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Home My WebLink About1049 PARKHILL DR - Building PermitsMary Katherine Wells 1049 Parkhill Drive Costa Mesa, CA 92627 September 26, 2006 Ed Petros City of Costa Mesa, Building Division PO Box 1200 Costa Mesa, CA 92628-1200 Dear Mr. Petros: I have recently found out that the permits on my re -model have expired. As far as I know, I just need a final inspection. I have had no success in contacting the contractor that I had used and do not know what steps to take next. Please contact me at your earliest convenience to advise me on what I need to do to next. I can be reached at work 714-428-6716 or cell 949-378-2160. The permit #'s in question are: B04-02032, E05-00335, M05-00188, P05-00268 for a room/kitchen addition. Thank you very much for your assistance. Sincerely, Mary K Wells ` 14� vV C (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 1049 PARKHILLDR Suite: Vicinity: FAMILY ROOM/KITCHEN Primary Occ: R-3 Dwellings/ Cong Res <10 Type of Construction: V -N Parcel Number: 42431304 Zoning: Applicant: JOHN WOLCZANSKI Address: 254 CLAREMONT AV LONG BEACH, CA Owner: WELLS, MARY K Address 1049 PARKHILL DR COSTA MESA, CA Phone: 562-439-3224 Zip: 90803 Phone: Zip: 92627-4534 Contractor: WOLCZANSKI BROTHERS CONSTRUCTION Address: 254 CLAREMONT AV Phone: 562-439-3224 Status: ISSUED Applied: 12/01/2004 Issued: 04/18/2005 i -rt5 //'tiro LONG BEACH, CA Zip: 90803 License: 821866 Arch : Eng: ALHAKEM A ALINA Address: Address: PARLEE ENGINEERING Phone: LONG BEACH, CA Phone: 562-433-8882 5937 E NAPLES PLAZA Zip: License: 90803 License: C53044 SCOPE OF PERMIT 291 SF ONE-STORY ADDITION WITH 220 SF DECK ABOVE TO EXISTING TWO-STORY SFD. WORK TO INCLUDE: EXTENSION OF EXISTING KITCHEN AND FAMILY ROOM WITH PARTIAL DECK ABOVE; REMODEL OF EXISTING KITCHEN; NEW EXTERIOR STAIR; CHANGE OUT EXISTING SECOND STORY WINDOW TO SLIDING DOOR TO ACCESS NEW DECK. FILING. - NOTICE OF ZONING APPROVAL SENT ON 2-14-05. APPEAL PERIOD ENDED 2-21-05 AND NO COMMENTS/APPEAL RECEIVED 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-aft'applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in fhe expiration oftfiis permit. FOR INSPECTIONS CALL: (714) 7545626 2x4646 (6'00) FEE SUMMARY Plan Check: $326.85 Calc Valuation: $35,654.80 Permit: $502.85 Claim Valuation: $0.00 SMIP Res: $3.57 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $833.27 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 25-11 Left 5-0 Right 16-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is 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-aft'applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in fhe expiration oftfiis permit. FOR INSPECTIONS CALL: (714) 7545626 2x4646 (6'00) DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain workers' compensalion insurance, as required by section 3700 of the Labor Cale, for the performance of the work for which this permit is issued. My workers' compensation Insurance carder and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars ($100) or less.) 10=1: certify that in the performance of the work for hich thispermit Is issued, I shall not employ any person in any manner so s to be me subject to the workers' compensation IS of C pfomie, nd agre th If I shou 131313131313 become subject to the workers' compensation provisions of Se tion 37 of the Labor Code, I shall forthwith comply withthes no ns. _Applican46ignature:_ ` GDakx— b WARNING: FAILURE TO URE WORKERS' COMPENSATION VERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL ENALTI AND CNIL MINES UP TOONE HUNDRED THOUSAND DOLLARE IS ,0001, INAODITIOJ TO THE COST COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3/013 OF THELABOR CODE. INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 ommencing with Section 7000) of Division 3 of the Business nd Professions Cale, and my license is in full force:and effeClzticra_R-� Contractors Signature DPIe CONSTRUCTION LENDINGAGENCY: ❑ 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 1 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 lot a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such Improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who Contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person Is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2. Grp 2, Art 2, Sec. 341, Title B. California Administrative Code). ❑ As owner-builder. 1 will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above. unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires. with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, Or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). __....................._,___.........................................._..__.._..........................__.._................._..................._._............._._............................................_........................................._.... 2 Does or will the applicant or present or future builtling occupant need to file a registration forth for acutely hazaMous materials? ❑Ves ❑ No (Section 25533 of the California Health and Safety Code. with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ........................................................................................................................................................................................................................................................................................................................................................................................_. 3 Does or will the applicant or present or future building Occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No ......_............................................................................................ .................................................... ................................................-..................................... ............................... ................................. ............................................. .... 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application apermit for such construction or modification from the South Coast Air Ouality Management District or from any other air pollution control district or agency? U Ves U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ..........._...................................................................... .............................................. ................................................ ................................................................................................................................................................... ............. ......................,. 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑ No (If yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ..............I..... ............... ...... ........................................................................................................-.........................................................................................._..................................._............_................. 7 application, a permit from the South Coast Air Quality Management a Heal or other eir pollution control 303 b or agency Is requiretl fOr the work which is the Subject of This ...have allot the disclosures prescribed by Calllornla Health and Safety Code Section 42303 been made? ❑Ves ❑ No B (If yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the Information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: 1 certify under penally of perjury that I have read this application and state that the Information given is correct. I agree to comply with all staip 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 inspecti p rposes. I agree not to Occupy or allow Occupancy of any building authorized by this permit until final inspection. Si a e t Legal Owners) D le th d Appltcanl� CODE It. PATE INTITIALS CODEINSPECTION TYPE PATE INITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 20B Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final BlocklRetaining 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 BuildinglOccupency P a (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: 1049 PARKHILL DR Suite No Vicinity: Parcel Nunmber: 42431304 Applicant: JOHN WOLCZANSKI Address: 254 CLAREMONT AV LONG BEACH, CA Owner: WELLS, MARY K Phone: 562-439-3224 Zip 90803 Address 1049 PARKHILL DR Phone: COSTA MESA, CA Zip: 92627-4534 Contractor: WOLCZANSKI BROTHERS CONSTRUCTION Address: 254 CLAREMONT AV LONG BEACH, CA Phone: 562-439-3224 Zip: 90803 License: 821866 Status: ISSUED Applied: 04/18/2005 Issued: 04/18/2005 ISSUED BY: v x_ N, 101VLA SCOPE OF PERMIT 291 SF ONE-STORY ADDITION WITH 220 SF DECK ABOVE TO EXISTING TWO-STORY SFD. WORK TO INCLUDE: EXTENSION OF EXISTING KITCHEN AND FAMILY ROOM WITH PARTIAL DECK ABOVE; REMODEL OF EXISTING KITCHEN; NEW EXTERIOR STAIR; CHANGE OUT EXISTING SECOND STORY WINDOW TO SLIDING DOOR TO ACCESS NEW DECK. REF.: B04-02032 ELECTRICAL TO INCLUDE: ADD 16 LIGHT FIXTURES, 8 OUTLETS, 6 SWITCHES, AND UPGRADE SERVICE TO 200 AMPS. 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 wool FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Temp Dist System / Lighting $0.00 0 Temp service test $0.00 Busway /100 It $0.00 0 Res. a/c package $0.00 Standing Section $0.00 0 New Res (1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res (3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool / Spa $0.00 0 ................up to 10 kva/kw $0.00 0 Lighting Fixts $17.60 16 .................up to 50 kva/kw $0.00 0 Recept Outlets $8.80 8 .................up to 100 kva/kw $0.00 0 Switches $6.60 6 ..................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 $30.50 1 Misc. Conduit $0.00 0 Service to 1000a $0.00 0 Misc. Conductor $0.00 0 Service over 1000a $0.00 0 Circus ( gen or ride) $0.00 0 Motors to 1 hp $0.00 0 Circus (mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 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 wool DECLARATIONS 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 Cade, for the performance of the work for which this permit is issued. My workers' compensation Insurance carder and policy number are: Cartier: Policy Number: (This section need not be completed if Mpe�itist on hundred dollars (S100) or less.) I certify that in the perfonoe a ohis ennit is issued, I shall not employ any person in any manner so to becom subjec ihdworkers'compensation laws Calif mia, become subject to the workers' compensation provisions of Se ion 37p0o th or Code, I shell forthwith ' comp with these p 'si s. O)( Applicant Signature: �Dete_ WARNING: FAILURE -TO SECL6E WORKERS' COMPENSATION",ERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER.TO N L PENALTIE ND CNIL FINES UP TO ONE HUNDRED THOI(SAND DOLLARE(S100, ), IN AMMON TO THE COSTO PENSATION, DAMAGES AS PROVIDED FOR IN SECTION W06 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: 1 hereby affirm that I am licensed under r visi sof Chapl r 9 (comm clog wi1M1 Section 7000) of Division 3 0l the Business and fe ions C e, and my license is in full force end effect Lic. e Clessa�—t Contract6r`iSgnaturei 1c:: ( a CONSTRUCTION LENDING ENCY: ❑ 1 hereby affirm that there is a construction lending agent or the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature: Data: 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 parmit 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 nor more than five hundred dollars ($500).): r ❑ I, as owner of the property, or my,employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through'his or her own employees, provided that such Improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of documont, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2. Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time cluing 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. ........................................... ..................... .......................................... .......... ...... ........................................................ ...................... .... ............ ............................................ ................................. .......................................................................... I............ 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No ._........................ ._....................................................... _.................................. ... .................................................................................................... ................................... .............................................................................................................. .......... 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this a plication 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 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ..._..............................................................._..............._............................................................................_.................................................._.................................................................................................................................................................. 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (It 'yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ............................................................................................................................................................................................................................................................................................................................................................................................ 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? [:]Yes ❑ No ...__...................................................... ___.................. ............................................... _............................................................................. _......................................... ...... .............. ................_........................................... ...................................... _... 8 (II yes', attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I cartify 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 ANDA ORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and slate that the information given is correct. I agree to comply with all stere la and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa toe ter upon the above-described property for inspe ion p oses. I agree not to occupy or allow occupancy of any building authorized by this per until final speclion. ig �OnZ.ad wners) Dat i n Opplicanl--� 7 UDat CODE If SPIJ MON TYP INTMAIL CODE INSPECTION TYPE gA]j IHSS 1616 FVd System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical Jr 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 BuildinglOccupancy (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT .lob Address: 1049 PARKHILL DR Suite No Vicinity: Parcel Nunmber: 42431304 Applicant: JOHN WOLCZANSKI Address: 254 CLAREMONT AV Phone: 562-439-3224 LONG BEACH, CA Zip: 90803 Owner: WELLS, MARY K Address 1049 PARKHILL DR Phone: COSTA MESA, CA Zip: 92627-4534 Contractor: WOLCZANSKI BROTHERS CONSTRUCTION Address: 254 CLAREMONT AV Phone: 562-439-3224 LONG BEACH, CA Zip: 90803 License: 821866 It Status: ISSUED Applied: 04/18/2005 Issued: 04/18/2005 SCOPE OF PERMIT 291 SF ONE-STORY ADDITION WITH 220 SF DECK ABOVE TO EXISTING TWO-STORY SFD. WORK TO INCLUDE: EXTENSION OF EXISTING KITCHEN AND FAMILY ROOM WITH PARTIAL DECK ABOVE; REMODEL OF EXISTING KITCHEN; NEW EXTERIOR STAIR; CHANGE OUT EXISTING SECOND STORY WINDOW TO SLIDING DOOR TO ACCESS NEW DECK. REF.: B04-02032 PLUMBING TO INCLUDE: 1 GAS EARTHQUAKE VALVE, 1 GAS (1-4 OUTLETS), AND 1 KITCHEN SINK. QTY FEESUMMARY AMT ISSUE FEE $23.50 Backflow irrigation $0.00 Backflow Preventer $0.00 Bathtub $0.00 Clarifier System $0.00 Connect (Ice,Soda,etc) $0.00 Dental Units $0.00 Dishwasher $0.00 Drain, Floor S0.00 Drain, Rainwater $0.00 Drain, Roof $0.00 Drinking Fountain $0.00 Expansion Tank $0.00 Gas Earthquake Valve $11.00 Gas (1-4 outlets) $6.15 Gas (Over 4 outlets) $0.00 QTY FEESUMMARY AMT Laundry Tub / Washer $0.00 Landscape Irrigation $0.00 P -Trap $0.00 Pressure Regulator $0.00 Process Piping (per 10 ft) $0.00 Receptors $0.00 Septic Tank $0.00 Sewer Cap for Demo $0.00 Sewer Connect $0.00 Sewer Private Line $0.00 Shower $0.00 Sink, bar $0.00 Sink, commercial $0.00 Sink, Floor $0.00 Sink, kitchen $9.80 Sink, service/mop $0.00 CITY AMT QTY 0 Sump Pump $0.00 0 0 Swimming Pool $0.00 0 0 Trap Primer $0.00 0 0 Urinal $0.00 0 0 Vacuum Brkr Bkflow(1-4) $0.00 0 0 Vacuum Brkr Bkflow(5+) $0.00 0 0 Wash Basin $0.00 0 0 Wash Basin Set $0.00 0 0 Waste and Vent System $0.00 0 0 Water Closet (Toilet) $0.00 0 0 Water Heater / vent $0.00 0 0 Water Piping (Inst or Rep.) $0.00 0 0 Water Re -pipe $0.00 0 0 Water Service $0.00 0 1 Water Softener $0.00 0 0 OTHER $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes,, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit FOR INSPECTIONS CALL: (714) 7545626 '.o -au (aw) DECLARAIrioms WORKERS' COMPENSATION DECLARATION: ' I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this pemtit is issued. ❑ I have and will maintain workers' compensation Insurance, as required by section 3700 of the Labor Cade, 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 it the permit is alued atone hundred dollars ($100) Or less.) -UK it certify that in the perform ce i thew rk f which this permit Is issued, I shall not employ any pe=THE ner so s to bec0 subject to the workers' compensation laws Calif mi and a e t If I should become subject to the workers' compenso Se tion 3200 o the LraDer6ode, Shall forthwith Comply with these to 'sl s. (OY} ApplicanLSgnatfi-W WARNING FAILURE T(5SE WORKERS' COM EN ATION COVERAGE IS UNLAWFUL AND SHALL SUMECT AN EINPL ENALTIES OCMLFINESUPTOONEHUNDRED THOISAND DOLLARE(StOO. I. IN ADDITION TO T OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SEHE LA R OODE. INTEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATI I hereby affirm that I em titans tly(td for i5ions f Chapter (com ening with Section 7000) of Division 3 of the Business and Profess i ns Code, nd my tic is in full _force end.effecL-Lic:.-Y— L Class a -Contractors'Sgnature�— Date: CONSTRUCTION LENDINGENCY2 C]I hereby at that the is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, Improve, demolish. or repair any structure. prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under secr : Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes . ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, i.a: - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 6, Califomia Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). .............._......................................................................................................................................................................................................................................................................................._..........._..................................................................... 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds. or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). _......................'.'r'.............................an't...................-......__....._.............................c'u"............................p,r_e,.................................................................................................................................10r—a......................................_.......nal_......... 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management end Prevention Program for acutety hazartlous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. .......................................................................................................................................................................................................................................................................................................................................................................................... 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No .......................................................................................................................................................................................................................................................................................................................................................................................... 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of thisa plication aSrmil for such construction or modification from the South Coasl Air Quality Management District or from any other air pollution control district or agency? byes LJ No (Section 65850.2 of me 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 teat from the outer boundaries of a school? ❑Yes ❑ No (it "yes*, the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ............................................................................. ............................................................................................ ...................................... ............................................... ......................... ......................... ....................... ............... 7 II a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 . been made? ❑ Yes ❑ No .............. ............................................................................................................................................................................................................................................................................................................................................................................ 8 (II yes', attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHOR VATION OF ENT : I comity 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 ordinance lacing to building construction, end authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agr a not ccupy or allow occupancy of any building authorized by this perp it until final spection. LA Signature f al a Is a An zed"Appel fi- CODE .,26H INLLAL@ CODE INSPEC71ON TYPE pArE IWITIAL9 1616 VSpy.'Firml stem Final Fire Prevention 206 Final Mechanical 1266 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical 201 Final Block/Relaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 MECHANICAL PERMIT Job Address: 1049 PARKHILL DR Suite No Vicinity: Parcel Number: 42431304 Applicant: JOHN WOLCZANSKI FEE SUMMARY Address: 254 CLAREMONT AV Quantity Phone: 562-439-3224 ISSUE FEE LONG BEACH, CA Zip: 90803 Owner: WELLS, MARY K Inst FAU <100 k BTU $0.00 Address: 1049 PARKHILL DR $0.00 0 Inst FAU >100 k BTU $0.00 Phone: Ventillation System $0.00 COSTA MESA, CA Zip: 92627-4534 Contractor: WOLCZANSKI BROTHERS CONSTRUCTION Address: 254 CLAREMONT AV Inst / Rep. Recess Wall HV $0.00 0 - - Phone: 562-439-3224 Refrig Sys <100 k BTU LONG BEACH, CA Zip: 90803 $0.00 0 License: 821866 Status: ISSUED Applied: 04/18/2005 Issued: 04/18/2005 SCOPE OF PERMIT 291 SF ONE-STORY ADDITION WITH 220 SF DECK ABOVE TO EXISTING TWO-STORY SFD. WORK TO INCLUDE: EXTENSION OF EXISTING KITCHEN AND FAMILY ROOM WITH PARTIAL DECK ABOVE; REMODEL OF EXISTING KITCHEN; NEW EXTERIOR STAIR; CHANGE OUT EXISTING SECOND STORY WINDOW TO SLIDING DOOR TO ACCESS NEW DECK. REF.: B04-02032 MECHANICAL TO INCLUDE: 1 REPAIRIALT COOLING/HEAT AND 1 HOOD W/MECH EXHAUST. 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 expirationfo this permit._ FOR INSPECTIONS CALL: (714) 7545626 2a64616roo1 FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Repair/ Alt Absorption 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 HV $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 / 100k BTU $0.00 0 Factory Fireplace $0.00 0 3 To 15 hp 1500 k BTU $0.00 0 Hood w/Mech Exhaust $10.65 1 15 To 30 hp 11,000 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 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 expirationfo this permit._ FOR INSPECTIONS CALL: (714) 7545626 2a64616roo1 WORKERS' COMPENSATION DECLARATION: - I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to sell -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permil is issued. ❑ 1 have and will maintain workers' compensation Insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance tamer and policy number are: Cartier: Policy Number: (This section need not be completed if the permit is valu/��WJ e hundred dollars ($100) or less.) ®�'I certify that in the p onneppce of the wor♦c io hlermit is issued, I shell not employ any person In any ma4LAR o becom subject to the workers' _� mpensafion law o C Its, nla, rid egr a t' t If become subject tothe workers' compensation provision3700 of a Labor Code, I shall forthwith comply with these visi ((s. Applicam$igneture:-- rDale:- WAIRNWG>FA RE TO SE E WORKERS' OOMPENSATI C ERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLDYER`TO CALTIES D CML FINES UP TOONE HUNDRED THOUSAND DOL41REfSR00. I. INADIXT TOTHECOS OFGOMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION WOSOF ODE, INTEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I herebyainn.Ihal Lam license nder pro i s of Chapter 9 comm ng with Section 7000) of Division 3 of the Business an Prof sions e, and rise is in full _force'and effect..Lie-9-J �C s a 7 Contractor's Signature: �-Date:--, �iLU I CONSTRUCTION LENDING A NCV: ❑ 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.1 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"isexempt 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 contractors) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend- will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ............................................................................................................................................................................................................................................................................................................................................................. _ .......................... 2 Does or will Ina applicant or present or future building occupant need to fila 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 Io or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ...............___....................._.............................._.__................... _................ _._.................... __.................... _.................................................................................. _._..................... _......... ___............... ... 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ........................................................................................................................................................................................................................................................................................................................................................................................... 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No ................................................................................................................................................................................................................................................................................................................................................. 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application aPPermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? UYes LJ No (Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits). .................................................................................................................................................................................... _.................................................................................................................................................................................................... 6 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Ves ❑ No (II yes', the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ....................... I....... .......................................................................................................................................................... ................................. .......................... ...................-.............. .......................................... ....................... 7 a permit from the South Coast Air Quality Management District or other elm pollution control tl0or agency Is r for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 3 been made? ❑ Yes Ves [I No 8 (If'yes', attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: 1 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 Y: 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 ordina as relating to building construction, and authorize representativ s of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree n to occupy or allow occupancy of any building authorized by this D rmit until fi al inspec Sig t e l eg wner(s I a CODE I, gejE II171LAL$ G.ggj( INSPECTION TYPE IQ IHprA`g 1616 7eSystem Final Fire Prevention 206 Final Mechanical1266 a Fine l 208 Final Plumbing 200 Final Re -Root 210 Final Electrical 201 Final BlocWRetaining 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 MAR -31-2008 08:41 TENET CALIF March 31, 2008 Ed Petros Chief of Inspection City of Costa Mesa PO Box 1200 Costa Mesa, CA 92628 RE: Property Address: 1049 Parkhill Drive Costa Mesa, CA 92627 Permit #'s:B04-02032; E05-00335 Mr. Petros, 714 428 6701 P.01i01 I am writing this letter to find out how to re -open my expired permits for final inspection. I had a remodel which included an addition to my home, and my contractor left me stranded when the house was almost complete. I had your inspectors out and they signed off on some of my permits, and gave me a list of work on the others. I am a single mother and had paid my contractor to complete his job, but ended up having to pay people to come out and finish my house. Since I have limited financial resources, it took me some time to get all the unfinished work done. Please let me know what I need to do to get my permits re -open and signed off. I also had permit # M05-00188 and P05-00268 which I believe were signed off by Henry, I appreciate your help, Respectfully yours, Mary Wells TOTAL P.01 5937 E. Naples Plaza Long Beach, CA 90803 Tel.: (562) 433-8882 Fax. (562) 433-1306 Par`lee Eng�neemg May 18, 2005 Owner: Mc_ Wells ---- Address: _____Address: 1049 Parkhill Dr. Costa Mesa, CA 92627 To whom it may concern: We at Parlee Engineer'_�� testify that the footing at the steel column can be poured on 2 times, leaving a 18 . `t}e16t- DCtween two pours. If you have any question please feel free to call us at our office. Sincerely, Khalil M. Shakhtour Structural Con3ulkng & Deszgn R&q&n621 &Commensal (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 1049 PARKHILL DR Suite: Vicinity: Parcel Number: 42431304 Zoning: 09/10/2001 Applicant: EVE,DA-RYL $0.50 Address: 5151 WALNUT AVE #2 " Other: $0.00 Phone: (949)653-5722 IRVINE, CA Zip: 92604 Owner: WELLS; HENRY TR Address 1049 PARKHILL ' Phone: " "COSTA MESA, CA Zip: 92627 Contractor: SUNDANCE ROOFING CO Address: 5151 WALNUT AVE #2 Phone: (949)653-5722 IRVINE, CA Zip: 92604 License: 718369 Status: ISSUED Applied: 09/10/2001 Issued: 09/10/2001 ISSUED BY: CZ2� Arch Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT TEAR OFF WOOD SHAKE & CAP SHEET . REROOF WITH 30 YR COMP WITH 30 LB ASTM. TORCH DOWN MODIFIED ROLL ROOFING ON THE FLAT SECTION. - Plan Check: $0.00 Permit: $97.25 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $97.75 SETBACKS MAIN STRUCTURE Front 0-0 ACCESSORY Front 0-0 PARKING Existing: 0 NOTES: FEE SUMMARY Calc Valuation: Claim Valuation PLANNING & ZONING Rear 0-0 Left 0-0 Right 0-0 Rear 0-0 Left 0-0 Right 0-0 Required: 0 Proposed: 0 $3,900.00 $3,900.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 244646 (6/00) 14 W KERS' eOMPENSATION DECLARATION: 1 hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to salt-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for therrformance of the work for which this permit is issued. - I have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance carrier and policy number are: Carrier: Policy Number: This section need not be completed if the permit is valued at one hundred dollars ($100) or less.) I Certity that in the parto mar i i i,rthlTw I i, i i iSI'ch this Pel s issued, I s all not employ any person in any manner so as to become subject to the workers' Compensation I Califc le,-arr ree a f 1 sh Id ecom s h workers' compensation provisions of S Grtion 37QQ90 of the Labor Code, I shall forthwith compI y with tti $e pro 'on a--��jiJ / Applicant Signature: - Date: _ _ WARNING: FAILURE TO ECURE WORKERS' COMPENSATION COVERAGE I LAWFUL AND SHALL SUBIECT AN E PLOYER T RIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED USAND $100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FORIN SE 1060E THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES, LICENSED. CONTRACTORS DECLARATION: i---� "� I hereby-affirm/ that 1 am titans dVfiCa � visions o h t (c mmencing with Section 7000) of Division the Business a I� rofaeyj®s Code, and my license is in full foice end�effeot. .. / Class # —S r Contractors Sig lure: i Date: / CONS UCTI LENDING AGENCY: ❑ I h y affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). ders 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 pertN' 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 contractors) 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 ❑ 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 live (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200cubic 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. ❑Ves ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). .......................................................................................................................................................................................................................................................................................................................................................................................... 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials). ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ............................................................................................................................................................................................................................................................................................. ................. 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No ............................................................................................................................................................................................................................................................................................................................................................................................ 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication aermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes a No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). .............................................................................................................................................................................................................................................................................................................................. fi Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? Yes No (If yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ................................................................................................................................................................................._........................................................................................................................ 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No ......................................................................................................................................................................................................................................................................................................................... 8 (If yes", attach certificate of compliance tram 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 pro tion oses. a ree not to occupy or allow occupancy of any building authorized by this permit until final inspection. r %w 1 r(s) And r orizedApplicant CODE t, INSPECTIONTYPE !L INTITIALS CODE N INSPECTION TYPE RiIQLA4 $ 1616 Fixed System 206 Final Mechanical Final Fire Prevent) n 1266 Pool Spa Final 208 Final Plumbing � "�� 210 Final Electrical 200 Final Re-Roof _a 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 CITY OF COS`IA MESA REQl TRACT N0,_,yo �3 " LOT NO._, ADDRESS% �T FOR OCCUPANCY DATE The developer of the above entitled tract desires to sell the above set forth lot prior to the time that the tract has been completed and its streets accepted by the City of Costa Mesa The undersigned, by execiting this agreement, acknowledges that (he-she-they)Z_...(was or wereZ�il�/✓_ advised that this tract has not been given final inspection nor has it been accepted by the City of Costa Mesa as having complied with _he conditions of approval which were imposed by the city at the time the final tract map was approved. The city assumes no liability for the enforcement of the conditions necessary for approval other tlian those conditions protected by surety bond. The undersigned agrees to indemnify and hold the city harmless from any claim resulting in damage or personal injury to the undersigned by reason of the aforementioned uncompleted condition. Purchaser elopcx--axsaiork_ tKoeizea epresentative BY , Le ' er Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. :ITY OF COSTA MESA COaN ST UCLL�(T; N PERMIT Project Address, I�� 0 4.r�� Applicant's Mailing Address)) S(2 let t Owner's Name ' JB L i Phone Address Arch/Eng. _ License No. Address Contractor's Nam n6/s/_-1.-,�� Address (mailing) City LicenseNo. 3073,- _' LICENSED CONTRACTOR DECLARATION khereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and no license is in 11 f antl effect. License lass gi��pp!! Lic e N Date l.i— Signature WORKERf- COMPENSATION DECLARATION !,hereby affirm that I have a certificate of consent to self -insure or a certificate Workers' Compensation Insurance, or a certified copy thereof (Section y, ^b0, Lab. Pol No.lN7LfCL— Company I ad copy is hereby furnished. Certified co J led with the city B Ivisio Date Applicant41, 41 EXEMPOI150elFROM WORKERS' COMPENSATION DECLARATION (Thissection need not be completed if the permit is for one hundred ($100) or less). certify that in the performance of the work for which this permit is issued, I shall not employ any parvo in any manner so as to become subject to the Workers' Compensa ' n' 2 of California. Date nature NOTICE: If, afte m C t is declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply .with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which thi;�p�r�f° is issued (Section 3097 Civ. C.) Under's Name Leader's Address _ OWNER BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional 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/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt "herefrom and the basis for the alleged exemption. Any violation of Section -=031.5 by any applicant for a permit subjects the applicant to a civil PS'enalty of not more than five hundred dollars ($500). ❑ I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im. Eve for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed Con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractor(st license pursuant to the Contractor's License Law). I am aware that proof o// their Worker's Compensa insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason ' Date weer '1 I hereby certify that I have read this application and state that the above Information is correct. I agree to comply with all city and County ordinances Signature Drivers' License or SS # on, and hereby authorize repre- above-mentioned or per Date TYPE OF CONSTRUCTION LI NEW IJ ADD LJ ALTERATION - LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. TYPE OF PERMIT _ LJ GRADING LJ_9GHNDATION LJ STRUCTURAL ❑ TENANT Cl ELECTRICAL L6TPLUMBING ❑ MECHANICAL_ - ❑ OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY— CONSTRUCTION CCUPANCY— CONSTRUCTION TYPE VALUATION $ ZONE GRADINGCU.YDS. ACRES Remarks: Reinspection Fee i $15 1 Issue Fee'. $ 3 Boiler Hood or Type 1 ❑ Duct - Under Ground Canopy Type 11 ❑ Duct -Structural Refrigeration System Duct -Ventilating ❑0-100,000BTU ❑100,000 Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBO # Heating System & Ducting E10-100,000 BTU ❑ 100,000 BT Reinspection Fee 1 $15 1 1 Issue Fee CMF 0865-46, rev. 4/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod -Assessor $ 3 PLUMBING 3ar Sink - Showers 3ackflow Preventer--' - Service Sink 3ackflow Irrigation Sewer Cap 3athtubs ' Sewer Connection Clarifiers Solar Collectors Dishwasher Solar Piping Drinking Fountains Solar Tank Floor Drains Swimming Pool W/Spa Floor Sinks - Urinal Gas Service Outlets Water Closet - Interceptors Water Heater Kitchen Sink 'Water Service Lavatories - - P—Trap - Roof Drains ' Ping. Ref. # Reinspection Fee i $15 1 Issue Fee'. $ 3 Boiler Hood or Type 1 ❑ Duct - Under Ground Canopy Type 11 ❑ Duct -Structural Refrigeration System Duct -Ventilating ❑0-100,000BTU ❑100,000 Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBO # Heating System & Ducting E10-100,000 BTU ❑ 100,000 BT Reinspection Fee 1 $15 1 1 Issue Fee CMF 0865-46, rev. 4/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod -Assessor $ 3 Automatic Washer . Construction Poie Sub. Cooking Unit' - Dishwasher Dryers ❑Gas ❑Elec' Fan F.A.U. Fixtures - Device Boxes Outlets Switches Garbage Disposal Generator ❑0-5 KW C Fee ELECTRICAL Transformer ❑-15-50'KW - ❑ 50+KIN Meter ❑up to 100 amps Meter ❑over 100 amps Sub Panel Motors E10-1 HP ❑ 1 % - 8 Inc. Solar 09;15 HP 1:116-15+ Pole Light Range Sign ' Standing Sections 5 KW Trash Compactor $15 I I Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By FEES $ 3 8008 2/21/85 590, A.P. # Zone $ S Main Building: Accessory Building: PLUMBING $ S'— ISSUANCE E T Front I -' $ Z O B A Rear •' $ MICROFILM N I C Right $ N KG S Left R Ping. Ref. # Par king'Req./Provided E Planning Notes: M S,S. Automatic Washer . Construction Poie Sub. Cooking Unit' - Dishwasher Dryers ❑Gas ❑Elec' Fan F.A.U. Fixtures - Device Boxes Outlets Switches Garbage Disposal Generator ❑0-5 KW C Fee ELECTRICAL Transformer ❑-15-50'KW - ❑ 50+KIN Meter ❑up to 100 amps Meter ❑over 100 amps Sub Panel Motors E10-1 HP ❑ 1 % - 8 Inc. Solar 09;15 HP 1:116-15+ Pole Light Range Sign ' Standing Sections 5 KW Trash Compactor $15 I I Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By FEES $ 3 PLAN CHECK 25% $ SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ S'— ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $C�- MECHANICAL • $ TOTAL FEE $ PLAN CHECK 25% $ CONSTRUCTION AND PLANNING APPROVALS Permit # , Date Inspector POOL PA 'APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole,, - 52. Pool & Equipment Location 2. 'Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. - •� .' 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement - - . - 56. Rough Plumbing & Pressure Test -, 6. Electrical UFER"Grnd. - 57. APPROVAL TO COVER-GUNITE T. 'Footings '• ,� i14 • 'f 58. Electrical Conduit-Undrgrnd. � 8. Foundation ,r' - 59. Gas Pipe, 0 Undrgrnd., Test 9: Water Pipe-Undrgrnd., 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK - 11. Property Sewer Line & House Connection, 'r' 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 APPROVALS Permit # 20. Rough, Factory Fireplace !, 21. Ducts, in Structure r' 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas •E] Oil 23. Gas Pipe-Rough & Test - - 72. Underground Flush 24. Roof Framing - 73. Undergrnd. Storage Tank O Gas' Doll 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 �;,- r ,HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or,Canopy - 37. Final Factory Fireplace - 38. Final Plumbing I (gyp 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final ' 42. Backflow Preventer - 43. Backflow.lrrigation ..,, .. .. 44. -Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release,to Edison - - 50. Gas Release to Southern California Gas Co ' 51. CERTIFICATE OF OCCUPANCY No. - Date ' 46,- 3 PAID J i'..BR 7_h-7lcnsn00 6e2rr ***133.50 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 Z . d U I- Z Z_Q O (n am J Z) J N aW m J 00 J Q U U Za WCC aW JO m Z J � W W Z I- WC N 2 �O lot— For Applicant to Fill in Completely 4-2 APPLICATION FOR BUILDING PERMIT RECEIVJjDBV s DTE RE EIVED — / DAjLoan BUILDING ADDRESS A.P. NO.MAILADDREs PEOWNER ADDRESS 66 Via-LidoTEL. 1049 Parkhill Dr. _ NC&73_1 330CONSTRUCTION TRACT 7043 LOT2#CITY W p`LENDER same ------ Im erial Savin s &ADDRESS BRANCHOWNER VALUE SE % $OR ARCITECTTE ENGINEER NFIRE ZONE TYP GROUP ADDRESS 2 Via -O Ort Ne t-Bc APPROVED CONTRACTOR B V DATE ADDRESSL510B CITYNewport—BeachNOL _8833 ZONE Rl NO. OF PLANS 2 USE OF NEW BUILDING R A STATE CITY YARDS APPROVED YARDS APPROVED LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING SIZE NO. OF BLOCS. OF LOT 0 X OIL NOW ON LOT 0 (FROM C/L S EET) FRONT h FT. FT. USE OF EXISTING BLDG. Ll R. SIDEJ FT. FT IZE OF 8 • EWBLDG. 1620 NROOMS 6 STORIES 2 L. SIDE FT. FT. EXTERIOR WALLl,, COVERING sLilcc0 ROOF COV ERING .911HI{e- REAR 0 IFT. FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN 8i MAIN BLDGS. ACCESS SLOGS. residence VAR.* C.U.P.# DATE APPROVED APPROVED WLD: am DATE 3-24-71 1 hereby acknowledge that I have read this application and state that the above Information is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of O. FT. .4116 the State of California. I hereby certify that I am properly licensed as a contractor under THE AMOUNT SHOWN UNDER ALUATION IS FOR the State of California Business and Professions Code, Division 3, Chapter 9, and that such licenses are In full force and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am ivkion exempt from t provisions of the Stojp .Ilfornia Business antl Prof essi ode, .Cha er9. Signat Permittee VALUATION $ � l 3 // PERMIT FEE $ ♦ CJ PLAN CHECK $ r �� Auth z Agent TOTAL FEE $ / 3 O