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Home My WebLink About493 19TH ST - Building Permits(714) 754-5v3 • Fax (��4) 75a-ae56 • www.ci.costa-mesa.ca.us 77 hAIM UMIVt, GUJ I A MtAA, GA tlZti20 Job Address: 493 E 19TH ST Suite No A Vicinity: Parcel Nunmber: 71734122 Applicant: KELLY PYKA Address: 21925 JINETES MISSION VIEJO Owner: SARINAS, JEAN M TR Address 11059 CqMIN1T0 ARCADA SAN DIEGO, CA PLUMBING PERMIT Phone: 949-454-8233 Zip: 92691 Phone: 85&735-4935 Contractor. KELLY pYKA CONSTRUCTION Address: 21925 JINETES MISSION VIEJO Zip: 92131-3667 Phone: 949-454-8233 Zip: 92691 License: 609254 ISSUED BY: SCOPE OF PERMIT ADD 129 SF. REF BOS00006. 1 TOILET, 1 WASH BASIN AND 1 SHOWERlfUB COMBO. AND 1 SEWER CONNECTION ISSUE FEE BackFlow irrigation BackFlow Preventer Bathtub Clarifier System Connect Qce,Soda,etc) Dental Units Dishwasher Drain, Floor Orain, Rainwater Orain, Roof Drinking Fountain Expansion Tank Gas Earthquake Valve Gas (1-4 outlets) Gas (Over 4 outlets) Gas Repipe Gas Service Interceptors (Grease, Oip Interceptors (Sand Auto ) AMT 523.50 $O.OQ so.00 so.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 so.00 $0.00 30.00 � 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FEESUMMARY AMT Launtlry Tub / WaSher $0.00 Landscapelrtigation $0:00 P-Trap $0.00 Pressure Regulator . $0.00 Process Piping (per 70 ft) $0.00 Receptors $0.00- Seplic Tank $0.00 Sewer Cap for Demo $0.00 Sewer Connect $24.65 Sewer Private Line 50.00 Shower $9.80 Sink, bar $0.00 Sink, commercial 50.00 Sink, Floor $0.00 Sink, kitchen � $0.00 Sink, service/mop $0.00 Spa (private) $0.00 Spa (public) � � $0.00 >� �TY 0 0 0 0 0 0 0 0 1 0 � 0 0 0 0 0 0 0 ,. Status: ISSUED Applied: 02/22I2005 Issued: OZ22/2005 SumpPump Swimming Pool Trap Primer Urinal Vacuum Brkr BkAow(1-4) Vawum Bikr BkBow(5�) wash Basin Wash Basin Set Waste and Vent System Water Closet (Toilet) � Water Healer / vent Water Piping (Inst or Rep.) Wafer Re-pipe Water Service � �Water Sokener OTHER . VIOLATION '. PLANCHECK � REINSPECTION AMT so.00 so.00 so.00 $0.00 so.00 60.00 89.80 30.00 50.00 39.80 50.00 50.00 50.00 50.00 50.00 $0.00 50.00 50.00 $0.00 QTY 0 0 0 0 0 0 t 0 0 1 0 0 0 0 0 0 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, § 1, 1241•92) EXPIRATION: This permit shall automatically ezpire and become void if work is not cammenced within 180 days, or if work Is suspended or abandoned for e period of 180 days. INSPECTIONS: In order for ihe work authorized under this permit to be considered legel, such work must comply with all appliCeble codes, and 811 requlred Inepeetlona end finel approval must be obteined. Failure lo obtain inspections end final approval will result in the expiratlon ol this permit. FOR INSPECTIONS CALL: (714) 7545626 _ 2aasae(aroo) WORKERS'COMPENSATON DECLARArON: � I hereby eHirm under penalry ot perjury one of t�e following declaratlons: ❑ I heve entl will melntein e cenilicata ol consent to sell-Insure tar workers' compensatlon, as provided tor by sectlon 3700 ot the Lebor Code, for ihe peAortnflnce oi che ork tor w�ic� thls permit is issuetl. I heve and will meintain xrorkers' compensation insurance, as reduired by sectian 3700 of Ne LeDor Cotle, lor Ne peRortnanca of Ne work la whkh this pertnit is issued My workers' comp tion Insurence cartler a polcy number are: Cartier. �1J�� c-2 � Poliry Numher. ��(xi�� / (Tnrs secHon neeC nof be complefed Ir Ne permlt rs lued er one nwMred dollers (s 100) or less.) ❑ I caritly ihat in the pertormanca of the work lor which this partnit is issued, I shall noi employ any peroon In eny menner so es co bewme sub�ect to ihe workers' compensation lews oi Callfo�nia, gree the i I should Eecome subject to the workers' compensellon provislons af Sectlon 3700 ot t�e Lebor Cotle, I shall torthwith comply with Ihesa proviy S Applicant Sipnature: � Dete: �— � 2 "O� WARNINO: FAILURE TO SECURE WORI(ERS' ENSATION ODVEMOE IS UMAWFUL ANO S WLLl SU&IECT Ml EMPLOYER TO CFIMINAL PENALTIES AND CML FlNES UP TO ONE HUNDRED TFKKISAND DOLURE (5100,000�, IN ADDITI T THE ODST OF COMPENSATION, DAMAGES AS PROVI�ED FOH IN SECiION �OB OF THE UBOR CO�E. IMEREST, PND ATTORNEY'S FEES. IICENSEDCONTRACTORS DECIARATION: I hereby affirtn that I am Ilcense under provlslons ot Chepter 9(cammenGng with Sectlon 7000) of Dlvlslon 3 af Ihe Buslness end Professlons Catle, and my Iicense Is In full force end eHect. Llc. q Z �-i Cless p �J CantrectofsSlgneNre: �� _R Dete: �—%J—GS�— CONSTRUC710N LENDING AGENCV: V ❑ I hereby effirm thet Ihere is e canstruction lending agency for the peAortnance ol Ihe work tor whic� ihis permlt Is issued. (Sec. 3097, CIWI Cotle). Lendefs Name: Lenders Address: Signeture: OWNER-BUILDER DECLARA710N5: Date: I hereby eNirtn Ihet under penelry af perjury thal I em EXEMPT FROM THE CONTAACTORS LICENSE LAW for Ihe Iollowing reeson (Sec. 7031.5, Business entl Professions Cotle: Any ciry or caunry which requires a pertnit to construct, eltar, improva, demolish, or repair any sWCNre, pnor to its issuance, elso requires Ihe epplicant for such pertnit to Nle e signetl stetement Ihet he or she is Iicensed pursuant to Uie D«sions of Ue Gontrectors License Lew (Chepter 8(cammencing with Sectlon 7000) 01 DMslon 3 of the Business antl Profe55ions Code) or Nat he or she Is exempi therefrom antl the basis for Ihe allege0 exemptlan. Any Ndation of Sectlan 7031.5 by eny epplicant tor a pertnit subjecis ihe epplicam to e dNl penalry at not more Ihan tNa hundred dollars (5500) J: ❑ I, as owner ot Ihe property, or my employees with wages es their sde compensetion, WILL DO THE WORK, end the siructure Is not IntendeC or otteratl tor sale (Sec. 7044, Busineu end Professions Cade: The Cantrectors License Law dces not appty to an owner ol properry who builtls or Improves therean, end who tloes such work himselt or herself or Ihrough his or her own emplqrees, provided that such improvements are not intended or oMered tor sale. If, however, the building or improvement is wltl within one year oi completion, ihe ownerbuilder will have tha burden ot proving Ihat he ar sha did not builtl or Imprwe lor purpose ol sale.). � ❑ I, as owner oi tha property, am EXCLUSIVELY CONTAACTINC WITH LICENSED CONTRACTORS to cronstruct Ihe project (Sec. 7044, Busineu anG Proteuions Code: The contractors lJcense Lew does not appy to en owner oi property who builds or Improves ihereon, end wha cantrects tor such pro�ed with a coniractor(s) license pursuant lo the Cantractors License Lews.). ❑ I am exempt under sec. Business enA Pmtessions CoCe for this reeson: Signeture: Dete: Owner ID verllletl by tlrivefs Ilcense. ❑ Ves ❑ No Drivets License No. Expires: Verificatlon of Owners�ip by (type of document, i.e. - property tex bill or deed): DIVISION OF INDUSTRIAL SAFE7Y PERMIT CERTIFICATION: ❑ I hereby cartify that no excaveilon tive (5) or more feet in depth inta which e person is required to descend, wlll be made In connection with work authorizetl by ihis permil, end that no builtling s�ructure, scaHolding, falsework, ar demditian ar dismantling Ihereol, will be moro then Ihirty-slz (36) feet high. (Chep. 3.2, Grp 2, Art 2, Sec. 341, Title 8, Califomia Adminisiretive Code). ❑ As ownerbulltler, I wlll not employ enyone ta do work which would require e pertnit Irom the Dlvislon of Intlustrlel Sefery, as nated eDove, unless such person has e permlt to do such work Imm the tlivlsion. Signature: Date: Division oi Industrial Salery Permit Number: CERTIFICATE OF COMPLIANCE AND AUTHORIZA710N OF E1fIAV: I certity untler penalry ol perjury that I heve read ihis epplication and state ihet the information given is correct. I agree �o comply with ell stete lews end clty orEinences relating Io builtling constructlon, entl authorize ropresentetives ol the Ciry oi Costa Mesa lo enter upon Ihe ebove-describeC property lor inspaction purposes. I egree not to accupy or ellow acupency of eny builtling euthorized by this permil until finel inspectlon. COUE I, INSPECTIONTYPE Q� UIDR�Ii$ 1616 Fixed System Final Fire Preventlon 1288 200 Pool Spa Finel Finel Ro-Rool 201 Final BIocWRetaining Wall 202 Final Factory Fire Place 203 Final Sign 204 Final Demolitlon � -7�� Date COpE1 INSPECTIONTYPE Qd¢ �� 208 Final Mechanicel ,� 208 FinalPlumDing � O-1.17 � 210 Flnal Electrical 212 Flnal Flre Preventlon 220 Flnal Planning ApOroval 222 Flnal Site 250 Final BuilAing/Occupanty (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR OHIVE, GUSIA MtSA, GA 9'Lti2ti ELECTRICAL PERMIT Job Address: Suite No Viciniry: Parcel Nunmber: Applicant: Address: Owner: Address 493 E 19TH ST A 11734122 KELLY PYKA 21925 JINETES MISSION VIEJO SARINAS, JEAN M TR 11059 CAMINITO ARCADA SAN DIEGO, CA Contractor. KELLY PYKA CONSTRUCTION Address: 21925JINETES , 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 1000a . Service over 1000a Malors to 1hp Motors to 10hp Motars to SOhp Motars to 100hp Motors over 100hp Communication drops Sub panel to 200a Pate Light Pkg MISSION VIEJO Phone: 949-454-8233 Zip 92691 Phone: 858-735-4935 Zip: 92131-3667 Phone: 949-454-8233 Zip: 92691 . License: 609254 SCOPE OF PERMIT ADD t29 SF. REF BOS-00006. � .. � _ -. 5 LIGHTS, 2 OUTLETS AND 5 SWITCHES. - ` $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $5.50 $220 $5.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 - $0.00 $0.00 $0.00 Quantity_ 0 0 0 5 2 5 0� l 0 0 �0 0 0 p.. 0 0 0 0 0 0 FEE SUMMARY � � Temp Dist Syslem /•Lighting Busway /100 ft 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 kva/kw � � Low Voltage Equipment - ' - � Low Volt Wiring System / Ck . Misc. Conduit � ., Misa Conductor . - Cirws ( gen or ride)� � - . � � • Circus (mech ride or lights) "� - Christmas Tree Stand � � ., Fireworks Stand �- , � � Other Electrical Fee Investigation Fee � � Plan Check Fee-�.,, '� - � �Reinspection Fee � � Status: ISSUED Applied: 02122/2005 Issued: 02/22/2005 ISSUED BY: � Quantiry $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 f $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 $0.00 $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related ragulations. (Ord. No. 92-28, § 7, 12-27•92) E%PIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if woik is suspended or abandoned 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 inapectlona 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 , 2aasas (sioo) WORKERS'COMPENSAnON DECLARArON: ' I hereby eHirm untler penalry of parjury one o� the following declaratlons: ❑ I have entl wlll main[aln a certllicete ol consent to setl-Insure tor workers' compensation, es provitletl tor by saction 3700 ot ihe Lebor Cotle, for tha pe�ortnance oi the � work for whlch this permit is Issued. �I heve end will maintain workere' compensatlon insurance, as required by section 3700 ot the Labor Code, tor the perfortnance of the work for which �his pertnit is Issued. My workero' compensetlon Insurence Gerner policy number ere: Certier. ty,_�U2�%2n� /�� PolicyNumber. ��aC��S I (Th/s section neetl not�/ie pB�nit ls alued af one hundred dollers ($100) or less.) ❑ I certify ihat In Ihe performanca of Iha work for which this Dermit is Issued, I s�all not employ any person In any manner so as to becoma su0ject to Ihe workers' compensatlon laws of Gelito , nl eBrae Ihet � shoultl 6ecome sub�ect to the workers' compensatlon proNsions of Section 3700 of the Lebor Cotle, I shall foehwlth comply with these provisiQ s ^� ApplicantSipnature: � Date: /`- � Z—i) WARNINO: FAILURE TO SECUR WORKERS' SATION CAVERAGE IS UNLAWFUL PND SMALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND GVIL FINES UP TOONE HUNDRED T110USANDDOLLAiiE($100,000),INADDRION O ECOSTOFCOMGENSATION,DAM4GE5lSPROVIOEDFORINSECilON3/O60FTHELABORCODE,INTEREST,ANOAT70RNEV'SFEES. LICENSEO CONTRACTOHS DECLARATION: I hereby aHirm that I am license nd rov�sions f Chapter 9(commencing with Section 7000) of DIvlslon 3 of Ihe Busin and Professlons Code, entl my license Is in full farce end eflect. Lic. a Class q� Contractofs Signeture: Dete: � _�� CONSTRUCTION LENDING AGENCV: ❑ I herehy aHirtn thal there is e consiructlon lending agency for Ihe perfortnance of ihe work tor which ihis permit is issuetl. (Sec. 3097, Civil Cotle). Lendefs Nema: Lender's Address: Signeture: OWNER-BUILOER OECLARATIONS: oate: I hereby eHirm Ihat under panalry ot perjury t�et I em EXEMPT FROM TME CONTRACTORS LICENSE LAW lor the tollowing reason (SecJ031.5, Business entl Pmtesslons Cotle: Any ciry or counry which reQuires e pP�mit to construct, elter, improva, tlemolish, or repair any structure, pnor lo i�s issuance, elso requires the epplicant for such permit to lile e signetl statement �hat he or she Is Iltensed pursuent lo Ihe proWslons of the Contraaors LJcense Lew (Chepter e(commencing with Sectlan 7000) oi DMsion 3 oi the Business antl Professions Code) or Ihat he ar she is exempt therelran antl the 6as15 for Ihe ellegad exemptlon. Any violatian of Section 7031.5 by eny epplicant for a pertnit suD�ects the appliwnt to a clvll penelry ot not more than five hundred dollars (5500�.j: ❑ I, as owner of ihe properry, or my employees with wages as Iheir sole compensatlon, WILL DO THE WORK, and Ihe structure Is not Intentle0 or oHeretl for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an axner of property who builds or improves thereon, end who tloas such work himself or herselt or Ihrough his ar her own emplayees, provitletl t�at suc� improvements ere not intendad or oHered tor sele. If, howevar, Ihe building or improvemen� is sold within one year oi completion, ihe owner-builtler will have ihe burden oi proving that he or she did not bulld or improve for purpose ot sale.). ' ❑ I, as owner of Ihe propehy, am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to consiruct the project (Sec. 7044, Business ana Protesslons Cotle: 7he contractow License Lew does not apply to en owner of pwperty who bulltls or improves thereon, antl who contracis lor such pro�ect wlih e contractor(s) license pursuant to the Contrectore License Laws.). ❑ I em eaempt under sec. Business end Protessions Code for this reeson: Signature: Date: Owner ID venfied by drivals license. ❑ �es ❑ No Drivefs License No. VerilicaHon at Ownership by (type ol document, i.e. - property tax bill or tlaetl): Ezpires: DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATON: ❑ I hereby certity ihat no excavetlon Ilve (5) or more feet in depih into which e person is required to descend, will be mede in connedion with work authorized by Ihis permit, and ihat no building structure, s�attolding, falsework, or demolition or dismantling ihereof, wltl be more than ihirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title B, Calitornia Administretive Code). . ❑ As owner-builder, I will not employ anyone to do work which would reQulre e permit from the Divislon of Industriel Safety, es noted ebove, unless such person has e pertnit to do such woAc hom the division. Signature: Date: Division of Intlustnal Safery Permit Numbar: CERTflCATE OF COMPLIANCE AND AUTHORIZATION OF ENiAY: I certify under penalty of perjury iha� I have read �his applica�ion and s�ate tnet Ihe information given is correct. I agree to comply wlih all staie laws end clry ortlinances relating to building constructlon, and authorize representatives of ihe Clty of Costa Mesa to enter upon the ebove-descnbed property for inspection purposes. I agree not to occupy or allow occupancy ot eny building au�horized by ihis permit until final inspection. COUE I. INSPECTIONTYPE 1616 1266 200 201 202 203 Fixed System Final Fire Preventlon Pool Spe Final Finel Re-Root Finel Block/Retaining Well Final Factory Fire Place Finel Sign 20a Final �emolition PA1F I[RII19L5 2.-2��i�� cooe� ixsvecnoxnve 206 Final Mechanical 208 Finel Plumbing 210 Finel Electncal 212 Finel Fire Prevention 220 Finel Planning Approval 222 Finel Site 250 Final Builtling/Occupancy � � i • �� (��a) �54-52�3 • Fax (71a) 754-4856 • v+ww.ci.wsta-masa.ca.us n rniH unrvt, cu� i n meaN, cN yzozo PLUMBING PERMIT �obAddress: 493 E 19TH ST Suite No Vicinity: Parcel Nunmber: 11734122 npp�icant: COMBS, LANDON Address: 3801 LENAWEE AVENUE CUWER CITY, CA ownec SARINAS, JEAN MSR Address 11059 CAMINITO ARCADA - , - SAN DIEGO, CA/" � i � . Phone: 310-838-0408 Zip: 90232 Phone: (714)337-7210 2ip: 92131-3667 Contractor. ORANGE COUNTY SERVICES INC DBA GEORGE BRAZIL PLU Address: 3801 LENAWEE AVE � � Phone: 310.253-5229 CUWER CITY, CA ' Zip: 90232 � License: 679898 SCOPE OF PERMIT INSTALL 2`�G6J CLEAN OUT FOR SFD. � � ISSUE FEE Backflow irrigation Backflow Preventer Bathtub Clarifier System Connect (Ice,Soda,etc) Dental Units Dishwasher � Drain, Floor Drain, Rainwater , Drain,-Roof Drinking Fountain Expansion Tank Gas Earthquake Valve Gas (1-4 outlets) Gas (Over 4 outlets) Gas Repipe Gas Service � - Interceptors (G�ease; Oip Interceptors (Sand Auto ) AMT 823.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 so.00 50.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00, $0.00 QTY" 0 0 0 0 0 ' 0 0 0 0 0 0 0 0 0 p�.-�� - 0' ., . 0,=�, 0 Q FEE SUMMARY AMT Laundry Tub / Washer 50.00 Landscape Irrigation $0.00 P-Trap $0.00 Pressure Regulator 80.00 Process Piping (per 10 ft) ,$0.00 - - ReceptorS � $0.00 � Septic Tank $0.00 Sewer Cap for Demo $0.00 SewerConned .$0.00 Sewer Private Line $0.00 Shower 50.00 Sink, bar � - $0.00 Sink, commercial $0.00 Sink, Floor 50.00 . Sink, kitchen $0.00 � � Sink, service/mop $0.00 Spa (private) � , $0.00 " Spa (public) 50.00 gN 0 o. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 � . - _ COMMENTS / SPECIAL CONDITIONS Status: ISSUED Applied: O1I032006 Issued: 01/03I2006 ISSUED BY: � SumpPump Swimming Pool Trap Primer Urinal Vacuum Brkr Bkflow(1-4)� Vacuum Brkr BkOow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (foileq Waler Heater/ vent Water Piping (Inst or Rep.) Water Re-pipe Water Service W aler Softener OTHER VIOLATION , PLAN CHECK REINSPECTION TOTAL CALCULATED FEES: AMT so.00 so.00 $0.00 $0.00 $0.00 $0.00 so.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $9.80 $0.00 50.00 $0.00 533.30 � 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 NOTICE: The work aulhorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) . EXPIRATION: This permit shall automatically expire and become void if work is not commenced wi�hin 780 days, or it work is suspended or abandoned tor a period of 180 days. INSPECTIONS: In order tor the work authorized under this permit to ba considered legal, such work must comply with all applicable codes, and all requlretl inspectlona end final epproval must be obtained. Failure to obtain inspections and tinal approval will result in the ezpiration of this parmit. FOR INSPECTIONS CALL: (714) 754-5828 zaa+e �e�no� WORKERS'COMPENSAnON DECLARAnON: I hereby eKrm untler penalry of perjury one of Ihe following tledaretlons: ❑ I have entl wili maintein a certificate of consent lo selt-Insure for workers' compensation, es provitled lor by section 3700 0l ihe Lebor Code, tor Ihe pertormance oi the �rinrKlor which this pertnit is issuetl. Q I.Aevo efM will malntain wakers' cwn nsation insurance. as } Pe required by settlon 3700 of Ihe Labor Cotle, for the pertormence of Ihe work tw wNch Nis permit is Issued. �workere' compen}a� insurance carder p�ber ere: 7 �Cerrie � (s � �- Gi Pptfcy Number �� '� Z/ 'a�i �(T�H secNar nee0 no com0�efed i! fhe permit is valued et one huntlred dollars ($100) or IessJ � r ❑ I certity Ihat in the perta�ance ol the work for whic� this pertnit is Issuetl, I shall not employ any person In eny manner so as to 6ecoma sub�ect to t�e workere' compansatlon lews ot Celifomie, end egree t�et II I shauld Oocome su6fect to the workers' campensatlon ptavislons of Sectlon 3700 oi the LeDor Code, I shall forihwith comply with Ihnse provis��s. �'�'� �ApplleBnt'StgnaNre: r-7 ppf �� 3 Z r 'WnRMNG FAILURE TO SECU RS' COMPENSATION COVERAGE IS UNLAWFUL AND SHFLL SUBJECT AN EMPIOYER TO CRIMINAL PENALTIES AND GVIL FlNES UP TOONE HUNDRED TIKK/SAND OOLLARE (E100,000), IN MDITION TO THE CAST OF CAMPENSATION, DAMAGES AS PiiOVIDED WR IN SECTION 3108 OF TME IABOR COOE, IMEREST, AND ATfORNEY'S FEES. CONTRACTORS DECLARATION: �n�IhaLLam IicenSeO undar provisic end ot Chaptar 9(commencing with Section 7000) of Division 3 ohMe�Business and Pi9fessions Code, and my license Is in full Glass a � � i -� oec��j � —,3=rr CONSTRUCTION LENDING AGENCY: ❑ I hereby eHirtn t�et there is e construction lending egenty for Ihe peAormance ol �he work far which ihis pertnit is issueO. (Sec. 3097, Civil Cotle). Lenders Neme: LenOers AtlUress: SlgnaNre: Date: OWNER•BUILDER DECLARAnONS: I hereby ettlrtn Ihet untler pendlty of perjury Ihat I em EXEMPT FROM TME COMRACTORS LICENSE LAW tor the following reeson (Sec. 7031.5, Business end Professians Catle: Any city or counry whicP �equires a permlt to consimct, elter, improve, tlemolish, or repalr any siructure, pdor lo its luuance, elso requlres Ihe epplicant lor such permil to flle e slgned stetement ihat he ar she is Ilcensed Dursuent ta the O�oNslons oi Ihe Comrectars License Lew (Chapter 9(commencing with Sectim 7000) ot DiNslon 3 of �ha Business ena Protessions Code) or that he or she is exempl t�eretrom and the basis lor Ihe elleged exemption. Any doletion o� Senion 7031.5 by any epplicant for e permit sublects ihe flpplicant to a clvil penalry of not more �han live �untlred dollers (5500).): ' ❑ I, es owner oi Ihe propeM, or my employees with wages as t�elr sole compensetion, WILL DO THE WORK, antl Ihe slrucWre is not IntendeC or oHered tor sale (Sec. 7044, Busineu and Protessions Code: The Contracbrs License Lew tloes not apON �o an owner of properry who hullds or improves thereon, antl who does such work himsell or herselt or through his or her own employees, provided Ihai such improvements ere not intended or oHered tor sele. If, however, Ihe builCing or improvement is soltl wit�in one year ot completion, ihe owner-builtler will have the burden ol proving that he or she did not build or improve for purpose of sale.). � ❑ I, es owner oi the property, am EXCLUSIVELY CONTRACTNG W17H LICENSED CONTRACTORS to construct the prqect (Sec. 7044, Business and Pwfessions Cotle: The contractors lkense lflw does not apply to an ow�er at propeny who builds w Imp�oves thareon, e'W wtro conVacts tor such pro�ect wiih a wntractor(s) license pursuant to the CF�«actors License Laws.). ❑ I am exempt under sac. Slgnature: Owner ID verified by tlrivers licensa. ❑ Yes ❑ No Business and Pmfessions Code for this reason: Venfiwtion ot Ownership by (type ol tlocument, I.e. - properry te.r 6ill or tleed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTFICA710N: Driver's License No. Date: E�cpires: ❑ I hereby cenity that no e%��atlon five (5) or more leet In tlepth Into which e person Is required to descentl, wlll be made in connectlon with work authodzed by this pertnit, end that no builtling structure, scaHolding, lalsework, or demolition or dismentling thereof, will Ge more then thirty-six (38) teet high. (Chep. 32, Grp 2, Ah 2, Sec. 341, 7tle B, Calilornla Adminisiretive Cotle). ❑ As ownao-builtler, I will not employ anyone to tlo work which would require a Dermi� from ihe Divislon ot Intlustrial Sefety, es noteA aDwe, unless such person has a permit to tlo such work irom the tlivision. Signature: Date: Division ot Industrial Safery Pe�it Number: ICERTIFlCATE OF COMPLIANCE AND AUTHORIIATON OF ENTAY: I cenity untler penalcy ot perjury that I heve �ead this application and state that the informatian given is I correct. I egree lo comply wlt� ell stete laws end dry ortlinances releting to builtling construction, en0 euthorize represemetives ol the Ciy of Coste Mesa to enter upon ihe ebove-described properry lor inspection purpases. I egree not to occupy or allow occupenty ot eny builtling au�honzed by this permil until finel inspection. COUE /. INSPECTIONME 16}g Fixed System Finaf Fi(e Prevsatbn 126fi Pool Spa Final 200 Final Re-Root 201 Final BIacWRetaining Wall 202 Final Factory Flre PIaCe 203 FInelSign 204 Final Domdlibn �jE � j�QQEj INSFECTONNPE 2�6 Final Mechanical 208 Final Plumbi�g 210 212 220 Final Electdcal Finel Fire Preventlon Final Planning Apprrnal 222 Final Site 250 Finel Building/Oaupancy PdI& 1N�lELS (774) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR OFIVE, GOSTA MESA, GA 9262ti BUILDING PERMIT Job /+ddress: 493 E 19TH ST Suite: A Vicinity: MASTER BEDROOM AND BATH Parcel Number: 11734122 Applicant: PAYKE,KELLY Address: Owner: SARINAS, JEAN M TR Address 11059 CAMINITO ARCADA SAN DIEGO, CA Contracror. KELLY PYKA CONSTRUCTION Address: 21925 JINETES Zoning: Phone: 949-454-8233 Zip: Phone: (714)337-7210 Zip: 92131-3667 Phone: 949-454-8233 ISSUED BY: Stalus: ISSUED Applied: 01/OS/2005 Issued: 02/22/2005 MISSION VIEJO Zip: 92691 License: fi09254 Arch : WALTER HEIM, AIA Eng: ESI I FME Address: 508 WESTMINSTER AV Address: STRUCTURAL ENGINEERS Phone: 949-645-7089 � SANTA ANA, CA Phone: 714-835-2800 NEWPORT BEACH, CA 1800 E 16TH ST Zip: 92636 license: C13423 92701 License: 36840 SCOPE OF PERMIT CONSTRUCT 129 SF ADDITION TO INCREASE THE SIZE OF AN EXISTING MASTER BEDROOM AND BATHROOM. Plan Check: $163.31 Permit: $251.25 SMIP Res: $1.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $416.06 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0-0 PARKING Existinq: o NOTES: - Rear� � 0-0 Rear 0- 0 Re uired: 0 FEE SUMMARY PLANNING 8 ZONING Left 0- 0 Left 0- 0 Proposed: 0 Calc Valuation: Claim Valuation: Right 0- 0 Right " 0-0 ' � $15,000.00 si s,000.00 NOTICE: The work authorized by this permit shafl compfy with all appficable handicap access requiremenis under Califomia statules and related regulations. (Ord. No. 92•28, § 7, 12-21-92) E%PIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or If work is suspanded or ebandoned for a period of 180 days. INSPEC710NS: In order tor ihe work authorized under this permit to be consideretl legal, such work must comply with all appllcable codes, antl all required Inspeetiona and final approval must be obtained. Failure to obtain inspections and final approval will result in the ezpiration of lhis permit. FdR INSPECTIONS CALL: (714) 7545626 zus-ae (sioo) WORKERS' COMPENSATION DECLARATION: I hereby ettirm under penelty oi perjury one ot the following declarations: �] I have and will melntein a ceNficete oi wnsent lo selbinsure for workers' compensation, as provided for by seciion 3700 of the Lebor Cotle, far Ihe peAortnence ot Ihe wwk lor which thls permit is issued. � I �ave antl will maintein workers' compensation Insurance, as repulred by section 3700 ot the Lebor Cotle, tor the peAortnance of the work tor which this pertnit is issued. My work rs' mpens n I nce Carder entl pollcy number ere: Carrier: �'�_� poticy Number: I% OO � S I (ThLs section need nat be cromp/efedll fhe perm�f is ve/ued et one hundred dollars (5100) orlessJ ❑ I cenify that in t�e peAo compensetion laws ot C comply with these pro Applicant Slgnature: � WARNINO: FAILURE TO SE�IRE THOUSIWD DOl1ARE (5100,000), work tor which lhis permit Is issued, I shall nat employ eny person in any menner so as to become subject to the workers' egree t It I s�ould bacome subjecl to the workers' compensetion provlslons oi Section 3700 ot Ihe Lebor Code, I shall forihwith Data: � � � L'�� PENSATION COVERAGE IS UNLAW � AND SHML SUBJECT MI EMPLOVER TO CRIMINAL PENALTIES AND dVIL FlNES UP TO ONE NUNDRED ) THE WST OF COMPEN$ATION, DAAMGES AS PROVIDED FOfi IN SECf10N 3]080F THE LPBOR CODE, IMEqEST, AND ATTORNEI"S FEES. IICENSED CONTRACTORS DECLARATION: I hereby afllrm Ihat I am force and eHect. Lic. N_ Contractol& SignaNre: tONSTRUCTION LENDING AGENCV: of Chepter 9(commencing with Section 7000) of Division 3 ot tha Business�nd Protessions Cade, and my license Is in tull Glass a _� ,�n Date: � — �� d I hereby aKrtn ihat there is a consiruction lending egenty for ihe peAormance ot the work for which this pertnit is issued. (Sec. 3097, Civil Cotle). Lentlers Neme: Lentlers Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby ettirtn that under penelry of per�ury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW tor the tollOwing reason (Sec. 7031.5, Business end Professions Code: Any ciry or counry which requires e pertnit to construd, alter, improve, tlemolish, or repair eny structure, prior to its issuance, elso requires the epplicant for such permil to file e signed statement ihat he or she is Ilcensetl pureuent to t�e provlslons of tha Contrectors License Lew (Chepter 9(commencing with Sectlon 7000) of Dlvlslon 3 of the Business end Professions Code) or thet he or she is e:empt theretrom end Ihe basls tor tha alleged exemption. Any vloletion oi Sectlon 7031.5 by eny applicent 1or e permit Subjects the appticant to e dNl Oenatry ot nat more than flve hundred tlaltars ($500)J: ❑ I, as owner of Ihe properry• or my employees with weges as thelr sole campensation, WILL DO THE WORK, antl t�e structure is not intantletl or oHeretl tor sale (Sec. 7044, Business and Professions Code: The Conlractors License Lew dces not apply to an owner of property who builds or improves Ihereon, entl who tloes such work himself or herself or Ihrough Ms or her own employees, providetl that such improvemenis are not Intended or oHered tor sale. It, �owever tha bullding or Improvement Is sold within one yrear o! cnmplation, the owner-bu'dder will have the burden ot proving that he or she did not build or improve !or purpose of sele.). � ❑ I, as owner of the property, am EXCWSIVELV CONTRACTINC WITH LICENSED CON7RACTORS to conswcl the project (Sec. 7044, Business and Pro1e55ions Code: The contractors Llcense Lew does not epply ta en owner ol property who builds or impwves thereon, and w�o wntrects lor such pmject with a contractor(s) license pursuant to the Coniractors License Laws.). ❑ I am exempt untler sec. Signature: Owner ID verltied by driver's license. ❑ Yes ❑ No 9usiness an0 Professions Code (or thfs reason: Vedfication of Ownership by (type of documenC i.a. - property tex bill or deed): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION; DriveYs License No. Date: Ezpires: ❑ I hereby certity that no excavatian flve (5) or more teet in dep(h inro which a person is required ro descend, wiil be mede in connection vnth wark aathonzed by fhis permit, and that no building structure, scettolding, falsework, or demolition or tlismentling ihereol, will be more than thirty-six (38) feet high. (Chap. 32, Grp 2, Ar12, Sec. 341. T1Ue 8, Galitomia Atlministretive Code). � ❑ As owner-6uilder, I will not employ enyone to tlo work whicb would require e permit irom Ihe Divlsion of Indusidel Safety, es notetl above, unless such person bas e permll to do such work irom the division. Signature: Date: Division oi Industrial Setery Pertnit Number: 1 CERTIFlCATE OF COMPLIANCE ANU AUTHOFiQAiION OF ENTRY: I cenify under penalty of perjury that I have read Mis applicetion and state that the intortnetlon given is Icorrect. I agree to comply with all stele lews antl city oMinences relating to Cuilding construction, end euthonze represeniatives ot t�e Ciry oi Costa Mesa to enter upon the ebove-descnbetl property tor inspection purposes. I agree not to occupy or allow occupancy of any building au�horizetl by this permit until final inspection. COOE 1. INSPECTION TYPE 1616 Fized System Final Fire Preventlon 7266 Pool Spa Finel 200 Finel Re-Rool 201 FIneI Block/ReIalning Wall 202 Flnal Fadory Fire Place 203 Finel Sign 204 FlnalOemoli(ion �F IMITIRlS Date 7-�7�.� Date CO�E� INSPECTIONTYPE 206 Final Mechanical 208 Finel PlumEing 210 Finel Elecidcal 212 Final Fire Preventlon 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy PdIE ItIIIDALfl L-{ - �G-PS- CITY OF COSTA MESA . BIIILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT ,. . PER MBER _ - E99-00066 (714) 754-5273 • Fax (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: Suite No Viciniry: Parcel Nunmber: Applicant: Address: Owner: Address ELECTRICAL PERMIT 493 E 19TH ST A BLDG A 11734122 WILLIAM THOMAS MAHAFFEY 2381 FOXDALE AV LA HABRA, CA JEAN SARINAS COSTA MESA,CA 493 E 19TH ST Contrector: WILLIAM THOMAS MAHAFFEY Address: 2381 FOXDALE AV ISSUE FEE 7emp service test Res. a/c package New Res (t-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 1000a Motors to 1 hp Motors to tOhp Motors to 50hp Motors to 100hp , Motors over t00hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits LA HABRA. CA Phone: 562-6913461 Zip: 90631 Phone: 714337-7210 Zip: 92627 Phone: 562-6913461 Zip: 90631' License: 6� 81 � 0 status: ISSUED Applled: 02/07J7999 Issued: 02I07J1999 SCOPE OF PERMIT �20 LIGHTS, 13 OUTLETS, 5 SWITCHES, 1 SERVICE UP TO 200AMP & 1 CONDUIT. BLDG A. " CONTRACTOR WILL PROVIDE INSPECTOR RWITH ELEC., LAYOUT TO INCLUDE SINGLE LINE DIAGRAM 8 PANEL SCHEDULE. . � $22.00 50.00 50.00 $0.00 $0.00 $0.00 szo.00 $13.00 $5.00 $0.00 $0.00 $27.25 80.00 80.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 so.00 $0.00 $0.00 QuanUty 0 0 0 zo 13 5 0 0 1 0 0 0 0 0 0 0 0 0 0 0 FEE SUMMARY . Temp Dist System / Lighting Busway /700 ft Standing:Sedion Misc Electrical Equipment Transformers up to 1 kva/kw ................up to 10 kva/kw .................up l0 50 kva/kw .................up to 100 kvalkw ..................over 100 kvalkw Low Voltage Equipment Low Volt Wiring System / Ckt Misa Conduit Misa Conductor Circus ( gen or rida) Cirws (mech ride or lights) Christmas Tree Sland Fireworks Stand Other Eleclnwl Fee Investigation Fee Plan Check Fee Reinspection Fee Quantity 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $1625 1 80.00 0 $0.00 0 80.00 0 $0.00 0 50.00 0 50.00 $0.00 80.00 $0.00 E%PIRATION: This permit shall automatically expire and become void ii work is not commenced within 180 days, or if work is suspended or abandoned tor a period of 180 days. . INSPECTIONS: in order tor the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inapeetlona and final approval must be obtained. Failure to obtain inspections antl final approval will result in the ezpiration of ihis permit. FOR INSPECTIONS CALL: (714) 754-5626 WORKERS' COMPENSA710N DECLARATION: � I here0y eHirm under penaly of per�ury one ot the tdlowing tleGerellons: ❑ I have end wlll malntaln e certiflcate ot consent to setl-Insure for workers' compensatlon, es providetl tor by sectlon 3700 ot the Lebor Code, lor the pedarmance of the �wark for w�ich this permit is Issued, I have entl wlll meintein workers' wmpenseiion insurance, es required Gy seclion 3700 oi Ne Lebor Code, for the peAortnance W Iha wark lor w�ich I�is permit is issuetl. My workers' compenseGon Insurance carrler entl policy number are: Certiar: Pollcy Number: (Th/s section neetl nof be Qomp/eted 1!!he permlt ls valued ef one hundred dollers ($100) w less.) ❑ I ceRity Ihai in the pertormance of the work lor which this permit is issue4 I shall not employ eny person in eny manner so as to become subject to the workers' com orrlaw� of Celifomla. and egree that if i shoultl become subject b Ihe workefSLcompenratbu�orn�Asions ot Section 3700 ot the Lebor Cotle, I shall forthwith 'Urttsese pt � isi n5, '` %�� `\ plica f Signature: </ � Date� ) 2� 2—�� WARNI � TO SECIJRE WORKERS' COMPENSATION COV qAGE IS � FUL AND SHML SUflIECT Ml EMPI.OYER TO CRIMINFL PENALTIES /WD GVIL FlNES UP TO ONE HUNORED DOOl1ARE(5100,Opp),INMDITIONTOTHECOSTOFCOlAPENSAT ,�AMAGESASPROVIDEDFORINSECilON3%OBOFTHEUBORCODE,INfEREST,ANDATTORNEY5FEE5. LICENSED I he aMi�jn Ihet I em Il�ensetl rce end efl�d. Lic. M Canlractofs Signeiure: �� ot ChaPter 9(commencing wllh Sectlon 7000) ol DlWslon 3 yNhe Business end P�qfessluns Catle, end my Ilcense is In tull Dete: CQR�TRUC710N LENDING AGENCY: v ❑ I hereby aKrtn Nat ihere is e consiructlon lending egency for ihe peAom�ance of ihe vrork for which Ihis permii is issued. (Sec. 3097, Civll Code). Lendefs Neme: Lendefs Address: Signeture: Date: OWNER-BUILDER DECLARATIONS: I hereby aHirtn thet under penelry oi per�ury that I em E%EMP7 FROM THE CONTRACTORS LICENSE LAW tor ihe tollowing reeson (Sec. 7031.5, Business and Protessians Catle: Any ciry or counry.whlch requlres e parmit to construd, alter, Improva, demdlsh, or repair eny aWcture, pdor to Its luuance, elso requlros the eOD��a�l for such permlt ro tile e signetl stetemenYthat he or ahe is Iicenaetl pursuem ta the pmvislons oi iha Contreaors License Lew (Chepier 9(commendng wit� Section 7000) of Division 3 of the Business arM ProfessionslCoAe) or, that �e or she is exempt tharefrom enC the 6asls for Ne alleged ezemptlon. Any dWatlon of SecUon 7031.5 by eny appliwni tor e permit su6�ects the eppllcanfto'a�inal.penalry.of not mwe than Me hundred tlollars (5500)J: `v_q n �� r . ❑ I, es owner.of the property,:or my,employees with wages es thelr sole compensation, WILL DO THE WORK, end ihe sirunure Is not Intended or oHared tor sele (Sec, 7044, Business,end ProtessionsAode: The Contractors License Lew does not apply Io an owner of O�operry who bullds or improves Uereon, antl who tloes such work himself or harself onihrough his or her,own employees, provitletl that such improvements ere not intentletl or aHeretl far sale. It, however, Ihe builCing or ImprovemeN is sold within ane year oi iompletlan, the owneo-builder will have the burden of proving that he or she did not build or Imprwe for purppse of sale.). ❑ I, es owner of the property, em EXCLUSIVELY CON7RACTING WITN LICENSED CONTiiACTORS to construct ihe project (Sec. 7044, 8usiness antl Professions Code: The contractors Llcense Law Coes not epply to en owner ot properry who bullds or improves Ihereon, end who coniracts tor such project with a contradar(s) license pursuam to the Gontrectors License Lews.). ❑ I am exempt untler sec. Businass entl Prolessions Code tor this reeson: Sipnetura: Dete: Owner ID verlfleC by OriveYs Ilcense. � Yes ❑ No Dnvefs License No. Explres: Vedflcetion ot Ownership by (rype ol tlocument, i.e. - property tex bill ar deed): DIVISION OF INDUSTRIAL SAFETV PERMR CERTIFICATON: ❑ I hereby certify that no excevetlon fNe (5) or more feet In tlepth Imo which a person is required to tlescend, will be matle In cannanian wilh work authodzetl Oy this permit, end that no huilding sirucNre, sceflolding, falsework, or tlemolitlon or dismanlling thereof, will ba more than thirty-six (36) feel �igh. (Chep. 32, Grp 2, Atl 2, Sec, 341, Title B, Cfllifomia AdminlstratNe Code). ❑ As owner-builCer, I Will noI employ enyone to do work whic� would require e permit irom Ne Dlvlsion ol Industriel Safery, es noted above, unlesa such person hes e pertnit to tlo such wqrk from ihe division. SipneWre: Date: DHlsion of Industdal Satety Pertnit Number. ICERTIFlCATE OF COMPUANCE AND AUiHOROAl10N OF ENiHY: I certify under penelry ot perjury Ihet I heve read t�is appllcetion entl state Ihet the intormetion given is I correc�. I egree to comply with all stete lews and ciry ordinflnces relating to building construction, end euthodze representa6ves at the Clry oi Coste Mesa to enter upon Iho ebove-described property for Inspectlon purposes. l agree not to occupy or allow occupancy of eny building authorized by this pertnit until (inel Inspeclion. COOE 1. INSPECTIONTYPE 7816 Fixetl System Finel Fire Prevention 1266 200 �i 202 203 204 2MW6 Pool Spa Final Flnel Re-Roof Final BIacWReteining Wall Final Fectory Flr� place Final Sign Flnal Demolitlon �pp� wsveenoNrrve 206 Finel Mechenical 200 Flnel Plumbing 270 Flnel Elecirlcal 212 Finel Fire PrevenGon 220 Finel Plenning Approval 222 250 Final Site Fnal Building/Ocapan�y i CITY OF COSTA MESA BlIILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT � . PERMIT (714) 754-5273 • Fax (714) 754-4856 Job Address: Sulte No Vicinity: Parcel Nunmber. Applicant: Address: ELECTRICAL PERMIT 493 E 19TH ST B BLDG 8 11734122 WILLIAM THOMAS MAHAFFEY 2381 FOXDALE AV LA HABRA, CA Phone: 562-691•3461 Zip: 90631 Owner. JEAN SARINAS Address COSTA MESA,CA Phone: 714-337-7210 493 E 19TH ST Zip: 92627 Contrador:- WILLIAM THOMAS MAHAFFEY Address: . 2381 FOXDALE AV � LA HABRA, CA Phone: 562-697-3461 Zip: 90631 ' License: 6� 8110 ISSUE FEE Temp service test Res. alc package New Res (1-2 units) Naw Res (3+units) Pool I Spa Lighting Fixts Recept Outlets Switches Non Res Appl Res Appl Service to 200a Service to 1000a Service over 1000a Motors to 1hp Motors to 10hp Motors to SOhp Motors to 100hp Motors over t00hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole �' p'� PEfiMIT NUMBER E99-00065 77 FAIR DRIVE, COSTA MESA, CA 92626 s�aws: ISSUED Applied: 02IO2/1999 Issued: 02/02/1999 r� n�� .a a f O^G L/ 5 LIGHTS, 7 OUTLETS , 5 SWITCHES, 1 SERVICE 2 NTRACTOR WILL PROVIDE INSPECTOR WITH E L E C T.� A Y O U T T O I N 6 E t f D E S I N G L E L I N E D I A G R A M 8 P A N E L S C H E D U L E. Te�nc�4de E22.00 50.00 $0.00 $0.00 $0.00 $0.00 55.00 $7.00 85.00 $0.00 $0.00 $2725 50.00 so.00 $0.00 $0.00 $0.00 $0.00 $0.00 SO.00 $0.00 $0.00 $0.00 $0.00 Quantlty FEE SUMMARY Temp Dist System I Lighting Busway/100ft Standing Section Misc Electrical Equipment Transtormers up to 1 kvalkw ................up to 10 kvalkw .................up to 50 kva/kw .................up l0 100 kva/kw ..................over 100 kva�kw Low Voltage Equipment Low Volt Wiring System / Ckl Misc. Conduit Misc. Conductor Circus ( gen or ride) Circus (mech ride or lights) Christmas Tree Stand Fireworks Stand Other Electrical Fee Investigation Fee Plan Check Fee Reinspeclion Fee Quantity ao.00 0 50.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $16.25 1 50.00 , 0 80.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 $0.00 TOTAL CALCULATED FEES E82.50 EXPIRATION: This permN shall automatically expire and become void if work is not commenced within 180 days, or Ii work is suspended or abandoned for a period of 1 BO 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 Inepectlonm end tlnal epprovel must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545628 WORKEHS' COMPENSA710N DECLARATION: I hereby eflirm under penalry oi parjury one of t�e tollowing tleclarations: • ❑ I �ave entl wlll maintain e cgNifiw(e oi consent to setl-Insure tor workers' compensation, as provideC tor Dy section 3700 of the LeDor Cotle, for lhe pertortnence of the work tor which Ihis pertnit is issued. ❑ I heve ana wlll mainiain workers' compensa�ion insurance, es requiretl Dy seIXion 3700 oi I�e Lebor Code, fo� tha perlortnence ot Ihe woAc lor which this permi� is issuetl. � My workers' compensation Insurence caMer entl policy number are: Certier: WARNINO: Policy Number: lon need not be comp/eted p the permif /s velued et one hundred dollars ($100) or /ess.) rtl Ihel In the perfarmance of Ihe work tor which this pertnit is issued, I shell not employ eny person In any manner so es to become sub)ect to the workers' nsetlon of Califomia, and egree that If 1 should becoma sub'ect to tha workera' compensatlon proWs � of Seciion 3700 0l Ihe Lebor Cotle, I shall torthwith ee�p � 'si� ns. 1 q Q SlgnaNre: ` . Date: / � 2 � / / FAILUR�S SEWFE WOpNER$' COMPEN$ATIpN CpJERAGE 1 IGWFUL AND SHML SU8IECT AN EM VER TO CRIJIdWAL PENALT7E5 M!D pVIL FlNES UP TO ONE H�INDRED �E (5100.000�. IN AppR�p.� TO THE OOST OF C�OMP , �AAUGES AS PROVIDED FOR IN SECfI THE Lr�BOR CADE, INTEREST, AND ATTORNE`f5 FEES. LI TORS DECLARATION: ereby eHirm�et I em 'cens UnQe provisions of Chapter 8(commencing wlth Section 7000) ol DIvlslon 3 u'ne n0 Prolessions Code, an0 my Iicense Is In full force en0 eNe Lic. q / au a Contrector's Signeture� � Date: = .w NST N LENDING AG�NCY: ❑ I hereby aflirm ihat ihere is e canstruction IenOing egency tor t�e paAortnance oi the work for whlch this permit Is IssueC. (Sec. 3097, Clvll Code). Lentler's Neme:/� Lentler's Address: Signature: «�� Dare: OWNER•BUILDER DECLARATIONS� �(� I hereby ettirtn Ihet under penalry W�per�ury Nat I flm E%EMPT FROM THE CON7RACTORS LICENSE LAW lar the tollowing reeson (Sec. 7037.5, Business and Professions Cade: Any ciry or counry which requires e permii to consirucL alter, improve, tlemdish, or repair eny sWcture, pnor to its Issuance, elso reQWres the epD�icant tor sucA pertnll to Ille e slgneC statement Ihat he qr,she.b Iicensed pursuant to ihe pro�risions oi Ihe Contrectors License Lew (Chepter 9(wmmencing with Section 7000) oi Division 3 of Ue Business end Protessions Cotle) or thal he or she is eaemp� theretrom and the basis lor tha elleged exemptlon. Any violetion ol Section 7031.5 by any appliwnt for g permlt subjects the epplicant to a ci��l penelry at not more Nen tive hunCretl tlollars (5500).): ❑ I, as owner at ihe proparry, or my employees with wages as ihelr sole compensetlon, WILL DO THE WORK, and the strucNre Is rat Iniended or oflered br sale (Sec. 7044, Business and Prolessions CoOe: The Contrectors Llcense Ww tloes not epply lo an owner ot property who bulltls or Improves Ihereon, entl who Coes such work himselt or herself or through his or her own employees, provided that such impmvemems ere not intende0 or oHeretl for sale. If, however, tha building or Improvement Is sold within one year of completion, the owner-bullder will �ave the burden of proving ihat �e or she tlitl not build or improve for purpase of sale.). � I, es owner ot Ne properry, em EXCWSIVELY CONTBACTING WI7H LICENSED CONTRACTORS to construct the prolect (Sec. J044, Business and Protassions Gotle: 7Te coniractors License Lew does not eppty to en owner of property who Dullds or improves thereon, entl who contracls tor such project with a conirector(s) license pursuant to �he Conkectors License Lews.). 0 I em exempt under sec. SigneWre: Owner ID verifed by drivers license. ❑ Yes ❑ No Business and Professions Code for this reeson: Varlllcation oi Ownership Dy (rype of dacumeni, i.e. - propeM tax bill or dee0): DIVISION OF INOUSTRIAL SAF�TY PERMR CERTIFICATON: Drivels License No. Dete: Expires: ❑ I hereDy certly thet no excavetlon tive (5) or more leet in depih into whlch e persan is required to descentl, wlll be metle in connection wlt� work euthorizetl by Ihis permlt, and t�et no building Siructure, scattolding, lelsework, or tlemolition or dismentling I�ereaf, will ba more ihen thirry-six (38) laet hlg�. (Chap. 32, Grp 2, An 2, Sec. 341, Title 8, Celifomie Atlministretive Cotla). ❑ As owner�builtler, I will not employ enyone �o tlo work which woultl require e pertnit Irom Ihe Dlvision o1 Industriel'Sefery, es notetl ebove, unless such person has a pertnit to do such work trom the tllvision. Slgneture: Date: Dlvlslon of Industrlal Safety Pertnit Number. CERTFlCATE OF COMPLIANCE AND AllTT10ROA710N OF ENTTiY: I certily under penalty ot perjury Ihat I have read this epplicatlon end 5tete Nat Ihe infortnation gNen is I corcect I egree to comp�y witb aA state laws antl ciry ordlnances reWting to building construction, entl euthorize represenietives ol the Ciry ot Costa Mesa to enter upon the ebove-described proparry ior inspecUon purposes. I agree not to occupy or allaw occupanq of any building authorized by �his pertnfl until linal Inspedion. cooe �. INaPECT10NTYPE �� pd¢ II�ELS 1618 Fixetl System Fnel Flre preventlon 1266 200 Pool Spe Finel Final Re-Roof 201 Flnal BIocWReteining Wgll 202 Finel Fectory Flre Place 203 Final Sign 20d Flnal Demolitlon 2a48-�6 .�Qp� INSPECTIONTYPE 208 Finel Mechenlcal 20B Final Plumbing 210 Finel Electrical 212 Flnel Fire Preventlon 220 Final Planning Approvel 222 Final Site 250 Finel Building/Occupancy (714) 754•5273 • Fax (714) 754-4856 �ob Address: 493 E 19TH ST Suite: B Vicinity: UNIT B Parcel Nunmber: 11734122 CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT BUILDING PERMIT Zoning: Applicant: SARINAS, JEAN Address: �, � , " -' .• ' - - . _ COSTA MESA, CA �. � � � -Phone: (714)337-7210 493 E 79TH ST� �'� �_ ' Zip: 92827 �, , Ownec SARINAS, JEAN �' , ` � � Address '��-`�� , � � /�",COSTAMESA,�CA` �� _ G - Phone: (714)337-7210 �� 493"E 19TH ST % ZIp: 92827 /n� �i � � /: � �;; �' 'ontractor. �\�� i Address: . ji/ 77 FAIR DRIVE, MESA, CA 92626 Status: ISSUED Applied: 04/02/1999 Issued: 04/02/1999 ISSUED BY: CG`"C- � , , ;; � �� : ��:�� ,� /� � � Phone:-• ,',:�„ _ . . �' � � . / � ,=1, ;� � ; . . �'Zip,/ License:, . . . ;, , � �%,�� . .. .. ' , Arch : . . . - - s � !�'� — ' . Eng. , � Address: .' -� - ' , , . ,' ` � Address: . � - _� �' . " L` , � Phone:-� - - - . ; Phone: , � ;'� �� ; .�_ .,'�_ � . ' `� Zip � " � ' � � . . license: Zip: � � � License: ��A f . / �. i � � � ;' � - - SCOPE OF PERMIT � � , �� INSTALL A PARTION WALL�IN THE CENTER�OF THE GARAGE. LEGALIZATION OF EXISTING WORK. THE WIDTH OF THE WALL IS�MINIMAL AND WILL NOT ENCROACH INTO GARAGE'AREA. � - - ' � ' FEE SUMMARY .. " `<.r:`� � . , Plan Check: , $13.65 =_ _ _ Permit: - $21.00 - - _ — . � i i SMIP Res: $0.50 ;SMIP Com: `,.��. $0.00 __ _ _ � � Ather. �� $0.00 . _. - � Inspection: $OAO -• � �'�� ,TotaL• � . $35.15 . " � � , ,�, ,;�, � � � �� -'' � . PLANNING & ZONING . - : ,, _ � �, .,�� , . SETBACKS � � � � - � . .� �_,_� MAINSTRUCTURE�Front 00 �, _� Rear�-_�0-0�''` - �• �Left' �0-0 . � ACCESSORY Front� �0..0 � "� Reai� 0-0 Left 0-0 PARKING Existinq: �0 - , Required: �0 Pro osed: 0 NOTES: . . . , . � . . Calc Valuation: Claim Valuation: Righl 0- 0 Right 0- 0 ��,��i�D , �. .. � - $250;00 s25o.o0 NOTICE: The work aiithorized by this pertnit shall comply with all applicable handicap access requirements under Califomia statutes and related regula�ions. (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 e 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 requlred Inepectlone end flnal epproval must be obtained. Failure to obtain inspections and final approval wlll result in the expiration of this permit. FOR INSPECTIONS CALL: (7/4) 7545626 WOFiXERS' COMPENSATION DECLAfiATION: . ` "• � I hereby aHlrtn untler penelry ot perjury one of ihe lollowing declarations: . ❑ I heve end wlll mainteln a certificete of consent to selt-Insure for workers' compensetion, es pravidetl for by section 3700 of the Lebor Cotle, for the per(ormence of the work for wNcn tnis pertnit is Issued. � �. . ❑ I have antl wlll maintaln workers' compensatbn insurance, as required by section 3700 of the Lebor Code, tor tl�e peAortnance of the woilc tw which this pertnit is Lswed. My workere' compensetlon Insurence carrier end policy number are: Certier: Policy Number. (Thls sectlon neetl not be completed il fhe permif is valued et one hunOred dollers ($100) w less.) ❑ 1 cenify thet in the peAormence ot the work tor which ihis pertnit Is issuetl, I shell not employ eny person in any manner so es to becoma sublecl to the workers' compensetion laws oi Celifomla, and agree that if I should became subjecl b the workere' compensetion provisions of Sectlon 3700 oi the Lebor Code, I shell torthwith wmply wit� Ihese provlsions. Applicant Signeture: . Date: WARNING: FAILURE TO SECURE WORKEPS' COMPENSATION COVERAOE IS UNIAW FUL AND SW1LL SUBIECT PN EMPLOYER TO CRIMINAL PENALTIES AND GVIL FINES UP TO ONE MUNDRED THOUSAND OOLLARE (E100,000), IN ADDIPIXJ TO iHE CQST OF COMPENS4TION, DAMAGES PS PROVIDED FOR IN SECTION 3]O60F THE LABOR CODE, INfERE5T, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby afllrtn ihat I em Ilcensed under prwisions oi Chapter 9(wmmencing wli� Section 7000) of Division 3 of ihe Business anA Proteuions Cotle, entl my license is in full force end ettect. Lic. q Class # Coniractofs SlgnaNre: Dele: CONSTRUCTION LENDING AGENCY: ❑ I hereby eflirm Ihet ihere Is e consWctian lending a9ency for Ihe pertormance o1 �he work for which Ihis permit is issuetl. (Sec. 3097, Clvil Code). Lentler's Name: Lenders Address: Signeture: Date: OWNER-BUILDER DECLARATIONS: I hereby effirtn thet untler penalry of perjury Ihat I am EXEMPT FROM TME CONTRACTORS LICENSE LAW for the following reeson (Sec. 7031.5, Buslness end Professlons Code: My dry or county which requires a permit to construct, alter, improve, demolish, or repair any structure, D�o� �o its issuance, elso requlres the epplicant for such permil to file e signed stetemen� Uet he or she is licensed pursuant lo Ihe provislons ot the Contredors LJcense Lew (Chapter 9(cwnmendng vriN Section 7000) ot Dlvision 3 ot the Business and Professions Code) or that he or she Is exempt therefrwn entl the Dasis for Ihe alleged exemption. My violation of Sectlon 7031.5 by eny epplicant tor e permit subleds ihe appllcant lo e civil penelry of nol more Ihan Me �undretl tlollare ($500).): � ❑ I, es owner o1 the property, or my employees with wages es �heir sole comDensetion, WILL DO 7HE WORK, and Iha strudure is not Intended or offeretl for sale (Sec. 7044, Busineu entl Protessions Cade: The Coniractors Licensa Law tloes not apply to en owner of pro0erry who builds or improves Ihereon, end who daes such work himself or hersell or through his or her own employees, provided thet such Improvements ere not Intended or oHeretl for sale. If, however, Ihe bulltling or improvement is sold within one year of completion, the owner-builder will heve Ihe burden ot proving thet he or she did not build or improve for purpose o1 sele.). � I, es owner oi Ihe pmperty, em E%CLUSIVELV CONTRACTING WfTFf LICENSED CONTRACTOFiS to consWct ihe pro)ect (Sec. 7044, Buslness entl Professions Cotle: The contrectors License Lew does not eppty to en owner ol property who bullds or improves ihereon, end who coNrects for such pro�ect with e contractor(s) license pursuant to the Contrectore License Laws.). Busineu entl Professlons Cotle for t�is reason: O�v nef�D veNfla�by tlriver's lice'iy� �Ves � � No Verificetion ot Ownership by (type ot document. i.e. - property tex bill or DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: Date: Expires ❑ I hereby certity t�et no excevation tive (5) or more feet In depih Into which e person Is required ta descend, will be made in connectlon wlih work authorizetl by t�is pertnit, end thet no builGing siructure, sceflolding, talsework, or demollilon or tllsman0ing thereoi, will be more ihan thlrry-six (38) teet hlgh. (Chep. 32, Grp 2, Art 2, Sec. 341, 77tle 8, Celitomia Adminlsirative Code). ❑ As owner-Duilder, I will not employ anyone to tlo work which would require a pertnit irom ihe Divlslon of Intlustrial Safery, es noted above, unless such person has a permit to do 5uch work from Ihe division. Signeture: Date: Division of Industrial Sefery Pertnit Number: CQOE I. INSPECTION TYPE 1616 FI%eC System Flnel Fire Prevention 1266 Pool Spe Flnel 200 Finel Re-Rooi 201 Final BIacWRetaining Wall 202 Final Fectory Fire Placa 203 204 2a4&48 Flnal Sign Finel Demolitlon , f7-�f� COUE I INSPECTION TYPE 206 Final Mechanical 20B Final Plumbin9 210 Finel Electricfll 212 Final Fire Pravention 220 Final Planning ADprovel 272 Final Site _250 ,FlnalBuilding/Occupancy � ISI -W!1S�'1 , —� 1- � ' '�' CITY OF COSTA MESA ' � evuo�N� �nns�oN � � � DEVELOPMENT SERVICES DEPAATMENT � � PERMIT PERMIT NU ER •� � 699-00306 (714) 754-5273 • Fax (714) 754d856 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 493 E 19TH ST Suite: 8,g Vicinity: BACK HOUSE ParcelNunmber: 11734122 Applicant: SARINAS, JEAN Address: COSTA MESA, CA 493 E 19TH ST � Owner. SARINAS,�JEAN " Address ��;r�i!:� `�, � COSTA'MESA,�CA . 493�E 19TH ST. '� , . _ r, i�� . COf1�f8C�Of: - - � i Address: , " - r �� , BUILDING PERMIT Status: ISSUED Applied: 03/04/1999 Issued: 03/04/1999 Zoning: Phone: '(774)337-7210 - . . Zip: 92627 - - .' � � . -��\.��: , Phone: , (714)337-7210 _ " - ' � , ': � Zip: 92627 � _ , - � �� ' '.\? , ; -.�.� , � . J� ��,,.:� . , ' , . - . ' Phone: AA � „ i� �" �� , Zip: . "�' Licenser`" .i" . � r�= � - Arch : � � ' -� � � � , Eng: , � Address: - . � � � � .� -, � '� � ` Address: � . � r'�' � , ` Phone: � - � � , ,- � � , License: Zip: Phone: License: . � � � SCOPE OF PERMIT ` REPLACE N/1NDOWS IN FAM�RM, BEDRM & BTHRM WITH NEW WINDOWS IN SAME LOCATION & SIZE. REPLACE WOOD PANELING IN FAMILY RM WITH NEW DRYVJALL. -� - � - , , Plan Check: ' Permit: SMIP Res: SMIP Com: Other: I nspection: Total: $O.Otl $za�.ze $2.00 $O.Otl $28725 $0.00 $576.50 SETBACKS MAIN STRUCTURE Front D- 0, ACCESSORY Front �D-0 _ PARKING Ezistinq: o NOTES: FEE SUMMARY �',' , _ — _- -- �/ �% . � � x Rear w._Y,.-:� PL"ANNING & ZONING 0- 0 Left 0- 0 : Rear 0, 0 - � Left �, 0- 0 Reauired: 0 � • Proposed: 0 � _Calc Valuation: Claim Valuation: y7 ' Right 0-0 Right 0- 0�� E��ED o� OR'PE .-- \ s2o,000.00 ' szo,000.00 EXPIRATION: This permit shall automatically expire end become void if work is not commenced within 180 days, or If work is suspended or abandonad for a period of 180 days. INSPECTIONS: In order for the wOrk aNhorized under this permit to be considered legal, such work must comply with all epplicable codes, and all requlred Inapeetiona and finel approvel must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5628 WORKEHS' COMPENSATION DECLARATION: I hereby ettirtn under penalry ot perjury one of the tollowing declarations: , ❑ I have end will meintein e cenificete of consent to self-Insura for workers' compensatlon, as provitled tor Dy sedlon 3700 01 ihe Labor Code, for the peAortnence a� the work for which IhlS permit is issued. ' ❑ I have and will maintain workers' compensation insurence, as requiretl by section 3700 01 the Lebor Code, far the peAortnance of Ne work tor which this pertnit is issued. My workers' compensation Insurence certiar entl policy number ere: Canler: Policy Number: (Th/s sectlon need not be complefed i! the permif Is ve/uetl et one bundied dollars ($100) or /ess.) ❑ I certify that in Ihe pertortnence of ihe work for which t�is permit is issued, I shell not employ eny pereon In eny menner ao es to become sub�ect ta �he workers' compensation lews of Celifornla, entl egree ihat If I should become subject to tha workers' campensetlon provislons of Section 3700 ot the Lebor Coae, I ahell forthwHh comply with ihese provisions. Applicant Signeture: Dete: WARNING FAILURE TO SECURE WORKERS' COMPENSATION CAVEPAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENA�TIES ANO CIVIL FINES UP TO ONE HUNDRED TMWSAND DOLLARE (§100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAOES AS PROVIDED FOR IN SECTION 3]OB OF THE LABOR CODE, INfEREST, AND ATTORNEI"S FEES. LICENSEU CONTRACTORS DECLARA710N: I hereby aHirm thflt I em licensed under proNsions af Chapter 9(commencing wlth Section 7000) of Dlvislon 3 ot the Business end Pmfesslons Catle, end my Ilcense is In full force entl eNea. Lic. u Cless 8 Contrflcror's Signalure: Dete: CONSTRUCTION LENDING AGENCY: ❑ I hereby aflirm ihet �here is e constructlon lending agancy tor the peAom�ance of the work tor which this permit is iuued. (Sec. 3097, Clvll Cotle). . Lenders Neme: Lenders Address: - SignaNre: Date: OWNER-BUILDER DECLARATIONS: I hereby atflrtn thet un0er penelry of perjury ihat I am EXEMPT FROM TME CON7RACTORS LICENSE LAW for t�e following reesan (Sec. 7031.5, Business entl Protessions Code: My ciry or counry which requlres a permit to consiruct, alter, improve, demolish, or repelr eny structure, pdor to Its Issuence, elso requires ihe epplicent for such permi� to file a signetl stetement that he or she is Ilcensed pursuant to the proNsions of Iha Cantrectors Licensa Lew (Chapter 9(commencing wlth Sectlon 7000) of DlWsion 3 of ihe Business antl Professions Code) ar that ha or sha Is exampt therefrom end the basis for the alleged exemptlon. Any Nolatlon of SeMlon 7031.5 by eny epplicant lar a partnit sub�ecGs ihe epplicant to e civil penalry of not more then five hundred dollars ($500).): ❑ I, as owner of ihe property, or my employees with weges es thelr sole compensatlan, WILL DO THE WORK, end the structure Is not Intended or oifered for sele (Sec. 7044, Business end Professions Cade: Tha Contractors License Lew does not flppty to en owner of property who builtls or improves thereon, entl w�o tloes such work himselt or herself or ihrough hls or �er own employaes, provlCetl thet such Improvements ere not intendetl or ottered lor sele. II, however, the building or improvement is sald wlthin one year of completion, the owner-huilder will have tha burden ot praving thet he or she ditl not bulld or improve tor purpose ot sale.). ❑' I, as owner ot Iha property, am EXCLUSIVELY CONTRACTNG WfTH LICENSED COHTRACTORS to canstruct the project (Sac. 7044, Business end Protessions Cotle: The contrectors Llcense Lew daes not eppy to en owner of properry who builOs or improves thereon, end who conlrecls tor such project with a coMredor(s) license pursuant to ihe Contractors License Lews.). ❑ I am azempt�yf��d�njr �se�c. —�--�— Business and Pratesslons Code for this reason: Signeture: i/,C/�' / _i�/ vb�✓L6�,i Date: � Owner ID verlfietl by tlnvefs lic ❑ Yes No Drlvefs License No. Ezpires: Veriflcetlon of Ownershlp by (rype of document, I.e. - propefty tex blll or deeO): DIVISION OF INDUSTRIAL SAFETY PERMR CERTIPICATION: ❑ I hereby certity thet no e:cevation Ove (5) ar more teet In depth into w�ich e person is requiretl ro descend, wlll be mede in connectlon wlth work aut�odzeG by this pertnN, end thet no Duiltling stnidure, scaHdding, falsework, or demolition or dlsmantling t�ereof, wlll be mare than Ihirty-six (38) teet high. (Chep, 3.2, Grp 2, Art 2, Sec. 341, TNIe 8, Celitomla Atlminlstretive Coda). . ❑ As owner-builder, I will not employ enyone to do work which would requlre a pertnit irom Ne Division ot Industrlel Safety, as notetl above, unless such person �as e pertnit to do such work trom t�e division. Signature: Dete: D'Msion ot Industrial Setery Pertnit NumEer. CERTIFlCATE OF COMPLIANCEAND AUTHORIiATON OF ENTFiY: I certify under penelry af perjury that I have read lhis epplicetian end stete that the Infarmallon given is coned. I egr to compty with ell sfete lews�and ary ordinances releNng ro building consiructlon, end euthodze represemetives of Ihe Ciry of Caste Mesa to enter upon Ihe ebove-descdD \ pr rry for f spe2li purposes!I ap`re�e�� Lto accupy or allow acupency of any bullding euthodzed by Ihis rmit until tinal Inspection. %�i°il%��L�i' �- ��//v� Gi sid� re Of Legel Owne ata v�,(ly� Md/Or AUNodzed Appllcant Date COOE I. INn_pELTONTYVE PAiE I�{S 1616 Fiaetl System Flnal Fire Prevenllon 1288 200 Pool Spe Flnel Flnel Re-Faof 201 FIneI BIocWReteining Well 202 Finel Fectory Fire Plece 203 Finel Sign 204 Finel Demolitlon za&a6 SQQ[j INSPELTONTYPE 208 Flnel Mechenicel 208 Finel Plumbinp 210 Finel Electdcel 212 Finel Flre Preventlon 220 � Finel Planninp Approval 222 Final Site 250 Final Bullding/Occupency DAg Q�lLS CIN OF COSTA MESA BYILDING pMS10N DEVELOPMENT SERVICES DEPARTMENT PERMIT P MIT NU BER P99-00148 (714) 754-5273 • Fax (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92628 Job Address: Suite No Vicinity: Parcel Nunmber: 493 E 19TH ST A Q 11734122 Applicant: SARINAS, JEAN Address: COSTA MESA,CA 493 E 19TH ST,-- Owner: SARINAS, JEAN Address � � � � Contrector: Address: ArchlEng: Address: COSTA MESA, CA' 493 E 19TH ST PLUMBING PERMIT Status: ISSUED Applied: 03I0417999 Issued: 03/04I1999 Phone: (714)337-7210 Zip: 92627 Phone: (774)337-7210 Zip: 92627 i Phorie:� ' Zip: License: -- ��` , .�.� �K �� r t a �i � Phone: Zip: License: SCOPE OF PERMIT , RELOCATE WTR HTR FROM EXTERIOR OF BATHROOM TO�EXTERIOR REAR OF GARAGE & DO A COMPLETE COPPER REPIPE TO HOUSE. (B99-00306). � ISSUE FEE BackBow irtigation Backflow Preventer Bathtub Clarifier System Connect (Ice,Soda,etc) Dental Units Dishwasher � Drein, Floor Drain, Rainwater Drain, Roof Drinking Fountain Expansion Tank Gas Earthquake Valve Gas (1-4 outlets) Gas (Over 4 outlets) Gas Repipe Gas Service Interceptors (Grease, Oip Interceptors (Sand Auto ) AMT $22.00 50.00 50.00 $0.00 50.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 50.00 $0.00 so.00 $0.00 $0.00 aTv FEE SUMMARY Laundry Tub / Washer Landswpa Irrigation P-Trap Pressure Regulator Process Piping (per 10 ft) Receptors Septic Tank Sewer Cap for Demo , Sewer Connect Sewer Private Line Shower Sink, bar Sink, commerciat Sink, Floor Sink, kitchen " Sink, serviCe/mop Spa (private) Spa (public) AMT $0.00 $0.00 $0.00 $0.00 $0.00 so.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 so.00 $0.00 QTY 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 COMMENTS / SPECIAL CONDITIONS SumpPump Swimming Pool Trap Primer Urinal Vacuum Brkr Bkflow(7-4) Vacuum Brkr BkFlav(5+) Wash Basin Wash Basin Set ' Waste and Vent System Water Closel (Toilet) Water Heater I vent Water Piping (Inst or Rep.) Water Re-pipe Water Service Water Softener OTHER VIOLATION PLAN CHECK REINSPECTION TOTAL CALCULATED FEES: AMT $0.00 $0.00 80.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $11.00 $0.00 $8.75 $0.00 $0.00 so.00 $19.75 50.00 $0.00 $61.50 aTr 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 EXPIRATION: This permit shell eutomatically expire and become vold it work is not commenced withln 180 days, or if work Is suspended or abandoned for a perlod of 180 days. INSPECTIONS: In order for the work euthorized under this permit to be considered legal, such work must comply with all epplicable codes, and all requlred Inepeetlone and flnel epprovel must be obtained. Feilure to obtain inspections end finel epproval will result in the ezpiretion of this pertnit. FOR INSPECTONS CALL: (714) 7545828 WORKERS' COMPENSATON DECLARATION: I hereby etfirm untler penalty of perjury one of Ihe fdlowing dedarations: . . � ❑ I heve end will malntein e cenificate of consent lo setl-Insure for workers' compensaUon, as provitled tor by sectlon 3700 of the Lebor CoCe, for the pertortnence of the work for wNCh Ihis pertnit Is iuued. ❑ I have end will mainlain workers' compensation insurence, es required by seclion 3700 of itie Labor Cotle, for �he peAormflnce of Ne work tw which NLa pertnit is issueE. My workere' wmpensatlon Insurance rertier entl pollq number ere: Certler: Pollcy Number: (Th!s secHon need not be comp/efetl i7 fbe perm/t Is veluetl et one �undred dollers ($100J or /ess.) ❑ I certtly thet In the peAortnence ot ihe work tor which ihis pertnil Is Issued, I shell no� employ eny person In eny menner eo es to become sub�ect to the workere' compensetion laws ot Celltomie, entl egree ihet II I should became sub�ect to !he warkers' compensetlon provislans o1 SecNon 3700 oi t�e Lebar Code, I shell forthwlth comply wlih ihese provisions. Applicant Signeture: Date: WARNINO: FAILURE TO SEIXIRE WORKERS' WMPENSATION ODVEM�E IS UMAW FUl AND SMALL SUBIECT AN EMPLOVER TO CRIMINAL PENALTIES AND CML FlNES UP TO ONE HUNDRED T710USAND OOUARE (5100,000). IN FDDITION TO THE COST OF COMPENSATION, DAMAOES PS PROVIDED FOR W SECTION 3106OF TNE LABOR COOE. IMEREST. AND ATfORNE1^S FEES. LICENSEDCONTRACTORSDECLARATON: I hereby etllrm that I em Iicensed unEer provislons ot Chflpter B(commencing with Sedlon 7000) ot Divislon 3 of the Buslness antl Profeuions Catle, entl my Iicense is in full lorce end eNeM. Lic. p Cless p Conuactofs Signature: Dete: CONSTRUCTION LENDING AGENCY: ❑ 1 �ereby aillrtn thal Ihere Is e constructian lendinp apenq for I�e peAortnance ol lhe work for which Ihis pertnit Is issued. (Sec. 3097, Clvil Cotle). LenOefs Name: Lentlera AtlGress: Signeture: Dete: OWNEH-BUILDER DECLARATIONS: I hereby ettirtn Ihet under penelry of perjury thet I em E7(EMPT FROM TNE CONTRACTORS LICENSE LAW far ihe tollowing reason (Sec. 7031.5, Business end Professions Cotle: Any ciry or counry whlch requlres e pertnit to construd, elter, improve, tlemollsh, or repalr any sirucNre, pdor to Its Issuence, elso requires ihe epplicant 1or such pertnit to flle e signetl stetemeN that he or she Is licensed pursuflnt lo the provislons af the Cantraclors lJcense Lew (C�aO�er B(commenGnp with Sectlon 7000) of Divislon 3 of the Business and Professions Cotle) or Ihat he or she Is exempt thereirom entl the basis for the alleged exemption. Any violatlon of Sectlon 7031.5 by any epplicant for e permlt sub�ects Ihe epplicant to e civil penelry of not more than five hundred dollars ($500).): ❑ I, es owner of the properry, or my employaes wlih wages es their sole compenutlon, WILL DO THE WORK, and the structure is not IntenCetl or oHereC for sale (Sec. 7044, Buslness entl Professions Code: The Contrectors License Lew daes nat eppy to an owner oi properry who builtls or Improves thereon, and who does such work hi If or hersetl or Nrough hls or her own employees, proNtled Ihet such Improvements are not intended or oHered tor sale. If, �owever, Ne bulltling or improvement b old withln one year at completion, ihe owner-builder will have the burtlen ot proving Net he or she tlid not build or improve tor purpose at sele.). I, es owner of the property, am EXCLUSIVELY CONTFiACT1NG WITH LICENSED CONTAACTORS to construcl the project (Sec. 7044, Business anC Professions Code: The contreMors License Lew does not flppty to en owner of property who builds or improves thereon, end who conirects for such project with a contractor(s) license pursuant �o the Contractors License Laws.). ❑ I am exempt der sec. _ Business and Professions Cade tar this reason: Signature: �� Date: � � Owner ID verlfied by drivefs license. Ves ❑ No DrNers lJcense No. Expires: Vedllcatlon of Ownership Dy (type ot tlocument, i.e. - properry tex hill or tleetl): DIVISION OF INDUSTRIAL ❑ I hereDy certlly tha� no excevetlan five (5) or more leet in depth inta whlch e person is requirad to descend, wlll be mede in connection with work euthorized by t�ls perml6 enG ihet no 6ulltling siructure, sceHoltling,—flaBwork, or demollNon or dlsmentling thereof, will ba mare then thirry-six (36) leat hlgh. (Chep. 32, Grp 2, Art 2. Sec. 341, Tltle 8, Celllomle Atlminisiretive Cotle). - ❑ As owner-Dulltler, I wlll not employ enyone to Oo work whlch would requlre e pertnit trom the DNlslon of Industrlel Setery, es noted ehove, unless such person hes e permlt to do such work irom Ihe diNsian. Signeture: Date: Oivlvlon of Induslrlal Safety Pertnit Number: CERTIFlCATE OF COMPLIANCE AND AVTHOH¢ATION OF EHTRY: I certity untler penalry of perjury Net 1 heve reed Ihls epplicatlon and stete that the infortnelion given Is correct. I epree compty wlth all stete lews and dry ordinances releting to bulltlinp wnstructlon, entl authorize representetives ol the Ciry of Coste Mesa to enler upon the ebove-describe r fo nsp�e 'purposes. I epree not to occupy or ellow occupanq af eny bullding euthorized by this permit until final inspedion. ,.� t"�%�ili�s�l��i� �%1�G/�' Slgnafure Of Lepfll Owner( Dete MNOr Authodzetl Applicenl Dete �QE_�, INSDECTIONTYFE 1818 Fized System Finel Ftre Prevention 1288 Pool Spe Final 200 Finel RaRoof 201 Finel BIocWReteining Wflll 202 203 200 2468JB Finel Fectory Flre Plece Flnel Slpn Flnel Demolitlon �g �� CODEI ixsvecnoxrrve 206 Flnel Mechenicel 208 Flnal Plumbinp 210 Flnel Electdcal 212 Finel Fire Preventlon 220 Flnel Planninp Approvel 222 FIneI5lte 250 Finel Builtllnp/Occupency � II�� CITY OF COSTA MESA ° BUILDING DIYISION > ._ � DEVELOPMENT SERVICES DEPARTMENT �,�� PERMIT P 9JIOO�OZ R (714) 754-5273 • Fax (714) 754-0856 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: Suite No Vitinity: 493 E 19TH ST $8 ParcelNumber: ��734122 Applicant: Address: Owner: Address: Contrector: Address: ArchlEng: Address: SARINAS, JEAN COSTA MESA, CA 493 E 19TH ST-' �. SARINAS, JEAN � COSTA MESA;CA 493 E 19TH ST; . MECHANICAL PERMIT Phone: (714)337-7210 Zip: 92627 Phone: (714)337-7210 ' Zip: 92627 ' Phone:,.' Zip: License: . � �- Phone: Zip: License: SWtus: ISSUED Applied: 03I0411999 Issued: 03I04I1999 � SCOPE OF PERMIT REPLACE EXISTING FAU WITH NEW UNIT & INSTALL A/C COND. AT REAR OF GARAGE. RELOATE WTR HTR FROM EXTR. OF BATHRM TO REAR OF GARAGE. (B99-00306). ISSUE FEE Inst FAU <100 k BTU Inst FAU >100 k BTU Repair / AIt CoolinglHeal Inst / Rep. Recess Wall Htr .. Refrig Sys <100 k BTU Refrig Sys >700 k BTU Gas Piping Factory Fireplace � � Hood w/Mech Exhaust VAV Box Vent Fan / Single Duct ' Appliance Fire Dampers " Smoke Dampers . Inst or Relocate Appl Vent Air Handlers < 10000cfm AirHandlers> 10000cfm Floor Furnace Floor or Suspend Heater � - FEE SUMMARY Quentity $22.00 $1325 1 $0.00 0 $0.00 0 $0.00 0 $13.25 1 $0.00 0 so.00 o . , $0.00 0 so.ao 0 $0.00 0 $0.00 6- - ` . , $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 Repair I Alt Absorbtion Unit Repair / Alt Refrigeration Unit Venlillation System Evaporative Cooler , Commerciallncineraror , . Domestic Incinerator - " Compressors / Absorption SVstems Upto3hp/t00kBTU 3To15hp/500kBTU ' 15 To 30 hp / 1,000 k BTU , 30 To 50 hp / 1,750 k BTU Over 50 hp / Over 1,750 BTU ' ' Boilers � - Upto3hp 3To15hp � 15to30hp , �' 30 to 50 hp Over 50 hp Other Mechanical Fee Investigation Fee Plan Check Fee Reinspeclion Fee � TOTALCALCULATED FEES COMMENTS / SPECIAL CONDITIONS Quantity $0.00 0 $0.00 0 $0.00 0 so.00 0 $0.00 0 so.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $26.50 $0.00 $0.00 E75.00 EXPIRATION: Thls permit shall automatically expire and become void if work is not commenced within 1B0 days, or it work is suspended or abandoned for a perlod of 180 days. INSPECTIONS: In order for ihe work authorized under this pertnit to be considered legal, such work must comply with all epplicable codes, and all requlred Inepectlona end final epprovel must be obtained. Failure to obtain inspections and final epproval will resutt in the expiration of this permtt. FOR INSPECTIONS CALL: (714) 7545828 WORKERS' COMPENSATION DECIARATION: 1 hereby affirm under penelry of perjury one ot the followinq decleretions: ❑ I have end wlll meintain a cenificate o� conseM to self-Insure tor workers' compensetlon, as provitled for by section 3�00 of iha Lebar Cotle, Por ihe pertortnence of the work tor which this pertnit is issued. ' ❑ I have and wiil meintain workers' compensation insurance, as required by section 3700 ot Ne Lebor Cotle, tor Ne peAortnance of the work for which Nis pertnit is issuetl. My workars' compensation Insurance carrier entl policy number are: Canler: Policy Number: (This section need nof be comp/etetl il the permit is velued et one hundretl dollars ($700) or less.) ❑ I certiy that in the performance of ihe work for which ihis permit is issuetl, I shall not employ any pereon in any manner so as to becoma subject to the workers' compensetion lews ot CalNornia, entl egree thet tl I shoultl became subject to the workers' compensation provisions of Section 3700 af the Lebor Code, I shall tort�with comply w%h these provisions. Applicent SigneNre: Dete: WARNING: FAILUFE TO SECURE WOFKERS' CAMPENSATION CAVEiiAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATIIXJ, DAMAGES AS PROVIDED FOR IN SECTION 31080F THE LABOR CODE, IMEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: 1 hereby flHirm Met I am licensed under provisions of Chapter 9(commencing wlth Section 7000) ot Division 3 of the Business antl Professions Code, end my license is in full force and eHecl Lic. u Cless k ConVectors SignaNra: Dete: CONSTPUCTION LENDING AGENCY: ❑ I hereby affirm ihat ihere is e consiruction lentling agency for tha pedormance o� the work for which this permit is iuued. (Sec. 3097, Clvll Code). Lendefs Name: Lenders Addreu: Signatura: Date: OWNER-BUILDER DECLARATIONS: I herehy eHirm ihat under penalry af perjury thet I am EXEMPT FROM THE CONTRAC70RS LICENSE LAW for the following reason (Sec. 7031.5, Businass and Professlons Code: Any city or counry which requires e pertnit to consiruct, alter, improve, demollsh, or repeir any siructura, prior to its Issuanca, alsa requlres Ihe applicent tor such permit to file a signed statement that he or she Is Ilcensed pursuaN to the provlslons of Ihe Contractors License Law (Chapter 9(commencing with Section 7000) of Divislon 3 of Ihe Business end Professions Code) or that he or she is exempt therefrom and the basis for the elleged examption. Any violetlon of Saclion 7031.5 by any applicant for a permit sublects the eppliceM to e civil penalry of not more then Me huntlretl tlollars ($500�J: ❑ I, es owner of the properry, or my employees wilh wages as thair sole compensation, WILL DO TME WORK, and the structure Is not intendetl or oHeretl tor sale (Sac. 7044, Business end Prafessians Cada: The Contrectore License Lew does not apply ta an owner at property who bullds or impraves ihareon, entl who tloes such work himself or hersetl or ihrouqh his or �ei own employees, provldetl t�et such improvementa ere not intendetl or oHeretl for sale. It however, ihe building or Improvement Is soltl within one year oi completlan, ihe owner-builder wlll heve the burden of proving that he or she did not build or Improve fo� purpase of sale.). ❑' I, es owner of ihe property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTHACTORS to construct the project (Sec. 7044, Business antl Professions Code: The conirectors License Law does no� epply to an owner of properry who bullds or improves ihereon, end who wntracts tor such pmject with e wntractor(s) license pursuant to the Contractors License LewsJ. ❑ I am axemp un r se< Signelure: � Owner ID verifie v drlvefs ❑ Yes `� p No Business end Protessions Cotle for this reason: — Date: L DriveYs License No. Expires: Verification of Ownership by (type ot documenL i.e. - property tart bill or daed): DIVISION OF INDUSTRIAL SAPETY PERMR CERTIFICATON: ❑ I hereby certity ihat no e:cavetlon five (5) ar more faet In tlepth Into which e person Is required to descend, will be made In connectlon with work authorized by this pertnit, end thet no building structure, scattoltling, falsework, or demolition or dismantling thereo�, will be more than thirty-six (36) feet high. (Chap. 32, Grp 2, Ar12, Sec. 341, Title 8, Celifomla AtlmlNstretive Catla). ❑ As owner-builder, I will not employ enyone to tlo work which would require e pertnit from the �Ivision of Intlustrial Sefery, as notatl above, unless such pereon hes a parmit to tlo such work from the division. Signeture: Date: Division of Intlusirial SafeTy Pertnit Number: CERTIFlCATE OF COMPLIANCE AND Al7fXORIZATON OF EMRY: I cehiy under penalry of perjury ihet I heve read ihis application end state that the in(ormetion given Is corred. 1 egree lo comply with all state laws and ciry ordinances relating to building construdion, end authonze representetives of the Ciry oi Cwta Mesa ro enter upon the ebove-descnbed rope�spec' n purposes.� e not to occupy or allow occupancy oi any building authonzed by this pertnit u�spection. � n� ig ture Of Legal r(a) Date And/Or AUNodzed Applicent Date CODE I. INSPELTWN TYPE 1616 Fixed System Flnel Fire Prevention 1266 Paol Spe Finel 200 Flnel Re-Roof 201 Finel BIocWReteining Well 202 Final Fectory Fire Plece 203 Final Sign 204 Fnal Demolitlon 2a&d8 �g ��$ yQyEj INSiECTIONTYFE PASE Q�ALS _... 206 FInelMec�enicel 208 210 272 220 Finel Plumbing � Final ElecMcal Final Fire Preventlon Flnal Plenning Approvel 222 Final Sile 250 Finel BUIIGing/Occupancy �� 493 E 19TH ST ivivaww: PqO9W3ELgSON9 yDOgRTOTHY E �'�� COSTA NE�A,CA 92627 �rv�. Muuw �oox�ss: YKNRECT OR FNfa!lFFA: JICM.OR FN6.'S ADDNES4: ��,,,,.�. CLAYTON ROOFING ��„�,f,,,,�,� 833 W 17TH ST ,�p� COSTA MESA 92627 uMT: I CITY OF COSTA MESA — BUILDING PERMIT PERMIT NO; B 084031 PLAN CHECK NO; N uc uo: uNr: (714>646-7884 CA „� „p, 6 012 2 6 �, 1 LICENSEO CONTNACTOH4 DEGWi�T10N: I Iw�sDy dlim �dw pwWy d papvy Ntl I mn fcrmed �vdr pwmau d CNqx Y (mmmenaq vrilh a00) d Di�+a'vi a d Ne Buemo W PNeadau Co e eM o n Iu0 brea eM cmuc(.n']o.: 0� 23 uc.cuss: C-39 c No.: b�2 CP: /9q � Dms: `� O � � Cmvador: / OWNER BUILOER DECIAH�TION: I Iraby afNm ivdse paWy d perjury thet I em ammp Iro e Gmroem Licema ler la IM �dw..:ro � ls.eo� �w�s a,.:,....�a v�e�e coe.: Nn w a�+v wha� � o�+�+u io owwn. ee.. �aoV.. dartaleh. a rapai enY ��w^; � b 4 evwiw. ebo mpwe� IM epPfiatl la ach pa�mi �o fib a eqnaC WtamN tl�et he a�M u IicemeE qmueni to IM po.itim� d tlr Canrean� Limn+a Ler IChaqx 9(�^^m9'�h Seaion ]OW) d Ovuion 3 d iM Buemem W Rdmaiora Coda� a thn he a kw o azsmq thsdmn md tM bsae ts IM elbped miemqm. Nry violtlian d Seqion � 1031.5 by eery eppFreM la e permY ubpN IM epp(rsN lo s dH peWly d nal mas Ihm frro hwdred doAvt �SSOOD. '�] I.mox�nrd�Mpopnyamyampbyw�w�Awepesn�hsadsmmqmeton.WdothewaF.andtMsmmraena"vtlrMeE w dleraE la sele (Seciion'lOa,. Bueinan arid Pmfwuons ('•ade: TTs Cavredwe lireeue law Eom ml eGW Io en ownerol poVeM ..no ww. « m�o�.. m.,.oa.�a.no do...w, � mm..e «n«.a «wwon w«n> o�.�.mWww. a� �n.�.�n impmnmem� ue nd intaMed ar alleeE la xb. tl. howwer. tM buitlinp a inpwemaM n wld wi1Nn aa Y� d mmpk�ion. Ns owrcr-0uilda x�0 hevs iM bwdon d qwirq M a kr did ml biriN a Mpo�a 1> �M pvpoee d selel. ❑ i... o.... a ine ww.m..m..�M ��:�a »w, xwee w��eno�. m oam�w �na c�iw cs«�v� ro... a,.w...�w Proleesiane CaEe: TM ContrMon Licanea lew Ams na epply lo en ow�wr d piapa�ly wM hritls a impovr �Miean eM xfio cOnbYtf �q vY31 WMh� wYh e tl11VtBtlIX(0) IiCOnffi WR�� b IM CANeMbf 1Yf11fG ldv). � I em azamp uMee Seuion: e. S P.C..lor No ruaon: Dme: �; I tlo hreM u�M Net I em ewva d vd u�Ms�bM Ihs �Mv��aca d Cd'faNellsel� eM Se1M' COG Satliom 25505. t�J. vd 255�i. ud ihet 1 a enY Mun drild'aq avqvu rY / wil nal (ucb ono) nsed ro camCN wYA eeid neia mdu eM �hs �epwmmmb br e permn la amewdion a modillwion trom IM Ai�y'Ireiupemsa Oinria. ReedaN iel mM�utlion epp4etiwm en eremp Iran Nra w��•. oeu: �00�'y+� WONKEH'9 COYYEN91Tp1 OECLAXATION: I Iwab� eMn uMr pwietly d pspvy ar d Ne bb�'vp AMe�Eiau: i �I �� PERM NO: B 08403 GOVT; N SUPF; N CONSTRUCTION TYPE: V—N PERMZT TYPE: STR PURPOSE: OTH JOB DESCRIPTION : T/O, SHEATH 6 REROOF W/COMP SHINGLES SQ FT: 5,500 CLAIM VALUE: 5,500.00 CALC—VALUE: 5,500.00 GROUP OCC: R-3 / COMMENTS: SMOKE DETECTORS REQUIRED PER 94UBC, REROOF 2800SF RESIDENCE W/COM it+r�r+t*******«*r�e��**it�rr*+r+tir*�r*it**********�rw**�r*r***r**********�**��r*+r*�********* Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN 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 PARICING REQ: PROV: PARCEL: 11739122 ZNE: REF NO: PLANNING NOTES>, ,� . 'lF 1f'!f fh f! 1F it if if 1f 1t M �f ik if iF it i! if !F it ik iF 1E iflt if !F if �f 3FlF iFl1� ff 1k if if'lF iF if iF if 1f iF ik iF if it if IE it iE iE ik k iF iF iF it iE iE aE f! �E �f']f if iF iF if if iF 1f �t i(� �t 1f if 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 . i'. 20NING APPROVED BY DATE: �'� �/ HUILDING APPR,OVED BY : DATE: � APPLICATION ISSUED BY: DATE: �?!�� ifkfF�fifNMifififititif{f�flf�Eitftiflfif ififitlFiFikikiFlEiF . if�f LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT:Y HLDG PMT PLUMBING ELECTRIC MECHANIC PERMIT 112.25 PLAN ISSUE FEE FIRE SMIP/R55 GRADING � SMIP/NON—RES � v � �AsvaWvMme'vu�n�MCrbedmr�YtouYav��bworken'm�qrmion,nqwNMfabyB�tlimJ]ODMtlrl�bor BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE coe..�«ineo.n�.ww.�i�.�mm�w�sm�w. TOTALS----> 112,80 0.00 0.00 112.80 112.80 .00 � in.»ena.a�nn.:,.�on�«.•oomo��.M*.•,�bMs.n�u,aroodm.�.e«coa..wu»v�«mm�osam. ,.,n�t«.Nauev.mmsm�.e.w.�.+'�+�..bo�r�e....: EXPIRES REVENUE DZVISION TOTALS--> COLLECTED: 112.80 OVER/SHORT: .00 `°'"°" O1/O1/98 BLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK Po0" Nimibi` 1 12 . 2 5 . 5 5 (TAii ewtion raW � M oomOM�d fW 0�l b b aw MNM ANx� Isi0o1 n Yn J �] icanMmau�urw�amenc.aurwkm.w�cn�wv�+b�r+e.iweno�«�wMm+rv�mmrmemar.omio atifiFk*ifitiF�f*ftitititiFitif7aitifitiF�tif*ieififitititit*ifitffitit*iF*i�iti�***icat%atia�fifitititiFitiaifaF*iEiF�fiiiFiFitiFit�t*aEififiF* bacan� a�OjW to tM wkwJ mipa�umion Isw a CaNwris. aM ypw Na i I dvdd . a4a to �Ir wMen' �,,,��.. ��.,.n , a sw� s�oo d in. i.ea cae.. i i«u»an �mv +ih iro. w �+. I N D I V I D U A L F E E B R E A K D O W N Dms: � MG�� w.,��:r.uw.ro..w .nn�.:ro�ro«�..rro��o.«.wi•w..w..�e.wi.�ehn � �m.ro�aP..�.ro..w TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST s u�irowemm t.�.��e,`�`in mtw.i'm��.r�'.�a.�`�"'""�"� "a"�°a�""�'ro��" SFR 5500 REROOF HY VALUE RESIDENTIAL NOZONE 1. 00 S, 500. 00 CONSTNUCTION LENDINO �OENCr: I Iraby tlNm uMr pauYy d pxjry iM iMn b a m�9�utlion bM'vp epaicy b Er perlormerca d �M wdM lar �M'vi� IM prmi u uawA (5sqm ]O61. Cwi. C). LENDEP'8 NYIE LENOEP'9 MOFE99: I anih �hat I haw mM No eDdieYm eM mu Ihtl IM ebovs'udamelion u canW. I apns to oomW wuh eY rYY enE muniY ad'v�enw� eM Mts lewe rNUM Io buidiq mmauGion W MrWy �ahor¢s �eP�� dNe my ro aNs upm tM Wwe�mW iwwd P�Wa�Y I'°"napetl10""'"D°°"' MATT CLAYTON oma: � � � (5tst.a6.wP) Wndo-Buikiq 8 Salery: arear�Fb: Cerory-AppSmX: Rnk-Revenue: f3ddenmd-Avamv �iJ�Zi)�7i�F�i� 88-04-1997/09:52 AM/f112.A0 RCDTq:fll-Q�1fl144 PEFCMIT:084031 � CONSTRUCTiON AND PLANNING POOL & S. • . APPROVALS Permit # Date Inspector AppROVALS Permit # Date Inspector 1, Temporary Electrical Service or Pole 52. Pool & Equipment Location � 2, Soil Pipe-Undrgrnd. . � � 53. Steel Reiniorcement • �3, -Electrical Conduit Utility-Undrgrnd.. 54. Forms " �� .4.-Electrical Conduit-Undrgrnd. .. 55. Electrical Bonding � ,5.. Steel Reinforcemertt 56. Rough Plumbing & Pressure Test ',6. Electrical UFER G�nd. 57. APPROVAL TO COVER�GUNITE �_ 7, Foot�ngs - � , 58. Electrical ConduibUndrgrnd. ��;8. �Foundation � ' S9. Gas Pipe, O Undigrnd., Test �'9. Water Pipe-Undrgrnd.- '_ 60. Backwash �{nes, P-Tra0. � Undrgrnd. i,10. Structural Floor Svstem 61. APPROVAL TO,DECK 1 i, Property Sewer Line & 4ouse Connection 62. Backwash & RecePtorF,inal � 12. $ewer Cap � � - 63. Heater & Vent-Final � 13. Aoof Drains '_ . 64. Plumbing Syscem - Final ` 14, floughPlumbing _ << � 65, Electricai�Final � 15. Rough Electriwl-Conduit ; ,� � 66. Solar Svstem�Final � �� 16. Rough Electric Wiring - 67. Fencing & Access Approval 17. Rough Wiring Sign '� � � 68. APPROVED FOR PLASTERING :� _ 18. Rough Electrical-T Bar Ceilibg�� 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning - � FIRE DEPT. REQUIREMENT 3 20.•Rough Factor.y K�replace �T _ _ t ., � = r ,i qppROVALS . Pe�rmii #' ' t. ,� � ,_ 21: Du s, in�Struaufe• ,.. ' S ' � t�? • -.� F e 7�._ Undeigrou�d HYdro 22. Ducts, Ventilating: ; . .. ' � _. S k�^• 77, producE.Piping't7�Gas C] Oil 23.•Gas�Pi e�Rou h&�test _ ; ,� ''f u ' " P 9 ; n. 72. Underground FJush� . 24, Roof Faaming ;_ . _. _ :.p- e, ; � �+:: 73. Undergvnd. Storage Tank O Gas QOiI � _,. , 25. Roof Sheathing `� ?� Qj,;i�� (A%f�' jq,-_pverhea'd Hydr'o � v 26."T�Bar Ceilin9 (Structural) & Monowat + ' [n' Tb. �Dry Chemical ' � � ` -.: 27.' Frame and Flashing _' _ _ � L' �6. 'Dry Sta�dpipe '' � . 26.�� Lathing_& Siding'. ,�, - �= e;_. � • 7A, FIXED SYSTEM FINAL ' 29. Insulation =' ' ' ' " +- � 78. FIRE PREV. FINAL : � � � 30. Orywall-Nailing . �� , � -. HEALTH DERT: REQUIREMENT �. 31. Plaster Qr,own Coat� ._ ;` � � ';� r 79. FINAL�INSPECTION :- �� 32. Electriwl Power Meter,Final�, ' �� '- 8Q. POOD CER7IFICATE ISSUED _ 33.�Finel Ekctric � *� � - � -� ' � Pl�otes: ' , ' , i . _ , 34.`�Fin51 He�ting�& AiriCoqditionipg. r � , • - . .- - � 35.'Final Ges Pipe•Test� • '� :�� ` ' - ,. . 36. HooB ors�anopv- .* _ ' ^ - s - ,. - - � . -� 37:'.Final Pactory Firealace�_ � S.� - # ;•' � - • , '� f . 't .., - .. . �_ ! ;,, . �� ._ . -- � 38. FinalPtumbing .:z. "`'� - . ` � � - 39. WaterService�Final! . �` - � ' _ �, � , 40. Gas Service•F3na1-_ � . . _ , y - � ' " �= 41, Solar pomestiaFinal � - � • _ � • , " 42. Backflow Preven{er' ' a -' � �� . , . 43. Backflow Irrigation � . __ t� � � ' i T l. 44. Landscape Irrigation System � ` _ ' , . � � '45.;Sou�d Atteauatian : • ... � ' � '46. HandicaPReyulaxions - ' � �' ' ' '-; - � �� - 47; FINAL STRUCTIJk?E & BUILD�NG �7.L;? � � 48. FINAL PLAfVNING � � i . � 4g„ Elettric�Release to Edison , � . - . . 50.. Gas Release to Southem California Gas Co ; � `'' � - , ' �� : '� 51'. CERTIFICATE OF'OCCUPA CY No. Date ' S66"�� . � . 2 „�,. , : - COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 7P00 - COSTA MESA� GALIFORNIA 92626 For Appflcanf to Fill ►n Campletaly TYPE OR PRINT � BUILDINO ADDRESB COSTA ME3A. CALIFORNIA 96i8wCK LIX[ I110M DESCRIPTION OF WORK r� 1 NHPHBY ACKHOWL[006 TNAT 1 NAV6 RRAD TX�Y APPL�GTION AND BTAT6 THAT TX6 I180V6 �� CORR6GT�AND I�ORBi TO COM- PLY WITH ALL CITY OpD1NANC�Y AND �TATi L11WD p�0UU1TIN0 BUILOINO CONBTRUCT�ON. PERMI'f'1'BG O' � / �A.L� C. /`r�-(.,LG AUTHORIZiD AOiNT � CiiY �r ..�� ES� MAY 5 1966 IAPPLICATION FOR PERMIT RLCi1P� �Y ��1� cnTe � =S =C ZONING MO. OP UDt 01 N[W� �ux� uao�no L-nT/�Pi 7-7/Z 1/S� r1 �., "s�/— � Z YARDH MPROV6D MAIN BUILDINO vwx.4i � � � sHw�� ee �ess rH� ` ^ .� (U.B.C.REqUIR6MENT1- � YARDSAPPROVHD ` n AGCHS80RYBUILGIN6 \ � \ ` ewre �'� —b 3US� TX6 AMOUM BHOWN UND6H VALUATION 18 POR TXB r4PP096 OP 6BTABLIBNINO A PEqMIT PHB ONLY. VALUATION � PERMIT FEfi � s �OD— �