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Home My WebLink About863 20TH ST - Building PermitsIi (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mese.c��LDING PERMIT n FAIR ORIVE, COSTA MESA, CA 92626 Job Address: 863 W 20TH ST Suite: Vicinity: FRONT OF HOUSE Primary Occ: R3 Parcel Number: 42251247 Applicant: LUZANNE FIGUEROA Address: Type of Consiruclion: V-N Zoning: Phane: 714-979-8794 ISSUED BY: Zip: Owner. SUSANNE GAGNON � Address 863 W 20TH ST- � - - � .� � . Phone: 949-642-1530 � COSTA MESA, CA -� Zip: - 92627 � � Contractor:� OWNER-BUILDER", , ,- � �- � � C� Address: � � � . � � � � " ; � .� �. -, - � Phone: � . , . � ' � >� y � . �Zip: ' - - License: 000000 � Arch : ' - Eng: MANSHADI, FARHAD Address: � - Address: 1800 E 76TH ST ' , .. , _ � „ Phone: � - Phone: 714.835.2600 � ' " SANTA ANA, CA Zip: License: �� 92701 License: 36840 Status: ISSUED Applied: O6/022006 Issued: 07/21/2006 SCOPE OF PERMIT EXPAND THE LIV�NG AREA AIJD CREATE A NEW ENTRY BY 85SF AND CONSTRUCT A NEW 35 PORCH OVER THE ENTRY AREA. REROOF THE EXSITING GARAGE WITH THE INSTALLATION OF NEW RAFTRES . INSTALL NEW 4X14 HEADER AT THE GARAGE ENTRANCE Plan Check: Permit: SMIP Res: , SMIP Com: Other: Inspection: Total: $117.81 - , $181.25 $0.94 S0.00 50.00 $0.00 $300.00 _ FEE SUMMARY PLANNING & ZONING SETBACKS ' � MAINSTRUCTURE Front 20-0 Rear 1U-0 Lek 5-0 ACCESSORY Front 0- 0 Rear 0- 0 Lek 0- 0 PARKING Existina: 4�� -Re uired: 4 Pr000sed: 4 � � : .- . - Calc Valuation: Claim Valuation: Right 20-0 Right 0-0 �;; �j/ ss,a�e.2o 50.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21•92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days, or lf work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for ihe work euthorized under this permit to be considered legal, such work must comply wkh all applicable codes, and all required Inapectlone and final approvel must be obtained. Failure to obtain Inspections and final approval will result In the expiration of this pertnit. FOR INSPECTtONS CALL: (714) 7545626 zaaaee (am) WORKERS'COMPENSAnON DECLARAPON: . �� I hareby aflirm under penalty oi perjury one of ihe following declaretions: .. � ❑ I heve.end will malniain a ceniticate of consent to selt-Insure br workers' campensetlon, es pmvitled for 6y sectlon 3700 ot the Lebor Code, for Ihe pertortnence of the work far which this permit is is5ued. ❑ I have anG will maintain workere' compensation Insurance, as requiretl by section 3700 ot the Lebor Code, for Ihe pertortnance of ihe work tor which Mis pertnit is Issued. My workers' compensation Insurence carner entl policy number are: Cerrier: Policy Numbe�: (Tfy'15 secfion need nof be comp/efed il the permif is velued af one hundred dollars ($100J or Iess.) i -- �r �$] f.�Lcertify ihat in ihe pertortnance ot the work tor which this pertnit is issue4 I shall not employ any person In any menner so as to become subject to ihe workera' , compensetion lews of Celifomia, antl egree ihet If�should Eecome sub�ect to Ihe workers' compensetion provisions of Section 3700 of ihe LaDor Cotle, I shell forthwit� comply with Ihese�,pr�oN� n5. ' ApPlicenfSignaturei �,y"��M! �.,,nrdZ GDete:---�/2�/�6� WARNIN(3 FAILUf1E TO SECURE RKERS' COMPENSAiIOf ERAGE IS UNIAWFUL ANO SHAl1 SUBIEGT AN EMPLOVER TO CRIMINAL PENALTIES AND GVIL FlNES UP LO ONE MUNDRED THOUSANDOOLURE(5100.000), DfiIONTOTHECOSTOFCOMPENSATION,�AMAGESASPflOVIDEDF-0RINSECTION3]OfiOFTHEIABORCODE,INTEREST,ANDATTORNEV'SFEES. LICENSED CONTRACTORS DECLARATION: I hereby ettirtn t�at I am licensetl under proWsions ot Chapter 9(commencing wit� Section 7000) ot DlNsion 3 ot lhe Business end Professions Code, and my license is in full forCe end eftett Lic. q Class A ContrectoYs Signature: Date: CONS7RUC710N LENDING AGENCV: � ❑ I hereby aHirtn that there is e construction lentling agency for the peAormance of the work for which this pertnit is issued. (Sec. 3097, Civil Coda). LentleYs Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLAflAT10NS: I hereby ettirm that under penelty of perjury ihet I em EXEMPT FROM THE CONTHACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business end Protesslons Code: Any ciry or counry which requires a pertnit to construct, alter, improve, tlemolish, or repair any sirucNre, pnor to ils issuance, also raqWres t�e epDlicflnt tor such pertnit to fle e signetl statement that he or she is Iicensed pursuent to ihe provislons of Ihe Coniractors License Law (Chapter B(commendng with Section 7000) of Division 3 of the Business antl Professlons Cotle) or thet he or she is ezempt therafrom entl the besis for tha ellagetl ezemption. Any vlolatlon of Sectlon 7031.5 by eny epplicent for e partnit subjects lhe applicent to e civil penalry of.not more than five hundred dollers ($500).): ❑- I, es owner of the property, or my employees with wages as their sole compensation, WILL DO 7HE WOqK, and ihe sWcture Is not intended or oHeretl for sele (Sec. 7044, Business and Protessions Code: The Contractors License Lew does not apply to an ownar oi property who builds or improves Ihereon, and who does such work himself or herselt or through his or her awn employees, provided thet such Improvemenis are nat Intended or oHeretl for sele. It, however, ihe building ar Improvement Is soltl within ona yeer o� completlon, Ihe owner-builder will have the burden oi proving that he or she did not build or improve for purpose ot sele.). ' ❑ I, es owner ol ihe property, em E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to conslruct the project (Sec. 7044, Business end Professions Coae: The caniractors Llcense Lew does not apply to an owner of pmperty who 6uilds or improves thereon, entl who camracts tor such project wlih e comrectar(s) Ilcense pursuant to the Gontractors License Laws.). ❑ I em exempt untler sec. Business end Professions Code for this reason: Signature: Date: Owner ID veritietl by tlrivar's Ilcense. ❑ Vas ❑ No Drivers License No. Ventication ot Ownership 6y (type af tlocument, i.e. - pmperty tex blll or deed): DIVISION OF INDUSTRIAL SAFETY PERMI7 CERTIFICATON: Expires: ❑ I hereby certity ihat no excavetlon tive (5) or more teet in depth into which a person Is requlred to descend, will he mede In connection with work euthodzed by Ihis permit, antl ihat no huilding strucWre, scaHolding, felsework, or demolition or dismantling Ihereol, will be more then thirty-six (3fi) feet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Tltle 8, Cellfomla Adminisirative Code). ❑ As owner-builder, I wlll not employ anyone to do work which woultl require a pertnit from the Division of Indusidel Sefery, as notee ebove, unless such person hes e permit to tlo such work fmm the division. Signeture: Date: Divislon ot Industriel Safery Pertnit Number: CERTIFlCATE OF COMPLIANCE AND AUT}IOFiIZATION OF ENTRV: I cenify under penelry oi perjury �hat I have read this epplication end state �het ihe infortnation qiven is correcL 1 agrea b comply with all state lews end ciry ordinences rela�ing b builtling constmction, entl authorize representaNves of the City of Coste Mese to enter upon Ihe ebove-descnbetl properry for inspeclion purpases. I agree not to occupy or ellow occupancy of eny Cuilding authorized by this permit until fnel inspection. SODE t. INSGECTIONTYPE � PdIE INIIDOI$ 7616 Fixed System Final Fire Prevention 1266 Pool Spe Finel 200 Finel Re-Roof 201 Flnal Block/Reteining Well 202 Final Fectory Fire Plece 203 FinalSign 204 Final Demolition . . . . . . COOE1 INSPECTIONTYPE � 206 Final Mechanicel 20B Finel Plumbing 210 Finfll Electrical 212 Finel Flre Preven�ion 220 . Finel Planning Approval 222 Final Slte 250 Finel Building�Occupancy �. I IJ111. . /!�— (714) 754-5273 • F� (774) 754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: 863 W 20TH $T Suite No Vicinity: SIDE OF HOUSE Parcel Nunmber: Applicant Address: Owner: 42251247 DOUG CONFER 863 W 20TH ST COSTA MESA, CA SUSANNE GAGNON Address 863 W 20TH ST COSTA MESA, CA ConVactor. Address: ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+unils) Pool / Spa Lighting Fixts Recept OuOels Switches Non Res Appl Res Appl Service to 200a Service to 1000a Service over'I OOOa Motors to 1 hp Motors to tOhp Motors to 50hp Motors to t00hp Motors over 100hp Communication drops Sub panel to 200a Pole Light Pkg OWNER-BUILDER Phone: Zip 92627 Phone: Zip: 92627 Phone: Zip: License: 000000 SCOPE OF PERMIT ELECTRICAL PERMIT FOR THE INSTALLATION OF A NEW AC UNIT. WORK TO INCLUDE: 1 SWITCH AND 1 MOTOR TO tOHP. $23.50 $0.00 $0.00 $0.00 so.00 $0.00 $0.00 so.00 $1.10 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 � 512.30 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 Quantity 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 FEE SUMMARY Temp Dist Syslem / Lighting Busway /100 ft Standing Section Misc Electncal Equipment Transformers up to 7 kva/kw ................up to 10 kva/kw .................up to 50 kva/kw .................up to 100 kva/kw ..................over 100 kva/kw Low Voltage Equipment Low Volt Wiring System / Ckt Misc. Conduit Misc. Conductor Circus ( gen or ride) Circus (mech ride or lights) Christmas Tree Stand Fireworks Stand Other Electrical Fee Investigation Fee Plan Check Fee Reinspection Fee Status: ISSUED Applied: O6/13/2005 Issued: O6/13/2005 ISSUED BY: f Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 so.00 0 $0.00 0 $0.00 0 so.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 so.00 0 $0.00 0 so.00 $0.00 $0.00 $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremants under Califomia st and related iegulations. (Ord. No. 92-28, § 1, 72-21-92) EXPIRATION: This permlt shall automatirally expire and become void if work is not commenced within 1B0 days, or If work uspended or abandoned for a pedod of 180 days. INSPECTIONS: In order tor the work authorized under this permit to be considered legal, such work must comply with all epplicable codes, and all required Inapectlons and finel epprovel must be obtained. Failure to obtaln Inspections and final approval wlll result in the expiration ot this permlt. FOR INSPECTIONS CALL: (714) 7545626 zaae�ae (e�oo� WORKERS'COMPENSAnONDECUWpnON: I hereby effirtn untler penelry of perJury one oi Ue following dedareLons: ❑ 1 �eve antl will maintain e certllipate of consent to setl-Insure lor workers' compensation, es proNded tor by section 3700 of the Lgyar Code, for the pertormence of Ihe work for whlCh IMs pertnli Is IssVBA. ❑ I have and wlll maintaln vroAcers' �p¢nsetion insu2nce. as required by secllon 3700 of t�e Lebor Cotle, for Ne peAortnance of IAe wwk fw whkh this pertNt Is IsweC. My workers' compensetlan Insurance cartler antl poilry number flre: Cartler. Paliry Number. (This sealon nee0 nof be rompleted I! the permit is veNed et one hundred Oollers (St00) or Iess.) �. �' It�at In the peAortnenc a the wwk for wNU pertn' ' ued,y$� ell not employ flny person in eny manner so es to become sub�ect to the wwkera' nsetlon lawa ot Celito i entl epree thet it I o d b subj �t 6 the workers' compensalion provisians of Secllon 00 ot t Lebor Code, I shell foMwlth comply wlth Ihese pro sio � �� ! ` � plkan SlgneWre' a�'61e: �� v WMNINO.i�FN.9H SECURE OfiKE0.S' COVERAGE IS UMAW FUL AN� SW1L1 SU6IECT AN EMPLOYER TO CRIMINAL P TIES AND CML FlNES UP TO ONE HUNDRED THOUSAND OOLLARE (5100,000�, ADDITIIXJ TO THE OF COMPENSATION, DMMGES AS PROVIDED FOR IN $ECTION 3]OB OF TME IABOR CpDE. IMERE$T. ANO ATTORNEI"$ FEES. LICENSED CONTRACTORS DECLqqAT10N: I hereby effirtn Ihet I em Iiconsed undgr provlsions at Chepter 9(commencing wllh Sectlon 7000) of Divislon 3 oi ihe Business end Protesslons Code, entl my Ilcense is In full �olCB 80d BNBCL LIC. M CI039 k Cantrectofs SlgnaWre: Date: CONSTRUCTION LENDING AOENCy: ❑ I hereby eMirtn tliet there Is e mnsiructlon IerMing egenq for the pertwmence ol the work lor w�lU this permit Is Issued. (Sec. 3097, CMI Code). Lentlefs Name: Lentlefs AtlAress: Signeture: Date: OWNER-BUILDER DECLARATION3: I here6y eHlrtn Ihet under penely oi perjury that I em E%EMPT FROM THE CONTFiAC70RS LICENSE LAW tor the tollowing reasa� (Sec. 7031.5, Business end Professions Code: Any dry or counry whkh requirgg e pertnit to canstruc1, alter, Imprwe, dertwlish, or repelr any sWCNre, pdor to its issuence, also requlres the epplicant lor such pertnit to file e signed statement Net he ar s�e Is Ikensed pursuent to Ue prwisions o1 the Contrectors ticense Lew (C�epter 9(commendng wIN Sectlon 7000) of Divislon 3 ot Ne Business and Professions Code) or that he or she is exempt theretrom end Ne beSLa for the elleged eaemptlon. Any violetlon of SecUon 7031.5 6y eny appllcant for e pertnit sub'e pllcant to e civil penalty ol not more t�an frve hundred dollers ($500j.): owner o1 Ihe properry, or my em0�oyees with wages as thelr sole compensetlon, WILL DO TME WORK, and the structura Is nm imended ar aHerad tor sele (Sec. 7044, Business and Professiong �pAe: The Contractors License Lew tloes noi epply lo en owner ot property who builds or improves thereon, end who tloes such work himselt ar herseli or Ihrough his or her awn employees, provitled that such improvements ere not Intended ar oHered lor sale. N, however, ihe building ar Imprrnement Is sold within one year o1 campletion, the owner-6uiider will have the Durtlen al proving thet he or she did nol build or Improve for Durpose ot sale.). ' ❑ I, es owner o1 the properry, am E%CL VELV C ACTNG WI7H LICENSED CONTRACTORS to wnstruct the prolect (Sec. 7044, Business entl Prolessions Code: The cont�rs License Lew oes ot a y ro owner oi property who builds or Improves thereon, end who coniracts foi such project wlt� e contractor(s) and Professions Code for ihis reason: Owner ID vedli�by ddvefs Iibens�e�./ iQ.�es ❑ No � Venfication of Owners�ip by (type Ory�ment, i.e. - property t� bill or tleetl): DIVISION OP INDUSTRIAL SAFETY pERMR CERTIFICATION: � I hereby ceNfy t�a� no excevetion five (5) or more feet in depth Into which a person Is requiretl to descend, wlll be made in connection with work euthodzed by Ihls pertnit, end t�at no bullding siNIXure, scattdding, talsework, or tlemdWon or Olsmanlling Ihereot, will be more then thirty-six (38) teet high. (Chap. 3.2, Gry 2, Art 2, Sec. 341, T10e B, Callfomia Atlminisqetive Code). ❑ As owner-�ullder, I will not emplq enyone to tlo work which would require e permit tmm t�e DlWsion at Intlustrial Satery, es notetl ebove, unless such person hea e pertnit to tlo such work Irom the Aivision. Signature: Date: Division ol Indusidal Satety Pertnit NUmber. CERTIFlCATE OF CAMPUANCE AND AllTf10HIZA710N OF ENTRV: I certify un0er penelty ol Der�ury that I heve reatl this epplicatlon antl stete Ihet the Intormallon gNen is correct. I agree to comply with ell slete laws entl Gry ordlnances relating to builtlinp constructlon, and authorize representetives of the Clry ot Coste Mese lo enter upon Ihe above-descdbetl �erty tor inspection p�es. I egree not to occupy or ellow occupency of eny building euthonzetl 6y Ihis permit until linal insDectlon. GODE t. 1616 1268 200 201 202 203 2P6 Fixetl System Final Fire Preventlon Pool SDe Flnal Finel RaRool Flnel BIocWRelelning Wetl Finel Fectory Fire Place Flnel Slgn Flnel Demdltlan Pdg 1t�EL5 �QQ� INSPELTONTYVE 206 20B 270 212 220 Flnal Mechenical Flnel Plumbing Finel ElBctriCel Finel Flre Preventlon Finel Planning Approval 222 Flnel Site 250 Flnel Bulltling�Occupency QAiF. II{fIDALH a i ,� (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 863 W 20TH $T Suite No Vicinity: SIDE OF HOUSE Parcel Number: 42251247 Applicant: DOUG CONFER Address: 863 W 20TH ST COSTA MESA, CA � owner: SUSANNE GAGNON Address: 863 W 20TH ST COSTA MESA, CA Contractor: OW N ER-BU ILD ER Address: MECHANICAL PERMIT Status: ISSUED Applied: O6/13/2005 Issued: O6/13/2005 ISSUED BY: _�T Phone: Zip: 92627 � Phone: 2ip: 92627 Phone: Zip: License: 000000 SCOPE OF PERMIT . MECHANICAL PERMIT FOR THE INSTALLATION OF A NEW AC UNIT. WORK TO INCLUDE: 1 REFRIG SYS UP TO 100 K BTU . ISSUE FEE Inst FAU <100 k BTU Inst FAU >100 k BTU Repair/Alt Cooling/Heat Inst / Rep. Recess Wall Htr Refrig Sys <�00 k BTU Refrig Sys >100 k BTU Gas Piping Factory Fireplace Hood w/Mech Exhaust VAV Box Vent Pan / Single Duct � , Appliance Fire Dampers Smoke Dampers Inst or Relocate Appl Vent Air Handlers < 10000cfm AirHandlers> 70000cfm Floor Fumace Floor or Suspend Heater $23.50 $0.00 $0.00 $0.00 $0.00 $14.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 so.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantity 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FEE SUMMARY Repair / Alt Absorbtion Unit Repair / Alt Refrigeration Unit Ventillation System Evaporative Cooler Commercial I nci nerator Domestic Incinerator Compiessors / Absorption Systems - - Upto3hp/100kBTU ' 3To15hp/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 � - � Upto3hp 3To15hp 15to30hp 30 to 50 hp Over 50 hp Other Mechanical Fee Investigation Fee Plan Check Fee Reinspection Fee Quantily $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 So.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspe d�ar2 anb d tor a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final epproval must be obtained. Failure to obtain inspections and final approval will result in the ezpiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 zaauae �sioo� WORKERS'COMPENSArON DECLARAnON: � I hereby aflirm under penel�y of perjury one ot the tollowing declara�ions: • � ❑ I have entl will maintein e certificete of consent to self-Insure for workers' compensetion, as provitletl for by section 3700 of the Lebor Code, for the pertormance of Ihe work for which this pertnit is issued. ❑ I heve end will maintain workers' compensation insurance, es requiretl by section 3700 of the Labor Cotle, for the pertortnence of Ihe work for whicti this pertnit is issued. My workers' compensetion Insurance carrier and policy num6er ara: Cartier: PoliCy Number: (7h/s secfi� need nof be comp/eted il Me pertnit is ve/uetl et one hunCred dollers ($f 00) or /essJ ,�(eer'tiiy ihat in the DeAortnance of the work for which �'S permit' issued, I shall not employ any person in any manner so es to hecome subject to tha workere' compensation laws of Ce iYknia, and a e Ih�tA o d be a subJect to ihe workers' compensation provisions of Sedlon 3700 of ihe Lebor otle, I s�all farthwith comply wlth IheSe p ovi o s / ��a: � a�a:, ' �3 0 WARNINO: FAI�URE TO SE E WORKERS' COMP ATION COVE E I$ IINLAWFUL M1D SHFLL SUBJECT AN E PIAYER T�O CRIMINAL PENALTIE AND CIVIL FINES UP TOIXJE HUNDRED TFIOUSANDDOLLARE(5100,000),INADdTIONTOTHECOSTOFCOMP NSATION,DAMAGESASPROVIDEDFORINSECTION3]OBOFTHELABORCODE,IMEREST,ANDATTORNE`fSFEES. LICENSED CONTRACTORS DECLARATION: I hereby eflirtn Ihat I em licensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 ot the Business end Protessions Cotla, antl my license is In tull � , force end eflect. Lla p Class A Contrectors Signeture: Date: CONSTRUCTON LENDING AGENCY: ❑ I hereby aXirm that Ihere is e consiruction lentling agency tor t�e peAormance of the work for which Ihis pertnil is issued. (Sec. 3097, Civil Cotle). Lentlefs Neme: Lendefs Address: SignaNre: �ate: OWNER-BUILDER DECLARATONS: � I hereby aHirtn ihet under penalry ot perjury thet 1 em E%EMPT FROM THE CONTRACTORS LICENSE LAW for tha tollowing reeson (Sec. 7031.5, Business antl Protesslons Code: Any ciry or counry which requires a permit to construct, alter, improve, tlemolish, or repair any structure, pnor to its issuance, elso requires the applicant for such permit to flle e signea statement that �e or she is licensed pursuant to the provislons ot ihe Contradore License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exemD� theretrom and the basis for the elleged exemption. Any violatlon oi Sectlon 7031.5 by eny apPlicant far a permit subjeds the appllcant to e civil penalry of not more ihan five huntlred tlollers ($500).): ❑ I, as owner at ihe property, or my employees with weges es thelr sola compensation, WILL DO THE WORK, and the struclure Is not intentled or ofrered for sale (Sec. 7044, Business antl Professions Code: The Contractors License Law does not apply to an owner of properry who builds or improves ihereon, and who does such work himself or herself ar through his or her own employees, provided thet such improvements ara not intendetl or oHeretl for sele. If, however, the building or improvament Is sold within one year of completion, the owner-builtler will heva the burtlen of proving that he or she did not build or improva for purpose of sale.). � ❑ I, as owner of the property, am EXCLUSIVELV CONTRACTING WITH LICENSED CON7RAC70RS ro construct the pro�ect (Sec. 7044, Business and Professions Code: The contr rs License Lew does no}.;pply to an owner of property who builds or improves thereon, and who wntracis tor such project with a contracbr(s) license pursue to he Contrado�SL�ceny4l,eEvs.). , ❑ lem Ow'ner ID verifiedDy tlriw Venticetion of Ownership Business and Professions Code br this reason: � Q�'es ❑ No document, i.e. - pmperty tae bill Or deod): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: � ❑ I hereby certity Ihat no e:cavation five (5) or more feat in depth into which e person is required to descen4 will be mede in connection with work authorizetl by t�is permiL antl ihat no builtling strudure, scaHolding, falsework, or demolition or dismanNing thereot, will 6e more ihen ihirry-six (38) feet high. (Chap. 32, Grp 2, Ar12, Sec. 341, Tltle 8, Celifornla Atlminisiretive Cotle). ❑ As owner-Gulitler, I will not employ anyone to do work which would require e permit irom the Division of Industriel Safery, es noted ebove, unless such person has a permit ta do such work irom Ihe division. SignaWre: Date: Division at Industrial Safely Parmit Num6er: CERTIFlCATE OF COMPLIANCE /WD AI7THOHIZATION OF ENTRY: I certify untler penalry of perjury ihat I have reatl this epplicatlon and state that t�e intortnetion given is correc�. I egree to comply with all state laws end ciry ortlinances relaling to building consirudion, entl authonze representetives of �he Ciry oi Costa Mesa to enter upon the ebove-descnbed properry for inspection purposes. I agiee not to occupy or allow occupancy of any building euthorized by this pertnit until final inspection. COPE1. INSYECTONTYPE QejE IIiIID9L$ 1676 Fizetl System Final Fire Prevention 1266 200 201 202 203 Paol Spe Final Final Re-Roof FIna181ock/Retaining Well Final Fedory Fire Place Final Sign 204 Flnel Demolltlon COOEt INSPECTION7YPE 206 Finel Mechanical 20B Final PlumDing 210 Final EleCiricel 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 FInelBulldlnq/Occupency l��l �1,� Laundry 0 c�i N Garage ad� �j W • 2 �-1-h �}- Gr� �a�a.7 110.0' /5� -�/�� v Y /�� cJh1C�, Kitchen � Bath 00 BD BD LR 1,035 SF 22 0� Ent BD BD 0 v 27.0' 92.0' -- -'� W � Q 'N'L �jT Vee'�` 0 � N CITY OF COSTA MESA PLANNING DI��[.�N SUBJECT TO BLDG.`� P'C• REG. NOTE: ADDITIONS, DELETIONS, OR CORRECTIONS SHALL BE APPROVED BY THE P1.ANNING DIV. __.�.,,.L .,��//0�05 DECLARATION OF AUT1iURITY FOR AGENTS OF PROPERTY OWNER TO APPLY FOR PERMITS Street Address: �� w_ �a-�s� Bldg. Permit # This Permit # AP Number: �/ ;D T._a�,►.ti�s_� 1. I(we), �UY 1�N� v„ W� ��V , declare that I am the Owner of Title of the above referenced real property, and that I(we) hereby authorize: Name: V v �� Telephone Number: �/ ��a� �` `� Street Address: G(�J V-'• �v l� Ciry: �oJ ( f'7 ' [C� �/7 State: � Zip: -��i� to obtain permits in my behalf, as ownerfbuilder, for at the above referenced property. 2. Should any person become an employee engaged in the improvement of the property, 1(we) shall immediately provide Workers Compensation Insurance coverage and cause a ceRificate of that coverage to be filed with the Building Division of the City of Costa Mesa, as required by State of California laws. 3. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other person, company or corporation. 4. I agree to indemnify and hold the Ciry of Costa Mesa and its employees or offcers harmless from any claim resulting in damage or personal injury to myself or any other parties as a result of work authorized by the permits from the City of Costa Mesa. 5. I declare under the penalty of perjury thal the foregoing is true and wrrect. Executed this ��„� day of �/U/V � 20 (%3 � ! , Califomia. 0]'l9d81rev.t 1/00) Print Name: SI�S�U�iJ� � fl L-� i�-� �� Signature: ( �..��v � .s .in✓ Date: _ (L�p — /� r0� Note: This author¢ation does not grent authorization to perform the work as ovmer, it soley provides for limited power of attomey to secure this pertnit in any behalf. nooeess: a63 W lOTH ST a'sN�ME: DONALD S SUSANNE GAGNON aoosess: SAME AS AHUVE 7i4/642�1.530 RXCN/ENGINEER: RODflE33: flEG.NO.: � uxir: (_ITY OF COS'CA MESA — HUILDING PERMIT PERM D10: EP 046591 PERMIT' NO: EP 046531 PLAN CHECK NO: Dl COVT: N SUFP: CONSTRUCTION TYPE: PERMIT TYPE: �LE PI,U PURPOiE: ,70H UESCRIYTIOTI : INSTAI�L GAS G$T.��CTRIC F'OR PORTAHLE SPA SQ F'f: UNIT: PEflMI1TEE: GOPIALD & SUSANNE GAGNON ( 714 ) 642—t 530 �oowess: A63 W. 20TH ST COSTA MESA CA 92627 . 11LENSED LONTMCTOfl OECIAMTION: I ImreOy affirm tlut I am IkenseE un0er pravhions ol Chapter 9(commencinq wit� Section 7000) of Oivision 3 0l tAe Business an0 Protessions CaOe. anE rtry ticense is in full lorce an0 ettecl. cm uc.: srnn uc.: cuss: oate: Slonature: ' �BKEHS' COMPENSIITION OEClAMT10N: I �ere0 allirm Itut I Aave a unifiute ol consent to setl-insu2 ar a ceNf¢ate of Workers' npenutian Insurance, ar a cenilie0 copy I�ereof �Section 3800, LaD. CI. - ALILY NO.: E%P. ORTE: ' COMP�NY: � Certilie0 copy i �ereby tumislre0. ❑ Cerllfle0 coDY is �IeA wit� ihe ciry BuilOinp Oivision. .�e: D•� � `D npp�icant: ��i�f� � IXEMPfIOX F110M VIONNFHS' COMPENS�TIOX OECWWTION: (11ns seclm neeO not 0e mmWeteO tl tlie ce� � w ane �untlrW (5100� a kn�. I certiry that in t�e pedormance ol t�e woM lor wNc� ihis permit is issue0, 1 sliall mt empby any person in any manner so as to Gecome suDiect to t�a WOMers CompEnsdtion �am ai Calilomu. Oate: ' SlpnaNre: NUTICE: It, aiter maknp IAis tleclaration, you s�oul0 Oecome suble�� o tAa Warkers' Compenutian O�avisions of ihe LaEor CoOe, you must fort�with camply vnt� suc� provisions or tlns permit SAall Ee AeemeE revakeA. CONSTBUCTION LENOING RCENCY: I AereUy atlirm Ihat tAere is a consiruIXian IenAinO a0ency lor I�e pedormance ot I�e wark lor wMc� tAis Oermit is issue0 (Section 3097, Civ. C�. ' IENOEfl: RDONE33: OWNEfl BUIIDEB DELlAMT10N: I hereby aiilrm t�at I am eMemp� from the Cantraciors' Staie License Law for the �ollowinp reason (Section 7031.5 Business anE Professlonal CoOe: My ciry of counry wtiicA requires a permit ro construct, al(er, imD�ove, tlemolish, or re0air any simcture. D�or to ds issuance, also requires I�e apDliwnt for SucA permit �o lile a siqne0 statement tAat he/s�e is IicenseG pursuam to the Dmvisions of t�e Cont2ctors' State License Law (C�apter 9(cammencinq vntA Section 7000) af Oivision 3 al I�e Buvness anA Pralessions Cotle) or t�at he/sha is exempt lherelrom and Ihe basis for t�e alleped exempUon. Any violation oi Section 7031.5 hy • aOPlicant for a peimit su�le� ��e aDPlicant la a civil penalry ol not more t�an live �unOred tlollars (f500�. I, az owner oi �Aa pmperry , will do the work, anE the slmcWm is not intenUeA or oflaretl lor sale ( ectian 7047, Business antl Protassional Cade: The Contracrors' State License Law �does not a001y ta an awner al a Draperry wAa �ulltls or imD�aves [hereon, antl who Aoes such woM himseli/hersali or thmupA his or Aer own emDloyees, provitleA tAat sucA Impmvements am not inten0e4 ar oiferetl for sale. It, however Ihe builtlin0 or impmvament is solE within one year of completlon, tAe owner will Aave Ihe OurAen of provinA he/she tlitl not build or improve " lor Ihe purpo50 of 5a18�. I, as owner af the pmDerty, am exclusively conlracilnp wiih IicenseE contractors Io consimct the pmlect (Section 7044, Business ❑ anG Pmt¢ssions COEe: The Contactors' State Licerea Law Ooes not appty to an ovmer of Omperry who OmIQs or improves t�ereon an0 wtw coniracR lor sucn Drol�u �th a coniracroqs) license pursuant ta tAe Cont2ctars' State License �aw). I am aware Ilwt praal ot ttreir Worker'S ComDensxtlon Insuance sAONO �e Dravitle0 to me. � I am exem0� un0er Section: B. 8 P. C. �orinb reason: Date: O�/` O Owner I Go �ereEy cenity ttut I am awaa al an0 unUerstan0 ehe requirtmenGs of Calitomu Heall� antl Safery COAe Section 505, 25533, anA 25534 anE Itut I or any future OuilGinp oaupanl vnlUvnll froi (circle one) neeOlo compty wilh sai0 stale codes anE I�e'requirements lor a Dermit for wnstmctwn ar moGification Irom t�e Au Oualiry ManaAement Oistnct. HesiEential constmction applications are exempt Imm theu Dmdsions. ' "' ..^ .. , Daro: � l�pplium; ' � ' I �ereEy cerliry that I Iwve reaC this apD��Gtian an0 st5le Ihat Ne aGove iniormation is cortecl I aAree to compty wrt� all tiry an0 counry wEi(wrces anU sute laxs rdaunp ro �uilGinp caiswction aiM Ircre aWwris rew�nutNes ol tNs d o enter upon the a6ove�meniionM Oroperry br i�rspection uryases. � Oaro: � w 90nature: � o�iver's �icenu or Sacia� Securiry x: :-. 19sLa8 WMte—BuilOirg; Green—COUe EnforcemenC Cenary—Applicam; Pink—Revenue; � OTH CLAIM VP.LOE: � CALC—VALLIE: GROUP OCC: / COMMEDI'CS : - �e***�**�e*�*�-�e�*a�x�*��*�t*�rr�r*****�t****�*x-*��*x�******�*��t�t�-*x�f�**�t*�r*�r�t�rit�tat��***��tx�* � 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 BOILDING —=—=------ -------- ACCESSORY BUILDING -------- FRNT: FT IN REAR; FT IN FRNT: FT IN REAIt: FT IN LEFT: FT IN RGH1': FT IN L6FT: FT IN RGHT: F'1' IN PARxING REQ: PROV: PARCEL: 42251247 'LNE: REP NO: PLANNING N01'ES> � iEiEiEifiEdf kklEltklEiEifiFMifitiEkitikik4iEklhiliFiEiEiElflEiEiEiEfElEifkifif�kkiEiEiEffifif7f#kkkiEk�fiEikifiFkfkklEihititiFiEiEjEX-iEifitlE D E V E L O P M E N T S E R V;I.0 E S R E p U I R E M E N T S ZONING APPROVED BY . ' DATE• BUILDING I�PPROVEU BY : APPLICATION ISSUED if 1E iE 3f iE aF �E 3f iElf i! fE if ib iF it iE iF if �t if iE iF iF iE iF iE fE if if iF 3E iF if if �k iE if LEGALIZATION:N Bi,DG PMT PERMIT PLUMBING 2.00 F E E � DAT�: � / DATE: o+-�� F:3E'ff3�IFR'iF�i 'i��iFiF�F7Fi�ititkitK-iEi�*iti��7F7F 'iFi�x- f iE iE if ik iE N iE iF if� 3E 3F iE 3E k)f iE 3t iE IE �F k 1f fE 1E iE iE it Ik iF 3E it i! iE i6 iE ik ik if if 1f iE 3E ih �E 5 U M'M A R Y STRUCTORAL SEGML•'NT:N ELECTRIC MECHANIC FIRE SMIP/RES GRADING 1 2. 50 � 0 0 0 258 SOY • SMIP/NON-NES PLAN ISSOE F6G 3.00 15.00 ; � BUILDING—DIV--? PERMIT ISSUE PLAN—CIIF.CK TOTAL PAID DOG TOTALS-----> 14.50 1.:8.00 0.00 32.50 ,;32.50- .00 REVENUL: DIVTSION TUTALS--> COI,LE:CTED: 9?..50 OVER/SIiOR1'.:. QO BLDG FM'P FI�UMBING rGECTRIC MECIiANIC FIRE SMIP/TOT .'GRADING PLAN—CHECK 5.0� 2�.5� ;;. k if �IF 3E IE �lf k iF iF if !k if if if i( # 4 if iE iE �lf 3E i! k 1E IE IE if �lE iE 1E iE if k iE iE 3f iE iE 1( it 3F iE ik if iE 3E �F it 1E 1f i!� If -k� if iF ik if iF iE iE�lE if iE if k�,"�ik 3E i4 �E iE iF �% i(� �IF 3f� 3f� dE k I A1 D I V I D O A L F E G II R E A K.D O W N i`-'' ` TYPF.. QTY D E S C R.I P T I O N ONiT COST '`c ' TOTAL GOST ELE 1 FT.XTURES. LIGHTIDiG 1 ST 20 EA. .75 � ,75 ELE 1 REC6P1'/OUTLEI' 1 S1' 20 GA. .75 .75 GLF•. 1 MISC Al>I'ARATUS NQT LISTE,� RE!? PERI4IT 11.00 � 1'I..00 PLU 1. GAS PIPIDIG SYS OF' 1 T� 4 OIITLBTS <.00 2.00 r:rir or• rEes . EXPIRED Incomplete Inspections ` � Date —�— ---.._ Sig��L \\\� � \ 01 �CG5�4A7-1C05o4?5 TL�'L �:.5: � DATE: Q3!20/9u TIt1E: 1.i:4D t� j . CONSTRUCTION AND PLANN�...i APPROVALS Permit # � Date i. Temporary Electrical Service or Pole ,.�,• . 2. Soil Pipe-Undrgrnd. � � 3. Electrical Conduit Utility•Undrgrnd. '�,� �4. Electrical Conduit-Undrgrnd. � 5. Steel Reinforcement 6 Electrical UFER Grnd. � 7=Footings � _ :8. Foundation . � .;9. Water Pipe-Undrgrnd. 70. Structural Floor SYstem � 11�. Property Sewer Line & House Connection � 12. $ewer Cap - ��. 13. Roof Drains - ��' % 14. Rough Plumbing ,' j 15. Rough Electrical-Conduit � 16. Rough Electric Wiring � 17. Rough Wiring Sign 18. Rough Electrical�T Bar Ceiling 19. 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 (Structural) & Monocoat , . 27:. Frame and Flashing . � 28. Lathing & Siding ' = ' -_ ' 29. Insulation ' 30. Drywall Nailing . _. . 31. Plaster Brown Coat .32. Electrical Power Meter-Final � 33. Final Electric � � - jtj 34. Final Heating & Air Conditioning• . 35. Final�Gas Pipe-Test. _ � �Q .36. Hood or Canopy ' - . � ' -37. Final Factory Fireplace � _ 38. Final Plumbing . , ' - ' ' 39. Water Service�Final� � 40. Gas Service-Final � - �41. Solar Oomestic-Final � 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irripation System- �' - � 45. Sound Attenuation . .. 46. Handicap Regulations - � . 47. FINALSTRUCTURE&BUILDING � 48.-FINAL PLANNING - ' 49. Elearic Release to Edison 50. Gas Release to Southern California Gas Co '51. CER•TIFICATE OF OCCUPANCY No. Date OOL' 'A Inspector 'PJ # Date Inspector APPROVALS ermit � 52. Pool & Equipment Location ' 53. Steel Reinforcement / .n 54. Forms � ! 55. Electrical Bonding • 56. Rough Plumbing & Pressure Test •� � 57. APPROVALTOCOVER�GUNITE 58. Electrical Conduit-Undrgrnd. 59. Gas Pipe, O Undrgrnd., Test 60. Backwash Lines, P-Trap, O Undrgrnd. 61. APPROVAiTO DECK ' 62. Backwash & Recep;or-Final � � 63. Heater & Vent-Final �.� r 64. Plumbing SYstem - Final • 65. Electrical�Final r � 66. SolarSystem-Final .; r ,� 67. Fencing & Access ApProval �-r 68. APPROVED FOR PLASTERING •� 69. POOL/SPASYSTEMSFINAL � .FIRE DEPT. REQUIREMENT . • APPROVALS� . Permit # ;'' i _70. Underground' Hydro - � 77. Product P.iping O�Gas OOiI 72. Underground Flush •73. Undergrnd.StorageTank �Gas ❑Oil � ' 74. Overhead Hydro_ � 75. Dry Chemical - - � � � 76. Dry Standpipe � ' 77: FIXED SYSTEM FINAL � 78: FIRE PREV. FINP,L �; � � � HEALTH DEPT. REQUIREMENT � 79. FINAL INSPECTION ' ` � $0. FOOD CERTIFICATE ISSUED � Notes: • ' „ ,r J 1� . 0 � ADORESSOFBUILdNG: [{ W OWNEWS NRME IF pqWN:GAG _ N� ' COSTA MESA,CA �cv�. �,wu'o �waess: ARCNRECT OR ENtlNFFN: AXCN. OF ENO.'S ADOXESS: SELECT HEATING 6 A/C coam�crarswwe: 520 GOETZ AVENUE carn�croirs�uimoSANTA ANA ADDNE53: ' Q 7 7(1 7 92627 CA UNT: uc. xo.: UNT: (714)432-1322 445205 uc. ra: CITY vF COSTA MESA - BUILDING PERMIT ERM NO; M 077066 PERMIT NO: M 077066 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE; V-N PERMIT TYPE: MEC PURFt�SE; ALT JOH DESCRIPTION : CHANGE OUT FAU SQ FT: CLAIM VALUE: CALC-VALUE: GROUP OCC: R-3 / COMMENTS: REPLACE EXISTING **��r****��*�*�**� � *******��*x � �**�**�***�r**�r*��*� *�+�**�x�*�r��+�****+r*�r**�r*�r �**�r Z O N I N G R E Q U 2 R E M E N T S ��T: sETBAcxs IJCENSEU CONTPACTONS OECLAPATION: I Mreby eflim uMer pare�y d rju IMI I em I'cemeE uMx provieione d Chapr 9 �mmmendnp�h�ing�2a��aomaooamine��dvrwesaio�a�°o9��ui{]�y(�k��tl3.i/97 ---_-_------ MAIN HUILDING ---------- --------- ACCESSORY BOILDING --------- c�rruc.no.: uc.cuss: uc.No.: FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN /�/_s_t�� Q�� n� LEFT; FT IN RGHT; FT IN LEFT; FT IN RGHT; FT IN oele: cootrea«: _ �/' OWNENBUILOEFDECLIFRTION:IherebyeffirmaMerpenellydperryrytheilamemmpiiromiMCont o��w�o�me PARKING RE(2: PROV: PARCEL: 42251247 ZNE: REF NO: �dbwvq ree.wn (seabn rvat s&o�esa e�d v�do��o�a code: ��y cry a oounry whidi rea�hee e��n io omswc�, enx, impwe, P LANN I NG NOT ES > 'vnolsh, or repei any awnun, prbr io n9 owenca, ebo repuiree Iha epplirenl fw auch permil to file a siB�� eletemaM ihet M w eM � icensad W�uent lo the povieiana ot iha Conlrenae Licenae Lew (Chepter B(comme�np wilh Sed'an )WO) M D'v'sian 3 d 6a 1 ' ei�endPrdeseianCodal«ihelMoreheiae�emWiharahomendthebesaiwlhadlepedexamqion.MYviolelional5etlion 1EiflEitiE1E1E1E1ElE1EiE1E1EiElEi43E1E1E3E1ElF1E1E1liE1E1EiE1ElEIEiE1E1E1F1FiEiE1ElEiFlFlfifiFiFifiElElEiE1E1E1EiEfEiflElEiE1E1EiElEiElE�IfiEiE�lE1E1E1EiFiflEaE ,wi.s ey �y eod�u i« e��ma wqae. ma �d�m m a�i o�M d �a m«. m� tae n��,a�aa ea�. �ssoop. 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 � I, av ox�wr W Ihe proparly w my empbyees w'ch wepee av Ihe'x eole mmpenaetion, wiil do the work. end the einwlure e m� inlended � � OlOHBflEICl96IB�$%IIOO�IOM�B11910l4tBMPfOI09910119C0EBIThBGOIIlI0C109LICBp9BI6WA0l90MBppIY�OBOOMTGIOIpfOpBllY ZONING APPROVED BY �i DATE: wM buiEa a mD� �hareon, vM xfio doea auch xok NmeeM w Mnetl or throuph he a hx own ampbyeea, provided ihel wch impovemeMa ere nd imeMed a oHerad la aeb. H. however. the buikiip a'vnpmwnem ia edd wnhin are Y� d mmpblion. tM � aw�at�iva��nne�mae�ba�aawi�nao�aneeboaw�iao�imp�wa�«msW�eotws�. BUILD.ING APPROVEQ BY ; !: DATE: � ❑ �. as ovmer a �ne orooeM. em e=dueiveN mmreauw wnn f.n.ed convecwn ro wn�rue ine o�9ea (seaun �aa. su.irm. ene r, ^ � Profeaeione Code: TM Conlradon L�anae law daea na epply to en owrer W qwMy w}w Euiltla a impovee ihmeon ad who �� — `— (� / ��,i«.��na�m�aoasr��..awnwm�omac��o..ua�:e�.,�. APPLICATION ISSUED BY: ., DATE: ✓ S�� Ieme�emptundarSeciion: 6.8P.C..br�hiareeaon: **'*'***.*'*'*'**'*********�'* � .; , 'K"K'*'*'***�'�'�hiF��FiF1E ome � LEGALIZATION:N F E E 8 U M M A R Y STRUCTURAL SEGMENT:N IAoherebyce�ityl�etlemewaredenEundentendihereQuimmwbWCellanieHael�held3daiyCodaSeqione25505,255�3.entl BL�G PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING 25534, end ihet I or eny Mure buiMiip oaupeM vnll / wNl rwl (drcb ona� need Io comply wYh aeid etete codm xM IM reQuirem�nn lor p ERM I T 9, � Q eCermilla�wmVuclionamodifiWianham�MAr ue�ty erepemontD'atrid.RnideniielmnxruaioneOV��iwuenuemqtromlheaa w�a. 25t SMIP/NON-RES ome: nooiK�: PLAN ISSUE FEE � 15,00 WORKEWSCONPENSATIONDECIAXATION:IhenbyelfiimundarpeeW�ydpajurymeWtlwlWbwiipEetleretnm: BUILDING—DIV—� PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE ❑ I heve and wil manlein e cerlBcete d mneem m�atl�imuro br xwkere' compenation, ea pwkeE lar by 6eaion 0)00 d the Lebor TOTAL S----> 9, � � 1 5, � � +�o �� . 0 � i 4, � � 2 Q, 0 � . � � { Code, lw tM Po�umerwe d IM xvh Iw wNch �hi� peimn i� inued. � w�i�n,"'u'„h;,"�,,,,�;�„bM� ;�@RFd;"'�9,',a°0p",�;��`�y,�''°'E4PF�°1"A'L°3"" REVENUE DIVISION TOTALS--> COLLrECTED: 24.00 OVER/SHORT: 00 c,,,;,,: UU 07/21/96 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECR. Pdiry Number: 2 4. Q Q ' : san;on ruee nw ee comd.ree r rM w�x s ror on. n��d�ed dwim. Isrool or bes.� ❑Icen �hdinihe rlormenceMiMwoAla�Mkhthia imnieiavuM.leheliridem if1E1E%i4iEfElEiEiEfElEiEiFiE1EiE1ElEiEfEiFiEiElEIf1EiElEfEiEiElEiElEif.lElEiElE1EIEifiPiEiFlFiffElf�iEifjEiEiE1EiE1EiEiEiElEiEiEiE1E1f�IfdfiElEiflEiElEiE1E1EiE M Ve W dM �Y Pe�n in eiry menner eo es io � " n�om..�trea io me .�en �a�.ua� m», d cd'n«��. �,e �re. inm e i.nww n«ome wqea �o in. ..�n�.n� I N D I V I D U A L' � F E E B R E A K D O W N compa ion pm+ieum d Setlbn �]00 0/ Ihe Lebor I lanhwnh rompy wnh �hwe wu. / oe�a: � S-� in noaiK�+�: �+-�`I-V S M�� TYPE QTY D E S C R I P T Z O,-N UNIT COST TOTAL COST W�minp:F�llunbs1cunwodm'romp�ruatloncowrp�bunl�wN(�nd ��wpct�n«�p�oyxrocNrnru�vanamume MEC 1 INST FORC-AIR/GAAV FURN <= 1�� K BTU 9.4� 9.0� clvll nro. w ro om nunarea rMuwrd ddbn lstoa,WnJ, In •dlltlon ro rh. cw� ol rompxwtan, e.mpsi .. provliee ror /n swnon sros o� me tmor ton�, ��taw6 a�a artomsy'a �s��. E ND OF FE E S ' CONSTNUCl10N LENDINf3 �OENCY: I MreW eifirm �Mer penelly d perN�Y �� Mro 'v e mnm�ueion brMi�p eperiry Im Ne peAormarim W ��a v.oM Iw which ihu pe�mi u esued (Seaun 309). Cir. C�. �� LENOER'S NAME: ' LENDEF'S AUDNE53: / -A � I cerlily Ihe� I have raetl ihia epplicmian end Me�e Ihei tha ebove inlormeiion ie mrteq. I epme �o compy wilh ell dly erM munty arEinences �-7' end state leyws �m'�letin�g °I�b�EjIQFdPMm��d11A�/ eNhorixe rapresente�ives d �hia dq ro enler upan Ihe ebova-menlbned pmpeM v( lar mCeaa 1Jn �� . [" ,.... _. T4�/ `� . ... - -- (5151d6 WP� Whna-Buildmp 8 Sdery; GraeMFle: Canery-Appicenl: Rnk-Revenue; GalEenm�Reaumr � CONSTRUCTION ANDP�ANNING �QQ� PA � APPROVALS Permit# Date lnspector AppROVALS Permit# Date Inspector t. T.erpporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil PiPe�Und�grnd. 53. Steel Reinforcement ��'3. Electrical Conduit Utility•Undrgrnd. - 54. Forms '� - 4. Electricai ConduibUndrgmd. 55. Electricai Bonding 5. Steel Reinforcerrient 56. Rough Pfumbing & Pressure Test - .-6. E{ectricalUFER'Grnd. 57. APPROVALTOCOVER�GUNITE �� 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O t7ndrgrnd., Test 9. Water Pipe�Undrgrnd�' . 60. Beckwash Li.nes, P•Trap, D-Undre�rnd. 70. Structural Floor System - St. APPROVAL�TO DECK it. Property Sewer line & House Connection 62. Backwash &�Receptor-Final �2• Se"�e� CaP , � 63. Heater & Vent-Final 13. Roof Drains 64. Ptambing SYstem � Finat 14. Rough Piumbing . 65. Electricai-Fina� . ' 15. Rough Electricai-Conduit �� 66. Solar SVstem�Einal 76. Rough Electric Wiring � 67. Fencinc� & Aceess Approval 77. Rough Wiring Sign .. 68. APPROVED'FDR PIASTERING ��. 18. Rough Electrical�T Bar Ceiling 69. POOUSPA 5YSTEMS FINAL 19. Ro�gh Heating & Air Conditioning . * �"-" c `FIRE=pEP�. REQUIREMEN'� �, _ " r: '_� .. .r . 20. .Rou�h F"actorY �ireplace - _ x .;= _ • AP.P.RO�V9;CS;' �Permit � _ 21. DuCts, in�Structu�e . � . ' 78: Unde.rgroun�l-Hydro k 22. Oucts, VentilAting' �,. � 71 . Product Pi ui ❑ Gas� O Oil P 3' 23. �Gas Pipe-Rough & 7est � - �- ' * �" 72, Underc,}rounii�Flush - 24. Roof Framing � _ , ' .73. Under.grnd.5[orageTank OGas COiI 25. Roof Sheathin9 �� . �• J4. Overhead HYdib ' , 26. T�Bar Ceiiing (Structural) & Monocoat - ,- 75. Dry Chemic�{..� .t ` i -- � 27. FrameaniiFlasFijqg - , � . 76. DryS20ndpipa�-- - ' 28. Lathing & Sid�ng '- - - _ r � ' :77. FIXED SYSTEM FI�AL ' 29. Insulation �� ,` - � '. t76. PiRE PREV:�FtNAL' 30. Drywall=Nailing � "- - "' HEALTH OEPT. REQUIREMENT 31. Piaster Brow.roCoat _�. # ', 79. FINA6INSPEGSION�: - • ,- 32. Electric2l Prnv2r MeterFinai ' ' 80. FOOQ CERT�I'F.ICAT� iSSUED � . 33. Final Electric. ., ' � .,.. - � . • � Notes:�,S � � .� ' 7-��'�-��=-- _ - 34. final Heating & Air-Gonditioning ' ,� / �� F � - ' _ � -q ��:_ � .�; 35. Final Gas Pipe-Tes( �� ` _ " .�" � ; Y - 36. Hood or CantlPY �' l • ! . ". ' 37. Final Factory Fireplace , " , ��_; '1 ,� '� . � 38. Finai�Plumbin9 ^. � ' = .- �� `;' � - , - -, 39. Water Service�Final - . , ; ^ ' " " � _ 40. Gas Service-Final • . � � • ' � 41. Solar pomesticPinal �� ". C` � c ' .-. 42. Backflow Prewenter - _� � -. •� - � - A3. Backflow Irrigation - � � � - � �44.. Landscapa Irrigation System , �� •' " � � - '�. 45. Sound Rttenuation _ " ` � ' � � ' ' . ,. - � • �,. _ - • • - 46. Handicap RegWations -_ � � .,, �,j . '- `- 47. FINAL STRUCTURE & BUILDING " �, .. 48. FINAL PIANNtNG + : ' � ' � 49. Elactric Release to Edison '' • 50. Gas Re4ease co Southern Catifornia Gas CA ' � � - _ ' - 51. CERTIFVCA7E OF OCCUPANCY No. Date AOo��ant to fill (n all sDaces ezeept those witnin neavy eortler lines ana si9n a1l a0orooriate aeelarations. � oF COSTA M SA CONsTRUCTION PERMIT ' ��3 I�✓ Zo111 . Project Address � / ApplTCar.c'y�iiing Address �6 ✓�r�� Owner'sNam ��/ �y. %79N!" Phonelc� Address �� 'L'• �'� „ ' Arch/Eng. License No. Address Contracmr's Name PhOne Address Imailing) Ciry l.icense No. LICENSED CONTRACTOR DECLARATION 1 hereDy atfirm thai 1 am licensetl untle� provlslons of Cnarter 9(commencing with section 7000) of Division 3 of the Business antl Professlons Coae, antl my license is in full force antl effect. License qass License No. Date Signature WORKERS' COMPENSATION DECLARATION I hereby atfirm that I have a certificate o( mnsent to self-insure or a certHicafe ' a-,n{ Workers' Compensation Insurance, o� a certifieC copy the�eot (Sectlon ""-i800, Lab. C.) I�Policy No. Company 8 Certifietl <opy is hereby fumisM1etl. Certified copy i5 filetl with the city Builtlinq DIvlSion. CA EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Thi55ection neetl not be completetl ii tne pe�mlt is far one huntlretl ($300) or less). I certity tha[ in the performance of the wo�k (or which thi5 e�m�t is i55u¢tl, I shall mt employ any pe�son in any manp e{(So a to t Subje<[ to [he Worke■y C m ry5a tip p ws oi Calirornp��'/� �n: Date /•OL9 P�.S /44r�5ignature /r"�Z�� Y�1 'NOTICE: If, a/ter making this tleclara[lon, you oultl becom ub�ect to the Workers' Compensation provisions of the Labor Cotle, you must forthwith comply wilh such provi5ions or thi5 permit Shall be tleem¢tl �evoketl. CONSTRUCTION LENDING AGENCV I hereby a(tirm tha[ [here i5 a mnztruc[ion IenUinq agency ior the performance of the work tor which this permit is issuetl (Sec[ion 3097 Civ. CJ Lenaer's Name Lentler's Atltlress OWNER BUILDER pECLARATION I hereby affirm that I am exempt from lhe Contracior's �Icense Law tor the tollowin9 reason (Section 7031.5 Businezs antl Professional Cotle: Any clty or county wM1ich requires a permit f0 const�uct, alte�, improve, tlemOlish o� �epair any sVucture, prior to itz issuance, also reqWres Ihe applicant for such permit to fi�e a siqnetl statement that �e/she i5 licensetl pursuan[ to lhe prov�sions of the Con[ractor's License Law (Chapt¢r 9.(commencin9 with Section 7000) ot Division 3 ot the Bu5ine55 antl Professions Cotle) or that h¢/She is exempt `here(rom an0 the basis for the alle9etl exemption. Any violatlon ot Se<tion '031.5 by any applican[ tor a petmi[ Subjects lhe appllcanl f0 a civll `eylty ot not more than five huntlretl tlollars (E500�. L�I, as owner ot the prooerty or my employees with wa9es as their solu mmpensation, will Oo the work, antl the structure Is not Intentletl or otferetl for sale (Section ]044, Business antl Professional Cotle: The Contractor'S License Law tloes nol apply to an owner Of a p�ope�ty who builtls or Imp�oves [hereon, antl who tloes zuch work himselt/berself or through M1is on c�r own employees, p�ovitletl that such improv¢ments are nOt Intentl¢tl o� o(teretl for sale. If, how¢ver, the builtling or improvement is soltl within one year ot com- pletioq the owner wi11 have the burtlen of proving he/she tlitl not build or im- provefortne purpose of sale). ❑ 1, as ownGr of the Oroperty, am exclusively conl�actinq with Iicensetl con- llactorz to constfuc[ [he projec[ ($eclion 7044, Busine55 antl PrOfe55ion5 Cotle: The Contractor's License Law tloes not apply to an owner ot properry who builtlz or improves thereon, antl who conVacts for such o�ojects with a con- tractor(sl license pursuanl�[o the ConVactor's Licens¢ Law). I am aware [M1at proot of [hei� Wo�ker's Compensation Insu�ance shoultl De provltled to me. ❑ I am exempt untler Section B. & P. C. ror this reason Daie Owner 1 hereby certity that I have reatl this application antl state that the above information i5 correct. 1 agree to compty with all city antl coun[y ortllnances antl state laws relating to builtlin9 construction antl hereby authorize repre- 5entativ¢s of [his y to ente u the� above-mentionetl P�operty fo� inspectian pur /�(� Signalure '�� Da[e 0✓r S. Yn/ Drivers' License ar 55 � �� i�v. ��i ��. 11 IVV. a? � � TYPE OFCONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOlISH ❑ OTHER q,p.# DESCRIPTION OF WORK/USE OF BLDG. S Main Building: E TVPE OF PERMIT GRADING FOUNDATION ❑ STRVCTURAL T FrOn[ ❑ TENANT �ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ OTHER A PROJECT DESCRIPTION 5c1. FT. oCCUv.arvCV C Right S Lef[ CONSTRUCTION TVPE VALUATION $ ZONE GRADINGCU.VDS. ACRES p�ng.Ref.al`- Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation 7rinking Fountains Floor Drains Floor Sinks uas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple FirepUFacLBIt.ICHO# . Heating System & Ducting ❑ai oo.000 sru o i ao,000 ReinspecTion Fee I $15 IF 0865-46, rev. 10/84 White - Builtlinq; Canary - Applicant: Pink - Accountin9: Goltlenrotl - Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank $wimming Pool w/Spa Urinal Water Clout Water Heater Water Service Auto-Wash laue Fee Hood or Typel ❑ Canopy Typell ❑ Reirigeration System ❑0-100,OOOBTU ❑700,000 System Repair/Alteration F ire Dampers Registers laue Fee FEES $ 3 $ 3 Automatic Washer Construc[ion Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Elec Fan f.A.U. Fixtures Device Boxes Outlets Switches Garbage Dispoul Generator �0-5 KW � Reinspection Fee 4139 II/15/85 Zone Accessory 8uilding: ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100 amps Meter over 100 amps Su6 Panel Motors 00�1 HP O 1 h- 8 Inc.Solar �9-15 HP �16-75+ Microwave Pole Li9ht Range ; Standing Settions 5 KW Trash Compacror $15 luue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By � SUMMARV OF FEES BUILDING PEfiMIT $ SMIP PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE PLAN CHECK 25% $ ENERGV P.C. ELECTRICAL $ � GRADING PLANCHECK 50% $ MICROFILM MECHANICAL $ TOTAL FEE PLAN CHECK 25% $ $ :ol.. TL FEES $ 3 Z O N I N G R E Q M T $ �CONSTRUCTION AND PLANNING POOL _.�PA � APRROVALS Permit# Date Inspector AppROVALS Permii# Date Inspector ` 1. Te orar Electrical Service or Pole p Y _ 52. Pool & Equipment Location 2. Soi �Pipe-Undrgrnd. � 53. Steel Reinforcement • 3. Electrical Conduit Utility�Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test , 6. ,Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings - 58. Electrical Conduit-Undrgrnd. 8, �Foundation 59. Gas Pipe, � Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System ' 61. APPROVAL TO DECK 11. Property Sewer Line & House 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 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19.�Rough Heati�g & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Faciory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 37. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric / Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe�Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing � 39. Water Service-Final 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. .Landscape Irrigation System T 45. Sound Attenuation 46. Handicap Regulations 47. FINALSTRUCTURE&BUILDING 46. Special Requirements Completed 49. Electric Release to Edison � 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY . No. Date _ OWNER v�TL` Ti Ci - ✓ JOBADDRESS 863 W. 2�t1'1 $t. BUILDINGPERMITNO. ZS3S GENERALCONTRACTOR (k.,,neY. VALUE $ �nn_nn � ' AP 115-'i5"i-!�7 s�ocK TRACT Enclose c arport for �araRe GROUP J TVPE V ZONE RZ FIRE DIBTRICT 2568 PERMITSISSUED INSPECTIONS DATE SUBCONTRACTOR DATE I NUMBER Footing Trench �/tc 6 �7' :7 "-� Foundation Forms and Grade to Garage Rough Framing � � — Plumbing, Rough to Slab Plumbing, Rough Complete Wirinc Heatin Final Tank or L ng, In i P. _ering Plumbing, Final, Fixtures Plumbing, Final Gas Test Wiring, Final � Occupancy FORM 210 3M 10�95 Y Costa Mesa Bnilding De�eartment P. O. Box 3!7 COSTA MESA, CALIFORNIA FOR APPLICANT TO FILL IN Building c� / Address p b� �/7/ ,�� S(. Costa Mesa, California Nearest /7 Cross St. l.: O /�/ % /� /✓-� %-j9 � Owner �� y �/ � �..�� Mail / � � Address �E:• 3•1/✓ `� D-GJ„� �('� Tel. ��tY C �Sr�Nr.�,S a n,o.Li�-9 Architect or Lic. Engineer No. Address I' City Lic. ntl'dCtoP O IM1� /{��(> /'�-' No. (Attach Metesand Bounds) Size of Lot 4se of Existing Bldg. �,� /�(/v/�. Sethack Line from L y Cente� of Strrf! /� � New I � Alteration Repair I I Moving Bullding No. of Size 1( •k�'G Roome `eNor Wall R� > —: 35 ,3 " �% o. of Bldgs aw on Lot � o. of I No. of � amilies Rooms o Rear Vard � p Sida Yard n' � WORH !� I Addition I :�PPLICATION FOR PERIVIIT 256� BUiLDING � FOR OFFICE USE ONLY Receipt No. Permit N� .:� S�" � Received by Date Rec'd. Date Issui - .�, � 3-�- a-ti � 3- a� Building Add ress Costa Mesa, California Nearest Cross St. CORRECTIONS l.7 iering ,$%U G � G I Covering APPROVAI.S Use oi New � Foundation Location Ins ecto Bullding �/Y � � f� $�� /+�/� ✓�� P P � Forms, Materials, �=v /- � � /- 4 f',Q_, Under-Pinning Frame: Fi re Stops, Bracing, Bolts I hereby acknowledge that I have read this Application and state that the abme is correct and agree to comply Lath. Int. with all City Ordinances and State Laws regulating building construCti/on. Lath. Ext. Signatureof j/ . _ �/) /P w p. Permittee [/�-4�-�i I�La��A _ Plaster, Int Valuation Permit Fee $ 03� �� Masonry Reinforced $ �� O O� / Tota Check $ Bond Beam Fee $ �' � � I FINAL O � � 2 D r PLOT PLAN Show Iocatlon and distances irom property Ilne and between bu{Idinga COSTC� a C•:}:';: !1 ..� �r'��P�JES;. � C7a Z. �n . � , ' ♦ i s � 0