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Home My WebLink About2836 NEVIS CIR - Building Permits(714) 754-5273 • Fax (714) 754-0856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 2836 NEVIS CI Suite No Vicinity: KITCHEN Parcel Nunmber: 13943154 Applicant: PARIS, JOHN Address: 6757 GAVIOTA AV LONG BEACH, CA Owner: KINDEL, WILLIAM H TR Address 2836 NEVIS CIR COSTA MESA, CA Contrector: JOHN C PARIS Address: 6757 GAVIOTA AV Arch / Eng : Address: LONG BEACH, CA PLUMBING PERMIT Phone: 562-428-5792 Zip: 90805 Phone: Zip: 92626 Phone: 562-428-5792 Zip: 90805 License: 457110 Phone: Zip: license: Status: ISSUED Applied: 09/11/2002 Issued: 09/11/2002 � i . : /i� . SCOPE OF PERMIT INTERIOR KITCHEN REMODEL TO INCLUDE FRAMING LIGHT-WELL IN AN EXISTING CEILING IN A SFD. ELEC, MECH AND PLUMBING PERMITS PULLED IN CONJUNCTION WITH THE KITCHEN REMODEL. 1 GAS OUTLET (1-0), 1 KITCHEN SINK REF: 802-01462 ISSUE FEE Backflow irrigation Backflow Preventer Bathtub Clarifer System Connect (Ice,Soda,etc) Dental Unifs Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Drinking Fountain Expansion Tank Gas Earihquake Valve Gas (1-4 outlets) Gas (Over 4 outlets) Gas Repipe Gas Service Interceptors (Grease, Oil) Interceptors (Sand Auto ) AMT $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 so.00 50.00 $0.00 $0.00 $0.00 $6.15 $0.00 $0.00 $0.00 $0.00 $0.00 QTY FEE SUMMARY AMT Laundry Tub / Washer $0.00 Landscape Irrigation $0.00 P-Trap $0:00 Pressure Regulator $0.00 Process Piping (per 10 ft) $0.00 Receptors $0.00 Septic Tank $0.00 Sewer Cap for Demo $0.00 Sewer Connect $0.00 Sewer Pnvate Line $0.00 ShOwer $0.00 Sink, bar $0.00 Sink, commercial $0.00 Sink, Floar $0.00 Sink, kitchen $9.80 Sink, service/mop $0.00 Spa (private) $0.00 Spa (public) $0.00 QTY 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 SumpPump Swimming Pool Trap Primer Urinal Vacuum Brkr BkFlow(t-4) Vacuum Brkr BkFlow(5+) Wash Basin Wash Basin Set Waste and Vent System Wa[er Closet (Toilet) Water Heater / vent Water Piping (Inst or Rep.) Water Re-pipe Water Service Water Softener OTHER VIOLATION PLAN CHECK REINSPECTION AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 TOTAL CALCULATED FEES: E39.45 QTY 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 NOTICE: The work authorized by this permit sf(dpjbjy{�yj� pl$��pfjlg p�jf�q�$ requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) /�j EXPIRATION: This pertnit shall automatically expire and become void it work is not commenced within 780 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,�d all required Inspeetiona and final epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this peimit. FOR INSPECTIONS CALL: (714) 7545626 2C4&48 (fi/00) WORKERS' COMPENSArON DECLAfiATON: � � I hereby ettirm under penalty of perjury one of the following declarations: ❑ I have and will meintain a cenificate ol consent to self-Insure for workers' compensation, es providad for 6y section 3700 of the Labor Cotle, for ihe pertormence ot the work tor which this permit is issued. ❑ I have and will maintain workers' compensatlon Insurance, as required by sectlon 3700 oi the Labor Cotle, for the perfortnance of ihe work for which this pertnit Is Issued. My workers' tompensetion Insurance Cerrler Bnd policy number are: Cerrier: Policy Number: (Thls section nseO nat be completed il the permit Is value�d ef one huntlred tlollers ($100) or Iess.J � I cetlity that in ihe peAormen of ihe work lor 1 if� Ifthis permit is issued, I shell not employ any person in eny manner so as to become subject to the workers' compensetlon laws of eli nia, end egree �fl should becroma subject to t�e workers' compensatlon provislons of Section 3700 of Ihe Labor Cotle, I shell forthwi[h comply with thesa p�' ns. 1 Applicant Signeture: � � Dete: � — ` � _�� WARNING:FAILURET ECUFE9�'MKERS'COMPENSFTIONCOVERAGEISUNUWFULANDSNALLSU6IECTANEMROVERTOCRIMINALPENALTIESANDpVI�FlNESUPTOONEHUNDRED THOUSMlD DOLLAR St W,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTIIXJ 3)O60F TNE LABOR CODE, INTEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby ettirm that I em 'ce s d.un�prqvysi4 force end eHect. Lic. k �� • Coniractor's Signature: CONSTRUCTION LENDING AGENCY: with Sectlon 7000) of Division 3 ot Ihe Busl�ss ar�tl�r\es�ns Code, antl my license is in tull qass N �� F� Date: � �' � � � � I here6y aflirtn Ihat Ihere is a consiruction lending agency tor the pedormanca of iha work for which this permit is issued. (Sec. 3097, Civil Gode). Lenders Neme: SignaNre: _ OWNER-BUILDER DECLARA710NS: Lendefs Adtlress: Dete: I hereby aXlrtn Ihet under penelry ot perjury Ihet I em EXEMPT FROM TME CONTRACTORS LICENSE LAW for Ihe following raason (Sec. 7031.5, Business entl Pratessions Code: Any ciry or counry which requires e permit to constmct, alter, improva, demolish, or repeir any structure, prior to Its Issuance, also requires ihe epplicant for such permit to tlle a signed stetement that he or she Is licensetl pursuam to ihe provisions oi ihe Contractors License Law (Chapter 9(commencing with Section 7000) oi Divlslon 3 of ihe Business and Protessions Code) or thet he or she is eaempt iherefrom end the besis for the allegetl eaemption. Any violatlon of Section 1031.5 6y any epplicant tor a pertnit subjecis ihe applicent to a civil penalty of not more than five hundretl dollars ($500).): ❑ I, es owner of the property, or my employees with weges as iheir sole compensatlon, WILL DO THE WORK, end the structure is not intendatl or oHeretl for sele (Sec. 7044, Business and Protessions Cotle: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work hlmself or herself or Ihrough his or her own employees, pmvitled that such improvemenis are not intended or ottered for sale. tl, however, iha building or Improvement is soltl within one year of completion, the owner-builtler will have the burden of proving t�at he or she did not builtl or improve for purpose of sale.). � I, es owner of ihe praperry, am EXCLUSIVELY CONTRACTNG WITH LICENSED CONTRACTOPS to construct tha prolect (Sec. 7044, Business and Protessions Cotle: The conlractors License Lew does noi eppty to an owner ot pmperty who builds or improves ihereon, and who conirects for such pmject wl�h e Conlraclor(s) license pursuam to ihe Contractors License Laws.). ❑ I am eaempt under 5ec. Si9n8tUl8: Owner ID veritietl by tlnveYs license. ❑ Ves ❑ No Business antl Profe55i0n5 COde fOr thi5 re85on: Vedflcation ot Ownewhip 6y (type of document, I.e. - propeny tau 6ill or tleetl): DIVISION OF INDUSTRIAL SAFETY VERMIT CERTIFICATION: DriveYs License No. Date: Ezpires: ❑ I hereby certity that no excavation five (5) or more feet in depih into which e person Is required to tlescentl, wlll be mede in connection wit� work euthodzed by this permit, entl that no 6uilding strucWre, sceHolding, falsework, or demolition or tlisman�ling ihereof, will be more Ihan ihirry-sia (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Ttle 8, Califomia Adminisiretive Cotle). ❑ As owner-builder, I will not employ enyone to do work which would require e permil from the Division of Industnal Setery, es noted above, unless such person hes a permit to tlo such work from the tlivision. Signature: Date: Division of Indusirial Setery Permit Number. CERTFlCATE OF COMPLIANCE AND AUTHOHIZA710N OF EMAV: I cehify under penalty ot perjury that I have read this application and state ihat the Informetion given is correct. I agree to comply with all state lews entl ciry ordinances relating m builtling constmction, and aut�onze reprasentetives of the City of Cos�a Mesa to enter upon the ebove-described properry for inspection purposes. I agree n�o occupy or ellow occupancy of any building euthorized by Ihis permit until final inspection. COOE 1. INSPECTION TYGE 1616 Fixed System Final Fire Preven�ion 1286 Pool Spe Final 200 Finel Re-Roof 201 FIneI BIocWReteining Well 202 Final Factory Fire Place 203 Final Sign 204 Finel Demolitian � ' �IIIIn47 �� 'O�e Data COOE 1 INSPECTION TYVE 206 Final MeChaniCel 208 Finel Plumbing 210 Finel Elec�riCal 212 Finel Fire Preventlon 220 Final Plenning Approval 222 Final Site 250 Final BuiltlingiOccupancy Q� ItIIID�Lfl • • ��7 . (714) 754-5273 • F� (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: Suite No Viciniry: Parcel Nunmber: Applicant: 2836 NEVIS CI KITCHEN 13943154 PARIS, JOHN Address: 6757 GAVIOTA AV LONG BEACH, CA Owner: KINDEL, WILLIAM H TR Address 2836 NEVIS CIR COSTA MESA, CA Contracror: JOHN C PARIS Address: 6757 GAVIOTA AV ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool / Spa Lighting Fixts Recept Outlets Switches Non Res Appl Res Appl Service to 200a Service to 1000a Service over 1000a Motors to 1hp Motors [0 10hp Motors to 50hp Motors to 100hp Motors over 100hp Communication drops Sub panel to 200a Pole Light Pkg Si9n Circuits Temp Pwr Pole Intertned Pole LONG BEACH, CA ELECTRICAL PERMIT Phone: 562-428-5792 Zip: 90805 Phone: Zip: 92626 Phone: 562-428-5792 2ip: 90805 License: 457110 ISSUED BY: Status: ISSUED Applied: 09/11/2002 Issued: 09/11/2002 SCOPE OF PERMIT INTERIOR KITCHEN REMODEL TO INCLUDE FRAMING LIGHT-WEIL IN AN EXISTING CEILING IN A SFD. ELEC, MECH AND PLUMBING PERMITS PULLED IN CONJUNCTION WITH THE KITCHEN REMODEL. 10 LIGHT FIXTURES, 4 OUTLETS, 7 SWITCHES REF: 802-01462 $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $11.00 $4.40 $7.70 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantity 0 0 0 10 4 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FEE SUMMARY Temp Dist System / Lighling Busway /100 ft Standing Section Misc ElecVical Equipment Transfortners up to 1 kva/kw ................up to 10 kva/kw .................up to 50 kva/kw .................up to 100 kva/kw ..................over 100 kva/kw Low Volfage Equipment Low Volt Wiring System / Ckt Misc. Conduit Misc. Conductor Circus ( gen or ride) Circus (mech ride or lights) Christmas Tree Stantl Fireworks Stand Other Electdcal Fee Investi9ation Fee Plan Check Fee Reinspection Fee Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 $0.00 TOTAL CALCULATED FEES $46.60 COMMENTS I SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handirap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28. § 1, 1241-92) 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 requlred inspections and final approval must be obtained. Failure to obtain inspections anG tinal approval will result in Ihe expiration of this pertnit. FOR INSPECTIONS CALL: (714) 7545626 zaae�ae (voo) // WORKERS' COMPENSATION DECLARATION: — I hereby eXirm under penalry of perjury one of ihe following declaratlons: ❑ I heve and will maintain a ceniticate of consent to salt-Insure for workers' compensation, es provided for by section 3700 of ihe Labor Code, for ihe pertormance ot ihe woM for whiCh ihis pertnit IS issuetl. ❑ I have entl will maintain workers' compensation insurance, es requiretl by section 3700 of ihe Lebor Cotle, lor Ihe pertormance of Ne work for w�ich Nis permlt Is Iuued. My workers' compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be comp/eted i/ the peimit is valuetl al hundred dollars ($100) or less.) �I cenity that in the pert an ot the work br whi ihI permit is issued, I shall not employ eny person In any manner so as to become subject lo the workers' compensa�lon laws alif ia, end egree tha �rrbuld �ecome sub�ect to the workers' compensatlon provlslons of Section 3700 of the Labor Code, I shell forthwit� comply with �hes� vi i s. ��, /��/ �/� 1 AppliCant Siqneture' �� L��'� ' Dele: – I' 1 I`�Z WARNINQ: FAILURE T SECURE WOFKEfiS' COMPENSATION CAVERAOE IS UNLAWFUT AND SHALL SUBJECT AN EMP�OVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HIINDPED TIIOUSANDDOLLA ($100,0OO�,INADDITIONTOTHECOSTOFCOMPENSATION,�AMAGESASPROVIDEDf-0RINSECTION3]080FTMELABORCAOE,IMEFEST,ANDATTORNEY'SFEES. LICENSED CONTRACTORS DECLARATION: I hereby affirtn ihat I am ' ense under provis� torce enC ettect. Lic. M Conirectofs SigneWre: with Section 7000) of Division 3 ot t�e Busir�pss antl �ofissi� Cotle, entl my Ilcense is in tull CI855 M I � Date: � " ) � ' � �_ CONSTRUCTION LENDING AGENCY: ❑ I hereby aflirtn that ihere is e consirudion lentling agency tor t�e peAortnance of iha work for which this permit is issued (Sec. 3097, Civil Cotle). Lenders Name: Lenders Address: Signeture: OWNER•BUILDER DECLARATIONS: Date: I hereby eHirtn Ihet under penalry ot periury ihet I am E%EMPT FROM 7HE CON7RAC70RS LICENSE LAW tor Ihe following reason (Sec. 7031.5, Business entl Professions Cotle: Any ciry or county which requires a permit b construct, elter, improve, demolish, or repair any structure, prior to its issuance, also requires the epplicant for such permit ta file e slgnetl statement thet he or she is licensed pursuent to ihe provisions of the Conirectors License Lew (Ghepter 9(commencing with Sectlon 7000) of Dlvision 3 of the Business end Professions Code) or ihat he or she is exempt Iherefrom and Ihe basis for the allegetl exemptlon. Any violation oi Section 7031.5 Dy eny epplicant for e pertnit su6jects Ihe epplicant to a civil penfllry of no� more than five hundred dollars ($500).): ❑ I, es owner ot Iha properry, or my employees with weges es their sole compensation, WILL DO TlIE WORK, and Ihe structure is not intended or oHeretl lor sale (Sec. 7044, Business and Professions Code: The Coniractors License Law dces no� apply to an owner of property who builds or improves �hereon, and who tloes such work himsetl or �ereelf or through his or her own employees, pmvided ihat such impmvements are not imenaetl or oHeretl for sale. If, however, �he bulltling or impmvement is solA within ane year of completion, Ihe owner-Duiltler will �eve t�e burden ot prodng that he ar she did not build or improve for purpase oi sale.). ❑ I, as owner of the property, am E%CWSIVELV CONTRACTNG WITH LICENSED CONTRACTORS to construct the project (Sec. 704a, Business antl Protessions Code: Tha contrectors License Lew does not apPly to en owner of property who builds or Improves t�ereon, entl who contracts tor such pro�ec� with a conirector(s) license pursuent to the Coniractors License Laws.). � I em exempt under sec. Signature: Owner ID venfied by dnver's license. ❑ Ves ❑ No Business and Professions Code for this reason: VerHication of Ownership by (type ot document, I.e. - propeny tex blll or deed): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: Driver's License No. Date: E:pires: ❑ I heraby certify ihat no excavation five (5) or more teet in depth into which e person is required to descend, will be meda in connection with work euthorized by this pertnit, end that no building structure, sceHolding, felsework, or demolition or dismantling thereof, will be more then ihirry-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, 71I1e 8, Califomia Adminisiretive Code). ❑ As ownerDuiltler, I will not employ enyone to do work which would require a permit from the Division ot IndusMal Satery, as noted abwe, unleu such person has e pertnit to do such work from ihe tlivision. Signeture: Date: Division oi Intlusirial Sefety Pertnit Number: ICERTIFlCATE OF COMPLIANCE AND AUTHORIZATON OF ENTRV: I cenify under penalry oi perjury ihat I have reatl this application and state ihat the infortnation given is I correct. I agree to comply with all state laws and clry ortlinances relating to building construction, and authonze representatives ot Ihe Ciry of Costa Mesa lo enter upon the ebove-tlescriDed property for inspaction purposes. I ac�r e not to occupy or allow occupancy of eny building euthonzed by this pertnit until finel inspaction. COUE I, INSPECTIONiYPE 1616 Fixetl System Final Fire Prevention 1266 Pool Spe Finel 200 Finel Re-ROot 201 Finel BIocWRetaining Wall 202 Finel Factory Fire Place 203 Final Sign 204 Finel Demalition Q� INTRIALS °� —11 ,o_a°=�a oa�a COUEA INSPECl10NTYPE 206 Finel Mechanical 20B 270 212 220 Final Plumbing Final Elaciriwl Final Fira Prevention Final Planning Approval 222 Final Site 250 Final Buildin<y0aupancy � � (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: Suite No Vicinity: Parcel Number: ApplicanC Address: Owner: Address: 2836 NEVIS CI KITCHEN 13943154 PARIS, JOHN 6757 GAVIOTA AV LONG BEACH, Cq KINDEL, WILLIAM H TR 2836 NEVIS CIR COSTA MESA, Cq Contractor: JOHN C PARIS Address: 6757 GAVIOTA AV LONG BEACH, Cq MECHANICAL PERMIT Phone: 562-428-5792 Zip: 90805 Phone: Zip: 92626 Phone: 562-42&5792 Zip: 90805 License: 457110 Status: ISSUED Applied: 09/11/2002 Issued: 09/11/2002 SCOPE OF PERMIT INTERIOR KITCHEN REMODEL TO INCLUDE FRAMING LIGHT-WELL IN AN EXISTING CEILING IN A SFD. ELEC, MECH AND PLUMBING PERMITS PULLED IN CONJUNCTION WITH THE KITCHEN REMODEL. 1 HOOD WITH MECH EXHAUST REF: B02-01462 ISSUE FEE Inst FAU <100 k BTU Insl FAU >100 k BTU Repair/Alt Cooling/Heat Inst / Rep. Recess Wall Htr Refrig Sys <100 k BTU Refrig Sys >100 k BTU Gas Piping Factory Fireplace Hootl w/Mech Exhaust VAV Box Vent Fan / Single Duct Appliance Fire Dampers Smoke Dampers Inst or Relocate Appl Vent Air Handlers < 10000cfm Air Handlers > 10000cfm Floor Furnace Floor or Suspend Heater $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.p0 $6.15 $0.00 $10.65 $O.DO $O.DO $O.DO $0.00 so.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantity FEE SUMMARY Repair! Alt Absorbtion Unit Repair / Alt Refrigeration Unit Ventillation System Evaporative Cooler Comme rci al I ncinerator Domestic Incinerator Compressors / Absorption Svstems Upto3hp/t00kBTU 3To15hp/SOOkBTU 15 To 30 hp / 1,000 k BTU 30 To 50 hp / 1,750 k BTU Over 50 hp / Over 1,750 BTU Boilers Upto3hp 3To15hp 15to30hp 30 to 50 hp Over 50 hp Other Mechanical Fee Investigation Fee Plan Check Fee Reinspection Fee i ��✓ �uantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 TOTAL CALCULATED FEES $40.30 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under Califomia 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 1 BO 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 inspectlona 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) 7545626 crr�.1(•1:91 WORKERS' COMPENSAnON DECLAfiAnON: � � I hereby ettirm under penelty of perjury one of the tollowing declarations: ❑ I have end will maintain e cenificate of consent to self-Insure tor workers' compensetion, es provided tor by section 3700 of the Lebor Code, For ihe pertormanca of ihe work for w�iCh this pertnit is issued. ❑ I have and will maintain workers' canpensetion Insurance, as requiretl by section 3700 of tha Lebor Code, for the pertortnance of the work for which Ihis permit is issuetl. My workere' wmpensation Insurence carrier entl policy number are: Carrier: Policy Number: (This section need not be cromple/ted il the permif �s v ued et one hunUred dollers ($100) or /ess.J �I cerliy that in the p�(fo gnce of ��e work�lor hich this permit is issued, I shall not employ eny person in any manner so as to become subject to iha workers' compensation law f�tomia, 9nd egree at It I s ultl becoma subject to t�e workere' compensetion provisions ot Section 3700 of iha Labor Code, I shell forthwith comply with ihes o ions. //� G Applicant Signe�ure: V Date: 1� \� � O� WARNINO: FAILURE TO CURE WORKERS' COMPENSATION COVEMGE IS UNLAWFUL AND SHALL SU&IECT AN EMPLOVER TO CRIMINAL PENALTIES AND dViL FlNES UP TOONE HUNDRED THOUSAND DOLLARE ( 00,000), IN ADDITION TO THE COST OF COMPENSATION, DAMFGES AS PROVIDED FOF IN SECTION 3]OB OF THE LABOR CODE, INTEREST, AND ATTOFNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirm ihat I an torce an0 eHecl Lla M, Gontractors Signeture: CONSTRUCTION LENDING AGENCY: (commencing with Section 7000) of Division 3 ot Ihe Busjn055 a�d�P\ofj3ssions Coda, and my license is in full Class A �� \-1 li oate: �1 - I 1 - b .�- � ❑ I hereby aflirm ihal there is a construction lending agency for the pertormance of the work for w�ich this permit is issued. (Sec. 3097, Civil Cotle). Lender's Neme: Lender's Address: Signamre: OWNEH-BUILDER DECLARATIONS: Date: I hereby aflirtn Ihet under penalry ot perjury Ihet I em E%EMPT FROM THE CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business and Protessions Cotle: Any ciry or county which requires e pertnit ro constmct, alter, improve, tlemolish, or repair any siructure, pnor to its Issuance, elso requires the applicant tor such permit to file e signetl starement that he or sha is licensed pursuant ro t�e provisions of ihe Contredore License Law (Chapter 9(commencing with Section 7000) of Divislon 3 ot the Business end Professions Code) or that he or she is e:empt thereirom and ihe basls 1or the elleged exemption. Any violetion of Sectlon 7031.5 by any applicent far e permi� su6�ects the applicant to e civil penalry of not more than five hundretl dollars ($500)J: ❑ I, as owner ot the property, or my employees with wages as their sole compensaiion, WILL DO THE WORK, and iha structure is not intendetl or oHeretl tor sale (Sec. 7044, Business antl Professions Cotle: The Contrectors License Law does not apply to en owner of properry who builds or improves Ihareon, antl who does such work himself or herself or through his or her own employees, provided ihat such improvemenis are not intentled or ofleretl for sale. If, however, the building or impravement is soltl within one year o� completion, ihe owner-builder will have the burden of proving that he or she did not build or improve ior purpose oi sale.). ❑ I, as owner ot the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRAC70R5 to construci the proJect (Sec. 7044, Business and Protesslons Code: The contreCtors License Lew does not epply to en owner of pmparty who builds or Improves thereon, end who contracts tor such pmject with a conlrector(s) license pursuant to t�e Contractors Licansa Laws.). ❑ I am exempt under sec. Business end Professions Code for this reason: Signeture: Date: Owner ID venfied by dnvefs license. ❑ Ves ❑ No Drivefs License No. Expires: Verification of Ownership by (rype of document, i.e. - praperty tax bill ar deed): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby cartity Ihat no excavation five (5) or more feat in depth into which a person is required to descend, will be made in connection with work authonzed Dy ihls permi�, antl �hat no builtling s�ructure, scattoltling, falsework, or demoli�ion or tlismantling t�ereof, will be more ihan thirty-six (36) fee� high. (Chap. 32, Grp 2, An 2, Sec. 341, Titla 8, Calitomla Atlministrative Cotle). ❑ As owner-6uilder, I will not employ enyone to do work which would require e permit irom ihe Division of Indusirial Sefery, es noted above, unless such person has a permit to tlo such work irom the division. Signature: Data: Division of Intlustnal Safety Partnit Number: CERTFICATE OF COMPLIANCE AND AUiHORVA710N OF ENfTiY: I certify untler penalry of perjury that I have reatl this epplicetion antl state that ihe informa�ion given is conect I egree to comply with all state laws end ciry ortlinances relating to building construction, end authotlze representatives ol the Giry oF Costa Mesa to enter upon Ihe abova-descn6ed property for inspection purposes. I egree�not to occupy or allow occupency ot any building authonzed by this pertnit until final inspection. [�rr��r,E�raa�c�r_n�� 1676 Fi:ed System Final Fire Prevantion 1266 Pool Spe Final 200 Finel Re-Roof 201 Finel BIocWRetaining Well 202 Final Factory Fire Place 203 Final Sign 204 Finel Demolition PA7� INTRIRLS � J` 1 _ O �va�e Date COUEf INSPEC710NTVVE � 20fi Final Mechanical 20B Final Plumbing 210 Final Electrical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final BuildingiOccupency P9IE 1JiipIALS U-6-OZ- b� (714) 754-5273 • Fex (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT JobAddress: 2836 NEVI$ CI Suite: Vicinity: KITCHEN Parcel Number: 13943154 Applicant: PARIS, JOHN Address: 6757 GAVIOTA AV LONG BEACH, CA Owner: KINDEL, WILLIAM H TR Address 2836 NEVIS CIR COSTA MESA, CA Contracror: JOHN C PARIS Address: 6757 GAVIOTA AV LONG BEACH, CA Zip: 90805 Arch : Address: Zoning: R1 R1 Phone: 562-428-5792 Zip: 90805 Phone: Zip: 92626 Phone: 562-428-5792 License: 457110 Eng: Address: Slatus: ISSUED Applied: 09/11/2002 Issued: 09/11/2002 Phone: Phone: Zip: License: License: SCOPE OF PERMIT INTERIOR KITCHEN REMODEL TO INCLUDE FRAMING LIGHT-WELL IN AN EXISTING CEILING IN A SFD. ELEC, MECH AND PLUMBING PERMITS PULLED IN CONJUNCTION WITH THE KITCHEN REMODEL. Plan Check: $63.21 Permit: $97.25 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $160.96 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0-0 PARKING Existina: o NOTES: Rear 0- 0 Rear 0- 0 Reouired: 0 FEE SUMMARY PLANNING & ZONING Left 0- 0 Left 0- 0 Pr000sed: 0 Calc Valuation: Claim Valuation: Right 0-0 Right 0- 0 $3,800.00 $3,800.00 NOTICE: The work authorized by lhis permit shall comply with all applicable handicap access requiremenis under Califomia statutes and related regulations. (Ord. No. 92-28, § t, 12-21-92) EXPIRATION: This permit shall automatirally expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all� required Inspections and final approval must be oblained. Failure to obtain inspections and final approval will result in the expiration of this permi� FOR INSPECTIONS CALL: (714) 7545626 zaaws (siool f / WORKERS'COMPENSAnON DECLARAnON: � � I hereby aXirtn under penalry of perjury one oi ihe tollowing declarations: ❑ I have entl will mainWin a certlficate of consem ro self-Insure tor workers' compensation, es providatl br 6y section 3700 0( the Lebor Code, tor the performenca ot the work lor which this pertnit is issued. ❑ I have antl will maintain workers' compensation insurance, es requiretl by section 3700 of Ihe Lebor Code, tor Ihe pertortnance ot t�e work br which Nis pertnil is issued. My workers compensation Insurence carrler antl policy num6er are: Cerder. Policy Numbec (This section need not be crompleted il the permi! is valuetl at one huntlretl dollers ($f 00) or less.) �I cerlity that in the perto enc 1 ihe work for wJaic his permit is issueQ I shall not employ any Derson in any manner so es to become subject to iha workers' \ compensation laws o lif a, end gree th fii shoultl become sublect to ihe workers' compensetlon provisions of Section 3700 of the Labor Code, I shell lorihwith comply with ihese si Applicen� Signeture: Date: G— � �' � a WARNINO: fAILURE TO UFE WORKERS' COMPENSATIIXJ COVERAGE IS UNLAWFUL AND SHAIL SUBJECT AN EMPLOYER TO CRIMINAL PEWILTIES AND GVIL FlNES UP TOONE HUNDRED TFIOUSMlDDOLLARE 100,000),INADDITIONTOTHECOS20FCOMPENSATION,DAMAGESASPPOVIOEDFORINSECTION310fiOFTHELABORCODE,IMEREST,ANDATTOfiNEY'SFEES. LICENSED CONTRACTOFiS DECLARATION: I hereby aflirm ihat I em force antl etfect Lic. # _ Contrector's Signeture: with Section 7000) of Division 3 ot the Busir�ess antl Prqfe\sio�Code, and my licanse is in tull Cless a __� i-� Date: G? —� 1 I � O a— CONS7RUC710N LENdING AGENCV: ❑ I hereby ettirm ihat there is a consiruction lending agency tor Ihe peAormance of iha work for whic� this permit is issued. (Sec. 3097, Civil Cotle). Lendafs Name: LentleYs Atltlress: SigneWre: OWNER-BUILDER DECLARATIONS: Date: I hereby ettirm ihat undar penelty of perjury thet I am E%EMPT FROM THE CONTRAC70RS LICENSE LAW for the following reason (Sec. 7031.5, Business and Pratessions Coda: Any ciry or counry which requires e permit to constmct, alter, improve, demolish, or repair eny stmcwre, prior m its issuance, elso requires the applicant for such permit to tile e signetl statement that he or she Is Ilcensed pursuant to t�e provislons ot ihe Conirectors Licensa Lew (Chepter 9(commencing wlth Section 7000) of Dlvislon 3 of ihe Busines9 end Professions Code) or ihet he or she is eaempt therelrom end the basis for lhe allege0 anemption. Any violelion of Sectlon 7031.5 by any appliCant tor e permit suDjects the applicant to a civil penalry of not more than five huntlred tlollers ($500).): ❑ I, es owner of the property, or my employees with wagas as their sole compensa�ion, WILL DO THE WORK, and the structure Is not Intended or oflered for sale (Sec. 7044, Business and Professions Code: Tha Contractors License Law tices not apply to an owner of property who builds or improves Ihereon, antl who does such work himsetl or herself or ihrough his or her own employeas, proviAetl tha� such improvemenis are not Intentletl or oHeratl for sale. If, however, lhe building or improvement is sold wit�in ona year of complation, the owner-builder will have ihe 6urtlen oi proving Ihat he or she did not build or improve for purpose ot sale.). ❑ I, a5 owner of Ihe property, am E%CLUSIVELV CONTRACTiNG WITH LICENSED CONTRACTORS to construct ihe prolect (Sac. 7044, Business end Professions Cotle: 7�e conirectors License Lew tloes not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a conirector(s) license pursuant to Ihe Contractors License Laws.). ❑ I em axempt under sec. Businass end Professions Code for thi5 reeson: Signeture: Date: Owner ID verified by driver's license. ❑ Yes ❑ No Driver's License No. Venfication of Ownership by (type af document, i.e. - property tex bill ar tleea): Expires: DIVISION OF INDUSTRIAL SAFETY PERMIT CERTFICATION: ❑ I hereby certity that no excavetion fiva (5) or more feet in depth Into which a pereon is requiretl to tlescend, will be mada in connection with work authonzed by ihis pertnit, and that no building structura, scaflolding, falsework, or demolition or tlismantling t�ereof, will be more than Ihirry-six (36) feei high. (Chap. 32, Grp 2, An 2, Sec. 341, Ttle 8, Califomia Atlminisiretive Cotle). ❑ As owner-builtler, I will no� employ anyone to do work w�ich would require a permit irom ihe Division of Intlustrial Sefety, as noted abave, unless such person hes e permit to do such work trom ihe division. Siqnature: Date: Division ol Intlusirial Safery Permit Number: CERTFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRV: I cehity under penalty of perjury that I have reatl ihis application entl siate that the information given is correct I agree to comply wilh ell stete lews and ciry ordinances relating to building consiruction, end euthorize representatives of iha Ciry of Coste Mesa to enter upon ihe ebova-described property for inspectiony�oses. I agree not to occupy or ellow occupancy of any building euthorized by Ihis permit un�il tinal inspection. COUE �. INSPECTIONTYPE 1616 Fixed System Finel Fire Prevention 1266 Pool Spe Finel 200 Final Re-Roof 201 Finel BIocWRateining Well 202 Finel Factory Fire Place i 203 Finel Sign , 204 Finfll Demolition PAIF INTIfIALS q Date I — 1 � — 0 � Date �qp� ixscecnoxTvve 206 Final Mechanical 20B Finel Plumbing 210 Finel Electrical 212 Finel Fire Preventlon 220 Final Planning Approval 222 Finel Site 250 Final Building/Occupflncy PAIF. I[�E13 _. 'az 1d Apo�icanl to fill in all svaces wlthin �eavy bortler lines antl sign all appropriate aeelarations. i� �CITY OF COSTA MESA PERMI NO. ,/ TRACT NO. LOT NO. � BLDG. NO. CONSTRUCTION PERMIT �' �i�'� ' ProjectAddreu � ' - � ��56 �Q��9�81 . 6��0 3�0 `Q 1 S C TYPE OF CONSTRUCTION '�- OWner � � w , Phone ❑ NEW ❑,A�D � ALTEftATION , , � � Addresi "j � y)7..0 � � � REPAIR �O CONVERSION O'DEMOLISN 20NING REGULATIONS - '- Arcli/Eng. � Licenie No. ❑'o'rHER , - A P� � DESCRIPTION OF WORK - ' Address ' . ZONE PLNG: REF. �� . Contracror Phone o G - CS-C TVPE'OFPERMIT �SEreaCKCLST. _ _ . ��oP��R�vNLINE_ � ' Addf¢55 - � 'O GRADING ❑ FOUNDATION O STRUCTURAL SIDE VARD GCENSED CONTRACTOR'DEGC ATION - ❑�TENANT ❑ ELECTRICAL C�PCUMBING ❑MECFiANICA � L5EDE VA �I. hereby affirm that I_am Iicensetl untler provisions of Charter 9,(com- � - ..,_ . . RIGHT. � iT¢ntin9 wi[h 5¢COon 7000) of , Divislon 3 ot th¢ 9usiness antl ❑ OTHER � �� ` "` �' �- � � '-� " �--- --�----""-"'"` "" -'� ""-�---�`- �' Professions Cotle, antl my Ilcense is in full force antl ff 4' " ''- ' REAR VARD (TO P/L) �� •��• � �PROJECT DESCRIPTION � - - - Litense Class Li55 nse No. �� PKG. SPACE REQ. � PROV IDED• �- Date�G' I� I cm..��.e '. . . X�s.�IL.� . 5�. FT. .. WORI(ERS' COMPENSATION DECLARATION ' OCCVPANCV_CONSTRUCTION TVPE - --- - � STREET WIDTFi - - 'PARIC FEE S � • __ _ I hereDy a(flrm that I have a certlflcate of consent to ulf-Insure or a VALUASION' "- '" ZONE _ ED B _ ZONING APPROV V DATE r4rtiflGat¢ of Worker5' Comp¢nsatlOn Insurance, oi cerUfletl� copy . . - � — - _. _. SPECIAL CONDITIONS s�reof.(SeE� �on 3�0 Lab. C.). GRADING CV. YDS. ACRES '" " '^icY No. ��`✓��/� CompanY �� - iJ CertlfieG copy is hereby furnlshetl. " REMARKS: - ' - -- -' - "' "�' - "' ' �--" �-Certifletl.copy is fileA with the tlty Builtling,Division, ' .. ._ _ � _ . . . _ . . ..(' _" .,.__ EXEMPTION FROM WORKERS' COMPENSATION DECLARATION . _. � �_.. • -. � � - i -" -' ' " -- (This sectlon neetl not be'cOmpletetl it the'permit is for one huntlretl � - � - � (5100) or less). . �� ., . ... , . � . � . .. . . . . = : _. , . _ . . . . : ,. .,....�' .. .:. .] . .� �. � ,� 1'certlty that in the pertormante of the work tor which this permit is - issuetl, I shall no[ employ any per5on in any manner so as to become PLUMBING � � � PLAN CHECK ELECTRICAL PLAN-CHECK � � Subj¢CttO'the Worke�5' COTpensa[lon CdwS ot California: - - - -' Date Slgnature BATHTUBS SHOWERS � � _ NOTICE: I� atter makin9 this tleclaratlon, you shoultl become zubject ;TOILETS- _ _ !_URINALS �GENERATOR Od KW_ 1-30'�KW - - to thE WorkerY Cortfpensabon provlsions of [he Labo� Cotle, you must � TRANSFORME(3 . . - -. � torthwith comply with such provislonz or this permit shall be tleemetl LAVATORIES DOVBLE LAVS . APPLIANCE 30-50 KW�50 + KW -- ��- -.. .. .. revOketl: ' - ' " - - ' CONSTRUCTION LENDING AGENCV KIT. SINKS DISHWASHERS MOTORS 03 HP_3-30 HP �- - I hereGy af(irm that there is a construction lentling agency for the per- SERVICE SINKS � �SVMPS UNC.50LAR) 30-50 HP 50,,+ HP torman<e oLthe..work for wnich tnls permit is Issuetl (Section 309] - ' Civ. C.). FLOOR SINKS FLOOR �RAINS FIXTURES OUTLETS SWITCHES Lentle�'S Nam¢ - - Lentler's Atldress DRINKING FOUNTAINS GAS TUBE SIGNS OWNER BUILDER OECLARATION INTERCEPTORS CLARIFIERS POLE LIGHTS �,� I,hereby attirm.that I am.exempt from.tne Contractor's License Law tor Ihe following reazon (Section 7031.5 Business antl Professlons CoOe: SWIMMING POOI PTRAP '� Any city- or .<ounty vehich requires..a permit .to construct, alter, �POLES METERED �SVB ' ' Improve, tlemolish or repair any ztructure, priar to its 6suance, also re- yyqTER SERVICE ALTERATION . PANElS MAIN , SUB quire5 tne ap0��nt for such pe�mit [o file-a signetl statement that he is licensetl pursuant to the provisions of the Contractor'S LicenSe Law GASSERVICE OU�YLET$ .SERVIGE qMP, , SCddpter 9.(mmmencing_with.Sectlon.�000)-af Division 3 oflhe - - "' --�'-. "' _ .. iess and Professions Code) or [hat he is exempt therefrom and the yyqTER HEATERS BTU OUTPUT . 3 m0 . �...��. �.. ... . . . � _. for the alleqetl exemption. Any violatlon..of Section J031.5 by - -- - applicant for a permit subjects the applicant to a tivil penalty SEWER CONNECTIONS � of not more than five huntlretl tlollars.�$500). ' - ❑ I, as owner of [he property, or my employees with wages as their SO�AR TANK COLLECTORS �' { � , sole'compensation; will tlo the work, antl the structure is not Intentletl --- ------ � � �' `' �� - or offeretl for sale. (Section �044, Business antl P'ofessions Cotle: The SOLAR PIPING SVS. � ISSUE FEE � ConHactor'S Llcense' Law tloe5 nOt appry to an owner o( a property p� APPLICATION APPROVED BV � who bullds or improves [hereon, antl who tloes such work himself or ISSUE FEE � _ �DATE through tlls own employees,-provltletl that such improvements are not inlentletl or otieretl tor sale. H, howeveq tne builtling or improvement MECHANICAL PLAN CHECK � SUMMARV OF FEES ' is sOltl within one yeat oi completion, the owner will have the�bu�tlen - - . of provinq ne tlitl not builtl or improve for [he purpose of sale). HEATING SV.STEM 0-300,000 BTU BUILDING _ ❑ I, as owner of tne �property, am exclusively con(racting with � BERMIT . $ ' " _ SMIP- E IicensCtl ronVacto�s to construct IM1e.proleG[. Section J044, Business AND DUCTING .( 300,000 + BTU PLAN CHECK $ , PERMIT antl Professions Cotle: The Contractor's License Law tloei not apply to -- � � � $�-_•,�ISSUANCE E � an.owner, of prOperty wM10 builtls ot improves thereon, and wh0 con- REFRIGERATION 0-100,000 BTU PLUMBING '� �. tracts frOm such p�ojects with a contractor(s) licesnetl OwsuanC to SYSTEM � . - � ��/ 'GRAOING $" ' the Contractor's License Law�. . SOO,OOO+BTU PLAN CHECK $- �- . ' . ❑ 1 am exempt untler Section B. & P. C. for tnis BOILERS BTU ELECTRICAL $'� $ . reason ' PLANCHECK g - �41CROFILM E� - _,SVSTEM REPAIR,ALTERATION. _Date 'Owner - -' - " ' ' - - - TOTAL FEE $ -- -- I hereby ceriifythat 1 have reatl [nis appliwtiomantl�sta[e9ha[ the�above EXHAVST $YSTEM MULTIPLE MECHANICAL 'S _ information iz correcL I aqree ro comply with all city antl county �- PLAN CHECK g �LE55-AD-- ottlinanc25�antl stateiawsrelatin9�to�tonstrutfion,-antl hereGy authorize� . ,, VANCE PC $ representatives of tM1is city [o enie� upon the abOve mentione0 � 6�o propv.rty to i pepy ion� _p�ur�py�s¢�s � -- - - - Signature ��-�"'� ISSUE FEE -- -- ' �mr 000a-ro wm�e-eunainy; wnary-.�appncant; rinn-Hccounting; uomeinou-..mcoao� ,� CONSTRUCTION AND PLANNING POOL & SPA ,. \ . "� ��P�� ai:!'\ Date �Ins ector � • Date Inspector APPROVALS Permit # �� 3 P APPROVALS Permit # i. Temporary Electrical Service or Pole 43. Pool & Equipment Location ' 2. Soil ipe-Un rgrn 44. Steel Reinforcement ' 3. Electrical Conduit Utility-Undrgrn 45. Forms ' 4. Electrical Conduit-Undrgrn 46. Electrical Bonding . tee ein orce 47. Rough Plumbin & Pressure Test � 6. Electrical UFER Grn 48. APPROVALTO COVER-GUNITE 7. Footings 49. Electrical Conduit-Undr rn 6. Foundation 50. � Gas Pipe, ❑ Undr rn, Test 9. Water Pipe-Undrgrn 51. Backwash Lines P-Tra ❑ ndr rn 10. Structural Floor System 52. APPROVALTO DECK - 11. Property Sewer Line & House Connection 53. Backwash & Rece tor-Final � 12. Street Sewer Connection � � 54. Heater & Vent-Final . ' " 13. Rough Plumbing " 14. Rough ElectrioConduit �56. Electrical-Final � 15. Rough Electric-Wiring 57. Solar System-Final � � � 16. Rough Heating & Air Conditioning • encing & Access Approval 17. Ducts in Strur.ture APPROVED FOR PLASTERING � �� 16. Ducts, Ventilating - � � 19. Gas Pipe-Rough & Test � � ' �� 60. - POOUSPA SYSTEMS F INAL � - � 20. Roof Framing � � � � � - � � 21. Roof Sheathin 22. Frame and Flashin NOTES: � � - • 23. Insulation - 24. Lathin & Siding 25. Drywall Nailing - 26. Plaster Brown Coat � � � 27. Electrical Power Meter-Final � � � ' � - 28. Final Electric ' � � 29. Final Heating & Air Conditioning 30. Final Gas Pipe-Test 31. Final Plumbing � Q'- 32. Water Service-Final � 33. Gas Service-Final � � � 34. Solar pomesticFinal - - 35. Landsca e S rinklin S stem ' 36. Sound Attenuation 37. Handicap Regulations�� - 38. FINALSTRUCTURE&BUILDING ' 39. Special Requirements Completed 40. Electric Release to Edison � 41. Gas Release to Southern California Gas Co. 42. CERTIFICATEOFOCCUPANCY No Date AOGlican� to fill in all spaces except those wilhin heavy bortler lines anE sign COSTA MESA CONSTRUCTION PERMIT . PERo,nT NO_ TRACT NO. LOT NO. _ct Address "�8-3� ��[uif Ctn plicant's Mailing Address � Owner's Name' �� Phone SxS- 6Y�'� Addres9 ��'�6 �e�.'s C:-%'� Arch/Eng.� LicenseNo. y�ZG%�y Ad¢Cess Contiactor's Nam '� �' - � Phone 633-F79f+ Address (mailing) � � City License No. �30/ LICENSED CONTRACTOR DECLA ATION I ItereDy attirm tha[ I am Ilcensetl untlei provisions ot Charter 9(commencing with section 7000) ot Division 3 oi the Business ana Professions Cotle, ana my Iicense is in (ull tJjrce ,a�n_tl Nfect. License Class �i i nse No. �z �S�P � Dale %��'� Sl9nature WORKEHS' COMPENSNTION DECLAR nereby affirm that I have a certificate of consent to selt-insurc or a cortlticate ^ �f Workers' Compensation InSurance, o� a ce�ti(ietl copy IhereOt ($ection 1 3800, Lab. C.��/�� ' Company �"� �`� Policy No. Q Cerlilied wpy is hlreby Iurnisnetl. n p� CerllBetl co is tiled witM1 the city Buildin �i�yl�i� Da[e %�� APPlicant �� X EXEMPTION F0.0M WORKERS' COMPENS DECLARHTION (Tnis seclion neetl not be completetl if the permit is for one huntlretl (§100) or less). I certify that In the perfOrmance Of the wo�k fo� which thi5 perm�t i5 i55uetl 1 shall not employ any person in any manner so as to become sub7ect to t�e WOrkers' Compensatlon Laws of California. Date Si9nature � NOTICE: If, af[er making this tleclaration, yau shoultl become subject to the Workers' COmpensation provi5ions oi [he Labor Cotle, you mus[ lorthwith comply wilh such provisions o� this permit shall be tleemed revoketl. � CONSTRUCTION LENDING AGENCV 1 hereby atfirm lhat there Is a consVuttion lentling agency tor t�e performance qt the work for .wnicn this permi[ is issuetl (Section 3097 Clv. C.) Lentler's Name L8pC2P5 QGtllESS� OWNER BUILDER DECLARATION I hereby aftirm that I am exempt from the Cmtractor's License Law for the following reason (Sactlon 7031.5 Business antl Professional Cotle: AnY titY or county whicb �equires a permit to construct, alte�, improve, tlemolish or repalt any st�ucture,'prio� ta It5 Issuance, alio requi�es the applicant tor Suclt pe�mit [o lile a Signetl slat¢men[ tttal he/She Is IicenSetl pu�suant to th¢ Provi5ion5 Of '4e Contractor's License Law (Cnapter 9(commencing with Sectlon 7000) of 'vislon 3 of fhe Business antl Professions Cotle) or that he/she is exempt erefrom antl Ihe ba5i5 fOr the alle9etl exemption. Any vlolation Of Section i031.5 by any applicant for a permit subjects the applicant [o a Civil �enalty o/ not more [han !rve huntlretl tlollars ($500). I, as Owner of [he O�OpGrty o� my em0loyees with wages as Ihei� sole comp¢nsation, will do th¢ wo�k, antl the st�ucture is not intentletl o� offer¢tl for sale (Sec[lon ]044, Busines5 an❑ Professional Cotle: The Contractor's License Law tloes not apply to an owner of a property who builtls or improvez lhereon, and who tloes such work himselt/herseli or throu9h hls or her own employeez, provitletl Ihat such improvements are not Intentletl or offeretl to� sale. If, hOweveq tbe bulltling or Imp�ovement is soltl wlthin one y¢ar ot com- pletiOn, t�e owne� will have Ihe burtlen of proving he/she tlitl not bulltl or iT- prove for th¢ pu�DoSe OI sale). ❑ I, as owner of the proper[y, am exclusivety contracting with licensetl con- tra<cors tb construct the oroject ISe<tlon ]044, Business anE Protesslons Cotle: Tne Conlrac[or's License Law does not apply to an owner of propmty who builtls or Improves tnereon, antl who canVacts for such projects with a con- trac[or(sl licanse pursuant to IM1e Cont�acto�'S License Law). I am awa�e that proo/ o( their Worker'S Compensation insurance snoultl be provitletl to me. ❑ I am ¢xempt untle� 5¢Ctlon 8. & P. C. Por thi5 reason Oate Owner I hereby certify tnat I have reatl Ihis apoliwfion antl state tnat the abova In/ormation is correct. I agree to comply witn all city antl coun[y ortlinances antl�state laws.relating [ 1 9 consiruc[ion, antl hereby au[horize repre- sen[atives oi Ih6 cit e upon the above-mentione0 p�operty for inspectlon purpases. / f/ Signature (� Date � yT� Orivers' License 55 �F �%� priate eeelarations. TYPE Of CONSTRUCTION LI NEW LI ADD L1 ALTERATION VJ REPAI R ❑ CONVERSION ❑.DEMOLISH ❑ OTHER r � A.P. �p OESCRIPTIONOFWORK/USEOFBLDG. S MainBuilding: E TVPE OF PERMIT GRADING FOVNDATION STRUCTURAL T Front ❑ TENANT •❑ E/L�E CT�R� AL ❑ PLUMBING'ti� MECHANICAL A Reaf PR�o7HER Nac.7-in� C Right ECT DESCRIPTION 5(i. FT. � ss I "�� nrCupnt•icv ._ CONSTRUCTIONTYPE TTION§ S%OO � g LCf[ ' i ZONE GRADING CU. VDS. ACRES Ping. Ret. �/k Remarks: �,��„_ "� , „_ - �� ry—, _.%/ J�('^]j y q Planning Notes: /, Sink Preventer Irrigation Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Kicehen Sink Lavatories P-Trap Roof Drains Reinspec[ion Fee . $15 Boiler Duct- UnderGround Duct - Structurel Duct - Ventilating Exhaust System � Multiple ❑ FireplfFacL BIL ICBO # Heating System & Ducting ❑6100,000 BTU 0100,000 BT Reinzpeetion Fee � � $15 CMF OB65-46, rev. 30/84 White - Builtling; Canary - Applicanh Pink - Accountlng; Goltlenrotl - Assessor Service Sink SeWer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Wate`r. Heater Water Service Auto-Wash Laundry Trays Issue Fee Hood or Type I ❑ Canopy Type II ❑ Refrigeration System ❑0�100,OOOBTU ❑100,000 System Repair/Alteration Fire Dampers Registers Issue Fee FEES Automatic Washe Construction Pol� Cooking Unit Dishwasher Dryers �Gas C Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator �0.5 8974 7/OB/86 28.50 TL Zone Accessory Building: Z O N � N G R Parking Req./Provided E Q M T S ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100 amps Meter �overi00amps Sub Panel Motors OO-1 HP O1 %- 8 Inc.Solar 09�15 HP 016�15+ Microwave ' Pole Light Sign Standing Sections KW �5-15 KW Trash Compactor FEES $ 3 I �. Reinspection Fae $15 Issue Fee $ 3 FEES DEVELOPMENTSERVICESRE�UIREMENTS: Zonine �+PV�ovad By Date Building Approved By Date—�-�—$7— Appliwtion laued By ' Dat�L�f2 SU RV O FEES � BUILDINGPERMIT $ � -SMIP $ �� PLAN CHECK $ PERMIT PLUMBING $ �SSUANCE $ PLAN CHECK -25% 3 � ENERG� P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50°6 5 MICROFILM S +�p �J� MECHANICAL $ TOTAL FEE $ �.� $ 3 PLAN CHECK 25% $ ' CONSTRUCTION AND PLANNING POOL & SPA APPROVALS Permit # Date Inspector, qppROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding ! 5. Steel Reinforcement . 56. Rough Plumbing & Pressure Test � 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. ' 8. Foundation � 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Prqperty Sewer Line & House Connection 62. Backwash & Receptor-Final . 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains - 64. Plumbing System - Final ' 14. Rpugh Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final � 16. Rough Electric Wiring 67. Fencing & Access Approval . 17. Rough Wiring Sign 68. APPROVED FOR PLAS7ERING . 18. Rqugh Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL J 19. Rough Fieating & Air Conditioning FIRE DEPT. REQUIREMENT j 20. Rough Factory Fireplace APPROVALS Permit # - 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating ' 71. Product Piping O Gas ❑ Oil ( 23. Gas Pipe-Rough & Test 72, Underground Flush I 24. Rqof Framin � 9 73. Undergrnd. Storage Tank 0 Gas ❑ Oil 25. Roof Sheathing / 74. Overhead Hydro �' 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78, FIRE PREV. FINAL � 30. DryWall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION � 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. HOod or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preventer 43. Backflow Irrigation � 44. Landscape Irrigation System 45. Sqund Attenuation 46. Handicap Reguiations � 47. FINAL STRUCTURE & BUILDING �� 48. Special Requirements Completed � 49. Electric Release to Edison � 50. Gas Release to Southern California Gas Cn , . 51. CERTIFICATE OF OCCUPANCY . No. Date ' � Avolicant to flll in all soaces excev� those witnin neavY boraer lines ana sign all aoP�opriate aeclaratians. CITY OF Cosra MESA CQNSTRUCTION PERMIT ProjectAddress ��-3�G �%%�iJ AppliCant's Mailing A d ess ,Owner.�Name � - PhonesY��+ ✓� Addrexs a�36 �/�u%� Cii. Arch/Eng. License No. yICC yf� AddrEss • Cc,nvactor's ma Lq� � �4/ �� Pho�e G�>-y�� Address (mailingl !�� / �n� ""�' City License No. -3-3D�7 LICENSED CONTRACTOR DECLARATION � I hereby alfirm that I am licensetl untler provisions ot Charter 9(cOmmencing witn 5action ]000) of Divislon 3 oi [he Business antl Professions Cotle, antl my licensa is in t W torce antl eifeci. (/ �icenze ciass Y�" s �" enze �No. 7�16✓% Date� -_%�j�. Si9nature VORKERS' COMPENSATION DECLA AYI ' . hereby aHirm that 1 have a certiticate ofsp ent to seli-insure or a cartificate of Workers' Compensation Insuranco, or a certifietl copy thereof (Section 3800, Lab. C%..� Policy No. ✓6O/6y Company _ � ' �`'� eCertilietl copy Is hereby tumiSM1etl. Certif�j tl co a �letl witM1 the city Builtling sion: �ate%-�� APpliwnt E%EMPTION FROM WORKERS' COMPENSA ATION �Tnis section neetl not be completetl if the permil IS for ona huntlr¢tl (E300) or IC55). I certify that in [he pertormance of tbe work tor which thls perm�t is issuetl, I shall not employ any verson In any manner so as to become subject to the workers' Compensation Laws o( Calitomla: Oate Signature NOTICE: If, atte� making [hiz tl¢tlaralion, you shoultl become subjecl to the Workers' Compenzation provislons of tne LabOr Cotle, y0u must tor[hwith <omply wilh sucM1 p�ovisions or this pe�mit shall bo tleeme0 �evoketl. CONSTRUCTtON LENDING AGENCV I hereby attirm ihat there is a constructlon Ientlin9 agency tor the perPormance of lho work for .wKith this permlt I5 issuetl (Section 309] Civ. CJ LPntler'z Name ' �Le�tler's AEtlress - OWNER BUILOER DECLARATION I hereby affirm that I�.am exampf trom lhe Contractor's License L.aw for Me following reason (Section ]031.5 Business antl Professional Cotle: Any city or county which �equiresa pe�mlt [o con5truct, alteq improve, tllmolislt o� rGPair any structure, prlor,to its Issuan<e, also reqWres the applicant for such permit b tile a Signetl statement tha[ he/5M1e I5 licensetl pursuan� to the prOvisions ot e Contractor's License Law (Chapter 9(mmmencing wiih Section 7000) of .vizion 3 of the Business antl Prof¢TsiOns Cotle) o� thdt h¢/She Is ex¢mpt .rierefrom antl [he basis tor th¢ alleged exemptiOn. Any vlolation o1 Section 7031.5 by any applican[ for a permil subjects the applican[ [o a civil eenalty oi not more than tiv¢ huntlretl tlollars (E500). LJ I, as owner of the property or my employees with wages as Ihoir sole compensation, will tlo the work, antl the structure is noi Intentletl or offeretl for sale (Sec[ion 7044,' Business antl Professional Cotle: The Contractor's License l.aw tloes not apply to an owner of a property who builtls or improves thereon, antl who tloes such work nimselt/nerseli or throu9h his or ner own employees, provi�ed that such improv¢ment5 ar¢ not in[enCetl or offeretl to� sale. I/, nowever, tne builtlinq o� improvement is soltl within one yea� of mm- pletion, tne owner will have the buraen ot proving he/she tlitl not bulltl or im- prove lor [he purpose oi zale). ❑ I, a5 owner of Ihe proPerty, am exUusiv¢ty cont�actlng wltb IIC¢nsetl con- Vactors to construct roe project (Section ]044, Business antl Professlons Cotle: The Conlrattor'S License taw Ooes not appty [O an owner ot properly who builtls or improves thereon, antl wno contracts Por such projects wlth a con- tractor(51�bcense pu�suant to the ConVactor's LicenSe Law). I dm aware that proot o( their WOrker's Compensatlon Insurance 5houlU be provitletl to me. ❑ I am exempt untler Section B. L P. C. for [hit reason �ate �Owner I h¢reby certify�[hat I have rg,� informaUon �s correcL I a9re antl state laws relating to b � r sentative5 ot Ihis city t t¢r inspectlon purposes. Signature Drivers' License or 55 � � a[ion antl state tnat tha above � all city antl county ortllnances on, antl he�eby aui�orize repre- above-mentionetl property tor Daf¢ 7 �S��G r � -�s a vy6 q TYPE OF CONSTRUCTION NEW HDD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. TVPE OF PERMIT LJ GRADING LJ FOUNDATION LJ STRVCTURAL ❑ TENANT ❑ ELECTyqJCA�L/1 ❑ PLVMBING ❑ MECHANICAL C�' OTHER NQOJ`'�/< - PROJECT DESCRIPTION 5q. FT. � � OCCUPArvCv— CONSTRUCTIONTVPE VALVATION$� -Si�� ZONE GRADINGCU.YDS. ACRES— Remarks: Sink kflow Prevenrer kflow Irrigation Clarifiers Dishwa5her Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Imerceptors � Kitchen Sink Roof Drains Reinspection Fee � $75 Duct- UnderGround Duct - Structurel Duct - Ventilating ExhaustSystem ❑ Multiple Firepl/Fact.8lt. ICBO # Heating System & Ducting ❑ 0.100,000 BTU � 100,000 Reinspeaion Fee � $15 CMF 0865-46, rev. ]0/84 Wttite - Builtling: Canary - Applicant; Pink - Accountin9: Goltlenrod - A558ssor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service' r Issue Fee Hoodor Typel ❑ Canopy Type I I '❑ Refrigeration System ❑0-100,OOOBTU ❑100,000 SVstem Repair/Alteration Fire Dampers Registers Issue Fee FEES r� �' �--�-� A.P. #'' v v� 1�J IJI S Main Building: _ -- Tfront �� I l/C �j^ � ARear C Right SLeft Ping. Ref. dk Planning Notes: Automatic Washer Consvuction Pole Si Cooking Unit Oishwasher Dryers �Gas ❑EI Fan F.A.U. Fixtures Device Boxes ' Outlets Switches Garbage Disposal Generator 00.5 KW Zone Building: Parking Req./Provided ELECTRICAI � Transformer ❑ 15-50 KW ❑ 50+ KW Meter ❑up to 100 amps Meter ❑over 100 amps Sub Panel Momrs �0.1 HP 01 h- 8 Inc.Solar �9-15 HP �76-75* Microwave Pole Light Range Standing Sections 5 KW Trazh Compactor $ 3 , � ; Reinspection Fee $15 Issue Fee FEES DEVELOPMENT SERVICES REQUIREMENTS: Zonin9 APProved By Building Approved By APPliwtion laued BY § 3 0 SUM/ryryy��ppqq 'V OF FEES _ I� PERMIT $ � SMIP PLAN CHECK $ PERMIT PLUMBING $ �� ISSUANCE PLAN CHECK 25% $ � ENERG� P.C. ELECTRICA� - $ GRADING PLAN CHECK 50% $ MICROFILM MECHANICAL $ TOTAL FEE PLAN CHECK 25% $ Z O N I N G R E � M T S FEES $ 3 _ ICONSTRUCTION AND PLANNING ', POOL & SPA APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement , 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Co�duit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAI TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System � 61. APPROVAL TO DECK 11. Property Sewer Line & HouseConnection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 73. Roof Drains 64. Plumbing System - Final 74. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-CAnduit 66. Solar System-final i6. Rough Electric Wiring . 67. Fencing & Access Approval 77. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling ' 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # - 21. Ducts, in Structure 70. Underground Hydro 22�. Ducts, Ventilating 71. Product Piping OGas ❑Oil 23. Gas Pipe-Rough & 7est 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Strutturaq & Monocoat � 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: � 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test � �� 36. Hood or Canopy . 37. Final Factory Fireplace 38. Final Plumbing � 39. Water Service-Final ' � 40. Gas Service-Final 41. Solar pomestic-Finrl 42. Backflow Preventer � 43. 8ackflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations ' - 47. FINALSTRUCTUaE&BUILDING / �-- ,f�: Q 48. Special Requirements Completed 49. Electric Release to Edison � 50. Gas Release to Southern California Gas Co ,: t 51. CERTIFICATEOFOCCUPANCY , / ' No. Daie � . � I9799 COSTA MESA BUILDING-SAFETY DEPARTMENT P. O. BOX 91� C08TA MESA. CALIFORNIA For Applieant to Fill In Completely Tr. 4341 -rvPe oR PRINT LOt 33 „..�..n n m � r r� _ � /� � A ■ MAIL COSTq MESA, CALIFORNIA ' Grove Park Construction, �nc., 1653 Minorca Drive Costo Mesa No � KI 9- ;R E. G. Kaltenbach No 772-3 9772 Katella Ave., Anaheim ,R Mesa Verde Development Co. 1653 Minorca Drive u� No. 181322 No • KI 9-0395 OF LOT �J X loo I N01'OP BLDaB. 0 USE OF EXISTIN6 BLD6. �-- BETBACK LINH FPOM C CENTBR OP 6TRH6T J REAR � 61DEYARD LEFT 16 I'RIGHT DESCRIPTION OF WORK � m F EE RECEIVEU . F��t � o FSE� c► r r�u�''�{�i�EP,V�'�e�R For Office Usa Only ZONIN(i NO.OR� U88 PUNB' BYII �1- Di- t � . NOTE: YARD3APPROVED MAIN Bl11LDING �y VAR. ?C SIZI�DIN6 ZZJH $.�.ROOMS $ STORIEp9 2 C.U.P. EXTERIOR WALL y�OOd pOOF 5 Qk Vc ABYPRO COVERING COVERIN6 5 I �C USEOFBUIL�IN RKTOBEP RFORM sin le famil residence and� attaclied garag Plan 4 BR �/,¢% �1 HEPEBY ACKNOWLpO08 THAT � NAVE RGO TXIB APPLIGTION •ND BTATB THAT THg ABOVH IB COFRECT AND AOq68 TO COM- PLY WITX ALL CITY pRDINANC89 ANO 9TFT! LAW9 p80YL11TIN0 BUILDINO CONfjlRqd}�ON. SHALL BE 4ES3 THAN YARDSAPPROVED ACCESSORY BUILDIN6 BEf. BET. MAIN @ 'a9. ACCE55. BLDGS. DqTE APPROVEO IAAA � � .,er� � �I ` AMOUNT ro88 OP ' AUTHORIZED AGENT � �� / � A l3!'� ° IB POH TXG F F88 ONLY. e �y /I pl/i 0 ////" " N / ///// 0 �£ ¢ . ilf � 4