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Home My WebLink About3206 IDAHO PL - Building Permitsr'-� � �. e August 6, 2010 CITY OF COSTA NdESA P.O. BOX t2D0 • 77 FAIR DRIVE � CALIFORNIA 92628-1200 DEVELOPMENTSERVICES DEPARTMENT BUILDING DIVISION COURTESY NOTICE OF PERMIT EXPIRATION Kathleen Ann Crogan Trust 3206 Idaho Ptace Costa Mesa. CA 92626-2297 PROJECT ADDRESS: (�33206 Idaho:Pl.,—'Costa Me'sa,—CA'� Our records indicate that the permits on the attached list never received an approved final inspection. As these permits have gone more than 180 days since issuance or the last inspection (1997 Uniform Building Code, Section 106.4.4'Expiration), they will expire in 10 days without a final inspection. Additional fees will be required to finalize expired permits. Work completed without an approved final inspection may not meet the building code. Requestina an inspection—If you need to request an inspection, please call our Inspection Request Line at 714-754-5626. Requestinq an extension—If you wish to request an extension, requests must be made in writing addressed to Bill Nunes, Senior Plumbing & Mechanical Inspector, at the above address, detailing circumstances and listing an estimated date of completion. If you do not have an approved final inspection, or send us a copy of the job card showing that a final inspection has already been approved, your permits will expire on August 18, 2010. If you have any questions, please contact the Building Division at 714-754-4871, between 8:00 a.m. and 4:30 p.m., and a staff inember will assist you. The accuracy of records affecting your property is our goal and we appreciate your working with us to resolve this matter. Sincerely, IJC�✓� Barbara J. wart Office Specialist II Builtlin[� Division (714) 75a-5273 • Code Enforcemenl (714) 75n.5623 • Planning Division p14) 754-5245 FAX Qt4) 754-a856 � TOD (774) 75a-52aa � wwa.ci.costa-mesa.ca.us 3206 Idaho Place Permit # Work Type Contractor P06-00226 Water Neater Nock Plumbing M07-00527 BUT Furnace Allied Plumbing, Heating & Air Conditioner E09-00223 Legalize Electrical Work Owner-Builder E09-00207 Forced Air Unit & AC Allied Plumbing, Heating & Air Conditioner M09-00067 Forced Air Unit & AC Allied Plumbing, Heating & Air Conditioner 1 � CITY OF COSTA MESA �� 5� "'FS, BIIILDING DIV/SION >�� 77 FAIR DRIVE. COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • vnvw.ci.costa-mesa.ca.us " � FOR INSPECTIONS CALL: (714) 754-5626 '�`'^r,�m•�'' PERMIT NUMBER: E09-00207 PERMIT TYPE ELEC y'""`�� APN: 13908402 DATE �� a�� JOB ADDRESS: 3206 IDAHO PL CM. Vicinity: . STATUS: DATE ISSUED: ISSUED BY: Suite/Unit: ISSUED 0 811 012 0 0 9 BJK SCOPE OF WORK: CHANGE-OUT OF AN EXISTING FAU AND AN A/C AT A SFD. ELEC: 1 RES APPL (JUNCTION BOX) OWNER: CROGAN,KATHLEENANNTR PHONE: APPLICANT: YE(YULONIS, LAURA PHONE: 909-213•1640 Address: 3206 IDAHO PL Unit: Ciry/State/Zip: COSTA MESA, CA Address: Unit: City/Slate/zZip: CONTRACTOR: ALLIED PLUMBING - HEATING - AIR CONDITIONING Address: 422 JENKS ClUnit: PHONE: 714-998�300 City/State: CORONA, CA ZipCode: 92880 ELECTRICAL PERMIT FEES Electrical Plan Check Fee: $0.00 Electrical Permit Fee: $2825 Reinspection Fee $0.00 TOTAL FEES $28.25 License No. 610780 CELL: NOTICE: The work aulhorized by this permit shall wmply wilh all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-g2) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure lo obtain inspections and final approval will resWt in the expiralion of this pertnit. OC pEt, INSPECTIONTYPE DAIE IN1111RL5 C00 C INSPECTONTYPE Or1TF� INi111AL5 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Poo� Spa Final 208 Final Piumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Appmval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy � WORKERS' COMPENSATION DECLARATION: I hereby aNrm untler penalry of perjury one o/ the following declara�ions: ❑ I have antl will maintain a cenificate ot consent to sel4lnsure for vrorkers' compensation, as providetl for by section 3700 of Ihe Labor Code, tor the peAormance o( Ihe work for which Ihis permi[ is issued. �-� �'� I have and will maintain wnrkers' compensation insurdnce, as required by secCqn 3700 of the Labor Code, for the peAortnance of the wurk tor v,fiich this pertnit is issued. My workers' compensation Insurance carrier and policy number are: �` � '.C'a`rrier, b � (missecronneedmtbew^mpetedd epemrtar�-a-w��ecd�a�menunaiedd'c1aa•rs(St00Jaiess) Policy Number. �.�\ -,�(�� 1 I.JD �D�] � i']l O ❑ I certify that in Ihe peAortnance of the work for vfiich this permit is issued, I shall not employ any person in any manner so as to become subjecl to the workers' compensation laws of Cali(ornia, antl agree that if I should become subject to the workers' compensation pmvisions of Seclion 3700 0( th Labor Code, I shall lorthwith comply vnth these propvisions. Q � • Cl O- �O� � � Apphcanfs SigwWre Oa�e WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLL4RS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aKrm �hat I am licensed under provisions o( Chapter 9(commencing with Section 7000) of Division 3 of the Business antl Pmfessions Code, and my licens is in /ull /ocrc��e �and eRect. r^^ Lic:�._, `�`��a" Class#��..d'V . V �� Contraclor'S Signalure �ale� � � CONSTRUCTION LENDING AGENCY: ❑ I hereby aKrm that there is a construcfpn lending agency tor the peAortnance of the nurk fa wfiich this pertnit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Da�e OW NER-BUILDER DECLARATIONS: I hereby aHirm that under penally of perjury that 1 am E%EMPT FROM THE CONTRACTORS LICENSE LAW for the foilowing reason (Sec. 7031.5, Business and Professions Code: Any ciry or counry which requires a permit to conStNct, alter, improve, demolish, or repair any sWCNre, prior to its issuance, also requires the applicant for such permit to file a signed statement thal he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9(commencing with Section 7000) o( Division 3 of the Business and Professions Code) or thal he or she is exempt therefrom antl Ihe basis for the allegetl exemption. Any violation of Section 7031.5 by any applicant tor a permit subjects the applicant to a civil penalty of not more than fve hundred dollars ($500).): ❑ I, as owner ol the property, or my employees with wages as their sole compensalion, WILL DO THE WORK, and the sWclure is not intendetl or offered for sale (Sec. 7044, Business antl Professions Code: 7he Contracrors License Law does not apply to an ovmer of property who builtls or improves thereon, and who does such vrork himself or herself or Nrough his or her ovm employees, provided that such improvements are not intended or offered for sale. If, however, the builtling or improvement is sold within one year of completion, the ovmer-builder vnll have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am E%CLUSIVELY CON7RACTING WITH LICENSED CONTRACTORS to construct the pmjec� (Sec. 7044. Business and Pmfessbns CoOe: The wntractors License law dces not apply to an owner of pmperty who builds or improves thereon, and who cont2cts for such project with a contnclor(s) license pursuant ro the Contractors License Lavrs.). ❑ I am exempt under sec. Business and Professions Code tor Ihis reason: 305��46�3/0]) � ' , Owner ID verifietl by driver's license. ❑ Yes ❑ No Driver's License No. Expires: Verifcation ot Ownership by (rype of documenC i.e. - property tax bill or tleetl): DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION: ❑ I hereby certi(y thal no excavation five (5) or more feet in tlepth into which a person is required �o descend, will 6e matle in connection with wvrk authonzed by this permit, and Ihat no building sWCNre, scafidding, (alsework, a tlemolition or dismantling thereof, will be more than thirty-sa (36) teet high. (Chap. 3.2, Grp 2, M 2, Sec. 341, Ttle 8, Califomia Administra�ive Cotle). ❑ As owner-builtler, I will no� employ anyone �o do work which would require a permit from the Division of Indus�rial Sa(ety, as noted above, unless such person has a permit to tlo such work from Ihe division. ApPlicanfs SgnaWre Dale Division of IndusVial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 7. Will the applicant or present or (uture builtling occupant need to file antl cenify a Business Plan !or emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the Califomia Health antl Safery Code requires, vrith some exceptions, that a Business Plan be fletl with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazartlous matenals equal to or greater than a vreight o( 500 pounds, or a volume of 55 gallons, or 200 cubic (eet of compressetl gas at stantlartl temperaNre and pressure). 2. Does or will the applicant or present or future building occupant need to file a registration form (or aculely hazardous ma[erials? ❑ Yes ❑ No (Section 25533 of the Cali(ornia Health and Safety Cotle, vrith some exceplions, requires regis[ration with the Costa MeSa Fire Depariment by each business which at any one time has on hand a quantity of acutety hazardous ma�erials equal to or greater �han a weight of 500 pounds, or a volume o( 55 gallons, or 200 cubic teet o! compressed gas at standard temperature antl pressure). 3. Does or will the applicant or present or future builtling occupaN need to prepare an RMPP (Risk Management and PreveNion Program for acu[ely hazartlous material5)? ❑ Yes ❑ No (Section 25534 of the Cali(omia Health and Safery Code provides that the Costa Mesa Fire Department may require the preparalion, certifcation and fling wiN the Fire Depahment of an RMPP by businesses which are required ro register acutely hazardous materials with the Fire Depariment. 4. If an RMPP is presently required, has Section 25534 of Ihe Califomia Health and Sa(ety Code been fully complied vnth? ❑ Yes ❑ No 5. Does or will the applicant or preseN or tuture building occupant require for lhe work which is the subject of this application a permit for such construction or modifcation from the South Coast Air �ualiry Management District or from any oNer air pollulion control distfict or agency? ❑ Yes ❑ No (Seclbn 658502 of ine Califomia Govemment Code requires that the requestetl informalion be fumished on applications for non-residential building permits). 6. Will any part of the facility lo be constructed under ihis permit be within 1000 feet trom the outer boundaries of a school? ❑ Yes ❑ No Qf "yes", the faciliry must meet the requirement of Sections 25534 and 42303 o( Ihe Calilornia Health and Safe�y Code). 7. If a permit (rom Ihe South Coast Air �uality Management Disirict Or o�her air pollution control disirict or agency is required tor the work which is ihe subject of this application, have all of the disclosures prescnbed by Califomia Health antl Safery Code Section 42303 been made? ❑ Yes ❑ No B. Qf "yes", attach certifcate o( compliance from ihe appropriate air pollution contml offcer). CERTIFICATE OF COMPLIANCE: I certi(y that under penalty of perjury the in(ormation given above is correcL I agree to comply vrith all state laws and ti[y ordinances regarding Hazardous Materials and Emissions. SlgnaWre �ate CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty ol perjury that I have read this application and state Ihat the information given is correcL I agree to comply wiih all state laws and city ordinances relating to building construction, antl authonze represeniatives of the City of Costa Mesa [o en[er upon the above-descnbed property (or inspection purposes. I agree not ro occupy or allow occupancy of any building authorized by Ihis permit un[il fnal inspection. ` \ Signamre egal pwneqs) oaie TS - �8flrn� $-\O-�� ntllnrA�ilFnn�MAnnlit'anl fUla'-� F y • yTp FS t�� 0 > : J a� �� {,+ ' � � CITY OF COSTA MESA � BUILDING DIVISION 77 FAIR DRIVE, COSTA MESA, CA 92626 • Q74) 754-5273 • Faz (714) 754-4856 • wv+w.ci.costa-mesa.ca.us FOR INSPECTIONS CALL: (714) 754-5626 PERMIT TYPE ELEC APN: 13908402 �l��d�.�� '� /(�;LS `I 0 0�' . PERMIT NUMBER: E09-00223 STATUS: ISSUED DATE ISSUED: 08126/2009 ISSUED BY: RMD JOB ADDRESS: 3206 IDAHO PL CM Suite/Unit: Vicinity: KITCHEN, HALLWAY, LAUNDRY, LIVING ROOM SCOPE OF WORK: ELECTRICAL PERMIT TO LEGALIZE ELECTRICAL WORK DONE WITHOUT PERMITS LOCATED IN HALLWAY, LIVING ROOM, KITCHEN AND LAUNDRY AREA, 24 LIGHT FIXTS 1 OUTLET AND 1 SWITCH. � � OWNER: CROGAN, KATHLEEN P,NN TR PHONE: 714-751-0718 � APPLICANT: CROGAN, KATHLEEN ANN . PHONE: 714-751•0718 , - � , CONTRACTOR: OWNER-BUILDER Address: Unit: PHONE: City/State: .. ZipCode: ELECTRICAL PERMIT FEES Electrical Plan Check Fee: $0.00 Electrical Permit Fee: $50.62 Reinspection Fee $0.00 TOTAL FEES `$50.62 Address: 3206 IDAHO PL � Unit: City/State/Zip: COSTA MESA, CA Address: 3206 IDAHO PL Unit: City/State/zZip: COSTA MESA, CA License No. 000000 CELL: i NOTICE: The work authorized by this permit shall comply with all applicable handirap access requirements under California statutes and related regulations. (Ord. No. 92-28, § t, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this,permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. CO�EA. INSPEGTIONTYPE �ATE INTITIRLS CO�EN INSPELTIONME UATE INTRIRLS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Fina1 Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention � 202 Final Facrory Flre Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolifion 250 Final Building/Occupancy � ' � WORKERS' COMPENSATION DECLARATION: I hereby aKrm under penalty of perjury one o/ the following declarations: ❑ I have antl will maintain a ceAificate o( consent lo seli-Insure for workers' compensation, as provided tor by section 3700 of Ihe Labor Code, tor the performance of the work (or which ihis permit is issuetl. ❑ I have and will maintain wnrkers' compensation insu2nce, as required by section 3700 of the Labor Code, (or the peAortnance o( lhe work fw which this pertnit is issuetl. My wnrkers' compensation Insurance carrier and policy number are: Cartier (IDis sMpn need irot Oe comdetetl � Ne pe�mrt is value0 al one nuntl�etl tldlars (E)00) w less ) [�Poli Number: •certify tha[ in Ihe peAormance o( the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Califomia, and agree that if 1 should become subject to the vrorkers' compensation provisions of Section 3700 of the Labor Code,.'I) shapll (oprth�w�it�h comply with these provisions. �K�.It.+.i �N,CLIAA i Ap� pllfanl' gnalu te i�— WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aKrm that I am licensed under pmvisions of Chapter 9(commencing with Section 7000) of Division 3 of ine Business and Pro(essions Code, and my license is in full force and effect. Lic. # Class # ConVaclor s SignaWre CONSTRUCTION LENDING AGENCV: ❑ I hereby affirtn that there is a conSWCCqn lending agency !or ihe peAormance ot the woB tp wfiich this pertnit is issue0. (Sec. 3097, Civil Code�. Lender's Name: Lender'S Adtlress: SignaWre Dale OWNER-BUILDER DECLARATIONS: I hereby affirm thal under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business an0 Professions Code: Any ci[y or county which requires a permit to consWct, alter, improve, demolish, or repair any slrucWra, prior to its issuance, also requires Ihe applicanl for such permit to fle a signed statement that he or she is licensetl pursuaN lo lhe provisions of the Contractors License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business and Pm(essions Code) or that he or she is exempt Iherefrom antl the basis for Ihe allegetl exemption. Any violalion of Section 7031.5 by any applicant !or a permil subjects the applicant to a civil penalty of nol more lhan five undred dollars ($500).): �Ip�aYowner of the property, or my employees vnth wages as their sole compensation, WILL DO THE WORK, and Ihe sWcture is not intended or oBered tor sale (Sec. 7044, Business and Professions Cotle: The Contractors License Law does not apply to an ovmer of property who builds or improves thereon, and who does such work himself or herself or Ihrough his or her own employees, provided that such improvements are not intended or oftered for sale. If, hovrever, the building or improvement is sold vrithin one year of completion, the owner-builder will have the burtlen of proving that he or she did not build or improve lor purpose ol sale.). ❑ I, as ovmer of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business ana Professbns Code: The contractas License Law dces not apply to an ovmer of property who builds or improves Ihereon, and who contracts for such project with a coniracta(s) license pursuant to Ihe Cont2ctors License Lavrs.). ❑ I am exempt under sec. Business and Professions Code (or Ihis reason: `�� (�ae-n,,..� S -�16 d� 9 L&g tore" Datq��p_ ' _ JOS�-46�3/0]) � � • ' . ' Y • Owner ID verifed by tlriver'S license. es ❑ No � �„^'...��. �.s � OriversCicense No. Expires: ��' Venfication of Ownership by (type of �ocument, i.e. - property tax bill or deetl): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certrfy lhat no excavalion fine (5) or more (eet in dep�h into wfiich a person is required to desrend, will be made in connection vrith work autFwnzed by this pertnit, and that no building strucwre, scaffdding, falsework, or demolition or dismantling thereof, will be more than Ihirty-six (36) feet high. (Chap. 32, Grp 2, M 2, Sec. 341, Title 8. Cali(omia Atlminislrative Code). ❑ As owner-builtler, I will no[ employ anyone to tlo work which wnuld require a permit from the Division of Industnal Safery, as notetl above, unless such person has a permit to do such work (rom [he division. APO��'S Signature Division of Industrial Sa(ety Permit Number: _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or fuWre building occupant neetl to file antl certily a Business Plan for emergency response to release or Ihreatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the Califomia Heatlh and Safety Code requires, vrith some exceptions, that a Business Plan be filed vnih Ihe Costa Mesa Fire Department by every business which has at any one time during a reponed year a quantity o( hazartlous materials equal to or greater than a weight ol 500 pounds, or a volume ot 55 gallons, or 200 cubic feet of compressetl gas at standard rempereture and pressure). 2. Does or will the applican[ or present or fuWre building occupanl need to (le a registra[ion form (or acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the Calitomia Health an0 Safety Code, with some exceplions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater Ihan a weight o( 500 pounds, or a volume o( 55 gallons, or 200 cubic feet o( compressed gas at s[andard temperature antl pressure). 3. Does or will Ihe applicant or present or fuWre building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Sec[ion 25534 0( the Califomia Healih and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certifcation antl filing with the Fire Department o( an RMPP by businesses which are required to register acutely hazardous materials with the Fire Departmem. 4. If an RMPP is presently required, has Section 25534 of the Califomia Health and Sa(ety Code been fully complied wi[h? � Yes ❑ No 5. Does or will the applicant or preseN or fuWre building occupant require (or the work which is the subject of Ihis appliwiion a permit (or such wnsiruction or modification fmm ihe South Coast Air Quality Management District or from any other air polWtion control dis[rict or agency? ❑ Yes ❑ No (Section 658502 of t�e Cali(omia Govemment Code requires Ihat ihe requested in(ortnalion be fumished on applications for noo-residential buil0ing pertnits). 6. Will any part of the faciliry to be constructed under this permit be within 1000 (eet fmm the outer boundanes of a school? ❑ Yes ❑ No Qf'yes", Ihe faciliry must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code�. 7. If a pertnit from the SouN Coasl Air �uality Management DisMcl or other air pollution control district or agency is requiretl for the v,ork which is the suDject of this application, have all of the disdosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. (It'yes", atlach certificate of compliance from the appropnate air pollution tontrol oKceQ. CERTIFICATE OF COMPLIANCE: I ceAify that untler penalty o! perjury the information given above is correcL I agree to comply with all state laws and city ordinances regartling Hazartlous Materials antl Emissions. SignaWre �ate CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify untler penalry of perjury that I have reatl this application and state Ihat the information given is correcL I agree to comply with all state laws and city ordinances relating to building consiruction, and authonze represenlatives ol the City of Costa Mesa �o enter upon [he above-described pmperty for inspection purposes. I agree not to occupy or allow occupancy ol any building authorized y this permit until al inspection. :1��.<,.��.:.0 S -ae-oq �—siqneia m�le9 Owneqs)�_, oa�`yi Antllor AutM1orizetl AO�I¢ant Date oSta l�/1�S�1 of Costa �l�t esa ��irzg �ivisio f z 77 Fair Drive, Costa Mesa, CA 92626 714-754-5273 / Fax 714-754-4856 C3YVfVER ��ILD�R ��Rl�l��`�iQ� Permit #� � nvz�3 Disclosures & Forms for Owner- Builders Applying for Construction Permits IMPORTANT! NOTICE TO PROPERTY OWNER Dear Property Owner: An application for a building permit has beery,sy�b�{tted ir�''p��rtame�j�g yourself as the builder of the property improvements specified at ��/�{�� a D�f . V�,�e are providing you �t•ith an Owner-Builder Ackno�vledgment and Informaticn Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in yeur name as lhe Owner-Builder. We will not issue a building permit un[il you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, lhe property owner, obtain the prior approval of the permitling authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION DIRECTIONS: Read and initial each sta ement belo�v to signi(y you understand or verl/y�liis inlonnation. C�1. I understand a irequent practice of unlicensed persons is to have the property owner obtain an "O�a�ner- Builder" building permit that e«oneous�y implies lhzt the property owner is providing his or her ovdn labor and material personally. I, as an Owner-Builder, may be held liable and subject lo serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. R1y homeowner's insurance may not provide cover2ge for those injuries. I am tivillfully acting as an Owner-Builder and am aware of the limits of my insurance coverage (or ir,juries to workers on my preperty. ��2. I understand building permits are nol required to be signed by property o�a-ners unless th=y =r< responsible for the construction and are not hiring a licensed Contractor to assume this responsibilily. �3;� I understand as an "Owner-Builder" I am the responsible party o( record on the permiL I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having fhe permit filed in his or her name instead of my own. �4. I undersland Contractors are required by law to be licensed and bonded in California and to list their licens`e numbers on permits and contracts. �5. I undersiand if I employ or othervaise engage any persons, other lhan California licenszd Contractors, �andrih,e tota� value of my construction is at �east five hundred dollars (5500), including labor and materials, I may be considered an "employer" under siate and federal law. �6. I understand if I am considered an "employer" under slate and federal law, I must register e;ith the stat2 �and=�fe"deral govemment, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also undersland my failure to zbide by th=se laws may subject me to serious financial risk. N' =7,�:;1 understand under California Centractors' State Lic=_nse Law, 2n Owner-Build?r who builds sing!e-family residential structures cannot legally build them with the intent to offer them for sale, unless oll v;ork is perform�d by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. ri��'$ �I.understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. 1 Of 2 M N ��I,understand I may obtain more in(ormation regarding my obligations as an "employer" fwm lhe Internal Revenue Service, Ihe United Stales Small Business Administralion, the Cali(ornia Departmenl of Benefit Payments, and the Cali(ornia Division of Industrial Accidents. I also undersiand I may conlact lhe California Contractors' State license Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed conlractors. {-�1,0-1�am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the party 1=gally and financi211Xro=poq=ible fop proposed�ns!ruc!ion zcti�:ity 2t ihs follo�•:ing zddress: '�,�/-11-1 agree that, as lhe party legally and financially responsible for this proposed construction activity, I will atiid`e by all applicable laws and requirements that govem O�vner-Builders as well as empfoyers. h�12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on lhis form. Licensed contractors are regulaled by laws designed (o protect the public. If you conlract wilh someone who does not have a license, lhe Contraclors' Stale License Board may be unable lo assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Coniraclors may be in civil court. It is also important (or you lo understand thal if an unlicensed Conlraclor or employee of that individual or firm is injured while working on your property, you may be held �12b!e for damages. If you cb:Eln a permit eS QP:�c^F�Ui1C�.Ef afld V:iSil t0 illi2 COfliiaCiuiS, y'ull WIiI uc responsible for verifying whelher or not those Contractors are properly licensed and the status of their �vorkers' compen5ation insurance coverage. � � Be(ore a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's /icense, form nofarization, or other veri(ication accepfable to the agency is required to be presented when the permit is issued to verify the properYy owner's signature. Si�nature-of-properly owner X a,Q„ II�AQt+� o��a: g a� o_ i'fOiE: T`E (viiG.Ji�� nULiG�lZaiiO� FGiiTI IS reGuired to ba cvmplafaJ by ihz propa�fy uwiieru��ly �vhen designating an agent of the property owner to apply for a construction perrnit (or the O�vner-Builder. AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice lo Property Owner, lhe execution of which I undersland is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and File lhe documents necessary lo oblain an Owner-Builder Permit for my project. Scope of Conslruction Project (or Description of Work): Projecl Localion or Address: Name of Authorized Agent: Address of Authorized Agent: Tel No I declare under penalty of perjury that I am the property owner (or the address listed above and I personally filled out the above information and certify its accuracy. fJole: A copy cf;ha o�vner's driver's license, iorrn notarizadon, or other veri(ication acceptable fo the agency is required to be presented when the permit is issued to verify the propertyowner's signature. Property Owner's Signature: Date: 20f2 CITY OF COSTA MESA � � BlIILDING DIYISION F � 77 FAIR DRIVE, COSTA MESA, CA 92626 • p14) 754-5273 • Fax (714) 7544856 •�wiw.ci.costa-mesa.ca.us �. FOR INSPECTIONS CALL: (714) 754-5626 lyro��m A' PERMIT NUMBER: M07-00527 ��JC'" dd1 ��_n- PERMITTYPE MECH DATE��o1� W+" STATUS: ISSUED DATE ISSUED: 11/0612007 � . ISSUED BY: RMD JOB ADDRESS: 3206 IDAHO PL"CM r Suite/Unif: . vicinity: � . � � .. . SQ. FT: 0 't SCOPE OF WORK: REPLACE�(E) 70,OOO�BUT,FURNACE AND 1 NEW RETURN FOR A SFD. � A .. ,- .,, . , . . . ...;,: OWNER: CROGAN,KATHLEENANNTR --- � . � Address: �32061DAHOPL: Unitr - �..�-. PHONE: 714-751-0718, • ' � '��City/State/Zip: 'COSTAMESA,CA - :` � APPLICANT: YENULONIS, LAUR4 ' � � � � - � Address: � � Unit ' � � PHONE: 714•998-4300 . ., . � '' City/State/zZip: - . - , � -- � CONTRACTOR: ALLIED,PLUMBING -��HEATING -�AIR CONDITIONING License No. 610780 .�� , Address: 422 JENKS ClUnit: �' - PHONE: �� 714-9964300 � _ � , City/State: CORONA, CA � � ZipCode: 92880 � - CELL: � " � - - � � MECHANICAL PERMIT FEE SUMMARY ' MECH ITEM FEE: � , ., - � $52.00 "- � PLAN CHECK FEE: � � $0.00 � - � INVESTIGATION FEE: ' , $0.00 � REINSPECTION FEE: � . $0.00 � �� ' TOTAL FEES: $52.00 � , � NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF-LAST INSPECTION. INSPECTIONS: In order for the work authonzed 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 ezpiration of this permit. OEA INSGEC110NTYPE OAIE INTIIIRL CO�E/ INSPECTONTYPE DRTE INTITIRLS 1676 � Fixed System Final Fire Prevention 206 Final Mechanical t266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roo! 210 Final Elechical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Fattory Fire Place 220 Pina� Planning Approval 203 Final Sign 222 Final Si�e 204 Final Demolition � 250 Final BuiltlinglOccupancy WORKERS' COMPENSATION DECLARATION: I hereby aKrm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certifica[e of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, (or the peAormance of the work for which this permit is issued. � I have and will main[ain workers' compensation insurance, as required by sectbn 3700 of [he Labor Cotle, for [he pedormance of [he vrork for which this permi[ is issued. My workers' compensation Insurance carrier and policy numberar01: \,..� �'C .— (� � ��G'arrierfi l . \ V Q,� � �-"C \ S . �--c� . (inis seuibn neetl 1rwt b'e`competed he peimrt is valuetl al one hunOretl cbtlars (S100J a less ) PoIlcyNumber: WC.� 1�4��OA(n��n�1 ❑ I certify that in ihe peAormance of the vrork for which this permit is issuetl, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that i( I should become subject to ihe workers' compensation provisions of Section 3700 0( �the Labor Code, I s II forthwith comply with these provisions. • ` \\_�� Applicanl's S�gnature Daie�`- �---'�-- WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($700,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affrm that I am licensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and ef(ect. � f' �"C2c� Cic. # Class # � - �_"�,= - �\-�(1x�:1 omrotlor's SignaWre DatE' CONSTRUCTION LENDING AGENCY: ❑ I hereby aKrm tha[ there is a construction lending agency (or the peAormance of Ihe v.ork far which Ihis pertni[ is issued. (Sec. 30W, Civil Cotle). Lender's Name: Lender's Address: Signalure Date OWNER-BUILDER DECLARATIONS: � . � �' I hereby affirm that untler penalry of perjury that I am EXEMPT FROM�THE CONTRACTORS LICENSE LAW for the following reason (Sea 7031.5, Business and Professions Code: Any city or counry which requires a permit to consWct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed sta�ement that he or she is licensed pursuant lo Ihe provisions of the Contractors License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code) or ihat he or she is exempt [herefrom and the basis for the allegetl exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalry of not more Ihan five huntlred dollars ($500).): - ❑ I, as owner of the property, or my employees with vrages as Iheir sole compensation, WILL DO THE WORK, and the structure is not intended or oHered for sale (Sec. 7044, Business and Protessions Code: The Conlractors License Law does not apply to an owner of property who builds or improves lhereon, and who does such vrork himself or herself or through his or her ovm employees, provided that such improvements are not intended or offered for sale. If, however, Ihe building oi improvemenl is sold within one year of complelion, the ovmer-builder will have the burden of proving that he or she did not build or improve for purpose of sale.�. . ❑ I, as owner of the�properly, am EXCLUSIVELY CONTRACTING WITH UCENSED CONTRACTORS to consWct the project (Sec. 7044, Business antl Professions Code: The contrac[ors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project vnth a cont2ctw(s) license pursuant to the Contrectors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: SignaWre � �a�e J059-G6�3I0]� Ovmer ID verifed by driver's ,. e. ❑ Yes � No Dnver's License No. Expires: Verifcation of Ownership by ([ype of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: � I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descena, will be made in connectbn wilh work aulhonzed by this permit, and that no building stmcture, scaffolding, (alsework, or tlemoli[ion or dismantling thereof, will be more than thirty-siz (36) (eet high. (Chap. 32, Gry 2. AA 2, Sec. 341, Ttle 8, Califomia Adminis[2[ive Code). ❑ As ovmer-builder, I will not employ anyone to do work which would require a permit from the Division of Industnal Safety, as noted above, unless such person has a permit [o tlo such vrork (rom the tlivision. ApphcaN's SignaWre Division of Industrial Safety Permit Number _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or tuture building occupant need to fle and certify a Business Plan (or emergency response to release or threatened release ot a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Heallh antl Safety Code requires, with some excep[ions, Ihat a Business Plan be filed with the Cos[a Mesa Fire Department by every business which has at any one time during a reportetl year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at stantlard temperature and pressure). 2. Does or will the applicant or present or (uture building occupant need to fle a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the Califomia Heal[h and Safety Code, wilh some exceptions, requires registra�ion with ihe Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous matenals equal to or greater Ihan a vreight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressetl gas at stantlard temperaNre and pressure). 3. Does or will ihe applicant or present or future builaing occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the Cali(omia Health and Safety Code provides Ihal the Costa Mesa Fire Department may require the preparation, certifica[ion and fling with the Fire Department of an RMPP by businesses which are required lo register acutely hazardous materials with the Fire Department. 4. I( an RMPP is presently required, has Section 25534 of the California Health antl Safety Code been fully complied with? ❑ Yes ❑ No 5. Does or will ihe applicant or presem or future building occupant require for lhe vrork which is the subjecl of lhis applicalion a permil for such construciion or modifcation from the Soulh Coast Air Quality Management DisMcl or from any olher air pollution control tlistncl or agency? ❑ Yes ❑ No (Secibn 658502 of Ihe Califomia Govemment Cotle requires that the requested infortnation be (umished on applications for non-residential building pertnits). 6. Will any part of the (acility to be constructed under this permil be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No Qf "yes", the facility must meet Ihe requirement of Sections 25534 and 42303 of the California Health antl Safety Code). 7. If a permit from the South Coast Air Qualiry Management District or other air pollution control district or agency is required for the work which is the subject of this applicalion, have all of the disclosures prescri6ed by Califomia Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. (I('yes", attach certificate of compliance fmm the appropriate air polWtion control oKcer). ' CERTIFICATE OF COMPLIANCE: I certify lhat under penally of peryury the information given above is correcL I agree to comply with all state laws�and city ordinances regarding Hazardous Materials and Emissions. � SignaWre Dale CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalry ot perjury that I have read this application and state that the information given is correcl. I agree to compty with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon ihe above-described pmperty for inspection purposes. I agree not to occupy or allow occupancy o( any building auihorized by this permit until final inspection. ��SgnaWreof alOwneqs) Da�e 1rv:� _ ._.� 1\_(n-(1-1 � V br'AOl�orizetl APPliwnl (y.pale��'^` .` � N CITY OF COSTA MESA BUILDING DIV/SION 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us FOR INSPECTIONS CALL: (714) 754-5626 �+�y PERMIT NUMBER: M09-00067 �ad�..�' i� L�.1' PERMITTYPE MECH �ATE IO'y1, �j'_� �I/ APN: 13908402 JOB ADDRESS: 3206 IDAHO PL CM Viciniry: SQ. FT: 0 STATUS: DATE ISSUED: ISSUED BY: Suite/Unit: ISSUED 08/10I2009 BJK SCOPE OF WORK: CHANGE-OUT OF AN EXISTING FAU AND AN A/C AT AN SFD. MECH: 1 FAU < t00K BTU, 1 CONDENSOR UP TO 3 HP/100K BTU � OWNER: CROGAN, KqTHLEEN ANN TR - Address: PHONE: City/Slate/Zip: APPLICANT: YENULONIS, LAURA Address: PHONE: 909-213-1640 City/State/zZip: CONTRACTOR: ALLI�D PLUMBING - HEATING - AIR CONDITIONING Address: 422 JENKS ClUnit: PHONE: 714-998-4300 CirylState: CORONA, CA ZipCode: 92880 MECHANICAL PERMIT FEE SUMMARY MECH ITEM FEE: $53.00 PLAN CHECK FEE: $0.00 INVESTIGATION FEE: $0.00 REINSPECTION FEE: $0.00 TOTAL FEES: $53.00 3206 IDAHO PL Unit: COSTA MESA, CA Unit License No. 610780 CELL: NOTICE: The work authorized.by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28. § 1. 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will resull in the expiration of this permit. CO�Et. INSPECTIONTYPE OATE INIIi1RL5 COOE� INSPEC110NTYGE ORT INTI11AL5 1616 Pixed System Final Fir� p�y�ention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roo( 210 Final ElectriCal 201 Final Block/Re�aining Wall 212 Final Fira Prevention 202 Final Factory Fire PIac2 220 Final Planning Approval 203 Final Sign 222 Final Sile 204 Final Demolition 250 FinalBuildinglOccupancy ( , � � WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of ihe follovnng declarations: ❑ I have and will maintain a certificate of consent to selbinsure for workers' compensation, as provided for by section 3700 0( the Labor Code, for ihe pedormance of the vrork for which this permit is issued. �' I have and vnll maintain workers' compensation insurance, as required by �ion 3700 0( the Labor Code, for the perfortnance of the work for which ihis pertnit is issuetl. My workers' compensation Insu�ance carrier and policy numDer are: 1 \^ Carrier. l�� Lii� � �� `(T�is sxlbn need ip1 be mmdeied he permR is vaNed al we huntlretl �llars (3100) orlessJ Policy�Number tl�C—��n�jLS��Q�J��R ❑ I certify Ihat in the pertormance o/ ihe work for which Ihis permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, antl agree that if I should become suhject [o [he workers' compensation provisions of Sec[ion 3700 of t e Lab r Code, I shall forthvnth comply with these provision`s,..� I� 8� �lJ� v \ AOPliranl's'SignaWre Dalei^ WARNING: URE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRAC70RS DECLARATION: I hereby affrm that I am licensed under provisions of Chapter 9(commencing wi�h Section 7000) of Division 3 of [he Business and Pro(essions Cotle, antl my license is in full foCrcAe .a�ntl effect. �^ Li !#�a �� a�./ Class�# �av � — Contracbr'S SignaWre ale / r. yv1�' CONSTRUCTION LENDING AGENCY: ❑ I hereby affrtn that there is a constNction lending agency (or the peAormance o( the v.ork /a which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: SignaWre OWNER-BUILDER DECLARATIONS: I hereby affrm ihat untler penalry of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business antl Professions Code: Any ciry or counry which requires a permit to consiruct, alrer, improve, demolish, or repair any stmcNre, prior to its issuance, also requires the applicant for such permit to fle a signed statement that he or she is licensed pursuant to Ihe provisions of Ihe Con[ractors License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Cotle) or Ihat he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permi� subjec[s the applicant [o a civil penalry of not more than fve hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or oRered for sale (Sec. 7044, Business antl Professions Code: The Coniracrors License Law does not apply to an owner of property who builds or improves thereon, and who does such vrork himsel� or herself or through his or her own employees, provided that such improvements are not intended or oftered for sale. If, however, ihe building or improvement is sold within one year of completion, the ownerbuilder vnll have the burden o� proving that he or she did not build or improve for purpose of sale.). ❑ I, as ovmer of the property, am EXCLUSIVELY CONTRAC7ING WITM LICENSED CONTRACTORS to construct [he pmjec[ (Sec. 7044, Business and Professions Code: The contractas License Law does not apply to an owner of pmperty who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Cont2ctors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: 305]-46 (3I0]� w�� Ovmer ID verified by tlriver's license. ❑ Yes ❑ No Driver's License No. Expires: Verifcation of Ownership by (type of document, i.e. - propeny tax bill or deed�: DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation fve (5) or more feet in tlepth into wfiich a person is required to tlescentl, wiil be made in connection vnth work au[horized by Ihis permit, and �hat no builtling slrucWre, scaffWding, falsework, or demolition or disman0ing �hereof, will be more Ihan thirty-six (36) feet high. (Chap. 32, Grp 2, M 2, Sec. 3h,1, Ttle B, Califomia AdministraMe Code). ❑ As owner-builtler, I will not employ anyone to tlo work which would require a permit fmm (he Division of Industrial Sa(ety, as noted above, unless such person has a permit to tlo such work (rom the division. Appliranfs SignaWre Date Dlvision of Indus[dal Safety Permi[ Num6er: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applican[ or present or Wture building occupant need lo fle antl certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the Califomia Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Departmen[ by every business which has at any one time during a reported year a quantiry of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic (ee[ of compressed gas at standard temperature and pressure�. 2. Does or will the applicant or present or future building occupant need to �le a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the Califomia Health and Safety Code, with some exceptions, requires registration wi�h ihe Costa Mesa Fire Depariment by each business which aI any one time has on hand a quanliry of acutely hazardous materials equal to or greater Ihan a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic fee[ o( compressed gas at standard temperaNre and pressure). 3. Does or will the applicant or present or fuNre 6uilding occupanl need to prepare an RMPP (Risk Management and Prevention Program for aculely hazardous matenalsj? ❑ Yes ❑ No (Section 25534 of Ihe Calitornia Heal�h and Safety Code.provides Ihat the Costa Mesa Fire Department may require the preparetion, certifcation and fling with the Fire Depariment o( an RMPP by businesses which are required to regis[er acutely hazardous materials with the Fire Department. 4. If an RMPP is presently required, has Section 25534 of Ihe Califomia Health and Safery Code been (ully complied with? ❑ Yes ❑ No 5. Does or will the applicant or presenl or fuWre building occupant require for the work which is the subject of lhis application a permit for such construction or modification from the SoWh Coast Air Quality Management DisVict or irom any other air pollution control distnct or agency? ❑ Yes ❑ No (Section 658502 0( the Cal'rfomia Govemment Code requires that the reques�ed in(ormation be fumishetl on applications fa noo-residential building permits). 6. Will any part o( Ihe (aciliry to be constructetl under Ihis permit be within 1000 feet from Ihe outer boundaries of a school? ❑ Ves ❑ No Qf "yes", Ihe facility must meet Ihe requirement of Sections 25534 and 42303 of Ihe Califomia Health and Sa�ety Cotle). 7. If a permit from the South Coast Air Quality Management Distnct or other air pollution control district or agency is required for the work which is [he subject of this applicatioq have all of the disclosures prescribed by Califomia Heal(h and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. Qf "yes", attach certificate of compliance from the appropriate air pollution contml offcer). CERTIFICATE OF COMPLIANCE: I cehify that under penalty of perjury ihe information given above is correcL I agree to comply with all state laws and ciry ortlinances regartling Hazardous Materials antl Emissions. Date CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury �hat I have read this application and sta[e that the information given is correct I agree to comply with all state laws and ci�y ordinances rela�ing to building cons�ruction, and authorize representaiives of the Ciry of Costa Mesa to enter upon ihe above-described property for inspeCtion purposes. I agree not to occupy or allow occupancy o( any building authorized by this permit until fnal inspection. SignaWreoj� galOwneqs) oa�e ��U�OM ulJ�h*nA� ��'x' $-IO-C`� ntllor�ut�wizeaABoli[ant Date . . �� . . 3 . � � . ,. � �. S��Oa. a_� o. ' .: --. :., . .. :�.;..... :.. •�— -��---�-�+ .�.a . _ � . . __ i T-""�t _ . � � i t ':� � N � v t � B, � ,, � � 1 � ` L � • � : ` B �,.-N �.�.! ' l • f--�...� � � � , f ✓ ,`w . I � .. ,e� +_�_f'��c-,�.� �t � rr'— r l" � � � � ("""�—a - w l� � t r. n � �`:: , { � , � ,�.. ^,�� t�d'^+�,j'.� � —_ - r � , � .4 - � I , . , � � �, � . � � ��d �C� n x" _ �I � , '� '�r,i �' Ih i ,.. p , 1 � , �� rr �� .; , � n.,„ T ��, > , � . . . , _.. �i" . `d ,. � -;-r - � � •; - i� , , d : � -„ °... � .. ,E,��.-�„�„�, yM.. � „� .. r ix, I _ , i��- -�" � - - -�� T �� '��-'_'_�''."'� I � � ��i�'. I , �� ,� �. �;j� y� i , ,, r� ' ��`.�41?� ��, � � , � � �v� > (Ei`� k � . �i � ��.,,.� �wF - . a �_. � � , . y ,.: . � � ��4'�5'1_'-' i➢.� r � � �t �r ~ : � 4e S � c ii � � n C � "�'�" �� - �� =4� wt ��' ��' � �� ,MP."^�Y� i�.�i 1''r 3a`.« .�"'- V i,�T�� : ��.�`'��ei7'y'u�.l�,_-S,•�y '-t"`... �t'..,__ � �j � . i "i G �� {r �''�4ia .. y7 _ J �� , �`(� ✓ / )� f� ��.{7 � �••�c� (� Ji S 1'71��.,. � i� �-� . \\\\�,a �� 1`�z ( \\ /t �Y ��' 4•'� %��°�-=.`+„ - �' �! �k-�C. a". � P ; y�- � `� � r, r 'v � ° �"�,"'1 � I �,�;� !� � � G ,' � ,r q. � �� Y� . ,t �. �, 1' � �j r�� i I � � _ �i i � � � t �" � 7 � �'�i� +, .�'.,, I � � :, ]�+i 1ypp J �-'�t� �{�� fY1�i� � '�, i V �� , ' I �� { S��}��e�yT -] .r'r'!' 'i '� _ _, y� ! V � �t "`�'�mma�v1 {� �V . -r`T� �n � � _�.f'.. : -_^-�- .':. P � �Yr J�1.0 n.�r_ _�_ �J ' � � _. � ve - . .�:.� �..:x:-:. �..� . _: . _ _n rs��e,�--- r n--- - �: � " -.,m.-.:.i.-.—..,s..r-,,, - --- . �. . ... y. �:__. e �. _ � _'_'__'.-""""___. - — . �i; - , �' � --- �� ._ ,_.,i August 14, 2009 CITY OF COSTA MESA P.O. BOX 1200 • 77 FAIft DRNE � CALIFORNiA 92628-1200 DEVELOPMENTSERVICES �EPARTMENT BUILDING DIVISION COURTESY NOTICE OF PERMIT EXPIRATION Kathleen Ann Crogan Trust 3206 Idaho Place Costa Mesa, CA 92626 PERMIT NUMBERS: M07-00527, P06-00226 PROJECT 3206 Idaho PI., Costa Mesa, CA �OR: Furnace/Water Heater Our records indicate the above listed permit(s) were obtained for property improvements or alterations at the above address. Per the 1997 Uniform Building Code, Section 906.4.4 �xpiration, permits are valid for 180 days from the date of such permit, or the date of the last inspection for the project. Our records do not show an inspection for these permits within the last 180 days nor have they had an approved final inspection. If you have a signed inspection card showing that an inspection was made within 180 days, or that the final inspection was approved, please contact this office so we may correct our records. If you do not have an approved final inspection, your permits will expire on August 25, 2009. Additional fees will be required to iinalize expired permits. Requestinq an inspection - If you need to request an inspection, please call our inspection Request Line at 714-754-5626. Requestinq an extension -If you wish to request an extension, requests must be made in writing addressed to Ed Petros, Chief of Inspection, at the above address, detailing circumstances and listing an estimated date of completion. If you have any questions, please contact the Building Division at 714-754-4871, between 8:00 a.m. and 4:30 p.m., and a staff member will assist you. The accuracy of records affecting your propeRy is our goal and we appreciate your working with us to resolve this matter. S'ncerel i arbara J Zwart Office Specialist II cc: Allied Plumbing, Heating, Air Conditioning Nock Plumbing Builtling Division (714) 754-5273 • Code EnforcemeN (714) 754-5623 • Planning Division (714) 754-5245 December 1, 2005 ca� oF cos�A n�a�sA P.O. BOX 1200 • 77 F41R DRIVE • CAIIFORNIA 92628-1200 DEVELOPMENT SERVICES DEPARTMENT BUILDING DIVISION COURTESY NOTICE OF PERMIT EXPIRATION Kathleen Ann Crogan 3206 Idaho PI Costa Mesa CA 92626-2208 PERMIT NUMBERS: B03-00225 FOR: Re-roof PROJECT ADDRESS: 3206 Idaho PI., Costa Mesa Our records indicate the above listed permits were obtained for property improvements or alterations at the above address. Per the 1997 Uniform Building Code, Section 106.4.4 Expiration, permits are valid for 180 days from the date of such permit, or the date of your last inspection for the project and additionai fees will be required to finalize expired permits. According to our records, the permits listed above have not had an inspection for a period exceeding 180 days. If you have a signed inspection card indicating an inspection was conducted within 180 days from the date of this letter, please contact this office so we may correct our records. If you need to request an inspection please call our Inspection Request Line at 714-754-5626. If you wish to request an extension, requests must be made in writing addressed to Ed Petros, Chief of Inspection, at the above address, detailing circumstances and listing an estimated date of completion. If you do not have an approved final inspection, your permits will expire on December 15, 2005. If you have any questions, please contact the Building Division at 714-754-5273, between 8:00 a.m. and 4:30 p.m., and a staff member will be happy to assist you. The accuracy of records affecting your property is our goal and we appreciate your working with us to resolve this matter, Sincerely, � ��`" `�,��`��..�� %� r Mary Jane Weidenkeller Office Specialist II cc: The Roofing Specialists 2428 Newport Bivd, Unit 5 Costa Mesa CA 92627 Building Division (774) 754-5273 • Code Enforcemenl (71a) i5s-5623 • Planning Divislon (71a) 753-52t5 FAX(71a)7yta856 • TDD(71a)7St52dd • ww.v_ci.costa-mesa.ca.us r (714) 754-5273 • Fax (714) 754•4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 3206 IDAHO PL Suite: Viciniry: Parcel Number: 13908402 npp�icant: COFFEY, BRIAN Address: Owner. CROGAN, KATHLEEN ANN TR Address 32061pAH0 PL COSTq MESA, CA Convactor: THE ROOFING SPECIALISTS Address: 2428 NEWPORT BLVD UNIT 3 COSTq MESA,CA Zip: 92672 Arch : Address: Zoning: Phone: Zip: Phone: Zip: 9262E2208 Phone: (949)722-8846 License: 734068 Eng: Address: ISSUED BY: Status: ISSUED Applied: 02I70/2003 Issued: 02/10l2003 Phone: Phane: Zip: License: License: SCOPE OF PERMIT TEAR OFF EXISTING ROOF, INSTALL SHEATHING OVER SPACED SHEATHING, FELT AND COVER WI7H 30 YEAR COMP. INCLUDES ALL RELATED FLASHING. Plan Check: $0.00 Permit: $111.25 SMIP Res: $0.50 SMIP Com: $0,00 Other. $Q.00 inspection: $0.00 Total: $111.75 SETBACKS MAINSTRUCTURE Front p-p ACCESSORY Front 0-0 PARKING Existina: o Rear 0• 0 Rear 0-0 ReQuiretl: 0 FEE SUMMARY PLANNING & ZONING Lek 0- 0 Le(t 0- 0 Proposed: 0 Calc Valuation: Claim Valuation Right 0- 0 Right 0- 0 sa,sio.00 Sa,s�o.00 NO710E: 7he work authonzed by this permit shall comply with all applicab7e harMkap access requirements under Calitomia statutes and related regulations. (Ord. No. 92-28, § 1, 1241-92) EXPIRATION: This permtl shall automaticalty 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. . , INSPECTIONS: In order for thp wprk authorized under Ihis permit to be considered legal, such work must comply with ell applicable codes, and all required Inspettiona and finel approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of this permit. �� FOR INSPECTIONS CALL: (714) 7545826 tans+e larool WORKERS'COMPENSAnON DECLARATON: I hereby aHirtn under penalry ai perjury one oi tha tollowing tledaratlons: ❑ I have and will maintain e cenificate at wnsent to self-Insure lor workers' campensation, es OroHded for by section 3700 at Ihe Lebor Cotle, lor the pertortnence of Ihe � �work tor whlch IhiS permit Is IsSueC. ty I nave end will maintan workers' campensatlon inwrance, es requiretl by secUon 37f10 ot the l�bor Cotle, lor Ihe peAortnence af Ne work lor whkh this pertnit is Lssuetl. "V My workers/',�eom�pensatlon Insu�g/�(1ce�W,�/r ri{e�r entl pollcy number ere: 1�� I} � Certier: ��! V� {/ paliry Number: G'W S (This section nee e pleted J the pe !s valued et one nuntlred tlollers (5700) or less.) , ❑ I certity that in tha peAortnance of the work lor whiCh �hls permit is i55ued, I s�all not employ eny Derson In eny manner so es to me sub�ect lo the workers' compensation laws ot galqpmie, and pre that II I s�oul0 became suDlect to Ihe workere' compensetlon pmvislore ol Sectlon 3 00 oi he lebor Catle, I ahall tort�wi[h comply with these D�Em90 tis. / 2 � � I�� ApDlicent Signeture: � Date: WARNINO:FFILURETOSECU WORKERS'CO SATIONOOVERAGEISUNUWFULANDSWILLSUBJECTANEMPLOVERTOCRIMINALPENALTIESANDGVILFlNESUPTOONEHUNDRED THOUSlWDOOLLARE�E100.000),INAODITIONTO ECOSTOFCOMPENS4TION,DNMGESASPROVIDEDFORINSECTION3]OBOFTHEUBORCODE.IMEREST,ANDATTOqNEV'SFEES. LICENSED CONttiACTORS DECLARATION: I hereby aHirm t�at I em Ilcensed un0er proWsions ol Chapter e(wmmendng with Section 7000) ot Division 3 0l ihe Business entl Proleulons Cotle, anA my Iicense is In tull force end ettect LIC. N /) _/___. Closs a i �. Contrector's Slgneture: l /�� CONSTRUCTION LENDING AGENCY: ❑ I hereby aHirtn Ihat Ihe�e is a cons Lende/9 Neme: SignaNre: OWNER-BUII.DER DECLARATIONS: oeto: lending agency for �ho pertormence ot Ihe work lor which t�is permit is issued. (Sec. 3097, CiNI Code). Lentlor's Atldress: Date: I here6y eHlrm Ihat under penelly ol per�ury ihet I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for ihe following reeson (Sec. 7031.5, Buslness end Professlons Cade: Any Gty or county which requires e permit to consiruct, alter, improve, demolish, or repeir eny stmcture, prior fo its issuence, elsa requires Ihe epplicant tor such permit to fila e signed s�etement that he or she Is Iicensed pursuent to the pmvisions ot the Contrectors License Lew (Chepter 9(cammencing with Section 7000) of Division 3 of the Business end Profeulons Gode) or thet he or she I5 exompt Iharofrom and tho 6asis lor ihe elleged exemptlon. Any vlolatlon of Section 7031.5 by eny epplicant 1or e pertnit subjecis Ihe epplicent to e civil penalty of not mora then five hundretl dollars (5500).): ❑ I, es owner ol the property, or my employees with wages es their sole wmpensatlon, WILL DO THE WORK, end the structure Is not Intendetl or oHeretl lor sale (Sac. 7044, Business entl Pratesslons Code: The Contractors Licensa Lew does not epply to an owner ol property who builds or improves ihereon, end who tloes such work himsetl or herself or through his or her own employees, pmvided that such Improvements are not Intended or oHered tor sale. If, however, ihe huiltling or Improvement is sold within one year ot completion, ihe owner�builder will have tha burden of pmving that he or she did not build or improve for purpose of sale.�. ' ❑ I, as owner of the property, em EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to constmct the project (Sac. 7044, Business enA Professions Cotle: The contrectors License Law does not epply to en owner of propeny who bullds or Improves Ihereon, antl who contrecis far such projeq with e contractor(s) license pursuent to the Contracrors License Lews.). � I em exempt under sec. Business end Professions Code lor this reeson: Signeture: Date: Owner ID verilled by drivefs license. ❑ Yes ❑ No Drivefs License No. Expires: Verification o1 Owners�ip by (type oi tlaument, i.e. � property tea bill ar tleed): DIVISION OF INDUSTRIAL SAFETV PERMR CERTIFICATION: ❑ I hereby certiy thet no e:wvatlon fNe (5) or more teet in depth imo which e person is reqWred to tlescend, wlll be mede In connection with work eut�odzed by this pertnit, entl t�at no builCinp struciure, sceMddinp, talsewark, or demolition or dismantling thereol, will be more �han thirty-siz (36) leet high. (Chap. 3.2, Grp 2, An 2, Sec. 341, Tltle B, Calllamla Adminlstretive Cotle). , � As owner-builder, I will not employ enyone to do work which would require a permit Irom tha Divislon ol Industriel Selety, es noted ebove, unlass suc� person hes e permit to do such work Irom Ihe dlNsion. Signature: Date: Division ot Industnel Safery Permit Numher: CERTFlCA7E OF COMPLIANCE AND AIffHORIZA710N OF EMAY: I cetlity under penelry ot perjury that I heve reatl t�is apDlication entl state Ihat lhe infortnatlon given is correct. I epree to wmpty wlih ell stete laws enG Gty ordinences relating to builCing wnstruclion, end euthodze represeniatives of the Ciry ot Costa Mese to enter upon Ihe ebove-descnbed property lor inspection puryoses. 1 epree not to occupy or allow occupency of any building authonzetl by Ihis permit until final inspecUon. COUE �. INSPECTIONTYVE I 1876 Fixed System Final Fire Preventlan 1288 Pool Spa Finel , 200 Final RB-Root 201 Final BIocWRetelning Well 202 Final Fectory Flre Plece 203 Finel Sign 204 ' Finel DomoOtion PAIE It�LB �� ( ate �ate COOE I INSFECTION TYPE 206 Final MeCheniCal 208 Finel Plumbing 210 Final Elecidcal 2/2 Final Fire Preventlon 220 Finel Plenning Approval 222 Flnal Site • 250 Finel Building/Occupancy ae� u�e�s December 1, 2005 CITY OF COSTA MESA P.O. BO% 7200 • 77 FAIR DRIVE • CALIFORNIA 92628-7200 DEVELOPn1EN i SERVICES DEPAR7MEN7 BUILDING DIVISION COURTESY NOTICE OF PERMIT EXPIRATION Kathleen Ann Crogan 3206 Idaho PI Costa Mesa CA 92626-2208 PERMIT NUMBERS: 803-00225 FOR: Re-roof PROJECT ADDRESS: 3206 Idaho PI., Costa Mesa Our records indicate the above listed permits were obtained for property improvements or alterations at the above address. Per the 1997 Uniform Building Code, Seclion 106.4.4 Expiration, permits are valid for 180 days from the date of such permit, or the date of your last inspection for the project and additional fees will be required to finalize expired permits. According to our records, the permits listed above have not had an inspection for a period exceeding 180 days. If you have a signed inspection card indicating an inspection was conducted within 180 days from the date of this letter, please contact this office so we may , correct our records. If you need to request an inspection please call our inspection Request Line at ' 714-754-5626. If you wish to request an extension, requests must be made in writing addressed t0 Ed Petros, Chief of Inspection, at the above address, detailing circumstances and listing an estimated date of completion. If you do not have an approved final inspection, your permits will expire on December 15, 2005. If you have any questions, please contact the Building Division at 714-754-5273, between 8:00 a.m. and 4:30 p.m., and a staff member will be happy to assist you. The accuracy of records affecting your property is our goal and we appreciate your working with us to resolve this matter. Sincerely, � ��/�Ai % Mary`"Jane Weidenkeller Office Specialist II cc: The Roofing Specialists 2428 Newport Blvd, Unit 5 Costa Mesa CA 92627 Building Di�ision (71a) 7Si-5273 • Code Enforcement (71a) 75�-5623 � Planning Division (71a) 75�-52a5 FAX(714)75a-0g56 � TDD(714)754-5244 • w�vw.ci.costa-mesa,ca.us (714) 754-5273 • Faz (714) 754-4856 • www.ci.costa-mesa.cBaUILDING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626 JobAddress: 3206 IDAHO PL Suite: Vicinity: PATIO ENCLOSURE @ REAR OF HOUSE Parcel Number: 13908402 Applicant: O'NEIL, AARON Address: 765 S STATE COLLEGE BL SUITE I FULLERTON,CA Owner. CROGAN, KATHLEEN ANN Address 32061DAH0 PL Zoning: Phore: (714) 871-0165 Zip: 92831 Phone: COSTA MESA, CA Zip: 92626 Contractor: MURDON CORP DBA AMBIANCE ADDITIONS Address: 765 S STATE COLLEGE BLVD #1 FULLERTON, CA Zip: 92637 Arch : Address: Phone: (714)871-4165 License: 541733 Eng: Address: Phone: ISSUED BY: Status: ISSUED Applied: O7l17/2001 Issued: O7/17I2001 Phone: Zip: License: License: SCOPE OF PERMIT CONSTRUCT NEW 280 SQ FT ICBO APPROVED (#4590-P), SCREENED-IN, ENCLOSED PATIO, ATTACHED TO REAR OF EXISTING SINGLE FAMILY RESIDENCE. Plan Check: $163.31 Permit: �25t25 SMIP Res: $1.46 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $416.02 SETBACKS MAIN STRUCTURE Frcrt 0. 0 ACCESSORY Front 0- 0 PARKING Existinq: o NOTES: P.2ar 12- 9 Rear 0-0 Required: 0 FEE SUMMARY PLANNING & ZONING Left 44- 0 Left 0- 0 Pro osed: 0 Calc Valuation: Claim Valuation: Right 10- 0 Right 0-0 s�a,sao.ao s�a,soo.00 ��. NOTICE: The work authorized by this permit shall comply with all applica6le 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 tor a period ot 180 days. INSPECTIONS: In order for Ihe work euthorized under this permit to be considered legal, such work must comply with all epplicable codes, antl all required Inepectlons entl flnal epproval must be obtained. Failure to obtain inspections and final approval will result in the expiratlon of this perml� FOR INSPECTIONS CALL: (714) 754-5626 / 2aabae (aN0) l WORKERS'COMPENSAnON DECLARAnON: I hereby aHirm un0er penaity of per�ury one ol ihe following tleclarallons: ❑ I have antl will maintain e certilicate of wnsent to selt-Insure for warkers' compensetion, as provitled for 6y section 3700 of the Lebor Code, for Ihe pertormence of [he , work for which ihis permit is issued. arM will mainWln workers' compensation insurance, as requiretl by sectlon 3�00 oi the Lebor Cotle, for ihe pedortnance of the work for which thls permit is issued. rker ' ompensallon Insurence carder antl pollcy number are: ��-Q/�(�.� ��L��— �eN.�.� �yNumtier:-__QZkiLoo'L19 %� i need nof be completed i! the permif Is va7Gede(one huntlretl dW/ars ($100) or less.) -� ❑ I certiy Ihat in the pertormance ol the work br which this permit is issueq I shall not employ any person In any manner so as to �ecoma subject to Iha workers' compansalion laws oi Califomia, and e ree lhat It I should beco�bjea4ae-t orkers' compensation provislons ot Secllon,2700 of� Labor Code, I shell torthwith lmply with these pro '' . � / Applicant SigneNre: - �'Date:- -- � � � � �L,A o� WARNINO�FAILURE TO S RE WORKERS' COMPENSATIqJ WVERAGE IS UNLAWFUL AND SHALL SUBJECf AN EMPLOVER TO CRIMINAL NRLTIES D CIVIL FlNES UP TOONE HUNDRED T/qUSAND DIX.LARE (5100.OW). IN A�DITIIXJ TO THE COST OF COMPENSATION, DAMAGES AS PROVIOED FOR IN SECTION �OB OF THE LABOR CODE, IMEREST, AND ATTORNEI^S FEES. LICENSED CONTRACTORS DECLAflAT10N: I hereby ettirm that I,am licensetl under provislons oi Chapter 9(com ncl wtl ec io of DNision 3 of ihe Business d Pmfeulons Code, end my license is In full force end ettect. hic. #��T4L Class q� CoNrectors Slgn2tu�e: _ � Dete: D - [ � LONSTRUCTION LENDING AGENCY: ❑ I hereby aRirm that ihere is a construction lentling agency for the pertormance of the work tor which �his pertnit is issued. (Sec. 3097, Civil Code). Lendefs Neme: Lentlefs Atltlress: Signeture: OWNER-BUILDER DECLARA710NS: De�e: I hereby ettirm that under penalty of perjury that I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for ihe following reason (Sec. 7031.5, Busineu and Protesslons Code: Any ciry or county which requires a permit ro construct, alter. improve, demolish, or repair any strucNre, prior to its issuence, also requires Ihe flpplicaN tor such pertnit to file a signed sta�ement Ihet he or she is licensed pursuant ro tha provisions oi ihe Contrectors License Law (Chapter 9(commencing with Sectlan 7000) of Divislon 3 of Ihe Business entl Proleuions Cotle) or ihat he or she is e:empt therefrom and ihe �asis for the alleged exemptlon. Any Noletion oi Section 7031.5 by eny epPlicant for e pertnit sub�acts ihe epplicant to a civll penalry at not more then five hundred dollers (5500).): ❑ I, es owner of the pmperry, or my employees wilh weges es Iheir sole compensetion, WILL DO 7HE WORK, entl Ihe stmcture is not imantletl or oNereO for sale (Sec. 7044, Business and Professions CoOe: The Contractors License Lew does not epply to an owner of property who builds or improves Nereon, antl who Coes such work himseN or herseN or ihrough his or her own employees, providad ihat such improvements ara not intentled or oXered for sele. I�, however, the building or Improvement is sold within one year of completioq Ne owner-6uilder will have ihe burden o( pmving that he or sha did not build or improve for purpase of sale.). ❑ I, es owner ol the property, em EXCLUSIVELV CONTRACTING WITM LICENSED CONTRACTORS to construct Na prqect (Sec. 7044, Business ena Protessions Code: The wntractors Llcense Lew does not apply to an owner of property who builtls or Improves thereon, and who coniracts lor such pro�act with e contractor(s) license pursuant to the Coniractors License Laws.). ❑ I em ezempt untler sec. Signature: Ow�ner ID verified 6y tlriver's license. ❑ Yes ❑ No Business enG Professions Cade for this reeson: Vedfication of Ownership hy (type oi document, i.e. - pmperty lax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: Driver's License No. Dete: E:plres: ❑ I hereby certify thai no excavation tive (5) or more feet In deplh Into which e person is required to descend, will be mede in connection wlih work auihorizetl Dy ihls pertnit, end that no building strucWre, scalloltling, lalsework, or Cemolition or tlismantling thereof, will be more Ihen ihirry-six (38) leet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Ttle B, Califomie Administrative Code). ❑ As owner-builder, I will not employ anyone to do work whlch would require a permit from the Division of IndusMel Safety, as notetl ebove, unless such person has a pertnit ta do such work from the tlivision. SigneWre: Dete: Division ol Indusinal Salety Permit Number: CERTiFICA7E OF COMPLIANCE AND AUTHORIZA710N OF ENTAV: I cetlify under penelty of perjury Ihat I heve reatl this epplicetion and stete thet the informetion given is correct I egree to compty with ell stete laws and ciry ortlinances releting ro buliding consiruction, entl authodze represantatives ol the Ciry of Costa Mesa to enter upon Ihe above-described property lor inspection purpos . or ellow occupency of eny building euthonzed Dy ihis permit until linal inspectian. COOE�, INSPECTIONTYPE 7�g IIiIIDSLS 1616 Fixed System Flnal Fire Preventlon 1266 zoo Pool Spa Finel Final Re�Roof 201 Finel BIocWRetelning Well 202 Final Fectory Fire Place 203 Final Sign 204 Final Demolition CODE� INSPECTIONTYPE 206 208 210 212 220 Finel Mechenical Final Plumbing Final Electncel Flnel Flra Preventlon Finel Planning ADproval QAg Itii�lL9 222 Final Site %,,j� 250 FinalBuilding/Occupancy � v'^'� (774) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ce.us 77 FAIR DRIVE, COSTA MESA, CA 92826 Job Address: Suite No Viciniry: Parcel Nunmber: Applicant: ELECTRICAL PERMIT 3206 IDAHO PL ENCLOSED PATIO @ REAR OF HOUSE 13908402 O'NEIL, AARON Address: 765 S STATE COLLEGE BLVD #1 FULLERTON, CA owner: CROGAN, KATHLEEN ANN Address 32061DAH0 PL COSTA MESA, CA Phone: (714) 871-0165 Zip: 92631 Phone: Zip: 92626 Contractor: MURDON CORP DBA AMBIANCE ADDITIONS Address: 765 S STATE COLLEGE BLVD #1 FULLERTON,CA Phone: (714) 871-4765 Zip: 92631 License: Sa1733 ISSUED BY: Status: I SS U E D Applied: 01/17/2001 Issued: 01/17/2001 SCOPE OF PERMIT ELECTRICAL PERMIT FOR NEW ENCLOSED PATIO ATTACHED TO REAR OF EXISTING SINGLE FAMILY RESID�LL 3 LIGHTS, 4 OUTLETS. & 3 SWITCHES. REF: 601-00058 ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool / Spa Lighting Fixts Recepi Outlets Switches Non Res Appl Res Appl Service to 200a Service to 1000a Service over 1000a Morors ro 1hp Motors to tOhp 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 523.50 50.00 so.00 50.00 £0.00 50.00 53.30 $4.40 53.30 SO.OQ 50.00 50.00 50.00 $0.00 50.00 so.00 30.00 50.00 50.00 50.00 50.00 $0.00 50.00 $0.00 $0.00 Quantity 0 0 0 3 4 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FEE SUMMARY Temp Dist System / Lighting Busway/100ft 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 Voltaga EQuipment Low Volt Wiring Syslem I Ckl Misc. Conduit Misc. Conductor Circus ( gen or ride) Circus (mech ride or lights) Christmas Tree Stand Fireworks Stand Other Electriwl Fee Investigation Fee Plan Check Fee Reinspection Fee Quantity so.00 0 50.00 0 50.00 0 30.00 0 50.00 0 50.00 D $0.00 0 50,00 0 50.00 0 50.00 0 50.00 0 50.00 0 50.00 0 50.00 0 50.00 0 50.00 0 $0.00 0 50.00 $0.00 $0.00 50.00 TOTAL CALCULATED FEES E34.50 COMMENTS / SPECIAL CONDITIONS NOTICE: The vrork 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 wlthin 180 days, or If work is suspended or abantloned for a period of 180 days. INSPECTIONS: In order for the work authorized undar ihis permit lo be consitlered legal, such work must comply with all applicable codes, and ell requlred Inepectlona end Ilnal approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration ot this permit. FOR INSPECTIONS CALL: (714) 7545626 / 2aae-se laroo) / / i� WORKERS'COMPENSAnON OECLARAnON: - `! I �ereby eMirm untler penalty o� por�ury one ol the tollowing declaretlons: ❑ I heve end wlll melntaln d certiflcate oi consent to selFlnsure br workers' compenseUon, es pmvided for by sectlon 3700 0l the Lebor Cotle, tor the pertortnence oi the �work tor`whlch this permli Is issuatl. 1 heve epd wlll meinlain workers' wmpensetion insurence, os requireA Oy sectlm 3700 0l the Lebor Catle, for Ihe pertortnance ol Ne work for whicli ihLq pertnit Is Lswetl. My worke compensatb� ��5urence carder @ntl polity number are: ce�a�: �_La.�-c�.n.�ti N�11o�iP.-� Loi�.ryN�_m_,oa�: OLK12aaz�4-� �(ThLa secffan need not be comp�eled i! Me pertnit is ve/ued et one huntlred dWlars ($100) or less.) �"- ❑ I ceNty that in the pertormence of the work for which this permit is issue4 I shall not employ eny person in any menner so as to become su�ject to the workers' compensation laws of Calllomle, end egree Ihat II I should becom^ �,.4jeeFtoih ers' compensatlon proWsions ol Saction 3700 ot Ihe Labor Code, I shall fort�with wmply wiih these ew9ien � /�% 1�.0 % ApPlicanl Slgnature: � �Data:� � WARNINO:�FNLURE-TOSECUREW�KER PENS COVERAGEISUN LPNUSHA�LSUBJECTANEMPLOVEFTOCRIMINAL NALTIES DCIVILFlNESUPTOONEHUNDRED TFIIXASMID DOU.ARE (5100.000), IN ADDfTION TO THE CQST OF COMPENSnTION, OAMAGES �S PROVIDED FO(i IN SECTION 37080F THE UBOR CODE, IMEREST, AND FTTORNEI"S PEES. LICENSED CONTRACTORS DECLARATION: I hereby eHlrtn t�al�l flm Ikensotl untl r proWsions Chapter 9(wmmenc n Sectlon ol DlWslon 3 0l �he Busineu tl Pmtesslons Code, entl my Iicense Is In tull torca en0 eflecL Lic. x 1 S� i%� � ��a,qq p V� i Contredor'sSigneture� � a � �� Date:� 7 ��o � i CONSTRUCTON LENUING AGENCY: ❑ I �ereby ettirtn that ihere is e construction lending agency far the peAormance ol the work tor which Ihis pertnit is issueG. (Sec. 3097, Civil Cotle). Lentlers Name: _ Lendefs Atltlress: Signature: Date: OWNER-BUILDER DECLARAnONS: I hereby eHirtn Ihat untler penulty ol per�ury thet I em EXEMPT FROM THE CONTHACTORS LICENSE LAW for Ihe tollowing reason (Sac. 7031.5, Business ena Pro}essions Cotle: Any ciry or county which �equlres a permit to consWcL alter, improve, tlemolish, or repalr any structura, pdor to Its issuence, also requlres tho applicant br such pertnit to file a signetl stetement Ihet ne or s�e Is Iicensed pursuent to ihe provisions oi the Contrectors License Lew (Cnepter 8(commenGng with SecNan 7000) of Division 3 0l the Business entl Professlons Cotle) or Ihet he or she is exem0� �heretrom end Ihe basis for iha ellegetl e:emptlon. Any vidation ol Section 7031.5 6y eny epPlicent for e pertnit sub�ects Ihe applicant to a civil penalty ol nol more t�an tive hundred tlollers ($500)J: ❑ I, as owner of the property. or my employees with weges es thelr sole compensatlon, WILL DO TME WORK, and the struciure is no1 Intendetl or oflered tor sele (Sec. 7044, Business antl Prof0.55ions Coda: The Contractors License Law does not eppty to an owner ol property who builds or improves thereon, ana who tices such work himsetl or herself or throU9h his or her own employees, providetl that such Imprwements are not Intendetl or ottered Iw ule. If, however, the bulltllnp or improvemem is soltl within one year ot completioq the ownerbuiltler will have the burden of proving that ha or she did not build or imprrne lor purpase of sele.). ❑ I, as owner Of lhe proporty, em E%CLUSIVELV CONTRACTNG WIT?I LICENSED CONTHACTORS to ConSlruct the ptoject (Sec. 7044, Busineu and Profession9 Code: Tha contractors Lltense Law tloes not appty to en owner ol property who builtls ar improves Ihereon, and who conirects for such pro�ect wlth e contraaor(s) license pursuant to iha CDnirectOrs Licanse Lews.). ❑ I em ezemp� under sec. Business antl Prolessions Code for this reason: Signeture: Date: Owner ID vorifletl by drivefs Ilcense. ❑ Ves ❑ No Oriver's LJcense No. Verllltetion oi Ownership by (type of dotumeni, i.e. - proparty �ax blll or deetl): Explres: DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: � I hereby certity that no ex�avetion five (5) or more fee� In tleplh into which a person Is requiretl Io descend, wlll be metle in conneciion with work euthorized by Ihis pertnit, and tha� no buildin8 siructure, scaHolding, falsework, or demolition or tlismantling thereot, will be more then Ihirry-six (36) teet high. (Chap. 32, Gry 2, Art 2, Sec. 341, TiUe 8, Calitomia Administretive Code). ❑ As ownerbuiltler, I will not employ anyone to do work which woultl require a permit from the Oivision of Indusirial Safety, es noted ebove, unless such person hes e permil to do such work from the tlivision. Sipnature: Date: Division ol Intlustrial Selery Permit Number: CERTIFlCA7E OF COMPLIANCE AND AUfHORQA710N OF ENTAV: I cenity under penelty ol perjury that I heve �ead Ihis epplicatlon entl steta that the infortnatlon gHen is correct. I egree to comply wllh ell state laws end ciry or01 ling to Oulltling constructlon, end eulhorize representetives of the Ciry of Caste Mesa to enter upon Ihe above-described propeny tor inspection purpos ree not to occupy ow occupency ol eny building euthorized by Ihis pertnit until tinel insDoction. �Kaa.ApPl�Cant' _" CQOE 1. INSPECTONTYPE 1616 Fi:etl System Finel Fire Prevention 1266 Pool Spe Finel 200 Final Ra-Root 207 Finel BIocWRe�alning Well 202 Final Factory Fira Place 203 Final Sign 204 Final Demolition QAIE I�L$ SeQQE! INSVECTIONTYPE 206 Final Mechanical 2U0 210 212 220 Finel Plumbing Finel ElecttlCal Final Fire Prevention Final Planning Apprwal 222 Final Site 250 Final BuiltlinyOccupency PAg Iti�L� � (714) 754-5273 • Faz (714) 754-4856 • wv+w.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: Suite No Vicinity: Parcel Nunmber: Applicant: Address: 3206 IDAHO PL SIDE OF HOUSE 13908402 MONTGOMERY.FRED ROBERT 9586 BLOOMFIELD ST CYPRESS,CA Phone: (714)952-1332 Zip: 90630 owner. CROGAN, KATHLEEN ANN Address 32061DAH0 PL Phone: COSTA MESA, CA Zip: 92626 Contractor: FRED ROBERT MONTGOMERY Address: 9586 BLOOMFIELD ST ISSUE FEE Temp service test Res. alc 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 l0 1000a Service over 1000a Motors l0 1hp Motors to 10hp Motors to 50hp Motors to 100hp Motors over 100hp Communication drops Sub panel to 200a Pole Ligh[ Pkg Sign Circuils Temp Pwr Pole Intermed Pole CYPRESS,CA Phone: (714)952-1332 2ip: 90630 License: 617473 ISSUED BY: Status: ISSUED Applied: 02/23/2001 Issued: 02/23/2001 SCOPE OF PERMIT ELECTRICAL PERMIT TO REMOVE & REPLACE EXISTING 100 AMP EIECTRICAL SERVICE PANEL, AND AD01 LIGHT81 SWITCH. $23.50 b0.00 $0.00 50.00 50.00 50.00 51.10 50.00 51.10 50.00 50.00 530.50 50.00 50.00 50.00 50.00 50.00 50.00 50.00 50.00 so.00 50.00 50.00 50.00 50.00 Quantity 0 0 0 1 0 1 0 0 7 0 0 0 0 0 0 0 0 0 0 0 0 0 FEESUMMARY Temp Disl System / Lighting Busway /100 N 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 700 kva/kw Low Voltage Equipment Low Volt Wiring System / Ckt Misc. Conduit Misc. Conductor Circus ( gen or ride) Cirws (mech ride or lights) Christmas Tree Sland Fireworks Stand Other Electrical Fee Investigation Fee Plan Check Fee Reinspection Fee Quantity $0.00 0 50.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 50.00 0 50.00 0 50.00 0 30.00 0 50.00 0 so.00 50.00 50.00 50.00 TOTAL CALCULATED FEES 556.20 COMMENTS / SPECIAL CONDITIONS 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, § 7, 12-27-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or ii work is suspended or abandoned tor a period ot 180 days. INSPECTIONS: In order for the work aulhorized under this permit to be considered legal, such work must comply with all applirable codes, ana all required Inapectfons and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of ihis permit. FOR INSPECTIONS CALL: (714) 754-5626 2maae �aroo� WORKERS' COMPENSATION DECLARATION: I hereby ettirm Under penelty ot perjury one of the following tleclaretions: ❑ I have and will meintain e cenificate ot consent ta selt-Insure for workers' compensatlon, es pmvidetl br by section 3700 of the Le6or Catle, lor the paAormance ot the work br which this pertnil is issued. � I hava en� w�� maintein workers' compensation insurance, fls required by secUon 3700 of the labor Coda, for the perfortnance ot ihe work lor w�iU Ihis pertNt is iswed. My workers' compensation Insurence carner entl policy number ere: Cerrier. Poliry Number: (T_ flls seGtlon ne� �or UB 4�wnplefBtl i! ffle pemtit Is V61uetl ef ale huntlrBd d011e/9 (S I00J or less.) ��I.certity th9t In the pertormance ol Ne work tor whlch lhis permit is issueQ I shall noi employ eny person in eny manner so as to become subject lo tha workers' compensa��on �ews of Calitomie, entl egree hat if I should became subject to the workare' compensetlon pmWsions ot Sectbn 3700 of Ihe Lebor Code, I shall torthwlt� comply with theSB visipn . �7,, � Applicnnt�Sign�eNre: � � Date: 2'Z�" �C7T> � WARNING: FAILUqE TO SECURE WORKERS' OdAPENSA I ODVEMGE IS ` FUL AND SHALL SUBIECT AN EMPLOYER TO CRIMINAL PENnLTIES AND dVIL FlNES UP TO ONE HUNDRED TFIOUSANDOOLLAFE�510p.000),INADpIT10NTOTMEWS OFCOMPENSATI OAMAGESASPROVIOEDFORINSECTION3]OBOFTHEUBORCODE,IMEREST,ANDATTORNEI^$FEES. LICENSED CONTRACTORS DECLARATON: I hareby aNirm t1�efPemlicensefl under Qrovisions of C�apter 9(commancing with Section 7000) of DlNsion 3 of �he�Business and Professlons Cotle, and my licanse Is in lull CONSTRUCTION LENOING AGENCY: ❑ I �oreby aHirtn that t�ere is e construction lending agenty br Ihe pedormence ot I�e work lor which this permit is issued. (Sec. 3097, Civil Cade). Londers Neme: Lendor's Atltlress: Signature: _ Date: OWNER-BUILDER DECLARA710NS: 1 hereby affirtn tt+ai under penalty of perjury that I am E%EMPT FROM THE CON7RACTORS LICENSE LAW lor ihe following raason (Sec. 7031.5, euslness antl Professions Code: Any ciry o� �ounry which requires a permit to construct, alter, improve, tlemolish, or repeir eny siructure, pnor to its iuuence, elsa requires the applicant lar suU pertnit ro file e signed statement Ihat he ar she is Ilcense0 pursuaN to Ihe pmdslons of Ihe Contractors License Lew (Chapter 9(commenring wlth Section 7000) at Divislon 3 0l the Business and Professions CodeJ or that �e or she is exempt therefmm antl the basis br the ellegetl exemption. Any violation o� Section 7031.5 by eny epplicent tor e pertnit subjects the apD�icant to a civil penalry ol not more than Trve huntlretl dollars (5500).): . ❑ 1, as owner ot the praperty, or my employees wiN wages es Neir sole compensation, WILL DO THE WORK, and the struclure is not intentled or ofteretl tor sale (Sec. 7044, BusiPess end Professions Code: The Contractors License Law does noI a0P�1 �o en owner ot properry who builds or impmves t�ereon, antl who does such work himself or perselt or through his or her own employeas, provided ihat such impmvements ara not intended or ottered br sale. If, however, the building or imprwemem is soltl within one year ot wmpletion, the ownerbuilder will have the burtlen ol proving that he or she ditl not build or improve for purpose ot ule.). � I, a5 owner of the property, am E%LLUSIVELY CONTRACTING W�Tri LICENSED CONTRACTORS to con5iruct the projett (Sec. 7044, Business and Profession5 Code: The conirectors License Law does not appty to an owner of pmperty w�o bulltls or improves thereon, antl who contracts for such pmject with a contrepor(s) license pursuant to iha Contractors License Lews.). ❑ I em exempt untler sec. Business entl Professions Code for ihis reeson: Signeture: Date: Owner ID verilied by dnvers Ilcensa. ❑ Yes ❑ No Dnvefs License No. Ezpires: Venficetion of Ownership by (type of tlocument, i.e. - properry tax bill or tlead): DIVISION OF INPUSTRIAL SAFETY PERMR CERTIFICATION: ❑ I hereby certtty �hat no excevation live (5) or more teet in depih Imo which e person is require0 to descanq will be made in connealon with work authorize0 by this pertnit, end ��ai no building structure, swttdding, lalsework, or demolition or tllsmantling Ihereol, will be more ihan thirty-siz (36) feet high. (C�ep. 3.2, Carp 2, Art 2, Sec. 341, Tltle 8, Califomla Administrative Code). ❑ As owner-bulider, I will not empby anywie to tlo work which woultl requlre e pormit from Ihe Division ol Intlustnal Sefery, as notetl above, unless such person hes e pertnit ta tl0 such work trom Ihe division. SignaWre: Date: DiviSion ol Indus��al Salety Permit Number: CERTiFICATE OF COMPUANCE AND AUTHORIZA710N OF ENiTiY: I certify untler penalry of perjury that I have read this applica�ion end state lhat the intormatlon given is wrrecL I egree ta �mply with ell stete lews and ciry ordinances relatinp to bulltling construction, entl aut�orize representatives ot the Ciry of Costa Mesa lo en�er upon Ihe ebovo-descnhod p�opony br inspection purposes. I agree not to occupy o� allow occupancy of any buildinq euthonzed by Ihis pertnit until tinel inspecUon. COUE 1. 1NSP.ESD4tl.IYPE PAg ItlIID�LS tme�s 1876 Fi.otl System Final Fire Prevention 1268 200 201 202 203 Pool Spa Finel finel Ro-A�� Finel BIticWRetaining Wall Final Factory Fire Place Final Sitln 204 Final Domolition COOE 1 INSVECTION TYPE 206 Final Mechanical 20B Final Plumbing 210 Final Electrical 212 Finel Fire Prevention 220 Final Planning Apprwal 222 Final Site 250 Final Builtling/Occupancy �OT 5S - TRACT 62 � .�.�:�� COSTA MESA BUILDING-SAFETY DEPARTMENT P. O. BOX 917 COBTA MEHA. CALIFORNIA For Applicanf fo Fill In Compleiely � TYPE OR PRINT BUILDING 3zo6 IDAHO PLACE AODRESS C05TA MESA. CALIFORNIA OWNER KENKOL CONSTRUCTION C0. mplL �555 PLACENTIA AVENUE ADDRE65 cln NEWPORT BEAGH NC1l�I 6- 22 ARCHITECT TEL. K•W• KOLL 2 �555 PLACENTIA F�VENUE j�f�.WPORT BEACH i t 95 TEL. M I 6-3227 NO. _ _ _ � ' NO. OP BLOG9. 8¢TBACK LINe PROM /O � REAR YARD ZO � CEMER Op 8TR66T O f I SIDE YARD I LEFT 1� RIGHT ,� DESCRIPTION OF WORK NFW I^ II ALTFRAT�(]N I II GOOITI(1N I 6ZEDING i6��.7SF NO.OF 6 � � ROOMS STORIES EXTERIOR WALL STUCCOIROOF �OD SHINGLES GOVERiNG COVERING USE OR BUILDING AND WORK TO BE PERFORMED SINGLE-FAMILY RES{-0ENCE AND ATTACHED GARAGE PLAN �-AR APPROVEO BY ZONE ^ � LEOAL �� ECEI�ED .S�-� s- �3 -�� INANCE DEPT. �ITY OF C�STA MESA APPLICATION FOR PERMIT I� ` BUILDING � � For Office Use Only COSTA MESA. CALIFORNIA ZONING NO.OP � / lI6P OF NEW PLANB /� eUILDINO / YARDS APPROVED (CCNTER LIN6 OTJ � �� — EVES -�_� -�a P � HE0.88Y .�CKNOW0.ED62 TNAT I HAVE HEAO TX19 APPlAGT10N TXE AMOUNT BHOWN UNOEP VALUATION 18 POR THE AND BTATe THAT THe I1BWE IS CARPEGT AND AGRHE TO G061- pUIiP086 OP E8TA6LISHING � pERM�T pEe ONLY, PLY WITH A1L CIN 041D1NANCEB AND 8T/.Te LAWB REOULATINO Bu�loIN6 CONBTHUmoN. VALUATION / SIGNATURH OP / / :'ERMI7 FEE $ �(O � PERMITI'E I{� SlI(� � � , S / PLAN CHEGK S �� 'AUTHORIZEDAGENYrLM'W� YL��:�-'vllVh'��F Imr.� «< a �i �L�