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Home My WebLink About235 24TH PL - Building Permits a. 1 i .. `�STa MFS. 1 • :F 9: CITY OF COSTA MESA _ - N ! BUILDING DIVISION .1- 1 '__•....: ;' i DEVELOPMENT SERVICES DEPARTMENT ° PERMIT PERMIT NUMBER •N.,•,'-.w.-o,9`"• BOO-00488 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 235 24TH PL Status: ISSUED Suite: Applied: 04/14/2000 Vicinity: MASTER SUITE ADDITION 8 NEW GARAGE Issued: 06/28/2000 Parcel Number: 11910107 Zoning: y Applicant: COX, J PATRICK ISSUED BY: / // Address: 235 24TH PL Phone: (949)642-4876 COSTA MESA,CA Zip: 92627 Owner: COX, J PATRICK Address 235 24TH PL Phone: (949)642-4876 COSTA MESA, CA Zip: 92627 Contractor OWNER-BUILDER Address: Phone: Zip: License: 0 Arch : FLEETWOOD JOINER ASSOC. Eng: ' Address: 5010 CAMPUS DR#101 Address: Phone: (949)640-0606 - Phone: NEWPORT BEACH,CA Zip: 92660 License: License: . SCOPE OF PERMIT CONSTRUCT NEW 668 SF MASTER BEDROOM SUITE ADDITION; NEW 447 SF ATTACHED 2-CAR GARAGE; NEW 354 SF TRELLIS PATIO COVER;CONVERT EXISTING 354 SF GARAGE TO NEW LIVING ROOM;ADD FRENCH DOORS AND WALL IN EXISTING DINING ROOM MINOR MODIFICATION 00-14 TO ALLOW A 16 FT. FRONT YARD SETBACK FOR THE GARAGE(20 FT.REQUIRED.-20 PERCENT REDUCTION) FEE SUMMARY . Plan Check: $632.29 Calc Valuation: $96,018.78 Permit: $972.75 Claim Valuation: $0.00 SMIP Res: $9.60 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $1,614.64 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: , NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and fInal approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. / > FOR INSPECTIONS CALL: (714)754-5626 // DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: • Policy Number: (This section need not be completed If the permit Is valued at one hundred dollars($100)or less.) ❑ 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,end agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with 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 3706OF 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.Lic.N Class If Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit su ects the applicant to a civil penalty of not more than five hundred dollars($500).): I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exemi3ot7 c. r� Business and Professions Code for this reason: Signature — 22/• /Y• /- Expires: Verification of Ownership by(type of documen,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,Gm 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 Catifomia 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 feel 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 epereit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes 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). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (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 CO ••- •r' D AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and slate that the information given is correct.I agree t• amply with atf state laws ci ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-des jaw,y for inspection pu os . e of to occupy or allow occupancy of any building authorized by this permit until final' pectio0. • Signature Of Legal ner(s) Date And/Or Authorized Applicant Date COPE t INSPECTION TYPE BATF INTRIALS CODE INSPECTION TYPE DATE INTRIALS 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 Signm 222 Final Sitey n 204 Final Demolition 250 Final Building/Occupancy s "13— � ,✓ 2446-46 • • NEWPORT-MESA UNIFIED SCHOOL DISTRICT 3 3 8 3 CERTIFICATE OF COMPLIANCE OF DEVELOPMENT FEES PURSUANT TO AB 1600 AND AB 181 To: Mv` City of Costa Mesa District Receipt No. ( ) City of Newport Beach ( ) County of Orange Plan Check No. 5,f7f?•/Y •se Applicant: :IV. PkV4.3.Q S Address: 2? 24�' L.. CCCLY\ LAE-&A DA} s Telephone Number: ( 7 4 R )\ct 2. ( — C �4 B-7 Tract/Parcel and Lot Number(s): j / t tS in I 'r)-7 PL. Location of Project: 7 .l l Ilii L. CQSS /APS'��^ CA- Number of Square Feet of: Residential Space C7?. Z- x $1.84 Total N250'ran Commercial and Industrial Space x $ .30 Total Commercial/Industrial 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 (his 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. By: t.P,tjttA N )2. AXJ??I* Authorized R- resentative The above representation as to square footage is true. Applicant agrees that if it is later determined that such representations are not true,then this certificate shall automatically terminate and the approp ' e City/County shall be notified. JUN 28 2860/9:34 NM/1 1880.48 2 r-0 RCPT0:61-0861646 Date: ° / Y. I 110191 ( pplicant • • 0ORMFs ( - L�9, - CITY OF COSTA MESA BUILDING DIVISION I A' } ( DEVELOPMENT SERVICES DEPARTMENT PERMIT NU R • PERMIT ~f�APOMPfEO�¢�. M00-00256 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 • MECHANICAL PERMIT Job Address: 235 24TH PL Status: ISSUED Suite No Applied: 06(2812000 Issued: 06/28/2000 Vicinity: NEW ROOM ADDITION Parcel Number 11910107yyy��y//)�� ISSUED BY: !,7 / Applicant: COX, J PATRICK / Address: 235 24TH PL Phone: (949)642-4876 COSTA MESA,CA Zip: 92627 Owner: COX, J PATRICK Address: 235 24TH PL Phone: COSTA MESA,CA Zip: 92627 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 0 Arch/Eng: Address: Phone: Zip: License: SCOPE OF PERMIT 1 FAU, 1 AC UNIT AND 1 VENT FAN FOR NEW ADDITION/REMODEL. REF:B00-00488 FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $14.80 1 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0 Inst/Rep. Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $14.80 1 Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace $0.00 0 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct $7.25 1 Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers Fire Dampers $0.00 0 Up to 3 hp $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0 Air Handlers z 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $60.35 COMMENTS I SPECIAL CONDITIONS • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections end final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 DECLARATIONS ' WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: • Policy Number: (This section need not be completed If the permit is valued at one hundred dollars($100)or less.) ❑ 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 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.Lic.4 Class 4 Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). 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 Bustss 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 su ' cts the applicant to a civil penalty of not more than five hundred dollars($500).): 2 na 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 em e r sec. Business and Professions Code for this reason: p�O Signatur : r Date: 0-2-0 Own° rifled by driver's license ❑Yes 0 No Drivers License No. Expires: Verification of Ownership by(type o 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,Gry 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? ❑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 ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application akermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes D No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes's,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 com II state aws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described pr fo inspecti gree not to occupy or allow occupancy of any building authorized by this perr nitirtil final inspection. CY se.- Signature Of eget Owner(s) Date And/Or Authorized Applicant Date CODE A INSPECTION TYPE DATE f6TIDAL$ CODE r INSPECTION TYPE gqPATE TRIAL 1616 Fixed System Final Fire Prevention 206 Final Mechanical 3-9 -0( 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 S446-46 • .-4IA'MFS �9, - CITY OF COSTA MESA 4 fA ! BUILDING DIVISION PERMIT NUMBER i �: i• DEVELOPMENT SERVICES DEPARTMENT ,.• .....?f• °i PERMIT // ./, Test-.:-co`f.' r00-00335 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 235 24TH PL Status: ISSUED Suite No Applied: 06/28/2000 Issued: 06/28/2000 Vicinity: NEW ADDITION Parcel Nunmber: 11910107 ISSUED BY: Applicant: COX, J PATRICK Address: 235 24TH PL Phone: (949)642-4876 COSTA MESA,CA Zip: 92627 Owner: COX, J PATRICK Address 235 24TH PL Phone: COSTA MESA,CA Zip: 92627 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 0 . Arch / Eng: Address: Phone: Zip: License: SCOPE OF PERMIT 1 BATHTUB,4 FLOOR DRAINS,4 GAS OUTLETS, 1 LAUNDRY TUB, 1 SHOWER,2 FLOOR SINKS, 1 WATER CLOSET AND 1 WATER HTR FOR NEW ADDITION/REMODEL. REF:B00-00488 FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $9.80 1 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $9.80 1 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 $9.80 1 Drain, Floor $39.20 4 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) $9.80 1 Drain,Roof $0.00 0 Shower $9.80 1 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 $0.00 0 Sink,Floor $19.60 2 Water Service $0.00 0 Gas(1-4 outlets) $6.15 1 Sink,kitchen $0.00 0 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $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: $149.75 COMMENTS I SPECIAL CONDITIONS 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,. 7 required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit j FOR INSPECTIONS CALL: (714)754-5626 DECLARATIONS • WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. _ ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ 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(S100000),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.Lic.# Class k Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit arts the applicant toe civil penalty of not more than five hundred dollars($500).): I,as owner of the property,or my employees with wages es 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 cont - • • 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 purs . t t• he Contractors License Laws.). ❑ I am exeu , . AP Business and Professions Code for this reason: Signawr . _IC �Or 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 ❑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 ❑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_agermit 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 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 meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). —. - _ ._ __ _.._._.___._-..—__.___.-._o—.._—__-- _---_.--___.__.hich_.—.._________....._._. 7 If a permit from the South Coast Air Qualify 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 • r PLIANCE 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 agr=, o •ly with all state w -nd ci '•-noes relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-d •e. • ••, •r inspecti pu••se-c t to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Leval Owner(s) Date And/Or Autho •ed Applicant Date CODE r INSPECTION TYPE PAIS fNTtTIALS CODE I INSPECTION TYPE PATE INTRIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing i`r;-O 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 2446-46 elCITY OF COSTA MESA 4 BUILDING DIVISION > 9,t DEVELOPMENT SERVICES DEPARTMENT /r'ERMIT NUMBER Ft.1 I(47 I BUILDIt/ PERMIT *�ro ,�r.' P00-00456 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 235 24TH PL Status: ISSUED Suite No Applied: 08/24/2000 Issued: 08/24/2000 Vicinity: POWDER RM&KID'S BATH Parcel Nunmber: 11910107 ISSUED BY: Applicant: COX, J PATRICK Address: 235 24TH PL Phone: 949-640-9881 COSTA MESA,CA Zip: 92627 Owner: COX, J PATRICK Address 235 24TH PL Phone: COSTA MESA,CA Zip: 92627 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 0 Arch / Eng: Address: Phone: Zip: License: SCOPE OF PERMIT SUPPLEMENTAL PLUMBING PERMIT. 1 BATHTUB, 1 KITCHEN SINK, 1 WASH BASIN, 1 WASH BASIN SET,2 WATER CLOSETS. REF:B00-00488&P00-00335 FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $7.25 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $9.80 1 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 $9.80 1 Dishwasher 50.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $9.80 1 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 $0.00 0 Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) $0.00 0 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: $66.05 NOTICE: The work authorized by this permit cQNIMPp)IsilasP IAL2CaNEVIE S requirements under California statutes and related regulations. (Ord. No. 92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446.46(6/00) •-� DECLARATIONS 1 WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit Is valued of 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 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.Lic.If Class D 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: Lenders Address: Signature: • Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that 1 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.704.4,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 purs : t to the Contractors License Laws.). ❑ I am ex e• nd•r sec_ir— . Business and Professions Code for this reason: Signa e:- ' `i Date: Li,--C90 Own'r • edified by drivers rinse. ❑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 6,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be tiled with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑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 a_pennit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? IJ Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any pan of the facility to be constructed under this permit be within 1000 feel from the outer boundaries of a school? ❑Yes 0 No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 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 ANr 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 : to e laws and city or ces relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property to cti n purposes. re of t9.occupy or allow occupancy of any building authorized by t7drmit until final inspection. Signature Cl Legal Owner( Date C/ And/Or Authorized Applicant Date CODE IINSPECTION TYPE PAIS !EMU CODE INSPECTION TYPE PATE MAA 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing , e2401 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 4 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy • F CITY OF COSTA MESA A On M __ 44, -1- BUILDING DIVISION ; r DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER I1;I PERMIT / M00-00408 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 • MECHANICAL PERMIT Job Address: 235 24TH PL Status: ISSUED Suite No Applied: 09/20/2000 Issued: 09/20/2000 Vicinity: LIVING ROOM Parcel Number: 11910107 ISSUED BY: Applicant: COX, J PATRICK Address: 235 24TH PL Phone: COSTA MESA,CA Zip: 92627 Owner: COX, J PATRICK Address: 235 24TH PL Phone: COSTA MESA, CA Zip: 92627 Contractor: OWNER-BUILDER Address: • Phone: Zip: License: 0 ' Arch/Eng: Address: Phone: Zip: License: SCOPE OF PERMIT SUPPLEMENTAL MECHANICAL PERMIT FOR A GAS FIREPLACE FOR A SFR. 1 FACTORY FIREPLACE, 1 GAS PIPING. REF:B00-00488&M00-00256 FEE SUMMARY Quantity Quantity ISSUE FEE $7.25 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $0.00 0 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler - $0.00 0 Inst/Rep. Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping $6.15 1 Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace $10.65 1 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct $0.00 0 Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers Fire Dampers $0.00 0 Up to 3 hp $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $24.05 COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 // 2446.46(6/00) (' DECLARATIONS 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 if 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 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.Lic.N Class 4 Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097.Civil Code). 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 fit 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 Bu ess 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 s jects the applicant to a civil penalty of not more than five hundred dollars($500).): to 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 exem sec. Business and Professions Code for this reason: Signature: ? Date: 9., 20-0-A Owner I tied by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,I.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: O I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). O As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 10 Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 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 corn th all state I s and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described o r. spection u a ree not to occupy or allow occupancy of any building authorized by this permit until final inspection. !Signature Of L al Owner(s) L Date And/Or Authorized Applicant Date T,00E A INSPECTION TYPE PLL INTmAL5 CODE! INSPECTION TYPE .gAjE�� ns 1616 Fixed System Final Fire Prevention 206 Final Mechanical 0/(1 I"`CLJJLJ/AVr • 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 •`54 M4:$4 CITY OF COSTA MESA >#'11 BUILDING DIVISION P MIT NUMBER DEVELOPMENT SERVICES DEPARTMENT 00-00605 �•. PERMIT '"Po4a4009' (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 235 24TH PL Status: ISSUED Suite No Applied: 06/28/2000 Vicinity: NEW ADDITION Issued: 06/28/2000 Parcel Nunmber: 11910107 .{1 �/yy�� Applicant: COX, J PATRICK ISSUED BY: (J- 0 '/ Address: 235 24TH PL Phone: (949)642-4876 COSTA MESA,CA Zip: 92627 • Owner: COX, J PATRICK Address 235 24TH PL Phone: COSTA MESA,CA Zip: 92627 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 0 SCOPE OF PERMIT 19 LIGHTS,21 OUTLETS, 11 SWITCHES AND 200 AMP METER FOR NEW ADDITION/REMODEL. REF:600-00488 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 $20.90 19 up to 50 kva/kw $0.00 0 Recept Outlets $20.73 21 up to 100 kva/kw $0.00 0 Switches $12.10 11 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 lhp $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 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $107.73 Intermed Pole $0.00 0 COMMENTS/SPECIAL CONDITIONS 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 / DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: O 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. O I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: • Policy Number: (This section need not be completed if the permit Is valued at one hundred dollars($100)or less.) O 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 III 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 M EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(Meow),IN ADDmON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.a Class Contractors Signature; Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit Is issued.(Sec.3097,Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to Its Issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Busin ss and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit sub cts the applicant to a civil penalty of not more than five hundred dollars($500).): I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code:The contractors License Law does not apply to an owner of properly who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exam u Business and Professions Code for this reason: .,('� Signature{'� r Date: 6r2.. Owner I died by drivers license. Yes 0 No Driver's License No. / Expires: Verification of Ownership by(type of docu nt,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: o I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). O As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the dMsion. 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,ore 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 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 kPaermit 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? ❑Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 6 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF 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 .,; r.I state laws nd rdinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described p' tion pu e .I ag of to occupy or allow occupancy of any building authorized by this perm til final Inspection. Signature Of Legal er(s) Date And/Or Authorized Applicant Date ;ODE r INSPECTIONTYPE PATE fame COOEr INSPECTIONTYPE PATE INTITUL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical //may/////' 1266 Pool Spa Final 210 Final Plumbing rC(w.bti 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 2446-46 _ Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.• _ _ -- _ .- - _ CITY OF COSTA MESA- - Efl IT NO. / • TRACT NO. • LOT NO. BLDG.NO. •' iI _ ' _ f- i , - ' CONSTRUCTION PERMIT j/�6,q-'to- - • ' wm ' INSPECTION Applicant's Mailing Address '10422 Trask Ave. Garden Grove TYPE OF CONSTRUCTION U NEW .0 ADD U ALTERATION U.REPAIR �(� � ��R �N'Jf Cls1 �QN Project Address 235 24th P1.. • . -• 0 CONVERSION ❑ DEM IS ❑ OTHER ' . - - 'f ,]JC- 4/�U/{j-j .]ip O'J ,TL Owner's Name Mr. Christinsen 548-2566 DE RIPTI N FWORK ep ,acemenFt of Water Heater and - Phone • - Repipe -• - - 'ZONING REGULATIONS - . .. Address ' 235 24th P1. Cgsta Mesa - • TYPE OF PERMIT _ GRADING ❑ FOUNDATION - 11��11 U STRUCTURAL ' A. ZONE • Arch/Eng. - License NO. - ii TENANT ❑ ELECTRICAL 'A`1 PLUMBING Ill MECHANICAL 'PLNG.REF.596 BUILDING , Address. - :❑,'OTHER I •: ' = - ° TO BUILDING cFrn wry Cn 5r I PROPERTY LINE i -REAR YARD (TO P/L) �\ Contractor's NameA-amen Plumbing-HeatingphoneI 530-2440 PROJECT DESCRIPTION SG. FT. OCCUPANCY _ - - nldr'ess'(naigng) 10422 flask Ave. Garden Grove 92642 U CONSTRCTIONTYPE ' VALUATION$ I • . ' 'LEFT SIDE YARD RIGHT-SIDE YARD - License No: _2_5030] ZONE GRADING CU. •.ACRES PKG.SPACE REQ. PROVIDED LICENSED CONTRACTOR DECLARATION i I Remarks: STREET WIDTH - PARK FEE$ - - I hereby affirm that Pam licensed under provisions ofl,Charter,9 (commencing ' _ ' with section 7000) of Division 3 of the Bull Professions .tl= and 1 SPECIAL CONDITIONS: • my license is in fie fipe ancteffect. 1 / ; ' / _ • I -License Class Class' VV - License No. =,I �y • �, i ; PLUMBING ' , - Date.4-'13-83 9gnalure� �� Bar Sink Sewer Cap —� • ELECTRICAL - --aRKERS'COMPENSATION DE to of co ONt -_ -_ reby affirm that I have.a certificate of copse to self-insureher a certificate- - - Automatic Washer 1 - - Meter Clover 100 amps' orkers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer - Sewer Connection'- - ' ' Construction Pole. Sub Panel 600, Lab. 830]6419� Fremont ' Backflow Irrigation Solar Collectorz i PouCe No. Company . - - Cooking Unit Sub Pole i ® Certified copy is hereby furnished. Bathtubs Solar Piping ; - Certified{ ydslfiled with the city B iltling Division. Dishwasher Motors (]0-1 HP ❑1 h$ ! Date +-.LVJ Applicant a amen rLumbinA-Heating Clarifiers - Solar Tank EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Dishwasher Swimming Pool w/Spa Dryers OGas DElectric Inc.Solar ❑9-15 HP ❑16-15+ (This section need not be completed if the permit is for one hundred($100)or ' less). ! - , Fan Microwave ' ' 1 all-not employ in the performance of the work for Which this permit is Issued, I Drinking Fountains Urinal • • shall.not employ any person in any manner so&s to become subject to te - - - - F.A.U. 'Pola'Light • 1 Workers'(CompensatlOn Laws of California.' j Fldor Drains, Water Closet, l - ' Date I Signature ' - Fixtures • NOTICE:If,after making this declaration, Laborshould become subject to the . - Floor Sinks - - ' - - 1 Water Heater ' 2 00 - - ;Range - -. __- Workars'. Compensation provisions of the Labor Code, you.m ued rorthwithevoked. - , . Device Boxes • ' ' comply with such provisions ,or E this •permit shall be'deemed revoked- : 1 Gas Servicer Outlets - Water Service Sign' i , • CONSTRUCTION,LENDING AGENCY - Outlets I hereby affirm that there is a cis untain' •I5 issued (Section 3097 Civ: C.)- - - - - •Lender's; Name Name - - ' Kitchen Sink 1 • Repipe' _ .. 2 I00 Switches Trash Compactor Lender's Address - - - ' - - Garbo a Dis o • OWNERBUILDER DECLARATIONLavatories ' - - 9 P sal I hereby'affirin that I am exempt,from the Contractor's License Law for the -- , - Generator'❑0-5 KW 05-15 KW ' ' . ' following reason (Section-703L5 Business and Professional Code: Any city or P-Trap 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 Roof.Drains. - - .i I _ Transformer 15.50 KW , I •, to file a signed statement that he/she Is licensed pursuant to the provisions of - - - - ❑5U+KW ' •„''e Contractor's-License Law(Chapter 9.(commencing with Section 7000)of - - - I ' ' _ Reinspection Fee $15 • iision 3 of the,Business and Professions Code),or that he/she is exempt ' Shpwers • , Reinspection.Fee - $15 ' refrom-and the basis for the alleged exemption.-Any violation-of.Section . - " - Meter ❑up t0 100-amps 'Issue Fee' r $ 3 '.fl1:5 by:'any applicant fora,permit subjects .the -applicant to a- civil - _ anally of not more than five hundred dollars($500): •, , Service Sink i ; - Issue Fee $ $ - - - rr _ Zoning Approved By •Date co I,'as owner of:the(property or my employees with wages as Meir sole - ' ' - I fo sale l(Sem will70 the work,and the Professional structure.is not intended'Contractor's ._ _ , MECHANICAL Application Approved By 'Date ' , for sale'(Secrlon 7044, Business;and'Professional.Code:'Thehds or ractor's - __ ‘,19.8. , ' ' Cleanse Law does not apply to an owner of a property who builds or improves ' Boiler. I ' Refrigeration System 1 I /I r'�, }� ' thereon„and who d that ch work himself/herself or through his or her own I Application Issued By '/ / Data l/ ��t+ '+ , j employees, provided that such Improvements t intended or offered for Duct=Under Ground ❑0;100,000 BTU ❑100,000 BTU i iii , sale. If, however, the 11 have or improvement Is sold within one y com- , , I SUMMARY OF FEES - elation, the owner will have the burden of proving he/she did not build or Im- - . - , LJrove for the purpose of,sale)! I • ' , i i Duct-Structural I System Repair/Alteration ,BUILDING PERMIT $'. I SMIP $ ! I, as owner of the property, am exclusively contracting'with-licensed con- I i - tractors to construct.the'project 'Section 7044,.Business and Professions Code:-.- - , Duct.-Ventilating . ' -.., _.. _r -- L -.I - PLAN CHECK. $, ' . PERMIT , The Contractor's License Law does not apply to an owner of property who , QQ ' ISSUANCE I $ �V V builds or. Improves thereon,and who contracts for such projects with a con- I Exhaust System 0 Multiple 0 I ! PLUMBING $ tractor(s) license pursuant to the Contractor's License Law); - - I GRADING $ i ' • 0 I am exempt under Section B & P.C.for this reason ' Firepl/Fact.BIt ICBO# I PLAN CHECK' $ ' HearinDucting , ELECTRICAL $' I I• $ Date ' Owner' : I HeatingSystem& I MICROFILM • $ ' i-hereby-certify-that • •. B read this a•.,iic.tion and-state county he-above - - ' 000.100,0006TU 0100,000 BTU - - -- -” - - - • PLAN CHECK $- , IMIla Information is correct. I ay.-- to comps rwi all t d d county ordinances 1 - 1 1 - i ' TOTAL FEE' $ and state laws rolatin• to b iltlin• tr ion,'and hereby auth• ze repro- —^Hood or Type I 0 'MECHANICAL $; , ( .I { • sentative5 of ; , - • ante�Il• he above-mentioned - •pe for Reinspection Fee $15 1 • LESS i i Inspectlo • rpo;ice rr i . / �� , Cano• T •e II ❑' I PLAN •CHECK' , $ ; ADVANCED PC $ ' Signature .i air- .1m.„,,ase��ii A/) I .:b i , •f I i 1 1 1 Drivers' i .nae or SS • ' i ' ' •• Registers , Issue Fee $ 3 ],QO t _ i , . FINAL FEE 1 $ CMF 0865-46 rev,12/82 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod-Assessor C- rCONSTRUCTION.ANDePLA I G' _' :„../:: x- - C ; ' -"POOL PA - L ` ` , .-.Date Inspector - ° ` - - ^ .. Date 'Inspector 2 I: ^APPROVALS m Permit#;__^ -- _ `'APPROVALS.APPROVALS"; - _ v .J _ I. .t ' y�ry I t i _ n ,1; Temporary,Electrical Service or,Polet. • -- ., i. :- E.e ' .'52,. cool &:Equipment,Location- _ i - ti Q; Soil Pipe-Undrgrrid." c I r -o v 2 •, r r.r :B3'.'" Steel Reinforcement- 7 3: Electrical Conduit Wtility-undrgrnd ; N. - • G ; ' _ ";54. 'Forms ?- _ -- - ` N 4tCT. ti, Electrical Conduit-Uhdr,gr nd• r>; _ -• ; 55:- Electrical Bonding' - ,•- _ '. 5. Steel Reinforcement) :-.I ' t ' I ' ,`:,, ; ' - _ 56. Roughm • Plubing& Pressure Test.C _ 6' Electrical UFER Grnd" • a ' - D 671! APPROVAL(TOCOVER GUNITE • - . 7 7. Footings .1-' I .-j ='I I '- 7" 's" : i ^ _ „ , .1581 Electrical Conduit-U . ndrnd or : - - 8. Foundatiori 1 • ^I 1 ` o.: ^" •' - ' ' 59. Gas Pipe;-O"Undrgrnd,Test , ° 9. Water Pipe&Undrgrnd.nC I _'. L .`60. Backvvash Lines;P-Trap, O'Undr -�grnd. 10. Structural Floor System • ? - ^- . ' -61. APP,ROVALT,O:DECK - ' • r 11. Property Sewer Line'&HouseConnection r - - ` ;262. Backwash &Receptor-Final :- : ' 2- - .• • 12. Sewer Cap I 1 •1 zj j - I ; ' I '. .• -'63. Heater &_VTent-Final ' - • - ' ::13. Roof1Drlains I I i1 `,; 2' ,= ' ' ., , ` 64. Plumbing;System:Final -s ' i - a 14. Rough Plumbing 1 0 : c - I n 'Th ' 65. Electrical-Final • . t` ' o - CI t Ir-15Rough-Efectrical=Conduit-,--" - : 'T-- "• -- -"-"'" T r I :1 I , I 66., Solas System-Final I , c !c18:-.Rough.Electnc Wiring., _. •s , I! I'-` ¢,,--v,,,,-; -• ri- 671Fencin &-Access.A royal ; - - :. .t17.)Rouglct4tirigg1Sign; n rl ; :' , I • I , I' I 7 ' I ! - I; I - 68.I APPROVED FOR'PLASTERING aj18.'RoughiE(Qctrical;TBar,Ceiling! 1 u I- I , 7 I : 69.1POOL/SPASYSTEMS,FINAL , .. " f119. Rough`f-feating,&'Air Conditioning I • I I , I I I FIRE DEPT, REQUIREMENT' : . • ' .. <, c_ I r t • 1 f 1 I 20:•'Rough Factory,Fireplace , , Ii ' 1 1 • ' ' I I APPROVALS I Permit# '- - - a 'II 21. Ducts, in'Structure I ; I 1 •1 ji I ; I I 70.i Underground Hydro ' • , x 1122. Ducts;Ventilating ,.. ,. I l II il ' ' I '• I 71.1 Product Piping 17 Gas El Oil . ' g 1 L23. Gas Pipe-Rough&Test c ; , - ' I - •! -I . 72.^Under round Flush ' I f24. Roof`Framing`- I , 5 I I ;ia 1„• i I " I r ; I ? ' .- I.,• 73.; Uridergrnd.Storage Tank 0 Gas :0 Oil d c n I yah ' 25._Roof Sheatliirig ' I I I ; I,: , I r I : : I C. I h, ' '14. Overhead Hydro • - , -26. T-Bay Ceiling (Structural),& MonocoSt : I o . ,: I . 75. DryrChemical anj a I .. 1 1 , , t . I - 1 ' - - I 1 i < 217 Piame.and Ffaihirig I - ' • t , I ' i, r 76.(DrLy Standpipe i �28,c c+ , !Lathing&Siding ! k c. . 1 . it II I i I I I 't I I 77.1 FIXED SYSTEM FINAL I i 129. Ansulation' c; s I e n' c ! ' II - I{ 1 . ; ' � f I 78., FIRE;PREV. FINAL • . I , • c y_30. Drywall Nailing r { I II 1 I '' ; I Notes:: .4 e a 31. Plaster Brown Coati ! , I ' , i ; I ; I -. -I-- --- - I, -l -i l - .- - - -- .. - - 4`32. EI'ectrical Power Meter�Fi'nal I i1 II I l I -, I . ' ! 1 C ' 33. Final ElectricI ii 34. Final Heating &'AirIConditioningI , ' I ' ' ' , g : I, p - 1;-•," m 1 -.I .. , , I I I i. • .t . I' ,. r,' I n. t -.I e . r 35. Final Gasr. ,P: i •1-_`, c1 r I I. - , . _ - - - 36. Hood orCanopY_ _1cIei 1 'I II I7 ' I ; I ' ' . l _ 37. Final Factory Fi'repla• se r. E' I S'd q i - - I i ,v i I I . I ' -c; • ( . 38. Final Ptilumbing I I c' ' I Rut ',. 'i L 39. Water Serbice-FinalI f ' , I t I , - - • 1 I ! 40. Gas Sewice-Final I 1 I r 1 • I , , , • 41. rpomestic-Final j I I I - _-.'_ -I_-L_ - - - .., _.Ft • 42.�ckflowjPrever4.1 iterl ' ' I . . , _ - I I " -.� ., • I .r. _. I 43.11ackflow,Irrigation,I +lii ' I I 1... ' -- 3 I - -• ' I a. I - , . - _ i - 44.0landscape Irrigation System , l ; { = '. 1 t L 1 . . P t•l ' I I: ;;`. •- - • - 45.SSoundl:Attenuationt > I : 1 - - ??,,,�• i,r 1 •e 1 . c I , ; z • , y 1 I , I T. ;i - - 46rHandicapRegulations; i , I , . ', },' _ , , i I . i 'g v1 4 �r 7rSINAL"Si-ROC-id-RE & BUILDING � I I I I ,i l 1 I ? i ' 4g,,,, son pecial Requirernents Completed, ; ; ! l ' : ; I 1 I •' I •I m I `I : 4&Electric Release to Edi ' I I ,i. __r J ' L. .,_ , ., ' ; ci, , , ti t , • 50. Gas Release to Southern California Gas Co I I 1 I I ! - " 11 r r 1 , 1 I , . I '.flc,e . 51. CERTIFICATE OFjOCCUPANCY _ - 1__I _J_ _� ._} ..• - I.4 No II , I • Date I , I 1 _�_ I i I • , 1 _.-.. H , .1 1. COUNTY OF ORANGE Application for Building Perm._ BUILDING DEPT. I/78 636 No.Broadway AND FOR A Permit No.--.... .-.. Santa :'a'California Certificate of Use and Occupancy Phone:KI 2-6211 p y Date. SOPt. 22.1 1952 1. OWNER'S NAME F. H. Paulsen PHONE- Beaoon 6749J MAILING ADDRESS-...z..5..-Sxr.Ita...1aahe1..St. CITY Coate-_Maea Name (MINX Name Unnor (Architect or Engineer) (Contractor) ' Address Address City City State State Lic. No Phone Lic. No Phone PROPOSED USE• Jwelling..adnd At tfkanc.&.garage 2. JOB LOCATION.-.255 2.4th.-P.lace Coata..ltesa. (House No.) (Name of Street) (Town or School District) NAME OF AND DIRECTION FROM NEAREST CROSS STREET Wte.atminate-r..2laae Sat 3. LEGAL DESCRIPTION: Lot 29 Block Tract 1442 (Metes and Bounds Description—Use reverse side of form) 4. CORNER LOT ( ) INTERIOR LOT ( x ) THROUGH LOT ( ) SLOPE OF LOT ( ) S. SIZE OF BLDG 41x42 AREA• 1080 SIZE OF LOT- 7.8x95. AREA- 7200L 6. HEIGHT OF BLDG ' 12' CEILING HEIGHT- B'-4" NO. OF STORIES 1_ 7. NO. FAMILIES 1 Size of Smallest Bedroom- 1QX1Q Size of Kitchen. _.9.m6" 8. EXTERIOR WALL CONSTRUCTION- t9. .k,Ano INTERIOR WALL COVERING Plaster (Frame, Stucco, Etc.) (Plaster-Drywall,Etc.) ROOFING COVERING 09MPAIl tiQn 9. STATE HOW MANY BUILDINGS NOW ON LOT AND GIVE USE OF EACH...none 10. SETBACKS: Front Yard From Center Line of Street Q.0 —0 II Nearest Side Yard 10' Rear Yard. M.' Distance in Feet Between Bldgs. on Same Lot.none (Property Line) (Property Line) 11. A COMPLETE PLOT PLAN IS REQUIRED, SHOWING ALL STRUCTURES AND USE OF EACH. 12. (a) Footing: Width 14" Depth in Ground 12" Width of Wall 6" (b) Size of Studs- 214 Spacing 15 "CC Material of Floor wind (c) Size-of Floor Joists• 2x8 Spacing 16 "CC (d) Size of Rafters- 2x6 Spacing 24. "CC 13. VALUATION OF PROPOSED WORK: Incling/all labor, plumbing, electrical wiring, heating, fire sprinklers, painting and sewage disposal $ 7300,00 .91 L..J-4 0 14. 1 HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE INFORMATION IN THIS APPLICATION IS CORRECT AND THAT THE CONSTRUCTION WORK WILL CONFORM TO ALL LAWS OF THE•COUNTY OF ORANGE AND THE STATE OF CALIFORNIA APPLICABL THERETO. Signed' Gi Plans Filed• SEP 2 4 1952 (Owner) By• (Authorized Agent) FOR DEPARTMENTAL USE ONLY FEES: CHECKING BY Bldg. Permit - $ jig 4.° GROUP.... APPLICATION HEALTH Plan Check - $ 3 TYPE ZONING FIRE Total - - - $ J Q G DIST. MARSHAL /�y PLANS AND `. Receipt No. - S�- 7 M`A'P SPEC'S STATE Paid to - - SHEET NO CORRECTIONS ENGINEER Date . SER.-.&.4--igs2- VERIFIED CAL TIS .i r— N COUT e t.•L ;. �' - UIIDING SEP 2 4 1952 •r INSPECTOR DATE /�� ' �— snoo-->-sa ;ePUTY Cbl • METES AND BOUNDS DESCRIPTI. .. . • 6,0 . -1 I 11111114111- 11 1111111E1111111 1111111111E -M - 11 - mai= MMME OM MMINEENNOMEMEMMMIIIIIIIII 11111111. - 11-1 -1111111111111111111111111111111111111 NI III , :III 111111111•1111111 11111111111111 III III 0. • ElE1111111 111MMINEN 11 111 1111 1111 11110 mm al. 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