HomeMy WebLinkAbout224 PAULINE PL - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIF DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
JobAddress: 224 PAULINE PL
Suite:
Vicinity:
Parcel Number: 42614110
Applicant: FRANK MINNAMEYER
Address:
Zoning:
Phone: 949375-4026
Zip:
owner: MINNAMEYER, FRANK RONALD
Address 224 PAULINE PL
Contractor:
Address:
Zip:
Arch :
Address:
COSTA MESA, CA
Phone:
Zip: 92627-1842
Phone:
License:
Eng:
Address:
Phone:
Status: ISSUED
Applied: 12/09/2004
Issued: 12/09/2004
ISSUEDBY: ��dl
Phone:
Zip: License: License:
SCOPE OF PERMIT
T/OFF AND REROOF 1000SF RESIDENCE W/COMP SHINGLES. ' �
Plan Check:
Permit:
SMIP Res:
SMIP Com:
Other:
Inspection:
Total:
$0.00
$54.00
$0.50
$0.00
$0.00
$0.00
$54.50
SETBACKS
MAIN STRUCTURE Front 0- 0 Rear 0- 0
ACCESSORY Front 0- 0 Rear 0- 0
PARKING Existina: o Required: o
NOTES:
FEE SUMMARY
Calc Valuation: Si,5oo.00
Claim Valuation: S�,soo.00
PLANNING & ZONING
Left 0-0 - Right 0-0
Left 0- 0 Right 0- 0
ProDosed: 0 �
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statNes 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 780 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply wiih all applicable codes, and all
requlred Inspections and final epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
I FOR INSPECTIONS CALL: (714) 7545626
taas-as (a�oo�
�
WORKERS' COICIPENSATION DECLARATION:
I hereby aftirm under penalry oi perjury one oi ihe following tleclarations:
❑ 1 have antl will maintein a cetlificate of consant to selbinsure for workers' compensation, as provided for by section 3700 0l the Lehor Code, for the padormance of ihe
work �or which IhiS permii i5 i55ued.
❑ I have and will maintain workers' compensetion insurance, as required by sedion 3700 of the Labor Code, for ihe peAortnance oi Ihe work for which this pertnit is issued.
My workere' compensation Insurance carner end policy number are:
Carrier: Policy Number:
(This sec(ion need nof be complefed /l fhe permit is veluetl a! one huntlretl dollars ($100) or less.)
❑ I certity ihat in the pedormence of ihe work for which this pertnit is issueQ I shall not employ any person in eny manner so es to become subject to tha workers'
compensetlon laws of Cellfomla, antl egree that if I should become subject to ihe workers' compensetion provisions of Sactlon 3700 0l the Lebor Code, I shell tonhwith
comply with these provisions.
Applicant Signeture: Data:
WARNINO: FAILURE TO SECURE WORKERS' COMPENSATIIXJ CAVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED
THOUSAND OOLL4RE (E100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIOED FOF IN SECTION 3]O60F THE LABOR CODE, IMEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby attirm that I am licensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 of Ihe Business en0 Professions Code, entl my license is in full
torce end BNeCt Lic. q CIa55 #
Contrecrols Signeture: Date:
CONSTRUC710N LENDING AGENCY: I
❑ I hereby aflirm fhat ihere is a cons�ruction lentling agency for ihe performance of ihe work for which this pertnit is issuetl. (Sec. 3097, Civil Code). .
Lentler's Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATONS:
1 hereby aHirm that under penelry of perjury ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Business and Professions
Cotle: Any ciry or counry which requires e permit to construct, altar, improve, demolish, or repair any structure, prior to its issuance, also requires ihe applicant for such permit
to file a signed slatement ihat he or she is Ilcensetl pursuant to Ihe provisions of ihe Contradors License Lew (Chapter 9(commencing with Section 7000) of Division 3 of ihe
Business and Pmfeuions Cotle) or that he or she is exempt Iherefrom antl Ihe basis for ihe alleged exemptlon. Any violetion oi Sectlon 7031.5 by eny applicant for a pertnit
subjects iha applicent to e civil penalry of not more than tive hundred dollars ($500).):
❑ I, es owner of the property, or my employees with weges as thelr sole compensation, WILL DO THE WORK, and ihe slructure is not intentletl or offered tor sale (Sec.
7044, Business and Professions Code: The Coniractors License Law dces not apply to an owner ot property who builds or improves thereon, entl who does such work
himself or hersetf or through his or her own employees, provided that such improvements are not intended or oNered for sale. If, however, the building or improvement is
sold within one year oi completion, the owner-builder will have the 6urden oi proving that he or she did not Ouild or improve for puryose of sele.). '
❑ I, as owner of ihe proDerty. am EXCLUSIVELY CONTRACTING WITH LICENSED CON7RAC70R5 to consiruct Ihe project (Sec. 7044, Business and Professions
Cotle: The contractors License Lew does not apply to an owner of property who bui�ds or improves ihereon, end who conirecls lor such pmject with e contractor(s)
license pursuant to the Contrectors License Laws.).
���
Owner ID
Business and Professions Cotle tor this
❑ Ves ❑ No Driver's Licensa No.
Veritication of Ownership by (Iype of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION:
❑ I hereby certity ihat no excavation five (5) or more feet in depih into which a person is required to tlescend, will be mede In connection with work authorized by ihis
permit, and Iha� no building simcture, scattolding, falsework, or demolition or dismantling thereof, will be more ihan thirty-six (36) teet high. (Chap. 32, Gry 2, Art 2, Sec.
341, Title 8, California Adminisiretive Code). �
❑ As owner-builder, I will not employ enyone to do work which would require a permit from the Division of Industrial Sefery, es noted ebova, unless such person has a
permi��o tlo such work from the tlivision.
Signature: Date:
Division of Indusinal Safery Permit Number:
ICERTIFICATE OF COMPLIANCE AND AUTHORIZA710N OF ENTRY: I cenity under penairy of perjury that I have read ihis epplication entl state ihat Ihe infortnation given is
correct I agree lo comply 'th ell stete laws end city ordinances relating to building construction, and authonze representatives oi ihe Ciry of Cos�a Mesa to enter upon ihe
abov - ri e or �5qectioripurposes. I egree not to occupy or allow occupanc�otany building euthorized by this permit until finel Inspect�on.�
IAnd/Or Authonzed Applicant Dale I
CODE t. INSPECTIONTYPE
1616 Fised System Final Fire Prevention
1266 Pool Spa Final
200 Finel Re�Root
201 Final Block/Retaining Wall
202 Final Factory Fira Place
203 Final Sign
204 Final Demolition
PAjS I n
COOE 1 INSPECTION TYPE
206 Final Mechanical
208 Final Plumbing
210 Final Electricel
212 Final Flre Prevention
220 Final Planning Approval
222 Final Site
250 Final Builtling/Occupency
o"re L�EL4
C'',� � C.�. �� ��:�� D��
OWNER-BUILDER
VERIFICATION
A city or county, which is reyuired to give notice pursuant to Section 19R30, shall attach ro such notice, and,
as a condition preceden[ to issuing a building permit, require the comple[ion and require the retum of, an
owner-builder verifica[ion.
A[[en[ion Propehy Owner:
An 'owner-builder' building permit has been applicd for in yuur name and bcaring your signature.
Please complete and retum this information in the envelupe provided at your eadies� opportunity iu avoid
unnecessary delay in processing and issuing your building permii. No buildine pennil will be issueJ until this
venfication is received.
I. I personally plan to provide lhe major labor and ma�erials (or construction of lhe proposed
property improvemenL (� Yes ❑ No
2. I(have/have not) �� �Ni signed an applic.�lion for a building pertnit Gx
thc proposed work. _
3. I havc cuntracted wilh thc followi
Namc �� ST �
(limi) lo pruvidc �hc proposed construction:
/�o�7N�Co
Address City �'�'>'� M` >' i'
Phonc ( / �q) ' �� � ° � � � � Conlractur's Lic. No.
4. I plan lu provide portions of the work, but I havc hired �he fnlluwing person to cuordina�e,
supervise and provide the majur worA:
Namc
Address
Phone (
City —
Contractor's Lic. No.
5. 1 will provide some of the work but I have contracted (hired) Ihc followin�+ persons to
provide the work indicated:
Name
IM2�afi (FEV 998)
Address
Phone 7'ypc of W'ork
v' �
I hereby affirtn that I have received a copy of tha infonnation set forth in Section 19830 of the State
of Califomia Health and Safety Code and have completeA the above infortnation ro the bes[ of my personal
knowledge, in compliance with this State law. '
�
Signed:
Name: �l V'N r� M�NN' I'� / G2
(Prin[ed or Typed)
C.D.L. #
Date: l � ` � � �
For more information call City of Costa Mesa Building Division at (714) 754-5273.
101216 (REV. A981
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIF DFIVE, COSTA MESA, CA 92626
BUILDING PERMIT ,
Job Address: 224 PAULINE PL
Suite:
Vicinity:
Parcel Number: 42614110
Zoning:
Applicant: MINNAMEYER, FRANK RONALD
Address: 224 PAULINE PL
COSTA MESA, CA
Phone: 949375-4026
Zip: 92627-1842
Owner: MINNAMEYER, FRANK RONALD
Address 224 PAULINE PL
COSTA MESA, CA
Contractor:
Address:
Phone:
Zip: 92627-1842
Phone:
Zip: License:
Arch : SMITH, BRAD Eng:
Address: 365 B OLD NEWPORT BLVD. � Address:
Phone: 949 63�-3682
Stalus: ISSUED
Applied: 03/19/2004
Issued: O6/25/2004
ISSUED BV:
� � .
� � , �� i
,, .
Phone:
NEWPORTBEACH,CA
Zip: 92663 License: License:
SCOPE OF PERMIT
REMOVE EXISTING SUN ROOM & ADD NEW BEDROOM & BATH - 300 S�.FT. SINGLE STORY ADDN. 1 STORY.
REF: PA-0332, MM-03-42
Plan Check: $287.46
Permit: $442.25
SMIP Res: $3.00
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $732.71
SETBACKS'
MAIN STRUCTURE Front 2G 0
ACCESSORY Fmnt 0-0
PARKING Existina: c
Rear 10- 0
Rear 0- 0
Reouired: 0
FEE SUMMARY
Calc Valuation: S3o,000.00
Claim Valuation: S3o,000.00
PLANNING & ZONING
Lek 0- 0 Right
� Lek 0- 0 � Right
Pr000sed: 0 .
4- 0
NO710E: The work authorized 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
tor a period of 180 days.
INSPEC710NS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred inspectlons and final approval must be obtained. Failure to obtain inspections and tinal approval will result in ihe expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
2a46a816/00)
WORKERS'COMPENSA710N DECLARATION: �
I hereby affirtn under penalty of perjury one oi ihe Following tleclarations:
❑ 1 heve end will maintain a certificete of consent lo self-Insure for workere' compensation, es provided for by section 3700 of the Lebor Code, for the pedormance of the
wotk for which this permii is issuetl.
❑ I heve and will maintain workers' compen tion insurance, as requiretl by section 3700 of ihe Labor Code, for ihe performance of the work for which Nis pertnit is issuetl.
My workers' con�peqs�tiQairt�s}�rence �r and policy numbar ere:
Carriar:
Policy Number:
ar lest.)
� I carlity that in the pertormance oi Ihe work for which this permit is Issuetl, I shell not employ eny person in any manner so as to become subject to tha workers'
compensetlon laws of Calii ale-a agr , It I should becoma subjoct b the workers' compensation provisions of Se�tlon 3700 of the Labor Coda, I shall forthwith
comply with ihese provisi � q {�
AppllcantSlgneWre: Lf Dete: �-ti V
WARNING: FAILUiiE TO SECURE WORKERS' COMPENSATION COV�� E IS UNLAWFUI PND SHALL SUBJECT PN EMPLOYER TO CRIMINAL PENALTI 5 AND CI IL FINES UP TOONE HUNORED
T/IOUSAND DOILARE ($100,000), IN FDDITION TO THE COST OF COMPE�f SATION, DPM4GE5 AS PROVIDED FOR IN SECTION 3106 OF THE L480R CODE, IPfrERES , AND ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aNirm ihat I am licensetl under provisions of C�apter 9(commancing with Sec6on 7000) of Division 3 oi Ihe Business and Professions Coda, ar�tl my license is in full
force antl e%ecL Lic. N Class #
Coniractor's Slgnature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby aflirm ihat ihere is a consiruction lending agency for ihe performance of ihe work for which ihis permit is issued. (Sec. 3097, Civil Cotle).
Lendefs Neme: Lendefs Address:
Signatura:
Date:
OWNER-BUILDER DECLARA710NS:
I hereby aHirm that under penelty ol perjury Ihat I am EXEMPT FROM TME CONTRAC70RS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business and Protessions
Code: Any ciry or counry which requlres a permit to consimct, elter, improve, demolish, or repair any structure, prior to its issuance, elso requires the applicant for such permit
to tlle e slgned statement ihat he or she Is Ilcensed pursuent to ihe provisions ot the Contractors License Lew (Chapter 9(commencinq with Section 7000) of Division 3 at ihe
Buslnes ntl Professions Cotle) or thet he or sha is exempt therefrom end ihe besis tor ihe alleged azemption. Any violation of Section 7031.5 by eny applicant For e permit
sub s Ihe epplicant to a civil penelty of not more than five huntlretl tloilers ($500).):
I, as owner oi ihe propany, or my employees with wages es their sole compensa6on, WILL DO THE WORK, antl the stmdure Is not intentleG or oHered tor sala (Sec.
70E4, Business and Professions Code:�The'Coniractors License Law does not apply to an owner ot property who builds or improves thereon, and who does such work
himsetl or herself or t�rough his or her own employeas, provi0etl thai such impravements ere not intentled or oNered tor sale. If, however, the 6uilding or improvement is
soltl within one year of completion, the`owner-builder will have the burtlen of proving ihat he or she did not 6uild or improve for puryosa of sale.). �
❑ I, es ownar oi the property, am EXCLUSIVELV CONTRACTING WITH LICENSED CON7RACTORS to construct the projaq (Sec. 7044, Business antl Professions
Coae: The contractors License Law does nm epply to an owner ol propeny who �uilds or Improves Ihereon, end who contracts lor such project with a contrador(s)
license pursuant to ihe Co rs License Laws.).
❑ I am exemp �� Business and Professions Code for this reason: �_
Signature: ' V\ / Date: �
i
Owner ID ventiad by drivefs license. Ves ❑ No Driver's License No. Expires: _
Verificetion af Ownership by (type of tlocument, i.e. - properry tex bill or deed):
DIVISION OF INDUSTRIAL SAFE7Y PERMIT CERTFICATON:
❑ I hereby certify ihat no excavation tive (5) or more feet in depih into which e person is required to descend, will be maCe in connaction with work authonzetl by this
permit, and �hat no builtling sirucWre, scaHolding, falsework, or demolition or tlismantling �hereof, will be more than thirly-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Title e, Calitornia Adminisiralive Gode).
❑ As owner-6uilder, I will not emplay anyone to do work which would require a permit irom the Divislon oi Industnel Setety, es notetl ehove, unless such person hes a
permit to do such work from ihe division.
SigneNre: Da�e:
Division of Industrial Satery Permit Number:
CERTIFICATE OF COMPLIANCE �A ORIZA710N OF ENfAV: I certify under penalty oi perjury that I have read this epplication and stale thet the intormation given is
correct. I a co wlth t laws nd city ordlnances relating to buiiding consimction, and authorize representatives of ihe Clry of Costa Mesa to enter upon the
above-de rib � inspe io, n pu(po 3s I egree not to occupy or allow occupency of eny building authorized by �hi�permit un final inspection.
l.� � CP � 2sy� �1
Signature Of Legal Owner(s Date
And/OrAuthonzed Appliwnt Date
COOE �, INSVECTIONTYPE 2LE p�
1616 Fixed System Final Fire Preven�ion
1266
200
201
Pool Spa Final
Final Re-Root
Final Block/Retaining Wall
202 Final Factory Fire Placa
203 Final Sign
204 Final Demolition
COOE� INSVECTIONTYPE
206 Final Mechanical
20B Final Plum6ing
210 Final Electrical
212 Finel Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final BuildinyOccupency
DAh It�EL@
C� � ��ta ?�'�a i�uc��sy D�vi�a�
OWNER-BU(LDER
VER�FiEATION �3�� � ��.3
A city or county, which is reyuired to give no[ice pursuant [o Sec[ion 19R30, shall attach to such no[ice, and,
as a condition precedent to issuing a building permit, require the completion and require the retum of, an
owner-buildcr vcrifica�ion.
Attention Propehy Owner.
An 'ownco-builder' building permit has becn applicd for in yuur name xnd hearing ynur signature.
Please complete and retum this information in the emelupc pruvided at your earliest opportunity tu avoid
unnecessary delay in processing and issuing your building penniL No buildine pennit will be issued until this
verifica�ion is received. � �
I. I personally plan to provide lhe major labur and materials for construction of the proposed
property improvement. � Yes ❑ No
2. I(have/have not) /7�7:�(:� signed :m applica�ion Cor a building permit for
the proposed work. .
l. I have contracted with thr following pertion (tirni) tu provide the proposed conswction:
Namc
Adclresti City _
Phonc ( ) Contructor's Lic. No.
4. I plan lu providc purtions of the work, but I havc hired the fnllowing person to coordinate.
supervise and pruvide the majur work:
Namc
Address
Phonc (
City —
Con(ractor's Lic. No.
5. I will provide some of the work but I iiave cuntracted (hired) the following persons to
provide the work indica[ed:
Namc Address Phonc Typc of Work
1M2-a6 (REV 9/9P�
I hereby affirm tha[ I have received a copy of the infortnation set forth in Section 19830 of the State
of California Heal[h and Safety Code and have comple[ed [he above informa[ion ro Ihe best of my personal
knowledge, in compliance with this State law. -- �'•
� . .� j
i
�
Signed:
Name: �� v"� I v� ��lV� C' !��
(Printed or Typed)
C.D.L. #
� Z�' %
Date:
For more information call City of Costa Mesa Building Division at (714) 754-5273.
iazrs �aev. ase�
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
ELECTRICAL PERMIT
Job Address:
Suite No
Vicinity:
Parcel Nunmber:
ApplicanC
Address:
224 PAULINE PL
�yz:�«���
MINNAMEYER, FRANK RONALD
224 PAULINE PL
Phone:
COSTA MESA, CA
Owner: MINNAMEYER, FRANK RONALD
Address 224 PAULINE PL
Contrector.
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 to thp
Motors to tOhp
Mo[ors to SOhp
Molors to 100hp
Motors over 100hp
COSTA MESA, CA
Zip: 92627-1842
Phone:
Zip: 92627-1842
Phone:
Zip:
License:
Status: ISSUED
Applied: O6/25/2004
Issued: O6/25/2004
ISSUED BY:
� • ,:/
� � / �v'
�'
SCOPE OF PERMIT
REMOVE EXISTING SUN ROOM & ADD NEW BEDROOM & BATH - 300 SQ.FT. SINGLE STORY ADDN. t
STORY. REF: B04-01159. . .
ELECTRICAL TO INCLUDE: 12 LIGHT FIXTURES, 9 OUTLETS, 8 SWITCHES, 1 RES APPLIANCE.
$23.50
$0.00
$0.00
$0.00
$0.00
$0.00
$13.20
$9.90
$8.80
$0.00
$4.75
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Quantity
0
0
0
12
9
8
0
1
0
0
0
0
0
0
0
0
FEE SUMMARY
Temp Dist System / Lighting
Busway /100 ft
Standing Section
, MiscElectrical Equipment
' Transformers up to t kva/kw
................up to 10 kva/kw
.................up to 50 kva/kw
.................up to 100 kva/kw
..................over 100 kva/kw
Low Voltage Equipment
Low Volt Wiring System / Ckt
Misc. Conduit
Misc. Conductor
Circus ( gen or nde)
Circus (mech ride or lights)
Christmas Tree Sfand
Fireworks Stand
Other Elechical Pee
Quantity
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
50.00 0
$0.00 0
$0.00 0
�0.00 0
50.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00
NOTICE: The work authorized by this permit shall comply with all applicable hantlicap access requirements under California statutes and related
regulations. (Ortl. 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, antl all
requlred 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
2aas-as (s/oo)
A
WORKERS' COMPENSATION OECLARATON:
I hereby aflirm untler penalty ol perjury one ot the following declarations:
❑ I have antl wlll malntain a certificate ol consent to self-Insure tor workers' compensatlon. es provlded for by section 3700 of the Lebor Code, for Ihe pertormance of the
work for which this pertnit is issuad.
❑ I have and wlll malntaln workers' compensati insuranCe, as requiretl by section 3700 of the Lebor Code, for the peAortnance of the work br which this pertnit Is Issuetl.
M workers' com g�/p�tIQ�n /Iy nce cerri ntl c number are:
/ P ` P.� Y Y
Certier / � Polic Number.
need
one
or less.)
� I certity thet In Ihe pedormence of the work f r which this permit is issueQ I shell not employ eny person in eny manner so as to become suhject to iha workers'
compensatlon laws oi QgWeral end e a'f I should become subjoct to the workers' compensetion provislons of Section 700 of th Labor Code, I shell torthwith
complY with these p OGswns. \ �
Applicant Signature: L� Date:
WARNING:FAILURETOSECURE RS'COMPENSAT10NC1�VEiiAG UNUWFULANDSHALLSU6IECTANEMPLOYERTOCRIMINALPE TIESANDGVIL ESUPTOONEHUNDRED
T/10USAND DOLLARE (5100.000), IN ADDITION TO7HE COST OF COMP ON, DAM4GE5 AS PROVIDED FOR IN SECTIIXJ 3'/OB OF THE UBOR CODE, IMEREST, AN ATTOiiNE1^S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby attirtn that I am Ilcensed untler provisions of Chapter 9(wmmenUng with Sectlon 7000) ol Divislon 3 ot Ihe Business antl Professions Code, antl my Iicensa is in tull
force end efteci. Lic. a Class M
Contractors Signeture: Date:
CONSTRUC710N LENDING AGENCV:
❑ I hereby eHirtn Ihat there is e construction lending agency tor the pertortnanca of tha work br which Ihis permit is issued. (Sea 3097, Civil Code).
Lentler's Nama: Lendar's Address:
Signalure:
OWNER-BUILDER DECLARATIONS:
Date:
1 hereby attirm �hei under penalry of perjury thet I am EXEMPT PROM 7HE CONTRAC70RS LICENSE LAW Por the following reason (Sec. 7031.5, Business and Professlons
Code: Any ciry or counly which requires e permit to construct, alter, improve, tlemolish, or repair eny atmcture, prior to its issuance, also requires ihe applicant for such permil
ta lile e signed stetement that he or she is licensed pursuent to the provisions of lhe Cantrectoro License Lew (Chapter 9(commencing with Section 7000) of Dlvlsion 3 ai the
Business end Prolesslons Gode) or ihat he or she is ezempt thereirom and ihe basis lor lhe allegeA exemption. Any vloletion oi Section 7031.5 by eny applicant for e permlt
�ubl �s the eppllcant to e civil penalry of not more than five huntlretl tlollars ($500).):
, es owner ot t�e property, or my employees with wages as their sole wmpensatlon, WILI DO TNE WORK, antl �he strudure Is not intendetl or otlered tor sela (Sec.
V 7044, Business end Professions Cotle: The Con�ractors License Law tloes not epply to an owner ot property who builtls or improves theraon, antl who does such work
hlmself or herself or ttirough his or �er own employees, provided that such Impmvemenis ere not Intendetl or oHered for sale. If, however, the 6uilding or improvemen� is
sold within one yeer of completion, the owner-buiitler wiil have the burden of proving thet he or she ditl not huild or improve for purposa of sale.). �
❑ I, as owner of the property, em EXCLUSIVELY CONTRACTING WI7H LICENSE� CONTRACTORS to consiruct the project (Sec. 7044, Business antl Professions
Code: The contrectore}.7y�ea4,�w tloes not:epply ro an owner oi propeny who bulltls or impmves thereon, antl who coniracts for such pmjea with a contractor(s)
❑ lam�
SignaWra:
Owner ID ventietl Dy tlnvers
_ Business anA Professions Code lor �his reason:
Date:
❑ No Driver's License No. Expi s:
Vedfication of Owners�ip by (type ol tlocument, i.e. - propeny tas 6ill or Aeetl):
OIVISION OF INOUSTRIAL SAFETV PERMR CERTIFICATION:
❑ I hereby certiy Ihet no ezcavetion tive (5) or more feet in dapih into which e parson is requiretl to descen4 will ba made in connaction with work euthonzed by Ihis
permit, end thet no Duiltling sWcture, scallolding, falsework, or tlemolition or tlismantling Ihereof, will be more then Ihirly-six (36) teel high. (Chap. 32, Gry 2, Art 2, Sec.
341, Ttle B, Callfomia Atlminisirelive Cotla).
❑ As owner-bullder, I wiil not employ enyone �o tlo work which woultl require a permit irom ihe Dlvision of Industnel Safery, as notetl above, unless such person has a
pertnit to do such wark tmm ihe didsion.
Sipnature: Date:
Division oi Industrial Sefety Parmit Number:
CODE t. INSPECTIONTYPE
1676 Fi:etl System Final Fire Prevention
1266 Paol Spa Finel
200 Final Re-Rool
201 Final BIxWReteining Well
202 Final Factory Fire Place
203 Final Sign
204 Finel Demolition
�.17���lili{I/I�
CODE� INSPECTIONTYGE
206 Final Mechanical
20B Final Plumbing
210 Pinal ElecidCal
212 Final Fire Praventlon
220 Final Planning Approval
222 Final Site
250 Final Building/OCcupancy
PDIE It�
(774) 754-5273 • Fax (7/4) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
PLUMBING PERMIT
Job Address: 224 PAULINE PL
Suite No
Vicinity:
Parcel Nunmber: 42614110
Applicant: MINNAMEYER, FRANK RONALD
Address: 224 PAULINE PL
COSTA MESA, CA
Phone:
Zip: 92627-1842
Owner: MINNAMEYER, FRANK RONALD
Address 224 PAULINE PL
Contractor.
Address:
Arch / Eng :
Address:
ISSUE FEE
Backflow irrigation ��
Backflow Preventer
Bathtub
Clarifier System
Connect (Ice,Soda,etc)
Dental Units
Dishwasher
Drain, Floor
D2in, Rainwater
COSTA MESA, CA
Phone:
Zip: 92627-1842
Phane:
2ip:
License:
Phone:
Zip:
License:
Status: ISSUED
Applied: O6/25/2004
Issued: O6/25/2004
ISSUED BY:
SCOPE OF PERMIT
REMOVE EXISTING SUN ROOM 8 ADD NEW BEDROOM 8 BATH - 300 SQ.FT. SINGLE STORY ADDN. 1
STORY. REF: B04-01159.
PLUMBING TO INCLUDE: 1 BATHTUB, 2 SHOWER, 1 SEWER CONNECT - PRIVATE LINE, t WASH
BASIN SET, 1 TOILET, 1 WATER HEATER.
AMT
$23.50
$0.00
$0.00
$9.80
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
FEESUMMARY
�TY AMT
Laundry Tub / Washer $0.00
0 Landscape Irngation ' $0.00
0 P-Trap $0.00
1 Pressure Regulator $0.00
0 Process Piping (per 10 ft) $0.00
0 Receptors 50.00
0 Septic Tank � $0.00
0 Sewer Cap for Demo $0.00
0 Sewer Connect $0.00
0 Sewer Private Line $24.65
QTY
0
0
0
0
0
0
0
0
0
1
SumpPump
Swimming Pool
Trap Primer
Unnal
Vacuum Brkr BkFlow(t-4)
Vacuum Brkr BkFlow(5+)
Wash Basin
Wash Basin Set
Wasle and Vent System
Water Closet (Toilet)
AMT
$0.00
$0.00
$0.00
$0.00
50.00
50.00
so.00
$9.80
50.00
$9.80
QTY
0
0
0
0
0
0
0
1
0
7
NO710E: The work authorized by this permit shall comply with all applicable handicap access requiremenis under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRA710N: 7his permit shall automatically expire and become void if work is not commenced within 700 days, or if work is suspended or abandoned
for a period of 780 days.
INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval musl be obtained. Failure to obtain inspections and tinal approval will result in the ezpiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
zaas-as �5roo�
i
WORKERS' COMPENSATION DECLARATION:
I hereby efllrm under penalry of peryury one ot lhe following declarations:
❑ 1 have end will malntain a certificete ot consant to sell-Insure for workers' compensetlon, es provided for by section 3700 of lhe Lebor Code, for the peAormanca of the
work tor whiCh IhiS pertnit is i55ued.
❑ I �ave and will malntain workers' com nsatlon insurance, as requiretl by section 3700 of the Lebor Code, for the peAormance of the work tor which this pertnit Is luued.
My workers'�omp�6�n InSurer�P�g�dacgntl pollty number ere:
Gartier:
CJ I tertity that in Ihe peRorm
t compensation laws of Cal
complY wiih the59 provi�
Applicent Signatura:
WAPNING: FAILURE TO SEGURE W
THOUSAND DOLLAPE (5100.000), IN
LICENSED CONTRACTORS DECLARATION:
PoliCy Number:
one hundred dollars ($100) or less.)
rtnit is issueq I shall not employ any person in any manner so es to become subJect to the workers'
il� come subject to the workars' compensation proNsions ol S ctlon 370 0l the Labor Code, I shall forthwit�
� � b
Date:
GE IS N L AND SHr1Ll SUBIECT AN EMPLOVER TO CRIMINn1 PENALTIES AN GVIL FlNES UP TOONE HUNDRED
IPENSAT10N,0 ESASPROVIDEDFORINSECTION31060FTMELABOqCODE,INiE EST,ANDATfORNEY'SFEES.
I herehy aHirtn that I am licensed under provlslons of Chepter 9(commencing with Section 7000) of Division 3 0l ihe Business entl Professions Code, ard my license is In full
force end ettecL Lia A Class x
Contrecrofs Signemre: Date:
CONSTRUCTION LENOING AGENCY:
❑ I hereby aflirm t�at Ihere is a construction lending aBency tor t�e peAormance of ��e work for which Ihis pertnit is iuuetl. (Sec. 3097, Civil Code).
Lentler's Name: Lendefs Address:
Signature:
OWNER-BUILDER DECLARATIONS:
Date:
I hereby eHlrtn that under penalry ot perjury Ihat I am E%EMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business end Professions
Code: Any ciry or county which reQuires e permit to constmct, alter, improve, demolish, or repair any structure, pnor to its issuance, elso requires the applicant for such permil
to file e signed stetemeN Ihet he or she Is Ilcensed Dursuent m the provisions of the Coniractors License Lew (Chapter 9(commencing with Section 7000) ol Divlslon 3 af Ihe
Business entl ProFesslons Code) or that he or she is exempt thereirom end the basls for lhe alleged e:emption. Any violetion oi Seclion 7031.5 by eny applicent tor e pertnfl
sub�e e epplicant to e civil penalry of nat more ihan live hundred dollars (5500).):
I, es owner of the property, o�my employees with wages as their sole compensetion, WILL DO TT1E WORK, antl ihe structure Is not intentleC or oNered tor sele (Sec.
7044, Business and Professions Code: Tha Comrectors License Law does not epply to an owner ot properry who Duilds or improves thereon, and who does such work
himself or herself ar through his or her own amployees, pravided thet such improvements ere not in�entled or ofleretl tor sele. II, however, ihe building ar improvement is
sold within one year of completion, ihe owner-builder will hava the burden ol proving that he or she did not build or improve tor purpose ot sale.). �
❑ I, as owner of ihe proparty, am EXCLUSIVELY CONTRACTING WITH LICENSED CON7RACTORS to consiruct tha pmject (Sec. 7044, Business and Professions
Code: The contrectors License Le not'ep01Y�to an owner of property who builtls or improves thereon, end who conirecls for such pmject with a contrector(s)
license purs nt to t e trec Llte �Lews.)�
� �.;
❑ I am ecempt u c. Business antl Professions Code for ihis reason:
SignaWre: � Date:
Owner ID vertlied by dnvers license. Ves ❑ No Driver's License No. � xpiras�
Verification ot Ownership by (type at document, i.e. - pmp�rry t x bill or daed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby ceriity �hat no ascavation five (5) or more feet in depth into which e person is required to descend, will be mede in connection with work authorized by this
permil, antl �ha� no building structure, scaHolding, lalsework, or demolition or dismantling thereof, will be more �han thirry-six (36) faet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Title e, Califomia Adminisira�ive Code).
❑ As owner-builder, I will not employ enyone ro do work which would require e pertnil Irom the Division of Intlustriel Satety, es nated above, unless such person has e
permlt to do such work from the divlslon.
Signature: Date:
Division of Indusirial Sefery Permit Num6er:
CER7IFlCATE MPLIANC ORIZATION OF ENTAV: 1 certity under penalry oi perjury that I have read this epplicetion and state tha� ihe informetlon given is
correct. I p ee to co I w' stete I s end city ordlnances relating �o builtling construction, end authonze representatives ol ihe Ciry of Costa Mesa to enter upon the
ebove-tl6crsilae y or i pectio pu poses. I egree not to occupy or allow occupancy of eny building authonzed/p y this p it until tinal inspection.
Vi l ll7
Signature Leg wn@r(s) Data
CO�E I, INSPECTIONTYPE
1616 Fizetl System Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Roof
201 Final BIocWRetaining Wall
202 Final Factory Fire Place
203 Finel Sign
204 Final Demolition
j�¢ �( INSPECTIONTYPE
206 Final Mechenical
208 Final Plumbing
210 Final Electrical
212 Final Fira Preventlon
220 Final Planning Approval
222 final Site
250 FinalBuilding/Occupency
D� I[�LS
(774) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DFIVE, COSTA MESA, CA 92626
Job Address:
Suite No
Vicinity:
Parcel Number:
Applicant:
Address:
MECHANICAL PERMIT
224 PAULINE PL
42614110
MINNAMEYER, FRANK RONALD
224 PAULINE PL �
COSTA MESA, CA
Phone:
Zip: 92627-1842
Owner: MINNAMEYER, FRANK RONALD
Address: 224 PAULINE PL
COSTA MESA, CA
Contractor:
Address: . . ,
Phone:
Zip: 92627-1842
Phone:
Zip:
License:
Status:
Applied:
Issued:
ISSUED BY:
ISSUED
06/25/2004
06/25/2004
SCOPE OF PERMIT
REMOVE EXISTING SUN ROOM & ADD NEW BEDROOM & BATH - 300 SQ.FT. SINGLE STORY
ADDN. 1 STORY. REF: 804-01159.
MECHANICAL TO INCLDUE: A FAU < 100K BTU, ADD DUCT WORK TO DWELLING, GAS PIPING.
ISSUE FEE
Inst FAU <100 k BTU
Insl FAU >100 k BTU
Repair/Alt Cooling/Heat
InsU.Rep. Recess Wall HV
Refrig Sys <100 k BTU
Refrig Sys >100 k BTU
Gas Piping �
Factory Fireplace
Hood w/Mech Exhaust
VAV Box
Vent Fan / Single Duct
Appliance
Fire Dampers
Smoke Dampers
Inst or Relocate Appl Vent
Air Handlers < t0000cfm
Air Handlers > t0000cfm
Floor Furnace
Floor or Suspend Heater
$23.50
814.80
$0.00
$13.70
$0.00
$0.00
$0.00
$6.15
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Quantity
1
0
1
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
FEE SUMMARY
Repair / Alt Absorbtion Unit
Repair / Alt Refrigeration Unil
Ventillation System
Evaporative Cooler
Commercial I n cinerator
Domestic Incinerator
Compressors / Absorption Systems
Upto3hp/100kBTU
3 To 15 hp / 500 k 8TU
t5 To 30 hp / 1,000 k BTU
30 To 50 hp / 1,750 k BTU
Over 50 hp / Over 1,750 BTU
Boilers
Upto3hp
3To75hp
15to30hp
30 to 50 hp
Over 50 hp
Other Mechanical Fee
Investigation Fee
Plan Check Fee
Reinspection Fee
Quantity
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00
$0.00
$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 it work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days. '
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the ezpiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
24464fi (6/00)
WORKERS' COMPENSATION DECLARATION: �
I hereby ettirm under penalry of perjury one oi the following declarations: �
❑ I have end will maintain a certificate oi consent to self-Insure for workers' compensetion, es pmvided for by section 3700 of tha Labor Code, for the pertormence of the
work tor which Ihis permit is issuetl.
❑ I have and will maintain workers' compens tion insurance, as requiretl 6y section 3700 of Ihe Labor Cotle, For ihe pedortnance of the work for which this permit is issuetl.
My workers' ccy5tp9psay�Jn�y an� ce c� r e policy number ere:
Carrier. r� x��r 1�.�1/ Policy Number:
�i ection need nof be comp/eted l/ fhe imi is velued a( one hundretl tlollars ($100J or IessJ
certity that in Ihe DeAo ce of lhe ork f ich t's pertnit is issued, I shall not employ eny person in any manner so es to becoma subject to the workers'
compansetion laws of C@lifomia.m e t t if 1 s ild Dec�me suDject ro the workers' compensation provisions of Se tion 3700 1 the Labor Cotle, I shall forthwit�
comply with these provisions.
Applicant Signeture: _ Date:
WARNING FAILURE TO SECUFE WORKERS' CAMPENSATION COVERAGE IS LAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTI AND CN FINES UP TOONE HUNDRED
THOUSANDDOLLARE($100,0OO�,INAD�ITIONTOTHECOSTOFCAMPENSr`TIO DAMAGESASPROVIDEDf-0fiINSECTiON37060FTHELABORCOOE,INiERESTANDATTORNEY'SFEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aHirtn ihat I am licensed under provlslons ot Chapter 9(commencing with Section 7000) oi Division 3 of ihe Business and Professions Code, anA my license Is in tull
forte en0 eHeCL Lia N Class N
Coniractofs SignaNre: Date:
CONSTRUCTION LENDING AGENCY:
❑ I here6y aHirtn that there is a construction lending agency for the pedormance of Ihe work tor which this permit is issued. (Sec. 3097, Civil Code).
Lendets Neme: LentleYs Atldress:
Signature: Date:
OWNER-BUILOER DECLARATIONS:
I hereby eXirm Ihet under penalry of perjury thet I em E%EMPT FROM THE CONTRACTORS LICENSE LAW tor the following reason (SecJ031.5, Business end Protessions
Cotle: Any city or county which requires e permit to constmct, alter, improve, demolish, or repair any stmqure, prior to its issuance, also requires ihe epplicant tor such pertnit
to file e signed statement that he or she is Ilcensetl pursuant to the provislons of lhe Conirectors License Lew (Chapter 9(tommencing with Section 7000) of Didsion 3 of the
Business end Professians�Cade) or that he or she is ezempt therefram and the besis tor tha alle9ed exemption. Any violation o� Saction 7037.5 by any applicent for e pertnit
subjects the epplicent to a civil penalry of not more than five hundred dollars ($500).):
❑ I, es owner of Ihe property, or my employees with wages as iheir sole compensation, WILL DO 7HE WORK, antl the siructure is not inientletl or offered for sale (Sec.
7044, Business and Professions Code:�The Coniractors License Law does not apply to an owner of property who builds or improves ihereon, and who does such work
hi self or harself or ihrough his or her own"employees, pmvided that such improvements are not intended or oRered for sala. If, however, Ihe building or improvement is
Id within one year of completion, the owner-builder will have ihe burden of proving that he or she did not builtl or improve lor purpose of sale.).
I, as owner of the pry , am EX� LY CONTRACTING WITM LICENSED CONTRACTORS lo construct tha project (Sec. 7044, Business and Professions
Cotle: The co r8ciors Li anse L oes n t epply to an owner ot property who builds or improves ihereon, antl w�o contracis tor such project with a contractor(s)
license pu ant to th n1 or icense ews.).
❑ I em exe un ' r sec. � Business and Professions Code tor this reason:
Signature: Date:
Owner ID verified by drive cense. ❑ Ves ❑ No Driver's License No. Ezpires:
Verificetion of Ownership 6y (type oi tlocument, i.e. - propery t Lill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certity that no excavation tive (5) or more feet in depth into which a person is required to descen4 will be made in connection with work authonzed by ihis
permit, antl ihat no building sWcture, scaHolding, falsework, or demolition or dismantling thereof, will be more than thirty-sia (36) feet high. (Chap. 32, Grp 2, Atl 2, Sec.
341, Title 8, Califomia Atlministretive Code).
❑ As ownerbuiltler, I will not employ enyone to do work which would require e permit irom the Division of Indusirial Safery, es notetl above, unleu such parson has e
permit �o tlo such work from tha division.
Signature: Date:
Division of Intlustnal Safety Permit Number:
W III the applicant or present or future builtling occupant neetl to file and cenify a Business Plan for emergency response to release or threatenad release ol a hazerdous
materlal7 ❑ Yes ❑ No
(Section 25505 ot Ihe Califomia Haalth end Safery Code requires, with some exceD�ions, ihat a Business Plan be filed wiih ihe Costa Mesa Fire Department by every
business which has at any one time dunng a reported year a quantiry of hazardous matedals equal to or greater than a weight ot 500 pounds, or a volume ot 55 gallons,
or 200 cubic leet of compressed gas a� siantlard lempereture and pressure).
........................................................................................................................................................................................................................................................................................................._...................................................................
Does or will ihe apPlicant or present or future builtling occupant need to file a registration fortn br acutaly hazardous materialsl ❑ Yes ❑ No
(Section 25533 of the Calitornia Health end Sefery Code, with some exceptions, requlres re915tration with tha Costa Mesa Fire Department by each business which e1 any
ona Iime hes on hand e quantity of acutely hazerdous materiels equel ro or 9reater ihen e weight of 500 pounds, or e volume of 55 gallons, or 200 cubic feet ot
compressetl gas at standard temperature entl pressure).
........................................................................................................................................................................................................................................................................................................._...................................................................
Does or will the applicant or present or future building occupant need to prepare en RMPP (Risk Management antl Prevention Program tor acutely hazerdous materials)7
— Ves ❑ No
iction 25534 ot the California Health antl SafeP
oertment ot en RMPP bv businasses which ere
that the Costa Mesa Fire Department may require Ihe
ler acutely hezardous materials with the Fire Depertme
4 u en HMvr is presemry reqwrea, nas secuon zoo;fn or me canromia Hen�th end Safery Code been fully complied wi
..................................................................................._...............................................................................................................................................................................
5 Does or wlll the applicanl or present or future builtling occupant reQuire br �he work which is Ihe subject ot this a p
from ihe South Coast Air Qualiry Management District or from any other air pollution control disinct or agency7 �'
(Section 658502 of the Galifomia Govemment Code requires Ihat the requeste0 intormation �e tumishetl on applica
...................................................................................................................................................................................................................................................................
8 Will eny part ot �he faciliry lo be canstrucled untler �his pertnit be within 10001eet trom �he outer houndanes of a schi
Qf "yes", the faciliry must meet the requirement of Sections 25534 and 42303 0l the Calilomia Healih and Salery Cod
.....................................................................................................................................................
7 If e pertnit from the South Coast Air Oualiry Manegement District or other eir pollution control disirict or egency
epplicetlon, have all of �he tlisclosures prescdbed by Calitomia Healih antl Sefery Cotle Section 42303 been made7
....................................................................................................................................................................................................................................................................
B (If'yes", attech certificate of complience from the appropriate air pollution control oHicer).
aparation, cetlitication and filing with the Fire
Yes❑ No .......................................................
.................................................................................................
i oermit for suth tonStmCtion or modification
[] No
lor non-resitlentiel
�
CERTIFICATE OF COMPLIANCE: I cerlify that under penalty oi perlury the information given above is correct. I egree to comply with all state laws and ciry ortlinances
regarding Hazardous Materials and Emissions.
Signeture: Date:
�p/1�E ID AUI�FIORIZATION OF ENTRV: I certify under penalry of periury that I have reatl this epplication and state that ihe inlortnation given is
with slate IaN�s antl ciry ordinances relating to builtling consWction, and authotlze representatives of Ihe Ciry ot Costa Mesa to enler upon ihe
or i pection /pesqs. I agree pot to acupy or allow occupancy of any building authorized by Ihis �t unt; �al in�paction.
/ I �f
Signatur t LegsF6 ne Dat
COUE N, MSPECTIONTYGE
1616 Fixed System Final Fire Prevention
1268 Pool Spa Final
200 Finel Re-Roof
201 Final Blak/Retaining Wall
202 Final Factory Fire Place
203 Final Sign
204 Final Demolition
Q�j[ LNjjj��$ �Q�EN INSPECTIONTYPE
206 Final Mechanical
20B
210
212
220
222
250
Final Plumbing
Final Electrical
Final Fire Prevemion
Final Planning Approval
Final Site
Final Building/Occupancy
on.e L�LALS
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Job Address: 224 PAULINE PL
Suite:
Vicinity:
Parcel Number: 42614110
Zoning:
Applicant: MINNAMEYER, FRANK RONALD
Address: 224 PAULINE PL
Phone: 949-375-4026
COSTA MESA, CA Zip: 92627-1842
Owner: MINNAMEYER, FR,4NK RONALD
Address 224 PAULINE PL
Phone:
COSTA MESA, CA Zip: 92627-1842
Contraclor.
Address:
Zip:
Arch :
Address:
Phone:
License:
Eng:
Address:
ISSUED BV:
Status: ISSUED
Applied: 06/25/2004
Issued: O6/25/2004
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
DEMOLISH EXISTING ALUMINUM PATIO ENCLOSURE FOR ROOM ADDITION. REF: B04-00573 '
Plan Check: $0.00
Permit: $23.50
SMIP Res: $0.00
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $23.50
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY '� Front 0-0
PARKING Ezistinq: o
NOTES:
Rear 0-0
Rear 0-0
Required: 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Left 0- 0
� Proposed: 0
Calc Valuation:
Claim Valuation:
Right 0- 0
Righl 0- 0
ssoo.00
ssoo.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under Calitornia statutes and related
regulations. (Ord. No. 92-28, § 7, 12-21-92)
EXPIRA710N: This permit shall automatically expire and become void if work is not commenced within 780 days, or if work is suspended or abandoned
for a period ot 180 days.
INSPEC7ION5: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspeetions and final approval must be obtained. Failure to obtain inspections and tinal approval will result in ihe expiration of ihis permit.
FOR INSPECTIONS CALL: (774) 7545626
!db6.d6 (N00)
WORKERS'COMPENSAnON DECLARAnON: '
I hereby aHirm under penal�y of perjury one of tha following declarations:
❑ I have and will maintein e certiticate ot consent b self-Insure tor workers' compensatlon, es provided for by section 3700 of ihe Labor Cotle, for the pertormence of the
wark tor which ihis pertnit is issuetl.
❑ I have and willrr�aintain workers' compen@ation insurance, as requlred by section 3700 of the Lebor Code, for the pedortnance oi the work tor which this permit is Issued.
My workers' cot�eens ti n Insa q urance caYne�tl policy number ere:
Cartier: C J�4a��i � vi�� PolicyNumber:
�I certity that in the pedormance of the work y1�' hich this permit is issued, I shell not employ eny person in any manner so as to bewme suDject to the workers'
compensation laws of Calito�ni , eMUaC1 hould become subject to the workers' compensation provisions of Se lon 3700 ot the Labor Code, I shall forthwlth
comply with these pmvisiod / �
Applicant Signature: Date:
WARNING:FAILURETOSECUREWORKERS'COMPENSATIONCOVERAGEIS� WFULANDSHALLSUBJECTANEMPLOVERTOCRIMINALPENALTI SANDCI ILFINESUPTOONEHUNDRED
TFK)USANDDOILARE($t00,00D),INADDITIONTOTHECOSTOFCOMPENSAT DAMAGESASPROVIDEDFOPINSECTIIXJ3]OBOFTHELABORCADE,INTERES�,ANDATTORNEY'SFEES.
LICENSED CONTRACTORS DECLAHATION:
I hareby aftirm ihat I am licensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code, erA my license is in tull
torce and eHecL Lic. e . Class k
Contractofs Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby aHirm Ihat Ihere is a consWction lentling agency for the pedormance of Ihe work tor which ihis permit is issuetl. (Sec. 3097, Civil Code).
Lendefs Name: Lendefs Address:
Signature: Date:
OWNER-eUILDER DECLARATIONS:
I hereby aHirtn that under penalry ot perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for Ihe tollowing reason (Sec. 7031.5, Busineu and Professions
Cotle: Any city or counry which requires a pertnit to construct, alter, improve, demolish, or repair any strucWre, pnor to its issuance, also requires ihe epplican� for such permit
to file a signed statement Ihat he or she is licensetl pureuant ro the provisions of the Comrectors License Lew (Chapter 9(commendnq wi�h Sectlon 7000) of Division 3 oi the
Busine s and Professions Code) or thet he or she is e:empt therefrom and the basis for Ihe alle9ed e:emption. Any violetion oi Section 7031.5 Dy eny applicent for a permit
ub' ts the applicant to a civil penalry of not more than five huntlretl tlollars ($500).):
I, as owner of the property, or my employees with wages as thair sole compensation, WILL DO THE WORK, antl the slrudure I5 not intended or otteretl for sale (Sec.
7044, Business and Protessions Code: The Contractors License Law does not apply to an owner ot property who builds or improves thereon, and who does such work
himsetl or herself or Ihwugh his or her own employees, provided Ihat such improvemems ere not intentled or oNeretl br sale. If, however, Ihe building or improvement Is
sold within one year ot wmpletion, the ownerbuiltler will have Ihe burden of proving ihat he or she did not build or improve tor purpose of sale.). '
❑ I, as owner oi the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to consiruct fhe project (Sec. 7044, Business and Professions
Code: The contractors License Lew does not apply to an owner of pmperty who 6uiltls or impmves thereon, end who contracts for such project with a contrectoQs)
license pursuant to ihe Contra ' nse Laws.).
❑ I am eaem er sec. Business and Profession5 Code for this reeson:
Signature: �--� Date:
Owner ID venfied by dnvers license. es ❑ No Drivefs License No. Expires: T_
Verification ot Ownership by (rype of docu nt, I.e. - pmperty lac bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certity ihat no azcavation five (5) or more teet in depih into which a peroon is requiretl to descend, will be made in connection with work euthonzed by this
pertnit, and Ihat no building sirudure, scalloltling, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Ghap. 32, Grp 2, Art 2, Sec.
341, Title 8, Calitornia Administra�ive Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit irom the Division ot Industrial Safery, es noted above, unless such person has e
pertnii lo do such work from �he division.
SignaNre: Date:
Division ot Industnal Safery Pertnit Number:
CERTIFlCATE OF COMPLIANCE UiHORIZATON OF ENTRY: I certily under penalry of perjury tha� I have reatl ihis epplication and slate tha� t�e iniortnation given is
correct I agree to com I with ell t end city ortlinances relating to building construction, and euthorize repres ntatives ryof the Ctiry of Costa Mesa to enter upon the
a6ove-describ� � � on pury . I@ egre@ not to occupy or ellow occupancy oi eny building authori;ed b tpis �er it,umi� inal inspection.
L� � \ 4/ (CJ / l / /
Signature Of Legal Owner(s �—f Date
And/OrAuthonzed Applicant Date
40DE t. INSPECTIONTYPE DATE
1616 Fized System Final Fire Prevention
7266
200
Pool Spe Final
Final Fie-Roof
201 Final Block/Retaining Wall
202 Final Factory Fire Place
203 Final Sign
204 Final Demolilion
ixrrtu�s CODE� INSPECTIONTYYE
206 Final Mechanical
20B Final Plumbing
210 Finel Elec�riwl
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final BuildincyOccupency
P� 1[i�15
(714) 754-5273 • Fa�c (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
ELECTRICAL PERMIT
Job Address:
Suite No
Vicinity:
Parcel Nunmber:
Applicant:
Address:
224 PAULINE PL
FRONTBEDROOM
42614110
MINNAMEYER, FRANK R
224 PAULINE PL
COSTA MESA,CA
Phone: 949-548-8562
Zip: 92627-1842
Owner: MINNAMEYER, FRANK R& TERRY E
Address 224 PAULINE PL
COSTA MESA;CA
Contracror OWNER-BUILDER
Address:
ISSUE FEE
Temp service test
Res. a/c package
New Res (1-2 units)
New Res (3+units)
Pool / Spa
l.ighting Fixts �
Recept OuUets
Switches
Non Res Appl
Res Appl
Service to 200a
Service to 1000a
Service over 1 OOOa
Motors to 1 hp
Motors to 10hp
Motors l0 50hp
Motors l0 100hp
Motors over t00hp
Communication drops
Sub panel to 200a
Pole Light Pkg
Sign Circuits
Temp Pwr Pole
Intermed Pole
Phone:
Zip: 92627-1842
Phone:
Zip:
License: 0
Status: ISSUED
Applied: 10/30/2000
Issued: 10/30/2000
ISSUED BY:
SCOPE OF PERMIT
FRONT BEDROOM BAY WINDOW INSTALLATION WITH ASSOCIATED ELECTRICAL OUTLET
REPLACEMENT. '- � � � "
4 OUTLETS.
REF:B00-00714
$23.50
$0.00
30.00
$0.00
$0.00
$0.00
$0.00
$4.40
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
so.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Quantity
0
0
0
0 -
4
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
FEE SUMMARY
Temp Dist System / Lighting
Busway /100 ft
Standing Section
Misc Electrical Equipment
Transformers up�to 1 kva/kw
................up to 10 kva/kw . ,.
.................up to 50 kva/kw
.................uP to 100 kva/kw
..................over 100 kva/kw
Low Voltage Equipment
Low Volt Wiring System / Ckt
Misc. Conduit
Misc Conductor
Circus ( gen or ride)
Circus (mech ride or lights)
Christmas Tree Stand
Fireworks Stand
Other Eledrical Fee
Investigation Fee
Plan Check Fee
Reinspection Fee
Quantity
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00
$0.00
50.00
$0.00
TOTAL CALCULATED FEES $27.90
COMMENTS / SPECIAL CONDITIONS
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related
regulations. (Ord. No. 9240, § 1, 1241-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
tor a period of 180 days. �
INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspeetlons antl flnal approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of this permit.
FOR INSPECTIONS CALI: (714) 754-5626
2446-06 (NW)
WORKERS' COMPENSATION DECLARATION:
I hereby aHirtn untler penalty of perjury one ot the followinq declarations:
❑ I heve entl will malntain a certificate ot consent to selFlnsure for workers' compensation, es provided for by section 3700 of ihe Labor Code, for Ihe pertortnance of ihe
work tor which this permi[ is issued.
❑ I have and will maintain workers' compensation insurance, as requiretl by section 3700 of the Labor Cotle, for Ihe pertortnance of the work for which Ihis pertnit is iuueG.
My workers' compensation Insu2nce carner and policy number are:
Carrier: Policy Number:
(lhis section need no( be complefed ii the permif is va/ued et one hundred dollars ($100) or /ess.J
❑ I carlify that in the peAormance ot the work for whic� this permit is issueQ I shall not employ eny person in any manner so as to become sublect to tha workere'
compensation lews of Califomia, and agree that If I should become subjed to Ihe workere' compensation provisions of Section 3700 of tha Labor Code, I shall forihwith
comply with these provisions.
Applicent Signeture: Dete:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION CqVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYEP TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED
THOUSAND DOLLAPE ($100,000�, IN ADDITIIXJ TO THE COST OF CAMPENSATION, OAMAGES AS PqOVIDED FOR IN SECTION 3]O6 OF THE LABOF CODE, IMEREST, AND ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLAHATION:
I hereby aXirm ihat I am licensetl untler provisions ot Chapter 9(commencing with Section 7000) of Division 3 ot Ihe Business and Professions Code, antl my license is in full
forca and eNect. lic. M Class M
Contractor's SlgnaNre: Date:
CONSTRUCTION LENDMG AGENCY:
❑ I hereby aHirtn ihat Ihere i5 a con5lruttion lending egency for the performance ot �he work for which Ihis permit i5 issued. (Sec. 3097, Civil Code).
Lendefs Neme: LendeYs Aatlress:
SignaWre:
OWNER-BUILDER DECLARA770NS:
Dale:
I hereby eflirm ihat under penelty of perjury that I am EXEMP7 FROM THE CONTRACTORS LICENSE LAW for ihe following reason (Sec. 7031.5, Business and Professions
Code: Any ciry or county which requires e permit to constmct, alter, improve, demolish, or repair any stmcwre, prior to its issuance, also requires ihe applicent for such pertnit
to file e signed statement that he or she is licensed pureuant ro the provisions ot the Contractors Licensa Lew (Chapter 9(commencing with Section 7000) of Division 3 of ihe
Business antl Professions Cotle) or that he or she is e:empt therefrom antl the basis For the alleged exemption. Any violation of Section 7031.5 Dy eny epplicent for a permit
subjects the applicant to a civil penalty ot not more than five hundred dollars ($500).):
! �
;� I, as owner ot ihe pmperry, or my employees with wages as their sole compensa�ion, WILL DO TME WORK, and Ihe structure is not intended or oHeretl tor sale (Sec.
7044, Business and Professions Code: The Contractors License Law does not apply to an owner of properry who builds or improves thereon, and who does such work
himself or herselfbcthrough his or her own employees, provide0 that such improvements are not intentletl or oflered tor sale. If, however, the building or improvement is
soltl within one year of completion, the owner-builder will have the �urden oF provinq iha� ha or she did not builtl or improve for purpose of sale.).
❑ I, as owner oi the property, em E%CLUSIVELV CONTRACTNG WITH LICENSED CONTRACTORS to construct tha project (Sec. 7044, Business and Professions
Cotle: The contractors License Law tloes not�apply to en owner ot propeny who builtls or improves thereon, end who contracis tor such projad with a coniractor(s)
liCenSe pur5uant to lhe Contraclors License'Lews.).
❑
Owner ID
❑ No
Business and Professions Code for this reeson:
Date: �
Driver's License No. Expires:
Verification ot Ownership by Qype of document, i.e. - property tex bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify ihat no excavetion five (5) or more fee� in depth in�o which a person is required to descand, will be made in connection with work euthodzed by ihis
permit, and ihat no building stmcNre, scattolding, falsework, or tlemolition or dismantling Ihereoi, will be more Ihan thirty-six (36) feet high. (Chap. 32, Gry 2, Art 2, Sec.
341, Title 8, Califomia Atlminisirative Cotle).
❑ As owner-builder, I will not employ anyone to do work which would require a permit irom the Division of Indusinal Safety, as noted ebove, unleu such person has a
permit Io tlo such work from the division.
Signa�ure: Date:
Qivision of Indus�rial Safety Permit Number.
CERTIFlCATE OF COMPLIANCE AND AUiHORVA710N OF ENfAY: I certify under penalry of perjury that I �ave read ihis application and state that the infortnation given is
correct. I agree to ly with all laws entl ciry ortlinances relating to building consiruction, and authorize reDresenia�ives ot tha Ciry of Cos�a Mesa to enter upon �he
ebove-descri of1' ectio oses. I egree not to wwpy or allow wcupancy of eny building authonzed 6y this pertnit until finel inspection.
�' _ %c7 •3o-OC>
Signature Of Legal Ow Date
And/Or Authorized Applicant Date
COOE�, INSPECTIONTYVE Q��, IMRIALS
7616 Fised System Final Fire Prevention
1266
200
201
Pool Spe Final
Final Re-Roof
Final BIocWRetaining Well
202 Final Factory Fire PlaCe
203 Final Sign
204 Final Demolition
CO�E 1 INSPECTION TYPE
20fi Final Mechanical
208 Final Plumbing
270 Final EleciriCal
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Builtlin<yOccupancy
PdIE 1�LH
+
(714) 754-5273 • Fau (714) 754-0856
,lob Address: 224 PAULINE PL
Suite:
Vicinity: FRONT BEDROOM
Parcel Number. 42614110
CITY OF COSTA MESA
BUILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT.
PERMIT
npp�icant: FRANK MINNAMEYER
Address: 224 PAULINE PL
COSTA MESA, CA
Owner: MINNAMEYER, FRANK
Address 224 PAULINE PL
COSTA MESA, CA
Contractor: O WN ER-B U I LD ER
Address:
Zip:
Arch :
Address:
BUILDING PERMIT
Zoning:
Phone: (949)548-8562
Zip: 92627
Phone: 949-6504520
Zip: 92627
Phone:
License: 0
Eng:
Address:
NUMBER
I�00-00714
�
77 FAIR DRIVE, COSTA MESA, CA 92626
Status: ISSUED
Applied: 05/18/2000
Issued: OS/19/2000
ISSUED BY: �( �
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
INSTALL 36 SF BAY WINDOW IN EXISTING FRONT BEDROOM.
Plan Check: $6321
Permit: $97.25
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $160.96
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0-0
PARKING Existinq: o
NOTES:
Rear 0- 0
Rear 0-0
Required: 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Left 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation:
Right 0-0
Right 0-0
EXFT�.ED
D� a 8 oi
° ���c��si-,
`�11,
$3,078.00
so.00
NOTICE: The work authorizad 6y 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 1 BO 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 inspectlona and flnal epproval must be obtained. Failure to obtain inspections and final approval will result in [he ezpiration of this permit.
FOR INSPECTIONS CALL: (714) 754-5626
WORKERS' COMPENSATION DECLARATION:
I hereby attirm untler penalry oi perjury one of the tollowing tleclaretions: .
�� I hava antl wlll maintain a certificate oi consent to salf-Insure for workers' compensation, as pmvided for by seciion 3700 of the Labor Code, for tha peRormance of ihe
work for which this permit is issuetl.
❑ I have end will maintain workers' compensation insurance, as requiretl by section 3700 of the Labor Code, br Ihe performance of Ne work for which this pertnit is issued.
My workers' compensation Insurance carriar and policy number are: .
Cartier. Policy Number.
(This section need nof be crompleted i/ the permit Is velued et ane hundred dollars ($100) or less.)
❑ I certiTy that in the pedormance of the work for which this permit is issued, I shall not amploy any person in any mannar so as to become subject to the workers'
compensacion laws of Califomia, and agrea ihat ii I should become subject to the workers' compensation provisions of Section 3700 of tha Labor Code, I sha0 forihwith
comply with ihese provisions.
Applicant Signature: Dete:
WARNINO: FAILURE TO SECURE WORKERS' CAMPENSATION COVERAGE IS UNLAWFUL AND SHALL SU&IECT AN EMPLOVER TO CRIMINAL PENALTIES AND qVIL FINES UP TO ONE HUNDRED
THOUSAND DOLL4RE ($100,000), IN ADDITIQY TO THE CAST OF CAMPENSATION, DAMAGES AS PROVIDEO FOR IN SECTION 31060F THE LABOR CODE, INTEREST, AND ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby attirm ihat 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 antl ettect. Lic. k Class #
Contrectofs Signature: Date:
CONSTRUCTION LENDING AGENCV:
❑ I hereby atlirm that ihere is a constmction lending agency for the peAortnance of the work tor which this permit is issued. (Sec. 3097, Civil Cotle).
Lender's Nama: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby ettirm ihat under penalty of perjury ihat I am EXEMPT FROM THE CON7RACTORS LICENSE LAW tor ihe foilowing reason (Sec. 7031.5, Businass and Professions
Code: Any ciry or county which requires a permit to constmct, alter, improve, demolish, or repair eny stmcture, prior ro its issuance, also requires ihe applicant for such parmit
to tile e signed statement that he or sha is licensed pursuant to the provislons oF the Contractors Llcense Law (Chapter 9(commencing with Section 7000) of Division 3 of tha
Business antl Professions Code) or ihat he or she is exempt t�eretrom antl the basis for the allegetl e:emption. Any violation of Section 7031.5 by any epplicant tor a permit
subJects the epplicant to e civil penalry oi not more then tive hundretl tlollars ($500).):
� I, as owner of the property, or my amployees with wages as their sole compensation, WILL DO THE WORK, antl the structure is not intended or oRered for sale (Sec.
7044, Business antl Professions Cotle: The Contractors License Law does not apply to en 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 ottered for sale. It, however, the building or improvemam is
soltl within one year of completion, ihe ownerbuilder will have the burden of proving that he or she did not build or improve for purpwe of sale.).
❑ I, as owner of the properry, am E%CLUSIVELV CONTRACTING WITT1 LICENSED CONTRACTORS to construcl Ihe pwject (Sec. 7044, Business antl Pmfessions
Code: The contractors License Law does not epply to an owner ot property who builds or improves Ihereon, and who conirects for such project with a coniractor(s)
license Dursuant to the Coniractors License Laws.).
❑ I am ezer9p
Signeture: �
Business and Professions Code tor this reason:
Owner ID verifietl 6�ver's license. VD Yes ❑ No Drivefs License No. � Expires:
Verification of Ownership by (type of document, i.e. - propehy �ax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five (5) or more teet in tlepih into which a parson is required to tlescend, will be made in connection with work authorized by ihis
permit, end Ihat no building structure, scattolding, falsework, or tlemoli�ion or dismantling ihereot, will be more ihan thirty-siz (36) teat high. (Chap. 32, Gry 2, Art 2, Sec.
341, Title e, Califomia Atlministra�ive Cotle).
❑ As owner-builder, I will not employ anyone to do work which woultl require a permit irom tha Division of Industnal Safety, as noted above, unless such person has a
permit to do such work from ihe division.
Signature: Date:
Division of Industrial Safery Permit Number:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATON OP ENTRV: I certify under penalty'of per�ury ihat I have read this application an0 s�ate ihat ihe infortnation givan is
correct I agree to comply wi�h all state laws and city ordinances relating to building constmction, antl authonze representatives of the Ciry of Costa Mesa to enter upon the
aDove-descnbetl perF}i r ins rposes. I agree not to occupy or allow occupancy of eny building authonzed by this pertnit until tinal inspection.
�-.• s--�y�oo
Signature Of Leg ier(s) Dete
And/Or ANhorized Applicant Date
COOE X. INSPECTIONTYPE
1616 Fixed System Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Root
201 Final BIocWRetaining Wall
202 Final Fec�ory Fire Place
203 Finel Sign
204 Final Demolition
2a46a8
QAjf, INTRIpL
40DEt INSVECTIONTYPE
206 Final Mechanical
20B Finel Plumbing
210 Final Elec�ncal
212 Final Fire Prevention
220 Final Planning Approval
222 FinalSite
250 Final Building/Occupancy
QAjE INTITIAL
�� "D. (� %� �uu�C�us f �usiQiacs
OWNER-BUILDER
VERIFICATION
A ciry or coun[y, which is required to give notice pursuant [o Section 19830, shall attach to such notice, and,
as a condition preceden[ to issuing a building permit, require the completion and require the re[um of, an
owner-builder verification.
Attention Property Owner:
An `owner-builder' building permit has been applied for in your name and bearing 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 pertnit. No buildine permit will be issued until this
verification is received.
1. I personally plan to provide Ihe major labor and materials for conswction of the proposed
property improvement. � Yes ❑ No
2. 1(have/have not) �iA �% C signed an application for a building permit for
the proposed work.
3. I have contracted with the following person (6rm) [o provide the proposed conswction:
Name
Address
Phone (
City _
Contractor's Lic. No.
4. 1 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 to
provide the work indicatad:
Name
10a2>fi (REV.958)
Address
Phone Type of Work
.
�1
I
[ hereby af$rm that I have received a copy of the information set forth in Section 19830 of the State
of Califomia Health and Safety Code and have comple[ed the above infortnation to [he best of my personal
knowledge, in comp�iance wi[h [his State law.
Signed
Name:
C.D.L. # OR S.S. # �.� ��
Date: �9/ �� � �
For more information call City of Costa Mesa Building Division at (714) 754-5273.
1062�18 (REV.9/9B)
�
PflOJECT POONESS: Z z 4 PAUL I NE PL ;
OWNEfl'SNpME: SMIT JACOBUS L `M"
noosess: ZZq fiAULINE PL
COSTA MESA,CA 92627
ANLN/ENGINEEfl:
ROOflESS:
flEG.NO.:
UNIT:
PEXMITTEE: WEST COAST CUSTOM ROOMS ( 714 ) 594-7547
nooness: �g6 PINE FALLS AV
UCENSED CONTBAC70p�6€L'CJ1HFr�T,I�N: I herepy allirm IAat I am licensed underC•pr�ovisio9s o� ao9r 9 gommencinp wit� Section
7000� ol Orvisian 3 0l IAe Business an� Pmlessions Code, anC my license is in tull fome antl elfect.
CITY LIC.: STAiE LIC.: SS:
440 5 471619 B
�aie' Signatura — — . - —
WONI(Efl COMPEN AT CIABRTION: Ihc�eGyatiirmihatl�aveaceni ateoi sentlosell-insureoracetlifiwteoiWorkers'
ComDenu�ion Insurance. or a certihea cooY thereal (S¢Ction 3800. LaD. C�.
eoucrNo.: 1004744-93 E%P.DRiE: OLI /94
comraxr: STATE FUNI)_,
� C¢tlilied COpy is �¢reby WmiS�etl. L3t Cehilie0 to � if I�e ci�y uiltlin ivision.
oate: � AVDlicant:
E%EMY�ION FflOM WOPKE S' COMPENSATION OEC4flATI0N: Qhi55e ion ne nol G pleleA if Ihe permit is lor ane �unAreO (5100� or less).
I tetlily I�a� in Ihe petlormance ai Ihe work Ior whic� Ihis permii is issuetl, shall employ any persOn in any manner So as lo heCOme
5u01eci �o I�e Workers' Compensa�ion Laws ol Calilomia. '
�ale: SignaWre:
NOTICE: I�. aller making �his tleclaration, yop s�oultl b¢come suUle�t to the WoBers' Compensa�ion pmvisions of Ihe labor
Cotle. yau musl �orlhwilh comply wiih SUt� provisions or this permrt s�all he deemetl rewked.
' CONSTflUCTION LENDING AGENCY: I hereby aliirm thal Iher¢ i5 a conS�Nction lentling agency �of �he pedormance ai the work for
w�ich Ihis permil is issuetl (Section 3097. Civ. C�.
IENUEfl:
ROUNE55:
��
OWNEfl BUILDEB DECLABRTION: I �ere�y affirm tlwt I am exempt Iram ��e Coniracmrs' State Lkense Law Por tAe followinp reason
(Seclion 7031.5 Business antl Professional Code: Any ci�y ol county wtlich repuif¢5 a permii to constmc�, alte�, impmv¢, Eemoi6tl, of
repair any slmcture. prior lo its issuance, also repuires ine aDPlicant for such permil to Iite a signee statement Ihat he/she is licensetl
pursuam �o ��e pmvisions ol lhe ConVacmrs' Stat� License Law �Chapter 9 �commencing with Seclion 7000) ol �ivision 3 al Ihe Business
ane Pmles9ons CAee) or inal helshe is ezemp� �herelrom an0 ihe ba9s for lne allegeA exemption. My vialatipp of Section 7037.5 Oy
any aOPlicani lor a p¢rmit su6jecis ��e a001iwnt lo a tivil penatty ot not more tllan five hunGred CollaR (5500�.
I, as owner ol �he property or my nmployees with wages as IAeir sole compensa�ion, will tlo ��e work, anJ �he
❑ slmcWre is not intentleA or oflere0 for salp ($ec�ion 7044, Business and Pm�essional Cotle: T�e ConiraC�ors' Slaie license Law
Eoes not appty lo an awner of a pwperly who �uilAs or impwves t�ereon, antl wha tloes such work him5ell/hersel� or �Amugh
hi5 or her Own employees. D�ovitle0 �hal SutA impmvemen�s are nol inientled Or otler¢tl for Sale. II, hOwever �he building or
impmvemenl is Soitl within one year ol Completion. Ihe awner will have tAe burAen ol Droving �e/she Oid not bui10 or impmve
lor t�e Durpose o� sale).
I, as owner ol t0e pmDe�Y. am exclusivelq conVacting witb licensetl contractors m constmct ihe pwlect (Section 70ad, Business
❑ an0 Prolessions CoOe: 7he Coniracmrs' g�ate License Law Eoes not apply to an ovmer oi Droperty wlw 6m145 or imprmes thereon
an0 w�o wntracts for suc� pmleps vnt� a camractoqs)license pursuant to the Coniractors' State Ucense Law�.l am aware
I�a1 D�aol ol iheir Warker's Compensa�ian in5urance stwuld Ge DmNtletl la me.
� I am ¢xempi un0er Section: 8. d P. L.
lor Ihis reason:
Oaie: Oaner
I ao hereGy cenify inx� I am aware ol antl unaerstantl tne requiremenls ol Califomia Healtn ana Sale�y Cade Seclions 25505, 25533, antl
25534 and I�al I or any IUWre buil0ing occupan� willlwill no� (circle one) need to comply wi�h saitl sta�e codes and �he reQuiremen�s for a
permit lor conslmction or modilicaiion Imm the Air Ouality Management Oisiricl. flesitlential constmction aDPlicalions are e�empt Iwm
ihese pwvisions.
Date: NPplicant:
I hereUy t¢tlily Ihal I have rea4 ihis application aqtl Slaie ��al IM1e a0ove in�ormaiion i5 torreC�. I�ree to comply wi�� all city and counry
or0inanceSanOstalelawsrelatingtobml4ingconstruc�ionan0�er ufha' represen�ativeso�t cityloenteruponiheabove�mentione0
pmperly br ins0 �ion p poses.
�aie: � SignaWre:
Oriver's License o� Social Sewrity �:
i6ai-as W�ne—Bwldino: Green—CaEe Enlo¢emem: Canerv—Aoolicant: Pink—Fevenue; GOIQenroE—Assesmr
��—�F�TY OF COSTA MESA — BUILDING PERMIT PERM NO: B 06359
PERMIT NO: B 063594 PLAN CHECK NO; 03123-93 S GOVT; N SUPP; N
CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: ADD
,70B DESCRIPTION : 200SF ENCLOSED ALUMINUM PATIO COVER SQ FT; 200
CLAIM VALUE; 6,500.00 CALC—VALUE; 7,900,00 GROUP OCC; R-3 /
COHMENTS• ENCLOSED PATIO COVER ICBO#2521 6 3421
*�**�e**�r*�r�e+e�r�r�e*x�rr�e*�r*�e*�e*��r��x+r�e+��r�r+rr+r�r*�r*+�***�e�r*�rx��r�r*�r*�e�r�r*�r*�e**��r*+r+�*�r****�r
Z O N I N G R E Q U I R E M E N T S ,
S E T B A C K S
---------- MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: 22 FT IN REAR; 2 FT IN FRNT: FT IN REAR: FT IN
LEFT: 1 FT IN RGHT: S FT IN LEFT: FT IN RGHT: FT IN
PARKING RE • PROV; PARCEL: 42619110 ZNE: R1 REF NO:
PLANNING N�1'ES> 200 SQ FT, ALUMINUH PATIO ADDITION TO EXISTING NON—CON—
> FROMIRG RESIDENTIAL PROPERTY.
k if !f k 1t it k it k 1f iF iF k ik iF iF it it iF k if if if fF ik M 1F if if !F 1t 3F �f 1f !f fk if !F iF if �F �f M iF fF ik k!f k it if iF iE 1f ik it k ik if k iF k if �t it fk k it iF�if iF iF iF ik ik k 1f iF ff
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N.,T S
ZONING APPROVED BY C� � C� DATE; ����3
BUILDING APPROVED BY ; DATE:,
APPLICATION ISSUED BY: DATE: `� .�
iflfifltklFlFiFMkklEiFkkiFifiklkkifif iF�FkifMiEikklf�f 1Fif
iflfiflFif 1kiFkMiFkkkitifiFifif 1f1f kifltikiFifkkifiFiflfififkitikiEikkiklfkkkifiF�fiFiEkiFlEiFiEltif�tMlflf M1flflfkitlfiEiFitlfil�kilkk�Fif
LEGALIZATION:N F E E S U M M A R Y S2RUCTURAL SEGMENZ Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMZP%AES GRADING
PERMIT 99.00 ,74-
SMZP/NON—RES
ISSUE FEE 64.35
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 99.74 0.00 64.35 164.09 164.09 ,00
REVENUBLDGVPMT PLUMB NG ELECTRIC�MECHANIt FIRE4�SMIP�TOT/SG�RAD�NG PLAN—�RECK
99.00 ,74 64.35
iflfkifkkkMfflklfiFkiFifikkiFklflFiflkkMitffiFiFif �f iFiFkiFiFkikMkifitifitiElFiFifikifiFlfiFififif kikif kiFkiF�llFifiFiEikiElFklflfifklFkik
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 200 RES—PATIO COVER—ENCLOSED PATIO 37.00 7,400.00
END OF FEES
,
O1 00145400-001454G2 Ti� T 164.0^�
UATE: G8/2D/S3 T1hIE: i4:50
� � \
�` �♦
CONSTRUCTION AND PLANNWG P��' 'PA
APPROVALS Permit #_� Date Inspector qppROVALS Permit # Date Inspector
1. Temporary Electrical Servi ry or Pole _- 52. Pool & Equipment Location �-
2. Soil Pipe�Undrgrnd. ��' c: Vf 53. Steel fleinforcement �
.�
���Ic�trical Cond�.Ti U,IFrlity-Urid��y'rnd am 54. Forms
.14.-5leytrical Conduit Updrgrnil, T,j ' 55. Electrical Bonding
���I Reinforcers�'t LL�� 56. Rough Plumbing & Pressure Test '�
'�6�_�IaptricalUFER�_,nd. � 57. APPROVALTOCOVER-GUNITE ''
�, r.datings �`" ' -� ;� 58. Electrical Cqnduit-Undrgrnd.
,,-8.� F�oundation ''.y °' . 59. Gas Pipe, � Undrgrnd., Test `'
9- Water Pipe�UndG�grnd. ' � 60. Backwash Lines, P�Trap, O Undrgrnd. �
10. Strucwral Floo{�System �' � '� 61. APPROVA� TO DECK - �
1 t. Property Sewer�inq-& Hopge°Conna.qtion 62. Backwash & Receptor�Final -
� '
12. Sewer CaP y, ;r � � � 63. Heater & Vent-Final
73. Roof Drains t- ' � 64. Plumbing System - Final '
14. flough Piumbin� a' 65. Electricai�Final
15. Rough Electricb:Condu�i , 66. Sotar System-Finaf �
16. Aough Electricairing � 67. Fencing & Access ApProval .
17. Rough Wiring Sign � 68. APPROVED FOR PLASTERING
18. Rough ElectricaWT Bar Ceiling 69. POOL/SPA SY5TEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
-.`7 Cr :r r, m t� cc .� H N
20. �flough Fd¢tory Fiteplace i ac+7 �S �.t O J tr .+. > UVppR�VALSv:��Permlt # �•� v«
r t v' Y �'� :< H h':.. �'+��..{ � 'l �,T
21. �„ ,. i t»r-� xs x �1 '-� •y- .. s=��a n� a ��
uC(� irLStri'��itu;�,� i.. .. �„S � �- d�..i,., p 0. l�ndergroupd�iY(§o �:
22. Duct9, VBmtilating-�r � f�S a, � ..S �i,R •' 1, Product;Pi$iri9 Q'G3P ❑Oil
23. �as� Pe` ou &' sc �`'"' � s o� � r a: 1 T i � '"'7 + Os
i-i r� � TS � cnS .k tr b� ¢ Gt r: �--�12. UndergroUs+d�Flty�,i"Ja+ �' F-�
24 iBoo,.f��Fr�ming� ca i�-.�-. •q- a;> G a�+ r`73.�lJndergrnd`StoraqeQ'ank � Gas ❑ OiP
r . -� � T
' 25. Roo�JSh�thing `�� g: N*M !T.' Q!v"�a�si4.r er � '"'F�o a
r O. 4 � i> G .� f x {�y head HYdro �-j ri
26..�Y.,-BaryCeiling (StruGsural) & fyoraocoat o� �•w .n '.^� m> +r 75.'=0ry Chemical " > W _ Q '
27.�Prameand Flashin • � `= ��` d '-' 76.`�Y Stand'�''gt� -'�• # 5 ,'; '�L
�*J t79 * J S x .�: 7 � m x. -...V r,. .
.� �.o • d, �_� :7t -�s .. �f • �.
�25. � Lathing &�Siding��+. r,� y�r, ^p -a S ••a > 77,ufIXED SYSTEM"FiIVAI � , d
•. �
c? 'J; p H�. .. � ,;r, � x i ,. ��a
=29. �nsulati�i r S •,�, t ,:,y 78.��IREPREV.F�N�4.� :r> ' O
* .. r
�30. Drywall �ailing J, . • �r � i. �-. HfcALTH�DEPT.eA-6oW4REMENT
n
�31. Plaster Bf w Coa '� i, ;.j � w %�.I9.�fINAL IN'Sf,ECTf(¢.i$1 � C cr � '
�{� }: 1 r� ~ �% r Y t- T T• '�4
��2.i61ectrica<<�owgr Meiet,Final i g_�: ;v I ... �-$O.;F�OOD CER �IFIC<iTiE ISSdI�ED � i
33. •r+,in�y^ EleCtriG�I �".� ' i tr'S a: [n *�• [rj,�o{¢': b• '�x s j S
�n d � rin i � * . x t I� 7 'y(*! ?'y t� n'
` 4. Fin ' 'Hea in °� �'Co itio� i`:`� '� . , r. ,., : .• � �
;� ii � �� fa � �.3.5 Ct t: r 9 :.; S i iS :n S OC
35.�P.inlHGas-PideSTesQ�•.� .7•=_'^. *' C� ��� r^,•- � r mG
-+a n x fy t� .r '� :J . x '�T
�. � .. K r ..H . .� � ?,,-=, , ,;; . "
36. �ioocJ,or�anopy �. ] ��r ] aQ x�� �. r�. g r �.� . cr r
�37.'Einat.Fa�foryFire�tace � S.• ro•t��.!Ti ^ �. : i. +� � £-.•
i - � �ci
. . , � .. . n C ; r. : - � - -
�8. F.inal;Plumbing i;r'�:� � -�.� fi �" �„ s `' :, '., .p
i59. ANater.Service�Finalr i o.� x: k+ Ct '�!T� x=
d I a' .^ r!, 1
�0. Gas Service�F"iial ` °�S ' " � '.' '
c�. :;r t,rt,+ � x r, t w ;;�a ..
:41. �Solar poRlesticFinal S C ••G * : � * z {�+ � + >
r > rt• ;c �r . x -?
�42. �Backflow Preventer' F` z., '. ' "' '� `_ � '. '
. ,x T > . , c i-,
�. _
43. Backflow IrR�ation> � '�C�� a7 * x' A s.`� �. ; v ��
. x � �'l:
."44. Landsca e Ir qatio+ System '�'' `' x T Y y �� '" ; �`�
F? �� �l .J!�7i.. xS O G 17�t � s: ^t n� �. T;,l i V ��
i v : �.. . : ., . - :: .� -� .�� '
7t5. �S*ound AtrenDationtt �-+x(-a , � * F. �- ;- -�r � c', .+ -+ s•s s¢ +.
1 ' G' rt1 �J �'
�6.�Handica(�•Re�utatio�s d ..•. '.0 #: � , T� "a � ' ,-`� �
-+ OS '� / •5 ��y S
47. FIN L STRUCTUHE & BUI:LDING C'. �ti/ _ `. �� ^ *
'� � l : , �' ` -
48. �INAL PLANNING� �m s . � * ' :� a, , � ,�
� I . � � lL % '. T T � X
�49. ElecEjic Rele�se to Edison i x ' � � :� ir. � � . ; _i.
. e .r .t -
�50. Gas,�ele3Se to SoutTiem Califa�r'�a,Gas Co " ''' ' "`' _ � "-, m .
'•, t. CERTIFICATE OF�CCUPANCN , ;, y �; T.� x-_ � F�
No. Date
I�
�
�
��
PHOJECT ROUNESS: Z•1 4 pAUL I NE PL
OWNEN'S NIIME: SMIT JACOBUS L M
aoosess:'ZZ4 �AULINE PL
' COSTA MESA,CA 92627
APCN/ENGINEEfl:
FOOflE55:
NEG.NO.:
UNIT:
UNIT:
PEflMITTEE: WEST COAST CUSTOM ROOMS ( 714 ) 594-7547
aooxess: 786j7'PINE FALLS AV "] q
UGENSEO CONTflACTOp��ECCdHATION: I �ereby allirm Ihai I am licensed underCpr�o�visio9ns1 � C�BapYer 9(commencing wil� Seciion
7U00� ol Divsion J ol ��e Business ana Pm�essions CoOe. ana my license is in lullfaece an0 eilect.
CRV LIC.: STATE LIC.: 55:
044 OS 471619
�ate: Signature'. _ _ _ _ _
WOBREBS' OMPE P I� L�: I �ereby affirm ihal ave a erlilicate ol ca nt to self-insure or a cenificate ol WOM1ers'
Compensation Insurance, or a cenitiea copy tnereal (Seciron 3800. LaG. C�.
voucvxo.: 1004744-93 E%P.�ATE: OSIOSI94
COMPRN7: STATE FUNI�,
7 Cenilietl copy is here6y fumishetl. L3C CenilieC copy is liletl wit� the ciry Builtli OiviSion.
Daie:�.� Ap0licanl
EEEMPTION FBOM WOBNEPS' COMPENSRTION �ECUflpTION: �This seclion neetl no� Campkle0 il Ihe permil is lor one AunereG (SI00� or less�.
1 cerlify I�al in I�e Oarlormance ol �he work for w�ich ��is permil is iSsueE, I sha oi em0�oy any De�son in any manner so as to hecome
Subleci lo the Workers' ComDenSaiion Laws o� Cabfomia.
Oai¢: $ignaWR:
NOTICE:If. atter making IAis declara�ion, you 5�au10 Eecome sublec� �o �he Wark¢rs' Campensation O�a�isions of tne La�ar
Cotle. you mus� Iorlhwii� comDly wi�� suc� pmvi5ion5 ar Ihis permi� shall Ee OeemeO revakeA.
COBSTflULTION LENOING RGENLY: I hereby alfirm �ha� ��ere is a rAnstmction lenaing aAency lor �he peAarmance o� Ihe wnrk lar
wnic� t�a perrtot is issuM (Senian 3W7. Gv. C).
LENOEN:
FOOflESS:
OWNEB BUILOEF OECUM710N: I hereby affirm Ihat I am exempt Irom tne COntractori 51ate License Law lar tne tollowinp reason
�Seciion 7031.5 Business antl Professional Cotle: Any cily ot counly w�ich tepuires a permit Io mn5imct, alttr, improve, demolish. or
repait any S�mcWre. Drior lo i�s issuanc¢. also r¢quir¢Slhe aD0litanl for Sut� p¢rmii Io �ile a SigneO 5�a�¢meni ��a� �e/S�e i5 liC¢nsed
pursuant Io I�e D�ovisions oi t�e Caniracmrs Slate License Law �C�apler 9(commencing wilh Seclion 7000) ol Division 3 0l Ihe Business
and Pmiesuons Code) or �hai �e/she is exempt tAerelmm and the basis for ��e alleqeG eKemO�ion. Any viaWtron ol Sectwn 7031.5 Gy
any applicant fw a permil suaec�s ine applicant to a civil Oenaliy oi nat rtwre tlian live AunUred dollars (5500).
I. as owne� ol ihe prooeny or my employees wilh waAes as ineir sole compensation, will tla ihe waM, antl Ine
❑ slruclure is nol inlen0etl or ollere0lor sale (Section 70d4. 8usiness antl Pwlessional Code: The Coniractors' State License Law
Aoes not ap0�y �o an owner ol a o�oDenY wM builas or imo�oves ihereon, antl who Coes such work Aimsell/�erseli or NmupO
�is or her awn em0�oyees. D�%+OeO ��ai suc� improvemenis are not intentle0 or otlereA for sale. II, �owever t�e building ar
imprwemeni is 5014 vnihin one year of cample�ion, t�e owner will twve ihe OurOen of pmtinp �Us�e EiG not buiW or im0�ove
lor Ihe purpo5¢ ot sale�.
I. as owner ol ��e D�operly, am ¢x[lusively canirac�ing mlh Iiten5e0 contraCiors Io con5lmci IAe prolecl ($eclion 7044, Business
� anG Profeuians CaOe: The Conlracmrs' Slaie License law Oces not appN �o an wmer al OropeM � �wlds or improves thereon
antl wM contracis for sucn pmjects witn a cantractor(s) license pursuanl to ine Contractors' Siate License Law�. I am aware
Ihai 0��� ol t�eir Workei 5 Compensation insurante S�ou10 he D�OMOeU la me.
� I am erempi unUer Sec�ion: 9. 8 P. C.
for Inis reason: '
Date: Ow�er:
I ao �ereUy cenify I�ai I am aware ol an0 un0ers�antl Ihe requiremenis at Cali�ornia Healih anU Sa�eiy CoUe Sections 25505, 25533, anG
25534 and lhat I ar any IuWre builOmg octupant will/will not (circle one� nee0 to comply wit� said slale caUes anA ihe requiremenls for a
permit lo� constmc�ion or mo0ification Imm �he Art Ouahty Manag¢menl Dis�rict. BeSiAen�ial con5lm[lion appli[ation5 are eeemD� ��om
inese pmNsions.
Daie: Npplicanl:
I here�y cetldy ��at I have reaa ��is applicaiion an0 slale ihai Ihe a0ove informalion i5 corre I I a0ree �o comply wilA all ciry anE counry
arOinaMeS antl siat¢ Wws r¢Wting to Guiltling cons�ruclqn anG � r¢e repreu tative � I�is bry ta enter upon lhe above�meniione0
pmperiy IOr i(rs cii0n pur Ses.
Dale: � Signaw '
Omer'S lic se ot $O[ul 5¢Curily M: '� �
t6at-a6 Whi�e—OuilEing; Green—Latle Enbrcam¢nL
GolEenroa—Assesmr
CITY OF COSTA MESA — BUSLDING PERMIT PERM NO: E 06359
PERMIT NO; E 063595 PLAN CHECK NO: N GOVT; N SUPP: N
CONSTRUCTION TYPE: PERMIT TYPE: ELE PURPOSE; ADD
JOB DESCRIPTION ; 200SF ENCLOSED ALUMINUM PATIO COVER SQ FT:
CLAIM VALUE; CALC—VALUE; GROUP OCC: R-3 /
*�*******�r****�e�***��e+�r�***�e�+�r*�*******�r****fr****�**+e*�**�r��******��r*H********��
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY HUILDING ---------
FRNT; FT IN REAR; FT . IN FRNT: FT IN REAR; FT IN
LEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT; FT IN
PARKING RE • PROV: PARCEL: 42614110 ZNE: REF NO;
PLANNING N TES> p
i
iflfkifMlfMMkff kifif MMlfffiFlfififlfkiFMiklf�fkifiFlFifMikk�fMkkif If1F�fklfil�fkMififiFk�EilMkikitlFiFfFiFikififikiF�fkltitiflflflfiEiF
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
ZONIN� APPROVED BY DATE;
/
BUILDING APPROVED BY ; DATE:
APPLICATION ISSUED BY; " DATE; � ��
iflfMkMMififiFikkifikififkkkffitifk Mifif�flFlf�kilMif iFk
kftiFMkititkif kitifitifififlfftif kif�fiFikkMiFltlfikifkMiFMKkkikMifiFlfitikMkklk�FkifkltitiFffiFiFitiFkiFiFiFlF�f�FltltiFlflEif�fififiEiF
LEGALIZATION:N � F E E S U M M A R Y STRUCTURAL SEGMENT:N
PERMIT BLDG PMT PLUMBING ELECSR25 MECHANIC FIRE SMIP/RES GRADING
SOt SMIP/NON—RES
PLAN
ISSUE FEE �15,00
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTP,LS--�—> 5,25 15.00 0,00 20.25 20,25 ,00
REVENUE DIVISION TOTALS--> COLLECTED; 20,25 OVER/SHORT: .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADZNG PLAN—CHECK
20.25 ;
ifkiFifitififififkkikifkMMMkififkMitifikkkkilkifitiflflflFifiFifMififlFkMlfififlfifkkM�FkkifkifkikifiFiFMlflfiFiElElkiEkk�kifiFlklE
I N D I I D U A L, F E E B R E A K D O W N
TYPE QTY� D E C I P T I O N UNIT COST TOTAL COST
ELE 2 FIXTUAES LIGHTING' 1 ST 20 EA. .75 1.50
ELE 3 RECEPT/OGTLET . 1 ST 20 EA. ,75 2,25
ELE 2 RECEPT/SWITCH 1 ST ZO EA, ,75 1,50
END OF FEES
i7 _
�` �I�F`503—��0�l14�403 T�]T
DA1E: do"/20IS3 TI11E: 14:51
4
20.?5
,� W
CONSTRUCYION AND PLANNING ' P�� P'0'
APPROVALS Permit# Date Inspector APpROVALS Permit# Date Inspector
-i;'� f�. -
- i. Temporary Electrical Service�orPole � 52. Pool & Equipment Location � �
2, Soil Pipe-Undrgmd. �.- u.y 53. Steel Reinforcement
3yEl�trical Condu�LUtrity-Undf nd.,; " ��j 54. Forms
�4.-[1e�,trical Conduit-yinirgrnd. �� 55. Electricel Bonding �
�S=Sie�Pl Reinforcen�'rit� '� 56. Rough Plumbing & Pressure Test Q
���� 51G4trical UFER�Grnd. 57. APPROVAL TO COVEfl�GUNITE `�
S2: Fdatings �'t" ' 58. Electricaf Conduit-Undrgrnd. ��
�n. ,rr.
._S.,F�undation =��; ' 59. Gas Pipe, O Undrgrnd., Test �� `''
3�Water Pipe-U�dC§rnd. � 60. Backwash Lines,P-Trap, � Undrgrnd. ��
70. Strucmral Floor ~ :� ` � '
r5ystem '^ 67. APPROVAL TO DECK _
11. Prpperty Sewer ��ne�& Ho�se.Conn�ciion ,; � 62. Backwash & Receptor�Final � ��
72. SeWer Cap y �.� y, ' �<'� 63. Heater & Vent-Final '';
13. Foof Drains - - � . 64. Plumbing System � Finaf '
14. Rough Plumb�ng� G � 65. Electricai-Final �
15. Rough Electr� - onduit � ��� 66. Solar System-Final
16. Rough Electr�c �Niring � � 67. Fencing & Access Approval
17. Rough Wiring Si�n � 68. APPROVED FOR PLASTERING
18. Rough Electrica�-T Bar Ceiling 69. POOLlSPA SYSTEMS FINAL
/9. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
'7 T b'HS�k• �. V' �^ :+li (+1
20. ;�ougm FQptorW Fi�Place � x,�; ¢�J .. �� b n'.F APPR�NACS�vD�E',erm'tt # a "�' "�
c � � n)r it- a' �
� F 1 F'f. X'� :P H 'J '7M'1 } c.•,] f "� Y ��•
21.t'�?,uc��in�>Str�u:e'r,o i.... �-.g ,� S C�at �0. Underg'ri�nl}-j�YbCo r
22. buct� VewtilBtinc�-.�: i CJS fi M S -L»� � cpi, pioducil°ir�nl� Q'G�is ❑�7i1
23. �as �ipe-�`1�ouB� & T�st i i�is x r*7 a 6 O* i� � 9 (�+, � �n A O:
�2. Under r�u d Flu
24. �ijoof¢ra�ting•• r7��. � r�F ^[-� x � G tr' ��* �:,L3.' �ndergrnd�=Storar�4ank @Gas Q�N�''� "•�
� a.
25. Roo�Sh�thing 7>� ' t'� � M a� � N• .. a �H +
m '_ ,,. M •7 , : J a. �4. yverhead FYVdro 0
26. -��Bai;Ceiling (Siry6tural) & (Vloraocoat a �� � �.�*�,x , 75. �Dry Chemical ' 7 w �+ �� t* � �.
.�, � �
27. � rame a�d Flashin� �' '1 ' � " 76. `Dry Stand'�e, `.n,,,g' ` S m"� Ci
�� ,.C,-.; e a r C7� D � F..A
�8. ��Lathin9 �Siding n: ..� y + i s, �; F. • � •� .. 77. .'FIXED Sl`S�7fM-�YNAL -= � �["t,
....
�r�j ..... � .: � r . � ...� i ♦ ?J CJ
319. Insulati� „$ ` a_ 78.�IREPREV.FINA,.{y #;> � _;,-�
30. Drywail Plyiling A s' �� _ ; rJ H6ALTH qEP7.#i�Eql�}ftEMEN7
�37. Plaster Bi51wn Co��t ,; � '` ' 79. �FINAL IN�ECT1�� " �-� 7� `a' x'
t t � Y•r (: l� Y'
c32. lectricai,�ov�r ter inal � � �� �- � � `
� � � y , ' i8p. ,FOOD CERYIFI�#tRE�IS9kJED ��-,
; _ ���-,,� _ _.
_33. .Fin'7"Elec riG � cnr n, i � r x � # F 'PBot� � y`: � �
_,. .. 1 ;, � `y_3_?r��.�;����,�� �� o���,��.
�-3,4. iF�ina�Hea��ng�t A�r,'�ortdi,tionira$� i� * h; ..,. ,S C�... i�. S Ci
35. tAin91-GasfipEaTest � .yx' ..) ` . n,v ,� ,`,�� T,� � T ,_ " J
c �•. �t. v h+ �t So '7�--+ .^7!l::.11T
36. Floo�',or' nopy •'.y; _ S > .� . ..• � . r.^
� � i r; n. r r�. . i. Y ['�:� x� t�'
�37. �inalFFattory Firealace� ' S�� ' � " F n " `����'-'�
.T i=� r- x � a 2 '<
.. .. Y r i .. ., s ` . ' r
�. FinalPlumbin9 , .. '• i s :� �,; p
i39. Water Servic¢-FinaL � i o � � C1 �n *+ v�z
(- � > ^ i +,, z. c - >+ ?�,r, .,
�;�0. Gas Serv%�Final " G ' ` r`' � f ' . . .
G � r a:^v � n �rt * Oo c�;v a�
�1. Solar pomesticFiqa6 ; C� � •• > (� -' a Q:.+ a �
- � K � '7u a = � �
ri E"^ ��J A'_ • F-f i/ R
-42. BackflowPreventert :� � � x � �F, .r'� -�
� �
43.Backflowlrri�tio�iL� a:�s T .r.. oc� xQ
�. x, x' ;v / # i • •
�?l4. Landscap`e Ir(tgatipriSystem,p��=, -r ��r, � p -+a u, :J x!') r N ti:�� �.
�.. i ' � �.. . , .. .. � �. .. .
45. �5ound ALtenIIatiOnR �::;: � !-�• r ?', _ _ ry �. �-� �� ,..i tro tr� �
�� k !n Y�. ? 7 G ...�
$6. �pandicad,Re�ulatioqs - � �' -'�� •• ••y . � x S QL� •c�i x
i
47. fIN�L STRLLCTIkR�E & BUII;DING x � e ,�o S � +'
�� �n. wr.. � ,y �'
48. EINb�L PLANNING,` �� : .� Y - :,. .r � , "
;y9. �ledte�ic Reledse toaEdison � . - k F 'F � �' '�
- . � n
`50. .Gas Release to Souttyern Californi� Gas Co � - � y �;.� * �O: �
�� a
$1. CER�IFICATEOFQCCUPA(JCY' , „� ,, p `c r ,, [�. ,]'JO
No. Date
owrr�R CLINTON, CARL E
JOB ADDRESS 221� pgt�2
GENERAL CONTRACTOR F
A�� '^��� 118-112-o9B LOT
1_ 1GCTIONS
Soil
Gas
OCCUPANCY
:(1GA1 [1116 . 5M �
«
DATE
PERMIT
illders VALUF $ 10,, 10,00
TRACT FIRE 7.ONI's DESCRIPTION OR WORK
Signatur DA1'E GROUPI � J TYPE V 7.ONE
� S a `�� SUBCON7'RACl'OR ,��—
C�
, 15�: s9 �
COSTA MESA BUILDING•SAFETY DEPARTMENT
P. O. BOX 9f7 C06TA MEBA. CALIPORNIA
Fo� Applleanf fo Fill In Complefely
TYPE OR PRINT
ADD EI66 �L' N�'�-�
COSTA MESA CALIFORNIA
O ,�1N�lS
CI7Y L C }''f /� /
STATH % � �
LIQ NO.
size 3 J—.X l L o
OF LOT
IISE OF
EXI6TIN6 BLDG
9HTBACR LIN6 PRON
i(�n�2 S APPROVED
BY
Pv�2 Y
FE� RECEIVE
' � SEP I 41gg9
�FINANCE DEPT.
CITY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
ACC8IPT NO. P6R/N/1S I
�r ��''/� r
!Y I OAfiX'�/ �.� �'TEn J
Y �
COSTA MESA,
�NING
ZONE�( / NO. OP U86 OF NEW �
�7 Il �1 I �uNB z BUILD�NO
� J � �3 �Q BSCRIPTION vi +� ZS3 �j.�Nt
xo. or e�oae. p
NOW ON LOT � A. P. NO. I�— � 2 — �/ �
YARDS EVES
APPROVED ALLOWED
(CENT6R LINC 8TJ � �
AR YARD cwnvr _ rO �' cr �
DESCRIPTION OF WORK
BUIL�ING C NO. OF
SIZE �� ROOMS � STORIF
EXTPRe�OR WA ROOF
_ �C"fJr�O rnvro�ur �O G`
1 HEpeT' ACKNOW�iCOC THAT 1 XAV6 PBAD� THIB APPIIGTION
ANO eTAT6 THAT TM6 ABOVe 18 CO �ND AOR88 TO COM•
PLY WITX /�LL WYY INANCHB D Ti lAWB REOU4TING
BUILDINO CDN9TRUGT N. //' �
61GNATUR •� . ��yjL�qGt.Pl
PERMITTB
/o
efE�
� � r
TX8 �MOUM BHOWN UNDEfl VALUATION IB POR THH
PIlRP09H OP eBTA�LI8H�N0 A PERMIT FEE OMLY.
VALUATION //'
/ a pp� PERMIT FEE $ � `� --
$ ��i � � PLAN CHEC% $ /�J •`
TOTAL FEE -�