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Home My WebLink About363 GRENOBLE LN - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us � i rnin unrvt, w5 i A mesn, �H azo[o JobAddress: 363 GRENOBLE LN Suite No Vicinity: Parcel Number: 43914132 Applicant Address: Owner: Address: LOPEZ,JOSE 9911 LARSON AVE GARDEN GROVE, CA i SMITH, FRANK H ' 363 GRENOBLE LN COSTA MESA, CA MECHANICAL PERMIT Contractor. A AMES PLUMBING, HEAT, AC Atldress: 9911LARSON AVE GARDEN GROVE, CA C/O FAU WITHSAME < �OOK BTU. ISSUE FEE Inst FAU <100 k BTU Inst FAU >100 k BTU Repair / Alt Cooling/Heat Inst / Rep. Recess Wall Htr Refrig Sys <100 k BTU Refrig Sys >700 k BTU Gas Piping Faciory Fireplace � Hood w/Mech Exhausl VAV Box Vent Fan / Single Duct Appliance � Fire Dampers Smoke Dampers Inst or Relocate Appl Vent Air Handlers c 10000cfm Air Handlers > 10000cim Floor Furnace ` Floor or Suspend Heater $23.50 $14.80_ $0.00 $0.00 $0.00 50.00 50.00 $0.00 $0.00 50.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 Quantity 1: 0 0 0 0 0 0 0 0 0 0 ', 0 0 ° 0 0 0 0 0 0 ISSUED BV: Phone: 714-530-2440 Zip: 92644 Status: ISSUED Applied: O6/02/2003 Issued: O6/02/2003 Phone: � y�� Zip: 92627 ��l02 Phone: 714-530-2440 Zip: 92644 License: 250307 SCOPE OF PERMIT FEESUMMARY Repair / Alt Absorbtion Unit Repair / Alt Refrigeration Unit Ventillation System ' Evaporative Cooler Commercial I ncinerator Domestic Incinerator Compressors I Absorption Systems -,Upto3hp/100kBTU � 3To15hp/SOOkBTU 15 To 30 hp / 1,000 k BTU 30 To 50 hp! 1,750 k BTU Over 50 hp / Over 7,750 BTU Boilers Upto3hp 3To15hp 15 to 30 hp 30 to 50 hp Over 50 hp Other Mechanical Fee Investi9ation Fee Plan Check Fee Reinspection Fee TOTAL CALCULATED FEES E"� Quantity $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 50.00 0 $0.00 0 50.00 0 50.00 50.00 50.00 538.30 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void ii 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 requlred inapeetiona and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2aaae (aroo� WORKERS' COMPENSATION DECLARATION: I hereDy etfirm untler penalry of parjury one of t�e following tleclaretions: ❑ I �eve enE wlll malnteln e certiticate ot conseN to self-Insure br workers' compensatlon, es pmvided lor by section 3700 of the Lebor Code, for the pedormance of ihe wark tor which ihl5 parmil is issued. entl wlll malntain workers' compensation insurance, es requiretl by section 3700 of t�e labor Code, for t�a peAortnance of the work for which this pertnit is issuetl. My w kers' compensation Insurence ce•rri/er end policy numbor ere: , �/n,''t artier STA"�Fi �lJNi� Po yNu ber. �(, ��Z DO✓�� Sg�i anl�nn nnnA nn1 ha rmm�lalnN if IAa nairnil ie �iel��vN a1 �nn A��nilicr! il�llnrc /C1/1/11 n� /�nn 1 0 I certity ihet in the peAormance of the work for which this permit is Issued, I shell not employ any person in any manner so es to 6ecome subject to Ihe workers' ' n laws ot Calitomle, an0 agrea thai if I shoulA become suhject to Ihe workers' comp row t Section 3700 0l Ihe Lebor Cotle, I shell forthwith ply ith hese provislons. plican� SI ura: (T�SG /i, GofC Z a. %�6 � ryZ �O 3 G FAILURE TO SECUPE WORKERS' COMPENSATION COVERAGE IS UNLAWFU� PND SHNLL SUBIECT AN EMPLOYER TO CRIMINAL PENALTIES M1D CIVI� FlNES UP TOONE HUNDRED TFKKISAND DIX.LARE (5100,000), IN ADDITION TOTHE WST OF COMPENSAiION, �Mi4GE5 AS PRWIDED FOR IN SECiIIXJ 31O60F iHE LABOR CODE, IMEREST, AND ATTORNEI"S FEES. IICENSED CON7RACTORS DECLARATION: ettirm thatl3lm Ilcensed Z 9(commancing with Section 7000) ot z Prolessions Code, anQmy licensa Is in full CONSTRUCTION LENDING AGENCY: ❑ I hereby aHirm that ihere is a consimciion lending a9ency for ihe peAormence of the work for which ihis pertnit is issued. (Sec. 3097, Civil Code). Lendefs Name: Lendar's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby aflirm lhet untler penelty ot perjury thet I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for Ihe following reeson (SecJ031.5, Business entl Professlons Cotle: Any ciry or counry which requires a pertnit to construct, alter, improve, demolish, or repair any strucWre, prior to its issuance, elso requires t�a eppliwnt for such permit b file e signad statement that he or she is licensed pursuant to the D�ovisions ol the Comrectors License Lew (Chapter 9(commencing with Sectlon 7000) of Division 3 ot Ihe Business en0 Protesslons CoEe) or that he or she is exempt therefrom and t�e basls for the allegeC e:emption. Any Wolation oi Sectlon 7031.5 by any appliwnt for e pertnit subjects ihe applicent to a clvil penalry ot not more than five hundred dollars ($500).): ❑ I, es owner ol the property, oi my employees with wages as their sole wmpensation, WILL DO THE WOfiK, antl the strucWre I5 not intentletl or otteretl tor sale (Sec. 7044, Business end Professions Cotla: The Coniractors License Lew does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or Ihrough his or her own employees, provitled Ihet such improvements ere noi intended or oMered for sele. II, however, the building or improvement is sold within one ye9r of completioq the owneabuilder will have�lhe burtlen ot Omvinp ihal he or she did no� builtl or improve for purp0.5e of sal6.). ' ❑ I, as owner ot t�e property, am EXCLUSIVELV CONTRACTNG WITM LIGENSED CONTRAC70RS to cronstruct the D�alect (Sec. 704d, Business antl Professions Code: The conirectors Llcense Law does not apply to en owner ol property who builds or Improves Ihereon, antl w�o contracts for such project with a comractor(s) license pursuent �o t�e Contrectors License Lews.). ❑ I am exempt under sec. Business end Pmfessions Code for this reason: Signaiure: Da�e: Owner ID varllied by driver's Ilcense. ❑ Ves ❑ No Drivefs License No. Vedfication ol Ownership by (type ot tlocument, i.e. - property tax bill or tleetlJ: Expires: DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: . ❑ I hereby cehlly ihet no excavetion five (5) or more feet in depih into which e person Is required to tlescentl, will be matle in connec�ion with work authorizetl by this pertnit, and Ihat no building structure, swttoltling, falsework, or demolition or disman�linq Nereof, will be more �han thirry-six (38) faet high. (Chep. 32, Grp 2, Ar12, Sec. 341, Ti11e 8, Celitomia Atlminislrative Cotle). ❑ As owner�Duiltler, I will not employ anyone to do work which would require e permit from the Division ol Intlustnel Sefety, as noted ehove, unless such person hes a pertnit to do such work tmm the tlivision. Signature: Da�e: Division ot Intlustnel Sefery Permit Number: CERTFICATE OF COMPLIANCE AND AI7T}IORIZA710N OF EMRV: I cehify under penalry of perjury t�at I have read t0is epplication end slate that t�e infortnation given is correct. I agree to comply with all state laws end ciry ordinences relating to building constructlon, and euthodze representutives of ihe Gry o1 Coste Mesa to enter upon ihe ebove-described property for inspaction purposes. I egree not to occupy or allow occupancy ot eny building authorized by Ihis permit until tinel inspection. , COpE �. INSPECTIONTYPE P�IE II�LS 1616 Fixetl System Final fire Pr 1266 200 207 202 203 204 Pool Spe Final Final Re-Raol Final BIocWRetaining Well Final Factory Fire Place Final Sign Finel Demolition CODE� INSPECTIONTYFE 206 final Mechanical 20B Finel Plumbing 210 Finel Elecincal 212 Final Fire Prevention 220 Final Plenning ADProval 222 Final Site 250 Final Building/Occupenty 5 Ig �`1 bt 1 �� i (714) 754-5273 • Fax (714) 754-4856 • www.c�.costa-mesa: BUILDING PERMIT » FAIR DRIVE, COSTA MESA, CA 92626 Job nddress: 363 GRENOBLE LN Suite: Vicinity: 363,365,357,8 369 GRENOBLE LN. Primary Occ: R-1 Hotels/Apts/Res >10 Occ Type of Construction: V-N Parcel Number: 43914132 Zoning: Applicant: SIMMONS, DEBORAH Address: 9582 HAMILTON AVE #281 HUNTINGTON BEACH, CA Owner: SMITH, FRANK H Address 363 GRENOBLE LN COSTA MESA, CA Convactor: HIRSCHMAN, RP 8 SONS INC Address: 9582 HAMILTON AVE #281 HUNTINGTQN BEACH, CA Zip: 92646 Arch : Address: Phone: Phone: 714-960-8329 Zip: 92646 Phone: Zip: 92627 Phone: 714-960-8329 License: 781923 Eng: Address: Status: ISSUED Applied: 03I30I2005 Issued: 03I30I2005 ISSUED BY: """ — Phone: Zip: LiCense: License: SCOPE OF PERMIT REROOF EXISTING 4-UNIT CONDOMINIUM BUILDING (INCLUDES 363, 365, 367, 8 369 GRENOBLE LN). TEAR OFF EXISTING BUILT-UP 8 COMPOSITION ROOFS, AND INSTALL 4-PLY BUILT-UP ROOF & 30 YR. COMP (52 SQ). Plan Check: PermiL SMIP Res: SMIP Com: Other: Inspection: Total $0.00 $293.25 $1.77 $0.00 �0.00 50.00 $295.02 SETBACKS MAINSTRUCTURE Front 0-0 ACCESSORY Front 0. 0 PARKING Existinq: o Rear 0- 0 Rear 0. 0 Required: 0 FEE SUMMARY Calc Valuation: S»,s�s.00 Claim Valuation: Sn,s�5.00 PLANNING & ZONING Left 0- 0 Right Left 0- 0 Right Pr000sed: 0� 0- 0 0- 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Orcl. No. 92-29, § 1, 12-21-92) EXPIRATION: This permit shall automatically ezpire end become void if work Is not commenced within 1 BO days, or if work is suspended or abandoned for a period oi 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered lagal, such work must comply with all applicable codes, and all requlred inepectlona end final approvel must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of this permlt. FOR INSPECTIONS CALL; (714) 754-5626 �.. o �awi WORKERS'COMPENSAnON DECLAflAnON: I herehy ettirtn under penelry ol perjury o�e of Ihe following dedereilons: ❑ ve a�tl wlll meintain e certificate of cron5enl lo self-Insure lor workers' compensatlon, es proWtled for by section 3700 0} t�e Lnbor Cotle, fo� tha pertormance ol t�e � work tor which Ihis pefmit is issued. ''I he.� end w�tl meintain woAcere' compensetlon insurence, es raquiretl hy sedlon 3700 0l the lebor Cotle, for I�e peAormance ot tha work lor w�ich t�is pertnit is issuetl. �M"y wo. rkers ymP�nsa� nsu cerder end potlry num0er ere: �. /7�/�n n Caiiier: . � 1/ � �/�/�� P��c r Numb ra '��W/l.Y:�C ol�d %Th/sa4�cNon need not be crompleted i! the permit is velued et one huntlretl aollers ($100) or IessJ �^—'-•�F' ❑ I cenily thet in the peAortnence ot Ihe work lor which thls pertnit is issued, I shell not employ eny person in any manner so es lo Cocnme sub�ect to Ihe workers' compensBiion laws ol Celitomia, end eqr e Ihet 11 I shauld become sub�ac� �o ihe workere' campensetlon provlslons of SaC�ion 3700 of Ihe Lehor Cotle, I shell torthwl�h cromply Wit� thes9 ro� i�. ��7LL "� �"` J �rp�� /�/05 �IiceGtSign, a_tu'e: F�(� C2'}« �_,a'_�— WARMNOfFAICUAE TO SECURE WORKERS' OMPENSATION COVERAGE IS UMAWFUL AND SHALL SU&IECT AN EMPLOVER TO CRIMINAL PENALTIES AND CML FlNES UP TOONE HUNDqED Ti0U5AN� DOLLARE (StOp,OW�, IN ADqT10N TO THE WST OF Op1.1PENSAti011, DAMqGE3 AS PROVIDED FOq IN SECTIpJ �p5 OF THE U90R CODE.IMERESi, M1D ATiORNEI^5 FEES, LICENSED CtlNTRACTORS DECLARATION: 1 hereb eHirm that m.licen etl 7d o ons o Che ter 9(cnmmencin wilh Sectlon 7000 of Divislon 3 0l �6e•Busl�ess a Pr es5jon5 Cotle, and m license is in full �.{� ¢j Y �orce and etteci.l,ic..�--"��li/ Y�� P� 9 ress a ��% CONSTAUC710N LENDING AGENCY: ❑ I hereby fittirtn tha� ihere is e cronstnmlion lending egency /or Ihe pedormence ol lhe work tor which Ihis permit is issuetl. (Sec. 3097, Civil CotlB). Lender9 Name: lender's Atltlre93: Signeture: Dete: OWNER-BUILPER DECLARATIONS: I hereby ettirtn thet uneer penalry ol perjury t�at I em EXEMP7 FROM THE COMRACTORS LICENSE LAW lor ihe fdlowing reason (Sec. 7031.5, Business and Professions Code: Any ciry or county which repuires e pertnl� to Conslrucl, el�Br, Improve, demdi5h, or repeir eny strucWre. Onor to its iSSuantB, also requires Ne applicant for suU pertnit to file e signetl statemant t�et he or she Is Iicensed pursuent ta the pmWsions of the CoNrectore License Lew (CheD�er 9(commencing wit� Section 7000) of DlWsion 3 of the Busi�ss antl Proiauions Gode) o� thai he w she is exempt thewlrom afW the bests br the ellegetl exemption. Any vidation ot Sectlon 70J1.5 hy any a00��1 for e pertnil subl��s Ihe epPlicent to e civil penelry oi not more t�en Iive �undred tlollars (5500).): ❑ I, es owner ol lhe D�operty, or my employees wilh wages es their sole compensetion, WILL DO TNE WORK, an0 the siructure is not intentletl or offeretl for sale (Sec. 7044, Business end Pmfessions Cotle: The Contrectors Llcense Law does noi apPly lo an ownor of pwpeny who builtls or improves Ihereon, and who aoes such work himseN or �ersell or Ihrough his or I�er own employees, provided that such improvements are not imentled or oHered for sale. IC however, Ihe building or improvement is soltl within one year of completion, Ne owner-builder will �ave the burden ol pmving that he or she did not 6uild or imprwe for purpose o1 saleJ. ❑ I, es owner oi tha prOperty, em EXCLUSIVELV CONTqACTING WITH LICENSED CONTRACTORS to constmct the pmject (Sec. 70a4, Business and Professions Cotle: The contractors Licensa Lew tloes not eppty to en owner ol pmpeny who bulltls or Improves thereon, antl who wntracts for suc� prolect with a contracbqs) license p�rsuent to the Coniractors License Lews.). ❑ I em exemp� under sac. 8usine55 and Profession5 Code lor this reason: Signature: Date: Owner ID verified by tlrivers license. � Ves ❑ No Drivers License No. Vedlication ol Ownership by (type of documem, i.e. - pmpeny taa bill or tleetl): DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION: Expires: ❑ I hereby certify thet no ezwvetion five (5) or more feet in Oepth into which e peroon is requiretl to descend, will be made in connection with worK authodzed by Ihis permit, antl t�at no builtling strucNre, scaHolding, lalsework, or demolition or dismantling Ihereol, will be more I�an thirty-si: (36) leet high. (Chap. 32, Grp 2, An 2, Sec. 341, Title 8, Calitomia Atlminisiretive Cotla�. ❑ As owner-�uilCer, I will not employ enyane to tlo work which would require e portnil Irom the Divislon of Inausinal Safety, es noted aCove, unless such person hes e permil to tlo suU work from the diWsion. Signemre: Date: Division ol Intlustnel Safery Parmil Number: CERTIFlCATE OF COMPLJANCE AND AUfHORVA710N OF ENTRV: I cenity undor ponally ol porjury that 1 have reetl this aOD��ion entl slate Ihat Ihe informatim given i5 correct. I agree to wmply with ell state lews entl city ordlnences relatin8 to huiltling construcllon, entl eN�onze represeNatives ot Ne Clry ol Casta Mesa to enter upon t�e eDove-EescriDed P�openy for inspection puryoses. I eyrao nol to occupy or elbw occupaM.y ol any building auttrorixetl by tMs petmit untii tineV inspection. cooe .. IN�PECYION TYPE 1618 128Q 700 _.Y�' 202 203 Flxod 5ys�em Final Fire Prevontion Pool Spe Finel Finel Fe-Rool Flnel BIocWRetaining Well Final Fectory Fire Plete Finel S�8^ 204 Final �amolilion �E � COpE I INSPECTION TYPE 206 Finel Mechenical 20B Final Plumbing 210 Flnel Electdcal 212 Finel Flre Prevenllon 220 Final Plenning Approval 222 Finel Site 250 Finel BuilAing/Occupency (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT JobAddress: 363 GRENOBLE LN Suite No � Vicinity: Parcel Nunmber: 43914132 Appliwnk SMITH, MARILYN „, Address: 363 GRENOBLE LN .� '. - - . - . �. " �, , � Phone: 714-761-5157 X302 COSTA.MESA,�OA' <- , Zip: 92627 ISSUED BY: ' /' ' �i.� . ' . _ % � • � . . �i��; . ' , - _ � . . /j � � Owner. ��SMITH; FRANK H � �� / S'��// r Address/363GRENOBLE:LN " '- . , - � � ., ��' Phone: � • COSTA MESA; CA Zip: 92627 , , , ��; /�� . Contractor ,%OWNER-BUILDER � ' � _ �- � - . � � Address i � �' • • _ • � . . . . , , '�' , , . - . , ��Phone: " . " � �� ' . � . 7 ' Zip: ,, - -� �� License: 0 Status: ISSUED Applied: 03127/2001 Issued: 03/27/2001 `, . � � � \ � �� \��; �` \ � �\ \ i � �� `�. � . � � �. , � AV`� � �� `V� �� .�� '. � ��'. � � - ,A \ � �� , ! � i `. � - ,A � ,. � � � i � ; ' � . � �. � , �� \� � � , �' � ' �" . SCOPE OF�PERMIT � � � � � � � ' � " ELECTRICAL WORK (REPLACEMENT)�TO AN EXISTING.SFR. 3 RES APFLICANCES, 7 SERVICE TO �. � � ,'. 200A, i SUB PANEL TO 200A. � �. � . . - � . . . 1_ - . ' . - � �� - FEE SUMMARY - ' - �i � � � � J " __ � . � �� . Duaritiry . _ ,,,'� .� Quanhty %�� - � � � �ISSUE FEE -- $23.50 Temp Disl System / Lighting , $0.00 0 %i� ,' ;' � -/ Temp service test '� $0.00 ' Busway I100 R, • 50.00 0�%! .�� ' ��'� Re's. a/c package� � ��., � $0.00 � Standing Section �- ' $0.00 0 '� � �� 1�� New Res;(1-2'units)� `� �. �, $0.00 , 0 .�.Misc Electrical E ui ment $0.00 % i \� Q P I/ ^' n � AJ New Res (3+units)� `� � $0.00 0 - �;. �'." Transformers up to 1 kva/kw $0.00 �'�0� � � � �� ` Pool/Spa � �,:-50.00 0 � .. .._:.:.up-to70kvalkw $0.00,�%�0 ,�'�'� Lighting Fixts �� - � $0 00 0 � . � ..up to 50 kva/kw $0 00";`' 0 � ". Recept Outlets • `� $0 00 0 . �' ' � - _ '� � � � . i� . , \ . ' :up to 700 kva/kw _q;; $0 00� 0 '. � Switches `� ^ $0.00\ \ _ 0� �` `� ��. ' �� .: _.. - ...over 100 kva/kw `_ $0 00 �0 Non Res Appl V� �$0.00��0 � ' Lovi Volta e E ui ment i�� \� -, � 9 Q p $0.00 0� Res Appl �� $1q:25 �3\_ �", Low Volt Wiiing SysteinJ,Ckt�$0.00� ��0� Service to 1000a \\� $$0.00� ^�� 0�.; �~�`��<�__. Mi�sc� Conductor =,-� i�$0�.00/� �0 �J 1 � $0.00 � 0. �/ Service over 1000a �`�\ $0.00� /` , �,� 0� ; \ ' - Ciras ( gen or ride) _ , $0.00 Motors to 1 hp \ �$0.00 \ / � 0 -� � % ` - �� Cirws (mech ride,or lights) \\; `$0.00 Motors to 10hp �$0.00-� � �,0 �� ' � - . Christrnas Tree StanC ` � $0.00 Motors ro SOhp $0.00��-� 0� _,� � Fireworks Stand = L� �j$0�.00 Motors to 100hp $0.00 ��> �0� . � �� . , \�Other Electrical Fee - '%��$0.00 Morors over t00hp $0.00 '�0 - �� , - „�ii � �/ Communicationdrops $0.00 0 "�- `' -� , �, Investigation-Fee� -�' $0.00 Subpanelto200a $30.50 1 --- ----PIan�CheckFee $0.00 Pole Light Pkg g0.00 0 Reinspection Fee $0.00 Sign Circuils $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES 598.75 Intermed Pole $0.00 0 COMMENTS / SPECIAL CONDITIONS 0 0 NO710E: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ortl. No. 92-28, § 1, 1247-92) 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 ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inapaetlone and finel approvel must be obtained. Failure to obtain inspections and tinal approval will result in Ihe expiration. of this permit. FOR INSPECTIONS CALL: (714) 754-5626 244648(N00) WORKERS'COMPENSAnON OECLARArON: I hereby eflirm under penelty of perJury ona o� the following declarelions: � � ❑ I have and will malntain a cenificate of wnsent to selt-Insure tor woBers' compensation, es provitled for by section 3700 0l the Lebor Code, for the pedormanca of tha work lar which this permii is issuetl. ❑ I have entl will maintain workers' campe�u��on i�suranca, az required by section 3700 of the Labor Code, for the peAortnanca ot the work tor w�ich this permit is issuetl. My workers' compensation Insurence qrner and policy number ere: Carrier. Policy Number. (This section need not be com0lefed i! the pb��t is ve/ued et one hunOred dollars (5100) or less.) , ❑ I certity thai in the peAortnance of t�e work tor which t�is permit is issued, I shall not employ eny person in any manner so as to become suD�ed to the warkers' canpensation laws ot Callfomia, antl a8ree t�at 11 I shoultl bewme sub�ect ta the workers' compensation provisions oi Seclion 3700 oi Iha Lebor Code. I ahell toMwiih comply wi�h these D�a�isians. Applicant Signatura: Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNIAWFUL AND SHALL SUBIECT AN EMPLOYER TO CRINJNAL PENALTIES AND GVIL FINES UP TO ONE MUNDRED THOUSMlD DOLLARE (5100,000�. IN ADDIT70N TO T17E COST OF CAMPENSATION, DPMAGES AS PROVIDED f-0R IN SECTIIXJ 31O60F THE LABOR CODE, IMEREST, AND AiTORNEY'S FEES. LICENSED CONTRAC70RS DECLARATION: I hereby eHirm that I em Ilcensed under provisions of Chepter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my Ilcense is in full force and ettect Lia N Class x Contraaofs Signatura: Da[e: CONSTRUCTION LENDING AGENCY: ❑ I hereby aHirm that thera is a construction lentling agency for ihe pedormance ot ihe work for which ihis permit is issued. (Sec. 3097, Civil Code). Lender's Neme: Lender's Address: Signature: Date: OWNER•BUILDER DECLARATIONS: I hereby eNirtn that under penelry of De�ury that I em EXEMP7 FROM 7HE CONTRAC70RS LICENSE LAW for the following raeson (Sec. 7031.5, Busine55 antl Professions Cotle: Any ciry or county which raquires e pe�it to consirucl, alter, improve, tlemolish, or repair any sirucNre, prlor to its issuance, elso requires the epplicant for auch pertnit to file e slgnetl statement thel he or she Is IlGensatl pursuenl to ihe provisions of tha Contractors License Law (Chapter 9(commencing wi�h Section 7000) of Division 3 of the Business end Protessions Code) or thet he or she is exempt t�erefrom entl Ihe besis tor tha alleged exemption. Any vlolatlon of Section 7031.5 by eny applicent for a permlt subjecis Ihe epplicent to e civil penalry of not more Ihen flve hundred dollers ($500).): ❑ I, as owner of the property, or my employees with weqes as �helr sole compensation, WILL DO THE WORK, ana the siructure Is not intended or ottered tor sela (Sec. 7044, Business entl Pmfessions Code: The Comractors License Law does not apply to an owner of property who builds or impmves thereon, and who tloes such work himself or �ereelf or ihrough his or her own employees, providetl that such improvements are not intended or oHeretl for sale. If, however, iha building or Impmvament Is /sold within ona yeer of completion, Ihe owner-builder will have the burden of proving ihat ha or she did not 6uild or improve for purpose of selo.). [�" I, es owner of lhe pmperty, am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS ro constmct Ihe proJect (Sec. 7044, Business and Professions Cotle: The contrectors License Lew tlaas not epply to an owner ol property who bulltls or improves Ihereon, antl w�o contracis tor such pm�ecl wlih e comreaor(s) license Dursuant to ihe Coniractors LicBnse Lews.). ❑ I em exempt under sBc. Signature: Owner ID verified by dnv s 6 ❑ ves ❑ No and Professions Code for ihis reason: Venfication ol Ownership by (rype of dacument, i.e. - property tax blll or deed): Drivers License No. oate: (73 -a 7 -0 EMpires: DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereDy certify the� no e:wvatlon Ilve (5) or more teat in depth into which a person is raquired to descend, will be made in connection with work euthonzed by this pertnit, end thai no building siructure, s�Holtling, talsework, or demolition or dismantling ihereof, will be more than thirty-six (36) leet high. (Chap. 32, Grp 2, Atl 2, Sec. 345, Ttle e, Califomie AtlministratNe Code). ❑ As owner-builder, I will nat emplay enyone to tlo work which would require e pertnit from the Division ot Indusirial Safary, as noted above, unless such person has a permit to do such wark from the tlivisior�. Signawre: Date: Division ol Industrial Salery Permit Numher: CERTIFlCATE OF COMVLIANCE ANO AUfHORVA710N.OF ENTRY: I cenify under penalry of perjury thai I have read this application and state that the iniormation given is wnect. I egree lo compty wilh ell state laws and ciry ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enler upon the ebove-descnbed property tonr inspection purp0.s s. I egreeneF�to occupy or allow acupancy of any building authonzed by this permit until final inspection. �'Yln�.�/�,rrt� �. l .i„J -�il..l� 1�.4 -o?7-n l Signature Of Le9al Owner(s ate And/Or Authorizetl Applicant , Date CODE �, INSPECTIONTYPE Q�IE' p� 7616 Fixetl System Final Fire Preventlon 1266 200 201 Pool Spa Finel Fin01 Re-Root Finel BIaWReteining Wall 202 Final Fectory Fire Plete 203 Finel Sign 204 Finel Demolltion CpDE� INSVELTIONTYPE 206 Final Mechenical 208 Final Plumbing 210 Final Electrical 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final BuildingiOccupancy D�TE .1�11. DOYLE & SHIELDS JOB ADDRESS jb,$ GENERAL CONTRACTOR P" Vo. I_ ECTIONS Co..Inc. DATE 6-3-63 BUILDING PERMIT NO. SUBCONTi2ACTOR W � a9b2i FE .�RECEIVED 'COSTA MESA BUILDING-SAFETY DEPARTMENT �JUN 3 iJ63 P. a. aox �„ COSTA MEBA. CALIFOHNIA F NANCE DEPT. For Appllcant ro Fill In Completely APPLIC�(T10N'FOR'PERMR`� TYPE OR PRINT BUILDING ior Office Usa Only BUILDINO � q, ADDRE59 . 11[C61PT NO. P��] I COSTA MESA. CALIFORNIA JVL i r//� R [IV[D Y OAT6P6C[IV6D UATl18911EO OWNER O C J /� �(/J („f)�G �? 'G� N� 1 B INO �/ MAIL �( A RESS o/[D ADDRESS �I SO. 0.NL QJ ((Y ✓ /� [A(/�j E�� FIRE l' ,/ CITY • 1%� 0.� f�M ` ��T NO.� Il� /�POa� =ONE TYPE GROUP� I` ARCHITECT /� TE �p APPROVED ORFNGINEH!R/�0.�' `� /ah ry�'J�� /4�0 BY DATE nc_ .<ss T/0o ! Cp/h�.oH a�ee-�� ZONING � Z � NO. OP UB[ OP NH �� N' � PI.AN9 BYILOINO CONTftACTOR �/\�1 LBG�L �J ADDRHBB `—^' ��` DeeCnIrtION O� J.Z a .35�33 CITY ' J Q �H �� A. P. NO�- 6TATE (/j TEL //�� ` LOT TO B�IDH Q REAR pH LNO SHALL BE LE88 THAN LIC. NO. IS_I a�� ,J �� NO. 1/� �' Q 0�-"O EAVEB 612E �j f—V Ho.ovBloae^� ALLOWED �U.B.C.REQUIREMENTI OF LOT J.� -�3 • NOW on LOT USEOF �.—' VARDSAPPROVED YARD9APPROVED E%ISTINGBL�O. MAINBUILDINO ACCESSORYBUILDING � ( RROM C/L 6TREfiT ) BETBACI( LINB P110M �i � �� cervT¢n OP aTneeT '�� REAR YARD — FRONT 81DE YARD I LEFT �� RIGHT "'�� R� 61OH � FT. Pf. DESCRIPTION OF WORK �. s�os � rr. �. N6' ALTHRATION ADDITION . RBAR O FT. Ff. pISTANCb BET. BET. MAIN Q REPAIR. M VINO DEMOLISH MAIN BLDGS. ACCE69.BLDG9. / i % '7 VAR. iR OATE 6 ZIE DIN�33 XS.�.,(v ROOM9 b BTORIH9 d� C. U. P. p APPROVEO EXTERIOR WALL/1/ I RO�P % S!%�N6i�E APPROVC •. . �� Il P'l U6H O UIIDING I�ID WORK TO BE P R OftM6D " -�' W / e c�,� � ar..�cJ�n'r � oc�L� 3Z— .rSC� sc. �. �-✓ �a � � 1 HEREBY ACKNOWLED08 TX�T 1 H�V6 NEAD TH19 APPLICATION TM! AMOUNT BHO UNDBP V�LYATION IB POR TX8 Z •NO 6TAT8 TNAT TH6 A�OVB 19 CORRER AND AOREH TO COM- PIlpPoSH O! U BL�8H�N0 A PBRMIT FH8 ONLY. � PLY WITX ALL CITY OFDINANC[8 AHD YTATB LAWY ReOULATIHO �IALUATION p ou1LO1NO GONBTRYCTION. /� /� � � PERM^I7TE E� 'L(,t,�'L �` , PERMIT FEE $ j � , p7 p�, ' � 8%G,79a � E� o AUTHORIZHD AGHNT � LL TOTAL FEE $ �/