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Home My WebLink About385 19TH ST - Building PermitsCITY OF COSTA MESA - BI/ILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT ��ia� �sa-s2�a • Fax (714) 754-b856 • www.ci.cosca-mesa.��fiLDING PERMIT .lob nddress: 385 E 19TH ST Suite: Vicinity: REAR OF GAR4GE Parcel Number: 11729413 Zoning: npp�icant: RODGERS, ROSEMARY Address: 3001 CLIFF DRIVE � � �Phone: (949)631-2345 � NEWPORT BEACH, CA " Zip: 92663 owner: HEMPSTEAD, STEVE Address 385 E 197H ST - � " " ' Phone: ' COSTA MESA, CA Zip: gpgp7 Contractor: PETER S RODGERS PROPERTY IMPROVEMENT Address: 3001 CLIFFDRIVE - - � Phone:, (949) 631-2345 NEWPORT BEACH, CA Zip: 92663 License: - 337169 PERMIT NUMBER B99-01884 77 FAIR DRIVE, COSTA MESA, CA 92626 ISSUED BY: Arch : JULIE CHAMBERLAIN _ Eng: TIMOTHY DAI Address: 2647 WESTMINSTER PL � Address: 385 19TH ST Status�. ISSUED Applied: 11/24/1999 Issued: 07/05/2000 �. � ��Q 7 OR� � _ : � � � rnone: �eaa�esi-uat t , ,� Phone: 949-631-0811 COSTA MESA, CA C.M., CA ' Zip: 92627 � License: 92626 License: C39489 SCOPE OF PERMIT ' 276 SF SINGLE STORY ADDITION TO REAR OF EXISTING DETACHED GAR4GE. GARAGE ADDITION. � , FEE SUMMARY Plan Check: $90.51 Calc Valuation: Ss,zio.00 Permit: $13925 - -- - Claim Valuation: So.00 SMIP Res: $0.62 SMIP Com ` ' $0.00 Other: $0.00 Inspection: $0.00 Total: $230.38 SETBACKS , • MAINSTRUCTURE Fronf 0-0. ACCESSORY Front 0-0 PARKING Existinq: o NOTES: � Rear. -0-0 Rear 0- 0 .Re uired: 0 .. PLANNING 8 ZONING Le(l 0- 0 Left 0- 0 Pr000sed: �0 ; ;' � '�i �-Right , .0-�0,. � �i /. �� / i Rigfit�� 0-0� - - , NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitornia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or it work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for tfie Work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred inspeetlona and final epproval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2446d8 (NW) 15' COMPENSATION DECLAtiA'nON: �� reoy ettirtn under penalty of perjury one of the tollowing tleda2tions: ❑ I have end will maintein a certificate o� ��sen� b selt-Insure for workers' compansation, es provitled for by seclion 3700 0l ihe Lebor Code, for Ihe peAortnance of Ihe work for which �his pertnit Is issuee. � I have en0 will maintaln workers' canpensation Insurence, es required �y sectlon 3700 of the Lahor Cade, lor the peAortnance oi ihe work for which Ihls pertnit Is issued. My workers' compensatlon Inj urance �erder entl policy number are: Cerner. S Ti3T 12 %v !<J policy Number: � yY � 13 3s (This section need nof be completed il the permit is ve/ued af one hundred dollers ($ f 00) or less.) ❑ I cenity that in ihe perfortnence of Ihe work tor which this pertnit is Issued, I shell not employ eny person in any manner m es ta become subject to the workers' compensatlon laws of Calitomia, an0 agree thet II I should become sub�ed to the workere' compensetlon provisions of Sactlon 3700 of Ihe Lebor Code, I shell fonhwith comply with these pr�� 7 � n Applicant SignaNre: �'��' Date: �" � � &' � WARNINO: FAILURE TO SECURE WORKERS' CCMiPENSATION COVERAGE IS UNLAW FUL M1D SMALL SUfl1ECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FlNES UP TOONE MUNDRED RNJUSAND DOLLARE (5100,000), IN ADDfiION TO THE CO6T OF OOMPENSATION. �AMAGES 0.5 PROVIDED FIXi IN SECiION 3]O60F THE tABOR WDE, INTEREST, AND FTTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: 1 hereby aHirm that I am licensed under prohsions ot Chepier 9(commencing wiih Section 7000) ot DiWsion 3 of the Business entl Pmtessions Cotle, entl my license is in full � force entl eHect. Lic. q 3 3 / ° Glass x �• / Comrenols Signeture: ..-� ��- Date: 9• 2&- �" LONSTRUCTION LENDING AGENCV: ❑ I herehy aHirtn that there is e construCtion lending egency tor the pedormence at the work far which this permit is issuetl. (Sec. 3097, Civil Code). Lentlefs Name: Lentlefs Atltlress: Signature: Dete: OWNER-BUILDER DECLARATONS: I hereby eHirm thet under penalry of perjury thet I am EXEMPT FROM THE CON7RAC70RS LICENSE LAW br the following reason (Sec. 703t5, Business entl Professions Code: Any ciry or counry which reQuires a permit to consiruct, alter, improve, demolish, or repair any strucWre, prior �o its issuance, also requires the upplicant tor such pertnit to file a signed statement �het he or ahe is licensed pursuent ta Ihe proNsians af the Camracrors License Lew (Chepter 9(commencing with Section 7000) of Division 3 of the Busineu entl Professions Code) or that he or she Is exempt Iherefrom and the basis tor the allegad exemption. Any violatlon of Section 7031.5 by eny epplicent for e Dertnit subjects the applicant to e civil penatly of not more than tive huntlretl tlollare ($500).): � ❑ 1, as ownar of the properry, or my employees with wages es their sole wmpensation, WILL DO THE WOHK, antl Ihe slrucWre Is not intended or oHeretl for sale (Sec. 7044; Business and Professions Cod@� The Contractors License Lew tloes not appy to en owner of property who builOs or Improves theraon, and who tloes such work hiriiself�o7.herselt or through his or hel �+'n employees, provided that such impmvements are nat intendetl or oftered lor sele. If, however, ihe building or Impmvement is sold'viilliin one year of comp� fion, the owner-builder will have Ihe burden of provin9 that he or she ditl not build or improve tor purpose ot saleJ. ❑ I, as owner of the propeityyem EICCWSIVELV CONTRACTING WI7H LICENSED CON7FiACTORS to construct ihe D�o�ect (Sec. 7044, Business antl Professions Cotle: The contrectors License"�Law does not epply 10 an owner af propeny w�o bullds or improves Iherean, end who con�rects for such project wilh e contractor(s) license pureuaN ta the Coniractors LiCense Laws.). ❑ I em ezempt untler sec. `-'��'^ Business entl Professions Code for this reason: Signature: Date: Owner ID verifietl by tlriver's Ilcense. ❑ Ves ❑ No Drivels License No. Expires: Verltication of Ownership by (type oi tlocument, i.e. - property len bill or deed): DIVISION OF INDUSTRIAL SAFETY PERM�T CERTIFICATION: ❑ I hereby cenify that no evcavatlon tive (5) or more feet in depih into which a person is requlred to descen4 will be made In connedion with work euthonzetl by Ihls permi�, and that no builtling slrucNre, swHolCinq,lalsework, or demoli�ion or Aismantling Ihereol, will be more �hen thirry-six (36) fee� high. (Chep. 32, Grp 2, Art 2, Sec. 341, Title 8, Celitomia Atlministrative Coda). ❑ As owner-builder, I will noI employ anyone to do work which would require e permit trom the Division of Industnel Setety, es notetl above, unless such person hes a permit to do such wofic trom the divisia�. SignaNre: Date: Divlsion ol Indusinal Safety Permit Number: CERTIFlCATE OF COMVLIANCE AND AUTNORQATION OF ENTAY: I cenity under penalry of perjury Ihat I have read this epplication and state that the intortnation given is conecL I egree ro compy wit� all stete laws end ciry oMinences relating to building construction, anG euthonze representatives of the Ciry oi Costa Mesa �o enter upon t�e above-descnbed properry for inspection purpases. I egree nat to occupy or ellow occupency of any building euthonzed by Ihis permit until linal inspection. Signature Of L09a1 Owner(s) Dete ��'.� � �„� 9 �a � . �.- AnNOi Authorized Applicant Date GOOE 1. MSPECTIONTYPE 1618 Fixetl System Final Fire Prevention 1266 Pool Spa Final '� 200 Finel Re-Roof 201 FInaI BIocWReteining Well 202 Final Factory Fire Place 203 Final Sign 20d Final Demolition P�IE IN�Li � INSPECipNNPE 206 Finel Mechanicel 20B Final Plumbing 210 Final Eleciricel 212 Final Fire Prevention 220 Final Planning Approval 222 250 Final Site Finel Building/Occupancy PAff. Iti�d4fl � � (714) 754-5273 • Fax (774) 734-4856 • www.ci.costa•mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 385 E 19TH ST Suite No Vicinity: Parcel Nunmber: 11729413 Applicant: RODGERS , ROSEMARY Address: 3001 CLIFF DRIVE NEWPORT BEACH, CA Owner: HEMpSTEAD, STEVE Address 385 E 1gTH ST COSTq MESA, CA PLUMBING PERMIT Phone: (949)631-2345 � Zip: � 92663 � , Phone: Zip: 92627 Status: ISSUED Applied: 08/02/2000 Issued: OB/02/2000 ISSUED BY: � � �. �;�� . Contractor. PETER S RODGERS PROPERIY IMPROVEMENT Address: 3001 CLIFF DRIVE � � � Phane: (949)631-2345�� NEWPORT BEACH, CA Zip: 92663 License: 337169 �l� OR � Arch/Eng: - -- -- .--- , -- . , _ , Address: �. . , ' . � • � � ' � Phone: Zip: License: SCOPE OF PERMIT RELOCATE WASHER AND DRYER. REF B99-01884. _ - ISSUE FEE 33ackFlow irrigztion Backflow Preventer Bathtub � . Clarifier System � Connect (Ice,Soda,etc) � Dental Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Drinking Fountain Expansion Tank Gas Earthquake Valve Gas (1-4 outlets) Gas (Over 4 outlets) Gas Repipe Gas Service Interceptors (Grease, Oil) Interceptors (Sand Auto ) ry AMT Sz3.50 50.00 $0.00 $0.00 $b.00 $0.00 50.00 $b.00 50.00 $0.00 SD.00 SD.00 $D.00 50.00 $8.15 $0.00 $0.00 50.00 $0.00 50.00 � 0 � "' 0 0. 0 0 0 0 0 0, 0 0 0 0 1 0 0 0 0 0 FEE SUMMARY, � � AMT _ � �f"- � � AMT LaundryTub/Washer . � $9.80 �:�'1' -. Sump�Pump ,' $0.00 � Landscape Irrigation � $0.00'� �0 `,-� �� .��- �SwinSriiing Pool � �.; ,%� i $0.00 P-Trap $0.00 0 � TrapPrimen � .�$0.00 Pressure Regulator $0.00 �0 - Urinal �i�._` �� /� $0.00 �Process Piping (per 10 ft) $0.00 0 ;'Vawum Brkr Bkflow(1-4)� $0.00 Receptors $0.00 0-_ "�' , Vacuum Brkr Bkflow(5+j $0.00 SepticTank $0.00 - 0 �� Wash Basin �, 50.00 Sewer Cap for Demo $0.00 0 , � Wash Basin Set ' $0.00 Sewer Connect $0.00 0 � Waste and Vent System $0.00 Sewer Private Line ' �� $0.00 ' 0 � Water Closet (Toilet) $0.00 Shower . � $0.00 -0 � � Water Heater / vent 312.30 Sink, bar $0.00 0 ". -' �Water Piping Qnst or Rep.) $0.00 Sink, commercial $0.00 , 0 " � Water Re-pipe $0.00 Sink, Floor � $0.00 0 Water Service $0.00 Sink, kitchen $0.00 0 Water Softener $0.00 Sink, service/mop $0.00 0 OTHER $0.00 Spa (private) $0.00 0 VIOLATION $0.00 Spa (public) $0.00 0 PLAN CHECK $0.00 REINSPECTION $0.00 COMMENTS / SPECIAL CONDITIONS TOTAL CALCULATED FEES: 551.75 QTY 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 , NOTICE: The work authonzed by this permit shall comply with all applicable handicap access requirements under California statutes and related i regulations. (Ord. No. 92-28. � 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 780 days, or if work is suspended or abandoned for a period of 180 days. � INSPECTIONS: In order tor the work authorized under ihis permit to be considered legal, such work must comply with all applicabla codes, and all requfred inspectlona and final epproval must be obtained. Failure to obtain inspections and final approval will result in the ezpiration of ihis permit. FOR INSPECTIONS CALL: (71q) 754-5626 � zaa5ae(dool WORKERS'COMPENSATON DECLARAnON: I hereby ettirtn under penalry of perjury one of the following tleclarations: ❑ I heve entl wlll malntain e certificete of consent to sell-Insure for workers' compensetlon, es providetl tor by section 3700 of the Lebor Cotle, for the peAormance of the work tor whiCh �his pertnit is Lssuetl. �'�/Glave anO wlll malntain workers' mmpensation insurance, es raquiretl by sectlon 3700 of Ne Lebor Cotle, for the peAortnence oi Ihe work for which Ihis pertnit is issuetl. y My workers' compensation Insurence cartier and pollty number are: car�er. �fdT.F Fr�.. D. PolicyNumber: � yS�� ' 3S (This section need not be canpleted ll the permit !s ve/ued et one hunered tlallers ($100) or Iess.J ❑ I cenify that in Ihe pertormance of the work for which this pertnit is Issuetl, I shall not employ eny person in any menner so es to become subject to t�e workere' compensetion laws of Galitomie, and agrea that It I should become suh�ect to ihe workere' compensation provislons of Sectlon 3700 of the Lebor Code, I shell ton�with crompty with t�ese p%m �'�ons. O Applicant�Signeture:� —Ti�.+ i�- Date: �. 1' i- �• a" WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAW FUL M1D SHFLL SU6IECT Ml EMROYEA�TO CPIMI�AL PENALTIES AND CML FlNES UP TO ONE HUNDRED hKK1SAND DOLURE (5100,000), IN MdTION TO THE COST OF COMPENSATION, DPAUGES AS PROVIDED FOR IN SECiION 37080F TME UBOR CODE, IMEREST, AND ATTORNEV'S FEES. LICENSEO CONTRACTORS UECLARATION: I hereby affrtn thet I am licensetl under provisions of Chapter 9(commencing wlih Section 7000) of Division forca and ettectrLic'M:� 33 7/ �9 Professlons Code, and my licensa is in full _ o� CONSTRUCTION LENDING AGENCY: ❑ I hereby attirtn thet ihere is e construction lending agenq lor ihe peAormence of the work tor w�ich this pertnit is iuued. (Sec. 3097, Civil Cotle). Lendefs Name: Lendefs Adtlress: Signalure: OWNER-BUILDER DECLARATIONS: Dete: I hereby aHirm Ihet untler penelty oi perjury ihat I em E%EMPT FROM TME CONTRACTORS LICENSE LAW for the tollowing reeson (Sec. 7037.5, Business end ProFessions Code: My ciry or caunry which requires a pertnit lo construct, elter, improve, tlemdish, or repeir eny structure, O�or lo Its issuance, also requires the apD�� or such pertnit lo tile a signed stetement lhat he or she is Ilcensetl pursuent to Ne provisions oi Ue Coniractors LJcense Law (Chapter 9(commencing wllh Saction 7000) ot Division 3 of ihe Business end Professions Cade) or that ha or she is eaempt tharefrom entl the Dasis tor Ne allepetl exemption. My vidation of Sectian 7031.5 by any epplicant for e permit subJects the eppllcant to a civil penalry of not mare ihan five huntlred tlollers (E500).): ❑ I, as owner of the O�operry, or my employees with wages as their sole compensation, WILL DO TME WORK, and the structure is not intentled or oMeretl for sale (Sec. 7044, 8usiness and Professlons Cotle: The Conirectors License Law does not apply lo en owner of properry who builds or Improves Iheraon, and who does such work himsetl or �erselt or Ihrou9h hls or her own emplayees, pravided thet such improvemenis ew not Intended or oXerad for sale. If, howaver, Ihe builtling or impmvement is sold within one year of completion, the owner-builder will heve the burden of proving that he or she ditl not build or improve for purpose of sale.). ❑ I, as owner of the properry, am E%CWSIVELV CONTRAC7ING WI7H LICENSED CON7TiACTORS to construct Ihe prqect (Sec. 7044, eusiness end Pmtessions Cotle: Ttie coniracrore Llcense Law Ooes not apply to en owner of property who builQs or Improves Nereon, end who conlracts for such project with e contrector(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. _ Signature: Owner ID veritied by driver's license Business and Profeuions Cotle for this reason: No DnveYs License No. Venfication of Ownership by (rype of�tlocument, I.e.'- property la�c bill or deetl): DIVISION OF INDUSTRIAL SAFETY Da�e: Eapires: ❑ I hereby certity thet no excavetion tive (5) or more teat In tlepth into which e persan is required lo descentl, will be made in connedion with work autharized by Ihis permit, antl thal no building structure, scaflolding, falsework, or demolition or dismantling ihereof, will ba more than Ihirty-six (36) tee� high. (Chep. 3.2, Grp 2, M 2, Sec. 341, Title 8, Califomia Adminisiretive Code). ❑ As ov.•ner-buildar, I will not employ anyone Io tlo work which would require a permit from the Division of Industrial Sefety, as notetl above, unless suc� person hes e pertnit to do such work trom ihe tlivision. Signature: Date: Division of Industrial Salery Permil Number: CERTIFlCA7E OF COMPLIANCE AND AUTHORVATION OF ENTRY: I cenity untler penalry o� perjury lhat I have rea0 this applicalion ena state fhet iha iniormation given is wrtect. I agree to comply wilh all state laws and dry ordinances relating to building construction, and euthorize representatives of Ihe Ciry of Costa Meu to enler upon the ebova-descnbed properry for Inspection purpases. I agree not to occupy or allow occupancy ol eny building authorized by ihis permit until final inspection. COOE t. INSPELTIONTYPE 1616 Fiaetl System Final Fire Prevention 1266 Paol Spa Final 200 Final RaRooi 201 Final Block/Retaining Well 202 Final Factory Fire Place 203 Finel Sign 206 Final Demolitian �� CODEt IMSPECTIONTYPE 206 Final Mechenical 208 Final Plumbing 210 Final Eleclrical 212 Final Fire Prevention 220 Final Plenning Approval 222 Flnal Site 250 Final Building/Occupency QaIE L�lfi (774) 754-5273 • Fax (714) 754-4856 • www.cl.cosla-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAI PERMIT _vI ��71 (�1 Job Address: 385 E 19TH ST Status: �Ep. Suite No Vicinity: Parcel Nunmber: 11729413 Applicant: RODGERS , ROSEMARY Atldress: 3001 CLIFF DRIVE - " Phone: (949) 631-2345 NEWPORT BEACH, CA Zip: 92663 Owner: HEMPSTEAD, STEVE Address 385 E 19TH S7 Phone: COSTA MESA, CA Zip: 92627 Contrector: PETER S RODGERS PROPERTY IMPROVEMENT Atldress: 3001 CLIFF DRIVE ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool / Spa Lighting Fixts Recept Outlets Switches Non Res Appl Res Appl Service to 200a Service to t000a Service over 7000a Morors to 1 hp Motors to tOhp Motors to 50hp Motore to 10php Motors over 100hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole Phone: (949) 631-2345 NEVJPORT BEACH, CA Z'ip: 92663 License: 337169 Applied: 08IO2/2000 Issued: OBI02Y2000 ISSUED BY: SCOPE OF PERMIT 1 750AMP MAIN PANEL, 1 100AMP PANEL, 15 OUTLETS, 8 SWITCHES AND13 LIGHTS.899-01884. $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 514.30 516.50 58.80 $0.00 $0.00 530.50 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 $30.50 $0.00 $0.00 $0.00 $0.00 Quantiry 0 0 0 73 15 8 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 FEE SUMMARY Quantity Temp Dist System I Lighting - 50.00 0 . � Busway /100 ft - - $0.00 0 � Standing Section - 50.00 0 � � Misc Electrical Equipment 50.00 0,' ' Transformers up to 1 kva/kw $0.00 0, "� . � " ................up to 10 kva/kw $0.00 0 ", � � .................up ro 50 kvalkw 50.00 ,;0 � -� .........._.....up to 100 kvalkw 50.00 . 0: � . ...........e:...:.over 100 kvalkw 50.00 „ �,0 � � . Low Voltage Equipment $0.00 -, ' � 0 � � Low Volt Wving System I Ckt- _50.00 : � 0 � � • � , � Misa Conduit � . � -50.00" 0 ` � Misa Conductor ", 50.00 , 0 - Circus ( gen or ride) � � $0.00 , ; � 0 � . . Circus (mech ride or lights)' = � $0.00 � ;,0 � ChnstmasTreeStand �� $0.00" . 0-� � FireworksStand � � �50.00' �0�� Other Electrical Fee � , �;50.00: ; ' / Investigatlon Fee , , � $0.00 � Plan Check Fee � � '$0:00 Reinspection Fee , 50.00 TOTAL CALCULATED PEES E124.10 COMMENTS I SPECIAL CONDITIONS � NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitornia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become voitl if work is not commenced within 180 days, or if work is suspended or abandoned for a period bf 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered Iegal, such vrork must comply with ail applicable codes, and all requlred Inapections end final approvel must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 zawas Is�ool WORKERS'COMPENSAnON DECLARATON: I hereby aHirtn under penalry of perjury ane of Ihe tollowing declaretlons: ❑ 1 heve end will meintain e cenllicete o1 consent to setl-Insure tor workers' compensatlon, es provlded tor by sectbn 3700 of the Lebor Code, fa the peAormence of �he work br which Nis pertnil Ls issuetl. ❑ I heve antl will maintain workers' compensetlon in5urance, as requiretl by sectlan 3700 01 Ihe Lebor Cotle, for the peAortnance of Ihe xrork for whiC� Iltls pertnit is issuetl. My workers' compensation Insurence cartier enA policy number era: Carrier. S I�/ i� �v h� C� Pollry Number: � S� �� (ihis sectlar need not be comp/eted /l ffre permlf /s valued et one huntlretl tlallais ($100J or less.) ❑ I certiy Ihet in the pertormanco ot Ne work for which Ihis permit b Issued, I shall nat employ any person In eny menner so es ro Decane subject m the workers' compensetlon laws of Celifomla, end egrea lhat If I s�oula become eub�ect to the workers' compensatlon provisions of Section 3700 ot Ne Lebor Code, I shall forthwith comply wilh ihesa pr �.� r� Applicem SlgneNre: Date: � �� ' a' WARNINO: FMLURE TO SEIXIRE WORKERS' COMPENSATIIXJ CWERAGE IS UMAWFUL AND SVIALL SU&IECT AN EAIROYER TO CRIMINAL PEN�LTES M!D CML FlNES UP TOONE HUNDRED THWSAND OOLLARE (f100,000), IN FD�fTION TO THE WST OF COMFF1dS+1TION, UAM1KGES AS PROVIDED fOR IN SECTION 3�OB OF TNE LABOR CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTOflS DECLARATION: I hereby eflirm t�at I am licen ed under provisions of Chepter 9(commenGng with SecGon 7000) ol Divisbn 3 ot Ihe Business anA Prolessions Cade, end my Iicense is In tull iorce end enect tic. u � 3 7�64 qass a �i � I Gomrecmrs Slgnemre: -�-� 1t Data: 9'a- 4c -� CONS7RUCTION LENDING AGENCV: ❑ I herehy affrtn Ihat there is e consiruction lending egenry tor Ihe peAortnanca of ihe work lar which this pertnit is issued. (Sec. 3097, Civil Gade). Lendefs Name: Signature: _ Lentlefs Atltlress: Date: OWNER-BUILDER DECLARATIONS: I hereby eHirtn thet under penfllry of perjury that I em El(EMPT FROM 7HE CONTRACTORS LICENSE LAW tor the following reawn (Sec. 7031.5, Business end Professlons COAe: My ciry or counry which requires a pertnit to construd, alter, improve, demolish, or repair any structure, prior ro its (ssuance, elso requires the eppliwnt tor such pertnit to file a signed stetemem ihet he w she is licensed pursuant ta the proWsians at the CanlreMors Lkense Lew (Cheptar 9(commendng with Section 7000) ot DM1dsion 3 of �he Business end Professions Code) w Ihat ha or she is exempt Iherefrom and the basis for the alleged exemptlon. My videtlon ot Section 7031.5 by any epplicant for e pertnit subjecis Ihe epplicent to e dvil penally of not more than tive hundred dollere ($500).): ❑ I, as owner ot the properry, or my employees wlth weges es ihelr sole compensation, WILL DO THE WORK, entl t�e structure is noI Intended or oNeretl for sale (SeC. 7044, Business and Professions Cotle: The Contrectors License Lew does not epply lo en owner of property who bW�ds or improves theroon, entl who does such work himself or herself ar Ihrough his or her own employees, pmvided Ihat such improvements ere uot intendetl or oNered lor sale. II, however, the bulitling or Improvement Is sdd within one year oi completion, the owneo-builder wi0 have the burden ol proving iha� he or she did no� build or improve for Durpose of sele.). ❑ I, es owner ol Ihe properry• em EXCLUSIVELV CONTRACTNG WITH LICENSED CONTiiACTORS to construct the Drolec� (Sec• 704d. 6us�ness and Protessims Code: The conVectors Ucense Lew does not apply to an owner of propeny who builtls or improves Nerean, entl w�o contrects tor suU pro�ect wlih a comrector(s) license pursuam to t�e Comractors License LewsJ. ❑ I am exempt untler sec. SigneWre: Owner ID verifletl by tlrivers Iicense. ❑ Ves [] Na Business end Prolessions Cade lor Ihis reamn: Vedficatlon ot Ownership by (type of documem, I.e. - properry tax bill or tleetl): DIVISION OF INDUSTAIAL SAFETY PERMR CER7IFICATON: DrivefS Litense N0. Date: Expires; ❑ I hereby cenity Ihat no excevetlon five (5) or more �eet In depth Into which e person is requiretl to descend, wlll be made in wnnectlon with work euthorized by Ihis pertnit, end thet no building structure, scattolding, telsework, or Cemolltion or dismantling Ihereot, will be more ihan lhirty-six (38) feel high. (C�ap. 32, Grp 2, Ar12, Sec. 341, Tiile 8, Celilomia Atlministrative Cade). ❑ As owner-builder, I will not employ anyone to Ao work which would requlre a pertnit Irom Ihe Division of Intlusiriel Sefery, es noted ebove, unless such person hes a pertnit to tlo such work irom tha division. Signature: Data: Division of Intlustrial Safety Permil Number: CEHTIFlCATE OF COMPLIANCE ANO AllT}fORIZA710N OF EHTTiY: I ceniy untler penalry at perjury tha� I have read this epplicaUon end 5tate �hat Ihe inlormation given Is corred. I egree to compy wit� ell stete laws antl dry ortl�nences relating to building consvuclion, and euthorize re0�esentatives of the Gry of Coste Mesa to enter upon Ihe ebove-tlescribetl property for inspecUon purposes. I epr9e noi Io occupy or ellow occupenty ol eny huiltling euUrorized by Nis pertrvt until final inspeMion. igneture Of Legel Owner(s) �,.a.� 9-ae, �- An r Authorized Applicant WOE �. MSPECTqNT1PE 7676 Fixed System Final Fire Preveniion 1266 Pool Spa Final I, 2pp Final RaRoof I 201 FInaI Block/Retaining Well 202 Final Fedory Fire Place 203 FInalSign 204 Final Demolition PAIE It�9 CO�EI pSPECTIONTYPE 208 Finel Mec�anicel 20B Finel PlumDinp 210 Final Electdcal 212 Finel Fire Prevention 220 Final PWnning Apptwal 222 250 Final Site Final Bullding/Occupanty Q� �� - .. .. . AVGlicant to fill in all spacas exeept t�ose witNn heav ' CITY OF COSTA MESA PERyy T NO. � TRACT NO. � CONE�PRCS�TION PERMIT ' /J // Sic� %. � - Projett Address ' T j�� TYPE OF CONSTRUCTION rvEW ApplicanYsMailingAddress : y�-'� QL l��'' ��'�0 T��l�' O CONVERSION ❑ DEMOL H❑ C Owner's Name � � • hone� G�y�'_Z_�S�3 � DESCRiPTION OF WORK �1 � �4S � /9t>, S �i�.s�, ,o� eoraer anC sign all appraP��ata Eeelarations. ADD;, ALTERATION REPAIR Address - - TVPEOFPERMIT ,GRADING FOUNDATION LISTRVCTURAL A�ch/Eng., LicCnSE No. ❑ TENANT � E ECTRI AL ❑ PLUMBIfVG ❑ MECHANICAL, A�ddress ' �'J'/// ��OTHEf3 ' �C E ��i�J � Contracto`r'sNam // �/� /� '/ QrC'� p Lo�e '� ppOJECTDESCRIPTION 5q. FL %r36i7 �,. nrc_�c� Addf255,(mailing�-"�'��d� QG !/QILSeiT��'//�/Q �9�%�� CONSTRUCTIONTVPE S�Q VALUATION§ City License No. _ . �Qrp�l/) � LICENSED CONTRACTpR DECI.ARATION ' I hareby affirm that I am Iicensetl untler provislons of Charter 9(commancing wlth section 7000) of Division 3 of the Business antl Professions Cotle, antl my Iicanse Is In fu tor e gp;f ef(e<L � LJcense Clasz �- � °'� ' Q � Z- LitenSe o. � � ll�Etl� oate� �.3�iYsly at �i.+p � WORKERS' COMPENSA710N DECLARATION • ereby atflrm that I have a tartl(Iwte of mnsent to self�insure or a certificate Workers' Compansatiqn Insurance, or a certltietl <opy theraof (Saction .,800, Lnb. C.) � Policy No. Company eCerUfietl copy I5 hereby furnishetl. ; , - Certi(letl topy is flletl W�th the clty Bulltling Dlvislon. Oate � qppp�ant � EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This tectlon neetl not be Completetl I/ [ha permlt is for one huntlretl (5100) or less): I c¢rtify'that In the perfOrmance of the work 1or whlch th15 parmit IS ISSuatl I sM1all. not employ any person In any manner sp as to become su ct to t�e Workers' Co pansatl n ws of Callforn Date -'� �_ �_�-� T�519nature ��[i.'( A �. �Q/i�,Q % NOTICE: It,iafter making thls tledaratlon, you shoultl become subject to tne Workers' Compensatlon provi5ion5 of Ihe Labor Cotle, you must forthwith I hereby aftirm that thare I5 a constructlon lentling agency for the parformance Of tna work fOr whiGh thi5 perTlt IS ISSuetl (SeCtion 309] Civ. C.) LenEer'S Name LenUer'S Atltlra55 OWNER BUILDER DEC�qRAT10N ' I hereCy affirm Ihat I am axempt fram the Contractor'z License Law Tor the following reason (Sectlon ]031.5 Business antl Professional Cotle: Any city or county which requires a permit to construct, al[er, Improve, tlemolish or rapalr any structure, prior [o Its Issuance, also requlres tha applicant for such permit to flle a signetl statemant that ne/she is Ilcensetl pursuant to the provl5ion5 of the Contrac[or'S License La�y (Chapter 9(commencing with $ectlon 7000) ot '.;;3;{Islon 3 of the Builne¢5 antl Professlons Cotle) or that he/she is exempt e�rom antl t�e ba5i5 1or tne alle9aG exem0��an. Any violation ot Sectlon '�y�'��1.5 by any applicanr for a permlt subjects the applicant to a civil TLenalty o1 not moro than flve huntlYetl tlollaR (E500). U I, as owner of tha praperty or my employeez with wages as thair sole compensation, wlll tlo tha work. antl the structure Is not Intendetl or otfa�etl �✓vry w an ownnr er a proparry wno oullas or Improves es sUch wOlk hlmself/hels8lf Or tFllOugh hi5 Of hBl Owll .hat such improvemenls are not intantlatl or offaretl for bulld��g or Improvement Is soltl wlthin one year of com- II hdve Ihe burtlen of proving he/she tlitl not builtl or Im- of salel. as ny�vvea u�ervyp, ana wno conimcn ror sucn pro�ett5 w�tn a tOn- tractor(s) Iicense pursuant to the Contrattor's Llcensa Law). ❑ I�am exempt un0er Septlon B. & P. C. for t�is reason Date Owner� I hereby cartify that I have�reatl �thiz applicatlon antl state that [�e above In/ormatlon Is correct. I agree to comply with all ci[y anE county ortlinances antl state laws relatinq to Ouiltling constructlon, antl �ereby au[horlie repre- sentatives ot Ihii Nty [o enter upon the bove-mentlonatl Oroparty tor Inspectlon pur0ase � � ,�,� �� Slqnatum !L� � r [f4,�G Oat8�1 GRADINGCU.VDS. AC Bar Sink Beckflow Preventer Betkflow Irrigation Bathtubs � Clarifiers ' Dishwasher � Drinking Fountains Floor Dreins ' FloorSinks - Gas Service �Outlets Kitchen Sink � Lavataries P-Trep Roof Drains Reinspection Fee' $25 Dutt - Under Ground Duct - Structurel Duct • Ventilating Exheust System ❑ MWtiple ❑ Firepl/Fact. Blt. ICBO # Heating System & Ducting , ❑4100,000 BTU 0100,000 BT Drivers' License or 55 � - I I Reinspection Fee I $25 CMF OB6546 rev. 12/83 White - Builtlinq; Canary - APPliwnt; Pink - Accounting; GolOenrotl • qssessor ' K Showers • Servite Sink Sewer Cap Sewer Connection Solar Collecrors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service laue Fea Hood ar Typel ❑ Canopy Typell ❑ Refrigeration$ystem , �0.100,000 BTU ❑100,000 BTU System Repair/Alteration Issue Fee 0 FEES $ 3 FEES S 3 A.P. 5W S Main Building: E T Front g Rear A C Right g Lef[ Ping. Ref. # - Parking Req./ProvitlE Use of Building: Planning No[e5: Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher , Dryers ❑Gas � �Electric Device Boxes Outlets : cone _ Accessory Building: " - Park:Fees $ - u ELECTRICAL �� Transformer ❑ 15-50 KW � ❑ 50+KW. �Meter ❑up ro 100 amps . Meter ❑over100amps�. Sub Panel Motors �0.1 HP �1'F, � 8 Inc. Soler �9-15 HP �16-15+ ' Microwave Pole Light � Garbage Disposal Generator 065 KW �5-15 KW /,� Reinspection Fee � $: PUBIIC SERVICES REUUIREMENTS: Zoning APProvad By Building Approvetl By —�� Aooliration Issued 8v � ��' �.,..,.. TL• z 0 N _ ,'� N G . , , A ' E Q U I R E M E N T " S FEES ` Sign Standing Sections Trash Compactor luue Fee $ 3 Date ' Y -. � SUMM RV OF FEES G � �'1 BUILDING PERMIT $ • �% U SMIP � � $ � � � j PLAN CHECK $ � PERMIT � PLUM8ING $ ISSUANCE $ �1 PLAN CHECK 25% $ ENERGY P.C. $ // ELECTRICAL $ ' GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL �$ TOTALFEE $ �� . PLAN CHECK 25% $ � � �' CONSTRUCTION.AND-PLANN�NG. '' � � II�F`fq .APPROVALS '" Permit #�_I ! `Temporary Electrical Service or;Pole � � 2.. Soil Pipe-Undrgrnd. � - - � � ' " ' 3> Electr�ical Conduit Utility-Undrgrnd. ��. �? 4. Electrical Conduit-Undrgrnd. ' � 5. Steel Reinforcement ' � . 6. Electrical UFER Grnd. ' • 7. Footings , - � 8. Foundation � 9. Water Pipe-Undrgrnd. 70. Structural Floor System 11. Property Sewer Line & House Connection 12. Sewer Cap ' 13. Roof Drains _ � , 14. Rough Plumbing - 715. Hough Electrical-Conduit - ' ' `16. Rough Elect�ic Wiring • � � � "17. Rough Wiring Sign � �� 18. Rough Electrical-7 Bai Ceiling - � 19: Rough Heating & Air Conditioning 20. Rough Factory Fireplace ' , 21. Ducts, in Structure � 22. Ducts, Ventilating � 23. �Gas Pipe-Rough & Test ' � -24. Roof Framing , 25. Roof Sheathing '@6. T-Bar Ceiling (Structuraq & Monocoat r `:27. Frame and Flashing � , '28. Lathing & Siding .' �� 29. �Insulation � 30. Drywall Nailing � 31. Plaster Brown Coat 32. Electrical Power Meter�Final � � 33. Fina��Electric � ' 34. Final'Neating & Air•Conditioning 35. Final Gas Pipe-Test � ' 36. Hood or Canopy � . 37. Final Factory Fireplace � 38. Final Plumbing , 39. Water Service-Final . � ' ' 40. Gas Seivice-Final ' . � 41. Solar pomestic-F,inal • 42. Backflow Preventer � 43. Backflow �Irrigation � � ' 44. .Lands`cape Irrigation System • 45. Sound Attenuation� � , 46. Handicap Regulations �� 47. FINALSTRUCTURE & BUILDING� 48. Special Requirements Completed; � 49. Electric Release to Edison ' � 50. Gas Release to Southern California Gas Co 57. CERTIFICATE OF OCCUPANCY � lo. � - � � Date POOL 'A , Date Inspector �� '- '' •�Date� Inspector " APPROVALS Permit # - _ . � . , - . _ '52. Pool & Equipment Location"'�,'� - � � �'. . - • 53. Steel Reinforcement , ` - __ , � - . 54 ' Forms � - - - " � � ' 55. Electrical Bonding � . - � ` � 56. Rough Plumbing & Pressure Tesi . ' . � � � 57. APPROVAL TO COVER-GUNITE - - ' " � . 58. Electrical Conduit-Undrgrnd. - � � ' - � 59. Gas Pipe, O Undrgrnd., Test' �� . 60. Backwash Lines, P-Trap, O Undrgrnd -- •-� . '� 61. APPROVALTO�DECK - � 62. Backwash & Receptor-Final ^ - . 63. Heater & Vent-Final . . - � �' ' 64. Plumbing.SYstem - Final - � ' �- - ' � 65. Electrical-Final � ' � 66. Solar System-Final � -��' -- - --� ' 67. Fencing & Access Approval : j- � - - � - � � �r ��= ' 68.' APPROVED FOR PLASTERING � . , : , ' - 69. POOL/SPASYSTEMSFINAL � � _ , FIRE DEPT. REQUIREMENT ' � , � � APPROVALS Permit # � � - � ' � 70. Underground Hydro � � ' 71. Product Piping OGas ❑Oil . � . 72. Underground Flush - . . - � 73. Undergmd. Storage Tank [7 Gas - O Oil �' . 74. Overhead Hydro . � . � , ,- 75. Dry Chemical � � - � 76. Dry Standpipe . . � � - , , , 77. FIXED SYSTEM FINAL : � '-� � ; ' 78. FIRE PREV. FINAL " � . ' � HEALTH DEPT. REQUIREMENT ' ! , 79. FINAL INSPECTION � B0. FOOD CERTIFICAT'e ISSUED ' � � NoceS: ��.v`.f'L �� a-a7��u ��,c,�, �� _ �:.�_.. � Z _ ZY• f�7= G.N\, ' � 4 -. ' ' , r . , , � . r' _ f S . -. , :� � . . i I� C W a Q � y S F A W F Q G .d a > r � a w a � a a Z {il x 3 o�s�o COSTA MESA BUILDING•SAFETY DEPARTMENT P.O. BOX 7200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only BUILDING ��r./�l/ f • �•/�^. AODRESS TL� �� OWNER JCry� �A MAIL � _ . TEL. qTV NO. BRANCH A�DRESS ARCHITECT li__� I �e�..�. TE CONTHACTOR Ct�y�}� U�(ytJ/�1 �,`� ADORESS TEL. CITY NO. STATE CITY LIC. NO. IIC. NO. SIZE � k' 3 � NO.OFBLDGS. OF LOT NOW ON LOT USE OF EXISTING BLOG. Separate permits are required for electric, plumbing and heating work. USE OF BUILDING AND WORK TO BE PERFORMED � � . . /11 . .. I hereby acknowledBa thet 1 have �eetl this app�ieation antl state that tha above Information {s carrect end agree to comply wlth all lews reguleNnp butitllnB �onstructi0n, antl I shall not employ any parwn in violailon of the workman'a compensailon lawz of She Stete of Calitornla. i �e�eby certify that I am properly Ilcansetl as a conttactor untlar the State of California Business antl Professions Cotle, Dlvislon 3, Chepter 9, and t�ai such licenses ere In full force entl effect, or 1 am exempt from Me provisions of the Stata of Callfornia Businau end Professions ColJa�plvisiqn 3, Cheytef5fn ` Auth ri tl Aeant �C \ 741AbU0/@3/78 7.50 TI APPLICATION FOR STRUCTURAL PERMIT "' RECEI DATE RECEIVED ..�r� ice��. A.P. NO. �� 7'a Q S�' BUILDING 3 G� � ADDRESS p TRACT I//� C� . i VAWE ��/I /'`'�. D �DATE � ZONE NO.OF USE OF NEW T�i"I /U R, PLANS p2 BUILDING O(%E `\ _ VAROSAPPROVED VARDSAPPROVED �� MAIN BUILDING ACCESSOFY BUILDING 1 (FROM GLlS�EEb) 1 �V 0 eer. VAR. qW C.U.P. #5 APPROVED N n m m' m SQ. FT, ' �`+ THE AMOUNT $HOWN UNDER VALUATION IS FOR 0 THE PURPO6E OF FSTABLISHING A PERMIT FEE ONLV: � VALUATION PERMIT FEE E QD a �m PLAN CHECK 5 � p LL ^ $ D O TAX S � O u/ � TOTALPAID S � � � �