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HomeMy WebLinkAbout242 19TH ST - Building Permits 1 �L�s9 CITY OF COSTA MESA et- ' BUILDING DIVISION PERMIT NUMBER v i DEVELOPMENT SERVICES DEPARTMENT PERMIT BOO-00713 - !oasino,4� (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 242 E 19TH ST Status: ISSUED Suite: Applied: 05/18/2000 Vicinity: REAR GARAGE Issued: 05/18/2000 Parcel Number: 42627115 Zoning: Applicant: HOOFE, PAUL T ISSUED BY: Address: P 0 BOX 5038 Phone: (949)642-9748 NEWPORT BEACH,CA Zip: 92662 Owner: HOOFE, PAUL T Address P 0 BOX 5038' Phone: NEWPORT BEACH,CA Zip: 92662 Contractor OWNER-BUILDER Address: Phone: Zip: License: 0 • Arch : Eng: Address: Address: • Phone: Phone: Zip: License: License: SCOPE OF PERMIT DEMOLISH/REMOVE 2 GARAGE SIDE WALLS AND 2 GARAGE DOORS INCLUDING ROOF TO ALLOW FOR CONSTRUCTION OF NEW 2 CAR GARAGE. FEE SUMMARY Plan Check: $0.00 CaIC Valuation: sl,000.00 Permit: $38.75 Claim Valuation: st,000.00 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $39.25 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: • Policy Number: (This section need not be completed If the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is Issued, I shall not employ any person In any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100.000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full ' force and effect.Lic.# 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 and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit sub Is the applicant to a civil penalty of not more than five hundred dollars($500).): I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or Improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt !sec. A Business and Professions Code for this reason: f� —L --9-,--) �J Signature: 7_ ._ s ' ` Date: ) � Ex Ides: ZOO 7 Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ' ❑ I hereby certify.that no excavation five(5)or more feet In depth Into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this Application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 0 No (Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 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 COMPIJ MII D AUTHORIZATIO" O- ' -Y: I certify under penalty of perjury that I have read this app'cation and state that the information given is correct. I agree to comp! ith all'state laws d city •r s relating to building construction,and authorize representativ s of th City of Costa Mesa to enter upon the above-described pro y for inspection pu es.I alt.-4 •• to occupy or allow occupancy of any building authorized by thi er it ntil final Inspection. ,./ZZ24/ >5 /I z Signature Of ?IT( Owner(s) Date And/Or Authorized Applicant Date CODE 4 INSPECTION TYPE PAN RIIIDA15 CODEI INSPECTION TYPE QM INTITIALS 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 1I � 222 Final Site • 204 Final Demolition ///41/56 1ZJ '•r 7/Ya,r.- -250 Final Building/Occupancy ..2448-48 �" Uq^'. • 6-1"111:14•,, CITY OF COSTA MESA ,ty41 BUILDING DIVISION PERMIT NUMBER • DEVELOPMENT SERVICES DEPARTMENT, 0 . • PERMIT ' „no"° BOO-00528 • (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 242 E 19TH ST Status: ISSUED • Suite: A Applied: 04/21/2000 • Vicinity: HOUSE ONLY Issued: 04/21/2000 Parcel Number: 42627115 Zoning: Applicant: HOOFE, PAUL T ISSUED BY: Address: P 0 BOX 5038 .Phone:' (949)642-9748 • NEWPORT BEACH,CA Zip: 92662 ' T SI O1�T Owner: HOOFE, PAUL T - EXEN 1��\ Address P,O BOX 5038 ALLOW . ` Phone: - ' i , NEWPORT BEACH,CA - - Zip: 92662 pED Contractor: ' OWNER-BUILDER EXPIRES-OS , Address: _ _ Phone- [ fi ` � Zip: License: . 0 y • )I / Arch.: _ �_ r "✓ ' Eng: Alt IVOv • Address: - Address:- 9p' - Phone: Phone: Zip: / - , - License: \License: , - ' SCOPE OF PERMIT • / REROOF-PO, USE EXISTING SHTG, INSTALL 1"LAYER OF 30#FELT AND 30 YEAR COMPOSITION SHINGLES. ' FEE SUMMARY ' Plan Check: . $0.00 . r. t' _ — - 4 , Calc Valuation: $800:00 Permit: - •. $32.65 __ . • - / ` ' " Claim Valuation: ' $800.00 SMIP Res: $0.50 •SMIP Com: $0.00 , • Other: $0.00 _• -- Inspection: $0.00 Total: $33.15 , ' PLANNING &ZONING SETBACKS v MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 ' Rear 0-0 Left - 0-0 Right 0-0 PARKING Existing: 0 Required: 0 - Proposed: 0 NOTES: • ` NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not-commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 DECLARATIONS C 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 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 FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5104000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lk.# Class# Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued.(Sec.3097,Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the 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 ow -r-builder w' have the burden of proving that he or she did not build or improve for purpose of sale.). 0 I,as ownerof am EXCLUSI ELY CO-TRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code:Cliercontractow •.nse Law does of app to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuan • e •ntractors Licens Laws . ❑ I am exe • under sec ; lV Business and Professions Code for this reason: ' 11 Signature - i/ �a- Date: V' Gi ZoL�O Owner lu citified by drivers cense. Ft Yes 0 No Drivers License No. �( ,�� C pires: 2 cJO V' Verification of Ownership by(typapf ent, .e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet In depth into which a person is required to descend, will be made In connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? El Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application akermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Lj Yes LJ No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",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 •' • AUTHORIZATION OF ENTR :I certify nder penalty of perjury that I have read this applic on and ate that the information given is correct.I agree to comply with - state laws and city ordinances r.lating to •uilding construction,and authorize representatives the City of Costa Mesa to enter upon the above-described property f• spection purposes. -gree not too upy or low occupancy of any building authorized by itis Be _ z It until fi I inspection. Allf1%J Z 40•t+t '�O � al A - Date And/Or Authorize• pplicant Date CODE 4 INSPECTION TYPE QAIE INTDIAL$ CODES INSPECTION TYPE PETE INTTIALS 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 2446.46 CITY OF COSTA MESA 4% BUILDING DIVISION > • ,,,,. - DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER i� PERMIT 4 B01-00617 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDINGJob Address: 242 E 19TH ST Status: ISSUED Suite: A Applied: 05/03/2001 Vicinity: UNIT A-RECONSTRUCT SINGLE FAMILY RESI Issued: 07/10/2001 Parcel Number: 42627115 Zoning: Applicant: HOOFE, PAUL ISSUED BY: Address: P 0 BOX 5038 Phone: (949)631-8453 NEWPORT BEACH,CA Zip: 92662 (� Owner: HOOFE, PAUL EI XTENSION Address P 0 BOX 5038 Phone: (949)631-8453 A` T OTEJ NEWPORT BEACH,CA Zip: 92662 Contractor: OWNER-BUILDER pER Address: EXPIRES a� t Phone: Zip: License: 0 Arch : Eng: DESA STRUCTURAL Address: Address: 270 S BRISTOL Phone: SUITE 101 Phone: (714)825-0309 COSTA MESA,CA Zip: License: 92626 License: SCOPE OF PERMIT CONSTRUCT/REMODEL NEW 2399 SC)FT,2-STORY SINGLE FAMILY RESIDENCE-2 BEDROOM/3 BATHROOM-1443 SQ FT 1ST FLOOR&956 SQ FT 2ND FLOOR. PLANNING CONSIDERS THIS A REMODEL BECAUSE PORTIONS OF THE EXISTING WALLS WILL BE RETAINED. PROPOSED FAR IS.48; PROPOSED OPEN SPACE IS 45%.OVERALL HEIGHT'S 26'HIGH. SECOND FLOOR IS 66% ' OF THE FIRST FLOOR. MINOR MODIFICATION PROCESSED FOR 8'SEPARATION BETWEEN HOUSE AND EXISTINGGARAGE—SEE MM-01-25. FEE SUMMARY Plan Check: $1,039.06 • Calc Valuation: $207,031.94 Permit: $1,598.55 Claim Valuation: $0.00 SMIP Res: $20.70 • SMIP Corn:, $0.00 rA Other v $0.00 , - /:.725j tInspection: $0.00 - b ,rt al Total: $2,658.31- • DA ' PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 20-0 Rear 61-0 Left 6-0 Right 16-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 3 Required: 3 Proposed: 3 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) J 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. 'U 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(WOO) WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit Is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100.000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECRON 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I em 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 end effect.Uc.0 Class 0 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: 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 Bus ess and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit s cts the applicant to a civil penalty of not more than five hundred dollars($500).): 1,j 1 SBse owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I.as owner of the property,am __„„ USIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors U , • I:7does not apply •an •r of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to •- •ntractors License ❑ 1 am exemp •er sec. �� Business and Professions Code for this reason: Signature:. a i / AIM/ �� ° r Expires:_ i� Veril 0:tion of Ownership by(type of docu =m,L: - •roperty fax bill or deed): — l y DIVISION OF INDUSTRIAL SAFETY PERMIT• RTIFICATION: ❑ 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 thirtysix(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes ❑No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑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 ❑ o 7. (Section 255344the 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. i _..__ .._ _..__... ...__._.._._. _.._ 4 if en RMPP s presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes S No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Wit 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 Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes ❑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 • •RIZATION OF -Y:'I :nil)/under penalty of perjury that I have read this ap• cati• • d state that the information given is correct.I agree to comply with a + • a laws end city ordi r es drat' g to building construction,and authorize representat "s of th• City of Costa Mesa to enter upon the above-described property I. pection purposes.I ••rr; of t. • cu,y or allow occupancy of any building authorized by th'.permit til final inspection. ��// • o IT ej11�I �— And/Or Aut rzed •••licant Date CODE/ INSPECTION TIFF I1d1E .1111. ' ;ODE( INSPECTION TYPE 257E IIfI7t1AU 1618 Fixed System Final Fire Prevention 206 Final Mechanical 1288 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy • ir- CITY OF COSTA MESA :#111 BUILDING DIVISION >: DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER it �...� PERMIT B03-02100 (714)754-5273, • Fax(714)754-4856 • www.ci-costa-mesa.rf LDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 242 E 19TH ST Status: ISSUED Suite: A Applied: 12/04/2003 Vicinity: OFFICE AREA AT FRONT OF SFD • Issued: 12/04/2003 Parcel Number: 42627115 Zoning: Applicant: HOOFE, PAUL T ISSUED BY: I ...- Address: Address: P 0 BOX 5038 - , . . Phone: 949-631-8453 NEWPORT BEACH,CA Zip: 92662 Owner HOOFE, PAUL T • Address P 0 BOX 5038 • ' Phone: . . / #49 - NEWPORT-BEACH,CA Zip: 92662 , Contractor: OWNER-BUILDER r �� �� Address: Phone: Zip: License: 000000 Arch : Eng: Address: • - Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT ADD 105 SF OFFICE AREA.TO THE 2ND STORY. , - ' - , REF:601-00617 FEE SUMMARY Plan Check: $29.15 Calc Valuation: $1,200.00 Permit: $44.85 Claim Valuation: $1,200.00 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $74.50 ' - - - ' PLANNING &ZONING ' SETBACKS.\ , MAIN STRUCTURE Front 0-0. Rear 0-0 Left i 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 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)754-5826 2448-48(MO) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'compensation Insurance carrier and policy num.'r are: Carrier: Policy Number: (This section need not be completed/f the pe •• va ed at• e h ndred dollars($100)or less) i;1=. I certify that in the performan • . e work for which t•s permit is issued,I shall not employ any person in any manner so as to be me subje to the workers' compensationh laws of Cali agree that if I s••ultl become subje t to the workers'compensation provisions of Section 37 0l the / r Code,I shall forthwith comply with these pro•.ons. FJ.{! E../� Applicant Signature: Date: WARNING:FAILURE 10 SECURE WORKERS'COMPEN IS U FUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL P NALTE 0 CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5I00,000),IN ADDITION TO THE COST OF COMP: •TION,r AMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in lull force and effect.Lic.Y 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: 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 statementthat 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 end 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 fore permit subjects the applicant to a dvit penaltyof not more than five hundred dollars($500).): t it �I;as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044.Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt und: Business and Professions Code for this reason: _ / Signature: Date: /L/ 5t 03 � Expires: Q 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,falsewark,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,An 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 Flre Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 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 aksrmit for such construction or modification from the South Coast Air auntIty Management District or from any other air pollution control district or agency? 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). J T 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 California Health and Safety Code). 7 If a permit from the South Coast Air Ouatry 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 e (Ii yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I Certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLI AUTHORIZATION OF E • : I certify under penalty of perjury that I have read this a plicatio and state that the information given is correct. I agree to co I I state laws and city dinances elatin• to building construction,and authorize represent yes of a City of Costa Mesa to enter upon the above-describe party inspection os I gree not t• • •'or allow occupancy of any building authonzy by per unci nal inspection. Signe ala :r( Date And/Or Authonzed Applicant Date CODE I tNSPECTIONITPE PATE 20111611 cow E INSPEC110N TYPE PATE ILLS 1618 Fixed System Final Fire Prevention 208 Final Mechanical 1288 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy r I. CITY OF COSTA MESA 4 - BUILDING DIVISION >:� , DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 1 ' PERMIT o II ' E01-00613 SttoRanuot (714)754-5273 • Fax(714)754-4856 • wci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ww. ELECTRICAL PERMIT Job Address: 242 E 19TH ST Status: ISSUED Suite No A Applied: 07/10/2001 Vicinity: UNIT A Issued: 07/10/2001 Parcel Nunmber: 42627115 Applicant: HOOFE, PAUL T ISSUED BY: (1� Address: P 0 BOX 5038 UUU Phone: (949)631-8453 NEWPORT BEACH,CA Zip: 92662 Owner: HOOFE, PAUL T irrENL+T®N Address P O BOX 5038 F,x 1,►71 Phone: (949)631-8453 J.�AL( ® D NEWPORT BEACH,CA Zip: 92662 L I PER ' Contractor: OWNER-BUILDER EXPIRES (95 Address: Phone: „n/1 ZIP: t ..-4 0 /y License: 0 :J . DA ' SCOPE OF PERMIT " ELECTRICAL PERMIT FOR NEW TWO-STORY SINGLE FAMILY RESIDENCE. INSTALL ELECTRICAL THROUGHOUT NEW 2399 SQ FT SINGLE FAMILY RESIDENCE. _ REF:B01-00617 • 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) $134.34 2399 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 Transformers up to.1 kva/kw $0.00 0 " Pool/Spa $0.00 0 up to 10 kva/kw . . .$0.00 0 Lighting Fixts - $0.00 . 0 up to 50 kva/kw $0.00 0 Recept Outlets - / $0.00 0 - - up to 100 kva/kw . ,".$0.00,_ 0- " Switches $0.00 - �0 over 100 kva/kw-- , $0.00 0, Non Res Appl $0.00 , 0 ` Low Voltage Equipment . - '$0.00 ' 0 7,, , 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 1 hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 • 0 - Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee - $0.00 ' Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $157.84 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 i 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 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 of this permit. FOR INSPECTIONS CALL: (714)754-5626 \ 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. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed/f 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 CML FINES UP TO ONE HUNDRED THOUSAND OOLLARE($100,0)0),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 37050F THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lie.O Class A Contractor's Signature: Date: • CONSTRUCT1OtI`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 C sub s the applicant to a civil penalty of not more than five hundred dollars($500).): Lswner 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. 044,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.t ner-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,a USIVELY••NTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors w does nom •ply t• n owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to C rectors Liw :ws ❑ I am exemp Business and Professions Code for this reason: Signature:— - Arr I•:te: ----N _irea 1 Owner e ���;CVO—idled by driver's lice•.:, a es 0 o Driver's License o. —• � Expires:— Wi Verification of Ownership by(type of document,i.e.-pro.orty 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: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds.or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No (Section 25533 of the California Health and Safely 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). �..._ _..._.___.._....__._Management _ _._ails_..._. 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 apermit for such construction or modification from the South Coast Air(Duality Management District or from any other air pollution control district or agency? 0 Yes j5 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Wit 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 Califomia Health and Safety Code). .. South 7 If a icatiofrom the South Coast Ads Quality Management District or other air pollution control districtn 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? ❑Ves 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: i CERTIFICATE OF COMPLIANCE AND . •--I•'NATION OF E :I�ity un•.r penalty of perjury that I have read this application a tate at the information given is correct. I agree to comply with all . e I' s and city ordinanc:"rel. 0•• .ng construction,and authorize representatives of the of sta Mesa to enter upon the above-described property for i...ection p s.I .re 4'• r elle occupancy of any building authorized by this permit un' final i pectlon. r�i�eA'r 7/0 t y Signature OfL- gal• ,/ s) ' ` 1e.._—, And/Or Authorized Applicant Date ODE 0 INSPECTION TYPE QM 1NRmAL5 CODE. latECTIONTYPE DAIS INiOWALS 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 CITY OF COSTA MESA 4 BUILDING DIVISION Y:l% %a DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER J. t®0 PERMIT E03-01130 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 242 E 19TH ST Status: ISSUED Suite No k Applied: 12/04/2003 Vicinity: - Issued: 12/04/2003 Parcel Nunmber: 42627115 Applicant: HOOFE, PAUL T _ ISSUED BY: 4L-1- Address: P 0 BOX 5038 - Phone: 949-631-8453 ' NEWPORT BEACH,CA Zip: 92662 Owner: HOOFE, PAUL T Address P 0 BOX 5038 " , - • - Phone: ,py1• iOda NEWPORT BEACH,CA Zip: 92662 4Y SIO b ,a, 0 i , Contractor: OWNER-BUILDER 00 , Address: - - • 'Phone: Zip: License: 000000 N • SCOPE OF PERMIT ADD 105 SF OFFICE AREA.TO THE 2ND STORY, ' - 4 LIGHT FIXTURES,7 OUTLETS REF:B03-02100 AND B01-00617 • 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 $4.40 4 up to 50 kva/kw - $0.00 0 Recept Outlets. $7.70 7 up to 100 kva/kw $0.00 0 Switches $0.00 0 over 100 kva/kw $0.00 - 0 Non Res Appi $0.00 0 Low Voltage Equipment $0.00 0 Res App] $0.00 0 Low Volt Wiring System/Ckt $0.00 0 . Service to 200a $0.00 0 ,Misc.Conduit $0.00 0 Service to 1000a $0.00 0 Misc.Conductor $0.00:. �0 Service over 1000a $0.00 0 ' Circus(gen or ride) $0.00 "0 Motors to 1hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee. $0.00 Motors over 100hp $0.00 0 - Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21.92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections end final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(WOO) DECLARATIONS WORKERS'COMPENSATION DECLARATION: • I hereby affirm under penalty of perjury one of the following declarations: ❑ (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 Me work for which this permit Is Issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This s need not be completed/t the pet!). one hundred doll: $100)or less.) I certify that in the performance owhy ork which this permit is I-- :•,I shall not employ any person In any manner so as t become bject to the workers' compensation laws of Calif co- and a• that It I should be - .act to the workers'compensation provisions of Se ti 3700 of a Labor Code,I shall forthwith comply with these provi • s. � Applicant Slgneture: Date: y(1 WARNING:FAILURE Ti,- r RE WORKERS'COMPENSATION• • 5 UNLAW F AND SHALL SUBJECT AN EMPLOYER TO CR I PENAL ES AND CML AMES UP TO ONE HUNDRED THOUSAND DOLLAR $100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMA'ES AS PROVIDED FOR IN SECTION 3709 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.tic.tl 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). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that 1 am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to Its Issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subje9s the applicant to a civil penalty of not more than five hundred dollars($500).): px!i,as owner of the property,-ocmy employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not Intended or offered for sale(Sec. 7044,Business and.Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property, :•• + LUSIVELYtCONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractor :•. Law does not-apply to: • nor of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursu:• •the •ntractors Ucense Laws.). ❑ I am e. pt undoJ.sec. Business and Professions Code for this reason: Signet / rfl i Date: JTSZS Owner ID verified by driver's license. • Ye• -411•4 No Driver's License No. S xpires: )6 Y Verification of Ownership by(type of document,I.e.-property to 'Ill 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: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). _ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the 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). ..._ _...___r___.... 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? 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 akPermit 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 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 24544 and 42303 of the California Health and Safety Code). ... __ .___..._ ._____ _ .__ ._..._.required 7 a permit fromn the South Coast disclosuress Ouacn ed by CaliforniaHealtheal or and Sr et po S coon 4l district3been agency is required for the work which is the subject of this application,have all of the __ prescnbed by Califoia Safety Code Section 42303 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 COMPU DE A b UTHORIZATI• ENTRY:I certify under penalty of perjury that I have read this application a state that the Information given Is correct. I agree to co Ith.all state laws a • c' or an •slating to building construction,and authorize representatives f the fly of Costa Mesa to enter upon the above-described rly for inspection pu ••�- agr no• upy or allow occupancy of any building authorized by th it u I final inspection. Signa arms • er(s) And/Or Authorized Applicant Date CODE t INSPECTION TYPE PAIS ltffilAU CODE It INSPECTION TYPE V=ImAke 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 c CITY OF COSTA MESA • BUILDING DIVISION et;.,' ldaliTit--1 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT J In 41%ft*OstaT60 11. M01-00350 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 242 E 19TH ST Status: ISSUED Suite No A Applied: 07/10/2001 Issued: 07/10/2001 Vicinity: UNIT A / Parcel Number: 42627115 ' ISSUED BY: I A Applicant HOOFE, PAUL T Address: P 0 BOX 5038 Phone: (949)631-8453 NEWPORT BEACH,CA Zip: 92662 . Owner HOOFE, PAUL T NSIoN Address: P 0 BOX 5038 FAN WIN 6/ Phone: (949)631-8453 +�,�"(� ZQ� D NEWPORT BEACH, CA Zip: 92662 A , .LO W� P+U / Contractor: OWNER-BUILDER PER L6 , Address: Eons`RES • Phone:• Zip: +'ot' 9 ,�,. I License:0 IS L ',I'1 , Ito . , SCOPE OF PERMIT .�''0�.. MECHANICAL PERMIT FOR NEW TWO-STORY.SINGLE FAMILY RESIDENCE(UNIT Ap STALL 1 FAU&3 VENT FANS. • , REF: B01-00617 . _FEE SUMMARY Quantity . - - Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 ' Inst FAU<100 k BTU $14.80 1 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0 , Inst/Rep.Recess Wall Htr $0.00 0 - Commercial Incinerator $0.00. 0 Refrig Sys<100 k BTU $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 ,`� '/ i) $0.00 :"0 - 30 To 50.hp/1,750 k BTU; ' -; // "$0.00 0 Vent Fan/Single Duct . ' ' ,.,$21.75 3, - - - Over 50 hp/Over 1,750 BTU ' - c, , $0.00 0 Appliance - - $0.00 0 - ;- Boilers � Fire Dampers - ` $0.00 v0 - . 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 $60.05 COMMENTS 1 SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all' 7 required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit./ FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed It the permit Is valued at one hundred dollars($100)or less.) O I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that 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($100,050),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37050F THE LABOR CODE.INTEREST.AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: 1 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 If Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Busii�tess 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 Stlb(ects the applicant to a CMI penalty of not more than five hundred dollars(5500).): �`_�.[f/-1,es aner 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. 70441Business 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 EXCLUSIVE!. ONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does nota..ly to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) Iiiense pursuant to the • ..ctprs Lice .e : s.). ❑ I am exempt u i Business and Professions Code for this reason: _ Signature:— .e i "i i ./�� L—•- : 1 i (Owner ler„a ed bydrivers a V s ❑No (Driv=rs cense.Nor _ Expires: Verification of'Ownprship'by(type of docum: t,':.-property tax bill or deed): pd.• ;zi, nil. - . DIVISION-OF INDUSTRIAL_SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that to excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). o As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. • Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health 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? 0 Yes C7 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 ❑No (If"yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify 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 COMPUAN • D AUTHORIZATION OF/1 - : I certify under penalty of perjury that I have read this ap icatio and state that the information given is correct. I agree to comp) all state laws and city or.nano: relatin. to building construction,and authorize represents' es of t City of Costa Mesa to enter upon the above-described prop: for inspection.urposes.I ag ii,not .occ ••or allow occupancy of any building authorized by t • permi ntil fjnal inspection. Slgnature.Ot - LDate__../ And/Or Authorized Applicant Date POPE II INSPECTION TYPE lAg MN& CODE II INSPECTION TYPE PAU INTMALS 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 '�c CITY OF COSTA MESA t 9 BUILDING DIVISION >#-...„,.,,„,„v„,-S-1.'- DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4PERMIT .F P01-00415 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 242 E 19TH ST Status: ISSUED Suite No A Applied: 07/10/2001 Issued: 07/10/2001 Vicinity: UNITA Parcel Nunmber: 42627115 ISSUED BY: Applicant: HOOFE, PAUL T Address: P 0 BOX 5038 Phone: (949)631-8453 NEWPORT BEACH,CA Zip:: 92662 . Owner: HOOFE, PAUL T Address P 0 BOX 5038 Phone:. (949)631-8453 NEWPORT BEACH,CA Zip: 92662 EXTENSIO ALL 0V' D . Contractor: OWNER-BUILDERy�/ �1 Address: PER `� Phone: a6 f/ Zip: EXPIRES License: 0 Arch / Eng : ,. . . - . 14 T Address: O Y4, SII.' Phone: v3� 1� - _. zip:.__ - - It y, V'. License: SCOPE OF PERMIT - • PLUMBING PERMIT FOR NEW TWO-STORY SINGLE FAMILY RESIDENCE. INSTALL 1 BATHTUB, UP TO - 4 GAS OUTLETS,2 WASHERS, 1 SEWER CONNECTION,3 SHOWERS, 1 KITCHEN SINK,3 WASH BASINS,3 WATER CLOSETS,8. 1 WATER HEATER. ` REF: B01-00617 - „ - -- - _ . - - FEE SUMMARY AMT ;QTY AMT QTY % .,% AMT QTY ISSUE FEE 123:50 - - -Laundry Tub/Washer $19.60 -2 - . - Sump Pump - $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 -Swimming Pool . $0.00 0 Backflow Preventer $0.00 0 -P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $9.80 I Pressure Regulator $0.00 0 Urinal - $0.00 0 Clarifier System $0.00 0. - Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 -0. Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $29.40 3 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain, Floor $0.00 0 Sewer Connect $24.65' 1 Waste and Vent System $0.00 0 Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $29.40 3 Drain,Roof $0.00 0 Shower $29.40 3 Water Heater/vent $12.30 1 Drinking Fountain $0.00 0 Sink, bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) $6.15 1 Sink,kitchen $9.80 1 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $194.00 regulations.(Ord.No.92-28,§1, 12-21-92) COM NTS/S• CIAL CONDITIONS EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if 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 expiration of this permit. 7 FOR INSPECTIONS CALL: (714)754-5626 V 2446.46(6/00) DECLARATIONS ( ) WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: . ❑ I have end 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.) O I certify that in the performance of the work for which this permit is Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that 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 CNIL FINES UP TO ONE HUNDRED TFNYJSAND DOLLARE($1c0,000).IN ADDMON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECRON 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of DMsion 3 of the Business and Professions Code,end my license is in full force end effect.Lic.# 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 and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit _sub) s.the applicant to a civil penalty of not more than five hundred dollars($500).): �I,,a 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. e 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 own: 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 prope ,am EXCLUSI V CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contras -cense Law doe. • apply to an owner of property who builds or Improves thereon,and who contracts for such proje t with a contractor(s) license pursu o the Contractors Li-; . Laws.). ❑ 1 em ex t er sec. / Business and Professions Code for this reason: (Strati: ' ' '7 " ( ate:.--'�� . -• _ 0 � • ----Expires: 0 y Verification of Ownership by(type of documen,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,end that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I.will.not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes ❑No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one lime 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 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 end Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant Or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District ar 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? 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 COMPLIANC .,"/AUTHORIZATION OF E - :I certify under penalty of perjury that I have read this applica' a state that the information given is correct. I agree to comply ' al : ate laws and city a•LI•.-nce elatin. o building construction,and authorize representativesh ity of Costa Mesa to enter upon the above-described prop: or�j tion purposes.I . not toss up or allow occupancy of any building authorized by this pe it iI final inspection. /r-/.s, 01- :— Signaatu ra. :gal -. nel(s) 1— ate And/Or Authorized Applicant Date CODE L INSPECTION TYPE PAI€ INTITIALE CODE• !ISPECTION TYPE PAIL INTRIAL$ 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 • CITY OF COSTA MESA •• y '� BUILDING DIVISION PERMIT NUMBER f;' "7 .I DEVELOPMENT SERVICES DEPARTMENT. �• 666 . PERMIT .mm 800-00529 (714)754-5273 • Fax(714)754-4856 • 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 242 E 19TH ST Status: ISSUED Suite: B Applied: 04/21/2000 Vicinity: HOUSE AND STORAGE SHED • Issued: 04/21/2000 Parcel Number: 42627115 Zoning: , 21.12p Applicant: HOOFE, PAUL T ISSUED BY: c� Address: P 0 BOX 5038 ' Phone: (949)642-9748 NEWPORT BEACH,CA Zip: 92662 Owner: HOOFE, PAUL T Address P.O BOX 5030 Phone: T� NEWPORT BEACH,CA - Zip: 92662 L " Qp T ' 163 Contractor: OWNER-BUILDER / 117 Address: - - DAA+• Phone: Zip: License: 0 Arch : - Eng: Address: Address: • Phone: Phone: Zip: License: License: SCOPE OF PERMIT REROOF-HOUSE AND STORAGE BUILDING-1/0, USE EXISTING SHTG, INSTALL 1 LAYER OF 30#FELT AND 30 YEAR COMPOSITION SHINGLES. FEE SUMMARY ; , • Plan Check: , $0.00 Calc Valuation: $800.00 Permit: $32.65 - - - .,' , Claim Valuation: $800,00 SMIP Res: $0.50 SMIP Com: $0.00 Other $0.00 Inspection: $0.00 Total: $33.15 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front - 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front . 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0,- Required: 0 Proposed: 0 NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not-commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 I - ECLARATIONS WORKERS'COMPENSATION DECLARATION: • I hereby affirm under penalty of perjury one of the following declarations: _ ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: . Carrier: Policy Number: (This section need not be completed i/the permit is valued at one hundred dollars($/00)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(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lia# 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). 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 Businesa:and,Professlons 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 cts the applicant to'e civil penaltyoi not more than five hundred dollars($500).): ssu �: rq I,as owner of the propertror-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 ,ill 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 CO'TRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044, Business and Professions Code:The contractors Lice•se Law does not app to an owner of property who builds or improves thereon, and who contracts for such reject ith a contractor(s) license pursuant to the •r'ractors License Law- . ❑ I am exempt un•- . Business end Professions Code for this reason: / Signature: / ' •ate: 7 L t/ �,��t9/ Owner ID . fied by d vers Iia e. /■ - 0 No Driver's License No. , E ires: `"7 /7Pr%Y' Verification of Ownership by(type o docume 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,Ttle 8,Califomla Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and 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 ..-....... h t.... building occupant .. ui_._.._ whi subject .t_..this_.applicat rmit nstr.. modification 5 Does or willthe CoasttcAor present a emen building o frm require for the work ontch is the district or agency? application epermit for such construction or modification from the South Air Quality Management District or from any other air pollution control or �Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the Information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF C• •U AND AUTHORIZATION OF4 " :I certi under penalty of perjury that I have read this ap• cation a • state that the information given is correct. I agree • amply h all state laws • city ordj�nces elating t•building construction,and authorize representati :s of the ity of Costa Mesa to enter upon the above-descri•=d propert or ins.: tion p •• :..1,0 not t•occupy or flow occupancy of any building authorized by) •actin u•jllylal In rctign. / / GdvC/ r Si•ature Of L:eaiOwner(s) F- Date And/Or Authorized Applicant Date GOOF 8, INSPECTION TYPE MTh ItIM S CODE! LNSPFCTIONTIPE PSIS IN1T IALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical • 1266 Pool Spa Final 298 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 2446-46 ,sill Mtc CITY OF COSTA MESA - 4• ° BUILDING DIVISION y-ClifEdITTE4 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER• 4 ' PERMIT E00-00757 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ELECTRICAL PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 • Job Address: 242 E 19TH ST Status: ISSUED Suite No B Applied: 08/01/2000 Vicinity: UNIT B Issued: 08/01/2000 Parcel Nunmber: 42627115 Applicant: HOOFE, PAUL T ISSUED BY: Address: P O BOX 5038 . Phone: (949)642-9748 NEWPORT BEACH,:CA Zip: 92662 _ Owner •'HOOFE, PAULT. - - Address PO BOX 5038 - - Phone: (949)642-9748 , • NEWPORT BEACH; CA Zip: 92662 *� AADIry! �� D Contractor: OWNER-BUILDER DA ' • I, Address: - . Phone: Zip: ' License: 0 SCOPE OF PERMIT ELECTRICAL PERMIT FOR NEW GARAGE&STORAGE ADDITION. INSTALL 69 LIGHT FIXTURES,41 RECEPTACLE OUTLETS;22 SWITCHES,&1-100 AMP ELECTRICALSERVICE. • REF: B00-00923 - -- - - > - FEE SUMMARY ARY - - 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 Fizts ' ,$55.77 69 - up tb 50.kva/kw $0.00 0 Recept Outlets $35.33 ..;.41i - up to 100 kva/kw. $0:00 / 0 - Switches $21.46 . i ' 22" , " over 100 kva/kw -" $0.00 0 Non Res Appl - -$0.000 Low Voltage Equipment .1,- $0.00 0 , " Res Appl $0.00 0 - Low Volt Wiring System/Ckt $0.00 " -- 0 Service to 200a . - ' $30.50-- - - 1 ,•_ Misc.Conduit _ $0.00 ,�=0 , ' Service to 1000a $0.00 - 0 . Misc. Conductor - $0.00 0" " / Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 " ' Motors to 1hp $0.00 . 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 - 0 Christmas Tree Stand . $0.00 " 0 Motors to 50hp 50.00 ' 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 $166.56 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 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 appllcable-codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ 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(Sico,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full force and effect.Lie.N Class 4 Contractors Signature: _ Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). 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 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 end 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).): .❑r-Iras owner of,tho 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 emplo •:s,proved that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,ttie owner-bit':-r will ft the burden of proving that he or she did not build or improve for purpose of sale.). ❑ 1,as owner of the property, : CLUSIVEL •NTR- ING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractor ense Law does n. :•sly to.?rwner of property who builds or improves thereon,and who contracts for such roj with a contractor(s) license pursuant • e Contractors Licen- . s.). ❑ IIam eke • nder sec. Arid Business . Da:-C/ �/ 9 Owner ID verified by d censer • e- • No (priversLicense•No. LExpires:w Verification of Ownership Dy(type•f... en .e.-•operty tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CER FICATION: ❑ 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 then thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes 0 No (Section 25505 of the California Health and Safety Code requires,with 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 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 11 an RMPP is presently required,has Section 25534 of the California Health end Safety Code been fully complied with? ❑Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application akermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes LI No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 8 Will any part of the facility to be constructed under this permit be within 1000 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 (II'yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penally of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: / Date: CERTIFICATE OF COMPLIANCE ORIZATI.• OF ENT., I Celt n•/penalty of perjury that I have read this appliiratI and :to that the information given is correct. I agree to comply wit state laws and city •rdinanyelating tsp.• ding construction,and authorize representativ:- • the Ci•. of Costa Mesa to enter upon the above-described property mspe• • pu •-es-1'-.'ree (t• • cupef allow occupancy of any building authorized by t .. ' nti7:1 inspection. dip • (gnaturile Leg-i,•wn: s)- - Date- And/Or Authorized Applicant Date cODE L INSPECTION TYPE IAIE I Ii1OLS CODE! INSPECTION TYPE PAIS EMBALX 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 ��M CITY OF COSTA MESA �. • 4L9 BUILDING DIVISION it�� .r PERMIT NUMBER F f rm.rfrai t DEVELOPMENT SERVICES DEPARTMENT J PERMIT 444>ownso e" P00-00425 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 242 E 19TH ST Status: ISSUED Suite No B Applied: 08/01/2000 Issued: 08/01/2000 Vicinity: UNIT B Parcel Nunmber: 42627115 ISSUED BY: Applicant: HOOFE, PAUL T Address: P O BOX 5038 Phone: (949)642-9748 NEWPORT BEACH,CA Zip: 92662 • Owner: HOOFE, PAUL T Address P 0 BOX 5038 Phone: (949)642-9748 NEWPORT BEACH,CA Zip: .92662 EX•PI 9 , D • ,,y� Contractor: OWNER-BUILDER t DATE i • Address: . Phone: Zip: License: 0 Arch / Eng: -- Address: _ - _ Phone: - Zip: License: • - SCOPE OF PERMIT PLUMBING PERMIT FOR NEW GARAGE&STORAGE ROOM ADDITION. INSTALL 1 WASHER, 1 WASH ' BASIN, 1 WATER CLOSET,& 1 WATER PIPING. " REF:B00-00923 - - - - FEE SUMMARY •�- AMT QTY - • AMT QTY _ . ' AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $9.80 1 Sump Pump "$0.00 0 Backflow irrigation "$0.00 0 Landscape Irrigation $0.00 0 Swimming Pool - $0.00 0 Backflow Preventer $0.00 0 - -P-Trap - $0.00 0 Trap Primer , $0.00 0 Bathtub $0.00; 0 Pressure Regulator $0.00 0 , Urinal $0.00 0 Clarifier System $0.00 0' Process Piping(per 10 ft) $0.00 0Vacuum Brkr Bkfiow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 • 0 Receptors $0.00 0 .Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00' 0 Septic Tank $0.00 0 ' Wash Basin- $9.80 1 Dishwasher $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) $9.80 1 Drain, Roof $0.00 0 Shower $0.00 0 Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 Sink,bar - $0.00 0 Water Piping(Inst or Rep.) $9.80 1 Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) $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) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease, Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 . TOTAL CALCULATED FEES: $62.70 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 applicable codes, and-al/ ) required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this/ FOR INSPECTIONS CALL: (714)754-5626 v 2446-46(6/001 DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carder: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.1r Class 11 Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): 1�1❑ 1,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. L—.7044"Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one'year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I`as tlwner of the property;am E%CLU-If ELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044, sine and Professions g Code:The-contractor ow..: not apply to an owner of property who builds or Improves thereon,and whocontracts for such oleo ith a contractor(s) license ursuan a niracto se Laws.). / q� ❑ I am-exe under sec. Business and Professions Code for this reason: Cil)0 (Si natur ' .-1i/i Expires J#$W 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,Ttle B,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 W.I.the applicant or present or future building occupant need to tile and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application 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 ❑No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑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 AUTHOR • le OF ENTRY:I •rtify u •er alty of perjury that I have read this applicatio .nd st. = that the information given is correct. I agree to comply with all state la,- .nd y ordinances ratag to buil;in. onstnlction,and authorize representatives of. e City• Costa Mesa to enter upon the above-described property for inspecti•' .us.I agreeenoel• ••py or alio upancy of any building authorized by thi u.til fin' ,pact --ignatbr •f-L .0 'r(s)— / And/Or Authorized Applicant Date POE INSPECTIONTYPE pATE 1NTRIALS COUP INSPECDON TYPE PAM INTRIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition • 250 Final Building/Occupancy CITY OF COSTA MESA 4 BUILDING DIVISION > :J'> DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER k".• jibPERMIT , ""eoR�,m BOO-00923 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.cBaUILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 242 E 19TH ST Status: ISSUED Suite: B Applied: 06/22/2000 Vicinity: UNIT B Issued: 08/01/2000 Parcel Number: 42627115 Zoning: Applicant: HOOFE, PAUL ISSUED BY: Address: P 0 BOX 5038 Phone: (949)642-9748 NEWPORT BEACH,CA Zip: 92662 Owner: HOOFE, PAUL Address P 0 BOX 5038 - I T Phone: (949)642-9748 L NEWPORT BEACH, CA Zip: 92662 � ' /it _ ' DATE 0 Contractor OWNER-BUILDER Address: Phone: Zip: License:: 0 Arch : Eng: DESA STRUCTURAL Address: Address: 2 SALTAIRE DR Phone: Phone: LAGUNA NIGUEL,CA Zip: License: 92677 License: SCOPE OF PERMIT CONSTRUCT NEW 487 SF GARAGE,416 SF STORAGE/LAUNDRY/ENTRY AT FIRST FLOOR;59 SF SECOND STORY DECK, &590 SF SECOND FLOOR STORAGE ROOM ATTACHED TO EXISTING SINGLE FAMILY DWELLING(UNIT B).ALL AREAS ARE NON-HABITABLE. 10/26/00:ADDITION OF 36 SQ FT NONHABITAL AREA TO WEST SIDE SFR SECOND STORY.TOTAL SECOND FLOOR AREA 626 SF: FEE SUMMARY Plan Check: $320.29 Calc Valuation: $34,602.58 Permit: $492.75 Claim Valuation: moo SMIP Res: $3.46 SMIP Corn:. $0.00 ' Other: $0.00 Inspection: $0.00 ' Total:. $816.50 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left - 0-0 Right 0-0 ACCESSORY Front 0-0 Rear '0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 /,// 2446.46(6r00) - / j DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carder: Policy Number: (This section need not be completed/t 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 CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is In full force and effect.Lic.# Class 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). 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-bu'Ider 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 EXCLUSIV- 'ONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does of a;ply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to th=Contractors Li ' se ws.). to 0 lam exam. . ler sec. Rusin: Date: /tV-C- Owner .ver,- .r :rs ' ,fro es Vi No Driver's License No. Exp res: Zinn '-( V; 'cation of Ow=rship .y( '.e of docu ent,i.e.- •roperty tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CE-TFICATON: ❑ 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,The 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). �.._ _..._._ 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program fororacutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? DI Yes No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by C: '•• la Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the a••ropri e air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that der penalty of perjury the information given above is correct.I agree to comply with all state laws end city ordinances regarding Hazardous Materials entl 9issions. Signature: / Date: • CERTIFICATE OF % 'FIANCE AND .-t OH ••TON OF ENTRY:I certify under penalty of perjury that I have read this:plication :nd state that the information given is correct.I agr:t • comply with ells:•<'lays and ty ordinances relating to building construction,and authorize represent- nes of I': City of Costa Mesa to enter upon the above-des '•ed pro' • Ins•: 'on purposes.I agree not to occupy or allow occupancy of anybuilding authoriz:.•by :pii nut final inspection. /r ure• -•- • - Date And/Or Authorized Applicant Date SODS t INSPECTION900E! INSPFOTION TYPF. RAIL MBA 1616 Fixed System Final Fire Prevention 208 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 tCITY OF COSTA MESA :t-_* BUILDING DIVISION • PERMIT NUMBER 1.- •_'•I' ' DEVELOPMENT SERVICES DEPARTMENT, ° . PERMIT E00-00409 (714)754-5273 • Fax(714)754-4656 - 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 242 E 19TH ST Status: ISSUED Suite No A Applied: 05/03/2000 Vicinity: ON EAST SIDE OF NEW GARAGE Issued: 05/03/2000 Parcel Nunmber: 42627115• p ��/ Applicant: HOOFE, PAUL T ISSUED BY: STA // Address: P 0 BOX 5038 Phone: (949)642-9748 NEWPORT BEACH, CA ' Zip: 92662 Owner: HOOFE; PAUL T - Address P 0 BOX 5038 , • Phone: - ' ' . NEWPORT BEACH,CA Zip: 92662 Contractor: OWNER-BUILDER Address: Phone: . - - Zip: License: 0 • ' SCOPE OF PERMIT • INSTALL NEW 200 AMPSERVICE ON BUILDING A. • REF:E00-00372 ` • ' FEE SUMMARY ' • , Quantity - Quantity ISSUE FEE $7.25 Temp Dist System/Lighting $0.00 0 r 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 0Misc Electrical Equipment $0.00 0 New Res(3•-units) • $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 •. 0 up to 10 kva/kw $0.00 0 Lighting Fixts "$0.00 0 .• up to 50 kva/kw $0.00 0 Recept Outlets $0.00 0 up to 100 kva/kw $0.00 0 Switches $0.00 0over 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 $30.50 1 Misc.Conduit $0.00 0 Service to 1000a $0.00 0 Misc.Conductor $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 • Motors to 1hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 • Fireworks Stand $0.00• 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0, Investigation Fee $0.00 Sub panel to 200a $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 $37.75 Intermed Pole $0.00 0 COMMENTS/SPECIAL CONDITIONS • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§1,12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not-commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 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.) ❑ 1 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(S100,003),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): 1;20 I,as owner of the properly,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or Improvement is sold within one year of completion,the ow -r-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 EXCLUSI ELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code:The contractors License Law-.••s of apply to an owner of properly who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to -_;ontractors ' en-= Laws.). ❑ I am exempt Jet sec. Business and Professions Code for this reason: Signature: dl –I ff ^Date: r �0 v Owner ID ,nfied by driver' -license/ ❑ '5 ❑No Driver's License No. Expires: - ZOO.2— 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,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 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 armit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? DI ppeYes L1 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? ❑Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No ...._...._ 8 (if"yes",attach certificate of compliance from theheappropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that un•:r 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 C• 'PLIANCEAND AUTHOR ON s i ENTRY:I certify under penalty of perjury that I have read this appl' tion a state that the information given is correct.I agree • comply with all state la s an6 • . dinances relating to building construction,and authorize representativ of the ity of Costa Mesa to enter upon the above-descri••d property for Int:pion. rposes. a• ee not to occupy or allow occupancy of any building authorized by this it u II final Inspection. ca Zoon 'gnat e.01 Le•-- ner( Date And/Or Authorized Applicant Date CODE 4 INSPECTION TYPE PATE INTRIAU CODER INSPECTION TYPE PAIS INTMALS 1816 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing c 200 Final Re-Roof 210 Final Electrical (/WOO ik..91714, 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 2446-46 C. i • �n1_IT CITY OF COSTA MESA i,v � BUILDING DIVISION PERMITNUMBER b.' "`." ' DEVELOPMENT SERVICES DEPARTMENT. °• e.. . PERMIT E00-00372 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 242 E 19TH ST Status: ISSUED Suite No A Applied: 04/24/2000 Vicinity: ON EAST SIDE OF NEW GARAGE Issued: 04/24/2000 Parcel Nunmber: 42627115 Applicant: HOOFE, PAUL T ISSUED BY: m Address: P O BOX 5038 Phone: (949)642-9748 NEWPORT BEACH,CA Zip: 92662 Owner: HOOFE,PAUL T Address P 6 BOX 5038 Phone: NEWPORT BEACH,CA Zip: 92662 • Contractor: OWNER-BUILDER Address: Phone: Zip: • License: 0 SCOPE OF PERMIT INSTALL NEW 400 AMP SERVICE. . FEE SUMMARY Quantity _ _ • Quantity ISSUE FEE $23.50 - 4 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 i Busway/100 ft $0.00 0 Res.a/c package $0.00 Standing Section $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 _ up to 10 kva/kw $0.00 0 Lighting Fixts $0.00 0 up to 50 kva/kw $0.00 0 Recept Outlets $0.00 0 up to 100 kva/kw $0.00 0 Switches '$0.00 0 - over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $0.00 0 Misc.Conduit $0.00 0 Service to 1000a $62.15 1 Misc.Conductor $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1 hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 - 0 ,Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee • $0.00 Sign Circuits $0.00 0 Temp Pwr Pole S0.00 0 TOTAL CALCULATED FEES $85.65 Intermed Pole $0.00 0 COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not-commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 • DEELARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penally 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 wNch 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 of one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is Issued, I shall not employ any person In any manner so as to become subject to the workers' compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: . WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(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 Ls in full force and effect.Lic.4 Class It 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 tor the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to Its Issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors license Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit sub'ects the applicant to a civil penalty of not more than five hundred dollars($500).): TitI,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:mployees,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 own•-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 EXCI SI ELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code:The contractors - se Law••• of apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant t. •Contractors ' en •Laws.). ❑ I am exam• • der sec. / Business and Professions Code for this reason: Signature: SIM- Date: — - �re Owner I I willed by driver's• •nse. -_ ❑No Driver's License No. • - Expires: 209 Verification of Ownership by(type of: CITY OF COSTA MESA 4 BUILDING DIVISION >:j ,:;, na 1 DEVELOPMENT SERVICES DEPARTMENT P RMIT NUMBER 4. PERMIT B01-00826 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us DING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 BUIJob Address: 242 E 19TH ST Status: ISSUED Suite: A Applied: 06/06/2001 Vicinity: FRONT DWELLING(UNIT A) Issued: 06/06/2001 Parcel Number: 42627115 Zoning: Applicant: HOOFE, PAUL T - ISSUED BY: Address: P 0 BOX 5038 Phone: 949-631-8453 NEWPORT BEACH,CA Zip: 92662 Owner: HOOFE, PAUL T Address P 0 BOX 5038 Phone: NEWPORT BEACH,CA • Zip: 92662 Contractor: OWN ER-BUILDER Address: Phone: Zip: License: 0 Arch : - Eng:. Address: Address: Phone: Phone: Zip: • License: License: i . SCOPE OF PERMIT • DEMOLITION OF WALLS,ROOF;BATH,WINDOWS;FLOOR&KITCHEN'OF AN EXISTING SFD(UNIT A).200A ELECTRICAL PANEL 82.8-FEET OF EXTERIOR WALL TO REMAIN. REF: B01-00617 aS FEE SUMMARY r Plan Check: $0.00 / Calc Valuation: $4,000.00 Permit: $97.25 Claim Valuation:.' $4,000.00 SMIPRes: $0.50 - � ''-- SMIP Corn: Other $0.00 • Inspection: - $0.00; • „ i Total: $97.75' // i /�� � , i%/ � A - PLANNING & ZONING-41' - S\7/ "/ SETBACKS MAIN STRUCTURE Front _0-0 ` j Rear 0-0 Left _ 0-.0 A Right 0-0" ACCESSORY Front 0-0 _ Rear 0-,0 Left 0-0 - Rightc, '0-0 PARKING Existing: 0 �Required`: - 0 Proposed:,,-"-0 NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void 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 expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 241816(8/OD) 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. o I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'compensation Insurance carrier and policy number are: Carrier: • Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ 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($103,C00),IN ADDmON 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 lull force and effect.Lic.R 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 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).): tEC 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 'cense 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„•rovided 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 I have the burden of proving that he or she did not build or improve for purpose of sale.). I,as owner of the prop° LUSIVELY CONT-ACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contracto cense Law does not apply •an•} er of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuan the Contractors License Laws.). / o I am exe under sec. / / Business and Professions Code for this reason: {/ Signature: yy �' t Date: 6//6.49 Owner °rifled drive I'IL`erlse. rA ,orI. o Driver's License No. (((JJJ Verification of Ownership by(type• •oc Iv• ,co.-property to•bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP Is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? (�Yes 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? 0 Yes ❑No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the ap• opriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that and.r 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 COM- ACE AND AUTH•-IZATI r •F E. •Y: I certify under penalty of perjury that I have read this appli'tion and ate that the infor ation given is correct.I agree to • ply with all state law-and city,Tina :s relating to building construction,and authorize representative- of the ' of Costa Mesa D enter upon the above-describ:. •roperty for inspection pu •oses.I ag/:e •t to• py or allow occupancy of any building authorized b this •erm' unt' in inspection. i i / / i r ' •gnature• •'Ow er(s Date And/Or Authorized Applicant Date CODE r INSPECTION TYPE DATE INTITIAL$ OODEt INSPECTIONTYPE PATE IMrIAL$ 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 2/7/ ,LT 250 Final Building/Occupancy ADDRESS OF BOLDING: _242 E 19TH ST ' cal"' 1 /2 CITY OF COSTA MESA — BUILDING PERMIT VY17 We smwIEw taivn&HOOFE PAUL AU 8T s. PERM NO: B 087254 ADDRESS: BALBOA,CA 92662 PERMIT NO: B 087254 PLAN CHECK NO: N GOVT: N SUPP: N APR..MRwDADDRESS: CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: OTH ARCHITECT DR ENGINEER: UC.NO.: JOB DESCRIPTION : T/OFF RESHAETH & REROOF W/COMP SQ FT: 1 , 000 ARCA.OR ENG'S ADDRESS: MT: CLAIM VALUE: 2, 000 . 00 CALC—VALUE: 2, 000 . 00 GROUP OCC: R-3 / CONTRACTORS NAME CW11ACTORSUMIDND COMMENTS : *** EXTENSION FOR PERMIT NO. 083724 *** STUCCO & INSTALL SIDING I ADDRESS: UC NO.: ******************************************************************************* wit ZONING REQUIREMENTS LICENSED CONTRACTORS DECLARATION:I hereby affirm under penaly of perjury that Ian licensed under provisions of Chapter 9 SETBACKS (commencing with Section 7000)of Division 3 of the Business and Profession Code,end my license is in full force and sew. ' CITY LIC.NO.: LIC.CLASS: UC.NO.: EXP.: MAIN BUILDING ACCESSORY BUILDING FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN DB1e: O4ntma LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN OWNER BUILDER DECLARATION:I hereby affirm under penaly of perjury that I am exempt from the Contractors License Law for the bwig reason(Section 7031.5 Business and Professions Code:Any city or county which rewires a permit to canmd,alta,improve. PARKING REQ: PROV: PARCEL : 42627115 Z N E: REF NO: nolish,or repel any tinpermitcture,prior to its issuance,also requires the applicant for such pit to file a signed statement that he or she licensed pursuant to the prwieioo of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the PLANNING N TES> Business end Professions Code!or that he or she is exempt therefrom end the basis for the alleged exemption.My violation of Section 7031.5 by any applicant for a permit subjects the applicant to a chit penally of not more than the hundred dollars R500D. ******************************************************************************* )43 L as owner of the property or my employees with wages as their ode compensation.will do the work,ad the strutom is not intended .D E \V E L O P M E N T SERVICES R E or offered for sale(Section 7044.Business and P..ssios Code The Contractors License Law does not appy to en owner of properly - Q U I R E M E N T $ who beide or improves thereon.and who.. _ work himself or hersel or through his or her own employees,provided that such improvements are d intended or offered to - .,f,however.the building or improvement i sold within one year of completion, ZONING APPROVED BY DATE: owner-0uilder w01 have the burden of proving or .did d build or improve for the purpose of sale). - ❑ I,as owner of the property.am exdusiveT .. t - with licensed contractors to construct the project(Section Met Business and Prdeseions cods:The comrdora lies no appy to an owner d peppery wla builds or Improves thereon O d caro BUILDING APPROVED BY ; DATE: s ler . .. . ...a wnh a Irdr' - pursuant to the Contractors License Law). ■ es:. : anee seaon: //%^ / B.AP.c., aMereeson: APPLICATION ISSUED BY: DATE: �'® / /I owner: ******************************************* ******************** ** by certify that t am- :«dad Sections island the requirements of California Health and Safely Cale Sions 25505,25wm3,aLEGALIZATION: F E E SUMMARY STRUCTURAL SEGMENT; I .. ..- dan ormobrdldiagoccupantntoualdyldlge one)nsddoompywihaeidsWewdeineeremptfrontaferBLDG PMT PLUMBING ELECTRIC MECHANIC FIRE $MIP/RES GRADING pand thata um buliin pll/Duality Mot(circle District)nee to comply rarmmibt erode and theremptfineMove provisions PERMIT 62 . 25 Dae: Applicant: SM I P/NON—RES WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalperjury one of the following dedaatbns: PLAN y of ❑ Ihave end wR consentdi maintain certificate of consent tosnaendows' ar r endows'compensation, prodded for by Section 37004 the Labs ISSUE FEE Code,for the performance of the workfowhichthispermitisissued. BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE ❑ I have and wil maiMain workers'compensation insurance.as required by Section 3700 of the Labor Code.for the performance of the TOTALS----> 31 . 12 0 . 00 0 . 00 31 . 12 31 . 12 . 00 work for which this permit is issued.My workers'compensation insurance caner end policy number are: Carrier: REVENUE DIVISION TOTALS —> COLLECTED : 31 . 12 OVER/SHORT: . 00 Policy Number: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK (This section need nor be completed 1I the permit is for one hundred dollars rsf001 or less) 31 . 12 ❑ 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 became subjd to the wakes'compensation taws d Ceglomi& and Woe that R I elauld become subject to the wwkes' ******************************************************************************* compensation provisions of Section 3700 of the Labor Code.I shall forthwith comply with those provisions. Date: Applicant: INDIVIDUAL F E E BREAKDOWN Warning:Failure to securewOrkers'compensation coverage launlawful,and shah subject an employer to criminal penalties end TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST civil fines up to one hundred thousand dollars($000,000),M addition to the cwt of compensation,damages as provided for In Section 3706 of She Labor Cods,Interest,and attorneys New SFR 1000 ALTER BY VALUE RESIDENTIAL NOZONE 1 . 00 1 , 000. 00 CONSTRUCTION LENDING AGENCY: I hereby affirm under penaly of perjury I ' there a a constmdion lending agency for the SFR 1000 REROOF BY VALUE RESIDENTIAL NOZONE 1 .00 1 , 000 . 00 performance of the work for which this panni is owed(Section 3097.CM.C). LENDER'S NAME: END OF FEES LENDER'SADDRESS- THE BACK UNITS S ORALE I certify that I have red this application 'donation is .. .I.. to corrrply with ell ply and county ordhurerty and state laws relating to building con ereby authorize repress Ives of.rt y to anter upon tM abowdmenlioned propeM ppp��� .'- ° ��` ///��� ,r 1pp�Ll Ica inspection puryosea. /�`_ J P xoo erinl NameCr • , I, ' V '� `') MAR 1 © 1998 / / Dale: 7/07;e A�11C I Signals:d. ! AgenUA..-...... ....7.:e" NiSI t r it•f.. . (5151da.WP) While-B,ikc •a Safely;Orem-Fla;Canary-Applicant;Pink-Revert»;Goldenrod-Aeeeesor • Pr . . CONSTRUCTION AND PLANNING • zPO / SPA APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole. 52. Pool & Equipment Location _z, Soil Pipe-Undrgrnd. 53. Steel Reinforcement T e:3: lectrical Conduit Utility-Undrgrnd. 54. Forms _ '14i:Electrical Conduit-Undrgrnd. 55. Electrical Bonding - '.-5' Steel Reinforcement 56. Rough Plumbing & Pressure Test r - -67 Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE ti .07. Footings 58. Electrical Conduit-Undrgrnd. . H. 8. Foundation • . 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK . 11. property Sewer Line & House Connection 62. Backwash & Receptor-Final 12.Sewer Cap ---63. Heater & Vent-Final 13. Roof Drains ' 64. Plumbing System - Final 14. Rough Plumbing - 65. Electrical-Final 15. Rough Electrical-Conduit • 66. Solar System-Final .,, 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling . 69. POOL/SPA SYSTEMS FINAL 19.-Rough Heating&;Air Conditioning 7 74 y,; u, - r '-+'=.... FIRE-DEPT.:REQUIREMENT .. - - _ :' -.fin:, ,r, r 20.;Rough Factory F(replace 1 -I^ •'xf _ APPROVAL"` Permit# - St` •� •-• 24 L » 1 S -, 21. DuctL in;Structure,: st`-.. .: - l r -- 70.rUnderground Hydro 22.-Duca Vepti181in9'4 1 u..r" 2 'a f;, cam- 71. Product piping OGas 0 Oil ,� -„ 23. Gas PipeTRough &,Test .. r " • lir ' -` - I y"�' - •'-' _ -) _ 72. Underground F•fush • 24. Roof-Framing r. - s _ 'it; rl'- • 731 Undergrnd.StoTanROGas OOiI 25..Roof Sheathing i, y V `•,'" -, r ' •. 74�•.overhead Hydra as I 26. T•Bar.Ceiling (Structural) & Ma-no`coat =' _ -- 75:-bry Chemical =� Iffl t7: - , 27. 'Frame and Flashing_ -mC a• r 7• >� ri• 76. Dry Standpipe.' o -, .J wj 28. Lathing&Siding Sv . _r;,. n + y 'y 77t FIXEDSYSTEM FIN4' -2 29. Insulation • T. ;j • 4 s 78.. FIRE PR EV. FINAL '• •••••' 30. Drywall Nailing * '. I fr� '-HEALTH DEPT.REQUIREMENT u t 31. Plaster 8$wnLCoar: S a.. I ii, it79. FINAL IRISPECTJON p r-, 'n y , • 32. ElectricaLPower Meter-Final ,- ••r it r, 80: FOOD C'ERTIFJ'CATE ISSUED' rt 33.-Fina4Electri •' n x � '1 ti . -- J <`i Jtn 5c1 z �.- x , Notes: r J`' •r, 34._Final Heating-tv A`ir-Conditioning" `r, it. a - �+ - :-r '�':•- - K 1 4; n * p- -S 35.;Finai Gas-Pi p4 Te T - t: *- i-' La •r4 171 27 r 36. •Hood-or Canopy 7.., tM, : :, I I K m, . --L • 17) 37. Final'Factory Firctgce. . "" ,' c n. ,r ..,, :�: - ,i , •J ' t r. F -, 38. Final.Plumbing • - n t It' : ;, r -gin 39. Water Service:Final. - K I, ' r j -. .: i- 40. Gas Service-Final =. i-i- �; H `r. r*. -. .r Ji tJ Y^ ...t.... - 41. Solar Domestic-Final m r t t -4 4 .r 4 y 42. Backflow Preventer. n; r-.;.i * e In yO * -, 43. Backflow irrigation 1 �'x _ c•• ' ' J 2' _ • '] :i tU i. 'i!7lJ C' .F Ln J J •J.. : y •' 1. _ . 44. Landscape Irrigation System' r;,.- ;r, .* Ky .:•,�: ' £ 0-. r S • 45. Sound Attenuation u in " Y E tP t^ A ' ',...721 r Nr.., * 2 i .. vv .a " 46. Handicap Regulations S ,. x I 1 ,' - n " •47. FINAL STRUCTURE& BUILDING tt^ � ' r • -5 t •r-::1 ,. '- _1 t: - - A 48. ,F,INALPLANNING: I r ` y s x - t 49. Electric Release to Edison ii I ,4. b! ‹ , 50. as Release to Southern Californ a Gas Co 1 '7 tel 51. CERTIFICATE OF OCCUPANCY •" No. Date I\ ADDRESS OFBNLDNO: 242 z. 191'H 5'1 RS NAYEIF Dow HOOFS, PAUL T WIT: � - CITY OF COSTA MESA BUILDING PERMIT JWNEPERM NO: B 083724 X94 P 0 BOX 5038 Z BALBOA,CA 92662 PERMIT NO: B 083724 PLAN CHECK NO: N GOVT: N SUPP : N APPL. Act ADDRESS: CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: OTH ARCHITECT OR ENGINEER: UC.N0. JOB DESCRIPTION : T/OFF RESHAETH & REROOF W/COMP SQ FT: 1 , 000 FNG ARCH.0" BADD"�'` °M` CLAIM VALUE: 2, 000 . 00 CALC—VALUE: 2, 000. 00 GROUP OCC: R-3 / C0N1""CTOP""I� �� COMMENTS: STUCCO 6 INSTALL SIDING ICBG # NER-405 CONTRACTORSMNIaq ******************************************************************************* ADDRESS: 11C N0: DMT: ZONING REQUIREMENTS UCENSED CONTRACTORS DECLARATION:I hereby affirm under penally of perjury thatm licensed I ern underpt oveima s of Chanter 5 E T B A C K 5 (commencing with Section 7000)d Orationa N 3e&sinesand Professions Coda and my&cense is n tpn end affect. MAIN BUILDING ACCESSORY BUILDING CITY UC.No.: UC.CLASS: UC.NO.: h]XS YY FRNT; FT IN REAR: FT IN FRNT: FT IN REAR : FT IN Date: Contractor: LEFT; FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN OWNER BUILDER DECLARATION:I hereby darn under penury of perjuy that I a exempt hon,the Contractors Lkese Law for the lclowip mom(Section 7331.5 Busiest and Professions Cede:Any W or county which requires a permit to caunKt alter.improve, PARKING REQ• PROV: PARCEL: 42627115 ZNE: REF NO: demolish.a reps any structure;prior to b wauance.No requires pp& thearanb s.M such permit a signed manent dathat he or she PLANNING NOTES> licensed pusuva to the provisions of the Contractors License Law[Chanter 9(commencing et Session 7000)a DSerin 3 of the > .5b and PrdarekmCode] rmitathea eeaeexertla Maeefrom yofd oneb Ne ale ed hudre dela, y 5OODatindssctian ******************************************************************************* .1.ebynroferaalaoderos at he o she S to thaw ancon thnorMae lM axehundredptin. [&.5008. [3 I.es owner of the property or rmy rooky'',wkh wages as their sok compensetion•will do the talc end the iMUCIUM it.nce intended DEVELOPMENT SERVICES REQUIREMENTS or offered for sale(Section 7044.Business and Professions Code:The Cones Lkense law does not appy to an owner of property who but,or inpnvs thereon and who does such work lensed or herself or through he or her cm employees.swUed that such imprwa"w are nor welled ordN Blore .&,howr,w.de budding or inprwemert is she within one yeas of completion.the ZONING APPROVED BY DATE: ownerbuiker wN have the beds of prove he sr she sad not but or improve for the aapose of .. ❑ Lesow"er a the eneS*°oamiro tit Ecersedoatsms tocamuct the: •'. (eeaiom 7044,Ds'araInd BUILDING APPROVED BY : DATE: _ IC contracts .The ' sant L contractor(s) Law dos m suers to th ow•- a s ere s s es a tip.wr thereon erhd cerin conuecs fa wthemasaa(U Tcen.sa aysnant to the :!'�Llorse L. APPLICATION ISSUED BY: DATE: m fun few 7 B.&P.C..b sees.. : *********************ib3F************* +' n• **eth********************** i Pt*** I Deis l ( Owner. 1-- ---1 —fill—Al _ LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT :Y doI afety Cade Sections 25505.25533.and .and hatIor futurebwdopoo wuy inderstand�note0t(�&tboneernerts)need"to wCw*wtnlsaid MI6 Cain he OMMOnt5Ia BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING sperms for construct a"cdarlian born its As wary Manses/nem Laatrict.Raddrtel construction app&°niaw we exempt form Nee PERMIT 62 , 25 50 provisions SMIP/NON—RES Date: APptant: PLAN WORKER'S COMPENSATION DECLARATION:I hereby affirm under penally of perjury one of the hosing d dsatirs: ISSUE FEE ❑ I have and MI rainfall acertificate a one for weM1ers'ompenemkn.s provided for by Bodice,3700 of the Labor BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID' DUE coattorlhe pence a amenthe workb ch this ms a whiperSued. TOTALS----> 62 . 75 0 . 00 0 . 00 --y62 . 75 62 . 75 . 00 ❑ I hero end MI maintain*ethane compensation ismer.as required by Semkn 3700 a the Labor Code.b the performance of the work for which Popernneissued.Mywork«rwr n,pratimw insurance carnet collet REVENUE DIVISION TOTALS--> COLLECTED: 62 . 75 OVER/SHORT: , 00 M Ce ` BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT . GRADING PLAN—CHECK Pol62 . 25icy . 50 completed vection need riot becompleted y the pe m&er b one hundred dams 01001 or Ss) . I candy tut NnpMrorca the malhe work the permit is issued. wnot onmss kers m anl oemploy any Person manner ******************************************************************************* ..r become subject to the wornpe"Wio lees of Gallant,and eons that I I shpad become subject to the compensationcompensationna workers' compensation prees Soa lon 3700 the Labor Code.I del fwtwth campy with Noe provisions. INDIVIDUAL F E E BREAKDOWN Date: "p0 "tl` TYPE QTY DESCRIPTION UNIT COST TOTAL COST Warning:Failure to secure workers'compensation coverage Is unlawful,and shell subject an e motayet to Crural penalties and civil lines O6to one hundred thousand dollars onnomA In aolatlen to the past of compemsatiorL donnas as Prodded for in SFR 1000 ALTER BY VALUE RESIDENTIAL NOZONE 1 . 00 1 , 000 . 00 Section 3706 0l the Labor ode,Interest, re and attorney'. s. CONSTRUCTION LENDING AGENCY: !hereby ram under • .� •.MOW ' then e e c°natrmion Wdirp epeney b the SFR 1000 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 1 , 000 , 00 performance a the work for which this Fermi is'slued(Sorin 3057 Cie END OF FEES • LENDER- ADDRESS:THE BACK C4 . 6 STORAGEEXPIRED I candylhm I have sed the.i.. _.'..:AUL 1� a�., in, iscomm.I ... ocompty*eh al sty county ., and state tare raMrg m butdrp.• .r. .•er e} .`. .. coy m mer upon ihe cohere sees 'orispeabn larpoee. PAUL :.JOF ' I vQ .� �/ DATE , ✓ C"1 � C W-14-1997RCPTpe81�0889872 t,�i I \ oats: �/ PERMIT:083724 (5151-46.WP) Whee-8utding&SdaY:Gree -Re:Canary-Appimt:Pink-Rwasro:Odderuod-Assessor if ONSTRUCTION AND PLANNING - POOL " 'A • - 7tPPROVALS Permit Date Inspector - APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe•Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test • 9. Water Pipe•Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 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 Healing & Air Conditioning - - FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts,in Structure 70. Underground Hydro 22. Ducts,Ventilating 71. Product Piping 0 Gas OOil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank OGas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing& Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE KIEV. 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: , j 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backf low Preventer -43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation ' a; 46. Handicap Regulations - g - a 47. FINAL STRUCTURE & BUILDING 48.'F INAL PLANNING .1 49'. Electric Release to Edison • 0 .,r ' 50. Gas:Release to Southern California Gas Co _ 51_. CERTIFICATE OF OCCUPANCY No. Date PROJECT WNE 'S NAME: 242 E 19TH ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 062644 OWNER'S ADDRESS: BRINK FRANK D a00REss: 419 MAIN #213 PERMIT NO: B 062644 PLAN CHECK NO: N GOVT: N SUPP: N HUNTINGTON BEACH,CA 92648 CONSTRUCTION TYPE: 5—N PERMIT TYPE: STR PURPOSE: DEM ARCH/ENGINEER: ( 714 ) S3S-4255 REG.NO.: JOB DESCRIPTION : DEMOLISH NON—PERMITTED STORAGE ADDITION SQ FT: ADDRESS: UNIT: PERMITTEE: CLAIM VALUE: 1 , 000 . 00 CALC—VALUE: 1 , 000. 00 GROUP OCC: M-1 / ADDRESS:FRANK D, BRINK ( 714 ) 535-4255 1205 MORAGA COMMENTS: NOT A CONSTRUCTION PERMIT! DEMO OF APPROX , 400SF STORAGE AREA. �AEy�p{.j 7Aq pp ****************�E�r*****�t**********�r� **********yr�r�r**i**********sE�r+E�t�r�E*******� *** LICENSED CONTRAC111N OECEAgT(i1tl I hereby anion that I am licensed under provisions oo Chapter 9(commencing with Section ZONING REQUIREMENTS 7000)of Division 3 of the Business and Professions Code,and my license is in IUB force and elted. CITY LIC.: STATE LIC.: CLASS: S E T B A C K S Date: Signature: MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a cenificateof consent to self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT; FT IN REAR: FT IN Compensation Insurance.or a certified copy thereof(Section 3800.Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN POLICY NO.: EXP.DATE: COMPANY: PARKING REQ• PROV: PARCEL: 42627115 ZNE: REF NO: r0 Certified copy is hereby furnished. a Certified copy is filed with the city Building Division. PLANNING NOTES> > — . Date: Applicant: **********************************************************************,********* EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is fa one hundred($100)or less). DEVELOPMENT SERVICES REQUIREMEN ,TS I certify That in the performance of the work for which this permit is Ws I sh 01 employ any person in any manner so as to become subject m f Workers m enation Laws of California. ZONING APPROVED BY DATE:mac ...Workers' CVS 1 7• Signature: . NOTICE:II.alter making this declaration,you should me subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : DATE: , Code.you must forthwith comply with such provisions or this permit shall be deemed revoked, //�/ Q CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the pedormance 01 the work for APPLICATION ISSUED B Y: `� / - �, 7 3 wMch this permit is issued(Section 3097. Civ.C). d — DATE: {F ********************** • ************ * * * ** LENDER: ******************************************* **** **************************** ADDRESS: LEGALIZATION:N F E E S U M M A R STRUCTURAL SEGMENT:Y OWNER BUILDER DECLARATION: 1 hereby allirm that I am exempt from the Contractors'Stale License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 2 5• 0 0 - repair any structure.prior to its issuance,also requires the applicant for such permit to tile a signed statement that he/she is licensed / pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 01 the Business " •P SMIP/NON—RES and Prolessions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN - ''( . 50 any applicant for a permit subjects the applicant to a civil penalty 01 not more than five hundred dollars(5500). ISSUE FEE ,' Li' e I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE Cl structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 25 . 50 0 . 00 '• 0 . 00 25 . 50 25 , 50 , 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through his or her own employees,provided that such improvements are not intended or offered for sale. If.however the building or improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED: 2 5 . 5 0 OVER/SHORT• ,00 tor the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 25 . 00 /1 y . 50 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s)license pursuant to the Contractors'Slate License Law).1 am aware ***************,*,*.***,**********,******fit*,*,N,*********,*****,************************** that proof of their Worker's Compensation insurance should be provided to me. I am exempt under Section' B.8 P.C. I N D I V I D U A 'L�" F E E B R E A K D O W N for misreas/m�: ynRT�}.BDEMO 4BY OWNEf /� / TYPE QTY D E S C R I P T I v , ..-' UNIT COST TOTAL COST Date: �v �G /`7�i Owner 1• I do hereby certify that I am awarewaul and understand the requirements o Idornia Health and Safety Code Sections 25505.25533,and NO FEES WERE SELECTED FOR THIS PERMIT 25534 and that 1 or any future building occupant wilVwill not(circle one)need to comply with said state codes and the requirements fpr as permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from e these provisions. G ' Date: Applicant: .- i I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above.mentioned property for inspection purposes. , Date: 6`h. /7f3' Signalusn 01 00141144-00141145 TOT 25.50 Driver's License or Social Security•: DATEt 06/17/93 TIME: 11735 1641.46 while—Building:Green—Code Enforcement;Canary—Applicant;Pink—Revenue:Goldenrod—Assessor • • -I. CONSTRUCTION AND PLANNING POO1 :PA APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector 1, Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd.-• 53. Steel Reinforcement 8. Electrical Conduit Utility-Undrgrnd. 54. Forms 4..Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6.,Electrical OF ER Grnd. 57. APPROVAL TO COVER-GUNITE • 7. Footings 58. Electrical Conduit•Undrgrnd. 8. Foundation ' 59. Gas Pipe, 0 Undrgrnd., Test ' 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line& House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains _ 64. Plumbing System • Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT. 20. Rough Factor Fireplace - APPROVALS" Permit# 21.,Ducts,in-Structure.; , •- - - - - ' ' 70. Underground'Hydro . 22. Ducts, Ventilating - . ,�1. Product-PiP.igg 0Gas ❑Oil 23. Gas Pipe-Rough&-Test - - - - .72. Underground Flush. 24. Roof Framin • - '' 9 _ 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing - 74.-Overhead Hydro - . 26. T•Bar Ceiling (Structural) & Monocoat _ , - 75.;Qry Chemical 27. Frame and Flashing• ' - - ` 76. Dry Standpipe 28. Lathing•& Siding r. I77.:FIXED SYSTEM-FINAL 29. Insulation .f , 78. FIRE PREV. FINAL - - • . 30. Drywall Nailing - 1 I _ HEALTH,bEPT. REQUIREMENT 31. Plaster Brown Coat ' 4 .- . ' .19. FINAL INSPECTION .32. Electrical Power Met r'Final ` 80. FOOD CERTIFICATE ISSUED , 33. Final Electric- rIm. Notes: , fir 84. Final Heating& Air'Conditioning' , I 35. Final Gas Pipe-Test . ; I L. 36. Hood or Canopy . - I - 37.`Final.Factory Fireplace • ' - - 38. Final Plumbing I �- . 39. Water Service-Fina'?_ i 40. Gas Service-Final ' . I - - I '41. Solar Domestic-Final I 1 . 42. Backflow Preventer 43. Backflow Irrigation . - r 44. Landscape Irrigation System . - r - _ - , - 45. Sound Attenuatipb - • - 46. Handicap Regulations - ' _ - - 47. FINAL STRUCTURE & BUILDING JO 21I�I I - - 48. FINAL PLANNING / t i 49. Electric Release to Edison 1 i ,I • . 50. Gas Release to Southern California Gas Co I I I • 51. CERTIFICATE OF OCCUPANCY 't No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CFYleF..COSTA^mEsPs. CONSTNO.UCTI N PERMIT PERMIT NO. TRACT NO. , � LOT NO. UNIT • Project Address .01-10.01-10.t �= " ` - - pwsi-- (332558 Nuipt �}�}/J pOr l73 U REPAIR 6608 3/I I fall ?. 0 TL Applicant's Mailing Address 4/0 /L X 744 . TYPE OF CONSTRUCTION U NEW U ADD ALTERATION5 5 Owners' ame ,q p /C+ICONVERSION DEMOLISH. 0 OTHER A P # ) �l N �' l{ V1Q�/✓'I� Phone/lav�. S ' rd1AJve t fres--7d Z.4c) p- a"-7/ -I s 1 Zone lam-/ I DESCRIPTION OF ORK/USED BLDG. Address L/1/C:' /6 'L.E Sr- /-fifty; /Beg pihc2 i _i.� . . .iii •.J!/.�/ 11 •: ire ; va. • S Main Building: Accessory Building: •Arch/Eng. (-1) License No. TYPE OF PERMIT, IN GRADING N FOUNDATItO—IMI STRUCTURAL T Front• • UAddreSs ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING Q MECHANICALA Rear N Contractor's Name Phone D OTHERPROJECT DESCRIPTION SQ. FT. OCCUPANCYC Right N AddreSs(mailing) CONSTRUCTION TYPE VALUATIONS K Left G City License No. R ZONE GRADING CU.YDS. ACRES Ping. Ref.# Parking Req./Provided E LICENSED CONTRACTOR DECLARATION v� 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: 1�]�l.Asr,l I •1—/ Planning Notes: *) AtG�w( M with section 7000 of Division 3 of the Business and Professions Code, and xAi4,,. l l `f, my license is in full force and effect. Q �QsyQ 7, /9439 baLk- TQ qr.?"'a�/ 'r I�n w., . n- �eti S License Class License No. C^l(/`',` 7Lp�I Vsiv Date Signature - -- - PLUMBING FEES Am..— : onu d ii-A-ne, Q ((`�'l/p�) WORKERS'COMPENSATION DECLARATION Bar Sink Showers ELECTRICAL Cf " FEES hereby affirm that 1 have a certificate of consent to self-Insure or a certificate I Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink - Automatic Washer Transformer ❑ 15-50 KW • 300. Lab. C.) Policy No. Company Backflow Irrigation Sewer Cap Construction Pole Sub. 0 50+ KW A Certified copy is hereby furnished. Certified copy Is filed with the city Building Division. Bathtubs • Sewer Connection Cooking Unit Meter pup to 100 amps Date Applicant EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter (Dover 100 amps (This section need not be completed if the permit Is for one hundred ($100) or - loss). Dishwasher • Solar Piping Dryers ❑Gas ❑Electric Sub Panel I certify that in the performance of the work for which this permit is issvetl I shall not employ any person in any manner so as to become bject tb the Drinking Fountains Solar Tank Fan DOrk0f5' Com t'a Laws of Califoh , /� _� Motors 00-1 HP ❑1X-8 Date nature 7 /NYU Floor Drains Swimming Pool w/Spa F.A.U. NOTIC after making thisdeclaration,the a shout beco a sub)ec to the Inc.Solar 09-15 HP 016-15+ Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures comply with such provisions or this permit shall be deemed revoked. - MiCtOWave CONSTRUCTION..LENDING AGENCY Gas Service Outlets Water Closet Device Boxes I hereby affirm that there is a construction lending agency for the performance Pole Light of the work for -which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets • • Lender's Name Range Lender's Address Kitchen Sink Water Service Switches Sign OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories , Auto-Wash GarbageDisposal following reason (Section 7031.5 Business and Professional Code: Any city or P Standing Sections county which requires a permit to construct,alter,improve,demolish or repair P—Trap Laundry Trays Generator ❑0.5 KW ❑5.15 KW any structure,-prior to Its issuance, also requires the applicant for such permit - - Trash Compactor to file a signed statement that he/she Is licensed pursuant to the provisions of Roof Drains the Contractor's License Law(Chapter 9 (commencing with Section 7000)of Division 3 of the Business and Professions Code) or that he/she Is exempt T erefrom and the basis for the alleged exemption. Any violation of Section ' RI31,5 by any applicant for a permit subjects the applicant to a civil $ Oalty of not more than five hundred dollars($500). I. as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 - co pensation, will do the work,and the structure Is not Intended or offered - Reinspection Fee I $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREMENTS: /N ,s, O� employees, provided that such improvements are not intended or offered for Boiler Hood or Type I 0 (1(f6C' O sale. If, however, the building or improvement is sold within ono year of com- Canopy Type II ❑ Zoning Approved By Dat �/ prove , the owner will have the burden of proving he/she did not build or Im- Duct- Under Ground -f ' rove for the purpose of sale). Building Approved By Date y I,as owner of the property, am exclusively contracting with licensed con- Duct-Structurel Refrigeration System Application Issued By �s Date 1"''I V" ' tractors t0 construct the project (Section 7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑0-100,000 BTU Dioo,000 BTU SUMMARY OF FEES • builds or improves thereon,and who contracts for such projects with a con- tractos license pursuant to the Contractor's License Law). I am aware that Exhaust System D Multiple 0 System Repair/Alteration BUILDING PERMIT $ 2SV SMIP $ D� tractor (s) oft their Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT saki am exempt under Section 8.& P.C.for this reason Firepl/Fact.Bit. ICBG# Fire Dampers PLUMBING $ PERMIT ISSUANCE $ Date __-•/�� T Owner _- -i _ Heating System& Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $ I hereby certify that I have read I application . ' . e t a e above ❑0.100,000 BTU 0100,000 BT ELECTRICAL GRADING $ Information is correct. I agree to comply with all city and county ordinances $ and state laws relating to building construction, and hereby authorize repre- sentatives of this city to enter µdo n the above-mentioned property for Inspection purygses. ��y, n MECHANICAL $ TOTAL FEE S ZcS�� Signature r ses.. dOA� .� Dat ( OQ Drivers' Lice or SS# //" Pink - Accounting; Goldenrod - Assessor l (CONSTRUCTION AND PLANNING POOL& SPA v Date Inspector Date Inspector APPROVALS Permit# APPROVALS Permit# L 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location i 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit•Undrgrnd. - 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVE R-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. • - 60. Backwash Lines,P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater& Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT • 20. Rough Factory Fireplace APPROVALS Permit# - - - 21. Ducts, in Structure 70. Underground Hydro • 22. Ducts, Ventilating 71. Product Piping 0 Gas q Oil 23. Gas Pipe-Rough& Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank.0 Gas ❑Oil 25. Roof Sheathing 74. Overhead Hydro • • 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe ' 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL t` 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 'l• - • 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED .. 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy • 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final /40. Gas Service-Final • 41. Solar Domestic-Final - ��• 42. Backflow Preventer / ' 43. Backflow Irrigation •-� ' ,• 44. Landscape Irrigation System - 45. Sound Attenuation , 46. Handicap Regulations -" .• 47. FINAL STRUCTURE & BUILDING `O //y�/,0 .fJ e �yit- 48. Special Requirements Completed / /o • 49. Electric Release to Edison !` 50. Gas Release to Southern California Gas Co • 14, 51. CERTIFICATE OF OCCUPANCY. 4; No. r^ - -- r Date _ Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. PERMIT NO. TRACT NO: LOT NO. UNIT NO. CITY OF COSTA MES}A��JCONSTR)U NP RMIT -� • A.P.# - Zone Project Address .) / /� /9 / rr II S Main Building: Accessory Building: Applicant's Maili i Address 0 - ` . i — or TYPE OF CONSTRUCTION u NEW Li ADD Li ALTERATION U REPAIR E Z �/ // ❑ CONVERSION ❑ DEMOLISH ❑ OTHER T Front O Owner's Naar�r�e� Phone 76f. $ 7f DESCRIPTION OF WORK/USE OF BLDG. ' B Rear N Address T/O /' ' - w - ,� i•Cf 9p20Se .. A - I Arch/Eng, License No. TYPE OF PERMIT 111���yyy---❑ GRADING ❑ FOUNDATION ❑ STRUCTURAL C _ Right N Address ,y7� _ • ❑ TENANT yQ ELECTRICAL ❑'PLUMBING ❑ MECHANICAL $ • Left - _ R Contractor's Name G�,K(a Phone CI OTHER '\. - Ping..Ref.# Parking Req./Provided E PROJECT DESCRIPTION SQ. FT. - OCCUPANCY PlanningNotes: Q Address(mailing) - - CONSTRUCTION TYPE . VALUATION$ M T City License No. - ZONE GRADING CU.YDS. ACRES $ LICENSED CONTRACTOR DECLARATION - - I hereby affirm that I am.licensetl under provisions of charter 9 (commencing Remarks: �) �s� - with section 7000) of Division 3 of the Business and Professions Code, and a'-� my license is in full force and effect. ELECTRICAL FEES License Class License No- • Date Signature PLUMBING I FEES Automatic Washer Transformer '❑ 15-50 KW WORKERS'COMPENSATION DECLARATION Bar Sink Showers Construction Pole Sub. ❑ 50+KW I hereby affirm that I have a certificate of consent to self-insure or a certificate • of Workers' Compensation Insurance, or a certified copy thereof (SectionBackflow Preventer .Service Sink Cooking'Unit Meter Duo to 100 amps 800, Lab. C.) olicy No. Company Backflow Irrigation Sewer Cap • _ Dishwasher Meter Dover 100 amps Bcertifietl copy Is hereby furnished. - Dryers ❑Gas DElectric Sub Panel Certified copy is filed with the city Building Division. Bathtubs Sewer Connection + Date Applicant Fan Motors 00-1 HP 01%-8 ! EXEMPTION FROM WORKERS'COMPENSATION DECLARATION • Clarifiers Solar Collectors - I ssis section need not be completed if the permit is for one hundred ($100)or Dishwasher Solar Piping F.A.U. _ Inc.Solar 09-15 HP ❑16-15+ - • I certify-that in the performance of the work for which this permit Is issued, I �• FlXtufes shall not employ any person in any manner s as to become subject to the Drinking Fountains Solar Tank � Microwave Workers' ompe sati Laws of Califossrye d{�� r Date' c Signature •+tf �'S//moi Floor Drains Swimming Pool w/Spa - t, Device Boxes Pole Light ' NOTIC :If,after making this declarat n, y u ultl become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith - Floor Sinks Urinal - _ ! Outlets : Range - - - - - comply -with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY - - - Switches Sign - Gas Service Outlets Water Closet g I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C-) _ - Garbage Disposal Standing Sections Interceptors Water Heater, • Lender's, Name Generator 00-5 KW❑5-15 KW Trash Com actor Lender's Address - Kitchen Sink Water Service - P OWNER BUILDER DECLARATION' - _ • I hereby affirm.that I am exempt from the Contractor's License Law for the Lavatories , ' ' Auto-Wash• - , • -- " following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct,alter,improve,demolish or repair P—Trap Laundry Trays • any structure, prior to its issuance, also requires the applicant for such permit - . -to file a-signed statement that he/she is licensed pursuant to the provisions of • • Roof Drains • • 'the Contractor's License Law (Chapter 9(commencing with Section 7000) of • Division 3 of the Business and Professions Code) or that he/she is exempt Reinspection Fee . $15 Issue Fee .•%l< • $fr jherefrom and the basis for the alleged exemption. Any violation of Section • _ - 131.5 by any applicant for a permit subjects the applicant to a civil - - '`.,. . ' _ DEVELOPMENT SERVICES REQUIREMENTS: I -natty of not more than five hundred tlollars($500). yryi, I, as owner of the property, o Reinspection Fee $15 1 Issue Fee $ 3' Zoning Approved By Date ' 'iBlrrrpprnav,m', will do the work, and the structure is not intended or offered - -/ for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES Building Approved By. Date License Law does not apply to an owner of a property who builds or Improves / thereon, and who does such work himself/herself-or through his or her own - • Application Issued By • Dat employees, provided that such Improvements are not intended or offered for Boiler - - Hood or Type I ❑. sale, If, however,the building or improvement is sold within one year of com- Canopy, Type II 0 SUMMARY OF FEES 4pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground • larove for the purpose of sale). BUILDING PERMIT $ • SMIP $ �1 I, as towner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System PLAN CHECK r tors to construct the project (Section 7044,Business and Professions Code: ' - • - $ PERMIT The Contractor's License Law does not apply to an owner of-property who Duct-Ventilating 00-100,000 BTU_❑1.00,000 BTU PLUMBING $ ISSUANCE $ 'builds or improves thereon, and who contracts for such•oroiects with a con- - - ENERGY P.C. $ tractor(s) license pursuant to me Contractor's License Law). I am aware that Exhaust System 0 Multiple❑ . System Repair/Alteration PLAN CHECK 25% $ proof of their Worker's Compensation insurance should.& P.C.provided to me. ELECTRICAL . $ GRADING $ ' 0 I am exempt u der Section B.& . .for this reason i Firepl/Fact.Blt. ICBO# Fire Dampers MICROFILM . $ Date owner Heating System&Ducting - Registers PLAN CHECK 50% $ - ❑0.100,000BTU ❑100,000 BTL.-.- MECHANICAL $ TOTAL FEE $ ' /(8• 13 I hereby erti y that 1-have read t Is application and state that the above - - - -- Information is correct. I agree to comply with all city and county ordinances PLAN CHECK 25% $ • and state laws relating,to buildinge -r construction, and hereby authorize repre- - inspe sentatives of this y to en u•• the ab•ve-mentioned ,property for , • Inspection purpos-I� ' I Signature �7(I/ / , _/,/ Date/9-'14 - Drivers' License or SS# ��� Reinspection Fee �$15• Issue Fee $ 3 0100016047-0001604E TOT 16,13 0865-46,rev. 5/88 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod -Assessor - - DATE: 10/04/88 -TIME: 08:40 - - a .'CONSTRUCTION AND PLANNING POOL 'A _ ., APPROVALS Permit# Date Inspector APPROVALS Permit 46 Date Inspector 1. Temporary Electrical Service or Pole "I 52. Pool & Equipment Loc4tion r 2. Soil.Pipe-Undrgrnd. .. • 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms (.• 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding .r i '5..SteehReinforcernent 56. Rough Plumbing & Pressure Test ..✓' 6:(Elecrt cal UFER Grnd. 57. APPROVAL TO COVER-GUNITE .a. 'I t . 7. Footings . , 58. Electrical Conduit-UnOrgrnd. -/I •' ,8. Foundation ,t 59. Gas Pipe, O Undrgrndd€,Test r r I •5 :9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Tra%t,.0 Undrgrnd. ' it 1,0. Structural Floor System �� 61. APPROVAL TO DECK - fl 11. PAapertyl Sewer Line & House Connection /; 62. Backwash & ReceptorfFinal '- 12. Sewers Cap 63. Heater & Vent-Final L 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 117,. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18; Rough Electrical-T Bar Ceiling, 69. POOL/SPA SYSTEMS FINAL ;19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT '20. Rough Factory Fireplace II APPROVALS Permit# „Jo21. Ducts, in Structure. .I 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil • 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing. 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT , 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric JO-204 RC“ Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace ' 38. Final Plumbing 39. Water Service-Final - - . . 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation • ) ' 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations • , 47. FINAL STRUCTURE & BUILDING �` 48. Special Requirements Completed • 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co ' 51. CERTIFICATE OF OCCUPANCY `' .6.2.-- _..,..2 No. Date "-; Costa Mesa Building Department APPLICATION FOR PERMIT Air. 9 111 EAST 20th STREET 2215 BUILDING 1 ' COSTA MESA, CALIFORNIA FOR OFFICE USE ONLY FOR APPLICANT TO FILI.IN Receipt No. Permit No. Address �� z l_= /9 Ca f G� II ca-/ 9C- Costa C- Costa Mesa, California / ' Received by Daatty�3ec'd. Date Issued Nearest /,? a_?-S (/i''�' HOZoZ 2—' � J-3 Cross St. Building v `7/� P. `� Address Owner �, Costa Mesa, California Mail /� ..,�zt //// ///''' Address/.[/3l �+..p! /If/ :9,:a(.Lz1=(C (' / Nearest Tel. /' Cross St. Cit No. Zone/71./' No.of peGroup .! T Architect or Lic. I Plans I Ty Engineer No. Approved by Date Address 01u„_24 CORRECTIONS City Lic. Contractor No. Address \,..,..___ Legal I Lot I I _ Description No. Block fib I Tract r ii," 11 111 1 .-_ 1!r' (Attach Metes and Bounds)//; — d 9/— AO I�.,�Z� ,! !� : ,i1v, Ng \ Size of Lot 7/ ,/'/3 I Now o.of onBldLots. . 1 O Use of I No.of I No.of Vt(, . 9 Existing Bldg. 5Z-raga, Families Rooms iU=� • Setback Line from t g Rear Yard -3 I Center of Street �O Side Yard ➢>,:1_ DESCRIPTION OF WORK �f �O,j iH illi e n r -V,I New I Alteration I I Addition .I Repair I I Moving I I Demolish I� Building No.of Size !o X a b Rooms ) Stories / Exterior Wall I Roof Covering I Covering Co„�,,.acf'�:,i APPROVALS Use of New Q ,, Building _ST CA'.',^C" Foundation Location Inspector Date ` Forms,Materials, Fj4..X0-41,-0 , Under-Pinning Frame: FirStops, Bracing,Bolts I hereby acknowledge that I have read this Application and state that the above is correct and agree to comply Lath. Int. with all City Ordinances and State Laws regulating building construction. Lath.Ext. Signature of 1/ �Q A , _L� Permittee �QrC-LGZ+G !!cj .rr�A�{v Plaster, Int. Authorized Agt. Plaster,Ext. 11 - Valuation .J �0` D Permit Fee $ + n O Masonry Reinforced Plan Check$ on Bea $ Total /f 0 9 / 6o /—I/--$6 Fee $ $, 1 L ening ,ns c_AP 2M 6-55 0 c o 0 o o a a` DEC 2?-55PDXESAcosrn3G3a *,y*t„II.(10 Street • PLOT PLAN Show location and distances from property line and between buildings. 1 ' O 3518( PAID 30.14 j UAUG 14-72cM;AOO 881* **** COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR BUILDING PERMIT For Applicant to Fill in Completely �f �wy�f RECE ED Dt�iE/WEIV��� ISSUED BUILDING OWNER \ �0r^1N5 v. VTAN.T /VL A.P.NO. /f) _ 0/1 r IO /196 MAIL T�'J�� f. 1 BUILDING ��1f iF-�' I (- ADDRESS 5S VO S\ . tRMQ (/JALI . ADDR SS d• Y /-- • ' ^ s ( c d U CITY LotxjC,l BIEA�.4 NO.ui 43 3(o11 RAC r LOT//', BLOCK zQ CONSTRUCTION NEW I ADO ALTER J REPAIR MOVING VING DFMOLISH I- - LENDER / a m J c BRANCH VI . OWNER I 0 YN,+'f��lQl szt(If m J ADDRESS VALUE -CO ARCHITECT TEL. USEary tef2 $ Q OR ENGINEER NO. - ' U Q FIRE /��/JJ�/` z ZONE ' T P k GROUP ofo' W < ADDRESS F-,47 a w it:I // yyyy J O CONTRACTOR vLVNr 1Z.[ U�L.D�) APPROVED i2 DATE c0 Z in/ J cr ADDRESS W lL -TEL. ZON NO.OF USE OF NEW 0= CITY NO. f ' PLANS '. BUILD G Z ° -S AP IIIC�_ W- O STATE _ l CITY YARDS APPROVED YARDS APPR N LIC. NO. l3. r/� LIC.NO. • MAIN BUILDING ACCESSORY BUILDING'O �— (FROM C///L��STREET) jj r/ 7t.-K.2_/•Eq SIZE yy,� INOW ON LOQ FRONT C�'�?FT. tG (/-/L •4 r YY OF LOT 1\ .1t �+4'i� V USE OF . F�Vr�Di� EXISTING BLDG. F 'E I)ry Srpre-ANCLCH.SIDE CI FT. FT, I— SIZE OF NO.OF Z NEW BLDG. ROOMS STORIES L.SIDE -,"-f T. FT. EXTERIOR WALL ROOF 1 �M1c •IAI (p/ V_ COVERING �N�I �• COVERING Q 4 tTtREAR j FT. T.STATE J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN 0. 0- MAIN BLDGS. ACCESS. BL . /ci CIE //�J y r / Q - /26A-/O//EG �C..ri J rit1 G C U.P y#,E�/ (,//1 �[� APPROVED O/ T'Yg�7 co �GJ �A���` • RY 4. V-r a t� /'[ DATF AJ — / -7a. Z O .ar ifN.O FAR SPFCJAI, RnFOU'rir7 to VI hereby acknowledge foon I have read this application any state ,}}' /V '' that the above information is correct and agree to comply with '1 612.XL ,P� CC all laws regulating building construction, and shall not employ O (.0 any person in violation of the workman's compensation laws of -�'L', J/ Nthe State of California. C.p / a -V-.L>d^•'� ., _.6-✓`440 Z I hereby certify that I am properly licensed as a contractor under SO. FT. / o • the State of California Business and Professions Code, Divisicn 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: 0 fc am exempt from the p visions of the ate • California Business y v VALUATION �t'f ro and Professions C ivision 3,C 9 dr / PERMIT FEE $ . cc ^ w Signature o1 / !` /C ® v m Permittee .II�C[� /�" $ €6200 PLAN CHECK $ E sem(/ .3.0 a t9 LL Authoriz Agent TOTAL FEE $