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Home My WebLink About463 19TH ST - Building Permits�b•' � CITY OF COSTA MESA �`°"'FS, BI/ILDING DIVISION ' . � " F� � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.cosfa-mesa.ca.us . ., �. FOR INSPECTIONS CALL: (714) 754-5626 Ry�w,�•' ... . PERMIT NUMBER: BX09-00282 PERMIT TYPE B MISC STATUS: ' ISSUED- - APN: 11734128 DATE ISSUED: 12/24/2009 Zoning: , ISSUED BY: KJB JOB ADDRESS: 463 E 19TH ST CM Suite/Uriit: �� Viciniry: ROOF TOA P�mary Occ: , Const Type :?? SQ. FT: 0 Valuation: $6,000.00 SCOPE OF WORK: INSTALLATION OF A 1.4 KW ROOF MOUNTED PHOTOVOLTAIC SOLAR SYSTEM (6 PANELS) FOR A SFD W ITH ACIDC, MISC CONDUIT. MISC EL EQUIPMENT ANp INVERTER. PANELS WILL BE FLUSH WITH THE ROOF AND NOT VISIBLE FROM THE STREET. OWNER: THOMPSON, TODD HOWARD Ciry/State: COSTA MESA, CA Phone: 949-548-0694 APPLICANT: KEMME, JENNIFER Ciry/State: Phane: 909-754-8300 CONTRACTOR: SUNBELT SOLAR SYSTEMS Address: 26881 PRAIRIE DbG LANE City/State: MORENO VALLEY, CA �Zip Code: 92555 dRCHITECT: Phone ENGINEER: Phone FEE SUMMARY Building Plan Check: -�. Building Permit: ' Electricat Permit: SMIP Residenlial SMIP Commercial Bldg Std Admin Fund TOTALFEES Address:: 463 E 19TH ST Zip Code: 92627-2313 Address: Zip Code: � � " License No. 530809 Phone 1-800-794-1972 License No. License No. $81.41 $12525 $62.10 $0.60 $0.00 $1.00 $300.86 Unit _ � Unit: UniL' Cell: H FC�JG MISC Unit Uiu': UniP NO710E: The work authorized by this p@rmit shall comply wilh all applicable handicap access requirements under Califomia slatutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) 'EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be wnsidered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to oblain inspeclions and final approval will result in the expiiation oPihispermit. cQoe �. ixsrecnon rme 1616 Fized System Final Fire Prevention 7266 Pool Spa Final 200 Final Re-Roof 201 Final BIocWRetaining Wall 202 Final Factory Fire Place 203 Final Sign 204 F.inal Demolition OpTE IN� � INSPECTIONTYPE 206 Final Methanical 208 Final Plumbing 210 Final Electriw� � 212 Final Fire Prevention 220 FinalPlanningAppmval 222 FinalSite 250 Final BuilUinglOccupancy D� IN7fIlALS a� lO,�: � �4l 1 �.� v � WORKERS' COMPENSATION DECLARATION: I hereby aKrm under penalty o( perjury one of the following declarations: ❑ I have and will maintain a cetlifcate of consent lo selFlnsure for workers' compensation, as provided for by section 3700 of the Labor Cotle, for the peAormance of the vrork for which this pertnit is issued. ❑ I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the peAormance ol the �+ork for which lhis permit is issuetl. My workers' compensation Insurence wrrier antl policy numberare: �O� Carrier. (Thi55edionneeOrrolEBNrndet�y (hepem� isrd al enunMedtlalars(5100)aless) Po�c Number. I�certily I�at in the peAormance ol the wvrk for which this permit is ssued,'I shall not employ any person in any manner so as to become subject to Ihe workers' comp ns t n laws ot Califomia, an0 agree thal if I shoultl become subject lo Ih ers' compensation provisions of Section 3700 0l Ihe Labor Code, I shal fo h' h comply with these provisio . �A _'. �- na .rei. - � J WARNING: FAILU T ECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AN S Ll SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLIARS ($100,000�. IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE L4BOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS bECLARATION: I hereby aKrm that I am licenged untler provisions of Chapter 9(commencinq with Section 7000) of Divisi 3 of the Business antl Professions Cotle, and my license is in full force and ff t. � � � CE012 e � CONSTRUCTION LENDI G NCY: ❑ I hereby affrcm that there is a constmction lending agency fa the peAormance o/ the work far v.hich this pertnit ts issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Date OWNER-BUILDER DECLARATIONS: I hereby aKrm that untler penalry ot perjury lhat I am E%EMPT FROM THE CONTRAC70RS LICENSE LqW for the tollowinq reason (Sec. 7037.5. Business and Professions Cotle: Any city or wunty which requires a peimit to consWct, alter, improve, dEmolish, or repair any structure, prior lo its issuanca, also requires the applicant for such permit to file a signetl slatement that he or she is licensed pursuant to the provisions o( the Contrac�ors License Law (Chapter 9(commencing v.ith Section 7000) of Division 3 0( me Business antl Pro(essions Code) or that he or she is exempt therefrom and the basis tor the alleged exemption. Any violalion of Sectian 7037.5 by any applicant for a permit subjects the applicanl to a civil penalty ol not more than five huntlred dollars (5500).): ❑ I, as owner of the property, or my employees vrith wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered lor sale (Sec. 7044, BUsiness and Professions Code: The Contractors License Law does not apply lo an ovmer ol property who builds or improves Ihereon, �and who does such Work himsell or herself or through his or her own employees, provided Ihat such improvements are not intended or offered for sale. If, however, the buildinq or improvement is sold wilhin one year of completion, the ovmervbuilder will have the burden of proving that he or she did not build or improve for puryose of sale.). ❑ I, as owner ol the property. am EXCLUSIVEIY CONTRACTING WITH UCENSED CONTRACTORS to wnstruct ihe projecl.�Sec. 7044, Business and ProfeSsions Code: The wntractors License Law tices not apply to an owner of property who builds or improves thereon, and who cont2cts (or such projeci with a contractor(s) 6cense pursuant to Ihe Contractors License Laws.). ❑ I am exempt untler sec. Business and Professions Cotle for lhis reason: 9059�a6(]IO]� Ovmer ID verifetl by driver s license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certity that no excavation five (5) w more feet in depth into which a person is required to descentl, will be made in connectbn with wnrk authonzed by this pertnit, antl that no builtling sWcture, scaffdding, falsewnrk, a demolition or disman[ling thereo(, will be more than thirty-sa (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title B, Califomia Atlminislrative Code). ❑ As ovmeabuiltler, 1 will not employ anyone to do vrork which would require a permit from the Division ol Intlustnal Safety, as notetl aDove, unless such person has a permil to tl0 such work from the tlivi5ion. Ap0liwnt§ SiBnaWre Date Division of Industnal Safety Pertnit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 7. Will the applicant or present or fuNre Duiltling occupant need to file antl certify a Business Plan !or emergency response to release or l�reatened release of a hazardous matenal? ❑ Yes ❑ No (Section 25505 0( lhe Califomia Heallh antl Safely Cotle require5, wilh some exceptions, that a Business Plan be (!ed w'rttr Ihe Costa Mesa Fire Department by every business which has al any one time Ounnq a reported year a quantiry of hazardous materials equal to or greater than a weight of 500 pounds, or a volumo of 55 gallons, or 200 cubic feet of compressed gas at standard temperaWre and pressure). 2. Does or will the applicant or present or fuWre building occupant neeC to fle a registration fortn for awlely hazardous materials? ❑ Ves ❑ No (Section 25533 of the Califomia Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business v+hich at any one time has on hand a quantity of acutely hazardous materials equal lo or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at stantlartl temperature antl pressure). 3. Does or will the applicant or present or fuNre building occupant neeC ro prepare an RMPP (Risk Management and Prevention Prog2m for acutely hazardous mater'�alsJ1 ❑ Yes � No (Section 25534 of Ihe Calilomia Health and Safery Code provitles that lhe CosW Mesa Fire Department may require the preparation, certification and filing with the Fire Depariment of an RMPP by businesses which are requiretl to register acutety hazardous matenals with the Fire Department. 4. If an RMPP is presently required, has Seclion 25534 of ihe California Health and Safery Code been fully complietl with? ❑ Yes ❑ No 5. Does or will the applicant or presem or fuwre building occupant require for the work which is the subjecl of Ihis aDDliCation a pertnit (or such con5truclion or modificalion (rom �he Soulh Coast Air Quality Manaqement District or from any other air polWtion control district or agency? ❑ Ves ❑ No (Sectbn 65850.2 0l the Califomia Govemment Code 2puires that the requested in(ormation be fumished on applitatbns fa nomresidential build'ug pertni�s). 6. Will any pan of the lacility to be conswcretl unCer Nis permit he wit�in 1000 (eet from the outer poundanes o( a 5choot7 ❑ Yes ❑ No (If yes'. the facility must meel lhe requirement of Sections 25534 and 42303 of the Califomia Heallh and Safety Code). 7. It a permil from the South Coasl Air Quality Management Districl or other air pollution conlrol districl or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by Califomia Health and Safery Code Section 42303 been made? � Yes ❑ No 8. Qf "yes". attach cenifcate of wmpliance from the appropriate air pollution control oKcer). CERTIFICATE OF COMPLIANCE: I certify Ihat under penalty of perjury the information given above is correcL I agree to comply with all state laws and city ordinances regarding Hazartlous Materials and Emissions. Signature Date CERTIFICATE OF COMPLIANCE AND AUTMORIZATION OF ENTRY: I certify under penalty o( perjury that I have read this application and state that the information given is Wrrecl. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-0escribed pmperty for inspec[ion purposes. I agree not to occupy or allow occupancy of any building authonzed by thi ertnit until final inspection. Si ai . LepalOvmer(s) ' �e C: b� hO�ZBtl'Pppl¢n�t� l�' � Oal! ) (714)754-5273 • Fax(714)754-4856 �r CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT PLUMBING PERMIT �ob Address: 463 E 19TH ST Suite NO Vicinity: MASTER BATH/BEDROOM Parcel Nunmbec 17734128 Applicant: THOMPSON, TODD HOWARD & MARTHA MARI' Address: 463 E 19TH ST - �. ; � - - � Phone: (949)548-0694 COSTA MESA, CA '� ' ' Zip: 92627 Owner.," THOMPSON, TODD HOWARD & MARTHA MARY AddieSs- � 463 E 19TH ST _, ' , � " ' - " .' `,- Phone: ,� COSTA MESA, CA Zip: 92627 Contracroc OWNER-BUI�DER .. �� Address: ' � �� - % , � Arch / En9 : AddreSs: - ' ' > - ' " �. ��Phone: . Zip: License: 0 Phone: � Zip: � ��. � �-License;-- INTERIOR REMODEL OF EXISTING OF MASTER BATHROOh BATHTUB WITH NEW JACUZZI TUB, RELOCATE TOILET AND RELOCATE SINK. '-' REF:B00-00092 " . ISSUE FEE BackFlow irrigation Backflow Preventer BathWb Clarifier System Connect (Ice,Soda.etc) Dental Units Dishwasher Drain, Floor Drein, Rainwater Drain, Roof Drinking Fountain Expansion Tank AMT $23.50 $0.00 50.00 $9.80 $0.00 $0.00 $0:00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 QTY �� FEE SUMMARY AMT Laundry Tub I Washer $0.00 Landscape Irrigation � $0.00 P-Trap 50.00 Pressure Regulator $0.00 Process Piping (per 10 N) $0.00 Receptors $0.00 Septic Tank $0.0� SewerCapforDemo $0.00 Sewer Connect $0.00 Sewer Private Line $0.00 Shower $0.00 Sink, bar � - � $0.00 Sink, commercial $0.00� QTY 0 0 0 0 0 0 0 0 0 0 0 0 0 . PERMIT NUMBER� P00-00041 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 01/24/2000 Issued: 01/24/2000 ISSUED BY: , � ' . �,�,��; � � r AREA. REPLACE EXITING SumpPump Swimming Pool Trap Primer Urinal Vacuum Brkr BkBow(1-4) Vacuum Brkr BkFlow(5+) Wash Basin Wash Basin Sel Waste and Vent System Water Closet (Toilet) Water Heater / vent Water Piping pnst or Rep.) Water Re-pipe AMT 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $9.80 $0.00 $0.00 59.80 $0.00 50.00 $0.00 �TY 0 0 0 0 0 0 1 0 0 1 0 0 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 72-21-92) EXPIRATION: This permit shall automatically expire and become void it 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 ihe work authorized under this permit to be considered legal, such work must comply with all appliceble codes, and all required Inspectlona and tinal approvel must be obtained. Failure to obtain inspections and final approval will resufl in the expiration o( this permit. FOR INSPECTION5 CALL: (714) 7545628 WORKERS' COMPENSATION DECLARATION: I hereby ettirtn untler penalry oi perjury one ot the lollowing declarations: � ❑ I have antl will maiNain a certificate of cronsent to self-Insure for workers' compensetion, es provided for by section 3700 of t�e Lebor Cotle, for Ihe peAortnance of the work lar which ihis pertnit is is5ued. ❑ I have antl will maintain wwkers' compensation insurance, as required by sectlon 3700 0l ihe Labor Code, tor ihe pertortnance ot the work for which this permit is issuetl. My workers' compensation Insurence carder entl policy number are: Carrier. Policy Number: (lhis sect/on neetl nat be complete� i! (he permif is velued et one hundred dol/ers ($700) or /eu.) ❑ I cenity Ihat in the pedormance ot ihe work tor which this permit is issue�, 1 shell not employ eny person in eny manner so as to become subject to the workers' compensation laws ot Califomia, and egree ihal if I should become subject to �he workers' compensation provisions of Section 3700 oi the Labor Code, I shall fonhwith comply with these provisions. Applicant Signature: Date: WARNING: FAILLIRE TO SECURE WORKERS' COMPENSATION WVERAGE IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYEF TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED TMOUSAND Dq1FPE (5100,000). IN ADDITION TO TME COST OF COMPENSAiION, OAMAGES AS PROVIDED FOR IN SECTIIXJ 3106 OF THE LABOR CODE, IMEREST, AND ATTOiiNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aMirm ihat I am licensed under provisions of Chepter 9(commencing with Section 7000) ol Division 3 ot ihe Business and Professions Code, antl my license is in full torce antl eHect Lia N Class q Contrectofs SignaNre: Date: CONS7RUC710N LENDING AGENCV: ❑ I hareby aHirm that there is a construction lending agency for ihe pertormance ol tha work for which this pertnit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirtn thet under penalry of perjury thet I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the follaxing reason (Sec. 7031.5, Business and Professions Cotle: Any ciry or county which requires a permit to consiruct, alter, improve, demolish, or repair eny sirucwre, prior to its issuance, elso requires the applicant for such permit b file e signed stetement ihat he or she is licensed pureuant to the pmvisions ot the Conirecbrs License Law (Chapter 9(commencing wlih Section 7000) o� Dlvlslon 3 oi the Business end Pmtessions Code) or Net he or she is exempt therefrom end the basis tor the allegetl exemption. Any violation oi Section 7031.5 by any applicant for a pertnit subJects the applicant to a civil penalty of not more than tive huntlretl dollars ($500).): � I, es owner of tha Oroper�y, or my employees with wages as their sole compensation, WILL DO THE WORK, anA the structure is not intentled or offered for sale (Sac. 7044, Business and Profassions Cotle: Tlie Comrecrors License Law does not apply to an owner of proDerty who builds or improves thereon, antl who tloes such work himselF or hersetl or through his or her own employees, provided thet such improvements ara not intended or ottered for sale. It, however, ihe builtling or improvement is . sola within one year of comple�ion, ihe owner-builder will have the burtlen oi proving that he or she did not builtl or improve for purpose of sale.). ❑ I, es owner of ihe property, am EXCLUSIVELY CONTRACTING WITH LICENSEU CONTRACTORS to construct the prolect (Sec. 7044, Business antl Professions Coee: Ttie conirecbrs,Cicense Law does not aOP�Y �o an owner ot property who builtls or improves thereon, antl who contrecis for such pmject with a contractor(s) license pursuant to ttie Conliectors License Lews.). ❑ I am e empt u er sec. l� �� ' '��. •,� Business antl Professions Code for �his reason: Signeture: �.1� . C7:•%• � Date: Owner ID venfied by drivers license. ❑ Yes �� No Dnvers License No. �� Expiras: Venfication of Ownership by (rype of tlocumen( i:e. - property tax bill or deed): DIVISION OF INDUS7RIAL SAFE7V PERMIT CERTIFICATION: ❑ I hereby certify ihat no excavation live (5) or more feei in depih into which a person is requiretl to descend, will ba made in conneciion wi�h work authorized by this permil, and Ihat no building structure, sceNoltling, falsework, or demolition or dismantling ihereot, will be more ihan thlrty-six (36) teel high. (Chap. 32, Gry 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As ownar-bullder, I will not employ anyone to do work which woultl require a permit from the Division of Intlustrial Safety, as notetl ahove, unless such person has a permit to do such wark irom ihe tlivision. Signeture: Division of Indusinal Safety Pertnit Number: Deta: CERTIFICATE OF COMPLIANCE AND AUTHORVATON OF ENTFiV: I cehity under penalty of perjury �hat I have read ihis epplication entl state that Iha information given is correct. I agree to comply with all siate laws and ciry ordinances relating to builtling wnstruction, and au�horize representetives ot ihe City oi Costa Mesa to enter upon the ebove-described Ompeny tor in,s�c e�ction puryoses. I agree not to occupy or allow occupancy oi any building authonzetl by Ihis permit until final inspection. �il('i .�n c1� I Y 1, � LkYl1�� J0.!n . Z�-�- 7lil� Signat re Ot egel Owner( ) Date And/Or Authorized Applicant CODE �. MSPECTIONTYPE ' 1616 Fiaed System Finel Fire Prevention 1266 Pool Spe Final 200 Final Ra-Roof 201 Final B1ocWRetaining Wall 202 Final Factory Fire Place 203 Finel Sign 204 Finel Demolition zana�no pATE INTITIpLS y9p�� INSPECTIONTYPE 206 Final Mechanical 208 Final Piumbin9 270 Final Elacincal 272 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final BuildinglOccupancy BAg INTRIRLS r, ;.• (774) 754-5273 • Fex (714) 754-4&56 � CITY OF COSTA MESA � BU►LD►NG DIYISION DEVELOPMENT SERVICES DEPARTMENT PERMIT MECHANICAL PERMIT �ob nddress: 463 E 19TH ST Suite No Vicinity: MASTER BATH/BEDROOM Parcel Number: 71734128 App�icant: THOMPSON, TODD HOWARD 8 MARTHA MARY Address' 4F3 F 19TH ST COSTA MESA, CA �Phone: (949)548-0694 Zip: 92627 Owner: THOMPSON, TODD HOWARD & MARTHA MARY Addr¢ss: , " 483,E 19TH ST, . - - - � • - , . ", " Phone: - .- COSTA MESA, CA Zip: 92627 Contractor: OWN ER-B U I LD ER Address: . �, , Arch / Eng : � • � i Address: , .. . ' , � � REF:B00-00092 . Phone: . -• Zip: • � � -License: 0 Phone: Zip. ,License: � PERMIT NUMBEFi M00-00042 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applietl: 01124/2000 Issued: 01/24/2000 ISSUED BY: �� , SCOPE OF PERMIT INTERIOR REMODEL OF EXISTING OF MASTER BATHROOMIBEDROOM AREA. 1 VENT FAN. . . ' ,.,. � ,.,� - . , � ' ' ISSUE FEE Inst FAU <700 k BTU . Inst FAU >100 k BTU � Repair/Alt Cooling/Heat � � Inst / Rep. Recess Wall Htr ' Refrig Sys <700 k BTU Re(rig Sys >700 k BTU Gas Piping , Factory Fireplace Hood w/Mech Exhaust , VAV Box Vent Fan I Single Duct Appliance Fir¢ Dampers Smoke Dampers Inst or Reloca[e Appl Vent Air Handlers < t0000cfm Air Handlers > 10000cfm $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 30.00 $0.00 $0.00 $0.00 $0.00 $7.25 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantiry FEE SUMMARY " ' Repair/AltAbsorbtionUnit . Repair / Alt Refrigeration Unit Ventillation System . �, � Evaporative Cooler " Commerciallncinerator ' - � Domestic Incinerator Compressors / Absorption Svstems Upto3hp/700kBTU 3 To 15 hp / 500 k BTU � 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 15to30hp 30 to 50 hp " " OJer 50 hp Quantity $0.00 0 50.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 0 0 0 0 0 0 0 0 0 0 NOTICE: Tha 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) EXPIRA710N: This permit shall automatically expire and become void if work is not commenced within 18� days, or if work is suspe�ded or abandonad for a penod of 780 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 Inepectlona and final epprovel must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL• (714) 7545626 � WORKERS' COMPENSA710N DECLARATION: � I herehy ettirm untler penalry of perjury one ol the following tleclarations: ❑ I heve end will maintain a certificate ot mnsent Io self-Insure tor workers' Compensalion, as provided tor by sectlon 3700 of Ihe Wbor Code, for Ihe peAortnance of lhe work for which this pertnii is issuetl. ❑ I have and will maintain workers' compensation insurance, as required by seMlon 3700 W the Labor Code, lor the perfortnance ot the work for which this permit is issued. My workers' compensation Insurenca carrier and policy numbar ere: Cerrier. Policy Number. (Thts sectlon need not be comp/eted I! the permit is valued et one huntlretl tlollere ($100) or /ess.) ❑ I cenity that in the peAortnance of ihe work tor which ihis permit is issued, I shell not employ any pereon in eny manner so as to become subject to the workers' compensation laws of Calitomia, and agree ihat ii I should become sub�ect to Ihe workers' compensation provisions of Sectlon 3700 of ihe Labor Cotle, I shell forihwith comply with these provisions. Applicenl Signature: Date: WARNING: FAILURE TO SECURE WORKERS' CO!aPENSATIqJ COVEfiAGE IS UMAWFUL AND SNALL SV&IEGT AN EMPLOVER TO CRIMINAL PENALTIES AND pVIL FlNES UP TOONE HIINDflED THOUSAND OOLLARE (5100.000�. IN ADDRION TO iHE COST OF WMPENSATION, DAMAGES AS PROVIDED FOR IN SECiION 37080F THE LABOR ODDE, IMERESi, AND ATTORNEI^S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aXirm ihat I am licensetl under Drovisions of Chapter 9(commencing wiih Section 7000) of Division 3 of Ihe Business and Professions CoOa, and my license is in tull loroe and etlect. Lic. x Class a Contractofs Signature: Date: CONS7RUCTION LENDING AGENCV: ❑ I hareby aKrtn that there is a construction lending agency for the perfortnance ol ihe work for which this permlt Is issued. (Sec. 3097, Civil Cotle�. Lender's Name: Lentler's Address: Signature: Date: OWNER-BUILDER DECLARAT10N5: I hereby aNirm that under penalry of perjury that I am E%EMPT FROM THE CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business an0 Professions Code: Any ciry or counry which requires a permit �o constmct, alter, improve, demolish, or repair any slrucWre, D�ior to its issuance, also requires ihe applicenl for such permit to fila a signed statement ihat he or she Is licensed pursuant to the provisions oi the Contractors License Law (Chepter 9(commencing with Section 7000) ot Division 3 of the Business end Pmtessions Code) or Ihet ho or she is exempt Iherefrom and the basis lor the allegatl ezemption. Any vlolation of Section 7031.5 by eny applicent for a permit subjects the applicant to a civil penalry ol nof more Ihen five hundred dollars ($500).): �i 1 I, es owner of Ihe�D�aPerry, or my employees with wages as their sole compensetion, WILL DO THE WORK, antl the strucwre is not intended or ofleretl lor sale (Sec. 7044, Business antl.P�iofessions Cotle: The Contrectors License Lew does not appty to an owner of property who builds or improves thereon, antl who does such work himself or herself or through;fiis'oi,her own employees, provided Ihet such improvements are not intentled or oNered tor sale. If, however, the builtling or improvement is soltl withln one year oi compleGon, Ihe ownao-builder will have the burden of proving that he or she ditl not builtl or improve for purpose of sale.). ❑ I, as owner of th`eproperry, arn E%CWSIVELY CON7RAC71NG WI7H LICENSED CONTRACTORS to consiruci Iha pmject (Sec. 7044, Business and Professions Code: The contractors License tew tloes'noLapply to an owner of propeM who builds or improves thereon, and who cnmracts for such pmject with a coniractor(s) license pursuam to the Contrectors License Caws.). ❑ I em e empt 'und{ �r, s,e,c.�c7�� % Business end Professions Cotle for this reason: Signatura: �\ Yri�IJ� I 1 �.� N.YY A��• � �/ Expires: Ventication of Ownership by (Iype of documen6 i.e. - properry tax bill or deed): DIVISION OF INDUS7RIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby certity ihat no ezcavation five (5) or mora feet in dep�h into which e person is required to descend, will be made in connection wi�h work euthorized by this permit, entl Ihat no building strucNre, swtfoltling, lalsework, or tlemolition or dismantling thereol, will be more t�an ihirty-six (36) feet �igh. (Chap. 32, Grp 2, Art 2, Sec. 341, Ttla 8, Califomia Administretive Cotle). ❑ As owner-builder, I will not employ enyone to do work which woultl require a pertnit irom ihe Division of Intlustrial Safery, as noted above, unless such person has a permit to tlo such work from ihe division. Signawre: Data: Division of Industrial Safery Pertnit Number: CERTIFlCATE OF COMPLIANCE AND AUTHORVATION OF EMAY: I certify under penairy of perjury ihat I have reatl this application and state ihat the information given is correct. I agrea to comply with all state laws and ciry ordinances relating to builtling construction, and euthorize representatives ot Ihe City ol Coste Mesa to enier upon ihe above-Oescnbed �p,�opyert�y for iyn�s�pection p�u 'os^e`s._I agree not to occupy or ellow occupency of any hulltling authorizetl by this permIit uIntil final inspection. �11`--7CW� 1 V 1• A NWVI'�M�\ �1'i � 7�-F� %� Sign re LegalOwn (s) —� Antl/Or Authorized Applicant CODE �. INSPECTIONTYiE 1616 Fizetl System Final Fire Preventlon 1266 Pool Spa Final 200 Final Ra-Roof 201 Final Block/Retaining Wall 202 Finel Factory Fire Place 203 Finel Sign 204 Final Demolition p�j�,F INTRIALS COOE� INSGECTIONTYPE 206 Final Mechenical 20B Finel Plumbing 210 Final Electricel 212 Final Fire Prevention 220 Final Planning Approval 222 FinalSite 250 Final Building/Occupan�y QSjE INiRIAL ��_ PHOJEC ;RUOflE55: Q 6 3 E 1 9 TH ST OWNEfl'SNRME: (,1ZNE MARTHA M �� nooxess: q 6 3 � 1 9 TH ST COSTA MESA,CA (714) 644-7613 FBCMIENGINEER: FODPESS: UNIT: 92627 NEC.NO.: UNIT: PE"MiTTEE: MARTHA PINE (719 ) 548-0699 aooxess: q 6 3 E 19 TH ST C.M. CA 92627 LICENSEO cONTflaeTON oECUNRT10N: I IkreEy aflirm tlwt I am IicenSeE under o�avi5ians of Cnapter 9lcommencin0 witA Section 7000� ot Oiv,sion J oi t�e Business anU Pmlessions Coae. an0 my license i5 in lull force ana et�ect. QTY UC.: STRTE LIC.: CLASS: Daie: SiqnaWrt: WOBNENS' COMPENSRTION DECIAMTION: I nereUy altirm �nat I twve a cenilicate of consent to self-insure or a cenilicate of Workers' Compensation Insurance, ar a cenihea capy �nereof �Sectron 380D, lao. q. POLICY ND.: E%P. ORTE: COMPANY: ? CertilieC caDY is �ere�y �umiSAeA. ❑ Cehifie0 copy ¢ �ileG wilh Ihe uiy BuilOinq OiviSion. Jd�C: Applitdo�: EXEMPIION FHOM WOflNEHS' COMPENSRPON OECUIUiION: (ilis s¢t6on ne¢E nOt 0E CompkteU il Ihe perml b 1or Me hNqrW (S1IX1) ar Ie55�. I ceriify tha� in �he pedarmance ol the work for w�ic� tNs permit �5 i55ueG. I Shall nol emD��Y any person in any manner So 35Ia �ecome su �.. W kers' COmDe� ation LawS of Calitornu./y� � oate: — S'pnamre: / I I Cl L �, - n �lID)'I/�.� � TICE: Ii. af�er makinq t�is aecWration. you shoulE Eecome su0kct to tAe Workers' Compensation p visions ol the La�or Code. you must fonlrmt� compty wit� suc� proviswrt or tNs permit shall be U¢emeE revOkEG. CONSTPUCTION LENUING RGENCY: I here�y allirm tlwt there is a conswction IenOinp apency for I�e peAormance al the work lor w�ic� Ihis permit is issue0 (Seclion 3097, Civ. t�. LENOEfl: ADDFE55: OWNEfl BUILUEfl DECIAMTION: I hereEy allirm Ilwi I am exempt Imm tM Contranors' State Lkense law lor t�e idlowinp reason (Setlion 703t.5 BusineSS ana Protessional COOe: Any ciry of tounly wnich reQuireS a permit lo constmct, atler, imD�ave, tlemolish, or re0air any simcWre. Orior to its iuuance. als0 repuires ihe apqi[ant lor wth DerrtYt to lile a 9qntE statemeni tlWt �¢/she is lic¢nseE pursuanllo I�e provi5ian5 0� I�e Conlratiors' State License Law �Cnapter 9lcammencinp vnm Section 70001 al 0ivision 3 0l lne Business an0 Pro�essions Co�e) or tlu� �Ushe is evempt t�erelram aM t�e OasB lor t�e aUeOeG e.em0�an. My violation of Section 7037.5 Dy any applicant lor a permil SUGle�is I�e apD�iwnt to a civil penalty ol not moa t�an live �unCreO Oallars (5500). I. as owner ol tne Draperty ar my employees witn wapes as their 501e compensation, will Oo Ine work, anJ t�e ❑ strucwre is nol intenOeG or aflereE lor sale (Seclbn 706a. Business anG Pmlessimal Cotle: T�a Cantractors' SWie License Uw aoes not apON �o an owner ot a OmOeny wtn EutlOs or improves t�ereon, anG wtio Eoes suc� woA �imself/�ersell or I�rouAh �is ar �er own empayeu, proviEeE tlul sutl� imD��emenis are nol intenG¢E or aflert0 lor Sale. II. how0ver I�e OuilOinq or impmvement is SOIC vntnin one y¢ar ol cpmpletion, ine owner win �ave ine emaen of 0«�0 hdshe OiU not Oui10 or improve loi ihe ourpase ol 5ale). I, as awner ol t�e pmpeny. am eKclusively contractin0'M�� enseE contractors to constmct t�e Dmject (Sectlon 704d, Business I� anC Protessions Code: TAe Caniraclors' SWte Lke�e Law Qon ml appry to an owner ol properry wlro EuAUs oi improves Nereon antl w�o conuac�s lor suc� pmlecis vnt� a contractaqs�license Dursuam ta t�e Cantractars' State Licensa Law�.l am aware t�ai pmot al t�eir Worke.r'S CamO¢n5aiion insurance 51i0u10 E! WOviUeE lo me. � I am exempt un0er Section: B. 8 P. C. �p�^�ic rea5on: _ _ , , � Pxner. �y cenity ihat I am aware ol and unaerstana �ne ieVuirements of Calitamu Heatt� an0 Satery Cotle Seclians 255�, 25537, ana 2553d an0 Iha� I or any Wlure builtlinp occupant vrilVvnll noi (circle one� nee0 �o mmpty vnlh SaiO Stale coG¢5 anA �he reQuiremenls lor a permit lor conslNciion or m0�ilication Irom Ihe Air Ovahty ManaBement Usifitt. PeSiEential conitruction applications are exemOt Imm t�ese pmvisions. Oale: � FPVlkant: I nere�y cerufylhat I nave reatl Inis apo�ication ana slatelnallhe aUoveintormation is correct. IaAree to comDly witllall city an0 county ordinances an0 statelawsrelalingto OuilOing canslNciqn aiM �ereEyauttpriZerepresenialives allltisdtytoenter upOniheabOv¢�mentioneA propetl/k�n�oses. Date: _ Signamre: �� "�-� �� ✓ � � �� `� ' �-' icense or Socia� Securiry r: 164L46 Whue—Bmlainq: Grean—COGa Enlorceman�: Canary—ApPlicam: Pink—Revenue; GolEenmtl—Assassor CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 06589 PERMIT NO: E 065891 PLAN CHECK NO: N GOVT: N SUPP: Y CONSTAUCTION TYPE: 5—N PERMIT TYPE: ELE PORPOSE: OTH JOB DESCRIPTION : SUPPLEMENTAL TO E-64297 SQ FT: CLAIM VALUE: CALC—VALUE; GROUP OCC: R-3 / COMMENTS: UOGRADED PANEL TO BE BELOW 600 V HELOW 201 AMP. �e�*+r***��*�r�r�*+��rx�*+r�r*�r**�r*�r*�r****�+e�r�r**+r*x�**�r+r��*x�r��r�**+�+c�*�+r*�r***+�+rx�*��***� Z O N I N GS ERTEB�AUCIKRSE M E N T S ------------ MAZN HUILDING ---------- --------- ACCESSORY BUILDING --------- FRNT: FT IN REAR; FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ• PROV; PAACEL: 11734128 ZNE: REF NO: PLANNING NdTES> > iE iE iE iE iklE if i4 it if iE i! it iE iE fE �F jE 7E if if iE iE iE ik iE 1E ff iE iElE iE if.if iF ik iE i! �f %iE iE if if if it iE if it if iE if iE it if it iE iE ic if iE±E iE fE if if 4 if IE iE if it iE iF iF iF jE iE �E D E V E L O P M E N T S E R C� I C E S R E Q U I R E M E N T S ZONING APPROVED BY _ DATE: BOILDING APPROVED BY : . DATE: APPLICATION ISSUED BY; (�—'R Tr DATE: Z \ �' +�+�*fr****r*x��rx�*****�r***�FiF�3FiF3FTrTr3F3F�F'iF'7F * iFiF3F �'3F�3FiF'�F�iF�r**�****** � �.* iE iE it 1E i! 1f iF fE 7f ff iE if iE if 1E iE if fE i! 1E iE �E 1t iE 1f ik if if if i! iE if if if if !f iF iE iE k!f iF iE if iE 1f if i� iE if if 1f iF iF if if iE aE iE M 1F 1F N if f! if iF if j! iF if 1f iF 1E M iE i! iE iE LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT;N PERMIT BLDG PMT PLUMBING ELECTR75 MECHANIC FIRE SMIP/RES GRADING SOS SMIP/NON—RES PLAN ISSUE FEE 4,50 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS----> 0.75 4.50 0.00 5.25 5.25 .00 REVENUE DIVZSION TOTALS--> COLLECTED: 5.25 OVER/SHORT: .00 BLDG PMT PL[IMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 5.25 fhff7fitlfififMititiE4iFkkififiEkitififititifiFilkikMfFifklfifltillEitifiEiFiEiElEiEif�fiEMififlFifilMifilififiEiEiFMfflfiflflflfiEillfiEitiEk%1f I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST ELE 1 RECEPT/OOTLET 1 ST 20 EA. ,75 .75 END OF FEES 01 001;,4671—ODl54672 TLIT DATE= 02/OS/4< rirtE: io:o7 \ CONSTRUCTION AND PLANNING POOL PA , , � APPROVALS Permit # Date � Inspector APPflOVALS Permit �k Date Inzpeccor k � 1, Temporary Electrical Service or Poie 52. Pool & EpuiPment Location � � ., 2. Soil Pipe-Undrgrnd. - 53. Steel qeintorcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms � 4. Electrical Conduit-Undrgrnd. 55. Electricai Bonding '. 5. Steel Reinforcemenc 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVA� TO COVER�GUNITE 7. Footinqs 58. Electrical Cond�it-Undrgrnd. $. Foundation 59. Gas Pipe, � Undrgrnd., Test � 9. Water Pipe-Undrgmd. 60. 8aekwash Lines, P�Trap, O Undrgmtl. t 10. Structural Floor SYstem 61. APPROVAL TO DECK � -� 11, Property Sewer Line & House Connection 62. Backwash & Receptor�Final - � 12. Sewer Cap � 63. Heater & Vent�Final -r .� 73. Foof Drains 64. Plumbing System - Fina1 J -� 74. Rough Plumbing 65. Electrical-Finai ' ' 15. Rough Electrica6Conduit � 66. Solar System-Final `� � 16. Rough Electric Wiring 67. Fencing & Access Approvai ' 17. Rough Wirin9 Siyn 68. APPROVED FQR PLqSTEflING � ; 18, Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEi:7S fiNAL 19, Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT � 20. Rough Factory Firep!ace qppROVAIS Permit # 2t. Duccs,in Structu�e 70. Underground Hyd.o 22. Ducts, Ventilating �1. Produci Piping O Gas ❑ O�I 23. Gas Pipe�Rough & Test 72. Underground Plush 24, floof Framing 73. Underyrnd. Storaye Tank O Gas ❑ Oii 25. Roof Sheathing 74. Overhead Hydro 26. T•Bar Ceiling ISvucturaq & tdonocoat 75. Dry Chernical 27, Frame and Flashing . 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation . 76. FIRE PREV. FINAL 3p, DrVwall Naiting HEALTH DEPT. REQUIREh7ENT 37. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter�Final / 80. FOOD CERTIFICATE ISSUED 33. Fina1 Eleccric �,l,(,g�� * Notes: f ,� 34. Final Heating & Air Conditioning - 35. Final Gas Pipe•Test ' � 36. Hood or Canopy � �' 37. Final FactorY Fireplace 1 38. Final Plum6ing 39. Water Service�Final 40. Gas Service-Final 41. 5o�ar �omesticFinal , 42. 6ackflow Preventer 43. 6ackflow Irrigation 44. Landscape Irripation SYscem - 45. Sound Attenuation 46. Handicap Regulations � 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING - - - 49. E�ectric Release to Edison _, � ' 50. Gas Release to Southern Calitornia Gas Co '�- 51. CERTIFICATE OF OCCUPANCY � No. Dace (714) 754-5273 • Fau (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DFIVE, COSTA MESA, CA 92626 .lob nddress: 463 E 19TH ST Suite No Viciniry: Parcel Nunmber: Applicant: Address: Owner: ELECTRICAL PERMIT 11734128 THOMPSON, TODD HOWARD 463 E 19TH ST COSTq MESA, CA THOMPSON, TODD HOWARD Address 463 E 19TH ST ConVactor. Address: ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool / Spa Lightlng Fixts Recept Outlets ' Switches Non Res Appl Res Appl Service l0 200a Service to 1000a Service over t000a Motors to 1 hp Motors to 10hp Motors to 50hp Motors to 100hp COSTq MESA, CA Phone: Zip: 92627-2313 Phone: Zip: 92627-2313 Phone: Zip: License: ISSUED Status: ISSUED Applied: 17J30/2004 Issued: 12I30I2004 SCOPE OF PERMIT REF: 804-01139 - ADD 2,478 S.F. TO EXISTING S.F:D. WORK TO INCLUDE: ADD 526 S.F. TO 1 ST S70RY AND ADD A NEW 1,952 S.F. 2ND STORY. ADD A 100 S.F. BALCONY ANp 376 S.F. FRON7 PORCH. RELOCATE EXISTING FIREPLACE IN LIVING ROOM AND ADD A NEW FIREPLACE TO NEW FAMILY ROOM IN 1ST STORY, CREATE A NEW RETREAT AND GAME ROOM IN 2ND STORV. ELEC7. PERMIT IS FOR 36 LIGHTING FIXTURES, 77 RECEPTACLE OUTLETS & 30 SWITCHES. $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $33.68 563.61 $29.30 $0.00 $0.00 so.00 $0.00 50.00 $0.00 $0.00 so.00 $0.00 Quantity 0 0 0 36 77 30 0 0 0 0 0 0 0 0 0 FEE SUMMARY Temp Dist Syslem / Lighting Busway /100 ft Standing Section . Misc Electrical Equipment TranSformers up l0 1 kva/kw ................up to 10 kva/kw .................up to 50 kva/kw .................up to 100 kva/kw ..................over 100 kva/kw Low Voltage Equipment Low Vol[ Winng System / Ckl Misc. Conduit � Misc. Conductor Circus { gen or ndeJ - Circus (mech ride or lights) Christmas,Tree Stand Fireworks Stand Olher Electrical Fee $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 S0.o0 $0.00 50.00 $o.00 " $0.00 $0.00 So.00 $0.00 so.00 $0.00 Quantiry 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 NOTICE: The work auihodzed by this permit shall comply vdth all applicable handicap access requirements under Califomia statufes and relafed regulations. (Ord. No. 92-28, § 1, 12-21-g2) EXPIRATION: This permit shall automatiwlty expire and become void ii work is not commenced within 1 BO days, or II work is suspended or ebandoned for a period of 180 days. INSPECTIONS: In o�de� fo� thg woAc au(horized untler ihis permit to be considered legal, such work mus� comply with ell applicable codes, and eli requlred Inapectlone and final epproval must be obtained. Failure to obtain inspections and final approvel will result in the expiration of this permit. FOR INSPECTIONS CALL: (71q) 75q-5gpg tS.l::Y1�1:91 WORKERS'COMPENSATON DECLARAnON: ' I hereby aHlrm untler penalry of perjury one at the tWlowing dederetions: ❑ I heve entl wlll maintein e certiflcate of cnnsent to selt-Insure for workers' crompensetlon, es pmvided br by section 3700 of the Lebor Code, lor the Oedormence ot Ne work for which this pertnit is Issuatl. ❑ I heve and vnll malntaln workers' compensatlon Insurance, as required 6y sectim 3700 of the Lebor Cotle, for Ne pertortnance ot Ihe wark for whlch Nis pertnit is LsweA. My workers' compensatlon Insurenca wrrier entl policy num0er are: Cartler. Policy Number. (TNs secf/on neeE not be complefed!! fhe permit is velued el one huntlred dollars (5100) or /ess.) 0 I ceNfy thet in tha OeAormance ot the work for w�lch �his pertnil is Issued, I shell not emplay eny person in any manner so as to becoma sub�ect to the workers' compensation lews ol Celifomia, entl egree the� II I should become sub�ect to the workers' compensatlon provislons oi Sectlon 3700 of t�e Lebor Cade, I shell t6rthwlth comply with Nese provisions. Applicant SlpnaNre: Dere: WARNINCi: FAI WRE TO SECURE WORKfRS' COMPENS4TION COVEMGE IS UNLAW R1L AND SHALL SUBJEGT AN EMPIOYEF TO CPIMINAL PENALTIES AND GVIL FlNES UP TO pNE HUNDRED T/MJIISPND OOLIARE (E100,000�, IN ADORIIXJ TO THE WST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3]OB OF THE UBOR CODE, IMEREST, AND ATTOHNE`fS FEES. LICENSED CONTRACTORS DECLARATION: I hereDy aNirm thet I em Iicensed unCer provlsbns ot Chepter 9(commendnp wlih Section 7000) 01 Divislon 3 ot the Business entl Protessions Catla, enC my license Is In full ' lorce entl eNect. Lic. a Cless q GonlrectoYs SlgneWre: Oete: CONSTRUCTION LENDING AGENCY: �.. ❑ I hereby eflirm that ihere is e consiruction lending egency lor Ihe DeAormanca ol the work tor which t�is pertnit is issued. (Sec. 3097, Civil Cotle). Lentler'e Neme: Lentler's AtlAress: Signeture: Date: � OWNER-BUILDER DECLARATIONS: I hereby eMirm that under penelry of perjury thet I em E%EMP7 FROM THE CONTRACTORS LICENSE LAW for ihe following reeson (Sec. 7031.5, Business anA Professlons Catle: Any ciry or counry which requlres a permit to construct, alter, impmve, demolish, or repair any stmcWre, prior to Its issuence, elso requlres �he flpplicant for such pertnit lo tile e signed slatement that he or she is licensed pursuant ro Ne proWslons ot lhe CONrectors License Lew (Chepter 9(commenGng with Sectlon 7000) ot Division 3 of Ue Business enC Professions Cotle) or thet ha or she is ezempt therefrom end the besls tor the ellegetl exemption. Any violation of Sectlon 7031.5 by eny epplicent tor e pertnit sub�ecLs the applicant to a civil penalry of not more ihan five huntlred tlollers ($500).): �] I, as owner ot the property, or my employees with wages as Iheir sde mmpensetlan, WILL DO 7HE WORK, end Ihe structure b not Intended or oHeretl tor ule (Sec. 7044, Busineu entl Professions Code: The Cbnlractars License Lew does not apply to an owner ot property who builds or Improves thereon, antl who tloes such work himsell or hersetl or thmugh his or her own emplqrees, provitletl ihat such ImprwemeMs are nat intended or otteretl for ule. If, however, the building or imprwement is sold within one }rear of completion, ihe owner-builtler vrill �ave Ue Durden oi proving ihat he or she did not builtl or improve for purpose of sale.). ' ❑ I, as owner ot the properry, am EXCLUSIVELY CONTAACTNG WITH LICENSED CONTAACTORS to construct Ihe prqect (Sec. 7044, Business and Professions � Catle: The cromrecmrs License Law tloes nm appty to en awner af pmperty w�o bulltls or impmves thereon, end who contracts for such project with e coniractor(s) license pursuent to the Contraciors License Laws.). � �I em ex�e tyntle c. Business enE Pmlessions Code lor this reason: Signature: r!.oYt�� Date: 2—'�O — U y Owner ID verified by dnvels license. ;�Ves ❑ No � Drivefs License No. /(� Expire5: � � Verlllcation ot Owners�ip by (rype oi tlocument, i.e. - proparty tax blll ar tleea): DIVISION OF INDUSTflIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby certify Ihat no excavatlon Tive (5) or more feet in tlepth into whlch e person is required to descend, wlll be mede In connec0on wlth work euthodzed Dy thls permit, end that no building strucNre, scalloltling, falsework, or Cemolitlon or Aismentling thereol, witl be more then thirry-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title B, Calllomie AdministratNe Code). � ❑ As owner-6ulltler, I will not employ enyone to Ao work whic� woulA require e permit trom the Divislon ol Intlusiriel Sefery, es noted ebove, unless such person hes a pertnit to Oo such work Irom �he division. Signature: Date: Division ot Intluslnal Safery Pertnil Number. CERTFlCATE OF COMPLIANCE AND AUTMORIZA710N OF ENfTiY: I certily under penelry of perjury that I have reatl this epD��a�ion end state thet the iniortnation given ie correct. I egree to comply wlth ell stete lews end ciry ordinences reletinp to bullding construction, entl authonze representetives ol Ihe Ciry of Coste Mesa to enter upon the ebo cribe erty for i pection uryoses. I egree not to acupY or ellow occupancy of eny building euthorized by this permil unlil linel inspection. G�� -- �� l,.Q.N.r�a�-_. iz 3o-z�y —� Signature 01 Legal Owner(s) `� Date AnA/Or Authodzed Applicent CODE �• INSPECiIONTYPE i616 FIzeC System Finel Fire Preventlon 1268 Pool Spa Finel 200 Finel Re-Roo1 201 FIneIBIaWRetainingweli 202 Flnel Fectory Fire Placa 203 Finel Sign 204 Final Demolition Pdg �,§ f�QQ�t INSVECTIONTYPE 206 Final MecheniCel 20B Final Plumbing _ 2ID Final Elecidcal 212 220 222 250 Finel Fire Prevention Final Planning Approval Final Site Final Building/Occupancy PAff 1tffID�LS Y • �,+ eTi� (714)754-5273 • Fax(714)754-4856 Job Address: Suite No Vicinity: Parcel Nunmber: � CITY OF COSTA MESA � BI/ILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT 463 E 19TH ST MASTER BAT/BEDROOM 11734128 ELECTRICAL PERMIT Applicant: THOMPSON, TODD HOWARD & MARTHA MARY Address: 463 E 19TH ST COSTA MESA, CA Phone: (949)548-0694 Zip: 92627 Owner: THOMPSON, TODD HOWARD 8 MARTHA MARY Address . 463 E 19TH SL � � � � COSTA MESA, CA � Contracror. OWNER-BUILDER Address: a AND TWO OUTLETS. REF:B00-00092 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 7000a Service over too0a Motors to 7hp Motors to 10hp Motors to SOhp MOtor5l0 700hp Motors aver t00hp Communication drops Phone: Zip: 92627 Phone: Zip: License: 0 PERMIT NUMBER E00-00048 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 0124I2000 Issued: Ot/24/2000 ISSUED BY: • , � � � . 1! 'I� ♦' SCOPE OF PERMIT INTERIOR REMODEL OF EXISTING OF MASTER BATHROOM/BEDROOM AREA. 9 SWITCHES, 7 LIGHTS 823.50 $0.00 50.00 $0.00 $0.00 $0.00 $7.70 $2.20 $9.90 50.00 50.00 50.00 50.00 50.00 $0.00 $0.00 50.00 50.00 $0.00 $0.00 Quantiry FEE SUMMARY Temp�Dist System / Lighting � Busway /100 ft Standing Section 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 Vollage Equipment Low Volt Wiring System I Ckt Misc. Conduit Misa Conductor Circus ( gen or nde) Cirws (mech ride or lights) Christmas Tree Stand Fireworks Stand Other Eledrical Fee Investigation Fee Quantity $0.00 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 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 NOTICE: The work authorized by this pertnit 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 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 Inapeetlone end final epprovel must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of ihis permit. FOR INSPECTIONS CALL: (714) 7545628 WOHKERS'COMPENSAnON DECLARATON: � I herehy eNirtn under penelry of perjury one ot the lollowing dedarations: ❑ I have antl will maintein a certificate of cronsent b selt-Insure for workers' compensation, as provitled for by sectlon 3700 of tha Labor Cotle, br t�e peAortnance of ihe work for which thi5 Dertnit is is5ued. ❑ I have and will maintain workers' compensation insurance, as required by section 3700 of Ihe Lebor Code, br the pertartnance oi Ne work fw which Nis pertnit is lswetl. My workers' wmpensetian Insurance carner and policy number are: Cerder. Policy Number. (Thls section need not be cromp/eted i! fhe permif is velued el one huntlretl tlollaro ($700) or /ess.J ❑ I certify that In tha peAormance ot ihe work for which ihis permit is IssueO, I shell not employ any person In any menner so as lo become suD�ect to tha workere' compensation laws ol Calilomia, and agree that If I should become subJect to Ihe workers' compensation pmvisions ol Sectlon 3700 ot the Lebor Cotle, I shall forthwith compry with t�ese provisions. Applicant Signature: Dece: WARMNG: FAILURE TO $ECURE WORKERS' COMPENSATION COVERAGE I$ UNUWFUL rWD SHALL SUBIECT Ml EMPLOVER TO CRIMINAL PENALTIES AND CM� FlNE$ UP TOONE HUNDRED THOUSAND DOLLARE R��•�1� �N ADDfiION TO iHE WST OF �MPENSAiION, OAh41GES AS PROVIDED FOR IN SECi1QV 3)OB OF TNE LABOR COOE, IMEREST, AND ATfORNEY'S FEES. LICENSED CONTRACTORS DECLARA710N: I hereby eHirtn �hat I em Ilcensetl untler provisions of Chapter 9(commendng with Section 7000) of Dlvision 3 of the Buslness end Professions Cotle, entl my license is in tull force antl etfect. Lic. a Class q Conireaofs Signature: . Date: CONSTRUCTION LENDING AGENCY: ❑ I hereDy eNirtn thet there is e construc�ion lentling egency lor Ihe pertormence ol ihe work for which this Oermit Is issued. (Sec. 3097, Clvll Cotle). Lender s Name: Lenders Atltlress: SlgnaNre: Date: OWNER-BUILDER DECLARATIONS: I hereby aHirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW tor t�e fallowing reason (Sec. 7031.5, Business and Prolessions Code: Any ciry or counry which requires a pertnit to construct, alter, imprrne, demolis�, or repair any siructure, prior ro its issuance, also requires the applicant for such permit to file a signetl statement Ihat he or she is licensed pursuant ro the proNsions of t�e Contractors Licensa Lew (Chapter 9(commencing wlth Sectlon 7000) ol Division 3 of the Business and Professions Code) or that he or she is exempt therefrom antl �he basis for ihe alleged axemption. Any violatlon oi Section 7031.5 by any applicant for e permit sub�acts Ihe applicent to e civil penalry ot not more Ihen tive hundreA tlollars ($500).): � I, as owner of ihe property, or my employees with wages as their sole compensation, WILL DO THE WORK, enC the siructure is not intendetl or oNeretl for sale (Sec. 7044, Business end Professions Cotle: Tha Contractors License Law tloes noi appty to an owner ol property who builAs or improves thereon, and who tices such work himselt or herself or thrwgh.his or her own employees, providetl t�at such impmvements ere not intentled or oNeretl for sale. If, however, the building or impmvemem is soltl within one year \vomp� �ion; the_owneo-builtler will �ave the burtlen of proving ihat he or she did not build or improve for purpose ot sela.). � I, as owner ot tha property„em'EXCLUSIVELY CONTAACTING WITH LICENSED CONTRACTORS to construq the pmject (Sac. 7044, Business and Protessions Cotla: The comradors License Cavi'does noi'80PN, �o an owner ot pmperry who builds or impmves thereon, antl who contracts tor such project wiN a con[ractor(s) license pursuant b the Contracbrs license'Cews�): ❑ I em :empt un,�d�(s�ec�. Business end Professions Cotle for t�is reason: Signature: �� 1�'VVI� _ ] Expires: Venlication of Ownership by (type of daument, i.e. - property Wrz bill or deed): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTFICATION: ❑ I here6y cenity that no excavetion tive (5) or mora feet In depth Into which a person Is requlred to descend, will be metle in connection wlth work auihorizetl by Ihis permit, antl that no Dulltling structure, scaHOlCing, felsework, or tlamolition or tlismantling Ihereot, will be more then ihirty-siz (3fi) feet high. (Chap. 32, Grp 2, An 2, Sec. 341, Title 8, Califomla Atlminislretive Cotle). ❑ As ov+ner-Duiltler, I will not employ anyone to tlo work which woultl reqNre a pertnit from the Division ot Intlustrial Safery, as notetl above, unless such person has e permit fo do such work tmm the division. SlgnaNre: Date: Division of Indusiriel Safery Pertnit Numbec CERTIFlCA7E OF COMPLJANCE AND AUTHORIZA710N OF EMAY: I ceM1ify under penalty of per�ury Ihat I have reed this application and state that the infortnation given Is correct. I agree to comply with all state laws and dry ordinances relating to building consiructlon, and authonze represemetives of ihe Ciry of Caste Mesa to enter upon �he ebove-tlescribed propeny tor inspection purposes. I egree not to occupy or ellow occupancy of any building authonzadp y this permil until linal inspaction. mU�,__`��+ YY1. ��rflv�n !� �YiYI . Z� 71i� Slgnat e Of Legel Owne ) ate AnNOr Au�honzed Applicant GODE t. INSPECTIONTYPE 1816 Fixetl System Final Fire Prevention 1268 Pool Spa Final 200 Final Re-Root 201 Final BIocWReteining Wall 202 Finel Fectory Fire Place 203 Final Sign 204 Final Demolition �g � COUE I INSFECTION TYPE 206 Finel Mechanlcel 20B Finel Plumbing 210 Finel Elec�ricel 212 Final Flre Preventlon 220 Final Plenning Approval 222 Final Site 250 Final Building/OcCupancy ��CYIMl�61 6 �F �4 hY-�''=�- :, .i , �,;• � a� �q o, � > _ r J •�noW�to`� (714) 754-5273 • Faz (714) 754-4956 � CITY OF COSTA MESA � Bl/ILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT .lob nddress: 463 E 19TH ST Suite: Vicinity: MASTER BATH/BEDROOM Parcel Number: 11734128 BUILDING PERMIT Zoning: Applicant: THOMPSON, TODD HOWARD & MARTHA MARY Address: 463 E 19TH ST ' - � - .Phone: (949)548-0694 COSTA MESA, CA , Zip: 92627 � Owner. THOMPSON, TODD HOWARD & MARTHA MARY , Address 463 E 197H ST � � / . � ' - , � , Phone: � COSTA MESA, CA �� Zip: 92627 Contractor. - OWNER;BUILDER' Address Phone: Zip: Arch : ' License: 0 �' Eng: PERMIT NUMBER' B00-00092 77 FAIR DRIVE, COSTA MESA, CA 92626 ISSUED BY: Status: ISSUED Applied: 01124/2000 Issued: 01/24/2000 Address: , " ' -, \ � -- � � Address:. � - - " ,. � � � Phone: � Phone: < , Zip: ' " � - � License: License: SCOPE OF PERMIT � INTERIOR REMODEI, OF EXISTING OF MASTER BATHROOM/BEDROOM AREA. REMOVE EXISTING SLIDING GLASS DORR AND REPLACE WITH NEW 10 (GLASS) PANEL FRENCH DOOR. CONSTRUCT TWO NEW CLOSETS, INSTALL NEW JACUZZI TUB. Plan Check: $54.11 Permit: $83.25 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $137.86 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0- 0 PARKING Existina; o �" � �' FEE SUMMARY. _ _ �, Rear 0-0 Rear 0-0 Required: 0 PLANNING & ZONING Calc Valuation: gs,000.00 Claim Valuation: gs,000.00 Left 0- 0 Right 0- 0 Left 0- 0 Right 0- 0 ProPosetl: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 72-21-g2) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a poriod 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 required Inapaetlona and final epprovel must be obtained. Failure to obtain inspections and final approval will result in the expiration ot this permit. FOR INSPECTIONS CALL: (714) 7545626 � WORKEHS' COMPENSATION DECLARA710N: I here6y aflirtn untler penalry of peryury one ol the lollowing declaretions: ❑ I heve end will maintain a certificete ot consent to salf-Insure for workers' compensation, as providetl for by sec0on 3700 of tha Lebor Cotle, tor the petlormance oi the work for which this pertnit is issuetl. � I have entl will maintain workers' compensation insurance, as required by sec�ion 3700 of Ne Lebor Code, tor the peAortnance of tha work for which this pertnit is issued. My workers' compenution Insurence carner and policy number are: Carner: Policy Number: (fhis secNon neetl no[ be comp/eted i! fhe pertni( is veluetl at one hundred dWlars ($100) or less.) ❑ I certify thal in Ihe pedormance of the work for which this permit is issued, I shall not employ any person in eny manner so as to become subject to the workers' compensation laws of Califomia, and agree that if I should bacome subject to the workers' compensation provisions of Saction 3700 of t�e Labor Code, I shall forthwith comply wi�h Ihese provisions. Applicent Signatura: Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION CAVERAGE IS UNUWFUL AND SHALL SUBJEGT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRE� TMOUSAND DOl1ARE ($100,000), IN ADDIT�ON TO THE COST OF CAMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3]O60F THE IABOR CADE, INTEREST, AND AiTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby attirm ihat I am licensetl under provisions of Chapter 9(commencing with Section 7000) oi Division 3 of t�e Business and Professions Coda, antl my license is in full torCa entl BNett Lic. # Class M Comractofs Signature: Data: CONSTRUCTION LENDING AGENCV: ❑ I hereby aMirtn that Ihere is a construclion lentling agency for Ihe pertortnance ot t�e work tor which this permit is iuued. (Sec. 3097, Civil Cotle). Lentlefs Name: Lentler's Atldress: Signature: Date: O W N E R-B UILDER � DECLARATIONS: u n�N I hereby aflirtn thaLunde�penalty�o`perjury thai I am EXEMPT FROM THE CONTRACTORS LICENSE LAW br t�e lollowing reason (Sec. 7031.5, Business end Pmfeuions Code: Any ciry or co`unly�which reqwrere�permit to consiruct, alter, improve, demolish, or repair any siructure, prior to its issuance, also requires Ihe epplicant tor such permit lo file e signed stetament thafhe�o �stieJs Ocensed pursuant to Ihe provlslons of the Coniractors License Law (Chapter 9(wmmencing wlth Section 7000) ot Division 3 0l the Business antl Pmfessions Code) or tfiaf�fie or she is exempt iherefrom and Iha basis tor the allegetl exemption. Any Wolation of Section 7031.5 by eny epplicant for a permit s��ecis ihe apP�icant ro a civil penalry of not�mora t�an tive huntlred tlollars ($500).): I, as owner ol the propeny, or my:employees with wages as their sole compensation, WILL DO THE WORK, entl ihe struciure is not intendetl or oHeretl for sale (Sec. 7044, Business antl Professions COCe: The Coniractors License Law tloes not apply to an owner oi properry who builtls or improves thereon, end who tloes such work himself or herself or ihrough his or her own employees, provided Ihet such improvements are not intentletl or oNered for sale. It however, the builtling or impmvement is sold within one year of completion, �he owneabuilder will have ihe burden of proving that he or she tlitl not Duiltl or improve for purpose of sale.). ❑ I, as owner of the propeny, am EXCLUSIVELV CONTRAC7ING WI7H LICENSED CONTRACTORS to constmct ihe project (Sec. 7044, Business and Protessions Coda: The coniractors License Lew does not apply to an owner ot property who builds or improves ihereon, end who contrects for such pro�ect with a coniracmr(s) license pursuant to the Contractors Licensa Lews.). ❑ I am� ,e�m^pt u�nd`�{ s�ec. Business entl Professions Coda tor this reason: Signature: l "N..l`�'V�0.� , - _ Date� Owner ID venfietl hy drivafs license. ❑ Ves ❑ N Dnvefs License No. � Expires: Venfication of Ownership by (type of tlocumenC i.e. � pmperty taa bill or tleed): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby certify Ihat no excavaiion five (5) or more fee� in Oepth into which a person is required to descend, will be made in connection wl�h work authorizetl by ihis permit, entl that no building stmcture, scaHolding, falsework, or demolition or dismanNing thereof, will he more ihan Ihirty-six (36) feet high. (Chap. 32. Grp 2, Art 2, Sec. 341, Title B, California Administrative Code). ' ❑ As owner-builtler, I will not employ anyone to do work which would require a permit trom ihe Division of Intlustrial Safery, as no�etl above, untess such person has a pertnit to do such wark from the division. • Si9neture: Date: Division oi Intlustrial Safery Permit Number: CEH'TIFICATE OF COMPLIANCE AND AUTMORIZATION OF EN7RY: I cenify under penalty of perjury iha� I have read Ihis applicetion end state that Ihe intormation given is correct. I agree to comply with all state laws and city ordinances relating to building consiruction, and authonze representatives of �he Ciry of Costa Mesa to enter upon ihe �ebov -descri�etl r peny for inspection pur oses. I agree not to occupy or allow acupancy ot any building authonzetl by t�is permit umil final inspection. � ��a ��nc�xr.(?�!1v.. �--n. z�, �l�?SO Signa e egelOwner ) ' Date AnNOr Authonzetl Applicant Date COpE L INSPECTIONiYPE 1676 Fl.etl System Final Fire Prevention 1266 Pool Spa Final 200 Final Re-Roof 201 Final BIaWRetaining Wall 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition 244&OB pATE - f�$ CODE� INSPECTIONTYPE 206 Final Mechanical 208 Final Plumbing 210 Final ElecMcal 212 Final Fire Prevention 220 Final Plenning Approval 222 Final Site 250 Final Building/Occupancy (714) 754•5273 • Fa�c (714) 754•4856 • vnvw.ci.cosla-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT �obAddress: 463 E 19TH ST Suite: Vicinity: Primary Occ: R-3 Dwellingsl Cong Res <10 Type of Construction: V-N Parcel Number: 11734128 Zoning: Applicant: THOMPSON, MARTHA Atldress: 463 E 19TH ST COSTA MESA, CA Owner: THOMPSON, TODD HOWARD Address 463 E 19TH ST COSTA MESA, CA Contractor: Address: Zip: Arch : Address: Zip: Phone: 949-548-0694 Zip: 92627-2313 Phone: Zip: 92627-2313 Phone: License: Status: FINALED Applied: O6/232004 Issued: 72/30/2004 ISSUED BY: Eng: JERRY TUCKER AND ASSOCIATES Address: 350 E 17TH ST Phone: SUITE 210 Phone: 949-645-2422 COSTA MESA,CA License: 92627 License: 2187 SCOPE OF PERMIT ADD 2,478 S.F. TO EXISTING S.F.D. WORK TO INCLUDE: ADD 526 S.F. TO 1ST STORY AND ADD A NEW 1,952 S.F. 2ND STORY. ADD A 100 S.F. BALC4NY AND 376 S.F. FRONT PORCH. RELOCATE EXISTING FIREPLACE IN LIVING ROOM AND ADD A NEW FIREPLACE TO NEW FAMILY ROOM IN 1ST STORY, CREATE A NEW RETREAT AND GAME ROOM IN 2N0 STORY. CONVERT EXISTING 3 BEDROOM, 2 BATH S.F.D. TO A 5 BEDROOM, 4 BATH S.F.D. REF: ZA-03-101 LOT AREA; 7,659 SF FOOT PRINT: 3,197 SF OPEN SPACE: 58°h BUILDING HEIGHT: 27'-0" NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92•28, § 1, 1241-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In o�der for the work authonzed under this permit to be considered legal, such work must comply with all applicable cotles, antl all requlred Inspectlons and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 yJ�.� �.�i(•�111 WORKERS' COMPENSATION DECLAflATION: I herehy aHirm under panelry of perjury one at the tollowing declaretlons: ❑ I heve end wlll melnteln e certificeta of consent ta self-Insure for workers' compensatlon, es providetl for by section 3700 ot ihe Labor Cotle, lor Ihe pertartnance of ihe work tor whlCh this permlt Is issuetl. ❑ I have end wlll meintein workers' compansation insurence, as required by section 3700 ot the Lebor Cotle, for the perfortnence of Ihe work for which I�Is pertnli is IssueO. My workers' compensation Insurence cartier end policy numDer ere: Carder: Policy Number. (Thls sectian need nof be comp/eted i! fhe permit is ve/uetl et one hundred dollers ($100) or less.) ❑ I ce�ity Ihet In the pedortnance of the work tor which this pertnit is issued, I shell nat employ eny person in any menner so as ta become subjact ro t�e workers' compensation laws ot Cell}omla, antl agree that if I shoul0 became suh�ect to the workers' compensation provisions ol Section 3700 of the Lebor Code, I shall forihwit� compty with these provlsions. Applicent SlpneNre: Date: WARNINO: FAILURE TO SECURE WORKERS' COMPENSATION COVERAOE IS UNUWFUL AND SHALL SUBJECf AN EMPLOYER TO CRIMINAL PE W�LTIES AND CNIL FlNES UP TO ONE HUNDflED THOUSAND DOLURE (5100,000), IN ADDffION TO TME COST OF COMPENSATIIXJ, DAMAGES AS PROVIDED FOR IN SECfION 31O60F THE IABOR CODE, INfEREST, Ml� ATTORNEY'S FEES. LICENSED CONTRACTOHS DECLAFiATION: I hereby aMirm Ihat I am Ilcensetl under provisions ot Chapter 9(commencing with Section 7000) of DiNsion 3 ot the Business end Professions Code, and my license is in lull force end eHecL LIC. N Class p Conireqofs Slgneture: Oate: CONSTRUCTION LENDING AGENCV: ❑ I hereby eftirm that there Is a construction lending agency lor the pedormence of the work tor which this pertnit is Issued. (Sec. 3097, CNII Code). Lentlefs Neme: Lender's AAtlress: Signet Date: OWN % UIL �� ONS: I here flftlrtn t�eF� � pen ry thet I am EXEMPT PROM THE CONTRACTORS LICENSE LAW for ihe tollowing reason (Sec. 7037.5, Buslneu entl Professions Cotle: Any Gry or n i hi equire permit to wnstrud, alter, impmve, demolish, or repair eny structure, prior to its issuance, elso requires Ihe epplicant for such pertnit to file e signed steteme r s s licensed pursuant to the provlsians at the Contrectore License Lew (Chapter 9(commencing with Secllon 7000) of Divislon 3 ot ihe Business end Prafessions Code �� he or she is exempt Neretrwn end the basis for the allegetl evemptlon. My violatian ot Secllon 7031.5 by eny applicflnt for a pertnit sub�eMs Ihe epplicant to e civil pena ot not mora than frve hunEred dollers ($500).): � I, es owner ol the properry, or my employees with wages es thelr sola compensation, WILL DO THE WORK, and the structure Is not IntandeC or oitereG for sele (Sec. 7044, Busineu end Professions Code: The Contractors License Lew does not apPb �o an owner of properry who builtls or improves Ihereon, end who does such work hlmsetl oi herself or ihrough his or her axn employees, provided that such improvemenis are not intendatl or oHered tor sele. II, hawever, ihe bullding or Improvement is soltl wlthin one year ot comple6on, the owner-builder will heve ihe burden of proving that he or she did not huild or improve tor purpose of sale.). ' ❑ I, es owner oi the property, em EXCLUSIVELY CON7RAC71NG WIT}I LICENSED CONTRACTORS to consiruct Ihe projacl (Sec. 7044, Business and Professions Code: The contractore Llcense Lew does not epply to an owner of propeny who bullds or impmves t�ereon, and who coNrects tor such pro�ect wlih e comractor(s) license pursuant ta tha Cantracrore License Laws.). ❑ I em exempt under sec. Business end Pmfesslons Code for this reeson: Signature: Date: Owner ID vedflad by tlnver's Iicense. ❑ Yes ❑ No Driver's License No. Verlticetlon ol Ownership by (rype ot document, i.e. - properry tax bill or deed): DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION: Expires: ❑ � hereby certify Ihat no excevation tiva (5) or more feet in depth into which e person Is required to descend, will be matle In connec�ion with work euthodzed by this pertnit, end thet no building structure, scaffolding, talsework, or demolition or dismantling ihereot, will be more Ihan thir�y-si: (36) feet high. (Chep. 3.2, Gry 2, Art 2, Sec. 341, Tltle B, Celifomla Adminisiretive Cada). ❑ As owner-builder, I will not employ anyone to do work whlch would requlre e permit from the Division ot Industriel Sefery, es noted ebove, unless such person hes e permit to tlo such work from �he division. SignaNre: Date: Division oi Industrial Salety Pertnit Number. CER7IFlCATE OF COMPLIANCE AND AUh10RIZATION OF ENTRV: I certify under penalry of perjury that I heve reed this applicatlon antl stete Ihat the infortnation given is cor�ect. 1 egree to comply with ell stete laws end ciry ortlinances releting to bullding construction, end authonze representatives ol the Clry oi Costa Mesa to entar upon the ebove-descdbetl propetly for inspection Duryoses. I egree not to occupy or allow occupancy ot any building euthonzed by this permit until finel inspection. Signeture Of Legel Owner(s) Date AndfOr Aut�orized Applicant Date COpE �. INSPECTIONTYPE PEIE II�IELS 1678 Fixed System Final Fire Praventlon 1268 200 201 Pool Spa Final Final Re-Roof Finel BIocWRetelning Well 202 Flnel Factary Fira Place 203 Finel Sign 204 Final Demolition LQUE I INSPECTION TYPE 206 Final Machanical 200 Final Plum�ing 210 Final Electripl 212 Flnal Fire Prevention 220 Final Planning Approvel 222 Final Site 250 Flnal Buildinq/Occupency � l�L'6'J L� I i i� --� � °u"", q63 E 19TH ST �"S'�"ME' PINE, MAATHA M nroxess: q 6 3 E 19 TH ST COSTA MESA,CA 92627 AflCWENGINEEfl: � 7 1 9) 6 9 4— 7 6 1 3 qEG.NO.: POONE55: UNIT: UNIT: PEHMITTEE: MARTHA PINE ( 714 ) 548-0694 ADUHF55: 4 6 3 E 1 9 TH ST C.M. CA.92627 ❑LENSEo CONTXRCTOB oELUMTION: I IreRDy affirm Ihat I am licen5ea unaer ptonsions ol ClNplet 9(commencing witn Sectian 7000) af Orvision 3 0l Ine Busineu ark Prof¢Ssions Code. ana my licerrs¢ is in full force anE efleci. Cltt UC.: STATF L1C.: CLASS: Date: 9gnawre: WOflREBS' COMPENS�TION OECIAMTION: I �et¢by aliirm Ihal I tuve a certdi[ate ol cOnsenl lo Selbinwr¢ or a ceM1iliw�e ol Workers' Opmpenulian Insurance, ar a cenifiea cooY ��ereof (5ection 3800. La�. CI. PoLICY NO.: E%P. ORTE: COMPRNV: CerlAieO coOY �s �ere0y Iumis�e0. ❑ Cenifiee capy is IileO wii� t�e ciry BuilOinp Division. Oaie: pODlicanC E%EMPTION iBOM WOHRENS' fAMPENS/iTION OECIAflATION: Qhis scclian nee0 w� be wmpleied il lhe perrrvl is loron¢ �uMreO (5100) ar les5�. I ceriify Nal in ��e Detlormance ol I�e work br w�ich I�is permil is issue0. I s�all not employ any person in any manner so as to become Suble�� o IAe WOrkerS=CAm ensation LawS of Cali�omia. ^ / � � �)��(l� Date: �� SignaNre: �' Ki� NOTICE: II. a�ief makinp IhiS 4EClafaiion, y0u ShOuIA 0¢C e Subletl to I�e Warkers �Compenta�ion provi5i n5 01 IAe Labor Cotle. you must lotlhwilh comOty wit� suc� Dmvisions or I�is Dermi� s�all Oe Geemed revoketl. CONSTNUCTION LENOING RGENCY: I �ereGy allirm I�al I�ere is a mnsimc�ion 1¢ndinp aBency lor �Ae petlormance Of Ihe work �or wnich Ihis ne�mit is issuee (Seciion 3097. Gv. C�. LENDEfl: ROOflE55: OwNEB BUIlOEN DECUNRTION: I nereey affirm that I am eKempt imm rti¢ Contracrors' State License Law lor ine fonowing reazan (Section 7031.5 Business antl Pwlessional CaOe: Any cily ol counry which repuires a permii �o cons�mct, alttr, improve. Oemolis�. or rppair any slNCWr¢, prior Io i15 issuan[e. a15p rtQuir¢5 Ihe ap0litdnt br such permii �a file a 9gfleU Slalem¢ni tlWl MJSIie i5licen5e0 pursuam �o I�e D�ovisions at Ine Canlracbrs' Slaie License law (Clwprer 9(commenting vni� Section 7000) ol Oivision 3 0l Ihe Business anG Pmlessi0irs Code) oi I�al �¢/5�e h e.empl Ih¢r¢Irom anOlhe basis to� IAe allegetl eK¢mplion. My viaW(ian o� $Ctlion 7031.5 Ey airy aOW�nl lar a De�mil wGjKis l�e applirzni to a civil penalry al nol more Ilwn live �unGrtE Uallars (3dW1. I, as owner ol t�e O�oDeny ar rtry employees wit� wages az Ilieir Sole compen5alion, vAI Uo I�e wOrk. an0 Ihe ❑ sVuciure is nm intenEeG o� ollereA lor ule (Stc�ion 70a4, Buwiess and Pmteuional CoEe: TM Contractwi Siate Licenu Law Goes not apply to an Owner ol a DroDetly who �uiltls or imprwes t�er¢On, an0 wtia Ooes suc� work Nrtlutf/herself or t�mupll NS or her own em0loyee5. 0«� �� 5uc� impravemenis are n0i intenEeG or oliered for sat2. 1�, tpwevef ��e Guiltlinp Or impmvemen� is 5oia wit�in on¢ year ol complelion, I�e ovmer vn0 hav¢ �he burG¢n ol pmvinp �e/5�0 GiG �rot UuilU ar imprwB la� ihe OurpOse ol Salel. � I, �5 awner ol the pmperty. am exUuvvely contracling with ticensea conVaclors lo conslmci [�e D�oie�� on 704a. Business anA Pw�estions CaGe: i�e Conlraciws' Stale License law Oce5 �roi apph/ �a an owner ol Droperry wM OmMs or Impmves t�erean arb w�o wnirat�s �or SUC� pmle[IS wilh a COnVaCto�(5� lirense pursuan� �o I�e ConVaclor5' Slaie LittnSe Law�. I am aware I�al D�� ol Ineii Woiker's ComOensalion Insurance 5�ou10 6e pravitleE 10 me. � I am eeempl un0er Seciian: B. 8 P. C. lOr I�is reason: o,�e: IU—`I—� Owner./L�u�l� � � I Oo M1ereby [erlily Ihat I am aware oi an0 unGer5�an01M1e rcquirements ol Califomia Heali� anA Saleiy CoUe $ection515505, 25 3� 2553d ana Inat I oi any lulure euileing octupanl willlwill not (circle one) neeA to comDly wilA saia state ca0e5 and ine lepuiremen�s for a permil br conslmclion or motlilica�ion Imm the Fu Oualiiy Managemenl OiSVici. flevden�ial cons�mclion apD��ions are exempl lmm tnese provisions. Oa�e: ApPlicanL I �¢reGy certily IAat I �ave reatl Nis aOV��alion antl slal¢ Ihai I�e above infarmaiion i5 rorrec�. I agree Io campty with all ciiy anE coun�y ortlmanc6 ane slale laws ielating to GuilOing constmction antl hereW autharRe reD�euniatives of INs tity ta enler upon ttre abOve�mentianetl pfOp2�IY �0� itISpCLiiOfl p�lpO5C5. � � �lJ' �f ��- �–+8� "=�i � "'(— oa�c: _ sia�awe Orivei's L¢ense or Social Searity �: '•, t W Id6 Whilo—Bwltling: G�een—�a EnlorcamenL Canary—Applica^t: Pink—Revenue: GoltlenroC—Rssessor\ CITY OF COSTA MESA - BUILDING PEAMIT PERM NO: E 06929 PERMIT NO: E 064297 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: 5-N PERMIT TYPE: ELE PURPOSE: OTH JOB DESCRIPTION : UPGRADE ELECTAICAL PANEL SQ FT: CLAIM VALUE: CALC-VALUE; GROUP OCC: R-3 / COMMENTS: UOGRADED PANEL TO BE BELOW 600 V BELOW 201 AMP. *�e�r�e*�e*�x�x�rr+r+r�r�t«*�r�rr�r�r****rr**x�**�r�r*�r+t+r*�r�r**x�x��r�rir�r**ri�*****x�x�**�-*�r***�**r+t*+��* Z O N I N GS ERTEBQAUCIKRSE M E N T S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDZNG --------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGfiT: FT IN PARKING REQ: PROV: PARCEL: 11734128 ZNE: REF NO; PLANNZNG NOTES> > • �r�**ir�r�rit*�**�r**+�+t+tit�ir*�r�r+t**xir*itir*ir*+t*+r*��r�*+titirx��r��r�rr*r+r***+rx ��r+r+�irx�********** D E V E L O P M E N T S-�E R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY -' - DATE: HUILDING APPROVED BY ; " DATE: APPLICATION ISSUED BY; -'�y` DATE: fl 13 iflEiflfMMlkifiEik7tiEiFifififllititifkih MifiEltifilMifltK iiif 1f i! iE 1f if !k if 1F 1E if if 1E ik if fE %1E it 1f if 1F 1f �E ff 1t �F M �f if 1t if 1E ff 4 if k fE if iE k k iF fF k iF it if 1f k M!E k!E M IE 1f 1f IE if if it fF 1f if 1f M M if 1F iF �F ii if iE iE iE 1F if 1E LEGALIZATION;N F E E S U M M A A Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT PLAN ISSUE FEE HUILDING-DZV-> PERMIT TOTALS----> 18.50 18.50 5�3 15.00 ISSUE PLAN-CHECK 15.00 0.00 SMIP/NON-RES TOTAL PAID DUE 33.50 33.50 .00 REVENUE DIVISION TOTALS--> COLLECTED; 33.50 OVER/SHORT; .00 HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK 33,50 ififkififlfifiFiFlflFkkifiEifffklfMif7fititlflFififitiliklfllilffMlfklfkitiEMffKlfitiEiFMMfEikifiklfififlflfMlEkMlfikltlfklEffifiElEif1E�liffE I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST rELE 1 SEAVICES BELOW 600 V& BELOW 201 AMP 1$.50 18.50 END OF FEES O1 0014&243-00148243 TiC1T DATE� 10/D4/93 TIME: 13:45 I 33.50 I �,,_ ,, :ONSTRUCTION AND PLANNING APPROVALS Permit 4`k 7. Temporary Eleccrical Service or Pole 2. Soil Pipe-Undrgrnd. 3: Electricai Conduit Ulility�Undrgrnd. 4.:E�ectriwl Conduit-Undrgrnd. 5. Steel Reinforcement s• FJectricai UfER Grnd. "7: footings - 8. Foundation 9. Water Pipe-Undrgrnd. 70. Structural Floor System i i. Property Sewer Line & House Connection 72. Sewer Cap 13. Roof Oroins 14. Rough Plumbing 15. Rough Eloctrical•Conduit 16. Rough Electric Wiring 17. Rough Wiring Siyn 18. Rough Electrica�-T Bar Ceiling 79. Rough Heating & A�r Cond(uoning 20. flough Factory Fireplace � 27. Ducts,in Structure . 22. Ducts, Ventilating � 23. Gas Pipe�Rough &'Yest 24. floof Framinq 25. Roof Sheathing ' ' 26. T-Bar Ceilin9 (Structural) & Monocoat 27. Frame and Flashing 28. Lathing & Siding , � ^ 29. insulation �� . �' �� •. 30. Drywall Nailing 37. Plaster Brown Coat . 32. Electrital Power Meter�Final 33. Final ElectriC. � 34. Final Heating"& Air Conditioning:� � 35. Final Gas Pipe-Test ,36. Hood or Canopy ' - .. 37. Final�Factory Fireplace . � ' • 38. Final Plumbing � 39. bVater Service•Fina1 � 40. Gas Service�Final - 41. Soiar pomestic-Final 42. Sackflow Preventer 43. Backflow Irriyation � • 44. Landscape Irripation System 45. Sound Attenuation� � . 46. Handiwp Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL P�ANNING 49.-Electric Release to Edison 50. Gas Release to Southern California Gas Cc 51. CERTIFICATE OF OCCUPANCY Dace POG SPA Data Inspector qPpROVALS Permit# Oa2e 52. Pooi & Equipment �ocation 53. Steei Reinforcement 54. Forms 55. Electrical Bonding 56. Rough Plumbing & Pressure Test 57. APPROVAL TO COVER•GUNITE 58. Electrical Conduit�Undrgrnd. . 59. Gas Pipe, � Undrgrnd.. Test 60. Backwash Lines, P-7rap, O Undrgrnd. 67. APPROVALTODECK � 62. Backwash & Receptor-Final - 63. Heater & VenbFinal - 64. Plumbing SYstem - Final • 65. Electrical-Final 66. Solar SVstem�Final � 1 67. Fencing & Access ApProval ' 68. APPROVED FOR PLASTERING , 69. POOL/SPA SYSTEMS FINA� FIRE DEPT. REQUIREMENT ' ' � APPROVAtS Permit -"�r � ' 70. Underground Hydro � - � ' '71. Product�Piping QGas �Oil . 72. Underground Flush ' -73. Undergrnd.StorageTank OGas ❑Oil • �74.-Overhead Hydro 75. Dry Chemical 76. Dry Standpipe � • �� - 77. FIXED SYSTEM�FINAL - ' 78. FIRE PREV. FINAL � � - HEALTH DEPT. REQUIREMENT . ` _79. FINAL IN$PECTION ^� �� 80. FOOD CERTIFICATE ISSUED � Q�l Notes: � , ' 0 . :� Inspector s � � �� 243�9 C�STA MESA BUILDING-SAFEfY DEPARTMENT V.O. 60Z 8f7 C08TA MBBA� CALIPONNIA For Applicant to Ftll In Completely TYPE OR PRINT ILDINQ /i /� /�' �p�Gx DRESS i�'(O /-i / /� _ COSTA MESA, CALIFORNIA CITY OF C�STA NiESA JUN 29 1965 APPLICATION FOR PERMR 3 PIRB �(pZ ZONI 68TBACK LINB PNOM � ' c8rvT6R oF eineai D RHAR YARD I i�� I r �. 81DH YARO LERT RIQHT –� DESCRIPTION OF WORK I XHRBBY ACKNOWLHD� •ND 8TAT8 TH�T TM¢r PLY WITH /�LL CITY BUILOINO CONBTRO 516NATURE OF PERMITTfi � AUTHORIZED AOENT �NO.OP � ROOM6 , ROOF L60� NOTH: NOEAVE YARDS MPROV ED MAIN BUILDING VAR. SC ZONINCi U860PN[W � BUILOINO � � �.�� rR /ls�� T-�- � �NO SHALL BH LH88 THAN (U.B.C.RBQUIRHMHNTI \ VARDBAPPROVED � ACCfi690RY BIIILDINO �. I Y'f. �� Rr. BET. MAIN Q ACCE85. BLI DATE / � 8 . PT. � 1 XAVe qBAD THIB PPLIWiION TM6 AMOUNT 9XOWN UNOeP VALU�TION IB FOR TNe = � CORRHCT AND [[ TO COM- PYflPo9H OP 88TAOL19MIN0 A PEflMIT P88 ONLY. p a �Ho TwT[ n[6uuiiHa ypLUAT10N �O n PERMITFEB Y �� 0 , $ �3gi = z ; 6� ` TOTRL FEE ��