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Home My WebLink About2798 FRANCIS LN - Building Permits(714) 754-5273 • Fax (714) 754<856 •�wiw.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: Suite No Vicinity: Parcel Nunmber: Applicant: Address: Owner: 2798 FRANCIS LN 14133211 ROHN,JEFFREY 1050 W KATELLA AV ORANGE,CA TICKENOFF. JOSHUA P Address 2798 FRANCIS LN COSTA MESA, CA ELECTRICAL PERMIT .Phone: 714-538-1411 Zip: 92867 Phone: Zip: 92626-5806 Contractor: FREEDOM PLUMBING HEATING AND AIR INC Address: �050 W KATELLAAV ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool / Spa Lighting Fixts Recept Outlets Switches Non Res Appl Res Appl Service to 200a Service to t000a Service over 1000a Motors to 1 hp Motars to 10hp Motors to 50hp Motors to t00hp Motors over 100hp ORANGE,CA Phone: 714-538-1411 Zip: 92867 License: 808080 ISSUED BY: Status: ISSUED Applied: 07/09/2004 Issued: 07/09/2004 SCOPE OF PERMIT CHANGE OUT FAU, ADD AIC AND CHANGE/UPDGRADE DUCT WORK FOR AN EXISTING SFR. REF: M04-00373 ELECTRICAL TO INCLUDE: 1 MOTOR FOR CONDENSOR, 1 OUTLET AND MISC CONDUIT. $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $7J0 $0.00 50.00 30.00 $0.00 $0.00 $0.00 $0.00 $12.30 $0.00 $0.00 $0.00 Quantity FEE SUMMARY Temp Dist System / Lighting Busway/100 k Standing Section Misc ElecUical Equipment Transformers up to 1 kva/kw ................up to 10 kva/kw .................up to 50 kva/kw �. .................up to 100 kva/kw ..................over 100 kva/kw Low VolWge Equipment - Law Volt Wiring System YCkt Misa Conduit � � Misa Conductor � , Circus ( gen.or ride) Circus (mech ride or lights) Christmas Tree Stand . Fireworks Stand , OtherElectrical�Fee - Quantity $0.00 0 50.00 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 , $0.00, 0 $1820 1: $0.00 % ��0'� $0.00 � / 0 $0.00 " 0 $0.00 0 $0.00 0 $0.00 NOTICE: The work authorfzed by this permit shall comply with all applicable handicap access requiremenis under California statutes and related regulations. (Ord. No. 9248, § 1, 12-21-92) EXPIRATION: This permit shall automatically explre and become void if work is not commenced within 780 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order tor the work authonzed under this permit to be considered legal, such work must comply with all applicable codas, and all requlred inepeetiona and final epprovel must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (774) 7545626 244&d8 (8�00) WORKERS'COMPENSArON OECLARAnON: I �ereby eflirm untler penalry oi perjury one ol the lollowing dedaratlons: ❑ I heve anA will maintaln e certificate at wnsent to self-Insure tor workers' oompensatlon, es praWtleA lor by section 3700 at the Lebor Cade, for the peAarmance of the work tor wNCh Ihi9 pertnit Is issuetl. ❑ 1 heve arW wlll My workers' c Cerrier. (Thls sectloJi.need i bY �� 3700 ot Ihe Lebor Cotle. for the pertortnence of the wark fa whid� this pertNt Is Issuetl. orless.) Policy Number: terttly ihet in 1�0 DertormenCe ol the work lar which Ihis permit is IssueA, I Shell nOt emplay eny person In any menner so es lo hecome subf ed to Ihe workeis' wmpensation laws o1 Celltomia, enC egree t�at if I shoulC become sub�ect to the workers' compensetion proNsions ot Section 3700 of Ihe Lebo Cotle, I s�all IOMwlth comply wlth these �I. � /� ADPlicent Signelure: �� HDS� � Dete: �-- �-�l 1 WFRNINO: F/ILURE TO SECUREIYORKERS' COMPENSFTION CWERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENA�TIES AND CNIL NES UP TOONE HUNDRED TFIOUSAND DOLUFE (5100,000). IN AODfTION TO THE CO6T OF COMPENSATION, DMNOES AS PROVIDED f-0{i IN SECTION 31080F THE LABOR COOE.IfJ�EREST, M1D ATTORNE'fS FEES. LICENSED CONTRACTORS DECLARATION: I hereby eflirtn Ihat I em Ilcensed under provislons ol CheO�er 9(commencing with Soctlon 7000) ot Division 3 0l the 8usiness and Professlons Cade, antl my license Is in lull force Bntl eNecL Lic. q CIesS a __, ContractoYs Slgneture: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby efllrm t�at there Is e wnsWctlon lending egency lor Ihe peAortnance ot tho work tor which Ihis perml� Is issued. (Sec. 3097, Civil Code). Lentlers Neme: SigneWre: _ OWNER-BUILOER DECLARATONS: LenOers Address: Dete: I hereby aHirm t�at untler penalry oi per�ury thet I em E%EMP7 FROM TME CON7FiACTORS LICENSE LAW for Ihe tdlowing reason (Sec. 7031.5, Buslness antl Prolessiwu Cotle: Any ciry or counry which requires e pertnit to construct, elter, Improva, tlemolish, or repair eny strucWre, pnor to its issuance, elso requires the eppliceN for such pertnit to flle e signed stetament thet he or she is Iicensed pursuent to Ne provislons ol the ContraQors LJcense Lew (Chepter 9(commendng with Sectlon 7000) of DMsion 3 of the Buslness enA Prafesslons Code) ar that he or sha is eaempt therelrom end tha basis lor the ellegetl exemption. Any violation ot Section 7031.5 by eny epplicent for e pertnil subJects the applicant to e cMl penalry oi nat more than frve hundrad tlollars (5500).): ❑ I, es owner of t�e pmperty, or my employees with wa9es es �heir sole compensatlon, WILL DO THE WORK, entl t�e structure is not intenCeC or ottered for sale (Sec. 7044, Business antl Professions CaOe: The Contractors License Lew does not apply to an owner of property who builds or improves Ihereon, en0 who does such work himsell or hersett or Ihrough his or �er own employees, provitled that such Imprwemenls ere not Imended or oHered for sale. It, however, the builtling or improvement is sold wit�in one year oi completion, the owner-builder will have the burden of proving ihet he or she did not build or improve for purpose of sele.). � ❑ I, es owner of Ihe pmperty, am EXCLUSIVELV CONTRACTNG WITH LICENSED CONTRACTORS to constmct the project (SecJ044, BuSiness antl Profeulons Coda: The conirac�ors Llcense Lew tloes not appty to en awner af pmperty who bulids or Improves lhereon, antl who contrects br such proJect with a contrector(s) liCenSe pursuent to t�e Contrectors License Laws.). ❑ I em exempt under sec. Business end Prolessions Code for Nis reason: Signeture: Date: Owner ID verifletl by tlnvefs license. ❑ Yes ❑ No Drivers LJCense No. Vedficetlon ol Ownerehip by (rype of documem, i.e. - property tex blll or deed): Evpires: DIVISION OF INDUSTRIAL SAFETV PERMR CERTIFICATION: ❑ I hereby certity thet no excavatlon five (5) or more teet in tlap�h into w�ich e person Is required to descend, will be made in cannection with work euthoAzetl by Ihis pertnit, end thet no builtlinp sinuture, scefldding, talsewark, ar demdition w dismantling thereoi, wlll be more than Nirty-six (36) leet high. (Chap. 32, Grp 2, Art 2, Sec. 341, 71t1e B, Celifomla Administretive Cade). ❑ As owner-huiltler, I wlll not emplay enyone to do work whic� wwld reQulre e permit Imm lhe DlWsion oi Industrial Safey, as notetl ehove, unless such peraon hes e pertnll to tlo suc� work Irom tho diWsion. Signature: Date: Divislon of Indusfdal Safery Permit Number. CERTiFICATE OF COMPLIANCE AND AIITHORIZATON OF ENTRV: I certity under penalty of perjury thet I heve read ihis ap0licetlon end state Ihat the intortnetion given is correcc I egree to comply with ell stete lews end ciry ordlnences relating to bullding consiruction, end authodze represen�atives of �he Ciry of Coste Mesa to enter upon the ebove-descnbetl property lor inspec�ion purposes. I egree no� Io occupy or ellow occupency ol eny building authonzetl by this permit until tinal inspection. GO�E I, INSPECiIONTYVE PdIF II�LH 1816 Flzed System Flnel Fire Preventlon 1288 200 201 202 203 204 Pool Spe Finel Flnel Re-Rool Finel Block/Re�alning Well Final Fectory Fire Plece Finel Sign Finel Demolition yOUE� INSPECTIONTYPE 206 Finel Mechanical 20B Finel Plum�ing 210 Flnel Electrlcal 212 Finel Fire Prevention 220 Finel Planning Approval 222 Final Slte 250 Finel Bullding/Occupency Pdg I�L� ... � L ► (714) 754•5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us �" -' r 77 FAIR DRIVE, COSTA MESA, CA 92626 Jobnddress: 2798 FRANCIS LN Suite NO Vicinity: Parcel Number: 14733211 Applicant: ROHN, JEFFREY Address: 1050 W KATELLA AV ORANGE,CA Owner. TICKENOFF, JOSHUA P Address: 2798 FRANCIS LN MECHANICAL PERMIT Phone: 714-538-1411 Zip: 92867 Phone: COSTA MESA, CA Zip: 9262&5806 Contractor: FREEDOM PLUMBING HEATING AND AIR INC Address: 1050 W KATELLA AV ORANGE,CA Phone: 714-53&1411 Zip: 92867 License:808080 ISSUED BY: Status: ISSUED Applied: 07/09/2004 Issued: 07/09/2004 SCOPE OF PERMIT CHANGE OUT FAU AND RELOCATE TO ATTIC, ADD A/C AND CHANGE/UPDGRADE DUCT WORK FOR AN EXISTING SFR. REF: E04-00794. � MECHANICAL TO INCLUDE: 7 FAU < t00K BTU, DUCT WORK REPLACEMENT, 1 GAS PIPING ANDICOMPRESSOR. ISSUE FEE Inst FAU <100 k BTU Inst FAU >100 k BTU RepairlAlt Cooling/Heat Insl / Rep. Recess Wall HU Refng Sys <100 k BTU Refrig Sys >100 k 8TU Gas Piping Factory Fireplace Hood w/Mech Exhaust VAV Box Vent Fan / Single Duct Appliance Fire Dampers Smoke Dampers Inst or Relocate Appl Vent Air Handlers < 10000cfm Air Handlers > 10000cfm Floor Fumace Floor or Suspentl Heater $23.50 514.80 $0.00 $13.70 ao.00 $0.00 $0.00 $6.75 50.00 50.00 50.00 30.00 50.00 30.00 $0.00 $0.00 50.00 $0.00 $0.00 50.00 �uantity FEE SUMMARY Repair / Alt Absorbtlon Unit Repair / Alt Refrigeration Unit Ventillation System Evaporetive Cooler Commercia l I nci ne2tor Domestic Incinerator Compressors / Absorption Svstems Up to 3 hp I 100 k BTU 3To15hp/SOOkBTU 15 To 30 hp / 1,000 k BTU 30 To 50 hp / 1,750 k BTU Over 50 hp / Over 1,750 BTU Boilers Upto3hp 3Tot5hp 15 to 30 hp 30 to 50 hp ' - Over 50 hp Other Mechanical Fee .- Investigalion Fee Plan Check Fee Quantity so.00 0 so.00 0 $0.00 0 $0.00 0 ao.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 50.00 0 $0.00 0 50.00 0 � � 527.15 1 50.00 0 30.00 0 50.00 0 50.00 50.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21•92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced withln 180 days, or if work is suspended or abandoned tor a period of 180 days. INSPECTIONS: In order tor lhe work authorized under ihis permit to be Considered legal, such work must comply with all flpplicable codes, and all required Inapeetiona end tinal approval must be obtained. Failure to obtain inspections and final approval vnll result in the expiration of this pertnit. FOR INSPECTIONS CALL: (714) 7545626 244&IB (8�00) WORKERS'COMPENSAnON DECLARAnON: I hereby eMirm under penelry of perjury one of the lollowing dedaratlons: ❑ I heve and will maintain e certiliceta of consent to self�lnsura tor warkers' campensetlon, es proWdetl lor by sectlon 3700 at the Lebor Code, for the pertormance of the work fOr whith thi5 permi� is lssuetl. ❑ I have antl will m iniain workers' compensatbn I wrence, as required 6y 5ettion 3700 of �he Lebor Code. tor I�e pertortnante o� �he work tor which Ihis pertnit Is Iswed. My workers' co pe No u nce cartie i policy number ere: Cerrier: Policy Number: (This se tiar need no e c rp e(e i! (he pe Ns ve/ued er one huntlred dollarr.($!IX+) :yless.) I certity thet in tha paAortnence of the wo c tor wNch this permit Is Issuetl, I s�all nol employ eny person In eny manner so es to ecome subject to Ihe workers' compansation lews of Celllamle, BnA epree I�eI If I ShOuld betome SuD�oCi to Ihe warkers' compensatlon proNSions ol Section 700 0l t e Lebor e, I shail forthwlih comPN �th these pro cro . _ Applicent SlgneWre: — Date: WAqNINp: FNWRE TO SEW WOf1KE0.5' OOMPENSAiION COVEMOE I$ UMAWFlIL M1D $HALL $UBJEGT AN EMPLOVER TO CfiIAVNAL P T1E5 D CML ES UP TO ONE HUNpRED TKKISANOOOLLARE(5f00.000),INr1DDITIONTOTHEODSTOFODMPENS�TIIXJ,DAAUOEShSPqOVIUEDFORINSECTIpJ3l08OFTHELr1BORWOE,IMEPEST, DATTORNEI^SFEES. LICENSED GONTRACTORS DECLARATION: I hereby eNirtn that I em Ilcensed under proN5lons ol Chapter 9(commenUng wit� Section 7000) al Dlvlsion 3 of the 8uslnes5 and lorce end eMect. Lic. a Class a CONrecmfsSigneWre: � Date: ' CONSTRUCTON LENDINC AGENCY: Code, and my Iicense Is in full ❑ I hereby eflirm Nat there is e consiruction lending agenry lor the peAortnance ot t�e wark lor whiU this permit Is IssueO. (Sec. 3097, Clvil CoOe). Lentlefa Name: Lentlers Atldress: Signeture: _ Dete: OWNER-BUILDER DECLARA710NS: I hereby aHirm t�et under penalry of perjury Net I em EXEMPT FROM TNE COHTRACTORS LICENSE LAW for tha tollowing reason (Sec. 7031.5, Business end Professlons Code: Any ciry ar counry whlch requlres a permit to canstruct, elter, Improve, demdish, or repalr eny strucWre, pdor to its issuance, elso requires Ue ap0licani br such pertnit to flle a signad statement t�et he or she is Iicensed pursuant to the provisions ol Ihe Contrectors Llcense Lew (Chapter B(cammencing with Section 7000) of OMsion 3 of Ne Business end Professions Code) or thet he or she Is exempt t�eretrom anA t�e besis tor the elleged e:emptlon. Any dolation of Section 7031.5 by any epplicant far e pertnit sub�ects the applicam to a cidl penalry of not more than flve hundred ddlers ($500).): ❑ I, es owner at the praperty, or my employees wlth weges es thelr sole compensation, WILL DO THE WORK, antl the structura Is not intended or aHered tor sale (Sec. 7044, Business and Protessions Cotle: The Contractors lJcensa Lew does not apply to en owner of propeny who builtls or improves thereon, end who does such work himself or herself ar through his or her ov.n emplqrees, providad that such improvemenis ere nat intanded or oHered for sale. If, however, Ihe building ar lmprrnement is sold within one year oi comple�ion, the owner-builder will have the burden ol Droving that he or she did not build or improve tor purpose of ule.j. ' ❑ I, es owner of the O�operty, am EXCLUSIVELV CONTRACTNG WITH LICENSED CONTRACTORS to Conslruct Ihe O�o�ect (Sec. 7044, Business and Professions Coda: The comrecbrs Licenso Law tloes not appy to en owner of property who bulltls or Improves thereon, ena who contracts for such project with a contracmqs) . license pureuam to ihe Contradors License Laws.). ❑ I am exempt under sec. Business end Professions Codo /or ihis reeson: Signature: Date: Owner ID veritied by drivef9license. ❑ Ve5 ❑ No Orive/b License No. Vedficallon at Ownership by (type ol tlocument, i.e. - pmperry taz bill or deed): Expires: DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATON: ❑ I here6y cenlry thet no excavetion tive (5) or more teet In dapt� into which a person Is requiretl to tlescen0, will Oe matle In connection with work authorized by this pertni�, antl thel no Dulitling structure, scaHdtling, telsework, ar demditlon or dismemling thereoi, will be more than thlrtysi: (36) teet high. (Chep. 3.2, Grp 2, Art 2, SeC. 341, Title 8, Cellfomla Administrative Cotle). ❑ As owner-Dulltler, 1 wlll not employ anyone to do work which would reqWre a Oermit Imm t�e Divlslon ol Indusidel Setery, es nated ebove, unless such parson has e pertnit to tlo such work from the divisbn. ' Slgne�ure: Date: Dlvlsion of Intlustrial Safety Permit Number: CERTIFlCATE OF COMPLIANCE AND AUTHORPA710N OF ENTAY: I certify under penalty of perjury that I have reaC this application antl state that iha infortnation given is cortect. I egree to wmply wit� ell state laws enC dry oMinences relatlng to bulldinp construc�lon, en0 euthodze representetives ot the Ciry ot Costa Mesa to enter upon ihe ebova-descnbetl properry for insDecGon purposes. I agree not to occupy or ellow occupancy of eny builtling authorized by this pertnit until linal inspection. �aWre Of Legal Own� r Aut�adzed Appllcant �OOE �. INSPECTIONTYPE PdIE Ii�ELS 1618 Fi:ed System Final Fire Preveniion 1288 Pool SDa Finel 200 Flnal Re-Roof 201 Finel Block/Reteining well 202 Final Fectory Fire Place 203 Final Sign 204 Finfll Demolltion COOE 1 INSPECTIONTYVE 206 Finel Mechanicel 20B Flnel Plumbing 210 Flnel ElettAtal 212 Flnel Fire Preventlon 220 Finel Planninp Approval 222 Finel Slte 250 Finel Builtling�Occupancy � Y Ll l-' i' �� `e �:.tJ CITY (JF COSTA titESA ' ` PLANNING p1Y1510N SUBJECT TO 9LDG. DEPT. REG. NOTE: ADDIT[ANS. DEI.ETIONS, OR CORRECTIONS SHAI.L BE APPROVED BY THE PLANNING DIV. �c- .� � �a�;�5` , a� Cl � ��,� c � S (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 �ob Address: 2798 FRANCIS LN Suite No Vicinity: Parcel Nunmber: 74133211 Applicant: HAYES, EVA Address: 3 EDENDALE LADERA RANCH, CA Owner: TICKENOFF, JOSHUA P AddreSs 2798 FRANCIS LN COSTA MESA, CA Contractor: HAYES PLUMBING Address: 3EDENDALE LADERA RANCH, CA Arch / Eng : Address: ISSUE FEE BackFlow irrigation BackFlow Preventer Bathlub Clarifer System Connect Qce,Soda,etc) Dental Units Dishwasher Drain, Floor Orain, Rainwater Drain, Roof Drinking FounWin Expansion Tank Gas Earthquake Valve WATER HEATER CHANGE OUT. AMT $23.50 $0.00 $0.00 $0.00 50.00 50.00 50.00 50.00 $0.00 $0.00 50.00 50.00 So.oO 50.00 PLUMBING PERMIT Phone: 949•246-7852 Zip: 92694 Phone: Zip: 92626-5806 Phone: 949•246-7852 Zip: 92694 License: 768729 Phone: Zip: License: SCOPE OF PERMIT FEESUMMARY QTY AMT Laundry Tub / Washer $0.00 0 Landscape Irrigation 50.00 0 P-Trap $0.00 0 Pressure Regulator $0.00 0 Process Piping (per 10 ft) $0.00 0 Receptors $0.00 0 Septic Tank $0.00 0 Sewer Cap for Demo $0.00 0 Sewer Connect 30.00 0 Sewer Private Line 50.00 0 Shower 50.00 0 Sink, bar $0.00 0 Sink, commercial $0.00 0 Sink, Floor $0.00 QTY 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Status: ISSUED Applied: 10/75/2002 Issued: 10/15/2002 ISSUED BY: Sump Pump Swimming Pool Trap Primer Urinal Vacuum Brkr Bkflow(1-4) Vacuum Brkr Bkflow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (Toilet) Water Healer / venf Water Piping (Inst or Rep.) Water Re-pipe Waler Service AMT 50.00 $0.00 50.00 50.00 50.00 $0.00 50.00 30.00 30.00 $0.00 $12.30 30.00 50.00 $0.00 QTY 0 0 0 0 0 0 0 0 0 0 1 0 0 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under Calitornia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become vold if work is not commenced within 180 days, or il work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorizetl under this permit to be considered legal, such work must comply with all applicable codes, and all required Inepeetions and flnal epprovel must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALI: (714) 7545626 244Gdfi (fl�00) WORKERS'COMPENSATON DECLAAATON: I hereby atllrtn unde� penalry of perjury ane ot the following tleclaratlons: ❑ I have entl wlll maintain a cerUfirate oi consent to self-Insure lor workers' compensation, es provitle0 tor by section 3700 of the Lebor Cotle, to� Ihe peAortnance of the work for w�ich this pertnit is issued. ❑ I �ave and wlll maintain workers' compensatl n insurence, es requlred by sectlon 3700 oi ihe LeDor Catle, for ihe peAortnance ot Ne wo for whiU W5 pertNt I5 issuep, M workers' c0 ensa' Insurance ca ' oli numDer are: r � � � �.�J Carrler.Y � �� Pollcy Numbor. 1 wVU '�` (This sec9on nee not be completed'rf the rmit s vsluetl et one hundred datlers j3]00) or /ess.) ertlly that In iha peAartnence of Ihe wark for which Ihis permit is issuetl, I shell not employ eny person In eny manner so as to 6ecome suC�ect to t�e workera' compensatlon lews ol Calllomle, end agree that If I should become sub�oct to tha workers' compensatlon provlslons ot Secllon 370 0l Ihe Lebor Cotla, I shell tort�with complywiththnse �S�ansCfv""—'' � � r� � ^ (� � { Appllcant Slgneture: � Dete: U \ � WARNINO: FAILURE Tp SECURE WORKERS' B MPENSATION COVERAGE IS UNUWFlIL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES ANO IVIL FlNES UP TOONE HUNDRED T/10U5lwD DOUARE (5100.000�. IN ADIXiION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDEO FOR IN SECTIpJ 3]OB OF THE LABOR CODE, INTERE51, AN� ATTORNEI^S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirm ihal I am lic�ens�ed �und—er7pr;o�v,isGio lorce end eflect. IJw p'� CONrectors Signature: of Chepter 9(commencing wit� Section 7000) ol Division 3 0l Ihe Bi ciess a Date: _ Catle, entl my license Is In full CONSTRUCTION LENDING AGENCY: ❑ I hereby aHirtn that t�ere is a construction IenOing egancy for I�e pedormance of Ihe work Por whlch Ihis permit is issued. (Sec. 3097, Civil Code). Lentler's Nemo: LentleYs AOdress: Signe�ure: Date: OWNER•BUILDER PECLARATIONS: I hereby eflirtn Ihet untler penalty of perjury that I em E%EMPT FROM 7HE CONTRACTORS LICENSE LAW for ihe following reason (Sec. 7031.5, Buslneu flnd Prolessions Cotle: Any ciry or cou�ry which requires a Dertnit to construct, elter, Improve, tlemdish, or repair any siructuro, pdor lo its issuance, also requires ihe epplican� lor such pertnit to tile a signetl siatement that he or she is Iicensed pursuam ro Ne provisions oi the Contrectors License Lew (Chepter 9(commendng with SecOon 7000) oi DMsion 3 ot Ne Business and Professians Cotle) or that he ar she is exempt theretrom and Ne basis lor the alleged ezemptlon. Any Nolatlon of Section 7031.5 by eny applicant br e pertnit suD�ecis ihe epplican� to e civil penalry oi not mora tnen Ilve hundred tlollare ($500).): ❑ I, as owner ol Ihe property, or my employees wlih weges es thair sole compensation, WILL DO THE WORK, and Ihe structure is not intendeC 0� oHered for sale (Sac. 7044, Business anA Professions CoCe: The ContraIXors LJcensa Lew tices not appty to an owner ol property who builds or imprwes therean, a�0 who does such work hlmself or herself or �hrough his or her own employees, pwvidetl t�at such imorovements ere not Intended or ofleretl tor sale. If, �owever, the bulltling or improvement is sold within one year o1 completioq Ihe ownarbuilder will �ave ihe burden ol proving ihat he or she tlid not builtl or improve for purFwse of salaJ. ❑ I, 85 owner of the properry, am E%CLUSIVELY CONTRACTNG WITFf LICENSED CONTRACTORS to ConstNct the prolect (Sac. 7044, Businesg end Professions Catla: The con��actors Licensa Lew does noi aODh �o an awner ol properry who builtls or improves thereon, antl who contrects br such project wlih e contraqor(s) liCease purwan� m I�e Conlcactors Ucense Laws.). ❑ 1 em exempt untler sec. Signeture: Owner ID veritied hy tlnvers license. ❑ Ves ❑ NO Business and Pmfessions Cotle for this reeson: Vedflcation af Ownershlp Dy (typa af document, i.e. - property tax �III or deed): DIVISION OF INDUSTRIAL SAFE7Y PERMIT CERTIFICATION: Dnvers License No. De�e: Expires: ❑ I hereby ceNty that no exwvaLon tiva (5) or more leet in deON into w�ich e person is reqWreO to descend, wlll be matle in conneclion wlth work authodzed by ihls perml�, an0 iha� �o Cuiltling structure, scaHoltling, lelsework, or tlemolitlon or dismantling Ihereol, will be more than thirry-six (36) teet high. (Chep. 3.2. Grp 2, Ari 2, Sec. 341, Title 8, Celitomia AdminislretNe Catle). ❑ As owneabulltler, I will not empioy anyone to tlo work which waultl require a permit Irom the Oivlslon al Intlustdel Sefery, es notetl eDove, unless such pereon �as e permil lo do such work from ihe tlivision. Signature: Dete: Dlvision of Industrial Sefery Permit Number: CERTIFlCATE OF COMPLIANCE AND AllT}IORVATON OF EMRY: I cerlify under penel�y ol perjury thet I heve r0ad Ihis epplication and sWta that Ne Infortnatlon given is corteCt I egree �o comply with ell state lews end ciry ordinences relating to building conswaion, end euthodze reD�esentatives ol the Clry of Caste Mese to enter upon Ihe ebove-described property lor inspection purposes. I aBree not �o acupy or allow occupancy ol eny building euthorized by this permit until final inspeclion. YN I I .Signatu�alOwner(s) ,^ I� ,Qate�. �-fZI � V � U O d/Or Aulhorized Appllcant � � Date COUE 1, INSPECTIONTYPE �818 Pizetl System Final Fire Preventlon 1268 Pool Spe Finel 200 Finel Re�Roo� 201 Flnel BIocWFeteininp well 202 203 Final Factory Fire Place Finel Sign 204 Final Demalition � INI�dLi CODE� INSVECTIONTYPE 206 Finel Mechanical 208 Finel Plumbinp 210 Flnel Electrical 212 Flnel Fire Preventian 220 Final Plenning Approval 222 Final Slte 250 Final Bullding/Occupency Q� It�L,S Il-ly-o1 ,�f AOP��cant to (ill in all spaces exeeot those witnin heavy boraer Iines antl sign al1 appropriale Geclarations. iCl}�N"Oh�COSTA MESA COpNST�R,IU,,.'CCTI,O•N' PERMIT . PERN�T NO. � TRACT NO. LOT NO. UNIT NU. '�, � P�njFct Address _ /��d ��✓�" W • -- ,-. 9zo N.7dcuN� Applicant's Mailing Address • Owner's Name �� Phone � , � Address �E ��r% Arch/Eng. Licenu No. Address Convactor's Nom � � Phone - d�� Address (mailing) �'�F � �'�UC6�Mi City License No. Q�s%�/� LICENSED CONTRACTOR DECLARATION I here0y af/irm �hal I am licensed untle� p�ovlsions of Charter 9(commencing wiM section 7000) ot Division 3 0� tn Business antl Professions Cotle, antl my license is in tul�i� antl efte�t. L,/� ' License.f�aur�'f�� "� � Date � y � c� �a� _ — WORKERS'COMPENSATION DECLA�AT10� I hereby aftirm that I have a certificata ot consent to self-inzure or a certificate � Wo�ke�s' Compensation Insuiance, or a Cer[ifietl coOY the�eo( (Sectlon 00, Lab. C.1�/ � �/ , Cy�� olicy No. -_l��9�Q6 — Compan �� p �Certifietl Co y i5 hereby �umishetl. Certi i is tiletl with the �Ity ull ''si n. � Date 7 APplicant EXEMP 10 FROMWORKERS'�OMPENS TION ECLA0.ATION (Thissection neetl not be completetl if tne permit is for one huntlretl (5100) or less). I certity thal in tM1e pe�fo�mance of tbe work fOr whith thi5 pe�m�t is issued, I SM1all not employ any pe�son in any manne� so as to become SubjeCt to lhe Worker5' CompensatiOn Laws�of Cdli/omia. Date Si9naWre NOTICE: H, alter making this tledaration, you shoultl become su0ject to tno Workers' CompensaHon provisioPs of the Labor Cotle, you must forthwi�h comply wilh suc� provi5ions Or thi5 permit shall be tleemetl revoketl. CONSTRUCTION LENDING AGENCV 1 hereby aflirm tha[ there iz a Con4buGtiOn lentling agency tor tne Oe�fo�ma0ce Of the work lor whicn this Oermit is ISsuetl (Setfion 309] Civ. C.) Lentler's Name LenOer's Adtlress OWNERBVILDER �ECLARATION I hereby attirm that I am exempt from the ConVacror4 License Law for [he following reason (Section �031.5 Business antl Profe55ional Catle: Any cl[y or counly which requires a permit to �onstruct, alter, improve; tlemolish or repair any 5[ruc�we, p�io� to it5 isSuanLe, also �equires the applicant for such pormit t0 file a signetl slatement that hC/she is Iicensetl pur5udnt to [h¢ provision5 of the Conlrac[or'S License Law (Chapter 9(commencinq with Section ]000) of Division 3 of Ihe Business antl Prote55ion5 Cotlo) or that he/she is exeTPt '�erefrom an0 the ba5i5 tor the allegetl exemptlon. Any violation of Section 31.5 by any applican[ fo� B Permil Subjec(5 the applicant [o a Civll nalty ol not more than five huntlretl tlollars (E500). � J i, as owner ot tne property or my empioyees witn waqes as tneir soie ! rompensation, will tlo the work, antl tna structure is no[ inientletl or ofteretl Itor sale (Sectlon 7044, Business antl Prolessional Cotle: The Contrattor's Lic¢nse l. w tloe5 nol apply to aA owner of a prop¢rty who builtli o� improves '� t0ereon, antl who tloes such wo�k himselt/nersel/ or through his or her own employecs, provitletl fhat such iMProvement5 a�e no[ intentletl o� offCretl 10r sdl¢. If, howeve�, the builtling or improvement is soltl witM1in one yea� ot cOm- pl¢tlon, lhe owner will M1ave the bu�Uen of p�oving he/She tlitl not builtl o� Im- prove Por [M1e pu�pose ot sale). . ❑-I, a5 owner of the p�operty, ilm exClusively conlractin9 with lic¢nSCtl con- tractors.t6 construcl the project (Section 7044, Business antl Professions Cotle: Tha Conl�actor'S Litense L.aw tloes not apply [o an owner ot property wh0 builas or improves thereon, antl who contracts ior such projects wlth a con- lraclor(51 I¢en5e�pursuant to Ihe ConlraCtor's License Law). 1 am aware that proof o! lheir Worker'S CompePsation insu�ance SboulC be provitletl to me. ❑ I am exempt untler Section B. & P. C. for this reason Date Owne/ I-hereby certity tnat I h�ve reatl this application antl state fhat the above 'wmalion is correct. I�ree to comply with all city antl county ortlinances � '�tate laws relatino nuiiniiia conzKuction. antl herebv authorize.reore- ives `lon i N `re .- �_i i � TYPE OF CONSTRUCTION LI NEW U ADD U ALTERATION� REPAI R ❑ CONVERSION ❑ DEMOLISH ❑ OTI-�j( �ia TYPE OF PERMIT � �J GRA�ING LJ FOUNOATION LJ STRUCTURAI ❑ TENANT ❑ CT CAL ❑ PLUMBING MECHANICAL .1� OTHEIi � IV� /{/� PROJECT DESCRIPTION 511. FT. �� a�� CONSTRUCTION TVPE VALUATION ZONE GRADINGCU.VDS. � Remarks: Bar Sink Backflow Prevenrer - Backflow Irrigation Bathtubs Clarifiers Dishv.asher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Kitchen Sink Lavatories ?-Trap Roof Drains Reinspaction Fee $75 Duct - Under Ground Duct-Structural Duct - Ventilating ExhaustSystem ❑ MWtiple Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑ ai oo,000 sTu � i oo,000 . or 55 , - �-- I I Reinspaction Fee � $75 _� 10/84 -White - 6uiltling; Canary - Applicant; Pink - Accountlng; Goltlenrotl - AsSesso� Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Fleater Water�Service Issue Fee Hood or Type I ❑ Canopy Type II ❑ Refrigeration System ❑0-t00,0006TU ❑100,000 System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 5 3 A.P. � 5 Main Building: E T Front ARear C Right g Left Ping. Ref. # Planning Notes: Automatic Washer � Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Eleci Fan F.A.U. FixWres Device eoxes Outlets Switches Garbage Disposal Generator �0-5 KW C ' Q281 !/c"�./'� .:ro. Zone Accessory Buildin9: Z O N I N , G R Parking Req./Provided E Q M S ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Meter Oup to 100 amps Meter pover100amps ' Su6 Panel Motors �0-1 HP � i h� 8 Inc.Sola� �9-15 HP 016-15+ Microwave Pole Li9ht Ran9e I I Standing Sections 5�15 KW I I Trash Compactor FEES Reinspec[ion Fee I S15 luue Fee $ 3 DEVEIOPMENT SERVICES REaUIREMENTS: 2oning Approved By Data Building Approved By Date�-�{--Qt� Appliration laued 6y Date—(,Q��f}_/ - SUMM VRE/� FEES ` BUILDING PERMIT $ a�• ^"� SMIP $ �Su PLAN CHECK $ PERMIT • PLUMBING . $ ISSUANCE $ PIAN CHECK 25% $ ' ENERGV P.C. $ ELECTRICAI § GRADING S �� PLAN CHECK 50% $ MICROFILM S � MECHANICAL $ TOTAL FEE $ C PLAN CHECK 25% $ I i CONSTRUCTION ANDPLANNING POOL&SPA APPROVALS Permit # Date Inspector AppROVALS Permit # Date Inspector 1. Temporery 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 UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings � 58. Electrical Conduit-Undrgrnd. 8. Foundation � 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgmd. 60. Backwash Lines, P-Trap, � Undrgmd. 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 20. Rough FactorY Fireplace APPROVALS � Permit # _ , 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 77. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.StorageTank �Gas ❑Oil � 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 _. �2. Electriral 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 � 40. Gas Service-Final 41. Solar pomestio-Final - 42. Backflow Preventer � 43. Backflow Irrigation � ,' . 44. Landscape Irrigation System . � , 45. Sound Attenuation . 46. Handicap Regulations , 47. FINAL STRUCTURE & BU LDING �_b> 48. Special Requirements Com leted 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co . ; � 51. CERTIFICATE OF OCCUPANCY Date I �/ . � — fl — �, aG��;� . DEC 9 '196U' CbSTA MESA BUILDING•SAFETY DEPARTMENT ,•i;;,;j.'�_- �i._i • P. O. BOX 9fY C08TA MEBA. CALIPORNIA ' ' Lo � S/, P�- n�✓ ' 3�% �?W ��:�� For Appliednt to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT BUILDING BUILDING ADDRE65 COSTA MESA CALIFORNIA Fo� Office Use Onl y RHCCIPT NO, ��6RM{T�NO � ARCHITEC� � STATE � 9ETBACN LINB FROM TEL. NO. INO. OF eLD6B. ILEFT .�/ I RIGHT S/ DESCRIPTION OF WORK II OEMOLI61 � S70R1 WORK 70 BE FIRE ZONE APPRf BY zorve LEGAL OESCPI � A. P. � YARD: APPR< � IClNTI I�Y/HEREBY//.CNNOWLlpG! TXAT 1 XAV6 qH�D TMiB ARYGTION Uj�NO BTAt6 THAT TH6 ABOV¢ IB LOPnECT AND.A HH TO CON- PLY WITX ALL CIiYj�N�9 �VID BTATC�R6OULATINO BUILDINO CONBTRURI A SIGNATURE OF i/,�A Q � ev COSTA MESA. CALIFORNIA ZONING Ho. ov use ov rv PLANB /f BUILDING /TJ I6811E0 TH6 AMOUNT BXOWN UNDER VALUATION �8 FOP THE PUNPOBE OP 88TAGLIBHINO A PEHMIT FEE ONIY. S 1�� 30, o-D I PLAN CHECK $ �� (J'� ,