The URL can be used to link to this page

Home My WebLink About1361 GARLINGFORD ST - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: 1361 GARLINGFORD ST Suite No Vicinity: Parcel Nunmber: 14102111 Applicant: DARLING MUMFORD Address: 2295 S GRAND AV ISSUED BY: Phone: 949-279-5575 Zip_,,- -92705 ; Status: ISSUED Applied: 0727/2006 Issued: 07/272006 Phone n \ \ "Zip: --_�92626`�_,_,\ Phone: 949-279-5575 Zip: 92705 -V�\ License: 355425 SCOPE OF PERMIT,,--,. _INSTALL NEW AIC UNIT AT REAR OF PROPERTY ELECTRICAL TO INCLUDE: 1 A/C UNIT AND 1 SERVICE TO 200 AMPS. j SANTA ANA, CA FEE SUMMARY Owner: HANEY, GAIL -A!_ Address 1361 GARLINGFORD ST'__1 V / COSTA MESA, CA - Quantity, $23.50r - /' -� �i r, v // Temp Dist System•/Lighting `� " " Contractor: COAST AIRE $0.00 - -'Address 2295 S GRAND AV $0.00 0 i Iii $54.50 `, - SANTA ANA, CA Standing Section -zy, i $0.00 0 New Res (1-2 units)', $0.00. 0 ISSUED BY: Phone: 949-279-5575 Zip_,,- -92705 ; Status: ISSUED Applied: 0727/2006 Issued: 07/272006 Phone n \ \ "Zip: --_�92626`�_,_,\ Phone: 949-279-5575 Zip: 92705 -V�\ License: 355425 SCOPE OF PERMIT,,--,. _INSTALL NEW AIC UNIT AT REAR OF PROPERTY ELECTRICAL TO INCLUDE: 1 A/C UNIT AND 1 SERVICE TO 200 AMPS. j FEE SUMMARY I, ISSUE FEE Quantity, $23.50r - /' -� �i r, v // Temp Dist System•/Lighting `� Quantity $0.00 0 ` Temp service.lest $0.00 - �Lp,I-/ -,- Busway /100 it -- . $0.00 0 Res. a/c package, $54.50 `, Standing Section -zy, i $0.00 0 New Res (1-2 units)', $0.00. 0 Misc Electrical Equipment $0.00 0,New RSpa +units) (, -� $0.00 rp= \ /�_ \ n5for iars W; Pool _`/ .'~_' �_ up to,10 kva/kw . $0.00 0 LiglilingFixts_ - $0.00 • •'0 to 50 kva/kvv _.. $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 A ' 1 , •,, '� ;, $0.00 0 Low Volt Wiring System / Ckt $0.00 Service -to200ai i �•;��. $30.50 1 -Misc. Conduit $0.00 /ii0 Service to,1000a, $0.00 0 yti"-�i Mlsc:,Conductor i $0.00 �0 Service over 1000a �� $0.00 0 Circus (gen or ride) $0.00', 0 Motors to 1hp, \ 10.00 0 .F,_ - - Circus (mech ride or lights) - $0.00''/ 0_� Motors to)0tip�, 'S0.00 1 ..0; -. .Christmas Tree Stand ' �:- -; $0.00, 0 Motors to 50hp ", .i / $0.06W 0` - , Fireworks Stand 0 Motors to t OOhp-`' "' $0.00 ';: - 0 ,.$0.00 ; Other Electrical Fee i/ $0.00 - Motors over 100hp- A $0.00 ��" 0� , �i Communication drops' -$0.00 --0_ �0- Investigation Fee--_ '$0.00V Sub panel to 200a $000 % _ ,_Plan Check Fee r Pole Light Pkg` `x$0.00"/ ..0-� "� Reinspection -Fee �, �� -$000 Sign Circuits _-$0 00� J� 0; Temp Pwr Pole$0.00, 0 = - TOTAL CALCULATED FEES $108.50 Intermed Pole �'s0.06 - 0 i 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) 7545626 C 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 peril is Issued. I,f)ave 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 y workers' compensation Insurance carrier and policy number are: / / /Goner: rWTF� �17 j7 PWity Number: ©Y 6 �ii I 7-6 q section need not be competed if the permit Is valued at one hundred dollars ($100) or less.) ❑ 1 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 AppNcent Signature:' - / ! / Dater �7 —�7 6 G r- y.WARN - FAILUREE( 10 EWORKERS'COMPENSATIONCOVERAGEISONLAWFUGANDSHALLSUBJECTIDEDFOR AN ECn OF ERT OC RIMINALPENALTIES AND CML AND UP N ONE HUNDRED SAND DIX.LARE (Stc0,000), 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 affix that I am licensedunder revisions of Chapter 9 (commencing with Section 7000) of Division ol-the Business and Professions Code, and my license is in full -font and off ad. Pcra _7,�]r-5�Z�7 class.9_ (132e-) Contract0s,.Signalure: r+9atei-7--, 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 01 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. 11, 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.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Dale: Owner ID verified by drivers license. ❑ Yes ❑ 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? ❑ 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 en RMPP Is presently required, hes Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No ..............................................._................... ........ ..... __.__.......................................__.............................._........................_...................................._..__...................................__.__.___............. ..._........ ....__...... ..... ___....... .__............ 5 Dees or will the applicant or present or future building occupant require for the work which is the subject of this a plication a ffPrmit for such construction or modification tram the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ 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 (It '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? ❑ 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: Data: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the intonation 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. Sign a gal Owners) Date And/Or Authorized Appfcant' CODE I. INSPECTION TYPE 2&IE INTRIALS CODES INSPECTIONTYPE PAS, INTMAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 17� 200 Final Re-Rcof 210 Final Electrical 1i lAR yv1 201 Final Block/Retaining Well 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 (714) 754.5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ra.us 77 FAIR DRIVE, COSTA MESA, CA 92626 MECHANICAL PERMIT ,lob Address: 1361 GARLINGFORD ST Suite No Vicinity: Parcel Number: 14102111 Status: ISSUED Applied: 07/27/2006 Issued: 07/27/2006 Applicant: DARLING MUMFORD Address: 2295 S GRAND AV /�/! %- Phone. 949-279-5575, SANTA ANA; CA i Zip j 92705 Owner HANEY;,GAILAA _•_ ` � � ��/ �A� Address 1361 GARLI NGFORD ST ��-%; Phone ,COSTA MESA' CA j � Zip: 92626 i Contractor: `COAST-'AIRE-/ 'Address: 2295 S GRAND AV Phone;,_949-279-5575 SANTA"ANA, CA Zip: cr92705 - . License: 355425 � ij i' ` _SCOPE OF PERMIT r INSTALL NEW AIC UNIY'AT'REAR OF PROPERTY. REF.: E06 -00830 -- "MECHANICAL TO INCLUDE: 1 COMPRESSOR/ABSORPTION SYSTEM Air Handlers? .10000cfm ? i Quantity; FEE SUMMARY ' $0.00- 0 " 'Other Mechanical Fee $0.00 0 . ' QuantityISSUE 0� FEE $23..50 -1 n/s7"!Repair /Alt Absorbtion'Unit, Inst FAU <100 k BTU $0.00"'.01 g , /! _Repair./'Alt Refri eretion Unit Inst FAU >100 k BTU $0.00 0 - - - - = -- Ventillation System Repair/ Alt Cooling/Heat $0:00 0 Evaporative Cooler Inst / Rep. Recess Wall Hlr $0.00 0_ r CommercialJ'ncinerator Refrig Sys <100 k BTU $0.00- --0 -"�� . " �� ` - Domestio lnanerator Refrig Sys >100 k BTU $0.00 --0'-- — —_ ---'� Compressors /Ati`sorotion Systems Gas Piping - - $0.00".'o Up.to 3'hp / 100 k BTU - Factory Fireplace $0.00 0 3 To:15 hp / 500 k BTU Hoon w/Meth Exhaust $0.00 0 15 To 30;hp / 1,000 k BTU_ VAV Box $0,00 0 30 -To 50 hp / 1,750 k BTU Vent Fan / Single $0.00 0 Over 50 hip / over 1,750 BTU 'Duct Appliance - $0.00 0 .� ,. ':-Boilers Fire Dampers . ; " V $0.00 0 -t" -� Up to 3 hp ` Smoke Dampers $0.00 0 '' _ 3 To 15 hp- p Inst or Relocate App] Vent Inst Air Handlers < 10000cfm \ $0.00 $000-0:, =_ 0 ', 15 to 30 hp-,.- f� .30 to 50 hp' "- - Air Handlers? .10000cfm ? i Quantity; $0.00- 0 " 'Other Mechanical Fee $0.00 0 . ' $0.00_ 0� $0.00 0 i $0.00 0 -F_Reinspection.Fee $0.00 0, S' „TOTAL CALCULATED FEES $50.65 ,$0.00 0 � $0.00- .0 - 0 _$0.00 /$0.00-', 0 $000 0i ' x.$000 o, $27.15 /1, $0.00' 0 $0.00/0 $0.00 0 Air Handlers? .10000cfm ? x$0:00 0O ver Over 50 hp -' -/ Floor Furnace �; �' $0.00 " 'Other Mechanical Fee Floor or Suspend Heater .0 - $0.00 0 -- 'InvestigabonFee - - /i �/%� /$0.00 - „' Plan Check -Fee �' " ,$0.00 $0.00 -F_Reinspection.Fee S' „TOTAL CALCULATED FEES $50.65 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 L MAC1:41 DECLARAVIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the fallowing 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 Cade, 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 Coo rs' compensation Insu�rence carrier end policy number ere: / � Carder. �(�' �E N --I J ♦J n Policy Number: /19/0876!? X (This section need not be Completed if the permit is valued at one hundred dollars ($100) or less.) ❑ I certify that in the perfornance 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 Calif la, 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 provi n Applicant Signature: Date: 7-27— 0 WARNING: FAILURE T CUR ORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND MIL PINES UP TO ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3106 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under p ovisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Businggs and Professions Code, and my license Is in full force and effect. Lic. 4 Class M ' Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 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 70DO) 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).): ❑ 1, 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.). ❑ 1, 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 drivers license. ❑ Yes ❑ 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: ❑ 1 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 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 Califomia Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Cada 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 a pllcahon a emit 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 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 feat from the outer bountlades of a school? ❑Ves ❑ No (If "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). .................................................................................................................................................................................................................................................................................................................................................................I.......................... 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 ❑ No ............................ ..................... .... ......... ............... ................................................................................................... ......................................................................................................................._.................. ........................ ....................................... B (II'yea", attach cartificate 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. Signature Of Legal Owners)✓�� Date —Q i ZX A d/Or Authorized Applicant Date CODE 1. INSPECTION TYPE gdTE INTITIA{,$ CODE INSPECTION TYPE R AU INIIDALB 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Root 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/Occupency (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 1361 GARLINGFORDST Suite: Vicinity: Parcel Number: 14102111 Zoning: R1 R1 Applicant: KIM, JOO Zip: 92626 Address: 14037 GARFIELD AV Address: 14037 GARFIELD AV SUITE L Phone: 562-630-7795 SUITE L PARAMOUNT, CA Zip: 90723 Owner: HANEY,GAIL A Zip: Address 1361 GARLINGFORD ST Existing: 0 Required: 0 Arch : Address: Eng: Address: ISSUED BY: Status: ISSUED Applied: 03/31/2004 Issued: 03/31/2004 Phone: Phone: Zip: License: License: SCOPE OF PERMIT REROOF; (FRONT FLAT ARPA OF HOUSE ONLY) TEAR OFF EXISTING BUR ROOF & REPLACE W/SAME; DOES NOT INCLUDE PITCH AREA OR ANY OTHER AREA OF ROOF -7 SOR'S. Plan Check: $0.00 Phone: $83.25 COSTA MESA, CA Zip: 92626 Contractor: ALL SEASONS HOME IMPROVEMENT Address: 14037 GARFIELD AV Inspection: $0.00 SUITE L Phone: 562-630-7795 SETBACKS PARAMOUNT, CA MAIN STRUCTURE Front 0-0 Rear 0-0 Zip: 90723 License: 815910 Arch : Address: Eng: Address: ISSUED BY: Status: ISSUED Applied: 03/31/2004 Issued: 03/31/2004 Phone: Phone: Zip: License: License: SCOPE OF PERMIT REROOF; (FRONT FLAT ARPA OF HOUSE ONLY) TEAR OFF EXISTING BUR ROOF & REPLACE W/SAME; DOES NOT INCLUDE PITCH AREA OR ANY OTHER AREA OF ROOF -7 SOR'S. Plan Check: $0.00 Permit: $83.25 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $83.75 SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 ACCESSORY Front 0- 0 Rear 0-0 PARKING Existing: 0 Required: 0 FEE SUMMARY Calc Valuation: $2,125.00 Claim Valuation: $2,125.00 PLANNING & ZONING Left 0-0 Right 0-0 Left 0-0 Right 0-0 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 DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 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. ❑ 1 have and will maintain workers' compensalion 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 carder and policy number are: Carder: Policy Number: (This section need not be completed /f 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 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 provisions. Applicant Signature: Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES A.NDCIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE (5100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE. INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that 1 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. Lic. N Class a Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 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: 1 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 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 contractors) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ 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: ❑ 1 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, 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 ❑ 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 reposed 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 standar 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). .......................................................................................... ........................................................... .................................................... .................................. .................................................................................................. .................. ...... I................ ._. 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 Cade 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 ...d..........Department. .enR.M.P................................................................................................................................................................................................................................................. .............................................................._............................... is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes [I No ... ..........................................................................................._..... ... ___.... _.......................................................... ..................... _-_............................__............................................................................ .......... _....................................... _-........ 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication eEarmit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ NO (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ............... .......................................................................................................... ................................................. ............................................... ....... ................................ ... I.................... .......................................................................................... 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 (Ii 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? ❑ Yes ❑ 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: 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. Signature Of Legal Owners) Date And/Or Authorized Applicant Date CODE, INSPECTION TYPE PATE 1NTRIALS CODEINSPECTIONINSPECTION TYPE PATI: IyIIIIAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Finales 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 (714) 754-5273 • Fax (714) 754-4856 CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT Job Address: 1361 GARLINGFORD ST Suite: Vicinity: REAR Parcel Number: 14102111 Applicant: BRANDENBURG, WILLIE Address: 11040 WASHINGTON BL #A WHITTIER . CA Owner: HANEY, GAIL A Address 1361 GARLINGFORD ST COSTA MESA, CA Contractor: RYAN CONSTRUCTION Address: 11040 WASHINGTON BL Issued: #A WHITTIER , CA Zip: 90606 Arch : Address: Phone: BUILDING PERMIT Zoning: R1 R1 Phone: 562-699-5000 Zip: 90606 Phone: Zip: 92626 Phone: 562-699-5000 License: 404279 Eng Address NUMBER B00-00628 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 05/08/2000 Issued: 05/08/2000 ISSUED BY: L//� Phone: Zip: License: License: SCOPE OF PERMIT ADD 726SF ROOM ADDITION FOR A BONOUS ROOM AND BEDROOM EXTENSION". AND CONSTRUCT AN ATTACHED 450SF SOLID COVER OPEN PATIO. REPALCE EXIST. 7 WINDOWS AND A PATIO DOOR WITH SOME SIZE. 300 SQ.FT. REAR YARD COVERAGE OK; 154 SQ.FT. PROPOSED. PATIO COVER MAINTAINS A 32' REAR SETBACK OPEN SPACE OK. FEE SUMMARY Plan Check: $523.09 Calc Valuation: $72,627.00 Permit: $804.75 Claim Valuation: $0.00 SMIP Res: $7.28 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $1,335.12 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 13-0 Left 5-0 Right 5-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 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 suspendedoi�rabndoned 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 of4his permit. FOR INSPECTIONS CALL: (714) 754-5626 I C F 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. 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' comp9nsation InSy(9nce cartier and policy number are: ` (' �y 2 z�- ov u,v F ooh 7 Carrier: sj F -11 9S Policy Number: (This section need not be co plated it the permit Is valued at one hundred dollars ($100) or less.) ❑ 1 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 alifomia, d e that 'f I sh Id become subject to the. workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith corn i o Is ns. pplica ignature URE WORKERS' COMPENSATION COVERAGE IS UNI -AW L AND SHALL SUBJECT LOYER TO CRIMI �L PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND DOLLARE($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTI LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I her em licensed under provisio�Cha9 (commencing with Section 7 IVISIon usiness and Professions Cotle, and my license is In full tl effect. Lic. p t%a: 7r1 - Class It Contractor's Signature: CONSTRUCTION LENDING AGENCY: ❑ 1 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 Coda: 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 Coda: 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.). ❑ 1, 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 drivers license. ❑ 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 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 Mese 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 tiling 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 a plication appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ 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 pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (It "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 proscribed by California Health and Safety Code Section 42303 been made? ❑ 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. Sig lure Of Legal Owner) _ - Dat ' S And/ whmzedAppli�nt D CODE r. INSPECTIONTYPE ILLS CODED INSPECTION TYPE r p93 gam$ 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 BlocWRetaming 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 244646 To NEWPORT -MESA UNIFIED SCHOOL DISTRICT CERTIFICATE OF COMPLIANCE OF DEVELOPMENT FEES PURSUANT TO AB 1600 AND AB 181 ( v<ity of Costa Mesa ( ) City of Newport Beach ( ) County of Orange 3345 District Receipt No. Y01 1 Plan Check No. -00 28 Applicant: f'\Ual'I I, ')'7%ff "FlarI Address: j 1040 A G. Was hinchbi p [ n In Telephone Number: _52-\\ Tract/Parcel and Lot Number(s): I Location of Project: c Number of Square Feet of: l �/ Residential Space 72(e x $1.84 Total I�,� y L-- Commercial and Industrial Space x $ .30 Total Commercial/Industrial Project is: (Check One) Warehouse Motel Preschool _ R & D Bank Auto Repair Movie Theater Neighborhood Shops Hospital Mini -storage Racquet/Health Large Office Heavy Industrial Hotel Office Bldg. Regional Shops Medical Office Restaurant Light Industrial Office Park Fast Food This project is exempt because This certifies that the above-named Developer/Applicant has paid school facility fees in compliance with Government Code sections 53080 and 65995. The Building Permits for this square footage in this proposed development may now be issued by your jurisdiction. Checks are to be made payable to Newport -Mesa Unified School District. By: Authorized Representative The above representation as to square footage is true. Applicant agrees that if it is later determined that such representations are not true, then this certificate shall automatically terminate and the appropriate City/County shall be notified. Date: 5 / 6?1" Appncanr CITY OF COSTA MESA BUILDING DIVISION PERMI NUMBER t DEVELOPMENT SERVICES DEPARTMENT. ` PERMIT 00-00194 (714) 754-5273 Fax (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626 MECHANICAL PERMIT Job Address: 1361 GARLINGFORD ST Status: ISSUED Suite No Applied: 05/08/2000 Issued: 05/08/2000 Vicinity: Parcel Number: 14102111 - ISSUED BY: Applicant: BRANDENBURG, WILLIE Address: 11040 WASHINGTON BL #A Phone: 562-699-5000 WHITTIER , CA Zip: 90606 Owner: HANEY, GAIL A Address: 1361 GARLINGFORD ST Phone: COSTA MESA, CA Zip: 92626 Contractor: RYAN CONSTRUCTION Address: 11040 WASHINGTON BL Arch / Eng : Address: #A Phone: 562-699-5000 WHIT-FIER , CA Zip: 90606 License: 404279 Phone: Zip: License: SCOPE OF PERMIT ADD 726SF ROOM ADDITION FOR A BONOUS ROOM AND BEDROOM EXTENSION". AND CONSTRUCT AN ATTACHED 450SF SOLID COVER OPEN PATIO. REB B00-00628, ALTER DUCT SYTEM AND 1 FACTORY FIREPLACE, FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Repair / Alt Absorbtion Unit $0.00 0 Inst FAU <100 k BTU $0.00 0 Repair/ Alt Refrigeration Unit $0.00 0 Inst FAU >100 k BTU $0.00 0 Ventillation System $0.00 0 Repair/ Alt Cooling/Heat $13.70 1 Evaporative Cooler $0.00 0 Inst / Rep. Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys <100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Refrig Sys >100 k BTU $0.00 0 Compressors / Absorption Systems Gas Piping $0.00 0 Up to 3 hp/ 1001k BTU $0.00 0 Factory Fireplace $10.65 1 3 To 15 hp / 500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 15 To 30 hp / 1,000 k BTU $0.00 0 VAV Box $0.00 0 30 To 50 hp / 1,750 k BTU $0.00 0 Vent Fan / Single Duct $0.00 0 Over 50 hp / Over 1,750 BTU $0.00 0 Appliance $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 $0.00 0 Inst or Relocate App] Vent $0.00 0 15 to 30 hp $0.00 0 Air Handlers < 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers > 10000cfm $0.00 0 Over 50 hp $0.00 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. 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) 7545626 e// 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. 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' comLpBnation Insunmc carver a [icy number are: Carrier: I /.i� �n>uO C�+1i .+�.� Policy Number r��9-UC"J �"LJtiTWUos� (This section need not be cofilplet6d if fhe permit Is valued at ane hundred dollars ($100) or less.) ❑ 1 certify that In the performance of the work for which this permit Is Issued, I shall not employ any person in any manner so as to become subject to the workers' co to s of Califomia and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith /11 triply with these ro to Y at pp)cent Si nature / �'� �'1j�� ?�!/G g / �— Dat3TO., WARNING FAILUR SECURE WORKkRS' COMPENSATION COVERAGE I6 UN WFUL AND SHALL SURIF TAN EMPLOYER INAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED RE I$l00.000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FO SECTION 37E LABOR CODE, INTEREST, AND ATTORNEY'S FEES. [Contractors CEN TRACTORS D ARATION: e affirm that 1 am licensed u der provisions of Chapter 9 (commencing with Section 7000) of a usln d Professions Code, and my license is in full rc and effect. Lic. a % Class k Signature — Date: CO ON 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 Profe]work 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 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 Business and Professions Code) or that he or she Is exempt therefrom and the basis for the alleged exemption. Any vi n of Section 7031.5 by any applicant for a 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 7 ORK, and the structure is not Intended or offered for sal 7044, Business and Professions Code: The Contractors License Law does not apply to an o of property who builds or Improves thereon, and who does suchimself or herself or through his or her own employees, provided that such improvement not intended or offered for sale. It, however, the builtling or improve sold within one year of completion, the owner -builder will have the burden of provin he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITHL SED CONTRACTORS to construct the protect (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of arty who builds or improves thereon, and who contracts for such project with a contractors) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. amass and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑ Yes <Q 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: ❑ 1 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 aperortl -fhe 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 F-1No orkwhorsuch construction or m _ ificati_ 5 Does or will the applicant or present or future building occupant require for the work which is the subject c this a plication epermlt for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? � Yes LJ 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 pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (it "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 It 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 ❑ 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: 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. 1 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 Le Jm _ S"L v And/Or Authonzetl Applicant- CODE pplicant 000E 1, Fixed System PE PATE 1tIIIDAlB COGEN INSPECTION Iec TYPE 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 244646 (714)754-5273 • Fax(714)754-4856 Job Address: Suite No Vicinity: CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT. PERMIT 1361 GARLINGFORD ST Parcel Nunmber: 14102111 Applicant: BRANDENBURG, WILLIE Address: 11040 WASHINGTON BL #A WHITTIER , CA Owner: HANEY, GAIL A Address 1361 GARLINGFORD ST COSTA MESA, CA Contractor: RYAN CONSTRUCTION Address: 11040 WASHINGTON BL #A WHITTIER , CA Arch / Eng : Address: PLUMBING PERMIT Phone: 562-699-5000 Zip: 90606 Phone: Zip: 92626 Phone: 562-699-5000 Zip: 90606 License: 404279 Phone: Zip: License: PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 ISSUED BY: Status: ISSUED Applied: 05/08/2000 Issued: 05/08/2000 SCOPE OF PERMIT ADD 726SF ROOM ADDITION FOR A BONOUS ROOM AND BEDROOM EXTENSION". AND CONSTRUCT AN ATTACHED 450SF SOLID COVER OPEN PATIO. REF B00-00628, 1 GAS FOR FIRE PLACE AND 1 HOSE BIBB. NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes 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 O 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 1 FEESUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub / Washer $0.00 0 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P -Trap $0.00 0 Trap Primer $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping (per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect (Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet (Toilet) $0.00 0 Drain, Roof $0.00 0 Shower $0.00. 0 Water Heater / vent $0.00 0 Drinking Fountain $0.00 0 Sink, bar $0.00 0 Water Piping (Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink, commercial $0.00 0 Water Re -pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0 Gas (1-4 outlets) 56.15 1 Sink, kitchen $0.00 0 Water Softener $0.00 0 Gas (Over 4 outlets) S0.00 0 Sink, service/mop $0.00 0 OTHER $9.80 Gas Repipe $0.00 0 Spa (private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa (public) $0.00 0 PLAN CHECK $0.00 Interceptors (Grease, Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors (Sand Auto ) $0.00 0 TOTAL CALCULATED FEES: $39.45 n NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes 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 O 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 1 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. 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/��surance car rid polic umbaar/�re: /' Carrier: X/7c�� (aYA/iJ - Til?,, Policy Number: 4 � 1 a/Li/10Jcr_( (This section need not be completed it hehe perm�at one hundred dollars ($100) or less.) ❑ 1 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 ase provisio3s. - / pplicant Signatur->/,r. ��4� RE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN MPLOYER TO C MINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOUARE($100,060), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SE ONB�eBI THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: I hereb sed under provision of Chapter 9 (commencing with Section 7000) of Division 3 of the Bu ss and Proles ns Cade, and my license is in full effect. Lia # Class # Contractor's Signature:/d �. Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there I$ 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 ($500).): ❑ 1, 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 drivers license. ❑ 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: ❑ 1 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, 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 ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mese 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. _.............._ ____...___..._—_.___.._..__---.---....--Seco-----.....534 o _ -- 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? C] Yes ❑ No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? _J Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 rWill any pan 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? ❑ 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: 1 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 Owners) Is nze ppl CODE 0. INSPECTIONTYPE 1N Lll AL COD INSPECTIONTYPE DATA INTRIAL 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing —1- 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 2446-46 4 CITY OF COSTA MESA BUILDING DIVISION PERMIT NUMBER DEVELOPMENT SERVICES DEPARTMENT, PERMIT 00-00423 (714) 754-5273 • Fax (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: 1361 GARLINGFORD ST Status: ISSUED Suite No Applied: 05/08/2000 Vicinity: Issued: 05/08/2000 Parcel Nunmber: 14102111 SCOPE OF PERMIT ADD 726SF ROOM ADDITION FOR A BONOUS ROOM AND BEDROOM EXTENSION". AND CONSTRUCT AN ATTACHED 450SF SOLID COVER OPEN PATIO. REF B00-0062, 5 LIGHTS, 18 OUTLETS AND 5 SWITCHES, ISSUED BY: V V Applicant: BRANDENBURG, WILLIE Address: 11040 WASHINGTON BL Quantity ISSUE FEE #A Phone: 562-699-5000 $0.00 WHITTIER , CA Zip: 90606 Owner: HANEY, GAIL A $0.00 0 Address 1361 GARLINGFORD ST Standing Section $0.00 0 Phone: $0.00 0 COSTA MESA, CA Zip: 92626 Contractor: RYAN CONSTRUCTION 0 Transformers up to 1 kva/kw Address: 11040 WASHINGTON BL - $0.00 0 #A Phone: 562-699-5000 Lighting Fixts WHIT-FIER , CA Zip: 90606 $0.00 0 License: 404279 SCOPE OF PERMIT ADD 726SF ROOM ADDITION FOR A BONOUS ROOM AND BEDROOM EXTENSION". AND CONSTRUCT AN ATTACHED 450SF SOLID COVER OPEN PATIO. REF B00-0062, 5 LIGHTS, 18 OUTLETS AND 5 SWITCHES, 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 abanod ned 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 code97-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 FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Temp Dist System / Lighting $0.00 0 Temp service test $0.00 Busway /100 it $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 $5.50 5 .................up to 50 kva/kw $0.00 0 Recept Outlets $19.80 18 ...... --- .... up to 100 kva/kw $0.00 0 Switches $5.50 5 ..................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 t0 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 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 abanod ned 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 code97-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 WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 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. M work�cLLom ensa}tJ�°j`^� Insuran�f�^�Br and ��y�-v num er are: n Carrier: y T7 IPP (y /'7ir7/� Policy Number: An-Qns7�i (This section need not be completed it the permit is valued at one hundred dollars ($100) or less.) ❑ 1 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 3790 of the Labor Code, I shall forthwith e pr visi r 9�/ D plicant Signature Date:j / TO SECURE WORKERS' OOMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMP YER TO RIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOU ARE (S100,000), IN ADDRJON TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION OF THE LABOR CODE. INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby Iic s e provisions Chapter 9 (comma ing with Section 7000) of n o t "ass and Professions Code, and my license is in full for d effect. Lic. # ass # onlractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 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 em 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.). ❑ 1 em exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ 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: ❑ 1 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, 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 ❑ 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, hes 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 thisa plication aermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? M yes a No (Section 65850.2 of the California Government Cade requires that the requested information be furnished on applications for non-residential building permits). 6 Will any pan of the facility to be constructed under this permit be within 1000 feel 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 It 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 ❑ 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. Signature Of Legal Owner(s) ate CODE Jr. INSPECTION TYPE DATE I[iTITIALS CODE! INSPECTION TYPE PATE liemeLs 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 1 ' 200 Final Re -Root 210 Final Electrical 201 Final Block/Relaining 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 2441146 PROJECT ADIFTI 3361 GARLINGFORD ST UNIT: OWNER'S NAME: HANEY GAIL A ADDRESS: 1361 GARLINGFORD ST COSTA MESA,CA 92626 ARCHIENGINEER: REG.NO.: ADDRESS: UNIT: PW PERMITTEE: ARMSTRONG 6 SONS (619)942-3307 ADDRESS: 978 P.O. BOX CARDIFF CA 92007 LICENSED CONTRACTOR DECLARATION: I hereby affirm that am li.ensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my muse is in full rce and effect. arYUD.:0 4720 STATEUC.:586482 CLASS: Date: ( 1 �iSignature: WORKERS' COMPENSATION DECLARATION: I hereby affu have a cenilitale of consent to self ins or a certificate of Workers' Compensation insurance, or a certified copy thereof (Section 3800. Lab, C). POLICY NO.: EXP. DATE: COMPANY: .❑ Carl copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. Date: Applicant. EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This sect n need not be completed if the permit is for one hundred S1W) or less). I comply that in the performance of the work for which this permit is ed, s II t employ any person in any manner so as to become subject to Iht Work%frs Compensation Laws of California. Date: I 'S/91 Signature: NOTICE: It, after making this declaration. you should become subject to the Workers' Compensation provisions of the Labor Code. you must corthwith comply with such provisions or thus 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 which this permit is issued (Section 3097. Civ. C). LENDER: GARAGE IS A ' FLAT ROOF' S ADDRESS: WILL BE 'HOT MOPPED' . OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of 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/she is licensed pursuant to the provisions of the ContractorsState License Law (Chapter 9 (commencing with Section 7D00) of Division 3 of the Business and Processions Code) or that he/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 (Section 7044, Business and Professional Code : The Contractors' Slate 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 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 build or improve for the purpose of sale). I,as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business ❑ antl Protessions 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 contractm(s) license pursuant to the Contractors' State License Law). I am aware that prooc of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: B. 8 P. C. for this reason: Date: Owner: I do hereby surely that I am aware of and understand the requirements of California Health and Safety Code Sections 25505, 25533, and 25534 and that I ar any future building 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 Quality Management District. Residential construction applications are exempt from these provisions. Date'. Applicant I hereby certify that I have read this application and state that the abov mimmation is correct. l agree to comply with all city and county ordinances and state laws relating to building construction and hereby a .tmrize rap r a lives of this city to enter upon the above-mentioned property lot inspection purposes. Date: I � II . 9I Signature: Driver's License or Social Security p: 1641-46 While—Building. Green—Code Enforcement Canary—Applicant Pink—Revenue; Goldenrod—Assessor CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 05508` PERMIT NO: B 055085 PLAN CHECK NO: N GOVT: N SUPP; N CONSTRUCTION TYPE: 5-N PERMIT TYPE: STR PURPOSE; ALT JOB DESCRIPTION : T/O SHAKES, RESHEATH, APPLY COMP SQ FT: 6,000 CLAIM VALUE: 6,000,00 CALC-VALUE: 6,000.00 GROUP OCC: R-3 /M-1 COMMENTS: SMOKE DETECTOR(S) REWIRED IN HOME. ¢� y�7�^�7�� i¢� [� kkkkkkkkkkkkkkkkkitkkk kk kk kk kk k kkkk kk kkkk kk kk kk kk kk E kkkkk�+EaET IE igkwx�lll1 2 0 N I N C R E Q U I R E M E N T S '�/'�f (�C ��,,J/�C S E T B A C K S pp EEQ oo ------------ MAIN BUILDING ----- -------------- ACCESSORY HU LISIN��n D--- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT:. FT IN RGHT: FT IN PARKING RE8: PROV: PARCEL: 14102111 ZNE: REF NO: PLANNING NTES> > kkkkkkkkitkkkkkkkkkkkkkkkkatkkk kkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkitk D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N'T.S ZONING APPROVED BY DATE: BUILDING APPROVED BY DATE: APPLICATION ISSUED BY: % DATE: kk kitkkkkkkkkkkkkkkkkkk kkkkkitk kitk kk kkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkilk kkkkkikkkkkkkkkkkkkkkkkkkkkkkkkkkkkk LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y BLDG PMT PLUMBING ELECTRIC' MECHANIC FIRE SMIP/RES GRADING PERMIT 81,00 60 SMIP/NON-RES PLAN ISSUE FEE BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK TOTAL PAID DUE TOTALS ---- > 81.60 0,00 0.00 81,60 81,60 .00 REVENUE DIVISION TOTALS--> COLLECTED:'i 81.60 OVER/SHORT:00 I BLDG PMT PLUMBING ELECTRIC MECHANC; FIRE SMIP/TOT GRADING PLAN -CHECK 81.00 ;..; .60 k kkkkkkkkkkitkkkkkkkkkkitkkkitkkkkkkikkkkkkit kaFk kkkkkkkitk kkkkkkitkkkitkkkkkkitkkkkkkkkk I N D I V I D U A -L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST SFR 6000 REROOF BY VALUE RESIDENTIAL NOZONE 1.00 6,000,00 END OF FEES 1 CONSTRUCTI0ii AND PLANNING POOL ?A APPROVALS Permit # Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Serviee'or Pole 52. Pool & Equipment Location - 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement �. ~• ,f tEtsctrical CondGit,l`{ii lity-Und _-rgrnd. '4. Forms Electrical Conduit•_U r„ 75.ndrgrnd. e5. Electrical Bonding Reinforcenenf - 6. Rough Plumbing & Pressure Test .ra5.`,$tRel .r �::&,-tlectrical UFEA Grnd. cr L.�57. APPROVAL TO COVER-GUNITE . 7 'Footings Electrical Conduit-Undrgrnd, n, ,= 8.1 Foundation r i .. K59. Gas Pipe, 0 Undrgrnd., Test , -,•�'� 9. Water Pipe-Undrgrnd. 0. Backwash Lines, P -Trap, ❑ Undrgrnd. '10:Structural Floor System I i -61. APPROVAL TO DECK 11. Property Sewer Line & HonBe Connection �•� - 62. Backwash &Receptor -Final x 12. Snwer Cap •� 1' 63. Heater & Vent -Final '! 13. Roof Drains o 64. Plumbing System - Final 14. Rough Plumbiffg % 65. Electrical -Final 15. Rough Electric'aI-Conduit 66, Solar System -Final 16. Rough Electric?Niring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electri(T-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT IN -PPRV�SPemitfIIO:# 'k IC- Z"--:- v T. 20;Rogh6ctcry YS' .f :4 -tr Y xO r 'T •r 21. u s, In,Stryctt�4e,. , r•c- ^`- T Hy{ro 1 i-$ F V ;ti:* .T .70. UnderSgw 7 22.rDucts,Uentuating' �1S_ •• t S `SC+.:, i71. ProduLTPiipingE:Gas aOil y 23 =GajTip6IRough &'test a Cr * _ "'" ' _72. Underg qq nh FIU.sCr. y !T' 24. Roo. Framing > :r •• ;> `.n -r73AUndergrru'-StoragerTan1< {] Gas O Oil 25. Roo; Sheathing.* �� ; "' �_° ,�lx ' 74�C}verhead'Hydro�_ c :r x Y11 26,& -Ear Ceiling (StCgstura0 8(:Mopocoat M W - n> , 75 -Dry Chemical - 27. rame and Flashing 76: -6'ry Stan��ie _: W'Z .. y. toy.,. -•v ;_, _ ;.,28.Latk)ingj& Si�ling.� t , _ `-;<Y i± 'x -r ;V 77- FIXED S-Y$TEIv1 f.INA Lx V tr r �. >29. Insulat'i �' 78=FIRE PREY. FI AL t �., v > Lz r 30. DrywalF'¢laifing 'i EALfH•DEPT;. REQUIREMENT r > ,ir .r ;H •.-31. Plaster 8r'ow4 CIiSt` '. ° s 79'.�FINAL I gECTI(�N G y ,r r tri -r I a r r v .� pa • ,.. 80, -;FOOD CER`f'IF(6PTE ISSdED- --32.-ElectricgPo4erVetT,-Final, ,334lr4l Eectr-:• " E b tar 7 ntl ;;34 Hoting & F 1, ConditidnSng + I * az ;FinJI y "s 71 _ •35:5inal Ga"5 PipB-Test.' ' - J 1'2 - 2- ,��• •t Z p367HoO or.CanoPYr...' 7d w �:' i(Jci✓f - ! C'r Hi 37.Final Factory Fir`eplac,, ' S -T' rn .W r ^� X38. Final Pl'u'mbing S , 39. Water SeLvice Fina6 t' L't' x :� or. r11 -nal '1 40Service v ..7 . Gas _ .. rn Qtr lr r. Y In �• •=a- l ->. n ,I s41. Solar Domestic-FinelS ••` - �, ; ¢� ` j m rr -� 42.`Backflow Preventef . of 43. Backflow Irrigatiorn•J ix If EtiFL: •r :; •- 1 Y '� 44. Landsc e kyi atigh.S ste rte{ tijP 9 Y r!j �r ;> -, 1:' � X45 =Sound Aiterluatiora 7 F 'r 4i " 7 [ 'n �- !- ry y {u ... nom' - 46: Handica7Re6"qulatidps `• I .. ...i •47..,FINAL STRJ�CTIIRFx eaU' DING • �- ��( W .. L • �•.J ♦ J :v v.4 't480aFIN-AL ,k. J PLANNING `," `• ,r ,a r .. ,.; V ,-;49 Electric Release to;Edisort '-'50 Gas Rel'e se io So ern California Gas Co ',51. CERTIFICATE0F,:000UPANC :rte r No. Date CGMPLXINT INVESTIGATI CJ Received by Sal '` o `, p Date / J� Made by: ' v-' 2-, ./ Address /9�� 2--44// -/G9�fi" Ph.No. Against: /-- '—�! Address 540 �� Yye- Directions: / il. Natut= .£Complaint: Ate(+1j � �/ /i / � ../. /� j / /� � � / // Li°116r4 , / / ' _ / r'/ �/ 46, t ' / L/ 7 I mer �� Lis_ arra /a� �.�_ tri .�� a— 4 < , / ....--<7- iuz.c_' I Ac r..n taken:. `///n 4 ,e ereta c j .a c tK yc .a. 1 w vice gz-Pteta , /�.//: .1 ' - , (4,4 ..d Luce ze —'�-a r/cc?aro , a..6ce ..moo, l,�jP�P._ ees. , 5-, . --,i .�,,t cs cM> Y,4-'v is VA'41 J • w, ,. . . a se 4 .� i --ea �Gr.. Lst — _ �J�t �,y-�,y ��i.(leu i4G ..� . _ :. �_. tie" 'L l e_• /2tt! .(/". A-- .4 6£) -X110-,'- A' t - �� , i. _ / - � 1 - ___... Gam' (a/ 1 4- CZ Complete: Yea , Complainant Yes • By: ' -dd 7 Interviewed: p ,.y--AV. No No Da A CCOMPiXINT INVESTIGATI Received by— Made by: /7jJ/, J �%/L�l�'��J��% Address Against:T/, VV' �l��T�"�� Address Directions: Nature of Action taken: Complete: Ye Complainant Yes By: No,�Interviewed: liy No Date: Date Ph. No..d__�lc�� 7r/ J TONY JOB ADDRESS 1361 Garlingford Street BUILDING PERMIT NO. 22357 GENERAL CONTRACTOR H & R Builders VALUE $ 1,,000.00 AP No. LOT 6 CT IF 55 FIRE ZONE DESCRIPTION OF WORKgtt, pat. Paver INSPECTIONS Signature DATE GROUP J TYPE V ZONE SUBCONTRACTOR PERMITS ISSUED V DATE NUMBER Water Rough Com. Refrig. p Air Cond. D Rough Heating Rough Plumbing Miscellaneous Prop. Swr. Line D House Con. D St. Swr. D Sprinkling System _ Construction Pole Underground D Power, Rough Wiring Trenches'D Forms D Steel Reinf. D slab 8 footing_existing — W i ai Z!t. 7 Floor System Bond Beam ❑ Steel Reinforce D Sheathing Frame and Flashing - Lathing — In ,D Onto Plaster brown coat Rig. 17 A r Con, ❑ Final Fi-_:-=rig, Final r=j P Final Gas Test Electric Fixtures, Final Building,Final _ —6 _ OCCUPANCY Form BU"M-3-63--S-B P 77ZS7 r� 23.57 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 926M For Applicant to Fill In Completely TYPE OR PRINT COSTA MESA, CALIFORNIA OETBACK {.INK PROM EFT I RIGHT DESCRIPTION OF WORK WALL 1 H[REBY ACKNOWL[DO[ TKATA AND BTAT[ THAT TK[ ABOV[.UP PLY WITH ALL gC�W1IRR �\OHDINANC[[ BUILDING CONOTRUC QH. A FEE RECEIVED MAY 91 1984 FINANCE DEPT. CITY OF COSTA MESA APPLICATION FOR PERMIT BUILDING For Office USE Only R[C[IPT NO. P[RNI=NO.- 1 3 7 R[C[I [Y Tl/R[C[IV[D GT[IO GOURD IMG ADDR ! C7 QL/ FIR[ ZONE TYPE GROUP APPROVE / BY' DATE b ZONING =ory, iuNi � BUILDINGS R%%o 61.er "GAL11rtION A. P. NO. NOTE: NO EAVE OVERHANG SHALL BE LESS THAN 90•TOSIDEQ REAR .L EAVES ALLOWED (U. B. C. REQUIREMENT) YARDS APPROVED YARDS APPROVED MAIN BUILDING ACCESSORY BUILDING (FROM C/ eTRER) FA NT R. ID �% Fr. t L. SID FT. Fr. ZS 3/ REAR FT. Fr. DISTANCE BET. BET. MAIN e MAIN BLOCS. ACCESS. SLOGS. VAR.* DATE C. V. P. APPROVED / APPROVgq_/ Illy K t DATE 80. PT. THE AMOUNT [MOWN UNDER VALUATION IB FOR TH[ PURPOB[ OF ■BTABUBNING A PERMIT P[[ ONLY. VALUATION PERMIT FEB 6 — PLAN CHECK STOTAL FEE CU OWNER ne un nttw' Ur rtuz normo, iau. DATE DEC 1 1 JOB ADDRESS 1361 Garlingford St. BUILDING PERMIT NO. GENERAL CONTRACTOR Lifetime Residential Bldg. Corp. VALUE 817,075.00 AP No. LOT 6 TRACT 355 FIRE ZONE DESCRIPTION OF WORKRE 'ECPIONS Signaturi DATE GROUPI & J TYPE V ZONE Ri Sml U/ - -C SUBCONTRACTOR PE MITS ISSUED Gas ;� DATE NUMBER Water Rough Com. Refrig. ❑ Air Cond. ❑ Rough Heating Rough Plumbing S Miscellaneous Prop. Swr. Line ❑ House Con. St. Swr. E N Sprinkling System Construction Pole Underground p Power Rough Wiring -G (i /- - 6 Trenches V k'orms eel em . L/• U— Floor System I -Yl - li3 Bond Beam ❑ Steel Reinforce p Sheathing Frame and Flashing Lathing — In E7d- Out P' T =r, brown coat i. ..g. ❑ Ir on . ❑ Final Heating, Final Plumbing Fixtures, Final -i7. •G 3 Final Gas Test 14-/7 I COSTA MESA BUILDING -SAFETY DEPARTMENT P. O. BOX 917 COSTA MESA. CALIFORNIA For Applicant to Fill In Completely TYPE/AOR PRINT BUILDING ADDRESS 1361 G'<Y%� ��YA fr• COSTA MESA. CALIFORNIA FEE RECEIVED Lot 6, Tract 4 5, P1Fr400-0 FINANCE`" ftW' APPLIC TI(00 (Qp CMTMESA BUILDING For Office Use Only MAIL //// RECEIVED BY DATE /p8CE1/@D DATE ISSUED ADDRESS. p_o_ Psny ;)0" - i)"^�A7 Z /ii //_ � _ DEC I 1 1962 N0. OF BLOBS. SETBACK LINE FROM LEFT 5' 1 RIGHT 51 DESCRIPTION OF WORK RE"..R I II MOVING 1 II DEMOLISH 9 ZE DING 16081 NO. OF ROOMS 9 STORIES 1 EXTERIOR WALLP1aSter I ROOF..., .St1aICB nnveR wr i HEREBY ACKNOWLEDGE T T 1 HAVE READ THIE APPLICATION AND STATE THAT THE B IS CORRECT AND AGREE TO COM- PLY WITH ALL CITY 1 BUILDING CONST 1. 10 CES AND TE LAWS REG TING SIGNATURE OF _ .i - AUTHORIZED AGENT COSTA MESA. CALIFORNIA TYPF IIS ARnup J'y APPROVED ZONING ZONA -1 NBE OF N8V/J•nf�/, PLANO.EOF I UBUILDING w//T7 .Y 'Y3ss- YARDS EVES APPROVED ALLOWED (CENTER LINE BT.) FRONT •S / FT. IN. sFT. R. SIDE IN. L. SIDE -<--FT. IN. ", REAR /moi `� FT. IN. APPROVED BY DATE 6-%0Z,o 4 i' o THE AMOU HOWN UNDER VALUATION IB FOR THE PURPOOK OF EBTABLISHING A PERMIT FEE ONLY. $ /', O .3 I PLAN CHECK