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HomeMy WebLinkAbout1850 NEW JERSEY ST - Building Permits y�11J�' CITY OF COSTA MESA 4 •@@ BUILDING DIVISION • >f-, " DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER tt 004 I PERMIT !' (A05-00030 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 1850 NEW JERSEY ST Status: ISSUED Suite No _Applied: 01/12/2005 Vicinity: Issued: 01/12/2005 Parcel Nunmber: 13910337 �j/�7 ISSUED BY: / /v Applicant: LINDSAY,DENISE (1 Address: • 1850 NEW JERSEY . " - Phone: 714-549-3407 , - COSTA.MESA,CA'- � , .Zip: 92626 . , . - -_,�� SNA _ - - A Owner'-,-LINDSAY,DENISE-,:. � Address, %1850 NEW JERSEY:"" - Phone: 714-549-3407 ' COSTA MESA,-CA Zip: 92626 v - • Contractor:_ OWNER-BUILDER Address: - _ - • Phone: Zip: - . License: 000000 - - -. ' - - • r :SCOPE OFPERMIT ' ' '- : - , • CONVERT A 280SF,STORAGE ROOM-T,O A LIVING SPACE.(' ._ _ . _ ' . , 3 LIGHTS,6 OUTLETS, 3 SWITCHES AND 1 BATHROOM'FAN - , , - - . FEESUMMARY ' - - Quantity - - Quantity ,,1 . - - , , ISSUE FEE $23.50 Temp Dist System/Lighting ,, $0.00 Temp service test $0.00 Busway/100 ft '$0.00 0/f' Res.a/c package $0.00 • Standing Section $0.00 :0,;. ' New Res(1-2 units) $0.00 0 Misc Electrical Equipment ,$0.00 /0' , ' New Res(3+units) - $0.00 0 `Transformers up to 1 kva/kw $0.00 ,,,Y•0� Pool/Spa_ - ' . -. $0.00 0 fop to 1.0 kva/kw $0.00.'/ !0 Lighting Fixts , - , $3.30 3 -up to,,50.kva/kw $0.00:,:;' 0.,- ' Recept Outlets $6.60 -.6 - up to 100 kva/kw-�'.v. $0.00;/ 0/ Switches - $3.30 3 ' , over 100kva/kw- $0:00 -, 0 . - Non Res Appl-- - $0.00 0 ' . Low Voltage Equipment '_$0.00(/- 0 - / Res Appl ,\ $4.75 - '1 - ' Low Volt Wiring System_ --/Ckt' $0:00 <%'0 �2 / Service to 200a \�'V v'. $0.00- • .0i� ;r , , - Misc. Conduit $0.00." c'0,'",, Service to 1000a A�-'\ $0.00 , 0 _ - _ _-. Misc.Conductor -- ' ;;$0;00;- 0 Service over 10004 $0.00 .' -0- - •' - - Circus(gen or ride) . � ,`' .$0.00 /,/0://Motors to 1 hp $0.00 - 0 - . Circus(mech.ridev?lights) ,i,$0.00i�/0 Motors to 10hp , $0.00 0 Christmas Tree.Stand'• $0.00'��0 Motors to 50hp $0.00 0 Fireworks Stand : , - '. $0.00 0 i Motors to 100hp $0.00`- - ' 0 Other Electrical'Fee - :"- $0.00 Motors over 100hp $0.00 0 - - ���_%- Communication drops $0.00 0--- - ,Inv"estigation Fee _. $0.00 ' Sub panel to 200a $0.00 0 - - - Plan-Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 2 i 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) 4 Ji EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned fora period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 / 244646(6/00) . DECLARATIONS U C ) WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carder: Policy Number: (This section need not be completed ii the permit is valued et one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND In I ARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ' ❑ I,as owner of the property,em EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) . license put nt to the Contractors License Laws.). ❑ I am ex p der•se . Business and Professions Code for this reason: 4 -Signature: /7/. 7<y ` !;D: (- 12- -06 'Owner I verified by driver's license. ❑Yes I No Drivels Ucense_No. / '#) Expires:,, -0 7 Verification of Ownership by(type of document,i.e.-property tax bill or deed): ----� DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more then thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title B,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If en RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application a permit for such construction or modification from the South Coast Air Duality Management District or from any other air pollution control district or agency? Yes ❑No (Section 65850.2 of the Califomia Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Duality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMP CE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to co ith all state laws and ci dinance eta'ng to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described pr for inspection pu ose •e no,.• • cup •r z ow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owner(s)' \ rpete And/Or Authorized Applicant Date WORE/ INSPECTION TYPE p INTIALS CODE I f$SPECTIONTYPE PAM gig 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing C 200 Final Re-Roof 210 Final Electrical 7'/gyp•� G 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy • CITY OF COSTA MESA < BUILDING DIVISION Y' s.�..� . DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER . j • PERMIT ' e e,,,so+F B05-00051 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 1850 NEW JERSEY ST Status: ISSUED Suite: Applied: 01/12/2005 Vicinity: Issued: 01/12/2005 Parcel Number: 13910337 Zoning: Applicant: LINDSAY,DENISE _ ISSUED BY: Address: . 1850 NEW JERSEY - i.': _ , Phone: 714-549-3407 - COSTA MESA;CA-. Zip: 92626 - -i , , Owner: LINDSAY,DENISE. . - . - - - . , Address 850 NEW JERSEY _ Phone: 714-5493407':; v'.--c,,,, '.COSTA MESA,CA":;:,'. Zip: 92626 Contractor: OWNER-BUILDER � N ' Address: Phone: • �.`. Zip: - .. License: - 000000 . , " Arch : • - - Eng: Address: - - - •Address: ' . , • - Phone: Phone: - . Zip: License: License: / - . - 7 SCOPE-OF PERMIT;; , -_r--, , ' . N CONVERT A 280SF STORAGE ROOM TO A.LIVING SPACE-., ' . - . ' .1 . . , .- I FEE SUMMARY ' ' ':: Plan Check: ' $0.00 _ - " , . ' ' Calc Valuation: ;< . /So.00; Permit: . $0.00 Claim Valuation: S - - Sabo SMIP Res: _ $0.50 `SMIP"Com: ' $0.00 ' ' Other:`• $0.00 - yInspectioM ' x$0.00 -7,/ ;, r ,i ,l/ "Total: $0.50 ,- '',;„2Y PLANNING &ZONING /'1-7 /, % 'i' SETBACKS ' ' / ,/,'' , //: - , _ ' - MAIN STRUCTURE Front 0-0 Rear..- -0-0_ - ' Left 0-0= ' Right 0 0- , ACCESSORY Front -0-0 - > • ' Rear 0-0 Left 0-0 - ' Right ' 0-0,/i i PARKING Existing: 0 Required: 0 Proposed , 0 ...I/:1', ,->Oji- NOTES: i r 'f; 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) f EXPIRATION: This permit shall automatically expire and become void if work is not commenced withint180 days,or if work is suspended or abandoned for a period of 180 days. j' INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all ' required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS O WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued et one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class# Contractor's Signature: Date: • CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve tor purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contra s License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) . license pursue he Contra •rs License Law •. `am axe . Business and Professions Code for this reason: +Signature: 3Expirs: i'ZS�7 Verification of Ownership by(type of document,I.e.-property tax bill or deed): — •F DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes ❑No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No • (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and tiling with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. a If an RMPP is presently required,has Section 25534 of the Califomia Health and Safety Code been fully complied with? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 0 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 8 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF PLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agre ply with all sstter la�vt��aand city or.' ances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-d s ' p for inspectio1 ose -=e not t• •ccupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of LeC-I Owner(s) Date And/Or Authorized Applicant Date CODE I INSPECTIONTYPE QCT 1NTMALS COOFJ INSPECTIONTYPE DAM ILCEMAl..S 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Root 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 3—Rog- c ct Land Imo UTem? 5 use Ke with n vv� F; �e DSc/cited roorr Pte'' 514* in echoti /131 /o5 , 7 Pt; : 605- mow w 2A-oy _ 33 Bedroom La! U z Ili tt anOt ( w o 14 8.-1 4 Go _ J 2 Z Uo 7 Lu*- 0 Q � I o �y N � Q 1 Lxvifl9 IR oorvt *Plan no-f #o scale_ 5 . ./ 6M CITY OF COSTA MESA a4/ P.O. BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 92628-1200 O✓ /y / .. .r[ �' V; Ay; DEVELOPMENT SERVICES DEPARTMENT December 23, 2004 Denise Lindsay 1850 New Jersey Street . Costa Mesa, CA 92626 RE: ZONING APPLICATION ZA-04-83 1850 NEW JERSEY STREET, COSTA MESA Dear Ms. Lindsay: Review of the minor conditional use permit for the above-referenced property has been completed. Based on the following background, project description, and findings, the project has been approved, subject to the conditions set forth below. BACKGROUND The subject property contains a one-story, single-family residence with an attached, two-car garage and a 280 square-foot, detached structure, which was originally permitted as a storage building behind the residence. The present property owner is paraplegic. The existing residence is not handicap accessible and the property owner cannot afford to alter the residence to accommodate her roommate, who is also paraplegic. A handicap accessible bathroom containing a toilet, sink, and bathtub was installed (without City approval) in the detached storage . building to accommodate the owner's roommate. PROJECT DESCRIPTION The property owner proposes to legalize the full bathroom in the storage building and use the building as a detached bedroom. A minor conditional use permit is required because the bathroom containing a toilet, sink, and bathtub will be located in an accessory structure. To accommodate the special needs of both the property owner and her roommate while minimizing the possibility of converting the detached bedroom to a separate dwelling unit, a condition is included requiring the property owner to record a land use restriction to inform future property owners that the accessory building cannot be used as a dwelling unit. Additionally, the land use restriction will require discontinuation of the bedroom use and removal of the toilet, sink, and bathtub in the detached bedroom/accessory structure Building Division(714)754-5273 • Code Enforcement(714)754-5623 • Planning Division(714)754-5245 • ' � z a � . eery V V at (aa g' DfldGO . vaw °` rr . , � s OWNER-BUILDER-1r VERIFICATION A city or county, which is required to give notice pursuant to Section 19830, shall attach to such notice, and, as a condition precedent to issuing a building permit, require the completion and require the return of, an owner-builder verification. Attention Property Owner: An 'owner-builder' building permit has been applied for in your name and bearing your signature. Please complete and return this information in the envelope provided at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received. I. I personally plan to provide the major labor and materials for construction of the proposed property improvement. ❑ Yes ❑ No 2. I (have/have not) i- - R-t.-Fe--- signed an application for a building permit fin- the rthe proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction: Name Address City Phone ( ) Contractor's Lic. No. _ 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work: Name Address City Phone ( ) Contractor's Lic. No. 5. I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: Name Address Phone Type of Work ClaPrt 1 R. LI Yi d5/ S I J 104246 (REV.9/98) S 9 CITY OF COSTA MESA 4 /� BUILDING DIVISION >:f ' ,w DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER JI i PERMIT egbePoRmsol. P05-00032 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 1850 NEW JERSEY ST Status: ISSUED Suite No Applied: 01/12/2005 Issued: 01/12/2005 Vicinity: -, ISSUED BY: / fff��� Parcel Nunmber: 13910337 Applicant: , LINDSAY,DENISE : - • . , Address: 1850 NEW JERSEY ' Phone: 714-549-3407 ` v''.. "COSTA MESA,CA ,/ 'ii', i Owner: LINDSAY,DENISE , ��. ,Address 1850 NEW JERSEY - Phone: 714-549-3407 � -' COSTA MESA,CA Zip: 92626 Contractor: OWNER-BUILDER Address: \ Phone: ' _ Zip: License: 000000 , ' . ' Arch / Eng:, : . . , .. .. Address: . . Phone: . . __ _ - Zip: ' License: - ' , , ./' SCOPE OF PERMIT CONVERT A 280SF STORAGE ROOM TOA LIVING SPACE.- %%'i i// ' \, `. 1'BATHTUB, 1 WASHBASIN AND 1 TOILET.,.-• -- - A -2" - ,FEE SUMMARY /. j% .: AMT QTY AMT QTY - ,AMT QTY ISSUE FEE , $23.50 Laundry Tub/Washer $0.00 0 . Sump Pump ,'$0.00 0 Backflow irrigatin, . ,$0.00 0 Landscape Irrigation $0.00 0 -;Swimming pool ', " $0.00 0 Backflow Preventer $0.00 0 :,PTrap " - - , $0.00 . 0. - Trap Primer ,' ii�' ' $0.00 0 Bathtub - $9.80 - 1 " - .Pressure Regulator' $0.00- :0 ' ,"Urinal/ / ,'%. '2 $0.00 0 Clarifier System \ -_1$0,00 - 0 , - Process Piping(per 10 ft)'_ ' $0.00 .. -0 \,Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) ' N$0.00 0 , - Receptors ' $0.00 ,0 -•- \ Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 - ' 0. , ` Wash;Basin" $9.80 1 . Dishwasher $0.00 0. Sewer Cap for Demo .$0.00`'. :10 . ,Wastl'BaSin Set $0.00 0 Drain, Floor $0.00 - 0 Sewer Connect $0.00 - 0 GWaste and Vent System $0.00 0 Drain,Rainwater $0.00 0 Sewer Private Line $0.00 0-'0j1 -Water Closet(Toilet) $9.80 1 Drain,Roof $0.00 0 ' .-Shower. - _ • $0.00' "'0 - Water Heater/vent $0.00 0 i Drinking Fountain $0.00 0Sink, bar- :. _ '__' $0.00 - 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 / NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28, §1, 12-21-92) // EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if.work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. r FOR INSPECTIONS CALL: (714)754-5626 / 2446-46(6/00) DECLARATIONS l--7 (� . WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Cartier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that In the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,000),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is In full force end effect.Lk.# Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.if,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ' ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) . license pursue o the Contractors License Laws.). ❑ahem axe r sec. _ _ Business and Professions Code for this reason: Signature: �L) - - /�/� -2 C-491. Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,faisework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMP -AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comp! th :!!state laws d city in: ces rel g 1,o building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-describe» •r i.spection,purpo s.I era n• o ..y or all• occupancy of any building authorized by this permit until final inspection. • Signature Of Legal'Owner(s) •Date) And/Or Authorized Applicant Date CODE I DISPECTIQN TYPE j?dTE INTRIALS CODER INSPFCYIOHTYPE DATE I[i11TIAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 3-1ro cede,' 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 2 oy'*'"'Fs9, CITY OF COSTA MESA b02 • ,, P.O. BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 92628-1200 N , ... DEVELOPMENT SERVICES DEPARTMENT December 23, 2004 Denise Lindsay 1850 New Jersey Street Costa Mesa, CA 92626 RE: ZONING APPLICATION ZA-04-83 1850 NEW JERSEY STREET, COSTA MESA Dear Ms. Lindsay: • Review of the minor conditional use permit for the above-referenced property has been completed. Based on the following background, project description, and findings, the project has been approved, subject to the conditions set forth below. BACKGROUND The subject property contains a one-story, single-family residence with an attached, two-car garage and a 280 square-foot, detached structure, which was originally permitted as a storage building behind the residence. The present property owner is paraplegic. The existing residence is not handicap accessible and the property owner cannot afford to alter the residence to accommodate her roommate, who is also paraplegic. A handicap accessible bathroom containing a toilet, sink, and bathtub was installed (without City approval) in the detached storage building to accommodate the owner's roommate. PROJECT DESCRIPTION The property owner proposes to legalize the full bathroom in the storage building and use the building as a detached bedroom. A minor conditional use permit is required because the bathroom containing a toilet, sink, and bathtub will be located in an accessory structure. To accommodate the special needs of both the property owner and her roommate while minimizing the possibility of converting the detached bedroom to a separate dwelling unit, a condition is included requiring the property owner to record a land use restriction to inform future property owners that the accessory building cannot be used as a dwelling unit. Additionally, the Land use restriction will require discontinuation of the bedroom use and removal of the toilet, sink, and bathtub in the detached bedroom/accessory structure Building Division(714)754-5273 • Code Enforcement(714)754-5623 • Planning Division(714)754-5245 FAX(714)754-4856 • TDD(714)754-5244 • www.ci.costa-mesa.ca.us ZA-04-83 December 23, 2004 Page 2 prior to the transfer of ownership of the subject property, or will require future property owners to obtain proper City approvals to retain the toilet, sink, bathtub, and/or bedroom. FINDINGS A. The information presented complies with Costa Mesa Municipal Code section 13-29(g)(2) in that the proposed improvement is compatible with developments in the same general area. Granting the minor conditional use permit will not be detrimental to the health, safety, and general welfare of the public or other properties or improvements within the immediate vicinity. Specifically, the paraplegic property owner could not improve the existing residence to accommodate the special needs of her paraplegic roommate. Alternatively, the storage building is handicap accessible and could be used as a detached bedroom for the roommate. A condition is included requiring the property owner to record a land use restriction to inform future property owners that the detached bedroom/accessory building cannot be used as a dwelling unit. Additionally, the land use restriction will require discontinuation of the bedroom use and removal of the toilet, sink, and bathtub in the detached bedroom/accessory structure prior to the transfer of property ownership, or will require future property owners to obtain proper City approvals to retain the toilet, sink, bathtub, and/or bedroom. Granting the minor conditional use permit will not allow a use, density, or intensity that is not in accordance with the general plan designation for the property. B. The proposed use complies with Costa Mesa Municipal Code Section 13-29(e) for the following reasons: 1. The proposed use is compatible and harmonious with uses both on-site as well as those on surrounding properties. 2. The proposed use is consistent with the General Plan in that a land use restriction is required to minimize the possibility of converting the detached bedroom into a second dwelling unit. 3. The planning application is for a project-specific case and does not establish a precedent for future development. C. The project has been reviewed for compliance with the California Environmental Quality Act (CEQA), the CEQA Guidelines, and the City environmental procedures, and has been found to be exempt from CEQA. D. The project is exempt from Chapter XII, Article 3, Transportation System Management, of Title 13 of the Costa Mesa Municipal Code. CONDITIONS OF APPROVAL Ping. 1 . The detached bedroom/accessory structure shall not be used as a dwelling unit. 2. Any kitchen or kitchenette is prohibited in the detached bedroom/accessory structure. 3. Use of the detached accessory structure as a bedroom shall discontinue prior to the transfer of property ownership. ZA-04-83 December 23, 2004 Page 3 4. The toilet, sink, and bathtub shall be removed from the detached bedroom/accessory structure prior to the transfer of property ownership, or future property owners must obtain property City approvals to retain the toilet, sink, bathtub, and/or bedroom. 5. The detached bedroom/accessory structure and bathroom shall be served from the same utility meters (electric, gas, and water) as the main dwelling unit on the property. 6. A land use restriction executed by and between the applicant and the City of Costa Mesa shall be recorded prior to the issuance of building permits, to inform future property owners of the restrictions contained in condition numbers 1 , 2, 3, 4, and 5. Applicant shall submit to the Planning Division a copy of the legal description for the property, and either a lot book report or current title report identifying the current legal property owner so that the document may be prepared. 7. Any new mechanical equipment such as air-conditioning equipment and duct work shall be screened from view in a manner approved by the Planning Division. Roof mounted equipment is prohibited. 8. Construction, grading, material delivery, equipment operation, or other noise- generating activity shall be limited to between the hours of 7 a.m. and 8 p.m., Monday through Friday, and between the hours of 8 a.m. and 6 p.m. on Saturday. Noise-generating activity shall not be allowed on Sunday or Federal holidays. Exceptions may be made for activities that will not generate noise audible from off site, such as painting and other quiet interior work. 9. Applicant shall obtain permits no later than 60 days from the date of this letter. 10. The conditions of approval and ordinance or code provisions and special district requirement of Zoning Application ZA-04-83 shall be blueprinted on the face of the site plan. 11. The applicant shall contact the Planning Division to arrange for an inspection of the site prior to final building inspection. This inspection is to confirm that the conditions of approval and code requirements have been satisfied. CODE REQUIREMENTS The following list of federal, state and local laws applicable to the project has been compiled by staff for the applicant's reference. Any reference to "City" pertains to the City of Costa Mesa. Ping. 1. Approval of the zoning action is valid for one (1) year and will expire at the end of that period unless building permits are obtained and construction commences, or the applicant applies for and is granted an extension of time. A written request for an extension of time must be received by Planning staff prior to the expiration of the zoning action. 2. All contractors and subcontractors must have valid business licenses to do business in the City of Costa Mesa. Final inspections, final occupancy and utility releases will not be granted until all such licenses have been obtained. 3. Development shall comply with all requirements of, Chapter V, Article 1of ZA-04-83 December 23, 2004 Page 4 Title 13 of the Costa Mesa Municipal Code relating to development standards for single-family homes/ projects. Bldg. 4. Comply with the requirements of the California Code of Regulations, Title 24, also known as the California Building Standards Code, as amended by the City of Costa Mesa. SPECIAL DISTRICT REQUIREMENTS The requirement of the following special district is hereby forwarded to the applicant: Sani. 1. Applicant shall contact the Costa Mesa Sanitary District at (949) 645-840 for current district requirements. Upon receipt of this letter, your project has been approved, subject to the above-listed conditions. A copy of the conceptually-approved plans are enclosed. The decision will become final at 5 p.m. on December 30, 2004, unless appealed by an affected party (including filing of the necessary application and payment of the appropriate fee) or by a member of the Planning Commission or City Council. If you have any questions regarding this letter, please feel free to contact the project planner, Hanh Tran, at (714) 754-5640 between 8 a.m. and 12 noon, Monday through Friday. Sincerely, i • R. MICHAEL ROBINSON Zoning Administrator Enclosure: Conceptually-approved plans cc: Engineering Fire Protection Analyst Water District Building Division PLANNING APPLICATION SUMMARY Location: 1 850 New Jersey Street Application: ZA-04-83 Request: Minor Conditional Use Permit to legalize a full bathroom containing a toilet, sink, and bathtub in an existing detached, accessory structure. SUBJECT PROPERTY: SURROUNDING PROPERTY: Zone: R1 North: R1 Single-family residences General Plan: Low Density Residential South: R1 Single-family residences Lot Dimensions: Irregular East: R1 Single-family residences Lot Area: 8,876 sq.ft. West: R1 Single-family residences Existing Development: A 1,450 sq. ft., 1-story, single-family residence with attached 2-car garage. DEVELOPMENT STANDARD COMPARISON Development Standard Code Requirement Proposed/Provided Density: Zone 1 du: 6,000 sq.ft. 1 du: 8,876 sq.ft. General Plan 1 du: 5,445 sq.ft. Lot Size: 6,000 sq. ft. 8,876 sq.ft. Building Coverage: Building - existing residence 1,450 sq. ft. (16%) Building - existing attached garage 400' sq. ft. (5%) Building - existing detached structure 280 sq.ft. (3%) Driveway 480' sq.ft. (5%) TOTAL - coverage 2,610 sq.ft. (29%) Open Space 3,550 sq.ft. (40%) 6,266 sq.ft. (71 %) Building Height (detached bedroom): 1 story/15 ft. 10 ft. 1 Setbacks (detached bedroom): Front 20 ft. 100 ft. ' Side (left/right) 5 ft./5 ft. 50 ft. '/5 ft. Rear 10 ft. 30 ft. Parking: Covered 2 2 Open 2 2 TOTAL 4 4 Estimated CEQA Status Exempt-Class 1 Final Action Zoning Administrator • tx r CITY OF COSTA MESA ,`y4 BUILDING DIVISION �. DEVELOPMENT SERVICES DEPARTMENT P98-00366 PERMIT PERMIT NUMBER %%erno (714)754-5273 • Fax(714)754-4856 PLUMBING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 1850 NEW JERSEY ST Status: ISSUED Cit .- Suite No Applied: 05/13/1998 Issued: 05/13/1998 Vicinity: ' Parcel Nunmber: 13910337 • Applicant: LINDSAY, CRAIG Address: Phone: _ _ Zip: Owner: LINDSAY, CRAIG Address LINDSAY, DENISE " - . , ' • _ 1850 NEW JERSEY - - - . Phone: ' DEMETRAKOS Zip: 92626 , , Contractor: ' SOUTH SHORE CONSTRUCTION DESIGN & DEVELOPMENT.r. Address: 350 FOREST AV Phone.--'1714-248-9100 LAGUNA BEACH,CA •Zip:, 92652 • . ' • -'License:705374 ' ' , __ . , - ,' \ - Arch/Eng. - - - - Address: , ." Phone: ./ Zip: , - . . 'License: , " ' • .• SCOPE OF PERMIT MISC.PLMB.RELATED.TO.NEW ADDITION.'INSTALL HOSEBIB. • - FEE SUMMARY' / ' AMT QTY - AMT.,_ QTY AMT QTY ISSUE FEE $22.00 Laundry Tub/Washer - $0.00 --0Sump Pump,, $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool ' ' . $0.00 0 ' Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer' .$0.00 0 Bathtub $0.00 ' 0 Pressure Regulator , '.•$0.00 0 Urinal - ' - '.,.$0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 ' Connect(Ice,Soda,etc) $0.00 , 0 Receptors '$0.00; 0 Vacuum Brkr Bkflow(5+) , $0.00 0 Dental Units $0.00 ` 0 • ' Septic Tank , - $0.00 •0 ' ' Wash Basin $0.00 0 Dishwasher - $0.00 0 Sewer Cap for Demo ' ' $0.00. '0. - _ " Wash Basin Set $0.00 0 Drain, Floor $0.00 0 . ' Sewer Connect . , . ,$0.00 0 '-- Waste and Vent System $0.00 0 Drain,Rainwater $0.00 0 Sewer Private Line " $0.00 . 0 - Water Closet(Toilet) $0.00 0 Drain,Roof $0.00 0 Shower' -- - . • - - $0.00 0 - Water Heater/vent $0.00 0 Drinking Fountain $0.00 - 0 Sink, bar $0.00 0 Water Piping(Inst or Rep.) $8.75 1 Expansion Tank $0.00 0 _ Sink,commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water,Service $0.00 0 Gas(1-4 outlets) $0.00 0 _ Sink, kitchen $0.00 0 ' Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 ' Sink,service/mop . $0.00 0 - OTHER $0.00 Gas Repipe $0.00 0 -Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa(public) '$0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $30.75 COMMENTS/SPECIAL CONDITIONS • EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 �t"l�7 V DECtAR4TIONS ( ) fl -;, WORKERS'COMPENSATION DECLARATION: - I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Cartier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so es to become subject to the workers' compensation laws of California.and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. pplicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML RNES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: i • I hereby affirm that I am licensed under provisions of Chapter 9 coening with Section 7000)of Division 3 of the Business and Profqyft Ions Code,and my license Is in full force and effect.Uc.N / no 5 Class it t.' " 1 Contractor's Signature: I V Date: S " 1 Z7 / 71 CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). ' Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such Improvements are not Intended or offered for sale.If,however,the building or Improvement Is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,I.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: ' Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP Is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes ❑No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If'yes',the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Alr Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 es 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state la• - :n• city ordina es rel. ' • • building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for Inspection • .0-i-.I -•ree upy• Mow occupancy of any building authorized by thi rmi final inspa;1i It 1 14t--) Signature • Legal Owner(s) Date • '9.-----1:1 And/Or Authorized Applicant Date COE L BISPFCTION TYPE WI IM916 con IN EWIIIIN TYPF DATE IIID 1616 Fixed System Final Fire Prevention 206 Final Mechanical 67 /�/}�(� 1266 Pool Spa Final 208 Final Plumbing �q6/90� 00-- 200 Final Re-Roof 210 Final Electrical . 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval • 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 2446-46 I a.' • fr ��' CITY OF COSTA MESA at,i BUILDING DIVISION • tI��yy DEVELOPMENT SERVICES DEPARTMENT M98-00164 4• PERMIT PERMIT NUMBER (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 1850 NEW JERSEY ST Status: ISSUED (/PC.'" Suite No Applied: 05/13/1998 Issued: 05/13/1998 Vicinity: Parcel Nunmber: 13910337 Applicant: MYKE, WILLIAM Address: _ Phone: Zip: Owner LINDSAY, CRAIG - , , �v Address: LINDSAY, DENISE - _ 'v�_ \��A . 1850 NEW JERSEY ` : Phone: , ''' -' DEMETRAKOS :, Zip: 92626 ,,/ / V• N \ /k Contractor SOUTH SHORE CONSTRUCTION DESIGN & DEVELOPMENT. .• Address: 350 FOREST AV � - '•:ti ' - Phone: 714-248-9100 LAGUNA BEACH,CA ' Zip: 92652 . Licens :705374- ' - - " Arch/Eng: Address: ' Phone: , Zip " - License:- , , SCOPE-OF PERMIT ,' ' _ . , MISC:KMC.. RELATED-TO NEW ADDITION" - "- . MEc4• - . , ' / ', • FEE SUMMARY Quantity - - " Quantity ISSUE FEE $22.00 • Repair/Alt Absorbtion Unit ' $0.00 0 Inst FAU<100 k BTU $0.00 '' Repair/Alt Refrigeration Unit - $0.00 •r'0 • Inst FAU>100 k BTU $0.00 Ventillation System -, . $0.00 0 Repair/Alt Cooling/Heat ,$0.00 0 " Evaporative Cooler $0.00 , 0 Inst/Rep. Recess Wall Htr $0.00 0 Commercial Incinerator , $0.00' 0 Refrig Sys<100 k BTU $0.00 0 , Domestic Incinerator " - $0.00 0 Refrig Sys>100 k BTU $0.00 .0 . Compressors[Absorption Systems • Gas Piping $5.50 1- Up to 3 hp/100 k BTU Factory Fireplace $9.50 1 '3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust .$0.00 0 • - • "15 To 30 hp/1,000 k BTU . / $0.00 0 VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct $0.00 0, Over 50 hp/Over 1,750 BTU - $0.00 0 Appliance $0.00 0 Boilers Fire Dampers $0.00 0 Up to 3 hp - $0.00 0 Smoke Dampers $0.00 0 ' 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent . $0.00 0 - - ' 15 to 30 hp $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 • TOTAL CALCULATED FEES $37.00 COMMENTS/SPECIAL CONDITIONS • •EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 S • DECLARATIONS n 3,-., WORKERS'COMPENSATION DECLARATION: • • . - I hereby affirm under penalty of perjury one of the following declarations: • ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. 95( I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number. (This section need not be completed it the permit/s valued at one hundred dollars($100)or less.) ❑ I certify that In the performance of the work for which this permit Is issued I r: r. employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that If I should.: . : "led to the workers' ••mpensatlon provisions of Section 3700 of the La Code,I shall forthwith comply with these provisi. s. "\ Applicant Signature: ailliM Date: 1 WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. C LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisionsf C pter 9(commencing with Section 7000)of Division 3 of the Business and Prrfessions Code,and my license is In full force and effect.Lic.# 1'V° S 'SClass# '1`� Contractor's Signature: 4".......--- Date: S-. \ -6---6 _ CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature; Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or Improvement Is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,I.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. • Signature: Date: Division of Industrial Safety Permit Number. HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP Is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes ❑No (Section 65850.2 of the California Government Code requires that the requested information be fumished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Alr Quality Management District or other air pollution control district or agency Is required for the work which Is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 es 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply ith :II state laws an. rdinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described prope fori pection pu •y- of 15 ccupy or allow occupancy of any building authorized by this permit until fi • spection. r \ / • Signature 4 egal Owner(s>/ Date And/Or Au aired Appl' nl Date CODE L it INSPECTION TYPE DATE hSS CCU4 INSPFCnna TYPE tq `I#r 1616 Fixed System Final Fire Prevention 206 Final Mechanical l7�yo q e 7.0 1266 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention • 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site • 204 Final Demolition 250 Final Building/Occupancy 2446-4e 4 �� � CITY OF COSTA MESA 4.1t:. BUILDING DIVISION F r ”..."1" ' DEVELOPMENT SERVICES DEPARTMENT Ega-on4n4 1/- PERMIT PERMIT NUMBER (714)754-5273 • Fax(714)754-4856 • ELECTRICAL PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 1850 NEW JERSEY ST Status: ISSUED CAC, Suite No Applied: 05/13/1998 Vicinity: Issued: 05/13/1998 Parcel Nunmber: 13910337 Applicant: MYKE, WILLIAM Address: Phone: Zip Owner: LINDSAY;CRAIG , ` Address LINDSAY,DENISE - /- - " , 1850iNEW JERSEY - - _ Phone:. . . - DEMETRAKOS ' - . Zip: 92626 ''.,-c- _ Contractor: SOUTH SHORE CONSTRUCTION DESIGN & DEVELOPMENT7:,V�,." ' Address: 350 FOREST'AV \,,\,,�/' -:,:'y',, \\t> \, . Phone:'�714-248-9100 -�" ;,j LAGUNA BEACH, CA Zip: i92652 _ „\,, -License-705374 _I , . . _ , SCOPE OF PERMIT MISC. ELEC. RELATED TO NEW ADDITION. , FEE SUMMARY • ' Quantity , ' - • . - . Quantity ' ISSUE FEE $22.00 Temp Dist System/Lighting $0.00 0 ' Temp service test $0.00 - Busway/100 ft . $0.00 0 Res. a/c package $0.00 _ Standing Section ; $0.00 0 New Res(1-2 units) $0.00 0 . ,- .=Misc Eledtrical Equipment_-% $0.00 0 , .. ' New Res(3+units) $0.00 " '0. . -- - ' Transformers,up to-t kva/kw ' $0.00 0 , Pool/Spa $0.00 0 - - up`to/10 kva/kw $0.00 0' , Lighting Fixts $5.00 5 --up to 50 kva/kw $0.00 0-. ' .Recept Outlets $3.00 3 up to 100 kva/kw . $0.00 0 Switches ' $3.00 3 -- - over 100 kva/kw $0.00 �0, Non Res Appl $0.00 0 Low Voltage Equipment $0.00 , 0 - Res Appl $0.00 0 r Low Volt Wiring System/Ckt $0.00,. 0 •i, Service to 200a $0.00 0 , ' Misc:Conduit $0.00'., . 0 -, Service to 1000a $0.00 0 Misc.Conductor $0.00 0 Service over 1000a - $0.00 0 .Circus(gen or ride) ,, $0.00 0 Motors to 1hp. $0.00 0 ' 'Circus(mech"ride or lights) - $0.000 Motors to 10hp $0.00 ,. 0 Christmas Tree Stand . $0.00 , . 0 -i. ' Motors to 50hp $0.00 0 , ' . "Fireworks Stand - - $0.00. 0 , •. . Motors to 100hp $0.00 0 ' . Other Electrical Fee - $0.00 , Motors over 100hp $0.00 0 .. Communication drops $0.00 0Investigation Fee $0.00 Sub panel to 200a $0.00 .0 . ' Plan Check Fee. $0.00 Pole Light Pkg $0.00 0 Reinspection Fee - $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $33.00 Intermed Pole $0.00 0• COMMENTS/SPECIAL CONDITIONS EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 DECLARATIONS . WORKERS'COMPENSATION DECLARATION: • I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'compensation Insurance carder and policy number are: Cartier: Policy Number (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become sub:. : e workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provi••ns. - `� -J' ^^ -b Applicant Signature: -L� — Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED i /THOUSAND DIXURE(E100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. C UCENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions o Chapter 9(commencing with Section 7000)of Division 3 of the Business and P,r3}fessions Code,and my license is In full force and effect.Lic.# �0 �J1 Class# (- v Contractors Signature: � Date: iS- l� °) CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such Improvements are not intended or offered for sale.If,however,the building or Improvement Is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code:The contractors License Law does not apply to an owner of properly who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes 0 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 8 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which Is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF CO ' CE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agr to •: with all state la,s a•• •rdinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-de e- •PA: for inspection •occupy or allow occupancy of any building authorized by t 's permit until final�/inspection.) AP Signature o Legal a. ner(s) aD tAr \ And/Or A ••" ed Applicant Date CODE t INSPECTION TYPF DATE =LS CODF2 DISPFC11fN TYPF DATE UOIDALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final _ 208 Final Plumbing //�� 200 Final Re-Roof 210 Final Electrical . 5-I( 'COP 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Anal Demolition 250 Final Building/Occupancy 2446-46 4'Y CITY OF COSTA MESA ' y`w � BUILDING DIVISION f' j: DEVELOPMENT SERVICES DEPARTMENT v 666 F9R-00560 Ste J' ..., PERMIT PERMIT NUMBER ongo (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT , 4 Job Address : �' 18501.NEW JERSEY ST Status: ISSUED Suite No Applied: 06/15/1998 Vicinity: Issued: 06/15/1998 Parcel Nunmber: 13910337 Applicant: MIKE, WILLIAM Address: Phone: Owner: LINDSAY,CRAIG- - /` Address LINDSAY,:DENISE . - L� t 1850 NEW JERSEY 'Phone:- _ - N, ,, ` DEMETRAKOS ---Zip: 92626 - ",� " < \ \\'\ •Contractor: SOUTH SHORE CONSTRUCTION DESIGN & DEVELOPMENT. 'y / 7' \\,`. \',', 7'. A,,,v\ Address:,j 350 FOREST AV vvhv,v , Phonel:714-248-9100 ` LAGUNA BEACH,CA Zip: 02652 I : ;License:705374' '• - , o - • . - SCOPE OF PERMIT . UPGRADE SERVICE TO 200 AMP., INSTALL NEW PANEL. . FEE SUMMARY' >r . Quantity . . .. - .. Quantity ' ISSUE FEE $6.50 Temp Dist System/;Lighting $0.00 0 -, , Temp service test $0.00 _ _Busway/100ft ./•�, $0.00 0 " ` Res.a/c package $0.00 -. Standing'Section '.:,,:`_ / $0.00 0- ' - New Res(1-2 units) ' $0.00 . -0 - -- Mist Electrical'Equipment t $0.00 0 1. ' New Res(3+units) $0.00 0 -- Transformers up to 1 kva/kw $0.00 Oi ' ' Pool/Spa • ' $0.00 0 -_up 16 10 kva/kw $0.00 Lighting Fixts $0.00 0 up-to 50 kva/kw $0.00 '0/ ' Recept Outlets . � $0.00 0 -'= up td 100 kva/kw $0.00 '0 "'' Switches , $0.00 0 . over 100 kva/kw $0.00 ' ','0 . Non Res Appl , ' $0.00 0 ' Wit Voltage Equipment $0.00/l `0 Res Appl - $0.00 0 ' Low Volt Wiring System/Ckt 50.00/,- 0 r Service to 200a $27.25 1 ,• ' ' ' Misc.Conduit . Service to 1000a - $0.00‘., 0 " - , Mlac.Conductor -. "'$0 ,00 0 Service over 1000e $0.00` " 0 1 `Circus(gen or ride), , $0.00. - 0 Motors to 1hp - $0.00 - 0 • - - Circus"(mech ride or,lights), = $0.00 - 0 - / Motors to 10hp "'$0.00 -0"' -,' - Christmas Tree Stand. 50.00-* 0 7, I / Motors to 50hp $0.00 0 Fireworks'Starid-'- $0.00, 0 ',/ Motors to 100hp $0.00 0 ` - •Other Electrical Fee - $0.00 Motors over 100hp - $0.00 . . 0. - Communication drops . $0.00 . 0 - Investigation Fee $0.00 Sub panel to 200a $27.25 . -1 . Plan Check Fee' , $0.00 Pole Light Pkg $0.00 0 Reinspection'Fee $0.00 Sign Circuits $0.00 0 - , Temp Pwr Pole $0.00 0 • TOTAL-CALCULATED FEES $61.00 Intermed Pole $0.00 0 - COMMENTS I SPECIAL CONDITIONS • • EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 DECLARATIONSWORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the "work for which this permit Is issued. I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'compensation Insurance carrier and policy number are: Cartier: Policy Number. (This section need not be completed it the permit is valued at one hundred dollars($100)or less.) ❑ I certify that In the performance of work for which this permit is issued, I shall not employ any person in any manner so as to become • the workers' compensation laws of California, agree that If I should become subject to the workers'compensatign.provisions of S:ctlon ;700 of the --..r Code,I s : forthwith' comPly_wlth these-pr Ions. / Applicant Signature: • Dater c —WABWEI_ AlLURE-TO-SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SU:. AN EMPLOYER TO CRIMI rNALTIES AND CML FINES UP TOONE HUNDRED THOUSAND COLLARS($100,000),IN ADDfRON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR I" ... - LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby-aft at I am licen :• der• ovisnS.,pfih:pter 9(commencing with Section 7000)of Division 3 of�the.8usiness and P/��9s Code,and my license is in full force and effect.Lic.# $ lass#_1\ ,J (Contractors Signature: (Date: • r I CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such Improvements are not intended or offered for sale.If,however,the building or Improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044, Business and Professions Code:The contractors License Law does not apply to an owner of properly who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes ❑No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: • ❑ I hereby certify that no excavation five(5)or more feet In depth into which a person Is required to descend, will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,Califomla Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No • (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the Califomla Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No • (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application appemit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? DI Yes 0 No (Section 65850.2 of the California Government Code requires that the requested information be fumished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomla Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described properly for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ea a—. And/Or Authorizt Art tent _ Da CODE E. INSPFC'.TInN TYPF DeII MOWS CDDEU INSPECTIONTYPE DATE =RIDAIS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing � 200 Final Re-Roof 210 Final Electrical g-it 17 ) Q 201 Final Block/Retaining Wall 212 Final Fire Prevention • 202 Final Factory Fire Place _ 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Anal Demolition 250 Final Building/Occupancy 244848 • • . CITY OF COSTA MESA `w � BUILDING DIVISION ti i' '' DEVELOPMENT SERVICES DEPARTMENT arkell 898-00807 PERMIT PERMIT NUMBER (714)754-5273 • Fax(714)754-4856 BUILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 1850 NEW JERSEY ST Status: ISSUED(taC, Suite: Applied: 05/11/1998 Vicinity: Issued: 05/13/1998 Parcel Nunmber: 13910337 Zoning: Applicant: MIKE, WILLIAM Address: 350 FOREST AV Phone: 714-248-9100 LAGUNA BEACH,CA. Zip: .92652 Owner: LINDSAY, CRAIG ' • Address LINDSAY,DENISE " - 1850 NEW JERSEY - - - Phone: DEMETRAKOS " ' _ Zip: . 92626 ,� Contractor: N Address: - N • Phone: Zip: y ,'N License:, Arch/Eng : Address: Phone: • .. - License:. _ _. . - I SCOPE OF PERMIT 192 SQUARE FOOT ROOM ADDITION, 11 FT HIGH, LOCATED 37 FT FROM FRONT P/L,6 FT FROM SIDE P/L: • FEE SUMMARY • Plan.Check: $186.71 __ - • _ • Calc Valuation: ' $9:o0 ' Permit: ' $287.25 • - . Claimed Valuation: $20,000.00 • Other $0.00 . . Inspection: $0.00 Total: $475.96 • PLANNING &ZONING • SETBACKS . . , MAIN STRUCTURE Front 20-0 ,: -Rear t 20-0 - Left 5-0 ' . : ,'Right 5-0 - - - - . ACCESSORY Front 0-0 Rear . 0-'0' . , Left - 0-0 Right 0-0 PARKING Existing: 0 . Required: 0 Proposed: 0 NOTES: _ • • EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned 'ora period of 180 days. NSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, a d'al squired Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this peria'',' OR INSPECTIONS CALL:,(714)754-5626 (,: DECLARATIONS ( ) i'M WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: - Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less) ❑ I certify that In the performance of the work for which this permit is issued. I shall not employ any person in any manner so as to become subject to the workers compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisi•ns. /�{�Applicant Signature: .4 . - Date: ./�i - 1 /� '�S /WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100.000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: r I hereby affirm that I am licensed under p�vis)gns o1 C pter 9(commencing with Section 7000)of Division 3 of the Business aneCrofessions Code,and my license is in full force and effect.tic.k // 77 1 (9----- �� \ Class ft 1`7 \ Contractors Signature: (/✓/`''' ' - — i Date: 5_ \ �. — CONSTRUCTION LENDING AGENCY: ' ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed statement that heorshe is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sate(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of properly who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement Is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044, Business and Professions Code:The contractors License Law does not apply to an owner of properly who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(38)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 6,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health end Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a it for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 0emNo (Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (It'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (if yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-desci•e• ••roperty for inspection. es.I a•ree not to occupy or allow occupancy of any building authorized by this permit until final ins ion. / //A S 1 � r' Signatu= • . eg Owner(s) Date And/Or A o• ed Applicant Date "co' DE 1 IISPECTWN TYPF PATE MIDIS ShcgEt gime-nos TYPF UTE INLO3Ab5 fi 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final _ 208 Final Plumbing _ 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Anal Fire Prevention 202 Final Factory Fire Place - 220 Final Planning Approval 203 ' Final Sign 222 Final Site q 204 Final Demolition 250 Final Building/Occupancy l 12-qpp f6r. (- 2446-46 r—th 2 C7) -• Insulation Certificat ( g 5O AI JerscM sf co .sem- MeS � ^ Number and Street City C� -e-- County Subdivision l.ot`lumber Description of Installation • ROOF Material Brand Name • Thickness(inches) Thermal Resistance(R-Value) CEILINGa � "' 4k — + d Bac[or Blanket Type y. � Brand Name Kr o� ce Thickness(inches) 9' 9 Thermal Resistance(R-Value) 30 Loose Fill Type Brand Name Contractor's minimum installed weight/ft" lb Minimum thickness inches Manufacturer's installed weight per square foot to acheive Thermal Resistance(R-Value) • EXTERIOR WALL Material134--rt Brand Name Vrc4 t ' 0-•r-F ckct4 Thickness(inches) 0 Thermal Resistance(R-Value) ( 1 RAISED FLOOR Material Brand Name Thickness(inches) Thermal Resistance(R-Value) SLAB FLOOR Material Brand Name Thickness(inches) Thermal Resistance(R-Value) Width(inches) FOUNDATION WALL Material Brand Name Thickness(inches) Thermal Resistance(R-Value) Declaration I hereby certify that the above insulation was installed in the building at the above location in conformance with the current Buildine Energy Efficiency Standards for new residential buildings contained in Title 24 of the Calijomia Administrative Code. 1 Sar SI�Qr� CON-S±.• 70537 q rn /np 7 7Z ral C nuactor(Builder) , License Number CT 'I , CcSf. 7—I 5— 92 • Sig cure and Tide Date Sub-Contractor(Insulation Installer) License Number Signature and Title. Date Compliance Forms January 1, 1995 . ADDRESS OF BALM: 1850 NEW JERSEY ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT 'ONNERSNAMEIFIWOcVN: LINDSAY, CRAIG FLOOD : AE-37 ERM NO: B 076492 Au:^Ess: LINDSAY DENISE ,fir ' DEMETRAKOS PERMIT NO: B 076492 PLAN CHECK NO: 00579-96 L ' GOVT: N SUPP: N 10 NEW NJERSEY COSTA MESA,CA 92626 APPL.MMUNG ADDRESS: CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: ADD ARCHITECT OR ENGINEER: UC NO.: JOB DESCRIPTION : STORAGE BUILDING 280 SQ FT ---„SO FT; 280 ARCH.OR ENG.'S ADDRESS: WIT: _ _ CLAIM VALUE: 5, 600 . 00 CALC—VALUE: 5, 768 . 00 GROUP OCC:—U----1-__ / CONTRACTOR'S NAME: 1 CONRACTOR'SMMUNG COMMENTS: 14 X 20 STORAGE BUILDING ADDRESS --„/: UC.NO.: ifiklElElk1(-iE#1Eil•1EiElElElflkiffklElElE********1E1E**********•**1ElE***********1f****l41E3E**************1F'\ uMT: ZONING R E Q U I R E M- E N T S ---, , Z. LICENSED CONTRACTORS DECLARATION:I hereby affirm under,penally of perjury that I am licensed under provisions of Chapter 9 SETBACKS (commenting with Section 7000)of Division 3 of the Business end Professions Code,and my license is in full force and effect. CITY LIC.NO,: LIC.CLASS: '.'sac.No.: EXP: MAIN BUILDING ACCESSORY BUILDING :< FRNT: FT IN REAR: FT IN FRNT; 10 FT IN REAR: 30 FT IN Dalt Contractor:, FT IN RGHT: FT IN LEFT: FT IN RGHT: 5 FT IN OWNER BUILDER DECLARATION:I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason(Section 7031.5 Business and Professions Code:Any city or county whish requires a permit to construct.alter.improve, PARKING REQ: .t . ' P RO V: PARCEL: 13910337 Z N E: R1 REF NO: demolish,or repair any stmcture,prior to los issuance,also requires the applicant for such permit to file a d signedDstatement that he or she is licensed pursuant to the provisions d the Contractors License Law[Chapter a(commenting with Semen 7000) i®ion 3 of the PLANNING N TES>'' 141 BY 20 ' , 10 ' HIGH STORAGE BUILDING TO BE CONSTRUCTED CONSTRUCTED Business and Professions Code]«that hie(she iseiempttheishom and the basis for the alleged exemption.Any violation d Section 1> BEHIND AN XISTING SFD. NO ELECTRICITY/PLUMBING PROPOSED. 7031.5 by any applicant for a permit subjects the applicant to a end penalty of not more than Ns hundred dawn ISSDOU. *******************4*********************************************************** ❑ I,as owner of the propeny or my employees vveh wages as their sole compensation.MII do the‘vork.and the structure is not intended D E V E- L O P M E N T SERVICES R E Q U I R EMENTS or offered for sale(Section 7044.Business and Professions Code:The Contractors License Law does not apply lean Owner of properly who Q 2'" 1 — t who builds or improves thereon,and who does such-Work emcee or herself or through he or her own employees.provided that such �' improvemmets are rot intended or offered for sale.B,however,the building or improvement a sold within one year of completion,the ZONING APPROVED BY ,-9,1--1 (4713r K. DATE: owner-builder will have the burden of proving he or she did not build or improve for the corpses of sak). /o (/s ❑ Pas ower dthe Terly,Coameore exclusivelycontractingLawaoe not licensed coan owner atoconertycttheproject(improv7044,stheeoni who G V Professions Code:The Contractors License Law does not apply to owner d proParty who builds or improves thereon and who BUILDING APPROVED B Y. : �,{� DATE: contracts for such projects with a conlradods)licensed pursuant to the Contractors License Law). n v i ese�mplundersection:BP.7044 B,8'PC.f«th�iissJ/gao_:OWNER UIL ER APPLICATION ISSUED .B,Y: DATE: ate: r Owner: /(/{'�/.J.CQ.I/ *******************,******************************1E*******************,,***** *** coli/nl� LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y 1 hereby caddy that I am aware of and understand the requi ion Calioma Health end Safely Code Sections 25505. ,and 25534.and that I or any future building occupant will/will not(circle one)need to comply with said slate codes end the cements for 'T apermit for construction«modification from the Ar aragement District.Residential constructionepplcatierne are ex ptfrom these BLDG PMT PLUMBING ELECTRIC MECHANIC ' FIRE SMIP/RES GRADING provisions, PERMIT 81 . 00 rt . 58 Date: Applicant: SMIP/NON—RES PLAN 52 . 65 td WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one of the following dedaralions: ISSUE FEE o I have and wiN maimain a central.of consent to self-insure for workers'compensation,as provided for bySeeing 3700dthe Labor BUILDING—DIV—> PERMIT ISSUE PLAN.fCHECK TOTAL PAID DUE Code,for the performance of the work for which this permh is issued. TOTALS----> 81 . 58 0 .00 ' 752 . 65 134 . 23 134 . 23 . 00 ❑ I have and oil maintain workers'compensation insurance,as required by Section 3700 d the Labor Code,f«the performance of the work for whrh the permit a issued.My workers'compensation insurance mamer and policy number are: Carrier REVENUE DIVISION TOTALS--> COLLECTED : — 81 . 58 OVER/SHORT: . 00 Policy Number BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK (This section need not be completed 1 the permit is l r one hundred dollars[Pool or less.) 81 . 00 ,p' . 58 ❑ I certify that in the performance of the work for which this permit a issued,I shall not employ any person in any manner so as to become subject to the workers'compensation laws of California.and agree that H I should become subject to the natters' ****************************************************************************fH** compensation provisions of Section 3700 of the Labor Code,I shall fodhwith comply with those provisions. INDIVIDUAL .c• F E E BREAKDOWN Dale: Applicant) Warning:Failure to secure workers'compensation coverage Is unlawful,and shall subject an employer to criminal pena/lles and TYPE QTY DESCRIPTIO N' UNIT COST TOTAL COST civil fines up to one hundred thousand dollars($104000),in addition to the cost of compensation damages as provided for In section3706oftheLaborCode,Interest,,andattprneysl«s. SFR 280 RES GARAGES TYPE V 20 . 60 5, 768 ,00 • CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty of perjury thet there is a construction lending agency for the END -OF FEES performance of the work for which the permit is issued(Section 3097,Civ.C). LENDER'S NAME: LENDER'S ADDRESS: - • I candy that I have read this application and state that the above information is correct,I agree to comply with all city and county ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned properly for inspection purposes. DENISE LINDSAY ..... OAGi�'0- _ y TC•/ "1.6 //tom_iL./i ✓ . Data: CO . /./ /TG ' Signatur:of. t/ApplcanContractor ._ - - -. I -- —" - — - --- - - - — (5151-46.WP) While-Building$Soley;Oreert-Flo;Canary-Appliranl;Pink-Revenue Goldenrod-Assessor f % - r CJJSTRUCTION AND PLANNING POG . SPA Date Inspector Date Inspector Ar ROVALS Permit# APPROVALS Permit# '1,J etnporary Electrical Service or Pole 52. Pool & Equipment Location ,- . '2. Soil Pipe-Undrgrnd. Reinforcement4 . _3._Electrical Conduit Utility-Undrgrnd. •/ j :r ••4,-Eectrical Conduit-Undrgrnd. =• ' I. ,57.-. teel Reinforcement , -Ca (tt4-:. 56. Rough Plumbing • 7 6,Electrical UFER Grnd. • • • , Sjr• T.'i;'Footings . 3- - -4'6 4(4/ , 8:-Foundation " ah P`Cp _7 (( -?I ,�'e•. ( 59.. Gas Pipe, 0 Undrgrnd.,Test - {j 9. Water Pipe- Undrgrnd. w - 60. Backwash Lines, P•Trap, 0 Undrgrnd. `, i/ 4-10. Structural Floor System 61. APPROVAL TO DECK 11, Property Sewer Line & House Connection 62. Backwash & Receptor-Final ' 12. Sewer Cap 63. Heater & Vent-Final ▪ • 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final f5. Rough Electrical-Conduit 66. Solar System-Final • ." 16. Rough Electric Wiring 67e Fencing & Access Approval 17. Rough Wiring Sign '68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning o - - - _ FIRE DEPT. REQUIREMENT I 20. 6Augh Faetor'y;FiCgpface r• ' - OE' t" . APPRVAL•SPemit# It, � 21. Ducts in Structure-+: •• = s S ' 70. iUndergrou'rjid Hydro 22. Duct's Ventilating" . `•` V,. - ' 71, Product Piping D'Gas OtQil 23. Gas Pipe-Rough&Test _ _ '72. Underground Flush L - 24. RoofFrain-mg•' `-w - " 4. A 73., Undergrr�aa.Storage Tank'.0 Gas 0 Oil 25. Roof Sheathing Z- 745 Overhead Hydro 26. T1-Bar Ceiling (Structural) & M no`coat4. s. - :? .•; 75 :Dry.Chemical• 27. Frame and Flashing, _ ,, 1E0....T6j 76. Dry Standpipe • ,_ r y28. Lathing &Siding *••• - •.7: - r ZJ` •• " ' ;x 77,? FIXED SYSTE7�{i�FINAL ... c` 29. Insulatioj. arr .- �; ,r 7&- FIRE PREV. FINAL * =sA7 • 30, Drywall Nailing Ft "" '' H •HEALTH DEPT. REQUIREMENT 4 >:* c ;- 31. Plaster Brown,Coat--. - 79. FINAL INSPECTION : I • 32. Dectrical'Pow`er Mgt2r-Fypal •-80;FOOD CERTIFICATE ISSUED _ - i I 33. Final:Electric- 1; Notes: •••:, r ` "34. Final Heating Air Conditioning __ • T�` v•� .47:- -' 35. Final Gas`PipeTest - _ - n- C l ✓36. Hood.or Canopy - _ -- - - a * _ . , •• -,37. Final Factory Fireplace n: -1• 38. Final Plumbing • _ 39. Water Service-Final ; ' ' ''` c _ . pA -.40. Gas Service-Final c rtr 7. 04. r..nt; t I '-Al. Solar Domestic:Final, 4,; r j._ 42. Backflow Preventer Y. Cr =•h • a r n r., F: I) ti CL 43. Backflow Irrigation r 44. Landscapeirrigation System .'c, a• ti";" ^J 45. Sound Attenuation " - •";r,. • _' `Ts 46- Handicap Regulations r. 47. FINAL STRUCTURE & BUILDING `l�Z`� 9G (1/vr 0,_,c. .. - x 48. FINAL PLANNING r • - * ` a-: ' ` - I - - ,4 4: 49. Electric Release to Edison `. 50. Gas Release to Southern California-Gas Co ' -• 51. CERTIFICATE OF OCCUPANCY ," No 'Date I i r 20Ibs.ROOF CONNECTION • DEVELOPMENTDETAILS SERVICES PATIO C_0'VER BUILDING SAFETY DIVISION, T Y P. PLANS `` 1 CONT. SOLID BLOCK LEDGER 1, RAFTER OWNER: c FRIG ' .r�PNese L//JI2 16ATE : 1 ADDRESS: l �S� yP'& —PiesV S PHONE: 293yo7 I/2" DIA. X 5" LAG SCR. CONTRACTOR: LIC. NO.szo.AT " c. . ADDRESS: - PHONE: # DETAIL I RAFTERS RAFTERS .APPROVED FOR CARPORT, PORCH OR PATIO LIGHT WEIGHT ROOF COVER OF . BUILDING PERMIT NOT SUPPORTING CEILING LATH, FIBERGLASS, ALUM. By Date SIZE SPACING SPAN SIZE SPACING SPAN CR B CL "TECO" 2"x4" 12"O.C. 9'-6" 2"x4" 16"O.C. 9'-6" GRIPS OR JOIST 16" 8'-O" 24" 8'-0" GENERAL NOTES: HANGER 24" 6'-6" 32" 6'-6" 1. These plans must be kept on the job at . COLEDGER 167%%%%%%140, 32" 6'-O" 48" 5'-6" ' 48" 5' -0" 2"x6" 16" 16'-6" all time during ��� 2"x6" 12" 16' _6" 24" 14'-6" construction. 16" 14'-6" 32 • 12' -0" 2. All framing to be 24" 12'-O" 48" 1O'-O" Douglas Fir N4 . DIA. X 5" LAG SCR. , grade minimum. AT AT 16" O.C. 32" 10'-6" _ 2"x8" 24" 19' 0„ I 48” 8'-0" 32" ' -15'-6" 3. Rafters may not - 4"2 2"z8" 24" 15' -6" 48" 13'-6" attach to facia ex- 32"' 13'-6" cept for lolbsroofs 48" 11 '-6" • • as shown on details;_, IOIns0R LIGHT WEIGHT ROO' 24" 17' -0" ' HEADERS 20IWroofs must use ONLY CONNECTION DETAILSIIIIIIr32" - 15-'z0" a continuous ledger 36" . 14' -0" LIGHT ROOF ONLY attached as shown 2" x FACIA-MIN. REO. 4"x8" 24" 21' -0" SIZE POST SPACING on details #14#2.- 32" 19.'.-0"• 6' -0" 4. Light weight roofs _ 36" a 18"-0" '- ' 9' -O" may attach to facia 48" 16'-O" 3' 12' -0" • • for 14' span max. , EPA RAFTER 4"x10" 32" 22'=0" . 4x10 . 15' -0" spans over. 14' must 36" 21 ' -O" • use a continuous CARPORT, PORCH OR PATIO ledger as shown in APPROVED METAL 48" 70'-0"• - ' ' SIZE ; POST SPACING detail 113..; HANGER 72" 17' -0" 4x4 5 5'- 0" 4x6 . 8' -O" ' �c DETAIL 3 '4x8 l0'=0" • 4x10 12' -6" OCyRM • NOTE: SHOW AND DIMENSION PROPOSED PATIO COVER AND YARD AREAS . _-SEE DETAILS ON REVERSE SIDE :111r%,........•• ROOF SHEATHING e ., 01-t , • • SPE T'O ........... OVERHANG j — '- a� sT s �y�r 40 -`� � 754-5624 N• r 5O5 ! . —x_ BEAMT-STRAP EA. SIDEn , . • FOR POST- BEAM Et- CONNECTION. a I • I- U o f a a Z z J K W i W I • I m 1 , N 4 N Q V IIco - O ¢ Z O • ' I x 1 O O r0 LL 1,1 NOTE ' P.OP PATIO W LL Z x Z O 'A110 311 OOR 2' J om AO 3DNVNIOHO H3H1• ANV AO HO 3000 SI1l 3O NOIIV10IA NI 1 g'� _� �O 8 Q ON1N3A3HdO3NOHJ f�40 SN31�:::131D3dSDEI ,OO's 3SNVld10OIVS pIT1nN9. DELETIOTIS, OR Cu RRECTION�� 4L0PE TO DRAIN am I PLATE 1" �• NI SH0883 JO NO110-t HOO Sid.f' JIHIlo3H H3-JVIIJJ'11 PiOHJ 1'• 11u1_ l j ABOVE SLAB �� BY THE PLAivI IyG DE' o . Ila IVIDIddO OMOI OE 3r,.L 1N 3dc -ION 1N115 SNO'LVDI:'D3dS VED p o ONV SNVld N O...i 0:oV�J iV I ,J V JO 3DNVOSSI DI-11 AD - - -'1 e110 ' OI^':''HOHIflviI H31E1M 26 GA. G.I. FLASHING I a I I 3Sf1 HO MOM 3CC.S'.' IV: . =;Cid:lVA 31 1;'.;-S 3003 A9/Psi WOOD FLOOR 2 I __ J SIHI AO"NC':rI C! _ '' 3.1 Oin Al' - NtriV !// CONSTRUCTION PIERS 12" SOJA La 3A100 ilIYI - :41 JO SN(. !A i'f?I i - O �I ' Q 0 ANV SON v }:-,.V N J h0 I ...1 All" 4Vo8O103iJ .. _ ' .i,'•d¢ "• . .,v d���,( a dp iiear V ..L.. :,:::' 3Jrl7:i_S. diII , Y'` t I . 1)66 UK 3G.lei:::: ':`M.' ", - ,:. 'd' ii PLANNING DIPT. LL 3NWIIS3Ni1111' : ::.! iS:.' , :-STR'EET� �� . .: SIDE ELEVATION DA ;pea t?lip'fly : .,r b', -.so All t C 907 taw el --1 7 P- Lb ."/ PLAN CONSTRUCTION DETAILS U �a9 CL 0d.aa V • PROJECT ADDRESS: 1850 NEW JERSEY ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 061797 \ OWNER'S NAME' LINDSAY, CRAIG \ x ADORESS:LINSAY DENISE D PERMIT NO: B 061797 PLAN CHECK NO: 01294-93 S GOVT: N SUPP: N 1850 NEW JERSEY ST COSTA MESA,CA 92626 CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: ADD ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION 3005F TRELLIS PATIO COVER SO FT: 300 (tis ADDRESS: UNIT: CLAIM VALUE: 4 , 000 . 00 CALC—VALUE: 4 , 440. 00 GROUP OCC: R-3 / PERMITTEE:PDH CONSTRUCTION SERVICES ( 714 ) 779-7383 ADDRESS: 5245 GRANDVIEW COMMENTS: X T p YORBA LINDA CA 92686 ***********+�****�E*>Frt�E�E�6�E**�E********�6�r**,E�E�E�ESE**�E*** ***�t�E�E*�E**x***** DET * 1 Q1"1 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z O N I N G REQUIREMENTS 7000)of Division 3 of the Business and Professions Cod .0 my license is in full force and effect. 5 E T A C �( S SMOKE CITY ULC.: STATE LIC.:368293 LASS:BD p �('y'� Dale:J' 19 sign..ure:_ _ ._ . . _ MAIN BUILDING ACCESSORY BUIntEi :11RE1 __ WORKER 'COMPENSATION DECLARATION: I hereo m that I have a certificate of consent o self-insure or certificate of Workers' FRN T: FT IN REAR: 31 FT IN FRNT: FT IN REAR, r 1' IN Compensation Insurance.or a certified copy thereof(Section 3800,Lab.C). LEFT: 6 FT IN RGHT: FT IN LEFT: FT IN" RGHT: FT IN POLICY NO.: EXP.DATE: COMPANY: PARKING REQ: PROV: PARCEL; 13910337 ZNE: R1 REF NO: ❑ Certified copy is hereby furnished. 0 Certified copy is filed with the city Building oivismn. PLANNING NOTES> 300 SQ. FT, PATIO COVER IN REAR OF EX RES. > / I. Date: Applicant: ******************************************************-1f*************i •.******)E** ' EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). DEVELOPMENT SERVICES REQUIREMENIS I certify that in the performance of the work for which this.. ••' ' 'sued.I shall not employ any pe on in any manner so as to became I subject to the workers'Compensation Laws of Califor•'.. ZONING APPROVED BY SCC. DATE; .'f )9 I� 3 Date: y�19/ 93 Sign.ure: !_ , iii) NOTIC If.al er making this declaration.you s rued .ecome subject to the Workers'C pensation provisions of the Labor BUILDING AP PROVED B Y DATE: '? Code.you must forthwith comply with such prom rns or this permit shall be deemed revoked. q CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y: — DATE: I 14 which this Permit is issued(Section 3097.Civ.C). �_ ********************1(********************* - A t-******************** iE* �'�. LENDER: *******-lE1E*************IE**********?e***********K******************************3E** ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT;Y ed OWNER BUILDER DECLARATION: I hereby affirm that jam exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRI'G•? MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code. Anycity of county which requires a permit to construct,alter,improve,demolish,or PERMIT 7 2 . 0 0 \! . 50 repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed '.; pursuant to the provisions of the Contractors State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business I SHIP/NON—RES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN 46 . 80 any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars($500). ISSUE FEE f" I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE ❑ structure is not intended oroffered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 72 . 50 0 . 00 46/ 80 119 . 30 119 . 30 , 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through 12'his or her own employees,provided that such improvements are not intended or offered for sale. If,however the building REVENUE DIVISION TOTALS--> COLLEGT'EDT: 119 , 30 OVER/SHORT 00 improvement is sold within one year of completion.the owner will have the burden of proving he/she did not build or improveve mrthe purpose olsale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SNIP/TOT GRADING PLAN—CHECK I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 72 . 00 . 50 46, 8 0 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves(hereon 14 and who contracts for such projects with a contractor(s)license pursuant to theContractors'State License Law). l am aware .x..**.µ.)E.)E****.**.***.**.**-*{p**.*..)E*.***a(-.x.**a(.*.x..Nf***.*****.***{(.{(.*.-x.*.*.N.*.N.{(.****.x.*******.9(.y(.******* that proof of their worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN ❑ I am exempt under Section: B.8 P.C. }, ry for this reason: TYPE QTY DESCRIPTIO Na: ; UNIT COST TOTAL COST Date: owner: SFR 300 RES—PATIO COVER—POSTt6' TRELLIS 14 . 80 4, 440,00 I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OC'f FEES 25534 and That I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a rk permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from these provisions. Date. Applicant: i 1 Z 7 a I hereby certify That I have read this application and slate that the above information is correct.I agree to comply with all city and county i, l' ordinances and state laws relating to building construction and • r orize representatives of this city P•nter upon the above-mentioned L�;it• A properly for inspection purposes r j i r Dale: / 3a. .- `T , , ——-- _. L J / Signature: 4 . /, 01 00137485— 111Iri rine— :91 Driver's cense or Social Canary—Applicant:Pink—Revenue:Goldenrod—Assessor - r ., CONSTRUCTION AND PLANNING POOL& SPA APPROVALS Permit# - Date Inspector APPROVALS 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 10 ----565- ctricalCnnduit-Undrgrntl. ' _ 8. Foundation 59. Gas Pipe, 0 Undrgrntl„ Test ,e, i 9. Water Pipe-Undrgrnd. , i r'r 60. Backwash Lines, P-Trap, D Undrgrnd. 10. Structural Floor System - 61. APPROVAL TO DECK ri 11. Property Sewer Line & House:Connection 62. Backwash & Receptor-Final 12. Sewer Capr 63. Heater & Vent-Final 13. Roof Drains ,4e. - 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final /- to 15. Rough Electrical-Conduit 66. Solar System-Final r 16. Rough Electric Wiring r,ii 67. Fencing & Access Approval 17. Rough Wiring Sign ) ( 68. APPROVED FOR PLASTERING i 18. Rough Electrical-T Bar Ceiling 69. POO L:SPA SYSTEMS FINAL I 19. Rough Heating & Air Conditioning ' FIRE DEPT. REQUIREMENT ' 20. Rough Factory Fireplace APPROVALS Permit # I --I 21. Ducts,in Structure 70. Underground Hydro i 22. Ducts, Ventilating • 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough& Test 72. Underground Flush 24. Roof Framing .73. Undergrnd.Storage Tank 0 Gas ❑Oil ) 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical r- 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing - I - HEALTH DEPT. REQUIREMENT I 31. Plaster Brown Coat i 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating& Air Conditioning -/2-el- iy_ Gt.-c ast __ 35. Final Gas Pipe-Test • ett e 36. Hood or Canopy 6cc-(4_ i , 37. Final Factory Fireplace ' ` -_____, 38. Final Plumbing 39. Water Service-Final i 40. Gas Service-Final ( i 41. Solar Domestic-Final . - 42. Backflow Preventer J 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation , : . 46. Handicap Regulations 47. F(NAL STRUCTURE & BUJLDING 1..._17-f:67- QCt/ 48. FINAL PLANNING - 49. Electric Release to Edison L 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date • I PROJECT ADDRESS: UNIT: A1Efl'S NAM1850 NEW JERSEY ST CITY OF COSZ/A MESA — BUILDING PERMIT • PERM NO: B 060950 I ADDRESSE:LINDSAY, CRAIG LINSAY DENISE D PERMIT NO: B060950 - PLAN CHECK NO: N GOVT; N SUPP: N 1850 NtW JERSEY ST COSTA MESA, CA 92626 CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: OTH c. ARCHIENGINEER: 949-3407 REG.NO.: ;t ADDRESS: UNIT: JOB DESCRIPTION : REROOF W/3 TAB SHINGLES SQ FT: 2, 500 PERMITTEE: CLAIM VALUE; 2, 500 , 00 CALL—VALUE: 2, 500. 00 GROUP OCC: R-3 /M-1 TOP HAT ROOFING ( 714 ) 586-6978 ADDRESS: 27121 PUEBLO NUEVO DR COMMENTS• REOOF 2500SF RESIDENCE W/SHINGLES REPLACE ROTTED PLYWOOD MISSION VIEJO CA 92691 ***+ESP �E�F�k�k**************************�E�E�P�P�P+E�EIE� *******RE*****\�Ea�Eca,(VENT * i*** LICENSED CONTRACTOR DECLARATION: 1 hereby affirm that I am licensed under provisions of Chapter (commencing with Section Z O N I N G R E Q U I R E M E N T S v `jTOR 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. SETBACKS CITY LIG: TATE LIC.648632 /'W C/Lp/'js:C39 Date: a—er-9 -4 signature,_`Cy .//ham/ MAIN-BUILDING ACCESSORY BUILD? ("H'-I+�'L-+--- 7 WORKERS'COMPENSATION DECLARATION: I hereby affirmtha�haavee^aa certificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN Compensation Insurance.or a certified copy thereof(Section 3800.Lab. C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN POLICY NO.: EXP. DATE: COMPANY: PARKING REQ: PROV: PARCEL: 13910337 ZNE: REF NO: 0 Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. PLANNING NVTES> > vl . Date: Applicant: ********************************************************************.*'********** EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (Thissertin need not be completed if the emit is for one hundred($100)or less). DEVELOPMENT SERVICES R E Q U I R E M E N ,.T -S I certify that in the performance of the work for which this perm sued, hall not employ any ,in any manner so as to become r% subject to the workers'Compensation Laws 01 California. �� ZONING APPROVED BY DATE 4, Date: a ` $.,3 Signature: 4 C' •.. NOTICE:If.after making this declaration,you should become sub to the Worker Compensation provisions of the Labor BUILDING APPROVED BY DATE: ' Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. . ^/ p CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPL I CAT ION ISSUED BY: — DATE: Z'(Q � l S which this permit is issued(Section 3097,Civ.CI. *****************************************..* ************************************ LENDER: *******************************************************************if*********** ADDRESS: LEGALIZATION:N F E E S. UIM M A R Y STRUCTURAL ''SEGMENT:Y OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for following reason BLDG PMT PLUMBING ELECTRIC-3`• MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter.improve,demolish,or PERMIT 5 4 , '00 1 ..- :i 50, repair any structure,prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed . pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business •--7 1,t( f " SMIP/NON RES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN / any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars($500). ISSUE FEE -.) ❑ I. as owner of the property or my employees with wages as their sole compensation. will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN=CHECK TOTAL PAID DUE structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS----> 54 . 50 0 . 00 ," •�-- 0::00 %7 54 . 50 54 . 50 ,+/ 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through 4.• I/ • • his or her own employees, provided that such improvements are not intended or offered for sale. If,however the building or - ' improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLliECTED} r..•• 54 . 50 OVER/SHORT; 00 for the purpose of sale), BLDG PMT PLUMBING ELECTRIC MECHANI,C ' ,FIRE SMIP/TOT GRADING PLAN—CHECK I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 54 . 00 . c c J / %,, 50 . ❑ and Professions Code: The Contractors'State License Law toes not apply to an owner of property who builds or improves thereon • ti)I,_ o i i and who contracts for such protects with a contractor(s)license pursuant to the Contractors'State License Law).l am aware *,.*•*.**..*..*.***.*,*,*,.*.*..N•**.**,**.**,****.***.******,7F** *'*.****.**,*.*,****,***.**.****,*,****i(.**.*,****** that proof of their Worker's Compensation insurance should be provided to me. I N D I V I D U A 1,' 'F4;E E �' B R E A K D O W N / o I am exempt under Section: B. 8 P.C. I j' 1'f • ini f for this reason: TYPE QTY DESCRIPTIO N�'.� r UNIT COST TOTAL COST Dale: Owner: 1 ,41 I do hereby certify that am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and SFR 2500 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 -I 2 , 500, 00 25534 and that I or any future building occupant will/will not(circle ane)need to comply with said state codes and the requirements for a END .OF FEES /,/, permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from ; J j these provisions. f" 7 Date: Applicant: 1 • • !i p • I hereby certify that I have read this application and slate That the above information is correct I agree to comply with all city and county •4L,14,` ^ ordinances and state laws relating to building construction a e yya lyhhorir�ize representatives oofLt/hiscity enter upon the above-mentioned -• �^ property for inspection purposes. /� ��//"V" .r Date: 2-^ 8-/ 3 Signature �� Driver's License or Social Security" Canary—Applicant;Pink—Revenue:Goldenrod—Assessor —�— -- -- t t. `NSTRU�ION AND PLANNING POL,..& SPA _ APPROVALS Permit# Date Inspector APPROVALS Permit Date Inspector air 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd., : Ir •l 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. i . 55. Electrical Bonding 5: Steel Reinforcement • - - 56. Rough Plumbing& Pressure Test ' 6. Electrical UFEA Grnd. ' 57. APPROVAL TO COVER-GUNITE 7. Footings58. Electrical Conduit-Undrgrnd. . '8. Foundation - i /: 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System c. - 61. APPROVAL TO DECK 11. Property Sewer Line & House connection - 62. Backwash & Receptor-Final 12. Sewer Cap s. - 63. Heater & Vent-Final , I 13. Roof Drains i 64. Plumbing System - Final - 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough ElectricWiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-I Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace 1i APPROVALS, Permit# 21. Ducts, in Structure, i . - - 70. Underground Hydro 22. Ducts, Ventilating ! , , : F 71. Product,Piping OGas 000 23. Gas Pipe-Rough& Test I 72. Underground Flush - 1 24. Roof Framing •, , , - 73. -Undergrnd.Storage Tank 0 Gas 0 Oil 1 25. Roof Sheathing - .e . - •- 7q, Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat '. _ 75. Dry Chemical 27. Frame and Flashing - _ i 76. Dry Standpipe 28. Lathing& Siding' - _ j 77.- FIXED SYSTEM FINAL - , i 29. Insulation ! 78. FIRE PREV. FINAL - '30. Drywall-Nailing HEALTH DEPT, REQUIREMENT 31. Plaster Brown Coat ) .r79: FINAL INSPECTION !II 32: Electrical Power Meter-Final • - I - 80. FOOD CERTIFICATE ISSUED _ I 33. Final Electric :. - I L: Notes: 34, Final Heating& Air Conditioning - 35. Final Gas Pipe-Test j 36. Hood or Canopy - - - I l 1` 37. Final Factory Fireplace - I I I 5 a`h r%X ai. 2/(6/Pf�iY/ 38. Final Plumbing - _ i , I _ 39. Water Service'FinaI i I I - •40. Gas Service-Final` - 41. Solar Domestic-Final - i j 42. Backflow Prevenier. - F - - 43. Backflow Irrigation,-„ - ' " - • 44. Landscape irrigation ystem- - - ' 45. Sound Attenuation7: -;' 'A I 46. Handica P-Regulatib I / _{_ ' I 47. FINAL STRUCTURE.& BUILDING Z t3 6- • Sere, /'a-, co/M 48. FINAL PLANNINGI,,^ - I I 'Tit 49. Electric Release to Ed 'yori 1 s i ) ' 1. - 50- Gas Release to Southern California Gas Co " i• 1 `•'1 I 51. CERTIFICATE OF.00pUPANCY - I No. Date • Applicant to fill in all spaces_except those within heavy border lines and sign all appropriate declarations. _ _ _ - - C 5.40-..TL CITY OF COSTA MESA CONSTRUCTION PERMIT , - PERM NO. . TRACT NO. ' LOT NO. _ • nI i ._ r UNIT/NO. �G� .'J�7ChG�BFJ Project Address I 5O - it/&.,o '3erse y • �-1 c1e3 ! „_ • �. 1+ __ _ - 1 Applicant's Mailing Address F( Q-- itheik _ret IL�/ly q ` / TYPE OF CONSTRUCTION . ' LI NEW U ADD .U ALTERATION`--C�YRE� PAIR - - l - - + , Owner's Name �'C/16'�S Phone)Y7Y07 ❑ CONVERSION '❑ DEMOLISH 'II/ OTHER '' A.p-# t.• , ._ - I • '`' Zoned• - _ "" �f - I DESCRIPTION OF WORK/USE OF BLDG! Address • 0 - • _ .. !, l - r : - S Main Building: - ; . s. Accessory-Building: , i S. -' E i +. -, 1 . . Z Arch/Eng. • - 'License No. • - TYPE OF PERMIT Li GRADING�JDUNDATION ID'STRUCTURAL - - T Front _ l O Address L ' ' ' ❑ TENANT ❑ ELECTRICA ' PLUMBING ❑'MECHANICAL . B 'Rear - t 1 I t` ' - N j �1AA I Convactor's Nam- L ,_I . P NA 1 ' Phone L'(/ '❑ 'OTHER ' - - - , C Right ' - ' ' - • - N $[' I r I�� � . PROJECT DESCRIPTION SQ. FT. ' OCCUPANCY - - - ' G Address(mailing) - - [ ' •R an. K L •eft , , ) i IC _ ! --y 2n • - CONSTRUCTION TYPE • VALUATION § Cit License No. �JL' ZONE GRADING CU.YDS. ACRES LICENSED CONTRACTOR DECLARATION - 'Ping. Ref.# I Par klo9 Req./Provided I ...•• Q 1'hereb affirm that I-am-licensed underprovisions of Charter 9(commencing ' Q ,� Y Remarks: ; Planning Notes: ' ' , - - M with section 7000) of Division 3'of the Business and Professions code,and my license is in !tap - and:effect. _ i • I r T License Clas - 'oe ss r o ' • • , I S t 1 Date _ RSSignature SAM i _ AWif' _ PLUMBING - I . ' FEES ' - ' WORKER 'COMPENSATION DECLARATION Bar Sink i I • Showers i • ' ELECTRICAL ' I hereby affirm that I have a certificate of consent to self-insure or a certificate , i - . • i FEES , of Workers' Compensation Insurance, or_a certified copy hereof (Section 4 - Backflow Prevegter' Service Sink'. - '— - - - •" -" '-- �'" • -' - - -3800, Lati /• I gy `I Automatic Washer:- •Transformers❑ 15-50 KW ! - Policy No:2,C S) I0 J Company R(/l/(�� f �S' Backflow Irrigation Sewer Cap ! 0 so, KW •' L Construction Pole'Sub. l I • rtified copy is hereby furnished. -• ` 4 est ifie y js-filed with the city iJ��], V/��{/v�( n,^��'�% 1y%/) /�//‘/ i Bathtubs f Sewer Con nection Cooking Unit 'rR' . I -Meter ❑up to'100 amps j Date yds.%c/�9Lj KERS'COMPE COMPENSATION DECLARATION `C%i - EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors _ { Dishwasher _ 4 Meter Dover 100 amps - __1. _ _ les )(Thissection need not be completed if the permit is for one-hundred ($100)or - - - - "- — ' I r ! Dishwasher l Solar Piping ' , - Dryers ❑Gas'❑Electri' Sub Panel • I certify that in the performance of the work for which this permit is issued, I - • shall not employ any person in any manner so as to become subject to the . Drinking Fountains Solar Tank .Fan_ • // Workers' Compensation Laws of California. - Motors 10 0-1 HP ❑1%-B . Date - Signature ' Floor Drains i Swimming Pool w/Spa i F.A.U. Inc Solar ❑9-15 HP 016-15+ ' 'NOTICE:If,after making this declaration, you should become subject to the - _ Workers' Compensation,provisions of the Labor.Code, you must forthwith , Floor Sinks r-- ' '^ -- ' - Urinal - - - - 'Fixtures comply with such provisions or this permit ,shall be deemed revoked. ._ - _t - f • CONSTRUCTION LENDING"AGENCY I - • - ' .' - - - i u Gas Service -Outlets+ .. ,. Devibe Boxes .Pole Light l I I hereby affirm that there is'a construction lending agency for the'•performance- - ' of the work for which this permit is 'issued (Section 3097 Civ. C.) - ,,--77 , Lender's Name`, • - I 1 Interceptors / Water Neater, - p•- Outlets • • - -Range , Lender's'Address. - - r Kitchen Sink _ • a er e - Switches • Sign t 1 ' OWNER BUILDER DECLARATION " ' - _ _ _ _ I hereby'affirm that I am exempt from the•Contractor's License Law for the 1. Lavatories. •n Auto-Wash • - I following reason.(Section 7031.5'Business and.Professional Code: Any city or ' ^ _ - - Garbage Disposal ;Standing Sections 1 • - county which requires a permit to construct,alter,improve,demolish or.repair ' — P_Trap i - '' Laundry Trays : - I 'Generator 00-5 KW 05-15 KW Trash Cornpactor 1 any structure, prior to Its'issuance, also requires the,applicantfor such permit : '- - - _ • ,to file a'signed statement that'he/she is licensed pursuant to the provisions of - ROOF Drains • - the Contractor's License Law (Chapter 9(commencing with Section 7000) of - - - I ; _ - Division 3.of the Business and Professions Code) or that he/she is exempt - • • therefrom and the basis for the alleged exemption. Any:violation of Section - + - i i ' 7031.5 by. any applicant for a permit subjects the applicant to a civil _ - enalty of not more than five hundred dollars($500). --1 i , I .' - • ' • LI1, as,owner of the property or my employees-with wages as their sole i 'Reinspection Fee ' x$15 Issue Fee + $ 3 compensation, will do the work,and the structure is not intended or offered - 'Reinspection Fee 4 $15 IssueiFee i 1$ 3 . for sale (Section 7044, Business and Professional Code: The Contractor's- . - - MECHANICAL i I FEES, l i License Law does not apply to an owner of a property who builds or improves , thereon,,and who does such work himself/herself or through his or her own . , - DEVELOPMENT SERVICES'REQUIREMENTS: ' • employees, provided that such improvements are not Intended or offered for • Boiler Hood or ' Type 1 ❑ i sale. If, however, the building or improvement is sold within one year of com- Canopy Type II ❑ ' i - _• Zoning Approved By Date 1 pletion, the owner'will have the burden of proving he/she did not build or im- , Duct-Under Ground - i prove for the purpose of sale). - Building Approved By `•^„ - Date 0 I, as owner of the property, am exclusively contracting:with licensed con- , Duct-Structural I Refrigeration System Application Issued By ' �V Dar s i tractors to construct the project (Section 7044,Business and Professions Code: - The Contractor's License Law does not apply to an owner of property who Duct-Ventilating, i _, - _. 00-100•000 BTU D100,000 BTU I • SUMMARY OF FEES '- builds or-improves thereon,and who contracts-for such projects with-a con- - - - I • • tractor(s) license pursua ntt0 the Contractor's License Law). am aware that - BUILDING PERMIT '$ SMIP '$ — ' Exhaust System 0 Multiple 0 System Repair%A lteiation ; proof otheir Worker's Compensation insurance should be provided to me. • PLAN CHECK '$ PERMIT I '❑ I:am exempt under Section B.& P.C.for this reason . Firepl/Fact.Bit. ICBO# ' Fire Dampers i PLUMBING $ 011) ISSUANCE $ ' • Date I. ' Owner I ( Heating System& Ducting Registers , PLAN CHECK 25% $ ENERGY P.C. I$ ' •• I-hereby.certify-that-have'read thivapplication and state that the-above - ❑0-100,000,BTU 0100,000 BT - -- - - - . GRADING '$ t ELECTRICAL Ind'tate la is correct. log bee toicomply with all andconstruction, hereby authorize repre- ) • I I PLAN CHECK 50% $ MICROFILM ,$ sentatives of ' pis cit //y//to (��/e�ntr :upon tM1e above-mentioned prop rt for inspection pQii� � ' -Accounting; Goldenrod -Assessor CONSTRUCTION AND PLANNING • - - POOL&SPA APPROVALS Permit#/o�9D 3,' Date Inspector APPROVALS 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, 0 Undrgrnd.,Test • 9. Water Pipe-Undrgrnd. .60. Backwash Lines,P-Trap, 0 Undrgrnd. • 10. Structural Floor System 61. APPROVAL TO DECK - - ,1.1. Property Sewer Line & House Connection 62. Backwash & Receptor-Final - 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains • 64. Plumbing System - Final 14. Rough 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 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 0 Gas 0 Oil 23. Gas Pipe-Rough &Test 72. Underground Flush 24. 'Roof Framing- 73. Undergrnd.StorageTank D.Gas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat75. 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 Conditidning ' 35. Final Gas Pipe-Test - - 36. Hood or Canopy - - • 37. Final Factory Fireplace, .,,/ 38. Final Plumbing ' 'J�.E(B5- • 39. Water Service-Final 40. Gas Service-Final . ' 41. Solar Domestic-Final . 42. Badkflow Preventer t - • - - .43. Backflow.Irrigation. . • ' •44. ,Landscape Irrigation System - , " 45. Sound Attenuation - - . • 46. Handicap Regulations - ' . - - 47. FINAL STRUCTURE & BUILDING •• ' 48. Special Requirements Completed • • - • i 49. Electric Release to Edison ; - . - - , ' '150. Gas Release to Southern California Gas Co ' - , 51. CERTIFICATE-OF OCCUPANCY _ - - i --. - - - - - No. Date• 12488 FEE RECEIVED COSTA MESA BUILDING-SAFETY DEPARTMENT JUL 111960 P. O. BOX 977 COSTA MESA, CALIFORNIA FINANCE DEPT. CITY OF COSTA MESA For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT BUILDING BUADDRESS 1850 New Jersey St. COSTA MESA. CALIFORNIA For Office Use Only I RECEIPT NO. I 121188 OWNER New York Avenue Properties, Inc. MAIL - - RECEIVED BY DAre RECKIVGD DATE ISSUED ADDRESS A 1 9 E. 17th St.. 0-- c 7 I Lkd I AULI 11960 IN cm Costa Mesa M.TEL. BUILDD Li81159 ADRESSG ARCHITECT Carlson & TEL. COSTA MESA. CALIFORNIA OR ENGINEER Middlcbroo:C NO. ADDRESS Garden Grove - FIRE ZONE Vp- ZONE TYPE GROUP�I! CONTRACTOR Di ke & Col egrove,, Inc. APPROVED DATE ADDRESS 41.9 E. 17th St. ZONING 4 .�� I. ZONE NO.OF USE OF N `` CITY Costa Mesa . i I PLANS L....-----BUILDING (1. a i� STATE 167293 O. Li. 8-1159 LEGAL Lot 99, Tr. 9648 LIC.NO. .. DESCRIPTION SIZE NOP BLD OFF LOT 53 x 125 I NOW. OoN LOT". non A.P.NO. /7.-1 USE OF YARDS EVES EXISTING BLDG. none _ . _ APPROVED ALLOWED SETBACK LING FROM c 50 (CENTER LINE ST.) i CENTER OP STREET 621 REAR YARD I FRONT 5 / FT. IN. SIDE YARD ILEFT 51 I RIGHT 51 R.SIDE .c FT. _ IN. DESCRIPTION OF WORK IpI L.SIDE �7<FT. IN. NEW I X ((ALTERATION I (ADDITION I REAR (.,/)//��FT. /� IN./ ~ REPAIR II MOVING I (DEMOLISH BYPROVED / A //// DATE /�53 60 BUILDING, NO. OF U AA)/I SIZE .50 SCI JD. ROOMS 6 STORIES 1 ✓� EXTERIOR WALL ROOF COVERING stun^C COVERING COmO. 8L Rock . - USE OF BUILDING AND WORK TO BE PERFORMED - - Sinrj.e family residence with attached garage. Plan 40 A I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTION. VALUATION VALUATION / �"" SIGNATURE OF / , PERMIT FEE $ 35. N PERM ITTEF s 15,045. PLAN CHECK s 17.50 4 AUTHORIZED AGENT Dike Colegrove, Inc. ei X TOTAL FEE $ 52.50 u