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Home My WebLink About3128 PIERCE AVE - Building Permits(714) 754-5273 • Fa�c (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: Suite No Vicinity: Parcel Number: Applicant: Address: 3128 PIERCE AV 14165208 DUKE, BRIAN 9911 LARSON AVE GARDEN GROVE, CA Owner: GORMAN, MARY JANE TR Address: 1200 G ST #B MODES70,CA Contractor. Address: MECHANICAL PERMIT A AMES PLUMBING, HEAT, AC 9911 LARSON AVE GARDEN GROVE, CA ISSUED BY: Phone: 714-530-2440 Zip: 92644 Phone: Zip: 95355 Phone: 714-530-2440 Zip: 92644 License: 250307 SCOPE OF PERMIT CHANGE OUT OF AN FAU ON EXISTING RESIDENCE. ISSUE,FEE Inst FAU <100 k BTU Inst FAU >100 k BTU Repair / Alt CoolinglHeat Inst / Rep. Recess Wall Htr 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 V¢nt Air Handlers < 10000cfm Air Handlers > 10000cfm Floor Furnace Floor or Suspend Heater $23.50 514.80 $0.00 30.00 $0.00 $0.00 $0.00 50.00 30.00 $0.00 50.00 $0.00 50.00 $0.00 50.00 $0.00 $0.00 50.00 $0.00 $0.00 Quantity 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FEESUMMARY Repair / Alt Absorbtion Unit Repair / AII Refrigeralion Unit Ventillation Syslem Evaporative Cooler Com me rcial 1 nci neratOr Domestic Incinerator Compressors / Absorption SVstems Upto3hp/100kBTU 3To15hpl500kBTU 15 To 30 hp / 1,000 k BTU 30 To 50 hp / 1,750 k BTU Over 50 hp / Over 1,750 BTU Boilers Upto3hp 3To15hp 15to30hp 30 to 50 hp Over 50 hp Other Mechanical Fee Investigation Fee Plan Check Fee Reinspection Fee TOTAL CALCULATED FEES Status: ISSUED Applied: 03/04/2003 Issued: 03/04/2003 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 50.00 0 50.00 0 50.00 0 $0.00 0 50.00 0 $0.00 50.00 50.00 $38.30 NOTICE: 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 1 BO days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the wark auihorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspectlons end final approval must be oblained. Failure to obtain inspections and final approval will resull in the ezpiration of ihis permit. FOR INSPECTIONS CALL: (714) 7545626 2d4&461��) WORKERS'LOMPENSAnON DECLAHAnON: • I hereby aNirm untler penelry ot perjury one ot lhe following tleclarations: ❑ 1 heve entl wlll maintein a certitiwte oi consent to self-Insure br workers' compensation, es provitle0 for 6y sectlon 3700 ot 1he Lebor Cafe, br the pertortnance of the work for whiCh IhiS permii I5I55uetl. ❑ I heve end wlll maintain woAcers' compensetion Insurance, es required by section 3700 of t�a Lahor Cotle, tor I�e pertormance ot Ihe work for which Ihis pertnit is luued. My workers' compensatlon I surenceS� rrier antl poliry number are: L� t� Camer.- � �JE"G1.�@_ �iJY'�(J� �PolfcyNumber: 1� 7 S �-i � (This secfion need nat be complefed i! Ne permit is valuetl et one hundred dol(ars ($100J or less.) , ❑ I cently that in the peAortnenca ot the work tor w�ich this permit is issued, I shall nat employ any person In eny manner so es to become subject to the workers' compensetlon laws of Celifomia, end egree t�e� ii I should become suD�ect to the workars' compenSaUon proWsions of Sectlon 370p of Ihe bor CoAe, I shell forthwlth _comply wiih �hese Dr ions. . � /C` 'ApplicantSigneture: �.�. �C�/6'L- Date: � T �� WARNINO: FAIWRE TO SECURE WORKERS' COMPENSATIqJ COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENPLTIES AND CIVIL FlNES UP TO ONE HUNDRED THOUSAND OOLLARE (5100,OW), IN ADDITION TO THE C0.ST OF CqMPENSATION, OAM4GES AS PPOVIDE� FOF IN SECTION 3]OB OF iHE LABOR CODE, IIJrEREST, AND NTTORNEYS FEES. LICENSED CONTRAC70RS DECLARATION: I herehy ettirm that I em Ilcensetl untler p�rovislons ot ChaO�er 9(commencing with Section 7000) of Division 3 ot t�e Business end Profes lons Code, and my license is in tull torce end enec6 uc. a O— ZL N� ciess a !/ 3 Contredoda Signature:--- � j .--iN� �/t Dete: _ f �— CONSTRUCTION LENDING AGENCV: ❑ I hereby affirm that t�eie is a construction lending agancy for the pedortnance of Ihe work for which Ihis pertnit is issued. (Sec. 3097, Civil Code). Lendefs Neme: . __ __. _ _ Lender's Atltlress: Signature: OWNER-BUILDER OECLARATIONS: Dete: I here6y aNirtn thet under penalry of perjury Ihat I am EXEMPT FROM 7HE CONTRACTORS LICENSE LAW for lhe fallawing reason (Sec. 7031.5, Business and Protessions Cotla: Any ciry or counry which requires e permit to consiruct, elter, improve, tlemolish, ar repeir eny structure, prior to its issuance, also requires the applicant for such permit to file e 51pneA statemeN t�et he ar she Is Ilcensetl pursuant to tha pmNsions of lhe Conirectors License Law (Chapter 9(commendng with Section 7000) ot Division 3 of the Business end Prolessions Code) or Ihat he or she is exempt t�erefrom and t�e basis tor the elleged e:emption. Any Woletlon ol Section 7031.5 by flny apPlicant for a pertnit subjects Ihe epDlicant to e civil penalry ot not more than tive hundretl tlollars ($500).): ❑ I, es owner ot Ihe D�operty, or my employees wl�h waqes es their sole compensatlon, WILL DO THE WORK, and Ihe structure is not Intended or oHared for sale (Sec. 70aa, Business and Protessions Cotle: The Contractors License Law does not appty to en owner of property who Gullds or improves thereon, and who tices such work himsaN or herself or ihrough his or her own employees, provided Ihat such improvaments ere not intended or ottered for sale. If, however, the builtling or improvemant is sold within one year of completion, iho owner�builder will have ihe burtlen of proving that he or she did not build or improve tor purpose ol sele.). � ❑ I, as owner of the property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to canstruct the project (Sec. 7044, Business and Professions Coda: The contrettors Llcen50 Lew doe5 not epply to an owner of pmperty who builds or Improves thereon, end who contrects for 5uch projact with e conirador(s) license pursuant to the Contrectors License Laws.). ❑ I am exempt untler sec. Signa�urB: Owner ID venfietl by driver9liCense. ❑ Ye5 ❑ No Business antl Professions Code for Ihis raason: Venfication ot Ownership by (rype oi document, I.e. - property tan bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: Drivets License No. Date: Expires: ❑ I hereby certAy ihet no excavation five (5) or more faet in depih inio which a person Is required to descend, will be made in connection with work authorized by ihis permii, and that no building sWcture, scaHolding, talsework, or demolition or tlismantling ihereot, will be more ihan thirty-six (36) feel high. (Chap. 32, Gry 2, Art 2, Sec. 341, TINa 8, Celifornia Adminisiretive Code). ❑ As ownerbuilder, I will not employ enyone to do work which would raquire e permit from ihe Division of Industrlel Safety, es notetl ebove, unless such person hes e permit to do such work from iha divislon. Signature: Date: Division oi Industrial Safery Permil Number: CERTIFlCATE OF COMPLIANCE AND AUiHORVATION OF EMAY: I certi(y untler penalry of perjury that I have read this application and siate that the infortnation given is correct. I egree Io comply wlih all s�a�e laws end city ortlinances relating to building consiruction, and authodze representatives of the City of Costa Mesa to enter upon ihe ebove-tlescn6ed property lor inspaction purposes. I egree not to occupy or allow occupency of any huiltlinq authonzed by this permil until finel inspection. COOE 1. INSPECTIONTYPE 1616 Fizetl System Finel Fire Prevemion 1266 Pool Spe Final 200 Finel Re-Root 201 Flnal BIocWRetaining Well 202 Final Fectory Fire Place 203 Final Sign 204 Final Demolition ' -' LJ 'r . _ ,.: DAiE f� �Qp�� INSPECiIONTYPE � 206 Finel Mechenical 208 Final Plumbing 210 Finel Electncal 212 Finel Fire Preventlon 220 Finel Planning Approval 222 Final Sita � 250 Final Building/Occupancy -�B-c�3 �n/ a em�m+o: 'OSTA MESA,CA wr�. �wuxa �oo�ss: Iurcxrtecrax�m+vn: ARCH ON EN�.'S 1DDRESS: PIERCE AV , JOHN L , MARY JANE IERCE A��E 92626545-7840 UNT: FLOOD: X 47 Z`�C �I uc. xo.: UNT; mr+macrarsru� NOCK PLUM$ING ( 714 ) $95-1246 ca,m.croRs�uuNo11612 KNOTT ST �oox�ssGARDEN GROVE CA uc.ao: 707775 9 2 8 41 uNt: 17 LICENSEU COMflACTORS UECLIN�TION: I lqroyy eRiem uMm penely d pmjw/ thet I un liroemed uMer pwi�bn� d Chepm 9 (commariaiq wn� SecYon 100�) d Oivi�ion � d iM Busi�n eM Praleswma Code. aM mY licema e in lull Mtt eM dtep. cmuc.No.:050386 ��$C-36 uc.N/o.�:707775 EXP; 02/98 Dele: ��L� CamaCa: / �(/� ��' z��v OWNER BUILDER DECIAXATION: I MnDy eRUM1i undar qnely d{wjvy iha� I em axemp hom ihe �Ganlruawcocmpa�wia-e� '�Ooxnp rwaon (SeUion'l0�15 &eiqat W Pmla� Code: M�' flY n mumY x1iiN n0�iim e Po�R �o mutrW. eCet. impraw. amdeh, a rapei mry atruUwe. p'v m b eauvte, ebo �eqid�m iM eppfiwu la ach parm§ �o fils e eyneA �tm�nwX tlW M a 4r � liomeed pmuenl Io IM prwiecns d Ne Caqrmda limnse lew ICheqer B(�mmoiq xiiA Secion )tp0) d Di.•eion � d Ihe Buemeu ud Prolmevn COEaI a�� ^ ^� �^ ie uemp Ihaehan ud tM beae 1« tln ellpaC uemqion. My vidtlion tl Saeion ]OJ1.5 b/ a�ry eppYunl Iv a perm! wEptl� IM appfra�l �o a tirJ penMy d nd mon �hen fHs huMred ddlen �5500�. � I. es oxner W IM qoW�Y a mY smPM^^+wih we6aa ea �hei sda oomG�eelion. WIEo Ne xwk. eM iM struc�uro u rwl inieMad «m«ea ro� w. (s«tion 1a.. aueime. ena riaa.man. ceee: me c«u,ean.li�,.e lew me. nw wNr �oen oxmm,a propenv wln buida a inpmves t�rson. eM wM10 doea euM Mak limxp or MnN a Nrap� I�e a hm own amployae�. prmidod Ihm wM imG�*me�m ere nol iNwdad ar Waed In eele. tl. however. tM buitliM a'enpv.anml o mtl xnNn ar Yav d aomdMnn. Ur owiwr-0uikx wJl heva tM bnden d povinp ly a ehe d'd riq duM « impwa /or tM puryme d seN). � I. n rnnrr d iM piapsiy. em udmny mnirmip w'nh fcenaed mNrMon ro conctrud Na ppw (`.wfion 10u. Bw'v�m� md PMaaeone coEe: Ths Comrrfon LF,enaa lew dma na MdY b en ownm a pwMY Mn bu5b «"unV�'« IMrsan ad x1a wnUa[b la mch proptla wiN a mNeetla(0) Gceved W�%� �o IM CaMretlaa lioeiue Lewl. � I em exemp uMu Sociion: B. 8 P C.. M No �eavm: Dme: Owner: I do hereEy cenity thm I em ewere d erd uMente�p �li¢ �equiremanta d CdAomle NeaM1h arM Sefey Code Sedion� 25505, ?5539, eM 25551, end ihat I a eny INun WilEi1p aaupeni will / will nW �d�cb oiw) neeE b canply w1h uid meie oodw eM �M �pulremenn br e peimil lorronewciionor moEificvion hom IM 4i��emem Dimna. RmkeMiel conat�uqion eppfutbru ere eaemq /mm theee aow.�a,.. ov.: nop�u: WONKEN'S COMPENS�TON DECLAH�TION: I �payy y(� �y pyeryy d psjuy ons d IM IoOow+np dedeielnro: � IMneMWmaviteneun!'wedmwMtosetl+�muetorwvk>e'mmpemuion.mpwiddlaby3wiuiJ]OUdIMIeEar coa. �u �n. c«�wm.nce d �n. wwk �o. wr:U Mi. v� o m.i,.d. x❑ � n.r..na w meinien.oix«,� wmc�Un �wivm. o �w�� M s.cim a]oo N me len« coa.. a.lro w�«mmm a u» wak la MtiN Nb pxmu e mueE. MY �Fan' oompensetian'umurence wns mH po4y wmMr ua: c.�:.: GOLDEN EAGLE EXPIRES Pdiy NumMr: C 0 9/ 0 1/ 9 7 �n;a,.n;o� �mee,�w w cancroiaa. np ro�� e m, o,. w,�eree ewe,9 rsioo� a �s,.� ❑ I ceniy Ow m Ne pMmmuca d the wark Ior Mfich tho pamp b uaueE. I MNI ml emplq eiry pr�on in ury manirr �o m to became wbjM �y iM v.a�lws' wmGeroNion lexe d Cefdomie. end qlree Ntl ! I NouN becaro w4� lo IM r.aMsa' cwnparoeiun p 4u'cen d eaion T/00 d �M lebar LaEe. l ehaA i�xah Upp p'weio�r. �� I Dete: �cv��: ��f W�mMp: F�9�n ro ueun wak�n'rorrpNuetlan covoraps li un4rM, uMW/l u�/�ct an �nrplryw ro crhNiW� uvn nn.. w ro w,. Nner.a momro adl�n !11 W 000A x.m�aon ro m. cwt or eo�w�^+•��^n �W u v�rkLe ror �n sxnon aros o� m. tmo. coe.. �nM1n,t .�w.rromer', r... CONSTHUCTION LENDINO �OENCY: I heeW etfiem uMer penely d pxjury �Mt IMm w a mewivaion bMiip pmry tor tM panamanm a m..un� rw wnitl, m: o�� „ ewea csenun �oa), civ. cl. LENDEF'S N11ME: LENDEfl'3 AODNESS: I cenity �hel I have rced thn epplkelim uM eteb tlyi �M1e ebove inlormetion ia canw. I eprea to compM �h NI ay uM counry aEirienme end eids lexe relelmp lo WiWip coAna'Vuq�+ion* erd hereby aulhor¢e rtpreaentelrvm d Iho dty to enter upon �M ebove�menlbned pmpercy IOfII19D��q11W�WM0T�O�`� IYO`l� �PnM Namn / o�,: 3 � � Spr�pure �pemlAppfcenUCon�retla (5�5t<B.WV) WM1ns-Buildip 8 Sdety:OreemFb: Ce�ary-Appirenl: Rnk-Rewnw: GddenioFAvaeev CITY OF COSTA MESA - BUILDING PERMIT PERM NO: P 082220 PERMIT NO; P 082220 PLAN CHECK N0: N GUVT: N SUPP; N CGNSTRUCTION TYPE: V-N PERMIT TYPE: PLU PORPOSE: OTH JOB DESCRIPTION : DISHWASHER CHANGE OUT SQ FT: CLAIM VALUE: CALC-VALUE: GROUP OCC: R-3 / COMMENTS: NO OTHER WORK ASSOCIATED WITH THIS PERMIT ��***��***x�*�e**�+r*��**�r�rx�**+�*�*x��*x�x�+r*+r*+�x�r***�rx�*x�*****x*�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: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT; FT IN LEFT; FT IN RGHT: FT IN PARKING REQ: PROV: PARCEL: 14165208 ZNE: REF NO: PLANNING NOT£S> i L- iF'IE fE if iF if 1E'IE if'lE if if if iF 1f if ih if 14 i4 iE iE iE iE iE iElE 1E iE fE 1E i%if 1f 1F iF iF iI' it ih if if 1E iE iE iE 1f if k iE i%ih 1F ih if if iF if if 1f if')f if if if if 1F 1E fElE iE iE iE fE iE 1E iF IE if 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 APPRO��ED HY . �' DATE: BUZLDING APPROVED HY : DATE: APPLICATION ISSUED BY: ��it�� DATE: ��# **�t*x�ftiFitititiF*it��t�*****x�lF3FTFTFTF�Fli-3F�F�F7F�FTF�F3FiF�F�F3F7FTF'R�iFiFTF'fF TFTF3F7F3FTF�f�FiFit*itit*x�*itit ' �r* LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N i .r' BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 8.75 � 25$ ,y L SMIP/NON-RES PLAN .� ISSUE FEE 22.00 �. B(IILDING-DIV-> PERMIT ISSUE PLAN=CHECK TOTAL PAID DUE TOTALS----> 8.75 22.00 = 0.00 30.75 30.75 .00 REVENUE DIVISION TOTALS--> COLLECT:�ED: 30.75 OC�ER/SHORT: .00 HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK 30.75 �, � IE fE M IE IF if 1E if if !E �f iE 1E k iE fE iE IE %iE ik if IE 1E fE iE!(� iE' Ik IE iE jf 1E fE jF 1E iE if �E 1E �F 1E IF fk IF fE 1f k iE iE 1f ik if iE if IF iE fE ik 1E 1E 1E �E �E 1E 1F iE if iF 1E IE fE IE fE fE iE fE 1E fE I N D I V I D U A L �F E E B R E A K D O W N avp��QTY D E S C R I P T I O N•� UNIT COST TOTAL COST PLU 1 DISHWASHER ' � t3�� 8.75 END OF. FEES �� / ' ;.,, � t�81�R � 11997 ' J CIiY OF CQSiA MESA � .�; �, RUCTION AN� PLANNING J VALS Permit # - porarY Electrical Service or Pole 2. Soil Pipe•U�drgmd. � . 3. Electrical Conduit'Utility�Undrgrnd. 4, Electrical Conduit-Undrgrnd. 5. Steel Reinforcement 6. Electricai UFER Grnd. 7. Footings 8. Foundation 9. Watet Pipe-Undrgmd. 70. Structurai Pioor SYstem 11. PraPerty 5ewer line & Ho�se Connection 12. Sewer Cap 13. Roof Drains 14. Rough Plumbing � 15. Rouqh Electrica6Conduit 76. Roegh ElectricWiring • 17. Rough Wiring Si9n 18. Rough Electrica6T Bar Ceiling 79. Rough Heating & Air Conditioning _ 20. Rough Facmry Fireplace . 21. Ducts,in.Structure 22. -0ucts, Ventilating 23. Gas Pipe-Rough & Test • 24. Roof F.aming � 25. Roof Sheaching . 26. T-Bar Ceiling (Structurall & Monocoat 27. Frame and Flashing ' 28. Lathing & Siding - 29. Insulation 30. Drywall Nailing � ___._ .. _.. _ 31. Plaster Brown Coat 32. Electrical Power Meter�Final 33. Final Electric � 34. Final Heai�ng & Air Conditioning 35. Final Gas p�Pe-Test 36. Hood or Canopy - 37. Final Faciory Fireplace - " 3$. Final Plumbing 39. Water Service-Final � 40. Gas Service-Final - � 41. Solar pomestic•Final � 42. Backflow Prevencer 43. Backflow Irrigation � 44. Landscaps Irripation System 45. Sound Aitenuation 46. Handicap Regulations 47. FINAL S7RUCTURE & BUILDING 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas ReleaSe to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY Date Dete PO � SPA Inspectar AppROVALS Permit # Date Inspector 52. Pool & Equipment Location 53. Steel Reinforcement 54. Forms 55. Electrical8onding " 56. Rough PVumbing & Preszure Tes[ 5). APPROVALTOCOVER�GUNITE 58. Electrical ConduiI-Undrgrnd. 59. Gas Pipe, O Undrgrnd., Test • 60. Backwash Lines, P-7rap, G� Undrgrnd. 67. APPROVALTODECK fi2. Backwash & ftecepmr-Pirtal 63. Heater & Vent-Final 64. Plumbing System - Final , 65. Electricai-Final . 66. Solar System-Final 67. Fencing & Access Approval 68. APPROVED FOR PLASTERING 69. POOUSPASYSTEMSFdNAL FIRE DEPT, REQUIREMENT ' - APPROVALS Permit # 70. U�derground Hydro 71. Product F'iping O Gas ❑ Oil . 72. Underground Flush 73. Undergrnd. Storage Tank � Gas O Oil . 74. Overhead Hydro 75. Dry Chemical - " 76. Dry Standpipe : . ' 77. FIXED SYSTEM FINAL 78. FIRE�PREV. FINAL � HEALTH DEPT. REQUIREMENT 79. FINAI lNSPECTfON - 80. FOOD CERTIFICATE iSSUED Notes: �-�� PPOJECT ADOPESS: 3 S Z S P 2 ERC E AC' uxir: OWNEP'SNPME: CORMAN, JOHN L FLOOU; X 47 nooa[ss: GORD9AN MARY JANE 3128 PfERCE AVE COSTA MESA,CA 92626 545-7840 PflCH/ENGINEEfl: ADOflESS: NEG.NO.: I1NIT: PEpMinEE. 1�610PSEABOARD CIR ��14)895-1246 noowEss: STANTON CA 90680 LICFNSEO CONTBRCTOfl DELNBATION: I her¢Cy allirm thal I am licensetl unGer pmvision5 ai C�aO�e� 91�ommencin0 with Section iOW) ol Omsion 3 ot 0e Busine5s an0 Professions Cotle. anE my license is in full force anE eflect. �ic.:050386 sTnrcuc.:511971/Jcuss:C—�- EXP: 0'/95 ,/ ' Sipnature: � �� _�- � NI(ENS' COMPENSaTION OECLA n7lON: I hereey auirm ihat I nave a certificate ot consent to self-insure or a cenificate ol workers' Comoensalion I s a IAie c oY �nereol ISecuan 3800. La� voucr wo.: g� �7��—�'� E%P. �ATE: 3 I O S I9 S camvar+r: STATE nilie0 copY is hereby fumis!hetl, Q Cenifiea coDY �� ed the city B Dimsian a� • � � �! � � / APVlicanL ✓ �/�V� � � E%EMPTION FHOM WONNEBS' COMPENSATION DECIAXATION: (Thi55etlion neea nol be completetl if Ine Oefmit is lar one hwdred (5100) of 1e55). I certify Ihal in Ihe pedormance ol Ihe work for which ��is permit is issuetl. I shall nat employ any person in any manner so as lo become sub�ec� m �he workers Compensaiion Laws ol Califomia. Oate: Sipnawre: NOTICE: II, alier making Iltis Oeclaraiion, yau 5houlA become suElect to �he Warkers' Compensa�ion pmvisions of �Ae LabOr CoOe. You musi lotlhwi�h comply wilh such Omvisions or ��is permi� shall be deemetl revoked. WNSTPUCTION LENUING RGENCY: I �ere0y aflitm IAaI there i5 a tOnslmCtion lenaing agenty �or the p¢dOrmanCe at lhe wOrk lor wNch ihis permit is issuea (Section 3097. Civ. q. LENOEfl: aooaess: OWNEB BWLOEB OECIAHATION: I �ereby atlirm tAa� 1 am exempt Imm t�e Convactars' SWte License Law �or �he followinp reawn (Sec�ion 7031.5 Business antl Proles5i0nai Coae: Any cily o� counry w�ich repuires a permii lo can5�mci, alter, imprOv¢, aemolish, or repair any slructure. prior to its issuance. also requires the apolitant for such permit to file a signetl statement inat he/she is license� pursuant m �ne pmvisions ol Ihe Comracmrs' Slale license Law (CAaO�er 9(commencing vnN Sec�ion 7000) ol �ivision 3 al ��e Business an0 Pmles4ons Cotle) o� OWt nelshe is esempt tAerelmm antl t�e Gasis for ihe allege0 eKemption. Any vioWtion ol Sec�ion 7071.5 Ey any ao4liWnt tor a Dermil suhjecis tne aDD�itdnt to a civil oenalty ot not mare than tive hundreE Eotlars (5500). I, as owner ol ine O�aDeny or my employees wilh wages as tAeir Sole compensation, will Ea the wark, and iha I❑ stmcWre is noi inten0etl oi auerea lor sale 15ecuon 7044, Busmess ana Pmlessional Cotle: T�e Contractors' State License Law tloes not apoly to an axnet af a pwoerty who buil�s or impwves ihereon, and w�o tloes sutn work nimself/hersell or �nwuAh his or her own em0loyee5. provitle0 lhai SUC� improvemenls are nol inten�ed or oHeretl �or sale. I�, Mwever t�e 6uiltling ar improvemenl is soltl vninin one year ot wmpletion. ine ownet wll have t�e hurAen ol proving hPJSAe did not �uild ot imprwe lor ihe purpose ol sale�. I, as ownei ol �Ae pmpeny. am exclusively conlracting wit� Iicense0 conVacmrs m consimc� �he pmject (Section 70aa, Business ❑ ana Pmfessions Caae: T�e Comracmrs' State License Law aces not aDDN �o an owner ot DroDeM who Owltls or im0�ovu iherean an0 w�o tOniracis lor 5uch O�ojetis vn�h a tonVatlor�s) license pursuan� t0 th¢ Conlratiors' Staie Litenu Law). I am aware tnal pr0ol ol Ineir Woder's Compen5ation insurante sMWA be pmvitle0 to me. � I am exempl unEer $eclion: B. 8 P. C. br this reason' Date: Owner I tlo �ere�y renify Inal I am aware ol ana understantl Ihe requiremenis o� Cabbmia Heal�h ana Sa�ery Coae Sec�ions 25505, 25539, antl 25534 antl Ihal I or any IUWre building occupanl willlwill nol (circle one) need Io comply wi�h said s�a�e cotles and Ihe reQuiremenls lor a permit Im constNction or modificalian Irom ihe Nir Ouality Management �isiricL Fesidential conslmction applications are exempt fmm these Dmvisions. Date: ApPlicam: I �ere6y retlily ��ai I �ave reaa Ihis applicalion antl slate Ihat Ihe a inlormalion is ortlmancesan4slalelawsrelatingloUuilAingconsiru[�ionanOhe yau�� r¢erepre5eni �/jetly Iorinspetiion Durpo5Ge5.� �1 Da(e�, � r'� �7 `7 Signalure: / � o�iver's �icense a� Socia� Securi�y x: to comply wiih all ci�y antl counly �o ¢nteruDonlhe above�mentiDned �6ai�a6 W�ile—BotlOing; Green—Cotle EnlorcemenC Canary—Applicam; Pmk—Revenue; GOltlevoE—Assessor CITY OF COSTA MESA — BUILDID7G PEP,MIT FEP.M NO; P 0�006s PERMIT NU: F� 070065 PLAN CHECK D1U: N GOI�T; D7 SUPP: N CONSTRUCTION TYPE: ��—N PERMIT TYPE: °LU PURPOSE: OTH JOB DESCRIPTION : CHANGE OUT OF A WATER AEATER SQ FT; CLAIM VALUE; CALC—VALUE; GROUP OCC: R-3 : COMMENTS: NO OTHER WORK AUTHORIZED BY THIS PERMIT r it �lf af i� �t+F i� ih+c+r aF af at iF it �f a iF 1E aF «if +f iF i� if �lc iR * r �f-iF it �c it at it r�+F+F aF x i�- if if fF. �iF s aF r+t 3t �ic �c iF 1F s 3: if a�F #'� �t w> ic � x- �c �- *�lf 3c ac ��N iF+� 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 5 ------------ MAIA] BUILDING ---------- -------- ACCESSOP.Y BUILDING --------- FANT; FT IN AEAR; FT IN FP,NT: FT IN REAP,; FT IN LEFT; FT IN RGHT; FT IN LEFT: FT IN P.GAT: FT IN PARKING RE • PROV; PARCEL; 14165208 ZNE; P.EF NO; PLANNING N `I'ES> � . itiE�ltlrititit+!.}�.iFlritiF�ki�rxiri.itititifitxrititifilrkit�ltiFitifr�Irltitifirittek�rY+(-itr+tiFit4rifritiritltitat�r�.i,irritarif�EiFitirlflf-r D E CT E L O P M E N T S E R C' I C E S R E Q U I R E M E N T S 20NING APPRGC'ED BY . DATE; BUILDING APFROVED BY ; DATE; p APPLICATION ISS'UED BY; �� -. DATE; I ( ��tr*+r+r***r+ri�+��trrir,.�tr*�r*x�.�rr*z*�x,r*+cr�**+r.+r�r***,r�*.�*u�r.+r<*�***+rr*rv�r-r..+.r �*v-**J�c � if+fifitftriFiFififjfitlEififif#fiF+EifYtFlElfMirififiFiEifiF3fiEitrifl!+(-4ififY�+EMiFiEiEif4riFit+FflifrtiEiEkriEifiEi`iFihsfrrifif +f�tatita�jc LEGALIZATION;N F E E 5 U M1 M A R Y STRUCTURAL SEGMENT;N , BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMZP/RES GRADiNG PERMIT 7,Q0 25R SMIP:NON—RES` PLAN ISSUE FEE 20.00 BUILDID7G—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS----> 7,00 Z0,00 0.00 27,OQ 27,00 ,OQ REVENUE DIVZSION TOTALS--> COLLECTED: 27.00 OVER/SHORT: ,00 FiLDG FMT PLUMBZNG ELECTRIC MECAAAIIC FIAE SMIP/TOT GRADING PLATI—CI-IECK �%,Q� jf �lE if M it if 1E �lf it �lf it if i�-�N- ff jf k it if if iF if �1f r�M-iF+! iE M 1f ft if +E+f at if x if it� 1t if 1t at it-r ih iM1 x iE i� iM1 if it �1�-s iE r it it iF r It iE� ic it it it r N at �lt if +f- iE if iF acY-+F S N D I V I D U A L F E E B R E A K P O!J N TYPE QTY D E S C R I P T I O N, UNIT COST TOTAL COST PLU 1 IdATER HEATER AND/OR C'ENT 7,00 7,00 END OF FEES 01 �0172511-00172511 T�7 T 27_pp DATE; fi/?9/94 TItIEc 13�43 CONSTRUCTION AND PLANNING PO� s SPA ' qPpROVALS Permit # Date Inspector APpROVALS Permit # Date lnspector t. Tamporary Eleccrical Service or Pole 52. Pool & Equipment Location 2. $pil Pipe�Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. EI¢ctrical Conduit-Undrgrnd. 55. Electrical 8onding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL 70 COVER�GUNITE 7. Footings 58. Electricai Conduit�Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe�Undrgrnd. 60. Backwash Lines, P�Trap, O Undrgmd. 10. Structural Floo� System 67. APPROVAL TO DECK t t. Pr�perty Sewer Line & House Connection g2. Backwash & Receptor�Final 12. Sewer Cap � 63. Neater & Vent�Final 73. Roof Drains 64. Plumb�ng System - Final 14. fiough Plumbing 65. Electrical-Pinal 15. Rough Electrical-Cond�7t 66. Solar SYstem•Final � 16. Rougfi Elec2�ic Wking 67. Fenciny & Access Approvai 17. Raugh Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical�T Bar Ceding 69. POOUSPA SYSTEMS PINAL 79. Rough Heating & Air Conditioning FtRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 27. Oucts, in Structu�e . 70. Underground HYdro 22. Ducts, Ventilaung 71. Product Piping OGas OOiI 23. Gas Pipe�Rough & Tesc 72. Underground Flush 24. Roof Framing 73. Undergmd.StorageTank OGas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T•Bar Ceiling (Structuraq & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 7g. FIRE PREV. FINAL 30. Drywali Nailing HEALTH DEPT. REQUIREMENT 37. Piasrer Bro��n Coat 79, fINAL INSPECTION 32. Electrical Power Meter�Finai 80. FOOD CERTIFICATE ISSUED 33. fi�al Electric Notes: � ` 34. Fihal Heating & Air Conditioning ' 2�( 3�c B .� "' L -�� 7r T �"LR G� 35. Final Gas Pipe�Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Piumbin9 n_/�� , t�-( 39. Water Service�Final 40. Gas Service•Final 41. Solar pomes[ic-Final 42. Batkflow Preventer A3. 8ackflow Irrigatio� 44. Landscape Irrigation Sys:zm 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49. Eleccric Release to Edison ' 50. Gas Release to Southern Ca�ifornia Gas Co •/ 4 � 51. CERTIFICATE OF OCCUPANCY No. Date � I`. �. s 87s8 G�OSTA MESA BUILDING-SAFETY DEPARTMENT P. O. BOX 9f7 COffiA MEBA. CALIFORNIA For Applieanf fo Fill In Complefely TYPE OR PRINT � BUILDING COSTA ME5A. CALIFORNIA � AR� � BTATE USE OF EXISTING BLDG. H8T9ACK LINH PROM � EJCTERIOR TEL. FIRE ,-�._ }- t_„ � I L� " \L��:.G ��1�� FE'6 1 9 1963 ffN�',�!CE DEPT. APPLICATION FORiPERMITOSTA MESA BUILDING For Office Use Only NECEIPT NO. PPJl1.Ui�1 r� � j 0Y DATE RECEIVED I DATE I88UED cc: � e 96B �•' l'e 3 �ia8 ��Q� , COSTA MESA. CALIFORNIA >n D�i�ve ZONING l 20NE /� NO.OF USE OP NEW Si� )/L/LLQ. /� —� I �uns � aui�.n�Ha;� �_8940 �a�.�o,,.,..0 Lo-t 3.s r.� y� � 6 NO. OP 9LpG9. DESCRIPTION OF WORK NO. OF I �II, ICeNT6R LIN6 r� � > FT. -S— FT. 'S FT. � 8 Fr. 3 iA/vv� DATE �" I oP - /%5�8` � � °� - `��'7 �.. I HEReBY ACKNOWLEDOE TX�T I H�VH READ TMIB AVPLIWTION TN6 AMOUNT eHOWN UNOEH VqLUATION 18 FOR THE ANU 9TATE THAT THE ABOV6 IB CORRHCT AND AGREE TO COM- pUflPOBE OP EBTFBLI9HING � P¢RMIT FH6 ONLY. PLY WITH �1LL CITY OROINANCE9 ANO HTATE LI.We RCOUI.�TINO Buao�No coxernucilON. VALUATION � 91GNATURE OF PERMIT FEE $ � �� PERMITTE %/ [//� j/ S � � / / /� PLAN CHECK $ '� v � AUTHORIZED AGE 7f �� TOTAL FEE V �� OWNER Ga �� JOB ADDRES: �� GENERAL CO Q 'ECTION! �� } Pool Location \ Forms _ Main Drain Steel Reinforce Elec. Bond Approval to Cover Underground Electric _ Gas Piping Test Filtering System Lines _ Backwash Lines and Recep. Electrical Final Heater and Vent Final •er System Final .,ackwash and Recep. Final Co. RACT R\C. �s' DATE $_�_� BUILDING PERMiI DESCRIPTION of WORK P1it. Spa FIRE ZONE VALUE E 1 5�, GROUP J TYPE III > SUBCONTRACTOR Dare Electric g-�z- Plumbing , ; r 2 . ww d U za ON am J 7 .� J � Q Uy Za 2 aw WZ J Q m Z J � W w O= Z F- w� 70 � z Q U Q � H N Z O F U � � H N Z 1�3€�`% COSTA MESA BUILDING-SAFETV DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely OWNER MAII ADDRE: CITV i BRANCH ADDRESS AFCNITECT Ofi ENGINEER ADDRESS - CONTRACTO ADORE55 �i CITY STATE UC. NO. SIZE OF LOT USE OF EXISfING BLOi SIZE OF BUI T U TEL. NO. CITV UC. NO. NO. OF BLDGS NOW ON LOT ROOF COVERING AND WORK TO BE PERFORMED F�:��./� (� IIG ��Z'%S�Fltt�l/ 6�}7'� fi.`. � fiZ�.CV APPLICATION FOR BUILDING PERMIT :FJVFJp 6V DRTE RECEIVED neTc iccu. BV I LDING ADDflESS FIRE ED ZON NO.OF PLA1�5� VARDSAPPROVEO MAIN BUILDING DISiANGE BET MAIN BLDGS. VAR. iW C.U.P.�W 1 hereby acknow�etlBa Ihet I hava �eaG this aOP��etfon entl stata Max the above i�formetlon Is eorraet and aB�ee to comply with nll laws regula[InB builtlinB �omttucNon, and I s�all not amploy ony parson in violation of t�e workman's compensetlon laws af tha Stato of Celi�ornie. I hereby cartify that I am properly Iicenfetl a� a contractor untlar SQ. FT t�e Stem o( California Businass antl Profaxsiona CoGa, Dlvisicn 3, THE AMOUNT S Chapter 9, nnd Nat wc� Iicanxs era In full torce antl aftact, or I THE PURPOSE OF am axempt irom Na provlalons of [he Stam of California Boalneo VALUATION antl Professlone Cotlo, Dlvi�ion 3, Chepter 9. Slpneture ot v� . . %� �1�+ 1 - • � �/. Il� ) „�/ In Parmittea OA.:�3�LX�+=•ff'i. )..II�LC g %(`� a^, �O Authorizatl ABont VALU$ � �j..�� V UP \ DATE I USE OF NENj � BUILDING -1 /9 i: BET. MAIN & AOCESS. BLDGS. R4TE APPROVED DATE �—�Z — / STqTE 1