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HomeMy WebLinkAbout2554 ELDEN AVE - Building Permits 49��t M CITY OF COSTA MESA a frac BUILDING DIVISION > • PERMIT NUMBER .'' DEVELOPMENT SERVICES DEPARTMENT 4• " i* PERMIT P00-00122 , (714)754-5273 •• Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT • Job Address: 2554 ELDEN AV Status: ISSUED Suite No Applied: 03/10/2000 Issued: 03/10/2000 Vicinity: (� yy1� Parcel Nunmber: 93585010 ISSUED BY: (T// Applicant: LORIE GLOVER - • Address: 2737 S CRODDY - - Phone: (714)241-1414 SANTA ANA,CA Zip: 92704 Owner:. MONARCH,-IDA . " c - Address /2554 ELDEN AVE#D-103 • Phone: � 1'•II' COSTA M1;13L ESA,CA Zip: 92627 1 . L Contractor: COAST ROOTER PLUMING HEATING &AIR CONDITIONING 91‘' - Address: 2737 S CRODDY .' % 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. 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 wor�k�}r 'c`orn nsati Insurance carrier antl policy number are: A` Carrer: I I / fP� Policy Number: Rai a;or)2 07 (This section need not be completed if he perm 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 provisions. 7 Applicant Signatur � Date: 3—/ > WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES:UP TO ONE HUNDRED THOUSAND DOLLARE(S103,000),IN ADDITION TO THE C1IST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. • I LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Businesand Professions Code,and my license is in full force and effect.Lic.# ��T/ Class# C. 1 Contractor's Signature: Date: 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 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 anylapplicant for a permit sub�jef'he�appplicant to a civil penalty of not more than five hundred dollars($500).): ❑ Ihas,owne,,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 he_selcor'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 ofcompletion,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 Cade: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 pursued to.the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: _ 1 Owner ID verified by driver's license. ❑Yes ❑No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): 1• • • 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: 1 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 ❑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 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. P._._ .. required,_ Section 2 Health . .._-ty-_ ............... J............ -..........---.-....-...-.... 4 If an RMPP is presently reqhas 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 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? fJ Yes iNo (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? in Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). a ta 7 Ifa permit from the South CoastlosAir Quality Management is at or dother t pollution controln district 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...----.. a__ . oc. ..riat- er)._. -.--___... ... .. - __...._.. ...._—.._....- 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. Signature Legal Owner(s) 3 ate itetc An Or Authorized Applicant Date CODE#, INSPECTION TYPE pAT[ INTITIALS CODES INSPECTION TYPE [PATE 1NTITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1 1266 Pool Spa Final 208 Final Plumbing 3-a 6`c�S 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 2446-46 ztitill-P-Cx- CITY OF COSTA MESA .0-ma BUILDING DIVISION ti DEVELOPMENT SERVICES DEPARTMENT -'{ _ PERMIT PERMIT IJIBER E98-00919 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 2554 ELDEN AV Status: ISSUED Suite No Applied: 08/28/1998 Vicinity: Issued: 08/28/1998 Parcel Nunmber: 93585001 Applicant: LEE BURKS Address: _ -- - - _�Phone • _ _ �. /`! - Zip Owner QUAID,.GREGORY S // ! (\/ � -A Address OUAID�PAULETTE Y 2> -_,,,,,-..„<„.1-,- - C V , �� .\� COSTA MESA:CA 7/777,..c.7"1,-la"..-----"Phone: - '� C� n/2554 ELDEN AVE UNR A704 Zip 92627 \i _ :_ i!Contractor \-7, \, %\ . \ • /Address:%% �� I- /,`dI 7 // Phonei \ � . V \ `. , i. >. /� 'S\ SCOPE OF PERMIT 7 �'� T I \\ ,, STATE HEALTH'S.SAFETY CODE SECTION 116049.1 PUBLIC POOL INSPECTION. v, \ Z i t r. ems. I '' . /I.\1 :: v A1 - ]'.. + - FEE SUMMARY __ ' 'Quantity .AmA/ Quantity ' _ ' ISSUE FEE - - r. $22.00 -% .7 �`', -Temp.Dist System/Lighting,/ $0.00 0 ,, , • Temp service test $0.00 '-'1."‘ - '-�"�- \Busway 1100 ft/ -' \ - ' $0.00 0 Res:a/c package $0.00 s = -- ____' Standing Section - ' $0.00 0 , r' New Res-(1-2 units), $0.00 0 Misc Electrical Equipment $0.00 0'. ' New Res.(3+units)" i‘ $0.00 . 0 Transformers,up to 1 kva/kw -- $0.00 0' . - ? ' Pool/Spa\ $0.00 0 '- yup to_10-kkva/kw $0.00 j0 /- Lighting Fixts • `A1 $0.00 0 up to 50 kva/kw $0.00 4 0' ) - Recept Outlets V-\\-$1.00 1 i, up to 100 kva/kw $0.00 7;147'50 ' . i/ Switches .. - \\\$0.00 0 '` • over 100 kva/kw $0.001 ' 0 Non Res Appl V Ay$0.00 0 r':.,(>' - Low Voltage Equipment 1$0.00/% 0 Res Appl V. $0.00 0 \ P �, Low Volt Wiring System/Ckt $0 00 0' - Service to 200a $0.00 . 0 '�'' w.. Mise.Conduit's \ �� t - $0.00 0 Service to 1000a $0.00 _ ` 0 r ' / Misc,Conductor,, - X $000/; 0 Service over 1000a , x'$0.00 A� 0 • - Circus(gen or nde) ,L./.-5,:7-,'," $0.00 \/.,/,) 0 ,r Motors to 1hp v , $0.00 �0 -,A� I :1 i ' Circus(meth ndeeor lights) „ $0.00 `/0� Motors to lOhp ` . w $0.00 �' 0 Christmas TreeStand �( $000' /0// Motors to 50hp '-.c ` $0.00, ,-/ 0 _ Fireworks Stand-- '< �'• $0.00 /' -0 Motors to 100hp .$0.00 !0^` .. Other Electrical Fee '`\, $000 " T Motors over 100hp � �-; Communication drops $0.60 0 : / Inveshgatwn Fee $0.00 Sub panel to 200a $0.00 ;0. _ '- 1_/ AyPlan Check Fee"s ,_77:;:.:i6:66- ,_ $0.00 Pole Light Pkg $0.00 - .0 - - - -, .ReinspectionFee�;' $0.00 Sign Circuits $0.00 0 k _;��. Temp Pwr Pole $0.00 0 ' - - TOTAL CALCULATED FEES $23.00 Intermed Pole $0.00 0 COMMENTS/SPECIAL CONDITIONS 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 finalapprovalwill result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 DECLARATIONS • WORKERS'COMPENSATION DECLARATION: I 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 Insurance carrier and policy number are: Carrier: Policy Number: (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 provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL.PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEYS 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.Lk.N Class N Contractor's Signature: Date: 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 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 fwe 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 exem t uncle sec. Business and Professions Code for this rea Signature: j > �I� Llii4C7 Date: 9 —a sr— 9#9 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 Safely Code requires,with some exceptions,that a Business Plan be filed with the Costa Mese 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 en 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 agpermit 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 fumished 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. 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 penally of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Em s. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penally of perjury that I have read this application and state that the information given is correct.I agree to comply with ell 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. �A��1[/_-$ual QJ)Nner(s) Date 8 - a And/Or Authorized Applicant Data gg=E_L I85EEOLOMM OAR IKONS COGS I INSPECTION TYPE GATE INIMALZ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1288 Pool Spa Final 208 Final Plumbing p� 200 Final Re-Roof 210 Final Electrical S/SIRS' f r 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 2446-46 a�*'t'l'%.; CITY OF COSTA MESA .` oyer, BUILDING DIVISION lib: ...„7....;;..: DEVELOPMENT SERVICES DEPARTMENT E98-00713 PERMIT PERMIT NUMBER (714)754'5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT n Job Address: 2554 ELDEN AV Status: ISSUED 0 Suite No Applied: 07/07/1998 • Vicinity: Issued: 07/07/1998 Parcel Nunmber. 93585001 Applicant: MCEVILLY, LEO Address: Phone: 714-692-8700 - -}( j 1- �_�\ � r i�/X-1.i AI 1 �� Owner: QUAID, GREGORY-S� 1 �v \�\ Address QUAID;PAULETTE Y -Th 11 14 COSTA'MESA,CA\�� "Phona:_�_= J /�\ /2/5514S-ELDEN AVE UNIT•A1Zip:-"92627 - V� ) •�� i/14( \\:/- - Address: \ !C _ •:License �� -� V0\VA - �` ik/ 1 C�/Iiiii r-, 111/-r9 1 ' _.�. x'15, Win. • 1 ?>,1 it �. (IV/ 1 - � -I p I���r 1 /,1 (/ j , 7T��SCOPE OF PERMIT " ��� /r 'INSTALL-75000 BTU FURNACE AND 3TON NC ADDON, 1 MOTOR 1.1 TO 10:0 HP. < ' - 1 • � �1 \ ll/• A• \\> \\! �'I('_� �1 q�, FEESUMMARY ) c 6___17 ,er i �I \ J� � , Cv 1. I In,,a.�IR,k,1 .5 I JiSstr l I , n 1 ,i LQu 'itlty __ ___ -._= Quantity ISSUE FEE ') $22.00 Temp Dist System�LLighting r $0.00 0, Temp service test"'1 $0.00 \ re^ Busway/100 ft / Resp a/c package 1���•)"t, $0.00 i L Ju�`,7��Stantlmg"Section'����� �i $0.00 0 4 :,�' New Res,(1=2 units) 4, -.• $0.00 --0-- :----- -Misc Electical,Egwpment - $0.00 0 i rtr New Res(3-units)-1 ,';'',] $0.00 ', es---- ' -L-Trensforners upto t kva/kw $0.00 0 ` / ,/ ' ,' ' Pool/'Spa t .� $0.00 0 tip to/10 kva/kw 1 $0.00 0'�; ' ,`�-__ ,Ib / Lighting Fiats- \:,, $0.00 0 Snip to_50 kva/kw '-$0.00 0��4/ ' 1". / Recept Outlets - $0.00 0 -up.to:100 kva/kw :$0.00 01/ ,. /L r Switches��� `\ �\ V`V'\ $0.00 0 over 100 kva/kw $0.00 �/i0_/ / ' / Vit,' Non Res A I "- i $0.00 0 Low Volta e Equipment $0.00 /y 0 \ i Res Appi \\ \\$0.00 , 0 i,Low Volt Wiring System/Ckt $0.00 0 �' Service to 200x. x$0.00 0 4 � �Mis;.Conduft. $0.00 0,-/" ��, Service to Service overr1100 0a. i$0.0�`'-.. 0' r, -',V7 oCircu(gen o�ide), "Se 0.00 0 � i�?// Motors to i hp �, //,=$0.00A\\;0 e� Q o - Grans(meth ide or'Iights) ,-2,7$0.00.'/'' 0 /r��' - Motors to 50hp Motors to 10hp \�� x50.00,-;;;„ '0\-\` �U l ��Firew rks Sta ristrilas dStand �� $0.00 0 %�/7 Motors to 100hp $0.00 \0 - �T<-)Other Electrical Fee= .\A $0.00- �,, Motors over 100hp ;$0.00J r/0� - -'- . A, <� %./ Communication drops $0.00 *_'-i 0i r Investigation.Fee -, ' `)" $0,00! • DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: • . I ❑ I have and will maintain a certificate of consent to sell-Insure for workerscompensation,as provided for by section 3700 of the Labor Code,for the performance of the wo for which this permit Ls 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 worke ' mpens't(L In nce carder god policy number are: /7 6-6S--a J Cartier: �/L /Y� � 7,-9 Policy Number. Alike.3 (This section need not be completed U the permit Is 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' 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 sons. �� Applicant Signature: Q' Xh' 99 7 ^Date: / ( WARNING:FMLURE TO SECURE WORKERS'COMPENSATION COVEPM3E IS UNLAWFUL MD SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES MID CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS(5100,000),IN ADDRMON TO THE COST OFCOMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR 000E,INTEREST,AND ATTORNEY'S FEES. UCENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under rq sionsof Chapter 9(commencing with Section 7000)of Division 3 of the Business e d Pro Ions Code,and my license is in full force and effect.Lk.# no 7 Li Class# � Contractor's Signature: t -- Date: — �—`1r� 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). Landers 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 Tor 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 DMsion 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 live 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 Lew 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 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 ❑ I hereby certify that no excavation five(5)or more feel 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,faisework,or demolition or dismantling thereof,Mil 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 DMsion 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 ❑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). I 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 compiled 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 pplication a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district 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). 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 i 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? ❑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. nature Of Legal Owner(s) • ( And/Or prized Applicant I Da e • WOE M 5NPECTION TYPF USE MMUS jai INSPECTWN TYPE DALE 2013 1616 Fixed System Final Fire Prevention 208 Final Mechanical – 1266- Pool Spa-Final - 208 Final Plumbing , 200 Final Re-Roof 210 Final Electrical I 1/615Y RAW 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 2446-46 -`ti'i11.! CITY OF COSTA MESA �`" k BUILDING DIVISION ti�i "�•..1 : DEVELOPMENT SERVICES DEPARTMENT M98-00293 PERMIT PERMIT NUMBER nse • (714)754-5273 • Fax(714)754.4656 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT . Job Address: 2554 ELDEN AV Status: ISSUED 0 Suite No Applied: 07/07/1998 Issued: 07/07/1998 Vicinity: Parcel Nunmber. 93585001 Applicant MCEVILLY, LEO Address: __ _ _ ��,,Phone:-x714-692-8700::_,�\ ���j��!;l Zip., •I ,' 1 ' Owner: QUAID,.GREGORY-S \ t ' i -• ' " V � iw v �Th L ! l: � 1..-------. ..,,,,N, � \--_-,....„,,,Address: QUAID,PAULETTE Y / //iii _ �/ / COSTA'MESA,CA ''- "Phone:_��""-���-- -\ ti /1` / /EDEN AVE UN�A �/ -sem" Zip: 92627~ � �/ / �\ , Addres:Attie Phone: AC � NN „,/, \ <_/ \-,. � Zip: I *n�, A v�v ?� License ,� I t F \,' v, �,1 \� '�, A.'chIEn171 , - �,�Adare •g:j ����J � ,- =� A? ,' y` � kr �J ���' , 111 l - ' -\�Phboe: ' "-"`/ r 1, �r l �� �w.- � � l ,_ --:'-:--P___--.1------ Zip. I r�� , ` t 1 N �Y1 . License: . li"(<' / =-SCOP-EOF-PERMIT'---=___--- C • �a X11 ,�,:V)' /INSTALL 75000-BTU FURNACE AND 3TON A/CIADOON,C1 MOTOR/.LTO 10.0 HP. ( I f -, r ., �,1p vu a IL_� , ii'-i,.A.,- f ICS A jl AC;'i , �\ r FEE SUMMARY /�}'� / �, t� � .A \ i 1t�L' '',Quantity a (,-v 1.-..,(40'/S:};r'-.n1 Quantity ISSUEFEE) \``1i 1.1 $22.00 i� r• Repair/All Absorbtion Unit , $0.00 0 l 1'- - InstFAU<100 k.BTU �,AA^�: $13.25 ; - Repair,/ Refrigeration Unit j ,, $0.00 '0 i� Inst FAU>100 k BTU \'\.n $0.00 i Ve t llation System it $0.00.? 0, 1r RepairAlt Cooling/Heat, \', $0.00' 0 Evaporative,Cooler ` _$0.00 0 .� � l % /" - -/ Inst/Rep.Recess Wall Htr '1 $0.00 0 Commercial.lncinerator 7i'// / $0.00 0'', Refrig Sys<100 k BTU� '\A\ 513.25 1 . Domestic Incinerator ; �� A x$0.00 r0 / Refrig Sys>100� k BTU/ \\,' $0.00 0 Compressors I Absorption Systems `� / /�,. / Gas PipingV'�A\ \--- \A' $0.00 0 ��1 P��,(�'� Up,to 3 hp/100 k BTU $0.00' '0 Factory Fireplace �, A $0.00 0 ��"�51 nctl' 3;To.15'hp 1500 kBTU �� -i $0.00�i 0 Hood w/Mech�Exhaust 50.00 0 �0/ Q ?15 To 30 hp/1,000 k BTU.././4-/� /-v" 50,00/ 0 VAV Box \\�. ,, `$0 00' 0". ,---,‘;•'7"--i-` �,v30 To 50 hp'/1,750 k BTU,:- $0.00 0 Vent Fan/Single"Duct // $0.00?'`0 �, U ���R o- �,`Over 50 hp/.O er 1 750 BTU /„v $0.00 0 Appliance c <, �/__ �0 �r• 0 ,, Up l0 3 hp�i L ��j ^V) ' / ,;ii,$0.00 0 Fire Dampers v _ / . / \�~.� v Smoke Dampers $0.00 0 --•3 To 15 hp : � - v (<- C /// $0.00 0 Inst or Relocate Appl Vent $0.00" 0 . - 15 to 30 hp ,., AV"--/ /'" $0.00 0 Air Handlers< 10000cfm `, C) ' p. \ i.,/ $0.00 0 . ��.$O.00�iO , 30 to 50h �` A�1� Air Handlers> 10000cfm `-C$0.00 O/\c/�' G3 ET)r;'Over 50 hp-i yA„ �jf� $0.00 0 Floor Furnace $0,66:-.---.9 't 1 i , i I -Other Mechanical Fee.�.,,,,--A „- Floor or Suspend Heater $0.00 ;0 .. ' .• Investigation Fee ''' $0.00 `--'` -",.-••-- Plan CheckFee - $0.00 -� --;�=r- 'Reinspection Fee $0.00 TOTAL CALCULATED FEES $48.50 ' COMMENTS/SPECIAL CONDITIONS • 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 , DECLARATIONS WORKERS'COMPENSATION DECLARATION: _ I hereby affirm under penally of perjury one of the following declarations: i ❑ 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. fYThave 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 works 'corn en ation I surence carder an policy number ere: ��/ .319°.. t c ) Carder: 7iY� Policy Number: (This section need not be completed If the permit Is valued et one hundred dollars(8100)or less) ❑ I certify that In the performance of the work for which this permit Is issued, I shell not employ any person in any manner so es 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 proviso s. /1 � 5 -e4–Applicanl Signature: C7 " �"r.67Date: -2'— /7 r� / WARNING:FAILURE TO SECURE WORKERS'COMPENSATIOy`rVERADE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100.000),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 liconse�, y%.pro lsiglLs of apter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full lace and effect.Uc.# -- (C�p 11 Class# C dO Contractor's Signature: _ =nu e... 4! Date: ��- -9,k-- 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 UCENSE 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.My 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 wit have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the properly, 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 sac. _ 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 fromthe 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 Flre 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 Callfomia 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 a plication apermit for such construction or modification from the South Coast Air Duality 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(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 COMPUANCE: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. _c S cure Legal Qwner(8) at 1517-11 And/Or A zed Applicant7 - �nt Date - =DLL DlwnemON TYPF DAIS =ALS VODE I INSPECTION TYPF DALE . INUBASS t , 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1–9_'48 ESN/ • 1268 ' Pool Spa Final ' ' 208 -Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final BlocdRetaining Wall 212 Final Are Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign - 222 Final Site r . , 204 Final Demolition250 Final Building/Occupancy 2446.48 4 ADDRESS OiBEMO 2554 ELDEN AV UMT: CITY OF COSTA MESA — BUILDING PERMIT *AYNERS NAME IFIOpWN:CEDAR GLEN H.O.A. ,"PERM NO: B 077964 m s 2554 ELDEN AV PERMIT NO: B 077964 PLAN CHECK NO: 02185-96 L GOVT; N SUPP : N :OSTA MESA,CA 92627646-7068 APPL.MAIUNG ADDRESS: CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: ADD ARCHITECT OREf EER: UC NO.: JOB DESCRIPTION : 334 LIN FT OF 6 ' HIGH BLOCK WALL SQ FT: 334 ARCH.OR ENDS ADDRESS: OMT: CLAIM VALUE: 10, 000 . 00 •CALC—VALUE: 6, 680 . 00 GROUP OCC: R-1 / CONTRACTOR'S NAME: CCTRACTORS MARINO COMMENTS : 6 FT HIGH CMU WALLS TO REPLACE WOOD FENCES ADORES& lit NO.: ******************************************************************************* um ZONING REQUIREMENTS UCENSED CONTRACTORS DECLARATION:I hereby Slim under penaly of perjury that I am licensed under provision,of Chapter 9 SETBACKS (commencing with Section 7000)of Division D Of the Business and Professions Code,and my license is in lull force and Sled, • CITY LIC.NO.: UC.CLASS: LIC.NO.: EXP: MAIN BUILDING ACCESSORY BUILDING Ode: cadreda: FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN OWNER BUILDER DECLARATION:I hereby affirm under penalty of perjury that I am exempt from the Contrail=License Law for the ' flowing reason(Section 7031.5B.oiwaeandProfessions Coda:Any cry«opuntyxhichrequires apenes tocon,bud,atter,improve, PARKING REQ PROV: PARCEL : 00000000 ZNE: R2—H REF NO: 4radishr vdpursuanttotheprepak any re,pliOr to its oviiwsolthscontr.mUce.eLawj altrequires the haptrae(msuch mmeenncinggrmit tmifhSedum statement 0O oDe.�ion3d°n: PLANNING NOTES> CONSTRUCT 6 ' HIGH BLOCK WALLS 86 ' LONG ALONG BLDG. "A"c AND Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section > 183 ' LONG AONG B LD G S "D"6"E" i 7031.5 ty any appkcan for a perms aubjedi the°pelican)to a chat penalty of not more than fire hundred dollars($5001). ***********se*****se******#******se**********************#**k**Sic******** ********* ❑ 1,as owner of the pnpenyor my employees well wages as their sole compensation,will do the work,and the structure is not intended D E V E L O P M E N T SERVICES R E Q U I R E M E N T S or offered f«sale(Section 1044,Business and Professes Code:The Contractors license Law does not apply to en owner of properly Q who bunds or improves thereon.and who does suC.work himself or herself or through his or her own employees,provided that such - improvementsae not intendedoroffeiedforsale:Chowever.the building ZONING APPROVED BY ��4-n C) , DATE: --,„ / ' 9,6 ownerbuidar wet d have the burden proving ha or she did not or improve for the purpose eek). 1..1 I,as owner of the properly.am exclusively aatradkq cosh licensed contractors to construct the project(Sedan 7044,Busirn®a and ,,,, II Y�.ja� ��f,, �/ Professions Code:The Cadradm License Law does not apply to an owner of moony who bads or knprovee thereon and who BUILDING APPROVED BY : W IJd.J DATE: .(� contracts for such projects with a conUador(s)licensed pursuant to the Contred«s License Law). '/ ❑ Iamaemq under Section: f B.aP.c.,romisr�ea,��:�� 0Q' APPLICATION ISSUED BY: DATE: S;3/- 9 a St4J-7,, *********************************************�E ****�E********�E****4(-* *�E�E�E Af*�E one: S 31 x1 /. owns LEGALIZATION: N F E E SUMMARY STRUCTURAL SEGMENT:Y I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505.pccnn,and 25534,pardmam norny modfcitiing rwntheAtwin/wRna Lgme«n)nee.R Reddenlid construction ions therequirements these for BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING apermttnd that'or an«moeifiWiinoccuMAr u�y ote(rm°oei)nee d to iodniel with said codes en the remgemmlMea 7 provision,. PERMIT 124 . 75 . 67 Dae: Applicant: )A SM I P/NON—RES PLAN WORKER'S COMPENSATION DECLARATION:I hereby affirm under penaltyper'ryry one the owing declarations: ISSUE FEE 81 . 0 9 d d wowing o Ihave end ail maintain acertificate dconsent tosell-insure for workers'compensatn,eapori iodedf«bySection37ODdtbsLabor BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL „ PAID DUE Code,for the p.normanceathe work for which this permit is issued. TOTALS 125 . 42 0 . 00 81 . 09 206 . 51 206 . 51 . 00 ❑ I have and wt on maintain workers'compensation insurance,as required by Seat3700 of the Labor Code,for the performance d the l work for which this perms is Sued.My workers'compensation insurance carrier end policy number are: Carrier: REVENUE DIVISION TOTALS--> COLLECTED : 206 . 51 OVER/SHORT: . 00 Policy Number: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT . GRADING PLAN—CHECK (This section need not be completed f the permit is for see hundred Mars(Slog or leas.) 124 . 75 . 67/ , 81 . 09 No I catty that in the performance d the work for which this permit is issued,I Nell not employ any person in any manner so as to become subject to the workers'compensation laws of '\l Cantona,and agree that f I should bane°ubjed to tet workers' ******************************* b******************************* **************** compensation provisions of Salo3700 of the Labor Code. colt "° mmpry"- tro.°ieri'ipn' IND I VIDUAL F E E BR EAKDOWN Dire: i—".31 - C/ APPlira4 #2 .4'1 ) ] Warning:Failure to secure woraera'compensation coverage Its unlawful and shall subject an employer to smmnel penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST civil fines to to one hundred fhoussld dollars(dfa4000A In addith m to the cal of comp rsnUon,demean as Provided for In Section 3106 of the Labor code,Interest,and attorney's lea SFR 334 RES—CONCRETE BLOCK WALL / FT. 20 . 00 6, 680 . 00 CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty of perjury that there is a construction lending agency for the END OF FEES performance of the work for which the perms is issued(Section 3097,CN.C). i't/ LENDER'S NAME: LENDER'S ADDRESS: r IcNiy that l have read this spoliate and date that the above information n coned.l agree to comply with all city and cuntyordinances j•v'� and state laws relating to building construction and hereby authorize representatkee of this city to enter upon the above'mentioned property r. for inspection purposes. II' J LEE BURKS j ljare Data: S 3/ 9 ••/,Signatured Qnwr!AgentfApplra uCannad« • (5151d13.WP) White-Buioiq 8 Salary:Green-Fit Carry-Appkcant:Pink-Revenue:Goldenrod-Assessor • POt._ a SPA CONSTRUCTION AND PLANNING 4 APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Poie 52. Pool & Equipment Location r 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 7 54. Forms 4: Electrical Conduit-Undrgrnd. 155. Electrical Bonding 5. Steel Reinforcement O- / (y I-� �('(� r�l./�( 56. Rough Plumbing & Pressure Test. . 6, Electrical UF ER Grnd. 1 - 57. APPROVAL TO COVE R-GUNITE 7. Footings (•-,(O -- lb W1, 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test i 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63, Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical•Final 15. Rough Electrical-Conduit - 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-7 Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace •• APPROVALS Permit# 21. Ducts,in Structure • - - 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas OOil 23. Gas Pipe-Rough& Test - 72. Underground Flush 24. Roof Framing - - 73. Undergrnd.StorageTank-O Gas ❑Oil 25: Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat - 75. Dry Chemical - 27. Frame and Flashing - - 76. Dry Standpipe 28. Lathing&Siding - 77. FIXED SYSTEM FINAL' 29. Insulation 78: FIRE PREV. FINAL . 30. Drywall Nailing - HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED {IL 33. Final Electric Notes: _ 34. Final Heating& Air'Conditioning - • , 35. Final Gas Pipe-Test 36. Hood or Canopy , • , 37. Final Factory Fireplace_, i, , 38. Final Plumbing -. - 39. Water Service-Final • - •' . 40. Gas Service-Final -- 41. Solar Domestic-Final " 42. Backflow Preventer / 43. Backflow Irrigation . 4 17-767 6� n!�[_ pat�� - 44. Landscape Irrigation System - - _ - be-1, 45. Sound Attenuation - • 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 7-3-t ' 6 4Z---, 48. FINAL PLANNING , - _ 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No Date I 1DDREssweMLOWC: 2554 ELDEN AV Wit CITY OF COSTA MESA - BUILDING PERMIT ONNERstwawmank CEDAR GLEN HOMEOWNERS PERM NO: B 071618 i's" ADDRESS ASSOCIATION 2554 ELDEN AVA-101 PERMIT NO: B 071618 PLAN CHECK NO: 01056-95 S GOVT; N SUPP : N COSTA MESA, CA 92627 ( 714 ) 646-7068 APDL.MINING ADDRESS CONSTRUCTION TYPE: V-N PERMIT TYPE: STR PURPOSE: OTH ARCHITECT ON ENGrIIEER: IX.NO.: JOB DESCRIPTION : REPLACE WOOD FENCE W/6 'HIGH MASONRY WALL SQ FT: 312 • ARCH.OR ENDS ADDRESS: WIT: CLAIM VALUE: CALC-VALUE: 6, 240 . 00 GROUP OCC: R-1 / CONTRACTORS NAME CONTRACTORS"RUNS COMMENTS: 312 LIN FT OF RCMU WALL @ 6 ' HIGH TO REPLACE OLD WOOD FENCING ADDRESS IID NO.: ********************************iflf***lEffififiEiffflflEiFiEi(•iflFifitMlfieiEiR✓'f MiEiliFi4ltitifillFlFifififififif*** MIT: ZONING REQUIREMENTS LICENSED COMPACTORS DECLARATION:t hereby affirm under penalty of perjury Ow I em licensed under provisions d Chapter 0 SETBACKS (commencing with Section 7000)d Divaun 9 of the Busmen and Professions Code.end my license is in full force end effect. CITY UC.NO.: UC, LASS: UC.NO.: EXP : MAIN BUILDING ACCESSORY BUILDING FRNT; FT IN REAR: FT IN FRNT: FT IN REAR: FT IN Dale: OontlBtlor LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN OWNER BUILDER DECLARATION:I hereby affirm under penally of perjury that I am examp'from the Connectors License Law for the reasonAnyrequires PARKING REQ: PROV: PARCEL : 93585002 ZNE: R2 REF NO: modish.or repes any suudure.prior to is issuance.also requires the applicant for such permit to Be anions]statement Nat he or she lioarsed pursuantto the provisions d the Contractors License Law[Chapter9(comrencig with7000)o DHuion3 of Ihe PLANNING NOTES> REPLACE EXISTING WOOD FENCE WITH 6 ' HIGH BLOCK WALL ALONG FR Business and Professions Code]«that Ma she is exempt'herefrotn end the basis l«the alleged exemption.My violation d Section > ONT AND DIVIDING UNITS ( 5 ' FRONT SETBACK PRIOR VARIANCE) 7031.5 by any applicant for a permit subjects the applicant foe evil penalty of not mote than free hundred dolma ES 5000. ******************************************************************************* ❑ I,as owner of the propend or my employees with wages as thei sole compensation.wen do the work,end theelnrmun is fid intended DEVELOPMENTSERVICES R E U I R E M E N' T S or offered for saki(Section 7044,Business and Professions Code:The Contractors License Law does not apply to en owner of progeny Q who builds or improves thereon,and who does such work himself or hereellar through his or her own employees provided that such improyemern are not intended or offered for sale.e,howevenf u r,the building inprovemesold withins ayear d completion,the ZONING APPROVED BY cit. vownerbuilder win have the burden d proving he or she did rat buildor improve f«the purpose of sale/. DATE; LQJ, L n owisr d the propend,em exclusively contracting with licensed mntrmtors to construct the project(Semon 7044,Business ens BUILDING APPROVED BY Professions Code:The Contractors Linder nLew does nal apply to an owner of y who builds or improves thereon end who : DATE: contracts for such projects with a catratl a L)liceroed pitmen to the Contractors rs LaceLicense Law). r ❑ lameemgdeSection: B.AP.C..for this reason: APPLICATION ISSUED BY: • --- 3DATE: Dale: •-, pr f/ " .{ % 0} - / rr Owner. R:**************#IE********M** :::***ill***************4**MM*** * * ill 1f** LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT;Y I do hereby certify that I run aware of and understand the requirements of Cdtornia Health and Safety Code Sections 25505,px5nr.end a353sand thell«ionormre WiMingomthahe Aw'uakyna(dmb«w)needroideMWly wconstndstmamdeerne erhe e sor BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE: ' SMIP/RES GRADING 2pertfooatIoran«moeibuiliin occupant Guill/ itManagement e)nee to comply oih said site codes an t exemptemnthese provisions. PERMIT 90 . 00 62 •— Date: 3-a ({-995— Applicant /Byr .o) PLAN 58 . 50 SMIP/NON-RES WORKER'S COMPENSATION DECLARATION:I hereby Slum under penalty of sedan/one of the following detler*ios: ISSUE FEE ❑ Ihave and wilmananacertiicateof cement losesoinsure for workers'mmp aiosnprovldedforbySe on3700afMLabor BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL - PAID DUE Code.for the performance dthe work for which IN,pemrt is issued, TOTALS----> 90 . 62 0 . 00 58 . 50 149 . 12 ' 149 . 12 . 00 ❑ I have and will maimmM workers'anpereaton insurance.es required by Sedan 3700 d the Labor'Code,for the performance of the w«kf«wnhtnmpst: mamw issued.my and are: Cat: REVENUE DIVISION TOTALS--> COLLECTED: 149 . 12 OVER/SHORT: . 00 Policy Number. BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK (Tlu's section need not be completed i the pare is A>,one hundred dollars(SIM«len) 90 . 00 f . 62 58 . 50 ❑ i arty the'in the perlormence of the work for which Oils per)is issued,I shall nor employ any person in any manner so a to become subjed'o the workers'mnpensaion laws of California,and agree Nat if I should barons subject to the workers' ******************************************************************************* compensation provisions of Section 3700 of the Labor Cods.I shall forthwith comp/itoe prMabv. INDIVIDUAL F E E BREAKDOWN ClamClam ,Z-2/T/ - 9.5-- Appian: *et. Waning Failure fuss compensation coverage Is untieM.and shall tabled an employer tocrmlMl penaltles and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST civil tines op to one hundred thousand dollars(310R00oA N addition to the cost of compensation.damages as provided ler In Secsn3706 of Ne Labor Code,Interest.and SNomeya feet SFR 312 RES-CONCRETE BLOCK WALL / FT. 20 . 00 6, 240 . 00 CONSTRUCTION LENDING AGENCY: I hereby affirm under penally of perjury that then is a constriction lending regency for Ne END OF FEES performance of the work for which this permit is issued(Sedan 3097,CM.C). LENDER'S NAME LENDER'S ADDRESS: I minify that I have read this application and state that the above information is Donect l agree to comply with all oty and county ordinances and state lam miming to building constriction and hereby authorize representatives of this day to enter upon the ebove'me tioned property for inspection purposes. • .L , /P4 .t ks Prot app Date: 13 - 4 -96— Signature d Ownauegan/Appleandaontredor 0100178674-00178676 TOT b4c.,; (5151.46.WP) White-Mac 8 Spey Germ-Rh:Canary-Appicant:Pink-Revenue:Goldenrod-Meese DATE: 02/24/95 TIME: 14:49 POC. . SPA -•-•-....... CONSTRUCTION AND PLANNING - _,�AP OVALS Permit# ( Date Inspector APPROVALS .Permit # Date Inspector 1. Temporary Electrical Service or Pole '' 52. P41 & Equipment LocationlIti 2. SoJI Pipe-Undrgrnd. c11 53. Steel Reinforcement a 1- . 3.•Electrical Conduit Utility-Undrgrnd. ' 54. Fgrms I �• ey "0,:`Electrical Conduit-Undrgrnd. - co 55. Electrical Bonding N - :'Y / 'nkli-SleRI Reinforcement ''jio-Vs (pw 56. Rough Plumbing & Pressure Test ` :, _ =•"6:._klectrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 'L "'• -•.r,T:,,Footings -LO-151CoU 58. Electrical Conduit-Undrgrnd. r- l 8,•:Foundation 59. Gas Pipe, 0 Undrgrnd.,Test 1/47 rl 9...1M-ter Pipe-Undrgrnd. 4; 60. Backwash Lines,P-Trap, O>lithdrgrnd. :10. Stfuctural Floor System 61. A/PROVAL TO DECK )0:: =11. Property Sewer Line & House Connection 4; 62. Ba.akwash & Receptor-Finn -4e, 12. Sewer Cap 63. He'Ater & Vent-Final 4,1 13. F1134 Drains - 64. eiumbing System - Final ,,f 14. Rough Plumbing M 65. Electrical-Final i 15. Rough Electrical-Conduit C 66. Solar System-Final ' .n 16. Rough Electric Wiring 67. Fencing & Access Approval y 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 2 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL I- 19. Rough Heating & Air Conditioning IT Fricti4 DIEPT. REQUIRREMEN Cu M n . 7 n n*c m'••1 r..tt• rt rn m t « oC • 20.1o fgtoiFRtlace gni Xr O2 b T, APPYOA\tVnig., Prmit # sc. • tri,.. s "1 .... f . V 21.:Ouc&s,irtztrt-ttucut •••• t4S nr 1S C tn-i•Lc• •o- 70 'Undeihcrid Fj;'dro n '- It• DTi rt %< CJS '% S 4* -- '1'ci1, t�ttg 22. Duc , V1tiin '# CJ d O F* 71. ProdtPmgas ]Oil NM If l4- H N t- t•( • I s. V .• CO 23."a3ast$ipeJRoygn&TMest tiS * L*] C 05 i- 72. Undergto" thd FuTh14 S F LU O r :-3 --:w •^r o:C o , t« . ,_...• .. �,. 24,oRooTPrinting' w0 ItFF 111 #D O a HX#t ' 4 Undergr' d.Sttj`Lttr T,anCtOGas [Mil F•• U k 11,1 .F Is) 1 G 4114 r` V V .-,r•..+ ' 1 25. Roof.;Sheathin9 `1# . +' rn �7 y N# 74tcOve ead Hydr�d,F w - I 26.'r-Ba"i1 Ceiling (Strlic ura11 &iC4'�{,}{roat G D# m C ((cryLn 7 Dr Che oical n ti t7 a « « SS th S n O 71 C7 A riG 10 _,.;3. 'Etc.) rr m u m '1 -15 to S 6.0 a (iso. F tt. S4 .� m :I 27. rar9e agd Flashipg# Daa y n CS' 71 con 76. Dry Stat7dpipeFtri n tr. , a1 28.yLatfing: SidingOnrn •1c�•J:' ans>XS •• •• ••# 7�+ FIXEDFS��,,••STE�,•ta'FINPL O :, Mn t70.'F Ott1,74 �r "7 F•L. ..fYJ' t-t n II •1 G, #U M ^ •• .� * Ill J I u t 29. Insulation CO S ••:4 :- V 78:. FIRE PREV. F9N_AL #> x a tt' 30. Drywall,Klailing �rt f+ 1 N -iia F I I Sc ALTA DEP -REQUI MENT U 31. Plaster 8*ywQ'coagcs I r+tr' rl-+# I 144 t N. FINAL p r'EC7tt,ON .t to : 32. Iectrical_Pov r M CerF yal I1 tJ• '5*Y[ N is L' 801 FOOD CERTIFaCATE (SSUE� n , 1 / t 'j �' F' 1 * I tr'3 7_u M ✓ J R P --71(.. a iC 33.�Fin IEl� triol, �# th I O * I Dotes: y •']t'1 # '1 o M L( i. t:: V. � n .. tt 34.(Einal:Heatingg't AIr:Conl3itionit11j (tU �# 1 `yF,*.,` tC .i C1x a S ,�.•tC t• til �� _ fc h'1 to U* ',7 I Rr It M I t.-.< TF '7 y 35..Final'Ga�Pip' Tent n 01a 'yM # ri I i F cl et tlN * t* nuDi . .0 4 a - P� •I "- :-1 t: 36. Hood,or•Canopy [J# al"; 1 tit; an LS n a x Ifni S m n te m x• ;*I ft n I WM tut?' •• x< 0.* til X Xc M M . - r1 1� H t t*' 1,2-,„x * -- 2 (1 xt m j 37.�ina(•Faory Firgp ace x IFF *'# _ ]C N I t w v•. .. .. r.-'..: ... GI 3 -fr. :'• . -1 38.cEinaiPlu•mbing # N I OH 05 I h S 4 H # tri i t 39."Water Se%icejing# S I ti�� a I I F' � n ,y ym n Cg H ii 40. Gas Service-Final.4x, LT/ 1,at'i••- 5 ", M I I _. po' -+N :< •. ( 4 7M - n•: nc.r_. RIM_ -r R-1 • ti) it l^', :: 41.rSolar Dourest -Flna. s 'pi ••r-1 71xrt O( I I FD fir+ ✓, u _ 1 M ^ n v t M H rn to u X 1-1 . . 42. Backflow.Preventer ' . .• 43. Backflowlrridation. - :: - I-' - -3 _tc'' " ®� 4 ! 44-- .. . .. I •44. Landscape Irrigation Systems , • 45._Sound Atterivationy ;u. ; , 46. Handicap.Regulations i. r' ' 47. FINAL STRUCTURE & BUILDING .7-45"--‘75- rP.0lL-• �• I Ii 48. FINAL PLANNING ' 1. - - - . 49. Electric Release to Edison • 50. Gas Release to Southern California Gas Co _ - . • 51. CERTIFICATE OF OCCUPANCY - No. bate 4c;36� 8:1 -,7. 36 /12%78 30.50"'It • COSTA MESA BUILDING-SAFETY DEPARTMENT "` '' P:0.BOX 1200 COSTA MESA,CALIFORNIA 92626 • 'PLICA. ION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely— Use Ink Only RE =V DATE RECEIVED D E ISS ED ii BUILDING , 4 ADDRESS M • I :,1 • •. .' 4 .. ' / / idi ' ...9C—' C.J •E R I NO. OWNER j BUILDING//��I , ' Z , • r S• a A.P.NO. , C',.---2/ — I AMAILDDRESS�Q/(/ VF ADDRESS pt S-7' 5-46 et) �v� •' p O7''`�nO.Q�/'�� �u7,/[/E/„/O�yy TRACT 371p LOT�� BLOCK CITY NAN p€,,. ifFp N /�7Lg ilr CONSTRUCTION NEW A D ALTER I REPAIR MOVING DFMOI ISH LENDER BRANCH ,��-- OWNER?Cr C± •06(/C,� ADDRESS n sV/ ALUE ARCHITECT •. _ �2 �� S .• / / 40 OR ENGINE R! • o A . /.a.k •v• ♦ Alniti., c' ./.sy�/� �/:C FIRE r ADD R ESSJy7NO/((• Oftg.4v J TRaEr ZONE /VPE GROUP����� JJJJ�J CONTRACTOR Sn/f/►LNF•l y PL�j/Hbii%f• APPROVED C DATE7>/t2 ADD R ESSOSPE�nIOrb v-/r74tt- TE ZO NO.OF USE OFNEW/IOC 4F- PLANS Z BUILDING AAv(-Lf CITY • n ' V _ NO. f0 a ai E` STATE • CITY YARDS APPROVED YARDS APPROVED LIC.NO�J&5'9LI/ LIC.NO./2/9q (FROMAIN BUILDI M CIL STREETG ACCESSORY BUILDING W SIZE NO.OF BLDGS. 4 OF LOT NOW ON LOT FRONT FT. FT. Q USE OF , ,/`' � EXISTING BLDG. F R.SIDE FT. ,7'v lV t/ FT. 3 SF Separate permits are required for L.SIDE ELFT.” FT. electric,plumbing and heating work. /' � O F REAR �/ FT. FT. SU USE OF BUILDING AND WORK TO BE PERFORMED IS DISTANCE BLD BET. BET.MAIN& IS MAIN BLDGS. ACCESS. BLDGS. •1 Inc 721/47;0011, San/s Ave g/IIt C..Ute.P.¢P APPROVED fikei E-t7ss 1? �y ROVED QQ� DATE / /' Z /7/ x w O I hereby acknowledge that I have read this application and state n IX that the above information Is correct and agree to comply with m 0. all laws regulating building construction, and I shall not employ • Z any person In violation of the workman's compensation laws of u T the State of California. m 3 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 PERMIT FEE S � a ) and Professions Codi on C rf r d m (/'{t//- PLAN CHECK y /• /1' m Signature of / (J ^-7� 0 Permittee t S TAX $ V LL c Authorized AgentU TOTAL PAID $ )1/ OWNER BOURSE, PETER DATE 7-17-78 JOB ADDRESS 25514 Elden Avenue BUILDING PERMIT NO. 1461401 GENERAL CONTRACTOR H. -B. Enterprises DESCRIPTION of WORK Non-Elec.Tract Sign AP No. LOT TRACT FIRE ZONE VALUES 100.00 , INSPECTIONS Signature Date TYPE GROUP ZONE SOIL SUBCONTRACTOR • PEJtMITS ISSUED GASData I Number I Signature WATER • Plumbing ROUGH PLUMBING PROP. SWR. LINE ❑ HOUSE CON. U SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING . TEMPORARY SERVICE OR POLE - UNDERGROUND 0 POWER 0 ROUGH WIRING Heating and Vent. . TRENCHES U FORMS U STEEL REINF. I I FLOOR SYSTEM _ BOND BEAM n STEEL REINFORCE n ___"" SHEATHING (/� n I\ II P _J 11 FRAME AND FLASHING (f '' K \� I, \� it I' i 'I I LATHING - IN in OUT n U t---Ax II \ l AA O II .I I PLASTER, BROWN COAT \�J U U U 'I `i '-... ---- 1 Electric STRUCTURAL, FINAL HEATING, VENT., REFRIG. AND A.C., FINAL I PLUMBING. FINAL AND GAS TEST n D„I rl/-i�'74 -en---Lel_ -_ 1 ELECTRIC, FINAL ____ BUILDING. FINAL R' ` = p 28-7� -0 480* 4,bo-5.50 rt; - r .- CnSA ra 1'r„tr I - '=w.-J f r .r; ` 4 4 -:' STA MESA BUILDING-SAF TY DEPARTMENT __:%: -P.0.-BOX-1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely — Use Ink Only RECEIVED BY DATE RECEIVED BUILDING -1 ! / I ' 0 TEgIS(}SUED ADDRESS m<SS:�4 . ,/z ) Ian. ib -p �^ ---/ j PERMI •, • OWNER A.P.NO, _ �IP• ��/�/(�� _ MAIL 93/ 7)OV,F,C �,r BUILDING f e--„to 4)6: ADDRESS ADOREBS �n/ CITY �Je:al ;/)('Ir(' ,dc-- ee NOTEL - TRACT / W BLOCK CONSTRUCTION `—' NEW ADD ALTER REPAIR MOVING DEMOLISH LENDER / BRANCH ft�V�) • �•]/ OWNER Z , (J ADDRESS ARCHITECT TEL. �t ( USE VALUE OR ENGINEER ////���J�{)/`eJ- C C NO.TEL. peptic) C' , ��. //-� SFIRE �� ADDRESS /3"�f e[� 4(f#_ ZONE T/JPE y GROU ,�,!fJ /�/ // 47 CONTRACTOR -�55 f I C-4/42,1''tib( /- /Y���t)1,e BY APPROVED DATE �/ r ADDRESS /.�.r�/� (J,J. /l -T�LC ,Ai s NO.OF USE OF— l r ..//� TEL. ZON�`� PLANS Q BUILDING NEW 12•0 V /72 E-- CITY G/�ZJJ-(J!' NO, LIC.NO. .._ 5-0 ._J7 9 L/C.NO. yARMAIN BUILDING _ ACCESSORYPROVED BUILDING LD SIZE NO.OF BLOCS. (FROM WI-STREET) 4 OF LOT I NOW ON LOT FRONT/ T. F USE OF \ /� V: EXISTING BLDG. /J(y„JM a R.SIDE FT. Cr FSeparate permits are required for L.SIDE FT. ��_ C Y FT. electric,plumbing and heating work. (CCJ/!� CL W REAR FT. FT. E,,. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& ' C MAIN BLOCS. ACCESS.SLOGS. ..1 . ! /J ��/ a /-n n. VAR.91A DATE /�,�/('(�(„r(/ ��j C.U.P.qW y/��/J APPROVED 1 "ft !A's" �! APPROVE wl BY DATE CC CC W 0 I hereby acknowledge that I have read this application and state n N ( 94 that the above information Is correct and agree to comply with m 4 all laws regulating building construction, end I shall not employ Z any person In violation of the workman's compensation laws of xthe State of California. m I hereby certify that I am properly licensed as a contractor under SO. FT. S' the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR w Chapter 9, end that such licenses are in full farce and effect,or 1 THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: m am exempt from the provisions of the State of California Business VALUATION PERMIT FEE E and Professions Code,Division 3,Chapter 9. .6:0 D In m PLAN CHECK $ 'n Signature of �9 c Permittee Jar. z $ p_)`�©—� TAX $ S"O t U 1 Authorized gent TOTAL PAID $ C.5_0 f / .- 7936 12/06/79 8.50 TL COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 REC BY PERMIT For Applicant to Fill in Completely— Use Ink Only �/// N2 4 9 2 4 Q . BUILDING2S / . 42;,t,.._.4.,,, 4 e4 / / /c A.P.NO. 937 -/6/- _53 ADDRESS // / /V /7 / �\ /� , / BUILDING �t S tic C/deny �//_ TENANT QJ/LL l�Ujr//67t' ADDRESS✓ 7i L(:Q�j�. .d(,- -- L, /..� ^ / /feet- OR �+'s� ADDRESS 255 / `c--Z/E-V // �• SPACE NO. TAI`1�,OZ LOT / / r7 �BLK. .- �y��..s. TEL./V6.- / c r,r Y' G CITY �(J.S/l/ ///C3!T NO.rj �fl� N ADD ALTER jREPAJR 1 MOVING DEMOLISH CONSTRUCTION /-,(V/ LENDER /\ BRANCH 10-7 s _ OWNERs�f�{ ADDRESS USE fitly/11P- VALUE$ gal..--ARCHITECT TEL. fitly • /11P- ENGINEER NO. J^J N. _ADDRESS ZONE //� Z VPE GROUP APPROVED CONTRACTOR C9 JA SKIC/6/dT ,..4,,,.._ BY DATE a(s-//(7 ig ADDRESS/ ,D / S/`y# 9€K Cif �/ 111 lL CITV//2///V L. NOL>Ss2_S/4 Fi STATE APPROVED SETBACKS LIC. NO. 350- .55 CIC.ITY NO. SIZE NO.OF BLDG (FROM C/L SYR . By OF LOT I NOW ONLOK.-VN PO FRONT I - Q USE OF Ca EXISTING BLDG. COA/vO • 1/J T. FI Separate permits are required for L. E ` T/ E- d electric,plumbing and heating work: REAR T USE OF BUILDING AND WORKW/ TO BE PERFORMED /,//[��PLANNING ACTIOxt _ • Q CO/✓�O //V S�/%G 4k/7 7. r 1 DATE APPROVED �1 > APPRS pgPj. /2 .572 � .Y DATE / IY▪. W QI hereby acknowledge that I have read this application and state pr that the above information is correct and agree to comply with Bo 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. 0 SQ. FT. I hereby certify that I am properly licensed as a contractor under ND 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 am exempt from the provisions of the State of California Business VALUATION PERMIT FEE $ 'J Y and Professions Code,/ jDivision 3 Chhaappttee�9. s © n "�/ /1/./`�' f/tif� PLAN CHECK $ �. m /% m Signature of //�� 0 Permittee $ lssr00t CJC� TAX $ 0. Sb F or VVf� U Authorized Agent Date ,L /7t� TOTAL PAID $ re.So �� CITY OF COSTA MESA 4 • w„�.t BUILDING DIVISION PERMIT NUMBER tel ""' ! DEVELOPMENT SERVICES DEPARTMENT 4• "�° PERMIT �Oee° �� Die° (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTP9 OO48Q626 PLUMBING PERMIT Job Address: 2554 ELDEN AV Status: ISSUED Suite No A101 Applied: 08/23/1999 Issued: 08/23/1999 Vicinity: NEXT TO THE SWIMMING POOL ISSUED BY: Parcel Nunmber: 93585001 - - - - -- Applicant: LORIE GLOVERS ' <-- �� /r -. Address: N _ �- " ' i f--,,,------„.. ,-�� i �� i'. 1 /� ,/ A .i� , Phone: I _ ll �i V iii" - \ _ i N- • -..,,..- ,,,,/, /2 A -\-:.-_,- moi_ -------„.. ------->„-z-,,,,-..., A) Owner BURK ;LEE. /, ��\N / /\ -<-.,v fres . 2 iEUNIT ������ i�\" ' Address. 2554 ELDEN'AVE UNIT A704 ��� - , /4/ NV V/7�� Phone: (949)646-7068 \ c`1 j ' 'V / COSTA'MESA,CA Zip:t. 92627 N, Contractor' COAST ROOTER PLUMBING:HEATING&AIR COND I i - � , • ' ,Address: ." ,2737 S.CRODDY. f-� -I . " ,. t '',SUITED ' /• A / ` Phone_ 714 241-14114,.4). ^ • ,' /SANTA ANA CA,-. 1 = Zip: 92704 `\ � • ��.�/ �\ ; .'� ,- , �., - License: 529127 j N. '• Arch/Eng.:e< i _ - • /Address:- •-a. -' . :" '2 .' ' f. ' ' _ `Phone>. . -.., - _ _, - �. • .. <N Zip: sY ' , v License: \i i , /ll-- iii-c! '\� - /-_ �--)--,- i :-.1.-1,,-.. .i / , SCOPEOF�PERMIT/7 ' - - ' , N WATER HEATER CHANGE OUT. • < ,'1 --FEE SUMMARY I V'v, N- ' `�AAMT QTY_ . .. i- AMT QTY • "-- /" < AMT/ QTY ISSUE FEE 7 $23.50 Laundry.Tub7 Washer ,�H• $0.00 0 Sump Pump' '- $0.00 0 Backflow irrigation $0.00.'. 0 Landscape Irrigation ". , '50:00- 0 . Swimming Pool ' $0.00 0 Backflow Preventer S0.007", 0 - P-Trap - $0.00.. 0•- - . . Trap Primer , " / $0.00 0 Bathtub ' ' , /- $0.00 -,0 _ Pressure Regulator,-,' ' ,$0.00'' - 0 `- / •- • Urinal' $0.00 0 Clarifier System:, ,$0.00 0 - ' Process Piping(per 10 R)., '50.00 0 , Vacuum Brkr Bkflow(1-4) , $0.00 0 Conned(Ice,Soda,etc) /,-50.00 0, ,,, ' Receptors , $0.00 . 0 / -. Vacuum Brkr Bkflow(5:)i $0.00 0 v,• Dental Units �N '' <50.00, 0 ' `Septic Tank - ., 50.00 , 0 Wash Basin-' ,';, / $0.00 0 Dishwasher �. , 50.00// -Be . ', Demo50.00 Sewer Cap,for De50.00 - 0 'Wash Basin Set ,' $0.00 0 Drain,Floor \,-...,`,.‘50.60, . 0 -, Sewer Connect' - ' ' '.50.00 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 'S0.00'. 0 " - ''Shower - - $0.00 0 • 'Water"Heater/vent $12.30 1 Drinking Fountain $0.00- .0., Sink,bar $0.00 '0Water'Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink, commercial \•, , 50.00. 0 �•.Water Re-pipe $0.00 0 Gas Earthquake Valve 50.00 0 - - Sink,Floor ' ' . " ' " $0.00 0. - - water Service $0.00 0 Gas(1-4 outlets) $0.00 0 - . Sink,kitchen , ; so.00i:i'o'-- Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop - 50.00 0 OTHER $0.00 Gas Repipe 50.00 0 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa(public) 50.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCU TED FEES: $35.80 COMMENTS I SPECIAL CONDITIONS EXP ED DATE i 0/ t° 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 DECLARATIONS I ) • 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 work�rs'compens tion Ins rance carrier and policy number are: N Carrier. y,1a (I4fl' Ur t Policy Number: V i 0 ? 8? 0 (This section II not be completed if me pejt nit Is valued at one hundred dollars($100)or less.) ❑ I certify that in the pertormaance 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 Signatures Date: g'63_9, WARNING FAILURE TO SECURE WORKE ENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF 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 Iicensed,Jlvdder rovisions of Chapter 9(commenting with Section 7000)of Division 3 of the Business and Professions Code,and my license Is In full force and effect.Lic.0 Da Yy 2 Class If i 'a CO Contractors Signatur . Date: R- x3-99 CONSTRUCTION LENDING AGENCY: O 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 penally 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 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.). 0 I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes ❑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 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 anyone time during a reported year a quantity of hazardous materials equal to or greeter 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 ❑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 0N (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 compiled with? D 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 apgermit 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 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 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 MD 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. Sire Of Legal Owner(s) Date p-._ B- a?- I AIIE/Or Authorized Applicant Date POLE r INSPECTION TYPE PAIS MAO CODE 1 INSPECTION TYPE DATE as 1616 Fixed System Final Fire Prevention j 206 Final Mechanical r� 1286 Pool Spa Final 208 Final Plumbing 3 a5'O'1 200 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 244646 ti:�i�?� CITY OF COSTA MESA 4 • ~'^'1R'w`aG- BUILDING DIVISION > 4 DEVELOPMENT SERVICES DEPARTMENT PER NUMBER 4 ; • PERMIT B03-02077 - (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.e.EnLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 • Job Address: 2554 ELDEN AV Status: ISSUED Suite: A Applied: 12/02/2003 Vicinity: Issued: 12/02/2003 • Parcel Number: TPN003180 Zoning: Applicant: HARTMAN, HEIDI L Address: 2626 NEWPORT BL - - - ISSUED BY: / • ,/ Phone: (949)548-1645 COSTA MESA;CA Zip: 92627 - - Owner: CEDAR"GLEN HOA , Address 2554 ELDEN AV - - Phone:. _ _ / 'COSTA MESA,CA .-- - Zip: 92626 - ` 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 OFF EXISTING ROOF SYSTEMS AND INSTALL 1/2"CDX,COVER WITH CLASS 1 EO YEAR COMP SHINGLES ON SLOPE AREA OF ROOF.ONE LAYER OF TORCHDOWN ON FLAT ROOF'AREA. - - - - / '-" ' " - `' FEE SUMMARY Plan Check: $0.00 __ -.__. - - Calc Valuation: $7,360.00 Permit: $153.25 Claim Valuation: $7,360.00 SMIP Res: $0.74 EMIP Com:, . - $0.00 Other: ' "x.$0.00 - . • Inspection: $0.00 �:r<` - - - �Total: $153.89 . _:.�.. , PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 ,. Rear' 07 0 Left 0-0, • Right . 0-0, ACCESSORY Front 0-0 - Rear 0-0 Left , 0-0 ' Right 0-0 PARKINGExistin : ' 0 • Required: b 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 2448-46(WOO) 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. ^�Mand 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. y works'�.ae ation surance carder d policy nu r are: Cartier: ✓ Policy Number / (This section need not be completed if t e 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, d agree that if I should eco subject to the workers'compensation provisions of Se ion 37.9 of the Labor Code,I shall forthwith comply with these provisions./ (� yL^�� Applicant Signature: i1�lr OS - +6 Date: S WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL 'ENAL ES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),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 under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Prole ions Code,and my license is in full force and effect.Lic.N 4- O 0 7 Class M Os I I -Contractor's Signature: Date: fIflhl/ 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 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 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'iwho 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.). 0 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.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes ❑No Driver's License No. Expires: Verification of Ownership by(type of document,I.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby 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: I 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? ❑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 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). I 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 a.aermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LI 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? ❑Yes 0 No j (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 far 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 (11 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. t re O el Owner(s) 212/� Date (#1,7440 And/Or Authorized Applicant ✓ Date CODE 0 INSPECTION TYPE PAS INTIML$ CODED INSPECTION TYPE PAIX INEDALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 2'ZAu{ `• 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 Ir. ----___- ' ' 44366 ~'��� '/ JUL 1-77ctisA —00 24 07* ***172.86 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 PP C' ION FOR STRUCTURAL PERMIT For Applicant to Fill in C m lately- Usg Ink Only may, /� R . BY D' ERE EI • DATE/ ISSUED BUILDING�`V A ADC /0j "4 '' • !0 �i- ) ADDRESS 5-5-f OWNER ,4 to: I = !'id _k1 PE �.'. O�O - �, - 4‘366 BUI ADDRESS cioI .�CJVR •6'm 110 . ADDRESS .A.40-1b , r• — l ' t AD � � 74(/ TE CITY Nivffp r I t NOL64678c0 TRACT 7 LOT BLOCK LONSTRUCTION / M 1' A ^ ADD ALTERREPAIR MOVING DEMOLISH D LEN ID C FO 'VMt Rl-i' BRANCH C -7 - MG_ �y ` , �j �4 2/00 �? at/o OWNER dou cF 11 ADDRESS /j/ J�(i Q /� � St/�J ARCHITECT - TEL. • r• USE �I UAILT ��V�F�Ir°IUE /0 1 OR ENGINEE-A IL.ar "kA♦^c • eel "410 ADDRESS 144 H• OI Y t f or FIRE ZONE TYPE 1• GROUPle4 t 7 CONTRACTOR ] (101nj 1( 71N' APPROVED DATE ADDRESS las . s' ZOI.E NO.OF USE OF N L / TEL. LJ /1 PLANS BUILDING)/J CITY /\ NO. I\d-' - F STATE CITY YARDS APPROVED YARDS APPROVEDof LIC. NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING r.0 SIZE leo rI NO.OF BLDGS (FROM C/L TRENT)/ 0. OF LOT IU t A 305NOW ON LOT FRONT ' FT. [ .L FT. _ G USE OF „/ ' JCL), EXISTING BLDG. R.SIDE 4] FL FT. // FSeparate permits are required for L.SIDE SFT.1/ 3/14J 14 FT. electricCi. ,plumbing and heating work. REAR 0 FT. ' FT. W I- USE OF BUILDING AND WORK TO BE PERFORMED ' "'F[ DISTANCE BET. BET.MAIN& Q< Cyt /'`/�� _MAIN BLDGS. ACCESS.BLDGS. // in 4 uott �' U �jri - DATE CU.P�#aE-J7-^�Js 5/ APPROVED /S^Ir�G-7, >s APPROV _ie DATE /`� .1/-.2” LU - 0 I hereby acknowledge that I have read this application and state N DA that the above Information is correct and agree to comply with m O. all laws regulating building construction, and I shall not employ i Z any person in violation of the workman's compensation laws of LU the State of California. AJ� T /�s�s - 3 I hereby certify that I am properly licensed as a contractor under l t/s/SO.FT. �J 11((s/s� til` the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR to 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 and Professions Coha,Division 3e provisions�Chaptarf the at�a of California Business VALUATION �s PERMIT FEE $ n Y' m I PLAN CHECK E L ^� Signature of/k •// -//,./ $ D/1 WO/ ` s J , l_ Permittee i/LL/ / 6 T1 vV TAX S r �j U VN� Authorrhed Agent J TOTAL PAID $ /TA7- /R '• E' _• ilii Sl'7-retrszetr-rvov'—tr^---- 44366 • COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 4 APPLICATION FOR STRUCTURAL PERMIT Om For Applicant to Fill in Completely —Use Ink Only RECEIVED BY DATE RECEIVEDBUILDINAT�y1 U ADORES tJ�J b'7/c v /01 ✓ 7 OWNER O(J/CSE Z tV � r / I PERMIT NO. � A.P.NO. � l Awe MAIL ADDP ESb5J 4 az et' Awe ADDRESS TEL. CITY NO. TRACT I LOT BLOCK CONSTRUCTION NEW DD ALTER IREPAIR MOVING DFMOI KH I LENDER BRANCH . OWNER /�e.l`e- _ , ADDRESS VALUE ARCHITECT TEL. AV $ OR ENGINEER NO. FIRE ADDRESS ZONE TYPE GROUP APPROVED CONTRACTOR BY DATE ADDRESS ZONE INO.OF USE OF NEW TEL. PLANS BUILDING CITY NO. ,F. STATE CITY YARDS APPROVED YARDS APPROVED LIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING (4 SIZE NO.OF BLDGS (FROM C/L STREET) Ox OF LOT NOW ON LOT FRONT FT. . FT. Q USE OF rin EXISTING BLDG. R SIr)F FL_ FT. CA S Separate permits are required for L,SIDE FT. FT. Cl electric,plumbing and heating work. REAR FT. FT. k USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& , Q MAIN BLDGS. ACCESS.BLDGS. G VAR.#1 DATE QC.U.P.$ APPROVED 7 APPROVED I O I hereby acknowledge that I have reed this application end state N cd that the above information is correct and agree to comply with m L all laws regulating building construction, and I shell not employ i Z any person In violation of the workman's compensation laws of u the State of California. I hereby certify that I am properly licensed as a contractor under SD.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:y,— am exempt from the provisions of the State of California Business VALUATION PERMIT FEE $ 2 -) / ss//� and Professions Code,Division 3,Chapter 9. — f in m PLAN CHECK S Signature of 0 G Permittee $ TAX S LL ���fff U Authorized Agent TOTAL PAID s75� Applicant to fill In all spaces except those within heavy border lines and sign all approoriate declarations. , CITY OF COSTA MESA, _ PERMIT NO. Tf1CT NO. LOT NO. BLDG.NO. ' • 1 CONSTRUCTIONPERMIT , 6i(, 3 / (3 lot! ` 0689 6/2: /63 (i.CU TL Applicant's Mailin•Addl.:- - " •" - TYPE OF CONSTRUCTION IL NEW U ADD U ALTERATION U REPAIR - - - • , r Protect Address;' SS fff./i/J.' if'I- 0 CONVERSION-• :0 DEMOLISH ❑IOTHE , - - '• • 1 ��/ i ��'�� s/a i/ L ' DESCRIPTION OF WORK S(•�-OTHER Owner s N- e - Lalag i 1.11.: • One 7 Q " ZONING REGULATIONS ' - _ Address' mr �• �'o«��«`�'�r=/ - /-'� • ���Z� TYPE OF PERMIT U GRADING ❑ FOUNDATION I STRUCTURAL A.P.# ZONE • ' Arch/Eng. ' License No.• ❑ TENANT 0 ELECTRICAL ❑ PLUMBING'. 0 MECHANICAL PLNG.REF.# - BUILDING . - Address •- '- • - ❑,OTHER - - TO BUILDING ca Tperr rn ST S . ' - - PROPERTY LINE REAR YARD(TO P/L) - ' Contractor's Nam- s�-L,.!---<.auraiLzaea- , e PROJECT DESCRIPTION SQ:FT. OCCUPANCY ' - • CONSTRUCTION TYPE ' VALUATION$ ALEFT SIDE YARD RIGHT SIDE YARD • Address(mailing) _ (• // - ,ZONj3 GRADING CU.YDS. AC RFG PKC.SPACE,REG. PROVIDED License No: __ - - - LICENSED CONTRACTOR DEC ARATION Remarks: �r -�� I STREET WIDTH PARK FEE.$ I"hereby affirm that-I am licensed under provisions of Charter,9 (commencing I' 7�J/ ' O Q l.7(} •- with section 7000) of Division 3 of the Business and Professions Code,and , SPECIAL CONDITIONS: , ' my license is In full force and effect. - . , License Class License No.' PLUMBING Date Signature ' '- -� R KERS'COMPENSATION DECLARATION • Bar Sink • Sewer Cap • - ELECTRICAL❑ ' - `",.ereby affirm.that I have a certificate of consent to self-insure or a certificate. r- --: Backflow Preventer " Sower Connection- — Automatic Washer... !Meter. over 100 amps.- ... Workers' Compensation Insurance,t or a certified copy thereof (Section - - - 1 � - - Construction Pole 'Sub Panel' ; 800, Lab. C.) Backflow Irrigation . Solar• _Collectors j Policy No. Company 1 • i -`• -. --'- CookingUnit Sub Pole ' 6 CertifiedcopyIs hereby furnished. ; , ' j Bathtubs i . I Solar Piping , • • I . 1 , I . Certified copy Is flied with the city.Building Division. Dishwasher • Motors ❑0-1 HP ❑1y.$ Date Applicant ' • __ Clarifiers -- __ _, • 1 Solar Tank _ . • _ ,. EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Dryers ❑Gas ❑Electric Inc.Solar • (This section need not be completed if the permit Is for one hundred($100)or Dishwasher Swimming Pool w/Spa ❑9-15 HP ❑16-15+ less): - -- - Fan Microwave I certify that in the performance of the work for which this permit is Issued I ' Drinking Fountains Urinal shall not employ any person in any manner so as to become subject,to the - - - - F.A.U. Pole Light ' Workers',Compensation Laws of California. ( , ' Floor Drains• • Water Closet: . Date - Signature -_---"—•I Fixtures -- !Range NOTICE:If,after making-this declaration,you should become:subject to the - Floor Sinks • - - .- Water Heater -- - - - 9 - - -- - - j • Workers', Compensation provisions of the Labor Code, you must forthwith - • Device Boxes . comply ;with, such provisions! or this:permit shall be deemed revoked.; : Gas Service Outlets ' Water Service - Sign I - , • I CONSTRUCTIONLENDINGAGENCY - - " I hereby affirm that there Is a-construction-lending agency for the performance ! Interceptors . - 7 . - • Outlets • Standing Sections of the .work for, which this, permit Is ,Issued (Section 3097- Civ. C.) - - $witches ) ' I Lender's: Name•- ' _ Kitchen•Sink - Trash Compactor : 'Lender'st Address - - , - - Garbage Disposal - • • OWNER BUILDER DECLARATION `' - . . Lavatories- ; - - _ 9 P I hereby affirm that I em'exempt'from the Contractor's.License Law for the - P-Tra Generator 00-5 KW 05-15 KW ' following reason (Section 7031:5 Business and Professional Code: Any city or' P - - - • county which:requires a permit to construct,alter,improve,demolish or repair - _ - - Transformer ❑15-50 KW 'any structure;prior to its'Issuance, also requires the applicant for such permit Roof Drains to file a signestatement that he/she is licensed pursuant to the.provisions of - , • ❑5U+KW I • the Contractor's.License Law,(Chapter 9(commencing with Section-7000)of ` ✓ ' -. 1 Reinspection Fee. ' $15' $`,(;gIsion 43 of-the Business and Professions Code) or-that he/she'Is•exempt - - Showers '"_, Reinspection-,Fee . x'$15 . - efrom-and the basis for the alleged exemption: Any violation'of-Section • • Meter ❑u to 100 amps ! �, 31.5 by'any applicant for. a;permit "subjects the applicant to a=civil - „ __ _ p p Issue Fee $ 3 enalty of not more than five hundred dollars($500): Service Sink I Issue Fee $ 3 Zoning Approved By Date , U I, as owner off the property or'my employees.with wages.as their sole I i MECHANICAL I • - comensation', will do the work,and-the structure'is not intended or offered , Application Approved By - - • - • -Hate ' ' , for sale,(Section 7044; Business and•Professional Code: The Contractor's • - / License Law does not apply to'an owner of a property who builds or Improves Boiler •I • Refrigeration System I - ` •Date /2-/FII• thereon,•and who does such'work himself/herself or through his or her own ' - • Application Issued By _ /•� ` • employees, provided that such improvements are,not intended or offered for , DO-100,000 BTU ❑10D,000BTD sale. If, however,the building or improvement is sold within one:year of com- • Duct-Under Ground , SUMMARY OF FEES pletion,the owner will have the burden of proving he/she did not build or im- I , - • ''�ve for the purpose of sale). Duct-Structural System Repair/Alteration a l� 1 $ , I ' I,es owner of the property,am exclusively contracting with licensed con- ' BUILDING PERMIT $ • ' �• SMTP • tractors to construct the project (Section 7044,Business and Professions Code:..;. ._. Duct_Ventilating. - '. ;. _ _ '• _ t .._ _ PLAN CHECK: $ , PERMIT - ' The Contractor's License Law does notapply to an owner of property who - � I • ISSUANCE $ • builds or improves thereon,and who contracts for such projects with a con- • Exhaust System ❑ Multiple ❑ PLUMBING $ tractor(s) license pursuant to the Contractor's License Law). -• ' - - GRADING I $ • ❑ ram exempt under Section , B.&P.C.for this reason . Firepl/Fact.Bit. ICBG# ' • i- 'I ' , (PLAN CHECK' $ ' • • 'ELECTRICAL $ - I $ , Date ' Owner 1 ' Heating System&Ducting , _ 1 'PLAN CHECK' $ MICROFILM $ I hermation rtify-that Irhave read'this application-and state that the above ; 00-100,000 BTU 0100,000 BTU , .- -• I , information is , ect. I agree to comply with all city and county ordinances ' - • ' ) TOTAL;FEE1 $ " and state law re sting to bui ding on.,ruction, and hereby authorize repro- ! Hood or Type I ❑. ', ' - MECHANICAL ' $ I sentatives of Ft is ci y; - - - - - I n CdONSTRUCTION.ANDPL'ANNING1 0 0• . Ij BITS '1'-' ?0 7` - • c :POOL PA r - ' :- a -t , - I- Q I r h s ` n . ;t= 0 a 1 {Date•, _ ,Inspector `- - _ . ,- 1; Date Inspector 9 SAPPROVALS „= Permit;#- - .c •_• _„ • :APPROVALS` ,Permit# = ,L 7e mporarylElectriical ServiceorL•Pole I Nn -'n.-• oa t'_ ; 52.- Pool &7Eguipment Location';' _ a'- ` ▪ _ 1- ! 1Soil Pipe Und grnd:: u I r c; I .S' _ I Y+ ,ro yF I 5p.3i Steel Reinforcementi.iii i a. , 3: Electrical Conduit Utility Undrgrnd' I o - -• ctx ;54(Porins - t----‘9122 L 51";', ;-Pc" ▪ I '4: Electrical Conduit i-Undrgrnd?_ 1° ' ` I Y t 0-^. '-rc,rl ••55.•Eleetricak Bonding'' - ' i-- } . _ W. Steel�Reinforcemeritt ' 1 R � " ' S v ' ` • _-` ' 56. Fit ti ti Plumbin - '` =. - , q _ ,; , 1= F.y: = 9 g; _ Pressure Test.' - 4 --r` 6: Electrical LIFER Grnd.1 ' tt '_°- ' I 151 m c1 : 57' APPROVAL TO COVER GUNITE °... 'r 7. kootings -I' ' i I i : it, ic, I I F; ° 711.2, \ '?r:r S8'E . , ^ � ' Electrical'C&nduit=Undrorn1:,..:.±. ... � }= 8. Foun'dation I I: ; ' ' ' : ' air ' - - t I 1 t I 0 I _ 159. Gas Pipe`O Undrgrnd Test " 9. Water Pipe-U drgmd. I i . c _ I J, , I r` ;60. Backwash Lines,P-Trap,'0 Undrgrnd.' p 10. hLuctural,FloorSystem 1 7- 'o I ., o ° "` I_61, APPROVAL TO DECK ` -1 ' 11. Pro ert Sewer Line&IHouse,Cannection; a - t. - I 1 I t p, Y I I i , e., ,-; I '162. Backwash & Receptor Final,. ; ,, 12. Sewer Cap-i 1 I 1 3- ' { a ^�. I 63. Heater& Vent-Final - ' i ' .a' , I Er1 . 1 5 1 1 13. Roof'Drains i ' I ; `t I i - - 1 ` i ,. . 4. Plumbing;System -:Final' `-� - 4' 14. Rough Plumbing ; I o-i ' I ' = '- - - -F' 9 g I 1 '65. Electrical Final . .- - ' ` •-15 Rough-Electrical'-Cdnduit' - I ii yT1 1 ; -T -'66.: Solar Sytem-Final i---------Y--i---1 - - •- ' 1"--1 pr:16. IRough-Eleotric Wiring. r I E II :t 'I ;14 I ` 1-f"4Ti ill.' "67. Fencing& Access Appprroval - - " -'� o _ h.r., • . m' J LI .. I _ I , 1 "i I ': t` - --7.-: -I _ 1`17, iifidughW iriiig;SignE' f I " 1 1 '- I i I". { _ I ; I= ' c j, X68.' APPROVED FOR PLASTERING - •' i - 1f 18. ,t n ugh Electrical. A :-..Ceiling{ • 11 {I I I , I I - I �' { 1 69.i POOL/SPA SYSTEMS-FINAL ' I `' . ' N 19. IRough�Heating & AirConditioningIt 1 :1.0 I I I I I I I FIRE DEPT, REQUIREMENT, '., ' - I .1 z 20. ' ou h Factor. Fire lace I' I 1 II APPROVALS' ,Permit'# ' 1- �'�, ri 1 p> : I 1 II 'i I 1 I I I t •� t L'1','Zt. Duds n Seucturec T 1 ( 11 II { I { I ! f i I 170.1 Underground Hydro i . - - I N a 1x22. IDucts Veniiilacing F I p 1 .1 11 I; I I I I I i , ;71.; Product Piping 0 Gas ❑Oil i;223. ;Gastkipe-Rough&Test 1 1 r!I 1 r F 1 T 172:Undergrountl Flush, , ; , °c24. Roof Framingi ' I ; 'n I II;: Ii„, f v I r� .n ! 'g g 73,' Under r , .Stora a Tank Gas.❑Oil' , a., tn ) n I 10. 1 : 1 ri . i .i�' I 1 , - , ;1 125. IRoot,Sheathing . i y i I IIr: 11 ^t , I 1 1„ 11' 1 e I-± ' -,I 174, Overhead Hydro - . fl�6. hT_Bar Ceiling (Structura0,& Monosoat- ( 12.1 r I Ia 1 i ;I 75. Dr,y Chemical .- 1 ; i I :, 4 r.27. 'Frame and Flashing 1 1 •, 1 11 i' I - 11. 1 1 1' I 1 176.' Dry Standpipe - , L 28. ;LKthing & iding) o^° = I 1 i 11 11 I 1 I 1 1r.-i ; I 77., FIXED SYSTEM FINAL ! ' ¢ , r it 1 : i l i , i ( r ' 7 pi.29. tl2sulation s 1 "' nn, I I Ii 1 1 1 11 i 1 '!78.1 FIRE,PR,EVI. FINAL 1, , ' 1 •-31- 'Drywall Nailing 1 1 �i 1 11 II I I {. 1 I 1 1NOI - ' P I ,Q.J ; 1 o 30.. 1 I I s , t a S� atto �1 LcS�1_ C ,,i' 11--. I I ! 1 it _ ( 'l 1 1 t 0---8.-AMA-42.2"&"‘"? I 1 i'- (Plaster Brown Coat 11• ( II 11 I 1 1 t 1 r 11 ec • Via, S'v I .n ✓i32: 'Electrical Power Meier=Final I r 1 I I I i " I 1 i ` .' i 1 .. 1 {_ : __ _ e.,. , C@._LZ�i _ /�4�C.-�_ ��iP.,2 �5 �_-��•e� 7.3 IL_I , 1 1 1 33 ,....- Electric i -• ,,v Li: I ( I , "� I a ' I I I -.7,- � 1 ' I I i I I e 34. Final Heilting &I 3 IA Gonditioni sg 1 I I i I l ' ' ' i t : r% ' II i " I, r; < I-o 'O : 1 . ' .J `2.. . _ 35. Final [[;;as Pipe-Testi '� I m 1 1 It 1 � 1 0 1 I � „ I j I`' , = ' ' - ' 36. Hood Or Can:914:3I7I ' '( 1 11 li 101 _ ISTI ' - 1 I 1 •i 5 P._ _ n n Pi I 37. Final Factory Fireplacem,I 1 01 11 I= •10- 1▪ `• I I , ! I i ' i t. - - • ._ %: I i I I 1 .I 11.. I 191 i I -" I 1 i I 1 1 38. Final Plumbing 39. Water pervice-Fi'nall : 1 I 1 {I. I I I i 1 1 I I 1 I - • , . 40. Gas Service-Final I ' ' I ' ' ' Y 11 I I I i 1 { i 1 11 I 1 I I I I I I -• . , ' 41. Solar Dolnestic-Final I I I I '' 1 ,,k1 I . t .. , . 42. Backflow Preveriterl I I rt I I 1 1 „_:___,„__t__1 _ 1 ktI ni 1 v1 ¢,I I 1 11--,r"h*�1� t __. 4_ .,.-_1 4_ _ 1 ,1 I ,I 43, Backflow Irrigation) ?i . I 1 1 it l: i V 1.` I 1 ' I`• . ' fcl -'� ' i I 44. Landscape Irrigation;System 1 I t�i- • I 1 I ^ , - 1 _ r:: i .. r i- '• . - 1 "_ 45. Sound"Atteniiaiion ,'� � I < I I iJ '1s ' -1 ` I I = : I _ I . -I c ":• ' p.-p: 1t_ 1 1_ -I 1 1 e? , - 46. Handi aplRegulatlons', 1 .m. I 1 11` 1 1 I. I°- i it; i 1 I � i ;.I ' , I - 1 r, Li ' . I'' r . 'T; ,•, 1 _1 47. FINAL STRUCTURE& BUILDING 1= 1; I'� I i . : I i I ' 1 ' - ,I. i. I I i i ' i` . In' .1 I I , I 1_ 48. Special Requirerne its Completed) I I I r I ' I 1 1 , 49. Electric I eleaseito Edion' I I f 1-_-I-__. ._1 I I, J. _t__�. I' ' - ' t • it 1 I I I I , II I 1 i I I I '1' 1 1 i - 50. Gas Release to Southern California Gas Co I I 1 I , 0 :m . 1 1 1 1 ! I 1 • 1 1 1 I I 51, CERTIFICATE OFIOCCUPANCY i--t_ I, I I _T j___,'._ -1_ _ I No ` I' 1 1 I Date 1 II 1 I 1' 1 I I , r 7r- . :.' 2566 9/06/76 5.50 R. ' '.COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 RECEIVED BY PERMIT *rp - 48743 For Applicant to Fill in Compplletely/�— Use Ink Only 1V ADBUIDRESS L. S ref E4A/b AC U,1/t I&fO4 A.P. NO. /� �� BUILDING OWNER OR ` ADDRESS_ 0140/41 --e.... TENANT r"/ JL �cH r • UNIT OR - ADDRESS ZS-4t 4C/1 "AC , SPACE NO. .644" /0 [L / TR.NO. LOT BLK. / � rCITY 7� / s•✓c^f NOCW..;D•?O NEW ADD ALTER REPAIR MOVING DEMOLISH 'l CONSTRUCTION LENDER fj/A BRANCH .(/////-1 OWNER �R.10-A/AC S//j6�a ADDRESS N ALUE 91 ARCHITECT k //11 TEL. USE f1DD Dov l2 Tu fo. $.�� OR ENGINEER /X( NO. - ADDRESS PA ZONE let----- TYPE GROUP APPROVED CONTRACTOR oCr/Q1•l( S3jrtp` BY DATE ADDRESS S' ADDRESS 'V/� TEL. I, CITY NO. I h STATE CITY APPROVED SET: • r4; LIC.NO. LIC.NO. SIZE NO.OF SLOGS. (FR \ C/L STR .t If. OF LOT NOW ON LOT FRO' ', I j . Q USE OF /� I, Ca EXISTING BLDG. L//O/ZACC 1'? FL con �� � Ji I; Separate permits are required for L.d,-. welectric,plumbing and heating work. R R I•FT. i xt F USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION CI r - lila( / L 4 1 DATE • a /�/d (scYt� 70 7A L•iJV`D caw APPROVEDED �7i APPROV86- t.A O DATE 5- �7 / .a ��CC CeW o. • I hereby acknowledge that I have read this application and state o r. a, g 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. 50FT. C . I hereby certify that I am properly licensed as a contractor underw D the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR ' CO 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,Division 3,Chapter 9. 0-0 - •110. PLAN CHECK § `n Signature of �srp Permittee -�_ $ �/1� TAX $ ♦S� F or ' • OJ`-��v U Authorized A•en Date TOTAL PAID $ ""b 7292 5/2"'/"ii „5 • COSTA MESA BUILDING-SAFETY DEPARTMENT APPLFOR STRUCTURAL PERMIT CALIFORNIAP.O.BOX 1200 COSTA MESA,CA92626 REC BY PERMIT ' , For Applicant to Fill in Co/mpplleteelyQ— Usee Ink Only CO /3& ADDRESS oBUILDING QSSl FLrl/V Q—'/{c. A.P.NO. /J ^3}' / - 5 Q - TENANT TOR //�� Mta,�,q AUDDRESS /,�S JP�..a� zJ��O2 ` e� /lY UNIT OR MAILING SPACE NO. 9 Q n 2— ADDRESS S 7 TR.NO. L.0 . BLK. TEL. r� �yy ..Fy:�J•.34 . CITY �'�rr10 H�7 NO.L% �Qv `IV EW ADD ALTER REPAIR MOVING DEMOLISH LENDER BRANCH GCiION� E tE^ D_ n OWNER Q/ (a���/J��(A.fL ADDRESS USE S.OI/Y.t t AV ^ l — ARCHITECT TEL. -- �,rr// /S OR ENGINEER NO V• T ADDRESSs ZONE k TYPE GROUP y CALa2) 40;9% crit itHTS BYYPROV sf23/ta CONTRACTOR DATE ADDRESSI7'ig,1.... 0 S.C(ji'AItC s �AO �� _` ' TEL. CITY --2—C(1)/�/.• NOS7•Syca STATECITY APPROVED SETBACKS LIC.NO. 5 v/1 D— LIC.NO. SIZE NO.OF BLDGS. (FROM C/L STREET) 0. OF LOT NOW ON LOT FRONT FT. Q USE OF „N„ EXISTING BLDG. R.SIDE T — U' _ (-0 Separate permits are required for L.SIDE FT. electric,plumbing and heating work. REAR FT. W.. USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION Q G ..7 ' 'XQ/1 S'_ I,m DATE (�(JY r r�C�V' '/t APPROVED _124 APPROVED/r F el DATE .3 /ZF.5/per Cd ILI • Ct. I hereby acknowledge that I have read this application and state N (ti that the above information is correct and agree to comply with I 0. all laws regulating building construction, and I shall not employ .Z any person in violation of the workman's compensation laws of a the State of California. m 3 I hereby certify that I am properly licensed as a contractor under 5G. FT. N the State of California Business and Professions Code, Division 3, D THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and that such licenses are In lull 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 $ Qp q and Professions Code Division 3,Chapter 9. �f� m Signature of PLAN CHECK $ en0 or 7SD V Permittee $ TAX $ O �0 is S_ �O U Authorized Agent Date ` TOTAL PAID $ I . J r, 1 10 21103 4 .4365 t‘ 10.111 ,o4 a 21-77-00 24 06* If****168.77 '• / COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only A P C TION FOR STRUCTURAL PERMIT L ,/ ���� RE EDPV iatTE.JYECEIVE�OJ TE ISSUED ADORESS26.3,_ li<y:-,�r���'�/�y`/ /G— ')/ ,r�-y—a Z/ I —^ 1. �I��OLI�� 7 Dr� -27 j[ OWNER N` t Se v"VELn 1Itl l . AP.NO. _TII DC 58 PE RMI�JO BUILDING ADDRESS 51I,.I�I(1/t�\�� L •`illi 1L II© ADORESS�5J9 JT-(�Fi CITY N Rt-ri tsoil- TEL NO TRACT LOT BLOCK le-ONST FILICI `,CAl.i�`t}91 Li1l s 111A�I.I�. NEW ADD(ALTER REPAIR MOVING DEMOLISH BRANCH l i00---r 1 /IOWA }�1 `,,�^� �IIO,IK�E D`/ . 2700 H/ po \ a OWNER 1 V G �(lly ADDRESS 'LI , I yr a qA '�,re/� ORCHITECTA_Fra sewAe TEL,rm S USE %/JN� /1 SlAC.eLU: n� /Or OR ENGINES !'R//�iJ/YJl(LU t4C/ I _�l(�!l �/J,I� /,�' FIRE T ADDRESS I't4 N . 41��I1�� ST• ZONE T PE„J---- GROUP R/77 �NIr APPROVED /)J� _ CONTRACTOR /�� _. _rk'Jgg .J ii • BY / , A DATE /(/y 1 ADDRESS 'O/^ E. 15m-sr. TEZ NO.OF USE OF NE CITY[ H M� NO. PLANS �. BUILDIN - l C _� F STATE ' ` CITY YARDS APPROVED YARDS APPROVED / ' LIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING O. ET SIZE ,/f(1/ I : •s OT (FROM C/L STS . O. OF LOT f`'Ir7 P M T. l FT. Q USE OF ,�.i —EXISTING BLDG. R.SIOF /7FT, FT. C F Separate permits are required for L,SIDE 5 FT. FT. electric,plumbing and heating work. Fy,/PEAR �7 _ IFT. FT. w., USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& 'C MAIN BLOCS. ACCESS. BLOCS. CIDATE / ..1 CU.P.4" -77 y APPROVED SI{--77 } APPROVEPr/i./r DATE 7O .73/__7/ [/�(/ CC m o I hereby acknowledge that I have read this application and stater. in C4 that the above Information is correct and agree to comply with m L all laws regulating building construction, and I shall not employ %t , sem4a II N°G� �/ V o L ( z any person in violation of the Workmen's compensation laws of e may, the State of California. 2 /r faO �FTrIR (7 ^/ rm^i I hereby certify that I am properly licensed as a contractor under C1 the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR w I 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 $ Chapter 9. n ‘k end Professions Co e, Division 3, /� 0� c e1•'' PLAN CHECK $ o Signature of 7 •� Permittee $ yi -/'� `� TAXJ $ f r / U Author! d Agent TOTAL PAID $ ` y 77 • PP •/ 414•36S _ OCT 31'77PAIDOO16H6 0^** CMSA 251.00 . COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 P C ION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely— Use Ink Only BUILDING <�i� /('�I�ts���� , R ,BY DATE RECEIVED �: CITY OF COSTA MESA / ;� BUILDING DIVISION >• r„.. ..4r1 rill DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 0. PERMIT se P01-00527 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 2554 ELDEN AV Status: ISSUED Suite No C104 Applied: 09/05/2001 Issued: 09/05/2001 Vicinity: Parcel Nunmber: 93585013 ISSUED BY: v Applicant: NOCK, RON - ''` _ Address: 'Zit/J.7-1\i, - Phone: 714-895-1246 "j/ T�,:., A ':� • ' Zip: Owner HOUSE JOANNE E- / • '� ' ' Address -2554-C104 ELDEN-AVE ' _ . , Phone: � '� 30 Q COSTA-MESA,CA Zip;" 92627 r ': ' Contractor: NOCK PLUMBING '' . - . , 7 , Address: 11612 KNOTT ST - / , _ - Phone: (714)895-1246 - , ' - - GARDEN-GROVE, CA Zip: 92841 ' -- License: 707775 , Arch / Eng: -/ Address: - Phone: - . Zip:. -- - - License: _ SCOPE OF PERMIT . - WATER HEATER CHANGE OUT. - - - FEE SUMMARY , - • AMT QTY :-'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 /50.00 0'' . _P-Trap $0.00 0 'Trap Primer - $0.00 0 Bathtub $0.00 , 0 ` ;Pressure Regulator $0.00 0 - Urinal-, $0.00 0 Clarifier System - , $0.00 t 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 $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 244646(6/00) 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 w for which this permit is issued. I have and will maintain workers'compe Don 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 ca er and policy number are: ,Q" g� Carder: 1 _�9—/o Policy Number: .rd/5 . U (This section need not be completed if the permit is valued et one hundred dollars 0100)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 o. nd agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shell forthwith comply with these pro sion /\/ Applicant Signature: ' Date: �rlo _6/ WARNING:FAILURE TO SECURE W RS'COMPENSA ON COVERAGE IS UNLAWFUL AND SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,MID ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed rovisio ofC"��apt ( m ncing with Section 7000)of DIw the Business and Pr01a45io ° and my license is in full force end effect.Lie.4 underD / / Class L� �-`� Contractors Signature: C 1 h Date: • V 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 she Is licensed pursuant to the provisions of the Contractors Ucense Law(Chapter 9(commencing with Section 7000)of DMsion 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 perm: subjects the applicant to a CMI 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 offeIred for sale(Sec. 7044,Business and Professions Cade: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 cairn 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,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 B,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. I 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 materiel? 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). orneed 2 Does or will the applicant or present or future building occupant neeto 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 Safely 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? 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 irks a plication a ermit for such construction or modification Irom 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 Pinot the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Ves ❑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 fromv the South Coast res prescribed ed Management District or other et 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-describ_—nspection purposes.I agree not to occupy or allow occu, ncy of any building authorized by this permit until final Inspection. gnature Of Legal Owner(s) 1. And/Or Authorized Applicant Date CODE• INSPECTION TYPE MIL Ramdl9 GOOF INSPECTION TYPE. gdTf. ILLS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 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 I , PROJECT ADDRESS: 2554 ELDEN AV UNIT: C-103 CITY OF COSTA MESA - BUILDING PERMIT PERM NO: P 051768 OWNER'S NAME: EDWARD BAKER • ADDRESS: SAME PERMIT NC): P 051768 PLAN CHECK NO: N - GOVT: N SUPP; N CONSTRUCTION TYPE: V-N PERMIT TYPE: PLU PURPOSE; OTH ARCH/ENGINEER: 662-1552 REG.NO.: ADDRESS: UNIT: JOB DESCRIPTION : REPLACE WATER HEATER SQ FT: PERMITTEE: CLAIM VALUE: CALC-VALUE: GROUP OCC: R-3 / ADDRESS: GEORGE BRAZIL ( 714 ) 535-7905 3022 N. HESPERIAN WY ' T COMMENTS; REPLACE WATER HEATER SANTA ANA CA 92706 **** * F;rk#k*>F>E****at*** ****3i*rrx*% ***.x*xx>*K>E>E>F**>F}r*•aF******x* Ex;e***********.**** LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(•rmmencing with Sect'.n Z ONING REQUIREMENTS 7000)of Division 3 of the Business and Professions Code,and my license is in lull three and effect. .• SETBACKS CITY LIC 99$ 9 S T7D.:443064 t� -36 /'� / Date: �pr — Signature:_//`r/-/D ��- /, MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I hae a certificate ofc•m int to sell-insure or acicate of Workers' FRNT: FT IN REAR: FT IN FRNT; FT IN REAR: FT IN Compensation Insurance.or a certified copy thereof(Section 3800,Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN • poucr NO.: WC 0 297893 EXP.DATE: 01 /01 /92 " COMPANY: UNITED PA TFIC PARKING REQ: PROV: PARCEL: 00000000 ZNE: REF NO: ❑ Certifiedcopy is hereby furnished. Certified copy is filed with the urldin jDivsior — PLANNING NOTES> If Date: -9/Applicant /�> �J.- 7 > (* 6iF***3 *x@x* ** 6*ifx* f* PxF*x*} E**i **x* eif6*} }� *} F* Fbf*x* hi (iF**? FF** rE**xs*l3c EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This ction need not be c) ••ed if the permit is for one hundred($100)or less). r DE VEL ORMENT S ER V IC E Sv- REQUIREMENTS 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. ZONING APPROVED BY T i DATE: Date:re - Signature: NOTICE:II.after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : DATE: Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED : / —� DATE• O4 ZZ9 • which this permit is issued(Section 3097.Civ.CI N-**********)K*x.3HE** :—`^— --- . . ”m .A.ir***1F***Y x 3E3ei?fi!**LE#it******»x ei- LENDER: ******3E***3C-***N-***********};.**FE )-***** ***************}i****3F********N..?f*******34x3( ADDRESS: LE:GAL.IZATION:N F E E • SUMMARY STRUCTURAL SEGMENT:N OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELE :TRIC MECHANIC FIRE SM.IP/RES GRADING (Section 7031.5 Business and Professional Code; Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 2 O O ' repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed r pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business 2 5% SM I P/NON-RES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN - any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500). ISSUE FEE 3 . 00 I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING-DIV—> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 2 . 00 3 . 00 0 . 00 5. 00 5 . 00 , 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/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 will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED : 5 , 00 OVER/SHORT• • 00 for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SNIP/TOT GRADING PLAN-CHECK I,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business ' J. 00 ❑ and Professions Code'. The Contractors'Slate License Law does not apply to an owner of property who builds or improves thereon , and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law),l am aware *******,*x**.Y,+EiE*,f.,*,x3i,*3,,,N*k,+f3r*+:**3E****R******N•*****N-**•x•**1i-***3E*yr' 3E***3F**********i.*?} that proof of their Worker's Compensation insurance should be provided to me_ ❑ I am exempt under Section: B.8 P.C. INDIVIDUAL F E E BREAKDOWN r for this reasonTYPE QTY D F S C R' I P T I O N UNIT COST TOTAL COST Date: Owner: I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and PLU 1 WATER HEATER AND/OR VENT 2 . 00 2 , OO 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a - - END OF FEES . permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from . these provisions. \ Date: • Applicant: I hereby certify that I have read this application and state that the above information is correct.I agree to comply with j II city and county , ordinances and state laws relating to building construction and hereby authorize represent.fives of this city to enter -•mile••• property for inspect]w(�u/rposes. ey�e 0:,),.t. ' 0 / �.-- --/ nature; /.�� Sr / .r ' " " L 91 08085433-08085433 TOT , Mb mense or Social Security Applicant:Pink—Revenue;Goldenrod—Assessor CONSTRUCTION AND PLANNING PGS_& SPA APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, ❑ Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection • • 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final• 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval • 17. Rough Wiring Sign • 68. APPROVED FOR PLASTERING 1 . 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough& Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe ' 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat - 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test ' 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing //J79/ l%�I IN 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49. Electric Release to Edison • 50. Gas Release to Southern California Gas Co - 51. CERTIFICATE OF OCCUPANCY • No _ Date _ _ Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. •_ _ _ ' CITYJAF COSTA MESA / .CON TRU T�ONciPERMIT 1I PER)0'13" �J TRACT NO. LOT NO.' UNIT NO. - 13��2 �� •I /� ' .'4.,9 • 'I ♦ Protect Address !�/—S/7P1/e d't 16 { 1 l / rel/ I 1 ! l • , _ 3 4t/ ) y/ TYPE OF-CONSTRUCTION ❑ NEW ❑ ADD LJ ALTERATION L+� REPAIR r ' - Applicant's Mailing A dr ss 7 �7`n / �/'� 7.� ,%+ /'-,Ci/r"--, �.��� _ Phone /4"r�' % ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# •_ _ i Zone - Owner's Name ' DESCRIPTION OF WORK/USE OF BLDG. • Address * / '�J . S Main Building: Accessory Building: I Z Arch/Eng. ' License No. ' TYPE OF PERMIT ❑ GRADING l6❑_[.Y UNDATION ❑ STRUCTURAL T Front O • Address �j {�,�; /� ❑ TENANT ❑ ELECTRICAL L'4PLUMBING ❑ MECHANICAL ' BA Rear • N Contractor's Name y' (A p /I.t/2 t/e . Phppe Ac4'4 O r ❑ OTHER - C Right r N _ 9 / fit, PROJECT DESCRIPTION SQ. FT. OCCUPANCY• Address(mailing) dpi��/"� �9�_�yS / CoN STRUCTION TYPE VALUATION$ ' ' S Left . G City License No. 0/1/1'...&-..._ ZONE • 'GRADING CU.YDS. ACRES , I teAf10Q E • LICENSED CONTRACTOR DECLARATION • Ping. Ref.4 ����`,r Pa(1'r��k ifhq�R@A./�o "`TT110000 M I hereby affirm that I am licensed under provisions of Charter 9(commencing Remarks: Planning Notes: IY G1..1 J�H�`n1 o with section 7000) of Division 3 of the Business and Professions Code, and ,- _ T /� my license is in fu /[e and effect. fn ,- I S V License Class- /�A .,/� v',�G�I�A�CnSC I�O'. / M Date /'i"*1( Signature �II//I SHIN^/Je- '-✓ , - PLUMBING - FEES _v WORKERS' COMPENSATION DECLARATION Bar Sink Showers - ELEC• TRICAL • • FEES 1 sreby affirm that I have a certificate of consent to self-insure ora certificate . ' - Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink \ od00, Lags. C�.y /��y �/� C,fj� /� y ,J Automatic Washer i Transformer 0 15-50 KW p• Policy No /'f1%.A7 'ei Company Vim///�•7L '/a,,,/tet Backflow Irrigation. Sewer Cap - - - 0 50+KW' • , ' Construction Pole Sub. . . - \ .Certified copy is hereby furnished. ' Certniqg cqpy,is filed with the city B tlif Iv to Bathtubs Sewer Connection Cooking Unit- Meter. Dun to 100 amps ' Date /- --415 Applicant /�� rr��/C./ - - - EXEMPTION FROM WORKERS'CO P NSATION DECLARATION Clarifiers Solar Collectors - Dishwasher Meter Dover 100 amps (This section need not be completed if the permit is for one hundred ($100) or . ' ' less). Dishwasher •Solar Piping Dryers ❑Gas ❑Electric Sub Panel 7' 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 Drinking Fountains Solar Tank - . Fan, . I Motors ❑O-1 HP D11/2-8' , - Workers' Compensation Laws of California. - • Date Signature I Floor Drains I Swimming Pool w/Spa' • F.A.U. Inc.Solar ❑9_15 HP ❑16-15+ NOTICE: If,after-making this declaration,you should become subject to the — - - - - -- .— Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks • Urinal Fixtures Microwave - comply with such provisions or this permit shall be deemed revoked. - _ ' CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet , Device Boxes hereby affirm that there is a construction lending agency for the performance - Pole Light , of the work for which this permit is issued (Section. 3097•+Civ. C.) Interceptors i. Water Heater `— ' Lender's Name p (� Outlets Range • Lender's Address - - - - Kitchen Sink- Water Service - g Switches ' ' - " Sin - - ' OWNER BUILDER DECLARATION -_' , , I hereby affirm that I am exempt from the Contractor's License•Law for the Lavatories Auto-Wash • Garbage Disposal Standing Sections fallowing reason (Section 7031.5 Business and Professional Code:.Any city or , county which requires a permit to construct,alter;improve,demolish or repair P—Trap ' Laundry Trays - Generator ❑0-5 KW ❑5-15 KW Trash Com actor any structure, prior to its issuance, also requires the applicant for such-permit P - • to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains ' the Contractor's License Law (Chapter 9(commencing with Section 7000) of , -)ivision 3 of the Business and Professions Code) or that he/she is exempt ' - ''- - - ' - ' ' ' . ' herefrom and the basis for the alleged exemption. Any violation of Section . . j /031.5 by any applicant for a permit subjects the applicant to a civil - •. • - penalty of not more than five hundred dollars ($500). • 0 I, as owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee. $ 3 compensation,.will do the work,and the structure is not intended or offered Reinspection Fee ! $15 • Issue Fee , $ 3 , for.sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES - ' License Law does not apply to an owner of a property who builds or improves - thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such improvements are not intended or offered for Boiler Hood.or Type I ❑ - sale. If, however, the building or improvement is sold within one year of com- • Canopy Type II ❑ Zoning Approved By • - Date - p , the owner will have the burden of proving he/she did not build or im- Duct- Under Ground - Building Approved By - Dat prove• for the-purpose of sale). . ID I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural , Refrigeration System - Application Issued By . Dat tractors to construct the project (Section 7044,Business and Professions Code: .... The Contractor's-License Law does not apply to an owner of property Duct-Ventilating - ❑0-100,000 BTU 0100,000 BTU . - SUMMARY OF FEES builds or improves thereon, and who contracts for such projects with a con- _ - - • tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple D System Repair/Alteration- - • BUILDING PERMIT $ SMIP - _ $ ' 7' proof of their,Worker's Compensation insurance should be provided to me. - PLAN CHECK $ L PERMIT- // Z. ❑ am exempt under Section' B.& P.C.for this reason Firepl/Fact.Blt. ICBG 4 Fire Dampers PA PLUMBING $ L ISSUANCE $ • Date • • - • Owner - - Heating System& Ducting Registers - - ENERGY P.C. $ PLAN CHECK 25% $ I hereby certify that I have read this application and state that the above ❑0-100,000 BTU 0100,000 BT GRADING $ j information is correct. I agree to comply with all city and county ordinances • ELECTRICAL $ and.state laws relating to building construction, and hereby authorize repro- , epro- - PLAN CHECK50% $ • MICROFILM $ ', sentatives of this cit to enter •on t�M1e�bove-mentioned property for - - : inspection pur e$ :/"'' MECHANICAL - $ TOTAL FEE $ 5790 Signature _ Date fry' C' - Drivers' License or 55# - �� Reinspection Fee $15 Issue Fee $ 3 PLAN'CHECK 25% $ CMF 0865-46,rev. 10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor CONSTRUCTION AND.PLANNING POOL &SPA - _ _- ' Date - Inspector i ' c Date Inspector APPROVALS Perm rt:#- . APPROVALS Permit# 1- 1 remporary Electrical Service or Pole : 52. Pool & Equipment Location ' . 2. Soil Pipe-Undrgrnd. ; 53. Steel Reinforcement • 3. Electrical Conduit Utility-Undrgrnd. 54. Forms L'!; • ', 4. Elect ical Conduit-Undrgrnd. 55. Electrical Bonding 0315 - • 5. Steel!Reinforcement 56. Rough Plumbing & Pressure Test • 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUKitE - =;': 7. Footings,. .. y 58. Electrical Conduit-Undrgrnd,'^fir • 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Tests ' 9. Watef PipUndrgrnd. 60. Backwash Lines,P-Trap, 0 Urulrgr end. : 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer COPi 63. Heater & Vent-Final 13. Roof Drains - - 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final , 16. Rough Electric Wiring 67. Fencing &-Access Approval - - - 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING - - 18. Roudh Electrical-T Bar Ceiling - 69. POOL/SPA SYSTEMS FINAL . - 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT ' i 20. Rough Factory Fireplace APPROVALS Permit# ' _ r 21. Ducts, in Structure • i 70. Underground Hydro . 1 22. Ducts, Ventilating .71. Product Piping d Gas 0 Oil 23. Gas Pipe-Rough &Test 72. Underground Flush 24. RooflFraming 73. Undergrnd.Storage Tank ❑Gas 0OiI . 25. Roof Sheathing 74. Overhead Hydro ' • - 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical i 27. Frame and Flashing ' 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT , 31. Plaster Brown Coat 79: FINAL INSPECTION r :l 32. Electrical Power,Meter-Final 80. FOOD CERTIFICATE ISSUED - 33. Final Electric Notes: 74��- z -UQj. // �i r.���nr .yl 34. Final!Heating & Air Conditioning - 3/17/88 L 7.. cc •C�Q-Ro L - ,E,D -- 35. Final Gas Pipe-Test - - - 36. Hood or Canopy • . 37. Final Factory Fireplace - 38. Final Plumbing ?✓/ �( ( , 39. Water Service-Final _ L 40. Gas Service-Final - 41. Solar;Domestic-Final - l 42. Backflow Preventer - . - . . 43. Backflow Irrigation • • 44. Landscape Irrigation System ' I 45. Sounld Attenuation lJ1, 46. Handicap Regulations n - -' 47. FINAL STRUCTURE & BUILDING ' 48. Special Requirements Completed - , ' 49. Electric Release to Edison - - 50. Gas Release to Southern California Gas Co _ - 51. CERTIFICATE OF OCCUPANCY No. ' Date - • - F . �� • PAID 44368 A' -'o '` o- ii JUL 21-77 -002 *%17431 lol,1O1I COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 t ' I TION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely — Usf Ink Only R , E s V D c D ,( /� d /� s DATE ISSUED BUILDING 6- `T /7UCj /a3,z/ i /r 1 �1 7 ADDRESS /w ��/^� ,/ Q PERMIT NO. OWNER k rip ft �7&Y1i�1l W . A.P.NO '--, n-iV36 .'. i, I �i �0I /e`er ADDRESS ADDRESS _��(JI JG II ADDRESS��5 __ TEL. CITY k 'do,+ .-IZLJ NO Al - s TRACT. A ale BLOCK CONSTRUCTION O4J /to "' riet:ERAI I NEW ADD ALTER MOVING f1FMOLISH LENDER L_�f(iff V1\'�I -I l/ /� ccori:s BRANCH �j � M me " OWNER ioU e1v ADDRESS 27(,L/ MT/DR/3140' • ARCHITECT dj-j/.tr't7�perviIy„/�TEOL6•31.p SE At raj W 0 S' VALUE 0 OR ENGINES /JtI6r�F�t�YJ Pt�CN / 0 FIRE ADDRESS �` ' . ��,1 ,������._,..�yy �i,t ZONE TYPE GROUP CONTRACTOR ( -21c: 3 �c tJ' '-' ! • BYPROVED DATE ADDRESS fob . . 18n !! TEL. 2 NO.OF /J_ USE OF NE CITV� r�' I"`•- - NO. ,�, PLANS 0,(/ BUILDINGI �r 1'w� r- 15 STATE CITY YARDS APPROVED YARDS APPROVED W LIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING �^t- NO.OF SLOGS. W S (FROM C/L STREET/ 0. OFIZE LOT 1 COI X 305 1 NOW ON LOT FRONT ci. FT. i A FT. G USE OF q C4 EXISTING BLDG. R.SIOF /7 FT.Cglani FT. E Separate permits are required for L.SIDE 15--FT. FT. electric,plumbing and heating work. REAR ZOFT. PT. DJ USE OF BUILDING AND WORK TO BE H PERFORMED DISTANCE BET. BET.MAIN& -'1C MAIN BLOCS. '/ ACCESS. SLUGS. �/ DATE Q • _c URP. -97-94c APPROVED�SJ x/4,-'7'/ —BAPYPROV ,N/'yv"( DATF�O�-Y-. 7l a L.4 o I hereby acknowledge that I have read this application and state N OL that the above information is correct and agree to comply with �,,��� _ m O• all laws regulating building construction, and I shall not employ g 7 Z any person in violation of the workman's compensation laws of �" I 'I� v 41 the State of California. V g 7C T e I Ln 7 2.& I hereby certify that I am properly licensed as a contractor under hQ// SO. FT. ela G(� �+I the State of California Business and Professions Code, Division 3, THE MOUNT 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 y and Professions Code, Division 3,Chapter 9. r VALUATION PERMIT FEE $ ,n ilk N. Signature of a _ /J�,�[.J/ CV PLAN CHECK $ �/ J( Q�/ss IL ti Permittee .G%k6 / $ `� (100 TAX $ L/Vnv4' ( 6ii U v Autho dAgent A TOTAL PAID $ 7 51. 3 i U • . PAID 44-34'.& A//��/��e Q OCT + 77cnsa001684 j *259.00 . 44 /aV S , COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely—Use Ink Only RECEIVED BY DATE RECEIVED BUILDING /0�/ / I' DATE ISSUED A D OW /� �� a / I PERMIT NO. OWNER A.P.NO. MAIL BUI LDIN y�L�(/� �����i��J ]]](((��� / /J. ADDRESS ADDRE� _ " ' EVIOI' TEL. CITY NO. TRACT I LOT BLOCK CONSTRUCTION NEW ADD ALTFRI REPAIR I MOVINR DEMOLISH LENDER BRANCH /� OWNER Bel/GS ADDRESS VALUE _(D ARCHITECT TEL. USE $ — OR ENGINEER NO. FIRE ADDRESS ZONE TYPE GROUP APPROVED CONTRACTOR BY DATE ADDRESS ZONE INO.OF USE OF NEW TEL. PLANS BUILDING CITY NO. F STATE CITY YARDS APPROVED YARDS APPROVED LIC. NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING Lt7 SIZE NO.OF BLOCS. (FROM C/L STREET) M OF LOT NOW ON LOT FRONT FT. FT. Q USE OF # EXISTING BLDG. - _A SIDE FL FT. CA FSeparate permits are required for L.SIDE FT. FT. C electric,plumbing and heating work. REAR FT. FT. _ I.W., USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& G MAIN BLOCS. ACCESS. SLOGS. VAR.# DATE ..I C.U.P.# APPROVED a • 7 APPROVED (-I —ELY -DATE C {sl CI hereby acknowledge that I have read this application and state �n gg that the above Information is correct and agree to comply with m L all laws regulating building construction, and I shalt not employ Z any person in violation of the workman's compensation laws of g {t the State of California. 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, 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�s FEE ONLY; am exempt from the provisions of the State of California Business VALUATION PERMIT FEE $,y _.... .6 and Professions Code, Division 3,Chapter 9. V` m PLAN CHECK $ n Signature ofG Permittee - $ TAX $ �i_ LL Authorized Agent TOTAL PAID $ a���///7 �y • CITY OF COSTA MESA . BUILDING DIVISION f•/40111t i 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us Wit , FOR INSPECTIONS CALL: (714)754-5626 441°"'°"e` PERMIT NUMBER: M10-00066 PERMIT TYPE MECH STATUS: ISSUED APN: 93585009 DATE ISSUED: 07/12/2010 ISSUED BY: RMD JOB ADDRESS: 255413104 ELDENL� i )j; Suite/Unit: D104 Vicinity: CARPOR D 04 ROOF SQ. FT: 0 SCOPE OF WORK: MECHANICAL PERMIT FOR THE INSTALLATION OF A NEW ROOFTOP CONDENSING UNIT LOCATED ABOVE CARPORT AND CHANGE OUT FAU LOCATED IN CLOSET FOR CONDO UNIT D104. FAU< 100 K BTU, 1 CONDESING UNIT < 100 K BTU. COMPLIANCE FORMS ATTACHED TO JOB CARD AND CITY PERMIT. OWNER: BRIENZA,TOM Address: 2554 ELDEN AVE Unit:UNIT D104 PHONE: 714-478-6422 City/State/Zip: COSTA MESA,CA APPLICANT: BRIENZA,TOM Address: 2554 ELDEN AVE#D104 Unit: PHONE: 714-478-6422 City/State/zZip: COSTA MESA, CA CONTRACTOR: OWNER-BUILDER License No. 000000 Address: Unit: PHONE: City/State: ZipCode: CELL: • MECHANICAL PERMIT FEE SUMMARY MECH ITEM FEE: $53.10 PLAN CHECK FEE: • $0.00 INVESTIGATION FEE: $0.00 REINSPECTION FEE: $0.00 TOTAL FEES: $53.10 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28.§1. 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. ODE E INSPECTION TYPE LTE IN1TOALS CODES INSPECTION TYPE /•pn1F IN L$ 1618 Fixed System Final Fire Prevention 206 Final Mechanical RA 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Root 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 t WORKERS'COMPENSATION DECLARATION: Owner ID verified by driver's license. []Yes ❑No ,,I-,_ �I I hereby affirm under penalty of perjury one of the following declarations: �D�' 'e-tic iso e No &Expires:to(3U I O I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document.i.e.-property tax bill or eed): compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. O 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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: I permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a number are: person is required to descend,will be made in connection with work authorized by this permit,and that no building structure.scaffolding,falsework,a demolition Carrier: or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp (This seam need not becompretedd the pane isv&ueu at one hundred dollars WON Of less) 2,Art 2,Sec.341,Title 8,California Administrative Code). Policy Number: 0 As owner-builder, I will not employ anyone to do work which would jf tcartify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless issued.I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of Appli ant's Signature Date the Labor ode,I shall forthwith comply with these provisions. Division of Industrial Safety Permit Number: ,.app4caots.Synatore HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes 0 No ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST.AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. 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 LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons,or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file my license is in full force and effect. a registration form for acutely hazardous materials? 0 Yes 0 No Lic.# Class# (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 Contractor's Signature Date 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 CONSTRUCTION LENDING AGENCY: temperature and pressure). ❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work fa which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? 0 Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Lenders Address: 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. Signature Date 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 0 No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes 10 No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the Califomia Govemment Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits). 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 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? 0 Yes 0 No applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes",the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the California Health and Safety Code). ❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec.7044.Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by California License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes 0 No 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 8. (If yes attach certificate of compliance from the appropriate air pollution sale. If, however, the building or improvement is sold within one year of control officer). completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and ❑ s'owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code: The contractors License Law does not apply to an owner of Signature 'Dale property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractor(s)license pursuant to the Contractors License Laws.), certify under penalty of perjury that I have read this application and slate that 0 I am exempt under sec. the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described property for inspection •urposes. I agre- of to occupy or allow occupancy of any building 7-la-aDAD .�:LI authoriz by this per mal inspection. r /I\�1 7—:k BO J 3057.48(3/07) Andlp Authorized Applicant Date CITY OF COSTA MESA ^or • Set BUILDING DIVISION ) 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)7544856 • www.ci.costa-mesa.ca.us rcli - FOR INSPECTIONS CALL: (714)754.5626 4'"°`va PERMIT NUMBER: E10-00169 PERMIT TYPE ELEC STATUS: ISSUED APN: 93585009 DATE ISSUED: 07/12/2010 ISSUED BY: RMD JOB ADDRESS:—•=E554434U47EL-1]EN;AV_CMrn. Suite/Unit: D104 Vicinity: CARPORT D104 ROOF TOP SCOPE OF WORK: ELECTRICAL PERMIT FOR INSTALLATION OF A NEW ROOFTOP CONDENSING UNIT LOCATED ABOVE CARPORT FOR CONDO UNIT D104. NEW NC ELECTRICAL WORK. REF#;M10-00006 OWNER: BRIENZA,TOM Address: 2554 ELDEN AVE#D104 Unit: PHONE: City/State/Zip: COSTA MESA,CA APPLICANT: BRIENZA,TOM Address: 2554 ELDEN AVE#D104 Unit: PHONE: 714-478-6422 City/State/zZip: COSTA MESA,CA CONTRACTOR: OWNER-BUILDER License No. 000000 Address: Unit: PHONE: City/State: ZipCode: CELL: ELECTRICAL PERMIT FEES Electrical Plan Check Fee: $0.00 Electrical Permit Fee: $78.00 Reinspection Fee $0.00 TOTAL FEES $78.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. CODE INSPECTION 117E I?P1;: INTmAL$ Oaf INSPECTON TYPE DAFT IN1111ALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing >k q-Z6-io RNl3 L/lo 200 Final Re-Root 210 Final Electrical 9-/ 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 WORKERS'COMPENSATION DECLARATION: Owner ID verified by driver's license. Yes ❑No I hereby affirm under penalty of perjury one of the following declarations: I se, t if l(2 (-Z0 / 13 ❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document.i.e.-property tax billoror deeeedr): 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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a number are: person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding.falsework,a demolition Carver: or dismantling thereof,will be more than thirty-six(36)feet high. (Chap.3.2.Grp (This melon need not be comPletud AThe permit is valued at one hundred dollars($100)or kss) 2,Art 2Sec.341.Tile 8,Califomia Administrative Code). Policy Number: 0 As owner-builder, I will not employ anyone to do work which would c4 ybcertify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of Califomia, and agree that if I should become subject to the workers'compensation provisions of Section 3700 of Applicant's Signature Date the Labor Code,I shall forth ; - omply with these provisions. — /2-a- 'w Division of Industrial Safety Permit Number: Applicanfs_ siaoptuce,_ca__ Dite�' HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATIONS WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes 0 No ($100,000),IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE. INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. 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 LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons.or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file my license is in full force and effect. a registration form for acutely hazardous materials? 0 Yes ❑ No Lic.# Class# (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 Contractors Signature Date 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 CONSTRUCTION LENDING AGENCY: temperature and pressure). ❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? 0 Yes 0 No (Section 25534 of the California Health and Safety Code provides that the Lender's Address: 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. Signature Dale 4. If an RMPP is presently required, has Section 25534!of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 0 No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5. the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes 0 No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Govemment Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be fumished on applications for non-residential building permits). 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 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? 0 Yes 0 No applicant for a permit subjects the applicant to a civil penalty of not more than (If yes the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the California Health and Safety Code). O I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec.7044.Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by California License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes 0 No thereon,and who does such work himself or herself or through his or her own 8. (If yes attach certificate of compliance from the appropriate air pollution employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of control officer). completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and was owner of the property,am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. LICENSED CONTRACTORS to construct the project(Sec.7044.Business and Professions Code: The contractors License Law does not appy to an owner of Signature Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that 0 I am exempt under sec,�. the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of Business and Professions Code for this reason: 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 autho ed by this permit until final inspection. 99.�, ; l2 - 010 - 1 Z - Pl//0 ShirrafShirra eT2 of egal Owner(s) Date I C=r1"-- 3057<6(3/07) And/or Authorized Applicant Dale PI" oalr PROJECT ADDRESS: 2554 ELDEN AV . UNIT: D 104 CITY OF COSTA MESA — BUILDING PERMIT , PERM NO: P 052309 Dw"ER's "ME: BUENTGEN, B ADDRESS: 2554 ELDEN AVENUE PERMIT NO: P 05230S PLAN CHECK NO: N GOVT: N SUPP: N UNIT 0 104 COSTA MESA, CA CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU PURPOSE: 0TH ARCXIENGINEEfl: 650-0230 REO.ND.: ADDRESS: 0 UNIT: JOB DESCRIPTION : CHANGE OUT DISHWASHER SQ FT : PEflMrrTEE: 00000 CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 / ADDRESS: NOCK PLUMBING (714)895-1246 11610 SEABOARD CIR COMMENTS: SMOKE DETECTOR REQUIRED IN THE HOME STANTON CA 90680 **s******:a*******************s*********************************zr************n** LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING S E REQUIREMENTS 7000)of Division 3 of the Business and Professions Code,and my license is In tut force and effect. CITYuCITY uc.[:�[p-950386 aT"TE uc 511971 Cusse crlat4e 50386Y/ signature: �.�osv( i ------ MAIN BUILDING -- ------- ACCESSORY BUILDING. ---c-- WORKERS'COMPENSATION DECLARATION: I hereby affirm that lhave acertificate of ttoself-insure oracertificate ofwodurs' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN Compensation Insurance,ora certified ropy thereof Section 3805,Lab.c). LEFT: FT IN R GHT: FT IN LEFT: FT I N RGI-IT: FT IN POLICY NO.: 116799290 EXP.ORM: 03/01/92 COMPANY: STATE / PARKING REQ: PROV: PARCEL: 00000000 INE: REF NO: i„W;1 Certified copy is hereby furnished. DI Certified copy is Id— With the dry 1 Ming Division. PL ANN I N G NO T ES> • (} / • � r Date: 16 —/B ' L/ Applicant: I ��! /eJ f ******************************************************************************* EXEMPTION FROM WORKERS'COMPENSATION DECIMATION: (This section need not competed if the permit is fa one hundred(5100)or less). DEVELOPMENT SER V I -C E S ,.. R E Q U I R E. M E N T S 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 theWorkers'Compensation Laws of California. ZONING APPROVED BY DATE: Date: Signature: NOTICE:If,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BU IL DING APPROVED B Y : . : DATE: • Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. ri q CONSTRUCTION LENDING AGENCY: I hereby affirm that there s a construction lending agency for the performance of the work for AP PL IC AT ION ISSUED BY: DATE:a3 S"V—`I which this permit is issued(Section 3097,Civ.C). ********************** ******* ******* ***4r*********************#****# *** LENDER: ******************************************************************************* — ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SKI P/RES GRADING (Section 7031.5 Business and Professional Code: My dry of county which requires a permit to construct,atter,Improve,demolish,or PERMIT 2.00 repair any structure,prior to Is Issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors'State Ucense Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business 25% _ S MI P/NON—RES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PL AN any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(SSW). ISSUE FEE 3.00 I, as owner of the properly or my employees with wages as their sole compensation, wit do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE ❑ tructure is not intended or offered for sale(Salim 7044,Business and Professional Code: The Contractors State License Law TOTALS---> 2.00 3.00 . 0.00 5.00 5.00 .00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through his or her own employees,provided that such improvements are riot Intended or offered for sale.If,however the building or improvement is sold Within one year of completion,the owner wit have the burden of proving he/she did not build or improve REVENUE DIVISION TOT AL S—> COLLECTED: 5.00 OVER/SHORT: .00 for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SNIP/TOT GRACING PLAN—CHECK I.as owner of the propertyam exclusively contracting with licensed contractors to construct the project(Section 7044,Business 5.0U '•. ❑ and Professions Code: The Contractors'Sate License Law does riot apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractors)license pursuant to the Contractors'State License Law).l am aware ;p4*********************************4******************************************** that proof of their Worker's compensation insurance 5fSd be provided to me. - INDIVIDUAC FEE BREAKDOWN ❑ I am exempt wrier Section: B.S P.C. • for this reason: TYPE QTY DESCRIP TION UNIT COST TOTAL COST Date: Owner PLU 1 DISHWASHER 2.00 2.00 I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END 0 F FEES 25534 and that I or any future building occupant wWwlll not(circle one)need to comply with said state codes and the requirements for a permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from Nese provisions. Date: Andcst: • I herebycertifya that l cos aad this application and state that the above nares is coes of agree to comply all city and county i V/ ordinances and state laws relating to building construction and here authorize representatives of this city to enter rte above-mentioned - ,� property for inspection purposes. / Q i (late: (6— I (l Signature: t o 260,94:5-f'.. - 'i-7,;: , Driver's License orSocial Security Pink—Revenue;Goldenrod—Assessor I CONSTRUCTION AND PLANNING POOL SPA , Date Inspector Date Inspector APPROVALS Permit # - ��� APPROVALS Permit # �-. 1. Temporary Electrical Service or Pole, , _ 52. Pool & Equipment Location a. r.s. /• 2.• ,So;I: ipe.Undrgrnd. , 3 -r.. 53. Steel Reinforcement . 3! Elebtridal Conddit•Ufility-Undrgrnd. 54. Forms -y . • 4'4: Electrical Conduit:Undrgrnd. 55. Electrical Bonding . -i 5: Steel^Reinforcement 56. Rough Plumbing & Pressure Test ._ 57. APPROVAL TO COVER-GUNITE 36� Elecaical UFER;Gind. I-- 7. ,Footings _ 58. ElectricalConduit•Undrgrnd. 1 I• 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test • 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. -4 10. Structural Floor System -' - .e, 61. APPROVAL TO DECK 11. Property Sewer Line& House Connection 2' 62. Backwash & Receptor-Final - i 12. Sewer Cap • :er 63. Heater & Vent-Final 13. Roof Drains ."-r.„ 64. Plumbing System - Final 14. Rough Plumbing' .-<.-• ., 65. Electrical-Final - ,- 15. Rough Electrical-Conduit ti i66. Solar System-Final • 16. Rough Electric Wiring -- r 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 418. Rough ElectricatT Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. •Rough Heating & Air ConditioningIRfi DEPT. REQUIREMENT a. -1 -4.• 1 -- 7 1 :: J J r.:,:-;:. -'1-J 7 , -� a } - 20.-Rough Factory Fireplace I - ,. - ., ,y - gpPROTALSJ�.P.ermit 4 21. _Ducts,in.S4.trueture.: I •' •' _ '4• ;: -4 : - _y0. Urjdergrou'dj-lydlo 4 22. Ducts, VentilatingJ,} i J - +i -, -t -ra 31. Product P,ipirig ❑Oas ❑Oil 1 I 23.'Gas Pipe-Rough& Test I -r , • • -I s - ?y 72. Undergroundl)IQ3h ' •24.`RootFraming' I - ••i• ..' -ICI:a ,73.-UndergrndiStorageTankOGas ❑OII 25. Roof-Sheathing d ./* , t 4i•i Il} a'> 4•-Overhead Hydro ' _ 4 26. T•Ba:Ceiling (Structural) &'MEMOcoat75. Dry Chemieal -j •' 27. Frame and Flashing • )-C : •.' r - 4 71. 76. Dry Standpipe - t 0 r -28. Lathing & Siding-Tit 1 1' - j 'r 7 '•( ••I .Iy`1; 77,;FIXED SYS EM,¢IN'AL',: - i 29. Insulation �a _ � a e.e. - bn 78, FII, EPREV. FINAL ' - n I„ .r 1 1 tr •-1 ALTH DEPT.: EQUIREME NT 30. Drywall flailing „�,,, • I a- 1 I Ia:r A F 31. Plaster Brown:Coaow -: I - r 4 I I . I-.a 19. FINAL INSPECTION * r I - .. I I In.n • L^__ -.1 n , •- `'32.-cclectrical'Pow'er nnnn33'erFinal l ani I I 'Ib4 •BO ' FOOD CERTIFICitE ISSUED I * 1 u a• 1 1 1 -.•14un -r -33.-FinahElentric7 .,4 "'1 1 S u_ I I ".1•µa Notes:j/2i %: //pbjeaomi s o-ttp 4. inal'He tingAirCorditiohirg� •� ab& i. ?¢ 7= sL � • � . * 1 l A -/ `1 a 1 1 •Ia. :r i35.-Fina•TGas-PipelTet,a • .• i--. I ., lao -� x.n -., - - T to-1 i r-1 a 1 1 lata ` Z. �a * 11 ri '36. Hoor}or Canopy 74 1 1 [-1 a I r1 I ,. 1 J N 1 1 1 b€'. 1. -.37.•.FinaJ,Factory Fireplace-c 1 --1 n o I 11µan 2 Y A :V V8. Finat.:Plurnt ng env I •i /111:14( (W/I:oris I s ay, 39. Wate?Service-Final`_ . I a c I I lYo a• _ u i 40. Gas Service-Final ^ 1 s r r C a n I h.* -Imo m a.•J * ♦ fly- 1 a I 17313 1-- • :n1 * ,_ ,,-41. Solar Domestic-Final ' 'r x u n- .4.......4......- - 4 %I I1r a -1J T • : 42. Backflow Preventers •4 * I les* d -r *Cl -. • a.0 .7•... a•. as m Tin * r C t} C * Aa ..t 9') .4 43. Backflow Irrigation,} }- V *s a a v i * '3 • -I a _ - .. .� ,44. Landscape Irtigatio? Systeme 1tt X * T J .i J*a ..a 10 •'s.) T., ' -7 d . x -5 q r K e w Q t s r -3 Sr 1r .1 GZ a e -• r45.4§ound Attenuation r-oT1- .r a r r C.C. a , -. .. 04”..) uca x -i.. .• * n ,� mo*P.- a s a • •-(-1 b _ - _ T. _ . . • T_J - •"' - - - - -46.•Handicap-Regulationstr 4 a r. s tr. 70 b aft .• ar 1 I *.o4 m en r b J7.`FINiLSTR!ACTUATE & BUIL'DING a. I QAC y a 11-:- 48. FINAL PLANNING; I 1-1- ;= .9 I I .• ATI TI * r .. .. I I. I 1 es n n. .0 c a a 49.-Elect�ic Releaie to Eiison I '4 o n x 1 I. t 1 :r z Al .50.•Gas•Release to Southern California.Gas Co a I I 17 a - -. l • n.'l t. 1,0 • I- n 1 'v v * 6 4 n 1 -1 CI it •IJ .'5 51. CERTIFICATE OF OCCUPANCY * * * •c .-) _, A a •- No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA SSA_ CON STTROUCTION�PERMIT PERMIT'/p/r�, TRACT NO. 1 LOT NO. 'UNIT NO. Project Address .7(�)`I( �/ �/�/l 9� 2q /��F/tJ y�/�/� ��� • Applicant's Mailing A dress q /I(rlV,ltQ 1 H TYPE OF CONSTRUCTION ❑ NEW 0 ADD H ALTERATION EtR€PAIR 1 {S ❑ CONVERSION ❑ DEMOLISH ❑ OTHER Owner's Name Li eA )) Phon4?)1-r�Q.S� DESCRIPTION OF WOR K/USE OF BLDG.' - -__ A.P. - •- • Zone y Address rs(/✓y r 19 S Main Building: • Accessory Bujldjngre + +� TYPE OF PERMIT ❑ GRADING• H FOUNDATION ❑ STRUCTURAL E Front /M � "' �•- a Z Arch/Eng: License No. _.,/ T ,}tyy--�� \4, t 0 • ❑ TENANT ❑ ELECTRICAL la PLUMBING ❑ MECHANICAL B , ./ v N Contras /I n M 7 Fenn ❑ OTHER 'A Rear ff11// 1y G Contractor's Name n ISAC� l�L�/Lblt� Phone u7'"1"I��� I - .- 11 ry `Jp� Cat ,,IMI �t rr PROJECT DESCRIPTION Sq. FT. OCCUPANCY C Right. f -(j N Address(mailing) ^L ^ ` r- IYY[.YI P. Left l -+ �^�2 CONSTRUCTION TYPE i VALUATION _ $ 5I ��•'� City License No. f I �J ZONE GRADING CU.YDS. ACRES ♦♦♦♦--- R LICENSED CONTRACTOR DECLARATION Ping. Ref.# 1 forking R • CI., E I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: • -, - P Planning Notes. [ CP Q with section 7000)•of Division 3 'of the Business and Professions Code,and ' - ' . my license is in full and effect. �1ty O1 M License 1.55 �°l r r .f• ii/em N•90 - - - i S Date /' '� Signature t»L_ _ . . I PLUMBING -FEES, !' tiff ? [� 1qg7 WORKERS'COMPENSATION D CLARATION a ` E.'C. VC� 11 1 'hereby affirm that I have a certificate of consent to self-Insure or-a certificate Bar Sink Showers FIIUAL - FEES ' Workers' Compensation Insurance, or a certified copy thereof (Section -Backflow Preventer Service Sink - I .800, Lab.Syi /y-7 Automatic Washer . -• Transformer ❑ 15.50 KW Policy No. MiQ 4—S '7 Company-c'ttt P--• " i.41'1 Backflow irri ation 1 . ' Sewer-Cap , 0 50+KW a 9 ,- I. Construction Pole Suh. • „Certified copy is hereby the cit - . - Certi o ys filed with the city/tea c gl rr - . - Bathtubs Sewer Connection .. Cooking Unit Meter ❑up to 100 amps Date 311-4c I Applicant(iK�f t l.kL._V Y✓l�'✓ V" . _ ' EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers t Solar Collectors- i - - Dishwasher Meter Dover 100-amps (This section need not be completed if the permit is for one hundred ($100)or . --- - ' less). + Dishwasher _ i Solar Piping _ Dryers ❑Gas DElectric Sub Panel ' ' 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 Drinking,Fountains, Solar Tank Fan , Motors❑0-1 HP ❑1'/x-8 Workers' Compensation Laws of California. - Date Signature Floor Drains ' ' ,Swimming Pool w/Spa ' . • NOTICE:If,after making this declaration, you.should become subject to the - F.A.U..U. Inc.Solar 09-15 HP 01615+ Workers' Compensation provisions'of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures comply with such provisions or thin permit shall be deemed revoked. Microwave CONSTRUCTION LENDING' AGENCY Gas Service .Outlets ' Water Closet Device Boxes I hereby affirm that there is a construction lending agency for the performance , Pole Light' . of the work for which this permit Is issued (Section 3097 CIv. C.) Interceptors Water Heater Outlets Lender's Name • Range l Lender's Address. ' Kitchen Sink • - . Water Service - - - - - - OWNER BUILDER DECLARATION Switches Sign I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposal , following reason (Section 7031.5 Business and Professional Code:.Any city or 9 P Standing Sections county which requires a permit to construct,alter,improve,demolish or repair P—Trap LaundryTrays ' any structure, prior to its issuance,also requires the applicant for such permit y Generator❑0.5 KW 05-15 KW Trash Compactor to file a signed statement that he/she is licensed pursuant to the provisions'of Roof Drains the Contractor's License Law(Chapter 9(commencing with Section 7000) of -Division 3-of the Business and Professions Code)-or that he/she is exempt - • - therefrom and the basis for the alleged exemption. Any violation of Section 1031.5-by any applicant for a permit subjects the applicant to a civil •-LIe nalty of not more than five hundred dollars($500). 3 I, as owner of •the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee $ ' compensation, will do the work, and the structure is not intended or offered - Reinspection Fee I $15 Issue Fee $ 3 • for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES License,Law does not apply to an owner of a property who builds or Improves _ _ _ _ __ ___ _ thereon, and who does such work himself/herself or through his or her own - --� DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such improvements are not intended or offered for Boiler Hood or Type I 0 sale. If, however, the building or improvement is sold within one year of com- Canopy Type II 0 Zoning Approved By Date 1 . pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground , Building Approved By Date prove for the purpose of sale). (�/ O I,as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System - Application Issued By a nate S 24/a / tractors to construct the project (Section 7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑0.100,000 BT,U E1100,000 BTU SUMMARY OF FEES builds or Improves thereon, and who contracts for such projects with a con- tractors) license pursuant to the Contractor's License Law). I am aware that, BUILDING PERMIT $ SMIP $ proof of their'Worker.'s Compensation insurance should beExhaust System 0 Multiple❑ System Repair/Alteration provided to me: PLAN CHECK $ ^�PERMIT 0 I am exempt under-Section B.& P.C.for this reason - Firepi/Fact.Bit. ICBG# Fire Dampers • PLUMB!NG $ 1's....CPOP SSUANCE $ g/ / Date. ' owner Heating System&Ducting Registers ENERGY P.C. $ PLAN CHECK 25% $ I hereby certify that-Ihave read this application and state that the above 100.100*0008TU ❑100,000 BTL ELECTRICAL GRADING $ information is correct. I agree to comply with all city and county ordinances - - $ _ and state laws-relating to building construction,and hereby authorize repro- - - $ MICROFILM $ sentatives:of this city to a ter upon the above-mentioned property rfor_- - _ PLAN CHECK 50% • iInspection rpos.� l-� y ' Pink -Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING POOL &SPA APPROVALS Permit Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location ri 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms • 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding •-r 5. Steel Reinforcement I 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Udrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgkq.,Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap • 63. Heater & Vent-Final 13. Roof Drains I 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring : 67. Fencing & Access Approval • 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test, 72. Underground Flush 24. Roof Framing - 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing , 76. Dry Standpipe 28. Lathing & Siding l 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meted-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test • . 36. Hood or Canopy • 37. Final Factory Fireplace 38. Final Plumbing 4(a/87 &CO 39. Water Service-Final : ' - 40. Gas Service-Final ' 41. Solar Domestic-Final 42. Backflow Preventer • 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING • 48. Special Requirements Completed 49. Electric Release to Edison 50.'Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY • • No. ' Date PIT . - - IItts� 1177 ' COSTBOESAIILDIIG- FTYEPAT APPL ATION Fg3STIiOCTU4 .PERMIT I Be 50 TL A SAEIA T6E6 REG' PERMIT B For Applicant to Fill in Completely —Use Ink Only I N 4 8 919 BUILDING A.P.NO, y 4r r/6l_ s,� ADDRESS 2 559 ELDezz 4eQ D•ioi 6/ OWNER OR LDR FovntD P,- oscorr ADESS e2JrSf ,.5"/An doe ,O' UNIT OR DQSPACE NO. ADDRESS 2559 ezG/✓a iJ� D JO/ �j TR.NO. LOT BLK. CITY COST/°) N Sp NO/.z31 239 a/ CONSTRUCTION NEW ADD ALTER REPAIR MOVING DEMOLISH LENDER /� BRANCH y! _ / 4 OWNER /PP��Q L'OTI— ADDRESS /J S, ' VALUE /2O¢ oc ARCHITECT TEL. - USE G �.�yf� $ y OR ENGINEER NO. �` _ _ADDRESS ZONE fit_ YPE GROUP �L/� S APPROVED /_��/�Q CONTRACTOR //( �/`�lJs *WC- BY DATE W 7 ADDRESS )789/ SX/,4Qen cwt. CITY J,ei//4/Lr N OLS✓/S314/2 F STATE //// CITY /' APPROVED SETS•I KS 1.61 LIC.NO. 3 7��� z. LIC.N2oy37 w 512E NO.OF BLOGS. (FROM Tr z ) P, OF LOT NOW ON LOT FRONT FT. /' G USE 1OF N 4g� �� G / � EXISTING BLDG. / •.ri FT.a� to FSeparate permits are required for I.s1DE/� tT. G electric,plumbing and heating work. REA / II FT. (W. USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION Q DATE iit /A/s'/i3GL Two S*(3/1/g9T5 ''��st 4 APPROVED /Y� �/ 9 �Y ROV � z I NATE /0 / " f IX GM aI hereby acknowledge that I have read this application and state n ce that the above information is correct and agree to comply with s all laws regulating building construction, and I shall not employ ai Z any person in violation of the workman's compensation laws of u I l the State of California. m I hereby certify that SQ. FT. am properly licensed as a contractor under D the State of California Business end 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: ,n am exempt from the provisions of the State of California Business VALUATION PERMIT FEE �J Y $ and Professions Code,Division 3,Chapter 9. /G s 00 n PLAN CHECK $ Signature of 6 v QO 0 2 Permittee A $/200 ^, TAX c U. or /�J 9/7) / $ % `+0 U Authorized Agent Date / 7 /`�j TOTAL PAID $ !�s .co • ,nqPl}i COSTA MESA BUILDING-SAFETY DEPARTMENT APPLI ATIO ORg� Bair,PERMIT 6.50 TL P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 ww RE11I aD PERMIT N° - 48999 For Applicant to Fill in Completely — Use Ink Only // BUILDING ADDRESS c5v ecce ./ 0-/or A.P. NO. '/j9 -/b/ - •s'3 BUILDING aCS-V cs OWNER AN OR LOMy/p ZW ADDRESS �.xQ,Q�� MAILING , UNIT OR SPACE NO. ,, se/O4i ADDRESS SS// 61061/ p Tay Tr �s LOT BLK. agr— CITY (-OS rs ',AnnN -/6d3 7 O~NEW D ALTER REPAIR O/NG DEMOLISH CONSTRUCTION LENDER )1.%\C BRANCH OWNER L E E Lowrnr ADDRESSVALUE Q� 100 ARCHITECT TEL. USE SNYL / t(• $ oVf/r OR ENGINEER NO. ADDRESS ZONE R 2- PE GROUP //``//�� // APPROVED / // CONTR ACTOIa.17UpF si�f`/�T /^./C BY DATE /.0./!7/ 79 ADDRESS 179 /1 SX/ /wit cue {{ G CITY Jty//r/e' L/t NtS. 5#n FsAPPROVEDSTE APPROVED SETBACKS R. LIC.ATNO. 3SG- g$s' LIC. NO. SIZE INO.OF BLOCS. (FROM CA_STREET) L OF LOT NOW ON LOT FRONT FT. C•0201,USE OF 0ypp CA EXISTING BLDG.li R SIDE FSeparate permits are required for L.SIDE T. C electric,plumbing and heating work. REAR FT. ck7 USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION /l ES/1>e vrr � ,/ DATE In /IIIc-�yeG. Ssayu r APPROVED —AAPPROVED � e/_-�• DATE /0//7/`•� 7 �1 CdW O. I hereby acknowledge that I have read this application and state N /, that the above information is correct and agree to comply with O. all laws regulating building construction, and I shall not employ i Z any person in violation of the workman's compensation laws of a ,W the State of California. .: SO. FT. er 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 n 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 $ '0 Y and Professions Code,Division 3, apter 9. t 0 w m Signature of/✓.� �n OG PLAN CHECK $ -� o u. Permittee K/ S BV"' ��— TAX $ .51:3 or U Authorized Agent Date /O 7��/7 ,� TOTAL PAID $ O J CJ .". Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations- . ... . - - ..__ _ e CITY OF COSTA MESA _ - PERMIT-N0. TRACT� rNNO. LOT NO. BLDG.NO. CONSTRUCTION PERMIT. 76i990a— ppI/ DtOl 0545; ' 6/1 l%83 LoUO TL v -: A. 4 4 'TYPE OF CONSTRUCTION U NEW U ADD awl ALTERATION U REPAIR APpYam'4 Mailing A�dd�r(:- �� •r��'�"(/•�[�� - - _ , • . • Project Address./�S•'r & 4 /1L. t3aT Ck 'c . ' 0 CONVERSION 0 DEMOLISH 0 OTHER• - Owner's Name HSE C �`& Phone49' 7CZ� ,DESCRIPTION OF WORK e _ ZONING REGULATIONS __ Address, " CCC'v` la✓E - - ' TYPE OF PERMIT U GRADING U FOUNDATION .k] STRUCTURAL A.P.spa ZONE' F • Arch/Eng. Lice =- No; 0 TENANT 0 ELECTRICAL 0 PLUMBING ❑ MECHANICAL PLNG• . REF"# BUILDING Address . - ❑•OTHER orrnery rn sr _ TO BUILDING • F d' r - PROPERTY LINE REAR YARD (TO P/U , Contractor's Name -- • / - Phone CS7 —.� 3 - PROJECT DESCRIPTION SG.FT" ' OCCUPANCY F —Jr , • .••sr/�/� CONSTRUCTION TYPF VALUATIONS LEFT SIDE YARD RIGHT SIDE YARD Address(Mailing)/ ' • • - ZONE GRADING CU.YDS. ACRFS - PKG.SPACE REG. PROVIDED - License No. _ - j� /' • ' . __..- LICENSED LICENSED CONTRACTOR DECLARATION Remarks: Re-Ar r. 17 1 CLQ}.Gl • STREET WIDTH PARK FEE$ u I hereby affirm that I am licensed under provisions of Charter 9(commencing - ( _ Q 7 ( , with section 7000) of Division 3 of the Business and Professions Code,and .- - - SPECIAL CONDITIONS: my license is in full force and effect. - . - , Ucense Class License No. ' PLUMBING Date- Signature Bar Sink Sewer Cap , ELECTRICAL fl' "'ORKERS'COMPENSATION DECLARATION - - - _- ereby affirm that I have a certificate of consent to self-Insure or a certificate :-Backflow Preventer Sewer Connection' Automatic Washer Meter Clover 100•amps - - Workers' Compensation Insurance, or a certified'copy thereof (Section ' - - - 3800, Lab. C.) Backflow Irrigation Solar Collectors Construction Pole ' Sub Panel • Policy-No. Company - - .. -. _.. CookingUnit Sub Pole ' �I' 8 Certified-copy is hereby furnished. , Bathtubs I - Solar Piping ; Certified copy is filed with the city,Building Division. Dishwasher Motors ❑0-1 HP ❑7 K$ • Date - Applicant Clarifiers - Solar Tank , • EXEMPTION FROM WORKERS'COMPENSATION DECLARATION . Dryers OGas ❑Electric Ina Solar ❑9-15 HP'❑16-15+ ' ' (Thissection need not be completed If the permit is for one hundred ($100)or ' Dishwasher , $wimming Pool w/Spa , fess).. , Fan 'Microwave "' I certify'that in the performance of the work for which this permit Is Issued I Drinking Fountains Urinal shall not employ any person in any manner so as to become subject.to the - - • F.A.U. Pole Light I '" • Workers' Compensation'Laws of California.. Floor Drains' Water Closet g i• Date Signature I I 1 1 - Fixtures ? I ' NOTICE:-If,after making this declaration,you-should become subject to the Floor-Sinks - - Water Heater, -- - -- - - . - -Range _ _ , Workers' Compensation provisions of the Labor Code, you must forthwith , ' comply with such provisions or this permit shall be deemed revoked. • Gas Service' Outlets • Water.Servic¢ - Device Boxes Sign. - CONSTRUCTION LENDING AGENCY - • - • I hereby affirm that there is a construction-lending agency for the performance, interceptors - , •' • - Outlets Standing Sections i I 1 of the 'work for. which this: permit Is issued (Section 3097' Civ. C.) . • - • " • . 1 - Lender's Name Kitchen Sink • - u - Switches - (Trash Compactor ' I 1 Lender's, Address, ' - ' - ' ' - •- - � I OWNER BUILDER DECLARATION ' ' ` - • , Lavatories_ F. -, I ' • ice ;,! Garbage Disposal I • I , 1' I I hereby affirm that I am exempt.from the Contractor's License Law for the . - N -, Generator ❑0-5 KW ❑5-15 KW ' following reason•(Section.7031.5 Business and Professional Code: Any city or ' P-Trap _ - , - > i I i rt - i I • • county which requires a permit to construct',alter improve'demolish or-repair - .- - Transformer ❑15-50 KW I i any structure, prior to its issuance, also requires the applicant-for such permit Roof Drains- _ i _ :L- ' f' -' ' • to file a signed statement that he/she is licensed pursuant to the provisions of - ❑50+KW, - ' •he Contractor's License Law(Chapter 9(commencing withSection-7000)of - 1 - ' - •� - ' Reinspection Fee $15' vision 3•of the Business and-Professions Code) or that he/she.is exempt - Showers 4 -. - Reinspection Fee • Co c$15- _ _ - I arefrom and the basis for the alleged exemption. Any violation of Section - . ' - - - - Meter Cup to 100 amps 'Issue Fee $ 3• I .031:5 by,any applicant for a permit subjects the applicant to a civil - 'penalty of not more than five hundred dollars($500). .- Service Sink. ' •' Issue Fee • r,$ 3,..• • — Y ; ., r1 / Zoning Approved By Date •• - co I; as owner of the property or my employees with wages as their sole - MECHANICAL +' compensation will do the work,and the structure Is not Intended or offered _ -" Application Approved By • I nate for sale Law doe a lyBusiness'and Professional oper Code: The Contractor's _ _ „ I I J) 0 �/� q • License does not apply to an owner of a property who ghhbuilds or Improves , Boiler ' . I Refrigeration System Application Issued ByJ/I •J ' thereon,'and who does,such work himself/herself or through his or her own - - - t .� PP Date employees, provided that such Improvements is withintended or offered for ' • - - ''❑0-100,000 BTU ❑100,000 BTU •P= sale. If, however,the buildingor improvement Is sold oneyear of com- Duct'-Under Ground , i I { I • SUMMARY OF FEES • pletlon, the owner will have the burden of proving he/she did not build or im- �rove for the purpose of sale). , Duct-Structural System Repair/Alteietian BUILDING PERMIT $ 4.00 SMTP : I . $ i I,as owner of the property, am exclusively contracting with licensed con- t tractors ctors to construct the project (Section 7044.Business and Professions Code: Duct-Ventilating _ ;, PLAN CHECK $ PERMIT • The Contractor's License Law does not apply to an owner of property who - - - - , ISSUANCE $ builds or Improves thereon,and who contracts for such projects with a con- ' , Exhaust System 0 Multiple❑' I '! f PLUMBING $ tractor(s) license pursuant to the Contractor's License Law). , I ' "- 0 lam exempt Lacier Section B.& P.C.for this reaon , Firepl/Fact,Blt. (CBO# I `t " " r •PLAN CHECK; $ GRADING $ •,. I • ELECTRICAL $ j $ Date ' , • owner 1 ' I Heating System& Ducting I 1 - ! - • I I - .PLAN CHECK t MICROFILM . $ ' I-hereby certify correct. agree have-read-this application and state that the above- '- ❑0.100,000 BTU ❑100,000 BTU- - - • h4 • $ ' information Is correct" agree to comply with all city and county ordinances , ' 'MECHANICAL TOTAL FEE $ - , and:state laws relati,`•j o building cd ruction,and hereby authorize repro- Hood Or Type I ❑ ' I $ sentatives of•this �[1v t en�,•-•r the above-mentioned property for YP ) Reinspection Fee s$15 LESS Inspection purpo g' / Canopy. Type II ❑. M't _ PLAN CHECK. $ gDVANCEDIPC $ Signature so-- - ._ •^ Datil/frt./ Issue Fee ' • • n Drillers' LIcen' , or SS#' ' ' • , Registers1 $ 3 FINAL FEE, • $ ' `, CMF 0865-46 rev.12/82 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod-Assessor , Proal/3 e - '1 : DNSTRUCT10NAND.PLANNINGl9 = -+ x- ' T =" - - - ;:"POO' ,PA I7-.; p ;�,C• - >, (�/ a Aate - Inspector . .a Date ' Inspector., `. r'APP'ReiVALS - earl-nit-4k 8' 9 - o _- APPROVALS-_. =Permit'-# ' ' °: 1` 4 2_mporary1Electrical Synik9ki,F�Fole I '4„1.: ' - I n2 I, '52', Pool &ZEguipmeht Location ' ' -- o _, i. 2! (Boll PIPe-Undigrnd `_ !,�• -o: I I a•: E J. _ r. I r53_ Steel Reinforcement _ - .,, F- •,31 Electrical Conduit.Utilitv,•Undrgrndt ' .• „.. F. I" _ .54. Forms" -., _ 1 i:° 11 •4: Electrical onduit-Undr ria? : -.� 1 "" = •- o' E9:471s !!56o..'ElectricaBonding - 7. � . ' >. 5t SteeI Reinforcement -;.] lc' o 2 - I " c= ; 5 : ` a ?FP ', ''56:Rough Plumbing:&Pressure Test . 4 . , '8: IElect'rical LIFER 4r,"nd�l 12 I 1 j:• , n z ` 572APPROVAL^TO COVER-GUNITE =. + ^ 7. Footings I I ;-y 1 n ?:, i I tri, . 79 ...Lc. r 58:, Electrical C_nnduit-Undrarnd:., - . , ' 8. Foundation �C I ' _ ! ' > - . ,59. Gas,Pipe;'17='Undrgrnd:,Test'- ' _• - 1 -t 1 e - l %�ig.• - ; - - - - _ 9. 1Natei Pipe-iUndrgrnd. ; 1 ; s- Ba 160. ckwash O Lines, P-Trap, Undrgrnd. : r 2 -• • I 10. Structural Floor System I -S- i, 1 a:- , '2-, 7 .61. APPROVAL TO DECK -- 11..Property Sewer Line&'House'Connection 6 r 62. Backwash&'Receptor-Final .I 12. Sewer CaP j ; 1.'.' ;;; o i - -' '..63. Heater &Vent-Final - - ' • , . 13. IRoof,Drains ..j I ° - '''' ' o -.� '64. Plumbing•SYstem; F!nal . •- t - ` O 14. •Rougli.P.lurhbing:31.:1 I I - . I I ' `- ` -• 65. ElectricalFinal- ' - •r ' - ot-T -7,---yr15=Rough'Electrical-Coondui �; T "'f�' - �-- X66.1 Solar;Sysfem-Final - - 7--- ' ei-„116: I.R�ough;Electric Wirling, 1 I 1 ;; 1",i;471 -;'.., .z m'� 5 i ry t :".1:. 67.1 Fencing &;Acca s Approval {-'. •!-,:---2 ' - 1: .l , 1T.`Rough-Wiring Slu• m m M !1 I:e I , . t- 1 ' I_ 1 ` 168. APPROVED FOR=PLASTERING I 1 - T u 18Y,tR'oughl.ElectricallITIBar. Ceiling! I,1 1( . I I I I 569.; POOL/SPA SYSTEMS FINAL . I " 19e'Rough'Heating &IAir'Cooditioning Ij { I -I I 1 14, : ; I , !FIRE DEPT.:REQUIREMENT + 1 20. !Rough Factory Fireplace 1- 1 �1 ' I i 1 1 ! I I ' APPROVALS , Permit# ' • - -- 21.ID'ucfs;in Stiuctuiev I r ,I II i I 1 I ' I R0.1 Undeiground Hydro , ' 1 i 1 ' 1 c '__.✓1 I _ , Q I I I . ?;22:Ducts,Veptilating" 1 - i- 1 1I (' II 71., Product Piping Gas OOiI . .23!.Gas'Pipe-Rough & Tesi o I I II'T 17. 1 ! I I I I j 172: Undeiground Flush' I + • 1 f;24.'Roof Framing I 1 I I ?{ q.1 II I I ;re I° I:� i : . I j '73.1 Undergrrid.Storiage Tank,O Gas D,Oil 25.ILRoof Sheatihirig I 1 ` > I 1 11.811'f1;,' 14'1-1 1 L ' 4 ,. . 174 I O1erF ead Hydro ' . ;. , I ' , ' , I-,26. NT�,IBar Ceili g'(Struq urall.& Monocoatr I ; . I . I 1 :175.1 Ditty Chemical 1 r �' .c27, Frame and'Flashing ; I , I' I', ; "I I • <, 1 I ;76.1 Dry Standpipe I . , - ! _ 1 28. NLathing&Siding' r i I. •1 it I. 1 I 1 "S' ' 1771 FIXED SYSTEM_FINAL i 4 ', - { 29. ,Insulation _ c I C r; r I .1 .I I I + I . ; 1 ; 78! FIRE PREV. FINAL ' ''..+. �r l . , C 1 1 ,. 1 II r 1 I 1 1 .,f r, r -' - - +30,:!Drywall Nailing i , `, I _ 1. I ' I ! 1 I I !Notes:* , 7/4,44o/ is y��x . dee i( 31 "Plaster Brown Coat 1 ' 1 ' 11 . I 1-1 ; I -I- i- 1- 1 j , �'C - - i1 I + I a d I ! I { WL., /f,�KM�'J� /Qrl� OWNttl yrJ32.IElectrical�Power MeterrFinal 1 1I I,._ i_ ! a . 1 1 -! 1. ,?�rE�CyT- /�«<f el; d� /�KJ�B/4e73t.6 ` ? 33.',Final Electric I I ; ( ;_..11.II ":_ I .1 I „�,,,.I_. . I Ln-W -€4ic'- ° cot �Lq ` 34. Final `bleating&!Air Conditioning . I 1 I I . ' • ! K '1 1, CI � 1 ft 1 F- C I , I 1 1 II 1 ',LI"' I 11 Ic In n P C ln: ' ;, . - rn ti 35. Final Gas Pi`e�T'esil m• ` 1 • 1 _ jr: I ' ' I - 1 c. . -' _ - - , r1 I; I, p 1..., yINmI aI �I cIn I=1 I � I - .. • _ 36. 36. Hood or'Cariopyaf) _`,I n I ` I" , 1 I , ' - _ _ • 1 _ _ . I. I IIS! Imi �Ini II I ' 1. I ' { ;I I I I „ - i _ I�• - ! -- 37. Final Factory Fireplacen 1 ...";1 °i Is - d 11 I - .. I I 1 , ^'n• I I - _ - 38. Final Plulinbing 1 I I I I oI Ii 1 ' I 1 l I , I I 1 ,. 1 " . 39. Water Service-Final' I 1 1 '1 Ii ; 1 ! • k = - t . I. I I I , iiii I I c , I • •I -. -. 40. Gas Service-Final I 1 • I _ I n o 1 1 I1 1 { 1 I I 1 i ' • 41. Solar Domenic-Final I I I ;� i_ I _!_y _i 1_ _ •._____*�__-_ - ' 42. Backflow:PrreventerlcI I 1 1 ;it i__ _I_- _ I _,. _, �-_ 4- 1 -___,,_�_.L_i__. . .• n.: it i -1 't! I 1 1�..- Ir: IV ' 1. 1 I._ I -, Ic1 1' � I 43. Backflow Irrigation - ; r - __ I I,C. I 11_i _ I r11 r. 1 C. 1 , 44. Landscape Irrigation- System 1 ! i; 1 , I, •_ ` , � ; " I - ' 1 -I ; I "" - - ' , - . l 'I I-. I.o-I " 1^ 111' I 1 " 11 : I , I I I 1 - �, 1 I L 45. Sound,.Attenuation a I , '' I , I ^.' I t �'I . 1 '1 - ;s , Nq { I - I i' I I I r' i ..1 I 1 1 _ ._I I . , ' ` 46. Handicap Regulations ' 1 R 1 1 •' ,l J; e -1 1 t .; 1 1 ,I • 47. FINAL STRUCTURE& BUILDING' I!. 004! We ' 1 1 I 1 IY ' 48. 1 Special R 1,e uiremerits Completed 1 I I i , ' I ' ` I t , , ,. 41 I 1 1 I I I 1 I + - 49. Electrr Releaselto Edison! 1 1 w .1.___1._I_I. :_,___i___;,_�!!! '_ . - - , n 1: I I I I ., I I I 1 50. Gas Release to Southelln California Gas Co 11 11 1 1 I I I I ` • 51. CERTIFICATE'OFOCCUPANCY ' 1 I 1 .-j_1-_'_ 1 ' No I Date I I. i i 1 1 1 j 1 ' • 1 • • •COSTA MESA BUILDING-SAFETY DEPARTMENT APPLI ATIO OR'gtafferiliaLPERMIT 6.5U Ti. - P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 IFF 01 PERMIT IkrO 48999 For Applicant to Fill in Completely— Use Ink Only k 1�,1 BUILDING 2.5-5,,, ezoe-Al o-'a A.P.NO. 3Q �I b I �3 ADDRESSBUILDING TTENANTOR LOS/We z � R ADDRESS �C� � UNIT OR a MAILING SPACE NO. y - /O 41 ADDRESS ZSSy pet, Q—�6'y T Ns �s LOT BLK. CITY eon,' ,„on", NQS ,.J oJ)t20~ amt. / NEW ADD ALTER REPAIR MOVING DEMOLISH CONSTRUCTION - - - - - LENDER /( BRANCH OWNER LEE ZONMr ADDRESS USES &L i Li.'}'- VALUES FM!"IS ARCHITECT TEL. !/[ r OR ENGINEER NO. ...---- ADDRESS //�jj�e '/ ZONE R Z PE GROUP / / • CONTRACTOC#4. c4j4'/ar IAtt APPROVED DATE /0//7/ 79 ADDRESS 170 !J ay ft4q l C�,ojr �y� !!! LLL L CITY 1 s/,'/✓eF et* N 5,15 'J F STATE APPROVED SETBACKS a$ L C NO. 390•.* g$S CIC.ITY NO. WSIZE 1NO.OF BLDGS. (FROM C/L STREET) 0, OF LOT NOW ON LOT FRONT FT j •, Q USE OF N.. EXISTING BLDG. Co~oU g,_�I_E /- Separate permits are required for L.SIDE T. c electric,plumbing and heating work. REAR FT. cGU USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION Jr651,t)e v e ''/ 7.1 1 /IcT'LL S�l1/!//4' DATE APPROVED _yrilt cane Li DATE /01 17/77 C 14 GI hereby acknowledge that I have read this application and state o' W that the above Information Is correct and agree to comply with C 0- all laws regulating building construction, and I shell not employ Z any person In violation of the workmen's compensation laws of a la) the State of California. N 3 I hereby certifySO. FT. certify that I am properly licensed as a contractor under N the State of California Business end 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 S 0 and Professions Code,Division 3, spier 9. �t 0 n PLAN CHECK S -� o SSignature of "YTVJJ .-- PermitteS e 5O 00 �( — TAX f St L2 Or U Authorized Agent Date S—i— TOTAL PAID S e Fa- t I ris. iiit 4 til" 1 Pato $ 4) 1164 JUL 21-77u-1 002405* ***175.72 4364 to I COSTA MESA BUILDING-SAFETY DEPARTMENT • P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 For Applicant to Fill in Com lete1 PP IC ION FOR STRUCTURAL PERMIT pp Li p y — )se Ink Only P I RQC I E V D TiPIEC�E1tIDATE - ISSUED BAUILDING nK5jrESS 44 � � /0///07i, , II - -7OWNER /\13)R.__yr�pys'1t2VI.�yi.py,—W. Us. N�7o" cl3 / �jJf�,� ERM4T4 A4 MAIL CPI •DDVr ` ✓1 ` y.-1'-•I'© BUILDING�� r4 yrs ALe MAIL SIS �(J • �t-t 1� ADDRESS V CITY 1 f) TNOL. 70025 TRACT LOT BLOCK CONST{{{RUCTION GALA�i'\tp(" hYi= A-, NEW ADD ALTER REPAIR MOVING DEMOI ISH LENDER CON* CJI `��1� I �-' 4 1 BRANCH I J^j��I1y* �//}�p . MVP OyyNER INOU� E}y1��, J�(j/./ ADDRESS lam/ Y(-V { Y �I Vxl / SrR'KC`�ALU$ /! 10 ARCHITECT /(ry., I �,p� EEt-co G62 USE UNIit I� Irk OR ENGINEER `4 7U7 (/7./(_/ z FIRE i GROUP ADDRESS N. ke /gir, r� ZONE TV /I J/� CONTRACTOR ""�� CCN NIe Tk�N APPROVED /_ DATE/4'5i- AT /fit,5I� i- ADDRESS J . 18711 I `� / FECI ZeYE NO.OF USE OF NE CITY C PLANS BUILDIN'- CjrA TEL.TEL. Fii i!, i STATE CITY YARDS APPROVED YARDS APPROVED LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING u SIZE 19SI7( 1 I NO.OF BLDGS. (FROM C/L ST�iEET) / — 0, OF LOT 8 (\ NOW ON LOT _FRONT G7 FT. r�J i/rri/_V-1 FT. Q USE OF � 4 EXISTING BLDG. R.SIDE "FT. R6u'M FT. tn F Separate permits are required for L.SIDE g- FT. FT. electric,plumbing and heating work. , Q - REAR / FT. ,tryt FT. GU [., USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& ' Q MAIN BLfv'-S. ACCESS.BLDGS. CI VA ..1 DATE C URP. ��7I APPROVED 57.7e/(p -77 RAPPROV� f r DATFL `� �j- 77 .d R4 W Q I hereby acknowledge that I have read this application and state .()7 /�1� N N p(, that the above information is correct and agree to comply with a f`N m 0+ all laws regulating building construction, and I shall not employ /(�j Z any person in violation of the workman's compensation laws of �'1"A_ s the State of California. ,J rs.6O FT. ✓ ^.2.4 0 U n 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 m Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: t am exempt from the provisions of the State of California Business a V and Professions Code, Division 3,Chapter9. VALUATION PERMIT FEE $ Lb en / 7..1. PLAN CHECK $ /4 Oo \ SiPegrmttee of .//�/ $ f 7p� TAX $ 07 ' VV ))) .7 floV1 Authorized Agent TOTAL PAID $/ 2, 2. OCT 31 77pri PAsu001662 E15***261.00 . COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 . tATION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely — Use Ink Only R I g/V DATE RECEIVED DATE ISSUED BUILDING £G A ) R r��Q/ /J�ry/_/a`7 L/ C ADDRESS T aptit /OY NO�j t 2 ^ PERMIT NO. OWNER (`-C=J A.P.NO. MAIL BUILDING p25-303/ ��/ ✓53/ Ewa �L ADDRESS ADDRESS `f C TEL. CITY NO. TRACT I LOT BLOCK CONSTRUCTION NEW 1ADD ALTER IREPAIR IMOVING f1FMOLISH LENDER A BRANCH _ OWNER V0- iesDtrl/ ADDRESS ARCHITECT TEL. USE( "ryI/rIt SPA,C #ALUEE OR ENGINEER NO FIRE ADDRESS ZONE TYPE GROUP APPROVED CONTRACTOR BY DATE ADDRESS ZONE INO.OF USE OF NEW TEL. CITY NO. NS PLABUILDING F STATE CITY YARDS APPROVED YARDS APPROVED LIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING izd SIZE NO.OF BLOCS. (FROM C/L STREET) Q. OF LOT NOW ON LOT FRONT FT. FT. Q USE OF EXISTING BLDG. R SIOF FT FT. N 'ElF Separate permits are required for L.SIDE FT. FT. electric,plumbing and heating work. D REAR FT. FT. F USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& (:1 MAIN BLOCS. ACCESS.SLOGS. Q VAR.#W DATE C.U.P.# APPROVED APPROVED >.. _RY DATE ..7 $§ in C.. o I hereby acknowledge that I have read this application and state n g that the above Information is correct and agree to comply with m L all laws regulating building construction, and I shall not employ i Z any person in violation of the workman's compensation laws of e .SW. the State of California. - 3 I hereby certify that I am properly licensed as a contractor under SG. FT. ry 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 affect,or I THE PURPOSE OF ESTABLISHING A PERMITFEE/ ONLY: to am exempt from the provisions of the State of California Business VALUATION PERMIT FEE E PnV n' a and Professions Coda, Division 3,Chapter 9. a, PLAN CHECK § fa Signature of O Permittee $ TAX § LL F U Authorized Agent TOTAL PAID E / 44367 •1 y JUL 21-77CM5i002408* *** 168.73 r tt tot4lo t'lo4 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 'P IC TION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely — Use Ink Only _ •. / ` - •` v • BY DATE ECEIVED DATE SUED BUILDING --s - t/ - //OW. ADDRESS 2SL. 7 -��.Er 4D' /D' _ (OW - fl-u � _ /— PE- 436 OWNER a7 Lp_. , do�Uesl /r IA.P.NO. — ,,,-,,a13_4. _ BUILDINGMr� ADD �. ,r ,; •- ,r r ADDRESS r i, ��;y a ADDRESS �l}� A/r� �I���.�j TEL. C CITY IY�1/11Ugt TJ3l`YJr) TEL. bail. �� TRACT fta OT BLOCK CONSTRUCTION /�/` 4 f ) t`— ,)�• _ MINIM A R u• s • ,A• lo LENDER C.,f-r /V V/{d• �S ,� pr. _ BRANCH ( M ' ,� 1OWNER r\ es •A ADDRESS *di •P� - C%yC. � ' - ARCHITECT TEL / i. Plgrefficit.' ALL`izair ' V. en OR ENGINEE'AIk—,t 11 01AL_ OL—I .44 FIRE 114 N. h1.1e ✓I ' k �. ZONE APPROVED II ES- GROU�' • T �, ADDRESSCONTRACTOR ,t'a _&atti 4t1t s BY DAT= ' `I ADDRESS 165Mr--.--A ,'.-,s'�" t Z. E NO.OF USE OF N CITY r-,,(264- I` lwA NOL PLANS �, BUILDING ./t. i L /. I` STATE CITY YARDS APPROVED YARDS APPROVED LIC. NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING W SIZE �,/�'�j1 l NO.OF BLDGS. (FROM C/L STREET) �• OF LOT 1981 X../�-/ I NOW ON LOT ROM I FT. G FT. 4 USE OF L/' 41 EXISTING BLDG. B.SIDE a FT. y F Separate permits are required for L.SIDE B FTM 7 •• Atriel FT. electric,plumbing and heating work. L ,_REAR91 FT. A FT. ca I.. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& OMAIN BLOCS. ACCESS.BLOCS. VAR. .a _C U.P#— -/ — /y APPROVED /h...71 'C ^J AnammIlimi oW. 0 1 hereby acknowledge that I have read this application and state 'n 0.v that the above Information Is correct and agree to comply with - 5-6w r{� co r+ all laws regulating building construction, and I shall not employ (Q/1% "^ � _ Z any person in violation of the workman's compensation laws of dill the State of California. // /� _ I hereby certify that I am properly licensed as a contractor under 2 SO(F .IF,� 11 T 7- D W aa N the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR ra` Chapter 9, end 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 Stpte of California Business a VALUATION PERMIT FEE S O and Professions Code,Division 3,Chapter 9. �i - ,/ _ e+ ln- PLAN CHECK $ "/ k, 5• 1\ Signature of/ �/[t/ /// �s / (rs Permittee -/� ���i�.t/�" $ /J6 /n s TAX $ •e U `s�•1 Author zed Agent (/ /s� V TOTAL PAID Er4 lgl.VV�'� 4-4 O / PAID - OCT 31-7707i-4001681 ox**251.00 • COSTA MESA BUILDING-SAFETY DEPARTMENT . P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely— Use Ink Only RECEIVED BY DATE RECEIVED ISSUED 6UILOING /f�i1�r f1^,I O 'E3/r74 ADDR ES 7 (�//F�/V /�.'acrd /� PERMIT NO. OWNER �I/// U �/-�C�J A.P.NO. MAIL BUILDING �54 Etas 47 ADDRESS ADORES �+LJ��t/ TEL. CITY NO. TRACT I LOT BLOCK CONSTRUCTION NEW DD ALTER I REPAIR MOVING OFMOI ISH LENDER BRANCH ��// ✓` OWNER �O{//C6- Ca ADDRESS VALUE ARCHITECT TEL. USE S OR ENGINEER NO. FIRE ADDRESS ZONE TYPE GROUP APPROVED CONTRACTOR BY DATE ADDRESS TEL. ZONE NO.OF USE OF NEW PLANS BUILDING CITY NO. .. STATE CITY YARDS APPROVED YARDS APPROVED LIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING fat SIZE NO.OF BLDGS. (FROM C/L STREET) 3. OF LOT NOW ON LOT FRONT FT. FT. a USE OF .N. EXISTING BLDG. R SIDE FT. FT. rn (x-' Separate permits are required for L.SIDE FT. FT. electric,plumbing and heating work. W- REAR FT. FT. I.. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& Qn MAIN BLOCS. ACCESS BLDGS. Q VAR.# DATE C.U.P.# APPROVED APPROVED } —gY DATE ..1 CS RI 0 I hereby acknowledge that I have read this application and state 'a n yv that the above information Is correct and agree to comply with m 0• all laws regulating building construction, and I shall not employ Z any person in violation of the workman's compensation laws of 2 the State of California. I hereby certify that I am properly licensed as a contractor under SQ. FT. 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: u am exempt from the provisions of the State of California Business ' a VALUATION PERMIT FEE $ and Professions Code, Division 3,Chapter 9. v+ m PLAN CHECK E a5 Signature of C V. Permittee S TAX $ U Authorized Agent TOTAL PAID $ai'7 `0 4 CITY OF COSTA MESA - • BUILDING DIVISION Y V�,,,r , DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER �: <� t PERMIT pplft.m�mte E04-00328 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 2554 DIA AV Status: ISSUED Suite No I DIA Applied: 04/01/2004 Vicinity: Issued: 04/01/2004 Parcel Nunmber: 93585008 Applicant: CONNELL, JUDITH ISSUED BY: Address: 2554 ELDEN AVE.E-104 - - Phone: 949 645-8567 COSTA,MESA,CA 92627 Zip: Owner_- '-CONNELL, JUDITH 0 _ Address - '• � �� � - . CA 'i flip: M r:! 258 . 91 Contractor: , Address: _ Phone: Zip: License: SCOPE OF PERMIT PERMIT FOR REPLACEMENT OF BATHROOM FIXTURES ONLY; 1 WHIRLPOOL TUB, 1 SINK,&1 TOILET(SAME LOCATION)&ELECT. MOTOR&SWITCH FOR•WHIRLPOOL TUB. FEE SUMMARY ' Quantity - • Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test - $0.00 - Busway/100 ft •• $0.00 0 Res.a/c package • $0.00 Standing Section $0.00 0 • New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 _ - -Transformers up to 1 kva/kw $0.00 0 Pool/Spa • $0.00 0 • -up to 10 kva/kw $0.00 0 Lighting Fixts ' .$0.00 0 - - up to 50 kva/kw $0.00 0 Recept Outlets $0.00 0 • ' up to 100 kva/kw- , $0.00 ' 0 Switches - $1.10 • ' 1. - over 100-kva/kw - $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl - $0.00 ' - 0 . Low Volt Wiring System/Ckt $0.00 ' 0 Service to 200a ' ' • $0.00-, - -- 0 , _- Misc,Conduit $0.00 • , 0 Service to 1000a , \ $0.00$0.00 0 - Misc,Conductor -_ - $0.00 0 Service over 1000a $0.00 i • -' ,0 - • Circus(gen or tide) '$0.00 ' 0 , Motors to 1 hp ' $4.75 1 Circus(mech ride or lights) • $0.00 " 0- Motors to 10hp , $0.00 0 • Christmas Tree Stand ' $0.00 ,. 0 Motors to 50hp - $0.00- 0 - Fireworks Stand- $0.00 0 Motors to 100hp $0.00 _ 0 . Other Electrical Fee $0.00 Motors over 100hp $0.00 - 0 , Communication drops $0.00 0 _ Investigation Fee $0.00 Sub panel to 200a $0.00 0 - ' ' -Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days,or if work is suspended or abandoned for a period 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(&00) I r^; 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. ❑ 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: 1 Cartier. Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) 1 ❑ 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. I Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE'HUNDRED THOUSAND DOLLARE(3104000),IN ADDmON TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. I LICENSED CONTRACTORS DECLARATION: 1 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.# Class# Contractor's Signature: Date: 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: I OWNER-BUILDER DECLARATIONS: w 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;den olish,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.theiContractors 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 basts,for the alleged exemption.Any violation of Section 7031.5 by any applicant fora permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ' 'j-7-i, I � / 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 en;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 arenot 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 provirig:that he or she did not build or improve for purpose of sale.). • I ❑ 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 Contractor License Laws.). ❑ I am exe, pt under se Business and Professions Code for this reason: Signature: i, e' �iYf/ c'( cDate: If /(Art (Owner ID ied by driver's license. Ci'Yes 0 No LOdver's License No. Expires: 3/L 3/c Vedficeti. I Ownership by(type of document.i.e.-property tax bill or deed): 1 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: I ❑ 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). I ❑ 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. I Signature: Date: I 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 Noii- (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 Cale 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 Califomia Health and Safety Code been fully complied with? 0 Yes 0 No I 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 U No I (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). I 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 prescnbed 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. I ' Signature: Date: I 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 state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-d scrib pro arty for i action purpos .I agree not to occupy or allow occupancy of any building authorized by thiyermit Jntil final inspection. 1 0( U �O Signature Of Legal Owner(s) �d ate I i And/Or Authorized Applicant Date BODE 11 INSPECTION TYPE DATE MEM LODES INSPECTION TYPE ME INIILDMS 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 4`501 MF 9 CITY OF COSTA MESA BUILDING DIVISION • is4DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 1 1S° Irk* PERMIT 4° 40 nuaarm PO4-00228 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 2554 ELDEN AV Status: ISSUED Suite No b,- ` 04 Applied: 04/01/2004 Issued: 04/01/2004 Vicinity: ISSUED BY: 1!)_ __4A_ Parcel Nunmber: 93585008 Applicant: CONNELL, JUDITH. Address: 2554 ELDEN AVE.E-104 Phone: 949 645-8567 COSTA MESA,CA 92627 Zip: Owner: CONNELL, JUDITH 0 Address - il' - • Phone: LO6'ANCCLCC,CA Zip: 90036-52 t 44 1 • Contractor: - Address: YYYY- Phone: Zip: ' License: Arch / Eng : Address: • ' • Phone: . Zip: License: SCOPE OF PERMIT . PERMIT FOR REPLACEMENT OF BATHROOM FIXTURES ONLY: 1 WHIRLPOOL TUB, 1 SINK,&1 TOILET(SAME LOCATION)&ELECT. MOTOR&SWITCH FOR WHIRLPOOL TUB. • 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 . $9.80 1 Pressure Regulator $0.00 0 • . Urinal, $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. $9.80 1 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) $9.80 1 Drain, Roof $0.00 0 - Shower $0.00 ,"0 Water Heater/vent $0.00 0 DrinkingFountain $0.00 0 Sink,bar r $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 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(6/001 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. ❑ 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 Ls Issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (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 provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UPTO ONE HUNDRED THOUSAND DOLARE(5100,000),IN ADDMON 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 provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in lull force and effect.Llc.# Class# Contractors Signature: Date: 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: I 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 arid 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 sub' ets the applicant to a civil penalty of not more than five'hundred dollars(5500).): I U //n as owner of the property,or my employees with wegea'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 doe's 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 who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). qJ{ con ❑�1 am exem t un r s Business and Professions Code for this reason: Signature: .' y v 'Dale a (Aq Owner ID ve'I d by drivers license. \[❑Yes ❑No r cDnver's License No. „Expires: ?/13/0-C Verification wnership by(type of dorument 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 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? ❑Yes ❑No (Section 25505 of the Califomla 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). I 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 nt of of the Californiaby Health and Safety Code provides that the ly z Mesa Fire Department with tt 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. I 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑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 gernit 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 LJ No (Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits). I 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 ❑No B (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 la and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described p party for i tion p s.I agree no o occupy or allow occupancy of any building authorized by this permit ntil f al inspection. \,-," Signature Of Legal Owner(s) Dat — I C _1 And/Or Authorized Applicant Date CODE/ INSPECTION TYPE gAIL INTRIALS CODE JNSPECTION TYPE gdIE BMW 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical I 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 CITY OF COSTA MESA 4�. .. 'BUILDING DIVISION oq.�..4 H DEVELOPMENT SERVICES DEPARTMENT PER T NUMBER PERMIT 03-02078 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.BWLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2554 ELDEN AV Status: ISSUED Suite: E Applied: 12/02/2003 Vicinity: Issued: 12/02/2003 Parcel Number: TPN003180 Zoning: Applicant: HARTMAN, HEIDI L Address: 2626 NEWPORT BL ISSUED BY: Phone: (949)548-1645 COSTA MESA,CA " Zip: 92627 Owner: CEDAR GLEN HOA Address 2554 ELDEN AV Phone: N COSTA MESA,CA - Zip: 92626 Contractor PETRONELIA 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 OFF EXISTING ROOF SYSTEMS AND INSTALL 1/2'CDX,COVER WITH CLASS 1 EO YEAR COMP SHINGLES ON SLOPE AREA OF ROOF.ONE LAYER OF TORCHDOWN ON FLAT ROOF AREA. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $7,360.00 Permit: $153.25 • Claim Valuation: $7,360.00 SMIP Res: $0.74 SMIP Com: $0.00 • Other: $0.00 Inspection: $0.00 • Total: $153.99 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 • ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work is not commenced withln.180 days,or If work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections end final approval must be obtained.Failure to obtain inspections and final approval will result In the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6I ) DECLARATIONS WORKERS'COMPENSATION DECLARATION: , I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the lork for which this permit is issued. I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.ci My work mp nsatign Insurance�rd$�and poli mbar ar�. Cartier: i� �L�alued %LCiGn— Policy Number: 4S9 7 IPr2 CJ —R/_3 (This section need not be completed A the permit is valued et one hundred dollars(.5100)or less.) ❑ I certify that In the performance of the work for which this permit is issued,I shall not emp141any person in any manner so a to become subject to the workers' compensation laws of California,and agree that if I s Id be erne subject to the workers'compensation provisions of Sec n 37 of the Labor Code,I shall forthwith _comply with these ro ' i .ApplicantSignature: ? et' n .0vr� �_ Date: I/1- 03 WARNING:FAILURE TO CURE WORKERS' TION COVERAGE IS UNLAWFUL MD SHALL SUBJECT M EMPLOYER TO CRIMINAL ENALTI S AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDMON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3709 OF THE LABOR CODE,INTEREST,MD ATTORNEY'S FEES. t "LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Buslnesgpn ss' ns Code,and my license Is in lull force end effect.Lic.# �p • • �y,. Class# (,i 6611yyAAJJ// 2-/cam'. Contractor's Signature: \ W lir- .lSG�i - Date: CONSTRUCTION LENDING AGENCY: I ❑ 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 toe 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 properly,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 ❑ 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(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 e 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 al 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 materialsr 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 a future bullding 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 _ _—.._.t.._e building _ _._....Wcon ._.� 5 Does he willo the oast Air present a future D isdioccupant at requirer for the work which Is the subject age of this application a0 Nnit for such construction or modification from the South Coast Air Duality Management District or from any other air pollution control district or agency? Yes LI No I (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 contni 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"yet,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. r&gm • Legal•;r: s) -// �7`'�1�/-��DJate �_ I2l 21.4a:3/ate •nd/Or Authorized Applicant I ODE INSPECTION TYPE MAIL =AU LODE I INSPECTIONTYPE PATI _____ 1618 Fixed System Final Fire Prevention 208 Final Mechanical 1266 Pool Spa Final `/1 208 Final Plumbing 200 Final Re-Roof 7'2 6(L 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 PROJECT ADDRESS: 2554 ELDEN AV UNIT:E104 CITY OF COSTA MESA — BUILDING PERMIT ' PERM NO; M 061897 OWNER'S NAME: JUDITH CONNELL ADDRESS: 2554 ELDEN AV PERMIT NO: M 061897 PLAN CHECK NO: N GOVT: N SUPP: N COSTA MESA CA 92627 CONSTRUCTION TYPE: PERMIT TYPE: MEC G, PURPOSE: DTH " ARCH/ENGINEER: ( 714 ) 646-2014 flEG.NO.: ADDRESS: UNIT: JOB DESCRIPTION : CHG. OUT A/C UNIT 6 FAU SQ FT: I'--- CLAIM VALUE: CALL—VALUE: GROUP OCC: / PERMITTEE:PRO—FORMANCE INC. ( 714 )779-6868 ADDRESS: 4085 E. LA PALMA COMMENTS: CHANGE OUT ONLY ANAHEIM CA 92807 a*******************•*+t********Te#******#*#*******TEN•>E ********T6*+EBF****r.**#IE+E**+txdc LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS 7000)of Division 3 of the Business and Professions Code,and my license is in lug force and effect. SETBACKS CITY uc.:0 4 0702 STATE uc.4 8 3 41 1 cuss:C—2 0 Date:_IP 221 I q—1 Sgnature:=f`��C Cas MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR : FT IN FRNT: FT IN REAR: FT IN Compensation Insurance.or a certified copy thereof(Section 3000.Lab.C). LEFT: FT IN RGHT : FT IN LEFT: FT IN RGHT: FT IN POLICYNO.:BWC220724 EXP.DATE: 09/12/93 C=MPANY:HIGHLANDS PARKING REq• PROV: PARCEL : 00000000 ZNE: REF NO; ❑ Certified copy is hereby furnished. EJ Certified copy is filed with the city Building Division. PLANNING NOTES> Date: i/)'-7 /q7 Applicant: v l c C l"a **********************##*************44**#*****1E********#*****#*#************** EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (Pis section need not be competed if the permit is for one hundred(5100)or less). DEVELOPMEN T SEVVICES REQUIREMENTS 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, _ ZONING APPROVED BY DATE: Date: Signature: NOTICE:II.after making this declaration.you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : DATE: Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y: r \- /` DATE; y/2]/f 3 t which this permit is issued(Section 3097,Civ.C). ***********************it, t< ***it***..**#*•**r *###� #it*#4t*xx#**********Kei Xn•**x-A Ls*LE* • LENDER: *********************************************** **********#*****************J.•** ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMEN4•,:N OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from theContractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 18 . 00 repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business 2 5 t SMIP/NON—RES and,Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE 15. 00 I. as owner of the property or my employees with wages as their sole compensation. will do the work. and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS—---> 18 . 00 15 . 00 0 . 00 33 . 00 33 . 00 . 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through his or her own employees,provided that such improvements are not intended or Offered for sale. 1.however the building or improvement is sold within one year of completion•the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED: 33. 00 OVER/SHORT: 00 forthe purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK I,as owner of the properly,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 33. 00 ❑ and Professions Code: The Contractors Slate License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware *************************************************************************.****** that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: B.8 P.C. IND I V IDUAL F E E BR E\ K D O W N for this reason: TYPE QTY DESCRIPTIO N \. UNIT COST TOTAL COST I Date: Owner: MEC 1 INST FORC—AIR/GRAV FURN <= 100 K BTU 9 . 00 9 . 00 I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and NEC 1 REFRIGERATION SYSTEM <= 100 K BTU/H 9 . 00 9 . 00 25534 and that I or any future building occupant wilUwill not(circle one)need to comphy with said state codes and the requirements for a permit for construction or modification from the Ah Duality Management District.Residential construction applications are exempt from END OF FEES these provisions. Elate: Applicant: I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction and hereby authorize representatives of thus city to enter upon the above-mentioned property for inspection purposes. M,-, Date: -Li /D-1. ' `e ) signature: —in—\\ eC Ctac-s 01 00138011-00138011 TOT 33.00 Driver's License or Social Security Applicant:Pink—Revenue;Goldenrod—Assessor • ' l -__F • /CONSTRUCTION AND PLANNING POO., ar SPA I APPROVALS Permit Date Inspector APPROVALS Permit ; Pate Inspector 1, Temporary Electrical Serviceor Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Urt-grnd. 54. Forms 4. Electrical Conduit-Urdrvnd. 55. Electrical Bonding i 5. Steel Reinforcement 56. Rough Plumbing & Pr--;art T,a ` - 6. Electrical UF ER Grnd. 157. APPROVAL TO COVE H•Gt'NITE I --t j 7. Footings - I __ 58.1Electrical Conduir.Undrernd. - -� 111 -J.----+ 8. Foundation I 59. Gas Pipe, it Undine J , list ' 9. ',Neter P1 Pe-Undr red. _-- --- ____,I__-_ ^-'�--- 9 60. Ridavash Line., P Trap J^9•ania 10. Structural Floor System I 61. APPROVAL TO DECK I I 11. Property Sewer Line & House Connection - I 62. 3acke.ash & Receptc' Gina' 12. Sauer Cap 1 63. Heater & Vent-Final 13 Roof Drams 64. Plumbing System F•'i l i- - i "- 14. Roug` Run-thing -- +- IV 65. Ekctrical-Final r -1----" 15. Rough Electrical-Conduit 66. Solar System-Final �- -J- 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 1 18 Rough Electrical-7 Bar Ce.l'ng 69. POOL'SPA SYSTEflS FINAL I 19. Rough Heating & Ad- Cord t,omr,g I FIRE DEPT. REQUIREMEICT 20. Rough Factory Fireplace 1 APPROVALS Permit ;r_ 21. Ducts,in Structure 70. Underground Hyuro I 22. Ducts, Ventilating 71. Product Rping Fi Gas Li Oil I 23. Gas Pipa-Rough & Test I-_- 72. Underground Audi 24. Roof Framing I 73. Undergrnu_Stor3i_• -:_r.k C G_, J I 1-7 25. Roof Shr atiii Ca -- - -�II -1- 74 Ocr•cr d Hymn�- - - -- 1 -- -- - - - - - L - - ' --- -- - 26. T•Bar Ceding (Strucrur.:a Li k.'o.•ocout I 75 Dry Chem:cat ---! _ 27. Frame and Flashing 76. Dry Stanu'p;pc -_-- - _- 28, Lath,ng& Srd:rg _-- -- - /7. FIXED SY;i El INAL ---- -- -~-- -- 29. Insu4rt.un 78. FIRE PREY. FI_NA!-- -- L _, . _ 23. 9.::..i'. ,:c,ling I HEALTh DEPT. HEOUIRE.,EreT - --- -I 31. P...4t, i R oval Coat 1 I 79. FINAL INS"FCTIN': - - i I- -- -.___ _ ...t__... __'_-__ _.___ ._ _ __ _ ._ ___ L_ ___ 32, Elect!.ca l Poe !.:et,./•T 1 r„ + 30. FOOD CERT:FP:ATI „'! I) 33. Final Electric -_----- ! Notes: - _- _-- -` - - --- - - _1_ -_ - 34 Fine) Heating Ei Aar Cc7 _,t ,., 77 4Sish iLep 4. I - - -- - ------- - - -- - - -- - - ---- 35. Final Gas PIpe.Te.t 36. Hee:: or CacopY -_-_ -- -- _ -_-_-- - _ _- -1 -_-_ 37. F.nal Factory Firep.ace T- - - - - - 38. Final Plumbing 39. Water Service-Final rr i 40. Gas Service-Final .- I - -- ----- --- 41. Solar Domet'c-F'ra ' 42. Backf low Preventer 43. Backflow Irrigation - -- ---"'-- -------- - -- --- -- 44. Landscape Irrigation SysteiT - 45. Sound Attenuation f I • 46. Handicap Regulat:ons --- I - -- - ----------- - -- ^ . 47. FINAL STRUCTURE 1 BUILDING 48. ANAL PLANNING VI. . 49. Electric Release to Edison 50, Gas Release to Southern California Gas Co - 51. CERTIFICATE OF OCCUPANCY No. Date COIL O/ I ,J/Du G/oOU lL. Applicant to fill in all spaces except those within heavy border tines and sign all appropriate declarations. • CITY QE COSTA MESA CONSTRUCTION PERMIT (- P�E�R�MIT1N/O..(� TRACT NQ. LOT NO. UNIT NC' •; Project Address 2rrl F/dev ' /O/ - E . [7C 4 U-1 6:14/0c•;1• (O� I • - AppliCant's Mailing Address TYPE OF CONSTRUCTION U NEW U ADD R/O ALTERATION REPAIR v ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.{fe y.3C�_ {a� _`' I Zone ;Q 2 Owner's Name AAAPAI ,4496 alec'r/vnr� Phone DESCRIPTION OF VVVjjj(((QQQRK/USE O BLDG. e Address 49 wN C-o.•73ae- C.'!C •s-400 /Dk/G/B/.//4( �`t/S /�,P S x/ (S4-Ai'r S Main Building:, Accessory Building: •Arch/Eng. License No. TYPE OrP1PERMITIIqq GRADING FOUNDATION big-SfRUCTV RAL T Front ^,l 0 Address • LI TENANT 0-ELECTRICAL 0 PLUMBING ❑ MECHANICAL R B Rear • K X' /✓ / 1 1 p // 0-OTHER yr/t.J- g /t"/L' Contractor's Name D(•C/NP �•7 U/iG�,�rT Phone C Right tV N PROJECT DESCRIPTION so pp77 OCCUPANCY G Address lmailing) - 1/ —lam, K1/10 /t CONSTRUCTION TYPE ^!Y VALUATION 5 k��L^7 S Left n� LN/ ( - R ' City License No. - ZONE GRADING CU.YDS. ACRES ///��� ...ttt - 'LICENSED CONTRACTOR DECLARATION - - Ping. Ref.ire �� -.A ,l� /rErk barking Req./Provided E I hereby affirm that I am licensed under provisions of Charter 9(commencing Remarks: P=, ..t&& /60 - 73-s $E-70/2- Planning Notes: (2" _,Asti,`(!'/" U M with section 7000) of Division 3 of the Business d Pr fessions Code,and -/-fes _ my license is in full force and effect. .'Ifw`)� / n rZ/� /�� T License Class Lic0oa6 `/ _/�? J J - S Date ' Signature PLUMBING FEES • WORKERS'COMPENSATION DECLARATION Bar Sink • Showers . I hereby affirm that I have a certificate of consent to self-Insure or a certificate ELECTRICAL FEES of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer ' Service Sink - 3800,' Lab- C.) .. .. - - - - .. Automatic Washer - -. - Transformer ❑ 15-50 KW - --- P - Construction Pole Sub. Policy No. Company Backflow Irrigation Sewer Ca ❑ 50'+KW Certified copy is hereby furnished. Certified copy is filed with the city Building Division. Bathtubs Sewer Connection' - Cooking Unit Meter ❑up to 100 amps Date Applicant ' EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers • Solar Collectors:. Dishwasher • ' Meter Dover 100 amps (This section need not be completed If the permit Is for One hundred($ .0)or - - . less). -- - Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel I certify that in the performance of the w• •r Ichs •„J;.• a -d, I shall,not employ any person in any ���} s '•rt`.� . .rt!,/t to the Drinking Fountains Solar Tank Fan Motors❑41 HP Di'4:8 , Worker plop Ion Laws of Calif.+11{� / • • X . Date ...3 Signature Sass .At��.y Floor Drains Swimming Pool w/Spa F.A.U. 5 / Inc.Solar'❑9.15 HP ❑16-15+ 'NOTICE: If, fter making this soclar- ton,he you /•ul• become bject to the • Workers' Compensation provisions of the Lab. Code, you must forthwith Floor Sinks Urinal •Fixtures ' comply with such provisions or this permit shall be deemed revoked. I .Microwave - -_ .- CONSTRUCTION LENDINGAGENCY Gas Service •Outlets ,Water Closet Device Boxes ' I hereby affirm that there is a,constr action lending agency for the'performance - POI¢.Light , of the work for which this permit is Issued (Section 3097 Clv. C.) Interceptors: Water-Heater Outlets Range Lender's Name - Lender's Address Kitchen Sink. Water Service • Switches 'Sign OWNER BUILDER DECLARATION ' I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories • - -Auto-Wash • Garbage Disposal following reason (Section 7031.5 Business and Professional Code: Any city or Standing Sections county which requires a permit to construct,alter,improve,demolish or repair P-Trap . Laundry Treys Generator 00-5 KW❑5-1$KW any structure, prior to Its issuance, also requires the applicant for such permit - Trash Compactor to file a signed statement that he/she Is licensed pursuant to the provisions of Roof Drains • q ) the Contractor's License Law(Chapter 9 (commencing with.Section 7000)of - /•u /{`t0� /� Division' 3 of the Business and Professions Code) or that he/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 . - - anally of not more than five hundred dollars($500). • U I,.as owner of the property or my employees with wages as their sole Reinspection Fee I $15 - Issue Fee $ 3 compensation, will do the work,and the structure-s not intended or offered • Reinspection Fee ' $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES License.Law does not apply to an owner of a property who builds or Improves thereon, and who does such work himself/herself or through his or her own • - DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such Improvements are not Intended or offered for Boiler Hood or Type 1 ❑ sale. If, however, the building or Improvement Is sold within one year of corn- Canopy Type II ❑ Zoning Approved By 0lb i Iwo Date //per` 6t5pletlon, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved Bytag Dab fL.�7/� w. prove for the purpose of sale). p J ..,e ,4 - Dat L J\• tractors to construct the project (Section 7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property who Duct-Ventilating • ❑0-100,000 BTU ❑100,000 BTU SUMMARY OF FEES builds or improves thereon,and who contracts for such projects with a con- - ,. !e tractor(s) license pursuant to the Contractor'i License Law)- I am aware that Exhaust System ❑ Multiple❑ System Repair/Alteration • BUILDING PERMIT $ 10' r- SMTP $ U proof of their Worker's Compensation Insurance should be prov ed to me. • PLAN CHECK $ I (n •SO PERMIT 0 I am exempt under Section this reason Firepl/Fact.Blt. ICBG# Fire Dampers. PLUMBING $ PERMIT ISSUANCE $ Date owner Heating,System& Ducting Registers ENERGY P.C. $ • -. _ PLAN CHECK 25% $ 1 hereby. certify that I have rea is ep ICatIon and state that the above E10-1op,000 BTU D100,000BTL ELECTRICAL $ [�J-OO GRADING $ Information is correct. I agree to comply with : city and county ordinances - - and state laws r: ting •building c•n , and hereby authorize repre- , PLAN CHECK 50% $ 7 -S O� MICROFILM $ s • ig at ure of t r. ante I �'•ove-mentioned property for inspection p 2-7 .�O i ,i.I� s7//71W - MECHANICAL .$ TOTAL FEE $ - ' Signature �• Date 2 ' x Drivers' License Or SS ' C Pink -Accounting; Goldenrod - Assessor- - - - - - - - - l CONSTRUCTION AND PLANNING - ` - POOL &SPA •APPROVALS"- Permit# Date Inspector APPROVALS . Permit# • - Date Inspector 1. Temporary Electrical Service or Pole - - 52. Pool & Equipment Location . 2. .Soil.Pipe-Undrgrnd. - ,53. Steel Reinforcement i 3. Electrical Conduit Utility-Undrgrnd. . - - 54. Forms 'i/-• ri . 4. Electrical Conduit-Undrgrnd. - 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical OF ER Grnd. 57. APPROVAL TO COVER-GUNITE •,/ i �• 7. Footings /' !n"n 58. Electrical Conduit-Undrgrnd. ,'r ! 8: Foundation 4 59. Gas Pipe, 0 Undrgrnd.,Test - �• 9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd. ' 10, Structural Floor System ,,.' 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection ' ' / ,.t. ,, 62. Backwash & Receptor-Final •. 12. Sewer Cap t•# 63. Heater & Vent-Final "r 13. Roof Drains - • 1 64. Plumbing System - Final , 14. Rough Plumbing _ • 65. Electrical-Final 15. Hough Electrical-Conduit - 66. Solar System-Final • 16. Rough Electric Wiring - - 67. Fencing & Access Approval 17. Rough Wiring Sign - 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling. 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating &-Air Conditioning FIRE DEPT. REQUIREMENT . • 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure • 70. Underground Hydro 22. Ducts, Ventilating' 71. Product Piping 0 Gas ❑Oil 23. Gas Pipe-Rough & Test ' - 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas OOiI 25. Roof Sheathing • - 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing /414/41( - 76. Dry Standpipe . 28. Lathing & Siding . 77. FIXED SYSTEM FINAL 29. Insulation - - 78. FIRE PREV. FINAL 30. Drywall Nailing - HEALTH DEPT-. REQUIREMENT 31. Plaster Brown Coat - . - 79. FINAL INSPECTION 32: Electrical Power.Meter-Final 80. FOOD CERTIFICATE ISSUED '. 33. Final Electric 1`ii) si .ri0d Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test - 36. Hood or Canopy ' 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final • 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer . 43. Backflow Irrigation 44. Landscape Irrigation System . 45. Sound Attenuation 46. Handicap Regulations • ' - 47. FINAL STRUCTURE & BUILDING 17/8 c' Ai • 48. Special Requirements Completed L 49. Electric Release to Edison - - . - . -• 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY - No. ' Date - - -- Applicant to fill in all spaces except those with heavy border lines and sign all appropriate declarations. CITYoE_coSTA MESA CONSTRUCTION PERMIT I pr1-i V . co‘ T LO (3.0 /NIDT O. E Ploject Address _Acre/ E(a'�a��e-N &/74 c-/o" i 11�11 D,r'/ ,L,�' 1473 6/01 /84 26.90 'TI.• Applicant's Mailing Address Reg-e_.- - f/"' bys_/9Zrr TYPE OF CONSTRUCTION `I�WEW X]IADD ALTERATION LI REPAIR Owners Name aigNe. Y2g-e_Z pi Ile C9,-7o ' ' ❑ CONVERSION ❑ DEMOLISH ❑ OTH - zi A.P.46 935 -550-e6 Zone 12-Z �,,I DESCR IPT I•N OF WO R K/USE 0 BLDG. A" S G/ 6 G Address C .I'e- /, . 4- . _.-- , / • >c _ • S Main Building: Accessory Buildin : E iet Z Arch/Eng, License No, TYPE OF PERMIT . GRADING M FOUNDATION 4 STRUCTURAL T Front • 0 Address s / 0 TENANT 0 ELECTRICAL 0 PLUMBING 0 MECHANICAL B Rear j/v7cd // N •Contractor's Name CS�Q(//G{/eQs i/ Phonda3'Z--e/6/ ❑ 'OTHERC Right C✓A// N Address(mailin )_ Z'/e• ene.n,4. ar3A2F'gr5.e/a"zPROJECT DESCRIPTION SO. FT.�� - OCCUPANCY KG g 3 / CON ST RUCTION TYPE VALUATION$ 900, S Left R City License No. 1/61 ZONE GRADING CU.YDS. ACRES LICENSED CONTRACTOR DECLARATION Ping. Ref.# �Q �) Parking Req./Provided J�J,/(/�/'7+' E I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: v 4.. -L/ M with Section 7000) of Division 3 of the Business and Professions Code, and ' C C �w my license Is in full force a it effect. - - T 42 • Licen • a seen • 0,17/-L �L fti tis /-t I,s+filNk.. S. Date • /tf Signature _ _ . .f. _Jt PLUMBING FEES Z/ WORKERS' COMPENSATION DEC • RATION ^ I hereby affirm that i have a certificate of consent to self-Insure or a certificate Bar Sink • Showers • ELECTRICAL FEES of Workers' Compensation Insurance, or a certified,copy thereof (Section Backflow Preventer _ Service Sink . 3800, Lab. C. - - - - - - Automatic Washer - - Transformer 0 15-50 KW . _. „.• 360 No. 147 -rConran Core- Cor- Backflow Irrigation ' Sewer Cap _' • . ❑ 50+KW 3 Company Construction Pole Sub. Certified copy is hereby furnished. - Certipee otiVs filed with the city B Ing Div, n. Bathtubs Sewer Connection Cooking Unit Meter ❑up to 700 amps Date 6/ /'✓7 Applicant - - EXEMPTION FROM WORKERS'COM ENSATION DECLARATION Clarifiers Solar Collectors!. Dishwasher Meter Dover 100 amps (This section need not be completed if the permit is for one hundred ($100)or - - less). Dishwa3her Solar Piping • Dryers ❑Gas ❑Electric Sub Panel 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 Drinking Fountains • Solar Tank •• Fan Workers' Compensation Laws of California. _ Motors❑0-1 HP ❑1W-8 , - Date Signature Floor Drains Swimming Pool ev/Spa' F.A.U. Inc.Solar 09-15 HP 016.15+ NOTICE: If,after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks . _ Urinal - Fixtures Microwave comply ,with such provisions or this permit shall be deemed revoked. - CONSTRUCTION LENDING AGENCY: Gas Service Outlets Water Closet Device Boxes • I hereby affirm that there is a construction lending agency for the performance Pole Light of the work for which this permit is issued (Section 3097 Civ. C.) Inters¢ tors Water Heater - Lender's Name P Outlets Range • Lender's Address Kitchen Sink Water Service Switches ' Sign OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories following reason (Section 7031.5 Business and Professional Code: Any city or _ Garbage Disposal Standing Sections county which requires a permit to construct,alter,improve,demolish or repairP-Trap any structure, prior to its issuance, also requires the applicantforsuch permit Generator 00-5 KW 05-15 KW Trash Compactor to file a signed statement that he/she Is licensed pursuant to the provisions of _ Roof Drains - the Contractor's License Law(Chapter 9(commencing with Section 7000)of - Division 3 of the Business and Professions Code) or that he/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). o I, as owner of the property Or my employees with wages as their solo Reinspection Fee I $15 Issue Fee $ 3 compensation, will do the work,and the structure is not intended or offeredReinspection Feb I $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL ,j FEES License Law does not apply to an owner of a property who builds or improves t thereon, and who does such work himself/herself or through his or her own Boiler Hood or T e I ❑ DEVELOPMENT SERV EDU E EN S: employees, provided that such Improvements are not Intended or offered for _ yP /- sale, if, however, the building or improvement is sold within one year of com- Canopy Type II CI Zoning Approved By Date W-/-RSI pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under GroundBuilding Approved By Date rove for the purpose of sale). • I, as owner of the property,am exclusively contracting with licensed Con- Duct-Structural Refrigeration System Application Issued By Dat tractors to construct the project (Section 7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU ❑100,000 BTU SUMMARY OF FEES builds or improves thereon,and who contracts for such projects with a con- /�7 0'Ca I tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ / SMTP • $ proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ le•tit PERMIT • ❑ 1 am exempt under Section B.& P.C.for this reason Firepi/Fact.Bit. ICBG# PLUMBING $ ISSUANCE $ Date owner - Heating System& DuctingPLAN CHECK 25% $ ENERGY P.C. $ I hereby certify that I have read this application and state that the above 00.100,000 BTU 0100,000 BT ELECTRICAL $ GRADING $ information is correct. I agree to comply ith all city and county ordinances and state laws r ating to building • ction, and hereby authorize repre- - PLAN CHECK 50% $ MICROFILM $ sentatives of th city t• •Iter, •pa the above-mentioned p for inspection our s, • //yo ,f / 7 MECHANICAL $ TOTAL FEE $ ���o Signature ,LR— Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ CMF 0865-46,rev,4 84 - / White-Building;Canary-Applicant;Pink-Accounting;Goldenrod -Assessor r 'CONSTRUCTION AND PLANNING ,,/ =- - POOL &SPA 'r APPROVALS Permit# Q -/3S[� Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole . 52. Pool & Equipment Location - 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement i 3.'Electrical Conduit Utility-Undrgrnd. - 54. Forms -' • 4. Electrical Conduit-Undrgrnd. 1 55. Electrical Bonding ' 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. ,Electrical UF ER Grnd.' 57. APPROVAL TO COVER-GUNITE 7. Footings . - 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System • 61: APPROVAL TO DECK 11.,Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final I i 14. Rough Plumbing 65. Electrical-Final 1 15. Rough Electrical-Conduit 66. Solar System-Final - ' . 16: Rough Electric Wiring • 67. Fencing & Access Approval _17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18) Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning • FIRE DEPT. REQUIREMENT 20: Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in'Structure 70. Underground Hydro . I 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil I . 1.!23:0 Gas Pipe-Rough&Test 72. Underground Flush i� -.24.,Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 127! Frame and Flashing /Q/S/scr -6_5 76. Dry Standpipe '28. Lathing& Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing '1- HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final • 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning ' 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace ' 38. Final Plumbing 39. Water Service-Final - ' 40. Gas Service-Final 41. Solar Domestic-Final - 42. Backflow Preventer i - t 43. Backflow Irrigation , I - , 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations - 4 - i 47. FINAL STRUCTURE & BUILDING `�-lshcf .D5' 48. Special Requirements Completed ' 49. Electric Release to Edison - 50. Gas Release to Southern California Gas Co , , ' 51. CERTIFICATE OF OCCUPANCY No. Date , • mr. ' 47 10/26/79 20.30 TL . -COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT PLG.BOX 1200 COSTA MESA,CALIFORNIA 92626 REG BY PERMIT - For Applicant to Fill in Completely — Use Ink Only PERMIT � �0 4 9 0 5 8 ADDRESSBUILDING 2SSV eC Aid/ F/Q/ A.P.NO. 9JS U✓ BUILDING c 5T /. ,0/ OWNERORGd7-G�&-Z ADDRESS T EV CV V /7 UNIT OR MAILING ADDRESSZSS� CG O��(// �U/ SPACE NO. /D ,s TR. •. LOT ALK. TE CITY COST/; ! _4- N• r — 7;rt; IA( Apr N' ADD ALT R REPAIR MOVING DEMOLISH CONSTRUCTION LENDER BRANCH OWNER J///JJJ• ��n -n L ADDRESS USE 2 VALUE s ALUEE / •^ARCHITECT TEL. OR ENGINEER NO. ��JJ ,/ ADDRESS ZONE,1 ? PE ' GROUP J CONTRACTOR C/A(/f ._54y j/&t'/r' J4I� APPROVED„\\ DATE �0��/� A DORESS /,7O �/ SXy4494 C40.1 1 TEL CITY //iL (/z*c CA/ NO,S�s(/ F STATE 22�j a CITY APPROVED SETBACKS �” LIC.NO.,J(JD�'9SS LIC.Nt/�2Z W SIZE NO. BLOCS. (FROM C/L STREET) 6. OF LOT NOW ON LOT DONT �B. . 1 Q USE OF FC0044)(0C0044)(0 /l EXISTING BLDG. CUez.GI R.SIDE NT. L to FSeparate permits are required for L.SIDE T. O electric,plumbing and heating work: REAR FT. SU r..., USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION Q 0 ':1 /A/57796 Z..- SKyL4,,e/TS (2) APPR vt APPROVED > /i✓ G/I///i/G IXn/ APPROV ��/� / // / CCC��j ,..1 C • / / W QI hereby acknowledge that I have read this application and state N g. that the above information is correct and agree to comply with L all laws regulating building construction, and I shall not employ s Z any person in violation of the workman's compensation laws of Sthe State of California. m 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 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 / and Professions Code,Division 3,Chapter 9. VALUATION PERMIT FEE E /Z• 00 n Signature of /� �yPLAN CHECK E •QO Cl Permitteenatur $ /ti o or 0�2 %2a/t TAX E s(� V Authorized Agent Date / G�79 TOTAL PAID s 44363aJUL 21-77PAID 07002404* ****16.10 . .COSTA MESA BUILDING-SAFETY DEPARTMENT f P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APP IC• ON FOR STRUCTURAL PERMIT For Applicant to Fill in om letely — Use Ink Only D TEI SUE BUILDING ADDRES2554 /dee. 11c /t RECEI s •�:.j..• CEI /O j/ r� 1 VV� fd O 7(J Ti r/ 'T i PERMIT/ NO. OWNER A.P. p. Y /J C -fDI�R � 1n ADDRESS BUILDING ZsLsq GL P4 6' MAIL 1012:2:505R i/I ` • l�� I!. ADDRESS �y� CITY 4IA elJl\ . ff TE NOL W TRACT LOT BLOCK CONSTRUCTION Cf4lOSN/PN li N ADD ALTER REPAIR MOVING DFMRI KH LENDER 'v) \ht I C' ^' BRANCH n7�y 1�A OWNER 6U�.,7� EY ADDRESS 705 Clli1�;'�� a /111 ��'��rJJJs � � ARCHITECT 1(�y,IM_J.y / TEL /J� USE•_a'' cow OR ENGINEE ILs-ter/ o�`f�i NO. �(Q./ abet ADDRESS 144 N . ""' ( j . ZIREZONE GROUP rj CONTRACTOR 9-�.� rifw .- h N,. APPROVED • DATE yD "J��7�' ADDRESS 1(.. -S. IF31^ ZO1.1� NO.OF USE OF N /f plfl� CITYC 111 M TEL ' z(� PLANSttrGUILDING IJ66•eti.444 F STATE CITY YARDS APPROVED YARD PPROVED gLIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING/� W SIZE r^.r� IN .OF BLDGS. (FROM C/LS -ylEE B. OF LOT Icrf J X 035 I NOOW ON LOT FRONT �A(L/J FT. FT. _ Q USE OFC13 /��7 EXISTING BLDG. R,31DF . (FT. _ FT. HCPI 4? 1311/4,1-V1 Separate permits are required for L.SIDE �I FT. FT. electric,plumbing and heating work. REAR 46 FT. Vary)tyr it7 /J sr'( FT. E.., USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& • GMAIN BLDGS.` �j / ACCESS.BLOCS. Q 1 DATE L. .- C U.P.n,. - / /'�'y APPROVED 5---/G —77 APPROVE .rl RY MATE .40— 3f-77 Cd W A. I hereby acknowledge that I have read this application and state N N. D4 that the above Information Is correct and agree to comply with m 15.1 all laws regulating building construction, and I shall not employ Z any person in violation of the workman's compensation laws of ' 2 the State of California. /11 I hereby certify that I am properly licensed as a contractor under CI SO. FT. a the State of California Business and Professions Code, Division 3, THE MOUNT SHOWN UNDER VALUATION IS FOR D Chapter 9, end 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 FEE Se Y VALUATION and Professions Code,Division 3,Chapter 3. u. In i ,�� PLAN CHECK E f��A ^I • Signature of _ p Permittee ./i����, I��i% $al TAX 5 V Authoriz.• Agent TOTAL PAID $ 7 ,41,0 PAID • n—, • 44436 7 I OCT 31-77?Nsh001683 ts****24.00 • COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely —Use Ink Only s..,/be / sfi S RECEIVED BY DATE RECEIVED ADORES S�SVELDC - DAiI- 7 OWNER�U� . ��ss PERMIT NO. j� r � A.P. NO. BUILDING � &i b C. ADDRESS ADDRESS L TEL. TRACT I LOT BLOCK CITY NO. CONSTRUCTION fIEW IADD ALTER I REPAIR�MOVINO nFMDI ISH LENDER � BRANCH OWNER VQ en-SC' Fi y/ ADDRESS VALUE 7 ARCHITECT TEL. , USE 3 OR ENGINEER NO. FIRE ADDRESS ZONE TYPE GROUP APPROVED CONTRACTOR BY DATE ADDRESS TEL. ZONE NO.OF USE OF NEW PLANS BUILDING CITY NO. -. STATE CITY YARDS APPROVED YARDS APPROVED LIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING W SIZE INO.OF BLOCS. (FROM C/L STREET) 0. OF LOT NOW ON LOT FRONT FT. FT. Q USE OF u EXISTING BLDG. R.SIDE FT. FT. rA E— d Separate permits are required for . L.SIDE FT. FT. electric,plumbing and heating work. WREAR FT. FT. i.. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& O MAIN BLOCS. ACCESS SLOGS. VAR.* DATE ', C.U.P.# APPROVED Q APPROVED >+ —IELY _DATE .J a 0T.I. . — 0I hereby acknowledge that I have read this application and state n CC that the above Information is correct and agree to comply with n m all laws regulating building construction, and I shall not employ i z any parson in violation of the workman's compensation laws of o SW the State of California. I hereby certify that I am properly licensed as a contractor under SQ. FT. co the State of California Business and Professions Coda, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR fe 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 'a VALUATION PERMIT FEE f and Profms{ona Code,D{vis{on 3,Chapter 9. 2 f n PLAN CHECK $ Signature of o o Permittee S TAX $ LL IL U Authorized Agent TOTAL PAID 3,9 ADDRESS Of BUILDING: 2554 ELUJtN—AV UNIT: D-103 CITY OF COSTA MESA — BUILDING PERMIT vNERS NAME IF KNOWN: MONARCH, IDA PERM NO: P 074117 I,/ '' ADDRESS 2554 ELDENI AV • , PERMIT NO: P 074117 PLAN CHECK NO: N GOVT: N SUPP: N - COSTA MESA, CA I 714-645-3179 APPL.MING ADDRESS: CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU PURPOSE: REP ARCHITECT OR ENGINEER: ue.No.: JOB DESCRIPTION : CHANGE OUT WATER HEATER SQ FT: ARCH OR END.'S ADDRESS: UNIT: CLAIM VALUE: CALC—VALUE: GROUP OCC : R-3 / cONTRACTORSNAME: NOCK PLUMBING ( 714 )895-1246 comucTORSMNUND 11610 SEABOARD CIR COMMENTS : NO OTHER WORK AUTHORIZED BY THIS PERMIT ADDREst STANTON CA uc.No.: 511971 ****+E**+tTt******+ **+t******x*********TEit***ic+ +r****************x**it************tt*it-* 90680 OMT: ZONING R EQU I R EMENTS LICENSED CONTRACTORS DECLARATION:I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter a SETBACKS (commendng with Section 7000)of OMsin 3 at the Business and Profession Coda,and my license is In full force and aged. CRY LIC.NO.: 050386 LIC.CLASs: C-36 LIc.NO.: 511971 EXP: 02/96 MAIN BUILDING ACCESSORY BUILDING PLvMtl X16 FRNT: FT IN REAR: F7' IN FRNT: FT IN REAR : FT IN Da.: 9/1 21 g � Cont*ao LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN OWNER BUILDER DECLARATION:I hereby affirm under penalty of perjury that I ern exempt from the Contractors License Law for the following reason(Section 7031.5 Business and Professions Code:Any ciy oropenly whidl requires a Penn to construct.eller.Improve. PARKING RE • PROV: PARCEL: 00000000 ZNE: REF NO: derndish.or repel any structure.pia its issuance.tosuance.also requires the applicant for such Penna to files vpned statm eent Crthat he sae PLANNING NOTES> ' 'e licensed pursuant to the provisions of the Contractors License Law[Chapter S(mmmendng with Section 7000)of Division 3 of the liminess and Professions Coal or that he or she is exempt therefrom and the basis lot the alleged exemption,Any violation of Section > 7031.5 by any applicant for a permit subieds the applicant to a dug penally of not mon than fee hundred dollen 15500D. ****************************************!E****3E**3E****************fE********1E**** ❑ I.as owner of the property or my employees with wages es their scat pomperaatlon.wl doge wk.and the sticture i no intended DEVELOPMENT SERVICES REQUIREMENTS or offered for sale(Section 7044.Business and Professions Code:The Contractors License Law does nal apply to an Sneed property holds rmmprovements are rrataWe�Medoor��faessale such work however.the building or inelf or pr nadis sold within mugh his or her own oi year of completion.the ZONING APPROVED BY each DATE: owner.kuilder will have the burden of proving he or she did not build or improve for the purpose of sale). ❑ I,as owner°the property.am exclusively contracting weh licereedcontatos tomnmuct the°reject(Section 70441.Bushes'and BUILDING APPROVED BY : DATE: Professions Code:The Contractors License Law dose not apply to en owner of progeny who builds or improves thereon and who contracts for such projects with a ccrnrector(s)licensed pursuant to the Contractors License Law). ❑ Iamexempt under Ratko: B.AP.C..for this -41-95 reason: APPLICATION ISSUED BY: DATE: ********************************************* * ********************** Dale: Owner LEGALIZATION: N F E E SUMMARY STRUCTURAL SEGMENT:N I do hereby certify that 1 am aware of end understand the requirements of California Health and Safety Code Sections 25505,25533,and 5,/ 25531.andthat I o any futureWilding occupant will/will na(circle anal need to comply withsaid Mate codes and the requirements ler BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING a permit for construction or modification from the As Oualny Management District.Residential construction appitatinsw exempt from these provisions. PERMIT 7 . 00 v Data: Appant: 25% 70 SMIP/NON—RES PLAN V WORKER'S COMPENSATION DECLARATION:I hereby affirm under penally of palsy one of the following dedeations: ISSUE FEE 20 . 00 l, (Y❑ Ihave and iomairuanacantinas dconsent tosatlinsurefor wake.conpensetion,mpwkedlpbySertion3700atheIota BUILDING—DIV—> PERMIT ISSUE PL"AN-CHECK TOTAL PAID DUE Code,la!he wdamenadlnewklawschmapenmulsesed. TOTALS----> 7 . 00 20 . 00 I 0 . 00 27 . 00 27 . 00 . 00 O I have and w0 mental waken'mmpem°tion insurance,"required by Section 3700 of the labor Code,kr the perfem a:Ice of the 7C work for which this permit is issued.My workers'Dom rsetion insurance carrier and policy number we: Canis: GOLDEN EAGLE EXPIRES REVENUE DIVISION TOTALS--> COLLECTED : 27. 00 OVER/SHORT: . 00 Petry Numbs: NWC.J21131UU 09/01 /96 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK This section need not be completed I the perms for one hundred dolsns moot or Ansi 27 . 00 ❑ I candy that in the pefamroe of the work for which thio permit is issued.I shill nos employ any person in any mane so as to became subjed to the workers'comprmmun laws d Cat. Net if 1 should become subject to the workers' ******************************************************************************* compensation of 3700ofthelabrCade.l f. corn*.h .hcowrh ". ' ' '' '. I N D I V I D U A L.' F E E BREAKDOWN t? Dalt / /p .c Applicant: --- .. p r fl Warning:Failure to secure workers'conpansadon coverage b unlawful,end shall ete/ect an employer to criminal penal,es a • —TYPE QTY D E S C R I P T I O'-N UNIT COST TOTAL COST civil fines up to one hundred thousand dollars($108000),In addition to rhe cost of compensation damages to provided for In '? Section 37°5ofthe Labor Code,Interest and etromey'alees. PLU 1 WATER HEATER AND/OR,.VENT 7 . 00 7 . 00 CONSTRUCTION LENDING AGENCY:I hereby affirm under penady of perjury that there is a construction lending agency for the END' OF FEES performance of the work for which this permit is issued(Section 3097.Civ.C). LENDER'S NAME: /l LENDER'S ADDRESS: I certify that I have read this application end stale That the above information s correct.I agree to comply with all city end county ordinances •a' end state laws rearing to buildrg construction and hereby authorize representatives or this city to enter upon the above-mentioned properly -'! for inspection purposes. EXPIRED RON NOCK ntN ` ,,�;�; Name ✓ I ---e) V 03156627-L8190027 TGT 27.00 's Date: // / �7 c1� DRTE �/ C/....� V 01 631SuGA•:: C7/7:/?` T Ir.E: t r Signature /AgentAppicant/Cordrador (5151 d5.WP) White-Building&Safety:Green-Fie:Canary-Appfcant:Pink-Remove:Goldenrod-Assessor 4 1 JO 1 CQNSTRUCTION AND PLANNING - POOL ?A APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. _• . 53. Steel Reinforcement • 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test ♦. 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. - 60. Backwash Lines, P•Trap,❑ Undrgrnd. 10. Structural Floor System • 61. APPROVAL TO DECK - 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final r 13. Roof Drains • 64. Plumbing System • Final ., 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit . 66. Solar System-Final • 16. Rough Electric Wiring 67. Fencing & Access Approval.' I _ 17. Rough Wiring Sign - 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace • APPROVALS Permit# 21. Ducts, in Structure - • 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing • - , • 73. Undergrnd.Storage Tank 0 Gas 0 Oil • 25. Roof Sheathing - 74. Overhead Hydro 26. T-Bar Ceiling (Structurall & Monocoat 75. Dry Chemical i 444 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding • •- • 77., FIXED SYSTEM FINAL ' I 29. Insulation 78. FIRE PREV. FINAL � +�,�• 1 30. Drywall Nailing HEALTH DEPT. REQUIREMENT . r 31. Plaster Brown Coat 79. FINAL INSPECTION • 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED, 33. Final Electric • Notes: q 34. Final Heating & Air Conditioning C7,-2-4‘ + _ et, 35. Final Gas Pipe•Test 36. Hood or Canopy • I _ 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final • 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System -" " • 45. Sound Attenuation - • - ! 46. Handicap Regulations _ 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING • 49. Electric Release to Edison 50. Gas Release to Southern California Gas O • 51. CERTIFICATE OF OCCUPANCY No Date S