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Home My WebLink About490 19TH ST - Building Permits(714) 754-5273 • Fex (714) 7541856 • www.Ci.Costa-me58.Ca.us 77 FAIR DRNE, GO51 A MtSA, GA 926Lti BUILDING PERMIT Job Address: 490 E 19TH ST Suite: Viciniry: RESIDENCE ONLY Parcel Number: 42632112 Applicant: WILSON, BOB Address: 485 E 18TH S7 COSTA MESA, CA - , Owner. COX, BRIAN J � Address 490 E 19TH ST ' . COSTA MESA, CA Conuacror: BI WILSON AND SONS Address: 485 E 18TH ST WSTA MESA, CA Zip: 92627 Arch : Address: Phone: Zoning: � � Phone: (949) 64G1740 Zlp: 92627 Phone: Zip: 92627-2314 Phone: (949) 6461740 , License: 377487 ,, Eng: Address: Status: ISSUED Applied: OS/16/2002 Issued: O6I12/2002 ISSUED BY: Phone: Zip: License: License: SCOPE OF PERMIT REROOF RESIDENCE ONLY: REROOF EXISTING RESIDENCE NOT COVERED BY ROOM ADDITION (802-00682). 22 S�UARES. COVER WITH COMP SHINGLES. Plan Check: Permit SMIP Res: SMIP Com: Other. Inspection: Total: $0.00 $11125 $0.50 $0.00 $0.00 $0.00 $111.75 SETBACKS MAINSTRUCTURE Front 0-0 ACCESSORY Fmnt 0-0 PARKING Existinq: 0 NOTES: Rear 0-0 Rear 0- 0 Re uired: 0 FEE SUMMARY PLANNING & ZONING Left 0- 0 Left 0. 0 ' Proposed: 0 Calc Valuation: Claim Valuation: Righl 0• 0 Right 0-�0 � � ss,000.00 as,000.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days, or if work is suspended or abandoned for a period ot 180 days. INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must compry with ali applicable codes, and all requlred inepeetlons and final epprovel must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. 'i FOR INSPECTIONS CALL: (714) 7545626 , - 2618d8 (8�W) WORKERS' COMPENSATION DECLAFiq710N: I hereby ettirtn ander penelty of perJury me of the following tleUeretions: ❑ I heve enq will meintein e certificate ot wnsent to self•Insure for workers' compensation, as provitled for by section 3700 0l Ihe Lebor Code, for ihe pertormance of Ihe work for w�ich this permi� is IssueC.� ��eve entl wlll maintalny+orkers' com n�atlon Insurance, as requiretl by section 3700 of ihe Lebor Cade, tw ihe peAoimance ol the work for which Ihls pertnit is issuetl. � My workers' compenseperuryfurenc rtler e�Ql pqlicy number are: Cerrier: (Thls settlon orless.) Policy Number: ❑ I certity t�et in the peAortnance of the or br which this permii is issuad, I shall no1 amploy any person in any manner so es to become suDject ro the woAcers' compensetlon laws of Celifomla, e� e e that if I should become sub�ect to Ihe workers' compensetion proNsions of Sectiqqqnnn 3700 of Ihe Lebor Cotle, I shall tort�with compty with Ihesa prodslons. , / �/ I�� Ap0licam SlgneWra: ��.-!� �� Date: �� WARNIN(3: FAILUf� 7p SEWRE WORI(ERS' COIAPENSATION COVEMGE IS UMAWRIL AND SHALL SUBIECT AN EMPLOVER TO CRIAVNAL PENALTIE AND qNL FlNES UP TO dJE NLINDREO THOUSrW D DOLLAqE (5700,000), IN ADDIiION TO THE 0.'LSi OF W/dPEN5A710N, DAM4GESAS PFOVIOEDiOR W SECTION 37CB OF TME LABOR CODE, IMEHEST, AND ATTORNET"9 FEES. UCENSED CONTpACTORS DECLARATION: 1 hereDy ettirtn chat I em Ilcensetl untler provisions at Chapter 9(commendng with Section 7000) of D'Mslan 3 of the Business antl Professions Catle, antl my license Is In tull 10rce Bntl Btted. LIC. M Cless N—/— Contrectors Signeture: � Oate: l / 1 1 CONSTpUCTON LENDING AGENCY: � ❑ I hereby ekirtn ihat t�era Is e consiruMion lentling e8ency for ihe peAortnance of lhe work tor which this pertnit is issued. (Sec. 3097, Civil Codej. LendefsNeme: . ___ __ Lentler'sAaAress: SigneWre: OWNER-BUILDER DECLARATONS: Oele: I �ereby afflrtn Ihat under penelry of per�ury thet I em EXEMPT FROM THE CONTitACT08S LICENSE LAW for Ihe following reason (Sec. 7031.5, Buslness anA Professlons Cotle: Any ciry qr counry w�ich requlres a pertnic to construct, elter, improve, demolish, or repair eny structure, prior to its issuenca, elso requires Ihe appliwnt far such permit to flle e signed 8letemem thet ha or she I5 Ilcensed pursuflnt to Ue provisions oi tha Contractors License Lew (Chepter 9(commenGng wllh Section 7000) of Dldsion 3 of Ihe Businoss entl Professlons Code) or Ihet �e or she is exempt therefrom end the basis for iha ellepetl examptlan. Any violdtlon of Sedlon 7037.5 by eny eppibent for e pertnit subjecis t�e epplicent to e civil penelry ot not more than tNe �undred dallers ($500).): ❑ I, es owner at the properry, or my employees wlih weges es thelr sole wmpensatlon, WILL DO 7HE WORK, and the structure is not Intentled or oflered for sale (Sec. 7044, Buslness and Professions Catle: The Contredors License Law tices not appy to an owner of pwperry who builds or imprmes theraon, entl who does such work himseN or herself or Ihrough his or her own employees, provitletl that such improvemenis are not imenaed or oHered (ar sale. It, �owever, tha building or impmvement is soltl within ona year oi completion, the ownor-huilder will have �he burden ol proWng that �e or she did not build or Improve for purpose of sele.). ❑ I, es ownar ol the proPorty, em E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS lo conslruct Ihe prolect (Sec. 7044, Business entl Prolessions Code: The contrectors License Lew Coes not epply ta en owner ot propeny who builds or impmves therean, en0 who comrects tor suc� pro�ect with e contrector(s) Ilcense pursuent to t�e Comrectors llcense LawsJ. 0 I em ezempt under sec. Busineu end Professions Cotle for Ihis reason: Signature: Date: Owner ID verilied Dy tlrivefs license. ❑ Ves ❑ No DriveYs License No. Verificetlon ol Qwnership by (rype oi dacumenL i.e. - property tax blll or deed): DIVISION OF INDUSTRIAL SAFEN VERMIT CERTIFICA710N: E:plres: ❑ I hereby c9rtity Ihat no excavation flve (5) or more tee� in depih into which a person is required to descend, will �e made in connectlon wllh work aulhorizeG Cy Ihis pertni4 entl that no building 5truc[ure, scaflolding, falsework, or demdition or tlismantiing thereol, will be more than thirty-six (36) feet �ig�. (Chap. 32, Grp 2, ArI 2, Sec. 341. TIOe 8. CalilanW AtlministralJv9 CoOe). ❑ As owner-builtler, I wlll not employ enyone �o do work which woultl raquire a permii Iran Ihe Division at Industriel Safery, es notetl ebove, unless such person �as e permit to qo such work from the CM51on. SignaNre: Date: Division o1 InduStrial Safery Pertnit Number: CEH7IFlCATE OF COMPLIANCE ANU AVTMOHVATON OF ENTAY: I ceRily under penalry ot perjury �hel I have reed Uis epplication and state thet the infortnetion gWen is correct I agree to rnmply wlth all state laws and ciry a0lnances relating to bullCing constmction, entl euthodze representetives uf the Ciry ol Costa Mese ta enter u0on 1he above-describetl property tor InspecGon Ourposes. I egree nat to acupy or allow acupancy ot eny building euthorized by Ihis pertnit until final inspection. SlgnaNre O� Legal Own (s) ( � /� aj@ ��—�— /,�� l� c� �. AnNOr Autlwrized ApPlicant ---�—� Date COUE �. IxSPECTONivVE 1616 Fixetl $ysiem Final Fire Prevenilon 1286 200 201 202 203 Pod Spa Finel Finel Rg-Raol Final 91ock/Retalning Well Final Fectary Fire Place Finel $Ign 204 Final4emollllon eeiE II�� I/�� % ..' / COOE� INSPECfIONTYPE 206 Final Mechanical 20B Finel Plumbing 210 Pinel Electrical 212 Finel Fire Preventlon 220 Final Plenning Approval 222 Final Site 250 FinalBuilding/Occupency � I�� !" -' (71a) �5a-52�3 • Fax (»a) �sa-4856 • www.ci.costa•mesa.ea.us n rnm vnrve, cw i� mcaM, �r acoco Job Address: Suile No Vicinity: Parcel Nunmber: �I 490 E 19TH ST 42632112 Applicant: WILSON, BOB Address: Owner. �' � COX; BRIAN J Address 490 E 19TH ST - � COSTA MESA, CA Contractor: BI WILSON AND SONS Address: 485 E 78TH ST ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool / Spa Lighting Fixts . Recept OuUets Swilches Non Res Appl Res Appl Service to 200a . Service to t000a Service over 1000a Motors l0 1 hp Motors to 10hp Motors to SOhp Motors to 100hp Motors over t00hp Communica6on drops Sub panel to 200a Pole Light Pkg Sign CircuiLs Temp Pwr Pole Intertned Pole COSTA MESA, CA ELECTRICAL PERMIT Phone: Zip: Phone: Zip: 92627-23'14 �Phone: (949)646-1740 Zip: 92627 License: 377487 Status: ISSUED Applied: O6I12I2002 Issued: 06/12/2002 SCOPE OF PERMIT CONSTRUCT A 495 SF MASTER BEDROOM/BATH AND LAUNDRY ROOM AT THE REAR OF AN EXISTING SINGLE-STORY SFD. ALl SINGLE-STORY WORK. REF: B02-00682. ELECTRICAL TO INCLUDE: 10 LIGHT FIXTURES, 24 OUTLETS, 12 SWITCHES, 1 SERVICE TO 200 AMPS. $23.50 $0.00 $0.00 $0.00 $0.00 50.00 $11.00 $24.92 51320 50.00 50.00 $30.50 $0.00 50.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 ao.00 30.00 $0.00 �uantity 0 0 0 10 24 12 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 FEE SUMMARY Temp Disl System / Lighting Busway /100 R Standing Section Misc Electrical Equipment Transformers up to 1 kva/kw ................up to 10 kva/kw .................up to 50.kva/kw� : � .................up to 100 kva/kw ..................over 100 kvalkw Low Voltage Equipment Low VOIt Wiring Sys[em / Ckl Misc. Conduit Misa Conductor Circus ( gen or ride) Circus (mech ride or lights) " Christmas Tree Stand Fireworks Stand Other Electrical Fee �nvestigatlon Fee Plan Check Fee Reinspection Fee Quantity $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 50.00 0 50.00 0 $0.00 0 $0.00 0 50.00 , 0 $0.00 0 $0.00 0 $0.00 0 so.00 $0.00 $0.00 $0.00 TOTAL CALCULATED FEES $103.12 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitomia statutes and related regulations. (Ord. No. 92-28, § 7, 1241-92) EXPIRATION: This pertnit 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 Ihe work authorized under this permit to be considered lagal, such work must comply with all applicable codes, and all required inspeetlone and flnal epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 zaae�ae �aroo� WORKERS'COMPENSATON OECLARAnON: � I hereby eMirm under penetly of perjury ona of the tolbwing dacleretians: ❑ I hev nd wlll meintaln e certificate of consent to sell-Insure br workers' compensatlon, es proNCed for by sectlon 3700 0l tha Lebor Code, tor the pedormance of the w tor which t�is permit Is issuetl. ^ ve end will maintajry workers' compensatlon�nsurence�s required by sectlrn 3700 ot the LaDor Cotle, for tha perfortnflnce of the work br which this permit is Issued. My workers' compen�etlon InsuraRce cerrler tl pplicy rt8er ere: Carrier. (lhls se efOne Policy Number. � I certify Ihet in the peAprmance of Ihe work for � Ihis pertnil is issued, I sAall not empby eny per5pn in any manne� so as !o becane subject to the workers' compensatlon laws o1 Celitomia, end agree Ihe 1 should becwne sub�ect to Ue workers' compensetion provlslons o1 Section 3700 of Wbor C e, I shell foMwiN complywiih these proVisions. 9 /�J � �� I � l` � Applicam Signeture: �-.-� �i/i�C.G��rati Data: U WAPNIN(i: FAILURE TO SECUqE WORKERS COMPENSATIIXJ COVERAGE IS UNLAW FUL M1D SNALL SU9IECT Ml EMGLOYEF TO CRIMINAL PENALTIES AN CM� FlN UP TOONE HUNORED THOUSAND DOLLARE (5100,OOq), IN ADDRION TO THE COSi OF COMPENSATION, DMN�ES 0.5 PROVIDED FOR IN SEGTON 3NB OF THE IABOR OODE, INfEREST, AND ATfOqNEV u FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirtn thel I em Iicensed untler provisions oi Chapter e(wmmencing wllh Section 7000) of Division 3 ot t�e Business entl Prolessions Cotle, end my license Is in full lorce entl eMecL Lic. a Class q Contractofs Signatwa: Date: 2 � �� CONSTRUCTION LENDtNG AGEMCY: � ❑ I hereby aHirm Ihat th9re is e wnslruIXion Iending egency lor the pertormance oi the work for which Ihis permit is Issuetl. (Sec. 3097, Civil Code). Lentler's Name: Lenders AdOress: Signeture: Date: OWNER•BUILDER DECLApATONS: I hereby ettlrtn Ihet under p9nalry ot perjury thet I em EXEMPT FROM THE CONTFiACTORS LICENSE LAW for ihe tollowing reason (Sec. 7031.5, Business end Professions Code: My ciry or counry which repuires a permit lo canstruct, elter, improva, demolish, or reDair any structure, O�a<<o Its luvance, also requires the applicant tor such pertnit to file e slgneO statemem �het he or she is licensed pursuam lo Ihe pmvisions of Ne CoNractors License lew (Chapter 9(wmmendng wit� Section 7000) of Divlsion 3 af the Businoss antl Professions Coda) or Ihat he or sha is exempt therefrom end ihe Oasis for tha elleged exemptlon. Arry Noletlon at Sectlan 7031.5 6y any applicant far e pertnil sub�ecls I�e epplicent to e c{vil penalry of not more than Ilve hunEreO Collers ($500).): ❑ I, es owner of t�e D�oPeny, or my employees wit� weges es their sole compensetlon, WILL DO 7ME WORK, and the s�ructure Is not Intentletl or otteretl for sale (Sec. 7044, Businew entl Professions Cotle: The Conirectors License Lew does not flpply to an owner of property who builtls or Improves ihereon, and who does such work himsel! or herself or through his ar her own employees, pmvitleC ihet such improvements ere not fntendeC or oHeretl lor sale. If, however, the building or improvement Is sold wilhin one yeer of comple�ion, ihe owner-bullder wlll �evo t�e burden of proving ihat he or she tlitl not 6uiltl or Improve lor Ourpose of sale.). ❑ I, es owner ol the properry, em EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to consiruct the D�oject (Sec. 7044, Business end Professions CoOe: 7he mmrectors License Lew tloes not epply to an owner of propeny who builds or Improves thereon, entl w�o cantrects tor such pro�ect with e wntrector(s) license pursuent to th4 Contrecmrs License Lews.). ❑ I am exempt untler seC, Business en0 Professions Cade for this reason: Signeture: Dete: Owner ID varlfleG by drivers Ilcense. ❑ Ves ❑ No Dnvers License No. Expires: Verillcation oi Ownership Dy (type ot dacument, i.e. - property lex blll or tlee0): DIVISION OF INDUS7RIAL SAFETY PERMR CERTIFICATION: ❑ I hereby certlty Na� no excevetion Me (5) or more feet In Oept� into which a person is requiretl to Gescenq wlll �e mede in connection with wwk euthoAzed by Ihis permit, ertd that rro building shucture, scaHWdirig, talsework, o� tlemWition or dismaniling thereof, will pe rtrore than thirty-six (38) }eet hgh. (Chap. 32, Carp 2, Art 2, Sec. 341, lltle 8, Califamia Adminisirative Cotle). ❑ As ownervbuildar, I will not employ enyone to tlo work which woultl require e permit fmm Ne Division o1 Intlustriel Setary, es noted above, unless such person hes a pertnit Io do such work trom the dlvlsion. Signatura: Date: Divislon of Industnal Safery Permit Number: CERTIFlCATE OF COMPLIANCE AND AUfHORVJ1T10N OF EMRY: I certify under penalty of perjury ihat I have reatl this eppficalion antl state Ihat the information given is correct. I agree to compy with ell stete laws end city ordinences relating to building construction, end authodza represematives of the Ciry of Costa Mese ro enter upon the ebova-describetl property for inspection puryoses. I egree not to accupy or ellow oxupancy of any building euthorizetl by Ihis permit until final inspection. � SignaWre Of Le/el wnar(s) ( „ � ^ ?t9� �\ � �o-G. �� ,.,�✓ � � / ) And/Or Authodzed ADPlicent ��- COUE �. INSPEC110NTYPE Qdg, UIIIDALS 1616 Fixed System Final Fire Preventlon 1268 Pool SOe Final 200 Final RaAoof 201 FInaI BIocWRelaining Wall 202 Finel Factory Fire Place 203 Finel Sign 204 Final Demolition COOE I INSFECTION TYPE 206 Finel Mechenical 208 210 212 no Finel Plumbing Final Eleclrlcal Flnal Fire Prevention Final Planning Apprwal 222 FInalSite 250 Finel BuilCing/Oaupency � I�� T (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ce.us 77 FAIF DRIVE, GOSTA MESA, Gn 92s2s Job Address: 490 E 19TH ST Suite No .Vicinity: Parcel Nunmber: 42632112 Applicant WILSON, BOB , Address: � ' Owner. COX, BRIAN'J Address 490 E {9TH ST " COSTA MESA, CA Contractor: BI WILSON AND SONS Address: 485 E 18TH ST Arch / Eng : Address: COSTA MESA, CA PLUMBING PERMIT Phone: Zip: Phone: Zip: 92627-2314 Phone: (949)646-1740 Zip: 92627 License: 377487 Phone: Zip: License: � �" ISSUED BY: Status: ISSUED Applied: 06/12/2002 Issued: O6I12/2002 SCOPE OF PERMIT CONSTRUCT A 495 SF MASTER BEDROOM/BATH AND LAUNDRY ROOM AT THE REAR OF AN EXISTING SINGLE-STORY SFD. ALL SINGLE-STORY WORK. REF: B02-00682. PLUMBING TO INCLUDE: 1 BATHTUB, 1 GAS (1-4 OUTLETS), 1 LAUNDRY TUBNJASHER, 1 SHOWER, 1 WASH BASIN SET, 1 TOILET, t WATER HEATER. - � , , . ISSUE FEE Backflow irrigation Backflow Preventer Bathtub Clarifier System Connect (Ice,Soda,etc) Dental UniLs Dishwasher Drain, Floor Drain, Rainwaler Drain, Roof Drinking Fountain Expansion Tank Gas Earthquake Valve Gas (1-0 outlets) Gas (Over 4 outlets) Gas Repipe Gas Service Interceptors (Grease, Oip Interceptors (Sand Auto ) AMT 523.50 so.00 $0.00 39.80 $0.00 $0.00 $0.00 $0.00 50.00 50.00 50.00 50.00 $0.00 $0.00 $6.15 $0.00 50.00 $0.00 $0.00 $0.00 QiY 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 FEE SUMMARY AMT Laundry Tub / Washer $9.80 Landscape Irrigation $0.00 P-Trap $0.00 Pressure Regulator 50.00 Process Piping (per 10 fl) 50.00 Receptors $0.00 Septic Tank - 30.00 Sewer Cap for Demo 50.00 Sewer Connect 80.00 Sewer Private Line ' � 50.00 Shower $9.80 Sink, bar $0.00 Sink, commercial $0.00 Sink, Floor � $0.00 Sink, kitchen $0.00 Sink, service/mop $0.00 Spa (private) $0.00 Spa (public) $0.00 QTY 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 SumpPump Swimming Poal Trap Primer Urinal Vacuum Brkr BkFlow(1-4) Vacuum Brkr BkFlow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (Toilet) Water Healer I vent Water Piping (Inst or Rep.) Water Re-pipe Waler Service Water Softener OTHER VIOLATION PLAN CHECK REINSPECTION AMT $0.00 50.00 S0.00 $0.00 $0.00 $0.00 $9.80 $0.00 $0.00 $9.80 $12.30 $0.00 $0.00 $0.00 $0.00 $0.00 so.00 $0.00 $O.OD TOTAL CALCULATED FEES: E90.95 QTY 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 NOTICE: The work authorized by ihis permit s�ppp��p�e Q�tj�p� requiremenis under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This pertnit shali automatically explre and become vold if work is not commenced within 180 days, or if work is suspended or ebandoned for a period of 780 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 Inepectione end final epproval must be obtained. Fallure to obtain inspections and final approval will result in iha ezpiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 . 2u6se(bml WORKERS'COMPENSATON DECLARAnON: ' I hereby attirm under penelry of perjury ane ol the lollowinp dedaretions: 0 I heve end wlll maintain e certifkate ot con5eni lo sell-Insure far workers' compensetlon, es D�detl for by secllon 3700 of ihe Lebor Code, tor tha peAortnance o1 the wo tor whiCh IMs pertnit is Issued. . . � ave an0 will mainiain workers' compensatlon insurenca, as require hy section 3700 of Ne Lebor Code, for ihe peAortnarica oi Ihe work lor wh4h this pertnit is issued. My workers' compensation Insurance carder en number � Certier: Policy Number: (This sec8on need not be crompleted!! the permiNs va/ueO et one hun ollars ($100) or less.) ❑ I ce�ify Ihet in Ihe pertortnance of the work tor wNch t�is permit is i ued, I shall not employ eny person in any manner sa es ta become su6�ect to the workers' compensatlon laws ol Celifomla, antl epree t�at tl I shaultl become b�ect to the workers' compensatlon proNslons W Section 37/pp 0l theLL��oo r Catle, I shall tort�wit� comply with �hese Drovisions�._0��/ � �/ /.�/ / O� Appllcan� Signeture: i i � Date: �— � WMNIN(3: FNLURE TO SECURE WORKE0.5' COMPENSATION COVERAf3E IS UNUW FUL M10 $HMl SUBJECf Ml EMP�OYER TO CRIMINAL PENA[TES MID CML FlNES UP Rl ONE HUNORED THOUSAND DOl1AR8 (5100,000),IN AODfTION TO THE WST OF COMPENSATION, DAM14IGES AS PROVIDED FOR IN SEGTION 31050F THE LABOR WOE, IMEREST, M!D ATTORNEYS FEES. LICENSED CONTAACTORS DECLARATION: I hereby eHirtn Ihat I am licensed under provisions ol Chapter 9(commencing wiih Secllon 7000) ot DlNsion 3 oi the Buslness and Protessions Code, and my license Is in full torce end ettect. LIC. a Class A Contrectofs SlgnetUre: Date: CONS7RUC710N LENDING AGENCY: � ❑ I hereby aHirm Ihat there is a consiructlon lending egency for Ihe peAormance ot the work lor w�ich this pertnil is issuetl. (Sec. 3097, Civil Cotle). LBnCels Name: Lenders Address: Signeture: Date: OWNER-BUILDER DECLARAitONS: I �ereby effirm that untler penalry of per�ury Ihet I em E%EMPT FROM THE CONTRACTORS UCENSE LAW for tha fdlowing reason (Sec. )031.5, Business and Professions COCe: My Gry or cbunry which requires e permit to construct, elter, improve, demolish, or repair eny structure, pnor to its issuence, also requlres the epplicant lor such permil to file e slpneC stetgment that he or s�e is Ilcensed purauant to Ne provislons oi Ihe Contrectors LJcense Lew (Chapter 9(commencing wlih Sectlon 7000) of Dlvision 3 ai Ne Business entl Professions Code) or tha� he or sha Is exempt thereirom end tha basis lar I�e allegetl exemption. My Wdatbn of SecUon 7031.5 Dy eny applican� tor a pertnit sub�ects Ihe eppllcant to a civil penalty oi not more than flve huntlretl Oollars ($500).): ❑ I, es owner oi ihe property, or my employees with weges es their sole compensation, WILL DO THE WORK, end the structure Is not intentletl or otfered for sale (Sec. 7044, Businegs antl Professions Cotle: The Coniractors License Law does not apO�Y �o an owner of property who builds or improves ihereon, end who does such work hlmselt or herseN or ihmugh his or her own employees, provided thet such improvements ere not Intended or oHered lor sale. H, hawever, the building or improvement is sold within one year of completion, ihe owner-buifder witi heve tha borden ot proNng that he or she did no1 build or improve for puryosa o( sale.j. ❑ I, es owner oi the property, em EXCLUSNELV CONTHACTING WI7H LICENSED COMAAC70RS to wnsiruct the project (Sec. 7044, Business antl Professions Catle: The contrecbrs License Lew Coes not epply to an owner oi property who bullds or Improves thereon, and who contrects lor such project with a contractar(s) license pursuBnt to ihe Contradors Licensa Lews.). ❑ I em exempt under sec. Business and Profossions Cotle lar this reason: Signature: Date: Owner ID veritied by tlrivers license. � Ves ❑ No Drivefs LicenSe No. Verificatlon ot Ownership by (type o1 dacument, i.e. - proparty tex Dill or deed): DIYISION OF INDUSTRIAL SAFETY PERMR CER7IFIGATION: Expires: ❑ 1 hereby certify that no excavation five (5) or more teet in depth into which e person is required to descend, will be matle in connection wit� work euthonzed by ihis permit, end thet no building structure, scaMoldinq, telsework, or demolition or dismaniling Ihereof, will be more than Ihirry-sia (38) leet high. (Chep, 3.2, Grp 2, Art 2, Sec. 341, 71t1e B, Calilornia Adminisiretive Cotle), � ❑ As owner•bulltler, I will not em0loy enyone to do work which would require e permil Irom Ihe Division ot Intlustriel Sefety, es noted ebove, unless such person hes e pertnit to do such work trom ihe division. Signeture: Date: Division of Intlustrial Safery Pertnit Number: CERTiFlCATE OF COMPLIANCE AND AURIORVATON OF EMHY: I ceM1ily under penelry ol perjury that I have read this application en0 siate that tha information given Is correct. I agree ro comply with all siete laws antl ciry ordinances relatlng to builtling conswction, and authorize representatNes ot the Clry of Costa Mesa to enter upon the ebovetlescribeA Properry tor inspection purposes. I egree not to occupy or allow ocwpanty ol eny building authonzed by this pertnit un�il tinel inspection. ��netur jtL el ner(s), r n I� i�5��9� ��n� tY r � lJ And/OrAuthodzed Applicent Date cooe �, msvecnoN� pAIE 1tIIIDSLS 1676 Fi:ed System Final Fire Prevention 1266 200 201 Pool Spe Kinel Finel Re�qooi Flnal BIocWRetaining Well 202 Final Fectory Fire Place � Finel Sign 200 Final Demolition COOE� INSVECTIONTYPE 206 Final Mechanicel 208 Finel Plum6ing 210 Final Eledrical 212 Finel Fire Preventlon 220 Final Planning Approval 222 Final Site 250 Final Building/Occupency (714) 754•5273 • Fax (714) 7544856 •�wiw.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 490 E 19TH ST Suite No Vicinity: Parcel Number: 42632112 Applicant: WILSON, BOB " , Address: Owner: COX, BRIAN J Address: 490 E 19TH ST �� COSTA MESA, CA Contrecror: BI WILSON AND SONS Address: 485 E 18TH S7 ,COSTA MESA, CA MECHANICAL PERMIT Phone: Zip: Phone: Zip: 92627-2314 Phone: (949) 646-1740 Zip: 92627 License: 377487 ISSUED BY: Status: ISSUED Applied: O6/12/2002 Issued: 06/12/2002 SCOPE OF PERMIT CONSTRUCT A 495 SF MASTER BEDROOMIBATH AND LAUNDRY ROOM AT THE REAR OF AN EXISTING SINGLE-STORY SFD.�ALI SINGLE-STORY WORK. REF: B02-00682. MECHANICAL TO INCLUDE: 7 VENT FAN TO A SINGLE DUCT. � � ISSUE FEE Inst FAU <700 k BTU Inst FAU >100 k BTU Repair / Alt Cooling/Heat Inst / Rep. Recess Wall HU Refrig Sys <700 k BTU Refrig Sys >100 k BTU Gas Piping , Factory Fireplace Hood w/Mech Exhaust VAV Box Vent Fan / Single Ducl Appliance _ Fire Dampers Smoke Dampers Inst or Relocate Appl Vent Air Handlers < 10000dm Air Handlers > 10000cfm Floor Furnace Floor or Suspend Heater Quantity $23.50 $0.00 0 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 $7.25 1 $0.00 0 $0.00 0 $0.00 0 $0.00 0 30.00 0 50.00 0 $0.00 0 30.00 0 FEE SUMMARY Repair / All Absorbtion Unit Repair I Alt Re(rigeration Unit Ventillation System Evaporative Cooler Commercial I ncinerator DomesUc Incinerator Compressors / Absorption Svstems Up to 3 hp /.100 k BTU 3 To 15 hp / SOO k BTU _ 15 To 30 hp I 1,000 k BTU 30 To 50 hp / 1,750 k BTU Over 50 hp / Over 1,750 BTU Boilers Upto3hp 3To15hp 15to30hp 30 to 50 hp.' . Over 50 hp Other Mechanical Fee - " Invesfigation Fee � � Plan Check Fee - Reinspection Fee TOTAL CALCULATED FEES COMMENTS / SPECIAL CONDITIONS Duantity $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 50.00 0 $0.00 0 $0.00 $0.00 $0.00 530.75 NOTICE: The work authorized by this pertnit shall comply with all applicable handicap access requirements under California statutes and related regulations. (O�d. No. 92-28, § 1, 1241-92) EXPIRATION: This permit shall eNomatically expire and become void it work is not commenced within 180 days, or if work is suspended or abandoned lor a period of 7 BO days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inapaetlone end final epprovel must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 . �rvaoro law� WORKERS'COMPENSAnON DECIARAnON: I hereDy aflirm untler penalry oi per�ury one of Iha tollowing CeUaraUons: ❑ I heve end will melntaln a cehifcate of conseni to self-Insure lor workers' crompensation, es proNded lor by section 3700 of the Labor Cotle, tor the pertarmance ol the wo for which Ihis permli is Igsuetl. . ve end will ma(nteln workets' compensatl insuran , s required by sectlon 3700 oi Ne Lebor Code, tor the pertortnance of ihe work tor w�ich ihis pertnit is issued. My warkers' compensati n rence rri r ntl polV ber ere: Cartler. Polity Number: (rnls sealon need not he canD erey i! rhe perm is lued et one hundred eol/ars (StoO) or less.) ❑ I certity that in t�e pertormencq pf Ue wo or hich ihis pertnit is issueQ I shall no� employ any person in eny menner so as lo become subject to the workers' compensatian laws af Celllamia, antl agrae t It I shoultl Decome sub�ecl to the workers' compensetion provlsions o1 Section 37 0l tha r Code, I shell IOMwIN compy with Ihese provisiwu/. � � /J ) (� � r, AppUcent Sipnalure: 71 it-/ ��Jn�i✓ Date: �-(' /� v� WFRNIN(i: FAILURE TO SECURE WOPI(Ep$' �pM1�pEN5ATI0N COVEMOE IS UNLAWFUL AND S/ULL SU&IECT PN EM%.OVER TO CRIMINAL PENPLTIES FNO VIL FlNES UP TO ONE HUNDRED THIXISAND OOLLRRE (f100,000). IN ADDITION TO THE W5T OF COMPENSATION, DAMAGES AS PROVIDED:OR IN SECTION 3]OB OF THE LABOR �ppE, IMEREST, M1D ATfORNEV'S FEES. LICENSED CONTRACTORS DECLpRAT10N: I �ereDy aNirtn that I am Ilcensed under provisions ot Chepter 9(commendng with Sectlon 7000) ot Dlvision 3 of I�e Business end Prolessions Code, end my Gcense is In tull �, force antl eMect Lic. q Class p ��,, Contrecrofs Signeture: t y�n -.-.�.� Dete: � � �� c CONSTFiUCTION LENDING AGENCV: � 0 I hereby a�rm that there is e Gonstruction lending egency ior the pedortnance of Ihe work Por which ihis permil is Issuetl. (Sec. 3097, Civil Code). Lende/s Neme: Lentler's Atltlress: Sipneture: Date: OWNER•BUILDER DECLAfiAT10NS: I �ereby eNirtn that under penalry o1 perjury that I am EXEMVT FROM TME CONTRACTORS IICENSE LAW for the following reason (Sec. 7031.5, Business anC Professions Cotle: Any ciry or counry which requires a pertnit to construd, elter, improve, tlemdis�, or repair eny sirucNre, pdor to its issuance, alw requlres the applicant for such pertnit to Ole e signetl statemem thet he or she is Iicensetl pursuant to Ihe provisions ol the Cantrectars License Law (Chepter 8(commencing wit� Sectlon 7000) of DNL51on 3 ot ihe Business end Professions Code) ar Ihet he or she Is exempt therefrom and ihe besls tor the alleged exemption. Any vialatlon a� Sectian 7031.5 by eny epplicant for e pertnit sublecis the epplicant ta e civil penalry of not more Ihan iive huntlred tlollars (5500�.): ❑ I, es owner of t�e property, or my emplayees wlih weges as Neir sole compensatlon, WILL DO 7HE WORK, anC ihe siructure is not intendeC or oflered for sale (Sec. 7044, Business antl Professions Cotle: The Contractors License law tices not apply to an owner of properry w�o builds or improves thereon, and who does such work himsetl or hersetl or ihrough his or her own amployaes, provided Ihat such impmvemenLs are not intendetl or ofleretl tor ule. If, howavar, tha building or impmvement is sold wit�in one year ot complation, the owner-Duilder will have the 6urdan of proving that he or she did not build or imprwe far purpase ol sale.). ❑ I, es owner of the property, am EXCLUSIVELV CONTRACTING WITFf LICENSED CONTRACTORS to construct ihe prqect (Sec. 7044, Business and Professions Cotle: The contractors Licens� Lew tloes not eppty to an owner ot pmperty who builds or imprwes thereon, end who wntracis for suU pm�ect with a coniracror(s) license pursuant to tha Contractors License Lews.). ❑ I am exempl under sec. Business and Prolessions Cotle for this reason: Signeture: Date: Owner ID venfied by drivers Iicense. ❑ Ves ❑ No Drivers Licensa No. Vedficetion of Ownership 6y (type o1 daumenL i.e. - praperry terz bill or deed}: DIVISION OF INDUS7RIAL SAFETy pEFiMR CERTFICA710N: Expires: ❑ I hereby carlNy Nat no excavetion frve (5) or more feet in tlepth into which e person is raquired to descend, will be made in wnnection with work euthorized by this pertnit, end Ihet no building sttucture, scaHdding, lalsework, or demolitlon or dismantling Nereof, will be more ihan thirty-six (38) leet �ig�. (Chep. 32. Gry 2, Atl 2, Sec. 341, 71t1e 8, Califomia AtlminiSlralive Code). ❑ As awner-builtler, I wlll not employ anyone to tlo work which would requlre e pertnit trom the Dlvislon of Indusirial Sefety, es noled ebova, unless such Derson hes a permit to tlo such work Irom tha tllNsion. Slgnature: Date: DiNsion o1 InCustrial Selery Pertnit Num�er. CEHTIFlCATE OF COMPLIANCE AND AUfHOHIZATON OF EMRY: I certily under penelry of perjury that I heve read this epplication enC steta that the Infortnation given is cortect. I egree to comply wit� ell stete laws end dry ortlinences relating to bulltling wnstruction, anG euthorize representatives oi the City ot Costa Meu to enter upon t�e ebove-descnbad property tor Inspection Duryoses. I egree not to occupy or ellow ocapanry ol any building aulhorized by ihis permit until final inspaction. `� 'SlgnaWre Ot eg I Owner(s) �f�/" c��.r.-�-J AnNOr Authonzetl Applicant COUE A, INSPEGfIONTYPE 7616 Fi:etl System Final Fire Preventlon 1286 Pool Spe Flnel 200 Finel Re-Roof 201 FIneI BIacWRetaining Wall 202 Finel Factory Fire Place 203 Final Sign 204 Finel Demolition PAIE 1ti�dLS y00E� INSPECTIONttPE 206 208 210 212 220 222 250 �: : � I � �.: Finel Mechenicel Final Plumbing Final Electncal Finel Flre Preventlon Finel Planning Approvel Finel Site Flnal Bullding/Occupanty � ! b Z- (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 490 E 19TH ST Suite: Vicinity: REAR OF AN EXISTING SFD Parcel Number: 42632112 Applicant: WILSON, BOB Address: Owner. COX,�B�RIAN J �� Address , 490 E 19TH ST. , � � COSTA MESA,.CA � contracror. BI WILSON AND SONS Address: 485 E 18TH ST COSTA MESA, CA Zip: 92627 Arch : Address: Phone: Zoning: Phone: 949-646-1740 Zip: Phone: Zip: 92627-2314 Phone: (949) 6461740 License: 377487 � , Eng: Address: Status: ISSUED Applied: OS/16/2002 Issued: O6/12/2002 ISSUED BY: Phone: Zip: � License: License: � ..- SCOPE OF PERMIT CONSTRUCT A 495 SF MASTER BEDROOM/BATH AND IAUNDRY ROOM AT THE REAR OF AN EXISTING SINGLE-STORY SFD. ALL SINGLE-STORY WORK. � � 40% OR 3,104 S�.FT. OPEN SPACE REDUIRED; 63% OR 4,877 SQ.FT. OPEN SPACE PROVIDED. Plan Check: Permit: SMIP Res: SMIP Com: � Other: Inspection: Total $372.81 $573.55 $4.23 $0.00 $0.00 $0.00 $950.59 SETBACKS MAINSTRUCTURE Front- 0-0 ACCESSORY Front 0-0 PARKING Existinn: 2 NOTES: Rear 46 0 Rear 0- 0 Reouired: 4 FEE SUMMARY PLANNING & ZONING Left S 0 Left 0- 0 Pr000sedr 4 Calc Valuation: Claim Valuation Ri9ht 0. 0 Right 0- 0 $42,322.50 so.00 NO710E: The work authorized by ihis permit shall comply with all applicable handicap access requiiements undei Calitornia statutes and related regulations. (Ord. No. 92-28, § 1, 1241-92) EXPIRATION: This permit shall automatically expire and becoma void if work is not commenced within 180 tlays, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requfred Inapeetlona and final epproval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration ol this permit. FOR INSPECTIONS CALL: (714) 7545626 , za+e-ae �aroo� WORKERS'COMPENSAnON DECLARAnON: I hereby eflirtn under penally of perjury one ot �he tollowing declerations: ❑ 1 heve enC will maintain e cetliticate ot consent to setl-Insure for workers' compensation, es proviAetl for by section 3700 ot the Labor Code, for ihe pertortnence of ihe � w�/ork for whlch ihi4�pertnit is issuetl. . �,7�rneve and will mflinlNin workere' carr�pen {wn insurance, as required by sectlon 3700 of ihe tabor Cotle, for Ihe peAortnance of tha work for which Ihis pertnit is Issued. ^ My workers' comper�atio �5}�rencbra 'er en ollcy number ere: Certier: � � Policy Number. (Th/s sectlon need naf be cromplefed N the pe ve/ued af one hundred dollars ($/00) or /ess.) ❑ I certify that in Ihe pertormance of the wo 1 r which this pertnit is issued, I shall not employ eny person in eny manner so as to 6ewme sublect �a Ihe workers' compensation laws of Calitomia, and agr at If I should become sub�ect to the workers' compensetion provisions o1 Section 3700 f the LeW{{{ Code, I shall torthwlth comply with these pmvisions. � / / g I � P��/ �` � Applicant SignaNre: ��co�� L(/u�iM� Dete: � � � WARNINp: FAILURE TO SECURE WOFKERS' CAMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYEfl TO CRIMINAL PENALTIES AND CIVIL INES UP TOONE HUNORED THOUSPND DOLIARE (E100,000), IN ADDITION TO THE COST OF CAMPENSATIIXJ, DAMAGES AS PqOVIDED f-0R IN SECTION 3]Ofi OF THE LABOR CODE, INTEREST, AND ATTORNEI"S FEES. LICENSED CONTRACTORS DECLARATION: 1 hereby eHlrtn Ihet I em Ilcensed under provisions af Chapter 9(commencing with Section 7000) of DiNsion 3 oi the Business and Profess�ons Code, flnd my license is in full torce end ettecl Lla x Class N Contractafs Signature: Data: �1% �� •(1 r% CONSTRUCTION LENDING AGENCY: ❑ I hereby attirtn that there is a consiruction lending agenty tor the perfortnance ot the work lor which this permit is issued. (Sec. 3097, Civil Code). Lentlels Name: Lentler's Adtlress: SlgnaNre: Date: OWNER-BUILDER DECLARATIONS: I hereby eHlrm thet untler penelry of perjury Ihat I em EXEMPT FROM THE CONTRACTORS LICENSE LAW far Ihe tollowing reason (Sec. 7031.5, Business entl Professlons Cotle: Any ciry or counry which requires e permit to wnstruct, elter, Improve, tlemolish, or repelr any stmcWre, prior to its issuance, also requires the epplicent tor such permit to tile a signed statement t�et he or she is Ilcensetl pursuant to the provisions of the Contractors license Lew (Chepier 9(commencing with Sectlon 7000) ol Dlvision 3 ot ihe Business end Professions Code) or lhat he or she is ezempl Iherefrom enA the basis for the elleged e:emptlon. Any violation ot Section 7031.5 by any epplicent for a Dertnit su6jacis ihe epplicent to e civil penelty of not more �hen five hundred dollers ($500).): ❑ I, es owner of the property, or my employees wlih weges es �helr sole wmpensation, WILL DO THE WORK, end Ihe structura is not Intentletl or oNeretl for sele (Sec. 7044, Business end Pmfessions Gode: The Contradors License Lew does not apph/ to en owner of properry who builds or improves thereon, end who tloes such work himself or herself or thmugh his or her own employees, providad that such improvemenis ere not Inlended or oflered tor sale. N, howaver, Ihe building or improvement is sol0 wit�in one year of completion, the owner-builder will have Ihe burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, es owner of the property, am El(CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct Ihe prqect (Sec. 70a4, Business antl Profeuions Cotle: 7he conirectors Licensa Lew does not epply to an owner of propany who builds or Improves ihereon, and who contracis for such pro�ect with a contracbr(s) license pursuant to the Conirectors License LewsJ. ❑ I am exempl untler sec. Business and Profassions Code for this reeson: Signeture: Date: Owner ID venfed by drivels license. ❑ Yes ❑ No Drivefs License No. Vedficetion oi Ownership ty (rype ol document, i.e. - properry tex Oill or tleetl): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: Expires: ❑ 1 hereby certify that no exwvation fiva (5) or more feet in deplh into which a person is requlred to descend, will be made In connectlon with work euthodzed by t�is pertnil, and that no building shucture, swHoltling, falsework, or demalition or dismentling thereot, will be more than thirty-six (36) feet high. (Chep. 3.2, Grp 2, Art 2, Sec. 341, Tltle B, Califomia Administrative Code). . ❑ As owner-builder, I will not employ flnyone to do work which would require a permi� trom the Division of Intlustrial Safery, as noted above, unless such person has a pertnit ro do such work From Ihe division. Signature: Date: Division ol Industrial SaFery Permit Number: CERTIFlCATE OF COMPLIANCE AND AUTHORRATON OF ENTAY: I cenify under penaHy of perjury Ihat I have read this application end stete �het ihe iniortnation given is corted. I agree to compty with all state laws end ciry oNinences relating m building construction, antl euthorize represeNatives of the Ciry ot Costa Mese to enter upon the ebove-described properry for inspection purposes. I agree not to acupy or allow acupancy of any builtling authonzed by Uis permit until Tinal inspection. � 0 I I2- �`a� Applicam Date GOUE N, INSPECTONTYPE PArE �NfITIRLS 1616 Fivetl System Final Fire Preventlon 1266 Pool Spe Final 200 Final Re-Roof 201 Final 81ocWRetaining Wall 202 Final Factory Fire Place 203 Finel Sign 204 Final Demolilion � fgp� ixsvecnoxrrre 206 Finel Mec�enical 208 Final Plumbing 210 Final Electrical 272 Finel Fire Prevention 220 Final Plenning Approval 222 Final Site 250 Final Building/Occupancy PA7E I[4�Lfl OWNEA'SNRMF. �nt,..`C�.�,,• gtR 7• AODflE55: ��A. �- Tb: yS"�:J:\. .. .:t� � _'Y �-''• : a p'E' ' g^�• g^ � =JS:a �:�sa,..A 9J�?7 APCN/ENGINEEN: nooxess: flEG.NO.: UNIT: uxiT: PEflMITTEE:rR�� J��'IV$1�.J (7:4)546—�9iPr aooness:" q90 19TH ST ��X CA 9�627 UCENSEO CONTflACTOP �ECIAPATION: I �ereby aliirm ihat I am licensetl under pmvisions ol ChaD�er 9(commencing with Section 7000� of Urvision 3 of Ihe Business and Pmlessions Cotle. antl my license is in �ull �orce antl etfec�. CITY LIC.: STATE LIC.: ClASS: Date: Signa�ure: WOflKENS' COMPENSFTION OECLANAiION: I hereby ailirm Ihat I have a CetlifiCa�e ol tons¢n� Io Sell�in5ufe Or a Cetlifita�e of Workers' Compen5aiion Insurance, or a cerlifietl copY �hereoi (Seciion 300�. La�. C). POLICY NO.: E%P. ORTE: COMPANY: � CeNfietl coOY is here7y lumis�ea. ❑ C¢tli�ied topy i5 Iiied wit� �he Ciry BuildinB Div6ion. Dale: Appli[ani: E%EMPfION FNOM WOflMEflS' COMPENSRTION OELUIIATION: (This seciion nee0 no� Oe completeA i� Ne permit ¢ for me huntlrcd (5100� or less�. eNty thai in I�e pedOrrtunte o� t�e �'rork lor whith this permi� is i55ue0, I 5� II no� ¢mp any Oerson in any manner s0 as Io Gecome subjecl to I�e Worker ' Com n aUon Laws ol Cali�amia�� ii �ate: Z Signaiure: NOTICE: it, atier making ihis dectaretian, you s�oWd Gecome suble�� o t�e orkers' Compensation provisions al t�e Labor Coae. y0u mu5i IOtl�wil� [omply vnlh Suth prOvision5 or Ihis De�mii Shall Ge E¢emea revokeA. LONSTHUC710N LENOING �GENCY: I here�y aHirm t�at ihere is a mnsimction len�ing a0ency lor ihe pedormance of ��e work lor whic� �his oe�mit is issuetl �Section 3097. Civ. C�. LENUEN: ADUflE55: OWNEN BWLOEfl UECLl�NATION: I hereby af�irm ��a� I am exempt Imm t�e Conlraclors' State License Law lor �he following reason (Seciion 7031.5 Business an0 Pmlessional Code: Any ciry oi county which reQuires a De�mit �o [onSlrucC alter, impmve, demolish, or ' repair any simcture. D�ior to its issuance. also requires ihe applicant for sucn Dermit to lile a signed statement Ihat he/she is licensetl pursuam m Ihe pmvisions of Ihe Comractors' Slale License Law (Chapter 9(commencinA with Seclion 7000� ol Division 3 of Ihe Business anU Pmlessions Co0e) or ihal he/sne is exempt iherelmm antl ihe 6asis Ior Ue allegetl exemption. My violalion of Sec�ion 7031.5 by any a001icant lor a Dermit suEjetls the aDPlicant to a civil penalry ot not more than live huntlred aollars (5500�. I, as owner ol ine o�openy or my employees with wages as their sole compensation, will Ao the work, antl ine ❑ simcture is not intentletl or ofieretl lor sale (Section 7044, Business and Pmlessional CoOe: T�e Contracmrs' S�are License Law aoes nol apply to an owner ol a propeny wlw �uilds or imprWes inereon, ana wAo tices suth work himself/nerself or tNough �is ar her own employees. D�oNdetl tlut such impmvemenis are not intentled or oiferetl far sale. Ii, however the �uilding or imOmvement is soltl wilhin one year o� completion. the owner vnll have ��e buraen al provinA �e�s�e tlid no� builE ar impmve tor ine Ourpose of Sale�. I. as owner of Ine propetly, am exclusively conirading with licensed cantractorz to consirucl ihe D�Mect (S¢ttion 7044, Buvne55 ❑ and Protessions CaOe: T�e Contrat�ars' Siate License Law Ooes nol appry IO an owner ol DropeM1y who bwltl5 Or impmves lhereon and wM cOniracis for such prolecls wit� a coniraclor�s) lic¢nse Oursuan� Io �h¢ Conlractor5' Slaie License Law�. I am awar¢ Inal O�oot af Ineir Warker's Compensatian insurance shaul0 be provi0e0 to me. .0 I am exempl unUer Sedion: B. d P. C. io�tnisreason: BP%044 ,�, :dOR:i BY O:v�ER y Oaie: � �� Owner: 9- I Oa hereby [enily I�ai I am aware oi and untlers�antl I�e reOUirem¢ms o� Cali�omia Heal�h ana Sale�y Cotle $eC�ions 25505, 25533, antl 25534 an0l�at I or any fulure �wlemg oaupani willlwill noi (Circle one� nee0lo Compiy wilh 5aitl Stale t0ae5 ana I�e requir¢m¢n[s lor a permil lor conSlmcimn or moUilicalion �mm ihe Air �vaii�y Managemeni DiSUic�. flesi0en�ial cons�mc�ion ap0lica�ion5 are exemp� �mm ihese pmvisions. �ate: APPlicanl'. I here�y cetlily Iha1 I �ave read ��is aoPlica�ion antl slate ��a� ��e above in�ormalion is correcl I agree Io comD�Y wilA all ciiy an� caunly ardinances ana slale laws relaling lo builaing constmction anG hereby autl�orixe re0�e5¢ntative5 0l ihis ciiy lo en�er upon Ihe above-mentionetl p etly tor inspeciion DurD es. � /.E (A / �ale'. SignaWre: �� n ""2— Oriver's License or Sociai Securiiy x: �� t64ba6 W�ne—OunEmg: Green—Coae Entorcemem; Canary—Applicam: Pink—Revenue; GolaenroE—Assessor Ci �'Y OF CGSTA ..��A - _ ..�:,�T_:i= 9�?:.=. '.'-.�: .`'- • _ ^ � �- - ?ER::'• ?:G: ° 062?35 P:,A�' CE�C�� ?:��: G^_oc'-°3 c (�OVT: ?: _":�:. `• _O::S':R:,'C':=0^' �Ypr: V-\ PERP�'.:: TYPE: £:R P;,'�PC��. ,,:._ �On Dt.SCR�P:�OSI . RtP:,ACt 7..�:•:.�,0:ti£/�CBU 1204 £C� r:': ,C�C CLAIX VAi.::E: 3,000.00 CALC-VA��E: 3,OOC.00 GRO:.'P .�.:C; n-3 / CQ::::Eti:S: 53!OKE DE:E��ORS RE�ID.ICBO�t1210 ?ExifiEiFiF?f±f�k+:�i��If?Fif1�7F?!�x±fi!-if+E#?F?EiFi!�+k. x?fiflEiE9flE3flfK}FiEY.�iE'.t#1E?fiF}.kiF#:t�1E:t#t:lEiiK�f�at�l(K##iF��#? #Kii'^�iii#yi.i� Z U A I N G R E Q U� R E,Y E �^_' S s�:Bacx� ------------ ?:Ai\ H:JILDZ�IG ---------- FR\�: F: T_:ti rZEAR: F: �\ i.EF':: F': IN RGHT: P.- I:v --------- ACCESSORY 3JIi.D�SG --------- FRUT: FT �'.d �EAR: - :��F:'. c'T ?R RGH=. F: _.. PARRTtiG P,EG: PRGV: PARCE:+: 526321? 2 ZtRE: REF ?'0: P�A?'.tiI�:G \6:'=S> � iE if iF dF # iE ie ## iR ?f if # 3f iE #?E if� iF iF# 3F# ##� # iE i° 3E iF if iF if if iE � iF if ?f F iF if iE iE 3E jF ####�# tF 3f �':� 3E i� iE K if ## i�+' # iE #�# K� C� #:: ir �14 a+h;r L D E C� E � O" P� �: E:� ; S E R C� I C E S R E Q II I R �'! E\:' S ZOR:=tiG APPr^.OVED BY ;• DA:E: B;i:iDl\G A?PRuVEI� B fl: DA.E: APP"CATTON ISSJ£D EY• LA'�'E: o,z-zs�3 iEifif?f?EjFiE?ElE�E�7fiEiE34iE#1E±Ei"�.iEiE. . - x. x s.�a�.: . iE##?61�±fi�i4iFi�;.'� ��'�"".,s,-c'iF'?c�#K iEiE#iEieiF#?E#ifiEiEiE##K�##�ff1F#jE#iERx�rtFiE#iEiEififif## �Flf#ifit###i.�K#iF3f#if#}'.;:i�#f%#lliii:ii*�#�1f::#i::::}#'s�ir+FY�#x i,EGAi,I2ATIO:v:DF F E E � U:! �: A R Y STRUCTCRAL ScG?:Eh:T•Y l�tt�i:`:l �i BLDG P:�:_ r � . � � PLA:�? 35.?0 TSS;JE FEE PL'JMB Z;vG E� IC 4?ECHAI3IC FIRE 5MIP/RES G:R,�L1T_�;G .50 SMIY/i0�!-RES Bli�LDING-DZV-> PER:�.IT �SS:J� PLA\-CEECR TO?AL ?A�U D:7= TOTA',5----> 59.50 0.00 35.10 94.60 89.60 .C'J REVEh:tiE LIVIt:IOti TC7TAL5--> COL?�ECTED: 89.60 OV£R/SHCRT: ,GC� B:.DG PX.T P.T�:.'.`4BIhG cLEC.TRIC .":i.CHAti-C FiR:. 5:+��P/Tu� GRAJ' �tiG P:,A�-CEE�:: SS.00 .SO 3�..� iF if �f if iF i�?E ?f iF?f i(' # if !E ie #?f i4?f if iF iE if 3f if')f iE } if if 3i' ?� iF if if if if i� ic if # if if' if iF 3f iC # if'lE ii' i.'-if ?4 i(' ## Y' # if iE YC iI' if :; jf ��:' {<:';' �. } if 9F if' � i�-1k = ti D 1�i � L;: A:. F E r. B R.-�. A'.t D O'vI N :YPE Q:Y D E S C 3 I t� T I O N JtiIY COST TOTAi COS� £FR 3000 A:.TER 9Y VA�UE RESIPfi:Q�IAi NOZONE ?.00 3,000,0� ENP OF :�EES �x�rRED � /o a 9� . . u-,�u-- OS DUi39777-00139�79 TOT 39.oD OATE: O5/2S/93 TIfIE: 12:30 �3raad CONSTRUCTION AND PLANNING APPI�tDVALS Permit # I 1. ;emporary Electricai Service or Pole 2. Sod Pipe-Undrgrnd. 3, Electrica� Conduit Utility�Undrgrnd. 4. Electrical ConduibUndrgrnd. 5. Steel Reinforcement 6. Eiectncal UFER Gmd. 7. Footings i 8. Foundation 9. lVater Pipe-Undrgmd. � 10. Structurai Floor System 11. Property Sewer Line & House Connection � 12. Sewer Cap �13. Roof Drains 14. Rough Plumbin9 � 15. Rough Electrical�Condua ; 76. Rough Electric4Virin9 17. Rough 6tiiring Sign 18. Rough Electrical�T Bar Ceiling 79. Rough Heating & Air Conditioning 20. Ro�.yh Factory Fireolacz 2t. Ducts, in Structure 22. Ducts, Ventilating 23. Gas Pipe•Rough & Test 24. Roof Framing 25. Roaf Shcathing 26. T-Bar Ceihng IStructurall & Monocoat 27. Frame ar.d Flashir.g 28. Lathing & Sitling 29. Insulation 30. D�ywall Nailing 37. Plaster Brown Coat 32. Elecincal Power Meter-F�nal 33. Final Electnc 34. Final HeaLng & Air Conditioning 35. Final Gas Pipe�Test 36. Hocd or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Wacer Service•Final 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preventer 43. Backflow irngation 44. Landscapa Irripation System 45. Sound Attenuation 46. Handicap Regulations 47, FINAL STRUCTURE & BUILDtNG 48. FINAL PL.ANNING 49. Electric Release to Edison 50. Ga: Release to Southem Califomia Gas 51. CERTIFICATE OF OCCUPANCY do. Date Date Inspector POO �PA APPROVALS Permic -r 52. Pool & Equipment Location 53. Steel Reinforcement 54. Forms . 55. Electrical Bonding � ' 56. Rough Piumbing & Pressure Test 57. APPROVALTOCOVER�GUNITE 58. Electrical Cqnduit�Undr�rnd. 59. Gas Pipe, � Undrgrnd., Test 60. Backwash Lines, P-Trap, � Undrgrnd. 6/. APPROVALTODECK 62. Backwash & Receptor•Final - °� 63. Heater & Vent•Final ' 64. Plumbing System � Final 65. Elecuical-Final .. - 66. Solar System•Final 67. Fencing & Access ApProval 68. APPROVED FOR PLASTERING 69. POOVSPASYSTEMSFINAL FIRE DEPT. REQUIREMENT APPROVALS Permit # 70. Underground Hydro 71. ProductPipingOGas ❑Oil 72. Under�round Flush 73. Undergmd. Storage Tank OGas ❑ Oil 74. Overhead Hydro 75. Dry C�emical 76. Dry Standpipe 77. FIXED SYSTEM FtNAL 78. FIRE PREV. FINA� HEALTH DEPT. REQUIREMENT 79. FINAL INSPECTION J_ 80. F00� CERTIFICATE ISSUED I Notes: Date inspector c � � \ PflOJE�7 p�OflE$$: q y O E 1 9 TH S i � • OWNEfl'SNAME:JOHNSTON, ERIC nooxcss:GRANT, JOHNSTON JUDITH 490 E 19TH ST COSTA MESA,CA 97.627 ANCM/ENGINEEN: R�OflE55: PEG.NO.: UNIT: UNIT: PEflMITTEE:SUDITH ;JOHNSTON ( 714 ) 646-7880 aooxess: 4 g 0 E 19 TH S T COSTA MES� CA 92E��7 IICENSEU CONTBRCTOq DELIAMTION: I �ere allirm I�a� I am ficenu0 un0er D«+s��s o fiapter 9(commencinp wii� Section 7000� pt Oivision 3 0l Ihe Busineu ana Proles9ons CoOe. and my license 4 in lulllarce an0 efl¢ct. LITY ��.: ST�TE LIC.: CIASS: Oate: 9gnaWre: WOBNEBS' COMPENSRiIDN DECLABAitON: I nereey affirm �twt I have a cenilir,ate of consent m se&insure or a certilicate al workers' Camp@nSalion Insurance, or a cenifie0 copy Inereo� (Seciion 3g00, LaD. C�. POLICY NO.: EXP. ORTE: COMPpNY: ❑ Cenified copY is nereby lurnis�ea. O Cenifie0 copy is filea vnt� t�e ciry BuilGinA Division. Date: Applitan�: ENEMPf10N FPOM WOPIIEHS' LOMPENSATION OEClA11AT10N: (Tltis sttlim nttU nW Oe mmpete0 il Ne pemh is la one IiuMrM (St00) or le5s�. I Ceriily �hai in Ih¢ perlOrman[e ol �he H'oAt fOt whith thi5 OetrN� 5 issueU. I shatl no doy any verson in any manner w as m oecome subleclto t e WOBeri Cqmpensation LawS of Cd4lornia. Oa�e: � i ��I .� SiOnatu e: � � NOTI : II. a�ter making ihis 4ttW�ation. yau sho come 5u01�< <O ihe r5' ComOensa�ion pmvisions o� t�e La�or CoOe. you mu5i IOtlMnlh comD�Y m�h Sut� pm i s or ttus permit snall eemed revokea. CONSTflUCT10N LENOING AGENCY: I �er¢Dy al�irm a1 Inere is a wns�mclion IenEinB aAency lor ihe pedormanCe o� t�e work for which ihis permit is issuetl (Seclion 3097. Civ. C�. LENOEN: AODflE55: OWNEB BUILUEN OECIAqATION: I �ereEy at6rm Itu1 I am ez¢mpi Imm I�e Conlracio�s' Slate LitertSe law lor I�¢ lollawinp reason (Senion 703t.5 Business antl Pmlessional gpGe: l+ny city oi coumy whic� repuires a permit m constmct, alier, imDrove, aemalis�, or iepair any simcmre. vnor to i¢ issuance. also reyuires me apptium for wU perrttii �o file a SiA�eG statement ttai �Ns�e a IicenseE pursuam io t�e D�ovisions ol ihe Canvactors' S�ate License Law (Clupter 9(commencinp vut� Seclian 7000) ol Division 3 ot ihe Business and P�oles9ons CoGe) orl�ai �e/s�e i5 eaempli�etelwm a`M t�e Ua5i5 for I�e allepeE CKemO��on. My violalion ol S¢ttion 70.31.5 Dy any applican� �or a permil sublec�s t�e applicani lo a civil pEnalry ol not mOre I�an live hunOred Oollars (E500). I, as owner of Ihe vmDeny or my employees wiin waqes as ineir so�e compensation, vnll tlo ihe work, and Ihe ❑ Slmtlure i5 nol inlen0etl or ollereE �or 5aie (Setlion 7044, Business an0 Professional COUe: fhe COntratlofs" S�ai¢ lit¢nse Law docs nol applY lo an owner ol a prop¢tly w�o OuiltlS orim0�ove5 Ih¢reon. an0 v/�o aaes such work �imselll�ersell orlhmuBh �is or �er Own ¢m01oy¢¢5. Omvitle0 Ilul Suth imprOvemenis ate not intenAetl or Oflered fot 5ale. I�, hOwevef Ne buildinp Or impmvement is sold wit�in one y¢ar ol complelian, t�e owner will �ave t�e UWOen of O�oWng �elsha GiC not �ui10 0� improve lor Ne purD�e ol saie�. ^ I, as owner ol ihe prop¢tlY. am ¢rGusively conlracGng wth licensed conVaclOR to constNtl the pmjeci (Section 704a. Business k� aM Prolesvms GoCe: The fm�raziors State Licertte LawOces irot appy lo an owner o1 W0p¢�IywM �Wds w improves ihereon an� w�o Coniratls �or Sut� D�OI¢��5 wii0 a ConlraCl0r�5) litenu pur5uanl Ia I�e COnlratlar5' Sla�e Litensc Law�. I am awafe Ilut p�oo� ot IAeir WOrker'S Compensatpn insurante 5MW0 Ce proviOeE IO me. � I am erempi unUer $eclion: 8. 8 P. C. for �his reason; .� Da1e: �� Ow I Ao here�y cetlily I�at am aware ol antl unaersiantl �ne revuiremems al Aomia Heati� anE Sa� t�� o0e Sections 25505, 25533, ana 2553a and that I or any lulure �uil0ing occupam wilUwill noI (circle one� n 0 b tomO�Y wilh Said FIe1e Wdes an0 ihe reduirements �or a permi� �or con5imciion or maEilicaiion Irom I�e Nr Ouatiiy Manaqem¢nl Disintl, fleSiGeniial canSlNttion applicaiians are e�empi Irom IheSB pmvisions. DdIP: AppbCani: I �¢�ppy certilyltal I have�ea0 this applica�ion an0 sta�e lhal ihe a6oveinlormd�ion is mrrecl.lagree ro camply vnlh all[ily antl counry orOmancw ana state Wvrs relating �o OudEl�g mnsvuction a�b �eretry autnorize reWesmutives ol this qty to enter upon �he a0ove�mentionetl D�oOErry br i Specli0 pw0ase5. �� —_ q1 i Oaie�, �_! ,Z__ $ignaiurt��/ l�6<Lq6 While—Builamg: Green—CoOe EnlorcemenC Canary—ApPlicam; Pink—Revenue; Goltlenmtl—Assassor CITY OF' COSTA MESA — BUILDING FERMIT PERM NO: P 061492 PEkMIT NO; P 061442 PLAN CNECK n70; N GOVT; N SUPP; N CONSTRDCTION TYPE; PERMIT TYPE; PLU PURPOSF.; O'PH JOB DESCkIPTTON : INSTALL GAS LINE FOk BBQ SQ FT; CLAIM VALUE: CALC—VALOE: GROUP OCC; R-3 /M-1 COMMENTS; GAS FROM METER TO BB� LOCATION IN $ACK YARD 3tikatMlEihklEiEifkififiEiElFiflEifititafiE�lEf4lEi(�iEfE3f iE�%�kiEi(�fEifiEiF1(�%3kiEiEiEikiffbiFl6!fiEkif3b�iEitiFH�k�1(��E�kiE%iE?FiE�lEifiFikiE#�1EiF1E Z O N I N GS ERTEBQAUCIKRSE M E N T S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING --------- FRNT; FT IN REAR; FT IN FRN'C; FT IN REAR; fiT 1N LEFT; FT IN RGHT; FT IN LEFT; FT IN RGHT; FT' IN PARKING REQ � PROV; PARCEL: 42632112 ZNE: REF NO: PLANNING NdTES> > )_• i6 ik iE iF fF � iE iE if a! IE iF%# iElf ih iF iEiE i(� iE k it # 3f iF-lE iE it 7k if iE i! iE fF lF?F iE�E ik �IE iE if 1f i41k it if iE iE if iF iF 9E%3F �Ik IF K� It IE if� i(� Ih iF 3E if iF Ib it if 1h iF i4 if iE #?E D E V E L O P M E N T S E R V I C E S R E Q J I R E M E N T S ZONING APPROVED HY . BUILDING APPROVED HY ; AFPLICATION ISSUED BY:��F3F�3F'iF3�. � ( �1t1E#iE3flfltiElt�1liflFiliEifiEiEih1lillfik it x .. .. p . . . iEiFlkitiF�EiEiEiE�k1E1EfFilx�iEiEikititkifk3kif�fEiEiEikifiE-1(�!kiEifitikiF�K��FihkiF3FiEik�F i' LEGALIZATION;N F E E S U M M A k PERMIT BLDG PMT PLUMSI00 ELECTRIC MECHANIC PLAN �5S ��- � ISSUE FEE 20,00 �'f- BUILDING—DIV—> PERMIT ISSUE P],AN—CHECK TOTALS----> 5.00 20,00 .. 0,00 Y _ DATE: DATE; DATE; / �3 �iF1E1Fi4i(�if3(�lf!!ik!! u�� ftw� �x�xif# iE iE iF IF 1F i(• f41E i(� k!f if ## if iF df 3h k� I(� iF%!4 !k ]E STRUCTURAL SEGMENT;N FIkE SyIP/RES GRADING SMIP/NON—RES TOTAL PAID DUE 25,00 25.00 ,00 REVENUE DZVISION TOTALS--> COL-�ECTED: 25.00 OVER/SHORT; 00 BLDG PMT PLUMBING ELEC7'RIC ME,CHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 25.00 �, if !! !f if 76 �k if if lf if iE if �k fE fE Ik iF IFiE ik !f % if fE fF if fF iE k iE i6 iF 7flf �{/�c lE if !h !f� 1(- lE fF if it fF if 1E k!E ik IF �F if 1F il� N� 1f� M� !E N� !f lF IE !F iklElF fE 1F i(�!f !4 # ik iE %i(� if I N D I V I D iJ A L' F E E B R E A i( D O W N TYPE QTY D E 5 C k I P T I O:N UNIT COST TOTAL COST PLU 1 GAS PIPING SYS OFEND10F FEEOUTLETS 5.00 5.00 n; ' CONSTRUCTION ANO PLANNING APPROVALS Permit�''r i, Temporary E�ectrical Service or Pole 2. Soil Pipe-Undrgr�d. 3. Electrical Conduit Ut�lity�Undrgrnd. 4. Electrical Conduit-Undrgrnd. 5. Steet Reinforcement 6. Electrical UFER Grnd 7. Footings 8. foundation 9. Water Pipe-Undrgmd. 10. Struct�ral Floor System 11. Properiy Sewer Line & House Conncction 12. Sawer Cap 13. Roof Drains 14. Rough P�umbing 15. Rough Elec[rical-Contluit 16. Rough EleMric Wiring 17. Rough Wiring Sign 18. Rough Elettricaf-T 8ar Ceiiing 19. Rough Neating & Air Condit�onmg 20. Rough Factory Fireplace 21. Ducts, in Svuaure 22. Ducts, Ventilating 23. Gas Pipe•Rough & Test 24. fioof Framing 25. Roof Sheathing 26. T•Bar Ceiling IStructurall & Monocoat 27. Frame and Flashing 28. Lathing & Sidi�g 29. Insulation 30. Drywall Nail�ng . 31. Plaster Bro�vn Coat _ 32. Electrical ?ower Meter-F�nal 33. Final Electric 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Tesi 36. Hood or CanopY 37. Final FactorY Fireplace 38. Finai Plumbing 39. LNater Service-Final 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preventer 43. Backflow irri8ation 44. Landscape irripation Syztem 45. Sound Attenuation 46. 1landiwp Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49. Electric Retease co Edison 50. Gas Release to $outhern California Gas Co 51. CERTIFICAYE OF OCCUPANCY Date POOL PA Date Inspector qppROVALS Permit � 52. Pool & Equipment Location � 53. Steel Reinforcement 54. Forms 55. Efectrical8onding 56. Rough Plumbing & Pressure Test 57. APPROVA� TO COVER�GUNITE ' 58. Eluctrical ConduibUndrgrnd. 59. Gas Pipe, O Undrgrnd., Test 60. Back�•iash Lines, P-Trap, � Undrgrnd. 61. APPROVAL 70 DECK � 62. Back�vash & ReceptorFinaf 63. Heater & Vent•Final 64. Plumbing SYstem • Final 65. Electrical-Finai 66. Solar System•Final 67. Fencing & ACCess ApP�oval 68. APPROVED FOR PLASTERING 69. PpOLlSPASYSTEMSFINAL FIRE DEPT. AE�UIREMENT APPROVALS Permit # 70. Underground Hydro 71. Product Pipin9 � Gas ❑ Oi� 72. Underground Flush 73. Undergmd. Storoge Tank � Gas ❑ Oii 74. Overhead Hydro _ 75. Dry Chemical 76. Dry Standpipa 77. FIXED SYSTEM FINAL 78. FIRE PREV. FINAL HEALTH DEPT, REQUIRENIENT ' � 79. FINAL INSPECTION � 80. F000 CERTIFICATE ISSUEO � Oate �Inspector r' i Notes: �I?:L`Qj' �•(pTCnw�AutiE.- L ic.0 AVP��ant to fill in all so��es exeeo� tnose within neavy eoraer Iinas ana sign all apvropriate tlaclaratlons. �N OF COSTA MESA CONSTRUCTION PERMIT PER NO_ __,, � TRACT NO. LOT NO. UNIT NO. Pr � �+ddress �Q� � , / y � Applicant's Mailing Address Owner's Name Phone� Z.419'1 Address �Q �5 Q-b O ✓G Arch/Eng. License No. Address Contracmr's Nam Phone Address (mailingl_ City Licen�P Nn LICEfJSED CONTRACTOR DECLAqqTION 1 bereby aftirm t�at 1 am licensetl uqtler p�ovisions of Cbarter 9 �commenclnp witn saction ]000) ot Divlsion 3 of tne Business antl P�O�¢5510�5 COCC� dfltl my Ilcense is in full lorce antl eftect. License Class License No. Date Signature WORKERS' COMPENSATION DECLFRATION i heroby atfirm tnat I havo a certificata of consent to self-Insure or a certificate ' Wo�kers' CompenSatiOn InSu�anCe, or a certitietl cOpY [ne�eot (Settion 00, laD. CJ Policy No. Company 8 Certifietl coDY �s hereby fumisheq. . Certitied copy is flletl with the city guiltling Division. Oate Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLHRATION (Thissectian need nat be Comple[ed it lhe pe�mit is for On¢ huntlretl ($100) or less). I certify that in Ibe Oerlormance of th¢ work for whiGh this perm�t is i55uetl, I shall not employ any person in any manner so az [o become subject to tlte Wo�ke� ' mpens ' Laws of Cal��p�ni �� Date �%�Si9nature _�i � ' NOTIC :�, at er ma In9 tnis tleclaration, you shoultl bacome sub�ect to tha IIWorkers' Compen5ation prOvizions o1 the Labo� Cotle, y0u must fo�thwith comply wi[h sucn provi5ions or Nis pe�mit Shall �e deemetl revoketl. CONSTRUCTION LENDING AGENCV I hereby atiirm that there is a conztry��on lentlin9 agency for the performanca oi th0 work ror wbith this Oermit is ISsuetl (SeCliOn 3097 pv. C.) . Lpntler's Name � Lontler's AOtlress OWNER BUIL'DEN DECLARATION I he�eby atflrm l�al I�am exempt t�om Ihe ConVdttO�'s Uc¢n5a ldw for [he lollowing reason (Secti9n 7031.5 Business antl Professlonal Cotle: Any city or CounlY which �equl�es a permit to Consl�uGt, aller, Improva, Uemolish o� re0alr any slructure, prlOr'la its issuante, also rGquires the applicanl for zuch permit to fiie a signee stat¢ment that he/ihe ii IlcenS¢tl pu�suaOt tOlhe O�OvisiOns o1 thn ConVactor's.LicCnso Law (Chapllr 9(COmmendn9 with SaCtion 7000) of DIvlSion 3 of th¢ Bu51n855 antl Prq(psslon5 Cotle) or that ho/ShC is exempt `e�afrOm antl the basi5 f0/ the allpgetl ¢xOmptlon. Any vloldlion of SeCtlon 31.5 by any applican[ for a permi[ subjec[s the applicant to a clvll alty �t not mor¢ lhan fiv¢ huntlrCtl tlollars (5500). I, a5 owne� 01 �ho property �..+pd�••��^—will tlo iho work, antl the ilructure is nol IntanOetl or offeretl lor sale jSecNon 7044, BuSiness entl Protessional Cotle: Tna Contractor'S Licenie Law tloas nol apply to an owner ol a pro0erty wl�o builEs or improves tM1ereon, antl who tloes sucn work nimselt/harselt or tnrough his or her own employ ees, provitica tnat such improvomonts are not intentletl or offeretl for sale. 11, however, the builtling or irnprovement I5 soltl within ona year of com• pintlOn, the Ownor wlll hav¢ the burtlan Ot P�Oving he/sh¢ CI4 nol builtl or im- p�ovG fo� Iha OurpOso of Sale). ❑ 1, as owner ol tho property, am ezclusively contratting with Ilcensetl con- I�aCtors to tOnsiru<t [ha Oroject (Se�tlon ]044, Busin¢ss antl Profe55ions Gotla: The Contractor's License Law tloes mt appty to an owner of property who builtls or improves thereon, antl who contracts for such projects with a con- Vdctor(51 bceni0 pursuant to tne COnt�actor's License Law). I am awara that proo( of lheir Worker's Compen��o➢ insura ceihOUIE ba provltletl to me. ❑ 1 am exempl under Section�„B. 3 P. C. tor tnis reason Dato Owner _�J` «� /��J1eL I hereb cert y'tna 1 have reatl tnis aDP��ation ana state that the above Inlormatlon I5 wrrocL I agree to COmpry witb all city antl counly o�tllnanCes antl state laws relatin9 to builtling construcHon, antl hereby authorize repre- sentatives o1 lhis city lo enter upon the above-mentionetl vroperly for Inipectlan pur Sl9nature Date (G Drivers' LicenSe or 55 � ' � OFCONSTRUC CONVERSION TVPE OF PERMIT� LJ GRADIN� ❑ TENANT ELECTRICAL ❑ OTHER PROJECT DESCRIPTION 5�. FT._ CON STRUCTION TVPE VALUATION $ _ GRADINGCU.Y�S. ACR :W LJ ADD ❑ OTHER Bj �� FO NDl\1 7 PLVMBING ALTERATION U REPAIR IJ STRUCTURAL MECHANICAL Remarks: Bar Sink - Backflow Prevenrer Backflow Irrigation Ba[htubs Claritiers Dishwasher Drinking Fountains Floor Drains Floor $inks Gas Service Interceptois Kitchen Sink Roof Drains Reinspection Fee Outlets S15 Duct - Under Ground Duct - Sttuctural Duct � Ventilating Exhaust System ❑ MWtiple � Firepl/Fact. BIL ICBO �k Heating System & Ducting ❑0.100,000 BTU 0100,OOOBT Reinspection Fee � $15 CMF 0865-46, rev. 10/84 White - 6uiltlin9: Canary - Applicant: Pink - Accounting; Goltlenrotl - Assessor PLUMBING Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Pipin9 Solar Tank Swimming Pool wlSpa Urinal Water Closet Water Heater Water Service Auto�Wash Lsundry Trays laue Fee Hood or Typel ❑ Canopy TyNell ❑ Refrigeration System ❑aioo.000eTu ❑ioo,000 System Repair/Alteretion Fire Dampers Regizters Issue Fee 0 FEES $ 3 S 3 A.P. 5W S Main Building: E T Front ARear C Righ[ g Left Ping. Ref. # Planning Notes: 5883 1� — � p i� j �K/ Zone Accessory Buildin9: Parkin9 Req./Provided ELECTRICAL Automatic Washer � � Transformer ❑ 15-50 KW Construction Pole Sub. � 50+ KW Cooktn9 Unit _ Meter ❑up ro 100 amps' Dishwasher Merer ❑over 100amps Dryers ❑Gas ❑Electric Sub Panel Fan Momrs 041 HP � 1'f..- 8 F.A.U. Inc. Solar �9�15 HP �16� Fixtures Microwave Device Boxes Pole Light Outlets Range Switches Garbage Disposal Generator �0.5 KW �5-15 KW Standing Sections Trash Compacror Fee I$15 I � luue Fee DEVELOPMENT SERVICES RE�UIREMENTS: Zoning Approved By BuildinB APProved BY � Appliwtion luued By- � n 15t 1800(' TL FEES S 3 - SUM M�AR�V� FEES � BUILDING PERMIT $ _L/iZ SMIP 5 '� PLAN CHECK $ PERMI7 PLUMBING S ISSUANCE 5 PLAN CHECK 25% $ ENERGV P.C. S ELECTRICAL $ GRADING S PLAN CHECK 50°6 $ MICROFILM 5 /1J� MECHANICAL $ TOTALFEE S ��`��/ PLAN CHECK 25% $ Z O N I N G R E Q M T $ CONSTRUCTION AND PLANNING POOL & SPA APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector t. 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-Undrgmd. _ 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE � 7. Footings � 58. Electrical Conduit�Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Und�grnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 70. Structural Floor Svstem 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains � 64. Plumbing System - Final � 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Appro'val 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling � 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # _ 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating '' 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing . 73. Unde}grnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75.. Dry Chemiral 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 Firep�ace ' 38. Final Plumbing � 39. Water Service-Final � � 40. Gas Service-Final ' 41. Solar pomestic-Final - 42. Backflow Preventer i „ 43. Backflow Irrigation � � ' r 44. Landscape Irrigation System � 45. Sound Attenuation '46. Handicap Regulations ' � 47. FINALSTRUCTURE&BUILDING � � . 48. Special Requirements Completed 49. Electric Release to Edison � 50. Gas Release to Southern California Gas Co �- 51. CERTIFICATEOFOCCUPANCY. , �� No. Date � ' � � ,� �� • ", � �STA MESA BUILDING•SAFETY DEPARTMENT �� P. O, BOX Si7 COBTA MEBA. CALIFORNIA For Appliean+ +o Fill In Compleiely TYPE OR PRINT ADO EISS � /% �� COSTA MESA. CALIFORNIA �wNFp L. �xr,�GY � 1Jd REY IA�ORESS 77 � �• /� ■ BTATE �l I NO. OP B1D09. USE OF EXISTING BLOG � 66TBACK LINe PROM ILEFT �� I RIGHT L DESCRIPTION OF WORK / EXTERIOR WALL r� ROOF COVERING �S/1�LCC COVEI U6E OP BUILDINO AND WORK TO I �� '�1�� •. APPLICATION F��P�h��' �� BUILDING For Offiee Use Only REC¢IPT NO. P.BRMIT, NO. HEG8IVHD BY DATB R8C81V8D �, � �i BUILDI � � ADDREBS COSTA MESA. CALIFOR � FIRE ZONE TYPE GRC APPROVED� BY DATE / ZONING 20! �I HO.OP �8H OP N PLAN9 BUILDINO LBG�L �O � I � oesca�rriora A. P. NO. ^ � •✓ YARDS EVES APPROVED ALLOWED ICEM[R L1N8 BTJ .� . � � i � � - � A � ��, _ . 1 HERBBY �CNNOWL¢DOH TNAT 1 XAVB HBAD THIB MPLIWTION THE AMOUM 6HOWN UNDHR VALUATION IB POR TH8 AND 8TAT8 TNAT TH8 ABOVe 19 CORHECT ANO A6RE8 TO COM- pUPP088 OP HBTABLI8NIN0 A PeRMIT R86 ONLY. PLY WITM ALL CITY ORO ANC88 AND 8TAT8 9 ReOULATINO eU1lDIN0 CON6TIIUCT � VALUATION PERM^ITTEe OF � PERMIT FEE $ /i 3 y�'O'� V� PLAN CHEGK S /• OG AUTHORIZED AGENT -� _ � 7 N �, �