HomeMy WebLinkAbout307 19TH ST - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.d.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
PLUMBING PERMIT
.lob Address: 307 E 19TH ST
Suite No
Status: ISSUED
Applied: 08/16/2001
Issued: 08/16/2001
Vicinity: BATHROOM
Parcel Nunmber: 11725421 ISSUED BY:
Applicant: AKINS, SHAWNii
Address: 307E 19TH ST�-
�� - Phone: (949) 514-0170
COSTA MESA, CA � - _ - Zip: 92627 -
Owner: �MAEZ-AKINS, ANGELA
Address '307 E'19TH ST:
Phone: (949)514-0170
COSTA MESA, CA Zip: 92627
Contractor: OWNER -BUILDER
Address: _
.. Phone:
Zip: _
License: 0
Arch / Eng
Address:
Phone:
Zip: -
License:
SCOPE OF PERMIT
PLUMBING PERMIT FOR NEW BATHROOM CONVERSION. INSTALL 1 BATHTUB, i WASH BASIN, & 1
WATER CLOSET. '
REFS B01-01287
NOTICE: The work authorized by this permit sMMMI9 fJtf'S pgp"Le CUftpr1EM 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) 7545626
244646 (6W)
'FEE' SUMMARY
/AMT-
'QTY
'-
AMT
QTY
- -
- AMT
QTY
ISSUE FEE -
$23.50 '
- -
Laundry Tub I Washer
50.00
0
Sump Pump -
$0.00
0
Backflow irrigation
$0.00-
.0
Landscape Irrigation
$0.00
0
Swimming Pool"
$0.00
0
Backflow Preventer
$0.00
0
P -Trap
$0.00
0
Trap Primer
$0.00
0
Bathtub
$9.80
1
Pressure Regulator
$0.00
0
"Urinal 1
$0.00
0
Clarifier System
$0.00
0
Process Piping (per 10 R)
$0.00
0
Vacuum Brkr Bkflow(1-4)
$0.00
0
Connect (Ice,Soda,etc)
$0.00
0
Receptors -
$0.00
0
Vacuum Brkr Bkflow(5+)
$0.00
0
Dental Units
$0.00
0
Septic Tank
$0.00
0
-Wash Basin
$9.80
1
Dishwasher
$0.00
0. -
Sewer Cap for Demo.,,
$0.00
0
- Wash Basin Set
$0.00
0
Drain, Floor
$0.00
_
0 --
Sewer Connect
$0.00
-
0
Waste and Vent System
$0.00
0
Drain, Rainwater
$0.00
0 -
Sewer Private Line
$0.00"
0 -
Water Closet (Toilet)
$9.80
1
Drain, Roof
$0.00
0
Shower
$0.00
0
Water Heater/vent
$0.00
0
Drinking Fountain
$0.00
0
Sink, bar
$0.00
0
Water Piping (Inst or Rep.)
$0.00
0
Expansion Tank
$0.00
0
Sink, commercial
$0.00
0
Water Re -pipe
$0.00
0
Gas Earthquake Valve
$0.00
0
Sink, Floor
$0.00
0
Water Service
$0.00
0
Gas (1-4 outlets)
$0.00
0
Sink, kitchen
$0.00
0
Water Softener
$0.00
0
Gas (Over 4 outlets)
$0.00
0
Sink, service/mop
$0.00
0
OTHER
$0.00
Gas Repipe
$0.00
0
Spa (private)
$0.00
0
VIOLATION
$0.00
Gas Service
$0.00
0
Spa (public)
$0.00
0
PLAN CHECK
$0.00
Interceptors (Grease, Oil)
$0.00
0
REINSPECTION
$0.00
0
Interceptors (Sand Auto )
$0.00
0
TOTAL CALCULATED FEES:
$52.90
NOTICE: The work authorized by this permit sMMMI9 fJtf'S pgp"Le CUftpr1EM 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) 7545626
244646 (6W)
DECLARATIONS
WORKERS' COMPENSATION DECLARATION:
I hereby offiml under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a cortiflcate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the
work for which this permit is Issued.
❑ 1 have and will maintain workers compensation Insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued.
My workers' compensation Insurance carder and policy number are:
Center. I Policy Number.
(This section need not be completed If the permit Is valued atone hundred dollars ($100) or less.)
❑ 1 canity 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 becano subject to the workars'
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 SRAU. SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED
THOUSAND DOWIRE ($100,000). W ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 31080E THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full
force and effect. Lic. a Class N
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued. (Sac. 3097, Civil Code).
Lenders Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that 1 am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sac. 7031.5, Buslness and Professions
Code: Any dry 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 DMslon 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 peril'
sub ects.lhe applicant to a civil penalty of not more than five hundred dollars ($500).):
1„as Owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure Is not Intended or offered for sale (Sec.
--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 sets. If, however, the bullding or improvement is
sold within one year o1 completion, the owner-builder will have the burden of proving that he or she did not build or Improve for purpose o1 sale.).
❑ 1, 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.).
❑ 1 am exempt under sec. Business and Professions Code for this reason:
�Igneture:7 -- ( Date, /I O
Owner ID vedflad by drivers license. ❑Ves ❑ No-DriversticonseMo.
Verification of Ownership by (type of document, i.e. - property tax bill or deed):—��
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 1 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, talsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Tide S. 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 certiy a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑ Yes ❑ NO
(Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons,
Or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building ocoupenl need to lila a registration form for safety hazardous materiels? ❑Yes ❑ No
(Section 25533 of the California Health and Safety Code. with some exceptions, requires registration with the Costa Mese 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 O ea will O epp6wnt or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for safely hazardous materials)?
(Section 25534 toff 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 compiled with? ❑Ves ❑ No
5 Does or will the applicant or present or future building occupant require for the work which Is the subject ofthis a plication appemit for such construction or matlificetlon
from the South Coast Air Oufllity 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 pen of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑ No
(Ii 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 Oualiry Management District or other air pollution control tlistdct or agency is required for the work which is the subject of this
appllcatlon, have all of the tllsclosures prescribed by California Health and Selery Code Section 42303 been made? ❑Ves ❑ No
S (II yes', attach certificate of compliance from the eppropdate air pollution control oNicop.
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: Data:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of penury that I have read this applicatlon 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-desccgo property for inspection purposes. I aggrrreee not to occupy or allow Occupancy of any building authorized by this permit until final inspection.
�
Signature Of Legal Owner(s) Date
t_ C-.:
And/Or Authorized Applicant Data
CODE tINSPECTION TYPE RM lite gg2E.I INSPECTIONTYPE gag grTmA
1616 Fixed System Final Fire Prevention 206 Final Mechanical �1
1266 Pool Spa Final 208 Final Plumbing -f7pk
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
(714) 764.5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 307 E 19TH ST
Suite No
Vicinity:
Parcel Nunmber: 11726421
Applicant: APPELL, JOHANN
Address:
Owner: PARKS, MICHAEL L
Address 307.E 19TH ST
7
i
Contractor:
Address:
PLUMBING PERMIT
ISSUED BY:
Status: ISSUED
Applied: 03/20/2001
Issued: 03/20/2001
COSTA MESA, CA
MICHAEL RAY CLEAVINGER
2085 PLACENTIA AV
Phone:
Zip: , 92627
. STE 4 _ Phone: (949) 631-3344 ,
,COSTA MESA, CA Zip: 92627
L' n e' 594924 -
ce s
+. Phone:
-- -Zip'_-
r ,
License:(-
' REPAIRS TO WATER HEATER AND VENT.
'FEE SUMMARY
AMT ,\�,OTY . 7- .AMT :OT -Y> t �,a/�,/� �, AMT QTY
ISSUE FEE`. ' $2350 ,;� - .Laundry Tub / Washer' -—$0.00' '0"Sump Pump r $0.00 0
Backflow ungation\ $000 �0 ` Landscape Irrigation �� $000 0 %Swimming,Pool x'19 $0.00 0
Backflow Preventer�� C$000/� 0 � V `P Trap = $0 OOJ 0 f� Trap Primer $0.00 0
Bathtub ` $000 j/ 0, ��VPressure Regulator .. $000 O�Unnal���j� �j� $0.00 0
Clarifier System \ ��� $0 00 �/ 0' Process Piping (per 10-ft)'� $0, 00 - ---,-o Ur
iVac6um�Brkr Bkflov/(1-4) $0.00 0
Conned(Ice,Soda,etc)' \,$0.00 0 Receptors $0.00 - 0 \�Vacuum'Brkr6110 5+) $0.00 0
Dental Units .$0.00 ' 0 '. Septic Tank $0.00 0 - ��'wash Basini % $0.00 0
Dishwasher $0.00 �,� 0" Sewer Cap for Demo, , - $0.00--10Wash Basin Set $0.00 0
Drain, Floor $0.00 0�� ` Sewer Conned $0.00 0` J Wasteand Vent System $0.00 0
Drain, Rainwater $0.00 ',0, Sewer Private Line ,$0.00,_--0 "'Mater Closet (Toilet) $0.00 0
Drain, Roof $0.00 0 - Shower $0.00 ,0 .=,c .,-Water Heater/ vent $12.30 1
Drinking Fountain $0.00 0 ,Sink, bar $0,00, '0- _ - Water Piping (Inst or Rep.) $0.00 0
Expansion Tank $0.00 0 Sink, commercial x$0.00- -0 Water Re -pipe $0.00 0
Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0
Gas (14 outlets) $0.00 0 Sink, kitchen $0.00 0 Water Softener $0.00 0
Gas (Over 4 outlets) $0.00 0 Sink, service/mop $0.00 0 OTHER $0.00
Gas Repipe $0.00 0 Spa (private) $0.00 0 VIOLATION $0.00
Gas Service $0.00 0 Spa (public) $0.00 0 PLAN CHECK $0.00
Interceptors (Grease, Oil) $0.00 0 REINSPECTION $0.00 0
Interceptors (Sand Auto ) $0.00 0
TOTAL CALCULATED FEES: $35.80
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) 7545626
244646 (M)
J
�
,
r,
VX,,!
'FEE SUMMARY
AMT ,\�,OTY . 7- .AMT :OT -Y> t �,a/�,/� �, AMT QTY
ISSUE FEE`. ' $2350 ,;� - .Laundry Tub / Washer' -—$0.00' '0"Sump Pump r $0.00 0
Backflow ungation\ $000 �0 ` Landscape Irrigation �� $000 0 %Swimming,Pool x'19 $0.00 0
Backflow Preventer�� C$000/� 0 � V `P Trap = $0 OOJ 0 f� Trap Primer $0.00 0
Bathtub ` $000 j/ 0, ��VPressure Regulator .. $000 O�Unnal���j� �j� $0.00 0
Clarifier System \ ��� $0 00 �/ 0' Process Piping (per 10-ft)'� $0, 00 - ---,-o Ur
iVac6um�Brkr Bkflov/(1-4) $0.00 0
Conned(Ice,Soda,etc)' \,$0.00 0 Receptors $0.00 - 0 \�Vacuum'Brkr6110 5+) $0.00 0
Dental Units .$0.00 ' 0 '. Septic Tank $0.00 0 - ��'wash Basini % $0.00 0
Dishwasher $0.00 �,� 0" Sewer Cap for Demo, , - $0.00--10Wash Basin Set $0.00 0
Drain, Floor $0.00 0�� ` Sewer Conned $0.00 0` J Wasteand Vent System $0.00 0
Drain, Rainwater $0.00 ',0, Sewer Private Line ,$0.00,_--0 "'Mater Closet (Toilet) $0.00 0
Drain, Roof $0.00 0 - Shower $0.00 ,0 .=,c .,-Water Heater/ vent $12.30 1
Drinking Fountain $0.00 0 ,Sink, bar $0,00, '0- _ - Water Piping (Inst or Rep.) $0.00 0
Expansion Tank $0.00 0 Sink, commercial x$0.00- -0 Water Re -pipe $0.00 0
Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0
Gas (14 outlets) $0.00 0 Sink, kitchen $0.00 0 Water Softener $0.00 0
Gas (Over 4 outlets) $0.00 0 Sink, service/mop $0.00 0 OTHER $0.00
Gas Repipe $0.00 0 Spa (private) $0.00 0 VIOLATION $0.00
Gas Service $0.00 0 Spa (public) $0.00 0 PLAN CHECK $0.00
Interceptors (Grease, Oil) $0.00 0 REINSPECTION $0.00 0
Interceptors (Sand Auto ) $0.00 0
TOTAL CALCULATED FEES: $35.80
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) 7545626
244646 (M)
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.
❑ 1 have and will maintain workers' compensation Insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
My workers' compensation Insurance carrier and policy number are:
Carder: Policy Number:
(This section need not be completed if the permit is valued at one hundred dollars ($100) or less.)
❑ 1 certify that in the performance of the work for which this permit Is Issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California, and agree that If I should become subject to the workers' compensation provisions of Seftlon 3770 of the Labor Code, I shall forthwith
Jy with the} si as. LCII >1
Applicant Signature: Date: ((�%
WARNINOfFAINRE T 0 E ORK S' W NSATION COVERAGE IS UNLAWFUL AND SMALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
TlKK1SAND DOLIARE (5100, ), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3m6 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 Cade, and my license Is In full
force and effect. Lic. a Class a
Contractors Signature: Date:
CONSTRUCTION LEN ING AGENCY:
❑ 1 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:
1 hereby afflrn that under penalty of perjury that l 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 Ucense Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Cade) 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 contractods)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. ❑ Yes ❑ No Driver's License No. Expires:
Verification of Ownership by (type or document, 1.9. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 1 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) feel high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Title B. California Administrative Cade).
❑ 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 bulldIng occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
...........................................................................................................................................................................................................................................................................................................................................................................................
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous 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).
...__............_._.....................__......_........................_._........._.._..............................__._........................_............................................... _................................................................................................ ....._............................................ I...........
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 Cade 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 II an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? []Yes ❑ No
................................................ ......_................................_......_........... .........,.......................___.........................._.................... __........................___......................................... .......................... _._..................... ._............................. _...............
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication aernit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 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 ❑ 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 Quell 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 [I No
....
.......................................................................................................................................................
...............................................................................................................................................................................................................................
B (If yes", attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the Information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION. OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
S e Of Legal Owners) D to
wk npt_4i��
nci/Or Authorized Applicant T 1 D to
CODE I. INSPECTION TYPE VAI&INITTIALs CODE1 INSPECTION TYPE DAA[ INTITALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Root 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
1I--
PROJECT ADDRESS: 307 E 19TH ST
AD
OWNER NAME:: PARKS, MICHAEL L
ADDRESS: 307 E 19TH ST
COSTA MESA,CA
ARCHIENGINEER: 548-2440
ADDRESS:
UNIT:
92627
REG.NO.:
UNIT:
PERMITTEE. MICHAEL PARKS (714)548-2440
agOREss: 307 E 19T ST
COSTA MESA CA 9227
LICENSED CONTRACTOR DECLARATION: 1 hereby affirm that I am licensed under provisions o aper 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code. and my license is in lull force and effect.
CITY LIC.: STATE LIC.: CLASS:
Date: Signature:
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self insure or a certificate of Workers'
Compensation Insurance, of a certified copy thereof (Section 3800. Lab. C).
POLICY NO.: EXP. DATE:
COMPANY:
❑ Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division
Date. Applicant:
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred ($100) or less).
cenify that a the performance of the work for which this perm suetl, l Spit not empl e any manner so as to become
schrift to tie��CCthe performance
Compensation Laws of California. C%i�/%
Date: A55"I�� Signature�Z
NOTICE: It, after making this declaration, you should hecome subject to the Workers' Compensation provisions of the Labor
Code. you must fprthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCa I hereby affirm that there is a construction lending agency for the performance of the work for
which this permit is issued (Setiio097. Civ. C).
LENDER:
ADDRESS:
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, atter, 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
pursuant to the provisions of the ContractorsState 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. Any violation of Section 7034.5 by
any applicant lot a permit subjects the applicant to a civil penalty of not more than live hundred dollars (5500).
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 (Section 7044, Business and Professional Code: The Contractors' State License Law
does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through
his or her own employees. provided that such improvements are not intended or offered for sale. If, however the building or
improvement is sold within one year of completion. the owner will have the burden of proving he/she did not build or improve
for the purpose of sale).
I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business
❑
and Professions Code: The Contractors' Slate License Law does not apply to an owner of prolaiy who builds or improves thereon
and who contra cls for such projects with a contractors) license pursuant to the Contractors' Stale License Law). I am aware
that proof of their Worker's Compensation insurance should be provided to me.
am gexempt under Section: B P 704 4 B. & P. C.
t
mrmisreason:OWNER DOING OWN WOC�
Dale: /h1— i ss ' ! 3 Owner. ,Gem Ce./"
I do hereby certify that I am aware of and understand the requirements of Calllornia Health and Safety Code Sections 25505, 25533, and
25534 and that I or any luture building occupant will/will not (circle one) need to comply with said stale codes and the requirements for a
permit to: construction or modification from the Air Duality Management District. Residential construction applications are exempt from
these provisions.
Date: Applicant:
I hereby certify that I have read this application and state that the above information i5 correct. I agree to comply with all city and county
ordinances and state laws relating to building construction and hereby au horde representatives of this city to enter upon the above-mentioned
property for inspection purposes.
Date:/0— /r7 — ! 3 Signature
Driver's License or Social Security A:
1641-46 While—Building: Green—Code Enforcement; Canary—ApplicanC Pink—Revenue: Goldenrod—Assessor
CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 06448
PERMIT NO: B 064489 \ J PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: V—N \\\ PERMIT TYPE: SIR PURPOSE: ADD
JOB DESCRIPTION : INSTALL NEW COMP. SHING. OVER EXIST. SQ FT: 2,000
CLAIM VALUE: 2,000.00 CALC—VALUE: 2,000.00 GROUP OCC: R-3 /
COMMENTS: SMOKE DETECTORS ARE REQUIRED AS PER U.B.C. 1991
�. Z O N I N GS E R T E B Q A U C I K R S E M E N T S
------ -------------------
ACCESSORY BUILDING---------
FRNT: FT IN REAR: FT IN FRNT:
FT IN REAR: FT IN
LEFT: FT IN RIGHT: FT IN LEFT:
FT IN RGHT: FT IN
PARKING REQ; PROV: PARCEL: 11725421
ZNE: REF NO:
PLANNING NOTES>
_
D E V E'L O P M E N T S E R V I C E S
R E Q U I R E M E N:T S
ZONING APPROVED' BY
DATE:
BUILDING APPROVED BY
DATE:
r
^
APPLICATION ISSUED BY:
DATE: o I)
LEGALIZATION:N F E E S U M M A R
Y STRUCTURAL SEGMENT:Y
i
BLDG,.PMT PLUMBING ELECTRIC MECHANIC
FIRE SMIP/RES GRADING
PERMIT 4'5.00
.50-
SMIP/NON1,—RES
PLAN i^
ISSUE FEE
/'
BUILDING—DIV—>!, PERMIT ISSUE PLAN—CHECK
TOTAL PAID DUE
TOTALS ---- > 45.50 0.00 0.00
45.50 45.50 T .00
REVENUE DIVISION TOTALS--> COLLECTED: 45.50
OVER/SHORT: .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE
SMIP/TOT GRADING"PLAN—CHECK
45.00
,50
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 2000 REROOF BY VALUE RESIDENTIAL NOZONE 1,00 I'+ 2,000.00
END OF FEES !.
SMOKE DETECTOR
REQUIRED
01 00144016-001440I7 TOT
DATE: 10/18/43 TIME: 09:0
1
CONSTRUCTION AND PLANNING
- APPROVALS Permit # Date
POOL. .,PA
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.
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. Electriral-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
APPROVALS Permit #
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
'E1
22. Ducts, Ventilating
71. Product Piping GGas 0Oil
23. Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing
25. Roof Sheathing
26. T -Bar Ceiling (Structural) & Monocoat
- 7//3. Undergrnd;StorageTank GGas ❑Oil
75.-.''U7Ury Chemical))
_' rr
27. Frame and Flashing
76. Dry Standpipe
J `•,'�'
28. Lathing & Siding
77. 'FIXED SYSTEM FINAL'
t�.
29. Insulation -
78. FIRE PREV. FINAL
s_,>
30. Drywall Nailing
HEALTH DEPT. REQUIREMENT
31. Plaster Plaster Brown Coat
79. FINAL INSPECTION
32. Electrical Power Meter -Final
80. FOOD CERTIFICATE ISSUED
33. Final Electric
Notes:
-34. Final Heating & Air Conditioning
35. Final Gas Pipe -Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final'-
ervice-Final'-40.
40.Gas Service -Final
41. Solar Domestic -Final
42. Backflow Preventer
,
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
-
47. FINAL STRUCTURE&BUILDING�CLv
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
Job Address: 307 E 19TH ST Status: ISSUED
Suite: Applied: 05/13/2005
Vicinity: Issued: 09/01/2005
Primary Occ: R-3 Dwellings/ Cong Res <10 Type of Construction: V -N
Parcel Number: 11725421 Zoning:
Applicant: DON ALBRIGHT
Address: 24661 MENDOCINO CT
Phone: 949-425-1515 ISSUED BY:
LAGUNA HILLS, CA Zip: 92653
Owner: MAEZ-AKINS, ANGELAa
Address 307E 19TH ST '
Phone (949) 514 0170
COSTAMESA, CA Zip 92627-2348 -R
1P
Contractor: VICTOR,'JASNIY INC
Address: 24661 MENDOCINO CT
' Phone: 949425-1515
LAGUNA HILLS CA
Zip:92653, - License: 853836
Arch : THOMAS BURGER r' Eng:
Address: 20331 IRVINE AV Address:
STE 7 - Phone: 714-850-0700 Phone:
SANTA ANA ,HEIGHTS, CA.
Zip: 92707 License: 15902`License:- ' -
=- SCOPE OF PERMIT
ADD 589 S.F. TO EXISTING S.F.D. AND A NEW 265 S.F. COVERED PORCH. WORK TO INCLUDE: NEW MASTER BEDROOM, BATH AND LAUNDRI
DEMOLISHCAND REPLACE EXISTING EXTERIOR STAIR.
CONVERT 3 BEDROOM, 2 BATH S.F.D. TO'A 4'.BEDROOM 3 BATH SiF.Dcv
.:. --"- - '
NOTE: EXISTING 2ND STORY BATHROOMABOVE THE GARAGE IS LEGAL (SEE BUILDING FILE)
REF: MM -05-24^
PLANNING:
LOT.SIZE =-6,750 SQ.F.T. -Y,
RESIDENCE= 1,756 SQ.FT. -
GARAGE = 375 SQ.FT.
PATIO MORE THAN 5 FT. DEEP= 347 SQ.FT.
DRIVEWAY =670 SOFT
17
LOT COVERAGE =3,148 SQ.FT. (47%)j -
OPEN SPACE = 3,602 SQ.FT. (53%)',:
r S`
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) 7545626
24464616001
f
FEE SUMMARY k
Plan Check:
- $645.94
a
a�_ >d. C $100,000.00
� � , .� � alc Valuation
Permit:.
>. $993.75
Claim Valuation: $100,000.00
SMIP Res:
$10.00
SMIPCom:=$0.00;
Other:
$0..'00
Inspection:
$000'^=-�
Total:
$1,649.69
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) 7545626
24464616001
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 Cade, for the performance of the work for which this permit Is Issued.
My workers' compensatlon Insurance carrier and policy number are:
Carder:.'-- 5'771—ice Fr/�U Policy�Number:_ 23 8 -00017 S 0 - 04-
(This
4(This section need not be completed It the permit Is valued of one hundred dollars (S 100) or fess.)-
❑ 1 certify that in the performanlsof-thSvW0rk•for which this permit is Issued, I shall not employ any person in any manner so as to become subject to the workers'
�mi
compensation laws of C Ia, and agre h s fou become subject to the workers' compensation provlslons of Section 3700 of the Labor Code, 1 shall forthwith
comply with these p Toro.
AppBcaniSigneture:�- (
rDaW ' — OS
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 DOUARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3/06 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES,
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under prowsi pter 9 (commencing with Section 7000) of Dlvision 3 of the Business and Professions Code, and my license is In full
force and effect: LJc: a 0 S 38 31, Class'#_. 8
Co totrrac� torsJture:
CONSTRUCTION LENDING AGENCY:
❑ 1 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:
Rf2R..
-BUILDS DECLNS:
tl effiml t oder pW_�g{eaulyt e EMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions
Ycity uny wlDalf re s a permit to construct. after. Improve, demolish, or repair any structure, prior to Its issuance. aim requires the applicant for such permit
to file igned 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 appy 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.).
❑ 1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to convict the project (Sec. 7044, Business and Professions
Code: The contractors License Lew does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractors)
license pursuant to the Contradofs License Laws.).
❑ I am exempt under sec. Business and Professloro Code for this reason:
Signature: Date:
Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires:
Verification of Ownership by (type at document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 1 hereby cadity 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 auttwrized 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 AdminislreGve 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: Data:
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 ❑ No
(Section 25505 of the California Health and Safety Code requires, with some exceptions: that a Business Pian be tiled with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 5DO 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 fila a registration form for acutely hazardous materials? ❑Ves ❑ 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 theappplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)?
[:I Yes 1--)No
(Section 25534 of the California Health and Safety Code provides that the Costa Mese 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.
.........___..........._._.............._.......................__.....as ..............................................................................................................................._._.................................................a........................................................................................
4 If an RMPP is presently required, has Section 25534 of the Califomla Health end SafetyCode been fully complied with? ❑Ves ❑ No
5 Does or will the applicant at or future building occupant require for the work which Is she subject This a plication appermll for such construction or oditicatlon
from me South Coast Air Quality
liry Management District or from any other air pollution control district or agency? UYes u No
(Section 65850.2 of the California Goverment 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? ❑Ves ❑ No
(If yes', the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
._._........._........................_.........._.........._ __ _.............
__.
7 If a omit 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
appllcatlon, have all of the disclosures prescribed by Califomia Health and Safety Code Sectlon 42303 been made? ❑ Ves ❑ 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 1 have read this application and state that the Information given Is
correct. I agree to comply with all state laws and dry ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the
above-described prepeRyfoTf spection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
// rterts) Date
�A rAuthodzed Applicant Dale— —�--a
CODE If INSPECTION TYPE 263 INTITIAL$ CODE INSPECTION TYPE PATI INTMA
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 BlocktRetalning 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
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
MECHANICAL PERMIT
Job Address: 307 E 19TH ST
Suite No
Vicinity:
Parcel Number: 11725421
Applicant:
GINA SERRAO�
SCOPE OF PERMIT
Address:
33231 ACAPULCO
MECHANICAL TO INCLUDE: 1 INST
At < 100 K BTU AND 1 REFRIG SYS Z 100 K BTU.
Phone:
(949) 496-3639 .'
DANA POINT, CA
Zip:
92629 -
Owner,
MAEZ=AKINS, ANGELA
FEE SUMMARY
Address:
307 E 19TH ST
Quantity
-
Phone:
(949)514-0170
ISSUE FEE
COSTA MESA; CA
Zip:
92627-2348
Contractor: SEASIDE AIR CONDITIONING & HEATING
Address: 33231 ACAPULCO
Phone: (949) 496-3639
DANA POINT, CA Zip: 92629
License: 736214
ISSUED BY:
Status: ISSUED
Applied: 07/31/2003
Issued: 07/31/2003
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
2"646 161110)
SCOPE OF PERMIT
MECHANICAL TO INCLUDE: 1 INST
At < 100 K BTU AND 1 REFRIG SYS Z 100 K BTU.
FEE SUMMARY
Quantity
Quantity
ISSUE FEE
$23.50
Repair / Alt Absorblion 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
Refdg Sys <100 k BTU
$14.80
1
Domestic Incinerator
$0.00
0
Refrig Sys >100 k BTU
$0.00
0
Compressors / Absorption Systems
Gas Piping
$0.00
0
Up to 3 hp / 100k BTU
$0.00
0
Factory Fireplace
$0.00
0
3 To 15 hp / 500 k BTU
$0.00
0
Hood w/Mech Exhaust
$0.00
0
- 15 To 30 hp / 1,000 k BTU
$0.00
0
VAV Box
$0.00
0
30 To 50 hp / 1,750 k BTU
$0.00
0
Vent Fan / Single Duct
$0.00
- 0
Over 50 hp/ Over 1,750 BTU -
$0.00
0
Appliance
$0.00
0
Boilers
Fire Dampers
$0.00
0
Up to 3 hp
$0.00
0
Smoke Dampers
$0.00
.0
3 To 15 hp
$0.00
0
Inst or Relocate Appl Vent
$0.00
0
15 to 30 hp
$0.00
0
Air Handlers < 10000cfm
$0.00
0
' ' 30 to 50 hp
$0.00
0
Air Handlers > 10000cfm
$0.00
0 -
Over 50 hp
$0.00
0
Floor Furnace
$0.00
0 _
Other Mechanical Fee -
Floor or Suspend Heater
$0.00
0
Investigation Fee
$0.00
Plan Check Fee
$0.00
Reinspection Fee
$0.00
"-TOTAL
CALCULATED FEES
$53.10
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
2"646 161110)
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a certificate of consent to sell -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
❑ 1 have and will maintain workers' compensation Insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit Is issued.
My workers' compensation Insurance carrier and policy number are:
Cartier: Policy Number:
s 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 became 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 thes ovisions.
Applicant Signature: / >l .Serra O Date: -7/3 1/0 3
WARNING: FAILURE TO RE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE ( 00,000), 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 527
3 is ' I Class a LP �O 1—f
Contractor's Signature:C. .c.o Date:
CONSTRUCTION LENDING AGENCY:
❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code).
Lenders Name: Lenders Address:
Signature: Date:
OWNER -BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions
Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to Its Issuance, also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).):
❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not Intended or offered for sale (Sec.
7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work
himself or herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or Improvement Is
sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ 1, 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 contractors)
license pursuant to the Contractors License Laws.).
❑ 1 am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. ❑ Yes ❑ No Drivers Ucensa No. Expires:
Verification of Ownership by (type of document, i.e. - property tax bill or dead):
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? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a to deal year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
.....................................-......................................................................................................................................................................................................................... .............................. .......................................... .......................... .........................
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous 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).
............................................................................... I_..........................................................................................................................................................................................................................................................................................................
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 ❑ No
............................................................................................................................................................................................................................................................................................................................................................................................
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication appermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes u No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
..............._._........_.._—_.................__.........._....____.............._...._.-..__..._................_____................_.___.........................___....................................... ................._....__..........................__.................. _..._
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
(If yes', the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
___.......—_.-.....from ._.......South ...o _._......_...rict.._—_._...._...._...__..........on"t.....___......................................___.____._......._.....___......................._.....___.__ 1'h. i._..
7 If a permit from the South Coast rAires Quality Management District or other eir Dolde S control district or agency is required for the work which is the subject of this
application, have all of the disclosures prescribed by Califemia Health and Safety Code Section 42303 been made? ❑Yes ❑ No
B (If yes", attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the Information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Signature Of Legal Owners) Date
And/Or Authorized Applicant Date
CODE r. INSPECTION TYPE QATE INTmALS CODE INSPECTION TYPE DATE
1616 Fixed System Final Fire Prevention 206 Final Mechanical �Q�
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
J
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesaEC-ECTRICAL PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 307 E 19TH ST
Suite No
Vicinity: ADDITION
Parcel Nunmber 11725421
Applicant: ALBRIGHT, DON
Address: 24661 MENDOCINO CT
Phone: 949425-1515 ISSUED BY:
LAGUNA HILLS CA Zip.. -92653,
Owner: MAEZ-AKINS, ANGELA"
Address 307 E 19TH ST"
COSTA MESA, CA -;
Contractor: - VICTOR JASNIY INC
Address:' 24661 MENDOCINO CT
LAGUNA HILLS CA
Status: ISSUED
Applied: 09/01/2005
Issued: 09/01/2005
=" SCOPE OF PERMIT
PERMIT FOR ADD 589 S.F. TO EXISTING-S.F.D. AND A NEW 265 §.F. COVERED PORCH
REF#: B05-00772
WORK TO INCLUDE 24 LIGHTING FIXTS, 22 RECEPT OUTLETS, AND 16 SWITCHES 1 -
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 cow, a
required Inspections and final approval must be obtained. Failure to obtain Inspections and final approval will result in the expiration of Ing permit.
FOR INSPECTIONS CALL: (714) 7645826
2"546 (W)
>. FEE SUMMARY P
3.
ISSUE FEE,
$23.50
Temp Dist System /Lighting
. $0:00
0 "
Temp service test
$0.00
-
:Busway /100 it °
$0.00
0 , '
Res. a/c package
$0.00
_
"z " Standing Section':
_�' '•
- $0.00
New Res (1-2 units)
$0.00'
- '0�'
Misc Electrical Equipment '-'".
$0.00
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
"`01,'
Lighting Fitts`
$24.92
24
up to 50 kva/kw
$0.00
0-
Recept Outlets
$23.46
22
.................up to 100 kva/kw
$0.00 ..=
0
Switches :_ -
$17.60
i 16
.. .:.............over 100 kva/kw
50.00 "
0 -
Non Res Appl:. •"
x $0:00-
0
- ` ' Low;Voltage Equipment
$0.00 -
r' 0
Res Appl . , •
$0.00
0
, ,, Low,Volt Wiring, System / Ckl
$0.00',
0
Service to 200a, -
$0.00•
0 •;,
„�> MisEConduct ` -�
$0.00
`$0.00
0
Service to 1000a
$0.00�t'
`�# Opr a"
- °" Misc! Conduc or
0
Service over 1000a
x$0.00
0.
Circus ( gen or ride)
'$0 00�
0
Motors l0 1 hp
� so.00
_- 0: -
Circus (mech rid_e.or lights),',
$0.00'
'. 0
Motors to 10hp - A
- .$0.00
0 =
'• ' Christmas Tree Stand ; -:
`$0:00
0 , t
,
Motors l0 50hp_
$0.00
•-,•
- ' .0`"'�
..,:Fireworks Stand ;;"'
$0.00`
-_; 0^'
Motors to 100hp
$0.00
0 -. -
- -,. Other ElectricafFee ,
$0.00,-.
'
Motors over 1 00h
. '$0.00
'0-,i°�
-"
�
Communication drops
- $0.00
0 •
- Investigation Fee - --
$0.00 '
Sub panel to 200a
$0.00: =
'c ,- 0 -
.-_ ; ;Plan?Check Fee., ;. _ `
$0.00
Pole Light Pkg
$0.00
•- _0'
-,ReinspectionFee
- $0.00
Sign Circuits
$0.00'--0,�,-,
'
_
Temp Pwr Pole
$0.00
0
_ -, ,,TOTAL CALCULATED FEES
$89.48
Intermed Pole
$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 cow, a
required Inspections and final approval must be obtained. Failure to obtain Inspections and final approval will result in the expiration of Ing permit.
FOR INSPECTIONS CALL: (714) 7645826
2"546 (W)
DECLARATIONS
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 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 Me Labor Code, for the performance of the work for which this permit Is issued.
�My workers' compensation Insurance carder and policy number are:
carder POIC Number- Z 3 23 ^ 000 / 7 S O - O 4
rTTls section need not be completed if the permit Is valued at one hundred dollars ($100) or less.)
❑ 1 certify that in the perfo nce o �Is
is Issued I shall not employ any person In any manner so as to become subject to the workers'
compensation laws ofiforria, enme subject to the workers' compensation provisions of Sectlon 3700 of the Labor Code, I shall forthwith
comply with se p Ion .
'App cant Signature:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBIECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED
THOUSAND DOLIARE ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 370e OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby.alfirn.thal,l am licensed under provisions yf2 r'F epla 9 (cing with Section 7000) of Division 3 of the Business and Professions Code, and my license is In full
fora end e56-cl-um.'a 8 5 3 `d 3 fo/ �rO/ 7..�) �ClassA B
_Contractors Signature: STvvv Date: '
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code).
Lenders Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby ettirtn'.Ihat untler penalty of perjury theft em EXEMPT FROM THE CONTRACTORS LICENSE LAW far the following reason (Sec. 7037.5, Business antl Professions
Code: Any city O'r,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 slgl)¢d•5tatement t¢at he or sfie7s Iicensetl pursuant to the provisions of the Contractors License law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Prif455ions Cade) 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 eppljmAnt to a bvg penalt�afnot fnbre then�fiu_r! hundred tlollars (5500).):
❑ 1, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not Intended or offered for sale (Sec.
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.).
❑ 1, 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.).
❑ 1 am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires:
Verification of Ownership by (type of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five (5) or more feet in depth Into which a person Is required to descend, will be made in connection with work authorized by this
permit, and that no building structure, scaffolding, 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, Celifomia 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? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Cade requires, with some exceptions, that a Business Plan be filed with the Costa Masa 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 forth for acutely hazardous materials? ❑Yes ❑ No
(Section 25533 of the Callfomia Health and Safety Code, with some exceptlons, requires registration with the Costa Masa 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 theappplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)?
❑ Yes 11No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
....................................................................................................................................................................................................................................................................................... .................................................... ..........................................
4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑ No
5 Does or will the applicant orpresent or future building occupant require for the work which is the subject of this a plication eppermit for such construction or moditicatlon
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? ❑Yes ❑ No
(If yes", the facility must meet the requirement of Sections 25534 and 42303 of the Callfomia Health and Safety Cade).
............................... ........................................... ...............................................................................__........................................................................................................................._.....................................................................
7 If a permit from the South Coesl 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 Califomia Health and Safety Code Section 42303 been made? C] Yes ❑ No
..................... ................................... ... ...... .... ........ .............................................................................................................................. .................................................... ............................. _...........................................................
e (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 ins tion purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final Inspection.
Signatu Date
n OrAuthorized Applicant
CODE #. INSPECTION TYPE Qej.F IIiTITLA4$ CODE# INSPECTIONTYPE gpg INTITIA�
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Raaf 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/Cocupancy
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
MECHANICAL PERMIT
.lob Address: 307 E 19TH ST
Suite No
Vicinity: ADDITION
Parcel Number: 11725421
ISSUED BY:
Applicant: STOKES, JEFF
Address: 24661 MENDOCINO CT
Phone: 949-425-1515
LAGUNA HILLS CA Zip: 92653
owner: MAEZ-AKINS, ANGELA
Address: 307 E 19TH ST
Phone: (949)514-0170
COSTA MESA, CA Zip: 92527-2348
Contractor: VICTOR JASNIY INC
Address: 24661 MENDOCINO CT
Phone: 949425-1515
LAGUNA HILLS CA Zip: 92653
License: 853836
SCOPE OF PERMIT
PERMIT FOR ADD 589 S.F. TO EXISTING S.F.D. AND A NEW 265 S.F. COVERED PORCH.
REF#: B05-00772
WORK TO INCLUDE: 1 VENT FAN/SINGLE DUCT AND RELOCATION OF AC UNIT.
Status: ISSUED
Applied: 09/01/2005
Issued: 09/01/2005
FEE SUMMARY
Quantity
ISSUE FEE
$23.50
Quantity
Inst FAU <100 k BTU
$0.00
0
Inst FAU >100 k BTU
$0.00
0
Repair/ Alt Cooling/Heat
$0.00
0 -
Inst / Rep. Recess Wall Htr
$0.00
0
Refrig Sys <100 k BTU
$0.00
0
Refrig Sys >100 k BTU
$0.00
0
Gas Piping
$0.00
0
Factory Fireplace
$0.00
0
Hood w/Mech Exhaust
$0.00
0
VAV Box
$0.00
0
Vent Fan / Single Duct
$7.25
1
Appliance
$0.00
0
Fire Dampers
$0.00
0
Smoke Dampers
$0.00
0
Inst or Relocate Appl Vent ',
$0.00
,0
-0
Air Handlers < 10000cfm
$0.00
0
Air Handlers> 10000cfm
$0.00
0
Floor Furnace
$0.00
0
Floor or Suspend Heater
$0.00
0
Status: ISSUED
Applied: 09/01/2005
Issued: 09/01/2005
FEE SUMMARY
Quantity
Repair / Alt Absorbtion Unit
$0.00
0
Repair/ Alt Refrigeration Unit
$0.00
0
Ventillation System
$0.00
0
- - - Evaporative Cooler
$0.00
0
Commercial Incinerator
$0.00
0
Domestic Incinerator
$0.00
0
Compressors / Absorption Systems
Up to 3hip /100k BTU
$14.70
1
3 To 15 hp 1500 k BTU
$0.00
0
15 To 30 hp / 1,000 k BTU
$0.00
0
30 To 50 hp / 1,750 k BTU
$0.00
0
Over 50 hp / Over 1,750 BTU
$0.00
0
Boilers
Up to 3 hp
$0.00
0
3 To 15 hp
$0.00
0
15 to 30 hp
$0.00
0
30 to 50 hp
$0.00
0
Over 50 hp
$0.00
0
Other Mechanical Fee
Investigation Fee
$0.00
Plan Check Fee
$0.00
' Reinspection Fee
$0.00
TOTAL CALCULATED FEES $45.45
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 issuspended or abandoned
for a period of 180 days. lY//
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
2446.48 (600) _ • ...
V
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 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 fwhich this permit is issued,
fh 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' compo yLion InslJ►aann4a car' r nd policy umber are: �--�_ ('
Ca 'mar"f -Tl , ` Pdicy Number: 'C7�C O Vy ( ! i
(This section need not be completed /f the permit is valued at one hundred dollars ($100) or less.)
❑ 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as lo become subleel to the workers'
compensation laws of TUNIfi, andgree that I should becomes j to the workers' compensation provisions of tl 3700 the Labor Code, I shall forthwith
comply win 11 ovision ! S q J V
r
�Appficant Signature:�-�'�
WARNING: FAILURE TO SECUR ORKERS' COPENSATION COVERAGE IS UNIAW UL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
LL
THOUSAND DOARE ($10Q , 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 _aflininthat I am licensed under p Isions C Bear 9 rnmmencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in tun
for end effect. Lici S �� Class'ii
( �r.. --
1Contractors'Slgnatu0_ Datce:'^r Z2 U LD
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER -BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions
Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).):
❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec.
7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work
himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is
sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ 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. ❑ yes ❑ No Driver's License No. Expires:
Verification of Ownership by (type of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 1 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, ialsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chep. 3.2, Grp 2, Art 2, Sec.
341,7111a 6, California Administrative Code).
❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every
business which Ras at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
......._................................................_........................_....................._....................................._....................................._........................................................_._.._............._.._.................................._............._.....................................................
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous 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 appplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)?
E] 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 presentty required, has Stiction 25534 of the Cakfomia Health and Safety Code been tufty complied with? Oyes ❑ No
5 Does or will the applicant orpresent or future building occupant require for the work which is the subject this a plicaP
tion aLl No 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 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 6a within 1000 feet from the outer boundaries of a school? ❑Yes ❑ No
.
(if -yes-, the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
.
............... .....................................................................................................................................................................................................................................................................................................................................................
7 If a permit Irom the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
................................_...................... ................ -._..............................................-........................................................................................................................................................ _........................... ...............................................
..................ttac .
e (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 slate 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 allo upancy of any building authorized by this permit until final inspec ion.
ure eg (s) at
u to
Or thorizetl Applicant Date
CODE I, INSPECTIONift9i gN INTITIALS CODE INSPECTION TYPE ggg INTRIALS
1616 Fixed System Final Fire Prevention 206 Final yeanical
1 . ool Spa Final r'Fl•1 20 Final Plbing
2 Final Re- f II
21 Final EI M
201 fdn B Rate, I g II 11 27 FInaI:Fd6 Prev6 . B
I
202 Fi k acto F' JIa���; 22'01 Final Pl'a/nning proval �lII
203 Final Signe 222 Final Site "may I
204 Final Demo ition 250 Final Building/Occupancy
(714) 754-5273 • Fax (714) 754.4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 307 E 19TH ST
Suite No
Vicinity: ADDITION
Parcel Number: 11725421
MECHANICAL PERMIT - -
Status: ISSUED
Applied: 09/01/2005
Issued: 09/01/2005
ISSUED BY: rn
Applicant: ALBRIGHT, DON
Address: 24661 MENDOCINO CT
Phone 949-425-1515 -
-:=-
LACUNAHILLS CA - '' Zip: 92653 .-
owner: MAEZ-AKINS, ANGELA"
Address 307-E 19TH ST e
�Bhone (949)I5�140170 �-•
COSTA MESA, CA ' Zip 92627-2348
Contractor.' VICTOR JASNIY INC
Address: 24661 MENDOCINO CT
Phone: .949-425-1515.
LAGUNA HILLS CA Zip: 92653 -
. License: 853836 1 -
FEE SUMMARY
VAV Box
.$0.00
Quantity :.,--.
_ ._.
- --
Quantity
ISSUE FEE - ; '
$23.50
$7.25 ,
Repair) Alt Absorbtion Unifr
sobo --0
7 Over 50, hp'/ Over 1,750 BTU
Inst FAU <700 k BTU '
$0 00
0
----Repair:/ Alt Refrigeration Und ���_'
��,_Ve'ritillatio,n'System
$0.100
_ 0
Inst FAU >100k BTU ?-
$0.00
0 _
.��;', ..";'-
? $000,
0'''?
Repair/ Alt Cooling/Heat �-
$0.00
0 ;'.' --- -- _
Evaporative Cooler,
$0-00k
0
Inst / Rep. Recess Wall Htr
$0.00
0
Commercial Incinerator -'
($0.00 "
0
Refrig Sys <100 k BTU
$0.00.
0
Domestic Incinerator
- $0.00'
,0
Refrig Sys >100 k BTU
$0.00
0
Compressors / Absorption Systems
�30 to 50 hp---- -• % F,^: - >
_'' $0.00
Gas Piping
$0.00
0
Up to 3 hp / 100 k BTU
-
'._:`.Over 50 hp- - -
Factory Fireplace
$0.00
0
•;' 3 To 15 hp / 500 kBTU -
- '$0 00 ---�0
Hood w/Meth Exhaust'
$000
0
-15 To 30 hp / 1,000 k BTU
$0.00 %
-^0
VAV Box
.$0.00
0.t.,,;
,"•-30To50:hp/1,750kBTU `-
'$0001,-
0
Vent Fan /Single Duct
$7.25 ,
1
`" `" -
7 Over 50, hp'/ Over 1,750 BTU
$0.0W
0
Appliance
$000
0'''
�Boilers
Fire Dampers _
$0.00
0 '' -
t--
�• Up to 3 hp, f'
"$0.00
0
Smoke Dampers
$0.00
0,'
- 3 To 15 hp, ,
- `$0.00
0
Inst or Relocate Appl Vent.
$000
0:
15 to 30 hp '
$0.00
0
Air Handlers < 10000cfm
$0.00
0, --
- -
�30 to 50 hp---- -• % F,^: - >
_'' $0.00
0
Air Handlers > 10000cfm -
$0.00
0 -.,
-
'._:`.Over 50 hp- - -
$0.00
0
Floor Furnace
$0.00."0
^
- Other Mechanical Fee
Floor or Suspend Heater
"-$0.00
0
z ,"`�
,. .. Investigation Fee- ^. -
$0.00
-
Plan,Check Fee 3
$0.00
,uReinspectionFee": _�''
$0.00
r,
TOTALCALCULATED FEES
$30.75
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 app) caf b�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) 7545626
DECLARATIONS
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 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.
"ffFI 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.
�CerrleMry-,sw,a•_•`e✓` mpensSiJoY7—T£ ce Cn.d policy number are:
•.¢) PWIcyllS,-2300
(This section need not be completed if the permit Is valued at one hundred dollars ($100) or less.)
❑ i certify that in the perform ca of me orf+ eewhldRthJs permit Is issued, I shell not employ any person in any manner so as to bocome subject to the workers'
compensation laws of Ca fomia, an ere the h5 ma subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with these provisi s.
r—i
tApppcanl SlgneNie:
WARNING- FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED
THOUSAND DOLLARE (5100,000), IN 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:
Lhereby,afflrmdhat I em licensed under provisions c hapter (a mlYroncirtg Ith Section 7000) of Division 3 of the Business and Professions Code, and my license Is in full
force end effect. uc. a S 3 3 s _
-ContraUor� s ,.Signature:.
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 affiml 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 coun�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 stetem_ which
he or she,is licensed pursuant to the provisions of the Contractors license Law (Chapter 9 (commencing with Section 7000) of Division 3 o1 the
Busines9 rofessf{iri'e Code)'or;that ha or she Is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subject plicant 61 civil penaltyoi not more than five hundred dollars ($500).):
❑ I, as r of Iheperty, or mvy employees with wages as their sole compensation, WILL 00 THE WORK, and the structure is not Intended or offered for sale (Sec.
7044, Iness and Professions Cade: 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 W. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires:
Venfcatlon of Ownership by (type of document, I.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 1 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, Califomla Administrative Code).
❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such portion 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 Cr threatened release of a hazardous
material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons,
.or 200 cubic feet, of compressed gas at standard temperature and pressure).
............. ................................................................................._......................._.........................._.._.......................__._...___........................__............................ ............... _..........................
2 Does or will the applicant or present or future building occupant need to file a registration forth for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the Califomia Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
......................._.............. _........... ___.................. .... ......... ...................................... ___..................... ..................... _......................... __......................... _..................................................... _.......................... _.... ...............................
__......
3 Does or will theapplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)?
❑ Yes ❑ WI
(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.
............._..........._.................................."........_._...........................__.._.....................................__...................._._................."'C-0.......................__..................................__..... ____......._............_......................_._..........................
4 If an RMPP Is presently required, has Section 25534 of the Califomia Health and Safety Code been fully camplietl with? ❑Yes ❑�No
.............................. ....................................................................................................................................................iCh........th...-su............................................................................................."...""_..........................._......................
....................... .
5 Does or will the applicant u present or future building occupant require for the work which Is the subject c this a plication appertnit for such construction or motllficatlon
from the South Coast Air Quality Management Distract 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 an................................................................................................
y pert of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Ves ❑ No
(If yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
... .................... _.................................... __.........._..........._......._._.........................................._......................_.......................__..........................._................................................................_.......""..._...............................I.............................
7 If a permit from the South Coast Air Quality Management District or other air pollution Control district or agency is required for the work which is the subject of this
application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
e (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 inspe uposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Date
r.AncUOr"Autho`ila ApplicanI_I, Date—'
CODE b. INSPECTION TYPE 2&M II®AL$ CODED INSPECTIONTYPE PAU /
1616 Fixed System Final Fire Prevention 206 Final Mechanical eo
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
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa."MBING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 307 E 19TH ST
Suite No
Vicinity: ADDITON
Parcel Nunmber: 11725421
Applicant: ALBRIGHT, DON
Address: 24661 MENDOCINO CT
Status: ISSUED
Applied: 09/01/2005
Issued: 09/01/2005
ISSUED BY: `' D
Phone: - 949-425-1515
LAGUNA HILLS CA Z+p.--
Owner: MAEZ-AKINS,ANGELA.
Address 307 EA 9TH STr `
COSTA MESA, CA, Ph Z p 92627-2348170 W"I
P
Contractor: VICTOR JASNIY"INC
Address:. 24661 MENDOCINO CT
Phone: 949-425-1515
LAGUNA HILLS CA Zip: i -..92653 -
License: 853836_1 -
'-"-- SCOPE OF PERMIT=- -
- PERMIT FOR ADD 589 S.F. TO EXISTING S.F.D. AND A NEW 265 S.F. COVEREDIPORCH' � ..�
REF#:BO5-00772,
"WORK • TO INCLUDE: 1, BATHTUB, -1 GAS (1-4 OUTLETS) 1 LAUNDRY TUB/WASHER, 1 SHOWER 1 t •,',�
[-WASH-BASIN SET, 2 WASTE AND VENT SYISTEM,i1;WATER CLOSET (TOILET) AND71 WATER,: '�^
+HEATERIVENT.
COMMENTS / SPECIAL CONDITIONS
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and elated
regulations. (Orel. 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 suspe ed or abandoned
for a period of 180 days. ell
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 expirationofthis permit.
FOR INSPECTIONS CALL: (714) 7545626
rVie.m
>.FEE SUMMARY
41
1
AMT
- _. -. _-----,-:AMT
SOT
-Y-'
-- ,-✓,'
.."AMT
CITY
ISSUE FEE -
$23.50
-
' ` Laundry Tub/ Washer
--$9.80
1 -
Sump Pump
$0.00,'
0
Backflow irrigation
$0.00
0
- Landscape Irrigation
$0.00
0
Swimming Pool-
$0.00
0
Backflow Preventer
$0.00
0
P -Trap
' $0.00
0
Trap Primer
$0.00
0
Bathtub' `-:
,-
"$9.80
1",
Pressure Regulator
$0.001-,,-
0
Urinal! :e
$0.00
0
Clarifier System
$0.00
`0 i�
Process Piping (per 10
ft) $0.00
0
Vacuum Brkr Bkflow(1-4p
$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 w
=$0.00
0
Wash Basin .,
=; $0.00
0
Dishwasher -
$0.00:
0
Sewer Cap fdr D
$0 00 „„
0
Wash Basin Set --.
$0.00
0
Drain, Floor
''$0 00�-
".0
Sewer Connectemo
$0.00 : ;.0
�, Wasteand Vent System.'
$19.60
2
Drain, Rainwater
$0.00
-'0
„i-SewerPrivale; Line
` $0.00 '"'
0
.'".--"Water Closet (Toilet) _'
$9.80
1
Drain, Roof
$0.00
0- --
Shower -.
-$8.80
1
-aWater Heater/vent
$12.30
1
Drinking Fountain
$0.00.
0
Smk bar - - ""
$0.00 .0
-' " Water Piping (Inst or Rep.)
$0.00
0
Expansion Tank
.$0 00
0
Sink, commercial - - ..
,
» $0.00.'...-0`
Water Re•pipe,
$0.00
0
Gas Earthquake Valve
,`,,,-`$0 00
• •,'' 0
jr=�.� Sink Floor ;
$0.00 %s.0
i0'' Water Service,E '�
$0.00
0
Gas (1-0 outlets)
--$6.15
`' 1 tip'
-`- Sink, kitchen-
_
E $0:00 -"'0
' _•� `;Water Softener`
$0.00
0
Gas (Over 4 outlets)
$0.00
0 '-�_'_
- ...Sink, service/mop
$0.00 . x,03',.
OTHER.;
$0.00
Gas Repipe
$0.00
- 0-
=f ,. �Spa,(private);�
- '$0:00„„:0
--
VIOLATION
$0.00
Gas Service
$0.00 �`
6
`Spa (public)
^ -i $0.00, : `0
= PLAN CHECK
$0.00
Interceptors (Grease, Oil)
$0.00
0REINSPECTION
$0.00
0
Interceptors (Sand Auto )
$0.00
0
.._ .
%•.;+ .,
TOTAL CALCULATED FEES:
$100.75
COMMENTS / SPECIAL CONDITIONS
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and elated
regulations. (Orel. 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 suspe ed or abandoned
for a period of 180 days. ell
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 expirationofthis permit.
FOR INSPECTIONS CALL: (714) 7545626
rVie.m
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a certificate o1 Consent to self -Insure for workers' compensatlon, as provided for by section 3700 of the Labor Code, for the pedornance of the
work for which this permit is issued.
gi�I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor COdO, for the performance of the work for which this permit is Issued.
My workers' compensation Insu/ran�ce carder and Policy number are:
Cartier. Si7}-/� NNS paipy2:38-000I�so -04
-(This section need not be completed If the permit is valued of one hundred dollars ($100) or less.)
❑ 1 certify that in the Perferme o t work for which this permit is Issuod, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of Ca' oris, and r tat s ul me subject to the workers' compensation provisions o1 Section 3700 of the Labor Code, I shall forthwith
comply with.these provi ons
ApplltahCSigneture: Date:
r a-
WARMNG: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER.TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED
THOUSAND DOLLARE (5100,000), IN ADDMON TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR W SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm. that I am licensed under provisio of Chapte 9�gmme�Ong with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full
foormanA iifhx: 'Lic8 . a 85 3 i iClass ate:. 3
Contr� Signature. Date:" 9
L�
CONSTRUCTION LENDING AGENCY:
❑ 1 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).
Lendefs Name: Lenders Address:
Signature: Date:
OWNER -BUILDER DECLARATIONS: . .
I hereby het under penalty ofJu'ry that I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business antl Professions
Code: A�f-bounty whlph require6:e.pertnit to construct, alter, improve, demolish, or repair any sWcture, prior to its issuance, also requires the applicant for such permit
to file a s st lament (hat he or she9s licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (cemmenclng with Section 7000) of Division 3 of the
Business and essions'�Cotle) or Wp1 he Or she is exempt Nerefrom end the basis for the ellege0 exemption. Any viWation of Section 7031.5 by any applicant for a permit
subjects the nt to e ciHl 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.
704, 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.).
❑ 1, 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 contractors)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires:
Verification of Ownership by (type of document, Le. - property tax bill or dead):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 1 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 ❑ No
(Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons,
or 200 cubic feet of compressed gas at Standard temperature and pressure).
...........................................................................................................................................................................................................................................................................................................................................................................................
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the California Health end 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).
................................................................................. I ........... .-.............................................................................................................................. ................................................................................ ............................... ... ....................................... ... .
3 Does or will the appplicant or present or future building Occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)?
❑ Yes ❑ fJ0
(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, hes Sactlon 25534 of the Celitornle Heelfh end Selety 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 apo mit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes a No
(Section 65850.2 of the California Govemment Code requires that the requested Information be furnished on applications for non-residential building permits).
..........__...................................................................................................................................................................................................................._..........................................................................._..........................................................................
8 Will any pen of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
(if -yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
...........—_.................._.............................................................,..........................
.............................................
......
................................................................................................................................_........................._...............................................
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this
application, have all of the disclosures Prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8 (If yes', anach certificate of compliance from the eDPropdate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the Information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for in pec"`n rposea. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
e
Date
And/Or.AuthonredApplicant ice+ ( Dete 17
CODE f, INSPECTIONTYPE PATY jNTMAL CODEf INSPECTIONTYPE UM INTRAIL¢
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re -Root 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
2G4 Final Demolition 250 Final BulidingrOccupancy
(714) 754.5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
ELECTRICAL PERMIT
Job Address:
307 E 19TH ST
Status:
ISSUED
Suite No
Applied:
08/16/2001
Vicinity:
BATHROOM
Issued:
08/16/2001
Parcel Nunmber: 11725421
Applicant: AKINS, SHAWN ISSUED BY:
Address: 307 E 19TH ST - - - - - -
'� . Phone: (949) 514-0170-
1
COSTA MESA, CA - Zip:92627
Owner �MAEZAKINS ANGELA
Address " • 307 E 19TH ST
A
Phone: (949) 514-0170 ' �-
COSTA MESA, CA Zip: 92627
Contractor: OWNER -BUILDER
Address:
:Phone: -
Zip: _
License: 0
SCOPE OF PERMIT
ELECTRICAL PERMIT FOR NEW BATHROOM CONVERSIONANSTALL 51IGHTING FIXTURES, 2
RECEPTACLE OUTLETS, & 1 SWITCH.- - - • < •- - ,
REF: BOI-01287
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' - $5.50 5 .. _ .............up to 50 kva/kw $0.00' 0
Recepl Outlets $2.20. 2 .................up to 100 kva/kw $0.00 0
Switches $1.10 1 ..................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 10
Service to 1000a - $0.00 - 0 Misc. Conductor - "$0.00 0
Service over 10000 $0.00 0 Circus ( gen or ride) $0.00 ; 0
Motors to lhp $0.00 0 Circus (mech ride or lights) $0.00 / 0
Motors to t Ohp $0.00 0 Christmas Tree Stand $0.00 0
Motors to 50hp $0.00 0 - Fireworks Stand - $0.00 0
Motors to 100hp $0.00 - 0 Other Electrical Fee $0.00
Motors over 100hp $0.00 0 '
Communication drops $0.00 0 Investigation Fee $0.00
Sub panel to 200a $0.00 0 Plan Check Fee $0.00
Pole Light Pkg $0.00 0 Reinspection Fee $0.00
Sign Circuits $0.00 0
Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $32.30
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 vold 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) 7645626 /
2"6-48 (600)
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.
❑ 1 have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit Is Issued.
My workers' compensation Insurance carder and policy number are:
Cartier: Polity Number:
(This section need not be completed N the permit is valued at one hundred dollars ($100) or less.)
❑ 1 certify that in the performance of the work for which this permit is Issued, I shall not employ any person In any manner s0 as to became 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 3716 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. IJc. # Class #
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code).
Lender's Name: Lenders Address:
Signature: Date:
OWNER -BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the fallowing 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 perrn
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.).
❑ 1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professlons
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.).
❑ 1 am exempt un or sec. fiiismess and Professions Code for this reason:
ure
Signat- k � --- Date: —7 �. _ /( d
Owner ID verified by drivers license. ❑ Yes C]No Driver's License -No. Expires:--�
Verification of Ownership by (type of document, I.e. -property tax bill or deed): �— �.__/—T
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five (5) or more feet In depth into which a person is required to descend, will be made in connection with work authorized by this
permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap, 3.2, Grp 2, Art 2, Sec.
341, Title 8, Califomia Administrative Code).
❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
..........................................................................................I........_.......................................................................................................................................................................................................................................................................................
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous 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
❑ Yes ❑ IJo the appplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)?
(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 It an RMPP is presently required, has Section 25534 0l the CAlifomie Health and Safety Coda 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 ofthis ,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? LI 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 pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? [D Yes ❑ No
(if 'yes". the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
_............_._............__.................__................................._....._...._............... __...... ___...................... _._........................ _.......................... _...................................... __.._........................................ _._............. .................. _
7 If a ppeermit from the South Coast Air Oualiry Management District or other air pollution control district or agency is required for the work which Is the subject of this
epplleation, have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? ❑ Ves ❑ 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 inlormatlon 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 n to occupy or allow occupancy of any building authorized by this permit until final inspection.
�- /P f_ .
Signature Of Legal Owner(s)� Date
And/Or Authorized Applicant Data
CODE r. INSPECTIONTYPE ATE INTITI LA $ CODE INSPECTIONTYPE gdg INTITIA
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
G
(714) 754-5273 • Fax (714) 754.4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Job Address:
307E 19TH ST
Suite:
08/16/2001
Vicinity:
BATHROOM
Status:
ISSUED
Applied:
08/16/2001
Issued:
08/16/2001
Parcel Number: 11725421 Zoning:
Applicant: AKINS, SHAWN _ ISSUED BY:
Address: 307 E 19TH ST
Phone: (949) 514-0170 _ -
COSTA MESA; CA= - Zip: 92627
Owner: MAEZ AKI ANGELA �-
Address 307E_19TH-ST
�` Phone: (949) 514.0170-
,COSTA MESA; CA - Zip: 92627
Contractor: 'OWNER -BUILDER
Address: '
Phone: - �A
Zip: License: 0 ,
Arch - - Eng: -
Address: Address:,
Phone: - Phone: -
Zip: - - - License: license:
" JV VrL Vr rLl�l�lll
CONVERT EXISTING 56 SO FT LAUNDRY ROOM INTO NEW BATHROOM./FRAME IN EXISTING DOORWAY, REPLACE FLOOR,
& CREAT NEW DOORWAY IN EXISTING NON-BEARING WALL.
PARKING Existing: o Required: 0 Proposed: o
NOTES:
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit
FOR INSPECTIONS CALL: (714) 7545626
244646 (6=)
FEE SUMMARY
Plan Check:
$72.31
Calc Valuation: $5,000.00
Permit:
$111.25
=
Claim Valuation:
SMIP Res:
$0.50
„$5,000.00
SMIP Com:
$0.00
Other:
$0.00
Inspection:
$0.00
,
Notal:
$184.06
PLANNING&ZONING
SETBACKS
MAIN STRUCTURE Front 0-0
Rear 0-0 Left 0-0
Right 0-0 -
ACCESSORY
Front 0-0
Rear 0-0 Left 0-0
Right! 0-0
PARKING Existing: o Required: 0 Proposed: o
NOTES:
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit
FOR INSPECTIONS CALL: (714) 7545626
244646 (6=)
WORKERS' COMPENSATION DECLARATION:
I hereby oferm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a certificate of consent to Self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance o1 the
work for which this permit Is Issued.
❑ 1 have and will maintain workers' compensation insurance, as required by secfion 3700 of the Labor Cade, for the performance o1 the work for which this permit is Issued.
My workers' compensellon Insurance caller and policy number are:
Cartier. T Policy Number.
(This section need not be oompleted if the permit Is valued of we hundred dollars ($f00) or less.)
❑ 1 certify that in the performance of the work for which this permit Is Issued, I shall not employ any person in any manner so as to became subject to the workers'
compensation laws of California, and agree that if I should become subject to the workers' compensation provisions o1 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 SUSIECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED
THOUSAND DOLIARE ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR OODE, 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 NII
force and effect. Lid. N Class M
Contractors Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ 1 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 affirn that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW lot the following reason (Sac. 7031.5, Business and Professions
Code: Any dry 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 DNlslon 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 party'
,subjects the applicant to a cMl penalty of not more than five hundred dollars ($500).):
"k-11, .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 appy to an owner of property who builds w 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 o1 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 contreclor(s)
license pursuant to the Contractors License Laws.).
0 l am exempt -under sec. B ass and Professions Code for this reason:
`ignatura:%'"'�/�� Data:, . G
Owner ID verified by drivers license. ❑ Yes ❑ No IOnvers,Uoemse N6: \'
Verification of Ownership by (type of document, Le. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certity 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? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
..._..—.._........_—__............_......................................._._.._........................................................_................ationt.............__.___.""""—".......__..... a,............."_
..._......_....__........._.....".....__.................
2 Does or will the applicant or present or future building oaupant meati to lila a registration form for ecutety hazardous materials? ❑Yes ❑ No
(Section 25533 of the California Health and Safety Code, with some exceptlons, 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 Mass 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 Selery Code been fully cromplietl with? ❑Yes ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject ofthis a plication eggernii 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 pan of the facility to be constructed untler this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑ No
(it 'yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
.................................... _........_................._..___......_.__..__......"--"'--'._..._...._....._._.._.... ..___................. _..........................
7 If apermit from the South Coast Air Quell ry Management District or other air pollution control district or agency Is rotred for the work which is the subject of this
application, have all of the disclosures press bed by California Health and Safety Code Section 423D3 been made? ❑Yes ❑ No
8 (If'yes', attach certificate of compliance from the appropriate air pollution control o11lcar).
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 inspectlon purpwe9. 1 agree no o occupy or allow occupancy of any building authorized by this permit until final inspection.
Signetuma Of Legal Owner(s) .s:DAte z
And/Or Authorized Applicant Date
CODE t. M$PECf10N TYPE PAIR Q(TIT11, CODE INSPECTION TYPE gdjE INTITLALS
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/Relalning Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site �n���-,+�
204 Final Demolition 250 Final Building/Occupancy u' -'0v--"-�
PROJECT ADDRESS; 307 E 19TH ST UNIT:
OWNER'S NAME: MR. MIKE PARKS
*40OGEss: 307.E 19TH ST
COSTA MESA "
r. CA 92627
(714)557-2063
' ARCHIENGINEER: ACTEC ENGINEERING CORP. REG.li NONE
ADDRESS: 1312, WEST•COLLINS,AV UNIT:
ORANGE- CA 92667
PERMITTEE: MIKE PARKS (7 14) 5 -2440
ADDRESS: 307 E 19TH ST
CM - CA 92626
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing b Batman
7000) or Division 3 of the Business and Professions Code, and my license is in full force and effect. - -.";. •,•
CITY LIC.: STATE LIC.: . , CLASS: r
Date: Signature: '
YORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure or a cer ificam of Workers'
1mDensafion Insurance, or a certified copy thereof (Section 380D, Lab. C).
POLICY ND.: EXP. DATE:
ICOMPANY:'�.
El Certified copy is hereby fumished.' ❑ Carolled copy is filed with the city Bullding Division.
`1 � .
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION_r.(This section need not be Completed if tmhg permit is for one hundred ($100) m less).
I certify that in the performance at the work for which this permit is issued, I she not amp l ny pe on m manner so as to become
subject to th W//orr�kers'C(Jam/osensa[ian Caws of California., 7//
.Date: —"E '— 4V-"' Signature: r�'� -
NOTICE: If, off B this declaration. you should become object to the Workers' Compensation provisions of the Labor
Code, you mus th comply with such provisions or this permit shall be deemed revoked. ,
CONSTRUCTION lE AGENCY: I hereby affirm that there is 9 construction lending agency for the performance of the work for
which this permit' (Section 3097, Civ. Q.
IFNDE�
ADORES : .. . .
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason
(Section 7031.5 Business and Professional Code:' Any dry 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
pursuant to the provisions o/ the Contractors' State License Law (Chapter 9 (commencing With Section 7000) of Division 3 at the Business
and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
applicant for a permit subjects the applicant to a civil penalty of not mom than five hundred dollars ($500).
I, as owner of the property or my em
ntr
loyees With wages as their Sole compensdion, Will do the work, and me
—I Structure is riot intended or offered for sale (Rection 7044, Business and Professional Code: The Coactors' State License Law
I does not apply to an owner of a property who builds or improves thereon, and who does Such work himself/herself or through
wn
his or her oemployees, provided that such improvements are not intended or offered for sale. If. however the building or
improvement is sold within one year of completion, the owner Will have the burden of proving he/she did not build or improve
for the purpose of sale).
1 1, as owner of the property, am exclusiveN contracting with licensed contractors to construct the project (Section 7044, Business
and Professions Code: The Contactors' State License Law does not apply to an owner of property who budd3 or 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 am exempt under Section: G. & P. C.
for this reason:/} 7v i
Data: 4 ; i q —`Zy Owner:
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505, 25533; and
25534 and that 1 or any future building occupant Wilgwill not (circle ane) need to comply with said state codes and the requirementsfor a
permit for.construction or modification from the Air uality Management District. Residential construction applications are exempt from
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 f and state laws reposes to building construction and here amlrorize representatives of c e the above-mentioned
ordinance�s ninspection ure%lla� /purposes.
`OateiB`R—`ZV Signature:
Driver's License or Social Security w:
164146 White—Building; Green—Cade Enforcement; Canary—Applicarl; Pink—Revenue; Goldenrod—Assessor
Y�
CITY OF COSTA MESA - BUILDING PERMIT PERM NO: HEP 046865
PERMIT NO: HEP 046865
CONSTRUCTION TYPE: 5-N
PLAN CHECK NO; 03533-90 S
PERMIT TYPE: ELE PLU STR
JOB DESCRIPTION : ADD HOBBY.ROOM 6 BATH O/EXISTING GARAGE
GOVT: N SUPP: N
PURPOSE: ADD
SQ FT: 380
CLAIM VALUE:- CALC-VALUE: 26,220.00 GROUP OCC: R-3 /M-1
COMMENTS: ADD HOBY ROOM ABOVE DETACHED GARAGE
**r*�:rsrsr�:r�*EHsr**rr:r**�t****:rsrx•Sr*+tr*r+t****SE*+trH:r�t�E**rr*r:E:r*it:H*r+t*!t*�*w�*�****+E�*�+E:r*
Z O N I N G R E Q U I R E M E N T S
Y S E T B A C K•S
--=--------- MAIN BUILDING ---------- --------- ACCESSORY BUILDING ----------
FRNT: FT IN:REAR: FT IN FRNT: 41 FT IN REAR: 46 FT' IN
.LEFT: FT IN RGHT: FT IN LEFT: Q2.FT 6 IN RGHT: 5 FT IN
)=
ilfARKING REO• PROV: PARCEL: 11725421 ZNE: R1 REF NO:
PLANNING N TES> 2ND FLOOR HOBBY ROOM OVER AN EXISTING GARAGE. LAND USE
f '>-RESTRICTION HAS BEEN RECORDED.
9t9tit****itiE?N**i>Eit*itfit*et**iEif9t*;tt***it*iE**4H9eiti>Eieit*iH***ititNiFrtik9a94***coed*iF******M*if ifiElt+EiEifikit%Ik
D E V E ,•L' O P M E N T S E• ,R V I C E S ./ R E Q U• I R E M E N •T S
ZONING APPROVED BY DATE:
BUILDING APPROVED BY : DATE:
APPLICATION ISSUED BY DATE:9(
ked*ee iFMik*3t*4H cent***k***it*MMefet lk*1t MiFN
k*9H*iIHM9e it9eM M4FM%edit**MiFMMik*ifMM9f Mek toed 4FiHx ***9t iF �FiFw***eFit*iF34 iE*****stir•****M1HiF***iE;t*iF et
LEGALIZATION':N F E E';`: U M M.A RY." STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELEC- IC :•MECHANIC i, 'FIRE SMIP%RES l :GRADING
PERMIT 265.00 15.00 '2 25._.. �,' J'• ,1'.8'4Y
PLAN 172.25.
2541. 50%, } SMIP;/NON-RES
,�
ISSUE FEE 3.00 x'15.00 y
BUILDING -DIV-> PERMIT ISSUE PLAN-CHECKr-- TOTAL PAID `' DUE
'
TOTALS ---- > 305:09 18,.00 172.25 495.34. 495.34 r. .00'
'T • ,
Y
REVENUE DIVISION TOTALS--> COLLECTED!:-' 323.09:' OVER /SHdRT:;'-.' .00
BLDG PMT PLUMBING ELECTRIC 'MECHANIC.:.rFIRE SMIP/TOT GRADING PLAN-CHECH
265.00 18.00 -38.25
iF 9F**k*Mekit ee 9Fit9t****iFitit Btererititie*;w***Mgt 941 M4tM9ritit 941 ilia*****et eF******k MM±F;µet**et;tetitit*941 et it 4F 4F etk9tt
I N D I V I D U.AL` F 'E E B •R E- A'K DO W'N,
4
TYPE QTY D E S Ce R I P T I OI N ! UNI.T COST NOTAL COST
SFR 380 DWE-TYPE V -WOOD FRAME V GOOD' • 'y ,,69.0.0A, ' ( 26, 220.00
ELE 7 FIXTURES, LIGHTING . 1 ST 20 EA; .75 ma`s 7 , 5. 25
ELE 14 RECEPT/OUTLET 1 'ST 20 EA;:: .75.) _ 10:! 50
ELE' 10 RECEPT/SWITCH 1 ST EA.' .75 i''++ _=7:50
PLU , 1 SHOWER ..! 2.00 �; 0 0o_ :� 2.00
ASIN
PLU- 1 WATERPLU I WASH CLOSET(TOILET) 2,00 ,'•,p '! 2.00
PLU 1 WATER HEATER AND/OR...VENT- r•. 2.00 `t. +2.00
PLU 1 SEWER, CONNECTION.TO BUILDING EACH' 5.00, <'y,::., ;r 5.00
PLU 1 SINKS, SERVICE. / MOP 2.00,' ,,;C y ;.-+' %2:00
END OF • FEES.. !, Il rti ' j
Es 01 00058104-0005 1 T CrT -323.09.
- DATE: 04/09%90. TItiE: 10:20
CONS`PRUCTION AND PLANNING
OOL t
APPROVALS _ Permit #
•Temporary
Date
Inspector
APPROVALS Permit #
Date In W_for
1. Electrical Service or Pole
52. Pool & Equipment Location
,Sail,Pjp� Unr1rgFnd,,
53. -Steel Reinforcement
'-� 3ihs_l�ctrfciN6orQitlii-Utility-Undrgrnd.
54. Forms - -
` H� �, it-Undrgrnd.
55. Electrical Bonding
;El SmeF El tforc6ment
-
56. Rough Plumbing & Pressure Test
o
'" rtect6'RbFE`M;Qrnd.
57. APPROVAL TO COVER-GUNITE
V
_
``-Footiggstp �L
58. Electrical Conduit-Undrgrnd-'.
-`' B. Foundawo t-
59. Gas Pipe, O Undrgrnd., Test
^'
9. Water Pipet ndrgrnd.
�'
60. Backwash Lines, P-Trap, O Undrgrnd,
10. Structur9_ loor System
61. APPROVAL TO DECK
11. Propert,,Se r LiJ& House Connection
62. Backwash & Receptor-Final -
-
12. Sewer Cap cu Cv
63. Heater & Vent-Final
13. Roof Drains(b- �
L r ;
64. Plumbing System - Final
r
14. Rough Plumbingv
lr
65. Electrical-Final
-
15. Rough gectritst'I-Conduit
1 66. Solar System-Final
16. Rough ectriot iring
Fencing & Access Approval
17. Rough Wiring Sign
68. APPROVED FOR PLASTERING
18. Rough Electri -T Bar Ceiling
69. POOUSPA SYSTEMS FINAL
19. Rou h Heating &Air Coriditioniny
FIE CI VOUIR�MENT
Ir
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26.4.''1--B r Ceiling (St ktural) " „S.ScoatS
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'u51. CERTIFICATE OP-OCCUPANCY
No. Date
PRWt'Uv ADORESS: 307 E 19TH ST UNIT:
OWNER'S NAME: MR. MIKE PARKS
ADDRESS: 307 E 19TH ST
COSTA MESA
92627
(714)557-2063
557-2063 REO.NO.: NONE
ARc1uENCIxEER: ACTEC ENGINEERING CORP.
ADDRESS: 1312 WEST COLLINS AV UNIT:
ORANGE CA 92667
PERMITTEE: MIKE PARKS (714)548-2440
ADDRESS: 307 E 19TH ST
CM CA 92626
LICENSED CONTRACTOR DECLARATION: I hereby affirm Out I am Accrued under previsions of Chapter 9 (commencing with Section
70DO) of Division 3 of the Business and Protessions Code. and my Bcense is in led force and eNea.
CITY LIC.: STATE LIC.: CLASS:
Signature:
RAERS• COMPENSATION DECLARATION: I hereby afrirn Out I have a artlflCate of m at to Self4mum m a cerbfiwte of WorkCM'
.npensation Insurance. or a certified copy thereof (Section 3800, Lab. C).
1 POLICY NO.: EXP. DATE:
ICOMPANY:
❑ Certified copy is hereby fumished. ❑ Carolled copy is fried with the dry Building Division.
Date: Applicant:
ESEMPRON FROM WORKERS' COMPENSATION DECLARATION: This section neednot be completed d the permit is lam hundred ($IBM or less).
I army that in The performance of the work for which this Permit's issued. I shall not smoky arty pe in airy manner so as to become
subject le the Wo�rkerns' Compensation Laws of California. y�� �n )/\.7�/U s-'sl//'In
Date: g - �` A - aC) Signaturecv r r J,2"
NOTICE: If, after making this declaatlon, you should become subject to the Workers' Compensation pmvisions of the Labor
Code. you must forthwith comply with such provisions Of 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
which this permit is issued (Section 3097, Civ. C).
LENOER:
ADDRESS:
IOWNER BUILDER DECLARATION: 1 hereby affirm that I am exempt from the Contractors' State License Law for the following reason
(Section 7031.5 Business ad Professional Code: Any city of county which requires a permit to construct, atter, Improve, demolish, or
repair any structure, prior to Its issuance, also requires the applicant for such permit to Me a signed statement that he/she is Incensed
pursuant to the provisions of the Contractors' State Liam Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
•-" Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
iplicant for a permit subjects the applicant to a civil Penalty of not more than five hundred dollars (5500).
A I, as owner of the property or my ampMYeeS with wages as their sole compensation, will do the work, and the
LJ structure is not intended or offered for sale (Sedfon 7044, Business and Professional Code: The Contractors' State License Law
I does not apply to an owner of a property who bu0ds or Improves thereon, and who does such work hlmsUt/herselt 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 yew of completion, the Mer will have the burden of proving he/she did not build or Improve
for the purpose of sale).
I, as owner of the groperty am exduSivery rndratting with licensed antncms to construct the project (Section 7044, Business
and Professions Code: The contractors, to Lkense Law does not apply ro an owner of propel
who MAlds a Irgrrwes we"
and who contracts for such projects with a contactors) ficense pursuant to the Cca tnicton' State License Law). I am aware
that proof of their Worker's Compensation Insurance should be provided to me.
I am exempt under Section: B. & P. C.
for this reason: Dole:
ia ti'"' �,r
Dale: _�4— G0 Owaw ✓rt
I do hereby unity that I am aware of and undersand the requirements of Califoma Health ami Safety Code Sections 25505, 25533, and
25531 and that I or any furore building occupant WIMI not (circle one) need to comply with said state codes Md the requirements for a
permit for construction or modification from theAm Dan—yManagementDistrict. Residential construction applications are exempt from
these provisions.
Date: Applicant:
I hereby an ty 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 budding construction and hereby aNMr® city to enter upon the abwo-mentimed
4
property/Z-4
four inspection purposes.
Date: - `t b% Signature: Y114_s"a'
Driver's License or Soca) Security e:
-•• A_vveita-Build nom; Gmar,Code Enforcement; Canary -Applicant; Pink -Revenue; Goldenrod-Aeaeasor
CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 047075
PERMIT NO: E 047075 PLAN CHECK NO: N GOVT: N SUPP: Y
CONSTRUCTION TYPE: 5—N PERMIT TYPE: ELE PURPOSE: OTH
JOB DESCRIPTION : ADD SERVICE RISER RELOCATION SQ FT:
CLAIM VALUE: CALL—VALUE: GROUP OCC: R-3 /M-1
COMMENTS: BEP -46865
ie ie k9t ie ie ie of ee iF aE it kA �r et*ir at ee let ee at•+A let eE et ice 4r*a4 at eeN9er�t is ifi'L*ieif*�+F it itft�t i��k+E �E��E**�E �E fE�E*x x+F it it*it*+E*�r*��F �t+r*
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RIGHT: FT IN LEFT: FT IN RIGHT: FT IN
PARKING RE8• PROV: PARCEL: 11725421 ZNE: REF NO:
PLANNING N TES>
>
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D E V E L O P M E N T S'E-_Jk_ V I C E S R E Q U I R E M E N T S
ZONING APPROVED BY DATE:
BUILDING APPROVED BY ; DATE:
APPLICATION ISSUED BY; _ DATE: p
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LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N
BLDG
PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES
GRADING
PERMIT
11.00
502
SMIP/NON—RES
PLAN
ISSUE FEE
4,50
BUILDING—DIV—>
PERMIT ISSUE PLAN—CHECK
TOTAL PAID
DUE
TOTALS ---- >
11.00 4.50 0.00
15.50 15.50
.00
REVENUE DIVISION TOTALS--> COLLECTED:
15.50 OVER/SHOAT:
00
BLDG PMT
PLUMBING ELECTRIC MECHANIC
FIRE SMIP/TOT GRADING
PLAN—CHECK
15.50
#♦f*ie le ie iE*Mie ekMMitY
aA if iA***kllek*ice iA*ee ie ftlE itkatit*9t 9Ex♦E kiE lEkkiE
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1e*eE it iE iekiek%
I N D I V I D U A L F E E
B R E A K D O W N
TYPE QTY
D E S C R I P T I O N
UNIT COST
TOTAL COST
ELE 1 MISC APPARATUS NOT LISTED REQ PERMIT
END OF FEE
11.00 11.00
01 00059331-00059331 TOT 15.5c
DATE: 04/24/90 TIME: 09:13
- CONSTRUCTION AND PLANtr...,3
APPROVALS Permit #
1
Date
Inspector
'00L & SPA
APPROVALS Permit #
Date
Inspector
1: Temporary Electrical Service or Pole
52. Pool & Equipment Location -
2. Sail 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 LIFER Grnd...
57. APPROVAL TO COVER-GUNITE
7. Footings. -
58. Electrical Conduit-Undrgrnd.
8. Foundation
59. Gas Pipe, ❑ Undrgrnd., Test
9. Water Pipe-Undrgrnd,
60. Backwash Lines, P -Trap, O Undrgrnd.
10. Structural -Floor System
61. APPROVAL TO DECK
11. Property,Sewer Line & House Connection
-62. Backwash & Receptor -Final
12. Sewer Cap _
63. Heater & Vent -Final '
13. Roof Drains -,
64. Plumbing System - Final
14. Rough Plumbing
65. Electrical -Final
15. Rough Electrical -Conduit
66. Solar System -Final
16. Rough Electric Wiring
67. Fencing & Access Approval
17. Rough Wiring Sign
_
68. APPROVED FOR PLASTERING
18, Rough Electrical -T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
19, Rough Heating & Air Conditioning
_
FIRE DEPT. REQUIREMENT
APPROVALS,.',Permit# t
20. Rough Factory Fireplace
--'
21. Ducts, in, Structure ' " _;_
_
-.70. Underground Hydro
22. Ducts, Ventilating
-
-77.
Product Piping OGas 17Oil
23. -Gas Pipe -Rough & Test
- _
- - •
72. Underground Flush
24. Roof Framing.73.,Undergrnd.StorageTank-0Gas
❑Oil
25. Roof Sheathing
74. -Overhead Hydro -
26. T -Bar Ceiling (Structural) & Monocoat
71
75; -Dry Chemical =
27. Frame and Flashing
7
76. Dry Standpipe
28 Lathing & Siding
77. FIXED SYSTEM F,INA� ,
29. Insulation
78: FIRE PREY. FINAL
30. Drywall Nailing
HEALTH DEPT; REQUIREMENT
31. Plaster Brown Coat
79.'FINAL INSPECTION•
-
:32-Electricef Power Meter -Final
_
'1w"FOOD CERTIFICATE ISSUED
:.33. Final Electric
6�
Notes:
n
'34., Final Heating'& Air Conditioning'
=
35. Final Gas Pipe -Test
• -j
-
'-
:36..Hood or -Canopy _ -?
-37.-Firial Factory Fireplace
y
.
.. 38. Final Plumbing
,r "
39. Water Service -Final,
-40. Gas Service -Final ?^' -
0
;41. Solar Domestic -Final
42. Backflow Preventer
43. Backflow Irrigation
-
44. Landscape lirigationSystem
-45.-Sound Attenuation
- r
.46. -Handicap Regulations
v
47. FINAL STRUCTURE & BUILDING
_
48: FINAL PLANNING
.49.. Electric Release to Edison
��
r
50:'Gas.Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
'
^;r.3n-7�IPA�J001202"- �-•-�4U.OG
`1 39449
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1260 COSTA MESA, CALIFORNIA 92626
P *TION FOR BUILDING PERMIT
For Applicant to Fill in on; etely
REC E DATE RECEIVED III nATp Issue
USE OF N1
BUILDING
YARDS
SET. MAIN &
ACCESS. BLD
DATE
BUILDING
ADDRESS
VALUATIONIS FOR
OWNER
A.P. NO.
MAIL
ADDRESS ,(•
BUILDING 307
ADDRESS
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TEL.
CITY
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APPROVED
BY
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NO. OF
PLANS
STATE / LSTy C. NO. �5.�
LIC. NO. G�
VARDS APPROVED
MAIIN BUILDING
W O
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SIZE
NO. OF SLOGS.
(FROM C/L STREET)
OF LOT
NOW ON LOT
NT FT.
USE OF
EXISTINGBLDG. [-J/ Fi!C'R_
SIDE IL
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SIZE OF NO. OF
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NEW BLDG. ROOMS STORIES
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EXTERIOR WALL
COVERING
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COVERING
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REAR FT.
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USE OF BUILDING AND WORK TO BE PERFORMED
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APPROVE11k /1D '
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hereby acknowledge that I have read this application and state
that the above Information is correct and agree to comply with
all laws regulating building construction, and I shall not employ
any person in violation of the workman's compensation laws of
the State of California.
1 hereby certify that I am properly licensed as a contractor under
THE AMOUNT SHOT
the State of California Business and Professions Code, Division 3,
Chapter 9, and that such licenses are In full force and effect, or 1
THE PURPOSE OF ES
am exempt from the provisions of the State of California Business
antl Professions Chapter 9.
VALUATION
sCCode,
(JDDii�iv/isl�pr-S,,
Signature of L,`, zl /r.'/l
Permittee �.•�'
$0_V__�{..�
�!/(awl
Authorized Agent
USE OF N1
BUILDING
YARDS
SET. MAIN &
ACCESS. BLD
DATE
VALUATIONIS FOR
A PERMIT FEE ONLY:
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$
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CITY OF COSTA MESA
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626.
APPLI A tlON Hi"&LdfflfiAL PE IT
For Applicant to Fill in Completely — Use Ink Only
RSC IV DAj FjL DATE I SU
L
ADDRESS BUILOING�-0 L . ) NCo A MLSA �Au
27w�_ /1
sPERMI
OWNER
MAIL p )
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BUILDING �^ 'ice
ADDRESS 30 -
ADDRESS' O-7 `. I
CITY L D /I "126 -1
TRACT116\ I LOT BLOCK
CONSTRUCTION
EW A A RP
LENDER
BRANCH
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OWNER AIJL
ADDRESS
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ARCHITECT TEL.
OR ENGINEER N 0.
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ADDRESS
FIRE
ZONE TYPE GROUP
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CONTRACTOR
APPROVE DATE
(NS
P,c 'i'tz.
ADDRESS
TEL.
Z NO. OF -!>USE OF NEW
IiPLANS
CITY NO.
BUILDING
n
F"
STATE CITY
YARDS APPROVED YARDS APPROVED
LIC. NO. LIC. NO.
MAIN BUILDING ACCESSORY BUILDING
fil
C.
SIZE NO. OF BLDGS
OF LOT NOW ON LOT %
(FROM C/L S ET)
FRONT FT. FT.
a
USE OF C
EXISTING BLDG. vh L
R. SIDE FT, FT
y
FSeparate
permits are required for
L SIDE FT.
FT.
electric, plumbing and healing work.'
REAR (!�CP CFT.'_t7
Fr.
US OF BUILDING AND WORK TO BE PERFORMED
DISTANCE BET.
BET. MAIN &
MAIN SLOW.
ACCESS. BLDG§.
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VA. 4L
CURP #
DATE
APPROVED
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APPROVED
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DATE
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1 hereby acknowledge that I have read this application and state
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a
that the above Information is correct and agree to comply with
m
9L•
all laws regulating building construction, and I shall not employ
W
any person in violation of the workman's compensation laws of
m
the State of Canfornla.
-
3
I hereby certify that I am properly licensed as a contractor under
SO. FT.
H
THE AMOUNT SHOWN UNDER VALUATION IS FOR
the State of California Business and Professions Code, Division 3,
m
Chapter 9, and that such licenses are In full force and effect, or I
THE PURPOSE OF ESTABLISHING A PERMIT F E O
em exempt from the provisions of the State of California Business
a
VALUATION
PERMIT FEE $
and Professions Code, Division 3, C�haDter 9.
J�
ro
n
PLAN CHECK $
Signature of I
o
TAX $ �
Permittee rl '
§LL
2
Authorized Agent
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TOTAL PAID S J0