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Home My WebLink About128 21ST ST - Building Permits j1.1r - CITY OF COSTA MESA BUILDING DIVISION la•g-�, i DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER .e. fl . PERMIT 41a,r o ost E05-00561 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 128 21ST ST Status: ISSUED Suite No C Applied: 06/09/2005 Vicinity: REAR OF HOUSE Issued: 06/09/2005 Parcel Nunmber: 42612103 yn Applicant: HASSETT, MARY ISSUED BY: rILL� Address: 128 E 21ST ST . . Phone: . COSTA MESA,CA Zip 92627 Owner: HASSETT, MARY t �� Address 128E 21ST ST ��1R Phone: COSTA MESA,CA Zip: 92627 Ott Contractor OWNER-BUILDER • Address: • - ' Phone: Zip: License:000000 SCOPE OF PERMIT UPGRADE EXISTING SERVICE PANEL TO 200A AND ADD 2'100A SUB PANELS. FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft $0.00 0 'Res.a/c package $0.00 Standing Section $0.00 0 - New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 • Pool/Spa $0.00 0 - up to 10 kva/kw $0.00 •0 Lighting Fixts $0.00 0 . up to 50 kva/kw $0.00 0 Recept Outlets $0.00 0 - • up to 100 kva/kw $0.00 0 Switches • $0.00 0 over 100 kva/kw $0.00 0 Non Res Appl $0.00 ' 0' Low Voltage Equipment ' $0.00 0 Res Appl , $0.00' 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $30.50 - 1 Misc.Conduit $0.00 0 Service to 1000a $0.00 0 Misc.Conductor $0.00 "0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp -$0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 •Fireworks Stand $0.00 0 Motors to 100hp ' $0.00 " 0 Other Electrical Fee -$0.00 Motors over 100hp $0.00, 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $61.00 2 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $115.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2448-46(6/00) • DECLARATIONS • . ° : 13 - WORKERS' WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'compensation Insurance carder and policy number are: Carder: Policy Number: (This section need not be completed iY the permit is valued at one hundred dollars($100)or less.) I C Ity that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' -compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these prov sons. 74wan Signature: Fb7oiQ )<4.542.441— Dete:' oe A NI< O43�RT -WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class# Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects thy:pplicant to a civil penalty of not more than five hundred dollars($500).): L .1104Vas mer of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. .o-7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ' ❑ 1,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044.Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempj,L39der sec. Business and Professions Code for this reason: Signal /77/(07/ moires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: _ Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes I.J No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No 6 (if"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions, Signature: Date: CERTIFICATE OF COMPLUWCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property fo inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ff p a ie.Of.Legab•wner(s) Date And/Or Authorized Applicant Date CODE I INSPECTION TYPE DEE CODE I INSPECTION TYPE 2M 1l�ALE 1616 Fixed System Final Fire Prevention _ 206 Final Mechanical 1266 Pool Spa Final _ 208 Final Plumbing 200 Final Re-Root _ 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place _ 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy ,gam 6 - CITY OF COSTA MESA BUILDING DIVISION >•�„ DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4� PERMIT V 'kaa ems, B05-00050 •(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 128 21ST ST Status: ISSUED Suite: C Applied: 01/12/2005 Vicinity: UNIT C Issued: 03/07/2005 Parcel Number: 42612103 Zoning: Si" Applicant: TERRY GUOIN ISSUED BY: Address: 24523 LOS ALISOS BL SUITE 249 Phone: 949-859-6872 LAGUNA • HILLS,CA Zip: 92653 Owner: HASSETT, MARY Address 128 E 21ST ST Phone: COSTA MESA,CA Zip: 92627 Contractor SOUTH COUNTY SUNROOMS INC Address: 24523 LAS ALISAS BL SUITE 249 Phone: 949-295-8261 LAGUNA HILLS,CA Zip: 92653 License: 816279 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT ADD 163 SF TO UNIT C OF EXISTING DUPLEX.REMOVE WALL BETWEEN EXISTING DWELLING AND ADDITION AND INSTALL HEADER. FEE SUMMARY Plan Check: $172.41 Calc Valuation: $15,061.20 Permit: $265.25 Claim Valuation: $11,000.00 SMIP Res: $1.51 SMIP Corn: $0.00 Other: $0.00 • Inspection: $0.00 Total: $439.17 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46 WOO) - DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. ❑ I have end will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed it the permit is valued at one hundred dollars($100)or less.) s I certify that in the parlor ce of the work for which this permit is issued,I shell not employ any person in any manner so as to become subject to the workers' ompensation law Ilio nia,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these pr Ions. / '7 Applicent'Signature: .� alcite`.,?' / -0S app / �' ER TO . k.",,,,0. TO SECtlRE WORKERS'COMPENSATION COMPENSATION, IS UNLAWFUL AND SHALL SUBJECTFOR AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I harebyFaffirnspatt 44.7 ilic un ;gists of Chapter nrne In Ith Section 7000)of Division 3 of the 6ysin@6a�5 an f0 fispfessions Code,and my license is in full ?;Canlracgtgrs,SI ure: Date:. `7OS CONSTRUCTION LENDING AGENCY: O I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement Is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). . ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon.and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business end Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). O As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 if an RMPP is presently required,has Section 25534 of the California Health end Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aRPermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes L.I No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (II'yes',the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (II'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ..v Signature Of liped Owner(s) 7-,5' Date ridthor/D Au 'App.licant•••- �1 V L' tDat,d,__rL CODE# INSPECTION TYPE DATE I/ITITIALS CODE1 gsSPECTION TYPE PATE INTRNL* 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 6-71 • O SFS, CITY OF COSTA MESA 4 BUILDING DIVISION t ,r DEVELOPMENT SERVICES DEPARTMENT PERM NUMBER . I ril I 4�' PERMIT "+ro.mcn le E05-00189 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 128 21ST ST Status: ISSUED Suite No C Applied: 03/07/2005 Vicinity: Issued: 03/07/2005 Parcel Nunmber: 42612103 S`, Applicant: TERRY GUOIN ISSUED BY: '� Address: 24523 LAS ALISAS BL SUITE 249 Phone: 949-295-8261 LAGUNA HILLS,CA Zip 92653 Owner: HASSETT, MARY Address 128 E 21ST ST Phone: COSTA MESA,CA Zip: 92627 Contractor: SOUTH COUNTY SUNROOMS INC Address: 24523 LAS ALISAS BL SUITE 249 Phone: 949-295-8261 LAGUNA HILLS,CA Zip: 92653 • License:816279 SCOPE OF PERMIT ADD 163 SF TO UNIT C OF EXISTING DUPLEX. REMOVE WALL BETWEEN EXISTING DWELLING AND ADDITION AND INSTALL HEADER.REF.: B05-00050 . ELECTRICAL TO INCLUDE:2 LIGHT FIXTURES,4 OUTLETS,AND 2 SWITCHES. FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft $0.00 0 Res.a/c package $0.00 Standing Section $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0 Lighting Fixts $2.20 2 up to 50 kva/kw $0.00 0 Recept Outlets $4.40 4 up to 100 kva/kw $0.00 0 Switches $2.20 2 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $0.00 0 Misc.Conduit $0.00 0 Service to 1000a $0.00 0 Misc.Conductor $0.00 0 Service over 1000a 50.00 0 Circus(gen or ride) $0.00 0 Motors to 1hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result In the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(WOO) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'compensation Insurance carder and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) I — U__ofy that in the performs a of the work for which this permit is Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of oris,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall fdrthwlth comply with thes ions. ? 7-nr LSignelure: J �` - Date: er iNNa.FAICURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPCOYER TO CRIMINAL PENALTIES AND CIVIL FINES uP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDmON TO THE CAST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm,that.l.am li ed ndex orovJxsions of Chapter 9(commencing with Section 7000)of Division 3 offbe.Busin$�s and Professions Code,and my license Is in full -force end a eff ct.L(b.p ( /7 Glass p L,S:-/TIC. kghr@u signam ---9- `I_/C_ fe:-5 7-O CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such Improvements are not Intended or offered for sale.If,however,the building or Improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license 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. ❑Yes ❑No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet In depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 6,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has e permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes ❑No (Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Flre Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes El No (If'yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Le al ilwner(S) Date iskt d/Or AUNaized.Applicant ;ODE# INSPECTION TYPE PATE JNIITIALS ;Opel( INSPECTION TYPE g�jf 1BTITIS6S 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing / A / 200 Final Re-Roof 210 Final Electrical , 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy CITY OF COSTA MESA ) 4 BUILDING DIVISION • r.e___rice DEVELOPMENT SERVICES DEPARTMENT PER T NUMBER F 1 wow,me i te. PERMIT P05-00225 (714)754-5273 • Fax(714)754-4856 • www.ci.costa•mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 128 21ST ST Status: ISSUED Suite No A Applied: 04/01/2005 Issued: 04/01/2005 Vicinity: o I Parcel Nunmber: 42612103 ISSUED BY: !r��'1'V/ Applicant: TYER, DON Address: 24523 LAS ALISAS BL SUITE 249 Phone: 949-295-8261 LAGUNA HILLS,CA Zip: 92653 Owner: HASSETT, MARY Address 128 E 21ST ST Phone: COSTA MESA,CA Zip: 92627 Contractor: SOUTH COUNTY SUNROOMS INC Address: 24523 LAS ALISAS BL SUITE 249 Phone: 949-295-8261 LAGUNA HILLS,CA Zip: 92653 License: 816279 SCOPE OF PERMIT PLUMBING PERMIT FOR NEW GAS LINE 8 WATER PIPING. • REF: B05-00049 FEE SUMMARY AMT QTY _ AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation - • $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P-Trap - •$0.00 0 Trap Primer $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 - Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0 Drain,Roof $0.00 0 Shower $0.00 0 Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $9.80 1 Expansion Tank '$0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) $6.15 1 Sink,kitchen $0.00 0 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $39.45 Gas Service $0.00 0 Spa(public) 50.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-01 WOO) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this penile is issued. o I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation insurance carrier and policy number are: Cartier: Policy Number: (This section need not be completed ii the permit is valued at one hundred dollars($100)or less.) • certify that in the performance of the work for which this permit is issued,I sh; • employ any person in any manner so as to become subject to the workers' compens:'lo :ws of Call`. ia,and a..ee that 'I should become sus •the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith (..comply wit' the - provia.1' ` , • 4.0. _.. /4245o5 Applicant Signature: . . 1. ,b, ■ A ■/ ate:. - 11 ' 1 WARNING:FAILURE TO RE WORKERS'•,PENSATI• 00 -GE,'�P4S. AND SHALL SUBJECT AN EMPLOOERTOCPoMIN L PENALTIES A CIVIL FINES UP TO ONE HUNDRED THOUSANO DOLLARE(SIC0,000),IN ADDITION TO THE COST OF•r1ul' NSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE R 000E,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that 1 am licensed under rovisions o Chapter 9(commencin• th Section 7000)of Division 3 Business anr�uPro}`esssisi'''ons Code,and my license is in full for• Coce ndeNea-a- y '` /I ` ? './0.plJ_'ir^' i Y� plpds.Si nature L— �A!� 'SCate. `,- 5 e2A00' CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the properly,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). O I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractors) license 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. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: o I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or Pres$pt or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes G No (Section 25505 of the California Health and Safety Code requires,with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes 0 N (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification LJ from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 0 No (Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No (if yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 if a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the a'' described properly for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Ilk • NW"atu ' •f Lega Own: p I e e 't �,� 1 r . t--A " •r Authpd •'A•�y4� ate CODE a INSPECTION TYPE , PAIS BMW CODES INSPECTION TYPE PATE tf1TITIALE 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing -'24-65— 'SVC 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy ` CITY OF COSTA MESA 4 BUILDING DIVISION Y 64-1P715 ) ,ai DEVELOPMENT SERVICES DEPARTMENT PERM UMBER r t 11.Wrg 4. • PERMIT C VHS-00188 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 128 21ST ST Status: ISSUED Suite No A Applied: 03/07/2005 Vicinity: Issued: 03/07/2005 Parcel Nunmber: 42612103 Applicant: TERRY GUOIN ISSUED BY: Address: 24523 LAS ALISAS BL SUITE 249 Phone: 949-295-8261 LAGUNA HILLS,CA Zip 92653 Owner: HASSETT, MARY Address 128 E 21ST ST Phone: COSTA MESA,CA Zip: 92627 Contractor: SOUTH COUNTY SUNROOMS INC Address: 24523 LAS ALISAS BL SUITE 249 Phone: 949-295-8261 LAGUNA HILLS,CA Zip: 92653 License:816279 SCOPE OF PERMIT ADD 110 SF TO UNIT A OF EXISTING DUPLEX.REMOVE WALL BETWEEN EXISTING DWELLING AND ADDITION AND INSTALL HEADER. REF.:B05-00049 ELECTRICAL TO INCLUDE:3 OUTLETS AND 2 SWITCHES. FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft $0.00 0 Res.a/c package $0.00 Standing Section $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0 Lighting Fixts $0.00 0 up to 50 kva/kw $0.00 0 Recept Outlets $3.30 3 up to 100 kva/kw $0.00 0 Switches $2.20 2 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $0.00 0 Misc.Conduit $0.00 0 Service to 1000a $0.00 0 Misc.Conductor $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) '- v1- 0; I certify4that in the pedorman of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws o orn a,end agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with the ons. ft /C -7. Ct W Ri INdtfSignature: i - - Et T CRIMINAL VFARNING:'FA1LfIRE TO SEC RE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(510 .000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I,hereby affiim-thatlrerr livens,,;; •'r t,ovisi`s of Chapter 9(commencing with Section 7000)of Division 3 of the Busing and/Professions Code,and my license is in full fore andeffectrtics -'f 'rt•;e - rL��G--less-#-- -----s'a-a- - i! ContractoISignature:- : _ te:-3- 7-c)F -r` u�.r_. ._-a - -... n .,. CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): O I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license 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. ❑Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: • ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). O As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: 1 HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be tiled with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application akermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify mat under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. tOrfLeO -wner(s) xDate .3 -7 La.' Gimdized.Applica-a___,, V..:,,,., „ i ._ v CODE N` JNSPECTION TYPE DATE INTRIALS CODE✓t JNSPECTION TYPE DATE INTmALS i616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final - 208 Final Plumbing p 200 Final Re-Roof 210 Final Electrical ,%J� 201 Final Block/Retaining Wall _ 212 Final Fire Prevention 202 Final Factory Fire Place _ 220 Final Planning Approval 203 Final Sign - 222 Final Site 204 Final Demolition _ 250 Final Building/Occupancy �`,5 l 9 CITY OF COSTA MESA BUILDING DIVISION F sin r.,, ,.DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT %Ponle B05-0004 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 128 21ST ST Status: ISSUED Suite: A Applied: 01/12/2005 Vicinity: UNIT A Issued: 03/07/2005 Parcel Number: 42612103 Zoning: Applicant: TERRY GUOIN ISSUED BY: Address: 24523 LOS ALISOS BL SUITE 249 Phone: 949-859-6872 LAGUNA HILLS,CA Zip: 92653 Owner: HASSETT, MARY Address 128 E 21ST ST Phone: COSTA MESA,CA Zip: 92627 Contractor: SOUTH COUNTY SUNROOMS INC Address: 24523 LAS ALISAS BL SUITE 249 Phone: 949-295-8261 LAGUNA HILLS,CA Zip: 92653 License: 816279 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT ADD 110 SF TO UNIT A OF EXISTING DUPLEX.REMOVE WALL BETWEEN EXISTING DWELLING AND ADDITION AND INSTALL HEADER. FEE SUMMARY Plan Check: $126.91 Calc Valuation: $11,000.00 Permit: $195.25 Claim Valuation: $11,000.00 SMIP Res: $1.10 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $323.26 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days,or If work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections end final approval must be obtained.Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446.4e 16/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This sectionseneed not be completed I/the permit Is valued et one hundred dollars($100)or less.) nary- reify that in the perky a of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of If ia,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with the loris./� 7- ^ c A p fan5,slgneture:- / st s' Date:.;�3' / "O 14.':.'• WARNaNG'tFAILURB'TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFl1L AND SHALL SUBJECT AN Eli/6;140 CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that t am lice :• u de provi ions of Chapter 9(commencing with Section 7000)of Division o1.Ihe.Busin arid P(pie ssions Code,end my license is in full •to Q and effect.LIc a opt 'Class,#1 /7/C. Cpm rt ec(oYs.SIgnit ret— -. Dete:--- 7-03 CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,CMI Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,altar,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the properly,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of properly who builds or Improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ' ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework.or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has al any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health end Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prere paan RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Vas ❑NPo (Section 25534 of the California Health and Safety Cade provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application agermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Li Yes LU No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescnbed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws end city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ..- lgn ureegal Owner(s) Date Z-( 1 .4 7-Q� e-�� Or,authorized Applicant POE 1 INSPECTION TYPE 2AIE PSI OOOE0 INSPECTION TYPE 1AM INCIMALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy e �-Or e.y� .' . 4 'P CITY OF COSTA MESA - ra� BUILDING DIVISION ). • �,,.. 11 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER �. /. I PERMIT -1� o suit " E05-00560 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 128 21ST ST Status: ISSUED Suite No A Applied: 06/09/2005 Vicinity: REAR OF HOUSE Issued: 06/09/2005 Parcel Nunmber: 42612103at /^J Applicant: HASSETT, MARY ISSUED BY: Address: 128E 21ST ST . Phone: COSTA MESA,CA Zip 92627 • Owner: HASSETT, MARY Address 128E 21ST ST Phone: COSTA MESA,CA Zip: 92627 Contractor: OWNER-BUILDER Address: Phone: Zip: License:000000 SCOPE OF PERMIT UPGRADE EXISTING SERVICE-PANEL TO 100A(SAME LOCATION). WORK TO INCLUDE: 1 SERVICE UP TO 200A. FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft $0.00 0 Res.a/c package $0.00 Standing Section $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 - Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 - up to 10 kva/kw $0.00 0 Lighting Fixts $0.00 0 up to 50 kva/kw - $0.00 0 Recept Outlets $0.00 0 up to 100 kva/kw $0.00 0 Switches ' $0.00 ' - 0 over 100 kva/kw $0.00 0 Non Res Appl / $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0- Low Volt Wiring System/Ckt $0.00 0 Service to 200a $30.50 1 Misc.Conduit $0.00 0 Service to 1000a $0.00 0 Misc.Conductor $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1 hp $0.00 0 - Circus(mech ride or lights) $0.00 0 Motors to 10hp . .$0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 - Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2448-46(6/00) Es=rimingariamiHmisisiaraii WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed If the permit Is valued at one hundred dollars($100)or less.) l "�Y 'fy that in the performance of the work for which this permit is Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisio / ,/� tL� ;;;A-0 a tt:$gnitu'ie: illiZOL¢ Flee rpa)e: -7 A -a 9-OS- -Ur G: AILS URE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN ADDMON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR WDE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Cade,and my license is In full force and effect.Llc.I Class I Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit sub' cts the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or Improvement Is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: �j Sgnature: jiaai', - tom✓fiAl' r-pate:' 3 ,4 -07-0 S IOWne IrDverified by driver's license. es 0 No Driver's_License lio. i Exp ret s:� Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding,faisework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be tiled with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 if en RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied withr 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application°Permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? DI Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health end Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have at of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). • CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPUANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all stale laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described properly for inspect'on purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. �Y/ p6'01 D� - Aa ,— )SignatuM'Of Legal Owner(s) Qale And/Or Authorized Applicant Date BODE F INSPECTION TYPE PATE INID$14 CODE i INSPECTION TIFF RAIL MOM 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing _nom •`,. 200 Final Re-Roof 210 Final Electrical 'r11-CIS— �i'_\ 201 Final Block/Retaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy PROJECT ADDRESS: 128 21ST ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO; P 056729 . OrIER'SNAME: FINKEL, PAUL E ,ADDRESS: FINKEL MARY H PERMIT NO: P 056729 PLAN CHECK NO: N GOVT: N SUPP: N 511 IRVINE AVE NEWPORT BEACH,CA 92663 CONSTRUCTION TYPE; V—N PERMIT TYPE: PLU PURPOSE: OTH 646-1571 ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : GAS SERVICE 2 OUTLET (WATER HEAT & DRY. ) SQ FT: ADDRESS: UNIT: CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 / PERMITTEE: C. C. COLE PLUMBING & HTG ( 714 )645-1161 ADDRESS: 2280 NEWPORT BL COMMENTS: SERVICE FOR WATER HEAT & DRYER COSTA MESA CA 92627 #**********#****+E#*##*##########+E##*****##aE#*****kE#*#####**#####kE##****#*+E##+E## LICENSED CONTRACTOR DECLARATION: I hereby attirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. SETBACKS cITY alx— : 127/(8 STATE LIC.:27558 D DL0.SS�= -�•—D�.— 3II 27 97- Signature: (J MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self.insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN Compensation Insurance,or a certified copy thereof(Section 3800.Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN POLICY ND.: 80019835 EXP.DATE: 01 /01 /93 COMPANY: TRANSAMERICA PARKING REQ: PROV: PARCEL: 42612103 ZNE: REF NO: 0 Certified copy is hereby furnished. ® Certified copy is filed with the city Building Division. PLANNING NOTES> c ^A > Jw�3J11l)1 1�. Applicant (_7 r` ************1E**if*************Jf******************IE*ik*****fP***1E***************IE#* EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). DEVELOPMENT SERVICES REQUIREMENTS • I candy that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California. ZONING APPROVED BY DATE: Date: Signature: NOTICE:If,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : _ DATE: Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. LICONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY• DATE: a-7--which this permit is issued(Section 3097.Civ.C). *********************4**** ************ ' •*** ######*** ********** LENDER: ******************************************** ' ' ' ******************************** ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'Slate License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct.alter,improve,demolish,or PERMIT 2 .00 repair any structure.prior to ds issuance.also requires the applicant for such permit to fife a signed statement that he/she is licensed 2 5 Z SMIP/NON—RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE 3 . 00 I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS--——> 2 . 00 3 . 00 0 . 00 5 . 00 5 . 00 . 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through ' imps rovements soldr her own t within onevyear of competiothat such n improvements ownerare will have ot intended burden offered of povinrsale.11,g he/she did not build orr the tilmprove REVENUE DIVISION TOTALS--> COLLECTED: 5. 00 OVER/SHORT; 00 for the purpose el sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 5 . 00 • ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).l am aware ********#*****#*#*#*###*##*#******************#******************************** that proof of their Worker's Compensation insurance should be provided to me. I N D I V I D U A 'L F E E BREAKDOWN ❑ I am exempt under Section: B.A P.C. for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Dale: — Owner: PLU 1 GAS PIPING SYS OF ! 1 TO 4 OUTLETS 2 . 00 2 . 00 I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and .END OF FEES 25534 and that I or any future building occupant Mime not(circle one)need to comply with said state codes and the requirements for a permit for construction or modification from the Air Ouahty Management District.Residential construction applications are exempt from these provisions. Date: Applicant: I hereby certify that I have read This application and stale that the above information is correct.I agree to comply with all city and county ordinances and slate laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned property for in peclion purposes. ,/''tel Da ' 17/55- Signature: C.) le 3[I11•:.'t--' 14: . -- Driver's License or Social Security N: OliTi: .1%/ / ri9 1641-46 Whito—Building;Green—Code Enforcement:Canary—Aoolicent:Pink—Revenue:Goldenrod—Assessor I 4A POOL 'A CONSTRUCTION AND PLANNING `APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole -- 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement - 3. Electrical Conduit Utility-Undrgrnd, 54. Forms 4. Elecjrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement . 56. Rough Plumbing& Pressure Test 6. Electrical OF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe,0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 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 13. 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 Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace , " ` - APPROVALS Permit # - 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating - - ' ' -71, Product Piping El Gas 00i1 23. Gas Pipe-Rough & Test - 72. Underground Flush 24. Roof Framing - 73. Undergrnd.Storage Tank O Gas ❑Oil 25. Roof Sheathing - - • 74--Overhead Hydro 26..1-Bar Ceiling (Structural) & Monocoat - 75. Dry Chemical 27. Frame and Flashing ,. 76. Dry Standpipe - 28. Lathing& Siding - 77, FIXED SYSTEM FINAL!' • "29. Insulation - - 78. FIRE PREV. FINAL - 30. Drywall Nailing '- - - . . • HEALTH-DEPT. REQUIREMENT 31. Plaster Brown Coat ; 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric ' Notes:3/ TV IYOT Rang. L.e.•-() 34. Final Heating& Air Conditioning - y s 35. Final Gas Pipe-Test • Y 3 n - 36. Hood or Canopy - - - r. 37. Final Factory Fireplace • 38. Final Plumbing -Lt 3-I. C 0 _ 39. Water Service-Final' 40. Gas Service-Final - - 41. Solar Domestic-Final : - 42. Backflow Preventers 43. Backflow Irrigation 44. Landscape Irrigation System - - ' 45. Sound Attenuation - ` _46. Handicap Regulations - 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING - . 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co , 1 - . _ 51. CERTIFICATE OF OCCUPANCY / - • - - No. • Date I PPOJECTAOOflESS: i 128 21ST ST UNIT: • r. ! CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 056614 OWNER'S NAME: FINKEL, PAUL E _____ ADDRESS: FINKEL MARY H PERMIT NO: E 056614 PLAN CHECK NO: N GOVT: N SUPP: N 511 IRVINE AVE NEWPORT BEACH,CA 92663 CONSTRUCTION TYPE: V—N PERMIT TYPE: ELE PURPOSE: OTH ARCH/ENGINEER: 548-7855 REG.NO.: JOB DESCRIPTION : NEW HOUSE METER FOR LAUNDRY ROOM SQ FT: ADDRESS: UNIT: PERMITTEE: CLAIM VALUE: CALC—VALUE: GROUP OCC: R-1 / ADDRESS: RANDAL JOHN WEBER ( 714 ) 646-1571 128 21ST ST 2 COMMENTS: METER FOR LAUNDRY ROOM CM CA 92627 RE+E+E**+E**4***********x*** **************************************+E************+E** LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING R EQU IR EMEN TS 7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. SE TB ACK S CITY LIC.: 031027 $TATE LIC.:412104 j:0001 —1 Date: Z'—f C.2-- Signature:— _ — MAIN BUILDING ACCESSORY BUILDING WORKERS'COMP SATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN Compensation Insurance.or a certified copy thereof(Section 3800.Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT; FT IN POLICY NO.: EXP.DATE: COMPANY: PARKING RE • PROV: PARCEL: 42612103 ZNE: REF NO: ❑ Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. PLANNING NOtES> > Date: Applicant: ******************************************************************************* EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred(8100)or less). DEVELOPMENT SEER VICES REQUIR EM EN TS I certify that in the performance of the work for which this permit is issued,I shat not yRploy any pers n in any manner so as to become subject to the Workers'Compensation Laws of California. ZONING APPROVED BY DATE: _— Date: 379--v L Signature: NOTICE:II.after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY DATE: Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. - CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BSE `—"— DATE: C #-7 which this permit is issued(Section 3097.Civ.C). ************************************** ' ************* * ************�F* ** *k* LENDER: ************************************** **************************************** • ADDRESS: LEGALIZATION:N F E E S UMMARY STRUCTURAL SEGMENT:N OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELEC ' IC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 1 : 50 repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business 50% SM I P/NON—RES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.My violation 01 Section 7031.5 by PLAN any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($5o0). ISSUE FEE 15 • 00 I. as owner of the property or my employees with wages as their sole compensation. wit do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE ❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS----> 18 . 50 15, 00 0. 00 33 , 50 33. 50 . 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through his or her own employees,provided that such improvements are not intended or offered for sale. II,however the building or improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS——> COLLECTED: 33. 50 OVER/SHORT: . 00 lot the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK I.as owner of the properly,am exclusively contracting with licensed contractors to construct the project(Section 7044.Business 33 . 50 ❑ and Professions Code: The Contractors'State License Law does not appy to an owner of property who builds or improves thereon and who contracts for such projects with a contractors)license pursuant to the Contractors'Stale License Law).l am aware ******************************************************************************* that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN ❑ I am exempt under Section: B.8 P.C. ler this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: Owner _— ELE 1 SERVICES BELOW 600 V 6 BELOW 201 AMP 18. 50 18 . 50 I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505.25533,and END OF FEES 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from these provisions. Date: Applicant: I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction and hereby authorize repress lives of I ' city to enter upon the above-mentioned �,. property for inspection purposes. r.1 ' '-1 1 1E;.-Ont t r.r;'. —!--.1.H . . NTE: r.;_ yn — Tn.-7 Date: 3— /7^`P Z Signature' Driver's License or Social Security a: 1641-46 While—Building:Green—Cope Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor lui TL 4. CONSTRUCTION AND PLANNING POOL .,PA APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector 1.. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd._ ` • r 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 UF EA Grnd. - 57. APPROVAL TO COVE R-GUNITE •- ' 7. Fbotings 58. Electrical Conduit•Undrgrnd. d. Foundation - - 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undl'grnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System : 61. APPROVAL TO DECK 11. Property Sewer Line'& Hoose•Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric•Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrica6T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating& Air Conditioning FIRE DEPT. REQUIREMENT 20, Rough Factory Fireplace .. - , - APPROVALS -.:.Permit# 21.-Ducts, in✓Structute .. . • . 70. Underground-Hydro • 22. Ducts, Ventilating > _ - 71. Product'Piping CTGas OOil • 23. -Gas Pipe-Rough & Test - 72. Underground Flush r24. Roof Framing _ _ • '•73.•Undergrnd:StorageO Gas O Oil 25. Roof Sheathing .1 •: - - ` 74, Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat r w 75. Dry Chemical , - * , 27. 'Frame and Flashing: 1 r - 76. Dry Standpipe 28. Lathing& Siding: • . _ . , •- • 77. FIXED SYSTEM FINAL v 1 '29. Insulatidn - , ' • ` 78.-:FIRE PREY. FINAL - ' r30. Drywall Nailing . HEALTH-DEPT. REQUIREMENT `-31. Plaster Blown Coat, : .79."FINAL INSPECTIQN- , -32.-Electrical Power Meter,-Final �. '80. 'FOOD CERTIFICATE ISSUED • r .:33. Final Electric c.• . Notes: - 4. Final Heating& Air Conditioning •- • . _ ' 35. Final Gas Pipe-Test - - ' 1 - - - - ,36- Hood or Canopy ; • - T * 1 r •- ,f- -37. Final Factory Fireplace - ' -° = . Io t -38. Final Plumbing . _ ' 1 - .'39. Water Service-Final' LL . : ♦ ` 40. Gas Service-Final _ • ; , 41. Solar Domestic-Final' - • - - 42..Backf low Preventerr 43. Backflow Irrigation 'C-` • - 44. Landscape Irrigation System: , r - - , 'i, - • - r ;45. 'Sound Attenuation • - stz , 46. ,Handicap Regulations •• • 2 47. FINAL STRUCTURE & BUILDING t - • 48.;FINAL PLAN-NINE • _ r 49._Electric Release to Edison . , _ , '50. Gas Release to Southern California Gas Co I ( - - " .51. CERTIFICATE OF OCCUPANCYr No. Date \ .U`',A Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. r _ PERMIT NO. TRA T NO. LOT NO. UNIT NO. CITY OF COSTA MESA ONSTRTCTIONPERMI G- 2�'97�' �1,- 0476 - Pro feet Address ,a- Qo5/-A- c/c_/"7 4 jZ�� y} S1"' N~Yr` i 7_(t� TYPE OF CONSTRUCTION NEW ADD Li ALTERATION LI REPAIR ' Applicant's Mailing Address I i� PAPAL � w t.. /'/K2C- 6YS=73a ❑ CONVERSION C7 DEMOLISH CI OTHER Owner's Name T # >� Urine A.P.# �. III • OR Zone Rt ,�f DESCRIPTION OF WORK/USE OF BLDG. • alddress3y2s �-h'4 $ 1 y/ yam/ e / �/'L/p(p Zj Asaeco.„ T it ' L. ge S Main Building: Accessory Building: Arch/Eng. License No. TYPE OF PERMIT II GRADING . FOUNDATION C STRUCTURAL T Front Qrt-, p Address ❑ TENANT ELECTRICAL C PLUMBING LJ MECHANICAL B Rear es N Contractor's Name IO 4/ Phone CI OTHER 23�e,, aP-S C Right 3y N PROJECT DESCRIPTION SQ„EL OCCUPANCY `_ Address(mailing) CONSTRUCTION TYPE _� VALUATION$ 2/41/ 4 S Left ✓ R City License No. ZONE GRADING CU.YDS. ACRES •J� LICENSED CONTRACTOR DECLARATION Ping. Ref.# T` (6'l—;-- Parking Req./Provided E I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: M with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Pet //29- e7 d- S T License Class License No. ! �Y^�L J Date Signature PLUMBING FEES WORKERS'COMPENSATION DECLARATION Bar Sink Showers I hereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL FEES Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink 100, Lab. C.) Automatic Washer Transformer D 15-50 KW Policy No. Company Backflow Irrigation Sewer Cap ❑ 50+ KW Construction Pole Sub. Certified copy is hereby furnished. ' — Certified copy is filed with the city Building Division. / Bathtubs .Sewer Connection 00 Cooking Unit Meter pup to 100 amps Date Applicant ' EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps (This section need not be completed if the permit is for One hundred($100) or less). DishwasherSolar Piping Dryers ❑Gas ❑Electric Sub Panel I certify that in the performance of the wo for whic this per it is'ssued,I • ' shall not employ any person in any man r so eceme bj t to the Drinking Fountains Solar Tank • Fann Workerg Compensation Laws of Californi . / Motors 0-1 HP 01%-8200 • Date #-2C-y7 Signature. Floor Drains Swimming Pool w/Spa — F.A.U. Inc.Solar ❑9-15 HP ❑16-15+ NOTIC :If,after making this declaration, you should become subj ct to the Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures / comply with such provisions or this permit shall be deemed revoked. Microwave 60 CONSTRUCTION LENDING AGENCY Gas Service Outlets / Water Closet 41GO Device Boxes I hereby affirm that there is a construction lending agency for the performance Pole Light of the work for which this permit is issued (Section 3097 .Civ. C.) -•' - Interceptors Water HeaterOutlets Lender's Name / / .14 Range �O Lender's Address • - IVOL_/C Kitchen Sink Water Service s Switches _ OWNER BUILDER DECLARATION 2 oo I hereby affirm that I am exempt from the Contractor's License Law for the 7 Lavatories Auto-Wash () ; Garbage Disposal - following reason (Section 7031.5 Business and Professional Code: Any city or Ot 9 P Standing Sections county which requires a permit to construct,alter,improve,demolish or repair P-Trap • Laundr Trays r' any structure, prior to its issuance, also requires the applicant for such permit y y Generator ❑0-5 KW 05-15 KW Trash Compactor to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains ////--�/ /-�s� �3 -- the Contractor's License Law(Chapter 9(commencing with Section 7000)of -- 7110.5.6-aJ�C �/.w' Division 3 of the Business and Professions Code) or that he/she is exempt - Therefrom and the basis for the alleged exemption. Any violation of Section ` 31.5 by any applicant for a permit subject$ the applicant to a civil nalty of not more than five hundred dollars($500). s�y I, as owner of the property or my employees with wages as their sole Reinspection Fee 4 $15 Issue Fee $ 3 13_lmpensation, will do the work,and the structure is not intended or offered 1P Reinspection Fee J $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such improvements are not intended or offered for Boiler Hood or Type I 0 �, sale. If, however, the building or improvement is sold within one year of com- Canopy Type II 0 Zoning Approved By �J�Qj. Date pletion, the owner will have the burden of proving he/she did not build or im- Duct- Under Ground • Building Approved By V 1 Date b me prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Date tractors to construct the project (Section 7044,Business and Professions Code: - The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑0-100,000 BTU ❑100,000 BTU SUMMARY OF FEES builds or improves thereon,and who contracts for such protects with a con- license pursuant to the Contractor's License Law). I am aware that / Exhaust System Ere Multiple 0 System Repair/Alteration DB •L•BUILDING PERMIT $ l 00 SMIP $ 0,87 proof of their Worker's Compensation insurance should be provided to me. L I am exempt under Section B.8 P, PLAN CHECK $ & Oa PERMIT t• his reason Firepl/Fact.BIL. ICBG# Fire Dampers /ge 00 ISSUANCE $ - Date �_L_24p=484_ Owner ,C+_.� / PLUMBING $Heating System& Ducting Registers PLAN CHECK 25% $ 4,00 ENERGY P.C. $ I hereby certify that.) have read't is application and state that the above 00-100,000 BTU 0100,000 BTLELECTRICAL �0. 20 GRADING $ information is correct. I agree to comply with all city and county ordinances $ and state laws relatin to buil g constructs n,and hereby authorize repre- PLAN CHECK 50% $ 3. 60 MICROFILM $ inspection fives of this c• to a uqo the boye-mentioned property for inspection purposes D '214"-Cf • MECHANICAL $ 7. 00 TOTAL FEE $ 306.69 Signature Drivers' License or SS# Reinspection Fee I $15 Issue Fee $ 3 PLAN CHECK 25% $ /, 0 O CMF 0965-46,rev. 10/84 White - Building; Canary - Applica ; Pink -Accounting; Goldenrod - Assessor / 1 CONSTRUCTION AND PLANNING • POOL &SPA APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector . 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location /• 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement • 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement • 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. ^-II 57. APPROVAL TO COVER-GUNITE ,7. Footings MIB? Q� 58. Electrical Conduit-Undrgrnd. 8. Foundation. (r/ 59. Gas Pipe, 0 Undrgrnd., Test --`9.Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 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 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring q_yp_sj, ncing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling • 69. POOL/SSYSTEMS FINAL - 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace _ APPROVALS Permit# _ 21. Ducts, in Structure _ 70. Underground Hydro 22. Ducts, Ventilating . .ser op 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) &i+i&ocoat' 75. Dry Chemical 27. Frame and Flashing - 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation p - 78. FIRE PREV. FINAL 30. Drywall Nailihd :.. 1 lit-WO HEALTH DEPT.;REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION ' [_ 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric 7%-86 Notes: , 34. Final Heating & Air Conditioning *IC "la - • 35. Final Gas Pipe-Test - 36. Hood or Canopy 37. Final Factory Fireplace """�� .. OM 38. Final Plumbing (a 39. Water Service-Final 7T •� 40. Gas Service-Final - - ,41. Solar Domestic-Final . - -42. Backflow Preventer 43. Backflow Irrigation . 44. Landscape Irrigation System , 45.'Sound Attenuation I • , 46. Handicap Regulations r 47. FINAL STRUCTURE& BUILDING s/lee pie-- 48. Special Requirements Completed 49. Electric Release to Edison . •1 50. Gas Release to Southern California Gas Co . 51. CERTIFICATE OF OCCUPANCY., 4 ;� No. Date •-'' 4 CERTIFICATE OF COMPLIANCE PAYMENT OF SCHOOL FACILITY FEES NEWPORT-MESA UNIFIED SCHOOL DISTRICT Developer/Applicant : pet. t- q7 Ai ke,L- Address : 3320 az-41 ci , L) CwfolZT L' v&/ (7.4. 526 0 Telephone Number : (n y S--7 so I 9 Tract/Parcel and Lot Number(s) : (�-�- �� q �j Location of Project : /.2-8 a 'a rte . c I ' � /" "' � ) a " ( 2'427 Number of Square Feet of Residential Space 3 6 x $1 . 50 Total 35- q—. (9-1° Number of Square Feet of Commercial and Industrial Space x $0 . 25 Total 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 Newport-Mesa Unified School District . /J CS Yerycebc BusiYSess Manager 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 representations are not true then this certificate shall automatically terminate and the appropriate City/County shall be notified . . Date : ,7- 6 "47Deve oper/Applicant Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. - PERMIT NO. TRACT O. LOT NO. UNIT NO. I �, `�.. `tl'T •F COSTA MESA CONSTRUCTION P RMIT 0471 E/"eE/27 2.._. �' fi. __ BPc -28 9�S Project Address -,// Applicant's Mailing Address 32-2'r 044.4 S''r til•L. iA�3 TYPE OF CONSTRUCTION (J ADD H ALTERATION H REPAIR Owner's Name PR N.L- T-iN kel-- / Phone +YS'7)0j Ill CONVERSION ❑ DEMOLISH 111 OTHER A.P.# 42.6+ fl-j. 03 Zone R2 �I I DESCRIPTIO OF WORK/USE OF BLDG. Address "�22••r Lil.TA`TI SD/ /t/' Q.� a }"rg Z-�O DESCRIPTION RF-I• Ec•4L/ZE E Main Building: Accessory Building: Z Arch/Eng. License No. TYPE OF PERMIT' ❑ GRADING I�/❑ FOUNDATION B STRUCTURAL T Front et -, 0 Address I1, . , ^w ❑ TENANT LJ ELECTRICAL LJ PLUMBING ❑ MECHANICAL B Rear Z . N Contractor's Name O W Phone ❑ OTHER A I • PROJECT DESCRIPTION SQ. FT QD OCCUPANCY R- C Right C( N Address Imailingl;v /r CONSTRUCTION TYPE �- VALUATION $ 2f/0� S Left • �• • G City License No. f ✓ ZONE GRADING CU.YDS. ACRES sp.�� R LICENSED CON•TRACTOR DECLARATION Ping. Ref.# `p-/.aS Parking Req./Provided E Q I hereby affirm 7 that I am licensed under prosiness charter i (commencing Remarks: Planning Notes: M with section 7000) of-Division 3 of the Business and Professions Code, and T my license is in full force and effect. P c. 4 ze -- ,7 S S License Class License No. 'TL- Date I"Signature PLUMBING FEES , WORKERS'COMPENSATION DECLARATION Bar Sink Showers I hereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL FEES 4 Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink Automatic Washer Transformer 0 15-50 KW ;800, Lab. C.) {�y ' Policy No. t" ' Company Backflow Irrigation Sewer Cap ❑ 50+ KW 8 Certified copy is hereby furnished. Construction Pole Sub. • Certified copy Is filed with the city Building Division. Bathtubs- Sewer Connection Cooking Unit Meter Oup to 100 amps • Date v-' Applicant EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers • Solar Collectors Dishwasher Meter Dover 100 amps (This section need.not be completed if the permit is for one hundred ($100) or Dishwasher less). ' .i• Solar Piping Dryers ❑Gas DElectric Sub Panel I certify that in.the performance of the war for which this pe mit i Dishwasher I shall not employ-any person in any man so a beta sub' t to the Drinking Fountains Solar Tank Fan Motors 00-1 HP ❑1'/x-8 Workers' Compensation Laws of Californ' . . n _ _ 5( Date eta^14 17 •Z7 Signature - Floor Drains Swimming Pool w/Spa — F.A.U. Inc.Solar ❑9-15 HP 016-15+ NOTICE: If,after making this declarant you should become s bject to the - Workers' Compensation provisions of the you s Labor Code, you must forthwith Floor Sinks Urinal 2- Fixtures Microwave 0 80 comply with such provisions or this permit shall be deemed revoked. • CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes Pole Light I hereby affirm that there is a construction lending agency for the performance 9 of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors / Water Heater 00 • Outlets Lender's Name Range 0 4‘ - y� � _ Lender's Address 7+RA - Kitchen Sink - Water Service 2 Switches OWNER BUILDER DECLARATIONSign O I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash 4 00 Garbage Dis Disposal following reason (Section 7031.5 Business and Professional Code:'Any city or sp Standing Sections county which requires a permit to construct,alter improve,demolish or repair P-Trap, LaundryTray5 any structure, prior to its issuance, also requires the aplicant for such permit Generator ❑0-5 KW ❑5-15 KW Trash Compactor to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains the Contractor's'License Law (Chapter 9(commencing with Section 7000) of - Division 3 of the Business and Professions Code) or that he/she is exempt - . Therefrom and the basis for the alleged exemption. Any violation of Section 031.5 by any applicant for a permit subjects the applicant to a civil natty of not more than five hundred dollars($500). • ^_ I, as owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee $ 3 �' ompensation, will do the work,and the structure is not intended or offeredza • Reinspection Fee ! $15 Issue Fee • $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own Hood or Type I ❑ DEVELOPMENT SERVICES REQUIREMENTS: (�,,�. ! rl employees, provided that such improvements are not intended or offered for Boiler q(.t'� b � 3a sale. If, however, the building or improvement Is sold within one year of com- Canopy Type II ❑ • Zoning Approved By �y l' Date pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By Y/ Date prove for the purpose of sale). ❑.-I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By • Date tractors-to construct the project (Section 7044,Business and-Professions Code: The Contractor's License Law does not apply to an owner of property who Duct-Ventilating Do-loo,000 BTU 0100,000 BTU SUMMARY OF FEES builds or improves thereon, and who contracts for such projects with a con- _ _ tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple ❑ System Repair/Alteration Dec •BUILDING PERMIT $ 77,00 SMIP $ 0.SO proof of their Worker's Compensation insurance should be provided to me. _ _ -- - - - PLAN CHECK $ 2...c. PERMIT 0 I am exempt under Section B.&LL P. C.for this reason Firepl/Fact.Blt. IC80# Fire Dampers PLUMBING $ /1• 00 ISSUANCE $ Date .1L.0—.. -1 Owner f 4ia LT.. FrL Heating System& Ducting Registers 00 ENERGY P.C. $ PLAN CHECK 25% $ 2, I hereby certify that I have read this application and state that the above 00.100,000 BTU 0100,000 BTU 00 GRADING $ _ information is correct. I agree to comply with all city and county ordinances • ELECTRICAL $ and state laws relatin to building onstruc ion and hereby authorize repre-. PLAN CHECK 50% $ /• DO MICROFILM $ sentatives of this cbit ter .pun t a].ve-mentioned property for — inspection purposes. -.Z, MECHANICAL $ TOTAL FEE $ 12/r .52 Signature Date Reinspection Fee $15 Issue Fee $ 3 • PLAN CHECK 25% $ Drivers' License or SS 7jt - _ CMF 0865-46,rev. 10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING POOL &SPA APPROVALS Permit# Date Inspector APPROVALS Permit+ Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location ' 2. Soil Pipe-Undrgrnd. • 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd: 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation - 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 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 13. 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 Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# _ 21. Ducts, in Structure 70. Underground Hydro • 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil • 23. Gas Pipe-Rough &Test: 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical • • 27. Frame and Flashing 76. Dry Standpipe 28. Lathing &Siding • 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION , 32. Electrical Power Meter-Final / OD CERTIFICATE ISSUED 33. Final Electric U' t6/ s: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38.,Final Plumbing la/II LEO 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final • 42. Backflow Preventer • 43. Backflow Irrigation . 44. Landscape Irrigation System • 45.•Sound Attenuation • 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING SSA --J 48. Special Requirements Completed _ - �- 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co S 51. CERTIFICATE OF OCCUPANCY No. Date sit CERTIFICATE OF COMPLIANCE PAYMENT OF SCHOOL FACILITY FEES NEWPORT-MESA UNIFIED SCHOOL DISTRICT Developer/Applicant : e{}4, L / J k-e Address : 3225 C/)-i44 PCWia �j.Q.lic , 0 ,52-G ,J Telephone Number : GC-Cc-130i Tract/Parcel and Lot Number(s) : Location of Project : 1,4 • l ' ��°Z7 Number of Square Feet of60 , 60 Residential Space 'TV x $1 . 50 Total Number of Square Feet of Commercial and Industrial Space x $0 . 25 Total 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 Newport-Mesa Unified School District . .1•rw7 .n *tel Busi'ess Manager 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 representations are not true then this certificate shall automatically terminate and the appropriate City/County shall be notified . Date : ( ,1e -8 '1 Developer/Applicant Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. i1 PERMIT NO. TRACT NO. LOT NO. UNIT N CITY OF dressCOSM120 CSO;STR 9t ON PERMITm_ 2._ 1 S-3 49 3 7 .�(yr-� A.P.# I Zone Project Address /(. �Y S=- _ `� U S Main Building: Accessory Building: ApSRn7E TYPE OF CONSTRUCTION U NEW ❑ ADD U ALTERATION REPAIR E Z Owner's Na Mailing Address��r� '_,..C2 ,t ❑ CONVERSION ❑ DEMOLISH ❑ OTHER T Front . O Owner's Name r«N✓=� PhoneL ,.�i DESCR I•reN OF WO' / SE OF BLQG. ' A Rear N Address 91 ` vlh it`• Ad . Infos S - TYPEOFPERMIT U GRADING U FOUNDATION U STRUCTURAL •i C Right N •Arch/Eng. License No. ,r--�� K G Address ❑ TENANT LYELECTRICAL ❑ PLUMBING ❑ MECHANICAL $ Left —1..R Contractor's Nam- ' •- 4 -. 0 we-''•hone CW , ❑ OTHER n� Ping. Ref. # Parking Req./Provided Q p • r- PROJECT DESCRIPTION S FT. OCCUPANCY Address(mailing) ��8 �/ S r Planning Notes: City License No. 3 i D 2'j CONSTRUCTION TYPE N __ VALUATION$ M T ZONE GRADING CU.YDS. ACRES S- LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: E.Y E. 3 rt 20 with section 7000) of Division 3 of the Business and Professions Code,and my license is in fill rce and effect. 'I ELECTRICAL FEES License lass cense No. "e12/6'` �1' Date Signature PLUMBING FEES Automatic Washer Transformer 0 15-50 KW WORKERS' COMPENSATION DE6LARATIONConstruction Pole Sub. • 0 50+ KW • I hereby affirm that I have a certificate of consent to self-Insure or a certificate Bar Sink Showers -'f Workers' Compensation Insurance, or a certified copy thereof (SectionCooking Unit Meter ❑Up to 100 amps 100, Lab. C.) - Backflow Preventer Service Sink • rolicy No. Company _ Backflow Irrigation Sewer Cap Dishwasher Meter ❑over 100 amps B Certified copy is hereby furnished. — - Dryers ❑Gas DElectric Sub Panel Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Date ApplicantFan r Motors F.0-1 HP 01%-8 Ot EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors lessis section need not be completed if the permit is for one hundred($100) or Dishwasher Solar Piping F.A.U. Inc.Solar 09-15 HP 016-15+ I certify that in the performance of the work for which this permit is issued, I - Fixtures shall not employ any person in any mann r 3P as o become subject to the Drinking Fountains Solar Tank Microwave Workers' orgpa Laws of Calitorpi Date tj-//V Signature Floor Drains Swimming Pool w/Spa ;h r Device Boxes Pole Light 7s NOTICE: If,after ma ing this decia tion, you should become subject to the Outlets Range Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal comply with such provisions or this permit shall be deemed revoked. • CONSTRUCTION LENDING AGENCYGas Service Outlets Water Closet Switches Sign I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued (Section 3097 Civ. C.) interceptors Water Heater Garbage Disposal Standing Sections Lender's Name Lender's Address - Kitchen Sink - Water Service Generator 00.5 KW 05-15 KW Trash Compactor OWNER BUILDER DECLARATION --- �,J.�� I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash I tterfeZ" 7 S, following reason (Section 7031.5 Business and Professional Code: Any city or / �/W county which requires a permit to construct,alter,Improve,demolish or repair' P-Trap Laundry Trays /[ any structure, prior to its issuance, also requiG res the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains the Contractor's License Law(Chapter 9(commencing with Section 7000) of - Division 3 of the Business and Professions Code) or that he/she is exempt -- Reinspection Fee $15 Issue Fee it-QD -"/Therefrom and the basis for the alleged exemption. Any violation of Section . ":?? 31.5 by any applicant for a permit subjects the applicant to a civil "<`nalty of not more than five hundred dollars($500). $ 3 DEVELOPMENT SERVICES REQUIREMENTS: ❑ I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee Zoning Approved By Date compensation, will do the work,and the structure is not intended or offered MECHANICAL for sale (Section 7044, Business and Professional Code: The Contractor's FEES Building Approved By .0 Date License Law does not apply to an owner of a property who builds or improves /� thereon, and who does such work himself/herself or through his or her own Hood or Type I 0 Application Issued By __'I_�ii��__ Date ;i<,<•7 Je employees, provided that such improvements are not intended or offered for Boiler _ sale. If, however,the building or improvement is sold within one year of com- Canopy Type II 0 SUMMARY OF FEE pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground prove for the purpose of sale). BUILDING PERMIT $ - SMTP $ 0 I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System PLAN CHECK $ PERMIT tractors to construct the project (Section 7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑G- 000 BTU ❑100,000 BTU PLUMBING $ ISSUANCE $ builds or imoroves thereon.and who contracts far such oroiects with a con- • ENERGY P.C. $ tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration PLAN CHECK 25% $ •f/_ GRADING $ proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section - B.& P.C.for this reason Firepl/Fact.Blt. ICBG# • Fire Dampen ELECTRICAL $ .2 co •'`67 MICROFILM $ HeatingSystem& DuctingRegisters - PLAN CHECK 50% $ ! ,�/ Date Owner yMECHANICAL $ 2„.G.2 I hereby certify that I have read this application and state that the above ❑O-100,000 BTU 0100,000 BTL TOTAL FEE $ information is correct. I agree to comply with all city and county ordinances PLAN CHECK 25% $ and state laws relating to building construction, and hereby authorize repre- sentatives of this y ante upon the above-mentioned property for 1 inspurr.:. /- ,_ 7'9tt�L1? J Signature Date 1177 ..11- CC.COY• Drivers' License or SS# Reinspection Fee $15 Issue Fee $ 3 0865-46,rev. 5/88 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor Di 0012203-00012203 TCT 26.25 DATE: 08/16/88 TIME: i4:1111 CONSTRUCTION AND PLANNING POOL ;PA APPROVALS Permit Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole ' 52. Pool & Equiprnent Location , •2. Soil Pipp-Undrgrnd. 53. Steel Reinforcement I ' Electrical Conduit Utility-Undrgrnd. - • . 54. Forms - - c( - 42Electrical Conduit-Undrgrnd. 6-17-68g 55. Electrical Bonding - I / bSteel iReinforcement , ffflll 56. Rough Plumbing & Pressure Test .:&bElectrical UFER Grnd. I . 57. APPROVAL TO COVER-GUNITE '7. Footings58. Electrical Conduit-Undrgrnd. • 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 11 9. Water.Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10..Structural Floor.System • ' 61. APPROVAL TO DECK , 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final I 12: Sewer Cap 63. Heater & Vent-Final 13. Roof'Drains - 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final • 1,6. 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 HH,�eating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough-Factory Fireplace ;,I APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating in, 71 'Product Piping 0 Gas 0 Oil . 23. Gas Pipe-Rough & Test "1 ,72. Underground Flush r 24. Roof Framing • I 73. Undergrnd.Storage Tank 0 Gas 0 Oil ( 25. Roof SFieathing 74. Overhead Hydro r 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing r . 76. Dry Standpipe 28. Lathing & Siding t2 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30, Drywall Nailing HEALTH DEPT. REQUIREMENT 4- 31. Plaster Brown Coit 79. FINAL INSPECTION t. 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric //9,67 t{ 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 1 41. Solar Domestic-Final �,• r 42. Backflow Preventer -• ` • • 43. Backflow Irrigation V• 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations t I47. FINAL STRUCTURE & BUILDING ' 48. Special Requirements Completed 49. Electric Release to Edison ,'.: ;i 50. Gas Release to Southern California Gas Co '. ri - / 51. CERTIFICATE OF OCCUPANCY + i• No. Date c '- r- t Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. PERMIT NO. TRACT NO. LOT NO. UNIT NO. - CITY.OF COSTA MESA CQNSTRUCTIOII PERMIT J E 3 L t 20 A.P.# Zone Project Address (2.€5 ��. �T EJ S Main Building: Accessory Building: Applicant's Malik, Address -San LF TYPE OF CONSTRUCTION U NEW LJ ADD U ALTERATION ❑ REPAIR Gµs73°1 III CONVERSION Li DEMOLISH ❑ OTHER ' T Front 0 Owner's N he % N C - Phone tom.,- DESCRIPTION OF WORK/USE OF BLDG. i s Rear N Address / TR you e 41 e N /if mirk, of A OF PERMI U GRADING ❑ FOUNDATION Li STRUCTURAL C Right N TYPE Arch/Eng. - License No. _ T K G. Address ❑ TENANT 1X'I ELECTRICAL ❑ PLUMBING ❑ MECHANICAL $ Left ❑ OTHERE Contractor's Name R AtipA-t._ P'f`, I✓agahone C Y): /S71 Ping. Ref. # Parking Req./Provided E Address(mailing/ /)9 a15 Z ,s 47—• PROJECT DESCRIPTION SQ. FT. - -_ OCCUPANCY Planning Notes: M CONSTRUCTION TYPE VALUATION$ T City License No. UC' IMI 3 t 021 2 ZONE GRADING CU.YDS. -- ACRES _ _ - I. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: with section 7000) of Division 3 of the Business and Professions Code, and my license is in full f e and effect. ELECTRICAL ' FEES License lass ense No. N044 Date - Signature PLUMBING I FEES Automatic Washer Transformer 0 15-50 KW WORKERS'COMPENSATION LA ATIONConstruction Pole Sub. ❑ 50+ KW I • I hereby affirm that I have a certificate of consent to self-Insure or a certificate Bar Sink Showers of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink Cooking Unit I Meter $up to 100 amps IQ 3800, Lab. C.) • ' C� Policy No. Company _ Backflow Irrigation Sewer Cap Dishwasher Meter Dover 100 amps El Certified copy is hereby furnished. - `- Dryers ❑Gas ❑EI2CIf IC Sub Panel Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Date ApplicantFan Motors 00-1 HP ❑115-8 EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors This section need not be completed if the permit Is for one hundred ($100)orDishwasher Solar Piping - F.A.U. Inc.Solar 09-15 HP 016-15+ less). P g I certify that in the performance of the work for which this permit is issued, I - • Fixtures shall not employ any person in any manner o s to bec me subject to the Drinking Fountains Solar Tank Microwave Workers' CO pen [ A Laws of Cantor", • Date /[- i Signature / Floor Drains Swimming Pool vv/SpaDevice Boxes Pole Light NOTICE:If,after making this declarat on,you should become subject to the Outlets Range Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal - comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Switches Sign I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Garbage Disposal Standing Sections Lender's Name Lender's Address - Kitchen Sink Water Service Generator 00-5 KW 05-15 KW Trash Compactor OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains the Contractor's License Law(Chapter 9 (commencing with Section 7000)of lc- 1"' Division 3 of the Business and Professions Code) or that he/she is exempt Reinspection Fee $15 Issue Fee -$-a-- therefrom and the basis for the alleged exemption. Any violation of Section 7031.5by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars($500). DEVELOPMENT SERVICES REQUIREMENTS: LI I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 compensation, will do the work,and the structure is not intended or offered Zoning Approved By Date for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES Building Approved By �� Date License Law does not apply to an owner of a property who builds or improves - RT thereon, and who does such work himself/herself or through his or her own Hood Or Type I D Application Issued By Date �]-� 1 -(X-i employees, provided that such improvements are not intended or offered for Boiler • sale. it, however, the building or improvement is sold within one year of corn- Canopy Type II 0 SUMMARY OF FEES pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground prove for the purpose of sale). BUILDING PERMIT $ SMIP $ ❑ I, as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System PLAN CHECK $ PERMIT tractors to construct the project (Section 7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00.100,000 BTU 0100,000 BTU PLUMBING $ ISSUANCE $ builds or improves thereon.and who contracts for such oroiects with a con- tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple 0 System Repair/Alteration PLAN CHECK 25% $ ENERGY P.C. $ proof o their Worker's Compensation insurance should be provided to me. ELECTRICAL $ "7�� GRADING $ IDI am exempt under Section B.& P.C.for this reason Firepl/Fact.Bit. ICBO# Fire Dampers MICROFILM $ — PLAN CHECK 50% $ Date Owner Heating System &Ducting Registers MECHANICAL $PLAN CHECK TOTAL FEE 32 J I hereby certify that I have read this application and state that the above ❑0.100,000 BTU 0100,000 BTL 25% $ information is correct. I agree to comply with all city and county ordinances $ and state laws relating to ilding construction,and hereby authorize repre- sentatives of thi ci enter upon the above-mentioned property for inspection pure Or- Signature 4 , DateO(•I_:. l Drivers' Lic se or 55 yf ^'- /' Reinspection Fee $15 Issue Fee $ 3 01 00012026-00012026 TOT 33.500865-46,rev. 5/88 White - Building; Canary -Applicant; Pink -Accounting: Goldenrod - Assessor DATE: 08/15/8$ TIME: 14:10 • „ CONSTRUCTION AND PLANNING POOL a SPA Date Inspector Date Inspector • APPROVALS Permit# APPROVALS Permit # 1. TemF.Crary Electrical Service or Pole • 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. .: 53. Steel Reinforcement 3.,Elecctrical Conduit Utility-UndrgrOd. 54. Forms • 4.:Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5.,Steel Reinforcement 4 56. Rough Plumbing & Pressure Test 6.'Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE .7. Footings + 58. Electrical Conduit-Undrgrnd. • 8. Foundation • 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. ' 60. Backwash Lines, P-Trap, 0 Undrgrnd. , • 10. Structural Floor:System 61. APPROVAL TO DECK 0 • 11. Property.Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough.Plumbing 65. Electrical-Final • 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval "171 Rough Wiring Sign 68. APPROVED FOR PLASTERING 18., Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# 21: Ducts, in Structure 70. Underground Hydro 22. Ducts,.Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat q 79. FINAL INSPECTION 32. Electrical Power Meter-Final S-�6..6 vf( 80. FOOD CERTIFICATE ISSUED 33. Final Electric vvv��` 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 Domestic-Final 42. Backflow Preventer -- 43. Backflow Irrigation • 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison `-)I 50. Gas Release to Southern California Gas Co ' r 51. CERTIFICATE OF OCCUPANCY I - yl No. Date - 1