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1849 ILLINOIS ST - Building Permits
CITY OF COSTA MESA BUILDING DIVISION F 77 FAIR DRIVE, COSTA MESA, CA 92614) 754-5273 •Fax (714) 754-4856 www.ci.costa-mesa.ca.us g�CTIONS CALL: (714) 754-5626 �+ V PERMIT NUMBER: BC08-00578 PERMIT TYPE: B_COMBO�'� STATUS: EXPIRzo Sub Type: RES_RRIP Q` DATEISSUED: 12116/ISSUED BY: YHJOBADDRESS: 1849 ILLINOIS STTM Suite/Unit:APN: 13904202 Zoning: , , Vicinity: INTERIOR & EXTERIOR OF HOUSE Primary Occ: R-3 Const Type: V -B SO. FT: 0 Valuation: $15,000.00 SCOPE OF WORK: REPLACE 6 WINDOWS W/SAME SIZE WINDOWS, REPLACE 5 DOORS W/SAME SIZE DOORS, REMOVE EXTERIOR STUCCO & REPLACE WAVOOD SIDING, INSULATE FRONT ELEV. AREAS OF HOME & ATTIC SPACE. ELECT. - REPLACE 6 LIGHTS AT DOOR AREAS. OWNER: CARILLO,ELISABETH AND TOTH, DAMON Address: 1849 ILLINOIS ST Phone: 714437-1147 City/State/Zip: COSTA MESA, CA APPLfCANT: CARILLO, TOTH, DAMON Address: 1849 ILLINOIS ST Phone: 949 683-5604 (CELL) City/State/zZip: COSTA MESA, CA CONTRACTOR: Phone: Address: Unit: Cell: City/State: ARCHITECT; License No. ENGINEER: License No. COMBINATION PERMIT FEE SUMMARY Building Plan Check: $0.00 Building Fees: $251.25 Electrical Fees: $30.10 Mechanical Fees: $0.00 Plumbing Fees: $0.00 SMIP Residential: $1.50 SMIP Commercial: $0.00 Bldg Std Admin Fund ?? TOTAL FEES: $282.85 "Refer to fee receipts for all foes paid for protect License No. Unit: Unit: : ZipCode PHONE: PHONE: EXPIRED n, DATE / _ a O —// Guy NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. CIN$PE"ON TYPE 1616 Fixed System Final Fire Prevention 1266 Pool Spa Final 200 Final Re -Roof 201 Final BlocidRetaining Wall 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition DAT INTMAL$ CODEC INSPECTION TYPE 206 Final Mechanical 208 Final Plumbing 210 Final Electrical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy DATE INnTlAL WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code. for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code. for the performance of the work for which this permit is issued. My workers' compensation Insurance carrier and policy number are: Carrier: Policy Nu ❑ Ice the mance of the work for which this permit is issued, II not on in any manner so as to become subject to the workers' co n ion alifornia, and agree that if should become subject to comp alion provisions of Section 3700 of the Labor Code, I shall fo it In these provisions. Applicant's Signature WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE 15 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 CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Lic. # Contractors Signature Class # CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature Date OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: rI - 3057.46(3/07) Omer ID verified by driver, ncense. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, i.e. - property tax lit(I or dead): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, a demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Applicant's Signature Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safely Code requires. with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2. Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3. Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4. If an RMPP is presently required, has Section 25534 of the California Health and Safely Code been fully complied with? ❑ Yes ❑ No 5. Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? ❑ Yes ❑ No (Section 65850.2 of the California Goverment Code requires that the requested information be furnished on applications for non-residential building permits). 6. Will any part of the facility to be constructed under this permit be wthin 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7. If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. (If yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature Date CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply wth all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature or Legal O ens) And/or AulhorRed Applicant Date . 1 April 30, 2010 CITY OF COSTA MESA P.O. BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 92628-1200 DEVELOPMENT SERVICES DEPARTMENT BUILDING DIVISION EXTENSION NOTIFICATION Damon Toth 1849 Illinois Street Costa Mesa, CA 92626 PERMIT NUMBERS: BC08-00578 FOR: Interior Improvements PROJECT ADDRESS: 1849 Illinois St., Costa Mesa, CA This is to advise you that an extension on the above permit(s) has been approved by Bill Nunes, Chief of Inspection. The extension is valid for 90days. The new expiration date is August 2, 2010. You must call 714-754-5626 for inspection at any time prior to this date or the permit will expire. Additional fees will be required to reinstate expired permits. If you have any questions, please contact the Building Division at 714-754-4871, between 8:00 a.m. and 5:00 p.m., and a staff member will assist you. We appreciate your working with us to resolve this matter. Sincerely, �W)L Barbara . Zwart Office Specialist II Building Division (714) 754.5273 • Code Enforcement (714) 754-5623 • Planning Division (714) 754-5245 FAX (714) 7544856 • TDD (/14) 754-5244 . v .ci.costa-mesa.ca.us April 15, 2010 City of Costa Mesa Building Division PO Box 1200 77 Fair Drive Costa Mesa, Ca 92628-1200 Attn.: William Nunes, Chief of Inspection Ref: Building Permit BC08-00578 1849 Illinois Street Costa Mesa, Ca 92626 Dear Mr. Nunes, �-3o-l0 cid l , aoio 1V K I am requesting an extension on the above mentioned Building Permit BC08-00578 (Exterior Remodel) in order to complete my project. During the course of the last year 1 have completed following on my project: Installation of new doors, windows, and garage door; insulated the exterior walls; insulated the attic; installed new electrical service panel- Permit E09-00239; sheathed the exterior with plywood; installed house wrap-Tyvek; install window trim/ sills. 1 need to complete the following: Install trim at building corners; install Flardiplank siding; and final painting. Other than the electrical scope, 1 have self performed all of the work on weekends only, by myself. By providing an extension this would insure my completion of this project by August 2010. Thank you, Damon Toth CITY OF COSTA MESA P.O. BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 9 26 28-1 20 0 DEVELOPMENT SERVICES DEPARTMENT BUILDING DIVISION EXTENSION NOTIFICATION August 24, 2010 Damon Toth 1849 Illinois Street Costa Mesa, CA 92626 PERMIT NUMBERS: BC08-00578 FOR: Exterior Remodel PROJECT ADDRESS: 1849 Illinois St., Costa Mesa, CA This is to advise you that an extension on the above permit(s) has been approved by Bill Nunes, Chief of Inspections. The extension is valid for 45 days. Your new expiration date is October 8, 2010. You may call 714-754-5626 for an inspection at any time prior to this date or your permit will expire. Additional fees will be required to finalize expired permits. If you have any questions, please contact the Building Division at 714-754-4871, between 8:00 a.m. and 5:00 p.m., and a staff member will assist you. We appreciate your working with us to resolve this matter. Sincerely, 6 Barbara J. ia Office Specialist II Ruilding Division (714) 754-5273 • Code Enforcement (714) 754-5623 • Planning Division (714) 754-5245 FAX (714) 7544856 • TDD (714) 754-5244 • ..ci.costa-mesa.ca.us August 18, 2010 City of Costa Mesa Building Division PO Box 1200 77 Fair Drive Costa Mesa, Ca 92628-1200 Attn.: William Nunes, Chief of Inspection Ref: Building Permit BC08-00578 1849 Illinois Street Costa Mesa, Ca 92626 Dear Mr. Nunes, lokllo I am requesting an extension on the above mentioned Building Permit BC08-00578 (Exterior Remodel) in order to complete my project. I still need to complete the following: Install Hardiplank siding; and final painting. Thank you, c _ � Damon Toth �0$3 '(0 C) J August 6, 2010 CITY OF COSTA MESA P.O. BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 92628-1200 DEVELOPMENT SERVICES DEPARTMENT BUILDING DIVISION COURTESY NOTICE OF PERMIT EXPIRATION Elisabeth, Toth & Damon Carillo 1849 Illinois Street Costa Mesa, CA 92626-2262 PERMIT NUMBERS: BC08-00578 1849 Illinois St., Costa Mesa, CA FOR: Window & Door Change -out 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 106.4.4 Expiration, 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 18, 2010. Additional fees will be required to finalize expired permits. Requesting an inspection - If you need to request an inspection, please call our Inspection Request Line at 714-754-5626. Requesting an extension -If you wish to request an extension, requests must be made in writing addressed to Bill Nunes, 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 property is our goal and we appreciate your working with us to resolve this matter. Sin/"�c,"eD'r,"el`y, Barbara lwi Office Specialist II Building Division (714) 754-5273 • Code Enforcement (714) 754-5623 - Planning Division (714) 754-5245 FAX(714)754-4655 • TDD(714)754-5244 • w .ci.costa-mesa.ca.us CITY OF COSTA MESA BUILDIMG DIVISION >` 77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 • Fax (714) 754-4856 • www.ci.00sta-mesa.ca.us r �.o�. FOR INSPECTIONS CALL: (714) 754-5626 PERMIT NUMBER: E09-00239 PERMIT TYPE ELEC APN: 13904202 JOB ADDRESS: 1849 ILLINOIS ST CM Vicinity: REAR OF HOUSE STATUS: ISSUED DATE ISSUED: 09/10/2009 ISSUED BY: RMD Suite/Unit: SCOPE OF WORK: ELECTRICAL PERMIT FOR A SERVICE PANEL UPGRADE TO 200A, SAME LOCATION (REAR OF HOUSE). OWNER: CARILLO, ELISABETH AND TOTH, DAMON PHONE: 714-437-1147 APPLICANT: TOTH, DAMON PHONE: 949-683-5604 CONTRACTOR: OWNER -BUILDER Address: Unit: PHONE: City/State: ZipCode: ELECTRICAL PERMIT FEES Electrical Plan Check Fee: $0.00 Electrical Permit Fee: $54.00 Reinspection Fee $0.00 TOTAL FEES $54.00 Address: 1849 ILLINOIS ST Unit: City/State/Zip: COSTA MESA, CA Address: 1849 ILLINOIS ST Unit: City/State/zZip: COSTA MESA, CA License No. 000000 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 result in the expiration of this permit. CODE 11 INSPECTION TYPE DATE INMAL CODE/ INSPECTION TYPE DATE INTMALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Root 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 1� WORKERS' COMPENSATION DECLARATION: I here"ffirm finder penalty of perjury one of the following declarations: ❑ I have and whit maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Cade, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance carrier and policy number are: Carrier: (This SWM need xx be compered ante pemv a rdamd at we rammed wilars ISM) w Ion) Policy Number: ted('certify that in the performance of the work for which this permit is , I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the less' compensation provisions of Section 3700 of the La Code, I shall( Jwt4 comply with these provisi ns. 0 — 9 b AI7%cwt'e Slgrnature cl)" -' 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, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Lic. # Carani a Signature Class # CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature Date OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($501 ❑ I, as owmer of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. IL however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). _1,=as•owner'6f the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contmcta(s) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: 1=Sfenature - Ql •- 3057-46(3/07) }* ` Owner ID verified by driverlicense. ci.4s ❑ No Driver's -License No. Expires•. Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, false work, or demolition or dismantling thereof, will be more than thirty-six (36) feel high. (Chap. 3.2. Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As ovmer-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Applicant's Signature Division of Industrial Safety Permit Number: Date HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons. or 200 cubic feet of compressed gas at standard temperature and pressure). 2. Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3. Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4. If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No 5. Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? ❑ Yes ❑ No (Section 65850.2 of the California Government Code requires that the requested information be fumished on applications for non-residential building permits). 6. Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7. If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. (If yes', attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature Date CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of 221sta Mesa t t r upon the above-described property for inspection rp ses. I agr o upy or allow occupa y of any building authorized y 16 permit ection. y �- �Sgllattue arLapt Ownerls) And/pr Authanxed Applicant Dale A4, City of Costa 9desa Building Division 77 Fair Drive, Costa Mesa, CA 92626 Costa Mesa 714-754-5273 / Fax 714-754-4856 OWNER BUILDER VERIFICATION Permit # Disclosures & Forms for Owner- Builders Applying for Construction Permits IMPORTANT! NOTICE TO PROPERTY OWNER Dear Property Owner: An application for a building permit has been sub ijjted in yo me me listing yourself as the builder of the property improvements specified at I U r, L4 V. We are providing you with an Owner-Bui d7r Ackno g nt and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until 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, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION DIRECTIONS: Read and initial each statement below to signify you understand or verify this information. understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner - Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner -Builder and am'aware of the limits of my insurance coverage for injuries to workers on my property. 2_L,i7I'_understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. OT3.,,I,understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may p-Qect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. �4._I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. �5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, Cand:thettotal value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. -1-,61 understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. Y t.,7-bunderstand under California Contractors' State License Law, an Owner -Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed 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. 3148-30 CALBO Jan 1, 2009 OB Packet template 1 of 2 A �8-(.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 1construction defects in the workmanship or materials. \9 unl derstand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. 0 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the party legally and financially res onsible for prgpose nstruction activity at the following address: �A IIlinDI'i E—:1 -1I agree that, as the party legally and financially responsible for this proposed construction activity, I will kidid-e by all applicable laws and requirements that govern Owner -Builders as well as employers. 01 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 this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. Before 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 license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is is4uo to verify the property owner's signature. EM Note: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder. I AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: Tel No I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: 3148-30 CALBO Jan 1, 2009 OB Packet template 2 of 2 January 5, 2006 CITY OF COSTA MESA P.O. BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 92628-1200 DEVELOPMENT SERVICES DEPARTMENT Elizabeth Carillo 1849 Illinois Street Costa Mesa, CA 92626 RE: MINOR CONDITIONAL USE PERMIT ZA-05-72 OPERATION OF A HOME-BASED CHIROPRACTIC BUSINESS 1849 ILLINOIS STREET, COSTA MESA Dear Ms. Carillo: Review of the minor conditional use permit for the above -referenced project has been completed. The application, as described in the attached project description, has been approved, based on the findings and subject to the conditions of approval (attached). The decision will become final at 5 p.m. on January 12, 2006, unless appealed by an affected party (including filing of the necessary application and payment of the appropriate fee) or by a member of the Planning Commission or City Council. If you have any questions regarding this letter, please feel free to contact the project planner, Hanh Tran, at (714) 754-5640, between 8 a.m. and 12 noon. Sincerely, WILLA BOUWENS-KILLEEN Acting Zoning Administrator Attachments: Project description Findings Conditions of approval Approved conceptual plans cc: Gary Wong, Engineering Fire Protection Analyst �j Building Division Eleanor Egan 1893 Parkview Circle Costa Mesa, CA 92627 Budding Division (714) 754-5273 • Code Enforcement (714) 754-5623 - Planning Division (714) 754-5245 FAX (714) 754-1856 - TDD (714) 754-5244 - www ci.costa-mesaca us 91 ZA 05.72 PROJECT DESCRIPTION • The property owner proposes to operate a home-based chiropractic office, providing treatment to a maximum of four clients/customer per day, one client/customer at a time. • One bedroom of the residence will be used as an office/treatment room for the business. The home-based business will allow the property owner to maintain her chiropractor license while being a full time mother. Staff supports the proposed use because the business does not involve more than one client/customer at a time and because this type of business is limited in its ability to serve more than one client/customer at a time. Additionally, the business will not generate more than the eight clients/customers per day maximum allowed by Code with a minor conditional use permit. Coupled with the conditions of approval and Code requirements regulating home occupation permits, the proposed use will not be disruptive to surrounding residences. FINDINGS A. The information presented complies with Costa Mesa Municipal Code Section 13-29(g)(2) in that allowing a home-based chiropractic business is compatible with developments in the same general area. Granting the minor conditional use permit will not be detrimental to the health, safety, and general welfare of the public or other properties or improvements within the immediate vicinity. Specifically, the proposed business will be restricted to one client/customer at a time and a maximum four clients/customers per day. Granting the minor conditional use permit will not allow a use, density, or intensity that is not in accordance with the general plan designation for the property. B. The proposed use complies with Costa Mesa Municipal Code Section 13-29(e) because: 1. The proposed use is compatible and harmonious with uses both on-site as well as those on surrounding properties. 2. The use is consistent with the General Plan designation for the property. 3. The zoning application is for a project -specific case and does not establish a precedent for future development. C. The project has been reviewed for compliance with the California Environmental Quality Act (CEQA), the CEQA Guidelines, and the City environmental procedures, and has been found to be exempt from Class 1 of CEQA. D. The project is exempt from Chapter XII, Article 3, Transportation System Management, of Title 13 of the Costa Mesa Municipal Code. CONDITIONS OF APPROVAL Ping. 1. The use shall be limited to the type of operation described in the staff report, i.e., the home-based chiropractic business restricted to a maximum of four clients/customers per day, and not more than one client/customer at a time. ZA 05-72 2. Hours of operation shall be limited to the hours between 8:00 a.m. and 5:00 p.m., Monday through Friday. No client/customer shall be permitted on the premises on Saturday, Sunday, and federal holidays. 3. There shall be a minimum of 15-30 minutes between treatment sessions to allow departing client to leave the premises before the next rliont arrivcc 4. Any change in the operational characteristics including, but not limited to, hours of operation or client/customer visits, shall require approval of an amendment to the minor conditional use permit, subject to Planning approval. 5. The use shall be conducted, at all times, in a manner to allow the quiet enjoyment of the surrounding neighborhood. The applicant shall institute whatever operational measure necessary to comply with this requirement. 6. If parking shortages or other parking -related problems arise, the applicant shall institute whatever operational measures necessary to minimize or eliminate the problem, including, but not limited to, reducing the number of clients/customers. 7. The minor conditional use permit herein approved shall be valid until revoked, but shall expire upon discontinuance of the activity authorized hereby for a period of 180 days or more. The minor conditional use permit may be referred to the Planning Commission for modification or revocation at any time if the conditions of approval have not been complied with, if the use is being operated in violation of applicable laws or ordinances, or if, in the opinion of the Zoning Administrator or his designee, any of the findings upon which the approval was based are no longer applicable. 8. A copy of the conditions of approval for the minor conditional use permit must be kept on premises and presented to any authorized City official upon request. CODE REQUIREMENTS The following list of federal, state, and local laws applicable to the project has been compiled by staff for the applicant's reference. Any reference to "City" pertains to the City of Costa Mesa. Ping. 1. Approval of the home occupation permit shall remain valid until revoked and shall not be transferred, assigned, or used by any person other than the original permittee, nor shall such permit authorize any home occupation at any location other than the designated one for which the permit was issued. 2. There shall be no employment of persons other than permanent residents of the premises. 3. There shall be no direct sale of products, either wholesale or retail on the premises. 4. No more than one room in the dwelling may be used for the home occupation. 5. No building, space outside of the main building, or garage, attached or ZA 05-72 detached, shall be used for the home occupation. Storage of necessary supplies or equipment used in the home occupation may be permitted in a garage if the storage does not diminish the usable parking space in the garage. 6. There shall be no use of utilities or community facilities beyond that normal to tha rocirlantial i mo of tha nrnnorty .7. No use of material or mechanized equipment not recognized as being associated with a normal household use or hobby is permitted. 8. The structure or appearance of the exterior of the dwelling shall not be altered or remodeled for home occupational purposes either by color, materials, construction, lighting, or in any other way. No part of the interior of the structure shall be remodeled for home occupation purposes other than the interior of the room where the home occupation is being conducted. 9. No signs shall be displayed in connection with the home occupation, and there shall be no advertising using the home address, with the exception of advertising in the telephone directory. 10. The home occupation shall not involve the use of commercial vehicles for delivery of materials to or from the premises, other than a vehicle of no more than one ton capacity, owned by the operator of the home occupation, which shall be stored in an entirely enclosed garage. The storage of equipment such as trailers, tractors, trucks in excess of one ton, wheeled construction equipment, etc. is not permitted. 11. The home occupation shall not generate pedestrian or vehicular traffic beyond that normal to the neighborhood where it is located. 12. The home occupation shall not result in or generate parking or storing of commercial vehicles on public streets. Commercial vehicles are defined in the State Vehicle Code and, in addition, shall include construction equipment and any other mobile paraphernalia used in connection with the home occupation. 13. Any home occupation permit may be revoked by the Planning Division at any time after its issuance if the Planning Division notifies the permittee, in writing, of the decision to revoke the permit. The notice shall state the reasons for the action and shall refer to the appeal procedures prescribed in TITLE 2, CHAPTER IX APPEAL, REHEARING AND REVIEW PROCEDURE Bus. 14. A valid home occupation permit and a business license are required to Lic. conduct business in the City of Costa Mesa. Bldg. 15. Any alteration to the residence to accommodate the home-based business shall comply with the requirements of the California Code of Regulations, Title 24, also known as the California Building Standards Code, relating to ADA accessibility, as amended by the City of Costa Mesa. V 0 0 (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us NG PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 1849 ILLINOIS ST Suite: Vicinity: ROOF AND SKYLIGHTS Parcel Number: 13904202 Zoning: Applicant: CARILLO,ELISABETH AND TOTH, DAMON Address: 1849 ILLINOIS ST COSTA MESA, CA Phone: 714-437-1147 Zip: 92626-2262 Owner: CARILLO,ELISABETH AND TOTH, DAMON Address 1849 ILLINOIS ST Contractor: Address: Arch : Address: Phone: 714-437-1147 COSTA MESA, CA Zip: 92626-2262 Phone: Zip: License: Phone: ISSUED BY: Eng: KENNETH E AGEE Address: Status: ISSUED Applied: 09/25/2002 Issued: 10/16/2002 Phone: Zip: License: License: 3340 SCOPE OF PERMIT RE -FRAME EXISTING FLAT ROOF ON THE ADDITION TO CHANGE ROOF PITCH. ADD ONE SKYLIGHT IN THE ENTRY, TWO SKYLIGHTS (ICBO #NER216) IN THE DINING ROOM AREA. ROOF TRUSSES WILL NOT BE ALTERED FOR INSTALLATION OF SKYLIGHTS. EXTEND OVERHANG AT EXISTING GABLE ENDS. RE -ROOF ENTIRE RESIDENCE WITH 40 YEAR COMP SHINGLES AFTER ROOF FRAMING IS COMPLETED. Total: $300.06 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void 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 the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 e."b (WW) FEE SUMMARY Plan Check: $117.81 Calc Valuation: $10,000.00 Permit: $181.25 Claim Valuation: $10,000.00 SMIP Res: $1.00 SMTP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $300.06 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void 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 the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 e."b (WW) WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit 13 issued. ❑ 1 have and will maintain worKers' compensation Insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed it the permit is valued at one hundred dollars ($700) or less.) ❑ 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person In any manner so as to become subject to the workers' compensation laws of California, and agree that If 1 should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE (5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3100 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Lic. A Class N Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its Issuance, also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not Intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement Is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractors) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: O - yo^ c>7— Owner ZOwner ID vented by driver's license. Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or dead): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet In depth Into which a person Is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administtative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any o0e time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or ...2..........D....o..2e..0.s0 o cubic feet of compressed gas at standard temperature and pressure). ...................... p ................... ...... r will the applicant or present or future buildingoccupant need to file a registration form for acutely hazardous materials? ❑Yes ❑No .. .... (Section 25533 of the Califomla Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ................_.........................._............................._._....................................................._...................................__...................................._........................................................................................................ _............... ..._..................._............_... 3 Does or will the aFFplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP ispresently required, has Section 25534 0l the California Health and Safety Code been fully complied with? ❑ yes ❑ No 5 Does or will the applicant u present or future builtling occupant require for the work which is the sor age c this a plication agermit for such construction or modifiwtlon from the South Coast Air Oualiry Management District or from any other air pollution control district or agency? � Yes IJ No (Section 65850.2 of the California Government Cade requires that the requested information be furnished on applications for non-residential building permits). ....................................................... ................................................... ................................................................................. ................................................. _._.___..................................... ____.................... _................ _.............. __.......... _._.... 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ..... ..................................... ............................-........................................ ................................................... ... ...................................................................................... ......... ... ..... .... ........... .................................... ............ -....................... ...................... 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ..................................................... ................................................................................. ....................... .... .............................. ................................................. .......................... ............. .......................................... ............... ....................................... ..... 8 (If yes", attach certificate of Compliance tram the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the abov(�.Ns nbed property for inspac/ilk/p ,;r es. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owners) Date And/Or Authorized Applicant Date CODE 1. INSPECTION TYPE DATE INTRIASS CODER INSPECTION TYPE gATF RQ1RSLS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical 201 Final BlocktRetaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site �{7 204 Final Demolition 250 Final Building/Occupancy 1�1 (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: 1849 ILLINOIS ST Suite No Vicinity: FAMILY ROOM Parcel Nunmber: 13904202 Applicant: TOTH, DAMON Address: 1849 ILLINOIS ST COSTA MESA, CA Phone: 714-437-1147 Zip: 92626-2262 Owner: CARILLO,ELISABETH AND TOTH, DAMON Address 1849 ILLINOIS ST Phone: 714-437-1147 COSTA MESA, CA Zip: 92626-2262 Contractor: OWNER -BUILDER Address: Phone: Zip: License: 000000 ISSUED BY: Status: ISSUED Applied: 12/10/2002 Issued: 12/10/2002 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 9248, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or it work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 244646 (S00) - SCOPE OF PERMIT ELEC PERMIT FOR ELECTRICAL WORK IN AN EXISTING FAMILY -ROOM IN A SFD. 8 LIGHT FIXTURES, 3 OUTLETS, 3 SWITCHES. REF: B02-01560 FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Temp Dist System / Lighting $0.00 0 Temp service test $0.00 Busway /100 it $0.00 0 Res. a/c package $0.00 Standing Section $0.00 0 New Res (1-2 units) $0.00 0 - Misc Electrical Equipment $0.00 0 New Res (3+units) $0.00 0 - Transformers up to 1 kva/kw $0.00 , 0 Pool / Spa $0.00 0 _ ................up to 10 kva/kw $0.00 0 Lighting Fixts $8.80_ 8 .................up to 50 kva/kw $0.00 0 Recept Outlets $3.30 3 .................up to 100 kva/kw $0.00 0 Switches $3.30 3 ..................over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment - $0.00 "0 " Res Appl $0.00 0 Low Volt Wiring System / Ckt $0.00 0 Service to 200a $0.00 0 Misc. Conduit - $0.00 0 Service to 1000a $0.00 0 Misc. Conductor $0.00 0 " Service over 1000a $0.00 0 Circus ( gen or ride) $0.00 - 0 Motors to 1hp $0.00 0 Circus (mech ride or lights) "' $0.00 ' 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee - $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 9248, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or it work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 244646 (S00) 1 DECLARATIONS i WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain Workers' compensation Insurance, as required by section 3700 of the Labor Cade, for the performance of the work for which this Permit Is Issued. My workers' compensation Insurance canner and policy number are: Carder: Policy Number: (This section need not be completed it the permit is valued at one hundred dollars ($100) or less.) ❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person In any manner so as to become subject to the workers' compensation laws of California, and agree that If I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license Is in full force and effect. Lic. a Class N Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affimm that there is a construction lending agency for the performance of the work for which this pernit is issued. (Sec. 3097, Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, Improve, demolish, or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professlons Code) of that he of she Is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure Is not Intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ 1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an Owner of property who builds or Improves thereon, and who contracts for such project with a contractors) license pursuant to the Contractors License Laws.). ❑ I am pt under sec. Business and Professions Code for this reason: Signature` I/w...-+ti—� Date: IZ - 1 O - OZ. Owner ID verified by drivers license. ❑ Yes ❑ NO Drivers License No. Expires: Vanitcalion of Ownership by (type of document, i.e. - property tax bill or deed... DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet In depth into which a person Is required to descend, will be made In connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 WIII the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ............................................................................................................................................................................................................................................................................................................................................................................................ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Ves ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 2DO cubic feet of compressed gas at standard temperature and pressure). ._....................._........................... .......................................... ._...... _..... _....... ............................................. ....................... ........................................................ .................................... ................._..................................................... I......................... 3 Does or will the applicant or present or future building Occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, carnification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ..............._.._....................._........................_._...__._..._...._............... .... .................... _................. ................._....................... ........... __......................................._..__._. .........................._... ....... _.............. __........ ..._........... _ 4 If .. RMPP is presently required, has Section 25534 of the California Health and Safety Cade been fully complied with? ❑Ves ❑ No 5 Does or will the applicant or present or future building Occupant a require for the work which Is the subject c this a plication a permlt for such construction or modification from the South Coast Air Qualify Management Distract or from any other air pollution control district or agency? � Yes lJ No (Section 65850.2 of the Califomla Government Code requires that the requested information be furnished on applications for non-residential building permits). ................................................................................................................................................................................................................................................................................................................ 6 Will any facility P ........................................................................ y part of the faclli to be constructed under this permit be within 10001ae1 from the outer boundaries of a school? ❑Ves ❑ No (If yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ......................................................................................................................................................................................................................................................................................................................................................................................... 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ............................................................................................................................................................................_... ................................................. ...I-- ........................ .................................................................. .................... I............... _..I............. B (If yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and slate that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the abovey- �crlh'ed property for ins as, I agree not to Occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owners) Date And/Or Authorized Applicant Data CODE If. INSPECTION TYPE PAIS IfQIDALS CODE INSPECTION TYPE gAg INTMALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Root 210 Final Electrical (6 3 201 Final BIocWRstaining Wall 212 Final Fire Prevention 202 Final Factory Fife Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final 8ultding/Occupancy 4F PERMIT CITY OF COSTA MESA �� BUILDING DIVISION F _ DEVELOPMENT SERVICES DEPARTMENT °• �O*noymco `� (714) 754-5273 • Fax (714) 754-4856 Job Address: 1849 ILLINOIS ST Suite No Vicinity: Parcel Nunmber: 13904202 Applicant: CHET WILLIAMS Address: MECHANICAL PERMIT Phone: Zip: Owner: MATSON, KENNETH S JR Phone: Zip: License: Address: CHRISTOPHERSON, COLETTE F COSTA MESA,CA Phone: 1849 ILLINOIS Zip: 92626 Contractor: PRO-FORMANCE INCORPORATED Address: 04085 E LA PALMA Phone: p D 7 7'? ANAHEIM CA Zip: 92807 _ Repair/ Alt Absorblion Unit License: 483411 PERMIT NUMBER M98-00560 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 12110/1998 Issued: 12/10/1998 Arch/Eng: Address: Phone: Zip: License: SCOPE OF PERMIT FAU & DUCTS REPLACEMENT, FEE SUMMARY Quantity Quantity ISSUE FEE $22.00 Repair/ Alt Absorblion Unit $0.00 0 Inst FAU <100 k BTU $13.25 Repair /Alt Refrigeration Unit $0.00 0 Inst FAU >100 k BTU $0.00 Ventilation System $0.00 0 Repair / Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0 Inst / Rep. Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys <100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Refrig Sys >100 k BTU $0.00 0 Compressors / Absorption Systems Gas Piping $0.00 0 Up to 3 hp / 100 k BTU $0.00 0 Factory Fireplace $0.00 0 3 To 15 hp / 500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 15 To 30 hp / 1,000 k BTU $0.00 0 VAV Box $0.00 0 30 To 50 hp / 1,750 k BTU $0.00 0 Vent Fan / Single Duct $0.00 0 Over 50 hp / Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers Fire Dampers $0.00 0 Up to 3 hp $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0 Air Handlers < 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers > 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0_ Other Mechanical Fee Floor or Suspend Healer $0.00 0 Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $35.25 COMMENTS / SPECIAL CONDITIONS EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 r1i DECLARATIOMS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance carrier and policy number are: Cartier: / Policy Number: (This section need not be completed if the permit is valued atone hundred dollars ($1 ) or less.) ❑ 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these pr Applicant Signature: (,-- Z Date: ' -;L-1 -/ —� D WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND HALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37M OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 000) of Division 3 of the Business end Professions Code, and my license is in full force and effect. Lic. P � KI j Class s �' ri-U Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civ,l penalty of not more than five hundred dollars ($500).): ❑ 1, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such Improvements are not Intended or offered for sale. If, however, the building or Improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Dnver's License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gasat standard temperature and pressure). .................................................................................................................................................................................................................................................................................... 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). .................................................. r,pr............. iu.1'.............................................................................(Ris.......................................enti.......rogr...............utel.......................aterials.... 3 Does or will the applicant or present or future Duiltling occupant need to prepare an RMPP (Risk Management end Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ......................... _..................... .................................. ..................................................................................................................................................................... ............................ 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No .................................................................................................................................................................................... 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this plication aomit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes La No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). .................................................................................................................................................................................................................................................................................... 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ........................................................................................................................................................................................................................................ 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is regwired for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made. ❑ 9as ❑ No ............. ................................................................................................................................................................................................................. 8 (If 'yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: _ Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy ofanybuilding authorized by this permit until final inspection. (ASignature Of Legal Owner(s) / D}ta ((( And/Or Authorized Applicant Date CODE ti INSPEIy$!EC]gfi E 1197E INTIMAL 5 OODEt INSPECTIONTYPE 1 I E INTIMALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spe Final 206 Final Plumbing 200 Final Re -Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site _ 204 Final Demolition 250 Final Building/Occupancy 2446-46 11 11 PROJECTADDRESS: 1849 ILLINOIS ST UNIT: OWNER'S R'S NAME: INEZ ALMARODE agOREss: SAME ARCHIENGINEEfl: 546-6192 flEG.NO.: ADDRESS: UNIT: PERMITTEE: INEZ (714)546-6192 ADDRESS: 1849 ILLINOIS CM CA 92626 LICENSED CONTRACTOR DECLARATION: 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. CITY LIC.: STATE LIC,: CLASS: Date: Signature'. WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self insure or a certificate of Workers' ompensation Insurance, or a certified copy thereof (Section 3800. Lab. Q. 1OLICY NO.: EXP. DATE: Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. Date: Applicant! EXEMPTION FROM WORKERS' COM PENSATLON: (This bo eed not be rnplEtee tel permit for one hundred ($100) or less). I certify that in the performance of the wIONork for OECwhAflAT1ich this permit is sued sha' of em eLj an person I�y manner so as to become subject to the WorkersCompensation Laws of California. Date'. �a' 3 O _0 Signature: NOTICE: If. after making this declaration, you should beco blect t Wall a Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permi he be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a co tr tion lending agency for the performance of the work for which this permit is issued (Section 3097, Cry. C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that t am exempt from the Contractors' State License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or repair any structure. prior to its issuance. also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the 1N� structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractors' State License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. N, however the building or improvement is sold within one year of completion, the owner will have the burden of proving he/she did not build or improve for the purpose of sale). I, as owner of the properly. am exclusively contracting with licensed contractors to construct the dialect (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s) license pursuant to the Contractors' Sta icense Law). I am aware that proof of their Worker'S Compensation insurance should be provide me. E] I am exempt under Section: B. S P. C. for this reason: p Date: _� � • 3 � � / V Owner: _ I do hereby comfy that t am aware of and understand the requirements of California aI and Safety Code Sections 25505, 25533, and 25534 and that I or any future building occupant will/will not (circle one) need to c I I with said state codes and the requirements for a permit for construction or modification from the Air Doody Management District. R Ibential construction applications are exempt from these provisions. Date'. Applicant. I hereby certify that 1 have read this application and state that the a ov informatl s car, t I agree t comply with all cit ordinances and state laws relating to building construction and hereb' aut orizer esentat s this city enter upon the aba property for inspection purposes. Date: ��%'3O• O Signature: Driver's License or Social Security N: 164146 While—Building: Green—Code Enforcement, Canary—Ddolicant. Pmk—Revenue: Goldenrod—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 04970 PERMIT NO: B 049703 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: V—N PERMIT TYPE: STA PURPOSE: ALT JOB DESCRIPTION T/OFF REROOF W/COMP SQ FT: 300 CLAIM VALUE: 3,000.00 CALL—VALUE: 300,00 GROUP OCC: R-3 / COMMENTS: REF B49030 iE iE BF+E iE * * * BE 9E BEif iE 1f iE OE 4E dk * RE * ** * * * iEiE iEiF IE BE iE Rt iE+PiERE BE * BE 9E iP Rf BE BF BP iFi4 iEir iFiF * iE BE * * 9EiF iE iE iEiE iE iF ie B(•BE iP if if iF iEIE itB� iE 9P Z O N I N GS ERT EBQAUCIKRSE M E N T S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RIGHT: FT IN PARKING REQ' PROV: PARCEL: 13904202 ZNE: REF NO: PLANNING N TES> > BFkkkkRFk*iF Rk****it iP iF**BE iF*RFk iEdP kiFk*iiiF BP*iE***iE Bf iE iF*kiP it iE iE iF *BEit )E iERE*1t iEiPiE**BE *iFif **1E iE *ftiE****** D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N.T S ZONING APPROVED BY DATE: BUILDING APPROVED BY ; APPLICATION ISSUED BY: �P IE*BP iP BE iF IE Bf iE if iE if lF***3E lEfE iE IE ice€ iP * iH %BE iE iF iF iE iEiE * 1E iE BF iE IE iE IP Rf RE iE BE iE iE iF * * * iE iE iE * iE iE LEGALIZATION:N F E E BLDG PMT PLUMBING ELEC PERMIT 15.00 PLAN ISSUE FEE DATE: iE* BFk ikk if iE BPiE iE Rf iPlE lF iE iF IEif*iE 1F iE$E iE iP iF BE Bf *If i(•iF iE *BEiE if iP iE iE U M M A R Y STRUCTURAL SEGMENT:Y IC MECHANIC FIRE SMIP/RSO GRADING SMIP/NON—RES BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 15.50 0.00 0.00 15.50 15.50 ,00 REVENUE DIVISION TOTALS--> COLLECTED: 15,50 OVER/SHORT:00 BLD15P00 PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOOT GRADING PLAN—CHECK 3F if IE RF k iE * if IF iC RE iE * it RE iE * iE iE iF 3P iP 9E * iP 1E iE iF iP RFiE * * iE iF M RE iF BE 3E RE iP iE iE i6 if KRE iP iP K iE iF iF iP iF iP iP BF iE iE if * iE iE iE 1E BF1E iEiP 1P iP * iE li iE *RP I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST 51-R 300 REROOF BY VALUE RESIDENIAL NOZONE 1.00 300.00 END OF FEES 01 00073128—OC73409 TO -r OATS. A/30/90 T'((Es 11:22 / CONSTRUCTION AND PLAN NIN ' SPA I APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole I 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement .� 3.;.Electri6l Conduit'.Uiility-Undrgrnd. 54. Forms , :• 4. Electrical Condui[cUndrgrnd. 55. Electrical Bonding ' 5F Steel Reinforcement 56. Rough Plumbing & Pressure Test ' - -6' Electrical LIFER Gind. 57. APPROVAL TO COVER-GUNITE j V Footings 58. Electrical Conduit-Undrgrnd. •_� T f"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 u 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 - 'r 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL ' 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT - - - - APPR OVALCS��(Permit# _ :- D7 __10 • -1 20.Rough Factory Fiteplace ! m[c; Z �• :� ,=; => 7, 21,'DuctsStruyturet'z In > -�.. '� .--' :,T o t„ r -70. Underground , .I . .. -. - i. .,_.. * _Hyd_ro 22. Ducts, Ventilating- _ .f c-71. Product!gi ip g O'GBs ❑Oil 23. GasPipe,-_Roug}t &"Test c'•,� y �; [`72. Underground FIu3hC,_. L� hT ,. Y F. 24..800f2Framing: :j- j �:73.cUndargrnd 'St orage-Tank SGas DOT 25. Roof Sheathingr74,�-pyerhead Hydro` -c ; 26.'T -Ban Ceiling (Structural) & Monocoat •�V R �- G 75.cDry Chemical '^ Frame and Flmhin r 27.-9' '.;: x n .t :.,, 76.E -Dry Stand ;':�. S M x _ _ n,V ;28. Lathing & Sid_in9 - , . -_'-L r, r -; .. ••t' ,. 77„7'FIXED SYSTEM�RINAL* t+' .� 29. Insulation ' - '• "'}`� 1 �I°' 78„ -FIRE PREV. FINA4 .A '� . r60. Drywall.Nailing '1. •i I i/ t.m �,'ii .JJ -_ HEALTH•DEPT�R-EQUIREMENT ;31.Plaster Brown�Coat" �!�;•_�9. FINAL INSPcECTION 32. -Electrical Power MetereFinal ; " a n, f + 80. FOOD CER I IFICATE ISSUED �. 33.°Ein5l Electric' '' •' ` U 'f' t°1 k " ['Notes: '7 = T '- 1 =, , r, r 34. Final+Heating'& Air:;Conditi oning1 i p �e _ 35. Final Gas Pipa=Test` .7 - '`'', ` *' • • IT, 36.`Hood or Canopy . + m '� _37.`.Fina l'Factory Fireplace• �•n' =' a "' i !�! !i: ` �- ;' "•.. , T T. 1 •• •- �. `.38. Final}Plumbi ng PJ Y N I d � �•. (�- V, ty I H xln r 1'39. Water Service -Final= .. R i ' T ^ - • �''X O ' 40. Gas Service -Final ' .41. Solar Domestic -Final r•• ^ ' 't't '; 42.'Backflow Preventer;�' ns r I 43. Backflow Irrigations t ':5:5- • • iT"-'^ '+ L- -+ �44. Landscape Ir.fgatioA Systeme;:': -n r- •�•+ ry ,. -- 0! 00 .'t.10 at o -45.k*und AttenLatiom F- ry 7- �• -:46. Handicao'Regulations S -:46. " .r •• .p '� ="` - -' 47.,FI1\AL STRUCTURE & BUILDING ` Q-YQI 1 ' 1:j S I A t,7• F 48..F,INALPLANNING .r ; t .;.,; 1 _49.,Eleciric Release to Edison .t }`r : i:; W _ r50. Gas Release to Sout�ern California, Gas Cc V. i , ^ �' '' "'�" 51. CERTIFICATE OF,OCCUPANCY No. Date PROJECT ADDRESS: 1849 ILLINOIS ST UNIT: OWNER'S NAME: INEZ ALMARODE ADDRESS: SAME 546-6192 ANCHIENGINEER: REG.11 ADDRESS: UNIT: PERMITTEE: INEZ (714)546-6192 ADDRESS: 1849 ILLINOIS CM CA 92626 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (Commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full face and effect. CITY LIC.: STATE LIC.: CLASS: Date: Signature: WORKERS' COMPENSATION DECLARATION: there Ey affirm that l have a certificate olcament to sell -insure or acenuflum of Workers' ce, Compensation Insuranor a unified copy thereof (Section 3800, Lab. Q. POLICY Ill EXP. DATE: Certified Copy is hereby Iumished. ❑ Certified Copy is filed with the city Building Division. Orate: Applicant: ' EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: Obs section need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is Issued, I shall not employ any person in any manner Co as to become subject to it* Workers' Compensation Lam of California. . Date: Signature: NOTICE: If, alter making this declaration, you Should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civ. C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason (Section 7031.5 Business and Professional Code: Any City of county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she Is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not mom than five hundred dollars (3500). I, as owner of the property or my empployees with wages as their sole compensation, will do the work, and the ❑ structure is not intended or offered for sale (Sectlon 7044, Business and Professional Code: The Contractors' State License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however the building or improvement is sold within one year of Completion, the owner will have the burden of proving he/she did not build or improve for the purpose of sale). V I, as owner of the property, am exclusively contracting with licensed contr and Professions Code: The Contractors' State License Law does not apply and who contracts for such projects rilh a contractors) license pursuar that proof of their Worker's Compensation insurance should be provid ❑ I am exempt under Section: B. A P. C. for this reason: Date: 9 17 I do hereby cer ity that I am aware of and understand the requirements of Callum 25534 and that I or any future building occupant will/will not (circle one) need to c permit for construction or modification from the Air SuaTy Management District. these provisions. , Date: Applicant: _ I hereby certify that I have read this application and state that I ordinances and state laws relating to building construction and In property for inspection purposes. Date: i —/ 7 ::if6O Signature: 11`z Driver's License or Social Security N: IMIWhite—Buitdino: Green—Cade Enforcement; Ca tion 7044, Business or improves thereon e Law). I am aware id Safety Code Sections 25505, 25533, and said state codes and the requirements for a construction applications are exempt from I agreecomply with all city and =my Nis cdy anter upon the above-mentionetl Pink—Revenue; Goldenrod—Assessor ' CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 049030 PERMIT NO: B 049030 .PL*N CHECK NO: 04584-90 S GOVT: N SUPP: N CONSTRUCTION TYPE: V—N PERMIT TYPE: SIR PURPOSE: ADD JOB DESCRIPTION : ADD TO SFD CFa_&A,L ky SQ FT: 418 CLAIM VALUE: 12,050.00 CALL—VALUE: 28,842.00 GROUP OCC: R-3 / COMMENTS: ADD TO SFD Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ----------- --------- ACCESSORY BUILDING--------— FRNT: 20 FT IN REAR: 12 FT IN FRNT: FT IN REAR: FT IN LEFT: 5 FT IN RGHT: 5 FT IN LEFT: FT IN RGHT:. FT IN PARKING REQ: 2 PROV: 2 PARCEL: 13904202 ZNE: R1 REF NO: PLANNING NOTES> 418 SF ADDITION TO EXISTING RES. ENCROACHING INTO REAR > YARD BY APPROX. 15 PER..�� D E V E L.O P/M-E N—T S E•'R V I C E S R E Q U I R E M E N T S ZONING APPROVED." BY c SCC _ DATE: gw�7 G d BUILDING APPROVED BY,:_; _ __ _ DATE: _7 Z/-2 j0 APPLICATION ISSUED BY- ` DATE: `sr ############### *for .fir iFR# +YS '#'fir .. xa'p iF. F #R�. fF'$R' if#####lE it##�F 9i„'3f",4'3 WX K3F#7f LEGALIZATION:N F E E"' S U M M A R Y STRUCTURAL SEGMENT:Y BLDG PMT PLUMBING ELECTRIC MtCHANIC FIRE SMIP/RES GRADING PERMIT 278.00 -1 2.02 SMIP/NON—RES PLAN 180.70 ISSUE FEE l BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 280,02 0,00 180,70 , 460,72 460,72 ,00 REVENUE DIVISION TOTALS--> COLLECTED:"'r 280.02 OVER/SHORT:00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 218.00 2.02 I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST ./ SFR 418 DWE—TYPE V—WOOD FRAME ` —GOOD 69,00 28,842.00 END OF FE_FS 01 120061752-000697`9 Ti 0 I .._ .. DATE: 07/17/90 Tit4E: 16121 qr - r CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector PO PA APPROVALS Permit #_ Date Inspector 1. Teriporary Electrical Service or Pole 52. Pool & Equipment Location ` 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms ' 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding ' 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical OF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, 0 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 r f 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING. 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank OGas ❑Oil 25. Roof Sheathing n, /n a ��. 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat-1=f 75. Dry Chemical 27. Frame and Flashing (Q- -IQ 6w#� 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation -30 66i! 78. FIRE PREV. FINAL 30. Drywall Nailing (( �Q, �® HEALTH DEPT. REQUIREMENT 31 'Plaster Brown Coat ��-��- !S°W 79. FINAL INSPECTION 32: Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric 1A2d_g0 U\. Notes: Q O -(Q -I& L94 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or CanopyC4'/pr! 37. Final Factory Fireplace : 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co r= 51. CERTIFICATE OF OCCUPANCY No. Date PROJECT ADDRESS: 1849 ILLINOIS ST UNIT: GWNER'SNAIE: INEZ ALMARODE ADDRESS: SAME 546-6192 ARCHIENGINEER: REG.NO.: ADDRESS: UNIT: PERMITTEE: I N E Z (714)546-6192 ADDRESS: 1849 ILLINOIS CM CA 92626 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full farce and effect. CITY LIC.: STATE LIC.: CUSS: Date: - Signature; WORKERS' COMPENSATION DECLARATION: I hereby affirm that l have a certificate of consem to sell4nsum or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab, Q. POLICY NO.: EXP. DATE: Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. Date: Applicant: EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: This section need not be completed N the pemk is lot one hundred ($10D) or less). I certify that In the performance of the work for which this permit is issued. I shall not employ any person in any manner so as to became subject to the Workers' Compensation Laws of California. Date: Signature; NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Cade, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm met there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civ. Q. LENDER: ADDRESS: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 049032 PERMIT NO: E 049032 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: V—N PERMIT TYPE: ELE PURPOSE: OTH JOB DESCRIPTION ; ADD TO SFD (FAMILY ROOM) SQ FT: CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 / COMMENTS: RE: B49030 PRIMARY BLDG. PERMIT, ############################################################################### Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------- MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR: FT IN FRNT; FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ• PROV: PARCEL: 13904202 ZNE: REF NO: PLANNING N TES> BLDG PMT PLUMBING ELECTRIC MECHANIC .00 FIRE SMIP/TOT GRADING PLAN—CHECK for the purpose of sale). 26. 2 5 `v I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business © Law does not apply tow owner otpropeny builds improves thereon and Professions Code: The Contractors'Slate License who or and who contracts for such projects cith a contractor(s) license pursuant to the Contra icen Law). I am aware that proof of their Worker's Compenset:on Insurance should be provide e. D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY DATE: BUILDING APPROVED BY : _ _ DATE: APPLICATION ISSUED BY: DATE: F3F.; %IF'iF LEGALIZATION:N F E E S U M PA R Y STRUCTURAL SEGMENT:N OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors' State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 11 25 (Section 7031.5 Business ad Pro:essional Code: Any city of county which requires a permit to construct, alter, improve, demolish, or the for to file helshe Is licensed 50% repair any structure, prior to its issuance, also requires applicant such permit a signed statement that pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business PLAN SM I P / NON —RE S and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by ISSUE FEE 15.00 Safety de Sections 25505, 25533, and any applicant for apermisuthectstheapplicanttoacivipenaltyofnotmorethanfivehundreddollars($500). BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE I, as owner of the property or my a hyees with wages as their sole compensation. will do the work, and the ❑ structure is not intended or offered for sale l3echon 7040. Business and Professional Code: The Contractors' State License Law TOTALS ---- > 11,25 15.00 0.00 26,25 26. 25 .00 does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such Improvements are not intended or offered for sale. If, however the budding or REVENUE DIVISION TOTALS--> COLLECTED: 26.25 OVER/SHORT: improvement issdd within one year of completion, the Owner will have the burden of proving he/she did not build at improve BLDG PMT PLUMBING ELECTRIC MECHANIC .00 FIRE SMIP/TOT GRADING PLAN—CHECK for the purpose of sale). 26. 2 5 `v I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business © Law does not apply tow owner otpropeny builds improves thereon and Professions Code: The Contractors'Slate License who or and who contracts for such projects cith a contractor(s) license pursuant to the Contra icen Law). I am aware that proof of their Worker's Compenset:on Insurance should be provide e. I N D I V I D U A L F E E B R E A K D O W N ❑ I am exempt under Section: B. 8 P. C. for this reason: Lfid TYPE Date: �— V Omer: LE I do hereby candy that I am aware of and understand the requirements of Ca I omia Hea Safety de Sections 25505, 25533, and E L E 25534 and that I or any future building occupant w�lIVMII at (circle ane) nee tl to comp permit lot construction or modification from the An D ity Management Distract. Bes . said state codes and the requirements for a final construction applications are exempt from EL E these provisions. Date: Applicant: I hereby eeNy that I have mad this application and slate I the a inform n a Mct. I a ree to comply with all city and county PunWdID Ordinances ad state am maWg to building construction and hem f mum of tit to enter upon ed property for inspection purposes. Date: �/ 7_ ?OSignature: Driver's License or Social Security N.: 1641-48 White—Building: Green—Code Enforcement: Cart.1—Applicant: Pink—Revenue: Goldenrod—Assessor QTY D E S C R I P T I O N 5 FIXTURES, LIGHTING 1 ST 20 EA 7 RECEPT/OUTLET 1 ST 20 EA 3 RECEPT/SWITCH 1 ST 20 EA END OF FEES UNIT COST TOTAL COST 75 3,75 ,75 5,25 .75 2,25 L: 000E"'57—'COE77t9 7!57 DATE* 09/17/90 TinE: i6:V CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector PO PA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location ' 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement - 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test " 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test " 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 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 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL ' 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas 00il 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas 000 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing - HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final ,� 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final `I 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irriqation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date PROJECT ADDRESS: =h� — L— NC.. Jr• ST UNIT: OWNER'S NAME: = = ADDRESS:~"••�—.0-'7C .:h:_L A?.—.H 0 O:S COSTA XESA,CA J 92626 ARCHIENGINEER: REG.NO.: ADDRESS: UNIT: PERMITTEE —N-7 A ADDRESS: . j St 9 _ —.. I :� Cg: S" ST C.:' CA 92626 LICENSED CONTRACTOR DECLARATION: I hereby alhrm that) am licensed under provisions of Chapter 9 (commencing with Section i000) of Division 3 of the Business and Professions Code. and my license is in full force and effect. CITY LIC.: STATE LIC.: CLASS: Dale: Signature: WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800. Lab. C). POLICY NO.: EXP. DATE: COMPANY: ❑ Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division, Date. Applicant: EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This: Qhis sectit a dol be completed i���r one hundred ($100) or less)oot be completed i���r one hundred ($100) or less). I teddy that in the performance of the work for which this permit is is l I hall not emp person m y manner so as to become subject to the Workers' C3 pensation Laws of California. Date: 37 2-' / Signature: NOTICE: It alter making this declaration, you should become lett to t orkers' Compensation provisions of the Labor Cotle, you must forthwith comply with such provisions or this permits a deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for which This permit is issued (Section 3097. Civ. C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the ContractorsState License Law lot the following reason (Section 7031.5 Business and Professional Code: Any City of county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior t1% is issuance, also requires the applicant for such permit to file a signed statement that he she is licensed pursuant to the provisions of a Contractors' Stale License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7034.5 by any applicant for a permit subjects the applicant to a civil penalty of not mare than five hundred dollars (S500). h as owner of the property or my empployees with wages as their sole compensation, will do the work, and the O structure is nal intended or offered for sale f5ection 7044. Business and Professional Code: The Contractors' State License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. H. however the building or improvement is sold within one year of completion, the owner will have the burden of proving he/she did not build or improve for the purpose of sale). I, as owner of the properly, am exclusivelyy contracting with licensed contractors to construct the project (Section 7044, Business 13 and Professions Code: The Contractors' Stale License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractors) license pursuant to the Contractors' Stale License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: B. 8 P. C. for this reason: Dale: S• ZLf' 3 Owner I do hereby certify that I am aware of and understand the requirements of California Healt Safety Code Sections 25505, 25533, and 25534 and that I or arty future building occupant will/will not (circle one) need to comply said stale codes and the requirements for a permit lot construction or modification tram the Air Duality Management District. Residential construction applications are exempt from these provisions. Date'. Applicant: I hereby cedify that I have read this application and state that the above information is correct. I agree to comply with all cit ordinances and state laws relating to building construction and herebyauth - repreaentali nter upon the abo property for inspection purposes. 2 Date'. S-Zl�_J Signature: Driver's License or Social Security N: ,, - 164146 White—Building; Green—Cotle Enforcement: Canary—ApplicanC Pink—Revenue: Goldenrod—Assessor antl C:TY CF COSTA .`:ESA - BJ:L:''}:G ?ERY:_ -::R:. ..-, E C - -- PER.,:-_7 ?:C: - 0623:3 .LA:� CHa :', NO; 30VT: ''2N TRJCT:O?: TYPE. ?E',..:. TYPE. _LE ?;;R?CSE. 0= S03 DESCRIPTION LEGALIZE -CECT. riORri FOR PORTAFLE SPA T3 FT: ZLA::. VALUE: CALC-VALUE: GR'DJ? C -C: :0 07=ER :ORI: A:.THCR:ZED BY THa' PERM' #######'F#Yl'jF####?{Yil-{•'-Jj-ai#%V'###MY#i'•###tT##%9E!F#u)P#:1'##t{:i. n. int #'1''######4'�+-#'#1E Y -#i ±•Y.•.: .�##'V' Z 0 N_ :. G R y; R E Y E T S S E . B A—Q+.. 2 ------------ :--'.A:?' PL:iD:�G ---------- --------- ACCESSORY B"TLDING--------- FR�" FT :N REAR: - '?' FAN7 FT :X REAR: FT " ..-.. :N RGH'. FT ::\. FT :N tSGH7. FT :X PARKING REQ: PROV: PARCEL: 13904202 ZNE: REF D:O: PLAN: ':NG NO. ES> ##########±%####'isi:1F###i#i###%#F###�'M'i^###i6 jC#{�##?'.'?iE{.:i#{c.i •.'=##if%#V#i###i;l: ti{ 'J.N ',: {'ie {Y. DEVELOPIXENT S &.R V I C E S REPUIREYENTS ZONING APPROVED BY LATE: BU:LDING APPROVED BY APP':CAT:ON TSSJED BY: _ LATE: ##############{i#######+,:% %.;%:.RY- %% ..w%.%'%RR R!'% •:.k##"-ftYYl YY. :+r♦ -ttt >#{F ###########{(}r.u###?F###iE?E###+i####ii##r�F{###iF###i'#«#}##3E#}�.#Y-####?E#u+-±. a,+.• '-#3:+i%#x LEGALIZATION;Y F E S Y YAR Y STRUC':RA:i SEGMENT:X BLDG PXT PLJ?^.9'NG ELECT:LIC XECEA,ti7C F:RE 5:::?/ ES GRAD:\G PER" -::T 22 • 130 Pr AN _ 5 FEE .00 E;." :G --:V-> PE t:'-- T :SEUE PLAN-CF:ECIC TOTAL ?A: DL TO=A:-'----> 22.00 :5.00 0.00 37,00 37,00 ,00 REVENUE D'?T-S:Gti ,C -,C--> COL_ECTED: 37.00 CVER/SF,-,R .00 BLDG P?:T P:,::MB:NG ZLECTR:C .:ECRA_=C FT_RE SYIP /TOT GRADI?'3 ?LA?:-CEEC:{ 37.00 i : X D I V I D ;.IA L FEE B R E A N D 0 W N. TYPE OTY D E S C R: P_' O N UNIT COST TO'T'AL COST ELE _ XISC CONDUIT NOT L:STED REO PEZ:':T 11.00 :1.00 END OF FEES RM�'UUAY, a 1993 2 CITY OF Cl" ,*A MESP� �1 CONSTRUCTION AND PLANNING APPROVALS Permit Date Inspector POL . SPA APPROVALS Permit "- Date Inspector I, i 1. Temporzry Electrical Service or Pole 52. Pool & Equipment Location I 2. Soil Pipe Undrgrnd. 53. Steel Remtu,cement 3. Electrical Conduit Ur hty-Undigrild. 54, Forms -- 4. Electrical Condu.t-U-d-7pci 55. Elecvical Bond rg - T� 5. Steel Reinforcement 56. Rough Plumb.rg & Pressure Test I ~ 6. Eicctrical UFER Gr,d 57. APPROVAL TC COVER GU:,: TE 7. Fcotings 58. Electrical Cocdu B. Foundation 59. Cas Pipe. r, Uru-r, r ,'cs, I 9. Water Pipe-Undrgrnd. 60. &icl,v:ash Lm , P Trar, n U,.urrrnd I 10. Structural Floor System 61. APPROVAL TC DECK ' ~� 11. Property Sewer Line & House Connection 62. Backv.zsh & Receptur-r it:al 12. Sewer Cap 63. Heztcr & Vent -Final - 13. Roof Drains 64. Plumbing System - Fi^aI 14. Rough Plumbing 65. Electrical -Final . 15. Rough Electrical -Conduit 66. Solar System Finz' 16, Rough Electric Wiring 67. Fencing & Access Approe::! - - 17. Rough lW.r,rg S.gn 68. APPROVFD FOR PLA`iFERING -1 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SVSTE.IS FINAL r~ FIRE DEPT. REQUI3Efl'EN7 APPROVALS Pcrrmrt :i� 19. Rough Hcatmg & Air Cardrtmrr,n9 20. Rough Factory Fireplace 21. Ducts, in Structure - 70. U.idcrgrcu-id 22. Ducts, Ventilating 71. Product Pining f ; Gas -.' OI' 23. Gat Pipe -Rough & ?est 72. Undergrccnd Flus-, , 24. Roof Framing 73. Undcrgrnd.Stnrzyr Tank L7Gas Od 25. Roof Sheathing 74. Ovcrecac Hydrr I 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standp.; c 28. Lathing & Siding 77, FIXED SYSTEM FINAL l 29. Insulation - 78, FIRE PREV. Fl%AL - -f 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 70. Fli_A_. IR'-'ECTICU--- �� -- - - 80. FOOD CERTIFICA-, E ISSUED / 31. P,astcr Broc:n Coal 32. Electrical Power Meter -Final -_+ 33. Fina' Electr c 34. F.nal Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fbep'ace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final -I 42. Backflow Preventer ~ 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co -y 51. CERTIFICATE OF OCCUPANCY No. Date l + i ER DATE JOB ADDRESS 1849 Illinois Street BUILDING PERMIT NO. 43300 GENERAL CONTRACTOR Taylor Const DESCRIPTION of WORK Patio Cover -AP No. 139-042-02 LOTTRACT FIRE ZONE VALUES 450.00 GAS + SUBCONTRACTOR PROP: SWR. LINE Ej HOUSE CON. ❑ SPRINKLING SYSTEM SCELLANEOUS ROUGH HEATING AND AIR CONDITIONING' TEMPORARY SERVICE OR POLE UNDERGROUND ❑ POWER ROUGH WIRING TRENCHES Lj FORMS STEEL REINF. FLOOR SYSTEM BOND BEAM 'STEEL REINFORCE ❑ SHEATHING FRAME AND FLASHING LATHING - IN ❑ OUT ❑ PLASTER, BROWN COAT STRUCTURAL. FINAL HEATING, VENT., REFRIG. AND A,C., FINAL PLUMBING. FINAL AND GAS TEST I -I ELECTRIC. FINAI 433 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 7200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only BUILDING ESS , 1�i A0� BUIL OWNER v MAIL ADDRESS + CITY C(b NOL��Cp��, CONSTRUCTION BRANCH ADDRESS ARCHITECT /Ar '� TEL. Or Pn I:w i a-77TM�"d0 509 '> tet; * **5.50 APPLICATION FOR STRUCTURAL PERMIT RECElAfEMWI DATE RECEIVED ffRTIPTRJ.n A.P. N OWNER T BLOCK FIRE ADDRESS ZONE TVP GROUP - 'APPROVED 7 CONTRACTOR By DATE ADDRESS ,20 E. —4;2—d TEL. ZO NO. OF USE OF NEW p407. t4. s D CITY NO� PLANS BUILDING STATE �./�� CIT -V s- LIC. NO �,3 Zs f'�D I LIC. NO./Zj3.,;;' YARDS APPROVED MAIN BUILDING YARDS APPROVED ACCESSORY BUILDING W SIZE NO.OF BLDGS. (FROM C/L STREET) L OF COT NOW ON LOT FRONT FT. G USE (/ EXISTING BLDG. T FSeparate permits are required for - L. SIDE FTJ FT. electric, plumbing and heating work. or . REAR FT. FT. I.W. USE OF BUILDING AND WORK TO BE PERFORMED DISTANC9 BET. BET. MAIN & Q MAIN SLOGS. ACCESS. BLDGS. C -X2 VAR. # DATE Q1:2 -4V C.U.P,+ APPROVED 7p _ APPROVE 'I } r ATE a. W 0. I hereby -acknowletlge that I have read this application and state' n I% that the above Information is correct and agree to comply with f S a all laws regulating building'constru'ction, and I shall not employ m any person In vlolatlon of the vvcrkman's compensation laws of o IZ the State of California. - 3 I hereby certify that I am properly licensed as a contractor under SQ. FT. v THE AMOUNT SHOWN UNDER VALUATION IS FOR the State of California Business and Professions Code, Division 3, to Chapter 9, and that such licenses aro in full force and effect, or'I THE PURPOSE OF ESTABLISHING A PEI FEE ONLY: am exempt from the provisions of the State alnornia Business y antl Professions Co Ivitlon 3, Cha for 9. sl VALUATION PERMIT FEE E 0 JL PLAN CHECK § �� Signature Od m c TAX $ Permitt $ �O u. u TOTAL PAID II Author) gent k;, -',l Vi I Ci J aU i 2�01UAAA 7tcn—,c Z, ell I P 17 . ,Z: 'k /jcu6-7 '53 COSTA MESA BUILDING -SAFETY DEPARTMENT P. O. BOX 917 COSTA MESA. CALIFORNIA For Applicant to Fill In Completely TYPE OR PRINT COSTA MESA. CALIFORNIA EEE RECENED _.'i -i MAY 161960 FINANCE DEPTPr>�l CITY OF COSTA MEA APPLICATION FOR .PERMIT BUILDING For Office Use Only OWNER Vermont Avenue Land Co. Inc. fl8C81PT NO. ,J2,11��y-� qN •Gyf MAIL RECEIVE I OATS RE EZI Dir VSBUE ^O� ADDRESS Vim(-- C// mN 1J Costa iMesa Li811 UILDIN BUILDING CITY NO. ADDRESS ARCHITECT Carlson & TEL. COSTA MESA. CALIFORNIA OR ENGINEERNO. •Garden ADDRESS Grove FIRE ZONE D TYPE GROUP`ry� CONTRACTOR Dike & CO e aveIRC• APPROVED BY DATE E. 17th St. ZONING ADDRESS 419 /� 'rr Costa Ursa ZONE NO. OP USE OP NEW ing e Fat CITY RLAN BUILDING STATETEL. Ll8_11 LEGAL LIC. NO. 167293 NO. • EGCRIPnoN SIZE NO. OF BLD08. I OF LOT 1 Now ON LOT none A. P. NO. nnnp USE OF YARDS EVES EXISTING BLDG Nnnn APPROVED ALLOWED SETBACK LINE PROM (CENTER LINE ST.) CENTER OF STREET 01 REAR YAR 11 11 FRONT 2 FT. IN. SIDE YARD I LEFT 51 I RIGHT 51 R. SIDE FT. IN. DESCRIPTION OF WORK L. SIDE FT. IN. NEW I I ALTERATIONI IIADDITION I REAR _ FT. IN. REPAIR MOVING I I DEMOLISH I BYPROVED DATE BUILDING NO. OF ' 82E O t ROOMS 7 STORIES 1 EXTERIOR WALL ROOF COVERING COVERING USE OF BUILDING AND WORK TO BE PECK D MED Sinp,le family residence with attached garage. Plan 20AR I HEREBY ACKNOWLEDGE THAT I NAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION Ie FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION BUILDING CONSTRUCTIO^ SIGNATURE OFv _PERMIT FEE $ 36. PLAN CHECK $ 18. PERMITTE S 16,101. AUTHORIZED AGENT Dike & aclegrove, Inc. TOTAL FEE 5L.