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Home My WebLink About2524 ELDEN AVE - Building Permits • - •� ,5TA ' CITY OF COSTA MESA _ 4 • BUILDING DIVISION FII DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT '`%D ,,di* P02-00017 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 2524 ELDEN AV Status: ISSUED Suite No Applied: 01/03/2002 Issued: 01/03/2002 Vicinity: Parcel Nunmber: TPN00129 - ISSUED BY: Y� Applicant: NOCK, RON- '' - ' Address: 11612 KNOTT ST �� SUITE'172,H: v" I Phone: 714-895-1246 ' - / \ -r - /' l � GARDEN GROVE,CA` Zip: 92841 -' / _ " Owner: 'ELDEN MESA-.HOA- \;- ,�" / / Address 2524 ELDENAV;" ' /" Phone: 714-431-1155 • COSTA MESA,CA Zip: 92627 +- Contractor 'NOCK PLUMBING - ' ' ' • - ` Address: 11612 KNOTT ST .. - _. - - � . Phone: (714)895-1246 - "1'"� �N /' A . 'GARDEN GROVE,CA Zip: 92841 .. License: 707775 N\ \ . _ . . - . \ , . �� .Arc `•- -�- --� _-._- ,_. .�� ,, . Address: - , Phone: - %� , i -_ - License:- , • _ j/ - _- - - - ' SCOPE OF PERMIT ' ' ' ' ' . . WATER HEATER CHANGE OUT. ' - `FEE SUMMARY . AMT,` QTY - - AMT " QTY ; / AMT QTY ISSUE FEE ^ - ' $23.50`: - i:•-^-s,-t-Laundry Tub l Washer $0.00 ,0.i "=";=°=_ --Sump Pump - '" $0.00 0 Backflow irrigation. $0.00 '�,0 N " 'Landscape Irrigation ---$0.00 0 - Swimming Pool /$0 .00 0 Backflow Prevent&' / $0.00 '0' P-Trap - - $0.00 0 Trap Primer "' $0.00 0 • Bathtub • ' , ' $0.00 0 -;`a' ,N Pressure Regulator - $0.00 ' 0 - Urinal / 1 -'% - / $0.00 0 Clarifier System $0.00 .' 0,- . '' Process Piping(per 10 ft), $0.00 0 . ' Vacuum.Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) . $0.00, . 0 ' - 'Receptors' . $0:00 0 , ti Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units ' ,` $0.00 - 0- -Septic Tank ' $0.00 0 ' 'Wash Basin 'N $0.00 0 Dishwasher . $0.60- b . - Sewer Cap for Demo $0.00 0- ` - Wash Basin Set $0.00 0 Drain,Floor $0.00' 0 ", 'Sewer Connect - ' .' $0.00 0 • Waste,and Vent System $0.00 0 Drain,Rainwater $0.00` ,' '0 ' 'Sewer Private Line ., $0.00 " '0„ Water Closet(Toilet) $0.00 0 Drain, Roof $0.00 '0. ' - Shower . , ,- , I_ $0.00 0 - '`Water Heater/vent $12.30 1 Drinking Fountain $0.00 0 Sink,bar $0.00 '0 , Water Piping(Inst or Rep.) $0.00 0 _ Expansion Tank $0.00 0 - Sink, commercial ;$0:00'' 0 ' Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink,Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) $0.00 0 Sink, kitchen $0.00 0 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $35.80 COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION:' This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections 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)754-5626 24043.46(6/00) - DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: • 0 I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the'performance of the rk for which this permit is issued. I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this pe it is issued. My workers' ompensation Insurance carrier and policy number are: � �� )) d Carder: 'tr� Policy NumberZ0'C/// 3a 1 ' (This section need not be completed if the permit Is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California a that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,IItshall forthwith comply with these provisions. 2 Applicant Signature: Date: //// �D WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AN, -•r SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE($10Oc00),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisi• s o hapLer�(commencing with Section 7000)of Division 3 of the Business and Profe'ons e nd my license is in full force and effect.Lic.# S 1 Class# C� Contractors Signature: ^ Date: / �J CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:My city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business andProfessions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or.her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion;the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). �7E � ❑ I,as owner of Ira property, L w dies hot apply owner WITH LICENSED CONTRACTORS tor construct, the nt (Sec.70uch4,Business and Professions Code:The contractors License Lew does dot apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: _f.',iA' Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safely Code been fully complied with? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application aggermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No • (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South T:wst Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescnbed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is Correct I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that 1 have read this application and state that the information given is correct. I agree to •mply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-descd•:•i:ny for Inspection purposes.I agree not to•• •y or allow occupancy of any building authorized by this permi nt� pection. Mir 'Mr Legal Owner(s) Date AndiOr Authorized Applicant Date ;ODE 6 YISPECTIONTYPt PATE Rai cnDFE INSPECTION TYPE PATE UITIDAI& • 1616 Fixed System Final Fire Prevention 206 Final Mechanical _. 1268 Pool Spa Final 208 Final Plumbing S 5-n y 4, 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention • 202 Final Factory Fire Place 220 Final Planning Approval • 203 Final Sign 222 Final Site • 204 . Final Demolition _ -. - - - .250 Final Building/Occupancy . . Costa�M'esa B 11oy/ILx-..Y__. TION FOR n ,,, ill EAST 20th STREET 3- ..It DING .n }COSTA✓MESA, CALIFORNIA FOR APPLICANT TO FILL IN FFICE USE ONLY I /' � �/[/ Receipt No. Per / Building /Y �i cjelatett_'�fi is _• I 1 I I '� . . •_ Address fi`J li1J'Y• e 'I • . . Received by. - Date Rec'd. Date Issued Costa esa, California Nearest - • I .' 4 n CC7-95 - / Cross St. ., Address S re.5....Z 4404 41 Owner r - ....=- I Costa Mesa, California Mail Address0144aNearest 1 I -, / %Q,� Tel.oCross St. / • i City L/(�f/� No. Zone�p No.of Type 1 ., 1 Group•T�"� Architect of Lie. ']. �'I I Plans V I i .�J Engineer No. Approved - I by Date ' i Address , CORRECTIONS City Lie. ' 'Contractor No. ! I ' Address I • Legal ' Lot �__ ` i Description I No. I Block I Tract " I , (Attach Metes and Bounds) //9 -07O-3 , i 1:;\No.ofdgs. � o Size of Lot dX,�� al Now oBlLot - B L J .— - -• Use of I No.of I No.of 9 ;+_�1 Existing Bldg. Families Rooms -1 • ,n Setback Line from /`\/ Rear Yard ' - -'- - JUN-g---1954 "- -" -- -- - - - CenterofStreet •�U / ide Yard -2. 2. DESCRIPTION OF WORK y ru'.`A r 2------ — I I alrO -�TA dE A ,_. New '•� I Alteration I Addition Repair ` I I Moving I I Demolish I - r. Building /5/1( /O No.of , -_Size , Rooms Stories Exterior Wall I Roofer ri_ - _Covering Coverin. �f. .�s, a APPROVALS Use of New •••r "' o Building 1 „• Foundation Location Inspector Date Forms,Materials, li;ir�i Art -�� Under-Pinning I IS / Frame: Fire Stops, _ Bracing,Bolts Lath. Int. ^cknowledge that I have read this Application ' at the above is correct and agree to comply Lath. Ext. v Ordinances and State Laws regulating ct �arit Plaster, Int. -„X. v Plaster,Ext. Masonry Reinforced •ermit Fee $ q 'an Check $ !A Bond Beam [�� C /'- $ :/' FINAL !S -G J //�`S, i >,� _ __ T; - irrL:i.i. . . _ u 2 . a. - a -J r :Street. _ ..... " ' ,, + t; ,u) PLOT PLAN . Show lo4t 2ioa,(land'eleitinbes,ifi'oniJ T f'\ IO -JU it,(...V0 It) 111 (14 - ' property line and between buildings. __ F . Costa Mesa Building Department — r - APPLICATION l it,av•_.-.___._________ 111 EAST 20th STREET 2046 G BUILDIN1 .,e. , " COSTA MESA, CALIFORNIA (` frCC➢➢ v 4 FOR OFFICE USE ONLY FOR 2-L5 121-.1&4"47,1,..c TO FILL INj Receipt No. Permit No. Building L5 i- � /jfij y/!7'rt�0. ,f` 4 c9 Address 7 C Costa Mesa, California Received by Date Rec'd. Date Issued Nearest- air//0_ (� �` n 7/`"/` k-- 7/—/ �C� Cross St//t s� \(:/-�y� Guiding/ < �e.,. 'r Addres " . MailOwner )) -' : .,� /')� Costa Mesa, California Address 1-` 'L` ex do Nearest /"l ✓ ` �,L�/ l Tel 4_ / at Terms St. City( - /';� 111 e r;t No. Zone4-', ! I Nians I Type ,/ Group 'if Architect or - Lic. X V �/ Engineer No. Approved by Date Address CORRECTIONS //1 City Lic. Contractor/lsC - No. Address /7 /- •j.(��/ / q - 070 - 3 Legal I Lot I Description I No. I Block I Tract (Attach Metes and Bounds)4P No.of#// y' O 2O z3 . ' L 9/ 1 ria 1 ldg Size of Lot Go x ,3301 Now ont Lots. IC/ __J O Use of �7� No.of No.of .1. 7Q z Existing Bldg. �..Famiiies I Rooms IV V V 1.55 ii Setback Line from i-7,C Rear Yard C X Center of Street /J 1.:t_ Side Yard r-A-• D DESCRIPTION OF WORK CITY OF COST►STA IVIESA r New IA--I Alteration I I Addition I Repair . I I Moving I I Demolish I Building No.of Size Rooms Stories Exterior Wall I Roof — 1 Covering Covering n APPROVALS Use of New // // , /5,�% Foundation Location Inspector Date Building `yam �'��[✓ ( ��,u�, P J Forms,Materials, , \-- _�,r,�4 7. ,. t ) Under-Pinning r Frame: Fire Stops, Bracing,Bolts I hereby acknowledge that I have read this Application and state that the above is correct and agree to comply Lath. Int. with all City Ordinances and State Laws regulating building construction .----, Lath. Ext. ' Signature of Permittee 41 ��/CX' Plaster, Int. Authorized Agt. Plaster,Ext. 0 Valuation Permit Fee $ / a U �MasonrReinforoed ,LiL-33--Y-C14:271 e Plan Check $ Bond Beam $ / Total v C) Yy. ':� a�2� 3G rawerinumwej Fee $ / _� FINAL wrinm 204 S-13P 2.24 6-55 71 N. . . J a i -- , .. . - p J --- _ o d ' - - - a` -- - . -- ).-).- • -.' . (,. Street - "'! .' - PLOT PLAN - .-- - , ) - Show location and distances from - property line and between buildings. - . :fir _— , — -_ - . . __ ,1 _ _ ' Y.11 . _-- ._ _.. . ... I . - - .. . ./ .. 1 - ' ) .. • - . .. - . i r Costa Mesa Building Department PLICATION FOR Y>t,ni.. n- 111EAST20thSTREET BUILDING 1 COSTA MESA, CALIFORNIA • FOR OFFICE USE ONLY FOR APPLIC NT TO FILL IN„._ Receipt No. I_ Permft No. J Building, 1 1 � 11,'3 0 : Address Cost Mesa, California Received by Date Reed. Date Issued II Nearest '77 .-l_ mar ' 3 -P - rte 3- .R- J �a Cross St. / Building a Address OwnerC ..a.- Costa Mesa, California Mall fff / • Address f .ca-_ •, Nearest 'ie , Tel. Cross St. City ' No. • �') 1 No.of I Grou• Architect o• 0,/ Lia ® I Plans I Type I•/ Engineer r No. ; Approved b Date Address city Lia e. . TION :�1: i I 1 Contractor • - ,., , • Cit _�, f • lip Address CITY Of CUJIA Legal I Lot I PLANNING GEp ESA Description No. Block Tract . (Attach Metes and Bounds)779-2"/?-0 "0— 3 ; GS t,,,, No.of Bldgs. LA - •- - b Size of Lot ir4' 3 ' I Now on Lot N.TECH. - Use of , , No.of No.of - - - - z Existing Bldg. S .LJ _4 a Families I Rooms ��J B Setback Line fr•.5, e, 4riar . Center of Street' ' '' � in r y111' ! - D DESCR i i N OF WOR 7atir: �i� New I I Alteration I I Addition IX y _ 1 - Repair I I Moving I I Demolish I - ` [1 Building j a No.of MAR ' 4 y 1956 .5 Size /,'l Rooms Sttt_o��-ri'e'''s,,,((( ExteriorWall I Roof C! , ' CoveringCovering ^1-�' t� fAilif SA Use of New gACIblb£Ct �•J fctor - F1 Building Fo Forms, ls Inspector Date Form ,Materials, Under-Pinning Frame: Fire Stops, �t '` - • - AA ,/,‘" - Bracing,Bolts I hereby acknowledge that I have read this Application Lath. Int. and state that the above is correct and agree to comply - with all City Ordinances and State Laws regulating ' Lath.Ext. building constructi Signature of • Plaster,Int. n. Permittee 9 . Plaster,Ext. Authorized Agt. Masonry Reinforced Valuation Permit Fee $ • , o n Plan Check $ -^ Bond Beam $ 7 • Total / O d Fee $ Ip - FINAL FORM 204 S-H 2M 5-54 ' 0 c - a . o a . . a o . . a . "dfl —2-56cUR rha5l a6. o >'r:'r a•.} • r I} . •.,,1e A . • _ i Street - -'�i •• • " ' PLOT PLAN • • Show location .and distant s'from • ' • - � ' property line and between buildings. y. L- ,. -t••••".• - - ' t"V . • , . - sb. 7U��.e # '. . .,d 1 99% 2 JUL 29 1959 COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPI. P.O.BOX 317 COSTA MESA. CALIFORNIA CII V OF COSTP MESA r fOR APPLICANT TO FILL IN COMPLETELY APPLICATION FOR PERMIT TYPE OR PRINT BUILDING BUILDING° JQ& I EELP&4 ADDRESS J t' /• C•� r/1 COSTA MESA, CALIFORNIA fOR OFFICE USE ONLY "� I RECEIPT NO. I MIT O. OWNER O�PI imp EIZ , 9 G MAIL o25Gzq IvF, wooer- RECEIVED BY I DATE RECEIVED sI D TE ISSUED ADDRESS dJ/"II / , w I/' I �.��/ 7 Q1 y [�_ lr CITY Co JTR -A4E5 / - TEL ADDRESS / / / J J 7 ARCHITECT LIO. OR ENGINEER NO. COSTA MESA, CALIFORNIA ' FIRE // ADDRESS /J�/ /nry J 17 S ZONE TYPE'," YPE v GROUP tie' CONTRACTOR/711�I- '+/- ✓� +‘ LCT NTO.I VI-70V BYPROVED � �'1� DATE ie./ . ADDRESS (21(09 (AnrLna1rr_-R. 5'!4 J ZONING LEGAL LOT I I ZONE /� Irk„; I UU I OP NEW 2 DESCRIPTIONJJNO. 7 BLOCK .�/ TRACT 360 Y FLANS BUILDING ,!`R4/f_/ A.P.NO. // y -0 3 o - 29 APPROVED DATE 7/1.V.iy OP �1 ' ./ 3 ZZ NO.OF BLDGs. �{ YARDS EVES / OF LOT 13Y /1 7J,,�O� NOW ON LOT ✓ REQUIRED ALLOWED EXISTINGUSE OF BLDG. . r FPM Dw E�(1 �`(G) (CENTER LINE ST.) FRONT 7 (/ FT. IN. SETBACK LINE FROM CO I 7n CENTER OF STREET REAR YARD ` R.SIDE FT. a IN. I SIDE YARD LEFT 0” I I RIGHTC. L.SIDE t� FT. IN. DESCRIPTION OF WORK 1.-"''''''/ REAR p-.S FT.�j� IN. NEW V II ALTERATION I II ADDITION Ire..Cf7SArid 7e_ y//I_ REPAIR I II MOVING I I DEMOLISH 1i � (2. er/ LP/'-- `"4--7- BUILDING f/,/ NO.OFI SIZE �e r ROOMS C.- STORIES / COVEREXTERIOR NG WALL SrUCC-0 I COVERING W M.I7 b • USE OF BUILDING AND WORK TO BE PERFORMED / rta, 0DJECLI /44 id/Orr rr 9502 '' - •1f 614g19GF 02x54 n I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE sis CORRECT AND AO EE TO COM. THE AMOUNT SHOWN UNDER LUATION IS FOR THE PLY WITH ALL CITY 0 A 'ES AN STATE LAW REGULATING PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. BUILDING CONSTRUC 1 VALUATION SIGNATURE OF PERMIT FEE $ a51*-' PERMITTEE J $ �` //7�j/- PLAN CHECK $ /02/-- AUTHORIZED AGENT // 7f- TOTAL FEE $ a 6'1- • it COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FIRER PERMIT . P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 �J�'([/ ��1•(�(�y FILM. RECEIVED BV PWCZNILT bJJ -,1'p For Applicant to Fill in Completely—Use Ink Only 9560 OM 4B AS 1 4' II . BUADILDING DRESS 2S.Z 1 CI-alai L r A.P. NO. /6 / I �/ OWNER OR BUILDING I TENANT ��},S SklabOb.0 2,Lc,�' ADDRESS_ �� /�� MAILING C t� UNIT OR /' 7 ADDRESS I'}Zy C t l_A3oA %L /0 SPACE NO. l / ,(� (�� o / TRI LA 9 / IBLK. CITY NCw��T v.T' H l INo tiecc //U CONSTRUCTION `NEW` ADD ALTER REPAIR I MOVINGI DEMOLISH LENDER / BRANCH OWNER ADDRESS �• @_,,, �rr� � \ /� VALUE OARCHITECT R ENGINEER ti �� W`..�C1`NOL•grG'Z32 Ca USE L,v"r�BA'y ��/^�"�/ $ ADDRESS 14114 ' SK`{ `{t"tC ctilisE TaViiir ZONG 2- TYPE GROUP APPR/OWED CONTRACTOR °C✓It_stZc,-( &a,w t-ri_ BY DATE ADDRESS TEL. CITY NO. F STATE CITY APPROV VETBACKS // LIC. NO. LIC. NO. iX re"--1,GYn e/ _ {y SIZE /�! '1y,�., / NO.OF BLOGS (FROM C/L STR/EET), / S OF LOT (a2 K �C./ NOW ON LOT y.- FRONTAL, FT. Y!� Q USE OF //� / /// !/ CO EXISTING BLDG. Vit rv1 R SIDE f0 FTC �L , / F Separate permits are required for L,SIDE/ /7 FT.* /// electric,plumbing and heating work. REAR 77 FT. g tt >4 ,Qlirn m USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION J F Q . G >64---4,* z6 q7,,9//JJ3./�n%7 APPROVEES- 771 7 � APPR i ,�f ,F-/L / p • >. �V ftATF7 .J / ce W 0 • I hereby acknowledge that I have read this application and state C ^V ce that the above information is correct and agree to comply with 0. all laws regulating building construction, and I shall not employ HOLD FOR SPECIAL REQUIREMENT: >n Z any person in violation of the workmen's compensation laws of m IJ.1 the State of California. _ LIS O 1 I hereby certify that I am properly licensed as a contractor under ?-SQ. FT. N the State of California Business and Professions Code, Division 3, T E AMOUNT SHOWN UNDER VALUATION IS FOR m � Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: ; am exempt from the provisions of the State of Californ`Business VALUATION PERMIT FEE $ % _- and Professions Code,Division 3,Chapter 9. I y--"•/�'� n m Signature of vs,' ,I . ' . l I /�s0e PLAN CHECK g S/r�V et / Permittee 0.1^^lA r\ 7 • $ t/s/(lI LL! TAX �LLU/// or r r� Authorized Ag t Date TOTAL PAID $ • - •� 1053 8/15/79 261 .00 712. COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 r RECEI Y PE MIT, IQ B For Applicant to Fill in Completely— Use Ink Only �� 7 N Iftat ADDRESS sa4 'I /Q / A.P.NO. OWN O , / /04 Aql BUILDING s ,I TENA i UNIT ORSp� / J ADD2Z ?_5a c / /0 SPACEC NO. S 0117,424 VV^^ _ NO. ,/J TR.NO. LOT BLK. CIT 1ilthi?� /�1 , NOL�(f7��(� NEW ADD ALTER REPAIR MOVING DEMOLISH CONSTRUCTIO F' LENDER /,/t BRANCH OWNFy�/�ytQ� (ff�/f/LUE ADDRESS /V✓//�� `VAAL"U�E� ARCHITECT TEL. USE $ I OR ENGINEER NO. r ADDRESS ZONE TYPE GROUP �mnar APPROVED / CONTRACTOR ©wr/`�c.�..1, BY DATE IS{/ 79 ADDRESS TEL. CITY NO. F. STATECITY APPROVED SETBACKS LIC.NO. LIC.NO. SIZE iNO.OF BLOCS. (FROM C/L STREET) ImuG. OF LOT NOW ON LOT FRONT FT. a USE OF N EXISTING BLDG. —8.SIr1F EL _ rn E Separate permits are required for L,SIDE FT, O electric,plumbing and heating work. REAR FT. i_, USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION Q 0 • DATE ..) APPROVED Q APPROVED )., —BY _DATE J 2r W a o I hereby acknowledge that I have read this application and state p' ct that the above information is correct and agree to comply with S all laws regulating building construction, and I shall not employ i Z any person in violation of the workman's compensation laws of ° Sthe State of California. I hereby certify that I am properly licensed as a contractor under SO. FT. N the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: e am exempt from the provisions of the State of California Business VALUATION $ /�. Y PERMIT FEE oV7I and Professions Code, Division 3,Chapter 9 Signature of //��JJll��,,.. PLAN CHECK $ e PermU. ittee !`V"`� t �n $ TAX $ U Authorized Agent Date .talll I r 1 ` TOTAL PAID SeZj 'COSo MBOXEA MESDEPARTMENTA,CALIFORNT APPLICATIOltF9, TRIdC�6'>fl�t..PERMITI39t77 TLI 6 r RECEIVED BY PERMIT - NB 48150 For Applicant to LFill in Completely—Use Ink OnlyBUleki N2LDING 4 8 2S 2 l (�L.�� {�U� A.P.NO. 6.799-/C-/-O A OWNER OR BUILDING ^S�g ,//� , ��, s�ta benL) l kt-- ADDRESS �( ..-aaaCCC///!LL"' TENANT v V.0 S IL.. MAILING UNIT OR - ADDRESS C Z'A C. p3i,,L( Otit ISL1.10 1 SPACE NO. r� Q (�7 �y TR.{112.6 o; t.OT (BLK. CITY N.EElJJ POS W CR 1 I NOLO Icsro NEW^ ADD ALTER REPAIR MOVING DEMOLISH LENDER BRANCH OWNER ADDRESS ^� VALUE ARCHITECT �^,� p� �, �t TEL.SY' 3o USE N E OR ENGINEER rprrps�iv .s C-'pVJ+�`- kjm - y° Cv/"101 ®�/ ADDRESS I ll6 SY li1A C.I(CL0 y�V� (IJ� ZONE /s TYPE GROUP APPROVED CONTRACTOR FyCy)N{a(t ( ( .LIN,Iv-fll-nL BY DATE ADDRESS TEL. CITY NO. F STATE CITY APPROVE TRACKS LIC.NO. LIC.NO. 6.<-i-e, Co7t.04 44--frti 14 SIZE Av.,/ NO.OF BLDCS. (FRO C/L STREET ' /' CI. ty OF LOT d K 50 j I NOW ON LOT • FRONT /�FT . 74 �g y EXISTING BLDG. J�tC FL SIOF 6 F� // / ElSeparatepermits are required for L.SIDE /y FT.AI /7L- 1 r . d electric,plumbing and heating work. REAR ,-c t--T. 0 G /- /•90--/-. - 9/, IW. ., USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION �O 'C . 0_ /'� y/.� E-77--3 �j 7 ', O��M6'A� • -z �,/ APPROVED-3-'24;7? 6 7 APPROVE }.1 —ELY /� 7 DATe-�S - 7 C v kl 0 I hereby acknowledge that I have read this application end state N C that the above Information is correct and agree to comply with S all laws regulating building construction, and I shall not employ BOLD FOR SPECIAL RE Z any person in violation of the workman's compensation laws of 'REQUIREMENTS m v• , the State of California. ''// \ a O SO. FT. 41. 0 N 816 V m / I hereby certify that I am properly licensed as a contractor under A the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m ..,-- Chapter `Chapter 9, and that such licenses are in full force end effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY; w- arn exempt from the provisions of the State of California Business v VALUATION PERMIT and Professions Code, Division 3,Chapter 9. tu FEE $ i Signature of A 1I '/jI/�/t �,, vi 5�L ) PLAN CHECK $ /3E's0 mo b. Permittee �CI.AMI/J gf�t[ yTwp,� �`+�'�Y $ TAX E )-1 .+.py_} 2 or / - I ' 1 l' / �.II rfi'� V Authorized Agent Date I TOTAL PAID S I _-,/s Nam— ' / • 1052 8/15/79 267.00 Ti. COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT i • P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 i' Rr EC�j BY IT • For Applicant to Fill in Completely —Use Ink Only 1J�/ I7a'/.SbN2 BUILDING If v. �j//// A.P.NO. • .DRESS �(/ / � �++'}'. NER OR, BUILDING / V V / �/ AOD RESS�� / //L.J�• /J UNIT OR /A DDR NS999�� 5r�//�/ r / SPACE NO. TR.NO. LOT (BLK. CITY TNO(pE7EL//1��... a CONSTRUCTION NEW ADD ALTER REPAIR MOVING DEMOLISH LENDER BRANCH _// a ADDRESS -/VJAALLU_]EI• ARCHITECT TEL. SE $ OR ENGINEER NO ADDRESS ZONE 4YPE GROUP APPROVED veil—/ 9 7 CONTRACTOR BY DATE d` 7 ADDRESS TEL. CITY NO. (•" STATE CITY APPROVED SETBACKS 5 LIC. NO. LIC. NO. W SIZE INO.OF BLDGS. (FROM C/L STREET) ne OF LOT NOW ON LOT FRONT FT. 4 USE OF EXISTING BLDG. R.SIDE FT. rA (-1 Separate permits are required for L.SIDE FT. electric,plumbing and heating work. REAR FT. 1.4 USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION 'S EM DATE ..I APPROVED Q 7 ' APPROVED } _HY DATE J IY 14 O I hereby acknowledge that I have read this application and state n yr that the above information Is correct and agree to comply with L all laws regulating building construction, and I shall not employ i Z any person in violation of the workman's compensation laws of = the State of California. m SO. FT. I hereby certify that I am properly licensed as a contractor under a the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: 0— am am exempt from the provisions of the State of California Business VALUATION PERMIT FEE E��7 4 and Professions Code, Division 3,Chapter 9. to m PLAN CHECK i —s• Signature of e Permittee4W%. 1 S TAX `�` Lor pij ACQ�)_ ' 'S) uC UAuthorized Date TOTAL PAID E .6 Ps *, 1055 Sf15/79 5.50 TL' • COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626• RE BY PERMIT N2 ' 48640 For Applicant to Fill in Completely — Use Ink Only ADDRESSUILDINt..c•-2..L.‘�j L••Ltk � �V�C • A.P.NO. 4W. - ,0% —Cr/- BUILDING r TENANTOOR _ cis t. ADDRESS 0.,4-t1-1L.LJ�- G � �� l: V GvY ` UNIT OR MAILING 1/4y ( (� SPACE NO. AMDDRESs ' X32. 1 Lt �y eatwdr �l�v t , ` 0j0'%r, �ttII �//rrffq Sttei T,RC'NCO.0 LOT i BLK, CITY i3 a ottl' '.]�rta.cT NO.4ttS-J"f \t �� --Ilft�` NEW ADO ALTER REPAIR MOVING DEMOLISH CONSTRUCTION , LENDER w�EccL# y�11�,Rs� 0.�kC_ l ►,,t BRANCH `jtA-k►� K'�� OWNER V i' 1 V /� ORADDRE OC ENGINEER r \ t s�W.J.a�tiyQ� 's a a USE C `..rsee 0 `I VALUE o++�© Ink • ADDRESS ZONE TYPE GROUP s� ��_* APPROVED . l DATE Q/i+51/7 CONTRACTOR IwV ADDRESS TEL. CITY NO, STATE CITY APPROVED SETBACKS LIC.NO, LIC.NO. W SIZE /y T,..,,r^/ NO.OF BLMS i (ROOT Ch.STREET) S OF LOTfop +t a7 NOW ON LOT (i-CT \ USE OF C/✓�//) EXISTING BLDG. _ R.SIDE Fd H 4 Separate permits are required for , L.st¢E electric,plumbing and heating work. FT. ly F PLANNING ACTION USE OF BUILDING AND WORK TO BE PERFORMED _ LSC� i .` . DATE APPROVED Q — T �Y) _M D 1f'w 5 AMPRl -DAt&v$ ;9 t a w 4 I hereby acknowledge that I have read this application and state c. C' gd that the above Information Is correct and agree to comply with C. all laws regulating building construction, and I shall not employ a Z any person In violation of the workman's compensation laws of 1 the State of California. iS ,• SO.FT. N I hereby certify that I am properly licensed es a contractor under N the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR o Chapter 9, and that such licenses ere in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: — ' am exempt from the provisions of the State of California Business VALUATION PERMIT FEE $ 0 0 Y and Professions Code,Division 3,Chapter 9. „'^, Signature pt (� /PLAN CHECK S •^""�'— 0 Permittee t...-- - S /[/'/V �•// TAX S • U G7"� So Z or U AuthorRed Agan Date TOTAL PAID $ s- iii ----- r STA MESA BUILDING-SAFETYDE1ARTMENT k APPLICATION FBftaFRI.C'P17E..tPERMITI39.e77 4'P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 q.�{j,.7�q F,H1I'/7q 149 77C f RECEIVED BY IP9:7L97 d� 481 A" For Applicant to Fill in Completely — Use Ink /Only r/� '/`f- - '4ti i 4 8 • BUILDING ADDRESS 26.241 to c rV AyLf, A.P. NO Uq — /6j ( / �' \ OWNER OR �,( BUILDING/ TENANT --,kv\I.� S,4L�..l�011 t\L[- 1 ADD RESS02 ..,,e7q jeat.2,,,, 49 MAILING UNIT OR ADDRESS t-�j2 J (v fA;L_.psoA 3t...Vb , SPACE NO. �� . ,,tt stss�� p -// TR �Nt O. /�/rLOT .BLK. CITY w4i - Li OA) oa-i 6 NNOL�a r6 ,C'�Q �F ' ( CONSTRUCTION a,L-Q,(et NEW I ADD ALTER REPAIR MOVING DEMOLISH LENDER I BRANCH ' OWNER k ADDRESS VALUE C ARCHITECT p TEL USE is �_ $ OR ENGINEER t �� Z1/4 -IL NO.Ley-, ICZ?OO ADDRESS 'Gc, lit 848 Sc;Pgt. deaCiatitd Era TYPE GROUP _ OWAN.X1L I A `�`� BYPROV ED CONTRACTORU\ BY DATE ADDRESS TEL. CITY NO. I-0 STATE CITY APPROVED SETBAC/I�{S ,1 LIC.NO. LIC.NO. -42 Cr -' dd / _LDHs (FROM Cat ST.1T. 4-n*, d' USE OF /*/ N EXISTING BLDG. JAE'. w-r-- R.SIDE COF V) , / / F Separate permits are required for L.SIDE /Y FT. 4i A: ��/,/ C electric,plumbing and heating work: REAR�[jFT. Y>7 /1 �j DJ USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION ill"' j CI C -11-00 DATE �7 ///��y ..1 C�tiOO WPLL:X 7� /'7 ei 9 APPROVEIFC.. c-? a 7 APPROVfQ / // .-, RY / C /Ll4L�- DAT / SS7 ..I C/ Ce B. QI hereby acknowledge that I have read this application and state N yz that the above information is correct and agree to comply with ,.O B. all laws regulating building construction, and I shall not employ HOLD FOR SPECIAL REQUIREMENT;. c Z any person In violation of the workman's compensation laws of v ILI the State of California. SiI hereby certify that I am properly licensed as a contractor under t/ SQ.FT. 0 the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the provisions of the State of California Business VALUATION PERMIT FEE $ and Professions Code,DivisioAALA. n 3,Chapter 9. ��]%t� v+ Permittee is Signature of 74`^"�"� ad SCI. 5120 TAX PLAN CHECK $6�aIL or G t U Authorized Agan Date TOTAL PAID $ l39, 77 ✓// 1054 0/15/79 267e00 TL , iTAMESUING.SAF ETYDEPARTMENT a- . -PPLICATION FOR STRUCTURAL PERMIT • • P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 f� 1< For Applicant to Fill in Completely— Use InkOnly RE' 7 ' ' PE UTP 7 No - BUILDI a a i / / _ A.P. NO. �L�( BDDREDRENS L�Q� I� Fat„,OWNS- aR / sae, i� ADDRESS /"Z�rAL� l �4F + TENANT MAI LIN '� /^/ UNIT OR ADORES� G.� _ all-ra_ SPACE NO. `.3._ TR.NO. LOT ALK. CIT NOTELIo'7S NEW ADD ALTER (REPAIR MOVING DEMOLISH CONSTRUCT! LENDER /�1 //�j� a� BRANCH E., JfMFS5 `--• • /60- � V4. _ OWN ADDRESS VALUE ARCHITECT TEL. USE $ OR ENGINEER NO. ADDRESS ZONE ciaTYPE GROUP f(/7/cp-/ APPROVED / /tfQ CONTRACTOR V-"s/ �t BY DATE cr/r` ' l ADDRESS TEL. CITY NO. F. 'STATECITY APPROVED SETBACKS LIC.NO. LIC.NO. W SIZE NO.OF BLDGS. (FROM C/L STREET) Cl.! OF LOT NOW ON LOT FRONT FT. Q USE OF 41 EXISTING BLDG. R.SIf1F ET. rn Z Separate permits are required for L.SIDE FT. O electric,plumbing and heating work. REAR FT. I.W. USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION 'C G DATE QAPPROVED Nir APPROVED DATE .}.1 —BY W 0 • I hereby acknowledge that I have read this application and state w D W that the above information Is correct and agree to comply with G all laws regulating building construction, and I shall not employ . Z any person in violation of the workman's compensation laws of x S the State of California. - m ' I hereby certify that I am properly licensed as a contractor under SQ. FT, w the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: a '‘.3 am exempt from the provisions of the State of California Business VALUATION PERMIT FEE $267�.�O y and Professions Code, Division 3,Chapter 9. n Signature of � PLAN CHECK $ �— ^ o Permittee V•^z� S TAX $ �— LL Authorized Age7`Ob nSaint Date �,11 I� TOTAL PAID S31_Or U + • , , . 2241 3/03/80 36e50 TL • COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 ,z�', N. RECEIVE? PERMIT ,/4727 For ApplicantBUILDING ictos�Fill �in�Completely — Use Ink Only) � /U1 ADDRESS ).-c:‘,s-1 €I[J�(p4a _atIhC_,k 2$2.4 A.P.NO. '� 9/��' /// 6I/�n_ O � ,r, �`• . '\`LL l BUILDING SS �5: I ( �r ��in � /` .GY OWNER OR v✓ ADDRESS ( S 2� TENANT DRESS 131,E e'. R#1/4-L. g()� 6wor SP26UNA T OR ADCE NO. /��p 2 TR.NOO� LOT I BLK. E . CITY 1.9��aitr (l-le-1,* NOL 1r71 )-+r7_ tae‘ CONSTRUCTION NEW ADD ALTER I REPAIR MOVINGI DEMOLISH LENDER t-/---- BRANCH NJ%,1 rl DWOWNER ADDRESS USE (--.612,L. J ' P/2 VAL cs gf/U" ARCHITECT TEL. - OR ENGINEER NO. JJn /� ADDRESS ZONE A 1TYPEVN GROUP A .7•� AP CONTRACTOR 41� (L\LIC( BYPRO V\\ED )1_ GATE 3-3-SJ ADDRESS rte• 't•C TEL. CITY NO. ` STATE CITY APPROV cc l'/ �/ x \ LIC. NO. LIC.NO. ab .... /) /n/i ul SIZE / NO.OF BLDGS. (FROM L TREE ) ( R. OF LOT 00 r 3CI NOW ON LOT FRONT FT. (; fg 113 Q USE OF .-„ EXISTING BLDG - _F1 SIDE FT. to E-. Separate permits are required for L.SIDE FTp. G electric,plumbing and heating work. REAR an 4a or- Itra-L Z . F USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION CI t DATE Q `. . ' \ k(t_ 7 Rci., N42,to APPROVED r.7 (419-11 R E /Yt DAT ✓ ! ! G rx W k o • I hereby acknowledge that I have read this application and state 0 cg that the above Information is correct and agree to comply with CL all laws regulating building construction, and I shall not employ i Z any person in violation of the workman's compensation laws of o the State of California. SQ. FT. 3 CJ CO.42" m I hereby certify that I am properly licensed as a contractor under the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR al Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: m am exempt from the provisions of the State of California Business VALUATION PERMIT FEE $ Y and Professions Code,Division Chapter 9. �9 )Q n Signature of PLAN CHECK S �C)�-U(]_ o b. Permittee TAX M 1\` \r'��.Js.�'�( S TAX E s� u Authorized Ag Date `�o V TOTAL PAID $36, cc c '0 UT T w COSTA MESA BUILDING-SAFETY DEPARTMENT - APPLICATION FOR STRUCTURAL PERMIT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 J e RECRJGBY 'PERMIT I / DU `t7 08 TL For ApplicantJJpto Fill in Completely-Use Ink Only V ` / N- 4 9 5 4 5 BUILDINf�L"'SL-�t.7� I•) �i/ €624.4._ // _ A.P.NO. I�l -Q • ADDRES /.(((f7� �W� • --- BUILDING OWNER OR t it\ R\L, i 41 -40cit CAsc6 ADDRESS 2. q �j , TENANT R ```` 1`c L, t�MAILING �7 (� UNIT _ cv ADDRESS`2,ZY c, IJ�"'7f� •Lt_V Dr CITY NL VZr4.. t3LRA* NOL' QI-J ✓7 .. I ' CONSTRUCTION •• ALTER REPAIR MOVING 1 LLNDERWLV0babS BRANCH IO -niC k3 I.C.C./1c.--1,__ ADDRESS C .4.. t/s. " l—— A r VALUE _ajWiral ARCHITECT r^�ss,,� 1/ ,/504 4 T:L. 1USE W le- - - OR ENGINEER I(Cttf��♦4 ♦r'"�'•♦��-y N• 55�O�Z� • ADDRESS 1,6W� 'SKI'PrVl\ C.A��r • � _ GROUP CONTRACTOR coj,oLn I ao I LQLYt , APPROVED DATE ADDRESS \ TEL. CITY NO. F •STATE CITY APPROVED SETBACKS LIC.NO. LIC. NO. SIZE I NO.OF BLDGS. (FROM C/L STRF/ET) 0. OF LOT L 7, •„I NOW ON LOT ROW . 1i FT. . 4 EXISTING BLDG. r tzsont_. R SIf1F 7g-- FTC Fx- Separate permits are required for ti L.SIDE /© FT. electric,plumbing and heating work: REAR /C�/J r fel USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION 'C 7q"--77C /^J// �J ,Q c2c r / ! 77 APPROVEg7-7/3 ' . >. _,•s APPRO -. �//7 (((��• -1� I ,r.) _ C fa as I hereby acknowledge that I have read this application and state tQ • PLC- A t�L•e•L'I ' • N C that the above information is correct end agree to comply with - L all laws regulating building construction, and I shall not employ i Z any person in violation of the workman's compensation laws of .'WL' the State of California. 6/12,(56- ,r�,�'r /// .: I hereby certify that I am properly licensed as a contractor under ' SQ. FT. (/r VL/[:� - 46 9 re a the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR 0 Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: e am exempt from the provisions of the State of California Business VALUATION I PERMIT FEE S Y ti and Professions Code, Division 3,Chapter 9. �+/ /n^ C� UUtl" / J SCJ `� PLAN CHECK S qr. so `n u. Signature of a Permittee sa. �' \ $ s/�- r- _` TAX $ 3 rs. U (1%- or ♦ Authorized Agen Date TOTAL PAID $ 99• -. Pr "G" «i .5. COSTA MESA BUILDING-SAFETY DEPARTMENT "" APPLICATION F.OR STRUCTURAL PERMIT' °u- TL P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 _4 • REC V PERMIT gq s9c' For Applicant�] to Fill in Completely — Use Ink Only ADDRESS v�JZ, rilebt, A.P.NO.BUILDING /� /^/--_ mai:To � /1^c� Jim Lli r I ADDRESS C. Qoe. TENANT L/`V ,C • / UNIT OR MAILING /'�// • p •.{./ SPACE NO. C.r ADORESS fL EU ON $te-- IA till //ryy ��'^ TEL......,r / TR.NO. LOT BLK. CIT Q' r `-�J NO,f9-6.50t NEW{, ADD ALTER REPAIR MOVING DEMOLISH CONSTRUCTION V LENDER BRANCH 2 / 2E e OWNER _ AY/L�U/M. .(lv . _ADDRESS L//✓'��_ ARCHITECT TEL. USE $ ` ORENGINEER NO. II _ ADDRESS '� ,s By DATE (066 ZONE IF VPE V GROUP/ CONTRACTOR ©,2t/b{,.Q— APPROVED VVVV / Stee ADDRESS TEL. CITY NO. F -STATE CITY APPROVED SETBACKS LIC.NO. LIC.NO. W SIZE NO.OF SLOG (FROM C/L STREET) Ci.. OF LOT NOW ON LOT FRONT FT. Q USE OF Cn EXISTING BLDG. R.SIDE FT. VI FSeparate permits are required for L.SIDE FT. _ G electric,plumbing and heating work. REAR FT. F USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION 473 4 DATE .] APPROVED Q RV ROVED ..• DATE J CL W o.o I hereby acknowledge that I have read this application and state N N that the above information Is correct and agree to comply with 0. all laws regulating building construction, and I shall not employ >: Z any person in violation of the workman's compensation laws of n .1: 7q44 the State of California. //((��/ / m ( T 4 SQ. FT. . . w I hereby certify that I am properly licensed as a contractor underD the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN DER VALUATION IS FOR m Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: e am exempt from the provisions of the State of California Business and Professions Code, Ision Cha ter 9. VALUATION PERMIT FEE $ /Q/s to e m / �'r_ O�� PLAN CHECK $ 'n 0 Signature of Al � a Permittee 2 S TAX $ f or a U Autho d Agent Date TOTAL PAID 5 /g/ , Cap tic 6UbJr COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICAMOWFOR STRUCTURAL PERMIT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 luiil.i I nil.Ian Q9 08 TL REC PERMIT N2 4 9 5 4 7 For Applicant to Fill in Completely— Use Ink Only 1� 7 BUILDING yy�' n� /'� q,P, NO. YZe _ h1-OS� ADDRESS (`taaV l_�.s'`l Zj F (,.,., (j ` �lyr,�,��1 BUILDING Fail_ TTENAN OR .time-(k AoV'v TSL, ADDRESS 2 •• MAILING I� ^ �n��tn/ UNIT OR ADDRESS) E. 1 (/� SPACE NO. TR.NO.`OLOT ( BLK. y� CITY Kus.co2F ` Ic ! NOL..a3-5 1y / NEW ADD ALTER REPAIR MOVING DEMOLISH CONSTRUCTION � ,.' 'Q LENDER /i'tzt j+t 1R* > // BRANCH .....Add-1 NF} Nit0...21--3.1___ L, 1 1 1 ,-2,l rte �r- • OWNER Ili �R.IU1:. `IW ADDRESS cot(0 [tiys✓` V0,41202-.0\ VALUE OR ARCHITECT t-. K. t c..w,_ Na'7.3-Siy USE C�tU•/� /( �I� l �� ADDRESS ieaL t�WZ SKCYL a CLO.J.:__ ZONES` .K TYPE GROUP i. APPR SED\ 'CONTRACTOR ric.Afluziti ‘_.111_10(,�-/ BY DATE ADDRESS TEL. CITY NO. I-. STATE _ CITY gAPPROVED SETBACKS LIC.NO. LIC.NO. a1 SIZE q 1 NO.OF BLT.(/ (FROM C/LST l O. OF LOT TL IWO NOW ON LOT to FRONT (/I t..% C//{,�- . Q USE OF 11--ra � �ln/� / (( Ca EXISTING BLDG. V `-�ct-.1' R.SIDE/6FT. l / N / r a' FSeparate permits are required for L,SIDE/2 FT.O('�' electric,plumbing and heating work: fff�/� r 5 et W - REAR / .i FT. I. USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION a CooQo Z_ VVV77-/ . A RO� f/ 37 _BY_ ... i 7' 1 .t _ DATt•,25:- 1 'U GO — a. I herebyacknowledge that I have read this application and state -IOLD FOR SPECIAL REQUIREMENTS C that the above Information is correct and agree to comply with - Q RENiENTS L all laws regulating building construction, and I shall not employ i Z any person in violation of the workman's compensation laws of 'U the State of California. tt�,// ! ��s ITV SO.FT. -�•uA�i� y6� N I hereby certify that I am properly licensed as a contractor under a the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9. and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: e am exempt from the provisions of the State of California Business VALUATION PERMIT FEE $ ,q 0 and Professions Code, Division 3,Chapter 9. 1PLAN CHECK $ 9r 0en Signature of �tI1� OQ LL Permofttae OV^^t d $ S�t `OD�� TAX $ aSi f r� v\ Authorized Ag t Date -. TOTAL PAID $ 907 •,I.y. C/ /eft It'la Tl • COSTA MESA BUILDING-SAFETY DEPARTMENT APPL Ii IOPTFOR STRUCTURAL PERMIT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 REC B V\PERMITV"? y7 For Applicant to Fill in Completely — Use Ink Only 77 ADDRESSG BUILDIN .02;S'cSEI�E.t, de A.P.NO. 7� �y/ S!A -'_ {//t�� OWNER On _ / //fin, Tt ADDRESS ZSL ( (�. HrG�VL TENANT `s/O/fbi, \ h4 ce 4%J1Ph /4[ lP. UNIT OR MAILING it ADDRESS p ag1e five URf+ SPACE NO. P. TR.NO. LOT BLK. CITY TEL.Nog-c*, NEW ADD ALTER REPAIR MOVING DEMOLISH CONSTRUCTION r LENDER &e BRANCH t OWNER aj ADDRESS VALUE ARCHITECT TEL. USE E OR ENGINEER NO. re. on ADDRESS ZONE 2 Z YPE V GROUP y1-- O 1— APPROVED ED DATE �/`S/e0 CONTRACTOR 111 ADDRESS TEL. CITY NO. F STATE CITY APPROVED SETBACKS LIC.NO. LIC.NO. tri SIZE NO.OF BLDG& (FROM CIL STREET) L OF LOT NOW ON LOT FRONT FT. a USE OF 4, EXISTING BLDG. R SIDE FL z 2 Separate permits are required for L.SIDE FT. d electric,plumbing and heating work. REAR FT. w F USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION SG 0 A .r� tJ - �"� �-�"J'^-� _ 1 DATE APPROVED •te7 APPROVED >, ...Sy DATE .-1 a w gg0. • I hereby acknowledge that I have read this application and state to that the above Information is correct and agree to comply with 0. all laws regulating building construction, and I shall not employ i Z any person in violation of the workman's compensation laws of ELIthe State of California./4[/� �C� 7(O m 3 I hereby certify that I am properly licensed as a contractor under SQ. FT, w the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN DER VALUATION IS FOR re Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: m am exempt from the provIs'ons of the State of California Business VALUATIONPERMIT FEE E Y and Professions Code, Div Ion 3,Chapter 9. •Q PLAN CHECK E en o Signature of o Permittee ��^ r S0 TAX E u.u. Or Author' Agent Date 6/t-5/`l0 .. TOTAL PAID $ /AI 00 U i -'11 Ott CULT COSTA MESA BUILDING-SAFETY DEPARTMENT APPL CATION FOR STRUCTURAL PERMIT • P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 - flea❑ I /OI. ion " 914 IL REC BY PERMIT For Applicant to Fill in Completely — Use Ink Only ' N-0 4 9 5 4 8 BUILDING // /) Cp__ ,_ -- A.P. NO. \ - G _oc ADDRESS .i., L,(ti'•C r 1/IWVK\ BUILDING Liii. OWNER 1 ADDRESS �Z's{ �/ ,�TENAT ...,k, Ir3Uc \ _ROiT*-\ C-- UNIT OR MAILING z� SPACE NO. ADDRESS l3Z.li F. bq(12�/) IJI,/7- -t Cr TR.NO.. LOT BLK. CITUIiJFo(LT Ip�..,��-(Ac(l NOL6T1—STY/ NEW L5L5 ADD ALTER REPAIR MOVING DEMOLISH LENDER \/JC�i21--0*-i(Dc s�I t�.�f ♦.� BRANCH (, {J^J� Nl�oL71C1.� d I, ` �lL'G 1 I40ttsJ C•c.>,L ADDRESS rO o 1 _ -, OWNER VALUE / i ARCHITECT TE \ba i _, Ill USE "'Ate J C C B0 OR ENGINEER((% .L.'__�� • to zo `^/ ADDRESS LSWI _ 5tyou _ G-`OLLJ. ZONE• 'per TYPE GROUP APPR• ED CONTRACTOR c L.v-%,. /L//S‘..1 I LQL—/ — BY DATE ADDRESS TEL. CITY NO. F STATE CITY APPROVED SETBACKS LIC.NO. LIC.NO. (FROM C/L STREE W SIZE I NO.OF BLOCS. c r - (� Cs. OF LOT L X 3C� NOW ON LOT �RONr/A F Q USE OF ' n /� ty .r. EXISTING BLDG. tC4.._-Y�}C. R.SIDE / O FT.O FCO /� ti Separate permits are required for L,SIDE T / O• electric,plumbing and heating work. star yyy/ yr fo I-„ USE OF BUILDING AND WORK TO BE PERFORMED PLANKING A' CTION 'r st I RO E[T'I > �Y ,_ W (A «//IIJJ DATE�in X— I W ' 0 I hereby acknowledge that I have read this application and state m tz that the above Information is correct and agree to comply with a 1��3 `1JL �i U L r (�-C C. all laws regulating building construction, and I shall not employ 1 IOLV FUR SPLC AL R QU I::i, IEiN 1 S > Z any person in violation of the workman's compensation laws of - o Zthe State of California. L/�r� /f , zt'- .: (&7 SQ. FT. f 71C,•�'K%e% 9 80 N I hereby certify that I am properly licensed as a contractor under N the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR CI (z� Chapter 9, and that such licenses are In full force end affect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: m {Yd am exempt from the provisions of the State of California Business VALUATION • PERMIT FEEY and Professions Code, Division 3,Chapter 9. $ n PLAN CHECK $ 93. o (�. SignaturePermittee ofitma_n $ Cc if, rod ofd TAX S. T,et tL U.V ' [(� J TT Authorized B!1 Date I \Lti-D ii, TOTAL PAID $ 96 .4i ID. 2496 6/25/60 1370CC IL COSTA MESA BUILDING-SAFETY DEPARTMENT APPL TION FOR STRUCTURAL PERMIT r P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 REC BY PERMIT q For Applicant to Fill in Completely— Use Ink Only q / S� BUILDING �)C�V !•"/.✓B� 9so A.P.NO. ADDRESS p'CJ /G� /(.(G( /� �`— // �J ///� TENANTOWNER ORD LA / �s_�,•j,� .T� l� ADDRESS (.�� {/C MAILING s� Jnr l.l'CS E grist /` UNIT OR T� ADDRESS _/ ?'S`'ICN ILa SPACE NO. v ! `� //r/ /� TR.NO. LOT �BLK. CITY 6757$ Mass NOLS•1""II`2t, CONSTRUCTION f NEW ADD ALTER REPAIR MOVING DEMOLISH LENDER 4/1 BRANCH OWNER $ %Cr PARCHESS VALUE ARCHITECT TEL. USE n, w/V✓ OR ENGINEER NO. rv-� r ADDRESS ZONE /_ Z TYPE V GROUP •�ri CONTRACTOR O f APPROVED DATE 4�Lvl /eel ADDRESS TEL. CITY NO. I" I STATE CITY APPROVED SETBACKS LIC.NO. LIC. NO. {r] SI2E NO.OF BLOCS. (FROM C/L STREET) D• OF LOT I NOW ON LOT FRONT FT. Q USE OF cn EXISTING BLDG. R.SIDF FTS in F Separate permits are required for L.SIDE FT. C electric,plumbing and heating work. REAR FT. Lsl .. ✓ USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION Q - C ^ DATE ..1 C APPROVED Q Com' 'CC��' "��TTT��T� APPROVED } —BY DATF CC tz.1 o. •o I hereby acknowledge that I have read this application and state m ce that the above Information Is correct and agree to comply with C L all laws regulating building construction, and I shall not employ i Z any person in violation of the workman's compensation laws of - ° S the State of California. i/ t m /�OSO. FT. s�a� N I hereby certify that I am properly licensed as a contractor under D the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN U ER VALUATION IS FOR m Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: u am exempt from the provisions of the State of California Business /41`� and Profession de,Division 3,Chapter 9. VALUATION PERMIT FEE $ I s Co PLAN CHECK $ n Signature of • 0 u. Permittee ��' E ear.aTAX $ 2 f Autho f/Agent Date TOTAL PAID $ d U iD° owl- I ntpn 1/2h/RD 96x94 TL COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 2222n \• REC 3; 'PERMIT lsi0 49549 \V\ For Applicant to Fill in Completely —Use Ink Only �� Lrr`� N BUILDING ..._r„ /f // ,//1 A.P. NO. '92,i- (CI OY ADDRESS �S�fr�, (�j,fv(, l / / BUILDING (24 OWNER OR ADDRESS Z TENANT �f IN Qtl.�ti(� e lJ CkSt.; UNIT OR MAILING (3Z� C. -A' n0A TEra u (y'!3 r TR.NO. O� /� / (BLit. ADDRESS 'c�-r3 TEL ZZ�J 71/4-fa -SPACE CITY TION w %1�^Ja�,(.( NO.(OT'JtNEW J ADD ALTER REPAIR MOVINGI DEMOLISH CONSTRUCTION �� /I LENDER ,at�-.oc.. 1e 1oc, I 1 BRANCH L0°0t` ft T�tvcilt___ el /� l ��//77 ly� OWNER "I• t ICL& 1 40 HO CMc ADDRESS 3,0/(c �Cayl 1/cd& 1 VALUE C.� ORARCHITECT ENGINEER L 7c. `J--C ,L s TE NO,t((iW\\� SJe-L3C"J(� USE ��/ ( ��C•J�i foe �J r� �0 y,7 ` / �.. ADDRESS 1cc9c7L StC 1 PALK CAA,-. c ZONE �j� TYPE el GROUP tri- APPROVED CONTRACTOR _9f Jc . / h(J'(C--1...3ty:}1—) BY DATE ADDRESS TEL. CITY NO. F STATE CITY APPROVED SETBACKS LIC.NO. LIC.NO. 9I. SIZEh ( )J l'9691:2 NOW BLDGS. (FROM ClL STR a Le / OF LOT -V ,( 7690 NOW ON LOT FRONT („e•- cdvC a USE OF /f / /1 yEXISTING BLDG. /LP.s.s _II SIDE "6 FT�r _ H Separate permits are required for L.SIDE J 9 F6 /f C _ electric,plumbing and heating work: REARIQ [�') d (.., USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION -C C �,� �(/,/i� _/�� / 9 ....."•1 (^FJ•v-�"-U / 6, ! ! �-7,6" APPROVE//l�7. >" SAY (!/ %1L [S DATE61" /X� -a ce GU aI hereby acknowledge that I have read this application and state g4 that the above information is correct and agree to comply with f r�•n rnr �a 11 C((''�� fin^r."-"Ir L all laws regulating building construction, and I shall not employ I'�O L� 1 Vn vs t.C�riL R..�{L..._. -...v j,,,. si Z any person In violation of the workman's compensation laws of o Sthe State of California. (,`� ,t, r (�(�� -� `I SO.FT. G•Y ML -(pV m I hereby certify that I am properly licensed as a contractor under N the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: ; Q am exempt from the provisions of the State of Ca la Business VALUATION PERMIT FEE $ and Professions Code,Division 3,Chapter 9. Signature of /1t \\\(((�� COOe PLAN CHECK $ 173. reLL �. Permittee or.. A.' q Q E 44 91 `�/ TAX $ u I/ /1 Authorized Age Date ( 14 f)�j TOTAL PAID $ 94 s49 \ 4n44 ,r 11. r 2497 6/25/80 167.0r IL 1 COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 '//J1///��--�� RECEIQ1C ■PERMIT 9 y? For Applicant to Fill in Completely — Use Ink Only V rr ' aT tT 7 BUILDING pJ0T fl le t1 . q p NO. ADDRESS T ! ,t;),, ,,++.. /'� BUILDING 7cis/ £2e OWNER OR ` 1,y4''7� r y ADDRESS F 4 "'�vC/ TENANT , G Q P-.Y `JIIW )/ MAILING �J UNIT OR �/ . MODUSADDRESS ac',E 4 /7vc' Graf- F SPACE NO. I (` TEL TR-NO. LOT BLK. 4. CONSTCITY RUCTION resy N NEW. ADD /ALTER REPAIR MOVING DEMOLISH LENDER 1/ ///�� BRANCH �1 // OWNER A— /V�L��J ADDRESS Vs.eliALUE ARCHITECT TEL. USE E OR ENGINEER NO. N. ADDRESS ZONE ITYPE GROUP APPROVED CONTRACTOR ©. ` BY DATE ADDRESS TEL. CITY NO. .r.. STATE CITY APPROVED SETBACKS LIC.NO. LIC.NO. is SIZE INO.OFBLDGS. (FROM CM-STREET) P. OF LOT NOW ON LOT FRONT- FT. 4 USE OF r EXISTING BLDG. R.SIDE rA F-' Separate permits are required for L.SIDE FT. O electric,plumbing and heating work. REAR FT. iir USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION -..1 4 rneVe i D APPROVED Y APPROVED _ELYDATE ATE :4 W 0I hereby acknowledge that I have read this application and state in a that the above Information Is correct and agree to comply with 0. all laws regulating building construction, and I shall not employ si K any person In violation of the workman's compensation laws of c W the State of California. ; . a. X I hereby certify that I am properly licensed as a contractor under /�� SQ. FT. the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN NDER VALUATION IS FOR m Chapter 9, and that such licenses are In full force and effect,or I THE PURPCGE OF ESTABLISHING A PERMIT FEE ONLY: l- am exempt from the provisions of the State of California Businessire�j n and Professions Cod Oivitlo 3.Chapter 9. VALUATION PERMIT FEE $ / el Signature of /,./1 PLAN CHECK § o it Permittee $ l // TAX § f Authorit nt Oate �� -s�t7 ///yyy�� TOTAL PAID $ 7 .Ot' U p^U►—►LT _ COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 \ • REC PER49fr i/''0 DU i,) 50 TL \V For Applicant to Fill in Completely — Use Ink Only V.—kat �j $ 4 9 5 5 9 BUILDING )/ // A.P. NO. C.i —O t7 ADDRESS z\ p r��. I �. ,(� BUILDING n TTENAN�R.d IS-t RILL-`i f '�/�'1�/ cAse ADDRESS �.J'X4 ¶I�, (L . UNIT OR MAILING ncLA �`J13r SPACE NO. '- ADDRESSim t `J T n T/� s� /'/� ..t 'I t� TR.NO.ILOT a BLK. CITY NL'�n7"!' -1 -JL .`I." NO.6)-3-5 rl? cloy CONSTRUCTION' . V �y ! NEW ADD ALTER REPAIR (MOVING DEMOLISH LENDER COC--- 1-1-AcN 0/)`� •Y// 1I^ BRANCH ( IccjNA Ntt,c ( rC . OWNER�Ih VI.IW�"( S -jt >J CkSlr ARCHITECT ADDRESS 11f� /0,^) 'tall.� USE - OD �j •VALUE it/�/60 OR EN (NEER t_I\s • s• -2- CPO ^ s ADDRESS ( L SKY PikalL CA QLA±- ZONE .2._ TYPE � GROUP e B /�t'( Lk/� YPRO ED CONTRACTOR AP DATE ADDRESS TEL. ,CITY NO. w.F. STATE CITY APPROVED SETBACKS LIC.NO. LIC.NO. iQ SIZE NO.OFBLDGS. (FROM C 7REETY /t o. OF LOT Z 'C UO NOW ON LOT ONT / V FT[J Q USE OF �� j/ / ",05er „F. EXISTING BLDG. v- R.SIDE 7 Fit/ / V) I if• 9 Separate permits are required for L.SIDE 9FTO G electric,plumbing and heating work. REAR �� I Fr,Yj a/ 1_, USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION G DATE // a l c9t '0Q / ' �////JJ,6 APPROVED/77 N CAPPJR E2'- (IAT ' !!! //�.J� RY ..I ce W Q • I hereby acknowledge that I have read this application and state q/ T m 4 that the above Information is correct and agree to comply with —tiULD FV— jY-`-AL REQL.. -f'.s.5. i wC all laws regulating building construction, and I shall not employ L REQ ... v __ ��+ Z any person In violation of the workman's compensation laws of e the State of California. S /,� //�♦♦ ti 1 COO SQ. FT. G irt.66_ l a I hereby certify that I am properly licensed as a contractor under o, the State of California Business and Professions Code, Division 3, TME AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and that such licenses are In full force end effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: :AT; am exempt from the provisions of the State of California Business I and Professions Code,Division 3,Chapter 9. VALUATION PERMIT FEE y n O Ai E. Signature of On PLAN CHECK E 93..w O m Permittee $ t /00 — TAX $ J 7 el/1 u. or 77 CIL. Authorized Agen Date 11L4��`'' TOTAL PAID $ 94. 9471. ".l?° 2kpe 6/25/80 187000 n COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 1REC41PERMIT(?t s`For Applicant to Fill in Completely—��,///II1Use Ink Only 9 S o BUILDING Ci �tl� A.P. NO. ADDRESS /� �'^/r� {/J� �� OWNER OR-1-1' ''''7t``I•,, ADDRESS 2al Z� (,(�11GXc4 atm_. s TENANT xcl/3M7 KIy �C.3Itis' Cots0-. MAILING /l UNIT OR ADDRESS is_ SPACE 5710/64, /`/ve_ (ter- SPACE NO. L-r p-/ TR.NO. LOT (BLK. CITY Cost rne��r NOL..TE 4A ' 'j$,4 -NEW/ ADD ALTER REPAIR MOVINGI DEMOLISH CONSTRUCTIONV/ LENDER at-4e._ BRANCH I e_ — OWNER (�@U� fl ADDRESS VALUE ARCHITECT TEL. USE OR ENGINEER NO. mv� /^ ADDRESS ZONE �[.� TYPE IL GROUP J.* CONTRACTOR Oma- APPROVED Vrr/F/� DATE 61�S16d ADDRESS 111 TEL. CITY NO. FSTATE CITY APPROVED SETBACKS gLIC.NO. LIC.NO. _ p] SIZE NO.OF BLOCS. (FROM C/L STREET) L OF LOT NOW ON LOT FRONT FT. . .. USE OP .Nr EXISTING BLDG. R.SIDE FT. rn (-1 Separate permits are required for L.SIDE FT. electric, plumbing and heating work:GT REAR FT. _ F USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION A - CA L/1 QS DATE APPROVED 7 Ltda.,- >, --ELY DATF J C W 0 I hereby acknowledge that I have read this application and state o' gd that the above information Is correct and agree to comply with C G. all laws regulating building construction, and I shall not employ al Z any person in violation of the workman's compensation laws of I44 the State of California. ///DO a SO. FT. D I hereby certify that I am properly licensed as a contractor under T the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UN R VALUATION IS FOR o Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: e am exempt from the provisions of the State of California Business VALUATION PERMIT FEE EY and Professions de,Division 3 Chapter 9. AP Ti f'C PLAN CHECK E O1 Signature of o Permittee $ TAX E 4 Or 1_,„17.1.0- 00/ Authors d Agent Dat ,, TOTAL PAID E /8 71 de PCuruNIr .di bOSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 ////�!!��-�� nl.nC I fn•. •..n nn Oe+ TL REC �PERMIT N° - 49551 For I /n/BUILDING •nrto Fill in Completely — Use Ink Only VV �� ADDRESS •l� _- 0/ / ) A.P.NO. C{ I — k(0 _ d tt —'^ CASA:: ^t�,��-.. BUILDING �s �'�//�/_ OWNER I t`1 R.lt�f 41 ti1J �oLADDRESS ZS �� U��XX� �t-�. .s UNIT N MAILING 13 Ly l /, /�� 4' /L1/u/?r// SPACE NO. f ADDRESS t Y�.�[(�(j // •� p CITY r CD9cH TEL.NO4�_�] .� Ttf,cfo LOT BLK. a ADD =MOVING DEMOLISH CONSTRUCTION ' LENDER (vvc„ t.,.r`tJl%)I BRANCH L. ut. D titCdx_'L u ADDRESS ,y 1 0a , L.f S / USE __ AR HIT T , T L. `anal, •I ____ 'aCi ! _• OR ENGINEER a s�.i.- s• ADDRESS I _ %IC. Y '.i _ cif_� " • ) TYPE V GROUP APPR•VED CONTRACTOR ( r .L/L/ Av(L9 LLQ BY DATE • ADDRESS TEL. CITY NO. Fy STATE CITY APPROVED SETBACKS LIC.NO. LIC.NO. Lu SIZE ^^ ( ,..r NO.OF BLDGS. (FROM C/L TR;ET9, //' L OF LOT -G. `F 7c9-0 NOW ON LOT FRONT �'a/j�' T. - Q USE OF (n/ 74F-r.1) /� r (/ cO EXISTING BLDG. �l.A... Lj' R.SIDE / 4F /1 t // F Separate permits are required for L.SIDE�/ FT electric,plumbing and heating work:CS REAR 0 IW., USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION Q y/7 7 f 7�4 DATE 7^_.S�y Q l_Oti OO APPROV 5 /j% 7 APPROVr gd Li] 0 1 hereby acknowledge that I have read this application and state HOLD FOR SPECIAL REQUIRZ:vIEN si eg that the above information is correct and agree to comply with 6, all laws regulating building construction, and I shall not employ i Z any person in violation of the workman's compensation laws of a Zthe State of California. ,!I t_ _ � � �� SQ.FT. m 1 hereby certify that I am properly licensed ase contractor under a the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the provisions of the State of California Business VALUATION PERMIT FEE E Y Q and Professions Code,Division 3,Chapter 9. rt N Q PLAN CHECK $ gr. Signature of / A 7 O Permittee i s LL or V �/ �t/V �' TAX S 3.^S p V (� Authorized A` Date ••� TOTAL PAID $ - �,OQ `\ J 2492 6/25/EC . 191 .Cr TL " I COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT r P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 RE BV PERMIT C.�Q For Applicant to Fill in Completely—Use Ink Only G / Sci BUILDINGA.P.NO. ADDRESS �S�y '�,.Elie L(-7� ite_, BUILDING rz, �J�[ OWNER OR/� _ICYI..__Z/11....rrlte '7 4 ADDRESS OW T a ' ' TENANT '7G-S�— Oli UNIT OR IiI MAILING ! ��LYdn. SPACE NO. /Vs ADORESS/��C' - Ave.- TR.NO. LOT CITY ( IJNES 6:Ceia NEW/ ADD ALTER REPAIR MOVING DEMOLISH CONSTRUCTION Y/ LENDER n BRANCH / w '- I 1 / _. OWNER ((��ii((-�C� /si!'JIYj/�� ADDRESS VALUE ARCHITECT TEL. USE E OR ENGINEER NO. ADDRESS ZONE /Z 2- YPE V GROUP/ Os-fro s— _ APPROVED / CONTRACTOR ODM" �ar By DATE (pL/ Q • ADDRESS TEL. CITY NO. I-1STATECITY APPROVED SETBACKS F LIC.NO. LIC.NO. u SIZE NO. BLOC (FROM C/L STREET) fax OF LOT NOW ON LOT FRONT FT. . Q USE OF cn EXISTING BLDG. R SIDE ET, Ut I-0 Separate permits are required for L.SIDE FT. C electric,plumbing and heating work. REAR FT. fs] F USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION At 0 _ Q Q 0h dQ S DATE APPROVED APPROVED } —HY _DATE .-I 12 W - . 0 I hereby acknowledge that I have read this application and state h. (X that the above information Is correct and agree to comply with IL all laws regulating building construction, and I shall not employ i Z any person in violation of the workman's compensation laws ofi. 'jW.' the State of California. I m I hereby certify that I am properly licensed as a contractor under /1714 SO. FT. 6 w the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN U ER VALUATION IS FOR ro Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: e am exempt from the provisions of the State of California Business VALUATION PERMIT FEE $ /710 Yn and Professions Code, Div Ion 3,Chapter 9. I PLAN CHECK $ L. Signature oflc/ 0 Permittee S 0 TAX 5 a Authorize/gent Date T 6 ` TOTAL PAID 5 { / / 00 U G" 00/ �"� COSTA MESA BUILDING-SAFETY DEPARTMENT APP CATION F�'IASTR�JC�UROA4L PERMIT 99"�� TL P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 REL E Y (PERMIT N - 4 9552 For Applicant to Fill Fill in Completely/--Use Ink Only.BUYYYY ISI ADILDING DRESS 7...57` ) at( � � gUILDINGA.P.NO. q��_(�(/--nO��/ TENANTO —WNER OR jtt--t7 r` usj 41 clok4'IJ �L` ADDRESS 'I�-rS�� ca,a, W'(I•G . _ UNIT OR MAILING SPACE NO. Li ADDRESS 1��r . C s �/�3Qa is Luc) TR.NO. /'��'` LOT (/ BLK. TECITY ') c--(L'� � �� NOL�T� L(� NEW/ ADD ALTER REPAIR MOVING DEMOLISH CONSTRUCTION LENDER (Pt3Cs(t kit-/. BRANCH Cii&O)-4. GU(•7�— kit, OWNERV I�2t-L-r'i 5. NiO tfd,..t CASSIS ADDRESS 1( QE.t1J , VALUE OARCHITECT R ENGINEER 1'-0.AL9� •Joh` NO (�'�(p USE �(`��t i ay Q /�� ' • tsoo ADDRESS Igcsc LL cc'lIC P C�,✓([,L(�r ZONE TYPE GROUP ft �,I APPR VED CONTRACTOR / hV.L-Z—GE-/./ BY DATE ADDRESS TEL. CITY NO. .F. STATE CITY APPROVED SETBACKS LIC. NO. LIC.NO. 4.2 SIZE ( NO.OF SLOGS. (FROM C/L�STR / L OF LOT X WO NOW ON LOT FRONT // '('Per//� a USE OF per - f n '�( /, „4,� EXISTING BLDG. it.Q.0 JFLJ( CA • F Separate permits are required for L.SIDE 7 �FT.CJ !� electric,plumbing and heating work: REAR f/ FT 6/ LO F USE OF BUILDING AND WORK TO BE PERFORMED PLAN FY1 NG ACTIOK 'C Q a Crr7, ,OD ' DATE�JAROV //3 ' sit > _ APPRO 5. DATE .a CO • O. I hereby acknowledge that I have read this application and state HOLD FOR SPECIAL REQUIi _i.l TSP. (X that the above information is correct and agree to comply with L all laws regulating building construction, and I shall not employ Z any person in violation of the workman's compensation laws of a bl the State of California. �� I,/�� 4/ 3 I hereby certify that I am properly licensed as a contractor under WY SQ. FT. (.3714. &/ 7/ 1 w the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR 0 Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the provisions of the State of California Business VALUATION PERMIT FEE $ Y Q and Professions Code,Division 3,Chapter 9 Signature of 11 1 CN PLAN CHECK $ Q S"O moii_ Q Permittee _i.� a / $ 57. loot TAX $ ( 3 Si �' Authorized A.- t D-te Q� or ,�� ` TOTAL PAID $ ! Op O arr- P493 6/25/60 191.00 TL • 'COSTA MESA BUILDING-SAFETY DEPARTMENT APPATION FOR STRUCTURAL PERMIT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 ` � RE BY PER I For Applicant to Fill in Completely — Use Ink Only ADIDRESS S� T �W gut, A.P.NO. ��/ �� [/�� OWNER ORI ,(� mans-Li ac ._ c[r()C TENANT .07111 'r•�(a ly \DIA ��`5� _ UNIT OR ADDRESSMAILING asa�. Y �1o(P� live r TR.NO.ND• LOT BLK. / pi TEL. CITY •5`T'((' ''I(%5`A NO,J '(e,f'tl�' NEW _ ADD ALTER REPAIR MOVING DEMOLISH CONSTRUCTION _( V/ LENDER BRANCH �1 OWNER „al/ J ADDRESS VALUE TQARCHITECT TEL. USE E OR ENGINEER NO. /) ADDRESS ZONE E.1 TYPE �• GROUP Z APPROVED CONTRACTOR D / BY DATE 6/ ero ADDRESS TEL. CITY NO. — F. STATE CITY APPROVED SETBACKS LIC.NO. LIC.NO. W SIZE NO.OF BLDGS. (FROM C/L STREET) fax OF LOT NOW ON LOT FRONT FT. a USE OF EXISTING BLDG. __B.SIDE FT. - rn ^FZ Separate permits are required for L.SIDE FT. A electric,plumbing and heating work: REAR FT. USE OF BUILDING AND WORK TO BE PERFORMED (PLANNING ACTION A _/ 711 GOI�G6 DATE APPROVED P' APPROVED ✓ —_BY DATE 0-1 ce W pI hereby acknowledge that I have read this application and state r, od that the above Information is correct and agree to comply with P. all laws regulating building construction, and I shall not employ zi Z any person in violation of the workman's compensation laws of x L the State of California. I hereby certify Chet t am properly licensed as a contractor under /tea SD. FT. illirs 174424ry the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN NOER VALUATION IS FOR m Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: to— am exempt from the provisions of the State of California Business VALUATION PERMIT FEE $p d and Professions Code,Division 3,Chapter 9. s Bt7 Signature of tp. $ PLAN CHECK E `I. o PermitteeTAX E — u or • 0 0 V Authoriz Agent Date / TOTAL PAID $ /4.e - ' Ms - CITY OF COSTA MESA - 6 BUILDING DIVISION F Ial• DEVELOPMENT SERVICES DEPARTMENT PER NUMBER rIrr<s PERMIT '4" 01-00632 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.c_a,4gEpING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 • Job Address: 2524 ELDEN AV UI Status: ISSUED Suite: A Applied: 05/07/2001 Vicinity: UNIT A&B Issued: 05/07/2001 Parcel Number: 93704001YP/Y^er/—2'7 Zoning: Applicant: MANSFIELD, ALEX - ISSUED BY: _,„ (, ___. Address: 1447 SUNNY CREST DR , ; / t/ • - - - - _ , Phone: (714)738-4477 FULLERTON,CA Zip: 92835 . Owner ELDEN MESA HOA Address ' . - - Phone: 714-431-1155 Zip: Contractor: MANSFIELD ROOFING Address: 1447 SUNNY CREST DR • Phone' (714)738-4477 FULLERTON,CA Zip: 92835 •License: ' 580433 , Arch : Eng: . _. Address: . , Address(: Phone: - • Phone: Zip: • License: \ License: T / SCOPE OF.PERMIT,� ''; ` . .. REROOF FOR UNIT A&B:T/O EXISTING SHAKE'ROOF,7/16"OSB'SHTG,1 LAYER'OF 15#FELT,APPLY 30-YEAR "ELK"COMP SHINGLES. , \ , / 32 SQUARES - �, - _ A� ; ;- FEE SUMMARY';-'>_ 2'', Plan Check: $0.00 �.' :i Calc Valuation: f., ' , - $6,800.00 ' Permit: $139.25 i- - Claim Valuation:,' " C $6,800.00 SMIP.Res:, $0.68 — _ Sr � SMIP Corn: ‘•. `"$0.00 -, z r_- d�/ ' /. ,,.Other-' $0;00 ,, A ,� N, Inspection. - $000, ; ,�% �.. !� Total: $139.93C".,� ��// - 7 �\ //'N%/ � �\- N- . PLANNING 8 ZONING?! \%2)v i 'i SETBACKS V\-��' v / - c' —.,A - /::/% % � iii=1 MAIN STRUCTURE Frontes 00 N� _// Rear 0 0 Left 0 0 '�-r- Right (20 0 �/ / `, ---t , �// ACCESSORY Front�0-0 ;� Rear 0-0_ ) 'Le0-�0r%)�-- RighGO-0 c-.7 ., A.._ 1 _\.,5,t_,, 1 L Li _..--,,,„7.---,-- .,„ PARKING Existing: 0 "'-Required^:--0- —. _ Proposed:-7,50---; ,�''� NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections 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)754.5626 244646(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ' O I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'compensation Insure ce carrier and policy number are: Carrier: ' $-GAFe Policy Number: 13]') �& (This secaon need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these pr• t`•ns. Applicant Signature: 41 Y./ Date: 37?/° WARNING:FAILURE TO SECUR • ORKERS'COMPENS/ON COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOGARE($100,000),IN ADDITION TO THE a/•• T OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Buslne�5y arnfessions Code,and my license is in full force and effect.Lic.# �/��. -t�IPS 3 _ Class A�C-y Contractors Signature: . Date: 7//7/h I CONSTRUCTION LENDING AGENCY: ! J ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that ha or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or Improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: O I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: • 1 Will the applicant or present or future building occupant need to tile and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application akermit for such construction or modification 0 from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Si of L a s) (Date prized Applicant �/�Date — CODE t INSPECTION TYPE DATE INTIIIAL$ CODE INSPECTION TYPE gruE IA 1616 Fixed System Final Fire Prevention _ 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof ^51-0/ -. 210 Final Electrical 201 Final Block/Retaining Wall _ 212 Final Fire Prevention 202 Final Factory Fire Place . _ 220 Final Planning Approval 203 Final Sign _ 222 Final Site 204 Final Demolition 250 Final Building/Occupancy - _ r 5t5111 M 9 , . j CITY a1F COSTA MESA 4` BUILDING DIVISION > � DEVELOPMENT SERVICES DEPARTMENT P MIT NUMBER 4 Primo • PERMIT ,_' 'o'c�11� B03-01796 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesas 4sPERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 • Job Address: 2554 ELDEN AV BUILDINGStatus: ISSUED Suite: B Applied: 10/15/2003 Vicinity: Issued: 10/15/2003 Parcel Number: 93585003 Zoning: Applicant: PETRONELLA ROOFING ISSUED BY: �-"— Address: 2626 NEWPORT BL - . Phone: (949)548-1645 COSTA MESA;CA - Zip: 92627 Owner CEDAR GLEN HOA Address ,2554'ELDEN AV - 7- COSTA MESA'• , - - Phone: , NEWPORT,BEACH,CA-` Zip: 92660 Contractor PETRONELLA ROOFING Address: 2626 NEWPORT BL Phone: (949)548-1645 COSTA MESA,CA Zip: 92627 : License:- 460707 Arch : - , Eng: Address: Address: , - ,"Phone: - - Phone: Zip: - , -License: License: SCOPE OF PERMIT TEAR EXIST.WOOD SHAKE INSTALL 1/2'PLYWOOD AND 1-15LB FELT AND 30 YR COMP.TEAR OFF BUR AND INSTALL 1 SINGLE LAYER OF TORCH DOWN. - '-- - - - FEE SUMMARY Plan Check: $0.00 Calc Valuation: $6,800.00 Permit: $139.25 Claim Valuation: $6,800.00 SMIP Res: $0.68 SMIP Corn: $0.00 Other: . , $0.00 Inspection: $0.00 Total: $139.93. ' 17 - PLANNING &ZONING SETBACKS ' - MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-.0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 • Required: 0 Proposed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 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 Inspections 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)754-5626 2446-46(6/00) DEs'LARATIONS WORKERS'COMPENSATION DECLARATION: r 1 I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the ppdormance of the rk for which this permit Is issued. I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. workers'compensation��-yInsurance carrier and policy number are: artier 5n4c6 EZ,t a?•".P Wr—' . Policy mbar. I T5 '/ (.0c4 S' O� action need not be completed if the permit/s valued et one hundred dollars($100)or less.) ❑ I certify that In the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' :tion fomia,and agree that if 1 should become subject to the workers'compensation provisions of Sectl. 37,•of the Labor Code,I shall forthwith —•ply wit' t se provis sy1 ifr.Iicant Sig : re -�7 Date: /0 \c : AILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUEUECT •a OYER TO CRIMNAL•ENALT1 AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($10,0),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION37OQOF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES, LICENSE, •11NTRACTORS DECLARATION: I h: :.y affirm-fhat I am licensed under provisions of Chapter 9(commencing with Section 7000)of Divisi• of the Business and PSofessions Code,and my license is in full :en. .._ L . 6 b1 .. L— • Co actor's Signatur an Dates. • CONS UCT1ON LENDING AGENCY: ❑ I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500),): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of properly who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or Improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ennit for such construction or modification from the South Coast Air Duality Management District or from any other air pollution control district or agency? Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the Information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. • Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,end authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal tar Date aer /0/n °f And/Or Aut oriz:d Applica (�(�� BODE/, gISPEDTIDN TYPE PATE MAi.S SODEE WSPECTION TYPE \ _ PAIS I1910A65 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing / 200 Final Re-Roof (L79't7 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy CITY OF COSTA MESA 449 BUILDING DIVISION >• bisDEVELOPMENT SERVICES DEPARTMENT P RMIT NUMBER F .��... kPERMIT B03-01881 N •bei.asans, (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.caus.LDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2554 ELDEN AV Status: ISSUED Suite: C Applied: 10/29/2003 Vicinity: BLDG C Issued: 10/29/2003 Parcel Number: TPN003180 Zoning: Applicant: GOMEZ, PAUL ISSUED BY: Address: 2626 NEWPORT BL Phone: (949)548-1645 COSTA MESA,CA - Zip: 92627 . �N Owner: CEDAR GLEN HOA Address 2554 ELDEN AV - - N • Phone: ,COSTA MESA,CA Zip: 92626 Contractor: PETRONELLA ROOFING N Address: 2626 NEWPORT BL N ' Phone: (949)548-1645 COSTA MESA,CA Zip: 92627 . License: 460707 Arch : _--, Eng: • Address: Address: Phone: ," Phone: Zip: - License: License: - SCOPEOFPERMIT . TEAR OFF EXISTING ROOF. INSTALL 1/2••CDR,30 YEAR COMPOSITION ELK SHINGLES, 1 LAYER OF FIRESTONE FR 180 TORCH DOWN, • BUILT UP ROOF.35 SQUARES FOR SLOPE AND 7 SQUARES FOR FLAT. BLDG.C ONLY. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $9,200.00 Permit: $181.25 • Claim Valuation: $9,200.00 SMIP Res: $0.92 SMIP Corn: $0.00 7 Other: $0.00 Inspection: • $0.00 - Total: $182.17 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 - Left -0-00- ACCESSORY Front 0-0 ' Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0- NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 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 Inspections 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)754-5626 2446-46(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: 7 ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. My workers'compensation Insurance carrier and policy number are: Carder: Si oc:R= jCcf_.g .. “--S'' Policy Number: I c5 *-11 V Zj- 1j (This section need not be completed it the permit is valued et one hundred dollars($700)or less.) ❑ I certify that in the performance of the work for which this permit Is Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of mia, nd agree that If I should become subject to the workers'compensation provisions of action 700 of the Labor Code,I shall forthwith comply with these ovisio e Applicant Signature: Date: (0 1 S iA '3 WARNING:FAILURE TO SEC E WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000L IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3705 OF THE LABOR WDE,INTEREST.AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.It r4 Len 7� Class a C— S9 Contractors Signature: 4/\.—t.0 Date: (o,b CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: 1 hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to fila a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption,Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his of her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement Is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ' ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,end who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,lalsework,or demolition or dismantling thereof,will be more than thirty-six(35)1 eet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health end Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? IYes 0 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the informatlo given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter pon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final Inspection. �nS' naturg Legal Owner(s) Date �/ .,/ /b ' 94 And/0 uthorized Applicant Data CODE I INSPECTIONTYPE ' DATE IIITITIAL4 CODE! INSPECTIONTYPF DATE ItDIDAL9 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final C 208 Final Plumbing — 200 Final Re-Roof /L�/9/3 210 Final Electrical• _ 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition _ 250 Final Building/Occupancy i t CITY OF COSTA MESA 4 � 'D BUILDING DIVISION j;� "�ThonlJJDEVELOPMENT SERVICES DEPARTMENT RMIT NUMBER 1 y rim r PERMIT 601-00633 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa. a,4�LDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2524 ELDEN AV U Status: ISSUED Suite: C Applied: 05/07/2001 Vicinity: UNIT C&D Issued: 05/07/2001 Parcel Number: -9e teerl TP/`/-OOI— 2-9 Zoning: Applicant: MANSFIELD, ALEX ISSUED BY: _:se‘&___ Address: 1447 SUNNY CREST DR - - Phone: (714)738-4477 , FULLERTON,CA Zip: 92835 : . Owner: ELDEN MESA HOA Address " • Phone: 714-431-1155 Zip: Contractor: MANSFIELD ROOFING Address: 1447 SUNNY CREST DR Phone: (714)738-4477 FULLERTON,CA Zip: 92835 License: 580433 Arch : - Eng:• . Address: Address: Phone: - - Phone: Zip: License: License: i % SCOPE OF PERMIT , REROOF FOR UNITS C&D:T/O E XISTING.SHAKE ROOF,7/16"OSB SHTG; 1 LAYER OF 15#FELT,APPLY 30-YEAR "ELK"COMP SHINGLES. 32 SQUARES - FEE SUMMARY Plan Check: $0.00 ° Calc Valuation: $8,200.00 Permit: $167.25 Claim Valuation:/: $8,200.00 SMIP Res: $0.82 = / � SMIP Com: $0,00 /4 • Other: $0.00 • %% Inspection: $0.00, - � Total: $168.07 .7/ PLANNING &ZONING%� \, /V SETBACKS /` � Ai // MAIN STRUCTURE Front.:l. 070 \`'�i Real; --0-0 Left 07 0 ,TO Right050,, ACCESSORY Front 0-0 ' Rear 0.-0 - Left 0-0- Right", i-0-0' PARKING Existing: 0 Required:- 0 Proposed:/,,-;-.0 NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections 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)754-5626 244649(6/00) DECLAWATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'compensation�IInnsu�ranc�e gamier and policy number are: 2 [/ I Carrier: �}—Q-4—e �-v YLvl Policy Number: 131 7 rJ -1 1p (This section need not be completed if the permit Is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of 'fomia,and agree that If I should become subject to the workers'compensation provisions of Secti 3700 of the Labor Code,I shall forthwith oomph/with these p ns. WARNINGApplicant FAILUSignaRE T ''/(� �� Date: f D / 7rw IAL WARNING:FAILURE T ECU ADDITION S ION COVERAGE IS UNLAWFUL AND SHALL PROVIDED FOR AN EMPLOYER TO CRIMI PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS(5100,000),IN ADDITION TO TH T OF COMPENSATION,DAMAGES AS FOR IN SECTION 37060F THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed underpprovisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Coda,end my license is in full force and effect.Lis.if _i '-S Class S Contractors Signature: iye if 1 - Date: 5/7/DI CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: 1 hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter.Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he Or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ 1,as owner of the properly,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that n0 excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code.with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health end Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If en RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No 5 Does or will the applicant or present or fun/nil-building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? al Yes IU No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ''` $tgpq(We O eget O Dpte V !.4411//a`•�thonzed Applicant 77/ IDate CODE INSPECTION TYPE RATE INTRIALS cosDI INSPECTION TYPE 26Th INTRIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Root Sp / 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition . 250 Final Building/Occupancy yin Mac CITY OF COSTA MESA °w�� - 4 D BUILDING DIVISION F • ,,,,� � t DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER i PERMIT P07-00080. • *tb+roMO'"° - - (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.41UMBING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2524 ELDEN AV •• . Status: ISSUED Suite No D E Y L�J X,PIRED Applied: 02/02/2007 Issued: 02/022007 Vicinity: D 9 /he (-E30 Parcel Nunmber: 14172'226 .-1j74Y0Oy DA'fE � • Applicant RICHARD LA OUTS Address: 12025 ARROW ROUTE _. - ISSUED BY: i , .'% " Phone: . 888-615-3330: _ _ RANCHO CUCAMONGA,CA-- - - Zip: 91730 iy . � - • Owner DAYNA-CORNELIUS _- ' / Address //,984 PAULARINO AV r - / � - i \..c; Phone: /rI , i Zip: 92626 Contractoi: ALL 111:50/PLUMBING CORP \ ,'. / - , /.Address:" 12025,4121.46W ROUTE - N',A Phone: - 888-615-3330 RANCHO CUCAMONGA,CA Zip: 91730 ` - • License: 778137•• ' ,1 ', ' `r- >ii 1 / i o� , ' 7,1 -- SCOPE OF PERMIT - - _ , /% ' ATER HEATER CHANGE OUT - , - , , % ' 7 FEESUMM__AR_Y AMT QTY,-- -,- n • - AMT QTY ISSUE FEE I $23.50 LaundryTub/Washer%-?_ _$0.00 ' 0 ' \ Sump Pump $0.00 0 Backflow irrigation $0.00 0 - -- Landscape Irrigation -. $0.00 0 - - Swimming Pool - $0.00 0 Backflow Preventer , $0.00 0\ P-Trap $0.00 0-; Trap Primer $0.00 0 Bathtub $0.00 0 j Pressure Regulator $0.00 ,0 Urinal $0.00 0 Clarifier System , $0.00 0 - `% Process,Piping(per 10,11) $0.00' 7.0 -- ,. Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc)- $0.00 0 . - -- Receptors- --- $0.00 JO' ' '- Vacuum Brkr Bkflow(5+) - $0.00 0 Dental Units . \ $0.00 0 - Septic Tank- - • $0.00 i 0 ' Wash Basin $0.00 0 Dishwasher - $0.00 0 , Sewer Cap for Demo $0.00 0 Wash Basin Set- , $0.00 0 Drain;.Floor - I $0.00 0 ; Sewer Connect '$0.00'' 0 ,Waste and Vent System $0.00 0 Drain,Rainwater; 1 , , .$0.00 01` Sewer Private Line $0.00; , 0 Water Closet(Toilet) $0.00 0 Drain,Roof 1 1 .'$0.00 0 Shower $0.00 '0 Water Heater/vent $12.30 1 Drinking Fountain- ' $0.00 0 Sink,bar _ ' - $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank \$0.00 0 Sink,commercial ,$0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00. 0 Sink,Floor'' ' _ $0.00 , 0 Water Service / $0.00 0 Gas(1-4 outlets) '`'1" $0.00I,',+, , 0 Sink,kitchen' ° - r' $0.00'-0 Water Softener $0.00 0 4 o Gas(Overutlets) 7 • $0.00. .0 .,-y?,�,--;Sink,service/mop $0.00 '- 0- .1- ' OTHER" - $0.00 Gas Repipe\ � , $0.00 A 0� ' Spa(private) . ` $0.00 0 ' VIOLATION $0.00 Gas Service V \\ //:',50.00, 0 �,� -_Spa(public)'" - $0.00 , 0 :-PLAN CHECK. $0.00 Interceptors(Grease,Oil)`'($0.00 ,. 0'' V ° - o , - :'REINSPECTION $0.00 0 Interceptors(Sand Auto). I$0.00� o. III:---In', ,� .. / v' = N / , ,.-A - _ - - TOTAL CALCULATED FEES: $35.80 N' .A •-) ' / /!l _A - - - -- i.�/ >\ - ''/ COMMENTS]SPECIAL CONDITIONS %/ NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days,or if work is suspended or abandoned fora period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections 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)754-5626 2446-46(6/001 f DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. M workelq:eornbensati Instaance carrier;,end policy number are: ��/ D // uC d.-,ti 5 INc Policy, as: /Ge,10J 4/6"5 (This section need not be completed U the permit is valued at one hundred dollars($100)or less.) _— Police , ❑ I certify that in the performance of the work for hich this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of C mia and agr if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith ��,�.}m��• yI!IE� ase prov, — •tar: r (le ' Date:• G/ 07 W''`NG:FAILURE TO SECURE WORKERS COMPENSAm COVERAGE IS UNLAWFUL AND SHALL SUOJECT AN E -['ANALi/ENA IES AND CIVIL FINES UP TO ONE HUNDRED •ISAND DOLLARE($100,000),INADDmON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37090E THE LABOR DE.INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereb • m the I am licensed u de pro'siofls of Cha 9(commencing with Section 7000)of Divisi he Business a Prpfetlons Code,and my license is in full for - :w�" . i s T��lO _...arr C C. TRUCTION LENDING AGENCY: . ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500).): ❑ I.as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes ❑No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation live(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safely Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). __..........._.._..__......_.._.....r..._..._.rf_�.."_....___ __._strati _._ .... 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aQermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 0 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct.I agree to comply with all state laws end city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection .... as.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. g;: .rte a Of Legal Owner(s) /Date — A d/0 :nzed Applica >'e CODE F INSPECTION TYPE PATE If1I11DAL9 coon INSPECRON TYPE PATE MAO 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1268 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220. Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy _ • ' Al CITY OF COSTA MESA 4,4vs: BUILDING DIVISION :gr4I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER . F t I 61� PERMIT • 1B03-01987 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 2554 ELDEN AV Status: ISSUED Suite: D Applied: 11/17/2003 Vicinity: BUILDING D Issued: 11/17/2003 Parcel Number: TPN003180 Zoning: Applicant: PAUL GOMEZ _ ISSUED BY: Address: 2626 NEWPORT BL , ; ,i - - _ - - Phone: (949)548-1645 COSTA MESA,CA Zip: 92627 . - Owner: CEDAR GLEN HOA- , . ' N Address /2554 ELDEN AV - - - ._ - y ` N '/7 Phone: ' / i/:COSTA MESA,CA -- - Zip: 92626 - A N �. . Contractor: NPETRONELLA ROOFING !Address: 2626 NEWPORT BL ! ;' Phone:/ (949)548-1645 N- _ COSTA/MESA,CA Zip: 92627 . License: 460707 Arch : Eng: Address: Address: Phone: - Phone: 'Zip: - - - License: License: SCOPE OF PERMIT TEAR OFF EXISTING ROOF. INSTALL 1/2'CDX, 1 LAYER OF'15#FELT,30 YEAR COMPOSITION SHINGLES.ON FLAT INSTALL 1 LAYER OF SINGLE PLY FIRESTONE F-R 180.45 SQUARES FOR BLDG. D. ' - _ FEE SUMMARY ` ', Plan Check: $0.00 ' - ' Calc Valuation: $9,600.00 Permit: $181.25 Claim Valuation: $9,600.00 SMIP Res: $0.96 SMIP Com: $0.00 • Other:. ' $0.00 ''-Inspection, . $0.00 � . - • - V ' Total: . -;$182.21 ,‘ PLANNING &ZONING SETBACKS\ MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front ' 0-0 Rear 0-0 - Left 0-0 Right 0-0 PARKING Existing: 0 ., Required: .0 , Proposed:. 0 i NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days,or If work is suspended or abandoned for a period of 180 days. ' INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result In the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2448.46(6/00) DECLARATIONS o WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which thislpermlt is issued. -❑ -*have have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is ice-lied. ' ---My workers'compenlp/ation Insurance carder and policy number are: OCerde% -t"1"e E- Aar a.-cc `Policy Number: l r 9 t G 2-$- c? (This section need not be completed If the permit Is valued at one hundred dollars($100)or less.) ❑ I certify that In the perfo of the work for which this permit Is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of alll le,an agree that if I should become subject to the workers'compensation provisions of Se Ion 37 of the Labor Code,I shall forthwith comply with these prOvlsl Applicant Signature:, -w'y Cpgtg: 11 7 ^3 < -WARNING:FAJLURE TO SECURE WORKS COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE(S100,000).IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm.that.I am licensed pun'�d�er provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full H force and effect.Llc. It / CClass p - C-' 3 9 r L/ tractors Signature:- -� �( 'Date: )!,!7 r7J CONSTRUCTION LENDING AGENCY: / ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued.(Sec.3097,CMI Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he Or the is licensed pursuant to the provisions of the Contractors Ucense Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the properly,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not Intended or offered for sale(Sec. 7044,Business end Professions Code:The Contractors Ucense Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through hit or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I.as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors Ucense Law does not apply to an owner of property who builds or improves thereon,end who contracts for such project with a contractor(s) license pursuant to the Contractors Ucense Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑Yes 0 No Driver's Ucense No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2.Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Cede,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently requireq,has Section 25534 of the California Health and Safety Cale been fully complied with? ❑Ves 0 No the applicant.. r.._._.,- _.___ _ _ __..._ 5 Does or willo the CoasttoAir or present or emen building occupant any other air the work which districtis the subjectr of this application aL Nnit for such construction or modification from the South Alr Quality Management District or from other air pollution control or agency? Yes IL No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). '6 Will anfacility - _.. _. ..............._ y part of the to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If yes-,the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safely Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No 8 (If'ye?,attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. • Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given Is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Si ur i Lpgsl Owner(s) D `d/OTAu Applicant-_ - te— pope) UISPECTiON TYPE QIP PODS( PI5PECRON TYPE QAIE PIMA 1816 Fixed System Final Fire Prevention 206 Final Mechanical 1268 Pool Spa Final //rte 208 Final Plumbing _ 200 Final Re-Roof /t & Af 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval - 203 Final Sign 222 Final Site _ I 204 Final Demolition 250 Find BuildinglOccupancy _ p F CITY OF COSTA MESA 4 BUILDING DIVISION � � DEVELOPMENT SERVICES DEPARTMENT - PERMIT NUMBER 1. 1 :Almon 1 14111 . � � PERMIT \y/ / BOO-01567 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.§iLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2524 ELDEN AV Status: ISSUED Suite: D Applied: 10/02/2000 Vicinity: UNIT D Issued: 10/02/2000 Parcel Number 93794004 Zoning: Applicant: SCHLAGEL, JIM ISSUED BY: Address: 1235 N SAN DIMAS AVE Phone: (626)852-2110 SAN DIMAS,CA Zip: 91773 Owner: ELDEN MESA HOA Address 2900 BRISTOL ST#B-303 • Phone: (714)434-6662 - COSTA MESA,CA ' Zip: 92626 • Contractor: CONDOMINIUM CONSTRUCTION SERVICE, INC Address: 1235 N SAN DIMAS AVE Phone: (626)852-2110 SAN DIMAS,CA Zip: 91773"- License: . 691243 ' Arch : - Eng: ' - Address: Address: Phone: Phone: , Zip: License: License: SCOPE OF PERMIT REROOF EXISTING CONDOMINIUM UNIT(UNIT D)FOR"ELDEN MESA HOA".TEAR OFF EXISTING SHAKES&,RESHEATH , WITH 1/2"CDX PLYWOOD.INSTALL 30#FELT UNDERLAYMENT&REROOF WITH CLASS'A'30 YEAR COMPOSITION SHINGLES(13 SO). - FEE SUMMARY - . Plan Check: $0.00 Calc Valuation: $2,500.00. Permit: $83.25 Claim Valuation: ' $2,500.00 SMIP Res: $0.50 SMIP Corn: • $0.00 , Other: $0.00 Inspection: $0.00 . Total: $83.75 PLANNING & ZONING SETBACKS ' MAIN STRUCTURE Front 0-0 -Rear 0-0 Left 0-0 Right 0-0 , ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 -, NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within.180 days,or if work is suspended or abandoned for a period of 180 days. - - INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections 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)754-5626 i 2448-48(&W) t DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the ♦•�'/ work for which this permit Is issued. /"Yf hgperformance will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the of the work for which this permit is Issued. M9 workers'cornu ensatlon Igsurance carrier and policy number are: Cartier. l' a•• )0/%I Policy Number: 1/•I _(This.sectlon need not be completed it the permit Is valued at ono hundred dollars($100)or less.) ❑ I certify that in the performance of e work f which this permit is Issued,I shall not employ any person In any manner so as to become subject to the workers' compensation laws of Mamie, d agree at if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply wlih_rese pr Bions. /n r 0 D Applicant SlgrtaWre: Dale: !J WARNING:FAILURE TO SECURE ORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SMALL SUBJECT AN EM OVER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100.000),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 370a OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm thattar lice etl d r revs s f Chapt@r 9(co�j'mencing with Section 7000)of Division 3 ofthe Busines and Prof tai i.Code,and my license is in full L.one andeffect. a �� y � /' // Gass N ) r [ Contractors Signature: � L:`\1^ - _ Date: I /0— CONSTRUCTION Q—CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commenting with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I em exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,I.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the a plicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ID yes ❑f�o (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑No will.............. ..._... ____u_ _. aton a._..e..__—uch const__ _. 5 Does or othe oast Air or present or emen building occupant any other for the won wntch districtis the subject of this application eU Nnii for such construction or modification Iron the South Coast Air Quality Management District or from other air pollution control or agency? �Yes 8 No (Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits). -. .bh__ ._et __._ —.._.__..._.........._.____. 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No ...8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the Information given above is cored.I agree to empty with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. 0Fr re Of Legal Owner(s) /� x� Dao O And/Or Authorized Applicant 's ) Date CT coOE I INSPECTION TYPE 12E1 IIIaAL$ cm E INSPECTION TYPE gAIF. 1ti1TUAL6 1616 Fixed System Final Fire Prevention • 206 Final Mechanical 1266 Pool Spa Final n � /3.1/3.1208 Final Plumbing 200 Final Re-Rolf /l%f1'O ✓J� G n.# 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy CITY OF COSTA MESA 4a0 - BUILDING DIVISION Pit 7117 DEVELOPMENT SERVICES DEPARTMENT ERMIT NUMBER fi PERMIT B00-01542 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca C LDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 • Job Address: 2524 ELDEN AV Status: ISSUED Suite: G Applied: 09/29/2000 Vicinity: UNIT G Issued: 10/02/2000 Parcel Number: 93795007 Zoning: Applicant: SCHLAGEL, JIM Address: 1235 N SAN DIMAS AVE ISSUED BY: Phone: (626)852-2110 SAN DIMAS,CA Zip: 917473 Owner ELDEN MESA HOA Address 2900 BRISTOL ST#B-303 Phone: (714)434-6662 COSTA MESA,CA Zip: 92626 Contractor CONDOMINIUM CONSTRUCTION SERVICE, INC Address: 1235 N SAN DIMAS AVE Phone: (626)852-2110 SAN DIMAS,CA Zip: 91773 License: 691243 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT REROOF EXISTING CONDOMINIUM UNIT(UNIT G)FOR"ELDEN MESA HOA".TEAR OFF EXISTING SHAKES&RESHEATH WITH 1/2"CDX PLYWOOD. INSTALL 30#FELT UNDERLAYMENT&REROOF WITH CLASS'A'30 YEAR COMPOSITION SHINGLES(13 SQ). FEE SUMMARY , Plan Check: $0.00 Calc Valuation: $2,500.00 Permit: $83.25 Claim Valuation: $2,500.00 SMIP Res: $0.50 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 • Total: $83.75 -• • PLANNING &ZONING . SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right -0-10 PARKING Existing: 0 Required: 0 Proposed: - 0 NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12.21-92) EXPIRATION: This permit shall automatically expire and become void if work IS not.commenced,within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections 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)754-5626 2448-48(6Ne) DECLARATIONS WORKERS'COMPENSATION DECLARATION: " I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. 'have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. My workers' mpensatlon Insurance carrier and policy number are: Cartier:— 7 14 0,4 Po11c Number, SIV tt 2aL5� S� (This section need not be completed if the permit Is valued at one hundred dollars(5100)or less.) ❑ I certify that in the pe.ormance•1 thefor which this permit is Issued,I shall not employ any person In any manner so as to become subject to the workers' compensation laws• Califomil and:!e that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these p.. lions. / !Applicant Signature: -• ilk [Date: Y 0 -.7 -0 0 WARMNOrRNLURE•TO SECURE ORNERS'COMPENSATI COVERAGE IS UNLAWFUL AND SHALL SUBJECT Mt EMPLOYER-TO CRIMINAL PENALTIES AND CML RNES UP TO ONE HUNDRED THOUSAND DOUARE(S100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37050F THE LABOR CODE.INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm t atlam ticc9nse9jji+nder pr ons o Chapter 9(commencing with Section 7000)of Division 3 of the Busin§6�and Prof Ss&ode,and my license is in full force and effect.Lic.a110 7) 7 Class '- tic.) C_ / _ Contr ctoCs.Signature:a < Date--•• /Q r o, ' 0 a CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any dry or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or Improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: _ Date: Owner ID verified by drivers license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet In depth Into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). _ _ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPA Is presenty required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No _.._ require--- _._....._ which __..t.ia.__ ....._.._. . 5 Does he will the oast Air present ar n busting ofrrom at yothr for toe work ontch is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes S No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air duality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct.I agree to comply with all stale laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described pr.. occupy for inspection purposes I agree not to or allow occupancy of any building authorized by this permit until final inspection. A if At:Of Leggy/ ner(s) Date • .•r •uthorized ••iicanl, f Date .- ;ODE r INSPECTION TTPE PATE Ifi1IDAL$ SODS t INSPECTION TYPE PATE =NJ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final p by 208 Final Plumbing 200 Final Re-Roof /0-1/-00 g` 6qd- 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy CITY OF COSTA MESA ' c BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT `1 B00-01543 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.Etu1LDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2524 ELDEN AV Status: ISSUED Suite: H Applied: 09/29/2000 Vicinity: UNIT H Issued: 10/02/2000 Parcel Number: 93795006 Zoning: Applicant: SCHLAGEL, JIM ISSUED BY: Address: 1235 N SAN DIMAS AVE Phone: (626)852-2110 SAN DIMAS,CA , Zip: 91773 Owner ELDEN MESA HOA Address 2900 BRISTOL ST#B-303 Phone: (714)434-6662 COSTA MESA,CA Zip: 92626 Contractor: CONDOMINIUM CONSTRUCTION SERVICE, INC Address: 1235 N SAN DIMAS AVE Phone:. (626)852-2110 SAN DIMAS,CA . Zip: 91773 License: 691243 Arch : Eng: Address: Address: Phone: Phone: Zip: • License: License: SCOPE OF PERMIT T/OFF SHEATH AND REROOF 2600SF 2 UNITS(A&B)W/COMP SHINGLES,SMOKE DETECTORS REQ PER 97UBC. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $2,500.00 Permit: $83.25 Claim Valuation: . $2,500.00 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $83.75 - • PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0, Rear . 0-0 Left 0-0 Right 0.0 ACCESSORY -Front 0-0 Rear 0-0 Left 0-0 Right 07 0 PARKING Existing: 0 Required: 0 Proposed: O. NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections 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)754-5626 2445-46(WOO) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penally of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the X��///'''---work for which this permit is issued. pq. I.heve and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is iewied. •"My workers' mpensatlon In ranee carder and policy number are: ',)(� ,�^ Cartier. �C-62(dt Policy Numb v'T?��1J (Thissectlon need not be completed if the permit Is valued et one hundred dollars(5100)or less.) ❑ I certify that in the pe ormanc of the w for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws Califom' and a that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith canpty with these p 'sion / O r3 _ v 0 –Applicant Signature:_ rO tte:e– ..WARMGt NFAkf1RETO SECUR ORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND DOUARE(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 370e OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: • I hereby affirm t+ami e/pssed nder pr ions of Chapter 9(commencing with Section 7000)of Division 3 o tha.Busi`2a nd Profe ions Spde,and my license Is In full bice and effect.Lie.p lf� (1� ,( Glass l - G.�' Contractors Signature: X —e{F v�/\\ Date: c /l9 a —Gra VVY L— t CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,CMI Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit to tile a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater then a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safely Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? 0 Yes 0 No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP Is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication a armit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). • 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes,the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a pernit from the South Coast Air QualityManagement District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:1 Gerrity that under penally of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ' Sign.111%:Of Le Owner(s) c (l/(-1 r_ DateO 0 AndiOr Authorized gcamr f Date ct BODE t INSPECTION TYPE QdTT. INTrM65 CODES INSPECTION TYPE PATE MOW 1616 Fixed System Final Fire Prevention s"'00 "",, 206 Final Mechanical 200126 Spa 8 Final Plumbing 6 Final Re-Rooll /0- ✓' con„ 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy _ % . • ' CITY OF COSTA MESA / BUILDING DIVISION > _a DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 1. I _ r PERMIT ' 11.10ra601-00634 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca,usNG PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDIJob Address: 2524 ELDEN AV Status: ISSUED Suite: L Applied: 05/07/2001 Vicinity: UNITS J,K,L Issued: 05/07/2001 Parcel Number: 9'3 01 TM-429/-29 Zoning: Applicant: MANSFIELD, ALEX ISSUED BY: Address: 1447 SUNNY CREST DR Phone: (714)738-4477 FULLERTON,CA Zip: 92835 Owner: ELDEN MESA HOA Address - - Phone: 714-431-1155 Zip: Contractor: MANSFIELD ROOFING Address: 1447 SUNNY CREST DR Phone: (714)738-4477 FULLERTON,CA Zip: 92835 License: 580433 Arch : • Eng: • Address: Address: Phone: - Phone: Zip: • License: License: -` SCOPE OF PERMIT :, • REROOF UNITS J, K,L:T/O EXISTING SHAKE ROOF_,7/16"OSB•SHTG;1 LAYER OF-15#FELT,APPLY 30-YEAR "ELK"COMP SHINGLES. 44 SQUARES , `FEE SUMMARY Plan Check: $0.00 j Calc Valuation: • s1o,000.0o • Permit: $181.25 Claim Valuation'./ " '$10,000.00 SMIP-Res: $1.00 SMIP Corn: $0.00 Other:- $0.00 Inspection: $0;00, � � Totah $182.25 �� / / N;:-Z ,1 = c PLANNING 8 SETBACKS SVV%NG / �: MAIN STRUCTURE Front ,0.0 � i -Rear -0.0 Left 07 0 \ - \ Right> 0;.0'%"� i ACCESSORY Front 0 0 'Rear 0-0 _ Left 0 0— - - Ri ht2-'0-0 PARKING Existing: 0 Required: 0 - Proposed: ,0.7'K NOTES: - _ _�- -•- NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections 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)754-5626 2446-48 WOO) y DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the r-�/work for which this permit is issued. la 'have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'` compensatiig Insurar1/ce carrier and policy number are: t� , / Cartier: , -)t'L t"�r'c1 Policy Number. 131'7 5�1 Co (This section need not be completed It the permit Is valued at one hundred dollars($700)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these / ions. �j///_ Applicant Signature: 4 �� -r� Date:—`/ � TIES�D C�/NES UP TO ONE HUNDRED WARNING:FAILURE TO SECURE WORKERS'COMPEN TION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL THOUSAND DOLLARE($100,000).IN ADDITION TO T OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Busine?a Professions Code,and my license is in full force andeffect.Lic.# �J -'!3 ilf Dlawate:# �) 0 / Contractor's Signature: yr �tj/ Date: X77 CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that 1 am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to Ble a signed statement that he or she Is licensed pursuant to the provisions of the Contractors Ucense Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors Ucense Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,Califomia Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes 0 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (It yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? ❑Yes '❑No 8 (if yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPUANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property/� for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.in 6.2 / / qZiicant 7 /�? 007 / Date gODE I. INSPECTION TYPE PATE 1NTITIALS CODE! INSPECTION TYPE PAPE INTRIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical • 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof g'—'iiS—4y ..... Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy • CONSTRUCTION AND PLANNING POOL&SPA „. - , ,cViIJ APPROVALS Permit# 76 61...1Y7/ Date Inspector APPROVALS Permit# Date. _ - Inspector 1. Temporary Electrical Service or Pole 43. Pool & Equipment Location (--ll-En_ tie 2. Soil Pipe-Undrgrn - - - . . 44. Steel Reinforcement , 3. Electrical Conduit Utility-Undrgrn_ • 45. Forms • . . 4. Electrical Conduit-Undrgrn _ • - 46. Electrical Bonding - 5. Steel Reinforce _ 47. Rough Plumbing & Pressure-Test G'-11-%i .t 6. Electrical UFER Grn _ - _ - . 48. ' APPROVAL TO COVER P'E .-.. - - .. 7. Footings _ _ __ _ 49. Electrical Conduit-Undrgrn • . 8. Foundation - ._. • 50. Gas Pipe, ❑Undrgrn,Test 9. _Water pipe-Undrgrn.. . . . _ 51. Backwash Lines. P-Trap. ElUndrgrn 10. Structural.FloorSystem . , 52, APPROVAL TO DECK 6-11_,R-2- d_ o._- 1.1... Property Sewer line &-House Connection. . 53. Backwash& Receptor-Final • 4.-16 Wz,. CC . 12. .Street Sewer Connection . - ' -. - _ 54. Heater &Vent-Final _13. Rough Plumbing_ _. - . ' 55. PlumhinaSvstem=Final 14. Rough Electric-Conduit - • - •- - --56. Electrical-Final - 6-44.12, C .• 15. Rough Electric-Wiring - __ - 57. Solar System-Final • - - _ 16. Rough Heating & Air Conditioning• -- - -- -- _ - 58. Fencing &Access Approval 6-I 6717- QC6 r , 17. Ducts, in Structure . -. - _ _ - _-' - 59. APPROVED FOR PLASTERING 18. Ducts, Ventilating . . _ - - .. _ - - 19. Gas Pipe-Rough &Test _ 60. POOL/SPA SYSTEMS FINAL 4 -//.jt. tC - 20. Roof Framing - _. , 21. Roof Sheathing - - . - - 22. Frame and Flashing - - ._ NOTES: ' 23. Insulation - ' - - - - 24. Lathing & Siding - - - - .- .. _ . - - - -- 25. Drywall-Nailing . _ t _ _ . . _ . .. , - 26. Plaster Brown Coat - • _ - . _ _. "" - , 27. -Electrical Power Meter-Final- - - -- ' . _ . . - - 28. - -Final Electric . .- _ : . _ - - LI 29. -Final Heating & Air Conditioning -.. _ '_ . _ - - 30. Final'Gas Pipe-Test - _ - 31. .Final Plumbing _ - 32i --Water Service-Final • . - • ---- 33. Gas Service-Final .. . - ' • - 34. Solar Domestic-Final - - 35. Landscape Sprinkling System - - _ 36. Sound Attenuation - - , 37. Handicap Regulations - - - , 38. FINAL STRUCTURE & BUILDING - - ) . 39. Special Requirements Completed 40. Electric Release to Edison - - 41. Gas Release to Southern California Gas Co. • 42. CERTIFICATE OF OCCUPANCY - No Date Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations. • I CITY OF' STA'MESA PERMIT NO. TRACT NO. - LOT NO.' BLDG.NO. ' '- - ' - ' . - ICOISSTR TION PERMIT ,3� 387 ,:, .',.721.8 6/I4/82 18.00 TL Project Address 259 J- - K _ELOEn? . TYPE OF CONSTRUCTION - . �. ' • Owner'f'•O�yn 4-, L L . 4 A•nDi Phoneyo4-L-S97p 0 NEW 0 ADD 0 ALTERATION (� Q r ••� , Addrea - -7 - -- • ❑ REPAIR 0 CONVERSION ODEMOLISH Lni? 1 . . . . SAYL„� ZONING REGULATIONS, • ' • :Arch/Eng. . .enkjg�l - License No. • - ❑OTHER • - - - - Addres5 - DESCRIPTION OF WORK _ •ZONE , PLNG. REF.$ -, . Contractora '4 ' -- Phone -' - TYPE OF.PERMIT - - 'BUILDING -- • ." �� 1 {?`,UNE SETBACK CA_ST. • .. • • ' Address `s - '+' - ' '_ - ; 0 GRADING,,,�� 0 FOUNDATION -0 STRUCTURAL IDFF6 VA RO -' - - ' LICENSED CONTRACTOR DECLARATION 0 TENANT C4C CTRICAL Uia•COMBING ❑MECHANIC 9I EI• -- -- - - ---- - -- I - • - I hereby affirm that I am licensed under provisions of Charter 9 (corn- - - RIGHT. ir ' meeting with section 7000)- of Division- 3 of the Business and ❑OTHER - -1 - - - REAR YARD(TO P/C.)- ' • Professions Code, and my license Is in full force and effect. .PROJECT DESCRIPTION. _ _ _ _ _ License Class • License No. I'- PKG.SPACE-REO. PROVIDED,- Date )' Signature - - - - - 50.FT. ' i ..._ - - -- ,STREET WIDTH - -, • ".PARK•FEE-E.., • WORKERS'COMPENSATION DECLARATION- - _ 'OCCUPANCY—CONSTRUCTION TYPE _ ZONING A,PPROVED.B V- - - I DATE I hereby affirin that'•I $ave'a certificate of consent to self-insure or a VALUATION ZONE --- - - 'certificate of Workers' Compensation- Insurance;-or•a-certified copy _ _ - . _ _ - - ___ -_ thereof(Section 3800, lab: L C.). I . y GRADING CU.YDS. - ' ACRES SPECIACONDITIONS: 'FY No.• Company - _ _. __ �- _ _ _ _ ___ - • _ _ t _ ,y ertllletl copy is hereby_f urnisheif. _ T __ _ _ . REMARKS: - _ _ _ 1. - _ • _ __ ._._ _ Certified Copy is filed withtheCity Building Division. - -- _ Y 1. 'C I , Y i EXEMPTION-FROM-WORKERS' COMPENSATION-DECLARATION 1' -- ----- ' - -' - - - (This section"need not be completed if the permit is for one hundred - : ' _ ••n- '- ' - - ($100) or'less). t• . -- _ - '. - _ ._ ^ _. -__- II-certify that-In.the.performance of the work for which Is permit Is - - Issued, 1 hall not employ any person I any man r to become : PLUMBING- • PLAN'CHECK • - ' }'ELECTRICAL - - -PLAN CHECK - - subjec t Lha orkers:Compensati ws of Cal r _ - _ - _ _ Date ��jj /y Signature BATHTUBS `SFIOW ERS SO FT rvG - .. SO FT .- rQp Z� - - •SO FT SO FT toNOTICE:the !halter making this deet ration, you shout• become subject TOILETS.• f• URINALS' '-' i- _ - .lOR _0-1 to the Workers' Compensation provisions of the Labor Code,you must TRANSFORMER - forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBCE'LAVS-- +' "�- 'APPLIANCE' - ' 10.50•KW_50+KW - - - - CONSTRUCTION KIT.SINKS -.. DISHWASHERS - - - " -' ' MOTORS '-0-1 HP'_PIO-HP'-' ' _ I herebyaffirm that there is a construction lendingagency for the per- - •-- • -. . - (INC.iSOLAR - - ' - -. . -e Y ) 30•SPI'IP 50+HP -formance Of Ih0 work for which this permit is issued (Section 3097 SERVICE SINKS 1._• SUMPS"' • - _ Lender's Na -' ' ' - FLOOR SINKS ' ` FCOOR DRAINS'• -I- ' ' FIXTURES ' '-OUTLETS . -4SWITCHES" - - ' Lentler'z Name _ _ __ _ _ ' Lender's Address DRINKING FOUNTAINS" , - •-. - OWNER BUILDER DECLARATION - - • INTERCEPTORS CLARIFIERS. • 1 - 'POLE-LIGHTS '- - - -( I hereby affirm that 1 am exempt from the Contractor's License Law for - - - + the following'reason•(SectIon 7031.5-Business and-Professions Code: SWIMMING /I ,,TRAP" -" "'- 'i- 'LUN�I KV L.IMV _ Any_ city or county which requires a permit to construct, alter, T" J �� 'POLES METERED SUB -. , Improve,demolish or repair any stied file rlsrto itsatemene,also reWATER SERVICE "' ALTERATION- --' "7 •' 'PANELS- MAIN• -.t':" -' SUB - - .- , ' quires the apt Ilcant for such permit to file a signed statement that he - (Chaplicensed-pursuant-to the'provisions of t7000) tractor's-License Law GAS SERVICE OUTLETS - - ""' -;SERVICE'" -' "'-' (Chapter 9 (commencing.with Section 7000) of Division 3 of the arn Business ane'Pllegedlons Code) or that he is exempt therefrom and the -WATER HEATERS — BTU OUTPUT" -. j •."' -' j / �!. • _ - 9 BV '+ I-- for the alleged exemption. Any violation of Section 7031.5 by ' applicant for a hum permit-subjects the-applicant II penalty SEWER CONNECTIONS - --- - " 1- -' • -. " .- -- .. ' at more than fiveehundredreddollars (8500). - -- - ' pa I, as owner of the property,e+-,.., - r - SOLAR'TANK- _ -COLLECTORS' " - - -( -- , " ' - -_ rt 9�•Yw'+warrri, will.do the,work„and the structure Is not intended _ _ _ or offered for sale. (Section 7044, Business and Professions Code: The SOLAR PIPING SYS. - �_�a' ' Contractor's.Llcense LaW does not apply to an owner of a property- gppLICATION•APP ROV ED'BV - �J �0 DATE •((-Q Z who builds or improves thereon, and who does Such work himself or ISSUE FEE - T' d.00 -'`'.G.-`- through.his own employees, provided that such improvements are not _ _ _ _ _ _ _ _ _ _ _ Intended or offered for sale. If, however, the building or Improvement MECHANICAL PLAN CHECK y SUMMARY OF FEES., Is sold within One year of completion, the owner will have the burden _ _ of proving he did not build or improve for the purpose of sale). r - - *BUILDING -- - - - • - . l] I, as- owner of the property, am exclusively contracting with-. HEATING SYSTEM 0-100,000 BTU '- - !PERMIT _ E _ SMTP, -E licensed contractors to construct the AND DUCTING project e Law d e0no, applyess 100,000 ? BTU r PLAN CHECK E' PERMIT 1 , , and-Prof essions Code:-The-Contrattor -License Law does no who con- to __ _ to - ISSUANCE=E an owner of property who builds or improves thereon, and who cREFRIGERATION 0-100,000 BTU PLUMBING 8 •{ tfrom-such projects-with a contractor(s). licesned•pursuant to SYSTEM - - - - - -- I _ _ - 'GRADING_ E - j thehe Co Contractor's License Law). 100,000+BTU PLANCH ECK -E ..De_ Oe - ,-,- p E • , El lam exempt under Section --- "' - B.&P.C.for this - - - - 'ELECTRICAL E�� I BOILERS BTU reason -- - - -- - - - - -- !PLAN CHECK $ - - _ MICROFILM E SYSTEM REPAIR,ALTERATION 1 • -' 1 ' Date Owner M • ECHANICAL'E• • _ __ _TOTAL FEE E I hereby certify that I have read t application and state that the above EXHAUST SYSTEM MULTIPLE I ; • '1' LESS AD- information is correct. I .nee comply with all city and county "PLAN CHECK 8 - -- VANCE PC- $_ ' . ordinances and tate laws r- all-• o co• _truction,and hereby authorize ' .. representati ,• of this ' ty • edt/$ upon the above a boned Property •r in •ecll• Purr• s.s/ ,777/2 FINAL FEE $I/•w .. i_-/ • ✓ Date -. Drivers' License or ISSUE FEE - - - - L - • - - --• -- - _ ._ __ CMF 0865-46 White-Building; Canary-Applicant: Pink-Accounting;Goldenrod-Assessor c • rt CITY OF COSTA MESA • Ant? , 4.sion...-4. ►9e BUILDING DIVISION > y� "gen.ca DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER F 1 prat :1�+ PERMIT J'sa, eF P00-00548 (714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 2524 ELDEN AV Status: ISSUED Suite No L Applied: 10/02/2000 • Issued: 10/02/2000 Vicinity: GARAGE Parcel Nunmber: 93795003 ISSUED BY: _i4j-Z_____ Applicant: GLOVER, LORIE Address: 2737 S CRODDY Phone: (714)241-1414 SANTA ANA,CA Zip: 92704 ,\ i/d Owner: COLWICK, MARTHA K Address 2524 ELDEN AVE#L Phone: COSTA MESA, CA Zip: 92627 • Contractor: COAST ROOTER PLUMING HEATING &AIR CONDITIONING Address: 2737 S CRODDY Phone: (714)241-1414 SANTA ANA,CA Zip: 92704 License: 529127 . Arch / Eng : Address: • Phone: • " __Zip.• , Licenser - SCOPE OF PERMIT - 1 WATER HEATER CHANGE-OUT. FEE SUMMARY AMT QTY AMT QTY AMT QTY • ISSUE FEE $23.50 • Laundry Tub/Washer $0.00 0 ' ' • Sump Pump ` " $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool , , $0.00 0 Backflow Preventer', , $0.00 0 P-Trap $0.00 0 Trap Primer , $0.00 0 Bathtub - $0.00 0 Pressure Regulator $0.00 0 Urinal. -'2 $0.00 0 Clarifier System ' $0.00 0 Process Piping(per 10 ft) $0.00 0 - - Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 ' .Vacuum Brkr.Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 , ,Wash Basin y $0.00 0 Dishwasher $0.00' 0- . Sewer Cap for Demo ,$0.00 0 Wash Basin Set $0.00 0 Drain, Floor $0.00 0 Sewer Connect '$0.00 0 . Waste and Vent System $0.00 0 Drain, Rainwater $0.00 0 Sewer Private Line " $0.00 0 Water Closet(Toilet) $0.00 0 Drain, Roof $0.00 0 - Shower $0.00 0 Water Heater/vent $12.30 1 Drinking Fountain $0.00 0 "Sink,bar $0.00 0 - Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial -$0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) $0.00 0 Sink,kitchen $0.00 0 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $35.80 COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections 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)754-5626 2446-48(WOO) • DECLARATIONS 4 WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have end will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. 1E7T') I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workvi chomp nsatl Insurance carder and policy number are: Carder: I y L(cY r LIO 4/1 Policy Number: Al Di O a2 09 (This section need not be completed if the permits valued at one hundred dollars(5100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person In any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: ' 0'd—o WARNING:FAILURE T CURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES uP TO ONE HUNDRED THOUSAND DOLLARS(5100,000),IN ADDr1ON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR WOE.INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lie.it Class 0 Contractors Signature: Date: I D-a •C O CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued.(Sec.3097,Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that.under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any;city,or county-which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed stateinent that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professioe'sbode)or That he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects-the applicant toe civil penalty of not more than live hundred dollars($500).): ❑ I,as ownerof the propertyor my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or Improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ 1,as owner of the properly,am EXCLUSIVELY CONTRACTING WITH UCENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet In depth into which a person is required to descend,wit be made in connection with work authorized by this permit,and that no building structure,scaffolding.falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feel of compressed gas at standard temperature and pressure). _ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Masa Fire Department may require the preparation,certification and filing with the Fire Department of en RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If en RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this ipplicatlon apereit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes;the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to complywith all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPUANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the Information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described properly for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. 'gRe u Of Legal Owner(s) Date /a- a-OD nd/Or Authorized Applicant Date CODE t INSPECTNON TYPE OLIE INIMALS CODE( INSPECTION TYPE PATE BMW 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final • 208 Final Plumbing . 3-z-09 6nr • 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Anal Sign 222 Final Site 204 Final Demolition _ 250 Final Building/Occupancy CITY OF COSTA MESA BUILDING DIVISION 1. 1 �)g DEVELOPMENT SERVICES DEPARTMENT PERMI NUMBER 7ti !d PERMIT �-I`�"�w,ro d, 01-00635 (714)754-5273 • Fax(714)754-4856 • waw-ci.costa-mesa.BdrLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2524 ELDEN AV Status: ISSUED Suite: N Applied: 05/07/2001 Vicinity: UNITS M&N Issued: 05/07/2001 Parcel Number: 03704001.TPN-ODI 2q Zoning: Applicant: MANSFIELD, ALEX ISSUED BY: tet Address: 1447 SUNNY CREST DR Phone: (714)738-4477 FULLERTON,CA Zip: 92835 Owner: ELDEN MESA HOA Address Phone: 714-431-1155 Zip: Contractor: MANSFIELD ROOFING Address: 1447 SUNNY CREST DR Phone: (714)738-4477 FULLERTON,CA Zip: 92835 License: 580433 • • Arch : Eng: Address: Address: Phone: - Phone: Zip: License: License: SCOPE OF PERMIT:. ' REROOF UNITS M&N:110 EXISTING SHAKE ROO_F,7/1.6"O_SB SHTG,1 LAYER OF 15#FELT,APPLY 30-YEAR - "ELK"COMP SHINGLES. 32 SQUARES - FEE S UMMARY' ;' I Plan Check: $0.00 - ' ° Calc Valuation: $9,000.00 Permit: $167.25 Claim Valuation;.'- $9,000.00 SMIP Res: $0.90 _ _ SMIP Com: $0.00 j Other $0.00 - - / Inspection: $0.00. /� Total: $168.15` �� i� N ' !/, > �\ :," PLANNING 8 ZONING% / ,,j`7 i SETBACKS \ - _ MAIN STRUCTURE Front 0 0 -Rear , 0-0 Left 0-0 - Riht /79-,0 g ACCESSORY Front 0-0 _ 'Rear 0-0 Left 0-0 Right; DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the Avork for which this permit is issued. .t❑ I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My wo ers'compensation}Insurancq carrier and policy number are: l c Cartier: 0. 2 (./ Policy Number. 13/ 7✓(162 (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these p Ions. —7 Applicant Signature: ',J,�/ Date: .S77/t1/ WARNING:FMLURE TO SECURENIORKERS'COMP AnON COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE(Sioo,00i).IN ADDITION TO E COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business nd2ofessions Code,and my license is in full force and effect.Lic.0 e)•Y -3 Class# C�---.� Contractors Signature:dee / _ Date: J/0-2/O/ CONSTRUCTION LENDING AGENCY: v ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to en owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,wit be made in connection with work authorized by this permit,and that no building structure,scaffolding,faisework,or demolition or dismantling thereof,will be more than thirty-six(38)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Wilt the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions.that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does aors ❑ will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 if an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any partof the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (if yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No _._ ____ 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the Information given above Is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the Information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for Inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Slgnel�Le � Date An Or ALu zed Applicant ayn Date coDS t INSPECTION TYPE g11IE ILLS CODF I INSPECTION TYPE DATE R1lEOaLS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof �"J- c/ 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy