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Home My WebLink About940 PAULARINO AVE - Building Permits� •� (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us JobAddress: J40 PAULARINOAV SWte No Vlclnity: ATTIC Parcel Number: �4172215 Applicant: PINO, EULALIA Address: 940 PAULARINO AVE . . �.fi COSTA MESA CA � � � Owner: �PINO; EUCALIQ Address:� ,940 PAULARINO AVE � � �i . . , .; ��, // COSTA MESA, CA' � " � . . �i . ,: ,/i . '/i,: ' / Contrector: OWNER=6UILDER .� � Address:7 ��; �� r/ /?. MECHANICAL PERMIT Phone: 714-540-2006. Zip: 92626-2848 Phone: 714-540-2006 Zip: 92626-2848 Phone: Zip: ' ; ' License: 000000 // rNln un�vc, l.Va � li mwn, 1.�+ acom ISSUE � Status: ISSUED Applied: 02/12/2007 Issued: 02/12/2007 ' ��SCOPE OF PERMIT � -� MECHANICAL PERMIT TO CHANGE OUT (E) HEATING AND AIR CONDITIONING AND RELOCATE �� TO ATTIC ARE FOR A SFD. �_ _ " WORK TO INCLUD: 1-INST FAU <100 K BTU, 1-3 TO 15HP/500 K BTU AND 1 GAS , .-PIPING. � " � PROVIDE 22"X30" ATTIC ACCESS W/IN 20'-0" OP.UNIT, CONTINUOUS SOLID WALKWAY AT LEAST 24" WIDE AND A LIGHT.OVER�UNIT W/SWITCH AT ACCESS (OWNER INDICATES THAT EL IS ALREADY�EXISTING). � - - � ' � FEE SUMMARY • ' ' � . ., ��-Quantlty----�----- :. , - , � - ISSUE FEE � ' $23.50 � - - Inst�FAU <100�k BTU .,' $14.80 1 InstFAU>100kBTU��, $0.00 0 Repair/Alt Cooling/Heat- � $0.00 0 Inst / Rep. Recess Wall Htr $0.00 0 Refrig Sys <100 k BTU � $0.00 0 � Refrig Sys>100 k BTU ��"� $0;00 0 , �� '' Gas Piping��: ��,� �� $6.15 1 �. %:�� "�_, � . FadoryFireplace � �� $0.00.._0_�.��'�` � Hoodw/MechExhaust .� ��`:$0;00°- 0"� > > � VAV Box �� - . � �� A $0.00� � 0 - " = _ Vent Fan / Single.Dud (i � -��, $0:00, � 0 - - _ - Appliance � . `.� C i' '%„$0.00 `.� 0"-� - � - . FireDampers � � �//� $0.00 �0��--�>^>.-,�,. , � � Smoke Dam ers �` � � - � P � y�� _ $0,00�` 0 . - Inst or Relocate Appl Vent �-\ "$0.00 �; 0-; ., Air Handlers < 10000dm \ � `� $0.00 , �.0 , .' � , , AirHandlers> 10000dm ' �- '.� $0.00' � 0 , - FloorFurnace '�,$0.00� 0 � Floor or Suspend Heater �$O.OR'-.��0,, . � ' Repair / Alt Absorbtion Unit Repair / Alt Refrigeretion Unit Ventillation System Evaporalive Cooler , Com mercia l I ncinerator Domestic Incinerator Comoressors / Absorntion Svstems . � Up'to'3 hp / 700 k BTU � , 3 To 15 hp'% 500 k BTU , �- 15 To 30 hp % 1,000 R BTU �, � 30 To 50 hp / 1,750 k BTU - Over 50 hp / Over 7,750 BTU - � Boileis - - � - = Upto3hp-:,.�" � .,� .3To15Hp � � - 15 to 30 hp � , , ' 30 to 50 hp . � - , Over 50 hp , " ' Other Mechanical Fee Investigation Fee -, � Plan Check Fee�' � Reinspection Fee � Quantity $0.00 0 so.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $27.75 1 so.00 0 $0.00 0 $0.00 0 . $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 ..� NOTICE: The-wor� authorized by this permit shall comply with all applicable handicap access requirements under Calitornia sta�utes and related regulations. (Ortl. No. 92-28, § 1, 7241-92) ' � EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be consideretl legal, such work must comply with all epplicable codes, and ell requlred Inspectlona and finel epprovel must be obtained. Failure to obtain inspactions and final approval will result in tha ezpiration ot this permit. FOR INSPECTIONS CALL: (714) 7545626 2aas-as (evoo) WORKERS' COMPENSATION DECLAilAT10N; I hereby aHirm untler penalry oi perjury one of the following declarations: ❑ I have entl will maintain a certificete of conSent to sol4lnsure for workers' compensation, as provided tor by section 3700 of ihe Labor Cotle, for the pertormance of the work tor whiCh ihis permit is issued. ❑ I have and will maintain workers' compensation insurance, as required by section 3700 of the Lebor Cotle, for Ihe Dedortnance of the work for which this pertnit is issued. My workers' compensation Insurance carrier antl policy number are: Cerner. nof be cromplefed il the permit is velued ef one hundred dollars ($100) or Iess.J Policy Number. '[]�"I cetlify thet in t�e pedormence ol �he work �or w�ich �his permit is issuetl, I shall no� employ eny person in any menner so as to become subjec� �o ihe workars' compensatlon laws oi Celifornia, end egree thal If I should 6ecome sub�ect b the workers' compensation provisions oi Section 3700 of the Labor Code, I shall forthwith comply with these pro ' ions. � r_ ��_. 7 /J q �1 Applic� ant SignaWreY � i o X.A/ ' U_ ._--� /u(1' Data:�--. d d—�� — oC �!� � WARNING: FAIW RE TO SECURE WORKERS' COMPENSATIOfJ CAVERAGE IS UNLAW FUL AND SHALL SUBJEGT AN EMPLOVER TO CWMINAL PENAIJfIES AND CIVIL FW ES UP TO ONE HUNORED THOUSAND DOLURE (5100,Op0), IN AODITION TO THE COST OF COMPENSATIOtJ, DAMAGES AS PROVIOED FOR IN SECTION 3]O60F THE LABOR CADE, IMEREST, AND ATTORNEV'S FEES. LICENSED CONTAACTORS DECLARATION: I hereby aHirtn ihat I am licensed untlar provisionS of Chapter 9(commencing with Saction 7000) of Division 3 of the Business and Professions Code, antl my licensa is in full force antl eNecl Lic. M Class a ContractoYs SlgneWre: Date: CONSTRUCTION LENDING AGENCV: ❑ I hereby aHirm that there is e consiruction lending egency for the peAormance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lentlers Name: Lender's Adtlress: Signeture: Date: OWNER-BUII.DER DECLARATIONS: I hereby eHirm Ihat under penalty oi perjury Ihet I am EXEMP7 FROM THE CONTRAC70R5 LICENSE LAW tor the foilowing reason (Sec. 7031.5, Business and Professions Code: Any ciry or counry which requires a permit to wnstmct, alter, improva, demolish, or repair eny stmcture, prior to its issuance, also reQuires the applicant for such permit to file a signatl statement that he or sha is Ilcensed pursuant to the provisions oi the Contractors License Law (Chapter 9(commencing with Sec6on 7000) oi Division 3 of ihe Business and Professions Gode) or Ihat he or she is ezempt theretrom and the basis br the elleged exemption. Any violetion of Section 7031.5 by any epDlicaM for a permit sub�ects the applicant to e civil penalry ot not more than tiva hundred tlollars ($500).): ❑ I, as owner ol the property, or my employeas with weqes as Iheir sole compensation, WILL DO TME WORK, and Ihe siructure is not intentled or oHeretl for sale (Sec. 7044, Business end Professions Code: The Coniractors License Law does not apply to an owner of properry who builds or improves ihereon, antl who does such work himseN or herself or ihrough his or her own employees, pmvided ihat such improvements are not intendetl or oHered for saie. If, however, ihe building or improvement is soltl within one year ot comptotion, the ownerhuilder will have thfl hurtlen ot 9�oving that he or st�e tlid not builtl or improve br purpose of safe J. ~ I, as owner 01 the propetly, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRALTORS to cons(mct �he pmjec� (Sec. 7044, Business and Pwfessions Code: The contractors Licanse Law tloes no� apply to en owner of property who builds or impwves ihereon, and who contrects tor such project with a contracror(s) license pursuam to ihe Comractors License L.ews.). ❑ I am ex 1 undar/� ec. Business and Pmfessions Cotle for this reason: Siqnawre:. �,t[�'O ' � ��' y � E�,��es�.y,.,�r��bo ❑ I hereby certity that no excavetion tive (5) or more feet in depih into which a person is required to descenq will be made in connection with work authonzed by ihis permit, antl thai no building structure, scaHo�tling, falsework, or tlemolition or dismantling �hereof, will be more than t�irty-six (36) feet high. (Chap. 32, Gry 2, An 2, Sec. 341, T�le B, Calitomla Adminisira�lve Code). ❑ As owner-builder, I wiil not employ anyone �o do work which woultl require a pertnit imm ihe Division of Industrial Safely, as noted above, unless such person has e pertnit to tlo such work fram ihe division. Signature: Date: �ivision of Intlustnal Safety Permit Number. CERTIFlCA7E OF COMPLIANCE AND AUTHORIZ�UION OF EMRY: I certily under penalry of perjury �hat I have read this appliration antl s�ate ��a� ihe intormation given is correct I agree to comply with ell state laws antl ciry ortlinances relating to building consiruaion, and authonze representatives of the Ciry of Costa Mesa to enter upon Ihe ebov ;descnbe pwp for insp ion purposes. I egree not �o occupy or allow occupancy of any builtling authonzed by this permit until final inspection. ,.,�y a a - /a-� �o �' ' �gnaWre�Ol.LegefOwner(S)` ' Dete�. h And/OrAuthonzed Applicant Date COpE �, �NSPECTIONTYPE 7676 Fixed System Final Fire Prevention 1266 Pool Spa Final 200 Final Re-Rool 205 Final BIocM/Retaining W sll 202 Final Facfory Fire Place 203 Final Sign 204 FinalOemoiilion cei� irmru�s COpE� INSPECTIONTYPE 206 Final Mechanical 20B Final Plumbing 210 Final Electrical 212 Fiaal Fire Paevention 220 Final Planning Approval 222 Final Si�e 250 FinalBuilding/Occupancy � � .n �r i�� Address: C� °� �?o�ta ��leda �u�uE��us� Z�iui�iac� OWNER-BUILDER VERI FI CATI ON Permit #: A city or county, which is required to give notice pursuant to Sec[ion 19830, shall attach [o such notice, and, as a condition precedent to issuing a building permit, require the completion and require the retum of, an owner- builder verification. At[ention Propert}' Owner: An bwner-builder' building permit has been applied for in your name and bearing your signature. Please complete and retum this in£ormation in the envelope provided at your earliest oppommity to avoid unnecessary delay in processing and issuing your building peRnit. No buildine permit will be issued until this verification is received. Q7 I personally plan to provide the major labor and materials for construction of the proposed property improvement. ❑ Yes �No �� (have ave not) � i �� signed an application for a building permit for the proposed work. � � I have contracted with the following person (firm) to provide the proposed construction: Name r I� �k. �'1 Address Phone ( City _ Contrac[or's Lic. No. 4. I plan to provide portions of the work, but [ have hired the following person to coordinate, supervise and provide the major work: Name Address _ Phone ( ) City — Contractor's Lic. No. 5. I will provide some of the work but 1 have contracted (hired) [he following persons to provide the work indicated: Name t0a2-as (Rev, n�0a) Address Phone Type of Work I hereby affinn that I have received a copy of the infonnation set forth in Section 19830 of the State of Califomia Health and Safety Code and have completed the above infortnation to the best of my personal knowledge, in compliance with this State law. 6ig en d �,��/%��i� � !„[��lr�' Date: b� —�o� '.�00 7 Name: _� 4��e �i A r//7 0 � (Pnn[ed orTyped) CDL.#ORS.S.# % For more information call City of Casta Mesa Building Division at (714) 754-5273. tOd2�d6 �Rev.tt/04) (714) 754-5273 • Fa�c (714) 754-4856 • www.ci.cosla-mesa.ca.us 77 FAIR DRIVE, GOSTA MESA, GA 92626 BUILDING PERMIT JobAddress: 940 PAULARINOAV Suite: Viciniry: Parcel Number: 14172215 Applicant: PINO, EULALIA Adtlr@ss: 940 PAULARINO AVE COSTA MESA, CA Owner: P1N0, EULALIA Address 940 PAULARINO AVE COSTA MESA, CA Contractor: OW N ER-BU ILD E R Addr�ss: Zip: Arch : Address: Zonin9: R1 R1 Phone: 714-547-2006 Zip: 926264848 Phone: 714-547-2006 Zip: 92626-2848 Phane: License: 000000 Eng: Address: ISSUED BY: Status: ISSUED Applied: 02/07/2005 Issued: 02/07/2005 Phone: Phone: Zip: License: License: SCOPE OF PERMIT INETERIOR qLTERATIONS CONSTRUCT A WALL IN THE GARAGE TO CREATE A CLOSET AREA BETN/EEN THE GARAGE AND THE KITCHEN AREA. Plan Check: $54.11 Permit: $83.25 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $137.86 SETBACKS MAlN STRUCTURE Front 0- 0 ACCESSORY Front 0. 0 PARKING Existin : 0 Rear 0- 0 Rear 0- 0 Re uired: 0 FEE SUMMARY PLANNING & ZONING Left 0- 0 Left 0- 0 Pr000sed: 0 Calc Valuation: Claim Valuation: Right 0- 0 Right 0- 0 $2,500.00 �2,soo.ao NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 7, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1 BO days, or if work is suspended or abandoned for a period of 180 days. INSPEC710NS: In order for ihe work authorized under this permit to be consideretl legal, such work must comply with all applicable codes, end all requlred Inepections and final epprovel must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of ihis pertnit. FOR INSPECTIONS CALL: (714) 7545626 ?44&d8 (6/OD) WORKERS'COMPENSAnON DECLARAnON: I hereby aflirm under penalty of perjury one oi the following declarations: ❑ I heve entl will maintein a cenificate of consem b seli-Insure for workers' compensation, as pwvided for by section 3700 of the Lebor Coda, for the peAormance of the work for which this pertnll Is i55uetl. ❑ I have end will maintain workers' compensation insurence, as requiretl by section 3�00 0l the Lebor Cotle, for the pertortnance ol tha work for which this pertnit Is Issued. My workers' compensatlon Insurance cerner and policy number ere: Carriec - Poliry Number. (T�is section neetl nat be completed I! fhe permif is valued et ane huntlretl dollers ($ f00) or less.) ❑ I certily that in tha peAormence of lhe work for which this pertnit is issuad, I shall not employ any person in any manner so as to become subject to the workere' compensation laws of Celltomia, entl egree ihat if I should become subjact lo Iha workers' compensetion provislons ot Saction 3700 of the Lebor Code, I s�all fotlhwith comply with these provisions. Appllcant Signatura: Date: WARNING FAILURE TO SECURE WORKERS' COMPENSATION CAVEMGE IS UNIAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE HUNORED THOUSAN� DOLURE (5100,000), IN ADDITION TO THE COST OF CAMPENSATIIXJ, DAMAGES AS PROVI�EO FOR IN SECfION 3]060F THE IABOP COOE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRAG70RS DECLARATION: 1 hereby attirm that I am Iicensetl under proWsions of Chapter 9(commencing with Section 7000) of Division 3 0l the Business and Prafessions Code, end my license is in tull lorce end eHect. Lic. # Class k Contrectors SignaNre: Date: CONSTRUCTION LENDING AGENCV: ❑ I hereby attirm Ihat ihere is a consiruction lending agency for ihe pedormance of ihe work br which this permit is Issued. (Sec. 3097, Civil Code). Lenders Neme: Lender's Address: Signatura: Date: OWNER-BUILDER DECLARATIONS: I hereby aHirm thai untler penalry oi perjury t�el I am E%EMP7 FROM 7HE CONTRACTOHS LICENSE LAW br ihe following reason (Sac. 7031.5, Business and Pmfessions Cotle: Any city or county which raquires a permit to consiruc6 elter, improve, domolish, or repair eny strucwre, pnor to its issuance, also requires the aDD��ent tor such permit to lile a signed statement ihat �e or sha Is Ilcensed pursuam to Ihe provisions ol the Contrectors License Lew (Ghapter 9(commencing with Section 7000) of Divisian 3 of the Business end Professions Code) or thet he or she is exempt therefrom end tho basis for the elleged exemption. Any violatian of Section 7031.5 by eny epplicant lor a permit s�u 'ects the epplicant to e civll penelry oi not more than fiva hunAred tlollers ($500).): I, es owner of the property, or my employees with weges es iheir sole compensation, WILL DO 7HE WORK, end the sWCNre Is not imendetl or ofleretl for sale (Sec. 7044, Business and Professions Code: The Contractors Licensa Lew does not apply to en owner of property who builds or improves Ihereon, and who does such work himselt or herself or ihrough his or her own employees, provitletl that such improvements are not intende0 or oNered for sele. If, however, the building or Improvement is sold within one year of completion, the owner-builder will heve ihe burden ot proving tha� he or she did not build or improve for purpose ot sale.). � ❑ I, as owner ol the property, em E%CLUSIVELY CONTRACTNG WIT1 LICENSED CONTRACTORS to consWct the project (Sac. 7044, Business antl Professions Code: The contractors License Law Aoes not apply to en awner ol pmparty who builds or Improves thereon, antl who comrects lor such prolect with a contrector(s) I' nse pursuant to the Business antl Protessions Code lor ihis reason: 6�'�% �� 0�,' �� [ � igne�ure: �/.+��-ft lo � � % � Owner ID verified Dy tlnver's license. • W s ❑ No ¢7flV c�ce�F1b� � Veriilcation of Ownership by (type oi tlaument, i.e. - property tez blll or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby cenify that no axcevation five (5) or more leet in tlepth into which a person is required to tlescend, will ba made in connectlon with work authonzed by this pertnit, and Ihat no building structure, sceflolding, telsework, or demolition or disman�ling Ihereol, will be more then thirry-sia (36) leet high. (Chap. 32, Grp 2, Art 2, Sec. 3at, Tltle 8, Califomia Administrative Code). . ❑ As owner-builder, I will not employ anyone to do work which would require e permil imm �he Oivision of Industdal Safery, es notad above, unleu such person has a permil to da such work irom the division. SignaWra: Date: Division of Indusirial Safery Permit Number: CERTIFlCATE OP COMPLIANCE AND AIffHORVATON OF ENTRY: I cenify under penalty of perjury ihat I have read this epplication end state ihet Ihe information givan is correct. I agree to comply with ell stete laws end ciry ordinences relating to building construction, and authonze representatives of ihe Ciry of Costa Mesa to enter upon ihe e�e-descri d prpp�rty tor ipsyection purposes. I egree not to occupy or ellow xcupency of eny building au�horized by this permil until final inspecGon. // /% c7 �i%G ��--�C.-c.c�lY l9/� � O -� /��j`. Cku�w�nmRlftmrtj[QWp9f{9' P (�Ddi6j_ � Gc'�::.J=�a�a And/Or Authonzed Applicant Date CODE �, INSPECTIONTYPE 1618 Fixed System Final Fire Prevention 1266 Pool Spa Final 200 Finel Re-Fooi 201 Flnel BIaWReteining Well 202 Final Factory Fire Plece 203 Finel Sign 204 Final Demolition QejE RI COOEI INSPECTIONTYPE 206 Final Mechanical 208 Final Plumbing 210 Final Elecirical 272 Final Fira Preventian 220 Final Planning Approval 222 FInalSite 250 FinalBuiltling�Occupancy PAIE II�E4,4 (714) 754-5273 • Fax (71q) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIfl �HIVE, GUSTA MESA, GA 92626 Job Address: Suite No Vicinity: Parcel Nunmber: Applicant 940 PAULARINO AV 14172215 PINO, EULALIA Address: 940 PAULARINO AVE COSTA MESA, CA Owner: PINO, EULALIA Address 940 PAULARINO AVE COSTA MESA, CA Convactor. O W N ER-BU I LDE R Address: ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool / Spa Lighting Fixls Recepl Oullets Switches Non Res Appl Res Appl Service to 200a Service to 7000a Service over 1000a Motors to 1hp Motors to 10hp Motors to SOhp Motors to 100hp Motors over 100hp Communication drops Sub panel to 200a ELECTRICAL PERMIT ISSUED BY: Phone: 714-547-2006 Zip 9262G2848 Phone: 714-547-2006 Zip: 92626-2848 Phone: Zip: License: 000000 Status: ISSUED Applied: 02/15I2005 Issued: 02/15I2005 SCOPE OF PERMIT ELECTRICAL PERMIT FOR INTERIOR REMODEL. ADD/RELOCATE 5 SWITCHES & 2 RECEPTACLE OUTLETS. REF: BOS-00232 523.50 so.00 50.00 $0.00 $0.00 so.00 $0.00 5220 $5.50 $0.00 50.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 �uantity FEE SUMMARY Temp Dist System / Lighting Buswayl100ft Standing Section Misc Eleclrical Equipment Transformers up to 1 kva/kw ................uP to 10 kva/kw .................up l0 50 kva/kw .................up to 100 kva/kw ..................over 100 kva/kw Low Vollage Equipment Low Voll Wiring Syslem / Ckt Misc. Conduit Misa Conductor Circus ( gen or nde) Circus (mech ride or lights) Christmas Tree Stand Fireworks Stand Other Electrical Fee Investigation Fee Plan Check Fee $0.00 so.00 $0.00 $0.00 $0.00 so.00 $0.00 50.00 $0.00 $0.00 $0.00 50.00 50.00 $0.00 $0.00 50.00 50.00 $0.00 50.00 $0.00 Quantity 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 NO710E: The work authorized by this permit shall comply with all applicable hantlicap access requirements under Califomia statutes and related regulations. (Ord. No. 9&28, § 7, 12-21-92) EXPIRATION: This permit shall automatically expire and become void tl work is nol commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPEC710NS: In ordsr for the work authorized under Ihis permit to be considered legal, such work must comply with all applicable codes, entl all requlred inapeetlona ahd final epprovel must be obtained. Failure to obtain inspections end final approval will result in the expfration of ihis pertnit. FOR INSPECTIONS CALL: (714) 7545626 zae�ae 1�'aa� WORKERS'COMPENSAnON DECLARAnON: I hereby affirm under panelry af perjury one of t�e following decleretions: ❑ I heve end will meintein e certificete ot consent to sell-Insure tor warkers' compensa�lon, as providetl for by sectlon 3700 of the La6or Catle, for the peAortnence ot tha work for wNc� t�is permit is issued. ❑ I havB end will maintain wwkers' compensation Inwrence, es raquired by sec6on 3700 ot �he Labor Code. far IhB perfortnance af Ne vrork tor whkh this permit Is issued. My workers' compensatlan Insurance cartier antl poliq number are: Carrier: Policy Number. (T�ls sectlon neetl nof be comp/etetl i! Ne pertnif !s ve/uetl et ane hunOred dW/ers (3100) oNess.) �� I.cetlity t�et in t�e peAortnance ot the work Iw whiU fhis pertnit is issued, I shall nat amploy eny person In eny manner so as to become sub�ect ro t�e wwkers' —coi�/pensation laws ol Celifomia, entl egre� t�at If I�hq ultl become sub�ect to the workers' compenselion provislons ot Sectlon 3700 0l Ihe LaCor Code, I shall lorihwith compty with these�^ sions. � � AppllcanLSlpneture: Cp f Date_�� " � � – � �� WARNIN(3: FAILURE TO SECURE WORKERS' COMPENSATION COVEMOE IS UNLAWFUL AND SWLLL SUBIECT AN EMP`LOYERTOCRIhUNaL PENALTIES AND CML FlNES UP TOONE MUNDRED TMOUSANO OOLLARE (51 W,000). IN AD�ITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3]O60P THE tABOR CADE, IMEREST, ANO ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby eNirm ihat I am Ilcensed under provisions ol C�epter 9(wmmencing with Sectlon 7000) ot DlWsion 3 0l he Business end Prolessions Cotle, and my license is In tull torce entl eHec�� _ CONSTRUCTON LENDING AGENCY: ❑ I hereDy ettirm thet �here is e construction IenOing apency for Ihe peAortnance ot the work lor which Ihis pertnit is issuetl. (Sec. 3097, Civll Code). Lendefs Neme: Lentler's Atltlreu: Slpneture: OWNER-BUILDER DECLARA710NS: Date: I hereby eHirtn Ihet untler penelry af perjury thet I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for the tollawing reeson (Sec. 7031.5, Business antl Protessions Code: Any city or counry whic� repuires a permit to construct, aller, improve, demolish, or repair eny atrucWre, pdor to its issuance, elso requlres ihe appllcant for such pertnit b file e signed stetement that he or she is Ilcensed pursuent to the provislons ot lhe Coniractors License Lew (Chepter 9(commencing with Sectlan 7000) of Dlvision 3 oi the Business end Professians Cade) or that he ar she is exempt therefram antl the basis for t�e ellegeE e:emptlon. Any violetion oi Section 7031.5 �y eny epPlicant for a pertnit syub'Iects ihe applicem Io a civil penalry of not more then fiva hunEred dollars ($S00).): ��J-�1 ,es owner ol tha properry, or my employees with wages as iheir sole compensatlon, WILL DO TNE WORK, entl tha sWcture Is not intendad or ottered for sale (Sec. —�Od4, Business and Professions Cotle: The Contracbrs License Law tices noi apply to an owner ol properry who 6uilds or improves Ihereon, entl who dces such work himselt or herself or �hrough his or her own employees, O�ovided ihat such improvemenis are not intended or oHered for sale. If, however, tha building or Imprwement is sold within one year of wmpletion, the owner-builtler will �ave the burden of proving that he or she did not build or improve for purpose ot saleJ. ' ❑ I, as owner of the properry, am E%CLUSIVELY CONTRACTING WITF1 LICENSED CONTRACTORS to construct the prolect (Sec. 704d, Business and Professions Cotle: iTa cantractars Licensa Lew does wt apply to en owner of pmperTy who builtls or Improves thareon, and who contracts for such pro�ect with a coniractor(s) license pursuant to tha Contractws Licensa Laws.). ❑ I am ex pi untler sec. Business entl Prolessions Cotle for this reason: SlgneNre_ �i] .� ..�c.li,� i . �– OwnarlDve tAiedbydnverslicense. �-Yes}. �No Dnvera�Licensa�No.�- Vedfication ol Ownership by (rype of daume t In�,'.e. - property �ac �III ar deetl)r-�� DIVIS�ON OF INOUSTRIAL SAFETV PERMIT CEFTIFICATION: ❑ I hereby certlly �het no axcavatim Ilve (5) or more taei In depth imo which a person Is required Io tlescen4 wlll be mede In connectlon wl�h work euthonzetl by Ihis pertnit, end that no building siructure, scaflolding, talsework, or tlemolition or tlismanlling Iheraot, will be mao then Ihirry-siz (38) feel high. (ChaD� 3.2, Gry 2, Art 2, Sec. 341, Ttle B, Calilamia AdministreWe CoOe). � As owner-builtler, I will not employ enyone to do work which would repuire e pertnit from lha DiNsion of Industriel Safery, es noted ebove, unless such person hes e pertnit lo tlo such work fmm Ihe division. Signeture: Date: Division of InEusirial Safery Pertnit Number: CERTIFlCATE OF COMPLJANCE AND AUTHORQA710N OF ENTAY: I certity under penalry ol perjury that I have read this application and state that lhe infortnation given is correct. I egree to compry wit� ell state laws ena ciry ordlnances relating to building constructlon, antl eut�odza representatives of the Ciry oi Gosta Mesa ta enter upon the �above�d scnbed pro erty orjnspecti rposes. I egreo not to occupy or allow occuDency ol eny 6uilding authorized by this permi� until finel inspectlon. ��u� ��-�r-d' O � - /5 - o`� 0 d�` � Slgnamre,Of.Legel,Owner(s) [" �ate�^–�.-.�. L�.. Antl/Or Authodzetl Applicent Data GOpE I, INSPECTIONTYPE PAIE I616 Flxetl System Final Fira Prevention 1266 200 201 202 203 Paol Spe Finel Finel Re-Rooi Flnel Block/Reteininp Well Finel Factory Fire Place Finel Slpn 204 Finel Demolitlon p�; cooe� ixsreenoNTvve 206 Finel Mechanicel 20B Finel Plum�ing _ 210 Final EletldWl 2/2 Finel Fire Prevention 220 Finel Planning Approval 222 Final Site 250 Final BuildingiOccupency � � � / Iti�LS 24C?2 i COSTA MESA BUILDING-SqFEfY DEPARTMENT P. O. BO% 91] C09TA MgBp, CALIFORNIA For Appllcant fo Fill In Completely TYPE OR PRINT BUILDINO paularino Avenue ADDRES9 COSTA MESA. CALIFORNIA OWNER CCW Lund Com 4n aooaess 1304 W. Commomrealth Ave. cir Fullerton No'871-2 ARCHITEGT ..._ . . .. . TEL _ . . _ 18368 E. 4th p BtBtrtB1II r. 1304 w. co� CITY OF CflSTA MESA MAY 5 1965� For Office Uae Only P[C[II! NO. ZONINCi _ NO.OR �UB80P •� I �LANB / sUILO O A. STATE TP,L. 90'r TO S�IDH B REAR P LIC.NO. 19O�i1�I N , 8%1-2710 SIZE // EAVE9 OF LOT � �^ � � � I NO. OP BLDOB. O ALLOWED Now aN lAT YARDSAPPROVED USE OF MAIN BUILDIN EXISTING BLDO. z � ( FROM GL RE 6CTBACK L�NE PROM c� '�� FRONT FT. cervien OR sinaeT / REAR YARD 6IDE YARD LEFT I R16HT R. 61DH FT. DESCRIPTION OF WORK �.sioa rT. 1 vee v� eu��vin� wnu wonrt rv gfi PERFORMED Tract 5340 — Lot 61 Plan 447A R-1 Reaidence 1 HtHEBY �CKNOWL8DO8 TN�T 1 XAVg qgAD TNI�APPLIGTION •ND 9TAT8 THAT TH8 ABOVB IH COHRBCT ANO HH8 TO COM. PLY WITH M1LL CITY OqDINANCHB AND gTATH LAV10 q60ULATINO BUILDINO CONeTpURION. SfGNATUftH OF ` PERMITTEF� - G�"'�'v'�9� �, � � AUTHORIZED AOENT VAR. # BHALL BE LE6S THAN YARDSAPPROVED ACCESSORV 9UILDINO BET. . ACCE DATE THB AMOUNT BHOWN UNOBR VALUI�T�ON 18 FOR TN8 PURPoSB OR E9TABLI9HIN0 A PEpMIT PEE ONLY. VALUATION � �! PBRMITFEE $ (/J � Sl %�/5 9 �_ T TAL FEE