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HomeMy WebLinkAbout1372 GARLINGFORD ST - Building Permits �� CITY OF COSTA MESA @@ BUILDING DIVISION >:j • DEVELOPMENT SERVICES DEPARTMENT PE T NUMBER o. / . PERMIT -q� �+os#li B04-00969 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca,us - 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT • Job Address: 1372 GARLINGFORD ST Status: ISSUED Suite: Applied: 05/25/2004 Vicinity: 2ND FLOOR BEDROOM Issued: 05/26/2004 Parcel Number: 14102206 Zoning: R1 R1 Applicant: REMMEL, DONALD A ISSUED BY: y'//JJ ly(X'� Address: 1372 GARLINGFORD ST Phone: 714-668-2323 COSTA MESA,CA Zip: 92626 Owner: REMMEL, DONALD A Address 1372 GARLINGFORD ST Phone: , COSTA MESA,CA Zip: 92626 ' Contractor: Address: Phone: Zip: License: Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT ADD FIREPLACE TO 2ND STORY MASTER BEDROOM. REPORT NUMBER J9902-5863C SUPERIOR H-C36. . FEE SUMMARY Plan Check: $29.15 Calc Valuation: $1,200.00 Permit: $44.85 _ _ _ Claim Valuation: $1,200.00 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 . / Inspection: $0.00 Total: $74.50 . • PLANNING &ZONING SETBACKS ' MAIN STRUCTURE-Front 0-0 , Rear 0-0 Left 0-0 Right -0-0 ACCESSORY s Front 0--0 Rear 0-0 - Left 0-0 Right 0-0 , PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: • i 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 it work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) • DECLARATIONS 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 i ura ce,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'corycpens-0.n n-I r/n e carrier .., cy number are: Carrier: ` / Policy Number: (This se tion need not be completed if the permit s valued a ne hundred dollars($100)or less.) . 1 certify that in the pe or soca of the work or whit is permit Is issued,I shall not employ any person in any manner so to become subject to the workers' compensation laws of C (torula,and a that If hould become subject to the workers'compensation provisions f ion 3700fof a Labor Code,I shall forthwith comply with these provi ns. //- Z i 6 Applicant Signature: � ��u! Date: t WARNING:FAILURE TO SECURE WORKERS'COMPENS ION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINA PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),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 I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit - subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-bu'.er 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 EXCLUSIVE CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The con ctors License Law does%/apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursua 1 o the Contractors Licem= Laws.). ❑ 1 am exempt u r sec. .s Business and Professions Code for this reason: - /OLI Signature: C - ///al Date: (J Owner ID verifie by drivers (cense. 1 .s ❑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? 0 Yes ❑No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be tiled with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes 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? 0 Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE COMPLIANCE AND AUTHOR N 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 sta: .ws an Ity ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described opertyqfor insp�y0�'purpos .I agree not to occupy or allow occupancy of any building authori;etliy/this permit til final inspection. w// Signature egal Owner(s) 4.�//( p to And/Or Authorized Applicant Date COOS t INSPECTION TYPE QdIE INTRIALE CODE I INSPECTIONTYPE PAIS EMU 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 in en- Fireplace HC-36 tested and ...,II " approved CONC. PAD II iI N _ Warrock Hersey 2' SQ x 20" THK - Ili ill —si ! I ; .. Report IF J9902-5865C I I ++IIIII ' ,.. $1,000.00 purchase STEEL PLATE 1 I ' . .i 8" -/ _ j 1 $200.00 install 12" SQ x 1/4" THICK � � ""-'' � I i $1 ,200.00 total a ❑ lir : 09/16 THRU (4) -III o 0 II 2' 5Q NI/ ' Don Remmel RE"'ROM BOI" `4) • —_I 1 1. - ; ' • 1372 Carlingford St. 1/2-13 x 6" LG --IT TO CONC. PAD Costa Mesa, CA 92626 " II I -,:'llI . REBAR AS SHOWN • BOTH \ 20'-7" / 4 a / _ VEWJ 1 -7 . . ST6224 • viii e eLeriiiiiiiiiie.:iiioiiiArec ,Alf.se /Ye: ..fr e/Ae70':Ve li/ED SCALE .1"=1 0 av SO Y SVB�ECT R�1E CITY OF CO''egMESA . tt p S.01 OR ON S f PLANNING 1 VISION �DS PwwRO N SUBJECT TO BI 3. DEPT. REG. PO)"— la Wilk - NOTE:ADDITION DELETIONS, © -1F. • OR CORRECTION. L BE APPROVED BY TH '' ING DIV. / N \ i FAN 052" f �\ / 1 9P6/0 I- S . Ni' �, r. iI ��\� BY' Brit: 6 J . • / Y NEW BORM 4 \`. -(: • /.- S / / w NIi . T ,` K.Zi ala' f. 11' ''\` N. \ N db / < 7' --�' j • ti ? r 2 -9 ' 41-2 — 7 4 i m O 0 ` SI A O 7 •-OP I3I . .- 3.--- 1` l'''' N En In X16" ;16" JACUZZI ' w s 60"x6 O =rl- n LAV 18" .- . ,._. - . 1 •P 0 eat MI < AI \•\ ao ST6224 �QD ST6224 ST6224 A ST:224 - �. / G FC I S 1 riiiiiio nii/rur//ii 6'-7 4'-6' O I 0 4' / 10,-7., • 6' 21-9" _ 4._2., a C O o0 j 13'-4" 0 2ND FLOOR PLAN _ ii_ 0 a (3SCALE 1/4" = 1' F6 a 0_ oA 0 PT 4x4 o PT 4x4 E r . • '.1:141.;:k-1 1i Is t a}'' X6/42 '& .I D 36 42/ • y T ,t, Ind: tq. . , .r.'.. r. ,; -1 ' 11ARADIANT (RD) fireplaces have a "clean-face" design with no .-r—T\- louvers. This allows non-combustible surround materials to J �'k —-------- come right up to the edge of the front opening of the firebox, cre- ' ? '""-- I' " \ • ating the appearance of a conventional masonry-built fireplace. ±', ------ This custom look is further enhanced by the realistic, rounded ` � 1 1 edge brick liner. 0 U- CIRCULATING (HC) fireplaces offer energy efficiency and are 7 a ' _�� specifically designed to boost warm air output. They are attrac- ��/� tive and feature appliance-like louvers.The louvers come in black j from the factory with optional brass or brushed stainless finish- . es in sh- es available. Another option is the blower kit for increased warm HC-42 SHOWN RD-36 SHOWN air circulation. �� �� - '° A p A' =toil Complete,one-piece I— chimney top AllMiaiiiIMMIa, 44.40,/ _Jae" 7 ��la Storm collar. Ai CmAoen hrestop spacer- rie v. I • �pI 1111 / secures chimney in ceil- ingbetween floors. ` P,00f fleshing for 1111111 ? n 111 . innle. • I All-metal 8'double wall _____A NN G chimney system.Easy to Smooth exterior Hinstall,no tools required. front lace.IRDI �—• snaps together �I a I —1--t- k—P I DurcFslc powder FRONT VIEW RIGHT SIDE VIEW Minimum clearance to %/I coot finish. combustible materials. Frame with wood. I x • l I Standard°Aside MOI i t t i i I Easy gas line access 1� air mechanism. -JJJ\ with convenient knock- I� F outs on both sides. '� '� t ‘Ig APPLIANCE DIMENSIONS Nk. RD/HC-36 RD/HC-42 I, (III Standard fuel _t_ A 44-1/4- 46-5/16' Realistic brick lines IIS - (�i V 'O grate. l� I I B 36-5/16 38-7/16- �II�R �e�©��� C 20-3/16" 22-5/16" TOP VIEW Standard metal D 36- 41- safety strip. J _r E 9' 8-318' 1 , y a FRAMING DIMENSIONS F 21-5/16 23-VT Hearth extension- MODEL WIDTH HEIGHT DEPTH G 17-7/16 17-5/16 Optional blower kit.IHC) kr secure to platform or HC-36 43- 44-I/7 21-3/4' H 10-1/8 10' floor No special �•'"+ foundation required. H C-42 48' 46-1/T 23-718- I 41-314' 46-314' C,,,. Ru-36 43' 44-1/2" 21-3/4- J 13-1/4' 15- \r . Optional gloss doors Rb-42 48' 46-1/2- 23-71T K 28.1/8- 31-9/16' available.your choice of finishes and styles INSIDE HEARTH Distributed by: i '%;± '/ of/ � , r r• G 12', .I t,/��i l 21-I/2, / i --f 24-3/4"—.1 I O. in P",:t. r.r^c1 /ft 1.e e 1 �. 16-314" I 2g�i o-ti' T'r'ip _.c 7//.'57: ..: allk . 'fr.:, 4 ; L 34" I 39' 9 .v '\ i • HC/RD-36 HC/RD-42 NOTE:Diagrams and rlpoesrocs ore not is scion and should net Warnock rHersey �1 SUPERIOR cat be used icr framing purposes-consult mvcNetron instructions �r Product designs.materials.dimensions.specifications colors end C Iry U$ 1own EN . prices sub;ect ro change or discontxunnce without nonce. v✓WW.LennoXHearthPraducts.com Printed in U.S.A.©2002 Lennox Hearth Products • 1110 West Taft Ave., Orange, CA 92865-4150 P/N 785082M Rev.A 03/02 All Superior wood-burning fireplaces include a 20-year limited warranty end are listed by notionally recognized listing agencies. CITY OF COSTA MESA 4 BUILDING DIVISION y'n�..� DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER � : PERMIT M04-00276 (714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 1372 GARLINGFORD ST Status: ISSUED Suite No Applied: 05/25/2004 Issued: 05/26/2004 Vicinity: 2ND FLOOR MASTER BEDROOM Parcel Number: 14102206 ISSUED BY: Applicant: REMMEL, DONALD A Address: 1372 GARLINGFORD ST Phone: 714-668-2323 COSTA MESA.CA Zip: 92626 Owner: REMMEL, DONALD A Address: 1372 GARLINGFORD ST Phone: COSTA MESA,CA Zip: 92626 Contractor: OWNER BUILDER Address: Phone: Zip: License:000000 SCOPE OF PERMIT ADD FIREPLACE TO 2ND STORY MASTER BEDROOM.REF:B04-00969 • 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 $0.00 0 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/100 k BTU $0.00 0 Factory Fireplace $10.65 1 . 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust 50.00 0 15 To 30 hp/1,000 k BTU 50.00 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 50.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl 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 Over50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $34.15 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 244649(6/00( 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 sell-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'comps ion insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'comp ensetian Insurance l policy number are: Carrier: (` „ 0� Policy Number: (Thissectionneed nl- completed if the&rmi is valued et one hundred dollars($100)or less.) 7-�Ly- I certify that In the rmance of the work f r which Is permit is issued,I shall not employ any person in any manner so as to become subject to the workers' lll..J�w compensation laws f alllomla,and agr at If I ould become subject to the workers'compensation provisions of Sectio 700 of the bor Code.I shall forthwith comply with these pr ons. �(p^ Applicant Signature: Try( fill Date: W WARNING:FAILURE TO SECURE WORKE S'COMPEN ON COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL P TIES AND CIVIL OFINES UP TOONE HUNDRED THOUSAND DOLLARE(5100,000),IN ADDITION TO THE OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3700 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,end my license is in full force and effect.Lt.a Class II Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: El I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of DMsion 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 ontractors License Law does t apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license .Contur ant to the tors Lic se Laws.). ) ❑ I am exemp der sec / Business and Professions Code for this reason: _ �/a,, r1 Signature: SJ * Date: L °/V\Lf/ Owner ID vers led by tlri Br's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet In depth Into which a person is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(38)feel high.(Chap.3.2,Grp 2.Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number. HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). _ 2 Does or will the applicant or present or future building occupant need to filo a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which et 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 a plicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes 0N (Section 25534 of the Celifomia 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 0 No ......._... _f ___......_.._ _._....._.___.r .._ .__ 5 Does or will the tcAir or Duality a ar emen building ictrfrm occupant Other for the work ontch isi the subject of this application epermit for such construction or modification from the South Coast Air Ouallry Management District or from any other air pollution control district or agency? �Yes LJ No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). .... _.....__.i-geme— _ _.._ _.._.i.._ 7 If a permit the South Coast s prescri ed ba Califo a eal or other airCd pollution ooncontrol district03 or agency? is required for the work which is the subject of Ihis application,have all of the disclosures prescribed by Celifomia Health and Safety Code Section 42303 been made? ❑Ves 0 No 8 (If yes-,attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATECOMPLIANCE AND AUTHOR ON OF ENTRY: I certify under penalty of perjury that I have read this application and slate that the information given is correct. I agree comply with all laws an Try ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described roperly for idiem�oon pu s.I agree not to occupy or allow occupancy of any building authorized by this permit unfit final inspection. Signature Legal Owner(s) L X /(I/loeJat And/Or Authorized Applicant ate ;ODE I INSPECTIONTYPE PAU II{MO CODE! INSPECTION TYPE c PATE ItII�ISL$ 1618 Fixed System Final Fire Prevention 206 Final Mechanical 5/22i67- �•Vt/� 1268 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 • ' CITY OF COSTA MESA • •i ►q BUILDING DIVISION ` ). , i .iir ..� DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER F 0004111 0i,� i PERMIT ♦ ft B04-00444 frowns,(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 1372 GARLINGFORD ST Status: ISSUED Suite: Applied: 02/27/2004 Vicinity: Issued: 02/27/2004 Parcel Number: 14102206 Zoning: R1 R1 Applicant REMMEL, DONALD A ISSUED BY: / Address: 1372 GARLINGFORD ST Phone: 714 668-2323ill COSTA MESA,CA Zip: 92626 Owner: REMMEL, DONALD A Address 1372 GARLINGFORD ST Phone: COSTA MESA,CA Zip: 92626 Contractor: Address: Phone: Zip: • License: Arch : Eng: Address: Address: Phone: Phone: Zip: License: • License: , SCOPEOF PERMIT REROOF;TEAR OFF WOOD SHAKE,INSTALLL NEW SHTG,&50YR.COMP.SHINGLES, INSTALL(1)NEW SKYLIGHT ICBG#ER-6075. FEE SUMMARY - Plan Check: $0.00 Calc Valuation: $3,300.00 Permit: $97.25 - - - Claim Valuation: $3,300.00 SMIP Res: $0.50 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $97.75 • PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result In the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ' ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit Is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Leber 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 AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(S1 W,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 affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class# Contractor's Signature: Date: • CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: • OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit ybj cts 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 ursuant to the Contractors License Laws.). ❑ 4 am ex pt under c. —./2 Business and Professions Code for this reason: rSignature: €.iiLu[/ Date: S%7/fes / Owner ID verified by driver's license. Yes 0 No Driver's License No. / Expires: F'c/Ifr 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,Gm 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: • Division of Industrial Safety Permit Number: - HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No - (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Li 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? 0 Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHOR' TION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. Ia e to comply with all state laws city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-describ d property forction pu es.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. b771 a—2 7-0fre Signature Of Legal Owner(s) Date And/Or Authorized Applicant Date COO I INSPECTION TYPE OIL jbTITIALS CODE I INSPECTION TYPE PATE 11a 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Finales_ 208 Final Plumbing - 200 Final Re-Roof ZZ e 7 c'.4'�"1 210 Final Electrical 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 a '^ CMTY,OF.COSTA MESA ,r 4 BUILDING DIVISION F ,.,,, ,I DEVELOPMENT SERVICES DEPARTMENT PER NUMBER 7 � PERMIT 05-00304 4• (714)754-5273 • Fax(714)7544856 • www.ci.costa-mesa.rg1LDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 1372 GARLINGFORD ST Status: ISSUED Suite: Applied: 02/18/2005 Vicinity: NEW 1ST&2ND STORY ADDITION Issued: 05/26/2005 Primary Occ: R-3 Dwellings/Cong Res<10 Type of Construction: V-N Parcel Number: 14102206 Zoning: R1 � (/J� Applicant: REMMEL, DONALD A • ISSUED BY: `,.—YD Address: 1372 GARLINGFORD ST • Phone: 714-362-5246 COSTA MESA,CA" Zip: 92626 Owner REMMEL, DONALD A -_ - Address 1372 GARLINGFORD ST Phone: 714-362-5246 " . COSTA MESA,CA, - - Zip: 92626 Contractor: Address: • Phone: Zip: • License: - Arch : . Eng: Address: - Address: ' Phone: Phone: . Zip: " License: License: - SCOPE OF PERMIT 443 SF ADDITION TO EXISTING S.F.D:AND 29 S.F.PORCH.WORK TO INCLUDE:ADD 220 SF TO THE 1ST FOOR AND 223 S.F.TO THE 2ND FLOOR. PLANNING: . LOT SIZE=6,900 SQ.FT. RESIDENCE FOOTPRINT= 1,620 SQ.FT. •GARAGE=451 SQ.FT. , DRIVEWAY=550 SQ.FT. LOT COVERAGE=2,621 SQ.FT.(38%) OPEN SPACE=4,279 SQ.FT.(62%) , , 2ND TO 1ST FLOOR RATIO=31%(579 SQ.FT./1,851 SOFT.) FEE SUMMARY ' ' Plan Check: $366.24 . Calc.Valuation: $41,400.68 Permit $563.45 -"Claim-Valuation: $0.00 SMIP Res: $4.14 .- • SMIP Com: - $0.00 " - Other: $0.00. ` ' Inspection: $0.00 Total: $933.83 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 a Boned 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 appll a codes, and all required Inspectionsend,final-approval must be obtained:Failure to obtain Inspections and final.approval.will'resutt in the expi on of this permit. FOR INSPECTIONS'CALL:1714)7545626 2446-46(WO) DECLARATIONS • ( � WORKERS'COMPENSATION DECLARATION: ' • x, I hereby affirm under penalty of perjury one of the following dedaratiorisi - • - ❑ 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 feared. My workers'compensation Insurance carder and policy number are: _ Carrier: Policy Number: • (This need not be completed If the permit is valued at one hundred dollars(S 100)or less.) (17 certify that in the perfo ante of the work for which this rmit Is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Ca omia,and agree t t if I she become subject to the workers'compensation provisions of S ction 3700 of the Labor Code,I shall forthwith empty with ifr Prow ns. r� App>;ican Signature: I.6f dal c j d3� « a WARNING;FAILURE TO SECURE WORKERS' ENSAT1ON COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,000),IN ADOMON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full force and effect.Lic.N Class a Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued.(Sec.3097,Civil Cale). 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,altar,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 al/gold 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.). 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) licens ursuant to the Contractors License s.). ❑ I am e pt undeJ s c. Business and Professions Code for this reason: SIg7liiture-, -- CDeia:+S-7dGjGS Own-ai'1Dve he"rlfy drivers license. Yes 0 Nor"D"river's License`IP . .-expyas•.eC���O� Verification of Ownership by(type of document,I.e.-property tax bill or de� DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding.falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,Califomla Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Wit the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). _._ . l _......_0-71-0 ..._.. 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). _.._ _ _.. r__..._...fr__... _ 3 Does or will the applicant or present or future building occupant need ticprepare an RMPP(Risk Management and Prevention Program for acutely hazartlous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safely Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 if an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes 0 No (Section 65850.2 of the Califomla Govemment 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? 0 Yes ❑No (if"yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 Ii 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 Califomia 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 CO ANCE 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 co ply ith all state law nd ci ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property I r inspection es. gree not to occupy or allow occupancy of any building authorized by this wrnit uptil final inspection. j241Of ySi natir`e-i4averiO11L"epe�;Owner(s� f'YDattie And/Or Authorized Applicant Date CODE I INSPECTION TYPE '• )t{IIDEL@ "CODE4 INSPECTION TYPE' - ' PAIL ' UAL$ 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 I�� 204 Final Demolition 250 Final Building/Occupencj ' • 'LLI • • .4, '4,, CITY OF COSTA MESA 4 ► BUILDING'DIVISION F is ,i DEVELOPMENT SERVICES DEPARTMENT PE -I-NUMBER Te 1j(10 • PERMIT • _Pomarstog E05-00508 (714)754-5273 • Fax.(714)754-4856.• www.ci.costa-mesa.ca.us 77 FAIRDRIVE;COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 1372 GARLINGFORD ST Status: ISSUED Suite No Applied: 05/26/2005 Vicinity: Issued: 05/26/2005 Parcel Nunmber: 14102206 �,�\ Applicant: REMMEL, DONALD A ISSUED'BY: TAD Address: 1372 GARLINGFORD ST - Phone: , COSTA MESA,CA',• Zip 92626 .. Owner: REMMEL, DONALD A-: Address. 1372 GARLINGFORO ST--' 'r: Phone: • ' COSTA MESA,CA Zip: 92626 -- . Contractor: OWNER-BUILDER Address: - • �. - Phone:_ _ ._ Zip: , License:000000 SCOPE OF`PERMIT ELECTRICAL PERMIT FOR 443 SF ADDITION TO EXISTING S.F.D.AND 29 S.F.'PORCH.WORK TO INCLUDE:ADD 220 SF TO THE 1ST FOOR AND 223 S.F.TO THE 2ND FLOOR. . REF#B05-00304 • WORK TO INCLUDE: 10 LIGHTING FIXTS,6 RECEPT OUTLETS AND 5 SWITCHES. FEE SUMMARY - Quantity Quantity • ISSUE FEE $23.50 '.Temp Dist System/Lighting $0.00 0 Temp service test $0.00 - - Busway/100 ft $0.00 . 0 Res.a/c package . $0.00 Standing Section $0.00 0 New Res(1-2 units) _ $0.00 0 Misc Electrical Equipment. _$0.00=' - 0 New Res(3+unitss) . $0.00 - '- :-.-0'' Transformers up to 1-kva/kw.'"1 $0.00" 0 Pool/Spa • $0.00 -0 • - ' up to 10 kva/kw $0.00 -' \0 Lighting Fixts •111.00 '10 up'to 50 kva/kw a - $0.00ti "1 0 - Recept Outlets - • $6.60 6 - up to 100 kva%kw'-'' $0.00. ' '0 ,- Switches $5.50 5over 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 lhp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 . Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand - $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 NOTICE: The.-work-authorized.by this.permit shall comply with all.applicabletandicap^access-.requirementsEunderCalifornia'statutes and related regulations.(Ord.No.92:28;.§:1;.12721:92) :EXPIRATION:.This.permit shall-automatically expire-and.become void if work-isnot commenced.withim180:days;or if work is•suspended or abandoned fora.period of 180 days:. INSPECTIONS:• In orderffor the_work•authorized:under.this:permit-to:be,considered legal;.such work-must:comply.with-all applicab codes, and all f required.lnspectIonsand:flnal approval must be:obtained.,Failure to-obtain inspectionsandfinal.approval-will result in the expirati of this-permit. .(FOR INSPECTIONS:CALL:.(714)754=5626] 2446.4e(6/00) DECLARATIONS ("`1 ( ; WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: - , ' ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: . Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) artify that in the pormance of the work for w ch this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' ' ee th if I should become subject to the workers'compensation provisions of compensation laws f alifomia,and Section 3700 of the Labor Code,I shall forthwith complywith these _oo/�sions. fir Applicant Signature: 074. Liktias WARNING:FAILURE TO SECURE WORKKEERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE MKT OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under 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.# Class# Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business andProfessions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant fore permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ 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 properly 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.). • VI,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 a ly 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 L s.). ❑ I am a pt under se Business and Professions Code for this reason: Signature:, .,Date:,r-Y`!-/r r-. Owner' verified by driver's license. es ❑No Driver s License.No.. �"'"""'Expir��0es��— T D 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,Gm 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: • 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑No (Section 25533 of the Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes DI No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑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 AUTHORIZA N 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 co ly with all state laws and ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the • above-described props for inspecti rpos .I agree not to occupy or allow occupancy of any building authorized by this permit u finalirapection. eZerf j4Sgnature 2 ego)pwner(a)J lD'atel"w:=--�-•' And/Or Authorized Applicant Date CODE* INSPE2DOLTPF DATE" INTRIALS - •- ' ' CODED INSPECTION TYPE • - •PATE INTITIALS 1616 Fixed System Final Fire Prevention - • • . , ' . . . . 206 . Final Mechanical 1266 Pool Spa Final 208 Final Plumbing • 200 Final Re-Roof 210 Final Electrical I - t 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 , a, 1 CITY OF COSTA MESA 4 BUILDING DIVISION � F PE IT NUMBER • „„, I 'DEVELOPMENT SERVICES DEPARTMENT • PERMIT 05-00295 4c4tAaRaTro.4. (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 1372 GARLINGFORD ST Status: ISSUED Suite No Applied: 05/26/2005 Issued: 05/26/2005 Vicinity: Parcel Number: 14102206 _ ISSUED BY: Applicant: REMMEL, DONALD A.` Address: 1372 GARLINGFORO ST- "N • , , • - t , Phone: COSTA MESA,CA ;i Zip: 92626 '••• . Owner REMMEL,'DONALD'A - Address: 1372 GARLINGFORD ST " Phone: COSTA MESA,CA Zip: 92626 ' Contractor: OWNER-BUILDER Address: • • "" Phone:- - .. - • _ - Zip: .. , License:000000 - -. - SCOPE OF PERMIT " MECHANICAL PERMIT FOR 443 SF ADDITION TO EXISTING S.F.D.AND 29 S.F. PORCH. WORK TO INCLUDE:"ADD 220 SF TO THE 1ST FOUR AND 223 S.F.TO THE 2ND FLOOR. REF#805-00304 ' WORK TO INCLUDE: 1 INST OR RELOCATE APPL VENT. - _ - . FEE SUMMARY Quantity . . Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $0.00 0 - l'';'; Repair/Alt Refrigeration Unit $0.00 0 ' Inst FAU>100 k BTU $0.00 0 - Ventillation System $0.00 0 Repair/Alt Cooling/Heat , $0.00 0 Evaporative Cooler $0.00 . 0 Inst/Rep. Recess Wall.Htr $0.00 0 Commercial.lncinerator, - - $0.00. 0 Refrig Sys<100'k BTU , $0.00'" 0.4"" - Domestic"Incinerator"-'. $0.00 , 0 Refrig Sys>100 k BTU $0.00:N `0' ' ' -',Comp?essors/Absorption-Systems'�,`, Gas Piping , $0.00 -.0 - - k Up to 3'hp/100 BTU, • i-. ' $0.00 0 Factory Fireplace - ;r $0.00 0 - , . 3 To 15hp/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 15hp, ' . , , • $0.00 0 Inst or Relocate Appl Vent $10.65., 1 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 Floor Furnace $0.00 0 Other Mechanical Fee TICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and2rela NOelated regulations. (Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void it work is not commenced within 180 days,or if work is susp ed or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 • 2446-46(6/00) DECLARATIONS r) �1 WORKERS'COMPENSATION DECLARATION: - - . I hereby affirm under penalty of perjury one of the following declarations:, 0 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. a 0 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'pemtit is issued. My workers'compensation Insurance carrier and policy number are: , Carrier: Policy Number: (Taection. d not be completed if the permit is valued et one hundred dollars($100)or less.) 16`- I certify that in the performance of the work for wh' this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' • compensation laws 1 alifomia,and a tha ' should become subject to the workers'compensation provisions of Secti n 3700 of the Labor Code,I shall forthwith comply with these p stuns. aDliSigrieture /3 /}y Osler,: '2 O WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EM 0 CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.it Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): O I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is /sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). Pr 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 La O. ❑l„IIaam exam under sec. Business and Professions Code for this reason: , Signa f Date:.._ i 64' — Owner ID verified by driver's license. Yes 0 No Driv, sLisisksidei rise Expire's;', .0 O Verification of Ownership by(type of document,I.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safely Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes 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? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION • ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to co ly with all state laws and city :,41nances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described props for inspectio ses�ee not to occupy or allow occupancy of any building authorized by this per until nal inspection. 7 - �s Sgnnatre':OI'Legal Owner(s) ;Dte.`-- ° r " And/Or Authorized Applicant Date CODE r )NSPECT1ONTYPE ' JNTMALS t CODES INSPECTION TYPE' WTITL5 1616 Fixed System Final Fire Prevention - . 206 Final Mechanical r�I,(1 /\ 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 FactoryFire Place ' - 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy ' 0,16.1.0 15,,, CITY OF COSTA MESA BUILDING DIVISION F�� ____ ( DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER is PERMIT B03-01713 .a,� c . > (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.B{fLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 1372 GARLINGFORD ST Status: ISSUED Suite: Applied: 10/03/2003 Vicinity: MASTER BEDROOM/BATH ABOVE GARAGE . Issued: 12/08/2003 • Parcel Number: 14102206 Zoning: R1 R1 Applicant: REMMEL, DONALD Address: ISSUED BY: I Phone: 714-549-2357 Zip: Owner: REMMEL, DONALD A Address 1372 GARLINGFORD ST Phone: COSTA MESA,CA Zip: 92626 Contractor: Address: Phone: Zip: License: Arch : Eng: JOHN DINH TRAN Address: Address: Phone: Phone: Zip: License: License: C62653 SCOPE OF PERMIT CONSTRUCT 401 SF MASTER BEDROOM AND BATHROOM ABOVE THE EXISTING GARAGE AT THE FRONT OF A SFD.A 159 SF DECK AND 74 SF A-FRAMED PATIO COVER WILL BE CONSTRUCTED ON THE WEST SIDE OF THE ROOM ADDITION. SEE ZA-03-57 FEE SUMMARY Plan Check: $450.29 Calc Valuation: $57,000.00 Permit: $692.75 Claim Valuation: $57,000.00 SMIP Res: $5.70 - SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $1,148.74 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 25-0 Rear 62-0 Left 5-0 Right 23-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 • PARKING Existing: 4 Required: 4 Proposed: 4 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 clays. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS 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'compensatiQi IInnguranee carrier policy number are: Carrier: \ j( h Policy Number: (This section need not be completed if the perm Is valued at one hundred dollars($100)or less.) ' I certify that in the ped mance of the work for which is permit is Issued,I shall not employ any person in any manner so as to b ome subject to the workers' compensation laws of lifornia, agre that if I ould become subject to the workers'compensation provisions of Section 37 0 of a Labor Code,I shall forthwith comply with these provisi ns. i Applicant Signatures' 1 Date: G(/t/� WARNING:FAILURE TO SEC RE WORK andATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENAL ES AND CML UP TO ONE HUNDRED THOUSAND Des I ARE($100,0001,IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under 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.# Class# Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit sub. s 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 co' actors License Law doe not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursua to the Contrast.'- Lic-, se Laws.). ❑ I am exempt ur+er sec. / / Business and Professions Code for this reason: / _ Signature: ./iii ,� r - /, Expi - . Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: O 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). O As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to tile a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a0ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes 0 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia 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 Califomla Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTH TION OF ENTRY:I certify under penalty of perjury that I have read this applicationand state that the information given Is correct. I agredvo comply with all e law d city ordinances relating to building construction,and authorize representatives of the�pity of Costa Mesa to enter upon the above-describes property for i ion p set I agree not to occupy or allow occupancy of any building authorized by this pe I Il 'final i2spection. ignatu Of Legal Owner(s) Da (8 And/Or Authorized Applicant Date CODE 1 INSPECTION TYPE PATE INTRIAL$' CODE r INSPECTION TYPE MI MEELS 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 0 CITY OF COSTA MESA 01 BUILDING DIVISION F • ,, , DEVELOPMENT SERVICES DEPARTMENT P MIT NUMBER .; PERMIT E04-00043 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 1372 GARLINGFORD ST Status: ISSUED Suite No Applied: 01/16/2004 Vicinity: Issued: 01/16/2004 Parcel Nunmber: 14102206 Applicant: REMMEL, DONALD A ISSUED BY: Address: 1372 GARLINGFORD ST Phone: 714-549-2357 COSTA MESA,CA Zip: 92626 Owner: REMMEL, DONALD A Address 1372 GARLINGFORD ST Phone: 714-549-2357 COSTA MESA,CA Zip: 92626 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 000000 SCOPE OF PERMIT CONSTRUCT 401 SF MASTER BEDROOM AND BATHROOM ABOVE THE EXISTING GARAGE AT THE FRONT OF A SFD.A 159 SF DECK AND 74 SF A-FRAMED PATIO COVER WILL BE CONSTRUCTED ON THE WEST SIDE OF THE ROOM ADDITION. B03-01713. 8 LIGHTS,7 SWITCHES,16 OUTLETS, 1 SERVICE UPGRADE TO 200 AMP, 1 MOTOR UP TO 10 HP, 1 RES.APPL.<1 HP FOR THE BATHROOM. FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 ` Busway/100 ft $0.00 0 Res.a/c package $0.00 Standing Section $0.00 0 New Res(1-2 units) $0.00 0 - Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 Transformers up to 1 kva/kw - $0.00 0 Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0 Lighting Fixts $8.80 8 up to 50 kva/kw $0.00 0 Recept Outlets $17.60 16 up to 100 kva/kw $0.00 0 Switches $7.70 7 over 100 kva/kw $0.00 0 Non Res Appl $4.75 1 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 1hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $12.30 1 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 4 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446.46(6/00) DECLARAYONS 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 Lebar Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed it 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 AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000).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 I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.N Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ' ,..,/ ICd 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 mpt under Business and Professions Code for this reason: Signature::, ff51SW*Y Date: /—/6- 04/ Owner ID verified by driver's license. arYiliS\ ❑No Driver's License No. , '& / Expires: L—ZL-02/ 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? El Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to tile 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 Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which ere 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 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes 0 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑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 ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agreec ply with all state I s and city o, nances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described prop rty for inspect rposes.I a ea not to occupy or allow occupancy of any building authorized by this permit until final inspection. gna ure Of Legal wner(s) Date I. And/Or Authorized Applicant Date CODE 0 INSPECTION TYPE ME INTIIIALS CODE INSPECTION TYPE ME INTITIALE 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing �t{ �. 200 Final Re-Roof 210 Final Electrical -1 '-'0C—.o \MT 't 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 _ 44.4 r CITY OF COSTA MESA ) oBUILDING DIVISION F i r,,,,. : �. DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER • /� 4PERMIT %sift:wry>se M04-00025 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 1372 GARLINGFORD ST Status: ISSUED Suite No Applied: 01/16/2004 Issued: 01/16/2004 Vicinity: Parcel Number: 14102206 ISSUED BY: Applicant: REMMEL, DONALD A Address: 1372 GARLINGFORD ST Phone: 714-549-2357 COSTA MESA,CA Zip: 92626 Owner: REMMEL, DONALD A Address: 1372 GARLINGFORD ST Phone: 714-549-2357 COSTA MESA,CA Zip: 92626 Contractor: OWNER-BUILDER Address: Phone: Zip: License:000000 SCOPE OF PERMIT CONSTRUCT 401 SF MASTER BEDROOM AND BATHROOM ABOVE THE EXISTING GARAGE AT THE FRONT OF A SFD.A 159 SF DECK AND 74 SF A-FRAMED PATIO COVER WILL BE CONSTRUCTED ON THE WEST SIDE OF THE ROOM ADDITION.803-01713. 8 LIGHTS,7 SWITCHES,16 OUTLETS, 1 SERVICE UPGRADE TO 200 AMP, 1 MOTOR UP TO 10 HP, 1 RES.APPL.<1 HP FOR THE BATHROOM. REF 803-01713. 1 WALL HTR, 1 GAS PIPING, 1 VENT FAN TO A SINGLE DUCT, 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 KAU>100 k BTU $0.00 0 - Ventillation System $0.00 0 Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0 Inst/Rep.Recess Wall HV $14.80 1 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/100 k BTU $0.00 0 Factory Fireplace $0.00 0 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 $7.25 1 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 Appl 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 Floor Furnace $0.00 0 Other Mechanical Fee NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§1,12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-4f3(6/e0) DECLARATIONS WORKEfhS'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. ❑ 1 have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($700)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 AND CML FINES UP TO ONE HUNDRED THOUSAND DOLIARE(5100,000),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 affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.N Class It Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors Ucense 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.). ' Ly 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 t apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) licenseursuant to the Contractors Lice a .Laws. P ) ❑ I am efispt under sect. Business and Professions Code for this reason: Signature: ./2",27 _ Date: 7/(--0" Owner ID verified by driver's license. ,Yes ❑No Drivers License No, Expires: 6 'Z(-49 5" Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes ❑No (Section 25505 of the California Health and Safety Code requires,with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health end Safety Code been fully complied with? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 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 Alr 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 6 (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 AUTH RIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correree to comply with all state la and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-des nbed property f spection rposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. an �-2may /-/C-40 `/ Signature Of Legal Owner(s) Date And/Or Authorized Applicant Date CODE II )NSPECTION TYPE PETE ItTIE9L$ CODE! INSPECRONTYPE PATE INRRAJ 1616 Fixed System Final Fire Prevention 206 Final Mechanical '7 iS " 44-410 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 :1ii CITY OF COSTA MESA 4� BUILDING DIVISION -4r DEVELOPMENT SERVICES DEPARTMENT PERM UMBER t jib . PERMIT d,: PO4-00037 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: '1372 GARLINGFORD ST Status: ISSUED Suite No Applied: 01/16/2004 Issued: 01/1612004 Vicinity: Parcel Nunmber: 14102206 ISSUED BY: Applicant: REMMEL, DONALD A Address: 1372 GARLINGFORD ST Phone: 714-549-2357 COSTA MESA,CA Zip: 92626 Owner: REMMEL, DONALD A Address 1372 GARLINGFORD ST Phone: 714-549-2357 COSTA MESA,CA Zip: 92626 Contractor: OWNER-BUILDER Address: - Phone: Zip: License: 000000 Arch / Eng : - . Address: Phone: ' Zip: License: SCOPE OF PERMIT CONSTRUCT 401 SF MASTER BEDROOM AND BATHROOM ABOVE THE EXISTING GARAGE AT THE FRONT OF A SFD.A 159 SF DECK AND 74 SF A-FRAMED PATIO COVER WILL BE CONSTRUCTED ON THE WEST SIDE OF THE ROOM ADDITION.B03-01713. 8 LIGHTS,7 SWITCHES,16 OUTLETS, 1 SERVICE UPGRADE TO 200 AMP, 1 MOTOR UP TO 10 HP, 1 RES.APPL.<1 HP FOR THE BATHROOM.REF B03-1713. 1 BATHTUB SHOWER COMBO, 1 GAS(1-4 OUTLETS), 1 P TRAP, 1 PRESSURE REGULATOR, 1 EASH BASIN 1 TOILET. 1 GAS REPIPE. AMENDED 5/24/04:ADD 1 WATER HEATER FEE SUMMARY 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 $9.80 1 Trap Primer $0.00 0 Bathtub $9.80 1 Pressure Regulator $9.80 1 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 r NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(WOO) 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 sectionM700 of the Labor Code,for the performance of the work for which this permit Is Issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and 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 AND CIVIL FINES UP TOONE HUNDRED THOUSAND DOLLARE(S100.000).IN ADDR1ON TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 37C6 OF THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.N Class it Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement Is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous materiel? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑No (Section 25533 of the Califomla Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). _ present or ui__ e_._..._ __._ 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Or Yes 0 No (Section 65850.2 of the Califomla Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owner(s) Date And/Or Authorized Applicant Date CODE I INSPECTION TYPE PAIS INTFIAL5 LODE( INSPECTION TYPE PATE 1Ii�LS 1616 Fixed System Final Fire Prevention 206 Final Mechanical / �1 1266 Pool Spa Final 208 Final Plumbing {,�QC)—n5 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 q5" F 9 , .it CITY OF COSTA MESA 4 BUILDING DIVISION 1"..1 �l DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER n 'PERMIT +t PO4-00037 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 1372 GARLINGFORD ST Status: I :LIED Suite No Applied: .1/16/2004 Issue.. 01/16/2004 Vicinity: Parcel Nunmber: 14102206 ISSUED BY: Applicant: REMMEL, DONALD A Address: 1372 GARLINGFORD ST Phone: 714-549-2357 COSTA MESA,CA Zip: 92626 Owner: REMMEL, DONALD A Address 1372 GARLINGFORD ST \ Q Phone• 7 •- •9-23 , COSTA MESA,CA Zi. 9 .2. ' \ Contractor: OWNER-BUILDER ! //� Address: 17 7 Zip: ense: 00000• Arch / Eng : Address: • Phone: Zi•: Lice. e: S r OPE OF PERMIT CONSTRUCT 401 SF MASTER BED'*OM AND BATHROOM ABOVE THE EXISTING GARAGE AT THE FRONT OF A SFD.A 159 SF DECK AND 74 .F A-FRAMED PATIO COVER WILL BE CONSTRUCTED ON THE WEST SIDE OF THE ROOM ADDI ON. B03-01713. 8 LIGHTS,7 SWITCHES,16 OUT TS, 1 SERVICE UPGRADE TO 200 AMP, 1 MOTOR UP TO 10 HP, 1 RES.APPL.<1 HP FOR THE :ATHROOM.REF B03-1713. 1 BATHTUB SHOWER COM:s, 1 GAS(1-4 OUTLETS), 1 P TRAP, 1 PRESSURE REGULATOR, 1 EASH BASIN 1 TOILET. 1 GAS R.-IPE. FEE SUMMARY 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 $9.80 1 Trap Primer $0.00 0 Bathtub $9.80 Pressure Regulator $9.80 1 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 $9.80 1 • / • NOTICE: Th: ork 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 244648(eVa) DECLARATIONS v WORKERS'COMPENSATION DECLARATION: I hereby affirm unjf9?penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. •+ ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) O 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 taws 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 AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOU ARE($100.000),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 affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full force and effect.Lic.# Class# Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: O I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant 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.). • L �H 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 Uce Laws.). ❑ I am em t under sec. Business and Professions Code for this reason: Signature:. 62.7 Expires:r 6-26"--OV Verification of Ownership by(type of document,i.e.-properly tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,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 materiel? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safely Code been fully complied with? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: • CERTIFICATE OF COMPLIANCE AND AUTHOR •TION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I a999999������e to comply with all state laws('city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-des lb property for in - ion pp• es.I agree not to occupy or allow occupancy of any building authorized by this permit until final in pection. 077 l 7( O� Signature •f Legal Owner(s) Date And/Or Authorized Applicant Date CODEX INSPECTIONTYPE RATE INTITIAL$ CODEf INSPECTION TYPE '- 1 INTIDSLS • 1616 Fixed System Final Fire Prevention 06 Final Mechanical / , 1266 Pool Spa Final - 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 1. I 201 Final? ;:: aIl lock/RW212 Final Fi - •rave • 1. 41 ; - '\ 202 Final 220 F .I Planning P,,,. •.203 Final ign 22 Final Site ` ta HI ,=\" 204 Final Demolition' 250 Final Building/Occu+:ncy • ff Ott• CITY OF COSTA MESA ,0 . P.O. BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 92628-1200 J17 is DEVELOPMENT SERVICES DEPARTMENT September 4, 2003 Don Remmel 1372 Garlingford St. Costa Mesa, CA 92626 RE: MINOR DESIGN REVIEW ZA-03-57 1372 GARLINGFORD STREET, COSTA MESA Dear Mr. Remmel: Review of the minor design review for the above-referenced project has been completed. The application has been approved, based on the following project description and findings, subject to the conditions set forth below: PROJECT DESCRIPTION The applicant requests a minor design review for a second-floor addition to a single-story, single-family residence. The proposal consists of a bedroom, bathroom and balcony on the second floor. The addition is proposed on top of the existing 2-car garage and will result in a total of 4 bedrooms and 3 bathrooms in the house. ANALYSIS A minor design review is required for any 2nd floor addition in the R-1 (Single Family Residence) zone to ensure proper design consideration and compatibility with surrounding properties. The proposal conforms to all development standards and the residential design guidelines. The second story floor area is approximately 24% of the first floor area (443 sq.ft./1 ,885 sq.ft.) and is well integrated with the first floor configuration. It also incorporates an eyebrow roof to relieve the building mass. Staff has conducted a site inspection and determined that the addition would not negatively impact the surrounding properties or aesthetics of the neighborhood. Although the adjoining lots contain single-story structures, the proposed Building Division(714)754-5273 • Code enforcement(714)754-5623 • Planning Division(714)754-5245 FAX(714)754-4856 • TDD(714)754-5244 • www.ci.costa-mesa.oe.us ZA-03-57 September 4, 2003 Page 2 construction will not appear obtrusive since it is relatively small compared to the ground floor. The second-story windows will not have direct views into the windows of adjoining, single-story residences. The addition provides more than the required rear and right side setbacks to minimize privacy impacts while the left elevation overlooks the roof of the adjoining single-story structure. FINDINGS 1 . The information presented substantially complies with Section 13-29(e) and 13-29(g)(14) of the Costa Mesa Municipal Code in that: a. The proposed development and use is compatible and harmonious with uses on-site as well as those on the surrounding properties. The project meets or exceeds all residential development standards and design guidelines. b. Safety and compatibility of the design of the buildings, parking areas, landscaping, luminaries, and other site features including functional aspects of the site development such as automobile and pedestrian circulation have been considered. c. The project is consistent with the General Plan. d. The planning application is for a project-specific case and does not establish a precedent for future development. e. The proposed development is substantially compatible and harmonious with existing and/or anticipated development on surrounding properties. This includes site planning, landscaping, appearance, scale of structures, location of windows, and any other applicable features relative to a compatible and attractive development. The second floor addition is well integrated with the existing first floor and incorporates an eyebrow roof to relieve the building mass. The residence will also have more than the required rear and right side setbacks to reduce privacy impacts on adjoining properties and the left elevation overlooks the roof of adjoining single-story structure. 2. The project has been reviewed for compliance with the California Environmental Quality Act (CEQA), the CEQA Guidelines, and the City environmental procedures, and has been found to be exempt from CEQA. 3. The project is exempt from Chapter XII, Article 3 Transportation System Management, of Title 13 of the Costa Mesa Municipal Code. ZA-03-57 September 4, 2003 Page 3 CONDITIONS OF APPROVAL Ping. 1 . Street address shall be displayed on the fascia adjacent to the main entrance or front door in a manner visible from the public street. Numerals shall be a minimum 6" in height with not less than 1/2" stroke and shall contrast sharply with the background. 2. All new and existing construction shall be architecturally compatible with regard to building materials, style, colors, etc. Plans submitted for plan check shall indicate how this will be accomplished. 3. The conditions of approval and ordinance or code provisions of minor design review ZA-03-57 shall be blueprinted on the face of the site plan as part of the plan check submittal package. 4. The applicant shall contact the Planning Division to arrange for a Planning inspection of the site prior to the release of occupancy/utilities. This inspection is to confirm that the conditions of approval and code requirements have been satisfied. Eng. 5. Maintain the public right-of-way in a "wet-down" condition to prevent excessive dust and promptly remove any spillage from the public right- of-way by sweeping or sprinkling. CODE REQUIREMENTS The following list of federal, state and local laws applicable to the project has been compiled by staff for the applicant's reference. Any reference to "City" pertains to the City of Costa Mesa. Ping. 1 . Approval of the Zoning Action is valid for one (1 ) year and will expire at the end of that period unless building permits are obtained or the applicant applies for and is granted an extension of time. 2. All contractors and subcontractors must have valid business licenses to do business in the City of Costa Mesa. Final inspections will not be granted until all such licenses have been obtained. Bldg. 3. Comply with the requirements of the California Code of Regulations, Title 24, also known as the California Building Standards Code, as amended by the City of Costa Mesa. Fire 4. Provide approved smoke detectors to be installed in accordance with the 2001 Edition of the Uniform Fire Code. Eng. 5. At the time of development submit for approval an off-site plan to the Engineering Division and grading plan to the Building Division that shows sewer, water, existing parkway improvements and the limits of work on the site, both prepared by a civil engineer or architect. Construction access approval must be obtained prior to building or engineering permits being issued by the City of Costa Mesa. Pay offsite plan check fee to the Engineering Division. An approved ZA-03-57 September 4,2003 Page 4 offsite plan and fee shall be required prior to engineering/utility permits being issued by the City. 6. A construction access permit and deposit of $350 for street sweeping will be required by the Engineering Division prior to the start of any on- or off-site work. Parks 7. Existing trees in the public right-of-way shall remain. SPECIAL DISTRICT REQUIREMENTS The requirements of the following special districts are hereby forwarded to the applicant: Sani. 1 . Developer shall contact the Costa Mesa Sanitary District at (949) 631-1731 for current district requirements. Upon receipt of this letter, your project has been approved, subject to the above- listed conditions. A copy of the conceptually-approved site plan is enclosed. The decision will become final at 5:00 p.m. on September 11 , 2003, unless appealed by an affected party or a member of the Planning Commission or City Council, including filing of the necessary application and payment of the appropriate fee. If you have any questions regarding this letter, please feel free to contact the project planner, Wendy Shih at (714) 754-5136 between the hours of 1 p.m. and 5 p.m., Monday through Friday. Sincerely, R. MICHAEL ROBINSON Acting Zoning Administrator Enclosure: Conceptually-approved plans cc: Engineering Fire Protection Analyst Water District Building Division Lee Nguyen 407 S. Bristol St. Santa Ana, CA 92703 JUL-21-2004 11 :01 AM P. 02 7 07/16/2004 05:00 7147544056 COSTA MEDICALAGE PAGE 01/01 / CITY OF COSTA MESA /3 70- - // REFUND REQUEST FORM From: ❑ Finance Vendors: Building Safety 00 n Permit Planning �-:/ Amount 5 1.6 r S7 Public Services / ❑ Community Services Date: 7`/6/Q ❑ Other 2.-t..-4:"..:1182-c-1 �/�� / Dep: . ,. j-ignature Account Fund Organtzadon Program Projec/Gm% Amount YI T-13 i, 10/ trao ao D , Name end address of applicant: C(j� Qin /23/ Via, e �.otoo,•a C.4 �^922/ Phone: 90S/S� u! / i 1/4 Applicants Signature Otte • .. REASON FOR REFUND: i `4;e4Q CLC ,[ /, ..141e wlfinita / J.-wcAiLi , • •APPROVALS: Finance: City Manager: pnm.xi Mw onUne . .1444„. CITY OF COSTA MESA 'Cs. P.O.BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 92628-1200 1 a. ''!V J?' DEVELOPMENT SERVICES DEPARTMENT Transaction Receipt Date: 07-22-2004 ACTIVITY NUMBER: B04-01172 TYPE: Patio Cover SITE ADDRESS: 1372 GARLINGFORD ST Unit/Suite APPLICANT: NEGRET, ERIC CONTR. 909-232-6668 CELL OWNER: REMMEL, DONALD A STATE LICENSE CITY LICENSE TOTAL FEES: $90.51 TRANSACT. AMOUNT: $90.51 BALANCE:(PERMIT FEES) $0.00 PAYMENT METHOD: Check NOTATION: TRANSACTION RECEIPT DETAIL INFORMATION FOR TREASURY: BJK 2005 Building Plan Check 0320 $90.51 B000040722 Building Division(714)754-5273 • Code Enforcement(714)754-5623 • Planning Division(714)754-5245 FAX(714)754.4856 • TDD(714)754-5244 - www.ci.costa-mesa.ca.us `-'L1-2004 11 ;00 AM • . P. 0 1 4', , American Home Remodeling , Inc . "....," 4 FACSIMILE TRANSMITTAL SHEET TO: FROM: Bonnie—Building Safety Dept. Beth Receno COMPANY: DATE: City Of Cos Mesa 7/21/04 FAX NUMBER: TOTAL NO. OF PAGES INCLUDING COVER: 714-754-4856 2 PHONE NUMBER: SENDER'S PHONE NUMBER: 714-754-0185 909-520-0654 RE: SENDER'S FAX NUMBER: Pettnit#B04-01172 909-520-7837 0 U12Cf.NT 0 FOR RFVI1 W 0 PI.RASI;COMNIEN'I' 0 PLISASE. RP131 Y 0 PIMASE RECYCLE NOTES/COMMENTS: Here's the copy of the signed Refund Request Fonn. If you have any questions,please let us know. Thank you. 1,911 1 OMMERCE ST., STE.t07 CORONA, CA 92880 TEL.10909-520.0654 FAX#909.520-0495 • I PROJECT ADDRESS: UNIT: 1372 GARLINGFORD ST CITY OF COSTA MESA — BUILDING PERMIT PERM NO: BE 050816 OWNER'S NAME: MILLS, KENNETH M ADDRESS: 1372 GARLINGFORD ST PERMIT NO: BE 050816 PIAN CHECK NO: 00409-91 S GOVT; N SUPP: N r COSTA MESA,CA 92626 CONSTRUCTION TYPE; 5—N PERMIT TYPE: ELE SIR PURPOSE: ALT ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : LEGALIZE PAT/COVER, JACUZZI,MISCWIRING SQ FT; 235 I ADDRESS: UNIT: CLAIM VALUE: CALC—VALUE; 3, 243. 00 GROUP OCC ; R-3 / PERMITTEE: KENNETH MILLS ( 714 ) 641-8091 ADDRESS: 1372 GARLINGFORD S COMMENTS: SMOKE DETECTOR(S) REQUIRED IN HOME. COSTA MESA CA 92626 **%>E>E*ac;c************** x**** * * ESE***+r*** -* ¢**** **+t*** *******x****acs-********* LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIR EMEN TS 7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACKS CITY LIC.: STATE LIC.: CLASS: Date: Signature: MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I herebyatrirm than have a certificate of consent toselhinsure or a certificate of Workers' FRNT: FT IN REAR: 31 FT IN FRNT: FT IN REAR : FT IN P;Compensation Insurance.or a certified copy thereol(Section 3800.Lab.C). LEFT: 5 FT IN RGHT: 35 FT IN LEFT; FT IN RGHT: FT IN ”•POLICY NO.: EXP.DATE: • _. :', -COMPANY: PARKING REQ: PROV; PARCEL; 14102206 ZNE; R1 REF NO; • ❑ Certified copy is hereby furnished. CI Certified copy is filed with the city Building Division. PLANNING NOTES> 235 SQ FT. PATIO COVER ATTACHED TO REAR OF EX. RESIDENCE > LEGALTIZATION Date: Applicant: *************************I(-****)E**%*************IF1F****3E************** N********** EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). D E V E L O P M E ;TT SERVICES R EQUIREMENTS I certify that in the performance of the work for which this permit is issued.I shall not employ any person in arty manner so as to become subject to the Workers'Compensation Laws of California. ZONING APPROVED BY C DATE: _(�2=1 /ei/ Dale- Signature; / / NOTICE II,after making this declaration.you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY :_ OS *7 DATE; (_f_)... `/p Code.you must forthwith comply with such provisions or this permit shall be deemed revoked CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y: r A. / DATE: //Y/ which this permit is issued(Section 3097.Civ.C). *********-***************,. • ***** . ** ****x *********{E "*',�(.* _ " " - .k* LENDER: *OK***X-*************************************. ************i(**-*********iitE***-*** ADDRESS: LEGALIZATION: Y F E E SUMMARY ' STRUCTURAL SEGMENT: Y • OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct.alter,improve,demolish,or PERMIT 126 . 00 2 2 00 ,_50 repair arty structure,prior to its issuance,also requires rhe applicant for such permit to tile a signed statement that he/she is licensedi— pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business 0 t SMIP/NON—RES and Professions Code)or That he/she is exempt herefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN 81 . 90 any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE 15;00 "' 1. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILD ING" D IV—'> PERMIT ISSUE PLAN—CHECK TOTAL PAID' • DUE ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 1A8 . 50 15 . 00 4 0 . 9 5 2 0 4 . 4 5 2 0 4 . 45 .0 0 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. 11,however the buildingor improvement is solithin ne year of completion,the owner will have the burden of proving he/she did not build or imprve REVENUE DIVISION TOTALS--> COLLECTED; 204 . 45 OVER/SHORT,; Cr-- for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK • I.as owner of the properly,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 12 6 00 3 7 0 0 S 0 40 . 95 and who contracts for such projects with a contractor(s)license pursuant to the Contractors'Staterly alio kens or imp.oI a (hereon ' ❑ anand rofefeio sCole: Compensation ors'iStte te Liicznse Le awdoes not aply tloo an owner of prope' hbuildseLam. Iam aware ****#***##**************a ***********-**** *#** *%*d * *************#************* providedI N D 1: V I D U A I, F E E BR EAKDOWN ® lam exempt under Section: B P 704 4 B. &P.C. fur wisreason: ALL WORK BYOWNER TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date:1—rY-9I owner. SFR 235 RES—PATIO COVER—POST & TRELLIS 13 . 80 3, 243 . 00 I do hereby certify that I am aware of and understand the requirements of Cal ornia Heauh and Safely Code Sections 25505,25533,and ELE 1 M I SC AP P ASA•I'US NOT LISTED REQ PERM4T 11 . 00 11 . 00 25534 and that I or any future building occupant willlwill not(circle one)need to comply with said state codes and the requirements for apgY FEES permit for construction or modification from the AirQuality Management District.Residential construction applications are exempt from END OF these provisions. !'"a �� EXPIRED Date Applicant: ► rks Inco ❑lite Inspections I hereby certify that I have read this application and stale that the above information is correct.I agree to comply with all city and county 0. ordinances and state laws relating to building conslruCliOrl and hereby authorize representatives of this city to enter upon the above-mentioned i qq property for inspection purposes. L:o JAN /�9 1991 sig _ Date:j .2-1 V Signature: _fDate O Drivers License or Social Security a: / • CITY L c COSTA' MESA V i 1641-46 White—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor ' i• I/ 'CONSTRUCTION AND PLANNING PUUt & SPA . APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location '� • 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor Slvstem 61. APPROVAL TO DECK - 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final - 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace • APPROVALS Permit # j t1/421. Ducts, in Structure - 70. Underground Hydro " ._. 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil �4_ -" .-, i r'i' S 7e- 23. r23. Gas Pipe-Rough &Test 72. Underground Flush . ''si '0 .a a .w 24. Roof Framing 73. Undergrnd.Storage Tank OGas 0 Oil r.,_,-;,, %-. is - 25. Roof Sheathing 74. Overhead Hydro i;'v` - 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 1 "-4r Q 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding . - 77. FIXED SYSTEM FINAL 29. Insulation \ 78. FIRE PREV. FINAL 30. Drywall Nailing -. _- -; HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 4., '� 80. FOOD CERTIFICATE ISSUED 32. Electrical Power Meter-Final = ,,..)...1• 33. Final Electric - Notes: 11!(11 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test . 36. Hood or Canopy v/:' - 37. Final Factory Fireplace -7 . - . . - 38. Final Plumbing ki-- 39. Water Service-Final �n k. 40. Gas Service-Final \ • - 41. Solar Domestic-Final 42.'Backflow Preventer 1. . 43. Backflow Irrigation .1 44. Landscape Irrigation System L- AP I R L Incoie'lla.Q Inspections 45. Sound Attenuation 46. Handicap Regulations bate - Sts - 47; FINAL STRUCTURE & BUILDING ii 48. FINAL PLANNING k '- I , Y 49. Electric Release to Edison ` '� 1 50. Gas Release to Southern California Gas Co . -- ri� �- 51. CERTIFICATE OF OCCUPANCY . No. Date \, , PROJECTADDRESS: 1372 GARLINGFORD ST UNIT: CITY OF COSTA MESA - BUILDING PERMIT PERM NO; E 067434 ovvr,ls NAME: REMMEL, DONALD A. ADDRESS: 1372 GARLINGFORD ST PERMIT NO: E 067434 PLAN CHECK NO: N GOVT: N SUPP: N • COSTA MESA, CA 92626 CONSTRUCTION TYPE: V-N PERMIT TYPE: ELE PURPOSE: OTH 549-2357 • ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : ELEC. HOOK UP FOR ABOVE GROUND SPA SQ FT: ADDRESS: UNIT: CLAIM VALUE: 400 . 00 CALC-VALUE: GROUP OCC: R-3 / PERMInEE: DONALD A. REMMEL ( 714 ) 549-2357 ADDRESS: 1372 GARLINGFORD STREET COMMENTS : MUST COMPLY WITH MUNICIPAL CODE ORDINANCE 93-12 COSTA MESA CA 92626 *s6+Ee6*+6****+r#**rF*>F****+6* **************it+reEr******************************x-****** LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions o1 Chapter 9(commencing with Section Z ON ING REQUIR EMENTS 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. SETBACK S CITY LIC.: STATE LIC.: CLASS: Date: Signature: MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT; FT IN REAR: FT IN FRNT : FT IN REAR: FT IN Compensation Insurance,or a certified copy thereof(Section 3800.Lab.C). LEFT: FT IN RGHT: FT IN LEFT : FT IN RGHT; FT IN POLICY NO.: EXP.DATE:CPARKING RES• PROW r1 PARCE,T 1410220$ INE. REF NO: erer: PLANNING NOTES>In54-‘31 59A `N Fec.1� (' o p L' ' `d •d O Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. •�/� /'o � . 5 �Oc S i e s e}back Prov; cd, Date: Applicant: EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (Thi section need not be completed if the permit is for o hundred(5100)or less). DEVELOPMENT SERVICES R E Q U I R E M 'E N T S I certify that in he performance of work for which this permit issued,I s II not employ an person in an annex so as to became v all/-911 p, / subject to th W/oy/fe�rs'C mpeof then Laws of California ZONING APPROVED BY _at • P DATE; 6',/ /`f rote: �7� you should .� j' BUILDING APPROVED BY sr+-I�- e. // -7-fry NOTICE:I(,after making this declaration,you should become subject to the Workers'Compen on provisions of the Labor ._ DATE: (9 �'/ / Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. 61-51E CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY ; e ��� DATE . G/-/ c which this permit is issued(Section 3097,Civ.C). *********************** *i. -****** Y+F� *******************4******** -s*** LENDER: **************************************n ********************************* ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT; N OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish.or P ERM I T 15 , 50 ' repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed 5 0% SMIP/NON-RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN and Professions 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($5113). ISSUE FEE 15 . 00 I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 15 . 50 15 , 00 G. 00 30 . 50 .30 . 50 . 00 does not apply to an owner of a properly who builds or improves thereon,and who does such work himself/herself or through improvement is soldowithin one year alacompletionrthe owner will have intended of rprovinrg he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED: 30 . 50 OVER/SHORT: 00 for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 30 . 50 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware ***************************************************.**************************** that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL FEE . BREAKDOWN 7U�' I am exempt under Section: 8P7044 B.8 P.C. forth reaon: ALL WORK BY OWNER i� TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST • � �( owner. �X�/ ELE 2 RECEPT/OUTLET 1 ST 20 EA. . 75 1 . 50 I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 2551.25533,and ELE 1 MOTOR/POWR APPARATUS 0 . 0 - '1 0 HP 3 . 00 3 . 00 25534 and that I or any future building occupant wilt/will not(circle one)need to comply with said state codes and the requirements for a ELE 1 MISC CONDUIT NOT-LISTED REQ PERMIT 11 , 00 11 . 00 permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from these provisions. END OF FEES Date: Applicant: � RE I hereby certify that I have read this iion and state that above information is correct.I agree to comp with all and county X P i s ordinances and state laws relating to building construction and er y authorize revue tatives of this a e enter upon the ementionetl te rsp property for Ir, ec n purposes. /A' 1110411 b1./o Q1 G7�� /� � `� (/ S4 • DATE0106 01/40161518 TOT TIME: 14:14 30.50 Signature: (� ' ^ Driver's License or Social Security x: V�^'I� .. s ^ 1641.46 White—Building;Green—Code Enforcement:Canary—Applicant;Pink—Revenue;Goldenrod—Assessor CC CONSTRUCTION AND PLANNING POOL ?A Date Inspector Date Inspector `APPROVALS Permit# APPROVALS Permit # _ 1. TemporaryElectrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. r 53. Steel Reinforcement "• 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation /- 59. Gas Pipe, 0 Undrgrnd., Test - ,I 9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd. :- 10. Structural Floor System 61. APPROVAL TO DECK 4 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 1 e, 12. Sewer Cap t 63. Heater & Vent-Final 13. Roof Drains ' : 64. Plumbing System -Final J. 14. Rough Plumbing 65. Electrical-Final / �7 � I 15. Rough Electrical-Conduit 66. Solar System-Final • = 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough electrical-7 Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts,in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas C Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat - 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL • 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED• L 33. Final Electric Notes:6 jo'-9 Na One /bate je 34. Final Heating & Air Conditioning . CP I 1aq 1-1 35. Final Gas Pipe-Test - 1. 4 - • 36. Hood or Canopy f 9_ _ S� CQQ_O L 37. Final Factory Fireplace -1 J - 38. Final Plumbing • 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation • 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49. Electric Release to Edison - • 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date OWNER SIMMONS, JACK DATE 2-24-70 JOB ADDRESS 1372 Carlingford Street BUILDING PERMIT N0. 31440 �GFNERAL CONTRACTOR Anthony Pools DESCRIPTION of WORK Pvt. Swim Pool 4 F ). 141022-06 LOT 19 TRACT 4 55 FIRE ZONE VALUE $ 1,900.00 INSPECTIONS Signature Date GROUP J TYPE I,i ZONE R-1 SOIL SUBCONTRACTOR PERMITS ISSUED GAS /� Date I Number f Signature WATER lumbin���rr�# or-aOp 64527 ROUGH PLUMBING -r sin LX PROP. SWR. LINE n HOUSE,CON. 0 SPRINKLING SYSTEM �' MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND ❑ POWER ❑ ROUGH WIRING Heating and Vent. TRENCHES ❑ FORMS 0 STEEL REINF. 0 FLOOR SYSTEM BOND BEAM 0 STEEL REINFORCE n SHEATHING FRAME AND FLASHING LATHING — IN n OUT n PI 'ER, BROWN COAT S (URAL, FINAL Electric HEATING, VENT., REFRIG. AND A.C., FINAL PLUMBING, FINAL AND GAS TEST n ELECTRIC, FINAL 31440 PAID r FEB 24-7CcusK00 704* ****?8.50 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 For Applicant to Fill in Completely APPLICATION FOR BUILDING PERMIT /� (� _, RECEIVED BY TEg47*- D' DATE 2 ISSUED ADDRESS BUILDING 1 �l� cn t1;UYL� 1 eb Si . lA{C•/y�/_,l/ /�-zJ/7/La- 7[ //V ' (^�_/7/ OWNER S 11 t. --fY\..t 1NU J A.P. NCO r. �y '- .c Owl'y O � 1 �(J e MDI L BUILDINGkr- n j\ L 7"� h Q A M Wu, Z ADDRESS 4�G/.(V\¢J A'ryD1;REBS U ( tY� `YfZ U CITY NOTEL ` A LOT 19 aZ CONSTRUCTION Oath.) N€Y}' ADD ALTER REPAIR (MOVING DFMOL6SH O- N LENDER /X` p- 03 < J 7 BRANCH \ F J CO OWNER. ...Y Lii ADDRESS -ORO(• ,(iy,�y/� VALUE �yz m ARCHITECT /'�,�,^ r TEL. USE �2,q l�I M'\ 1'1 $ `1 lo� J Q OR ENGINEER t-Xl Amis NO, V Q FIRE /�//y, d W ADDRESS ZONE TYPE •+•�'4 GROUP ear ��\ APPROVED %�/'J J O CO NTRACTOf� �J�\�\���^\-1�\f��(I{��Vq BY Ind DATE 2 -24)-7,0 W= CITDR ESS.5.-C2)CO z _�Q NO.Y V�LLY` • 2OyE / P�OF USE OF� y BUILDING WC �� , TEL. ON p{ W-O STATE CITY YARDS APPROVED YARDS APPROVED co LIC. NO. \q C: ,r1q LIC. NO. MAIN BUILDING ACCESSORY BUILDING SIZE INO.OF BLDGS. (FROM C/L STREET) vq OF LOT NOW ON LOT FRONT FT. d/ FT. USE OF EXISTING BLDG. , ,��`` , R.SIDE FT. / qq ll FT, 2 NEW BLDG. \",1 O V f ROOMS STORIES L.SIDE FT. / oC FT. CQ.1 EXTERIOR WALL I ROOF _ COVERING COVERING REAR FT. 4 FT. J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN& d MAIN BLDGS. ACCESS. BLDGS. a Q , VAR.# APPR '� Q 1 a s\o6NY. •L`�d �(\ *Q(}9 j21 CUP.SY APPROVEDf V) _ p 4•dP�'�" �(� APPROVED _ / '/ n V) (75. p 1 1 \ ` s . ii l_7J.NS�aI-_BY 42154 DATE .aL -�' `( 2't� 0 {V\ UI hereby acknowledge that I have read this application and state 7 that the above information is correct and agree to comply with CC all laws regulating building construction, and I shall not employ F any person in violation of the workman's compensation laws of N the State of California. 'I m I hereby certify that I am properly licensed as a contractor under SO. FT. o the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, and that such licenses are in full force and effect,or I THE PURPCGE OF ESTABLISHING A PERMIT FEE ONLY: v am exempt from the provisions of the State of California Business VALUATION and Professions Code, 'vision 3,Chapter 9. CO PERMIT FEE S / 9, o O ni D Signature of 1 / y� 00 m _ Permittee -I C/ $ ) 9UO PLAN CHECK $ / s V 0 E f o Authorized Agent ' TOTAL FEE $ 2gt •�O OWNER SIMMONS, JACK DATE 4-16-70 JOB ADDRESS 1372 Carlingford Avenue BUILDING PERMIT N0. 31628 'G, $!ERAL CONTRACTOR Anthony Pools DESCRIPTION of WORK Pvt. Swim Pool VALUE $2.300.00 A.'I") 141-022-06 LOT 19 TRACT 355 FIRE ZONE INS ECTIONS Signature Date GROUP j TYPE III ZONE R-1 SOIL ���i SUBCONTRACTOR PERMITS ISSUED l/Y i[ inC) Date I Number I Signature WATER.7t i /fQG✓Yt �. /V[ S'6--Li6 /�/ Plumbing A' // �/'/ pp+,,// //,, ROUGH PLUMBING �� ,9j f..2a [L �YW sS `iif EnR_ro e> PROP. SWR. LINE U `.USE CON.I2 ij-4 4, c Lt �f_�. �..-.. / 'l SPRINKLING SYSTE ,„`ffT ( . - r �, -?:.;170 " /f��,�/ MISCELLANEOUS __ e .Y�--e7- 0 Q�5 �n>. ROUGH HEATING AND AIR CO4NDe�ITIONING �! /,_ TEMPO�D7 f c"4-41.j. 20 UNDERGROUND POWER C 515-.?v ROUGH WIRING frfide S.S-74 Heating and Vent. TRENCHES ❑ FORMS Q STEEL REINF, El FLOOR SYSTEM p BOND BEAM ®STEEL REINFORCE L��.� jlvjt --td SHEATHING „a . ✓ . i - - _ FRAME AND FLASHING LATHING - IN n OUT n P' ER, BROWN COAT Si LURAL, FINAL /-/-- -�/ E a�trlC HEATING. VENT., REFRIG. AND A.C., FINAL ♦�` _/; V CX-�%e/'' H-7)177r7 0/07-- PLUMBING, FINAL AND GAS TEST n /e L J k•"1-Ze ELECTRIC. FINAL �[_ Runnn FINAL /�L __99e r/7 I' 1," 3 ' 628 APR 16-70PatD001028 34.50 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR BUILDING PERMIT For Applicant to Fill in Completely Q/]n r\ //1 I� ' RECEf„V ED li'V D7 R�$.—laO DAy£ IS/Sy, BUILDING i.I c7 1 [71 ``�. �'t til a • s,'S)( A/f/_ /Y/J '/7 /[f OWNERSS n.i _ lik Al A —/2�— ) A.P. NO. oG R .ye.) BUILDING Z ADDRESS i ") ADDRESS/3 MAIL g 0-W 1, NEL. a Z CITY NO. TRACT/73SS 9 LOT / BLOCK Z NEW ADD ALTER REPAIR MOVING DEMO!ISH Z Q LENDERCTIO a m LENDER ��� J r BRANCH • /� ,r 't/0ts--C � J fn [9.OWNER aLU N —I a&sADDRESS nom..,,DVALUE m ARCHITECT /'� TEL ^�r��]/�^' VSE 'io,fte't E JQ OR ENGINEER C. ` � "PA)1 NO �. !4Jb e5 W 1 w CC ADDRESS /� ZONE< FIRE ^ "5 TYPE//4 GROUP �/s W W CONTRACTOFR iergA BVAPPROV ED I� .//,.ATE I� �/ W Z �/ •-may —to-1w Vp-Lw c7 /3f" : cc 5 [lr)i 1 1 o fV-�-- Jw ill ADDRESS /^ t/� }1 /N/E n USE OF ZCITY `� � NO�` �s1 d��'l) ZO/�- PLANS /- BUILDING NEW W� STATE BO19q CITY 'I YARDS APPROVED YARDS APPROVED j CC LIC. NO. •I LIC.NO. MAIN BUILDING ACCESSORY BUILDING SIZE I NO.OF BLDGS. (FROM C/L STREET) //'' a OF LOT NOW ON LOT FRONT FT. (/,FT. USE OF r EXISTING BLD Q y" Q7 _e- ( k ) R.SIDE FT. / 5 FT. !G H SIZE OF /NO.OF y�,/ Q NEW BLDG. ROOMS STORIES L.SIDE FT. iC FT. V EXTERIOR WALL ROOF _ COVERING COVERING REAR FT. —7 FT. J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& d a MAIN BLDGS. ACCESS.BLDGS. Q ^�j ,J/ VAR.# DATE 0 'V A ;JJNj//.,_,624-2—[�/ 4.1�/L-1-et-(�/A C.U.P.# �J/ APPROVED // ,{ z "t�tfff"`^s r/ � o.... L(.� APROVED��ZarAT E�Y /l�'7U o UI hereby acknowledge that I have read this application and state D that the above information is correct and agree to comply with Ir all laws regulating building construction, and I shall not employ F any person in violation of the workmen's compensation laws of On the State of California. eo W zI hereby certify that I am properly licensed es a contractor under SO. FT. o the State of California Business and Professions Coda, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the provisions of the State of California Business CC VALUATION 7 and Professions Co DI islon 3,Chapter 9. � N PERMIT FEE $OC3, cJ G D Signature of / �/� ` al Permittee -,/ .,../ me/. $ ��� PLAN CHECK $ //6—' E y`7 � v. o Authorized Agent x. TOTAL FEE $ a1WNER SJMMONS, JACK E. DATE 5-13-70 08 ADDRESS 1372 Carlin ford Avenue BUILDING PERMIT NO. 31833 •tGENERAL CONTRACTOR Robert H. Guritz DESCRIPTION of WORK Pvt. Block Wai 1 ' l• 141-021-06 LOT 19 TRACT 4355 FIRE ZONE VALUE $ 280.00 IN.,.ECTIONS • Signature Date GROUP j TYPE 'TT ZONE R-1 SOIL SUBCONTRACTOR PERMITS ISSUED GAS Data Number Signature • WATER Plumbing ROUGH PLUMBING PROP. SWR. LINE HOUSE CON. 9 SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND ❑ POWER ❑ ROUGH WIRING 1 Heating and Vent. TRENCHES ❑ FORMS 9 STEEL REINF. 9 Q �77 b FLOOR SYSTEM BOND BEAM 9 STEEL REINFORCE 9 SHEATHING FRAME AND FLASHING LATHING - IN in OUT [j Pt"TER, BROWN COAT S (URAL, FINAL Electric HEATING, VENT., REFRIG. AND A.C., FINAL PLUMBING, FINAL AND GAS TEST in ELECTRIC. FINAL ��( BUILDING, FINAL X49 -TA-7A° r .7 31 833 MAY 13 �cP=—cnsn1000 aPT *�* 5.00 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR BUILDING PERMIT For Applicant to Fill in Completely e /� / RECEIVED BY DATE RECEIVED DATE ISSUEDBUILDING /� . ADDRESS /37Z I ic4 //✓9Foie F_/�-70 �-/�-�V /, v �/ I/ / PEflM OWNER .tigc ( t ' c/MMONS A.P. NO. I-/I-OOI I'-O2GF/j/��l�I PER n (s��, BVIDRES / 7 7 �J /&d^r , 11 3--r MAIL SAME ADDRESS .7 '{ !` -'s ADDRESS ZTEL. SVC / 0_c.) CITY C - "-3-/ 9 TRACT`^f363 LOT/ 1 BLOCK Z Z Q CONSTRUCTION /1 NEW ADD ALTER REPAIR MOVING DEMO!ISH OI- LENDER 0 N F \K/\ d co J J BRANCH Q�� c . k� J V) OWNER (/J < W ADDRESS CO Q OR ENGINEER NO. USE hi 2,4aVALUso? ?S u c�� FIRE �/�-"t� ffi W CC ADDRESS (Tv/ '' y ZONE' � TYP/F, Q s GROUR- J Z CONTRACTOR O/l O 8/c/P f y I Y v/ i tz BVP R(,tAJ �ZQ/JJ C.c.CJLDATE /5—�Q _ ZI JCC ADDRESS n 90 CA- JTAL W w TEL. 5/,Z ZONEyy�� NO.OF USE OF NEW /��1[ZX�� zCITY CI .�l.i . NO. 9 AS i 1 - / PLANS BUILDING W STATE CITY YARDS APPROVED YARDS APPROVED LU CC LIC.NO. 2 1 9 70 / LIC.NO. /,Z (,$ MAIN BUILDING ACCESSORY BUILDING - 0 (FROM C/L STREET) SIZE NO.OF BLOCS. OF LOT I NOW ON LOT ' FRONT FT. FT. USE OF EXISTING BLDG. HO U'.5'i; R._$IDE FT. _ FT. I- SIZE OF NO.OF 2 NEW BLDG. ROOMS STORIES L.SIDE FT. ---FT -- UEXTERIOR WALL I ROOF - / // _ COVERING COVERING REAR FT. FT. J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN& d MAIN BLDGS. ACCESS. BLDGS. C- - gr / ,/ VAR.ak DATE O r 2 o c k L4J f9 .4 L h /7 1� C.U.P.# APPROVED APPROVED ` Z _BY DATE l.2 - /3 -7,0o S'6 d " J A--Ai 9 Mt I UI hereby acknowledge that I have read this application and state . ✓ that the above information is correct and agree to comply with CC all laws regulating building construction, and I shall not employ N any person in violation of the workman's compensation laws of N the State of California. co I hereby certify that I am properly licensed as a contractor under SQ. FT. o the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: rc am exempt from the provisions of the State of California Business VALUATION and Professions Code, Division 3,Chapter 9. $ 00 N PERMIT FEE Signature of /� ACA,, v'7 n,t Q�O o Permittee W(�' �`f' // $C/,J(JxU PLAN CHECK $ �_ E Authorized Agent N u \ TOTAL FEE $ f. n O OWNER HARBOR HALL OF FAME HOMES, INC. DATE DEC 1 1 1962 JOB ADDRESS 13(2 Garlingford St. BUILDING PERMIT NO. j S401 GENERALCONTRACTOR Lifetime Res.Bldg. Cott. . VALUES 17,075.00 I To. LOT 19 TRACT x+377 FIRE ZONE DESCRIPTION OF WORK Res.w/att.Gar . INSPECTIONS Signature DATE GROUP I & d TYPE V ZONE R1 Soil �/ r PERMITS ISSUED Gas � b.!I. _ SUBCONTRACTOR DATE NUMBER Water tiL!/ ' 2'417 Rough Corn. Refrig. 0 Air Cond. 0 H, _�5 Rough Heating 3g_ py / ,(f- 2-.76-�i /,9,'PD — Rough Plumbing T6ClQ_ ' -*envel. (a?.2g-ag.373 — Miscellaneous _ Prop.Swr.Line 0 House Con. I St.Swr. ❑ V7. S ti j4. 2-,26 -4f,..3 .e. 7-,41) Sprinkling System _�✓ Construction Pole Underground 0 Power ❑ Rough Wiring fiVe4Th 3'/Q/a Tr?Ac igUe72540e' .5-/„m/3 774;�^ 3,0 Trenches iB' Forms ®� Steel Rend. 0 47.,••-‘0 /-3-4) Floor Systems-(4_ /_2/- 63 Bond Beam 0 Steel Reinforce 0 Sheathing /��4�—3c fjf.-_(y� Frame and Flash'�8 / r -(�J� I ag — In [q' Out p- 04-/7 g P.__.er, brown coat .r-Zp 3 Refrig. 0 Air Cond. 0 Final Heating, Final ),Disb3 Plumbing Fixtures, Final -,_�.C> 77:_.,1f.__ n__. .�-,1 .� '. 1640F FEE Q,Etc EV ED COSTA MESA BUILDING-SAFETY DEPARTMENT Lot 19, Tract 4355\Plan.4eeP 111962 P. O. BOX 917 COSTA MESA. CALIFORNIA FINANCE DEPT. For Applicant to Fill In Completely APPLICATION FOI£I� RIATCOSIA MESA TYPE OR PRINT BUILDING ADDRESS i 3 7 a Qar in:,_ -tori --17'...r, COSTA MESA. CALIFORNIA `�' For Office Use Only p Harbor Hall of Fame Homes, Inc. I RECEIPT NO. I PI TO OWNER L MAIL p.0. Box 2066 RECEIVED BY DATE RECEIVED DATE ISSUED ADDRESS /J ,c- /&/j/ A.,-2....-I DEC 1 1 1962 CITY Santa Ana TarNOADDRESS I 9-220 ISS ,ARCHITECT Jam1SOII TEL. 544-004C COSTA MESA. CALIFORNIA AR ENGINEER NO. n ADDRESS 225 "D" St., Tustin FIRE ':y: 4V)' 7� ZONE TYPE Ui GROUP�j CONTRACTOR'ifetime Residential Bldg Corp. APPROVED ✓ BY DATE . ADDRESS 2131 SO. Artesia ZONING Santa uta ZONE I NO.OP I USE OP NEWfi+r'T.I.. CITY R�� PLANS BUILDINGI✓IR-n TM-• STATE 208676 TEL. KI 9-2204 LEGAL Le)'-/ 9 T-`!3s-.t DESCRIPTION SIZE 60001 I NO. OP 01.005.0 OF LOT NOW ON LOT A.P.NO. USE OP ['Ione YARDS EVES EXISTING BLDG, //�� APPROVED ALLOWED SETBACCENTERROPI LINEFROM 54'REAR YAROT2.76- (CENTERRNTUNE ST.) S`/ FT. IN. SIDE YARD I LEFT 51 I RIGHT 5# R.SIDE ...s--- FT. —^ IN. DESCRIPTION OF WORK L.610E f— _— FT. IN. �/ NEW I X II ALTERATION I II ADDITION I REAR / 2.•741 FT. IN. REPAIR I II MOVING I II DEMOLISH I APPROVED BY , ".. r, DATE A0lia./1L BUILDING�,8 iq 00,1‘f�O. OF `�F S1ZE y9�(OAOL 1•ROOMS 9 STORIES 1 ROOF COVERIING Y18st er I COVERING Shake USE OP BUILDING AND WORK TO BE PERFORMED Single family residence / 4100 • I ACKNOWLEDGE A AT I ATE AD THIS APPLICATION COM THE AMOUNTOSHOWN HONG VALUATION IS FOR ONLY. AND STATE THAT THE AIN E IS CORRECT AND AGREE TO COM- PURPOSE OP ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY •IN CEG 0T LAWS GULATING .-/��� BUILDING CONSTRU I. VALUATION 57, L"� -/)�✓%'� SIGNATURE O'Lp�0ASi /s S , I-O PERMIT FEE $ N PERMITTEF ` i ) 0 $ / /� vim✓ PLAN CHECK $ 02U :-S� AUTHORIZED AGENT 7 é. O ~ cc TOTAL FEE E $ r