The URL can be used to link to this page

Home My WebLink About209 PAULINE PL - Building Permits(714) 754-5273 • Faz (714) 754-4856 • www.ci.coste•mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 GRADING PERMIT JobAddress: 209 PAULINE PL Suite: Vicinity: Parcel Nunmber. 42614104 /+pplicant: PAGE, KERRY Address: E��E� � Zoning: OATE'' ISSUED BV: Phone: 949-675-7555 Zip: 92660 Owner: SIMPSON REVOCABLE FAMILY TR Address 2031YACHT DEFENDER CHARLES R AND ELIZABETH A Phone: NEWPORT BEACH, CA Zip: 92660 Contractor. R S MYERS COMPANY Address: 3500 E COAST HIGHWAY STE 10 CORONA DEL MAR, CA 2ip: 92625 Eng: ALPINE ENGINEERING, INC Address: 23011 MOULTON PKVJY J12 LAGUNA HILLS, CA Zip: 92653 Phone: 949-675-7555 License: 685215 Phone: 949-855-8058 License: C35715 Siatus: ISSUED Applied: O6/29/2007 Issued: 08232007 SCOPE OF PERMIT CUBIC VARDS GRADING FOR NEW SINGLE FAMILY DWELLING. 140 CUBIC YARDS OF FILL. NO CUT. MINOR SITE IMPROVEMENTS. REF: 607-b0200. iao Plan Check: S33.00 $0.00 Permit: $0.00 Other: $0.00 30.00 Inspection: S0.o0 $0.00 Total: $247.96 NOTES: FEE SUMMARY � PLANNING & ZONING Calc Valuation: 53,soo.00 � N077CE: The work authonzed by this permit shall comply with all applicable handicap access requiremenis 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 ortler for �he work authorized under ihis permit to be consldered legal, such work must comply with all applicable codes, and all requlred Inepeetione and tinal approval must be obtainetl. Failure to obtain inspections and final approval will resul� in the expiration of ihls permit. FOR INSPECTIONS CALL: (714) 754-5626 . " zaas�ae (6roo) WORKERS'COMPENSAnONDECLARAnON: 1 hereby eHirtn under penalry of perjury one ot the following declarations: ❑ I have antl will meintain a certiflcete of consent to seli-Insure for workers' compensatlon, es provlded for by sectlon 3700 of the Lebor Cotle, fo� Ihe pertormenca of Ihe work for whlch this permit is issued. [Y]' I have and will maintain workers' campensation insu2nce, as required by sectlon 3700 ot the Lebor Cotle, tor the peAortnance of Ihe work for whlch Ihis pertnit Is Issued. My woO�wmpencs�a�n I�rance carAer antl pollcy number ere: /�'� O b � y �Z �p CaMer. 1� � �T Policy Number. b (Thls section neetl not be comp/eted I! (he permif is ve/ued e( one hundred dollars ($100) or Iess.J ❑ I cenify that in the peAormence of the work tor which this permit is issuecl, I shall nol employ eny person in eny manner so es to become subject to Ihe workers' compensetlon lews of Calitomle, entl egree ihat Ii I should become sublect to Ihe workers' compensation provislons ol SecNon 3700 of ihe Lebor Cotle, I ahall forthwith comply with ihese D�a�slons. , � � . �O� Applicent Slgneiure: �_� Dete: �_� WARNINO: FAILURE TO SEW RE WORKER5 OOFAPENSATION dJVERAGE IS UNLAW Fl1L AND SNALL SUBJECr AN EMPLOVER TO CRIMINAL PENPLTIES AND CML FlNES UP TO ONE HUNDRED THOUSAND DOLIARE (5100.OD0), IN ADDITION TO THE W5T OF COMPENSATION, DAMAGES AS PROVI�ED WR IN SECTION 3]OB OF THE LABOR CODE, IMEPEST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby ettirtn that I am licery� e unAer ovisions of Chapter 9(commencing with Section 7000) oi Division 3 of Ihe Busi^�j and Professions Code, end my Iicense Is in tull force and effect Uc. N b� S� � S Class a �S Contrectots SlgneNre: Date: � `�(�� Z�O�/ � CONSTRUCTION LENDING AGENCV: ❑ I hereby eNirm that there is a conslruction lending egency for the pertormance oi the work tor which this permit is issued. (Sec. 3097, Civil Code). Lentlers Name: Lenders AOtlress: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby efllrtn thet under penalry ot per�ury ihet I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5, Business end Professlons Code: Any city or counry which requires e permit to consiruct, alter, improve, tlemolish, or repair any stmctura, prior to Its issuence, also requires the appllcant tor such pertnit to flle e signed statemeM that he or ehe Is Ilcensed pursuent to the provislons ot tha Comractors License Law (Chepter 9(commencing wlih Sectlon 7000) of Dlvision 3 ot ihe Business end Protesslons Code) or iha� �e or she is exampt Iherefrom entl I�e besls tor the alleged eaemption. Any vloletlon of Section 7031.5 by eny epplicent for e pertnit sublecis the epPlicent to e civil penalry ol not more than five hundred dollars ($500).): � I, as owner ot Ihe property, or my employees wlth weges as iheir sole compensetion, WILL DO THE WORK, entl ihe structure is not intendeG or ottered for sale (Sec. 7044, Businass and Professions Code: The Contrectors License Law tloes not epply Io an owner ot property who builds or improves thereon, and who tloes such work himself or hersalf or through his or her own employees, D�ovitletl thet such Improvemenis ere not intentled or ottered for sale. If, however, ihe building or Improvement is soltl within one year ot completioq t�e owner-builtler will have ihe burden ol provinq Ihat he or she did not build or improve for puryose of seleJ. � ❑ I, es owner ol lhe properry, em E%CLUSIVELV CONTRACTNG WITM LICENSED CONTRACTORS to construct the project (Sec. 70E4, Busines5 end Professions CoAe: Ttie cantractors License Lew tloes nat appry to en owner ot pmperry who builtls or Improves thereon, and who contracts for such pro�ect with e contwctor(s) license Oursuant to the Contracmrs License Laws.). ❑ I am exempt untler sec. Signeture: Owner ID varitietl by tlrivets license. ❑ Ves ❑ No Business end Prolessions Code for ihis reason: Verllication ot Ownership by (rypa of daument, i.e. - properry tax bill or deed): DIVISION OF INDUSTPIAL SAFETY PERMIT CERTIFILATION: Drivefs License No. Date: Expires: ❑ I hereby certity that no axcavation five (5) or more leet in depth into whic� e peroon is requlretl to descentl, wlll be mede in connection with work authorized by this pertnit, end Ihat no building siructure, scettoltling, lelsework, or demolition or dismantling �hereot, will be more than thirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Ti11e 8, Celifornie Administretive Code). ❑ As ownerbulider, I will not employ enyone to do work which would raquire e pertnit tmm Ihe Division ot Intlustdel Sefery, as noted ebove, unleu such person has e permii to do such work tram the division. SignaWra: Date: Divislon ot Intlusirial Satety Pertnit Number. CERTIFlCATE OF COMPLIANCE AND AUTHORVA710N OF ENiAY: I certify untler Denalry of perjury ihat I have read this epplication antl state that ihe iniorme�ion given is wrred. I egree to comply with ell state lews an0 city orGinances relating to bullding consiruction, and authotlze re0�esentatives of Ihe Clry of Casta Mesa to enter upon the ebove-described property tor inspection purposes. I egree not to occupy or allow occupancy of any building authorized by this pertnit until final inspaction. Signature Of Legel Owner(s) �� a�g i nY� �.i - 7 GK� And/OrAuthorized Applicant Date cooe �. ixsvecnoNnae 1616 Fixed System Final Fire Prevenlion 1266 Pool Spe Finel 200 Finel Re-Roof 201 Final BIocWRetaining Wall 202 Final Factory Fira Place 203 Finel Sign 204 Finel Demalition pe¢, 1�¢ �Qpf�j INSPECiIONTYPE 206 Finel Mechenical 208 Final Plumbing 210 Final ElecMcel 212 Final Fire Praventlon 220 Final Planning Apprwal 222 Final Slte 250 � Final Building/OCcupency P�ff. I�� COAST GEOTECHNICAL, INC;.� � � 14747 Artesia Blvd., Suite 1-D, La Mirada, CA 90638 Ph: (714) 521-0169 or (714) 521-2827 Fa�c: (714) 521-0179 ' .. � _-._-._-_.. __.- � "-_: - _ - , ,. _ _ : _ �_ _ - _ - —_--' _ .. -'. ' ' -_ -'�' `._.__- �' -.�._ �. -. . "_ ' - �� '�� `� 0 October 22, 2007 � � � � J � _� � L % �V.O. 330307-01 Mr. Andrew Terpstra 3254 Washington Ave. Costa Mesa, CA 92626 �� l�p Subjecr. Rough Grade Compaction Report, Proposed Residence, 209 Pauline Place, Costa Mesa, Califomia Reference: 1. Geotechnical Enginecring Investigation of 209 Pauline Place, Costa Mesa, Califomia; by COAST GEOTECHN[CAL, INC., W.O. 330307, dated January 24, 2006. Dear Mr. Terpstra: Forwarded here��ith is the rough grade compaction repoR for the subject site. The grading opera[ion was conducted from October 17, 2007 to October 19, 2007 utilizing the referenced geotechnical report. PLACEMENT OF FILL Compacted fill material was placed on the subject site to provide adequate support for the proposcd struclurc. Overexcavation extended down to competent native earth material. The depth of overexcavation was about three feet below original grade. The exposed surface was scarified, moisture conditioned, and compacted to a minimum of 90% relative compaction. Subsequent on-site and import fill soils were blended and placed in six to eight inch loose lifts and compac[ed to a minimum of 90% by rolling. Finish rough grade is near original grade. Limits of grading are shown on the attached Plate l. Equipmen[ used for compacting the fill soils consisted of an excavator and a Cat 953-track loader. Soils were moisture conditioned as necded. rarthwork was by Tight Quazters, Inc. � TESTING Maximum density optimum moisture relationship de[erminations �vere performed for each soil type encountered during b�rading operations. Test results were as folloa•s: Laboratory Standard: (AS7'M:D-1557) 4-inch diameter mold; 1/30 ft' volume; 5 layers at 25 blows per layer, ]0 lb. hammer dropped 18 inches COAST GEOTECHNICAL, INC. �lc "Ce�pstra 2 W.O. 330307-01 Roueh Grade Compaction Report October 22, 2007 Soii Type Classification Optimum Moistwe, % ivtax. llry Density, lbsJfi' I Orange Brown, Silty Sand 9.0 125.0 II Orange Brown Silty I�inc �� 0 120.0 Sand Compaction tests were performed a minimum of every hvo feet and/or 500 cubic yards of compacted fill soils placed. "I�hese tests were performed in accorda��ce with ASTM test method. The test results are summarized in Table I. The approximate test locations are sho��m on Plate l. FOUNDATIONS—COMPACTED FII.L 'I'he proposed structures may bc supported by continuous spread footings only placed a minimum depth of 24 inches below lowest adjacent },Tade utiliz,ing an allowable bearing value of 1,800 pounds per square foot This value is for dead plus live load and may be increased 1/3 for total including seismic and wind loads where allowed by code. Isolated pad footing should be [ied to con[inuous footings with gradc beams. Foundations should be rei�forced with at least four #4 bars, [wo top and rivo bottom. Footing excavations shall be obscrved by a representative of COAST GL07'L'ChINICAL, [NC. prior to placement of steel or concrete to verify competent soil conditions. If unaceeptable soil conditions are exposed mitigation will be recommended. LATERAG DES[GN Lateral restraint at the base of footings and on slabs may be assumed to be the product of the dead load and a coefficient of friction of 35. Passive pressure on the face of footings may also be used to resist ]ateral forres. A passive pressure of zero at the surface of finished grade, incrcasing at the rate of 300 pounds per square foot of depth to a maximum value of 3,000 pounds per square foot, may be used for compacted fill at this site. If passive pressure and friction are combined when evaluating the lateral resistance, the value of the passive pressure should be limited to 2/3 of the values given above. EXPA�SIVE SOILS Results of expansion tests indicate that the near surface soils have a very low to lo�v expansion potential. Irrigation should be controlled and limited around foundations. FLOOR SLABS Slabs on grade should be atleast four inches thick and reinforced with #3 bars on 18-inch centers both ways. The slabs shall be supported on engineered fill compacted to a minimum of 90%� relativc compaction. Subgrade soil should bc kcpt moist during construction. "Che subgrade shall be presaturated to 3 to 5% over optimum moisture contcnt prior to visqueen placement. In arcas where a moisture sensitive floor covering will be used, a vapor barrier. consisting of a plastic film (6 ml polyvinyl chloride or equivalent) should be used. The vapor barrier should be properly lapped and sealed. T�vo inches of clean sand should be placed below the vapor bartier for perforation protection. Since the vapor barrier will prevent moisture from draining from fresh concrete, a better concrete finish COAST GEOTECHNICAL, INC. Mr. Terpstra 3 �V.O. 330307-0] Rough Grade Compaction Report October 22 2007 can usually be obtained if at least two inches of sand is also spread over the vapor barrier prior to placemen[ of concre[e. HARDSCAPE Gxterior hardscape shall be underlain by a minimum of 12 inches of engineered fill soils, and designed for low expansive soil conditions. If cracking of concrete cannot be tolerated the use of flexible pavers should be considered. POST-GRADINGSERVICES lluring construction of the residence, it is recommended, and at times required by the regularory agency, the following be observed and/or tested by the geotechnical engineer: • Excavation of footings • Testing of interior slab areas • Backfill of interior trenches • Backfill of exterior utility trenches • Hardscape subgrade It is the responsibility of the developer to schedule the required observations and testing. REGtiLATORY COMPLIANCE I hereby certify that the subject grading was observed by a representative from this office, and the work was done in Cul] compliance with the Grading Ordinance of the City of Costa Mesa and in accordance with the best accepted practices o£the applicable chapter of the California Building Code. All cuts, fills or processing of original ground under the purview of this report have been completed under the observation of and with selective testing by COAST GEOTECHNICAL, INC. and found [o be in compliance with the Grading Code oC the City of Costa Mesa. The completed work has been observed by COAST GEOTGCHNICAL, INC. and is considered adequate for the development. Our findings were made and recommendations prepared in accordance with generally accepted professional engincering practices, and no further wananty is implied nor made. This report is subject to review by the controlling authorities for this project. We appreciate this opportunity to be of service to you. Respectfully submitted: COAST GEOTECHNICAL, INC. �� Ming-Tarng Chen� RCE 54011 L (�� -�� aniel E. Here Staff Geologist COAST GEOTECHNICAL, INC. Mr.Te�psVa 4 \V.0.330307-01 Koueh Grade Comoaction Report October 22 2007 COMPACTION TEST RESULTS TABLE 1 Below Moisture Dry Unit Relative Test Location Proposed Content Weight SO1� Compaction Date No. Grade (ft) "/o (Ibs/ft') Typc p�a 1 Pad Arca 3.0--3.5 8.0 1 16.1 I 92.9 10/] 8/07 2 Pad Arca 3.0-3.5 9.0 116.6 I 93.3 10/18/07 3 Pad Area 1.5-2.0 9.2 116.8 1 93.4 10/18/07 4 Pad Area 1.5-2.0 9.4 117.1 I 93.7 10/18/07 5 Pad Area 3.0-3.5 8.0 113.5 1 90.8 10/18/07 6 Pad Area 1.0--1.5 9.5 109.4 Il I1.1 10/18/07 7 Pad Area 0.5-1.0 10.2 109.9 II 91.6 10/18/07 8 Pad Arca P.G. 12.5 I 16.6 1 93.3 10/19/07 9 Pad Arca P.G. 13.4 I 15.4 1 92.4 10/19/07 10 Pad Arca P.G. 12.0 I 14.3 1 91.4 10/19/07 P.G. --- finish gradc ___T�� 4rY t/NES SITE PLAN �� Approximate ;_;B]6� Limits of Grading ��, a � o '��: � � �w 0 0 e o �� o 0 c Z r Approximate Compaction Test Location �' �a� C�j � i .: . ss,. y — --� +� N50'GO'00'\✓ 58.0� r��l .�_— -- WI— —' \ _ � _ _ Rough Grade Compaction Report Work Order 330307-01 209 Pauline Place C t M C I�f Plate No. 1 os a esa, a i omia COAST GEOTECHNICAL, INC. 4 CITY OF COSTA MESA P.O. BOX 1200 � 77 FAIR DRIVE � CAIIFORNIA 92628-1200 DEVELOPMENTSERVICES DEPARTMENT BUILDING DIVISION COURTESY NOTICE OF PERMIT EXPIRATION July 9, 2010 Stephen S. Terpstra Q%� 3254 Washington Avenue Costa Mesa, CA 92626-2249 PERMIT NUMBERS: G07-00019 209 Pauline Pi., Costa Mesa, CA FOR: Grading for New Single Family Dweliing Our records indicate the above listed permit(s) were obtained for property improvements or alterations at the above address. Per fhe 1997 Uniform Building Code, Section 106.4.4 Expiration, permits are valid for 180 days from the date of such permit, or the date of the last inspection for the project. Our records do not show an inspection for these permits within the last 180 days nor have they had an approved final inspection. If you have a signed inspection card showing that an inspecfion was made within 180 days, or fhat the final inspection was approved, please contact this office so we may correct our records. If you do not have an approved final inspection, your permits will expire on July 20, 2070. Additional fees will be required to finalize expired permits. Requestinq an inspection - If you need to request an inspection, please call our Inspection Request Line at 714-754-5626. Requestinq an extension -If you wish to request an extension, requests must be made in writing addressed to Bill Rlunes, Chief of Inspeciion at the above address, detailing circumstances and listing an estimated date of completion. If you have any questions, please contact the Building Division at 714-754-4871, between 8:00 a.m. and 4:30 p.m., and a staff member will assist you. The accuracy of records affecting your property is our goal and we appreciate your working with us to resolve this matter. Sincerely, IJn�d,,v� � Barbara J. Zwart Office Specialist II cc: RS Myers Company Builtlinq Division (719) 754-5273 • Code Enforcement p14) 754.5623 � Planning Division (714) 754-5245 FAX (714} 754-485G • TDO p14j ]54-5244 • �wrvtci.co5ta-mesa.ca,us CITY OF COSTA MESA . BYILDING DIVISION i � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.w.us °. POR INSPECTIONS CALL: �(714) 754-5626 4arowrt �� PERMIT NUMBER: P07-00574 PERMIT TYPE PLUM STATUS: ISSUED DATE ISSUED: 11105/2007 ISSUED BY: BJK JOB ADDRESS: 209 PAULINE PL CM ' Suite/Unit :. Vicinity: NEW SFD ' - , - � SCOPE OF WORK: CONSTRUCT NEW TUVO STORY 2046 SF SINGLE FAMILY RESIDENCEWITH 439 SF ATTACHED GARAGE. REF: B07-00200, G07-00019 1. BATHTUB, 1 DISHWASHER, 4 GAS OUTLETS; 1 GAS SVS, 1 LAUNDRY, 1 SEWER CONNECT, 2 SHOWERS, 1 KIT SINK, 4,WASH BASINS, 3 TOILETS, 1 WATER HEATER, 1'WATER SVS � �- OWNER: SIMPSON (CHARIES R'AND ELIZABETH A) REVOCABLE FAMILY TR �Address: '-�- - 2031 YACHTDEFENDER .. _ � �' � '�`'�� . - � PHONE: � �, � City/State/Zip: NEWPORTBEACH�CA�� ' � APPLICANT: TERPSTRA, ANDY -� , . Address: 3209 WASHINGTON AV : PHONE: 949-735d551 � � � - � " � " �� : City/State/zZip: COSTA MESA, CA_ ' � CONTRACTOR: OWNER-BUILDER Cicense No. 000000 � Address: — - ' . PHONE: City/State: ZipCode: " � CELL: ' ' � PLUMBING PERMIT FEE SUMMARY PLAN CHECK FEE: � $0.00 PERMIT FEE: $213.60 - TOTAL FEES: $213.60 � . .. . .. . . 1.,, �. 0 ti 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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. . INSPECTIONS: In order for the work authonzed under this permit to be considered legal, such work must wmply 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. CODEt, INSPEL710NTYPE DATE IN7fML5 GODEt INSPEG710NTYPE DATE INTITIRLS 1616 Fized System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing �—�� 200 Final Re-Roof 210 Final Electnwl 201 Final Block/Retaining Wall 212 Final Fire Prevention . 202 Final Factory Fire Place 220 Final Planning Approval � 203 FinalSign 222 Final Site 204 Final Demolition - 250 Final Buildin<yOccupancy � WORKERS' COMPENSATION DECLARATION: I hereby aKrm untler penal[y of perjury one o( the (ollowing declarations: ❑ I have and will maintain a CertifiCate of con5ent [0 Self-InsUre (or vrorkers' compensation, as provided for by section 3700 of the Labor Cotle, for the peRormance o/ the vrork for which [his permit is issued. � ❑ I have and will maintain workers' compensation insurance, as required by section 3700 0( the Labor Code, for the peAormance of the work fo� which this pertnit is issued. My workers' compensation Insurance carrier and policy number are: Carrier: (IDis se[fun need rpt Ee mmdetetl Alhe pe�mrt u valuetl af one huntlretl tlollars (Et00J orless ) Policy Number: I certify that in the perf rmance o! ihe work for which this permit is 5 ed, I shall n y a erson in any manner so as to become subject to the worke p nsaC laws ot Califomia, and agree that if I should become su ec t e ers' compensation provisions of ection 3700 of the Labor od , I all fo with compty with these provision . ' 0 S' U � pli a 1's5i naWre Da WARNING: FAILURE SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SU&IECT AN EMPLOVER TO CRIM17INAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN AODITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Sec[ion 7000) of Division 3 of the Business and Professions Code, and my license is in full force and eRect. Lic. # Class # Conhactor's Signalure Dale CONSTRUCTION LENDING AGENCY: ❑ I hereby affirtn that there is a constNction lending agency for the peRortnance of the work for which this pertnit is issued. (Sec. 3097, Civil Cade). Lender's Name: Lender's Address: Date OWNER-BUILDER DECLARATIONS: I hereby affirtn that under penalty of perjury that I am EJ(EMPT FROM THE CONTRACTORS LICENSE LAW for [he following reason (Sec. 7031.5, Business and Professions Code: Any city or counry which requires a permit to consiruct, alter, improve, tlemolish, or repair any stmcture, prior to its issuance, also requires the applicant for such permit to fle a signed statement that he or she is licensed pursuant to tha provisions of the Con[ractors License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business antl Professions Cotle) or that he or she is exempt therefrom and Ihe basis for ihe alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjecls the applicant to a civil penally of not more ihan five huntl�etl tlollars ($500).): ❑ I, as owner of the property, or my employees with wages as Iheir sole compensation, WILL DO THE WORK, and lhe structure is not intended or oftered 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 himsel( or herself or Ihrough his or her ovm employees, provided that such improvements are not intended or oKered for sale. If, however, the building or impmvement is sold within one year of completion, the owner-builder will have the burden of proving that he or she dyyyid not build or improve for purpose of sale.). � �I, as owner of ihe property, am EXCLUSIVELY CONTRACTING WITH NSED CONTRACTORS to construct the project (Sec. 7044, Business and Professbns Code: The conirectas License Law dces not apply to an owner of pmperry who builds or improves Ihereon, and who cont2cts for such project with a contractw(s) license pursuant to the Contractors License Laws.). ❑ I am exempt Business and Ps6(esSibns�Codel"6r Ihis reason: JOS)�ab Owner ID verifed by driver's . .e. ❑ Yes ❑ No Dnver's License No. expires: /� o Veriflcation of Ovmership by (type o( document, i.e. - property lax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby cenrfy that no excavation five (5) or more feet in deplh into which a person is required to descend, will be made in wnnection vnth work authorized by this permit, and ihat no builtling structure, scaHdding, falsework, a tlemolition or dismantling thereof, will be more than [hirty-sia (36) feet high. (Chap. 32, Grp 2, M 2, Sec. 341, Ttle 8, Cali/omia Atlminist2tive Code). ❑ As owner-builder, I will not employ anyone [o do work which vrould require a permit from the Division of Intlustrial Safery, as noted above, unless such person has a permit to tlo such work from the division. Appliwnl'S $ignaWre Division of IndusVial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or future builtling occupant need to file and certify a Business Plan for emergency response to release or threatened release o/ a hazardous material? ❑ Yes ❑ No (Seclion 25505 of [he Califomia Healih and Safery Code requires, vrilh some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time dunng a reported year a quantity of hazartlous materials equal to or greater Ihan a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperaWre and pressure). 2. Does or vnll the applicant or present or future building occupant need to file a registration form tor acutely hazardous malerials? ❑ Yes ❑ No (Section 25533 of the Califomia Health antl Safety Code, with some exceplions, requires registra[ion with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal [o or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard tempera�ure and pressure). 3. Does or will [he applican[ or present or (uWre building occupant neetl to prepare an RMPP (Risk Management antl Prevention Program for acutety hazardous materials)? ❑ Yes ❑ No (Section 25534 of the Cali(omia Heal[h and Safety Code provitles that [he Costa Mesa Fire Department may require the preparation, certifcation and fling with [he Fire Depariment of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4. I! an RMPP is presently required, has Section 25534 of Ihe California Health and Satety 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 appliwtion a permit for such constr�ction or modification from Ihe South Coast Air �ualiry Management DisMcl or from any other air polWtion control district or agency? ❑ Yes ❑ No (Section 658502 of the Califomia Govemmeni Code requires tha[ the requestetl infortnation be fumished on applications for nomresidential builtling pertnits). 6. Will any part ot Ihe faciliry to be conslructed under ihis permit be wi[hin 7000 fee[ from [he outer boundanes of a school? ❑ Yes ❑ No Q('yes", the facility must meet the requirement of Sections 25534 antl 42303 of Ihe Califomia Health and Safery Code�. 7. If a permi[ from the South Coast Air �ualiry Managemenl District or other air pollution control district or agency is required for the work which is the subject of this application, have all ot the disclosures prescribed by California Health and Safety Cotle Section 42303 been made? ❑ Yes ❑ No 8. Qf'yes", attach,certificate of compliance from the appropnate air polWtion control offcer�. . CERTIFICATE OF COMPLIANCE I certi�y that under penally of perjury the information given above is correct. I agree lo comply with all state laws'and city ordinances regarding Hazardous Materials and Emissions. SignaWre CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certi(y under penalry of perjury that I have read this application and stale that the informa[ion given is correct. I agree to comply vnth all s[ale laws and city ordinances relating t buildin nstruction, and authorize representatives of Ihe City of Cost a to e er upon the above-described property for inspection purp es gr e to occupy or allow occupancy of any building au�horized by�t�iis r� n' inal inspection. Sig Wre L galOwn r(s) Da // US An0/or on pplicant Da�e CITY OF COSTA MESA - . B!/ILD/NG DIVISION r � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa. s r �.� � FOR INSPECTIONS CALL: (714) 754•5626 �* PERMIT NUMBER M07-00524 PERMIT TYPE MECH STATUS: ISSUED DATE ISSUED: 11/05/2007 � � - ISSUED BY: BJK JOB ADDRESS: 209 PAULINE PL CM � Suite/Unit: .' Vicinity: NEW SFD � � .. - . � � . . SQ. FT: 0 , , ' • _ - - . . . - . . !�.`�<'�� . , � ' � . � - ., ... SCOPE OF WORK: CONSTRUCT NEW TWO STORY 2046 SF SINGLE FAMILY RESIDENCE WITH.439 SF ATTACHED GARAGE. REF: B07-00200, G07-00019- - � � � �� - MECH: INST 1 FAU < 100K BTU, 1 FAC F,IREPLACE, 1 HOOD, 1 VENT FAN SINGLE DUCT, 9,COMPRESSOR 3-15 HP (A/C) OWNER: SIMPSON (CHARLES R AND ELIZABETH A) REVOCABLE FAMILY TR �-Address " . �- ' 2031 YACHT DEFENDER' Unit:' ° .' "" � - � PHONE: ' - ' � City/Stale/Zip: NEWPORT BEACH, CA , ' • APPLICANT: TERPSTR4, ANDY - . � Address: 3209 WASHINGTON AV � Unit: PHONE: 949-735-7551 ' � �� ". - ' City/State/zZip: COSTA MESA, CA ' � CONTRACTOR: OWNER-BUILDER License No. 000000 Address: Unit: . � :;' : PHONE:.... -� � .... �: .- . , � . . ;��.. City/State: . -�ZipCode: ' . ,' � CELL: . � - � - � � �i � MECHANICAL PERMIT FEE SUMMARY MECH ITEM FEE: $94.00. PLAN CHECK FEE: $0.00 INVESTIGATION FEE: �'�� $0.00�� . � REINSPECTION FEE: �: �,' $0.00 � - � � . �. ' ,� - , TOTAL FEES: $94.00 ' NOTICE: The work authorized by this permit shall comply with. all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) � EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. � INSPECTIONS: In order for the work aulhorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approvat must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. CODE1. INSPEC710NTYPE DAiE IN1111RL5 40oE� INSPECiIONTPE 0�1 INTITIALS 1616 Fixed System Final Fire Prevenlion 206 Final Mechaniral ,�y�� 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electnwl 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Fac�ory Fire Place 220 Final Planning Approval -j� 203 Final Sign 222 Final Site 204 Final Demolition - 250 Final Building/OauOancy l WORKERS' COMPENSATION DECLARATION: 1 hereby aKrm untler penalty o! perjury one o( the following tleclarations: ❑ I have and will maintain a certificate of consent to self-Insure for vrorkers' compensation, as provided for by section 3700 of the Labor Code, for the peAormance o( Iha work (or which Ihis permit is issued. ❑ I have and will maintain workers' compensation insurance, as required by secibn 3700 of the Labor Code, for the pertormance o( the vrork !or which this pertnit is issued. My vrorkers' compensation Insurance carrier and policy number are: Carrier: (TIYs sec0on nCCC nof pe mriyeletl d Ne pemN k valuM af one �unbe0 W/ars (E100J b kss ) Policy Number: yMV I certify ihat in the perf ance ot the work for which this permit is �ssUetl, I shall not loy any rson in any manner so as to become subject lo the worke ' co e sati laws o( Califomia, and agree that if I should become su ' ct t rs' compensation provisions of Section 3700 ot the Labor ode s I fort ith comply with these provision / OS O A II 'sSlg aWre �ale WARNING: FAIL RE SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLL4RS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affrm �hat 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 eHect. Lic. # Class # Lontraclor's Signalure Dale CONSTRUCTION LENDING AGENCY: � I hereby aKrtn thal there is a constmction lentling agency for the peAormance of the work (a wfiich this pertnit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: OW NER-BUILDER DECLARATIONS: I hereby affvm that untler penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for lhe 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, pnor to its issuance, also requires the applicant for such permit to fle a signetl statement that he or she is licensetl pursuant to the provisions of the Contractors License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business and Protessions Code) or that he or she is exempt therefiom antl the basis for the alleged exemplion. Any violation of Section 7031.5 by any applicaN for a pertnit subjects the applicant to a civil penalty of not more than five huntlretl dollars ($500).): ❑ I, as ovmer of the propeAy, or my employees with vrages as Iheir sole compensation, WILL DO THE WORK, and the stmcture is not intended or oHered for sale (Sec. 7044, Business and Professions Cotle: The Conlractors license Law does not apply to an ovmer of property who builds or improves ihereon, antl who does such vrork himsel( or herself or through his or her ovm employees, provided that such improvements are not intended or oRered for sale. If, however, the building or improvement is sold within one year of completion, Ihe owner-builder will have ihe burden of proving Ihat he or she did not build or improve for purpose of sale.). I, as owner of the propeRy, am EXCLUSIVELY CONTRACTING WITH I NSED CONTRACTORS to construct the prqect (Sec. 7044. Business and Professions Code: The wntractors License Law dces not apply to an owner of pmperty who builds or improves thereon, antl who cont2cts for such project with a cont2cta(s) license pursuant to the Contractors License Laws.). ❑ I am exempt uny$r sec. Business and Pf6feySiqryS Code j6r this reason: JOS]46 pl0]) Ovmer ID venfietl by driver's .. .,,e. ❑ Ves ❑ No Driver's License No. � Expires: �� U i0 Verificalion of Ownership by (type of document, i.e. - property tax bill o deed): DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION: ❑ I hereby certdy that no excavation frve (5) or more feet in depth into wfiich a person is requiretl to descend, will be made in connectbn with work authonzetl by this pertnit, and that no building struclure, scaffdaing, falsev.oB, or demolition or dismantling thereo(, will be more than thirty-su (36) feet �igh. (Chap. 3.2, Grp 2. Art 2, Sec. 341, Title 8, Califomia Adminisl2tive Code�. ❑ As owner-builder, I will not employ anyone to do work vfiich would require a pertnit from the Division of Industnal Safety, as noted above, unless such person has a pertnit lo do such work from the division. AppLcanfs Signa W re Date Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or fuWre building occupant need to file and certify a Business Plan (or emergency response to release or threalened release of a hazardous matenal? ❑ Yes ❑ No (Section 25505 ot [he Califomia Health and Safety Code requires, vrith some exceptions, Ihat 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 grealer than a weight o( 500 pountls, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard tempereture and pressure). 2. Does or will the applicant or present or future builtling occupant need to file a registration form for acutely hazartlous materials? ❑ Yes ❑ No (Seclion 25533 of the Califomia Health antl Salery Code, with some ezceptions, requires registretion with the Costa Mesa Fire Departmen[ by each business which at any one time has on hantl a quantity of acutely hazardous materials equal to or grea[er than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at stantlard temperaNre and pressure). 3. Does or vnll the applicant or present or fWure building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutety haZardou5 malenals)? ❑ Ves ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification ana fling with the Fire Department of an RMPP by businesses which are required to register acNely hazardous materials with the Fire DepanmeN. 4. If an RMPP is presen[ly required, has Section 25534 of [he 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 aDDlication a permil for such construction or modification from [he South Coas[ Air Quality Management District or from any olher air polNtion control disMct or agency? ❑ Yes ❑ No (SeCtbn 658502 Of the Califomia Govemment Code requires thal the reques[ed informatbn be fumished on applications for rrornresidential building pertnits). 6. Will any part of the facility to be constructed under lhis permit be wi[hin 1000 leet from the outer boundaries of a school? ❑ Yes ❑ No (If 'yes", Ihe lacility must meet the requirement of Sections 25534 and 42303 o( the California Health antl Safety Code). 7. I( a pertnil from lhe South Coast Air Quality Managemenl Dis[rict or other air pollution control disMcl or agency is required for the vrork which is the subject of this application, have all of the tlisclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes � No 8. (It'yes", attach certifcate of compliance trom the appropnate air pollution control oKcer). , CERTIFICATE OF COMPLIANCE: I certify that untler penalty ot perjury the information given above is correct. I agree to comply�with all state laws and city ordinances regarding Hazardous Materials and Emissions. SignaWre Da�e . CERTIFICATE OF COMPLIANCE AND AUTMORIZATION OF ENTRY: I certi(y under penalty ot perjury that I have read this application and state that the information given is correcC I aqree to comply with all 5late laws and city ordinances relating to building consWclion. and authonze representatives of the City of Costa Me a a enter upon Ihe above-descnbetl pmperty tor inspeclion puryoses ag � iot 4 ccupy or allow occupancy of any building authorized by [his er �( � il fina nspection. gna oi al erts) Date // 3— nd/or 0on AOOIi 1 D te CITY OF COSTA MESA �' � � BYILDING D/VIS/ON it � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 �• �wiw.ci.wsta-mesa.ca.us °.4�0�. FOR INSPECTIONS CALL: (714) 754-5626 �� PERMIT NUMBER'' E07-00887 PERMIT TYPE ELEC STATUS: ISSUED DATE ISSUED: 11/05/2007 � . ISSUED BY: BJK JOB ADDRESS: 209 PAULINE PL'CM ' Suite/Unit:' Vicinity: NEW SFD ` SCOPE OF WORK: CONSTRUCT NEW TWO STORY 2046 SF SINGLE FAMILY RESIDENCE WITH 439 SF�ATTACHED GARAGE. REF: B07-00200, G07-00019 ''- �--�-- . ... . � � � - ELEC: 1 TEMP POWER POLE, 1 RES A/C�PKG;,1'NEW 2046SF SFD. GARAGE: 4 LIGHT FIXTURES, 4 OUTLETS,.2 SWITCHES . . ., . . . _,. � �� ) EVOGABCE FAMICV TRAddress: . �- � ,�- - ,`-�. OWNER: SIMPSON (CHARLES R AND��ELIZABETH A R . 2037YACHT��DEFENDER'Unit: , � .� . -- .-'�, � ' � -� . . PHONE: „ �''�;; �" " - Ciry/State/Zip: � NEWPORT BEACH, CA � APPLICANT: TERPSTRA, ANDY . -, Address: 3209 WASHINGTON AV � Unit:,-. PHONE: 949-735-755� . -- - , � . . � � ' � �Ciry/State/zZip: COSTA MESA, CA � - . � CONTRACTOR: OWNER-BUILDER License No. 000000 " Address: Unit ' . - PHONE: . - ' _ - City/State: � -: 2ipCode: - _- . - CELL: . , , � ELECTRICAL PERMIT FEES ' . Electrical Plan Check Fee: . ° '$0.00 Electrical Permit Fee: � � $227.08 � "- Reinspection Fee $0.00 ' TOTAL FEES $227.08 • NOTICE: The work authorized by this permit shall wmply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applirable codes, and all required inspections and final approval must be obtained. Failure4o obtain inspections and fnal approval will result in the expiration of this permit. COOEt. INSPECTIONTYfE ORTE INTITIALS LOOE/ INSPELlIONTYPE DRiE IN70IAL5 1618 Fizetl System Final Fire Prevention - 206 Final Mechanical 1266 Poo15pa Final 208 Final Plum6ing f� 200 Final Re-Roof 210 Final Electrical /F7 G� � 201 Final Block/Retaining Wall pi2 Final Fire Prevention 202 Final Factory Fire Place _ 220 Final Planning Appmval / 203 Final Sign 222 Final Site / 204 Final Demolition ' 250 Final Builtling/OccuOancy � WORKERS' COMPENSATION DECLARATION: I hereby aKrm untler penalty of perjury one of ihe following tleclaretions: ❑ I have antl will maintain a certifca[e of consent to self-Insure for workers' compensation, as provided for by section 3700 of ihe Labor Code, tor the peAormance of Ihe work (or whiCh lhi5 permit i5 issued. ❑ I have and vrill maintain workers' compensation insurance. as required by � sectbn 3700 of the Labor Code, (or !he performance of the work for which this pertnil is issued. My wnrkers' compensation Insurance carrier and policy numher are: Carrier. (iNs seciion nee� irof be cnmpleletl d fbe permR is valueE at one huntlreaCollars (E100) or less.J Polity Number: I certify that in the peAorm e o( [he work for which this permit is iss ed, I shall � y any pe n in any manner so as to become subject to lhe vrork s'� o nsation of Cali(omia, and agree that if I should hecome bj t to e wo � compensation provisions of Secti n 3700 ot the La r de, hall forth 't � compty with these provision . %� S G Appli nf SignaWr ale WARNING FAIWRE TO�SE2i1RE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100.000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS �ECLARATION: I hereby aKrm 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 # Comrac�or's Signawre Date CONSTRUCTION LENDING AGENCY: ❑ I hereby aKrm that Ihere is a constructbn lending agency for the performance M the work fa which this pertnit is issued. (Sec. 3W7, Civil Code). lender's Name: Lender's Address: OWNER-BUILDER DECLARATIONS: I hereby aKrm 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 stmcture, prior to its issuance, also requires the applican[ for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Con[ractors License Law (Chapter 9(commencing with Section 7000) of Division 3 of ihe 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 subjecis the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees wiN vrages 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 vrork himself or herself or through his or her own employees, pmvided that such improvements are not intended or oHered for sale. I(, however, the building or improvement is sold within one year of complelioq 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 I NSED CONTRACTORS to construct the project (Sec. 7044, Business antl Professions Code: The contractws License Law dces not apply to an oHner of property who builds or improves thereon, and who contracts for such prqect with a contractw(s) license pursuant tothe Contractas License Laws.). ❑ I am exempt under sec. Business and Profe s Code f � this reason: ii J- a i awr 9 �e 305]-46(JIO'/) Owner ID verifed by driver's . ,e. ❑ Ves ❑ No Drivers License No. %� Expires: / US 0 Verifcation of Ownership by (type of document, i.e. - property tax ill or deetl): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certAy that no excavalion frve (5) or more feet in depth into which a person is required to descend, will be matle in connection with work authorized by this pertnit, and that no building struclure, scaffdding, falsework, a demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Title 8, Califomia Administ2tive Code). ❑ As owner-builtler, I will no[ employ anyone to do vrork which vrould 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. ApDlicam's SignaWre Dale Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or future building occupant need to fle and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Seclion 25505 of Ihe 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 tlunng a reponed year a quantity of hazardous materials equal [o 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 fle a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the Califomia Health and Satety Code, with some exceptions, requires registration with the Cos[a Mesa Fire Depa�men[ by each business which at any one time has on hand a quantity of acutely hazardous matenals equal to or greater than a weight of 500 pountls, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard femperaWre 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 acu[ely hazartlous materials)? ❑ Yes ❑ No (Section 25534 of the California Heaflh and Safety Code provitles that the Costa Mesa Fire Department may require the preparation, certifcation and fling wi�h �he Fire Department o( an RMPP by businesses which are required to register acutely hazardous materials with the Fire Departmenl. 4. If an RMPP is presently required, has Sec[ion 25534 of ihe Califomia Health antl Safety Cotle been fully complied with? ❑ Yes ❑ No 5. Does or will the applicant or present or future 6vilding occupant require for the work which is the subject of this application a permit for such consimction or modifica[ion from the South Coast Air �ualiry Management Dislric[ or (rom any other air pollution control dislrict or agency? ❑ Yes ❑ No (Section 658502 of the Califomia Govemment Code requires that the requested in(ortna[ion be fumished on applications fa non-residential builtling permits). 6. Will any part o( the facility to be constructed under this permi[ be within 1000 feet from [he outer boundanes of a school? ❑ Yes ❑ No (I! yes", the facili[y must meet the requirement of Sec[ions 25534 antl 42303 of lhe Cali(omia Heal[h antl Safely Code). 7. I( a permi[ from the South Coast Air Quality Management DisMc� 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 Sa(ety Code Section 42303 been made? ❑ Yes ❑ No 8. Qf "yes", attach certifcate of compliance from the appmpriale air polWtion control officer). CERTIFICATE �OF COMPLIANCE: I certify tha[ under penalty of perjury the information given above is conect. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. � Signature Dale 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 correcL I agree to comply with all state laws and city ordinances rela[ing to building cons[ruclion, and au[horize representatives of the Ciry ot Cos[a Mesa to enter upoy the above-described propeRy for inspection purposes. I e not to o upy or allow occupancy of any building aulhorized by Ihis fnal i ction. gnat e of al er�� Da /i dl D Nntllor ul�o tl Appli< m Dat JobAddress: 2O9 PAULINE PL Suite: Vicinity: Primary Occ: R3/U1 Parcel Number: 42614104 App�icant: TERPSTRA, ANDREW Address: Type of Construction: V-N Zoning: Owner: SIMPSON,CHARLES R TRUST Address 209 PAULINE PL COSTA MESA, CA Contractor: O W N ER-BU I LD E R Address: Phone: 949-735-7551 . Zip: Phone: Zip: 92627 Phone: ISSU Zip: License: 000000 , nrch : Eng: T D ENGINEERING Address: Address: 23011 LIPTON � � . Status: ISSUED Applied: 02/20/2007 Issued: 10/30/2007 Phone: � Phone: 949-312-6501 � � ELTORO,CA - Zip: License: � � 92630 License: 31619 � SCOPE OF PERMIT CONSTRUCT NEW TWO STORY 2046 SF SINGLE FAMILY RESIDENCE (1264 SF 1ST FLR AND 782 SF 2ND FLR) WITH 439 SF ATTACHED GARAC WCLUDES 62 SF BALCONY AT 2ND PLOOR MASTER BEDROOM, 87 SF FRONT PORCH AND 1,PREFAB FIREPLACE. 2 BEDROOMS, 2.5 BATHS, FIREPLACE IN LNING ROOM. _ _ REF: G07-00019 - — � � � FEE SUMMARY Plan Check: $1,020.86 Calc Valuation: Szoz,iat.es Permit: • . $1,570.55 _ . _ - Claim Valuation: so.00 SMIP Res: $20.22 � SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 '� Total: $2,611.63 SETBACKS MAW STRUCTURE Front � 0-0 ACCESSORY Fron� 0-0 PARKING Existinq: o . i_ , Rear f2ear -�, ' �= ., , PLANNING & ZONING' -- 0- 0� Lek � 0- 0� Right 0- 0� 0- 0 � Lek � 0- 0 � Right 0- 0 Reauired: 0 Proposed: 0 - NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is pended or abandoned for a-period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlred Inspeetions and final approval must be obtained. Failure to obtain inspections and final approval will resuli in tha expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2446-46(N00) WORKERS' COR'fPENSATION DECLARATION: ' � I hereby aHirtn under penalty of perjury one of the following declarations: ❑ I have and will maintain a certiTicate of consent to self-Insure for workers' compensatlon, es provided for by section 3700 ot the Labor Code, tor the performance of the work for whiCh this pertnit is issuetl. ❑ I have and will maintain workers' compensation insurance, as required by section 3700 of the Lebor Code, for the pedortnance oi the work tor which this permit is issued. My workers' compensation Insurance cartler antl policy number are: Carrier: Policy Number: (This section need not be completed i! the pe valued et one hundred dollars ($f00J or less.) �.�I cehity that in ihe performance of e w fo ich ih' �� issueA, I shall not employ any person in any manner so as to becoma subject to the workers' compensation laws of Calitomi , and ree t if 1 should becom subject fo iha workers' compensetion provisions of Section 3700 oi the L bor Code, I shall forthwith comply with ihese pravisions - Appll�cent,S,igneture: ' �.Date:`�-- /� /� aw� WAqNING: FAILURE TO SECURE WORKER5 CAM NSATI GE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENAL IES D CIVIL FINES UP TOONE HUNDRED TIKKISANDDOLLARE�$100,000),INADDITIONTO, TOFCOMPENSATION,DAMAGESASPROVI�EOFORINSECTION3]O60FTHELABORCO�E,IFIrEREST,ANDATTORNEV'SFEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirtn that I am licensed under provisions oF Chepter 9(commencing with Section 7000) of Division 3 of ihe Business and Protessions Code, and my licanse is in tull force and ettect Lic. # Class N ConlractoYs SigneNre: Date: CONS7RUCTION LENDING AGENCY: ❑ I hereby eRirm that there is a construction lending agency tor the pedormance of the work toi which Ihis permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby eftirtn that under penairy of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7037.5, Business and Professions Code: Any ciry or county which requires a permit to consimct, alter, improve, demolish, or repair any simcture, prior to its issuance, also requires the applicant for such permit to file a signed stetement Ihat he or she is licensed pursuant to the provisions of the Contractors License Lew (Chapter 9(commencing with Section 7000) of Division 3 of the Business antl Professions Code) or Ihat he or she is exempt therafrom and ihe besis tor ihe alleged ezemption. Any violation of Section 7031.5 by any epplicant for a permit subjects the epplicant to a civil penalty of not more than tive hundretl tlollars ($500).): ❑ I, as owner of ihe property, or my amployees with wages as their sole compensation, WILL DO THE WORK, and ihe simcture is not intendetl or otterad tor sale (Sec. 7044, Business antl Professions Code: The Contractors License Law does not apply �o an owner of properry who builds or improves ihareon, and who does such work himself or herself or Ihrough his or her own employees, provided ihat such improvements ere not intendad or oflered for sale. tl, however, Ihe building or improvement is sold within one year of completion, ihe owner-builder will have ihe burden of proving ihat he or she did not build or improve for purpose of sale.). ' I'as�owner ot ihe property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions --Code: The contracto�ce�w does not appty to an owner of propeny who builds or Improves thereon, and who conirecis for such project with e coniractor(s) ❑ I am exemp nder Business and Professions Coda for this reason: SignaWre:.— / Owner ID'veri i�� by driv rs licen es ❑ No Drivers'CiCBnse.NO. /� � Verification ot Ownership by (type of daument, i.e. - property taa bill or deed): �_ DIVISION OF INDUSTRIAL SAFE7Y PERMIT CERTIFICATION: ❑ I hereby cartify ihat no excavation tiva (5) or more teet in depih into which a person is required to descend, will be mada in connection with work authodzed by this permit, and that no building simcture, scaHolding, talsework, or tlemolition or tlismantling thereof, will be more than thirry-siz (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Tltle B, Calitornia Administrative Cotle). ❑ As ownervbuilder, I will not employ anyone to tlo work which would require a permit irom the Division of Indusirial Satery, as noted above, unless such person has e permit to do such work from ihe division. Signa�ure: Date: Division ot Indusirial Sa�ety Permit Number: COUE X. INSPECTIONTVVE 1616 Fized System Final Fire Prevention 126fi Pool Spa Final 200. Final Re-Roof 201 Final BIocWRetaining Wall 202 203 Final Factory Fire Place Final Sign 204 Final Demolition �ATE �NTRIALS COUEN INSVECTIONTYPE 206 Final Mechanical 20B Final Plumbing 210 Final Elecirical 212 Final Fira Prevention 220 Final Planning Approval 222 Final Site ' 250 FinalBuilding/Occupancy Ittl�Wulu�7 c� °� ��a,ta �!e�a �u�� ?�� OWNER-BUILDER VERIF(CA7'ION Addr� ��% P'u,,�;,� �� Permit #: N A city or county, which is required ro give notice pursuant to Section 1983Q shall attach to such notice, and, as a condition precedent to issuing a building permit, require the completion and require the retum of, an owner- builder venfication. Attention Property Owner: . An bwner-builder' building pennit has been applied for in your name and beanng your signature. Please complete and retum this information in the envelope provided at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No buildin� pertnit will be issued until this veriFcation is received. [1:�I'personally plan to prov�de e ma�o abor and materials for construction of the proposed property improvement. �Yes [V�XNo �[(have/have not) hG�V e- signed an application for a building permit for the proposed work. �,+ 35 ' 1 have contra�cted with the following person (firtn) to provide the proposed constmction: Name I)a�� Si�-;-F� C c�s-k�c��an Address �SGSC/ �r��Gr.l /��M Ln. City La�c ��sc� Phone (�jy�� )�7 �' �1� V Contractor's Lic. No. 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work: Name Address Phone( City _ Contractor's Lic. No. 5. I will provide some of the work bu[ I have contracted (hired) the following persons to provide the work indicated: Name Address Phone Type of Work 1042-d6 (Rev.it/04) r hereby affirm that I have received a copy of the information set forth in Secuon 19830 of the State of California Health and Safety Code and have completed the above information [o the best of my persona] knowledge, in compliance wi[h this State law. c:D.L a� � /�� CDate:_ /�/ 3G U For more information call City of Costa Mesa Building Division at (714) 754-5273. 1042-46 (Rez 11N4) NEWPORT-MESA UNIFIED SCHOOL DISTRICT CERTIFlCATE OF COMPLIANCE OF DEVELOPMENT FEES PURSUANT TO AB 1600 AND AB 181 To: ( City o( Costa Mesa ( ) Ci1y of Newport Beach ( ) Counry of Orange Applicant: Address: ,�nt(/'�eG-� - �.v� �:1 Z4c� ��n'',�,�" � Telephone Number. "�"� 1 �u�'`-" � �'r TractlParcel and Lot Number(s): "17/�+��I LocationofProject �� -l��r� � Number of Square Feet of: Residential Space Commercial and IndustrialSpace aou��_ ,� � �.� - � 51.84 CommerciaUlndustrial Projed is: (Check One) _ Warehouse _ R8D _ Movie 7heater _ Mini-storage _ Heavy Industrial _ Regional Shops _ Light Industrial _ This projed is exempt because x S .30 � Motel i Bank _ Neighbofiood Shops _ RacquetMeallh _ Hotel Medieal Office Ofice Park 1;J-T� i�2UD?,�U3.t7€'-'YP': .: _._ ^�'!i �y�y� (1�j Kp:�`ay�'��.'yyffi� a a � VIlIL�'rVV� l Yu� i`�> s s �° 6793 Distriet Receipt No. I��'�l, Plan Check No. QD�'� Total ��' �`�' Total Preschool Auto Repair Hosqtal Large Otfice Office 81dg. Restaurent Fast Food This certifies that the above-named DevelopedAppGcant has paid school faci6ry fees in comp6ance with Govemment Code sectlons 53080 and 65995. The Building Pemiils for this square footage in this proposed dev�pment may now be issued by your jurisdic6on. Checks are to be made payable to Newport-Mesa Unified School By: The above represenhation as to square (ootage is We. Appticant agrees fhat true, then this certficate shall automatically tetminate and the appropriate C Date: �� 3d � ied that such representatlons are not notlfied. C ITY 0'F C OSTA i�iESA CALIFORNlA P.O. BOX ,317 From the Office of t,he Planning Department Aug�:stb2, 1961 ?�1. K. �. JoHttson 210 Orange Ave. Costa Al�sa, Collforn3p Dear �, John3on; The City of Costa hiesa wishes to advise you that in revising street addresses, the numbers listed belor� Here changed: Old Address J12 Qrange Ave. ?114 C;•r.iuGe Ave. Neo� Address 209 PauZine P1. 215 Peuliue P1. For your convenience we are listing the ager.cies below that ro�e .�ill notify o£ this change. In addition to those listed� you may desire to notify your cors•espondents of the change, Your cooperation in this matter is appreciated. PL:rlb Very truly yours, ld. L. Dunn, Director o£ Planning � "" `"'l, By: Dave Leighton, Planning Technician cc: Southern California Edison Company Southern Counties Gas Company Costa Mesa County LJater District Paci�ic Telephone Company Post Of£ice Public t•iorks Department Engineering Department � County Clerk (1�� Y � March 5, 2007 TO: FROM RE: OFFICIAL PUBLIC NOTICE OF ZONING APPROVAL Distribution List Claire L. Flynn, Senior Planner ZONING APPROVAL OF TWO-STORY RESIDENCE AT 209 PAULINE PLACE (B07-00200) The Planning Division has completed its review of the above-referenced project. The application has been approved based on the following project description. PROJECT DESCRIPTION: The applicant proposes a 2,475 sq.ft. two-story, single-family residence with two bedrooms and 2.5 baths at 209 Pauline Place. The first floor of the new residence features a living room, family room, dining room, and two-car garage (1,743 sq.ft. total for first floor). The second floor will consist of two bedrooms, two bathrooms, and a balcony over the garage facing the street (732 sq.ft. total for second floor). With the proposed construction, the residence will be approximately 2,475 sq.ft., including the 421 sq.ft. two- car garage. The proposed residence will be constructed through the use of stucco and stone veener treatment along exterior walls and a composition shingle roof. The proposed structure will be approximately 25 feet in height, measured to the highest peak of the roof. Minimum five-foot side setbacks are observed. The right elevation of the second-story features three small windows in the master bedroom. There are no second-floor windows proposed along the left elevation of the residence. The Planning Division has determined that the proposed two-story single-family residence complies with the City's Residential Design Guidelines and Development Standards. i '� APPEAL PERIOD: The zoning approval will become final at 5 p.m. on Mondav, March 12, 2007, unless appealed by an affected party (including filing of the necessary application and payment of the $670 appeal fee) or is called up for review by a member of the Planning Commission or City Council. If you have any questions regarding this notice, please contact me at 714-754-5278. If you are interested, you may also call to arrange an appointment to review the building plans. Distribution: Tadao Kamiya 4423 E. Olive Branch Way Anaheim, CA 92807 - 3504 Nancy Bowdle P.O. Box 2567 Costa Mesa, CA 92628-2567 Royce W. Prior 208 E. 2151 St. Costa Mesa, CA 92627-2126 Barry James M Trust 1000 Quail St. Suite 130 Newport Beach, CA 92660 - 2719 Sonja Thompson 215 Pauline PI. Costa Mesa, CA 92627 — 1842 Charles Simpson (owner) 2211 Vista Hogar Newport Beach, CA 92660 R.S. Meyers Company (contractor) 3500 E. Coast Highway, Suite 10 Corona del Mar, CA ::, PLANNING ZONING REVIEW SUMMARY Location: 209 Pauline Place Plan Check/DR Number: 607-00200 Request: Construction of new 2,475 sq.ft., lwo-story single-family residence, consisting of two bedrooms, 2.5 baths and front second-floor balcony. SUBJECT PROPERTY: Zone: R1 zone General Plan: Low Density Residential Lot Dimensions: 58' x 75' Lot Area: Existing [ SURROUNDING PROPERTY: North: Single-Family Residential South: Single-Family Residential East: Single-Family Residential West: Sinqle-Family Residential DEVELOPMENT STANDARD COMPARISON Development Standard City Requirement Proposed/Provided . ,. (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.�.�LDING PERMIT 77 FAIR DRIVE. COSTA MESA, CA 92626 JobAddress: 209 PAULINEPL Suite: Vicinity: Primary Occ: R3 Parce� Number: 42614104 Applicant: SIMPSON, CHARLES Address: 2031 YACHT DEFENDER NEWPORT BEACH, CA owner: SIMPSON, CHARLES R TR Address 2031 YACHT DEFENDER NEWPORT BEACH, CA . Contractor: OWNER-BUILDER ' Address: - � - . Zip: Arch : Address: 2ip: Phone: License: - �. SCOPE OF PERMIT DEMOLISH (E) 1,126SF SFD W/ATTACHED GARAGE AND A 24SF SHED. PROPERTY OWNER TO CONTACT AQMD. Type of Construclion: V-N Zoning: Phone: 949-720-8155 Zip: 92660 Phone: 949-720-8155, Zip: 92660' Phone: License: 000000 Eng: Address: Plan Check: Permit: SMIP Res: SMIP Com: Other: Inspection: Total: $99.61 $15325 $0.72 $0.00 $0.00 $0.00 $253.58 SETBACKS MAIN STRUCTURE Front , 0- 0 ACCESSORY Front 0-0� PARKING Existina: o : FEESUMMARY _ � . ;. Status: ISSUED Applied: 07/17/2006 Issued: 07/172006 ISSUED BY: �' � � _ � �� -'�- —� r- CalcValuation: Claim Valuation: PLANNING& ZONING Rear 0- 0 Lefl 0- 0 -� Right Rear 0-0 � Left 0-0 Right Required: 0 Pr000sed: 0 � Phone: License: s�,zoo.00 $�,ioo.00 NO710E: The work aulhorized by this permit shall compty wilh all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) � EXPIRATION: This permit ahall automatically expire arM become void it xrork is not commenced within 180 days, or if work is suspended or aba� C for a period ot 180 days. / INSPECTIONS: In order tor Ihe work authorized under this permit to be considered legal, suc� work must comply wlth afl applicable codes, and all requlred Inap�tions and final epproval must be obtained. Faiture to obtain Inspections and tinal apprwal wili resutt in t�e expiration of,ttus permit. FOR fNSPECTIONS CALL: (/74) 7545628 � .s�s+s (e�ao) WORKERS' COMPENSATION DECLARATION: "' - I hereby affirtn under penalry oF perjury one of ihe following declarations: .. � ❑ I have and will maintain e cenificete of consen� b self-Insure tor workers' compensalion, as pmvided for by sec�ion 3700 of ihe Labor Code, tor ihe peAormance of Ihe work for which Ihis permit is issuetl. ❑ I have and wlll mainiain workers' compensation insurance, as required by section 3700 of the Labor Cotle, for the performance of Ihe work for which Nis pertnit is issued. My workers' compensalion Insurance carrier and policy numbar ere: Carner: Policy Number: (This sectlon need not be completetl i/ the permit is valued et one huntlretl tlollers ($f 00) or /essJ ' �,I.cenity'thet in Ihe pedormance ot lhe work for which t s permit is issuetl, I shall not employ any person in any manner so as to become subject to the workers' compensation lews of California, and agrae that if I I Id becoma subject to the workers' compensation provisions oi Section 3700 of Ihe Labor Code, I shall torthwith comply with these vi 'ons. / —7 � t- ��"�� ilO r plicent�Signeture: Data: � WARNING FFILURE TO SECURE WORKERS' CAMPENSATION CAVE E IS UNLAWFUL AND SHA1L SUBJECi AN EMPLOVER TO CFIMINAL PENALTIES AND QVIL FWES UP TOONE HUNDRED THOUSANDDOLLARE�$100,000),INADDITIIXJTOTHECOSTOFCAMP NSATION,DAMAGESASPROVIDEDFORINSECTION3]O60FTHEUBORfADE,INTEREST,ANDATTORNEV'SFEES. LICENSED CONTRACTORS DECLARATION: I hereby attirm Ihat I am licensed under provisions of Chapter 9(commencing with Section 7000) oi Division 3 ot Ihe Business and Professions Code, and my license is in full torce antl eMect. Lic. a qass N Contractors SlgneNre: Date: CONS7RUCTION LENDING AGENCY: ❑ I hereby eHirm that ihere is a construction lentling agency for Ihe pedormance of t�e work for which Ihis permit is issued. (Sec. 3097, Civil Code). Lendefs Nema: Lender's AAdress: Signature: Date: OWNER-BUILDER DECLARATONS: I hareby ettlrm ihat untler penelty of perjury that I am E%EMPT FROM THE CONTRACTORS LICENSE LAW for fhe following reason (Sec. 7031.5, Business and Professions Code: Any ciry or counry which requires a permit to conshuct, alter, improve, demolish, or repair any siructure, prior to iis issuance, also requires ihe applicam for such permit to tile e signetl stetement that he or she is licensed Oursuent to the provisions oi ihe Contrectors License Law (Chapter 9(commencing with Seclion 7000) of Division 3 ot ihe Business entl Professions Code) or that he or she is exempt iherefrom and Ihe basis for Ihe alleged axemption. Any violation of Section 703t5 by any applicant tor a permit subjects the epplicent Io a civil penalty ot not more ihan five hundred dollers ($500).): �I, as owner of Ihe properry, or my employees with weges as �helr sole compensation, WILL DO THE WORK, and the stmcture Is not in�entletl or oHered tor sale (Sec. 7044, Business and Professions Code: 7he Contractore License Law does not apply to an owner oi Droperty who builds or improves thereon, and who does such work himself or herself or ihrough his or her own employees, provitled that such improvements are not intendetl or oflered for sale. If, however, Ihe building or improvement is soltl within one year ol complelion, the owner-builtler will have the Curden oF proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of Ihe property, am EXCLUSIVELY CONTRACTING WI7H LICENSED CONTRACTORS to construct ihe project (Sec. 7044, Business and Protessions Cotle: The contractors License Law tloes not epply to en owner of property who builtls or improves thereon, and who contrects lor such project with a contractor(s) license Dursuant to the Contractors License Laws.). ❑ lam venfied by dnver'S license. Yes 0 ❑ No Bu5in855 Bnd o..de«:....� r,.w., r... ��.�� ..,e�,.... Venfication ot Ownership by (type of document, i.e. - praperty taz bill ar deetl): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby certify ihat no excavation five (5) or mora feet in dapth into w�ich a person is requiretl to descend, wlll be mede in connection with work authorized by Ihis permit, entl ihat no building stmcWre, scaHolding, felsework, or demolition or dismantling thereof, will he more then ihirty-six (36) feet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Tl�le 8, California Atlministrative Code). ❑ As ownar-builder, I wlll not employ anyone to do work which would require e permit from the Division of Industriel Setety, as noted above, unless such person hes a permit to do such wark from the division. Signature: Date: Division oi Industrial Safety Permit Num6er: CER7IFICATE OF COMPLIANCE AND AUTHORIZATON OF ENTAV: I certiy under penalry oi perjury ihat I have read this application and state that the infortnation given is correct. I agree to comply with all state laws d city ordinances relating to bullding construction, and authorize representalives ot the Ciry of Costa Mesa to enter upon the �above-described p operty for inspection pu—es. I agrea; ot to occupy or allow occupancy of any building aulhorized by ihis permit until finel inspection. ,,: � - �� —� r-��o �y'SignatureOfLegal. ner(s)_.� �Date " 40oE �. INSPECTIONTYPE 1616 Fiaed System Final Fire Prevention 7266 Pool Spa Final ' 200 Finel Re-Rooi 201 Final Block/Retaining Wall 202 Final Factory Fire Place 203 Finel Sign 204 Final Demolition 01TE INTRIALS �I INSPECTIONTYPE 206 Final Mechaniwl 208 Final Plumbing ' 210 Final EleC�riCel 212 Final Fire Preventlon - 220 Final Planning Approval 222 Final Site ' 250 FinalBuilding/Occupency 0 � � � ��: .-. �� °� L''a�ta �2�a �'cc�%�� Z�u�i�io�t OWNER-BUILDER VERIFICATION Permit #: A city or county, which is required to give notice pursuant to Section 19830, shall attach to such notice, and, as a condition precedent to issuing a building pemiit, require the completion and require the remm of, an ownerv builder verification. A[[en[ion Property Owner: An bwner-builder' building pem�it has been applied for in your name and beanng your signature. Please complete and retum this information in the envelope provided at your earliest opportunity to avoid unnecessary delay in processing and issuing your building pemiit. No buildine oermit will be issued until this verification is received. V_I..—_I^personally plan to provid the major labor and matenals for construction of the proposed property improvemenL �Yes ❑ No h' } . 1(have/have not) � signed an application for a building perniit for the proposed work. 3. I have contracted with the following person (firm) to provide Ihe proposed construction: Name I:rr1� Phone ( City _ Contractor's Lic. No. 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work: Name Address _ Phone( ) City _ Contractor's Lic. No. 5. I will provide some of the work but I have contracted (hired) the following persons ro provide the work indicated: Name 1042�d6 (Rev.11/04) Address Phone Type of Work I hereby a1'firzn that I have received a copy of the information set forth in 5ection 19830 of the State of Califomia Health and Safety Code and have completed [he above information to the best of my personal knowledge, in compliance with this S[ate law. �,/� �, � �gned: C�� a�-� Date:-t;�—�/—�j�o /� �. _ N ma e• � ��,Q [.�-S /� �/ �-/ � t oN (Pnntcd ur l'yped) �L.�# OR S.S. # % For more information call City of Costa Mesa Building Division at (714) 754-5273. 1042-C6 (Rev. H/04) (714) 754-5273 • Fax (714) 754-4056 • www.ci.costa-mesa.ca.us � 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: Suite No Viciniry: 209 PAULINE PL HOUSE Parcel Nunmber: 42614104 Applicant: SIMPSON, CHARLES Address: 2031YACHT DEFENDER NEWPORT BEACH, CA Owner: SIMPSON, CHARLES R TR Address 2211 VISTq HOGAR � , ' NEWPORT BEACH, CA � ` Contractor: .OW N ER-BUILDER Address: ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool / Spa Lighting Fixts Recept Outlets Switches Non Res Appl Res Appl Service to 200a Service to 1000a Service over 1000a Motors l0 1 hp Motors to 10hp Motors to SOhp Motors to t00hp Motors over 700hp Communication drops Sub panel to 200a Pole Light Pkg Sign Circuits Temp Pwr Pole Intermed Pole ISSUED BY: Phone: 949-720-8155 Zip -92660 , Phone: 949-720-8755 ' . � , - , � Zip: 92660. : _ . � � � ��.� . Phone: � � � � Zip: License: 000000 Status: ISSUED Applied: 07/11/2006 Issued: 07/11/2006 -. . SCOPE OF PERMIT' ELECTRICAL CAP TO DEMOLISH A 1,126SF SFD W/ATTACHED GARAGE. . , REF#; BO6-01155 $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 30.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 ffi0.00 Quantity 0 0 0 ` 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 . 0 0" 0 FEE SUMMARY - - - - - -. - .. _ . . - . Quantity ._ _ Temp Dist System'/ Lighting� $0.00 0' Busway I100 R $0.00 0 Standing Section�" $0.00 0 � Misc Electrical Equipment $1820 1 . , . Transformers up to.1 kva/kw�.. $0.00 0 .,. � ....'......-._up to 10 kva/kw - $0.00 0 � . � � ..............:..up to 50 kva/kw � $0.00 0 � .................up to 100 kva/kw $0.00 0 ...........:...:..over 100 kva/kw $0.00 0 � Low Voltage Equipment $0.00 0 .- Low Volt Wiring System / Ckt $0.00 �0 � �`�� Misa Conduit $0.00 0�' � -� � ' - Mise: Conductor $0.00 0 ` Cirws ( gen or. ride) $0.00 0 - Circus (mech ride or lighls) :, $0.00 ; 0 Christmas Tree Stand� ��' ^ , ` $0.00' 0 ' Fiieworks Stand - $0.00 , � 0 -0ther Electrical Fee $0.00 . "- , Investigafion Fee ' $0.00 � Plan Check Fee �. $0.00 � � Reinspection Fee , � , �, $0.00 , - � TOTAL CALCULATED FEES E41.70 � . COMMENTS I SPECIAL CONDITIONS NOTICE: The work authorized by this pertnit shall comply with all applicable handicap access requirements under-Cal�fomia statutes and�related regulations. (Ord. No. 92-28, § 1, 12-21-92) [/ EXPIRATION: This permit shall a4tomatically expire and become void if work is not commenced within 180 days, a if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this pertnit to be considered legai, such work must comply witn all applicable codes, and all requlred Inspeetions and flnal approval must be oDtalnetl. Failure to obtain inspections and final approval will result in the expiration of Ihis pertnit. FOR INSPECTIONS CALL: (714) 7545828 ' zeaeee(eroo) WORKERS' COMPENSA710N DECLARATION: � � ' I hereby aRirm under penalry of perjury one of the following declarations: ❑ I heve end will maintain a certificate of consenl to self�lnsure tor workers' compensation, as provided for by section 3700 of the La6or Code, tor ihe pertormance oi the work for which �his permit is issuetl. ' ❑ I have and will maintain workers' compensation insurence, as requiretl by section 3700 of ihe Labor Code, for the peAormance ot the work for w�ich this pertnit is issued. My workars' compensation Insurance wrder end policy number are: Carrier: Policy Number: (This sec(ion need not 6e completetl il the pe�mit Is valued et one huntlretl tlollars ($100J or less.) - � tity ihaCin ihe pedormence of ihe work for which t ;permit is issued, I shall not employ any person in any manner so as to become sublect to Iha workers' pensation laws oF Calitomia, and egrae that if I s Gld become subject to Ihe workers' compensation provisions of Section 3700 of the Labor Code, I shall forihwith ply with these pr '� ns. \ � �'-�-//-O � Signature: Date: FFILURE TO SECURE WORKERS' COMPENSATION COVEfiA IS UNLAWFUL AND SHALL SUBIECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED �DOLLARE�$100,000),INAODITIQYTOTHECOSTOFCAMPE ATION,DAMAGESASPROVIOEDFOqINSECTION3]O60FTHELABORWDE,IFIrEREST,NNDAiTORNEY'SFEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirm Ihat I am licensed under provisions ot Chapter 9(commancing with Sedion 7000) of Division 3 of the Business and Professions Cotle, and my licensa is in full force antl eHect Lic. # Class k �. Contractols Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby aHirtn that there is a construction lentling agency tor the pedormance of the work for which this permii is issued. (Sec. 3097, Civil Cotle). Lenders Neme: Lender's Address: Siqnature: Date: OWNER-BUILDER DECLARATIONS: I hereby aHirm that under penalty ot perjury that I am EXEMPT FROM THE CON7RAC70RS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any ciry or counry which requires e permit to consiruct, elter, improve, damolish, or repair any siructure, prior to its issuance, also requires ihe epplicaN tor such permit to flle a signetl statemen[ that he or she Is Ilcensed pursuent to ihe provisions of the Contractors Licanse Law (Chapter 9(commencing with Sectlon 7000) of Dlvision 3 of the Business and Professions Code) or that he or she is exempt theretrom and t�e basis for the alleged exemption. Any violation af Section 7031.5 by eny applicant tor e permit ,�ubJectsthe epplicant to a civil penalry oi not more then five hundred dollars ($500).): ��'� r�` p p rty, or my employees wi�h weges as iheir sole compensation, WILL DO 7ME WORK, and Ihe stmcNre is not intendetl or oNeretl for sele (Sec. �Ar I„as owner of ihe ro e Y\ 7044, Business and Professions Cotla: The Contraciors License Law does not apply to an owner of propeny who builds or improves Ihereon, and who tloes such work himself or harseN or through his or her own employees, provided Ihet such improvements are not intentletl or oNered for sale. fl, however, tha building or improvement is soid within one year of completion, the ownerbuiltler wili have tha Ourden of proving ihat he or she did not build or improve For Duryose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to consiruct ihe project (Sec. 7044, Business end Professions Coda: The contradors License Law does no epply to en owner of property who builtls or improves thereon, and who contracts for such project wlth e contractor(s) license pursuant to the Coniractors Licens�ws.). ❑ lam by ddvers licensa. Ll Ves /�iJ No of Ownership by (type ot dwumem, i.e. Business end Professions Cotle for this reason: tex bill ar tleetl): No. DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation tive (5) or more feet in depth into which a person is required to descend, will be made in connection with work authonzed by this permit, and Ihat no building strudure, swXoltling, (alsework, or demolition or dismantling thereof, will be more ihan thirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title 8, Califomia AOministrative Cotle). ❑ As owner-Duiltler, I will not employ anyone to tlo work which would require a permit from the Division oi Indusirial Safery, es noted abova, unless such person has e permit to do such work irom the tlivision. Signawra: Division of Industrial Satety Permit Number: Data: CERTFICATE OF COMPLIANCE AND A ORIZATION OF EMAY: I certily under penalty of perjury that I have read this epplication and state ihat ihe information given is correct. I egree to comply with all state la s�end ciry ordinances relating to bullding consiructlon, and authonze representatives of t�e City of Costa Mesa to enter upon the ebove-descr' d propetly fo�ins�tion p�boses. I agre�not to occupy or ellow occupancy of any building authorized by ihis permit until final inspection. 7-�/-D�� igoaWre Of Lege wner(s).-�` Dat� a � ��_... _ And/Or Authorizad Applicant Date CQOE t. INSVECTIONTYVE 1616 Fixetl System Final Fire Prevention 1266 Pool Spe Final 200 Final Re-Roof 201 Flnal BIaWRelaining Well ' 202 Final Factory Fire Place 203 Final Sign 204 Final Demolition Qajf, INTITIRLS 40UE 1 INSPECTION TYPE 206 Finel Mechanical 208 � Final Plumbing 210 Final Elec�riCal 212 Final Fire Prevention 220 Final Planning Approval 222 Final Site • 250 Final Builtling/Occupancy � (714) 754-5273 • Fax (714) 754-4856 . www.c�.costa-mesa.�UMBING PERMIT n FAIR DRIVE, COSTA MESA, CA 92626 JobAddress: 209 PAULINEPL Suite No Viciniry: Parcel Nunmber: 42614704 Applicant: SIMPSON, CHARLES Address: 2031 YACHT bEFENDER NEWPORT BEACH, CA Owner: SIMPSON, CHARLES R TR AiJdress 2211 VISTA HOGAR NEWPORT BEACH, CA Contractor: OW NER-BUI LDER Address: Phone: 949-720-8155 , Zip: 92660 . ISSUED BY: Phone: 949-720-8155 . Zip: 92660 � � � Phone: Zip: License: 000000 SCOPE OF PERMIT SEWER CAP FOR TO DEMOLISH A 1,126SF SFD W/ATTACHED GARAGE AND A 24SF SHED. BO6-01155 ISSUE FEE Backflow irrigation Backflow Preventer Bathtub Clarifer Syslem Connect Qce,Soda,elc) Dental Unils Dishwasher Drain, Floor Drain, Rainwater Drein, Roof Drinking Founlain Expansion Tank Gas Earthquake Valve Gas (1-4 outlets) Gas (Over 4 outlets) Gas Repipe Gas Service Interceptors (Grease, Oiq Interceptors (Sand Auto ) AMT $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 so.00 $0.00 so.00 $0.00 $0.00 $0.00 '�v' 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 � FEE SUMMARY -� - �AMT� ; QTY Laundry Tub I Washer� - $0.00 0 Landscape Irrigation $0.00 � 0� P-Trap $0.00 0 Pressure Regulator, , _$0.00 � �0 ", - Process Piping (per 10 tt) �$0.00 � -0-'.� Receptors $0.00 0- SepticTank 50.00 0 Sewer Cap for Demo �$9.80 1 Sewer Connect . $0.00 0 Sewer Private Line 50.00 0 Shower , • , $0.00 0 Sink,bar.-• -� � $0.00 0 Sink, commercial $0.00 0 Sink, Floor $0.00 . 0 Sink, kitChen � $0.00� " 0?c ` Sink, service/mop $0.00 0 - Spa (private) � - � $0.00 0 Spa (public) � $0.00 0 COMMENTS I SPECIAL CONDITIONS Status: ISSUED Applied: 07I712006 Issued: 07/11/2006 SumpPump Swimming Pool Trap Primer , Urinal Vacuum Brkr Bkflow(1-4) � Vacuum Brkr Bkflow(5+) Wash Basin - Wash Basin SeL Waste and Vent System Water Closet (Toilet) � W ater Heater� / vent Water Piping (Inst or Rep.) Water Re-pipe Water Service . - • � Water Softener � ' , OTHER , " VIOLATION PLAN CHECK REINSPECTION � TOTAL CALCULATED FEES: AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 50.00 50.00 $0.00 $0.00 so.00 $0.00 $0.00 $0.00 so.00 533.30 Qn 0 0 0 0' 0 0 0 0 0 0 0 0 0 0 0 0 NOTICE: The work authorized by this permit shall compty with aIi applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92•28, § 1, 12•21-g2) ""� -'� EXPIRA770N: This permlt shall eutomatically expire and become void if work Is not commenced within 180 days, or if work Is suspen�ded or abandoned for a period of 180 days. / INSPECTIONS: In order for ihe work euthorized under this permit to be considered legal, such work must comply withl epplicable codes, and all requlred Inepeetlo�s end finel epprovel musl be obtained. Fallure to obtain Inspectlons and tinal approval will result in the`�axpiratlon of this permit. FOR INSPECTIONS CALL: (714) 75M5828 CL':��:11�i:91 WORKERS'COMPENSATION DECLARATON: � � I hereby aNirm untler penalry oi perjury one ot the following declarations: ❑ I have end will mainlain e certificete of consent to self-Insure for workers' mmpensation, es provided for by section 3700 0l Ihe Labor Cotle, for the pertortnance of lhe work lor which this permit is issuetl. . ❑ I heve end will maintain workers' compensation insurance, as required by sectlon 3700 of the Labor Coda, Por tha peRormance of the work for whiU Ihis pertnit is issued. My workers' compensatlon Insurance carner antl policy number ere: Carrior: Policy Number: (fhis secfion need not be complefed i! fhe permit is velued af one hundred dollars ($100) or less.) tity �hat in �he performence ol Ihe work for which th)' permit is issueQ I shall not employ any parson in any manner so as to become subject to t�e workers' pensation laws of Calitomia, entl egrea that II I s 6 Id become su��ect to Ihe workers' compensation provislons of Section 3700 ot the Labor Code, I shell forthwith ply wlih ihese Provisi 5. ♦ SlgnaNre: � Date �"�% ��—(>G �'._ '� FAILURE TO SEGURE WORKERS' �MPENSATION COVEM IS UNUW FUL AND SHALL SUBIECT AN EMPLOYEq TO CqIMINAL PENPLTIES AND pVIL FlNES UP TO ONE HUNDRED I Dd1FRE (3100,OD0�, IN ADDITION TO THE COST OF COMP SAT10N, DAAIAGES AS PROVIOED FOR IN SEGTdJ 31080F THE LABOR CODE, If�TEREST, AND ATTORNEI^S FEES. LICENSED CONTRACTORS DECLARATON: I hareby aHirm that I am licensetl under provisions of Chapter 9(commencing with Saction 7000) of Division 3 ot the Business antl Professions Cotle, and my license is in full lorce entl eNetL Lic. # Class A Contrector's Signeture: Date: CONSTRUCTION LENDING AGENCV: �� ❑ I hereby aHirtn that thera is a construction lending agency for the perfortnance ol ihe work for which ihis permit is issued. (Sec. 3097, Civil Gode). Lentlers Name: Lentler's Address: SignaWre: � Date: OWNER-BUILDER DECLARA710NS: I hereby eXirm Ihat under penelry of per�ury Ihet I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7037.5, Business and Professions Cotle: Any ciry or counry whic� requires a pertnit to construct, alter, improve, demolish, or repair any siructure, prior to Its iuuance, also requires the epplicant tor such pertnit to Ille e signed statement that he or she Is Ilcensed pursuant to �he proWsions oi Ihe Contrectors License Lew (Chepter e(commencing with Sectlon 7000) ot Division 3 of the Business end Profeuions Code) or that he or she is exempt therefrom antl the besis tor Ihe allegetl evemptlon. Any violatlon ot Section 7031.5 by eny epplicant for a permit su ecis ihe eppliwnt to e civil penelry of not more ihan live hundred tlollars ($500).): I, es owner of ihe property, or my employees wlth wages es their sole compensation, WILL DO 7HE WORK, end the sWcture Is not intendad or oNeretl tor sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of propetly who builds or Impmves thereon, antl who does such work himsalf or herself or ihrough his or her own employaes, proviaetl thet such improvements are not intentled or oHered lor sale. tl, however, ihe builtling or Improvement is sold within one year of completion, ihe owner-builder will have the burden oi proving ihat he or she did not Duiltl or improve for purpose of sale.). ❑ I, as owner oi the property, em EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct tha project (Sec. 704G, Business end Professions Catle: Tha contractors License Lew does n t apply m an owner ol pmperty who builds or impmves thereon, end who contracis for such pmjem with e contraaor(s) licen58 Dursuan� �o �he Conlreclor5 LJ[enyf%Wws.). ❑ I am exerpptNnder sec._ ./ Business entl Professions Code tor this reason: Owner ID verilied by dnvers license. ❑ Ves U p No rorroers rcense�No. ��{ Bcpires�(�7 � LL„ `O�' Venfication ot Ownership by (type of tlocument, i.e. - property tax bill or deed�� " DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I �ereDy certify that no excavetion five (5) or more feet in tleplh in�o which a person Is required to descend, will be mede In connection wiih work authodzed by �his pertni6 end that no building sWcture, scaHolding, falsework, ar demolitian or CismanUing thereof, will be more Ihan thirry-sia (36) feet high. (C�ep. 32, Grp 2, An 2, Sec. 341, T�le 8, Califomia ACmInIS�reiive Cotle). ❑ As owner-builtler, 1 will not employ enyona to tlo work which would require a pertnil irom ihe Division ol Intlusirial Safery, as noted above, unless such person �as e pertnit ta do such wark irom Ihe division. Signature: Date: Division ol Industrial Setety Permit Number: CER7IFICATE OF COMPIJANCE AND AUTHORVA710N OF EMRY: I certity untler penalry of perjury that I have reaC this epD�ication antl state ihat the inlormation given is correct. I egree to comply with ell stete lews a iry ordinances rela�ing to bullding cons�ruction, and euthorize represantatives of the City of Costa Mesa lo enter upon the ebove-des/c/nb d properry tor inspec on purp e I agree not to acupy or ellow occupancy of eny 6uilding euthonzed by this pertnit until final inspection. ( � ig�re O ege��Ow r(sA-+o-• � �,_� And/Or Aut�orized Appliwnt Date COOE 1. INSVECTIONTYPE OpTE 1616 Fized System Final Fire Prevention 1266 Pool Spe Final 200 Final Re-Raof 201 Final BIocWRetaining Well 202 Final Factory Fire Place 203 Final Sign 204 Final Demalition �iw_ , � cooe� ixsrecnonTrve 206 Finel Mechanical 208 � Final Plumbing 210 Final Elec�rical �212 Finel Fire Preventlon 220 Final Planning Approval 222 Final Site ' � � ' � 250 Finel Building/Occuparicy � 1� �27 �-6� JVDL1LLRliJJ _ .�GVJ�%y�/�/ L twrer.CTOR Bay Coast Duilders AP. No. LOT2 3 TRACT NPt FIRE ZONE GROQP T R, ,T TYPE �] � ZONE p�� I ECTIONS DATE Trenches ocros Stcel v� aioo� sYsc' 3 y Stecl ReinForce Chimuey Re-Rod � asndsBcam J D / Eramc and Flashing � y/ Lathing, In Out oq Plaster. brown coa[ /. . SUBCONTRACTOR DATE BUILDING PERMIT NO. vAcue $ 9,207.00 OF WORK RBS. & BLb, PERMITSISSUED . � �/�c+�v T � 8��3� ` � �c�� C�i��D COSTA MESA BUILDING DEPARTMENT � P.o aox 3,� rif aFISk — COSTA MESA, CALIFORNIA ��r�� DEP.T. FOR APPLICANT TO FILL tN CIY� �`.`APPL' ICA;TION FOR PERMIT BUIIDiNG .�/` BUILDWG AODRE55 ' o2O c n MES . I R i FOR OFFICE USE ONLY �W RC/ti iUC " a�/1/�� en� AECEIPT NO. PER�T NO., n ,/ C IV1yO BjV OATE/�RE(�CEITVEpy.� O>TE ISSUEO A��RE55 .2 / �o �Z � �,�i�CCL `,, ,�l�,V r�-�X6 �7U i�-. V CITV� v"J�� ARC' ;T OR E IEER ADDRESS ES� TNO�)�G�<,`� ADDREI55 ��c. COSTA MESA. CALIFORNIA NO. FIRE ZONE 1/�,^ 'y )n(` 20NE/ y�y� NO.OF TYPE lH( V�iS/ SCnI(]C;TV NO. OL I //'\ PLAN$ A f Y ADORESy �� Z/ ✓ �`l / I7%J ' r /GGY^ APPROVED LEGAL LOT� (�7 %J DESCRIPTION NO.��J �Y G� 0 RAC F)1 A.P. NO. �' 1� '� � � $IZE //1 b 1� �S �� ` NO.OG 6LOG6. � OF LOT �� riow orv �o• USE OF `; . E%ISTING 9LD -- $ETBACK LINE FROM / �yy � �J CENTER OF STREET /�J f/ REAR YAFO�,.OG• ��, � G. ' SIDE YARD RIGHT-S IEFT �I DESCRIPTION OF WORK NEN � ALTERATION IIADOITION REPAIR� MOVING, DEMOLISH BtJILDING% /� ]� NO.OF % $IZE �/ /�/ •�' ROOMS STORIES r EXTERIOR WALL �. ROOF '`%/,� p � (� COVERING -�TVG�� COVERING( •!�/�'� �L USE OF NEW��'�/l �/ / EV�lL 1!' � C.J.. BUILDING STFTE TMFT CITV ORDINI TION. AUTHORIZED AGENT IS CORRECT ANO P AT L/.W REGUL JL ,/ < CORRECTIONS CITY OF OSTA ME.�'iA --iu��l l V l.! �. �1BJECT TO ' UG. D"cPT. REG. ��--ii-� � TO COMPLY WITH ALL BUILDING CONSTPUC� VAWATION �L�L�� PERMIT PEE $ /i/ �� y. � PLAN CHECK $ � / TOTAL FEE S � "DMi