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Home My WebLink About437 19TH ST - Building Permits(714) 754•5273 • F9x (774) 7543856 • www.cl.costa•mesaELECTRICAL PERMIT �� FAIH UHIVh, GUSIA MtSA, GA 92626 Job Address: Suile No Vicinity: Parcel Nunmber: ApplicanC Address: Owner: Address Contreclor. Address: ISSUE FEE � Temp service lest 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 1000a Service over �OOOa Motors to thp Motors to tOhp Motors to 50hp Motors [0 100hp Motors over 100hp 437 E 19TH ST 11734133 PEARLMAN, RICHARD G 437 E 19TH ST „ COSTA MESA. CA , PEARLMAN, RICFiARD G 437 E 19TH ST � COSTA MESA,�CA OWNER-BUILDER Phone: 949-631-4357 2ip 92627 Phone: 2ip: 92627 Phone: Zip: License: 000000 ISSUED BY: Status: ISSUED Applied: O4I07/2005 Issued: 04I07I2005 SCOPE OF PERMIT ADD'1385 SF TO (E) SINGLE-STORY SFD AND CONSTRUCT NEW 529 SF ATTACHED GARAGE IN THE REAR. REMODEL KITCHEN AND LAUNDRY ROOM. ALSO CONSTRUCT 195 SF PATIO COVER AT FRONT. VENTED GAS FIREPLACE/HEATER: ANSI Z21.88 AND CSA 2.33. 30 LIGHT FIXTURES, 18 OUTLETS, 15 SWITCHES, 1 TEMP POWER POLE REF: 804-01885 � 523.50 50.00 30.00 $0.00 50.00 50.00 529.30 519.80 5�6.50 50.00- $0.00 50.00 50.00 50.00 � 50.00 � 50.00 50.00 50.00 50.00 Quantity 0 0 0 30 IB 15 > 0\. 0?. ` 0 0 0 ', Q� 0 0 , 0 ' 0 FEE SUMMARY Temp.Dist System / Lighting Buswaylt00ft Standing Section Misc Electrical Equipment Transformers up to 1 kva/kw ................up to 10 kva/kw .................uP to 50 k'va/kw �. .................up to 100 kva/kw ..................over 100 kva/kw � Low Voltage Equipment , Low Volt Wiring System / Ckt Misc. Conduit . Misa Conductor , Circus ( gen or ride) � Circus (mech ride�or lights) ChrisVnas Tree SWnd Fireworks Stand , . Other Electrical Fee - Quantity 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 " $0.00 ��.0- $0.00 0 $0.00 0 $0.00 0 50.00 0 50.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92•28, § 1, 12-21-92) EXPIRATION: This permlt shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 tlays. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred Inepectiona and flnel epproval must be obtained. Fallure to obtain inspections and final approval will result in the ezpiration ol this permit. FOR INSPECTIONS CALL: (714) 7545628 , 2a�ee �eroo� WORKERS'COMPENSAnON DECLARATON: � I hereby eHirtn untler penalry at per�ury one ol the lollawing declaretlons: ' ❑ I heve end will meintein e certificate ot consenl to sell-Insure br workers' compensetion, as prwlded lor by section 3700 of the Lobor Cotle, for Iha peAo:mance of I�e work for w�ich Ihis pertnit is Issuetl. ❑ I heve entl will r�aintein woticers' compensatlon InSurence, es required Dy sectlon 3700 of iha La6or Code, tor the pertormance of tho work for which t�ls permit is issue0. My workers' compensation Insurence caMer end polity number ere: Certier. Poliry Number. /Thls sectlon need nOt be crompiete0 it Ihe Oermit is velued et one hundred daliers (3100) or less.) �1 certily thet in the Oertortnence ol ihe work lor w� h thi9 pertnit Is is9ued, I shell not employ eny pereon In eny manner so as to Decnme suD�ect ro t�e worken' compense�ion lews ol Califomla, e d egree thet shoWd hecome sub�ecl to the workers' crompensetlon provisions of Seciion 3700 of the Lebor Code, I s�all lorthwlth cromply with these D�ovisions. �/�/�// � L Appl�9igneNra: _� �� "`ri�i gef , 4 �� O %_ WFRNING: FAILURE TO SECUPE WORKERS' OOfdPENSATION COVEMOE IS UNL4WFUl AN� SHALL SUBJECi AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FlNE$ UP i00NE NUNDRED TTpU$AND DOILARE (5��.�). IN ADDITION TO THE COST OF COMPENSATION, DAMAOES AS PRpVIOED FOR IN SECTIpJ �O60F THE UBOR COpE, IMEREST, AND ATTORNEYS FEES. LICENSED CONTRPCTORS DECLARATION: I here6y eHirm thel I�m licensed undar provislons ol Chepter 9(commancing with SecUon 7000) oi Dlvislon 3 0l ihe Business entl Professions Code, and my license is in full foroe ene eiFect. Lic. � Clnss p Contraaa's Signature: Date: CONSTAUCTION LENUING AGENCV: ❑ I hereby aHirtn that I�ere Is e construclion lending agency for the Dedormence al the work lor which ihis permit is issuetl. (Sec. 3097, Civll Code). II Lender'9 Name: Lender's Atltlre95: Signeture; Dete: OWNER-BUILDER DECLARATIONS: I �ereby aflitm that under penetry ot pe�ury that 1 am E%EMPT FROM THE CONiRACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5, Business antl Pmtessions Code: Any dry or counry w�ich reduires a pertnit co construct, alter, improvo. demolish, or repair eny structure. prlor to its �ssuance, also requires the applicant tw such pertnit to tile e signetl statement thet he or sha Is BcenseA pursuent to the provisions ol the Cantrectors License Lew (Chepter 9(commencing vrit� Sectlon 700p) ot DlNsion 3 of t�e Business end ProfesS�s CoCe) or thet he w she is ezempt l�erefrom enA t�e basis tor Ihe elleped exemptlon. Any Wolation of Section 7031.5 Dy any aOP��nt fw a permit subjects Iha a0�licant to e dvil penelry ol not mora than tive hundred dollars (5500).): ❑ I, es owner ot ttre properry, or my employees with waqes e5lhair sWe compensetion, WILL DO 7HE WORK, entl Ihe structura is not intentletl or otteretl for sale (Sec. 70a4, Business antl Professions Code: Tha Contractore LJcense Lew does not eppty to en owner of property who builds or improves ihereon, and who Eoes such work himsetl or �ersetl or through his or her awn employees, O�aWded that such improvements ere not intentletl or offered for sale. If, �owever, Ihe building or imprwement is ..f soltl wit�in one year ol completion, the owner-builtler will have Ihe 6urtlen ol proving that he or she tlitl not build or imprrne br Ourpose ot sale.). 'y� I, es owner of the property, em EXCLUSIVELY CONTRACTING WITM LICENSED CONTRACTORS to constmct the project (Sec. 70A6, Business and Professions '�" Cotle: The contractors Ucense Lew does not eppty to en owner ol propeny who bullds or Improves thereon, and who wntracts for suc� Orolect wR� a contracior(s) license pursuant to the Contrectors License Laws.). ❑ I em azempt ei _� er ID vedfied I dmers license. [dyes ❑ No Busineu antl Prolessions Cotle lor ihis reeson: Venfkation ot Ownership by (type ol dacumem, i.e. - property �ax DIII or deetl): DIVISION OF INDUSTR�AL SAFETV PERMIT CERTIFICATION: .� ❑ I hereCy certify that no exwvetlon live (5) or more �eet in depth Inm whic� e person is required to descen4 will be meda in connection with work authorized by Nis permiC antl that �o building structure, sCaHolding, talsework, or demolition or Cismantling Ihereol, will be more then t�irty-six (36) feet �igh. (C�ap. 3.2, Grp 2, An 2, Sec. 341, Title 8, Celi�omia Atlmini5�reilve Code). ❑ As owner-Duiltle�. ��'ill not employ enyone to tlo work which woultl reqNre e permit Irom tho Didsion of Industrial Salery, as notetl ebove, unless such person hes a pertnit b Co such wak �rom lhe division. Signature: Date: Division ol Intlusirial5alery Pertnit Numbar: CERTIflCATE OF COMPLJANCE AND AUfHORVA710N OF ENfAV: I cenlry untler penalty ol porjury Ihel I heve reetl Ihls applicelion end state thet t�e inlormation given is correct. 1 agree b ply wilh ell te laws an0 dty orUlnences relating to bulltling cans�mc�ion, end euthodze represenletives ot Ihe Chy ol Casta Mesa to enter upon Ihe ebrne-descnbed pr� y or in lOn purposes. I egree not to occupy or allow xcupancy ol any bulldinp emhorized by Ihis permil until li�spec' n. A/.A.m 4 � � 7N'u�/ �� Signetu y.,._egal er(s) , And/Or Aut�orizoA Applicenl Date COOE /. iwsvernan*rvE PAIE I[fIII1SLS 1616 FIMed System Final Fire Prevenllon 1268 200 207 202 203 Pool SOa Find� Finel Re�Roo� Finel Block/Reteining Well Finel Fedary Firo Place Flnal Sign 204 Finel Demolition COOE1 INSPECTIONTYPE 208 Flnel Machenical 20B Finel Plumbing 210 Finet Eloctricel 212 Flnnl Plre Preventlon 220 Final Plenninq Approval 222 Final Sile 250 FIneI9ullAing/Occupency QA7E II{I�LS � � , '�� i (714) 754-5273 • Fex (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 437 E 19TH ST Suite No Vicinity: Parcel Number: 71734733 Applicant: PEARLMAN, RICHARD G Address: 437 E 19TH ST � COSTA MESA, CA- . Owner. PEARLMAN, RICHARD G Address: 437 E 19TH ST COSTA MESA, CA Contractor: OWNER-BU ILDER Address: MECHANICAL PERMIT Status: ISSUED Applied: 04/01/2005 Issued: 04/01/2005 ISSUEO BY: Phone: 949-631-4357 Zip: 92627 Phone: r�� Zip: 92627 L . � �� Phone: Zip: License:000000 SCOPE OF PERMIT ADD 1385 SF TO (E) SINGLE-STORY SFD AND CONSTRUCT NEW 529 SF ATTACHED GARAGE IN THE REAR. REMODEL KITCHEN AND LAUNDRY ROOM. ALSO CONSTRUCT 195 SF PATIO COVER AT FRONT. VENTED GAS FIREPLACEIHEATER: ANSI Z21.88 AND CSA 2.33. 1 FACTORY FIREPLACE, 2 VENT FANS SINGLE/DUCT REF:804-01885 � ISSUE FEE Inst FAU <100 k BTU Inst FAU >100 k BTU Repair / Alt Cooling/Heat Inst I Rep. Recess Wall HV Refrig Sys <100 k BTU Refng Sys >100 k BTU Gas Piping Factory Fireplace Hood w/Mech Exhaust VAV Box Vent Fan / Single Duct � - Appliance Fire Dampers Smoke Dampers Inst or Relocale Appl Veni Air Handlers < 10000cfm Air Handlers > 10000cfm Floor Furnace Floor or Suspend Heater $23.50 $0.00 50.00 50.00 50.00 so.00 $0.00 50.00 $10.65 $0.00 $0.00 $14.50 50.00 $0.00 50.00 30.00 $0.00 $0.00 $0.00 $0.00 Quantity 0 0 0 0 0 0 0 , 7 0 0': p �. 0 0 • 0 0 0 0 0 � 0 FEE SUMMARY Repair / Alt Absorblion Unit Repair / Alt Refrigeration Unit Ventillation System Evaporative Cooler Commercial I ncinerator Domestic Incinerator Compressors / Absorption SVstems Up to 3 hp I 100 k BTU 3To15hp/500kBTU 15 To 30 hp / 1,000 k BTU 30 To 50 hp / 1,750 k BTU � Over 50 hp / Over 1�,750 BTU � . Boilers , , � Up to 3 hp 3To15hp �Sto30hp 30 to 50 hp Over 50 hp ONer Mechanical �Fee Investigatlon Fee Quantity 50.00 0 50.00 0 $0.00 0 50.00 0 so.00 0 so.00 0 so.00 0 50.00 0 50.00 0 50.00 0 50.00 0 50.00 0 50.00 0 50.00 0 50.00 0 50.00 0 50.00 �TICE: The work authonzed by this permit shall comply with all applicable handicap access requirements under California statutes and related ulations. (Ord. No. 92-28, § 1, 12-21-92) PIRATION: This permit shall automatically expire and become void if work is not commenced wlthin 180 days, or if work is suspended or abandaned a period ol 780 days. iPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all epplicable codes, and all �ulred Inepeetlone and final epproval must be obtained. Failure to obtain inspections and final approval will result in the expiralion of ihis permit. R INSPECTIONS CALL: (714) 7545628 WORKERS'COMVENSAnON DECLARAnON: � I hereby eNirtn under penalty of perjury one o1 the follawing dedarations: ❑ I heve end will meintein a cerlificete ot consent to self-Insure lor workers' compensation, es provltled for by seqion 3700 oi the Lebor Cotle, for the pertormance at the work tor which Ihis permit is issued. ❑ I heve entl will meintain wo�kers' compensatlon Insurence, es reqWretl by sectlon 3700 of iha Lebor Code, for the pedortnance ot tho work for which ihis pertnit is issued. My workers' compensation Insursnce certler entl policy number ere: Cerrier: Policy Number: (T �his secNon need nof be completed il the permit is velued et ane hunared dollers ($100) or less.) �� 1 cetlity ihet in the peRormenca af Ihe wark for which ihls pertnit is Issued, I shell not employ eny person in any menner so as to bocome sub�ect to the worken' '�� comPensenon iaws o� canromie. nd ae�ee i u i sno�m become s�b�ec� �o me wo�ke�s comPa„sauon Pmv�sio�s m seaion s�oo or me �eoor coee, i snen ronnwun ' Se proVlsiO�s. a�a��e: .��(i� 6� 4-1—OS W�RNING: FAILURE TO SECUFE W KERS' COMPENSATION CpVERAOE IS UNLFWFUL AND SHALL SUBJECT FN EMPLOVER TO CRIMINAL PENALTIE$ RND CMl FlNES UP TOONE HUNDRED hKKISANO OOIURE R��.�1. �N PDdT10N TO TNE WST OF COt�IPEN5r1TION, OaMqGES AS PROVIDED FOR IN SECTIpJ 3106 OF THE L400R ODDE, IMERESt, AND ATTOqNEY'S FEES. LICENSED CONTAACTORS DECLARATION: I hereby eMirtn that I am licensed under proNslons ot Chepler B(commencing wilh Sectlon 7000) ol Divislon 3 ot I�e Business entl Prolessions Gode, antl my I'icense is in lull force antl eHect. Lic. M ' Cless a Contrecror's Signature: Dele: CONSTRUC710N LENDING A6ENCV: ❑ I hereby attirtn that there is e cnnstruclion lending egency tor Iha pedortnance ol �he work br wMch this permit is issued. (Sec. 3097, Civil Cotle). Lenders Neme: Lendar's Atltlra99: Signeture: Da19: OWNER•BUILDER DECLARAT10N5: I hereDy ettirtn I�at under penalry o� perjury ��a� I em E%EMPT FROM THE CONTRAC70R5 LICENSE LAW for the lollowing reason (Sec. 7031.5, Business and Protesslons Coda: Any ciry or COunty which require5 B pertni� lo Conslrucl, elter, improve, damolis�, or repeir eny 5trutNre. prior to its issuance, also rBquires Ihe applicant for 5uch pertnil to lile a signed statement Ihet �B or she Is Iicensed Dursuent to t�e proNsions ol Ihe Cantrectors License Lew (Chapter 9(commencing with Section 7000) 01 DMsion 3 ot ihe Business end Professions Cade) or thet �a or she is exempt Iheretrwn and Ihe besls tor t�e elleged exemptlon. Any violation of Sectian 7031.5 by any applicant tw a permit subjecis Ihe ep0licant to e civil panelry ol not mora Ihen five huntlretl tlollers ($500).): 0 I, as owner at t�e property, or my emplayeas wlth weges es Iheir sole compensallon, WILL DO TME WORK, antl t�e structure is not iniendea or olferetl for sale (Sec. 70dd, Business and Pmfessions Code: The Conirectors License Law does not apO�Y �o an ownor ol property who builds or imprwes thereon, and w�o Coes such work himself.or;heisetl or.through �is or,har own employees, provitletl that such improvemenls are not intendetl or oNered for sale. If, however, the building or improvement is sold wit�in one year of con+ple�ion,t�e owner-builder will have the burtlen of proving thal he or she ditl not build or improve tor purpose ot sale.). � 1, as owner oi tha properry, em E%CLUSIVELV CONTRACTINC WITH LICENSED CONTRACTORS to consimct the Drol�� (Sec. 7Daa, Business and Professions Cotle: The contractors Lice�se Law does not apply lo en owner of property who builtls or improves I�ereon, and who contrecis lor such Omject wit� a contracior(s) licensa pursuant m t�e CoNraqors License Lews.). ❑ lam O�verifietl Dy tlriver's license. Venficetion of Owners�ip by (typB o� _ Business antl Prolessions Code la lhis reason: _ ❑ Na Dri�L�feeri' o. _ i.e. - P�oPenY Iax bill or AeeA): '�IVISION OF INDUSTAIAL SAF� PERNR CER7IFICATION: ❑ I hereby certity Ihet no eace�ation tive (5) or more teet in depth inta w�ich a person Is requlretl Io Oescend, will be made in connection with work auNodzatl by Nis permil, antl that no building siructure, sceNoltling, lelsework, or demoliiion or tllsmentling thereoi, will be more ihan thirty-six (36) leet higR (C�ap. 32. Grp 2, Art 2, Sec. 341, Title 8, Celifomia Adminislreiive Cotle�. ❑ As owner-buil0er, I will not employ enyone to tlo work w�ich would require e permit Irom ihe Division ol Intlustnal Sefery, es noted ebove, unleu such perso� hes e pertnit to tlo such work Irorn Ihe division. SigneWre: Date: Division ol Industnfll Safery Perm�� Numbar. CERTIFlCATE OF COMPLIANCE AND AUTHORIZA710N OF ENiAY: I certity undor ponelty of Der�ury Ihel I heve reed this applica�ion entl s�ale t0at Ihe information given is correct 1 agree to wmpl wilh a11 stat ws enE dry orGfnances refating fo buNding constructlon, e�M emho�he represaMatives ol t�a City ot Costa Mesa to ente� upwi the flbove-descriDetl prope ins � purposea. I egree not to occupY or ellow occupancy ol eny building euthodzed by Ihls permit u� �il li=el� . r �� i d � signaw e pa dw q�yOr Autharized Appllcenl Date f�fj�/� IHSPECTIOHTYPE QAIE INTRIALg 16�6 Fixod System Pinal fire Preventlon 1266 Pool Spe Final 200 Finel Re-Roof 201 Flnel BIocN/Retaining Wall 202 Final Fectary Fire Placa 203 Final Sign 204 Finel Domolition GQQE! INSPELTIONTVPE 206 Flnel Mechenicel 208 Flnel PIum0ing 210 Final Electricel 212 Final Fire Prevenlio0 220 Final Planning Approval 222 finel Site 250 Finel Building/Occupency �E � (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 !ob Address: A37 E 19TH S7 Suite No Vicinity: Parcel Nunmber: 1'17J4133 ApplicanC PEARLMAN, RICHARD G Address: 437 E 19TH ST, � GOSTA MESA, CA i , Owner: PEARLMAN, RICHARD G Address 437 E 797H ST . � GOSTA MESA, CA Contractor: OWNER-BUILDER Address: PLUMBING PERMI7 ISSUED BY: Phone: 949-631-4357 � Zip: 92627 Phone: Status: lSSUED Applied: Oa/01/2005 I ssued: 04/01 /2005 . . . , . � , j ♦ i '� Phone: Zip: License: 000000 ` SCOPE OF PERMIT ADD 1385 SF TO (E) SINGLE-STORY SFD AND CONSTRUCT NEW-529 SF ATTACHED GARAGE IN THE REAR. REMODEL KITCHEN AND LAUNDRY ROOM. ALSO CONSTRUCT 195 SF PATIO COVER AT FRONT. � VENTED GAS FIREPLACE/HEATER: ANSI Z21.88 AND CSA 2.33. � 7 BATHTUB, 1 GAS OUTLE7 (1-4), t LAUNDRY TUB/WASHER, 1 SEWER CONNECT, 1 SHOWER, 1 KITCHEN SINK, 1 WASH-BASIN, 1 WASH BASW SET, 2 WATER CLOSETS, 1 WATER HEATERNENT REF: B04-01885 - ISSUE FEE Backtlow irrigalion BackFlow Preventer Bathtub ClariFler 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 ouuets) AMT $23.50 $0.00 50.00 59.80 S0.00 $0.00 $0.00 $�A� 30.00 � $0.00 $0.00 $0.00 $0.00 $0.00 $6.15 $0.00 QTY 0 0 1 D 0 0 � 0 0 0 0 0 0 t 0 FEE SUMMARY AMT LaundryTub'/Washer� � -$9.80 Landscape Irrigation $0.00 P-Trap $0.00 Pressure Regulator $0.00 Process Piping (per 10 ft) $0.00 Receptors $0.00 Septic Tank $0.00 Sewer Cap tor Oemo $0.00 Sewer Connect $0.00 Sewer Private Line $0.00 Shower $9.80 Sink, bar $0.00 Sink, commercial $0.00 Sink, Floor � $0.00 Sink, kitchen $g:80 Sink, service/mop ' $0.00 QTY 1 0 0 0' 0 0 0 0 0 0 1 0 0 0 �, 0 SumpPump Swimming Pool Trap Primer Urinal Vacuum Brkr BkFlow(1-4) Vacuum Brkr Bkflow(5+) . Wash Basin� Wash Basin Set Waste and Vent System �Water Closet (foilet) Water Healer / vent Water Piping (Inst or Rep.) Water Re-pipe Water Service Water Softener OTHER AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $9.80 59.80 50.00 $19.60 $72.30 $0.00 $0.00 $0.00 $0.00 50.00 QTY 0 0 0 0 0 0 1 1 0 2 1 0 0 0 0 NOTICE: The work authorized by this permit shall comply wi�h all applicable handicap access requirements undar Califomia statutes and related regulations. (Ord. No. 9248, § 7, 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 (or 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 Inapeetlona and final approval must be obtained. Failure to obtain inspections and final approval will result in �he expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 � (doo) WORKERS'COMPENSAnONDECLARAnON: ' I hereby effirtn under penelTy of perjury one of the following declarations: ❑ I heve end will meintain e cetlificele of consenl lo self�lnsure for workers' compenselion, es provlded for by seqion 3700 of the Lebor Cotle, for the pertormance of ihe work tor which ihis permit is issued. ❑ I heve enG will meintain workers' crompensetion Insurence, es required by section 3700 0l iha Lebor Cotle, for the pedo�ance of tho work for which this pertnit is issued. My woMers' compensation Insurence certler end pollcy number ere: Cerrier. Policy Number: (This secNon need n0� be cromplefed i! the permit is velued et one hundred dollars ($100) or Iess.J �I certify thet in �ha perfortnance ot the work for which Ihl9 permit is issuetl, I shell not employ eny person in eny manner so as to become subject ro the workers' compensetlon IBws of Calitomla, end ag/rg� Ihel II I 5hould become sub�ect to Ihe workers' compensetian pmvislons of Section 3700 01 Ihe Lebor Code, I shall forthwilh COmply with Ihese p� �i��+�"4///i{f�" _ T� I � �� WARNI� SEWRE WORKERS' COMPENSATION COVEMGE IS UNLAWFUL qND SHALL SUBIECT rW EM�O CRINJNAL PENPLTIES /.ND CML FlNES VP TOONE HUNDRED TTI(%ISAND OOLL4RE (3��.�1. IN AODITIIXJ TO iHE ODST OF COMPENSATION, OAMrIGES AS PROVIDED FOR IN SECTION 3/060F THE LABOq CODE, INfERESi. rWD ATTORNEVS FEES. LICENSED CONTRACTORS UECLARA710N: I hereby aflirtn iha� I 0m licensed under provisions ol Chapler 9(commencing with Saction 70W) ot Division 3 ot �he Business antl Pmfession5 Code, and my license i5 in full torce anE enect. Lic. M class b Contrector's Signeture: Dete: CONSTRUCTION LENDING AGENCY: ❑ I hereby aflirtn that there is e construction lending egency for the peAormance ol Ihe work tor which this permit is issuetl. (Sec. 3097, Civil Code). Lantler's Name: Lender's Address: Signeture: Date: OWNER•BUILDER DECIARATIONS: 1 hereby affirm thel untler penalry of perjury Ihei 1 em E%EMP7 FqOM THE CON7AACTORS LICENSE LAW ior Ihe lollowing reason (Sec. 7031.5, Business and ProFessions Cotle: Any dy or cou�ty which requires e parmit to construct, elter, improve, tlemolish, or repelr eny gtructure, prior to its issuance, also requires t�a applicant for such pertnit to file e signetl steteNent ihat ha or she Is Ilcensed pursuent to the proNsions of Ihe Contrectors License Lew (Chapter 9(commencing wii� Section 7000) ot Division 3 of the Business antl Pmfes4�on5 Code) or thet he or s�e I5 exempl Iherelrom end ihe basis lor the elleged exemption. Any vidation of Sectlon 7031.5 by any apDlicant for a pertnit subjects the applicant m e civil penelry ot not more then Ilve hundred dollars ($500).): ❑ I, es owner ol Ihe property, o� my employees wllh weges es their sole compensation, WILL DO THE WORK, antl the stmcture is not imentletl or oHered for sale (Sec. 7044, Business end Professions Code: The Contrectoro License Law does nol ep01y lo en ownor ol property who builas or improves t�ereon, and who tloes such work himsell or �erself or thmugh his or her own employees, provided ihat such Improvements ere not Intendetl or oHered for sale. If, howaver, Ne 6uilding or improvament is '� sold within one yeer of complation, the owner-builder will have ihe burden of proving that �e or she ditl not build or improve tor purpose of sale.). � 1�JA I, as owner ol the properry, em EXCLUSIVELV CONTRACTING WITH UCENSED CONTRqCTORS to wnstruct the pwject (Sec. 7044, Business and Professions /� CoCe: The coM�actors License Cew�0oe5 not epplY �o en owner ol proparty w�o bulltls or Improves thereon, antl who conirects br such projeci wi[h a wntractor(s) license Dursuanl to the Contractors Licensa LewSJ. ❑ I am axempt Business and Prote55ion5 Code fot thi5 reason'. r ID varilied by d��ar s license. J�p�( Yes ❑ No D v � cens o. Venficetion ol Owners�ip by (type ol daumBnt, i.e. - property tac 6ill or deed): UIVISION OF INDUS�7��L SAFETV PERMR CERTIFICATION: ❑ I hereby certiy Ihei no excavalion fiva (5) or mora faei in tlepih into which a person is requlred �o tlescend, will te matle in connaction with work autho�zed by ihis pertnit, end thet no building siructure, sceHolding; talsework, or demolition or dismanUing iheraot, will be more ihan thirry-six (38) teel high. (Chap. 32. Grp 2, Art 2, Sec. 341, Ttle 8, Califomia Atlminisiretive Cotle). ❑ As ownerbuilder, I will not employ enyone to tlo work which woultl require e permit irom Ihe Division of IntlusMal Sefery, as noted aDove, unless such person has a pertnii to tlo such woik from the division. Signature: Date: Division ol Industnel Safery Pertnit Number: CERTIFlCATE OF COMPLI CE AND AUTHORIZATION OF EMAY: I cenity untler penelty ot perjury that I have read Ihis application entl state �hat ihe information qiven is correci. I agree to wmWy th alt stete l �s eMl ciry orAlnaaces relating to bulltling crnsuuctlon, antl aut�oriza �ep�esentatives of t�e Ciry of Casta Mesa to enter upon the etwve-Cescnbetl D�oO�rtY � ction ��'�s. 1 egre �not to occupy or ellow accupency ol eny huiltling au�0orizetl by ihis pe� t-n�il tinal irySpection. l4l 4 � � i' Sig ) Deie, AnNOr Aulhorized Applicant Da�e COOE i. IMSPECTONTYPE 1616 Fi:ed System Final Fire Prevention 126fi Pool Spe Final 200 Final Ra-Roa� 201 FIneI8locWRetaining Wall 202 Final Fectory Fire Place 203 Finel Sign 204 Finel Demolition QdjE �N�L$ SQQE.( INSPECTIONTYPE 206 Finel Mechanical 20B Finel Plumbing 210 Flnel Elecidcal 212 Final Fire Prevention 220 Final Planninq Approval 222 Final Site 250 Final Building/Occupancy DSIE I[�EL9 �� (714) 754-5273 • Fax (714) 754-4856 • www.c�.wsta-mesa.��LDING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626 ,lob Address: 437 E 19TH ST Suite: Vicinity: Primary Occ: R3IU� Parcel Number: 11734133 Applicant: RICHARD PEARLMAN Address: Owner: Address Contractor. Address: PEARLMAN, RICHARD G 437 E:19TH ST � , COSTA MESA, CA,, ' Type of Construclion: V-N Zoning: Phone: 949-637-4357 Zip: Phone: Zip: 92627 Phone: Status: ISSUED Applied: 11/OS/2004 Issued: 04/01/2005 ISSUED BY: EXpIRED � � DA?E� Zip: � , ,License: Arch : ROGER L KR,4USE - Eng: DONALD ORIE Address: 66 CONGRESS PL � ' Address: 16980 VIA TAZON #290 . Phone: 714-665-8746 - � Phone: 858335-7643 IRVWE, CA Zip: 92602 License: C27152 SAN DIEGO, CA 92127 License: 53838 SCOPE OF PERMIT ADD'1385 SF TO (E) SINGLE-STORY SFD AND CONSTRUCT-NEW 529 SF ATTACHED GARAGE IN THE REAR. REMODEL KITCHEN AND LAUNDRY ROOM. ALSO CONSTRUCT 195 SF PATIO COVER AT FRONT.�VENTED GAS FIREPLACE/HEATER: ANSI Z21.88 AND CSA 2.33. BLDG BECOMES 3 BDRM 2.5 BATH SFD LOT - 8332. SQ.FT. � . �� -. � BLDG. - 3,009 SQ.FT. PAVING-SO6SQ.FT. . � OPEN SPACE - 4,517 SQ.Ff. (54%) ' NONCONFORMING 2-CAR GARAGE PARKING. ADDITION WILL NOT OCCUPY SPACE WHERE 3RD SPACE CAN BE PROVIDED. � FEE SUMMARY Plan Check: $897.10 Permit: $1,380.15, SMIP Res: $16.89 SMIP Com: ' $0.00 ;� Other: $0.00 Inspection: $0.00 , Total: $2,294.14, PLANNING & ZONING , c Calc Valuation: giea,esa.sa Claim Valuation: So.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 9248. § 1, 12-21-92) EXPIRA710N: 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 ihis permit to be considered legal, such work must comply with all applicable codes, and all requlred Inapeetions and final approval must be obtained. Failure to obtain inspections and final approval will result in ihe expira�ion of this pertnit. FOR INSPECTIONS CALL: (714) 754-5626 � zaae�ae �aroo� L ! WORKERS' COMPENSATION DECLARATION: I hereby affirtn undef penelty at perjury one oi Ihe lollowing declaratlons: ❑ I heve end will mflintein e certificate ol consent to selFlnsure lor workers' compensatlon, es provitled for by section 3700 af the Lebor Code, Por the pertortnance of tha work for which this pertnit is issuetl. ❑ 1 have antl wlll meintain workers' compensation Insursnce, es raqulred by section 3700 0l Ihe Lebor Code, for Ihe pertormance of t�e work for which this permlt is issued. My workers cumpensetlon Insurence cerder and policy numbar ere: Certier: Policy Number: (This secfion neetl nol be completed ii the pertnit is veWetl et one hundred dollers ($100) or lessJ I certify the� in the pertormence ol the work lor which this pertnll Is Is9ued, I shall not employ eny person in any menner so as to bacome sub�ect to the worknrs' crompensation laws of CeliFomie/, �9ntl egree th I should bacome sub�ect to Ihe workere' compensation provisions of Section 3700 of the LeDor Code, I shell forthwilh mmply with thOse provisionsL��:Gs/!/ ' � �/ �� — � ican e ure: RNING: FAIWRE TO SECURE WORKERS' COMPENSATION COVERAOE IS UNIAWFUL AND SHALL SUBJECT AN EMPLOVER TO CflIMINAL PENALTIES AND CMl FlNES UP TOONE HUNDREO iHOUSPND OOl1ARE (5100.000). IN RDDIPON TO THE �ST OF GY)MPENSATION, DAMRGES AS PROVIDED FOR IN SECTION 31p60F TME LABOR CODE.IMEREST, AND AT�OflNE1^S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aflirtn that I am licensed under proNsions of Chapter 9(commencing wllh Sectlon 7000) ol Divislon 3 of the Business aptl Pmfessions Code, and my license is in full 1D(CB 00d ENEU. LiC. M CI855 M Conirector's Signatufe: Date: CONSTAUCTION LENDING AGENCV: ❑ I hereby aHirtn Ihat there is a consiruction lending agency for Ihe pedormence ol lhe work lor which Ihis parmit is issued. (Sec. 3097, Civil Cotle). Lender's Name: Lender's Addrass�. Signature: Date: OWNER•BUILDER DECLARATIONS: 1 �ere�y aflirtn that under penalty ot pe�ury tha� 1 em EXEMPT FROM 7HE CONTHAC�OHS LICENSE LAW tor the tolirnving reason (Sec. 7031.5. Business and Professlons Cotle: Any ciry or coV�ry which requires e pertnit to construct elter, improve. demolish, or repeir eny struqure, pnor to its �ssuance, also raquires Ne applicant for suU pertnit to file e signed stelemem ihat he or she.is Iicensatl pursuent to the pravisions of Ihe Comrectors License Law (C�apter 9(commencing with Section 7000) of Divislon 3 of the Business end Profes5ions CoCe) or t6el.he,oi she is exempt theralrom end tha besis br Ihe elleged eKemption. Any violetion ot Section 7031.5 by eny applicent tor e permit subjecis ihe applicen� �o e civil penalty of not more than five �untlred dollars ($500).): ❑ I, es owner ol ipe property„or my'employees with wages es Iheir sole compansalion, WILL DO T1E WORK, ana �he stmcture is nm intentleE or oflered for sale (Sec. 70a4, Business antl Professions Cotle: The Contrectors License Lew doas no1 apply lo en owner of propeny w�o builds or improves thereon, antl who does such work himsetl or hers@tl or �hrough his or her own empl0yees, provitletl ihet such improvemenis ere not Inlentlea or oXere0lar sale. If, however, the building or improvement is soltl wit�in one year ol completion, t�e ownerbuilder will heve 1he burden oi proving ihat he or she did not build or improve for purpose of sale.�. � � I, as owner ol tne proparry, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to consiruct the project (Sec. 7044, Business antl Professions Cotle: The contrectors License Lew tloes not epply Io an owner ol pm0erty who �ulld5 or Improves thereon, enC who wntrects for such Omject wlt� a contraclor(s) license pursuant to the Contractors License Lews.). ❑ I em exempt u c. s�. ,� � Owner ID verifiad by G��eYs license. � Ves ❑ No Business end Professions Coda br this reason: Venficetion of OwnerShip by (rype of documen6 i.e. - proDerty tax bill or tleetl): DIVISION OF INDUS'�IAL SAFETY PERMIT GERTIFICATION: No. ❑ I hereby certity Ihat no axwvation five (5) or more teet in tleplh into which e person Is required Io descend, will be made in connection with work authonzed by this permit, and ihat no building structure, scaHolding, talsework, or tlemolition or dismantling ihereot, will be more than thirry-six (36) feet high. (Chap. 3.2. Grp 2, An 2, Sec. 341, Tdle B, Califomie Adminisiretiva Cotle). ❑ As owner-builtle�, � will not employ anyone to da work w�ich would require a permit from ihe Division of Industnal Sefery, as noted ebove, unless such person has a pertnit to tlo suc� wa�k �mm the division. Signature: Date: Division of Industrial 5atery Permit Num6er. CERTIFlCATE OF COMPLIANCE AND AU7MORIZA710N OF EHTtiV: I cenify untler penelty of perjury thal I have read tMs epplication enA state ihat Ihe in�ormation given is correct. I agree to comply wl�h I state laws en iry o�dinances releting to bullding cons�mctlon, end euthorize representa�ives ot I�e Clty ot Casia Mesa to enter upon Ihe ebove-descnbed pwparty for "/� n purp . I e�t to accupy or allow occupency ol eny building amhodzetl �y l�is permit until finel ins4 c�ion. �' ' l �0 J --7 Slgn _.,�.�fLe§el0 r(s) AnN6r Aut�onzed Applicent Date GOOE I. INSiELTIONTYVF 1616 Fixed System Final Fire Prevention 1266 Paol Spa Finel 200 Flnal Re-Roo1 201 Final BIocWRetaining Well 202 203 204 Final Fectory Fire Place Final Sign Final DemoliUon PAIF INIIIJELS COOE I INSPECTION TYPE 206 Flnel Mechanlcal 208 Flnal Plumbing 210 Final Electrical 212 Final Fire Prevention 220 Final Planning Approvel 222 Final Site 250 Finel9uilAing/Occupency PdIE INTRUL9 (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa��DING PERMIT �� FAIF DRIVE, COSTA MESA, CA 92626 .lob Address: 437 E 19TH ST � Suite: Vicinity: EXISTING GARAGE Primary Occ: U-t Private GadCarport/Shed Type of ConsWction: V-N Parcel Number: 11734133 Zoning: Applicant PEARLMAN, RICHARD G Address: 437 E 19TH ST COSTA MESA; CA -�'.�� ; Owner: PEARLMAN, RICHARD G Address 437 E 19TH ST % - COSTA MESA, CA " ' � Contractor: O W N E R-BU I LD ER Address: , ' � Phone: -949-631-4357 Zip: 92627 � �- Status: ISSUED Applied: 03/28/2005 Issued: 03/28/2005 ISSUED BY: � Phone: , �� y _ � Zip: 92627 , �� DA'1'E Phone: Zip: � �� License: 000000 , Arch : � � . Eng: � � Address: � � � - AddreSs: ' Phone: • Phone: 2ip: License: License: SCOPE OF PERMIT DEMOLITION OF A 351 SF GARAGE IN CONJUNCTION WITH THE 1385 SF ADDITION TO (E) SINGIE-STORY SFD AND CONSTRUCT NEW 529 SF AiTACHED GARAGE IN THE REAR. � -� - � - � REF:B04-01885 � Plan Check: Permit: SMtP Res: SMIP Com: Other: Inspection: Total $0.00 $38.75 $o.00 $0.00 $0.00 $0.00 $38.75 SETBACKS � �� MAIN STRUCTURE Fronh 0- 0�� ACCESSORY Front 0-0 . PARKING Existin : 0 FEE SUMMARY � �_ ,�„ � PLANNING & ZONING . � Rear 0- 0 Left 0- 0 � �.Resr 0- 0 Left 0- 0 Reouired: 0 Pr000sed: 0 Calc Valuation: Claim Valuation: Right� .0-0 Right 0- 0 5�,000.00 st,000.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under CaliFomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 780 days, or It work is suspended or abandoned for a period of 180 days. INSPEC710NS: In order for the work authorized under this permit to be considered legal, such work must comply vnth all applicable codes, and all requlred Inapeetions and finel approval must be obtained. Failure to obtain inspections and tinal approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 � zaaaae laroo) -.�7 WORKERS'COMPENSAnON DECLARAnON: I hereby eXirtn untler penaNy oi perjury one ot the tollowing decleretions: ❑ I heve e�d will meintein e cetlificete of consent ta self-Insure tor workers' compensetlon, es provided tor by section 3700 of ihe Labor Code, for the performance o� t�e work br which this pertnit is issued. ❑ I heve a�d wil� meintain wwkers compensatlon tnsure�e, es reqWred by section 3700 oi the Lsbor Code, for Me pertortnance ot the work tor whkh t�ls pertnit is issuetl. My worKere' cnmpensation Insurence cerrler entl pollcy number ere: Camer: Policy Number: (This sectbn nead nof be crompfefed i! the peimit is velveAef one hunAred dollars ($100J or less.) �dil I certify Ihat in the peRormance o� tha work for whlch Ihls pB�nit is Issued, I shell not employ eny person In eny manner so as to becroma sub�ect to Ihe workers' �y1 compensaiion laws of Celifomia, nd egrea I t il I shoultl bemme sub�ect to t�a workers' compenseilon provlsion5 of Section 3700 of Ihe Lebor Cotle, I s�all Iorlhwilh comply with these provisions. _ � -/ �i�re: � _et�• �� S M�M �WRE TO SECURE WORNERS' COMPENSATION COVERAQE IS UNIAW FUL ANp SNALL SUBJECT rW EMPLOYER TO CFIMINAL PENALTIES ANO GVII FlNES UP TOONE HUNOFiED hKKJ$AND DOlURE (E100,O00�, IN ApDIT10N TO THE COST OF COMPENSATION, DAMAGES AS PROVIOED FOR IN SECTION �p60F THE LABOR CODE, IMEFEST, AND ATTORNEI^S FEES. LICENSED CONTRACTORS DECLAFA710N: I hereby alfirtn that I am licensed under provisions of Chepter 9(commencing with Secllon 7000) of Divislon 3 0� tha Business end Professions Gode, and my license is in full tarce ena efle�i. Lic. a Class K Cantreaors Signeture: Dete: CONSTRUCTION �ENDING AGENCY: ❑ I hereby attirtn that there is a conSWction lending egency tor �he pedormance ol ihe work br which this permit is issued. (Sec. 3097, Givil Cotla). Lentler'S Name: Lender's Addrass: Signatura: Date: OWNER•BUII:DER DECLARATONS: I hereby aRlrto that under penalry of �perjury thet 1 em E%EMPT FFOM THE CONTRACTORS LICENSE LAW br Ihe following reason (Sec. 7031.5, Business and Pmfessions Cotle: Any ciy or counry which reQuires e•permit to constmct eNer, imp.ove, demolish, o� repei� any stmcture, prior l0 0s issuance, also requires Ihe ap011cant tor such permit to file e signed stetement that tie or she Is Ilcansed pursuent to the prodsions oi the Contrectors License Lew (Chapter 9(commencing wlt� Section 7000) at Division 3 of the Business antl Pmfessions Cotle) or thet he or she is exempt theralrom end the besis lor Ihe ellegotl exemption. Any violation of Section 7031.5 by any applicant for e pertnit suDjacts tha apP�icant to e civil panelry,ol.not mora Ihan flve hundred dollers ($500).): ❑ I, es owner ol the praperty, or my employeas wit� weges es their sole compensetlon, WIIL DO 7HE WORK, and tha stmqure is not inten0ea or oRered for sale (Sec. 7044, BU5ine55 end Protessions Code: The ContrettOrS License Lew tloes nol apPly lo en ownor ol property who builQs or improves Ihereon, and who does such work himself or herself or through his or her own employees, providetl that such imOrovemenis era not Intended or oNered for sale. If, however, Iha builtling or improvement is sold within one year ol completion, ihe owner�builder will ha�e the burden of provinp ihat ha or she tlid not build or improve for purpose o1 sale.). �I, es owner ot the proparry, am EXCLUSIVELV CONTRACTING WIT1 LICENSED CONTpACTORS Io consimct the Orqed (Sec. 7044, Business and Protessions Code: iTie contreciors License Lew does not epply �o en owner ol pmperty who bulltls or impwves I�ereon, antl who contracis for suc� Droject with a wntractor(s) license pursuant to ine Coni�ctors Licensa Lews.). ❑ I em esempt u�p,r sec. Business end Prolessions Code for Ihis reason: ��a�J / re a ,r�%�r �%iai��. �O venfietl by tlnvers 6cen5e. Ves ❑ No Dnv�"� �� Venfication ot Ownership by (rype of tlxument, I.e. - property tex bill or daed): DIVISION OF INDUS7RIAL SAFETY PERMIT CER7IFICATION: ��"e:'9 ❑ 1 hereDy Genliy t�st no excavetion five {5) or mora teet in tlepSt� into which a person 15 raquired to descand, will be mada in connection with work authoriza6 by this permit, antl Ihat no building siructure, scaHoltling, felsework, or demolition or dismentling thereof, will be more than ihirty-six (36) leet hign. (Chap. 32. Grp 2, Art 2. Sec. 341, Trtle B, Calilomia Administrativa Cotle). ❑ As ownef-builder, I will not employ anyone to do work whith would require e permit iram the Division ot Indusirial Safery, as noletl above, unless such person has a pertnit to tlo such work tram the division. Sipnature: Date: Division of IndUstrial Safery Permil Number. CERTIFlCATE OF COMPLIANCE AND AUTMORIZATION Of EMRY: I certify untler penalty ol perjury I�et I heve read t�is application and stata Ihat ihe information given is wrrect. I agree �o �mply wlih all stat ews end y ordlnances relating to builAing conslructlon, end au�horize rapresentatives ol t�e Clly ol Costa Mesa lo enter upon �he ebove-descnbed propetly for inspect �urpos . I agree not to occupy or allow acupancy ol eny builtling aulhorizad by ihis permit until t�l I� pect�� Signalure,.,�y��.;'OKegafOwner(s) :j, fliB7 la.'�k ic+--.-% AndfO� Authalxetl AppllceM Date LOOE1, INSVECTIONTYVE Qdjf, INTITI�LS 1616 Fixed System Final Fire Prevention 7266 200 Pool SOa Finel Final Fe-Fioof CODE� INSPECTIONTYPE 206 Finel Mechanical 20B Finel Plumbing 210 Final Eleclrical 201 Final 6�ocWRetaining Well 212 Flnel Flre Prevention 202 Final Fadory Fire Plece 220 Final Plenning Approval 203 Finel 5ign 222 Finel Site 204 Final Damalition 250 Final 8uilding/Occupancy PAIE INTRULg ' y, _ '"l-""��1.�'. i .�.�J � ' � ; � CITY OF COSTA MESA , BIIILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT (714) 754-5273 • Fa�c (�14) 754-4856 .lobnddress: 437 E 19TH ST Suite No Vicinity: SIDE OF HOUSE Parcel Nunmber: 11734133 npp�icant: SWART, ANDY Address: 1307 W TRENTON AVE ORANGE,CA owner: PEARLMAN, RICHARD G Address 437 E 19TH ST COSTA MESA, CA Contracror. DENICK ELECTRIC INC Address: 1307 W TRENTON AVE ORANGE,CA , . ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool I Spa Lighting Fixts Recept Outlets Switches Non Res Appl Res Appl Service to 200a Service to 1000a Service over 1000a Motors to thp Motors to 10hp Motors to 50hp Motors to 100hp Motors over 100hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Inlermed Pole ELECTRICAL PERMIT Phone: (714) 62&1490 Zip: 92867 Phone: (949) 631-4357 Zip: 92627 .Phone: Q14) 628-7490 - Zip: 92867 License: 501684 SCOPE OF PERMIT UPGRADE EXISTING ELECTRICAL SERVICE TO 200 AMP. $23.50 $0.00 $0.00 $0.00 $0.00 so.00 $0.00 $0.00 $0.00 $0.00 $0.00 $30.50 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantity FEE SUMMARY Temp Dist System / Lighting Busway /100 ft Standing Sedion Misc Electrical Equipment Transformers up to 1 kva/kw ................up to 10 kvalkw .................up to 50 kva/kw .................up to 100 kva/kw ..................over 100 kva/kw Low Voltage Equipment Low Volt Wiring System I Ckt Misc. Conduit Misc. Conductor Circus ( gen or ride) Circus (mech ride or lights) Chnstmas Tree Stand Fireworks Stand Other Electrical Fee Invesligation Fee Plan Check Fee Reinspeclion Fee PERMIT NUMBER E00-00644 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: O6I30/2000 Issued: 06/30/2000 ISSUED BY: Quantity so.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 so.00 0 $0.00 0 $0.00 0 so.ao 0 so.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 so.00 $0.00 $0.00 TOTAL CALCULATED FEES 554.00 COMMENTS / SPECIAL CONDITIONS NO710E: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authonzed under this pertnit to be considered legal, such work must comply with all applicable codes, and all required Inapaetlons and final approvel must be obtained. Failure to obtain inspections and (inal approval will result in the ezpiration o( this permit. FOR INSPECTIONS CALL: (714) 7545626 WORKERS'COMPENSAnONDECLARATON: I hereby aflirtn uneer penalty of perjury ona ot Ihe lollowing tlecleretions: ❑ I heve end will mein�ain a cetliflcate ot consent ro selt-Insure tor workers' compensatlon, es pmvided for by section 3700 of Ihe Lebor Code, for the pertortnance ot the /�'ork for which t�is permit Is issued. �/ I have and will mainlein workers' compensation insurance, as required by section 3700 of Ihe Lahor Cotle, for the performance oi �he work for which Ihis pertnit is issuetl. My worker ' omp nsellon I urence� flarner and policy number are: 1 Carrier: ��.. ��X � PolicyNumber. U�6 ��' uh1/r/- Gn0 �!�%S (This sectian need not be comp/eled /! the permit /s valued et one hundred dollars ($100) ar IessJ ❑ I cehify ihat in Ihe peRormence the work for which thi9 permit is issued, I shall nol employ eny person in eny manner so as to �ecome subjecl lo the workers' compenution laws o1 Calitomi , r a Ihat'd I shoNO become subject to Ihe workers' compensation pmvislons ot Saction 3700 of ihe Labor Code, I shall fotlhwiN compty with these provisions. Applicant SignaWre: Date: 6/S�4 v WARNING: FAILURE TO SECURE WORKERS' CAMPENSATION COVERAGE IS UNLAWFUL AND SHALL SU&IECi AN EMPLOYER TO CRIMINAL PENALTIES AND GVIL FINES UP TO ONE HUNDRED TNOUSANO OOLJ.AflE (5100.000). IN ADDRIIXJ TO TME CQST OF COMPENSATIIXJ, OAMAGES AS PROVIDED FOR IN SECTION 3'lO60F TME LABOR WDE, INrEREST. AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aflirm ihaLl.am liGensed und yro,visions of Chapter 9(Commencing wi�h Section 7000) of Division 3 of ihe Busine s and Pmfessions Code, antl my license is in full torce and ettect Lic. e S 0 �%��f Class N� �"�� Comractofs Siqnature: Date: %J 30 Uo CONSTRUCTION LENDING AGENCY: ❑ I hereby aNirm ihat tnere is a consiruction lending agency for the pertormance oi ihe work for whic� this permit is issued. (Sec. 3097, Civil Code). Lenders Name' Lendels Atltlress: Slgnature: Date: OWNER-BUILDER DECLAAATIONS: I hereby aHirm ihat undar penalry of perjury ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for Ihe tollowing reason (Sec. 7031.5, Business antl Professions Cotle: Any ciry or counry wNch requires a pertnit to wnsiruct, alte�, improve, demolish, or repeir eny sWCNre, prior lo Its Issuence, also requires the appliwnt tor such pertnit to file a signed statement Ihat he or she is licensetl pursuant b the provisions of t�e Contractors LJcense Law (Chapter 8(wmmencing with Seclion 7000) of Division 3 of Ihe Business antl Professions Code) or Ihat he or she is ezempt iherefrom and the basis for the ellepetl exemption. Any violation ot Section 7031.5 by any applicant for a permit sub�ects the appli'cant'to a��civll penelry af not more than live huntlred tlollars ($500).J: �v._W � ❑ I, as owner of iha.properry,, or my employaes with wages es their sole compensation, WILL DO THE WORK, and Ihe structure is not imentled or oHeretl for sale (Sec. 7044, Business enC:P�ofessions,Cotle: The Contrectors License Lew does not epply to en awner of property who builtls or improves thereon, and who does such work himselt or.herselt or thidugA his'or her own employeas, provitled that such improvemeats are not intended or oftered tw sale. !f, however, the buildi�g or improvement is sold within oneyear 0� completion!'tAe;ownerbuilder wlll have Iha burden ot proving Ihet he or she did not bulld or Improve for puryose ot sale.). �r�� fei ❑ I, as owner of ihe propeny, em EXCLUSIVELY CONTRACTNG WITH LICENSED CONTRACTORS to consiruct the prolecl (Sec. 7044, Business antl Professions Cotle: The contrectofs �cense,Law does not apply to en owner of pmpetly who bulids or impmves thereon, end who con�racts for such project with a contractor(s) license pursuant to Me Contracto y�License Lews.). ❑ I em eaempt untler s@�. 'r Busineu and Pmfessions Cotle for Ihis reason: Signature: Owner ID venfied by drivefs license. ❑ Ves ❑ No Drivefs License No. Ventication of Ownarship by (type of daument, i.e. - property ta�c blll or deed): DIVISION OF INDUSTRIA4 SAFETY PERMIT CER7IFICATION: Date: Expires: ❑ I hereby certity that no excavation five (5) or more feei In depth into which a person Is requiretl to tlescend, wlll be metle in connection with work authorizetl by Ihis permit, antl that no building stmcfure, scallolding, felsework, or tlemolition or dismantling thereof, will be more than thirry-six (36j teet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, Califomia AdmlMshetiva Code). ❑ As owner-builder, I will not employ anyone to do work w�ich would require a pertnit Irom tha Division of Intlustnel Salery, as notetl above, unless such person has a pertnit to do such wark irom the tlivision. Signatura: Date: Division ot Industrial Satety Pertnit Number: CERTIFlCA7E OF COMPLIANCE AND AUTHORIZATON OF ENTFiV: I certity under penalty of per�ury that I have read �his epplication and stata that the infortnation given is correct I agree �o comply With all stata laws and city ordinances relating to builtling consWction, end authonze representetives of Ihe Ciry ol Coste Mesa ro enter upon the aDove-descn6ed property lor inspection puryases. I agree not �o wcupy or allow occupancy of eny building authorizetl �y this pertnit until ilnal Inspection. CODE �• INSVECTIONTVPE 1616 Fixetl System Finel Fire Prevention 1266 Poal Spa Finel 200 Finel Re-Roof 201 Final Block/Retainin8 Wall 202 203 204 2666d8 Finel Factory Fire P�ace Final Sign Final Demolition INTff1ALS Date 6 30 00 � Date COOE 1 INSPECTION TYPE 206 Final Mechanical 208 Final Plumhing 210 Final Electrical 212 Final Fire Preventlon 220 Final Planning Approval 222 FinalSite 250 Final Bullding/OauOancy PAIE .uu. (714) 754-5273 • Fax (714) 7544856 CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT. PERMIT Jab Address: 437 E 19TH ST Suite: Vicinity: ALLEY AREA AND LEFT SIDE PL Parcel Number: 11734133 Applicant: MICHAEL DICKSON Address: � Owner. PEARLMAN; RICHARD G Address .437 E 1gTH ST �� ' i . � COSTAMESA,�CA � - Contractor. ,OWNER-BUILDER Address: Zip: • Arch : Address: � � Phone: r BUILDING PERMIT Zaning: Phone: (714)542-2619 Zip: Phone: (949)631�357 Zip: 92627 Phone: ' License: , 0 � Eng: � - Address:� PERMIT 77 FAIR DRIVE, COST/1MESA, CA 92626 Status: ISSUED Applied: 04/OS/2000 Issued: 04/OS/2000 ISSUED BY: Phone: � � ,: ' _ � . , . ��. Zip: ' " � .-- License: . License: SCOPE OF PERMIT ' CONSTRUCT 60 LINEAL FEET OF 6-FOOT HIGH �BLOCK WALL. CORNER CUT-OFF RE�URED AT DRIVEWAY APPROACH TO � ALLEY. , Plan Check: , $29.15 Permit: $44.85 SMIP Res: $0.00 SMIP Com: $0.00 Other: $0.00 Inspection: 30.00 Total: $74.00 SETBACKS MAINSTRUCTURE Fmnt 0-0 ACCESSORY Front- 0-0 PARKING Exislina: 0 NOTES: Rear 0- 0 Rear 0- 0 Required: 0 FEE SUMMARY _ , PLANNING & ZONING Left 0- 0 Left 0- 0 Proposed: 0 Calc Valuation: Ciaim Valuation: Right 0- 0 Right 0• 0 $1,200.00 so.00 NOTICE: The work authorized by ihis pertnit shall comply with ell applicable handicap access requiremenis under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-g2) EXPIRATION: This permit shall automatically expira and become void if work is not�commenced within 1B0 days, or if work is suspended or abandoned for a penod of 180 days. ,,., INSPECTIONS: In order tor the work aulhorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inepeetlone antl flnal approval must ba obtained. Failure �o obtain inspections and final approvai will result in the expiration of �his permit. FOR INSPECTIONS CALI: (714) 7545626 WORKERS' COMPENSATON DECLARATION: I hereby effirm untler penalry of perjury one oi the �a��owing declaratlons: ❑ I heve antl wlll maintain a cetllficare oi consent to self-Insure lor workers' compensation, es proWded tor by seclion 3700 of the Lebor Code, for the pertortnance oi the work far which Ihis pertnit is issued. � I have and will maintain workers' cwnpensation insuranca, as required by section 3700 of Ne Lebor Code, for the peAortnance ot Ne work for which this permit is issued. My workers' compensation Insurence carne� antl policy number ere: . Carrier: Policy Number. (This section need npt be complefed i! fhe permif is velued a1 one hundred dollare ($ f00) or less.) ❑ I cenity that in Ihe peAormence oi the work tor which ihis permii is issuad, I shell not employ eny person in any menner so as to 6ecome subject to ihe worNers' compensation laws ot Celitornla, end agree that if I should become subJect to Ihe workers' compensetion provisions of Section 3700 of Ihe Labor Code, I shell forthwith comply with Ihesa provisions. Applicant Signature: Date: WARNING FAILURE TO SEWRE WORKERS' COMPENSATION COVERAGE IS UNLAW FUL AND SHALL SUBIECT AN EMPLOVEfi TO CRIMINAL PENALTIES AND pVIL FINES UP TO ONE HUN�RED T/IOUSAND OOIJ.ARE (510D,000). IN ADDITIqJ TO THE C�.+T �F COMPENSATION, DAM4GE5 AS PROVIDED WR IN SECfION 3IO60F THE LABOR CODE, IMEREST, AND ATTORNE`f5 FEES. LICENSED CONTRACTORS OECLARATION: I hereby aflirtn Ihat I am licensed under provision5 oi Chapter 9(commencing with Section 7000) of Divislon 3 of ihe Business end Pmfessions Code, antl my license is in tull force and eHecL Lic. If Class N Contrectofs SignaWre:' CONSTFUCTION LENDING AGENCV: ❑ I hereby affirm Iha� �here is a consiruction lending egency for tha peAortnence ot the work tor which this pertnit is issuad. (Sec. 3097, Civil Cotle). Lendefs Name: Lendels Atldreu: Signatura: OWNER-BUILDER DECLARATIONS: Date: I hereby aHirm ihat untler penalty oi per�ury thet I em EXEMPT FROM TME CONTRACTORS LICENSE LAW for Ihe following reeson (Sac. 7031.5, Business and Professlons Code: Any ciry or county which raquires e permit to construct, alter, improve, tlemolish, or repeir any siructure, pnor to its issuance, elso requires ihe appliceN tor such permi� to tlle a signetl siatement that he or she Is licensed pursuent to the provislons of ihe Contrectors Llcense Lew (Chapter 9(commencing wlih SecGon 7000) ot Division 3 of the Business antl Professions Code) or ihet he or she is ezempt Iherefrom end tha basis tor the elleged ezemption. Any violation at Sectlon 7031.5 by any appliwnt for e permit sub�ects the epplicent to e civil panelry of not mord than five huntlretl tlollars ($500).): ❑ I, es owner of the property, or my employees with wages es their sole crompensation, WILL DO 7HE WORK, and the structure is not inientletl or offered for sale (Sec. 7044, Business and Professlons Code: The Contrectors License Lew does not apply to an owner of property who builds or improves Ihereon, antl who tloes such work himself or hersetl or through hls or her own employees, providetl thet such improvements ere not imended or otteretl for sala. II, howaver, the building or improvement is so10 within one yeer oi completion, Ne own�rbuilder will have the burden ot pmving ihat he or she tlitl not build or improve for purpose of sale.). ❑ 1, as owner of the properry, em E%CLUSIVELV CONTRAC7ING WITH LICENSED CONTRACTORS to construc� ihe project (Sec. 7044, Business and Professions Code: The conlractors License law does not apply to an owner of properry who builtls or improves ihereon, and who conirects for such project with e contractor(s) license pursuant to the Contrectors License L.aws.). ❑ I em ec under s�c. '—�jJ—��, Signature:�:d�/^4'—,� f�:�-��^ Owner ID verified by drivers license. ❑ Ves ❑ No Business antl Professions Code br ihis reason: Ezpires: Venilcatlon of Ownership by (type of tlocument, i.e. - proparty lax blll or tleed): DIVISION OF INDUSTRIAL SAFE7Y VERMIT CER7IFICATON: ❑ I hereby certify that no axcavation ilve (5) Or more teet In depth Into which a person is requlred to descen4 will be mede In connection wiN work authonzed by this pertnii, and ihat no builtling siructure, scaHolding, felsawork, or tlemolition or dismantling thereof, will be more Ihan ihirry-six (36) feet �igR (Chap. 32, Grp 2, An 2, Sec. 341, Title 8, Celifornia Administretive Cotle). ❑ As owner-builder, I will not employ anyone to tlo work which would require a permit from �he Division of Indusirial Safety, as notetl ebove, unless such person has a permit �o do such work trom the division. SigneWre: Date: Division ot Industnal Safery Permit Number: CERTIFlCATE OF COMPLIANCE AND AUTHORIIArON OF ENTRV: I certity under penalry of perjury that I have read this appliwtlon antl state that the intormation given is wrrect. I agree to comply wi�h ell slate laws and city ordinances relating �o building conslrucllon, entl euthonze representetives of the Ciry ot Costa Mesa to emer upon the above-descnbed property for inspection purposas. � egrea not to occupy or allow occupancy ot eny bullding authorized by Ihls Dermit until final inspec�ion. Sign re Ot gal Owner(s) Date �-j- s-o� AnNOr Authorizetl Applicant Date COUE �, INSVECTIONTYPE t816 Fixed System Flnal Fire Preventlon 1266 Pool Spa Final 200 Finel Re-Roof 20t Finel BlocklRetaining Wall 202 Finel Factory Fire Plece 203 Final Sign 204 Final Demolition za+e ae QA� 1[�9L5 -�1Q= � CODE� INSPECTIONTYPE 206 Final Mechanical 208 Final Plumbing 210 Final Electrical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy onre I[�LS � ACD�icant to flll in all spaees exceD� ��ose within heavy Gortle� Iines an0 si9n all aperopriata aeclarations. � F COSTA ESA T UCT ON PERMIT PER^^i NQ_ � � TRACT NO. LOT NO. UNIT NO. A P�y r3� �7�.� �` Address �j S Main Buildi ppliCanl'S Maili A res5 TVPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR E / ❑ CONVERSION ❑ DEMOLISH ❑ OTHER ' T Front Owner's Name PhoneY�,�� DESCRIPTION OF WORKIUSE OF BLOG. A Rear Atldress TVPE OF PERMIT GRADING FOUNDATI��orrr��}}} STRUCTVRAL � C Right Arch/Eng. License No. � K Left Addf255 � ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING MECHANICAL S' Convactor's Nam Phone�.{.�� aTHER Ping. Ref. •A` Address (ma'I'ng) Z��, � PROJECT DESCRIPTION Sq. FT. OCCUPANG�' e COIVSTRUCTION TVPE VALUATION $ Plannin Notei: City LiCen N n24 I ZONE GRADING CU. VOS. ACRES LICENSED CONTRFCTOR DEC4ARATION 1 her¢by atfirm l�at I am IlcenseU untler prOvi5iOn5 Of Chdrt</ 9(COmmancln9 Remarkf: with section ]000) of DivlSion 3 0l the Buslness antl Vrofesslons Cotle, an0 my Iitense Is in iy��c a tl itec Llcen Class ce o. Date " Signature lR RS' O NSATIONDECLA(ATION neby a/tirm that I have a certlilcate dt ronsent to self-insure or a certltiWte . Workers' Compensation InSurA��e, or a certlfietl coOY Ihereof (Settlon 3800, Lab. C.) [ �., '��1 Policy No. �4%S�y`�n� ComPanY � Certifie copy Is hereby fumisbetl. Certi ' y ' etl with tne cily tlin o. Date AOP��cant E%EMP ON WORKERS' �OMPEN �TION DEC RATION (Tni55ectiOn nlCtl nOt be completetl i1 lhe permlt is for one huntlr0tl (E100j or lesz). 1 cerlily lnat In tbe perfOrTdnG¢ 01 th¢ wOrk t0/ whic� Ihis pOrrti�t IS ISSUCtl I s�all not employ any person in any manner so as to become sub7ect to t�e � Workers' Compensalion Laws oi �alifornla. ' Date Si9nature NOTICE: It, after making t�is tledaratlon, you should become subject to [ne Workers' Compensalion provisions oi tne Isbor Cotle, you must fortnwith comply with Suth p�ovisions or tM1ls pe�mit shall be tleemed ravokBtl. CONSTRUCTION ILENDING AGENCV I horeby alfirm that Ihere is a cons�ruction lentling agency tor the performance of tlia work tor whicn thls permit is issuetl (Settion 3097 Clv. C.) Lentler's Name �entler's Atltlrezs OWNER BUILOER DECLARATION I hereby altirm lhat I am exempt �rOm Ihe ContractOr's Ucense Law tOr Ihe lollowing reason (Section ]031.5 Business antl Professlonal Cotle: Any clty or COunIY wM1lcb requires a permit t0 �Onst�uGt, dllCr improve, EemOliih Or repaii any struclura, pdor to its iszuance, also requires t{�e applitant tor sucb permil tA lile a Si9n8tl italem¢nt Ihal he/she i5 IIC¢nSeG pul5udnt t0 Ih8 prOVI51on5 of .neretrom antl me Dasis for Ihe r��e9etl exemption. Any violation ot Secvon � �031.5 by any applican[ for a Permit subjects the appllcanl lo a cWil eenalty oi not more than five hundretl tlollars (E500). LJ I, as owner o( ihe property or my employees with wa9as as their sola compensation, will GO Ihe work, antl the StruCtUre is not IntentlBtl Or 071Cretl tor zale ($ection ]046, Busine5i antl Protesslonal Cotle: Tho Conlractor's Licenie l.aw Co¢5 not apP�Y to an owner of d prOperty who bulltl5 or ITprOves thereOn, and who tloe5 Tuch wOrk hlmselt/narself or In�oug� h15 or her 0�+� ¢mployees, provitletl [ha[ suth irt�P�ovement5 dre nOt Intentlatl or o/feretl fo� sale. It, bowever, the builtling or �mprovement Is soltl within ona year of com- pletion, the owner wlil nave the �urtlan of proving he/she a10 not Duiltl or Im- !L/ove for the ourpose o1 zale). LJ I, as owner ol tne property, am oxclusivaly contracting wlth Iicansetl con- tractors lo construct the project (5ection ]044, Business antl Rofessions Cotle: Tne Contractor's License Law does not apply lo an owner ot property who builtls or improves thereon. antl '�'ho contracts �or zuch oroiects wltn a con- tractor(sj I¢ense pursuan[ m[ne Contractors License Lnw). I am aware tha[ proot o( th¢Ir Worker'S ComOe��tion insurance shoultl bB provitl¢tl to me ❑ I am exempt untler Section B. & P. C. for [hi5 reason Date Owner 1 heraby certiiy that I have rea0 iniormation is correct. agree to < antl Slate laws � latin to builtlin5 sentativas ol t is ci e�� InSpectlOn ai. / v Signaturo • �rivors' Lltenu or S $ 0865-46, rev. 5/88 Whi[e - BuiltlMg; Canary - Appllca Sink tflow Preventer kflow Irrigation Dishwasher Drinking Fountains Floar Drains Floor Sinks Gas Service Outlets Kitchen Sink Lava[ories P—Trap Roof Drains Reinspection Fee $15 Boiler Duct - Under Ground DUCt - $trUt W rel Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact 81t. iCBO dk H,.Aea'ting System & Ducting y�µ100,000 BTU 0100,OOOBTI Reinspection Fea Accoun[ing; Goltlenrotl - Assessor 515 Showers Servite Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming POoI w/Spa Urinal Water Closet Water Heater Water Service Auto-Wash laue Fee Hood or Typel ❑ Canopy Type I I ❑ Refrigeration System ❑6100,OOOBTU ❑100,000 System Repair/Altera[ion Fire Dempers Registers Iswe Fee Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas QElec Fan F,A.U. Fixmres Device Boxes OuNCiS Accessory Building: Parking Req./Provided ELECTRICAL Transformer ❑ 15-50 KW ❑ SO+KW Mo[er ❑up to 100 amps Meter �over100amps Garbage Disposal Generator OO-5 KW 05-15 KW Sub Panel Motors�0.1 HP�iX-8 Inc. Solar �9-15 HP 016-15+ Microwave Pole Light Range Slgn Standing Sections Trash Compactor Fee I$15 I I Issue Fee $ 3 DEVELOPMENTSERVICESREQUIREMENTS: 2oninp APProved By FEES Buildinq Approved By � ADDliotiOn IAUBd BV �� I N G R E Q M T S. FEES $ 3 SUMMARV OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ �SSUANCE $ PLAN CHECK 25% $ ENERGV P.C. 3 ELECTRICAL $ GRADING $ PLAN CHECK 50% $ ��\ MICROFILM $ MECHANICAL S ��"=tL TOTALFEE $ � PLAN CHECK 25% $ f:t i�!^''ii..�('^..,� . . _ �.. GF�TE: �8l3C/:v ': ; n.�` '`. ' T7fIE� :_• � �� _l�: � _ � �NSTRUCTION AND PLANNING P� & SPA . . PROVALS Permit # Date Inspector AppROVALS Permit # Date Inspector �� 1. Temporary,Electrical Service or Pole �� 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. - , ' 53. Steel Reinforcement "3:�Electrical Conduit Utility-Undrgrnd� �� 54. Forms 4."Electrical Conduit-Undrgrnd. , , 55. Electrical Bonding 5.� Steel Reinforcement, " ' � � 56. Rough Plumbing & Pressure Test 6.'ElectricalUFER�Grnd. " � . 57. APPROVALTOCOVER-GUNITE - �7. Footings . - " . 58. Electrical Conduit-Undrgrnd. � 8. Foundation - " ' 59. Gas Pipe, O Undrgmd., Test , 9. Water Pipe-Undrgrnd. , 60. Backwash� Lines, P-Trap, � Undrgrnd. �. 10. Structural Floor System �- . 61. APPROVAL TO DECK � 11. Property Sewer Line & House Connection . _ 62. Backwash & Receptor-Final 12. Sewei� 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 � 7•7- Rough Wiring Sign 68. APPROVED FOR PLASTERING u18. Rough Electriral-T Bar Ceiling 69. POOUSPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT �20. Rough Factory Fireplace APPROVALS Permit # ��2.1. DuCts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling �Structural) & Monocoat 75. Dry Chemical 27. Frame and �Flashing 76. Dry Standpipe • 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation � 78. FIRE PREV. FINAL „� 30. Drywall Nailing HEALTH DEPT. REQUIREMENT �! !- 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED � �, 33. Final Electric Notes: '% . '. 34. Final Heating & Air Conditioning / 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace . 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preventer � }� 43. Backtlow Irrigation .') n? 44. Landscape Irrigation SYstem � ' �% • 45. Sound Attenuation 46. Handicap Regulations 47. FINA�STRUCTURE&BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co ' '�• _� •�. 51. CERTIFICATEOFOCCUPANCY ' ,q No. Date �, i.i CITY OF COSTA Project Address _ ApplicanYs Mailin� L jOwner's Name 1 3 UCTIO�V PERMIT � �/ N S i IMA�.I Hr�D Ec h APDlicant to fill in all ipatts eacept tltose within �eavy borOer lines antl sign all aoo�oo��ate tleclaretions. PERMIT NO_ TRACT NO. LOT NQ � in�iT nin Address ' ' �" "' Arch/Eng. License No. � Address 'T Contractor'sName Ew � �'��$i�u[i�phonea3 'O�7a�� Addresslmailing) �4'O'7 l�� 791A�� O� OR/�7J City License No. LICENSED CONTRACTOR DECLARATION i,hereby afiirm tha[ I am licensetl untler provisions of Charter 9(commencin9 witn sec[ion 7000) of Division 3 0( e Business a tl Protessions Cotle, antl my Ilcense-is in ful rcq antl eftect. L�,' I+ ��y License las � Li se No. T T d Date �% Signature wORKER ' COMPENSATION DECLARATION =reby affirm that I have a certificate of consent to selLinsure or a cartlficate Workers' Compensa[ion Insurance, or a certifietl copy thereof (Sectian .,600, Lab. C.) Policy No. Company BCertifietl copy is hereby fumish¢tl. Certifietl copy Is filetl with the city Builtling Division. Date APPlicant EXEMPTION FROM WORKERS' COMPEN ION DECLARATION (This section neetl not be compleletl it the p rm i5 for one hu tlretl ($300) or less). 1 cer[ify that in [he performance ot the w rk f r wh thi rm�t is issuetl, I shall not mploy any p�on in any ma ner o as be o e subject to the Workers'� persa[ion ws of Cali(orn y . Date V Si9nature NOTICE: If, after makinq this tleclaratlon, shoultl become sublect to the Workers' Compensation provisions ot the Labor Cotle, you must forthwith comply with' such p�ovisions or this pe�mit Shall be netl �evoketl. CONSTRUCTION LENDING AGENCY` i I M1ereby affirm Ihat there is a construction lentling a or the perfo� of tne work for whicn this oermit is issu ' ctio 697 Civ. G. Lentler'h Name �entler'i Atltlress OWNER BUILDER DECLARATION ' I hereby aftirm'that I am exempt trom the Con tor's aw for the following reason (Section ]031.5 Business antl P e: Any city or coun[v:which repuires a permit to ConStruct, alte , tlemolish or repai ;;•Vefrom antl the basis tor the allegetl exemption. Any vfolatwn ot 5 �on ��31.5 by any applicant for a permic subjects Ihe applicant to a vil Penalty of not more than five huntlretl tlollars (5500). R �J I, as owner ot the property or my employees with wages as tneir compensation, will tlo the wo�k, antl the structu�e Is not intentletl o� offe� tor Sale (Section 7044, Business antl P�ofessional Code: The Contractor License Law tloes not apply to an owner Of a property wno builtl5 or Improve thereon, antl who tloes such work himself/herself or througb his or M1er own employees, provitletl that such improvements are not intentletl or offeretl for sale. If, however, the builtling or improvement Is soltl within one year of com- pletion, the owner wi11 have the burtlen ot proving he/she tlitl not builtl or im- prove for tne purpose of sale). ❑ I, as owner of the property, am exclusively contractinq with li<ensetl.�o = Vactorsto construct the project (Section 7044, Business antl Protessio : The Contractor's License Law does not apply to an owner of pro who builtls or improves therean. antl who contracts for such oroiects w con- tractor(sl Lcense pursuant to [ne ConVactor•5 License Law). 1 am a tha[ proof of thei� Wo�ke�'S CompenSatiOn insuvance shoultl be provitle❑ me ❑ 1 am ezempt untler Section B. & P. G. tor this r n Date Owner I hereby certify hat I have reatl this pplicatlon antl state that the abov Informdtion is c reCt. agree to cortf y wrth all Clty antl county o�tllnances antl state laws r latin to b ing c struction, and hereby authorize repre- sentatives of th s ci y ter u n Ihe above-mentionetl property for Inspection pu�po e5. �L �C 7p . Signature � �at Drivers' License or 55 � OB65-46, rev. 5/88 White - Builtling; Canary - Applicant; Pink - Ac<ounting; Goltlenrotl - Assessor ❑� TYPE OFCONSTRUCTION LJ NEW J��ADD LI ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER � DESCRIPTION OF WORK/USE OF BLDG. � TVPE OF PERMIT GRA�ING ❑ FOUN�ATION ❑ STRVCTV RAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION 5c1. FT. - oCCUPFiN v_�. CON STRUCTION TVPE ' VALUATION $ � ZONE GRADINGCU.YDS. ACRES�`L nemarks: S!+`1CtLE �Of �`1i�C�O� P Bar Sink I Backflow Preventer Backflow Irrigation ( Bathtubs � Clarifiers Dishwasher Kitchen Sink Lavatories P—Trap � Fee Under m Showers Service Sink Sewer Cap SewerCnnm A.P. # I / — S Main Building: E T Front B Rear A C Right g - Left Ping. Ref. # Planning NoteS: � i� � 2c7dM �a� M — .D— FEES Automatic Washer Construction PoleSub. Cooking Unit Dishwasher „�,� Dryers ❑Gas ❑Electric � Swimming Pool w/Spa Urinal Outlets � Water Closet Water Heater �[er Service $15 E�i�l�BFn LJ Multiple �irepVFact.8lt. ICBO # Heating System & Ducting ❑ o-i oo,000 sru O i oo,000 Reinspection Fee � $15 e■ Refrigeration System ❑0-100,OOOBTU ❑100,000 System Repair/Alteration Fire Dampers Registers luue Fee Fan F.A.U. Fixtures Device Boxes Ouil2ffi ��j Switches Garbage Disposal Generator �0.5 KW C — � Zona � Accessory Building: ' I Z O - N I N G R Parking Req./Provided E Q M T s. ELECTRICAL . Transformer ❑ 15-50 KW - ❑ SO+KW Meter ❑up to 100 amps Meter ❑over100amps Sub Panel Motors OO-1 HP O1'/: - 8 Inc.Solar �9-15 HP �16-75+ Microwave Pole Light � Range Standing Sections 5-15 KW Trash Compactor FEES � Reinspection Fee $15 luue Fee $ 3 3 DEVELOPMENTSERVICESREQUIHEMENTS: � Zoning Approved By Date '.ES Buildin9 APProved BY Date Appliption Issued By Data SUMMARVp� FEES BUILDING PERMIT $ ��(� SMIP $ PLAN CHECK $ PERMIT P�UMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE $ PLAN CHECK 25% $ __. � $ 3 �� c�oe ��3 ��- ; , . . . CONSTRUCTION AND PLANNING PO � SPA APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector � 1. Temporary ElectriCBl Service or Pole' ��n 52. Pool &«Equipment Location 2. Soil Pipe-Undrgrncl. ,� - 53. Steel Reinforcement . 3. Electrical Conduit Utility-Undrgrnd. - � 54. Forms . I 4' Electrical�Conduit,Undrgrnd. ia� 55. Electrical Bonding -� r.. r . 5.. Steel Reinforcement 56. Rough.Plumbing & Pressure Test �! � - � 6. 'Elecirical UFER Grnd. ---� 57. APPROVAL TO COVER-GUNITE � 1 7: Footings.� �,� �%, � � 58. Electrical Conduit-Undrgrnd. 8. Foundation ;� "�� ,', �`, � 59. Aas Pipe, O Undrgrnd., Test 9.' Water Pi e-Undr�rnd. ' � ✓ � `'^" �'� P 9 � 60. �ack�w2s6�Lines,P�Trap, O Undrgrnd. l , v� o-�t: i e� 10. �Structural Floor�Sy�stem •�' 61. APPROVAL TO DECK � 11: Fr'operty Sewer Li^ & House Connection ' � 62. Backw'ash & Recepror-Final . 12. Sewer Cap � 7' :: ' I � 63. Heater & Vent-Final , n: 13. Roof Drains �, � t�• 64. Plumbing System - Final r . s 14. Rough Plumbing� `.; � 65. Electrical-Final �� . ' � 15. Rough Electrical-Conduit 66. Solar System-Final � i6. Rough Electric Wiring •`: 67. Fencing & Access.Approval � 17. Rough Wiring Sign ��' �`�68 �APPROVED FOR P.LASTERING 18. Rough Electrical-T Bar Ceilitig`:� ' � 69. POOL/SPA SYSTEMS FINAL � 19. Rough Heating & Air Condit�o�ing FIRE DEPT. REQUIREMENT , . _ , s . 20. Rough Factory Fireplace � � �""+ APPROVALS Permit # . � 21. Ducts, in Structure �� '� ^p�,, 70. Underground Hydro ' 22. Ducts,Ventilating : -_ �, 71. ProductPiping.OGas ❑Oil � i1 23. Gas Pipe-Rough & 7est , _ _ 72. Underground Flush - • 24. Roof Framing ��' � 73. Undergmd:StorageTankL7Gas ❑Oil � •� • 25.' Roof Sheathing Y ,� , �( � 74. Overhead Hydro ' 26. T-Bar Ceiling (Structural) &�Monocoat r 75. Dry Chemical � 27. Frame and Flashing � � 76. Dry Standpipe ' 28. Lathing & Siding •`, .. � 77. FIXED SYSTEM FINAL 29. Insulation 4�� i 78. FIRE PREV. FINAL' ' 30. Drywall Nailing �� %` HEALT.�I DEPT. REQUIREMENT �. 31. Plaster Brown Coat �. ti 79. FINAL INSPECTION i 32. Electrical Power Meier-Final= � 80. FOOD CERTIFICATE ISSUED 33. Final Electric � � �� Notes: � 34. Final Heating & Air Conditioning � �2 f 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Firi81 FaMory �Fireplace � '38. Final Plumbing ' , 39. Water Service-Final� - - "40. Gas Service-Final � - '� 41. Solar pomestic-Final • - �.: �` ' 42. Backflow Preventer _ ' 1 43. Backflow Irrigation � � � 44. �andscape Irrigation System . '� ��,'� 45. Sound Attenuation � -- i�� 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CEFTIFICATE OF OCCUPANCY N0. Date