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Home My WebLink About1863 PARKGLEN CIR - Building Permits • �rCITY OF COSTA MESA - 4 ' BUILDING DIVISION ), :i _ ;"Ii DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER �. PERMIT , / ' mias�d4 V E05-01314 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 1863 PARKGLEN CI Status: ISSUED Suite No ® Applied: 12/15/2005 Vicinity: "-;.f_ Issued: 12/15/2005 Parcel Nunmber: 42431120 Applicant: NILA LEWIS A / Address: PO BOX 3341 ISSUED BY: Phone: 714-412-1025 NEWPORT BEACH,CA • Zip 92659 Owner: FARIS, JOEL J • Address 1863 PARKGLEN CIR Phone: -COSTA MESA,CA Zip: 92627-4506 Contractor: MIKE KILBRIDE, LTD Address: PO BOX 3341 Phone: 714-412-1025 NEWPORT BEACH,CA Zip: 92659 License:738400 • SCOPE OF PERMIT 1 TEMPORARY POWER POLE.REF.:E05-00775 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-i-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 Fills _ $0.00 0 - - up to 50 kva/kw - $0.00 0 Recept Outlets $0.00 0 up to 100 kva/kw $0.00 0 Switches $0.00 0 over 100 kva/kw $0.00 0 Non Res Appl ' $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 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 $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 • 0 Fireworks Stand • $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0,00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $23.50 1 TOTAL CALCULATED FEES $47.00 Intermed Pole $0.00 0 . COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related 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(6/00) 'r1t4FiL741I1-•116 WORKERS'COMPENSATION DECLARATION: • I hereby affirm under penalty of perjury one of the following declarations: O I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. O I have and wit 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: (T is section need not be completed It the permit is valued at one hundred dollars($100)or less.) . . - LceAify 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' "'coppeniation 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 provisio s. • A plinanusigntrtpre:'-.1 . 2,4 .14-01-n M&-776-W-11-4.5 .05 iW RAIEURETO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN'EMPLOYER TO_CRIMIT PENALTIES AND CML FINES UP TOONE HUNDRED • USAND DOLLARE(5100000).IN ADDmON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: 4ateyttertattarniicensed.under,provislons of Chapter 9(commencing with Section 7000)of DM ' 3.oLNe.Buslpes and Professi s Code,and my license Is in full t7 force end ecL,tlC_Y. ---N-716� "Clessyp •�0 a�. r b nature:--- T -.� -s,t-h�Qra& Date: /2-2(S.•05" SJ 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(5500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ' ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 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 ❑No uturebuil_ subjectof..thi_._. pca_o.._._..permitorsuchco.___.c onto cation_ 5 Does or So the applicant or Quality presentaor emen bustling occupant at y other for the work ontch la the r agency?this a plication aU Nnit for such construction or modification from the South Coast Air Ouallry Management District or from any other air pollution control district or �Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 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 prescnbed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No 8 (If yes".attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given Is correct.I agree to comply with ail 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. 1 ! Signet Of Legal ner(s) ( /S Da rctiAirpd`OrgufiodzedApplicant;� . CODE I INSPECTION TYPE DATE . j$TITIAtS ;ODE( INSPECTION TYPE _ SATE _ �"YNIDISLS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final, 208 Final Plumbing• �[ 200 Final Re-Roof 210 Final Electrical .9 'W _ 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 • . • ,�, :-P- --jar y� CITY OF COSTA MESA 4 BUILDING DIVISION >4-,iii ' � 8 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 1. 1 ...-..e �!p 1.1114 PERMIT B05-01664 • • • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.caLNLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 1863-PARKGLEN CI Status: ISSUED Suite: Applied: 09/21/2005 Vicinity: RESIDENCE AND ATTACHED GARAGE Issued: 09/21/2005 Primary Occ: R-3 Dwellings/Cong Res<10 Type of Construction: V-N Parcel Number: 42431120 Zoning: Applicant: CARRERE, J P - - Address: 833 W 17TH ST • STE 6 Phone: 949-645-8933 ISSUED BY: at) COSTA MESA,CA - 'Zip:. 92627 Owner MAYNE, BRENT AND HILARY Address 1863 PARKGLEN CIR Phone: COSTA MESA,CA Zip: 92627-4506 Contractor CUSTOM BUILDERS OF NEWPORT BEACH Address: 833 W 17TH ST • STE 6 Phone: 949-645-8933 COSTA MESA,CA Zip: 92627 License: 780417 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT REROOF RESIDENCE AND ATTACHED GARAGE:T/O EXISTING WOOD SHAKE ROOF, 1/2"OSB,2 LAYER 30#FELT,APPLY"50-YEAR PRESIDEN ASPHALT SHINGLES."20 SQUARES REF:B05-00485 FEE SUMMARY Plan Check: $0.00 Calc Valuation: $10,000.00 Permit: $181.25 Claim Valuation: sio,000.00 SMIP Res: $1.00 SNIP Com: $0.00 Other: , $0.00 Inspection: $0.00 Total: $182.25 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 R p • 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 veld 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 .7.< 2446-06(&00) V' DECLARATION ' . WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: O I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 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. n• My workers Ac�o.m�pensation Ins-urd1nce Cartier and polity number ere: —� -Carrier:- s � �1^' Policy Num_berr 175(14-520 \(This section need not be completed if(lf�permi(is valued at one hundred dollars($100)or less.) -- ❑ I certify that in the performa e 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 a gree the ' I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provision Applicant 9lgnature: L Date:. 1- 24�eb WARNING: FAILURE TO SECURE WO ERS'COMPENSATION COVERAGE IS U WFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN A ITION TO THE Onern octuoeucervlN MAGES 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.tic.1i' Crass a Contractors-Signature:=. -• - - Date?',, v___....,---- 1 a CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): O I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ' ❑ I,as owner of the properly,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business end Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to filo a registration form for acutely hazardous materials? ❑Yes 0 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 Califomia 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 a plication apermit for such construction or modification , from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes LI No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If"yes",the facility must meet the requirement of Sections 255 303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Maga:ament , ther air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescdtied by California - Safety Code Section 42303 been made? 0 Yes 0 No slut 8 (If'yes",attach certificate of compliance from the appribriate air foothill control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty elperjury 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 properly 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 eZl—(05 W " z-Authorized-Applica t- N. Date 't�,A CODE/ , . I•. 1' .A RETRIALS CODE1 INSPECTION TYPE PATE 1( Aa 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final Final Plumbing 200 Final Re-Roof /01,gl i l 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 / 7 CITY OF COSTA MESA - �' BUILDING DIVISION fDEVELOPMENT SERVICES DEPARTMENT PE MIT NUMBER i PERMIT °• ' B05-00485 .4 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.cB UILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 1863 PARKGLEN CI Status: ISSUED Suite: Applied: 03/28/2005 Vicinity: 2ND STORY Issued: 07/21/2005 Primary Occ: R-3 Dwellings!Cong Res<10 Type of Construction: V-N Parcel Number: 42431120 Zoning: Applicant: CARRERE, JP ISSUED BY: Address: Phone: 949-645-8933 Zip: 92618 Owner: MAYNE, BRENT AND HILLARY Address 1863 PARKGLEN CIR Phone: COSTA MESA,CA Zip: 92627-4506 Contractor: CUSTOM BUILDERS Address: 833 W 17TH ST STE 6, Phone: 949-645-8933 COSTA MESA,CA Zip: 92627 License: 780417 • Arch : JEFF JONSSON Eng: Address: 6 MORGAN#100 - Address: Phone: 949-561-1896 Phone: IRVINE,CA /- • - Zip: 92618 / / License: C27314 License: - SCOPE OF PERMIT - ADD 258 S.F.TO EXISTING 2ND STORY S.F.D.WORK TO INCLUDE:-RELOCATEEXISTING MASTER BATH AND EXISTING 2ND BATHROOM ON 2ND FLOOR. KITCHEN REMODEL,ADD WINDOW TO KITCHEN,ADD SLIDING DOOR TO FAMILY ROOM. EXISTING 4 BEDROOM,3 BATH S.F.D.TO REMAIN THE SAME. FEE SUMMARY Plan Check: $287.46 Calc Valuation: $30,000.00 Permit: $442.25 Claim Valuation: $30,000.00 SMIP Res: $3.00 SMIP Corn: $0.00 • Other: $0.00 Inspection: $0.00- - Total: $732.71 - - - • 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 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. LINSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and aft 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 244546 (I,10,3) DECLARATIONS] ( ) I r-" 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: Career: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) "'kcertify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Calif and agree 1 t if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisi cp`L] App�hcent iggature: t L. Dile,. 1 21(O'�' " WrRNTHOU AN: DOI.LAREAILURE ($l06.SECURE WO 51:15 OMPEN TUN,DWFUL AMAGES A SHALLPROIDDSUBFOR I N EE TI O ER37030TCISFTHE AL PENALTIESCOE, CIVIAFIND S UPATTORNEYS TO EV'S HUNDRED. THOUSAND OOLLARE($100,000),IN ADDITION TO THE ST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060E THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am liven d under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Busln and Professions Code,and my license is In full force and effect.Uic.A Glass zCoaractors.Signature8 Mite: CONSTRUCTION LENDING AGENGy: ❑ 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)ofDivision 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 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 compresse0 gas at standard temperature and pressure). _...._...Dr._ _.._.l_...-_._ ation c hazardous __..._.._ _._ _ _. 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 matedals)7 ❑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. _ _ _ ____ _e__.— ___ __ 4 If an RMPP is presently required,has Section 25534 of the California Health and Safely 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 apemit for such construction or modification from the South Coast Air Ouality Management District or from any other air pollution control district or agency? U Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 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 Alr Quality Management District or other air pollution control district or agency is required for the work which rs the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 yes _❑No _ 8 (If yes-,attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the Information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. ----. Tau L Signature Of Legal Owner(s) (S I Date AndlG7p haveC'ApptidRlt ZDa19^ CODE S 6/SHOWN TYPE PdIE 1MEIAL5 CODE! INSPECTIONTYPE PATE MALE 1618 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final BIa;WRetaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site O �11�� 204 Final Demolition 250 Final Bullding/Occupancy r- fn-US .16A ��'t 1' CITY OF COSTA MESA BUILDING DIVISION >: DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER : PERMIT 4tbiThasinsa#4. E05-00775 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 1863 PARKGLEN CI Status: ISSUED Suite No Applied: 07/21/2005 Vicinity: Issued: 07/21/2005 Parcel Nunmber: 42431120 Applicant: CARRERE, JP ISSUED BY: Address: 833 W 17TH ST STE 6 Phone: 949-645-8933 COSTA MESA,CA Zip 92627 Owner: MAYNE, BRENT AND HILLARY Address 1863 PARKGLEN-CIR Phone: COSTA MESA,CA Zip: 92627-4506 Contractor: CUSTOM BUILDERS OF NEWPORT BEACH Address: 833 W 17TH ST STE 6 Phone: 949-645-8933 COSTA MESA,CA . Zip: 92627 License:780417 • , SCOPE OF PERMIT ADD 258 S.F.TO EXISTING 2ND STORY S.F.D.WORK TO INCLUDE:RELOCATE EXISTING MASTER BATH AND EXISTING 2ND BATHROOM ON 2ND FLOOR.KITCHEN REMODEL,ADD WINDOW TO KITCHEN, ADD SLIDING DOOR TO FAMILY ROOM. EXISTING 4 BEDROOM,3 BATH S.F.D.TO REMAIN THE SAME. REF:B05-00485 28 LIGHT FIXTURES,24 OUTLETS, 18'SWITCHES,7 APPLS, 1 SERVICE TO 200A,2 MOTORS TO 1 HP 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 I Standing Section - -. $0.00 0 , New Res(1-2 units) $0.00>, , _ 0_ • - Mise Electrical Equipment $0.00 _ 0 New Res(34-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 N ' $27:84 28= up to 50 kva/kw $0.00 '0 - Recept Outlets $24.92 24 up to 100 kva/kw $0.00 0 Switches $19.80 18- - over 100 kva/kw $0.00 0 Non Res Appl $0.00 0: Low Voltage Equipment $0.00 0 Res Appl $19.00 4 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $30.50 1 Misc.Conduit $0.00 0 Service to 1000a $0.00 0 Misc.Conductor $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1hp $9.50 2 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. 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 2448-46(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: Cartier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) PI certify that in th 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 la o ifomia, nd a�ee that If I should become subject to the workers'compensation provisions o ectl 700 of the Labor Code,I shall forthwith comply with the s. 1,4 ' APPlIa�t�S'I�g`gatureif` (beteT. y oS WARNIING:FAILURE TO S URE WORKERS'COMPENSATION COV RAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMI PE TIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($1 , ),IN ADDmON TO THE COST OF ENSAT10N,DAMAGES AS PROVIDED FOR IN SECTION 31060E THE LABOR DE,INTEREST,MD ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am Ii ride pro ' ns Chapter 9(commencing with Section 7000)of Division 3 of.lhe.B}I si s and Professions Code,and my license Is In full force and effect.Lac:n-3 � I ^l 'Class If Contractors Signature.. tCarLel Dale:—', CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued.(Sec.3097,Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet In depth Into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 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 0N (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 Safely 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(Duality Management District or from any other air pollution control district or agency? LJ Yes LI No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 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 Coda). 7 if a permit from the South Coast Air Duality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑No —_ 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have reed 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 Mese 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. _. t.... Signature Of Legal Owners)tOk 1(2.1 /O S" Date A(1dfOt7 Othorized,Applicaht" I ( Dated CODE 1, INSPECTION TYPE QM II�ALS CODE! INSPECTION TYPE -..-1 gAIE MALI 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing `�y 200 Final Re-Roof 210 Final Electrical Ott, {1n� 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 4�i - BUILDING DIVISION >t ..I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER � . [.� . PERMIT - / lA V P05-00769 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 1863 PARKGLEN CI Status: ISSUED Suite No Applied: 10/10/2005 Issued: 10/10/2005 Vicinity: ADDITION Parcel Nunmber: 42431120 Applicant: JP CARRERE ISSUED BY: Address: 833 W 17TH ST - STE 6 ". .. Phone: 949-645-8933 - - COSTA MESA,CA Zip: 92627 -" . Owner: FARTS, JOEL J Address 1863 PARKGLEN CIR . - ". Phone: COSTA MESA,CA"' Zip: 92627-4506 Contractor: CUSTOM BUILDERS OF NEWPORT BEACH Address: 833 W 17TH ST fir . -` STE6 " Phone:' 949-645-8933 COSTA MESA,CAe: 92627 License: 780417 SCOPE OF PERMIT • PLUMBING PERMIT FOR REF#:B05-00 ." 485 - ., , WORK TO INCLUDE 2 BATHTUB, 1 DISHWASHER, 1 GAS(14 OUTLETS), 1 GAS(OVER 4 OUTLETS)„1 LAUNDRY TUB/WASHER, 1 SHOWER, 1.KITCHEN SINK;3 WASH BASINS,3 WATER , CLOSETS"(TOILET), 1 WATER HEATERNENT, 1 WATER REPIPE AND 1 WATER SOFTNER. FEE SUMMARY ' AMT QTY '_ ..::. . -" AMT QTY _ _ - AMT QTY ISSUE FEE $23.50 - Laundry Tub/Washer $9.80 1 Sump Pump $0.00 0 Backflow irrigation $0.00 0• Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer - $0.00 - 0 Bathtub $19.60 2 Pressure Regulator $0.00 0 Urinal. $0.00 0 Clarifier System $0.00 ' 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkfow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank " $0.00 0 Wash Basin $29.40 3 Dishwasher - $9.80 - 1 Sewer Cap for Demo $0.00 - 0 Wash Basin Set $0.00 0 Drain,Floor - $0.00 -0 Sewer Connect + $0.00 0 Waste and Vent System $0.00 0 Drain,Rainwater $0.00 0 . Sewer Private Line , $0.00 -0 Water Closet(Toilet) $29.40 3 Drain,Roof $0.00 0 . - -Shower $9.80. 1 - ,-Water Heater/vent $12.30 1 Drinking Fountain $0.00 0 - Sink,bar $0.00 0 ` -Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 _ Sink,commercial . .. $0.00 0 Water Re-pipe $9.80 1 Gas Earthquake Valve' :'s $0:00' 0 ,Sink,Floor - $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) '$6.15 .1 Sink,kitchen $9.80.' 1 ' Water Softener $9.80 1 Gas(Over 4 outlets) ' ' $1.10 1 - Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa(private) $0.00 0 • VIOLATION $0.00 Gas Service $0.00 0 ' - Spa(public) - $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0. - REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $180.25 COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned fora period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all ppl>cable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the all/ 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 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. - ri t ce 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 • kers'cot penstigp Inturance carrier and policy number are: 9� Carrier:.-.- A` E D ctofi Number • I 5C14CIEC (T(�iris sectio 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 law o alifornia,end agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with th= • Applicant.Signeta 111 Date: (Odle O� as".• 9+� THOUS GTFAILURE TOS rE WORKERS TOTENSAA1 RAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYERdO CFSMI PENAL IES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,• .1.1N ADDITION THETA.STOF CO PENSATION,DAMAGES AS PROVIDED FOR IN SECTIO 3PT-706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirmrthat-I am licen d under provisi sof Chapter 9(commencing with Section 7000)of Division 3 of the Busin ss and Professions Code,and my license is in full farce andettect Li�.# .11 � - `� LClass� C et,AA PP De1� lO to j Oc Contractors Signfl[ura p J L...� �: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: _ Lender's Address: Signature: Date: OWNER-BUI LDER)DECLARATIONS: I hereby affirm that un00r 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 cow*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 Seaton 7000)of Division 3 of the Business end 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 civibpenalty 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 ProfessionsCode: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 hil.b?fle 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,tf eowner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ' Yl ❑ 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 Levi does not apply to an owner of property who builds or Improves thereon,end who contracts for such project with a contractor(s) license pursuant to the Contractors License rI s.), ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: �'•"' Date: Owner ID verified by driver's license. ❑Yesy'f'❑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 then 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 01 the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa 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 in No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application agermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes A No (Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (Il 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. Signa re Of Legal Owner(s) Date •II . _ to to 101°5 An.,•r-Authorized-Applicant• • CODE I . ' •.•••- RAIL INTRUL5 CODF! INSPECTION TYPE PAIS .:r1- 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1, !L/ 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 • � '�„ CITY OF COSTA MESA 4 BUILDING J)IVISION � _ DEVELOPMENT SER 'ES DEPARTMENT P MIT NUMBER 1 PERMIT MOS-00578 (714)754-5273 • Fax(714)754-4856 • www.ci.costa•mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 1863 PARKGLEN CI Status: ISSUED Suite No Applied: 10/05/2005 Issued: 10/05/2005 Vicinity: SIDE YARD Parcel Number: 42431120 ISSUED BY: Applicant: BUSCHMANN, RUSS Address: 771 NEWTON WAY Phone: 949-833-1041 COSTA MESA CA Zip: 92627 Owner: MAYNE, BRENT Address: 1863 PARKGLEN CI Phone: COSTA MESA,CA Zip: 92627-4506 Contractor: B AND P SERVICES, INC. Address: 00771 NEWTON WAY Phone: COSTA MESA CA Zip: 92627 License:594563 • SCOPE OF PERMIT INSTALLATION OF A NEW HVAC SYSTEM,LOCATED AT THE SIDE YA D. FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 • Repair/Alt Absor Unit $0.00 0 Inst FAU<100 k BTU $14.80 1 Repair/At Refrigera ion Unit $0.00 0 Inst FAU>100 k BTU $0.00 " 0 Ventill - ,F stem $0.00 0 Repair/Alt Cooling/Heat $0.00 0 Evap tia'c••'-r $0.00 0 Inst/Rep.Recess Wall Htr $0.00 0 Com ci. Incinerator $0.00 0 • Refrig Sys<100 k BTU $0.00 0 Domesti ' erator $0.00 . 0 Refrig Sys>100 k BTU $0.00 0 - •mpressors/Absorption Systems Gas Piping $0.00 .0 ' 14`1 o 3 hp/100 k BTU $0.00 0 Factory Fireplace $0.00 0 Eil't;° ' p/500 k BTU $27.15 1 Hood w/Mech Exhaust $0.00 0 fIE o 0 hp/1,000 k BTU $0.00 0 VAV Box $0.00 0 T'• 50 hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct - $0.00 0 Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers Fire Dampers $0.00 0 Up to 3 hp $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate 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 $65.45 COMMENTS/SPECIAL CONDITIONS • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work Is not commenced within.180 days,or if work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(WOO) DECLARATIONS I i I 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'comp i sedan,Eits provided for by section 3700 of the Labor Code,for the performance of the' work for which this permit Is issued. have and will alntain 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'c pensdltI n Insu nce carrier and policy number are: (� .1 .1� _ +a` s'-ev lCi�- --a-G.a�[amu�-C Poli ,NGiritier: &PST T D 4H /n6 is section need not be completed/f the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in t :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 14 s of CallCode,mla and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor I shall forthwith comply with the:: provi•i., S. �.... . Signat r '► .-A k i • - - O8`te: 10 S —0 c- WARNING:FAILURE TO SECURE WORKERS'COMPENSA • COVERAGE IS UNLAWFUL AND SHALL SuEuEOi AN EMPLOYER TO CRIMINAL PENALTIES AND CNIL RNES LIP TO ONE HUNDRED THOUSAND DOLLARE(st W,o00),IN ADDITION TO THE MST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SEC/ON 3708 OF THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm thhat I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division atinetIusiness and Professions Code,and my license Is in full farce and ea .Lic.4 �yA59 H I.Se\ L'C a r...20 arjacrigIgnature: V' 1 1..iA Die:— j O -S -O`c CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 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 penally 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 properly,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of properly who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e4rterty tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CE,pCS7-lW CATION: ❑ I hereby certify that no excavation five(5)ortriore 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: e•s:, HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: - 1 Will the applicant or present or future building occupant need to file a doertify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No a,?t (Section 25505 of the California Health and Safety Code requires,withsome 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 0N (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 Califomia 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? Yes LJ No (Section 65850.2 of the Califomia Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 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 Califomia 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-describe property for Inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Sig ure Of Legal Owner(s) Date t �- Jo S 0c .--- wAhdxO)r i1LNorizetl'Ap cantDate . CODE I INSPECTION7W OM . lifinLa CODE! INSPECTION TYPEt.d-i 1616 Fixed System Final Fire Prevention 206 Final Mechanical s �� • 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 FinarDemolitlon - 250 '' Final Building/Occupancy ' k. APPROVED CITY OF COSTA MESA PLANNING DIVISION SUBJECT TO BLDG. DEPT. REG. NOTE: ADDITIONS, DELETIONS, OR CORRECTIONS SHALL BE APPROVED BY THE PLANNING DIV. BYG tPty re DATE/a 5 4 -I n 41( ern z -c 9 de.ycJ. 18�� ' M CITY OF COSTA MESA .� 9 BUILDING DIVISION . , DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER V• ,,,0PERMIT SbfrPo:nz so • B02-00842 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 1863 PARKGLEN CI Status: ISSUED Suite: Applied: 06/12/2002 Vicinity: RIGHT PROP LINE Issued: 06/12/2002 Parcel Number: 42431120 Zoning: der • Applicant: FARIS, SUZANNE ISSUED SY: Address: 1863 PARKGLEN CIR Phone: 949.548.1924 COSTA MESA,CA Zip: 92627-4506 Owner FARIS, JOEL J Address 1863 PARKGLEN CIR Phone: COSTA MESA,CA Zip: 92627-4506 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 0 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT CONSTRUCT 17 LF,4'HIGH RETAINING ON THE BACK 17'OF THE RIGHT SIDE PROPERTY LINE,NEXT TO THE PARK ACCESS PER CITY STANDARDS.. FEE SUMM RY Plan Check: $27.17 Calc Valuation: $1,020.00 Permit: $41.80 Claim Valuation: Woo SMIP Res: $0.50 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $69.47 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/GO) E=26:3mimmisiponim iiimmi WORKERS'COMPENSATION DECLARATION: 1 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'comperAatlon Insurance carrier and policy number are: Cartier: 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 TO ONE HUNDRED THOUSAND DOLLARE($1DO.COM,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.4 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 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 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.). 'IMA I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The co factors License Law does not apply to an owner of properly who builds or Improves thereon,and who contracts for such project with a contractor(s) license p :u t to the Contractors Livens.Laws.). ❑ I am ex: •I /a>+L •-r s./ec.� ' Business and Professions Code for this reason: Signature: II. . . I .ralteiA t.! /_/ Expires: rj�{-)0 Lf— Verification of Owners •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,Califomla Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: - Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 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 feel 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 lime 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 or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yeo ❑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.aermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control distrtct or agency? DI 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 Califomla Health and Safely Code Section 42303 been made? 0 es ❑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 0`;•MPLIANCE 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 agr- •mpfy 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-desA roper-1y for inspection•urp .-s.I agree not to occupy or allow occupancy of any building authorized by thi(permit Ufitiill final inspection. • / . / 4, \ �C� /� !/� S!nature• egal Owner(s)" Date And/Or Authorized Applicant Date CODE f INSPECTION TYPE PATE agalaa. CODE1 INSPECTIONTYPE MAEE MALE 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 q-L6-39.2-- 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 . . � . . ., �. &r oj & Vega van Det ;�� 0 RETAINING WALLS IF SURCHARGE 2'-O" OCCURS WITH THIS .� DESIGN, THE TOE ( .I MIN. �I OF THE SLOPE MUST MIN. / GRADE —I. 4111–j1 MINIMUM OFBE SET K2%0" r GRADE rj11 I opy:III=111=III=111-III / >. 111=III- Iv a- 2#3 BARS 2 #3 BARS ivIII N3 BARS 24" O.C. !lot III N3 BARS 24"O.C. y i_ 6" CONCRETE f VII $. i= MASONRY –_ 6" CONCRETE MASONRY 15111 WALL ALL CELLS S I;111 x WALL– ALL CELLS , 4i_ FILLED SOLID ! Ii= a FILLED SOLID 01 "i WITH GROUT z �s111 f WITH GROUT 5 OMIT HEAD fa i o JOINT IN FIRST 'a OMIT HEAD JOIN IN o COURSE AT 32" I % FIRST COURSE AT ii a O.C. FOR WEEP j 32" O.C. FOR WEEP HOLE HOLE II! S �'s_ 2" r 2" a 1 #3 BARS 024" O.C. 1 GRADE i , i GRADE 2. _O 6' ` N 2 ! 1=1 = = • . e �� MEd! 111=111 ! i. e n I N12��–.' • as � . 1' 211 2 #4 BARS CONT. • 2#4 B - I - a - - ARS I rm. •. L il- i�L e . e POUR FOOTING '.I6.�I AGAINST ` POUR FOOTING UNDISTURBED 2-0 ' AGAINST V ,I NATURAL SOIL UNDISTURBED NATURAL SOIL NOTES: 1. Retaining wall shall be grouted solid. 2. Reinforcing splices in masonry shall be lapped not less than 15",in concrete not less than 12". 3. Omit mortar at head joints of first course at 32" o.c. 4. Mortar shall be no leaner than 3 to I. 5. Inspection required prior to grouting cells. 6. Retaining walls greater than 4'-0" in height or with surcharge loads other than shown above shall be fully engineered by a licensed engineer. 7. Retaining walls with standard concrete block walls or fences of any materials constructed above, shall be fully engineered by a licensed engineer. 8. A survey of the lot may be required by the building official to verify that the structure is located in accordance with the approved plans (1998 CBC, Section 108.1). SPECIFICATIONS: CONCRETE: 2000 psi at 28 days. BLOCK: Grade N, Type I A.S.T.M. C-90. REINFORCING: Grade 40 A.S.T.M. A615. 1913-46 (REV.6101) • �`, 9 CITY OF COSTA MESA l he4 BUILDING DIVISION > :rPrataamriks ..4, DEVELOPMENT SERVICES DEPARTMENT PERMI UMBER O PERMIT apTO M02-00239 (714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 1863 PARKGLEN CI Status: ISSUED Suite No Applied: 06/07/2002 Issued: 06/10/2002 Vicinity: Parcel Number: 42431120 ISSUED BY: c•- if Applicant: FARIS, AMIE Address: 1863 PARKGLEN CIR • Phone: 949-548-1924 COSTA MESA,CA Zip: 92627-4506 Owner: FARIS, JOEL J Address: 1863 PARKGLEN CIR Phone: COSTA MESA,CA Zip: 92627-4506 Contractor OWNER-BUILDER Address: • • Phone: Zip: License:0 SCOPE OF PERMIT REF B02-00786. 1 ALTER DUCT SYSTEM. - • FEE SUMMARY • Quantity Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $0.00 0 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $13.70 1 Evaporative Cooler $0.00 0 Inst/Rep.Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping $0.00 0 Up to 3 hp/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 $0.00 0 Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers Fire Dampers $0.00 0 Up to 3 hp $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate 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 Fumace $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 $37.20 COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. • FOR INSPECTIONS CALL: (714)754-5626 24443.46(&0O) 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'compfnsation Insurance carrier end policy number are: Carrier: Policy Number rs section need not be completed I/the permit is valued at one hundred dollars($100)or less.) I certify that in the perfo once 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• .Iltornle,and agree that If should become subject to the workers'compensation provisions of Sectio 3700 f the Labor Code,I shall forthwith comply with these• 5. Ap�t:SigneWre- ' . it - �- �/.6CJ (Dater /e//o/O.2-- ------ WARNING: _ WARNING:FAILURE TO SECURE W"; ERS'we I' • :TION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL ENALTIES 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.tic.# Class k 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 pursue, to the Contractors License Laws.). C _—I am exempt:- ••er:sec..' zusiness end Professions Code for this reason: /�^,�/{� Signature:—mss/ .r..; 0�t"-._ 4 .4 cExplres: V Verification of Ownership by(type of docu :'t,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 then thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑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? D Yes L-I 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 (It'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 end Safety Code Section 42303 been made? 0 Yes 0 No B (If'yes-,attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFIC 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 ree to comply with all to laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the abov cribedpprropedyfor ins ion purposes.I agree not to occupy or allow occupancy of any building authorized by this perm u II fins inspection. hdt6Li 1( 1(/ G tore.Of.Lega_IOwner(s) �Cn And/Or Authorized Applicant Date goon# INSPECTION TYPE PATE 1KIIId1a CODE! INSPECTION TYPE gdg INTTALS 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 CITY OF COSTA MESA - BUILDING DIVISION o 1. 4 al. DEVELOPMENT SERVICES DEPARTMENT ERMIT NUMBER PERMIT E02-00470 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT . Job Address: 1863 PARKGLEN CI Status: ISSUED Suite No Applied: 06/07/2002 Vicinity: Issued: 06/10/2002 Parcel Nunmber: 42431120 Applicant: FARIS, AMIE ISSUED BY: Address: 1863 PARKGLEN CIR Phone: 949-548-1924 COSTA MESA,CA Zip: 92627-4506 Owner: FARIS,JOEL J Address 1863 PARKGLEN CIR Phone: COSTA MESA,CA Zip: 926274506 Contractor OWNER-BUILDER Address: - Phone: Zip: License: 0 SCOPE OF PERMIT REF B02-00786. 6 LIGHTS,8 OUTLETS AND 3 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+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 $6.60 6 up to 50 kva/kw $0.00 0 Recept Outlets $8.80 - 8 up to 100 kva/kw $0.00 0 Switches $3.30 3 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $0.00 0 Misc.Conduit $0.00 0 Service to 1000a $0.00 0 Misc.Conductor $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $42.20 Intermed Pole $0.00 0 COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS j WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintfiln 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'compo sation Insurance carrier end policy number are: Carrier: Policy Number: s section need not be completed if the permit is valued at one hundred dollars($100)or less.) II I certify that in the perto ante of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject io the workers' compensation laws of 1lfomie,end agree that If lc s +uld become subject to the workers'compensation provisions of section 3700 of the Labor Code, shall forthwith comply with these o ins. 4 /I p Applicenl.Signature: .4' ,y Date /12 /0/02 -WARNING:FAILURE TO SECURE WO,1 RS'COMPE -ATI.: COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND DOLLARE($100,0w),IN A«ITION TO THE COSTOF 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.# 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: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to Its Issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business 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 pursu,•r to the Contractors License Laws.). _f:am'ez: p. der sec. Business and Professions Code for this reason: 4 ignature: ' .AI : %u: _•Sr - La- J _ expires:-3 �f-/ryl— Verification of Ownership by(type of doe. :nt,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑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 kaermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? DI 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 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 Califomia 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 MPLIANCE 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 t omply with all state law and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-descri a operty for inspection p oses.I agree not to occupy or allow occupancy of any building authorized by this permi until fi I inspection. /, 7,4 AV �/ODS Sig Of; egal:Ovmer(s) • LDate---' And/Or Authorized Applicant Date NOOEII INSPECTION TYPE PAM INTITIALS CODES INSPECTION TYPE PATE RiTII166S 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical F RN 201 Final Block/Retaining Wall 212 Final Fire Prevention • 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy • 4 - CITY OF COSTA MESA 9 4.4 BUILDING DIVISION F • 3l..�1 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT J ft rF B02-00786 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 1863 PARKGLEN CI Status: ISSUED Suite: Applied: 06/05/2002 Vicinity: SIDE YARD Issued: 06/10/2002 Parcel Number: 42431120 Zoning: Applicant: FARIS,AMIE ISSUED BY: Address: 1863 PARKGLEN CL Phone: 949-548-1924 COSTA MESA,CA Zip: 92627 • Owner: FARIS, JOEL J Address 1863 PARKGLEN CIR Phone: COSTA MESA,CA Zip: 92627-4506 Contractor: Address: Phone: Zip: License: Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT . 434 SQ.FT.ONE-STORY FAMILY ROOM ADDITION AT THE SIDE OF AN EXISTING SINGLE FAMILY DWELLING.NO ADDITONAL PLUMBING PROPOSED. NO ADDTIONAL BEDROOMS. FEE SUMMARY Plan Check: $339.98 Calc Valuation: $37,107.00 Permit: $523.05 Claim Valuation: $0.00 SMIP Res: $3.71 • • SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $866.74 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 19-0 Rear 10-0 Left 6-0 Right 5-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 4 Required: 4 Proposed: 4 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) DECLAPATI(INS WORKERS'COMPENSATION DECLARATION: 1 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 thisipermit 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: Cartier: x Policy Number: (��(fyis section need not be completed if the permit is valued at one hundred dollars($100)or less.) L( 71 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' ` compensationlyith es of 95. ,,end agree thata if become subject to the workers'compensation provisions of S n of the Labor Code,I shall forthwith comply with these p s' s. ,( � j Ap M Signature? ! f L ' -6i.i pate:—. ! /U d WARNING:FAILURE TO SECURE W ERS'COMPENSATION COVERAGE IS UNLAWFUL AND SWILL SUBJECT AN EMPLOYER TO CRIMI PE TIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),I DIMON 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 1 am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.It 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 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 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.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of properly who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuan to the Contractors License Laws.). �iW-—tankers see— Business end Professions Code for this reason: Ignature:Th by t ?�- E fres:-3/4 Q Verification of Ownership by(type of docu ,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 Calitomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑No (Section 25533 of the California Health and Safety Code.with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP Is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification from the South Coast Air(Duality Management District or from any other air pollution control district or agency? Yes D 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 Calitomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMP • CE 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 ..I/With all state laws and city or.inances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described pr..e •r ins.ection purpos= I LitiCi not to occupy or allow occupancy of any building authorized by this permit ntil inai in ection. 0�/�/ a /I/O> ignature;O `i.• ner(s)— L: -. And/Or Authorized Applicant Date CODE I INSPECTION TYPE PATE mum CODE INSPECTION TYPE PATE IMMA'a 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 tC_t' L.- k • PROJECTADDRESS: 1863PARKGLEN CI UNIT: CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 051534 OWNER'S NAME: SWIETON CHRIS J ADDRESS: 1863 PAkKGLEN CSR PERMIT NO: 3 051534 PLAN CHECK NO: N GOVT; N SUPP : N COSTA MESA, CA 92627 CONSTRUCTION TYPE; V-N PERMIT TYPE: STR PURPOSE; REP 548-8917 ' ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : REPAIR VEHICLE DAMAGE TO SFD SQ FT; 2 , 500 ADDRESS: UNIT: CLAIM VALUE: 2, 500 . 00 CALC-VALUE: 500. 00 GROUP OCC; R-3 / PERMITTEE: CHRIS SWIETON ( 714 ) 548-8917 ADDRESS: 1863 PARKGLEN CI COMMENTS: FIELD VARIFY STRUCTURAL INTEGRITY CM CA 92627 **14**K.)fkg**#)<»F********ani;+FxaE**1#X.1<4.#*,r.+F*****1E16XFy** )1M-*kW ar** *#****3*l-4i-*****x.+E*****Ai- LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING R EQUIR E M N T S 70001 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 hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN =RNT: FT IN REAR: FT IN Compensation Insurance.or a certified copy thereof(Section 3800,Lab.Cl_ LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN 'LICY NO.: EXP.DATE: OMPANY: PARKING REQ: PROV; PARCEL: 42431120 ZNE; REF NO: J Certified copy is hereby furnished. ❑ Certified copy is sited with the city Building Division. PLANNING NOTES> Date: Applicant: *******************************•******)e*#* C**1F##***********Ic'Y*1(•#If**?!*)”F***#***IF* EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed it the permit is for one hundred(8100)or less). DE VEL OPMENT SER VICES REQUIR ENEWTS 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 suelect to the Workers'Compensation Laws of California. • ZONING APPROVED BY DATE: Date: Signature: NOTICE:II.after making this declaration.you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : DATE: • Code.you must forthwith comply with such provisions or this permit shad 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 BY• - - _ DATE. c Yom'Z� which this permit is issued(Section 3097.Civ.C). **.****.* **.*.****.***.**.*.* . .— L I.a' . . LENDER: *lE#******I4****iE*********#*.****#******## .*****1F***********#************#******** ADDRESS: LEGALI7.ATION:N F E E U M •M A R Y STRUCTURAL SEGMENT:Y OWNER BUILDER DECLARATION: f hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELE ;RIC 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 15 . 00 . 50 repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 70001 of Division 3 of the Business SM I P/NON- RES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred doltars($5001. ISSUE FEE ' I. as owner of the property or my employees with wages as their sole compensation, wit 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 TOTAL S----> 15. 50 0 .00 0. 00 15 , 50 15. 50 , 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through his or her own employees. provided that such improvements are not intended or offered for sale. If,however the building or improvement is sold within one year of completion.the owner wit have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED . 15 . 50 OVER/SHORT: , 00 for the purposeol sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK I.as owner of the properly,am exclusively contracting with licensed contractors 0 construct the project(Section 7044,Business 15 . 00 . 50 I and Professions Code: The Contractors'State License Law does not apply to an owner of propert who builds or improves thereon and who contracts for such projects with acontractor(S)license pursuant to the Contractors' eLaw).l am aware ***'.k*******?i*.*****i;****** *#*#************************N.}.*.*#****}.**.iG*******1E**** that proof of their Worker's Compensation insurance should be provided to me ❑ I am exempt under Section: B.&P.C. / I N D T V I D [I A L F E E B R E A K D O W N Mrteas ,idi TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: / y owner_ �� 4. '/,u�% SFR 500 ALTER BY VALUE RESIDENTIAL NOZONE 1 . 00 500 . 00 I do hereby certily that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from these provisions. Dale: Applicant: ' I hereby certify that I have read this application and state that t a informatio ' orrect, gree to comply with all city and county ordinances and s ale laws relating to building construction and % .Drize notes Mat es r mcity 1`nter upon the above.menlioned property fr/in Reno( purposes. r . I . j/J 2/�' �,� ,;�V�'I • e, e0'383?:4-CcJt39'.5 TC-1 i` Dale_ Signature: DATE: 04/02/91 Ts E: X:54 Driver's License or Social Security u: 164646 White—Building:Green—Code Enforcement;Canary—Applicant:Pink—Revenue;Goldenrod—Assessor CONSTRUCTION AND PLANNING- F & SPA Date Inspector Date Inspector APPROVALS Permit# APPROVALS Permit# 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 UFER 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, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final - - 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power MetertFinal 80. FOOD CERTIFICATE ISSUED 33. Final Electric - Notes: 34. Final Heating & Air Conditioning t4✓ )o„ `Ij / 5 j ,C v- 4.h. 35. Final Gas Pipe-Test /F //uj* Y • 36. Hood or Canopy - !Y 37. Final Factory Fireplace 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 t-79--411 64141- 48. W4F48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date -1OoS7 ' :AR 76-71u-is-AIM 706* ***133.50 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR BUILDING PERMIT iaroy For Applicant to Fill in Completely _slat RECEIV BY DATERECEIVED D ,TESSV ED BUILDING ADDRESS • • c • _ PERMIT NO. OWNER Tmperi Al SRVings k Loan. O. nnO07 Z 1863 rarkglen Circle ADDRESS 3366 via-Lido. ADDRESS C. BLOCK 0 CITY Newport-Resch. "W73-1_30 f TE}-. TRACT 701 Z Q CONSTRUCTION NEW ADD ALTER REPAIR MOVING OFMOLISH O- I- LENDER RAM .•- P- .• X 0- 03 J 3 BRANCH _I V) OWNER Imperial Savings & Loan -i ADDRESS 00I / BLUE • m ARCHITECT TEL. S_Lr � r Ar.1 • /$' t., J Q OR ENGINEER - .: • : • N• • - • I 5 to til lr -••- TE • • • • 1a .•• • • •IMIIIIH MI/ �R-'� tLW Z W • •- •. —I0 z : • •• • - a • • • • CO 71 cc ADDRESS 01 Birch St. W Lu ClTEL = RI PLAN,S 2 BUILDING W 0-88 Res.Att.Gar - o STATE CITY• YARDS APPROVED YARDS APPROVED to fr ' LIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING DSIZE NO.OF BLDGS. (FROM C/['L1 STREET) OF LOT I 50 X 100 NOW ON LOT O FRONT rJ7J FT. m , L FT. USE OF J EXISTING BLDG. R SIDE /0 FT. y/ FT. H SI2E OF NO.OF ZZ NEW BLDG.1 620 sq. 1 ROOMS 1 STORIES 2 L.SIDE T. FT. T..1• EXTERIOR WALL _ ROOF _ COVERING stair COVERING shake�ccnhipt REAR3_6 FT. FT. J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& 0- C- . MAIN BLOCS. ACCESS.BLOCS. Q VAR.# DATE O residence-gel-4a- , . C.V.P. W APPROVED H1( APPROVED WLD:am DATE 3-24-71 Z 0 V • I hereby acknowledge that I have read this application and state O 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 Cn the State of California. /- // ��77 /// e z I herebycertifythat am /( , cSO. FT. J v'r o properly licensed as a contractor under the State of California Business and Professions Code, Division 3, THE AMOUNT S N UNDER VALUATION IS FOR Chapter 9, and that such licenses ore in full force and effect,or I THE PURPOSE OF ABLISHING A PERMIT FEE ONLY: Cr am exempt from t , -visions of the State • ellfornia Busines VALUATION and Profession ••, • islon 3 Chapt• °� i i r Signature • m Permittee i �� i�! _ same i — E same a Auth• zed . .ant _ 2