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Home My WebLink About416 FORD RD - Building PermitsOWNER W. G. LO JOB ADDRESS Iy1C GENERAL CONTRACTC AP. No. IN4PECTIONS �.,, W � ._______' �__'e " ' OCCUPANCY DATE CT B FIRE ZONE DESCRIPTION OF DATE GROUP I TYPE p ��I SUBCONTRACTOR I ._ � Form Z10—SM-11•59 SB P UNIT A(1116) . �jOL� FOR SPECIAL REQUIREMETSiS 1�{602 � bwxEx w. JOB ADDRESS 1�'SPECTIONS OCCUPANCY DATE � GROUP SUBCONTRACTOR BUILDING PERMIT TYPE V ZONE R-1� � PERMITS ISSUED Form 210-5M-11 �59 5-B P jJPJI B& C 110LD FOR SPECIAL REQUIREMEN7S 1�16�3. .- n�� ' � ��, CbSTA MESA BUILDING-SAFETY DEPARTMENT P. O. BOX 917 COffTA MESA. CALIFORNIA For Applicanf fo Fill In Compleiely TYPE OR PRINT BUILDING AOORE88 r / COSTA MESA CALIFORNIA OWNER W. G. Lona Co. I ARCHITBCf � uc No. 93141-B1 No: Mz-67731 BIZE � � �,� � I NO. OF BLD69. 86T0ACK LIN6 pROM �NTeR ov 8TR66T T ftEAR YARD � BIDE VARODESCRIPT O'N OFR�WORKS�t FIRE ZONE APPR� BY ZON6 L80AL FE�i RECEIVED '� �s n�A� 2 6��s 1 fINANCE DEPT. , CITY OF COSTA MESA " 1�� APPLICATION FOR PERMIT � suauiN� � � For Office Use Only � nece�vr No. pgpyij� � `�1 i � BY I ��R��-°Ga G'�La-"G/ �" 11 //_ .4 L'.� o.� P n Co COSTA MESA. CALIFORNIA �—� TYPE GROUP � DATE /(7 Z `�(� / W ZONING w NO.OP OP NHW � PLANB BUIIDINO � ��,3 a 3..i Q EVES U ALLOWED 0. [CENTBR lINB 9T.) (n S � FT. IN. � . � 6 �N. �Q � I N. �* b r O FT. � IN. i' 1. APPROVED 0 II XBPHBY 1CKNOWLPDO[ TN�T 1 MAVE RlAD TMIB MPLIGTION AND 9TATE THAT TN8 ABOVE IB CORNER AND AGPEE TO COM- PLY WITH ALL CITY ORDINANCE9 AND BTOTE L11W6 PEOULATINO BUILDINO CON6lPULTIol�, n /l � " '7/ PLAN AUTHORIZED AGENT /l% �/!O � T f . ' . � L� COSTA MESA BUILDING-SAFETY DEPARTMENT P. O. BOX 917 C08TA MHBA. CAL�FORNIA For Applieanf fo Fill In Compleiely TYPE OR PRINT BUILDING 6 , _ °� _ � J �- I � C ADDRE88 COSTA MESA CALIFORNIA ADDRE65 � O O W�.}�� ST C GIN � rV � ARCHITEGT OR ENGINEER }� WJ� AD�RES 9� �/ � X.o� W14�' CONTRACTOR , .� e ADDRE D�O � P S� `� oir u,v �'� � �c; BTATE GY7 1/� i '7 i TEL. ��i/ 1 (, • ea� lt FIRE ZONE � APPF �\ � OF 91D66. F E RECEIVED � �lAY 2 61961 FINANCE DEPT. ciTr oF cos�a �� APPLICATION FOR P BUILDING For Offiee Use Only R8C81Pf NO. � g11�1j�� Y � I DATB�t¢Cel�(Hp (. . DATB 188U8D COSTA MESA. CALIFORNIA ZONING _ J I : �°a �I a8 �,�o USE OP YARDS EXI ING BLDG. APPROVED 96TB�CK LINB FPON ( �J 7� e fQM}HP LINe BT.1 CHNTeH OP sTneHi O I �l � REAR YARDIJ R FRONT SIDE YARD I LEPT ' b�� I RIGNT S� �,r R. SIDE DESCRIPTION OF WORK APPROVED t PXTERIOR WA ROOF I �y/ GOVHRINfi V�CO COVERING L USE OR BUILDING AND WORK TO BE PERFORMED l Sr � � l�z �C, C/ L. � S u c (� a r D TAcNE_D � 1 HHNBBY ACNNOWLPDG6� AT 1 HAV6 HBA� TM�B APPLIGT�ON TH8 AMOUM NOW NOeI AND BTATE TXAT TH8 ABOVC I8 CORPECT ANC AOREe TO COM• �pQ��g�.A LIBNINt PLY WITX ALL GIT' OPCINANCEB AND BTA18 4W8 iBOULATNO euu�tNa CONen+ucnon` � VALUATION ' / 61GNATURE OF PERM PERMITTE �J �J'7J $ OT� / /.i.� PLAN AUTHORIZED AGENT TOTA � � J !/ � �'/ `�- VALUATION 19 PDX THH A PHRMIT P¢E ONLY. f FEE $ �j �� CHEGK $ aO. J D FEE $ G�, S' O � CITY OF COSTA MESA , O�pMFS,p , . BUILDING DIVIS/ON � t p i�„ 0 77 FAIR bRIVE, COS7A MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • �wvw.ci.costa-mesa.ca.us �. ` � FOR INSPECTIONS CALL: (714) 754•5626 '`°�"° PERMIT NUMBER: P11-00147 PERMIT TYPE PLUM APN: 41920104 JOB ADDRESS: 416 FORD RD CM Vicinity: LAUNDRY ROOM STATUS: DATE ISSUED: ISSUED BY: Suite/Unit: . SCOPE OF WORK: CHANGE OUT WATER HEATER IN LAUNDRY ROOM. ISSUED 07/15/2011 KJB NO7E: OWfJER WAS UNABtE TO COMPLETE TITLE 24 tNFO. ADVISE OWNER TITLE 24 INFORMATION MUST BE PROVIDED AT INSPECTION OWNER: CST CAPI7AL LLC PHONE: APPLICANT: TRINH, JENNIFER PHONE: 818-530-6y77 CONTRACTOR: Address: City/State: ARCHITECT: ENGINEER: a ZipCode: Address: City/State/Zip: Address: City/State/zZip: License No. Litense No. 416 FORD RD COSTA MESA, CA 11311 PEPPERVIEW TERRACE SAN DIEGO, CA License No. PHONE: CELL: PLUMBING PERMIT FEE SUMMARY PLAN CHECK FEE: PERMIT FEE: TOTAL FEES: 50.00 $35.80' $35.80 NOTICE: The work authorized by lhis permit shall comply with all appliCable handicap access requirements under Calitomia 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. INSPECTtONS: In order for fhe work authorized under th'rs permit to be wns'rdered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and fnal approval will result in the expiration of this permit. CO�E t. INSGEGTIONTYPE DATE INPTIALS 4onE1 INSPECPONTYPE D� IN7I71AL5 1616 Fixed System Final Fire Prevention 206 Final Mechanical � �1266 Pool Spa Final 208 Final Plumbing %� -- —11 � 200 Final Re-Roof 210 Final Electrical 201 Final Block/ReUining Wall 212 Pinal Pire PreveNion 202 FinalFac�oryFirePlace 220 FinalPlanningAppmval. 203 Final Sign 222 Final Si�e � 204 Final Demolition 250 Final Building/Occupancy WORKERS' COMPENSATION DEClARA710N: . I �ereDy affirm under penalty of Derjury one of Ihe following declarations: ❑ I have and will maiNain a certificale of consent to selt-Insure lor vrorkers' compensation, as providetl (or by section 3700 of the Labor Code, !or Ihe peAormance of ��e vrork (or which this pertnil is issuetl. ❑ I have and will maintain v.arkers' compensation insurance, as required by seclion J700 of the Labor Code. (or Ihe performance of Ihe work (or wt�ich this pertnit is issued. My workers' wmpensation Insurance carrier and policy number are: Cartier: (ilussaCmneeCnafOecanp'etedl^lnep'nmnfa_r—dLM—anlw�efr .ud�eC0olarslSt001aleu.) Policy N ber: 1t�ir� S I certi�y Ihal in lhe peAOrmante af lhe v.ork (or whith this permit is is I shall not employ any person in any manner so as to become subjecl to Ihe workers' compensation laws ol Califomia, antl agree that if I shoultl become 5ubject lo Ihe vrorkers' compensation provisions o( Section 3700 of th or Code, I s• to with c ly vrith Ihese provisioni ! "��1�'� 1's Si alure Dale ' WA ING: FAIL E TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($700.000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE IABOR CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm t�at I am licensetl untler provisions of Chapter 9(commencing with Section 7000) of �ivision 3 of the Business and Professions Code, and my license is in full (orce antl e((ect. Lic. # ��" Class # Contractor'S Signa�ure:�..,� Dale i� CONSTRUC710N LENDING AGENCY: ❑ I hereby��aKrtn thal there is a conswcCon lending agency for the pertortnance o( the v.ork (a which Ihis pertnit is issuetl. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: SignaWre Daie a OWNER-BUILDERDECLA� TIONS: I hefeby a(frrtl thal Under p8nal�y of perjury lhat I am E%EMPT FROM THE CONTRACTORS LICENSE LAW for ihe following reason (Sec. 7031.5, Business antl Professions Code: Any ciry or coanry which requires a permit ro construcl, alter, improve, tlemolish, or repair any structure, prior to its issuance, also requires t�e applicant lor such permit to file a signed statement that he or she is licensed pursuant to the provisions of �he Contractors License Law (Chapter 9(commencing vrith Section 7000) o( Division 3 of the Business and Professions Code) or that he or she is exempt therefrom antl the basis for the allegeA exemption. Any violation of Section 7031.5 by any applicant for a permil subjecls the applicant to a civil penalty of nol more than fve hundred dollars (3500).): ❑ I, as owner of the property, or my employees with vlages as their sole compensalion, WILL DO THE WORK, antl the structure is nol intended or oBered lor sale (Sec. 7044. Business and Professions Code: 7he Cont2ctors License Law does not apply to an owner of property who builds or improves Ihereon, and who tloes such work himself or �ersel( or through his or her ovm employees, provided thal such improvements are not inrended or offered lor sale. If, hovrever, the building or improvement is sold within one year of comple' n, the owner-builtler will have the burden of proving that he or she tlid n builtl or improve (or purpose ol sale.). I, as owner of the property, am El(CLUSIVELY CONTRALTING WITH L ENSED CONTRACTORS to consWct the project (Sec. 7044, Business antl Piofessbns Code: The contractors License Law dces not apply to an ovmer of propetly who builds or improves thereon, and who contracts ta such project with a contracta(s) �icense pursuam ro tne Contractors License Laws.). ❑ I am exempl under sec. Business antl Professions Cotle for this reason: �I �IS�iI a r Dale 305]�4 (JIO]) Owner ID verified by tlriv�ense. ❑ Yes ❑ No Oriver's License No. Expires: Venfcation ot Ownership by (type of document, i.e. • property taz bill or deetl): DIVISION OF INDUSTRIAL SAFE7V PERMIT CERTIFICATION: ❑ I hereby certify Ihat no eacavatbn frve (5) or more (eet in tlepth inro ufiich a person is requiretl to tlescen4 will be matle in connection with wwk autha¢ed by this permit, and that no builaing sln�cture, scaffd0ing, false�wrk. a tlemolitbn or di5mantlinq thereof, will be more Ihan Ihiny-siz (36) feet high. (Chap. 3.2, Grp 2, M 2, Sec. 341, Tille B. CalifOmia Administrative Code). ❑ As owner-builtler, I will not employ anyone lo do work which would require a permit Irom the Division o� Intlustrial Salety, as notetl above. unless such person has a permit to do such work from the tlivision. ApWiranl's SignaWre Division of Industria! Sa(ety Permit Number. _ HAZARDOUS MATERIALS AND EMISSIOkS CERTIFICA710N: 1. Will the applicant or present or fuWre building occupant need �o file antl cenity a Business Plan tor emergency response ro release or lhreatenetl release of a hazardous material? ❑ Ves � No (Seclion 25505 0l Ihe California Heallh and Safely Cotle requires. wilh some exceptions, that a Business Plan be fled vrith the Costa Mesa Fire Department by every business which has at any one time dunng a reportetl year a quanlity of haZaftlous matenals equal lo of greater Ihan a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic leet o! compressetl gas at standar0 tempereNre and pressure). 2. Does or will the applicant or present or fuWre building occupanl need to Ne a registration form for acutely hazardous matedals? ❑ Yes ❑ No (Section 25533 ot the Califomia Health and Safery Code, with some exceptions, requires registralion with the Cosla Mesa Fire Department by each business which at any one time has on hand a quantity o( acutely hazardous materials equal lo or greater [han a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet o( compressetl gas at standard temperature and pressure�. 3. Does or will the applicanl or present or fuWre building occupant neetl to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials�7 ❑ Ves ❑ No (Section 25534 of the Calilomia Health antl Safety Code pmvides that the Costa Mesa Fire Department may require Ihe preparation, certification and fling with lhe Fire Department ot an RMPP by businesses which are required to register awtely hazardous materials with the Fire Department. 4. If an RMPP is presentty required, has Section 25534 0l the Califomia Heallh and Safety Code been fully complied with? ❑ Ves ❑ No 5. Dces or will Ihe appliwnt or present or IuWre building occupanl require for Ihe vrork whic� is ihe subjecl ol lhis appliCalion a permit for such con5truction or motlifcalion from Ihe South Coasl Air Ouality Management DistriU or Irom any other air pollution control tlistrict or agency? ❑ Yes ❑ No (Secl'an 65850.2 0! lhe Califomia Govemment Code requires that the requesletl intormation be fumis�etl on applications ta ran-resitlential builtling pertnit5). 6. Will any pan o! the lacility lo be constructetl untler Ihis pertnil be within 1000 feet from the outer boundaries of a schooll ❑ Yes ❑ No Qf 'yes". lhe facility must meet the requirement ol Sections 2553a and 42303 of the Calilornia Health antl Salery Code). Z If a permit Irom Ihe South Coast Air Quality Management DisMcl or olher air pollution control tlistricl or agency is required lor the work which is the suhject of this application, have all ol the disclosures prescribed by Calitomia Health and Satety Cotle Section 42303 been matle? ❑ Yes ❑ No 8. Qf "yes', attach certifcare ot compliance fmm the appropriate air pollulion control officer). CERTIFICATE OF COMPLIANCE: I certify that under penally ol perjury the information given above is correct. I agree to comply with all state laws antl city ortlinances regarding Hazartlous Materials and Emissions. CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I ceAity under penalty of perjury that I have read this application and state that the information given is correcL I agree to comply wilh all 5tate laws and city ordinances relating to builtling construction, and authonze representatives of the City of Cos1a Mesa to enter upon the above-described property for i ction purposes. I r not to o cupy or allow occuDancy of any Duilaing uth " e b t is p i it u' fin I i �.ction. / ( S� na . egal Ovmeqs) � J��e —' � Mtl/or AutbOnzeE AOGlicanl Wte (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 416 FORD RD Suite No A Vicinity: Parcel Number: 41920104 npp�icant: LAURA YENULONIS Address: . . . Owner, MCDANIEL,MILDRED G Address: � 416 FORD RD . COSTA MESA, CA MECHANICAL PERMIT Phone: 909-213-1640 Zip: Phone: Zip: 92627 Contredor. ALLIED PLUMBING - HEATING - AIR CONDITIONING Address: 422 JENKS CI ." CORONA,CA FAU CHANGE-OUT ISSUE FEE Inst FAU <100 k BTU Inst FAU >100 k BTU Repair / Alt Cooling/Heat Inst / Rep.�Recess Wall Htr Refrig Sys <100 k BTU Refrig Sys >100 k BTU Gas Piping Factory Fireplace Hood w/Mech Exhausl VAV Box Vent Fan / Single Duct Appliance Fire Dampers Smoke Dampers Inst or Relocate Appl Vent Air Handlers < 10000ctm AirHandlers> 10000cfm Floor Fumace , Floor or Suspend Heater � Quantity $23.50 _ $14.80 1 50.00 0 $0.00 0 50.00 0 so.00 0 $0.00 0 so.00 . o $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 - 0 " 50.00 0 $0.00 0 $0.00 0 Phone: 714-998�300 Zip: 92680 License: 610780 SCOPE OF PERMIT FEE SUMMARY Slatus: ISSUED Applied: 01I17J2006 Issued: 01/12/2006 ISSUED BY: -'�cJ . Repair/AltAbsorbtionUnit � � . Repair IAIt Refrigeration Unit � Ventillation System Evaporative Cooler - Commerciallncinerator . Domestic Incineretor - - � ' - � Comoressors / Abaorotion Svstems � Upto3hp/100kBTU 3 To�15 hp / 500 k BTU 15'fo 30 hp / 1,000 k BTU 30 To 50 hp / 1,750 k BTU Over 50 hp / Over 1,750 BTU Boilers Up to 3 hp , " 3To15hp 1510 30 hp 30 to 50 hp Over 50 hp Other Mechanical Fee Investigation Fee Plan Check Fee - .� . ReinspectionFee . , TOTALCALCULATEDFEES COMMENTS 1 SPECIAL CONDITIONS Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 50.00 0 50.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $D.00 $0.00 50.00 538.30 NO710E: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitornia 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 euthorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all requlred Inapections and final epproval must be obtained. Failure to obtain inspections and tinal approval will result in Ihe expiration oi this permit. FOR INSPECTIONS CALL: (714) 7545626 �acoan �vw7 WOflKERS'COMPENSAnON DEGLARATON: _ I hereby eRirm und6r penalry of perJury one ot Ne following tledarations: . ❑ I heve end will meintaln e certilicate ot consent to setl-Insure for workera' compensetion, es pmWtletl br by saction 3700 0l Ihe Labor Catle, tor the pertortnance of Ihe work for whic� t�ls pertnit is issuetl. � I have and wlll maintain workers' compensation Inwrance, as required by sectim 3700 oi the LeEor Code, for Ihe peAwmanca oi the wwk lor whkh Nis permit is iswed. My wor rs' Gormpe`ns^a'an Insur nce cartier entl policy number ere: /'� p/� Cerrier: �� \ � ii l�f�. � po�icy Number. ��y_a"I�OUI� �"�� (This section neetl not be comp/efed J Ne peimlt is Vsluea af one hurrtlretl tlW/ers ($100) or /ess.) ❑ I certify that iN the peAormance of lhe work for which t�is pertnil is issued, I shell not omploy eny persan in eny manner so es to �ecome su0lect to Ihe workers' compensetion laws ol Califomia, entl egree thet it I houltl become suD�ect to t�e workers' compansetlon provislons ot Sectlon 3700 0l the LeDor Cotle, I shall lorthwith comply with Iqese pro�'Pilons. ^� — \ Applicent SlgneNre: � � Dete: `� 1 R – �� /1 � � WFRNING: FAILURE TO SECUR ORNERS' PENSATION COVEMOE IS UNUWFUL AND SHFLL SUBIECT AN EMPLOYEF TO CRIMINAL PENA�TIES AND GVIL FlNES UP TOONE HUNDRED TIIOUSAND OOLLAHE (5100,000), IN ADDITI E CQ6T OF COMPENSaTION, DAMAGES AS PROVIDED f-0R IN SECfIIXJ 3]OB OF THE LABOq CODE, IMEREST. AND ATTORNEI"S FEES. LICENSED CONTqACTORS DECLARATION: I I hereby aHirm ihal I em torce and eHect. Lic. a_ ,� Cantracror's SignatUre: ot Chapter 8(commencinp with Sectlon 7000) ol Divislon 3 0l the Bi � _� Class R �. i �1�� Dete: _ Code, entl my license is in full CONSTRUCTION LENDING AGENCY: ❑ I hereby ettirm the� thore is a canstructlon lending agency for Ihe pertormance ol ihe wark lor which ihis permit is issuetl. (Sec. 3097, Civil Code). Lender's Neme: Lender's Adtlress: Signature: Date: OWNER-BUILDER DECLARATIONS: � I hereby atllrtn that under pen�liy of perjury t�et I em EXEMPT FROM TIiE CONTRACTORS LICENSE LAW for Ihe I011owing reeson (Sec. 7031.5. Business and Prolessions Code: Any city or county which reqWres e permit to conswct, alter, imprwe, tlemolish, or repalr any shucture, pdor to its Issuance, elso requires the epplicam tor such permit to file a signed statemem t�et �e ar she is Iicensed pursuam to t�e pmvisions of the Comrectors License Lew (Chapter 9(commendng with Sectlon 7000) ol Division 3 0l the Business and Professions Cotle) or thet he or sh�ls exempt therefrom end t�e besis tor the allegetl eaomption. Any violetion o� SecOon 7031.5 by eny applicant for e permit su6jects the appliwnt to e civil penalty ot not more.lhan five hundretl Aollars ($500).): ❑ I, as awner oi the proparry, or my employees wit� wa9es es their sole compensatlon, WILL DO 7HE WORK, end Ihe sWcture Is not intended or otteretl tor sale (Sec. 7044, Business an0 Professions Code: The Contrectors License law tloes not apply to en owner of property who bullds or improves theraon, and who tloes such work himself or herSeN or thmuqh his or har own employees, provitled that such improvements ere not Intendetl or oHeretl for sele. If, however, Ihe bullding or improvement Is sold wit�in on0 year of completion, ihe owner-builder will heva the 6urden ot proving �hat ha or she tlitl not build or improve for purpose ot saleJ. ' ❑ I, es owner of the property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct ihe project (Sec. 7044, Business antl Proleuions Cotle: Tha con�racrors License Law does not appN to an owner ol propeny w�o 6uilds or Improves thereon, entl who contracis tor such project wlt� a comractor(s) license pursuant to the Contractors License Laws.). � ❑ I am exempt under sec. Business and Prolessions Code lor this reason: Signature: Date: Owner ID venfietl Dy tlnvers license. ❑ Yes ❑ No Drivofs License No. Expires: Venfication of Owne�ship by (type of document, i.e. - property tax Dill or deetl): DIVISION OF INDUSTRIAL SAFETY PERMIT CEFTIFICATION: ❑ I hereby certily �het no excevation live (5) or more fee� in Eepth Into which a person is requiretl to tlascend, will ba made In connectlon wlih work euthorized by this permiL and IhAi no building structure, scattolding, falsework, or demolition or tlismentling thereof. will be more then thirry-six (38) teet high. (C�ep. 3.2, Grp 2, Ar12, Sec. 347, Title 8, C&��fomia Atlministrative Code). ❑ As ownervbuilder, I will no1 empfoy arcyone to tlo wo(1c which would require a pertnil imm the Dihsion ot lndustriat Satery, es noleU ebove, unless such person has a pertnit to tlo sU�h work from the tlivision. SipnaNre: Dato: Division ol InduStnel Se�ey Permit Number: CERTiFlCATE OF COMPLIANCE AND AUiHOfiPAT10N OF EMAV: I cenity under penalry of perjury that I have read thi9 epplication antl state Ihat the intormaiion given is correcL I agree lo cOmply with all state laws antl dty wdinances relating to bulltling consWnion, end euthadze representatives of the Ciry of Costa Mesa to enter upon the ebove-tlescnDed properry for Inspection purposes. I agree not to occuDY ar ellow occupanty of eny building authonzed by this permit until final inspection. CODE 1• INSPECTIONTYPE PAff. 1616 Fixed System Final Fire Prevention 1266 200 201 202 203 Pool Spe Finel Finel Re-Rooi Final BIocWRetelning Wall Final Factory Fira Plece Finel Sign 204 Finel DemollUon / Date � ,-\a1 -fil� Date � ��$ j�QQf,,,( INSPECTIONTYYE 206 Finel Mechenical 208 Flnel PlumDing 210 Final Electricel 212 220 Flnal Fire Pre�entlon Final Planning ApOroval 222 Final Slte 250 Final BulldinglOaupancy �. 1 11�11�. . � �li` N P. � /I PPOJECT ADONESS: Q 1( FC1P.D FiD �t%P OWNEH'SNAME: MCIiANIEL, MILDRED G TR nooxess: q 16 FORD RD - � � C05TA MESA,CA 92627 696-0662 AflCH/ENGINEEH: RODHE55: NEG.NO.: UNIT: � UNIT: PEflMITTEE: �JOGK PLUMHING ( 719 ) 895-1296 noowess: 11610 SEABOARD CIR STANTON CA 90680 LICENSEO CONTBRCTOfl DECLNNRTION: I �ereDy a��irm ��at I am licen5ea unEer Dmvisions ol COapler 9(commencinA with Section 7000� al Oivision 3 0l t�e Bu4�ness anE Prolessions Cotle. antl y'I ense i5 in �WI lorce an0 e��eci. arruc.: 050'3/86 srn�r/euc.:51197� cwss: C-3(�� '�ia�e: � ' � `/ — � / Sigreture. � � �f WOBREN$' COMPENSRTION OECIAPATION: I �ereby a um that I Aave a ceniticare o seu�insure or a certilicate al workers' ComOensalion Ipslapc� p� y,cp�riiliey cgPY I�ereol (Sec�ion 3800. Lab. GI. POLICY NO.: 1 b 7 7 9 E%P. ORTE: U 3/ O I/ 9 S COMPRNY: S TATE �y ❑ Cenified copy is herehy Iumis�e0, L'J Cetlilied cop s hle with tAe city Bmltling Dh' ion. Oa�e: G �' � " L AOVlican�: `�� E%EMPTION FNOM WOBI(EPS' COMPENSATION DECLAPATION: (This section neeA nol be com01ete0 il �he Oermil is lor ane hundretl (S1W) orless). I tetlify Iha� in Ihe peri0rmante ol �he work lOr which this permii is i55ueU, I Shall not employ any Derson in any manner 5o as �0 become su�le�� o ihe Workers' ComDensation Laws ol California. Date: Signature: NOTICE: II, alier making �hi5 DeClaraiion, you Shoultl Uetom¢ SU�jeti �o �he Wofiters' Compensation pmvisions o� Ihe La6or CoOe. you mus� Iorl�wi�P comply wi�h such provisions or this permi� shall be DeemeJ revaked. CONSTNUL710N LENOING AGENCY: I hereDy allirm ihat t�ere is a constmction lentling a0ency for the peAormance of the work br wAicn Inis Dermil is issue015ec�ion 3097. Civ. CI. LENOEfl: AUONESS: OWNEB BWLDEB OECU1H11710N: I �ere0y affirm ihat I am exempt irom Ne Contractars' State Licenu Law for I�e �ollowinq reason (Setlion 7031.5 Business anG Professional COGe: My city of coumy whicn requirzs a permil to cansimct, alter, improve. Uemolish. ar �eoai� any sUucture. Wioi to ils issuaace. a150 tequires the apWiCant Iw SuU permit to lile a Siqrt¢d SWlement that he/s�e a li[ensea pursuant lo Ihe provisions ol lne Coniractar5' Slate License Law (C�aO�er 9(commencing wilh $ection 7q10) af Division 3 of Ihe Business ane Pwlessions Catle) or thai he/s�e is exempt ��erelmm anE t�e Gasis �or I�e allegeE eMemD��on. Any violaiion of S¢ttion 7031.5 6y any applicant lor a permit 5u01��5 I�e appliWnt to a civil penalty of not more Ihdn live hunARO EWlars (5500�. I, as owner ol t�e Vmpeny or my employees witn wages as tAeir sole com0e�sation, vnll Eo the work, anA the ❑ slmmure is nal imentlea or oileretl lor sale (Section 704a, Business ana Pmiessi0nal Code: TAe Caneracmrs' Slaie License Law Goes not aOV�Y lo an Pwner ol a proDerty who builtls or improves Ihereon, antl who Eoes such work �im5ell/h¢rSNt or I�rough �is or �er own employees, D�a�itle0 thal such improvemenis are not intentleE or offereG for sale. II, �owever t�e huil0inq or im0�ovemeni is sold wit�in one year ol completian. �he owner will tWve the bur0en ol provinp hUs�e tlid not Cui10 or improve , lor ihe ourpose ol sa�el. I,as ownero�ihe praVeny.am exclusivel9 coniracting wilhlicensed conlractors�o consimct't�e O�olect(Section 70d4, Business ❑ antl Pmlessions Cotle: The Coniractors' Siate License Law Oces no� apply la an owner ol pmperty wha bwl0s ar imD�oves tAereon antl w�o conlracis fol SucA pmlects with a conVac�or(s� license pursuanl Io Ihe CanVac�of5' SIa1B Lic¢nse Law�.l am awdrp Ihal prool ol IAeir WO�ker'S Compensa�ion insurance s�oultl be pmvitled lo me. � I am exempl untler Section: B. 8 P. C. lor ihis reason: Date: U++ner. � I Ao �ereby cetlily Ihal I am aware ol and un0ersland the requirements o� Galilomia Healih an0 Sa�eiy Code $ections 25505, 25533. antl 2553a antl tnal I or any luture UuilAing occupam will/will not (circle one) need to compty with said state codes anJ ihe requiremenis for a permit lor consimclion or moaificalion Imm Ihe Air Oualiry Management Disiricl. ResiGeniial wnsiruciion applica�ions are eKempt trom Ihese D�ovisi0n5. Oale: PpPlicant: I hereDy cerlilylhal I have rea��is ap0lication anA statethattlte abow ordinances an0 sla�e Warsrelatinqto OuilCing conslrutlron an� eby au, praperty br in5pec�ion purposes. p� � IJaie: �l � L Signamre: L-� Oriver's License or Socia� Security n: lagree�o cOmply vnih all cily an0 couniy tNs uty ta enter upon the ahare-mentioneE 16aLa6 W�ue—BmlGmg: G�ean—CoCe Enlo¢emenC Canary—ApPlicanl; Pink—Revenue; GolGanroC—Assessor COSTA MESA - BUILDZNG PERMIT PERMIT NO: P 067540 PLAN CHECK NO: CONSTRU�:'?^N TYPE: : r�" IT TYPE: PLU SOB DESCRIPTIOT. : WATER HEATER C/O CLAIM VALUE; CALC-�'_,LUE; COMMENTS: NO OTHER WORK AUTEiORIZED BY TFIZS PLZMIT W PERM NO: P 067540 GOVT: N SUPP: N PURPOSE: OTH SQ FT: GROUP OCC: R-3 / faN-*x+c*�* 2 O N I N G R E Q U I 1`EiN T S S E T B A C K ------------ MAIN HUILDING ---------- --------- ACCESSORY BUILDING --------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR; FT IN LEFT: FT IN RGAT: FT IN LEFT: FT IN RGHT; FT IN PARKING REQ• PHOI,�: PARCEL: 4192010h ZNE; REF NO: PLANNING NOTES> > — if if iF if 3E iE iE if iE iE i� if iE if iE+f if 3E iE iF iE 9f * 1F iE if iF iE #F iE iE iE iF iF iF iE iE iE iE iE 1E iF if iE # iF iF af iFit {F iE iF iF+f iE 3F ic iE a' iF iF iE iE 3f iF if ff 1F if ik iP jF iE if ic * J(� if � D E V E L O P P7 E t3 T S E R �* I C E S R E Q U I R E M E N T S ZONING APPROVED BY ' DATE; HUILDING APPROVED BY : APPLICATION ISSUED BY; iF �t if iE if if it iE tF iF iF iE �F %iF ic If it ic if iE #�iF iE iElF 1f iE iE 1E iE #� if iE �R i61f i! if if af iF jf M-iE iF 1:1E K 1F if if LEGALIZATION:N BLDG PMT PLUMBING PERMIT 7.00 25R PLAN ISSUE FEE HUILDING-DIC�-> TOTALS----> DATE; DATE: � 1F i!� ie jf if iE 1F # iE iF M iE if �f if i4 if if ?G iE �lf fi#'!F 7t 7E if iE it iF �lE aF M ic iE 1f if +k *+`i: iF iE � iF �f M �Y �1f iF F E E S U M M� A-.R Y" STP.UCTURAL SEGMENT:N ELECTP.IC MECHANIC FIRE SMIP/RES GRADING � � SMIP/NON-RES 2�,�� PERMIT ISSUE PLAN-CAECA- TOTAL PAID DUE 7.00 20.00 • 0.00 27,00 27,00 ,OU REVENUE LIIVISION TOTALS--> COLLECTED: - 27,00 OVER/SHORT; ,00 BLDG PMT PLUMBING ELECTRIC MECHANIC �'FIRE SMIP/TOT GP.ADING PLAN-CHECK 2%,00 • .t # if'M if iF i.` 1f iF iE iF 1f 1k'k 1! 1f iF 1E')k �f if iF �1F'IF')h'lF iE iE iE �klE iE iF ff iE iE 1E iElf k iE 1E if if 1E 1f �f 1f'1F 1E if 1F')F'M iE if !E it 3!'k i(� 1E iE iE iEli iM1 if 1E iF if if if 4 N� if iF 1E jF'k I N D I �' I D U A L '' F E E B R.'E A K D O W N TYPE QTY D E S C R I P T I O N '•' UNIT COST TOTAL COST FLU 1 WATER HEATER AND/OR VEDIT * 7,00 7.00 END OE FEES, • ' . � . � •. ` ' / � � 01 OQ162?38-00162233 T�] T 2i.Q0 •-,� DA7E� Ob/d4/?4 TItlE: G4:S7 �. �� CQNSTRUCTION AND PLANNING POOL ..SPA �I APPROVALS Permit �`'r Date Inspector p�ppROVALS Permit �k Date Inspector 1 t. Temporary Elec[rir.al Service or Pole 52. Pool & Equlpment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electricai Conduit Utility-Undrgmd. 54. Forms i 4. Electrica� Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumhing & Pressure Test ' 6. Electrfcal UFER Grnd. 57. APPROVAL TO COVER�GUNITE 7. Footings 56. Electrical Conduit�Undrgrnd. � 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9�.Water Pipe-Undigrnd. ' 60. Backwash Lines, P�Trap, O Undrgrnd. 10. Structural Ploor System 61. APPROVAL TO DECK t 11. Properry Sewer Line & House Connection 62. Backwash & ReceptorFinat 12. Sewer Cap 63. Neater & Vent-Finai 13. Roof Drains 64. Plumbing System - Final 74. Rough Plumbing 65. Electrical-Final � 75. f;ough Elec2rical-Conduli 66. Solar System-Finai 16. Rough Electric Wiring 67. Fencing & Access Approval � ��17,. Rough Wiring Sign 68. APPROVED FOR PLASTERING � 16. Rough Electrical�T 8ar Ceiling 69. POOL/SPA SYSTEMS FINAL � 19. Rough Heating & Air Conditioning � FIRE DEPT. REQUIREMENT I 20. Rough Factory Fireplace APPROVALS Permit # � 2L �ucts, in Structure 70. Underground Hydro � 22. Ducts, Ventilating 71. Product Piping O Gas ❑ O�I 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Underymd.S[orayeTank OGas ❑Oil 25. Roof Sheathing 74. Overhead Hydro � i 26. T�Bar Ceiling (Structural) & Monocoat 75. Dry Chemical I 2J. Frame and Flashing 76. Dry Standpipe ! 28. Lathiy�g & Siding 77. FIXED SYSTEM PINAL � 29. Insulation 78. FIRE PREV. FINAL --y 30. Dry�vail Nailing NEALTH DEPT. REQUIREMENT i � 31. Plasrer Brown Coat 79. FINAL INSPECTION i 32. Electrical Power R1eter�Final . 80, FOOD CERTIFICATE ISSUED 33. Final Eleciric Notes: � 34. Final Heating & Air Conditioning ' 6 � ��-�ED _ �_�S=U K lT c�i'6�.- 35_ Final Gas Pipe�Test Nor I�cbZc�J One %�s��-�- - 36. Hood or Canopy I '1 �� `, ri ie� r ory '�epldCe 6 ZZ__GS � i 6 38. Final Plumb�ng ` � �Z �D-��- _ �2 y ��@�-12.��G�'� dk�9 - ^ °'-. � - - - - . � � � Z- - 9� �-G- 40. GasSe:vfce-Final / � 41. Solar `��.nestic-Fin;. i 42. Backfiow Preventer i 43. Backfbw Irrigation i 44. Landscape Irripation System 45. Sound� Attenuation i 46. Handicap Regulations 47. FINAL STflUCTURE & BUILDING , 48. FINAL PLANNING , . 49. Electric Release to Edison � 50. Gas Release to Southern California Gas Co � 51. CERTIFICATE OF OCCUPANCY No. Date