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Home My WebLink About180 22ND ST - Building Permits - ,1a"1—‘174- CITY CITY OF COSTA MESA • BUILDING DIVISION am , DEVELOPMENT SERVICES DEPARTMENT P IT NUMBER F 1 w�+s� I Oligh • PERMIT 05-01521 %PawnI' d. (714)754-5273 • Fax(714)7544856 • www.ci.costa-mesa.$IMLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 180 22ND ST Status: ISSUED Suite: Applied: 09/06/2005 Vicinity: GARAGE Issued: 09272005 Primary Occ: R3/U1 Type of Construction: V-N Parcel Number: 42606114 Zoning: Applicant: TUNSON, STEWART Address: 13337 SOUTH ST t/�/{'� STE 183 Phone: 562-809-6369 ISSUED BY: ' � CERRITOS,CA Zip: 9003 Owner: BROGAN, IRENE S TR Address 1970 SPYGLASS CIR Phone: 949-650-1620 VISTA,CA Zip: 92083 Contractor QUEST CONSTRUCTION INC Address: 13337 SOUTH ST STE 183 Phone: 562-809-6369 CERRITOS,CA Zip: 90703 License: 845473 Arch : Eng: VENTOCILLO, JOSE Address: Address: 24636 CRESTA CT Phone: Phone: 949-768-8583 LAGUNA HILLS,CA Zip: License: 92653 License: SCOPE OF PERMIT REFER TO B05-00466 FOR PC FEES,NOTES AND APPROVALS. ADD 820 S.F.2-STORY SINGLE FAMILY RESIDENCE 8 1,044 S.F.ATTACHED GARAGE TO EXISTING DWELLING UNIT TO CREATE A DUPLEX.AC BE USED AS A SECOND UNIT.GARAGE ON FIRST FLOOR,AND 820 SF DWELLING UNIT ON SECOND FLOOR(UNIT CONTAINS LIVING ROOM, KITCHEN,2 BEDROOMS,AND 2 BATHROOMS. PA-04-13 FEE SUMMARY Plan Check: $0.00 Calc Valuation: $102,637.20 Permit:• $1,010.55 Claim Valuation: $102,637.20 SMIP Res: $10.26 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 R ft p Total: $1,020.81 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 PARKINGExisting: 0 Required: 0 Proposed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and:rel ted 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(600) 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. f.De 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'comp nsatlon In nce Garner and policy number are: p Carder: 4,./f•ll1t'N 6 , i Policy Number: // -7 3 /5 t `(RNs section need not be completed It the permit lu at one hundred dollars($100)or less.) ❑ I certify that in th rformance of the wo for wh' this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation I of Calif la,and agr that I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with the 47e-1 ,.-^DS— Applkant Signature: L_Date: WARNING:FAILURE TO E WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE t$10o,COOi,IN ADDmON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am ilcerr� d undergrovisions o h ter 9(commencing with Section 7000)of Division 3 of the Business an Professions Code,and my license Is In full force and effect.Lk.# �1 3 Class p Contractor's Signature: -� (Data' V—Q 7'O r 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 t0 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 penally 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(typo 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? ❑Yes 0 No (Section 25505 of the California Health and Safety Code requires,with somo 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 p.ual 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 ressure) - 1 _ 2 Does or will the applicant or present or future building to file ^,r�rjistratidn~.re.,acutely hazardous materials? ❑Yes 0 No onetion 25533 time has on hand athe lfornia Health and quantity of acutelyafety Code,hazardous ma e r exual ILq.pc greats ELI n �{eightlth the Costa Mesaof 500 ponds, or a voluire mae of 55 rtment by oreach 1ness 200 cubicat feetf 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)? o Yes 0 No (Section 25534 of the California Health end 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 ❑No .._. ant.. ..resent._._...— ...._ ..._.. 5 Does he willo the tcAir or Quality a ar emen buildingsoccupant at other for the work ntch the subject of this u,.p estlon aggertnit for such construction or modification from the South Coast Air Ousliry 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). 8 Will any part of the facility to be constructed under this permit be within 1000 lest 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). _.._ __.e._._ _.o....._...._._.._ 7 a permit tram the South Coast res Duality cri ed Management al or other air pollution control 4l district3 or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Californiaia Health and Safety Code Section 42303 been made? 0 Yes ❑No certificate of compliance —__.__..__ 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 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 property r in pection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ignature Of Legal Owner(s) Date (----And/Or Authorized Applicant I Data CODE I INSPECTION TYPE PEI MALI LODES INSPECTION TYPE kAIF INImAL;i 1816 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 206 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 ,,L_ 204 Final Demolition 250 Final Building/Occupancy be(�-W . I) •640144,s, CITY OF COSTA MESA Building Safety Division 9\ J rP. O. BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 9 26 28-1 200 irY c. A% IV — — • 7- Ja. DEVELOPMENT SERVICES DEPARTMENT \'M1,f,iq p E 0,.. • April 6, 2005 To: Building Safety Division Comcast Cable Code Enforcement Newport-Mesa Unified School. Dist.(2) Communications Pacific Bell County Clerk Police Dept. - Planning & Research County Planning and Dev. Services Sanitary District Engineer County Registrar of Voters Sanitation Division Office County Tax Assessor So California Edison Company Engineering Division (2) Southern California Gas ESRI State Board of Equalization Fire Admin. - Training Officer U. S. Post Office - AIS Fire Admin. U. S. Post Office, Adams Fire Prevention Thomas Brothers Irvine Ranch Water District File (2) Mesa Consolidated Water District OLD ADDRESS NEW ADDRESS A. P. NO • 180 22"d Street 180 "A" and "B" 22nd Street 426-061-14 Your cooperation in this matter is appreciated. Sincerely, Willa Bouwens-Killeen ti Principal Planner c: Kim Brandt • Vi Pham Building Division(714)7545273 • Cale Enforcement(714)754-5623 • Planning Division(714)754-5245 FAX(714)7544856 • TDD(714)754-5244 • wwv.ci.costa-mesa.ca.us SHEET INDEX . us --- ...Lod.-- w C v ti 4°I n§I I .,71t..Tf.i:iifi'_ Y n 4 1 - 1 . .. . .. __ > � . r T ,.> I I a 8 ..._ __1 I SSI $$1— --- - ; I .wrM1.,�reerLz . o t o I 1 ; NikriiiI fi,NF:rr ` ROI �wiA ?Z a� Q st i 1I -. uo? il ,� r��.. 7."'`0; J p CRC�yQCNuC913➢ni/,. — II L—, 1 ..w...„e.. .. — e� I I .i... ...x... I 91 eeoweornrtrun 1 1 S 1 ----, 2e±]LK4G.LL,cx.emJ.x FX15TINh I I ONF STORY RESIDFNfw ..... S I Fi arum wmce ] I li .� a _._i 0 SITE AND ROOF PLAN"3 . ..,...<...,,... 1N1 A 1 EAST 22ND STREET • -On Mks CITY OF COSTA MESA 449,. 6'. P.O. BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 92628-1200 --„) y0�� ., wf `' zr d:' DEVELOPMENT SERVICES DEPARTMENT fj,AppygEPt' July 6, 2007 Tw�o:Bui Nlding Safety Division Comcast Cable Code Enforcement • Newport-Mesa Unified School. Dist.(2) Communications Pacific Bell County Clerk Police Dept. - Planning & Research County Planning and Dev. Services Sanitary District Engineer County Registrar of Voters Sanitation Division Office County Tax Assessor So California Edison Company Engineering Division (2) Southern California Gas ESRI State Board.of Equalization Fire Admin. - Training Officer U. S. Post Office - AIS Fire Admin. —Chip Dill (Station 5) U. S. Post Office, Adams Fire Prevention • Thomas Brothers Irvine Ranch Water District File (2) Mesa Consolidated Water District The City of Costa Mesa would like to inform you of the following address change: OLD ADDRESS NEW ADDRESSES A. P. NO 180 22ntl Street 180 22n° Street, #A 426-061-14 180 22nd Street, #B Your cooperation in this matter is appreciated. Sincerely, Hanh Nyguyen Assistant Planner cc: Kimberly Brandt, Development Services Vi Pham, Administrative Services/MIS Irene Beck Harriet Spain 1970 Spyglass Circle 180 22nd Street, #A Vista, CA. 92081 Costa Mesa, California 92627 Building Division(714)754-5273 • Code Enforcement(714)754-5623 • Planning Division(714)754-5245 FAX(714)754-4856 • TDD(714)754-5244 • www.ci.costa-mesa.ca.us Uni+ Cb above. °an e, Uni-E A 1-s+ory 180 ZZnd Si- / oC ZZ rid 54- N NEWPORT-MESA UNIFIED SCHOOL DISTRICT No5630 CERTIFICATE OF COMPLIANCE OF DEVELOPMENT FEES PURSUANT TO AB 1600 AND AB 181 To: ( ") City of Costa Mesa District Receipt No. ( ) City of Newport Beach ( ) County of Orange Plan Check No.$Drl --0)5Z1 Applicant: 1--Ltkle:AOn / ga',.�W6r-{- �' S}f�e.l� Cs �I016 Address: I 331 W"`a /1 / r �S UrT 3 Telephone Number: ( 5le a) /eO9 1°3/ill x/ Tract/Parcel and Lot Number(s)://�,] l-Z — "l[i 1- i9 Location of Project: I `f�D cd„o1 'S "4.L.L Number of Square Feet of: r [� nJ, Residential Space �� x $1.84 Total jJOz).W Commercial and Industrial Space x $ .30 Total CommerciaUlndustrial Project is: (Check One) Warehouse Motel Preschool R & D _ Bank _ Auto Repair Movie Theater _ Neighborhood Shops _ Hospital Mini-storage _ Racquet/Health _ Large Office Heavy Industrial _ Hotel _ Office Bldg. Regional Shops Medical Office Restaurant Light Industrial _ Office Park _ Fast Food This project is exempt because This certifies that the above-named Developer/Applicant has paid school facility fees in compliance with Government Code sections 53080 and 65995. The Building Permits for this square footage in this proposed development may now be issued by your jurisdiction. Checks are to be made payable to Newport-Mesa Unified School District. • B e. w Authorized 4 epresenta The above representation as to square footage is true. Apptica. :grim that if it i :r de rmin that such representations are not true, then this certificate shall automatically terminate and I opriate City/County s II be otified. If! Date: 7-2-7-03r p3r . ' CITY OF COSTA MESA BUILDING DIVISION F ;I DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER Pk. PERMIT ikwituntd* E05-01010 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.ug77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 180 22ND ST ELECTRICAL PERMIT Status: ISSUED Suite No Applied: 09/27/2005 Vicinity: DUPLEX Issued: 09/27/2005 Parcel Nunmber: 42606114 Applicant: TUSON, STEWARD �1Vn////v1111,��,�V Address: 13337 SOUTH ST ' ISSUED BY: STE 183 Phone:- 562-809-6369" CERRITOS,CA Zip 90703 Owner: BROGAN, IRENE S TR Address 1970 SPYGLASS CIR Phone: VISTA,CA - Zip: 92083 ' p Contractor: QUEST CONSTRUCTION INC R Address: 13337 SOUTH ST j STE 183 Phone: 562-809-6369 CERRITOS,CA Zip: 90703 License:845473 • SCOPE OF PERMIT ELECTRICAL PERMIT TO ADD 820 S.F.2-STORY SINGLE FAMILY RESIDENCE&1,044 S.F. i ATTACHED GARAGE TO EXISTING DWELLING UNIT TO CREATE A DUPLEX.ADDITION TO BE USED AS , A SECOND UNIT.GARAGE ON FIRST FLOOR,AND 820 SF DWELLING UNIT ON SECOND FLOOR(UNIT CONTAINS LIVING ROOM,KITCHEN,2 BEDROOMS,AND 2 BATHROOMS. - - , REF#:B05-01521 WORK TO INLCUDE: 18 LIGHTING FIXTS,29 SWITCHES,3 SMOKE DETECTORS,18 SWITCHES AND 1 SERVICE PANEL. , 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 $19.80 18 up to 50 kva/kw $0.00 0 Recept Outlets $43.90 50 up to 100 kva/kw $0.00 0 Switches $19.80 18 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 Sign Circuits $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.resultin the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 LY 24464e(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 ork.for which this permit is issued. 11 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 works co sation I seranceTrier and policy number are: ^7 2 Cerner: r'Z� Policy,Nomber: -77 J9�� _(Tliis section need not be co• •eted II the permit is alued•t one hundred dollars($100)or less.) ❑ I certify that in the p ance of the work f whic his permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws• '7 Ives and agree hat If hould become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these• Applicant Signature: LDate:-. 7^Z/f Oce. 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 DC 'ARE($100,000).IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACT" 'S DECLARATION: I hereby affirm that I am •�e ''U.•e provisions• Chapt: 9(commencing with Section 7000)of Division 3 of the r.Businessnd Professions Code,and mylicense is in full force and effect.Lic.# s ior Class ti /J. Conti tors'SIgnature: 'WS_ Date'.' 7-27-os' 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'ezempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects t i.'•plicant�Q civil penalty ofc. f not more than vg y ndred dollars($500).): ❑ $�.,, ti:r of the"{foperty,or fiy-emp oyees w t as their sole compensation,WILL DO THE WORK,and the structure is not Intended or offered for sale(Sec. ;i•- t.iness atidProfessions ori The C -,.ct-f icense Law does not apply to an owner of property who builds or improves thereon,and who does such work hl' :'t herself q"q'r,:hrough.d'(s;or hal-own e oyees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold w one ye (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 8,Califomla 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? ❑Yes ❑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 Califomla 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 ere 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 a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? j�Yes 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 ❑No (If"yes",the facility must meal 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 AUTHOR ' ••N 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 com•I with all state laws a d city o..inances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described• ••- or inspectionppurpo-es.I agr•e not to occupy or allow occupancy of any building authorized by this permit until final inspection. �9 Si•natbre Of Leal Orner(s) Date And/Or Authorized Applicant 'Date CODE* INSPECTION TYPE DATE INTrrIL$ CODE* INSPECTION TYPE )NTITIAL$ 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 4t4, CITY OF COSTA MESA ' < BUILDING DIVISION Y: 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' om�fensation/Insurance�Order and policy number are: 2 (� •Cartier. ' 5�a-"T C f' ./^«Y Policy Number: -/77 3 VSJ '-(This'section need not be completed lithe permit is lued at one hundred dollars($100)or less.) ❑ I certify that in the p- m rance of the work r w ich this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation law-• alifom:,and agre tha f I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these • •• •ns� q 27_ Applicant Sigrialure: ---:13t; - 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 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTO' DECLARATION: I hereby affirm that I am li52d u a provision o Chapter 9(commencing with Section 7000)of Division 3 of the Business v�Professions Code,and my license is in full force and effect.Lia 4 .">"7 75 CClass a r✓ ContrectorsSignature: rem a, Dr -y—27•-VC— 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 owrrecaf 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,Bussiness and Professions Code:The ContractorsLicense Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herbal 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. 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 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? 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 Calif omia 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 Califomia 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 a ermit for such construction or modification 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? 0 Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). e.t...strc 7 If a permit athe South Coast s Quality Management District or other airpollution control district3 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 compliance from the ppropriat...i.p... 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 , • -• TION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree . ply with all stet: laws and ity ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-describe•• •'erty for inspectio purpose I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. `e f gnatur:Ot :.al Owner(s) Date • 7-1 7 Ucr And/Or Authorized Applicant (' Date— CODE I INSPECTION TYPE Dr1IE INRRALS SODE I INSPECTION TYPE )RATE 1616 Fixed System Final Fire Prevention 206 Final Mechanical 513-o 4 I= V 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 9 CITY OF COSTA MESA BUILDING DIVISION > 4- r.,.r• II DEVELOPMENT SERVICES DEPARTMENT PER NUMBER t;t7s . PERMIT 4. I`so P05-00739 4thypoRmso se (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa. �MBING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 180 22ND ST Status: ISSUED Suite No Applied: 09/27/2005 Issued: 09/27/2005 Vicinity: DUPLEX Parcel Nunmber: 42606114 Applicant: TUSON, STEWARD +� Address: 13337 SOUTH ST ISSUED BY: _ STE 183 Phone: 562-809-6369 CERRITOS,CA Zip: 90703 Owner BROGAN, IRENE S TR Address 1970 SPYGLASS CIR Phone: R 1 P VISTA,CA- Zip: 92083 Contractor: QUEST CONSTRUCTION INC Address: 13337 SOUTH ST STE 183 Phone: 562-809-6369 CERRITOS,CA Zip: 90703 License: 845473 SCOPE OF PERMIT PERMIT TO ADD 820 S.F.2-STORY SINGLE FAMILY RESIDENCE&1,044 S.F.ATTACHED GARAGE TO EXISTING DWELLING UNIT TO CREATE A DUPLEX.ADDITION TO BE USED AS A SECOND UNIT. GARAGE ON FIRST FLOOR,AND 820 SF DWELLING UNIT ON SECOND FLOOR(UNIT CONTAINS , LIVING ROOM,KITCHEN,2 BEDROOMS,AND 2 BATHROOMS. REF#:B05-01521 WORK TO INLCUDE:2 BATHTUBS, 1 DISHWASHER, 1 GAS EARTHQUAKE VALVE,1 GAS(1-4 OUTLETS), 1 LAUDNRY TUBNVASHER,2 SHOWERS, 1 KITCHEN SINK, 1 SUMP PUMP,2 WASH , BASINS,2 WATER CLOSETS(TOILET)AND 1 WATER HEATER. FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $9.80 1 Sump Pump $9.80 1 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 $19.60 2 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 $19.60 2 Dishwasher $9.80 1 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) $19.60 2 Drain,Roof $0.00 0 Shower $19.60 2 Water Heater/vent $12.30 1 Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $11.00 1 Sink,Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) $6.15 1 Sink,kitchen $9.80 1 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 $0.00 Gas Service $0.00 0 Spa(public) $0.00 • 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $170.55 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 suspendedor abandoned for a period of 180 days. ..------ INSPECTIONS: --INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must'Compri-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 2446-48(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 w rk 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. C - My workers'comp nsation Inn nn reet artier and policy number are: �7 2 fCarder. "7-trY^�!� !ti/i/d ,POlicyNum6.F. . . 7 /9 cc ((This section n not be completed if the permit is valu d a e hundred dollars($100)or less) ❑ I certify that in th p ormance of the work for w Ich thi permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation lav s f Califo a,and agree that i I sho d become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith complywitho . .- 77- O� rApplicani Signature:e: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE(51®,000),IN ADDMO N TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS •ECLARATION: •I hereby affirm that I am tic:'-ad under•rovisions of'ha.er 9(commencing with Section 7000)of Division 3 of the Businessjnd Professions Code,and my license is in full force and effect.Lic.e - S4 Class e �jl. Contractors Signature: C ."• - Dater r-7,--27—OS 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 : • 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 Busin-r{:u:.•�.. Vi professions Code)or that he or she is exemptltherefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subje f;F{,,•:•Iicant to a civil penalty of not more than five,hundred dollars($500).): ❑ I,as•1q;:r of the property,or my employees wlthWagee as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044, : Mess and Professions Code:The Car*actotg'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.). ❑ 1 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: ❑ 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,Celifamla 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? ❑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? ❑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 matedals)? ❑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 a plication ale-ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 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? 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 Cale 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 penally 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 •ly with all state laws : •ity ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described p ..:rty for inspection pure' agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. 7 ,•.aura Of :.: • ner(s) 27 e o. to And/Or Authorized Applicant r Date CODE I INSPECTION TYPE PAM INTmAL5 900E t INSPECTIONTYPE MAIL INIDJALE 1616 Fixed System Final Fire Prevention 206 Final Mechanical , , ,� ^ 1266 Pool Spa Final 208 Final Plumbing 6 t; t_4 "t 11Mit 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 @ BUILDING DIVISION f 1y� `I6 DEVELOPMENT SERVICES DEPARTMENT P IT NUMBER 4•+ PK. PERMIT B05-01240 -`1Mamnr0 44. (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.B.W LDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 180 22ND ST Status: ISSUED Suite: Applied: 07/26/2005 Vicinity: DETACHED GARAGE Issued: 07/26/2005 Primary Occ: U-1 Private Gar/Carport/Shed Type of Construction: V-N Parcel Number 42606114 Zoning: • Applicant: TUNSON, STEWART Aer Address: 13337 SOUTH ST STE 183 Phone: 562-809-6369 ISSUED BY: �4/All CERRITOS,CA Zip: 90703 r — Owner BROGAN, IRENE S TR Address 1970 SPYGLASS CIR Phone: VISTA,CA Zip: 92083 Contractor QUEST CONSTRUCTION INC Address: 13337 SOUTH ST STE 183 Phone: 562-809-6369 CERRITOS,CA Zip: 90703 License: 845473 Arch : . • - Eng: Address: Address: Phone: Phone: • Zip: License: License: SCOPE OF PERMIT DEMOLITION OF A DETACHED GARAGE IN CONJUNCTION WITH THE 820 S.F.2-STORY SINGLE FAMILY RESIDENCE ADDITION&1,044 S.F.AT GARAGE TO EXISTING DWELLING UNIT TO CREATE A DUPLEX.ADDITION TO BE USED AS A SECOND UNIT.. REF:B05-00466 AND G05-00008 FEE SUMMARY Plan Check: $0.00 Calc Valuation: $11,000.00 Permit: $195.25 Claim Valuation: . . $11,000.00 SMIP Res: $0.00 SMIP Corn: , $0.00 Other: • $0.00 Inspection: $0.00 Total:. $195.25 • PLANNING &ZONING SETBACKS • MAIN STRUCTURE Front 0-0 r - Rear 0.0. Left • 0-0 Right 0-0 ACCESSORY Front 0.0 Y • Rear 0-0r: . ,Left 0-0 - Right 0-0 . PARKING Existing:- 0• . Required: 0 - Proposed: 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 / / 2448-46(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 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. l My workers'comps atlon irywrancerrier and policy number are: 7�7 it-Carder 5n fs/r1 P Poliryumber 3 /77 495 -(This section need not be completed If the permit Is valu:- :t one hundred dollars($100)or less.) ❑ I certify that in the performance of Ih:work for w ich t is permit Is Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of tgi omla,a.,: a that f I s •uld become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these pro ns.�� Z U-pr Applicant Signature: Da 7_ -7 WARNINOrFAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBIECi AN EMPLOYER TO CRIMINAL PENALTIES AND GVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(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 hereby affirm that I am lice ed under_provisl of Chapter 9(commencing with Section 7000)of Division 3 of.the.Businegs/a[pd Professions Code,and my license is in full force and effect.Uc,-A 4'5+• LCtess4 % Co�_rs.Signature:"' — . +Gate- 7-06 —QT -`.. 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 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: Signature: Date: Owner ID verified by driver's license. Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of d m t,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 apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes No (Section 65850.2 of the California Govemment Code requires that the requested information be fumished on applications for non-residential building permits). 6 Will any pan 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 oomph/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 law and cityordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described pony for inspection ry es.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signatur Of eget Owner(s) Date -ti 7-26 '-4S 1And/r.Authorized'Appllcant-- (—Gate ;ODE 1 INSPECTION TYPE PAH INTIALS CODE! INSPECTION TYPE PAM MALI 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 S4-I 1-6- get/ 250 Final Building/Occupancy i, 9 CITY OF COSTA MESA 4 BUILDING DIVISION Yt,:,, � DEVELOPMENT SERVICES DEPARTMENT P MIT NUMBER J• P PERMIT G05-00008 . `ibawrm • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ra.i�,aADING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 180 22ND ST l'ht Status: ISSUED Suite: Applied: 03/17/2005 Vicinity: Issued: 07/26/2005 Parcel Nunmber: 42606114 Zoning: Applicant: TUNSON, STEWART C / Address: ISSUED BY: ..11 :1/A Phone: 562-762-7420 -/ Zip: Owner BROGAN, IRENE S TR. Address 1970 SPYGLASS CIR Phone: VISTA,CA - - Zip: 92083 • Contractor: QUEST CONSTRUCTION INC Address: 13337 SOUTH ST • - - STE 183 • Phone: 562-809-6369 • CERRITOS,CA Zip: 90703 License: 845473 Eng: MAXWELL, MICHAEL Address: 378 E SHORLINE DR Phone:' 562-495-9567 ' LONG BEACH,CA Zip: ; 90802 - - License: • • • SCOPE OF PERMIT CUBIC YARDS GRADING FOR NEW SINGLE FAMILY RESIDENCE. 150 CUBIC YARDS OF FILL. 150 FEE SUMMARY Plan Check: -' • $33.00 Calc Valuation: moo • $0.00 .. Permit: $54.50 Other: $0.00 . $0.00 • Inspection: $0.00 $0.00 • Total: $87.50 • PLANNING & ZONING NOTES: • • L- 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 l 2448.4e(WOO) v" 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. II,,hhave 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. X., My work cc pensatlorylnsuranfa carrier and policy number are: �7 ?may (/ '1C rier: �"j 7E F4 Oda- Pollc7 Number..-- /!7 ✓(s7 (This section need not be completed it the permit is value. : one hundred dollars($700)or less.) ❑ I certify that in the •• ormance•t the work for w is permit is Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation law¢C: r. ree that •ultl become subject to the workers'compensation provisions of Section 3700 01 the Labor Code,I shell forthwith comply with these •• ovi Appribent Signature. Date:_ t 7 ZG—Q� WARNING:FAILURE TO S - RE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TOjCRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am liven yOdsr rr Isions enter 9(commencing with Section 7000)of Division 3 of the Buslnests gnd Professions Code,and my license Is in full effect. c force and .# _ �f Class 0 �/! Con/rad-tors SSIgnature J Date'1 7-7-0^d$ l 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 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 end 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 doc ment,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 ❑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 Safely 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 a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Ii 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 end 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 0 No 6 (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 inspe ' n purposes.1 agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Sig at a Of Legal Owner(s) Date 2�_Dj- AddiOr Authorized Applicant I.Date \ CODE it INSPECTION TYPE PATE BOOM POOF If trisprCTION TYPE QAII INTrM15 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 a fn- &'3-fl‘ �- 204 Final Demolition 250 Final Building/Occupancy r MAXWELL CONSULTING GROUP CIVIL ENGINEERS g LAM?SURVEYORS September 24, 2005 Mr. and Mrs. Beck 180. 22th Street Costa Mesa, CA �105 '000Vb Ref: Grading Certificate Dear Becks, On September 24, 2005, I conducted a field survey of the construction activity at the above referenced site. Field elevations were shot on the graded pad area of the construction site and were found to be in substantial compliance with the approved grading plans prepared by me. It is understood that final lot grading, beyond the pad area, will be completed once the building portion of this project has been completed. Sincerely yours, Maxwell Consulting Group Michael L. Maxwell, P.E.-L.S. P.E.- #C35896 Principal 378 E.Shoreline Drive Lorq Peach. CA 90502 I-562-495-9967 MAXWELL CONSULTING ( OUP 'i8 E.Shoreline Drove Long 4eack CA. 90802 Mr. and Mrs. Robert Beck 180. 22th Street Costa Mesa, CA 92627 t;EAL E5fAtt DEVELOPMENT CONSUL IANfS epirt! CITY OF COSTA MESA if � BUILDING DIVISION • ). • 4..4 . DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER Joacola PERMIT /E05\C/146 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 180 22ND ST Status: ISSUED Suite No ,Applied: 01/20/2005 Vicinity: Issued: 01/20/2005 Parcel Nunmber: 42606114 �� Applicant BROGAN, IRENE S TR ISSUED BY: // L1� Address: 180 EN 22ND ST ' Phone: 949-650-1620 COSTA MESA,CA Zip: 92626 Owner BROGAN, IRENE S TR Address 1970 SPYGLASS CIR Phone: VISTA.CA Zip: 92083 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 000000 SCOPE OF PERMIT RENEW EXPIRED 50746 FOR THE ADDITION OF 174SF LAUNDRY ROOM AND 56SF PATIO COVER. REF B05-00126. RENEW EXPIRED PERMIT NO.50746 2 LIGHTS,2 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 $2.20 2 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 2448.46(6/00) DECLARATIONS S i 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 It the permit is valued at one hundred dollars($100)or less.) ❑ I certify 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 provisions. Applicant Signature: Date: 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 37060F THE LABOR CODE,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 Code,and my license is in full force and effect.Lie.R Class II Contractor's Signature: Date: 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: 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 Cr 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.). ' 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 contractor(s) salicense purs ant to the Contractors License Laws.). LJI am exam uR er sec. Business and Professions Code for this reason: �� re: 'V �/ Expires: Verification of Ownership by(type ofocude.-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 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 ❑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 Califomia 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 then 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 Califomia 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 ere 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 a plication a ermit 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 IU 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 Net 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 Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (WNW,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,end authorize representatives of the City of Costa Mesa to enter upon the above-described property 1 r inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal naffs) Date A Affiant ua— CODE I INSPECTION TYPE Qdg IIIIIDALU CODE INSPECTION TYPE PAffi KOMI 1616 FixedSystem Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 14(2aAr 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 i 11- F . • t CITY OF COSTA MESA - l • 4 � A • BUILDING DIVISION - >:j ..� DEVELOPMENT SERVICES DEPARTMENT PERM UMBER �. rap.. 4 • PERMIT �'kaq•, ,t B05-00126 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 180 22ND ST Status: ISSUED Suite: Applied: 01/20/2005 Vicinity: Issued: 01/20/2005 Parcel Number: 42606114 Zoning: Applicant: BROGAN, IRENE S TR ISSUED BY: Address: 180 EN 22ND ST Phone: 949-650-1620 • COSTA MESA,CA - Zip: 92626 Owner: BROGAN;IRENE S TR Address :1970 SPYGLASS CIR Phone: - . VISTA,CA ' - - Zip: 92083 Contractor: OWNER-BUILDER Address: Phone: Zip: .License: 000000 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT - - RENEW EXPIRED 50746 FOR THE ADDITION OF.174SF LAUNDRY ROOM AND 56SF PATIO COVER. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $16,980.32 Permit: $279.25 - Claim Valuation: $0.00 SMIP Res: $1.70 SMTP Com: $0.00 Other: $0.00 Inspection: $0.00 • Total: $280.95 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 Calif mia 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 wo s uspended 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 wl a I applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result iin he'expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 r t/ 244646(6/00) /•/ se 11 DECLARATIONSI t i z 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/s valued at one hundred dollars($100)or less.) ❑ I certify 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 provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES 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.Llc.a Class x Contractors Signature: Date: 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). 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 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 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,em 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 pur ant to the Contractors License Laws.). pel em exem. u••er se . Business and Professions Code for this reason: qq�� 0 h . :r IA " ( 14iWfff� 4 sOre�hfied •y drivern'vs license. s 0 Na Dcert No. ires: Verification of Ownership by(type docum nt,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 Califomia 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 Califomia 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 appormit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes (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? ❑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 prescribed by Califomia 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. ecl/nOr ner(s) / 1 e_cCom' / /26atoSyrvd _ Autho licant CODE I INSPECTION TYPE PAIL MALL POE' INSPECTION TYPE , PAIL ltilmALS 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 r 204 Final Demolition 250 Final Building/Occupancy `1 ' ' sr Plans in Vault - is"-"fig Ir"-- awz4'>' 1-7.4"/"" - ' m m v z x i m Ia r ;n m a + - a c -. a r m a a F o m .lD O O crrr r yaxornoao vino ,. Do .om0E COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT - mc DamxOmcO ; cmnocwrr . ZW z P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 • !In," . O 2 - , .2 zy Ocn i a ai m a xi m :e1 PERMIT ' ns89 T4n ; • 1. DECLARATION OF AUTHORITY Bldg. Permit# 13651-O0/Zia FOR AGENTS OF PROPERTY OWNER This Permit# TO APPLY FOR PERMITS Street Address: / �� //// I v`' ` P,S7/A / ' ieS4 ` AP Number: 1. I (we), N1/4_9--frL� LL.Q— A. AP-r"-- , declare that I am the Owner of Title of the above referenced real property,and that I (we)hereby authorize: Name: RO/J 4 QRR/ £f 7 /e- Telephone Number: (WV ‘O-0 -' / ;2 o Street Address/: I 'O A::' "I, 23* n City: l . 65*4- M State: et_i l l- Zip: ya4 2 .y to obtain permits in my behalf,as owner/builder,for at the above referenced property. 2. Should any person become an employee engaged in the improvement of the property, I (we) shall immediately provide Worker's Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa Mesa,as required by State of California laws. 3. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other person, company or corporation. 4. I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any claim resulting in damage or personal injury to myself or any other parties as a result of work authorized by the permits from the City of Costa Mesa. 5. I declare under the penalty of perjury that the foregoing is true and correct. Executed this S day of -z jIL4 QfLc,r 20 0,S- , at ,California. Print Name: 2,ee/ye 3. E /?0S / Signature: 1/4._/4 -C e--i .tert--- Date: Per4t, r �.5` �d✓�Note: This authorization does not grant authorization to perform the work as owner, it solely provides for limited power of attorney to secure this permit in any behalf. • 077946(rev.11/00) CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER F 1prwringPERMIT t PO 0046 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIV ,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 180 22ND ST . Status: ISSUED Suite No Applied: 01/20/2005 Issued: 01/20/2005 Vicinity: ISSUED BY: Parcel Nunmber: 42606114 Applicant: BROGAN, IRENE S TR Address: 180 EN 22ND ST Phone: 949-650-1620 COSTA MESA,CA Zip: 92626 Owner BROGAN, IRENE S TR Address 1970 SPYGLASS CIR Phone: VISTA,CA Zip: 92083 Contractor: OWNER-BUILDER Address: • Phone: Zip: License: 000000 Arch / Eng: Address: Phone: Zip: License: SCOPE OF PERMIT RENEW EXPIRED 50746 FOR THE ADDITION OF 174SF LAUNDRY ROOM AND 56SF PATIO COVER. RENEW EXPIRED PERMIT NO.P506. " 1 LAUNDRY TUB, 1 GAS(1-4)OUTLETS AND 1 HOSE BIPP. FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $9.80 1 Sump Pump $0.00 0 Backflow inigation $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.) $0.0 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days,or if wo 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 campy,w°'h all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will rot' expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) • DECLARATIONS I, f j 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: Cartier. Policy Number: (This section need not be completed!!the permit is valued at one hundred dollars($100)or less.) ❑ I certify 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 provisions. Applicant Signature: Date: 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 DOUARE(5100,00(1),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 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.Lk.9 Class x 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). Lenders 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 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,end who contracts for such project with a contractor(s) ® lice se purs f t to the Contractors License Law-.). Imo' I am exemp n•er sec. Business and Professions Code for this reason: / ' lure: • � Agra te: j 0 Owner ID venfied.y drivers se. G U-s 0 Na '-v'eds Lic'nse No. Verification of Ownership by(type of aocu •nt,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? ❑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? 0 Yes LJ 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 pan 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). ....i Quality ... a ageme District o.. 7 if a permit fromn the South Coast s prescri ed by Di al or other airpollution ooncontrol district3be n agency is required for the work which Is the subject of this application,have all of the disclosures prescribed by CaliforniaCelifoHealth 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 above-described property •r inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owner(s) Date e c_Ant1/rd'Applicenl. ;ODE# INSPECTION TYPE Qd1E INTmAL$ goDF( tlSPECDON TYPE PETE UMW 1618 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing I-AI •05 C)('S 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 - . -..- ,ni n all spaces within heavy border lines and sign all appropriate declarations. ' CM.' OF COSTA MESA PER NO. TRACT NO. LOT NO. BLDG.NO. ' CONSTRUCTION PERMIT --50C. Prolect Address /s7-e, 6. . / !C7 e, . ` TYPE OF CONSTRUCTION J Owner 3 M- Phone v_ p'• :IH/4 ' /!'Gi 1 I ��(�/✓E .f>C'('' }y'� Ss� 0NEW 0ADD 0ALTERATION Address Ace E ,2 'LUC0 REPAIR 0 CONVERSION ❑DEMOLISH ZONING REGULATIONS Arch/Eng. License No. ❑ OTHER DESCRIPTION OF WORK A.P. ''f Address ZONE PLNG. REF.9P Contractor Phone TYPE OF PERMIT BUILDINGTTpp BtL/1ILp ING SETBACK C/L ST. PROPERTV LINE Address 0 GRADING 0 FOUNDATION 0 STRUCTURAL SIDE YARD EF LICENSED CONTRACTOR DECLARATION 0 TENANT 0 ELECTRICAL OPLUMBING ❑MECHANICAL LslIOET YARD I hereby affirm that I am licensed under provisions of Charter 9(corn- RIGHT mencing with section 7000) of Division 3 of the Business and 0 OTHER Professions Code, and my ❑cense is in full force and effect. REAR YARD (TO P/L) • PROJECT DESCRIPTION License Class License No. PKG.SPACE REQ. PROVIDED Date Signature SQ. FT. STREET WIDTH PARK FEE S WORKERS'COMPENSATION DECLARATION OCCUPANCY—CONSTRUCTION TYPE , I hereby affirm that I have a certificate of consent to sell-insure ora VALUATION ZONE ZONING APPROVED BY DATE certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab.C.). GRADING CU.YDS. ACRES SPECIAL CONDITIONS: P v No. Company rtified copy is hereby furnished. REMARKS: ,.ertified copy is filed with the city Building Division. �i (��// G _ ' EXEMPTION FROM WORKERS' COMPENSATION DECLARATION IC_I /r yJ 5— o (This section need not be completed if the permit is for one hundred /�`J Rn //J ($100 or less). 4 ,b I certify 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 PLUMBING PLAN CHECK ELECTRICAL PLAN CHECK subject to the Workers' Compensation Laws of California, uw tZLING GAHAbL Date Signature BATHTUBS SHOWERS $O FT SO FT NOTICE: If after making this declaration, you should become subject TOILETS URINALS GENERATOR 0.1 KW._1-10 KW to the Workers' Compensation provisions of the Labor Code,you must TRANSFORMER forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE LAVS APPLIANCE 10-50 Kw 50 + KW revoked, CONSTRUCTION LENDING AGENCY KIT.SINKS DISHWASHERS MOTORS 0-1 HP 1-10 HP I hereby affirm that there is a construction lending agency for the per- SERVICE SINKS SUMPS (INC.SOLAR) 10-50 HP 50.- HP romance of the work for which this permit is Issued (Section 3097 Civ. C.). FLOOR SINKS FLOOR DRAINS FIXTURES OUTLETS SWITCHES Lender's Name Lender's Address DRINKING FOUNTAINS GAS TUBE SIGNS OWNER BUILDER DECLARATION INTERCEPTORS CLARIFIERS POLE LIGHTS I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professions Code: SWIMMING POOL P TRAP LUNS I HUL I IUN Any city or county which requires a permit to construct, alter, POLES METERED y1pS�UpB improve, demolish or repair any structure, prior to its issuance,also re- WATER SERVICE ALTERATION PANELS MAIN E A'- I R E L quires the applicant for such permit to file a signed statement that he l's licensed pursuant to the provisions of the Contractor's License Law GAS SERVICE OUTLET$ SERVICE InCGmpleteNiPis p (Chapter 9 (commencing with Section 7000) of Division 3 of the eC I�nS Business and Professions Code) or that he Is exempt therefrom and the WATER HEATERS BTU OUTPUT Cancel be-'- for the alleged exemption. Any violation of Section 7031.5 by r pplica nl for a permit subjects the applicant to a civil penalty SEWER CONNECTIONS _� — Date,z- ' --- Sigealtliiti 11 . more than five hundred dollarsL(E500). 1 L ., as owner of the property, or my employees With wages as their SOLAR TANK COLLECTORS sole compensation, will do the work, and the str uctdre is not intended - or offered for sale. (Section 7044, Business and Professions Code: The SOLAR PIPING SYS. ISSUE FEE Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself or ISSUE FEE 3 - APPLICATION APPROVED BY DATE through his own employees, provided that such Improvements are not - intended or offered for sale. If, however, the building or Improvement MECHANICAL PLAN CHECK SUMMARY OF FEES Is sold within one year of completion, the owner will have the burden - of proving he did not build or improve for the purpose of sale). BUILDING HEATING SYSTEM 0.100,000 BTU PERMIT E SMIP $ I, as owner of the property, am exclusively contracting with osed contractors to construct the project (Section 7044, Business AND DUCTING E 100,000 + BTU PLAN CHECK g _ PERMIT and owner Property Code: The build cOr is prov se hew doe anow appy to L, ISSUANCE E to os hoof prwho a improves thereon, and who con- REFRIGERATION 0-100,000 BTU PLUMBING $ •-/ tracts horn such projects with a contractor(s) licesnetl, pursuant to SYSTEM GRADING S the Contractor's License Lew). 100,000 + BTU - PLAN CHECK S 0 I am exempt under Section B.& P.C.for this BOILERS BTU ELECTRICAL E $ reason MICROFILM $ Date Owner SYSTEM REPAIR,ALTERATION PLAN CHECK S TOTAL FEE E 1 hereby cert ify that l have read this application and state that the above EXHAUST SYSTEM MULTIPLE MECHANICAL S LESS AD- VANCE PC $_ FINAL FEE $ information is correct. I agree to comply with all city and county PLAN CHECK $ ordinances and state laws relating to construction,and hereby authorize representatives of this city to enter upon the above mentioned - property fo inspection purpyses. e V Signature r4 P-C?L_- f�} •'-(.0 - Date q' -d -a� Drivers' License or SS 8 ,.,\/ ISSUE FEE 4 CMF 0865-46 White-B ilding;Canary-Applicant; Pink-Accounting;Goldenrod-Assessor CONSTRUCTION AND PLANNING POOL& SPA • APPROVALS Permit # - Date Inspector APPROVALS Permit# Date . Inspector - t 1. Temporary Electrical Service or Pole 43. Pool & Equipment Location 2. Soil Pipe-Undrgrn 44. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrn 45. Forms • 4. ElectricalConduit-Undrgrn 46. Electrical Bonding 5. Steel Reinforce 47. Rough Plumbing & Pressure Test 6. Electrical UF ER Grn 48. APPROVAL TO COVER-GUNITE 7. Footings 49. Electrical Conduit-Undrqrn 8. Foundation 50. Gas Pipe, ❑Undrgrn,Test 9. Water Pipe-Undrgrn 51. Backwash Lines. P-Trap. ❑ Undrgrn - - 10. Structural Floor System {r-�G,,,� 52. APPROVAL TO DECK 11. Property Sewer Line& House Connection 4 7 -61 53. Backwash & Receptor-Final 12.. Street Sewer Connection 54. Heater & Vent-Final 13. Rough Plumbing 55 Plumbino System - Final 14. Rough Electric-Conduit 56. Electrical-Final 15. Rough Electric-Wiring 57. Solar System-Final 16. Rough Heating & Air Conditioning - 58. Fencing & Access Approval 17. Ducts, in Structure 59. APPROVED FOR PLASTERING 18. Ducts, Ventilating 19. Gas Pipe-Rough &Test 60. POOL/SPA SYSTEMS FINAL • 20. Roof Framing 21. Roof Sheathing 22. Frame and Flashing NOTES: 23. Insulation 24. Lathing & Siding 25. Drywall Nailing 26. Plaster Brown Coat -. 27. Electrical Power Meter-Final 28. Final Electric - • 29. Final Heating &Air Conditioning • 30. Final Gas Pipe-Test-- --• 31. Final Plumbing • 32. Water Service-Final 33. Gas Service-Final 34. Solar Domestic-Final 35. Landscape Sprinkling System 36. Sound Attenuation • 37. Handicap Regulations 38. FINAL STRUCTURE & BUILDING 39. Special Requirements Completed 40. Electric Release to Edison 41. Gas Release to Southern California Gas Co. S 42. CERTIFICATE OF OCCUPANCY No Date ..„___... ....m mien spaces within heavy border lines>ind sign allbppropriate declarations. ' On OF COSTA MESA PER TRACT NO. LOT AO. BLDG.NO. ' 'CONSTRUCTION PERMIT ti-5p43 ' Project Address e & aehac. . 4 TYPE OF CONSTRUCTION Owner LeEN a _Be+Lp PhontrineSa 0 NEW 0 ADD 0 ALTERATION Address Jto a.2 0 REPAIR 0 CONVERSION ❑DEMOLISH 'r Hof{ iyp�/RI �. I ZONING REGULATIONS Arch/Eng. License No. 0 OTHER AR.'F Address .- DESCRIPTION OF WORK - ZONE PLNG.REF.* Contractor 44&1 Phone TYPE OF PERMIT - BUILDING To g�/1 1 Address - 1 ❑GRADING 0 FOUNDATION 0 STRUCTURAL yAK C/LST. PROPERTY LINE LICENSED CONTRACTOR DECLARATION 0 TENANT 0 ELECTRICAL ❑PLUMBING °MECHANICAL SIDSylYARD - - I hereby affirm that I am licensed under provisions of Charter 9(tom- RIGHT mencing with section 7000) of Division 3 of the Business and 0 OTHER Professions Code, and my license Is in full force and ellett. REAR YARD(TO P/L) ,• License Class License No. PROJECT DESCRIPTION PKG.SPACE REQ. PROVIDED Date Signature SO. FT. WORKERS'COMPENSATION DECLARATION OCCUPANCY—CONSTRUCTION TYPE STREET WIDTH PARK FEES I hereby affirm that I have a certificate of consent to sell-Insure ora ZONING APPROVED BY I DATE VALUATION ZONE certificate of Workers' Compensation Insurance, Or a certified copy the' ' (Section 3800.Lab.C.). GRADING CU.YDS. ACRES SPECIAL CONDITIONS: / Pr o. Company - - -Med copy is hereby itirnlshetl. REMARKS: ' certified copy Is filed with the city Building Division. r n EXEMPTION FROM WORKERS' COMPENSATION DECLARATION AP �(D �— '- (This section need not be completed if the permit is for one hundred !] .b/ If100) or less . _ - — certlly 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 PLUMBING, PLAN CHECK ELECTRICAL PLAN CHECK subject to the Wwkars CompeneatlOn Laws of California. BATHTUBS SHOWERS • UWML1_1N4 4ARAGt - . - Date Signature SO FT SO FT NOTICE: If after making this declaration, you should become subject TOILETS URINALS GENERATOR 0-1 KW_ KW to the Workers'-Compensation provisions of the Labor Code,you must - - TRANSFORMER , forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE LAVS APPLIANCE 10-50 KW 50 4 KW revoked. _. _ CONSTRUCTION LENDING AGENCY KIT.SINKS DISHWASHERS MOTORS 0-1 HP_1-10 HP I hereby affirm that there Is a construction lending agency for the per- SERVICE SINKS SUMPS (INC.SOLAR) 10.50 HP 50+ HP formance of the work for which this permit is Issued (Section 3097 Civ. C.). FLOOR SINKS FLOOR DRAINS FIXTURES OUTLETS SWITCHES ' ' Lender's Name - Lender's Address DRINKING FOUNTAINS - GAS TUBE SIGNS ' OWNER BUILDER DECLARATION INTERCEPTORS CLARIFIERS POLE LIGHTS - I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professions Code: SWIMMING POOL P TRAP LUN]I HVL s IUN Any city or county which requires a permit to construct, alter, POLES METERED BUB improve, demolish or repair any structure, prior to its issuance,also re- WATER SERVICE ALTERATION PANELS MAIN E XLB I R I L quires the applicant for such permit to file a signed statement that he R licensed pursuant to the provisions of the Contractor's License Law GAS SERVICE OUTLETS • "SERVICE ,,,,/s1�115 (Chapter 9 (commencing with Section 7000) of Division 3 of the IrrcOmpleteNlPlSpeft Bin 's and Professions Code) or that he is exempt therefrom and the WATER HEATERS BTU OUTPUT • Cancel ba r the alleged exemption.it Any violation of Sectiontoa 7l 31.5 by / a>� - ,?4-dam Sig,S a pl scant for a permit subjectsdoilthe applicant to a civil penalty SEWER CONNECTIONS11., J ntorl more than five hundred d011arstJf500). '�, Qaiel L ., as owner of the property, or my 4 ployees With wages as their SOLAR TANK COLLECTORS sole compensation, will do the work,and lqe struccsLh4rre is not Intended . or offered for sale. (Section 7044, Buslness•bnd Professions Code: The SOLAR PIPING SYS. ISSUE FEE Contractor's License Law does not apply to an owner of a property APPLICATION APPROVED BY DATE who builds or Improves thereon, and who does such work himself or ISSUE FEE through his own employees, provided that such Improvements are not intended or offered for sale. If, however, the building or improvement MECHANICAL PLAN CHECK SUMMARY OF FEES Is sold within one year of completion,the owner will have the burden _ of proving he did not build or improve for the purpose of sale). HEATING SYSTEM 0-100,000 BTU PERMIT BUILDING 5 SMIP $ I, as Owner of the property, am exclusively contracting with AND DUCTING indmrtl contractors construct the project 7044, Business 100,000 + BTU PLAN CHECK f - PERMIT and Professions Code: The Contractor's Cocto Is License Law does not apply to d ^ ISSUANCE E fan owner of property who builds or Improves thereon, and who con- REFRIGERATION 0100,000 BTU PLUMBING s tracts from such projects with a contractor(s) Iitesnetl pursuant to SYSTEM GRADING f the Contractor's License Law). 100,000+BTU_ PLAN CHECK f ❑ I am exempt under Section B.& P.C.for this BOILERS BTU ELECTRICAL S f reason - -- __ Date - -- - MICROFILM S Date Owner SYSTEM REPAIR,ALTERATION PLAN CHECK 3 TOTAL FEE S I hereby certify that I have read this application and state that the above EXHAUST SYSTEM MULTIPLE MECHANICAL 3 Information is correct. I agree to comply with all cityand count PLAN CHECK f VAN EAP otpinances and state laws relating to construction,and hereby authorize VANCE PC 3 representatls of this city to enter upon the above mentioned Property to inspection purysls. —.- Signature SignatureDate -` h-a FINAL FEE f • Drivers'License or SS 9F ISSUE FEE CMF 0865-46 White-e Udine; Canary-Applicant; Pink-Accounting;Goldenrod-Assessor • ..�. • K• .1. CONSTRUCTION AND PLANNING - - - I -•Ii - - I _ •-- POOL'& SPA -. -- . • - ` ` " - Date i. Inspector•-1 +_. .--,„_-.. - ...--•J•_,_..,,- '-i',Data �l'• -Inspector APPROVALS Permit # i APPROVALS i tc J`;'• ( Permit# , 1 1. Temporary Electrical Service or Pole s2-:-:- _ 43. Pool & Equipment Loeation• -- - --- -- - - - ->= -= • 2. Soil Pipe-Undr rn-st.-. g •••"1> k 44. Steel Reinforcement--- ...:-..2 ' . 3. , Electrical Conduit Utility-Undrgrn__ _ 45• . Forms ,• - - . • -_ -" _ _. . • . __4,__Electrical-Conduit=Undrgm ;_ __ 46. Electrical Bonding J------ 5. Steel Reinforce: ; ,- w 47. Rough Plumbing& Pressure Test -- - _ _ _ -- - . . , 6. Electrical UFER Grn_ _ • 1 '48. APPROVAL TO COVER-GUNITE- - - - . _ _ p. 7.. Footings - 49. Electrical Conduit-Undrgrn• • • . 50._ Gas Pipe„O.Undrgrn;Ten ••• • - - • 4 __.9._ Water Pipe•Undrgrn 51. Backwash Lines. P-Trap 0 Undrarn • _10.. Structural Floor System ________ _•' '- 52. APPROVAL TO DECK- --- -- - 1 11. Property Sewer Line& House Connection 53. Backwash & Receptor-Final •• • , is _12,_ -Street.SewerSonoection __•�y_ - _. _ . • _ 54. Heater & Vent-Finals _ 13. Rough Plumbing .`55:-'•P1aintaina SJita n•-Final . __ ..... .. . _. f 14. Rough Electric-Conduit , _ -,-;‘ . ,• 66. Electfical-Final-----z • .. _ 15. Rough Electric-Wiring-----' -- _ I '., \ 67,, Solar System-Final ' ` " - • q• -18:-- Rough:Heating& Air-Conditioning • _ .- - ., -:_b8. '_Fencing &Access Approval ,i i < --17.- Ducts, in Structure.. ... _ • , ...... -- I 69. APPROVED FOR PLASTERING - - - 18.- Ducts;-Ventilating._._ . _ - - _ - - - _-_- --- 19. Gas Pipe-Rough &Test • ' • 60. POO L/SPA SYSTEMS FINAL • • 20.- Roof Framing_ '_ .. . _ _ - • _ r - • • • . • 11 21 Roof Sheathing • . . , 22:-Frame and Flashing - . .... . . NOTES: - 23i Insulation-- -- - - - . - 1 _ t . 24;- Lathing&-Siding._._ .- - . _ _ _ _ - .. . . _. _ . _. . , .• 25: • Drywall Nailing__--. _-- . . . -; . - - •• •. .. 6 . _ 26. - Plaster,&own Co�-i- ---' - - -. - 27: ElectricalPoer eter-Final_ __ - . - _ - _ - ,. a •1.1 '11_.I_nO-n ---Finalrl - 28. Electric - • -' -- -- - - - _.. . . .-. ._ . 29.-- .Final;Heating t`'AirConditioning__ - _ ' 30.-- Fi sal Gds it pe-Test ti“-AU 31. Final Plumbing _ - _ i 32: Water Service-Final - '• 3 33. Gas Service-Final . - . 34. Solar Domestic-Final -- 35. Landscape Sprinkling System - 1 • - - - • - • ' 36. Sound Attenuation . • . - 1 9 37. Handicap Regulations • • 38. FINAL STRUCTURE &BUILDING 1 39. Special Requirements Completed . - 40. Electric Release to Edison s - 4 41. Gas Release to Southern California Gas Co. - a 42. CERTIFICATE OF OCCUPANCY • • No - Date OWNER BECK, IRENE DATE 9/25/80 JOB ADDRESS 180 E. 22nd Street BUILDING PERMIT NO. 5074E7 GENERAL CONTRACTOR Owner-builder DESCRIPTION of WORK Ada Kitchen,Bath.Iaundry,Patin AP 426-061-14 LOT TRACT FIRE ZONE VALUES 12.681.00 Cover IN.. .CTIONS Sign Date TYPE GROUP ZONE R2 �, sou SUBCONTRACTOR PERMITS ISSQED •GAS Date Number Signature WATER '�,�`�•�� Plumbin• ROUGH PLUMBING Can C allille=anglatglaligla '} PROP. SWR. LINE FI HOUSE CON. E �� it-. 4-Dp u e y SPRINKLING SYSTEM �frn =WM MISCELLANEOUS , 1\jc„fL(I r;t/✓ e ' i -7. 5}1 ROUGH HEATING AND AIR CONDITIONING _- TEMPORARY SERVICE OR POLE -- UNDERGROUND LI POWER ROUGH WIRING 1' 6-3i1 Heating and Vent. I TRENCHES 0FORMS 0 STEEL REINF. ij QA,d EXPIRED if- 25'SD //i5-1 FLOOR SYSTEM je,I5-)_- I t>s_ i^1L1-f I, ' Igromplete IDcpertionc 4-3 r-I OOND BEAM 1, STEEL REINFORCE r] bSHEATHING ancel r7 FRAME AND FLASHJIIN/G / pp c' bete 3 ,9i{-� Sig 6 •iniL3 r H. LATHING — IN OUT 14-M -51 " 'P_LASTER, BROWN COAT 7-/.'i SSbe/81 5 'TUBAL. FINAL I (/y Electric ,,/; HL .ING, VENT.. REF RIG. AND A.C.,r'1 FINAL Q�W( 11-�„$O r S aPLUMBING. FINAL AND GAS TEST t l I 0 a H Lila ELECTRIC. FINAL BUILDING, FINAL 4 —.e . COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 ) nitro_ ., ar RECEIV BY PERMIT ' N4 50746 4 .89 T For Applicant to Fill in Completely —Use Ink Only / 1 V BUILDING G .P.NO. 7G, �..„veil(' /— ADDRESS /JU �Q3-/'" ), IF AN T / _ BUILDING /', ^mer OWNER OR // ADDRESS � � �� TENANT (e[+L/r si'-.�i /etn we _Re [z Y✓ UNIT OR _ MAILING Crq!S# _ SPAC . ADDRESS II,) /ztci-y' -�cr TR.NO. BLK. /s TEL. _ CITY C 0sk4 4j&,, , NO.Sia 1"_cd l CONSTRUCTION NEW ADD ALTER REPAIR MOVING DEMOLISH LENDER r BRANCH /} P'1 OWNER 'I re.aela I eC kl ADDRESS ( II VAL�sUE / ,..e ARCHITECT TEL. USE L. .�(J �i LCM.ss f Yst4-(1 $`��68I'T OR ENGINEER NO. V ADDRESS ZONE /.2_._ ITYPE GROUP /�� n APPROVED CONTRACTOR57.1.1C/ BY/) J'//) '/f/(/� DATE/ Jr '/ ADDRESS /t�C� CC' �f =l /`✓, ` 7 / !(('I+ �l--v CLL 7 TEL. CITY (aa0J4-7 /%Al.("5:.. NO.Su'i-fl-Z-C ♦ - Ar/ A 0i/' w i ii LYerr/F. • STATE CITY APPROVED SETBACKS - LIC.NO. LIC.NO. /// l R E n az SIZE NO.OF SLOGS. (FROM C/LST ) / EXP ectICnS O. OF LOT NOW ON LOT FRONT /7 ea C f./ •••- 1, ORtple..e Inst a USE OF ``an Cel- �� „,d, EXISTING BLDG. a, - _ �ayy y N / • .te ram, /Y FSeparate permits are required for L.SIDE 3' FTL O electric,plumbing and heating work. REAR W ' . rt....GE BUILD NG AND W TO E PERFOR D ( PLANN G ACTION 2 "' 1 / X I7 / !C) // %.,/___-- .S�' - i- .S(.�/ 2 - DAPPROVED 7 F-..2 Q .r] / JC / ] �J(/.4 70 Cove.7- APPRO �,,+s// - y. DATE G1 j7S��7 C/ IL' ]]] I !I�12�C / w L ir I herebyacknowledge that I have read this application and state n o r IfOLlJ FOR SPEC[AL REQ�IIR x.sF l,: ( . C that the above information is correct and agree to comply with - -. - -. all laws regulating building construction, and I shall not employ q /r L O Z any person in violation of the workman's compensation laws of Pc&*o LOVlr00 Cr : m La the State of California. 1.A.14 eele.. ;N 16 •• f 2 /3 'hi. m r� 1 hereby certify that I am properly licensed as a contractor under e6 T.5 i 6 3' N the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN NDER VALUATION IS FOR m Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: e am exempt from the provisions of the State of California Business /, ^ a e VALUATION PERMIT FEE S u, antl Professions Code,Division 3,Chapter 9. K - n /1 PLAN CHECK $ J 2 0 Signature of r Permittee , L.CCCi.. $ r��U 8/ TAX $ �, O� u orn c_ O Authorized Agent Date tX ] - 1�L) TOTAL PAID . S q 6,(5q 1PPLICATION FOR A BUILDING PERM'— • I G h[ BUILDING PERMIT NO. Permit it Electrical co Tract !Q / Block Lot No. R PlumbingBuilding3. Address /20 e„,,,„ sy . n 4 mA c 67 l,/ / Permit No. ` / / Cross I [� Mechanical 0. O. Area FA f7(JyfffO_, Street 'l t,X6- e_ Permit No. ray Owner /p`.i1vG en�, l//� rb Tape of Projech ❑ New ❑ Alter lJ Addition Address /•, /.T n�� ❑ Repair ❑ Convert ❑Demo ❑ Occupancy Pmt. Cit //�� G ZiP Pttone ��p D A.P. Sup.Dist./ Y L-0.Sif4//FAA � Ct2•f j- .Jt53. Insp.Area Architect/ Zone . SOL Pmt.No. Designer License No. s Setbacks P/L Front C/L St. Street Width Address Yards Left Right Rear City Zip Phone Eave Prot. Left Right F.P. Engineer License No. C Parking Spaces Required Provide Covered �qa Address m CityZip Phone Struct No.of No.of Height Stories Family u LICENSED CONTRACTOR'S DECLARATION Park Fees ❑ Yes co Fee Required LJ No C.T. Receipt m 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). Zoning Approved By: Date License Class License Number >. Date Contractor Mis<. E Address Proposed Use lL City and Zip— -_ Phone of Structure N CONSTRUCTION LENDING AGENCY ' I hereby affirm that there is a construction lending agency for the 9- performance of the work for which this permit is issued (Sec. 3097, Oce Type Code Civ.CJ. Class Cont. Year G; Lender's Name USE/OCCUPANCY SIZE SO.FT. C Lender's Address Zi OWNER-BUILDER DECLARATION y1. I hereby affirm that I am exempt from the Contractor's License Law — 1e ffooc.t,e following reason: D IET I, as owner of the property, or my employees with wages as their 2. C sole compensation, will do the work, and the structure is not - -- E intended or offered for sale. 3. 0 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. m 0 I am exempt under Sec. . B&PC for this reasonci 4' ci a Date Owner I.PBNP Rt't>.F E WORKERS'COMPENSATION DECLARATION Total Valuation 3 I hereby affirm that I have a certificate of consent to self-insure, Encroachment Permit Required ❑ Yes El No or a certificate of Workers Compensation Insurance, or a certified C COPY thereof. Grading Pmt. Grading '9 Policy No Company Required ❑Yes ❑No Pmt.No. G 0 Certified copy is hereby furnished. Rough Grading 'C 0 ❑ Certified copy is filed with Orange County, EMA. m Approved by: Date 3 Date Applicant CERTIFICATE OF EXEMPTION - FROM WORKERS'COMPENSATION INSURANCE Z c (This section need not be completed if permit is for 5100 or less). 3 I certify tnat 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 CS subject to the Workers'Compensation Laws of California. PERMIT FEES Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Structural 5 Plan Check 5 Exemption, you should become subject to the Workers'Compensation provisions of the Labor Code, you must forthwith comply with such Electrical 5 Special 5 provisions or this permit shall be deemed revoked. Invest. I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO Plumbing S COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION, AND HEREBY RUTH- Mechanical 5 ORIZE REPRESENTATIVES OF THIS COUNTY TOENTER UPON ABOVEINSPECTION MENTIONED PROPERTY FOR PUR- Pre-Grade 3E5. 4 CA–, y_ S. _/ler Inspection $ R Signature of Applicant or Agent Date Rec. No. Issue Permit $ $ Pre' rad i,ee,v N Re 9,6 Print Applicant's/Agent's Name All spaces within this box must be completed to process _ Chelan - p ApprIssuaove Check BY: s/^,1-IUI. Approved: CMF 0335-46(BU-28) rev.6/80 /17/6. c7/6' Q-LaA_ 11)/i ' o{ fid073 nom- _ ja I/IeV/dv dz. Mac- keci .p M (k Ja �ezim ,> > inc.baa_ Co- 4%) a, 011-12., f (i9 / / f f I , } .16*/ tat --7Lad G t—a, LW- cam `ad-a . w2d& ` d a coda a.��,� --('ice- � as c�.u, �� .ha& (ark) me y 4617 9 tat Meda (a ) aithinu 9549- o50-402,0 I, Irene Brogan [principal], of 180 22nd st , city of Costa Mesa, county of Orange, state of California, do make, constitute and appoint Robert C. Beck, of180 22nd st , city of Costa Mesa, county of Orange, state of California, my attorney in fact, for me and in my name, place, and stead, 180 22nd street Costa Mesa Ca. The attorney in fact is empowered and authorized to Design and construct an addition to any or all of the lands described above to any person for any price or prices, and on any terms, as the attorney in fact may deem proper, and to make, execute, acknowledge, and deliver in my name a good and sufficient deed or deeds of conveyance, lease, or other instrument necessary to effect any such sale, conveyance, lease, or agreement. j Initness etc. 92Z a _ __ _.- nrmja 11 spaces within heavy border lines and sign a 11 Tappro Driate declarations. _ __ __ __._-_ __ - CLTYOF COSTA MESA PER NO. TRACT NO. LOT NO. •BLDG.NO. CONSTRUCTION PERMIT -1-)—.50‘ Project Address /&D E , a i�Q/" . TYPE OF CONSTRUCTION % ' Owner Leen/s .dee Phon9r{g-8'DS$ 0 NEW 0 ADD 0 ALTERATION 28((8 /06/81 S..rnn TL Address /Jo E 07,2 •'a 0 REPAIR 0 CONVERSION ❑DEMOLISH ZONING REGULATIONS Arch/Eng. License No. 0 OTHER * DESCRIPTION OF WORK A.P. CONVERS ZONE PLNG. REF.$ Contractor / 41Phone TYPE OF PERMIT BUILDING To guI �ING SETBACK C/LST. PROPS V LINE _ Address 0 GRADING 0 FOUNDATION 0 STRUCTURAL SIDE YARD LICENSED CONTRACTOR DECLARATION 0 TENANT 0 ELECTRICAL OPLUMBING OMECHANICA LEFT YARD I hereby affirm that I am licensed under provisions of Charter 9(corn- RIGHT mencing with section 7000) of Division 3 of the Business and 0 OTHER Professions Code, and my license is in full force and effect. PROJECT DESCRIPTION REAR YARD(TO P/1-) License Class License No. PKG.SPACE REQ. PROVIDED Date Signature . SQ.FT. WORKERS'COMPENSATION DECLARATION OCCUPANCY_CONSTRUCTION TYPE STREET WIDTH PARK FEE $ I hereby affirm that I have a certificate of consent to self-Insure or a VALUATION ZONE ZONING APPROVED BY 1 DATE ' certificate of Workers' Compensation Insurance, or a certified copy SPECIAL CONDITIONS: 1 / thereof(Section 3800, Lab.C.). GRADING CU.YDS. ACRES P"Ilcy No. Company :ertlfied copy Is hereby furnished. REMARKS: r - .:ertified copy is filed with the city Building Division. GG ��11 '' EXEMPTION FROM WORKERS' COMPENSATION DECLARATION W O�/f0 (This section need not be completed if the permit is.for one hundred � q 74E1 ($100) or less). / h certify that n the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to become PLUMBING PLAN CHECK ELECTRICAL - PLAN CHECK Subject to the Workers'Compensation Laws of California. - DWELLING GHRHGE Date Signature BATHTUBS SHOWERS e 0 NOTICE: If after making this declaration, you should become subject TOILETS URINALS GENERATOR 0-1 KW_1-10 KW to the Workers' Compensation provisions of the Labor Code,you must TRANSFORMER forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE LAVS APPLIANCE 10-50 KW_50+ KW revoked. - . CONSTRUCTION LENDING AGENCY KIT.SINKS DISHWASHERS MOTORS 01 HP 1-10 HP - I hereby affirm that there is a construction lending agency for the per- SERVICE SINKS SUMPS (INC.SOLAR) 10-50 HP 50+ HP - ' formance of the work for which this permit is issued (Section 3097 Civ. C.). FLOOR SINKS FLOOR DRAINS FIXTURES OUTLETS SWITCHES Lender's Name Lender's Address DRINKING FOUNTAINS GAS TUBE SIGNS • OWNER BUILDER DECLARATION INTERCEPTORS CLARIFIERS POLE LIGHTS - - I hereby affirm that I am exempt from the Contractor's License Law for • • the following reason (Section 7031.5 Business and Professions Code: SWIMMING POOL P TRAP LUNS I RUL I IUN Any, city or county which requires a permit to construct, alter, POLES METERED SUB • improve,demolish or repair any structure, prior to its issuance,also re- WATER SERVICE ALTERATION PANELS' MAIN E XLIB I R E quires the applicant for such permit to file a signed statement that he Is licensed pursuant to the provisions of the Contractor's License Law GAS SERVICE OUTLETS 'SERVICE Incomplete'APlsper Ions (Chapter 9 (commencing with Section 7000) of Division 3 of the Cancel Business and Professions Code) or that he is exempt therefrom and the WATER HEATERS BTU OUTPUT basis for the alleged exemption. Any violation of Section 7031.5 by q applicant for a permit subjects the applicant to a civil penalty SEWER CONNECTIONS Date L.^ Sig ! j" �''r`, . it more than five hundred dollars ($500). ') 4.01 as owner of the property,or my'employees with wages as their SOLAR TANK COLLECTORS ' sole compensation, will do the work, and`t{le struct4re is not intended or offered for sale. (Section 7044, Business noProJessions Code: The SOLAR PIPING SYS. ISSUE FEE Contractor's License Law does not apply to an,owner of a property - APPLICATION APPROVED BY DATE who builds or improves thereon, and who does Such work himself or ISSUE FEE through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement MECHANICAL PLAN CHECK SUMMARY OF FEES IS sold within one year of completion, the owner will have the burden of proving he did not build or improve for the purpose of sale). BUILDING I, as owner of the property, am exclusively contracting with HEATING SYSTEM 0-100,000 BTU PERMIT $ SMIP $ ri tensed contractors to construct the project (Section 7044, Business AND DUCTING 100,000 + BTU PLAN CHECK $ PERMIT and Professions Code: The Contractor's License Law does not apply to L. ISSUANCE S an owner of property who builds or improves thereon, and who con- REFRIGERATION 0-100,000 BTU PLUMBING $ tracts from such projects with a contractor(s) licesned pursuant to SYSTEM - GRADING $ the Contractor's License Law). 100,000+BTV PLAN CHECK $ ❑ I am exempt under Section B.8 P.C.for thisBOILERS BTU ELECTRICAL $ 5 reasonPLAN CHECK S' MICROFILM S Date- - Owner SYSTEM REPAIR,ALTERATION TOTAL FEE E I hereby certify that I have read this application and state that the above EXHAUST SYSTEM MULTIPLE MECHANICAL $ LESS'PLAN CHECK $ VANCE AD- information Is tatrect. agreeito comply with all cityerand countye VANCE PC $_ rep ordinances and state laws relating to construction,and hereby authorize representatives of this city to enter upon the above mentioned property to inspection purppses. (, p Signature O_GLOi -/ i Date II ' ��a FINAL FEE $ Drivers' License or SS I.� ISSUE FEE CMF 0865-46 White-B Ilding;Canary-Applicant; Pink-Accounting:Goldenrod-Assessor CONSTRUCTION AND PLANNING POOL& SPA 'sr- APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole • 43. Pool & Equipment Location 2. Soil Pipe-Undrgrn + 44. Steel Reinforcement • 3. Electrical Conduit Utility-Undrgrn 45. Forms 4. Electrical Conduit-Undrgrn 46. Electrical Bonding - - 5. Steel Reinforce • 47. Rough Plumbing & Pressure Test 6. Electrical LIFER Grn 48. APPROVAL TO COVER-GUNITE • 7. Footings 49. Electrical Conduit-Undrgrn 8. Foundation 50. Gas Pipe, ❑Undrgrn,Test , 9. Water Pipe-Undrgrn 51, Backwash Lines, P-Trap. ❑Undrgrn 10. Structural Floor System ^ 52. APPROVAL TO DECK 11. Property Sewer Line & House Connection ` -(3( 53. Backwash & Receptor-Final 12.. Street Sewer Connection 54. Heater & Vent-Final 13. Rough Plumbing 55. Plumbina System-Final • - 14. Rough Electric-Conduit . , 56. - Electrical-Final 15. Rough Electric-Wiring 57. Solar System-Final 16. Rough Heating& Air Conditioning • - - bB. - Fencing &Access Approval 17. Ducts, in Structure 59. APPROVED FOR PLASTERING 18. Ducts, Ventilating 19. Gas Pipe-Rough &Test 60. POOL/SPA SYSTEMS FINAL 20. Roof Framing ' 21. Roof Sheathing 22. Frame and Flashing NOTES: 23. Insulation 24. Lathing & Siding 25. Drywall Nailing 26. Plaster-Brown Coat 27. Electrical Power Meter-Final 28. Final Electric 29. Final Heating'&Air Conditioning 30. Final Ges-Pipe-Test--- - `' t.L; 31. Final Plumbing 32. Water Service-Final 33. Gas Service-Final 34. Solar Domestic-Final 35. Landscape Sprinkling System 36. Sound Attenuation 37. Handicap Regulations 38. FINAL STRUCTURE& BUILDING 39. Special Requirements Completed 40. Electric Release to Edison 41. Gas Release to Southern California Gas Co. 42. CERTIFICATE OF OCCUPANCY No Date / • -APPLICATION FOR A BUILDING PEP"'f• G BUILDING PERMIT NO. Electrical W Tract 0 {O / Block Lot Permit No. 4 Building n S n Plumbing Address /G Q / �1 nn / sv . (,�q /}PSA �-0'7 y 6 Permit No. to l> ! oCCrross Mechanical a Area _ [s/ /p Street /�ORn'x e� Permit No. / H3] /1 (//�/v ray m /I Owner l.eSee At, Type of Project: CINew CI Alter LJ Addition Address / Od e,{ L701gr(i S'-f- CI Repair ❑ Convert El Demo CIOccupancyPmt. City &O(74 ///rM dZiP74 Qy Phone jz j. 05-3 A.P. i sp.Area Architect/ / Zone SPI.Pmt.No. Designer License No. Setbacks P/L Front C/L St. Street Width Address Yards Left Right Rear City ZIP Phone have Proj. Left Right F.P. Engineer License No. C Parking Spaces Required Provide Covered a Address CZ Struct No.of No.of m City ZIP Phone Height Stories Family Y LICENSED CONTRACTOR'S DECLARATION Park Fees — Yes Fee Cri m I hereby affirm that I am licensed under provisions of Chapter 9 Required _ No C.T. Receipt L (commencing with Section 7000 of Division 3 of the Business and Zoning Approved By: Date Professions Code,and my license is in full force and effect). License Class License Number > Date Contractor Misc. E Address Proposed Use of Structure it City and Zip Phone ta CONSTRUCTION LENDING AGENCY In E I hereby affirm that there is a construction lending agency for the OccTYpe ..9- performance of the work for which this permit is issued (Sec. 3097, Clas Cons Code Civ.C.). Class Const. Year y Lender's Name USE/OCCUPANCY SIZE SQ.FT. c Lender's Address J OWNER-BUILDER DECLARATION ✓ I hereby affirm that I am exempt from the Contractor's License Law 1 m forAtie following reason: ad I. as owner of the property, or my employees with wages as their 2. E sole compensation, will do the work, and the structure is not _ intended or offered for sale. 0 I, as owner of the property, am exclusively contracting with 3 licensed contractors to construct the project. 2 0 I am exempt under Sec. , B&PC for this reason 4. m Dep.-S-4;0.1 s- Owner tee NP SPgk,- E' / Total Valuation E WORKERS'COMPENSATION DECLARATION 3 I hereby affirm that I have a certificete of consent to self-insure, Encroachment Permit Required ❑ Yes ❑ No or a certificate of Workers' Compensation Insurance, or a certified C copy thereof. Grading Pmt. Grading 3 Policy No Company Required ❑Yes ❑No Pmt.No. O. 0 Certified copy is hereby furnished. Rough Grading to 00 Certified copy is filed with Orange County, EMA. Approved by: Date 2 Date Applicant 3 • CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE 2 (This section need not be completed if permit is for $100 or less). C I certify that in the performance of the work for which this permit is 3 ci issued, I shall not employ any person in any manner so as to become in • subject to the Workers'Compensation Laws of California. PERMIT FEES Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Structural $ Plan Check $ Exemption, you should become subject to the Workers'Compensation provisions of the Labor Code, you must forthwith comply with suchSpecial Electrical $ Invest. $ provisions or this permit shall be deemed revoked. I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO Plumbing $ COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION,AND HEREBY AUTH- Mechanical $ ORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON . THE ABOVE MENTIONED PROPERTY FOR INSPECTION PUR- Pre-Grade ES.tit /J r r_07�__/r� Inspection $ ,1plicant or Pre-Gratle Permit Signature of Applicant or Agent Date Rec.No. $ Issue $ Peeve Bee, ' Print Applicant's/Agent's Name Issuance All spaces within this box must be completed to process Plan I n Approve Pa Check By: CALL Approved: CMF 0335-46(BU-28) rev.6/80 "��'1///�ll--... OWNER BECK, IRENE DATE 9/25/80 / JOB ADDRESS 180 E. 22nd Street BUILDING PERMIT NO. 5074FY GENERAL CONTRACTOR Cwner-builder DESCRIPTION of WORK A e e Kitchen Bath iattn• . AES - . 426-061-14 LOT TRACT FIRE ZONE VALUES 12,681_00 Cover IN F=r3t.TIONS Signature Date TYPE GROUP ZONE R2 SOIL P RMITS ISSUED GAS SUBCONTRACTOR Date I Number I Signature WATER Plumbin ROUGH PLUMBING ft. KI'8 31 OL' F•as :DD I • jPROP. SWR. LINE In HOUSE CON. 0 Y I. rl�' LLie' 4l.:5 y SPSINKLING SYSTEM '�a MISCELLANEOUS ,us y1_(}-r-;g7N 8'M cg-7_'3I ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND ❑ POWER 0 •� ROUGH WIRING t'" ti3JitL Heating and Vent. 1 TRENCHES I_3 FORMS U STEEL REINF. n 0,I6 E X P I R E D _9-..,25;gn /7y53✓ FLOOR SYSTEM Xec2,"t' rmC 1-14 of l Incropplete Incpectionc .-I BOND BEAM n STEEL REINFORCE n bSHEATHING II/( 4�J nCeg iA,�-�- >FRAME AND FLASHI f3M q-C-4111" - NTJ4 Jr �1 - �'r� . LATHING — IN OUT Q-?--)FeI ((..�r,,�� PLASTER. BROWN COAT '7' M SJ/?BJ$f f!❑JF 'TUBAL, FINAL Electric .,A{ ae 'I�� C� H. ,NG. VENT., REFRIG. AND A.C., FINAL Or LI-*-OO Tdb41- S— 04PLUMBING, FINAL AND GAS TEST n O B II d /Ll G✓ , ELECTRIC, FINAL , BUILDING. FINAL .. lir _ COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT • P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 • nne, . RECEIV BY PERMIT- �C`"s`.' - - Aa89 For Applicant� to Fill in Completelyp — se Ink Only l /� / N° 5 00 7 4 6 • - _ BUADILDING DRESS / o &Q olaS �15� Si-iA.P. NO. !/"//_ _Q 6 7_7 ty BUILDING , ( // OWNER OR q ADDRESS TENANT /6/02e,e ) /tee -e jC(�,✓ NIT OR MAILING f / '"w/,rJr� SPAS_clal6: ADDRESS Ito ire St- TR.NO._ I DZ BLK. CITY ('�,9• ''IP_.f'A- NO`S Ft Sd - NEW LTER REPAIR MOVING DEMOLISH LONSTRRCTION - LENDERTRryt BRANCH OWNER 7V—C,vLe= 19 CL'. �'rl� ADDRESS USE L nc1 1 RI # les4ryt_UEs I2 ARCHITECT TEL. - N� /��/'� OR ENGINEER NO. L/ ADDRESS ZONE / ` � TYPE GROUP CONTRACTOR DA? APPROVEDBY i DATE ADDRESS / TEL. CITY ,. li - A NO d ed SO .1 A% re V "—Sri i� «T) ix.F STATE CITY APPRO ED SETBACKS a LIQ NO. LIC. NO. ff / 1 R E n W SIZE NO.OF BLOCS. (FROM C/L STR ` l� OE IX P eCt1Ons a OF LOT NOW ON LOT „__FRONT ` �J ",1 late Insp V USE OF ��rrL L Icy/Cancel n �,� F.: EXISTING BLDG. - s � 0 y R•• FSeparate permits are required for L.SIDE 3 'FT�' •tem G electric,plumbing and heating work: REAR W 3't` /Yil7 I.,,i SE F BUILD NG AND Wpg� O E PER FOR D PLANN G ACTION , X !/9 ' /o '' RYA zgV/r22•� AWROVO9 g' 4 ' f)•I° 1/ APPROV•ElS j" / K ! PG �OVe �aV G�A DATE N \' ` CCW o1 hereby acknowledge that I have read this application and state HOLD FOR SPECIAL REOUIREMF.NT, yz that the above Information is correct and agree to comply with -, .,_ _ es es Mx all laws regulating building construction, and I shall not employ //// /'L O > Zany person In violation of the workman's compensation laws of 9ocfr0 e, 'cr ' 906 e W S the State of California. (,Q4 ty {KiB ' a2 f S.--6D. T. i2 6 dr D 1 ro .: 'F 3 I hereby certify that I am properly licensed as a contractor under the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN NDER VALUATION IS FOR o Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: 0— am am exempt from the provisions of the State of California Business VALUATION PERMIT FEE $ Gi y ^ '1 and Professions Code,Division 3,Chapter 9. 'n m / PLAN CHECK $ 3 2. 0 Signature of /8 IL Permittee Orn $ t . TAX E a, 89 f Authorized Agent Date 7— IX ' ' /t& TOTAL PAID y 96,89 U ti OWNER HATCH, W..-A. JR. DATE 12-10-56 JOB ADDRESS • 180-E. 22nd St. BUILDING PERMIT NO. #4036 GENERAL CONTRACTOR Owner Bldr• VALUE $ 175.00 AP118-081-06 I{ BLOCK TRACT 269 Cover & close porch GROUP J TYPE V ZONE Rh FIRE DISTRICT 4084 PERMITS ISSUED INSPECTIONS DATE SUBCONTRACTOR DATE NUMBER Footing Trench Foundation Forms and Grade to Garage Rough Framing U'/,1",�i tZ- .Sl Plumbing,Rough to Slab Plumbing, Rough Complete Temporary Pole Wiring, Rough Heating,Rough Heating,Final Sewer, House Sewer,St. Septic Tank or Cesspool L;' 'ng, In Out P. wring Plumbing,Final,Fixtures Complete Plumbing, Final Gas Test Wiring,Final Occupancy alter /2 04'S� FORM 210 3M 10-25 h036 Pr Costa Mesa Building Departinent �—APPItI®CATIO1N `OR P!�'RMIT 7 P. O. Box 3!7 A��+� BUIL ING 1 COSTA MESA, CALIFORNIA _ FOR OFFICE USE ONLY FOR APPLICANT TO FILL I�IN// Receipt No. //Peermit No. Address/ru `-r, - 2L r2�s-/i", i� I TD 36 Costa Mesa, California Reeceiivve�d bby Date Rec'd. Date Issued / Nearest / X? %� z-`� `� /J` -JD '�� Cross St. 1 77� i Building Address owner��{ �, a�. Costa Mesa, California Mail Address/5r'--E -22- Nearest /t �.4-- Tel, rf Cross St. City L.9fvup "`2V.-e--5--4...- Not,' b�2y for ZoneNo.of Type Group Architect or Lic. I Plans Engineer No. Approved by Date Address City Lfc. !. 1 ntractor,TZy`'h44 No. Lq r y'' ° i• Address CITY OF CC,;,,T-'\ P+ 1'•t. Legal I Lot , / I I Wjc+ r PL,M:i:ING L'EI )'. Description No. /� Block i'r `f SUBJECT TO BLDG. DEPT. REG. I (Attach Metes and Bounds) / / Se—0c / •`/—D�p '�11 /_� - Size of LoteOi x ��7 I NNow. o Blot '/ BY DATd,y -( O-. "� Use of /� No.of No.of 13�sry T�Cn fl- s) Existing Bldg. "ey-Ar a_ I Families I Rooms 7 Setback Line from Rear Yard s/ 2 Center of Street Side Yard �f7 j DESCRIPTION OF WORK—129 r New I I Alteration I Addition I Repair I I Moving I I Demolish I ccr Building No.of N Size Rooms Stories Cs tenor WallI Roof tering 4....,2.4......e.. Covering 0-ear APPROVALS Use of NewI Building ve.-C'�-4R ...--C/5_,..4.42-0--.----(1114-I Foundation Location Inspector • Date 1-0.s-it" _c_ e / �� Under-orms, nnerials, l .�1+�� Under-Pinning // 2 `Li'� /L , Al Frame: Fire Stops, N t e g ha /O pplitiBracing,Bolts I e acknowledge that IA have read this A lila/tion CD and state that the above is correct and agree to comply Lath.Int. o with all City Ordinances and State Laws regulating building construction. Lath.Ext. Q I Signature of /� ,, �^ /� Permittee ?� l/cf Gtr-CN\ �//. Plaster, Int Authorized Agt. Plaster,Ext. Q. to V nation Permit Fee $ 02. Masonry Reinforced al.: .i./� 3: J Plan Check $ —' Bond Beam ` Total O Fee $ '—"s I FINAL n MI FORM 209 1055 O. P.6 5. V i I , 0 • c u J c a J o _ a a t 0. • Street .. • PLOT PLAN Show location and distances from property line and between buildings. L- C N .�..t. •. - . L t ti� VS() O IJ •