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Home My WebLink About395 18TH ST - Building Permits��ia� �sa-sz�s • Fax (714) 754•4856 • www.ci.cos�a-mesa.��LDING PERMIT Job Address: 395 E 18TH ST Suite: Vicinity: Parcel Number: 42502218 Applicant: MIKE JOHNSON Address: 288 VIRGINIA PL Zoning: Phone: 949-548-6588 COSTA MESA, CA Zip: 92627 owner. BURROWS, REX AND GRETCHEN Address .JOHNSON, MIKE AND PEGGY , COSTA MESA, CA , Phone:� '395 E 18TH ST� � .� Zip: 92627 Contractor. � - � Adtlress: Phone: 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 11/12I2003 Issued: 12/37/2003 ISSUED 8Y: i ., Zip: License: Arch : SHAM, ZACHARY Eng: Address: 2600 NEWPORT . � � Address: SUITE 154 Phone: � � � Phone: NEWPORT BEACH, CA - � � Zip: 92663 , License: C5004 . � License: SCOPE OF PERMIT ADD 620 S.F. TO EXISTING S.F.D. WORK TO INCLUDE: REMODEL AND EXTEND EXISTING KITCHEN AND BATH, ADD NEW A1ASTER BEDROOM AND BATH, NEW FAMILY ROOM. � - � � � ' � ADD A NEW 457 S:F. DETACHED GARAGE. GARAGE IS MAXIMUM 15' IN HEIGHT, MIN. 200 SQ.Ff. LANDSCAPE STRIP IN DRIVEWAY.�REF.: 803-01967 � " , . � � . . CONVERT 2 BEDROOM, 1 BATH S.F.D. TO A 3 BEDROOM, 2 BATH S.F.D. - � Plan Check: $477.59 Permit: $734.75 SMIP Res: $6.23 SMIP Com: $0.00 Otlier: $0.00 Inspection: $0.00 Total: $1,218.57 � SETBACKS MAIN STRUCTURE Front 20- 6 Rear 20- 0 FEE SUMMARY , _ PLANNING & ZONING Left 5- 9 Calc Valuation:' �' Claim Valuation: Right 13- 8 $62,288.00 30.00 NO710E: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 780 days, or it work is suspended or abandoned lor a period of 1B0 days. INSPECTIONS: In order for the work euthorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred Inspectlone and finel approvel must be obtained. Failure to obtain inspections and final approval will resul� in ihe expiration of ihls pertnit. FOR INSPECTIONS CALL: (714) 7545626 zaasee �aroo� WORKERS'COMPENSAnONDECLARAnON: � , I hereby effirm under panelry of perjury one oi the following declarations: ❑ I have and wlll mein�ain a certiflcete ot consant to self-Insure tor workers' compensatlon, es provided for by seclion 3700 of the Lebor Code, for Ihe pertortnance of the wark far which this permlt Is Issued. ❑ I have entl wlll maintain wo ers' compensation Insuran�e , as requiretl by sectiwi 3�00 af the Lebor Code, tor 1he peAortnarxe oi Ihe work tor which Nis pertnit is Issued. My workera' comqenu�lpn�psuJ¢nce carner entlfppNey number are: Camer. need nof be orIe55J Poliry Number. �/I cetlify that In the pertortn§a6e oi Ihe wo �w �ich �is permit is issued, I shell not employ any person in eny manner so as to become subject to the workere' )Y compensatlon laws ot �e1R (nla, e eg e t�at t I ultl bacome subject to Ihe workers' compensatlon provislons ot Sectlon 700 at tpe Labor Code, I shall torthwith comply vnth these P�gtiU �s. • �n r�) I J�/}� Applicent Siqnature: � Dete: ' �// —y �� ✓ WARNING: FAILUf1E TO SECURE WOFNERS' COM ATION COVEMGE IS UMAWFUL AND $HALL SUBJECT AN EMPLOVER TO CHIMItU1 PENdLT1E5 AND CML FlNES UP i0 ONE HUNDRED THOUSANDDOLLARE�E100,000),INADORIONTO COSTOFCOMPENSATIIXJ,DAMAGESASPROVIDEOFORINSECTIIXJ3]OBOFTHEUBORCODE,IMEREST,ANDATTORNEI"SFEES. LICENSED CONTIiACTOFiS DECLAFATION: I hereby eNirtn thei l em Ilcensetl under provlsions ot Chapter 8(commencing with Section 7000) of Divisian 3 ot t�e Business and Protessions Cotle, antl my license is In tull torce entl eNect. Lic. N Cless a � Cantracror's SigneWre: Dete: CONSTRUCTION LENDING AGENCV: ❑ I hereby aflirm Ihet there is a constmction lending agency for the pedormance of ihe work br whlch ihis permit is Issued. (Sec. 3097, Civil Cotle). Lentler's Neme: Lendefs Adtlress: Signeture: OWNER-BUILDER OECLARATIONS: Dete: I hereby eXlrm that under penelry ot perjury thet I em El(EMPT FROM THE CONTRACTORS LICENSE LAW tor ihe following reason (Sec. 7031.5, Business antl Professlons Cotle: Any ciry or counry which requires e pertnit to construct, alter, improve, demolish, or repair any siructure, pnor to Its issuance, also raquires �he ep0�iwn1 for such pertnit to lile e signed stetement that he or she is Ilcensed pursuant ta the provisions of the Cantrectors LJcense Lew (Chepter 9(commenGng with Sadian 7000) 01 Divislon 3 01 [he Business and Professlons Code) or thet he or she is exempt therefrom and Ihe basis tor tha elleged exemptlon. Any violetion of Section 7031.5 by any epplicent for e pertnit sub�ects the epplicant to e civil penaly of not more t�en tive hundred dollars ($500).): ❑ I, as owner ot Ihe property, or my employees with weges es iheir sole compensatlon, WILL DO THE WORK, end the structure is not intentletl or otteretl tor sele (Sec. 7044, Business and Professions Code: 7Te Contraciors License Law does not apply to en owner ot properry who builds or improves thereon, and who does such work hlmselt or hersell or through his or her ov.•n employees, provided that such imprwements ere not intended or oMered for sale. II, however, the building or improvement is sold wilhin one year of completlon, Ihe owner�builder will heve ihe Gurden of proving ihet he or she did not build ar imprave tor purpase af sale.). • ❑ I, as owner of Ihe property, em EXCLUSIVELV CONTRACTING WITFf LICENSED CONTRACTORS to construct tha project (Sec. 7044, Business and Professions Code: The ContwCtOrs Litense oes noi Bpply Io an owner ot properry who builds or Improves thereon, end who comrects for such project wilh a cornraccor(s) license pursuent t Ca r ors 'c se LewsJ. ❑ I am e:empt Cer ec: Business antl Profeuions Cotle for Ihis reason: Signature: Date: OwnBr ID verllied Dy Crlver'S1Iten5 . Y85 ❑ No OrivefS LiCen50 No. Expi Verilicatlon ol Ownership by (rype of docu�nbnt, i.e. - properry tax bill or deed): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby certly thet no excavetlon five (5) or more feet in depth Into which e person is required to descend, will De matle in connection with work authorized by this permlt, antl ihat no Duiltling siructure, scaHolding, falsework, or demolitlon or tlismantling t�ereoi, will be more than thirry-six (36) teet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Tlile 8, Californle Atlministrative Code). ❑ As owner-bullder, I will not employ enyone to do work which would requlre e permit Imm I�e Divislon of Intlustrial Sefery, as noted above, unless such persan hes e permit to tlo suc� work irom the tlivision. Signature: Date: Division ol Industnal Sefery Permit Number: WIII Ihe epplicant or present or tuWre builtling occupant need to file and certity a Business Plen for emergency response to releese or threatened release ot e hezerdous meteriel7 ❑ Ves ❑ No the Celitomi� 9 91 any one 3t a Business Plan be tileC with Ihe Costa Mesa Fire Depanmem by every equal to or greater Ihen a weigh� of 500 pounds, ar e volume of 55 gallons, (Sectlon 25533 of Ihe Calltomia Health end Safery Code, wl�h some exce�tions, requires registretlon with the Coste Mese Fire Depanment by each business which at eny ane time hes on hand a quantiry of ecutety hazardous matenals equa to or greater t�en e weigM at 500 pounds, or a vdume ot 55 gallons, ar 200 wbic teet of compressetl ges et stantlerd lempereture flnd pressure). will th❑e applicant or present or � No 25534 of the Celitomia Health ent at en RMPP Dy businesses a n en nrnrr �s presenny reduvea, nas secnon z5aw ................__................_..._.........._.....................................—......_......... 5 Does or wlll Ihe eppllcant or present ar future buildin from lhe South Coesi Air Oualiry Menegement DisMc (Sedion 65850.2 of the Calitomia Govemment Code en hazardous it Ihe Cosle Mesa Fire Department may requlre Ihe preparation, certilication end filing wlth the Fire ecutely hazartlous meterials with ihe Fira Depariment. of ihe Celifomia Health antl eny o�her eir pollutlon contral dlsMct or epenc� that the reduested inlortnetion be fumis�etl on any patl ol tne teclllry to be constNctetl untler Inls permll oe wlinln IUUu Ie6t rrom tne ouler oounaanes or a scni �es', the laciliry musl meet the requirement of Sections 25534 entl 42303 of Ihe Celifomia Heal�h antl Sefery Cod ................................................................................................................................................................................................................................................. Pertnit Irom ihe Sauth Coest Air Ouelity Menagement Distdct or o�her alr pollutlon conirol tlls�dc� or B9ency icatlon, heva ell ol the dlsclosures D�escrlbed by Calitomla Heali� an0 Salety Code Sectlon 42303 been mede7 on a Permit for such construction or �J N� for noo-resitlantiel building pertnits). work Qf'yes", ettech cenl8cete ot compllance from the appropnate air pollutlon conVol onlcep. CERTIFICATE OF COMPLIANCE: I certify that under penelry of perjury Ihe information given ebove is correcL I egree to comply with all stete laws antl ciry ordinenc85 regarding Hazardous Materials and Emissions. � Signature: Date: CERTIFlCATE OF COMPUANCEAy AIJfMOR17ATON OF ENTRY: I certity under panelry of perjury thet I have read this epplication entl state that the intormation given Is correct I agre��ply wit Irlet I rs end ciry ordlnences rela�ing lo building consiruction, end euthodze repr �entative� ot the City of Coste Mesa to enter upon t�e ebove-descrlb pr � erty to pecti n rposes. I agree not to occupy or ellow occupancy of any building au� rp d y Ihis De�mi ui til tinal inspection. SI ture Ot Leg I Owner(s) T AnNOr Authonzed Applicant Data CODE �. INSFECTIONTYPE 1616 Fixed System Final Fire Prevention 1288 Paol Spe Finel 200 Finel Re-Root 201 FIneI BIxWReteining Well 202 Finel Fectory Fire Place 203 Flnal Slgn 204 Finel Demolition �� COOE I INSPECTION TYPE 206 Flnal Mechanlcel 20B 210 212 220 222 250 Final Plumbing Flnel ElecMcal Final Fire Pravention Final Plenning Apprwel Final Site Final Builtling/Occupancy pAg II�ELB (714) 754-5273 • Fex (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 MECHANICAL PERMIT Job nddress: 395 E 18TH ST Suite No Vicinity: Parcel Number: 42502278 Applicant: REX, BURROWS AND GRETCHEN Address: JOHNSON, MIKE AND PEGGY � COSTA MESA, CA � Phone: 949-230-3354 CELL 395 E 18TH ST - . Zip: 92627 � �� ' Owner: REX, BURROWS AND GRETCHEN Address:. JOHNSON; MIKE AND PEGGY ,� COSTA MESA; CA �� Phone: 949-230-3354 CELL . - 395 E 18TH ST Zip: 92627 � Contractor. Address: ' - � � . � Phone: �Zip: License: Status: ISSUED Applied: 04127/2004 Issued: 04/27/2004 ISSUED BY: SCOPE OF PERMIT REF: B03-01966. ADD 620 S.F. TO EXISTING S.F.D. WORK TO INCLUDE: REMODEL AND ' EXTEND EXISTING KITCHEN AND BATH, ADD NEW MASTER BEDROOM AND BATH, NEW FAMILY ROOM. 603-01966. � � ` - � - - � - � , � � ' MECHANICAL TO INCLUDE: t NEW FAU < 100K BTU, DUCT WORK, HOODNJ EXHAUST, 1 VENT FANS. . ISSUE FEE Inst�FAU <100 k BTU Inst FAU >100 k BTU � � Repair%Alt Cooling/Heat-,�� Inst / Rep. Recess Wall Htr Refrig Sys <100 k BTU � Refrig Sys >100 k BTU " Gas Piping � Factory Fireplace Hood w/Mech Exhaust VAV Box Vent Fan / Single Duct � , Appliance \ � Fire Dampers ' � Smoke Dampers � Inst or Relocate Appl Vent Air Handlers < 10000cfm Air Handlers > 10000cfm Floor Furnace Floor or Suspend Heater \ . -�-- �=FEESUMMARY - � Quantity �. $23.50 Repair / Alt Absorbtion Unit .. $14.80 1 Repair / Alt Refngeration Unit $0.00 0 Ventillation System $13.70 1 . . �� ' Evaporalive Cooler $0.00 0 , .:�i:'�` " Commercial Incinerator , $0.00 0 � - � � � Domestic Incineretor , � $0.00 0 . - � ' Compressors�/ Absorption Systems ,- .$0.00�'0 � . " Upto3hp/t00kBTU� ; , $0.00 0 . 3 To 15 hp / 500 k BTU $10.65 �1 . 15To30hp/1,OOOkBTU � � $0.00 , 0 ,� , � 30 To 50 hp / 1,750 k BTU $14.50 2 � - , � Over 50 hp / Over-1;750 BTU ` ' $0.00 0 � � � ` Boilers � � ' " $0.00 0- " - Up to 3 hp _ , , $0.00 0 �. - . - . 3 To 15 hp � . � , $0.00 0. - � 15 to 30 hp , - $0.00 0 '- 30 to 50 hp -� . $0.00 ��0 : - ��' � Over50hp - $0.00 0 � " Other Mechanical Fee $0.00 0 1� -- - - ' - ' ' �Invesiigation Fee Quantity $0.00 0 $0.00 0 .�.$0.00 0 . $0.00' . 0 � ' $0.00 0 $0.00 0' 50.00 $0.00 � � $0.00 „ $0.00 �30.00 - �� $0.00 $0.00 $0.00 $0.00 $0.00 0 0 0 0 0 0 0 0 0 0 i INOTICE: The work authonzed by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related . regulations. (Ortl. No. 9248, § 1, 12•21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1B0 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authonzed under this permit to be considered legal, such work must comply with all applicable codes, antl all requiretl Inspectlone and final epproval must be obtained. Failure to obtain inspections and tinal approval will result in ihe expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 [G4b9ti 11YW� WORKERS'COMPENSATON DECLARAnON: � I hereby effirtn under penelry of perjury one of the following tlecleratians:� � I heve and wlll malntein e certificate ot consent to setl-Insure for workers' compensetion, as pmWdetl for by seaion 3700 ot the Labor Code, for ihe pertortnance of t�e work far which this pertnit is Issued. � ❑ I have and will malnteln workero' compensation Ins ance, as requiretl by section 3700 oi the Labor Code, for Ihe pertortnanca ot ihe work for which ihis pertnit is Issuetl. My workers' compe�setio Insur n�e carrier e II umbar ere: � Certier. \ PolicyNumber. (Th/s sectlon need not be co etetl/ e permtt i ve/ued et one huntlred Uollers ($f 00) or less.) certily that in the paAortnanca of the work for w�ich this pertnit is issued, I shell not employ any person In eny manner so as to become subject to the workers' compensation laws of Calitomie, � d egree thet II I shoultl become sub�ect to the workers' compensatlon pmvisions of Sectlo 3700 af t� Lebor Code, I s�all forihwith comply with �he50 provlsion9. ��^, __ � i ! �� 1�` � I �i��'b�(✓% oete: � / 4� App icant Signature: WAFlNINO: FAILURE i0 SECUHE WOFKERS' OMPENSATION COVERAGE IS UNLAWFUL AND SHALI SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FlN S UP TOIXJE HUNORED THOUSAN� OOLLARE (5100.000), IN ADORION TO TME COST OF CpAPENSATION, DAMNOES AS PHOVI�EO FOR IN SECTION 3]OB OF THE LABOR CODE, INTEREST, AND ATTORNE`fS FEES. LICENSED CONTRACTORS DECLARATION: I hereby aNirm that I am IlcenseC under provisions of Chapter 9(commencing wlth Sectlon 7000) of Divislon 3 0l the Business antl Pmtessions Code, anC my license Is in full force entl eHed. Lic. N Cless A Contrectofs Signature: Date: CONSTRUCTION LENDING AGENCY: � ❑ I hereby aflirtn that ihere is e consiruction landing agency for ihe pedormence ot the work for which Ihis pertnit is issuetl. (Sec. 3097, Civil Cotle). Lenders Name: Lender's Add�ess: SlgnaNre: OWNER•BUILDER DECLARATONS: Date: I hereby aHirm that under penelry of perjury thet I em E%EMPT FROM TFiE CONTFiACTORS LICENSE LAW for Ihe tollowing reeson (Sec. 7031.5, Business antl Professions Cotle: Any ciry or counry which repuires e permit to construct, eltar, Improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such pertnit to file a si8ned stetement thet he or she is Iicensed pursuent to the provisions of Ihe Contractore License Law (Chapter 9(commencing wlth Sectlan 7000) ot DiWsion 3 ot t�e Business end Professions Cada) or that he or she Is eaampt therelrom end ihe besis lor Ihe ellegatl ezemption. Any violation of Section 7031.5 by any epplicant for e pertnit ubjec ihe applicent to e civil penelty oF not more ihan five hundred dollers ($500).): I, es owner oi the properry, or my employees with wages as Ihelr sole compensellon, WILL DO TME WORK, and ihe structure Is not Intendetl or ottered for sale (Sec. 7044, Businass and Protasslons Coda: The Contractors License Ww does not applY to an owner ol property who builds or improves thereon, antl who tloes such work himself or hersetl or ihmugh hls or her own employees, provitled �hat such Improvements ere not Intended or oNered for sale. It, however, the building or improvement Is sold within one year ot completion, the owner-builder wlll hava the burden ot proving that he or she tlitl not build or Imprwe lor purposa ot sale.). ' ❑ I, as owner ot the property, am EXCLUSIVELV CONTRACTING WITH LICENSED CON7RACTORS to consirud tha project (Sec. 7044, Business entl Professlons Code: The comractors License Law tloas not apply m en owner ol property who Oulltls or improves ihereon, end who contracts for such proJect with e comracbr(s) license pursuant to t�e Contrectore License Lews.). ❑ I am exempt un ec. Business and Professions Code for this reason: Signeture: ��iln/� Date: Owner ID verified by dnv�censa. es ❑ No Oriver's License No. Ezpires: Vedficatlon of Ownership by (h/pe ot document, i.e. - property terz bill or deed): DIVISION OF INDUS7RIAL SAFE7Y PERMIT CEpTIFICATION: 0 I hereby certily that no excavetion five (5) or more feel in depih into which e�person is required to descenq will be made in connection with work authodzed by this permit, antl that no building sirucNra, scafloltllnq, falsework, or demolitlon or dismantling thereol, will be more than thirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, T�le B, Californla Administrative Code). ❑ As owner-bullder, I wlll not employ enyone to do work which would require e permit from the Division ot Intlusirial Safery, es noted ebove, unless such person has e pertnit to do such work irom the division. Signature: Date: Division of Industrial Selery Permil Number: CER7IFlCATE OF COMPLIANCE IWD AIffHORIZA710N OF EMRY: I certify under penalty of perjury that I �eve read this epplication entl state that ihe intortnation given is wrtect. I egree to comply wllh el tate laws and ciry ordinences relating to bullding consiruction, anC euthodze representati s of the City of Costa Mesa to enter upon the Bbove-d05Cnbetl property tof in tion pu es. I agree not occupy or ellow occupancy ot eny building authonzed by t' it� il �in�qspeption. / \f Signature Of Legai Owner(s) Date And/OrAuthonzed Appllcent Date COOE t. INSPECIIONTYYE 1616 Fixetl System Final Fire Prevenqon 1286 Pool Spe Finel 200 Final Re-Roof 201 Final BIocWRetalning Well 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition GAg 1[�LS ', � CODE� INSPECTIONTYPE 206 Final Mec�anical 20B Finel Plumbing 210 Final Electrical 212 Flnel Flre Preventlon 220 Final Plenning Appraval 222 Final Site 250 Final Building/Occupancy (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT lob Address: 395 E 1$TH ST Suite No Vicinity: Parcel Nunmber: 42502218 Applicanr REX, BURROWS' � Address: . � . � COSTA MESA, CA, � � � Phone: 949-230-3354 CELL .395 E 187H ST -� - Zlp: 92627 -� � � Owner: REX, BURROWS AND GRETCHEN ,Address JOHNSON, MIKE'AND PEGGY � - COSTA MESA, CA Phone: 9A9-230-3354 CELL 395 E'18TH ST Zip: 92627 Contractor: Address: Arch / Eng : Address: ISSUE FEE , �� Backfiow ivigatlon, BackFlow Preventer Bathtub Clarifier System Connect Qce,Soda,etc) Dental Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Drinking FounWin Expansion Tank OWNER-BUILDER Phone: Zip: License: 000000 . , :� �� . - - . , - t�- ". _ Phone: - -' . - -. . .Zip: License: Status: ISSUED Applied: 12/26/2003 Issued: 1Z26/2003 ISSUED BY: � � � , � �� ' ,,. �, '_ A SGOPt Uh PtKMI l - " INSTAL� pLUMBING LINES NO FIXTURES ARETO BE INSTALLED ONLY TRENCHING WITHOUT POURING ANY CONCRETE FOUNDATION. A SUPPIEMENTAL PLUMBING PERMIT SHALL BE RE�UIRED. 803-01966. . FEE SUMMARY � AM7 �` ; QTY �= � - AMT� ��QTY -�' � � ;� �" � ' � -AMT 823.50 � ' � - �- Laundry Tub / Washer . � $0.00 . 0 Sump Pump � $0.00 $0.00 0• , � Landscape Irrigation $0.00 0 Swimming�Pool ' ' $0.00 $0.00 0 , �P,Trap S0.00 0 Trap Primer, � $0.00 � , $0.00 0 Pressure Regulator $0.00 0 � - . Urinal �- . $0.00 � , .$0.00 � - 0� � . Piocess Piping (per 10 ft) $0:00 0 . Vacuum Brkr Bkflow(1-4) $0.00 $0.00 � 0 Receptors $0.00 .0 � �� Vzcuum Brkr Bkflow(5+� $0.00 � $0.00 0 " � Septic Tank . , - $0.00 '0 Wash Basin�" $0.00 $0.00 � �0 � - Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 $0.00 0 � Sewer Connect . 50.00 0 Waste and Vent System $0.00 $0.00 0 -, � Sewer Private Line � $0.00 0 -, , � Wa[er Closet (Toilet) $0.00 $0.00 0 �� . Shower. �0.00 �- �0 - � Water Heater I vent $0.00 $0.00 0 Siok, bar - �"� � "$0.00� 0 Wa[er Piping (Inst or Rep.) 50.00 $0.00 0 Sink, commercial �� $0.00 0 Water Re-pipe $0.00 QTY 0 0 0 0 0 0 0 0 0 0 0 0 0 NOTICE: The work authorized ty this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 7, 12-21-g2) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days, or it work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In ordar for the Work authorized under ihis permit �o be considered legal, such work must comply with all applicable codes, and all requlred inspectlons and final approvel must be obtained. Failure to obtain inspections and final approval will result in the expiration of this pertnit. I FOR INSPECTIONS CALL: (714) 7545626 24d6C6Ifi/00) WORKERS' COMPFNSA710N DECLARATION: � ' I hereby atfirm ur�,-'� penalry of perjury ona of the following tleclarations: � � ' �–--..� ❑� I heve end:will maintain e cartiticete of consam lo selFlnsure for workers' compensetion, as providetl tor by section 3700 of the Lebor Code, for Ihe performance of the work for wliich Ihis permit is issuetl. ❑ I have antl will maintain workers' compensation Insurance, as required by section 3700 oi the Labor Code, for the peAortnance oi Ihe work for which this pertnit is issued. My workers' compensa�ion Insurence carner and policy number ere: , Carrier: policy Number: (This secfion need not be compleretl il the permit is velued af one hundred dollars ($100) or less.) �, ❑ I certity that in the peAO�anca oi the work for which this pertnit is issued, I shall not employ any person in any manner so as to become subject to the workere' compensation lews of Califomia, antl egree that i� I should became subject to the workers' compansation provislons of Section 3700 ot Ihe Labor Code, I shell ionhwith comply with these provtsions. i Appliwnt Signatura: Date: WARNIN�: FAILURE TO SECURE �'�'ORKERS' WMPENSATION COVERAGE IS UNLAW FUL AND SMALL SUBIECT AN EMPLOVER i0 CRIMINAL PENALTIES AND GVIL FlNES UP TOIXJE HUNDRED THOUSAND DOLLARE (5100,000), IN AODfiION TO THE CQST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECiION 3]O60F THE LABOR CODE, IMEFEST, AND ATTOfiNEY'S FEES. LICENSED CONTRACTOR5 DECLARATION: '� I hereby ettirm Ihat I am licensed under provisions of Chapier 9(commencing with Section 7000) ot Division 3 ot Ihe Business end Professions Code, and my license is in full force and ettect Lic W ' Class N ContractoYs SignaNre: i Date: CONSTRUC710N LENDING AGENCY: ❑ I hereby aHirtn Ihat there is a consirudion lending agency for ihe pertormance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lendefs Nama: LenGer's AOdress: � SignaNre: I Date: OWNER-BUILDER DECLARAnONS: I hereby effirtn t�at untler penalry of perjury ihet 1 am EXEMPT FROM THE CONTHACTORS LICENSE LAW for the following reeson (Sec. 7031.5, Business end Professions Code: Any cily or counry whiCh requires e permit to construct, alter, improve, demolish, or repair any structure, prior Io its issuance, elso requires the applicant for suc� permil to file a signetl starement ihel he or she Is Ilcensed pursuent to the provisions oi ihe Contractore License Law (Ghepter B(commencing with Sectlon 7000) of Dlvlsion 3 of ihe Business and Professions Ctlde) or thet he or she is exempt ihereirom and the basis for the allegetl exemption. Any violation of Section 7031.5 by any applicent for e permit sublects the applicant to e civil penalry of not more then five hundred dollars ($500).): ❑ I, as owner of Ihe propehy, or my employees with weges as iheir sola compensation, WILL DO THE WORK, antl ihe structure is not intentled or oflefetl for sale (Sec. 7044, Business and Pro�essions Code: The Contractors License Lew does not apply to an owner of property who builds or improves ihereon, and who does such work himsetl or harself or ihrough his or her own employees, provided thet such impiovements are not intended or a%ered for sale. If, however, ihe building or improvement is sold within one year of Gompletion, ihe owner-builtler will have the burtlen of proving ihat he or sha did not builtl or improve for purpose ot sele.). • ❑ I, as owner af ihe prope�iy. em EXCLUSIVELV CONTRACTNG WITH LICENSED CONTRACTORS to constmct tha project (Sec. 7044, Business and Protessions Cale: The contractors b�aensa lew tloes not appty to an ow�r oi properry who hulltls or Impmves thereon, aMl who coNracis tor such project wilh a cornrector(s) �licensa pursuant to the Contractors License Laws.). �� I�esempt untlHAsec. � eusiness end Professions Code for this reason: �D venfied by dnver's license ❑ Ves ❑ No i Venfication ot Ownership by (�ype of docu t, i.e. - property taz bill or deed): DIVISION OF INDUS7RIA� SAFETV PERMI7 CER7IFICATION: � ❑ I hereby certify Ihat no excavation five (5) or more leet in depih into which e person Is required to descend, will be made in connec�ion with work euthorized by Ihis permit, and ihat no building siructure, scaHoltling, falsework, or demolition or dismantling Ihereof, will be more �han thirry-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Trtle 0, Califarnia Adminisirative Cade). • ❑ As owner-builder, I will not employ anyone to do work which would require a permit irom the Division ot Industriel Setety, es notetl ahove, unless such person hes a permit to do such work irom the division. �. Signature: Division of Indusirial Safey Pe�it Number. Date: NAZARDOUS MATEBIALS /W U GMISSIDNS GEHTIFlGATION: � 1 Will the eppliwnt or presant or future buildinq occupant need b file end certify e Busineu Plan for emergency response to releese or threatened release of e hazarGous materlal7 ❑ Yes [] No (Section 25505 of the Califomia Health end Safery Code requires, wit� some exceptions, ihet e Business Plen be tiled with ihe Costa Mese Fire Department by every business which has at any one time during a reported year e quentity of hazartlous meterials equal to or greater ihan a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic teet of comp�essed gas at standard tempereture antl pressure). � ........................................................................................................................................................................................................................................................................................................................................................................................ 2 Does or will Ihe applicant or present or future builtling occupant need to fila a registration fortn tor awtely hazardous matenals7 ❑ Ves ❑ No (Section 25533 of Ihe Califomia Healih end Safery Cotle, with some exceptlons, requires registretlon with the Costa Mesa Flre Depanment �y each business which at any one time has on hand a quantiry oi ecutely hazardous matedels equel to or greeter ihan e weight of 500 pountls, or e volume ot 55 gellons, or 200 cubic feet of compressed gas at stentlartl tempereWre and pressure). . ................................................................................................................................................................................................................................:....................................................................................................................................................... 3 Does or will the applicant or Dresent or tuture building occupant need to prepare en RMPP (Risk Management antl Prevention Program tor acu�ely hazarGous metenals)7 ❑ Yes ❑ No (Section 25534 of ihe Califomia Health and Safery Code provides that ihe Casta Mesa Fira Deparlment may require the preparatioq certification end filing with ihe Fire Depertment of an RMPP py businesses which ere required to register acutely hazerdous matenels with the Fire Department. ........................................................................................................................................................................................................................................................................................................................................................................................ 4 N en RMPP is presently rUquired, has Section 25534 of ihe Californie Healih end Satery Code Deen fully com0lied with7 ❑ Yes ❑ No 5 Does or will the epplicent or present or future building occupem requlre tor the work which Is the subject ot �his a plication a permit for such consiruction or modification from the South Caast Air �ualiry Management District or from eny other air pollullon conirol disiricl ar egency? � Ves LJ No (Section 658502 ot the Califomia Govemment Cotle requires that the requested iniortnation be tumished on appliwtions for noo-residential building pertni�s). .......................................................................................... ................................................................................._............... fi Will any part of the feclll �o be wnsiructed under ihis ertnit be within 1000 faet irom ihe outer bountlaries of e school� �� ry p . ❑ Ves ❑ No (It "yes", ihe facility must meet Ihe requirement of Sections 25534 and 42303 of ihe CaliPornia Health end Safery Cotle). ...............................................................................................................................................................................................................................:....................................................................................................................................................... 7 If e permit irom the Soulh Coesl Air �ualitY Manegament Distticl or othar elr pollution control dlsMct or egency is reQuired tor Ihe work which is tha subject of this epplicatlon, have ell ot ihe disclosures prescn6etl by Celitomia Heelih and Satery Code Section 42303 been meda7 ❑ Ves ❑ No ....... _ .............................................................................................................................................................................................................................................................................................................................................................................. 8 (If'yes", atlach cetlificate of compliance from Ihe eppmpnate alr pollution control oflicer). CERTIFICATE OF COMFLIANCE: I certify Ihat under penalry ol perjury the iniortnation given above is correct. I agree to comply with all state laws a�d ciry ordinances reAartlinA Hazardous Materials snd Emissions. Signeture: Date: CER7IFlCATE OF COMPLIANCE AND Al7IHORVA710N OF EMAY: I certify under penalry of perjury fhat I have reatl t�is application antl state that the informatlon given is correct I egree to comply witn all stete laws entl ciry ordlnences relating to builGing construction, antl authonze representatives of t�e Ciry oi Coste Mesa to enter upon the above-desc � d prop y For inspection ses. I egree not to occupy or allow occupency of eny building authorized by this permit until al inspection. �_�iVwu-5 �W� (z-2G�� Signat Ot Le al r(s) , ate And/Or Authorized Applicanl COOE t.' INSYECTIONTVPE 7616 Fixed System Finel Fire Prevention 1266 Pool Spa Final 200 Final Re-Roof 201 Finel Block/Retaining Wall 202 Final Fadory Fire Place 203 Finel Sign 204 Finel Demolition PAg It1�A6fl CODE 1 206 208 210 PAIE Il�L4 Final Mechenical FinalPlumbing /� /��_ �— Final Electrical 212 Finel Fire Prevenlion 220 Final Planning Approval 222 Finel Site 250 Final Building/Occupancy (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa•mesa�rt�CTRICAL PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626 Job Adtlress: Suite No Vicinity: Parcel Nunmber: Applicank Address: Owner: Address ConNactor. Address: ISSUE FEE Temp service test Res. alc package New Res (1-2 units) New Res (3+units) Pool / Spa Lightlng Fixls Recept Outlets � Switches Non Res Appl Res Appl Service to 200a Service to t000a Sarvice over 1000a MOtars to 1hp MOlors to 10hp MOtors to 50hp MOtors to 100hp Mq(ors over 100hp 395 E 18TH ST 42502218 JOHNSON, MIKE 244 VIRGINIA PL COSTA MESA, CA 949-548-6588 � Phone: Zip: 92627 ISSUED BY: Status: ISSUED Applied: 12/31/2003 Issued: 12/31/2003 REX, BURROWS AND GRETCHEN � � � JOHNSON, MIKE AND PEGGY � COSTA MESA, CA � Phone: 949-230-3354 CELL �� 395 E 18TH ST Zip: 92627 � . OWNER BUILDER _ Phone: Zip: License: 000000 SCOPE OF PERMIT REF: B03-01966. ADD 620 S.F. TO EXISTING S.F.D. WORK TO INCLUDE: REMODEL AND EXTEND EXISTING KITCHEN AND BATH; ADD NEW MASTER BEDROOM AND BATH, NEW FAMILY ROOM. ELECTRICAL TO INCLUDE: 15 LIGHT FIXTURES, 26 OU7LETS, 13 SWITCHES, 1 SERVICE UPGRADE TO 200 AMPS. $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 sisso $26.38 $14.30 $0.00 $0.00 $30.50 $0.00 $0.00 so.00 $0.00 $0.00 $0.00 $0.00 �uantity 0 0 0 15 26 13 0 0 1 0 0 0 0 0 0 0 FEE SUMMARY Temp Dist System / Lighling Busway/700ft , Standing Seclion . - Misc Efectrical Equipment �. Transformers up to 1 kva/kw ................up to 10 kva/kw .................uP to 50 kva/kw .................up to 100 kvalkw ..................over 100 kva/kw Low Voltage Equipment Low Volt Wiring System / Ckt Misc. Canduit Misc. Conductor Circus ( gen or ride) � Circus (mech ride or lights) Christmas Tree Stand Fireworks Stand Other Electrical Fee �uantity $0.00 0 50.00 0 50.00 0 $0.00 , ,� 0 $0.00 - -. � 0 $0.00 0 ao.00 0 50.00 0 So.ao 0 30.00 0 50:00 0 50.00 0 , $0.00 0 50.00 0 so.00 0 $0.00 0 $0.00 0 30.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ortl. No. 92-28, § 1, 1241-92) EXpIRATION: This permlt shall automatically expire antl 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 wark must comply with all applicable codes, antl all requlred Inepectiona and flnel approvel must be obtained. Feilure to obtaln inspections and final approvfll will result in the expiration of ihis permit. FOR INSPECTIONS CALL: (714) 7545628 c�+wo law� WORKERS'COMPENSAnON DECLARAnON: - I hereby affirm under penalty of perjury one of the tollowing tleUarelions: � I have an0 wlll meintaln e certificete of consent to selt-Insure for workers' compansation, as proWdetl lor by 6eMlon 3700 01 the Lebor Code, tor the pertortnance oi Ihe work for whlch ihis pertnit is issuetl. ❑ I �eve end wlll melntain workero' compe tlon insurence, es requlred hy sectbn 3700 ot the Lebor Cotle, Por Ihe pertartnance ot the work yr whlch Ihis pertnit Ls Issuetl. My workers' om%{ensatlon Insurence r er pollcy numCer ere: - I Carder. � N,C� �� Policy Number: O� y7hls secNon nee�d r be �ed i/ �h pe I ls velued ef one hundred dollers (8100) or IessJ Nly Ihet in ihe peAo nce of the or which Ihis pertnll Is issuad, I shell not employ any pereon in eny menner so es to become subject to ihe woAcera' compensetion laws o omia n egr th II I shoultl become suD�ecl to the workers' compensetlon provisions ol Section 3700pp 1 the r Code, I shell forthwit� campy wit� these o ions. � � /�(�O ^ �{ '/ Applicant SlgneNre: Dete: ,..� WARNINO: FAILURE TO SEWRE WORKER ' ENSATION COVERAGE IS UNUWFUL AND SHALL SU9IECT PN EMPLOYER TO CRIMIWIL PENALTIES AND dVIL FlNES UP TO ONE NUNDRED TIpUSAND DOILPAE (5100,000� IN ADDRION TO THE C0.ST OF COMPENS4TION, DAM4GE5 AS PROVIDED FOP M SECiION 37060F THE IPBOR CODE, IMEHEST, AND ATfORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I here�y eNirm ihat I em licensed under provLsions of CheD�er 9(cammencing with Section 7000) of DivLsian 3 ot ihe Business end Professions Cade, anC my Ilcense is In full . fofCe entl BttBCi. LIC. M Cless p Contrector's Slgneture: Date: CONS7RUCTION LENDING AGENCV: ❑ I hereby ettirm that there is a consiruction lending egency lor the pertormance of ihe work for whlch Ihis permil Is Issued. (Sec. 3097, Civil Cade). Lenders Neme: Lentlers Atldress: Signature: Date: OWNER•BUILDER DECLARATIONS: I hereby eMirm t�et untler penalry of perJury that I am EXEMVT FROM THE CONTRACTORS LICENSE LAW tor Iha tdlowing reason (Sec. 7031.5, Business entl Professions Code: My Gry or county whic� requires a pertnit to consWct, elter, impmve, demolish, or repair any slrucNre, prior ro its issuance, fllso requires Ne ep0�lcant for such pertnit to file e signetl stetement ihat �e or she is licensed pursuent to iha provisions of the Cantrectors License Lew (Chaptar 9(commendng with Seclion 7000) of DMslon 3 ot ihe Business erW Professions Cade) or ihat he or s�e is exemp� iherefrom antl the besis for the ellapetl e:emptlon. Any Woletlon of Section 7031.5 by eny eppllcant tor e pertnl� subl Ihe eOPllwnt to e cWil penalry ol not mare Ihan INe �untlretl tlollars ($500)J: I, as owner ot the properry, or my employaes with we8es es their sole compensatlon, WILL DO THE WORK, antl the structure Is rwt intentletl or ottereE lor sele (Sec. 7044, Buslness end Professions Cotle: The Contrectars License Law tloes not apply ta an avner of property who Dulids or impraves Ihereon, antl w�o tloes such work himsell or hersall ar through his or her own amployees, provitled Ihet such Improvemenis are nm IntentleC or oHeretl for sele. If, however, ihe building or imprwement is sold within ona yeer oi completion, the owner-bulider will have ihe burtlen ot proving ihel he or she did not �uiltl or improve for purposa of sale.). ' � I, es owner ol the pmperty. em E%CWSIVELY CON7RACTNG WITH LICENSED CONTRACTORS ta construct t�e pro�ect (Sec. 7044, Business entl Professions Cotle: The contracto�s IJcense s not eppty to an owner of pmpeny who builds or Impmves thereon, end who comrects tor such pro�ecl wilh a comrector(s) license pursua the Ire rs cen e Lews.). ❑ I em exe un er sec Business end Protessions Code for this reason: Signature: Dete: Owner ID venfie0 by tlrivers licens ❑ Ves ❑ No Drivefs License No. Ezp res: Verlflcetion ot Ownership by (type ot document, I.e. - properry te: 61110� deed): CERi1FlCATE OF CO VL1ANfiE IJIHOR¢ATION OF ENfAV: I cartlty untler penalry of perjury that I have reatl this epplicetion and stefe thal tha Intortnallon pNen is correct. I egree t pry wil�f tate ew � end Gry ordlnances relating to builtling construction, end euthodze reD�esentatives of Ne Ciry ot Coste Mesa to enter upon the ebove-descri pr erry f i pectio p es. I egree not to occupy or allow occupancy ot any building eutl on ed y this p rmit until final inspecUon. ��10�-� — m�e o� �ega ow�e�cs1 T oeie AnNOr Aut�orized ApD�lcent GOOE �. IXSPECTON TYPE 1816 FIxeC System Flnel Fire Prevention 1288 Pod Spe Finel 200 Final Re-Roof 201 Final BIocWRetalning Wall 202 Final Fectary Fire Place 2Q3 Finel Sign 204 Finel Demolilion Pdg CO�E I INSPECTION TYPE 206 Finel Mechanical 208 Finel Plumbinp 210 Finel Electdcal 212 Finel Fire Prevention 220 Finel Planninp Approval 222 Finel Slie 250 Finel Building�Occupency BAIE Q�LS �L �v (71a) 754-5273 • Fax (71a) 754d856 • www.ci.costa-mesa.ca.us PLUMBING PERMIT Job Aqdress: 395 E 78TH ST Suite No Vicinity: Parcel Nunmber: 42502218 APnlicant: JOHNSON, MIKE Address: 244 VIRGINIA PL COSTA MESA, CA 949-548-6588 � Phone: Zip: 92627 Owner: REX, BURROWS AND GRETCHEN Address �JOHNSON, MIKE AND PEGGY COSTA MESA, CA Phone: 949-230-3354 CELL 395 E 18TH ST Zip:� 92627 Contractor: ' OWNER BUILDER Address: , Arch / Eng : Address: Phone: Zip: License: 000000 - '�!� - � .. - �. ' �- � . Phone: Zip: . License:- � i i rtun univc, �+va i r, mwn, �.n acvcv Status: ISSUED Applied: 12131/2003 Issued: 12/31/2003 ISSUED BY: REF: B03-01966. ADD 620 S.F. TO EXISTING S.F.D. WORK TO INCLUDE: REMODEL AND EXTEND � EXISTING KITCHEN AND BATH, ADD NEW MASTER BEDROOM AND BATH, NEW FAMILY ROOM. � PLUMBINGTOINCLUDE:7DISHWASHER,�1'GAS(1-40UTLETS),1SEWERCONNECT„1.SHOWER,1 � KITCHEN SINK, 1 WASH BASIN, f WATER CLOSET, 1 WATER HEATER. � ' ISSUE FEE BackFlow irrigalion BackFlow Preventer � Bathtub Clarifier System Connect pce,5oda,etc) Denlal Unitg Dishwasher Drain, Floor Drain, Rainwater AMT $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $9.80 $0.00 $0.00 QTY 0 0 0 0 0 0 1 0 0 FEESUMMARY AMT Laundry Tub / Washer . $0.00 Landscape Irrigalion $0.00 P-Trap $0.00 Pressure Regulator $0.00 Process Piping (per 10 ft) $0.00 Receptors $0.00 SepticTank $0.00 Sewer Cap for Demo $0.00 Sewer Connect $24.65 Sewer Private Line $0.00 QTY 0 0 0 0 0 0 0 0 1 0 SumpPump , Swimming Pool � Trap Primer - � Urinal Vacuum Brkr Bkflow(1-4) Vacuum Brkr Bkflow(5+) Wash Basin Wash Basin Set � Waste and Vent System Water Closet (Toilet) AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $9.80 $0.00 50.00 $9.80 QTY 0 0 0 0 0 0 1 0 0 1 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under Califomia statutes and relatetl regulations. (OM. No. 92•28, § 7, 12-21-92) EXPIRATION: This permit shall automatically expire and become void it work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred Inapaetions and finel approvel must be obtained. Failure to obtain inspections and final approval will result in the expiration of this pertnit. FOR INSPECTIONS CALL: (714) 7545626 zaawn �mni� WOtiKEHS'COMPENSATION DECLARATION: � hereby ettirtn under penelry of perjury one of Ihe lollowing declaratlons: j ❑ I heve end will maintain e certificate of consent to selt-Insure tor workers' compensetian, es providetl tor by section 3700 of the Lebor Code, for t�e performence ol the work for Which lhis pertnit IS issuetl. � (] I have and will mainWin workers' compensa�ipn insurance, az requiretl �y sectlon 3700 of ihe Lehor Code, tor �he pertortnence of Ihe work ta w�ich Ihis pgrmit i5 issuetl. Myworkers,compnnsatio Insurancecarrje��icynumberare: Certiec \ Y p/:��% Policy Numbec (Thls section need na`�be co /eted i/ fhe pe it is veluetl ef one hundred dollars ($700) ar IessJ , � I certly thet In ihe peAartna �oi the ork 6r whi i this pertnit is Issued, I shall not employ any person In any manner so as lo become sub�ect to the workers' compensation laws of C i5 aptl re Ihet it s�ould become subject to the workers' compensation provisions ol Se lon 3700 1 the Lebor Code, I shell }orthwith comply with thesa pro 1�� P�� Applicent SlgnaNre: Dete: -�-� i 1 WARNINO:FAILURETOSECUREWORKERS'COMP TIpNCIJyEMOEISUNLAWFUTANDSHALLSUBJECTPNEMPLOYERTOCRIMINAL'PENALTIESANDqVILFlNESUPTOONEHUNDRED T/10USPND DOLLAPE ($100,000), IN ADDITIIXJ TO TME C0.5T OF CqMPENSATION, DAMAGES AS FROVIOED FOR IN SECTION 3]OB OF THE IABOR CODE, IMEREST, AND ATTORNEI"S FEES. LICENSEO CONTRACTOFS DECLARATION; � hereby eHirm Ihat I am Ilcensed under provisions ot Chapter 9(commencing with Section 7000) of Oivision 3 at the Busineu entl Professions Code, end my license Is in full �oroe and eNect. lic. �1 Class k Conireciors SlgneWre: Date: CONS7RUCTION LENDING AGENCY: ❑ I hereby ettirtn Ihat there is e construction lending agency for the pedortnance of Ihe work for which this permit is issued. (Sec. 3097, CiNI Cotle). Lenders Name: __ . . _. Lentlers Address: _ . . Signeture: Date: bWNER•BUILDER DECLARATIONS: I hereDy etfirtn t�et untler penelry ot perjury that I em E%EMPT FROM THE CONTRACTORS LICENSE LAW tor Ihe following reason (Sec. 7031.5, Buslneu antl Prolessions Code: Any Gry or county whic� requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the epplicant for Such pertnit �o file a signeA stetament �het he or she is licensed Dursuant to the provlsians ot �he Contreaors License Lew (Chapter 9(commencing with Section 70p0) of Division 3 af the Busine entl Professions Cade) or Ihet he or she Is esempt therefrom and the basis far the ellegetl exemplion. My violation o1 Section 7031.5 by any gpplicant for e permit suhj s ihe eppllcant to a civil penaliy of nat more than five hundred tlollars ($500).): , 1, as owner oi the property, or my employees wlth wages as thelr sole compensatlon, WILL DO THE WORK, antl the structure Is not intended or oNered for 581e (Sec. 7044, Business and Professions Cotle: The Contrectors License Law does not apply to en owner of properry who builds or Improves �hareon, antl who does such work �imselt or heisetl w through his or her own employees, providetl that such imp,ovements ere rrot inlendad a oflered lor sete. It, lrowever, the bulking or improvement 7s sold within one year ot completion, the ownar-builtler will heve ��e hurden of proving that he or she tlid not Duild or improve lor purpose oi sele.). � ❑ I, es owner of the pro0erty, em E%CLUSIVELY CONTRACTING WITH LICENSED CONTFiACTORS to consWa tha projeq (Sec. 7044, Business entl Pmfessions Coda; The co ctors Licen tloes not epply to en owner ot properry who huilds or impmves thereon, antl who conirects for such pro�ect with a contractor(s) license pu e to t� �actor Li nse Lews.). ❑ I em emp nder Business antl Protessions Code for this reeson: Siqnature: � Date: Owner ID verifietl by drivets II e. ❑ Yes ❑ No Drivefs License No. Expires: Verificetion of Ownership by (rype o( dwument, Le. - property tax bill or tleetlJ: bIVIS10N OF INDUSTRIAL SAFETY PERMIT CERTIFICA710N: ❑ t hereby certily thet no excevetion five (5) or more teet in depM into which a person is required to descend, witl be made in connec[ian with work eulhonzed by Ih(s pertnit, and ihat no building Structure, sceflolding, talsewark, or tlemolition or tlismantling t�ereof, will be more than ihirry-six (36) feet high. (Chap. 32, Grp 2, Ah 2, Sec. 341, 7itle 8, Califomia Adminisirative Cotla). ❑ As owner-builder, I will not Bmploy anyone to do work w�ich would require e pertnit trom the Division oi Industrial Safety, as notetl aDove, unless suc� person hes a pertnit to tlo such work irom Ihe tlivision. Signature: Date: bivision oi Industnal Safety Permit Number. (714) 7543273 • Paac (714) 754-4856 • www.Ci.cos�a•mesa��sCTRICAL PERMIT n FAIF DFIVE, GOSIA MtSA, GA 92626 Job Address: ' 395 E 18TH ST Suite No Vicinity: Parcel Nunmber: DETACHED GARAGE 42502218 Applicant: REX, BURROWS AND GRETCHEN Address: JOHNSON, MIKE AND PEGGY �� COSTA MESA, CA . �.� Phone: 949-2303354 CELL 395 E 18TH ST " Zip: 92627 , Owner.. REX, BURROWS AND GRETCHEN Address , JOHNSON,.MIKE AND PEGGY COSTA MESA, CA � Phone: 949-230-3354 CELL 395,E 18TH ST, � Zip: 92627 Contractor: OWNER BUILDER Address: � ISSUE FEE Temp service test Res. a/c package New Res (7-2 units) New Res (3+units) Pool I Spa Lighting Fix�s Recept Oullets Switches Non Res Appl Res Appl Service to 200a Service to 1000a Service over 1000a Motors to 1 hp Motors to 10hp Motors to SOhp Motors to 100hp Motors over 100hp Communication drops Phone: Zip: License: 000000 Status: ISSUED Applied: 12/31/2003 Issued: 12I31I2003 ISSUED BY: SCOPE OF PERMIT . ADD A 457 S.F. DETACHED GARAGE. GARAGE IS MAXIMUM 15' IN HEIGHT WITH A MIN. 200 SQ.FT. LANDSCAPE STRIP IN THE DRIVEWAY. REF: 803-07967. ELECTRICAL TO INCLUDE: 2 LIGHT FIXTURES, 6 OUTLETS, 3 SWITCHES, 3 RES APPLICANCES, 1 60 AMP SUBPANEL. $23.50 $0.00 50.00 50.00 $0.00 $0.00 $220 $6.60 $3.30 $0.00 a,a.zs $0.00 $0.00 $0.00 $0.00 $0.00 ao.00 $0.00 $0.00 $0.00 �uantity 0 0 0 2 6 3 0 3 0 D 0 0 0 0 0 0 0 FEE SUMMARY Temp Dist System ! Lightlng Busway /100 k SWnding Section Misc Electrical Equipment - ' Trensformers up to 1 kva/kw ' � � ................up to�10 kva/kw .................up l0 50 kva/kw �- � .................up to 100 kva/kw ..................over 100 kva/kw Low Voltage Equipment Low Volt Wiring Syslem / Ckt Misc. Conduit Misa Conductor " Circus ( gen or ride) � - Circus (mech ride or IighLs) � Christmas Tree Stand Fireworks Stand Other Electrical Fee Investigalion Fee �uantity 50.00 0 ' 30.00 0 $0.00 0 50.00 0 $0.00 . 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 ao.00 0 $18.20 1 - $0.00 0 $0.00 0 $0.00 0 $0.00 0 30.00 0 $0.00 NOTICE: The work authorized by this permil shall comply with all applicable handicap access requiremenis under Califomia statutes and related regulations. (Ord. No. g2-28, § 1, 12-21-92) EXPIRATION: This permlt shall automatically expire and become void if work is not commenced within 1B0 days, or it 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 w(ih all applicable codes, and aIi required Inspectiona end flnel epproval must he obtained. Faiture to obtain inspeclions and final approval will result in the expiretion ot ihis permit. FOR INSPECTIONS CALL: (714) 754-5646 2a48-e8 (flN0) WORKERS' COMPENSATION DECLARATION: I hereby aHirtn under penalty ol perjury one o1 Ihe tollowing Oecleretlans: ❑ 1 heve end will maintaln e cenificate of consent to self-Insure br workers' compensation, es provitle0 for by sectlon 3700 ot Ihe lebor Code, for �he peAormence of Ihe work for whiCh thi5 permii 15 issUed. ❑ I �ave arW will maintaln workers' compensation insurance, as required by sectlon 3700 oi the Lebor Cotle, for ihe perfortnance of theyyy...wk for whlch this pertnit is IssueA, My workers' w�npen�atlon In�urence 3r policy numbar ere: OI` Cartier. � a N PWiry Number. 1 �I(Thf ectlon need no�t b ple�`etl i! (he mi is veluetl ef one hundred dWlare ($700) or less.) � cenily Ihat In Ihe pertortn e of the o r whl Ihis permit Is issued, I shall not employ eny person in eny manner so as lo become sub�ect to Ihe workers' compensetlan laws of ifdnla� en eg e that II s uld become suD�ect to ihe workers' compensutlon praNsions o1 Sectlon 700 of t e Lsbor Cotle, I s�all Iorthwith comply with t�ese p isi bs. ,/�/ ��I �� Applican� Signe�ure: Ii� Date: �- WARNING: FAILURE TO SEIXIRE WORKERS' COMP TION COVEMGE IS UNLAW FUL AND SIULI SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND dVIL FlNES UP TOONE NUNDRED TIIIXISAND DOUARE (E100,000), IN ADDITION TO THE WST OF COMPENSAiION, DPl.NGES AS PROVIDED FOR IN SECTION 3](180F THE LABOR CODE, IMEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: � hereby eHirtn that I am Ilcensed under provisions ai Chapter 9(commencinp wilh Section 7000) of DMsion 3 of Ihe Buslness antl Protessions Cade, end my Iicense is in full torce end eMea. Lic. p Gass a ContractoYs Slgneiure: Dete: CONSTRUCTION LENDING AGENCV: ❑ I hereby aNirm that t�ere Is a construction lentling egency for Ihe pedormance ot t�e work for which this permit is Issued. (Sec. 3097, Civil Catle). Lentlefs Neme: Lentler's Atltlreu: Signeture: OWNER•BUILDER DECLARATIONS: Date: I hereby ettlrtn thet un0er penalry of pehury ihat I am E%EMPT FROM THE CONTRACTORS LICENSE LAW for the tdlowing reason (Sec. 7037.5, Business entl Professlons Cale: Any ciry or counry which requlres e permit to construct, alter, improve, tlemolish, or repair eny strucNre, pdar to its Issuance, alsa requires ihe epplicant for such permit to tile e slpneG slatement that he or she is Iicensetl pursuent to the provisions ol the Contrectora LJcense Lew (Chapter 9(commencing with Sectlon 7000) of Dlvislon 3 of the Busineu antl Profes5ion5 CoCe) or that he or she is exemp� therefrom enA the besis tor the ellepe0 exomptlon. Any ddetlon ot Sectlon 7031.5 by any applicent tor a pertnit D�the epplicent to e dvll penalry af not more Ihan INe �untlred tldlars (E500).): I, es owner ot t�e properry, or my employees wit� wages es t�eir sWe compenseuon, WILL 00 THE WORK, and ihe structure Is not Imentled or ottered for sele (Sec. 7044, Business end'PFolessions Code: The Conirectors LJcense Lew does not appty to an owner ot property who Duilds or improves ihereon, end who does such work himsetl or herselfoi�hrough his ar her own employaes, pmvitled ihat such improvemems ere not Intentled or oflered for sele. It, however, Ne building or imprwement is sold within ona yesr of compleGon, the or.nerbuilder will heva the burden of proving ihat he or s�e ditl not Guild or improve for purpose of sele.). ' \J/ �� ❑ 1, es owner of Ne property, em EXCLUSIVELV CONTRACTING WRH LICENSED CONTRACTORS to construct the pmject (Sec. 7044, Businesa anA Protessions Cotle: The cant7aitors IJcense � d�s no� epply to an owner of properry who bullds or Impmves Ihereon, and w�o contrects for such pmject with e comredor(s) liconso pursuen the Co tr ors Li n Cews.). ❑ I em exe un r sec. Business end Protessions Cade lor this reeson: Sipnature: � Date: Owner ID veriiletl by Criver's Ilcensg. Yes ❑ No Driver's License No. Expires: Venflcation af Ownership by (type of documeTi, i.e. - D�aPerty tex blll or tleed): DIVISION OF INDUSTRIAL SAFE7Y PERMIT CERTFICATION: ❑ I hereby certify Ihat no excevatlon tive (5) or more Ieei In depih Inio which e persan I9 requlred to descend, will be made in connectlon wlth work euthorized by thb permit, end t�et no building siructure, scaHoltlinp, falsework, or demolltion or dismantling thereoi, will be more Ihan ihirry-six (38) feet high. (C�ep. 32, Grp 2, Art 2, Sec. 341, Tltle B, Califomia Atlministrative CoGe). � As owner-builtler, I will not employ enyone to tlo work whic� would require e pertnit trom Ihe Divislon ot Intlustrial Safety, as noted ebove, unless such person has a pertnit to do suU work from ihe tlivision. Signature: Date: Division of Indusinal Setery Pertnit Number: CERTIFlCATE OF COMPLIAN 1D AUfHORPJITON OF EMAY: I certiy under penalry of perjury thet I have read Nis eppliption antl stete Uet the inlormatlon gNen Is cortect. I e �d compl� rth al stat aws entl dry ortlinences relating to huilding conswctlon, enO euthodze representatives of the City af Cos�e Mesa �o enter upon the ehove- crib pmpe � or in c' purposes. I egree not to occupy or ellow accupenry of eny building euthoriz b this ��i��al inspection. l Ignelure OI Legal Owner(s) ate And/Or Authorized Applicant Date COOF �. IHSPECTIONTYPE � QdjE II�IELS 1878 Fixetl System Flnal Fire Preventlon 1268 200 207 202 20.3 Paol Spa Finel Finel Pe-ROoI Finel BIocWRetaining Wall Flnal Fectory Fire Place Finel Slpn 204 Finel Demolltlon COOE� INSPECTIONTYPE 208 Finel MechaniCel 20B Final Plumbinp 210 Finel Electrical 212 Final Flre Preventlon 220 Finel Planning ApOroval 222 Final Site 250 Final Building/Occupanty Q� � (714) 754-5273 • Fax (714) 754-4856 • www.Ci.CoSta•mBSe.Ca.US 77 FAIFi DFNE, GOSIA MtJA, GA a'Lti26 PLUMBING PERMIT Job Address: 395 E 18TH ST Suite No Vicinity: DETACHED GARAGE Parcel Nunmber: 42502218 Applicant: REX, BURROWS_AND GRETCHEN Address: JOHNSON, MIKE AND PEGGY COSTq MESA, CA . , Phone: 94&2303354 CELL 395 E yBTH ST Zip: 92627 Owner: ,' REX, BURROWS AND GRETCHEN Address �JOHN$ON, MIKE AND PEGGY Contractor: Address: Arch / Eng : Address: Status: ISSUED Applied: 12/31/2003 Issued: 1Z31/2003 ISSUED BY: � � � . � � �._ : . �� / .. COSTA MESA, CA Phone: 949-230-3354 CELL 395 E 18TH ST Zip: 92627 OWNER BUILDER Phone: Zip: License: 000000 -. .- .• �� -, - . Phone: , TP: License: �� , y 9�'� . SCOPE OF PERMIT �. ADD q 457 S.F. DETACHED GARAGE. GARAGE IS MAXIMUM 15' IN HEIGHT WITH A MIN. 200 SQ.FT. LANDSCAPE STRIP IN THE DRIVEWAY. REF: 803-01967. PLUMBING TO INCLUDE: 1 GAS PIPING (1-0 OUTLETS), AND 1 LAUNDRYTUBNJASHER, „ ISSUE FEE Backflow ircigation Backflow Preventer Bathtub � Clarifier Syslem Connect Qce,Soda,etc) Dental UniLs Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Drinking Fountain AMT $23.50 50.00 $0.00 50.00 50.00 50.00 50.00 50.00 $0.00 50.00 $0.00 50.00 aN 0 0 0 0 . 0 0 0 0 0 0 0 FEE SUMMARY AMT Qrf Laundry Tub / Washer $9.80 1 Landscape Irrigation $0.00 0 P-Trap $0.00 0 Pressure Regulator $0.00 0 Process Piping (per 10 ft) $0.00 0 Receptors $0.00 0 . SepticTank - �$0.00 p Sewer Cap (or Demo $0.00 0 Sewer Connect $0.00 0 Sewer Private Line � $0.00 0 , Shower �- - $0.00 � � 0 - Sink, bar . '_ $0.00 0 SumpPump Swimming Pool Trap Primer � Urinal Vacuum Brkr Bkflow(1•4) Vacuum Brkr BkFlow(5+) Wash Basin �� Wash Basin Set Waste and Vent System Water Closet (Toilet) Water Heater / vent Water Piping (Inst or Rep.) AMT $0.00 $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 li NOTICE: The work authorizetl by this permit shall comply with all applicable handicap access requiremenis under California statutes and related � regulations. (Ord. No. 92-28, § 1, 1241-92) EXPIHATION: This permit shall automatically expire and become vold if work is not commenced within 780 days, or if work is suspended or abandoned tor a period of 180 days. INSPECTIONS: In order for the work authorized under ihis permit to be consldered legal, such work must comply with all applicable codes, and all required inapeetiona and final approvel must be obtainad. Failure to obtain inspections and final approval will result in ihe expiration of this pertnit. �I FOR INSPECTIONS CALL: (714) 7545626 zasae (srool WOHKERS' COMPENSA710N DECLARATION: I hereby attirm under penalty at peryury one of the following declarations: ❑ I have antl wlll maintain e centlicate ol consent to selt-Insure for workers' compensatlon, es providetl for by sectlon 3700 of the Lebor Code, for the peAormence o� the work lor which this permit Is issuetl. . ❑ I have and will maintain w0�ers' cwnpensation Insu2nce, es reQuiretl by section 3700 ot Ihe Lebor Cotle, for the pertortnance ot the work for which Ihis pertnit Is issuetl. My warkara' qom n Insuren carn � and policy number ere: Cartier. ` Pdicy Number. (This sectton neetl no be cromp�efetlll e ermit Is velued et one hundred dollars (S 100) or less.) certity thel in the perto ence ol ihe for which this permit Is Issued, I shall not employ any person in eny manner so as to become subject to the workere' compensetlon laws o I��orni , e egr Ihet If I should become sublect to Ihe workers' compensatlon provisions ot Sectior�3700 ot the Lebor Cotle, I ahell torthwith compty with these�ro 510�.4. �„ 1 � I r�� Applicant Slgneture: Date: � �%� '% V WARNING: FAILURE TO SECURE WORKERS' PENSATION ODVEMGE IS UNUWFUL AND SWll1 SUBJECT AN EMPLOYER TO CF0.9NA1. PENALTIES AND GVIL FlNES UP TOONE HUNDRED hKK1SAND DOLIARE (§100,000�, IN ��mOM TO THE WST OF COMPENSATION, DNA4IGES AS PROVIOED FOR IN SECTION 3]O60F THE LABOR CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARA710N: I hereby atfirtn t�at I am licensetl untler provisions ot Chapter 9(commencing with Section 7000) of Division 3 ot the Busineu enA Professions Code, end my Ilcense is in full lorce antl eflect Lic. M CIesS k Contractors SigneWre: Date: CONSTAUCTION LENDING AGENCY: ❑ I hereby aXirm that Ihere i5 a construction lending a9ency lor the pertormance of Ihe work tor which this pertnit is issued. (Sec. 3097, Civil Code). Lenders Neme: LentleYs AOdress: SignaNre: Date: OWNER-BUILDER DECLARAY�ONS: I hereby eHirtn that under penelry of pe�ury Ihet I em EXEMPT FHOM THE CONTRAC70RS LICENSE LAW lor tha tollowing reeson (Sec. 7031.5, Business end Professions Cotle: My clry or county which lequires a permit to construct, alter, improve, demolish, or repair any stnicture, pnor to its Issuance, also requlres the epplicant for such pertnit to tile a signed statement that he or she is Ilcensetl pursuant to the provislons of Ihe Contrectors License Lew (Chapter 9(commencing wich Sedlon 7000) ot DMslon 3 of the Business entl Pmfessions Code) or Ihat he or s�e is exempt t�erefrom end the basls br Ihe allegetl e:emption. Any violetlon of Section 7031.5 �y any epplicant for a pertnit ubje ihe epplicent to e civil penelty of not more t�en five hundred tlollers ($500).): I, as owner of Ihe property. or my employees wlth wages es t�elr sole compensa�ion, WILL DO THE WORK, end Ihe structure is not intentled or oHered tor sele (Sec. 7044, Business and Profe55ions Code: The Coniractore License Lew does not apply to en owner of properry who bUiltls or improves Ihereon, and who does such work himself or herself ar ihrough his or her own employees, praWded thet such improvements ere not intended ar oMered for ule. If, hov.ever, ihe building or improvement is sold within one year of wmpletion, Ihe owner-builtler wiil heve the Durden of O�oving Ihet he or she ditl not build ar improve for purpose oi sale.). ' ❑ I, as owner ol the prope��am E%CLUSIVELY CONTRACTING WITH UCENSED CONTRACTORS to consWct the pro�ect (Sec. 704d, Business and Professions Cotle: The contraaors LicU� e Cew does not epply to en owner ol pmperty who bullds or Improves Ihereon, and who contrects for such proJect wit� a contrecmr(s) license purs nt to t tra to�s License Laws.). ❑ I am e p unde b. '�� Business anA Professions Catle for ihis reason: Signature: ��a-1� Date: Ownar ID verified by drivefs li e�se. s� � � No Dnvefs License No. Expires: .� � VeriNcalion ot Ownership by (type of dwume , i.e. - pmperty tex bill or tleed): OIVISION OF INOUSTRIAL SAGETV PERMI7 CERTIFICA710N: ❑ I hereby certify �hat no exca�etion five (5) or more teet in tlepth Into which a person Is required to descen0, will ba mede In connec�ion wlih work euthodzed by this permit, and Ihat no builtling structure, swttoltling, felsework, or demolition or dismantling ihereof, will be more Ihan t�Irry-si: (36) feei �igh. (Chap. 32, Grp 2, AA 2, Sec. 341, Title 8, Califomia Atlrri�nisirative Code). ❑ As owner-builtler, I will not emplay anyone to do work which would reduire a permit from the Division ol Industnal Sefery, as noted ebove, unless such person has e permit to do such work from the division. Signature: Oivision of Industnal Safery Pem+it Number: Date: Will ihe eppllcant or present or fuNre building occupant neeA to ille end cetlity a Business Plen for emergency response ro release or t�reetened release oi e hezaMous materlal7 ❑ Ves ❑ No ' (Sectlon 25505 of ihe CelifOmia Healih end Setery Cotle reqWres, with some exceptions, thal a Business Plan be filed with the Costa Mesa Fire DepartmeN by avery business which has el any one Iime tluring e reported year e quantiry oi hazartlous meterials equel to or greater ihan e weight of 500 pounds, or e volume o� 55 gallons, or 200 cubic feet ot compressed gas at standertl temperaWre and pressure). ........._ ...................__............................—.................................................._..__........................._.._._........................_.................._._............................................................._.. ..._.._.......... .._..........'_'..........__......._.. Does or will the applicam or preseN or tuWre building occupem need to file a registration form tor acutely hazardous mateda151 ❑ Ves ❑ No (Sectlan 25533 of t�e Calib�nle Haalth antl Safery Cotle, with some exceptions, requlras registratlon with �he Cwte Mese Fire DepanmeN by each buslness which et eny one time has on hand a qUentiry of acutely hezerdous materials equal to ar greater than a weight ot 500 paunds, ar e volume of 55 gellons, or 200 cubic feet oi comoressed oas et stentlard temDereture end pressure). Of Wlll �hB 3p011C2nt Of 25534 of the Calitomia Health end snt of an RMPP by buslnesses whi� prepare en Fire Depanment may i materials with Iha Fira 4 If en RMPP Is presently reQWretl, has Section 25534 ot the Califomie Heelth entl Safery Cotle been tully complied wi .................._..................__.....................,.._..................................................._.......................—..........................__......................__................................ 5 Does or will the applicant ar p�esent or tuture building wcupent require br Ihe work which is Ihe su6ject oi this e{ frOm lhe Sou�h Coest Air Ouality Management Disidct ar fmm eny o�her eir pollutlon contml tlistrict or egenc)? � (Section 658502 of the Calilomia Govemment Code requires Ihat ihe reQuesteG Intormation be Fumishetl on applica .................................................................................................................................................................................................................._............................................. 6 Will any part of Iha teciliry to be constructed under this permit be within 1000 feet from t�e ou�er bountlatles of a sc� Qf'yes", ihe laciliry must meet Ihe �equirement ot Seciions 25534 antl 42303 oi I�e Califomia Healih end Setery Ca ...........................................................................................................................................................................................................................:....................................... 7 If e pertnit fmm ihe South CoeS� Air Quell�y Menegemeni Dis�dc� or ol�er alr pollutlon conirob dls�rlct or egency anoiiceuon. neva all of �ha dlsdasures orescnbetl bv Califomia Health antl SafeN CoAe Seccion 42303 been made? e Qt yes•, enech cenifi CERTIFICATE OF C regarding Hazerdous Signe�ure: � preparation, cetlllication and fllinp wIU Ne Fire nt. ............................ . ........................................................ ................. ❑ Ves ❑ No .............. _._........_....__..............._................._............__............. �n epe rmit for such construction or madificatlan LJ No for nomresitlentlel building pertnl4s). ..........................._................_................_.............._..........._._ ❑ Yes ❑ No ........................................................................................................ quired for ihe wotk whiCh is �he 5ub�ed of �hI9 fes ❑ Na I cenity that untler penalry oi perjury the intormetion given above is correct. I agree to comply wiN all state laws antl Ciry ordinanCeS Emi55ians. Date: CERTIFlCATE OF COMPIJANCE dND AUTHORIZATON OF ENTSiV: I cenify under penelty of perjury thet I have read Ihls epplication entl state t�at �he inlormation given is cortect I agree to�yompy wit� te laws end ciry ortlinances releting to huilding con5truction, en0 euthodze represenletives ot the Ciry o1 Costa Mesa ro enter Upon the sbove-tlescrib9d'gfoperry ' spect ryoses. I agree not to occupy or afbw occupancy W any building euttwriz by this rmit until tinal inspection. �;� � �3,LrQ� r ' aWre Of Legal Owner(s) —r Oate AnNOr Auihorized Applicant COOE �. INSPECiIONTYPE 1616 Flxed System Final Fire Prevention 1266 Pool Spa Final 200 Flnel Re-Roof 201 202 203 204 Flnel BIxWRetaining Well Flnel Factory Fire Plece Ffna1 Sfgn Finel Demditian veie Ir�ALs CODE� �INSPECTIONTYFE 206 Finel Mechanical 208 Finel Plumbing 210 � Finel Elettrical 272 Finel Fire Prevention 220 ' Finel Plenning Approvel I 222 Fl�al Site 250 Final BuilAincyOccupanry PAffi Itl7ID�� (714) 754-5273 • F2x (714) 754-4856 • www.ci.costa-mesa.g�LDING PERMIT 77 FAIR DRIVE, COSTA MESA, GA 92626 Job nddress: 395 E 18TH ST Suite: Vicinity: Parcel Number: 42502218 Applicant: MIKE JOHNSON Address: 288 VIRGINIA PL COSTA MESA, CA � 2oning: Phone: 949-548-6588 Zip: 92627 Owner: BURROWS, REX AND GRETCHEN Atldress JOHNSON, MIKE F,ND PEGGY � COSTA MESA, CA . , Phone: � 395 E 18TH ST '� - Zlp: 92627 Contractor. . , Address: - - � Phone: SWtus: ISSUED Applied: 11/12/2003 Issued: 12/31/2003 ISSUED BY: Zip: � License: - � Arch : SHAM, ZACHARY - Eng: Address: 2606 NEW PORT Address: . SUITE 154 . Phone: Phone: NEWPORT BEACH, CA , Zip; 92663 License: C5004 License: SCOPE OF PERMIT ADD A 457 S.F. DETACHED GARAGE. GARAGE IS MAXIMUM' 15' IN HEIGHT� WITH A MIN. 200 SQ.FT. LANDSCAPE STRIP IN THE DRIVEWAY REF.: B03-01966 Plan Check: $136.01 Permit: $209.25 SMIP Res: 51.11 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $346.37 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Front � 0. 0 PARKING Exisfinq: 0 Rear 0- 0 Rear 0- 0 Reouired: 0 FEE SUMMARY PLANNING & ZONING Left 0- 0 Left 0- 0 Proposed: 0 Calc Valuation: Claim Valuation: Right 0-0 Right 0- 0 - $ti,tos.to so.00 NOTICE: Thg work authorized by ihis permit shall comply with all applicable hendicap access requiremanis under California statutes and related regulations. (Ord. No. 9248, § t, 12-21-92) EXPIRATION: Thls permit shall eutomatically expire and become void if work is not commenced withln 180 days, or if work is suspendad or abandoned tor a period ot 180 days. INSPECTIONS: In order for the work euthorized under ihis permit to be considered legal, such work must comply with all applicabte codes, and ali requlred Inepeetions and flnal epproval must be obtained. Failure to obtain Inspections and final approval will result in the expiration of this pertnit. FOR INSPEC710NS CALL: (714) 754-5626 xaae�ae �aroo) � s WORKERS' COMPENSATION DECLARATIOM: I hereby aBlrtn untler penalry of per�ury one of tde tUlowing tledaraGons: ❑ I heve and will malniein a ceNficata ot consem ro sell-Insure tw workere' compensetlon, es proNded for by section 3700 at the Lebor CoOe, for Ihe peAortnance of Ihe work for which �hi5 permit Is iuued. � . ❑ I have antl wiil maintaln worke cwnpensaGon'nsur ce, as requiretl by sectlon 3700 0l Ne Lebor Code, for ihe peAortnance ol the work for wNch Ihis pertnit is iswed. My workers' comperaetign In�urg�ce wrr(er tl icy numbar ere: Certier: (fnls s�ctlon need not �/ I cenity Ihat in the pedo bi L T compansatlon lews ot I mla, comply with �hese Ws s. Ap011cent Signeture: WMNINO: FAILURE TO SECUHE WORKERS' � TKKISAND DOl1ARE (5100,000), IN ADDRION LICENSED CONTRACTORS DECLARATION: Pollcy NumCer. ch this pertnit Is Issued, I shall not employ any peroon In eny mannor so es { bewme subjact to Ihe workers' I shoultl become sub�ect to the workere' compenseNon provislons ot Sectlon 3700 o Ihe Lehor Cotle, I sha�l lonhwlih — Dete: V �,/ COVEMOE IS UNLFWFUL ANO SHALL SUBIECT AN EMPLOVER TO CRIMINAL PE TIES AND GVIL FlNES UP TOONE MUNDRED ° CO�dPENSATIIXJ, OMWGES AS PROVIDED FOR IN SECTION 37080F THE IABOR CODE, IMEREST, ANDATTORNEYS FEES. I hereby eNirm Ihat I em Ilcensetl untler provlslons of Chap�or 8(commencing wi�h Section 7000) of Dlvislon 3 of Ihe Buslness entl Protessians Cade, end my Ilcense Is In full lorce end eHect. IJc. a Class N Coniractors Slgnature: Date: CONSTRUCTION LENDING AGENCV: � I hereby eHirtn that Ihere is a constmciion lending epenty for the peAormanca of Ihe work Por which ihis pertnli Is issuetl. (Sec. 3097, Civil Code). Lentler's Neme: Lender's Atltlress: SigneWre: Date: OWNER-BUILDER DECLARATIONS: I hereby eflirtn that untler Oenalry of per�ury that I am E%EMPT FROM THE CONTRACTORS LICENSE LAW for ihe tollowing reawn (SecJ031.5, Business end ProfesSions Cotle: Any ciry or counry which requires e permil to wnsWcL elter, improve, tlemolish, or repair any slrucWre, priar to Its luuance, alsa requires t�e applicant tor such pertnit to file a sipned statement Ihet �e or she is licensed pursuant to t�e provisions of the Contrectors License Lew (Chapter 9(wmmencing with Sectlon 7000) of DiNsion 3 of the Business antl Pmfessions Cade) or Ihat he or sde is exempt t�erefrom flnd the baals tor the alleged eaemptlon. Any Woletion o1 Section 7037.5 by eny applicant for e pertnit suh is the eDP�� to e civil penelry of not more ihan live huntlretl tlollars ($500).): I, es owner ot the properry, ar my employeps with wages as t�elr sole compenseHon, WILL DO TME WORK, entl ihe stmctura is not intentle0 or oHeretl for sale (Sec. 7044, Business antl Professlons Code: ThB Contractors License Law does not epply to an owner of properry who builds or improves thereon, end who does such work himself or herselt or ihrough �Is or her own employees, provitleA that such improvements are not Intended or oflered for sale. If, hrnvever, the building or Improvement is soltl within one yeer ot completion, ihe owner-builder will heve tha burden ot proving �ha� he or she did not build or improve tor purpose of sale.). ' ❑ I, es owner of ihe propeny, em EXCLUSIVELV CONTRACTNG WITH LICENSED CONTRACTORS to constmct the O�alect (Sec. 7044, eusiness entl Professions Cotle: The cnntractors License tloes not apply to en awner ot property who builds or improves ihereon, end who crontrects tor such pwject wlth e conirector(s) license pursua Ihe n ctor Li sB Law ❑ I em exe u er g, Business end Professians Cotle for thi5 reason: Signature: Date: Owner ID verifi by dr'rvals lice Yes ❑ No Drivefs License No. xpires; Vedflcatlan of Owners�ip Dy (typa of d ent, i,e. � property tex WII or deed): DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATON: ❑ I hereby certity Ihat no excavetion five (5) o� more leet In depth Into which e person is requireG to descend, will be made in connection with wark euthonzetl by this pertnit, end t�at no builtlinp siruCture, scaHolding, falsework, or demolition or dlsman�ling thereol, will be more ihan thlrty-six (36) feet high. (Chep. 32, Grp 2, Art 2, SeC. 341, Ttle e, Callfomla�AtlminLsirative Catle). � ❑ As owner-builder, I wlll nol employ enyonp to do work which would require a permit Irom the Division W Intlusidel Selery, es noted ebove, unless such person hes e permit to do sucn work trom the divisim. Signature: Date: Divislon o1 Industrial Sefery Permil Number: HAZARDOUS MATEHIALS AND EMISSIONS CERTIFICATION: 1 WIII t�e eppliwnt or Dresent or fuNre building �upenl neetl to tile antl certlty a Buslness Plen lar emergency response to release or ihraetened releese ot e hezeMous meterlel7 ❑ Ves ❑ No (Sectlon 25505 of the Calilomla Health and Salety CaCe reqNres, with some exceptlons, Ihet e Business Plan 6e Illetl with t�e Coste Mese Flre Depenment by e�ery Dusiness which has at eny one time during A reportetl year e puantiry oi hazertlous meterlals equsl to or grealer than e weigh� 01500 pounAs, or a volume o155 gallons, or 200 cu0ic feet o1 compressetl gas et standard temperature antl pressure). ..._ .................._...............—_._..........._. _._..'___ "".....__.....................�..............................:.................................................."_"'."......._.__.�_...'__� 2 Does or will ihe epplicant ar present or tuturB bui101np occupem need to file a registretion torm br eatety hazerdous matedals7 ❑ Yes ❑ No (Sectlon 25533 oi the Calitomia Health antl Satety CoOe, wIN some exceptlons, requlres repistretlon wit� Ihe Caste Mese Fire Department by eech business which et eny one time hes on hend e quantiry ot acutely hazerdaus metedals equel to or preater then e weight of 500 paunds, or e volume o1 55 gellons, or 200 cubic teet of compressed ges et atantlarOlempereNre and pressure). ................... _................._...........................r.-......._.._.._. ""..........._.._.................._.............................�............................................._._._..__._._....................._.."_".........._........'_._."'_ 3 Does or will the aCplicant or present or futur0 builtling occupant need to prepare en RMPP (Risk Menagemenl antl Preventlon Program lor aatety ha�rdous materials)9 ❑ Yes ❑ No (SeMlon 25534 of Iha Calilomla Health and Safery Cotle proWtles that the Costa Mese Fire Depertment may requlre the preperation, certlflwtian anO filing with the Fire Department of en RMPP by businesses whic� ere requiretl Io register ecutely ha�rdous metedals with the Fire DeDertment. ........._ .....................__..........'_'.._....... .._._......_............._.."_—_ _"""'......._...........................__.............."'._.... _'_._........ _. �_ 4 If an RMPP is presently requireQ hes SecGon z5536 of t�e Califomia Heal�h entl Safery Cotle been fully complietl with7 ❑ Yes ❑ No .......__._...._........ _. _..."'_'...'_' ..............._........._..____.�_.� 5 Does or wlll the epplicant or present or future builtling occupani requlra lor the work which is Ihe subject ol this a plication e gertnit for such wnsiruction or motlificetlon from Ihe Soutll Coest Air Oualiry Managemen� Distda ar trom eny other eir pollutlon contml district or egenc)/7 � Yes u No (Section 658502 of the Celilomia Gwemme�� Code requires Ihat the reduested infortnation be tumishetl on epplicetlons for non-resitlential bulltling pertnits). .........._..._ ...................__...................__.................... ._...._.............__..........................._.._..............................._.........:........................................... ......__......... ..._.........."'_.._.."—'__ .... 8 W ill any part of �he fedliry Ia be cansiructed under this pertnit be within 1000 leel trom Ihe outer bountlaries oi a school7 ❑ Yes ❑ No (H yes", the faciliry must meei Ihe requireme�� a� Sections 25534 en0 42303 0l lhe Califomia Health end Safery Cotle). ...................................................................................................................................................._..........................................................................................................................................................................................................._....................... 7 If e pertnit from the South Coast Air Qualiry Menegement Distdct or other air polWtlon contml disMct or egancy is requiretl tor t�e work which is ihe subject ot Ihis epplicatloq �eve ell oi the dl5closures prescdbetl by CeOtomie Health antl Safery Cotla Sectlon 42303 been metle7 ❑ Ves ❑ No ................. . ............ ..............,...............__"—"'...._......."_'..........................."'................................................._._..._......................_..__......_........__........_ 8 Qt yes", ettach certificate ot compllance troM the appropriete air polWtion contwl otticer). CERTIFICATE OF COMPLIANCE: I certity that untler Denalry oi perjury t�e iniormation given above is correct. I apree to compy wi�h ell state laws and ciry ordinances regarding Hazallous Materials anC Emissions. Signature: Dete: CERTIFlCATE OF COMPLIANC AUTNORITI�7�ON OF EMRY: I certify unOer penelty ol perjury that I heve read lhis epplication end stete thet the Intortnatlon given is canect. I agree mply i ell s te pppws end �ry ordlnances relating to builtling constructlon, end euthorize representetiv s ot Ihe QQQIry of Coste Mesa to enter upon the ebove-descn d p�rty r nspe i� durposes. I egree noI to acupy or allow occupancy ol eny building authodzetl�by Is �unt�ip@I i� Ction. L 1 u neture Ot Legal Owner(s) �— Da And/Or AuNorized ApPlicent [d.11_;7=I:FiJi�il[•I:�NJj 1818 Fixed System Final Fire Prevention 1288 Pool Spa Final 200 Finel Re-Raot 201 Flnel BIocWRetaininp Well � 202 Final Fectory Fire Place 203 Flnal Sign 204 Final Demdi�on �8 � COUE 1 INSPELTION TYPE 206 Final Mechanlcal 208 Final Plumbinp � 270 Final Electncal 212 Finel Flre Preventlon 220 Final Plenning Approvel 222 Final Slte 250 Final Building/Occupenty PAiF IIii�Lfl ORANGE COUNTY BUILDING DEPARTMENT APPLICATION FOR PERMIT � `i � � 636 Ncreh�Broadway ' , ..5� I . +� . � � � I ■ �' � � r 5'ANTA''A'NA, C'ALIF,ORNIA � L � � TT T FOR OFFICE USE ONLY '�OR APPLICAN yO FILL+IN \ 4 ��"�1':y�� ` � � • � RECEIPT NO, PERMIT NO. BUILDING V ` r �' '" �� ' AODRE55 .. � .,�.� � � + "� `� G� �� /�9 SCHOOL DIST. ' ry• 5 � - �� OR TOWN � �� 3� � REGEIVEA BV DATE REC'D. DATE ISSIIED �Ra555n. 7'u � % , �w. � I/ L }� OWNER �/ {J� {� n//(/Jw�^ys� � \ �` ADDRE55 iJ / �- � • �� MAIL / .(�i / �r1' /r.�'�. � : __..__. _._� O. r1 _ . OR I.I�I_\:1�'Si PLAl15 ADDRESCS U�� LEGAL DESCRIPTION (ATTACH ME' SIZE OF LOT USE OF USE OF NEW BUILOING NO, OF NO. OF i FnM�u[e R � I RpqR VARD � O SIDE YARD ON OF WORK ATION � � ADDITION '6 I . I OEMOLISH 10. OF tOOMS STORIES _ � 7.1� � � . . 1. LU FOUNOATION: I HEREBV ACKNOWLEDGE THAT 1 HAVE READ THIS FORMS,� APPLICATION AN� STATE THAT TME ABOVE IS CORRECT UNOER�PI AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FRAME: FIRE BRACING AND STATE LAWS REGULATING BUILOING CONSTRUCTION. AUTHOftIZED AGT. ///JJJ _/ _w I� PBFMIT FHH S VALUATION ��t0 ] �Y�, Iy��' PL/�N CNECK E TOTAL FEE 9 _�_= O A I �% � ni �- Z D r r ��0-� `� _ %Zc. / �- '/ Y y ' ✓ALS VSPECTOR D �/✓� �'� I.Yi /Z -� ' �i �a . � � , � _ PLOT PLAN Sho�v location and distances from ` " property line ond between buildings. �- � ��-y;�:� � ' �� , ��.��,��- � =� ` � �- � �`�'` �'�' . - / Y .' �,`: 4 � ��' _- ..� .5,� �, y a.,,v� ) -, _�•i � \ . � ! J.a,� . /� i �a, �j . / v, k/, f�3 t�1`� . � � �� /� � - �� ! � _ i . . _ � � � � d � , � ��.��_ � �' ` , ` i FS` • � ��` :.�`-.1�� .J � � _ _ �� i . ' f � 1 � �i'n � •..�'' ., . C-� :. � ' f' t; `.� . '}�.i �h" . � J_ ` _ . . . „� v , . � . . .- - _ f --- - - fi .�1 - _. - -- � ' - . . - - --- _ %� ' . . 1.) _ - ,.� �� ` 1) � "`c . 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