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Home My WebLink About240 24TH PL - Building Permits • ' CITY OF COSTA MESA BUILDING DIVISION Y/ DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER :t ��%_ rPERMIT V t P' ' 5-00568 Firmo (714)754-5273 • Fax(714)754.4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 240 24TH PL Status: ISSUED Suite No Applied: 09/30/2005 Issued: 09/30/2005 Vicinity: REAR Parcel Number: 11910113 ISSUED BY: / Applicant: LIZA ZOSCAK Address: 7 EL PRISMA Phone: 949-859-9636 RANCHO SANTA MARGARITA Zip: 92688 Owner: BRANDE, W CHARLES Address: 240 24TH PL Phone: 949-6q 1110 • R I P COSTA MESA,CA Zip: 92627 Contractor: SUN COUNTRY CONSTRUCTION Address: 7 EL PRISMA Phone: 949-859-9636 RANCHO SANTA MARGARITA Zip: 92688 License:542772 SCOPE OF PERMIT 468 S.F.INGROUND HEATED POOL AND 50 S.F.SPA.REF.:B05-01735. MECHANICAL TO INCLUDE: 1 FAU> 100K BTU FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 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 $18.20 1 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 $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 $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 $41.70 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 applic a codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: 0 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 p.'ormance 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 law' • California,and agr that If I should become subject to the workers'compensation provisions of ction 3700 of the Labor Code,I shall forthwith comply with ih:se;•.vi n d Applicant Signature: Date: �,JLJ WARNING:FAILURE • E•I1 E WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES VP TOONE HUNDRED THOUSAND DOLLARE(5100,...),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am lice. :d nder. . r i..s of Chapter 9(commencing with Section 7000)of Division 3 of the Busin Sessions Code,and my license is in full force and effect.Lie.a .,/era Class a Contractor's Signature: Y ( ,' „_ Date: i CONSTRUCTION LENDING AG:y..Y: ❑ 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).): ❑ 7 4 ,owneriof the ofo ode: ee with,ont wages is their sole compo atiply WILL DO THE WORK,and the structuresrImis not intendeder , offeredo for sale(Sec. 7044,Business and Professions Code:The mol yees,provided Lew does not apply to is owner iofn 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 properly,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. ❑Yes ❑No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-properly 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(38)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will riot 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 wit 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 Cale 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 a plication a ermit for such construction or modification U from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes No (Section 85850.2 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). 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 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-descr.ed property for Inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. yr F' '!natf e0 Lel.'0 P•er(s) md/Or Authorized Applicant Date CODE I INSPECTION nag PATE INTITIALS CODE I! INSPECTION TYPE DAIS 1618 Fixed System Final Fire Prevention 206 Final Mechanical /'q'06 1288 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical • 201 Final Block/Retaining Wail 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 FC r/"'� ,, DEVELOPMENT SERVICES DEPARTMENT PERMIT UMBER ( ,.;.rte:='. � t PERMIT St*PoRmsto4. P05-00750 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 240 24TH PL Status: ISSUED Suite No Applied: 09/30/2005 Issued: 09/30/2005 Vicinity: Parcel Nunmber: 11910113 0;t- Applicant: LIZA _ ISSUED BY: Address: 7 EL PRISMA Phone: 949-859-9636 RANCHO SANTA MARGARITA Zip: 92688 Owner: BRANDE, W CHARLES Address 240 24TH PL Phone: R COSTA MESA,CA Zip: 92627Rip Contractor: SUN COUNTRY CONSTRUCTION Address: 7 EL PRISMA Phone: 949-859-9636 RANCHO SANTA MARGARITA Zip: 92688 License: 542772 SCOPE OF PERMIT 468 S.F.INGROUND HEATED POOL AND 50 S.F.SPA.REF.:B05-01735. PLUMBING TO INCLUDE: 1 POOL AND 1 SPA. FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $60.75 1 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 Bkffow(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.) $0.00 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 $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) $30.25 1 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: $114.50 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 f for a period of 180 days. i 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(emo) 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•perfornance 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: (chis section need not be completed it the permit is valued at one hundred dollars WOO)or less.) certify that in the pe ormance 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•.I alifomia,and agre that if I should become subject to the workers'compensation provisions g{Section 3700 of the Labor Code,I shall forthwith comply with thee •Crs'• s Applicant Signature: / l/ f!k Date: -30 WARNING:FAILURE TO CUi(. WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND DOLLARE(5100,• •,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 licen d n r v�aiivf Chapter 9(commencing with Section 7000)of Division 3 of the Busine ��/a.�,d'prplessions Code,and my license is in full force andeffect. Lic. / d'— r Dlassate: a Contractors Signature: �� (^!`!`�•\ Date:CONSTRUCTION LENDING AGE Y: ❑ 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).): 0 I,as owner of,the property,or my employees with wfiges cer eir sole compensation,WILL DO THE WORK,and the structure is not intendedor offered for sale(Sec. Th 7044,Business and Profes5lons Code: e'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) license pursuant to the Contractors License Laws.). ❑ am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: 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 B,California Administrative Code). O As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health 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 aRemtit 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 De 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 Califomia Health and Safely Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No B (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. /' Sig/ture eI Lggalfhvndifs) *— 30 Cc "...d/Or Authorized Applicant Date CODE I INSPECTION TYPE DEE JNTRIAk$ CODEI INSPECTIONTYPE g� UTITIIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing �."9')-OL 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 �q CITY OF COSTA MESA • 4BUILDING DIVISION 0,l ► F I � I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER pow; PERMIT leOS-01032 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa fI sCTRICAL PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 240 24TH PL Status: ISSUED Suite No Applied: 09/30/2005 Vicinity: REAR Issued: 09/30/2005 Parcel Nunmber: 11910113 Applicant: LIZA ZOSCAK _zt.... Address: 7 EL PRISMA ISSUED BY: Phone: 949-859-9636 RANCHO SANTA MARGARITA Zip 92688 Owner: BRANDE, W CHARLES Address 240 24TH PL Phone: 949-631-4492 ft COSTA MESA,CA Zip: 92627 Contractor: SUN COUNTRY CONSTRUCTION Address: 7 EL PRISMA Phone: 949-859-9636 RANCHO SANTA MARGARITA Zip: 92688 License:542772 SCOPE OF PERMIT 468 S.F.INGROUND HEATED POOL AND 50 S.F.SPA.REF.:805-01735 ELECTRICAL TO INCLUDE: 1 POOL AND SPA FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service teat $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 Eledrical Equipment $0.00 0 New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa 549.50 1 up to 10 kva/kw $0.00 0 Lighting Fixts $0.00 0 up to 50 kva/kw $0.00 0 Recept Outlets $0.00 0 up to 100 kva/kw $0.00 0 Switches $0.00 0 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $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 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES 573.00 Intermed Pole $0.00 0 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 it 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 exp>ratiorrof thispermit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) 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 ere: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) certify that in the p•rfornance 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 law-Of California,and agr'i that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with t es. •.o ion 11. i - • Applicant Signature:, Date: ' % --15 WARNING:FAILURE Ts SE4i RE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($1.17.0.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 Ilcen n1ogle/0 hapter 9(commencing with Section 7000)of Division 3 of the Busin-- _•• • •fessions Code,and my license is in full force and effect.LIG.# /'�) Class# Ws Contractor's Signature: q n, w Date: OFELI.4 S CONSTRUCTION LENDING AG Y: ❑ 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 undai 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 therefromand 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 huntlretl dollars($500).): 1•rth s'ot ❑ 7 4 .owneriof s the oo Cede: ee onth wages as their sole compensation,notply WILL DO THE WORK,and the structureimis not thereon, offeredwo 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 drivers license. 0 Yes 0 No Drivers 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,faisework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be 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 end 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 a plication a emit 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 LI 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 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 prescnbed by California Health and Safety Cade 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 slate 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-d:scribed property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. t ,ign:.ure •f Legal • ,•er(s) 3 !a--^ And/Or Authorized Applicant Date CODE I INSPECTION TYPE RAIL INTITIAL@ CODE I INSPECTIONTYPg PAIS MEALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical I—c-o6 63L- 201 _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 > • ,,,,,. /PER� al DEVELOPMENT SERVICES DEPARTMENT IT NUMBER y PERMIT 605-01735 %teams". (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.B4MLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 240 24TH PL Status: ISSUED Suite: Applied: 09/30/2005 Vicinity: REAR Issued: 09/30/2005 Primary Occ: Type of Construction: Parcel Number: 11910113 RZonii p Applicant: LIZA ZOSCAK Address: 7 EL PRISMA• R Phone: 949-859-9636 ISSUED By: RANCHO SANTA MARGARITA Zip: 92688 Owner: BRANDE, W CHARLES Address 240 24TH PL Phone: 949-631-4492 COSTA MESA,CA Zip: 92627 Contractor SUN COUNTRY CONSTRUCTION Address: 7 EL PRISMA Phone: 949-859-9636 RANCHO SANTA MARGARITA Zip: 92688 License: 542772 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT 468 S.F.INGROUND HEATED POOL AND 50 S.F.SPA. FEE SUMMARY Plan Check: $54.11 Calc Valuation: $2,900.00 Permit: $83.25 Claim Valuation: $2,900.00 SMIP Res: $0.50 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $137.86 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 - • 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 Inapeetlona 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)7545626 244646(6/00) • DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ '- I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. -❑ I'have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. iy.workers'compensation Insurance carrier and policy number are: "Cartier �-�Policy Number: • `(This sec' n 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 law 1 California,and agree that if I shout ecome subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with ih e $51 -30 �� Applicant Signature:T �/ (---"Data: - i WARNING: nOlAEE( SECURE WORKER PE COSTO COMPENSATION,PENE IS UNLAWFUL DAMAGAND SHALL IDED FOR IN EMSECTION OF THE ALPR CODE, CIVIL FIDESTO KEYS HUNDRED. C -THOUSAND fn I ARE(5100,000),IN ADDITI O THE COST OF DAMAGES AS PROVIDED FOR IN SECTION 3]O60F THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: ,�; —, thereby affirm that I am licen §�-Qrr i of Chapter commencing with Section 7000)of Division 3 of the Businetvq ayd a•fessions Code,and my license is in full force�and effect:Llc u �aa--'99$$,,��iiryryffp� / / (\' y a Lt1'> � fo ctor's Signature /A . `� a 14 L�M1E}'�Df .- -�� O CONSTRUCTION LENDING AGENQV: ❑ 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.It,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ' ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes ❑No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Cede). ❑ 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? ❑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 materiels 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 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? ❑Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this.implication apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? ID Yes LI No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑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,end 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. Loh t r \ A 1Or Authorized Applicant ;ODE I. INSPECTION TYPE RAN INTIGAL$ CODE, INSPECTION TYPE PATE INTOIAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final �-"1-� 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 `� • -„" "'R9 ! CITY OF COSTA MESA 4 BUILDING DIVISION o/r.,� .. F i 4.^,, I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT E00-00833 Runio (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 240 24TH PL Status: ISSUED Suite No Applied: 08/22/2000 Vicinity: FAMILY ROOM ADDITION Issued: 08/22/2000 Parcel Nunmber: 11910113 Applicant: BRANDE, PAMELA ISSUED BY: .P.----- Address: 240 24TH PL • Phone: (949)631-4492 COSTA MESA,CA Zip: 92627 Owner BRANDE, W CHARLES Address 240 24TH PL Phone: , t iI COSTA MESA,CA Zip: 92627 wir a '• Contractor: OWNER-BUILDER �Y0'" + Address: Phone: Zip: License: 0 SCOPE OF PERMIT ELECTRICAL PERMIT FOR NEW FAMILY ROOM ADDITION FOR EXISTING SINGLE FAMILY RESIDENCE. INSTALL 13 LIGHTS,9 OUTLETS,8 4 SWITCHES. REF: B00-00707 - 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 $14.30 13 up to 50 kva/kw $0.00 0 Recept Outlets $9.90 9 up to 100 kva/kw $0.00 0 Switches $4.40 4 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 Wring 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 1 hp $0.00 0 Circus(meth 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 $52.10 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) t EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended ed fora 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.orthis permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS 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 Cale,for the performance of the work for which this permit is Issued. My workers'compensation Insurance carrier and policy number are: Cartier: Policy Number: (This section need not be completed II the permit/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 CAVIL FINES UP TO ONE HUNDRED THOUSAND COUARE(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 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.# Class# 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 end 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 toa'civil penalty of not more than five hundred dollars($500).): -cc•r. ❑ I,as owner of the property,or iriy 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 y°b 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.). -GV fres 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.). 0 I am exemptrir er sec. Business and Professions Code for this reason: r� .Signature:------ .�-C- , C vires 4/- tit t.0 r 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 WIII 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 en RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ No (Section 65850.2 of the Califomia 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 COMPUANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the Information given is correct. I agree to comply with all 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 fppection pu ses.I agree t to occupy or allow occupancy of any building authorized by this permit pu79(/�I final insertion. • Signature Of Legal Owner(s)-------- '—Date /�__r And/Or Authorized Applicant Date COPE t WSPECTION TYPE PAIL IIIIfALE COpu MP.ECRON TYPE PAIS EMU 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 4 9 CITY OF COSTA MESA r- f -'17 BUILDING DIVISION q,' F•� DEVELOPMENT SERVICES DEPARTMENT PER NUMBER F I -1-11.7.1 i PERMIT o a. B00-00707 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 240 24TH PL Status: ISSUED Suite: Applied: 05/18/2000 Vicinity: REAR OF HOUSE Issued: 08/21/2000 Parcel Number: 11910113 Zoning: Applicant: BRANDE, PAMELA ISSUED BY: Address: 240 24TH PL Phone: (949)631-4492 COSTA MESA,CA Zip: 92627 Owner BRANDE, W CHARLES Address 240 24TH PL Phone: COSTA MESA,CA Zip: 92627 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 0 Arch : BROR MONBERG ARCHITECTS Eng: Address: 3432 VIA OPORTO#209 Address: Phone: (949)675-1404 Phone: NEWPORT BEACH, CA Zip: 92663 License: License: SCOPE OF PERMIT 470 SF SINGLE STORY FAMILY ROOM ADDITION TO THE REAR OF AN EXISTING SINGLE FAMILY RESIDENCE. FEE SUMMARY Plan Check: $359.68 Calc Valuation: $40,165.00 Permit: $553.35 Claim Valuation: $0.00 SMIP Res: $4.02 SMIP Corn: $0.00 Other $0.00 Inspection: $0.00 Total: $917.05 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 20-6 Left 17.0 Right 32-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 2 Required: 2 Proposed: 2 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 it work is not commenced within 180 days,or it work is suspended or abandoned fora 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 expirationof this permit. FOR INSPECTIONS.CALL: (714)754-5626 2446-48(MO) C=1:=111111.11111111.MIIIMMal 1.= ar 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 lithe 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 3708 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 N 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 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.). ila./cdas 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 unsec. Business and Professions Code for this reason: / (N Signature: G Date: � ,-� O'O Owner ID verified by dnvers license. ❑Yes 0 No Drivers License No. Expires: Y<iY/6.1— Verification 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 e permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 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 q 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 a plication appermit for such construction or modification from the South Coast Air Duality Management District or from any other air pollution control district or agency? 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? . ❑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 iouth Coast Air Duality 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 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 in action purposes.I agree not�occupy or allow occupancy of any building authorized by this perm) until fine}inspection. .�' G - ff/Z2 / c6 Sign tura Of Legal Owner(s) date And/Or Authorized Applicant Date ME I INSPECTION TYPE DAIS IMItAU CODE! I14SPECTION TYPE 2AIE R 1flAL9 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 f)'r`4:7 jc""#�L insulation Certificate `'6.r" a--�—ev _dtv —GAJ.7p7 Number and Street City County Subdivision Lot Number Description of Installation ROOF Material Brand Name Thickness(inches) Thermal Resistance(R-Value) CEILING Batt or Blanket Type gait- Brand Name Thickness(inches) ( " Thermal Resistance(R-Value) / ' Loose Fill Type Brand Name Contractor's minimum installed weightlftl lb Minimum thickness inches Manufacturer's installed weight per square foot to acheive Thermal Resistance(R-Value) EXTERIOR WALL Material PA1 Brand Name Thickness(inches) .0 f/t Thermal Resistance(R-Value) / f RAISED FLOOR Material Brand Name Thickness(inches) Thermal Resistance(R-Value) SLAB FLOOR Material Brand Name Thickness(inches) Thermal Resistance(R-Value) Width(inches) FOUNDATION WALL Material Brand Name Thickness(inches) Thermal Resistance(R-Value) Declaration I hereby certify that the above insulation was installed in the building at the above location in conformance with the current Building Energy Efficiency Standards for new residential buildings contained in Tide 24 of the California Administrative Code. '- enhalContractor(Builder) License Number • • tn9 —' lz/r Sign turnture an / Dace Sub-Contractor(Insulation Installer) License Number Signature and Title Date Compliance Forms January 1, 1995 4� �6 CITY OF COSTA MESA \.__J BUILDING DIVISION :4-• . -4r DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER to 1I. /,� I PERMIT MO M00-00358 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 240 24TH PL Status: ISSUED Suite No Applied: 08/21/2000 Issued: 08/21/2000 Vicinity: FAMILY ROOM ADDITION Parcel Number: 11910113 ISSUED BY: Applicant: BRANDE, PAMELA Address: 240 24TH PL Phone: (949)631-4492 • COSTA MESA,CA Zip: 92627 Owner: BRANDE, W CHARLES Address: 240 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 MECHANICAL PERMIT FOR NEW FAMILY ROOM ADDITION FOR EXISTING SINGLE FAMILY RESIDENCE. INSTALL 1 NEW FIREPLACE(ICBO#3195)WITH NEW GAS PIPING,AND ALTER 1 EXISTING HEAT/COOL SYSTEM. REF: B00-00707 FEE SUMMARY Quantity Quantity ISSUE FEE $23.50Repair/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 $13.70 1 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 Ref rig 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 $54.00 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 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, an required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expirationrmit. FOR INSPECTIONS CALL: (714)754-5626 244E-46(6(00) DECLARATIONS ( ) ' , l 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 OVIL 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.# Class# Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects 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 134old 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.). ,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 et under sec. — -- Business and Professions Code for this reason: Signature: r J- 0- jZ., -�>L Date: e(2�%'VII-L....,-----. Owner ID verifi d by drivers license. El 0 No Drivers License No. - Expires: V/2 I /c S Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,faisework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Ory 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,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? 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 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? 0 Yes ❑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? ❑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 propert inspection purposes.I a ee not to occupy or allow occupancy of any building authorized by this permit/111N final i spection. G . � �t Signature Of Legal Owner(s) Date And/Or Authorized Applicant Date CODE# INSPECTION TYPE PAIL IN1mALS COOFI INSPECTION TYPE ME QIIBBI.E I 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1 -2 an 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 `, ' 'ti. CITY OF COSTA MESA 4 BUILDING DIVISION • > .,.�. • , `_= DEVELOPMENT SERVICES DEPARTMENT IR IT NUMBER 4I V/ti I PERMIT 00-01274 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 240 24TH PL Status: ISSUED Suite: Applied: 08/21/2000 Vicinity: REAR OF HOUSE Issued: 08/21/2000 Parcel Number: 11910113 Zoning: Applicant: BRANDE, PAMELA ISSUED BY: Address: 240 24TH PL Phone: (949)631-4492 COSTA MESA,CA Zip: 92627 Owner BRANDE, W CHARLES Address 240 24TH PL Phone: COSTA MESA,CA Zip: 92627 Contractor: OWNER-BUILDER Address: • Phone: Zip: License: 0 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT DEMOLISH EXISTING ENCLOSED PATIO. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $500.00 Permit: $23.50 Claim Valuation: $500.0o SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $24.00 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) 1 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. 77 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 rmit. FOR INSPECTIONS CALL: (714)754-5626 244848(8/00) DECLARATIONS n) 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: Cartier: Policy Number: (This section need not be completed i/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 RNES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3705 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.Lie.If Class e 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 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.). 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.). O I amexempt.Mrrd sec. - Business and Professions Cale for this reason: Signature: Date: Chet/Qv Owner ID verified by drivers license. 0 Yes 0 No Driver's License No. Expires: V/2--i /O S Verification of Ownership by(type of document.i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet In depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,faisework,or demolition or dismantling thereof,will be more then thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,Califomia 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 Califomia 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? ❑Ves 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 apemit 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 . LI 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 pollutionrequired for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws end city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for ins ection purposes.I agree rygt to occu /or allow occupancy of any building authorized by this permit unti final ins action. Si ature Of Legal Owner(s) Date And/Or Authorized Applicant Data CODE i 18SPECTIQN TYPE DATE It 1ibl5 CODE( I$SPECTION TYPE PATE INImALS 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 g 4y—619 L( -.- 250 Final Building/Occupancy • COUNTY OF ORANGE ' Application for Building Permit BUILDING DEPT. W.Y# 7..-�' 636 No.Broadway AND FOR A Permit No.... . .. ...... SantaPhone: ' 2-6211mia Certificate of Use and Occupancy KI p y Datese-ptr 2....lA5Z 1. OWNER'S NAME F.H,Paulaen PHONE2eacon 6749J MAILING ADDRESS 258 Santa Isabel St CITY Costs—Mesa Name Owner Name (Architect or Engineer) tjyPrlB'r (Contractor) Address Address City City State State Lic. No Phone Lic. No - Phone PROPOSED.USE-Dwelling and attached getre.ge 2. JOB LOCATION...Hp -24thInane..._.--.-.----.-.--------------.-.-----..-...-Geettat_Mon (House No.) (Name of Street) (Town or School District) NAME OF AND DIRECTION FROM NEAREST CROSS STREET rieetmini9ter p1e,ce Fiat 3. LEGAL DESCRIPTION: Lot-.-.23 Block Tract 1442 (Metes and Bounds Description—Use reverse side of form) 4. CORNER LOT ( ), INTERIOR LOT ( it ) THROUGH LOT ( ) SLOPE OF LOT ( ) 5. SIZE OF BLDG • 39x42 AREA• 999 - SIZE OF LOT:.32xlO0 AREA• 7200 6. HEIGHT OF BLDG • 12'— CEILING HEIGHT- 8,'41 / NO. OF STORIES •1 7. NO. FAMILIES 1 Size of Smallest Bedroom 10x12 Size of Kitchen 9=6 a 16 S. EXTERIOR WALL CONSTRUCTION• stucco INTERIOR WALL COVERING. Plaster (Frame, Stucco, Etc.) (Plaster-Drywall, Etc.) ROOFING COVERING composition 9. STATE HOW MANY BUILDINGS NOW ON LOT AND GIVE USE OF EACHnOne 10. SETBACKS: Front Yard From Center Line of Street 50' Nearest Side Yard -(9') Rear Yard.561 Distance in Feet Between Bldgs. on Same Lot acme (Property Line) (Property Line) II. 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 G" (b) Size of Studs• 2"x4" Spacing 16" "CC Material of Floor_Jfopt (c) Size of Floor Joists 2"x8" Spacing 16" • "CC (d) Size of Rafters• 2x6 Spacing 2-14— "CC 13. VALUATION OF PROPOSED WORK: Including all labor, plumbing, electrical wiring, heating, fire sprinklers, painting and sewage disposal $----63.00...00---.47000 14. I 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 APPLICABLE TH TO. Signed- 7.1... 1 • ria "^---- Plans Filed- SEP• 2 4 1952 (Owner) By. (Authorized Agent) FOR DEPARTMENTAL USE ONLY • FEES: ppCHH.p��EECCKING BY Bldg. Permit - $ 7( o GROUP , S_ APPLICATION..I�l.I HEALTH Plan Check - $ a a TYPE t1C ZONING ✓ FIRE Total - - - $-.- 1 °v DISTM . G �� PLANS AND '� MARSHAL Receipt -- Rot 7'7 - SPEC'S STATE Paid to - • ........._... SHEET NO .1` CORRECTIONS ENGINEER Date ._ SEP...2..4...18 . VERIFIED ('a PERN4IT I$S 111 Nan INSIDE TOR DATE SEP 2 4 1952 71 /r/' -G- pun, 5000••7-s2 r..a e B PA 37073 * **** JULlUl 30 73 P0,-,A t9 10.50 • COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR BUILDING PERMIT For Applicant to Fill in/Completely �yO , 7v/A ////�� RECEIVED BY DATE- OECEIt/Ep� DATE ISSUED(, BUILDING // �A e.Q L///1/OJy 7 'N:J /i ADDRESST / ./ ✓ /�/t O. --Y G- C.:/� a A.P. NO. // _Yo/ - a P R5I7r) 3 OWNER /� u LG i//j) ,/st/ /�/J / �f MAIL 2Vi �V� / /792 ADIDRESSOC /O O.7 phAG� zADDRESS /J '�y 0- U CITY , / /I NOLul Li; ��6 dS.3° TRACT�yy LOT,/ BLOCK ~ Z CONSTRUCTION NEW ADD ALTER REPAIR MOVING DEMO115H - H LENDER A/race_ Cr,o co J D BRANCHxf JN OWNER :b. //. f_ O eAl„c e- LL/ Q W ADDRESS rti CO J VALUE �f -CO ARCHITECT TEL. USE S'w -ate rd7-,, $ I/M J Q OR ENGINEER N . Ci(I) FIRE J'/ WQ ZONE VPE / Y GROUP �T Q ADDRESS Q.41 //// ,,/ APPROVED ,/J Z JZ CONTRACTOR412.- ��/ (/t/N/A y BY �_ DATS - 1� CD WW ADDRESS/77,ADDRESS� �, S / [, A/ ZONE //y� NO.OF USE OF NE/Vy�� O= CITY / NOTEL S-/ oS /\ ( PLANS BUILDING /��d Cc4'5A _Z rC,r_��--rc J `1� Y - o STATE i CITY !� YARDS APPROVED YARDS APPROVED ul to O LIC. NQQ7 ./t9/ LIC. NO. /91/ MAIN BUILDING ACCESSORY BUILDING SIZE / / NO.OF B/LOGS. (FROM C/L SZ;TI OF LOT NOW ON LOT FRONT a '/'/ / FT. USE OF /- I11 EXISTING BLDG. /-1 yr Car / p • ` //.3 /I t FT F SIZE OF NO.OF Z NEW BLDG. ROOMS STORIES L.SIDE cPt3I' FT. VEXTERIOR WALL ROOF �� _ COVERING I COVERING REAR "Jrl. FT. J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& 0- a MAIN BLDGS. ACCESS. BLDGS. Q .e/ /J/ jr VAR.# DATE O / 7 if X ,' Se!.LPt.. C.U.P.0 APPROVED I- APPROVED /J P� co "an7-, a �Y /-(/� // DAT 77-30-73 O F/ UI hereby acknowledge that I have read this application and state ST" 7 that the above information is correct and agree to comply with CC all laws regulating building construction, and I shall not employ r b!/ F- any person in violation of the workman's compensation laws of fA the State of California.ornia. TAX m I hereby certify that I am properly licensed as a contractor under SQ. FT. a the State of California Business end Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: ro am exempt from the provisions of the State of California Business LL VALUATION &✓) m and Professions Cone, Division Chapter 9. PERMIT FEE $ /Dr V N Q 7 —. Signature of 0 O CO Permittee ///J C /,//Ji( /+ $/oDd - PLAN CHECK $ /C�—/,//I E AuthoHzetl•A�t (/ U. TOTAL FEE 5 • . i • A-'^ ' 42621: Pr.tl. Fp -8-7' oo 3Q ., :':-.'•*•,•:96 na COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely —Use Ink Only REC D•TE REC IVSD DA I: U D BUILDING ?b I /( �� - --? ---7---7 / ADDRESS 7 D /9'�" - / ,r ��////�� //p^/D/ `I3 • RMIT NO. MAOWNER /�J,f.l NIf3 Yo /M��/NI'1G1�� vc� ,e,ELLI A.P. NO / MAIL /4D 4 Gov/ qQ, `QQ ADIDRE SZ. of.z4T" -- ICI(-- CITY TNOL4v6'Od/‘ TRAC CI JLI I LOTt3 BLOCK CONSTRUCTIONI/ NEW ADD ALTER REPAIR I MOVING DEMOLISH LENDER ND'v/1•' BRANCH OWNER Lvc 112EtL./ ADDRESS r�t� 'FAA' 'el VALUE Coo ARCHITECT TEL. USE ISM ' $ /Zi OR ENGINEER N . FIRE //j) Z ADDRESS ZONE / TYP GROUP rr�� ,t / ,J APPROVED A� '`� CONTRACTOR W66� G'�;gp�I/1///a ed 1 CQA/(S/. BY DATE f �` ADDRESS 3,2 7 f, /!lc A 4Iti A/6 N NO.OF USE OF N et. OAft i) 64t NOL.sq-yam. g11 NO.O � BUILDING ��C+. F. STATE / CITY YARDS APPROVED YARDS APPROVED LIC. NO. 10747? LIC.NO. MAIN BUILDING ACCESSORY BUILDING W SIZE NO.OF BLDGS. (FROM 5.(L STREET) a. OF LOT NOW ON LOT / FRONT -J/l/ FT. FT. USE OF 4 EXISTING BLDG. Q 1/i LL,a, C- SI R. DE 1 r FT. FT. rn E Separate permits are required for L.SIDE fill- t/ FT. FT. electric,plumbing and heating work. QQ i OREAR (J FT. FT. [..i USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& AMAIN BLDGS. ACCESS. BLDGS. .a �I �OOA AO�// Snit/ VAR.# DATE a L�'sWA 'O /jA //n- I A //1- y C.U.P.# P 1 APPROVED (7�, --/Ir,, �" /�7C/�!�/�ri/s7 ago /-/� 4Y"u"�rU r//'(10 v1-1 _� 1 J _DATE ? � V l U' 00 ih /><3S w O. I hereby acknowledge that I have read this application and state n a that the above Information is correct and agree to comply with m a. all laws regulating building construction, and I shall not employ Z any person in violation of the workman's compensation laws of s Ill W the State of California. -7. - I hereby certify that I am properly licensed as a contractor under �s✓� SO. FT. w the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION I FOR m Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE NLY: e am exempt from the provisions of the State of California Business VALUATION PERMIT FEE $ 00 e and Professions Code, Division 3,Char 9. & n PLAN CHECK $ 2• mo Signature of Permittee // /1' y'/fes PLAN TAX $ �i Authorized Agent / TOTAL PAID $ OF 0 ex • $ I A