HomeMy WebLinkAbout2476 ELDEN AVE - Building Permits •
CITY OF COSTA MESA
4.aa BUILDING DIVISION
F q .'II 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
4. IA. FOR INSPECTIONS CALL: (714)754-5626
PERMIT NUMBER: B10-00080
•
PERMIT TYPE B_ROOF2 STATUS: ISSUED
APN: 43929111 DATE ISSUED: 03/25/2010
ISSUED BY: KJB
JOB ADDRESS: 2476 B ELDEN AV CM Suite/Unit: B
Vicinity: UNIT B AND C
Squares: 1900 Valuation: $5,500.00 •
SCOPE OF WORK: TEAR OFF EXISTING ROOF SYSTEM.INSTALL NEW SHEATHING AS NEEDED. INSTALL NEW 30 YR COMP
SHINGLE ROOF.ROOF PITCH IS 5:12.APPROX 1900 SO FT. INCLUDES UNIT B AND C.
OWNER: MAUZEY,DON W Address: 3742 HARDING ST Unit:
PHONE: City/State/Zip: RIVERSIDE,CA
APPLICANT: JACOBSON,ROBERT Address: 16828 S BROADWAY Unit: :
PHONE: 310-515-9423 City/State/Zip: GARDENA,CA
CONTRACTOR: AVALON ROOFING INC License No. 765042
Address: 16828 S BROADWAYUnit: PHONE: 310-515-9423
City/State/Zip: GARDENA,CA 90248 • CELL: ,.
ARCHITECT: License No. PHONE:
ENGINEER: License No. PHONE:
FEE SUMMARY
Reroof Plan Check: $0.00
Reroof Permit Fee: $125.25
Reinspection Fee: $0.00
Bldg Std Admin Fund $1.00
TOTAL FEES $126.25
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. Prohibitied 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 INTTALS CODE INSPECTION TYPE DATE INTMALSS
1616 Fixed System Final Fire Prevention _ 206 Final Mechanical
1266 Pool Spa Final `' 208 Final Plumbing
200 Final Re-Roof //(Zit O 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
N
•
WORKERS'COMPENSATION DECLARATION: Owner ID verified by drivers license. ❑Yes ❑No
I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. 7E •
xpires:
❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-properly 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
G, 1 _ "f' f `�G� e by this permit,and that no building structure,scaffolding,falsework,a demolition
Carrier: .ar�i,L_A 1 7 or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp
(This sect need not be a:mul�ef`s'the permt is valued al one hundred dolars(SIO0)w less)
W Ck-.)Ct SS 2,Art 2,Sec.341,Title B.Califomia Administrative Code).
:olicy Number: lJ
❑ As owner-builder, I will not employ anyone to do work which would
o 1.
\f
.-My 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
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.
rkers' compensation laws of California, and agree that if I should
bt bject 1• the work:rs'compensation provisions of Section_ 3700 of Applicant's Signature Date
tI hall forth th comply with these provisions.
- 2 �_� cI O Division of Industrial Safety Permit Number:
•
..Ir-nrs Signature Date HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: AILU, TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLA FUL A D SHALL SUBJECT AN EMPLOYER TO CRIMfNAL certify a Business Plan for emergency response to release or threatened
PENALTI • AND C VIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes ❑No
($100,000), • AD!.TION 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 C•NTRACTORS DECLARATION: 500 pounds, or a volume of 55 gallons,or 200 cubic feet of compressed gas
I hereby ell, that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with 'ecti. 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 l,.-n - is in full force and effect. G� a registration form for acutely hazardous materials? ❑Yes 0 No
Lic. I u 0— Z Class# c . 1 (Section 25533 of the California Health and Safety Code, with some
1 l / exceptions, requires registration with the Costa Mesa Fire Department by
h\ A A iii k Jl 3—zs--0 each business which at any one time has on hand a quantity of acutely
ontraci.'s•'T'-lure Dale 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
CONSTRUCTI• LEND G AGENCY: temperature and pressure).
❑ I hereby affirm th.t there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of - work f. which this permit is issued.(Sec.3097.Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? ElYes ElNo
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: Costa Mesa Fire Department may require the preparation, certification and
filing with the Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials with the Fire Department.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the Califomia
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes ❑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 Califomia Government Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be fumished on applications for non-residential building permits).
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code) or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes 0 No
applicant for a permit subjects the applicant to a civil penally 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 Califomia
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑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 control officer).
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 CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
❑ I, as owner of the properly, 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 contractors)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 inf• ation given is corn:ct. I agree to comply with all state laws and city
ordi :nc: relating to buildi�s construction, and authorize representatives of
Business and Professions Code for this reason: the City of Costa Mesa enter upon the above-described property for
inspect'en p rposes. I agr:- not to occupy or allow occupancy of any building
a tho' ed ., this permit u I final in pection.
Date
Signature Dale e-6-Z- - 'Q
305746(3/07) , h _
end/or Authorized pphcanta Date
-;:it►* pqb
CITY OF COSTA MESA -\
y 1, BUILDING DIVISION 1k`0 PERMIT NUMBER
f' • t_ ', DEVELOPMENT SERVICES DEPARTMENT, i \
° irks
�•®®® , PERMIT E00-00440
-gbomosto(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
ELECTRICAL PERMIT
Job Address: 2476 ELDEN AV Status: ISSUED
Suite No A Applied: 05/15/2000
Vicinity: Issued: 05/15/2000
•
•
Parcel Nunmber: 43929111 p
Applicant: MAUZEY, DON W ISSUED BY: ZS ..
Address: 3742 HARDING ST - -
Phone: 909-684-6378
RIVERSIDE, CA Zip: 92506 •
Owner: MAUZEY, DON W
Address 3742 HARDINGST •('�
Phone: _�
• RIVERSIDE,CA, Zip: 92506
Contractor: 91.fr'
Address: .
Phone:
Zip:
License:
SCOPE OF PERMIT
SUPPLEMENTAL ELECTRICAL PERMIT ADD 1-100 AMP SUB-PANEL,
11 LIGHTS, 23 OUTLETS AND 13 SWITCHES.
REF:B00-00202&E00-00122
FEE SUMMARY r -
Quantity ' Quantity
ISSUE FEE . $7.25 Temp Dist System/Lighting $0.00 0
Temp service test $0.00 - Busway/100•ft $0.00 0
Res.a/c package $0.00 Standing Section $0.00 0
New Res(1-2 units) $0.00 0 .. Misc Electrical Equipment $0.00 0
New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0
Pool/Spa $0.00 0 - up to 10 kva/kw $0.00 0
Lighting Fixts $12.10 11 up to 50 kva/kw $0.00 0
Recept Outlets $22.19 23 up to 100 kva/kw $0.00 0
Switches $14.30 13 over 100 kva/kw $0.00 0
Non Res Appl $0.00 0 , Low Voltage Equipment $0.00 0
Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0
Service to 200a $0.00 0 Misc. Conduit $0.00 0
Service to 1000a $0.00 0 • Misc.Conductor $0.00 0
Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0
Motors to lhp $0.00 0 Circus(mech ride or lights) $0.00 0
Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0
Motors to 50hp $0.00 0 Fireworks Stand $0.00 0
Motors to 100hp $0.00 0 Other Electrical Fee $0.00
Motors over 100hp $0.00 0
Communication drops $0.00 0 Investigation Fee $0.00
Sub panel to 200a $30.50 1 Plan Check Fee $0.00
Pole Light Pkg $0.00 0 Reinspection Fee $0.00
Sign Circuits $0.00 0
Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $86.34
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 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 /
v
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit Is issued.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are: .
Carrier: Policy Number:
(This section need not be completed if the permit is valued at one hundred dollars($100)or less.)
❑ I certify that In the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisions.
Applicant Signature: Date:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(5100.000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR 0000.INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lic.# Class#
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lenders Name: Lender's Address:
Signature: Date:
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
Busine 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
subj s the applicant toe civil penalty of not more than five hundred dollars($500).):
I,as owner of the property,of my,not
with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:,The Contractors License Law does not apply to an owner of property who builds or Improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.)•
❑ I am exempt under s . � 1 Business and Professions Code for this reason:
Signature: h N>, I . J ' 1
Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet In depth Into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,Califomia Administrative Code).
❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the 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 0 No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the Califomia Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this a plication a ermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes l�No
(Section 65850.2 of the Califomia Govemment Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No
(If"yet 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 scribed property for Ins ectlon u oses.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Signature Of eget Owner Date
And/Or Authorized Applicant Date
CODE I INSPECTION TYPE vacua CODE I INSPECTION TYPE QAIE )NTRM1I
1816 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing 1 T
200 Final Re-Roof 210 Final Electrical ‘-6-07 Ay Ad 09
201 Final Block/Retaining Wall 212 Final Fire Prevention•
J
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
2446-46
s
C, MF CITY OF COSTA MESA 4b IIII _
,s,"1, BUILDING
BUILDING DIVISION 2
I.' ' ' DEVELOPMENT SERVICES DEPARTMENT • PERMIT NUMBER
°• � PERMIT P00-00090
_
(714)754-5273• Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 2476 ELDEN AV Status: ISSUED
Suite No Applied: 02/16/2000
Issued: 02/16/2000
Vicinity:
Parcel Nunmber: 43929111 ISSUED BY: 6/ • ‘
Applicant: MAUZEY, DON W • -
•
Address: 3742 HARDING ST
. Phone: 909-684-6378 ,
RIVERSIDE,CA • Zip: 92506 •
Owner: MAUZEY, DON W -
Addiess ' 3742 HARDING/ST - ' • '
" - - Phone:
•
RIVERSIDE,CA Zip: 92506
Contractor: . . .
'Address: / . / ♦�
ti P . 0414:1
� ��. %
hone:_
. ' !)h, ,
Zip:
License: 9I'
Arch/Eng: '
Address:.$ , . ,
Phone: '
Zip:
•"License:
SCOPE OF PERMIT
2 BATHTUBS,2 TOILTES AND 2 WASHBASINS. B00-00202. -
FEE SUMMARY
AMT. QTYAMT QTY AMT QTY
ISSUE FEE . ' $23.50 . Laundry Tub/Washer $0.00 • 0 Sump Pump $0.00 0
Backflow irrigation ' $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0
Backflow Preventer $0.00 0 P-Trap ' $0.00 0 Trap Primer $0.00 0
Bathtub . $19.60 2 Pressure Regulator $0.00 0 Urinal $0.00 0
Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units $0.00 0 Septic Tank • $0.00 0 Wash Basin $0.00 0
Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $19.60 2
Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0
Drain,Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $19.60 2
Drain,Roof $0.00 0 Shower $0.00 0 Water Heater/vent $0.00 0
Drinking Fountain $0.00 0 Sink, bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0
Expansion Tank $0.00 0 Sink,commercial $0.00 - 0 Water Re-pipe $0.00 0
Gas Earthquake Valve $0.00 0 Sink, Floor $0.00. 0 Water Service $0.00 0
Gas(1-4 outlets) $0.00 0 Sink, kitchen $0.00 0 Water Softener $0.00 0
Gas(Over 4 outlets) $0.00 0 Sink, service/mop $0.00 0 OTHER $0.00
Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00
Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00
Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0
Interceptors(Sand Auto) $0.00 0
TOTAL CALCULATED FEES: $82.30
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.
1 FOR INSPECTIONS CALL: (714)754-5626 O
DECLARATIONS ( ) ( _ )
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations: .
❑ I have and will maintain a certificate of consent to self-Insure for workers'.compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit Is issued.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed if the permit is valued at one hundred dollars($100)or less.)
❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person In any manner so as to become subject to the workers'
compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisions,
Applicant Signature: Date:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,080),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
•
LICENSED CONTRACTORS DECLARATION:
• I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is In lull
force and effect.Lic.a Class#
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lenders Name: Lender's Address:
Signature: Date:
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)
jlicense pursuant to the Contractors-license Laws.).
am exempt under sec. ltd- h Business and Professions Code for this reason:
Signature: r rr� .,.
ic,res: —7—7—,p
Verification of Ownership by(type of document,i.e.-property tax 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,felsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aEEermit 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 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 oT 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
B (If'yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-de ' property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
2C�(MO
nature O Legal r s Dat
AndiOr Authorized Applicant Date
CODE I INSPECTION TYPE PATE INTITIAL$ CODE I INSPECTION TYPE PATE INTTIAL4
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing —0 J I
200 Final Re-Roof • 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
2446.46
%w9 SO CITY OF COSTA MESA W I D
>'4a�� �� BUILDING DIVISION �I\� •
\ PERMIT NUMBER
F I +��a� . d,. ' DEVELOPMENT SERVICES DEPARTMENT
°. "� • PERMIT% M00-00072
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
MECHANICAL PERMIT
Job Address: 2476 ELDEN AV Status: ISSUED
Suite No Applied: 02/16/2000
Issued: 02/16/2000
Vicinity:
Parcel Number: 43929111 •
-
ISSUED BY: OPIC
Applicant: MAUZEY, DON W
-
Address: 3742 HARDING ST
' " Phone: 909-684-6378 , -
RIVERSIDE, CA ; ' Zip: 92506 ,
Owner MAUZEY, DON W -- -",:<- . t-,• - r
Address:''3742HARDING ST - • - . • .
A . • Phone: - -
RIVERSIDE;CA'r " Zip: 92506 '
Contractor: - #1110 ,a
Address: . , w1�
. .Phone' - 2- A '1
• r' ` - Zip. • �' /
- --y. .IF, : '�Liicense: v
/
Arch/Eng: 90'
, Address: - .
•
- Phone: -
- Zip: . ,
..- - License: - /
SCOPE OF PERMIT - -
2 LIGHTS,4 OULETS,4 SWITCHES.
2 BATHROOM FANS, • - --- -
_ ` ' ,
2 BATHTUBS,2 TOILTES AND 2 WASHBASINS. •- . • - ' . .
/ /
•
'FEE SUMMARY
Quantity Quantity
ISSUE FEE $23.50 Repair/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 - • $0.00 0 . ' 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
Ref rig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems
Gas Piping - $0.00 0 - " Up to 3 hp/100 k BTU $0.00 0
Factory Fireplace ' $0.00 0 • 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 $14.50 2 Over 50 hp/Over 1,750 BTU $0.00 0
Appliance $0.00 0 Boilers
Fire Dampers '$0.00 0 Up to 3 hp $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< 10000cfm $0.00 0 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
Floor or Suspend Heater $0.00 0 Investigation Fee $0.00
Plan Check Fee $0.00
•
Reinspection Fee $0.00
• TOTAL CALCULATED FEES $38.00
- - \ -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 inthe expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
6'
DECLARATIONS ( ,JC _1
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations: •
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
O I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are:
Carder: Policy Number:
(This section need not be completed It the permit is valued at one hundred dollars($100)or less.)
o I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisions.
Applicant Signature: Date:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lic.x Class x
Contractors Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lenders Address:
Signature: Date:
1
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).):
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 ownner-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 Licenset'aws.)
I am exempt under sec. "i \/ Business and Professions Code for this reason:
Signature: _ ' A. _� _ � OTO 2— I Le —70 00
n
Owner �erlfied by d' ars license. ❑No er's License Ery�'res' '7—"7^O Y—
Verifi ion of rshipby \ '�/
(type of document,i.e.-properly tax or de
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
O I hereby certify that no excavation five(5)or more feet In depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apEermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Ul Yes LJ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
8 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No
(If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes ❑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 pu oses.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Thi.. I •.--%JA,.. 2--1 70y
nature Of Le I O er(51 ( Date
And/Or Authorized Applicant ` .."—"--Date
CODE S IRSPFCTION TYPE BRIE INTmALS CODE* JNSPECTION TYPE DATE T
1616 Fixed System Final Fire Prevention 206 Final Mechanical 6—sol byLS
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
2446-46
I' n Fs 0 CITY OF COSTA MESA \
'ollallkk) BUILDING DIVISION ` 'V
iD
t-• PERMIT NUMBER
�' ""^' ' DEVELOPMENT SERVICES DEPARTMENT
PERMIT BOO-00202
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 2476 ELDEN AV Status: ISSUED
Suite: Applied: 02/16/2000
Vicinity: Issued: 02/16/2000
Parcel Number: 43929111 Zoning:
Applicant: MAUZEY, DON W ISSUED BY: CIAL
�'_'
Address: 3742 HARDING ST ' '- '
.Phone: 909-684-6378 - .
RIVERSIDE,CA Zip: 92506
Owner MAUZEY, DON W , ' .
Address 3742 HARDING ST -
Phone:
RIVERSIDE,CA- " - Zip: 92506
I.
4' a�
ContI ifractor: - ,1
Address: A1'Q. (k.Phone:- 9
-
' Zip: License: .
-
Arch : ' _ - Eng:
•
Address: - - - _ Address:
' , - Phone: -
Phone:
' ',Zip: /- ` - - , License: License:
SCOPE OF PERMIT.
REMOVE EXIST. BATHROOM AND CONVERT IT TO 2 BATHROOM AND MINOR INTERIOR WORK.
FEE SUMMARY
Plan Check: $54.11 . - - , . , Calc Valuation: $2,500.00
Permit: $83.25 - - _ ; _ Claim Valuation: $2,500.00
SMIP Res: • ' $0.50 •
SMIP Corn: $0.00
Other: $0.00 .
Inspection: $0.00 -
Total: $137.86 • •
PLANNING & ZONING
SETBACKS '
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTES:
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
fora period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626 /
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed if the permit is valued at one hundred dollars($100)or less.)
❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisions. .
Applicant Signature: Dale:
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 DOI ARE(S1oO,o06),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 provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lic.1r Class A
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty-of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business end 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.islicensed 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 sheisexempt 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).):
Vit ,C
ElI,as owner of the property,or my employees with�.wagIes 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.).
slt I am exempt under sec. Business and Professions Code for this reason:
Signature: N®- ' �" - 'eZ00
Owner ID verified by driver's license. j3Cs ❑No per's Linens • Cs ♦- ^0
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,Califomia Administrative Code).
❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management end 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 ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aper-nit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? DU Yes u No
(Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If yes",the facility must meet the requirement of Sections 25534 and 42303 of the Calif omia 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 end 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.
2-I L0 Ita �
�l lure Of a al ner(s) dip
And/Or Authorized Applicant Date
;ODE N INSPECTION TYPE PATE 'JNTITIAI CODE INSPECTION TYPE DATE INTITIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall _ 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy i A.-'S-C)f'y L7V
2446-46
f
iill
lib
4110
c9 CITY OF COSTA MESA
,4y, %` BUILDING DIVISION I PERMIT NUMBER
F' �"^�"w. I - DEVELOPMENT SERVICES DEPARTMENT . A I LA
J PERMIT E00-00122
%aworn"P.
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
ELECTRICAL PERMIT
Job Address: 2476 ELDEN AV Status: ISSUED
Suite No Applied: 02/16/2000
Vicinity: Issued: 02/16/2000
Parcel Nunmber: 43929111
Applicant: MAUZEY, DON W ISSUED BY: i
Address: 3742 HARDING ST
• Phone: 909-684-6378
RIVERSIDE,CA - Zip: 92506
Owner:-' -MAUZEY, DON W ' , - . . - .
Address'., 3742 HARDING ST -
Phone:
, RIVERSIDE,CA " Zip: 92506 4
Ys
Contractor: s� ti,,10.-
Address. /. • 9A1'Q.
•
- i Phone:
. ', Zip:
' License:
SCOPE OF PERMIT
2 LIGHTS,4 OULETS,4 SWITCHES. ' , '
2 BATHROOM FANS, ,
2 BATHTUBS,2 TOILTES AND 2 WASHBASINS. -
FEE SUMMARY
Quantity Quantity
ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0
Temp service test $0.00 Busway/100 ft $0.00 0
Res.a/c package $0.00 - -- Standing Section ' $0.00 0
New Res(1-2 units) $0.00 0 ' ' Misc Electrical Equipment $0.00 0
New Res(3+units) - $0.00 0 . Transformers up to 1 kva/kw $0.00 0
Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0
Lighting Fixts '$2.20 2 up to 50 kva(kw $0.00 0
Recept Outlets $4.40 4 ' ' up to 100 kva/kw $0.00 0
Switches $4.40 4 over 100 kva/kw $0.00 0 .
Non Res Appl _ $0.00 ' 0 Low Voltage Equipment $0.00 0
Res Appl $0.00 0 Low Volt Wiring System!Ckt $0.00 0
Service to 200a $0.00 0 Misc.Conduit $0.00 0 I
Service to 1000a $0.00 0 Misc.Conductor $0.00 0
Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 '
Motors to lhp $0.00 0 Circus(mech ride or lights) $0.00 0
Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0
Motors to 50hp $0.00 0 Fireworks Stand $0.00 0
Motors to 100hp $0.00 0 ' Other Electrical Fee $0.00
Motors over 100hp $0.00 0 '
Communication drops $0.00 0 ' . Investigation Fee $0.00
Sub panel to 200a $0.00 0 Plan Check Fee $0.00
Pole Light Pkg $0.00 0 Reinspection Fee $0.00 '
Sign Circuits $0.00 0
Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $34.50
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 if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
I
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626 /I
DECLARATIONS 1 j
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.
O I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed if the permit is valued at one hundred dollars($100)or less.)
❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisions.
Applicant Signature: Date:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lic.# Class#
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
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(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 thiough,fiis,or(herown 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,.theowner-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 EXCLUSIVELWCONTRACTING 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.).//
490,..7 exempt under sec. • ---_ Business and Professions Code for this reason: f ,
oqr
cgapires:'7-'7—CTT
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑N
(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).
._..--. occupant edopr. ....R_.. age and
materials)?3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management Prevention Program for acutely hazardous materials)?
❑yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑No
future
.-._ ue -_—_r-_ e_ a such
5 Does or will the applicant u present or emebuilding occupant at y other for the work which is the subject age of this application eppeNnit for uconstrubtion or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? LI Yes LJ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code).
._................ .......... ............ . . ............. .........conn ............... -..-....-.._ .,..conn .........--.7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑No
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.
2- Il ono
Signa re' WA Own s) e
And/Or Authorized Applicant Date
CODE r. INSPECTION TYPE DATE INTITIALS CODE, INSPECTION TYP. DATE INTmAL$
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Root 210 Final Electrical
201 Final Block/Retaining Wall - 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
2446-46
6 CITY OF COSTA MESA .
< �9 BUILDING DIVISION •
>:1 „' ;'ll DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
jii . PERMIT
E03-01055
,amm't
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
ELECTRICAL PERMIT
Job Address: 2476 ELDEN AV • Status: ISSUED
Suite No C Applied: 11/10/2003
Vicinity: • Issued: 11/10/2003
Parcel Nunmber: 43929111
Applicant KELLY MAUZEY ISSUED BY: C9213
•
Address: 2191 GLEN HELEN PKY . 7 ' '
Phone: 909-887-1408
SAN BERNARDINO,CA Zip: 92407
Owner ' MAUZEY,"DON W • D
Address ;3742 HARDING ST- " - t
Phone: , � �
RIVERSIDE,CA Zip: 92506 � / �� I
Contractor: . / z. '
Address:
Phone:
Zip: .
License: ' , ,
_. SCOPE OF PERMIT -
' REPLACE 200 AMP SUB-PANEL�FOR UNIT C. 4 .
FEE SUMMARY / -
Quantity • - - - - - Quantity
ISSUE FEE $23.50 - Temp Dist System/'Lighting $0.00 0 '
Temp service test $0.00 Busway/100 ft ' $0.00 0 " '
Res.a/c package $0.00 Standing Section . ' $0.00 0-- " -
New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 .
New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 •
Pool/Spa - $0.00 0 up to 10 kva/kw $0.00 - :0"
Lighting Fixts $0.00 0 ,,r - 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 $0.00 0.
Service to 1000a $0.00 0• Misc.Conductor - $0.00 0
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 . 0 Christmas Tree Stand • • $0.00 - 0
Motors to 50hp $0.00 , 0 Fireworks Stand . $0.00 0
Motors to 100hp '$0.00 0 Other Electrical Fee $0.00
Motors over 100hp $0.00 . 0
Communication drops $0.00 - 0 Investigation Fee $0.00
Sub panel to 200a $30.50 1 Plan Check Fee / $0.00
Pole Light Pkg $0.00 0 Reinspection Fee $0.00
Sign Circuits $0.00 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord.No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or If work Is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result In the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
244846(WOO)
DECLARATIONS 4
'
WORKERS'COMPENSATION DECLARATION:
I hereby affirm und&penalty'Jf perjury one of the following declarations: ' •
0 I have end will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Coda,for the performance of the
work for which this permit is issued.
O I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed it the permit Is valued et one hundred dollars($100)or less.)
.1 certify that in the performance• •• ,• for whic •' •-. . •, rot employ any person in any manner so as to become subject to the workers'
compensation .••v-c•Il . orniaan agree t'>'...i• sho Id become subject to the wo '-5'compensation provisions of Secti 3700 o the Labor Code,I shall forthwith
comply with
Applicant Signature:../4�%si,..,...r.,/
Date //i
T/�
WARNING:FAILURE T• CRE ORKERS'••MP• ATION COVERAGE IS •� AD SHALL SUBJECT AN EMPLOYER TO CRIMI PE � IES AND IL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($l00,000),IN ADDITION TO ' E COST OFCOMPENSAT ',DA S AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECL•-ATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lic.# Class It
Contractors Signature: Dale:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Bust s 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
s acts the applicant to a'civil penalty of not more than five hundred dollars($500).):
• ^ ras 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.
L J7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or Improves thereon,end who does such work
himself or herself or through his or her owri 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 EX IVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors • aw d•- not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursuen . e Contractor cense Laws. .
❑ I am exem`L••er,>/ 4,1“ and Professions Code for this reason:
-Signature:__-/I/����ra• —�_. . .
Expires:- Lem
Verification of Ownership• ••e of document,I.e.-props .x 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,ora volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If en 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 pplication apermil for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes ❑No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
8 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No
8 (If yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF • •••' ., 0 AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correc I -• •• t• co ply with , s•te laws end c' • •- •s-retat • • building construction,and authorize representatives of the City of Costa Mesa to enter upon the
abov"seri w.A.p,'ep f•,; rt?.. ...:dyyossee •• •• •• • •, u• or•low occupancy of any building authorized 4y t ' pp§mit until ti I inspection.
/ t i arture Of Legal Own: / Date
And/Or Authorized Applicant Date
CODE t INSPECTION TYPO PATE ' INTITIALS conF( INSPECTION TYPE DATE INTRiALB
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 '
CITY OF COSTA MESA -
BUILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT RMIT NUMBER
tot itThrl
J1 raI PERMIT
!► B03-00467
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.causDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
BUIJob Address: 2476 ELDEN AV Status: ISSUED
Suite: Applied: 03/24/2003
Vicinity: BACK UNIT ON PROPERTY-UNIT C Issued: 03/24/2003
Parcel Number: 43929111 Zoning:
Applicant: DAVINO, JOHN ISSUED BY: �l% ! i/[i✓��
Address: 7732 TALBERT AV
SUITE A Phone: 714-841-6323
HUNTINGTON BEACH,CA Zip: 92648
Owner MAUZEY, DON W
Address 3742 HARDING ST
• Phone:
RIVERSIDE,CA Zip: 92506
Contractor: QWIK-BILT SERVICES
Address: 7732 TALBERT AV
SUITE A Phone: 714-841-6323
HUNTINGTON BEACH,CA
Zip: 92648 License: 388878 •
Arch : -
- Eng:
Address: Address:
Phone: - - Phone:
Zip: License: - License:
SCOPE OF PERMIT
REPLACE STAIRCASE AT AN EXISTING SECOND STORY DWELLING.LANDING TO REMAIN:STAIRS ARE GOING IN SAME LOCATION AS
BEFORE.
FEE SUMMARY
Plan Check: $41.05 _ Calc Valuation: $1,800.00
Permit: $63.15 Claim Valuation: $1,800.00
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: , $0.00 .
Total: $104.70
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord. No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6/e0)
DECLARATIONS }
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit Is issued.
❑ I have and will maintain workers'compensation insuran required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued.
My workers'compinsatiIns r ce carrier p • number are:
Carrier: vg1 Policy Number:
Is section need not be comp Bred it the permit valued at one hundred dollars($100)or less.)
certify that in the performance of the work��.. Ich this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws• Califor and agred I should become subject to the workers'compensation provisions of Secti 3700 of the Labor Code,I shall forthwith
comply with thee Cto Or 1I1
replicant Signature: .•v/4 .4. a Rocs , Date: 2
WARNING:FAILURE TO-i .GAITERS'COMPENSATION COVERAGE UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL TIES AND CIVI UP TO ONE HUNDRED
THOUSAND DOLLARE($1 ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am lice oder pr slons of C•.. :r'7 O 9(c y�'th Section 7000)of Division 3 of the Business and Profession Code,and myense is in full
force and effect.Lic.a 7 Class a ..sI ry/
Contractors Signature: a , ' Date: q 3
CONSTRUCTION LENDING GENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lenders Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
1 hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business end Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commenting with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.II,however,the building or Improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). •
❑ I.as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
0 I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by 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,faisework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Pventi
reon Program for ac
utely 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 ❑No v
5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this a plIcation appermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? BD Yes LJ No
(Section 65850.2 of the Callfemia Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to he 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 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.
ignature 0 1 Owner(s) 3I 2-(4-10 Date
"1'j0Date
IL
c_And/Or Authorized Applicant Date
CODE f PISPECIION TYPE PAM INTIALS COOS( INSPECTION TYPE PM grttTlALE
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 Well 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site N
204 Final Demolition 250 Final Building/Occupancy `--2-g 47
•
CITY OF COSTA MESA
� BUILDING DIVISION PERMIT NUMBER
r(
'1" 24 I DEVELOPMENT SERVICES DEPARTMENT.
rik�• lt PERMIT MOO-COI
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSA"NIESR,CAI92626
MECHANICAL PERMIT
Job Address: 2476 ELDEN AV Status: ISSUED
Suite No Applied: 04/25/2000
Issued: 04/25/2000
Vicinity: BEHIND GARAGE -Q
Parcel Number: 43929111 ISSUED BY: V 299
Applicant: OWNER-BUILDER
Address:
Phone:
Zip:
Owner: MAUZEY,DON W
Address: 3742 HARDING ST - actS4S)
Phone: (909)684-6378
RIVERSIDE,CA Zip: 925062
•
Cbirb
Contractor OWNER-BUILDER Y 4 .
Address: . 91
Phone:
•
License: 0
, Arch/Eng:
Address:
Phone:
Zip:
License:
SCOPE OF PERMIT
• INSTALL NEW A/C UNIT BEHIND GARAGE FOR EXISTING SFD.
REF:B00-00202 - - -
FEE SUMMARY
Quantity Quantity
ISSUE FEE $23.50 Repair/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 $0.00 0 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 $14.80 1 Domestic Incinerator $0.00 0
Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems
Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0
Factory Fireplace $0.00 0 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 - $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< 10000cfm $0.00 0 - 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
Floor or Suspend Heater $0.00 0 Investigation Fee $0.00
Plan Check Fee $0.00
Reinspection Fee $0.00
TOTAL CALCULATED FEES $38.30
• - COMMENTS/SPECIAL CONDITIONS '
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord.No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not-commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
DECLARATIONS
WORKERS'COMPENSATION DECLARATION: 1
Itlereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are: .
Carrier: Policy Number:
(This section need not be completed if the permit Is valued at one hundred dollars(5100)or less.)
❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisions.
Applicant Signature: Date:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,0011),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 provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lic.a Class 6
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction tending agency for the performance of the work for which this permit Is Issued.(Sec.3097,Civil Cale).
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
Busines 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
subje the applicant to a civil penalty of not more than five hundred dollars(5500).):
‘ y or
I,as owner of the properly;ssio my employees with wages c their sola compensation,WILL DO THE WORK,and the structure is not Intended or offered for sale(Sec.
7044,Business and Professions Code:The Contrectors 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.).
r
❑ I am exam t under sec. Business and Professions Code for this reason:
Signature. ,
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,faisework,or demolition or dismantling thereof,will bo 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 Wit the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the Califomia Health end 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 end 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 0 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 en RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication appermit for such construction or modification
from the South Coast Alr Duality Management District or from any other air pollution control district or agency? Yes LJ 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? ❑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 at of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 No
6 (If yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the Information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials end 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 urposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
�7r�1Qur(s) 4 2 �17oc7
Signature Of Le al Owner(s) ' Date
And/Or Authorized Applicant Date
CODE 4 gISPECIION TYPE PATE MEW CODE( INSPECTION TYPE DAM eJTmALs
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
2448.48
•44�w -
- CITY OF COSTA MESA
p'7f�`4, BUILDING DIVISION v f
i
t' "-"=i' ' DEVELOPMENT SERVICES DEPARTMENT PERMIT MBER
4., PERMIT
`+ORURO 99-01297
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 2476 ELDEN AV Status: ISSUED
Suite: Applied: 08/16/1999
Vicinity: HOUSE&GARAGE Issued: 08/16/1999
Parcel Nunmber: 43929111 Zoning:
Applicant: MAUZEY, DON W ISSUED BY: —4-11)1
Address: 3742 HARDING ST ,- -
- - , - -Phone: (909)684-6178-._?
RIVERSIDE CA .r ir �- k Zip: 92506 /
Owner: MAUZEY,-DON W
-
Address 37ARDNGS /A / - - / ')
V ��
� �
�//42V N A . -Phone_ ' -,_� � N � 1
�JRIVERSIDE\,CA,/ �% • Zip92506 �: C. -7 /7 A5
\
/n/�/ N. %j z \' ,� i/ i AvA
\j : Aato \� i/Contrc ''";„\\;,`,,, � `" i' .` "\
•
',/, _
/Address: 1/4..N...,2, A',��
/ " % Phone: �, ': .(,/� /%, �
/ r7 p J //4/ License:I t
�Zi
i Arch
rr - 6,2_ - Eng: r 1 'r ,\ ,,
A
1 r1ddress: i f' — — - -� / �C-. r Address: i I r_,' \
,
i ,, _ � / / l ' .71_ phone: _ _ _ - `�' /�\ Phone:
r
1 '
, � Zip: %;7t., License:
License: `
•
2 <,--- ' SCOPE OF PERMIT i
1/REROOF-T/O, INSTALL 7?16'"OSB BOARD;;1 LAYER OF 307/FELT AND NEW 25\YEAR COMPOSITION SHINGLE ROOF. 'N
FEE SUMMARY • '
Plan"Check:,' $0.00 . , � Calc Valuation: - ' - 54,800.00
l�,, , Permit`, ,„ $111.25 _. _ 1-- ` - ' 1 ' '-.� Claim Valuation: • • $4,800.00.
SMIP Res: - $0.50 - - - �� ° ,
,ISMIP Com:' , $0.00 �- ,
,' \ 'Other: $0.00
-
' \Inspection:. o� .> $0.00 I
,
-
` v\,Total: $111.75
,V�\' ,
•
y'moi • v .• PLANNING & ZONING':,,. . „
' -
,-
SETBACKS\ // - •- - .
MAIN STRUCTUREFront nt 0 0 Rear, 2-0 - -Left - 0-0 Right -0-0- 2, /
ACCESSORY " Front, 0-0 Rear 0-0 Left 0-0 N Right '0-0
PARKING Existing:"- .0 ' Required: , 6 Proposed: 0 .
NOTES: _ •'
, .
EXPI kE,D° I
Dim
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§ 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
DECLARATIONS - a
WORKERS'COMPENSATION DECLARATION: `
i hereby affirm under penalty of perjury one of the following declarations:
❑ ' I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued. •
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed ll the permit is valued at one hundred dollars($100)or less.)
❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person In any manner so as to become subject to the workers'
compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisions.
Applicant Signature: Date:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(S100,000),IN ADOrTION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is In full
force end effect.Lic.# Class#
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
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
subject the applicant to a civil penalty of not more than five hundred dollars($500).):
ae'n,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the Owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044, Business and Professions
Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: v-LfJ{,.� Date: c3^((o._9C
Owner ID verified by driver's license. ❑Y 1.3 No Driver's License No."' Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation live(5)or more feet in depth Into which a person is required to descend, will be made In connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(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 Wit 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 end 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)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑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 aRermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? j�Yes LJ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any pan 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 ENT19+I cert-under emelt;ot e u that I have read this application and state that the information given is
dY P y �o dry vP
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
ab scribed property for inspection purposes.I agree not to occupy or allow occupancy X411 of anytbuilding authorized by this permit until final inspection.
, +
Signature Legal Own(r(s) Date
f And/Or Authorized Applicant Date
•
CODE I INSPECTIONTYPE PAIL IMO ;NEI INSPECTION TYPE PAg INTITIALS
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 Flre Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Slte
204 Final Demolition 250 Final Building/Occupancy
2446-46
J� CITY OF COSTA MESA . .
,4y' ''., BUILDING DIVISION PERMIT NUMBER
t' `•^' '' DEVELOPMENT SERVICES DEPARTMENT.
4. arica
. PERMIT E00-00378
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
ELECTRICAL PERMIT
Job Address: 2476 ELDEN AV Status: ISSUED
Suite No Applied: 04/25/2000
Vicinity: BEHIND GARAGE Issued: 04/25/2000
•
Parcel Nunmber: 43929111
Applicant: MAUZEY, DON W •
ISSUED BY:
Address: 3742 HARDING ST
Phone:
RIVERSIDE,CA . Zip: 92506
Owner: MAUZEY, DON W
Address 3742 HARDING ST
Phone:
RIVERSIDE,CA Zip: 92506
•
Contractor: OWNER-BUILDER Y
.Ht9 .
Address: . . � ..c
- - Phone: gip.-L"
• . r , Zip:
License: 0
SCOPE OF PERMIT
SUPPLEMENTAL ELECTRICAL PERMIT FOR NEW A/C UNIT.
REF:B00-00202&M00-00171
'FEE SUMMARY' ' . .
• Quantity Quantity
ISSUE FEE $7.25 Temp Dist System/Lighting $0.00 0
Temp service test $0.00 Busway/100 ft $0.00 0
Res.a/c package $54.50 Standing Section $0.00 0
New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0
New Res(34-units) $0.00 0 Transformers up to 1 kva/kw $0.00 0
Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0
Lighting Fixts $0.00 0 up to 50 kva/kw $0.00 0
Recept Outlets $0.00 0 up to 100 kva/kw $0.00 0
Switches $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 $0.00 0
Service to 1000a $0.00 0 Misc.Conductor $0.00 0
Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0
Motors to 1 hp $0.00 0 Circus(mech ride or lights) $0.00 0
Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0
Motors to 50hp $0.00 0 Fireworks Stand $0.00 0
Motors to 100hp $0.00 0 Other Electrical Fee $0.00
Motors over 100hp $0.00 - 0
Communication drops $0.00 0 Investigation Fee - ' $0.00
Sub panel to 200a $0.00 0 _ Plan Check Fee $0.00
Pole Light Pkg $0.00 0 Reinspection Fee $0.00
Sign Circuits $0.00 0
Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $61.75
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 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.
1 FOR INSPECTIONS CALL: (714)7545626
DECLARATIONS • t
Ne
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carder and policy number are: .
Carder: Policy Number:
(This section need not be completed)t the permit Is valued et one hundred dollars($100)or less.)
❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Cade,I shall forthwith
comply with these provisions.
Applicant Signature: Date:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARS($100.O03),IN ADDITION TO THE CAST 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 provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lic.0 Class 0
Contractors Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Namo: Landers 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
subjs.-is-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,end 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 propel 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 properly who builds or Improves thereon, and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws:)`]
❑ I exempt under sec. "' Business and Professions Code for this reason:
Signature' I CLIO. +
' Expires:
Verification of Ownership by(type of document,i.e.-properly tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑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 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 en RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safely Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Cade 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 appermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district Cr agency? fj Yes L i 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 end 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 Cede Section 42303 been made? 0 Yes 0 No
B (if yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized bby this permit until final inspection.
2S- 2000
Signatu Of Legaln (s) Date
And/Or Authorized Applicant Date
CODP I, INSPECTION TYPE Plff. entSkS CODES jNSPECTIONTYPE QAff. EMU
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
244646
Li
43853 }PR 2?-7 PAID
„OO1711 c` *** 1110.11
- COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
A P C TION FOR STRUCTURAL PERMIT
For Applicant
s to Fill
lin�Completely— Use Ink Only RE V V DA i OE(EI DATE ISSUED7
BU
LDING
ADDRESS 24 h F/4sWAi Aug (� /�� /\/i71 /p�/�y/p/
OWNER•] QAJ ij M L1 A.P.NO. 1' 7. 04 I•-r I PT T/7 r
MAIL 241C' €5C3 C BUILDING
ADDRESS 2474, En2.54 AL1CADDRESS ZQ mar) M %EL Ew 3U0CT LCT
BLOCK easy q ry �� eJ9�2
CONSTRUCTION N-W ADD A R REPAIR MOVING DFMOLISH
Pr
LENDER
BRANCH MAI
OWNER se Mi MARS/
ADDRESS e-
pi,
pi, -♦ VALUE o ddb
ARCHITECT �s' TEL. S_
OR ENGINEER ^1 y NO.
Aiy♦ FIRE �_ - )�
ADDRESS ‘V r/NJJV ZONE arz.
GROfU�P J : /
CONTRACTO�\�_\�.
APPROVED DATE ✓�//���
ADDRESS I�l/R�VV►■' • /\ /j
TEL. 2ON ^ INO.OF e� USE OF NEN/ / _ //
CITY NO. / PLANS / BUILOING,f////I-(/f/�/ /L//^///-y`!
F STATE CITY YA DS APPROVED YARDS APP OVER "
gLIC. NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING
Lal SIZE NO.OF BLDGS. • (FROM C/L SJPEET )
o OF LOT 6%; X /4d NOW ON LOT / RONT air FT /•$ If / an _ _J
yUSE OF Ca I/
EXISTING BLDG.FAM,l Lsii 77c ibst 'TS R SIDE c J FT. /./ FT.
cn
F Separate permits are required for L.SIDE /9 I
F ./77/012, FT.
electric,plumbing and heating work. /'/ //
ter] REAR aa) FT.0 FT.
I--, USE OF BUILDING AND WORK TO BE PERFORMED/ DISTANCE BET. BET.MAIN&
c CDcISn2UCr/0/14 biz 'JEW 171117110141-4I, MAIN SLOGS. ACCESS. BLDGS.
.2 J n / VAR.* DATE
Q .DiLI�[( �•y C� D/ (e f�,/ C,U.P.50s APPROVED
7 APPROVE -�/sem) ''')�7
.] ri/Y•('ea)4,7ta7 `�/S - I _FLY ��� DATE ir-6g2-
Lu /1/ [ ���
-
C I hereby acknowledge that I have read this application and state n
X that the above Information is correct and agree to comply with
L all laws regulating building construction, and I shall not employ HOLD FOR SPEC. 51 REQUIREMENT`
Z any person in violation of the workman's compensation laws of
k7 the State of California. 77 - _ D0
I hereby certify that I em properly licensed as a contractor under 3/ SO. FT. J Ttv
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 effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from the provisions of the State of California Business VALUATION PERMIT FEE $ v
and Professions Code,Division 3,Chapter 9. eI�
.PLAN CHECK $ //3
V 1J O{/
QPnateee � $ 4g 9 / /PermItte
i+ / `. U
Authorized Agent
TOTAL PAID S/y 0•7/
O rr
--A'.
�/ 3 4'J� MAY 31-77cAsU,001466 0**'*209.00
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APP IAION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely — Use Ink Only
REC V V DATE RECEIVED DATE ISSUED
BUILDINGn/f7‘ _Loc / -v
ADDRESS //�/,s� (� E/V /V v - n PERMIT NO.
OWNE /W Th vp� �y��Qr�7• t A.P. NO.
MAIL BUILDING 07976 Fib
ADDRESS V 4
v
ADDRESS
TEL. TRACT LOT BLOCK
CITY NO.
CONSTRUCTION hf EW ADD ALTER REPAIR (MOVING DFMOLISH
LENDER
BRANCH OWNER �(/�Do 1Awzgy
ADDRESS �JVALUEI
ARCHITECT TEL. USE DLIan $
OR ENGINEER NO.
FIRE
ADDRESS ZONE TYPE GROUP
APPROVED
CONTRACTOR 0/6 BY DATE
ADDRESS
TEL. ZONE INO.OF USE OF NEW
CITY NO.
PLANS BUILDING
F• STATE CITY YARDS APPROVED YARDS APPROVED
G LIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING
0.1 SIZE NO.OF BLDGS. (FROM C/L STREET)
O. OF LOT NOW ON LOT FRONT FT. FT.
a USE OF
.�., EXISTING BLDG. R.SIDE FT. FT.
rn
F Separate permits are required for L.SIDE FT. FT.
C electric,plumbing and heating work. REAR FT. FT.
iz7 USE OF BUILDING AND WORK TO BE PERFORMED
F DISTANCE BET. BET.MAIN&
Q< MAIN BLOCS. ACCESS.BLDGS.
VAR.# DATE
a C.U.P.# APPROVED
APPROVED
_BY DATE
..1).1
Ui
LW
0 I hereby acknowledge that I have read this application and state n
C$ that the above information is correct and agree to comply with m
L all laws regulating building construction, and I shall not employ
Z any person in violation of the workman's compensation laws of o
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 m
Chapter 9, end that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: —
az
am exempt from the provisions of the State of California Business VALUATION PERMIT FEE $ ��/��_ o
and Professions Code,Division 3,Chapter 9. �b! m
PLAN CHECK $ n
Signature of G
Permittee 5 - TAX S LL
u
U
Authorized Agent TOTAL PAID sign,-
...
4tn244 .
COSTA MESA BUILDING-SAFETY DEPARTMENT - -
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely - Use Ink Only 111���{{L��GG��p
J o .s/ RECE DATE RECEIVED DATE ISSUED
BUILDING 4700 ��.t AV (t�r.r--
ADDRESS C
\A MALI �J� �/��{ /'/�+ PERMIT NO.
OWNER MAO i9 * / A L..G�� /1 A.P.NO:I-/t97' '' "!I!/'�`'. ,:1 i
AMAILDDRESS zf720 EThrs.s Nil yyr'r '4s BUILDING j,__�/�C�� J
CITY46574 ,14 ' et A NOLO QQC TRACT LOR BLOCK
CONSTRUCTION ,y4 NEW ?{ALTER
REPAIR MOVING Donn}LSH
LENDER
BRANCH /� Ur
OWNER
ADDRESS ARCHITECT J�A /� �JJ ^ ,,'`/` ) VALUE aL
OR ENGINEER 4/t�M1IEIZ NO 573111 E� USE I .(/'.00. $
AMe
FIRE -T
ADDRESS ZONE TYPE {r GROUP ge
(tJ�rz�
APPROVED
CONTRACTOR c, 1` BY DATE
ADDRESS P
TEL. ZONE///1 NO.OF USE OF NEE- t�c�"p
CITY NO. /�� PLANS` BUILDING 4h AVL7�
wv F STATE CITY ' YARDS/ APPROVED YARDS APPROVED
VL
g LIC. NO. LIC.NO. MAIN BUILDING 0, ACCESSORY BUILDING
(FROM C/L STRE T)
W SIZE NO.OF BLDGS. �.--��
0., OF LOT &Si l NOW ON LOT __FRONT .3 /FT. FT.
a USE OF / 1-
41
41 EXISTING BLDG. 24€ R.SIDEFT.
4
FSeparate permits are required for L.SIDE i�' FT.
Ll electric,plumbing and heating work. REAR C 0 FT.
W U OF BUI ENG AND vv K TO BE PERFORMED
a TU CO � DISTANCE BET. BET.MAIN&
G 1 ( C5-1 MAIN BLOCS. ACCESS. BLDGS.
all
C.U.P.VAR. I' DATE
C.U. qs APPROVED
.}.7 —$-Y Rir �" DATE cif'.
t 70
W
O. I hereby acknowledge that I have read this application and state in
CC
that the above Information Is correct and agree to comply with m
all laws regulating building construction, end I shall not employ
z any person in violation of the workman's compensation laws of 2
SSW the State of California. • a
I herebycertifythat I amSQ.FT. ry
properly licensed as a contractor under
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR L
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: -
to
am exempt from the provisions of the State of California Business VALUATION PERMIT FEE ` Y
$
and Professions Code, Division 3,Chapter 9. J •'Q Q v+
of
Signature o a $ 50O a s PLAN TAX CHECK S ✓� o
Permittee (,LJI 4.
coU
Authorized Agent TOTAL PAID $ 5e `.
-
•
' COUNTY OF ORANGE
BUILDING DEPT. 'J 4/2? c7;
636 No.Broadway
Permit No •471-7 �:l. Ll.�
Santa Ana,California Application. for Building Permit
Phone:KI 2-6211 • AND FOR A
Certificate of Use and Occupancy
Date De cemkex..11,...1952
•
1. OWNER'S NAME Dike & Colegrove PHONE:..Bea...2225
MAILING ADDRESS 15th....&..Irvine_Sts.. CITY....1 atglort..Beach,...Ca1if...
Name Name Dike & Colegrove
(Architect or Engineer) (Contractor)
, Address Address ....15th. & Irvine Sts,
• City City Nawport..Beaeh.,...flnl if
State State
Lic. No Phone - Lic. No 125202 Phone....B.ec'1....722.5
PROPOSED USE• Residence and attached garag,
2. JOB LOCATION 2476 Elde.n..St.. Caste Mesa, Calif
(House No.) ( amc S c T nor drool Di trier)
Ex0e t'ppg ale 1� ��' also Exerting( � iererom the SE 165' of
3. LEGAL DESCRIPTION: Lot L4 3...:trfl.Gt•.. 0 Block Tract
(Metes and Bounds Description—Use reverse side of form)
' 4. CORNER LOT ( ) INTERIOR LOT ( X ) THROUGH LOT ( ) SLOPE OF LOT ( )
. ° 5. SIZE OF BLDG.:42_X..25 AREA:. 1050 SIZE OF LOT- 65..X..140 AREA- 9100
6. HEIGHT OF BLDG - 14' CEILING HEIGHT- 8!..1! NO. OF STORIES 1
7. NO. FAMILIES One Size of Smallest Bedroom• 10...X..lO.'.6" Size of Kitchen 10..X..10
S. EXTERIOR WALL CONSTRUCTION:fallit&..iStllc00 INTERIOR WALL COVERING neater
(Frame, Stucco, Etc.) (Plaster-Drywall, Etc.)
9. SETBACKS: Front Yard From Center Line of Street 5.0' '
Nearest Side Yard 5 Rear Yard 60 Distance in Feet Between Bldgs. on Same Lot None
10. A COMPLETE PLOT PLAN IS REQUIRED, SHOWING ALL STRUCTURES AND USE OF EACH.
11. For (a) Footing: Width 14" Depth in Ground 12" Width of Wall 6"
Accessory
Bldgs. and
Similar (b) Size of Studs: 2..X...4 Spacing 16" "CC Material of Floor 1✓ood
Structures:
(c) Size of Floor Joists 2.%..6. Spacing 16" "CC
(d) Size of Rafters: 2..X..6 Spacing 24" "CC
12. VALUATION OF PROPOSED WORK: Including all labor, plumbing, electrical wiring, heating, fire sprinklers, painting and
sewage disposal is 7i200 . -
13. I HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE INFORMATION IN THIS
APPLICATION- IS CORRECT AND THAT THE CONSTRU 90, WORKL CONFORM'TO ALL LAWS OF '
THE COUNTY OF ORANGE AND THE STATE OF CALII4. F }.13:1; C J.HE.ETQ. ,
t °"�
Signed
(Owner)
Plans Filed
By
(Authorized Agent)
FOR DEPARTMENTAL USE ONLY
FEES: T _ C KING BY
GROUP... J APPLICATION r HEALTH
Bldg. Permit - $ b 0 �a
Plan Check $ u TYPE 0 es ZONING Z-,------ FIRE
Total $ 3.113 MAP c_ R PLANS AND `I MARSHAL
Receipt No. ��C � ql SPEC'S STATE
Paid to • - ._TiAI- SHEET NO.,..5 CORRECTIONS ENGINEER
Date / a '-/C 5'- VERIFIED CAL
1 t$ 'fl/
'ERMIT lSSldEA)B�YC ZU0.'; %t."�ft-• !{2yQ3
DATE J(7 --i/ — tS13 I• . w..
5 M-8-51 �_� .. - I�
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