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HomeMy WebLinkAbout1952 PELICAN PL - Building Permits 4‘0610 MF CITY OF COSTA MESA 41 pe BUILDING DIVISION >':�'�'-,� DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 0041k PERMIT 4%„ ,o ° B05-00250 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 1952 PELICAN PL Status: ISSUED Suite: Applied: 02/08/2005 Vicinity: SIDE OF PROPERTY Issued: 02/08/2005 Parcel Number: 13947218 Zoning: R1 R1 Applicant: TERRY GUOIN ISSUED BY: Address: 24523 LAS ALI8SAS BL SUITE 249 Phone: 949-295-8261 LAGUNA HILLS,CA Zip: 92653 Owner: ROWERDINK, JEFFREY D Address 1952 PELICAN PL Phone: COSTA MESA,CA Zip: 92626-4732 Contractor SOUTH COUNTY SUNROOMS INC • Address: 24523 LAS ALISAS BL SUITE 249 Phone: 949-295-8261 LAGUNA HILLS,CA Zip: 92653 License: 816279 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT INSTALL 80 SQ FT PATIO ENCLOSURE AT SIDE OF PROPERTY. ICBG#459013 FEE SUMMARY Plan Check: $90.51 Calc Valuation: $7,000.00 Permit: $139.25 - Claim Valuation: $7,000.00 SMIP Res: $0.70 SMIP Com: $0.00 Other: $0.00 - Inspection: $0.00 • Total: $230.46 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 5-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of Consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) WI certify that in the perform of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of for a,and agree t t if 1 should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these o ns. AIWA italic o LSignature:' � < <f --'71r I - �' QS WARNING:FAILURE TO SECURE ORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLO ER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE Gloom IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I a`licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Busin= a • Professions Code,and my license Is in full ,force end effect.Lic 4 . '.1... less,a_ •on>racsor Signature "aai.« r f.Dete 1---. - 4"- as .— CONSTRUCTION LENDING AGENCY: o I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her Own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ' ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes ❑No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: 9 I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). o As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes ❑No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). .... ... 2 Does or will the applicant or or future building occupant need to file a registration form for acutely hazardous materials? 13 Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a,aermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the Calitomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. //J�ignatur 2 Of�.egal Owner(s) Date / - 8-os r And/Or;AfRh"orlieA-Appllcanl•-._�R RDate'Lu„ +,p T J CODE 0 INSPECTION TYPE pATE,-.1,lrrrmALS gODE0 INSPECTION TYPE BALE INTMAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 4/020/0-5-q O/AS PP p5ll 9 CITY OF COSTA MESA 4 BUILDING DIVISION ey 1 F i i r DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER J • PERMIT ""oma' E05-00095 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 1952 PELICAN PL Status: ISSUED Suite No Applied: 02/08/2005 Vicinity: PATIO ENCLOSURE Issued: 02/08/2005 Parcel Nunmber: 13947218 • Applicant: TERRYGUOIN ISSUED BY: Address: 24523 LAS ALISAS BL SUITE 249 Phone: 949-295-8261 LAGUNA HILLS,CA Zip 92653 Owner ROWERDINK, JEFFREY D Address 1952 PELICAN PL Phone: COSTA MESA,CA Zip: 92626-4732 Contractor SOUTH COUNTY SUN ROOMS INC Address: 24523 LAS ALISAS BL SUITE 249 Phone: 949-295-8261 LAGUNA HILLS,CA Zip: 92653 • License:816279 • SCOPE OF PERMIT INSTALL 80 SQ FT PATIO ENCLOSURE AT SIDE OF PROPERTY. ICBO#4590P. REF.: 905-00250 ELECTRICAL TO INCLUDE:2 LIGHT FIXTURES,3 OUTLETS,AND 2 SWITCHES. FEE SUMMARY - Quantity Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft $0.00 0 Res.a/c package $0.00 Standing Section $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment - $0.00 0 New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 - up to 10 kva/kw $0.00 0 Lighting Fixts $2.20 2 'up to 50 kva/kw $0.00 0 Recept Outlets $3.30 3 up to 100 kva/kw $0.00 0 Switches $2.20 2 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 ' Low Volt Wiring System/Ckt $0.00 0 Service to 200a $0.00 0 Misc.Conduit $0.00 0 Service to 1000a $0.00 0 Misc.Conductor $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1hp $0.00 0 Circus(mech ride or lights) $0.00 - 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. O I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit Is valued at one hundred dollars($100)or less.) TI certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of C • ia,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these pr ns. a ApplieaM;,Sfgnature:—"- ,. / Deter-� .N ' g' d SRT CRIMINAL THOUWAsIgAN. ($lOO. E WADDITIO TOTCOMPENSATION CO MPENS IT UN.DAMAG ANA SPRLLIDED FOR I N EMP 376 O FHE PENALTIES I ANDEST, RNES UP ONE HUNDRED THOUSAND DOLLARE($1 W,OD%,IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 31060E THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: .hereby'ettirm thatT-am'licensed n er r visions of Chapter 9(commencing with Section 7000)of Division 3 of,ihe.&uin>e s a d Professions Code,and my license is in full farce end effect-L'ic,'# -}Class x c H Con s Sidriature: 7 /� l Date" �,• g- n 5 CONSTRUCTION LENDING AGENCY: O I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale,If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: O I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or wit the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Duality Management District or from any other air pollution control district or agency? 0 Yes L-I No (Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature O egal Owner(s) Date 05 / itlirAnd/Ol Authorized Applicant'nV72c-. Date;, son 0 INSPECTION MI DATE INTTTIALS CODES INSPECTIONTYPE DATE. INTID9L5 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical Ltnn03• 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy L401111 West CITY OF COSTA MESA , 4 BUILDING DIVISION > °trilligaCI1 -, DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT 4 E02-00077 4(b4PoprtRo 6 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 1952 PELICAN PL Status: ISSUED Suite No Applied: 01/28/2002 Vicinity: REAR YARD Issued: 01/28/2002 Parcel Nunmber: 13947218 Applicant: TERRANOVE, DON A ISSUED BY: ._I__I‘? ,_ Address: 16281 SANTA ANITA , . -Phone: 949-278-6772 HUNTINGTON BEACH, CA Zip: 92649 Owner: ,/ROWERDINK, JEFFREY D • Address 1952 PELICAN PL " Phone: - , COSTA MESA,CA Zip: 92626-4732 Contractor: SWAN POOLS OF SOUTHERN CALIFORNIA Address: 24512 BRIDGER RD " " ' Phone: (714)859-8466 - - LAKE FOREST,CA Zip: -92630 . License: 440333 - SCOPE OF PERMIT . - GUNITE POOL AND SPA. ELECTRICAL FOR POOL AND SPA: - REF: 602-00135. ONE ADDITIONAL OUTLET FOR BBQ.--' - • • FEE SUMMARY . Quantity _ / _ - •- _ Quantity •- ISSUE FEE . $23.50 Temp Dist System/Lighting $0.00 0 • Temp service test $0.00 Busway/100 ft - $0.00 0 - Res.a/c package $0.00 Standing Section ' $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 "0 . New Res(34-units) $0.00 0 - ->Transformers up to 1 kva/kw $0.00 0 Pool/Spa - - $49.50 1 - - up to 10 kva/kw $0.00 / 0 ' Lighting Fixts v' $0.00- 0 - - up to 50 kva/kw $0.00, 0 Recept Outlets ' $1.10 1 , up to"Ido kva/kw:. - $0.00 . 0 Switches $0.00. ,t-'" 0", " . over 100 kva/kw' $0.00 0 Non Res Appl $0.00 ;' 0 Low Voltage Equipment . $0.00 0 Res Appl $0.00 " ' 0 Low Volt Wiring System/Ckt $0.00, 0 Service to 200a ' - $0.00 ' ' 0 - Misc.Conduit $0.00 0 - ' Service to 1000a - • $0.00 , 0 - Misc.Conductor $0.00 0 Service over 1000a '' - $0.00 0 Circus(gen or ride) 1 $0.00 , 0 ' Motors to 1 hp $0.00 0 Circus(mech ride or lights) $0.00 " 0 Motors to 10hp N $0.00 ' 0 Christmas Tree Stand $0.00' '0 Motors to 50hp " $0.00_ " 0 Fireworks Stand $0.00- " 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $74.10 Intermed Pole $0.00 0 COMMENTS/SPECIAL CONDITIONS • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28, §1,12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 244646(WOO) . • DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the uuuu���� work for which this permit is issued. �I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECU RS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUEUECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class# Contractor's Signature: {.k - Date: I — 02'—C)Z CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes ❑No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes Lj No (Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all slate laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owner(s) rptate And/Or Authorized Applicant Date CODE I INSPECTION TYPE PATE INTRIALS CODE 4 INSPECTION TYPE PAIS UIlIINL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing .. � ,� 200 Final Re-Roof 210 Final Electrical 3-,,L/ Q3 63f i 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place _ 220 Final Planning Approval _ 203 Final Sign 222 Final Site 204 Final Demolition 250 .Final Building/Occupancy 4`O S 9 ,, CITY OF COSTA MESA BUILDING DIVISION f • ,I . DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT 'ha,Me ,d4. Pica e P02-00050 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT • Job Address: 1952 PELICAN PL Status: ISSUED Suite No Applied: 01/28/2002 Issued: 01/28/2002 Vicinity: REAR YARD • Parcel Nunmber: 13947218 - • ISSUED BY: 4/„.Z_______ Applicant: TERRANOVE;DON'A - Address: 16281 SANTA ANITA - Phone: 949-278-6772 HUNTINGTON,BEACH,CA Zip: 92649 _ Owner: ROWERDINK, JEFFREY D Address 1952 PELICAN PL- - Phone: COSTA MESA,CA Zip: 926264732 , " Contractor: SWAN POOLS OF SOUTHERN-CALIFORNIA Address: 24512 BRIDGER RD • - Phone: (714)859-8466 - - ' , LAKE FOREST,CA Zip: 92630 ' License: 440333 Arch / Eng : - Address: , • Phone: -- Zip: - / `__ - - , License: • SCOPE OF PERMIT • GUNITE POOL AND SPA. PLUMBING FOR POOL AND SPA.ADDITONAL GAS OUTLETS FOR BBQ AND FIREPIT. REF:1302-00135. . ' FEE SUMMARY ` -a- -AMT AMT "QTY`, - . / - AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer . $0.00 0 Sump Pump '$0.00 0 Backflow irrigation - - $0.00 6-. ‘\\ Landscape Irrigation $0.00 0 Swimming Pool _ ' $60.75 1 Backflow Preventer \ $0.00 , 0 - , P-Trap - $0.00 0 - .,Trap Primer- $0.00 0 Bathtub $0.00 ' - 0 Pressure Regulator $0.00 0 - - Urinal - $0.00 0 Clarifier System $0.00 0 , - Process Piping(per 10 ft) $0.00 '0 Vacuum Brkr Bkflow(14) $0.00 0 Connect(Ice,Soda,etc) . $0.00 . 0' • - Receptors $0.00 0 ` Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units ` $0.00 0 Septic Tank $0.00 0 . - ` Wash.Basin, $0.00 0 Dishwasher $0.00 0 ' , Sewer Cap for Demo $0.00 0 . Wash Basin Set $0.00 0 Drain, Floor $0.00••" 0 Sewer Connect $0.00 ..0 Waste and Vent System $0.00 0 Drain, Rainwater $0.00 -0, Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0 Drain, Roof $0.00 0 Shower $0.00 0 Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 " Sink,bar $0.00 0 -- Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink,Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) $6.15 1 Sink,kitchen $0.00 0 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00. 0 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $90.40 COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 I 2046.46(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: 0 I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the Vfor which this permit is issued. wIC have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subj ct to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 700 of the L bor Code,I shall forthwith comply with these o ^ 7 0 2 Applicant Signature: Date: "-L/� WARNING:FAILURE TO E WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL P LTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,o00),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is In full force and effect.Lic.4Class 4 Contractor's Signature! — ' ' Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,Califomia Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has e permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes ❑No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the Calif omia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application akermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 0 No (Section 65850.2 of the Califomia Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? ❑Yes ❑No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owner(s) to Gorr eft %racn opt I Ze Oa_ And/Or Authorized Applicant Date CODE t INSPECTION TYPE OATS INTrrtALS CODE II INSPECTION TYPE PATE MALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical f 1266 Pool Spa Final 208 Final Plumbing _. S"/9-03 ELL 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition ' 250 Final Building/Occupancy • 40 5111 M 9 CITY OF COSTA MESA BUILDING DIVISION F • ',,-�,.,,,ii. 1 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4 PERMIT 4 mo` s M02-00047 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT - Job Address: 1952 PELICAN PL Status: ISSUED Suite No Applied: 01/28/2002 Issued: 01/28/2002 Vicinity: REAR YARD • Parcel Number: 13947218 ISSUED BY: ,__19K____ Applicant: • TERRANOVE, DON A ' Address: 16281 SANTA ANITA . Phone: 949-278-6772 - HUNTINGTON BEACH, CA Zip: 92649 / Owner: ROWERDINK, JEFFREY D ' Address:. 1952 PELICAN PL - Phone: > COSTA MESA;CA Zip: 92626-4732 N Contractor: . SWAN POOLS OF SOUTHERN CALIFORNIA Address: 24512 BRIDGER RD - - • - , 'Phone: (714)859-8466 - - • LAKE FOREST,CA - Zip: " 92630 License:440333 - SCOPE OF PERMIT GUNITE POOL AND SPA.MECHANICAL FOR POOL AND SPA HEATER. REF: B02-00135. "• ' - - FEE SUMMARY ]: . . . ._ , . Quantity Quantity • ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $0.00 0 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 -0" - - - . - Ventillation System - $0.00 0 Repair/Alt Cooling/Heat $0.00 •0 - Evaporative Cooler • $0.00 0 Inst/Rep. Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 ' 0 Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace $0.00 0 , • • =13 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU • $0.00 0 VAV Box - $0.00 0 30 To 50'hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct, $0.00 ,. 0 , Over 50 hp/Over-1;750 BTU - - $0.00 0 Appliance . - $0.00 • 0 Boilers Fire Dampers $0.00 0 Up to 3 hp $0.00 0 Smoke Dampers . - . $0.00 • 0 3 To 15 hp 427.15 1 Inst or Relocate Appl Vent ' ' $0.00 0 ' . . 15 to 30 hp $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers> 10000cfm ' $0.00 0 Over 50 hp $0.00 0 Floor Furnace _ $0.00 . 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee - $0.00 Plan Check Fee - $0.00 Reinspection Fee $0.00 , TOTAL CALCULATED FEES $50.65 COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§1, 12-21.92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 244648(6/00) DECLARATIONS •• WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. �[J \I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. / v My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed i/the permit is valued at one hundred dollars($100)or less.) O I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with the rt �y �Y'� Applicant Signature: Date: /"' 2 T] -V Z_ WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class# Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: O I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the properly,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: _ Date: Owner ID verified by drivers license. ❑Yes ❑No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). • ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Signature: _ Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 WIll any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? ❑Yes ❑No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owner(s) ate I - 2 29- QZ And/Or Authorized Applicant Date CODE INSPECTION TYPE PATE INTmALS CODE# INSPECTION TYPg _ RALE INEUES$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 5 (9-03 ORI) 1266 Pool Spa Final 208 Final Plumbing _ 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention • 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy BUILDING DIVISION FINAL NOTICE OF PERMIT EXPIRATION • May 6, 2003 Jeffrey D. Rowerdink 1952 Pelican PI. Costa Mesa, CA 92926 PERMIT NUMBER (S): 602-00135, E02-00077, M02-00047, P02-00050 FOR: Gunite Pool & Spa PROJECT ADDRESS: 1952 Pelican PI., Costa Mesa This is to advise you that the above permit(s) are about to expire. Per Ed Petros, Chief of Inspections, you have 10 days in which to complete the job and have an approved final inspection. If you do not complete work and have an approved final inspection, your permits will expire on May 22, 2003. Additional fees will be required to finalize expired permits. If you have any questions, please contact the Building Division at 714-754-5273, between 8:00 a.m. and 4:30 p.m., and a staff member will assist you. We appreciate your working with us to resolve this matter. Sincerely, Mary Jane Weidenkeller Office Specialist II Property Profile Page 1 of 1 Property Profile m 2003 DataQuick Information Systems This information is compiled from public documents and is not guaranteed. Primary Owner: ROWERDINK,JEFFREY D& DEBORAH Secondary Owner: Mail Address: 1952 PELICAN PL COSTA MESA, CA 92626 Site Address: 1952 PELICAN PL COSTA MESA, CA 92626 uSe TelephoneNumber: 39 472-18 Reference APN: Ca:iForimA ,, Census Tract: 638.031 '` Housing Tract Number: 5289 Geo Level:0 Lot Number: 58 Page Grid Old: 27-B5 Page Grid New: 858-G6 Legal Description: N TR 5289 LOT 58 Subdivision: Property Characteristics Bedrooms: 3 Year Built: 1965 Square Feet: 1,462 Bathrooms: 2.0 Garage: Lot Size: 7,000 sq ft/0.16 acres Total Rooms: 6 Fireplace: Number of Units: 1 Zoning: Pool/View: Use Code: Single Family Residence Heating/Cooling: Sale & Loan Information Transfer Date: 03-06-1998 Seller: Document: 0000128300 Transfer Value: $305,000 Cost/Sq Feet: $208.62 Title Co.: Old Republic Title First Loan Amt: $198,250 Lender:Ameriquest Mtg Last Trans W/O$: Loan Type: Interest Rate Type: V Last Trans W/O$ Doc: Assessed& Tax Information • Assessed Value: $329,665 Percent Improvement: 22.11 Homeowner Exemption: Land Value: $256,776 Tax Amount: $3,669 Tax Rate Area: 15045 Improvement Value: $72,889 Tax Status: default [ Report Menu] [Select New Target Property] http://www.gotitle.com/cgi-bin/profile.asp?rmt=TOPS&graphic=%2Faccounts%2FT073 78%2 Fcompan... 03/27/2003 • • MF 9 CITY OF COSTA MESA BUILDING DIVISION %jig„:' _ ,r DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER ...T.! PERMIT E102-00135 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa,t;Ay DING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 1952 PELICAN PL fU�L Status: ISSUED • Suite: Applied: 01/28/2002 Vicinity: REAR YARD Issued: 01/28/2002 Parcel Number: 13947218 Zoning: R1 R1 Applicant: TERRANOVE, DON A ISSUED BY: Address: 16281 SANTA ANITA Phone: 949-278-6772 HUNTINGTON BEACH,CA . Zip: 92649 Owner: ROWERDINK, JEFFREY D Address .1952 PELICAN PL Phone: COSTA MESA,CA Zip: 92626-4732 Contractor: SWAN POOLS OF SOUTHERN CALIFORNIA Address: 24512 BRIDGER RD Phone: (714)859-8466 LAKE FOREST,CA Zip: 92630 License: 440333 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT • GUNITE POOL AND SPA. " FEE SUMMARY • Plan Check: $199.71 Calc Valuation: $18,500.00 Permit: $307.25 - Claim Valuation: $18,500.00 SMIP Res: $1.85 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 • Total: $508.81 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 ' Rear 0-0 Left 0-0 Right 0-0 " PARKING Existing:, 0' Required: 0 Proposed: 0 NOTES: • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92.28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446.46(8/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. OA have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. y workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars(SIOG)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these• • ' i••..� Applicant Signature: a Date: 0 Zg'- t3 2 WARNING:FAILURE TO S ERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOLLARE($100.000).IN AODITON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full force and effect.LIc.# Class# Contractor's Signature: \L1 ' Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: - Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the properly,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes ❑No Drivers License No. _ Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): - DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,talsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. - 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person hay a permit to do such work from the division. Signature: Date: • Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present Or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health end Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes U No (Section 65850.2 of the Califomia Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owner(s) Date Lix n ^' 0? r And/Or Authorized Applicant Date CODE/ INSPECTION TYPE OdIE WIMPLE ;ODE( INSPFCTION TYPE GATE ltd 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 5—/r-/-b 208 Final Plumbing -. 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy SWAN POOLS OF SOUTHERN CALIFORNIA 24512 BRIDGER ROAD • LAKE FOREST, CA 92630 • (949) 859-8466 4-4-02 City of Costa Mesa Building Department 77 Fair Drive Costa Mesa, CA 92626 To Whom it May Concern: Jeff Rowerdink, homeowner, and Swan Pools, contractor, understand that the city of Costa Mesa's approval to gunite the pool at 1952 Pelican Pl. does not release us (homeowner/contractor) from obtaining an encroachment permit/plan approval for said pool in writing from S.C.E. Sincerel„ .411 /7 Fraser Jeff Rowerdink, eneral Manager, Swan Pools Homeowner 24512 Bridger Road 1952 Pelican P1. Lake Forest, CA 92630 Costa Mesa, Ca 92626 • (949) 859-8466 (714) 434-9749 CONTRACTOR LICENSE NO. 440333 SINCE 1954 01/23/02 15•:53 FAX 714 708 1919 CDFA/RIFA 'EO""w"` 91/16/2002 11:39 949859P ' PATE' 01 , i,fijoy • U Cooperative Red Imported Fire Ant Project b Notification of Intent to Move Soil from or within Quarantined. a iv a Areas of Orange, Riverside, and Los Angeles Counties a Di RIFA Compliance Agreement ti 3050501DS19 Permit ii te r Issuing City/Coutes Agcary o v n/� • Name of Company Requesting Approval: Sw''j 11 Pool' o 1 U3 • x Contact Person: 1 PCa I 1 r�tsc'nfL- _ y L. ^ '_ • Address: 15 1 Z. 3�,Lysic 1' {l2 . City. La.Ye Ebres 1 up: V-O g. A Telephone: ( Chq ) e517-- 8 41 Fax ( q ti` ) g67 nv5311 PExcavation Location: gime/Ault TB': 753-Glp t , tea ?ee►cw Pt. ACRES: • . Fo P _ Com, Mock, CA, Gig-4a to a . Destination Location TB: 0 ACRES: cn ssr. ' Yt C A T V Estimated Quantity of Soil(e.g. Cubic Yards): ha to It 0 W Anticipated Date of Movement .• Ma n Uroenq Level.for ImsnMiatt inspection and Release: [Circle One) ma) Medtma la „t,, o G 7. Movement of Son is Permitted. P • i 111 Hold Movement Until Site Checked-WE WILL CALL AS SOON AS POSSIBLE TO • ;$• S CIImULE INSPECTION DATE AND TIME. Date Trapped: #of Traps: Trapped by: Acres Date Picked Up:• Comments: PDR#: Soil Movement is Strictly Prohibited for the Following Reason(s): • Name of RUFA Project Regulatory Official: ' 2 rte/6./i�(/�/�/KG(/�- Date: /-A3—0 2-1 Signanue: e „ XIFA TomCA-1 Re..QU99 `TB is Thomas Brothers p abe and gfid d:sirpado= 1001a Y31S%Y.aorr or ar en ... .... ”- j r,� Apr-08-03 07:05 From-SCE HUNTIWON BEACH 7-680 P.002/002 F-119 FAX COVER SHEET cTirzip SOUTHERN cAUforenA EDISON An FAISVN INTER"ATIPN'Ae'COM PDX"! HUNTINGTON BEACH SERVICE CENTER TO: Mike Ruiz—Swan Pools DATE: 8/12/02 FAX NUMBER: 949-859-0253 • FROM: David Lee DEPT: Planning PHONE NUMBER: 714-895-0363 MESSAGE: Edsion has cleared the right of way for the easement encroachment at 1952 Pelican, Costa Mesa. Please call me at 714-895-0363 if you have any questions. Dave NUMBER OF PAGES INCLUDING COVER SHEET 1 Please notify sender if any pages are missing (714) 895-0244 - PAX 54244 SOUTHERN CALIFORNIA EDISON COMPANY 7333 Bolsa Avenue, Westminster, CA 92683 -FAX: (714) 895-0188 -PAX FAX: 54188 4I OWNER WRN:N .FRS CONNIE E. DATE OCT 2 8 1364___ JOB ADDRESS 1952 Pelican Place BUILDING PERMIT NO. - 23161, N'AIENERAL CONTRACTOR Owner-Builder VALUE $ 400.00 • f P No. LOT 58 TRACT 5289 FIRE ZONE 3 DESCRIPTION OF WORKAdd. 2 Patios to CC INSPECTIONS Signature DATE GROUP J TYPE 1[_ ZONE Res_. SUBCONTRACTORPERMITS ISSUED DATE NUMBER Water Rough Corn. Rettig. :0 Air Cond. 0 Rough Heating Rough Plumbing Miscellaneous Prop. Swr. Line 0 House Con. 0 St. Swr. 0 Srinklin System Construction Pole Underground 0 Power 0 Rough Wiring Trenches gl Forms X Steel Reinf. 0 OM_to/e/r Floor System Bond Beam 0 Steel Reinforce 0 Sheathing E. 5idt ! /tgy,C3 4,161:7! (c if/fr Frame and Flashing F• 410 nn / p/c1- Lathing — In,0 Out.0 Plaster, brown coat lying. 0 Air Con. 0 Final Y.cag, Final PIU bing Fixtures, Final Final Gas Test Electric Fixtures, Final n d // ,/ /1W ../.% ./h - 2316 ? FEE RECEIVED 4`''''' OCT 2 8 19S4 -COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOY 317 COSTA MESA.CALIFORNIA TTFII NAFFNCE DEPT. For Applicant to Fill In Completely APPLICA71bN0FOR PERMIT^ESA TYPE OR PRINT BUILDING BUILDING /(]t•2 e yl For Office Use Only ADDRESS /1-/d /I" RECEIPT NO. COSTA MES.40 231 '�W CALIFORNIA c �rl ror I .• R8C8IV)D BY DATE iG) /D .. V . OWNER �.:-ic . i - G(.i I/I( II MAIL 1 ,'1- BUILDING / & ) J_ ADDRESS I9 J~ Z ?Ah 1 c ARI /'I. 17e E ADDRESS / /� .l■. /y� r �y FIRE CITYCO $• / b /// L /7 NO. ZONE 7Y' - GROUP I Ar APPROVE; --re ll' ` / O { ) 'TELT l� TEL. BY ,.•ATE/0 (p C 'INEER NQ. ZONING -//� {�/J) .l ADDRESS �1_' J ZONW NO.OP USE Or NE4Vl W CONTRACTOR OVW N'P r B I i`, PUN; (//�eNILDINO(j/N/'� }/ (, LEGAL ILP J ` X r//( J ! O ADDRESS -"-- DESCRIPTION (`�li , V V Z ss/�^^� A.P.NO. CITY NOTE: NO SAVE OVERHANG SHALL BE LESS THAN STATE TEL. 30•TO SIDE a REAR P.L LIC.NO. NQ. EAVES SIZEA X I NO.OR BLDGS. A ALLOWED - (U.B.C.REQUIREMENT) OF LOT /0O 70 NOW ON LOT YARDS APPROVED YARDS APPROVED USE OF MAIN BUILDING ACCESSORY BUILDING EXISTING BLDG. keetria.6 - - - (FROM C/L SETBACK LINE FROM / Y•O A�U REAR YARD O FRONT FT. CENTER OF STREET 2© --- SIDE YARD I LEFT See) ' I RIGHT �7 w R.SIDE FT. F'r. DESCRIPTION OF WORK L.HIDE / /5 FT. FT. NE _ ALTERATION _ADDITION REAR / C, FT. FT. DISTANCE BET. BET. MAIN a REPAIR MOVING DEMOLISH MAIN BLDGS. ACCESS.BLDGS. - BUILDING NO.OF VAR•' DATE SIZE ROOMS STORIES / C.U.P.$CAPPROVED •I Q EXTERIOR WALL I ROOF COVERING ay V.' ``.,�� �L" DATE [(0• `CJ�� COVERING U/$�E OF BUILDING AND WORK TO BE PERFORMED 0j • .I fa l Pittia GoY/Ey's ✓ Tb ftb N SQ.FT. G ' I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION 3 --- BUILDING CONSTRUCTION. kiltai p /nI • g PERMIT FEE $ SIGNATURE OF A, , co PERMITTEE 1 61�WI�/li`O /��'/] �•/ $ j V �'� PLAN CHECK $ E r i AUTHORIZED AGENT TOTAL FEE $ 2`— ~� rtt KECEIVED Lot 7IR77 OW 314114 •COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT P.O.BOX 917 COSTA MESA.CALIFORNIA CITY OF COSTA MESA \ For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT BUILDING For Office Use Only BUILDING ADDRESS 1952 Pelican Place RECEIPT NO. /pF�MLTyQ� COSTA MESA. CALIFORNIA 2 3 J/� RECEIVED BY TE RECEIVE T 'frig OWNER Pemba Subdividers, Inc. --�'/— p.. 64 p BUILDING MAIL 2850 MesaVerde Drive - ADDRESS ADDRESS ail FIRE ,{ CITY Costa. Mesa No�5490395 ZONE TYPE GROUP !T APPROVED AP- 1T NEER E. G. Kaltenbach TE 5478046 BY DATE ZONING ADDRESS 1833 E. 17th St. , Santa Ana--'—. ZONENO.OF USE OFNEW sing]. tam, p c R-1 I PLANS 2 I euILDINGW/ at& gar. CONTRACTOR v W IlCl J a rh `C GA DESCRIPTION Lot 58. Tract 5289 ADDRESS A.P.NO. none CITY STATE 187318 - TEL. NOTT: NO O SIDE VE REAR P.LNG SHALL BE LESS THAN LIG.NO. NO. VES OELOT 70X100 I NO.OF BLOTSI\ NOW ON LOT •-• ALLOWED (U.B.C.REQUIREMENT) OF L YARDS APPROVED YARDS APPROVED USE OF MAIN BUILDING ACCESSORY BUILDING EXISTING BLDG. (FROM C//LLSTRREET) ,5S SETBACK LINE FROM 501 30( FRONT VF . FT. CENTER OF STREET REAR YARD SIDE YARD LEFT 51 I RIGHT 51 R.BIDE SFr. FT. DESCRIPTION OF WORK L.SIDE EFT. FT. NE\ X ALTERATION _ ADDITION REAR 3 at FT. DISTANCE BET. BET.MAIN @ MAIN BLDGS. ACCESS.BLDGS. REPAIR MOVING DEMOLISH BUILDING 1 912 NO.OF 6 1 VAR.11; DATE SIZE ) ROOMS STORIES C.U.P. • . APPROVED bluing Shake & •)� EXTERIOR W. I ROOF b APPR• L ii DATE - 0 11 COVERING • C 0 COVERING _ hin� e BY L • � --� USE OF BUILDING AND WORK TO BEPERFORME• , Dom Single family with attached •arage,_� Lin e • I E t Garage 462 sg,ft, Plan 51 AR /4/5-4Q. / ito G -" I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE i AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEC ONLY. O PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION BUILDING CONSTRUCTION. Jj NO PERMIT FEE S SIGNATURE 0 PRMTTE / / / $ /✓:f2/-- PLAN CHECK S a3 G AUTHORIZED AG * ' T•TAL FEE ' / J` V