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Home My WebLink About2515 ELDEN AVE - Building Permits • • CITY OF COSTA MESA - F�� BUILDING DIVISION ,act DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER 1.1411 • PERMIT J `10een�m �, E05-01266 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa€LfTRICAL PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2515 ELDEN AV Status: ISSUED Suite No B Applied: 12/05/2005 Vicinity: UNIT B Issued: 12/05/2005 Parcel Nunmber: 43917138 Applicant: FAMILIES UNITED NOW LLC „Zi%Nn2 Address: 301 LARKSPUR AV �' Phone: 949-566-0011 ISSUED BY: i /L. CORONA DEL MAR,CA Zip,- -- -92625- - Owner: FAMILIES UNITED NOW LLC ; . . - Address 2515 ELDEN AV „ '' - _ . Phone:-949-566-0011 ' : - - , COSTA MESA;CA ,..--<?--; Zip:'`_,,92627 - - " ' Contractor `. OWNER,BUILDER ' � ' Address « Phone: - - - - Zip: - - - License:(m000 • • i, ._ :_ SCOPE OF PERMIT ' } • INSTALLATION OF A NEFAU.IN AN'EXISTING SFD(REPLACEA WALL FURNACE). W . . 1<MOTORTO 10 HP 7, " NO OTHER WORK AUTHORIZED WITH-THIS PERMIT: r.. -:FEESUMMARY �;k:<• . • " �� - • : i Quantity _-- f: Quantity I ISSUE FEE $23.50 :-'' Temp Dist System:I Lighting -, -.$0.00 0 - - • Temp service test , , $0.00 - , _, . Busway/10011' $0.00 0£ - ' Res.a/c package $0.00 •' " - .. Standing Sec -tion New Res(1-2 units) $0.00 ' 0 Misc Electrical Equipment New Res(3+units) „ $0.00 0 Transformers up,to 1 kva/kw , $0.00 ;%0 0 `°-' up td-10 kva/kw $0.00 0 Lighting Fixts= =y $0.00" 0 - up to 50 kva/kw 1 $0.00 0 ��``�, . Recept Outlets. .1+"--10a0_" "( 0 up to 100 kva/kw -$0 00 0 `�' " _ Switches _$0.00. , 0 " ° 'o':a. over 100 kva/kw Non Res Appl $0.00,x, 0 *--,..(../•••-c'., ? .'Low Voltage Equipment $0,00,- 0. Res Appl • $0.00 ' 0 s Low Volt Winng System/Ckt^s;-'-$0.00 0 Service to 200a ^.^ _$0.00 0 -f:Mico.Condmt ; g .. $000,- 0 Service to 1000a . -',$0.00 0 ) - : Misc.Conductor $0.004. ' 0 ,r ', Service over 1000a „-$0.00 , :-o22,.:,.,?:.- z e ""Circus(gen or ride) ;--,.. �, $0.00" 0 Motors to 1hp $0.00 - '0,:,:-_-,'....,3 •Circus(mach ride:or:lights) `$0.00 0 Motors to 10h `' p +.,;' -$12.30 1 Christmas TreeStantl „ ` $0:00 0'.` Motors to 50hp 3^$0.00 ' r` :.-0-,�<- - . . .FireworksSttand - -$0.00 ` 0' Motors to 100hp -�`$0.00, ' 0.^- ':-,c, �� Other Electrical.Fee _ , $0.00; Motors over 100hp $0.00'.', '0 v a. '--.k s',,., Communication drops $0.00- «� 0 '" ` -ir Investigation Fee- ,' $0.00 Sub panel to 200a $0.00 > 0-;,... ._ Lt'`..-:--Plan Check Fee _ - $0.00 Pole Light Pkg $0.00 0 :- « Reinspection Fee"- - $0.00 Sign Circuits $0.00 0 _ ":;,1,-,"...-1,;:- .....""`- Temp Pwr Pole $0.00 0 ''" --TOTAL-CALCULATED FEES $35.80 Intermed Pole $0.00 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92.28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days,or If work is suspended or abandoned for a period of 180 days. • INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) • DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: • ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ 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: Cartier: Policy Number: (This section need not be completed it 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 RNES 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 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.» Class H Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: _ Lender's Address: I 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 si ned 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 sub' is the applicant to a civil penalty of not more than five hundred dollars($500).): Cr,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 whb 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.). .j ❑ 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 em exempt u r sec. Business and Professions Code for this reason: Owner ID verified by driver's license. Yes 0 No fDdvere'UCens9,No. ,-„. (^'EzplreS:-71,1 S-of Verification of Ownership by(type of doc ment,i.e.-property tax bill or deed):' DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet In depth Into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap!3.2,Grp 2,Art 2,Sec. 341,Title 8,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). I 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 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. I 4 If an RMPP Is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑No j _i........._.... 5 Does or will the oast Air or(Duality Mn building occupant at other for the work which is the or age of this application aPPermit for such/construction or modification from the South Coast Air Oualiry Management District or from any other air pollution control district or agency? �Yes LJ No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 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 Califomla Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health end Safety Code Section 42303 been made? ❑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 COMPUANCE AND AUTHORD'ATION 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-desc' ed property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. /a Signature Of Legal Owner(s) Date( And/OreAuthorized'Apptrcant Date coos f INSPECTION TYPE PATE INTmAL$ CODE! INSPECTION TYPE I all ltd 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1268 Pool Spa Final 208 Final Plumbing / 200 Final Re-Roof 210 Final Electrical I / t'.6 „Etat: 201 Final Block/Retaining Wall 212 Final Fire Prevention I � 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy ' .k.„„ CITY OF COSTA MESA 4 . ` BUILDING DIVISION ). .` ,.,1 DEVELOPMENT SERVICES DEPARTMENT P IT NUMBER F 1 W..', r PERMIT 5 I 05-00692 -"lbownso de' (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 2515 ELDEN AV Status: ISSUED Suite No B Applied: 12/05/2005 Issued: 12/05/2005 Vicinity: UNIT B e Parcel Number: 43917138 �j� !�= ISSUED BY: .%///_ Applicant: FAMILIES UNITED NOW LLCryt Address: 301 LARKSPUR AV , Phone: 949-566-0011- - • • CORONA DEL MAR,CA Zip: 92625 Owner: FAMILIES UNITED NOW LLC Address: 2515 ELDEN AV .. , - - Phone 949-566-0011 , COSTA MESA,CA -- Zip: 92627 Contractor OWNER-BUILDER Address: " ' Phone: -, Zip: _ ,License:000000 - SCOPE OF PERMIT . - • INSTALLATION OF A NEW FAU IN AN EXISTING SFD(REPLACE A WALL FURNACE). 1 INST FAU . . 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 ❑ 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 et one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shell not employ any person In any manner so 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 those provisions, Applicant Signature: Date: WARNING:FAILURE TO SECURE wocacRS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,0X),IN ADWT1ON TO THE COST OF SENSATION,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(commenting with Section 7000)of Division 3 of the Business and Professions Code,and my license Is In full force and effect.Uc.a Class p 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 e signed statement that he or she is licensed pursuant to the provisions of the Contractors Ucense Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business nd Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit sub' 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 Ucense Law does not apply to an owner of property who builds or Improves thereon,and who does such work himself or herself or through his or her 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 exam nder sec. Business and Professions Code for this reason: .� Signature:— fr / LUala:s 12- d " 01 Owner ID verified by drivers license. ,.gYes 0 No Driyeriucense.No,-- Expire-RD-7-1 5--›+' 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,Califomla Administrative Code). ❑ As owner-builder,1 will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous materiel? 0 Yes 0 No (Section 25505 of the Califomla Health and Safely Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑No (Section 25533 of the Califomla 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 ❑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 appernit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? D Yes 101 No (Section 85850.2 of the Calitomia Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the fatality to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above Is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: • CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under 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-descr property for inspectio rpesertagree not to occupy or allow occupancy of any building authorized by this permit until final ins ction. SignatureO6LegalOwner(s)""—"- D� ate , And/Or Authorized Applicant Date 600E I, INSPECTION TYPE PATE EMU yeDE( INSPEC11ONTYPE ge dill egf 1616 Fixed System Final Fire Prevention 206 Final Mechanical / 'PP 1266 Pool Spa Final 208 Final Plumbing `- a 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 9 CITY OF COSTA MESA 4 BUILDING DIVISION ). rl.' ,� DEVELOPMENT SERVICES DEPARTMENT PER NUMBER PERMIT `fto.mm 05-01267 (714)754-5273 • Fax(714)754-4856 • www.ci.costa•mesagt fTRICAL PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2515 ELDEN AV Status: ISSUED Suite No C Applied: 12/05/2005 Vicinity: UNIT C Issued: 12/05/2005 Parcel Nunmber: 43917138 �� /� Applicant: FAMILIES UNITED NOW LLC , ..4 %&2'�' lc Address: 301 LARKSPUR AV Phone: 949-566-0011 ISSUED BY: Ss CORONA DEL MAR,CA ,Zip 92625 _ Owner FAMILIES UNITED-NOW'LLC - Address 2515 ELDEN AV- - ' - Phone:-949-566-0011 . - COSTA MESA;CA, �A, r . 'Zip: "' 92627 - -• , \' Contractor2. :`, OWNER-BUILDER Address: ' Phone: ' .. . .1- Zip: - . ' ,-' ,License::0000002.., .�_ • Y - ".;� SCOPE OF PERMIT UNIT CI .. , ; 4.:; , INSTALLATION OF A NEW FAU IN AN EXISTING SFD(REPLACE A WALL'FURNACE) j'3.',,;', 1'.MOTOR TO 10 HP,t' ; - = ''� • NO OTHER WORK AUTHORIZED WITH THIS:PERMIT: .. ` . ' FEE SUMMARY 'Quantity Quantity, ; ISSUE FEE $23.50h•;.---' , J'" -Temp Dist System%Lighting-, $0.00 0 - `' : Temp service test :.,,L,,, `$0 00 :Busway/,100 ft" 7 ""_i,� c$0.00. 0>s':' - Res.a/c package t ` $0.00 -_` -: ^ - • , Standing•Section 4 $0.00 - 0 . - t New Res(1-2 units) .. $0.00 -.- _ • 0 Misc Electrical Equipment $0.00 0 . - New Res(3+units) $0.00 0 Transformersupto 1 kva/kw $0.00 .-0 Pool/Spa '' /7, $0.00 0 - up to 10kva/kw $0.00 0' Lighting Fixts• . ' $0.00 0 _ up to 50 kva/kw $0.00 ,- 0 ; Recept Outlets $0.00 '( 0 ..i up to 100 kva/kw $000: - 0 . Switches . X. ` .$0•.00 _ 0 `s'y� � " -,over 100 kva/kw Non Res Apo!' $0.00 y 0 »", s �' .Low Voltage Equipment $0.00_' 0° -Res Appl $0'.00 0 .,e:: x ;Low you wiring system/Ckt gr'.-,$0:00 0•;' ' Service to 200a ,. �,,4$0.00 0 % Mist.Conduit 4ir-' $0'00 0 Service to 1000a o $0.00 :g 0 '., Misc.Conductor , '$0 00 , 0 Service over 1000a x"$0.00,-_ '''„:0:`,-.:.. ...":54:,�` ,„7,_.;. . . Circus(gen or.ride),,i.m ..r ,.$0.00 0 .. Motors to lhp '?-.'. $0.00• - 0•'....;,':....:..,;;7„--- =Circus(meth ride or.lights) - $0.00;" 0.. ",; Motors to 10hp -- $12 30 1 ` k ` `Christmas Tree1Stand -. $0.00' -0` '4 Motors to 50hp ',:•$0.00 *, .:"...4);','",-- - -.Fireworks Stand �. , =$0.00 •:`0 OtherFee Motors to 100hp ' 1$000 ) 0'`�' _ Electrical .i. "...2, $0.00': Motors over 100hp $0 00' ''0 . .. 1 s. , ' Communication drops $000`t.: 20 F" ;t ,Investigation Fee , $0.00 Sub panel to 200a $0.00 0; , '..Plan Check Fee ` '. • $0.00 Pole Light Pkg $0.00 4.''‘O.,"2-,-",-,--- " Reinspection Fee's%` $0.00 Sign Circuits $0.00 _ % . " ""�-�� "• "•�' .. Temp Pwr Pole $0.00 0 "-----TOTAL CALCULATED FEES $35.80 Intermed Pole $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 244646(8/00) . DECLARATIONS WORKERS'COMPENSATION DECLARATION: • I hereby affirm under penalty of perjury one of the following declarations: I ❑ I have and maintaina is issued.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 15 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.) LE D.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. Appkeant'Signetu C Darr,. WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES 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 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.Lie.N Class N Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,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 s reed 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 Bush 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 su cts the applicant to a civil penalty of not more than five hundred dollars($500).): _ 1,as owner of the properly,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such Improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the properly,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)1 license pursuant to the Contractors License Laws.). ❑ I am exemp er sec. Business and Professions Code for this reason: signature:— - — CDat 1.2 - 8--=/ OwTh v. 8- Ownr ID vedhed by driver's license. 0 No Ddvv�ucense.Nor—Qw1S 8❑30 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 Coda). ❑ 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: p 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? ❑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 an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If 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 application apermit for such construction or modification • from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes ID No (Section 65850.2 of the Califomia Government Code requires that the requested Information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia 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 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-desc'••d property for Inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final ins,peEtlon. la ...-c>ro.1 Signature Of Legal Owner(s) Date (Amf(DrAuthorized Applicant y'Dale7 goer/, INSPECTNONTYPE 2TE iffl ;ODE if INSPECTION TYPE 26TE UMW 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electricalb 201 Final Block/Retaining Wall 212 Final Fire Prevention P 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 1. 204 Final Demolition 250 . Final Building/Occupancy p • ' CITY OF COSTA MESA 4 BUILDING DIVISION Y %� ,•' ,� DEVELOPMENT SERVICES DEPARTMENT P MIT NUMBER er4 • PERMIT M05-00693 tb4 Nanoo.44 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca,us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 2515 ELDEN AV Status: ISSUED Suite No C Applied: 12/05/2005 Issued: 12/05/2005 Vicinity: UNIT C • Parcel Number: 43917138 ISSUED BY: � _� Applicant: FAMILIES UNITED NOW LLC Address: 301 LARKSPUR AV - ; "-`� Pho 94956 0011 ..:i CORONA DEL MAR CA :" Zip:. 92625 Owner FAMILIES UNITED NO_W LLC , Address: 2515 ELDEN.,,,-r, ' „ '^ '• • • Phone "949-5664:1011 COSTAMESA CA t �€x4 "- •Zip: 92627' ` • Contractor " OWNER BUILDER • Address .' Phone: Zip: License 000000 `- • ' , SCOPE OF PERMIT,, INSTALLATION OF A NEW FAU IN AN EXISTING SFD(REPLACE A WALL FURNACE) 1 INST EAU> 100K BTU._ �, '* y NO OTHER WORK AUTHORIZED WITH-THIS PERMIT::: .„ s ',0 FEE,SUMMARY YCY'IItt. � `E „7x, Quantity r- q - f ' Qua;ntity ISSUE FEE " $23.50 -Repair/Alt Absorbtion Unit . $000 0 Inst FAU<100 k BTU ,i$0001'0 t. , '`' ,.Repa€r!AIC Refngerat€on Urid $0.00 j 0 Inst FAU>100 k BTU 'Act -1,$18•20 1 - I ,cVentillation Systee- :., �° $0.00 0 Repair/Alt,Coolmg/Heat $0.09,c;ty 0 . Evaporative Coolerm -' :$0:00 0 zz Inst/Rep Recess Wall Htr=" 0 Commercial Incinerator �-- ".0;0 - rx $0.00' 0;, Refrig Sys �` <100 k BTUbe$0.00 m 0 DoesticIncinerator - Refrig Sys>100 k BTU - "$0.00'. 0 Compressors/Absorption Systems - dy. -_ Gas Piping t . ` $0`.001 0 Up l0 3 hp/100 k BTU ' 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 A $0.00,4 0 VAV Box ''• �' $0.00€ 0 s�- 30 To 50 hp/-1 1,750,KBTU BTU F. $0.00/` 0 Vent Fan/Single Duct $0.00 0 - ' fe Over 50 hp/Over 1 750 BTU 4 $0.00 0 Appliance � $0.00 0 Al 3 Boilersc. • Fire Dampers \ =, '� $0.00 0��c `��g 0 �� Up to 3 hp - y,.r = ?$0.00 0 Smoke Dampers F $0.00 0 it -33• To 15 hp ° .) , ' z°$0.00 0 Inst or Relocate Appl Vent% x`$0.00 0 „ a`15 to 30 h . : � p _ ..,, $0.00 0 Air Handlers< 10000cfm < '• $0.00 0 ” � „„M30 to 50 hoc.— t = ' > $0.00 0 Air Handlers> 10000cfm $0.00 0 ' ' .3-0,...0":50- ver 50 hp " -- $0.00 0 Floor Furnace $0.00 0 � .Other Mechanical Fee Z`" Floor or Suspend Heater •C,$0 00� 0 ��' x �' Investigation Fee. $0.00 a ` Plan Check Fee ss,:� $0.00 Reinspection Fee"fl $0.00 * =TOTAL CALCULATED FEES $41.70 COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§1, 12.21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 244&-45(ano) DECLARATIONS " WORKERS'COMPENSATION DECLARATION: • • I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and this ea 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 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 UNIAWFUL AND SWILL 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,end my license is in full force and effect.Lic.# Class# Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: - ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued.(Sec.3097,Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I em 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 'Professions Code)or that he or she is exempt therefrom end the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit sub) the applicant to a civil penalty of not more than five hundred dollars($500).): V�YI,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 properly who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt u c. Business and Professions Code for this reason: Slgnetur - {Dale-- %.1 - ' - L7c Owner ID verified by driver 'cense. es 0 No Ddverstdcense No- c - '1_ -4 Verification of Ownershi y(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). ....._...._Do __.._ _..__.__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 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 ❑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 end Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication a.aEermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes jJ No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No I (If yes-,the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescnbed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No _li_._ —__ _ _ _.._............__...._._......__._....._...__...__ _._ -__._ B (If"yes",attach certificate of-Complianceofrom 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 lgiven is correct. I a ree 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- 'bed property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owner(s) Date And/or Authorized Applicant cOat7 CODE IffSPEFixed System gdIli USImELS 206 INSPEFinal Mechanical 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 .Y-iitt;4,, CITY OF COSTA MESA <tv - BUILD2NG tIVISION }• ,,,,, DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER F t 0 PERMIT al 1 T.I. 64 605-01019 (714)754-5273 • Fax(714)754-4856 • www.cLcosta-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 2515 ELDEN AV Status: ISSUED Suite: Applied: 06/20/2005 Vicinity: REAR OF BUILDING Issued: 07/20/2005 Primary Occ: R1 Type of Construction: V-N Parcel Number: 43917138 Zoning: Applicant: TIM DOSS - - - , ISSUED BY: PAD Address: • . - - Phone: 714-728-7284 - Zip: Owner: FAMILIES-UNITED NOW LLC - -- - - _ -- - - Address /2515 ELDEN AV V - - - _" - - - /, -, Phone: 949-566-0011. - , /COSTA MESA;CA•! j Zip: 92627 - Contractor: Address: / A , / r' ' V�/-�� 44Phone: A - . Zip: - `,License:.- . Arch : ' TIM DOSSEng: Address: ,'5154 SIERRA RD '' A / ' - ., - -• , Address:: .• - Phone: 714-728-7284 , .1 Phone: SAN BERNARDINO,CA ' Zip: 92407 A/ License: C23447 `V \ License: i /" - i'^;;' -'--;f -'/ ' ;SCOPE OFPERMIT.-, r,:7 ,�i CONSTRUCT PARAPET AT REAR OF BUILDING AND INSTALL HVAC ROOFMOUNTED-EQUPMENT AND EQUPMENT SCREENS ON AN EXISTING 2 STORY APARMENT BUILDING'ALSO INCLUDES 5 NEW ROOF SCUPPERS.FOR DRAINAGE.. - - FEE SUMMARY Plan Check: $72.31Calc Valuation: $5,000.00 Permit: $111.25 - Claim Valuation: , $5,000.00 \SMIP Res: ,, $0.00 SMTP-Com:,, - $1.05 I Vy,', Other: \ \$0.00 Inspection: $0.00 ;;r Vk\\:- .,r- . .. ; Total: $1') ' ''L —'' vv\A c/7/ ,< , - - PLANNING &ZONING �� ✓ - /' SETBACKS\'�\ � , MAIN STRUCTURE.Front. 00.0 ,/,,r; r-Rear 0-0 - Lei- 0-0 -Right 0-0 - ACCESSORY Front-.6-ch. C'- t Rear' �0-'0 1,Left - . 0-0" Right .0-0 / ' - - H - PARKING Existin : 0 -Required: 0 / ,`, .Proposed:' 0 1 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2448-46 WOO) ____.----- -- DECLARATIONS WORKERS'COMPENSATION DECLARATION: I I hereby affirm under penalty of perjury one of the following declarations: 1 7 o I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. 1 ❑ 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: I (This section need not be completed it the permit Is valued at one hundred dollars($100)or less.) ':-$,ylceNfy 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,an. ..re: that ill should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shalllforthwith comply with thes: . . 'sions. --dppliraM'.B!Qnawra: Ata- - -' - - ate:-_..,._r `j- �G -f J 1 ‘WARNING,FAILURE TO SECURE W•- E- '•• PENSATION COVERAGE IS LAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN-••m• r.THE COST OF COMPENt5AtC• ,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.N Class 4 Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of DMsidn 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 far 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.). • • 0 as owner of the properly,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Prof Ions 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 Business and Professions Code for this reason: I ' r. ��vZ Date: '7—, 20 —051 Owner ID vedfi by drirvve license. ❑Yes dig No s ticense'N—o ,_ E—ires: = Lflc 'I Verification of nership by(type of document,i.e.-property tax bill or deed): I DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,Califomla 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 hiazardous 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 feel 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). 1 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 1 (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 Cade been fully complied with? 0 Yes 0 No 1 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? 0 Yes I�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 California Health and Safety Code). 7 If a permit from the South Coast Air Duality Management District or other air pollution control district or agency Is required for the work which Is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPUANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given Is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described properly for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. I Ignature'O ga OwOar(s(� ,� Date c �Ahd7 r Authorized A{ ilicant�� -Date CODE I INSPECTIO TYPE QM E I om& CODE! tHPECTWN TYPE l PATE ILLS 1616 Fixed System Final Fire Prevention 206 Final Mechanical I 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 I 203 Final Sign 222 Final Site � 204 Final Demolition 250 Final Building/Occupancy I-3'0`L 'd` 7 CITY ACOSTA MESA BUILDING DIVISION r , DEVELOPMENT SERVICES DEPARTMENT PERMIT N MBER • PERMIT BO -02060 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 2515 ELDEN AV Status: ISSUED Suite: D Applied: 12/07/2004 Vicinity: Issued: 12/07/2004 Parcel Number: 43917138 Zoning: ry Applicant: GLENN SALSBURY ISSUED BY: � // Address: 301 LARKSPUR AV Phone: 949-566-0011 CORONA DEL MAR,CA Zip: 92625 Owner: FAMILIES UNITED NOW LLC Address 2515 ELDEN AV • Phone: 949-566-0011 COSTA MESA,CA Zip: 92627 -,Contractor: OWNER-BUILDER Address: Phone: • Zip: License: 000000 Arch : Eng: Address: • Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT REMOVE ALL CABINTRY,SINKS,DRAINS AND CAP GAS LINE IN ORDER TO RETURN UNIT D TO ITS ORIGINAL STATE. CONVERT EXISTING KITCHEN AREA BACK TO A LIVING/RECREATION ROOM AND ELIMINATE UNIT D AS A SEPARATE UNIT. FEE SUMMARY . Plan Check: $0.00 Calc Valuation: $100.00 • Permit: $23.50 Claim Valuation: $100.00 SMIP Res: $0.50 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $24.00 " 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 Califomla statutes and related regulations.(Ord.No.92.28,§1, 12.21-92) EXPIRATION: This permit shall automatically expire and become void II 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.aII- requlred Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration ' . mil. FOR INSPECTIONS CALL: (714)754-5826 • 244648(600) DECLARATIONS r? WORKERS'COMPENSATION DECLARATION: • I hereby affirm under penalty of perjury one of the following declarations: : I ❑ I have and will maintain a certificate of consent to 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. 0 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 tion 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 C rnia,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 pro ' ns. _ Applicant Signature: Date: / -'7' -4 WARNING:FAILURE TO SECURE W ERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN ADDI1ON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3700 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!liens is in full force and effect.Lie.if Class a Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: • OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a s ed 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 Busin and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit sub' is 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) Cense pursuant to the Contractors License . .. Vam exem' )nder se• Business and Professions Code for this reason: Signature: /t Date: 1.2 4 Owner ID verified by d.•ers license. IIIYes ❑No Drivers License No. . Expires:7 Verification of Owne hip by(type of doc int,I.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY P RMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: I HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I 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 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 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 akermit 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 U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No I (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I a e 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-d ad props for i action purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Applicant ' Da Signature Of Legal Owner(s) Date And/Or Authorized Applicant Date BODE E PISPECTION TYPE PAIS =ALE COPSE INSPECTION TYPES PAIS IIl®EL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing ' 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place ' 220 Final Planning Approval 203 Final Sign 222 Final Site �'1�_ 204 Final Demolition •' 250 Final Buuding/Occupancy '-lOr�-W � ria,, CITY OF COSTA MESA oq. BUILDING DIVISION f I I DEVELOPMENT SERVICES DEPARTMENT PERMIT N BER 4 PERMIT .1EO - 278 tboumm (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 2515 ELDEN AV Status: ISSUED Suite No D Applied: 12/07/2004 Vicinity: Issued: 12/07/2004 Parcel Nunmber: 43917138 a Applicant GLENN SALSBURY ISSUED BY: Address: 301 LARKSPUR AV ' Phone: 949-566-0011 - CORONA DEL MAR,CA • . Zip: 92625 , Owner FAMILIES UNITED NOW LLC ' Address 2515 ELDEN AV - Phone: 949-566-0011 COSTA MESA,CA Zip: 92627 Contractor: OWNER-BUILDER Address: . Phone: Zip: License: 000000 SCOPE OF PERMIT REMOVE ALL CABINTRY,SINKS,DRAINS AND CAP.GAS LINE IN ORDER TO RETURN UNIT D TO ITS ORIGINAL STATE.CONVERT EXISTING KITCHEN AREA BACK TO A LIVING/RECREATION ROOM'AND ELIMINATE UNIT D AS A SEPARATE UNIT.REF.;B04-02060 ELECTRICAL TO INCLUDE:LEGALIZE 2 OUTLETS AND 1 LIGHT FIXTURE. 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 upto1 kva/kw $0.00 0 Pool/Spa $0.00 _ 0, - up to 10 kva/k)ry -_ . $0.00 ' 0 ,. Lighting Fixts $1.10 1 up to 50 kva/kw $0.00 0 , Recept Outlets ,/,/,, $2.20 2 -, up to 100 kva/kw - --$0.00 0 • _ Switches $0.00 '0 . over 100 kva/kw . $0.000' - Non Res Appl V, v $0.00 -. - ;_0', -V ,Low Equipment - . $0.00 v „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 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 applic codes, and all required inspections and final approval must be obtained. Failure to obtain Inspections and final approval will result In the expir o of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(WOO) . • DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: • ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided far by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is IssUed. My workers'compensation Insurance carrier and policy number are: Carrier: • Policy Number: (_Thhiis�seCflon need not be completed if the permit Is valued of one hundred dollars($100)or less.) 13 I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so es to become subject to the workers' compensation laws of fomia,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 ions. / Applicant Signature: Date: 1 -1-" 2 0 WARNING:FAILURE TO SECURE WO RS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN DITION 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# I 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 applicaht for a permit subjearhe 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.). ' ' '/ O I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions e: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 cont i ctor(s) Icense pursuant to the Contractors License Laws.). I am exe under sec Business and Professions Code for this reason: Signature: / Expires: 7-I2 Verification of Ownership by(type of docu S.t,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PE-, IT 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? 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 hazardouslmaterials)? ❑yes ❑No (Section 25534 of the California Health and Safety Coda 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 I 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application akermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits)., 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Cade). 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 i 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 c'yordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above- 'bed prop y for inspection pu .I agree not to occupy or allow occupancy of any building authorized by this permit until fi`al inspection. Signature Of Legal Owner(s) Date And/Or Authorized Applicant Date CODE• INSPECTION TYPE 17AIE INIIDAL5 CODE e INSPECTION TYPE PATE mama 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Firtal 208 Final Plumbing 1 . 200 Final Re-Roof 210 Final Electrical /'l rias_ 201 Final Block/Retaining Wall 212 Final Fire Prevention I 202 Final Factory Fire Place - . • 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition • : . 250 Final Building/Occupancy • I • CITY OF COSTA MESA• BUILDING DIVISION F , PERMIT NUMBER ,, I DEVELOPMENT SERVICES DEPARTMENT ta PERMIT flig • VP04-00838 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 2515 ELDEN AV Status: ISSUED Suite No D Applied: 12/07/2004 Issued: 12/07/2004 Vicinity: /4/ / ISSUED BY: I_I Parcel Nunmber: 43917138 Applicant: GLENN SALSBURY Address: 301 LARKSPUR AV- - ,. Phone: 949-566-0011 CORONA DEL MAR,CA Zip: 92625 Owner: FAMILIES UNITED NOW LLC • Address 2515 ELDEN AV Phone: 949-566-0011 COSTA MESA,CA Zip: 92627 Contractor: ' OWNER-BUILDER • Address: • Phone: Zip: License: 000000 Arch / Eng : - - . - - Address: _ - - ' - - • - • Phone: - Zip: - . License: ' SCOPE OF PERMIT REMOVE ALL CABINTRY,SINKS,DRAINS AND CAP GAS LINE IN-ORDER TO RETURN UNIT D TO ITS ORIGINAL STATE.CONVERT EXISTING KITCHEN AREA BACK TOA LIVING/RECREATION ROOM AND ' , ELIMINATE UNIT D AS A SEPARATE UNIT. REF.:.804.02060. • PLUMBING TO INCLUDE:CAP DRAIN AND WATER SERVICE. _ , FEE SUMMARY AMT QTY ' AMT QTY - ' AMT QTY ISSUE FEE $23.50 .Laundry Tub/Washer $0.00 0 Sump Pump 7 $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 , $0.00 0 " 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 $0.00 0 Drain, Floor $0.00 0 -Sewer Connect $0.00 0 - Waste and Vent System $0.00 0 Drain,Rainwater $0.00 0 'Sewer Private Line , $0.00 0 Water Closet(Toilet) $0.00 0 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 abandons 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 applicabl , and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of is permit. FOR INSPECTIONS CALL: (714)754-5626 244646 woo) • 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: Carder: .-------- Policy Number: , (This tion need not be completed ll the permit is valued at one hundred dollars($100)or less.) ,.I edify that in the performance of the work for which this perm' ssued,I shall not employ any person In any manner so as to become subject to the workers' ompensatlon laws of Calif a,and a ree that If I sh come subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provlsl I -ignewre:..—r-v" IDate: 1 Iascr- 0'f i Wl. : vitt URE TO SECURE WORKE COMPENSATION COVERAGE IS UNLAWFUL AND SWILL SUBJECT AN EMPOYL ER TO CRIMINAL PENALTIES AND OWL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADD ON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. I LICENSED CONTRACTORS DECLARATION: , I hereby affirm that I em 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.Llc.k Class 4 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: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit sssuubj s 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.). ' j ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions C r•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 contiactor(s) ininse pursuant to the Contractors License Laws.). andexempt ur,: sec. Business and Professions Code for this reason: Lignanire•,w""' . - Ex fires:._- c.C�Y' Verification of Owners Ip by(type of d.um.nt,i.e.-property lax bill or eetl): i DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: i ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Gni 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. I Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 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 I (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 then a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). I 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 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 lime 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 filinglwith the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. I 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No I 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes IJ No I (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits): 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No , (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 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: l CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have reed this application and state that the information given is correct. I agree 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-desc. property for i spection purposes.I 'not to occupy or allow occupancy of any building authorized by this permit until fi0a1 inssppe Ion. itra9YCegaYOwner( , Dete ..-4, , And/Or Authorized Applicant Date • CODE t INSPECTION TYPE PATE MALS CODEC gISPEC1lON TYPE PATE ! Its 1616 Fixed System Final Fire Prevention 206 Final Mechanical _ 1266 Pool Spa Final 208 Final Plumbing j—I$-a) r I 200 Final Re-Roof 210 Final Electrical I 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place • 220 Final Planning Approval I 203 Final Sign 222 Final Site • 204 Final Demolition • • 250 Final Building/Occupancy I CITY OF COSTA MESA tat' BUILDING DIVISION , DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER ti ai I i PERMIT� • 602-00468 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 2515 ELDEN AV Status: ISSUED Suite: Applied: 04/05/2002 Vicinity: RESIDENCE ONLY Issued: 04/05/2002 Parcel Number: 43917138 Zoning: Applicant: HIGUERA, JOEL ISSUED BY: . Address: 555 W 182ND ST / i'� 'Phone: 310-527-6770 - . �., ,� GARDENA,CAS Zip:, 90248 ' / / -\\ -* Owner: BATES/GORDON FRANK TR', _ Address /490 WALNUT PL ,/ , N V ' " 'COSTA MESA,CA Zip: 92627 v vj r`-'� N AN / /// / N /31/4-.:„;;2' \\ �\�', // / \" \\\\ Contractor: \CENTRAL.RCOFING COMPANY �:�� /\ ,,./ " ' 'Address:- 555 W'182ND ST v N quo `` \�A �`" � � Phone: (310)527-6770 ` c '7 GARDENA,CA Zip: ,' 90248/ •: Licenser 684960 i - .. .vA Arch : — -"-� Eng: Address: - / � 3 , ---- 3. Address: . / : .Phone: - - Phone: -. 'Zip: i License: — -V Dcense: -7 \ . . ' ' - SCOPE OF PERMIT_, - TEAR OFF;INSGTALL NEW SHEATHING AND cx COVER WITH 25YR COMP SHINGLES>WORK DOES NOT INCLUDE DETACHED Y GARAGE. --- _ . . .. '. .. '- v ✓ - ,v- , .-FEE SUMMARY j ;,Plan Check:'. $0.00 _ - /,' tr Calc Valuation ' t $3550.00 Permit: ' $97.25 .. Claim Valuation 2 $3,550.00 ,NSMIP Res: ‘ , $0.50 /-r r: SMIP Corn:, $0.00 - Other: ', , ,$0.00 ' Inspection:; •$0.00 Total: • , $97.75, ,,/ i - % , � � v yv Vii' N/ N� PLANNING&ZONING SETBACKS / ,/ MAIN STRUCTURE Front,. 0'0 Rear 0-0 ' Left 0-0 - - Right _ 0'0'� 7 ACCESSORY Front QO '/ ^ Rear ',,0-,0 3 - Left 0=0 , \ Right 0-0 !/ _� i PARKING Existing: 0.;;-_'Required: '0 , . Proposed: 0 �/4�% 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 244646(arae) DECLARATIONS WORKERS'COMPENSATION DECLARATION: • I hereby affirm under penalty of perjury one of the following declarations: • 0.. 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. ve and will maintain workers' pen lion i ce,as requi by sectl'a 9700 oLlfte Labor Code,for the performance of the work for which this permit Is Issued. My workers'comps satlon r and poli Yy number,�,� r • Carrier: Y3 1` � WYL. Policy Number:15L/5 l )O V I o7 (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 Coded'shall forthwith comply with these provisions -0 Applicant Signature: t'' -'/ ' Date: J 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 TME COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I 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,agml' Is in full force and effect.Lic.N Class M Contractor's Signature: Date: Lk- 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)01 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 ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such Improvements are not intended or offered for sale.If,however,the building or improvement Is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a Contractor(s) license pursuant to the Contractors License Laws.). ❑ I am 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: I 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: i Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No I (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 oor will the❑applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? e 0 (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. I 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this a plication a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes ID No (Section 65850.2 of the California Govemment Code requires that the requested information be fumished 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? ❑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 penally 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. dere r r Signature Oi Legal Owners) / 6-.0 1 ate And/Or Authorized Applicant Date CODE t INSPECTION TYPE PALE. IMBALS CODE( INSPECTION TYPE DEMI HMSO 1616 Fixed System Final Fire Prevention 208 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof .S_Ij�O2- 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 Ji I ADDRESS OF SNlAWO 2515 ELDEN AV °"TI' A-D CITY OF COST 1ESA - BUILDING PERMIT 47.11T5 NAME BATES, GORDON FRANK TR PERM NO: B 084141 ~ NERADDRESS: 490 WALNUT PL COSTA MESA,CA 92627 PERMIT NO: B 084141 PLAN CHECK NO: N GOVT: N SUPP : N A. APPL.IMAMS ADDRESS: CONSTRUCTION TYPE: 5-N' PERMIT TYPE: STR PURPOSE: OTH ARCHITECT ORBYANEER: M.NO.: JOB DESCRIPTION : T/OFF & REROOF W/CAP . SHEET SQ FT: 4 , 500 ARCA OR ENG'5 ADORERS: UMT: CLAIM VALUE: 4 , 500 . 00 CALC-VALUE: 4 , 500 . 00 GROUP OCC: R-1 / CCmRACTDaUNAIt SANTA ANA ROOFING ( 714 ) 558-3707 CONTRACTORSMNUNG 923 N. LOGAN COMMENTS: UNITS A-D ADDREss, SANTA ANA CA UC Rat 463596 ***********************->F***lr****iE***)r*******yE**lt+(********EEaE*******y(************ 92702 Mgt Z ONING REQUIREMENTS LICENSED CONTRACTORS DECLARATION:I hereby Slim under penalty or perjury that I ern licensed under provisions d Chapter 9 SETBACKS (mm i..:. .with Section 7000)d Diweion 3 d the Business end Professions Cab.and my license:In hof foam and effect. C r UC. O.: I 5308 LIC.CLASS: C-39 LIC.NO.: 4635 6 EXP: 01 /98 MAIN BUILDING ACCESSORY BUILDING ane: i (( Lt9j Contractor: �� FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN OWN ' BUILDER DECLARATION:1 hereby affirm under pendy d perjury Mall em exempt fmm the Contractors Litems Law for the fa••en.orrepel(Section suutlaee..p�riamb sance,efnrsOrdwland Professions Coda:M fes«wthcity or scanty hppen fierequire*a°;ignedstatema,,thath«u» PARKING REQ: PROV: PARCEL: 43917138 ZNE: REF NO: licensed pursuant to the provisions d the Contractors License Law(Chapter 9(commencing with Section 7003)d Delion 3 of the PLANNING NOTES> • .eines"and Professions Cade]or that he a she is exempt therefrom and the bene for the alleged exemption.Any violation of Sectio •.,>: •- 7031.5 by are appiwre for a perrS subject the appliad to a chid penaby of not more then fee kindred are 1$5001). ******************************************************************************* ❑ Lae ownerdthe properly«ms"ernpbyeas with wegesesmei sole worm Ms work and Ms Mucha not intended D E V .E.L OPM EN T SERVICES REQUIREMENTS or offered for sale(Section 7044,Business end Professions Code:The Contractors License Law does not apply to an ewer d popery who Wide or improves thereon.and who does such work himself a herself or through he e or her own mployees,provided thee such r . . improvements ere not ceded or altered for sae.I,however,thebikting or inpl«ementa sold within one year dcompletion.the ZONING APPROVED BY DATE: owner.budder will have the burden of proving he or she did not build or improve for the purpose d sats). ❑ I.ea ower of the property,am exdumvely contracting with 4pensed connectors to construe the pro ed(Section 7044.Business erd / Professions Code:The Contractors Lienee Lew does not only b en owed progeny who holds or karma Mersa and who BUILDING APPROVED BY : DATE:' contracts for such projects with e cuaador(s)Tuned pursuant to the Contractors License Law). . *** 41. 1 ElIan exempt under Section: B.AP.C..f«Mereason: APPLICATION ISSUED BY: f ** DATE: ***************************************** * **************** . . . . . . .** Date: Owner LEGALIZATION.:•N F E E S U M -A R Y STRUCTURAL SEGMENT:Y I do hereby certify that I am aware d end understand the requirements of California Heath and Safely Code Sections 25505.25533.and 35534,and that I or any future building occupant will I wit not(done one)need to can*with said area codes end the requirements for tempi penileVeneta me BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING provisions. PERMIT 99 . 75 . 50 Date: Applicant: S M I P/NON-RES • WORKER'S COMPENSATION DECLARATION:I hereby ahem under penally of priesone d othe following dedarsens: P LAN ISSUE FEE ❑ Ihave and wMmatd of wedWaaumseg-insurero workers' omoam«.oprovided faM «m Section 3700 dthe t<W BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE Code,for the performance the who for Mich this permit is issued. ❑ Ihave and MA manta.workers'compensation insurance.asrepuredbySedion3700othe Labor Code.kr the perbrmancedthe TOTALS----> 100 . 25 0 . 00 0 . 00 100 . 25 100 . 25 . 00 ic work for whdm this permit is issued.My workers'compensation insurance sane and policy amber are: Carrier rnT.nFN FAGT•F EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 100 . 25 OVER/SHORT: - . 00 Policy Number: n5WC491 A44nl 01 /01 /98 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK nit sed/on need not be completed tithe ami is Are one hundred dollars($1001 or 1esaJ 99 . 75 . 50 o I Sy 003 in the performance d the work for which this penne::sued,I shag not employ any person In any macer n es to subject to the workers'compensation laws d California end agree mat If should become subject to the workers' ******************************************************************************* wrap matin onedSedan3700dtheLaborCode.Ishagf complyeuw. I N D I V I D U A L F E E B R E A K D O W N Dae: Gi '�j7 Applicant: • Waal Fe9vnroanuewoflrriwnpwwtlonrorerapelsun ahwUaubieehanemployer toaMNnSpenaltiesand TYPE QTY D E S C R . I P T I O N UNIT COST TOTAL COST civil a up b one hundred thousand dollars($100.000),In addition to the cost of coupe eaart damages as provided tor In on 3706 the ro Interest, SFR 4500 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 4 , 500 . 00 CONSTRUCTION LENDING AGENCY: I hereby affirm under penally Of perjury That there is a conetnwon lending agency for the END OF FEES performance of the work for which this permit is issued(Section 3097,Cb.C). LENDER'S NAME LENDER'S ADDRESS: ` I certify that I have read this app5cation end arae that the above information is coned.I agree to comply with all dry and county ordinances 'v and state taws relating to bulking construction and hereby a thorbe representatives of this city to enter upon the above-mentioned popery for inspection purposes. JOHN KIDWELL 08-11-1997/82:27 031/5100.25 • • n ante G�/� • RCPT!I:01-6818555 �- cA.. .i, ._t,/L�j Dae:O • (�( 97 PERMIT:084141 Signature of•"-riAgenUA i• v (5151d6.W P) White-Building&Safety:Green-Ale: - - ppkad:Pink-Revenue:Goldenrod-Aseesor 'CONSTRUCTION AND PLANNING POOL 'PA I Date Inspector Date Inspector APPROVALS Permit# APPROVALS Permit # I • 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location •2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement j . 3. Electrical Conduit Utility-Undrgrnd. 54. Forms -.4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding I 5'Steel Reinforcement , 56. Rough Plumbing & Pressure test " _6:. Electrical UFER Grnd. ' 57. APPROVAL TO COVER-GUNITE •. J.,Footings - 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test • '9. Water Pipe-Undrgrnd. . 60. Backwash Lines, P-Trap, 0 Undfgrnd. 10. Structural Floor System . 61. APPROVAL TO'DECK ••r 11. Property Sewer Line& House'Connection 62. Backwash & Receptor-Final ' , •12. Sewer Cap / j • 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final i 14. Rough Plumbing, - 65. Electrical-Final ' 15. Rough Electricat-Conduit - 66. Solar Svstem-Final 16. Rough Electric Wiring 67. Fencing & Access Approval I ' 17. Rough Wiring Sign . • 68. APPROVED FOR PLASTERING ' 18. Rough Electrical-1- Bar Ceiling- . : . - - 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating& Air Conditioning -" FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace 1 M ' APPROVALS: ! Permit# 21. Ducts,in Structure L ., ., i a 70. Underground Hydro + i 22. Ducts, Ventilating , ' - ` ` 71. Product Piping O Gas °Oil 23. Gas Pipe-•Rough nest , rp -,i 72. Underground Flush t 24. Roof Framing • - '- ' 73, Undergrnd.Storage Tank.0 Gas 0 Oil 25. Roof Sheathing - • (1794 74„ Dverhead.Hydro• - 26. fear Ceiling (Structural) & Monocoat . _ 75: Dry Chemical - • ` 27. Frame and Flashing _ ry, 76. DStandpipe -. - 28. Lathing & Siding . - _ - 1 77-., FIXED SYSTEM FINAL; _ . • - 29. Insulation : • .. : I:I: 78. FIRE PREV. FINAL . , -- - 30. Drywall Nailing . i HEALTH DEPT. REQUIREMENT - 31. Plaster Brown Coat I ' . . 79.E FINAL INSPECTION 32. Electrical Power Meter:Final . - I : , 80:0 FOOD CERTIFICATE ISSUED LA 33. Finatr,Electric Notes: , . - 34. Final Heating & Air Conditioning - . I • - - v , . 35. Final Gas Pipe,Test f • c • 36. Hood or Canopy , _ ' - - ' r-.', . I . _ 37. Final Factory Fireplace '+ - ' 38. Final Plumbing . '1 - _ , - --- .. .. I. 39. Water Service-Final - ; I. 40. Gas Service-Final ' . 41. Solar Domestic-Final • , -. 42. Backflow Preventer . • -. 43. Backflow Irrigation • } 44. Landscape Irrigation System - . , " • 45. Sound Attenuation ' • - _ 46. Handicap Regulations - _ 47, FINAL STRUCTURE & BUILDING g/��T - - 48'. FINAL PLANNING ' l` • • ' 49. Electric Release to Edison . . r 50. Gas Release to Southern California Gas Co - • 1 51. CERTIFICATE OF OCCUPANCY ' No. Date f 1. 7.•, 4 wAVF x� � n,',Illy.a a �j .4::1_-, r City of Costa Mesa ' '.- y - i 7,PH ‘q- :i'.' s 3 Budding Safety Depart ant CERTIFICATE OF OCCUPANCY 7 `y cl' - i The Building located at. 2N.5. 4.. Avenue "' anr..�.a .v .. :h"as been.,inspected'and found to comlr`ply with the,provisions,of 'difiCity:of Costa Mesa Ordinances applicable thereto' R 14. . a for a Group ff ' ` 'Occupancy F - - _ r• , i. .6 .".C.11.-;:;;'.... 17¢ , - .,'"•'4-:#1:; �^ t ,� f; � :i_ i' o - ,--A.:',";'''.' " • '' ''17.7'.."'. .;,'; ,a r„'` Use of Building 2*3712G Fft4 �1YFttC d � ` 1`,.‘-.1i I ' r •Legal Description • A. r. #U3„&d010+3r-o . . , n• - S s,., F fi1 r (Sea reverse side for Metes end Bounds) £ r "`� t. Building Permit'No7-' i4~4 --71.r Electrical Permit No. r»` `- Plumbing Permit No 4 1-ARl, s :.'.•.--, Number.of-apartments F` 4 and/or guestrooms - - D 0 t - T V,;,. ISSUE ,T : "1:),+' _,-,� , ;fit a = , .,.w.. ,....: •f .• ;ri - ..' .. t .. Building''Official .. o ...r : . it by / a'f'+'.✓tt t` ' e a�.i �. "+:� _ �1^k 1 ••' - II - ' Date FtoVL2t k: 21, 1(711.' ,, i_ This Certificate of Occupancy SHALL BEI posted m a conspicuous place on.the premises and SHALL NOT BE removed except,by the a ','Building Official of the,City of Costa'Mesal+1I1under.Sec 306'(e1"U.B:C.-' ,: I '` ` i'l r r • ' ' .. . . . ru- • ry t II` - ? 7 ” u 'It- 1; i % . '4°1.. maw. ,,: L � r A 32492 °;l ,VV h-,F P„oo 931 z4*****9.Oa COSTA MESA BUILDING-SAFETY DEPARTMENT t YI'\^ P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 For Applicant to Fill in Completely APPLICATION FOR BUILDING PERMIT 02 5 / S — N&n - /, RECEI Q6V #—€214 / T CEIVED��i ISSUED 7o BUILDING C/Z�' (,f�JI/O�LT1 7 E�` ADDRESS/�// ///q � f(/J/7 �/// /�y`� .�X" ,ryj� �I� a�/S !/✓ ...tecY.u_ f "' _ I / —O3 ).-- � PER✓`Tlf O/9 OWNER A.P. NO. ��Q�� ,, MAIL , BUILDINGDRS '1 `/ C]' C/E"Vr"VC ADDRESS d'J Z ADDRESS �� L{�`/ 0 U CITy� ��"' / C 111 NOJ 7S(� 7 TRACT 300 LOT7.2. BLOCK Z Z CONSTRUCTION NEW ADO ALTER REPAIR MOVING DEMOLISH Z Z O N LENDER V dam' • J co) BRANCH '�— /J W•s` # f�"� Cr / /F - OWNER Iv/VI N Leer /Fe W ADDRESS ----------- al J VALUE /�ppt BV ' -CO ARCHITECT ASI R,/_ J.,ry rj_ TEL. $ Q OR ENGINEER[(+��yLii.r-sq'+.+��J NO. marhaistr U NJ FIRE WQ ZONE TYPE GROUP 2 ADDRESS 2 w APPROVED ,/� WZ CONTRACTOR BY 2 / XATE/F23`70 Jp \\ J 2 ADDRESS W W TEL. ZO�y� /J �NO.OF USE ON NEW lore., Cr CITY NO. --aPLANS BUILDING ;% STATECITY YARDS APPROVED VAR APPROVE LU K LIC.NO. _-- LIC.NO. MAIN BUILDING ACCESSORY BUILDING U SIZE / / ./ ///��Ja r NO.OF BLDGS. (FROM C/L��STREET) XOF LOT f-r T 7 NOW ON LOT r FRONT � FT. FT. USE OF EXISTING BLDG. �J R $IDE /0 FT. FT. I— SIZENEW BLDG.O /b ' `-� ROOMS STORIES / L.SIDE A / FT. I- NEW feEXTERIOR WALL ROOF C.)_ COVERING COVERING REAR 39 FT. Eat FT. J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& 0 0- MAIN BLDGS. ACCESS.BLDr=S. d � C ( 1DATE ,4119 I C.0 P / APPROVED CO APPROVED . / _BY DATE I 3// 0 2 U/it/ 0 ' UI hereby acknowledge that I have read this application and state 7 that the above information is correct and agree to comply with CC all laws regulating building construction, and I shall not employ I— any person in violation of the workman's compensation laws of CO the State of California, m Z 7 o O Qo I hereby certify that I am properly licensed as a contractor under "� S .FT. the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, and that such licenses are in full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: e CC am exempt from the provisions of the State of California Business }}} VALUATION and Professionsuotle/e3,Cha ter N `/�///7 PERMIT FEE $ O Signature of qq�� q� `� m Permittee e $ lio Ute- PLAN CHECK $ E Onod Authorized Agent u. TOTAL FEE $ 33451 i - .07S& E570* *** 178.50 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 7200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR BUILDING PERMIT For Applicant o_F' 'n C plate/y DATE ISSUED ffTT RECEIVED BY DATE RECEIV D BUILDING. 55' t e '' ',./'-'7� 7-27-71 ADDRESS // q ^� q/p�I•I/�, OWNER G ( �_ i i /� ..- A.P.NO. // / ®38.-3 E✓t,/ !d/ BUILDING c n,, �J,� /� ' MAIL / , ti.e- 79 /J ADDRES 0/afne.jIU E ci—d...., Z ADDR ESS /Ill LL1 ^r,7/s r ""✓ ,[J.ICS//�[ /�` 7. CL 0 CITY � „ NO?TS�r�r� TRACT�o--O LOT�a- BLOCK ZZ Q CONSTRUCTION /� ,, ,/ NEW/ ADD ALTER REPAIR MOVING DEMOI ISH Otn LENDER (�'�'�'✓<-c'N ✓ 0- J 7 BRANCH J /4,g / N OWNER /4,g J .LU ADDRESS VALUE J CO ARCHITECT TEL. USE $ Q OR ENGINEER NO. r/ w CL ADDRESS ZONE TYPE GROUPN V 91 LI? 2 7-7/ //////{{//�� // /��r� APPROVED J O CONTRACTOR l.Yltt.c .a.C�� `&4.cJ � , BY /� DATE W W ADDRESS ZONl�E NO,OF USE OF NEW / /'f TEa CITY NO. /��IPLANS-9._..., BUILDING� ( / �( Z FXilk, tJ STATE CITY YARDS APPROVED YARDS APPROVED to IL LIC. NO. LIC.NO. . MAIN BUILDING ACCESSORY BUILDING 7O ♦ - (FROM C/L STREET)ta SIZE 'r I NO.OF BLDGS. p OF LOT /s-t� Y INOW ON LOT / FRONT a/t FT. ./{/N, FT. USE OF EXISTING BLDG. SIDE SFT. FT. 1 SIZE OF nl ( NO.OF / I ,- Z NEW BLDG. �t✓ ' Cr- / ROOMS/ TORIES L.SIDE SFT,'T_O STO.(0.(-L1 CF tl Q EXTERIOR WAL ROOF . V COVERING 1,-e-0-0--- COVERING r�p 2-71 REAR cSFT, FT. , 1 J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& a MAIN BLDGS. ACCESS. BLDGS. S LC - C/1-'t.--^ .ref ' APPROVED N CF APU / r T —/7 " HOLD 1� CIAL REQU R EM NTSO I hereby acknowledge that I have read this application and state ,/) �! D that the above information is correct and agree to comply with 0� per/ CC all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of CrYl CO the State of California. ,$� ro ry b Z •I hereby certify that I am properly licensed as a contractor under �o SQ. FT. /2-1t:' O`t o the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNVALUATION IS FOR Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: o CC r am exempt from the provisions of the State of California Business VALUATION and Professions Code, Division 3,Chapter 9 / 9 �. (V PERMIT FEE $/ / O Signature of I ��s fl.. [�///, (Lek:. CO Permittee G`/LL'✓t��LP'/ c$.5n li PLAN CHECK $ 5,i LL / o Authorized Agent .. TOTAL FEE $/ 7 Dpi Si County of Orange • .Building Department APPLICATION FOR ,]] � Room 322 PERMIT PERMIT NO. -(1 \ � 7 Court House Annex Santa Ane, California t Phone: KI 2-6211 (o - , 19 5-01. OWNER'S NAMF P<1-.."/% "I PHONE: rflLo'1.-, MAILING ADDRESS .2S/) iff-is n „sexy (Street or P.O. Box No.) a NAME %✓ �fiLt . o. v ' -n-n. t - NAME -- tom ' '...4✓VV1OWI ' (Architect or Engineer) (Contractor or Builder ADDRESS 2 r/S` ADDRESS _ S / -i CITY - Com/ - i>.z CITY -a 4-0'41 �f f1/.,�,�C, State Lic. No. Phone �• State Lic. No ph„, ,62-11‘ 2. JOB LOCATIOoZS S 7 '�i .s<�J �t+{ ,Ci,/`z% 0-(4,0 . (House NO.) (Name of Street) (Town or School District) 3. LEGAL DESCRIPTION: Lot 70 • flock • Tract Sad 4. Meets and Bounds Description — Use Reverse Side of This Form. 5. CORNER LOT ( ) INTERIOR LOT (AV; THROUGH LOT ( ) SLOPE OF LOT% •net-e-e THIS APPLICATION CANNOT BE PROCESSED UNLESS"LEGAL DESCRIPTION )% ;4 Z I0 T ekces 2 x IS ACCURATE AND COMPLETE / �sd 6. PR POSED WORK: New Building ( ) New Stru a (k Addition ( ) Repair ( ) Alterations 011 Moveve ( ) Demolish ( ) Conversion ( ) 7. PROPOSED USE: /r"'�/ //-14 aria/ � 1j2 i �'— c ✓v" 8. . SIZE OF BUILDINF;.�cr_ .4 AREA 9 3 Z SIZE OF LOT/0.1,X/2 ? AREA / 2 5"-cl---<" 9. CEILING HEIGHT si TOTAL BUILDING HEIGHT r O NO. OF STORIES (0. NO. LIVING UNITS D SIZE OF SMALLEST BEDROOM U SIZE OF KITCHEN O 11. EXTERIOR WALL CONSTRUCTION: Brick- ( ) Concrete Tile ( ) Monolithic Concrete ( ) Wood Frame (K) Steel Frame ( ) Concrete Frame ( ) 12. WALL COVERING: Wood ( ) Metal ,( ) Stucco pc) Other_ 13. FRONT YARD SETBACK FROM CENTERLINE OF STREET 14. DISTANCE TO PROPERTY LINE: Side Yard G-4✓RE�� Rear Yard .2 //1�?� .. 15. SHOW ON PLOT PLAN EXISTING BUILDINGS NOW ON LOT, STATE USE OF EACH. 16. DISTANCE IN FEET FROM PROPOSED BUILDING TO NEAREST EXISTING BLDG.:/0a ••17. VALUATION OF PROPOSED WORK:•-/-4)"6\--IncludintgAll Labor, Plumbing,_g, Electrical Wiring, Heating, F'ire Sprink- lers, ��..LL Painting, Sewage Disposal $ e / 2' o� / ! 'jh 04/41W/ 18. I HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE INFORMATION IN THIS APPLICATION IS CORRECT AND THAT THE CONSTRUCTNTON WORK WILL CONFORM TO ALL LAWS OF THE COUNTY OF ORANGE AND THE STATE OF'tALIFORNIA APPLICABLE THERETO. Plan Filed. SIGNED: .2;71/ /; //• 02'n�'- 1 ✓i�1 Owner or Authorized Agent Data G - - BY FOR DEPARTMENTAL USE ONLY• 19. GROUP TYPE__.- • DISTRICT MAP get. NO. S • PERMIT FEE $ �•� RECEIPT NO.• Z./ 'V PAID TO 302/-.1 DATE k.- /3 -ST) • • CHECKING FEE $ RECEIPT NO. PAID/TO a • • ttOUILOING CPERMIT GRANTED JUN 19 950 19 tr' '!% , ! I NSPECTOR PLANS CHECKED BY CHECK SF h ATTAC FPl TY APPROVED BY: HEALTH DEPT. STATE FIRE MARSHAL STATE DIV. 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