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Home My WebLink About2976 MINDANAO DR - Building Permits(714) 754-5273 • Fax (774) 754-4856 • vnvw.c�.costa-mesa.r��LDING PERMIT n FAIR DRIVE, COSTA MESA, CA 92626 .lobAddress: 2976 MINDANAODR Suite: Vicinity: FAMILY ROOM, MASTER BED/BATH Parcel Number: 13923111 nppiicanC HALL, BARRY Address: Owner: Address OHLAND, JEFF P 2976 MINDANAO DR COSTA MESA, CA� Zoning: R1 R1 Phone: 714-966-3048 Zip: Phone: Zip: 926263614 Contractor. CONSTRUCTIVE IMPROVEMENTS Address: PO BOX 1740 - Arch : Address: COSTA MESA. CA Zip: 92626 na�rv�ran:� Phone: 714-9663048 License: 757535 Phone: 714-5458646 Slatus: ISSUED Applied: 07I09I2003 Issued: 08/1&2003 ' �� : /a/ Eng: JERRY TUCKER R ASSOCIATES Address: 350 E 17TH ST COSTA MESA Phone: (949) 6452422 SANTA ANA, CA SUITE 210 Zip: License: C5012 92628 License: 2187 SCOPE OF PERMIT CONSTRUCT 1,053 SF ONE STORY ADDITION-TO AN EXISTING SINGLE-STORY SFD. WORK TO INCLUDE ADDITION OF A NEW FAMILY ROOM WITH A BAR, MASTER BEDROOMIBATHROOM AND WALK-IN CLOSET. REROOF EXISTING HOUSE WITH MONIER LIFETIIE (6PSF) ICBO #2656. ALSO INCLUDES FURRED ARCHES/SOFFITS IN KITCHEN AND DINING ROOMS. 25% MAXIMUM REAR YARD LOT COVERAGE ALLOWED; 25% PROPOSED. Plan Check: �671.42 Permit: $1,032.95 SMIP Res: $10.63 SMIP Com: $0.00 Other: $0.00 Inspeclion: $0.00 Total: 51,715.00 SETBACKS MAIN STRUCTURE Front 20- 0 ACCESSORY Front 0. 0 � Rear 10- 0 Rear 0. 0 FEESUMMARY PLANNING & ZONING Left 5� 0 Left 0- 0 Calc Valuation: Claim Valuation: Right S 0 Right 0- 0 sios,zsz2o So.00 NOTICE: 7he work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 1241•92) EXPIRATION: Thls pertnit shall automatirally explre antl become void if work is not commenced within 180 days, or If work is suspended or abandoned for a period of 1 BO days. INSPECTIONS: In order for the work aulhorized un0er �his permit �o be considered legal, such work must comply with all epplicable codes, end all requlred Inspeetlone and final epproval must be obtained. Feilure to obtain inspec�lons and final approval will result in the expiration of lhis pertnR�� FOR INSPECTIONS CALL: (714) 754-5626 / zae-�e �aoo� a WORKERS' COMP6NSA710[yDECLARATON: � � • •+ I hereby aflirtn under penalty of perJury one ot the following tledareUons: ❑ I heve end W��I meinteln e ceNlkate of consent to self-Inwre for workere' compensatlon, es Orovided br 6y section 3700 of the Lebor Code, br tha peAormence of the work lar wNc� t�is permit is Issuetl. ❑ I have end w�il maintein workers' compenseGon insurence, es reQulretl by seclion 3700 ot Ihe Lebor Coda, for tha partoimance ol t�e work for wNch this permit L9 issuetl. My workers' mpensetlon �In.suranQ�� er entl pol�yqumber ere: n�j Camar: `'�`�_l�Il�� C� PdtryNumber: OC G� �O� �� (This sect/on need not be cnmplefed I! fhe �Serrtur 1s valued at me nunareU dollers (S I00) or less.) ❑ I certity ihet �� Ue peAartnance o wo�k 1or which this pertnit iswe4 I s�all nm emplq eny pereon in any manner so as lo become sub�ect to the workers' wmpensatlOn laws ot Cellfom ntl egree Ihat It 1 should bec � e sub�ect ro Ihe workers' compensatlon proWsions o1 Section 3700 0l t�e Lebor Cotle, I she0 forthwith campty with Nese DroN a /� Applicant Slgneture: Date: �i—' % � l� � WARNINO: FAILUfiE TD SECU WORKERS' COMPENSATION COVERADE IS UNLAW FUL M1D SWLLL SUBIECT MI EMPLOVER TO CRIMINAL PENALTIES M!D pVIL FlNES UP TOONE NUNDRED TFIOUSAND DOLLME (f100.000� IN ADDfT10N TO7HE C46T OF COMPENS4TION, pAANGES il4 PpOMDED iIXi IN SECTION 3)OB OF TNE UBOR COOE, INfEREST, AND ATTORNEYS FEES. LICENSED CQN717ACTORS DECLARATION: I �ereby eHirtn Ihe� I em force end eHect. U�• M_ Cantractofs Signe�ure: (oommendng wlih SeNon 7000) of DMsion 3 ot the Busine end Pro}esslons CoCe, end my Ilcense Is In tull Cless x � Date:,�„�_ , � ['� Z i CONSTRUCTION LENDING AGENCY: ❑ I �eroby efllrm thet Ihare is e consiruction lending egency for Ihe peAortnanco ol Ihe work for whlch �his permit Is Issued. (Sec. 3097, CINI Cotle). Lentlefs Namo: Lentlefs Address: Sipneture: Date: OWNER-BUILDER DECIARATIONS: I here6y eHlrtn Iha� under penalry ot pe�jury Net I em EXEMPT FROM THE CONTRACTORS LICENSE LAW far the following reason (Sec. 7031.5, Business entl Professlons Code: Any ciry or rounry which reQuires e parmit to wnstrucL elter, improve, demolis�, or repair any swcture, Dnor to its issuance, elso reqNres the eppllcaN tor such permlt to tile e signetl stetement thet he or s�e is Ilcensed pursuant to the prmdslons of Ihe Contredors License Lew (Chapter 9(commendng with Sectlon 7000) 01 Division 3 01 [he Business flnd Professbns Code) or Nat he w she is exempt Nerefrom erM the basls lor the ellegetl ezemption. Any vidatlon of Sectlon 7031.5 by eny flpplirant fa a permil subJects the applicent to a civil penelty of not more than frve huntlred dWlers ($500).): ❑ I, as owner a1 the OroPerty or my employees wl�h wages fls Ihelr sde compensetlan, WILL DO THE WORK, and the structure Is not Intentled or otfered for sale (Sec. 7044, Business end Professions Code: The ConVactors LJcense Law does not epply to en owner ot properry who builds or improves Ihereon, anA who does such wwk himself or herselt or t�rough his or her own employees, proNdetl thet such Imprwemems ere not Intended or oflered lor sale. If, however, Ne building or Improvement is sold wiihin one yeer of completion, the owner-0uiltler vrill have the burden of proving Ihat �e or she did not build or improve tor puryose of sale.). � ❑ I, es owner o� the property, am E%CLUSIVELY CONTRAC7INC WfTli �ICENSED CONTRACTORS to consiruct the pro�ect (Sec. 7044, Busfness end Professions Code: The comrecrors LJcense Lew does nat eppry to en owner of praperty who bullds or Improves ihereon, entl who wntracts 1or such pro�ect wlih e contredw(s) license pursVent to the Contrectors LJcense Laws.). ❑ I em exempt under sec. Business end Professions Code for this reason: Signature: _ Date: Owner ID veriiled Dy tlriver'e Ilcenso. ❑ Ves ❑ No Orivers Licensa No. Expires: Vertlicatlon ai Ownershlp �y (type ol dxumenL i.e. - pmperly tea blil or tleetl): DIVISION OF INDUSTfiIAL SAFETY PERMR CERTIFICATION: ❑ I hereby cenity that no excevetlon five (5) or more feet in Oepth Into which e person Is requlred to descentl, wlll be mede In connectlon wlt� work eufhorized by ihis permi�, end Nat no DuIltling structure, sraHdding, falsework, or demdlUon or tlismantlinp thereof, will be more �hen thirty-six (38) feet high. (Chep. 32, Grp 2. Ar12, Sec. 347, 71t1a 8, Celllamle AtlminlstretNe Codej. ❑ As owner•bu��der, 1 will not empby enyone to do work which would require e permll trom the Divis�on ot Industnal Safery, es noted ebove, unless such person hes e pertnit to do Such work lrom Ihe GlNslon. Signeture: Date: D'MSion o1 industAdl Selery Pertnit Number. CERTFlCATE OF COMPLIANCE AND AUiHORVATON OF EMRY: I cetllty under penelty ol per�ury ihat I have reatl thls epplicetlon entl state Ihet Ihe infofmatlon given is conect. I agrea to Comply wilh ell slate laws end ctry ordinances reletinp to buNtlf� conslnetfon, anC eul�odze represantatives ot the Ciry ot Coste Mesa to anter upon Ihe above-tlescdCed propeM br Inspection purposes. I egree not to occupy or ellow occupency of eny building euthonzed by Ihis permit until linel Inspectlon. COOE 1. �y$Q�Qj{IYPE 1618 Fixed System Final Fire Preventlon 1288 Pod Spe F��el 200 Final Re-R�� 201 Finel BIocWReteining Wall 202 Flnel FectOry Fire Plece 203 Final Slgn 204 Final DemPlitlon � It�E� .: : '� ��/ / /�:: � �Qy(j INSiECTIONTYYE 206 Flnal Machanlcal 208 Finel Plumbing 210 Finel Electrical 212 Final Fire Preventlon 22o Flnel Planning Approvel 222 Flnel Site 250 Final BulltlingiOccupency < • NEWPORT-MESA UNIFIED SCHOOL DISTRICT N� 4715 CERTiFlCATE OF COMPLlANCE OF DEVELOPMENT FEES PURSUANT TO AB 1600 AND AB 187 To: (�) Ciry of Costa Mesa ( ) City of Newport Beach ( ) Counry of Orange ApplicaM: Address Telephone Number. � � � ^ �� -<<� ^ � D � r � TrecUParcel and Lot Number(s): Location of Project: Number of Square Feet o(: Residential Space Commercial and Industrial Space CommerciaVlndust�al Project is: (Check One) _ Warehouse R8D Movie Theater _ Mini-storage _ Heavy Industrial _ Regional Shops _ Light Industrial This project is exempt because C' C� x E1.84 District Receipt No. Plan Check N ' i�O Z Total I -1 0'�) 7� � xE.30 ��I 4 p�M� � � ` ��vL� Bank �'�� _ Neighborhood Shops _ RacqueVHealth _ Hotel Medical Otfiee O(fice Park Preschoo� Auto Repair Hospital Large OfRce Office Bldg. Restaurant Fast Food This certifies that the above-named Developer/Appficant has paid school faci.tity fees in comptiance with Government Code sections 53080 and 65995. The Building Pemiihs for this square footage in this proposed development may now be issued by your jurisdic9on. Checks are to be made payable to NewpoR-Mesa Unified School Dishict. AuMorixad Rapresenhtivs The above representation as W square /ootage is true. AppYwnt aprees fhat if it is later determii true, then this certificate shall automatiCalN termnate and ihe appropriatyCil�r/County shall be Date:�� Q� _ suchrepresentations are nol (714) 754-5273 • Fax (714) 754-4856 • www.ci.cosle-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: Suite No Viciniry: �Parcel Nunmber. Applicant: Address: 2976 MINDANAO DR 13923111 BARRY HALL PO BOX 1740 � COSTA MESA, CA ' Phone: 714-966-3048 Zip: 92626 Owner. OHLAND, JEFF P Address '2976 MINDANAO DR � . Phone: , COSTA MESA, CA Zip: 9262G3614 Contractor: CONSTRUCTIVE IMPROVEMENTS Address: PO BOX 1740 ISSUE FEE Temp service test Res. a/c package New Res (1-2 uniLs) New Res (3+uniLs) Pool / Spa Lightlng Fizts , Recept Oullets Switches Non Res Appl Res Appl Service to 200a Service l0 1000a Service over t000a Motors to thp Motors to 10hp COSTA MESA. CA Phone: 714-96&3048 Zip: 92626 License: 751535 ISSUED BY: Status: ISSUED Applied: 08I18I2003 Issued: 08I18I2003 SCOPE OF PERMIT CONSTRUCT 1,053 SF OIJE SYORY ADDITION TO AN EXISTING SINGLE-STORY SFD. WORK TO INCLUDE ADDITION OF A NEW FAMILY ROOM WITH A BAR, MASTER BEDROOM/BATHROOM AND WALK-IN CLOSET. REROOF EXISTING HOUSE WITH MONIER LIFETILE (6PSF) IC80 #2656. AlSO INCLUDES FURRED ARCHES/SOFFITS IN KITCHEN AND DINING ROOMS. REF.: 803-01162 . ELECTRICAL TO INCLUDE: 6 LIGHT FIXTURES, 15 OUTLETS, 7 SWITCHES, AND 1 SERVICE TO 200 AMPS. 523.50 50.00 50.00 $0.00 $0.00 50.00 56.60 $16.50 $Z70 $0.00 $0.00 530.50 50.00 50.00 50.00 50.00 Quantity 0 0 0 6 15 7 0 0 1 0 0 0 0 FEESUMMARY Temp Dist S'ystem / Lighting Busway ItoO ft . . Standing §ection Misc ElecVical Equipment Transformers up to 1 kvalkw ................up to 10 kvalkw .................up to 50 kva/kw .................up to 100 kva/kw ..................over 100 kva/kw Low Voltage Equipment Low Volt Wiring System / Ckt Misa Conduit Misa Conductor . Circus ( gen or nde)' - Circus (mech.ride or lights) Christmas Tree Stand Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 , 0 so.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomla statutes and related regulatlons. (Ord. No. 92•28, § 1, 1241-92) ' EXPIRATION: This permit shall automatkally expire and become void if work Is not commenced within 180 days, or il work is suspended or abandoned tor a perlod of 180 days. INSPECTIONS: In order tor the work aNhorized under thls permit to be considered legal, such work must comply with all applicable codes, end all requlred Inepeetlona and finel approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of this permit. ; FOR INSPECTIONS CALL• (714) 754-5626 ' ' � zaaasa�avo� WORKERS' COMPENSAnON DECWiAnON: � � I hereby affirtn untler penalty of perjury one ot the tollowinq declaratlons: ❑ I heve end will melntein e certi(cate oi wnsent to sell-Insure Por workers' compensetlon, es pravitletl for by sectlon 3700 of the Lebor Cotle, tor the pertormence of the work far w�lch lhi5 permli is issuetl. ❑ I have entl wlll malntein workers �mpensatlon insurenca, as required by sectian 3700 of the Lehor Code, lor Ne peAortnance of the work for w��h Utis permit is issued. My worka1rs' co�m ensation Ins carrier e'ntl`N'o licy number ere: q �u, �q Cartier. ��T�.� � N v' Policy Number: Z Z (�W Ci ' T)7?i� (Th/s secf%wr need not be completed i/ the permifls velued et one hundred dW/ero ($700) or less.) ❑ I cenity thet in the peAormance oi t ork lor which Ihis pe it Is issued, I shall not employ any person In eny manner so es to become subject to t�e workers' compensatian lews of Caltloml&. C egree thet If I should. ecome suD�act to the workers' compensetion provislons of Sectlon 3700 0l the Lebor Code, I shall forthwith Comply with these pmvisions. �� ' � � Appllcant Signature: Dete: W ARNIN6'. FAILUHE Po SECUfiE iOfiKER3 OOIAPENSASION COVERAGE IS UNLAW FV� AND SMALL SUB.fECT NJ EMPLOYER TO CRIMINAL PENALTES AND CML FlNES W TO ONE HUNDRE� TMOUSANO OOLURE (E100,000). IN ADDf�ON TO TNE CQST OF COMPENSATION, DAhU1GES AS PROVIDED FOR IN SECiION 3�08 OF THE IABOR ODDE, INTEREST, AND ATTORNEVS FEES. LICENSED CONTRACTORS DECLARATION: I �ereby aflirtn thel I em force entl enect. Lic. x_ ContractoYs SlgneNre: (commencing wit� Section 7000) oi Dlvision 3 of the Business enQ Professions Code, entl my Ilcense Is in full Cless M %S �_ oaie: — r A — O � CONSTRUCTION LENDING AGENC�: ❑ I hereby eNirtn that ihere Is e cOnsiruction lending agency tor Ihe pedortnence of the work lor which �his Oermit Is issued. (Sec. 3097, Civil Code). Lendefs Neme: LenCers Adtlreu: Signeture: OWNER-BUILDER DECLAFiAT10N$: Date: I hereby eRlrtn that under penalry oi perjury that I am EXEMPT FROM 7ME CONTRACTORS LICENSE LAW lor ihe following reeson (Sec. 7031.5, Business entl Professions Cotle: Any ciry or counry which requifes e permit to consiruct, elter, improve. tlemolish, or repeir eny structure, pnor to ils issuance, alsa requlres Ihe epplicant for such pertnit to file e slgneC statement that �e or she Is Iicensetl pursuent to Ihe proNsions oi the Contredors License Lew (Chepter 9(cammencing with Seqlon 7000) af Divislon 3 of the Business antl Professions Code) or Ihat he or sha is e:empt therefrom entl the basis lor ihe elleged exemption. Any violation of Sadion 7031.5 by eny applicant tor e pertnit subjects iha applicent to e civil penalry oi not more than fWe hundreE tlollare (5500).): ❑ I, as awner af t�e pmperry, or my employees with wages es their sole compensation, WILL DO THE WORK, and the sirucNre Is not imenaed or oHeretl for sale (Sec. 7044, Business and Profession9 Code: The Con�rectors Ucense Lew tloes not eppy lo an owner of property who 6uilds or improves thereon, flnd who does such work himself or herseM or Ihrough his or her own employees, provided thet such improvements ere nat intentletl or ottered far sele. It, howeveq Ihe building or improvement Is sold within ona year of completion, the owner-bullder will have the burtlen of proWng that he or she did not build or improva for purpose of sale.). ' ❑ I, as owner of the properry, am EJ(CLUSIVELY CONTRACTING WfTH LICENSED CONTRACTOHS to construct Me projed (Sec. 7044, Business and Prolessions Cotle: The contrectors License Law does not eppty to an owner ot pmperry who builtls or Improves thereon, and who comrects for such projea with e comreaor(s) license pursuant to ihe Contractors License WwsJ. ❑ I am exempt under sec. Business end Profeuians Cotle tor Ihis reason: Signature: Date: Owner ID verifiatl by dnvers license. ❑ Ves ❑ No Drivefs License No. Verificatlon of Ownership by (type ol d�umem, i.e. - pmperry tea biil or deed): DIVISION OF INDUSTRIAL SAFE7Y FERMR CERTIFICA710N: Expires: ❑ I hereby certtly ihat no excavatlon fNe (5) or more teet In depth inta which e person Is required to descenQ wlll ba made In connectlon with work authorized by Ihis pertnit, and that no building structure, scettdding, falsework, or tlemUltlon or dismentling thereof, will be mae than thirry-slz (36) teet high. (Chep. 32, Grp 2, Atl 2, Sec. 341, Tltle 8, Califomla AdminislfatNe Cade). ❑ As owner-bullder, I will not employ enyone to tlo work whlch would require e permit trom tha Divislon of Intlusiriel Sefety, as notetl aDwe, unless such person has e permit to do such work from the divislon. Signature: �ale: Divisian af IndusMel Safety Pertnit NUmber. CER7IFlCATE OF COMPLIANCE ANtl AUfMORIZA710N OF EMRV: I cehify untler penfllry oi perjury ihat I have read �his apDlication end stata that the Iniortnation given is wrrect. I agree to comply with ell ste�e laws en0 dry ordinances releting to buliding cons�ructlon, and authorize representatives of ihe Ciry of Costa Mese to enter upon the ebove-described property tor Inspection puryoses. I ac�ree not to oaupy or ellow occupency oi eny building euthonzed by Ihis pertnit until final inspectlon. Signature 01 Lep el wner(s) �� ..�� ,%�_ /f/ ��—� AnNOt Aulh Applicant Dale COOE t. INSPECiIONTYPE P�. Qii�EL: 1616 Fixetl System Flnal Fire Prevention 1288 200 207 202 203 Pool Spa Finel Final Re-Roof Finel BIocWRetaining Well Finel Fectory Flre Piece Finel Slpn 20d Finel Demolitlon COQE� INSPECTONTYVE 20fi Flnel Mechenlcel 208 210 212 220 Finel Plumbing Finel Eledrlcal Finel Fire Preventlon Final Planning Approval 222 FIneI5lte 250 FinelBullding/Occupenty � I�� (714) 754•5273 • F� (Y14) 754-4856 •�wiw.cl.costa-mesa.ce.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 2976 MINDANAO DR Suite No Vicinity: Parcel Nunmber: 17923111 Applicant BARRY HALL , Address: PO BOX 1740 - COSTA MESA, CA Owner: OHLAND, JEFF P - Address 2976 MINDAIJAO DR COSTA MESA, CA PLUMBING PERMIT Phone: 714-966-3048 Zip: 92626 Phone: Zip: 9262&3674 Contraitor. CONSTRUCTIVE IMPROVEMENTS ndd�e55: Po eox nao COSTA MESA, CA Arch / Eng : Address: Phone: 714-96G3048 Zip: 92626 License: 751535 Phone: Zip: License: Status: ISSUED Applied: 08I18/2003 Issued: 08I18/2003 ISSUED BY: SCOPE OF PERMIT CONSTRUCT 1,053 SF ONE STORY ADDITION TO AN EXISTING SINGLE-STORY SFD. WORK TO . � INCLUDE ADDITION OF A NEW FAMILY ROOM WITH A BAR, MASTER BEDROOM/BATHROOM AND �. WALK-IN CLOSET. REROOF EXISTING HOUSE WITH MONIER LIFETILE (6PSF) ICBO #2656. ALSO INCLUDES FURRED ARCHES/SOFFITS IN KITCHEN AND DINING ROOMS. � �, REF.:803-01162 � ISSUE FEE BackFlowirrigation BackOow Preventer Balhtub Clanfier System Connect (Ice,Soda,etc) Dental UniLs Dishwasher PLUMBING TO INCLUDE: 1 KITCHEN SINK, 1 WASH BASIN SET AND 1 WATER CLOSET. AMT 523.50 $0.00 $0.00 $�.UO $0.00 50.00 50.00 50.00 FEE SUMMARY QTY' AMT Laundry Tub / Washer $0.00 0 � Landswpe Irtigation $0.00 0 P-T2p $0.00 0 � Pressure Regulator $D.00 0 Process Piping (per 10 ft) $0.00 0 � � Receptors 50.00 0 Septic Tank . $0.00 0 Sewer Cap (or Demo $0.00 QTY 0 0 0 0 0 0 0 0 SumpPump Swimming Pool Trap Primer Urinaf Vacuum Brkr Bkflow(1-4) Vacuum Brkr Bkflow(5+) Wash Basin Wash Basin Set AMT $0.00 30.00 50.00 50.00 $0.00 50.00 $0.00 $9.80 on 0 0 0 0 0 0 0 1 NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92�28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void il work is not commencad within 1 BO days, or If work Is suspended or abandoned tor a period of 180 days. INSPECTIONS: In order for the work authorized untler this permit to be considerad legal, such work must comply with all appllcable codes, and all requlred Inepectiona entl final epprovel must be obtained. Fallure ta obtain Inspectlons and flnal approval will result in the explretlon ot this permit. I POR INSPECTIONS CA4L: (714) 7545628. '�� zae�ae �aroo) WORKERS'COMPENSAnON DECLARAnON: � � I hereby effirm untler penalry of Derjury one of iha fdlowing Oedarations: ❑ I have entl will melniain e ceNficata of consent to sell-Insure tor workers' compensatlon, es proWded for by sectlon 3700 0l ihe Lebor Code, for the pertormance of the work lor whkh this pertnil Is issued. . ❑ 1 hflve flnd wUl maln�ain woAcers' mmPBnsaUon Inwrence. as �equtreC hy SecUm 3700 of ihe La�or Co6e. tor Ihe peRortna�e ot the woAc tor wh'd� tlils pemtit b iswed. My worken' pensetlon Insure rriar an0/�mI Icy number ere: � �j r Cartiar: �ir'�' �.621l–r � ' PolicyNumber. vy ` ��6b � Z�i (7h/s secNon �eed nof`�e cwnplete0l! fhe permlf fs vulued et one hundied dollers ($100) or /eu.) . �'— ❑ I conify Ihat in the pertormance ol Ihe work lor which Ihls pertn t Is issued, I ahell not employ eny person in eny mannei ao es ta become subject to the workers' compe05alion lews ot CeIIIJ mla, e= ree thet If I s�ould me sub�ect to Ihe warkera' compensatlon provisions o1 Sectlon 3700 of the Lebor Cotle, 1 shell foMwith comply wlih these pravisions. �7 Appllcan�SlpneNre: Dete: � ��A "�"v ,l WAPNINO: FJJLUAE TO SECURE WORI(ERS' CCMPENSAiION CWEM6E IS UIJJ�WFll� AND SHf11 SUBJECf AN EMPLOYER TO CRIA9NAL PEWILTES iV1D CML FlNES UP TO ONE HUNDRED TYIOUSWD OOU.�RE (f100.000�.IN ADIXTION Rl THE C46T OF COMPEIJSATION, OAANGES A$ VROVIDED FOF IN SECTION 31080F THE IABOR COUE, INTEREST, rWD ATTOfiNEYS FEES. LICENSED C��ACTORS DECIARATION: I hereby eXirm thet I em force entl efl0ct. Lic. p_ Coniroctors SlBneture: (commendng with SecUon 7000) oi DMsion 3 ot t�e Business gnd Professions CoOe, end my Ibense is in lull Cless N � Date: , ^ l - O 2 CON9TRUC'�ON LENDING AGENCV: ❑ 1 here�y aHlrm that ihera is e caistrucibn Iending apenty tor the peAortnance ol the work tor wMch Ihis permll Is issued. (Sec. 3097, CMI Cotle). Londefs Name: Lsntlels Adtlress: Sipnature: OWNER•BUILDER DECLARATIONS: Date: I hereby eMirm t�at under penalry of per�ury Uat I em EXEMP7 FROM THE CONTRACTORS LICENSE LAW tor t�e lallowing reeson (Sec. 7037.5, Business erM Professions Cotle: Any ciry o� �unry whlch requires e permit to construct, alter, improve, OomWish, or reDelr flny structure, pdor to its issuence, elso requires Ihe epplicent for such pertnit b tile a sipned stetament Uat he or she Is Ilcensed pursuant to the pmNsions ol ihe Contrectors LJcense Lew (Chepter e(commendng with Sectlon 7000) 01 Division 3 of ihe Business end Professions Coda) or thet he w she is eaempt therefrom and the Desis for the ellegetl exemptlon. Any NWation oi Secllon 7031.5 by eny epplicent for e pertnit subjects the Applicent to e civil penelry af not more ihan five �undred dallers ($500).): ❑ I, as oWner of the properry, or my employaes wit� wages es their sole compensallon, WILL DO THE WORK, end Ihe siructure �s not IntendeA or oXereC lor sale (Sec. 7044, Buslness anA Prote551ons Cade: ThB Coniractor5 License Lew does not epDN �o an owner of proporty wha builds or Improves thereon, en0 who does such work hlmsetl or herself or through hls or her awn employees, providetl t�et such Impravemenis are not Intendee or OHered lor sele. If, howevar, �he bulldinp or Imprwement Is soltl wit�in one year o1 compleGon, ihe owner-builder will have �he Ourden of proving Ihat he or she tlid not build or improve for puryose of sale.). ' ❑ 1, as owner oi the propery, am E%CWSIVELY CONTRACTING W17H UCENSED CONTRACTOHS to construct the projecl(Sec. 7044, Business and Professions Cotle: ilie contraaors License Law tloas rwt appy m a� owner ol property who builds or Improves Ihereon, and who comracls for such pro�ecl with a Conueaor(s) license pureuflnt to the ContreIXors License Lews.). ❑ I am exampt under sec. Business enA Professions Catle for this reeson: Signeture: Data: Owner ID ved�ietl Dy drivefs license. ❑ Ves ❑ No DrHers License No. Explres: Vedilcetlon ol Ownership by (rypa ot tlocumem, i.e. - property tex bill or tleetl): DIVISION OF INDUSTAIAL SAFETY PERMfT CERTIFICATION: ❑ I hereby �enily that no excavetlon Me (5) or more teet in depN into w�lch e person is requlred ro tlescend, wlil be made In connection with work euthorizetl by this pertnit, dnd that no bulltling siruclure, scaHdtling, felsework, ar tlemdltlon w dlsmantling Ihereof, will be more Ihan Ihirry-sia (38) feet �Ig�. (Chap. 3.2, Gry 2, Art 2, SBc. 341, 71Ue 8, Celitomia Atlminislretive Cotle). ❑ As owner-builder, I wlll not employ enyone to Co work whkh woultl require e pertnit trom the Dlvision ot IndusMal Sefery, es notetl ebove, unless wch person hes a permil lo tlo such work from Ihe tlivision. Slgnalure: Date: Dlvislon ol Indusirial Safery Pertnit Number: CERTIFlCATE OF COMPLIANCE AND AlliT10RQA710N OF EMRY: I cenity under penalry ot perjury Ihet I heve reed this appllwtion end stete t�et the Infortnation piven is correct. I egree m compty wRh eil siete laws erM dry orOlna�es relaUnp to buNEinp consirucifon, entl euthorize rapresentetNes of the City ot Cosla Mese to enter upon Ihe ebove-described property tor Inspection purposes. I agree not to occupy a allow occupancy of eny huilding euthorized by ihis permit unW finel inspectlon. SlgnaWreOfLe.lOwner(s) �( �D�eQ� • �o �� AnNbr AuShodzed Applicam . Date COOE �. INSVFCTIONTYPE 1616 Flaed Sysrem Final Flre Proventlon 1268 Pod Spe Finel 200 Flnal Re-Roof 201 Flne� BIocWRetelning Wall 202 203 204 Final Fectory Fire Place Fins{Stqn Flnel DemollUon PAg II�LS COOE I INSPECTION TYPE 206 Finel Mechanicel 20B Final Plumbinp 270 Flnal Electdcel 212 Finel Flre Prevention 220 Final Planning Approvel 222 FInalSite 250 Flnel Bullding/Occupanry Q� �� 1�a,5-o3 � OWNER F7KFT7 flF'VF�,(1P�pj� (!(i � Ij�j(! DATE 6-13-60 JOB ADDRFSS BUILDING PERMIT NO. GENERAL CONTRAC OR K_ W_ Knl l VALUE S i R L�� nn . INSPECTIONS DATE � GROUP I$cS TYPE \7 ZONE � j� Un!ierground So' :JlQ.G9U.G. Water � ,�� SUBCONTRACTOR I PERMITS ISSUED OCCUPANCY Form 210—SM-11-59 5-B P ]_'�' � L�j►` 1 -.Tr. �� ' ° �`,��i:� COS7A MESA BU�LDING-SAPETY DEPARTMENT P. O. BOX 917 COBTA MEBA. CALIFORNIA For Applioanf fo Fill In Complefely � TYPE OR PRINT � AOD E�66 2976 Minda.nao Drive C05TA MESA CALIFORNIA � SIZE aecerveo B28Ch iao:l I BUILDING ' ADORE6S , TEL. � NO. F{RE ZONE W� KOIS APPROVED BY 'acentia Avenue Be aCll ZONE ' No`:MI 6-3227 `s°"` oeacn��r�orv .. � • _ - .I NO. OF BLDG6. .. eeie�cK uxe naoM 6S � REAR YAR[ C6NTHR OF BTReeT 81OE YARO I LEF7 S�- I RIGHT 6 i ' DESCRIPTION OF WORK FEE RECEIVED �'� b�i3-� FINANCE DEPT. APPLICATIf�� R�IIBIIi�E� BUILDING For Office Use Only OATE CASTA MESA, CALIFORNIA ZONING NO.OF I U6E OF NEW PUNB q BUILDINa y — YAROS APPROVED ' �cexren uNa eT.� FRONT BBUZIELDING �VQpSF ROOMS � STORIES 1 EXTEHIOR W L IROOF ROCK COVERING COVERING USE OF BIJILOING AND WORK TO BE PERFORMED Attached Garage PLAN 21A 1 H[ReBY ACKNOW�DOE THAT 1 HAVE PEAD THIB APPtIGTION AND BTAl6 TXAT THE ABOVE I6 CORREGT ANp AGREE M COM- PLY WI1H ALL CIT' OIiDINANCEB AND BTATE LAW9 REGULATING BURo�Na CONaixJrno ' 61GNATURE OF - - PERMITTE � - ' ..;;a v � I�"�1 AUTHORIZED AGE °- APPROVED EVES � TX! AMOUNT BXOWN UN�EP VALUATION 19 FOH THE PUPP08E OF EBTABLIBNINO A PERMIT FE6 ONLY. VALUATION 7 p' ,` � PERM17 FEE $ V � r $ / `� / �� PLAN CHECK S � ( ` OWNER �� M DATE�-19-60 JOB ADDItESS 2976 Mindaneo 7lrive BUILDING PERMIT NO. 1i512 GENERAL CONTRACTOR � � DATE OCCUPANCY VALUE SUBCONTRACTOR I PERMITSISSUED Form Y10—SM-11�59 5-B P '� PJ�%0.wi c 1g5� C` 1 ��J�'�� COSTA MESA BUILDING-SAFETY DEPARTMENT P. O. BOX 917 C08TA MEBA. CALIFORNIA For Applieanf fo Fill In Completely TYPE OR PRINT BUILDING jq 7� M/N nRN V K � ADDRE55 � C05TA MESA. CALIFORNIA OWNE�'✓L= /O y /l� e� aF�s �.9 `7! M in� DA.v� PR� eS'T/a FEE RECEIVED � APPLICATION� f' !��- L'U9�. � SiA MESA BUILDING For Office Use Only RECEIPT NO. Q kAn1�0. �1 RECENEO BY DAiE IjECE1VED DATE 198IIE0 .-�'/YJ I /.,7_iy��Ul..3-i9-ca GOSTA MESA, CALIFORNIA ADDRE56 A7_S �� ul'7f%' ZONING cirv ,i�.v/�cN �'3 CN9 ///� zone I NO. OF � use or New PLAN9 BUII.DINO L G NO. � YS9• NoK �O`f97 �au. 5 - f�, oeecn�rr�o � 61ZE NO, OF BLDGB. ' � OF lOT S � Now ox LOT p, p, NO. ��` USE OF YARDS EVES EXIBTING 9LDG APPROVED ALLOWED 86TBAGK LINE PROM ICCNTew lIN6 BT.1 �� _/ PTION OF WORK NO. OF EXTERIOR WALL IROOF COVBRING COVERING U6E OF�UILDING AND WORK TO B PERFORMED [o >c ss' x 7' ��r• (, �� k �,�'' / O ` C o...�. !�c/ a��— I HEREBY �ACKNOW�ED6E THAT 1 XAVE PEAD iH18 APPIJGT�ON AND BTATE THAT THE ABOV6 18 CORREGT AIi� AGRHE TO COM- PLY WITH ALL CI'!Y OPUINANCEB AND 9TATE LAWB REOULATINO BUILDINO CONBTHUG?�QN� . � AUTHOftIZED 0 THE AMOUM 6HOWN IINOER VALIIATION IB FOR THE PUqPOBE OR EBTABLIBHING A PENMIT FEE ONLY. .UATION `cQ PERMIT FEE $ �. ' � ' �/ eo . l��i��` � �, t / $ r PLAN CHEGK $ TOTAL FEE $ �� 9