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HomeMy WebLinkAbout2903 BAKER ST - Building Permits CITY OF COSTA MESA -/ BUILDING DIVISION tie) 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us FOR INSPECTIONS CALL: (714)754-5626 PERMIT NUMBER: E09-00118 PERMIT TYPE ELEC STATUS: ISSUED APN: 13926214 DATE ISSUED: 05/29/2009 • ISSUED BY: BJK JOB ADDRESS: 2903 BAKER ST CM Suite/Unit: Vicinity: • • SCOPE OF WORK: CHANGE-OUT OF A FAU WITH THE ADDITION OF NC AT AN EXISTING SFD. 1 FAU>100K BTU, 1 COMP 3-15 HP ELEC:NC PKG OWNER: HOPE,MARGARET FRANCES TR. - Address: 2903 BAKER ST Unit: PHONE: City/State/Zip: COSTA MESA,CA APPLICANT: DOMINGUEZ, ROY Address: 7600 GARDEN GROVE BL Unit: PHONE: 714-901-0500 City/State/zZip: WESTMINSTER,CA CONTRACTOR: A PLUS HEATING AND AIR CONDITION License No. 763154 Address: 7600 GARDEN GROVE BLUnit: - - PHONE: 714-901-0500 City/State: WESTMINSTER,CA ZipCode: 92863 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. CODES. INSPECTION TYPE GATE INTITIALS CODES INSPECTION TYPE DAT INTRIALs 1616 Fixed System Final Fire Prevention 208 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing '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 WORKERS'COMPENSATION DECLARATION: Owner ID verified by drivers license. ❑Yes 0 No I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires: 0 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 deed): compensation, as provided for by section 3700 of the Labor Code, for the perfor ce of the work for which this permit is issued. C 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,or demolition eairier. or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp (This section a the Acted Nlhe permit is vatued of one hundred doNars($100)w less) 2,Art 2,Sec.341,Ttle 8,California Administrative Code). Pol-cyrNumber&71 -3 g S-0 ❑ As owner-builder, I will not employ anyone to do work which would ❑ I certify 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 Applicant's Signature Date the bor C e,I shall forthwith comply with these provisions. Division of Industrial Safety Permit Number: /whets - ure 5----,a?-c-) 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? ❑Yes ❑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 LTc;. 7 c—/ „Olass-#—1 0�p cetio 25533 re the California Health and SafetysaCode, with somet b ///�1`/ � / q. exceptions, requires registration with the Costa Mesa Fire Department by 5�/ each business which at any one time has on hand a quantity of acutely raa 5(_ _ re rD�te. 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 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 penally 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 Califomia Government 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? ❑Yes ❑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 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 ❑ I, as 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 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 authorized by this permit until final inspection. Signature of legal Owner(s) Date Signature DateIII 3057.4613/071 J ��9Tt And�' _AppN«ri . �tfb. CITY OF COSTA MESA toBUILDING DIVISION 77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 • Fax (714) 754-4856 • www.ci.cesta-mesa.ca.us FOR INSPECTIONS CALL: (714) 754-5626 PERMIT NUMBER: M09-00048 PERMIT TYPE MECH APN: 13926214 JOB ADDRESS: 2903 BAKER ST CM Vicinity: CLOSET AND SIDE YARD SO. FT: 0 STATUS: ISSUED DATE ISSUED: 05/29/2009 ISSUED BY: BJK Suite/Unit: SCOPE OF WORK: CHANGE -OUT OF A FAU WITH THE ADDITION OF A/C AT AN EXISTING SFD. 1 FAU/ 100K BTU, 1 COMP 3-15 HP OWNER: HOPE, MARGARET FRANCES TR PHONE: $0.00 APPLICANT: DOMINGUEZ, ROY PHONE: 714-901-0500 CONTRACTOR: A PLUS HEATING AND AIR CONDITION Address: 7600 GARDEN GROVE BLUnib City/State: WESTMINSTER, CA ZipCode: 92863 MECHANICAL PERMIT FEE SUMMARY MECH ITEM FEE: $68.85 PLAN CHECK FEE: $0.00 INVESTIGATION FEE: $0.00 REINSPECTION FEE: $0.00 TOTAL FEES: $68.85 Address: 2903 BAKER ST Unit: City/State/Zip: COSTA MESA, CA Address: 7600 GARDEN GROVE BL Unit: City/State/zZip: WESTMINSTER, CA License No. 763154 PHONE: 714-901-0500 CELL: 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. 400E r, INSPE System pJ/jE II IIALj 206 ON TYPE 1616 Fixed Fixed System Final Fire Prevention 206 Final Mechanical Final Mechanical 1266 Pool Spa Final 206 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 WORKERS'COMPENSATION DECLARATIO : Owner ID verified by driver's license. ❑Yes ❑No I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires: 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 deed): compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. CI have and will maintain workers'compensation insurance,as required by s tion 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,or demolition Cartier:.. V] / or dismantling thereof,will be more than thirty-six(36)feet high. (Chap.3.2,Grp (miss need not bem et d:ne permitrhiscvalued at one hundrtH dollars(5100)or less) 2,Art 2,Sec.341,'Title 8,Califomia Administrative Code). Policy.Number: ©`1 35 V 5 0 As owner-builder, I will not employ anyone to do work which would ❑ I certify 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 Applicant's Signature Date the La Code, hall forthwith comply with these • %visions. �/ Division of Industrial Safety Permit Number: Applifanl's'Signal - See., HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARN! G: FAILURE TO S" E 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. ��/Y 5"-S '��{/�J a registration form for acutely hazardous materials? ❑Yes 0 No vil #` 7 6 3l Class.#, 0`5"—J (Section 25533 of the California Health and Safety Code, with some -( q. ,+, exceptions, requires registration with the Costa Mesa Fire Department by r1-7--Ci, each business which at any one time has on hand a quantity of acutely ontraaor's Sign 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 CO TRUCTION LEN G 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 hazardous materials)? 0 Yes ❑No Lender's Name: (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 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? ❑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? ❑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 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 O I, as 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 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 authorized by this permit until final inspection. Ap Signature of Legal Owner(s) Date Signature Date ® _ 1– Q�qG� -a 305] 6(3107) / I7/ no/or AUT arced Applicant 1 ►> �'.( CITY OF COSTA MESA ;,/, � BUILDING DIVISION f,. ,.__, DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER t. 1 .rr.... 1 tt Prr1 PERMIT f j805-01048 (714)754-5273• •-Fax(714)-754.4856-••www.ci.costa-mesa.lyfLDING PERMIT "7TFAIR.DRIVE,COSTA MESA,CA 92626 Job Address: 2903 BAKER ST Status: ISSUED Suite: Applied: 06/23/2005 Vicinity: - Issued: 06/23/2005 Primary Occ: R3 Type of Construction: V-N Parcel Number: 13926214 Zoning: R1 / Applicant: BRAD GULSRYD - -- - - - , .1� / Address: - .- --- -- - ISSUED =Y: '4 �'(- _'' Phone: '714-966:2907r K,/ r „ ice. Zip: ' ' / -) Owner: MARGARET HOPE . f ' / ' ' Address 2025 BALTRA PL - _ _ ',.� •• - Phone: COSTA MESA,CA , - Zip: 92626 ' -....• Contractor: NEW IMAGE CONSTRUCTION INC Address:- 3628 W PENDLETON AV Phone: SANTA ANA,CA Zip: 92704' i License: 625387 - Arch : • rte'' Eng: Address: - Address:, Phone: - - Phone: Zip: 'License: License: , _- , -, SCOPE OF PERMIT: - - ' . REMOVE EXISTING 10 FT WIDE WINDOW IN THE LIVING ROOM FACING BAKER STAND EXPAND THE AREA BY 20 SF BY INSTALLING A BAY WINDOW.REMOVE EXISTING WINDOW IN THE LIVING ROOM ON THE SIDE OF THE HOUSE AND REPLACE WITH THE SAME SIZE AT THE SAME.LOCATION.REMOVE • EXISTING WINDOW IN THE BEDROOM AND REPLACE:WITH THE SAME SIZE AT THE SAME LOCATION.WINDOW SHALL COMPLY WITH UBC SEC310.4 • FEE SUMMARY ' • Plan Check: - $117.81 Calc Valuation: $9,950.00 Permit: $181.25 • Claim Valuation: $9,950.00 SMIP•Res: ' $1.00 - , SMIP Com: $0.00 . ,,, - - • Other „ $0.00. :.�- - Inspection: i ' $0,00,: , , �,_;_ • / i Total: - $300,06v > 3„; , 1 • - - PLANNING &ZONING SETBACKS - , . MAIN STRUCTURE Front - 0-0 Rear 0-0 • 'Left •0-0 -2:1 ‘ -\' Right - 0 0 • ACCESSORY Front 0-0 Rear _ 0-0 Left 0-0 _ Right 0-0 • 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 expireand 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.authodzed under this:permit tote considered legal,-such-work must comply with all applicable codes, and all . required Inspections end.finalapprovel-must be-obtained:Failure to obtain Inspectionsand flnafapproval.will.result in the-expiration-of this permit. - °:FOR'INSPECTIONS'CALL:1714)754-5626 2448-46(6/00) DECLARATIONS i 1 • 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. - 1 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'comae - 'on In urance carrier and policy number are: q 9�n Cant - of Nut : )T07 549 'd-wS (TAie-sectron need not be completed if 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 anymanner so as to become subject to the workers' compensation I: . . fomia,and agree that i iiikhould become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith corn I with the e p ovisi.•s. WARNING:FAILURE TO SEC RE WORKERS'COMPEN ATON 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 3706OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under revisions of Chapter 9(commencing with Section 7000)of Division 3 of the Busi an rte) ssions Code,and my license Is in full force and affect.Lic�Y 2? Lit Class M -� 1 COTItrecroll Sty, axe:-ti under +? r-Datt7 di•a3-GS— CONSTRUCTION GfCONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of penury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to Its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commenting with Section 7000)of Division 3 of the Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant fore 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 who does such work himself or herself or through his or her own employees,provided that such Improvements are not intended or offered for sale.If,however,the building or Improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or Improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: AyesOwner ID verified by drivers license. /Ly Ves ❑No Drivers License No. Expires: Verification of Ownership by(type of document,I.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2.Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safely Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑_Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑N0 (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 a plication 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? OP Yes U No (Section 65850.2 of the California Govemment Code requires that the requested Information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If'yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). .__.._ _ other airutodo ._ w _..__ 7 application,If a permit haveatae South Coast res AC-Quality Management DistrictHor and tCodeeion controloon district3bn agency is required for the work which Is the subject of this all of the disclosures prescribed by California Health Safety Section 42303 been made? 0 Yes 0 No 6 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPUANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. p $igr t9u a Of Legal Owner(s) (l .gats— _ nd/Q:Authpdzed Applicant' Date CODE f 'INSPECTIONTYPE • " -'"- 5- "" Com E INSPECTION TYPE _ 4 DAME • REIMS 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 G `p5� ' CITY OF COSTA MESA 4 BUILDING DIVISION > • ,g;,' _: , DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER t ..._rs PERMIT ` J ka„b " BO 023 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 2903 BAKER ST Status: ISSUED Suite: Applied: 01/07/2005 Vicinity: REAR OF PROPERTY Issued: 01/07/2005 Parcel Number: 13926214 Zoning: R1 R1 Applicant: MIKE NOON ISSUED BY Address: 1590 BAKER ST Phone: 714-932-3455 COSTA MESA,CA - Zip: 92626 Owner: PILMER, CAROLYN R TR Address 2025 BALTRA PL Phone: COSTA MESA,CA Zip: 92626 Contractor OWNER-BUILDER Address: Phone: Zip: License: 000000 Arch : Eng: Address: - Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT CONSTRUCT 396 S.F.PATIO COVER LOCATED AT REAR OF PROPERTY, FEE SUMMARY Plan Check: $90.51 Calc Valuation: $6,383.52 Permit: $139.25 • Claim Valuation: - $3,000.00 • SMIP Res: $0.64 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 • Total: $230.40 • = 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-o PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§1, 12-2192) 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(a100) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: r • ❑ 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 i1 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 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 fdrthwith 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(SI W,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.Lic.I1 Class If 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). Lenders Name: Lenders Address: Signature: -• Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): 2,1,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or Improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt u er Business and Professions Code for this reason: Signature: 'Date: 1' 7 .o� Owner ID verified by drivers license. es 0 No Drivers License No. ! Expires: 7•/9• D7 Verification of Ownership by(type of ment,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,Caiifomla 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? ❑Yes 0 No (Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No (Section 25533 of the Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If en RMPP is presently required,has Section 25534 of the Califomia Health and Safety Code been fully complied with? 0 Yes ❑No 5 Does or will the applicant or present ar future building occupant require for the work which is the subject of this application a eit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? al Yes ImNo (Section 65850.2 of the Califomia Govemment Code requires that the requested Information be furnished on applications for non-residential building permits), 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If'yes',the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes`,attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the 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. ature Of Legal Owners) / 7 Date /41 r .O� And/Or Authorized Applicant Date CODE I INSPECTION TYPE DATE INTITIALS CODE INSPECTION TYPE QAIE MALS 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 `1• ,A 204 Final Demolition 250 Final Building/Occupancy l-l.°L-a E1 `-9i�'` Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. PERMIT NO. TRACT NO. LOT NO. UNIT NO. CITY OF COSTA MESA CONSTRUCTION PERMIT 5 3 g O� A.P.# Zone Project Address 2 9D3 I�J. Rke 2• TVP�j�F CONSTRUCTION LI NEW LI ADD LI ALTERATION S Main Building: Accessory Building: Applicants Mailing Address PQ- °% 701 Oa.A••f c.dr t266G /�� U REPAIR E Z /•s CONVERSION ❑ DEMOLISH ❑ OTHER _ ' T Front Q Owner's Name G•e n4-7a I-f).r.• e2 Phone Tr 7-653 1- Address D ff �tfF ke /Loot 9 N DESCRIPTION OF WORK/USOF BLDG)) � J A Rear - Address �.•OyS QA�f.•t,A COSTA �••p5A 4,07 f-I Ae rat/nee-4SGr A FsS 36.3114771 • 30 T fake Ll-s+c2 C Right • N Arch/Eng. License No. TYPE OF PERMIT LI GRADING ❑ FOUNDATION ❑ STRUCTURAL g K Left G Address ` ❑ TENANT CI ELECTRICAL ❑ PLUMBING CI MECHANICAL S 4JGRTWtta• f6•PLV Roof' 9 ❑OTHER p00'c-wq I Ping. Ref.# ParkingRe /Provided R Contractor's Name lahone 37-rVo V '1 / �--� Req./Provided Address(mailing) . a� 7 1 ` ,OtA�Gj." C91._ PROJECT DESCRIPTION SQ. FT. 3 O - OCCUPANCY S'• 0 /JO p _ 7 y6 G G p � Planning Notes: M 'Alt '4 CONSTRUCTION TYPE Phi_ 1J VALUATION$ 64/c/OT City License No. - 1 ZONE GRADIN/G CU.YDS- ACRES $, LICENSED CONTRACTOR DECLARATION 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: - with section 7000) of Division 3 of the Business and Professions Code, and • my license is in full force and effect. ELECTRICAL • FEES License Class - . nse - 9 13S 'te 4'S-Y 5 • Signature PLUMBING FEES Automatic Washer Transformer 0 15-50 KW /RKERS'COMPENSATION DE LARATION Construction Pole Sub. 0 50+KW .tereby affirm that I have a certificate of consent to self-Insure or a certificate Bar Sink • Showers of Workers' Compensation Insurance, or a certified copy thereof (SectionCooking Unit Meter Dub)to 100 amps 3800, Lab. C.) Backflow Preventer Service Sink - - i' Poli No. III'NO If - Y`/ Company ¶rn re Fes.+-•D . Backflow Irrigation Sewer Cap Dishwasher Meter Dover 100 amps - Certified copy is hereby ec___hetl. � Dryers ❑Gas ❑Electric Sub Panel ' - Certified copy is flied withth the city din iv . Bathtubs Sewer Connection Date U-S' r1 Applicant � • Fan Motors 00-1 HP ❑1'/r-8 EXEMPTION FROM WORKERS'C MPENSATI DECLARATION Clarifiers Solar Collectors • I (Thisessection need not be completed if the permit is for one hundred ($100)or Dishwasher Solar Piping F.A.U. Inc.Solar 09-15 HP'❑16-15+ - I certify that in the performance of the work for which this permit is issued I Fixtures i shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Microwave Workers' Compensation Laws of California. rT ate Signature Floor Drains Swimming Pool w/Spa Device Boxes Pole Light V ITICE: If,after making this declaration,you should become subject to the Outlets Range .Irkers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks- Urinal - - e I comply with such provisions or this permit shall be deemed revoked, Switches CONSTRUCTION LENDING AGENCY • Gas Service Outlets • Water Closet 1 Sign ---"' a, , I hereby affirm that there is a construction lending agency for the performance f ' i of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Garbage Disposal Standing Sections Lender's Name • Lender's Address _ - Kitchen Sink Water Service - Generator 00-5 KW 05-15 KW Trash Compactor OWNER BUILDER DECLARATION J• I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash - -" following reason (Section 7031.5 Business and Professional Code: Any city or �• `- .y county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays - " i i any structure, prior to its issuance, also requires the applicant for such permit -- • + file a signed statement that he/she Is licensed pursuant to the provisions of Roof Drains ' '< r ,e Contractor's License Law(Chapter 9 (commencing with Section 7000) of I h. sivision 3 of the Business and Professions Code) or that he/she is exempt Reinspection Fee $15 , ° Issue Fee -^ ••4. .:1 " $ 3 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). $ 3 • i"DEVELOPMENT SERVICES REQUIREMENTS: .4 0 I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee - j compensation, will do the work,and the structure is not intended or offered -Zoning Approved By nate for sale (Section 7044, Business and Professional Code: The Contractor's - MECHANICAL I FEES 'Building Approved By 'Date 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 Boiler Hood or Type I 0 Application Issued By - Datey r'ec employees, provided that such improvements are not intended or offered foryP sale. If, however, the building or improvement is sold within one year of com- Canopy Type II 0 SUMMARY OF FEES ,r j T pletion, the owner will have the burden of proving he/she did not build or im- Duct- Under Ground q h r V ,� prove for the purpose of sale). BUILDING PERMIT $ 1 p - SMIp,,l• „ -' $ V ❑ I, as etner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System . PLAN CHECK $ PERMIT 'factors to construct the project (Section 7044,Business and Professions Code: - )e Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00.100,000 BTU 0100,000 BTU PLUMBING $ ISSUANCE $ lids or improves thereon,and who contracts for such protects with a con- - • a actor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System El Multiple ❑ System Repair/Alteration - PLAN CHECK 25% $ ENERGY P.C. $ proof of their Worker's Compensation insurance should be provided to me. 1 ELECTRICAL $ GRADING $ ❑-I am exempt under Section B. & P.C.for this reason F,irepl/Fact.Blt. ICBG# Fire Dampers MICROFILM $ PLAN CHECK 50% $ Q di� Date owner Heating System&Ducting• Registers - ` MECHANICAL $ L ' I hereby' certify that I have read this application and state that the above - 00-100,000 BTU 0100,00067E - TOTA'L FEE $ information is correct. I agree to comp y with all city and county ordinances I PLAN CHECK 25% $ and state laws relating t• but ding c.jtruction,and hereby authorize repre- sentatives of ,t*•is city • . ter u`• the above-mentioned property for - e Inspection p 'J ses. _ r � --�" Signature , atr. .�_ Date 5'-S ,'-j Reinspection Fee $15 Issue Fee $ 3 01 GGG2R,5G• G�G29991 TOT dt .Il Drivers' Li ense or 55 - � i --_Li" White - Building; Canary - Applicant; Pink -Accounting; Goldenrod • Assessor DATE: 04105/89 TIME: 13:111 e N i • CONSTRUCTION AND PLANNINL - &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, 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 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 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: V llo<.�1'�--^ ' Q/c "/ LX•+�-1 \ 34. Final Heating & Air Conditioning % 00-elPre. x4-6-,L ,�-- 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 /// �j 46. Handicap Regulations }--/i4/4U /c. he sof k 7 47. FINAL STRUCTURE & BUILDING / ie e 48. Special Requirements Completed ! 49. Electric Release to Edison - 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No Date _ 10 7 23L • 11738 r ', d. 0 . . I COSTA MESA BUILDING-SAFETY DEPARTMENT I'd- q-2400 P. O. BOX 317 COSTA MESA. CALIFORNIA �.1Wr1iTE LFII. For Applicant to Fill In Completely APPLICATION FOR-PC ERMIT as s TYPE OR PRINT ADDRESSBUILDING 2905 -0464( 12-- BUILDING sr COSTA MESA. CALIFORNIA For Office Use Onlyl OWNER F _) V LICCA) _glee O ee l T C v RECEIPT No. I 1pg1R!/41b en MAIL �`' RECEi y DATTE/REECEIVED DATE/_ ISSUED ADDRESS / 6 SJ - C111 ( ,�/`�T / 7'-6.0 �ft�/1'-/67e / k� _ TEL. BUILDING G 3 t�`0��et4e-- � 5/ : CITY /I/'A 53 NO. ADDRESS / G ARCHITECT TEL. COSTA MESA. CALIFORNIA OR ENGINEER NO. ADDRESS FI E N ,�2 ^/ 1 [•/' FIRE TYPE GROUP CONTRACTOR�,4 • 1/OCL APPROVED BY DATE ADDRESS ZONING ^ ' ZONE NO.OF USE OF NEWUIIL� C fGJII. res. CITY R-1 PLANS 2 BUILDING w/ att. ga-age LIC.STATNO. �/ NO.L TELEGAL DESCRIPTION Lot 1 It -2,G 2.(-) SIZELOT 57 /�V i 7I NO. OP BLOCS. OF NOW ON LOT A.P.NO. NONE USE OF YARDS EVES EXISTING BLDG. APPROVED _ ALLOWED SETBACK LINE PROM ..-7 2 J4 (CENTER LINE ST.) CENTER OF STREET `T'/.4 REAR YARD FRONT Ciq/ VFT. IN. [` SIDE YARD I LEFT '> I RIGHT 7. SJ R.SIDE 17. C FT. IN. DESCRIPTION OF WORK L.SIDE ,7' FT. IN, NEW SII ALTERATION I II ADDITION I REAR 9 FT. IN. REPAIR I II MOVING I II DEMOLISH I BYPROVED �` , �1) ATE , (TE ? _/ 0 BUILDING .1 h n NO. OF / �115 f ILS SIZE / {J V y ROOMS 6 STORIES J EXTERIOR WALL (ROOF S Ne< F: COVERING COVERING USE OF;BUILDING AND WORK TO BE PERFORMED ` - FA/Yl. re c 4'7 7' &d 2 . I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE 1 AND STATE THAT TH' +OVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT/FEE ONLY. PLY WITH ALL C ' ORD1•ANCES A•D STATE LAWS REGULATING BUILDING CO.- -U 10 /e► VALUATION �j {� SIGNATOR' OF ?, / 133 PERMIT FEE $ r 7 O N PERMITTEF / Q $ ./ PLAN CHECK $ // qh E AUTHORIZED AGENT li_ TOTAL FEE $ ..) .7 0