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Home My WebLink About931 19TH ST - Building Permits(714) 754-5273 • Fax (714) 754•4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 � Job Address: 931 W 19TH ST PLUMBING PERMIT Status: ISSUED Suite No Applied: 04/OB/2002 Issued: 04/OS/2002 Vicinity: UNITS 5, 6, 7, 8, 9, 10, 11 AND 12 � Parcel Nunmber. 42432109 __-� - --�'-' - �--- - - ISSUEDBY: 06�/�--� _- ' �,,.,1-i�_„��.�_,,.:� ,,,,"^,�. ��/%%�-- �. / - ,_ -- . ._+ -._ - --� ^`__ \ Applicant BERGER, EDDA I%- i"�- - � �%-��_� ( � � ,� �\\`�" �_\ Address: 931 W 19TH ST �� i �� ; � " ' 1� ;� � �`�� i ' . .�� ` ,; --. _� , <o ,�_ �i � �l. Contractor - ° � � � � I' : > ' � r- � , � � ` , � , /% , r 3v*%"�,� � •,� I , � A�� A. �� ,.� � �Address � :; � . . � i �- - �= ' --�- . � _ � - _ , � ' �. _ . , � .. Phone: _ �: .� � / � , � � % V � � _ " � _ _ _ ` '' ��' . � . � r , . �, � Zip: . . . AP�B� % �:- �� \-�'� Phone ' 949-5480492 � . ,` � �•-, COSTA MESA, CA�� i - Zip: -92627 . �i � ; � \V��` 1� � � � ��/ i � � � .- - - _ _ _ ` ..� � �\ i, �`. �; 1 � � i/ . //� � � �. �: 1 �� Owner.; ' BERGER EDDA I� : " � � � -�' / `: � Address �931 W�19THST%% �'';� �� '� /� ' ��\ `. � �� i j APTB��j� Phone: 949-548-0492 `\\\ \\;./ \�� . =��' COSTA�MESA,CA Zip:�92627 \; �,�\ � `\\�� > � �� - . � �'�`� �l� �� v`, _, �� , �i �� - . i ! ,�� A �\ ' Aich / Eng: °'T Address: � : _ ;/ � %�, � \ � - - License: � �' ' � � � /��'r�( ,r .�/:l4 ✓ +'- l �' f u:(��.� � . ._.c.., � - � ' Phone: - � _ , ., '�, Zip.�, _ �, l� � � - _ --_ --� _' . _ : . 1 L-. , .., _ , License:" � , _ �c'/ � � �__ , i� ' � - ' SCOPE OF PERI PLUMBING TO INCLUDE: REPAIR HOT AND COLD WAT � � AND 12. �� ,�,. � � �- \ �� ""' i tr. , . ;v: ti '�".�FEE SUMM �. _ � �� - �.,� ` ,-: . � 'J,'�� ` � ; AMT �A�aTY'-r. c _!:` � � " � � _ 133UE FEE�� $26 50 �� Laundry Tub / Washer Backflow ivigation �`, .'$0.00 0�� Landscape Irrigation- Backflow Preventei�V �$0.00 j 0 ��' �`C�P-Trap �� -�' ' Bathtub V`�� $0.00�,��0�- � -�=PressureRegulator, Clarifier System �� `50.00 0 �, � � �Process�Piping (per 10 ft) ConnectQce,Soda,etc)��: $0.00 �--0; '�Receptors- DentalUnits �`$0.00� � 0�; �,�� SepticTank Dishwasher $0.00 --'-0 , Sewer Cap for Demo' Drain, Floor $0.00� �; 0, � �-SewerConnect� , . Drain, Rainwater $O.W �0� � -Sewer Private Llne � � , , Drain, Roof $0.00 0 � --- Shower Drinking Fountain $0.00 0 `-Sink; bar - � � _-,--� Expansion Tank 50.00 0 Sink, commercial �� - Gas EaAhquake Valve $0.00 0 Sink, Floor Gas (1-4 outlets) , $0.00 0 Sink, kitchen Gas�(Over 4 outle4s) $0.00 0 Sink, service/mop Gas Repipe $0.00 0 Spa (private) Gas Service $0.00 0 Spa (public) Interceptors (Grease, Oil) 50.00 0 Interceptors (Sand Auto ) $0.00 • 0�, ' � _; . - _' �' ; . � �FOR UNITS 5, 6, 7, 8, 9, 10; 11�� _ � , �" ' i � � '` . / ARY�� . ��i � �-'/ " AMT= <QTYi �'+`�':-• i�i > �' AMT $0.00 0 � Surrip Pump, - / .$0.00 ��r $0.00 �-0 �:SwimmingPool, : �' �/ $0.00 � $0.00 `0 �' " '"%Trap-Primerj- ��: �� $0.00 -� $0.00 -0- - ' Urinal-;,' � -- / $0.00 b0.00 0- � - Vacuum Brkr BkOow(1-4) $0.00 $0.00 �0 � Vacuum Brkr BkBow(5+) $0.00 $0.00 • 0 -,�� Nlash Basfn"/ $0.00 $0.00 0 �� Wash Basin Set $0.00 $0.00 �0. ' ,-�Waste and Vent System $0.00 . $0.00 0 � " . � �- Water qoset (Toilet) $0.00 $0.00 �, 0� �'� � � - �Water Heater / vent $0.00 �$0.00`� _ 0--'- ` Water Piping (Inst or Rep.) $78.40 $0.00- 0 WaterRe-pipe $0.00 $0.00 0 Water Service $0.00 $0.00 0 Water Soflener $0.00 $0.00 0 OTHER $0.00 $0.00 0 VIOLATION $0.00 $0.00 0 PLAN CHECK $0.00 REINSPECTION so.00 TOTAL CALCULATED FEES: E101.90 QTY 0 0 0 0 0 0 0 0 0 0 0 8 0 0 0 NOTICE: The work aulhorized by this permit shall comply with all applicable handicap access requirements under Califomia statu[es and related .regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 7 BO days, or If work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and ell requlred inapeetlo�s and finel approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this pertnit. FOR INSPECTIONS CALL: (714) 7545626 zaes-,e (eroo) WORKERS' COMPENSATION DECLARATION: � ' 1 hereby atlirtn untler penalry oi perjury one ot the �a�lowing tleclaratians: � ❑ I have end will meintain a cenificate of consent to seli-Insure (or workers' compensatlon, es pmvided for by section 3700 ot ihe Lebor Code, for ihe pertortnance of Ihe work for whlc� this Dermit is issuetl. - ❑ I have anA wlll maintain workers' compensatlon Insurence, as requiretl by section 3700 W Ihe Lebor Cotle, for Ihe performance W tha woAc for whiU UJs pertnit is issued. � My workers' compensetion Insurence cerde� end policy number are: Cerrier. Policy Number: (This sec0on need not be comp/eted il the permit is veluetl et one hundred Dallers ($f 00J or less.) �� I certity that in the performance of the work for whlch this pertnit is issued, I shall not employ eny person in eny manner so as to become subject to the workers' compensetion lews ot Californle d egree Ihat If I should bemme subject to the workers' compansatlon provislons ot Sectlon 3700 af ihe Lebor Cade, I shell fonhwith comply with thesa provisions. ,�w��rs��e:;�� ,�� . ,�S.r��.c. e a:— �(— 4-0 2 ARNINO.V7 ' FAILUHE TO SECURE WORKE0.S' COMPENSATIOM COVERAGE IS W FUL AtJD SHAl1 SUBJECf AN EMPLOYER TO CRIMINAL PENALTIES AND CML FlNES UP TO ONE HUNORED THWSAND DOLLARE (5100,000), IN ADDf71IXJ TO h1E fAST OF COMPENSATION, OAMAGES AS PROVIDED FOR IN SEGTIpJ 3]OB OF THE LABOR CODE, IMEREST, AND ATfORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby eflirtn that I am licensed under provislons ot Chapter B(commencing with Section 7000) of Dlvision 3 of the Business antl Profeuions Cotle, end my license is in full force and eXect. Lic. q Class k Contractors Signeture: Daie: CONSTRUCTION LENDING AGENCY: ❑ I hereby eflirtn that thera is a conslructlon Iending egency tor the pedormance of the work for which this permit is issued. (Sec. 3097, Civll Cotle). Lentlers Name: Lentlers Address: Signature: � Date: OWNER-BUILDER DECLARATIONS: I hereby ettirtn that unUer penalry oi per�ury thet I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for tha tollowing reason (Sec. 7031.5, Business antl Professlons Code: Any ciry or counry which reduires e pertnit �a construct, alter, improve, tlemolis�, or repair any structure, D�or lo its issuance, elso requlres the applicant for such pertnit to file e signed stetement ihat he or she is Ilcensed pursuent to ihe proNsions ol Ihe Contrectors License Lew (Chepter 9(commendng with Sectlon 7000) of Division 3 of Ne Business end Prolessions Cotle) or ihat he or sha is exempt therefrom antl the besis tor the ellege0 exemption. Any Wolation of Sedlon 7031.5 by any epplicant for a permit subJects Ihe epplicent to e civil penalry of not morB ihen live hundred dollars (3500).): ❑ I, es owner of t�e property, or my employee5 wilh wages es Iheir sole compensa�ion, WILL DO THE WORK, and the structure is no� Intended or oHered for sale (Sec. 7044, Business end Prafessions Code: The Contractors License Law does not apply to en owner of properry who builds or improves thereon, entl who daes such woAc himself or herself or ihrough his or her own dmployees, providetl Ihat such Improvaments ere not Intended or oHeretl tor sele. II, however, ihe building or impmvament is sWd within one year of completion, iha ownB�-bullder will have ihe burden of proving ihat he or sha did nol6uiltl or imprwa tor purpose N saie.). �� I, as owner of Ihe property, em E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS m constmct the project (Sac. 7044, Business end Professions Cotle: The comrec�ors License Lew does no� epply to an owner of properry who builds ar improves Ihereon, antl w�o wntraas lor suc� prqed with a comrector(s) license pursuan� to the Contraqors License �ews.). ❑ I em exemyWpdef sec. Owner ID vediied by drivers liwrt. Vedficatlon ot Ownership by (type Business and Pmfessions Code for this reason: is ❑ No Driv Ys,Cicense No: � i.e. - praperty tex Dill or tleetl): DIVISION OF INDUSTRIAL SAFETY PERMR CBATFICATON: ❑ I hereby certily that no excavetion ilve (5) or more faet in depth inio which e person Is requlred to descend, will be mede in wnnection wlth work authorized by Ihis pertnit, end that no building siructure, scaMolding, felsework, or demolition or tlismantling thereof, will be more then thirry-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Tllle 8, Callfomia Administrative Code). ❑ As owner-builder, I will not amploy enyone to tlo work which would reQulre a pertnil from the Division of IndusMel Setery, as noted ebove, unless such pereon hes a permit to do such work from ihe tliNsion. Signeture: Date: Division of Indusinal Safaty Permit Num6er: CERTIFlCATE OF COMPLUWCE AND AUiHOR¢ATON OF ENfAY: I certify untler penalry ot perjury that I have reaG Uis apD�ication enO stale t�et Ne infortnetlon given is conect I agree to compty with all sate laws and pry ordinences relating to building conswction, and authorize representatives of the Ciry oi Costa Mesa to enter upon the ebove�descnbed rty f r inspecY n pu es. I egr9e not to occupy or ellow occupency of eny building au�horized by this pertnit until tinel inspection. ,p� U— 4-02 �SlgnaNre O1 Legal_ ner(s) DateJ.. �— COOE �. INSVECTIONTYPE QAIE 1616 Fixed System Final Fira Preventlon 1266 200 Pool Spe Finel Final Re-Roof 201 Final BIacWRetaining Well 202 Final Factory Fire Place 203 Final Sign 204 Finel Demolition GOOE I INSPECf10N TPE 206 Final Mechanical 20B Finel Plumbing 210 Finel Elecincal 212 Final Pira Preventlon 220 �r � Final Planning Approval Final Site Final Buildinq/Occupency PAff Itf�lL$ =�`� � (714) 754-5273 • Fax (714) 754-4856 • www ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 931 W 19TH ST ��'''��JJJ�'''j��{�� Suite: �� Vicinity: �� Parcel Number: 42432109 Zoning: �pIREST � O r Applicant BERGER, EDDA _ _ _ Address: _ , ' -,�r�• - . , . , � _ /�� Phone: 94&54&0492� � \ /��%.� �,� � � 2ip: � 1 i ' i . ' � _ �; � , / �i,� �'. i � ' � i Owner BERGER; EDDA I `� � � � � _ � � �� Address ; 931 W 19TH ST, � -, .� '. " , , ., � APT 8� , , � , _ - = 'Phone: � 949-548 0492:' -`�� .. � !%COSTA MESA, CA:' %_ �. �� :=� Zip: 92627 - j � � - i �G. i -'" � I ` i' �� : Conh ctor: � � \�"��/�� \ add�e5s:; , / . � Phone:'� Zip: � � License:� � � � - Arch : Address: � 2ip: . . -i;�� . . �� Eng: . , , �� - _ Address:; � . ' �,_-' . . .. . , -. . �' -Phone: - �' - , , i/��'� - � . , �, �'�icense: � , � v� � ' � INSTALL COSMETIC WOOD OOVERING TO 12, RE;P02-00203. � � � �.Plan Check: , Permit: SMIP Res: SMIP Corri`. Other: Inspection: � � �. Total: , $0.00 $54.00 $0.50 , $0.00 $0.00 $0:00 �. $54:50 ; � � � '- ISSUED BY: Status: ISSUED Applied: OS/02/2002 Issued: OS/02/2002 S �� . Phone: � �� - ; � �i _ - � License: � iRMII__...,..�,- ' �, - , . LD�PLUMBING�FOR UNITS 5, 6, 7, 8, 9, 10, 11, � � �- � i � FEE SUMMARY � =' - ; _ ; /' ' " ' Calc Valuation: � . Claim Valuation: , ' , i % P.I � SETBACKS � � �� - MAIN STRUCTURE Front � 0-�0, .' '� - ,_ Rear � �0- 0 � � � �� " ACCESSORY Front'�� 0-'0 ' . Rear �0-0 � � � PARKING Existlnq: �0:\ �Reauired: 0 _ �� - NOTES: left , Left � �%,' , _ ;' ",� _ , - _ �� ', , : ;; ; ZONING � �., . � 0- 0" - . � RigFit. ., ;p- p.' �., �0=0-- � Righb 0-0 � �� Pr000sed: - 0� � �' . . _ . _ _ ; , ' . �>�i.�. _ _ � si,soo.00 51�,500.00 ," NOTICE: The work aulhorized by ihis permit shall comply with all applicabla handicap access requirements under Caiifomia statutes and related regulations. (Ord. No. 92•28, § 1, 12-21-92) EXPIRATION: This permit shall automatirally ezpire and become void if vrork Is not commenced within 180 days, or if work is suspended or abandoned for a period of 780 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 requlred Inspeetlons and flnel epproval must be obtained. Failure to obtain Inspections and final approval will result in the expiratlon of ihis pertnit. FOR INSPECTIONS CALL: (714) 750-5626 ' zsae-,e �aroo� y � � WORKERS' COMPENSA710N DECLApA710N: . � I hereby eflirtn untler penelty ot peryury one ol the tollowing tlecleretions: � ' ❑ I have antl will malntain e ceriitiwte ot consent to self-Insure for workers' compensation, es providad for Oy section 3700 of the Lebor Code, for the�performance �of Ihe work tor which Ihis permlt Is issueC. ❑ I heve and will maintain workers' compensation Insurance, es raquired by section 3700 of the Labor Code, for t�e peAormence of the work for which this pertnit is issued. My workers' compensatlon Insurance cartier and poliry number are: �. Cartier: Policy Number: (This section need not be comp/eted i! fhe peimit is veluea af one huntlretl tlollers ($f00) or less.) ❑ I certify Ihat in the paAormence of iha woric tor w�ich this Dermit is issueq I shall not employ any Oerson in any manner so as to 6ecome su��ect to Ihe workers' compensation laws of Celifomia, and agree that If I shoultl become sub�ect m the workers' compensation provislons ol Section 3700 of the Labor Code, I shall forthwith comply with these pwvisions. Applicent Signature: ' Date: WARNING FAIWRE TO SECURE WORKERS' WMPENSATION COVEMGE IS UNLAWFUL AND SHFLL SUBJECT AN EMPLOVER TO CRIMINA� PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND DOLLARE (5100,000), IN ADDRION TO THE COST OF COMPENSATION, DAA44GES AS PROVIDED FOR IN SECTION 3]O60F THE LABOR CWE, IMEREST, AND ATTOfiNENS FEES. LICENSED CONTRACTORS DECLARATION: --'�=""^ � - _ _�-` �� I hereby ettirtn ihat I am licensetl under pmvisions of Chapter 9(commencing with Sectlon 7000) of Division 3 ot the Business and Profeuions Code, enC my license is in full torce end ettect. Lia N ' '•eTPi � Cless a ComractaYs Signeture: CONSTRUCTION LENDING AGENCY: ❑ I hereby aftirtn that there is e consiruction lentling egency for the pertormence of the work for which this pertnit is issuetl. (Sec. 3097, Civil Code). Lenders Name: Lentler's Address: Signatura: �� ' Date: ii nr_� OWNER•BUILDER DECLARATIONS:�� 1 hereby eflirtn ihat under penelty of perjury thflt9"am E%EMPT FROM THE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Business end Protesslons Code: Any ciry or county which requires a permit to construct, elter, improve, tlemolish, or repair any simcNre, prior to its issuance, elso requires ihe epplicant for such pertnit ta file e signed statemant ihet he or sha is licensed pursuant ro t�e D�ovisions of ihe Comrecbrs License Lew (Chapter 9(commencing with Sectlon 7000) at DiNsion 3 of the Business end Protessions Code) or that he or she is eiempt Ihereirom and ihe besis for iha elleged e:emption. Any violation of Section 7031.5 Dy eny apP�icent for e permit subjects the applicant to e civil penalry ot not more ihen five hundred tlollars ($500).): ❑ I, es ov+ner of the properry, or my employees wlih wages as iheir sole compensation, WILL DO 7T1E WORK, antl the structure Is not intendetl or ottered for sele (Sec. 7044, Business and Pmtessions Code: The Contraclors License Law does not apply �o an owner of pwperty who builtls or improves thereon, end who does such work himself ar herseN or Ihrough his or her own employees, provided that such improvements ere not intended or offeretl tor sale. If, however, ihe building or improvement is sold within one year ol completion, the owner-builder will have �he burden of proving that he or she did not build or improve for purpose ot sale.). ❑ I, es owner of ihe property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the prqect (Sac. 7044, Business and Profeuions Cotle: 7Te coniradors license Lew does not apply m an owner of property who builtls or Improves thereon, and who wntracts for such project wit� a contractor(s) licensa pursuent to the Coniractors License Lews.). ❑ I em ex p d r sec. Signature: Venfication at Ownership by (type of Businass and Professions Cotle for this is ❑ No onvers License No. i.e. - property tex bill or tleetl): DIVISION OF INDUSTRIAL SAFETY PERMR CER7IFICA710N: Expires: ❑ I hereby certify that no escavetion five (5) or more leet in depih into which e person Is requiretl to descend, will ba made in connectlon wlth wark euthonzetl by Ihis permit, and that no building structure, scaHoldinq, talsework, or demolition or dismantling thereoi, will be more than thirry-six (36) feet high. (Chap. 32, Gry 2, Ar12, Sec. 341, Ttle 8, Califomie Atlminisiretive Code). ❑ As owner-builtler, I will not employ anyone to do work which would require e permit from the Division ot Industnel Setery, as notetl above, unless such person hes e pertnit to do such work irom the division. Signatura: Date: Division of Industrial Safery Permit Number: CERTIFICATE OF COMPLIANCE AND AUTHORVATON OF ENTRY: I certity untler penalry oi perjury that I heve read this application end state that the infortnetlon given is cortect. I agree to comply with ell stete laws and ciry ordinances relating to builtling construction, and authorize representatives ot the Giry of Costa Mesa to enter upon Ihe ebove-de;oribe5� prgperty for �Ispep}ion purposes. I agree not to acupy or ellow occupancy of eny building authorized by this permit until finel inspection. / AnNOr Aut�onzed Applicant COUE I, INSPECTIONTYVE 167fi Fixed System Final Fire Preventian 1266 Pool Spe Final 200 Final Re-Root 201 Final BIxWRetaiMng Wall 202 Final fedory Fire Place � 203 Final Sign 204 Final Demolition �� I�$ f,Qjf� INSPECfIONTYPE 206 Final Mechanical 20B Final Plumbing 210 Fina1 Eleclrical 212 Final Flre Prevention 220 222 250 Final Planning Approval Final Site . Final Builtling/Occupenty Date PAg It�l,4 � . (�ia� �sa-s2�s • Fax (714) 754-4856 CIN OF COSTA MESA ' BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT BUILDING PERMIT �ob nddress: 93y W 19TH ST Suite: Viciniry: REROOF BACK HALF OF ROOF ONLY. Parcel Number: 42432109 npp�icant: JAMES FIEGE Address: 11664 TRASK AVE GARDEN GROVE, CA .- owner: BERGER, HARVEY A Address 10481RVINE AV . . . �S7E 628 �� - ,' NEWpORT BEACH, CA � � Coritracror: WORLD WIDE ROOFWG Address: 11664 TR4SK AVE � GARDEN GROVE, CA Zip: 92843 Arch : Address: - � � . � � . , , � Phone: Zoning: Phone: (714)539-7200 � Zip: 92643 Phone: 949-548-0492 ". Zip: 92660 Phone:- (714)539-7200 License:, 726693 � - Eng: ' ' Address:� PERMIT NUMBER B00-00115 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 01/26/2000 Issued: 01/26/2000 ISSUED BY: �/ � / Phone: , Zip: ' ' � License: License: . SCOPE OF PERMIT REROOF BACK HALF OF ROOF ONLY - T/O, USE EXISTING SHEATING, INSTALL NEW 4 PLY BUILT UP ROOF. � Plan Check: Permit: SMIP Res: SMIP Com: Other: Inspection: Tota I: $0.00 $167.25 $0.00 $1.70 $0.00 $0.00 $168.95 SETBACKS ` MAINSTRUCTURE Front 0-0 ACCESSORY Front 0-0 PARKING Existinq: o NOTES: - FEE SUMMARY . �� . . — - �� Calc Valuation: _ _ — Claim Valuation Rear 0- 0 Rear 0- 0 Reauired: 0 PLANNING 8 ZONING Left 0- 0 , Right 0- 0 Left 0- 0 Ri9ht 0- 0 Proposed: 0 sa,ioo.00 $8,100.00 NOTlCE: The work authorized by this permii shall comply with a71 applicable hand'icap access requirements under California stetutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned �or a penod of 1 BO days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspectiona end flnal approvel must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 WORKERS' COMPENSATION DECLARA710N: I hereby aHirm under Oenalry ol perjury one of the tollowing Aeclara�ions: ❑ I have entl will meintain a cenilicate of consent b selt-Insure tor workers' compensation, es providetl for by section 3700 of Ihe Labor Code, for Ihe pedormance ot the J. work tor which ihis permii i5 i55uetl. - LJ I have end will meintain workers' compensation insurenca, as required 6y section 3700 oi t�o Lebor Code, tor lhe peAortnance oi the work for which this pertnit is issued. My w rkers' compensation Insurance carner end policy number are: Cerrier: �e�� /+r--' Policy Number: (fhls section need not be comp/efetl i/ the permit is valued af one hundretl dollers ($f 00J or less.) ❑ I certify that in Ihe pertortnance of the work for which this pertnit is issueQ I shall not employ any person in any manner so as to become sub�ect to lhe workers' compensation laws of Califomia, end agree �hat it I should become subject to ihe workers' compensation provisions of Section 3700 of the Lebor Cotle, I shall fotlhwith comply with these provisions '� �, Applicant Signature: � / i/'-""Zi-� Date: �� 2� � � J � WMNING:FAILURETOSECU9 WORKERS'WMPEN COVEFiAGEISUNLAWFULANDSHALL5UBIECTANEMPLOYERTOCRIMINALPENALTIESANDCMLFlNESUPTOONEHUNDRED TMOUSAND DOLLARE (5100,odo), IN A�ORION TO THE COST OF WMPENSATION, DAMAGES AS PiIOVIDED FOP IN SEGTION 31O60F THE LABOR WDE, IMEREST, AND ATiORNE1"5 FEES. LICENSED CONTRACTORS DECLARATION: I hereby eNirm that I am licensed under ro 'sions ot Chapter 9(commencing with Section 7000� ot Division 3 of ihe Busing�s endP[4fessions CoOe, antl my license is in tull torce antl eHact. Lic. # ? �� Class a � S 7 Contrectors Signature: Data: �� 2 6 � O c.� CONSTRUCTION LENDING AGENCV: ❑ I hereby aHirtn that Ihere is a construction lending egency for the pertortnance of Ihe work for which Ihis pe�mit is issued. (Sec. 3097, Civll Code). Lender'S Name: � Lender'S Address: Signeture: Date: OWNER-BUILDER DECLARATIONS: I hereby aHirtn that under penalry ol perjury Ihai I am EXEMPT FROM THE CONTRACTORS LICENSE LAW tor �he tollowing reason (Sec. 7031.5, Business antl Professions Code: Any ciry or counry which requires a pertnit to consiruct, alter, improve, demolish, or repair any swcture, pnor to its issuance, also requires Ihe appliwnt for such permit to lila e signed statement ihat he or she is licensetl pureuam to t�e pmvisions ot the Coniractors License Law (Chapter 9(commendng with Section 7000) ot Division 3 ot ihe Business and Pmfessions Code) or thet he or she is exempt therefrom end the Dasis tor the allegetl exemption. Any vloletion of Section 7031.5 by eny epplicant for a permit sub�ects Ihe applicant to e civll penalry of not more than five huntlretl tlallars ($500).): ❑ I, es owner oi iha property, or my employees with wages as their sole compensatlon, WILL DO THE WORK, entl the structure is not intended or oHered tor sale (Sec. 7044, Business and Pmfessions Code: The Conirectors License Law does not apply to en owner of properry who builtls or improves ihareon, end who dces such work himself or herself or through his or her own employees, providetl thet such improvements ere not intended or oMered tor sale. If, however, ihe building or improvement is sold within one year of completioq �ha owner�builder wlll have ihe burden of proving Ihet he or she tlid not builtl or improve tor puryose of sele.). ❑ I, es owner oi the property, em E%CLUSIVELV CONTRAC7ING WITH LICENSED CONTRACTORS to construct Iha pro�ect (Sec. 7044, Business and Professions Code: The contrectors License Law does not epply to an owner of property who builtls or impmves thereon, and who comracis for such project with a contractor(s) license pursuant to the Contractors License LawsJ. ❑ I am exempt under sec. SignaWre: Owner ID verified by drivers license. ❑ Ves ❑ No Business and Professions Gode for this reason: Verification ot Ownership by (rype of tlaument, i.e. - properry tax bill or deed): DIVISION OF INDUSTRIAL SAFETV PERMIT CER7IFICATION: Driver's License No. Date: Expires: ❑ I hereby cetliy Ihet no excavation five (5) or more faet in depth into which e person is required to descend, will be mede in connection with work aut�onzed by Ihis permit, antl t�at no builtling structure, scattolding, felsework, or demolition or tlismantling thereof, will be more than Ihiriy-six (36) teet high. (Chap. 3.2, Gry 2, Art 2, Sec. 341, Title B, California Adminisire�ive Cotle). ❑ As owner-builder, I will not employ anyone to tlo work which would require a permit Irom the Division of Industnal Salery, as noted above, unless such person has a permit to do such work Irom the division. Signawre: Division of Intlustnal Sefery Pertnit Number: Date: ICERTIFICA7E OF COMPLIANCE AND AUTHORVATION OF ENTRY: I certity under penelry ot perjury that I have read t�is application and state that Ihe information given is I correct. I agree b comply wllh all state laws antl city oMinances relating ro building construction, and authonze representatives ot the City of Coste Mesa ro enter upon the above-describatl property tor inspection purposes. I agree not to acupy or allow occupancy of any builtling authorized hy this permit until final inspection. COpE �, INSPECTIONTYVE 1616 1266 Fixed System Final Fire Prevention Pool Spa Final 200 Final Re-Root 201 Final Block/Retaining Wall 202 Final Factory Fire Plece 203 Final Sign 204 Final Demolition 2an6-a6 Qy/jF INTIfIALS / � V Date l — Z � - O-o Date COpE� INSPECTIONTYPE QdjE INTRIpLS 206 Final Machanicel 208 Final Plumbing 210 Final Electncel 272 Final Fire Prevention 220 Final Planning Approvel 222 Final Site 250 Final Builtling�Occupancy (714) 754-5273 • Fa�c (714) 754-4856 • www.ci.coSte-meSa.Ce.Us 77�FAIR DRIVE, GOSTA MESA, GA 92626 BUILDING PERMIT Job nddress: 931 W 19TH ST Suite: Vicinity: REAR AND SIDE PROPERTY LINES Parcel Number: 42432109 Applicant: CATON, JAMES I. Address: Owner: BERGER, EDDA I Address�� 931 W 19TH ST -� APT 8 COSTA MESA, CA - Contractor: JIM CATON MASONRY Atldress: PO BOX 1288 GARDEN GROVE, CA . Zip: 92642-2315 Arch : Address: Zoning: ISSUED BY: ,Phone: 714-63&2315 � Zip: Phone: 949-548-0492 , Zip: 92627 Phone: (714) 63&2315 License: 305339 - Eng: ' ' � Address: Phone: Status: ISSUED Applied: 01/17I2003 Issued: 01I17I2003 Phone: Zip: License: License: . , . SCOPE OF PERMIT ., . CONSTRUCT 72 LF, 6' HIGH BLOCK WALL — 57 LF ON THE LEFf SIDE�PL;`15 LF ON JHE REAR�pL PER CITY STANDARDS. Plan Check: Permit: SMIP Res: SMIP Com: Other: Inspection: 7otal: $35.10 $54.00 $0.50 $0.00 $0.00 $0.00 $89.60 SETBqCKS � - � _ �. MAIN STRUCTURE Front 0. 0 Rear 0. 0 ACCESSORY � Front 231-0 � Rear 0.0 PARKING Existinq: o Reauired: o NOTES: FEE SUMMARY Calc Valuation: " Claim Valuation: PLANNING & ZONING �en a o Left 0- 0 Proposed: 0 , Right 0. 0 Right 135- 0 ai.aoo.00 So.00 NOTICE: Tha work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ortl. No. 9248, § 1, 12-21-92) E7(PIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or If work is suspended or abandoned for e period of 180 days. INSVECTIONS: In order for the work authorized under this permit to be considered legal, such. work must comply w7th all applicable codes, and all required inapaetlons and Iinal epprovel must be obtained. Failure to obtain inspectlons and tlnal approval will result in ihe explratlon of this permil. FOR INSPEC710NS CALL: (714) 754-5628 :aas�.e �aroo� WORKERS'COMPENSAnON OECLAFiAnON: ' , � � - I hereby aifirm untler penalry of perjury one at the Idlowing tledarations: ❑ I have end wlll meintain a ceNficate of consent Io sell-Insura tor workers' compensation, es provltleA tor by section 3700 ot the labor Cotle, for Ihe peAormance of ihe LL work lor w�ich tNs pertnit Is issuetl. �I��fiave entl will maintaln workers' compensaUon insurance, es requireO Dy sectlon 3700 of Ne Lebor Cotle. for Ihe peAormance of the wwk for whkh Nis pertrtit Is lssued. My worke wmpepsetionn Insu2nce cartier entl policy number are: Cerrier:��-"��ii r� FNN� rP�Nump¢—� f�'"a�0�'�� (TpLa aec�on need not be completetl i! Ne permlf fs ve/ued et one huntlred dol/ars ($100) or Iess.J , ❑ I cenity that in the peAartnencey the work tor which I�Ls permit is Issuetl, I shell not employ any person In any mennar so es to become sub�act ta �he workere' compensetian lews ot CaJtomla nd agrea t�at If I, ould be om sub�ect to Ihe worker� compensetlon provislons of Sactlon 3700 oi ihe Labor Catle, I s�all fon�with comply with thase.pr i51ons. epplicen� . �-- � _ . �te.� �/�7�0 � WARNINO: FAILURE TO SECUS WORKERS' COMPENS�TION COVERA�E IS UNUWFUL ANO SMALL SUBJECT AN EMPIOYER TO CfiIMINAL PE TIES PND qVl� FlNES UP TOONE HUNDRED TFIOUSAND DOLURE R��o60), IN ADqT10N TO THE CO6T OF COMPENSATION, OMMGES AS PROVIDED �OR IN SEGTON 31080F THE UBOR CODE, INTEREST, AND ATTORNEVS FEES. LICENSED CONTRACTORS �ECLARATION: I herehy eflirtn that I em Iic�sed under pmvlsions of Chepter 9(commenGnp with Sectlan 7000) of Dldslon 3 at Ihe entl my Iicense is in full CONSTRUCTION LENDING AGENCY: ❑ I horeby eHirtn that there is a construction lendinp epency tor t�e peAormance at the work lor which this pormlt is issued. (Sec. 3097, Civil Cotle). Lentlefa Neme: Lentler's Adtlress: Signaturo: OWNER-BUILDER DECLARATIONS: Date: I hereby effirtn thet untler penelry oi Oerjury t�et 1 em EXEMPT FROM THE CONTRACTORS LICENSE LAW for the tollowing reeson (Sec. 7031.5, Business end Proteulons Cotle: Any ciry or counry which requires a permit lo construct, elter, Improve, demolish, w repalr eny struciure, pnor to Its issuance, fllw requires t�e apD��ent tor such pertnit lo file e signed stetemenl �het he or she is IlcenSeG Oursuent to Ue provisions of lhe Conirectors Llcense Lew (Chepter 9(commenUng wilh Sectlon 7000) of DlWsian 3 01 the Busineu end Professions COCe) or Nat he or she is ezempt Uerelrom entl t�e basis for t�e allegetl e:emption. Any vidation ot Secllon 7031.5 by any eppllcant tor e pertnit sub�ects Ihe applicant to a Gvil penalry oi not more than fne hunOreO Collars (5500)J: ❑ I, as owner oi the properry, or my employees with weges es their sole compensatlon, WILL DO THE WORK, antl t�e slrucNre Is not intendetl or oNeretl for sale (Sec. 7044, Business and Professions Code: Tha ConUectors lJCense Law doas not apply to an owner ot property who builtls or imprwes thereon, antl who Aoe9 such work himself or herselt or t�rough his or her or.n employaes, pravidetl ihet such imprwements ere not intendetl or oHered far sale. If, hawever, the building or improvement is sold within one year of compleGon, ihe owner-builder will have the burden oi proving that �e or s�e tlitl not build or imprwe for purpose of sale.). ' ❑ I, es owner ot t�e properry, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the pmject (Sec. 7044, Business anA Professions CoCe: 7he comreciors Licensa Law does not eppty ro en ownar oi property who builds or Improves thareon, end who crontracts tor such project with a conirector(s) license pursuant ro the Contmctors License Lews.). ❑ I em exempt untler sec. Businass end Proleuions Cade for t�is reeson: Signetura: Date: Owner ID verlfletl Dy tlrivals licansa. ❑ Yes ❑ No Drivers License No. Expires: Verlflcation at Ownership by (type oi tlocumenL i.e. - property tez hlll or tleed): DIVISION OF INDUSTRIAL SAFE7Y PERMR CERTIFICATION: ❑ I hereby cetlify that no axcavation Me (5) or more teet in Cepth into which e person is requiretl ro descentl, will be maCe in connaction with work authodzed by this permit, end �hat no buildinp simcture, scattdding, talsework, or demolition or dismantling Ihereot, wlll be more t�an Ulrty-six (36) teel hiph. (Chap. 32, Gry 2, An 2, Sec. 341, lltle B, Celifomia AdminislratNe Cotle). , ❑ As owner-bullder, I wlll not employ enyone to do work which wauld require e permil Irom the Divlsion of Induslrial Satety, es noted ebove, unleu auch parson hes e permit lo do 5uch work trwn Ihe division. � Signature: Date: DiNsion of Intlusirial Sefery Permit Number: CERTiFlCA7E OF COMVLIANCE AND AUTHOR¢ATION OF EMRY: I certiy under penalry ol perjury that I heva read this application and Slate that the Inlortnation given is conect I agr mpty with ell state lews end Ury ortllnances relatlng to builtling wnswctlon, end euthodze representatives ol the Ciry ol Costa Mese to enter upon ihe ebove- nbed ooeM br inspectioq Ourposq9. I egree not to occupy or allow occupancy of eny builCing authonzed by Ihis pertnit un61 final inspectlon. cooe �, insrecnoxnve 1618 Fixod System Finel Flre Preventlon 1266 Pool Spa Finel 200 Final Re•Root 207 Finel Black/Retalning Wall 202 Final Fectory Fire Place 20.3 Finel Sign 264 Final Demolitlon ' QLff. I[�ELS �� COOE 1 INSPECTION TYPE 206 Finel Mochanical 208 Flnel PlumDing 210 Final Elecldcal 212 Flnal Fire Prevention 220 Flnal Planning Approval � 222 Finel Slte 250 Final Bulltling/Occupency QAg 1[�Lfl (714) 754-5273 • Fez (714) 754d856 • www.ci.costa-mesa.ca.us BUILDING PERMIT Job Address: 931 W 19TH ST Suite: Vicinity: DETACHED CARPORT Parcel Number: 42432109 Applicant: GURREA, SEAN Zoning: 77 FAIH OHIVt, GO51 A MtA'A, l:A tlZ626 Status: ISSUED Applied: 10/24/2001 Issued: 10124/2001 ISSUED BY: � Address: � - - � •' - � . ' ,_ "�'' � � � � - � Phone: 714-731-3425 - - , , . , �P _ ��.%� ' , ! _ ' % �\ owner BERGER�, HARVEVA � . � � Address .1048 IRVINE AV ' � � � � ' " - . � . �.STE 628 � � . , � � Phone: 949-548-0492� , - � � �- ` � . NEWPORT BEACH, CA . Zip: 92660 � " - Comractor: ' WEATHERLINE ROOFING INC �� Address: 1013 E WACNUT ST . �- - �, � , - Phone:. (714) 731-3425 SANTA-ANA, CA - ' ' � � � Zip: 92701 "% • License: � 729560 � . � ' � � � Arch : � - . .� E�9; . �. .. ., Address: �� . ' � �? �. � • Address: � \ - � � � Phone: � , , - . Phone: � � . - i� � ;. - ' _ - Zip: � , �icense: , �License: � � � � SCOPE OF PERMIT % TEAR OFF ROCK ROOF, INS7ALL THREE PLY FIBERGLASS CAP SHEET�SYSTEM. CARPORT ONLY. � � �. - -- . . . _. .. . , FEE SUMMARY Plan Check: $0.00 ' Calc Valuation: $2,soo.00 � Permit: $83.25 - - � � � ° , � ' - Claim Valuation: � $z,soo.00 SMIP Res: SMIP Com: Other: Inspection: Total: $0.50 $0.00 $0.00 $0.00 $83.75 i:_ � SETBACKS ��- , MAIN STRUCTURE FronL 0- 0 � Rear � 0- 0 ACCESSORY Front' 0-0 � � Rear 0-0 � PARKING Exislina: o Requiied: , 0 NOTES: PLANNING 8 ZONING LeN 0- 0 - Right � 0- 0 Lefl 0- 0 Right , 0- 0- Proposed: 0 " NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremeMs under Californla statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void ii work is not commenced within /80 days, or if work is suspended or abandoned for a period of 180 days. � INSPEC710NS: in order tor t�e work authorized urMer this permit to be considered legal, such work must comply with all applicable codes, antl all required Inepeetiona end final approval must be obtained. Failure to obtain inspections and final approval will result in the expiratlon of this permit. FOR INSPECTIONS CALL: (714) 7545626 � WORKERS'COMPENSAnON DECLAFiAnON: I hereby ettirm under penalry of peryury one ol the following declarations: ❑ I heve entl will malntain a certificate of consent lo sell-Insure for workers' compensetlon, es providod tor by section 3700 of the Labor Cotle, for Ihe peAortnence of the work for which ihis pertnit is luued. ❑ I have end will maintain workers' compansetion Insurance. es required by sectlon 3700 0l the Lebor Catla, for Ihe perfortnar�ce oi the work fa which Uis pertnit is issued. My workers' compensation Insurence carrler and policy number ere: Cerder. f� . � Policy Number: (7his sectlon need nof be comp/efed il fhe permif Is va/ued af one hundretl tlollare ($700) or lees.) ❑ I cenHy that In t�e pertormance of t�e work for which Ihis permit Is Issued, I shall not employ any person in any manner so as to become sub�ect to the workers' compensetlon lews 4C i ia, end egree thet II I should bacome subject ro Ihe workers' compensatlon pmvisions of Sectlon 3700 01 the Lebor Cotle, I shall fonhwith cam wit� th rovi ' ns. / ApplicentSgneture:� ��iC� Date: /D—J.y—o/ WARNINO: FAILURE TO SECUR� WORKERS' COAIPENSATION COVERAGE IS UNIAWFUL AND SHALL SUBIECT AN EMPLOVER TO CRIMINAL PENALTIES AND GVIL FlNES UP TOONE HUNDRED hKK1SAND DOl1AR�E ,$108;000), IN ADDITION TO TME COST OF COMPENSATION, DAMAGES AS FROVIDED FIXi IN SECiION 3]O60F THE Lr�BOR CODE, INTEREST, PNO ATTOpNE1^S FEES. LICENSED CONTRACTORS DECLARATION: I hereby ettlrtn Ihat I em Iicensed untler prov�% ions ot Chap�te '9(commencing with Section 7000) oi Divl,lon 3 ot the Busineu and Profeuions Cotle, end my license is in full force and eMecL Lia x i� �/� // Class B Contrectors Slgnature: _� ii_ � /—�— Dete: / i. �� Y—o / CONSTRUCTON LENDING AGENCY: ❑ 1 hereby ettirtn that ihere is a constructlon lentling agency for the peAortnance of iha work for which Ihis pertnit is issuetl. (Sec. 3097, Civil Coda). Lentler'sNeme: _ ____. LendefsAdtlress: Signeture: OWNER-BUILDER DECLARATONS: Date: I hereby eHirm Ihet untler penalry of perjury Ihel I em EXEMPT FROM THE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Buslness end Professions Code: Any ciry or counry which requires a permit to construct, elcer, imprave, tlemolis�, or repair any stmdure, pdor to its Issuance, elso requires ihe eppliwnt for such pertnit ta lile a signed statemem that he or she is IlcenseA pureuant to Ihe prm4sians at the Contrectore License Lew (Chapter 9(commenUng with Secllon 7000) of DMslon 3 of ihe Buslness end Professions Gode) ar Ihet he ar she Is exempt t�erefrom and the besis for the ellegetl eaemption. Any violetion o1 Section 7037.5 by eny applicant tor e pem+' subjecis the epplicant ta e civil penelry ot not more then flve hundred dollers ($500)J: ❑ I, es owner of the property, or my employees wlih weges es �heir sole compansatlon, WILL DO THE WORK, antl the siructure Is not Intended or otteretl for sale (Sec. 7044, Business and Professions Code: The Contractois Ucense Law dces not apply to en owner of properry who huilds or improves t�ereon, and who does such work himseH or herseN or ihrough his or he� own employees, provided ihat such imp�ovemanis ere not Intended or oHered for sata. If, however, ihe building or Improvemant is soltl wit�in one year of complation, tha owner-bullder will heve the burden of proving thet he or sho did not build or improve for purpose ot sele.). ❑ I, es owner of the properry, em EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to consiruct tha project (Sec. 7044, Business anC Professions Code: The conireaors License Lew does not appty lo an owner ol property who Dulids or Improves theraon, end who comracts for such pmjact with e contractar(s) licanse Dursuant to ihe Coniractors License Lews.). ❑ I em exempt under sec. Business and Profeulons Code lor ihis reason: Signe�ure: Daie: Owner ID venlied by drivafs licensa. ❑ Ves ❑ No Dnvels License No. Verllication oi Ownership by (type ol document, i.e. � property tav blll or deed): DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION: Expires: ❑ I hereby cartity thet no excavation five (5) or mare laet in depth into which e person Is requlred to descend, will be made in connection wlih work authorized by Ihis pertnit, and Ihet no building siructure, scafloltling, talsework, or demolition or tlismaniling Ihereof, will ba more than thirry-six (38) leet high. (Chep. 32, Grp 2, Art 2, Sec. 341, Title B, Calitornla Atlminlstretive Cotle). ❑ As owner-builder, I will not employ enyane ta do work which would reQuire a permit Irom ihe Division ol Industnal Sefery, es notad e6ove, unless such person hes e pertnit to tlo such work irom the division. Signature: oate: Divislon of Indusirial Safety Pertnit Number: CERTIFlCATE OF COMPLIANCE AND AUTHORIZA710N OF ENTRY: I certity untler penalry ot perjury that I heve read this epplication and stete that the infortnation given is canect I egree to compty with all stete laws enC ciry ortlinances relating to builAing constructlon, and euthonze representetives of t�e Ciry ol Costa Mesa to enter upon the ebove-described property for inspactian purposes. I egree not to accupy or allow occupency ol eny building authorized by ihis pertni� until fnal inspection. COUE I, INSPECTIONTYPE 1618 Fixed System Final Fire Preventlon 1266 Paol SDe Final 200 201 202 203 204 Finel Re-Root Final BIocWRetaining Well Final Factory Fire Place Finel Sign Finel Demolition Q�¢, IMRIALS I--�— -*� /�1l'elZ/2�/ Da e CODEt INSPEC110NTYPE 206 Final Mechanical 20B Finel Plumbing 210 Finel Electrical 212 Flnal Fire Prevention 220 Final Planning Approvel 222 Final Site 250 Final Building/Occupency Q� �� (714) 754-5273 • Faz (714) 754•4856 • www.ci.costa-mesa.ca.us BUILDING PERMIT �ob Address: 931 W 19TH ST Suite: Vicinity: DETACHED CARPORT Parcel Number: 42432109 Zoning: npplicant GURREA, SEAN Address: � ' - , -„ '� � Phone: 714-731-3425 !� ' "_ Zip: Owner: BERGER;:HARVEY A � Address .1048 IRVINE AV � � � � � � STE 628 ' " - Phone: 949-548-0492 - NEWpORT BEACH, CA Zip: 92660 Contractoc WEATHERLINE ROOFING INC Address: 1013 E WALNUT ST - � Phone: ' Q14) 731-3425 � � SANTA ANA, CA � Zip:. 92701 � License: 729560 77 FAIR DRIVE, GOSTA MESA, GA 92626 Slatus: ISSUED Applied: 1 0124/2 00 1 Issued: 10/24I2001 ISSUED BY: ' Arch : ' ' Eng: Address: � . � , Address:' 2ip: Phone. License: SCOPE OF PERMI ! TEAR OFF ROCK ROOF, INSTALL THREE PLV,FIBERGLASS CAP SHEET; FEE SUMMARY Plan Check: $0.00 Permit: $83.25 „ � SMIP Res: $0.50 / SMIP Com: $0.00 Other. ' $0.00 Inspection: . $0.00 � Total: . $83.75 � � SETBACKS � _ , MAINSTRUCTURE FrOnt 0-0 � Rear 0-0 ACCESSORY Front 0-0 Rear 0-0 PARKING Existin : 0. Re uired: 0 NOTES: PLANNING & ZONING Lefl 0- 0 Lefl 0-"0 ProDosed: 0 ONLY Calc Valuation: Claim Valuation: Right 0- 0 Right . 0- 0 Phone: License: � 52,900.00 52,so0.00 NOTICE: The work authorized by ihls permit shall comply with all applicable handicap access requi�emenis under Californla statutes and related regulations. (Ord. No. 92•28, § 1, 1241•g2) EXPIRATION: This permit 8hall automatically expire and become vold if work is not commenced within 180 days, or if work Is suspended or abandoned for a period ot 180 days. INSPECTIONS: In order for the work euthoAzed under this permlt to be considered legal, such work must comply with all applicable codes, and all requlred Inapeetiona end final epproval must be obtained. Failure to oblain inspections and finel approval will result in the expiration of lhis permlt. FOR IMSPECTIONS CALL: (714) 7545628 � WOHKERS'COMPENSATONDECLARATON: I hereby aflirm under panalry at parJury one at the tdlowing Oederetlons: ❑ I heve end will maintein e ceNficate at conaent to se&Insure lor workers' compensetion, es pmvltled for by sectlon 3700 of t�e Lebor Cade, for the peAartnence of the work for whlch this partnit Is issuetl. ❑ I have entl will maintein workers' canpensation insurence, as requiretl by sectlon 3700 oi Ne Lehor Code, lor ihe peAartnance of ��e vrork for which this permit is issuetl. My workers' compensatlon Insurence cartier antl policy number are: • .,_._ Cerrier: Pollty Num�er. (Thls section need not be cwnpleted i! fhe permitls veNeC ef one �urMretl tlollers (5700) or less.) ❑ I certiy that In t�e peAormence of Ihe work tor wNch Ihis pertnll Is Issued, I shall not employ eny person in eny menner so es to �ecome subject to Ne workers' compensatlon lews li1ffirie, anE agree t 4i� ould Eewme suD�ect to 1he workem' compense�ion proNslans ol Section 3700 ot t�e Labor Code, I shall IoMwlth comply wlt� t�ese ovlsr . /� Appllcent Slgnature: Date: / b^'�' �' �/ WARNINO: FAILURE TO SECURE W (ERS' IPENSATION COVEMOE IS UNIAWFUL M'D SHML SUBIECf AN EMPLOYER TO CRIMINAL PEW�LTIES AND dVIL FlNES UP TO ONE HUNDRED THOUSAND OOLURE (5100 , ADDfTION TO THE CQST OF COMPENS4TION, DAAt4GE5 A9 P{qVIDED FOR IN SEGTION 3]OB OF TNE IABOR CODE, IMEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I �ere�y eHlrm thet I em Ilcensetl under provisic lorce end ettect. Llc. M� contractors slpneture: 9(commencinp with Sectlon 7000) oi Dlvlsion 3 0l ihe Business and Professlons Code, end my Iicense is In tull Cless a __ De�e: �s-lY- 6 i CONSTRUCTON LENDING AGENCV: ❑ 1 hereDy aNirtn thal there is a consirucibn lentlinp epenty tor the pertormance ol ihe work lor which this permil is Issued. (Sec. 3097, Clvil Code). Lenders Neme: Lentlefs AdEress: Signeturo: OWNER•BUILDER DECLAFiAT10N5: Date: I hereby elfirm Ihet under penalry of perjury the11 em EXEMP7 FROM TTIE CONTRACTORS LICENSE LAW lor the folbwing reason (Sec. 7037.5, Business end Proteulons Cotla: Any ciry or counry whic� reqWres e pertnit to construd, elter, imprave, tlemolish, or repair any strudure, pdor to its fssuence, elso requires the apDlicant br such pertnit to Ole e slgneC statement ihet he or she Is licensed puBuant to the provisfons ot the ContreIXors License Lew (Chepter 9(commencing wlth SecUon 7000) ot �ivision 3 af the Business entl Professions Cotle) or Ihet he or she is exempt Uerefrom and Ihe basis lor 1he ellegad exemptlon. Any vloletion o1 Section 7037.5 by any applicant for e pertr+' subjects the appllcent to a cidl penalry of not more Ihen five hunaretl Aollera (5500).): ❑ I, as owner of the pro0erty, or my employees with weges es I�eir sole compensetion, WILL DO T1E WORK, antl ihe strudure Is not intended or otteretl for sele (Sec. 7044, Business end Profeuions Code: The Contractors License Lew Ooes not eppty lo an owner ot propeny who Duilds or improves Ihereon, end who tloes such work hlmself or herself or through his or her own employaes, provided thet such impravemenis are not intended or offared for sale. H, however, the building or improvement Is sold wit�ln one year ot wmpletion, ihe owner-Duilder wlll heve the burdan of proving that he or she tlitl not bulld or improve for purpose ot sele.). ❑ I, es owner o1 the properry, am EXCLUSIVELY CONTRACTING WIiTI LICENSED CONTRACTORS to constmct the prolect (Sec. 7044, Business and Pmfessions CoAe: The comractors License Lew daes not flpply to en owner at pwpeny w�o builAs or improves thereon, and who contracis lor such pmject wiih a comracroqs) license pursuant to the Contractors License Lews.). ❑ I em exempt untler sec. Business and Prolessians Cotle for this roason: Signatura: Date: Owner ID verltied by dnvets license. ❑ Ves ❑ No Drivefs License No. Expires: Verillcetlon ol Ownership by (rype of dxument, f.e. - properry tav bill or deed): DIVISION OF INDUSTRIAL SAFETV PERMI7 CERTIFICATON: ❑ I �ere6y cenify that no excaveilon tNe (5) or more teet in Cepth into which e person is requlred to descend, will be mede In connectlon with work euthorized by thls permil, end Ihet no building strucWre, scaNdtling, talsework, or tlemditlon or Eismantling thereof, wlll 6e more then thirty-slx (38) teet high. (Chep. 32, Gry 2, An 2, Sec. 341, Tllle 8, Celllomla AtlminislreUve Catle). ❑ As owner-bulltler, I will not employ enyone to tlo work w�kh would requlro e pertnit tmm the DlWsion ot Indusidel Selery, es notetl above, unless such person �as e permit to Co such work Irom Iha division. Signeturo: Dete: Division of InEusidel Safery Permit Number. CERTIFlCATE OF CAMPLIANCE AND AUTHORQATION OF EMRY: I cenity untler penalry of perjury thet I have read this epplicetion end swte t�at the iniortnatlon given is corred. 1 apree ro compty with all state laws end Gry ordinances reletinp to bullding construction, end euthodze represenlatives oi the Ciy ot Costa Mesa ro enter upon the ebove-descnbed property tor inspedion Ourposes. I egree not to occupy or allow occupanty oi any building euthorized by this permlt until tinal inspection. CODE A, INSPECfIONTYVE 1616 Flxed System Final Fire Preven�ion 1288 200 Paol Spe Final Final Re-Roof 201 Flnal Blak/Retaining Well 202 Flnal Fadory Fire Place 203 Finel SiBn 204 Final Demollllon �. i ,uiin4' COOE 1 INSPECTION TYVE 208 Flnal Mechenlcal 20B Flnal Plumbinp 270 Flnal Electdcel 212 220 222 250 �O-�Y-G i Dat Flnel Fire Preventlon Final Plenninp Approvel Finel Slte Final BuildingiOccupency Qaff. I[�ALS � „,�, ,,.. ,�„ - , e. „ ,_, ..-.-_�� Job Address: Suite No Vicinity. 931 W 19TH ST POOL EQUIPMENT Parcel Number: 42432109 npp�icant: BERGER, EDDA Address: 1048 IRViNE AV STE 628 NEWPORT BEACH, CA Owner: BERGER, HARVEY A Address: 7048 IRVINE AV STE 628 NEWPORT BEACH, CA Contractor: OWN ER-BU I LDER Address: Arch / Eng : Address: MECHANICAL PERMIT ISSUED BY: Phone: 949-548-0492 Zip: 92660 Phone: 949-54&0492 Zip: 92660 Phone: Zip: License: 0 Phone: 2ip: License: SCOPE OF PERMIT REPLACE EXISTING POOL HEATER WITH NEW POOL HEATER IN SAME LOCATION. ISSUE FEE Inst FAU <700 k BTU Inst FAU >100 k BTU RepairlAlt Cooling/Heat Inst / Rep. Recess Wall Htr Refrig Sys <700 k BTU Refrig Sys >100 k BTU Gas Piping Factory Fireplace Hood w/Mech Exhaust VAV Box Vent Fan / Single Duct Appliance Fire Dampers Smoke Dampers Inst or Relocate Appl Vent Air Handlers < 10000cfrn AirHandlers> t0000cfrn Floor Furnace Floor or Suspend Heater $23.50 $0,00 $18.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 ao.00 $0.00 $0.00 Quantity FEE SUMMARY Repair I Alt Absorbtion Unit Repair I Alt Refrigeretion Unit Ventillation System Evaporetive Cooler Commerciallncinerator Domestic Incineretor Compressors / Absorotion Systems Up to 3 hp I 100 k BTU 3 To 15 hp I 500 k BTU 75 To 30 hp / 1,000 k BTU 30 To 50 hp I 1,750 k BTU Over 50 hp I Over 1,750 BTU Boilers Uplo3hp 3To15hp 15to30hp 30 to 50 hp Over 50 hp Other Mechanical Fee Investigation Fee Plan Check Fee Reinspection Fee Status: ISSUED Applied: 06/21/2000 Issued: O6121/2000 Quantity $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 50.00 0 50.00 0 80.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 50.00 50.00 TOTAL CALCULATED FEES b41.70 COMMENTS I SPECIAL CONDfTIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authonzed under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspeetiona end final epprovel must be obtained. Failure to obtain inspections and final approval will result in Ihe expiration of ihis permi[. FOR INSPECTIONS CALL: (714) 754•5626 � WORKERS'COMPENSAnONDECLARAnON: I hereby eHlrtn untlor penalry of perjury one ol the tollowing tledaratlons: ❑ I have entl wlll melntein e cetlificeta at consent to self-Insure tw workers' Compensetion, es O�a��detl tor by secUon 3700 oi the Labor Cotle, for iha pertormanca of ihe work lor which Ihis pertnit is issued. . ❑ I hava and will meintein workers' cwnpensaGon inwrance, as requiretl by secUm 3700 0� Ne Lebor Code, fw the peAormance oi the work tw whkh ihis pertnit is Issued. My workers' compensa6on Insurance wrrier and poGcy number are: CaMer: Policy Number: (ThJs section need nat be comple(ed il (he permif is valued et one hundretl tlollers ($100) or /essJ ❑ I cenity thet In Ihe peAormence of the work for which this permit Is issuetl, I shall not employ eny person in eny manner so es to become sub�ect to the workers' compensetion lews of Celifomia, entl eqrea that Ii I should become subject to the workers' compensetlon provisions o1 Section 3700 0l Ihe Lebor CoAe, 1 shell forihwith compty with Ihese provislons. Applicant Signatura: Dete: WARNING: FAILURE TO SECUFE WORKERS' COtdPENSATIIXJ G1�VEMGE IS UNLAWFUL AND SHFLL SU6IECT AN EMPLOVER TO CRIMINAL PENALTIES AND CML FlNES UP TOONE HIINORED THOUSPND OOLLARE (5100,000�. IN ADOfT10N TO THE CQST OF COMPENSATION, DAM4GE5 AS PROVIDED FOR IN SEGTIIXJ 3'lOfi OF THE L4BOp CO�E, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARA710N: I hereby attirm �hat I em licensetl untler provisions of Chapter 9(commencing wllh Section 7000) of Division 3 of the Business and Professions Code, antl my Ilcense Is In full force enA eflect. Lic. N Class N Comractofs Sipneture: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby eflirm t�at there is a consWction lending agency tor Ihe peAormance ot the work tor wNch Ihis permit is issued. (Sec. 3097, CMI Code). Lendefs Name: Lentlefs Adtlress: SignaNre: Date: OWNER-BUILDER DECLARATIONS: I �ereby eHirm that under penalry of perjury t�at I am EXEMPT fROM THE CONTRACTORS LICENSE LAW br t�e fWbwing reason (SecJ031.5, Business entl Prolessions Cade: Any ciry or counry wMch reqWres e permlt to construM, fllter, impmve, demdish, or repelr eny structure, pdor to Its issuance, elso reqNre9 Ue epplicant lor such permit �o lile e slgnetl stacemem thel he or she is licensed pursuam to Ihe provisians ol the Contracbrs LJcense Lew (Chepter 9(commendng with Sectlon 7000) ol Division 3 ot Ihe Buslneu entl Proteulons Code) or that ha or sha is exempt theretrom and Ihe basis for the ellepe0 e:omption. Any Nolation of Section 7031.5 by eny epplicent for e pertnit sub�ects the epplicant ro e clNl penelry ai nat more than five huntlred dollars ($500).): ❑ I, as owner of the properry, or my employees with wages as their sole compensation, WILL DO 7ME WORK, end the structure is not intended ar oHereO for sale (Sec. 7044, Business and Protessions Code: The Contractors License Lew does not apply to an owner of property who builtls or improves ihereon, and who tloes such work himself or herself or ihrough his or her own employees, provitled that such improvemen6 era not intended or oHeretl for sale. If, however, Ihe bulltling or improvement is sold wlthln one year ot completion, the owner-builtler will have the Ourden ol proving ihat he or sho did not 6uild or improve for purpose ot sele.). ❑ I, as owner of ihe p�operry, em EXCLUSIVELY CONTHACTING WITM LICENSED CONTRACTORS to construct the pro�ect (Sec. 7044, Business end Professions Code: The contrectore LJcense Lew does not apply to en owner ol properly who 6uiltls ar improves ihereon, and wha coMrecis for such proJect with a contrecbr(s) license pursuenl lo Ihe Contrectors LicenSe Laws.). ❑ I em exem er < Signamre: ---�� Owner ID venlied bv drivers Business end Prolessions Code for this reason: ❑ Ve�1 ❑ No Drivers Utense No. Venfication of Ownership by (rype of daument, i.e. - property ta�c �ill or tleetl): Date: Expiros: DIVISION OF INDUSTRIAL SAFETY PERMR CER7IFlCATON: � ❑ I hereby canity Ihet no excavation IHe (5) or more feet in deplh Into whic� a person is requlred to tlescentl, will be made in connectlon wlt� work authorizetl by t�ls perml4 entl t�et no bullding siructure, scaMWding, talsework, or demWitlan or dismentling Ihereof, wlll be more ihan thirry-six (36) teet high. (Chap. 3.2. Gry 2, Art 2, Sec. 341, Title 8, Celitomia Atlminisiretive Cotle). ❑ As owner�builder, I wlll not employ enyone to tlo wark which would requlre a parmlt Irom Itie DivLsion ot Inaustrial Salery, as notetl ebove, unless such person �as a partnil to do such work trom the division. Signature: Date: Oivision of Intlustrial Sefery Pertnit Number: CERTIFlCATE OF COMPLIANCE AND AUTHORVATION OF ENTRV: I cerliy under penelry oi perjury ihat I have reatl �his application antl stata ihat �he infortnation given is correct. I agree m compy with all state laws and ciry ordinances relating to building consimctlon, and au�honze representaHves of the City ol Costa Mesa fo enter upon ihe above-describetl prope ins//pec�Jtion purpos s. I ee not to occupy or allow occupancy at any building authorized by this permit unUl finel Inspection. /.i/3'�l . Pi�/.�Lf i �i — .Z� � d't) SignaWre f Lege Owner(s) Date And/Or Authorized Appliwnt Date CODE �. INSPECTIONTYPE 1676 Fizetl System Finel Fire PrevenGon 7266 200 201 202 203 Pool Spa Finel Final Re-Rool Final Blak/Retaining Well Final Fectory Fire Place Finel Sign 204 Finel Demolition 2aEs8 Qy/T� �Q �� INSPECTONTYPE 206 Final Mechanicai 208 Final Plumbing 210 Final Electncal 212 Final Fire Preventlon 220 Final Planning Approval 222 Final Site 250 Final Building/OccupanCy �y: • � �r � e i _ F J 4^semm � (714) 754-5273 • Fex (714) 754-4856 Job Address: 931 W 19TH ST Suite: vciryity: STAIRWAYS ParcelNunmber: 42432109 CITY OF COSTA MESA BUILpING pIVIS10N DEVELOPMENT SERVICES DEPARTMENT PERMIT Applicent BERGER, HARVEY A Address: 1048 IRVINE AV STE 628 NEWPORT BEACH, CA owner: BERGER, HARVEY A Address� �10481RVINEAV � � STE 628 �, - �"' . ' %NEWPORT BEACH, CA Contractor. �� N?� ^ =,.Addre'ss: - �� Zip: Arch : Address: Phone: BUILDING PERMIT 2oning: Phone: 949-548-0492 Zip: 92660 Phone: 949-548-0492 Zip: 92660 Phone: License: Eng: Address: .� ti PERMIT NUMBER ' T7 FAIR DRIVE, COSTA MESA. CA 92828 ISSUED BY: Status: ISSUED Applied: 0628/1999 Issued: O612811999 d Phone: ' � a � �� Zip License: Zip: License: SCOPE OF PERMIT . OCEANAIR APTS: REPLACE STAIR TREADS ONLY, ON EXISTING STAIRWAYS LOCATED AT NE CORNER, SW CORNER & SE CORNER OF THE COURTYARD. (WELDING TO BE PERFORMED). FEESUMMARY Plan Check: $0.00 Calc Valuation: 53,000.00 ` Permit: $74.75 Claim Valuation: S3,000'00 SMIP Ftes: $0.50 ' SMIP Com: $0.00 � �`.�� Other: ��$0.00 • � � '; Inspection: $0.00 Total: $75.25 SETBACKS MAIN STRUCTURE Fronf� 0- 0 ACCESSORY Front 0- 0 PARKINC� Existinn: o NOTES: Rear 0- 0 Rear 0- 0 Required: 0 PLANNING & ZONING Lefi 0- 0 Left 0- 0 Proposed: 0 Right 0. 0 Right 0. 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statules and related regulations. (Ortl. No. 92-28, § 1, 12-21•92) EXPIRATION: 7his permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned fo� a period ot 1gp deys. � INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred Inapeetlone antl finel epproval must be obteined. Failure to obtain inspections and finel approval will result in the expiretion of this permit. FOR INSPECTIONS CALL: (714) 7545828 WORKERS' COMPENSATION DECLARATON: j i hereby ettirm unEer penalry ol perjury one of the lollowing declarallons: Q ❑ I have end will meintain e cenificate of consent to setl-Insure for workere' compensation, es provitlad for by section 3700 of the LeDor Code, for the pertormenca of Ihe work lor which this permit Is Issued. ❑ I heve an0 wlll maintein workers' compensatlon insurence, as requlretl by sectlon 3700 of Ne Lebor Codo, for ihe peAortnance ot Ne work lor whid� Nis permll Is issuetl. My workera' compensatlon Insuranca cerrlor end policy number ere: CeMer. Pdicy Number: (Th/s secNai need not be com01efe01l Ihe permlf Is ve/ued et one hantlred dW/ars (S I00J or less.) ❑ I ceNly that in the peAarmance oi tho work lor whic� this permit is issuetl, I s�all not employ eny person in eny manner so es to become sub�ect to the workere' compensation laws of Celifamia, and epree that If I should become subject to Ihe workers' compensetlon provlsions oi Section 3700 oi Ne Lebor Code, I shall forthwlth campty with these proNslons. Applicant Signature: Date: WARNINO: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAW FUl AND SHML SUBIECT AN EMPLOYER TO CRIMINPL PENALTIES AND CML FlNES UP TO ONE HUNORED THOUSAND DOLLARE (5100.000), IN ADDITION TO THE COST OF CAMPENSATION, OAAMGES PS PROVIDED FOR IN SECTION 3]O60F THE LABOR OOOE. INTEREST, AND FTTORNEV'S FEES. LICENSED CONTRACTORS DECLARA710N: I hereby aflirtn thet I am licensed under provlsions of Chepter 9(commencing wlth Section 7000) of Division 3 of the Business and Professions Gotle, and my Ilcense Is In full forte and elfect. Lic. # Class M Comrenofs Signeture: Date: CONS7RUC710N LENDING AGENCV: ❑ I hereby aHirtn Ihat there Is a canstruc0on lending egenc.y tor t�e pertortnancs ot t�e work tor w�ich Ihis pertnil Is issuetl. (Sec. 3097, Civil Code). Lender's Neme: Lendels Atltlress: Slgneture: Date: OWNER-BUILDER DECLARATIONS: I hereby eMirm Ihet untler penalty of per�ury ihat I em EXEMPT FROM THE CONTRACTORS LICENSE LAW tor the lollowing reeson (Sec. 7031.5, Business end Professions Cotle: Any ciry or counry which requlres e pertnit lo construct, alter, Imprrne, demolish, or repalr any structure, prior to Its issuence, elso requires the epplicant for such permit to file a signetl stetemem that he or she Is Ilcense0 pursuant to the proNsions of the Contrectors License Lew (C�apter 9(commencing with Section 7000) of DlNsion 3 of Ihe Business entl Professions Code) or thet he or she Is e:empt lherefrom end the basis for Ihe elleged exemption. Any violatlon ot Sectlon 7037.5 Dy any epplicent lor e permit sub�ecis Ihe eppllcant to e civil penalry o1 not more Ihen five hundred dWlers (5500).): ❑ I, es owner of lhe properry, or my employees with wages as l�eir sde compensetion, WILL DO TME WORK, end the strudure Is not intenOed or oHered tor sele (Sec. 7044, Business and Protesslons Cade: The Contreccors License Lew tloes not eppty to en owner of property who Duiitls or improves thereon, antl who does such work himselt or hersetl or through his or her own employaes, pravidetl Ihai such improvements are not intentletl or offered for sale. II, however, the building or improvement is sold within one year of wmpletlon, the ownerbullder will have the burtlen of proving Ihat he or she did not huild or Improve tor pwpose ot sele.). �I I, as owner ot the property, am EXCLUSIVELY CONTHACTING WfTH LICENSED CONTRACTORS to mnsiruct t�e proJect (Sec. 704a, Business flntl Prolessions Code: The contrectors License Law Ooes no� aDPly to an owner ot pmperry who builtls or Improves Ihereon, end who contracts for such D�o�ect with a comrectoqs) license Oursuant to Ne Contrectors License Lews.). ❑ I em exempt/u/p^d� se'c SigneWre: �L Owner ID verlfied by drivels Business antl Professions Code for this reeson: ❑ No DAvefs LlcenSe No. Verlficalion of Ownership by (rype of daument, i.e. � property tex blll or Geetl): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: �� . /�L• � ❑ I hereby certity ihat no excevetlon Ilve (5) or more teat in depih into which e perwn Is requiretl to tlescend, wlll De made in connecllon with work euthorizetl by Ihis pertnit, and that no �uiltlirg strucwre, scalloltling, falsework, or demWitlon or dismantling thereof, wlll be more ihan thlrty-siz (38) feet hlg�. (Chep. 32, Grp 2, Art 2, Sec. 341, Title B, Califomia Administretive Cotle). ❑ As owner-bulltler, I will not employ enyone to do work which would require e pertnit irom the Division of IndusMal Safery, es noted above, unless such person hes e permit to do such work irom the divislon. Signamre: Date: Division of Intlustnal Safery Permit Number: CERTIFlCA7E OF COMPLIANCE AND AllTHORIZATON OF ENTAV: I certily under penelry ol per�ury that I have reaC this epplicetian entl siate that Ihe Information given is correct. I egree to compty wIN ell stete lews end Gty ortllnences releting to bullding conswction, entl euthonze representetives oi the City ot Coste Mese lo emer upan Ihe aDove-0eudbed prope lor Inspectlon purposes. I apree not to ocwpy or ellow occupancy of any building euthotlzetl Dy thiy pe? II� 111 tinal inspection. (C�/''� � r� A _ � (l� 9 8 " SlgnaNre OI Le I Ownar(s) Date AnNOr Authodzed Applicant COOE 1. INSPECTIONTYPE 1616 Fixed Sysiem Finel Fire Prevention 1266 Pool Spa Final 200 Final Re-Roof 201 Final Block/Fletaining Wall 202 Flnai Fectory Fire Place 203 Final Sign 200 Finel Demolition x..e.e J�jfi � j�Qlj�i INSPECTIONTYPE 208 Final Mechenical 208 Final Plumbing 210 Final Electdcel 212 Final Flre Praventlan 220 Finel Plenning Approvel 222 Final Site 250 ,FinelBulldinp/Occupan�y P�g APPLICATION FOR A BUILDING P VIIT BUILDING PERMIT N0. E�ectriw� m Tract Block Lot Pormit No. � �(�� ry � / � PermtiNo. � aemesi y� �j(� ' � Y'� y7 �5 'J 1� 3 D cross Mechanita a Area - SVeet Permlt N Ownor - � Type oi Project: ❑ New ❑ ter ❑ Atltlition # Atltlreu j� �� ❑ Repalr ❑ Converl ❑ mo ❑ Occupan<y Pmt. CItY Z"7�j! V' �on Y�� A.P. 5 sP. Airea Archltect/ Zp�e S�I. Pmt. No. �esigner License No. Setbacks P/L Front C/L 5[. Street WICth AtlAr¢ss Vartls Leit ig ear CItY ZIP Phone ava o�. e i9 . . r Enginear lJte�se No. � Park ng Spaces equ re rov e overe p, Atltlress ry Struct No. ( No. a1 m City Z�P Pho�e HBi9ht Sto Bs Family � LICENSED CONTRACYOR'S DECLARATION aark Fees Ves Fee m 1 hereby aftirm that I am licensed under provisions of Chepter 9 Requlre0 No 0.T. Raceipt t (commancing with 5¢ction 7000 Of Oivision 3 of the Business antl Zp��9 qDPioved By: Date Professions Coda, a/xf =y I)eanse is i� full force antl q(fec[). �/ ?� License Clax Y� I License Numbar l I 33 �% X > Dete �-S ��fJ Co vuctor Misc. E Address � ��*-4'h ` L A'oposetl Vse j� Cityantl Zip $�� n '�^- Pn�a=F27-4sGn of Structure N CONSTRUCTION LENDING AGENCV � 1 hereby affirm [hat [hera is a cP�struc[ian lentling a8enty (or the a performanca ot the work tor which ��ppp is parmii is issued �Sac. 3097, �<c. Type Cotle ` CIv. C.1. �� Class Const. �'ear y Lendar's Name—�/�— USE/OCCUPANCV S12E SQ. FT. C Lender's Adtlress I - � � OWNER-BUILDER DECLARATION y 1. I hereby aftirm that I om exampt from the Con[rector's Licensa Law 10 tor the following reeson: � ❑ I, as owner ot the prOperty, or my amployaes with wages es thai� 2. sola compensation, will do thd work, antl Ihe struc[ura is nOt t intBntled Or O((eretl fOr mIB. « 3. � ❑ 1, as owner of the property, am exclusively conbactinB �+'ith licansad conttactors to cOns uc t projatt. � ❑ I am ezempt under Soa &PC to� this reason 4• a Dei Owner E WORKERS' COMPENSATION DECLARATION 7otai Vaivatlon � 1 hareby affirm thet 1 hove a ceftificaxe ot consent io selt-insure, Encroachment P¢rmlt Requlratl ❑ Vez Na or e certi(icate oi Workars' Compensation Insurence, or a cartifiad � copy t�ereof ��21 }(._ '�'� `&/ Gratling Pmt. Grading � PolicyNo��Z,��Z, Company �- RequireG ❑Ves ❑No Pmt.No �a �Certified copy is hareby turnished. n Rou9h Grading � QCerI[-ii�iatl-w�Cp�y'Iis filetl wiih �ef'-?h-�4t -�'�.r qpp�Ovetl by: Ddte � Deta y�..t� Applicant�LLN.(i' s�.� 3 CERTIFICAT �EXEMPTIO �+ FROM WORKERS'COMPENSATIONINSURANCE z �Thia section neetl not ha comple<etl it permit is tor $/00 ot less). � 1 certify thet in the pertormanc of thc work tor which this permit is Q issuetl, I shall not employ"e y orson In any mann¢r so as to become ' sublect to thc Worke.s' C e se ' � Laws ot Celifornia. PERMI FEES Dat• Appi�a t NOTICE TO APPLICAN � I, fter meking Nis Certitiwte of SVuctural S Plan CneCk § Exemption, you shoultl bec ro sublect to the Workers' Compensetion provisions ot the Labor Co e, you must (orthwith comply wlth such EleCtrital - SPecial provisions ot this permit eholl be deameA revoketl. E InveSt, a I CERTIFV THAT I HAVE PEAD THIS APPLICATION AND STATE p�umbing E THAT THE ABOVE INFORMATION IS CORRECT. 1 AGREE TO COAIPLY WITH ALL COUNTV ORDINANCES AND STATE lAWS RELA IQG TO BUILDING CONSTRUCTION, AND HEREBV AUTH- Mechaniwl E ORI R'EPRESENTATIVES OF YHIS COUNTV TO ENTER UPON TH A VE IONED PROPERTV FOR INSPECTION PUR- p�e-Gratle P SES e ��{(� Inspectlon S � � " � Pre-Gratle Pe�mit Sig r f App icent or Agant Data Rec. No. E Issue s A�N�E ShJ('� Print qpplicanYs/Agen['s Neme < � All spaces within this boz mun 6e completed to process P�an issuance Check BY: App�oveC: I CMF p335-46 (BV48) rev. 6/80 � �nr�t YLAN MU�T 0 ON JOB AT i MAKEI NO CH NGE$ WI HOU PR OR Of DiFf. ITHE ISSI�FMCf. OR G �ANTIN, OF PERMIT OF OF PLA�p'S NttD SP:f,IFIC TION 3H.� L NOt BE i T� BE A PERMR f� A, 0 AN ppRD AL OF� ANY OF ANYI OF THE PR 6':310'S OF iHI.,�;UDE. NO PI SUMING TO �IVE UTHO�7ITY 0 VIQIATE �OR C PROVISIONS 9F THI� CO E SHT{LL B�j VALID. E%1 FAR AS iHE WORK OR US WHICH IT AUTHORIZES '� � � � TH[ ISSIIRNCE OF PE' IT B�SED PON I S,ECIFICATION� SHa �, NO F,;� �,i „� L tl.Ul,'t FROM T�, �., [;�UI rvG ? E C NRECTOt! f i s,,,io o��,� �r ; s: Ficnr o;cs e rr rn �i 8 ILD'F ,; ", �' i_I G CAf R:EO �N iH} RFUfV IN1'��.. .- ' ;.�{F U? pr. uMy 97�!En : I I SO � r��n .,N—I n��Z-N-�mo 2.� S p � I C v. �� m�' D tn � m A�� C7 oAn'�c � � .w ; � -Ti ._� H E,. ��. �" Cn R' 1. �_% :� n`O 4II` � ,k' _ ' - I � � t "= `<- -- � ,: :� � <€-. . � �. �. _� : i . .� � � � � �'. �— ' � �,� � ,. : . � .. I � `' i, ., � � . m . .. � . == _. v_ �� , O y� Q r I � i'J ' 1 V� G i T ; D' _ c�_'-. `.,, z I _:. � r �n ? cn � = 1 S % : � -? : p OZ-�-I�� . N a 1 � '� �.J .. OOS�I � � I I G -G I _ A �n m o � L__-I � - I _I _ �_ I I I 0 �� PT � �a�� -J ;�, � s«. � i�inST 19R?i STRs.�'T `ljl e c i 15174 - 4-10-62 D:!.Cct-:c_�.:; °v1"Q,�75• , 15175 - 4-10-62 :; �.::: .:rc.3�::.;. 216,379• � : 15414 - 9-14-61 D.:�_cl_-:� <in,• lol.� �5y53 - ('7-(2 �.:.._-=:z.�,:-. =�ci 4�200.' • a�_�_. :iC �E �.i.:i.� 5'i�7 - 5-�-70 4 , . �18/�F9-6�5"�� P�gG.uC° (G 5ys.) 51193�ia�a9��:,epair�Firfl 1,000. � — Ikmage (Apt. S) — . 4�� $25486 RE FOOF 513,787.00� ��% �$ �o _ j _ n „. �'' �5� `7� . COSTA MESA BUILDING-SAFETY DEPARTMENT P. O. BOX 917 COSTA MEBA. CALIPORNIA For Applicanf fo Flll In Complefely ' TYPE OR PRINT ADD E'SS / �' '” I / '� �� COSTA MESA GALIFORNIA TEL. NO. TEL. F�E R";EIUED AUG 2 31961 fINANCE DEPT. CIiY OF COSTA MESA APPLICATION FOR PERMIT BUILDING For Offite Use Only HECEIPT NO. PBPMIT NO. 0Y DAi9 weceiveo ` /.TE 19BUEO X—� �.7_/_A -�i � .c _ /_ i __ 1✓� W' 1 I J.� • COSTA MESA. CALIFORNIA �Y v1u% e. FIRE ZONE TYPE GROUP y — RIOSL� � GI� APPROV BY DATE �4� t�l��.,w-�� ti ZONING -� L //� o e No. on use oe r+e > •!O �/ `� l�' CYG I PLANB I BUILDINO `I � � �f NO. �� J C� /CY LECAL - D69CRIPTION �/D O -� NO. OP BLDG9. ��' '�� ,S L'' �� NOW ON LOT A_ P_ NO_ I� I -- 8� ��/I�J 9� � 86TBACK LIN6 PPOM DESCRIPTION OF BUILDING NO. �F 9IZE ROOM6 5 EXTHRIOR WALL ,�JI�� ROOF �� COVERING COVERING USF_.OF BUILDING qND WORK TO BE _. ICBNTeR LINE 9T.1 / �" �✓ FRONT SFT_ . R. SIDE �� L.SIDE � /' �FT�/ REAR � � FT.�� I � APPROVEO 1 r BY l,i \ DATE ` � '� �I --e'�.�- � 9 � f,l� �— y� , ... .� k� .: � 1.. S - '• 1 _ ,� � R I HEREBY AGKNOWL6D0H THAT 1 NAV6 R D TH P IGTI }Hg AM011NT 9HOWN AND BTATB THAT TXE BOV¢ 19 CORREC AND AORE! TO COM- pYHP09E OP EBTABI PLY WITH ALL CITY P INANCE9 AND 6! T W8 IiEOULATING BOILOINO CONBTRU � N. ) Ys�TJ1L 61GNATURE OF '. � �/y. �'�T� PERMITfE APPROVED AUTHORIZED AGENT _— �O �/�/ ` � � � VALl1ATION IB ROR TH! R P6pMIT FEE ONLY. _ . .'!1 . $ Oa � ^.'• g � ��. " -., /�/ 9� /�/ �4u"�-� l� s . '� v- //� � a � ��- �oi a �af �F E RECtIVED 8, � ,G,��vz�/ry COSTA MESA BUILDING-SAFETY DEPARTME T �� a� QUG231961 ��r� P. o. aoX s�� COBTA M68A. GALIRORNIA FINANCE DEPT. e For Applicant to Fill In Comp fely APPLIC�t�rPFF�R"P�Fi11TSA TYPE'OR PRINT BUILDING � BUILDING q 3 ! w �' / � '+�� ` ADDRESS COSTA MESA. CALIFORNIA FOr Office Use Only , • - -M8C81PT NO. PlHMIT yp. OWNER A .S� 5 MAIL �., - HECB BY OA 8Cfi TE 9O8D ADDRESS � �7-lYP✓tiia� � / � �� 1 TEL. ,�y`` �UICDING� 2 � CITV �> I bL• a NO. �R' ADDREBS �l ARCHITEGT ie�. COSTA MESA. CALIFORNIA + OR ENGINEER F� NO. AODRESS N �% (�✓«� ✓ FIRE ''� +/'� ZONE PE GROUP j ""_'".._'_ �_ 1 ��G.C�n.n.n�: �=Y �i_�� APPROVED� r/ /.I _1 ADORESS I i V 1 M ��• ►" 17ti � ZONING n //�' N 1' NO. OP U86 OP N arr 13 O O� `? � ` C I �uNB � I BUILDINO �C.TNO. � //� ry NO. O� �� 9 �✓ DESCRIPTION 1 VV OF LOT I b O X�� V I NO. OP BtD68. NOw ON LOT p, p, NO. ' O O USE OF YARDS EVES EXISTING B DG APPROVED • ALLOWEC 6HT6�C1( LJNB FROM � �� CSTn4R LINB BTJ C8NT6R oP erneHr C REAR YARD FRONT O FT. � / SIDE YARD ILEFT RIGHT R.SIDE FT. DESCRIPTION OF WORK ,., ., /,,, BUILDING SRH �l EXTERIOR WALL COVERING USE OF BUILOIN 1 HEREBY ACKNOWLHD06 AND 9TATE THAT TXE A81 PLY WITM ALL CITY;OROI BUILDINO CONBTRUCiI SIGNATURE OF PERMITfE AUTHORIZED AGENT ~ 1 HAVE ReAD THIB MPLIGTION PRCR ANO AOREE TO COM- � 6TATE �AWB REOYLATINO � ■ �'' E Special requirements; . . '� • . , � , /�� c� (1) Dedication of a11 land 40' from the,cenCer line oY U-x"�"" West 19th Street to the City of Costa Mesa for f-If' �� . street purposes. U/»2 . , .� (2) Parking under Director of Planning � ' • I .'; . „', � � A �. `� �5�:�� COSTA MESA BUILDING-SAFETY DEPARTMENT v. o. Box 977 cosrw MEew, CwLIpoRNlw For Applieanf fo Fill In Compleiely TYPE OR PRINT 1 BUILDING cosra Mesa ■ ARCHITEGT NO. USE OF EXIBTING BLDG 8[TBACK LINH IROM DESCRIPTION OF WORK J PXTERIOR WALL ROOP COV8HIN6 CovH USE OP BUILDING AND WORK TO f�e.yi � /.:S,C, FEE REC��VED �Y SEP 7 �set FINANCE DEPT, CITY OF COSiA MESA APPLICATION FOR PERMIT BUILDING For Office Use Only PECEIPT NO. P[Rf11T RECHIYF'� OY I OA��EC�IyEOi/ [r` / � BUILDING i� /� I �' ' ADDRE88 I � CASTA MESA. CAIIFC FIRE ZONE TYPE G APPROVE� BY DATE ZONING i.0 ` C-� I NO. OF I U8H OP N � f PLAN9 BUILDINO LEOAL 0 , � D88CflIPTION C A. P. NO. u�"� .� 0� YAROS EVE6 APPROVED ALLOWEC (CENT6H LIN6 BTJ j APPROVED 1 X8P6BY ACRNOWI.[DO8 TXAT 1 HA� A�� TM�B MPYGTION }�{g AMOt1M BHOWN UNp[R VALUATION IB FOR TM¢ AND BTATB TXAT TH¢ ABOVH 18 COR�� AND AOP88 TO CAM- PURPOBB OP 88TA�LIBXINO A PBFMIT F6E ONLY. PLY WITX �LL CITY OPOINANC89 AND BTAT¢ LAW6 Ii60UUTINO Bu1lDINa CONeilIU ON. VALUATION BIGNATUHB OF ��J r(/�� ' �JG PERMIT FEE S Y� PERMI7TE /n� : S� S /"" PLAN CHEGK $ �_ AUTNORIZED AGENT � ,_ �/'��f ____ ___ � - 2 O LL : � 15�5� 'OSTA MESA BUILDING-SAFETY DEPARTMENT P, D. BOX 917 COHTA MEBA. CALIPORNIA For Applieanf fo Fill In Complefely TYPE OR PRINT ADORE�SS 83I� W" T9th ' COSfA MESA CALIFORNIA / aooeess TT47 MIRA MAR DR ��T. NEIYPORT BEAC$ No: ARCHITLGT TEL. �R ANTEIONY POOLS 537T wTRF.S'PnNF. ur.vn_ SOUTH GAT�, CALIFORNIA i'3 �� NEo: Sa _ 3� � � No. oP LIN6 FROM DESCRIPTION OF WORK WALL IROOF FEE RECEIUED sEP 2 o�ss� ' AaP�I��NGM��SA iT ' �j�o�+o`. y"�-.Y• '"` For Offlee Use Only R8C81P� NO. � 6RMIT NO� � �� - �. necei eo er oe as rvee re iesuse � �— ��G-{, ' 1�0 . ,aoiwc 831 iY' 18th �� JDRE88 COSTA MESA� CALIFOR 1� ` J /�'y�C� I ruxs �' eue�.c�no�� -`/ �f f HBCRIPTION( f(/ t� _�-}�f/' l d Ol� yU A. P. NO. I/(D _" b.�/.�' J C q_' YARD6 EVES APPROVED ALLOWED fCHMeF LINB 6T.1 ��' ^ � FRONT FT. Iyo ' R.611]F Ii�T : � =Ip�T_ L !/� IOFT. (O IN. ! � � L�J• i � � DATE / '� -N � — D�.� ca--�-� �v 6 FOR SPEC A[, i2£ UIREML-N , v. o , .. 1 HENEOY ALKNOWLEOOB TXAT I HAVB PEAO TMIB APPLJGTION TXE AMOUM BHOWN UNDER VALUATION IB ROR TH[ ANC 8TAT8 TMAT T IB LORRECT AND AOREB TO CAM- pURP08H OP ¢BTABLI9HING A PERMIT F6E ONLY, PLY WITN ALL ORDINANC68 ANO BTATE LA UTATINO Bu1LDIHo � urnoN. VALUATION / PE �� Op O PERMIT FEE $ J� // 0 /� p ,LC/ $7o?DO �' PLAN CHECK $ /--� AU RIY D AGENT a/.— o TOTAL FEE LL a . F C W 6. Q � ti i F G fr] F 6 C ..1 Q 7 } ..1 a m a � � a z S 3 1 � COSTA IOIESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only BUILDING j '� .Ji-L ADDRESS ( 'tY �+. O W N E R O R �� i w i... �-/- TENANT /�WV�+••/ ADDRE55 �� C'V . / v `� �I CITV � NOL�r,��' CONSTRUCTION _ � BpANCH ADDRESS ARCHITECT ADDFESS CONTRACTO TEL. CITV O�D�-CT O �`� NOI�J��-f STATE �� CITV IIC. NO. a' LIC. NO. SIZE NO.OF BLOGS. OF LOT NOW ON LOT USE OF � T EXISTING BIDG. R./vl.r Separate permi[s are required for electric, plumbing and heating work. USE OF BUILDING AND WORK TO BE PERFORMED %r.d'" .�i� F �`�e��t�v-�r�J I haraby ecknowlatlga thet 1 havo reetl this applicatlon entl stote thet the abova intormetion if correct antl agrea to comply wIM all laws reBuleting buiidinB conrtruction, and I s�ell not amploy eny parwn in violatlon of the workman's eompensation lawa of tha State ot California. I �ereby certify that I am Droperly Iicensetl as e conttactor unEar Me Stnta ot California Bus(neza antl Professions Cotle, Divlsion 3, Chapter 9, and th¢t canses are in full forca antl affect, or I am axampt trom e provtsions ot the State of Calitornla BusineO entl Professions otle, Divialon 3, fer 9. SlBneture ot Parmlttee or ` �� Author)zatl ABeni Date \ ; —.'�t!- APPLICATIOI�T1F�RaSTRUCTURA�LPERM[T{p�'00 Tl� RECEIVED PERMIT Ai0 51193 i., ir A.P.NO.�L� — BUILDING �j ADDRE55 '7, UNIT OR � SPACE NO. AOD IALTER IREPAIR OwNER VSE PL/iNNING ACTION VALUE S V DATE APPROVED m � i m SQ. FT. 4 VO�' �� N 7 THE AMOUNTSHOWN UNDER VALUATION IS FOR m THE PURPpSE OF E5TABL5HING A PERMIT FEE ONLY: � VALUATION PERMIT FEE E N � �� m PLAN CHECK § ^ � ^� 0 LL 5 IOOO'� TAX E J, • "` U V TOTALPAID E ��.rjO Applicant to fili in all svaces exceDt thase within heavY boraer linez ana.sign all approDriate tleclarations. -- - - - - -- - -- -._ . .._ ..,, r • -• OF COSTA N1ESA � .t Address Y3/ G canYs Mailing A�Jdres; ; Owner's Name � � � - � Phpne-�7"� �c�`»"� Address /�� -�*U� � � � �a� Arch/Eng. '� License No. � Add�ess ' Contracto 's Name ) � Ph� e �o�'�/n�ry Address (mailing) /� e � ,�L Ciry�LicenseNo. �� .310� LICENSED CONTRACTOR DECLARATION (� 1 he�eby affi�m tbat I am licensetl untle� provi5ions of Chd/ter 9(commencing y- with section �000) ot Oivision 3 of [he Bu5ine55 antl�Profe55ions Cotle, antl A my license is in full fo\e tl ffeCL i/ �� License Class _� Lice �No. �7 � Date 912� s�e t f� �� WORKERS' COMPENSATION DECL ATION - _� I hereby attirm that 1 have a certificat ot mnsent to self-insure or a certiticate /h � Workers' Compensation Insurance, or a certitietl copy thereof (Sect' n v 300, Lab. C.) �/D��O ' '� Policy No. Company � ��Certifiea mpy is nereby turnisned. LtI ��t,�„i �SiCertitietlyopy��111gQwith'tnecit� i n'Divisio �y�� /O Date' � � L If// qpplicant �� - EXEMPTION FROM WORKERS' COMPENSATtON DECLA Ta N -- (Thissectlon neetl not be mmpletetl if tbe pe�mit i5 for one huntlretl ($300) or less). I certify that in the performance o( the wo�k for which this permR is issuetl, 1 snall not empioy any person in any manner so as to become subject to the Workers' Compensation Laws of Calitornia. Date ' Signature 'NOTICE: If, after making this tleclaration, you shoultl become subject to the . Workers' Gompensation provisions o( the Labor'Cotle, you must forthwith lcomply uvRn„Suth provisions or this permit shall be tleemetl �evoketl. . CONSTRUCT,ION LENOING AGENCV I hereby affirm that [here is a conztruction lentlin9 agency for the perPormance of the work tor which thii permit is issuetl (Section 309� Civ. C.) Lentler's Name � Lentler'S Atltl�ess _ . OWNER BUILOEH DECLARATION � I nereby aftirm that I am exempt from the ConVactor's License Law tor the followin9 reason (Section ]031.5 Business antl Professional Cotle: Any city or county which requires a permit to construct, alter, improve, tlemolish or repair any st�ucture, prior to its is5uance, also �equires the applicant for such permit t0 file a signetl statement that he/she i5 licensetl pursuant to the p�ovisions of tne Contractor's License Law (Chapter 9(commencin9 with Section �000) of Division 3 of the Business antl-Protessions Cotle) or that he/she is exempt � therefrom antl the basis for the alle9etl exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil �e�dlty of not more than five huntl�etl tlolla�s ($500). . L.1 I, as.owner o( the propevty or my employees witM1 wages as their sole compensation, will tlo the work, antl ihe structura is not intentletl or oiterea tor. sale (Section ]044, Bu5ine55 antl Prote55iondl Cotle:'The Contractor'S' License law tices not apply to an owner ot a property wM10 builtlz or improves the�eon, antl wno tloes such work himself/he�seli or throu9h his o� h¢r own employees, provitled Ihat such improvements are not Intentletl or offe�e� tor Shce. If, noweJer;'the-builtling or improvemeni is soltl within one year of com- pletioq the owner will have Ihe burtlen of proving he/she aitl not builtl or im- ' p�ov< for the purpose ot sale). ' ❑ I, as owner of the proper[y, am ezclusively cont�acting with IicenSetl con- Iractorst6 construct the project ($ection ]044, Business antl' Protessions Cotle: The Contractor'S' License l.aw tloes not apPly to an owner of property who builtls or improves thereon, antl who mnVacts for sucn projects wlth a con- [ractor(51 licensa pu�suant to the Cont�acfo�'S License Law). I am aware that proof oF titeir Worker'S� Compensation insurance Shoultl be provltletl to me. ❑ I am exempt untler Section B. & P. C. for this reason Date ` Owner _ I hereby certity ;that 'I have reatl this a Information i5 WtreGtrl a9ree to comply antl.state laws relating to builtlin9 �onst Signature /� Drivers' Licen ar 5$ " 0865-46, rev. 10%84 [ion antl siate that the above all city antl county ortlinances i, antl h¢reby authoriie r¢pre- bove-mentionetl prop�er�ty �f�o/r �� oate_�1�`f A(� TYPE OFCONSTRUCTION LJ NEW UTADO LJ TERATION lJ REPAIR : ❑ CONVERSION ❑�DEMOLISH � OTH R �D�S�RVBT;ONO WO/K/US'1�LD��6�rRUC7URa� l� �� TYPE OF PERMIT GRaoiNG '❑ TENANT ❑ En` E,,CTR'IC—ALJ' O�PLUMBING � MECHANICAL . � �OTHER ' /SJG /�/ %�- - PROJECT DESCRIPTION SQ. FT. � oCCUvnniCv CONSTRUCTION'TYPE � � VALUATION$'i[� ZONE- GRADINGCU.VDS. ACRES Rema�ks: � � , , � Sink ' zflow Preventer - <flow Irrigation �tubs ' . �_ . Drinking Fountains Floor Drains • Floor Sinks Gas Service Outlets Intercepmrs Kitchen Sink Lavatories P-Trap Roof Drains ReinspeMioo Fee� $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact.8lt ICBO # Heating System & Ducting ❑ o-i oo,000 eTu O i oo,000 sr� Reinspection Fee � �:$15 White - Builtling; Canary - Applicant; Pink - ACcoUntin9; Goltlenrod - A5se55or Showers Service Sink � Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Cbset - Water Heater - Water Service Auto-Wash ; Issue Fee � , 3752 -9%25%86 � , , � . ' _ A.P. # � S Main Building: ' E T Front A Rear � - C Right� ' -- - S �g Left - '� - Ping. Ref. # � Planning Notes: � Automatic Washer Construction Pole Sub. Cooking Unit ; - � Dishwasher Dryers �Gas ��Elec Fan F.A.U. - Fixtures Device Boxes Outlets Switches ' Garbage Disposal Generator �0-5 KW C ' 150.,97 TL Zone Accessory Building: � . Z O . N I .- . N G ' R Parking Req./Provided E _ Q � M D T S � Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100 amps Meter ❑over 100 amps - Sub Panel, Motors DO-1 HP � 1%- 8 Inc.Solar �9-15 HP �16-15+ Microwave Pole Light Fange ', Standing Sections Trash Compactor � � Reinspection Fee $15 Issue Fee IANICAL 'FEES' Hoodor T � DEVELOPMENTSERVICESREQUIREMENTS: ypel ❑ Canopy Type I I �❑ Zoning Approved By /� - . Building Approved By /„ � � Refrigeiation Sys[em , - ❑0-100,OOOBTU ❑100,OOOBTU . System Repair/Alteration Fire Dampers - Issue Fee $ 3 0 FEES $ 3 � BUILDWGPERMIT $ SUMr��aF�FESMIP - $ � � PLAN CHECK $ ' PERMIT ' � PLUMBING �. $ ��UANCE . $' PLAN CHECK 25% $ ENERGV P.C. $� - ELECTFICAL � •$ � GRADING� -. $.•.' � - PLAN CHECK 50% '$ MICROFILM $ .� / " � MECHANICAL $ - TOTAL FEE $ J� . PLAN CHECK 25% $ � i.- CONSTRUCTION AND PLANNING POOL & SPA� � � APPROVALS � Permit # Date Inspector qppROVALS Permit #�- ' Date Inspector' �� 1. Temporary Electrical Service or Pole . 52. Pool & Equipment Location � -r. 2. Soil Pipe-Undrgrnd. .53. Steel Reinforcement :^ , � , � 3. Electrical Conduit Utility-Undrgmd. 54. Forms � ' � � ' 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding ..ti ' 5. Steel Reinforcement . 56. Rough Plumbing & Pressur�Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-CiUNITE . 7. Footings 58. Electrical Conduit-Undrgrnd. ,� 8. Foundation 59. Gas Pipe, � Undrgrnd., Test , 9. Water Pipe-Undrgrnd. � 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11, Property Sewer Line & House Connection 62. Backwash & Receptor-Final • . 12. Sewer Cap ' 63. Heater & Vent-Final 13. Roof Drains . 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final � 15. Rough Electrical-Conduit 66. Solar System-Final � � 16. Rough Electric Wiring � 67. Fencing & Access Approval . . 17. Rough Wiring Sign " 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough He2ting & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Struc[ure 70. Underground Hydro 22. Ducts, Ventilating 71 . Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush ' - 24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil ' 25. Roof Sheathin9 74. Overhead Hydro � , 26. T-Bar Ceiling (Structural� & Monocoat 75. Dry Chemical � - , 27. Frame snd Flashing � 76. Dry Standpipe � 28. Lathing & Siding - 77. FIXED SYSTEM FINAL � � 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT' � � � 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final � 80. FOOD CERTIFICATE ISSUED �- 33. Final Electric Notes: 5i� '(�' �. � � 3 (o �� 34. Final Heating & Air Conditioning . 35. Final Gas Pipe-Test ' 36. Hood or Canopy 37. Final Factpry Fireplace ' . ' . � 38. Final Plumbing . . � 39. Water Service-Final • .- � ' " 40. Gas Servica-Final . � • , . . I 41. Solar pomesticFinal . � � , , ' � 42. Backflow Preventer 43. Backflow Irrigation � . . , � � 44. .Landscape Irrigation System - 45. Sound Attenuation , ' 46. Handicap Regulations , , 47. FINAL STRUCTURE & BUILDING Q � ��- � 48. Special Requirements Completed 49. Electrie Rllease to Edison � � • 50. Gas Release to Southern California Gas Co � - ' 51. CERTIFICATE OF OCCUPANCY � }\ � � No� _ Date . . �