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Home My WebLink About424 OGLE CIR - Building Permits(714) 754-5273 • FaX (714) 754-4056 • www.ci.costa-mesa.g�y{LDING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626 JobAddress: 424 OGLECI Suite: Vicinity: REAR OF PROPERTY Primary Occ: R-3 DWellings/ Cong Res <10 Type of Construction: V-N Parcel Number: 42514319 Zoning: Applicanc ZOSCAK, LISA Address: owner: MARQUIS, JEFFREY C Address 424 OGLE CIR - COSTq MESA, CA Phone: 9493384189 Zip: Phone: Zip: 92627-3227 contractor: SWAN POOLS OF SOUTHERN CALIFORNIA Address: 24512 BRIDGER RD LAKE FOREST, CA Zip: 92630 Arch : Address: Phone: Phone: 949-859-8466 License: 440333 Eng: Address: Status: ISSUED Applied: 03/01l2006 Issued: 03/01/2006 ISSUED BY: � Phone: Zip: License: License: SCOPE OF PERMIT 87 SQ.FT. IN-GROUND SPA WITH NO AREA ABOVE 6". EXCLUDING PLANTER WALLS FEE SUMMARY Plan Check: $208.81 Permit: $321.25 SMIP Res: $2.00 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Calc Valuation: Szo,000.00 Claim Valuation: $zo,000.00 Total: $532.06 P.LANNING & ZONING SETBACKS MAINSTRUCTURE Front � 0-0 Rear � 0-0 Lek 0-0 Right 0-0 ACCESSORY Front 0-0 � Rear 0-0 'Lefl 0-0 Right 0-0 PARKING ', Ezis�ina: 0 Reauired: 0 Pr000sed: 0 NOTICE: The work authorizetl by ihis permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 1241-92) / EXPIRATION: This permit shali automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. . INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicableyLo� and all required inapectlons end flnal approval must be obtained. Failure to obtain inspections and tinal approval will result in the expiratio�f this permit. FOR INSPECTIONS CALL: (714) 7545626 zanaao �ww� � WOHKERS'COMPENSAnON DECLARAnON: , I hereby eRirm untler penalry oi perjury one of Ihe tollowi g declarations: � ❑ I heve end will maintain a cetlificate oi consent m selbinsure for workers' comp�nsatlon, es+provided for by section 3700 of the Labor Code, for the pertortnance of the �work For wnich this pertnit is issued. �I,have antl will maintain workers' ompensation insurance, as requiretl by section 3700 of the Lebo� Code, for ihe perfortnance of the work Por which this ermit is issued. My�prkgrs' om ation Ins anca carner antl poliCy number are: �� S�� j Camvai:( �� Pbi�Number:!�— �V b . (!h!s secNon neBd not be completatl i the pe�mit is valued af one huntlre0 tlollars ($100) or less.) �� - ❑ I cetlify thet in the.pert rmance of the work or which this permit is issued, I shall not employ eny person in any manner so as to become subject to the workers' compensation la s o alifomia, and agre hat ii I shoultl become subjact to the workers' compensation provisions of Section 3700 of the Lebor Cotle, I shall tort�with compiy witn Ihe pr '' ns }� �pWicanFSignelu�: ; i Data:—� ��v�� WARNING:.FAIl.URE-T R WOFKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EM OVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED fHOUSAN�WUARE(31 , ),INADDITIIXJTOTHECOSTOFCOMPENSATION,DAM4GESASPROVIDEDFORINSECilIXJ3/OfiOFTHEUBORCODE,INTEREST,MIDATTORNEY'SFEES. LICENSED CONTRACTORS DECLARATION: 9(commencing with Section 7000) of Division 3 of the Cotle, and my license is in full CONSTRUCTION LENDING A .�F11CY: ❑ I hereby aHirm that Ihera is a constmction lending agency tor Ihe peAormance of t�e work br which this permit is issuetl. (Sec. 3097, Civil Code). LendeYs Name: Lender's Address: Signature: OWNER-BUIIDER DECLABATIONS: Date: I here6y affirm th2t under penalry of perjury that I am EXEMPT FROM TME CONTRAC70RS LICENSE LAW lor ihe following reason (Sec. 7037.5, Business and Professions Code: Any ciry or counry which requires e permit to consiruct, alter, improve, tlemolish, or repair any stmcWre, prior to its issuance, also requires ihe applicaN for such permit to tile a signed sta�ement ihat he or she is licensetl pursuant to ihe provisions oi ihe Conirectors License Law (Chapter 9(commencing with Seclion 7000) of Division 3 of the Business and Pmfessions Code) or that he or she is enempt theretrom and ihe basis for ihe allegetl exemption. Any violetion of Sec�ion 7031.5 by any applicant for a permit su6jecis ihe epplicant to a civil penalry of not more than five hundred dollars ($500).): ❑ I, as owner of ihe properry, or my employees wi�h wages as their soie compensetion, WILL DO THE WORK, end Ne sirucNre is not intended or oNered lor sale (Sec. 7044, Business and Protessions Cotle: The Contractors License Law does not apply to an owner of property who builtls or impm�es thereon, and who tloes such work himself or herself or through his or her own employees, providetl ihet such improvemenls are not intended or oftered lor sate. U, however, the 6uilding or improvement is sold wiNin One year of comple�ion, the owneabuilder will have ihe burden of proving that he or she did not build or improve for purpose of sale.). � � I, as owner o� the pmperty, am E%CWS�VELV CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business antl Professions Code: The Gontractors License Law does not apply to an owner ot proparty who builtls or impmves �hereon, and who coniracis for such project with a coniractor(s) liCense pursuant to the Contrectors Litense Laws.). ❑ I am exempl under sec. Signature: Owner ID verifietl 6y dnver's license. ❑ Yes ❑ No Business and Professions Code for this reason: Verification of Ownership Dy (typa of documeni, i.e. - property taa bill or tleed): DIVISION OF INUUS7RIAL SAFETY PERMIT CER7IFICATION: Driver's License No. Date: Expires: ❑ I hereby cedify ihat no ezcavation five (5) or more laet in depth into which e person is requiretl to descend, will be matle in connection with work authonzed by this permit, and that no building sirucWre, scattoltling, falsework, or tlemolition or dismantling thereof, will be more ihan Ihirty-six (36) feet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Title e, Califomia Atlministretive Code). ❑ As ownerhuiltler, I will not employ anyone to tlo work which would require a permit irom ihe Division of Intlustrial Safey, as noted above, unless such person hes e permit to do such work from ihe division. Signature: Date: Division ot Industrial Safety Permit Number: ICERTIFlCATE OF COMPLIANCE AND AllTHORIZATION OF EN7AY: I ceriity under penalry oi perjury lhat I have read lhis application and state ihat ihe infortnation given is I correc�. I agree to comply wi�h a�l sta�e laws and ci�y ortlinances releting to building consWc�ion, and authonze representatives of ihe City of Costa Mesa to enter upon the above-tlescnbed property for inspection purposes. I agree not to occupy or ellow occupancy of any buildinq authorized by ihis permit un�il final inspection. cooe x' INSP CE ll4ti2YP.€ — 7616 Fi:ed Sys�em Final Fire Prevention 1266 200 201 202 203 204 Pool Spa Final Finel Re-Poot Fina181wk�Retaining Wall Final Faclory Fire Place Final Sign Final Demolition � � r 7 • 4j • 206 Final Mechanical 208 Final Plumbing 210 Final Elecirical 212 Fina� Fire Prevention 220 Fina� Planning Approval 222 Final Site 250 Final Building/Occupancy un3 � INTRIRLS (71a) �54-5273 • Fax (7ta) 75a-aess • www.ci.costa-mesaELECTRICAL PERMIT �� FAIR DRNE, GOS IA MESA, GA 92626 Job Address: Suite No Vicinity: Parcel Nunmber: Appliwnk Address: 424 OGL� CI 42514319 ZOSCAK, LISA 24512 BRIDGER RD LAKE FOREST, CA Owner: MARQUIS, JEFFREY C Address 424 OGLE CIR . COSTA MESq,-CA Phone: 949-338-4189 Zip 92630 Phone: Zip: 92627-3227 Contractor: SWAN POOLS OF SOUTHERN CALIFORNIA Address: 24512 BRIDGER RD ISSUE FEE Temp service test Res; a/c package New Res (1-2 units) New Res (3+units) Pool / Spa Lighling Fixts Recept Outlets Switches Non Res Appl Res Appl Service to 200a Service to t000a Service over t000a Molors to 1 hp Molors to tOhp Motors to SOhp , Motors to t00hp Motors over t00hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuils Temp Pwr Pole Intermed Pole LAKE FOREST, CA Phone: 949-859-8466 Zip: 92630 License: 440333 Status: ISSUED Applied: 03I012006 Issued: 03/012006 ISSUED BY: i SCOPE OF PERMIT 87 SQ.FT. IN-GROUND SPA WITH NO AREA ABOVE 6", EXCLUDING PLANTER WALLS. REF.: 806-00351 ELECTRICAL TO INCLUDE: 2 OUTLETS AND i SPA. $23.50 $0.00 50.00 $0.00 50.00 $49.50 $0.00 $2.20 $0.00 50.00 50.00 $0.00 so.00 $0.00 � 50.00 50.00 50.00 50.00 $O.Op 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantity 0 0 1 0 2 0 0 0 0 0 . 0 0 0 0 0 0 0 0 0 0 0 0 FEE SUMMARY Temp Dist System / LigMing Busway /100 fl Standing Sedion Misc Elecirical Equipment Trans(ormers up to 1 kva/kw ................up to 10 kva/kw .................up to 50 kva/kw .................up to 100 kvalkw ..................over 100 kva/kw Low Voltage Equipment Low Volt Wiring System / Ckt Misc. Conduit Misc. Conductor Ciras ( gen or ride) Circus (mech ride or lights) Chiistmas Tree Sfand Fireworks Stand Other Electriwl Fee Investigation Fee Plan Check Fee Reinspection Fee Quantiry $0.00 0 $0.00 0 So.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 50.00 0 50.00 0 50.00 0 $0.00 0 $0.00 $0.00 $0.00 $0.00 TOTAL CALCULATED FEES E75.20 COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related regula�ions. (Ord. No. 92-28, § 1, 12-21-g2) EXPIRA710N: 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 Ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all raqulred Inapeetiona end tlnel epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permi� FOR INSPECTIONS CALL: (714) 754.5626 2aabae Iflrool v WORKERS' COMPENSATION DECLARATION: 1 here6y aHirtn under pertalty of per{ury one ot the tollowing declaretions: ❑ I have end wlll maintein a certifiwte ot consent to self-Insure tor workers' compensation, as provitled lor Dy section 3700 of Ihe Labor Code, for the pertormance o� the r work for which this permit is issued. entl will n insurance, as requiratl by sectlon 3700 of Ihe Labor Code, for Ne pertortnance ot the worK lor which Ihis pertnit Is issuBd. antl policy number are: � � r"'"'PORcy'Number: �� % : valuetl ef wre huntlred dollars (§100J or /ess.) --, Q I certih/ that in Ihe p o ce of Ihe work for which this permit is issued, I shall not employ eny person in eny manner so as to become subject to the workers' compensation laws i C i rnia, and egree that i s�ould become subject to the workers' compansation provisions of Section 3700 of Ihe Lebor Cotle, I shell forihwith compty with ihese pr v' s �/� qpplicanl�Signetuie_, "`� � � �+ Date�^^—�. �� W/�pNINp.`FAILURE TO SE RE KEFS' COMPENSATION COVERAGE IS UNIAWFUL lWD SHALL SUBIECT AN EMP,I LOYER TO CRIMINAL PENALTIES AND pVIL FWES UP TOONE MUNDRED TFi0U5AND00l1ARE(510p,000),I DDITIONTOTHECQSTOFCOMPENSnTION,DAMAGESASPROViDEDF-0FINSECTION31060FTHELABORCODE,IfJrEREST,ANDATTORNEY'SFEES. LICENSED CONTRACTORS DECLARATION: . I hereby aflirm Ihat I am C�NS7RUCTION LENDING AG ❑ I hereby enirm Ihat therB is �gntler's Neme: Signeture: OWNER-BUILDER DECLARA710NS: Chapter 9(commencing with Sectlon 7000) of and my licensa is In full lending agancy for the peAormance of �he work br which Nis permi� is issued. (Sec. 3097, Givil Cotle). Lenders Adtltaes: Dete: I Merahy aftirm that untler penalry ot perjury that 1 am EXEMPT FROM THE CON7RACTORS LICENSE LAW for ihe fWlowinq reason (Sec. 7031.5, Business and PrWassions COde: Any ciry o� counry which raquires a pertnit to construct, alter, impmve, tlemolish, or repair eny stmcture, prior to its issuance, also requires the epplicani for such pertnit �o �ile e signetl statement that he or sha is licensea pursuant to the provislons ot the Contractors License Law (Ghapter 9(commencing with Section 7000) ot DIvISIon 3 of the B�siness antl Professions Cotle) or that he or she is exempt therefrom entl the basis for the ellegad exemption. Any violation of Section 7031.5 hy any epplicant for e permit subjects Ihe appliwnt to a civil penalry of not more Ihan five huntlreA dollars (S500).): ❑ I, es owner of t�e propeM, or my employees with wages es Iheir sole compensation, WILL DO 7HE WORK, and Ihe structure is not intendae or oMeretl for s¢le (Sec. 7044, Business end Prolessions Cotle: The Comrectors License Law dces not apply to an owner ot pmperty who builds o� improves IhBreon, antl who tloes such work himsell or herselt or through his or her own employees, provi0ed Ihat such improvements ere not Intendetl or ofleretl tor sale. If, however, ihe building or improvement is sold wit�in ona year of completion, the owner-builder will �eve ihe burtlen of proving iha� he or she did not builtl or improve for purpose of sale.). ' ❑ I, as owne� ol Ihe propeAy, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRAGTORS to construct the project (Sec. 70a4. Business antl Professions Code: Tha contraaors Ucense Law tloes not epply ro an owner of Dropeny who builds or improves t�ereon, antl who con�racts for such project with e comractoqs) Ilcense pursuent to ihe Contractors License Lews.). ❑ I em exempt under sec. Business and Professions Code tor lhis reason: Signawre: Date: Owner ID verified by driver's license. � Ves ❑ No Drivefs License No. Ve�fication of Ownershlp by �typa of tlocumem, i.e. - pwperry tax blll or tleetl): DI��SION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: Expires: ❑ I hereby cehity Ihat no excava�ion five (5) or more feet in Oepth into which a person is required to tlescend, will be made in connection with work authonzed by this permit, and ihat no building sirudure, scaflolding, falsawork, or demolltion or dlsmantling thereol, will be more than Ihirty-six (36) leet high. (Chap. 32. Grp 2, Art 2. Sec. 341, Ttle B, California Adminis�ra�ive Code�. ❑ As owner-builder, I will not employ anyone to tlo work which would require a permit from the Division of Intlus�rial Safery, as notetl above, unless such person has a permit to Go such work irom ihe divisian. Signature: Date: Division oi Intlustnal Safety Permit Number. ICERnFICATE OF COMPLIANCE AND AUfMORVATION OF ENTAY: I cenify under penalry of perjury ihat I heve read ihis application and state that lhe infortnation qiven is I corfect. I egrea to comply with all siate laws and city ordinences relating to �uilding consWc�ion, end aut�orize representatives ot the Ciry ol Costa Mese to enter upon the ebo�e-descdbed�wperty for inspection purposes. 1 egree not to ocapy or allow occupancy ot any building authonzed by this pertni� uMil finel inspection. y�tp¢,J, INSPECiIONTYPE Qdif. 1676 Fixed System Final Fire Prevention 1268 200 207 202 203 204 Pool Spa Final Finel Re-Roof Final BIocWRetaining Wall Final Faciory Fira Place Final Sign Final Demolltion �NTITIALS CO�EI INSPECTIONTYPE 206 Final Methanical 208 Flnat Plumbing . . . 210 Final Elec�ncal 212 220 222 250 Final Fire Preventlon Final Planning Appmval Final Site Final Building/Occupancy PdIE 1[�Ql�ki �� (774) 754-5273 • Fax (�ia) �5a-aess • www.ci.costa-mesa.ca.us �� Fnia oHive, cos i n nnesn, cn szbzb Job Address: 424 OGLE CI Suite No Vicini�y: Parcel Number: 42514319 Applicam: ZOSCAK, LISA Address: 24512 BRIDGER RD LAKE FOREST, CA Owner: MARQUIS, JEFFREY C Address: 424 OGLE CIR MECHANICAL PERMIT Phone: 949-338-4189 Zip: 92630 Phone: . COSTA MESA, CA Zip: 92627-3227 Contrador: SWAN POOLS OF SOUTHERN CALIFORNIA Address: 24512 BRIDGER RD LAKE FOREST, CA Phone: 949-859-8466 Zip: 92630 License: 440333 ISSUED BY: SCOPE OF PERMIT � 87 SQ.FT. IN-GROUND SPA WITH NO AREA ABOVE 6", EXCLUDING PLANTER WALLS. REF.: B06-00351 MECHANICAL TO INCLUDE: 1 FAU > 100K BTU ISSUE FEE Inst FAU <100 k BTU Inst FAU >700 k BTU Repair/Alt Cooling/Heat Inst / Rep. Recess Wall Htr Refrig Sys <100 k BTU Refrig Sys >100 k BTU Gas Piping Factory Fireplace Hood�w/Mech Exhaust VAV Box Vent Fan / Single Ducl Appliance Fire Dampers Smoke Dampers Inst or Relocate Appl Vent Air Handlers < t0000cfm Air Handlers > 10000cfm � Floor Furnace � Floor or Suspend Healer. $23.50 $0.00 $1820 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 . $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantity 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FEE SUMMARY Repair / AIt Absorbtion Unit Repair / Alt Re(rigerafion Unit Ventillation System Evaporetive Gooler Com me rci al I nci ne rator Domestic Incinerator Comoressors /Absorotion Svstems Upto3hp/100kBTU 3 To 15 hp / 500 k BTU 15 To 30 hp / 1,000 k BTU 30 To 50 hp / 1,750 k BTU Over 50 hp / Over 1,750 BTU Boilers Up to 3 hp 3To15hp 15 to 30 hp 30 to 50 hp Over 50 hp Other Mechanical Fee Invesiigation Fee Plan Check Fee Reinspection Fee TOTAL CALCULATED FEES COMMENTS / SPECIAL CONDITIONS Status: ISSUED Applied: 03/01/2006 Issued: 03/01/2006 Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 E41.70 NO710E: 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, 1241-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or iF work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicabla codes, andrall requlred Inspectlona and finel epproval must be obtained. Failure to obtain Inspections and final approval will resufl in the expiration of this permit.' FOR INSPECTIONS CALL: (714) 7545626 � �r� zaas-ae�voo� „�/ WORKERS'COMPENSAnON DECLARATON: _ I hereby eHirm under penalry of perjury one of the following tleclaretions: ❑ I �ave end will maintain a certificata of consent to setl-Insure for workers' compensation, es provitled for by section 3700 of the La6or Code, for tha pertormance of the I� work for which this permit is issued. will ❑ I cetlih/ Ihat in Ne { compensation taws TO TMOUSAND c pensation insurance, as requiretl by sectlon 3700 of the Labor Cotle, for Ihe pertormance of ihe work for which ihis pertnit is issued. � ce wrner end policy number are: /��^ ^�� " Poficy N ber:� ��/� J i1 the permit is valuetl at one hundred dollars ($100) or less.) of ihe work for which this permit is issued, I shall no� employ any person in any manner so as to become subiect to the workers' i, and.egree �hat if I shoulC become subject to the workers' compensation provislons of Section 3700 of Ne Labor Code, I shall forthwith �0 !1 A 0, ��D Y /� /// n 1l1 d�l CS � �Dafe:� : RS' COMPENSATIQY COVERAGE IS UNLAWFUL PNO SHALL SUBIECT AN EMFLOYER'TO'CRI IW1L PENALTIES AND CNIL FMES UP TOONE MUNDRED 'ION TO THE COST OF COMPENSATIQY, DAMAGES NS PROVIDED FOR IN SECTION 3]OB OF TNE LABOR CADE, INTEREST, qND ATTORNEV'S FEES. LICENSED CONTRAC70RS DECLARATION: CONSTRUCTION LENDING / ❑ I hereby attirm thauhere Lender's Name: Signature: 9(commencing with Sectlon 7000) of Division De[e: antl my license is in tull constmction lending agency for ihe pedormance of ihe work for which �his permit is issuetl. (Sec. 3097, Civil Code). Lender's Atldress: Date: OWNER-BUILOER DECLARATIONS: I hereby aHirm Ihet untler penelty of pequry �hat I em EXEMPT FROM TNE CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5, 8usiness and Professions Code: Any ciry or county w�ich requires a permit to consimct, alter, improve, tlemolish, or repair any stmcture, prior to its issuance, also requires ihe applicant tor such pertnit to tile a signed statement Ihet ha or she is licensetl pursuaN to the provisions oi the Contractors License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business antl Professions Code) or that he or she is exempt thereirom entl the basis for the alleged exemption. Any violation o� Section 7031.5 by any epplicant for a permit subjeds ihe applicam m a civii penalty of not more ihan five hundred dollars (5500).): ❑ I, as owner of ihe property, or my employees with wages as iheir sole compensation, WILL DO TME WORK, end ihe strucWre is not intentletl or oMeretl for sale (Sec. 7044, Business and ProfesSions Code: The Contractors License Law tloes not apply to an owner of property who builds or improves ihereon, and who doas such work himself or herself or througn his or her own employaes, providetl that such improvements ere not Intentled or ottered for sele. If, however, the building or improvement is soltl within one year of completion, ihe owner-builtler will have the burtlen of pmving ihat he or she did not builtl or improve for purpose of sale.). � ❑ I, as owner of the pwperty, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS lo cons�mc� �he pmject (Sec. 7044, Business antl Professions Code: The contrectors Licensa Law tloes not epply Io an owner of propeny who builtls or Improves ihareon, and who conlrecis br such project with a contrector(s) license pursuam to ihe Coniractors License Laws.). ❑ I am ezempt untler sec. Business and Professions Code for ihis reason: Signature: Date: Owner ID verifiad 6y driver's license. ❑ Ves ❑ No Driver's License No. Verification of Ownership by (type o� document, i.e. - properry tax bill or tleetl): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICA710N: Ezpires: ❑ I hereby cenity that no exca�ation five (5) or more feet in dep�h into which a person is required to descend, will be made in connaction with work authorizetl by this permiL antl ihat no building structure, scallolding, talsework, or demolition or dismantling Ihereot, will be more than thirty-si: (36) teet high. (Chap. 32, Grp 2, Atl 2, Sec. 341, Ttle B, California Atlminisirative Code). ❑ As owner-builder, I will not employ anyone ro do work which woultl require a permit imm ihe Division of Industrial Safety, as notetl above, unless such person has a permit to do such work irom �he tlivision. Signature: Dale: Division o( Intlustrial Safety Permit Number. CER7IFICA7E OF COMPLIANCE AND AUfHORIZA710N OF EN7RY: I cenity untler penalty of perjury that I have read ihis application and state ihat the information given is correct. I agree to comply with all state laws antl city ortlinances relating to buiiding constmction, and authonze representatives ot ihe City of Costa Mesa b enter upon the ebove-descrit�$d prpperty for inspe��ion purposes. I agree not to occupy or allow occupancy ot eny building authonzed by this permit until fnel inspection. COpE 1'. INSPECTIONTVPE 1616 Fi:etl System Final Fire P�evention 1266 Pool Spa Final 200 Final Re-Roof 201 Final BIocWRetaining Wall 202 Final Facrory Fire Place 203 Final Sign 204 Final Demolition Qp1E INTITIALS ��QQEJ� INSPECTIONTYPE 206 Final Mechanical 208 Final Plumbing 270 Finel Elecirical 212 Final Fire Prevenflon 220 Final Planning Approval 222 Final Site 250 Final Building/Occupency JobAddress: 424 OGLE CI Suite No Vicinity: Parcel Nunmber: 4251431g npplicanr. ZOSCAK, LISA Address: 24512 BRIDGER RD LAKE FOREST, CA Owner: MARQUIS, JEFFREY C Address 4240GLECIR � COSTq MESA, CA PLUMBING PERMIT Phone: 949-338-4189 2ip: 92630 Phone: Zip: 926273227 Contractor: SWAN POOLS OF SOUTHERN CALIFORNIA Address: 24512 BRIDGER RD Phone: 949-859-8466 LAKE FOREST, CA 2ip: 92630 License: 440333 ISSUED BY: SCOPE OF PERMIT 87 S�.FT. IN-GROUND SPA WITH NO AREA ABOVE 6", EXCLUDING PLANTER WALLS. REF.: 606-00351 PLUM9ING TO INCLUDE: 1 GAS (1-0 OUTLETS), 1 GAS LINE, AND 1 SPA. ISSUE FEE Backflow irrigation Backflow Preventer BathWb Clarifier System Connect pce,Soda,etc) Denial Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Drinking Fountain Expansion Tank . Gas Earthquake Valve Gas (1-4 ouilets) � Gas (Over 4 oullels) Gas Repipe Gas Service Interceptors (Grease, Oil) Interceptors (Sand Auto ) AMT 5z3.so $0.00 $0.00 $0.00 $0.00 $0.00 so.00 $0.00 $0.00 50.00 $0.00 50.00 50.00 $0.00 56.15 50.00 $9.80 50.00 $0.00 50,00 QTY FEE SUMMARY AMT Laundry Tub I Washer 50.00 " Landscape Irrigation , $0.00 P-Trap $0.00 Pressure Regulator 50.00 Process Pipin9 (per 10 ft) $0.00 Receptors $0.00 Septic Tank $0.00 Sewer Cap for Demo' $0.00 SewerConnec� 30.00 Sewer Private Line $0.00 Shower $0.00 - ' Sink, bar $0.00 Sink, commercial $0.00 Sink, Floor ' $0.00 Sink, kitchen $0.00 Sink, service/mop $0.00 Spa (private) $30.25 Spa (public) 50.00 QTY 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 COMMENTS I SPECIAL CONDITIONS Status: ISSUED Applied: 03/01/2006 Issued: 03/01I2006 SumpPump Swimming Pool Trap Primer Urinal Vacuum Brkr BkOow(t-4) Vacuum Brkr Bkflow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (Toilet) W ater Heater / vent Water Piping (Inst or Rep.) Water Re-pipe Water Service Water Softener OTHER VIOLATION PLAN CHECK REINSPECTION AMT $0.00 $0.00 $0.00 50.00 $0.00 so.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 TOTAL CALCULATED FEES: §69.70 arv 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 NOTICE: The work authorizad by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-g2) EXPIRA710N: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned% tor a period of 1 BO tlays. // INSPECTIONS: In order for Ihe work authorized under ihis permit to be considered legal, such work must comply with all applicable code rand all required Inapectlona and finel epproval must be obtained. Failure to obtain inspections and final approval will result in Ihe expiration of permit. FOR INSPECTIONS CALL: (7yq) 75q-5626 zaae<e �aw� WORKERS' COMPENSA710N DECLARATON: _ I �eraby ettirtn under pena�ry of perjury ona of [he tollowing tleclaretions: ❑ I have antl wlll mainteln a cetlificate of consent to setl-Insure for workers' compensation, es provitletl for by sectlon 3700 of Ihe Lebor Code, for ihe pedormance of ihe L work for which t�is pertnit is iuued. and ansatlon insurence, as requiretl by section 3700 0l the Le�or Cotle, lor Ihe pedortnanceN ihe work Por which Ihis pertnil is issued. cernerandpolicynumDerare: 1��/} �� I Poticy;Numtier.^�l �� ermit is Valued aI one hunOretl dWlars /S f0o1 or less.l ❑ I cenity t�at in the ped ance of the work for which t�is pertnit is iuueQ I shall not employ any person in any menner so as to become subject to the workers' compensation laws of lifomia, antl agree Ihat shoultl become subject to the workers' compensation Orohsions of Sectlon 3700 of the Labor Cade, I shall tocNwiN camply wiih �he pr s�n , /� i� AppHcaM1fSign ure: __br�€�/J �� / �, Dete:__`..�J �AR11�M0"fAILURE TO SE U W EHS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SU&IECT AN EMPIOVER TO CRIMINAL PEW�LiIES AND GML FlNES L/P TOIXJE HUNDRED THOUSAND DOLLARE (E100.000). �ITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDEO FOR IN SECTIIXJ 3]O6 OF THE LABOR CODE, IMEREST, AND ATTORNEV'S FEES. UCENSED CONTRACTOPS DECLARATION: of Chapter 9(commencing with Section 7000) oi antl my license is in lull GONSTRUC7�ON LENDING AGNN�Y: ❑ 1 hereby atflrtn Ihat ihere is e constmction lending agency for Ihe pedormance of the work for which ihis permil is �ssued. (Sea 3097, Civil Cotle). Lentlers Neme: Lendar's Adtlress: Signature: Date: O�NNEH-BUILDER DECLARATIONS: I hereby ettlrm thet untler penalry of perjury ihat I em EXEMPT FFOM THE CONTHAC70RS LICENSE LAW for the following reeson (Sec. 7031.5, Business antl Professions Code: Any ciry or county which roquires a permit to construcL alter, improve, Cemolish, or repair any siructure, pnor to its Issuance, also requires the applicant for such pertnit to file e signed statament ihet ha or she is licensed pursuant to the pmvisions of ihe Contrectors License Lew (Chepter 9(commancing with Section 7000) of Division 3 ot Ihe gusiness antl Protessions Code) or that he w she is exempt lheretrom and the basis tor tha allegad axemytion. Any viWation W Section 7031.5 by arcy applicant tor a permN subjects the applicant to e dvil penalry of not more ihan five hundred tlollars (5500).): [] I, es owner ot t�e pmpeny, or my employees with wages as their sole compensation, WILL DO TME WORK, and Ihe structure is not intendetl or oflered for sala (Sec. 7044, Business and Professions Cotle: The Coniractors License Law does not apply to en owner of property who Duilds or improves thereon, and who does such work himself or herself or Ihrough his or her own employees, providetl ihai such imprwemenis are nat intendetl or ofte�ed for sale. It, howaver, the building or improvement is sWtl within one year o1 compfetion, the avner-buM1ltler wilf have tha bu�den ot proving that �e or she ditl noi builtl or imprwa tor purposa oi sale.). ' [] I, 85 owner ot the property, em EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS co construct Ihe project (Sec. 7044, Business and Professions Cotle: The comractor5 License Law does not appty to an owner of propeny who �uilds or Improves Ihereon, end who coniraas for such pmject with a crontractor(s) license pursuent m t�e Comracbrs License Laws.). ❑ I em exempt untler sec. Signa�ura: Owner ID verified by tlriver's license. ❑ Yes ❑ No Business antl Professions Code br this reason: Venfication of Ownership by (rype of documem, i.e. - property tax �ill or deed): Driver's LicenSe No. Date: Expires: DI�ISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby cenify ihat no excavetion five (5) or more feet in depih into which a person is requiretl �o descenq will be matle in connection wi�h work authodzed by �his permit, and Ihet no builtling simcture, scaffolding, falsework, or demolition or dismantling thereof, will be more then thirty-sia (36) fee� high. (Chap. 3.2, Grp 2, Atl 2, Sec. 341, Title 8, Califomla Atlministrative CWe). ❑ As owner-builder, I will not omploy anyone to do work which would require a permit from the Division ol Indusiriel Sefe�y, es notetl above, unless such person has e permil to tlo such work irom iha division. SignaNre: Date: Di�ision of Intlusinal Saleiy Permit Number: ICERnFlCATE OF COMPLIANCE AN� AUT/iORVA710N OF EMAY: I certify untler penalry of perjury that 1 have read this application and state that ihe information given is I colrect. I egree to comply wil� all slate laws and ci�y ordinances relating to builtling consWclion, end emhonza representatives of Ihe City ot Costa Mesa to entar upon t�e abo�e-descnb�Q property for inspeclion purposes. I agree not to atupy or allow occupancy ol eny building euthorized by lhis permit until final inspection. yQIj�J, INSPECTIONTYPE U� INiIiIpLS 1676 Fi:ed System Flnel Fire Prevention 1266 200 201 202 203 204 Pool Spe Final Finel Re-Fooi Finel BIocWRetaining Wall Final Factory Fire Place Finel Sign Final DemollHon COpE I INSPECTION TYPE 206 Final Mechanical 20B Final Plumbing 210 Finel Electrical 212 Flnel Fire Prevemion 220 Finel Planning Approval 222 Final Site 250 Final Building(Occupancy QA� INTff1��5 (�� e..,v�/�O � l �rl;�lo lo �b8^^'\ i1�.��I �i I Y I�� V+ � i . . � ( . �,;'� ,.!� t....� i c:,.,v��1 4:�,�. �'0^�,' . c5;.<< 7 . . '� r:;,� � � �. .,',.�, ,';c. Y,;� ,� , RICHARD �UIZ 5071 LOYOLA AVENUE WESTMINSTER, CA 92683 Report of Special Tnsgection ?c =.�•: �',_.^,�btr F��l,)lO��.u.r—J�_�� . !.^.spcc�,�on Typc(s) Gunite :-.>y::::o^ Dalc(s) ��1 � ) Pcriodic ( XXX J Con�inuous Dcs�ri'a: !nspcction Madc, including Locations: Ins ec£ion of the swimm �/� C� the above 3ddress on 1-{—lj -O _!s. Tci.s Madc: ��a! !nspection'�imc Each Day: � _.s. l�.c -�.s R:qviring Corrc:tion, includc uncorrtctcd ittms prcviously Gs�cd r'pmf-;t.^.lS'. T� �.re bcs'� o( my knowledge, �he work inspcc�ed wss in accordance wi�hlhc Building Dcpar�.r.�cr- .,.�rov�s �csign drawings, s�cci icalio and applicable workmanship pro�isions o( ine U E� ; �.f'p'. 2S ^OICd 2bOv . � - ;;3�.:_ Date �—Z3—O�O ❑!: �'amc I.C.B4O. ;r Richard T, Lui2 RcgistrationNo. 1075691-49 Co�cre:2 �l1NT"� 0�-�'QA�'��4- LtC.� 1250 �ORM t;.^: ;. � VPG.[Li .V �: VAC F -' .LL11v.i5 OCM ��' 4p�±1V�t � i�3T SP='f.iMFN f.K(i COMDP�S$?VE 9TRENCrTH l:A.f4 SIIEET _:9.:b: _ "" _.""'_" _ �.�s:�:Cnn.[.rG.iir.• "C"nidL__ _ _ '.. _:�Gy:F�('3J _.. _._��._. �.. . 'w�hCC�:'u�t. .l^.l.di��_iL__ _ C:(u,�n A��rY�. :N :If,�•6i'!p __ _ {-\vf'.Li[ •..('•.�j C(1M1iRT41:i _ �ti o-�.. w.✓:�p.•e::.•�i: 'Y�r`� � LvJ�n�'� :�rs �nSC� :U<i.S.P-�Gn' �!!:� 'v.v.' ''L,. _'_ •P:�4:lu:_� _ .. 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' "�,�.-� " it`;" i �� ti"tUYtND'MFh4yJ�Aan'T _� AgiA^..�0�:.. � �.�YV af "b �� p,•t ^K� I . i � � 4 � � i 6C. 4/ Lflg e.Gpi .rb I 6 9� '"' i_Nd_ y�"'�`�. � _�...�..... . � ' ,..- � �. �_.�._�.�..��.r.r�r�. ' -1 _ :� _» i :r.: I :i:�o� ,F�� : . - , .. ' `..:J:�, i . :J. � :J• J ]^q : - ._� ,_"'—_"_ "_ I I $ Y)ft^ '. S o�� Y' � �—__— � F. .p � ____f_'_.M�, �a�� ` F r _^ 5�:: °� , . .. ; . � a o�t. I a ; 'r ----=— - I ` ' , i � ' O DC] I J �J3 ' if ; __L _ _ _ _? ..�.�._._ . � � . ' . } . . - ' I . _ � � _ � - -- - - : -�- -- ;---- . -.- - j ;-. 3? 7N3 :p)�� ; YC' BNEAM , V51 I trPE' f^ � 2,5/2 :-3 1,903 Aa 1 �.�. I ! s,.d r< < z.�.sr �-- - -- - - - - � - ---- � I i� �.. St : J^ae ni^Ynm v . �., e nu ru+' ",a�n �are r, m�:. • v.,,.on . .a:A.^rv:..yrc .: rt. e...en ��'OM (Il'� .O� �i�lC'� � • . .�:1 I . � . t.�Y. �� ♦ . �'J�] ✓�i ��N' ')��1lI . �L��MW ^.f.u+JV:rE +. ��• ga�C'�rp i-°s,�y�"c �: qyUEM �•<'�:0 9Atic. � 4'�C9��i! i'ii�ncC59 /C u':P�NGr� ^1CCGJ_ Tht tlPG:r tGVU.L': i ii ,�••✓ " i . i �.UL�(1J:: ��-_i:4v�� f�._ A��3�CE"v7�0�r'CF[ / ' / ` , � '+� ' . . ' . .�__"_�. CS S�_:jl 'it_I:J�/1��dl� ppOJECTNAME: PROJECTA��RESS: veRuit Huwaea: TEST SPECIMEN AND COMPRESSIVE STRENGTH DATA SHEET MdfGU15 INSPECTION FIRN OR CLIENT: PV A'O9ICCIfUB - INSPECTOR'SNAME: Ca INSPECTOR'S LICENSE NO.: B06-OOJSi, SET IOENTIFICAPON NUMBER: Richard Luiz Richard Luiz N/A GAST DATA �ATTACM Dl1TA SHEET OP OTHERS WHEN AVAIUBLE) CAST �ATE 4/��/� DESCRIPTION CoarN� GmN Monnr SMtueta Muonry Pnzm ORier GUNITE CONiAACTOR Swan SPEqFIED Pc � PSI $,OOO CEMENT ttVE V SUBLONTRACTOR AlCO CAST BY {y( qDMI%TU0.E NIA ENGINEER OM Pasel NO. OF SMIPI,ES 2 WATER qpDED N/A �ONC.SUPP�ER N/A TOTALYUS.PLACED N/A SLUMP N/A p�ANT N/A TCNETNUMBER N/A NRLONTENT N/A MI%DESIGNNO. 41/Z-1 CASTTME N/A NR/CONC.TEMP. N/A �ocanow iH e�oo.: Bottom of the Swimming Pool rvores: NR = Not Reported Samples cast using wire mesh (no moltl used). Test specimens were sawcut into 3-in. x 3-in. x 3-in. shapes for cAmpression tesUng. Results relate only to the tesletl specimens. COMPRESSIVE STRENGTH DATA SPEGIMEN nGEni iEST TEST SPECIMENOIMENSIONS�IN.� AREA LOAO F'� BREAK IOENTIFICNTION TEST DATE TIME � Z � 4 SO.IN. LBS. PSI TVPE' NUMBER DFVS 5 8 h/C 6.002 6.003 72.61 F07077A 35 5R2/O6 2:OOpm 4.005 4.009 33,7B0 2,572 c-3 5.978 5.977 1.50 F07077B 35 5l22/O6 2:03pm 4.006 4.002 6.011 6.012 12.59 30,211 2,303 tl-4 6.992 5.993 7.50 Avg. F'c = 2,477 ' Soeumen Cimmsiona t� 0= wiCth ar�tl lenpth M earh face at mltl�eiqM; 4 Nrouph 8= specimen help�t et mldwiON. 'Break rype deaipnalim per ASTM C38 Fiquro 2: e=Cwa, WCone eIM SDItt, o-Caw anC Shear, O�Shea�, e=Columnar COMPLIANCE W1iH SPECIFIED 9TAENGT}17 COMMENT9: THE TWO SAMPLE AVERAGE COMPRESSNE STRENGTH EXCEEDS TME SPEpFIED VALUE AUT RIZEDSiGNATURE 2-05 V{ (714) 754-5273 • Fax (714) 754-4856 •��ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, GA 92626 ELECTRICAL PERMIT JobAddress: 424 OGLE CI Suite No Vicinity: Parcel Nunmber: Applicant: Address: !f��.7iCBiF!] FENTON.MARLON owner: MC GOVERN, DENNIS J Address 424 OGLE CI COSTA MESA, CA Contractor: Address: ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool / Spa Lighting Fixts Recept Outlets Switches Non Res Appl Res Appl Service to 200a Service to 1000a Service over 1000a Motors to 1 hp Molors to 10hp Molors to SOhp Motors to 100hp Motors over 100hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole ISSUED BY: Phone: 714-565-0100 X102 Zip: Phone: Zip: 92627 Phone: Zip: License: Stams: ISSUED Applied: 17/16I2000 Issued: 11 /16/2000 SCOPE OF PERMIT REF: B00-01771. ELECTRICAL FOR 813 SQ. FT ADDITION AND REMODEL TO SINGLE FAMILY DWEL�ING. ADD 22 OUTLETS, 18 SWITCHES, 1 SERVICE UPGRADE TO 200 AMP, 1 SUBPANEL (700 AMP). , _ - - _ $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $24.19 $23.46 $19.80 $0.00 $0.00 530.50 $O.OP $O.OP $O.OP $0.00 $0.00 $0.00 $0.00 $0.00 $30.50 $0.00 $0.00 $0.00 $0.00 Quantity 0 0 0 23 22 18 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 FEE SUMMARY Temp Dist System / Lighting Busway/t00k Standing Section Misc Electrical Equipment Transformers up to 7 kva/kw ................up to 10 kva/kw ............... :up to 50 kva/kw .............:...up to 100 kva/kw ..................over 100 kva/kw Low Voltage Equipment Low Volt Wiring System ! Ckt Misc. Conduit Misc. Conductor Circus ( gen or ride) Circus (mech ride or lights) Christmas Tree Stand Fireworks Stand Other Electrical Fee Investigation Fee Plan Check Fee Reinspection Fee Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 i0.00 0 ' $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 50.00 $0.00 TOTAL CALCULATED FEES $15'I.95 COMMENTS / SPECIAL CONDITIONS NO710E: 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, 72-21�92) EXPIRA710N: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned tor 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 Inspectlons and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of fhis permit. FOR INSPECTIONS CALL: (714) 7545626 zaas-as ��voo� / WORKERS'COMPENSAnON DECLARAnON: �� I hereby affirtn under panalty of perjury one of ihe following declarations: ❑ I have entl will malntain a cortificate of consent lo self-Insure tor workers' compensetion, as provitled for by section 3700 of Ihe Labor Code, for the peAormance of ihe work far which this permit is issued. ❑ I have and will maintain workers' compensation ins�rence, as requiretl by section 3700 ot the Labor Cotle, tor ihe pedortnance ot the work for which Ihis pertnit is issuetl. My workers' compensation Insurance carner and policy number are: Cerrier ' Policy Numbec (This section need not be comple(ed i/!he permi( is velue0 at one hundred dollars ($100) or less.) ❑ I cenify that in the performance oi ihe work for which Ihis permit is issued, I shell not employ any person in any manner so as �o become subjed �o the workers' compensetion laws of Calitornia, antl egree thet if I should become subject to ihe workers' compensation pmvisions ot Section 3700 oi ihe Labor Cotla, I shall forthwith comply with ihese Drovisians. Applicant Signature: Date: WAPNING FAIWRE TO SECURE WORNERS' CAMPENSATION COVEPAGE IS UNLAWFUL AND SHALL SUflIECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDREO THOUSAND DOLLARE �5100,000). IN ADOITIIXJ TO THE COST OF CAMPENSATION, DAMAGES AS PROVIOEO FOR IN SECTIqJ 3�06 OF TME LABOR CODE, It�TEREST, AND ATfORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I herehy aHirtn that I am licensed untler provisions of Chapter 9(commencing with Section 7000) of Division 3 of t�e eusiness and Professions Code, and my license is in full force antl eHect. Lic. N Cless a ContracbYs Signature: Date: CONSTRUCTION LENDING AGENCV: ❑ I hereby aHirtn ihat there is a cons�mction lentling agency for the pertormance of the work br which ihis permit is issued. (Sec. 3097, Civil Cotle). LentleYs Name: Lendefs Address: Signature: OWNER-BUILDER DECLARATONS: Date: I hereby aHirm ihet under penalty of perjury ihat I am EXEMP7 FROM THE CONTRACTORS LICENSE LAW for ihe following reason (Sec. 7031.5, Business and Protessions Coda: Any ciry or counry which reQuires a permit to construct, alter, improve, demolish, or repair any stmcture, prior to its issuance, also requires the applicant for such permit to tile e signed statement that he or she is licensed pursuant to the provisions of the Contractore License Law (Chapter 9(wmmencing with Sedion 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the besis for Ihe elleged exemption. Any violation oi Section 7031.5 by any applicant for a pertnit suhjacts the epplicant to e civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of ihe property, or my employees with wages es their sole compensation, WILL DO TME WORK, and Ihe 5irucNre is not intended or ofleretl for sale (Sec. 7044, Business and Protessions Code: The Contractors License Law dces not apply to an owner of properry who builds or improves Ihereon, and who does such work himself or herself or ihrough his or her own employees, provided thet such improvements are not in�ended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builtler will have the burtlen ot pmving ihat he or she tlid not build or improve for purpose ot sale.). ❑ I, as owner of the property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct lhe prolect (Sec. 7044, Business antl Professions Code: The contrectors License Law does not apply to an owner of property who buiitls or improves thereon, entl who coniracts for such project with a conirector(s) licensa pursuant to the Contractors License Laws.). ❑ I am ezemp� under sec. Business and Professions Code for �his reason: Signature: Oate: Owner ID venfietl by drivers license. ❑ Yes ❑ No Driver's License No. Verification of Ownership 6y (rype of tlocument, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: Expires: ❑ I heraby ceriify that no excavation five (5) or more teet in depth into which a person is requirad to descend, will be made in connection with work authonzed hy ihis permit, and that no building structure, scalloltling, falsework, or tlemolition or dismantling lhereol, will be more ihan ihirry-six (36) teet high. (Chap. 32, Grp 2, Atl 2, Sec. 341, Tule e, Califania Administrative Cotle). ❑ As owner-builtlar, I will not employ anyone to do work which woultl require a permit from ihe Division ol Indusirial Safery, as noted ebove, unless such person has e permit lo do such work from the division. Signature: Date: Division of Industrial Sefary Permil Number: CERTIFICATE OF COMPLIANCE AND A ORVJITION OF EN7RY: I cenity under penalty of perjury ihat I have read this application and state ihat Ihe infortnation given is wrrect I agre¢ b comply with ell state la s and ciry ordinances relating to builtling consiruction, and authonze representatives of Ihe Ciry ot Costa Mesa to enter upon t�e above-descrjl$dpmperty for inspect�y ryoses. I agree not �o occupy or allow occupancy of eny building authorized by Ihis permit until final inspection. CODE �. INSPECTIONTYPE 1616 Fixed System Fina ire Preven�ion 7266 Pool Spa Final 200 Final Re-Roof 201 Final8locWRetaining Well 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition 2AiE 1tQIDA�@ %! �/Cv/t� -�� Date cooe� ixsv¢cnoNrrae 206 Final Mechanical 208 Final Plumbing 210 Final Electncal 212 Final Fire Prevention 220 Final Planning Approval 222 FinalSite 250 Final Builtling/Occupancy P9IE It�ELfl 'i��/ta /� (714) 754-5273 • Fa�c (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 424 OGLE CI Suite No Vicinity: Parcel Nunmber: 42514319 Applicant: Address: Owner: FENTON,MARLON MC GOVERN, DENNIS J Address 424 OGLE CI COSTA MESA, CA Contractor. -Address: Arch / Eng : Address: PLUMBING PERMIT ISSUED BY: Phone: 714-565-0100 X102 Zip: Phone: Zip: 92627 Phone: Zip: License: Phone: Zip: License: Status: ISSUED Applied: ii/16/2000 I ss ued: 11 /16/2000 SCOPE OF PERMIT REF: B00-07771. PLUMBING FOR ADDITION AND REMODEL. 2 BATHTUBS, 1 DISHWASHER, 1 GAS SYSTEM EXTENSION <THAN 4 OUTLETS, 1 SHOWER, 2 TOIIETS, 1 WATER HEAT, 1 WATER RE-PIPE, 1 SHOWER. ISSUE FEE Backflow irrigation Backflow Preventer - Bathtub Clarifer System Connect pce,Soda,etc) Dental Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Drinking Fountain Expansion Tank Gas Earthquake Valve Gas (1-4 outlets) Gas (Over 4 outlets) Gas Repipe Gas Service Interceptors (Grease, Oip Interceptors (Sand Auto ) AMT $23.50 $0.00 $0.00 $19.60 $0.00 $0.00 $0.00 $9.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $6.75 $0.00 $0.00 $0.00 $0.00 $0.00 QTY 0 0 2 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 Laundry Tub / Washer Landscape Irrigation P-Trap Pressure Regulator Process Piping (per 10 ft) Receptors Septic Tank SewerCapforDemo Sewer Connect Sewer Private Line Shower Sink, bar Sink, commercial Sink, Floor Sink, kitchen Sink, service/mop Spa (private) Spa (public) AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $9.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 QTY 0 0 0 0 0 0 0 0 0 0 i 0 0 0 0 0 0 0 COMMENTS / SPECIAL CONDITIONS SumpPump Swimming Pool Trap Primer Urinal Vacuum Brkr Bkflow(7-4) Vacuum Brkr Bkflow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (Toilet) Water Heater / vent Water Piping (Inst or Rep.) Water Re-pipe Water Service Water Soflener OTHER VIOLATION PLAN CHECK REINSPECTION AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $9.80 $79.60 $12.30 $0.00 $9.80 $o.00 $0.00 $0.00 $0.00 $0.00 $0.00 TOTAL CALCULATED FEES: b120.35 QTY 0 0 0 0 0 0 0 0 1 2 7 0 1 0 0 NOTICE: Tha 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 1 BO days. INSPEC710NS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. POR INSPECTIONS CALL: (714) 754-5626 2446-46(N00) �� V WORKERS' COMPENSATION DECLARATION: � — I hereby aHirm under penalty of perjury one of ihe following declaretions: ❑ I �ave and will maintain e certificate oi consent to seif-Insure for workers' compensetion, as provitled for by section 3700 of the Labor Code, for tha pertormence of the work for which this permit is issuetl. ❑ I have antl will maintain workers' compensation insurance, as required by section 3700 of ihe Lsbor Code, for the pedormence of the work for which ihis pertnit is issuetl. My workers' compensation Insurance carner antl policy numher are: Carner: ' Policy Number: (This section need not be complefed il the permif is valuetl at one hundretl tlollars ($100J or less.) ❑ I certify thet in the performance of the work for which this permit is issued, I shail not employ any person in any manner so es to become subject to ihe workers' compensation laws oi Celifomia, and egree ihat if I should bacome sublect to the workers' compensation provisions oi Section 3700 of the Labor Code, I shall torthwith compty with Ihese provisions. Applicant Signature: Date: WARNING: FAILUPE TO SECURE WOFKERS' CAMPENSATION CAVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FWES UP TOONE HUNDRE� THOUSAND OOLLARE �$100,OOOf, IN ADDITION TO THE COST OF COMPENSATIqJ, DAMAGES AS PROVIDEO FOR IN SECTION 3)O60F THE LABOR CODE, IMEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirm that I am licensed under provisions of Chap�er 9(commencing with Section 7000) ot Division 3 of ihe Business and Professions Code, end my license is in full force end eflect. Lic. M Class # Conirectors SigneWre: Dete: CONSTRUCTION LENDING AGENCV: ❑ I hereby aHirtn that there is a wnslruction lending agency for the pedormance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lentler's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby aHirtn ihat untler penelty of perlury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Business end Protessions Cotle: Any ciry or counry which requires a pertnit to consiruct, alter, improve, tlemolish, or repair any strucWre, pnor ro its issuance, also requires the applicant for such partnit to file e signetl statemen[ that he or she Is licensetl pursuant to the pmvisions of the Contractors License Law (Chapter 9(commencing with Seclion 7000) of Division 3 of Ihe Business and Professions Code) or Ihet he or she is exempt therefrom and Ihe basis tor the ellegetl exemption. Any violation oi Section 7031.5 by any applicenl for a pertnit sublecis ihe aOP�icant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as ownar ot Ihe pmperry, or my employees with wages as Iheir sola compensation, WILL DO THE WORK, and the simcture is not intentled or oRerad for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of properry who huilds or improves thereon, and who tloes such work himself or herself or ihrough his or her own employaes, pmvided Ihat such improvements are not intendetl or oHered for sele. If, however, ihe building or improvemem is soltl within one year ot completion, ihe owneo-builder will have the burtlen af proving thet he or she did not builtl or improve for purpose oi saleJ. ❑ I, a5 owner ot Ihe property, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS lo conslruct the prolect (Sec. 7044, Busineu and Professions Cotle: lTe contractors Licanse Law tloes not apply to an owner of propeny who builtls or improves ihereon, antl who contracts for such prqect with a contrector(s) license pursuant to ihe Contractors License Lews.). ❑ I am exempt under sec. Business and Protessions Coda for this reason: Signe�ure: Date: Owner ID ventied by drivefs licen5e. ❑ Ves ❑ No Drivers License No. Verification of Ownership by (type of documen�, i.e. - properry �ex 6ili or tleetl): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: Ezpires: ❑ I here6y cenify that no excavation five (5) or more feet in dep�h into which a person is required lo descend, will be made in connaction with work authonzea by �his permit, and ihat no building simcNre, scattoltling, falsework, or damolition or tlismantling �hereof, will be mora than ihirty-si: (36) teet high. (Chep. 32, Grp 2, Art 2, Sec. 341, Title 8, Celifomia Administrative Cotle). ❑ As owner-builtler, I will not employ anyone Io do work which would require a permit fwm the Division oi Industnal Safery, as noted ebove, unless such person hes e permit to do such work irom Ihe division. Signature: Date: Division of Industrial SafeN Permit Number: CERTFICA7E OF COMPLIANCE ANDyLLiH �HIZA710N OF EN7RY: I cenify under penal�y oF perjury that I have reatl this application and s�ate Iha� �he information given is correct I agreejk mply wit all st f�la s and ciry ordinances relating to building cons�mction, and authorize representatives of ihe Ciry ot Coste Mesa to enter upon the above-descnbe��prop yinsp tion pu�poses. 1 agree not to occup or a ow occupancy of any huildinq authonzed by Ihis permit until finel inspection. CpDE I. INSPECTIONTYPE `� 1616 Fi:ed System Final Fire Prevention 1266 Pool Spa Final 200 Final Re-Root 201 Final Block/Retaining W ell 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition oare ' INTRIALS /l /(oa�� —� ate LOOE 1 INSPECTION TYPE 206 Final Mechanical 208 Final Plumbing 270 Final Elecirical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Builtling/Occupancy P9IE I[i�ALi � (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 JobAddress: 424 OGLECI Suite No Vicinity: Parcel Number: 42514319 Applicant: Address: Owner: FENTON, MARLON MC GOVERN, DENNIS J Address: 424 OGLE CI COSTA MESA, CA Contractor. Address: Arch / Eng : Address: MECHANICAL PERMIT Phone: 714-565-0100 X702 Zip: Phone: Zip: 92627 Phone: Zip: License: Phone: Zip: License: ISSUED BY: SCOPE OF PERMIT REF: B00-01711. MECHANICAL WORK FOR 873 S�. FT ROOM ADDITION. 7 FAU INSTALL, 4 VENT FANS, 3 APPLIANCES. ISSUE FEE Insl FAU <100 k BTU Inst FAU >100 k BTU Repair/Alt Cooling/Heat Inst I Rep. Recess Wall Htr Retrig Sys <100 k BTU Re(rig Sys >700 k BTU Gas Piping Factory Fireplace Hood w/Mech Exhaust VAV Box Vent Fan / Single Duct Appliance Fire Dampers Smoke Dampers Inst or Relocate Appl Vent Air Handlers < t0000cfm Air Handlers > 10000cfm Floor Furnace Floor or Suspend Heater $23.50 $14.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $29.00 $31.95 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantity FEESUMMARY Repair / Alt Absorbtion Unit Repair / Alt Refrigera[ion Unit Ventillation System Evaporetive Cooler Commercial I ncinerator Domestic Incinerator, Compressors / Absorption Systems Upto3hp/t00kBTU 3To15hp/SOOkBTU 15 To 30 hp / 1,000 k BTU 30 To 50 hp I 1,750 k BTU Over 50 hp / Over 7,750 BTU Boilers Upto3hp 3To15hp 15 to 30 hp 30 to 50 hp Over 50 hp Other Mechanical Fee Irnesligation Fee Plan Check Fee Reinspection Fee TOTAL CALCULATED FEES COMMENTS / SPECIAL CONDITIONS t " Status: ISSUED Applied: 11/76/2000 Issued: 1 111 6/2 0 0 0 �uantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 so.00 0 $0.00 0 50.00 0 so.00 0 $0.00 0 50.00 0 $0.00 $0.00 $0.00 $99.25 . NO710E: 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) EXPIRA710N: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned tor a penod of 180 days. � INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all requlred Inspectlona and final approval must be ob�ained. Failure �o obtain inspections and final approval will resutl in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 , zaas-se ��roo� \ WORKERS' COMPENSA710N DECLARATION: I here�y ettirtn under penalry ot perjury one oi ihe tollowing declarations: ❑ I have antl will maintain e certificate ot consent lo self-Insure for workers' compensation, as proNCed for by section 3700 of ihe Lebor Code, for the pertortnance of the work for which Ihis permit 15 issuetl. ❑ I have antl will maintain workers' compensation Insurance, as required by section 3700 af Ne Lebor Cotle, for the perfortnance of the work for which this permil is issued. My workers' compensation Insurance cerner entl poliry number ere: Carrier: � Policy Number: (This section need nof be comp/efed 1! fhe permit is velued af one hundred dollers ($100) ar less.) ❑ I cenify t�et in the pertormence of the worK far which this permit is issued, I shall not employ any person in eny menner so es to 6ecome su6ject to ihe workers' compensatlon laws ot Celifomia, and egrab Ihat If I should become sub�ect to Ihe workers' compensation provisions ol Section 3700 0l the Labor CoEe, I shall forlhwiih comply with these provisions. Applitent Signature: Da�e: WMNING: FAILURE TO SECURE WORKERS' CAMPENSA90N COVERAGE IS UNUWFUL AND SHALL SUBIECT AN EMPLOYER TO CRIMINAL PENA�TIES AND GVIL FlNES UP TOONE NUNORED iHOUSAND OOLLARE �5100.000), IN nDDR10N TO THE �T OF CAMPENSATIdJ, DAANGES AS PROVIDED FOii IN SECTION 37060F THE LABOR CODE, INTEREST, ANO ATfORNE1^S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aNirm Ihat I am licensetl under provisions of C�apter 9(commencing with Section 7000) oi Divislon 3 ot t�e Business antl Pmtessions Coae, end my license is in tull torca end eHect. Lic. q Class M Contretlor's Signature: Dete: CONS7RUCTION LENDING AGENCY: ❑ I hereby aNirtn t�at there is a conswction lentling a9ency tor Ihe pertormance of ihe work for whic� ihis permit is issued. (Sec. 3097, Civil Code). �� Lentlefs Neme: Lender's Address: Signature: Date: OWNER•BUILDER DECLARA710NS: I �ere6y eMirm ihat untler penalry ot perjury t�et I am E%EMPT FROM TME CON7RACTORS LICENSE LAW tor t�e lollowing reason (Sec. 7031.5, Business en0 Professions Code: Any ciry or county which requires e pertnit to construct, alter, improve, tlemolish, or repair any structure, prior to its issuance, also requires tha epplicant tor such pertnit to tile a signed stetement that ha or she is Ilcensed pursuant to the provisions of the Contrectors License Ww (Chapter 9(commencing with Section 7000) of DiWsion 3 of t�e Bu5ine55 and Professions Cotle) or thet he or sne is e:empt iherelrom end the besis for ihe allegetl enemption, Any violation of Section 7031.5 by any epplicant for a pertnit subjects the applicant to a civll penalty of not mole than five huntlretl dollars ($500).): ❑ I, as owner of ihe property, or my employe@s with waqes as Iheir sole compensation, WILL DO TME WORK, antl Ihe structure is not intended or oHered for sale (Sec. 7044, Business and Professions Cotle: The Conlractors Ucense Law does not apply to an owner ol properry who builds or improves Ihereon, end who does such wo�k himsetl or herself or through his or her own employees, provided thet such impmvements are not Intendetl or oflered br sale. If, however, the building or improvement is soltl within one year ot completion, the owner-Duilder will heve ihe burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am E%CWSIVELV CONTRACTING WIT1 LICENSED CONTRACTORS to construct t�e pmject (Sec. 7046, Business entl Protessions Code: The wntractors License Law tloes not epply to an owner of pmpeny who Dullds or improves Ihereon, and who coniracts for such prqect with a contredor(s) license pursuant to the Contractors License L.ews.). ❑ I am exempt untler sec. Siqneiure: Owner ID verified by dnvefs license. ❑ Ves ❑ No Business end Professions Code for this reason: Veritication of Ownership by (type of tlocument, i,e. - pmperty tex blll or dead): Dnver's License No. Date: E:pires: DIVISION OF INOUSTRIAL SAFETV PERMIT CERTFICA710N: ❑ I hereby certify �hat no excavation live (5) or more fee� in depih into which e person Is required Io Oescen4 will be made in connection with work eu�horizetl by this permit, antl Ihat no building sirucWre, scaflolding, talsework, or tlemolition or dismentling thereof, will be more ihan Ihirry-six (36) teat hiqh. (Chap. 32, Grp 2, Art 2, Sec. 341, Ttle 8, Califomia AAminisiretive Code). ❑ As or.neo-Duiltler, I will not employ anyon9 to do work which would require e permit trom the Division ot IndusMal Sefery, as notetl above, unless such person hes e pertnit ta do such wark irom the divisian. Signature: Date: Division of Industnal Safery Permit Number: CERTFlCATE OF COMPLIANCE AND AUTHO WPON OF ENTRY: I ceniy under penalry ot perjury ihat I have read this application antl stata ihat t�e information give� is correct. I egree lo comply with ell state laws e d ciry ortlinances rela�ing to building construction, anA euthonza represemetives of Ihe City of Costa Mesa to emer upon the ebove-describeQ prope[ry tor�ion s. I egree not to occup or low occupancy of any building auihorized by ihis pertnii until final inspection. CppE A, IN9PECTIONTYPE `f 1618 Fixetl System Final Fire Preventlon 1266 Pool Spe Final 200 Final Ra-Roof 201 Final BIocWRetaining Well 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition QeIE UIIIilEL9 //. ��Date % —` Date SODE 1 INSPECTION TYPE 206 Finel Mechanical 200 Finel Plumbing 210 Finel Eleclncal 212 Final Flre Prevention 220 Final Planning Approval 222 Final Site 250 Final Bullding/Occupancy 5_ � I � � �Y-�-- (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.��SLDING PERMIT �� FAIR DFIVE, WSIA MESA, GA 92ti26 Job Address: 424 OGLE CI Suite: Vicinity: ParcelNumber: 4z514319 Applicant: FENTON, MARLON Address: 400 N TUSTIN AV SANTA ANA, CA Owner: MC GOVERN, DENNIS J Address 424 OGLE CI COSTA MESA, CA Contrector Address: Zip: Zoning: Phone: 714-565-0100 X102 Zip: 92705 Phone: Zip: 92627 Phone: License: ISSUED BY: Status: ISSUED Applied: 70/23/2000 Issued: 11 /i 6/2000 Arch : Eng: GOUVIS ENGINEERING Address: Address' 4400 CAMPUS DR Phone: STE A Phone: 949-752-1612 NEWPORT BEACH, CA Zip: License: 92660 _ License: SCOPE OF PERMIT CONSTRUCT 813 SQ FT ADDITION TO AN EXISTING 1-STORY SFR. ENLARGE MASTER BEDROOM/BATHROOM, KITCHEN, ADD LAUNDRY ROOM 8 ADDITIONAL BATHROOM AND BEDROOM. Plan Check: $532.19 Permit: $818.75 SMIP Res: $7.45 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $1,358.39 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0- 0 PARKING Existinq: o NOTES: Rear 0. 0 Rear 0- 0 Re uired: 0 FEESUMMARY PLANNING 8 ZONING Left 0. 0 Lek 0- 0 Proposed: 0 Calc Valuation: Claim Valuation: Right 0- 0 Right 0- 0 $74,517.50 so.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned for a period of 180 days. � INSPECTIONS: In order tor the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred inspectlons antl final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 •. . zaaa+a ceroo, v WORKERS'COMPENSA�ON DECLARAnON: �� I hereby eHirtn untler pena�ry oi perjury one oi the following declarations: ❑ I �ave and will maintaln e certificate of wnsent to selFlnsure lor workers' campensation, as pmvided tor by section 3700 af the Lebor Code, for the pertortnence ot the work for which thi5 pertnit is issuetl. ❑ I have antl will maintain workers' compensation insurence, as required by section 3700 of the LeDor Code, for the performence of Ne work for which Nis permlt Is issued. My workers' compensatian Insurance carner and policy number are: Cerder. � Poliry Numbec (This section neetl nof be Cwnp�eted il the permi! is velued at one hundred tlollers ($100J or less.) ❑ I cenity that in ihe pe�ormance of the work br which this permit is issued, I shall not employ any person in eny manner so es to become subiect to Ihe workers' compensation lews af Callfornie, entl egree ihet 111 should becrome subJect to the workers' compensation provisions of Section 3700 of t�e Labor Cotle, I shall forthwith comply with Ihese pro�isians. AppliCent Signature: Date: WARNING: FAILURE iOSECURE WOfU(ERS' COMPENSATION COVEMGE IS UNLAWFUL AND SMALL SUBJECT AN EM%.OVER TO CRIMiNAL PENALTIES AND GVIL FlNES UP TOONE HUN�RED THOUSAND DOLLARE (5100,OWI.IN ADOfiION TO THE COST OF COMPENSATION, DnMFGES AS PROVIDED FOR IN SEGTON 31O80F THE IABOR CODE, IMEREST, AND ATTORNEI"S FEES. LICENSED CON7RACTORS DECLARATION: � I hereby aHirtn that I am licensetl under provisions of Chapter 9(commencing wilh Section 7000) of Division 3 of the Business and Professions Code, and my license is in full torce antl eHecL Lic. N Cless # Contrettors SignaWre: Date: CONSTRUC710N LENDING AGENCY: ❑ I hereby aHirtn that there is a constructian IenCing egency for the peAormance at t�e work tor whic� ihis permit is issued. (Sac. 3097, Civil Cotle). lender's Name: Lentler's Address: Signeture: Date: OWNER-BUILDER DECLMAnONS: I hereby aHirtn that under penalty of perjury t�at I am EXEMP7 FFOM THE CONTFiACTORS LICENSE LAW for the following reason (Sec. 7031.5, Busineu entl Professions Cotle: Any ciry or counry whic� requires e pertnit to construct, aller, improve, demolish, or repair any structure, prior to its issuance, also raquires Ihe applicant for such permit to fila e signed statement tdet he or she is licensed pursuent to the provisions ot Ihe Contractors LJcense Law (Chapter 9(commendng with Section 7000) oi DlNslon 3 ot ihe Business antl Professions Gode) or that �e or she is exempt therefmm and Ihe basis for ihe allegatl ezemption. Any violation ol Section 7031.5 by eny applicant tor a pertnit su6jecis the applicant to a Givll penelry of not more then five huntlretl dollars ($500).): ❑ I, as owner of Iha proPerry, or my employees wlih wages as Iheir sole compensation, WILL DO T1E WORK, and the sirucNre Is not intendetl or otteratl for sale (Sec. 7044, Business and 7�ofassions Code: The Contractors License Law does no� apply to an owner ot property who builds or improves thereon. antl who does such work himself or herseH or Ihrough his or her own employees, providad ihat such improvemems are not Intendetl or oHered for sale. H, howaver, the builainq or Impmvement is sold within one year o� completioq the ownar-builtler will heve ihe burdan of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner ot the proPerty, am E%LLUSIVELV CONTRALTNG WITH LICENSED CONTRACTORS to conslruct the O�alect (Sec. 704d, Business and Professions Code: The comractors License Ww does not eppty �o an owner ol propeny who builds or impmves t�erean, entl who wntracis tor such pryect with e comrector(s) license pursueni to the Contractors Licensa Lews.). ❑ I am ezempt under 59c. Signeiure: Owner ID venfied by drivers license. ❑ Ves ❑ No BUsiness and Professions Code tor Ihis reason: Vetlficetion oi Ownership by (rype of tlocumen�, i.e. - property taz bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: Dnvefs License No. Data: Expires: ❑ I �ereby certity that no excavation five (5) or more feet in tlepih into which e person is required to descentl, will be made in connection with work authorizetl by Ihis pertnit, antl t�at no bUilding sWCWra, scaHoltling, falsework, or demolilion or dismantling thereoi, will be more Ihan �hirry-six (36) feat hig�. (Chep. 32, Grp 2, Ar12, Sec. 341, Tnle e, Cefitomia Atlminisirative Coda). ❑ As owner-builder, I w�ll not employ enyone to do work which would require e permit from the Division of Industnal Sefery, es notetl above, unless such person has e permit to do such work from the division. Signature: Date: Division oi Indusirial Salery Pertnit Numbar: CER7IFICATE OF/ COMPLIANCE AND AUTHOR TION OF EMRV: I cenity under penalry of perjury ihat I have read Ihis application end state that ihe intormetion given is correct. I egree tp wmply wl ell state laws a Icity ortlinances relating to buil0ing construction, antl authonze representatives of Ihe City of Costa Mesa to emer upon the above-descnbed'bro0��iorypurp s. 1 agree not m occupy or ellow occupancy of any building authorized by this pertnit until final inspection. CODE I, INSPECTIONTYPE PAIE UiI�dL: 1616 Fixed System Fina� Fire Prevention 1266 200 201 202 203 Pool Spe Final Final Re-Roof Final BIocWFetaining Well Final Factory Fire P�ace Final Sign 20d Fnal Demolition �/ / iv %et�"D ale fADE I INSVECTION TYPE 206 Final Machanical 208 Finel PlumDing 210 Final Electrical 212 Final Fire Prevention 220 Final Planning Approval 222 Finel Site 250 Final BuildinglOtcupancy To: .� . . � � " . .. � 3600, NEWPORT-MESA UNIFIED SCHOOL DISTRICT CERTIFICATE OF COMPLIANCE OF DEVELOPMENT FEES PURSUANT TO AB 1600 ANO AB 181 ( Ciry of Costa Mesa ( ) Ciry of Newport Beach ( ) Counry of Orange Applicant I v \U�V/� I Address: � "" Telephone Number: /!� Tract/Parcel and Lot Number(s): Locabon of Project: Number of Square Feet of: Residential Space Commercial and Industrial Space rUS 77 nl /`N�G . `�1�� r �/ L//f / � CommerciaUlndustrial Project is: (Check One) _ Warehouse R8D _ Movie Theater _ Mini-storage _ Heavy industrial _ Regional Shops _ Light Industrial __ This project is exempt because �d13 x$1.84 x$.30 DisUict Receipt No.��'� 7�� Plan Check No. ��a"b� 7� f �7-� z�io �� ' '�25 - /�3 - � _ Matel Bank _ Neighborhood Shops _ RacqueUHealth _ Hotel Medical Office Office Park Total Total /'/N%� _ Preschool _ Auto Repair _ Hospital _ Large Office _ Office Bldg. _ Restaurant _ Fast Food i his certifies that the above-named Developer/Applicant has paid school faciliry fees in compliance with Government Code sections 53080 and 65995. The Building Pemiils for this square footage in this proposed development may now be issued by your jurisdicflon. Checks are to be made payable to Newport-Mesa Unified School Dishict. Authoiaea The above representation as to square footage is We. AppGcant true, then this ce�Uficate shall automaticaly terminate and the a� Date: G L ' � /U f`7 that such representations are not NN/f � r pia� �sa-s2�a • Fax (714) 754-4856 • www.ci.cos�a-mesa.��LDING PERMIT " r�� u��, yv�� J ,��V�� JobAddress: 424 OGLECI �Suite: Vicinity: REAR YARD Parcel Number: 42514319 npp�icant: FENTON, MARLON J Address: 400 N TUSTIN AV STE 290 SANTA ANA, CA Owner: MC GOVERN, DENNIS J Address 424 OGLE CI COSTA MESA, CA Contractor: OWNER-BUILDER Atldress: Zip: Arch : Address: Zoning: Phone: 714-565-0700 X702 Zip: 92705 Phone: Zip: 92627 Phone: License: 0 Eng: Address: Status: ISSUED Applied: 10/24/2000 Issued: 10/24/2000 ISSUED BY: 9Y'' � Phone: Phone: Zip: License �icense: SCOPE OF PERMIT DEMO & FILL OF AN EXISTING POOL (INCLUDING HEATER 8 PUMP) AT A SFR. Plan Check: $0.00 � Permit: $35.70 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $36.20 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0- 0 PARKING Ezistinq: o NOTES: Rear 0-0 Rear 0-0 Required: 0 FEE SUMMARY PLANNING & ZONING LeR 0- 0 Lefl 0- 0 Proposed: 0 Calc Valuation: Claim Valuation: Right 0-0 Right 0-0 $850.00 $850.00 NO710E: 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 it work is suspended or abandoned for a period of 1 BO days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred inapectlona and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 � zaaaae(doo) / / v WORKERS' COMPENSATION DECLARATION: I hereby eHirm Under penalty of perjury one of ihe tollowing declarations: ❑ I �eve end will meintein e certiticate of consent to self-Insure tor workers' compensation, es provitletl for by section 3700 of the Lebor Code, for the pertormence ot the work for Whlch this permit Is issuetl. ❑ I have and will maintain workers' compensation insurance, as required Dy section 3700 of ihe Lebor Code, for ihe pedortnence ot the work for which ihis pertnit is issued. My worke/s' compensation Insurence camer end policy number are: Carrier: Policy Number. (This secfion neetl nof be comple(ed i! the permif is value0 at one huntlred dollars ($100J or Iess.J ❑ I certify thW� in the pedormance ot the work br which ihis parmit is �ssued, I shell not employ eny person in eny manner so as to become subjact to Ihe workers' compense�lon laws of Celifomia, end aBree that If I should become sub�ect to the workers' compensation provisions of Seciion 3700 of the Labor Code, I shall toMwith comply with thesa provisions. Applicant Signeture: Date: WARNING FAILUqE TO SECURE WORKERS' COMPENSATION COVEMGE IS UNLAWFLL AND SHALL SUBJECT AN EMP�OVER TO CRIMINAL PENPLTIES ANDGVIL FINES UP TOONE HUNORED TFKK15M1D DOLLARE (5100,OW�, IN ADDRION TO THE COST OF �MPENSAiION, DPMAGES AS PRWIDED FOH IN SECTION 7lO60F THE LA60R CODE, IMEREST, AND ATTOFiNE1"5 FEES. LICENSED CONTRACTORS DECLARATION: I here�y aNirm tpat I em licensed under provisions of C�apter 9(commencing with Section 7000) of Division 3 ot tha Business antl Professions Code, antl my license is in tull force end eHect Lic. a Class x ,. ComractoYs SignaWre: Date: LONSTRUCTION LENDING AGENCY: ❑ I hereby aNirm Ihat there is a construction lending agency for the pertormance of the work for which t�is permit is issued. (Sec. 3097, Civil Code). Lenders Neme: Lender's Atltlress: Signature: OWNER-BUILDER DECLARATIONS: Date: I hereby aNirm iHat under penelty of perjury that I am EXEMP7 FROM 7HE CON7RACTORS LICENSE LAW for the foilowing reason (Sec. 7037.5, Business entl Professions Code: Any ciry or counry which requires e permit to cons�ruct, alter, improve, demolish, or re0air any structure, pnor to its issuance, also requires Ihe appliwnt lor such pertnit b tile a signed s�atement Ihet he or she is licensetl pursuant to the provisians ot Ihe Contredors License Lew (Chapter 9(commancing with Section 7000) oi Divislon 3 of the Business end Protessions Code) or thet he or she is ezempt thereirom antl the basis lor the elleqed exemption. Any violation of Section 7031.5 by any applicent for e permit suDjects the applicent to'e �civil penelty ol not more Ihan fiva huntlred dollars ($500).): [] 1, es owner ot tha propany, or my employaes with wages as iheir sole compensation, WILL DO TME WORK, en� Me simcNre Is no� intendetl or ottered ior sale iSec. 7044, Business end Prolessions Code: The Contractors Licensa Law does not apply to an owner of property who builds or improves thereon, and who does such work �imsetl or I�erself or Ihrough his or her own employees, provided that such improvements are not imentle0 or ofleretl for sa�e. H, however, ihe building or improvemem is /sold within one year ol completion, the ownerbuiltler will have the burden of proving t�et he or she ditl not build or impmve br purpose of sale.). �� I as owner oi the property, am E%CL SIVELY CONTRACTING WITH LICENSED CONTRACTORS to consiruct the project (Sec. 7044, Business and Protessions �� Code: The wnt aaors Lic Lew d noi appy to an owner of properry who bulltls or Improves thereon, end who wmrac�s for such project with a contraaor(s) license pursu� ig _ nir ciors ense Laws.). ❑ lem� Siqna�ure: Owner ID v Venfication �� : Business and Professions Code tor Ihis reason: /� Date: b ❑ Yes ❑ No Dnvefs License No. F�pires: of tlaument, i.e. - properry tax bill or deatl): DIVISION OF INDUSTRIAL SAFETV PERMR CERTIFICATON: ❑ I hereby certify Ihat no azcavation five (5) or more feei in dep�h into which e person is requiretl to tlescentl, will be maAe in connection with work authorized by this pe�mit, entl ��at no Duilding strucWre, scattolding, falsework, or demolition or dismantling Ihereol, will be more ihan Ihirry-six (36) feet high. (Chap. 32. Grp 2, Art 2, Sec. 341, TIHe 8. Celitomia Atlminislrative Cotle). ❑ As owner-builtler, I will not employ enyone to do work which would require a permit from the Division of Intlustrial Safery, as notetl above, unless such person hes e permit to d0 such work from the division. Signe�ure: Date: Division of Indusirial Safery Permii Number: CERTFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I cenify under penalty of perjury iha� I have reatl this application and state ihat the information given is correct I agree to comply wlth ell stata laws and city ordinances relating to building cons�mction, and euthorize representatives of Ihe City of Costa Mesa lo eNer upon ihe ebove-descnbed property tor inspection purpo�s. I egree not to occupy or allow occupancy of eny buildinq authorized by ihis permit umil linal inspection. . cooe r. 1616 1266 200 Fixed Sys�em Final Fire Prevention Pool Spb Final Final Re-Roof 201 Final8lo�WRetaining Well 202 Final Feciory Fi�e Place 203 Final Sipn 204 Final Demolition o"re � I[�ELS cooe� ixsrecnoxTrve 206 Final Mec�anical 208 Final Plumbing 210 Final Electrical 212 Finel Fire Preven[ion 220 Final Planni� Approval 222 Flnel Site 250 Final Building/Occupanry � : 1 �L .i �. ' GAIE ItIIIDd4fl 6EC�ARATION OF�THORITY FOR AGENTS OF PROPERTY OWNER TO APPLY FOR PERMITS ____�� c�� GfieGl.�i Sireet Address Permit # This Permit # �i\J 1. I(we), ""'"�"'�S �' /Y��Y�� , declare that I am the Owner of Title of the above referenced real property, and that I(we) hereby authorize: ,�f�t�er.o� �1 �.�ro� , C�r¢� s�s- O/a� x�o� Name ' Telephone No. � I � � up to obtain permits in my behalf, as owner/builder, for �ALDL17%D� �Y�/uU�i1/ at the above referenced property. 2. Should any person become an emp{oyee engaged in the improvement of the property, I(we) shall im- mediately provide Worker's Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa Mesa, as required by State of California laws. 3. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other per- son, company or corporation. 4. I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any claim resulting in damage or personal injury to myself or any other parties as a result of work authorized by the permits from the City of Costa Mesa. 5. I declare under the penalty of perjury that the foregoing is true and correc[. � . Executed this �3 day of Q�� `}�� 18'��?at �✓�� , Califomia. � ��^�N. s -J , � � �v �2.J ,� Printetl Name , o .�.� � Date NOTE: This authorization does not grant authorization to perform the work as owner, it solely provides for limited power of attorney to secure this permit in any behalf. � � I� �,�:_ ,_�%.�R:*�i111�:,�::� 07I9.d6 Iflev. 2191) (7ta) 754-5273 • Faz (71 a) 754-4856 • www.ci.costa-mesa.ca.us 77 rniH uHrvt, cus i n mt�A, cn yzbzu MECHANICAL PERMIT Job Address: 4$7 OGLE ST Suite No ;, Vicinity: Parcel Number: 42515220 npp�icane COLLINS ,RON Address: 3908 CALLE REAL SAN CLEMENTE, CA Owner: KENNEDY, GREGORY Address: 457 OGLE ST COSTA MESA, CA Contrectoc COLLINS CUSTOM BUILDERS Address: 3908 CALLE REAL SAN CLEMENTE, CA REF 801-01008 1 ALTER DUCT SYSTEM. ISSUE FEE Inst FAU <100 k BTU Inst FAU >100 k BTU Repair/AIt Cooling/Heat Inst / Rep. Recess Wall Htr Refrig Sys <100 k BTU Refrig Sys >100 k BTU Gas Piping Factory Fireplace Hood w/Mech Exhaust VAV Box Vent Fan / Single Duct Appliance Fire Dampers Smoke Dampers Inst or Retocate Appl Vent Air Handlers < 10000cfm Air Handlers > 10000cfm Floor Furnace Floor or Suspend Heater $23.50 $0.00 $0.00 $13J0 $0.00 so.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantity Status: ISSUED Applied: 08/13/2001 Issued: 08/13/2001 ISSUED BY: � Phone: (949) 661-8493 ' Zip: 92672 Phone: Zip: 92627 Phone: (949) 661-8493 Zip: 92672 License: 368900 SCOPE OF PERMIT FEE SUMMARY Repair / Alt Absorbtion Unit Repair / Alt Refrigeration Unit Ventillation System Evaporative Cooler Commercia l Incine rator Domestic Incinerator Compressors / Absomtion Svstems Upto3hp/100kBTU 3 To 15 hp / SOO k BTU 15 To 30 hp / 1,000 k BTU 30 To 50 hp / 1,750 k BTU Over 50 hp / Over 1,750 BTU Boilers Upto3hp 3To15hp 15to30hp 30 to 50 hp Over 50 hp Other Mechanical Fee Investigation Fee Plan Check Fee Reinspection Fee TOTAL CALCULATED FEES COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 780 days, or it w tor a period of 180 days. INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply w requlred Inapections and final approval must be obtained. Failure to obtain inspections and final approval will result in� FOR INSPECTIONS CALL: (714) 7545626 2A4838 (8/00) Quantity $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 $37.20 and related orabandoned all applicable codes, and expiration of this permit. WORKERS'COMPENSAnON DECLABArON: . I hereby aHirm untler penalty ot perjury one of ihe tollowing declarations: ❑ I heve entl will mainteln e certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 ot the Labor Code, for ihe pedormence of the work tor which ihis parmit is issued. I have and will maintain workors' compensation insurance, as required by sedion 3700 of Iha Labor Code, for the Oertortnance of the work for which this pertnit is issued. My workers' campensatlon Insurance cartler and policy number ere: Cerrier: Policy Number: (fhis sectian need nof be completed i/ the permit is valuetl et one hundred dollers ($100) or /ess.J ❑ I certi ' a perfor � nce oi the rk ich this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' c ensatlon la of II mla, and g that I should become subject to the workers compensetlon provislons of on 3700 of the LaDor Code, I shall forihwith wi ese rov ion . % PPIlcant Signatur � ete: ��d/ WARNIN ' ETOSECURE PKERS'CAMPENSATIONCAVERAGEI5 NIAWFULANOSHALL50B1E EMPLOV RTOCRIMI PEN�TIESANDGVILFlNESUPTOONEHUNDRED DDOLLARE($100,000),INADDITIONTOTHECOSTOFCAMPENSATIIXJ,DAM4GE5ASPqOVi INSECrI O60FTHELABORCADE,IMEREST,ANDATTORNEI"SFEES. DECLARATION: jfi(m that I em effect Ua x _ IUC N LENDING AGENCV: reby ettirm that there is e c Name: OWNER-BUILDER DECLARATIONS: ot Chapter 9(commencing with Section 7000) of Date: Cade, and my license is in tull lending agency for the pertormance oi Ihe work for which this pertnit is issued. (Sec. 3097, Civil Code). Lenders Address: Date: I hereby atfirtn thet under penelry ot per�ury Ihet I em E%EMPT FROM THE CON7FiAC70RS LICENSE LAW for ihe tollowing reeson (Sec. 7031.5, Business end Pratessions Code: Any ciry or counry which requires e permit to consiruct, elter, improve, demolish, or repair eny structure, Pnor to its issuance, elso reQuires the epplicant for such permit b tile e signetl statement ihet he or she Is Ilcensetl pursuant to the provisions of ihe Contractors LJcense Lew (Chapter 9(commencing wit� Sedlon 7000) of DlWsion 3 of the eusiness end Protessions Code) or that he or she is exempt thereirom and tha 6asis For ihe elleged exemp�ion. Any violation of Section 7031.5 by any ep0licent for a pem+' subjects Ihe epplican� to a civil penelty of noi more �han five hundred tlollars ($500).): ❑ I, es owner of the property, or my employees with wages as their sola compensation, WILL DO THE WORK, and the siructure Is no� Intended or oHeretl for sele (Sec. 7044, Business and Professions Code: The Contrectors License Law does not apply to an owner of property who builds or improves ihereon, end who tloes such work himself or herself or through his or her own employees, provided ihat such improvements ere not intendetl or oflered for sale. If, however, ihe building or Improvement Is soltl within one year ot completion, the owner-builder will hava the burden of provinq �hat he or she did noi builtl or improve for purpose of sale.). � I, as owner of Ihe property, am EXCLUSIVELV CONTRACTING WITH LICENSED CON7RACTORS to construct the project (Sec. 7044, Business and Professions Cotle: The contrectors License Law does not apply to an owner oi pmperty who huilds or improves thereon, and who contracts for such projeci with a contrector(s) license pursuent to the Coniractors License Laws.). ❑ I em exempt under sec. Signature: Owner ID veritied by tlriver's license. ❑ Ves ❑ No Business and Professions Code for ihis reason: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: Drivers LiCenSe No. Date: Expires: ❑ I hereby certity ihat no excavetion five (5) or more feet in depth into which a person is required to descentl, will be mede in connectlon wlth work euthonzed by ihis permi6 and that no builtling sfmcWre, scaflolding, falsework, or demolition or dismantling thereot, will be more then thiny-si: (36) feet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Title B, Celifornia Adminisirative Code). ❑ As awner-builder, I will not employ anyone to do work which would require e permit from the Division of Industnal Safety, es notetl ebove, unless such person has e permit to do such work from ihe division. Signature: Date: Division oi Intlusirial Sefery Permil Number: CERTFICA7E OF COMPLIANCE AND AUTHORIZATON OF ENTRY: 1 certiy untler penairy of perjury Ihat I heve read this application end state thet ihe information given is correct I egree to compty with all stete laws end city ortlinances relating to building construction, and authorize represeniatives ot ihe Ciry ot Costa Mesa to enter upon the ebove-descnbetl property for inspection purposes. I egree not to occupy or allow occupancy of any building euthorized by this permit until finel inspection. COpE �, INSPECTIONTYPE p,j� �MRIRLS 1676 Fixetl System Finel Fire Prevemion 1266 200 201 202 203 Pool Spe Final Final Re-Roof Finel Block/Retaining Wall Final Factory Fire Placa Final Sign 204 Final Demolition COpE1 INSPECTIONTYPE � 206 Final Mechanical 208 Final Plumbing 210 Final Electrical 272 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building�Occupancy I � _ 1. �III. • � C� Y pia) �sa-sv3 • Fsn (�ia� �sa-aess � CITY OF COSTA MESA � BUILD/NG D/VISION DEVELOPMENT SERVICES DEPARTMENT PERMIT Job Address: 468 � OGLE ST Suite: Vicinity: Parcel Number: 42515304 Applicant: COLLINS , RONALD Adtlress� 3908 CAILE REAL SAN CLEMENTE, CA Owner: GATES, PATTY S Address 468 OGLE ST BUILDING PERMIT Zoning: Phone: 493-6520 Zip: 92672 Phone: COSTA MESA, CA 2ip: 92627 Contractor: COLLINS CUSTOM BUILDERS Address: 3908 CALLE REAL Arch : Address: Zip: Phone: 493-6520 SAN CLEMENTE, CA Zip: 92672 License: 368900 Phone: License: Eng: Address: PERMIT NUMBER I 699-01579 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 09/30/1999 Issued: 09/30/1999 ISSUED BY: (�_ Phone: License: SCOPE OF PERMIT KITCHEN AND ENTRY REMODEL TO INCLUDE THE CONSTR. OF CELING, REMOVING OF NON BEARING WALLS IN THE KITCHEN. Plan Check: Permit: SMIP Res: SMIP Com: Other: I nspection: Total: $99.61 $153.25 $0.75 $0.00 $0.00 $0.00 $253.61 SETBACKS MAW STRUCTURE Front 0-0 ACCESSORY Front 0- 0 PARKING Existinq: o NOTES: Rear 0-0 Rear 0-0 Required: 0 FEE SUMMARY PLANNING & ZONING Left 0- 0 left 0- 0 Proposed: 0 Calc Valuation: Claim Valuation: Right 0- 0 Right 0- 0 $7,500.00 $7,500.00 NOTICE: Tha work authorized by ihis permit shall comply with all applicable handicap access requiremenis under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned for a period of 180 days. - INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requiretl Inspeetlona end final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 WORKEPS'COMPENSATONDECLARATON: I hereby attirtn untler penalry d� Perjury one of the tollowing tleclarations: ❑ I have and will maintain a certificate ot consent to salf-Insure tor workers' compensation, as providetl for by section 3700 oi the Labor Cotle, for the peAormance of ihe work tor which this permit is issued. ❑ I have and will maintain workers' cwnpensation insurance, as requiretl by section 3700 of the Lebor Code, fo� ihe pedortnance ot the work for which this pertnit is issuetl. My workers' compensation Insurance carrier and policy number ere: Cerner policy Number: (This section need not be completed il the pertnit is veluetl ef one hundretl tlollars (5100J or less.) I certify thet in t�e pertor ce of ih iork tor which ihis permit is issued, I shall not employ eny person in eny manner so as to 6ecome subject to ihe workers' co�laws ot Cali r�a. an r e Ihet if I should become subject to ihe workers' compensation Qrovislons of Section 3700 of t�e LaGor Code. I shall (orthwith eseprovis� s � � �/^ '/�� plicant Sign ✓V FAILURE TO SECURE WO RS' CQMPENSATION COVERAGE IS UNIAWFUL PND SHALL SUBIECT AN EMPLOYEF TO CRIMINAL PE TIES D CIVIL FINES UP TOONE HUNDRED THOUSAND DOLLARE (5100,000). IN ADDRION TO iHE COST OF COMPENSATION, OAMAGES AS PROVIDED FOR IN SECTIdJ 3'!OB OF iHE LABOR COOE, IMEREST, PND AiTORNEY'S FEES. LICENSED CONTRACTORS PECLARA710N: of Chaptar 9(commencing with Section 7000) at �e antl eflea. Lic. COnIrOCtOlS SipnelV Date: Code, antl my license is in full CONSTRUCTION LENDING AGENCY: � ❑ I hereby aRirm Ihat ihere is a constmction lending egency for the peAormance of the work for which ihis permit is issuetl. (Sec. 3097, Civil Code). Lentlers Name: SignaWra _ Lentlefs Address: Date: OWNER-BUILDER DECLARAnONS: I hereby aHirm thet untler penalry of perjury ihat I am EXEMPT FROM THE CONTRAC70RS LICENSE LAW for the following reason (Sec. 7031.5, Business entl Professions Code: Any city or counry which �equires a permit to constmct, elter, impmve, demolish, or repair any strucWre, pnor to its issuance, also requires the applican� tor such permi� to tile a signetl stetement Ihat ne or she is licensed pursuan� to ihe provisions of the Contractors License Law (Chapter 9(commencing with Section 7000) oi Division 3 of ihe Business antl Profeuions Code) or that he or she is exempt iherefrom antl the basis for ihe allageA exemption. Any violation oi Section 7031.5 by eny epplicam for a permit sub�ecis ihe epplicant to e civil penalry of not more than flve �untlretl dollars (3500)J: ❑ I, as owner of the properry, or my employees with weges es Iheir sole compensation, WILL DO THE WORK, entl the sWcture is not intendetl or oHered lor sale (Sec. 70a4, Business and Pmfessions Code: The Comracmrs License Lew tloes not apply to an owner of properry who builds or improves thereon, antl who does such work himself or hersell or ihroU9h his or her own employees, provitled that 5uch improvemenis ere not iniendetl or oNered for sale. If, however, the building or imprcvement is soltl within one year of cOmplelion, ihe owner-builtler will heve Ihe burtlen of proving Ihat he or she tlitl not huild or improve for purpose ol sale.). ❑ I, as ownar ot Ihe property. am E%CLUSIVELV CONTRAC7ING WITH LICENSED CONTRACTORS to consimct the project (Sec. 7044, Business antl Professions Code: The comraciors License Law tloes not epply to en owner oi property who builtls or improves Ihereon, and who contracts tor such project wllh a comractor(s) license pursuant to the Coniractors License LawsJ. ❑ I am exempt under sec. Signature: Owner ID verified 6y driver's license. ❑ Ves ❑ No Business antl Professions Code for ihis reason: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUS7RIAL SAFETY 7ERMIT CERTIFICATION: Driver's Licensa No. Date: Expires: ❑ I hereby certity thet no excavation five (5) or more lee� In tlepth imo which a person is required to tlescend, will ba matle in connaaion with work authodzetl by this pertnit, entl ihat no building siructure, scattolding, talsework, or tlemolition or tlismantling thereot, will be mora Ihan thirty-six (36) teat high. (Chap. 32. Grp 2, Art 2, Sec. 341, T�le B, California Administretive Code). ❑ As owner�builder, I will n0� employ anyone to tlo work which would require a pertnit trom ihe Division of Indusirial Sefery, as noted above, unless such person has a permit to tlo such work from the division. Signamre: Date: Division ot Industrial Sefery PeY�nit Number. CERTIFICATE OF COMPLIANCE AND AUTHORVATION OF ENTRV: I ceriify under penalty of Derjury Ihat I have read this application and state that Ihe information given is wrrect. I agree to comply with all state laws and ciry ordinances relating to building construction, and euthonze re0�esen�atives of Ihe City ot Costa Mesa to enter upon �he ebove-described property for inspection purposes. I e9ree not to occupy or allow occupancy ol eny bullding euthonzetl by ihis pertnit until Iinal inspaction. CODE �. INSPECTIONTYPE /616 Fixetl System Final Fire Prevention 1266 Pool Spa Final 200 Final Re-Roof 201 Final BIocWRetaining Wall 202 Final Fectory Fire Place 203 Final Sign 204 Final:D Qiolition 2aas-as ,f, � .s OATE INTRIALS COOE I INSPECTION TYPE 206 Final Mechanicel 208 Final Plumbing 210 Final Electrical 212 Final Fire Prevention 220 Final Planning Approval 222 FinalSita 250 Final Builtling�Occupancy fj�R E INTRIpLS (714) 754-5273 • Faz (714) 754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 424 OGLE CI Suite No Vicinity: Parcel Nunmber: 42514319 Applicant: Address: Owner: FENTON,MARLON MC GOVERN, DENNIS J Address 424 OGLE CI COSTA MESA, CA Contractor: Address: Arch / Eng : Address: PLUMBING PERMIT Phone: 949-548-5680 Zip: Phone: Zip: 92627 Phone: Zip: License: Phone: Zip: License: SCOPE OF PERMIT EXTEND GAS LINE FOR A FIRELOG OUTLET. ISSUE FEE Backflow i«igation Backflow Preventer Bathtub Clarifier System Connect Qce,Soda,etc) Dental Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Drinking Fountain Expansion Tank Gas EaAhquake Valve Gas (7-4 outlets) Gas (Over 4 ouUets) Gas Repipe Gas Service Interceptors (Grease, Oil) Interceptors (Sand Auto ) AMT $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 so.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $6.15 $0.00 $0.00 $0.00 $0.00 $0.00 QTY FEE SUMMARY AMT , , Laundry Tub / Washer $0.00 Landscape Irrigation $0.00 P-Trap $0.00 Pressure Regulator $0.00 Process Piping (per 10 ft) $0.00 Receptors $0.00 Septic Tank $0.00 SewerCapforDemo $0.00 Sewer Connect $0.00 Sewer Private Line $0.00 Shower $0.00 Sink, bar $0.00 Sink, commercial , $0.00 Sink, Floor $0.00 Sink, kitchen $0.00 Sink, service/mop $0.00 Spa (private) 50.00 Spa (public) 50.00 QTY 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 COMMENTS I SPECIAL CONDITIONS Status: ISSUED Applied: 09/27/2007 Issued: 09/27/2001 ISSUED BY: � � ' SumpPump Swimming Pool Trap Primer Urinal Vacuum Brkr Bkflow(1-4) Vacuum Brkr Bkflow(5+) Wash Basin WaSh Basin Set Waste and Vent System Water Closet (Toilet) Water Healer / ven[ Water Piping Qnst or Rep.) Water Re-pipe Water Service Water SoRener OTHER VIOLATION PLAN CHECK REINSPECTION AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 50.00 $0.00 50.00 50.00 $0.00 $0.00 50.00 TOTAL CALCULATED FEES: 529.65 QTY 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 9248, § 1, 72-27-92) EXPIRATION: This permit shall aulomatically expire and become void if work is not commenced within 180 days, or ii work is suspended or abandoned tor 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 ell requlred Inspecliona end final epproval must be obtained. Failure to obtain inspections and final appioval will result in the expiration of ihis permit. FOR INSPECTIONS CALL: (714) 7545626 2d4Bd8 (fl�W) �-i � WORKERS'�COMPENSATION DECLARATION: I hereby aHirm untler penalry of perjury one ol ihe following tleclarations: ❑ I heve and will meinteln a certificete oi consent to self�lnsure for workers' compensation, es provided for by sectlon 3700 of the Lebor Cotle, tor the pertortnence oi the work lor which this pertnit is issued. ❑ I have and will maintaln workors' compensation Insuranca, as required by section 3700 ot the La�or Coae, for t�e perfortnance ol t�e work for whic� ihis pertnit Is Issued. My workers' campensatlon Insurenca carrler end policy numDer are: Cartier: � Palicy NumDer. (This secfion neetl not be complefed il the permit 15 ve/ued ef one huntlred dollars ($100) or less.) ❑ I cenify Ihat in the peAortnence of the woAc for which this pertnit is issued, I shall not emplay any person in any menner so es to bewme sub�ect to the workers' compensatlon laws of Celitomia, entl egree Ihet if I should become suh�ect to the workers' compensation provisions ol Sectlon 3700 at the Lebor Catle, I shell forthwith comply with these provisions, Applicant SignaNre: Date: WARMNG: FAILURE TO SECUPE WORKERS' COMPENSFTION COVEMGE IS UNLAWFUL AND SHPiL SUflIECT AN EMPLOYER TO CRIMINAL PENALTIES AND dVIL FlNES UP TOONE HUNDRED T/%)USANO DOLLARE (5100.000�, IN AODRION TO THE COST OF COMPENSATION, DMV.GES AS PROVIDED f-0R IN SECTION 3]OB OF T1E LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aflirtn that I am Ilcensetl untler pmvlsions of Chapter 9(commencing with Sectlon 7000) of Divislon 3 ot t�e Business and Pmtesslons Code, end my license is in full force anA BNBCL Lic. A qass tl ContrectoYs Signeture: Dete: CONSTRUCTION LENDING AGENCY: ❑ I hereby aHirm t�at Ihere is a construction lending agency for the pedormanca of ihe work for which this pertnit is issuetl. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby ettirtn ihat under penalry ot pe7ury t�et I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business entl Professlons Coda: Any ciry or counry w�ich requires e parmit to constmct, elter, improve, demolish, or repair any structure, pnor to its issuance, also requlres the applicant tor such permit to file e signed stetement ihet he or she Is Ilcensed pursuent to the provislons of Ihe Contractors License Lew (C�epter 9(commencing with Sectlon 7000) of DlNslon 3 ot ihe Busin ss and Professions Code) or Ihet he or she is exempt therefrom and tha basis for the alleged exemption. Any Wolatlon af Section 7031.5 by eny applicant for e perm�' sub' ts Ihe appllcant to e civil penalry ol not more ihen five hundred dollars ($500).): I, as owner of ihe property, or my employees wlth wages as Ihelr sole compensation, WILL DO THE WORK, end the structure is not IntenGed or oflerad for sele (Sec. 7044, Business and Professlons Coae: The Contractors License Law does not apply to an owner of property who builds or improves thereon, end who does such work himself or herself or through his or her own emplayees, pravided that such improvements ere not intendetl or oHered lar sale. It, however, t�e building or improvemen� is sold within one year oi wmpletion, ihe owner-builder will heva Ihe burden of proving that ha or she did not build or improve for purpose ol sale.). ❑ I, as owner ot t�e properry, am EXCLUSIVELV CONTRACTiNG WITH LICENSED CONTRACTORS to conslruct Ihe project (Sec. 7044, Business antl Professions Code: The comracio nse Le does not appy lo en owner ol property who Duilds or Improves Ihereon, end who contracis for such pra�ect with e contwctor(s) license pursyant e Co icensa Lews.). , ❑ lam Signature: Owner ID Venfication of Ownership by (type ol Business and Protessions Cade tor Ihis ves ❑ No 1.9. - pro0erty te�c blll or deed): DIVISION OF INDUSTRIAL SAFETY VERMR CERTFICATION: Drivets License No. ❑ I hereby certify that na ezcavetion tive (5) or more leet in depih Into which e person is required to descentl, will be mede in connection wi�h work authorized by ihis permit, and that no buildinq sWCture, scaflolding, talsework, or tlemolltion or dismantling thereof, will be more than thirry-six (38) teet high. (C�ap. 32, Grp 2, Art 2, Sec. 341, Title 8, Celitomia Adminisiretive Gotle). ❑ As owner-builder, I will not employ anyone to tlo work which would require a permit from ihe Division oi Intlustnel Setety, es noted ebove, unless such persan hes a permit to do such work fram the division. Signature: Dete: Division at Industnal Safery Permit NumDer: yQDE �. INSPECTIONTYPE Qag IIIIRIALS 1616 Fiaetl System Final Fire Prevemion 1266 200 Poal Spa Finel Finel Re-Root 201 Final BloCk/Retaining Well 202 Final Factory Fire Place 203 Final Sign 207 Final Demolition LOpE� INSPECTIONTYPE 206 Final Mechanical 208 Final Plumbing 210 Final Electrical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupency veg u�eii :N , ; , C''�i � C''�ta �zleQa �u�:��y Du,�ia�' : OWNER-BUILDER VERIFICATION A city or county, which is reyuired to give notice pursuant ro Section 19830, shall attach ro such notice, and, as a condition precedent to issuing a building permit, require the completion and require the retum of, an owner-builder venfication. Attention Property Owner: An 'owner-builder' building permit has been applied for in your name and bearing your signature. Please complete and rewrn this infortnation in the envelope provided at your earliest opportuniry to avoid unneeessary delay in processing and issuing your building permit. No buildina pemtit will be issued until this verification is received. I. I personally plan [o pr vid the major labor and materials for conswction of the proposed property improvement�Yes ❑ No 2. 1(have/have noQ �F�' signed an application for a building permit for the proposed work. 3. 1 have contracted with the following person (�irtn) �o provide the proposed conswction: Name Address City _ Phone ( ) Contractor's Lic. No. 4. 1 plvn tu provide portiuns of the work, but I have hired the following person to coordinute, supervise and provide the major work: Nume Address Ciry _ Phone ( ) Contracror's Lic. No. 5. 1 will provide some of the work bu� I havc con[rac[ed (hired) Ihe following persons to provide the work indicated: Name Address Phone Type nf Work �OC2�<6 (qEV.9/98) j BUILqNG: Q 2 Q UGLE � I riwown: SEELEY, MA�tIUN S AODHESS 424 UGLH CIR Cu5TA MESA,CA �vm. runmc �ooweu AXCHRECT OP F1MiNFEP: MCN Oq iNd'S AOORE55: uxT: 92627 uu xo.: UNT: car+m�crarsru� ELLIOTT ROOF' MAINTENANCE ( 714 ) 997-4938 carn�croxsMuiwa 324 S El\RLHAM wo�ss ORANGE CA uew_ 4e5344 52669 uNr: LICENSEO COMRACTONS DECLAP�TON: I Mmby � m uMx qnely W pe�ury ihet I am liceneed uMs poviircn d Cheqa 9 (mmmencing wilh SeMion )000) oi Diviaun 3 o11M Buainees enE Professrona COEe, enE my licenee ie in hll /aro end eHac�. cmuc.No.:0395b5 uc.cuss: �-3y uc.wNo-.: qb5344 EiCP: OG/OG � B: O riO11�IB41IX: A/�" / ��(" � , WN BU OEfl DE .I�flATION: I Mrtby eXi�m uMx paneYy d parjury ihe� I em ecemq liom tM Comratlaa lkenae law la tln i- g� ls�� a.�i.s ew:�. �e a,w�oM cma: nm on « oo��ro wnw� naw� a o�n �o �sv�, ad«. mwore. -,_�molah, ar repei eny eVuctura, pna to ils esuence, ebo requirea �M eppliceM br wch permil �o file a aq�wd eleleman� Mei he or eM '.�'v licenaed W�� lo IM yovisian d �M Conlredon LicenSe law �Chepler 9(commendnp vM� Sed'qn ]000) d Oi+iion 3 d �he Bueinaes arM Prdassiona Gade� w thel he a eha is eaemq iherahan end Iha bnws fa iM dbpad e�emqion. My vioW ion d Seaun ]o�t.5 by e'ry epplireni lor a permit eubpde the epvliceni to e dvil panelly W ra� m«a then liva hundred ddlen �55W��. � I.avowrerWthaqopaitynmyemWqeenxihwapesmiheiulsmmpe�metion.willdothexwk.eMtMebuclure'orwliMendad w oHered foraeb (Seclion )Oea, BusiMss eM Proleaeiona Code: The Con�reclon Licenx Lewdoae mt epplyto en ownerd propeity who diiEs a inG�'ea iherean. eM x1w daae e h waM FimsMl or henel ar ihraqh h6 or Mr am amP�. Cw�d thm ach improvemmU era mt intanded n oMsad la eeb. II. howaver. ihe WiMiip a'vnprovemeM ie vok wilhin ar Yeer d cpndatnn. the owner-0�iWer will heva Ihe buNm d povi�p ha w ehe dN na build « improw tw tM WNae d eeb). � I. ee oxner d iha OroPaM. em exd�2i�ah oonlrecliW wil� licenead wnUecbn lo conqruq iha Wal� (Saqun )Wd. Bus'ume anE Prafeaione Cab: The Coniredors licanse lew Eoee rwt eppF/ lo en ownar d propeny who buiNa « imqovr iMreon end who wntr�d ror a�cn peqaee wnh e mmree«(e) �� wn� �o IM Cant�arias lice'ue Iswl. -� 1 em acemp unCer Seclion: B. 8 P.C.. In thie nswn: De�e: Owner: I do Mreby wrlity Mei l em eware d end uMerstvM the requimnmb d Cdf«nie HaeM eM Sduy COEe Setliam 25505.25593, eM 255�6, end thm I a e�ry Mure buiMinO �P�� II / will nU (cicb one) naeE lo campty wIh eeid qeb codm uM �M requirsmems b e Ds^�A Iwmmwction «modifmtian ham iMA'�ereYement Disiia. Reude�uiel mrevutlion WN�iamera uempl hom Uwe yrovi¢iare. Dme: Rpd'raH: WONKER'S COMPENSATION DECL�N�TION: 1 Mreb� elfi�m uMer penelty d pujury one d Ihe bYox�eq Edvatiom: � I M1ere ard wil meinten e cMilicete d rauam io utl�imum fur wakeri compenamian. m prwNeE la by Sepion 3]00 d �M lebor Code, la iM pa�lormarwe M �M1e xwk lor wNch Ihie peimil ie iseued. �] i na.� �a m� �men waxa.• o�o�� ms�rence. es na��roe M sman a�ao a me ian« coee. ro. me wnam.�m w m. .��«.nwnm�soa��s�..�,ae.rny.«x��VLLEN EA��um��: E7SPIRES c�: raKr N�mna,: 08 / 01 / 9 8 �nuse�+;��e.e,�wm w�ameeirneo�.;,m.o�»n�,n�eeew�ersrs,00�o.�c..� ❑ � cenaY u�m In ine ronormence d �M ..vrk �o. wncn min oemiX c as�ee. �.nel� na emWvf enr va�mn m vrv m.�n., m.a �o beeome wbpq to tM worken' eompenution kwa d CeNamu. aed epree i1W 8 I elauM Eeemr eubptl to iM xaken' mpensetion pmvisona M Sed'wn 3J(10 d Iha lebor COEe. I ahell (orlhwilh compy wiM 1 pmmaw..ne�. �� a: 0 G r,oa�r—�� 4i�//� In Fsllun ro soc n�ror.Mi wmpauetlon mwrepl �whil, endslW/ HdMcf en emp/qw ro u1Mml pmeltlp eM c •'q ro aro hv�0rstl thouund dullen (St00,000A M edJitlon ro N� ro�t ol mmpwwWM1 demspu �a povlWG br In Ssctlon ]lflb of tlis Labor COJs, InNnst, aM ettomsy'a /esa CONSTFUCTION LENDINO IIGENCY: I hereby elfirm uMm penelry d perjury Ihel Ihen re a mnm�ufion lendiip epeM.y tar iM pBf�d1118fICB O� I�1B NOf�[ iIX W�1lf�l ��16 (BIT� 19 B9YBd ($BtlIfM'.1�J. CiN. ri�. LENDER'S NAME LENDEH'S ADOFE39: I cerlify �liet I hew reaE this epplicetion enA elete thm Ihe eEove inlamation ia mrteU. I pree to wmply xiih ell ciry uM counry oMiner�cee vM emta lawe ralet'vq lo WiNip con9ruqion erd hareby eWpr¢a reyaeentalivea d Ihia ary ta enta upon Iha eboae�mantioried pape�y ��°��°�� JIM ELLIOTT (515ba6.WP� Whne-Buik'rpBSdery: om.: /0 Pink-Revenue;OakenroJ��A�wwr �ITY OF CUSTH MESA - bUiLUiNG PERM3'T PERMIT NG: H G65270 PLAhI CHECK NG: N CUNSTRliCTIUN TYPE: V-N PERh3IT TYP6: S'fR JUb DESCRIPTION : T/OFF REsHEATH 6 RERUOF W/LUNF. PERM NU: n vii527- i;OUT: N SUPP: N PI7iiFOSE; UTH S'l,j F'C; S,VVV CLAIM VALUE; S,OGO.t�O CALC-VALUE: 5,000.00 i>RGUP OCC; k-3 ! COMMENTS: SMOKE DETECTOR RE4UIREU iEif 1E fEif �k ii if if ik iEif if ie iE �7FiE iEie iE 1f 3E iEif if iE iE iE ii iiie iF iF ie i'e if ieiE±E iF iE if iE iFif iEie'se'sEiFd'e iE leie 1'rie ie i'e iF iEiE ikie 1i ii if iE iE ii ii ii i'r if iiiEie it ii ii Z O N I N G A E Q U I R E M E N T 5 S E: T 6 tl C K S ------------ MtIIN BUILDING ---------- --------- ACCfiSSuAY' bliILDIN� --------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAk: FT 1N LEFT: FT IN RGHT: FT IN LEFT: FT iN kGHI': Fi Itv PARKING REQ• PROV: PAACEL: 42514315 ZNE: Rr:f' Nti: , PLANNING Nt5TE5'- :� if iF �M iP ii iF iP iE 9F iE iE iE 3F �k if,iE if iF iF if # K 9F�f �if ie ir 3e if �ie if �M' iF f't if iF if if iE iE 3E iF iF if �)f iF il d'e iE iE iF iF iF if iF if tif ih �li� ie iF iF ie iF iE ie iF iF if f4 i't iE if je iR i'r it+e i'r D E V E'L O P M E N T S E R V I C E S R E{1 U I R E M fi N�f 5 ZUNING AI'PRGVEIi� BY LATE: BUILLING AFPROVEL BY : LAIE: � AFPLICATION ISSUED BY: ��_ LA'IE: U; �I ififiFikifiFiFiFiisiiFiFiFiF.iFiFifiFiiififii�F"iF�"�eiFii7f""R7�iFiF�lii'f'if st if�si7F e7�Fi �fTiF#�7Fiii'tiii{'iEiFifiFiF fY ftft 1t ieie LEGALIZATION:N F E E 5 U M M A R Y SI'RUCTUttAL '�:C;MtNT:Y BLUG PMT FLUMHING ELE�1'RIC MECHANIC PERMIT 99.75 FLAN ISSUE FEE tTkfi SMIPiitc:s GkiAL3NG .7V SMIP/NON-ttES bUILLING-LIV-s FERMIT ISSUE FLAN-CHECii TOTAL PAZL 1iU� TOTALS----> 100.25 0.00 O,t7� 100,25 1G0.25 .GO REVENUE DIVISIGN Tt�IALS--> COLLECTEL: 100.25 UVER/5IiGR't: .0� BLDG PM2 PLUMBING ELECTAIC MECHANIC FTRE SMIP/7U'f GR1�.LING YLAN-CHECK 99.75 .SG if ik if 9i 1e iFiE i'r if iE i! if iF iF'1F i! iF iF if If iE iF 9E iE iE iE if if if iF ik if ik iF if iF 9F if il' ii sE if ih iE iFiE il' iE'1E iF iF iE iF iF iF if 3{"1F if iFie iF 9E iE if if �7e if ie iF'%e'iR'iE'R ieie iF iF'k' I N D Z V I D U A L F E E b R E A K u U W N TYPE (�TY D E 5 C R I F T 2 G N UNZT CUST 'CviAL CuSI SFR 5000 REROUF BY JALUE RESILENTIAL NG'lONE 1.0� S,�OV.uO ENU GF FEdS IB-17-1997/88:31 NM/f10B.25 RCPTR:81-BA14827 PERMITe085270 rCONSTNUCTiON AND PLANNING � - PG 9 SPA - � APPROVA4S Permit# Date inspector AppROVALS Permit# • Date Inspecror L Temporary Electrical Service or Pole 52. Pool & Eq�ipment Locauon . 2. Soil Pipe•Undrgrnd. �i� 53. Steel Reinforcement � . r i�.Electrical Gondu�t t$jiity-Un¢�rgrnd. � 54. Porms ;�'�9��fectricalConduit� Pdrgrnd. - 55. Elettrical8onding ,� '.Sj�Steel Reinforcemeni�' ' .56. Rough Piumbing & Pressure Test -j -I'"6. �� Iectricai UFEf�G'nd. 57. APPROVAL TO COVER�GUNITE � : � -�,. �_ ..,yZ� ��oo[ings , - � 58. Electrical CondL�Undrgrnd. �8. Foundation :.1 n �:- 59. Gas Pipe, O UrUrgrnd., Test �' r w :� �'9. Wate� Pipe-Und�md.�� 60. Backwash LineS;�F�Trap, � Undrgrnd. 10. Structural Fioor•7Svstem � 61, APPROVALTOl9ECK , ll.,�roperty Sewer-�.ine & Hous�-Conneccion fi2. Backwash & Rg�eptor�Final - 12 :'$ewer Cap :� � " . _ 63. Heater & Vent-Finai 13. Roof Drains � � � 64. Plumbing SYstem � Final 14. Rough Plumbirig ,� .' 65. Electrical�Final � 75. Rough Electricai-Conduit , � ' 66. Solar System-F�n�l � 16. Rough Electr'ic 4Viririg .�� 67, Fencing� & Acosss-ApProval 17, Rough Wiring Sign �� • � 68. APPROVED F R� P�ASTERING ' 78. Rough Electrici;�T Bar Ceiling ' � ' � 69. P00�/SPA SY�$�S-,�£MS FINAL � 19. Rough HeSting & Air Cunditioning FIflE DEPT. REQUIREMENT � .r: - �++ �;� _ Ltl.. �y� i� ..,t 20.'�iougfiFzcto;ryFi#g�ilace � ^!'? '�� * '= � `7'�' APPF�OV.1j�S�'-' Peimit# k " �� n .i :.. i .J.' '��2 'C S ,-t t7' K �', •.� T--` 21.. • uCu, irtStrt�ctUre i: i � �-�+S � :S = �� • . _ ,J� , ~ . k , � 70i-UndergrgJrld Fiydro r .. �, t 22.,PuCiS, V9ntil�inj! '' � � . r '" � K �_y � ; � .:; � _ 77. Produ�'�iping'��as Y Oii 23.'.Gas;$ipG �ough & T.est � �n c g �n, ;� � �� 7 � 72, UndergrSuhd FYuYfv' !� �- - : - �-�_ 24. ARoo� Fra�t�ing• .z R i�-' �-^ '• - r% '-� '"' ^!� : 7'�' Under r d. St�'� an1t ❑ Gas O"Oil i-� p.i '1 !: �:; o--� .: 9 i� [�.`�� M1. 25. Roof:ShL�athing .'�- � - �Z}-!�') �� 7q�lpverhead HydrD � r s �s 26.•xf-622 Ceiling {Structural) & 6Atrnocoat �' �b '-� •�:" 7�;Dry Chem�ai _._; �'"" 7 ,� • 1 -1.K v � Y. � :N Y -N �� 'J I I^IU I�i� �,J2� 27..��rra�e aci� F;I�xhi�� _��,� �.r �r, !r.��. 76. Dry StaqdPiPe�� + 28. Lat6'ngiffi S��in9,�.k � �_.' �z �t � �t; 7;� FIXED�_5,`�S?Ef. jFINA�L..� 1 � � �- _ C^.:Y. =� �-i •• .. i , 1� ( � �. . 29. Insuiation ��. �K ,� •• : 7.8. FIRE PREV. F.It¢'AL �> 'X r 30. DrywalP �ailiRg T. � � � � � �� :� ;.yF�EALTJ�I PEFT:YiEQUiFj�MENT -, 31, Plaster �Fowr+�CoaT � ,S � .n�-, e � �� 79: PINAL;�SPECT�ON ; - " �j ,�: �. . , .� . = .. � 32.r'Electricaf•PoiR2r h�l�tei.Plnai' '� `� I jF �' S� FOOD CERTIfICATE I�SyUED - iy Iti.l' (' I' .-� ]� 33.�in� Ei cric� � � -• 4 ,*� ( ! � rc � �� 7�� t �7 O �v y .� n17 e6 F �7 � •r{ 1: IK NDtes: � 34.'Finaa' HeaTing� Air�iConditioni�S �: � I l IY S �� - e: `. �y�7 •,• �r .�, p .� • .S G M 35.'�in31'G��PipHTest ` ,�'" . . � . I ! " - '• �� •,'�� K R Y�7 '7 � i . - ' - �,sj n 36.� Hooil or:�anoPY . ,� V i �:+'� _ .k � . ' �i. � � '1 �� . . r, y�r , o -.. � � ^ .t �`7 - _ e �n -] �7 ` 37.',�+,inal;Facj�ory Firep�ace _ � •� � `�' .� r � � � l -�� -- �� i r f� � 38. FioaUPlilYnbing � � t� ' _ �i: V I ..�� .S y�; .Y �� ;7 V - - � � 39. Wat'c% Service-� inal `, � i � k ,^ I ' `R '. ' � .� `� " ^ _' . � . . .. " r 40. Gas Service-�nal � �:, •y rm 5 !: ,n I jr �� n.t: v. . i u - �. �: ! 41. Solar pomest�c•Fin� .5 �, �' �' ' �� " ` .x ��: �7 • � c � .� � 42.'Backfiow Preventer-j � � �� , - � � � '� -. � f = � ♦ 1 ti - 43. Backflow Irrigation F .� � �- } �. ' �' �� ., ' . a r T - • -44, Landscap� tr�ipation SYstemnn7'� .x -: �"� '7 C. o �� u � ^ � r •�� :r ,�. �s ,� - ��45. ,�5ound Atte�ation« ^ x " . _ .'' "' _ � f " " � % = f� T ^ . , �T1 'n �: r A .�6.�Handicap.Regulatio5is � _ '" t . r. . S -,.v �'� '.. 47.:FIN:AL STRIaCTURE & BUI'LDING �, �� s _ � -� l. ,. 48. GINAL PLANNING', i�- � s.0 i �- - ; ,� c' :49.'Electric Re�ease to Edison ' * � � '� % � ' 7 ' . r, �: ` t s; .� F } ,�,`0. �Gas �Release to Sout�em Califor.nia Gas Co k I i ' �. �- : � y • � �? � .j ' . - t - -571 CERJIFICATE OF OCCUPANCY� � s > . �` . -, .. - � N0. Date �;��`.: ",- , �� . �° Soutl�� st Inspectioal arad'�' ting, Iric. 10826 South Norwalk Blvd., Santa Fe Springs, CA 90670 156?1 941-2990 • 17141 526-8441 • Fax 15621 946-0026 REGISTERED INSPECTORS'S DAILY REPORT 5��1?d� 7e:' Dat�/ L7_O� TYPE Of � Reinforced Concrete ❑ Siructural Steel Assembly �Quality Confrol INSPECTION � Post Tensioned Concrete ❑ Fire Proofing , Other ,c%Pd,� :�.%� AEOUIRED � Reinforced Masonry ❑ Asphal} y Job Addrgsjl . � � � � City � 7 �%�� c�v Job Na e ,� c Permit No. Issuetl y � � , S /300 --C1 / % J 1 �dl Type of SSrucf�� Archite�yt {� -/�'+lG .�`s.s�. Mat riol Descnpfion (fype. grode, source) afE Engineer •��.✓ ��T L`� Kf c :i '-1 CONroctor G=-Zc. Inspec}ar(s) Nam , ��✓ v Subconiracfpr4 �-� � TESTS PERFORMED TYPE OF SAMPLE SLUMP QUANTITY IN SET ADDITIONAL REMARKS ON SAMPLES INSPECTION SUMMARY — LOCATIONS OF WORK INSPECTED, TEST SAMPLES TAKEN, WORK REJECTED, JOB PROBLEMS, PROGRESS, REMARKS, ETC. INCLUDES INFORMATION ABOUT-AMOUNTS OF MATERIAL PLACED OR WORK PERFORMED, NUMBEfl, TYPE & IDENT. NO'S OF TEST SAMPLES TAKEN: STRUCT. CONNECTIONS (WELD MADE H.T. BOLTS TORQUED) CHECKED, ETC. � �J � � - :s� Y> L z.- % �.4v-Cf..;r x �v Jc�-�cK `�/ - ,t , 'y � o..Ui : i % _ �Lc• n ,/t 3/ •! y� �' / � Y( �;�Y'x/ �� .�-G6 /.1�'�r.J ! �-s ✓ R�..-2�C� 2— 7 �� ° c-�..-L.ei-G � % ��/1�r'c''✓X �S''/ , � „L �/ � .( I,i� e! % q ��.r �S'Ii �Dv^ %�-t��J�.Cv.��...,�. <z� si ('�Cyc.�;,,,z.�i t.r� � :L�.- �� ,i��/_" nn- �'L %�J Gi-��- ��c-G�' `t-�-' a-.e%/ CEflTIFICATION OF LOMPLIANCE I HEAEBY CEflTIFY THAT I HAVE OBSEqVED TO THE BEST OF MY KNOWLEDGE ALL OF THE ABOVE flEPOPTED WORK UNLESS OTNEAWISE NOTE�. I HAVE FOUND THIS WOAK TO COMPLY WITH THE APPROVEO PLANS, SPECIFICATIONS, AND APPUC�ABL-7E SECTIONS OF THE GOVEANING BUIIOWG LAWS. 1�� -// SIGNATUFE OF flEGiSTEflED INSPECTOfl 7 �Gsn� d/� : � / � /( �/i �'J -1 //( SPECIALN N0�— AGENCY CONTINUED ON NEXT PAGE ❑ PAGE OF TIME IN TIME OUT REG. HOURS O.T. HOURS CYLINDEHS J L �� Ail inspections based on a mi um o hours and over 4 hours - 8 hour minimum. In additiyn, any in �on extending past noon hour will be an 8 hour minimum. / �� Approved by Project Superintendenl WHITE - pFFICE COPY, CANARY - ACCOUNTING COPY, PINK - INSPECTOR'S COPY, COLDENROD - JOB SITE COPY INTERNATIONAL.TESTING CORPORATION GArfield 4b550 TEtEPHONES GArfield 2-7500 � 617] CMERRY AVENUE - V. O. BO% 62AB, LONG BEACH B, CALIFORNIA NEveda 6-7BP1 `Tdenti£ication No. � Architect or Engineer: .::.„ COntractor: 'r� Ready-Mix Co.: � Structure Smaple from: � � `Mix: Total Water Admistture: �g. RBPORT ON GUGTITB� TBST CYLINDER P-358-1139 � Mclntosh � �� Anthony Bros. Yools Inc. ��' o�T yv�FG Ci/y � g�� Ca�v �OS,� \ ��Q"��PJa i Blaine Seeley Swi�ning Pool, 424 Og1e,Circle, Costa Meaa, Calif. Floor � 1:4.5 P.S.I. Requireffient: 3000 @ 28 Daye 3.ga1. per sk. Sl�p: None $pacimen Nos. 1 Date Made; 9-2-58 Date Tested; 9-30-58 C0�11'RSSSION --- Totel load, Lbs.: 98,750. Lbs. per sq, inch:� 3.800* Specimens macie by: Anthony Poo2s Specimens delivered by: Sweet Specimena recaived; 9-28•58 *Ayarage Diamater 5.75 inches = 25.95 Sq. In. Surface Area IN�EEBNATIONAL TE3TI CO RA�IOAI CORRECTBD COPY ��G�`�� , %% OWNER SEELEY. $LAINE NEWLAND /�..J� � c-2L.�/ . DATE 8-1S—SS JOB ADDRESS 424 O�Xe Circle BUILDING PERMIT NO. %291 GENERAL CONTRACTOR AllthOrip � VALllE $ 2,500.00 AP. No. LOT iy TRACT 1776 FIRE ZONE DESCRIPT[ON OP WORK Swim Pool INSPECTIONS f S. coat F. DATE � SUBCONTRACTOR PERMITSISSUED ( NUMBEF 7�0� �' ' 'J2�i COSTA MESA BUILDING DEPARTMENT P. o. eox 3 n COSTA MESA. CALIFORNIA FOR APPLICANT TO FILL IN BIJILDING .��1 ./ /h n n . � „ COSTA MESA. CALIFORNIA OWNER �(��L.C�y�,PJ � MAIL , �^ ADDRE55 /�� dJ �� CITY /�(R�/J/.C�C�--K� ARCHITECT /�" ^ OR ENGINEER tQ�[��{,�^ ADDRE55 �Q � . ��% CO NTRA CTO �(.L(�Q�(�.�, AD�RE55.J � ( ` �/� I EGR1. DESCRIPTION Np? � �- A.P.NO. ��I� SRE �OF LOT USE OF � / EXISTING BLOG. �C.-C-.✓ SETB4CK LINE FROM � CENTEF OF STREEi �� TE�. NO. LIC. NO. �EE RECEIVED `�lis'js� v�. FINANCE DEPT. APPLI�AT�O�P�'QJF�E`�FERMIT BUILDING FOR OFFICE USE ONLY RECEIPT NO. � ER X �j0. Z Y/ RECENED BY DATE RECEIVED T i55�1 -/ � � /S/ � ADDRE55 / Z 7 " // � ` �RC/ 2 r COSTA MESA. CAIIFORNIA FIRE ZONE CITV LIC. 20N PD,NS TYPE GR( NO. �� TEL. APPROVE n � �v10._NO. BV ((. DATE IS __.__ ..-._. CORRECTIONS NO.OF BL�GS. / MOW ON LOT �:. REAR YARD • DESCRIPTION OF WORK / NEW _ .. __. � ALTERATION AOOITION REPAIft I � MOVING I I DEMOLISH BUILOING � �j / NO.OF 512E /J �_7 S ROOMS STORIES EXTERIOR WALL ROOF CITY OF _ STA MESA SUBJ—�ECT TOr11 G. DEPT. REG. STATE TH4T THE PBOVE �5 CORPECT AND AGNEE TO COMPLV WITH ALI. CITV OROINhNCES 4N� $TwTE L�WS flEGULATING B IL�ING CONSTRUC� norv. VALUATION SIGNATURE F � f�` � PERMITTEE //%�� U� AUTHORIZED AGENT Q,p.L�Ly ULY�H+-�—/ �SDO PERMiT F�E $ /� � PLAN CHECK $ S � TOTAL FEE 5 �S�— � . " 6''15� COSTA MESA BUILDING DEPARTMENT P.O. BOX 31� COSTA MESA. CALIFORNIA ■ecn, CITY 1YtlW ARCHITECT IEGRL oesCeiPriov -A.P. NO. �rv SIZE 1 FOR APPLICANT TO FILL IN l.24 Ogle Circle COSTA MESA. CALIFORNIA Croxn Hcnnes, Inc. 2826 IJewnort Hlvd. ort Beach Cal. T�o:OR �6601 :R & TS o�a � � � � 61195 2035 Newport Blvd., Costa Mesa, �di, lJ. Koll Const:�Y� ��0 8534 2826 N ort $lvd. No: OR 3-6601 NOT � BLOCK TRACT 1!!6 71e (� NO.OF BLOG6.�}� � X/S�� NOW ON LOi L�VCE SEtB�CN LINE FROM c[r+i[r+ oF srr+[[r � �j REAR YARO RIGHT j(� LEFT Q DESCRIPTION OF WORK NEW ][ p�TERATION ADOITION REPAIR SIZIE DING56� J i� , EXTERIOR Wqyl_ � COVERING rrtrt USE OF NEW _. . NO.OF ROOMS S STORIES �■ w - •��-- m-•\�^ , �� 1��.��8 v �a s- ��- s� v u- FINANCE DEPT. Cllr OF COSTA h1ESR APPLICATION FOR PERMIT BUILDING FOR OFFICE USE ONLY � ' � r- i � � -/ 7'" � „ i .... .. � ,. eui�niNc c/ Z / �� ADDRE55 J COSTA MESA. CALIFORNIA FIRE � ZONE 20NE � MO.OF TYPE GFOU //7h�• DATE J r CORRECTIONS V _ G � � �s-y - I HEREBY wCBNOWLEDGE TMAT I MnVE REetl TMI6 �PPLIQTION aNO / A � STRTE TMAT TME POOVE IS COPRECT PNO AGREE TO COMPLY WITH nLL Gs( /- w� �� CITV ORDINANCE$ �ND $T�TE 1�W5 NEGUL.�TING BUILOING CONSTNUC- � �� iiorv. VALUATION / SIGNATURE OF PERMiT FEE S � �p — PERMITTEE 5 / // / /�� PLAN CHECK $ � /� � \ (r � e��r�ne��r., e��.�� I�� '�.CJ'�� TOTAL FEE S V SL-- 9��