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HomeMy WebLinkAbout151 GEORGEANNE PL - Building Permits SsCITY OF COSTA MESA • i, � BUILDING DIVISION ,,,,,,„,,,,,H, I DEVELOPMENT SERVICES DEPARTMENT PER IT NUMBER i� PERMIT "P>a i 05-00713 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.usNG PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 BuiLDIJob Address: 151 GEORGEANNE PL Status: ISSUED - Suite: Applied: 05/04/2005 Vicinity: BETWEEN RESIDENCE AND GARAGE Issued: 07/12/2005 Primary Occ: R-3 Dwellings/Cong Res<10 Type of Construction: V-N Parcel Number: 43926205 Zoning: - a Applicant: JEREMY BAILEY - - ISSUED BY: ��:•. Address: 7 ORCHARD RD ��/ - - '- / " , Phone: 949-460=0655- LAKE FOREST;CA . --\ ' 1 Zip: 92630 - - - , , -- Owner: HERRON;ANDREW, v ' '- / Address 151 GEORGEANNE.PL----"�/ =- _ �/,-",,t,;' ` _ � i= - Phone. (949)2798156 - - -, ,/COSTA MESA,CA-'!-iZip: 92627-1513 ' ce ,A Contractor. FOUR SEASONS SUNROOMS -y- /. / ;Address:, 7 ORCHARD RD .��'��, ,,,,./ BLDO,101/ -<"`Phone: 949-460-0655 ' LAKE FOREST,CA �� Zip: 92630 .License: 501201 , - " ''Arch:: . / - ' %;*-- • - Eng: NARAGHI, KAMBOZIA S ' • Address: '� _ Address:;_8380 MIRAMAR MALL RD ' ', - - '' _ - Phone: - SUITE-212 Phone: 858455-6090 . i 1 /- a. SAN DIEGO;-A'' / — _ , Zip: N-,:'License: 92121:-`',, ' License: 42676 SCOPE OF. PERMIT... ,- ,z• ', ' AD D 297 S.F.TO EXISTING S.F.D.TO CREATE A NEW ATRIUM ;Cl/ ,34 (-. ' / ��; \S REAR YARD COVERAGE-25%(355 S.F.)ALLOWED;23%(322.5 S.F.)PROPOSED.'' ' FEE SUMMARY-`, _ - PIan.Check $320.29 = Calc Valuation: 1, ' $35,000.00 �'�, \Permit: , ;'$492.75 / �' Claim Valuation: , . : $35,000:00 'SMTP Res:. ' ,‘.,,$3.50 ' >- " ISMIP,Com `:'\$0.00 V`' 7 Other y$0.00 "^ . /" ' � In peCtiorr $0:00 r° '-// ��' i ! ' Total: $816 54*-::- � �� ' \A�\ /// ‘\: � �:o , /7/ / / l .)\::‘.\\ C� , A�\mac a . ;PLANNING&ZONING j % /' /� \i i/' ' `•'J '.<.,'-z- --\\,-... % A�/j /�/ SETBACKS .� �, , / MAIN STRUCTURE FrontZ,N..0-0�i 47. i-',Rear, 0-b "' Left 0 0 A Right 0:0 ' / ACCESSORY Front --0;,.-,0--:-:- " Rear^ 0-Q ,Leff ' ,0-0` ' `--, Right,,-->0-0..A PARKING Existinq: 0 ,Required:- „ 0 " ' Proposed: 0 . NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) C)/ WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: O I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. (9 1 have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Center-,----=(=a/Y4 Policy-Numtier: (This'section need not be plated if the permit is valued at one hundred dollars($100)or less.) I certify that in the performance of the work for which this permit is Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Califomla,andagree that if 'should-become subject to the workers'compensation provisions of Sect' n 37 of the Labor Code,I shall forthwith comply with these proviefons. r^� AP can[ i ffa ���J' DL ate a WARNING:FAILU Cir W GMPENSATIONTCOVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND E(S , ,IN ADDION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect_U -p os Sb� .Ol CIass ContIgr reNreN :1:�� =-� lUale.--r I}/I a./O$— i l CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: . Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commenting with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the properly,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • O I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,I.e.-properly tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,Califomla Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safely Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. —2r-ran RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or presegt or future building occupant require for the work which is the subject of this a plication a.zuc ernit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? PI Yes No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. S re Of Le I Ow _ Date •,7//,1JU� --- -•nWbr_ , �z`eYlCppiicant-. is ) ODE I <INSPECTION TYPE RALE INTMALS SOU( INSPECTION TYPE RATE ISLE 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical • 201 Final Block/Retaining Wall _ 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site / 204 Final Demolition 250 Final Building/Occupancy ... '"31-... '"31-� 3)- Y ��it�' � CITY OF COSTA MESA 4 :a"` '. BUILDING DIVISION ).?' 'lr DEVELOPMENT SERVICES DEPARTMENT PER IT NUMBER PERMIT rdarero,t J browny)f14. 05-00732 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesaELECTRICAL PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 151 GEORGEANNE PL Status: ISSUED Suite No Applied: 07/12/2005 Vicinity: Issued: 07/12/2005 Parcel Nunmber: 43926205 , Applicant: JEREMY BAILEY .:.,. . _ : .._. . ISSUED BY: ,�// Address: 7 ORCHARD RD ,, jr 7_ BLDG 101 , Phone: 949-460-0655 , / - t LAKE FOREST,CA• Zip . .. 92630 . , - Owner' " HERRON, ANDREWS- - -- - .N: , Address .151 GEORGEANNE PL-,-; _ Phone: (949)279-8156 / - COSTA/MESA;CA Zip: 92627-1513 - - - \ _ de: , . , ` / . . , �' ,l/ Contractor - / FOUR SEASONS SUNROOMS - - - - • Address: /7ORCHARD RD" _ : i - .BLDG-101 - Phone:.949-460-0655 : - - N ' '- - License:501201 i�' - - �. . ', ✓ GL ° r Tr r"'(7 SCOPE OF PERMIT / 7 , r-rCJ . . ,\ :ADD 297 S.F.TO EXISTING.S.F,D.TO CREATE A NEW ATRIUM.REF_B05-007-13 • - ` ‘, \ REAR YARD COVERAGE-25%(355 S.F.)ALLOWED;23%(322.5'SiFi)PROPOSED. .. .i -. . 'ELECTRICAL TO INCLUDE:33 UGH-IFIXTURES, 10 OUTLETS,10 SWITCHES, 1 SERVICE TO 200'": - - ' 'AMPS,AND 1 MISC;CONDUIT' - -'-- —N - - '- -- - - - ' FEE SUMMARY r, . , \k',\ , Quantity - - i Quantity// .' ISSUE FEE ) \ \.:,;.<2 $23.50 ,,.Temp Dist System/Lighting $0.00 )5):/ / ,, Temp;service test/ .,v' \ $0.00 ! .'Busway/100 ft $0.00 .�/,0' i'j Res:ak,package `$0.00 a;- T .. .1 Standing Sectlon $0.00 i0 �New Res(1-2 units) �N$0.00 0 Miss Electrical'Egmpment $0a02C-j 0 ;- New Res(3+units) $0.00. ..0r , Transformers up;to 1,kva/kw:-, -'$0.00 j 0 , Pool/Spa \ V /� $0.00 - 0 L,. - 2 ` up to 10 We/kW - .$0 00 - 0 v ,/ Lighting Fixts \ 7,//,$31 49 $ X33 7 up to 50 kva/kw 1$0.00(/ '0 - Recept Outlets \l� //,$11.00 - X10, o - , up to 100 kva/kw J! $0.00' , 0' / "- Switches $11.001, -10� .- over 100„kva/kw ' $0 00, CO / - • Non Res Appl CNV -'$0.00 , 0 �' Low,Voltage Equipment $0'00�' 0 -� Res Appl \L� 60.60 , tt ,0-'-� - ; - - Low-Volt WiringSystem/Ckt \\---$0.00 %0!-” Service to 200a $30.50�� 1-� , Misc.Conduit - A, A$18.204-,%1' Service to 1000a -$0.00 ' 110 ; `/ ] "7. _'Misc:Conductor.. � ' $0.60'',',-/0 Service over 1000a $0.00= 0 ` - / Circus(gen or ride) --i „..---5.--;$6.00-- 0 Motors to 1 hp $0.00' '`'0Circus(mech ride or lights)- " $0.00 0 Motors to 10hp $0.00 0 -- Christmas Tree.Stand-/" - -- $0.00 0 Motors to 50hp $0.00 0_, - - . Firewrks-Stand' o '_'.' $0.00 0 Motors to 100hp $0.00 0 -- --' Other Electrical Fee $0.00 IOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related lgulations.(Ord.No.92-28,§1, 12-21-92) KPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned r a period of 180 days. SPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all iuired Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. R INSPECTIONS CALL: (714)754-5626 '46(6/00) DECLARATIONS fl WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: O I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. EyI have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. ___M�y-workers'compensation Insurance carrier and policy number are: Carrier: c---XB/19 Polic�Number!- ("Mir tion 7hii Taction need not be cdmpleted if the permit is valued at one hundred dollars($f00)or less.) I certify that in the performance of the workfor whichthis permit is ,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Califomia-anilag '- .at if I should become sub ct to the workers'compensation provisions of Section 700 oft Labor Code,I shall forthwith _comply-will these pr. ='• Apppricarlt•Signaticre: .....r0r Datr:' 7 /a_ or WARNING:FAILU- 0 SECU: WORKS: '-•' PENSA 1•., • . _ I-AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND•• '- blit r!• ..• •- • •E COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that.lamJicensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business.nd Professions Code,and my license is In full force and effect.Licr# SCI d-C)I Class.#7 4 Catractors'SlgnaWre: --- Deter", fla. CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued.(Sec.3097,Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): O I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or Improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of properly who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑No (Section 25533 of the Califomla Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds. or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4—Tan RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present Or future building occupant require for the work which is the subject of thisgppplication apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes U No (Section 65850.2 of the Califomia Government Code requires that the requested Information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"res",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No 8 (If yes•,attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the Information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the ' above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. gnature Of L: c' n= ) yet te �L OrizedAggjjf'nt _ tem`• ;ODE t 1$SPECTIONTYPE PATE RIIDJE65 CODE! INSPECTIONTYPE BATF INTmALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical .S 31-a6 act 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign - 222 Final Site 204 Final Demolition 250 Final Building/Occupancy __ c'1l'r!4, CITY OF COSTA MESA �; `, BUILDING DIVISION F I .._.mar I DEVELOPMENT SERVICES DEPARTMENT PF�RMIT NUMBER � PERMITM05-00392 � (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 151 GEORGEANNE PL Status: ISSUED Suite No Applied: 07/12/2005 . Issued: 07/12/2005 Vicinity: ' Parcel Number 43926205 _ - .` - ISSUED BY: a Applicant: JEREMY BAILEY'; , / / Address: 7 ORCHARDRD '� . BLDG 101, • `, -- - Phone: -949-460-0655_ , - - - /. , /LAKE FOREST,,CA' !/ `Zip 92630 ;-'- Owner, 'HERRON, ANDREW Address: 151 GEORGEANNE PL - "`- ;'/U.///.` Phone: (949)279-8156 i" / A . `, COSTA'MESA,CA Zip: )92627-1513 - . .. Contractor FOUR SEASONS SUNROOMS - Address 7 ORCHARD RD - ` ,, �' \-'1, . , ,'BLDG 101 -, --.Phone: 949-460-0655 `• LAKE FOREST CV- Zip: 92630 - __•�- , - . License:501201 'N A t • - _ SCOPE OF PERMIT - / - ` / 1 'ADD 297 S.F.TO'EXISTINOS:F.D:TO CREATEAANEW ATRIUM. REF.:BO5-007.13 l', • ,,..l! ; .c 'i'.L' J: /, '/ /' II -.,`- °- >- ;•'REAR YARD COVERAGE-25%'(355 S.F.)ALLOWED;23%(322.5 S.F.)PROPOSED. - - - ' *7/ / ` MECHANICAL TO INCLUDE: REPAIR/ALT CODLING/HEAT.I, %' - - -FEESUMMARY r -- -,r . Quantity ."% i'; Quantity ISSUE`FEE �\ $23.50 Repair/Alt Absorbtion Unit , /24' ' $0.00 0 . Inst FAU'<100 k BTU \\ $0.00 0 • - Repair/Alt Refrigeration Unit /,,'- $0.00 0 Inst FAO>100 k BTU` , $0.00 0 ' - Venbllation System U-;'` / $0.00 0 Repair'/Alt-;Cooling/Heat \, $13.70 1 v r� Evaporative Cooler '1/ x$0.00 0; • Inst/Rep Recess Wall Htr V\'�, $0.00 0 f ;? Commercial.Incinerator 2/ $0:00 ' 0 , Refrig Sys<100 k BTU' \-•,\\:*x$0.00 0 -' - • ,�Domestic Incinerator _ y/ $000,., 0' Refrig Sys>100 k BTU: ' A-�i$0.00-y 0 v �t . ,Compressors//Ab'sorptiori:Systems 7 , , Gas Piping �,v-�, ') 'x$0.00 0 c ' Up to 3 hp/100 k BTU / / ..- $0.00 '0 Hood w/Mech hasFactory \t C/ 1/� $0.00'�0`� � - -- '' ' " 15 To 30 hp 5100 k BTU 000 kBTU ///21, �(_ //// /x$0.00 0 VAV Box �� /,"$0.00 -0--::-"-',,,c5,,,,,,,, - C ;30-To 50 hp./_1,75Ok-BTU ,'c/�-.- $0.00 0 Vent Fan/Single Duct. CN +. _$0.00�-0 --vOver50 hp/over 1,750 BTU ‘‘,:"-/�'" , $0.00 0 • Appliance A`--� $0.00 0 - - Boilers _ - � '. Fire Dampers - $0.00 �0 Up to.3.hp � •• �'! • $0.00 0 Smoke Dampers ����-$0.00 '-0- "' __,-�� ,, - 3 To 15 hp- �,� ' ,�„j $0.00 0 • Inst or Relocate Appl Vent --.$0.00 - 0 --'• I ' - 15 to 30 hp-' , --/ $0.00 0 Air Handlers< 10000cfm $0.00 0 - ' .�" -' : -30 to 50 hp -;_i" $0.00 0 Air Handlers> 10000cfm . $0.00 0 Floor Furnace $0.00 0 _ _ -,,I-, :_, : :. , .Other-MechanicalFee Floor or Suspend Heater $0.00 0 ' - --- --investigation Fee $0.00 • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§1, 12-21-92) 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 considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 �/p/ 2446-46(WOO) V i DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: O I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Z(]a I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. My workers'compensation Insurance carrier and policy number are: ( TEerte fa�XPrM Poll�ry � L�4 hifsection need not be leted if the permit is valued at one hundred dollars($100)or less.) I�7I certify that in the performance of the work f•Lwhich.this-pennitisissued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California anda.ree that If I should become Object to the workers'compensation provisions of Sectlo 3700 f the Labor Code,I shall forthwith comply with these provis'.•- ApplicaniSlgrtetures C OI1C'b Y Id-- °MC WARNINO:FAILURE T. ECU- r-...... . E IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMI PE ES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(- rn..r, • IIDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 otthe Businesspnd Professions Code,and my license is in full force and effect(Dore--s S , e (CI ss3t� lK C �odtre s:Signature: + aft fir Oatet—. of CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to Its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant fore permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): O I,as owner of the properly,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sac. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Flre Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). C Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future buildingt require for the work which is the subject of this application aUernit for such construction or modification from the South Coast Air Quality Management District orr from from any other air pollution control district or agency? LJ Yes LI No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 W Ill any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If Nes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). , 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No "yes", _ ___._ __ _._....._....... 8 (If es",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPUANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owner(s) Date AnNOi-AuUwoizedAppticant—'x'--' 1Datejz CODE cIIISPECTION TYPE PATE MALI CODE 4 IBSPECTION TYPE 2LX AU 1616 Fixed System Final Fire Prevention 206 Final Mechanical Z 3ji l✓)t 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final BIocldRetaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign _ _ 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 4`en Mac 9 CITY OF COSTA MESA BUILDING DIVISION >Y•,,,' 4. DEVELOPMENT SERVICES DEPARTMENT PERM NUMBER Itlatilfll �: `i� i PERMIT Ito�Po o 04, 00-01445 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.caus CUILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 151 GEORGEANNE PL Status: ISSUED Suite: Applied: 09/15/2000 Vicinity: MASTER BEDROOM CLOSET Issued: 10/04/2000 Parcel Number: 43926205 Zoning: - Applicant: DAVE, JODY ISSUED BY: --. Address: 9582 HAMILTON AVE Phone: (714)536-9628 HUNTINGTON BEACH, CA - Zip: 92646 Owner: GASTINEAU, ERIC & DELORES Address 151 GEORGEANNE PL CA Phone: (949)279-8156 " COSTA MESA Zip: 92627 Contractor FINE LINE CONSTRUCTION . Address: 9582 HAMILTON AVE Phone: (714)536-9628 HUNTINGTON BEACH,CA , ' Zip:, 92646 License: 759068 Arch : Eng: MICHAEL KHOYLOU . Address: Address: Phone: Phone: - • Zip: License: License: C36700 SCOPE OF PERMIT • • DEMOLISH EXISTING NON-PERMITTED CLOSET&ADD NEW 67 SQ FT CLOSET IN EXISTING MASTER BEDROOM. ' . FEE SUMMARY Plan Check: • $63.21 Calc Valuation: ,So.00 Permit: $97.25 - - Claim Valuation: - ' " $4,006.00" SMIP Res: $0.50 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 - Total: $160.96 - PLANNING &ZONING SETBACKS ' - • - MAIN STRUCTURE Front 0-0 _Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right' -0-0 PARKING Existing: . 0 Required: 0 Proposed: 0 NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related 'egulations. (Ord.No.92-28,§1, 12-21-92) :XPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned x a period of 180 days. ISPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all puked Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. )R INSPECTIONS CALL: (714)754-5626 5-46 000) DECLARATIONS (.J WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (Thi action need not be completed if the permit is valued at one hundred dollars($100)or less.) fI certify?that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these pr • I AcwieantS�eNre` C T-- r oate:_to- (4- 26-6-7) WARMNG°FAILDRE TO SEC E ORKERS' PENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPEOYERTO'CRIMINAUPENALTIES AND GVIL FINES uP TO ONE HUNDRED THOUSAND DOLLARE($100,000), N ADDrn THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3705 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions•Chapter 9(commencing with Section 7000)of Division 3,of.the Business and,Professions Code,and my license is in full force and effectL E ' at..... 1 ( Class_C N. (' �1 6 Contractor's Signature: wa��E�� Date: (-t')- Li- ,7(�v CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: ' Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044.Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. _ Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL.SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Masa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 if an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apernit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 0 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 01 the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and stale that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described�\ property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ( \ Signature f Legal Owner(s) ( i- 7 nDate `JI 1 C ICD- T -600 / • �� ( // An r Authorized Applicant'—'�_s_ (Date —� CODE t v1NSPECTION TYPE QM IKTITIAL$ FODE1 INSPECTION TYPE ' DMT. PERIMLS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign222 Final Site _ 204 Final Demolition _ 250 Final Building/Occupancy CITY OF COSTA MESA e,j �•. BUILDING DIVISION , > • .,, - i DEVELOPMENT SERVICES DEPARTMENT PER IT NUMBER PERMIT 0-01208 Sotsinso le (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 151 GEORGEANNE PL Status: ISSUED Suite No Applied: 12/27/2000 Vicinity: MASTER BEDROOM CLOSET Issued: 12/27/2000 Parcel Nunmber: 43926205 _j, _4k_ Applicant: DAYE, STEWARD ISSUED BY: Address: 9582 HAMILTON AVE Phone: (714)536-9628 HUNTINGTON BEACH,CA Zip: 92646 Owner: GASTINEAU, ERIC & DELORES Address 151 GEORGEANNE PL CA Phone: (949)279-8156 COSTA MESA Zip: 92627 Contractor FINELINE CONSTRUCTION Address: 9582 HAMILTON AVE Phone: (714)536-9628 HUNTINGTON BEACH,CA Zip: 92646 License: 759068 SCOPE OF PERMIT ELEC PERMIT FOR LIGHT FIXTURES IN MASTER BEDROOM CLOSET. 3 LIGHT FIXTURES, 1 SWITCH. REF: B00-01445 FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft $0.00 0 Res. a/c package $0.00 Standing Section $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 • Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0 Lighting Fixts $3.30 3 up to 50 kva/kw $0.00 0 Recept Outlets $0.00 0 up to 100 kva/kw $0.00 0 Switches $1.10 1 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $0.00 0 Misc. Conduit $0.00 0 Service to 1000a $0.00 0 Misc.Conductor $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 • Motors to 1 hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $27.90 Intermed Pole $0.00 0 COMMENTS/SPECIAL CONDITIONS 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 within 180 days,or if work is suspended or abandoned for a period of 180 days. . INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) . DECLARATIONS f . i I f WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to sell-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. ❑ I have and will maintain workers'com•=.sation i•" - ce,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Ls Issued. Myw ars'compensation Insuran -rrier . d •olicy numb: -re: Car er: Policy Number: (T i act/on need not be completed/'e -'= it"- valu:, :t/•ne h dred dollars($100)or less.) I certify that in the performan-:o` e • fo • i • his•=rmit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Call- -nom. -t I/ sho •be •me subject to the workers'compensation provisions of Section 3700 of the bor Code,I shall forthwith comply with these•rovi ': /� / Applicant Signature: Sig/L / -- Date: b//27 0t L WARNING:FAILURE TO ECURE WORKERS'COMPE r'liON•'•E UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL ENALTIES 0 CAVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,0W),IN ADDITION T�• T• COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,I EREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLAR' I hereby affirm that I am licensed un•- A 'Air.p a ••ter. en7000) with Section of Division 3 of the Business and Professions C e,and mylicense Is In full force and effect.Lie.N Class N Contractors Signature: 41.47i� -s�1P Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement Is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business end Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). 0 I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? . ❑Yes ❑No (Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes 0 No (Section 65850.2 of the Califomia Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 ll a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this application,have all of the disclosures prescnbed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: I Date: i CERTIFICATE OF COMP AN• ' .0: ,T10. OF - -Y:I certify under penalty of perjury that I have read this application and state that the information given Is 11, correct. I agree to comp -II :te la ' :nd ci• ordin. ces relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described props, or' s•-ctio C••ses agre: of to occupy or allow occupancy of any building authorized by this permit until final inspection. SS / /yr/grew,- - 4VDat= And/Or Authorized ArDate CODE I INSPECTION7TPE DATE INTRIALS CODE INSPECTION TYPE PATE ISL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof _ 210 Final Electrical I—11-0( 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place _ 220 Final Planning Approval 203 Final Sign _ 222 Final Site 204 Final Demolition 250 Final Building/Occupancy • 4�,`�sq CITY OF COSTA.MESA - awl BUILDING DIVISION ) • _ f r /MI ' DEVELOPMENT SERVICES DEPARTMENT • PE IT NUMBER •°/ °PERMIT 00-00660INe „ ro (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 151 GEORGEANNE PL Status: ISSUED Suite No Applied: 07/10/2000 Vicinity: SOUTH SIDE OF RESIDENCE Issued: 07/10/2000 Parcel Nunmber: 43926205 Applicant: AUGSBURGER, JEAN ISSUED BY: Address: 39 ESPALIER Phone: 949/770-3020 FOOTHILL RANCH CA • . Zip: 92610 Owner:. ", GASTINEAU, ERIC &;DELORES` . Address' 151'GEORGEANNE PL .. - CA. Phone: (949)279-8156 - COSTA MESA Zip: 92627 • Contractor: MR ELECTRIC OF SOUTH ORANGE COUNTY Address: 39 ESPALIER . - O - phone: 949/770-3020 ,FOOTHILL RANCH CA Zip: 92610 License: 763535 • SCOPE OF PERMIT . ELECTRICAL SERVICE PANEL . FEE SUMMARY'' , Quantity - , -___ - Quantity ISSUE FEE $23.50 - -- Temp Dist Systern/Lighting $0.00 0 Temp service test • $0.00 Busway/100 ft ' $0.00 0 Res.a/c package $0.00 Standing Section $0.00 0 New Res(1-2 units) . . $0.00 0 Misc Electrical Equipment • $0.00 0 New Res(3+units) $0.00 0 " - . Transformers up to 1 kva/kw ! $0.00 :0 Pool/Spa • $0.00 0 • - up to 10 kva/kw $0.00 0 Lighting Fizts - .$0.00 0 up to 50 kva/kw $0.00 0 Recept Outlets $0.00 0 up to 100 kva/kw $0.00 0 Switches - . '$0.00 0 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 1 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a . $30.50 1 Misc.,Conduit $0.00 0 Service to 1000a , ' - - $0.00 0 - Misc. Conductor $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1 hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 _ Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $54.00 Intermed Pole $0.00 0 COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related I regulations. (Ord. No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned I for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 I DECLARATIONS . • .c 1 I , j • WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the I ork for which this permit is issued. I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. — My workers'�cornn ensation Insurance carriererand policy number are: 7 Carrier: //I�`/4t-/a- JLc-Yc4' n1 07 Policy Number: c-5—a2o-S/r7/ (This' section need pdf be completed if the permit is valueed,ut one hundredp6llars($10 or less.) I certify that in the performance of the work for which this permit is issue shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree t if I sh• become subject to the workers'compensation provisions o1 Section 3700 of the Labor Code,I shall forthwith comply with these provisio A,./ �� Appfuant-SigneWrel- ' _ �>' �Dat�: 14 /•°0015 WARNING:FAILURE TO SECURE WORKERS'CO - NSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO GRIM PENALTI S AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(S100000).IN ADDIP• '•THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECI1ON 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.ac.4 '// � �$s,�S Class a GAO Tbntractors:Signature: _...2.9."-- `ates 7Uaa CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the properly, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes ❑No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit io do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). _____ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0-1C1-6- 5 No5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication akermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work whicIT is The subject of this application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? 0 Yes 0 No B (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: I CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:-I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Si• re' Legal Owner _ Air ../.....,V n�5/ pftcant at CODE I jNSPECTION TYPE PATE INTITIALS CODE I INSPECTION TYPE DATE INTRIALD 1616 ' Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 206 Final Plumbingeu..- /�(. 200 Final Re-Roof 210 Final Electrical 7' 3 I' (e 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign _ 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 2446-46 •�0'�'tN CITY OF COSTA MESA `+ ;`y - BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PER1/14 UMBER PERMIT -c"'°""`° 1,69-01 669 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 151 GEORGEANNE PL Status: ISSUED Suite: Applied: 10/14/1999 Vicinity: REAR PORTION OF HOUSE Issued: 10/14/1999 Parcel Number: 43926205 Zoning: Applicant: CLAYTON, MATT ISSUED BY: Address: 151 GEORGEANNE PL CA Phone: (949)279-8156 COSTA MESA Zip: 92627 Owner: GASTINEAU, ERIC & DELORES Address 151 GEORGEANNE PL CA Phone: (949)279-8156 COSTA MESA Zip: 92627 Contractor: CLAYTON ROOFING Address: 833 W 17TH ST CA Phone: (949)646-7884 COSTA MESA Zip: 92627 License: 601226 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT REROOF REAR PORTION OF EXISTING SINGLE FAMILY DWELLING(10 SQ).TEAR OFF EXISTING WOOD SHINGLES& RESHEATH WITH 1/2 CDX PLYWOOD. INSTALL 1-LAYER OF 30#FELT UNDERLAYMENT&REROOF WITH 25 YEAR COMPOSITION SHINGLES. FEE SUMMARY • Plan Check: $0.00 Calc Valuation: $1,700.00 Permit: $60.10 Claim Valuation: $1,700.00 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $60.60 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related I regulations.(Ord. No.92-28,§1, 12-21-92) 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. I INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 CECLARATIONS.'‘= ' ( ) ;3 `z ^:-; WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the zwork for which this permit is issued. I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My�yprker 'corn engation Insurance carder and policy number re: ` J Carder: I Le T ta-LL ` ' �' `� AS--a— I 7�c Q.M "h-4-1 Policy Number: O 11 1 -76 $ - O (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and ree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these Arov_isions. Applicant Signature: ✓ V` Date: IV I ( Le I 9. 1 WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,om),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under oro isions of Chapter 9(commencing with Section 7000)of Division 3 of the Busines andP{ofeasions Code,and my license is In full force and effect.Lic.# O I L Class# tiS 1 Contractor's Signature: nil Date: ( D C t `{ Ick 4 CONSTRUCTION LENDING AGENCY: 1 O I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: _ __ Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): . 0 I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). O I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding.falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,ore volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No -� (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes 0 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No (If'yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes".attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final Inspection. . e Of • ner(s) ate I trio" W - ( V ( f 9 5 And/Or Authlk ed Applicant Date COPES INSPECTION TYPE QAt8 INTRIALS CODES INSPECTION TYPE; PATE INTMALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof AD' /y-yfr 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place _ 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition ' 250 Final Building/Occupancy 2446-46 • 1a.' MF CITY OF COSTA MESA y°4y �• BUILDING DIVISION PE MIT NUMBER DEVELOPMENT SERVICES DEPARTMENT ' d PERMIT "" ' B99-01668 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 151 GEORGEANNE PL Status: ISSUED Suite: Applied: 10/14/1999 Vicinity: DETACHED GARAGE Issued: 10/14/1999 Parcel Number: 43926205 Zoning: Applicant: CLAYTON, MATT ISSUED BY: Address: 151 GEORGEANNE PL CA Phone: (949)279-8156 COSTA MESA Zip: 92627 Owner: GASTINEAU, ERIC & DELORES Address 151 GEORGEANNE PL • CA Phone: (949)279-8156 COSTA MESA Zip: 92627 Contractor: CLAYTON ROOFING Address: 833 W 17TH ST CA Phone: (949)646-7884 COSTA MESA Zip: 92627 License: 601226 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT REROOF EXISTING DETACHED GARAGE(4 SQ).TEAR OFF EXISTING WOOD SHINGLES&RESHEATH WITH 1/2"CDX PLYWOOD. INSTALL 1-LAYER OF 30#FELT UNDERLAYMENT&REROOF WITH 25 YEAR COMPOSTION SHINGLES. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $600.00 Permit: $32.65 Claim Valuation: $800.00 SMIP Res: $0.50 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $33.15 PLANNING&ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: DTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related gulations. (Ord.No.92-28,§1, 12-21-92) PIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned a period of 180 days. :PECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all aired Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. :INSPECTIONS CALL: (714)754-5626 DECLARATIONS - ( ) • WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. yyy��� U7 I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My worker 'corn en tion Insurance'carrier nd olicy number are: Carrier (LeI �— �GB "'0. I ��.p__/Y-� c Policy Number: CII-774. 6 (This section need not be completed it the permit Is valued at one hundred dollars($100)or less.) I ❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these rowsions. Applicant Signature: Date: t4 ( L 01 WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(3100,000),IN ADDITION TO THE MST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060e THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensedPunder provision of Chapter 9(commencing with Section 7000)of Division 3 of the Business and P fesygns Code,and my license is in full force and effect.Lic.ft b 0 t 'Z ,' ` _ Class k C — Contractors Signature: Inn Date: t o t Lfl q `7 CONSTRUCTION LENDING AGENCY: O I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: _ _ Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant toe civil penalty of not more than five hundred dollars($500).): O I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code:The contractors License Law does not apply to an owner of properly who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title B,Califomia Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes ❑No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? IJ Yes LJ No (Section 65850,2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. VThn i natur al Owner(s) (D I I qDa1te2 c1 < And/ uthorized Applicant DSte—1 CODE r INSPECTION TYPE DATE INTRIAL3 CODE! INSPECTION TYPE DAE INTRIAI< 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final20 Final Plumbing 200 Final Re-Roof �O—�/�q 210 Final Electricalal 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 2446-46 'A'it • PROJECT ADDRESS: 151 GEORGEANNE PL 0NIi CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 05148 OWNER'S NAME: DEYDEN, CHRISTOPHER • ADDRESS: 151 GEORGEANNE PL ` I' PERMIT NO; E 051488 • • PLAN CHECK NO: N GOVT: N SUPP: N COSTA MESA, CA 92627 r CONSTRUCTION TYPE: PERMIT TYPE • : ELE • PURPOSE; REP ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : REPAIR RAIN DAMAGED ELECTRICAL SERVICE SQ- FT: • 7 • ADDRESS: - UNIT: CLAIM VALUE: CALL—VALUE: • GROUP OCC; R 3 / ' PERMITTEE: CHRISTOPHER DEYDEN ( 714 ) 722-9266 ADDRESS:. 151 GEORGEANNE PL COMMENTS: * • COSTA MESA CA 92627 **************sc? *** :*>E********iF*****>F*•u***x* * ****+ ********************k***** i LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING R EQUIREMENTS 70001 of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACK S CITY LIC.: STATE LIC.: CUSS: I ' Date: signature: MAIN BUILDING ACCESSORY BUILDING .....__ WORKERS'COMPENSATION DECLARATION: I hereby affirm that t have a certificate of consent to self-insure ora certificate of Workers' FRNT; FT IN REAR: FT IN FRNT: ' FT IN REAR; FT IN ' Compensation Insurance.or a certified copy thereof(Section 3800.Lab.C). LEFT: FT IN RGHT: FT IN LEFT,: ' FT IN RGHT; FT IN t POLICY NO.: EXP.DATE: COMPANY: PARKING REQPROV: • -PARCEL: 43926205 ZNE: REF NO: 7 Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. PLANNING NOTES> - > Date. Applicant: ******************************* *fE***************ii:*******{E***Y•3e**7F********iEaESE*szf EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). DEVELOPMENT S�;E R V 1' C E S REQUIREMENTS I ceridy that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California. ZONING APPROVED BY DATE: Dale: - Signature: - NOTICE:II.after making this declaration,you should become subject to the Workers' Compensation provisions of the Labor BUILDING APPROVED BY ; . DATE; Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y• • �� DATE• Z /2 7 4 which this permit is issued(Section 3097,Civ.Cl. ******4***************IF -x t ce. -`. ***********��'�*1e PF N-,[xf'F** LENDER: *****************************************"** . ****************je*********.*-***** ADDRESS: LEGALIZATION:N F E E SUMM R Y • STRUCTURAL SSEGMENT: N OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE ' SMIP/RES GRADING (Section 70315 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 18 . 50 repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed / , pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business - -T 0% SM 1 P/NON—RES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN any applicant far a permit subjects the applicant to a civil penalty of not more than five hundred dollars($5W). ISSUE FEE15 , 00 • I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE ' ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS————> • 18 . 50 15 , 00 0 . 00 33 , 50 33 . 50 . 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however the building or • improvement is sold within one year of completion,the owner will have the burden of proving he/she did not Haim or improve REVENUE DIVISION TOTALS--> COLLECTED; 33, 50 OVER/SHORT• 00 for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK I,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 33 . 50 ) ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law). I am aware' *****..*.******.***.*.*.*.**.*.*.*.**.********.***.***.***!.*..X.,7p**{(..*.*****.*,*.}:.**.*.********y..*******y*i/• that proof of their Worker's Compensation insurance should be provided to me. IIVIDUAL ND F E E BREAKDOWN 34 I am exempt under Section:B P 7044 B.8 P.C. j for this reason• ALL WORK BY OWNER L� TYPE QTY DESCRIPTION UNIT COST TOTKL COST Date:'S—, '7— Owner: - �� ELE 1SERVICES BELOW 600 V S' BELOW 201 AMP 18 . 50 1. 18 ,,0 • I da hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505.25533,and END OF FEES 25534 and that I or any!acute budding occupant will/will not(circle one)need to comply with said state codes and the requirements for a ' permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from • / (hese provisions. Date: Applicant: - • I hereby certify that I have read this application and state that the above information 1. rect.I agree to comply with all city and county ordinances and state laws relating to building construction and hereby authorize repres es of this city to a ter upon above-mentioned - - 1 properly foe inspection purposes. i-A•�ET1/ 3-�V._er•n�..`.. - - //� 4.✓,isx. Date: 3 ��7 � Signature: L L'iRIE: :v.. �•� Driver's0069757 License or Social Security V' „—L��— 164146 White—Budding:Green—Code Enforcement:Canary—Applicant;Pink—Revenue:Goldenrod—Assessor t CONSTRUCTION AND PLANNING - ' PO1 i SPA Date Inspector - Date Inspector APPROVALS Permit# APPROVALS Permit # 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location .l 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement i' 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding ' 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final . 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval • 17!, Rough Wiring Sign 68. APPROVED FOR PLASTERING 184 'Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace 4 APPROVALS • Permit # 21. Ducts, in.Structure .- - • `70. Underground Hydro 22. Ducts, Ventilating - • 71. Product Piping ❑Gas ❑Oil 23. Gas Pipe:Rough & Test • 72. Underground Flush • 24. Roof Framing 4 • - • '73. Undergrnd:Storage Tank 0 Gas 0 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 i 31. Plaster Brown Coat . ti. 79. FINAL INSPECTION j 32. Electrical Power Meter-Final y,,,,,,,h,grA 80. FOOD CERTIFICATE ISSUED1 33. Final Electric - "' Notes: I 34. Final Heating& Air Conditioning. ' - 1 i 35. Final Gas Pipe-Test . / - 36. Hood or Canopy t /%/: 37. Final Factory Fireplace , ' - ! 38. Final Plumbing - - l E- ' - 39. Water Service-Final - - ' I 40. Gas Service-Final -41. Solar Domestic-Final - I 42. Backflow Preventer j 43. Backflow Irrigation - 1 I j 44. Landscape Irrigation System. - I 45. Sound Attenuation ' - 46. Handicap Regulations - I 47. FINAL STRUCTURE & BUILDING - 48. FINAL PLANNING 49. Electric Release to Edison ‘ I . 50. Gas Release to Southern California Gas Co _ I 51. CERTIFICATE OF OCCUPANCY •- . No Date ' I Cb71 I /GU/ o0�U 7 Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. .- ;�•,:_ ✓✓/ CITY OF COSTAIMESA CO N/�S�T�R UCTION PERMIT- PERS NO. • I TRACT NO. LOT NO. UNIT NO. , ILTL," 3l` / J J Vey Atiplicant's Mailing Address & 1 6o-MC TYPE OF CONSTRUCTION.-' Li'NEW U_ +ADD Li ALTERATION H REPAIR . • , Owner's Name "-9 S -• Phone ff��'d7V7 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.#- - • Zone /' DESCRIPTION OF WORK/USE OF BLDG. Address TL�k - - • - - S Main Building: - Accessory Building: " 'Arch/Eng. - ' ' License No. - ' • 'TYPE OF PERMIT ❑ GRADING •❑ FOUNDATION ❑ STRUCTURAL T Front - Q A• ddress ' -17 . I •'' • c • ' ❑TENANT' ❑-ELECTRICAL ❑ PLUMBING ❑ MECHANICAL •B Rear' I +- 'N • i Contractor's Name -2 Phone ❑ OTHER ' i A- - ' I • " PROJECT DESCRIPTION SQ. FT. ' OCCVPANCY C Right' _ - N Address(mailing) y, - K- -• I v ' 'C' i-� CON STRUCTION TYPE • VALUATION$ • $, Left , r I ' City License No. _ • ' ZONE - ' - GRADING CU.YDS. • ACRES LICENSED CONTRACTOR DECLARATION 1 ' - . 11 - - Pl0g. Ref.# Parking Req./Provided E I hereby affirm that L-am licensed under provisions of Charter'9 (commencing Remarks: '- ly^i I I ' 3�' 1 'Planning Notes: • . , Q with section 7000)of Division 3 of the Business and.Professions Code,and • - - '-f' ` -" M my license is In full force and effect. • j, ' - T ' ' ;License Class • D. �License.No. ' i + ' • ) , . S, r Date ! ' " -Signature . V i I , PLUMBING FEES. , :WORKERS'COMPENSATION DECLARATION ' I • hereby affirm that'I have a certificate of consent to self-insure or a certificate Bar,Sink Showers' - ELECTRICAL I FEES ' ;-Workers' Compensation .Insurance, or a certified.copy thereof (Section� ' Backflow Preventer - 'Service Sink -T - • - - - - - ,800, Lab. C-) • • "- Automatic Washer Transformer ❑ 15-50 KW , Policy No. C • ompany - Backflow Irrigation Sewer Ca - • ❑ 50+KW i '8Certified copy Is hereby furnished. • . p Construction Pole Sub. i i Certified copy is filed with the city Building Division. , Bathtubs Sewer Connection' Cooking Unit Meter ❑up to 100 amps 1 Date - Applicant - i ' • - ,. • EXEMPTION FROM WORKERS'-COMPENSATION DECLARATION _ Clarifiers _ ' Solar Collectors_ _-_ _- .- Dishwasher -• Meter ❑over 100 amps • i -„• t '(This section eed not be completed if the permit Is for one hundred ($100) or - I ,less)`. I / . Dishwasher • 1 Solar Piping • j ' Dryers ❑Gas ;❑Electric Sub Panel' 1 certify t it in^'" "rformance of the work for which this permit is issued, I I - 'shall`not , ploy r. person;in any manner so as tobecome subject to the ' . Drinking Fountains Solar Tank • Fan I I Workers' omp ion Laws of California. j ,--_ Motors❑0-1 HP ❑1%-6 Date's Signature Floor Drains ! SwimmingPool w/Spa • - - ' , I t P F.A.U. Inc Solar ❑9-15 HP ❑16-15+ 'NO CE:If,aft.• making this declaration,you should become subject to the - ! Workers';Corns nsation'provisions of.the Labor Code, you must forthwith Floor Sinks - - - - -'- -- Urinal - r - ;- Fixtures •• - • .comply with such provisions or, this permit shall' be deemed revoked. - Microwave " 'CONSTRUCTION LENDING AGENCY-- ' ' ' Gas Service'. . Outlets . i Water Closet , Device Boxes ' • I hereby affirm that there is-a construction lending agency for the performance , , Pole Light , ;of the work' for which t•his permit is Issued (Section 3097 Civ C.),- —Interceptors . Water Heater - i , . ./ Outlets 1 Flange �i ' ,Lender's Name - - -" " • - • - P 9 I Lenders Address - !� - - I r _• Kitchen Slnk i - - Water Service Switches - ',Sign, 1 OWNER BUILDER DECLARATION " r -. - — - I I hereby affirm that I am exemptlfrdm the Contractor's:License Law for the Lavatories - - ' Auto-Wash' _ i Garbage Disposal I Standing Sections I following reason (Section 7031:5 Business and'Professional Code: Any city or - = -' - - : - , ' county which•requires a permit-to construct,alter,Improve;demolish orrepair P-Trap - I Laundry Trays - Generator KW❑5-15 KW Trash Compactor i any structure/prior to its issuance, also requires pursuant licant for such permit" - - , to file a Signed statement that he/she Is licensed pursuant to the provisions S of - 1 Roof,Drains ' the Contractor's-LicenseiLaw:(Chapter 9 (commencing with Section 7000) of- I I I ' ' �ivislon 3'of.the Business and.-Professions'Cod¢) orahatihe/she is exempt , - - ' zrefrom and the basis for the,alleged t subjects thny violation of-Section - - - - _ t - 1 , 1 131.5 by any applicant for .a permit sublects)the applicant ao, a civil 7. - •- penalty of not-more than fivelh undretl dollars($500). ,. • • - , ' 0 I, as owner of-the property or'my'employees-.with'Wages'as their sole - •Reinspeetion Fee $15 1 ,- ' Issue Fee • r- $ 3.- . compensation; will.do the work, and,the structure is not intended or offered - - - Reinspection Fee ! 515 Issue Fee I ' $ 3 for sale (Section 7044; Business and Professional Code: The Contractor's ' • • _ MECHANICAL' FEES: - - - ' ' License Law does not apply to an owner of a property who builds or improves _ thereon, and who does-such work himself/herself or through his or her own _ - - - 'DEVELOPMENT SERVICES REQUIREMENTS: ' I t , employees, provided that such Improvements are not Intended or offered for ( Boiler` 1H00 or Type I ❑ + ' I !sale. If, however, the building or improvement is sold within one year bf com- 1 - - Canopy Type II ❑ , Zoning Approved By • Date 1 pletion, the owner will have the burden of proving h¢/she did not build or IM- I Duct-Under Grou ndl i • , Building Approved By • Date • rove for the Purpose of sale). ; j , ' I ./1., s ,L-,_ i I t 1 ,tet 1 I, as owner of the property,am exclusively contracting;with licensed con- Duct-Structural ( I I Refrigeration System : 1"; 'Application Issued By t (f.'W/ Dat I 1 L :tractors to construct the project Section 7044,Business and Professions Code: . I The Contractors License Lawdoes not apply to an owner of property who _ ' Duet-Ventilating.". -. -. _ ❑0.100,000-BTU, ❑100,000 BTU -_, - . SUMMARY OF FEES - • • buildsorimpr veslth n, a who contracts for such projects with-a con- - _ • 'tractor(s,lic se pur sem!, to a Contractor's License Law). I am aware that I— - - BUILDING PERMIT 1$ i SMTP . $ -++y Exhaust System ❑ Multiple ❑ System Repair/Alteration proof o�lt r Worke o pensation insurance should be provided to me. - - PLAN CHEC • K ;$ • PERMIT `❑ I a i un a B:&P.O (or this reason Firepl/Fact-alt. ICBO# • Fire'Dampers -� + • I - ' I PLUMBING $ ISSUANCE ,$ '( 'Date ! 7 owner + I i l : , Heating System& Ducting . I Registers' I — p(-AN CHECK 25% ,•$ ' i • ENERGY P.C. $ : • • II hereby'certify-t t-1- avelreadf this'a plication'-and state that the above' 1 ❑0-100;000 BTU.❑100,000BTU I GRADING .$ I information is:correct, agree to compl with all.city and county ordinances I I ELECTRICAL 1 .$ L'f',QQ I 'and state-laws relatin to bull ruction,and hereby authorize repre- 1 I — - 1 PLAN CHECK 50% $ "i I fl MICROFILM �$ )sentatives •Of this to ¢n the above-mentioned property for I ' , - , inspection purpo ,'`• /'./��'', I - • ' MECHANICAL • • —C Signature - '�" • I I , I $ - _- _T.OTAL-.cc��.--. • I. +�, i 1 Reinspection Fee $15 • ' Issue Fee $ 3 I PLAN CHECK 25%.:t. --- ----" Drivers' Ucense or SS# C F 0865-46,rev-10/84 •White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor• —___�� —-.� _ ... . . CONSTRUCTIO • , Permit .APPROVALS .Permit#N AND PLANNING - . • t. ' • 6 ' . POG SPA - . - APPROVALS - Date -Inspector - ' ' • • Date Inspector c #• • - -. . .. - 1. TieMporary EleetricalService or Pole ' . . -r !' - '52. Pool & Equipment Location • • - .".• -- ' - . . : 2. Soil Pipe-Undrgrnd. • -..-.-' :--' 53. Steel Reinforcement - ' - . •• _ .: 3. Electrital Conduit Utility:Undrgrnd. . , ,c. - 54. Forms -. .• .. , 4. Electrical Conduit-Undrgrnd. . • . • . 55. .Electrical Bonding ., ri 5. Steel Reinforcement 1 2 56: Rough Plumbing & Pressure Test ' 21 . . , . . . S. Electrical UFER Grnd. •:- 57: APPROVAL TO COVER-GUNITE . . • 7. Footings , • -58. Electrical Conduif-Undrgrnd. • . . . . . . . . . . , 8. Foundation ., . , . • l. 59. Gas Pipe0 Undrgrnd.,test - • ) ,-.. . 4. .. _ . . . _ . . S. Water Pipe-Undrgrnd. ' l • -60: Backwash Lines,P-Trap, 0 Undrgrnd. •:, • . . . •• 10. Structural Floor System . - 61: APPROVAL TO DECK • - 4 , . . 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final . 12. Sewer Cap . 63. Heater 84 Vent-Final , . 13. Roof Drains - 1 " 64. Plumbing System - Final . ' - . , • 14. Rough Plumbing 65. Electrical-Final ' • ' ' • . _ 15. Rough EleE4trical-COnOuit - . • . : - 66. Solar System-Final . - - . . 16. Rough Electric Wiring -• , //406--1/ &?..._ • 67. Fencing & Access Approval • • . . I - • • 17. Rough Wiring Sign / - • 68. APPROVED FOR PLASTERING . . 18. Rough .Electrical-T Bar Ceiling • . . 69. POOL/SPA SYSTEMS FINAL . ' • i 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT - . . 20. Rough.Factory Fireplace • APPROVALS Permit# . 21. Ducts, in Structure 70. Underground Hydro, - . . 22. Ducts, Ventilating . . 71.. Product Piping 0 Gas 0 Oil - 23. Gas Pipe-Rough & Test72. Underground Flush , . . _ . _ . _ _ 24. Roof Framing a 73. Undergrnd..Storage Tank10 Gas ..0 Oil • . 25. Roof Sheathing . . . .• 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat ' 75. Dry Chemical • 27. Frame and Flashing . • . I - 76: Dry Standpipe . 28. Lathing & Siding _ .- ' 77. FIXED SYSTEM FINAL . . . . . 29. Insulation . '. . 78. FIRE PREV. FINAL 30. Drywall Nailing A ii . . . . . HEALTH DEPT. REQUIREMENT ' 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED . . . . . . _ . _ . 33. Final Electric . . Notes: . - . . • 34. Final Heating 8(Alr Conditiqning. . . . • 35.. Final Gas Pipe-Test . . . • . .. i - . .• . . . . 3d. ;Hoc)*el or Canopy • . . , . . : • .. . , . . , 37-11-final Factory;Fireplace; , . ' . : - • 41 - . . 38. Final Plumbing ' • .i ' I 39(Water Service-Final . , - . .4 - . . I . . 46c*Gas Service-Final • ) ' ' I , . 41. Solar Domestic-Final - ' I - • ic , 1 ' I 42. Backflow Preventer • . ... - . . . . . • '43 Backflow Irrigation 1 - - . • . , . 44.. ,Landscape Irrigation System . , ' . . I . , . . i 45:;•Sound Attenuation; - ' . . • . , . - 46;.tlandicap Regulations ' . , • . 4irFINAL STRUCTURE &BUIL4DING i c . 48. Special Requirements Completed. • , . . ._ _ ... 49:::.Electric Release to Edison . __ _ • ; I _ .. '510...4das Release to Southern California Gas Co • . "51.;CERTIFICATE 0F OCCUPANCr .. •_. • . .._ . ..., - . - Date , - I • ' i . _ _ -. . . . . . . . _ _.. . , -• _ Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. r : - y CITY'D. 'COSTA MESA . -^ . Y PERMIT NO. .t 'TRACT NO. . ,LOT NO. BLDG. N0. CONSTRUCTION PERMIT •= - ' (n/ L'-,/.Z/a :?9 ' 18014 4/05/84 6.60 TL Project Address -C'e NW(^ r�' : TYPE OF CONSTRUCTION H NEW U ADO A TERA • •y,' 1- 'j _ - - _ • Applicants Mailing Address• 4? - ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A C 'J/�ir Ay:#, _ _ - • Zones'I .. ' • - Owners Name': is •• r!A Phone a s 7 • DESCRIPTION OF WORK - - _ - - • S Main Building: - Accessory Building Z . . Address - ,,�It' ' ; _ _ t o. - E - • = TYPE OF PERMIT U.GRADING--U FOUNDATION LI'STRUCTURAL .T. Front - N Arch/Eng - I License No., ' , ❑ TENANT ®-ELECTRICAL' ❑ PLUMBING ❑ MECHANICAL i +� B Rear . - ' s '• . ) - Address! - • _ "' ,,n ❑ OTHER , -. �y.� A. _ •N N�•IJAIZIle- -a'40C� VVS CPA PROJECT DESCRIPTION' SQ,FT. jv-� [/1 OCCUPANCY C• Right + ` - '- • G Contractor's Name l Phone / K, • • R CONSTRUCTION TYPE ` VALUATION $ Addressilrnai ling) ' _ • _ _ S' Left I E ZONE GRADING CU. .ACRES pfn Ref. , ! , Park.Fees $ ' Q City License No. - '- - , - : - . 9 ' e U LICENSED CONTRACTOR DECLARATION • i • n Remarks: - }�S // /�3. S • . Parking' Req./Provided' _ - I'hereby affirm that ram licensed under provisions of Charter 9 (commencing , f� -• i R with section 7000) of Division 3 of the Business and Professions Code,and : I Use of Building: 4 • E my license is in full force and effect. ' PlanningNotes: M License Class •'' License No.. PLUMBING FEESI E ',m<e Signature Bar Sink Showers • ' 7. N *T'RKERS'COMPENSATION DECLARATION • ' • - _ T • •."arebyaffirm that I.have a.certificate.of.consent to self-insure ora certificate_..' __. Backflow Preventer- 'Service Sink +• - - - -' S of Workers' Compensation Insurance,-or a certified,copy thereof (Section _ .. _ 3800, Lab. C.) • Backflow Irrigation Sewer Cap ELECTRICAL' FEES ' Policy No. Company - 8 Certified copy is hereby furnished, I Bathtubs Sewer Connection ' •• Automatic Washer - Transformer 0 15.50 KW Certified copy is filed with the city Building Division. I ' 0 50+ KW l Date • Applicant Clarifiers • Solar Collectors Construction Pole Sub. EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Dishwasher Solar Piping CookingUnit Meter ❑u to 100 amps I (This section need not be completed if the permit is for,one hundred($100)or p p less) a • Drinkin Fountains I shall [e in the performance the work fo hic ,/ kis issued, I 9 Solar Tank : Dishwasher Meter Dover 100 amps • shall not e pi y an���yyyyyy person In any manner as� - subject to the DateWorkers' eHs on.Laws of Calitorni .. Floor Drains' Swimming Pool w/Spa Dryers ❑Gas ❑Electric Sub Panel ' Date OO Signature - NOTICE: f, iter making this declaration,you should b come-subject to the Floor Sinks - Urinal • • Fan - ' Motors❑0.1 HP Div.-8 ' Workers' C pensation provisions of the Labor Code, you must forthwith comply 'with such provisions or this permit•shall be deemed revoked. Gas Service Outlets Water Closet ' F.A.U. Inc.Solar ❑9-15 HP ❑16-15+ CONSTRUCTION•LENDING.AGENCY - _ ' I hereby affirm that there is a construction lending agency for the performance Interceptors - Water Heater Z Fixtures lki�0;Microwave S(D of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Name - Kitchen.Sink Water Service Device Boxes Pole Light Lender's Address • ' OWNER BUILDER bECLARATION _ Lavatories • - ' ' 7 Outlets _ Range / t . ' I hereby affirm that I am exempt from the Contractor's License Law for the p-Tra following reason (Section 7031,5 Business and Professional Code: Any city or p -. Switches 1, Sign 4/D county which requires a permit to construct,alter,improve,demolish or repair . ,;_-iy structure, prior to its Issuance, also requires the applicant for such permit Roof Drains • - , Garbage Disposal tending Sections ,..Aire a signed statement that he/she is licensed pursuant to the provisions of „nContractor's License Law (Chapter 9(commencing with Section 7000)of Generator ❑0.5 KW D5-15 KW Trash Compactor{Lnereion 3 of the Business and Professions Code) or that he/she is exempt • - • - p nerefrom and the basis for the alleged exemption. Any violation of Section I - 7031.5 by any applicant for a permit subjects the applicant to a civil • Reinspection Fee t $25 Issue Fee $ 3 , Dchatty of not more than five hundred dollars($500), - r I, as owner of the property or my employees with wages as their sole - Reinspection Fee $25 Issue-Fee : -S.3 compensation will do the work, and the structure is not intended or offered . . • MECHANICAL FEES for sale (Section 7044, Business and Professional Code: The Contractor's PUBLIC SERVICES REQUIREMENTS: ' License Law does not apply to an owner of a property who builds or improves Bollerr. Hood Or; Type I ❑ • - , thereon,:and who does such work himself/herself or through his or her own Zoning Approved By • nate ' employees, provided that such.improvements are not intended or offered for Canopy Type II ❑ • sale. If, however,the building or Improvement Is sold within one year of com- Duct-Under Ground . Building ApprovedlBy - Date pletion, the owner.wlll have the burden of proving he/she did not build or im- - 1.)/ /f/ rove for the purpose of sale). Duct-Structural Refrigeration System i ' Application Issued By ' / Dat:y7-7-5- '' 7I,as ownerof theproperty, am exclusively contracting with licensed con- ❑0-i00 000 BTU ❑100,000 BTUtractorsto construct the project (Section 7044,Business antl Professions Cotle:, Duct:Ventilating _ _ SUMMARY OF FEES The Contractor's License Law does not apply to an owner of property whoBUILDING PERMIT $ SMTP , builds or Improves thereon, and who contracts for such projects with a con- Exhaust System 0 Multiple 0 System Repair/Alteration license pursuant to the Contractor's License Law). • PLAN CHECK '$ ' PERMIT ' i D•l.am exempt under Section B.& P.C.for this reason , Firepl/Fact.BIt. ICBG 4 , PLUMBING .$ ISSUANCE $ • Date Owner• Heating System& Ducting r PLAN CHECK 25% $ ENERGY P.C. '$ ' ' I hereby, certify.that I h.ve read this ap+ cation-and state that the above - ❑0-100,000 BTU ❑160,000BT information is correct. I�'•ree to comply 'ith all city and county ordinances 4 , ELECTRICAL $ Si Jc- 0 GRADING' $ and state laws relatin• • build ns fiction, and hereby author a pre- 4 . ' PLAN CHECK 50% $ i / / / 0 MICROFILM $ sentatives of:this el.' tQ -0.0•e the above-mentioned pr er, f r • • inspection purpoi . % ( • - - / ' Signature / ' i - Rate / 3 - MECHANICAL I$ TOTAL FEE '$ �(/�v�� Drivers' License or'SS# - Reinspection Fee I ;$25- Issue Fee . $ 3 - - PLAN'CHECK. 25% $ . .. -' CMF 0865-46 'rev'.12/83 White-Building:Canary-Applicant;Pink-Accounting;Goldenrod-Assessor -- PC &SPA CONSTRUCTION:AND PLANNING - - • .Date Inspector Date Inspector -APPROVALS - Permit# - - APPROVALS Permit# ,,:\1: Temporary Electrical Service o_r Pole r :52. Pool & Equipment Location '; .- _ _ 2:. SoilPipe-Undrgrnd.6 . . . 2253. -Steel Reinforcement .- s . . - • ,,3: Electrical Conduit;Utility-Undrgrnd. - 54., Forms .- ' tY 4. Electrical Conduit-17ndrgrnd, - - - 55. Electrical Bonding - - . - I i ' • 5:Steel Reinforcemen•t- 56. Rough Plumbing&Pressure Test • ' " . i ' 6:. Electrical'UFER Grnd. . ' - 57. APPROVAL TO COVER-GUNITE- ' ' `'+• 7. Footings .1, - - 4 58. Electrical Conduit-Undrgrnd.. = • _ - , t. 8. Foundation _ ' - i 59. Gas Pipe, 0 Undrgrnd.,Test-' 9. Water Pipe-Undrgrnd. _ 60. Backwash Lines,P-Trap, 0 Undrgrnd.. ' 10. Structural Floor System - - ' "61. APPROVAL TO DECK - ' - _ 11. Property,Sewer Line & House Connection . ';i 62. Backwash & Receptor-Final -• - - • 12. Sewer Cap _ i 63. Heater & Vent-Final - 5 • 13. Roof Drain's - 64. Plumbing System - Final - 14. Rough-,Plumbin .. g . , - - 65. Electrical-Final • 15. Rough Electrical-Conduit - - _ _- 66. Solar System-Final -- - . . . " 16. 'Rough Electric Wiring- � j�/Je v / Oso 67. Fencing & Access Approval 17. Rough Wiring Sign .� f. - 68. APPROVED FOR PLASTERING - 18. Rough Electrical-TBar 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 71. Product Piping 0 Gas 0 Oil - 23. Gas Pipe-Rough &Test . I 72. Underground Flush ' I - 24. Roof Framing ' - _ 73. Undergrnd.Storage Tank ❑Gas'Ooil . , i ` i ; ; - . 25. Roof Sheathing �.;: _ ' 74: Overhead Hydro � , 26. -1-..-.Bar Ceiling (Structural) & Monocoat ' - -75. Dry Chemical 1 . 27. ;Frme and Flashing 76. Dry Standpipe ' • 28. Latliing & Siding I 77. FIXED SYSTEM FINAL ' -. - 29. Insulation •• " 78. FIRE PREV. FINAL 30. brywall Nailing HEALTH DEPT. REQUIREMENT I ' 31. Plaster Brown Coat i , . - 79. FINAL INSPECTION 32. Electrical'Power Meter-Final . 80. FOOD CERTIFICATE ISSUED . ' ' s33. Final Electric • 7l t i Notes: . 34. Final Heating & Air Conditioning f ' , •, 35. Final Gas Pipe-Test - - - . . . • .. • 36. Hood or Canopy: , `' , - •. - • - _ • 37. Final Factory Fireplace - - ., . 38. Final Plumbing • ; , ' i . - 39. Water Service-Final, i 40. Gas Service-Final ' 1 .. • 41. Solar Domestic-Final , L - . - - . 4 I 42. Backflow Preventer _ - .4 - J 43. BackflowtIrrigation� ' : , ' _• _ 1_ • • 'I 44. .Landscape Irrigation System , , , • ' .. . . , 45. Sound Attenuation - - 46. HandicapiReguldtions i ' ' • i - - . 47. FINAL STRUCTURE & BUILDING I 48. Special Requirements Completed. . . - I 49. Electric Release to Edison . i , ' ,- - .- - j - • : 1 50..Gas Release to Southern California Gas Co •' ' I 51. CERTIFICATE-OF-OCCUPANCY _ - - - - - - - . - - I - - 1 _ _ Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. .-_ _` • • • f`?Y OF COSTA MESA .�. PE'MIT NO, R•CT Ne. Lou NO. BLD ivy.• 4661 : 2%22/84 - 34.32 IL CONS RUCTION PERMIT�- ' ' •- - C — / /4233' e j : . ' /. - - Project Address, • i ! S dr ITE L.IiSS' ' TYPE OF CONSTRUCTION M NEW . ADD r' ALTERATION U•REPAIR '- - • - Appllcantis Mallin! `ddrs of '1 )- ❑ CONVERSION ❑ DEM0pSH ❑ OTHER . A.P.# / v 2Gi ._ 7•/� .� 0 ^ Zone , C owner's Name • e_', `e`-'Phone ,S-ogr) DESCRIPTION OF WORK 1 L rOC� p `7 ✓Y QSL7 /, _ • ry� ,S, a Accessory Building' ,�Ip1reci.eit Address • C ` ' •TYPE OF PERMIT ❑ GRADING KJ FOUNDATION ll�� - �STRUCTURAL T FrOnt�7 it-shy` P -elit--- N Arch/Eng. License No. ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B - . • I • GC. /2( ���•��� ❑.OTHER A Rear .. N Contractor's Name• ©W C" / {)U if-CCA.Phona "r B.?PROJECT DESCRIPTION SG. FT.� - - OCCUPANCY Ai- / C Right �' r� • G CCC K R Address(Mailing) CONSTRUCTION TYPE I/ VALUATION$ ,(2Dc7 $ Left3 ._ ZONE GRADING CU.YDS. (7; - ACRES Ping. Ref.# r-- ' Park $ = Q City License No. -• r. — U LICENSED CONTRACTOR DECLARATION Remarks: • :Parking Req./Provided • - l F I I hereby affirm that I am licensed under provisions of Charter 9 (commencing " • " R with section 7000) of Division 3 of the Business and Professions Code,and ' • - Use of Building: �_ J• •- ,/' 7.-ice ^✓• . ' E my license:is in full force and effect. - zip yG - /�+ �'f`^ i Ucense Class License No. - PLUMBING f FEES Planning Notes: �. �7!- ��.. • E ,ate • Signature - Bar Sink Showers - /� / - ' N ^7RKERS'COMPENSATION DECLARATION ■ --�'~• . .._ `^ '�Q T :liereby:affirm that I have a certificate of consent to self-Insure or a certificate •- t� . .. . ._. -- -. • of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Mr■' Service Sink S 3800, Lab. C.) - i,;,l Backflow Irrigation Sewer Cap , ELECTRICAL FEES - Policy No. I -Company .- - ^ 8 Certified copy Is hereby furnished:-. - • , Bathtubs Sewer Connection . Automatic Washer ; Transformer 0 15-50 KW Certified copy is flied with the city Building-Division. 0 50+KW _ Date Applicant - Clarifiers • Solar Collectors ' _ Construction Pole Si .b _ _ EXEMPTION FROM WORKERS',COMPENSATION DECLARATION - ' • (This section need not be completed:If the permlt'Is for one hundred ($100) or ' Dishwasher Solar Piping Cooking Unit Meter ❑up to 100 amps; , less), Drinking •Fountains ' I certify that In the performance of.the work fo hlch t, s per tis Issued I I. , Solar Tank - Dishwasher • Meter Dover 100 amps shall not employ ny person In anyfmanner as ci"j m ubject,to the - Workers' Cptnpa9�pay Laws of California,. ,+ Floor Drains Swimming Pool w/Spa Dryers as Electra Sub Panel - Date 7 7'y O' Signature '-' / / - tl9ee NOTICE. If;iaf r making this declaration;you'shoul• be me subject to the Floor Sinks-- ' - - Urinal - - - - --- S Fonar - ' _c , d Motors❑0-1'HP-❑1,'/a ,B ' " -' ' Workers' Compensation provisions,of.the Labor Code,. ou must forthwith- - - - - comply .with such provisions:,or this ,permit'shall be'deemed revoked-j , - Gals Service ' .Outlets. - Water Closet - • • - ' �'' } : 4 ,F.A U. -t' 7"1 •,r,...-...1.11.' i , Inc.Solar ❑9-15 Ht.,016-15+ CONSTRUCTION LENDING AGENCY - _ - I hereby affirm that there.ls a•construction lending agency for,the performance Interceptors . , - Water Heater I Fixtures% 1 , - ' of the ,work for which. chi PPPggq It Is I ued:(Section 3097' Civ C.) - p - - _ , ) ,1, •Microwave , Lend'er's Name '� / - • ' _ ' - _ , Kitchen Sink• • Water Service • - - - c = C� )• I - ' '- ; Device Boxes J Pole Light Lender's Address Lavatories ❑ - '-• , - r f"r y - - a OWNER BUILDER DECLARATION • h ` I . •y - - . ^> l i - Outlets .' 1 :Range 1, �'' • I hereby affirm.that I am'exempt from the:Contractor's License Law for the - - - - - r - - • following reason (Section 7031.5•Rusin rss and Professional Code: Any city or t . F-Trap, ^ - . ' '•1 i m' Switches." r I I '( Si n county which requires a permit to construct,alter improve,demolish or repair - _ ' a - - i ',?..y structure, prior to Itt that he/she iso requires the applicant for such permit Roof Drains, .5. ', .r Garbage Disposal' r, •"i;-�; ,�, ,Standing Sections �, ,lila aislgned statement that he/she Is licensed pursuant to the provisions of - - - - • :Contractor's License Law(Chapter 9 (commencing with Section 7000) of - • • ' ' • • S"� .Generator❑05 KW�5-15 KW -{- .Trash Compactor ;r - of the Business and Professlons'Cotle) or that he/she.is:exempt , - -r. .. -031.5om-and the basis for the alleged exemption, Any violation-of Section r I - _ - _ - • :- Z031,5 by any applicant for- a, permit subjects the:applicant to a civil , l l •- - .jl - 7 3 -" A --' •-- - - Qtppaity of not more than five hundred dollars($500),+ - I _ r RemSpectlon Fee �•j I$25 Issue_Fee $ _ i - _ - •- `W.h as owner of the property•or my employees with wages'as their sole I i Reinspection•Fee...,., 7_ 'j+;- $25 •Issue Fee-• • .$ 3' compensation will do the work,-and the-structure Is not intended or offered • _ MECHANICAL . - , _ FEES' , - t for sale (Section 7044, Business antl,Professional.Code:I The:Contractor's -I r I- , l ,-r •• PUBLIC-SERVICES R QUIREMEE NTS: - r ". ' , •� License Law does not apply to an'owner of a property•who'builds or Improves , . Boiler .. t Hood or Type I 0 , •R • -, i-1 I 1/ c1 '].'. thereon;and:who does such work himself/herself or through his or her own' - l -' . Zoning Approved By ' /'�`� Date employees, provided that such Improvements are not intended or offered for - Canopy ; Type I I l ❑ I , - /l�� j sale. If, however, the building or improvement is sold within one year'of com-. Duct'-Under Ground . 1 Building Approved By _ j ~ ' Vr•^ - Date L2'' elation,the owner.will have.the burden of proving he/she did not build-or im- , 0 ! ,p) 7 rove.for the purpose of sale), : ;- - (• ` Duct-Structural I Refrigeration System •': - Application Issued By l-- y /` " - oat S�'��`^`" • LJ I as owner of the property, am exclusively contracting with:licensed con- ❑o-10Q,000'BTU D100,000_ BTU ___ '� • _tractors to construct the project.(Section-7044,.Business,and,professions Code: '_ Duct-Ventilating - . . .. _ ' h 2..� }�-SUVM�iMARY2 F FEES • J ' �Jv The Contractor's License Law does not apply to an owner of property who - 1 BUILDING PERMIT $11 SMIP! '$ - c[f builds or Improves thereon, and who contracts for such projects with a.con- ; Exhaust System ❑ Multiple❑l •• System Repair/Alteration - . 5,. ,-•- - ` i tractor(s) license pursuant to the Contractor's License Law), • - - ♦'116 : PERMIT '. xy' i , • . l PLAN. CHECK.,. ,$,I 3. .3r71 • 0 1 am exempt under Section • ' B. & P.C.for this reason Firepl/Fact,Bit, IC/30# i 1 ' ' '' '?�.; Il' • _i -ISSUANCE �'$ ' l . 1 I • , Heating System&Dustin I ' - ,.' PLUMBING' _ $I.- Date. Owner ' i i g � s' r'PLAN CHECK 4 25% $'L%' ENERGY P.C. $ ' , - I hereby certify-that-I'•have read this application and state•that the above• - GRADING •,...t$ Information Is correct. I ree to comp) Ith all city and-county ordinances 1Al...? ELECTRICAL '.,Si--" - - . ant;state laws relatin bul ons ctlon,and hereby authorizer pre- . - • r - i i •' ` f pLgN�CHECK 50%^ �� MICROFILM $ 71 . • sentatives of-this c tR e o the above-mentioned pr pert f • F' $ /� '7 JJ L2/gy MECHANICAL" " $ r-TOTAUFEE .$ 3"r�J� Inspection purpose --[` ` - 9 ✓'•_ Signature I �/a to - Reinspection Fee i _ r Drivers' License or SS# { •$25 ' . , -Issue Fee - $ 3 ' PLAN CHECK " 25%t $ ,l CMF 0865-46 rev.12/83 White-Building;Canary-Applicant;Pink.-Accounting;Goldenrod-Assessor - - - CONSTRUCTION AND PLANNING - '.C : .;�: SPAS•.; ,. _ �S,' - - . • . Date Inspector ' - -4 - ` 7"4: % . Date •- Inspector . i--; -%I, RROVALS Permit# - APPROVALS - Perm It# i;, Z 1.0 1•.•emporary Electrical Service or Pole - " •52.' Pool & Equipment Location r< ' • ; E :.l - -- T.'toil Pipe-Undrgrnd. 53'. Steel Reinforcement t = ° i - '> . 3. Electrical Conduit•Utility-Undrgrnd.• - -54- Forms - _ - L- ''-•- C • • ,/ 4: Electrical Conduit:Undrgrnd. 55.: Electrical.Bonding; .'. • ' • ' '- _'l , ; ' Y 5. Steel Reinforcement . -56. Rough Plumbing'& Pressure-Test.:*.2 - =i . 6. Electrical UFER Grnd'. 57 APPROVAL TO COVER GUNITE r' ? , '; , 7. Footings •' ;7 .4/sit j : 58 Electrical CondwfUndrgrnd :- I iy, .` ' 8. Foundation R ' 59. Gas'Pipe,-.0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd. - ; I (AI , 10. Structural Floor System e_p, 3,7.x- _ L - 461. APPROVAL.TO:DECK • • -- ' ` - • • 2' ! _ 11. Property Sewer Line & House Connection ; • • . - 62. Backwash & Receptor-Final=_Y- :_ _ ;.° . ,, 12. Sewer.Cap - . • 63. Heater,&.Vent-Firiail ' - , . -• ' 0t. 13. Roof Drains > : 64. Plumbing System =Final`- ';;-.: - - r , 14. Rough-Plumbing , , 65.1Electrical:Final` - - '':' - Tr -I 4,. `:(- ' ••: : 15. Rough-Electrical-Conduit - __ • - "66. SolaiSy'stem-Final" •-'' -'"- ) • "-T . 16. Rough Electric Wiring _ - i ' 67.; Fencing&=Access Appprovall: --' n;- -, , ' --� ' 17. Rough Wiring Sign - ; ' - 68. APPROVED FOR PIIASTERING ' M1 ' : p. ; ; I '" 18. Rough Electrical-T Bar Ceiling 69. FOOL/SPA SYSTEMS FINAL •. ` '' ' ` ; .. 1 i ) = - 19. Rough Heating& Air Conditioning - ' , FIRE DEPT. REQUIREMENT;•; - I 1 • , r '' - I ` 20. Rough Factory Fireplace • APPROVALSI Permit# = ) i u I;' I :. • •, _ _ • _i 701 Underground Hydro „ • ! ' r 21. Ducts,in Structure. - . l 22. Ducts,:Ventilating . ' , 71.' Product Piping b Gas"0 Oil : i ! ),J i ; -I 23. Gas Pipe-Rough & Test • , 72. Underground-Flush:- - i �- 24. Roof Framing . . 73. Undergrnd.Storage Tank1 Ga{3D 0i1:, I ;; i : I 2 !Roof Sheathing - ' - 74.' OveThead Hydro , 1, c - • •- I 2 •• T-Bar Ceiling (Structural) & Monocoit 75. Dry-Chemical - it - •' ' I SSE ROTE . Frame and Flashing 76. Dry Standpipe I 1 ,:- I _ i. 1 ' I , . , 28. Lathing &'Siding . 77.. FIXED SYSTEM FINAL '^- re r- I } 1 ' 29. Insulation ' 78. FIRE PREV. FINAL - ; 12 ' , ( I I ' 30. Drywall Nailing ' • ' l , HEALTH DEPT. REQUIREMENT i I i 1 • 31. Plaster Brown Coat ; 79 FINAL INSPECTION i r _ tl l 32. Electrical Power Meter-Final ' 80., FOOD CERTIFICATE ISSUED I I 33. Final ElectricNotes: + of 34. Final'Heating & Air Conditioning ; { j4 i _'a -- - -4`'7'x"�`"'te 67 (' .Te 35. Final Gas Pipe-Test ' • - - Ute/-r , �i 36. Hood or_CanopY I i ' S , o • , 37. Final FeEtory Fireplace ' ! 'e •' 38. Final Plumbing-„ • , ` • . ' H EL: GAT T ,OV !PASA/ET' C_OM PLYFS w1 .. 39. Water Service-Final - S _ - O�d� 1 Z0 Cl. QF 't5 ,7�7 Vi3cJ� 40. Gas Service-Final , , _ - - 41. Solar Domestic-Final - /. � ._. _ � �t 42. Backflow Preventer ;4 girtt 3r9,X_DIA)/ ir-L -.11O - EXTdikp TO , L (i.T70 t 43..Backflow•Irrigation - • r- : f- • 4- t @ : FA A PEI 44. Landscape Irrigation System - - ' _ .CORtR5c % , 45. Sound Attenuation - • { ..4=-010.4.,Zr e � 9""tc-eve 46. Handicap Regulations • . -n2t-4 ' ec�� •• i, ems' -•_`t- Tie 47. FINAL STRUCTURE & BUILDING• / t ,. " I� 48. Special Requirements Completed I fit 49. Electric Release to Edison ' , • ' -- , ' s-., 1' I I ` ' 1- , ! • . • , 50. Gas Release to Southern California Gas Co , I • ' i I �r 51. CERTIFICATE OF OCCUPANCY - --- - I-_-I , • . - - - - No. - Date ..r. . . 4 ! i l -, i .. . CITY OF COSTA MESA BUILDING DIVISION OWNER-BUILDER VERIFICATION . A city or county, which is required to give notice pursuant to Section 19830, shall attach to such notice, and, as a condition precedent to issuing a building permit, require the completion and require the return of, an owner-builder verification. Attention Property Owner: An 'owner-builder' building permit has been applied for in your name and bearing your signature. Please complete and return this information in the envelope provided at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received. 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement Yes ❑ No 2. I (have/have not) iffijr Ciesigned an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction: - Name U C_ Address City Phone ( ) Contractor's Lic. No. . 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work: Name AGE Address City Phone ( ) Contractor's Lic. No 5 I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: Name Address Phone Type of Work I hereby affirm that I have received a copy of the information set forth in Section 19830 of the State of California Healt and Safety Code nd have completed the above information to the best of my personal knowledge, in mpli e ith t s State law. /L � y Signed: /� / /�/' ^ /( � Date: / Name: C�Fl��S v" y),Oc- '" (Printed or Typed) C.D.L. #or S.S. # • 754-5273 CMF 1042-46 • • _ _ Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. - _ - _ _ ./••• COSTA MESA; _ PERMIT NOP '- TRACT NO. LOT NO. BLDG,NO. ( . ••4662 . 2/22/84 83.+Ej21.'TI YSTRUCTION PERMIT S —//L 3 -• . . 4Co'n ' ��yy1 . 7 Project Address ` C C—/ / C L TYPE OF CONSTRUCTION' "NEW ADD.-r�ALTERATION' L REPAIR '�/� /'� C • A it,`S Meiling Add/r/e_55 . 6thriEl CONVERSION El DE LIS ❑ OTt{ER- y -a • A.P.#U�7�/_ (Q�^O,J. !I Zona k/ ,- '�!`T� — C7/'-I •�S•'Q s• ' DES •IPTION@� yRK - ..r=�tw.W.I Z4er...W'iltiZfiva a _ Owner's'Name ' Steen -Phoner t , • 6 C 6u,-• E Main.B wilding: ] ' _ Accessory Building: J O • Address _ TYPE OF PERMIT II GRADING /4 FOUND• ION • STRUCTURAL T Fronto fl, , ie 0 . N Arch/Eng. License No.' ❑ TENANT I=� ELECTRICAL ❑ PLUMBING El MECHANICAL B Rear��•� 6�-��. -Q . - • N Address / • ❑ OTHER - • A' - wee � '•. J .Q3 C Right /D / �v•_ G Contractor's Nairn. 0 W N�/Boa- 4j Phone Oh Q�� l PROJECT DESCRIPTION SQ. FT s� L��• OCCUPArvc/v' K ' CONSTRUCTION TYPE yi • VALUATION $ Tf 7Lf� S Left 4 S, - '_ - ' E Address(mailing) - , ZONE • GRADING CU.YDS.' ACRES Ping. Ref.# • Park.Fees $ ' O City'License No. - - p y-, r • U LICENSED CONTRACTOR DECLARATION Remarks: I . G',- //3 ` :-s /-. • -Parking Req./Provided I •) I hereby'affirm that I am licensed under provisions of-Charter-9 (commencing ,tnn ,(,, (/�sl�ama�,�, nn �s//�� R with section 7000) of Division 3.of the Business and Professions Code,and . • , • . - `Use of Building:(Ay/4i two/7/0A) K/•vr/ .Q )f'YQ rQIZ'L�) ER my license is in full force and effect. - • License Class - License NOJ PLUMBING FEES . Planning Notes' ,¢/ , - M • E Date Signature - _ ' �•f ORKERS'COMPENSATION DECLARATION Bar Sink Showers - N 1, ereby affirm that I have a certificate of consent to self-Insure or a certificate Backflow Preventer '" • - - Service Sink . " • - - of Workers' Compensation Insurance, or•a certified.copy thereof (Section ' . - 3800, Lab. C.) - I . 1 -;• Backflow Irrigation ;Sewer:Cap ELECTRICAL . FEES Policy No. ' Company-- - , - _ - Certified copy is hereby furnished. '`• rY' • ; ' , Bathtubs - Sewer,Connection; - Automatic •Washer " Transformer 0 15-50 KW - Certified copy Is filed with the city Building-Division.• Clarifiers 1 Solar Collectors Construction Pole Sub. I 0 50+ KW • Date Applicant - , - . - .- .. . _ _. _ _ - EXEMPTIONFROM'WORKERS'COMPENSATION DECLARATION - ' Dishwasher Solar Piping . Cooking Unit Meter ❑u to 100 antis (This section need not be completed if the'permiE is for one•hundred ($100) or . ,, • P P less) , r •+w DrinkingFountains I tertify.that in th performance of the work for ich this erm;t isn' uetl I Solar4Tank , , Dishwasher .. Meter Dover 100 amps' shale not e loy ny person In anymanner s s to sub'f to the _ ' Workers' Laws of Calfornia •-,, • Floor Drains • Swimming Pool w/Spa '' \ Dryers ❑Gas ,❑Electric • Sub Panel' , Date Signature '' - NOTICE: Liaft r Sabo ng this declaration; you should become ubject'to the • t• Floor-Sinks -'- - --- • , :, • UrinaP - - - -•' , - ' - ' - - - • Workers' Compensation provisions,of the•Labor Code, you,mustCforthwlth: " 'Fan • -' - "Motors X0-1 HP ❑1%'=8 comply ,with; such provisions:or ythis;,permit Shrill be deemed revoketl': Gas Service, Outlets• Water Closet " '� I .A.U., ' ' . Ina Soler ❑9-15 HP 016-15+ l CONSTRUCTION'LENDING AGENCY ` I '' ' ' I hereby'affirm that there is a construction lending agency-for the performance ' Interceptors ) �.; - Water Heater 1 Fixtures ` ' • I Microwave of the.'work far which this er it -Is Issued (Section 3097 Civ. ••CJ - - Lender .s Name:. ' �}p, ,, ` Kitchen'Sink Water Service - tDevice Boxes i , Pole Light , I ' 'Lender's Address' ' tr- U�':J�. :. j I _ - .. _. . • , •OWNER BUILDER DECLAR TION ; . , '' ' } : Lavatories - - •�- Outlets 3. Range I hereby affirm that I am'exernpt from the Contractor's License Law for the : - - ' - - i• following reason:(Section-7031.5 Business and Professional Code: Any city or. f P-Trap , _ „ 1 - - . -, '•;. 1„ .Switches • ( Signl - .. �. 'county which requires a permit-to construct,alter improve;demolish or;repair • _ ., - ' •- .any structure, prior to its Issuance, also requires the applicabt,tor such permit ROOf'Drains - � f: Garbage.Disposal 'Standing Sections • ` file a.signed statement'that he/she Is licensed pursuant to the provisions of - - - ' - • Contract f the cense LaW (Chapter 9(commencingwlth Section 7000) of i i I - - • .) ision 3 'of thejBasiness and Professions Code)'or,that he/she. s exempt I { ' - ! ;Generator,❑0-5 KW ❑5'15 KW t Trash Compactor , • )'- I - erefrom and the basis for the alleged exemption.-Any violicant,of Section 'I .'- II _ - .' I i . 703115 by'any applicant for;;a;.pe subjects..the applicant.to a civil • Reinspection,Fee�r , x$25 • Issue Fee $ 3' ' ' - - ' ' . city of not more than five hundred dollars($500). .- , ,: 1 i , 1 , •�Q..J��I asi owner of, the property of my employees with wages'as their Tole i _ '' Reinspection Fee $25 Issue Fee ; l• , .$ 3 _ 'conlpensation will do the work, and the.structure is not intended or offered _ '. MECHANICAL - ' FEES. e••- . _ for sale (Section 7044, Business and Professional Code: The'Contractor's , PUBLIC SERVICES RE UIR MENTS: I ' ' License Law does not apply to an"owner of a property who builds or improves Boiler .. j • • Hood or Type I ' 0 r -,.. PP ,� ' : Date 2 L fi thereon, and'who does such work;hlmselt/herself or through his or her own . - - • , i ZoningApproved By 'I- - employees, provided that such'Improvements are not intended or offered for Canopy . Type II ❑ , , - salIf, however,the building or Improvement is sold within one year,of com- ; . ' Duct-Under_G round , ' Building�Approved,By Date - r++ -. pietion, the ownr will have the burden of proving he/she did not build or Im- - . . - , ' rove for the purpose of sale). t Duct-Structural Refrigeration System 4 7" i Application Issued By .Q,Id./ -. ' • ' • Dat: i . LI I, as owner of the property;am exclusively contracting with licensed con- - t ❑0-100,000 BTL1_0100,20_0 BTU '! ' . r -tractors to construct the project (Section-7044„Business and Professions Code:.. . „ Duct.;Ventilating --`: -_ _ _ , SUMMARY_QF FEES ,1 The Contractor's License Law does not apply to an owner of property who I r ` BUILDING PERMIT i$ 50, S Li • SMTP t ' :$ - • �7 a builds or improves thereon,-and who contracts for such projects with a con- Exhaust System ❑ Multiple ❑• System Repair/Alteration f i tractor(s) license pursuant to the Contractor's License Law). I i ' PLAN CHECK $ 3 0•l• �(�-- PERMIT .j 0 tam exempt under Section B.& P.C.for this reason ' Firepl/Fact.Blt. ICBG#• ! • 1- ' • - PLUMBING). '$ - ISSUANCE $ I Date ' l Owner • - ' • Heating.System& Ducting : - • + 'PLAN CHECK 25% $ ENERGY P.C.' ;$ - I hereby certify-that-I have read this appli ation and state-that-the above- • • 90-100,000 BTU 0100,000 BTU^- • - - - - - ELECTRICAL $ GRADING ,$ ' information is correct. I ee to comply w all city and county ordinances - ' . - ' • and-state laws relating b constr ion, and hereby authorize re re- I PLAN CHECK 50% $, , MICROFILM $ '` • sentatives of this:cito on a abve-mentionetl pro ere for I • • , I ''.a„ , i , - I Signature purpalCit _• s p , Signature ' Date Z B• �. • • , MECHANICAL ' $ TOTAL FEE s$ Sc3. O.,— �” • CMF 0665-46 rev.12/83 White-Building;Canary•Applicant;Pink-Accounting;Goldenrod--Aisessor - - - - ' •'- . / S 1 Y%TRUCTION AND PLANNING . _ ' - :•, -',C+ P06- "< SPAS _ - - r - 1 n / Y - Date Inspector, rAPPROVA LS n Perron-# r Date - Inspector i'` ,,��PP:�JA LS Permit#_ _ _ o_ C /1. Temporary Electrical Service or Pole . _ - _ 1;52.;Pool 8/:Equipment Location;: - - I • / r: 2: Soil Pipe,Undrgrnd. - • : -•`ri ' 53i'Steel Reeinf6rcen1ent "Y = _ e U o -+ ' i • 3. electrical Conduit Utility-Undrgrnd. - - • . 54. Forms ?•-" - - _ - .,I ' .4:electrical Conduit-Undrgrnd. _ 55..Electrical Bondirig'- : vL _ - = �''; _ '11 5: Steel Reinforcement - , i - = '-56.. Rough Plumbing & Pressure•Test ', , - " '= 6. Electrical UFER Grnd. - - : 57 • APPROVAL TO:COVER-GUNITEf - 7. Footings ' - 1 58.' Electrical Conduif-Undr rnd.-- '•`t •:;, . 8. Foundation- 424k( 59. Gas Pipe, O Undrgrnd.,Test`. • 9. Water•Pipe-Undrgrnd. !;60. Backwash Lines,-P_TraP, 0 Undrgrnd.; - - r 10. Structural Floor System ,7�1g!{ ., '.61. APPROVAL TO.DECK - _ - . •'" 11. Property Sewer Line & House Connection`'/ .{'fr. , 62. Backwash& - Receptor-Final- _ . _c - ' 12. Sewer Cap - • ' 63. Heater & Vent-Fin'd' •^ • - - ' • ; I 13. Roof Drains _ -^ ,,1 64. Plumbing SysterrI_;,Final T,'o= - 1 - , 14. Rough Plumbing - • '65. ElectricarFinal , - • t `• = • 1 - 15. Rough Electrical-Conduit -- - - -,- -661. Solas System-Final y 1.-' -_ -- - - ' '" -- . ' i . 16. Rough Electric Wiring _ • -., 67.-F.encing-&•Acces Approval;: ' - _ ;,-::t.:---. --t- ,_. ' I' gygy--17. Rough Wiring Sign 68.: APPROVED FOR PLASTERING' ' - : : 11 - I ' • •;9; Rough Ele•ctrical-T Bar Ceiling r 69. POOL/SPA SYSTEMS•FINAL . 1 . •- ' • , - g i ' ' ' a Rough Heating.& Air Conditioning , . . FIRE DEPT. REQUIREMENT' I, " - ' ; • ' 't Rough Factory Fireplace k I APPROVALS: I Pe�mitt# ' c 1"% ' Ducts, in Structure - ' . � . 70. Underground Hydro I 22. [Skirts,:Ventilating ` 71.; Product Piping O Gas'_ D Oil ! I -1 I I , i • 23. Gas Pipe-Rough &Test - i 72. Underground Flush: 1 i 242 Roof Framing z/s' j ' ;73.1 Undergrrid .Storage Tank. O,Gas,O 671,,.! :. , ; t i i 25. Roof Sheathing .•, • 1 0 ‘d ,/t......) 74. Overhead Hydro I _' ; , • • T 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry;Cherrlical I - . 1 I 27. Frame,and Flashing - • 76.; Dry Standpipe ! .- 1 t . ' R 28. Lathing& Siding X77. FIXED SYSTEM FINAL I _ ; ' i' W 29. Insulation (1/.2451{ p .4i , 178. FIRE PREV. FINAL '' - ' ! I • 1 1 30. Drywall Nailing iyelAY (/C/; HEALTH DEPT. REQUIREMENT { , i ' `,31. Plaster Brown Coat ' t i' i ' 179. FINAL INSPECTION - • i 1 ; , 32. Electrical Power Meter=Final ' ! I 80$ FOOD CERTIFICATE ISSUED a 33. Final Electric 'Notes: , ~ i 34. Final Heating & Air Conditioning' _ i 35. Final:Gas•Pipe-Test - . I - !, i ; 1` i - =« ,- ,: 36. Hood or Canopy - ^ , _ _ . . " -• - ¢ -1 'Cr i : L c - _ 37. Final-Factory Fireplace •r' f . ' ' _,I ` ,, 38. Final Plumbirig. f ` 't• - ' '1 ` 39. Water'Service-Final; • I 1 I ; I ' 1I i •• 7..: - 40. Gas;Service-Final ' 41. Solar Domestic-Final . ' - - - --i - .. - 42. Backflow Preventers - - I • , _i_ I'_ ; ! n-'1 tit 1. , 1 • :.r - 43. Backflow Irrigation r _ i ; 1 t Ij 4." r • , , ' , 44. ,Landscape Irrigation System I i - I • - . I 1 c 45. Sound Attenuation I `. .i ,.; 1 . I', •° - _ � •1 - i ' - l•• 1 '1 I 'i ill ,. 1 , 46. Handicap Regulations - -'� 1� I : ( 47. FINAL STRUCTURE & BUILDING i/� 1g /�I f ! ,, I :I. 48. Special Requirements Completed - 1 - 1 - ' ` •' - 49. Electric Release to Edison - _ I , -i ,' i ,l i 1 50. Gas Release to Southern California Gas Co ; t ! i' .. it il 51. CERTIFICATE OF OCCUPANCY : - - -' _ ------'- -I :-' -,- -1- ' -'''` •:1! • I No. - Date I . - 1 i 1754 c 6f EIVED p' /til•'?•"✓ JUL 1 1 1952 COSTA MESA BUILDING-SAFETY DEPARTMENf� FINANCE DEPT. P. O. BOX 317 COST" MESA. CALIFORNIA • CITY OF COSTA MESA For Applicant to Fill in Completely ; APPLICATION FOR PERMIT ' TYPE OR PRINT BUILDING ADDRESS /57 'CO/9 B'E nn E. Place COSTA MESA. CALIFORNIA For Office Use Only RECEIPT NO. -ERMIT NO. OWNER .` a,,/ AM/ I, I '-7 — RECEIV pY DA• RECEIVED DATE ISSUED ADDRESS DI //f'2"I JUL 1 2 1952 BUILDINGPP ADDRESS /J� / ''i A ' A - /�- _ARCHITECT COSTA MESA. CALIFORNIA • -- FIRE IR ADDRESS ZONE TYPE V GROUP L ,[0 /)/ APPROVED CONTRACTOR/ I BY DATE /J�1- / L ADDRESS Sant" -- ZONING IZON NO.OF USE OF NEWS/n'+T/.w14, CITY • - Z I PLANS Zi I BUILDING 4064/.. /_ STATE / may^ ,Ip LEGAL /.. p / y �+`+� LIC.NO. ''7 �L�/CEJ/ '/ NO. DESCRIPTION la'/ 1 2/1 4/ 1 7(J NO. OF OF LOT /�1�� /t QS I NOW ON LOTe 6 A.P.NO. USE OF YARDS EVES EXISTING BLDG. , APPROVED ALLOWED SETBACK LINE FROM • (CENTER LINE ST.I . CENTER OP STREET REAR YARD - FRONT / /O FT. g- IN. SIDE YARD I LEFT RIGHT R.SIDE /JO FT. —/� IN. • • DESCRIPTIONJ��/%OF WORK L.SIDE / FT. N. NEW I X II ALTERATION I II ADDITION I REAR /O FT. f/�'ar"e-7. IN. REPAIR 1 II MOVING 1 I DEMOLISH • BYPROVED/__/nA"�a DATE 7!'//-L SIBZE DING/f / 7 #y 2-NO. CO STORIES / �Spe a c e Ga/ JOF t � 4y4- EXTERIOR WALL ¢A ROOF / / ' COVERING �L- I COVES RR ZING L/ , r /o iPicy,-!per USE OF BUILDING AND WORK TO miniami e,..,_ 3 / I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION + AND STAYS THAT THE ABOVE IS CORRECT AND AGREE TO COM- ! THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PURPOSE OP ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING I SIGNATURE CONSTRUCT ON. // n� , VALUATION SIGNATURE OP✓ /�///�`7// L{/ .y// PERMIT FEE $ yT // PERMITTED $ // / /O / PLAN CHECK $ K 7 , AUTHORIZED AGENT TOTAL FEE 42\- \ •'. t,` - 1940i- '- • - F,EE REC --: VED COSTA MESA 'BUILDING-5AFL.. DEPARTMENT P.O.BOX 319 -COSTA MESA,CALIFORNIA V 3 .1969 _/�� \ , • • r II11rppO1V1l t1VV For Applicant to FillInCompletely FII�ilLICAMIOIILFOR PERMIT -TYPE OR PRINT • CITY OF 1�iS16i (6SP Hu1LOING _ //�� �J For Office Use Only ADDRESS /o � V 6V Tye ANN8 i. L}C�� . q�, 'RECEIPT NO. PERMIT NO. COSTA MESA, C IFORNIA l " 2r fop ED J` G ,.., /IT 7f 1 E�d 3 G . OWNER -Sce- 1 D Ni Al �/t Al _ BUILDING /f! L • OeCEw�NE ' P�ADDR85H ADDRESS Il> i T ei �rG8AANP. PIAGP FIRE - CO '' t TE CITY(,OS L A Mf, SA NoL..l-,/�B'70I( ZONE TYP GROUP- rr� • APPROVED . 'A� '/'- �/� J.OENGINARCHITECT � L. - TEL --� BY / ,) / n DATE OR ENGINEER - NO. .� ZONING I I fr ADDRESS ZONE NO.OF,2",..-. USE OF NEW ��pp �J` p ./ _ I '') PLANS I BUILDING CONTRACTOR e W N C /P - y h_ch • �� O / `� t LEGAL ADDRESS ,ep!,9rgIC DESCRIPTION yri CITY • L. , /4/. • A.P.NO: nI\.[/" -51- 1 NOTE: NO EAVE OVERHANG SHALL BE LESS THAN LIC.NO. • AL: • o/�/1fg 90'TO SIDE8REAR P.L. . EAVES SIZE �, ' ,�( l��',.(� % . NOW ON LOTS . ALLOWEDY (U. APPROVED (U YARDS APPROVEDB.C.OF LOT +_ USE OF MAIN BUILDING ACCESSORY BUILDING EXISTING BLDG. A b Ay P FROM C/L STREET) SETBACK LINE FROM FRONT FT. 90 FT. • CENTER OF STREET REAR YARD SIDE YARD I LEFT -' I'RIGHT R.SIDE FT. r--pr.— DESCRIPTION OF WORK L.SIDE ' FT. Fr. / lI • _ NEW ALTERATION — ADDITION REAR FT. • �T.—" DISTANCE BET. BET.MAIN 9 • • REPAIR MOVING DEMOLISH MAIN BLDGS. ACCESS.SLOGS.' BUILDING NO.OP • VAR.# DATE SIZE ROOMS STORIES C.U.P.#a .APPROVED EXTERIOR WALL ROOF ' BYPROVE 1 �� DATE 5 -3 "‘+� 'COVERING - - A. USE OF BUILDING VOO ANCRK TO BE PERFORMED - I -77 -9 Stock- w sk i. _ O'V> " .yid y,. PR)rmt: • - . • . N • SQ.FT. . B r. I HEREBY ACKNOWLEDGE THAT I'HAVE READ THIS APPLICATION . ' THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. O PLY WITH ALL CITY ORDINANCES AND.STATE LAWS GULATING VALUATION Or ; BUILDING CONSTRUCTION. / �M V'• PERMIT FEE 53 H SIGNATURE OF•�J�) //i e--1.4.1.4 �� /1� '� PLAN CHECK $ F CD PERMITTEE // �,iDy AUTHORIZED AGENT • Z LL TOTAL FEE $ J OWNER ROBINSON, Joe DATE 5-3-63 JOB ADDRESS 151 Georgeann P1. BUILDING PERMIT NO. 192401 GENERAL CONTRACTOR Owner-Bldr. VALUE $ 288.00 AP No. LOT 1 TRACT 4.698 FIRE ZONE DESCRIPTION OF WORK Pvt. Elk. ",11 INSPECTIONS Signature DATE GROUP J TYPE III ZONE R-1 Soil PERMITS ISSUED Gas SUBCONTRACTOR DATE NUMBER Water Rough Corn. Refrig. 0 Air Cond. 0 Rough Heating Rough Plumbing Miscellaneous Prop. Swr. Line ❑ House Con. 0 St. Swr. 0 Sprinkling System Construction Pole Underground ❑ Power 0 Rough Wiring Trenches p Forms D Steel Reinf. ❑ 5-4 5 ( a Floor System Bond Beam ❑ Steel Reinforce 0 Sheathing Frame and Flashing Lathing— In 0 Out 0 Plaster, brown coat Refrig. •0 Air Con. 0 Final Heating, Final Plumbing Fixtures, Final Final Gas Test Electric Fixtures, Final _ Building, Final � ���-����5-•�-- _— OCCUPANCY Form BU4—SM-3-63-8-B P I ohm • • i0.50 Ti.' COTMESAUDIIAMSAFLFlET APPL R ___ APERMIT . . .PoxCOSCAIORNIA 9 qRECBV PERMIT Aro 48654 For Applicant to Fill in Completely — Use Ink Only VVVVVV 1�I ABUILDING DDRESS Ph A.P. NO. f I l — 05 D_- 3' 21 OOEN ER OR N tJ�-�J ADBUILDING DRESS 1 5 ' L... '- i'rvlll�^fie/ C��‘,S UNIT OR JJ MAILING tic../ Gs'+,�, KCS,LKl //if SPACEPNNO. LOT BLK. ADDRESS `• / t `J'tA/1 L (� CITY t�`�C�ZL-� `/t{iein. NOL C (ST'G NEW ADD ALTER REPAIR MOVING DEMOLISH NSTR CTION L NDX BR CH OWNER 1 C(Y,(K rS 0C �- Y1 J SS A CHI ECT TEL. USE � � VALUE$ /�/( Vf R ENG EER NO. IU r ` ')� ADDRESS ZONE f\ I TYPE GROUP CONTRACTOR G(,Un}GTC.. /�[/g U[LQCI- APPROVED DATE'4)/(6/rg ADORE BY TEL. CITY NO. FST E CITY APPROVED SETBACKS i-ig LI .NO. LIC. NO. SIZE 1VV 1 y[�a? NO.OF SLOGS. (FROM C/L STREET) L OF LOT V NOW ON LOT FRONT FT. d USE OF EXISTING BLDG. , R.SIDE FT. V) E-. Separate permits are required for L.SIDE FT. • G electric,plumbing and heating work: REAR FT. W., USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION Q 0 DATE QAPPROVED 75'r APPROVED Ir i-' RY DATE igW aI hereby acknowledge that I have read this application and state N ge4 that the above information is correct and agree to comply with C. all laws regulating building construction, and I shall not employ i Z any person in violation of the workman's compensation laws ofu •_14 the State of California. I hereby certify that I am properly licensed as a contractor under SQ. FT. N N the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR to Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: - am exempt from the provisions of the State of California BusinessVALUATION PERMIT FEE /6.00 ; $ and Professions Code, ivision 3,Ch ter 9 ...._ . M © PLAN CHECK $ °t Signature of (.n. c� ` O ..... o Permittee \ LL $ or ���/IIWWW �'T� TAX 6 $ • SQ U Authorized Agent Date TOTAL PAID $ /o,4 J o mum_ COSTA MESA BUIL ..±S-SAFETY DEPARTMENT APPLICATION FMPSTRUC+UWittPERMIT 6.50 TL' P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 , '- _. •_ ' RECEIVED BY PERMIT L /1 /� 5--s— For ('' For Applicant to Fill in Completely—Use Ink OOn'ly///� -/i�V� PLJ J BUILDING C-it�2 t�i Jc.11�^-r/�: //_ ""'".05-2 - 3/ ADDRESS !,�// Q (/�) `� /� A•P• NO. G ��//�� of TO NANTOR C ! ( /\t$ �r /`. ( ) I" ADDRESS /J / gad ObJC / r-.. 'f '�"�J UNIT OR MAI LING L•-` f SPACE NO. ADDRESS / ILC-01Aill-,�-L� TR.N �.�s LOT .BLK. �j,�/ TEL. 1 �,/jV�I CITY C• / /7 ( NO. 'L!♦�`t NE ADD ALTER R PAIR MOVING DEMOLISH CONSTRUCTION -_____ `(X`' LENDER BRANCH /� p `//�j-��/J���I�]/, r OWNER KIS N ADDRESS �_ y� �J^' N ALUE ��r"'hyt;� ARCHITECT TEL. USFC �//CUZ7/ ! UIG� $ J(J I^`► OR ENGINEER ' - NO. I n ADDRESS ZONE e/ TYPE GROUP APPROVED CONTRACTOR OW iAJ efe /JSGi L.UC-rt BY DATE ADDRESS 7 TEL. CITY NO. FSTATE CITY APPROVED SETBACKS LIC.NO. LIC.NO. cc���, I eSIZE c o Pc igr NO.OF BLDGS. / (FROM CfL ST/7EET)� �+ OF LOT fs (S[j NOW ON LOT i#1/4, FRONT VFT. a • USE OF ti EXISTING BLDG. i.'4-o V S C _ Ft.SIDE FL F Separate permits are required for L.SIDE C.FT. Gi electric,plumbing and heating work: - REAR 44 FT. H USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION xt DATE Q C 0 V /� U�={L- r� .U 2�% y"r�y��/� �t APPROVED • } _BY ROSH �a DATE 8 -X- 79 w it 0 I hereby acknowledge that I have read this application and state n Z that the above information is correct and agree to comply with L all laws regulating building construction, and I shall not employ i. Z any person in violation of the workman's compensation laws of 2 S the State of California. m • SO. FT. I hereby certify that I am properly licensed as a contractor under N the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY; e am exempt from the provisions of theState of California Business VALUATION PERMIT FEE $ 6` Y and Professions Code, ivision 3,Chapter ter 9. e+ Pq/��/— '� w�i61 PLAN CHECK $ c m Signature of 1,.�/ Permittee $ J v •TAX $ L. SQ f Authorized Agent Date zTOTAL PAID $ G s s V OWNER CHRIS DEYDEN DATE 8-16-79. ()JOB ADDRESS 151 Georgeanne P1 ace BUILDING P RMIT NO. ita6 - As. '\GENERAL CONTRACTOR Owner ;U7 ser DESCRIPTION of WORK •• ' AP NO. 119-052-31 LOT 1' TRACT 4698 FIRE ZONE VALUES 550.00 IINSPECTIONS Signature Date TYPE GROUP ZONE (� OIL PERMITS ISSUEDy GAS SUBCONTRACTOR Date I Number ISignature ATER Plumbing ()UGH PLUMBING _ I I I PROP. SWR. LINE El HOUSE CON. SPRINKLING SYSTEM . MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING \I TEMPORARY SERVICE OR POLE ^^eUNDERGROUNO D POWER 0 l ROUGH WIRING Heating and Vent. �RENCHES I] FORMS Li STEEL REINF. ❑ Jo FLOOR SYSTEM E A P LITE D • BOND BEAM El STEEL REINFORCE rl Incnmole,e Inspect ons SHEATHING pre!FRAME AND FLASHING 2} _y �I LATHING — IN l OUT n Date/i I Sig Ar - PLASTER BROWN COAT STRUCTURAL. FINAL Electric HEATING, VENT. REFRIG. AND A,Cr„-�FINAL I IJ PLUMBING, FINAL AND GAS TEST ELECTRIC. FINAL BUILDING, FINAL _._ __