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Home My WebLink About415 EMERSON ST - Building Permitsp '4F t � O s : J �' t�� ' � ' CITY OF COSTA MESA �, BYILDING DIVIS/ON � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us FOR INSPECTIONS CALL: (714) 754-5626 - PERMIT TYPE B_ROOF2 APN: 42624312 PERMIT NUMBER: B09-00048 STATUS: ISSUED DATE ISSUED: 0410712009 ISSUED BY: RMD JOB ADDRESS: �� S EMERSON ST CM Suite/Unit: Vicinity: HOUSE ROOF Squares: 3000 Valuation: $6,100.00 R�,r�; � b�,Pi� �th i'fS . SCOPE OF WORK: _�' ?� _ TEAR OFF (E) ROOF, INSTALL 2 LAYERS OF 30# FELTAND REROOF WITH 30 YEAR FIBERGLASS SHINGLES, APPROX 30 S�UARES. REPAIR AND REPLACE SHEATHING AS NEEDED. OWNER: GEORGESEN, WILLIAM E PHONE: 714-282-1355 APPLICANT: RIOS, JAVIER PHONE: 909-887-3469 CONTRACTOR: INLAND VALLEY ROOFING INC Address: 2760 N STATE STREETUnit: Ciry/Slate/Zip: SAN BERNARDINO, CA 92407 ARCHITEC7: ENGINEER: ��1�1�1�I�1�1�:a�� Reroof Plan Check: Reroof Permit Fee: Reinspection Fee: Bldg Std Admin Fund 70TALFEES 50.00 $139.25 $0.00 $1.00 $140.25 Address: PO BOX 6252 City/State/Zip: ORANGE, CA Address: 2760 N STATE STREET City/State/Zip: SAN BERNARDINO, CA License No. � License No. PHONE: License No. 605026 909-887-3469 � CELL: . PHONE: PHONE: Unit: Unit: : NOTICE: The work authorized by this Dertnit shall comply with all applicable handicap access requirements under Califomia slatutes and related regulalions. (Ord. No. 92-28. § 1. 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work aulhorized under this pertnit to be wnsidered 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 Ihis permit. o � INSPECiIONTVPE p� ixvnn� 40oE� INSPECl10NttPE p� iN7f11AL5 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1268 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 4-�S � 210 Final Eleclrical 207 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 FinalSign 222 FinalSite 204 final Demolition 250 Final Builtling/Occupancy WORKERS' COMPEN�ATION DECLARATIOh. I hereby aKrm�nder penally of perjury one of lhe following Ceclarations: ❑ I have and vrill maiMain a certificate o! wnsent to sel6lnsure for workers' compensation, as provided tor by section 3700 ot the Labor Code, for the pertormance of the work for which this pertnit is issued. � I have and will maintain v.orkers canpensation insu2nce, as required by section 3700 0l [he Labor Cotle, fa the pertortnar�ce of the v.ork fa which this permit is issued. My workers' compensation Insurance carrier antl policy ny�mher are: ^ ' �� c�amer. _ fiTE ! [1/ld (Tnis seCion nred nW ae mnpe��r�/-g ra:.edat we nurwM eNars f5to0/ a lassl Poh�Numher: I 00� lL� �� I certity that in lhe pedortnance of lhe vrork lor which this permit is issued, I shall not employ any person in any manner so as to becoma su6ject to Ihe vrorkers' compensation laws of Califamia, and agree that if I should become subject o Ihe workers' wmpensation provisions of Seclion 3700 ot lhe afC� 5hall (orth� ' t molv wilh lhe5e provi5ion5. � � y- � 09 `� .. �� WARNING: FAILURE TO SECURE WORKERS' COMPENSATION CAVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($700,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby atfrm that I am licensetl untler provisions of Chapter 9(wmmencing with Section 7000) of Division 3 of the Business and Professions Cotle, antl my license is in full force and effect. ��y rt'�c'YF7 �Cta55 # ' � l�� Canv . re �^�Daler_T.�' CONSTRUCTION LENDING AGENCY: ❑ I hereby affvm that there is a consWction lending agency for the perfortnance o( the v.ork fa which this permit is issued. (Sec. 3097. Civil Code). Lentleis Name: Lenders Adtlress: Sigrewre OWNER-BUILDER DECLARATIONS: I here6y affrm that under penalty of perjury Ihat I am El(EMPT FROM THE CONTRACTORS LICENSE LAW for the (ollovnng reason (Sec. 7031.5, Business antl Professions Code: Any city or county which requires a pertnit to conslruct, alter, improve. tlemolish, or repair any structure, prior to its issuance, also requires the appliwnl (or such permit to file a signed statement Ihat he or she is licensetl pursuanl lo Ihe 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 lherefrom and the basis for the alleged exemplion. Any violation of Section 7031.5 by any applicant lor a permit subjects the applicant to a civil penalry of not more Ihan 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 slructure is not intentled or oHered for sale (Sec. 7044, 8usiness and Professions Code: The Contractors License Law tloes nol appty to an ovmer of property who builds or improves thereon, and who does such work himself or �erself or throu9h his or her ovm employees, provided that such improvements are not intentled or oKered lor sale. If, however, the building or improvement is sold within one year ol completion, Ihe ovmer-builtler will have the burden of proving ihat he or she did not build or improve for puryose of sale.). Owner ID venfed by drive. .. ucense. ❑ Yes ❑ No Driver's License No. Expires: Veriflcation of Ownership by (type of tlocument, i.e. - proDerty tax bill or tleetl): DIVISION OF INDUSTRIAL $AFETY PERMIT CERTIFICATION: ❑ I hereby cenify Ihat no excavation (rve (5) or more feet m depth into which a person is required [o descend, vnll be made in connection vrith work auUnrized by Ihis pertnil, and thal no building structure, scaNdding, falsev:ork, or demolition or dismantling thereof, v+ill be more than thitly-six (36) feel hgh. (Chap. 32, Gry 2, M 2, Sec. 341, Tille B, Califwnia AtlministraUve Cotle). ❑ As owner-buil0er, I will not employ anyone lo tlo work which wnuld require a permit Irom the Division of Intlustrial Salery, as noted above, unless such person has a permit to tlo such work (rom the division. Appliwnl's Sgnalure Dalp Division of IrMustrial Sa(ety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or fuNre building occupant neetl to fle and certify a Business Plan lor emergency response to release or Ihrea[enetl release of a hazartlous matertall ❑ Yes ❑ No (Seclion 25505 0( the Califomia Heallh antl Safety Code requires. wim some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has a1 any one time tluring a reported year a quantity of hazardous matenals equal to or greater than a vneight ol 500 pounds, or a volume o! 55 gallons, or 200 cubic feet of compressed gas at standard temperature antl pressure). 2. Does or vrill the applicant or present or future builCing occupant need to file a registration fortn for acutely hazardous materials7 ❑ Yes ❑ No (Seclion 25533 of the Califomia Health anA Safery Code, wilh some exceplions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hantl a quantiry of acutely 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 stantlard temperature and pressure). 3. Does or will the applicant or present or Wture builtling occupant need to prepare an RMPP (Risk Management an0 Prevention Program tor acutely hazardous materials)? ❑ Ves ❑ No (Section 25534 of the Calitomia Health and Sa(ery Code provitles Ihat tne Costa Mesa Fire Department may require Ihe preparalion, certification anC fling with the Fire Department ol an RMPP by Dusinesses which are required ro register acutely hazardous matenals wiN the Fire Department. 4. 11 an RMPP is presently required, has Section 25534 of the Califomia Heallh anC Safety Code been (ully complied with7 ❑ Yes ❑ No 5. Does or will the applicant or present or fWure buildinq OGGupant require (or lhe work whith is Ihe 5ubject of this ap0lication a permit for suc� consWction or motlifiwtion Gom the South Coast Air Quality Management Dislrict or (rom any other air pollulion control disMct or agency7 ❑ Yes ❑ No (Seclion 65850.2 of Ihe Cali(omia Govemment Code require5 lha[ the requested information be fumishetl on applicalbns (a frornresidential builtling pertnits�. 6. Will any part of the facility lo be constructetl untler this permit be vnthin 1000 leet (rom Ihe outer bountlanes o( a school7 ❑ Yes ❑ No �1t yes", Ihe tacilily musl meet �he requirement of Sections 25534 and 42303 of the Calilornia Health antl Safely Cotle). 7. II a permit (rom the South Coasl Air Ouality Management Dislrict or other air pollution conVol tlistricl or agency is required for the work which is the subjecl o� this application, have all of the disclosures prescribed by Califomia Health an0 Safety Code Section 42303 been matle'7 ❑ Yes ❑ No 8. (II'Yes", attach certifcate of compliance from the appropriate air pollWion control oKcer�. CERTIFICATE OF COMPLIANCE: I certify tha� under penalry of perjury �he information given above is correcL I agree lo comply vrith all state lav5 and city ordinances regarding Hazardous Materials and Emissions. LJ �, as ov.�ie� ui uie piuNeny, e�n cn�.�vaira� �.vn�nna.iin�a � LICENSED CONTRACTORS to wnswct ihe project (Sec. 7044, Business and Pro(essbns Cotle: The contractors License Law tices nol apply to an ovmer o( s�gnawre oaie property vfio builds or improves thereon, and who cmtracts tw such projecl with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: 1 a cont2cta(s� license pursuant to Ihe Contractors License Laws.). certify under penalty ol perjury Ihat I have rea0 this apDlication antl state Nat ❑ 1 am exempt untler sec. the information given is correct. I aqree to comply with all state laws antl ciry ordinances relating to building construction, and authorize representatives of Business and Professions Code for this reason: lhe City of Costa Mesa to enter upon the above�descdbetl pmperty for inspection purposes. I agree not to occupy or allow occupancy o( any building authorized by this permit unlil final inspection. - o'�—a 9' g lurepl erlpy Da� SignaWre Daie 305]�a61��) na7tir�AGlfioriiBOAppPiznt �Dn1e.,T� .: � ', iaccT noosess: 41 S EMERSON ST ~owxexsr+nMe: GEORGESEN WILLSAM E noosess: CHERNEY, I•7ICHAEL J � 9172 SANTIAGO DR HUNTINGTON BEACH,CA 92646 282-1355 RBCNrtNGINEEfl: flEG.NO.: �OONESS: uxR: UNIT: PENMITiEE: WILLIAM GEORGESEN ( 714 ) 282-1355 nooeess: 18241 SERRANO AVENUE VILLA PARK CA 92667 LICENSED LONTBRCTOB OECLAMTION: I hertby ailirm t�ai I am IicenSeE uMer O�ovitions ai Chapier 9(wmmencinp wilA Sec[ion 7000) ol Division 3 0l I�e Business an0 Pmlessions CoOe, ana my license is in INI lorce and eflect. CITY LIC.: ST�TE LIC.: MSS: Oate; Signalu2: WOPNEflS' COMPENSRTION OECLABATION: I here0y atfirm t�at I luve a cenilicate ot consent to ulNnsure or a certilicate oi Workers' Compensation Insurance, or a certi6etl copy tnereol (Section 3800. La�. C). POLICY NO.: E%P. OATE: COMPRNY: ❑ Cenilietl cooY is Aere�y Iumisne0. O CertilieG copy is IileE vnt� ihe ciry Builtling Oivision. Daie: Appliunt: E%EMPiION FPOM WOflIfEflS' COMPENSRTION OECWIiA710N: (itus uction nee0 rot Ee competeG ii Ihe pertiil ¢ iw ane huntlre7 �510D) or kss�. I Cetlity Ihat in ��e pedorman[e 01 ��e xrork lar whit� ��i5 p¢rmil is iS5ue0, I hall n0� employ a OefSon in any manner so as Io beCome subiec� �o I��e /y'o�rke/cyp' CamZ�e nulion Lavrs o� Ca0lomia.n ya{a: _�C�i�.� Si9namre: T/�� NOTI f: Ii. aLer makinp iNs OeUaraGon, you SMuIE Decame wEjmt lo ihe Warkers' Comp tian provisions oi the Labar Code. you mus� lOrthwth Compty vnlA SutA O�onsi0n5 ar lNs Oermii S�all Oe Geem¢E revOkeE. CONSTBULTION LENOING �GENCY: I �ere0y allirm Rai t�ert'a a constmction IenEinq aAency for t�e pedormanre ol tAe work foi wnicn ihis Oermn ¢ issue0 (Stttion 3097. Gv. C�. LFNOEN: nooxess: OWNEN BOILDEP OECUMi10N: I �erz0y atlirm tlat I am eKempt Imm Rm ConVapars' Slate Lice�ae Law lar t�e lollowing reason �. (Seclion 703f.5 Busineu anG Professional CoAe: My aty al wunty wNc� repuir¢5 a Dermit to tanstruct, alter, imD�ov& Uemolis�, or repair any stmcmre, Driw io its iuwnce. aLso «pures t�e aDd�� or sucA perml to file a sipne9 statemeni that he/5Ae a Iicense0 Dursuanl lo �he prOvi5i0n5 Ol l�e Canita[�Ors' State Licenm Law (Ctupte� 9(commentinp vnt� Section 7000) of Divivon 3 0l ��e Business ana Pmles9ons CaOe) or IIu1�U5he is e�emD� ��erelmm arlU Ihe Oasis lor 111e allepe0 exempiqn. My violation ol Settion 7IX11.5 Oy any apDlitant lor a penmt Su01ecR ine dpdiWnt to a tivd pwtty ol Mt more ihan live nunOrM GOIWrs (`3.�W). I, as Owner of I�e prop¢ny or rtty emWayea �+th wdpes u l�eit Sde COmpCrSaGon, will do tlle work, an0 ihe ❑ strucmre is not inlenOeU oi ottereE lo� ule (Section 70a4, Business �n0 Proleubnal CoOe: Tne Contracrori State License Law 7oe5 not appty to an oxnei ol a property wlq EudCs or im0�wes thereon, an0 who tloes suUi work Nmsdl/�eruli or ihmuAh nis oi ner own employees, pro�riAeOlna� sucn imvmvements am not inlen0etl ot ofler¢0 lar Sale. I�, �OwCver Ihe DuilUinA of imprOvemenl is SdE vnlNn one year ol cortql¢IiOn, t�e owner wtll luve �Irc DurOen ol provinp Mlshe OiE not EuiIE or imDrave lor Ine purvose ol ule�. I, as ownei ol i�e Ompeny, am exclusiveIy mnlractinq vn�� Iicense0 contracmrs to conAmn the O�ol�� (��ion 70Cd. Business ❑ aM Professbns CaGe: Tlre Convactas' Slate Licdse Law Aoes rot appy fo an ovmer ol properry x1n Mdas or impraves therem ana w�o conVacls br suc� pmjecis wiiA a comracmqs)liunse Oursuantto the Coniractars State License Law�.l am aware I�at prool ol Neir Worker'S fAmpe�ati0n inSuraMe SMNE De DrmiEM lo me. � � am eMempi unCer Section: A P% O A 4 B. 8 P. C. mr mis reawre LL WORK BY OWNER ��-, a�e: � � O+mer. i��<'�� I Oo �¢r¢by Ce tity �Aai I am awar2 0� anG unGerSUnG I�e repuirtmen�s al Cdliiomu Heallil anA Safe�y CuEe $etii0n 5505, 25533, and 25534 an0 ��al I or any luluro buil�ing acupan� vnll/will not (cirde one� neeE la mmpty wit� SaiG stale ca0es anU ihe reQuiremenis br a Dermn for consimc�ion or moAiliwlian imm t�e tir ua0ty Manaqemem Oistncl. BesiOentul constmc�ion apD��s are eKempl irom these pmvisions. Oate: AppliWnL ' I hereby tetlily Ihal I �av¢ reaG I�is a0�licalion antl Slale Ilwl I�e a0ove inlarmalian i5 wrr¢tl. I agree lo compty wilh all Ciry and Coun�y orUinances antl staie iaws relatinp �a Ouildinp conslmclian anG �ereGy;mtnr@e represenlatives of is ciry to enter upon I�e a�ove-mentionetl pmpetly tor in/s$�eclion purposes. � (� Daie: �/�Z� ` Signa�ure: � • o vn er's L¢ense o� saiai Security x: �a6 Wnne-9mlmnp: Green—Coae Entorcemem: Canary—Aoo�icnnt: Pink—Revenue: Goidenroe—As�eesor CITY OF COSTA MESA - BUZLDING PERMIT PERM NO; B PERMIT NO; B 058925 PLAN CHECH NO; N , , CONSTRUCTION TYPE: V-N PERMIT TYPE; STR PURPOSE; ALT JOB DESCRIPTION ; T/OFF RESHT, REROOF W/COMP SQ FT: 2,500 CLAIM VALUE: 2,500,00 CALC-VALUE: 2,500.00 GROUP OCC: R-1 / COMMENTS: SMOKE DETECTOR RE�UIRED IN THE HOME *+t�r*�r****�****+�************ **�*******�r�*xir********��r�t�***�r*******��*�*+t**�t***x Z O N Z N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN HUILDING ---------- --------- ACCESSORY BUILDZNG --------- FRNT: FT IN REAR; FT IN FRNT; FT IN REAR: FT IN LEFT; FT IN RGHT; FT IN LEFT; FT IN RGHT; FT IN PARRING REQ• PROV; PARCEL: 92624312 ZNE; REF NO: PLANNING Ni5'PES� /. � if iE iF if iE iF iFlt iE if if iF ik if �1f iF �E 1E iEiF iF iF if ik iE iF iE iF �E iF if ikif if iE �lk iF iF iF �E iE iFlf �IE iFiE iF iF iE if iE 1E iE if �E iE i! �F 1E if !E iE if jE iE iE k it iE iF if iE iE ik iF iF ik iE iE D E V E L O P M E N T S E R V I C E S R E Q U I R E M E NiT S W ZONING APPROVED HY DATE; e: BUILDING APPROVED BY ; (1 DATE; _1. i/ APPLICATION ISSUED BY; �V�-� ' — - if if iE if !E if 1E iF iE if iE 1E iF 1E �F iE iE iE iE iE iF if 3E ifiEitifi!lkkiflfihiEiFrtifkiflFifiEiF�flkkikiFififiklEfF�kMi!lFIE1E�E1f�k3EaF�! iE1E*iF�fifiFlEiFlEiEitiflF�f LEGALIZATION;N F E E S U M M A R Y BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE PERMIT 54,00 �' : 7��41� it i! 1E iF if iF ik iE iE iF'1E IE iF iE !f it iF dF if �F STRUCTURAL SEGMENT;Y SMIP/R50� GRADING SMIP/NON-RES PLAN �' �� ISSUE FEE +i- � � BUILDING-DIV-> PERMIT ISSUE PLAN-CFiECK TOTAL PAID �!' DUE TOTALS----> 54.50 0.00 ,�,0�.00 54,50 59,50 '„ ,00 J REVENUE DIVZSION TOTALS--> COLLECTED; 54,50 OVER/SHORT: ,00 BLD54P00 pLUMBING ELECTRIC MECHANI�C FIRE SMIP/T50 GRADING PqLAN-CHECK % � L' iEiFiEiEikif1E1E1f�KiEifififif%iFiFlEitiEiFiEMitfEfhififiEifiElEMiE1EiE1Eif+� iPifiEiElfjfifiFiEiEitlfiEiEiFlEififif3fiE�fifiFlEiE1FYEif,3EiFiEiEiEiElfMit I N D I V I D U A L F lE E B R E A H D O W N /t•' w _ TYPE QTY D E S C R I P T I O N • UNIT COST T.OTAL COST SFR 2500 REROOF BY VALUE RESIDENTIAL NOZONE 1,00 � 7t,500,00 END F� OF_ FEES � � 1 �'i / � P �' :: � r � i' /' �' � �`n �f ��. �77':.' . - " ; T if��E� G•��.�•: �� , . ; � CONSTRUCTION AND PLANNING � ,� �APPROVALS Parmit# , t. Temporary Electrical Service or Pole ' 2. Soil Pipe•Undrgrnd. 3.�Electrical Conduit Utility-Undrgrnd. �4. Electrical Conduit-Undrgrnd. � � 5. Steel Reintorcement 6. Electrical UFE�i Gmd. 7. Ff�otinqs 8. FoVndation . 9. Water Pipe-Undrgrnd. 10. Structural Floor Svs�em 11. Property Sewer Line & House Connection 12. Sewer Cap 73. Roof Oraint 14. Ro�gh Plumbing " 15. Rough Electrical-Gonduit 16. Rough Electric Wiring 17. Rough Wiring Sign 18. Rough Electrical-7 Bar Ceiling 19. Rough Heating & Air Conditioning 20.- Rough Pactory Firaplace � 21. DuCts,in Structu�e' 22. OuMs, Ventitating � . 23. Gas PipE�Rough & 7est , " 24. Roof Framing � 25. floof Sheathing 26. T-Bar Ceiling (Svucturall & Monocoat 27.� Fra�ne and Flashinq� 28. Lathing & Siding : _ . 29. Insulation � ' 30. Drywall Nailing 31. Plaster 8rown Coat , 32. Electrical Power Nleter-Final 33. Finai Electric 34. Final Heating & Air Conditioning - 35. Final Gas Pipe-Test 36. Hood os Canopy 37. Final Factory Fireplace 38. Final Plumbing � �39. Water Service=Final 40. Gas Service�Final - 41. Solar pomestic-Final 42. Backflow Preventer 43. Backflow Irrigation - 44. Landscape Irriqa[ion System - _ 45. Sound Attenuation � •46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING ` 48. FINAL PLANNING � 49. Electric Retease to Edison 50. Gas Release to Southern California Gas Co Date Date r ; 1 � 'Iospector . POOL _ oPA . . APPROVALS Permit # 52..Pool & Equipment Location -� 53. Steel Reinforcement � 54. Forms . , 55. Electrical Bonding ' 56. Rough Plumbing & Pressure Test 57. APPROVAL TO COVER�GUNITE 58. Electrical Conduit-Undrgrnd. 59. Gas Pipe, O Undrgrnd., Test 60. Backwash Lines, P�Trap, O Undrgrnd. 61. RPPROVAITODECK . 62. Backwash & Receptor�Final 63. Heater & Vent-Final � 64. Plumbing System - Final ' 65. Electrica�-Final 66. Solar SYstem-Final 67. Fencing & Access Anp�oval ' 68. APPROVED FOR PLASTERING � 69. POOUSPASYSTEMSFINAL ' FIRE DEPT. REQUIREMENT APPROVALS '�Permit # �70. Underground Hydro 71. Product Pipin� OGas OOiI . � . 72. Underground Flush 73. Undergrnci. Storage Tark O Gas ❑ Oil 74. Overhead Hydro- 75. Dry Chemical ' 76. Dry Standpipe 77. FIXED SYSTEM FINAL 76. FIRE PREV. FINA� - � HEAITH-DEPT. FEQUIREMENT 79. FINAL INSPECTION � I 80. FOOD CERTIFICATE ISSUED � Notes: � 4 t si� _ -� Date ' Inspector +�i K- �y%)ii 2 �7i�p(Cd � B_�G �--. � � � � . ii• - _ � � ;� � � � PflOJECT AOOflE$$: 4 1 EMERSON ST OWNEN'SNAME: GEOR ESEN, WILLIAM E aooaess: CHERNEY, MICHAEL J 9172 SANTIAGO DR ��. HUNTINGTON BEACH,CA 92646 ARCMIENGIN�Efl: 7 1 4 9 6 8— 4 4 5 8 flEG.NO.: ADORE55: UNIT: uxit: PEflMITTEE: RMS CONSTRUCT'ION ( 714 ) 841-5671 FDONESS: 1 I3O1 HEACH BLVD 16 HUNTINGTON BEACH CA 92647 LICENSEU CONTflACTOB OECLAflFTION: I OereOy allirm IAat I am lirens¢0 unEer D�ovisions of Chapier 9lcommencinp wii� Seciion 70D01 0� Oivision 3 01 the Business ana ProleSsions Code. ana rtry license is in full lo¢e anA eflect. arrnuc.:04818q2 STRTELIC.:S%I3S6s,,�ss Ai� �ate: A�—L-� Signature: q�� ff wOPREBS' COMPENSA7ION OELLABFTION: I nere�y ailirm tlwt I tuve a cenilicate ol consent m sell-inwre or a ceniliwie of Workers' Camoensaiion Insurance. o� a ceniliea cooY ��ereo1 �SecGon 3800. Lab. C1. POLICY NO.: E%P. URTE: COMPRNY: ❑ Ceniliee COpy is AereGy lumis�etl. ❑ C¢rl0ie0 copy a f1eG wit� t�e ciry Building Oivhion. Oate: FPpGunt ETEMPfIONFXOMWONKEflS'WMPENSIPONOECIAilATION: (TIti55eclpnnttCmtbecanple;eGifNepmril¢IaamhuMrtd�5100�a1e55�. I cenity �hal in t�e pedormdn[e al t�e work br wluc� iNs permit 6 isweG. I shatl not empby aM De«n in aM �nner 50 as to Gecome su�ject lo tAe vPoAers' LomcenSdtion �aw5 ot Catiforttid. e,/,�/, � Oate: Z� �^ � S�gnature: "'� w_• �� NOTICE: II, after maitinp �N5 4eGaraiion. yau 5hou10 Oecome SUDjttt lo ��e Woders' ComDenSation O�ovi5ion5 0� I�e LaOor Cotle. you must fonMvit� comply vn�� suc� provisions or tids permit slull Ee deemed rtvokeA. CONSTPUCTION LENOING RCENLY: I �ere�y allirm ttWt ihere i5 a tonstruttqn IenGinp apenty tor Ihe pedormance of ihe work lar whith Ihis permit iS i5SUB4 (SEctian 3W7. Civ. C�. LENDEN: AOOflESS: OWNEB BUILOEN OECLABR710N: I �ereGy alfi�m tAat l am exempt fmm ��e Comractors' S�ate license Law lor Ne lollovnnp reason (Seclion 703L5 Business ana Prolessional CaAe: My city of county wNc� r¢puires a permit io constmn, alier. imprme, tlemolis�, or repai� any slruclure, 0/ior ta ils issuance. also Rpuires t�e ap0�itdnt far such permit lo lile a signe0 statemen� ihai �Us�e is licensetl pursuam to t�e Omvisions af tAe Canlractars' State Licenu Law (Chapter 9(commencinq vni� Seciian 7000) oi Division 3 oi Ihe Business and Prolessions CaCe� or ��ai �Gs�e is e�empt iMreimm an0 ine hasa lar the alleqeU exemption. My violation ol Section 70.31,5 hy �y applicanl for a Dermlt suhle��s tAe appliWnl lo a ciNl Denalty ol not rtrote than live �unOred dollars (5500). I. as owncr Of Ihe pro0erty or my employees wilh wages as t�eir wle compensation, will tl0 Ihe work„ and Ihe l� s�ruclureis notinten4e0 orollere0tor5ale�5ection 70E4, Bu9neu antl ProleSsionalCotle: T�e Coniraclor5' Siate licensa Law ooes not apoly to an own¢r of a propeny wllo ouiltls or impmves �nereon, anU wlw does such wark nimsell/nersell or Ihmuph nis or ner own employees. prwiEeE tAat sucll imD��'emenis are nol inten0e0 ar allere0 br sale. If, however ihe buil0inp or impmvemenl is SOIE mi�in One y¢ar 0� [ompl¢tion. I�e owner vnll have Ihe CUNen ol pmvinp �Ushe dltl nol builU ar impmve lorine vuroose af ulel. 1, as owner oi i�e pm0erty, am eecluvvely wntnctinq vnth ticensed comractors to consimci i�e O�oject (Section 70aA, 8usiness ❑ antl �mfeuiuns CoGe: Tl�e CAnirattors' Slale Litense Law Oces n0i apply Io dn ovm¢r ol proptrry wtla GudGS Or impmves �her¢On ana wno coniracis lor sucn prolens wim a mmnctoqsllicense oursuantto Ine Comractors' Sia1e License Law),I am awara I�ai pma� 0� IAeir WOrker'S Compen5ali0n in5urant! 51roulE EE prdri4e0lo me. � I am eeempt under Sectiw: B. 8 V. C. lor t�is reason: oate: Or+ner. I Oo nereUy cenAy ihat i am awa�e al an0 unOerstand �ne repuiremenis ol Catilomu Heatln an0 Safery Coee Seciions 255U5, 25533, anU 255JA an0lhat I oi any luture Euilaing occupanl wilVvnn nol (titUe one) neea to wmpry vnih SaiU state coAes an0 ihe roQuiremenls lor a permil lor consVutlion or moEiliCa�ion Imm I�e Nr Oualiiy Managemenl Oistritl. FesiOeniial consimction apDlicaiians are eeempl �mm I�eSe O�ovisions. Date: MOtiwm: I hereUy artify Inal I luve rea� iMs apPlitatron ane state ttut t�e aEwe informdtiun is mrrett. I aAree to tomDN ��h all cily anE counry areinances a�d slale laws relaling Io Luilaing cunsirucinn an0 nereby aurtpr¢e reWeuntatives ol itis uty to enter upon ine aGove-mention¢d pioperiy brinspeclion purp0ses. Daie: _�=� � /_� Sipnaiure: � �� oriver's license or $ocial Security �: i6aLab wpne—Builtlmg�, Green—Cotle Enlorcemenl Canary—Apphcanp Pink—Revenue: GOIGenrotl—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 05088 PERMIT NO; B 050880 PLAN CHECK NO: N GOVT: N SUPP; N CONSTRUCTION TYPE: V—N PERMIT TYPE; STR PURPOSE: ALT JOB DESCRIPTION ; REROOF 3—TAB (GAF) COMP SQ FT: 1,800 CLAIM VALUE: 1,800.00 CALC—VALUE: , 1,800.00 GROUP OCC; R-3 / COMMENTS: REROOF COMP O/] LAYER COMP �r*�t*�t�r�r�r**�r***�r�*�r**��*�e**+t��—x**��r*�*�r�x�*�t�r�x��t�t� ****�rx�*�r��*�t*x**�x�t�r****rt�r*�* Z O N I N G R E Q U I R E M E N T S sETaacxs ------------ MAZN BUILDING ---------- ---------'ACCESSORY BUILDING --------- FRNT: FT IN REAR: FT IN FRNT: 'FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARRING REQ• PROV; PARCEL: 42624312 ZNE: REF NO: PLANNING Nf31'ES> 1 if ff iE iF if iE 1f K iE iE if if 1F 1E if iE if it k iE iE 1F if iE ik 1E iE iE iE iE if it if if !E if !E iElf iE �E iF if lE iE iE iE iE if if iE iF 3E if iF 1( iE iE it iF iElE if 3F �f iE iE 3f if iE �F 3(� 3f iE iE iE if �f !F D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY DATE: _ _ BUILDING APPROVED BY : APPLICATI013 ISSUED BY: if if i61k �E 3f i4 iE �f 1E K 1F iE iE iF 1E iFlf k!E iElE�F'{FiF 7E iE iF iE iE iE 1F 1E 1E 1E if if iE iF iE iE iE iE iF 3F �E iF it if it LEGALIZATION:N BLDG PMT PERMIT 41.00 PLAN ISSUF FEE F E E S"U M M A R Y PLUMBING ELECTRIC� MECHANIC FIRE DATE: ' 'DATE: � G��t**�rx�r* ��r I�iF+E if iE 3F IE iE if i(- iE IE rt it ik 1E iE iF iE k STRUCTURAL SEGMENT;Y SMIP/R50 GRADING SMIP/NON—kES BUILDING—DIV—> PERMIT ISSOE PLAN—CHECK TOTAL PAID DUE TOTALS----> 41.50 0.00 0.00 41.50' 41.50 ,00 REVENUE DIVISION TOTALS--> COLLEC'PED: 41,50 OVER/SHORT: 00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 91.00 ,50 ik iF if iE ik iE iE if k iE iE iE if iE iE iE iE 1FiE iE if ik 1E iE iE it ik iE if k k �E if if iE if iE iE 1E if if if� itlt iE iF if 3E if iE if if iE if iE jf iE iE k iE iE iE it �k �E �IE iE iF fE k lf # IE iE 1E iE if !f if I N D I V I D U A L F E E H R E A K D O W N TYPE QTY D E S C R I P T I O N UNZT COST TOTAL COST SFR 1800 REROOF BY VALUE RESIDENIAL NOZONE 1.00 1,800.00 END OF FEES o, 000�s�;s-oro�e�:;= � .�� OATE: p2/A;/31 7I(it= 1"':�7 /' CONSTRUCTION AND PLANNING . - JOL & SPA � APPROVALS Permit # � Date In:pector APpROVALS Permit # Date Inspector � . 1. Temp ary Electrical Service or Pole 52. Pool & Equipment Location ,i� 2. Soil Pipe-Undrgrnd., ' 53. Steel Reinforcement � . 3. Electrical Conduit Utility-Undrgrnd. 54. Forms y (-A: Electrical Conduit-Undrgrnd. 55. Electrical Bonding ' 5. Steel Reinforcement ' 56. Rough Plumbing & Press�re Test . .6s.Electrical UFER Grnd. - 57. APPROVALTO COVER-GUNITE � 7:'Footinqs � 58. Electrical Conduit-Undrgrnd. ._Ba.F,oundation � �,� 59. Gas Pipe, O Undrgrnd., Test �� 9: Water'Pipe�Undrgmd. � 60. Backwash Lines, P�Trap, O Undrgrnd. ��+,, , 10: Structural Floor System �� 61. APPROVALTO DECK ��7 � 11. Property Sewer Line�& House`Conneaion � 62. Backwash & Receptor�Final '� a 12. Sewer Cap � 63. Heater & Vent-Final � 13. Roof Drains '' `J '' � � % 64. Plumbing System � Final 14. Rough Plumbing ' ' � 65. Electrical-Final � 15. Rough Electrical-Conduit �) 66. Solar System-Final 16. flough Electric Wiring 67. Fencing & Access ApProval 77. Rough Wiring Sign� . 68. APPROVED FOR PLASTERING 18. flough Electrical-T Bar Ceiling _ 69. POOL/SPA SYSTEMS FINAL ' 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT :, � . . 20. Rough Factory Fileplace � - � � �� APPROVALS ' �' Permit # � 21.�Ducts, in Struaure r � � •• * ` � �� 70. Underground Hydro � � 22. Ducts, Ventilating R � . � '� , �± � : � 71, Product�Pipirig OGas ❑Oil 23.'Gas'Pipe-Rough & Test ; , ; ,,� ,;. - ' �' ' � � � � � �` ' : + 72. Underground Flush ,. 24.� Roof Praming� . � � . � ' � � 73.� Undergmd.�Storage',Tank OGas ❑Oil 25. Roof Sheathing � � ' - '" � �7q.� Overhead Hydro. �� 26. T�Bar Ceiling (Structural) & Monocoat • _ 75. Dry Chemical _ `� � 27. Frame and Flashing� ' 76.� Dry Standpipe � ' - `28. Lathing & Siding % � ••i '� 77.' FIXED SYSTEM FINAL' 29. Insulation '. ,' ' , i I' 78. FIRE PREV. FINAL � •30. Drywall Nailing � /� . HEALTH DEPT. REQUIREMENT 37. Plaster Brown Coat, , . ,� 79. FINAL INSPECTION a� ��32.� Electrical Power Meter:Final � � � I l�• � i 80. FOOD CERTIFICATE ISSUED 33. Final Electric: ; � , I i' , Notes: � � . � � _ ' �34., Final'Heating & Air Conditioning� _ �- ' � %(,' � , � � � 35. Final Gas Pipe'-Test'. � ' � - ' ; '2_,j�.. �((_. ,'�� i I !'I 36. Hood oc Canopy _ � � ; ��i� . � � � 64/� ' f «}, 37. Final Factory Firepface � , ` - ' � ,I - 38. Final Plumbing � � �� i y� i. _ � 39. Water Service-Pinal � I i��-i' � �- i r..,. . 40. Gas Service-Final - _ - I � f�, �� 41. Solar pomestioFinal • � � � �Ij�� * � ` , 42. Backflow Preventer� � - � ;�� 43. Backflow Irrigatior � , � � ' ' - / � . ' 44. Landscape Irrigation System � . _ 45. Sound Attenuation � � � � ' � ' 46. Handicap Regulations , � � � � � � � . � � � � 47. FINAL STRUCTURE & BUILDING � D^�l �(�(�/, � . � � ,b 48. FINALPLANNING, , I �,� 49. Electric Release to Edison � j f/� � 50. Gas fielease to Southern California,Gas Co I I� I , . . • • 51. CERTIFICATE OF OCCUPANCY , ; , , , , � . No. Date . I �onnessarea�nmo: q17 EMERSON ST oxraasr+uiEiFa+wm:WILLIAM GEORGSON ��417 EMERSON ST COSTA MESA,CA �va�. r,wia/a woxess: ANCIASECT OP ENtlNFFA: YKH OP ENG'S AUDNE59: uxr: 92626 1,�- u uc ao.: UNT: cwm�craasru�GEORGE BRA2IL �wm�crortsWnn�o 3022 N. HESPERIAN WY �ss SANTA ANA CA 92706 110EN5ED COMP1CTOfl4 DECL�X�TION: 1 Mreby allim uMs psuly d pa�jwy W (wmmentino �h Seclbn ]000) d Divieun 9 d IM &n"viem eM GMpebtu Code. �m�c.No.:O 05 8 uc.cuss:C-20 0.:6 � / e: Cam (714)541-9753 uexo.: 679898 uur: 101 IiceneeA m ere i 'a In e end P 0 /97 OWN N BNL EX 0 IAP�TION; I hreb/ effvm untler d thm am q Imn �M iredon lioeroe lew la tlw t �aemn (Setlqn R115 Butiieas md Prdmtiwu Loda: Iy wli" e Y lo mmNCY. Ms.'vnpaa. deR a repai mry ewcwn. pror m ne ueuvm, ebo rpuiro � wdi e siprod �wmwa tlW M a she i�a w�� o me wo+� a m. camree«. ��.. �w �cnaw« e�.�dm .vn swo� �000) a oa,s� a a m. eual�en eM a'd«.uin codel «�ne� ne «ans u.uma �nerdian .na �ne barie t« me e0so� axemqun. Nrv vu�mion a seaion ]W 1.5 by eiry epp6ranl fa e prmil wibjer�e Ne eppfrsN Io a d�il penMy d ml mas than fxa lw�dnd do0an �5500�. � I.eaovmerdtMpoperlyamymWbywv.i�wepmmtMisobmmpensetion.Wldothewk,vdihesv�nunim�inlmdsd a dleraE br aeb (Saciion )OII. Binueo eM Prdeae'vm CoOs: The CaMretlan l'xema Lawtlam ml eVW ben owner W pape�ly wlp puida a inprtwes iMrean, aM who doee cuM work himeell a Aenell a Nrouph he p Aer own empkyss�, pvridad Ihei euch impovanerue ars nd inleMeE a dlmad Im eeb. X, howo-ror, tM Witlirq a inpo.anM b soFl xilhin aro yw d canplelun. �M1e owr�ar�buiNar xill heve the buNan d pwirp M or ehs diC ral buik or unpare lar the purywe d seb). � I. as awror d iM O�MM. em ezd�eh oonuedM wnh lioeneed convaclaa lo canahW tln P%� (SWion )OM. Busime� aM Proleaiona COM�. TM Conlredwa li:mm lew Aom na epp!/ w en oww d popeny who builie a impwm �horaan aM who eonuazls br wq� qqam wbh s mNreCa(e) feanaed pwsuv4lo IM CONeetlon lieeme Lew). � I am uemq uMer Sedim: B. 8 P.C.. br ihb �adm: Dme: Oww: i ao nm.M �r uw i em m.�..e a.ne ��.ie�d m. Ac�=«�.�m a c.uami. rbeen.�w sder coa. s.ao�e uws. xuu..nd 45591. vM tlut I a enV Mure ddld�q oonqeM xi9 / wi nal (vcb ane) neeA ro camGN Mh �eitl Wle mda erd tM nW�nmams br • Ge�ll �IX N1ISINC�1p1 IX 1110d1�1q1 UII �f V II ��IB Af�M�lTM� �IB1M. �1�10� mllffiNtl 10119CVkd�011f N lZ0111V� �101111�1M pON]IJft1. Dme: AppliceM: WONKEN'S COMV6l9ATON DKUN�TION: I Mraby alfum undr per�My d pajury aw d Me bllow'up dedua�iom: �I haua enA xil meinlen a urlfrate d miw�t io vatlimura la wker�' mnpa�uetvn. m pwided la Ey Setlim 3]00 d IM LeEor Cada, la IM pManw�cs d iM w�k b Mirh Nie pemitl u iuued. .� I M1ew eM wJ meiMen xoM1wY aompwmc�'vw+eenoe. n�ayimsd by Setlion 3100 d Na leEa Cods. br tM pe�amenro d IM .. wak ta Midi Nu psmu w wa�el. My waken' mnWonulcn inwancs nniv W pofiry number ma: c� GOLDEN EAGLE EXPIRES va:.v �,n. 01 / 01 / 9 8 �rn;s s«.ia, neee mr e. ca�d� r m. v� u a a» nWmne da+w.lsiool d wa �i�na mm m ine wn� a m...o� ro� .ncn mm o� m�ed. iy i N.�r ..o m �b co e euMallo �M/�orkere' oompenatnn Igyo.�FCal�amie. entl/Qroe I leca9 wbje o IM Men' Inp: F�flvn ro ul�un wohui romoxwtlon eovw�p� l� bM91 i nns. �q ro m. n�ane rnou.w ewi.r.lSfaq000A � ��n Sxtlon 3)06 oI1M LtlorCoa, InMsst � attameyi Iw. CONSTtiUCf10N LFNDINO AUENCY: I hemEy elfirm wWx pmM1y d penama,re d �ne wark ror Mvtl, �he o�� u cara (s«a'v� aw]. civ. LENDEP'S NAME LENDEN'S �DDRESS: I ceNly tlai I heve read Nh epqiutian aM deb Ihet �he ebova iMamNion uWaletekx+role�inplobuikm9ro�M��^� ��_ �fOW� �elepr I«inapec�ion purpoese.��_ � �.` � wl Jwt.n �mpl ynlo crhNntl psrrltlu �rM w al compHwtb A�nrps� u pvHCW br In m. m.e m a odm�,a� w�e ro w�v m. m. ql e9� to oomdY wil� aA elyaM muMY adMenms A�h'v tiryto xuw upon �M above�memionW qaperly CITY OF COSTA MESA - BUILDING PERMI'f PERM NO: M 081508 PERMIT NO: M 081508 PLAN CHECK NO: N GOVT; N SUPP: N CONSTRUCTION TYPE; V-N PERMIT TYPE: MEC PURPOSE: OTII JOB DESCRZPTION : FAU CHANGE-OUT SQ FT: CLAIM VALOE: CALC-VALUE: GROUP OCC: R-3 / COMMENTS: NO OTAER OWRK AUTHORIZED BY THIS PERMIT �**+�x*�x�*�*�***��***�x*+�*xxx�**�**�*�*x�**��,��*��*��+�**�****�***�*��*�****�** Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING --------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT; FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING RE • PROV: PARCEI,: 00000000 ZNE; REF NO: PLANNING N TES> 7 iP �f iE if If iF if iE iE 1E IE IE IE IE fE IE IE 3E fE iE iE 1E 1f ib iF 1k ik if �E ff� iE IE fE fE iE 1E IE IE iE 1E 1E �E iE if if 1E if iE iE iE iF 1E iE if 1k fb 1E if �E iE iE 1E IE �1E 1E 1E if iElE iE iE fE iE 3E �E dF �E 3F if D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY . DATE: BUILDING APPROVED BY : APPLICATION ISSUED BY iE if ik if 1flf 7f if iE if if if if !E if if !f ff iE if fE LEGALIZATION:N F E E S U M M A R Y DATE: STRUCTURAL �EGMENT:N BLDG PMT PLOMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 13.25 258 SMIP/NON-RES PLAN '. ISSUE FEE 22,00 BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE TOTALS----> 13.25 22.00 -._ 0,00 35.25 35,25 . .00 REVENUE DIVISION TOTALS--> COLL'ECTED: 35,25 OVER/SHORT: ,00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK � 35.25 1 iI' iE iE iE'7E 1E if'lE if if if'lE iE'1E iE fE if'If'lE 1E')E iE 1E 1E ik i! k ik 1E 1E iE iE iE fE if,1E 1E 1f if 1F i6 ik if'1F iE iE iE iE if ik iE ik iE iE 1f iE iE ih')F iE i%iE iE 1E 1f iE iE iE if if i%iI' iE')E if IE'If 1E iE I N D I V I D U A L�� F E E B R E A K D O W N TYPE QTY D E S C R I P T I O�N ' UNIT COST TOTAL COST MEC 1 INST FORC-AIR/GRAV FURN <= 100 K BTU 13.25 13.25 END OF FEES Wr�u Ni=/� � r_= /-� Qn( 82-86-1997/84:14 PM/f35.25 PERMITPT081568 � � i - (5151�b.WG) WA .Qisa.Fb:Cuieiy-AppireM:Pink�isveew:(iatlenrob-Maeen � � CONSTRUCTION AND PLANNING - � OOL & SPA � t ' Date Inspector � � �a2e Inspector APPROV��S Permit # - APPROVALS Permit # , .. t. Tempo�/ary Electricai Service or Pole 52. Pool & Equipment Location � 2. Soil Pipe�Undrgrnd.- � : 53. Steel fleinforcement - �� 3. Electrical Conduit Ut�liry�Undrgrnd. � 54. Forms � � 4. Electrical Conduit-Undrgrnd. 55. Elearical Bonding . � 5. Steel Reinforcement 56. Rough Plumbing & Fressure Test . 6. Electrical UFER Grnd. 57. APPROVALTO COVER�GUNITE I .7. Footings . 58. Elect�ical ConduiI-Undrgrnd: "�8. Foundation „ - 59. Gas Pipe, O Undrgmd., Test � 9. Water Pipe-Undrgmd. " ' � � 60. Backwash Lines, P�Trap, L� Undrgrnd. 10. Structural Fioor SYstem 61. APPROVAL TO DECK � _ t t. Property Sewer Line & House Connection 62. Backwash & Receptor-Final � � - 12. Sewer Cap - ' � - . 63. Heater & Vent�Final � 13. Roof Drains ' 64. Plumbing SYstem • F.inal �� 14. Rough Plumbing• .- 65. Electrical-Final ' . 15. Rough Electricat-Conduit � 66. Solar System�Final i 6. ftough Electric Wiring 67. Fencing & Access Approval � 17. Rough Wiring Sign � �$. APPROVED FOR PLASTERING 18. Rough Electripl-T Bar Ceiling 69. POOI/SPA SYSTEMS FINAL 79. Rough Heating & Aii Conditionin9 . FIRE DEPT. REQUIREMENT ' -- 20. Rough Factory Fiieplace . -' . � . APPROVALS- _ Permit # 21. Ducts, in Structure - '' � 70. _Underground Hydro 22. Ducts, Ventilating �� 71. Product Piping O Gas 00�1 23. Gas Pipe•Rough & Test - ' _ 7Z, Underground Flush . 24. Roof Framing � � . 73�. Undergrnd.StorageTank �Gas OOiI 25. Roof Sheathing �' 74. Overhead Hvdro 26. T-Bar Ceiling (Structuraq & Monocoat � � 75. Dry Chemicai . 2J. Frame and Flashing� . ' ' - 76. Dry Standpipe . - 28. Lathing & Siding : � . - � - � -� ; 77�, FIXED�SYSTEM FINAL 29. Insulation - . ' • 78. FIRE PREV. FiNAL 30. Drywall�Nailing :.' ,_ � �� HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. F�NAL WSPECTION 32. Electricaf Power Meier�Final 80. FOOD CERTIFICATE ISSUED 33. Final Electrir �� Notes: . � m TI�Ln/� Z r.�(,, nl I � 34 ,Finai Heating & Air'Conditioning � �� ' M _ _ . � _ 35.� Final Gas PiDe-Test ' - � 36. Hood or Canopy � � .. , � 37. Final Factory Firep�ate - • � " � 38. Finai Plumbing � � ' � . . . 39. Water Service-Final � 40. Gas Service�Finai • ' . 47. Solar pomesticFinal : . � • 42. Backfiow Preventer ' 43. Backflow Irrigation . 44. Landscape Irrigation System . ' _ ' . _ _ 45. Sound Attenuation • , � - � � - . 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING - 48. FINAL PLANNING ' � 49. Electric Release to Edison , �50. Gas Release to Southern Califomia Gas Co ' �� 51. CERTIFICATE OF OCCUPANCY No. Date � r (714)754-5273 • Fex(714)754-4856 D CITY OF COSTA MESA BI/ILDING D/VISION '' DEVELOPMENT SERVICES DEPARTMENT PERMIT JobAddress: 417 EMERSON ST Suite: Vicinity: ParcelNunmber: 42624312 BUILDING PERMIT Zoning: PERMIT NUMBER T7 FAIR DRIVE, COSTA MESA, CA 92626 ISSUED BY: Applicant: GEORGESEN, WILLIAM E . � . • - • . Address: 18241 SERRANO -/ � � " ' , i �� - � Phone: 7142821355 � ' _ VILLA PARK,_CA - -�. " Zip: 92867 - . � ' r�: � � �. . '. , .� ,- �_ . Owner: GEORGESEN WILLIAM E � Address� `18241 SERRANO � � � ' J _ - , � � �ji �� ; � " Phone: ' ' �_ � ��`� VILLA PARK CA: Zip: 92861 - -�� !�;��, �.�, % � �� ,.- , � Contiactor: �� ' . � .� �� Address, �!';,/ � ��.� � � i ii; �i . , - i .• % "-�%i: PhoneC . . '�r 1, . .__, ��'. � .. , . % . I � ' ,•, " 2ip: � ,�'�, �' _ . .License: . _. ' : l" , . - , � . A�ch . . . � - � � �� .. . , �' � Eng: . � . i Address: . - , : , . � ' Address: . , . '� , � ^'' � f : i: - � '� Phone: . „ ��... Phone: � . - � � �� , ' h � .� _ - . . . •\ _�Y, ��2ip •r � � . . License: Zip: , � License: �, � � �' �� SCOPE OF.PERMIT �` �� ,. CON$TRUCT25 LF, 6' HIGH BLOCK WALL NEXT TO AN EXISTING UNIT Of A DUPLEX OFF A PRNATE DRIVE. � � . �. � FEE SUMMARY � �� Plan Check: , $38.68 = - _ � �' PermiE $59.50 - - - ' ' ��'� SMIP,Res: ' $0.00 _ ' ��SMIPCom: ' •. $0.00 --= -- ,`, , ;Other> `;'- $0.00 - -- Inspection: ` $0,00 ' , �A� , - . V`-;,Totah $98�.18.. - � � � � � �� .: , � �". .�; \ ��_ i , � � ;'� � � PLANNING & ZONING � SETBACKS;`�� ' � MAIN STRUCTURE Front 0- 0 � Rear 0- 0 ��Left 0- 0 ACCESSORY Front 0- 0 Rear 0- 0 Lek 0- 0 PARKING Existinq: 0' Required: 0 Pr000sed: 0 NOTES: ` . . . ' Status: ISSUED Applied: 07/13/7999 Issued: 07/13/1999 Calc Valuation: Claim Valuation: � � � ,` Right 0- 0 - ' Right 0- 0- " � $500.00 si,soo; o0 �, `, ; � NOTICE: The work authorized by this pertnit 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. INSPEC710NS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inapectlona and final epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5628 WORKERS'COMPENSAnON DECLARAnONT ' } I hereby aHirtn untler penalry o1 perjury one oi the tdlowing tlederetlons: ' ' ❑ I have end wlll meintain a Certificate of consent to self-Insure tor workers' compensatlon, as O�oviAetl for by section 3700 of the Labor Cotla, for tha pertortnence of the work tor which this pertnit i9 issued. ❑ I have and will meintein workers' compensetlon insurence, as reqWretl by section 3700 of Ne Lebor Code. for the peRormance ot the wark for which Ihis pertnit is issuetl. My workere' compensetion �nsurance carder entl poliry number ere: Cerrier.. ' Policy Number: (Thls section need nof be complefed il the permit !s ve/uetl af one hundred dollars ($100) or less.) ❑ I certly thet in Ihe performanca oi the work for which this pertnit is issued, I shall not employ eny person in eny manner,so as to become subject to ihe workars' compensation lews of Califomia, antl egree t�et If I shoultl become subject to the workers' compensatlon provisions ot Sectian 3700 of the Lebor Code, I shell forthwith comply with t�ese provisions. Appliwnt Signeture: Data: WARNINO: FAILURE TO SECURE Wtl��^' �M1IPENSATION COVERA6E IS UNLAWFUL AND SHALL SUBIECT AN EMP�OVER TO CPJhUr1AL PENALTIES M1D GVIL FINES UP TOONE HUNDflED TTqUSAND DOLIARE (E100,000), IN P�DR7IXJ TO THE CQST OF �MPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3108OF THE LABOfi CO�E, I�.TEFEST, AND ATTORNEI"S PEES. LICENSED CONTRACTORS DECLARATON: I hereby effirm that I em licensed under provisions ot Chapter 9(commenUng with Section 7000) at Divislon 3 ot ihe Business end Professlons Code, and my license is In full torce and ettect Lic. W Class k Conirectors Signeture: Dare: CONSTRUCTION LENDING AGENCV: ❑ I hereby eflirtn thet ihere is a consWctlon lending egency tor Ihe peAortnance of the work for which this pertnit Is issuetl. (Sec. 3097, Civil Cotle). Lender's Name: Lender's Address: SigneWre: Date: OWNER-BUILDER DECLARATIONS: 1 hereby aXirm ihat untler penalry of perjury �het I am EXEMPT FROM TME CONTRACTORS LICENSE LAW tor Ihe tollowing reason (Sec. 7031.5, Busineu end Professions Code: Any ciry or counry which raquires a pertnit to consiruct, elter, impmve, demolish, or repair any strudure, pdor lo its issuance, also requires the aDP�icant for such pertnit to file e slgneE slatement thet he o� she is licensed pursuem ro the provisions oi the Contraqors Ucense Lew (Chapter 9(commendng with Sectlon 7000) of DMsion 3 ot t�e Business enO Professions Code) or that �e or s�e Is exempt theretrom and ihe basis for ihe ellegetl exemption. Any Wolatlon ot Sedlon 7031.5 by any epplicant for a pertnit sub�ects Ihe epplicant to e clNl panalry of not more than iiva hundred dollare (5500).): ❑ I, as owner of the property, or my employees with wages es thelr sole compensation, WILL DO THE WORK, entl t�e structure is not intenaetl or offered for sale (Sec. 7044, Business end Profes5lons Code: The Conlrectors Llcense Lew does not epply to en owner ol property who builds or improves thereon, and who tloes such work himsalt or herseli or througn his or her own employees, provided Ihat such improvements are not IntendeA or oflered �or sale. If, however, t�e building or Imprwement is �soltl within one year of comp�etion, the ownei-builder will have t�e burden of proving that he or she did not 6uild or improve for purpase of sale.). I, as owner ot Ihe property, am E%CLUSIVELY CONTRACTING WI7H LICENSED CONTRACTORS to conswct Ihe projaq (Sec. 7044, Business antl Profassions Code: The contractors License Lew does not apply to an ownar oi property who builds or Improves thareon, and who coniracts for such pro)ect with a contrector(s) license pursuant to the Conlredors License Lews.). ❑ I am ex�n��r,yJs�`�� Business entl Professions Code for this reason: Signsture: j �d�f Date� Owner ID verifietl by driver's license. ❑ Ve ❑ No Drivefs License No. � Explras: Venllcetion of Ownership by (rype of dacumenl, i.e. - property teC bill or deed): DIVISION OF INDUSTRIAL SAFEn' PERMI7 CERTIFICATION: ❑ I hereby cently that no eacA�ation five (5) or more feet In Gepth into which a person Is requlred to descenC, will be made in connection with woAc euthorized by Ihis permit, anU Ihat no building structure, sceHoltling, IelsewoAc, or tlemolition or tlismentling theraoi, wlll 6e more Ihen ihirty-six (36) fee� �Igh. (Chflp. 32, Grp 2, Art 2. Sec. 341, Title 8, Cellfomia Atlml�ishe�ive Cotle). ❑ As owner-builtler, I will not employ enyane to tla work whlch wauld require e pertnit from ihe Dlvision oi Intlusirlel Satery, as noted ebove, unless such person has a permit to do such work trom the tlivision. Signeture: Date: Divlslon ot Industrial Sefary Pertnit Number: CERTIFlCATE OF COMPLIANCE AND AUTHORPA710N OF EMRY: I certify under penalry of perjury thet I have reaA this appliwtion flnd state that ihe infortnation given is correct I agree to camply wlih ell st�g laws end ciry ordinances relating to building consiruction, end euthorize representatives of Iha Ciry of Coste Mesa to enter upon the e ve-des�lj.yqa property fo�pUqC9�j,¢uR�oses. I egrea not to occupy ar ellow occupancy at eny bullding eut�onzetl by Ihis permit until final inspection. �I,�/YA/AiY/1 i\ i .c�.�.�.�- .%U /,� /3. /9 99 SignA�ure Of L Owner(s) -% � Dale qnNDr Authonzed Applicant Dete eooe.�, ixsvecnonTrve 1616 FIaeO System Finel Fire Prevention 7266 Pool Spa Flnel 200 Final Re-Roof 201 Final Block/Retaining Well 202 Finel Fectory Fira Place 203 Finel Slgn 204 Final Demolition 264&I6 -y � r`r eooer iNsvernoxTrre 206 Final Mechanical 208 Final Plumbinq 210 Finel Electrical 272 Final Fira Prevention 220 Final Plenning Approval 222 Final Site 250 Finel BullAingiOccupancy PAIE r � (714) 754-5273 • Fau (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT • Job Address: 417 EMERSON ST Suite: Viciniry: SIDE OF RESIDENCE Parcel Number: 42624312 Applicant: GEORGESEN, WILLIAM E Address: PO BQX 6252 . . i .� ORANGE, CA� �� Owner. GEORGESEN, WILLIANI E�' Address �iPO BQX 6252 � � - , �;�,�, . � �� , " , ORANGE, CA�'�� ' ` � � Contracroc OWNER-BUILDER � . � Address: �"� � i� Z�P: i Arch : -. : , . , � � � Address: � ' - � �� ' � % ,, f . `, c .Phone: \ _ Zip: . , � � Cicense: Zoning: Phone: 7�14-282-1355 Zip: 92863-6252 _ ' ' �� . � , � -- � ., .� Phone: ., � - � � � i� . . , Zip: 92863-6252 � . , . Status: ISSUED Applied: 07/13I2004 Issued: 07/13/2004 ISSUED BY: Phone: �,License: 000000 _ ' �. Eng: Address: +• JGurl CONSTRUCT A 108 SF PATIO ON LEFf SIDE OF HOUSE PER CITY Plan Check: $41.05 ; Permit: ; $63:15 SMIP Res: $6.50 ',':'SMIPCom: .,: $0.00 � Other:, '; $Q.00 Inspection: `� �,'�$0;00 '� . ��,`�Total: ,�-.$104�70 „ � SETBACKS` � � MAIN STRUCTURE Front � 0- 0 � :� ACCESSORY �Front �.0-0 PARKING Existinq: o NOTES: 9 � ;i � � , Phone: ' � '. � License: �: � FEE SUMMARY � � � ' � Calc Valuation: �S�,�ao.ss s , - - ' ,, : Claim Valuation: So.00 �/ I . �" • � - ii � . ,;;:;,' , � , '.,, - ..- �-�i -� � . , , � � i%i' � ' , � , _ �- . ;:,_ _._ , � PLANNING & ZONING � � � � i" ' . � � � % � , ;'�� . J�j /� . � � �-Reer� 0- 0 Left 0• 0 ' � Right ,��0- 0, �� .. .l '" ' _ -�- ' _r� _ C:,''„�Ci� �,j"� ,: Rear� 74- 0 LeR S 0 �_ Right �, 0- 0,� �.i� , � , � ��. � .� , Re uired: 0 Proposed� �� 0� � ' � � / / ,. �� _ _ -- .- � ' - �� NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related regulations. (Ord. No. 92-28, § 7, 12-21-92) EXPIRATION: This permit shali 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. INSPEC710NS: In order for the work authorized under this permit to be cansidered legal, such work must comply with all applicable codes, and all required Inspeetions and final approval must be obtained. Failure to obtain inspections and final approval will result in tha expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 � � WORKERS'COMPENSAnON DECLARAnON: I hereby eflirm under Oenalty of per�ury one ot the following decleretlons: � 1 ❑ I heve and wlll maintaln e cenificate oi consent ro self-Insure for workers' compensatlon, es pmvided for by section 3700 of Ihe Lebor Gode, for tha petlormance of Ihe work for which this permit Is issued. ❑ I heve antl wlll meintaln workers' compensation Insurence, es requlred by sectlon 3700 of Ihe Lebor Code, tor Ihe perfartnance af ihe work for whlch this pertnit is issued. My workars' wmpensatlon Insurence cerrler entl policy number ere: Carner. Policy Number. (Thl; sectlon need not be completed 1/ the permit /s velued et one hundred tlollers (3100) or less.) Q}'—I certity that In the peRortnence of the work lor whlch Ihls pertnit is Issued I shall not employ eny person in any menner so es to become subject to ihe workera' ��campensetlan lews oi Celifornia, end egree ih 1 should become sub�ect to Ihe workare' compensalion provlsions of Section 3700 oi the Labor Code, 1 shell forthwith complywiththese rovislp . _ %% AppllCenlSlgneNre: �� l De�tB:� �i�� 7�J 7�0d fC WARNINOt FAICURE TO SECURE WORKEPS' COMPENSA?ION C I RAOE IS UNLAWFUL AND SHALL SU6IECT Ml EMPLOYEPd IMI ENALTIE MIS D CIVIL FlNES UP TOONE HUNDRED THOUSAND DOLLARE (5100,000�. IN AODITION TO THE COST OF C PENSATIqJ, DMMGES AS PROVIOEO FOR IN SECTION 3] F THE CODE, IMEREST, AND ATTORNEI"S FEES. LICENSED CONTRALTORS DECLARATION: I hereby aflirtn that I am Ilcensed under proNslons ol C�apter 9(commencing with Section 7000) of Oivision 3 of the Business and Professions Code, and my license is in tull force en0 eHect Lic. q Cless N ContradoYs SignaWre: Date: CONSTAUCTION LENDING AGENCV: ❑ I �ereby eHirtn Ihat I�ere is a conslrudion lending agency for the padortnance ot ihe work lor which this pertnit is issuetl. (Sec. 3097, Civil Code). Lentlefs Neme: Lentlefs Atldress: SlgnaNre: Date: OWNER-BUILDER DECLARATIONS: I hereby eflirtn Ihet under penelry ot per�ury thet I am E%EMP7 FROM THE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7037.5, Business antl Professians Cade: Any ciry or wunry which requires e permit to consWct, elter, Improva, demolish, or repair any structure, prior to its issuance, also requires the epplicent tor such permit to file e SlgneC stetement thet he or she Is Ilcensed pursuent to Ihe provisions oi the ContraMors License law (C�apier 9(commendng wlih Sectlon 7000) of Dlvision 3 of ihe Business entl Professions Cade) or thet �e or s�e Is exempt therelrom end the basis br Ihe alleged exemption. Any vidation of Section 7031.5 by any epplicent for e pertnit subjecls ihe applicant to e clvll penalty ot not more Ihen tive �untlretl tlollars (E500) J: ❑ I, es owne� oi lhe properry, or my employees wlih weqes fls thelr sole compensetlan, WILL DO THE WORK, antl lhe slructure is not intended or aHeretl for sale (Sec. 7044, Buslness and Professions Cotle: The Contractors LJcense Lew does not apply to an owner oi property who builtls or improves thereon, end who does such work hlmself or �erself or Ihrough hls or her own employees, provitletl that such impwvemenls ere not imendetl or oNered for sale. If, howevar, ihe building or improvement is soltl within one year ot completion, ihe ov.•ner-builder wlll have the burden of proving that he or she did not build or improve for purpose of sale.). ' ❑ I, es owner ot t�e property, em E7(CLUSIVELY CONTRACTING WfTH LICENSED CONTRACTOHS ta construd ihe Droject (Sec. 704a, Business anA Professions COAe: The contrectors Llcense Lew tloes not epply to en owner ot property who bulids or Improves Ihereon, and wha comrects tor such pmject with e conirector(s) license Oursuant to the Contrectors License Lews.). by drivefs license. ❑ Vedfication ot Owners�iD by (type o1 document, Business end Protessions Code tor this reason: ❑ Na iOrivers Clc`ense No. property tex blll or tleetl):` DIVISION OF INDUSTRIAL SAFETV PERMR CERTIFICA710N: ❑ I hereby cerlity ihat no excevetlon five (5) or more feet In depth into which e person Is requlred ta descend, will be matle in connectlon with_work euthonzed by t�is permlt and Ihet no building structure, scettoltling, falsework, or demolition or dismantling thereoi, will be more then IhiAy-si: (36) teet high. (Chap. 32, Grp 2, Atl 2, Sec. 341, Ttle B, Celtlomle Atlministretive Code). ❑ As owner-huilder, I wlll not em0loy enyone to da wark which would require e permit From ihe Division oi IndusMel Satety, es noted above, unless such person hes e pertnit to Oo such work irom the division. Signature: Date: Division of Intlusirial Sefery Permit Number; CERTIFlCATE OF COMPLIANCE AND AUTHOROATION OF EMAV: I ceniy under penalry of perjury that I have read this aDPlication and state that the infortnetion given is correct I egree �o comply wlih ell s�t�j e laws end ciry ordinances releting to building consiructlon, anC euthonze representatives of Ihe Ciry ot Casta Mesa Io enier upon the flbova- e cri .proQerty iar insppt)j rt puryoses. I egrae not to occupy or allow occupancy ol eny building authorized 6y ihis permit until final inspection. (.�(" Y % � /, 3��0. � ' SlgnaWre�O .gal,Owner(s)�—' � �Data � `��" . And/Or Authorized Applicant Oata CODEI, INSPECf10NTYiE 1616 Fixetl System Final Fire Preventlan 1266 Pool Spa Final 200 Final Re-Roo1 201 FInaI8locWRetaining Well 202 Flnal Factory Fire Place 203 Final Sign 204 Flnal Demoll�ion p� �g cooe� ixsvecnoxnve 206 Final Mechanical 20B Final Plumbing 210 Final Electrical 212 Final Fire Preventlan 220 Finel Planning Approval 222 FinalSite 250 Final euilding/Occupancy onrE R�d1� �' ' �T .� :[ � �uon¢saeaimiu: 917 GMC.ttSVN SL oxrawsru�eva+ara: JORGENSON �oonEsx 419 EMERSON ST COSTA MESA, CA 92626 �vr�. w¢wa �ooxess: 1qt111fECT OP FNC�NFFA: ucr+a unr:�fA j CITY OF COSTA MESA - BUILDING PERMIT �� PERMIT NO: M 086530 PLAN CHECK NO: N CONSTRUCTION TYPE: V-N PERMIT TYPE: MEC 11MH OR EN6'S AUDNE53: UNf: coNm�crarsxu¢:GEORGE HRAZIL PI,MH, HTG, (714)541-9753 CONIAALTORSYARRM 3801 LENAWEE AV ,�o�� CULVER CITY 90232 CA uG"°.: 6�7N9898 LICENSED CONTPACTOFS OECLAflATION: I Mnby dlrm uMr pene�y d pa�jury tlet I em lioenaed wder prwiebns d Cheqs B ��m.�oo wan s.�ua, �aoo) d w+�o� a d in. s��..m a�a...�. coas. �e mr u� e� iw a�w �e .nw. cmuc.No.:060568 uc.cuss:C 20 uc.r+o.: 679898 EXP: 08/98 om.: �! I a-/ �1 t3 c�a��''Y✓� , t�:P-+.Jtpn..d-As� OW NEX BUILDEIi OECUIN�TON: I Iweby dfirm uMw paiWy d py'Nry �ry� � y� p�q ryy� �M Ca¢rmm Licmus lew la Na IOAowiq rsewn (Saaion ]O�t.5 &nneea md Rdmebro Cod�: My �y a mun�y wtivh mpwm e D�Y to aumbuct. Mw. imVv.e. Asmd'nh. a rM� e^Y etrwiva. 0� m da ewence. dro �e9�a �h eGV� ta mrA 0�� to fYs e dP� amrnmt Nm M a�M '. �icamad a�u io ine p�wivoiu d a. con'ma limnvs lew �GAepx e(mmmmeno wn sea'vn ]000) a oirewn 3 a �ro IiniMn eM Pralmom Codel a thm he a dro o uanq ihereM1an end �M besv tar Ihe eAepsE ssemqion. MY vide�ion d Swion lW t.5 by eiry eppliunl la a permil wblen+ iM eppfceM lo e uW ppal�y d rcl mae then fwa huMnE tla0en �S.AOp. ❑ �.a.oxn«auewowm«mremWw«ewmweo«min.:.d.mmw�.mim.wioeom.w«x.eneu».wwna�amimw.e yeryered br uy (Sec�pn ]p16. Butliww vM ProlxaionsCods: Ths CoMreGae L'xwe lewdoa nol epp�y loen ownmd poperry who buide a inqwae thareon, eM v.fio Eom auch r.vrk limey� y�y a Nraph he a Mr own omplv/eee, pwiAeE tMt a�ch imP�meMs ua rc�'vuenEed u dlend lar sab. tl. howaver. tM buiM'vq or inpo.a^eM o edd wnhin ona Ysar W oomPMion. Ne mmer-0wltler will hew the burtlen d painp M a 4a did nd pdd a impewa In Ne qvpoee d mlel. � I. n owerr tl �M O�W�Y. em exM�awlY eont�rf'rq wiN 6unlaE eanl�Mas b mnmw tln pMb (5etlion ]W�. Bw'vre anE Pmfesaans COCe: The Camratlon Licenr lew Eom M eppty lo en owmr d pw�Y v.Ao builds a'unV�'�w thaaon W who eanlreeb /a wrh pqeda xnh e mMeatlar�e) lieanaad punueM lo tM CamreGan Lioenae lnwl. � I em exemq uMar Senion: B. 8 P.C., lor thb reaeon: Dets: �� 1 eo MreM wnJY Nx I em .wue a eM ukasiuk ma rem+inm«b d CeOanie lbetlh vd selar coda Seaioro n5o5. 255�J. ane T5531. enG tlw I v enY Mws bd1EuV omqw_ will / wil m� (acM ww) mad ro mmCN w1� uid pme mds W tM �apuvam�nb b eDanmlacomUucuonumaErtrstonhamlMM�t enepanw�tlOblritl.MrideNilmW�uCionePO��msaaemNM1omlMw DNs: MN� WOHKER'S COMPEN9ITON DECIAXATION: I Mreby elf urdq py�y�y d psjuy ans d tM Idbw�ieq detleimum: � �nse.newilmeiolei�.catfrm.ammn��o.en;wnro�wak.:odno�:r.a+a�r«Mswianamotl�n.L.nv coa.. ia m. o«��. d o» �x i«.mKn mm v� e a.�.e. ❑ �n.ro.naWmeiM.b.o�kw.•mno��mwren..m�w�Ms.a'v�a�moam.leEvcode.w.mew�amenoeam. wak tu MiiM Uu W�e u minE. YY warFen' pn'vw umx aM D�Y �m a: ��», .�—�"n�,+r. 1�-e�.�.rbl Pdiry Numbar. � r aection iroM nw 6s cwnpleted I tM permk ie la one hu�M�ed dMlen �SIOJ) a len.) If M� I cenly Ihel in Ihe pe�lamerca d IM wark for whch thia pert�ll h buetl, I Mell ml empby vry pe�wn in em� menner eo m to T' bscwro aubl� to �M workere' rompeneelion levn of Celilomu. yM prea ihm X I Mwk becane wbjatl to IM xoiMnia' compenxlim pwia^iona oi Setlion 3]00 N iM labor COEe, I MyI1MhMilh aom wuh iMw p�ovi+o'n. DMe: � / � ?�� DdicW: � �Q�Bi�M , W�mMp: F�Nun b ucun irorten' mnperustlon rov�rep /s u�lnvlyl, NrdMtll ub/�ct �n w�np/qw� ro eAM�ul pwultluW uvn nn.. uy m m. n'nersd rnou,+na aann f�+W �A ��W�don ro m. eo.t or mmp.iwean �w u povaw ror �n S�ctlon 81a6 oI1MWor Cotiv. /nroro�4 uM �rtomql Isa. CONSTPUCTION LENMNU �OENCY: I MnW elfim undar penyiy d per'ryry �hm �hrs u e oomt�urlion bkiiq epam.y br Ms pMormar�ca d tM Mak M xhidi th'v paml u awed (Seaion �OY>, Civ. C�. IENDEP'S NAYE LENOEfl'S �ODflE55: I canilytlw I hew �ed iAu epplire�im eM nms Ihet IM ebv.a'vdwr�ypn o canetl. I epne to comply with eA dry aM wurqy ad'vwion uW sltls lewe raWiq b EuJdip conffiutlian vd herWf e�nlwca �yjy� d Ihis eryto mter upon tM e�ava.meNionaE popa�ry "`��'0"��P�°"`�MICHELLE HENDERSON Dme: `� �O'�� 0 (S151JB.WP) While-Buikirp 8 Sekry; Oreer�Fb; Cenery_Appfcent; Pink-Rarnnw; OdEenm'4Nae»v JOB DESCRIPTION : WALL HEATER REPLACMENT CLAIM VALUE: CALC-VALUE: m9 � D PERM NO: M 086530 GOVT: N SUPP: N PURPOSE: OTH SQ FT; GROUP OCC: R-3 / COMMENTS: NO OTHER WORK AUTHORIZED BY THIS PERMIT +r**�r************+�***r��+�**�r**� *�+�*�r***+�+�*�****�*+��r****x�+�**�**+t*********x *****�+�* Z O N I N G R E Q U I R E M E N T S S E T b A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING --------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ: PROV: PARCEL: 42629312 ZNE: REF NO: PLANNING NOTES> � •y� 1E iF ik iE iE iE 1E iE iE 1f iE if fE �1E �E 1E 1k 1f if 1E 1! k�E �t iF iE iE i! 1t 1E 1ElE ik k it it it jf iE 1Flf 1t it k it if if iE iE if if !f iE 1E if if if iF 1E M iF ik i! 1E 1F iE iE iF iF iE iE fE i! IE if �E iE �k jE D E V E L O P M E N T S E R V—I C E S R E Q U I R E M E N T S ZONING APPROVED BY . HUILDING APPROVED BY : APPLICATION ISSUED BY: DATE: DATE: �" DATE� � �Z �� LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADZNG PERMIT 13,25 258 SMIP/NON-RES PLAN ISSOE FEE 22.00 BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE TOTALS----> 13.25 22.00 0.00 35.25 35.25 .00 REVENUE DZVISION TOTALS--> COLLECTED: HLDG PMT PLUMHING ELECTRIC MECHANIC 35.25 35.25 OVER/SHORT: 00 FIRE SMIP/TOT GRADING PLAN-CHECK ik 1f if if !f iE ik it if� it iE it iE IE 1k iF iF ik if ik iE iE iE iE �E iE k 1E 1F iE iE iE �E 1E ik 1f iE fk 1E iE iE iE ik i! ik iE iE 1F 1E iE if 1E iE iE iF ik iE 1t iE 1F �F iE ik 1E iE iE iE 3k iF iE 1E 1f ik �E if if 1k 1! iE I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST MEC 1 INST/RELOC RECESSED WALL HEATER 13.25 13.Z5 END OF FEES �l-I2-.;iu/�3:31 P:1/;'s5.__ �C:;�'r:_ ;.i; s'c.:ii 1i: .T e �Efr:�c" CONSTRUCTION AND PLANNWG � POOI PA _-' APPROVALS Pe[Qit �h Daie Inspector qppROVALS Permit # Date inspector 1. Temporary Electrica! Service or Pole 52. Pool & Equipment Location __ -• 2. Soil Pipe-Undrgmd., -- 53. Steel Reinforcement - 3. Electrical Conduif-.Utility�Undrgrnd. 54. Formt �' �� 4;. Electrical Conduit-Undrgrnd. '`� 55. Electrical Bonding ".�, � 5. Steel Reinfo�cement 56. Rough Plumbing & Pressure Test , � 6. Electriwl UFER�Grnd_ 57. APPROVAL TO COVER-GUNITE . 7. Footings - 58. Electrical Contluit�Undrgrnd. 8. Foundation - 59. Gas Pipe, � Undrgmd., Test , 9. Water Pipe-Undrgrnd. - • 60. Backwash Lines, P-TraR. � Undrgmd. 10. $trutturel Floar SY:tem 61. APPROVAL TO DECK ' 11. Properry Sewer.Line�& House�Co�nection 62. Backwash & ReceptorFinal _ 12. Sewer Cap � 63. Heater & Vent-Final ' y 13. Roof Ora��s - '- � 64. Plumbing System • Finai � 14. Rough Plumbing ' - 65. Electrical-Finah '� 15. Rough Electrical�Conduit • � � - 66. Solar System-Final " . 16. Rough Electric Wiring � - 67. Fencing & Access Approval ; 17. Rou9h Wiring Sign , 68. APPROVED FOR PLASTERING � 18. Rough Electrical•T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL � 19.. Rough Heating & Air Conditioning . ! , - FdRE DEPT. REQUIREMENT � - - - ' + 20. Rough Factoiy Piaeplace • � ��. � - ' -� "- APPROVAL'S �; Permit # � � 21: Dupts, in 5truaure � � . • � 70. Underground Hydro � 22. Ducts, V¢ntiiating' . ' � 71. Product Piping O Gas � Oil 23. Gas Pipe•Rough & Test - � � _ 72. Undergvound Plush . 24. Roof Framing � , �� ' 73. Undergmd. Storage Tank O Gas ❑ Oil 25. Roof Sheathin9 :-+. � � . -� 74. Overhead Hydto • 26. T•Bar Ceiling (S2ructuraq &�Monocoat ' ' 75. Dry Cherpical , ' 27. Prame and Flashing . .' . 76. Dry Standpipe- �_ 28. Lathing & Siding "* � � ' 77. FIXED SYSTEM'FINAL � � - 29. Insulatio� ��- ' �. 78. FIRE PREV. FINAL 30. Drywall Nailing � , �,HEALTH DEPT. RE�UIREMENT 31. Plaster Brown Coat �-� � 79. FINAL INSPECTION ., . 32. Electrical Power Meter�Final 80. FO00 CERTIFICATE ISSUED � 33. Finel Eleciric. _ _ . Notes; - - ' - 34. �ina( HeOting & Air Conditioning !��! , �� -' 35. Final Gas P�PQ-Test ' � " � � , , �- � . ' 36. Hood or CanoPY � � ' ' .' -� . . ; 37. Final'FaCtory Firepiace ` " . , � . � � 38. FinalPlumbing « . '�� ' ` 39. Water Service-Finaly ' ^�� , ; 40. Gas Service-Finai . - � � . 41. Solar pomesticFinal - � 42. Backf�ow Preventer, ' � , , � � 43. Backflow irrigation - ' - 44. Landswpe IrriAation System - �. � i � � • , • 45. Sound Attenuation • ' �;� 'n' - , ' - ; 46.�Handicap Regulatio�s . . - �. � � 47. FINAL STRUCTURE & BUILDING � ' , . a ' 48. FINAL PLANNING� � - - 49. E�ectric Release to Edison ..� -� . ' 50. Gas Release to Southern California Gas Co : - . 51. CERTIFICATEOFOCCUPANCY No. Date (714) 754-5273 • Fax (714) 754-4856 • www.ci.casta-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 1ob Address: 41�i� EMERSON ST Suite No Vicinity: Parcel Nunmber: 42624312 Applicant: BROWN,BARBAR Address: 3801 LENAWEE AV CUWER CITY. CA Owner: GEORGESEN, WILLIAM E Address 18241 SERR4N0 VILLA PARK, CA PLUMBING PERMIT Phone: (310) 25&5229 Zip: 90232 Phone: Zip: 92861 Contractor: GEORGE BRAZIL PLUMBING, HTG. Address: 3801 LENAWEE AV Arch / Eng : Address: CULVER CITY, CA C/O OF WATER HEATER. ISSUE FEE Backflow irrigation Backflow Preventer , Bathtub Clarifier System Connect (Ice,Soda,etc) Dental Units Dishwasher Drein, Floor Drain, Rainwater Drein, Roof Drinking Fountain Expansion Tank Gas Earthpuaka Valve Gas (1-4 outlets) Gas (Over 4 outlets) Gas Repipe Gas Service Interceptors (Grease, Oil) Interceptors (Sand Auto ) AMT 523.50 50.00 50.00 ao.oa' $0.00 -' $0.00 $0.00 50.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 50.00 50.00 50.00 50.00 50.00 50.00 Phone: (370) 253-5229 Zip: 90232 License: 679898 Phone: ---Zip: License: SCOPE OF PERMIT FEE SUMMARY QTY . AMT Laundry Tub / Washer $0.00 0�� . Lantlscape Irngation 50.00 0�� ` � P-Trap 50.00 �0 , �� Pressure Regulator $0.00 0• � � Process Piping (per 10 ft) $0.00 0 , ' - Receptors $0.00 0- . Septic Tank $0.00 0- Sewer Cap for Demo 50.00 �0�- . Sewer Connect $0.00 0: - Sewer Private Line 50.00 0 -^ Shower $0.00 0 Sink, bar 50.00 0 Sink, commercial 50.00 0 Sink, Floor $0.00 0 Sink, kitchen $0.00 0 Sink, service/mop $0.00 0 Spa (private) $0.00 0 Spa (public) $0.00 0 0 Status: ISSUED Applied: OS/24I2001 Issued: OS/24/2001 ISSUED BY: Qrv. - �0�� SumpPump . . 0 .Swimming Pool � 0 - '�Trap Prim,er;� , � 0; ;=i'` Urinal !- ' 0 �' � "� , � � Vacuum Brkr Bkflow(1-4) 0 , . � Vacuum Brkr Bktlow(5+) 0 ` . Wash Basln - 0 � � Wash-Basin Set � 0 . Waste and Vent System - 0 , � - Water Closet (Toilep 0 , � � water Heater / vent 0� Water Piping (Inst or Rep.) 0 Water Re-pipe 0 water Service 0 water SoRener 0 OTHER 0 VIOLATION 0 PLAN CHECK REINSPECTION COMMENTS / SPECIAL CONDITIONS TOTAL CALCULATED FEES: AMT 50.00 50.00 50.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 50.00 512.30 50.00 50.00 50.00 $0.00 $0.00 $0.00 $0.00 30.00 535.80 QTY 0 0 0 0 0 0 0 0 0 0 i 0 0 0 0 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) y EXPIRATION: This permit�shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abantloned for a period of 180 days. INSPEC710NS: In ortler for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inepeetlons and tinal approval must be obtained. Failure to obtain inspections and final approval will result in the expiration ot ihis permit. FOR INSPECTIONS CALL: (714) 7545828 2a46d8 (8�00) WORKERS' COMPENSATON DECLAfiAT10N: ' � I hereby eHirtn unCer penelry ol perjury one ot the following tlecleretlons: ❑ I heve entl will meintein e ceNlicale of wnsent to sell�tnsure for workers' compenseLon, es proNtleE for by sectlon 3700 of the LeDor Cotle, tw Ne pertormance of Ihe work Por whlch Ihi9 pertnil is issued. '�-�I have antl wlll malntein workers' oompensation insurence, as require0 hy section 3700 ot the Lebor Cotle, tor fhe paAormance af the woAc for which Ihis pemtlt is IssueC. �- - My workers' c pe ation Insu�re^nce carriRr entl poliry number are: — ��J �� Cartier. ,S��L F-�l h�Y� Poliry Number:~ `Q /�� i �(Thls section need nof be comD�etetl i/ fhe permit is ve/uetl e( one hundred dollers (8/00) or less.) -- - ❑ I certity that In ihe peAo a ca W Ihe work for whic h pertnit I5 I55ueQ I s�all nat employ eny pereon In eny manner so as to bocome ubject to the workers' compensation lawa of el mia, e egree ihet It �o Itl become sub�ect to ihe workeB' compensatlon provislons ot Sectlon 00 of e Lebor Code, I shall tonhwlt� comply wllh �hese pr ns. � �� O� Appiicent Sipnature: - Dats: — WARNVJO:�FnILURE TO SE RE WORKERS' GOMPENSATION CpVEMpE IS UNUWFl1L AN� SMALL SUBJEGT MI EMPIOYER TO GRIAaNAL PENALTIES M!D GML FlNES UP R7 ONE MUNDREp T1IWSAND DOI.L4RE (5100.0OO�.IN AOIXiION TO h1E GOST OF COMPENS�TqN, DAMNOES 0.S PRdAOED Fdi IN SEGf10N 31060F THE IABOfi COOE.IMEREST, AND ATfORNEV'S FEES. LICENSED CONTRAC70R5 DECLARATION: I hereby efflrm ihat I am licensed upde�pr�s�ni oJ��apter 9(cammencing wi�h Section 7000) ot Division 3 oi the toroe and etfect. Llc..a. � � 7`' y 6 ., � `Cless Contrectofs Signature: �( �d��a�,.�. D`_te: ��_.-- Code, antl my IicenSe Is in full � CONSTiiUCTION LENDING AGENCY: ❑ I hereby ettirtn Ihal Ihera is e constructlon lending e8anty br Na DeAormence oi the work tor which Ihis pertnit is issued. (Sec. 3097, Clvll Code). � Lentlers Name: Lenders Adtlress: Signature: Oate: OWNER-BUILDER DECLARAT10N5: I �ere0y eflirtn thet under panelry of per�ury ihel I em EXEMPT FROM 7HE CON7RACTORS LICENSE LAW lor ihe tollowing reeson (Sec. 7031.5, Business antl Prolesslons Code: Any ciry or counry whkh requires e permit to consWcL etler, impmve, demolish, or repeir eny siructure, prior to its Issuance, elso requlros the epplicanl for such permit to file a sipnetl statement thet �e ar she Is Iicensad pursuam to the provisions of the Conireaora LJconse lew (Chapter 8(commencing with Sectlon 7000) oi Divlslon 3 ot the Business entl Proiessions Cotle) or ihet he or eho is ezempt Iheroirom and Ihe basls for the allepetl ezomptlon. Any violation oi Sectlon 7031.5 by any epplicent for e Oermit su0leds ihe applicant to e clvll penelry o1 not more then Ilve huntlred dollers ($500).): ❑ I, es awner ol ihe property, ar my employees with weges es thelr sole compensation, WILL DO THE WORK, and the structure Is not intentletl or oHered for sale (Sec. 7044, Business and Protesslons Code: The Coniractors LJcense Lew does not apply to an owner ot pmpeny who builds or improves thereon, end who tloes such work himself or herselt or through his or her own employees, pmvide0 that such Improvemenis are not intendetl or aHeretl tor sale. IL however, the building or improvement is sdtl within ona year af completion, ihe owneo-builtler will �ave the burtlen ot proving Nat he a she did not build or improve tor purpose af sale.). ❑ I, es owner ol the properry, am EXCLUSIVELY CONTRACTING WIT11 LICENSED CONTRACTORS to construct Ihe project (Sac. 7044, Business antl Prolessions Code: The contrecrors Llcensa Lew does not appty Io en owner of pmpeny who bulitls ar improves thereon, end w�o contracts tor such pro�ect with a contractor(s) Iicense pursuen� to l�e Contrectors LJcense Laws.). ❑ I am exempt undor sec. Slprreture: Owner ID ventied by tldvef9lkense. ❑ V09 ❑ No Businoss entl PrOfa55ions Cotle lor Ihi9 ree5on: Vedlication at Owners�ip by pype of documenL i.e. - property tex bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATON: Orive/s License No. Da1e: Expires: ❑ I hereby carliy thet no excavetion live (5) or more teet in depth into which e person is reQuiretl to tlescen4 will be msde in connection with work authorizetl by this pertnit, and Ihet no buildinq structure, scaHolding, taLsework, or tlemoli�ion or dismantlinp Nereat, will ba mwe than thirty-six (38j leet hig�. (Chap. 32, Grp 2, Art 2, Sec. 347, Titla 8, Celifomle AdminlstreUve Code). ❑ As ownerbullder, I will nol employ enyone to do work whic� wwid require e pertnit trom the Divislon ot Industrial Sefety, as noted eDwe, unless such peroon hes e pertnit to tlo such work tmm Ihe tlivlslon. Signature: Date: Division ot Industrial Safery Permit Numbar. CERTIFlCATE OF COMPLUWCE AND AU7HORIZA710N OF EMRY: I cenify under penalry ot perjury that I have read this flppliwtion and state that ihe Infortnation given is correct. I agree to compty wiN all siete laws entl ciry ordinances relating to Dulltling constn�ctlon, entl authorize representatives ot Iha Ciry ot Casla Mesa Io enter upan the above-descri�ed property for inspecGon purposes. I a9rae not ro oaupy or allow occuDancy ot any building authonzed by this permit until tinal inspection. COOE I. IHSPECTIONTYVE 1678 Fixetl System Final Fire Prevention 1288 Prol Spa Final 200 Final Fa-Root 201 FIna181ocWReteining Wall iI�Y] 203 Final Factary Fire Placa Finel Sign 204 Final Damolition PdiE IIII�Lfl CODE� INSPECTIONTYPE 206 Finel Mechanical 20B Final Plumbin9 210 Final Electrical 212 Final Flre Prevenlirn 220 Finel Planning Apprpval 222 Flnal Site 250 Finel Building/Oaupancy PAIF. I�L9 b-as-o� a !� ' r" ��ia> �sa-s2�3 • Fax (»a� �sa-aese Job Address: Suite: Viciniry: CIN OF COSTA MESA BUILpING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT 419 EMERSON ST REAR OF HOUSE Parcel Nunmber: 42624312 BUILDING PERMIT Zoning: � 77 FAIR DRIVE, ISSUED BY: App�icant GEORGESEN WILLIAM E - • - •. � CA 92626 Status: ISSUED Applied: 07/13I7999 Issued: 07/15I7999 , i..- - Address: 1ffi41 SERRANO � . . ' � � � . � - ' Phone: - � VILLAPARK,CA � , ' Zip: 92861 ." ' - �, �, �" �� , i � �, . Owner. GEORGESEN,�WILLIAM E ' . � � Address�i�18247 SERRANO�� .-- - � - - + � _ _ - �� ' i � � , ; - i . : Phone: ' � - A �ii / � �. .' . � \,' `._ /VILLA PARK, CA Zip: 92861 ti , - ,�� , A � ' �� , � Contractor. ��/�j�� '�;�� .,'. +i � /�,Address: /,�� :: "�.�� :.`,. � ��' ' Phone: � - ' / , � - � �;i /� � � "' , _ Zip. ,�'. _ . .: �License:� � � � � .. - � _ � „ � . ' � Arch : ' . � ' ' Eng: . � � '� Address: , i . Addresst � , . , j�,� " ' � Phone: ;, Phone: � .' ! ��Zip '. ' License: Zip: , ' Litense: �� i � � / :�, � 82SF SCOPE OP PERMIT \ CONSTRUCT 3 FOOTINGS 1� PATIO COVER.BEHIND AN EXISTING RESIDENCE. 510 SQ. FT. REAR YD � COVER4GE OK; 150 SQ.FT. PROPOSED (REFLECTS EXISTING PATIO COVER AT 415-B EMERSON WHICH IS ON THE � SAME LOn. � , �� , - . . � - � FEE SUMMARY , � „Plan Check: $48.59 � Calc Valuation: , �� . Permit ; $74.75 Claim Valuation: " �� SMIP Res: �.� �$0.50 � ��SMIP,Com:- � �$0.00 �, �. � � �1� Other.- �_,$0.00 � � � � � - Inspection: . $0.00 � �A � � � . �Total: � $123.84 � � � � � \\�� SETBACKS �` � MAIN STRUCTURE Front 0. 0 ACCESSORY Front 4 0 PARKING Existinq: o NOTES: Rear 12• 0 Rear 0- 0 Re uired: 0 PLANNING & ZONING ; Left 0. 0 Left 0- 0 Proposed:- �0 Right 0- 0 Right 0- 0 � � 52,933.84 $500.00 NOTICE: The work eNhorized by this permit shall comply with all applicable handicap access requiremenis under Celifomia stetutes and related regulations. (Ord. No. 9248, § 1, 12-21-92) EXPIRATION: This permit shall autometically ezpire and become void if work is not commenced within 180 days, or if work is suspended or ebandoned for e period of 180 days. INSPEC710NS: In order tor the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and ell required Inepectlone end flnal epprovel must be o6tained. Failure to obtein inspections and finel epprovel will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545628 WORKERS' COMPENSATION DECLARATION: . . � '� I �ereby eHirtn untler penelry ot perjury ona ot Ihe Idlowing dedereUow: � ' ' [�J I �ave entl will mainiein e certificate ai consent to setl-�nsure tor warkere'�compensetlon, as Drovitled for by section 3700 of the Lebor Code, tor 1he pertarmance of 1he work tor which �his pertnit i9 issued. ❑ I �ave entl will meintaln workers' compensation insurence, az required by seclion 3700 of Ne LeDor Code, for Ihe pertortnance of Ne vrork lor whkh Ws pemilt Is Lswetl. My workere' compensatlon Insurence wrrier erM pdi�y number are: Carder. Poli�y Number. (Th/s secHon nee0 not be wmpletetlll Ne pemilt is ve/uetl ef ane hundred ddlers (5100) or IessJ ❑ I canity Ihet In Ihe pertormance of Ihe xrork for which this pertnit is issued, I s�all not employ eny person in any manner so as to Decoma sub�ect to the workers' mmpensatlon laws of Califomia, antl agree that it I s�oultl become subjea to the workers' compensetion proNsions ot Seclion 3700 ot the Lebor Code, I shflll fanhwith comply wlih ihese provi5ions. Appllcant SlBnature: Date: WARNIN�: FAILURE TO SECURE WORNERS' QOMPENSATION ODVEMOE IS UNIAWFUL rWU SNALL SUBIECT Ml EMPLOVER TO CRIMINAL PENALTIES PND qVIL FlNES UP TO ONE HUNDREO THOUSAND DOl1ARE (5100.000), IN ADDRION TO THE W5T OF COMPENSITION, DAAMGES AS PFiOVIOED FOR IN SECTION 3]O60F THE UBOR CODE, IMEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirm Ihat I em Ilcensed under provlsions of Chapter 9(commencing with Sectlon 7000) al Dlvislon 3 of the Buslness end Professlons Code, end my Ilcense Is in full force entl eHect. Lic. a Cless x Contractors Slgnelure: Dete: CONSTRUCTION LENDING AGENCY: ❑ I hereby aflirm �het Ihere is a constructlon lending agency tor the pBAortnence oi l�e work tor which this permlt is luuetl. (Sec. 3097, Clvll Code). Lendefs Neme: Lendefs Address: Signeture: Date: OWNER-BUILDER DECLARATIONS: I �ereby atfirm Ihat under penalry ot per�ury ihet I am EXEMPT FFiOM TXE CONTRACTORS LICENSE LAW tor Ihe tollowing reason (Sec. 7031.5, Busineu aiW Profes5ions Cotle: My city or counry which requires e pertnit ro consWCl, alter, improve, demolish, or repair any slrucWre, pdor ta its issuance, elso requires t�e appllcant lor such pertnit ro tile e sipneG statement Ihat he or ahe is licensed pursuant to Ihe provisions of the Comractors License Lew (Chapter 9(commencing with Seciion 7000) of Division 3 of the Business enC Protessions Catle) or that �e ar she is e:empt Ihereirom a�M the �asis for the elleped exemptian. Any violatian ot Secllon 7031.5 by eny eppllcant tor a pertnit sub ects Ihe epPllcant to e Gvll penelry of not more Ihan frve hundretl tlollars (SSOOjJ: I, es owner ol Ihe D�aPB�Y. a� my employees with wages as t�eir sde cnmpen5etion, WILL DO THE WORK, antl the struciure is not intended or ottered lar sale (Sec. 7044, Business entl Professians Code: The Cantranors License Lew tloes not eppty to en owner of property who builds or improves thereon, end who tloes suc� work himself or herselt or Ihrough his or her own employees, provided thet suth improvements ere not intendetl or ottered for sale. If, however, ihe bullding or Imprwement is soltl wit�in one year oi completion, the owner-builder will have the burden ot proving t�at he or she diA not 6uild or improve for puryase oi sele.). ❑ I, es owner of the property, am EXCLUSIVELY CONTRACTNG WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business entl Protesslons Code: The contrectbrs License Law does not eppty to en owner of property who builEs or Improves thereon, antl who contracts lor such projact with e contractor(s) license pursuant to the Contractors License Lews.). ❑ I am e m t seF. Business end Professions Coda for thls reason: sigoawre: ��6rj¢2t /A-r-Q,/.GGs✓ oa�e: 6 Owner ID ved�d Dy tldver's Ilcense. �❑ Y ❑ No o��ars uoaoso No. / Eryires: Veritication of Ownership by (rype ot documenL I.e. - property tex bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby canlry thet no eacavetlon ilve (5) or more feet In tlepth Into whicti e person Is requlretl to descend, will De made In connectlon with work euthwized by this pertnit, entl thet no Duiltling struMure, scaXolEirig, talsework, w demditlon or Elsmentling thereot, wlll be more then thlrty-sia (3G) teet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, Cellfomia AdministretNe Code). ❑ As owner�builtler, I wlll not employ anyone to do work w�ich woulO require a permlt from t�e Division of Intlustriel Sefery, as notetl above, unless such peraon has e permil lo do such work Irom Ihe division. Signeture: Date: Division ol Industrlal Safery Permit Number: CERTIFlCATE OF COMPLIANCE AND AUTHORQA710N OF EMAV: I certity under penalry of per�ury that I have reatl this application antl state that Iha infortnation given Is cortect. I agree to comply with ell te laws and ciry ordlnences relatinp to hulltling wnstmction, end aNhorize representatives of Ihe Ciry at Coste Mesa to enter upon the� ebove-tles property tor Ins 11 purposes. I egree not to occupy or allow occupancy ol eny bullding authorized by ihis ermtl untll ilnal Inspection. �l//.��.� �' 7/P/6 /� �' �`�— SlgnaNre Oi gal Owner(s) � Dete AnNOr Authorized Applicant Date CQOE I, INSPECTIONTYPE 7618 Fl:ed System Final Fire Preventlon 1288 Pool Spe Final 200 Flnal Re-Rool 201 Finel BIocWReleining Well 202 Final Fecrory Flre Plece 203 Finel Slpn 204 Final Domolllion 2a668 � It4� ��J,�t i .%�i:' eooe� iHsvernoNTvre 208 Finel Mechenical 200 Finel Plumbing 210 Finel Electdcel 212 Finel Fire Preventlan 220 Finel Plannlnp Approval 222 Flnal Site 250 Finel Bulltling�Occupancy PAffi � �� onnessaew�m+u: q19 EMERSUN ST °""E"s"""E"'°'o�": JOkGENSON eooxEss: q 19 EMEkSON ST COSTA MESA, CA 92E26 APPL. WIIIIIG AUONER4: APCXRECT OR FNmIffA: RCN. di ENO.'S ADDNESS: uxt: J \�, uc no, UNf: ��+^+�T�g� GEORGE BRAZIL PLMB, HTG, ( 714 ) 541-9753 �«m+��*an�uu�o 3801 LENAWEE AV �o� CULVER CITY CA �� b7989�_ 110EN5EU COHffl�CTONS OECLAPATON: I elrrm udr pena�y d'prl � ' d CMqx B (wvneewnq wilh Seelian ]000) d Oivieion J d airon eed Pmlppoeu . and afl�W�. cm uc. no.: G� 5 6 A� ua cuss: L-- � 8 9 c • i(7tS /i3 (f ii�i�rr �n��i� � �'� ,`��. ...�I/. . r�: : � CITY VF COSTA MESA - bUILDING PERMIT PERMIT NO: M G89b57 PLAN CHEi'K NO: N Ct�NSTkUC720N I'YF�E: �-N JG& LESCRIPTION ; WALL HEATEk CLAIM VALUE: PERMIT TYPE: MEC C�1LC-VALUE: PERM NO: M G84b5 GOVT: N SUPP: N PUkPOsE: UTH 5�,7 FT : GkGUP OCC: R-3 / COMMENTS: X *iF�F*ii�rtitx�fif�FiEiE�Eir-�E�Ex�tiE�it�xit*�E�*�e�FiE�E�eit�t*�Fit�e*�e,r;tit�FiFi(�3c*x*�ieiF*iE�Ei��e�E�E��EiE**iE�iFhir�lE�E�*+esE,t Z O N I N G R E Q U I R E M E N T S '-1 S E T H A C K S ---------- MAIN BUILDING ---------- NT: FT IN REAR: FT IN FT: FT IN RGHT: FT IN - ACCESSORY BUILDING - - FRNT: FT IN REAk; FT IN LEFT: FT IN RGHT: FT IN °'°" ' �' "� °' °°"°°'• •• � PARKING RE PROV: PARCEL; 42624312 GNE: REF NO: emaleh. n r ' eiry e mre. q'v ia u�ueM.a. e6o ep �M ep Ip rmi lo fJe e dpinE amatl CW M a�M _ �� . ,r�„�,aap,�,�wmm.a�.am.com�m�.' i... «s .�v.vnsam �da.:�,3au» PLANNINV NOTES> � 8ua'viac en0 Prdwioro Codel a �ntl Ir u tlr e mcemq uM iM ' la ebpeE u . Nry vioWion d bwion � �mi.SMem'eoP��l«awrma+ubi��hewdiamto d a eooenl�U. iitiiexii3i3iicii3i�iiicici�iEiiic.raiFic�lciiicii�li�EiEi6jc�iFi'r�kjiiFieiEitiEiciEiEiEi'riiiEiffEiEriEifii�iEiE#ifii��iiFicifieii�iFiii'ririFiFi"rieii�x+eieier. ❑ i,��.,ainewow�v�mr«�dw».�••n,..oa.mm.: �.m�..;ua,m.�«x.�eme.w�no�a�iwea D E V E L V P N3 E N T S E R.V I L E S k E U I R E M E iV T S ndlmedlaeeblSectionlOu.Bum�aaeMVMaaaionaCods: CaMrotlaelinrueLewAoeaMWWYloanowrordpapMY i) who Wida a inpo.ea thereon. enE who doea euch xvk h'vneell a hrser a Ihra� h'v p M Oan emObYw. p�b IMI w[� " ' �p,w.�,�m,,.�„iw.�a.a«aro�.ai�.w.n.nm.....,m.waa��«mn�«aawu�,mnm�.r�d�pa�+.n» ZONING AF'PRVliEU BY v DATE: ownereuaa« .a i,m�s ine dmfe� d w�+�+o ne « ene eid na a.v «imo� �« me woa.• d mel. ❑ �. o o.nu a �ne nwdn..m a��r ma�.a�u wmn fos�wd wwxas ro wmma ms o�qa Isw'vn row. ae:rs ena PMmeioro Gods: The Cav�auaa L'canw lew dos iw eW�Y b en wnw d V�W�Y Mn ddd� a vnpa'w Ilwcn and Wn eonVmn br arh 0�9�� xtih a mueeaMa) �cemeE Wni�em �o �M Cam�mm L'cerue leW. � I em memq uMx Senion: B. 8 P.c.. b Nu reeaan: Dete: � i m nueM �r mm i em.�.,�. a.m �er.une u,e ranonm«m a uumd. �aenn.�a smw coe. swan uws. us.v..d T5591. enG Mel I a enV Mwe W�E'vi0 �wN wiA / wA m� (ticls ans) nseA m oomdY w�ih uid mte raMe eM IM n0�matls br e Ga�fmmruwction a moddm'v�hvm iMAi�eneYm+b Outrid. MrideitlNmWVAian eOV�iamen exaM hom tlws pamnu. o,ce: �oW�n: WORKEN'S COMPENS�TON DECLAR�TION: I hwsby eiRrm uMx penMy d px'ryry an d tM Idbw'up AMereton: ❑ in,.<.m.u�m�.Pons�.woa.«,im..rc;�m,.oaa:�wm...n��ws.mma�oodm.i.ce. Cade, ta iM pMamvice d Me xM la wFich Nb pamE's uswE. ❑ �nenmd.ameir0en.oita.•wnw��,�.a,�Mswim3looam.Lm«coa..w.u»pelamvicea�ns A �valk fa w1�irA tl�'v parm's u m11BA. MY ��'RkmY mmpenemian'vu�umce mnief W pofcY n+mNr M: c�.: r.nT.r,r.N FAa7.R EXPIRES Pd'ry Numbar. T7 W t 7 d 1 L. — 1 Jj'�Jr (ihia pCian neM ml Ds mnde�eJ l NSW�t if b aro �SIPO nJ �I cM Nel� �in t`'/,� perl�� d ihe wak c� ihw Po� q'' pl Mell n ury m nar� becmryie wdeOlO �M�e' canw wn lawe d Callomi ! a �M om.: i � naor / W�m4g: I n b�� un nort�n'ronpwu�flon • I N , uM I• ��Ix�mplarr b cr4N �I pwWtlpW clHl 9nu ro aw I�uWnd NouaaMOadYn (tl OA M�OGl/oi o fM e t o ompwu�fbM1 Eunpr proHWtl br /n 9�etlm J106 0l tlro Lebor Cod, Intaru4 xW �tro 1 ha. CONSTRUCTION LENDINO AOENLY: I MreEq uMer alry d prjury ih tlra b e mrWeutli enE"vp apeney br ths pmlormerca d iM wak br whid� thi prmi u ew 9081. Ciu. C). LENDER'S NAYE: LFNOEP'S ADUNE34: I ceMy tAm I Mw nad Ni pfrslun end pata we o ' n u wnq. I lo mnply w'v� e0 Ny enE muXyadirieiaes eMetalelexenleliq iN�qco u' lis eNhaixanpe enlet Ihu toeMaruponlMabvn� papMy laim on �rpo F'�F . EDW " DS �: � ".d5 W P) W 8 Seley: araeMFle: Cenery-App5ranl: Rnk-Revanw: (3a1Em BUILDING APPRt�C%ED BY : ICATION ISSUED BY LEGALIZATION:N F£ E 5 U M M A R Y BLDG FMT PLOMHING ELECTRTC MECHANIC PERMIT 13.25 258 PLAN ISSUE FEE BUILDING-DIV-> TuTALS----> Z2.�� i.i� PERMIT ZSSUE PLAN-CHECK TOTAL 13.25 22.00 0.00 35.25 DATE: /� Li�TE; '"/ ��J % iEjEififi�'aF3c3E i! irifiE iM1�i STRUCTURAL SEGMENT:N SMIP/RES GRADING SMIP/NON-RES PAIL DUE 35.25 .OU REVENUE DIVISION Tt�TALS--> COLLECTEU; 35.25 OVERJSHORT: .00 BLDG FMT PLUMBZNG ELECTRIC MECHANIC FIkE SMIP/iUT GRALING PLAN-CHECK �, 35.25 TN jtltlt'R'Rf�1t�')\")!<Ritftlt')t'!t'R)t"k'�'It�F9c'�')t'Rjt'1C'Rjt)t9tjllf'k*3tleYtF�'.�']f'K'ifltjt'Rx'1\'1tltFftilftat'�tit'R:f�FIl9t1!'K']�'R1Fit'itic'R1i"R I N U I V I U U A L F E E B R E A H D t� W N TYPE QTY U E S C R I P T I O N UNIT COST TUTAL COST MEC 1 RELU FOkC-iiIR/GkAV FUkN <= 1G0 K BTU 13.25 13.25 END OF FEES 89-10-1997/03:55 P'rf/635.25 5C4'TN:'vl-2G1e120 Ptkl'7IT e 0846`�7 CONSTRUCTION ANDPLANNING POl ,SPA� APPFOVALS Permit # Date Inspector . qppROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pooi & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Sceel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit�Undrgrnd. � 55. Electrical Bonding � 5. Steel Reinforcemeni 56. Rough Plumbing & Pressure Test 6. Electrical UFEfl Gmd. � 57. APPROVAL TO COVER•GUNITE J. Footingt 58. Electriral Conduit-Undrgrnd: 8. Foundation - . 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe�Undrgrnd. 60. Backwash Lines, P�Trep, � Undrgrnd. 10. Structural Ploor Svstem � 61. APPROVALTO�AECK f 11. Propxriy 5ewer Line & 4ousa Connection 62. Backwash & Receptor-Finai , ' � 12. Sewer Cap � .63. Heater & Vent-Final , 13. Roof Drains • �64. Plumbing System � Ffnal 74. Rough Plumbing �- 65. Electrica6Final - , 75. Rough Electrical-Conduit -. ' 66. Solar SVstem-Final ' 16. Rough Electric Wiring - 67. Fencing & Access Approvai 17. Rough Wiring Sign . ,- 68. APPROVEO FOR PLASTERING � 18. Rough Electrical-T Bar Ceiling ' � 69. POOL/SPA SYSTEMS FINAL � 19. Rough Heating & Air Conditioning - FIRE DEPT. REQUIREMENT � 20. flough FaGtory Fireplace APPROVALS Permit # 21. Ducts, in $truaure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping OGat ❑Oi� 23. Gas Pipe-flo�gh & Test 72. Underground Flush 24. Roof Frarning 73. Undergrnd.StorageTank ClGas ❑Oil 25. Poof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling ($tructurel) & Monocoat 75. Dry Chemical 27. Freme and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXEO SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywa�l Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter�Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning ! � 35. Finai Gas Pipe�Test 36. Hood or Canopy 37. Final Factorv Fireplace 38. Final Plumbing 39. Water Service•Final 40. Gas $ervice•Final 41. Solar pomestic-Final 42. Backflow Preventer �43. Backflow Irrigation � 44. Landscape Irriqation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL S7RUCTURE & BUILDING 48. F4fVAl PLANNING . 49. Electric R¢lease to Edison � 50. Gas Release to Southern California Gas Co 51'. CERTIFICATE OP OCCUPANCY No. Date