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Home My WebLink About2442 ELDEN AVE - Building Permits I p 1144. F 9 CITY OF COSTA MESA 4 BUILDING DIVISION ::1«,.. k. DEVELOPMENT SERVICES DEPARTMENT PER NUMBER F r ): PERMIT 4. 1.111 de 07-00359 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesagtfTRICAL PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2442 ELDEN AV Status: ISSUED Suite No Applied: 04/24/2007 Vicinity: Issued: 04242007 Parcel Nunmber: TPN00044 Applicant: BROWN, MICHAEL Address: 288 BOWLING GREEN D • R ISSUED BY: 0-449 Phone: 714-662-7226 _ COSTA MESA.CA Zip 92626 " Owner SPINNAKER COVE • Address 17942 SKYPARK CIR IRVINE,CA Phone: 949-955-0112 - 'SUITE H - Zip: 92614 '. ' - / Contractor: LIQUID ASSETS POOLS Address: 288 BOWLING GREEN DR Phone: 714-662-7226 COSTA MESA,CA Zip: > 92626 " License:826226 SCOPE OF PERMIT ' - ELECTRICAL PERMIT TO REPAIR AND REPLACE CONCRETE,DECK,PLASTER AND SPA EQUIPMENT (SAME LOCATION)FOR AN(E)IN-GROUND SPA. • WORK TO INCLUDE:REPLACEMENT OF CONDUIT. 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 i 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 $0.00 0 '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-. $18.20 1 Service to 1000a ', $0.00 0 Misc.Conductor - $0.00 0 i Service over 1000a $0.00 - ' 0 Circus(gen or ride)- - $0.00 0 _ Motors to 1hp , $0.00, 0 Circus(mech ride or lights) $0.00 . 0 Motors to 10hp . • , $0.00 I 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 1 Sub panel to 200a - . -.$0.00 - ' 0 I. ' Plan Check Fee - V $0.00', Pole Light Pkg - $0.00 0' '- Reinspection Fee ' .$0.00, Sign Circuits $0100 _ 0' , Temp Pwr Pole $0.00 0_ - ' TOTAL CALCULATED FEES 441.70 Intermed Pole $0.00 . 0 _ 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 it work is not commenced within 180 days,or it work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply 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 244846(60O) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: O I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑—I,Irave 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 carver and policy number are: Comer: Policy Number: (This section need not be completed if the permit Is valued at one hundred dollars($100)or less.) `j-----' I certify that in the performance o the wo for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation law f Califomi nd a that if I sh Id become subject to the workers'compensation provisions of Sectlgn 3700 of e Labor Code,I shall forthwith comply with rhes provisions. (D� 7 b/// Applicant Signature: I / Date:::; it I-4 V 7 WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL.MID SHALL SUBJECT AN EMPLOYER TO CRIMINAL ENALTIES MD CML FINES UP TO ONE HUNDRED THOI iSAND DOLLARS*meow).N ADDRION 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 ol.the.Business artt Prof.?,inns Code,and my license is In full force and effect.Uc'.4 Y7-Eft LZ [Claset C.• 5 Contactor'&Signature: I N �l I2 / 1 Date` f 11- r Z if .C/7 _ r" Y L.-- 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:My city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of 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 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.). O I em 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 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). 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)? No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Flre 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 a plication rm epek for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? II0 Yes 0 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). — 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (if'yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No _ __ _ 8 (If yes-,attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: _ Date: CERTIFICATE OF 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 urposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signet OIal to ( "_�" s) If . L r ®7 And/Or Authcilzed Applicant------'-' 'Date— BODE E, DISPECTIONTYPE PATE 9{IIIINLS gODEt IBSPEcneNTTPE PATE MEDIN$ 1616 Fixed System Final Fire Prevention _ 206 Final Mechanical _ 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 710-07 201 Final BlockfRetaining 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 • s'MF CITY OF COSTA MESA 4ow9 BUILDING DIVISION • > tow) .,gym DEVELOPMENT SERVICES DEPARTMENT P IT NUMBER 4 PERMIT 07-00210 itti4P0R:Trst se (714)754-5273 • Fax(714)754-4856 • www.ci,costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 2442 ELDEN AV ( Status: ISSUED Suite No " Applied: 04/24/2007 Issued: 04/24/2007 Vicinity: Parcel Number: TPN00044 � A 4 ISSUED BY: J I J Applicant BROWN, MICHAEL _ _ Address: 288 BOWLING GREEN DR . - - Phone: 714-662-7226 COSTA MESA,CA Zip: 92626 Owner: SPINNAKER COVE Address: 17942 SKYPARK CIR - _ ' IRVINE,CA - Phone: 949-955-0112 SUITE H - Zip: 92614 Contractor LIQUID ASSETS POOLS Address: 288 BOWLING GREEN DR Phone: 714-662-7226 _ COSTA MESA,CA Zip: 92626 - _ , License:826226 , -SCOPE OF PERMIT MECHANICAL PERMIT TO REPAIR AND REPLACE CONCRETE,DECK,SPA EQUIPMENT(SAME LOCATION)PLASTER FOR AN(E)IN-GROUND SPA. . REF#:B07-00514 WORK TO INCLUDE:t INST FAU>100•K BTU • ' ' - ' FEE SUMMARY - Quantity Quantity . ISSUE FEE $23.50Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU. $0.00 0 - _ , _ / • •_Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $18.20`_',1 " _. - ' - Ventillation System;• $0.00 0 Repair/Alt Cooling/Heat $0.00 0 ._ Evaporative Cooler $0.00 0 . ' Inst/Rep.Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 ,0 Refrig Sys<100 k BTU, $0.00 0 Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU . $0.00 0 Compressors/Absorption Systems Gas Piping . $0.00 0Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace $0.00 0 - 7 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust \\,,\, $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box . ` . $0.00 0 30 To 50-hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct - $0.00._ 0 .-.- ' Over 50 hp'/,Over.1,750 BTU ,[ $0.00 0 Appliance `•-. $0.00" •0 ' - Boilers"' °- ' - '' /% Fire Dampers ,,$0.00 0 . "Up to 3 hp , ' i "$0.00 0 Smoke Dampers -�' - $0.00 0_ _ -3 To 15 hp '$0.00 0 Inst or Relocate Appl Vent- , -$0.00, •0; , - . - 15 to 30 hp. % , . $0.00 0 Air Handlers< 10000dm $0.00 '.01 30 to 50 hp' - $0.00 0 Air Handlers> 10000cfm-\, $0.00 0 _ • Over 50 hp " - ;, ' $0.00 0 Floor Furnace ' $0.00 ' 0 - Other Mechanical Fee , „'i Floor or Suspend Heater _ . $0.00 •, 0..',./ • , Investigation Fee, $0.00 _ _ - " , Plan Check Fee $0.00 ' - Reinspection.Fee .":2 71,, $0.00 .. , -. - - - -.TOTALCALCULATED FEES $41.70 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)754.5826 • 244848(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 work for which this permit is issued. 1:1-- 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'compensation Insurance carrier and policy number are: __ Carried it Policy Number: (This section need not be completed If the permit Is valued at one hundred dollars($100)or less.) Xr I certify that in the performance the wo for which this permit Is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation la of Califom and a et if I Id become subject to the workers'compensation provisions of Sarni 3700 of_the Labor Code,I shall forthwith comply with then p visions / _Applicant Signature; I Dale:! 4 2-4!//a 7 )WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS(5lce 00),W ADDITION TO THE COST OF COMPENSATION,DAMAGES AS FRONDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: _thereby affirm that l 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:❑c:'a ' Lb, 6 Gass a-7 G ri 3 -Contradtor's Signature: /./At / ( / y� Dater - =y h 'v} '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,Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that Under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code: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(5500).): ❑ I.as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec, 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or Improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or Improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ' ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,end 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 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,end 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. 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 end 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 fled with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes___ 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will th applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes L)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 end Safety Code been fully complied with? 0 Yes 0 No — 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application apemhlt for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency'? Yes LJ 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 par of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health end 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. Sig re Of�.ega ner(s) ate ( 110-7 c nOAr thorized Applicant--- NDate____ ;ODE I, INSPECTION TYPE PATE IIII� Coot E INSPECTION TYPE P�AIrLI � 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1-0-6frr1 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 • , ,5 111 CITY OF COSTA MESA 4 a" BUILDING DIVISION ,.°: 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 sell-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 whkh this permit is Issued. My workers'compensation Insurance carder and policy number are: Carder: Policy Number: $section need not be completed If the permit is valued at one hundred dollars(5100)or less.) C I certify that In the pert) ance of the •rk for .• Joh this permit is Issued,I shall not employ any person In any manner so as to become subject to the workers' compensation laws of alifomla,any, ree I should e subject t0 the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith with these pro *ions. - L (/ r d Applicant Signature: • <DataL 7 WARNING:FAILURE TO SEWRE WORKERS'COMPENSA COVERA EIS UNLAWFUL SHA ll SL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED noictND DOLLARE(S100,000),IN ADDrrION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provision of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full force and effect.Lie.p C"7i 'b). (Class a, 5 I _C no tractate Sfgneture: L /�`— �D-e-1-'e:--- - Irl r )_..9, r tl CONSTRUCTION LENDING AGENCY: (. 7 ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to 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 are not Intended or offered for sale.If,however,the building or Improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ' ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such Work from the division. Signature: _ Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ..._ _. ...t__ _._ _.__� __. 2 Does or will the applicant or present or future building occupant to need file a registration form for acutely hazardous mateda151 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 oryes ❑ will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? No (Section 25534 of the California Health and 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 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 apernit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a 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 penally 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-descri property for inspection•urposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. • l. ,r-_. - Date Md/Or ' th• 'zed .•iNcent - ____ ---• ('Date- - BODE 1 INSPECTION TYPE DAM IMAIrS CODE I INSPECTION TYPE PATE lmP,ALE 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 206 Final Plumbing 1.10-c7 r5, 200 Final Re-Roof 210 Final Electrical 201 Final BIock/Retalning 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 -- � • 'F - .. CITY OF COSTA MESA • 4 4t BUILDING DIVISION >4 .tr DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER t • PERMIT /B00-01832 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesattLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2442 ELDEN AV Status: ISSUED Suite: C Applied: 11/14/2000 Vicinity: Issued: 11/14/2000 Parcel Number: TPN000045 Zoning: Applicant: MARION, RICK ±iii. , Address: ISSUED BY: Phone: 949-548-3012 Zip: Owner: SPINNAKER COVE C/O CC&R ASSOC. MGMT. Address 17942 SKYPARK CIR , , IRVINE,CA Phone: 949-955-0112 ,SUITE H Zip: 92614 Contractor: -MESA ROOFING" Address: 843 W. 17TH STREET Phoned (949)548-3012 , COSTA MESA,CA Zip: 92627' :License: 564151 Arch : - Eng: • Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT RE-ROOF BUILDING C.TO INCLUDE UNITS C001 THRU C005. - . . TEAR OFF, SHEATHING AS REQUIRED, INSTALL 25 YEAR COMP. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $14,950.00 Permit: $251.25 Claim Valuation: $14,950.00 SMIP Res: $1.50 SMIP Corn: $0.00 Other $0.00 Inspection: $0.00 Total: $252.75 . PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left -0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 , PARKING Existing: 0 Required: 0 Proposed: 0 - . NOTES: c% NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§ 1,12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 244646(BI00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: ir I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. ❑ I have and will maintain workers'compensa'• insurance,as required by section 3700 of the Labor Code,for the performance of the work for which thi permit is ksned. My workers'compe s rano caro r and,,y••• cy number are: Carrier WA a Policy Number: �. (This section need not be corn.eted it the pe i•'t is valued at one hundred dollars($t00)or less.) ❑ I certify that in the performance of the fi7•rk for which this permit is issued,I shall not employ any person in any manner so as to become su•I'tto the workers' compensation laws of California and:• •,that If I should become subject to the workers'compensation provisions of Section 3700 of the .••r Code,I shall forthwith complywiththese pro•"• . T l APp Date: l!Signature: i co 1/4 -WARNING:FAILURE TO SEW COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: .• I hereby affirm that I am licensed under p slQns of :liter•(••, mendng with Section 7000)of Division 3 of the Buslna�s eqd Pr s d my license is In full force and effect.Lt. �A Class a O 1/ T �.,t -Coritactors Sig tanSig tan uu : l �(' Date: i� i/ /ou 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(commenting with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500).): O 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 end Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: • Date: Owner ID verified by driver's license. ❑Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): I 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). O 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 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). _ 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 ❑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 S 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 S the subject Of this'application apernit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If*yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a 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 penally of perjury that I have read this application and state that the information given Is correct. I agree to comply with at 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 "//t 5L/rid ate -And/or Authorized Applicant ) Date CODE tINSPECTIONTYPE MTh MALI ;ODE( INSPECi10N TYPE PAIL MAO 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1286 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 { City of Costa Mesa • [ Building Safety Department CERTIFICATE OF OCCUPANCY • 1 . P.O.Box 1200 �- 2997 r Costa Mesa.California Art The Building located at ?AA? P1Advnnna — TTnR !' 4ia C1 f9 C4 fC l has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto tH Fi J ' fora Group Occupancy. i Use of Building 5 Condos with 2-Car Garages • Legal DescriptionA•P• 119-061-03,04 • . ' '(See ieverse'slde for'Metai endBoundsl`"""" `- - --" Building Permit No 47825 Electrical Permit No46646..46833 Plumbing Permit No7nnnt._75'1G0 f 1 Q Number of apartments and/or guest rooms S S ISSUED TO: Building Official S- ), b'y J �'e o. et �� ` SPINNAKRR (Y YPAAIY/TAMPMAN O NSTRTTfTTf1U Victor C. Newton- Director T,Yii1di Safct'• i Date I nth 20. 1989 i. This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the f S. Building Official of the City of Costa Mesa under Sec. 306 lel U.B.C. 2/ Form BU 34 Rev. 11/70 3 1 '4 L PROJECT ADDRESS: 2442 ELDEN AV UNIT: C-1 CITY OF COSTA MESA — BUILDING PERMIT puri NV: t unt .3. OWNER'S NAME: STANLEY TSUJIOKA ADDRESS: SAME PERMIT NO: E 056135 PLAN CHECK NO: N wV I : N smart•: n CONSTRUCTION TYPE: PERMIT TYPE: ELE PURPOSE: OTH 548-4767 ARCH/ENGINEER: REG.ND.: JOB DESCRIPTION : LEGALIZE BATHTUB TILING, RE:856134 SQ FT: ADDRESS: UNIT: CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 / PERMITTEE: STANLEY TSUJIOKA (714 ) 548-4767 ADDRESS: 2442 ELDEN AV C—i COMMENTS: REMODEL KITCHEN & BATHROOM C.M. CA 92626 *************x****,F##*>F#*###tE+E******N4c><>F******* x>t** ******#*vF********>F*#>E+c#**x LICENSED CONTRACTOR DECLARATION: 1 hereby atlirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS 7000)01 Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACKS CITY LIC.: STATE UC.: CLASS: Date: Signature: FRNT: FT MAI INBREARING FT IN FRNT: FTCESSINYREARLDING FT IN WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN Compensation Insurance,or a certified copy thereof(Section 3800.Lab.C). POLICY NO.: EXP.DATE: COMPANY: PARKING REQ: PROV: PARCEL: 00000000 ZNE: REF NO: PLANNING NOTES> Cerbli ❑ Certified copy is hereby furnished. 0 Certified copy is Med with the city Building Division. > • ******************************************************************************* Date: ApWcant: D E V E L O P M E N T SERVICES REQUIREMENTS EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed it the pewit H for one hundred(51170)or less). I certify that in the performance of the work for which this permit is issued,I shag not employ any person in any manner so as to become subject to the Workers Compensation Laws of California. ZONING APPROVED BY DATE: Dale: Signature: BUILDING APPROVED BY : DATE: NOTICE:If,atter making this declaration.you should become subject to the Workers Compensation provisions of the Labor Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICATION ISSUED H Y: r r ,� / CONSTRUCTION LENDING AGENCY: 1 hereby affirm that there is a contraction lending agency for the performance of the work for l F�_ DATE: 2' / �'L— whichthispermilisissued(Section 3097.Civ.C). **********************#*******************k*************X**********i. **f.** **it** LENDER: ******************************************************************************* ADDRESS: LEGALIZATION:Y F E E SUMMARY STRUCTURAL SEGMENT:N OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: My city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 9210 10 repair any structure.prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed 5 D% SMIP/NON—RES pursuant to the provisions al the Contractors State License Law(Chapter 9(commencing with Section 71130)of Division 3 of the Business PLAN and Professions Code)or that he/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 penally of not more than five hundred dollars(3500). ISSUE FEE 15 . 00 „,„i I, as owner of the property or my em gybes with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE in structure is not intended or offered for safe(Section 7044.Business and Professional Code: The Contractors State License Law TOTALS----> 92 , 10 15 , 0 0 0 . 00 10 7, 10 10 7 . 10 . 00 does not apply to an owner 01 a property who builds or improves thereon,and who does such work himsell/hersetf or through his or her own employees.provided that such improvements are not intended or offered for sale.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED : 107 . 10 OVER/SHORT: 00 fortheepurposeofsoldhe). one year of completion,the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK for the purpose of safe). I,as owner of the properly,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 107. 10 ❑ and Professions Code: The Contractors' tate License Law does not apply Wan owner of property who builds Law),ola aware ****,*,*,***************************************************#*******#****iF******** and who contracts for such projects with a econtractor(s)license pursuant to the Contractors'Stale License Law).I am aware that pmol of their Worker's Compensation insurance should be provided to , INDIVIDUAL F E E BREAKDOWN ❑ I am exempt under Sedan: B.8 P. w or mi esti rGGti 11141, TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST • Date: Ilr ELE 20 FIXTURES, LIGHTING 1 ST 20 EA. .75 15. 00 I do hereby certify that l am aware of and understand the requiremen ' '. • '• ..th and Safety Code Sec ons 25505,25533.and ELE 19 FIXTURES LIGHTING ADDITIONAL EA. . 45 8 . 55 25534 and that I or any future building occupant wivMiv not(circle one)need to comply with said state codes and the requirements for a ELE 20 REC EPT/OUTLET 1 ST 20 EA. . 75 15. 00 permit for construction or modification from theAir 0uabty Management District.Residential construction applications are exempt from ELE 10 REC EPT/OUTLET ADDITIONAL EA. . 45 4 , S0 mase provisions. ELE 1 RES APPLIANCE NOT OVER 1 . 0 HP 3 ,00 3. 00 Dale: A hcant: END OF FEES I hereby certify that I have read this applicati and state tha e above •formation is rrect.I agree to comply with an city andc8uny _ ordinances and state laws relating to buildin mruction and•ereby a4. raze represents f this city to enter upon the above me toned 0) 35 j('371a D01 e 2•F T I propertytar i spedi purposes. _I . DATE: CM!,c,2 Tilh:: ,4 i:Dat ! Co(min-- Signature: Driver's License or Social Security 1641.46 White—Building:Green—Code Enforcement:Canarv—Aoolicant:Pink—Revenue:Goldenrod—Mseesnr CONSTRUCTION AND PLANNING POOL PA 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, 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 l• 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 U 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 2.7-7/ otes: 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. Backf low 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 I. PROJECT ADDRESS: 2442 ELDEN AV UNIT: C-1 CITY OF COSTA MESA — BUILDING PERMIT PERM NO; P U�blit OWNER'S NAME: STANLEY TSUJIOKA ADDRESS: SAME PERMIT NO: P 056136 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: PERMIT TYPE: PLU PURPOSE; OTH 548-4767 ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : LEGALIZE BATHTUB TILING, RE:856134 SQ FT: ADDRESS: UNIT: CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 / PERMITTEE: STANLEY TSUJIOKA ( 714 ) 548-4767 ADDRESS: 2442 ELDEN AV C-1 COMMENTS: REMODEL KITCHEN & BATHROOM C.M. CA 92626 >E*******i**rt ** *******Tt******>t+r*TE** N>EaE**ar***>E*** F** ** **Tr*****>E**>t*****Tr* LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS 7000)of Division 3 of the Business and Professions Code.and my license is in lull force and effect. SETBACKS CITY LIC.: STATE LIC.: CLASS: BUIDate: Signature: FRNT: FT MAIN INBUILDING REAR: FT IN FRNT: FTCESSINYREAR�DING FT IN WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell-insure or a certificate of Workers' LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN Compensation Insurance,or a certified copy thereof(Section 38O.Lab.C). POLICYNO.: EXP.DATE: COMPANY: PARKING REQ• PROV: PARCEL: 00000000 ZNE: REF NO: COMPANYO ❑ Certified copy is hereby furnished. ❑ Certified copy is filed with the City Building Division. PLANNING N TES > ******************3E**********************if****#'N****lE****4i*34********1E********** Oat Applicant DEVELOPMENT S E R V I C E .2 REQUIREMENTS EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (Thus section need not be competed if the permit is for one hundred(5100)or less). I certify that in the performance al the work for which this permit is issuedI shall not employ any person in any manner so as to become V . subject to the Workers'Compensation Laws of California. ZONING APPROVED BY DATE: Date: Signature: BUILDING APPROVED BY ; ✓ , DATE: NOTICE:If.after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor 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: � I DATE: 2 (O which oris permit is issued)Section 3097.Civ.CI. ******************'************************ *•*y****}***************.' •'- - *44* LENDER: )4*********************************************i1EIE******************************* ADDRESS: LEGALIZATION: Y F E E SUMMARY STRUCTURAL SEGMENT:N OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'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,m PERMIT 1600 • repair any structure,prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she Is licensed 25% SMIP/NON—RES pursuant to the provisions of the Contractors'Slate License Law(Chapter 9(commencing with Section 7003)of Division 3 al the Business PLAN and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by ISSUE FEE 3. 00 any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). , I, as owner of tee property or my employees with wages as their safe compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE 7A CJ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The ContractorsStale License Law TOTALS----> 16, 00 3, 0 0 0 , 00 19 , 0 0 19 . 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 REVENUE DIVISION TOTALS--> COLL CTED• 19 . 00 OVER/SHORT' 00 improvement is sold within one year of completion.the owner wit have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MF_HANIC FIRE SMIP/TOT GRADING PLAN—CHECK for the purpose of sale). 19 . 00 9 OD I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon *****,x,***,x,*****,*,***,********,**-***N,**,-,N**,*,*,*****,***,***,**3c*****,***R*************** and who contracts far 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 INDIVIDUALA L FEE BREAKDOWN ❑ I am exem under Section: B.&P. for chson: ( . / TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST Date G �1— •,r-c�: PLU 1 BATHTUB 2 '00 2 . 00 I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code ections 25505,25533,and PLU 1 DISHWASHER 2 . 00 2 . 00 25534 and that I or any future building occupant will/will not(circle one)need to corn*with said state codes and the requirements for a PLU 1 SHOWER 2 . 00 2 . 00 permit for construction or modification from the Air Ouallly Management District.Residential construction applications are exempt from PLU 1 SINK, KITCHEN 2 . 00 2 . 00 these provisions. END OF FEES Date: Appli nt: I hereby certify that I have read this application nil state th. ..ov.' formati.•I •rect.I agree to comply with all city and count r ordinances d state laws retating to building c struction i hereby a .,rite represe ..•-if this city to enter upon the above.memion 01 00108!"12.-021887.13 TOT .. ,V" prop'enwl Insp ii}spurposes. . DATE: 02107/92 TME: 14.i:1 oat£" `-'�L l,e �%v- . �� Driver's License or Social Security Applicant:Pink—Revenue:Goldenrod—Assessor _ CONSTRUCTION AND PLANNING - - POOL PA 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 o 3. Electrical Conduit Utility-Undrgrnd. 54. Forms •"- y 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, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O 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 b 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 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: 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. Backf low 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 • PROJECT ADDRESS: 2442 ELDEN AV UNIT: C-1 CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 0761.34 OWNERS1AME: STANLEY TSUJIOKA ADDRESS: SAME PERMIT NO: B 056134 PLAN CHECK NO: N GUVY: N SUFI": N CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: OTH . 548-4767 ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : LEGALIZE BATHTUB TILING SQ FT; 400 ADDRESS: UNIT: p. CLAIM VALUE: 400 . 00 CALC-VALUE: 400. 00 GROUP OCC: R-3 / PERMITTEE: STANLEY TSUJIOKA ( 714 ) 548-4767 ADDRESS: 2442 ELDEN AV C-1 COMMENTS: REMODEL KITCHEN & BATHROOM L' C.M, CA 92626 ********* N***>E**** >E>E******+F>F***>t***>f**x-*** -Nx**N**>F>E+E**rLTE*+F*>Ex+E***x*+PAF*xr.>E*NtE* LICENSED CONTRACTOR DECLARATION: I hereby Arm 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 lull force and effect. S E T B A CK S CITY LIC.: STATE LIC.: CUSS: Date: Signature: MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to selbinsure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT I N LEFT: FT IN RGHT: FT IN LEFT: FTIN RGHT: FT IN Compensation'Insurance.or a certified copy thereof(Section 3800.Lab.C). , POLICY • EXP.DATE: COMPANY: PARKING REO' PROV: PARCEL: 00000000 ZNE: REF NO: 0 Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. PLANNING NC5 TES> > Date: Applicant: *****************************************************li**************ii;zjS99******* EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed it the permit is for one hundred(31(10)or less). D E V E L O P N. E N T SERVICES REQUIRENEN'T S I certify that in the performance of the work or 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: BUILDING APPROVED BY : DATE: 71 NOTICE:II.alter making this declaration,you should become subject to the Workers'Compensation provisions of the Labor Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. { DATE 2��C 2� CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y which this permit is issued(Section 3097,Civ.C). ***!P******#F***1P***li*%'*******1F********#** *****iE***3i*3r**3i***lE**ii**1Eht ' ':aril LENDER: *******************************************************************ti-#,********** ADDRESS: LEGALIZATION:Y F E E SUMMARY STRUCTUR'At/ SEGMENT;Y OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTR'IC MECHANIC FIRE SNIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 30, 00 ' .. ,50 repair any structure,prior to its issuance,also requires the applicant for such permit to tile a signed statement that he/she is licensed A SNIP/NON-RES pursuant to the provisions of the Contractors'Stale License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business P L AN and.Protessions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.My violation of Section 7031.5 by1 any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars($500). ISSUE FEE I, as owner of the progeny or my employees with wages as their sole compensation, wig do the work, and the BUILDING-DIV-> PERMIT ISSUE PLAN,r CHECK TOTAL PAID DUE tn structure is not intended or offered for sale(Section 7044,Business and Professional Code: The ContractorsState License Law TOTALS----> 30 , 50 0 . 00 ; 0 . 00 30 . 50 30', 50 I . 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 sate.If,however the building or REVENUE DIVISION TOTALS--> C0LLEC'TED • 30 , 50 OVER/SHORT' ' 00 improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve Ior the purpose of Seid). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK 30, 00 , 50 I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044.Business ' ❑ and Professions Code: The Contractors'projects License Law does not appMtoo theowner of property who builds Law). thereon ******************.**********.**.*****.* ****.***********************_* .************ and who contracts for such projects with a e License )license purs .it to the of Contractors'State License Law),I am aware that proof of their Worker's Compensation insurance should be• • e. INDIVIDUAL +.:F E E BREAKDOWN , ❑ I am exempt •der Section: B.8 P.C. for this mass : it � /TYPE QTY DESCRIPTIO Nn UNIT COST S TOTAL COST dp- 1.41.1 � ..rn.-�4Yi se Date: SFR 400 ALTER BY VALUE RESIDENTIAL NOZONE 1 , 00 400 .00 I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code fictions 25505,25533,and END.OF FEES • I 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 permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from I these provisions. ..-• i Date: Ap0lit t: ,,� I hereby certify that I have read this application state that th• .. . matio ' orrect.I agree to comply with all city and county %j ...... d ordinances and ate la relating to building co truction and he eby author a -presents s of this city to enter upon the above-mentione / , . property s Clear`\ oases. T nil _ Oat ` - Applicant:Pink-Revenue;Goldenrod-Assessor A CONSTRUCTION AND PLANNING POOL ,PA 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, 0 Undrgrntl. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-FinaC �-" ;, 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 OGas OOil 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 e_ -S 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 �' • �p niti ) 04-6( 47. FINAL STRUCTURE & BUILDING 2/1/2, A /UN) , 48. FINAL PLANNING / 49. Electric Release to Edison • 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Z 'V - 0410 CITY OF COSTA MESA BUILDING DIVISION Y : DECLARATIONS • WORKERS'COMPENSATION DECLARATION: • ' I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 12... Ihaveand wwill 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: Caudae 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 ped rmance of e work r 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 alifomla, d agr at"sho become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these p ions. /) �f ',I Applicant Signature:e: ( . I�-- `Dater 1 • Dt! -CI-7 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 OOLLARE($100,000),IN ADDITION TOME 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.l.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 end eff- ectrLic.# Y 2 b y 6 ,> LCtass a L l Contractors Signature: . f� , /.d Date 4 • L 4 • U !, III 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: -1- Lender's Address: Signature: ` A Date: • OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of.perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires'a:permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of 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.). O 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: O I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the 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 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 Califomia 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 aermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? D Yes UP No (Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Califomia 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. 6....A112 eget er(s) L/ L ,/Date And/Or.' rizedlAppllcant `J Date` COOE 6 INSPECTION TYPE DATE INm1AL$ CODE! INSPECTION TYPE PATE INTmALS 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 I 204 Final Demolition 250 Final Building/Occupancy + '-'ID'f71 City of Costa Mesa Building Safety Department CERTIFICATE OF OCCUPANCY P.O.P.O.Box 1200 :\TO 2998 Costa Mesa,California The Building located at 2442 FIcien Avenues- 11'nitnR1 .R2_R3_R4_RS Ah R7 has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group H n .T Occupancy. Use of.Building 7 Cnndnq w/ 7-Car r,nrnane nn Legal Description A. .P. 119-0(1-Oi Od - - (See reverse side for Mates and Bounds) { Building Permit No tt7R7fi Electrical Permit N . n44Ar A4n7? Plumbing Permit No. 7(S7.; 7(1C,r7 1 Number of apartments and/or guest rooms ISSUED TO: Building Official SPITINAICmZ C{&/YAWL/ ;AN CZLNSTRUCFTON Victor,C. Nstrton - Director I iidin3 Safety Date 1'nrrh 711 't(inn This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 306 lel U.B.C. Form BU 34 Rev. 11/70 ' ` • CITY OF COSTA MESA • OE^"w!14; " BUILDING DIVISION tak�. 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: M11-00003 PERMIT TYPE MECH STATUS: ISSUED APN: 93068410 DATE ISSUED: 01/03/2011 ISSUED BY: RMD JOB ADDRESS: 2442 C003 ELDEN AV CM Suite/Unit: C003 Vicinity: CLOSET SQ. FT: 0 SCOPE OF WORK: MECHANICAL PERMIT TO CHANGE OUT FAU < 100 K BTU LOCATED IN CLOSET.COMPLIANCE FORMS ATTACHED TO JOB CARD AND CITY PERMIT. OWNER: JONES, LISA B Address: 2442 ELDEN AVE#C-3 Unit: PHONE: 949-922-2838 City/State/Zip: COSTA MESA,CA APPLICANT: RASKIN,VLADIMIR Address: Unit: PHONE: 714-245-0505 City/State/zZip: CONTRACTOR: EXPRESS SERVICES AC AND HOME APPLIANCE REPAIRS INC License No. 625273 Address: 1358 EAST EDINGER AVENUEUnit: PHONE: 714-245-0505 City/State: SANTA ANA,CA ZipCode: 92705 CELL: MECHANICAL PERMIT FEE SUMMARY MECH ITEM FEE: $38.30 PLAN CHECK FEE: $0.00 INVESTIGATION FEE: $0.00 REINSPECTION FEE: $0.00 TOTAL FEES: $38.30 • 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 E. INSPECTION TYPE DATE INTMAIS CODES INSPECTION TYPE GATE INII9ALL'I ,Ao 1616 Fixed System Final Fire Prevention 206 Final Mechanical xI 7-1 1 Ot 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 WORKERS'COMPENSATION DECLARATION Owner ID verified by driver's license. 0 Yes ❑No I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires:• • ❑ 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. ❑ 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 ❑ 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 J.t9,-f.L. se CI by this permit,and that no building structure,scaffolding,falsework,or demolition Carrier. or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp L—�irno seem neat),be m-npetee/rnapemw B vaned al one nuMred ddars(sidd)nress.) 2.Art 2,Sec.341.Title 8.California Administrative Code). PLdlicy-Nu ,ymber: 0 0 0 Y 0 —i 0 0 As owner-builder. I will not employ anyone to do work which would O 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 Labor Code.I shall forthwith comply with these provisions. V. /1 q f 1c_1 f/3 / e o / I Division of Industrial Safety Permit Number: Appl�n't's signature 41r�'--w 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 Li�•-.E7 2-t' 273 r--Class#� C �/ .3 Z (Section 25533 of the California Health and Safety Code, with some v. RG I �Ll h/ I`3 / 20 /1 exceptions, requires registration with the Costa Mesa Fire Department by e5a each business which at any one time has on hand a quantity of acutely Contractors c to-. 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 constmitiorr(ending isency 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'309r,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: t hazardous materials)? 0 Yes 0 No `��z�( (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 Ir filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. Signature N 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 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? 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? ❑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 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 ❑ 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 Date J, ftq_r lc-; it 31 i 0 / I 0057-06(107) LPndforAuthonzed Applicant n—Date ell 84 CITY OF COSTA MESA 4 ®® BUILDING DIVISION >:1,,,,,' 1;$ - - - "- DEVELOPMENT SERVICES DEPARTMENT - . - PERMIT NUMBER F t �� ' PERMIT k4 BOO-01833 UI (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.g.us.LDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 ; ' s5 Job Address: 2442 ELDEN AV Status: ISSUED Suite: B Applied: 11/14/2000 Vicinity: Issued: 11/14/2000 �:I Parcel Number: TPN00045 Zoning: Applicant: MARION, RICK Address: ISSUED BY: ' Phone: 949-548-3012 Zip: Owner: SPINNAKER COVE CIO CC&R ASSOC. MGMT. Address 17942 SKYPARK CIR N. IRVINE,CA ` Phone: 949-955-0112 SUITE H . Zip: 92614 Contractor: MESA ROOFING Address: 843 W. 17TH STREET Phone: (949)548-3012 . COSTA MESA,CA Zip: 92627 •License: 564151 Arch. _Eng: Address: Address: Pho• ne: Phone: Zip: License: License: SCOPE OF PERMIT ' RE-ROOF BUILDING B TO INCLUDE UNITS 8001 THRU BOOZ TEAR OFF.SHEATH AS REQUIRED,COVER WITH 25 YEAR COMP. - FEE SUMMARY , Plan Check: $0.00 -. Calc Valuation: $20, 930.00 'Permit: $335.25 - - Claim Valuation: , $20,930.00 SMIP Res: $2.09 SMIP Com: $0.00 Other: $0.00 Inspection: - $0.00 • - Total: $337.34 PLANNING & ZONING - SETBACKS MAIN STRUCTURE Front 0-0 - Rear 0.0 Left 0-0 Right, 0-0 ACCESSORY Front 0-0 - Rear 0-0 Left 0-0 ' Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 ' - NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void it work is not commenced within 180 days,or it work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply 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: 0 I have and will maintain%certificate of consent to self-Insure for workers'compensation,as provided for by section 37U0 of the Who,Code,for the performance of the rk for which this permit is issued. I have and will maintain workers'•. •.:nr ion Insurance,as required by section 3700 of the Labor Code,for the performance of the work for whi thi permit is Issued. My workers'co Ion Ins - Y e =y ': a •policy number are: /�,� Carder: • Policy Number: ( f X...� (TMs section need not be completed ifIe permit is valued et one hundred dollars($100)or less.) ❑ I certify that in the performance. the work for which this •:mil is issued,1 shall not employ any person in any manner so as to become su lett to the workers' compensation laws of Car ••. - . EE,•r:become subject to the workers'compensation provisions of Section 37 of the Labor Code,I shall forthwith comply with mese• .• onsijr. CQptfirTSignet`ura. / Date: /51(0-6 WARNING:FAILURE T. lrA/ORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PE TIES AND CML RNES UP TO ONE HUNDRED THOUSAND DOLLARE(S100,000),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'revisions 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.II Class a. Cgnracmrs S' ��—� 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 require&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 shels licensedeursuant 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).): 9 d I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is riot 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 owiRampioyees,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.). O I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑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 parson 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 Safely,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 o1 the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes O 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. _.._..__l__r._ _._ v.... _.. _._ 4 If enn RMPP Is presently required,has Section 25534 of the Californiaeia Health end 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 application e,aermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑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 patroathe South Coast s Quality Management District or dSr air pollution control district3or agency is required for the work—Which H the subject of this application,have all of the disclosures prescribed by CaliforniaCelifoHealth and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air polluutionn 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 stale 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, /1 //T 6 TUU •uthorized'A••' •ate ODE# gaSPECTION TYPE all INIlllj& Foos! IIb$PECTION TYFg la7F =60 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final / 208 Final Plumbing [/-6 _ 200 Final Re-Root ` '0� L4.4-- 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 • 117111111111 --ADDIIca nt"t o'uernra......,._ - _reorder lines and sign all appropriate declarations. ..... • CITY OF COSTA MESA 'CONSTRUCTION PERMIT JRMIT N(O, TRACT NO. LOT NO. IUNIT NO. 0902 BIO Ib0 4 Project Address -9(414_2 (-cider) live, if s• -I �I �7 `�1 . /..-i//On, J Applicant's Mailing Address id 5/IA � I 1/i)Y2 .Ct r1S-r 1 yi��p/O I/I TYPE OF CONSTRUCTION H NEW H ADD U ALTERATION H REPAIR I - Owner's Name 21(Hfl N U/l1 Cr. 1 Phone v/��/1'VSI/-O`I I CI CONVERSION El DEMOLISH CI OTHER A P # Zone . 1 I �/� �j DESCRIPTION OF WORK/USE OF BLDG. • Address 2UUa eldeACI Ove k \I I - , S Main Building: Accessory Building: Arch/Eng. License No. TYPE OF PERMIT El GRADING LI FOUNDATION H STRUCTURAL E Front O ❑ TENANT ❑ ELECTRICAL El PLUMBING El MECHANICAL Address �s.,''' q �N� B Rear N Contractor's Name 1 Q 1/*)Y\ (IJ.(,Lar)/ Phone ri7i-1��eJ ❑-OT-M C Ri ht - - - N Address(mailing) sop lS 1 tion S P Q]�](� I • PROJECT DESCRIPTION Q. FT. • _ OCCUPANCY K g G • In I t MST-RUGT-IONTYPE VALUATION$ • ' S Left City License No. "l'\ . ZONE - GRADING CU.YDS. ACRES I E ' LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided E h 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: �1• [ -gip "yam"/� /J� // Planning Notes: L �'1 Q 1/\ with section 7000) of Division 3 of the Business and Pr ff�e@s;Ions Code,and - V� n^G ' �C�"f �y�v`-' `Cn f T'-�Pr RECEIVED J U L 2 ' M \C.-\ my license is in full fo e d effect. ST,ap�Qrj V• License Class License No. C*,,__ . w` • -✓f S Date 7-4S Signature Lit OA PLJ K 1/R. — A( —) PLUMBING , FEES ` i WORKERS'COMPENSATION DECLARATICIA `) Bar Sink Showers • treby affirm that have a certificate of consent to self-insure or a certificate ELECTRICAL FEES N. Workers' Compensation Insurance, ora certified copy thereof (Section Backflow Preventer Service Sink • ' ' — ..000, Lab. CAutom is Wa Transformer 0 15-50 KW Policy Nowa SUiQOrinQ�01 Company I-thPY1-1_'VYII7tlIRO Backflow lrri Irrigation • 0 50+KW T. f� ® Certifl d copyg Sewer Cap _ Constru n.Pole Suh. -' N\ is hereby furnished. Certified copy's filed with the city Bylldjng Division Bathtubs Sewer Connection Cooking nit Meter Dup to 100 amps Date 7—I.h-5"fin Applicant L 11.4iMil -\01:17.40 1-4---- . EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Diehwashe 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 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❑01 HP ❑1'h-8 - Workers' Compensation Laws of California. - ' Date Signature Floor Drains Swimming Pool w/Spa - F.A.U. - NOTICE: If,after making this declaration,you should become subject.to the - Inc.Solar❑9-15 HP❑16-15+ 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 el • Gas Service Outlets Water Closet Device Boxes I hereby affirm that there is a construction lending agency for the performance i Pole Light of the work for which this permit is issued (Section 3097. Civ. C.) Interceptors • ' Water Heater Outlets Lender's Name 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 . • Auto-Wash , Garbage Disposal ' following reason (Section 7031.5 Business and Professional Code: Any city or 9 p Standing Sections i county which requires a permit to construct,alter,improve,demolish or repair P—Trap Laundry,Trays Generator KW❑5-15 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 • -. the Contractor's License Law(Chapter 9(commencing with Section 7000)of f' �lYXYf-1� <SO/�lhP` ry O� skin 3 of the Business and Professions Code) or that he/she'is exempt - -- • - - ' ;from and the basis for the alleged exemption. Any violation of Section • s 1-5 by any applicant for a permit subjects the applicant to a civil - ' malty of not more than five hundred dollars($500). 1, 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 is not Intended or offered 1 - • - 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 D Zoning Approved By - - Date pletlon, 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). - - I ❑ I, as owner of the property, am exclusively contracting with licensee<on- Duct-Structural • Refrigeration System Application Issued By s'y t _ - Date 7.�4) --i(o 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- , tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System El Multiple ❑ System Repair/Alteration _ BUILDING PERMIT $ SMIP $ proof of their Worker's Compensation insurance should be provided to me. - - PLAN CHECK $ • PERMIT ❑'I am exempt under Section B.& P.C.for this reason . Firep/Fact.Bit. ICBG# Fire Dampers - ,, - PLUMBING $ ISSUANCE $ Date, Owner -' Heating System& Ducting Registers PLAN CHECK 25% $ ENERGY P.C. •$- - • I hereby certify that I have read this application and state that the above ❑0100,000 BTU 0100,000BTU • 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 repre- PLAN CHECK 50% $- MICROFILM $ - sentatives of this city to enter upon the above-mentioned property for - _ _ inspection purposes. ' Signature F04(1/ / /zi Date -7i-� " 2 - MECHANICAL $ ' TOTAL FEE $ Drivers' License or 55 9P Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ 1\ CMF 0865-46,rev. 10/84 White - Building; Canary - Applicant: 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 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement ; • 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Uridrgrnd. 55. Electrical Bonding to 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER,GIUNITE �. 7. Footings 58. Electrical Conduit-Undrgrod. 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test ' 1 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O.Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK V 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Ventlinal • 13. Roof Drains 64. Plu‘bing Si/e al 14. Rough Plumbing 65. Electrical-filia 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# _ _ I 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 •,I 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 q-i-v , C,ED 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 . I w 2682 5/18/81 17.00 Tl COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT • P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 REC/ ■PERMIT gy ce 7 For Applicanticnt" to Fill in Completely—Use Ink Only ANS /- I DDRE1-4. `-{-oe'4 AVE C3 A.P.NO. .¢ +L/n�j `— Oz �j /� ,,a,s ,t BUILDING TTENA TOR 1� 1C14 R01 M,k iL A ADDRESS Z c s UNIT OR MAILING n — 1 zs SPACE NO. G ADDRESS 2¢x' 2 EL_t7 /+tIC �� TR.NO. LOT IBLK. TE L.1 52-a7 I7 CITY CcsTA MESc4, NO.(o'f5'-577 CONSTRUCTION 404 NEW ADD ALTER REPAIR MOVING DEMOLISH 1 t LENDER Iy c X BRANCH // � '/ /.,/w /� OWNER N/• In-. At. PICkA2D ADDRESS AARCHITECT R ENGINEER OW N c ic TEEL• USE Th'CAo V� UE$ c /Z-0O ADDRESS ZONE (` Z (TYPE ,is-- GROUP TAA- I CONTRACTOR O W 4/4 t, IC BYPROV ED DATE c/fe/el ADDRESS TEL. CITY NO. Irynv APPROVEDCITY APPROVED SETBACKS , gLIC.NO. LIC.NO. 0.is SIZE NO.OF BLDGS (FROM CIL STREET/N.y l OF LOT NOW ON LOT FRONT Lt'r7?'R t+'J . - USE OF t!�� '/ - EXISTING BLDG. R.SI FT. H Separate permits are required for L.SIDE '1 FT.D G electric,plumbing and heating work: REAR /` FT. fill W., USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION 4TI l "Vc , DATE APPROVED L�j Q^/C/� , _AYROVED /in l/� •1 DATE ✓ 8/ CC sn O I hereby acknowledge that I have read this application and state n C 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 yyyy `W.t•' the State of California. /D� m 3 • certify that I am properly licensed as a contracto • SQ. FT. _ N the State o • Ma Business and Professions •'vision 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and that s :nses are • • orce and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: e am exempt from the - • tate of California Business VALUATION PERMIT FEE $ /0. Odit ..• - • ode, Division 3,Chapter ••. •/ m Signature of ,//�//� //�/ . I7 PLAN CHECK $ •SD o Permittee , �/.c••r-Vr V pp _ $ Li /o TAX $ 0 •SD F Authorized Agent Date Q/ L-- TOTAL PAID $ /7 ,(gyp D I. --f --- -M _c.-- ' _ (4 6736 4/13%79 B5.95 !TU COSTA MESA BUILDING-SAFETY DEPARTMENT i 'FiICATION FOR-STRUCTURAL'PERMIT •-' - P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 Q�/,.��,(y. A PE ;��O�r •/! For Applicant to Fill in Completely„�... """ ll ,�— Use Ink Only 34W-14 .ADDRESG ent� )=/ c v4/c A.P. NO. I I 5-64011.— Q3 o% ADDRESS ((_f.,� to ” I/� _ C TE NER OR p�/� SJr t�' R c v ADDRESS j 2 'tOgo J 42f UNITENANT rR �� I/11 AWI^ WI 1 ��/ "` 6 J ��/ /AE SPACEC N R MAILING NO. ADDRESS TR.NO. LOT BLK. CITY / / 6,1—• TEL NO. I D /0 Q o I CONSTRUCTION NEW ADD ALTER REPAIR MOVING DEMOLISH LENDER X BRANCH / .S S (J OWNER � it ' ADDRESS ,/ ARCHITECT'^/ 1 EL p/{ USE/ inN /� VALUE444 44do OR ENGINEER V't S' �� )2,s. wID �1 C , f�� 1 ADDRESS /le "� 0 ft/5°1 2�I ZONE fa[/ Y Air GROUP—! " CONTRACTOR f �2`�', (✓. • , r er DAT'/ I.t " 4- ADDRESS 9I DI� 6F (W 'f�({��j'P_ trjac TEL �( 3�r. CITY N NO.oJ —�- E STA CITY APPROVED SETBACKS LIC. NO. - —r LIC. NO. p (FROM : SIZE lit r7 I� _Dfr ` NU.OF NOW ON LOTSFRONT C/a (RFTTiQ G. Of LOT e"IZf G�C�JI Q USE OF 1-41 - EXISTING BLDG. ' • _R.SIDE 11 SFT. 0 y F.4 Separate permits are required for L.SIDE 5 FT. C) electric,plumbing and heating work: 0 REAR 2aOFT. 0 IW. ., USE OF BUILDING AND WORK TO BE PERFORMED pI a LSY. t L9k RSk'EGIAI. ItEQU1RtMt N l 0 / CONS W/ 7 �— _ I APPROVED 2 CAT/` & sa ROVED/ C 1.41-• DATE 4JT /7O / .1 ce W 0 I hereby acknowledge that I have read this application and state p$ 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 W the State of California. /'tommaw m I hereby certify that I am properly licensed as a contractor under An 750. FT. ,V/ the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR ro Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: e am exempt from the provisions of the State of California Business VALUATION Y and Professions Co , Division 3,Chapter •. en PERMIT FEE $ ,n Signature �///,1\ •, / (Fr.--..._ ` $11PLAN CHECK $ �•at LL Permitt / " `% • $ /a to TAX $ A-48 U i//'/^PJ /Y� ' V \\\ Authori t Date TOTAL PAID $ I f ft P111111111>-- d, COSTA MESA BUILDING-SAFETY DEPARTMENT XXPLI'tTION F8rt4IRI t1U*&9,PERMIT( 66.00 Ii 'J P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 11 7R A/ I'll f 70 I ctfl jc l a. RECEIVED BY P'� For Applicant to Fill in Completely—Use Ink Only .1'1'" ito24- r uty BUILDING A.P. NO. ADDRESS OWNER OR ADDRESS ;'/t' C 41/_ TENANT UNIT OR MAILING SPACE NO. ADDRESS TR.NO. LOT .BLK. TEL. CITY NO. NEW / ADO ALTER REPAIR (MOVING DEMOLISH CONSTRUCTION /NEVI/ LENDER BRANCH OWNER N`Sp� NXbeeg. Co ADDRESSCHITE /� 0/ VALUE $ ARCHITECT TEL. USE fN R�-.7dT�AL OR ENGINEER NO ADDRESS ZONE TYPE GROUP APPROVED CONTRACTOR BY DATE ADDRESS TEL. CITY NO. i'-, STATECITY APPROVED SETBACKS aLIC. NO. LIC.NO. [s7 SIZE NO.OF SLOGS. (FROM C/L STREET) a. OF LOT NOW ON LOT FRONT FT. a USE OF VI EXISTING BLDG. R Sion FT. rA fSeparate 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 -C G DATE 1 APPROVED APPROVED —EtY -DATE rZ 'U Qa . I hereby acknowledge that I have read this application and state m p: that the above Information is correct and agree to comply with O. all laws regulating building construction, and I shell not employ i Z any person in violation of the workman's compensation laws of 2 La_ the State of California. m I hereby certify that I am properly licensed ase contractor under SO. FT. the State 9, u Business and ullProfessions Code, effect, 3, THE AMOUNT SHOWN UNDER VALUATIO IS FOR m am Chapterxp and that such areisionseoin California and uI THE PURPOSE OF ABLISHINGF A PERMIT F66 _ am exempt from the provisions of the State of Cia Business VALUATION PERMIT FEE $ 6 �" and Professions Code, Division 3,Chapter 9. 'n P, PLAN CHECK E Cl • Signature of - IL LL Permittee $ TAX $ orif,• U Authorized Agent Date TOTAL PAID $ 'o (!r -"- 1' lo037 4/13/79 ' 309.49 YUr' -`- COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATIO1"Q'POR'STRUCTURAL PERMIT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 eNT`REC$Nbp%. 'PERMIT I /7825* For Applicant to Fill in Completely —Use Ink Only 72 �!!// V 17 BUILDING 9-442_ �? t /��,(e A.P.NO. C/ q -P0 6 I -o 5 s, Os y ADDRESS yyjj L (��/�t� /�.�,t� ! /� �} _ may' j/j��)! TO NANTOR 7tiie�'� fiti�y'`�I' y,2n1 ADDRESS. V''ff^�E�H✓"'t UNIT OR ADDRESS ICOS I LT tt sS SPACE NO. }RINE it.+- /./� TR.NO./ Q'f LOT ( BLK. CITY }1 t �L \,E („'(. . NO. �� ' r CONSTRUCTION NEW ADD ALTER REPAIR MOVING DEMOLISH LENDER L J BRANCH JNE '�` J OWNER] ! ADDRESS VALUE ARCHITECT w �/Lj)$�f/(EL.b`fb a gr sS& ft ppy,,,E 40 OR ENGINEER •v �1 /`C-Lli1J17tJ0, /j R J! — \ ADDRESS/iff SS at !i . • 65.,,_ 3i 1111 ZONE A PE ROUE' A, .k 1( rt, APPROVED nil �J/ CONTRACTOR WIL�f.. /I�,-s (f =Y // DATE /lj ADDRESS/Ey (� rzvE./E 6-r # 13cJ ;��7 CITY/ ,sW1 V(�'./ �, '..i ' 170'-..v6.5 3..(X- F STATE 1 CITY APPROVED SETBACKS LIC.NO. LIC,NO. SIZE /��/-7 NO.OF BLttT (FROM CIL STREET) OF LD7t ct./G(/�) .�',[�JJ/j()NOW ON LOT ��/ / FRONT 02.2j) FT. b 4 USE OF EXISTING BLDG. Slf +u ( � 7`s`r1l i D�.�,i�ltpE.� 7 1 1 , slaE 3 F7. 0 VI HSeparate permits are required for 4,sIDE FT, O Cik electric,plumbing and heating work. ,REAR „2.9 FT, o •IW„ UE O t11LDING AND WORK TO BE PERFORMED PLANNING ACTION dtaltesttED DATE DFPROVED ' � �q ,i 1ROVED�rp( JamDLP /LTJ �y .a Cd w a.0 I hereby acknowledge that I have read this application and state (Atli FOR SPECIAL REQUIREMENTS :Id that the above information is correct and agree to comply with dt. A. all laws regulating building construction, and I shall not employ Z any person in violation of the workman's compensation laws of F. xthe State of California. �A /�] ^� 'J� I hereby certify that I am properly licensed as a contractor under `� J `� SO'FT. L� -�JQ 1 Ni the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR o N, Chapter 9,and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: ,o am exempt from the provisions of the State of California Business VALUATION and Professions Codo,a vision 3,Chapter 9. Se ` PERMIT FEE E v, ✓FCAN CHECK E SM.0 Signature o A y �41146. Permits • $i 9 �1Y�1 TAX E in u Or s�t� vN' 'i({ �((( �y rd Authorizes. Date ' � ' , TOTAL PAID 2 .�ir/J U (}.x r -' �- / 52:00 h.:F 3TR COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION 1� . 7PERMI P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 52.000KTryO IREcEIvEOBV �Prya if V�('.fB`�`�f _ ^/. For Applicant to Fill in Completely— Use Ink Only 2-L71V allit 1{UJt/[ BUILDING A.P.NO. ADDRESSBU /� SPrN K LCA UNITILDIN� L /�E/11�i/� OWNER OR ADORES Ai-- TENANT MAILING OR ADDRESS SPACE NO. TR.NO. LOT 4BLK. TEL. t CITY NO. CONSTRUCTION NEW _ADD ALTER REPAIR MOVINGDEMOLISH LENDER Y BRANCH OWNER !/�}^ /JV ir.... ADDRESSVALUE ARCHITECT TEL. USE' C014,4 OD E OR ENGINEER NO 1 ADDRESS ZONE (TYPE I!�,/// GROUP RAT APPROVED •/ CONTRACTOR BY DATE ADDRESS TEL. CITY NO. .F. STATE CITY APPROVED SETBACKS LIC.NO. LIC.NO. 41 SIZE INO.OF BLOCS (FROM C/L STREET) Cie OF LOT NOW ON LOT FRONT FT. Q USE OF V) EXISTING BLDG _13 SIDE FT. Sn FSeparate permits are required for L.SIDE FT. electric,plumbing and heating work. REAR FT. falUSE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION Q R DATE APPROVED APPROVED _BY DATE IX W QI hereby acknowledge that I have read this application and state C gd 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 2 = the State of California. .-- co 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 O N 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 g �� Y , and Professions Code,Division 3,Chapter 9. RMIT FEE E pC vn Signature of /PLAN CHECK $ reo 0 Permittee $ TAX $ u.u. or rizetl Agent Date �U AuthoTOTAL PAID Ea it ' -COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION Ff it Ri HARL'PERMIIP8', 1;' y,L P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 - . Ili RECEI ,PERMIT ^ I7 26 For Applicant to Fill ll7in Completely—Use Ink aced Ii p■■ _ )TQ -//SU[�/ ADDRESS '- I rL� CJS '�t�a-,/1r-A} A.P.NO. 07 ,Q _ 0Q,/ _' 03 ,Y']O OWNEROi ISefitI IIA�AI e Camp ADDRESS p( ,Q • ga /V TENANT �J{i ``II Y/ �I '/�n•(,�� I/ 1'` ICC/ � 1../ UNIT OR MAILING SPACE NO. ADD RESRS \/ /�� gar TR.NO. y`p LOT / .BLK. /L `\MVP ��i / `� ' TEL. /CS‘ O ! CITY NO. CONSTRUCTION NEW ADD ALTER REPAIR MOVING DEMOLISH LENDER BRANCH n ///� OW NE/R�/�/g'� sP/�y IQs K / _,`�� ARLUE CHITE i��//yram� ��//��/J//�� [(r USE 7 .F/"' lTIA s Vyi1F/�gah OR ENGINEERI�Wr�j 1S'CC/ i/ � . {� NO. 8 ADDRESS I✓r 4N 6 T WeZONE /C TYPE GROU � QQ�A�A �j1 APPROVED ////// {'/p )// CONTRACTOR/JJJ �`-i/ BY / DATE/i '/ C_ 41.7,9 ADDRESS✓"/ �E - I ' op /I// lY / ((( _ CITY fi rnb (6C4ir i NOVI,' (-I STATE CITY APPROVED SETBACKS LIC.NO. LIC.NO. Is7 SIZE LGt-" 7/1 D CA. {�/+-NO.OF BLDG.S. 3 (FROM C/L STREET/ IY OF LOT :7, 24 Sa • I NOW ON LOT FRONT e2 9 FT. 0 Q USE N 6 P EXISTING BLDG. R.SIDE 10 FT. Q GO F SF Separate permits are required for L.SIDE 6 T. O electric,plumbing and heating work: REAR /b 8 FT. O la [-, USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION Q '7 (AMC 'WPM 2 ct2 DATE /` /� ,p APPROVED 61/4179 p /�,.��1�(I �.�,-Y� APPROVED IiI.I)IC DATE 1 ��I7 7 rtW CI hereby acknowledge that I have read this application and state w a! that the above Information is correct and agree to comply with 1101.1) FOR SPECIAL REQUIREMENTSN. 6• all laws regulating building construction, end I shall not employ Z any person in violation of the workman's compensation laws of ,W=, the State of California. 1J�(J O. FT. ✓�(,.r , q I o/ NrI I hereby certify that I am properly licensed as a contractor under I the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR D \ Chapter 9, and that such licenses are in full force and affect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: ut am exempt from the provisions of the State of California Business d . 'vision 3,Chaptar'y, t VALUATION PERMIT FEE E and Professions Cod. ✓Pr ,f3,,�t` a'/�_�,C/trCjJ �Le Signature of /1/ \ l.iC� /%� //�/�/��(PLAN CHECK $ (�"')ir4S p Permittee VVV OO6 S /� v V✓ TAX $ �` / u_ or Q O.4 Authorize. Date '�lr,5.479J.. TOTAL PAID $4311? 3 i • `' 0540 6114179 581:.00 " TU -/.. 5r81.000K! STA MESA BUILDING-SAFETYE , DEPARTMENT APPLICATION F �TRg��P ItMI"C_..•A . P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 Q ,- RECEIVED BY IIPp 11,LNo -- For Applicant to Fill in Completely —Use Ink Only .BUILDING A.P.NO. ADDRESS c..r, OWNER OR ADDRESS a ' l2 .7.On/ 4.4-- TENANT MAILING UNIT OR ADDRESS SPACE NO. TR.NO. LOT .BLK. TEL. CITY NO. CONSTRUCTION NEW ADD ALTER REPAIR MOVING DEMOLISH LENDER BRANCH OWNER1i ADDRESS USE /�^ evA'LUE$ ARCHITECT TEL. \f „ OR ENGINEER NO. ADDRESS ZONE TYPE GROUP APPROVED CONTRACTOR BY DATE ADDRESS TEL. CITY NO. o-, STATE CITY APPROVED SETBACKS LIC.NO. LIC.NO. W SIZE NO.OF BLDCS. (FROM C/L STREET) Ce OF LOT NOW ON LOT FRONT FT. Q USE OF EXISTING BLDG. R.SIDE FT. rn F Separate permits are required for L.SIDE FT. electric,plumbing and heating work: REAR FT. Izl F USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION Q CI DATE • APPROVED 'e APPROVED >.. —B_Y DATE -a tz 14 0 I hereby acknowledge that I have read this application and state N C4 that the above information is correct and agree to comply with G. all laws regulating building construction, and I shall not employ i Z any person in violation of the workman's compensation laws of x the State of California. m - SQ. FT. 3 I hereby certify that I am properly licensed as a contractor under N 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 - e and Professions Code, Division 3,Chapter 9. VALUATION PERMIT FEE $ I IIIm PLAN CHECK $ rn Signature of CI Permittee $ e TAX $ f or Authorized Agent Date TOTAL PAID 5 T/ IPIIIIIIIII r. ille/ 0196 6/12/79 5.50 l/ COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 0.1 RECEIVED BY PERMIT I( For Applicant to Fill j ill in Completelyr —Use Ink Only N° 4 8 217 ADBUIDRESS LDING a w ' E- OS'y A.P. NO. I I Q �I 6 6 v— O 3pag BUILDING G �//�� TENANTO OR NN QK6� CO 2,4/42 DE/V �' UNIT OR MAILING . ` .NO. 'SPACE NO. ADDRESS V(oli tEtFE2l Ncr S TRLOT BLK. --r--p NO. 97c 7L� /O8 f CITY t4V WE r! NEW ADD ALTER REPAIR MOVING DEMOLISH CONSTRUCTI_5I !, � p ^3 C LENDER CJ , O P BRANCH la&s.0 to RS BEtv_- OWNER Sp/A,ivfi 1 . ADDRESS et% l as 0 VALUE ARCHITECT EL. USE '�n ka['S.1�T.s4 OR ENGINEER W6sr&Etb c'K�LV r"t`IO (7Ioit— ADDRESS ZONE K} TYPE GROUP CONTRACTOR 4_44%NPMAN CONS eOCTIq,IJ BYPROV ED DATE ADDRESS 9dpl�, ^�p iJ $•1V/r o Q/ 3. CITY NEW Poer gGisck4 NO`1c 3352 (, STATE CITY APPROVED SETBACKS LIC.NO. LIC. NO. ILISIZE INO.OF BLDGS. (F ROM C/L STREET) c. OF LOT NOW ON LOT FRONT FT. Q F USE OF CZ/ EXISTING BLDG. R.SIDE )FT. co F Separate permits are required for slt1 F C electric,plumbing and heating work. i RE , Y] USE OF BUILDING AND WORK TO BE PERFORMED Psi NNING ACT Q A _ r� DATE C--; Q DC` Q�t l��/�S w��j `L p/�t APPROV/E/D� 9 --; IIACC _B.] //5.� , DATE IO -*/� —� / .-1 C lad 0 I hereby acknowledge that I have read this application and state - b. S. that the above Information Is correct and agree to comply with L all laws regulating building construction, and I shall not employ Z any person in violation of the workman's compensation laws of 2 Iz� the State of California. ii m I hereby certify that I am properly licensed as a contractor under SQ. FT. tv 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: to— am exempt from the provisions of the State of California Business T VALUATION PERMIT FEE E ,,, and Professions Code,Division 3,Chapter 9. ...m l=a m "'ant 0 b' PLAN CHECK b - mm o Signature of /y� DD r LL Permittee rr/CCC��' $ TAX S or / —/z 7e CO U Authoriz nt Date LL/ C( ' TOTAL PAID E St .1010 itCOSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FO��'RU�� PERMIT . P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 48 TL RECEIVED BY PERMIT 1�T0 48 - - - For Applicant /tooJFiilfl in Completely —Use Ink Only N �1 7 7 BU7LDING BUI .2 'J 7 L t'/ajN 3 h �s A.P.NO. '�' U' 3 V BUILDING /\�(� t OWNER OR p /, ADDRESS tat tt TENANT / (N,vei r�.-Q /Z C,Otte co. MAILING / / ' UNIT OR ADDRESS jC � , l/�itt� `v SPACE NO. l` �TE L. TR.NO?o(3 LOT �O BLK. CITY$ pj a.t 9 }.7/ y NO. �— NEW J ADO •LTER REPAIR MOVING DEMOLISH CONSTRUCTION 61 LENDER , C • a BRANCH /L./Lto. 0/fin ra / /' • 1 ti 4/4 r ADDRESS ALOE 'e ARCHITECT TEL USE,, -- I ORE GINEER '41111911r, • .f i / -1---- a s -7 a/ ADDRESS 30 /J6 / tI • :I i ZONE , �j ireillriall �" APPROVED /j I,��J', _ ONTRACTOR ��r4�(/"G re /// s fi BY /,/'/; DATE s ` ADDRESS -��vt '7 2- #*Altai' 4 B' t _ I ✓ CITY 1 13 , NOL, �'� .'7 STATE CITY /a4 O/I APPROVED SETBACKS LIC.NO. LIC.NO. ! f�(! W SIZE INO.OF BLOCS (FROM Ca STREET/ Cr OF LOT NOW ON LOT FROM FT. Q USE OF a 4 EXISTING BLDG. R. E tT 0})‘ to FSeparate permits are required for . I r. X electric,plumbing and heating work.CT R FT L kiiii (W- USE OJj�s l)ILDING AND WIIIC 41�fTO BE RFORM rjO�s ti P NNING ACTIOi�I■ Q PG/L91Y (NA/l it 4A,CiZA/ -",l Pal APPROVEDTE DA �. 1 p— ROVEp�,s. t J DATE l' /9- 4 IX `�1 F.('lL �V Z�. 1.61 QI hereby acknowledge that I have read this application and state r- ce that the above information is correct and agree to comply with As all laws regulating building construction, and I shall not employ Z any person In violation of the workman's compensation laws of LU▪ the State of California. SOFT. N . I hereby certify that I am properly licensed as a contractor underN the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUAT N IS FOR m Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERM FEE Iy4.J b am exempt from the provisions of the State of California Business VALUATION ,st�,� � Ort/ y and Professions Cod 'vision 3, a t LY^-7ERMIT FEE S v' n /PLAN CHECK E / (/ — m Signature of -�( o Signature - S/ 5� TAX $ $V u. u Authorized Agent •ate TOTAL PAID $ , 1410 8/20/79 --7711111 - _.. . ..- 46.70 - COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT r„ P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 prilriTall PERMIT , For Applicant to Fill in Completely— Use Ink Only r 7 l0 7 BUILDING A.P. NO. ADDRESS 2442 Elden Stre-t OWNER ORADDRESS „I BUILDING p /,// 100015111 TENANT Lampman Construction Co. UNIT OR MAILING , SPACE NO. ADDRESS 901 Dove St. Suite 130 TR.NO. LOT BLK. TEL. CITY Newport Beach No.955-335, NEW ADD ALTER REPAIR MOVING DEMOLISH CONSTRUCTION LENDER X , BRANCH OWNERS,o/NNA/lE. ADDRESS VALUE OR ENGINEER H. M. Hansen TEL 286-913 USE j^�. $ • ADDRESS 9126 Las Tunas/Temple City ZONE TYPE GROUP APPROVED CONTRACTOR - u e s ' .. •e e fl BY DATE i ADDRESS 15731 Texaco Avenue , TE CITY paramount No531-4040 F STATE CITY APPROVED SETBACKS LIC.NO. 185102 C 53 LIC.NO. SIZEXt 9NO.OF BLDGS. (FROM C/L STREET) a. ov-ee r //2.S�jr, /7 j NOW ON LOT RONI- FT. USE OF '4 EXISTING BLDG. /3 421 U-/1 L.%P-s*GLd . F.SIDE FT. VI FSeparate permits are required for L.SIDE FT. G electric,plumbing and heating work: REAR FT. F USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION Q DATE ' -a SpA ONLY APPROVED a APPROVED >+ DATE ..1 LU W 0 I hereby acknowledge that I have read this application and state N p, 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 o Sthe State of California. m • I hereby certify that I am properly licensed as a contractor underD the State of California Business and Professions Code, Division 3, SO. FT. N THE AMOUNT SHOWN UNDER VALUATION IS FOR la 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 VALUATIONY PERMIT FEE $ N 'ntl Professions Code,Division 3,Chapter 9. ♦ m m Sig„ PLAN CHECK § 2O c Perm. f `'000.2 . li or T `� TAX §� U Authoriz d''gent Date TOTAL PAID $ [moi 7 U ski 0 . 6,70 r--- _ _ 0621 12/14/79 40. 10 TL • COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT • P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 RECEIVED ED ey (PERMIT N0 49359 For Applicant to Fill in Completely�tl —Use Ink Only �77� I / lr ADBUILDING 4 DRESS ..L//Lz. ELDL.N t-i../k A.P.NO. I l� Onb I — /OJ 0± / OW NER et Wale= Firient,linta--1 / ADDRESS ....BUILDING e L/2,�� 'V✓K� MAILING UNIT OR SPACE NO. ADDRESS{f 39113ig Bigot 103 T/q��NSpq��` LOT(� _,./_ �'3 BLK. TECITY NEWPP/�r ke„e,�,,_ NO. 97g��+3 IU 1"Or jot /UO CONSTRUCTION C/q NEW A ALTER REPAIR (MOVING DEMOLISH LENDER G St �✓ -�// BRANCH ///� dot14f Jl� i�-�� OWNS: 0. ADDRESS // VALUE ARCHITECT //, ', TEL. USE $ OR ENGINEER $y-L) kie'v 692-6440. I - _ l ADDRESS ..-------- /' ZONE f Z TYPE GROUP PROVED CONTRACTOR 1 t y Of �J (,�j�j r BY 1DATE ADDRESS beg4y g1Rcrr av--./o6. p. —__ �I%/ TEL.�l 7Qy CITY NO. (/Kr/ �3 i.F STATE CITY #_.5-7/ APPROVED SETBACKS ,! LI O.NO�h rs 27 M/ LIC. NO. C ))) yI 1.4 SIZE -!/ / NO.OF BLOCS. / (FROM C/L STREET) pW/t-//r {yv/(,JV' L OF LOT 3 Z . C,� NOW ON LOT /3 FRONT T /7 a USE OF C �.�/� n/1'„ EXISTING BLDG. Cc. Ipo5/ R.SIOF c 9,_ A +JI/'bJ _ /j , f I-0 FSeparate permits are required for L.SIDE Fy./ j O electric,plumbing and heating work. REAR FT. " W USE OF BUILDING AND W K TO BE PERFORMED PLANNING ACTION C 7A ? SFF E-4/<.• 6 A/�Gs!gl-cesc w �— H' /-l570-2- / AELL-fS y 1y / APPROVED 4-171 --/-y�� re �y ROVED/,�Jn /jfi DATE 174 t l I• l ad .0 a. I 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 i Z any person in violation of the workman's compensation laws of S the State of California. ' m 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 0 Chapter 9, and that such licenses ere In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: 0 am exempt from the provisions of the State of California Business VALUATION PERMIT FEE $ 2 .00 q and Professions Code, Division 3,Chapter 9. ut n Signature ofC. �j/J ?Au PLAN CHECK $ 6a o Permittee a C Z_/ �� $ / �2 y IAX $ / rU. �6 U or C/ s1',J 000 ��, /// /T Authorized Agent Date - TOTAL PAID $ LLD !(.! 1. (I Applicant to fill in all spaces except those within heavy border lines and sign all appropriate-declarations. PERMIT NO. TRACT NO. CITY of coSTA MESA ,CONSTRUCTION PERMIT �y/ �gGf LOT No. 'UNIT NO. 0901 8/06./86 '7 0 5.50 . TL Project Address 1 .0 LP-1A ale Ilen tnj 4- -� • //�1 • - rI Applicant's Mailing Address 510 S. 1�6YJ St, LC7:3 TYPE OF CONSTRUCTION U NEW L I•ADD U ALTERATION L I REPAIR r • i Owner's Name CONVERSION-Ill-DEMOLISH THER AV S��/� Phone ��31' - A.P.# ( Zone - Address ' d--- LCI-0271-r �j/' . . - DESCRIPTION O K 6BLDG. ��5 �- ' 1� � ��{- .� S Main Building: 'Accessory Building: 1 E . Z Arch/Eng, License No. - TYPE OF PERMIT III GRADING ❑ FOUNDATION 0 STRUCTURAL T Front O Address �(� ��n ❑ TENANT 0-ELECTRICAL ❑ PLUMBING ❑ MECHANICAL A Rear • 1 N Contractor's Name' /C 14///YI :CA>C}/(1�(�!frPhone5?7(+S�'! ❑ OTHER `. ' C Ri ht• - _ - -- .- - N - 'c' r- - qq /� PROJECT DESCRIPTION SQ. FT. OCCUPANCY f ' • Address(mailing) l r�•. cCr -i/nom fJ� Qa 1' K _ G 10/C(-3. /_/2 •i r CON STRUCTION TYPE VALUATION$ S Left I r R City License No. .•. ) 1 ' ZONE • GRADING CU.YDS. ' ACRES ' EGEIvtO AS $( N LICENSED CONTRACTOR DECLARATION Ping. # a eq./Pl�v E I hereby affirm that fold licensed antler provisions of Charter 9 (commencing Remarks: - Planning Notes: RFCEIJUL ' M with section 7000)-ofSDivision 3 of the Business and Professions Code,and •` YED J . 2 1 1001:` my license is in full for e.and effect. ./,f:(G/5-.5-72. UCS , 1C/OU j T License CNA;�•1 �� Licens�No. /M ,PLUMBING FEES ' 1 Date '7 IIIel signature -70,71_,,. rIii '(€ems ' w WORKERS'COMPENSATION DECLARATION Bar Sink , Showers _ \ .:- - 'yereby affirm that I have a certificate of consent to self-insure ora certificate - - ,ELECTRICAL FEES Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink \ ,00, Lab. C.) [.k, /� Automatic Washer Transformer-❑ 15-50 KW (� Policy No. P Company L /he,-h/mtth.'I,f-V Backflow Irrigation Sewer Cap - • ❑ 50+KW - ' \\ Construction.Pole Sub. ,Certified co is heieby furnished. - - - Na Cert f ed co is filed with the city Bui m Division o / Bathtubs Sewer Connection CookingUnit Meter Dupto 100 imps Date WPZ5-1441)11647(flpphcant ��IF�A r J ilik —CffLJ • p ' EXEMPTION FROM WORKERS'COMPENSATION/DECLWRATION Clarifiers • • Solar Collectors Dishwasher Meter, Dover' 100 amps r- , (This section need not be completed if the permit is or one hundred ($100)or less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel - • 1 crtify 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 ❑1'/a-B _ • ` Date • Signature • FloorDrains Swimming Pool-w/Spa F.A.U. NOTICE: If,after making this declaration,you should become subject to the - Inc.Soler ❑9- 15 HP ❑16-15++ ` Workers' Compensation provisions of the Labor Code, you must forthwith t Floor Sinks Urinal Fixtures Microwave f ' • comply with such provisions or this permit shall ,be deemed revoked. r . CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet ' Device BO%es Pole Light- I hereby affirm-that there'ti3 a construction lending agency for the performance • — ' of the work for which this permit is issued (Section 3097-'Civ. C.) . Interceptors , Water Heater ! Outlets Range - ' Lender's Name ' ' - • . Lenders Address Kitchen Sink. . r • Water Service - - - - - Switches - • Sign . - - - - - OWNER BUILDER DECLARATION . , I hereby affirm that I am exempt from•the Contractor's LicenseLaw for the Lavatories Auto-Wash I Garbage Disposal Standing Sections - following reason (Section 7031.5 Business and Professional Code: Any city or ' county which requires alpermit to construct,alter,improve,demolish or repair P-Trap ; ' Laundry Trays , Generator ❑0-5 KW 05-15 KW � ' any structure, prior to its.issuance, also requires the applicant forsuch permit Trash Compactor to file a signed statements that he/she is licensed pursuant to the provisions of ROOF Drains • - • ' • - - the Contractor's License law(Chapter 9(commencing with Section:7000) of - • l 'livision 3 of'the Business and Professions Code) or that he/she is exempt - - - - - - trefrom and,the basis for the alleged exemption. Any violation of Section 1 Wa1ec<S aktryer a I •- , ' 31.5 by any applicant for a 'permit subjects the applicant to a civil - -� 1 natty of not more than five hundred dollars($500). : - , • ❑ I I, as owner of the property or my employees with wages as their sole Reinspection Fee, $15 - I Issue Fee l $ 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 I FEES I 1 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 1 Date pletion,'the owner will'have the burden of proving he/she did not build or im- • Duct-Under Ground - Building Approved By ' ' Date LIrove for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System' t Application Issued By !s IJ ` - Date c"'‘ to 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 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). Pam aware that Exhaust System 0 -Multiple 0 • System Repair/Alteration • BUILDING PERMIT $ �p SMTP ' _ '$ proof ofthen Worker's„Compensation insurance should be provided to me: PLAN CHECK $ r.. )t`7 PERMIT ❑•I am exempt under_Section - - B. & P.C.for this reason —Firepl/Fact.Bit'. ICBG# Fire Dampers - ' PLUMBING $_• ISSUANCE e $ - ' • • Heating System& ' Re isters ENERGY P.C. $ • f Date• Owner Ducting 9 PLAN CHECK 25% $ - I hereby certify that I have read this application and state that the above- ❑0.100,000 BTU ❑100,000BT - • - 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 repre- , - PLA N.CHECK 50% $ - - MICROFILM' $ ” - sentatives of this city to enter. upon the above-mentioned property for inspection purpo5esww. rJ � MECHANICAL $ TOTAL FEE $ f Signature! . V/1/1/11,(l/,d04:7 - . Date 7 z - - - • , - � '� Drivers' or 55# //' Reinspection'Fee $15 Issue Fee $,3 PLAN CHECK 25% $'. a CMF 0865-46,rev.10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor • CONSTRUCTION AND PLANNING POOL &SPA _ • APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector 2 • 1. Temporary-Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms -r 4: Electrical Conduit-Undrgrnd. 55. Electrical Bonding =: 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd. •57. APPROVAL TO COVER-GUNITE1 • 7. Footings 58. Electrical Conduit-Undrgrnd': e - 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test '.E.. 9. Water Pipe-Undrgrnd`, 60. Backwash Lines, P-Trap, ❑indrgtnd. 10. Structural Floor System 61. APPROVAL TO DECK `-' JJ • 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 ❑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 a ;est /gyp 39. Water Service-Final - 7 •- • 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 Applicant Rttool lfill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA ONSITR UCTf N PE,pJ,'M"'IT { Pti/ GN /�f.A c�TRACT NO. I LOT NO. UNIT NQ. A.P.# `( I Zone LProject Address J Z '�99nn eat/N/ ' �.Pzsel /�� !•• 7b17�1 LI U_�/R.IEyPAIR E Main Building: • Accessory Building: Z Applicant's Mailing Address /4Y+ 3 44-S .CvCEA/4 TYPE OF CONSTRUCTION NEW U ADD � ALTERATIONFront T �(�/� ❑ CONVERSION ❑ DEMOLISH ❑ OTHER ' . • T • O Owner's Name 'Of C/ • �G� - / Phone 6 V DESCRIPTION OF WORK/USE OF BLDG. B Rear N Address c9[.1 era' Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING ❑ FOUNDATION •❑ STRUCTURAL . C Right • G Address ❑ TENANT r ELECTRICAL ❑ PLUMBING W MECHANICAL $ • Left A''� ,.r.,.ttCC ❑ !OTHER R Contractor's Name IN iGL,o�D f g'4 "PRone G 3) l6 I Ping. Ref. # Parking Req./Provided E A PROJECT DESCRIPTION SQ. FT. OCCUPANCY O Address(mailing) w S lr9^'� &—��'� �% Planning Notes:' - M � CON STRUCTION TYPE VALUATION$ City License No. 1/V TZONE GRADING CU.YDS. ACRES • - LICENSED CONTRACTOR DECLARATIONS' I 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 1 . my license is in full force and effect. ELECTRICAL • FEES License ass'' — LI N y Automatic Washer Transformer 0 15-50 KW Date �t+Y` 'y/Q Signature UT PLUMBING FEES WORKERS'COMPENSATION DECLARATIONBar Sink Showers Construction Pole Sub. ❑ 50+ KW • I hereby affirm that I have a certificate of consent to self-insure or a certificate ' Workers' Compensation Insurance, or a certified copy thereof (SectionBackflow Preventer Service Sink Cooking Unit Meter Duo to 100 amps :00, Lab. C.) Policy No. Company Backflow Irrigation Sewer Cap Dishwasher Meter Dover 100 amps BCertified copy is hereby furnished. Dryers ❑Gas ❑Electric Sub Panel Certified copy is filed with the city Building Division. Bathtubs Sewer Connection nel Date Applicant Fan I Motors Ir -1HP 01'h-8 3 QQ EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors (This section need not-be completed if the permit Is for one hundred ($100) or • Dishwasher F.A.U. Ina Solar ❑9.15 HP ❑16-15+ less). Solar Piping I certify that in the performance of the work for which this permit is issued, I Fixtures shall not employ any person in any mann r so as to become subject to the Drinking Fountains _ Solar Tank Microwave Workers`Agrppgip tion Laws of Califor i . Device Boxes Date '/L7[/II 7 Signature Floor Drains ' Swimming Pool w/Spa Pole Light NOTICE: If,after making this declaration, you should become subject to the Outlets Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal .Range comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY _ Water Closet Switches Sign Gas Service Outlets 9 I hereby affirm that there is a construction lending agency for the performance • of the work for which this permit is issued (Section 3097 Clv. C.) Garbage Disposal Standing Sections Lender's Name _ Interceptors Water Heater Lender's Address Kitchen Sink • . Water Service • Generator 00-5 KW 05-15 KW Trash Compactor OWNER BUILDER DECLARATION _ _ _ 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 . county which requires a permit to construct,alter,improve,demolish or repair P—Trap - Laundry Trays 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 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 Reinspection Fee •-' "A C $ •erefrom and the basis for the alleged exemption. Any violation of Section PJ $15 Issue Fee. ' )31.5 by any applicant for a permit subjects the applicant to a civil - - 1 +penalty of not more than five hundred dollars($500). $ 3 - DEVELOPMENT SERVICES REQUIREMENTS: j • LI I, as,owner of the property or my employees with wages as their sole Reinspection Fee ` $15 Issue Fee Zoning Approved By Date compensation, will do the work,and the structure is not intended or offered • for sale, (Section 7044, Business and Professional Code: The Contractor's - MECHANICAL FEES Building Approved By _. ' Dat 89 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 - Application Issued By Dat 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 ❑ SUMMA Y OF FEES ' pletion, the owner will have the burden of proving he/she did not build or im- Duct- Under Ground prove for the purpose of sale). BUILDING PERMIT $ SMIP $ ❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System PLAN CHECK $ PERMIT f lJ{J PLUMBING $ tractors to construct the project (Section 7044,Business and Professions Code: .L�J/ The Contractor's License Law does not apply to an owner of property who Duct-Ventilating _t_ 0-100,000 BTU ❑100,000 BTU /^�� ' ' ISSUANCE $" builds or improves thereon. and who contracts for such oroiects with a con- , tractor(s) license pursuant to rile Contractor's License Law). I am aware that Exhaust System D Multiple ❑ System Repair/Alteration PLAN CHECK 25% $ G ENERGY P.C. $ proof of their worker's Compensation insurance should be provided to me. ELECTRICAL $ 7,..OD' GRADING $ ❑ I.am exempt under Section B. & P.C.for this reason Firepl/Fact.Bit. ICBO# Fire Dampers MICROFILM $ PLAN CHECK 50% $ Date • owner Heating System& Ducting Registers MECHANICAL $ d D b TOTAL FEE $ 4a. 0 0 I hereby certify that I have read this application and state-that the above 00-100,000 BTU ❑i00,000BTL - - - ' - information is correct. I agree to comply with all city and county ordinances - PLAN CHECK 25% $ and state laws relating to building construction, and hereby authorize repre- 1 - sentatives of'this city to enter upon the above-mentioned property for Inspection apposes. • � , & f Signature ppva.�_ 1f' 10 7� CI 60041140-00041141 TCT '.2. 0865-46,rev. 5/88 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod -Assessor 'DATE: 08/28/39 TIrE: 09:07 . .._ .. ,. ,. . .. _... A CONSTRUCTION AND PLANNING POO. SPA - APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. - - f1 53. Steel Reinforcement -- 3. Electrical Conduit.Utility-Undrgrnd. 'f'- 54. Forms. • 4,Electrical Conduit-Undrgrnd. , 55. Electrical Bonding • r .5�Steel Reinforcement ' 56. Rough Plumbing & Pressure Test 6. Electrical UFER GrndP 57. APPROVAL TO COVER-GUNITE • is ., - -. 7. Footings „ 58. Electrical Conduit-Undrgrnd. ! -8. Foundation i / - ii. 59. Gas Pipe,01 Undrgrnd.,Test ,I 9' Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. - /r 16..Structural FloorSystem • 61. APPROVAL TO DECK 'i 11C Property Sewer Lirie & House Connection . 62. Backwash & Receptor-Final 12. Sewer(Cap • ' . 63. Heater & Vent-Final 13. Roof Drains ' ;. 64. Plumbing System - Final - - 14. Rough Plumbing -i 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final -It. 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 Structure70. Underground Hydro ' 22. Ducts, Ventilating 71. Product Piping O 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 I 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 5 33. Final Electric Notes: i/Apo % // /owe; oev✓ 34. Final.Heating & Air Conditioning -� �J �"'� 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 . '' r ' 44. Landscape Irrigation System 1. 45. Sound Attenuation r �� I R r ,,,,.il:,-, a iil,pections 46. Handicap Regulations �7 /� ��T(J/ . 47. FINAL STRUCTURE & BUILDING Date _.J/iv r.- slg -�--=-- 48. Special Requirements Completed 1 • 49. Electric Release to Edison - - 1`„ „• i 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. P R IT O. TRACT NO. LOT NO. UNIT NO. CITY Of cos' -. ME94 CONS/T-R^U�CT`ION PERMIT A.P.# zone .•Preject Address* 241 .Z. .4 £2-zCN Igoe - 5/7�� I R r S Main Building: Accessory Building: _ _ Z TYPE OF CONSTRUCTION L I NEW U ADD U ALTERATION U REPAIR � caner anl's Mailing Address t0'n mArsnrf/�2 Phone .1� Na CI CONVERSION ❑ DEMOLISH ❑ OTHER T 0 Front Owner's Na •e �!l�nYT loco/iced `�7(o.Z3�j DESCRIPTION OF WORK/USE OF BLDG. 8 Rear - • - N Address • O 'yi:, _i1. -. a., 41 ._ • e 4. 2. .--41. A 1 Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING ❑ FOUNDATION U STRUCTURAL - I K Right - •- G Address ❑ TENANT ELECTRICAL ❑ PLUMBING ❑ MECHANICAL s Left H Contractor's Name F) • Phone CI OTHER • Ping. Ref. # Parking Req./Provided E PROJECT DESCRIPTION SQ. FT. OCCUPANCY Q Address(mailing) - r Planning Notes: - - - M City License No. ®T, CON ST RUCTION TYPE VALUATION$. T ZONE GRADING CU.YDS. . ACRES• • S. LICENSED CONTRACTOR DECLARATION '-..-- I 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 - License No. - PLUMBING FEES Automatic Washer Transformer ,❑ 15-50 KW Date - Signature _ - _ . • • WORKERS'COMPENSATION . , . my li •cPole Sub. 0 50+KW t • I hereby affirm that I have a certificate of consent to self-insure or a certificate Bar Sink Showers ' if Workers' Compensation Insurance, or a certified copy thereof (Section Cooking Unit Meter ❑up to 100 amps 3800, Lab. C.) - Backflow Preventer Service Sink •_ - - - -, - - --. - ' - - Policy No. Company Backflow Irrigation Sewer Cap - Dishwasher Meter Dover 100 amps BCertified copy is hereby furnished. • - - Dryers ❑Gas ❑Electric Sub Panel Certified copy is filed with the city Building Division. Bathtubs Sewer Connection . • Date Applicant Fan Motors 00-1 HP ❑1 h-8 EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors • (This section need not be completed if the permit is for one hundred ($100) or Dishwasher ^ F.A.U. • Inc.Solar❑9-15 HP ❑16-15+ less). Solar Piping I certify that in the performance of the work for which this permit is issuetl I t Fixtures' shall not e plo any person in an ••.,ner so as to be e s •je' to the Drinking Fountains Solar Tank - Microwave •• Workers'? pe yy n Laws of Ca •r,;._.;. a , 5 - • - Device Boxes Date { O • Signature at'_iel�, 4, _} Floor Drains Swimming Pool w/Spa Pole Light • NOTICE: If aft r making this declare '-, you hould beco a s - to the Outlets ' Workers'. Compensation provisions of the Labor Code, you mus thwith Floor Sinks - Urinal - . Range . _ • - -, comply with such provisions or this permit shall be deemed revoked. - CONSTRUCTION LENDING AGENCY - - • . Gas Serviee Outlets • Switches Sign , I hereby affirm that there is a construction lending agency for the performance _ Water Closet " 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 Servicei.. Generator ❑0.5 KW ❑5-15 KW Trash Compactor OWNER BUILDER DECLARATION , - - _ - I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash' r✓ ' •following reason (Section 7031.5 Business and Professional 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 P-Trap _ _ Laundry Treys ,y r :to file a signed statement that he/she is licensed pursuant to the provisions Of Roof brains - ,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 Reinspection Fee $15 Issue Fee -',4herefrom and the basis for the alleged exemption. Any violation of Section . $ 3 ''d„'70315 by any applicant for a permit subjects the- applicant to a civil ” . . - enalty of not more than five hundred dollars($500). DEVELOPMENT SERVICES REQUIREMENTS: UI, as owner of the property or my employee; with wages as their sole .Reinspection Fee . I ; $15 • Issue Fee $ 3 .compensation, will do the work,and the.structure is not intended or-offered • - Zoning Approved By Date 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 - $�� /J(� thereon, and.whodoes such work himself/herself or through his or her own a • Application Issued By nate - •�( '(W 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 11 0 - SUMMARY OF FEES pleti 'the owner will have the burden of proving he/she did not build or lin- e, Duct-Under Ground , or the purpose of sale). - - 4, BUILDING PERMIT $ - SMTP I $ - , as owner of the property, am exclusively contracting with licensed con- Duct-Structural t • Refri ration System . `' PLAN CHECK ors to construct the project (Section 7044,Business and Professions Code: , $ PERMIT The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 100,000 BTU ❑100,000 BTU Gi PLUMBING $ ISSUANCE $ ' 'builds or-Improves thereon. and who contracts for such projects with a con-• _ - - - - - - 1 tractor(s) license pursuant to the Contractor's License Law). i am aware-that 'Exhaust Sysiem 0 Multiple 0 ' System Repair/Alteration -. PLAN CHECK 25% $ ENERGY P.C. $ proof off•their Worker's Compensation insurance should be provided to me. ELECTRICAL $ GRADING $ ❑Tam exem/p�t//u�nnd��serr Section a C.for this reason Firepl/Fact.Blt. ICBG# ' • Fire Dampers MICROFILM $ Date �_(1._'2D— Own Y g System&Ducting - Registers l/v PLAN CHECK 50% $ �1 ,/ pe{{ �r Hearin MECHANICAL $ • o(4� �y I herebyrat ti y that 1 have read t s application and state t the above .. ❑0-100,000 BTU 0100,000 BTU - TOTAL FEE • $ information is correct. I agree to comply with all city and county ordinances 7" PLAN CHECK 25% $ : ' and state laws'relating-to buildin• onstruction,and hereby authorize repre- sentatives of Yp y to ent-0'n' , above-mentioned property for - • inspection purpos- ► • - ' Signature �I� -. Pink -Accounting; Goldenrod -Assessor • I.•1.I CwONSTRUCTION AND PLANNING POOL ol SPA AF'PRO VALS Permit Date Inspector APPROVALS Permit# 7 Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location . I• el. Soil Pipe-Undrgrnd. 53. Steel Reinforcement T. ;3:.'i Electrical Conduit Utility-Undrgrnd. 54. Forms ' •=.y,. • 4"•Electrical Conduit-Undrgrnd. 55. Electrical Bonding y `a ;' 5. Steel'Reinforcem'ent .- 56. Rough Plumbing & Pressure Test 6.. Electrical UF ER Grnd.' 57. APPROVAL TO COVER-GUNITE 7. F901,119.1 ' . k,�.? I58'. Electrical Conduit-Undrgrnd. • '' .'A •,,1 + 8,,Foundation I 59. Gas Pipe, 0 Undrgrnd., Testof ,- 9. Water Pipe-Undrgrnd. i. 60. Backwash Lines,P-Trap, 0 Undrgrnd. , i0:-Structural Floor System j�4 61. APPROVAL TO DECKI i 11. Property Sewer Line & House Connection ' �! -. 62. Backwash & Receptor-Final I • 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 11,6: Rough Electric Wiring '67. Fencing & Access Approval - 1.7. 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. UndergrncL Storage Tank 0 Gas 0 Oil ') 25. "Che 74. Overhead Hydro / 26. T-BarRooCeiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28: Lathing & Siding 77. FIXED SYSTEM FINAL • 29. Insulation 78. FIRE PREY. FINAL 30. .Drywall Nailing HEALTH DEPT. REQUIREMENT r'1 31. Plaster Brown Coat . 79. FINAL INSPECTION 32. Electrical Power Meter-Final80. FOOb CERTIFICATE ISSUED ? ' K 33. Final Electric Notes: ii-/r-cFP nnI 34. Final Heating & Air Conditioning irk L°P 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 y 43. Backflow Irrigation 44. Landscape Irrigation System • 45. Sound Attenuation '46. Handicap Regulations ' • 147. FINAL STRUCTURE& BUILDING r 48. Special Requirements Completed . 49. Electric Release to Edison II le `, 1 50. Gas Release to Southern California Gas Co r, 51. CERTIFICATE OF OCCUPANCY i No. . - Date ' Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. -.1111 — PERMIT N �'7'/G TRACT NO. LOT NO. UNIT NO. CIT/'�OF COSTA MESA CONSTRUCTION PERMIT �/ 7 6 j-y' A.P.# Zone 'v L• address O-y'/a '' /A/ ,CG.QeA) Aoc go c_ "� l� r S Main Building: Accessory Building: . r.Applicant's Mailin Address Yh4/O /07/314.4174.20 L4O g'3' TYPE OF CONSTRUCTION U NEW U ADD Li ALTERATION LI REPAIR E Z r 9wGp LI CONVERSION ❑ DEMOLISH ❑ OTHER T Front, 0 Owner's Namevv''t,/v+-t�T .—o%a-c Phone DESCRIPTION OF WORK/USE OF BLDG. A ,Rear N Address JIr/7t7 eni9e4A11 12 '3rl1n 41/1 l q,4100 • Arch/Eng. License No. TYPE OF PERMIT,,,LJ GRADING U FOUNDATION U STRUCTURAL K Right C Address ❑ TENANT ELECTRICAL ❑ PLUMBING ❑ MECHANICAL $• Left , ❑ 'OTHER R Contractor's NamP o Phone Ping. Ref.# Parking Req./Provided E PROJECT DESCRIPTION SQ. FT. OCCUPANCY Q Address(mailing) Planning Notes: M Q CONSTRUCTION TYPE VALUATION$ T City License No. ZONE GRADING CU.YDS. ACRES LICENSED CONTRACTOR DECLARATIONS. I hereby affirm that I am licensed under provisions of Charter 9(commencing Remarks: '1/ 1 .37 •/1 Y - ' with section 7000) of Division 3 of the Business and Professions Code,and l/V my license is in full force and effect. ELECTRICAL FEES ' License Class License No. Date Signature • PLUMBING FEES Automatic Washer Transformer 0 15.50 KW • WORKERS'COMPENSATION DECLARATION Bar Sink Showers Construction Pole Sub. ❑ 50+KW s 1 hereby affirm that t have a certificate of consent to self-Insure or a certificate • - ' )1 Workers' Compensation Insurance, or a certified copy thereof (Section Cooking Unit Meter Duo to 100 amps 3800, Lab. C.) Backflow Preventer . Service Sink Policy No. Company Backflow Irrigation Sewer Cap Dishwasher . - Meter Dover 100 amps 8 Certified copy is hereby furnished. • Dryers ❑Gas DElectric Sub Panel Certified copy is filed with the city Building Division. Bathtubs Sewer Connection • Date Applicant �// PISS EXEMPTION FROM WORKERS'COMPENSATION DECLARATION ' Clarifiers Solar Collectors Fan I Motors Ly(F1 HP I'/ h-8 phis section need not be completed if the permit is for one hundred ($100) or Dishwasher Solar Piping F.A:U. �..,Inc.Solar ❑9-15 HP 016-15+l �, J I certify that in the performance of the work for which this permit Is Issued,I shall not employ any person in any er so as t become subject to the Drinking Fountains Solar Tank Fixtures Microwave Workers' C en ion Laws of Cali o ^ - Device Boxes Pole Lighta, Date Signature Floor Drains Swimming Pool w/Spa T NOTICE: aft m ing this sellar you sd e e subject to the Workers' C mpentati On provisions of the laborr Cod , you must forthwith Floor Sinks Urinal ' Outlets • Range Comply with such provisions or this permit shall be deemed revoked. -' . CONSTRUCTION LENDING AGENCY Switches Sign--' - Gas Service Outlets Water Closet I hereby affirm t tial there is a permit issue (Section for the performance.) Garbage Disposal of the work for which this permit is issued (Section 3097 Civ. C.) 9 W Standing$edlions Interceptors Water Heater • - Lender's Name - Generator ❑0-5 KW❑5-15 KW Trraash-Com actor ' Lender's Address - -- - - Kitchen Sink Water Service P OWNER BUILDER DECLARATION ` .. I hereby affirm that Ian oxen pt from the Contractor's License Law for the Lavatories Auto-Wash % .... ) • following reason (Section 7031.5 Business and Professional Code: Any city or . N county which requires a permit to construct,alter,improve,demolish or repair P=Trap - Laundry Trays ' 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 ofROOf Drains I T•• � • 'the Contractor's License Law (Chapter 9(commencing with Section 7000)of " Division 3 of the Business and Professionsd Code) or that he/she Is exempt • - • Reins option Fee Ms $,40 therefrom and the basis for the alleged exemption. Any violation of Section - P $15 Issue Fee 7031.5 by any applicant for a permit subjects the• applicant to a civil chatty of not more than five hundred dollars($500). DEVELOPMENT SERVICES REQUIREMENTS: - LII, as owner of the property or.my employees with wages as their sole Reinspection Foe' I $15 Issue Fee '$ 3 , 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 • FEES Building Approved By Date �/ /� License Law does not apply to an owner of a property who builds or improves ///��J Y2/ thereon, and who does Such work himself/herself or through his or her own - Application Issued By tg IJ •' nate. employees, provided that such improvements are not intended or offered for Boiler Hood or Type I 0 s� sale. If, however, the building or improvement is sold within one year of com- Canopy Type II ❑ / SUMMARY OF FEES • ' • pletion the owner will have the burden of proving he/she did not build or Im- Duct-Under Ground �roye for the purpose of sale). BUILDING PERMIT $ ,SMIP $ I. az owner of the property,am exclusively contracting with licensed con- - Duct-Structural , Refrigeration System PLAN CHECK • tractors to construct the project (Section 7044,Business and Professions Code: $ - PERMIT The Contractor's License Law does not apply to an-owner of property who Duct-Ventilating ❑O-100,000 BTU ❑100,000 BTU - PLUMBING $ ' _ ISSUANCE $ builds or Imoroves thereon. and who contracts for such oroiects with a con- ,ENE ENERGY P.C. $ I tractor(s) license pursuant to tne Contractor's License Law). I am aware that Exhaust System 0 Multiple❑ System Repair/Alteration • • PLAN CHECK 25% $ proof of their Worker's Compensation Insurance should be provided to me. ELECTRICAL $ aa.Co GRADING $ 0 I am exempt///// under Section —/y, z & • C.for this reason Firepl/Fact.Blt. ICBG* Fire Dampers MICROFILM ' $ k /$i1 r�f�LtS9 HeatinggRegistersPLAN CHECK 50% $ Date -i� f • Owner --�• SYstem& Ductin MECHANICAL $ I hereby erti y the I have read •' application a .r to that the above 00.100,000 BTU 0100,000 BTL TOTAL FEE $ -•SD Information is correct. I agree to comply with all city county ordinances • . PLAN CHECK 25% $ , and state laws relating to buildingeeJJil�Krr(jj!!!ng�� construction,and hereby authorize repro- , sentatives o city to u n the above-mentioned property for Inspection u es. • ' SignaturesDate 3/ Drivers' L e or ss Reinspection Fee .$15 Issue Fee $ 3 01 00011225-00011225 TOT. 22.50 - 08865-465-4'6,rev. 5/88 White - -Accounting; Goldenrod - Assessor 0„TE: 08!03188 TIME: 16:09 • ' ,.lroN1STRl1CTION AND PLANNING POOL &SPA • Date Inspector ' Date Inspector �4PROVALS Permit# APPROVALS Permit # i' 1. Temporary Electrical Service or Pole . 52. Pool & Equipment Location 2: Soil ripe-Undrgrnd. :.- 53. Steel Reinforcement •• ' " 3:' Electrical Conduit Utility-Undrgrnd. 54. Forms ' 4:Electrical Conduit-Undrgrnd. 55. Electrical Bonding - • 5. SteeliReinforcemient. 56. Rough Plumbing & Pressure Test 6.' Elecerical OF ER Grnd: 57. APPROVAL TO COVER-GUNITE ' J 7. Footings ._ 1.., , 58. Electrical Conduit-Undrgrnd. it , 8. Foundation ,. 59. Gas Pipe, 0 Undrgrnd.,Test ' 9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd. I $ l i 10. Structural Floor System r 61. APPROVAL TO DECK r 1 11: Property Sewer Line & House Connection 62. Backwash& Receptor-Final • 12! Sewer Cap - 63. Heater & Vent-Final • I• 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 .- 1 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING '-18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heading & Air Conditioning FIRE DEPT. REQUIREMENT ' 20. Rough Factory Fireplace': APPROVALS Permit# 21. Ducts, in Structure I 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough &Test I 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 �/ Q 33. Final Electric Notes: Si0,0 he(/- No ie /l, 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 H 41. Solar Domestic-Final 42. Backflow Preventer - r - ' Y. 43. Backflow Irrigation •') EXPIRED 44. Landscape Irrigation System Incomplete Inspections 45. Sound Attenuatione� 2// '` Date ;1i Sig -_ _/// 46. Handicap Regulations j 47. FINAL STRUCTURE & BUILDING ' • L 48. Snecial Requirements Completed 4 49. Electric Release to Edison t, 50. Gas Release to Southern California Gas Co - _ N. i 51. CERTIFICATE OF OCCUPANCY - ; . r No. Date • , ,r, I _ - Applicant to fill In all spaces except those within heavy border lines_ and sign all appropriate declarations. CITY OF COSTA MESA : ", • PERMIT.N�J TRACT NO. I LOT NO. BLDG.NO. , CONSTRUCTION PERMIT ! •1 ; •' • • � -' o:9 .9 • - lc: oe.�.L g • Applicant's Meiling Address • / �_ - •C 4• TYPE OF CONSTRUCTION , U.NEW`__ ADD u ALTERATION'-1-1 REPAIR - % j ! ; I .• 4 , 1 Project Address Z-941— FLD4A) C �• 0 CONVERSION ❑ DEMOLISH ❑ OTHER - • - Owner'slName J1'1 El-A) SO/t,rS G P PIE'Phone d4L7-57Z' •. DESCR I ,OFF WORK /O X 1/ JA7T/Cf✓F 1�7r9 T/U -_ C'-'JU TL • _ • - / - ZONING REGULATIONS -- Address 2Q✓}1 Z- ' C- S ELQE.✓ ' . - . TYPE OF PERMIT. . U GRADING U FOUNDATION �„$TRUCTURAL A.P.SW' _ems. ce ZONE JAL Arch/Eng.. ' - • License No.' • — 1 0 TENANT ❑ ELECTRICAL 0 PLUMBING 0 MECHANICAL p EF,qy. ' - BUILDING + ' - - - 'unpack' p/1 CT • / �/�Y�! Address --t - ❑,OTHER . ' TO BUILDING "REAR YARD (TO P/U 0 • sO efSE BU/L(J[SCC Zff(} /</Sa : PROJECT DESCRIPTION SQ.FT. OCCUPAN V PROPERTY LINE Contractor's Name S Phone �p{y— • Address(mailing) _3Z0'_ 1//air- A HUA)T/46tOA) se 14 CH CONSTRUCTION TYPE • • VALUATION$ �J /J -- ' LEFT SIDE YARD i'0¢-'0 RIGHT •SIDE YARD �B rI�� License No. 30 ,Isb ' ZONE ' - - PKG.SPACE REO. , PROVIDED _ ' GRADING CU.YDS. !ACRFS (, { • LICENSED CONTRACTOR DECLARATION r 1 Remarks: STREET WIDTH . ,PARK FEE$ • hereby affirm that Pam licensed under provisions of Charter 9 (commencing • with section 7000) of Division 3 of the Business and Professions Code,and ' SPECIAL CONDITIONS: my license is In ful force and,effect. ' I •' I ' , • - LiCense CI s n- 1 ' �* License No..-II S� I • , PLUMBING ; , • Date -4 // Signature .- >•POo -Lam" ' % I r 'a'ORKE SR COMPENSATION DECLARATION ' • ' I + I Bar Sink Sewer Cap' j ! ELECTRICAL 1 'eby-atflrm that I-have a certificate of consent to self-Insure.Or a.certificata ' Automatic Washer_• I {Meter_❑over 100 amps. - �. ' ' or a certified copy thereof (Section ,. Backflow PreVenter• - - Sewer Connection' , _ - - - - - - +- -- -- .• . Workers' Compensation Insurance.) Construction Pole I • .4000, Lab. C.) I • • • I ! ' j Backflow Irrigation I Solar_Collectors- ( ,Sub Pane(• \-) Policy No. i Company I - - - - : - Cooking Unit 'Sub Pole' t A Certified copy Is hereby furnished, , Bathtubs Solar Piping • - - -- ' • Certified copy is filed with the City Building Division. , Dishwasher Motors ❑0-1 HP ❑1'h$ Date Applicant I Clarifiers y Solar Tank I _ 1 • EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Dishwasher i Swimming Pool W/Spa Dryers ❑Gas -❑Electric" . - Inc1 .Solar'❑9-15 HP ❑16-15+` "(• This section need not be completed If the permit is for,one hundred ($100)or • _ ' • less). , - - Fan' • Microwave I certify that In the performance of the work for which this permit Is Issued I , J Drinking Fountains Urinal . I - shall not employ any person in any manner so as to become subject.to the , F.A.U. - 'Pole ILi ht Workers'tPmpensatIon'Laws of Califpr , Floor Drains, Water Closet `r I ' 9 Date T!r' 1 Signature ' - 1 1 • - '- ' 1 - + ' I • _ Fixtures ' r ,Ran e ' NOTICE:it'after making this-declaration.You should-become subject to•the `• Floor Sinks -•- - -l- -- -Water Heater T .' - - - -- -.. _ r�. 9 -. .__ .. .. Workers' Compensation provisions of the Labor Code• you must forthwith - Comply ,with', such provisions Or this:permit!shall be;deemed revoked. ' ., I Gas Service' ,Outlets' • r -Water,Service ,� I y I ' Device Boxes • ;Sign - CONSTRUCTION•LENDING AGENCY ' - 1 - - - I hereby affirm that there Is a constrrmit-i•lending agencyfar the performance- Interceptors . .. _� I - - _ r, Outlets 'Standing Sections i . of the work for, which this permit-is Issued (Section 3097 Civ. C.). ' - - ' ' , ' Lend'er's Name' + _ - _ - - Kitchen'Sink _ - •• _ - Switches • Trash Compactor . • Lender's Address: _ • 4' " - - - - - - Garbe Garbage oral • ' • OWNER BUILDER DECLARATION Lavatori•es" , ' c _ :r 9 sr' • - ' • I herebyaf firm that I am-exempt from the-Contractor's-License Law for the ' P-Trap c _ Generator 0075 KW 05-15 KW - ' following reason (Section 7031.5 Business and Professional Code: Any city or F' - - -' - - ' county which requires a permit-to-construct,alter,improve;demolish or.repair , - - _ Transformer ❑75-50 KW I ' '-any structure; prior to Its issuance,:also requires the applicant for such permit ' . Roof Drains- - ( , ' ' 1. to file a'signed statement that he/she Is licensed pursuant to the provisions of ; - - ' ❑5U t KW. • ' tptp Contractor•s•License Law.(Chapter 9(commencingjwith Section 7000)of • - - 1 ; - , - • I Reinspection Fee $15' • dd.. "axion{3-of the Business and Professions Coderor that he/she Is:exempt j - Showers r . •i . 1 i 7 1 - Reinspeetion,Fee $15 r -Sfrom and the basis for the alleged exemption- Any violation-of Section , • _ •'- Meter ❑up to 100 amps 1 Issue Fee I' •$ 3 •_p omit by..any applicant for-a permit rs($500). , applicant to ar civil ' i - , f ' • I - __ .. - • _ _ Z//�/� • . penalty of not more than five hundred dollars($500). , - Service Sink 1 Issue Fee I i $ 3 Al • • I Zoning Approved By 'Date I, as.own, of: the work,erkpr' the structures with Intens d their sole _ 1 , compensation will;tlo the and structure is not Intended or tl 1 • - _ ! " MECHANICAL Application Approved By nate I • for sale (Section 7044, Business' and;Professional Code:.The'Contractor's • - --- _ ----- - - - - -- - yam License Law does not apply to-an owner of a property.who builds or improves Boiler - ' I Refrigeration System Issued By / /t=_/ Date I s/�/��i thereon, and who'does such work himself/herself or through his or her own ' - ' Application employees, provided that such improvements are.not intended or offered for ' - - '❑0-100,000 BTU ❑100,000 BTU sale. If, however, the building or improvement is sold within one year of com- - • Duct-Under.GFound , I 1' ' teflon, the owner-will • I SUMMARY OF FEES i D have the burden of proving he/she did not build or im- - , 1 - S-a rove for the purpose of sale). + - ; ' Duct-Structural S• ystem Re air/Alteration P p 1 I' P 'BUILDING PERMIT I. 3 SMIP ' $ • U I, as owner of the property,am exclusively contractingiwllhelicensetl con- 1 ; ,, • i I r I , %tractors toactor' , e,project (Section 7044,.Business.ane of--pr lona Cpde:_!, Duct-Ventilating_ , . . ,� . I _ ,PLAN CHECK I $ 8'TS I PERMIT t .. v The Contractor's, License Law does not apply to an owner Projects property who - - i ' + ; , r ISSUANCE, ' $ builds or improves thereon,and who contracts for such projects with a con- i. ' Exhaust System ❑ Multiple ❑' • ;PLUMBING $i I I tractor(s) license pursuant to-the Contractor's License Law)J ' l j I GRADING I $ 0 lam exempt under Section 1 B.& P.C.for this reason {' Firepl/Feat.Blt. ICBG* i I (PLAN CHECK $ { • • HeatingS st ' r 'ELECTRICAL $ . MICROFILM. I $ ' `^ Date ' - owner ' I System& Ducting { I I i ; V/ I hereby' certify-that 1 have-read this application andstatethat the-above -.- -- _ .. - 'PLAN CHECK; . PP 010-100,000:BTU❑t00,00081U -- - t --• $ h i Information is correct. 1 agree to comply with-all city and county ordinances • ' i TOTA L'FEE ,' $ 1 ancl.state laws relating to building cdnstruction,'and hereby authorize repro- ' r •MECHANICAL $ sentatives of this;cit to enter upon the above-mentioned pr /or y for -^ Hood a• r •7ype I ❑ 1 Reinspection Fee{ $15 ;. LESS i ; J J Inspection purpose C•• i i Canopy Type 11 O. I. 'PLAN CHECK $ PC ; • Signature Date -7/r� SJ� r I • , ( {( �1 Drivers' Llceri rISS# / ' Registers i i � 1 Issue Fee i ; $ 3 I I i FINAL PEE• r $ t OC�i .S CMF 0865.46 rev.12/82 White-Building;Canary-APPIIcant;Pink-Accounting;Goldenrod -Assessor - "'""'_ - ' ScONStFiP01ON ANDiPLANNING_ 9 f '- '. 2t p-y;-• ' ;^ `"< r ' _ �OLn•a�' PA-1r -+ : :- : 'y p iii F' J ' i r = u > Date : -Inspector, ^ZI it ' Date - Inspector, �, > cAPPR ; N Permit•#- APPROVALS Permrt# T c Tempor ryiElectrica1 ServiceorPole=l ,: a°• " g[ .-,y la . - :.f _52 PooI &1.EquipmenttLocatjon; ,;,,,' -.,',:,•:• c.:“ , ' ,;• `✓ _ 1 1 ,. .'a Si ! ALV" , O ?L ‘k.4::* _ .. 1 .r L. . . ,w 22 ISoil Pipe-Undrgrnd._ .? i i-c c .i .•I C. I ;;a r,, •, 'X53.` Steel Reinforcement ,E, -.. t;= i, y 3? Electncal Conduit Utility Undr rude s sv0 --54Y Forms - t, n P' I t1 IL •I � �,� , 1 , 1 gn rv` o a 3.a � it- =,. . rr: _c ' ! � . , '¢" 44 Electrical Conduit-Undr, rnd. -4:47;,5 i _ _ ;12 Electri I Bo'ridin ; `: - y - _a 1 I , , , , 9 � : I��a ;-:,1-4,,: 55.E Cao 9'' ?, , . r, Li 1 - m r ` 56.. Rou h1 Plumbin '&-Pressure`Test` _ - 5: Steel'.Reinforcement i ^ , :, e' i�?i ' +� 9 9. T,4;;:?.. . 6: (Electrical LIFER Grnd.I , 8=-1 I n , -- !it:::: !:'571. -GUNITE ▪ ' 1 ;1 w 7. Footings • ,- i:-. 4.,1 n,, - � Ig-- i 558. Electrical!(joiduit-Uridramr{:; - _ ! 8. Foundation i i ;-'.I Is: a ' `• F: 59. GaslPiperO Undrgrnd Testi:'.'" ` y" I 1 `..w I i' 9. Water Pipe-Undrgrnd. , ; y r. 04 •; it; 1 !'r60. Backwash Lines P Trap, 0 Undrgrnd ; ` ' , ' ' ,' 1; v 10. Structural Floor System 446 o 1 s ' • ^5 Br i :,61. APPROVAL°TO DECK1.,;••••: 1:;•• i ▪ j ,,* 1- 2-: 11. Property Sewer Line&Housetonnection, : 1 ? `: 62. Backwash&`Receptor Finaf-- _ °. : ` !. ' 12. Sewer Cap 1 .1 • ' I : 1 b or' -2 '63. Heater,& Vent-Final_ - •• 13. Roof'Drsins i 1 1 - 1 ! '. ^ '.- - - r , I . , ! .i I . A -o. ;:' X64. Plumbing SYstem;Final` . ,. .I ^ ,r 14. Rough-Plumbing • . ! 1 ^'� i i : ° I : 1 65. Ele -`_ ctrical-Final .9' -- ! I !I a `15:-.Rot hElectrical-Conduit'--- 't•-- -f'- -- -1 -*--- , - - -- - - - - - -- - - p g - �. r I '� d [ , �i f i . -�66TSolar.SYsiem=Final i", I 'i r 'o 16f1,Rough:Electric1Wiring• ^ Ig, I 1 ji,�1 ,:1-:,if-,-7,-,1-.7cc.-l-rr 167 FeiEing&Access-Approval n-T=1 :- ' """- . , �i-„ = - 1-17. Rough Wit ng Signc" `` 1 I 1 :- I ( =I"5 1 '68.i APPROVED FOR' 1 ' '; RING ?! ' T4s ;1 . ;-5 -, ?rcnir. ir _ . ± .. ' - - g1 ' 1 I I' i I I • I ,9 ;69.: POOL/SPA SYSTEMS'FINAL ' '- [° c ' I " 16. tRough_Electncal;T Bar,Ceiling: +� I I ,T I fl 19 Rough Heating &Air;Conditioning 1 I I ( >3 i i i `I !FIRE DEPT.'REQUIREMENT - I_ • h r o . I , I I 11 aI'o i i l I x V 20- !Rough Factory Fireplace i 1 11 ii II 1 1 APPROVALS 1 Permit# :i ' i 1 i - ' ,• Nt n - s > ' I li I. 1 1 I � I I I ; I I I 1 1; - I , : ' I . 1: 1 77 j 21.iDucts,•in S4ro5ture2 " f i `.a I i i I 1 I 70>! Underground Hydro j ' 1 ' o I G. 1122;:buds,Ventilating r 1 a : II (i I i I I i ' I 1711 product Piping O Gas 0 Oil i • : I ' ti-23'.!' as.Pipe-Rough& Test ¢ I 1 I F. 1" '-'r-'- II ---'--- �_ I ,� � � � r � i i72.j Underground Flush; ',4I . ▪ 1r24(1 Roof FramingFraming"; r ' ' I II ,' 1„ 1•n I r•1 '-- ! - '731 Undergrnd.Storage Tank 0 Gas 0 Oil ' ' ' ' , . „ _] f 1 . t, 1 1 1•til ce . L 2i= , i.:y I c• , ai a ' 25.koof Sheathing 1 1 I ; I I -;16�l I 'I�- i s t H- i r; . X74! Overhead HYdro 1 1 r 1 `. ', .i. ; I , 1 I • i 26 T Bar Ceiling'1Structurall,& Monocoat ! ' i: It I); =I 1 :1 175! Dry Chemical 1 . 1 - •., , . ' ' I ,o :^ J, Frame and'Flashingl e"r , I I n i' I +s,its 1 11 :76.1 Dry Standpipe 1 4 : , ' i : I I .174, I', • 28. IL,athln &-Sidin 1 2 " 1 1 ! r - , 1 ; .,` . M a 9 :. g. o `= i I I I I 1 - I 1 1 (77: FIXED SYSTEMiFINAL ', , l:, 1 ' 'p I .g . .- . f I - , a 29 Insulation 3 - r 1 !I ( q ; ( f II I I78; FIRE PREV. FINAL 1• ; ! ! I • R 5-30.(Drywall Nailing � n • " , , ,I II I I I I _ ( I I I Notes 1 , i 1 I i ,- 's ' ' ', i 31.„Plaster Brown Coat•, -, , 1 I II 4 I I I I I I 1 I I 11 I I , I. I - i -:-- i i I j , : i 1 1 1 I 11 t ! :: I ,, I r a - I g i 32. Electrical Power Meter-Final 1 i 1 11 -' I1 I 1 • w J 1. - -i i 1 -, I. � I I f I 7 1 ( '" t _ d 133�Final Electric i 1 I 1 !1 ; 1 ! .1, . '_.Lt 1. i t. 1. .1 _ 1 '. I I 34. Final Heating &;Air Conditioning e 1 ' til 1 I 1 I 8 trim ;-. . F , . , II 11 1 I I I 1 1 I t �. .. ,a m ! !COF� jG If. : 12 IJ 1 117- I,_ _ 1 J '' , 1,: ' - \ - r- E - - ^� t-7-, 35. Final ** r- •.e-Tests - i,yi ;. [ ; ; lclaf= ! . 1 = '•:: I * i4l ' 1i ' 1 - c -- `-i' - .. •' 36. Hood or'CanoPV : ' l1 n 1 d I c i A - I I I ! : f5. I.; I 1t., ' o . - J r. r+ 37. Final Factory Fireplaces: 1 t �I I I - a- ' 1 - I I 1 t P,I 1 ! H.. ; r' - M N r •'I +' r a �s " I f ; l I 1 laic I t 38. Final Pluinbing I 1..,I I 1 - 11 1 . V I 1 1 , 1 1 I ! 1 ' 1,_ 1t !•H:.. ° : - -li I1 � 1 ' ! 1 I I ! 39. Water<'Servi e-Final , I i '; It I I I , . 1 1 i l I 1 1 I,- 1" -i 4 - ,'; ;1; 40. Gas Survice.Final ..r.:1 t i, r 1 1 ! I I I I 1 1 , • 41. Solar D_o'mestic1Final 1 ; I 1 II ' i -� I 1_.L!-• �_.1L4 _. .�.._'i.'• ' °. ' 42. Backflow I?reventei 1 I ' ! -1 1 , I. I 11 1 ' ' i 1 1 1 I : I • I • i ' i . ' : 43. Backflow Irrigation1 -- I , 11 ";` I i 1 c I e I.Y I'_ 1 •'Ie,21 `.I I 11 I`I' t y 44. LandscaPe'Irrigatiori-System I l{.fI I . I ,, i. - I :1 w I z I iI I o I I , ! - , ^ - L - . - „ n. " 45. Sound Atteniiuation;I't ! I I 'i 1 I 2j �I I i i ! ii' - "- I I I, /1.6:1I+i 1 1 46. Handicap Reg ...{ ., ris. : m 1 1 '' I� I i - 1 :I I 1 t 1 1 , - ' .` U' - r.1 47. FINAL STRUCTURE'& BUILDING' 1r= I` • 1 ! x 1 ! 71..1, If 1 I i ! v 15-, I , l l'' 1 �'� X13 • I ; ! I i t . 1 4 ' '" 48. Special Requirements Completed 11 I I .?• . i II : ;i.-2,.., ; ..!, c ; t, ,. ,. a 49. Elect*2 IIReleaseitolc 1 i 1 I i r1--1-FI I � !---I---i--G-! I --1(--r--Y%'• , sI. 1 ! ! , i u , r I v' r i I. 't , 1. , , ,?7 i 50. Gas Release So:Southern California Gas Co j I I 11 I i I 1 1 - I I ce i , ! i', ' I ! ! I: a , I I I 1 I I I'„ 51. CERTIIFICATEO OCCUPANCY IY 1�� 1. .1_ 1_444_ ; _�T_f�l ri' i ' I f ' Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. PE IT NO. TRACT NO. LOT NO. UNIT NO. CITY QF COSTA MESA CO TJ�UCTION PER A.P.qW Zone P(oject Address (� c, 77 7 g • ayys' 33( / V . TYPE OF CONSTRUCTION LJ NEW Li ADD U ALTERATION IQ REPAIR S Main Building: Accessory Building: Applicant's Mailing Ad r¢/ss �W,1(#�{}r �/p ❑ CONVERSION ❑ DEMOLISH El OTHER T Front 0 Owner's Name nn PhonefCnfJ 7YQ DESCRIPTION OF WORK/USE OF BLDG. A Rear N Address Arch/Eng. License No. TYPE OF PERMIT U GRADING2I J.rOUNDATION ❑ STRUCTURAL C Right G Address • • ❑ TENANT ❑ ELECTRICAL YJ PLUMBING ❑ MECHANICAL S Left Contractor's Nam _//Na aIa . ' en AS.L- Phone (9.5720:05". ❑ 'OTHER IPing. Ref.dk Parking Req./Provided E ' i// 1'/ ,# C PROJECT DESCRIPTION SQ. FT. OCCUPANCY 0 Address(mailing) • . Planning Notes: M n07 CONSTRUCTION TYPE VALUATION$ T City License No. J ZONE GRADI NG CV.YDS. ACRES S. LICENSED CONTRACTOR DECLARATION I 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 ,d-� my license is in full I. d effect. n S. ELECTRICAL FEES V Licens- I. �1/ c•-sey. V 1 tl`` Date i tL Signature &A �&. -et_al PLUMBING I FEES Automatic Washer - Transformer 0 15-50 KW V` 'MORKE"5' OMPENSATION DECLARATION Bar Sink Showers Construction Pole Suh. ❑ 50+ KW ereby affirm that I nave a certificate of consent to self-Insure or a certificate \ Workers' Compensation Insurance, or a certified copy thereof (Section Cooking Unit Meter ❑up to 100 amps \ X800, Lab. i5 /QZ� ,I „� Backflow PIrrigation Service Sink Policy No. /t/V'II/ I�N//O Company-(✓_1�7i' OV !y(f/ Backflow Irri ation Sewer CapDishwasher Meter Dover 100 amps ertified copy is hereby furnished. Dryers ❑Gas ❑Electric Sub Panel — Cer Wryry� is filed with the city Bnin Is ,r Bathtubs Sewer Connection ate (O Applicant �/✓ Fan Motors Dai HP ❑1'/a-8 E%EMP 10 FROM WORKERS'COM ENSATION DECLARATION Clarifiers Solar Collectors (This section need not be completed if the permit is for one hundred ($100) or Dishwasher F.A.U.• Inc.Solar 09.15 HP ❑16-15+ less). Solar Piping I certify that in the performance of the work for which this permit is issued, I Fixtures 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. Date Signature Floor Drains Swimming Pool w/Spa Device Boxes Pole Light NOTICE: If,after making this declaration, you should become subject to the Outlets Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Range comply with such provisions or this permit shall be deemed revoked. Switches CONSTRUCTION LENDING AGENCY • Gas Service Outlets Water Closet Sign I hereby affirm that there is a construction lending agency for the performance a Disposal of the work for which this permit is Issued (Section 3097 Civ. C.) I � �7 , _ 9 W Standing Sections Lenders Name Interceptors Water Heater /l) Lender's Address Kitchen Sink Water Service >✓ Generator 045 KW 05-15 KW Trash Compactor OWNER BUILDER DECLARATION 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 ' county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays I' . 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 • Roof Drains . '•e Contractor's License Law(Chapter 9(commencing with Section 7000)of rizion 3 of the Business and Professions Code) or that he/she is exemptReinspection Fee I $15 Issue Fee $ 3 nefrom and the basis for the alleged exemption. Any violation of Section .J31.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars($500). DEVELOPMENT SERVICES REQUIREMENTS: $ 3 I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee ' compensation, will do the work,and the structure Is not intended or offered Zoning Approved By Date for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL 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 Application Issued By employees, provided that such improvements are not intended or offered for Boiler Hood or Type I 0 Dat sale. If, however, the building or Improvement Is sold within one year of corn- Canopy Type II 0 • SUMMARY OF FEES pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground prove for the purpose of sale). - BUILDING PERMIT $ SMIP $ ❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System PLAN CHECK T tractors to construct the project (Section 7044,Business and Profeszlons Code: $ �,OV PERMIT The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑4100,000 BTU ❑j,1'00,000 BTU - V ISSUANCE $ builds or improves thereon.and who contracts for such oroiects with a con- PLUMBING $ tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration PLAN CHECKa,25% $ ENERGY P.C. $ proof of their Worker's Compensation insurance should be provided to me. ELECTRICAL? $ GRADING $ IDI am exempt under section B.& P.C.for this reason Firepl/Fact.Bit. ICBG# Fire Dampers • _ _ _ ___ _ EXPIREDPLAN CHECK 50% $ MICROFILM $ Date Owner Heating System&Ducting Registers i �p�� ❑4100,000 BTU ❑100,000BTl.(�I r�titiyHANICAL $ TOTAL FEE $ Serb I hereby certify that I have read this application and state that the above II PLLAAN CHECK 25% information is correct. I agree ui toi comply cost with all dy and county h ordinance- $ and state laws relatingis tot building construction, and hereby authorize ert repor 1-11.11 nettos pofu this city to enter upon the above-mentioned pro for Inspection pus ses Signature I'/,�/ DatReinspection Fee $15 Issue Feb I $ 3 01 0002E134-00028134 TOT 5.00 Drivers' License or SS# .'( Pink -Accounting; Goldenrod - Assessor 1 CONSTRUCTION AND PLANNING PO' 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 Utitity-Undrgrnd. 54. Forms 4'..Eleclrical Conduit-Undrgrnd. __ 55. Electrical Bonding 5.`SteeiReinforcement', • 56. Rough Plumbing& Pressure Test J 6.,Elect`rical UFER Grnd. ., 57. APPROVAL TO COVER-GUNITE 77"Footings .%. .-) 58. Electrical Conduit-Undrgrnd. 8:'Foundation .' - 59. Gas Pipe, 0 Undrgrnd.,Test 9!Water Pipe-Undrgrnd. .1 • .2 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10TStructural Floor System ' ' -.. 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection - ' ' 62. Backwash & Receptor-Final - , • I 12'Sewer Cap 63. Heater & Vent-Final 13. Rog, 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 18: Rough Heating& Air Conditioning FIRE DEPT. REQUIREMENT n20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 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 1 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED R -1• 33. Final Electric Notes: 5, 9/p7 //d Cy4�,•.V'! � 34. Final Heating & Air Conditioning 7/ l wed 35. Final Gas Pipe-Test 01-4 L� .e. _` ry o..a 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 l �' 43. Backflow Irrigation 44. Landscape Irrigation System CI 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Snecial Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date City of Costa Mesa - Building Safety Department CERTIFICATE OF OCCUPANCY • P.O. Box 1200 kN2 2999' Costa Mesa,California The Building located at 2442 Elden Avenua - Unit A has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group H 6 J Occupancy. Use of Building 1 Condo with 2-Car Garage Legal Description A.P. 119-061-03,04 '- . - - -(See reverse side for Metes and Bounds) - - - - Building Permit No 47824 Electrical Permit No:6647,48806 Plumbing Permit N0 76S31.766c0 Number of apartments and/or guest rooms ISSUED TO: Building Official— ' �p by Ci' SPINNAKER CGMPANY/I.AMP;4AN (X3NSTRTT('rTON Victor C. Newton - Director Building Safety Date Mnrrh 7D 1OCD This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 306 lel U.B.C. Form BU 34 Rev. 11/70 CITY OF COSTA MESA o "MFS BUILbING'DIVISION FI Oleg}' 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us fie FOR INSPECTIONS CALL: (714)754-5626 PERMIT NUMBER: B11-00080 PERMIT TYPE B_ROOF2 STATUS: ISSUED APN: 42606204 DATE ISSUED: 03/15/2011 ISSUED BY: KJB JOB ADDRESS: C.2-141--A-ELDEN-AV-CM3 Suite/Unit: A Vicinity: Squares: 500 Valuation: $4,000.00 ,+ SCOPE OF WORK: TEAR OFF EXISTING BUR.INSTALL NEW SHEATHING.COVER WITH NEW BUR.FLAT SECTION OVER DEN ONLY. APPROX 500 SQ FT. NOTE:RESIDENTIAL RE-ROOF:Final approval of permit shall not be granted until access to dwelling unit(s)is provided for verification of the installation of smoke and carbon monoxide alarms by the City Inspector. See Attachment w/Inspection Card OWNER: STANG,FRANCIS A TRUST Address: 2242 ELDEN AVE Unit: UNIT A PHONE: 949-631-5536 City/State/Zip: COSTA MESA,CA APPLICANT: HADLEY,STAN Address: 9244 GARDENDALE ST Unit: : PHONE: 310.490-6805 City/State/Zip: BELLFLOWER, CA;, CONTRACTOR: HADLEY ROOFING AND WATER PROOFING License No. 712231 Address: 9244 GARDENDALE STUnit: PHONE: 310-490-6805 City/State/Zip: BELLFLOWER, CA 90706 CELL: ARCHITECT: License No. PHONE: ENGINEER: License No. PHONE: FEE SUMMARY Reroof Plan Check: $0.00 Reroof Permit Fee: $97.25 Reinspection Fee: $0.00 Bldg Std Admin Fund $1.00 TOTAL FEES $98.25 HOURS FOR CONSTRUCTION ACTIVITY; EFFECTIVE 3/18/2010 -PER CMMC Sec. 13-279 -, Monday thru Friday-7:00 am thru 7:00 pm. Saturdays-9:00 am thru 6:00 pm. Prohibilied all hours-Sundays and the following Federal holidays New Years Day, Memorial Day,Independence Day,Labor Day,Thanksgiving Day and Christmas Day 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 S. INSPECTION TYPE DATE MODALS CODES IN5PEC11ON TYPE, DATE INn11ALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final �n 208 Final Plumbing 200 Final Re-Roof X 3-a-1-I i IY)Pbq AD- 210 Final Electrical 201 Final BlockJRetaining 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 0 No I hereby affirm under penalty of perjury one of the following declarations: •Driver's License No. Expires: O I hve 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): comp cation, as provided for by section 3700 of the Labor Code- for the xe rmance of the work for which this permit is issued. I have and will maintain workers'compensation insurance.as required by sect n 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' cam ensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a number are:emery I person is required to descend,will be made in connection with work authorized S-kir- 7 y by this permit,and that no building structure.scaffdding,falsework,a demolition or dismantling thereof,will be more than thirty-six(36)feet high. (Chap.3.2,Grp Ksett4n need not be completed a the pemut is valued al me hundred&Ian(s 11X/)a less.1 5 E C clove `y� 2,Art Z Sec.341,Title 8,California Administrative Code). Pot'�cy'NUmber. U ✓ 0 As owner-builder, I will not employ anyone to do work which would O 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 ApWmnt's Signature Date the Labor Code,I shall forthwith comply with these provisions. 31 (s - ( I Division of Industrial Safety Permit Number: re5ignature 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 ATTORNEYS 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 4_e2(•2— Z 3 ( 63 y (Section 25533 of the California Health and Safety Code, with some 3 LI—( ( exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely -aT ssgnatureDale-" 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 •Aar-_-��° (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 J? 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 FRIM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sect 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. Ivor 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 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? 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 ❑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 cantractor(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. Si nature of Legal Owner(s) Date Signature Date 3 — (l c —l/ 3057-46(3/07) Grailla-Sulhortzeclapplicant rak Lit I,4 CITY OF COSTA MESA BUILDING DIVISION :•r„ •'r • DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER F i ....�.%.. i PERMIT 4. % B00-01834 (714)754-5273 • Fax(714)754-4656 • www.ci.costa-mesa.ca.usBUILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2442 ELDEN AV Status: ISSUED Suite: A Applied: 11/14/2000 Vicinity: Issued: 11/14/2000 Parcel Number: TPN000045 Zoning: Applicant: MARION, RICK - ISSUED BY: Address: U Phone: 949-548-3012 Zip: Owner: SPINNAKER COVE C/O CC&R ASSOC. MGMT. Address 17942 SKYPARK CIR - ' IRVINE;CA - Phone: 949-955-0112 - SUITE H Zip: 92614 Contractor: MESA ROOFING - Address: 843 W. 17TH STREET Phone: (949)548-3012 COSTA MESA,CA - Zip: 92627 License:. 564151 . Arch : Eng: Address: Address: Phone: Phone: . Zip: License: License: SCOPE OF PERMIT RE-ROOF UNIT A(BUILDING A).TEAR OFF/SHEATH AS REQUIRED/COVER WITH 25 YEAR COMP. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $2,990.00 Permit: $83.25 - Claim Valuation: / $2,990.00 SMIP Res: $0.50 SMIP Corn: $0.00 Other $0.00 Inspection: $0.00 • Total: $83.75 ' PLANNING & ZONING SETBACKS , , MAIN STRUCTURE Front 0-0 , Rear . 0-0 Left 0-0 .Right .0-0 ' ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: a NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 . 2446-48(6W) 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 sell-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 veil maintain workers'compensation Insu nce,as required by section 3700 of the Labor Code,for the performance of the work for which peril is Issued. My workers'compensation I�nAce carrier and oil mber are: ^ Carrier: / • ` Policy Number: Vt' \ .C. (This section need not be completed if the permit is /ued 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 Calif.•.. Id become subject to the workers compensation provisions of Section 3700 o o the Labor Code,I shall forthwith comply with these • • lonions. /t i/ 1)6 (ippllcanLSignature:• / Date: 1 WARNING:FAILURE T•-7-�• %'ri RS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED TH OI WAND DOLLARE(5100,...).IN ADDMON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisio _.•f hapter• ..y men• g • ection 7000)of Division 3 of the Busin an s and my license is In full force and effect.Lic.N t Si Class II ContractotsSgnature: Date: / / /54'!Z0 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 DMsion 3 of the Business and Professions Code)orthat he.or.she:isUxempt 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 perialtybf 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.). u ❑ I,as owner of tra tors m EXCLUSIVELY snt to WITH Uy oED or CONTRACTORS tor constructn, the ontea(Sec.704Business and Professions Code:The contractors License Law does not apply to an owner of properly who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I em exempt under sec. _ _ Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): „ _ DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,AR 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. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Wilt the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Are 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 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 California Health end Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application kpaermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes jJ 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 feel 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). District ._ ._ "- "._.... 7 a pard from the South Coast s Quality Management al or thcontroldistrictapplication, disclosuresprescribedCaliforniaHealth 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 slate laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct.1 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/fiinspection. Jit And/Or.• zed,Ariacant—) Date CODE I INSPECTION TYPE PATE Ifs LOGE E INSPECTION TYPE PAT. IMAL$ 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