��mn.z.. m nw�ba M s.d:.� a�w a m. �.no. coe.. w. m. wrtorm.�. a m. wark la xl�itli INa D� u csusd. MY waMers mmM�ion ireurercs urtbt uM WKY numEx ua: c�,: STATE FUND EXPIRES Pdiy Nwnber. O 1/ O 1/ 9 7 (ihis aa:m �ed na 6e ewn0�� i tM Pa'ml'd /w aro huHieOCaYers (i100/ ar bn.) � I cenh �� Ne pMwmence d ihe work la xAich thu pe�mn b bwetl. I Wd �wl emqry enY De� ��Y mennx �o m lo becann v�4� to tM wrMn• canD��ion Nvn a CelEmde. enE e0ree Net tl I�AadE berome wi4a to iM xorlan• compenwion pwisian d Sedion 3)00 d iM leEn Cods. l duAl� py wnh t � oma:�, I5� G �Porvm:�_ � Waminp: Fellun ro axun wroilrw�'rompxuatlon cormp� I� unNwNl, enG �Nll �uDJ�ct en �mployx ro ctlMml p�MMu enE dvll flroa �p b am hintlro0 tlrouurtl do/4n (SIPq000A M M1ltlon b fM roit ol ron�oxu�tbM1 dempu u provMetl br /n Sxtlon 9106 01 �h� LiDorCOM, Inhna4 �nd �tformy'� Iws. CONSTqULTON IENDING <OENCY: 1 MreW affirm uMer perWry d perjury Ihel iMn o e mnmrvaion IaMieq peney In Ne perlame�ce d �M wM In whiM �hu O�i ia uawE (Seaion �091. C'ru. CI. LENDEH'SNMIE:ALSO 2ND FLR WI CLOSET & �oioensnooness:STAIRWAY, EXTEND GARAGE I ceniy IM1m I hew raeE Ihis epdtie�im uM tlels �MI �M aCwe inlormelion ia mrted. I pres �o wmply xilh ell ay uq coumy ordi�e uN stete levn relet'vp io buiMvp crostruqion vd hereby eW�orize reprmmte�ives d �Id� dry b eMer upon iM ebae�mentionetl pmpaty ��'�"W'� MARK llEYDEN Dete: 'L' �i `�i/ ` (5151J6.WP) WMa-BuilEnp b Sa1NY:Oraerr-Fle: Cuiery-Rpplrsni: Nnk-Rmwe: (bWenroaAnmaor JOB DESCRIPTION ; ADD 2ND FLR MAST BEDRM, BATH,SITTING RM SQ FT: CLAIM VALUE: CALC-VALUE: GROUP OCC: R-3 /U-1 COMMENTS: 685SF 2ND STORY/ EXTEND EXISTING GARAGE 805F / REF B-76241 **��***�+��*+�*� ��+�+�+t��*+t+trt�� *� �rt�� **��r�*� �*�***�*x��***�**��r***x *****��**�*�+�� Z O N I N G R E Q U I R E M E N T S S E T H A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING --------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ: PROV; PARCEL: 42631249 ZNE: REF NO: PLANNING NOTES> , —" � if 1E 1f IE iklf if IE �E 1E iI� ik ik iE if iF iE 3f 1E if if iE if ik 1E jE iF 1E iE ik iF 1f iElE 1E if 1E 3f if iE ik 1E iE if 1E 3f iE iE iE 1E 3E 3E k IE iE iE 3E iE 1E aE iE aE 3E 1E 1E iE iE �k iE iklE �f if iE ik if 3E aE 1E D E�� E L O P M E N T S E R V I C E S R E Q U I R E M E N T S ZONING APPAOVED BY , . DATE: BUILDING APPROVED BY APPLICATION ISSUED BY iE if 1E 1E 1E iE if If 1E iF IF iE if iF IE if iE if 1f iE iE LEGALIZATION:N F E E S U M-M A R Y STRUCTURAL SEGMENT:N '.. �� _� BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT • ,/ ' 33.50 ^� , 25� SMIP/NON-RES PLAN • - ISSUE FEE ' �/� ` 15.00 BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE TOTALS----> 33.50 15.00 0".00 48.50 48.50 .00 REVENUE DIVISION TOTALS--> COLtECTED:'�' 48.50 OVER/SIIORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC , FIRE SMIP/TOT GRADING PLAN-CHECK .: 48. 50 I r' • if iE aE if If k if fE fE 1E iE �E iF fE �f iE iE iE iE IE 1E aE ff IE IE if 7E 1P �f IE 1E fE iE �E 3E �E !E fE iE fE ff ff 9E IE jE �E iE �EfElf 1E �)E 1E 1f 1E 1E iE iE 1F iE 1E iE 1E 1E �f 1E 1E fE iE iE iE iE IE iE iE fE IE jE if I N D I V I D U A L; ' F`E E B R E A K D 0 W N � /. TYPE QTY D E S C R I P T I O: N" "�,,r� UNIT COST TOTAL COST MEC 3 REPAIR/ALT HEATING UNIT%SYS W/CNTLS 9.00 27.00 MEC 1 FACTORY ��n:.-"'�E ' 6.50 6.50 V��C�i7�GSty�7.�;END OF, FEES r .-i �?ti( � �SD%'! 2 `�' `�! /2��Lrft6` ' ,?,��il' _ �T` - it " ,. ' _ 1` _ `' �� ;y'7i l� t � CONSTRUCTION AND PLANNING POOL & SPA APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector . i. Tempotary Electrica� Service or Pole 52. Pool & Equipment Location ' 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement � 3. Electrica! Conduit Utility�Undrgmd. 54. Forms 4. Electrical Conduit�Undrgmd. 55. Electrical Bonding 5. Stee4 Rei�forceme�t 56. Rough Plumbi�g & Pressure Test 6. ElectriGal UFER Grnd. 57. APPROVAL TO COVER�GUNITE 7. Footings 58. Electricai Condui[-Undrgmd. 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. lNater Pipe-Undrgrnd. 60. Backwash liaes, P-Tcap, � Urtdrgr�d. - 10. Struccurai floor Svstem • 61. APPROVAL TO DECK 11. Propertv Sewer Line & Housc' Connection 62. Backwash & Receptor-Final 12. Sewer Cap � ' 63. Heater & Vent•Final ' 13. Roof Drains � 64. Plumhinc� System � Ficiai 74. Rough Plumbincj . - 65. Electrical�Final 15. Rough ElectricaLConduh - 66. Solar System-Final � i6. Rough Electric Wiring 67. Fencing & Access Approval � 17. Rough Wiring Sign 66. APPROVEO PQR P�ASTERING . 18. Rou9h Electrical�T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 79. Ro�gh Heating & Air Conditioning 3��JclG ,� FIRE DEPT. REQUIREMENT 20. Rough Factory FirQplace 4..�.C'L/. „II / APPROVALS Permit # �a ��n 21. bucts,in Structure 7�. Underground Hydro " 22. �ucts, Ventilating , 71. ProducI Piping OGas OOiI 23. Gas Pipe-Rough & Test 72. Under9round Flush 24. Roof Framing ' 73. Undergrnd. Srorage Tank O Gas ❑ Oil 25. Roof Sheathing - 74. Overhead Hydro 26. T-8ar Ceiling (Structuraq & Monocoat 75. Dry Chemical � 27. Frame and F�ashing � 76. Dry Standpipe 2&. Lathing & Siding � 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAI 30. Drywall Nailing 'HEALTH DEPT. REQUIREMENT 31. Plaster 8rown Coat 79. FINAL INSPECTtON � 32. Electrical Powei MeterFinal 80.: F000 CERTIFICATE ISSUED 33. Fi�ai Electric Notes: .: � �-y'� ��g�� `�_ i 34. Final Heating & Air Conditioning �,� I � - � 4---�%�� 8�%��l�� _ _ . � _ 35. Finai Gas Pipe�Test � C 6 l�L e�v_t-2 �4c�f- - 36. Hood of Canopy ' ' �� ' 6' �rt_6 E-!_�� - - - - 37. Finat.faccory Firepiace i', 38. Fina� Plumbing • - ' f ,', . 39. Water Service-Final � 40. Gas Service-Final ,� 41. Solar pomestic�Final 42. BackfloW P�eventer � 43. Backflow Irrigation . 44. LandscaPe IrriQation System • 45. Sound Aitenuation 46. NandicapRegulations 47. FINAL STRUCTURE & BUILDING 48. FINALPLANNING • � 49. Electrie Release to Edison ' - 50. Gas Release to Southern California Gas Co ' 51. CERTIFICATE OF OCCUPANCY No Date � ADUq650FBURpNO: 4'11 E 20'LH ST °""`"s"''"E"'°+a'�": INGALLS, CHRIS 6 KAREN ADDNE54: SAME n � 714-650-6810 �vri. �,uw�o �ooxess: uHr: D ��T�p��+ DARLENE LA COMB �"�- 17069 u�cxonr„o•s�: z376 COLLEGE DR 4350525 �M C.M. CA 92626 . caeimura+srw� THOMAS ELECTRIC SERVICE (714)546-4377 cam�croas�uuna 2361 FORDHAM DR �oonEss: C. M. CA ua ra.: 4 O 1 3 6 0 92626 uxT: LICENSED COHfRRCTOflS DECLIHRTION: I hereW eflrm under penely d pe�ury ihel I em licemed uMer povuiona ot Cheqm B (oomme�np x�lh Seclion )OW) W Oiwun 3 d tha Busineas eM Profinebne Code, vd my licenee o in lull brte eM eMed. cmuc.No.:024401 uc.cuss: C-10 ��c.No.: 01360� ��//XP: OS/96 o e�, com,ee«: G.. � � I^_^� b 0 ER BUIL�EP OECIANATION: I hneEy elfiim uMer pene�y d perjury �MI I am uemp Imn iM Comreaore licaroe Law Iw Ihe wip imaon (Saabn )W 1.5 Busii»� eM Rdeasions Cotla: AnY UY a ooun�y r.fiich nVuiree e G�� to mmVucY. ellar. "unYova. Eemde�, a �epei airy aWclure. priar l0 4a wauarce, eMo requiree �he epplixnlla wch prme to Rb e eq�rod sblemen� Mel M a eM YeemeE W��I lo IM qwiebns d IM Conlretlwa lieenae lew �Cheqer 8(mmmercieq xilh $eqion ]000) d Diveon 9 d �M inses vM RWenona Code� w ihm he m Me is axemq Iharalmm ard ths buie la iM elbped mamqion. My vuW ion d Seqion .f1.5 Ey eiry eppliram In e parmn wbjetls iM epd�� o a wil peiuAy d rat mora Ihen fva huMfetl Edlen �5500��. � I. ea oxnar d iM popeny or mY �d%�'Mh wages es Ihei eda mmpeveiion. will tlo Ne xork. arM IM nrucluro o not imendaE a dlereE la eeb I�� )�. Buarcn eM ProlwaonsCade: The Conlreaon lioenae lawdoea �w epply io an owrer d pope�ly who bulde n inpraree tMrem. eM Ma doae auM xwk FimseX or henatl a Nruph he a hm am empbyees. paiAed �hm wch impovanmu era mt iruakW a Wered la eeb. tl, Mwever, tM buiMi�q u inponmeN b voW xilhin one yeer d oompW ion, the owmr-0uitlar xill hera tM EuNen tl pwinp M a she d'tl na duM a unpan la Ihe qvpoas d Wal. � I. ea owner M iM paD�Y. am wduv+dY mnirea�q x'vh fioensd conuman io cmmw tln P9b (Satlian 10u.8us'vms enE PMm�bm CoEe: TM Catlretlm l'smro lew dou ml eGWY b en ohnar d O�W�Y vAp dutls a impwae Ilvsan eM wM10 contrees br wM pqera� wah e mNratlap) �icemad Wnuem to tM Caurxfa� liwnes lex�. �- ' ❑ I un aaemq wdar Sar�im: B. 8 P.C., b Nu �seaon: � Dve: Oxnv �' I do Mnby cenily thu I em ewera d erd uMereteM IM requiremenN d Cd/omu HWIh uW Se/ely COEs SeGbrq A5504, 25539, ud RSS�a, anE �hd I a e�ry lulure buildi�p occupent wiil / will nm (a�cb me) neeE lo comON w�h eeid meta mdse vM iM requirememe br epsrmnlormnelruclionormodifmtionhan�heA'v u�i�Aiiy.enepemenlqmna.Raeldenlidwntlrud'aneppffatbruereeaemptiromihese poWsione. Dete: AVd�� W OPKEN'8 COMiFNSATION OECL�R�TION: 1 hersEyy tlfirm uMer Po�Y a OMury one d ths fdbwi�q dedarationa: ❑ I Mw eM xil meimen e ceMiuts d wnsent io eaMJmu�e fur xaken compenwion. v pmided ta Dy Setlion 9]00 d IM Lebor Cada. la IM pMmnuce d �Ia xak Ip wlich thia pmmil ie isewE. ❑ � n....�a xi� m.ime'n .�ohen� mnv�o� �.,rence. e. nw�d M sea4n a�oo a u» �mo. coe.. w in. w�«nwioe a �n. work la �Midi Nn prmn b u�ued. MY waYen' mnpenemion imurane� urriae erd pdiey wmbar va: c�: , GdiryNumber. � eection n�ed rrN bs cmplsrod /(M pxmt m br me huMisO dolbn (51001 a bn.) I pnN �� in iM peRmmencs d the wak M whch �hie pmnA u uaM. I Mell nol ampby enY W� � u�Y menmr m n to Eeca1m wbjeii lo IM xa�kmJ oomperiWion lewt d Celilanie. ep�es �IW tl I ehouk bxoma abjetl lo IM �wrken' canRpaiavcn qvnam�e qd S/adion 3]00 d tM lebar Cade. I I lo w4� canply pwmwv. ate; .��J—�—S—1 l� Mvr�eu: �n_��_ ' Mp: F�Nun ro weun wortwi rompwwtlon roverep� l� un4w?u( .M �NII ua/�ct.n �mylqw ro eilMiul pw��ltlu .M elHl �ns tp ro em nv1E.W fMUNM Adl�nlS10(4000A b�Itlon ro N� ewt ef rompau�Wn �W �+ pa�� br In S�ctlon ]108 0/ fM I.�bor Cob. Intx�st, �rW atlomsY'� lep. CONSTPUCl10N IENpINO AOENCY: I hereEy efFrtn uMer penely d parMrY �� hon ie a canp'utlion bMiiq epmcy for tlro perlormenm W Ihe v.ork la MiM t�u perml ie aaued (Seaun �OBI, Civ. G. LENDEfl'SNAME�� n FT 1� TT rr nccT & LENDEN'S ADDFE39: x I eeeliN �� * reed ihia epplieelbn end atata thet ihe ebove inlametbn ia eortep. I ap�ee lo eomON �h dl dly eiM county oNinenwe and eiele 4vn roletn0 �o builEiq conwutlbn eM hereby eWwrrze,epreaeniMivm W tMa Uy io enbr upon iM ebova�menlioned propery laimpeaion purpoase. „ STEVEN TAOMAS oma: �i ^ZS"—�'iG (5151<0 WP) Whne-8uikvq 8 Sdery: Green-Fle: Cenery-�00��: Ank-Rv.anue: (3dCenro�Aveeava CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 076895 PERMIT NO: E 076895 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: C�—N PERMIT TYPE: ELE PURPOSE: ADD JOB DESCRIPTION : ADD 2ND FLR MAST BEDRM, HATH,SITTING RM SQ FT: CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /0—i COMMENTS: REF: B-76241 �**��*x*�**rt**rt**at**�***�*�*at*�iFat��*�+�*it�*�*�itit*�at�*�r+��*�**�**�**�+E****at****+t� Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY HUILDING --------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT; FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ: PROV: PARCEL: 42631249 ZNE: REF NO: PLANNING NOTES> i ��+r+�*+�**��****+�*��*��****�+�**��****x**�**��***�+�a�x****�r�*��****��+�***x�x�+��**** D E V E L O P M E N T S E�R V I C E S R E Q U I R E M E N T S ZONING APPROVED HY � DATE: HUILDING APPROVED BY : DATE; r, APPLZCATION ISSUED BY: '' ��_ DATE: ZJ� �V '�1F1f1EiEiEiEiFiElflEiEifjEiFlEiElEiE14iE�E��iF�F�F3f��FiF�Sf��if�F� � �{FTF7F�f�F7F�jF��F��F'�F'iF{E{EiF'IEiElE3E1EiEif 3E � LEGALIZATION;N F E E; S U M M A R Y STRUCTURAL SEGMEN :N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PEAMIT 49.50 508 PLAN ISSUE FEE 15.00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTALS----> 49.50 15.00 0.00 REVENUE DIVISION TOTALS--> COLLECTED: BLDG PMT PLUMBING ELECTRIC MECHANIC 64.50 SMIP/NON—RES TOTAL PAID DUE 64,50 64.50 .00 64.50 OVER/SE{ORT: .00 FIRE SMIP/TOT GRADING PLAN—CHECK �1E 1E If iE iE if 1E 1f ib iE iE fl� iElE �ElE IE IE 1E iE af iE iE iE aElE 1E if 1F 1f IE 1f aE iE 1E iE fE 3E fE �)E iE if 1F 1E if !f ik 1E iE 3E 3E �E Ib 161E �f IE iE IF iE if iE 3E 3E �E fE iE �f if iE if if 1f iE if 3f !f f! fF I N D I V I D U A L F E E B R E A K D 0 W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST ELE 19 FIXTURES, LIGHTING 1 ST 20 EA. ,75 14.25 ELE 14 RECEPT/OUTLET 1 ST 20 EA. .75 10.50 ELE 17 RECEPT/SWITCH 1 ST 20 EA. .75 12.75 ELE 4 NON—RES APPLIANCE NOT OVER 1.0 HP 3.00 12.00 END OF FEES �� , C6NSTRUCTION AND PLANNING ,' POOI 'A APPROVALS Permit # - Date Inspector pppROVALS Permit # Date Inspector 1. 'femporary Electrical Service or Pole 52. Pool & Equipment Location ._ 2. Soil Pipe-Undrgmd. 53. Steet Reinforcement 3. Eiectrical CAnduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. , 55. Electrical Bonding - 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Gmd. 57. APPROVAL TO COVER�GUNITE i_ 7. Footings � 58. Electrical Conduit�Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd., Test � 9. Water Pipe�Undrgrnd. . 60. Backwash Lines, P-Trap, O Undrgrnd. � 10.StructuralFloorSYstem �-� 61.APPROVALTODECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor�Final , 12. Sewer Cap � 63. Heater & Vent-Final 13. Roof Dreins 64. Plumbing Sysiem - Final • 74. Rough Plumbin9 65. Electrical-Final . 15. Rough Electrical-Conduit : �". Solar System-Final 16. Rough Electric Wiring � 9 i'7, Fencing & Access Approval 17. Rough Wiring Sign ' 66. APPROVED FOR PLASTERING ` 78. Rough Electrical�T Bar Ceiling 69. POOL(SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioni�g FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVA�LS Permit # 21. Outts, in St�ucture �0. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe•Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T�Bar Ceilin9 (Structural) & Monocoat 75. Dry Chemical 27. Frame and Ftashing 76. Dry Standpipe 28. Lathing & Siding 77, FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywa�l Nailing . HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electricai Power Meter�Final R'; F000 CERTIFICATE ISSUED 33. Final Electric �9ll.i otes: 7!O 34. Final Heati�g & Air Conditioning - 35. Final Gas Pipe-Test 36. Hood or Canopy ' - . 37. Final Factory Fireplace 38. Final Plumping � 39. Water Service-Final 40. Gas Service-F�nal 41. Solar pomsstic•Final 42. Backflow Preventer 43. Backflow I�rigation - 44. Landscape Irripation System 45. Sound Attenuation 46. Handicap Fe9ulations � 47. FINAL STRUCTURE & BUILDING • . 48. FINAL PLANNING - - - 49. Electric Release to Edison � � 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: 421 E 20TH ST Suite No B Vicini�y: Parcel Nunmber: Appliwnt: Address: 42631246 MUMFORD, DARLING 2295 S GRAND AV SANTA ANA, CA Owner: MATTHEWS FAMILY TRUST Address 421 E 20TH ST B COSTA MESA, CA . - Contractor: Address: ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool / Spa Lighting Fixis Recept Outlets Switches Non Res Appl Res Appl Service to 200a Service to 1000a Service over 1000a Motors to thp Motors to 10hp Motors lo SOhp Motors l0 100hp Motors over t00hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole COAST AIRE 2295 S GRAND AV SANTA ANA, CA Phone: 949-279-5575 Zip 92705 .. Phone: 949-650-0918 Zip: 92627-2315. Phone: 949-279-5575 Zip: 92705 License: 355425 Stams: ISSUED Applied: 07I05/2006 Issued: 07/OS/2006 SCOPE OF PERMIT CHANGE OUT EXISTING FAU AND ADD NEW A/C UNIT IN REAR OF PROPERTY. REF.: MO6-00412 523.50 $0.00 554.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 50.00 $0.00 $0.00 $0.00 $0.00 512.30 50.00 S0.00 $0.00 $0.00 $0.00 $0.00 50.00 30.00 $0.00 Quantiry 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 FEE SUMMARY Temp Dist System / Lighting - -� , Busway/100ft , - Standing'Section " " Misc Electrical Equipment Trans(ormers up to 1 kvalkw ................up to 10 kva/kw .................up to 50 kva/kw �" .............:...upto 100.kva/kw .. � ..................over 100 kva/kw Low Voltage Equipment Low Volt Wiring System I Ckt Misa Conduit Misa Conductor , , Circus ( gen or ride) . �. � Circus (mech ride or lights) Chrislmas Tree Stand Fireworks Stand � Other Eleclriwl Fee �- '. - Quanlity $0.00 0 $0.00 0 50.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 50.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 . 0 50.00 0 50.00 . 0 50.00 Imestigation Fee ,$0.00 Plan Check Fee � $0.00 Reinspection Fee � $0.00 70TAL CALCULATED FEES-' E90.30� COMMENTS / SPECIAL CONDITIONS i NOTICE: The work authorized by lhls permit shaV compty with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This pertnit shall eutomaticalty explre and become void if work is not commenced within 180 days, or if work is suspended or abandoned Por 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 cades, end ell requlred Inapectlona end iinal approvel must be obtained. Failure to obtain inspections and finat approval will result In the expiration ot thls permit. FOR INSPECTIONS CALI: (714) 7545826 zuo-�a �aroo� WORKERS'COMPENSAnON DECLARAnON: ,e . I hereby aNirm under penelty of perjury one ot the following declarations: � ❑ I heve end will melntein e certHicele of consenl to self-Insure for workars' compensation, es provided for b1 section 3700 of lhe Lebor Code, lor Iha pertormance of the wotk for which this permit is Issued. 'H %heve entl will mainiain workers' compenution insurence, as required by secilm 3700 ot Ne LeDor COCe, for ihe peAortnance of Ihe work lor which Ihis pertnit is iswed. .Mv_wo[kers' wmpensation Ins`y�ce c�ar`ner and poliry number are: ��Q �/� M// ��^ ��i�rer�'��E `�[ A1J� . Roli - Number._ 5� l.V � (Tiiis section need nof be cromp/efed i! the permit is velued af one hundred dWlers ($100J ar less.) ❑ I certity that in Ihe peAormence of the work tor which I�is pertnit is issued, I shell not employ eny person in any manner so as to become sublect to ihe workere' compansalion lews of Calltomia, entl agree that it I should become subjecl to tha workere' compansation provisions of Section 3700 oi Ihe Labor Coae, I shall lorthwith comply with Ihese pro s s. / y �c.yan�t Slq,nratL—re�:_�� - Qate;_ ?��d�O WARNING: FAILURE TO 5 CURE WORKERS' COMPENSAT1qJ COVERAGE IS UNLAW FUL AND SNALL SUBJECT rW EMPLOYEP TO CRIhLNAL PENALTIES PND CMl FlNES UP TO ONE HUNDREO T}IOUSAN� DOLURE (5100,000). IN ADOITION TO THE WST OF COMPENSATION, DAMAGES AS PROVIOED WR IN SECTIqJ 3706 OF THE LABOR ODDE, IMEREST, AND ATTORNEV'S FEES. LICENSED CONTRAC70RS DECLARATION: 9(commencing wilh Section 7000) of Division 3 of the Busin�an Pmfesslons Code, and my license is in full ass a � . oata.'.; . -- =OC CONSTRUC710N LENDING AGENCV: � I hereby ettirm Ihet there is a consiruciion lentling agency for the pertortnance ol ihe work for which ihis permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lendefs Address: Signamre: OWNER•BUILDER DECLARATONS: Date: I herehy eflirtn t�at under penalry of Der�ury that I am EXEMPT FROM THE CONTRAC70RS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business end Protessions Code: Any ciry or counry whic� requires e pertnit to conswct, alter, improve, demolish, or repair eny strucWre, pnor to its issuance, also requires the epplicent tor such pertnit ro file e signed stetemem ihet he or she Is licensed pursuant to the prodslons of the Contrectors Llcense Lew (Chapter 9(commencing with SecUon 7000) of DlWsion 3 of ihe Busineu anA Prolessions Code) or Ihat he or she is ezempt t�erefrom antl the �asis lar the elleged ezemption. Any violation of Section 7031.5 by any epplicent lor e permit subjecis the eppllcant to e civil penelty of not mora than Tive huntlred dollars (5500)J: ❑ I, es owner ot ihe properry, or my employees with wages as iheir sole compenselion, WILL DO THE WORK, antl the strucWre Is not Intentled or ofleretl tor sale (Sec. 7044, Business and Protessions Cotle: The Contractars License Lew daes not apply ta en owner of properry who builtls or improves ihereon, end who does such work �imseH or herseli or ihrough his or her own employees, provided thal such improvements ere not intentletl or ofleretl for sale. If, however, lhe builtling or Improvement is sold within ono year oi completion, the owner-buiider will have the burden ot proving ihat he or she did not build or improve tor purpose ol sale.). ❑ I, es owner of tha property, am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to consimct Ihe prqect (Sec. 7044, Businas5 and Profeuions Code: The contractors License Law does not apply ro an owner ol property who builtls or Improves thereon, antl who contracts for such prolect with a contrector(s) license pursuant to the Conirec�ors License taws.). ❑ I em exempt untler sec. Business entl Professions Cotle tor �his reason: SignaNre: Date: Owner ID verified by driver'Slicense. ❑ Ves ❑ No Drivoi5 License No. Ventication ol Ownership by (type ot tlocument, i.e. - property te: bill or daed): DIVISION OF INDUSTRIAL SAFETV PERMITCERTIFICATION: Expires: ❑ I hereby ceriity that no excavation tive (5) or more fee� in depth in�o whic� e person is required to tlescend, will be mede in connection with work authorized by ihis permil, and Ihat no building structure, scaHoltling, falsework, or demolition or dismantling t�ereol, will be more than thirty-six (36) feet high. (Chap. 32. Grp 2, Art 2, Sac. 341, Title 8, Celifomia Administretive Code). ❑ As owner-builder, I will not employ anyona to do work which would redulre e permil irom the Division of Indusirial Satety, es notetl above, unless such person has a permit to do such work trom the division. Signamre: Date: Division of Industnal Safety Pertnit Numbar: CER7IFICATE OF COMPLIANCE AND AUTHORIZATON OF ENTRY: 1 cenity under penalty ot perjury ihat I have read this epplication end stete ihat ihe information qiven is correct I agree to comply with all stete lews and city ordinances releling to bullding construction, end authonze representatives oi ihe CIIy of Costa Mesa to enrer upon the above-described property for inspection purposes. I agree not to acuDY or ellow occupancy ol eny building authonzed 6y this permit until final inspection. COOE �. INSPECiIONTYPE 761fi 1266 Fixetl System Final Fire Praventlon Pool Spe Flnal 200 Finel Ra-Roat 201 Final Block/Retaining Wall 202 Final Fectory Fire Place 203 Finel Sign 204 Finel Damolilion Owner(s) QAIE It�IS COOE I INSPECTION TYPE 206 Final Mechanical 208 Final Plumbing 210 Final Electncal 212 Final Fire Prevenlion 220 Final Planning ApO�o�al 222 Final Site � 250 Final euiltling/Occupency INfITUlS /O' � S` H � r \ (714) 754-5273 • Fex (714) 754-4856 • www.ci.costa-mese.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 �ob Address: 421 E 20TH ST Suite No B Viciniry: Parcel Number: 42637246 npp�iwnt: MUMFORD, DARLING Adtlress: 2295 S GRAND AV SANTA ANA, CA MECHANICAL PERMIT Phone: 949-279-5575 Zip: 92705 Owner: MATTHEWS FAMILY TRUST Address: 421 E 20TH ST B � � Phone: 949-650-0918 COSTA MESA, CA Zip: 92627-2315 Contractor COAST AIRE Address: 2295 S GRAND AV SANTA ANA, CA Phone: 949-279-5575 Zip: 92705 License: 355425 SCOPE OF PERMIT CHANGE OUT EXISTING FAU AND ADD NEW A/C UNIT IN REAR OF PROPER7Y. REF.: E06-00730 � ISSUE FEE Inst FAU <700 k BTU Inst FAU > 700 k BTU Repair/Alt CoolingMeat Inst / Rep. Recess Wall Htr Refrig Sys <700 k BTU Re(rig Sys >700 k BTU Gas Piping Factory Fireplace Hood w/Mech Exhaust VAV Box Vent Fan I 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 51 a.80 50.00 so.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 50.00 50.00 50.00 $0.00 50.00 $0.00 Quantiry � 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FEE SUMMARY Repair I Alt Absorbtion Unit - - - � Repair/AI�RefrigerationUnit , � Ventillation System. Evaporetive Cooler C ommercia l' I nai nerato r Domestic Incinerator � Comoressors / Absorotion Svstems Upto3hp/100kBTU 3To75hp/SOOkBTU 15 To 30 hp / 1,000 k BTU 30 To 50 hp / 1,750 k BTU Over 50 hp / Over 1,750 BTU Boilers Up to 3 hp 3To15hp 15 to 30 hp 30 to 50 hp, . Over50hp � - � �� ' - , Other Mechanical fee Investigation Fee . Plan Check Fee , , Reinsoection Fee Status: ISSUED Applied: 07I05/2006 Issued: 07/05I2006 � = �r / � Quantiry $0.00 0 $0.00 0 $0.00 0 so.00 0 30.00 0 $0.00 0 50.00 0 50.00 0 50.00 0 50.00 0 $0.00 0 50.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 50.00 $0.00 $0.00 TOTAL CALCULATED FEES - �' � 538.30 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by thia permlt shall comply wlth all epplicable handicap access requirements under Califomla statutes and related regula�ions. (Ord. No. 92-28, § 1, 12•21•92) EXPIRATION: Thls permit ahall automaticalty expire and become void il work Is not commenced wlihin 180 days, or It work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work eulhorized umfer lhls permit to be considered legal, such xrork must compy vAth all epplieable todes, arW all requlred Inepaetlone and final approval musl be oblalned. Failure to abtaln Inspeclions and flnal approval will result in the ezplretlon of this permit. FOR INSPECTIONS CALL: (714) 7S458P8 zua�e (aroo) WORKERS'COMPENSAnON DECLARAnON: � � I hereGy eHirm untler penalry of perjury one oi tha tollowing tleclaretions: ❑ I heve entl will maintain a certiticate of consent to self-Insure lor workers' compen5ation, e5 providetl tor by settion 3700 0l the Labor Coae, for the pertormance of Ihe work br which t�is pertnit is issued. !�I Rave end will maintain workers' compensation insu2nce, es requiretl by section 3700 0l Ihe Labor Code, for tha paRormance ol the vrork lor which Ihis pertnit is issued. �'��'""M-� ers' wmpeT�satio Insuran m.e\ r en0 policy numDer are: �'` �`�/� OO//�� Garriei: �t �4" I � �N� PoIIcQNumber:— /� (Th�s'secfion nsed nol be completed il the permil ls velued ef one hundred ddlars ($100) or less.) . ❑ I tertiy t�at in Ihe pertortnance of Ihe work lor whiC� this pertnit is issueQ I shall nat employ any person in eny menner so es to Decome sub�ect to lhe workers' wmpensetlon laws of Calitomie, and agree that il I should hecome sub�ect ro the workers' compansatlon provislons at Sectlon 3700 0l Ihe Lebor Code, I shall IoMwlih �� coml'ywith.lhesep nj. ' /Appll" can�'SiBnature•,� �A ,r�D'ate:, �'�.�� iR�Pn r r. • iVARMNG: FAI�URE SECU E WORKERS' COMPENSATION COVEqAGE IS UNLAWFUL AND SNALlSUBJECi AN EM PER TO CRIMINAL PENALTIES AND GVIL FlNES UP TO ONE HUNDRED T/IOUSAND DOLLARE (5100,000), IN ADORION TO THE COST OF COMPENSAT1pJ, DAMAGES AS PRDVIDED FOfi IN SECiION 31080F THE IABOR CODE, INfEREST, AND AiTORNEYS FEES. LICENSED CONTRAC70RS DECLARA710N: 9(commencing with Section 7000) ol DIvISIo�n��W�s �tl Prolessims CoUe, entl my license is in lull Elase�.Y_ � C ) Date•, % . �O CONSTRUCTON LENDING AGENCV: ❑ I hereby aHirm that there is a wnslruction lentling agenry lor the peAormanco ot the work tor which t�is Oo�it is IssueO. (Sec. 3097, Civil Gode). Lentlers Nema: Lentlefs Atldress: Signeture: OWNER-BUILDER DECLARATIONS: Data: I hereby ettirm thet under penelry of perjury that I em E%EMPT FROM THE CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business entl Prolessions Cotle: Any dry or counry which requires a pertnit fo wnstruct, alter, Improve, Cemolis�, or repair any strucWre, pnor to Its issuance, elso requlres the applicant tor such pertnit lo file e signed stetement Ihat he or she is licensetl pursuant to the provisians at t�e Contrectors License Lew (Chapter B(commencing with Secllon 7000) ol DlWsion 3 of the Business end Professbns Cotle) or that he or she is exempt Neretrom and �he 6asis for the ellegetl exemptlon. Any vloletlon of Sectlon 7037.5 by any epplicant tor a pertnit subjects the epPlicant to e cNil penaly of not more lhan five hundred tlollers ($500).): ❑ I, as owner ol the pmperry, or my employees with wages es their sole wmpensation, WILL DO TME WORK, antl the strucWre is noI Inten0e0 or oHerad for sale (Sac. 7044, Business end Professions Coae: Tlie Contractors License Law does not apply to en owner ol property who builds or improves ihereon, entl w�o Ooes such work himself or hersell or Ihrough his or her own employees, pmvided that such imprwements are not intended or oHered lor sala. If, however, Iha 6uiltling or improvement is soltl within one year ot completion, ihe owner-builder will have the burden ot proving that he or she did not build or Improve lor purpOse ol sele.). ❑ I, as awnar ot Ihe property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS Io construct the prolect (Sec. 7044, Business flnd Proleuions Cotle: The croniractors Licensa Lew tloes not apply ro an owner of pmperty who builCs or impmves Nereon, end who rqntwcis br such prol�� Ih e coniractor(s) license pursuant to the Contractors License Laws.). ❑ I em exempt under sec. Business and Pmlessions Cotle br Ihis reason: Signeture: 4ate: Ownor ID verlllad by tlrivers licen5a. ❑ Ves ❑ No Drivel5 UCen58 No. Verilicetion oi Ownership by (type oi tlocument, i.a. - property tax bill or deed): Expires: DIVISION OF INDUSTRIAL SAFETY PERMR CERTFICATION: ' ❑ I hereby certtty thet no ezcavetion flve (5) or more leet in tlepth Into which e person Is required to descentl, wlll ba mede in connectlon wlih wark euthodzed by Ihis permit, and Ihat no bullding structure, scattolding, falsework, or tlemolitlon or tlismentling thereof, wlll be moro lhan thiny-siz (38) leet high. (C�aD� 32, Grp 2, Atl 2, Sec. 341, Title B, Calilomia Atlminisirativa Code). ❑ As ownor-bulltler, I will nat employ anyone to tla work which would require e pormit trom lhe Dlvision of Intlus�riel Selety. es noted ebove, unless such person has e permit ta do such work Irom Ihe dlvlsion. SignaWre: Date: Divislon at Industriel Safery Pertnit Number: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTAV: I certity untler penalry of perjury ihet I heve reatl this epplication and state t�at t�e intormation given is conecL I egree to comply with ell slete lews and dry ortlinances relating to Dullding conswctlon, and authodze representetives ot the Clry at Costa Mese to enter upon Ihe abovo-descnbed WoOerry lor inspecilon purposes. I egree not to occupy or allow occupancy of eny building euthorized by this permit until finel inspection. CODE I. INSPEC710NTYVE 1618 1268 200 201 202 203 Legal Owner(s) >dzetl Applicant - _ P� UiiQ1�L5 Fixetl System Final Flre Preventlon Pool Spa Finel Finel Ra-Roat Flnel BIocWRetaining Well Final Factory Fire Plate Final Sign 204 Finel Demollllon CODEI �INSPECTIONTYPE 20fi Finel MecheniCal 20B 210 212 220 Final Plumbing Finel Elocirical Finel Flre Prevantlon Finel Planning Approvel 222 Finel Sito 250 Finel Building/Occupanq � �uu' . , (714) 754-5273 • Fex (714) 754-4856 • www.cl.costa-mese.ca.us 77 FAIR DFIVE, COSTA MESA, CA 92626 MECHANICAL PERMIT Job Address: 421 E 20TH ST Suite No B Vicinity: REAR OF PROPERTY Parcel Number: 42631246 Status: ISSUED Applied: - 10/06/2004 Issued� 10/O6/2004 , ISSUED BY: Applicant: SILVER SPRINGS POOLS AND SPAS Address: 25625 MIRAIESTE LAGUNA NIGUEL, CA Owner:- PUALANI, MELAIJIA Address: 421 E 20TH ST B COSTA MESA, CA Phone: 949-218-8524 Zip: 92677 Phone: 949-633-8826 Zip: 92627-2315 Contractor: SILVER SPRINGS POOLS AND SPAS Address: 25625 MIRALESTE Phone: 949-218-8524 LAGUNA NIGUEL, CA - Zip: 92677 License: 809198 SCOPE OF PERMIT INSTALL 72 S.F. GUNITE, IN-GROUND SPA. REF.: 804-01723 MECHANICAL TO INCLUDE:-1 INST FAU > 100K BTU ISSUE FEE Inst FAU <100 k BTU Inst FAU >100 k BTU Repair / Nt Cooling/Heat Inst / Rep. Recess WaIINtr Refrig Sys <100 k BTU Refrig Sys >100 k BTU Gas Pipin9. Factory Fireplace' Hood w/Mech Exhaust VAV 8ox Vent Fan / Single Duct Appliance . Fire Dampers � Smoke Dampers Inst or Relocate Appl Vent Air Handlers < 10000cfm Air Handlers > 10000cfm Floor Fumace Floor or Suspend Heater $23.50 $0.00 $1820 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 50.00 50.00 S0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantity 0 1 0 0 0 0 0 0 , 0 0 0 0 0 0 0 0 0 0 0 FEESUMMARY Repair / Alt Absorbtion Unit Repair / Alt Refngeration Unit Ventillation System Evaporetive Cooler Com merci al I n cinerator Domestic Incinerator . Compressors / Absorption Svstems . Upto3hp/100kBTU 3 To-15 hp / 500 k BTU 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 �3To15-hp , 15to30hp � 30 to 50 hp Over 50 hp Other Mechanical Fee Investigation Fee Plan Check Fee - Relnspection 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 $D.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handlcap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 7, 12-21-92) � EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or If work is susp � o�ndoned 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 Inspectlons end final epprovel must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545628 zasee (srool WORKERS'COMPENSAnON DECLAFATION: � � - 1 �ereby eMirtn under penelry of perjury one of the following declarations: � ❑ I heve end will maintain e cetlificate of consent to sell-Insure br workers' compensetion, as provitletl br by section 3700 oi tha Labor Code, tor the peAormence at Ihe work for w�ic� i�is permit Is luuetl. ❑ I have and will maintain workers' compensalion insurance, as required by section 3700 ot t�e LeOor Cotle, lor ihe pedortnance oi tha woM br whlch this pertnit is luuetl. My workers'•compensation Insurence carrier end pollcy number ara: Carrier: Policy Number: (This sectlon need no! be comp/eted i! fhe permif is valuetl at one hundred dWlars (5100) or less.) , ��1✓es"riBy t�at in ihe pertormence of 1he work tor which chis pertnit is issued, I shall not employ eny person in eny manner so es to become sublect to the workere' T compensation laws ol Califomia, and gree thet il I should become subjact to the workers' compensetion pmWsions ol Section 3700 of the Lebor Catle, I shall forthwith comply with ihese provision� �, B o��115f9nenre:�. �!i � a6"le?'� �D — � C' WARNINO: FAILURE TO SECIIRE WORKERS' CAMPENSATION COVERAGE IS UNLAWFUL AND SNALL $UBIEGT AN EMPLOYEP i0 CRIMINAL PENALTIES AND QVIL FINES UP TO ONE HUNDRED T}IOUSAND DOLLARE (5100,000), IN ADDRION TO TME COST OF COMPENSATIqJ, DAMAGES AS PROVIDED FOR IN SECTION 3'IOB OF THE 1A80R CODE, INfEREST, AND AiiORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: ChaO�er 9(wmmencing with Section 7000) of Divislo� ,pLlh usiness and Pmfeuions Code, end my license is in full %�'�e�� G 5 i CONSTRUCTION LENUING AGENCY: ❑ I hereby affirtn thai Nere is e construction lentling egency for the DeAormance ot ihe work tor which this permlt Is issued. (Sec. 3097, Civil Coda). Lentler's Nama: Lentlefs Address: Signawre: Date: OWNER-BUILDER DECLARATIONS: I hereby eftirm that untler penalry of perjury ihet I am EXEMPT FHOM TME CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business end Professions Cotle: Any ciry or counry which requires e permit to consimci, alter, improve, demolish, or repair any structure, prior to its Issuance, also requires the epplicant for such permit to ille a signed statement ihat he or she Is Ilcensed pursuant to the pravisions ot the Contracmrs License Lew (Chapter 9(commencing with Section 7000) ol Dlvlsion 3 ot the Business antl Professions Cotle) or thet he or she Is exempt t�erefrom and the basis for Ihe elleged exemption. Any violetion of Section 7031.5 by any epplicant lor a permit su6jects the applicant to a civil penelty of not more then tive hundred doilers ($500).): ❑ I, as owner ot ihe properry, or my employees with wagas as iheir sole compensalion, WILL DO TME WORK, and the strucwre is not intended or oflered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of propeny who builds or improves �hereon, entl who tloes such work himself or herself or through his or her own employees, provided ihat such improvements are not INendetl or oNered tor sale. If, however, Ihe building or impwvemem is soltl within one year oi completion, the owner�Duilder will have the burden of proving tha� he or she ditl not �uiitl or improve for purpose of sale.). ' ❑ I, es owner ot the property, am EXCLUSIVELV CONTRACTNG WITH UCENSED CONTRAC70RS to constmct the project (Sec. 7044, Business end Profeuions Code: The contractors License Law does nol eppry lo an owner of propeny who builds or improves Ihereon, and who contrects lor such project with e contrector(5) license pursuant to the Contractow License Laws.). ❑ I am exempt under sec. Business and Professions Code for ihis reason: Signature: Date: Owner ID verified by driver5licen58. ❑ Ye5 ❑ No Driver'S License No. Verllicatlon of Ownership by (rype of daument, Le. - properry tes 6i11 or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: Expires: ❑ I he�eby certify Ihat no excavation live (5) or more feet in depth into which e person is required to descend, will be made in connecUon wlth work authonzed by this permit, and that no Duilding sirucNre, scaRolding, falsework, or demolition or dismantling thereol, will be more then thirry-six (36) feet high. (Chap. 32, Gry 2, Ar12, Sec. 341, Ti�le 8, Califomia AdmInlSlreilve CoOe). ❑ As ownar�builder, I will nol employ enyone to tlo work w�ich woultl require e permit irom ihe Division of Intlustrial Sefety, as noted ebove, unless such person hes e permit to do such work fmm the tlivision. Signeture: Date: Division of Indusirial Sefety Permit Num6er: CERTIFlCATE OF COMPLIANCE AND AUTHORIZA710N OF EMRY: I certity under penalry ol perjury t�at I have read this application and state Ihat the informatlon given is correct. I egree to comply with ell state lews entl ci�y ortlinences relating to building construction, entl euthonze representetives of �he Ciry ot Costa Mesa to enter upon I�e above-described property far inspection purposes. I egree not lo occupy or ellow acupancy ol any building euthonzed by this permit until final inspection. tooe �. ixsveenontvve 1616 1266 200 201 202 203 Fized System Final Fire Prevention Pool Spa Final Final Re-Root Final BIocWRetaining Wall Final Fectory Fire Place Final Sign 20d Final Demolilion � � CODE♦ INSPECTIONTYPE 206 Finel Mechanicel 208 Final Plumbing 210 Final Electrical 212 Final Fire Prevention 220 222 250 Flnel Planning Approval Finel Site Final BuildinyOccupancy PAIF II�dLS ��i�-O� t/ ^/� (714) 754-5273 • Fen (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR ORIVE, COSTA MESA, CA 92626 PLUMBING PERMIT Job Address: 421 E 20TH ST Suite No B Vicinity: REAR OF PROPERTY Parcel Nunmber: 42631246 Applicant: SILVER SPRINGS POOLS AND SPAS Address: 25625 MIRALESTE LAGUNA NIGUEL, CA Owner: PUALANI, MELAN�A Address 421 E 20TH ST � - B COSTA MESA, CA Phone: 949-218-8524 Zip: 92677 Phone: 949-633-8828 Zip: 92627-2315 Contractor: SILVER SPRINGS POOLS AND SPAS Address: 25625 MIRALESTE . Arch / Eng : Address: Phone: 949-218-8524 LAGUNA NIGUEL, CA Zip: 92677 License: 809198 Phone: Zip: - - . . � _ License: - SCOPE OF PERMIT � INSTALL 72 S.F. GUNITE, IN-GROUND SPA. REF.: B04-01723 ISSUE FEE BackFlow irrigation BackFlow Preventer BathWb Clarifier System Connect Qce,Soda,elc)� Dental Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Drinking Fountain PWMBING TO INCLUDE: 1 P-TRAP AND 1 SPA. _. , ` FEE SUMMARY AMT �TY �� AMT $23.50 . Laundry Tub / Washer $0.00 $0.00 0 . Landscape Irrigation - $0.00 $0.00' 0 P-Trap 59.80 $0.00 ", 0� -Pressure Regulator $0.00 $0.00 0 Process Piping (per 10 ft) $0.00 $0.00 0 Receptors $0.00 ��$0.00 0 , SepticTank $0.00 $0.00 0 Sewer Cap for Demo $0.00 $0.00 0 Sewer COnnect $0.00 $0.00 0 - ' Sewer Pnvate Line $0.00 $0.00 0 �Shower $0.00 $0.00 0 Sink, bar $0.00 �N 0 0 1 0 0 0 0 0 0 0 0 0 Status: ISSUED Applied: 10/06/2004 Issued: 10/O6/2004 Sump Pump Swimming Pool Trap Primer Urinal',, � Vacuum Brkr Bkflow(1-4) Vacuum Brkr Bkflow(5+) Wash Basin - Wash Basin Set Waste and Vent System Water Closet (Toileq Water Heater / vent Water Piping (Inst or Rep.) / AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $D.00 $0.00 $0.00 $0.00 $0.00 $0.00 aTY 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 requiremants under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIHA710N: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable cotlas, and all required Inspections and flnal approval must be obtained. Failure to obtain inspections and final approval will result in the expirati a, ethfs permit. FOR INSPECTIONS CALL: (714) 7545828 2ad6-a816100) WORKERS' COMPENSAnON DECLARAnON: ^' � � ' �� I hereby aHirm under penalty of peryury one of ihe following declaretions: � ❑ I heve entl wlll malntain e certificate ot consent to self-Insure tor workers' compensation, es providetl tor by section 3700 of the Labor Coda, for the pedormence ot ihe work for which this permit is issuetl. ❑ I have and will maintein workers' compensation insurance, as required by section 3700 of the Labor Cotle, tor the pedormance ot the work br which Ihis pertnit is Issued. My workers' compensation Insurance carrier and policy number ere: Cartier. Policy Number. (This sectlon need not be camplefed i/ the permit is valuetl a( one hundred dollars ($100) or less.) , C 4cgrtify Ihat in the pedormance oi the work for which ihis permit is issueQ I shall not employ any person in any manner so as to become subject to ihe workars' compensation laws of Calitornia, and egree Ihat il I should �ecome sublect to Ihe workers' compensation provisions of Saction 3700 ot the Lebor Cotle, I shall forthwit� comply with Ihese i ns. �qp^', �.��,$j9�+at��,- �— � /O . % � v y RAW NINB.'FA7CIIRE TO SECURE WOFKEFS' COMPENSATION CAVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER i0 CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDiiED iHOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF CAMPENSATION, DMMGES AS PROVI�E� FOR IN SECTION 3]Ofi OF THE LABOF COOE, INrEREST, AND ATiOFNEY'S FEES. LICENSED CONTRACTORS DECLARATION: with Saction 7000) of Division 3 of the 8usiness and Professions Code, end my license is in tull CONSTRUCTION LENDING AGENCY: ❑ I hereby attirm that there is a consiruction lending egency for the pedormance of lhe work for which ihis permit is issued. (Sec. 3097, Civil Cotle). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I haraby ettirm Ihat untler penalty of perjury that I am EXEMPT FROM THE CON7RAC70R5 LICENSE LAW tor the following reason (Sec. 7031.5, Business and Professions Code: Any ciry or county which requires a permit to constmct, alter, improve, demoiish, or repair any stmcNre, prior to its issuance, also requires Ihe apDlicant for such permit to file e signetl stetament ihat he or she Is Ilcensed pursuent to ihe provislons ot �he Coniractors License Lew (Chapter 9(commencing with Sectlon 7000) of Division 3 of ihe Business end Professions Code) or Ihat he or she is exempt therefrom and the basis for the alie9ed e:emption. Any violation of Section 7031.5 by eny applicant tor a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the propehy, or my employees with weges as their sole compensa�ion, WILL DO THE WORK, antl the struc�ure is not intended or oHeretl for sale (Sec. 7044, Business and Professions Code: The Coniractors License Law does not apply to en owner ot property who 6uilds or improves ihereon, and who does such work himself or herselt or through his or her own employees, provitled Ihat such improvemenis are not imended or oHeretl tor sale. If, however, ihe building or improvement is soltl within one year oi completion, the ownerbuilder will have ihe burden of proving that he or she did not builtl or improve for purpose of sale.). ' ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WIT1i LICENSED CONTRACTORS to construct the project (Sec. 7044, Business end Professions Cotle: The comradors License Law does not epply to an owner oi property who builds or improves Ihereon, antl who coniracts tor such project with a contrector(s) license pursuanUo ihe Contractors License Laws.). ❑ I am exempt under sec. Signature: Owner ID verifietl by tlnver's licensa. ❑ Vas ❑ No Business and Professions Code for this reason: Verification ot Ownership by (type of tlocumem, i.e. - propeny tax bill or deed): Driver's License No. Date: Expires: DIVISION OF INDUSTRIAL SAFETV PERMIT CER7IFICATION: ❑ I hereby certity ihet no excavation five (5) or more teei in depth into which e person is required to aescend, will be made in connection with work authorized by ihis permit, antl ihat no building simcture, scaftolding, talsework, or tlemolition or tlismantling ihereot, will be more ihan thiny-six (36) feet high. (Chep. 32, Gry 2, Art 2, Sec. 341, Title 8, Califomia Atlminisirative Cotle). ❑ As ownerbuilder, I will not employ anyone to do work which would require a permi� from the Division of Indusinal Safery, as notetl e6ove, unless such person has a permit to da such work from the division. SignaWre: Date: Division oi Intlusirial Sefery Permit Number: CERTFICATE OP COMPLIANCE AND AUTHORIZATON OF ENTRV: I cetlity under penalry of perjury that I have read this application end stete that Ihe information given is correcL I agree to comply with all state laws and ciry ortlinances relating to builtling construction, and authonze representatives of Ihe Ciry of Costa Mesa to enter upon ihe abova-describad property for inspection purposes. I agree not to occupy or allow occupancy of any huilding authorized by this permit until final inspection. COpE I, INSPECTIONTYPE — QBjF INTITIRLS 1676 Fixetl System Final Fire Prevention 1266 200 201 202 203 204 Pool Spe Final Final Re-Root Final8lxk/Retaining Wall Final Factory Fire Place Finel Sign Finel Demolition COOEX � INSPECTIONTVVE 206 Final Mechanical 208 Final Plumbing , 210 Final Electrical 212 Final Fire Prevention 220 Final Planning Approval 222 FinalSite ' 250 Final Builtling/Occupancy U� 4 —L OATE INTiTIpLB 1' _ ,.. . ,. ,,. �� CITY OF COa..+ N'B/ - BUILDING SAF{4Y,.DEF�iI . . POST IN CO PICUOUS , ON � !OB `�;.: PLACE :�:: �., „ � � � SETBAC � • � � ; A Front Yd � Side Yd. R • L�� Rear� i�� _ Side Yd. R � L�_1�iiear � BUtIDING INSPECTION RECORD �. TO KEEP BUIIDING PERMITS VALID, WORK MUST BE COM• . • MENCED WITHIN 60 DAYS WITH ROUTIN� INSPECTIONS AT �EAST EACH 120 DAYS TNEREAFTER UNTIL COMPLETED. Famt �--.......""""' FIOor SYft�rn ....... " "" " • .... ...... _ StMI R�inl .........................�.... ' _ an.uv�uy-""' .................'-••"' Fnms �M Fleahinp . . . . .. . .. . .. . .. . . . . . . . .. �y��{�� "__. "�� . V{h "p",,".�"",p�'.:'''.�.�.,.�� Ory WNI Wilinp-A�!�C/..w.-rr�sacy�oi %Mer. Brown CMI """""""""„" $o�nd Anenuation . ....... . . ... ... ""' • . H.rroicav ae0u4cion . . .. . • • • . . . . . : . .. . . . . . _ _ �•. FINAL PLUMBING jy�i ��i ......•--......--• .............." F` und�rvoum wsca .................... y . Ro�Plumbinp .............."'...... �.� ;� Vrop.SawrLlM�ndHouwConn..."'..... F : �trrtSew�r Corm. ."•"' •' • •".-x1[ r" ( � WrtwSwk� ..":""""""'..._.... � ' SpIlnklinp6Y�bm ...................... �. i � GM TOrt -....." " " ' .................. � ' FINAI HEATING, AtR�(:OND. AND REFpIGERATION �' MIr.11nw.PrsunTpt """"'""'"""" ; DuCIs.UMRQountl...."""""........... .DuPMinSvucturo _...""'-"'--•.c•'--• f� ; . • 'oueu, vemibtinp •------•••••:•-..._... Raph HMtio9 �nd Ak�Cord. " "_" " • • " •' � J i � . . .. FINAI �� ., ELECTRICAI ;;'.:. . f! ��.� T�mVorrV Swvia a Pob ...... .....::.::-. lh�OaYrW„nd . ..... . . . •Y. W POWMMht�-...- �.�. ... . _.w.. ... ."'. ... ..' RoWh Wilny ......"'".......:.."""" � FNg4 Do not oxupy thb pro(ect until final impectbn hp � � been meda and Ae� be�n proved � � BulMin Firol " Sqcisl Requiremend ' " � I... ��, �; � �NOTICE ' �'s� 24fir. notificaUon required whan tlre job is roady for inapeetbn. You �' must iumiih PERMIT NUMBERTnd the JOB ACDPfSe FOR EACH RESPECTIVE INSPECTION. CAtL 55fi-527;i: r� -f �� ✓� � A-�.� R g 3 '�/�� APPLICATION FOR A BUILDING PERMIT J BUILDING PERMIT NO. Ei`a��ui m Trac[ BIocM Lol R�rmit No. � BUIICin9 Plum�in9 6 naa«u 421 20th STREET r/ p(--i T/ r�.mii . � c,o:s v � J / � �� a n.� st�«i IRVINE AND TUSTI Po�� No. � � �"'^°' LUCAS DEVELOPMENT CORP. Tro��+'+�;«� � n�,. nue. � u.aon�o� Adtlress 4 ❑ Rapai� ❑ Cony�rt d/no ❑ Occupancy �mt. cir z'092660°npn` H O� A.P. $uD.0i51./ � IntD. A�ea pesq,nert� NUTTALL—UCHIZd�T�CdedUSSOCIATES zo�� soi.Pmi.no. naa.ass Z9zS C�LLEGE AVE. 5^�o,�ks P/LP�On c��si. sveeiw�asr. va.tls Lefi iqnt ear ��`y COSTA MES Zio ono�c E AS ABOVE +�` �� ` �B En9lnee� S'� UCanse No. — .:Y..n: N.:,e: ..ep ^re_ ovi c Overe gAEO�lSS R Pbone S��uct No. ol No. o� m CitY 2ID Malqnl StOries Famiq � � �ICENSED CONTRACTOR'S DECLARATION Pak F�ei ve: F« I � 1 �o�b � }lirm cnu 1•m lit�nwtl untl�r Reqolrotl No C.T. Raceipt � e p�ovis�on� o� C��o�� 9 Icammencinp wich Saction 7000 of Divisio� 3 ot cM Budn�w �nd � �20ni09 AOp�Ovltl BY: Dil¢ � ProlnsiOm Cotla, antl my lic�nw i� in 1�II torce enC eftecil. 7� Lit�nu Clef Linnv Numbo > Date Contnaor Misc. E Atltlrlsf �ODosOC VSe I ol Siructure I LL CitV antl 2iD P�On! tt CONSTpUCTION LEND�NG AGENCV I } ' �eroby aflirm tMt tqare i� a connr��iion Nntling egency io� the d p�rfo� OCG Type Cotle mance of rne wo.k io. wnicn ��is p�rmrt is isw�d ISec. 309]. Ous Const, vear I ' Civ, Cf. y Lentler'e Name USE/ CUPANCV SIZE $0. FT. I C Lentls�'s AOdren 1 J OWNER�BUI�DER DECLARATION Y I �ereby e116m t�at I em eaempt Irom t�e Connector's Licen�e Lew �� 1a. the iollawinv r��n: � ❑ I, 1s owne� O� f�e proDe�tv, o� mY �mDloy�as witp we9as es t�ei. 2. I fOle compen�ation, wi❑ Eo ine wOrk. entl tbe sVUCWra it nol I r inteny¢� or oHeretl �or sale. 3 ; ❑�. N owner ol the propeny, •m •zclmivNy co�tnninp wi�� lice��py conbectOr{ t0 con4VucL t�a D�ojecl. . � ❑ 1 em eumot untl�r Sec. , B&PC 10� tnis ruron 4• a Deta__Gwner , , E WDRKERS' COMPENSATION DECLARATION Total Veiu�tion � � I �p�py �Hirm tbat I ��ve e urtiliuw o� conum to �ell�imwq Encro�chment Rrmlt ReGulretl l�' Yes ❑ No or e cenifi�ete ot Wc�kus' Comp�nytion Inwnne�, or • cv2ifira c copy mm�o�. GraOm9 Pmt. GraO�ng B Pofcv NoCl 6 n 34 �,?,, TNS _ Cn _ nF N(1RT$ a�c�;,ea ❑�'es ❑ rvo vmt. r+o. � ❑ CMifiM coPV �� •ODV f�rnia�etl. AME��A Ro�pn Graarn9 v Q ❑ Cmtif iW mpY �� 1 wh� Or�nqa County, AOC�owE by: �e�e `� Deu Avoticent 3 CERTIi1CATE OF EXEMCTION FROM WORKERS'COMPENSATIONINSURANCE Z lT�i� sKtion ne�tl n0� b� comPl�tW il D�rmit i� 1or 5100 0. InsL � I cMtifY N�� In th1 pYlorm�nCa OI [t�� WOrk iOr wM1iCh ibii O�rmit if 3 ip1UC� �{11111 001 �TO�Oy OOy p0�bn IO �Oy mGnn�� tD 1� �O DICOTP R ��i�« tot�� Worbri Con.p�nutfon L�w�oi G��orni�, oERM1T FEES D�t�� APDlic�m Il NOTIC@ TO AVVLIC4NT: If dur nukinp ihis Crtifiut• o� SVu[tural i q�n Ghec f I Ea�mption, YO� Moultl Oecom� Wbj�ct ID�M WO�k�r( COmpmution ' provialOm p1 t�� L�bor Cotl�, you mU�� 1ort�wii� cOmply wii� �oc� EIlCVIuI SDeci�l provi�iom or this DMmit �p�ll b� tl��mW nvoketl. f InresL 3 I CERTIFV TMAT I NAVE RE4DTM15 APPLICATION ANDSTATE qumDing S TNAT THE ABOVE INFORMATION IS CORRECT, I AGAEE TO COMPLV WITM 4�L COVNTV ORDINANCES AN� STATE LAW$ AELATING TO BU�LDING CONSTRUCTION, AND MEREBV AUTM� �th�nlul f ORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON TME ABOVE MENTIONED PROpERTV FOR INSVECTION VUR� qe.GraCe POSES. lnspattion s Sipne�w� of AOV�icsnr or Apmc O�L Re-Cr�ae s iy ❑ s R�C. No. If e Print APPlicenY�/AO�nY� N�ma w+� sswnte I All sp�m witAin tAis boa m�ut W compl�Utl to Pro�ats Cnack Bv: Aooro.ea: CMF Od35<6 �BU-2B� rev. 6/80 a i�� o gtt,T i�� c�, t�ssoc t E��r i'�s . . , s�., .,�, �,.. „.,� , . . � �•,.. •� ,. , June 4, 1965 City oP Costa Afesa Building Department 695 West 19th Street Costa NFesa, Califarnia Attention: Mr. F�-ank Hruza SU&TECT: Timber Trues Znepection, Residential Con�truction Tom Muntean, 421 20th Street, Costa Mesa, California Gentlemen: We have cmpleted the lnapection of 124 timber trusaes recently conetructed at the Orange Pabricatlon yard of Trussco, Znc. These trusaes vere assembled for the subject proJect Polloving certifieQ conetruction plans issued by Trusval Systema West, Inc., Anaheim, California. Connectiona were made vith �lvanized ��truss-tite�� plates. The trusses inspected are identified as: t34 m-32-3-38 wood trusses, j0�p�� epan, 3�12 pitch 40 wood trueses 21'0`�, 3�12 pitch We hereby certif� that the above trusaea sl gied with ovr initisla crere a�aembled in accordance with the approved dravings using lumber xith stress �adea equnl to or greater than that epeclfied. All completed truases r+ere observed to be in acceptable condition vhen bundled in the ahipping area. Very truly ywrs, d HertMrt J. Dix� Civil Engineer 13,635 Fi.7D: vg CC: �4vssco, Inc. 14332 Roover Westminster, California I..�.��i�:�•I�� I�I� �-ni.� COif6UL'1'IN(: G\C:INF}�RS ,lUN `� ;� �yotGosD�2 Bu��d�n8 . �_�� . �. . PflOJELT ADONESS: Q Z 1 E � OTH $T �N�t� H OWNEN'S NAME: SUSAN I+UCx nooxess: q Z 1' B' E 20TH ST .• rncmn r.�rcn (7,14)598-2934 'AflCN/ENGINEEfl: xAADLEY ENGINEERING nec.xo.: 23012 , �oosess: 130 EL CAMINO REAL uxir: TUSTIN CA 92680 PEflMITiEE: NOONAN CONSTRUCTION ( 714 ) 998-6356 ' aooRess: 510 E. LINCOLN � ORANGE CA 92665 LICENSEU CONTPACTOB OECUIPRTION: I �ereby a��irm �hat I am licensea unGer Diovisions of COapter 9 �tommencing with Section 7000� o� Oivision 3 oi �he Business antl Protessions CoOe, an0 my lic is in tull lorce antl e��ec�. ciTruc.:005918 sTnTeuc.:297733 ss: i Date:._.��(_Q^�� Signamre:_ _ _ _ _ , WOBREHS' COMPENSFTION OECNPATION: I hereby affirm . n: etlihca e o consen lo sell-insure or a cenificate o� Worker5' Compansatian IrsgrapCe.,9[ �ca,rtifle{� r,ppy Ihereof (Sectlo 3fi00, lab. �O �01 / 9�� POULY NO.: 1 1 O! V 4 7l/ E7(P. �RTE: � COMPANY: STATE FUND,u p ❑ Cenilied coOY is here�y Iumis�eA. L1 Ceniliea copy is �'' � n e ci�il0ing Division. Oate: �J��_ Ap0licanC , EREMPTION FflOM WOflREflS' COM7ENSATION OECUBRTION: Seclion neeA noi be tomplele0 il IAe permi� is br one Aun�r¢� ($1W) or less�. I cetlily Ihal in Ihe pedormance o� �he work for w�ich Ihis p nil is issuee. 1 shall not employ any person in any manner so as to hecome su�ie�� o the VJorke[5' Compensalion Laws of Calilomi � �a�e: Signa re: NOTICE: 11. afler making this Ceclara�ion, y S�oNG GecOme 5u�1�� a ��e Work¢rs' Compensatian Drpn5ion5 0l Ihe Labor Cotle. you mu5i forthwiih tomply wi�h 5u pmvisi0n5 or Ihis permii Snall be Oeemetl r¢voke0. CONSTHULTION LENOING AGENCY: 1 her y a��irm lhat Ihere i5 a wnsWction IenGing apency �or ��e peAormance a� the work �or whic� �nis permi� is isuee (Section 3097 Civ. C�. LENOEfl: AO�XE55: � CITY OF COSTA MESA — BUILDING PERMIT PERM NO: G 0 0.. PERMIT NO: G 050258 PLAN CHECK NO: 06076-90 S GO T: � CONSTRUCTION TYPE: 5—N PERMIT TYPE: ELE MEC PLU STR PURPOSE: ADD JOB DESCRIPTION : ADD BEDROOM, BATH S FAMILY AOOM(2 STORY) SQ FT; 916 CLAIM VALOE: 58,000.00 CALC—VALUE: 63,204.00 GROUP OCC: R-3 /M-1 COMMENTS: SMOKE DETECTOR(S) RE�UIRED IN HOME, +r*�e�r�r******�r�r�e�e�r�e�r��r*�t�r�t�r�r*+r* +t�r�r*�e�*�r�r�r��r*�r+t�r�e��t�r�e**x*�r��t***�r��t*�*�r*�*�*�r*�r* Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING --------- FRNT: 6 FT ZN REAR: 10 FT IN FRNT: FT IN REAA: FT IN LEFT: 31 FT IN RGHT: 6 FT IN LEFT: FT IN RGHT: FT IN PARKING REQ• PROV: PARCEL: 42631250 ZNE: R1 REF NO� PLANNING Ni3I'ES> 1ST 6 2ND STORY ADDS TO AN EX SINGLE FAMILY RES, 20i REAR > STBR F/ 2ND STORY, 270 SF REAR YD COVER PROP — 315 SF.OH iF iF k if M iF M 11� iF iF If IF IF 3E if # iF If iF if iF�lf if iF ik ik IF 1f if if ff 3E iFiE if ik i61F iF iF 1f 1f ik if k iE �E ik If iE 1f !E IF if iElk 1E if IF 3F iE k lf If �F ik if 1f if If IF If I!� 3f iE 1F ib If iF D E V E L O P M E N T S E R V I C E S: R E Q U I R E M E N T S ZONING APPROVED BY �7J DATE: �.2—/O �C� BUILDING APPROVED BY ; • G. DATE; /2—/��--�v APPLICATION ISSUED BY• '� DATE; .2 — Cl iF�f3f�EifMifiEifiFlflflfiflfMiFlFiFiFkiFTF7Fi . IEkiFiflFllik7FiFiE IEaF iFiFiEifif�f�liFiflfk�EMkkiEiklF3FiE1F�f3fiFiEifiFiffF�kkkifiFiFlPiklfifaEfFIPjE iF�FklfiEiEiE�Ififlflf�fiFlfifklfiE�ElFkiEKiEff�fifk7FiFiE1F�7E LEGALIZATION:N ` F E E S U M M A R Y STRUCTURAL SEGMENT;Y OWNEBBWLDEBOECtAMTION: Iherebyatlirmt�atlameKemO��omiheComracmrs'StateLicenseLawtor�helollowingreason BLDG PMT PLUMBING ELECTRIC MECHANIC FZRE SMIP/RES GRADING (Se[�ion 70J7.5 Business anA Pmfessional Code: Any ci�y ol county which reQuires a permii �o wn5Vuc4 alter, improve, demolish, or P ERM I T 4% i, 5 � 2% 00 ' 4 0. 9 5 1 a 00 4 9 2 repair any simcWre. pnor to its issuance, also reQuires �he aODlicant for such permii to file a signeU statement ihat ArJshe is Iicense0 �15 Y S � Y 2 5 Y SM I P/NON—RES pur5uant�ot�eprovi5ion5ollheConlra[lors'StateLiCense�aw�C�apler9�comm¢ncingvnt�$ectian7000�o10ivision3o�IheBusines5 PL� 310.38 anU Professions CoOe) ar that ne/s�e is exempt Nerelwm anU Ihe �asis br I�e allegetl exempiion. Any violalion ol Sectian 7037.5 6y . any applicant lor a Dermit suGjec�S ihe aOClicant to 3[ivil penalry 01 noi more INn five huntlre0 tlollars (5500). ISSUE FEE 3, �� 1 r] , �� 1 5, �� i, as owner o� �ne propeny or my em �oyees wilh wage5 as Iheir so�e compensa�ion, will tlo I�e wo�n, and me BUILDING—DIV—> PERMIT ISSUE PLAN—CH$CI( T�Tp.1. PAID • DUE ❑ simcwre is nm inteneed or oneretl �or sa�e �S�ection 70a4, Busmess antl Pm�essiona� Code: Tne Camracmrs' State License Law T�TAL$ ----> 5 67 . 8 7 3 3, 00 310 . 3 8 911 . 2 5 91 1. 2 5 , � � aoes nol apply to an owner ol a D�oDe�Y who 6uilds or imo�oves ihereon, and wno Oces such work nimsell/hersell or througn ' ms or he� own empioyees, omviaeo thai such impmvemenis are nai imenaea or atrered mr saie. u, nowever ine ouiioing or REVENUE D IVIS ION TOTALS--> COLLECTED • 60 �.$% OVER /SHORT ; 0 � iorPin purpoae o�saiejhin one year ol completion, the owner win nave ihe 6urden oi oro�mg he/sne aitl not ouiia or imorove $LDG FMT PLUMB ING ELECTR IC MECHAN IC FIRE SMIP /TOT GRFSD ING PLAN—CHECK i, as owner oi tne nroneny, am e�cwsiveiy com�acting wiin iicensed comractors io cons�mct tne proiect �Section �Ona, ausiness 4%7 . S 0 30 . 0 0 S 5, 9 5 3 3. 00 4, 4 2 ❑ anU Pmfessians CoOe: The Conlractors' S�ale License Law Uoes noi apply Io an owner oi pmpetly who builtls or improves �hereon anawhocontractslorsucAprolectswitAaconiraclor�s)Iicensepursuanllot�eContractor5'SlaleLicenseLaw).lamaware K'�'**M'µi('#�1'kif*i('ff'*if'i('i('ifN"k3FiEiF*�F1f'kifil'M"K'#3FiEiEltit'1fi('iE'M'IFIF1flfafiklFlEiEiE3fiFlFdflflfiflfifiEiflFlEiflflF'IfjFi41(�iFlf�FaElf{(��E ma� pma� o� their Worker's Compensation insurance shoNa be omviaed �o me. I N D I V I D� F1 L F E E 8 R E A'K D � W N � I am exempt unaer Seclion: B. 8 P. C. iortms�easore TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COS� Oale: Owne[ I tlo nere�y cen�ry that I am aware ol ana unaerstana ihe requirtmems al Caiilornia Nealih anA Safery Code Sections 2550.5. 25533, antl 25534 an0 t�al I o� any IWure builtlmg occupant vnll/wAI no� (circle one) neea lo comply vn�h saitl state cotles antl the requiremenis lor a permil for con5imclion o� motlification Imm I�e Nir Ouali�y Managemenl Oisiricl. FeSiAen�ial consimc�ion ap0lica[ions are eeempt �mm IheSe O�ovisions. �, �aie: App�icant: ��, I he�e0y ceriitytha� Ihave reaa Ihis aDP�ica�ion and s�al¢�hal��e aboveinlo�ma�ionis correci.lagree lo compty vn�h all ci�y an0 couniy I or�inances antl slaielavrs relatinglo builaing con5imclion an ' � y au rrzereD�esen�alives ol�his ciryto enteruponl�e above�meniionea I pmperry fa� mspeaion purposes —� � Dale' _�_� 0=�� SignaNre: _ _ oriver's �icense ai Soc�a� Secunry e: �6ai.ab W�ite—Bvildng; Green—CoOe Enbrcemenl; Canary—ApplicanC Pink—Revenue; Goltlenrod—Assessor 1 SFR 916 DWE—TYPE V—WOOD FRAME —GOOD 69.00 • 63 209,00 ELE 8 FIXTURES LIGHTING 1 ST 20 EA. ,75 '' � 6.00 ELE 20 RECEPT/OGTLET 1 ST 20 EA, ,15 15,00 ELE 10 RECEPT/OUTLET ADDITIONAL A ,95 4,50 ELE 20 RECEPT/SWITCH 1 S ,75 15.00 ELE 1 RECEPT/SWITCH ADDI' - ,45 ,95 MEC 1 REPAIR/ALT HEATING UNIT/S S W/CNTL§ ,00 9,00 PLU 3 BATHTUBTION FAN CONN TO SENG�eiJF(i'�990 ;00 6,00 PLU 3 WASHEBASZN "'" 2,00 6.00 � C�+Y OF COSTA MESA \ 1 II / CONSTRUCYIOP.�AND PLANNING P��PA APPROVALS Permit # Date Inspector p�ppROVALS Permit # Date Inspector ♦ - - 1. Temporary Electrical Servtc2 or` Pole , � 52. Poo� & Equipment Location ' 2. Soil Pipe-Undrgrnd._ '"' - �)/ ct'D LEp 53. Steel Reinforcement � , 3.' Electrir,�I;Conduit Utility-Undrgrnd' � � 54. Forms 4: Electrical 6ondui[=Undrgrnd. �� •' `�• 55. Electrical Bonding ' `�5: Steel'Re nforcement • � _: �Z � � 56. Rough Plumbing & Pressure Test � -: 6. ElectricaGUFER�Grnd. �� 57. APPROVALTOCOVER�GUNITE � ' 7. Footings ,' �, �_ - 58. Electrical Conduit-Undrgrnd. � 8. �F.oundation� ,- , � 59. Gas Pipe, O Undrgmd., Test 9. Water Pipe�Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. � 10. Structurai �Floor System � r_ J�.�' � 61. APPROVAL TO DECK '� 11. Property Sewer Line & Hoose Connection � 62. Backwash & Receptor-Final " 12. Sewer Cap � ' 63. Heater & Vent-Final 73. Roof Drains � '� ��! � 64. Plumbing SYstem � Final ! 14. Rough Plumbing 65. Electrical-Final f 15. Rough Electrical-Conduit 66. Solar SYstem-Final 16. Rough Eiectric Wiring � 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning � FIRE DEPT. REQUIREMENT 20.'Rough Facto�y Fireplace �A Z ' v _ • APPROVALS% Perrriit # �'' � , _ • - " 21.''Ducfs, in Structure � .. �' � . - ~ ~ . ` . •+ � 70. Underground Hydro 22. Ducts, Ventiiating, � :�,71. Product'Pfping OGas ❑.Oil 23. Gas Pipe-Rough & Test � � - �� . 72, Underground Plush: � � " � 24. "Roof Framing � �• a " �T � � �73:�I�Undergrnd�.StorageTank OGas ❑Oil` �-�' ' 25. Roof Sheathing „ � , � . _ '7qrOverhead Hydror� ` 26. T�Bar Ceiling (Structural) & Monocoat _ - • 75r Dry Chemical ' - '� ' � �.r 27. Frame and Flashing' '' - , . ,r 76. Dry SYandpipe ''?,c � - �., `" � • • 28. Lathing & Siding - • � � • • • 77, FIXED SYSTEM-FIN'AL• , � . �' '_ 29. Insulation •. ,.�• . .. ' ' � • ' . � � � �l ^ _ . - � � .• � r . 78.>FIRE PREV. FINAL � - . � 30. Drywall Nailing - �� :v �.- � '�� HEALTH�DEPT: REQUIREMENT _ _ � , � 31. Plaster Brown Coat° . ' , r - ' ' .' •��.' ; ,79' FINAL INSPECTION ., - � ` � ' � 32. Electrical Power Meter•Fina� � _.'"; •� I i, t• .=80. FOOD CERTIFICATE ISSUED 33..Final Electric ^ �q �t, ' -� - . �?� � v C� „�e10�� otes: ,. � . 34. Final Heating & Air.ConditioniRg , -�� i� . � . .. , . � r _ � 35. Final Gas Pipe-Test - - • � ' �� _' o. �36. Hoodor_CanoPY� � , _ � � .- �. './..,.. s / . . 37. Final Factory Firepiace .. " ". t .. ' ` ,� ;�,. . ', - � C. ::' � � �38..�Final Plumbing � . � ' . 39.=WaterService�Final� ' � -- •' - ' �-' - ' �yV � i � 1��: V"� 40. �Gas Service-Final ' ; , � ', -_ , � - . �. - , . 41: 3olar pomesticFinal '' ' . � • � � : =� , � - � - . . - - 42. Backflow Preventer ; � ` . I � i' ., , - . . , �r`' - � `? -.. 43. Backflow Irrigation' - - � -• - - � ' s ;44. Laddscape Irrigation System;, � � . - . , � � , _ - � 45.'Sound Attenuatiom �. * • ' � � � - ` 46. Handicap Regulations '. " ' � � � , ' - , , 47. FINAL STRUCTURE & BUILDING �� , � �� (� � ��„�,( � 48.�FIN�ALPLANNING, � ` . ' � . " - .. 49. Electric Release to Edison - ' . ! . ' _ 50. Gas,Release to Southem California GasCo ;,I -�I ,� I' , _„� ' - `" ' ' 51. CERTIFICATE OF:OCCUPANCY � . . . . . - : No. Date (�14) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: Suite No Vicinity: Parcel Nunmber: Applicant Address: Owner. Address ELECTRICAL PERMIT 421 E 20TH ST B REAR OFPROPERTY 42631246 SILVER SPRINGS POOLS AND SPAS 25625 MIRALESTE LAGUNA NIGUEL, CA PUALANI, MELANIA 427 E 20TH ST 8 COSTA MESA, CA Phone: 949-218-8524 Zip: 92677 Phone: 949-633-8828 Zip: 92627-2375 Contractor: SILVER SPRINGS POOLS AND SPAS Address: 25625 MIRALESTE 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 t000a ' Service over 1000a Motors to thp Molors to tOhp Motors to SOhp Motors to t00hp Motors over 100hp Communication drops �Sub panel to 200a Phone: 949-218-8524 LAGUNA NIGUEL, CA 2ip: 92677 License: 809198 SCOPE OF PERMIT INSTALL 72 S.F. GUNITE, IN-GROUND SPA. REF.: B04-01723 ELECTRICAL TO INCCUDE: 1 SPA AND�1 LIGHT PIXTURE. � $23.50 $0.00 $0.00 50.00 $0.00 $49.50 $1.10 $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 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FEE SUMMARY Temp Dist System / Liqhting Busway /100 ft Standing Section Misc Electrical Equipment Transformers up to 1 kva/kw ..........:.....up to 10 kva/kw ..............:..up to 50 kva/kw .................up to.100 kva/kw - ..................over 100 kva/kw Low Voltage Equipment Low Volt Winng System / Ckt Misc. Conduit Misc. Conductor � Circus ( gen or ride) Cirws (mech ride or lights) Christmas Tree Stand Fireworks Stand Other Electrical Fee Investigation Fee Plan Check Fee Status: ISSUED Applied: 10/O6/2004 Issued: 10/O6/2004 ISSUED BY: 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 50.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § i, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 deys, 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 Inspectione end finel epproval must be obtalned. Failure to obtain Inspections and final approval will result in the expiration of this perrt�ii� FOR INSPECTIONS CALL: (714) 754-5626 eaawa �aw� WORKERS'COMPENSAnON DECLARAnON: , ' I hereby aHirm untler penalty of perjury one oi the following declaretions � ❑ I heve and wiil meintain e cenificate of consent ro selt-Insure for workers' compensation, es prodded br 6y section 3700 ot ihe Lebor Code, for the pertortnance ot ihe work for which ihis permil is issued. ❑ I have antl will maintain workers' compensetion insurance, as requiretl by section 3700 of ihe Lebor Code, tor ihe peAortnance of the work for which this permit is issuetl. My workers' compensation Insurance carner and policy number ere: Carner: Policy Number: (This section need nof be completed i! fhe Oermit is valued at one hundred dollars ($100) or less.) �f3T-'*I'cetlity thet in the partormance of the work tor which this permit is issuetl, I shall nol employ any person in any manner so as to become subject to iha workers' /T.��" fcompensation laws of Calito ia, and agrae ihat if I shoultl bacoma subject to the workers' compensation provisions of Section 3700 of lhe Labor Cotle, I shell forthwith comply with ihese provisio s. Ap icant�Signetura:" � Date:^�- � J� (O —0�-/ �WAA NG FAIWRE TO SECURE WORKERS' CAMPENSATION CAVERAGE IS UNLAWFUL AND SHALL SUBIECT AN F„EdP�ER`T7'C�IMINNL PENALTIES— AN� S UP TO ONE HUNDRED T}IOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF CAMPENSATION, DAMAGES AS PROVIDED WR IN SECTION 3]Ofi OF THE LABOq CADE, IMEREST, AND AiTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: Chapter 9(commencing with Seaion 7000) of Divisioa�3,ot.We.Busipess an mfessions Code, antl my license is in full �;«'._Cr--�� CONSTRUCTION LENDING AGENCY: ❑ I hereby aHirm ihat there is a cons�mction lending agency for the pedormance of the work for which this permit is issuetl. (Sec. 3097, Civil Code). Lender's Neme: Lender's Adtlress: Signawre: OWNER-BUILDER DECLARATIONS: Date: I hereby aHirtn thet under penaity ot perjury that I em EXEMPT FROM THE CONTRAC70RS LICENSE LAW for Ihe following reason (Sec. 7031.5, Business antl Protessions Code: Any ciry or counry which requires a permit to consWct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the epplicant for such pertnit ro(ile e signed statement that he or she Is licensetl pursuant to tha provisions of ihe Contractors License Lew (Ghepter 9(commencing with Sectlon 7000) of Division 3 of the Business end Pmfessions Code) or that ha or she is ezempt thereirom and the basis Por the ailegetl exemptioa Any violation oi Section 7031.5 by any applicent for a pertnit subjects the applicaN to e civil penalty of na� mora �han five hundred tlollare ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, entl Ihe sWdure Is not intended or oHeretl for sale (Sec. 7044, 8usiness and Professions Code: The Contractors License Law does not apply to an owner of property who huilds or improves ihareon, and who tloes such work himseN or herself or ihrough his or her own employees, provided �hat such improvemenis ere not intendetl or oHeretl for sele. If, however, the bullding or improvement is sold within one year of complation, the ownerbuiider will have the burden of proving that he or she did no� build or improve tor purpose of sale.). ' � I, as owner of the pro0erty, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct Ihe project (Sec. 7044, Business and Protessions Code: The con�rectors License Lew does not apply to en owner of pmperty who builtls or Improves ihereon, and who contracts for such prolect with a comracbr(s) licensa pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑ Ves ❑ No Driver's License No. Expires: Venfication ot Ownership 6y (type of dwument, i.e. - property tex bill or tleetl): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby cenify that no excavation tive (5) or more feet in depth into which a person is required to descend, will be mada in connection wi�h work euthorized by this permit, and that no building sirudure, sraffolding, falsework, or demolition or tlismanUing thereof, will be more ihan thirty-six (36) teet high (Chap. 32, Grp 2, Art 2, Sec. 341, Ttle B, California Atlministrative Cotle). ❑ As ownerbuilder, I will not employ anyone to do work which woultl require a pertnit tmm the Division of Indusinal Sefaty, as noted above, unless such parson has a permit to do such work irom the division. SignaWre: Date: Division of Industrial Safety Permit Number. CERTIFICATE OF COMPLIANCE AND AUfHORIZA710N OF ENTRY: I cehity untler penalry of perjury ihat I have read this application and state that the infortnation given is wrrect. I agree to comply with all stete laws end city ordinances relating to building consimction, and authonze representatives ot iha Ciry of Costa Mesa to enter upon the ebove-described property for inspection puryoses. I agrae not to occupy or ellow occupancy of any building authonzed by this permit until tinal inspection. COpEII, INSVECTIONTYPE Qajj INTRIALS 1616 Fired System Final Fira Prevention 1266 200 201 202 203 204 Pool Spe Final Final Re-Rooi Final BIocWRetaining Wall Final Factory Fire Place Final Sign Final Demolltion CO�E 1 INSPELTION TYPE 206 Final MeChaniCal 208 Final Plumbing 210 Final Electrical 212 Finel Fire Preventlon 220 Final Plenning Approval 222 Final Site 250 ` Final Building/Occupancy Q♦.��1�� r:,..�— �.L .111. � � � (714) 754-5273 • Fa�c (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT ,lob Address: 421 E 20TH ST Suite: B Vicinity: REAR OF PROPERTY Parcel Number: 42631246 ApplicanC CRYSTAL HARMON Address: 25625 MIRALESTE Zaning: . ISSUED BY: Phone: 949-218-8524 LAGUNA NIGUEL, CA Zip: 92677 Owner: PUALANI, MELANIA Address 421 E 20TH ST B , Phone: 949-633-8828 COSTA MESA, CA Zip: 92627-2315 Convactor: SILVER SPRINGS POOLS AND SPAS Address: 25625 MIRALESTE Phone: 949-218-8524 LAGUNA NIGUEL, CA 2ip: 92677 License: 809198 Arch : Address: Eng: Address: Status: ISSUED Applied: 10/06/2004 Issued: 10/O6/2004 Phone: Phone: Zip: License: . , License: SCOPE OF PERMIT INSTALL 72 S.F. GUNITE, IN-GROUND SPA. , , , - . - - - - . FEESUMMARY Plan Check: $254.31 � Permit' �$391.25 . " � � SMIP Res: $2.50 SMIP Com: $0.00 Other: $0.00 Inspection:. $0.00 Total: $648.06 SETBACKS MAINSTRUCTURE Front 0-0 ACCESSORY � Front 0-0 � PARKING Existinq: 0 NOTES: - - Rear 0- 0 Rear 0- 0 Required: 0 PLANNING & ZONING Calc Valuation: Glaim Valuation: � Left 0- 0 Right 0- 0 Left 0- 0 Right 0- 0" Proposed: 0 �25,000.00 $25,000.00 NOTICE: The work authorizetl by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) i EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or it work is suspended or abando tl for a period of 180 days. '� INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable c '� d all required Inapectlons and finel epprovel must be obtained. Failure to obtain inspections and final approval will result in the expiration of ' permit. FOR INSPECTIONS CALL: (714) 7545828 2d46-a6(600) . I WORKERS' COMPENSATION DECLARA710N: � . � — I hareby aHirm under penalry ot perjury one ot ihe following declarations: � � � ❑ I have and will maintain a cenificate ot consem to self-Insure for workers' compensetion, as pmvided tor by section 3700 ot the Labor Cotle, for ihe peAormance of ihe work for which Ihis permit is issued. ❑ I hava antl will maintain workers' compensation insurance, es requiretl Dy section 3700 of Ihe Lebor Code, for the pedortnance of the work Por which Ihis pertnit is issued. My workers' compensation Insurance carrier end policy number ere: Carrier: Policy Number: (This section neetl not be completed il fhe permit is valued af one hundred dollers ($ f 00) or less.) _��ceility ihat in ihe perfortnance ot t�e work for which ihis permit is issuetl, I shall not employ eny person in any manner so es to become subject to the workers' compensation laws of Calif ia, and agree Ihat ii I should become subject to ihe workers' compensation provisions oi Sectlon 3700 of the Lebor Cotle, I shell fort�with comply with ihese provisi s �J �/� �„_t.Signature:. ��L.lf� �— tDate:�- �� — �O��y WARNINOrFARURE TO SECUAE WORKERS' COMPENSATION COVERAGE IS UNL4WFUL AND SHALL SU&IECT AN EMPL�TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE HUNDRED TqUSANO WLLAHE ($1 W,000), IN ADOITION TO THE COST OF CAMPENSATIIXJ, DAMAGES AS PROVIDED FOR IN SECTION 310fi OF THE LPBOR CA�E, IMEREST, AND ATTORNEI^S FEES. LICENSED CONTRACTORS DECLARATION: 9(commencing with Sec�ion 7000) of Division 3 of the Business a�d PrQjessions Code, and my license is in full _ J CONSTAUCTION LENDING AGENCY: ❑ I hereby aftirm Ihat ihere is a consimction lending agency for the pedormance of the work tor which this pertnit is issuetl. (Sec. 3097, Civil Code). Lentler's Name: Lender's Atltlress: Signature: OWNER-BUILDER DECLARATIONS: Oate: I hereby ettirm ihat under penalty of perjury Ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW tor ihe following reason (Sec. 7031.5, Business and Professions Code: Any ciry or county which requires a permit to conswci, alter, improve, demolish, or repair any stmcWre, prior Io its issuance, elso requires the applicant for suc� permit to file a signetl statement ihat he or she is licensetl pursuant to the provisions oi the Conirectors License Law (Chepter 9(commencing with Section 7000) ot Division 3 oi the Business and Professions Code) or ihat he or she is exempt theretrom antl the hasis for ihe alleged exemption. Any violetion of Section 7031.5 by eny applicant for e permit subjects the applicant to a civil penalry of not more than tive hundred dollars ($500).): ❑ I, as owner of ihe property, or my employaes with wages as �heir sole compensation, WILL DO THE WORK, antl the struc�ure is not in�ended or ottered for sala (Sec. 7044, Business and Professions Code: The Coniractors License Law does not apply to an owner of propeny who 6uilds or improves thereon, and who does such work himself or herselt or through his or her own employees, providetl that such improvemanis ere not intended or offared tor sale. It, however, Ihe building or improvement is soltl within one year oi completion, ihe owner-builder will have the burtlen oi proving ihat he or she did not build a improve for purpose of sale.). ' ❑ I, as owner of Ihe property, am EXCLUSIVELY CONTRACTING WI7H LICENSED CONTRACTORS to construct the project (Sec. 7044, Business end Professions Code: The comractors License Law does not epply to en owner ot property who bWltls or Improves ihereon, and who comracts tor such project with a contractor(s) license pursuant to the Coniractors License Laws.). ❑ I em exempt under sec. SignaNre: Owner ID verified by driver's license. ❑ Yes ❑ No BuSiness and Professions Code for this reason: Verification of Ownership by (type oi tlocument, i.e. - property tea bill or deed): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: Oriver's License No. Date: Expires: ❑ 1 here6y certify that no excavation five (5) or more feat in depth imo which a person is required to descend, will be mede in connection with work authorized by ihis permit, and ihat no building siructure, scattoltling, talsework, or demolition or dismantling thereof, will be more then Ihirty-six (36) feet high. (Chep. 32, Grp 2, Art 2, Sec. 341, Title 8, Calitomia Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require e permit from the Division of Indusiriel Sefety, as noted above, unless such person hes e permit �o do such work from ihe tlivision. Signature: Date: Division ot Indusirial Safery Pertnit Number: CERTFICATE OP COMPIJANCE AND AIffHORIZA710N OF ENTAY: I certity under penalry of perjury that I have read this application and state ihet the information given is wrrect. I agree to comply with all state laws and ciry ordinances relating to building consWction, antl authorize representetives oi the Ciry oi Costa Mesa to enter upon the above-describad property for inspection puryoses. I agree not to wcupy or ellow occupency ot eny building authorized by this permit until finel inspection. CQOE I, INSPECTIONTYPE 1 fi16 Piaed System Final Fire Prevention 1266 Pool Spe Final 200 Final Ra-Roof 201 Final Block/Retaining Wall Qdj� INTRIALS COOE 1 INSPECTION TYPE 206 Final Mechanical 20B Final Plumbing 210 Final Elecirical 212 Final Fire Prevention 202 Final Factory Fire Place � � 220 Final Planning Approval 203 Final Sign � 222 Final Si�e 204 Final Demolition ' "' ' ' ' 250 Final Building/Occupency BAIE ltiiIDA6fl l' 7 or H.C. SUBCONTRACTOR JOB ADDR.ESS 1{21 B 20'th St. BUILDING PF1tIDIIT NO. GEN�RAL CONTi2ACTOA Thos. Muntean DESCRIPTION OF WOHK �i�'aa at't.Gas. I' S Gas — In SUBCONTRACTOR . -� � 2387I � COSTA MESA BUILDING-SAFETY DEPARTMENT P. O. BOX D1] COBTA M66A. CALIFORNIA For Applicanf fo Fill In Completely TYPE�IR PRINT BUILDIN6 L/ � 7 ��% C"'� rd ADDRESS L� d (i COSTA MESA, CALIFORNIA // � /• _ I MAIL C. / 7 T'� S�ZE �3 c �3 OFLOT `�bp USEOF Y�. DESCRIPTION OF WORK NO. OF ROOMS SfOR I ROOF /� � COVERIN6 RK TO BE PERFORMED 1 HEqEBY 6CKNOWL6OOE THAT 1 XAVB qfiAp THIB APPLICAT�ON ANO ST/TE THAT TH! ABOV6 18 COqpECT M1NO AOflEB TO COM. PlY WITH ALL CITY ORDI NCH9 AHO BT�TB LAWB ReOULATINO BUILUINO CON6TRU 10 qqq ,,,�� SIGNATURE OF � �� PERMITTEG AUTHORIZ6D A6ENT er �6TY �� l�SA APR 9 1965 .ICATBI tl F��:P�' !"'� T"�flCe i�4e-�rt� o�reiesueo APPROVED BY � DATE ONING pOT([ NO.OP UB80PNHW ; ��l I PLANB �>� pUILDINO � d't ��R�n,o� po R Lu fi � `� � i r � _ � �--c� �- YARO3APPROVED MAIN BIIILDiN6 :OM C/L HTREET) VAR. �i v 6HALL BE LESS THAN (U.B.C.REQUIREMENT'. YARD8APPROVED ACCESSORY BUILOIN6 DATE \ � N 2 so. Fr. � THE AMOUNT BXOWN IINOEfl VALUATION 18 FOp THE F PUPP09E OPa88TABL18NIN0 A PEHMIT FE6 ONLY. � VALUATION ,' �� Q � m PERMITFEE $ �L) � i y�{ m $ �'% ��[/ PLAN CHEGK $ • � ' 0 ,c� 7 � `�7 �, TOT.tl FEE � G %N�:,. trUlvtiLN:ti� ri. GENERAL CON7'RACTOR �OS. I'' S Gas or 4-21-65 v�u.u� g 32,bo�.00 SUBCONTIiACTOR ZONE wivlu�;n� n. GENERAL DATE �So([ BUII.DING )P�ER�MI�T NO. :P7'lON ON' WORK /�+��•�+a+• :ONE VALUE $ .32� � JUP & TYPE �% ZONE SUBCONTRACTOR I YERDi1T: n,r.. i nt�,. ; �- � .. �3872 �:ITY �; 6� �.a � � ;b9�SA ��COSTA MESA BUILDING-SAfETY DEPARTMENT APR 9 1965 P. O. BOZ 91] COSTA MEHA, CALIPORfiIA I �'�' F�+ 5 � a a � ti s F G w F a � � r � a w 4 O � a Z � S 3 • COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant [o Fill in Comple[ely — Use Ink Only BUILDING ADORESS /�2j .� ]] G t, owrveaoa LUCAS DEVELOPMENT CORP. TENANT MAILING ADDRE55 1451 QUAIL STREET cirv NEWPORT BEACH �T,o'-$33-001 COPLSTRUCTION . BRANCH ADDRESS nacHiTecrNUTTALL-liCHIZONQ TE'-545-376 OR ENGINEER NO. ADDRES52925 College ave, Costa Mes CONTRACTOR OWNER BUILDER ADDRESS TEL. CITY NO. STATE CITV UC. NO. IIC. NO. size 63x 100 No.oFe�ocs. ane OF LOT NOW ON LOT USE OF EXISTINGBIDG. STN-. •• F i�n7 .V RESIDENCE Separate permits are required for electriq plumbing and heating work. USE OF BUILDING AND WOFK TO BE PERFORMED .ircE-1Ei� �47GE I hereby acknowletlBa that I heve reatl this application antl rtate thet i�e above Information is corract antl apree to comply wiih all laws reBulatinp builtling connruction, antl I shall not empioy any person {n violation of tha workmen's compensetion laws of Me Siate of California. I hareby certify that I am properly Iicensetl es e canttactor under t�e Siate of California Business entl Prafeutons Code, Division 3, Chapiar 9, t t such licenses are in fu force antl e ect, or I am exe t fro ha p�vlsi�he a Californ�usiness and Pr assiona de, ��•ISIon apt of AOant Date J � � � ^ T[ONFOR�STRUCTU�2A'LPERMIT24•50 TL A.P. NO. F' BUI LDI NG ADDRE55 UNIT OR SPACE NO. l�itG1/iT'��?]`' 2r0 NEW ADD� LTER REPAIR I OWNER USE � APPROVED S APPROVEDSETBACKS �� // � 1 � r i� PLANNING ACTION 0.4TE A�ROV ED T� O" m C a' 3 m SQ. FT. N 7 THE AMOUNTSHOWN UNDER VALUATION IS FOR m THE PURP�E OF ESTABLISHING A PERMR F E ONLV: e VALUATION PERMIT FEE 8 . O O vi n % PLAN CHECK S . O O o $ l S(� S TAX E O•SO f U TOTALPAID $ � ��