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Home My WebLink About3004 JEFFREY DR - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, GOSTA MESA, CA 92626 BUILDING PERMIT Job nddress: 3004 JEFFREY DR Suite: Viciniry: DUPLEX Parcel Number: 41812103 Applicant: RAMIREZ, AJ Address: 200 16TH PL SUITE C COSTA MESA, CA Owner: WILLIAMS, THOMAS Address 2024 MONROVIA COSTA MESA, CA Contractor: A J R ROOFING CO Address: 200 16TH PL SUITE C COSTA MESA, CA Zip: 92627 Arch : Address: Zoning: R3 R3 Phone: 949-548-6654 2ip: 92627 '� Phone: 949-933-4173 Zip: 92627-0135 Phone: 949-548-6654 License: 58&479 � Eng: Address: ISSUED BY: Status: ISSUED Applied: 05/11/2004 Issued: 05/11/2004 � Phone: ' Phone: Zip: License: License: SCOPE OF PERMIT REROOF DUPLEX: T/O EXISTING SHAKE ROOF, 1/2" OSB SHTG, 1 LAYER 30# FELT, APPLY "30-YEAR COMP SHINGLES." 2800 SQ FT Plan Check: Permit: SMIP Res: SMIP Com: Other: Inspection: Total $0.00 $139.25 $o.s7 $0.00 $0.00 $0.00 $139.92 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0-0 PARKING Existinq: 0 NOTES: Rear .�, 0- 0 Rear 0- 0 Required:. 0 FEE SUMMARY PLANNING & ZONING Left 0- 0 Left 0- 0 Proposed: 0 Calc Valuation: Claim Valuation: Right 0- 0 Right 0- 0 $6,700.00 $s,�oo.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) EXPIRA710N: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all reqWred Inspections and final approval must be obtained. Failure to obtain inspections and final approval will resWt in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2466-bfi (fi100) WORKERS'COMPENSAnON DECLARAnON: I hereby eHirtn untler penalry of perjury one oi �he lollowing tlaclarations: ❑ I heve end will maintain a certificate ol conseni ro self-Insure tor workers' compensation, as provided br �y section 3700 of Ihe Lebor Cotle, tor the pertormance oi the wark for whiCh thi5 permit is issuetl. ❑ I heve and will maintain workers' compensation Insurenca, as requiretl by section 3700 of the Labor Cotle, for Ihe pertormanca of the work for which Nis permit is Issued. My workers' compensation Insurence carrier and policy number are: Cerrier: (Tlils se Policy Number: orless.) �I certify that in the paAom �nce of �6rlc fp/which this permit is issued, I shall not employ any person in any manner so es to become subJect to the workers' compensetion lews of ifomia egr �thet If I shoultl become subject to the workers' compensetlon provisions of Section 3700 of the L or Code, I shall iorthwith comply with ihese pro sions ApplltanlSigneiure: Dale: �/ )l UL/ WARNING: FAILURE TO SE (E0.5' COMPENSATION COVEPAGE IS UNLAWFUL ANO SHALL SU81EGf AN EMPLOYER TO CRIMINAL PENPLTIES ANDGVIL FlNES UP TOONE HUNORED T/NJUSAND DOLLARE (51 . ). IN AO�mW�1 TO THE COST OF COMPENSATION, DPNAGES AS PROVIOED WR IN SECTIdJ 31060F THE IABOR CODE, IfJrEREST, AND ATTORNEI"S FEES. LICENSED CONTRACTORS DECIARATION: I hereby aHirtn that I am force and ettect. Lic. a_ Coniractors SlgnaWre: Chapter 8(commencing with Section 7000) of Division 3 of the Business d PrNc es ' ns Code, anA my license Is in full Class k � J �. Date: !/ L CONSTRUCTION LENBING AGENCV: ❑ I �ereby aHirtn (hat there is a Gonsiruclion lending egency for ihe peAormance ot the work lor which this permif is issued. (Sec. 3097, Civil Cotla). Lentlers Name: LendeYs Atldress: Signeture: OWNER•BUILDER DECLARATIONS: Date: I hereby attirtn Ihat under penalry of per�ury thet I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for ihe tollowing reason (Sec. 7031.5, Business antl Protessions Cotle: Any ciry ar counry which requ�res e permit to conswct alter, impmve, demolish, or re0eir eny strucWre, pnor to its issuance, also requires the applicant tor such pertnit to lile e signed statemeni that he or she is licensed pursuant to the provisions of iha Contrectors Ucense Law (Chapter 9(commencing with Sectlon 7000) ot Division 3 oi the Business and Professions Cotle) or that he or s�e Is enempt therefrom an0 the basis for the allegetl e�emption. Any violation ol Section 7031.5 by any epplicant for e permit subjects Ihe epplicant to a civil penalry ot not mora Ihan five hundred dollars (5500).): ❑ I, es owner oi Ihe property, or rtiy employees with weges es their soie compensation, WILL DO THE WORK, and lhe structure is not intendeG or oHeretl for sale (Sec. 7044, Business antl Professions Code: The CoNractors License Law dces not apply to an owner of propeny who builds or improves thereon, and who does such work himself or harself or through his or her own employees, provided tha� such improvemems ere not Intended or oflered br sele. If, however, the building or impmvement is sold within one year ot compla�ioq the owner�buildar will have the 6urden of Droving ihal he or she did not buiid or improve for purpose of sale.�. ❑ I, as owner ot Ihe property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to consiruci the Orojecl (Sec. 7044, Business and Professions Cotle: The contrectors Licensa Law does not epply to an owner of proparty who bulltls or impmves Ihereon, and who contrects for such project with e wntrector(s) license pursuant to the Contractors License Laws.). ❑ I am axempt untler sec. Business antl Professions Code for this reason: Signature: Date: Owner ID venlied by driver5licen58, ❑ Yes � No Drivers License N0. Verilicetian of Ownership by (rype of tlocumem, i.e. - properry tax bill or deed): Expires: DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I herehy certify ihat no excavaCion five (5) or more feet in depth into which a person is requiretl to tlescend, will be matle in connectlon wiih work authorized by ihis permiC and Ihat no building sinicWre, scaHolding, falsework, or demolition or dismentling ihereof, will be more ihan ihitly-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, TM1Ie B, Califomia Administrelive Code). ❑ As owner-builder, I will not employ anyona m do work which wouid require e permit from the Division of Intlustrial Sefety, as notetl above, unless such person �es e permit to do such work imm the division. Signature: Date: Division oi Intlusirial Sefery Permii Num6er: CERTIFlCATE OF COMPLIANCE AND AUfHORVA'f10N OF EN7RV: I certify untler penalty of perjury iha� I have read Ihis application entl sta�e Ihat Ihe information given is correct. I agre pty with ell state laws end ciry ordinances relating to building consiruction, end authonze represeniatives ot the City of Costa Mesa to enter upon Ihe ebove-des ad oroo rtv for inSpsEpon purposes. I egree not to occupY or allow occupancy ol eny building authonzad by t�is permi� until finel inspection. CODE A, INSPEC�IONTYVE 161fi Fixetl Sys�em Final Fire Pr9�entlon 1266 Pool Spe Final 200 Final Re�Roof 201 Final elocWRetaining Wall 202 Final Factory Fire Placa 203 Final Sign 204 Final Demolition �: uil149 / 1 � //l�� Dat ��",`� Date COOEA INSPECTI�NTYPE 206 Final Mechanical 20B Final Plumbing 210 Final Electrical 212 Final Fire Preveniion 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy �E � (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: Suite No Vicinity: Parcel Nunmber: Applicant Address: Owner: Address Conlractor: Address: ,� ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+unils) Pool / Spa Lighting Fixts Recept Outlets Switches Non Res Appl Res Appl Service to 200a Service to 1000a Service over t000a Motors to 1hp Motars to 10hp Motars to SOhp Motors to 100hp Motors over 100hp Communication drops Sub panel to 200a Pole Light Pkg Sign CirCuits Temp Pwr Pole Intermed Pole 3004 JEFFREY DR UNI7 C 41812103 W I �LIAMS,THOMAS 2024 MONROVIA AVE W I �LIAMS,THOMAS 2024 MONROVIA AVE ELECTRICAL PERMIT Phone: 949-933-4173 Zip: 92627 Phone: 949-933-4173 Zip: 92627 Phane: Zip: License: Status: ISSUED Applied: 07124/2002 Issued: 07/24/2002 ISSUED BY: SCOPE OF PERMIT REPAIR TERMITE DAMAGED FLOOR AND WALL. NO CHANGE IN SQUARE FOOTAGE TO UNIT. REPLACEMENT OF WOOD SHALL BE OF THE SAME SIZE. REPLACE ONE SWITCH AND TWO OUTLETS. REF: g02-00137. WORK FOR UNIT C OF A TRIPLEX. $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $2.20 $1.10 $0.00 $0.00 $0.00 50.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantity FEE SUMMARY Temp Dist System / Liqhtin9 Busway /100 ft Standing Section Misc Electrical Equipment Transfortners up to 1 kva/kw ................up to 10 kva/kw .................up to 50 kva/kw .................up to 100 kva/kw ..................over 100 kva/kw Low Voltage Equipment Low Volt Wiring System I Ckt Misa Conduit Misa Conductor Circus ( gen or ride) Circus (mech nde or lights) Chnstmas Tree Stand Fireworks SWnd Other Electrical Fee Investiga6on Fee Plan Check Fee Reinspection Fee $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 TOTAL CALCULATED FEES $26.80 COMMENTS / SPECIAL CONDiTIONS Quantity 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 NOTICE: The work authorized by this permit shall comply vnth all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 7, 12-21-g2) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order fqr the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspeetions and Iinal approval must be obtained. Failure to obtain inspections and tinal approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 , zaaset �sioo� � ,� WORKERS'COMPENSAnON DECLARAnON: � I hereby ettirm untler penalty of perjury one of the followinq declarations: ❑ I have end will maintain a certificate ot consent to sell�lnsure lor workers' compensetion, es provided lor by sedlon 3700 of the Labor Code, for the pertormance of the work lor w�lch 1h15 permil is issuetl. . ❑ I have flnd wlll mainWin workers' compenution insurance, es required by section 3700 of ihe LaDor COGe, for the peRormance of the work tor which Ihis pertnit Is issued. My workers' compensatlon Insurance carrier end pollq number ere: Certier. permit /s velued ef one or less.) Policy Number: �I certity that In the DeAormance o� the work for which ihis pertnit is issuetl, I shall not employ eny person in eny manner so es to become subject to the workers' compensetion laws of Califomia, and agree that II I shorld become sub�ect ro Ihe workers' compensetion proWslons ot Secccqqqon 3700 ot tha Lebor Code, I shell fonhwith comply with thes pr is' s�_' ^' A� �� /^� � Applicent5ignetura: _ Ii�//V`(/`C_ � Dete: -�I ( WARNINO: FAILURE TO SECURE WORKERS' COMPENSATION COVERAOE IS UNLAWFUL AND SHALL SUBJECT Ml EMPLOVER TO CRIMINpLIpENALTIE 0 pVIL FINES UP TOONE HUNDRED TLKKISAND DOLURE (5100.000), IN AODRION TO iHE QDST OF WMPENSATION, OAMAGES AS PROVIDED FOR IN SECTION �W OF THE LABOR �DE, IMEFEST, AND AiTORNEY'S FEES. LICENSED CONTRACTOHS DECLAPATION: I hereby ettirm thet I am licensed under provisions of C�apter 9(commencing with Section 7000) of Division 3 of t�e Business and Professions Code, and my license is in full force and ettect. Lia A Class q Contractors Signawre: Date: CONS7RUCTION LENDING AGENCY: � ❑ I here6y aHirm thet there is e construction lending egency for Ihe pertormance of the work for which t�is permit is issuetl. (Sec. 3097, Civil Cotle). Lentlefs Name: Lenders Address: Signature: �ate: OWNER-BUILDER DECLARA710NS: I hereby ettlrtn thet under penalry of perjury Ihet I am El(EMPT FROM THE CONTRACTORS LICENSE LAW lor the tollowing reason (Sec. 7031.5, Business enA Professlons Cotle: Any ciry or counry which requires a pertnit to consiruct, elter, improve, tlemolish, or repeir eny structure, pnor to its issuance, also requiras ihe epDlicant lar such permit to flle e slgneA statement.thet he or she Is Iicensed pursuflnt to ihe praWsions of the Contrectors LJcense Lew (Chapter 9(commencing with SecNon 7000) oi DlNslon 3 of the Business and Prolessions,Code)�or-that he or she is exempt therefrom end the basis Por the elleged eaemptlon. Any vidation at Sedian 7031.5 by eny appllcaN for e pertnit ub�ecis Ihe eDP��en� to e G"vil penalTy o6not more than flve hundred tlollers ($500).): '�,_ ! d r! \�V N�i „- — s owner ot Ihe property, or.my employees with wages es their sole compensa�lon, WILL DO TME WORK, en0 the siructure Is not intendetl or oHered tor sele (Sec. 7044, Busineu end Pmfessions Code� The Conirectors License Law does not apply to an owner ol properry who builtls or improves thereon, end who tloes such work hlmself or �ereelf or ihrough his or her own employees, provided thet such impmvements ere not intended or oflered tor sale. tl, hov.•ever, Ihe building or improvement is soltl wlt�in one year ot completion, ihe ownercbuiltler will have the burden ot proving that he or she ditl not build or improve for purpose ol saleJ. ❑ I, es owner oi the property, am EXGLUSIVELY CONTRAC7ING WITH LICENSED CONTRACTORS to construct the projecl (Sec. 7040, Business and Professions Code: The conlreciors License lew does not epPly to en owner oi praperty who bulltls or Improve5 ihereon, entl who cantracts tor such pr0�ect with e contractor(5) license pursuant to the Contractors License Lews.). ❑ I em exemp er sec. Business and Pmfessions Cade for this reason: Signature:��///�7YLlR 1 �- � ��L6.� Data: Owner ID venfied by anver's license. es ❑ No Dnvers Licensa No. Expires: Vedficatlon ot Ownership by (type ot tlocument, i.e. � property tax blll or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby ceNty ihe� no escavetion live (5) or more feet in Oept� into which a pe�son Is requlred to descend, wlll be made in connection with work euihonzetl by this permit, and that no building strucWre, scattolding, lelsework, or demoli�ion or tlismantling thereot, will be more than Ihiity-six (36) teet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Tltle B, Califomia Administrative Code). ❑ As owner-�uiltlar, I will not employ anyona to do work which would require e pertnit trom the Division of Intlustnal Safery, as noted above, unless such person �es a pertnit to do suU work trom the tlivision. SipnaWre: Date: Division of InAustrial Salety Pertnit Number: CERTIFlCATE OF COMPLIANCE AND AUTHORVJITION OF ENfAY: I certify untler penalty ot parjury thet I heve read this application and state �het Ne information given is corract. I agree to omply with all state laws and ciry ordinances relaling to building constructlon, end euthodze reprfesentatives of [he Ciry ol Cosia Mesa to enter upon the ebove-desc' ed o`per�ty� for inspec'on puryoses. I egr� not`� wc�y or allow occupency of eny building au�thon)ze/p �this[ 0/�l.q�t (yu'(II � al Inspection. /./1JY�^J c l.ti �L.C�V�,.�� (--f I/ V Signature Of Legal Owner�s) Date IAnd/Or Authorized AppliCenl Date I COOE t. INSFEC710NTYPE Q�ff, INi1TIRL5 1616 Ficetl System Final Fire Prevention 1266 200 201 202 203 Pod Spe Finel Final Re-Roof Final Block/Fletaining Wall Final Factory Fire Place Final Sign 204 Final Demoli�ion COOEA INSPECTIONTYPE 206 Final Mechanical 208 Flnel Plumbing 210 Final Elettncal 2tt Final Fire Prevention 220 Final Planning ApOroval 222 Final Site 250 FinelBuilding/Occupancy O�g It�kfi (714) 754-5273 • Fax (714) 754-q856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT ,lob Address: 3004 JEFFREY DR Suite: Vicinity: UNIT C Parcel Number: 418121Q3 Applicant: WILLIAMS,THOMAS Address: 2024 MONROVIA AVE Owner: WILLIAMS,THOMAS Address 2024 MONROVIA AVE Contractor. Address: Zip: Arch : Address: Zoning: R3 R3 Phone: 949-933-4173 Zip: 92627 Phone: 949-933-4173 Zip: 92627 Phone: License: _ Eng: Address: Phone: Status: ISSUED Applied: 07/24/2002 Issued: 07/24/2002 ISSUED BY: I � � ' / �� , i /� � ►' Phone: Zip: License: license: SCOPE OF PERMIT REPAIR TERMITE DAMAGED FLOOR AND WALL. NO CHANGE IN SQUARE FOOTAGE TO UNIT. REPLACEMENT OF WOOD SHALL BE OF THE SAME SIZE. WORK FOR UNIT C OF A TRIPLEX. Plan Check: $35.10 Permit: $54.00 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $89.60 SETBACKS MAIN STRUCTURE Front D- 0 ACCESSORY Front 0-0 PARKING Ex�stlnq: p NOTES: Rear 0-0 Rear 0- 0 Required: 0 FEE SUMMARY Calc Valuation: g�,5oo.00 Claim Valuation: gi,soo.00 PLANNING & ZONING Left 0- 0 Right Lefl 0- 0 Right ProDosed: 0 � �, NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 780 days, or if work is suspended or abandoned for a period of 1 BO days. �� INSPEC710NS: In order for fhe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all I required inspeetions and flnal approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 , 244&d6 (8/00) WORKERS' COMPENSATION DECIARATION: I hareby eHirtn under penalty ot peryury one of the tollowing declaretions: ' ❑ I heve entl will maintain e certificate oi consent to self-Insure for workers' compensation, es provided br by section 3700 oi the Lebor Cotle, tor the pertortnance of the work for whic� this permit is issuetl. . ❑ I have anG will maintaln workers' compensation in5 rence, as required by 5l:tion 37W of tha Lebor Code, for Ne peMortnance of t ork br which thi5 permit is Issued. M workers' com ensat' I su carrier e olic mber are: � Y P � R fa� Y Carner. . / �( Policy Numher: is section need nof be complefe � e permit i valuea at one hundred dollers ($100) or Iess.J certity that in the peAormance of the work tor which t�is pertnit is issued, I shall not employ eny person in any manner so as to become subject to the workers' compensation lews oi Califomia, end eqree ihet it I should become subject to Ihe workere' compensetion provisions ot Sectio 3700 oi th9 Lebor Code, I shall iorthwlth comply with ihese provision5. I„ �% � Applicant Signeture: Date: �i� V V WARNING FAILURE TO $EWFiE WORKERS' COMPENSNTION COVERAGE IS UNLAWFUT AND SHALlSUBJECT PN EMPLOYER TO CRIMINAL P T1E5 AND CML FlNES UP TOIXJE HUNpRED THOUSMID DOLLARE ($100,OOD), IN ADDITION TO THE COST OF dJMPENSATION, DAMAGES AS PROVIDED FOR IN SECTIIXJ 3106 OF THE L400R CODE, INTEREST, AND ATTORNEPS FEES. LICENSED CONTRACTORS DECLARATION: I hereby ettirtn chat I em licensetl untler provisions of Chepter 9(commencing with Section 7000) of Division 3 of the Business and Professions Cotle, and my license is in full force end ettect Lic. a Class N Contractofs SignaNre: Date: CONSTRUCTION LENDING AGENCY: � ❑ I here6y aHirtn that there is e construction lenaing agency tor (he peAormance of ihe work br which t�is permit is issued. (Sec. 3097, Civil Cotle). LentleYs Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARA710NS: 1 hereby ettirtn ihat untler penalry oF perjury that I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reeson (Sec. 7031.5, Business end Professions Code: Any ciry or county which requires a permit to constmct, elter, improve, demolish, or repair eny simcture, prior to its issuance, also requlres ihe applicant for such pertnit b tile a signed'statement thet ha or she is licensed pursuent to ihe provisions of the Contrectors LJcense Law (Chapter 9(commencing with Sectlon 7000) of Division 3 ot the Busi s and P,rofessions Code) or ihet he or she is exempt Iherefrom end Ihe besis for Ihe alleged exemption. Any violation o� Section 7031.5 by any applicam for e Oermit cts t�e applicaoty�o e ci'vil'penalty.of not more than five hundred dollars ($500).): dv� �( � itx- I, as owner of Ihe properry, or,my employees with weges es Iheir sole compensation, WILL DO THE WORK, and ihe siructure is not intendetl or offered for sala (Sec. 7044,:Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, antl who does such work himself oF herself or Ihrough his or fier own employees, providatl ihat such improvements are not In�entled or oflered for sele. H, however, ihe builtling or improvement is sold within one year of completion, the ownerbuilder will have the burden ot proving that he or she ditl not build oi improve for purpose of sale.). ❑ I, as owner of ihe property, am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, 9usiness antl Professions Code: The contractors License Law does not epply to an owner of property who bullds or improves thereon, and who contracis for such project wlth a contractor(s) license pursuant to ihe Contractors License Wws.). ❑ I em exe t der sec. Business end Professions Code for this reason: SignaNre: � Date: Owner ID veniietl by tlnveYs licens ❑ Na DriveYs License No. E:pires: Verificetion oi Ownership 6y (type of ocume I, i.e. - properry tex bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby cehity ihat no excavation five (5) or more feat in depth into which a person is required �o descenq will be matle in wnnection with work authonzed by this permit, and ihat no building structura, scaHoltling, falsework, or demolition or dismantling ihereof, will be more than thirty-six (36) feet high. (Chap. 32, Grp 2, Ar12, Sec. 341. Title 8, Califomia Adminlsiretive Cotle). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division ot Industnal Safery, as noted ehave, unleu such person has a permit to do such work from the division. Signature: Date: Division oi Industrial Safery Permit Number: CER7IFlCATE OF COMPLIANCE AND AUTHORIZATION OF ENiAV: I certify under penalty ot perjury �hat I have reatl �his application antl state that the infortnation given is correct. I agrae to comply with all stete laws end ciry ordinances relating to building construction, antl euthonze representatives of the City of Costa Mesa to enter upon ihe abov�nb property for�pedi� uryoses. I agre�l to occupy or allow acupancy of any building authorized�hisbelnit nq til finql in�pection. ��4 A' " lZ T l 0 c� Gcr�•� Signature Of Legal Owner(s) D te And/Or Authorized Applicanf Date COpE �. INSPECTIONTYPE 1616 Fixed System Final Fire Prevention 1266 Pool Spa Final 200 Final Re-Poof 201 Final BIocWRetaining Well 202 Final Factory Fire Place 203 204 Final Sign Final Demolition U�TE IN AL GODE I INSPECTION TYGE 206 Final Mechanical 20B Finel Plumhing 210 Finel ElectriCal 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Buiiding/Occupancy Owner: ResidenC Site Address: City/Zip: Parcel Id: Loca[ion: Neighborhood: Wcalth Code: Lcgul Dcsc.: Zoning: Usage: Sryle: Conshvction: Year E3uilt Srories: Ddnns: Baths: Heating: Cooling: Irr. LoC Terrain: Water: Sewer: Sqft 1sC Sqfl Toml: CITY OF �ST D9ESA PROPERTY DETAILS 3004 Jeffrey Dr Costa A7esa, CA 92626-2929 Williams, Thomas+ Williams, Linda I.othien, Andrew 3004 Jeffrey Dr Cost:i Mcsa / 92626-2929 418-12I-03 Costa Mesa City Unknown 5.0 N '1'r 9474 Lot 3 Unknown Market Valuc: Assesscd Land: Assessed 61dg.: Assessed Total: Percent Improved: Delinquent'I'axes: 135: Tnplex Unknown Unknown 1977 Tot.Rms.: 2 Qsmt. Type: Bsmt. Fin.: None (or not available)Gac Type: Unknown GacSq.FL: Unknown Roof Mater.: Unknown Roo(Style: Unknown AtticType: Unknown Condition: Unknown Lot Dim: Lot Size: 3252 Lot Sq. Ft.: Phone: Phone: Tax Address: City/Zip: Own. Occ.: School District: Census Tract: Year Listed: Unknown Unkno�im Unknown UnknoµT Unknown Unknown Unknown 138 acres 60l 1.28 sq. feet PORT (714)S49-lIS9 2024 Monrovia CO5�:1 l�'�C51 no Newport-Mesa Unified 063908 Qlktop Paving: Concrt Paving: Carpon: Deck: Patio: Pole E3am: Pool: Fireplace: Gas: Eleclric: Units: $346,291 Gross Tax Semi Ann.: $184,400 H6920 Gedit Semi.: $161,891 2l3 Credit Semi Ann.: $346,291 R6A Credit Semi.: 47% Flomes�ead Lxemption: Spec. AssmL Semi.: Tax Semi Ann.: Unk. Unk. No Unk. Unk. Unk. No Unk. Unk. 3 $2, I 5924 $2,159.24 Sale Date: t�'ov-01-2001 Mongage Date: Nov-01-2001 Sale Amt.: 5350,000 Mortgage Amt.: $2SQ000 Decd Type: Survivorship Deed Mortgage Type: Conventional Volume & Page: Volume & Page: Seller: Lucas Dennis Gene Trstee Lender: Provident Savings Qk Title Company: Mortgage Term: 2031 Multi-Parcel: No Mng Rate: 7.12 / Adjustable The infomialion is Jeemcd rdiable hut is not guaran[eeJ. 2001-2002 Tax Ycar Copyright 2003 Flaines Printed feb-IS-03 Property Profile Page 1 0£ 1 Property Profile � 2003 DemQuick Informa[ion Systems This information is wmpiled (mm public dacuments and is mt guarantced. Properry Characteristics Bedrooms: BatUrooms: To[al Rooms: Zoning: Heating/Cooling: Sale & Loan Informatio�r Transfer Date: 11-01-2001 Transfer Value: $350,000 First Loao Amt: $28Q000 Loan Type: Primary Owner: WILLIAMS,THOMAS 8 LINDA Secondary Owner: Mail Address: 2024 MONROVIA AVE COSTA MESA, CA 92627 Site Address: 3004 JEFFREY DR COSTA MESA, CA 92626 Telephone Number. APN: 418-121-03 Reference APN: Census Tract: 639.081 Housing Tract Number: 9474 Lot Number: 3 Page Grid Old: 27-F4 Page Grid New: 859-05 Legal Description: N TR 9474 LOT 3 Subdivision: Year Built 1977 Garage: Fireplace: PoolNiew: Seller: CosdSq Feet: $107.56 Lender. Provident Sav Bk interest Rate Type: V Assessed & Trcr Informatian Assessed Value: $35Q000 Land Value: $196,910 Improvement Value: $153,090 Percen[ Improvement: 43.74 Tax Amount $4,397 Tax Status: current Square Feet: 3,254 Lot Size: 6,000 sq ft/ 0.14 acres Number of Units: 3 Use Code: Multi-family Dwelling (2-4 Unit) Document: 0000782168 Title Co.: Orange Coast Title Last Trans W/O$: Last Trans W/O$ Doc: Homeowner Exemption: Tax Rate Area: 15013 [ Re�ort _Menu ] [ Selcct_Ncw_Target_Prgperty ] http://www.gotitle.com/cgi-bin/profi le. asp?rmt=TOPS&graphic=%2Faccounts%2FT073 7... 02/ 18/2003 Attributes Map Layer Attributes for Parcels Property Address Address 1 3004 IEFFREY DR Address 2 COSTA MESA CA 92626 Parcel Informa[ion Assessor Parcel Number 41812103 Legal N TR 9474 LOT 3 Range Township Sec[ion Quarter Sedion Area 6000.07218 Atres 0.14 Owner Owner Address 1 Owner Address 2 Year Built Building Square Feet Building Count Stories Number Parking Spaces Number of Units garage Square Feet Front Footage Depth Footgae Bedrooms Owner Information WILLIAMS THOMAS COSTA MESA CA 92626 Property Specs 1977 3252 1 2 3 851 51 116 Page 1 of 1 http://mesagis2x/website/costamesa/parcel/popup.asp?opt=Attributes&HistoryID= {CD72... 02/18/2003 F � W a Q H y _ F C � F Q C ..l a > � � W a � R' 0. Z W 5 3 � _ i ; : � � 4.34�� • ,.' - - C0S7A MESA BUILDING-SAFETY DEPARTMENT P.O• BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only BVILDING __ _ OWNER �lL+}laT'C7 SeWQ�� TRC. ADDRESS 136 Roc3�ester Street TEL. qTV (`nG}p MPSA 92627 NO. ADOflESS ARCHKECT _ _ TE ADDRESS l.ib ifOCY1PSCPS JLiE'E?L. (..M. GONTRACTOR �ips ADDRESS TEL. CITV NO. STATE CITY LIC. NO, LIC. NO. S12E NO.OF BLOGS. OF LOT NOW ON LOT USE OF EXISTING BLDG. Separate permits are required for electric, plumbing and heating work. USE OF BUILDING AND WORK TO BE PERFORMED I haraby aeknowlatlps thet I heva raetl thia epplleetlon entl rtata chat ihe above informatlon la co�reet end epree to comply wlth all laws fepulatlnp builtllnB �onsiruetion, entl I aheli not employ any persP� �� olation of Ma workman'f eompanaatlon lawf of tha Smm of Californle. 1 hereby cartify t�et I em ptoperlV Ilcenfatl es e contractor untler the Stem ot Celifornle Bufinau a�tl Profeuion� Cotlo, Olvision 3, Chaptar 9, entl Nat such Ilcenses are in full }orce antl efiect, or 1 am axompi from the provislone of Ne Stete of CalHornio Business entl Profass�ona Code, Dlvision 3, Chaptnr 9. Slgnetura of Permittee Authorizetl nt �r3-�•'rr,r1000 >>�� u*�167_.04 APPLICATION FOR STRUCTURAL PERMIT RECENEDBV DATERECENED nnro�ccimn �N O.OF USE OF pYF tANS BUILDING VARDSAPPROVED YARDS DISTANCE BET. MAIN & �. BLDGS. OVED — � =3-R -�� THE AMOUNT SHOWN UNDER VALU THE PURPO6E OF ESTAHLISHING A VERP VALUATION PERMIT FEE S /�/ N PLAN CHECK E $/ �� J/ TAX E TOTALPAID E N n m\ m i m N ON IS FOR m FEE ONLV: ' v N m I � ` O 3 �` f U F � � a d � � x F COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA. CALIFORNIA 92626 , �__..��r,,I� ,, �, . ,,, �A�-. i1C`r.�rV� ��L tii:r'r'kL��.�,�� APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill in Comple[ely — Use Ink Only RECEIVEDBV DATERECEIVED DATEISSUED BUILDING ADDRESS 3004-A B C Jeffr Drive C.M PERMIT NO. OWNER R1CY1�3iC� S2W1��.1 IR . A.P• NO. MAIL AD'DRE S 3OD �,/E� E � ADDRE55 136 Rochester Stseet TEL TFACT LOT BLOCK arv Costa Mesa 92627 "��642-4 CANSTRUCTION NEW ADD ALTER P LENDEP BRANCH � OWNER E �' A�DRESS VALUE ARCHITECT TEL. USE $ 7oe OR ENGINEER NO. — FIRE ADORESS 136 Roch t .cit. S Sd ZONE TYPE GROUP APPROVED CONTRACTOR Q�rjj1eY BV DATE ADDRESS TEL. ZONE NO.OF USE OF NEW CITV NO. P�� BUILDING STATE CITV �'ARDSAPPROVED VARDSAPPROVEO LIC. NO. 'L LI0. NO. MAIN BUILDING ACCESSORV BUILDING SI2E NO.OF BLDGS. (FROM C/l STREET) OF LOT NOW ON LOT FRONT FT. FT. USE OF EXISTING BLDG. FT. FT Separa[e permits are required for �. sioe FT. FT. electriq plumbing and heating work. � REAR FT. FT. VSE OF BUILDING AND WORK TO BE PERFORMED DI5TANCE BET. BET. MAIN & MAIN BLDGS. ACCESS. BLDGS. VAR.# DATE TYl 12X Wl�l dttdC112d 3Y3 e C.U.P.# APPROVED APPROVED O I hereby acknowlatlga thai I hava �eetl ihis application and state � '^ thai the above Information is correct and agree to comply with � m all laws regulaiing builtling consvuction, antl 1 shall not employ any Darson in violatlon of the workman's compensatian laws of m Ma Stata ot Calitomla. 1 hereby certlfy that I am properly licensed az a conttactor under SQ. FT. N the Siaie of Celifornie Businass entl Professions Cotle, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOF m Chapte� 9, and that such licenses are in full force antl effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV: � am exempi trom tha p�ovisions of She Stare of California Business VALUATION PERMIT FEE 5. a antl Professlons Cotle, Dlvlsion 3, Chapter 9. i m Signeture of PLAN CHECK $ ^� `_ o Permlttea $ Tqx g LL � U Authorized A t TOTAL PAI D $ r�