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271 19TH ST - Building Permits
.1 4/0—(111.Zt.,,, CITY OF COSTA MESA • BUILDING DIVISION F 1 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER s• irita PERMIT l rsodP B04-01131 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 271 E 19TH ST Status: ISSUED Suite: Applied: 06/22/2004 Vicinity: Issued: 10/18/2004 Parcel Number: 89490156 Zoning: Applicant: MACBETH, CHRISTOPHER ISSUED BY: Address: 271E 19TH ST - .- Phone: 949-307-8255 - COSTA MESA,CA" / Zip: 92627 Owner: MACBETH, CHRISTOPHER Address 271 E 19TH ST v _ - , / - / - Phone: 949-307-8255- - ` i i ii , , COSTA MESA,CA - Zip: 92627 .i Contractor: ,. Address: i ` ` / • Phone: Zip: . " License: Arch : _ Eng: GOUVIS ENGINEERING Address: _ ._ — Address: 4400 CAMPUS DR . Phone: SUITE A Phone: ,949-752-1612 . NEWPORT BEACH,CA Zip: License: 92660 ` License: C38276 SCOPE OF PERMIT . CONSTRUCT A NEW 1693 SF SINGLE STORY RESIDENCE-WITH.A 698 SF ATTACHED GARAGE.ALSO INCLUDES 123 SF FRONT PORCH AND 150 SF PORTE COCHERE.3 BEDROOM,2 BATH RESIDENCE. REF:G04-00016 SCHOOL FEE PD ON CITY RECIEPT#127884-SCHO&DIST.RECIEPT NO.5156" - / . FEESUMMARY Plan Check: $929.86 Calc Valuation: $177,795.36 Permit: $1,430.55 -. _ _'' _ Claim Valuation:', - $0.00 SMIP Res: `. 'v$17.78 SMIP Com:_/ "$0:00 ..v."� Other: $0 00 : Inspection: ' ' $0.00;, // Total: $2,378.19 - - V ,, " „ -� '"PLANNING &ZONING-" <',/ \''':// , ',,-/ SETBACKS — MAIN STRUCTURE Front-.20-0- .Rear 10-'0 , `Left 5-0 i , , Right ,- 5-0 ACCESSORY Front 0-0 — - Rear 0-0 — , AA Left- , '0-0- _- "Right. V0-0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92.28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work Is not commenced within 180 days,or If work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 • 2446.46(sros) . DECLARATIONS WORKF,, S'COMPENSATION DECLARATION: - • - - I hereby affirmrinear penalty of perjury one of the following declarations: O I have and will maintain a certificate of consent to sell-Insure for workers'compensation,as provided far by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. O I have and wit 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 et 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 DOLLARS($100,000),IN ADDmON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is In full force and effect.L1c.I Class I 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 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 for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500).): 1�f I,as owner of the property,p or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of properly who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or Improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exery�tynde�rrs Business and Professions Code for this reason: Signature: Cid. ...4 ''f Date: /o//£( o7 Owner ID verified by driver's license. Yes 0 No Driver's License No. ( res: ///v.J 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,wit 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 end Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,ore volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ntuoccupnto. __..._....___... 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 Safely Code been fully complied with? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 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 CO UANCE AND AUTH RIATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the Information given Ls correct. I agree to ply w h all st and city ordinances relating to building construction,and authorize representatives of the City of osta Mesa to enter upon the above-desc' e erty •/,'��r to es.I agree not to occupy or allow occupancy of any building authorized by this permit un'I final i pection. /O ignature Of Legal Owner(s) / ate �/ And/Or Authorized Applicant Date CODE a INSPECTION TYPE PAIL INIITIAL,S COOS( INSPECTION TYPE PAIS INS 1816 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 `1 �i )�"Sty 204 Final Demolition • - 250 Final Building/Occupancy 7 ?.^ Ch f i ,401 I. �^`, CITY OF COSTA MESA o • llrUILDING DIVISION -• > >r,,,,, •r!- DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER f1 w.•...d , e PERMIT 4. OPPECII 44at• ,st B04-00664 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 271 E 19TH ST Status: ISSUED Suite: Applied: 04/05/2004 Vicinity: Issued: 04/05/2004 Parcel Number: 89490156 Zoning: Applicant: MACBETH, CHRIS ISSUED BY: Address: 271 E 19TH ST - Phone: 949-307-8255 ' COSTA MESA;CA - Zip: 92627 ' Owner: MACBETH, CHRIS . Address 271,E 19TH ST - - Phone: 949-307-8255 /�� D COSTA MESA,CA _ Zip: 92627 K/ Contractor '',OWNER-BUILDER Address: -/, Phone: Zip: License: 000000 Arch :.. k Eng: Address: - _ Address: _ Phone: - Phone: •Zip: License: License: SCOPE OF PERMIT TEAR OFF EXIST.COMP. SHINGLES REPLACE WITH 1/2'OSB WERE-NEEDED,2-15 LB FELT AND 50 YR COMP.SHINGLES.REMOVE EXIST. SIDING AND INSTALL NEW WOOD SIDING,REMOVE TERMITE DAMAGED EXTETRIOR WALL STUDS, INTERIOR NON BEARING WALLS AND FACIA AND REPLACE AS • NEEDED WITH SAME,REMOVE WINDOWS IN THE KITCHEN,LIVING AND BEDROOMS AND REPLACE WITH SAME SIZE AND LOCATION. ,REPALCED WINDOWS IN THE BEDROOM SHALL COMPLY WITH.SECTION 310.4 OF THE UBC.. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $5,000.00 Permit: $111.25 Claim Valuation: $5,000.00 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 r Inspection: $0.00 . Total - $111.75 . . , , . PLANNING &ZONING " , : SETBACKS ,, MAIN STRUCTURE Front ..,p-0- • ,Rear, 0-0, ` -.' - Left ,0-0 Right - 0.0 ACCESSORY Front 0-0 ' Rear 0-0 . \Left 0'0 ;Right - 0-0 r NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work Is suspended or abandoned for a period of 180 days, INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS • • WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: O I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,UL-the pe r;mance of the wprk for which this permit Is Issued. - • ha :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 Isaled. A My •rkcompensation Insurance carrier and poll n ••• . Carrier Policy Number: se•son n=-• ate. .•..• . .• epem,lt is valued et one hundred dollars($100)or less.) A 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 Is in full force and effect.Lic.# Class* Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: O I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature:. Date: I r OWNER-BUIL9EF DECLARATIONS: ',I.hereby affirm that wader penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions ,,Cide:Any city Or county which regbirris a permit to'construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file's signed statement'1hatthe or she is Ildensed 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 oh/Oen-ally 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,Btsiness 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 withimone year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business end Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursue to the Contractors License Laws.). • - = p •nder sec / Business and Professions Code for this reason: U� Inas • % „// !re—, Ex ices: 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 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 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). _......p nt need topr.ep__ _ —.�--_.Progr__ ......_....- 3 Does or will the applicant or present or future building occupant neetl to prepare en 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 tiling 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 agermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes 8 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 Safely Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct, I agree mply with all state laws a • city ordin: :s relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above- cri properly for in ycti u I air: t to occupy or allow occupancy of any building authorized b this perm) until fin Inspection. Signatu :OI Legal Owners Date And/Or Authorized Applicant Date SORE L INSPECTION TYPE gdIE JIMA& CODES INSPECTION TYPE DATE KOALA • 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 t alight c CITY OF COSTA MESA 4` 9 • - BUILDING DIVISION - Y:J•,,,,.' ,r DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER „r a PERMIT B04-01108 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 271 E 19TH ST Status: APPLIED Suite: Applied: 06/16/2004 Vicinity: •- Issued: Parcel Number: 89490156 Zoning: J Applicant: MACBETH, JOHN ISSUED BY: .I Address: 8 ARBORGLEN / Phone: 949-307-8255 CELL CHRIS IRVINE,CA Zip: 92604 Owner: CHRISTOPHER MACBETH EXTENSION NSION Address ,271 E 19TH ST Phone: 949-307-8255 A IL O �•A O COSTA MESA,CA Zip: 92627 e , S Contractor: OWNER-BUILDER PER • • r Address: EXPIRES Phone: Zip: License: 000000 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT DEMOLITION OF A SFD AND DETACHED GARAGE, BECAUSE PROP OWNER DISCOVERED THAT THE STRUCTURE HAS NO FOUNDATION AND THE TERMITE DAMAGE WAS EXCESSIVE. " - PLANS WILL BE SUBMITTED FOR A NEW STRUCTURE ASAP. AQMD HAS BEEN NOTIFIED PER PROPERTY OWNER. REF:B04-00664 FEE SUMMARY Plan Check: $0.00 Calc Valuation: So.00 Permit: $0.00 Claim Valuation: $0.00 SMIP Res: $0.00 SMIP Com: $0.00 Other: $0.00 • Inspection: $0.00 • Total: . $0.00 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 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 it work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS 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 Ls Issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed it the permit is valued et one hundred dollars($100)or less.) r'� B' I certify that in the performance of the work for which this permit is Issued,I shall not employ any person in any manner so as to become subject to the workers' 'compensation laws of :lifomia, :••agree that if uld beco ubject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with thlon Applicant Signature: Date: cc:/g• O WARNING:FAIL -'JP:SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND r•_i.RE(5100,000),IN ADDmON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.tic.# Class# Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: In 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 tile 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).): '-Se 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 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 t0 the Contractors License Laws.). ❑ I am. •111 ••/s' . _ Business and Professions Code for this reason: Signatur:r As _ . ` Date: S-/b-Oy O 'r ID verified by driver's license. ❑Yes 0 No Driver's License No. Expires: /0"ZS- cc Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet In depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the 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 end 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 apermit 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 Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree'to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. `-,.roc• Owner(s) S.-- Mc() c AndlOr Authorized Applicant Date CODE I INSPECTION TYPE OdIE INTmALS COOP II INSPECTION TYPE RATE alTRIALS 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 n�f 222 Final Site 204 Final Demolition 2 T�'�jb\ . 250 Final Building/Occupancy ' CITY OF COSTA MESA • BUILDING DIVISION Y:i ,fls DEVELOPMENT SERVICES DEPARTMENT PER T NUMBER � 1 7s PERMIT !�``�e° 04-00703 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 271 E 19TH ST Status: ISSUED Suite No Applied: 06/22/2004 Vicinity: Issued: 10/18/2004 Parcel Nunmber: 89490156 ISSUED BY: l Applicant MACBETH, CHRISTOPHER - Address: 271 E 19TH ST - Phone: 949-307-8255 - COSTA MESA,CA" : - Zip: 92627 , ,. - _ _ Owner: , MACBETH;CHRISTOPHER Address 271 E"19TH ST _ , Phone: 949-307-8255 �, COSTA MESA,CA'- ' Zip: 92627 , ' • Contractor: OWNER BUILDER Address: - 1 Phone: •• ' ip: . - license: 000000 - SCOPE OF PERMIT ,/ CONSTRUCT A NEW 1,693_SQ. FT.SINGLE STORY RESIDENCE WITH,A 698 SO. FT.ATTACHED GARAGE.REF:B04-01131.: i ' r , f' . ' . FEE SUMMARY- _ /, ,� Quantity. c _ - _ ' , Quantity - "' ISSUE FEE S23.50 - - - ' 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). $94.81 1693 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 _ , \ 'c -$8.80 8 ,,7,7-2" _ - -up to 50 kva/kw $0.00 . 0 Recept Outlets 46.60 6 '`.'' up to•100 kva/kw $0.00 ,/0 Switches - ' ',$6.60 6 - over 100 kva/kw -_ $0.00 0 Non Res Appl_• , $0.00 . ' 0 Low Voltage Equipment ' . $18.20 1 Res Appl -$0.00 0 - Low Volt Wiring System/Ckt $0.00 - '0 ' Service to 200a /�/ $0.00" N0 -Misc.Conduit $0.00, ' 0- ' Service to 1000a $0,00- ' 0.,--->._ - Misc.Conductor $0.00 % 0 / / Service over 1000a - $0.00" -/ - 6--„_. -, , Circus(gen or ride) 7 $0.00;- , 0, Motors to 1 hp N $9.50 , ' ' 2_ Circus(meth ride or"lights) -, , , $0.00 0. . Motors to l0hp .- ' $0.00 . 0 Christmas Tree Stand $0.00 -0- Motors to 50hp Fireworks Stand- $0.00 -� ' 0 Motors to 100hp ' $0.00 0, - ' Other Electrical Fee . -$0.00 Motors over 100hp Communication drops $0.00 0 - ' ' Investigation Fee 10.00 Sub panel to 200a $0.00 0_- ' - Plan Check Fee, $0.00 Pole Light Pkg $0.00 0 -- . - - ' --Reinspection Fee' ' $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become.void if work Is not commenced within 180 days,or if work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result In the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 ' 2446-46(else) 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. 0 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/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 DOUARE(5100,000),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 full force end effect.LIc.q Class d 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: 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(5500).): LT I,es 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 exemmpi�jpdeer s . Business and Professions Code for this reason: Signature: �G!%t� Date: /// `/ Owner ID verified by drivers license. ®-Yes ❑No Driver's License No. / Expires: //M`/ Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the 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 ono 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)? 13 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. __ ._......�a-.- t ..._ .._ _ —._..._. 4 if en RMPP is presently required,has Section 25534 of the California Heelih 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 Cr from any other air pollution control district or agency? IJ Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Cade). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above Is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city.ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the y above-described property finspectio pu gree not to occupy or allow occupancy of any building authorized by this permit un I fin inspection. Signature Of Legal Owner(s) Date And/Or Authorized Applicant Date per I, INSPECTION TYPE DEE BMW BODE(. yISPECTION TYPE • PAIL INITIALS 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 ,4ji CITY OF COSTA MESA 44 BUILDING DIVISION rr","%. DEVELOPMENT SERVICES DEPARTMENT PERMI UMBER t j j PERMIT v.. I'1 se MOA 0033A (714)754-5273 • Fax(714)754-4858 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 • MECHANICAL PERMIT Job Address: 271 E 19TH ST Status: ISSUED Suite No Applied: 06/22/2004 Issued: 10/18/2004 Vicinity: • Parcel Number: 89490156 ISSUED BY• t Applicant: MACBETH, CHRISTOPHER - . Address: 271 E 19TH ST . - Phone: 949-307-8255 - , COSTA MESA,CA Zip: 92627 - „ . Owner' MACBETH, CHRISTOPHER Address: , ,271 E 19TH ST . Phone: 949-307-8255 - • COSTA MESA,CA Zip: 92627 , Contractor: OWNER BUILDER • Address: ' , , Phone: . -,Zip: ' License:000000 SCOPE OF PERMIT ' CONSTRUCT A NEW-1,693 SQ. FT.SINGLE STORY RESIDENCE WITH A 698 SQ. FT. , ATTACHED GARAGE.REF:604-01131. , A MECH.PERMIT INCLUDED: 1 FAU,_1,FACTORY FIREPLACE;2 VENT FANS(SINGLE DUCT),2 APPLIANCES, 1 KITCHEN HOOD W/EXHAUSE 8 1 SUSPENDED FLOOR HEATER,. , . '- ' FEE SUMMARY ." Quantity-- - - -.� _ b - - 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 Ventilation 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 y' $0.00 0 ,.y.,; .1t:- • ')Domestic Incinerator ' V '�$0.00 ,01 Rettig Sys>100 k'BTU •` $0.00 0Compressors/Absorption Systems 1, - ' Gas Piping - ` $0.00 0 _ Up to 3 hp/100 k BTU , $0.00'' 0' Factory Fireplace $10.65 • 1 / 3 To 15 hp/500 k BTU - • / 7 $0.00' 0 Hood w/Mech Exhaust / '.. $10.65 1 - 15.To 30 hp/1,000 k BTU -1 -' 50.00, 0 ' VAV Box `� / •. ' . $0.00 - 0 30 To 50 hp/1,750 k BTU _ 50.00 0 Vent Fan/Single Duct - " $14.50--,2 - Over 50 hp/Over 1,750 BTU- = - $0.00 0 Appliance \,,--'N. -. $21,30 --2) ., ,• -Boilers - � `' / Fire Dampers `\• , ' ' $0.00 0 --_ N-- _ -Up to 3 h _,i. r :- ` -,'> / / 50.00 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, - •i 30to50 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 $14.80 -21 2„,- Investigation Fee $0.00 - „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 g work is not commenced within 180 days,or if work Is suspended or abandoned for a period of 160 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 Inspeetlons 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 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: 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.LJc.q Class e Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: o I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is Issued.(Sec.3097,CMI 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 submits the applicant to a civil penalty of not more than five hundred dollars($500).): 0- I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or Improve for purpose of sale.). o I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exem r!as., Business and Professions Code for this reason: Signature: C /"/a-5. Date: /7/A/0 Owner ID verified by driver's license. I$-Yes 0 No Drivers License No. Expires: //09 Verification of Ownership by(type of document,Le.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: o I hereby certify that no excavation five(5)or more feet in depth Into which a person is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 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,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 farm 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 ❑N0 (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 ❑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? IYes 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 pert of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the Information given is correct. I agree to comply with all state laws a city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-describe for i p ti p es.I agree not to occupy or allow occupancy of any building authorized by thisrmd u til final inspection. Signature Of Legal Owner(s) Date And/Or Authorized Applicant Date CODE f INsPEcnoNTYPE DAM INIIALS CODE( INSPECTION TYPE 1 DAM /7tl�Tl L5 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1 -,;75- 0‘)1` Lm NJ 1266 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 ,4$ L' CITY OF COSTA MESA t BUILDING DIVISION j 4( ,,,,,• ..4 DEVELOPMENT SERVICES DEPARTMENT PERMI NUMBER 4A el IT IA I t1a PERMIT I ' tit PO4-00439 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 271 E 19TH ST Status: ISSUED Suite No Applied: 06/22/2004 Issued: 10/18/2004 Vicinity: ISSUED BY Parcel Nunmber: 89490156 Applicant: MACBETH, CHRISTOPHER • Address: 271 E 19TH ST . , - - , Phone: 949-307-8255 , . COSTA MESA,CA . , Zip: 92627 , , /. - Owner „MACBETH, CHRISTOPHER . Address 271 E 19TH ST, ' . - Phone: 949-307-8255 - , - ' , COSTA MESA,CA Zip: 92627 , Contractor: OWNER BUILDER , Address: - Phone: Zip: License: 000000 Arch/ Eng': Address: �: ._ _- �i . . .. .� - . - ; . Phone: ' . Zip: /- i. •, - - SCOPE OF PERMIT !' CONSTRUCT A NEW 1,693 SQ.FT.SINGLE STORY RESIDENCE WITH A 698 SQ.FT.ATTACHED- ;4. , GARAGE. REF: B04-01131. - - ' - , � ' PLUMBING PERMIT IS FOR:BACKFLOW IRRIGATION,2 BATHTUBS, 1 DISHWASHER,GAS SYSTEM .; \ (1-4)&-2 ADDITIONAL OUTLETS FORIAPPLIANCE&EXTERIOR BBQ, 1 LAUNDRY TUB/WASHER, �� % ) / "LANDSCAPE IRRIGATION,4 P-TRAPS, 1 SEWER CONNECT,2 SHOWERS, 1 KITCHEN SINK,2 - TOILETS 8'1 WATER•HEATER. - ' FEE SUMMARY vv�v` AMT""'„QTY ' ' AMT ;QTY ',i�'- , / AMT QTY ISSUE FEE ' ' $23.50 ” Laundry Tubi Washer- - $9.80-''.1 - /, Sump Pump /%, $0.00 0 Backflow irrigation ,,, $9.80 ' 0 : " Landscape Irrigation $14.80 1 'Swimming Pool, $0.00 0 Backflow Preventer `$0.00 -. 1 , ,`--P-Trap , $39.20 --;4 - . Trap Primer % $0.00 0 Bathtub $19.60- '2 'Pressure Regulator ' - $0.00,_ 0 Urinal. , ' $0.00 0 Clarifier System $0.00' 01' ' Process Piping(per 10 ft) , $0.00 •—0, - ,Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0--'7-, ' - Receptors--' - \,. . -$0.00 0 -Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 -=Septic Tank $0.00 =,0=" ,.� - Wash Basin $0.00 0 Dishwasher $9.80 1 'Sewer Captor Demo; '$0.00 -0 Wash Basin Set $0.00 0 • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will 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(6100,000),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.4 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,CMI 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(5500).): lQ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors license Law does not apply to an owner of property who builds or Improves thereon,end who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exemyt/u/n rr�seec. Business and Professions Code for this reason: Signature: C/L i/ ./ Date: Owner ID verified by driver's license. Gees 0 No Driver's License No. . xpires: f/ c> 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: 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 ono 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 ❑No 5 Daes 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 U No (Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits). acili..._.........._c_ —1-060--feet _ 6 Will any part of the facility to be constructed under this permit be within 1000 teat 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 Of yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the Information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given Is correct. I agree to comply all state laws nd city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described/1i •r IDs es.I agree not to occupy or allow occupancy of any building authorized by this ermi ntil final inspection. /Signature Of Legal Owner(s) � '•'/7r/Date And/Or Authorized Applicant Date ;ODE F INSPECTION TYPE PAIL ILLS CODF( INSPECTION TYPE PEE INIIDEL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical ` 1 1266 Pool Spa Final 208 Final Plumbing J '?5.–o4 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall ; 212 Final Fire Prevention 202 Final Factory Fire Place _ • 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy CITY OF COSTA MESA BUILDING DIVISION ). t i -1. DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER oo tdielE 7 Ill ! ft .....r.. , V. PERMIT E04-00684 (714)7`54-o5.2a77c3� • Fax(714)754-4856 • w Av.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 271 E 19TH ST Status: ISSUED Suite No Applied: 06/16/2004 Vicinity: Issued: 06/16/2004 Parcel Nunmber: 89490156 r_ )K-- Applicant: KIRK NORTON ISSUED BY: Address: P.O.BOX 37 Phone: 714-997-2242 ORANGE, CA Zip: 92856 Owner:. CHRISTOPHER MACBETH • Address 271 E 19TH ST Phone: 949-307-8255 COSTA MESA,CA Zip: 92627 Contractor: BUILDERS POWER INC Address: P.O.BOX 37 Phone: 714-997-2242 ORANGE, CA Zip: 92856 License: 246046 SCOPE OF PERMIT TEMPORARY POWER POLE.REF.:804-01108 • 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 $0.00 0 up to 50 kva/kw $0.00 0 Recept Outlets $0.00 0 up to 100 kva/kw $0.00 0 Switches $0.00 0 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $0.00 0 Misc.Conduit $0.00 0 Service to 1000a $0.00 0 Misc.Conductor $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1 hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 - 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 -Reinspection Fee $0.00 Sign Circuits $0.00 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92.28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days,or if work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will 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: ❑ 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 rk for which this permit Is issued. "ErCI have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. _My works compensation In�su"rance carrier and policy number are: Carrier: 74170 zO Policy Number: O¢4 •-05 (Thls-sectfon need not be completed if the permit Is valued at one hundred dollars($700)or less.) C ❑ 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,a that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisl '/ AppllcenfSigneNre:-- Cdale:I- as J" WARNWG:,FAILURE.TO SE W ERS'COMPENSATION COVERAGE IS UNTAWFUL AND SHALL SUGIECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED -THOUSAND DOLLARE($100,000),IN ADDrrIow TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full -force and'effectrLic'N— Z G O I sa s a G —!U \Contractors Signature: "—• r----Data'(n /e/O. 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 and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or Improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,Le.-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). _._.._oe__. o_.._ acutely —._ 0 OT _ 2 Does or will the applicant or present or future building occupant need to lila a registration form for acutely hazardous materials? ❑Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous 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 t0 prepare an RMPP(Risk Management end 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 a_pPennit for such construction or modification from the South Coast Air(Duality Management District or from any other air pollution control district or agency? LJ Yes DO No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). any pane of th._.._.__ h __.-_ 6 Will any pert of the facility to be ConsWcted under this permit be within 1000 feel 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(Duality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (II yes-,attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the Information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for Inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Sign re Legal Owner(s) Date A Or'Auth6rized Applicant Date— CODE A INSPECTION TYPE PATE MEOW CODE IIISPECTION TYPE PATE MAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1288 Pool Spa Final 208 Final Plumbing j L�L LL, 200 Final Re-Roof ,_ 210 Final Electrical v `L7\ 201 Final Block/Retaining Wall 212 Final Flre Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 0.. ' ' CITY OF COSTA MESA 449 BUILDING DIVISION >' , a DEVELOPMENT SERVICES DEPARTMENT PERM UMBER t !II PERMIT J 1.111.4 '`°+ "F PO4-00428 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 271 E 19TH ST Status: ISSUED Suite No Applied: 06/16/2004 Issued: 06/16 004 Vicinity: I/ ISSUED BY: /e/� Parcel Nunmber: 89490156 // Applicant: MACBETH, JOHN Address: 8 ARBORGLEN Phone: 949-307-8255 CHRIS CELL IRVINE,CA Zip: 92604 • Owner: CHRISTOPHER MACBETH Address 271 E 19TH ST ' Phone: 949-307-8255 • Ex;TENS1Oj� COSTA MESA,CA Zip: 92627 �T (1 )l PER Contractor: OWNER-BUILDER ,' (I I Address: EXPIRES Phone: Zip: License: 000000 Arch / Eng: Address: . Phone: Zip: License: SCOPE OF PERMIT 1 SEWER CAP IN CONJUNCTION WITH THE DEMOLITION OF A SFD AND DETACHED GARAGE. REF:B04-01108 FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub!Washer $0.00 0 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0 Dishwasher $0.00 0 Sewer Cap for Demo $9.80 1 Wash Basin Set $0.00 0 Drain,Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain,Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0 Drain, Roof $0.00 0 Shower $0.00 0 Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 ' Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 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 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 carder end policy number are: Carrier Policy Number: (This action need not be completed li the permit is valued at one hundred dollars(5100)or loss.) re 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,a agree that I hould be a subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with rhes /��J �.,/' Applicant SIgnatur . IE S' Date: r� 76 0 / WARNING.FAIL O SECURE WORK COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND RE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is In full force and effect.Lic.N Class 4 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 suacts the applicant to a civil penalty of not more than five hundred dollars($500).): vritii 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 ama.: der •c. --_ .' Business and Professions Code for this reason: Signature Date: S` 66 0 CP Ow "Cerified by driver's license. 0 Yes 0 No Driver's License No. © Expires: /0 -2 S'- OS-- Verification S-Verification of Ownership by(type of document,I.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend.will be made in connection with work authorized by this permit,and that no building structure,scaffolding,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 Wit 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 end 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)? IJ ❑yes O (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and fling 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 a ermlt 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 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 Ta required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ,'.n: ur- • !al Owner(s) Dale -- .— - r S- /6-05/ And/Or Authorized Applicant Date BODE I, INSPECTION TYPE DM HMO CODE! INSPECTION TYPE PAff. IMI& 1616 Fixed System Final Fire Prevention 206 Final Mechanical t r 1266 Pool Spa Final 208 Final Plumbing I -qq 5 -o5 200 Final Re-Roof 210 Final Electrical 201 Final BlocldRetalning 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 1114r CITY OF COSTA MESA BUILDING DIVISION • :� r,,,• rt,", DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER ti /s PERMIT vow E04-00703 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT' Job Address: 271 E 19TH ST Status: ISSUED Suite No Applied: 06/22/2004 Vicinity: Issued: 10/18/2004 Parcel Nunmber: 89490156 Applicant: MACBETH, JOHN Address: 271 E 19TH ST ISSUED BY: Phone: 949-307-8255 COSTA MESA,CA Zip 92627 Owner: MACBETH, CHRISTOPHER AND JOHN Address - 271 E 19TH ST - - Phone: 949-307-8255 COSTA MESA,CA , - Zip: 92627 Contractor: Address: Phone: Zip: • ' License: 1 ' • SCOPE OF PERMIT REVISION ON 01/09/06 TO ADD A TEMP METER FOR TEMP POWER. •CONSTRUCT A NEW 1,693 SQ.FT.SINGLE STORY RESIDENCE WITH A 698 SQ.FT.ATTACHED GARAGE.REF:B04-01131. 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) $94.81 .1693 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 Fins $8.80 8 - up to 50 kva/kw $0.00 0 Recept Outlets • $6.60 6 - up to 100 kva/kw $0.00 0 Switches $6.60 6 _ over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 - 'Low Voltage Equipment $18.20 1 Res Appl . . - $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $0.00 0 Misc.Conduit $0.00 0 Service to 1000a $0.00 - . 0 - Misc.Conductor' $0.00 0 Service over 1000a - '$0.00 0 ' ' Circus(gen or ride) $0.00 0 Motors to 1hp'- $9.50 2 Circus(mech ride or lights) $0.00 0 Motors to 10hp ' ,// $0.00 - 0 Christmas Tree Stand $0.00 0 Motors to 50hp '-N '$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 $23.50 1 TOTAL CALCULATED FEES $191.51 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 2446413(eroo) 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: ,_ Cartier: •"r 'r"_-Fr.- (This (This s need not be completed if the permit is valued at one hundred dollars($100)or less.) f lewdly dly that in the performance of the work for which this permit is issued,I shall not employ any person In any manner so as to become subject to the workers' compensation laws of California,and a•ree that it I should b me subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith hr-----,. complywithlhese / 9plicamSlgn tura e:_— /•- roate: /^lsr• 0� W INArrNW.- • ECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED D DOLLARE($I00,000),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: • hereby affirm that I am licensed under provisions of ter 9(commencing w' ion 7000)of Div '•n 3 of the Business and Professions C••: and my license is in full Tare,-L_Lid14 a. a Eass b—i a _ `11111ntbact•- 'Sig •tu`re'. •- -1 CONSTRUCTION LENDING AGENCY: In 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.My 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 hi 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 Id 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 x ws.). ❑ I am / _ / Business and Professions Code for this reason: Signatu r7, Date: /--- r al?- OG ` p, .averif etl by drivers license. is Yes 0 No Drivers'Ut 'CensiNo Ex�1—PO Z 5' O`I Verification of Ownership by(type of document,i.e.-properly tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(38)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 WIII the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons. or 200 cubic feet of compressed gas at standard temperature and pressure). _ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 D�aoor will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? 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 0l 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 aEpermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U 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? ❑Yes 0 No (If'yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 II 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 W the disclosures prescribed by Calitomia Health and Safety Code Section 42303 been made? ❑Yes ❑No 8 (If yes'.attach certificate of compliance tram the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPUANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the Information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. r': Of Lam.=war Date /. 9. 06 t And/Or Authorized Applicant— (Date'" - oat INSPECTION TYPE PATE MdLi LOGE! IdSPECnON TYPE PAIL EMU 1616 $ki1ttyC;ceJtT ystem Final Fire vention 206 Final Mechanical /' n 1266 0naumgUP) \i l L1Ii�'tzo - ( ` 1 zl0 Fi L O {,fir21J V \21/2 I ire vent n AM1 t '22 � Z���. inLPlan invent 203 Inal Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 't! CITY OF COSTA MESA• itit qTBUILDING DIVISION - :/,,,,,,.—.-,� DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER :4: �gs � PERMIT G04-00016 (714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 GRADING PERMIT Job Address: 271 E 19TH ST Status: ISSUED Suite: Applied: 09/07/2004 Vicinity: Issued: 10/18/2004 Parcel Nunmber: 89490156 Zoning: ISSUED BY: Applicant: MACBETH, CHRISTOPHER Address: 271 E 19TH ST Phone: 949-307-8255 ; - - COSTA MESA;CA - Zip: 92627 / - Owner ,MACBETH, CHRISTOPHER Address- 271E 19TH ST , Phone: 949-307-8255 - - COSTA MESA,CA Zip: 92627 - / - Contractor: OWNER-BUILDER Address: / I Phone: Zip: License: 000000 ' ' Eng: CALES RIOS - Address:. - - - -Phone: 949-492-8586 ' • Zip: - License: 57587 • SCOPE OF PERMIT . CUBIC YARDS GRADING FOR NEW SFD. - _ - REF: B04-01131 ' 80 ._ _ _ _ _ _ - . _ -FEE SUMMARY / ' Plan Check: $22.00 Calc Valuation: , $5,000.00 $0.00 Permit: , 'v . $37.00 ' '� Other: ' \\:. $0.00 ' <. „; N $0.00 ',y ' . . i-; Inspection: .- v$o.00 „% / / $0.00 _ Total: t C$59.00. >_ - - .- C_� � is, , - - PLANNING &ZONING . i NOTES: _ i 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 • 2446-6(WOO) DECLARATIONS WORKERS'COMPENSATION DECLARATION: \--J . 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.Uc.a 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: 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 subJ cts the applicant to a civil penalty of not more than five hundred dollars($500).): as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,end the structure Is not intended or offered for sale(Sec. < ✓7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • O I.as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). 0'Ql am exe nder sec. Business Business and Professions Code for this reason: Signature: A"l ` - - C__Date:! yd// rY Owner ID verified by drivers license. \ [zT 'es 0 No CDrivers License No.1 L—Expires: y/f o Verification of Ownership Dy(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the 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 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? Da 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? ❑Yes 0 No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health end Safety Code). _._.__ ____. .._ Dsict.._ .� _ — the suct of this 7 Ifa a icpatit from the South Dost s prescri ed Management Healtheal or and Sr airpollution control district3 or agency is required for the work which is subject of this application,have all of the disclosures prescribed by Californiaia 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 AUTHORIZATION OF ENTRY:I certify under penally of perjury that I have read this application and state that the information given Is correct. I agree to comp) wit /all stat laws en ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described props spao u agree not to occupy or allow occupancy of any building authorized by this ermi rift Incl inspection. g –n / /B O Signature O Legal Owner(s), / I Date And/Or Authorized Applicant Date CODE# INSPECTION TYPE PAIS BMW CODE( INSPEO'r NTYPE • QAIE 1NTm•!LS ' 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1268 Pool Spa Final 205 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 � p,. 203 Final Sign 222 Final Site yrs.. ` M, 204 Final Demolition 250 Final Building/Occupancy PROJECT ADDRESS: 271 E 19TH ST _ -- UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: P 051138 OWNER'S NAME: DANA LINK ADDRESS: SAME • PERMIT NO: P 051138 PLAN CHECK NO: N GOVT: N SUPP: N COSTA MESA,CA 92627 CONSTRUCTION TYPE: • PERMIT TYPE: PLU PURPOSE: OTH 557-9632 ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : REPLACE WATER HEATER SQ FT: • ADDRESS: UNIT: CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 / PERMITTEE: GEORGE BRAZIL ( 714 ) 535-7905 ADDRESS: 3022 N. HESPERIAN WY 101 *O*M***S•********H*************DME*BNEITE*****iE�E�E�E�t+tIE�E*�E*�EEttE**EEat�E****kEEE*****�E�E***ItEtkE�E�t SANTA ANA CA 92706 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter (commencing with Section Z ONING REQUIREMENTS 7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACKS CITY UC.: 029919 STATE LIS.:443064^ ,¢gess: 36/7 . Date: 2 —2Z—I Signature: (!� �bGo MAIN BUILDING ACCESSORY BUILDING FRNT: FT IN REAR: FT IN FRNT: FT IN .REAR: FT IN WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN •Compensation Assa}}�� QQ�1 g�{{t a copy thereof(Section 3800, Lab,R. POLICY NO.: ••""�J EXP.DATE: V1 /01/92 comPANY: UNITED PACIFIC ! PARKING REQ• PROV: PARCEL: 11721418 ZNE: REF NO: OS PLANNING NOTES> 0 Certified copy is hereby furnished. L:1 Certified egged wit a city Building Division > . a�22 —ti Applicant T^O *******it*********************************�E**IE**.********le*********IE************* —+ EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed it the permit is for one hundred)5100)or less). D E. V E L O P M E N T SERVICES ; REQUIREMENTS 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 Calilomia. ZONING APPROVED BY DATE: Date: Signature.' BUILDING APPROVED BY NOTICE:II.after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor DATE: Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. • CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y: —sear air DATE: 67-2..71.91 which this permit is issued(Section 3097,Civ.Cl. *********************4 - '`•L-;-s's'- ****************** I** LENDER: *************************************** ' ************************************** AODRESS: LEGALIZATION:N - F E E ' t 'U MMA R Y STRUCTURAL SEGMENT:N • OWNER BUILDER DECLARATION: I hereby affirm that lam exempt from the Contractors'State License Law for the Iollowing reason BLDG PMT PLUMBING EL • TRIC MECHANIC FIRE SMIP/RES GRADING ••i (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct.alter,improve,demolish,or PERMIT' _ 2 0 0 repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed . SMIP/NON—RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 700(I)of Division 3 of the Business PLAN and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by r any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars MOO). ISSUE FEE 3 . 00 • I. as owner of the properly v or my employees with wages their sole compensation, wit do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE ❑ structure H not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 2 . 00 3. 00 0 •00 • 5 .00 S • 00 •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.IL however the building or REVENUE DIVISION TOTALS--> COLLECTED• 5. 00 OVER/SHORT' 00 • f fortheementissold within one year alcompletion.the owner will have the burden ofproving he/she did not build orimprove BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADNG PLAN—CHECK far the purpose of sale). 41I5. 00 L as ownsr of the property,am exclusivelyY contracting with licensedt conlra01 an to construct the protect(Section 7044,Business L� and who contractstlfo The ojectWith atseLaw dens pursuatoo the Cotictors'SteabnNsor improves thereon ******************************************************************************* and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License law).I am aware that proof of their Worker's Compensation insurance should be provided to me. I N D I V I D U -A L F E E BREAKDOWN ❑ I am exempt under Section: B.&P.C. for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: Owner: PLU 1 WATER HEATER AND/OR VENT 2. 00 2 . 00 I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505.25533,and END OF FEES 25534 and that I or any future building occupant wiltwill not(circle one)need to comply with said state codes and the requirements for a permit tot construction or modification from the Air Duality Management District.Residential construction applications are exempt bon these provisions. Date: Applicant: I herebyes and that I have read this application and state that theabove irde repr•.•nt••tett.I agree to e0 y with all C and boned ordinances and state laws relating to building construction and h infor alio ntat. this city to en rug the ave-mentioned property for inspection purposes- Date: aZ—Q/ Signature: 6 01 00021216-000 71216 r O T GATE: 02/22/91 TIeE: 4:57 Driver's License or Social Security 4: 164 i'45 White—Building;Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor I 1 CONSTRUCTION AND PLANNING I POOL & �- APPROVALS Permit # Jate Inspector APPROVALS Permit # Date Inspector ar ca. 1. Temporary Electrical Service or Pole... 52. Pool & Equipment Location , 2. Soil Pipe•Undrgrnd. • � 1 _ - t 53. Steel Reinforcement v' '3.1Electrical Condui(;Otilitylindrgrnii~-.'_ t 54. Forms s 4. Electrical Conduit-Undrgrnd„,- y l 55. Electrical Bonding 1 Y " 5. SSeel;Reinforcemed% 56. Rough Plumbing & Pressure Test a•.6. Electrical UFE- rid. - _ 57. APPROVAL TO COVER-GUNITE 1 7. Footings C- 58. Electrical Conduit-Undrgrnd. --� �, 8. Foundation ,� = 59. Gas Pipe, 0 Undrgrnd.,Test 7 `` 9. Water Pipe-Undrgind. , . - 60. Backwash Lines, P-Trap, 0 Undrgrnd. '1 , 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House,Connection 62. Backwash & Receptor-Final l 12. Sewer Capdr' ::......-c,"-1. 63. Heater & Vent-Final 13. Roof Drains L-• /' Wit; 64. Plumbing System - Final --' 14. Rough Plumbing '1' ./- n 65. Electrical-Final ci , 15. Rough Electrical-Conduit 66. Solar System-Final • i 16. Rough Electric-Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING /" 18. Rough Electrial-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT T 20.-Rough Factory Fireplace - = :APPROVALS.L. # ' >' .. . Tr C >_Y. 1 .3_-•.l ' _ • .J. 1,_- 21.'Duhs, in•Str ictu e- .. S c _ • _70. Undeiground Hydro . 22. Ducts, Ventilating K t"is _ < :71. ProductPiping OGas coil 23.•Gas Pipe-Rough & Jest t' < . 72. Undergro• und Fluse 24.:RoofFraming •:: .- . •• e ' - - s73.cUndergrna'.StorageTank'OGas 0 Oil - 25. Roof Sheathing ,. ` �• * `'• _ � ' ' r- � a'. _ p_",. 74?Overhead Hydro- . 26. T-Bir Ceiling (Structural( &4Monocoat a _ '53 r _ t 75::Dry Chemical �_ 27.'Frame and Flashing' - , >. .ry • 76. Dry Standpipe - - , • 28. Lathing:& Siding;:-: ?:C ti., Y X Y. 77: FIXED SYSTEM FINAL _ '29. Insulation ';., S n1 ! 1: . 78.,:v. FIRE PREY. FINAL . - r 7 30. Drywall Nailing .--•.* ' '' 1• J•L •'HEALTIiDEPT•. REQUIREMENT ..31. Plaster Brown Coat: . , . ,I i']t :l r.79 FINAL INSPECTION - .- 32.,•Electrical Power Meter-Final,' :; i I(11.1: :'80rFO0D CERTIFICATE ISSUED ..a33.;Firql Electric , _ 1I;4 7 : ''Notes: ....5' a..1. 1,34;Final Heating& Air-conditioning; _ .j /:s; 5. , 35, Final Gas Pipe-Testi na• - r' I r `/: ` ,rc r".~ r 7 y36. Hood or Canopy , - -:1 (Il . = yy. r`a • 37. Final Factory Fireplaces ' l'-^:.`; '; .r • ! ' I' • - 38. Final Plumbingr. - `3 • •u 31Zq�21ciFA•; _ ..39. Water Service-Final - - 1. -1 C' • 40. Gas Service-Final • - 1 : :41. Solar Domestic-Final, . • • y 'I--- '42:-Backflow Preventer - 711 * I 01 I f z' V . 43. Backflow Irrigation' • •�. ,•S- - r 44. Landscape Iriigation System;• r- c r. LU r: ' tc >•45.±Sound Attenuation •- • >- t. ' - c' xd ' :46:;Handicap Regulations - ' , - - -s - 1' CO 47.sFINAL STRUCTURE & BUDING v 1 " -• - . - .. IIL - r.. , z - ' ti . , C. . .- 48:!:FINAL PLANNING r.r - I • 'IC; . ` - - c 49.:Electric Release to Edisoni a I ••- - r • 50._Gas-Release to Southern Cal fornia Gas CD _ I I j ^rr - _ L ▪51. CERTIFICATE OF OCCUPANCY ;' - r c No. Date _ • PROJECT ADDRESS: 271 E 19TH ST UNIT' B CITY OF COSTA MESA — BUILDING PERMIT PERM NO: P 059595 OWNER'S NAME: HELEN BEATTIE ADDRESS: 271 E. 19TH ST PERMIT NO: P 059595 PLAN CHECK NO: N GOVT: N SUPP: N COSTA MESA CA 92627 CONSTRUCTION TYPE: 5—N PERMIT TYPE: PLU PURPOSE: OTH C. ARCH/ENGINEER: ( 714 ) 548-8582 gEG.NO.: ADDREss: ROBERT NEWLON C—1717 JOB DESCRIPTION : FOUNDATION W/PATIO COVER FOR MOBILE HOME SQ FT; 3550 LAS FLORES CANYON RD L MALIBU CA 90265 CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 / PERMITTEE: HELEN BEATTIE (714 ) 548-8582 ADDRESS: 271 E 19TH ST COMMENTS. TO BE USED FOR GRANNY UNIT / RE: B59593 COSTA MESA CA 92627 *****+E******+e*******+r+r+E********+tit+L*****+E#+6iE+Ex*********xx-x-***** **************** LICENSED CONTRACTOR DECLARATION: I hereby allirm that I am licensed under provisions of Chapter 9(commencing with Section Z ON I NG REQUIREMENTS 70(10)of Division 3 of the Business and Professions Code,and my license is in fun force and effect. SETBACKS CITY LIC.: • STATE LIC.: CLASS: Date: Signature: MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: thereby affirm that I have a certificate of consent to sell.insure or a certificate of Workers' FRNT; FT IN REAR; FT IN FRNT: FT IN REAR; FT IN Compensation Insurance.or a unified 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: 11721418 ZNE: REF NO: ' 1 Certified copy is hereby furnished. 0 Certified copy s Mee with the city Building Division. PLANNING NOTES> • 7Date: Applicant: *******************************t4r***** ************************** DEVELOPMENT SERVICES'.'- RE%QUZREMENTSEXEMPTIONFROM WORKERS'COMPENSATIONDECARATION: (Rrssectionpeed rot becompleldithe enmsfor one hundred(slm)orless). I may that in the erormanpe Of the work forwhich this permit Is I$su 1 shall not employ arson m any manner so as to become subject to the waaeri Compensation Laws of - .a. , ZONING APPROVED BY • DATE: 4--- Date:/One /47 LSignature: .con NOTICE:If.alter making this declaration.you should b me subject to e Workers'Compensation provisions of the Labor BUILDING APPROVED BY : , DATE: Code.you must forthwith comply with such provlsio r this permit n be deemed revoked. i/ CONSTRUCTION LENDING AGENCY: I hereby affirm that there is .construction lending agency for the performance of the work for APPLICATION ISSUED B Y• Aw �� ` y DATE: which this permit is issued(Section 3097.Civ.C). *********************ie*i/ idiot) / Irr#D�!- -34*4c '"YYYR.,*' • iF it . **w******i(-*****n- rtmt."-st it le LENDER: MOBILE HOME/BEING ***************************N****************.• ,E******************************** AODRE55: MOVED FROM "TUSTIN" TO CM LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors State License Law for the blowing reason PERMIT 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 repair any structure.prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed .}5 Y pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business SMIP/NON—k ES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.My violation of Section 7031.5 by PLAN any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE 20 . 00 I, as owner of the property or my empltyCes with wages as their Shia compensation, wit do the workb and thio BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE ❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS————> 20 . 00 20 , 00 0 . 00 40 , 00 40 . 00 , 00 does not apply to an owner of a properly who builds er imbroves(hereon,and who does such work himself/hersell or through hior improvementor her issole within one year of coat mpletih on, tthe ownerts awit have t the bured den offered proving he/she didwnot buver ild of ie mprove REVENUE DIVISION TOTALS--> COLLECTED : 40 , 00 OVER/SHORT: 00 for thepurposeolsale). 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 40 . 00 ❑ and Professions Code: The Contractors'State License Law goes 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 State License Law).l am aware ***************k********************************1(-hE***')T-************************* that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN ® I am exempt under Section:B P 7044 B.8 P.C. for this reason WORK BY OWNER ' S MILY &TECTYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: (Dile /I L Omer: Jul PLU 1 GAS PIPING SYS OF 1 TO 4 OUTLETS 5, 00 5 , 00 I do hereby Certify that I am aware of and understand the requirements of California i Ith and Sal Code Sections 25505,25533,and PLU 1 SEWER, BUILDING / TRAILER 15. 00 15 , 00 25534 and that I or any future building occupantwill/will permit far COnstrudArD not(drde one)need to co y with said ate codes and the requirements for a ien or modification from the Air Duality Management District eddential construction applications are exempt from END OF FEES these provisions. Date: Applicant: 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 peo1 ' city to enter upon the above-mentioned property for inspection purposes. . � Date: /IV 0I•'pu2 �. L — Signature: a A'� "de- - Driver's License or Social Security,x: ( t Tryv'' tris __ _ . LATE: ST'•'7. ., 1641-46 White—Building;Green—Code Enforcement:Canary—Applicant;Pink—Revenue:Goldenrod—Assessor CONSTRUCTION AND-PLANNING POO. SPA 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 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 COVER•GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. • 8. Foundation - 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. mil409 • �r0 jC 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System / 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection „kir pi y- 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 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 I 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing ( I "I HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat I 171- 79. FINAL INSPECTION 32. Electrical Power Meter-Final � i 80. FOOD CERTIFICATE ISSUED 33. Final Electric !. Notes: 34. Final Heating& Air Conditioning I i 35. Final Gas Pipe-Test I I 36. Hood or Canopy 37. Final Factory Fireplace f 38. Final Plumbing elj ttOi- 39. Water Service-Final I l; /40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer I . 43. Backflow Irrigation 44, Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47'. FINAL STRUCTURE & BUILDING .1 48. FINAL PLANNING I 49. Electric Release to Edison I 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Pfl0,7 LT ADDRESS: 271 E 19TH ST UNIT: B `_ ITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 059593 4NER'S NAME: HELEN BEATTIE • �' ADDRESS: 271 E. 19TH ST .e PERMIT NO: B 059593 PLAN CHECK NO: 03446-92 L GOVT: N STJP•P; N COSTA MESA L CA 92627 CONSTRUCTION TYPE: 5—N PERMIT TYPE: STR PURPOSE: NEW _ ( 714 ) 548-8582 • ARCH/ENGINEER: ROBERTa NEWLON flec.xo.: C-30717 JOB DESCRIPTION FOUNDATION W/PATIO COVER FOR MOBILE HOME SQ FT: _ 9, 376 ADIRESS: J.1550 LAS FLORES CANYON RD UNIT: MALIBU CA 90265 CLAIM VALUE: 9, 200 . 00 CALC—VALUE: 11 , 804 , 80 GROUP OCC: R 3 i / PERMITTEE: HELEN BEATTIE ( 714 ) 548-8582 HOLD FOR SPECIAL RE ADDRESS: 271 E 19TH ST 'COMMENTS: MOBILE HOME TO BE USED FOR GRANNY UNITREQUIREMENTS COSTA MESA CA 92627 ***************************************************x******* 6xx �t E *##x x*n-A ,. LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS 7000)0l Division 3 of the Business and Professions Code.,and my license is in toll force and effect. S E T B A C K S • 7-•CITY LIC.: STATE LIC.: '' CLASS: i ..--,- Date: Signature: MAIN BUILDING ACCESSORY BUILDING — WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a cerlificate of Workers' FRNT: 2 5 FT I N REAR: 7 2 FT 6 IN - FRNT; 8 4 FT IN REAR: 5 ' ,r IN Compensation Insurance.ora certified copy thereof(Section MOO,Lab.C). LEFT: 6 FT IN RGHT: 20 FT IN LEFT: 5 FT IN RGHT y_i__ 5- Trt i - - POLICY NO.: ',A)EXP.DATE: COMPANY: 1 ' PARKING REQ• PROV• PARCEL: 11721418 ZNE; R1 REF NO• DR-92-17 ❑ Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. PLANNING NOTES> ADD 492 SQ, FT, MOBILE HOME WITH A 176 SQ. FT, PATIO., Oate: Applicant: ****x*i(•#lflElfxiFiki@i(iExx-IEff1f#iEitifi(•1(iEiEIEi(•*iF-x3EiEi(•x)(f4ikiE****ifif3(•14IFiPi(%****16N1(•i(•***4(:* . ' - ***At* EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed it the permit is for one hundred($100)or less). DEVELOPMENT SERVICES R E Q U I R E M E N - J I certify that in the performance of the work for which this permit is issued,I shall not employ any per in any manner so as to become /� t. p subject to the W gker�s'CfOmpensation Laws of Cati T1�� ZONING APPROVED BY @,-_ DATE: %�/ O//Q Dale: /o/7e 9? Signature: (jy ', / s r NOTICE: aver making this declaration,you should became s lett to the We ers'Compensation provisions of the Labor BUILDING APPROVED BY .1 i DATE: 1 o 10 Code.you must forthwith comply with such provisioris'or th permit shall be emed revoked. CONSTRUCTION LENDING AGENCY: hereby affirm thal•Ih Is a construction lending agency for the pedormanceol the work for APPLICATION ISSUED BY: � rof t� DATE; , ( 77//�� which this permit is =.sued(Section 3097.Civ.C). 1.' *************************re 'ie** -A'*AC it**- *1 * x**********************x•-+e.x***44**** LENDER: MOBILE HOME BEING ******************************************t *********************43GIEj8**** • • ** ADDRESS: MOVED FROM "TUSTIN" TO CM LEGALIZATION:N F E E ,tS U M, M,•A R Y �. ,, . f7RUCTURAL9 tMENT:t-' �� . _. v :� = i • - OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC° ' ECHANIC" },• FIRE SHIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city gf county which requires a permit to construct,alter,improve,demolish,or PERMIT 135 . 00 • i •' L ' 1 4 1 , 1 repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed - •' - 1 ) r v SMIP/NO1�—RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business a )y_. e; ._> and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by P LAN 87 . 75 - Ct X. any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500). ISSUE FEE "_y• i r -I. I. as owner of the properly or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN±C @K 5 !TO`1'A�L PAID DUE ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 136, 18 0, 00 r; ;. 8 7'•,7.S-"J' '123: 911 . 1 223 . 93 • . 00 does not apply to an owner of a property who builds or improves thereon.and who does such work himself/herself or through . ,.,' ` l ' Y .y his or her own employees,provided that such improvements are not intended or offered for sale.If,however the building or 7,. r 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;; 13,6-.,1" 'OVER/SHORT: ,00 for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC • fidFIRE.2 SMIh./TOT GRADING PLAN—CHECK I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 135 . 00 Z1 ,,4 ,i' ..4� iv"' ` 1 . 18 • ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon S:L !� . {Lf• ^ and who contracts for such projects with a contractor(s)license pursuant Ic the Contractors'State License Law).I am aware *****************3E***************41f**** ********ff,**(e*3t*********36x-*****x'****3(-** that proof of their Worker's Compensation insurance should be provided to me. %' , I N D I V I D U ARL .FSE 6 B R ,E/4 KD O W N ® I am exempt under Section:B P 7044 B.B P.C. .., I y/5 , for this reason: WORK BY OWNER'S t'" ZLY TYPE QTY D E S C R I P T I; Os . ,' -'' UNIT COST TOTAL COST iOil° �f Z-- Owner: / �`/-1-�_.2 U A t r Date: SFR 176 RES PATIO COVER POST & SO_,iDOeL 14 , 80 2, 604 , 80 I do hereby certify that I am aware of and understand the requirements of Califor eallh and ety Code Sections 25505,25533,and SFR 9200 ALTER BY VALUE RES IDE NT•IA.., NO/ONE j• 1 , 00 9 , 200 . 00 25534 and that I or any future building occupant will/will not(circle one)need t amply with s state codes and the requirements for a ENII OF/ FEES) permit for construction or modification from the Air Quality Management District.Residential onstruction applications are exempt from y, these provisions. /1 Date: Applicant' /� 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 '-•• .- 11‘ w ' 1 (! 2 t' ;212 property sand state laws purpose to building construction and hereby authorize representatives of thly�'Yto enter upon the above-mentioned i ,a properly for inspection purposes. / / • _ . „�-- 'a a� Date: /Ober7 Signature: _ G•( • ' •✓• �;"/ ter % ' 1 r-'' •Driver's License or Social Security a: /: • ''• Cyt 1641-46 White—Building:Green—Code Enforcement:Canary—Applicant;Pink—Revenue:Goldenrod—Assessor /' I •f '�'_- f , • CONSTRUCTION AND PLANNING POOL 'A APYROVA;• .S Permit-# Date Inspector APPROVALS Permit# Date Inspector 1. Temporary:aectrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. , - _ 53. Steel Reinforcement - 3. Electrical Conduit Utility-Undrgrnd. - 54. Forms - 4. Electrical Conduit-Undigrnd. 55. Electrical Bonding 5. Steel Reinforcement - 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings ' fjf/ 58. Electrical Conduit-Undrgrnd. Ce_Nrtt; ,/lam 8. Foundation , 59. Gas Pipe, 0 Undrgrnd., Test . i t - 9. Water Pipe-Undrgrnd. - . ., 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System _ 61. APPROVAL TO DECK I 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final i 12. Sewer Cap • l 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 - I.. 16. Rough Electric Wiring .j 67. Fencing & Access Approval r 17. Rough Wiring Sign _ - 68. APPROVED FOR PLASTERING 1 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 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 .'s16. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical - 27. Frame and Flashing 76. Dry Standpipe K 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation I - 78. FIRE PREV. FINAL 1 • 30. Drywall Nailing '" I HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat , 79. FINAL INSPECTION • 32. Electrical Power Meter-Final I ; 80. FOOD CERTIFICATE ISSUED HOLD FOR SPECIAL REQUIREMENTS 33. Final Electric I I Notes ENTS///��� 34. Final Heating& Air Conditioning 1 . - ' F� ��� //� �L�• , r/(t ca-g 35. Final Gas Pipe-Test I � dl�=g L ._�tlurliir_a_f3_Cowr.�_e��✓.� 36. Hood or Canopy I I ' pjg_ '!..ai'r'y i A_ �, / ►_•.__PS cowss.Lk f agA 37. Final,Factory Fireplace j • c A,_ , eY 1 38. Final Plumbing I 39. Water Service-Final I Na=D�-^/W& 4/^ Og-' 'Auk_ 40. Gas Service-Service-Hai.Service-Hai. I !� (r/n-J 41. Solar Domestic 0inel 1 42. Backflow Preventer I a- !. 43. Backflow Irrigation 4k n 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations • / 47 F NAL STRUCT.D.RE & BUILDING `t/ rt 4!ricRel;ase49Y dison I 50. Gas Release to Southern California Gas Co ' f -.I q 51: CERTIFICATE Of,OCCUPANCY No. - Date PRO.), TAODREss: 271 E 19TH ST 0NIT` B CITY U'—,'OSTA MESA — BUILDING PERMIT PERM NO: E 059594 OWNEWS NAME: HELEN BEATTIE ADDRESS: 271 E. 19TH ST ]ERMIT NO: E 059594 PLAN CHECK NO: N GOVT: N SUPP: N COSTA MESA CA 92627 i CONSTRUCTION TYPE: 5—N PERMIT TYPE: ELE PURPOSE: OTH ( 714 ) 548-8582 ARCH/ENGINEER: ROBERT NEWLON RE"' C-30717 JOB DESCRIPTION : FOUNDATION W/PATIO COVER FOR MOBILE HOME SQ FT: ADQ@Ess: k 3550 LAS FLORES CANYON RD UNIT: MALIBU CA 90265 CLAIM VALUE: CALC—VALUE: GROUP OCC; R-3 / PERMITTEE: HELEN BEATTIE (714 ) 548-8582 ADDRESS: 271 E 19TH ST COMMENTS; TO BE USED FOR GRANNY UNIT / RE: B59593 COSTA MESA CA 92627 *******************************+E******#**4**+t******** m************************ LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. SETBACKS CITY LIC.: STATE LIC.: CLASS: ` Date: Signature: MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of 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: 11721418 ZNE: REF NO; 1]'Certified copy is hereby furnished. ❑ 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 for one hundred($100)or less). DEVELOPMENT SERVICES REQUIREMENTS I certify that in the performance of the work for which this permit is issued,I shall not employ any on in any manner so as to become subject to the Wo kers'CompensationClaws of Calito / / ZONING APPROVED BY x 1 DATE: r Date: /0 f7o l el? Signature: BY NOTICE:If.after along this declaration,you should bece subject to the orkers'Compensation provisions of the Labor BUILDING APPROVED DATE: Code.you must forthwith comply With such provisions is permit sha( a deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y: � DATE• A9,4;131...K* . which this permit is issued(Section 3097.Civ.C). ************************* eft •* n • w- ****—*-L ****.:***fe**********left*** **** LENDER: MOBILE HOME BEING **********************************ir*****ac****.: ******************************** ADDRESS: MOVED FROM "TUSTIN" TO CM LEGALIZATION:N F E Ej SUMMARY _ STRUCTURAL SEGMENT;N following BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING OWNER BUILDER DECLARATION: I herebyaffirm that I am exempt from the Contractors'State License Law for the reason (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or 00 repair any structure.prior to its issuance,also requires the applicant for such permit to tile a signed statement that he/she is licensed PERMIT Vl 50$ SMIP/NON—RES pursuant to the provisions o1 the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.My violation of Section 7031.5 by PLAN any applicant for a permit subjects the applicant to a civil penalty o1 not more than live hundred dollars($500). ISSUE FEE 15. 00 I. as owner of the property or my employees with wages as their sole compensation. wit do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS--——> 11 . 00 15. 0 0 '" - 0 . 00 26 , 00 26 . 00 . 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 ' r improvement is sold within one year of completion,the owner wit have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED- 26 . 00 OVER/SHORT• 00 for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE S4NIP/TOT GRADING PLAN—CHECK I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 26 , 0 0 'lj' ❑ and Professions Code: The Contractors'Slate License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractors)license pursuant to the Contractors'State License Law). l am aware ***>E*.*****************************:0******************************************* that proof of their Worker's Compensation insurance should be provided to me. I ND I V ID UAL F E E BREAKDOWN cil I am exempt under Section: 8p7044 B.8 P.C. for this naso: WORK BY OWNER ' AMILY TYPE QTY D E S C R I P T I p1 N UNIT COST TOTAL COST �= / Date 2b qt def. is . 11 , 00 11 . 00 I do hereby certify that I am aware 01 and understand the requirements 01 Calif).�'tAI ealth anety Code sections25505,25533,andELE 1 5UB—PANEL ED OF FEES 25534 and that I or any future building Occupant wilt/will not(circle one)need tly with said state codes and the requirements for a permit for construction or modification from the Air Duality Management Distriidential construction applications are exempt from Ly these previsions. . Date: Applicant: I hereby certify that I have read this application and state that the above information is correct.I agree to comply with an city and county ordinances and state laws relating to buil0ing Conten ' hereby authorize representativ city to enter upon the above-mentioned property lot in pectin purposes. _Date: /0 � �2 Signature: •—)1'>' 11 • - "- Driver's License or Social Security N: Ir.'Tr_; 1641-46 White—Building:Green—Code Entorceme .Cenary—Aoolicant:Pink—Revenue:Goldenrod—Assessor V r hp;he _ CONSTRUCTION AND PLANNING - POOL ?A APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector 1. Temporary 1 lectrical 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. i . r •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 'i 16. Rough Electric Wiring y 67. Fencing& Access Approval 17. Rough Wiring Sign ' 68. APPROVED FOR PLASTERING r 18. Rough Electrical-I 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 ❑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 & SidingI I 77. FIXED SYSTEM FINAL I 29. Insulation 78. FIRE PREY. FINAL '30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat '� 79. FINAL INSPECTION 32. Electrical Power Meter-Final l I 80. FOOD CERTIFICATE ISSUED � 33. Final electric /4019: , it' 33)1_ - r/10 cane. tt 34. Final Heating& Air Conditioning I . 35. Final Gas Pipe-Test I ) 36. Hood or Canopy 37. Final Factory Fireplace l �' 38. Final Plumbing 39. Water 5ervice-Final I ` r•1 40. Gas Service-Final I 'I 41. Solar Domestic-Final I ' 1 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation \ 46. Handicap Regulations \,/ � 47. FINAL STRUCTURE & BUILDING ; --1 48. FINAL PLANNING - I „' I 49. Electric Release to Edison j 50. Gas Release to Southern California Gas Co I • I r 51. CERTIFICATE OF OCCUPANCY No. Date