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Home My WebLink About2479 MONTRE WAY - Building Permits--e . I t � / i . Job Address: 2479 MONTRE WY Status: ISSUED Suite: Applied:09/01/2005 R � ' � Vicinity: Issued: 09/01/2005 Primary Occ: R-3 Dwellings/ Cong Res <10 Type of Construction: V-N Parcel Number: 43914139 Zoning: Applicant STEVE JANOSIK Address: Phone: 714-259-5120 Zip: owner: WRIGHT, ELIZABETH O TR Address PO BOX 15353 � �. , � Phone:�'; � ` . ` . � IRVINE, CA j � � ��, Zip[ � � 92623-5353 � �- , . _ _ � . . , . " �i,i., , _ - - . _. , Contractor ALUMINUM ROOFING SPEGIALISTS/DIAL ONE WINDOW REP Address:1621 E ST qNDREW PL , � - Phone: . ";(714)259-5120 SANTA ANA, CA Zip: 92705, - Arch : Address: -. , Phone: ; Zip: License: Licensei � 523043 - ��'��.' Eng: ' - ,. . -- Address: � � ' , . Phone: .. .. .., , � Cicense: � SCOPE OF PERMIT REPLACE ALUMINUM PATIO DOOR W/ANDERSON �, PATIO DOOR , _ _ _ _ _ _ _ , . � . � . - - �- ' �� . FEESUMMARY �� Plan Check: $O.00CaIc Valuation: Saoo.00 ' Permit: $32.65CIaim Valuation: Seoo.00. SMIP Res: $0.50- - - SMIP Com: $0.00 Other: $0.00 � Inspection: $0.00 �ISSUEDBY: �� ,�r'� Total: �$33:15 � -" ' � �`� � . .-:::i---�'�,��'".,r � . i'., PLANNING & ZONING - ' SETBACKS - , . ' - ` ' _ . _ ;' MAIN STRUCTURE�Front ,' 0; 0 Rear ;;0= OLek; 0- 0 Right 0- 0 - � �� . �� ` _ - � � , ACCESSORY Front �- 0. 0. Rear, 0- 0-� � Left . 0- 0�" RighL. 0- 0. " � . .. . � - � . . . �� PARKING Exisfi�: 0� ' Re'Wred:�� 0 Proposed: 0- � . �, " . %_, NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiraments 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 180 days, or if work is suspanded 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 ell , requlred inspectlone end final approval must be obtained. Failure to obtain inspections and final approval will result in the expiratlon of this permit. � FOR INSPECTIONS CALL: (714) 7545626 2448-08 (W00) I WORKERS'COMPENSAnON DECLARAnON: I hereby eNirtn under penalry of perjury ona of the following declerations: � ❑ I have and wlll melnlain a cenificate of consent to self-Insure for workers' compensetion, es provlded for by section 3700 of ihe Lebor Coda, for �he peAortnance of ihe work for which this permit is issued. [� I have antl will mainWin workers' compensatlon insurance, es required by seclion 3700 of tha Labor Cotla, for Na perfortnance ot the work for whicli Nis pertnit is issued. My workers' compansation Insurence carner and policy number are: /� (��(� Q �i,�-, Cerrier: �T �' i F�J � o / Policy Number. (\ `�+-� 1–� w� (This section need not be com0�eted i/ Me permit is va/uetl et one hundred dallers ($1 ) or less.) ' ❑ I certify ihat in ihe perfortnance of Ihe work for which this permit is issued, I shell not employ eny person in any manner so es lo becoma subject to Ihe worke�s' wmpensation lews of Califomie, end egree that Ii I should become ubjea to t�e workers' compensatlon provisions oi Sectlon 3700 oi the Lebor Code, I s�all torihwit� comply with these provision . " p� ` Applicent Signature: i Date: q—� �L� J / e WARNING: FAILURE �� E WORKERN$' COMPE SAT ~I'70pVE �ILpWFUL AND SFIFl1 SUBIECT AN EMPLOVER TO CRIMINAL PENpLT1E5 M1D CML FlNES UP TO ONE NUNDRED �7 THOUSMIDOOLLAR � ),INADOITIONTOTH _ .OFG\7MPF'1 Or{bAMAGESASPROVIDEDWRINSECfION3%O60FTMELABORCODE,IMEREST,AN�ATfORNENSFEES. LICENSED CONTRACTORS DECLAHATIOISi"`" ""' '� � I �ereby aHirm that I am licensed under vision Chapter 9(commencing with Sectlon 7000) of Division 3 of Ihe Business�nA Professions Code, end my license is In tull lorce end ettect. Lic. q ei � Class R �� ` CantractaYs Signature: / Date: Gi _� � � S— o-� � � CONSTRUCTION LENDING AGENCY: ❑ I hereby aflirm that ihere is a construction lentling agency For ihe performance oi t�e work tor which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lenders Address: Signeture: _ Date: OWNER-BUILDER DECLAFiATIONS: I hereby affirtn that under penalry of perjury ihet I am EXEMPT FROM THE CONTFiACTORS LICENSE LAW tor Ihe following reason (Sec. 7031.5, Business and Professions Code: Any ciry or counry which requires e permit lo construct, elter, improve, demolish, or repair any structure, prior to its issuance, also requires the epplicant tor such pefmit to file e signed stetement ihet he or she is Ilcensetl pursuant to ihe provisions of ihe Contradors LJcense Lew (Chapter 9(commencing wit� Sectlon 7000) of Division 3 oi the Business and Professions Code) or that ha or she is exempt Iherefrom end the basis for ihe alleged exemption. Any violatlon of Section 7031.5 by any epplicant for e pertnit subjects the applicant to e civil penalry oi not more Ihan five hundretl dollars ($500).): ❑ I, as owner ot the property, or my employees with wages es their sola compensation, WILL DO THE WORK, and the structure is nat intentletl or olfered for sale (Sec. 7044, Business end Professions Code: The Coniractors License Law tloes not epply lo an owner of properry who builds or improves ihereon, en0 who does such work himself or hersell or through his or her own amployees, provided that such Improvements are not intended or oHeretl for sale. If, however, the Duilding or improvement is soltl wi��in one year of completion, the owner-buiider will have ihe burden of proving ihat he or she did not build or improve tor Durpose of sale.). � ❑ I, es owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (SeC. 7044, Business and Professions Code: The comrecrore License Lew tloes no� aDPly to an owner of property who hullds or Improves thereon, antl who contracis for such projec� with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am azempt untler sec. Signeture: Owner ID venfied by tlnver5liCenSe. ❑ Ves ❑ No Business an0 Protessions Code for this reason: Verificetion of Ownership by (type ot document, i.e. - properry tex blll or deed): DIVISION OF INDUSTRIAL SAFETV PERMR CERTIFICATION: Driver's License No. Dete: Ezpires: ❑ I hareby certify that no excavation five (5) or more feet in depih into which e person is requireC �o descend, will be made in wnnection with work authorizetl Dy Ihis pertnit, and that no building siructure, scaHoltling, falsework, or demolition or dismantling ihereot, will ba more Ihan thir�y-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title 8, California Adminisirelive Cotle). ❑ As owner-builder, I will not emplay enyone to tlo work which would require e pertnil from the Divislon of Industrial Safery, es notetl above, unless such person hes e permit to tlo such work irom the Civislon. Signature: Deta: Division ot Intlustnal Safety Pertnit Number: CERTIFlCATE OF COMPLIANCE AND AUTHOHIZATION OF ENTAV: I cenify under penalty of perjury thet I have read ihis epplication and state Ihat the infortnation given is correct I egrea to comply with all stete lews antl ciry ordinances ralating to bullding consiructlon, an0 authodza representatives of Ihe Ciry of Costa Mesa to enter upon Ihe ebove-descnbed properry for inspection purposes. I agree not to acupy or ellow xcupancy of any building euthorized by this permit until final inspadian. CODE �. INSPELTIONTYVE Qdjj INTRIALg 1676 Fixed System Final Fire Preventlon 1266 200 201 202 203 204 Pool Spa Final Final HaRoof Flnel Block/Reteining Wall Final Fadory Fire Place Final Sign Finel Demolitlon �+ oa�c� / r oate ' COUE� INSPECTIONTYPE 206 Final MechaniCal 208 Final Plumbing 210 Final Electrical 212 Finel Fira Preventlon 220 Finel Planning Approval 222 Final Site 250 Final Building�Occupency ��LYI�I:IUILIk� � �_ � �� 6?� July 19, 2005 BAG_ BAY GARDENS ASSOCIATiV.1 Proje.caiannllv Managed by Oprimvm Properry Managrmenr. /rrc. (CMF) A C£,RTIFI6D MANACEMEM17 F/RM !)�31 Irvinc Doulevar�( Sulte 1/2, Tusrin CA 927B0 O�cc: (!/4) SOH-907U/Far: (714) 508-9071 www.uptimumpm.com EL.IZABETFI WRIGHT PO BOX 15351 IRVIN�., G 92623-5353 Prvprny: 7479MONIRE U%ii�' Regarding; Arsbi�uturollieyuo�t — L'iry/ I�ixdnv�r Deae Homeowner(s): The Eoacd of D'uectoco reviewed your archimcturel appGcation, received in our office on )une 8, 2005 For. Bedmom window iepine�nent. Your appGrntion, � aigned copy of wltich u mclosed for your recordv, hae been ]�+prc�ved arit6 the followi��g condirinm� Apptp,ved ndiOc hemcoamc[a ni$nature Qe J�qpacted NejQhbor Acknnwledggm4nt Fotr2 '11iu �nodification must be cqmpleced in accocd:uicc with the goveening documena. Pnilure to comply may resulc in you being ieqvired m ccaubnuc yuuc eppGcauun. All work and futuzc upkeep ie to be done nt }rou� expenFe and shall be petformCd at a dme end in a mannv ro minimizc interEerence and 'uiconveniencc to other homeowntrs. You shall aaRume all linbility xnd will Ae reFponeible foi oll dunage and/or injury �huc may ccyult from puFocmance of dv� wo�Ic. Fucthermon, you are cesponEible for complying widi al1 appGen6le federal, staae and local L�.vs, eodes and rcgulnuone and requirements in connection with chis woek, and ahall obtain any necessury govemmenu�l pecmin and appxoval foc the woek. T'ha Houd of D'uectoes, ite agm[ and the Committee have no reRponxibility with respecr m Ruch comp6ance and [he Board of Duecmzs or i[s designed commiteee s sppcwal of thi� mquest shall not be uederatood ay making of any repreeentaenn or warrnnty tl�at the pl»ns, speclfitations or woik eomply wieh nny )nw, code, cegvladon or Sovernmental cec�ukement. Should yuu hnvc auy h�rthec q�eEpone, Plcasc do not heeitate ro conmct thc undeisigned nt (714) 50l.i-9070 E:r. 250. At the Dication oF thc Boacd oF Di�eccocs BACK IIAY GARDENS ASSOCIA"1'10N R� Rogers CommuniryAasnciadon Maeaget LR/df Enelosuee a: Soacd of Dincrots Yahool Mail - enwrigM(a}yaho Owner's m � � _ �� r / 6, as ARDENS ASSOCIATION FACING, ADJACENT AND IMPACTED NEIGHBOR ACKNOWLEDGEMENT FORAA Yage .! 014 t. Acknowledgement f�om urrit owners whose units are cantiguous to tl�at upon which woAc is proposed or uuAririch will have any view of the proposed work w01 greaqy speed the work of the ArchitecWral Commiriee. Falure to obtain the neighbors' signatures may detay your request and the ass�T�n �� your neighbors in writing of your ir�ent and ewad theu response. LJ 2. Failure to suhmit your r�eigh6ors' acknowl��ment wilh an appliCation may or may not be prima facie grounds for disapproval by the mmmittee. 3. Neighbors' acknowledgement is iMended only to demonstrete to the tommiriee �d the BoarO oi Olrectors that those owners most directly aflected by Oie proposed change know oi its existence. a. Neighhors, pleese inrtial to eckirowletlge th8t �rou have seen me proposed plans. 5. If you disapprove of the proposed plans, ptease submit in writing to managemeni your reasons for disapproval within five days oF receipt of proposed plans. FACING NEIGF180R� Address Signalure Dete FACING NEIGHBOR: Name Addreas Signature Date �' " "7 � _ �� / � /� /. .': _ . U ' �. httpJ/us.f330.mail.yahoo.cocn/ym/ShowLcttct?bo�TnF+oxJ�MsgId=�032_2173648_5690_l ... 6J6/2005 (714) 754-5273 • F2x (714) 754-4856 • www.ci.cos�a-mesa.c�ILDING PERMIT Job Address: 2479 MONTRE WY Suite: Vicinity: MASTER BATH Parcel Number: 43914139 App�icane TUSTIN, KEITH Address: 10661 ELLIS AVE UNIT G FOUNTAIN VALLEY, CA owner: WRIGHT, ELIZABETH O TR Address PO BOX 15353 Zoning: Phone: (714) 968-3555 Zip: 92708 Phone: IRVINE, CA Zip: 92623-5353 Contractor: ANTOINES INTERNATIONAL TILE & MARBLE Address: 10661 ELLIS AVE UNIT G Phone: (714) 968-3555 FOUNTAIN VALLEY, CA Zip: 92708 License: 667375 Arch : Address: Phone: Eng: Address: 77 FAIR DRIVE, COSTA MESA, CA 92626 ISSUED BV: Status: ISSUED Applied: 09/23/2003 Issued: 09/23/2003 Phone: Zip: License: License: SCOPE OF PERMIT INTERIOR REMODEL FOR AN EXISTING BATHROOM. MISC PLUMBING AND ELECTRICAL - Plan Check: $6321 Permit: $97.25 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $160.96 SETBACKS MAIN$TRUCTURE Front 0-0 ACCESSORY Front 0- 0 PARKING Existinp: 0 NOTES: Rear 0- 0 Rear 0- 0 Re uired: 0 FEE SUMMARY PLANNING & ZONING Left 0- 0 Left 0- 0 Proposed: 0 Calc Valuation: Claim Valuation Right 0-0 Right 0-0 sa,000.00 $a,oao.00 NO710E: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 9248, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void it work is not commenced within 180 days, or if work is suspended or abandoned for a period Of 180 days. INSPECTIONS: In order for �he work authorized under this permit to be considered legal, such work must comply with all applicable cotles, and all requlred Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOH INSPECTIONS CALL: (714) 7545826 taa6ee �flroo) WORKERS' COMPENSATION DECLARA710N: � , �� I �ereby eNirm under penairy of perjury one oi the tollowing declarations: , - ❑� I have end will meintain a certificate of consent to self�lnsure for workers' compensation, as provided for by saction 3700 of the Labor Code, tor the peAormanca oi the �work for which Ihis permit is issued. 1 ve and will maintain workers' wmpensation insurence, as requlred by section 3700 of tha Labor Code, for the peAortnence of ihe work for which this permit is issued. ' vty workers' compensation Insurance carrier antl policy number are: Carrier: Policy Number: (This section need nat be campletetl iI the parmif is valued et ane huntlretl dollers ($f 00) or le�ss.) ❑ I certify Ihat in the performance oi the work for which this permit is issued, I shall not employ any person in any manner so es to become subject to ihe workers' compensetion laws of Galitomia, antl agrae ihat it I should become subject to t�e workers' compensation provisions oi Section 370 oi the Lab r Cotle, I shall forihwith comply with these �p h�si�o.pns. /] 9� ��T- ��^'�� Date: �� ..� Applicant Signeture: � � WARNINGFAILURETOSECUFEWORKERS'COMPENSATIONCOVERAOEISUNIAWFULANDSHALLSUBIECTANEMPLOYERTOCRIMINALPENAL ESANDCIVILFlNESUPTOONEMUNDRED THOUSAND OOUARE (5100,000�, IN ADOITIIXJ TO THE COST OF CAMPENSATIIXJ, DAMAGES AS PROVIDED FOR IN SECTIIXJ 31080F THE LABOR CODE, IMEREST, AND ATTORNEI^S FEES. LICENSED CONTRACTORS DECLARATION: I herehy aNirm thal I am licensed untler provisions of Chapter 9(commencing with Section 7000) of Division 3 of the Business end Professions Cotle, and my license is in full torce end ettect. Lic. A Class # � �� " � Contractor's SignaWre: _ _ _ Dete: �� CONSTRUCTION LENDING AGENCY: , . ❑ I hereby aMirm Ihat there is a construdion lending agency for the pedormance oi �he work for which this permit is issued. (Sec. 3097, Civil Cotle). F Lendels Name: Lender's Address: Signatura: Date: OWNER•BUILDER DECLARA710NS: I hereby attirtn Ihat untler penalry of peryury ihat I am EXEMPT FROM THE CON7RAC70RS LICENSE LAW lor ihe tollowing reason (Sec. 7031.5, Business an0 Protessions Code: Any ciry or county whic� requires a permit ro construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires ihe applicant tor such pertnit to file e signeA stetemant thet he or she is licensed pursuent to the provisions oi the Contractors License Lew (Chapter 9(commencing with Section 7000) 01 Division 3 oi the Business and Prolessions Cotle) or that ha or sha is e:empt iherelrom end the basis for the alleged exemption. Any violation ot Section 7031.5 by any applicant for e permil su6jects the epplicant to a civil penalry ot not more ihan five huntlretl tlollars ($500).): . ❑ I, as owner of the property, or my employaes with wages as their sole compensation, WILL DO TME WORK, and the siructure is not intentletl or offered tor sele (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of properly who builds or improves thereon; antl who does such work himself or hersalf or through his or �er own employees, provided ihet such improvements are not intended or offered for sale. N, howaver, the building or improvement is sold within one year of completion, the owner-builder will heve�the burden ot proving that he or she did not build or improve for purpose of sale.). ❑ I, es owner of the property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Cotle: The contractors License Law does not apply to an owner oi propeny who huilds or improves ihereon, end w�o contracts tor such projecfwith a contrectoqs) licanse pursuant to ihe Contradors License Laws.). ', �� ❑ I em exempt under sec. Business antl Professions Code for ihis reeson: SignaNre: Date: Owner ID venfied by dnvers license. ❑ Ves ❑ No Drivefs License No. Expires: Venficetion of Ownership by (lype of documen�, i.a. - property Iax bill or tleetl): DIVISION OF INDUSTRIAL SAFETY PEHMIT CERTIFICATION: ❑ I hereby certity ihat no excavation tive (5) or more teet in depth imo which a person is required to descend, will be made in connection with work authonzed by Ihis permit, and Ihat no building structure, scattolding, telsework, or demolition or dismantiing ihereof, will be more than thirty-six (36) feat high. (Chap. 32, Grp 2, Art 2, Sac. 341, Tttle 8, Celifornia Administrative Code). ❑ As owner�builder, I will not employ anyone to do work which woultl require a pertnit from the Division of Indusiriel Salety, as notetl above, unless such person hes e permit to do such work from �he tlivision. Signature: Date: Division ot Intlustriel Safety Permit Number: CERTIFICATE OF COMPLJANCE AND AUTHORIZATION OF ENTTiY: I cehity untler penalry of perjury thal I have read this application and state ihat the intortnation given is wrrect. I egree to comply with all state laws entl ciry ortlinances relaiing to building construction, antl authonze representatives of the City ot Gosta Mesa to enter upon Ihe ebove-describetl property for inspection purposes. I egree not to occupy or ellow occupancy oi any building suthorized by ihis permit until final inspection. 'l Signature t Legal Owner(s) KP 1 �� _ nd/Or Authorized Applicant � CODE 1, INSPECTIONTYPE 7616 Fiaed System Final Fire Prevention 1266 Pool Spe Final 200 Finel Re-Roof 207 Finel BIxWRetaining wall 202 Final Factory Fira Place 203 Final Sign 204 Final Demolition pgg ' IM�pL$ - - QQQF�� INSPECTIONTYPE . 206 Final Mechanical 208 Finel Plumbing 210 Final Elecidcal 272 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occuparicy PA7E /� 3a- ,m . , '�I VISIOIV pp B UILD jN _. . _ ..,_ _ �. CIFY,OF.CpSTA_ G.SAFETY .. . .. _.. . a. __. _-- . A. 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C�nui>.;rj � I �; _ � I ��;j ��«; ��1�:, To , � � . s� N;� � 16�a _ _;,, ?.�t I�� :.� �,� , _ .. .. ,. _ �� . � , �Jf'[;�.�.. y�� JJ (MLv{E I-Ur, : „�j �3`/ r.11 '�� S4� � '- �� j. . _ .I __ .� _ _ ,�. .t� uln�� '�� (7'� '-f ,i;,s� `. ; ._.., � _ -{ � . � �- . , .. — � —_. _ r ti , _. �' �t�x� ; 33,� �-�i� �� G�N � U �i tJi �� ;-,-� _ 1 I r, '-� a�,¢ _ _ � - - '��l� Glw�!� ir ��c1�1 r'l� 8' �( � - �� ; ` '.+A _-_- � �j�� . � II6 �' j .. . _ � , ; . . . �:-- r ,.' U ► {i t I � % ^V . U��', � _, _ �l��t��. ,� .:. ... � . G ��,�i� . g � , �, ,� : r-w�r`� -�� -". �� i`1�AST�R _'� _ F+��J��r. . `�. ; , o,, - �- _ ��_.-�- �, i��r--_�/_.,;DcoR ��./� _`� _,-�..�� . i��:�,I �� ^ ' �� . � i� .. �—. Uoa,. �i. ;_. .`r _ _ � ��, _ , _ .. . iT „ . � `�� .. i_, - �\ .. _ _ . _ ,. . ' ' . - ' f �� t� �, .� `. .. . V � � ��"L�.t:. l'.r� ; :1 �7~ � I �\ ,. ran� . -- —;_.. -- —..�- — . . � i � , �� ubr�i .. . �� — _ �— _ _ _ �� l i ; -, �� . . ��!f.;. �� _ q.. .. _ �J_. ,� h �.i ._ . .. . _. CWs'� � _._ a�% � z•i r . . I ��, .�U C� ��- , - � _ ; T . . . . . : : ... � : _ _ _ ___ ... . ,:_. _ - a�N� _.... � --�- -- � � - �— i ,. , _ , �... , ;- �j�r�_�:�,� -„ _ . � I-4r � �; f )� � .. . '. .. . .. , . .. : � � , / 3 3� ��, . � 6� �` �:' u � . 5 �j _ . _ 6� 7i � _ . _ _ . '------" _ . . _.� y .. _ . .. „ . _. ... _. . . . .. � � `I�I�.��IJ.. I`�'". �L�� J IJ�'La„ � _ . .. j=�01ti1 �kti i=. . . . . ._ . ; _ ... . _ . _ _ ..._ _.. .... . _ . .. . . All dimensions 8 size designations given are subjec� lo verilication on job site and adjustment to lil jah condilions. T��E I This is an original design and musl Ev pO not 6e released or copied uNess �� applicable fee has been paid or job order placed. �� IFC�! fLl C:l�'�`�ri`�- - � � --- -- - — 6120CSC4 Scale:t/2"=1' Desiynt06lt2103 MASTER BATH . Dale : 06/12/03 Efizabelh Wright — Designer INGUNIJ Uwg no. ; (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 2479 MONTRE WY Suite No Vicinity: MAST�R BATH Parcel Nunmber: 43914139 Applicant: TUSTIN, KEITH Address: 10661 ELLIS AVE UNIT G FOUN?qIN VALLEY, CA Owner: WRIGHT. ELIZABETH O TR Address PO BOX 15353- IRVIN�, CA PLUMBING PERMIT Phone: (714) 968-3555 Zip: 92708 Phone: Zip: 92623-5353 Contractor: ANTQINES INTERNATIONAL TILE 8 MARBLE Address: Arch / Eng : Address: ISSUE FEE BackFlow iirigation BackFlow Preventer Bathtub Clarifier System Connect pce,Soda,etc) Denlal Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Drinking Fountain Expansion Tank Gas Earthquake Valve 10661 ELLIS AVE UNIT G FOUN7AIN VALLEY, CA Phone: p14)9683555 Zip: 92708 License: 667375 Phone: Zip: License: ISSUED BY: SCOPE OF PERMIT INTER�OR REMODEL FOR AN EXISTING BATHROOM. MISC PLUMBING AND ELECTRICAL. AMT $23.50 $0.00 $0.00 59.80 $0.00 $0.00 50.00 50.00 $0,00 50.00 $O.pp 50.00 S0.00 50.00 FEE SUMMARY �TY AMT Laundry Tub / Washer $0.00 0 Landscape I«igation $0.00 0 P-Trap $19.60 1 Pressure Regulator 50.00 0 Process Piping (per 10 fl) $0.00 0 Receptors 50.00 0 Septic Tank 50.00 0 Sewer Cap for Demo 30.00 0 Sewer Connect $0.00 0 Sewer Private Line 50.00 0 Shower 50.00 0 Sink, bar $0.00 0 Sink, commercial $0.00 0 Sink, floor $0.00 QTY 0 0 2 0 0 0 0 0 0 0 0 0 0 0 Status: ISSUED Applied: 09/23/2003 Issued: 09/23/2003 SumpPump Swimming Pool Trap Primer Urinal Vacuum Brkr Bktlow(1-4) Vacuum Brkr Bkflow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (Toilet) Water Heater / vent Waler Piping (Inst or Rep.) Water Re-pipe Water Service AMT 30.00 $0.00 $0.00 50.00 $0.00 $0.00 59.80 50.00 $0.00 50.00 50.00 $0.00 50.00 $0.00 QTY 0 0 0 0 0 0 t 0 0 0 0 0 0 0 NOTICE: The work authorized by ihis 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 1B0 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for ihe work authorized under this parmit to be considered legal, such work must comply with all applicable codes, and all required Inspeetlona and tinal approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 2d46�46 (N00) WORKERS'COMPENSATION DECLARATON: ` � I hereby aHirm unAer penalry oi perjury one of the following declarations: ❑' I �ave and will malntain e cenificate ot consent to self-Insure for workers' compensation, es pmvidetl lor 6y Section 3700 of Ihe Labor Cotle, for the partormenca of Ihe work tor which this permit is issued. e end will maintain workers' compensa�ion insurance, as requiretl by section 3700 ot Ihe Lebor Cotle, for the pertortnance of the work tor wnich this pertnit Is Issued. My workers' tompensatlon Insurence carrier end policy number ere: Cerrier: - PoliCy Numbec (This secfion need not be cromplefed il the permit is veluetl e( one huntlred dollers ($100) or IessJ ❑ I certiry that in ihe performence ol ihe work for which ihis pertnit is issued, I shell not amploy any person in eny manner so as become subject to Ihe workers' compensetlon lews of Callfomia, antl egrae ihat if I shoultl becoma subject to the workers' compansation provisions oi,Septio�3100 oi th Labor Cotle, I shall forthwith com I with ihese r isions. �� `7 ApPlicant SlgneWre: P�� Date: v3 l!3 WARNING: FAIWRE TO SECURE WORKEflS' COMPENSATION COVERAGE IS UNLAWFUL rWD SHALL SUBIECT PN EMPLOYER TO CRIMINAL PENALTIES AND dVIL FlNES lIP TOONE HUNDRED T110USAND OOLLARE (5100,D00), IN A�DITION T01HE COST OF COMPENSAiiON, �AMAGES AS PROVIDED FOR IN SELTION 3]Ofi OF THE IABOR CODE, IMEREST, AND AITORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aftirtn that I em licensed under provisions of Chapter 9(wmmencing with Section 7000) at Division 3 of the Business and Professions Code, antl my license Is in lull force and effet�. Lit. k Class k Contrectols Signature: ,� F Date: 2� CONSTRUCTION LENDING AGENCY: ❑ I hereby eHirtn Ihat there is a construction lending agency for the peAormance af the work lor which ihis permit is issued. (Sec. 3097, Civil Code). Lendefs Name: Lentlers Atltlress: Signeture: OWNER-BUILDER OECLARATIONS: Date: I hereby effirm that under penally of perjury thal I am EXEMPT FROM TME CONTFiACTORS LICENSE LAW for ihe following reason (Sec. 7031.5, eusiness and Prolassions Cotle: Any ciry or county which requires e permit to constmct, alter, improva, demolish, or repeir eny stmcWre, prior lo its issuance, elso requires the epplicant tor such permit to file e signetl statement t�et he or she Is Ilcensed pursuant to the provisions oi ihe Contrectors Licensa Lew (Chepter 9(commencing with Section 7000) of Division 3 ai the Business end Professions Gode) ar thet he or she is exempt therefrom end the �asis for the ellegetl ezemp�ion. Any violatlon of Sectian 7031.5 by any epplicant lor e permic subjects the epplicant to e civll penelry of not more than five hundred dollers ($500).): ❑ I, es owner oi �he property, or my employees wilh wages as their sole compensation, WILL DO THE WORK, entl ihe simcNre Is not intanded or oHered tor sele (Sec. 7044, Business and Professions Code: The Coniractors Licanse Lew dces not appty to en owner of propetly who builds or improves thereon, antl who does such work himsetl or herself or through his or her own employees, provided ihet such improvements ere not Intendetl or oRered for sale. II, however, the building or impmvemenl is sold within one year of completion, ihe owner-builder will have�the burden of proving ihat he or she did not builtl or improve for purpose of sale.). ' ❑ I, es owner af the praperty, em EXLLUSIVELY LONTRACTING WITH LICENSED CONTRACTORS to construct the prolect (Sac. 7044, Business end Profossions ' Code: Tha conirectors License Law does no� apply to an owner of proparty who builds or ImOroves Ihereon, antl who contracts for such project with e contractor(s) license pursuant Io t�e CoNrectors License Laws.). ❑ I em exempt undar sec. Business entl Prolessions Cotle for Ihis reason: Signalure: Date: Owner ID ventied by ddver5 IiCenSB. ❑ Vas ❑ No Orivefs License No. Eapires: Venfication ol Ownership by (type ot tlocument, i.e. - properry lax bill or tleetl): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATON: � I hereby cerlity that no excevation live (5) or more feet in depth into which a person is requiretl lo tlescen0, will be made in connection with work euthorizetl by this pertnit, end that no building swcture, scattolding, falsework, or demolition or dismantling thereoi, will be more than thirty-sia (36) teet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title B, Califomla AOministretNe Cotle). ❑ A5 owner-Duiltler, I will noi employ enyone to tlo work w�ich would require a permit trom Ihe Division of Industrial Safety, es noted above, unless such parson has a pertnit to do suCh work Irom lhe divi5ion. Signature: Date: Divi9ion ot Intlustnal Safery Permit Number. CER7IFICATE OF COMPLIANCE AND AUTHORVATON OF ENTRY: I cetlity untler penelry oi perjury that I have read Ihis applica�ion and slete Ihet the intormatlon given is correct. I agree to wmply with ell slete laws end ciry ordinances relating to building wnstruction, and authodze representatives ot the Ciry ol Costa Mesa to enter upon the ebove-describetl property for inspection purposes. I agree not to occupy or allow occupancy of eny building authorized by Ihis permi� until final inspection. COOE �. INSVECTIONTYPE 1676 1266 200 201 202 Signature Of Legal wner(s) 0�' � i:.A Antl/Or uthorized Applicant ; � Fixed System Finel Fira Prevention Pod Spa Finel Finel Re-Rool Finel BIocWRetaining wall Final Fectory Fire Place 203 Finel Sign 204 Final Demdition o"re It�li COOE 1 INSPECTION TYVE 206 Final Mechanical 208 Final Plumbing 210 Final Eledncal � 212 Finel Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Builtling/Occupancy PAIE II�EL$ (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.�LtCTRICAL PERMIT �� FAIR DRIVE, COSTA MESA. CA 92626 Job Address: Suile No Vicinity: Parcel Nunmber: 2479 MONTRE WY MASTER BATH 43914139 Applicant: TUSTIN, KEITH Address: 10681 ELLIS AVE UNIT G FOUNTAIN VALLEY, CA Owner: WRIGHT. ELIZABETH O TR Phone: (714)968-3555 Zip: 92708 Adtlress PO 90X 15353 Phone: IRVINE, CA Zip: 92623-5353 Contractor: AN701NES INTERNATIONAL TILE & MARBLE Address: 10681 ELLIS AVE ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool / Spa lighting Fixls Recept Outlets Switches Non Res Appl Res Appl Service to 200a Service to 1000a Service over 7000a Molors ta 1hp Molors to 10hp Motors to SOhp Motars to t00hp Motors over 100hp Communication drops Sub panel to 200a UNIT G Phone: (714)968-3555 FOUNTAIN VALLEY. CA Zip: 92708 License: 667375 ISSUED BY: Status: ISSUED Applied: 09/23/2003 Issued: 09/23/2003 SCOPE OF PERMIT INT�RIOR REMODEL FOR AN EXISTING�BATHROOM. MISC PLUMBING AND EIECTRICAL. ELECTRICAL TO INCLUDE: 6 LIGHT FIXTURES, 2 OUTLETS AND 2 SWITCHES. REF: 803-01615. $23.50 50.00 50.00 50.00 50.00 50.00 $s.6o $2.20 52.20 50.00 $0.00 50.00 $0.00 50.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 Quantity FEE SUMMARY Temp Dist System / Lighting Busway/t00ft Standing Section Misc ElectriCal Equipment Transformers up to 1 kva/kw ................up to 10 kva/kw .................up to 50 kva/kw .................up to 100 kva/kw ..................over 100 kva/kw Low Voltage Equipment low Volt Wiring System / Ckt Misc. Conduit Misc. Conductor Circus ( gen or ride) Circus (mech ride or lights) Christmas Tree Sland Fireworks Stand Other Eleclrical Fee Investigation Fee Plan Check Fee Quantiry $0.00 0 $0.00 0 $0.00 0 $0.00 0 30.00 0 $0.00 0 50.00 0 50.00 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 50.00 0 $0.00 $0.00 $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under Califomia statutes and related regulations. (Ord. No. 9248, § 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 abantloned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be consitleretl legal, such work must comply with all applicable codes, and all requlred Inepectlons and final approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration ot this permit. FOH (NSPECTIONS CALL: (i14) 7545626 2aa6se l6/00l WORKERS' COMPENSATION DECLARATION: � � I hereby eMirtn untler penalry ot perjury one ot the tollowing declarations: . ❑ I have antl will malntain e certificate ot consent to self-Insure for workers' compensetion, as provitletl for by section 3700 of the Labor Code, lor 1ha pedormence of the ' work for whiCh Ihis pertnit is iuued. ❑ I heve end will maintain workers' compensation insurence, es requiretl by section 3700 of the Lebor Code, for Ihe pedortnance of the work for which this pertnil is issuea. My workers' compensation InSurance carrler end policy number are: Carrier. Policy Numher. (Th/s secfion neetl not 6e comp/eted il fhe permit is velued at one hundred dWlars (5100) or less.) ❑ I certity that in the performance of t�e work for which t�is pertnit is issuetl, I shall not employ any person in eny manner so s to �arqme subject lo Ihe workere' � compensatlon laws ot Calitornia, and agrae �hel If I should become sub�ect to Ihe workers' wmpensatlon pmNsions ot Sec ion 3700 Ihe Labor Code, I shell Iorthwith comply wit� t�ese pro��ion�s.�(� . %� '� Applicant Signeture: �L^Yl—� 7L� Dale: �� / �J WARNINQ: FAILURE TO SECURE WORKERS' CqMPENSATION COVERAGE IS UNL4WFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENA�TIES AND CIVIL FINES UP TO ONE HUNDRED TFIOUSAND DOLURE (5100,000). IN ADDITION TO THE COST OF COMPENSATION, �AMAGES AS PfiOVIDED FOR IN SECTION 3�O60F iHE LABOR CODE, INTEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby attirtn that I am licensetl under provisions af Chapter 9(commencing with Sectlon 7000) of Divisian 3 of the Busineu end Professions Code, entl my license is in lull force end ettect. Lic. a Clau tl ContractorsSignemre: � � � Oate: ,� � CONSTRUCTION LENDING AGENCV: ❑ I hereby aHirm ihat there is a consiruction lending egency tor the pedormanca ol Ihe work for w�ich Ihis permit is issued. (Sec. 3097, Civil Code). Lender's Neme: Lender's Adtlress: SigneWre: OWNEH-BUILDER DECLARATIONS: Dete: I hereby etfirtn thet under penelry of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE lAW for Ihe following reason (Sec. 7031.5, Business entl Professions Cotle: Any ciy or counry which requires e Dermil to consWct, alter, improve, demolish, or repair any strucNre, prior to its issuance, also requires the applicant for such pertnit to tile e signetl statement that he or she is Iicensed pursuent to the provisions of lhe Conirectors License Law (C�apter 9(wmmencing wlih Seclion 7000) ot DlNsion 3 ot t�e Business end Professions Code) or that he ar she is exempt theretmm and the basis for t�e alleged exemption. Any violatlan of Seciion 7031.5 6y any applicant br e pertnit sublects lhe applicent to e civil penalry of not more then five hundred dollars ($500).): ❑ I, es owner of the property, or my employees wlih wages as Iheir sola compensetion, WILL DO THE WORK, entl the structure Is not Inlendetl or aHeretl for sele (Sec. 7044, Busineu and Professions Code: The Contractors License Law does not apply to an owner oi propeRy who builtls or im0�oves Ihereon, and who tloes such work hlmself or herself or ihrough his or her own em0�oyees, pwvided Ihat such improvemems ere not intendetl or oHeretl lor sale. tl, howaver, Ihe builtling or improvement Is soltl within one year of completion, the owner�builder will have�ihe burden ol proving Ihet he or she ditl not buila or improve for purpose of sale.). � ❑ I, es owner of the property, em EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Cotle: The contrectors License Ww does not epply to an owner of propeny who builtls or Improves �hereon, end who contraas br such pmjeci wiN a conirector(s) liCense pursuent �o �he Con�ractors licen5e Lews.). ❑ I am axempt under sec. Business and Professions Cotle for this reason: Signeture: Date: Owner ID venfieA by drivefs license. ❑ Ves ❑ No DnvefS LicenSe No. Expites: Venfication of Ownership by (type ot tlocument, i.e. - property taz bill or tleetl�: DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I �ereby cariify that no exwvation tive (5) or more feet in dept� into which a person is required to descend, will be made in connection with work euthorize0 by Ihis permit, and that no building siructura, scaHolding, lelsework, or demolition or dismantling Ihereof, will be more �han ihirty-six (38) leet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Title B, Calitornia Administrative Code). ❑ As owner-builder, I will not employ enyone to do work which would require a pertnil Irom ihe Division ol Intlustrial Selery, es notetl ebove, unless such persan has e permit to do such work from lhe divisian. Signeture: Dete: Division of Indusirial Safery Permit Number. CERTIFlCATE OF COMPLIANCE AND AIfTMORVA710N OF ENfAV: I certify under penalry ot perjury that I have read ihis epplication antl state that the intortnetion given is correct. I agree to comply with all sWte lews end ciry ordinances relating to building conswction, and au�horize representatives of Ihe CI1y of Costa Mesa to enter upon t�e above-descnbed praperty for insDection purposes. I agree not ta accupy or allow occu0ency ot any Duilding authonzed by ihis permit until linal inspection. Sign Nre O Legal Owner(s)� �/ Date � 7'�-'-��c � / .� � � And/Or Authorizad ADPlicant ` Date COpE 1, INSPECTIONTYPE � � PAIE INTRIALS 1616 Fixed Sys(em Final Fire Preven�ion � � 7266 200 201 202 203 204 Pool Spa Final Final Re-Roof Final Block/Retaining Well Final Pactory Fire Place Final Sign Final Demolitian COOEI INSPECTIONTYPE 206 Final Mechenical 20B Final Plumbing 210 Final Eleclncal 212 Final Fire Prevention 220 Pinal Planning Approval 222 250 Final Site Final BuildingiOccupency veg u�i -;,, 31-03 � (714) 754-5273 • Fax (714) 754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 JobAddress: 2479 MONTRE WY Suite No Vicinity: Parcel Number: 43914139 Applicant COOTER, LYLE Address: 12922 HARBOR BL GARDEN GROVE, CA /, ownec WRIGHT; ELIZABETH.O Address: � ,13 VIA PALMA, LAGUNA NIGUEL, CA MECHANICAL PERMIT ISSUED BY: Phone: (714) 530-7320 Zip: 92840 Phone: 2ip: 92677 Contractor: , JIM WAYNE EICHAMN EMPIRE PLUMBING HEATING 8 A/C ' Address: ' 12922 HARBOR BL - GARDEN GROVE, CA Arch / Eng : Address: �.; ` FAU CHANGEOUT � � Quantity ISSUE FEE ` - � � $23.50 Inst FAU <700 k BTU-' � $74.80 7 Inst FAU >700 k�BTU $0.00 0 Repair / Alt �Cooling/Heat $0.00 0 Inst I Rep. Recess Wall Htr �$0.00 �- • 0 � Refrig Sys <100 k�BTU � � $0.00 0 Refig Sys >100 k BTU ' i� $0.00 � 0 . Gas Piping � 1� �� ; $Q00 �0 \, � Factory Fireplace �, � � " ': .$0.00 � 0 ; -c� � / Hood w/Mech Exhaust �` � � ' $0.00 .0 VAV Box � - � - $0.00 .0 Vent Fan / Single Duct �\ -$0.00" � 0" Appliance �\ � $0.00 -0 Fire Dampers �, $0.00 0 - Smoke Dampers $0:00 - 0 Inst or Relowte Appl Vent 50.00 - 0 Air Handlers < t0000cfm $0.00 0 - AirHandlers> t0000cfm $0.00 0 Floor Furnace $0.00 0 Floor or Suspend Heater $0.00 0 Phone: (714)530-7320 Zip: 92840 License: 652877 Phone: Zip: License: SCOPE OF PERMIT FEE SUMMARY Status: ISSUED Applied: O7/30/2001 Issued: 01/30/2001 ;, � � , � ' � : -Quantiry i � Repair / Alt Absorbtion Unit �%' � ' $0.00 � 0 •�/ Repair/AltRefrigerationUnit '- ' ��E0.00� �0 i Ventillation System - - $0.00 0 ' Evaporative Cooler " , $0.00 �! 0" Comriierciat Incinerato� - � �i �' $0.00; 0 Domestic Incineiator � -;'/ $0.00 0 Compressors / Absorption Systems � . , � / Upto3hp/100kBTU��" .'% �/� i$0.00 0 3 To 75 hp / 500 k BTU� --�`� � i� %$0.00 0 15 To�30 hp l 1,000 k BTU . �� ' ;.� %� $0.00 0 30 To 50 hp /1,750 k BTU�' ' �, -� � $0.00 0 Over 50 hp / Over 1,750 BTU ',,, - $0.00 0 Boilers � � � "i% �-� Up to 3 hp �, ' � $0.00 0 3 To 15 hp , - $0.00 0 15to30hp 30 to 50 hp Over 50 hp Other Mechanical Fee Investigation Fee Plan Check Fee Reinspection Fee TOTAL CALCULATED FEES COMMENTS / SPECIAL CONDITIONS $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 538.30 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 72-27-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred inspectlans and Iinal approval must be obtained. Failure to obtain inspections and final approval will result in the expiration.of this permit. � FOR INSPECTIONS CALL: (714) 7545626 2aaG48 (fiN0) WORKERS' COMPENSATION DECLAHATION: � I hereby ettirm under penalry oi perjury one ot the tollowing tleclarations: ❑ I have end will mainteln e certificate of wnsent to self-Insure lar workers' compensation, es provided for by section 3700 of the Lebor Code, tor ihe peAormance af the work tor which Ihis permit iS issued. ijd� I heve and will meintain worKers' compensation insurance, as required by sectlon 3700 of Ihe Labor Code, for ihe DeAormance of Iha work for which Ihis permit is issUetl. —�My workers' comp�elnsetlon Insurance carrier antl policy number are: y2 �Cerrler: /� (�,(JA�.�% / ^�:7 policyNumher. .� � 'l � ,(This section neetl not 6e cromple�ed i! fhe permit is velued at ane huntlretl tlollers ($100) ar less.) ❑ I certify thet in the peAortna��e of ihe work tor w�ich this permit is issued, I shall not employ eny person in any manner so as to become subject lo the workere' campensatlon laws of CellfOmia, end agraa thai il I shoul0 become sub�ect to the workere' compensation provisions of Section 3700 oi the Lebor Cotle, I shall fo�hwith comply wit� these pravisions. ' / AppllcaniSignetuie: � Data � � � Z UD � ' WNRNINO: FAILURE TO SECURE WO �' PENSATION COVEMGE IS UNUWFUL M!D SMAl1 SUBJECT AN EMPLOYER TO CRIMINPL PENALTIES AND GVIL FlNES UP TOONE NUNDRED T}IOUSAND DOILARE R��.�). IN ADD�TIIXJ TO THE COST OF COMPENSATION, DAAUGES AS PfiOVIDED FOR IN SECTION 3]O60F THE LABOR COpE, IMEREST, AND ATTORNEI"S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirtn Ihat I em licensed unde rov'sions of Chapter commencing wilh Section 7000) of Division 3 of�the�Busiqess end Proteuions Code, antl my license is in full torce antl etteci. LIc. a��Z, /�i/ G G� G 3 L Class tl. Contrador's Signe� tu e.? � �Date:-" �% —'io 2u� i �� ' CONSTRUCTION LENDING AGENCV: ❑ I hereby eflirm that there is a construction lending agency for the peAormance ol ihe work br which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: SigneWre: _ OWNER•BUILDER DECLARA710NS: Lender's Address: Oate: I herehy ettirtn Ihet under penelry o� perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the lollowing reason (Sec. 7031.5, Business end Professions Code: Any ciry or counry which r9quires a pertnit m consWct, alter, Improva, tlemolish, or repair eny structure, prior to its issuance, also requires the eppliwnt for such pertnit to file e signetl stetement thet he or she Is Iicensetl pursuent to Ihe provisions oi �he Contrectors License Law (Chepter 9(commencing wlth Section 7000) of Division 3 of the Business end Prolessions Code) or thet he or she is exempt iherelrom and ihe basis lor Ihe elleged exemption. Any violation of Section 7031.5 by eny applicant for a permit sub�ecis Ihe epplicent to a civil penalty of not more than five hundred tlollars ($500).): ❑ I, es owner of ihe property, o� my employees with wages as Iheir sole compensation, WILL DO 7HE WORK, antl ihe siruc[ure is noi Intendetl or oNered tor sale (Sec. 70a4, Business and ProfesS�ons COOe: The Contractors License Law Ooes not apply to an owner ot propeny who builds or improves ihereon, entl who does such work himself or herselt or througn his or her own employees, provided that such improvements are not intended or oHered tor sale. If, however, the builtling or improvement is sold within one year at completion, the owner-builder will have the 6urtlen ol proving Ihat he or she did not build or improve for purpose ol sale.). ❑ I, e5 owner of the property, em EXCLUSIVELY CONTRACTING WITM LICENSED CONTRACTORS lo construct the project (Sec. 7044, Business Bnd Proles5ions Cotle: 7ne con�waors Licensa Lew tloes not apply to an owner ot pmpeny who bullds or Improves thereon, and w�o cantracts for such projea wlih a comractor(s) license pursuant b tha Con�ractors License Wws.). ❑ I em exempt under sec. Business end Professions Code for this reason: Signature: Date: Owner ID verified by tlnver's licensa. ❑ Yes ❑ No Orivefs License No. Expires: Verification of Ownership by Qype a� document, i.e. - propeny tax hill or tleed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hareby certih/ t�ei no exca�ation five (5) or more feat in depth into which e person is required to descend, will be made in connec�ion with work authorized by thi5 permit, end thet no building sWcture, scaffolding, felsework, or demolition or dismantling thereof, will be more than thiny-six (36) teet high. (Chep. 32, Grp 2, An 2, Sec. 345, Ttle B, Celitomia Adminisiretive Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permlt irom ihe Division of Industrial Safery, es noted e6ove, unless such person has e permit to do such work irom the division. Signature: Date: Division of Industrial Safety Pertni� Numbec CERTIFICATE OF COMPLIANCE AND AIITHORIZA710N.OF ENTTiY: I certity under penalry of perjury that I have read this epplication and state that the infoima�ion given is correct. I egree to comply wl�h all s�ate lews antl city ortlinances relating to bulltling constmction, and euthorize represen�atives of the City of Coste Mesa to enter upon the ebove�describetl property tor inspA�lion purposes. I egrea not to occupy or ellow occupancy ot any building euttwrixed by lfiis permit un4il linel inspection. COUE 1, INSPECTOxTVPE 1616 Fixetl System Final Fire P�evention 1266 Pool Spa Finel 200 Finel Re-Roof 201 FInaI BIocWRetaining Well 202 203 204 Final Fectory Fira Place Finel Slgn Final Demolition � �� u� 7� / __ - , � � ; Date--- . PdIE' ItIIII10LB QODE� INSiELTIONTYPE 206 Final Mechanical 208 Final Plumbing 210 Final Electrical 212 Final Fire Prevention 220 Final Planning Appro�al 222 Final Site 250 FinalBuiltling/Occupancy i . �I ' � N.S1J� � �� ..� �� Applicant to fill in all sDaces excepl t�ose within �eavy borEer lines antl si9n all approDriate Eeclarations. CITY OF COSTA MESA CO S UCT ON PERM T PERMIT,MO. TRACT NO. LOT NO. UNIT NO. ., Project Address Applicant's Mailin Address � 1 � i �/ / � —7 Owner's Name �(��_;�Q' Phon Address — Arch/Eng., Licenu No.. , Address Con[ractor's Nam one�� Address Imailing) Ciry License No. LICENSED CONTftHCTOR DECLARA ION I hereby affirm tM1at I am lice��tl�der p�s oi Charter 9 Scommencing Wlih SECSI00 �OQ�) Of ��VI510 i i f I1510E d0(� PIOfC5510lIS GOtlC� dOC my �icense is in iw� tp�ce awpkt �GAM'l Datea ��K T—n n 5�g WORKERS'COMPENSAT ��I hereby atfirm that I have of Workers' Compensatioi 3800, la��.) ��_�_. copy i5 he�eby fumis pypy ig}yMy1 wiN the RATIS�N / or c6(sent to self-insure or a certiticate or a certifietl copy thereof SecHon i. � �mpany EXEMPTION FROM W00.KER5' C6MPENSATION DECLARAYION (This sec[ion neetl not be completatl if the permit i5 for one huntl�etl ($300) or less). 1 certify Ihat in the perfo�mance of the work for which this pe�m�t i5 issuetl, 1 shall not em0loy any person in any manner so as to become subject to the Workers' Compensalion Laws ot Califomia. Oate Signature NOTICE: If, atter making this tleclaratlon, you shoultl become subject to the Workers' COmpensation provisions of the Labor Cotle, you must torthwith mmply with SucM1 provisions or [his permit shall be tleemetl revoketl. CONSTRUCTION LENpING AGENCV 1 M1ereby attirm that Ihere is a mnstruction lentling agency tor the per/ormance of tM1e work tor which thls permit is issuetl (Sec[ion 3097 Civ. C.) Lentler's' Name i Lentler's Atltlress OWNER BUILDEH �ECLARATION I hereby affirm that I am ezempt trom the'Cont�actor'S License Law for the following reason (Section 7031.5 Business antl Protessional COCe: Any city or munty wbich requires a permit to const�uct, alt0r, imp�ove, tlemolizb o� repair any struGture, prio� to its issuance, also requires [he appli[ant tor suctt permit to file a siqnetl slatement that tte/she is licensetl pur5uant to [he p�ovizions of . tne Contrac[or's License Law (Chapter 9(commencinq with Saction 7000) of Oivision 3 of the Business antl Prolessions Cotle) or that he/she is exempt �erefrom antl the Dasis for the allegetl exemption. Any violation of Section )31.5 by any applican[ fo� a permit subjects the applicant to a civil ,enalty of not more than five buntlretl tlollars ($500�. ❑ I, as owner oi the property �or my emPloyees with wages as their Sole compensation, will tlo the work, antl the structure is not intentled or offeretl for sale ($ection ]044, Business anG Professional Cotle: The Contractor'S License Law aoes not apply to an owner ot a properTy wno builtls or improves thereon, antl who tloes such work himselt/herself or tM1rough his or he� own em0loyee5, provitletl that such Improvements are not intentletl o� offeretl for sale. If, noweveq the builtling or improvement is soltl within one year of mm- pletion, Ihe owner will have the burtlen of proving he/she ditl not builtl o� im- p�Ove fo� ttte purpose ot sale). ❑ I, as owner Of the Oroperty, am ex[lusivery con[racting with licensetl con- t�actors to consttuct the O�ojecl (Section 7044, Business antl Professions Cotle: The Contractor'S LicenSe Law does not apply to an owner of property who builtls or improves thereon, antl who cont�act5 for such projects witb a con- tractor(51 I¢ense pursuant to the Contractor's License Law). I am aware [hat proof of thei� Worker's Compensation insurance shoultl be pwvitletl to me. ❑ I am exempt untler Section B. & P. C. for this reason Date 1 hereby ce if infor tion arre antl sta e s relat sentativ f [his : inspectio ur Signatur Drivers' icnseor! CMF 0065- 6, rev. 10/B Owner _ LL¢ reatl if115 above TYPE OFCONSTRUCTION LJ NEW IJ ADD U ALTERATION IJ REPAIR '0 CONVERSION ❑ DEMOLISH ❑ OTHER ;DESCRIPTION OF WORK/USE OF BLDG. , TVPE OF PERMIT LI GRAOI FOVNDATION LJ STRUCTURAL `O TENANT ❑ ELECTRICAL PLVMBING ❑ MECHANICAL '❑ OTHER ' � ' . � PROJECT DESCRIPTION 5a. FT. occVPaNCV— 'CONSTRUCTION TVPE VAWATION $ +ZONE � GRADINGGU.VDS. ACRES— Remarks: /� n/1AA A. n. 1/.� ._ /V/] Pfl Preventer Irrigation Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Intercepmrs Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee � $15 Duct - Under Ground Duct - Strucmral Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Bit. ICBO # Heating System & Ducting ❑0.100,000 BTU 0700,000 Reinspec[ion Fee White - Builtling; Canary - Applicant; Pink � Accounting; Goltlenrotl - Assesso� $15 $hOwerS Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auio-Wash Laundrv Travs Issua Fee HooA or Typel ❑ Canopy Type II ❑ Refrigeration System ❑0-1W,OOOBTU ❑100,000 System Repair/Alteration Fite Dampers Registers luue Fee FEES A.P. # S Main Buiiding: E T Front ARear C Fight K Left S Ping. Ref. # Planning Notes: Automatic Washer Consiruction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator �0-5 KW �5-15 . Zone Accessory Buildin9: Z I �n p � n. N �"^- _ I � N G R Parking Req./Provided E � ,'�1� nn � ELECTRICAL Trensformer ❑ 15-50 KW ❑ SO+KW Meter ❑up to 100 amps Meter ❑over100amps Sub Panel � � Momrs � 0-1 HP O1 %- 8 InaSolar �9-15 HP �76-15+ Microwave Pole Light Range Standing Sections Trash Compactor FEES $ 3 Reinspection Fee $15 Issue Fee $ 3 FEES DEVELOPMENTSERVICESRE�UIREMENTS: � � Zoning Approved By Data Building Approved By Date Application Issued By Dat $ 3 SUMMARV OF FEES BUILDING PERMIT $ SMIP $ � PLAN CHECK $ PERMIT PLUMBING $ � ISSUANCE $ PLAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL $ GRADING $ PLANCHECK 50% $ MICROFILM $ MECHANICAL S TOTAL FEE $ �� PLAN CHECK 25% $ ' /I�, CONSTRUCTION AND PLANNING ` . POOL & SPA APPROVALS Permit# Date �Inspector qppROVALS Permit# Date Inspector 1.�Temporary Electrical Service or Pole 52. Pool & Equipmen[ Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement � 3. Electrical Conduit U[ility-Undrgrnd. 54. Forms • 4. Electrical Conduit�Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test • 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit�Undrgrnd. 8. Foundation 59. Gas Pipe, � Undrgrnd., Test 9. Water Pipe-Undrgrnd. . 60. Backwash Lines, P-Trap, � Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains , 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical�Conduit '66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign :` 68. APPROVED FOR PLASTERING 78. Rough Electrical-T Bar Ceiling `-'D 69. POOUSPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro ' 22. Ducts, Ventilating 71. Product Piping OGas ❑Oil 23. Gas Pipe-Rough & Test 72. Underground Flush � 24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing 74. Overhead HYdro � ,�� 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical . 27. Frame and Flashing `_, 76. Dry Standpipe � �. i 28. Lathing & Siding 77. FIXED SYSTEM FINAL " 29. Insulation 78. FIRE PREV. FINAL �% 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION � 32. Electrical Power Meter-Final S0. FOOD CERTIFICATE ISSUED � !0•3-�� L�7'�2� c..E� , 33. Final Electric � Notes: _. 34. Final Heating & Air Conditioning 2�%-�je) �J2mlt- �.{�'I l�n L�$ P�tiL_ � Q 3 35. Final Gas Pipe-Test V�L, L, ��. 36. ,Hood or Canopy `' �`� ' �i � 37..�Final Factory Fireplace r .. ' ' , ,•�i . �i � 38:• Final Plumbing ';" _ • �,� � }�� -� � ` !. � 39. �Wa[er Service-Final � � ' 1 � . � �'' v 40. Gas Service-Final �� . ' ' ' . ' 41 �Solar pomestic-Final '�� : �-f •- " ' ''" � ! .. � ,42: Backflow Preventer ' -�� ' � ' _ � 43. Backflow Irrigation � • '{ ' , , �� ` ` - 44. Landscape Irripation System .% •� .. � "� t.� t 45. Sound Attenuation �,. � ;" - . . ✓ 46. Handicap Regulations� �„ � . ' � " '' '- � 47. FINALSTRUCTURE&BUILDING • � :• 7 ' T� -/ 48. Special Requirements Completed - ^ ' '' ' ._ �' 49. Electric Release to Edison � n7 .. � - i7 i 50. Gas� Release to Southern California Gas Co . � % 51. CERTIFICATE OF OCCUPANCY ' ' No. Date _ � �� , �� . � ". ��` .. .. OWNtH �JOB ADDR GENERAL '� AP N6j3C I!"�,:;:,'.CTI( s i`:•rct.: GAS WATEft i''1'1'GG�:HALll ESS 2 79 Mo Y. ROUGM PLUMBING PROP. $WR. LINE � NOUSE CON. � SPRINKLING SYSTEM MISCELLANEOUS ROUGH MEATING RN� qlq CONDITIONING TEMPORARV SEPVIC� OR POLE UNOERGROUN� � POWER � ROUGH WIFING TRENCHES FOFMS STEEL RE FLOOR SVSTEM BOND BERM � STEEL REINFORCE [ SHEATHING FFAME AND FLRSHIN� � LATHING — IN � OUT n PLhSTER.BROWN COqT STRUCTURAI,FINAL MF S, VENT.. RECp�G. �ND �.C., FI PL� ...ING, FINAL AND GAS TEST n TRACT UAIt SUBCONTRACTOR lU-1V- i' Y ;�g 8,� -.�.T,o-��=s°oo 4,�� A,:w.A�.Se COSTA MESA BUILDING-SAFETY DEPARTMENT P O ROX 1200 COSTA MESA_ CALIFORNIA 92626 Z . aU Z ZQ ON am J � J N Q "� ! � � UN 2a � aW wz J Q m Z J � W W � ZH W � N � �O F Z Q U J Q F" N 2 O F- U � � r N Z APPLICATION FOR BUILDING PERMIT For Applicant to fill in Completely RECE D DATE RECEIVEO D EI ADDRESS ��` ` M ��r�' J �{ �� OWNER %—I /Z-�L`l��i-.A ' �3d"OC/_(J PEFMITNO. A.P. NO. MAIL BUILDING q n � ADDRE55 � /aDDRESS �/ dN�n � CITV � S/ ✓ I MESA NO�. TRACT ; y�J LOT 3/ BLOCK CANSiRUCTION ' W p' A P LENDER BRANCH � � OWNER ADDRE55 1� VALUE AFCHITECT TEL. S IO �!� $ � OR ENGINEER N FIRE' ADORESS ZONE TVPE GFiOUP CONTPACTOR pu�Ne�. �y _ APPFOVED 0� D� )3U /LpE,�� 8V DATE ADDFESS TEL. ZONE NO.OF USE OF NEW �/J'T�O CITV NO. R� P�� BUILDING .� STATE CITY �'ARDSAPPROVED VAPDSAPGROVED LIC. NO. LIC. NO. MAIN BUILDING ACCESSORV BUILDING SIZE NO.OF BLOGS. (FROM C/L STREET) OF LOT NOW ON LOT ROM FT. /�Cy(�F VSE OF EXISiING BLDG. �S � T. �"�5'ff� SIZE OF /i{ � V�!/ � NO. OF NEW BLOG. �r �� T ROOMS STORIES L SIDE FT. �l FT. EXTERIOR WALL FOOF COVERING COVERING REAF FT. D FT. USE OF BV IIDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & MAIN BLDGS. ACCE�. BLOGS. (- � T/ O �7 J I V�7� PrD VAR. #` R4TE C.U.P. # APPiiOVED APPROVED/.t P � / ' Ip_7� LV v �� I heraby acknowledBe that I hava reatl this epplicaHon antl state Mat tha ebove intormetion is correct entl aprea to comply with oll lews reBulating builtlinp construciion, enA I s�all not amploy r any person In violetian of Me workmen's compansation laws of tha Stata of California. m I hereby cartify ihet I am properly licansatl as a contractor untler SQ. FT. r� O tt+e State of Californle Businesa and Profassions Coda, Dlvlsicn 3, THE AMOVNT SHOWN UNDER VALUATION IS FOH � Cnapter 9, entl thet vuc� lieensez are In full forca antl effect, or I THE PURPO6E OF ESTABLISHING A PERMR FEE ONLV: Q am exempt from the prov(sions of the State of CalHornia euziness VALUATION � entl Profassions Codo, Dlvision 3, Chepter 9. � N ' / OQ PEFMIT FEE $ ] SIB�emra of // i. � � , / / m Permittee ��'� t�^��7N/ $ �DD PLAN CHECK $ E � o` Au[horizad Ageni � LL TOTAL FEE $ DOYLE & SHIELDS Development Co.,Inc. DATE 6-3-63 JOB ADDRESS �4�(�J GliNERAL CONTRACTOR AP No. I ECTIONS 9c,� fi Form SV4--6M-3-63—S-B P � JP ldul TYPE SUBCONTRACTOR ('� -~ � 19628 ✓ COSTA MESA BUILDING-SAFEfY DEPARTMENT P.O. BOX 9f] GOSTA MEBA, CALIFORNIA For qppliconf to Fill In Completaly TYPE OR PRINT BUILDIN6 t ` t�"l(1 ADDRE55 Y� / "� COSTA MESA, CALIFORNIA ,G. G_ v �f/ ,7` LIG.TNO./J / �� v �-- ry� sae ,33' � .T3. �� OF LOT USE OF EXISTING BLqp, BETBACK LIN! KqOM � CT e-wuiwa oc erwvm. lJ `� DESCRIPTION OF WORK r BLDOB. � BUILDINQy� � ,-v NO.OP � SIZE tJ-��f.J. ROOMS ST RIE9� EXTERIOR WAL - I ROOF � � � USE ORINGI`bIN6��/, NCD WORK TO B�'P[[g RF R�µ/��/� Q' QPN<<°- /7 �U4 b�Q/' e .P3 - Cj 1 MEREBY ACKryOWL8D0H TXAT � ryAVB HBAD THI9 /�pPLICATION ANO BTATE TryqT TXH ABOVB IH CORpECT ANC AOREB TO COM- GLY WITH ALL CITY ORDINANCHB AND BT�Te LAWB pQOYLATINO Bl11LO1NGCONSTRUCTION. � � � � � _ � � AUTHORIZEDAGENT FIRE FE REC�IVED JUN s 1963'- 1NANCE D�pr. ��u@F,rQ69ifiq9►E�'^R BUILDING For Offico Use Only 11[C[I'T NO. I c er onTc necerve o� 9 r sc_� `� NO. OF f � PUN I .�o%� 3 YARDSAPPROVED MAIN BUIL�ING DISTANCE 9ET MAIN BLOG9. VAR.it _ /S.T� so. � THe AMOUNT BHm PURPO88 OF 8(] VALUATION �� y, � S T SHALL B8 LESH THAN YARDSAPPROVED ACCESSORY BUILDING 6ET. MAIN ACCESS. B DATE % !j� � � " m UNDHH VALUATION �B FOR THE F 19MIN0 A PEflMIT F8H ONLY. � f 6y N PERMIT FEE $ � m PLAN CHECK S �� ¢ �`/ w� TOTAL FEE $ O / �